Noropsikiyatri Arsivi-Archives of Neuropsychiatry最新文献

Introduction: Porphyrias constitute a collection of hereditary metabolic disorders arising from disturbances in the enzymatic activities inherent to the heme biosynthetic pathway. Eight subtypes of porphyria, each associated with enzymes in the heme biosynthesis pathway, have been identified. Hereditary coproporphyria is one of the porphyria subtypes characterized by neuropsychiatric clinical features. It develops as a result of a deficiency in coproporphyrinogen oxidase enzyme activity. Consequently, an accumulation of coproporphyrin and its precursor metabolites is observed. Hereditary coproporphyria exhibits autosomal dominant inheritance. Following clinical suspicion, a diagnosis is made with biochemical and genetic tests. The presence of nonspecific symptoms and the lack of consideration for porphyria in differential diagnosis complicate the diagnosis.

Case: An 18-year-old male patient was referred to our psychiatry clinic only with psychiatric complaints. The mental status examination revealed affective signs, along with visual hallucinations and delusions. Blood tests and cranial scans at admission showed no abnormalities. After initiating treatment with valproic acid and olanzapine for a presumptive diagnosis of bipolar I disorder, a manic episode with psychotic features, the patient's general medical condition worsened. During clinical observation, the appearance of neurological and gastrointestinal system findings led to a reconsideration of the diagnosis, and porphyria was considered. Urine tests revealed elevated levels of porphyrin intermediates. The diagnosis of hereditary coproporphyria was confirmed by genetic testing, which identified the c.734 C>T mutation in the coproporphyrinogen oxidase gene. Symptomatic relief was observed following a carbohydrate-rich diet without the need for psychotropic treatment.

Conclusion: Although their subtypes exhibit distinct clinical features, porphyrias typically present with involvement of multiple systems. Cases that initially present with symptoms specific to a single system can pose diagnostic challenges. In our case report, we aimed to present the psychiatric onset of hereditary coproporphyria, a rare subtype of porphyria known for its potentially fatal attacks when untreated.

Introduction: Environmental and genetic factors, relationships and experiences established in the early years of life are involved in the etiology of bipolar affective disorder (BAD). The aim was to determine the frequency of childhood traumas, attachment styles, alexithymia and dissociative symptoms in BAD patients, to compare them with the healthy population, and to examine the direct and indirect relationships of childhood traumas with BAD.

Methods: The study included 100 patients diagnosed with BAD according to DSM-IV TR diagnostic criteria and who had been euthymic for the last 2 months, and 100 healthy individuals matched for age and gender. The participants were administered the Sociodemographic Data Form, Childhood Trauma Questionnaire, Dissociative Experiences Scale, Toronto Alexithymia Scale, Experiences in Close Relationships Inventory-II, Hamilton Depression Scale and Young Mania Scale.

Results: In the BAD group, childhood traumas, insecure attachment types, dissociative symptoms and alexithymia were found to be significantly higher than in healthy individuals. A positive relationship was found between physical abuse, dissociation and alexithymia levels and the number of attacks. Being physically abused was associated with earlier onset of the disease. A positive relationship was found between emotional abuse, physical neglect and total trauma score and dissociation. Trauma types other than sexual abuse were found to be associated with difficulty in recognizing and expressing emotions. It has been found that there is a relationship between emotional abuse and avoidant attachment dimensions. Alexithymia levels were found to be high in patients with early-onset BAD. It has been found that having a family history of psychopathology increases the risk of developing BAD, while externally oriented thinking and marital status protect against the disease.

Conclusions: There is a relationship between childhood traumas, attachment types, dissociative and alexithymic characteristics in BAD. Our study reveals that emotional and physical abuse in childhood affects the development of BAD and the course of the disease, and the importance of holistic evaluation of the individual in terms of clinical course and treatment process.

Introduction: Oxytocin (OXT) is thought to play a role in processes such as social bonding, empathy, and emotional regulation, as well as in the pathophysiology of repetitive/grooming behaviors. The aim of this study is to compare plasma OXT levels in individuals with body-focused repetitive behavior disorder (BFRBD) to those in a healthy control group, and to examine the relationship of OXT with disease severity, emotional regulation, and attachment styles.

Methods: This study included 35 patients aged 18-45 diagnosed with BFRBD who visited the psychiatry outpatient clinic, and 35 healthy controls with matched age, gender, and partner-status. Participants were assessed using the Beck depression inventory (BDI), difficulties in emotion regulation scale (DERS-16), experiences in close relationships inventory-II (ECR-II), and Hendrick relationship satisfaction scale (HRSS), and plasma OXT levels were measured.

Results: Oxytocin levels in patients with BFRBD were found to be significantly lower than in healthy controls (p<0.001). Patients had higher scores for insecure attachment and difficulties in emotional regulation (p<0.01). Additionally, a negative correlation was observed between the severity of skin-picking behavior and OXT levels (p=0.033).

Conclusion: The insufficiency of OXT levels in BFRBD patients and its association with disease severity suggest that OXT may play a role in the psychopathology of BFRBD. Further research is needed to explore the role of OXT and its therapeutic potential in this disorder.

Introduction: Suicide is a serious public health problem worldwide, with most suicides occurring in low- and middle-income countries. This nationwide ecological study aimed to explore the relationship between crude suicide rates of the sexes and gender inequality.

Method: The data on age and gender-stratified crude suicide rates in all 81 provinces of Türkiye were retracted from the Turkish Statistical Institute database. Gender inequality was measured using Türkiye's provincial-level Gender Equality Index (GEI). Additionally, the following variables were considered gender inequality indicators: early marriages, fertility rate, and marriage/divorce rates; data were obtained from the Turkish Statistical Institute database. Data from 2019 were used to avoid the confounding effect of the COVID-19 pandemic.

Results: The associations between gender inequality and crude suicide rate differed between women and men. There was a positive correlation between crude suicide rate and GEI in men aged 45-64 (r=0.294 p<0.01), but no correlations were found in other groups of age and gender. Early marriage rates (r=0.341 p<0.01) and fertility rate (r=0.333 p<0.01) were positively associated with crude suicide rates in women aged 15-44, while divorce/marriage rate (r=-0.256 p<0.05) was negatively related to these rates. Divorce/marriage rate was associated with an increase in men's suicides in both the 45-64 (r=0.452 p<0.01) and 65 and over (r=0.290 p<0.01) age groups.

Conclusion: Gender inequality indicators were related to suicide. That relationship may vary across different age and gender groups. The findings may be limited to low- and middle-income countries. Suicide prevention interventions should be designed to account for age group, gender, and cultural characteristics of the place of residence concerning gender.

Introduction: Late-onset depression (LOD) has been implicated in irreversible cognitive decline, potentially mirroring early Alzheimer's Disease (AD) pathology. This study aimed to investigate brain activity differences during an episodic memory (EM) task in LOD patients compared to healthy controls (HC).

Methods: We recruited 15 LOD patients and 13 HC matched for age and gender. Participants completed a face-name association task during functional magnetic resonance imaging (fMRI) focusing on both the encoding and retrieval phases of EM.

Results: The statistical contrast between the groups revealed that the HC group showed increased activity in the left visual association cortex (VAC) and left caudate compared to the LOD group during the encoding task. During the face recognition task, the HC group showed increased activity in the right caudate, and during the name recognition task, they showed increased activity in the right frontal eye field (FEF) compared to the LOD group.

Conclusion: The differences observed between the HC and LOD groups in the VAC, caudate, and FEF suggest early changes in maintaining attention, goal-directed learning, EM formation, and coordination of information from storage to retrieval before apparent impairment develops in LOD. Although we did not find statistically significant activations in areas linked to increased vulnerability to AD, our findings of hypoactivation in regions responsible for visual processing and attentional orienting in LOD patients are consistent with hypoactivation patterns observed in AD patients in previous research. These results enhance our understanding of the neural mechanisms underlying memory impairments in LOD and their potential overlap with AD pathology.

Introduction: Alterations in cerebral blood flow (CBF) in subjects with psychosis spectrum disorders (PSD) and clinical high-risk (CHR) states may provide insights into the pathophysiology of these disorders. Arterial spin labeling (ASL) facilitated a more comprehensive examination of CBF in these subjects. This meta-analysis synthesizes findings on CBF in PSDs and CHR states, addressing literature gaps.

Methods: A systematic literature search of the PubMed database was performed using a protocol based on the PRISMA statement and the recommendations of the MOOSE group. Studies eligible for inclusion in the review involved: I) individuals with PSD, first-episode psychosis or CHR state, II) had healthy controls for comparison, III) neuroimaging should be performed with MRI using the pseudo-continuous ASL method, IV) resting cerebral blood flow (rCBF) should be recorded. Information related to participants, CBF analyses, and results were systematically extracted.

Results: The PubMed search for the meta-analysis identified 69 publications, including 24 articles that met the inclusion criteria for the meta-analysis, representing 491 SSD patients, 185 CHR states, and 554 controls. Studies included rCBFs for the whole brain, gray matter, and striatum. The meta-analysis results indicated that patients with PSD had decreased gray matter rCBF compared to controls (Hedge's g=0.33, 95% CI [0.08, 0.57]), but no difference in the whole brain (Hedge's g=0.09, 95% CI [-0.70, 0.88] and striatum rCBF (Hedge's g=0.38, 95% CI [-0.23, 1.00]). Additionally, subjects with CHR state showed no differences in the striatum rCBF compared to the controls (Hedge's g=-0.15, 95% CI [-0.80, 0.51]).

Conclusions: This suggests that although perfusion changes in gray matter are present in PSD, they may not extend to wider brain regions or specific structures such as the striatum. Furthermore, the results imply that rCBF may be differentially regulated in subjects with PSD and CHR. Updated findings highlight hemodynamic correlations in PSD pathophysiology.

Introduction: Only limited information is still available concerning cognitive dysfunctions and cortical thickness in individuals who recovered from mild COVID-19 infections and did not require hospitalization. Our aim was to evaluate if the highly adaptive potential of cortical thickness might play a critical role in COVID-19-related cognitive disorder in a compensatory manner.

Methods: Fifteen individuals with no history of medical, neurological, or psychiatric disease and with positive COVID-19 test results, and sixteen healthy age and education-matched healthy controls identified from the official hospital health system were evaluated in terms of cognitive scores using Alzheimer Disease's Assessment Scale-cognitive subscale (ADAS-Cog) and brain MRI cortical thickness measurements using FreeSurfer, Version 7.4.0.

Results: An increased cortical thickness in the right entorhinal cortex (EC) and impaired cognition (increased ADAS score) were observed in the post-COVID 19 group as compared to the controls confirmed by the student's t test (respectively, p=0.006, p<0.001).The apparent correlation observed between cognitive impairment and increased entorhinal cortical thickness in our COVID-19 patients might suggest a continuum pathophysiology between healthy and COVID-19 affected brains that was not evident in previous COVID-19 cases with cognitive impairment.

Conclusion: Our findings of increased entorhinal cortical thickness, together with impaired cognitive scores, may indicate a flexible role of EC thickness in compensatory mechanisms of cognition.

Introduction: Electroconvulsive therapy (ECT) is an important treatment modality in psychiatry. Despite the efficacy of ECT, its use worldwide is less than expected. Although limited access and stigma are the main factors contributing to this controversy, cognitive side effects are an important issue for clinicians who administer ECT. The present study aims to provide an assessment of the frequency of neuropsychiatric adverse effects associated with ECT.

Methods: A retrospective evaluation of 2935 files of patients who underwent ECT between January 1, 2013 and December 31, 2017 was performed. Specific data obtained from patient records, such as sociodemographic characteristics, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses, scale scores, medical evaluations, length of hospital stay, previous ECT history and indications for ECT administration, stimulus parameters, seizure duration, and neuropsychiatric adverse effects were evaluated.

Results: A significant proportion of patients experienced no neuropsychiatric adverse effects across multiple sessions, with the proportion increasing steadily from 70.7% after one session to 97.3% after ten sessions. Additionally, the group that showed neuropsychiatric adverse effects underwent a significantly higher number of previous ECT sessions (p<0.001), longer duration of hospitalization after the last ECT session (p<0.001), and overall duration of hospitalization (p<0.001).

Conclusion: The fact that the majority of patients in this study did not experience any neuropsychiatric adverse effects during more than one ECT session and that the frequency of adverse effects decreased as ECT sessions progressed may contribute clinicians to approach ECT application more confidently.

Introduction: Visual hallucinations are one of the common non-motor symptoms of Parkinson's disease. Although various theories have been proposed, the pathological mechanism is not fully understood. This study aimed to investigate spontaneous brain activity in hallucinated and non-hallucinated patients with Parkinson's disease (PD) by using EEG and also its relevance to the behavioral and neuropsychological status of patients.

Methods: A total of 30 people were included in the study: 10 hallucinated PD patients, 10 non-hallucinated PD patients, and 10 healthy controls. Spontaneous EEG data were recorded in eyes-open and eyes-closed conditions. A neuropsychological battery was used to evaluate visual and verbal memory, visuo-spatial abilities, executive functions, and behavioral/emotional status of participants.

Results: The hallucinated group did not show an increase in alpha power activity in response to eye closure, although healthy controls showed a significant increase in alpha power in eyes closed condition. Parkinson's disease patients with hallucinations showed significantly higher intra-hemispheric beta and gamma coherence and the non-hallucinated group demonstrated significantly lower inter-hemispheric alpha coherence. Additionally, Hallucinated PD patients showed higher NPI (Neuropsychiatric Inventory) scores and RBD-SQ (REM Behavior Disorder Screening Questionnaire) scores, lower motor scores (Unified Parkinson's Disease Rating Scale - UPDRS), and a higher number of Stroop Test errors compared to non-hallucinated PD patients.

Conclusion: Increased abnormal resting-state EEG activity and a tendency towards greater impairment of executive functions were seen in hallucinated PD patients. These results can be interpreted as an abnormal resting activity in cortical networks that may underlie their visual hallucinations symptoms.