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Clozapine-induced myocarditis or any clozapine-induced inflammation may be a hypersensitivity reaction due to titration that was too rapid for the patient's clozapine metabolism. Clozapine metabolism is influenced by ancestry, sex, smoking and the presence of confounders including obesity, infections, and inhibitors (e.g., valproate) causing the patient to behave as a clozapine poor metabolizer (PM). A published study in a Turkish hospital identified 1 case of clozapine-induced pancreatitis and hepatitis and 9 cases of clozapine-induced myocarditis. To explore the hypothesis that the 10 patients were clozapine PMs, their serum clozapine concentrations were investigated using concentration-to-dose (C/D) ratios and their titrations carefully reviewed.Dividing the trough serum concentration by the dose produces the clozapine C/D ratio. The dose required to reach 350ng/ml was considered the minimum therapeutic dosage and was used to classify patients according to clozapine PM status. Titration speed was assessed.All 10 patients were possibly clozapine PMs (3 of them had as minimum therapeutic doses: 72, 82 or 83mg/day). Nine of the 10 patients may have behaved as clozapine PMs due to obesity and/or valproate co-prescription during titration. One also had an undiagnosed infection. Of the 10 patients, 9 had at least 1 of 3 factors: too-rapid titration in the first or second weeks, or a final dosage that was too high.Future studies using clozapine levels and considering the role of clozapine PM status should explore whether or not all cases of clozapine-induced inflammation could be explained by lack of individualized titration.

Objective: To evaluate the mental health of patients with schizophrenia spectrum disorders with the prolongation of the pandemic. Materials and Methods: This descriptive cross-sectional study was conducted between August-October 2020. Fifty-two patients with schizophrenia spectrum disorders who were hospitalized prior to the onset of the pandemic between March 2019-March 2020 at the inpatient clinic were reassessed during the pandemic. The Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S) Scale, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Fear of COVID-19 Scale were used to evaluate psychopathology during the pandemic. The PANSS and the CGI severity scores at discharge from the inpatient clinic for each patient were obtained from the medical records review for comparison along with sociodemographic variables. Results: A total of 34 patients, 33 with schizophrenia (97.1%) and 1 with schizoaffective disorder (2.9%) were included. There was no significant difference between the pre- and during the pandemic assessments in the PANSS total and the CGI severity scores. The PANSS total, the CGI, HAM-D, HAM-A and the Fear of COVID-19 scale scores, medical comorbidity and utilization of psychiatric health care services were significantly higher in patients who reported subjectively increased psychiatric symptoms during the pandemic. There was no significant difference in the change of PANSS total and CGI scores between the two groups. Fear of COVID-19 Scale and HAM-A scores were correlated positively. Conclusion: During pandemic increase in psychiatric symptoms may be related not only to psychosis but also depression, anxiety. According to the results of patients who reported subjectively increased psychiatric symptoms during the pandemic, while the psychotic symptoms did not worsen during the pandemic, patients with higher anxiety or depression scores reported an increase in their symptoms and were more likely to seek help.

Combining clozapine with a long-acting injectable antipsychotic (LAI) or using different, nonstandard formulations of the compound may improve treatment outcomes. We aimed to investigate the utility of the clozapine-LAI combination and different formulations of clozapine for compliance problems of clozapine treatment, and to describe a case series on the combined treatment.We conducted a PubMed search with no date restriction. The number and length of hospitalizations, the results of clinical scales, and adverse events were recorded. We also present a case series of 18 patients using the clozapine-LAI combination. Data were collected from the medical charts and electronic records.We extracted 9 records describing the use of the clozapine-LAI combination. The case reports and mirror-image studies showed a significant reduction in the number of hospitalizations, length of hospital stays, and number of visits to the emergency department on the combined treatment with no serious adverse events. We included 11 articles for clozapine formulations. The case reports and retrospective data suggested that short-acting intramuscular clozapine was often well tolerated and resulted in an increased acceptance of oral clozapine in the acute phase of illness. In our case series, illness severity and the number of hospitalization per year significantly decreased after the combined treatment, besides a significant improvement in the functioning scores. Hyperprolactinemia and extrapyramidal side effects were reported due to concomitant LAIs.Despite the encouraging evidence, the present data are preliminary and mostly based on retrospective studies, and oral-dissolving tablets or oral liquid formulations of clozapine have insufficient evidence for clinical practice. Well-designed, controlled, follow-up studies are needed for both clozapine-LAI combination and different formulations of clozapine.

Objective The aim of this study was to evaluate brain connectivity by diffusion tensor imaging (DTI) in schizophrenia patients with clozapine-induced obsessive compulsive symptoms (OCS). Methods Eighteen schizophrenia patients, nine of which had clozapine-induced OCS (Clz-OCS (+)), 9 without OCS (Clz-OCS (−)) and 9 healthy controls were included. Psychopathology was evaluated with Positive and Negative Syndrome Scale and Yale-Brown Obsession and Compulsion Scale in the patient groups. All groups were assesed with neurocognitive tests and DTI. Results Tract-Based Spatial Statistics based comparison of DTI revealed lower fractional anisotropy in the genu of corpus callosum (CC), right cingulum, left frontal white matter (WM) in the Clz-OCS (+) group, compared to controls. Fractional anisotropy was found to be lower in the bilateral occipital WM and higher in the bilateral medial temporal regions, anterior limb of internal capsule, cingulum, frontoparietal peripheral WM, right external capsule and genu of CC in Clz-OCS (+) patients compared to Clz-OCS (−). Conclusions WM integrity in several pathways such as cortico-striato-thalamo-cortical circuitry and orbito-frontal tracts seems to be affected differently in patients with Clz-OCS (+). Different neuroplastic effects of clozapine leading to occurrence of OCS in a subgroup of patients is possible, and needs further evaluation by longitudinal follow-up studies.

This international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300–600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75–150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175–300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100–200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250–400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150–300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300–600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.

It was expected that using a comprehensive scale like the Thought and Language Disorder Scale (TALD) for measurement of FTD would enable assessing its heterogeneity and its associations with cognitive impairment and functionality. This study has aimed to analyze the relationship between formal thought disorder (FTD) and cognitive functions, functionality, and quality of life in schizophrenia.This cross-sectional exploratory study included 46 clinical participants meeting the DSM-5 diagnostic criteria for schizophrenia and 35 healthy individuals as the control groups. Data were acquired by means of the Turkish language version of the TALD, the Positive and Negative Syndrome Scale, the Clinical Global Impression Scale, the Functioning Assessment Short Test, the Social Functioning Scale, the World Health Organization Quality of Life Instrument-Short Form, and a neuropsychological test battery on executive functions, working memory, verbal fluency, abstract thinking, and response inhibition. Correlation analyses were conducted to detect significant relationships.The clinical group scored failures in all cognitive tests. The objective positive FTD was associated with deficits in executive functions and social functioning. The objective negative FTD was associated with poor performance in all cognitive domains, physical quality of life, and social and global functioning. The subjective negative FTD was negatively correlated with psychological quality of life.This study demonstrated that objective FTD factors reflect different underlying cognitive deficits and correlate with different functioning domains. Significant correlation was determined between subjective negative FTD and psychological quality of life. Given the close relationship of FTD with functioning and quality of life, the FTD-related cognitive deficits should be the key treatment goal in schizophrenia.

Yerel kültürlerin font tasarımına etkisi konusunun işlendiği bu çalışmada, öncelikle konu ile ilgili kaynak araştırmaları yapılmış, konuyu doğrudan işleyen bir kaynak bulunamasa da yazı, alfabe, kültür, tasarım gibi konularda hazırlanan kaynaklardan yararlanılarak bir sonuca varılabileceği düşünülmüştür. Öncelikle eski medeniyetler ve bu medeniyetlerin ortaya koyduğu tarihi yazılar incelenmiş, bu yazılar ile yerel kültür arasında bir bağın olup olmadığı bulunmaya çalışılmıştır. Elde edilen bilgiler doğrultusunda," yazı ve font" başlıklı birinci bölümde, öncelikle yazı ve yazının tarihsel yolculuğu ele alınmış, yazının resim ya da semboller yoluyla kullanılmaya başlandığı medeniyetler üzerinden, yazı ve kültür ilişkisi anlatılmıştır. Bu konunun devamında yazı ve font kavramları üzerinde durulmuş, bu iki kavram arasındaki farklılıklar ortaya konmuş, fontun tarihsel süreci ve daha sonra da fontun tasarım süreci anlatılmıştır. Bu çalışmanın ana konusunun işlendiği "yerel kültürlerin font tasarımlarına etkisi" başlıklı ikinci bölümde, ön bilgi amacıyla kültür, sanat ve tasarım kavramları açıklanmış, yerel kültürlerde sanat ve tasarımın nasıl olduğu üzerinde durulmuştur. Dünya üzerinde kullanılmakta olan çok sayıdaki alfabe incelenmiş, bunların bir kısmında yerel kültürlere ait yansımaların olduğunu düşündürecek verilere ulaşılmıştır. Elde edilen sonuç, ilgili görseller ve alfabeler kullanılarak aktarılmıştır. Bu bölümde ayrıca, yerel kültürlerden etkilenerek font tasarımı yapan yabancı ve yerli sanatçılar kısa bilgilerle anlatılmış, modern sanat ve tasarım akımlarının font tasarımlarına etkisi üzerinde durulmuştur. Uygulama bölümü olan üçüncü bölümde, Göktürk alfabesinden esinlenilerek üretilen "Bitigen" isimli deneysel fontun oluşumu anlatılmış ve bu fonta ait çeşitli uygulamalar sunulmuştur. Dördüncü bölümde Sonuç, Kaynakça ve Ekler bölümü yer almaktadır. Ekler bölümünde, font tasarlama programı olan "Fontlab" uygulamasının anlatımı ile değişik ülkelere ait font örnekleri bulunmaktadır. Anahtar Kelimeler: kültür, sembol, yazı, font, yazı tasarımı, In this study which we researched the effect of local culture on the font design, first of all researches are made for the related topics, the sources which study on the subject directly couldn't find but it is thought to have a conclusion from the sources in the areas of text, alphabet, and culture. First, ancient civilization and historical articles have been researched, a study made to find out a link between these articals and the local culture. According to the information obtained, the title "writing and font" in the first chapter, first of all writing and its historical journey is focused, writing and culture is explained, the relation between writing and culture described over the civilization which writing began to used by pictures and symbols. Followingof the topic, writing and font concepts have focused, set out the differences between these two concepts, the historical process of the font and the design process of the font are discussesed. In this study, in the second part where the main topic was discussed which titled "impact of the local culture on font design", culture, art and design concepts have been explained as a preliminary information and focused on art and design in the local culture. Many alphabet which is used on the world is examined, in some of them have access to data which suggests that the reflection of local culture. The obtained results are transferred by using the relevant images and alphabets. Furthermore in this section, foreign and local artists who font design influenced by local culture has been described with a short description, focuses on the impact of modern art and desing movement on the design of the font. In the third part, Application part, the formation of the experimental font "Bitigen" which is produced inspired by the Gokturk alphabet is described and various embodiments of this font is presented. In the fourth chapter Conclusion, References, and Appendices section located. In the Appendix, there are description of " FontLab " applications which is use for font design and examples of fonts from different countries. Keywords: culture, symbol, font and writing design., Tez (Yüksek Lisans) - Süleyman Demirel Üniversitesi, Güzel Sanatlar Enstitüsü, Grafik Tasarım Anasanat Dalı, 2017., Kaynakça var.

Yerel kültürlerin font tasarımına etkisi konusunun işlendiği bu çalışmada, öncelikle konu ile ilgili kaynak araştırmaları yapılmış, konuyu doğrudan işleyen bir kaynak bulunamasa da yazı, alfabe, kültür, tasarım gibi konularda hazırlanan kaynaklardan yararlanılarak bir sonuca varılabileceği düşünülmüştür. Öncelikle eski medeniyetler ve bu medeniyetlerin ortaya koyduğu tarihi yazılar incelenmiş, bu yazılar ile yerel kültür arasında bir bağın olup olmadığı bulunmaya çalışılmıştır. Elde edilen bilgiler doğrultusunda,` yazı ve font` başlıklı birinci bölümde, öncelikle yazı ve yazının tarihsel yolculuğu ele alınmış, yazının resim ya da semboller yoluyla kullanılmaya başlandığı medeniyetler üzerinden, yazı ve kültür ilişkisi anlatılmıştır. Bu konunun devamında yazı ve font kavramları üzerinde durulmuş, bu iki kavram arasındaki farklılıklar ortaya konmuş, fontun tarihsel süreci ve daha sonra da fontun tasarım süreci anlatılmıştır. Bu çalışmanın ana konusunun işlendiği `yerel kültürlerin font tasarımlarına etkisi` başlıklı ikinci bölümde, ön bilgi amacıyla kültür, sanat ve tasarım kavramları açıklanmış, yerel kültürlerde sanat ve tasarımın nasıl olduğu üzerinde durulmuştur. Dünya üzerinde kullanılmakta olan çok sayıdaki alfabe incelenmiş, bunların bir kısmında yerel kültürlere ait yansımaların olduğunu düşündürecek verilere ulaşılmıştır. Elde edilen sonuç, ilgili görseller ve alfabeler kullanılarak aktarılmıştır. Bu bölümde ayrıca, yerel kültürlerden etkilenerek font tasarımı yapan yabancı ve yerli sanatçılar kısa bilgilerle anlatılmış, modern sanat ve tasarım akımlarının font tasarımlarına etkisi üzerinde durulmuştur.Uygulama bölümü olan üçüncü bölümde, Göktürk alfabesinden esinlenilerek üretilen `Bitigen` isimli deneysel fontun oluşumu anlatılmış ve bu fonta ait çeşitli uygulamalar sunulmuştur. Dördüncü bölümde Sonuç, Kaynakça ve Ekler bölümü yer almaktadır. Ekler bölümünde, font tasarlama programı olan `Fontlab` uygulamasının anlatımı ile değişik ülkelere ait font örnekleri bulunmaktadır. Anahtar Kelimeler: kültür, sembol, yazı, font, yazı tasarımı In this study which we researched the effect of local culture on the font design, first of all researches are made for the related topics, the sources which study on the subject directly couldn't find but it is thought to have a conclusion from the sources in the areas of text, alphabet, and culture. First, ancient civilization and historical articles have been researched, a study made to find out a link between these articals and the local culture. According to the information obtained, the title `writing and font` in the first chapter, first of all writing and its historical journey is focused, writing and culture is explained, the relation between writing and culture described over the civilization which writing began to used by pictures and symbols. Followingof the topic, writing and font concepts have focused, set out the differences between these two concepts, the historical process of the font and the design process of the font are discussesed.In this study, in the second part where the main topic was discussed which titled `impact of the local culture on font design`, culture, art and design concepts have been explained as a preliminary information and focused on art and design in the local culture. Many alphabet which is used on the world is examined, in some of them have access to data which suggests that the reflection of local culture. The obtained results are transferred by using the relevant images and alphabets. Furthermore in this section, foreign and local artists who font design influenced by local culture has been described with a short description, focuses on the impact of modern art and desing movement on the design of the font. In the third part, Application part, the formation of the experimental font `Bitigen` which is produced inspired by the Gokturk alphabet is described and various embodiments of this font is presented.In the fourth chapter Conclusion, References, and Appendices section located. In the Appendix, there are description of ` FontLab ` applications which is use for font design and examples of fonts from different countries.Key Words: culture, symbol, font and writing design. 163

Transcranial magnetic stimulation (TMS) studies show cortical inhibition (CI) abnormalities in patients with schizophrenia. However, the relationship between the changes in CI and the changes in psychopathology and cognition caused by antipsychotic treatment is not known. This is an 8 week follow up study which aims to evaluate the relationship of the change in the symptoms and cognitive functions with the change in the CI of the patients, who are switched to new atypical antipsychotic treatment, and to compare the TMS measures of patients with those of controls.Thirteen patients and age, sex, education matched 13 controls were included in the study. Patients were assessed with TMS, Positive and Negative Syndrome Scale (PANSS) and neurocognitive battery at baseline and 8th week, while the control group was evaluated once, with neurocognitive battery and TMS. The CI parameters studied by TMS were resting motor threshold, cortical silent period, ipsilateral silent period (ISP), short interval-intracortical inhibition (SICI) and intracortical facilitation.Intracortical facilitation (ICF) was weaker, ISP was longer in patients than the controls both at the baseline and at the end of the eight weeks. Intracortical facilitation decreased with 8 weeks of antipsychotic treatment indicating an increase in CI. The decrease in PANSS general psychopathology score was related positively with the decrease in ICF. SICI was related positively with cognitive test performances cross-sectionally and longitudinally.Our findings suggest that increase in CI is associated with the improvement in the symptoms and the action of the atypical antipsychotics.

The term epigenetic refers to long-lasting changes in gene expression that are beyond the DNA base sequence. Understanding the dynamic role of epigenetic mechanisms in the regulation of gene expression in adulthood has led researchers to investigate epigenetic mechanisms in psychiatric disorders. The aim of this review was to describe epigenetic mechanisms and to discuss the role of epigenetic modifications in stress, depression, schizophrenia, and substance dependence. For this purpose PubMed was searched using the keywords epigenetic, stress, depression, schizophrenia, and substance dependence; studies published between 2000 and 2011 were reviewed. Different maternal behavioral patterns and early life stress have been reported to yield heritable changes in gene expression via epigenetic mechanisms, which are reversible. Studies that investigated the role of epigenetic modifications in stress and depression focused on the proteins involved in the regulation of the hypothalamo-pituitary adrenal (HPA) axis, whereas epigenetic studies of schizophrenia primarily focused on changes in the GABAergic system. Studies on substance dependence, on the other hand, showed that substance use might change the expression of many genes by causing short- or long-lasting epigenetic modifications. These findings have led to the development of new therapeutic strategies that target epigenetic mechanisms. Among these strategies, histone deacetylase inhibitors are especially promising. More studies are needed to improve our understanding of the role of epigenetic modifications in the development of psychiatric disorders, and to aid in the development of new treatment strategies that focus on epigenetic mechanisms.

Modern psychiatric diagnostic systems classify neurological symptoms that cannot be explained by a physical disease or another psychiatric disorder as conversion disorder (CD) or dissociative motor disorder. It is a well-known fact that the overall rate of misdiagnosis of conversion symptoms is high. The most common presenting symptoms of misdiagnosed patients are gait and movement disturbances. Stiff-person syndrome (SPS) is a rare progressive autoimmune neurological disorder. The identification of antibodies against glutamic acid decarboxylase (GAD) in association with SPS provided an important contribution to the understanding of the pathophysiology of this syndrome. Patients may present with severe muscle rigidity and sudden contractions. Simultaneous contraction of agonist and antagonist muscles produces gait disturbance. SPS can be exacerbated by emotional stressors, and sudden auditory, visual, and tactile stimuli. Herein we present 2 patients that were referred for psychiatric assessment, because their neurological symptoms initially could not be explained by a neurological disease, and subsequently diagnosed as SPS. The aim of this case report is to draw attention to the psychiatric presentations of SPS and to emphasize the importance of complete psychiatric and neurological examination, including brain imaging and electrophysiological studies, in the differential diagnosis of CD.

Many structural and functional neuroimaging studies have investigated the neuroanatomical changes and possible pathophysiological pathways in autism. In this review the objective was to assess, with an integrative perspective, recent neuroimaging studies that have contributed to the explanation of the possible pathophysiological pathways in autism.Relevant attainable studies published between 1997 and 2007 were included in this retrospective literature review. The PubMed search engine and the keywords, autism, autistic spectrum disorders, neuroimaging, computerized tomography, magnetic resonance imaging, functional magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography, and diffusion tensor imaging were used.Structural neuroimaging studies reported an increase in total cerebral volume, both in grey and white matter, mostly in the frontal, temporal and parietal lobes. These global volumetric changes are suggested to indicate a diffuse disturbance in neural networks during early development. In functional neuroimaging studies, activation abnormalities were observed in the temporal lobes and amygdala, which are involved in language and social cognition. An increase in visual activity cortex was also reported.Clinical observations and results from neuroimaging studies were gathered to hypothize and explain the pathophysiology of autism. Yet, it is still very early to conclude with certainty the neurobiological process responsible for autism.

Conversion disorder is defined as the presence of functional impairment in motor, sensory or neurovegetative systems which cannot be explained by a general medical condition. Although the diagnostic systems emphasize the absence of an organic basis for the dysfunction in conversion disorder, there has been a growing interest in the specific functional brain correlates of conversion symptoms in recent years, particularly by examining neuroimaging and neurophysiological measures. In this case report, regional cerebral blood flow changes and evoked potentials of a patient with conversion symptoms are presented. Somatosensory evoked potentials (SEP) of this patient with conversion disorder who had signs of movement disorder revealed that the latency to N20, P 25 waves were in normal limits while the amplitudes of the P25 and N33 components were extremely high (giant SEP). Regional cerebral blood flow assessment revealed hypoperfusion in the left parietal and temporal lobes of the brain. Three months after the first assessment, the control scans showed that the left parietal hypoperfusion disappeared while the left temporal hypoperfusion was still present. The following SEP evaluations which were repeated twice in three months intervals after the initial recordings, showed the persistence of the abnormalities in somatosensorial measures. The neurophysiological and neuroimaging findings in conversion disorder were reviewed and the results of the evaluations of this case were discussed in this article.

Although hallucinations are among the cardinal features of schizophrenia, the mechanisms underlying these symptoms have not been fully understood yet. In this review our objective is to summarize the studies about the neurobiology of auditory hallucinations in schizophrenia and discuss their significance for understanding schizophrenia.This is a retrospective literature review and the relevant studies within the last 10 years are included. For this purpose Pubmed search engine and 'hallucination, schizophrenia, neurobiology' key words are used.Hallucinations cause sensory modality specific activation in cerebral areas involved in normal sensation. A disturbance in perception of speech seems to have a central role in occurrence of auditory hallucinations. Anatomically, auditory hallucinations appear to involve primary and association cortices, Broca's and Wernicke's areas, subcortical, paralimbic, limbic regions, ventral striatum and thalamus. Furthermore they are suggested to be associated with the dysmodulation of the information flow from ventral striatum to thalamus and cortex caused by increased dopaminergic activity in mesolimbic pathway.The validity of the models which are proposed to explain neurobiology of hallucinations in schizophrenia should be tested by new studies. The difficulties regarding the assessment and measurement of subjective mental phenomena are important impacts in studying and understanding the neural correlates of hallucinations. Functional neuroimaging, cognitive and molecular biological studies will hopefully enhance our knowledge about this disease.

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive prion disease that causes deficits involving movement, cognition, and mental status. The clinical heterogeneity of the disease can make diagnosis difficult. Thorough neurologic, cognitive, and psychiatric examinations are necessary for observing its clinical features. In this case report we describe a 62-year-old male patient who was initially followed with a diagnosis of depression and later was diagnosed with CJD. The patient had a one-year history of anhedonia, loss of interest, social withdrawal, anxiety and decrease in speech and was given paroxetin 20 mg/day with a diagnosis of depression. During follow up, neurological symptoms including ataxia and rigidity became evident and dementia and akinetic mutism developed in a rapidly progressive course. Although electroencephalography (EEG) and magnetic resonance imaging (MRI) revealed nonspecific findings initially, typical findings for CJD were seen during the follow up. The positive 14-3-3 protein in CSF supported the diagnosis. The aim of this report is to emphasize the fact that CJD may present with different psychiatric symptoms and can be initially misdiagnosed. CJD should be considered in the differential diagnosis of patients who have focal neurological signs in addition to psychiatric symptoms. Repeated neurological examinations, EEG and cranial MRI may help in the diagnosis of these patients.

Recent developments in neuroscience have increased our knowledge of the physiology of sleep and dreaming, and thus the number of studies about the influence of sleep on learning and memory have increased rapidly. In this review the objective is to assess the relationship between sleep and memory considering the evidence regarding the neurobiology of sleep and dreaming.This is a retrospective literature review and the relevant studies from the last 10 years are included. For this purpose the PubMed search engine and the key words "sleep, neurobiology, synaptic plasticity, memory" were used.Sleep-wake and NREM-REM cycles are accompanied by neuromodulatory influences on forebrain structures that affect behavior, consciousness and cognition. Animal and human studies in which learning paradigms are used to assess the influence of sleep deprivation on memory show the influence of sleep on memory consolidation. Different sleep stages have different effects on memory processes. Some investigators claim that NREM improves declarative memory while REM improves procedural and implicit memory. Other investigators suggest that NREM and REM affect memory in a complementary and sequential way. Molecular and electrophysiological evidence suggests that the influence of sleep on memory is through synaptic plasticity.Studies about the physiology of sleep and dreaming will help us to understand consciousness and memory better. The reverse is also true: understanding the contribution of sleep stages to memory will help us to determine the advantages of sleep and dreaming in an evolutionary perspective.