Noropsikiyatri Arsivi-Archives of Neuropsychiatry最新文献

Introduction: Hyposchematia is a rare disorder characterized by the underestimation of the size of a part of the body. To date, isolated facial hyposchematia has not been described. The pathophysiology of this syndrome remains poorly understood.

Methods: We investigated body schema disturbances and neuroimaging features of 2400 ischemic stroke patients.

Results: We found three patients who felt that the left side of their face was disproportionately smaller than the right side. There were no directly observable objective findings in the affected patients. In drawing tasks, the left side of the face in all patients was depicted as more compressed than the right side. In all three patients, the facial hyposchematia was attributed to lesions affecting frontal-insular circuits involved in the upper part of extrapersonal space and self-related systems.

Conclusion: These cases demonstrate that distortions and underestimation of extra-personal and personal spaces can affect specific body parts, such as the face, in isolation.

Introduction: Combined central and peripheral demyelination (CCPD) is a rare and heterogeneous condition, often associated with a poor prognosis. Contrary to the popular reports, we present a case of CCPD with a favorable prognosis and a 10-year follow-up.

Case: A 29-year-old female patient presented with progressive limb weakness following a Brucella infection. She was subsequently diagnosed with motor type chronic inflammatory demyelinating polyneuropathy (CIDP), which was characterized by motor conduction blocks and demyelinating motor conduction abnormalities in a nerve conduction study (NCS). In the following years, the patient was diagnosed with CCPD with relapse and remissions, with or without CIDP attacks and multiple cranial neuropathy, cervical myelitis, and optic neuritis attacks. Despite exhibiting motor CIDP, she did not respond to intravenous immunoglobulin (IVIg) therapy, and all her episodes were removed with intravenous methylprednisolone (IVMP).

Conclusion: Our case has been in remission with azathioprine therapy for the last three years and is notable for its prolonged course, good prognosis, and potential association with Brucella infection.

Introduction: Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. Priapism can be caused either by organic factors or as a side effect of drugs. Mood stabilizer induced priapism has been reported less frequently compared to other psychotropic agents. This paper reports a case of lamotrigine induced priapism.

Case: A 24-year-old patient had a diagnosis of bipolar disorder for 4 years. He had been treated with lamotrigine (200 mg/day), sertraline (25 mg/day) and risperidone (2 mg/day) for last year. He developed priapism one week after the lamotrigine dose was increased to 300 mg/day during a depressive episode. Priapism improved the day after the lamotrigine dose was reduced to 250 mg/day.

Conclusion: Epilepsy patients with lamotrigine-induced sexual dysfunction or priapism have been reported previously. In this case, a patient diagnosed with bipolar disorder developed dose dependent lamotrigine-induced priapism. In clinical practice, the possible risk of priapism should be taken into consideration in patients using lamotrigine, especially during dose increases.

Introduction: Numerous hypotheses have been proposed for the pathophysiology of bipolar disorder (BD). This study aimed to evaluate serum neuroserpin (NSP), tissue plasminogen activator (tPA), interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hsCRP), and sedimentation levels in patients with BD, based on the inflammatory and fibrinolytic system hypothesis, to understand the etiopathogenesis of BD. The second aim of our study was to determine the risk of developing BD type 1 by examining the relationship between tPA and NSP in patients diagnosed with BD type 1.

Methods: The study included 80 euthymic outpatients with BD type 1 and 80 healthy controls (HC). Individuals with a Hamilton Depression Rating Scale (HAM-D) score of less than 7 and a Young Mania Rating Scale (YMRS) score of less than 4 who did not show any symptoms of mania, depression, or hypomania for the last 6 months were included in the study. In both groups, serum levels of NSP, tPA, IL-6, BDNF, hsCRP, and sedimentation were measured.

Results: Compared to the healthy control group, the NSP and tPA levels were lower in the BD group (p<0.001). We found no linear relationship when we analyzed the relationship between tPA and NSP by excluding other variables. (p: 0.027).

Conclusion: These findings suggest that tPA and NSP may serve as potential biomarkers for the euthymic period of BD type 1. These biomarkers may provide guidance in understanding the pathophysiology of bipolar disorder.

Introduction: A-waves are late responses following the motor response during motor nerve conduction studies (NCSs) observed in healthy people and patients with neurological disorders. The aim was to define the prevalence and clinical associations of A-waves in a cohort referred to the electrophysiology laboratory for routine NCSs.

Methods: This is a retrospective study. We analyzed the medical and electrophysiological data of 456 patients admitted to our neurophysiology laboratory between January 2022 and December 2022, evaluated by a single examiner (A.G.), and had F-wave studies.

Results: We included 1197 nerves from 404 patients in this cohort. The most common diagnosis was entrapment neuropathy, followed by polyneuropathy, radiculopathy, motor neuron disease, myopathy, and other diagnoses. Twenty-five patients had multiple conditions, and 185 patients had no abnormal NCSs. The A-waves were seen in 42.2% of individuals with otherwise normal NCSs. The A-waves were most commonly found in patients with polyneuropathies, followed by motor neuron disorders, radiculopathy, and myopathy. However, the majority of polyneuropathy patients had multiple A-waves. A-waves were detected in 78 of 185 normal NCSs; 7 % had multiple A-waves. Multiple and single A-waves were more commonly recorded in the tibial nerves. The A-waves were more frequently observed in older subjects.

Conclusions: Other than multiple A-waves, A-waves were commonly seen in subjects with normal NCSs. As far as we know, this is the first study reporting the presence of A-waves in myopathy and neuromuscular junction disorders. Still, this finding should be interpreted cautiously given the limited clinical data available.

Introduction: Given the critical significance of cognitive functions in daily life and social interactions, the Screen for Cognitive Impairment in Psychiatry (SCIP) scale is particularly important in clinical practice. It can be administered quickly and offers alternative forms, avoiding issues with lengthy administration or a lack of parallel forms. This study examined the psychometric properties of the Turkish version of the SCIP scale (SCIP-TR), which enables rapid and practical assessment of cognitive impairment in psychiatric settings.

Methods: This study involved 137 healthy students and hospital staff aged 18-45. Three alternative forms of the SCIP scale were adapted into Turkish using direct and reverse translation methods, and experts approved them to ensure content validity. Participants were administered one of the three alternative forms of the SCIP-TR and the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), the Standardized Mini-Mental State Examination (SMMSE), and the Cognitive Failures Questionnaire (CFQ) scales. Test-retest reliability was evaluated using different forms of the SCIP-TR at 2-7 day intervals. The feasibility, reliability, and validity of the SCIP-TR forms were examined.

Results: The analysis showed no significant differences between the three forms in total scores. Cronbach's alpha (0.715-0.750) and omega coefficients (0.709-0.784) demonstrated that the scale had acceptable internal consistency. Correlation coefficients confirmed the scale's test-retest reliability. The exploratory factor analysis unveiled a single-factor structure that accounted for 50.2% of the total variance. The moderate correlation of SCIP-TR with B-CATS, which measures similar cognitive domains, supports convergent validity.

Conclusions: Findings demonstrate the validity and reliability of the Turkish version of the SCIP as a simple and practical tool for screening cognitive impairment in the general population. Its simplicity, brevity, and lack of need for a technological platform make it suitable for integration into clinical practice. Further research on SCIP-TR is needed in a more diverse demographic, including those with mental health disorders.

Introduction: It is suggested that Helicobacter pylori (Hp) can reach the brain via the oral-nasal-olfactory route, through Hp-infected monocytes in the disrupted blood-brain barrier (BBB), or through a rapid retrograde neural network leading to neurodegeneration from the gastrointestinal tract (GIS) and may lead to neurodegenerative diseases such as Alzheimer's (AD), Parkinson's (PD) and Multiple sclerosis (MS). In this study, we aimed to evaluate the possible immunopathogenesis relationship between Hp-specific antigens and neurodegenerative diseases by determining the frequency of seropositivity against different specific antigens of Hp in diseases such as AD, PD and MS.

Methods: In our cross-sectional, retrospective case-control study, the immunoreactivity frequencies of Hp-specific and non-specific CagA (p120), VacA (p95), p75, FSH (p67), UreB (p66), HSP homolog (p57), flagellin (p54), p50, p41, p33, OMP (p30), UreA (p29), p26, OMP (p19), p17 antigens were determined by Western Blot method in 36 AD, 35 PD, 91 MS cases with Hp-IgG reactivity, and 55 controls without a neurodegenerative/demyelinating by ELISA method.

Results: No significant difference was found between the immunoreactivity frequencies of Hp antigens between AD and control groups (p>0.05). In the multivariate logistic analysis performed for PD cases, age ≥ 50 and immunoreactivity frequency of p19 were found to be independent risk factors (OR: 36.752, p<0.05) (OR: 5.570, p<0.05). In MS cases, immunoreactivity frequency of p17 antigen was found to be a risk factor (OR: 2.646, p<0.05). In addition, the mean level of Hp-IgG reactivity was found to be negatively associated with MS development (indicating an inverse correlation) in the control group compared to the MS group (OR: 0.585, p < 0.05). Furthermore, logistic regression analysis in the total study group revealed that the immunoreactivity frequency of the p17 antigen was identified as a risk factor for MS (OR: 2.438, p<0.05).

Conclusion: Our data on AD cases are insufficient. In PD cases, the significantly higher frequency of immunoreactivity to the Hp-p19 antigen in individuals aged ≥50 years (OR=5.570) is noteworthy. In the MS group, the significantly high detection of Hp p17 antigen and its presence as a risk factor (OR=2.646), and the significantly high detection of p26 antigen suggest the relationship between these antigens and the MS development process. However, it is a fact that new and many prospective cohort-based case-control studies are needed to reveal this more clearly.

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.