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Objective: Iron element has critical roles such as myelin synthesis and neurotransmitter synthesis. Critical enzymes and proteins strictly control iron metabolism. Alterations in the enzyme activities could modify iron metabolism. Metabolic and endocrine changes may influence iron turnover in patients with major depression and anxiety disorders. Materials and Methods: 30 patients with major depressive disorder (MDD), 30 with anxiety disorders (ADs) according to the DSM 5 criteria, and 30 healthy controls were included. Hamilton Depression and Anxiety Scales were the clinical evaluation tools. Blood samples were collected 12 hours of fasting. Hepcidin and Ferroportin levels were measured with ELISA method. Results: Both Hepcidin and Ferroportin levels were lower in the MDD group compared to the ADs group, Hepcidin levels were found to be statistically significantly lower (p= 0.014). In addition, an inverse correlation was observed between the Hamilton Depression Scale score and Ferroportin levels (r= -0.214, p

Brain's aerobic energy metabolism, abundance of the fatty acids and unsaturated lipids, generation of Reactive Oxygen Species (ROS) by hormones, physiological roles of transition metals (i.e., iron and copper), and free radicals in the nervous system may cause inclination to oxidative stress in psychiatric disorders. Electroconvulsive therapy (ECT) may cause oxidative stress by the electrical field or by the induced seizure. It was aimed to review the literature in terms of the influence of ECT on levels of oxidant and antioxidant compounds.The literature search was performed with the keywords that were oxidative stress or "DNA damage" or "RNA damage" or "lipid peroxidase" or "superoxide dismutase" or "catalase" or "glutathione" or "nitrite" or "nitric oxide" and "electroconvulsive therapy" or "electroconvulsive shock" or "electroconvulsive seizure". Twenty of 1480 records were included.Eleven studies were performed in human subjects, whereas 9 studies were performed in rats. Human studies are conducted with serum, plasma, or urine samples; rat studies include brain tissues from various sites. In rats, four independent studies showed increased levels of lipid oxidation markers, and four independent studies reported increased levels of oxidative stress markers in brain samples. In human studies, studies were performed with circulating blood samples and the results were more inconsistent.Although some markers like superoxide dismutase or thioredoxin imply that ECT may increase the balance for oxidative stress, this notion is not supported by other markers of ECT. The current literature does not clearly suggest that the ECT is associated with oxidative stress in psychiatric disorders. Further studies with similar methods should be performed in big samples.

Background Nitric oxide (NO) is an endogenous substance which has several endocrine functions and may act as neurotransmitter in the brain. High levels of NO may provoke nitrosative stress. Aim It was aimed to examine serum levels of NO in patients with depressive episodes who were treated with electroconvulsive therapy (ECT) in this study. Methods The design was a case-control, follow-up study. Patients with depressive episodes (n = 23) and a healthy control group (n = 21) were enrolled. Three serum samples were obtained from the patient group (before ECT, after first and seventh sessions). NO, nitrite, and nitrate levels were examined. Statistical analysis Differences between groups were examined with t-test or Mann-Whitney U-test. Longitudinal data were evaluated with Panel Regression Analysis and Kruskal-Wallis Test. Results Serum levels of NO and nitrite decreased significantly after the seventh session of ECT administration compared to the baseline and first session. Nitrate levels did not differ between the assessments. Conclusions Reduction of the serum NO and nitrite levels might be a contributing factor for hypertension during the sessions. These findings are reflect the circulating NO levels. Further studies may dissect NO physiology in the brain in mental disorders and potential external effects.

Aim: The sharing about an important public health problem, schizophrenia is increasing on Twitter, whiches user number multiplies day by day. Stigmatization can be usually met in the disorder of complex etiology. In this study, we aimed to investigate perspectives and attitudes of community toward schizophrenia, schizopherene, schizophrenic, and paranoiac on social media -Twitter- in Turkey. Material and Method: During about a month, totally 1200 Tweets that contain one of these -“schizophrenia, schizopherene, schizophrenic, paranoiac”- are analyzed and evaluated according to these words’ usage in a pilot sample. After establishing inter-rater reliability, they are evaluated in 5 main dimensions; a) mocking/humorous b) negative c) inappropriate d) anti-psychiatric e) medically appropriate. In addition, those who shared their age and gender were also recorded. Results: It was seen that these four words were usually used “mocking/ humorous” (39.2% and “negative” (26%). The usage of the words in non-medical was predominant. Most medically appropriate usage belonged to “schizophrenia” (26.7%). The most “negative” and “mocking/ humorous” usage belonged to “schizophrenic” (33.2% and 45.8%, respectively). In terms of gender, the four words were used mocking/ humorous mostly in both gender (39.5% and 38.8%). Medically appropriate use of women was greater (14.8% vs 7.5%). Conclusion: Our findings show that the presence of a great deal of misuse of schizophrenia and related words on Twitter. This misuse is quite a few pronounced by the adjective use of the disorder. At the time of the easiness of reaching information and social media usage the lack of knowledge, stigma and attitude problems toward schizophrenia is at an important level.

INTRODUCTION[|]Ischemia modified albumin (IMA) is an altered type of albumin produced due to exposure to hypoxia, acidosis, inflammation, or oxidative stress. In this study, we aimed to evaluate the serum IMA levels in newly diagnosed and medication-naive generalized anxiety disorder (GAD) and panic disorder (PD) patients.[¤]METHODS[|]This cross-sectional study included medication-naive 23 GAD, 25 PD patients, and 28 healthy controls. The participants were evaluated with a sociodemographic form, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Venous blood samples were collected from all participants, and IMA levels and routine biochemical parameters were measured.[¤]RESULTS[|]There was no statistically significant difference between three groups in terms of age, gender, body mass index (BMI) and routine biochemical markers of the participants (p>0.05). The GAD and PD groups had significantly higher serum IMA levels than healthy controls (p

Introduction: Synthetic cannabinoid (SC) use, an important public health problem, is becoming increasingly widespread and leads to many medical and psychiatric problems. This study aimed to evaluate the impact of SC use on cognitive and psychomotor functions of patients. Materials and Methods: The participants (30 outpatients with SC use disorder and 33 healthy controls) were administered the Montreal Cognitive Assessment (MOCA) test, the Edinburgh Handedness Inventory (EHI), the Finger-Tapping Test (FTT), and the Adult Memory and Information Processing Battery-B form (AMIPB-B). Results: The SC users scored lower in AMIPB-B, MOCA. and FTT compared to the healthy controls. Conclusion: These findings suggest that SC might impair both cognitive and psychomotor functions. Therefore, outpatients with SC use disorder should be carefully evaluated for cognitive and psychomotor functions since neurological examinations and interventions may also be required in treatment programs for these cases.

OBJECTIVE: In this study, we aimed to study copper metabolism in schizophrenia, bipolar disorder, major depression compared with healthy control. METHODS: This is a single-centered cross-sectional study. The patients with schizophrenia (n = 36), bipolar disorder (n = 37), major depression (n = 40), and healthy control (n = 32) were included in the study. All participants were initially evaluated by a clinical psychiatrist to confirm the appropriate diagnosis using the Structured Clinical Interview for Diagnostic and Statistical Manuel of Mental Disorders-IV (DSM-IV) Axis I Disorders (SCID-I). Serum copper level, ceruloplasmin mass, and ceruloplasmin-ferroxidase activity were measured. One-way ANOVA and Kruskal–Wallis Tests were performed for statistical analyses. RESULTS: Serum ceruloplasmin-ferroxidase activity (χ2 = 9.11, p = 0.028) demonstrated a significant statistical difference in all groups compared with the control group. Serum ceruloplasmin-ferroxidase activity of the bipolar disorder group was significantly higher than the healthy control group (p = 0.012), major depression group (p = 0.027), and the schizophrenia group (p = 0.019). Erythrocyte sedimentation rate (ESR) (p = 0.028) and waist circumference (p = 0.005) in bipolar disorder group, and the C-reactive protein (CRP) (p

Lityum Avustralyalı psikiyatri hekimi John Cade ve İsviçreli Baastrup ve Schou’nun öncü çalışmalarla bipolar bozukluk tedavisine kazandırdığı bir duygudurum dengeleyicidir. Güncel tedavi kılavuzlarında akut mani, depresyon ve remisyon dönemlerinde idame tedaviler için hala altın standart tedavi olarak değerlendirilmektedir. Birçok sitoprotektif ve nörotrofik etkisinin yanı sıra lityum nadiren nörotoksisiteye de neden olabilmektedir. Nörotoksisite doz bağımlı ve dozdan bağımsız biçimde görülebilmektedir. Mekanizması tam olarak anlaşılamamıştır. Olası mekanizmalardan biri lityumun tau kaskadını inhibe etmesiyle beyinde bulunan demirin beyin hücrelerinden çıkışının zorlaşmasına neden olarak demir birikimine neden olmasıdır. Demir birikimi hidroksil radikali üretiminin artmasına neden olur ve sonuçta oksidatif nörotoksisite ortaya çıkarabilir. Ancak demir birikimine karşı düzeneklerinde dikkate alınması gerekir. Bu gözden geçirme yazısında lityuma bağlı kardiyak ve metabolik yan etkiler ile birlikte lityum nörotoksisitesinin klinik özellikleri, biyokimyasal düzenekleri ve demir birikimi ile ilişkisi incelenmiştir.

Amaç: Bilişsel mekanizmalar gelişimsel dönemlerde çevresel zorlayıcı olaylardan etkilenebilir ve bilişsel çarpıtmalar ortaya çıkabilir. Bilişsel çarpıtmalar psikiyatrik hastalıkların klinik seyrini etkilemektedirler. Bu çalışmada bipolar bozuklukta (BB) ve major depresif bozukluk-yineleyen dönemler (MDB-YD) çocukluk çağı travmaları (ÇÇT) ile duygu düzenleme güçlüğünün (DDG), otomatik düşünceler (OD) ve üstbilişler (ÜB) üzerindeki etkileri incelenmiştir. Yöntem: Çalışmamız 81 MDB-YD, 85 BB hastası ile 86 sağlıklı kontrol grubu olmak üzere 252 katılımcıdan oluşmaktadır. Ölçüm araçları olarak Otomatik Düşünce Ölçeği (ODÖ), Üstbiliş Ölçeği (ÜBÖ), Çocukluk Çağı Travmaları Ölçeği (ÇÇTÖ), Duygu Düzenleme Güçlüğü Ölçeği (DDGÖ) kullanılmıştır. Bulgular: BB grubun OD’leri ile ÇÇTÖ fiziksel istismar (β=0,34; p

Despite several alternatives for cellular iron influx, the only mechanism for cellular iron efflux is ferroportin mediated active transport. In cases of ferroportin dysfunction, iron accumulates in the cell and causes ferroptosis. Hepcidin suppresses ferroportin levels and inflammatory activation increases hepcidin production. Mild inflammation in schizophrenia and bipolar disorder may alter hepcidin and ferroportin.The study included a total of 137 patients aged 18-65 years, 57 diagnosed with schizophrenia and 80 with bipolar disorder, according to the DSM-IV diagnostic criteria, and a control group (HC) of 42 healthy individuals. Biochemical analyses, thyroid function tests, hemogram, serum iron level, iron-binding capacity, and ferritin levels were examined. Serum levels of hepcidin and ferroportin were measured with enzyme-linked immunosorbent assay (ELISA) method.A statistically significant difference was determined between the groups in terms of the serum ferroportin levels (F = 15.69, p 0.001). Post-hoc analyses showed that the schizophrenia group had higher ferroportin levels than in the bipolar group (p 0.001) and HCs (p 0.001). Hepcidin levels did not differ between the groups. Chlorpromazine equivalent doses of antipsychotics correlated with ferroportin levels (p = 0.024).Ferroportin levels were increased in the schizophrenia group, although iron and hepcidin levels were within normal ranges. Antipsychotics may alter the mechanisms which control ferroportin levels. Further studies are needed to examine the relationships between antipsychotics and iron metabolism for determination of causal relationship.

Bipolar disorder is a disabling psychiatric disorder which causes premature death and loss of quality of life. Despite the developments, novel treatments are partially effective and insufficient responses to treatment may cause loss of quality of life. Contemporary approaches to treatment planning involve taking the current symptoms and the personal treatment history of the patient into account and tailoring them for the treatment of each patient, i.e. individualized treatment. In this article, effects and side effects of antipsychotics, mood stabilizers and sedative hypnotic medications are reviewed and presented briefly for clinicians. Although novel developments have been observed in the literature about mixed states and psychotic symptoms, evidence-based options are still limited. Efficacy of mood stabilizers may be prolonged and additional medications may also be needed frequently in patients treated with mood stabilizers. Antipsychotics may cause several side effects and cannot be maintained for a long time in some of those patients. These factors may limit the use of mood stabilizers or antipsychotics. Therefore, the experience of the clinician and personal history of the patient still have importance in the procedure.

The ability of the brain to reduce the amount of trivial or redundant sensory inputs is called gating function. Dysfunction of sensory gating may lead to cognitive fragmentation and poor real-world functioning. The auditory dual-click paradigm is a pertinent neurophysiological measure of sensory gating function. This meta-analysis aimed to examine the subcomponents of abnormal P50 waveforms in bipolar disorder and schizophrenia to assess P50 sensory gating deficits and examine effects of diagnoses, illness states (first-episode psychosis vs. schizophrenia, remission vs. episodes in bipolar disorder), and treatment status (medication -free vs. medicated). Literature search of PubMed between Jan 1st 1980 and March 31st 2019 identified 2091 records for schizo-phrenia, 362 for bipolar disorder. 115 studies in schizophrenia (4932 patients), 16 in bipolar disorder (975 patients) and 10 in first-degree relatives (848 subjects) met the inclusion criteria. P50 sensory gating ratio (S2/S1) and S1-S2 difference were significantly altered in schizophrenia, bipolar disorder and their first-degree relatives. First-episode psychosis did not differ from schizophrenia, however episodes altered P50 sensory gating in bipolar disorder. Medications improve P50 sensory gating alterations in schizophrenia significantly and at trend level in bipolar disorder. Future studies should examine longitudinal course of P50 sensory gating in schizophrenia and bipolar disorder.

OBJECTIVE: Conformational change in the last four amino acid of the albumin’s N-terminus is called ischemia-modified albumin (IMA). Metabolic stress factors such as ischemia, hypoxia, acidosis or endothelial injury may cause these conformational modifications. In this study, we hypothesized that the plasma IMA level changes might help to determine the global metabolic risk in bipolar disorder (BD), unipolar depression (UD), and schizophrenia (SZ). Therefore, it was aimed to investigate metabolic risk factors affecting IMA levels in this study. Modification of the albumin molecule might be a marker of global metabolic risk in schizophrenia and mood disorders. METHOD: The study included 32 patients with BD, 32 patients with UD, 28 patients with SZ and 34 healthy individuals. For determining the IMA levels, standard amounts of cobalt ions were added to the serums, and the quantity of disengaged cobalt ions was measured by colorimetric assay. RESULTS: IMA (F = 3.04, p = 0.032) levels differed between the groups. IMA levels of the BD group were significantly higher than the healthy control group (p = 0.048). White blood cell count in the BD group (p = 0.034) and total oxidant status (TOS) in the SZ group (p

Background: Despite the diagnostic challenges in categorizing bipolar disorder subtypes, bipolar I and II disorders (BD-I and BD-II respectively) are valid indices for researchers. Subtle neurobiological differences may underlie clinical differences between mood disorder subtypes. The aims of this study were to investigate neurochemical differences between bipolar disorder subtypes. Methods: Euthymic BD-II patients (n = 21) are compared with BD-I (n = 28) and healthy comparison subjects (HCs, n = 30). Magnetic Resonance Imaging (MRI) and proton spectroscopy (1H MRS) were performed on a 3T Siemens Tim Trio system. MRS voxels were located in the left/right superior temporal cortices, and spectra acquired with the single voxel Point REsolved Spectroscopy Sequence (PRESS). The spectroscopic data were analyzed with LCModel (Version 6.3.0) software. Results: There were significant differences between groups in terms of glutamate [F = 6.27, p = 0.003], glutamate + glutamine [F = 6.08, p = 0.004], inositol containing compounds (Ino) (F = 9.25, p < 0.001), NAA [F = 7.63, p = 0.001] and creatine + phosphocreatine [F = 11.06, p < 0.001] in the left hemisphere and Ino [F = 5.65, p = 0.005] in the right hemisphere. Post-hoc comparisons showed that the BD-I disorder group had significantly lower metabolite levels in comparison to the BD-II and the HC groups. Limitations: This was a cross-sectional study with a small sample size. In addition, patients were on various psychotropic medications, which may have impacted the results. Conclusions: Neurochemical levels, in the superior temporal cortices, measured with 1H-MRS discriminated between BD-II and BD-I. Although further studies are needed, one may speculate that the superior temporal cortices (particularly left hemispheric) play a critical role, whose pathology may be related to subtyping bipolar disorder. The study was funded by Scientific Research Projects Committee of the Ankara Yıldırım Beyazıt University (Project Code: 803) and NIMH grant to CMM ( MH073998 ) and NIH grant to DO K24 ( MH104449 ). Dr. Phillips acknowledged the support of the Pittsburgh Foundation.

Background Retina is considered as a window to the brain due to the similarities in terms of development and pathologies. Optical coherence tomography (OCT) can perform quantitative examinations in the retina. In this study, we aimed to investigate the effects of drugs used in schizophrenia and bipolar disorder (BD) on retinal nerve fiber layer (RNFL) and macular thickness. Subjects and methods The study included schizophrenia (n=35) and euthymic BD (n=46) patients on various medications, and age, gender matched healthy control group (n=31). For retinal evaluation, measurements of RNFL and macula were performed with Optovue RTVue Premier OCT. Results In the schizophrenia group, chlorpromazine equivalent dose of antipsychotics was a statistically significant negative predictor of left RNFL nasal superior region thickness. In the BD group, serum valproate level was a significant positive predictor of thickness in the right macular inferior outer, left macular nasal outer region, right RNFL inferotemporal, left temporal and inferotemporal regions. Conclusion Since the retina consists of neurons, morphological or functional examination of retina may be beneficial for the evaluation of the effects of psychopharmalogical treatments in schizophrenia and BD. The outcome of this study implies that valproate has neuroprotective effects on the optic nerve and macula, and this finding is consistent with the literature implying neurotrophic effects of valproate.

Hemsley and Garety described the "jumping to conclusions bias" in which patients with delusions may reach unreasonable results with insufficient information. In this study patients with bipolar disorder and healthy volunteers were compared in terms of jumping to conclusions bias using the beads in the jar task.37 patients with DSM-5 diagnosis of bipolar disorder and 30 healthy controls were tested with the Beads Task (BT), Tower of London Test (ToL) and Barrat Impulsiveness Scale (BIS).In the BT, the mean score of DtD (draws to decision) and JTC (jumping to conclusions) scores were not statistically different between the two groups. In the ToL test, the duration of the total execution and the total time were significantly longer in the bipolar group than the control group. BIS scores were significantly higher in the bipolar group. YMRS (Young Mania Rating Scale) scores were not correlated with BT.This study is the first clinical study to assess the jumping to conclusions bias in patients with bipolar disorder. No JTC bias was detected in bipolar disorder. Further studies may assess JTC in larger samples to determine the effects of clinical state changes, psychotic symptoms, medication and impulsivity.

The aim of this study is to measure GABA levels of perisylvian cortices in schizophrenia and bipolar disorder patients, using proton magnetic resonance spectroscopy (1H-MRS). Patients with schizophrenia (n = 25), bipolar I disorder (BD-I; n = 28) and bipolar II disorder (BD-II; n = 20) were compared with healthy controls (n = 30).1H-MRS data was acquired using a Siemens 3 T whole body scanner to quantify right and left perisylvian structures’ (including superior temporal lobes) GABA levels. Right perisylvian GABA values differed significantly between groups [χ2= 9.62, df: 3, p = 0.022]. GABA levels were significantly higher in the schizophrenia group compared with the healthy control group (p = 0.002). Furthermore, Chlorpromazine equivalent doses of antipsychotics correlated with right hemisphere GABA levels (r2= 0.68, p = 0.006, n = 33). GABA levels are elevated in the right hemisphere in patients with schizophrenia in comparison to bipolar disorder and healthy controls. The balance between excitatory and inhibitory controls over the cortical circuits may have direct relationship with GABAergic functions in auditory cortices. In addition, GABA levels may be altered by brain regions of interest, psychotropic medications, and clinical stage in schizophrenia and bipolar disorder. � 2016 Elsevier Ireland Ltd

Objective: In our study, it is aimed to investigate impacts of cannabis use on information processing and psychomotor functions and to examine changes in the cognitive functions at the end of abstinence over a month. Method: The study was initiated with 34 volunteer participants using cannabis at least over two years, directed by a forensic unit. 34 persons were assessed at admission and were planned to assess after a month of remission. As 14 participants discontinued the study 20 participants only were assessed again at the end of a month. The participants were applied The Montreal Cognitive Assessment (MOCA) test, Edinburgh Handedness Inventory, Finger Tapping Test (FTT), Adult Memory and Information Processing Battery (AMIPB) A and B, and simple reaction time tests (auditory and visual) in admission and were applied Finger Tapping Test (FTT), Adult Memory and Information Processing Battery (AMIPB), and simple reaction time tests (auditory and visual) at the end of a month. Results: There was no statistically significant difference between participants continue to the treatment and those discontinue in terms of sociodemographic and clinical characteristics. The participants discontinue were using more daily cannabis dose. The auditory reaction time of the group continue to the treatment decreased statistically significantly after a month whereas there was no statistically significant difference in the visual reaction time. The scores of the AMIPB-A and AMIPB-B were detected statistically higher after a month compared to admission. The score of the dominant hand FTT after a month was detected statistically higher than that in admission whereas there was no statistically significant difference in the non-dominant hand score. Conclusion: Improvements in scores of AMIP-A, AMIP-B, FTT and auditory reaction time after one month of quitting cannabis suggest that cannabis use may impair cognitive functions such as information processing, reaction time and motor functions. We suggest that future studies to assess cognitive functions after either a shorter (i.e. 1 week) or a longer (i.e. 2 months) period of cannabis abstinence in larger samples may provide further useful data about the relationship between cannabis use and cognitive functions.

Objective: Several types of evidence have shown that auditory networks are dysfunctional in schizophrenia (Sch) and bipolar disorders (BD). Auditory cortices show abnormalities in hallucinations or during remission. This study aimed to assess resting-state connectivity of auditory cortices in Sch and BD. Method: Patients with BD-1 (n=28), BD-2 (n=21), Sch (n=30), and healthy controls (HC, n=30) were enrolled into the study. A 3 Tesla whole-body magnetic resonance imaging (MRI) system with a 32-channel phase-array head coil was used to acquire the MRI data. T1-weighted anatomical and gradient-echo based Echoplanar Imaging sequences were used. MATLAB and Freesurfer software packages were used for data analyses. Connectivity alterations within the auditory network guided our further seedbased connectivity analysis. Results: The left angular gyrus volume was decreased in Sch and BD-2 groups. The supramarginal gyrus had hyperconnectivity with the medial prefrontal cortices and decreased connectivity with the medial superior temporal gyrus (STG) in the BD-1 and BD-2 groups. The left superior temporal sulcus (STS) had increased connectivity with the bilateral posterior cingulate cortex in BD-1 and BD-2 and increased connectivity with the dorsal prefrontal cortices in the Sch group. The STS had increased connectivity with the medial STG in the BD-1 and Sch groups, whereas connectivity decreased in the BD-2 group. Conclusion: These findings suggest that functional connectivity of resting-state networks are altered in BD and Sch. Auditory network alterations may predispose to dysfunctional auditory information processing. Further studies are needed to determine the relationship between symptoms and auditory network dysfunction.

Objective: The aim of this study was to evaluate the dynamic thiol-disulphide homeostasis as a novel oxidative stress parameter in newly diagnosed and medication-naive general anxiety disorder (GAD) and panic disorder (PD) patients. Method: Medication-naive patients with GAD (n=21) or PD (n=23) and healthy individuals (n=23) were enrolled. Patients were administered a sociodemographic form, Beck Depression Inventory, and Beck Anxiety Inventory. Routine biochemical parameters, native thiol, total thiol, and disulphide parameters were measured in all patients and healthy individuals. Results: The native thiol levels of the GAD and PD groups were found significantly lower than those of the control group (p

Amaç: Bu çalışmanın amacı, üreme çağındaki kadınlarda demir eksikliği anemisinin bilişselfonksiyonlar, fiziksel fonksiyonellik, psikiyatrik morbidite, yorgunluk ve yaşam kalitesi üzerindekietkilerini incelemekti.Materyal ve Metot: Yaşları 18‐50 arasında değişen ve demir eksikliği anemisi olan 33 kadın ve anemisiolmayan 32 sağlıklı kadın çalışmaya dahil edildi. Laboratuvar analizi, nöropsikolojik testler, BeckDepresyon Ölçeği, Beck Anksiyete Ölçeği, VAS yorgunluk, Sağlık Değerlendirme Anketi ve Kısa Form‐36değerlendirildi.Bulgular: Gruplar arasında demografik özellikler açısından anlamlı fark saptanmadı. Demir eksikliğiAnemisi olan grupta Digit Forward/Backward, Digit Span Total, Sağlık Değerlendirme Anketi, BeckDepresyon Ölçeği, Beck Anksiyete Ölçeği, Kısa Form‐36 ve yorgunluk skorları kontrol grubuna goreanlamlı olarak daha düşüktü. Korelasyon analizinde eğitim, serum demir, ferritin ve hemoglobindüzeyleri ile bilişsel test skorları ve yorgunluk arasında anlamlı ilişkili bulundu. Serum demir, ferritin vehemoglobin düzeyleri ile Sağlık Değerlendirme Anketi, Beck Depresyon Ölçeği, Beck Anksiyete Ölçeğive Kısa Form‐36 skorları arasında anlamlı ilişki bulundu.Sonuç: Demir eksikliği anemisi üreme çağındaki kadınlarda bilişsel fonksiyonları, fizikselfonksiyonelliği, yaşam kalitesini, yorgunluğu, anksiyete ve depresyon semptomlarını negative yöndeetkilemektedir., Objectives: The aim of the study was to determine whether irondeficiency anemia (IDA) in reproductive-age women affects cognitivefunctioning, physical functioning, psychiatric morbidity, fatigue and qualityof life. Materials and Methods: Thirty-three women aged between 18-50years with IDA and 32 non-anemic healthy women were included in the study.Laboratory analyses, neuropsychological tests, Beck Depression Inventory (BDI),Beck Anxiety Inventory (BAI), VAS fatigue, Health Assessment Questionnaire (HAQ-DI)and Short Form-36 (SF-36) were assessed. Results: There was nosignificant difference in demographic characteristics of the patients betweengroups. Digit Forward/Backward, Digit Span Total, HAQ-DI, BAI, BDI, SF-36,fatigue scores in IDA group were significantly lower than the controls.Correlation analysis revealed that education, serum iron, ferritin, andhemoglobin levels were associated with cognitive test scores and fatigue. Serumiron, ferritin, and hemoglobin levels were found to be associated with HAQ-DI,BAI, BDI, and SF-36 scores. Coclusion: IDA negativelyaffects cognition, physical functioning, quality of life, fatigue, symptoms ofanxiety and depression in reproductive-age women.

Activity of the paraoxonase 1 (PON1) enzyme varies prominently according to the PON1 Q192R genotype. The arginine (R) genotype hydrolyzes peroxided lipids more quickly and efficiently than the glutamine (Q) genotype. The Q phenotype suggests greater liability to neurodegenerative processes, cardiovascular and malignancy risks than the R phenotype. Stimulated PON/ARES ratio is associated with the PON1 Q192R polymorphism. This study aimes to assess the Q192R phenotype in schizophrenia, bipolar disorder and depression.Patients with schizophrenia (37), bipolar disorder (n=50), depression (n=43) and healthy volunteers (n=43) were enrolled. Serum PON1, stimulated paraoxonase (sPON) and aryl esterase (ARES) levels were assessed with an automatic analyzer. Clusters of sPON/ARES ratio were detected with frequency analysis in PON1. QQ, QR and RR variant groups.There were significant differences between the bipolar disorder, depression, schizophrenia and healthy volunteer groups in terms of phenotype frequencies in groups (Fisher's Exact Coefficient=18.96, p=0.003). A higher prevalence of the PON1 RR variant was found in bipolar disorder whereas the PON1 QQ variant had a higher prevalence in depression and schizophrenia as compared to others. Serum PON1 activity correlated with number of episodes in the bipolar disorder group and with SANS, SAPS scores in the schizophrenia group.Difference between bipolar disorder, schizophrenia and depression in PON1 activity and PON1 phenotype might be suggestive of different liability to lipid peroxidation and neurodegeneration between the diagnostic groups. Longitudinal studies may identify long term differences between PON1 Q192R polymorphisms in clinical outcomes and neuropathology.

Dear Editor, Chewing, coughing, breathing, typing are activities that produce low level sounds and these audible activities are frequently encountered in the society. These background sounds are usually ignored in public places or at home. Some people may not ignore and perceive these sounds and become disgusted. Reasons of disgust are distraction and anger. Tension might be followed by anger which may then generate urge to leave the environment or intercept the background noise. Sensitivity to the group of background noise is called misophonia. 1-3 The term consists of two words: misos (strong hate or disgust) and phonia (sound) and was introduced by Margaret and Pavel Jastreboff in 2001. 4 It was aimed to present and discuss two cases of misophonia in this letter to the editor. The first case was a young man with generalized anxiety disorder. He was also suffering from misophonia and misophonia triggered anger. He reported that particularly his family life was devastated because of his anger. The second patient was suffering from obsessive compulsive disorder and misophonia. She reported that she was counting to ten, breathing slowly or leaving the environment as soon as possible, if she cannot relax. She was frequently listening music with headphones in public places to avoid from disgusting sounds. Both patients reported that they could not express themselves during their disgust, because of inhibiting themselves due to the fear of being called crazy. Misophonia is defined as immediate negative psychological responses to certain sounds that most people do not notice. 1-3 This novel psychopathology is proposed to be involved with dysregulation of emotional processing with a neurobiological basis. 5 Current classification systems have not defined misophonia yet and it is not clear whether it is a distinct entity or a dimension or symptom domain which accompany other disorders. 3 Post-traumatic stress disorder was the most frequently accompanying disorder in a recent large-scale study. 6 Accordingly, other psychopathologies may trigger or enhance the responses and therefore misophonia might be a dimensional concept. Misophonia may deteriorate quality of life and social functioning and thus should be further investigated. 1-3,5 A Google search with the key words “misophonia treatment” retrieved 217 results in the date of January 12th. 8 of the web pages’ name was including the term “misophonia”. Increased awareness of this problem would be useful in order to develop better treatments. 7,8

Gender differences in terms of Axis I and Axis II comorbidity in patients with panic disorder Objectives: Comorbidity in psychiatric disorders significantly affects the clinical course, the severity of symptoms, and the response to the treatment. Panic disorder can cause considerable disability, reduction of interpersonal relationships, avoidance of certain social situations, and staying away from high-risk jobs and consequently lowering work performance causing loss of job. A number of studies have shown that panic disorder is observed more frequently in females, indicating a gender risk factor. This study investigated potential gender differences in the distribution of Axis I and Axis II comorbidity. Method: A total of 63 patients who satisfied the inclusion criteria and had been diagnosed with panic disorder according to DSM-IV participated in this study. 31 (49.2%) patients were female, and 32 (50.8%) were male. Panic disorder was diagnosed with SCID-I (Structured Clinical Interview for DSM-IV-TR Axis I Disorders). Sociodemographic data were collected using a form developed by the researchers, and the Panic Agoraphobia scale was applied in all cases. The existence of possible childhood separation anxiety was also investigated, and SCID-II was applied to identify Axis II personality disorders. Gender differences in demographic and clinical characteristics and in the comorbidity of Axis I and Axis II disorders were then investigated. Results: The reported prevalence of separation anxiety was considerably higher in the female than in the male patients. Depression, social anxiety disorder, and specific phobias were more common in the female patients, whereas alcohol abuse was more common among the male patients. There was no gender difference in Axis II comorbidity. Conclusions: This comparison of gender differences in Axis I and Axis II disorders that coexist with panic disorders indicated that comorbidities of depression, social and specific phobias, and alcohol abuse comorbidities are different among the genders. However, there appeared to be gender differences in Axis II comorbidities.

Objectives: Depressive disorders are characterized by oxidative stress and burden of oxidative stress may provoke cellular and biochemical challenges. Thiols are converted into non-reactive disulphides after reacting with oxygen radicals and converted back to thiols. N-terminus of the albumin can be modified by biochemical strain and modified albumin is called ischemia modified albumin (IMA). In this study, it was aimed to assess potential effects of electroconvulsive therapy (ECT) on thiol disulphide homeostasis and IMA levels in depression. Methods: Twenty-three patients with depressive episodes (major depressive disorder n=16), and (bipolar disorder n=7) and 21 healthy controls were enrolled. Serum samples were collected at three time points: one day before ECT, one hour after the first ECT session and one hour after the last session (remission). Thiol disulphide homeostasis and IMA levels were measured. Results: Total thiol levels were significantly (p=0.032), native thiol levels were trend level (p=0.056) depleted in patients with depression in comparison to that of the healthy control group. Disulphide levels did not differ between the groups. IMA levels were higher (p

Objective: Although many studies have found a negative effect of lithium (Li) on the motor system in bipolar disorder, there is a lack of evidence about the effects of valproate (VP) on motor and s...

OBJECTIVE We present our 3 years' experience with electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases (BAKIRKOY) ECT Center after modification of ECT regulations in Turkey. Also included in this article is a brief overview and discussion on ECT applications. METHODS Bakirkoy medical records in electronic database were examined retrospectively (between January 2008 and December 2010), focusing on several aspects of short-term use of ECT: patient's age, sex, and diagnosis; mean number of treatments per patient; duration of stay in hospital; percentage of ECT use in hospitalized patients; and frequency and types of adverse events. RESULTS A total of 3490 patients hospitalized for acute conditions (2138 men and 1352 women) were treated with ECT in a period of 3 years, with a total of 27,660 ECT treatments performed. The total number of psychiatric patients hospitalized for acute conditions was 24,310 (14,132 men and 10,178 women) during the same period. The ratio of ECT use among acute care hospitalizations was 1:6.97 (14.36%). The mean ± SD age of patients treated with ECT was 35.02 ± 11.29. The mean ± SD number of ECT sessions was 7.89 ± 2.86. Affective disorders (46.99%) and psychotic disorders (52.12%) were among the leading diagnoses. No deaths occurred during ECT sessions, and no severe adverse events were observed. CONCLUSION The percentage of patients treated with ECT in BAKIRKOY is similar to rates reported in most Asian countries, which is higher than those reported in Western psychiatric centers. Absence of any life-threatening adverse effect or death, and presence of relatively few adverse effects, may be considered as an indication of conformity to current guidelines.

The comorbidity of structural or genetic diseases with schizophrenia is seen as an opportunity to understand the formation of schizophrenia. This case report presents a patient with comorbidity of schizophrenia, tetralogy of Fallot (TOF) and total situs inversus. TOF is a cyanotic heart disease, which can be linked to 22q11 deletion and trisomy 21. Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs, including the heart, are positioned in a mirror image from normal conditions. The comorbidity of TOF and SIT is quite rare. In our case report, schizophrenia is added to this rare comorbidity. This case report discussed the comorbidity and probable causal relationships. Furthermore, the research method of how transposition in internal organs is reflected in brain lateralization is also presented.

OBJECTIVE Activity of the paraoxonase 1 (PON1) enzyme varies prominently according to the PON1 Q192R genotype. The arginine (R) genotype hydrolyzes peroxided lipids more quickly and efficiently than the glutamine (Q) genotype. The Q phenotype suggests greater liability to neurodegenerative processes, cardiovascular and malignancy risks than the R phenotype. Stimulated PON/ARES ratio is associated with the PON1 Q192R polymorphism. This study aimes to assess the Q192R phenotype in schizophrenia, bipolar disorder and depression. METHOD Patients with schizophrenia (37), bipolar disorder (n=50), depression (n=43) and healthy volunteers (n=43) were enrolled. Serum PON1, stimulated paraoxonase (sPON) and aryl esterase (ARES) levels were assessed with an automatic analyzer. Clusters of sPON/ARES ratio were detected with frequency analysis in PON1. QQ, QR and RR variant groups. RESULTS There were significant differences between the bipolar disorder, depression, schizophrenia and healthy volunteer groups in terms of phenotype frequencies in groups (Fisher's Exact Coefficient=18.96, p=0.003). A higher prevalence of the PON1 RR variant was found in bipolar disorder whereas the PON1 QQ variant had a higher prevalence in depression and schizophrenia as compared to others. Serum PON1 activity correlated with number of episodes in the bipolar disorder group and with SANS, SAPS scores in the schizophrenia group. CONCLUSION Difference between bipolar disorder, schizophrenia and depression in PON1 activity and PON1 phenotype might be suggestive of different liability to lipid peroxidation and neurodegeneration between the diagnostic groups. Longitudinal studies may identify long term differences between PON1 Q192R polymorphisms in clinical outcomes and neuropathology.

Objective: Antidepressants are thought to cause manic switches and accelerate cycling in the treatment of bipolar depression. On the other hand, other evidence suggests that antidepressant neither cause manic switches, nor are effective for the treatment of bipolar depression. This study aimed to assess clinicians’ attitudes towards antidepressant choices for treatment of bipolar depressive episodes and subthreshold depression. Methods: Medical records of 784 patients with bipolar disorder were investigated retrospectively. Antidepressants were used in 55 of 263 depressive episodes (20.9%). Data regarding 78 episodes (23 subthreshold symptoms, 55 episodes) of 68 patients (54 female, 14 male; mean age: 39.64±10.99) were obtained. Descriptive statistics were the evaluation method. Results: In our department, antidepressants were used in 20.9% of the patients in the treatment of bipolar depression. One third of patients receiving antidepressant prescriptions had a history of manic switch, 5 (21.7%) of the patients with subthreshold symptoms receiving antidepressant prescriptions had a history of manic switch. However, manic switch occurred in only 5 (6.4%) patients. Selective serotonin reuptake inhibitors were the most common cause (58.3%) of the manic switch in patients with a history of manic switch. Discussion: Clinicians are still using antidepressants in the treatment of bipolar depression. Antidepressants targeting many neurotransmitter systems can be used in the first line treatments and antidepressants can be used even in patients with a history of manic switch. This controversial topic should be studied prospectively with larger samples and it must be clarified whether this phenomenon is a natural course of the disorder or triggered by antidepressant medications.

Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine the frequency of psychiatric morbidity in vitiligo patients treated at the dermatology outpatient clinic and to investigate the relation between anxiety, depression, social anxiety levels, and self esteem and disability in these patients. Method: Fourty-two patients with vitiligo were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), Liebowitz Social Anxiety Scale (LSAS) and Sheehan Disability Scale (SDS). Control group included subjects matched to patients in terms of age, sex and education level. Results: In comparison to healthy controls, the rate of psychiatric morbidity was found to be higher and mean self-esteem score was found to be lower in the vitiligo group. There was no significant difference between groups in terms of social anxiety. Majority of the patients were mildly disabled. Among the vitiligo cases, psychiatric morbidity was found more frequent in female and young participants. Anxiety and social avoidance scores negatively correlated with age. Conclusion: These findings suggest that the rate of psychiatric morbidity is higher in patients with vitiligo than healthy control subjects. Patients with vitiligo treated at dermatology clinics should be assessed in terms of psychiatric disorders and psychiatric interventions may become necessary in the course of illness.

Objective: Borderline personality disorder (BPD) is characterized with emotional, cognitive, behavioral disorders, and its manifestation becomes evident in adolescence or early adulthood. According to Linehan's biosocial theory, emotion dysregulation (ED) is a core feature of BPD. Self-esteem (SE) is known to be associated with borderline symptom severity and depression in BPD. In our study, we aimed to investigate the relationship between ED, SE and negative affect. Methods: Twenty-six patients with BPD and 26 healthy controls were included. Sociodemog-raphic data form, Cognitive Emotion Regulation Questionnaire (CERQ), Difficulties in Emotion Regulation Scale (DERS), Rosenberg Self-Esteem Scale (RSES), Positive and Negative Affect Scale (PANAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) were our evaluation tools. Results: No difference was found between the groups in terms of age, gender, education and marital status. The total and subscale scores of the DERS, the negative affect subscale of the PANAS (PANASn), the RSES were found to be significantly higher in BPD than healthy controls. Predictors of depression in the linear regression analysis were negative affect (PANASn), and predictors of SE (RSES) is depression. Emotion dysregulation (DERStotal) was the predictive vari-able of negative affect (PANASn). Conclusions: In our study, DDG was predictor of negative affect and it was observed that emotion dysregulation itself contributed to negative affect in addition to the innate emotional sensitivity. The predictive effect of ER on negative affect was thought to be triggered by dysregulating behavior. No relationship was found between ER and SE because of evaluating ER state and SE trait. It would be appropriate to evaluate whether DDG has an effect on self-esteem with large sample studies in the future.

OZET Iki uclu bozuklukta bilissel islev bozukluklarinin klinik belirleyicileri ve bilissel ara fenotipler Bilissel islev bozukluklari iki uclu bozuklugun klinik duzelme donemlerinde dahi hastalari etkilemektedir. Basta sozel ogrenme, sozel bellek ve yurutucu islev bozukluklari olmak uzere faal bellek, dikkat, dikkati surdurme ve islem hizi iki uclu bozuklukta one cikan alt bilissel alanlardir. Sozel ogrenme ve sozel bellek hastalarin yaninda birinci derece akrabalarda da en fazla etkilenmis islevler olduklarindan hastalikla ilgili bir ozellik olabilir, dolayisiyla bilissel ara fenotip kavramina en uygun aday gibi gorunmektedirler. Psikotik hastalik donemlerinin olup olmamasi, gecirilen hastalik donemi tip ve sayilari, hastaligin baslangic yasi ve hastalik suresi bilissel kayip- lari etkiledigi belirlenmis klinik parametrelerdir. Iki uclu bozukluklarin erken baslangicli formlari, tip II bozukluk, yaslilik ve komorbidite varligi durumlarinda bilissel islevlerin nasil etkilendigi ile ilgili sinirli sayida arastirma bulunmaktadir. Ayrica ilaclarin bilissel islevleri kalitatif ve kantitatif olarak nasil etkiledigi ile ilgili yeterli ve tutarli kanit bulunmamaktadir. Hastalarin birinci derece akrabalarinda bilissel kayiplarin gorulmesi ve kayiplarin ailesel benzerlik gostermesi bilissel islevler icin kalitim gostergesi olabilir, bu nedenle arastirmalarin desenlenmesin- de genetik modellerin dikkate alinmasi onemli veriler saglayabilir. Anahtar kelimeler: Iki Uclu Bozukluk, bilissel islev bozukluklari, ara fenotip, klinik belirleyiciler ABSTRACT Clinic determinents of cognitive dysfunctions and cognitive endophenotypes in bipolar disorder Cognitive dysfunctions influence patients with bipolar disorder even when they are clinically remitted. Verbal learning, verbal memory and executive functions foremost, working memory, (sustained) attention and processing speed are substantial cognitive domains in bipolar disorder. Dysfuntions in verbal learning and memory might be observed in first degree relatives as well; and thus seem to be best candidates for the cognitive endophenotype concept. Prior psychotic episodes, numbers and types of episodes, age of illness onset and duration of illness are clinical parameters seem to influence cognitive functions. There are relatively limited numbers of researches about cognitive dysfunctions in early onset forms, old age, type II disorder and comorbidity aspects of bipolar disorders. Results from the researches regarding qualitative and quantitative effects of medications on cognition are inconsistent. Cognitive deficits of first degree relatives and familial resemblance of deficits might be indicators of heritability of cognitive functions, therefore taking genetic models into account in designs of researches may provide considerable data.

Clozapine has been used for approximately 40 years and it is still the gold standard for treatment resistant schizophrenia even though it may cause considerable side effects. One of the common side effects during the treatment with clozapine is sialorrhea. Although clozapine has anticholinergic side effects, pathogenesis of sialorrhea is still unclear. Despite sialorrhea is quite common and might influence quality of life, treatment choices and their efficacy for this side effect is limited. Thus, in this article, pathophysiology and treatment of clozapin induced sialorrhea is reviewed.