Pub Date : 2015-12-01DOI: 10.5455/BCP.20150502072915
U. S. Copoglu, M. Iğci, Esra Bozgeyik, M. H. Kokacya, Y. Z. Igci, Aslan Özden, F. Bulbul, G. Alpak, M. Ari, H. Savaş
Objective: The endocannabinoid system contributes to the regulation of emotions, stress, memory, and cognition. It has been reported that endocannabinoids cause GABAergic inhibition and dopaminergic increase in the mesolimbic and nigrostriatal systems, thus playing a part in the neurobiology of schizophrenia. In this study, we investigate cannabinoid receptor 1 (CNR1) gene polymorphisms in schizophrenia patients. Methods: CNR1 gene polymorphisms were studied in 66 schizophrenia patients and 65 healthy controls. To obtain genomic DNA, proteinase K digestion and the salt-chloroform method were used. Clinical Global Impression severity scale (CGI-S) and Positive and Negative Syndrome Scale (PANSS) were administered to evaluate the severity of schizophrenia symptoms. CNR1 gene polymorphism was determined by using polymerase chain reaction (PCR), Restriction Fragment Length Polymorphism (RFLP), and Single Strand Conformation Polymorphism (SSCP) methods for the Rs6454674, Rs806368, and Rs1049353 sites. Results: There was no difference in CNR1 gene polymorphisms between schizophrenia patients and control groups (Rs6454674 T/G; p=0.973, Rs806368 T/C; p=0.349, Rs1049353 A/G; p=1.00). However, CGI-S, PANSS total, PANSS positive, PANSS negative and PANSS general psychopathology scores were significantly lower in schizophrenia patients with RS6454674 polymorphism than in those not showing polymorphism. Conclusion: Our results suggest that CNR1 gene polymorphisms may be associated with clinical symptoms and disease severity in schizophrenia patients.
{"title":"Cannabinoid Receptor 1 (CNR1) Gene Polymorphisms in Schizophrenia Patients: Rs6454674 Polymorphism is Associated with Disease Severity","authors":"U. S. Copoglu, M. Iğci, Esra Bozgeyik, M. H. Kokacya, Y. Z. Igci, Aslan Özden, F. Bulbul, G. Alpak, M. Ari, H. Savaş","doi":"10.5455/BCP.20150502072915","DOIUrl":"https://doi.org/10.5455/BCP.20150502072915","url":null,"abstract":"Objective: The endocannabinoid system contributes to the regulation of emotions, stress, memory, and cognition. It has been reported that endocannabinoids cause GABAergic inhibition and dopaminergic increase in the mesolimbic and nigrostriatal systems, thus playing a part in the neurobiology of schizophrenia. In this study, we investigate cannabinoid receptor 1 (CNR1) gene polymorphisms in schizophrenia patients. Methods: CNR1 gene polymorphisms were studied in 66 schizophrenia patients and 65 healthy controls. To obtain genomic DNA, proteinase K digestion and the salt-chloroform method were used. Clinical Global Impression severity scale (CGI-S) and Positive and Negative Syndrome Scale (PANSS) were administered to evaluate the severity of schizophrenia symptoms. CNR1 gene polymorphism was determined by using polymerase chain reaction (PCR), Restriction Fragment Length Polymorphism (RFLP), and Single Strand Conformation Polymorphism (SSCP) methods for the Rs6454674, Rs806368, and Rs1049353 sites. Results: There was no difference in CNR1 gene polymorphisms between schizophrenia patients and control groups (Rs6454674 T/G; p=0.973, Rs806368 T/C; p=0.349, Rs1049353 A/G; p=1.00). However, CGI-S, PANSS total, PANSS positive, PANSS negative and PANSS general psychopathology scores were significantly lower in schizophrenia patients with RS6454674 polymorphism than in those not showing polymorphism. Conclusion: Our results suggest that CNR1 gene polymorphisms may be associated with clinical symptoms and disease severity in schizophrenia patients.","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81650109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20150511053723
S. Shafti, Mohammad Jafarabad, Reza Azizi
ABS TRACT: Tackling negative symptoms in male patients with schizophrenia using a norepinephrine reuptake inhibitor Objective: Placebo-controlled trials of antidepressants in patients with schizophrenia with prominent negative symptoms usually have presented contradictory results. Reboxetine is a norepinephrine reuptake inhibitor (NRI) antidepressant. Preceding studies regarding possible advantageous effects of reboxetine on deficit symptoms of schizophrenia, too, have resulted in inconsistent outcomes. The present study again assesses the effectiveness of reboxetine as an adjunctive treatment in a group of patients with schizophrenia with prominent negative symptoms. Method: Fifty male inpatients meeting the diagnosis of schizophrenia were enrolled into a 12-week parallel group, double-blind study with random assignment to reboxetine (n=25 patients) or placebo (n=25 patients). Inclusion criterion, in addition to the diagnosis of schizophrenia, was the existence of obvious negative symptoms for a duration of at least two years. Cases with existing co-morbidities like major depressive disorder or diagnosis of schizoaffective disorder or cases that were prescribed long-acting depot or atypical antipsychotics, antidepressants, or lithium were excluded. The Scale for Assessment of Negative Symptoms (SANS) was used as the primary outcome measure. Scale for Assessment of Positive Symptoms (SAPS), Simpson Angus Scale (SAS), Hamilton Rating Scale for Depression (HAM-D) and Mini-Mental Status Examination (MMSE) were used for comparison of the intervening parameters in this study. Duration of the assessment was twelve weeks, and the patients were assessed at baseline (week 0), and at the end of the 4 th , 8 th , and 12 th week by SANS and SAPS. Treatment efficacy was analyzed by t test and repeated-measures analysis of variance (ANOVA). Statistical significance was defined as a 2-sided p value ≤0.05. Results: According to our findings, 76% of the patients in the target group showed some positive response to reboxetine, in comparison with 24% in the control group (p<0.01). Mean total score of SANS in the reboxetine group decreased significantly from 79.94±1.20 to 74.23±4.07 (p<0.0001) at the end of the study, while such an improvement was not significant in the placebo group with a decrement from 80.42±2.46 to 79.08±5.83 (p<0.29). Between-group analysis, as well, showed that the mean total score of SANS in the reboxetine group, in comparison with the control group, improved significantly at 8 and 12 weeks (p<0.03 and p<0.01 respectively). Repeated-measures analysis of variance (ANOVA) showed significant improvement of SANS in the reboxetine group (p<0.02), and also a significant difference in this regard between groups (p<0.001). Changes of SAPS were insignificant in both groups. Effect size (ES) analysis for changes of SANS at the end of assessment indicated a large improvement with reboxetine (Cohen’s d = 2.91). Post-hoc power analysis showed a power equa
ABS摘要:应用去甲肾上腺素再摄取抑制剂治疗男性精神分裂症患者的阴性症状目的:在具有明显阴性症状的精神分裂症患者中使用抗抑郁药的安慰剂对照试验通常会出现相互矛盾的结果。瑞波西汀是一种去甲肾上腺素再摄取抑制剂(NRI)抗抑郁药。先前关于瑞波西汀对精神分裂症缺陷症状可能有利作用的研究也导致了不一致的结果。本研究再次评估了利波西汀作为一组有明显阴性症状的精神分裂症患者的辅助治疗的有效性。方法:将50例诊断为精神分裂症的男性住院患者纳入为期12周的平行双盲研究，随机分配至瑞博西汀(n=25例)或安慰剂(n=25例)。除精神分裂症诊断外，纳入标准为存在明显阴性症状至少两年。排除存在共病的病例，如重度抑郁症或诊断为分裂情感性障碍，或处方长效长效抗精神病药或非典型抗精神病药、抗抑郁药或锂盐的病例。阴性症状评估量表(SANS)被用作主要结果测量。采用阳性症状评定量表(SAPS)、辛普森安格斯量表(SAS)、汉密尔顿抑郁评定量表(HAM-D)和简易精神状态检查量表(MMSE)进行干预参数比较。评估时间为12周，患者在基线(第0周)、第4周、第8周和第12周末分别接受SANS和SAPS评估。采用t检验和重复测量方差分析(ANOVA)分析治疗效果。统计学显著性定义为双侧p值≤0.05。结果:根据我们的研究结果，目标组中76%的患者对瑞波西汀有一定的积极反应，而对照组为24% (p<0.01)。研究结束时，瑞博西汀组SANS的平均总分从79.94±1.20显著下降到74.23±4.07 (p<0.0001)，而安慰剂组的改善不显著，从80.42±2.46下降到79.08±5.83 (p<0.29)。组间分析显示，与对照组相比，瑞波西汀组的SANS平均总分在8周和12周显著提高(p<0.03和p<0.01)。重复测量方差分析(ANOVA)显示，瑞波西汀组SANS有显著改善(p<0.02)，两组间差异有显著性(p<0.001)。两组SAPS变化均不显著。评估结束时SANS变化的效应量(ES)分析表明，瑞博西汀有很大的改善(Cohen’s d = 2.91)。事后功效分析显示该试验的功效为0.53(中间值)。结论:利波西汀辅助氟哌啶醇治疗精神分裂症阴性症状可能有积极作用。
{"title":"Tackling Negative Symptoms in Male Patients with Schizophrenia Using a Norepinephrine Reuptake Inhibitor","authors":"S. Shafti, Mohammad Jafarabad, Reza Azizi","doi":"10.5455/BCP.20150511053723","DOIUrl":"https://doi.org/10.5455/BCP.20150511053723","url":null,"abstract":"ABS TRACT: Tackling negative symptoms in male patients with schizophrenia using a norepinephrine reuptake inhibitor Objective: Placebo-controlled trials of antidepressants in patients with schizophrenia with prominent negative symptoms usually have presented contradictory results. Reboxetine is a norepinephrine reuptake inhibitor (NRI) antidepressant. Preceding studies regarding possible advantageous effects of reboxetine on deficit symptoms of schizophrenia, too, have resulted in inconsistent outcomes. The present study again assesses the effectiveness of reboxetine as an adjunctive treatment in a group of patients with schizophrenia with prominent negative symptoms. Method: Fifty male inpatients meeting the diagnosis of schizophrenia were enrolled into a 12-week parallel group, double-blind study with random assignment to reboxetine (n=25 patients) or placebo (n=25 patients). Inclusion criterion, in addition to the diagnosis of schizophrenia, was the existence of obvious negative symptoms for a duration of at least two years. Cases with existing co-morbidities like major depressive disorder or diagnosis of schizoaffective disorder or cases that were prescribed long-acting depot or atypical antipsychotics, antidepressants, or lithium were excluded. The Scale for Assessment of Negative Symptoms (SANS) was used as the primary outcome measure. Scale for Assessment of Positive Symptoms (SAPS), Simpson Angus Scale (SAS), Hamilton Rating Scale for Depression (HAM-D) and Mini-Mental Status Examination (MMSE) were used for comparison of the intervening parameters in this study. Duration of the assessment was twelve weeks, and the patients were assessed at baseline (week 0), and at the end of the 4 th , 8 th , and 12 th week by SANS and SAPS. Treatment efficacy was analyzed by t test and repeated-measures analysis of variance (ANOVA). Statistical significance was defined as a 2-sided p value ≤0.05. Results: According to our findings, 76% of the patients in the target group showed some positive response to reboxetine, in comparison with 24% in the control group (p<0.01). Mean total score of SANS in the reboxetine group decreased significantly from 79.94±1.20 to 74.23±4.07 (p<0.0001) at the end of the study, while such an improvement was not significant in the placebo group with a decrement from 80.42±2.46 to 79.08±5.83 (p<0.29). Between-group analysis, as well, showed that the mean total score of SANS in the reboxetine group, in comparison with the control group, improved significantly at 8 and 12 weeks (p<0.03 and p<0.01 respectively). Repeated-measures analysis of variance (ANOVA) showed significant improvement of SANS in the reboxetine group (p<0.02), and also a significant difference in this regard between groups (p<0.001). Changes of SAPS were insignificant in both groups. Effect size (ES) analysis for changes of SANS at the end of assessment indicated a large improvement with reboxetine (Cohen’s d = 2.91). Post-hoc power analysis showed a power equa","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89223481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20150502073029
M. Ateş
Antidepressants are undispensable part of treatment in depression. In addition to this, they are not only restricted to depression treatment. It is well known that antidepressants are also widely used in treatments of subgroups of anxiety disorders. Moreover, they are frequently preferred in areas of medicine other than psychiatry, including pain disorders, migraine, fibromyalgia etc. treatment. Increase of antidepressant use was not found to be associated with increase of population and incidence of psychiatric illnesses 1. Obviously, apart from prescriptions of physicians, accessing easily to antidepressants via pharmacies is a reality in Turkey. This has been emphasized several times by the mass media 2-4. They also observe the misuse of antidepressants. The majority of reported cases of antidepressant misuse occur in individuals with comorbid mood and substance use disorders. The most common m o t i v a t i o n f o r a b u s e i s t o a c h i e v e a psychostimulant-like effect, including a desire for a " high " or euphoria. While it is important to recognize that the most majority of individu als prescribed antidepressants do not abuse them, it is also critical for psychiatrist to be aware of the potential for misuse and abuse when prescribing antidepresants 5. In addition to access, perceptions of the nonmedical use or abuse of antidepressants as being more socially acceptable and less stigmatized, may be contributing to increased rates of misuse 6. In my opinion, another possible reason regarding widespread use of antidepressants in Western countries is the support and expectation of strong ego and extroversion. Additionally, feeling strong of self with these medications p r o m o t e s l o n g p e r i o d o f u n n e c e s s a r y antidepressant use. Besides to its benefits, such a group of drugs widely used in all over the world, have some undesirable side-effects 7. In addition to physical side effects like weight gain, antidepressants can emerge psychiatric conditions including maniac and hypomaniac shifts that effect familial and social life. Furthermore, subsyndromal symptoms of hypomania are quite often in population under antidepressant medications. These people might have an inflated ego, affective flattening of positive or negative emotions, relative impaired reasoning and risky behaviours 8,9. As a result of these reasons, side effects of antidepressants, in particular …
{"title":"Social Harms of Nonprescribed or Uncontrolled Use of Antidepressants","authors":"M. Ateş","doi":"10.5455/BCP.20150502073029","DOIUrl":"https://doi.org/10.5455/BCP.20150502073029","url":null,"abstract":"Antidepressants are undispensable part of treatment in depression. In addition to this, they are not only restricted to depression treatment. It is well known that antidepressants are also widely used in treatments of subgroups of anxiety disorders. Moreover, they are frequently preferred in areas of medicine other than psychiatry, including pain disorders, migraine, fibromyalgia etc. treatment. Increase of antidepressant use was not found to be associated with increase of population and incidence of psychiatric illnesses 1. Obviously, apart from prescriptions of physicians, accessing easily to antidepressants via pharmacies is a reality in Turkey. This has been emphasized several times by the mass media 2-4. They also observe the misuse of antidepressants. The majority of reported cases of antidepressant misuse occur in individuals with comorbid mood and substance use disorders. The most common m o t i v a t i o n f o r a b u s e i s t o a c h i e v e a psychostimulant-like effect, including a desire for a \" high \" or euphoria. While it is important to recognize that the most majority of individu als prescribed antidepressants do not abuse them, it is also critical for psychiatrist to be aware of the potential for misuse and abuse when prescribing antidepresants 5. In addition to access, perceptions of the nonmedical use or abuse of antidepressants as being more socially acceptable and less stigmatized, may be contributing to increased rates of misuse 6. In my opinion, another possible reason regarding widespread use of antidepressants in Western countries is the support and expectation of strong ego and extroversion. Additionally, feeling strong of self with these medications p r o m o t e s l o n g p e r i o d o f u n n e c e s s a r y antidepressant use. Besides to its benefits, such a group of drugs widely used in all over the world, have some undesirable side-effects 7. In addition to physical side effects like weight gain, antidepressants can emerge psychiatric conditions including maniac and hypomaniac shifts that effect familial and social life. Furthermore, subsyndromal symptoms of hypomania are quite often in population under antidepressant medications. These people might have an inflated ego, affective flattening of positive or negative emotions, relative impaired reasoning and risky behaviours 8,9. As a result of these reasons, side effects of antidepressants, in particular …","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85384545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20151128021707
M. Yıldız, M. Yazıcı, A. E. A. Yağcıoğlu, S. Karahan, A. Şevik, Nadide Gurses
Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a patient as non-responder. However, recent studies indicate that the response to antipsychotic medications starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of early improvement at 2 or 4 weeks for non-response at 6 weeks. Methods: Twenty seven in- and out-patients with a diagnosis of schizophrenia according to DSM-IV, between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative Syndrome Scale (PANSS) total score ≥ 75, with at least “moderate” level of severity / score>4 on at least 2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were receiving antipsychotic treatment for the first time, and 17 patients’ treatment was changed due to nonresponse to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication: “not minimally improved”, “not much improved” and “not remitted”. As previously described, “not minimally improved” and “not much improved” were defined as less than 28% and 53% improvement in the PANSS total scores, respectively. “Not remitted” was defined according to the criteria developed by “The Remission in Schizophrenia Working Group” without the time criterion. Signal detection methods using receiver operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value of cut-off points were calculated for predicting “not minimally improved”, “not much improved” and “not remitted” at endpoint. Results: The early response threshold for predicting “not minimally improved’ was less than 15.3% reduction in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for predicting “not much improved” was less than 22.1% reduction at week 2 and less than 44.3% reduction at week 4; for “not remitted” was less than 71.5% reduction at week 2 and less than 23.2% reduction at week 4. Specific thresholds of “much improvement” and “remission” were not identified at week 2, whereas thresholds calculated for week 4 had good discriminative power. Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead, the findings revealed that non-response could best be predicted at 4 weeks as in some other previous studies. The question of which time point for early prediction of response could be best predicted in schizophrenia patients needs to
{"title":"Prediction of Response to Antipsychotic Drugs in Schizophrenia Patients within the Early Phase of Treatment","authors":"M. Yıldız, M. Yazıcı, A. E. A. Yağcıoğlu, S. Karahan, A. Şevik, Nadide Gurses","doi":"10.5455/BCP.20151128021707","DOIUrl":"https://doi.org/10.5455/BCP.20151128021707","url":null,"abstract":"Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a patient as non-responder. However, recent studies indicate that the response to antipsychotic medications starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of early improvement at 2 or 4 weeks for non-response at 6 weeks. Methods: Twenty seven in- and out-patients with a diagnosis of schizophrenia according to DSM-IV, between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative Syndrome Scale (PANSS) total score ≥ 75, with at least “moderate” level of severity / score>4 on at least 2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were receiving antipsychotic treatment for the first time, and 17 patients’ treatment was changed due to nonresponse to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication: “not minimally improved”, “not much improved” and “not remitted”. As previously described, “not minimally improved” and “not much improved” were defined as less than 28% and 53% improvement in the PANSS total scores, respectively. “Not remitted” was defined according to the criteria developed by “The Remission in Schizophrenia Working Group” without the time criterion. Signal detection methods using receiver operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value of cut-off points were calculated for predicting “not minimally improved”, “not much improved” and “not remitted” at endpoint. Results: The early response threshold for predicting “not minimally improved’ was less than 15.3% reduction in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for predicting “not much improved” was less than 22.1% reduction at week 2 and less than 44.3% reduction at week 4; for “not remitted” was less than 71.5% reduction at week 2 and less than 23.2% reduction at week 4. Specific thresholds of “much improvement” and “remission” were not identified at week 2, whereas thresholds calculated for week 4 had good discriminative power. Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead, the findings revealed that non-response could best be predicted at 4 weeks as in some other previous studies. The question of which time point for early prediction of response could be best predicted in schizophrenia patients needs to","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85828745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20150707104145
M. Camkurt, M. S. Metin, Erdem Onder Sonmez
ABS TRACT: Black hairy tongue probably related to paroxetine use: a case report Black hairy tongue (BHT), also known as “lingua villosa nigra,” is a benign and reversible disorder characterized by hypertrophy of filiform papillae (longer than 3 mm) on the surface of the tongue. Although BHT is usually asymptomatic, in some cases nausea, halitosis and gagging may accompany to BHT. Poor oral hygiene, smoking, alcohol, cancer, and drugs are important in etiology of BHT. Previously reported drugs associated with BHT are antibiotics and psychotropics such as olanzapine, fluoxetine, clonazepam, thiothixene, and benztropine mesylate. BHT has not been reported with paroxetine before. Here we report a case of BHT occurred after initiation of paroxetine in a 30-year-old man for his anxiety disorder and disappeared after discontinuation, which identifies a probable association with paroxetine..
{"title":"Black Hairy Tongue Probably Related to Paroxetine Use: A Case Report","authors":"M. Camkurt, M. S. Metin, Erdem Onder Sonmez","doi":"10.5455/BCP.20150707104145","DOIUrl":"https://doi.org/10.5455/BCP.20150707104145","url":null,"abstract":"ABS TRACT: Black hairy tongue probably related to paroxetine use: a case report Black hairy tongue (BHT), also known as “lingua villosa nigra,” is a benign and reversible disorder characterized by hypertrophy of filiform papillae (longer than 3 mm) on the surface of the tongue. Although BHT is usually asymptomatic, in some cases nausea, halitosis and gagging may accompany to BHT. Poor oral hygiene, smoking, alcohol, cancer, and drugs are important in etiology of BHT. Previously reported drugs associated with BHT are antibiotics and psychotropics such as olanzapine, fluoxetine, clonazepam, thiothixene, and benztropine mesylate. BHT has not been reported with paroxetine before. Here we report a case of BHT occurred after initiation of paroxetine in a 30-year-old man for his anxiety disorder and disappeared after discontinuation, which identifies a probable association with paroxetine..","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83118352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20150207072424
Serdar Nurmedov, Onat Yilmaz, A. Darcin, O. Noyan, N. Dilbaz
ABS TRACT: Frequency of synthetic cannabinoid use and its relationship with socio-demographic characteristics and treatment outcomes in alcohol- and substance-dependent inpatients: a retrospective study Objective: The recent emergence of Synthetic Cannabinoids (SCs) has become a serious public health problem. Here we aimed to analyze the frequency of SC use and its relationship with sociodemographic characteristics and treatment outcomes in alcohol- and substance-dependent inpatients retrospectively. Methods: We retrospectively analyzed medical records of 323 inpatients that were treated at the alcohol and substance dependence treatment center between January 2012 and December 2013. The data were extracted from patient records. Results: The mean age of SC users was lower than for patients without a history of SC use. The mean duration of education was shorter for SC users. Age at first drug use of SC users was lower, numbers of hospitalizations were lower and duration of substance use was shorter in SC users compared with the other substance user groups. The rate of legal issues was higher in the SC-use group. The rate of lapse and the rate of dropout was higher in patients with SC use than in other substance users (for all p< 0.05). Age, age at first substance use, duration of use (years) and criminal records were predicted as determining variables for SC use in inpatients. Conclusions: In conclusion, the socio-demographic characteristics can be included as predictive factors for SC use.
{"title":"Frequency of Synthetic Cannabinoid Use and Its Relationship with Socio-Demographic Characteristics and Treatment Outcomes in Alcohol- and Substance- Dependent Inpatients: A retrospective study","authors":"Serdar Nurmedov, Onat Yilmaz, A. Darcin, O. Noyan, N. Dilbaz","doi":"10.5455/BCP.20150207072424","DOIUrl":"https://doi.org/10.5455/BCP.20150207072424","url":null,"abstract":"ABS TRACT: Frequency of synthetic cannabinoid use and its relationship with socio-demographic characteristics and treatment outcomes in alcohol- and substance-dependent inpatients: a retrospective study Objective: The recent emergence of Synthetic Cannabinoids (SCs) has become a serious public health problem. Here we aimed to analyze the frequency of SC use and its relationship with sociodemographic characteristics and treatment outcomes in alcohol- and substance-dependent inpatients retrospectively. Methods: We retrospectively analyzed medical records of 323 inpatients that were treated at the alcohol and substance dependence treatment center between January 2012 and December 2013. The data were extracted from patient records. Results: The mean age of SC users was lower than for patients without a history of SC use. The mean duration of education was shorter for SC users. Age at first drug use of SC users was lower, numbers of hospitalizations were lower and duration of substance use was shorter in SC users compared with the other substance user groups. The rate of legal issues was higher in the SC-use group. The rate of lapse and the rate of dropout was higher in patients with SC use than in other substance users (for all p< 0.05). Age, age at first substance use, duration of use (years) and criminal records were predicted as determining variables for SC use in inpatients. Conclusions: In conclusion, the socio-demographic characteristics can be included as predictive factors for SC use.","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84121871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20150902042021
S. Kazancı, M. Tarakçıoğlu, Lida Bülbül, N. Sağlam, S. Hatipoğlu
ABSTRACTAttention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric disease affecting 5.3% of school-aged children. Methylphenidate is the primary stimulant, which has been used widely more than 60 years to treat ADHD. In this paper 3 cases with orofacial and/or limb dyskinesia after methylphenidate administration are reported. In 2 of our patients, continuation of the methylphenidate treatment did not cause recurrent dyskinesia. We thought that despite dyskinetic side effects, in cases with normal IQ level, continuation of methylphenidate treatment may be safe and do not cause any recurrent dyskinetic movements. Despite dyskinesia, one more chance may be given to methylphenidate treatment.
{"title":"Should we continue methylphenidate treatment despite orofacial or extremity dyskinesias","authors":"S. Kazancı, M. Tarakçıoğlu, Lida Bülbül, N. Sağlam, S. Hatipoğlu","doi":"10.5455/BCP.20150902042021","DOIUrl":"https://doi.org/10.5455/BCP.20150902042021","url":null,"abstract":"ABSTRACTAttention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric disease affecting 5.3% of school-aged children. Methylphenidate is the primary stimulant, which has been used widely more than 60 years to treat ADHD. In this paper 3 cases with orofacial and/or limb dyskinesia after methylphenidate administration are reported. In 2 of our patients, continuation of the methylphenidate treatment did not cause recurrent dyskinesia. We thought that despite dyskinetic side effects, in cases with normal IQ level, continuation of methylphenidate treatment may be safe and do not cause any recurrent dyskinetic movements. Despite dyskinesia, one more chance may be given to methylphenidate treatment.","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79468252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20130925022238
M. Bulut, K. Gozukara, M. Kaya
Retrograde ejaculation refers to the propulsion of semen back in to the urinary bladder rather than the usual anterograde flow. Antidepressant drugs are frequently associated with sexual dysfunct ion (SD). Duloxet ine, a newer antidepressant agent, has sexual dysfunction as a side effect confirmed by placebo studies. In some cases, other rare sexual side effects such as hypersexuality have been reported during duloxetine treatment. Here, we report an unusual case of retrograde ejaculation after duloxetine treatment for major depressive disorder (MDD) with co-morbid generalized anxiety disorder (GAD). Written informed consent was obtained from the patient before writing this report. AN, a 43-year-old married man who met the DSM-IV criteria for MDD with co-morbid GAD. He had been prescribed several medications for MD GAD for 11 years (paroxetine, mirtazapine, venlafaxine, citalopram, escitalopram, tianeptine, milnacipran, sertraline, trazodone, imipramine, and clomipramine). The medications were discontinued because of the adverse effects of these drugs. He had been taking fluoxetine 20 mg/ day PO for the last 6 months. MDD and GAD symptoms were resolved but he was suffering from erectile dysfunction and diminished libido with fluoxetine treatment. The fluoxetine treatment was ended and a duloxetine 60 mg/day PO regimen started. On the second day of duloxetine treatment, difficulties with ejaculation started and continued after the wash-out period for fluoxetine (4 week). In the 4 week of the duloxetine treatment, sexual side effects of fluoxetine (erectile dysfunction, diminished libido) completely resolved and remission of MDD and GAD continued, although he had diff icult ies ejaculating. Due to his complaints, a urine specimen was collected following masturbation. Using a microscope with 10x magnification, the centrifuged urine sediment was examined for the presence spermatozoa. As spermatozoa were seen in the sediment, the patient was diagnosed with retrograde ejaculation according to the European Association of Urology guidelines on ejaculatory dysfunction. The duloxetine dose was decreased to 30 mg/day for two months, but retrograde ejaculation continued. In the 3 month, duloxetine treatment was stopped and bupropion 150 mg/day PO was started. Further confirming his report of retrograde ejaculation related to the duloxetine medication, the patient reported that he was able to ejaculate normally 2 days after cessation of duloxetine, and a urine specimen collected following masturbation contained no spermatozoa. According to the Naranjo probability scale, the adverse drug reaction was considered definite (Naranjo probability scale score: 10). Our patient reported no sexual side effects with bupropion treatment. If sexual function and fertility have priority for the patient, it may be better to choose antidepressants other than duloxetine. Duloxetine was shown to be safe and effective in the treatment of MDD, and no significant differences with
{"title":"Duloxetine-Induced Retrograde Ejaculation: A Case Report","authors":"M. Bulut, K. Gozukara, M. Kaya","doi":"10.5455/BCP.20130925022238","DOIUrl":"https://doi.org/10.5455/BCP.20130925022238","url":null,"abstract":"Retrograde ejaculation refers to the propulsion of semen back in to the urinary bladder rather than the usual anterograde flow. Antidepressant drugs are frequently associated with sexual dysfunct ion (SD). Duloxet ine, a newer antidepressant agent, has sexual dysfunction as a side effect confirmed by placebo studies. In some cases, other rare sexual side effects such as hypersexuality have been reported during duloxetine treatment. Here, we report an unusual case of retrograde ejaculation after duloxetine treatment for major depressive disorder (MDD) with co-morbid generalized anxiety disorder (GAD). Written informed consent was obtained from the patient before writing this report. AN, a 43-year-old married man who met the DSM-IV criteria for MDD with co-morbid GAD. He had been prescribed several medications for MD GAD for 11 years (paroxetine, mirtazapine, venlafaxine, citalopram, escitalopram, tianeptine, milnacipran, sertraline, trazodone, imipramine, and clomipramine). The medications were discontinued because of the adverse effects of these drugs. He had been taking fluoxetine 20 mg/ day PO for the last 6 months. MDD and GAD symptoms were resolved but he was suffering from erectile dysfunction and diminished libido with fluoxetine treatment. The fluoxetine treatment was ended and a duloxetine 60 mg/day PO regimen started. On the second day of duloxetine treatment, difficulties with ejaculation started and continued after the wash-out period for fluoxetine (4 week). In the 4 week of the duloxetine treatment, sexual side effects of fluoxetine (erectile dysfunction, diminished libido) completely resolved and remission of MDD and GAD continued, although he had diff icult ies ejaculating. Due to his complaints, a urine specimen was collected following masturbation. Using a microscope with 10x magnification, the centrifuged urine sediment was examined for the presence spermatozoa. As spermatozoa were seen in the sediment, the patient was diagnosed with retrograde ejaculation according to the European Association of Urology guidelines on ejaculatory dysfunction. The duloxetine dose was decreased to 30 mg/day for two months, but retrograde ejaculation continued. In the 3 month, duloxetine treatment was stopped and bupropion 150 mg/day PO was started. Further confirming his report of retrograde ejaculation related to the duloxetine medication, the patient reported that he was able to ejaculate normally 2 days after cessation of duloxetine, and a urine specimen collected following masturbation contained no spermatozoa. According to the Naranjo probability scale, the adverse drug reaction was considered definite (Naranjo probability scale score: 10). Our patient reported no sexual side effects with bupropion treatment. If sexual function and fertility have priority for the patient, it may be better to choose antidepressants other than duloxetine. Duloxetine was shown to be safe and effective in the treatment of MDD, and no significant differences with ","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77933541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20151125024949
N. Dilbaz
antipsychotics were first introduced for the treatment of schizophrenia in the 1950s. The introduction of second-generation antipsychotics (SGAs) in the last three decades improved the desired effects of these medications with a reduction of their undesirable effects such as extrapyramidal adverse effects, mortality and metabolic disorder. Medication is generally helpful in treating positive symptoms, but up to a third of people derive little benefit, and negative symptoms are difficult to treat. It has been shown that lack of efficacy and tolerability, often associated with poor compliance, results in treatment discontinuation or treatment switch. Despite critical importance of medication for patients with schizophrenia, nonadherence to treatment is an important issue worldwide. The most prominent patient-related factors associated with nonadherence included lack of insight into the need for medication, denial of illness, embarrassment and unsuitable living conditions. Although antipsychotic medications are necessary, they are not sufficient for the treatment of schizophrenia. The cognitive therapy (cognitive behavioral therapy and cognitive remediation therapy), social skills, psychoeducation programs, family intervention, training programs, and case management or assertive community treatment are the major categories of psychosocial intervention which is an important part of the disease management. The major considerations in disease management treatment include the comprehensive and continuous treatment for prolonged periods, integrated, biopsychosocial approach to care, active collaboration with the family while planning and delivering treatment and treatment sensitive to the patient’s needs and empirically titrated to the patient’s response and progress.
{"title":"New Targets for the Management of Schizophrenia","authors":"N. Dilbaz","doi":"10.5455/BCP.20151125024949","DOIUrl":"https://doi.org/10.5455/BCP.20151125024949","url":null,"abstract":"antipsychotics were first introduced for the treatment of schizophrenia in the 1950s. The introduction of second-generation antipsychotics (SGAs) in the last three decades improved the desired effects of these medications with a reduction of their undesirable effects such as extrapyramidal adverse effects, mortality and metabolic disorder. Medication is generally helpful in treating positive symptoms, but up to a third of people derive little benefit, and negative symptoms are difficult to treat. It has been shown that lack of efficacy and tolerability, often associated with poor compliance, results in treatment discontinuation or treatment switch. Despite critical importance of medication for patients with schizophrenia, nonadherence to treatment is an important issue worldwide. The most prominent patient-related factors associated with nonadherence included lack of insight into the need for medication, denial of illness, embarrassment and unsuitable living conditions. Although antipsychotic medications are necessary, they are not sufficient for the treatment of schizophrenia. The cognitive therapy (cognitive behavioral therapy and cognitive remediation therapy), social skills, psychoeducation programs, family intervention, training programs, and case management or assertive community treatment are the major categories of psychosocial intervention which is an important part of the disease management. The major considerations in disease management treatment include the comprehensive and continuous treatment for prolonged periods, integrated, biopsychosocial approach to care, active collaboration with the family while planning and delivering treatment and treatment sensitive to the patient’s needs and empirically titrated to the patient’s response and progress.","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77972691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.5455/BCP.20140123030857
O. Yanartaş, Hülya Akar Özmen, S. Çitak, S. Zincir, E. A. Sunbul, H. Kara
Objective: Different prevalence rates are reported for dissociative disorders (DD) in different clinical populations (inpatient, outpatient, emergency). It is around 10% among admissions to psychia...
{"title":"Childhood Traumatic Experiences and Trauma Related Psychiatric Comorbidities in Dissociative Disorders","authors":"O. Yanartaş, Hülya Akar Özmen, S. Çitak, S. Zincir, E. A. Sunbul, H. Kara","doi":"10.5455/BCP.20140123030857","DOIUrl":"https://doi.org/10.5455/BCP.20140123030857","url":null,"abstract":"Objective: Different prevalence rates are reported for dissociative disorders (DD) in different clinical populations (inpatient, outpatient, emergency). It is around 10% among admissions to psychia...","PeriodicalId":17852,"journal":{"name":"Klinik Psikofarmakoloji Bulteni-bulletin of Clinical Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76672161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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