Download HALL A

Turkish Association for Psychopharmacology (TAP)
th
5International Congress on
Psychopharmacology
&
International Symposium on
Child and Adolescent Psychopharmacology
Improved choices of psychotropic medications:
better mental health outcomes
October 30 - November 3, 2013
Cornelia Diamond Hotel, Antalya, Turkey
PROGRAM
www.psychopharmacology2013.org
COMMITTEES
PRESIDENT
Mesut Çetin (Turkey)
CHAIRS
Alican Dalkılıç (USA)
Oğuz Karamustafalıoğlu (Turkey)
Co-CHAIRS for Psychopharmacology
Feyza Arıcıoğlu (Turkey)
Nazan Aydın (Turkey)
Cengiz Başoğlu (Turkey)
Serhat Çıtak (Turkey)
Serdar Dursun (Canada)
Haluk A. Savaş (Turkey)
Co-CHAIRS for Child and Adolescent Psychopharmacology
Mücahit Öztürk(Turkey)
Bengi Semerci(Turkey)
Tümer Türkbay(Turkey)
Secretariat
Gökay Alpak (Turkey)
Treasurer
Yasin Bez (Turkey)
PROGRAM COMMITTEE
Coordinators
Erhan Kurt (Turkey)
Alpay Ateş (Turkey)
Scientific Program Comittee
C. Açıkel (Turkey)
R. Aşkın (Turkey)
A. Ayer (Turkey)
H. Balıbey (Turkey)
H. Ensari (Turkey)
A. Erol (Turkey)
E. C. Evren (Turkey)
A. S. Gönül (Turkey)
H. Herken (Turkey)
İ. Kırpınar (Turkey)
S. Köse (USA)
D. Ongur (USA)
Ü. B. Semiz (Turkey)
T. Tellioğlu (USA)
Ö. Uzun (Turkey)
S. Kırlı (Turkey)
A. Algül (Turkey)
M. Atmaca (Turkey)
G. Baker (Canada)
R.S. Diler (USA)
İ. Eren (Turkey)
H. M. Emül (Turkey)
Ö. Geçici (Turkey)
H. Günay (Turkey)
S. Kılıç (Turkey)
N. Konuk (Turkey)
M. Nebioğlu (Turkey)
D. Osser (USA)
A. Sır (Turkey)
M. H. Türkçapar (Turkey)
İ. Yargıç (Turkey)
A. Yıldız (Turkey)
S. B. Zincir (Turkey)
Ü. Yaşar (Turkey)
M. Yıldız (Turkey) INTERNATIONAL SCIENTIFIC
COMMITTEE
Chairs
I. Ak (Turkey)
G. Baker (Canada)
P. Morozov (Russia)
R. S. Diler (USA)
Members
E. Abay (Turkey)
M. Y. Ağargün (Turkey)
F. Akdeniz (Turkey)
C. Akkaya (Turkey)
A. Algül (Turkey)
T. Alkın (Turkey)
P. Aloupis (France)
K. Alptekin (Turkey)
V. Altınyazar (Turkey)
I. Anderson (UK)
B.B. Annagür (H A.M.S.Al Ansari (Bahrain)
M. Arı (Turkey)
Z. Arıkan (Turkey)
K. Arun (India)
N. Atasoy (Turkey)
A. Ateş (Turkey)
A. Axel Würz (UK)
Ç. Aydemir (Turkey)
C. Aydın (Turkey)
N. Aydın (Turkey)
A. Aydın (Turkey)
A. Ayer (Turkey)
I. H. Ayhan (Turkey)
B. Bahçeci (Turkey)
J. Bailey (UK)
G. Baker (Canada)
İ. Balcıoğlu (Turkey)
D. Baldwin (UK)
E. Bayraktar (Turkey)
L. Beşiroğlu (Turkey)
Y. Bez (Turkey)
M. Bilici (Turkey)
Ö. Böke (Turkey)
M. Bourin (France)
C. Bowden (USA)
S. V. Buturak (Turkey)
M. Çalışkan (Turkey)
O. Çalıyurt (Turkey)
F. Canan (Turkey)
I. Cascorbi ( Germany)
M. Çetingüç (Turkey)
A. Çevik (Turkey)
M. E. Ceylan (Turkey)
A. Ş. Çilli (Turkey)
C. R. Cloninger (USA)
J. Cookson (UK)
B. Coşar (Turkey)
P. Cowen (UK)
T. Crow (UK)
E. Dalbudak (Turkey)
A. Dalkılıç (Turkey)
B. Deakin(UK)
M. Delbello (USA)
M. Demet (Turkey)
N. Dilbaz (Turkey)
R. S. Diler (USA)
A. Doruk (Turkey)
S. Dursun (Canada)
S. Ebrinc (Turkey)
I.E. Eker (Turkey)
M. Erdem (Turkey)
E. Eşel (Turkey)
P. Falkai (Germany)
M. Fink (USA)
N. Glangeaud (France)
E. Göka (Turkey)
P. Gökalp (Turkey)
B. Gökler (Turkey)
G. Goodwin (UK)
D. Greenberg (Israel)
M. Y. Güleç (Turkey)
H. Güleç (Turkey)
Ö. Güler (Turkey)
A. Gürdal-Küey (Turkey)
M. H. Habil (Malaysia)
A. Halaris (USA)
J. Harro (Estonia)
Ç. Hocaoğlu (Turkey)
S. Hofmann (Canada)
J. Horáček (Czech Republic)
L. Hosak (Czech Republic)
C. Höschl (Czech Republic)
A. L. Hudson (Canada)
R. S. Kahn (The Netherlands)
H. Kandemir (Turkey)
F. Karaaslan (Turkey)
F. Karadağ (Turkey)
N. Karamustafalıoğlu (Turkey)
N. Kaya (Turkey)
C. Kaya (Turkey)
N. Kazantzis (Australia)
I. Kirsch (USA)
E. Kılıç (Turkey)
E. E. Kılıçaslan (Turkey)
S. Kırlı (Turkey)
N. Kocabaşoğlu (Turkey) E. Koçer (Turkey)
R. Konkan (Turkey)
K. Kora (Turkey)
A. Korkmaz (Turkey)
J. Krystal (USA)
L. Küey (Turkey)
I. B. Kulaksızoğlu (Turkey)
M. Kuloğlu (Turkey)
C. Kuruoğlu (Turkey)
S. Kutcher (Canada)
P. R. Martin (USA)
H. Meltzer (USA)
L. Mete (Turkey)
H. Mırsal (Turkey)
P. Morozov (Russia)
N. M. Mukaddes (Turkey)
N. Muller (Germany)
R. Murray (UK)
D. H. Myrick (USA)
Z. Nahas (USA)
M. Nebioğlu (Turkey)
J. Nielsen (Denmark)
A. Nierenberg (USA)
D. Nutt (UK)
S. Olgaç (Turkey)
Ö. Öner (Turkey)
P. Öner (Turkey)
Ö. Orhan (Turkey)
D. Osser (USA)
E. Ozan (Turkey)
H. Özbek (Turkey)
Ö. Özbulut (Turkey)
B. Özçelik (Turkey)
A. Özçetin (Turkey)
B. Özdemir (Turkey)
Ş. Özen (Turkey)
A. Özerdem (Turkey)
E. Özkorumak (Turkey)
N. Özmenler (Turkey)
T. Palenicek (Czech Republic)
G. I. Papakostas (Greece)
T. J. Paparrigopoulos (Greece)
A. Papavasiliou J. Peuskens (France)
J. A. Quiroz (USA)
R. A. Rashid (Malaysia)
S. Regunathan (USA)
H. Robertson (Canada)
G. Sachs (USA)
A. R. Şahin (Turkey)
A. Samancı (Turkey)
A. Sarandöl (Turkey)
H. Savaş (Turkey)
B. Saydam (Turkey)
S. Selek (Turkey)
Y. Selvi (Turkey)
Ü. B. Semiz (Turkey)
C. Şengül (Turkey)
Ö. Şenormancı (Turkey)
L. Sevinçok (Turkey)
U. A. Silim (Malaysia)
Y. Sivrioğlu (Turkey)
S. Sofuoğlu (Turkey)
C. Soldatos (Greece)
S. Sukiasyan (Armenia)
A. S. Sundar (India)
M. Z. Sungur (Turkey)
R. Tandon (USA)
M. Thirunavukarasu (India)
I. Tuğlular (Turkey)
Ö. Tuncer (Turkey)
T. Turan (Turkey)
T. Türkbay (Turkey)
H. Türkçapar (Turkey)
H. Tutkun (Turkey)
M. Uğur (Turkey)
Ş. Uğuz (Turkey)
F. Uğuz (Turkey)
B. Uluğ (Turkey)
A. Uluşahin (Turkey)
D. Umbricht (Switzerland)
S. Ünal (Turkey)
A. Ünal (Turkey)
C. Ünsal (Turkey)
J. Van Os (The Netherlands)
O. Vırıt (Turkey)
H. P. Volz (Germany)
İ. Yargıç (Turkey)
K. Yazıcı (Turkey)
B. Yeong (Singapore)
S. Yetkin (Turkey)
M. Yüce (Turkey)
N. Yüksel (Turkey)
H. Zakaria (Malaysia)
S. B. Zincir (Turkey)
J. Zohar (Israel)
ABBREVIATIONS
S
Symposium
JS
Joint Symposium
C
Course
KA
Keynote Address
ISS
Industry Supported
Symposium
RT
Round Table
PL
Plenary Lecture
PROGRAM AT A GLANCE
October 30, 2013
Registration
08:30-12:30
HALL A
C-1
Psychoeducation in Bipolar Disorders
14:30-15:00
HALL A
OPENING
15:00-16:00
HALL A
KEYNOTE ADDRESS:
DSM-5, How do the Changes Affect Decision-Making in Psychopharmacology?
16:00-16:30
16:30-18:30
Registration
08:30-22:00
COFFEE BREAK
HALL A
JS-1:
ICP-TAP
New Perspectives in Perinatal Psychiatry
From Depression to Dependency: Current
Problems in Psychiatry
COFFEE BREAK
18:30-19:00
19:00-21:00
HALL B
S-1
Current Data Towards Developmental
Defects
HALL C
JS-2:
TAP - Bosnia Herzegovina
HALL A
S-2
Insidious Threat: New
Generation Addictive
Substances
HALL B
S-3
Selection and Evaluation
of Treatment in Child
and Adolescent
Psychopharmacology
C-2
EMDR
C-3
Beyond Talk, into Action:
Working with Users’
Associations in Perinatal
Psychiatry
PROGRAM AT A GLANCE
October 31, 2013
07:30-09:00
C-4
Bipolar Disorders in Children and
Adolescents and Management of
their Comorbidities
C-5
DSM 5: Orientation and Training
HALL A
PLENARY LECTURE:
Symptoms or Poor Coping Strategies? Clarifying
09:00-10:30
the Confusion with Success Strategies for
Late-Diagnosis Adults with ADHD and Their
Loved Ones
HALL B
S-4
Psychopharmacological Treatment Difficulties
and Coping Methods in Children and
Adolescents - I
10:30-11:00
HALL C
JS-3:
TAP - Russian Scientific Society of
Pharmacologists
Neuroprotection: Myth or Fact?
HALL A
ISS - 1
12:00-13:00
LUNCH
HALL A
JS-4:
TAP - Czech Neuropsychopharmacological
Society
Actual Issues in Schizophrenia Treatment
HALL B
S-5
Psychopharmacological Treatment Difficulties
and Coping Methods in Children and
Adolescents-II
14:30-15:00
HALL C
JS-5:
TAP - ISNP
Treatment of Bipolar Disorder: From Molecular
Hypotheses to Clinical Reality
COFFEE BREAK
HALL A
15:00-16:00
ISS-2
16:00-16:30
COFFEE BREAK
16:00
Social Program:Painting Exhibition Opening
Entrance of Hotel
16:30-18:30
C-7
Experimental Animal Models of
Schizophrenia
COFFEE BREAK
11:00-12:00
13:00-14:30
C-6
Mastery in Pharmacotherapy Plus
Psychotherapy Combinations
HALL A
S-6
Eating Disorders: From Nosology to
Treatment - An Update
HALL B
JS-6:
TAP - Marce Society
Impact of Maternal Treatments on the Infant
During the Perinatal Period
18:30-19:00
HALL A
S-7
HALL B
Antipsychotics Based Weight
S-8
Gain due to Hypothalamic
19:00-20:30
Treatment and Therapeutic
Regulation of Eating Disorder,
Applications in Patients with
the Main Factor? METU-GATA
Schizophrenia
Sharing the Results of Project
Work
HALL C
JS-7:
Psychiatry and Psychopharmacotherapy in
Post Soviet Space: The Bridge Between Europe
and Asia
COFFEE BREA
C-8
Suicidality in Youth:
Risk Factors, Screening,
Assessment, and
Intervention
C-10
Rehabilitation in Severe
C-9
Fundamentals of Child and Mental Illnesses and Its Role
in Operation of Community
Adolescent
Mental Health Centers
Psychopharmacology-I
PROGRAM AT A GLANCE
November 1, 2013
C-11
C-12
Voluntary and Involuntary
Pharmacologic Treatment
of Autistic Spectrum
07:30-09:00 Admissions in Substance
Use Disorders. What Would Disorder from Childhood to
Adulthood
You Do?
HALL A
JS-8:
TAP - WPA
09:00-10:30
Immunology and Psychiatry: From Research
to Routine
C-13
The Scales and Tests Used
in ADHD
C-14
Acceptance and
Commitment Therapy
HALL B
S-9
Strategies to Manage Challenges in
Psychopharmacological Treatments in Children
and Adolescents-III
10:30-11:00
C-15
OCD: From Diagnosis to
Treatment
HALL C
JS-9:
TAP - ISNP
Schizophrenia: Focus on Special Aspects
COFFEE BREAK
HALL A
11:00-12:00
ISS-3
12:00-13:00
LUNCH
HALL A
JS-10:
TAP - IUPHAR
13:00-15:00
Individualized Psychopharmacology
Use of Molecular Biomarkers for Prediction of
Treatment Response
HALL B
S-10
Current Data and Approaches Related to
Attention Deficit Hyperactivity Disorder
15:00-15:30
HALL C
S-11
Does Current Biological Data Valid in
Psychiatric Classifications?
COFFEE BREAK
HALL A
15:30-16:30
ISS- 4
16:30-17:00
COFFEE BREAK
17:00-19:00
HALL A
RT
Psychopharmacology, Quo Vadis?
HALL A
HALL B
S-12
S-13
19:00-20:30
From Perspective of Impulse
Psychiatric Problems
Control Disorders
Encountered in Daily Practice
HALL C
JS-11:
TAP - Indian Psychiatric
Society
Bipolar Disorder: Treatment
Towards Symptom Recovery
vs Functional Recovery
C16
Fundamentals of
Child and Adolescent
Psychopharmacology-II
C-17
Cognitive Behavioral
Therapy in OCD
Resistance to Treatment
and Management in OCD
PROGRAM AT A GLANCE
November 2, 2013
07:30-09:00
09:00-10:30
C-18
Minnesota Model for
Addiction Treatment
C-21
C-20
From Childhood to
Psychiatric Semiology Course Adulthood Management of
Treatment-Resistant ADHD
C-19
How to Write Scientific
Articles?
HALL A
S-14
Unmet Needs in Psychopharmacology
HALL B
S-15
Tailored Treatments in Psychiatry and Methods
Used in Laboratories
09:00-11:00
HALL C-1
ORAL ABSTRACT PRESENTATION-1
10:30-11:00
COFFEE BREAK
11:00-12:00
HALL A
ISS - 5
12:00-13:00
LUNCH
13:00-14:30
HALL A
JS-12:
TAP - CCNP
HALL B
JS-13:
TAP - BAP
Potential New Biomarkers and Drug Targets in
Depression and Schizophrenia
From Pathophysiology to Treatment: Treatment
Refractory Depression (TRD)
HALL A
14:30-15:30
15:30-16:00
16:00-17:30
C-22
Psychiatric Emergencies,
Violence, and Violence
Approach
HALL C
S-16
Evidence-Based Therapies in Psychiatry
HALL C
S-17
Sleep and Psychiatric Disorders
ISS - 6
COFFEE BREAK
HALL A
JS-14:
TAP - Orthopsychiatry & American Association
for Social Psychiatry
HALL B
S-18
ECT in Clinical Practice
HALL C
S-19
New Addictions: Internet Addiction
Substance Abuse and Preventive Issues in
Adolescents
17:30-18:00
COFFEE BREAK
17:30-19:30
HALL C-4
ORAL ABSTRACT PRESENTATION-2
18:00-19:30
HALL B
S-21
Strategies to Manage Challenges in
Psychopharmacological Treatments in Children
and Adolescents-IV
HALL A
S-20
Phase Studies in Psychiatry, Quo Vadis?
Challenges and Benefits of Phase Studies
19:30-20:00
20:00-21:30
HALL C
JS-15
TAP - SINPF
Psychopathology During Pregnancy and Post
Partum Period
COFFEE BREAK
HALL A
S-22
Cerebral Blood Flow - The
Relationship Between
Cognitive Functions and
Pathologies
HALL B
JS-16:
TAP - MPA
Improved Choices of
Services Delivery: Better
Mental Health Outcomes:
A Malaysian Experience in
the Integration of Psychiatric
Services
HALL C
S-23
Post-Traumatic Stress
Disorder (PTSD) and
Associated Sleep Disorders
C-23
How to Read Scientific
Articles Correctly? Critical
Reading Techniques of
Scientific Papers
BS:
Brain Storms in
Psychopharmacology: CaseBased Therapeutic Options
for Refractory Schizophrenia
and Depression
PROGRAM AT A GLANCE
November 3, 2013
09:00-11:00
09:00-11:00
HALL A
S-24
Rational Drug Use in Psychiatry
Drug Metabolism Rates and Results in Turkey:
Pharmacogenetics to Clinical Practice
HALL B
S-25
Social Cognition and Emotion Recognition from
Facial Expressions in Psychiatry
HALL C
S-26
Achilles Heel of Psychiatry: Suicide Behaviors
C-25
Psychopharmacology Course in General Medical Practice
C-24
Schema Therapy
11:00-11:15
BREAK
11:15-12:00
Presentations of Winners of TAP Outstanding Research Awards
12:00-12:30
Award Ceremony & Closing
SCIENTIFIC PROGRAM
OCTOBER 30, 2013
HALL A
08:30-22:00
Registration
08:30-12:30
C-1: Psychoeducation in Bipolar Disorders
Ian Jones (UK)
14:30-15:00
OPENING
Announcer: Gokay Alpak ( Scientific Secretary of Congress)
15:00-16:00
KEYNOTE ADDRESS: DSM-5, How do the Changes Affect Decision-Making in Psychopharmacology?
David Osser (USA), Moderator: Mesut Cetin ( Turkey)
16:00-16:30
COFFEE BREAK
JS-1: ICP-TAP New Perspectives in Perinatal Psychiatry
Discussant moderators: Nazan Aydin (Turkey) - Ian Jones (UK)
16:30-18:30
Does childbirth cause postpartum psychiatric disorders? A natural experiment based on outcomes after in-vitro
fertility treatment, Trine Munk Olsen (Denmark)
Recent clinical and genetic research findings in perinatal psychiatry, Ian Jones (UK)
How to build efficient and sustainable community networks for new families, Jane Honikman (USA)
Delivery related post traumatic stress disorder, Onder Kavakci (Turkey)
Interpersonal psychotherapy in perinatal period, Oguz Omay (France)
18:30-19:00
COFFEE BREAK
S-2: Insidious Threat: New Generation Addictive Substances
Discussant moderators: Ilhan Yargic (Turkey) - Izet Pajević (Bosnia-Herzegovina)
19:00-21:00
Synthetic cannabinoids: more dangerous than cannabis, Ilhan Yargic (Turkey)
Buprenorphine: Its abuse and ways of prevention, Cuneyt Evren (Turkey)
Quetiapine abuse: myth or truth? Murat Kuloglu (Turkey)
New limits on alcohol use, what will they bring? Nesrin Dilbaz (Turkey)
SCIENTIFIC PROGRAM
OCTOBER 30, 2013
HALL B
16:00-16:30
COFFEE BREAK
S-1
Current Data Towards Developmental Defects
Discussant moderators: Eyup Ercan (Turkey) - Aynur Akay (Turkey)
16:30-18:30
Importance of inpatient treatment on pervasive developmental disorder, Ozgur Oner (Turkey)
What happens to children with autistic spectrum disorders in adulthood? Murat Coskun (Turkey)
Innovations of pharmacological treatments for problem behaviors of autistic spectrum disorder, Ali Sarper Taskiran (Turkey)
Pharmacotherapy for aggressive behavior in children and adolescents with mental retardation, Fatih Ceylan (Turkey)
18:30-19:00
COFFEE BREAK
S-3
Selection and Evaluation of Treatment in Child and Adolescent Psychopharmacology
Discussant moderators: Mucahit Ozturk (Turkey) - Yasemen Isik Taner (Turkey)
19:00-21:00
The importance of therapeutic drug monitoring in child and adolescent psychiatry, Ozgur Yorbik (Turkey)
Childhood psychiatric disorders, neuroimaging and biomarkers, Onur B. Dursun (Turkey)
Factors to be considered in the treatment of psychopathology in preschool children, Cem Gokcen (Turkey)
Are psychotherapeutic approaches always superior to psychopharmacological treatments in childhood? Tayyip Kadak (Turkey)
SCIENTIFIC PROGRAM
OCTOBER 30, 2013
HALL C
16:00-16:30
COFFEE BREAK
JS-2: TAP - Bosnia Herzegovina
From Depression to Dependency: Current Problems in Psychiatry
Discussant moderators: Dragan Babic (Bosnia-Herzegovina) - Atila Erol (Turkey)
Complementary medicine in antidepressant treatment, Dragan Babic (Bosnia-Herzegovina)
16:30-18:30
Type of traumatic experience and depression, Marija B. Radmanovic (Bosnia-Herzegovina)
Obsessive compulsive disorder and schizophrenia in adolescents, Abdulah Kucukalic (Bosnia-Herzegovina)
Quality of life of heroin addicts and their family members improved during the treatment of opiate dependence with
buprenorphine/naloxone (suboxone), Izet Pajević (Bosnia-Herzegovina)
Treatment for opiate dependence with buprenorphine/naloxone (suboxone) method as prevention of social exclusion of
adolescents – Tuzla model, Mevludin Hasanović (Bosnia-Herzegovina)
18:30-19:00
COFFEE BREAK
SCIENTIFIC PROGRAM
OCTOBER 31, 2013
POSTER SESSION
Poster Area-A: The Candidates of TAP Outstanding Research Awards.
(It will be exhibited continuously in the Poster Area-A between October 31 to November 2, 2013).
Poster Area-B (Amphitheatre): Poster Session for Group-1 (16:00-17:00)
Moderators: Selim Kılıç - Alican Dalkılıç - Murad Atmaca - Cengiz Başoğlu - Bengi Semerci
HALL A
PLENARY LECTURE: Symptoms or Poor Coping Strategies? Clarifying the Confusion with Success Strategies for
09:00-10:30
Late-Diagnosis Adults with ADHD and Their Loved Ones
Gina Pera (USA)
Moderator: M. Akif Ersoy (Turkey)
10:30-11:00
COFFEE BREAK
11:00-12:00
ISS - 1
12:00-13:00
LUNCH
JS-4: TAP - Czech Neuropsychopharmacological Society
Actual Issues in Schizophrenia Treatment
Discussant moderators: Pavel Mohr (Czech Republic) - Oguz Karamustafalioglu (Turkey)
13:00-14:30
Cardiometabolic risk in patients with schizophrenia: impact of medication and monitoring,
Jiri Masopust (Czech Republic)
Functional impairment and antipsychotic treatment of schizophrenia patients, Pavel Mohr (Czech Republic)
Can we eliminate relapses in schizophrenia? Filip Spaniel (Czech Republic)
Coping with adherence problems in longterm psychiatric treatments, Hakan Turkcapar (Turkey)
Smoking and beyond in schizophrenia, Koksal Alptekin (Turkey)
14:30-15:00
COFFEE BREAK
15:00-16:00
ISS - 2
16:00-16:30
COFFEE BREAK
S-6: Eating Disorders: From Nosology to Treatment - An Update
Discussant moderators: Alican Dalkilic (USA) - Atila Erol (Turkey)
16:30-18:30
18:30-19:00
Eating disorders in DSM-5 and the rationales for the changes compared to DSM-IV and epidemiology of eating
disorders, Hans Hoek (Netherlands)
Psychopharmacological treatments in eating disorders & comorbid conditions, Alican Dalkilic (USA)
The place of anorexia nervosa in obsessive compulsive disorders, Atila Erol (Turkey)
Psychiatric assessments and follow ups of obese bariatric surgery patients, Guzin M. Sevincer (Turkey)
COFFEE BREAK
S-7: Antipsychotics Based Weight Gain due to Hypothalamic Regulation of Eating Disorder, the Main Factor?
METU-GATA Sharing the Results of Project Work
Discussant moderators: Murad Atmaca (Turkey) - Ozcan Uzun (Turkey)
19:00-20:30
Regulation of normal eating behavior and METU-GATA information about working with a team of project
processes, Mehmet Ak (Turkey)
Atypical antipsychotic induced weight gain factor of hypothalamic neuropeptide gene expression regulatory
changes? METU-GATA rat results of the study group, Tulin Yanik (Turkey)
Other possible mechanisms of antipsychotic induced weight gain and preventive treatment options,
Suleyman Akarsu (Turkey)
SCIENTIFIC PROGRAM
OCTOBER 31, 2013
HALL B
S-4: Psychopharmacological Treatment Difficulties and Coping Methods in Children and Adolescents - I
Discussant moderators: Bengi Semerci (Turkey) - John T. Walkup (USA)
09:00-10:30
Epigenetics and psychiatry, Ozlem Ozcan (Turkey)
Alternative approaches to treatment resistance in children and adolescents with obsessive-compulsive disorder,
Kagan Gurkan (Turkey)
Difference of approaches for treatment of social anxiety disorder in adolescents, Sabri Herguner (Turkey)
Is it necessary to use antidepressants in children and adolescents with depressive disorders? Omer Faruk Akca (Turkey)
Pharmacokinetics, pharmacodynamics, and pharmacogenetics approach in child and adolescent psychiatry in
Turkey and the world, Caner Mutlu (Turkey)
10:30-11:00
COFFEE BREAK
12:00-13:00
LUNCH
S-5: Psychopharmacological Treatment Difficulties and Coping Methods in Children and Adolescents-II
Discussant moderators: Tumer Turkbay (Turkey) - Mucahit Ozturk (Turkey)
13:00-14:30
First-episode psychotic disorders in children and adolescents, Pinar Oner (Turkey)
Current approaches for treatment of tic disorders in children and adolescents, Canan Tanidir (Turkey)
Emergency situations in child and adolescent psychiatry and its management, Ayse Kilincaslan (Turkey)
The importance of pharmacogenetics in child and adolescent psychiatry, Nuket Isiten (Turkey)
14:30-15:00
COFFEE BREAK
16:00-16:30
COFFEE BREAK
JS-6: TAP - Marce Society
Impact of Maternal Treatments on the Infant During the Perinatal Period
Discussant moderators: Nine Glangeaud (France) - Oguz Omay (France)
16:30-18:30
18:30-19:00
Impact of psychotropic drug intake during pregnancy on infant outcome: results of the Marcé Francophone MBU’s
database, Nine Glangeaud (France)
What place for substitution treatments in obstetrics and neonatal care,
Impact of lithium treatment during pregnancy on infants, M. Luisa Imaz (Spain)
How to approach bipolar disorder patients who plan pregnancy? Mine Sahingoz (Turkey)
Ethical considerations, legal responsibilities and key notes on perinatal psychiatric patients in medical therapy,
Goksen Yuksel (Turkey)
COFFEE BREAK
S-8: Title: Treatment and Therapeutic Applications in Patients with Schizophrenia
Discussant moderators: Erdal Isik ( Turkey) - Orhan Dogan (Turkey)
19:00-20:30
Cope with depression in schizophrenia, Erdal Isik (Turkey)
Treatment of patients with schizophrenia collaboration, compliance with treatment, Orhan Dogan (Turkey)
Rational use of antipsychotics in patients with schizophrenia, Hulya Turgut (Turkey)
Properties of antipsychotics in schizophrenic patients care centers, E. Erdal Ersan (Turkey)
Psychiatric rehabilitation in schizophrenia, Mustafa Yildiz
SCIENTIFIC PROGRAM
OCTOBER 31, 2013
HALL C
JS-3: TAP - Russian Pharmacological Society: Myth or Fact?
Discussant moderators: Elena Valdman (Russia) - Numan Konuk (Turkey)
09:00-10:30
Neuroprotection through GABA receptors, Huseyin Gunay (Turkey)
Neuroprotective properties of the sigma-1 ligand afobazole, Sergey Seredenin (Russia)
Novel antiparkinsonian and neuroprotective drug hemantane, Elena Valdman (Russia)
Importance of neuroprotection in clinical practice, Umit Basar Semiz (Turkey)
10:30-11:00
COFFEE BREAK
12:00-13:00
LUNCH
JS-5: TAP - ISNP
Treatment of Bipolar Disorder: From Molecular Hypotheses to Clinical Reality
Discussant moderators: Konstantinos N. Fountoulakis (Greece) - Numan Konuk (Turkey)
13:00-14:30
Targeting specific receptors and neurotransmitter systems in the treatment of bipolar disorder,
Konstantinos N. Fountoulakis (Greece)
PKC & GSK3B pathways as potential new treatment targets for bipolar disorder, Aysegul Yildiz (Turkey)
Evidence based treatment and refined treatment guidelines for bipolar disorder, Matina Magiria (Greece)
Pharmacoepidemiology of bipolar disorder: a systematic review of the literature, Dimos Dimelis (Greece)
Treatment resistance and its management strategies in bipolar disorders, Erhan Kurt (Turkey)
14:30-15:00
COFFEE BREAK
16:00-16:30
COFFEE BREAK
JS-7: Psychiatry and Psychopharmacotherapy in Post Soviet Space: The Bridge Between Europe and Asia
Discussant moderators: Petr Morozov (Russia) - Haluk Savas (Turkey)
16:30-18:30
Introduction, Petr Morozov (Russia)
Psychiatric service of Republic of Kazakhstan: tasks and prospects, Sagat A. Altynbekov (Kazakhstan)
Unappropriate use of antipsychotic drugs, as a one of the problems of emotional burnout,
Tatiana I. Galako (Kyrgyzstan)
Correction of astenoadynamic option of postabstinent disorders, Nazira Khodjaeva (Uzbekistan)
Experience of Interregional collaboration within educational and scientific projects for Early career psychiatrists,
Daria A. Smirnova (Russia)
Can pharmaceutical firms support mental health reforms? Giorgi Geleishvili (Georgia)
SCIENTIFIC PROGRAM
NOVEMBER 1, 2013
POSTER SESSION
Poster Area-A: The Candidates of TAP Outstanding Research Awards.
(It will be exhibited continuously in the Poster Area-A between October 31 to November 2, 2013).
Poster Area-B (Amphitheatre): Poster Session for Group-2 (12:00-13.00)
Modertors: Hasan Herken - Cengizhan Acikel - Serdar Dursun - Dost Ongur - Mucahit Ozturk - Ozcan Uzun
HALL A
JS-8: TAP - WPA
09:00-10:30
Immunology and Psychiatry: From Research to Routine
Discussant moderators: Norbert Muller (Germany) - Feyza Aricioglu (Turkey)
Oxidative stress and related immunological aspects of psychiatric disorders, Salih Selek (Turkey)
Immune-tryptophan metabolism interaction in psychiatric disorders: pharmacological aspects, Aye-Mu Myint (Germany)
The role of inflammation in depression, Brian Leonard (Ireland)
Inflammatory pathways and anti-inflammatory therapeutic approaches in schizophrenia, Norbert Muller (Germany)
10:30-11:00
COFFEE BREAK
11:00-12:00
ISS - 3
12:00-13:00
LUNCH
JS-10: TAP - IUPHAR
Individualized Psychopharmacology
Use of Molecular Biomarkers for Prediction of Treatment Response
Discussant moderators: Ingolf Cascorbi (Germany) - Omer Ozcan (Turkey)
13:00-15:00
Pharmacogenomics of treatment response in depression, Umit Yasar (Turkey)
Use of human lymphoblastoid cell lines to identify tentative SSRI antidepressant response biomarkers, David Gurwitz (Israel)
Genomics and epigenomics of drug transporters at the blood brain barrier, Ingolf Cascorbi (Germany)
Neuroimaging as a tool to observe impact of CYP2D6 on neural activation in humans, Julia C. Stingl (Germany)
“The Symposium is Held Under the Auspices of IUPHAR Section of Pharmacogenomics”
15:00-15:30
COFFEE BREAK
15:30-16:30
ISS - 4
16:30-17:00
COFFEE BREAK
RT: Psychopharmacology, Quo Vadis?
17:00-19:00
Moderators: Serdar Dursun (Canada) - Dost Ongur (USA)
Participants: Pavel Mohr ( Czech Republic) - David Osser (USA)
Pharmaceutical Industry Representatives (listed in order of last name):
Andreas Schreiner (Janssen), Torsten Melgaard Madsen (Lundbeck), Serdar Ünlü (Nobel), Daniel Umbricht
(Roche), Semih Durmus (Abdi İbrahim)
S-12: From Perspective of Impulse Control Disorders:
Discussant moderators: Murat Demet (Turkey) - Rasit Tukel (Turkey)
19:00-20:30
OCD, Ozan Pazvantoglu (Turkey)
Eating disorders, Bahadir Bakim (Turkey)
ADHD, Elif Karaahmet (Turkey)
Bipolar disorders, Kursat Altinbas (Turkey)
Adult ADHD and co-morbidities, Zeynep Baran Tatar (Turkey)
SCIENTIFIC PROGRAM
NOVEMBER 1, 2013
HALL B
S-9: Strategies to Manage Challenges in Psychopharmacological Treatments in Children and Adolescents-III
Discussant moderators: Yanki Yazgan (Turkey) - Ozgur Yorbik (Turkey)
09:00-10:30
Managing potential risks in antidepressant use in children and adolescents, Ayhan Bilgic (Turkey)
Managing potential risks in antipsychotic use in children and adolescents, Ibrahim Durukan (Turkey)
Managing potential risks in psychostimulant use in children and adolescents, Ali Evren Tufan (Turkey)
The principle of drug use in children: Pharmacogenetics and pharmacodynamics factors influencing drug response,
Esra Saglam (Turkey)
10:30-11:00
COFFEE BREAK
12:00-13:00
LUNCH
S-10: Current Data and Approaches Related to Attention Deficit Hyperactivity Disorder
Discussant moderators: Bengi Semerci (Turkey) - Cengiz Basoglu (Turkey)
13:00-15:00
Differences in ADHD subtypes presenting the point of view from Turkey, Ali Bacanli (Turkey)
ADHD and multiple brain imaging (fMRI, DTII, and ASL), the intersection of the findings, Serkan Suren (Turkey)
Long-term effects of the drug treatment of ADHD, Eyup Sabri Ercan (Turkey)
Factors affecting the continuity of ADHD treatment, Muhammed Ayaz (Turkey)
What happens to children with ADHD in adulthood? Adult ADHD is real, the virtual is diagnosis? Hasan Herken (Turkey)
15:00-15:30
COFFEE BREAK
16:30-17:00
COFFEE BREAK
S-13: Psychiatric Problems Encountered in Daily Practice
Discussant moderators: Sakir Ozen (Turkey) - Alpay Ates (Turkey)
19:00-20:30
Current difficulties in outpatient treatment, Omer Ozbulut (Turkey)
Drug interactions, Filiz Karadag (Turkey)
Current issues in psychiatry dependency, Hasan Mirsal (Turkey)
Women-specific mental health disorders, Selma Bozkurt Zincir (Turkey)
Current issues in inpatient services, Huseyin Gulec (Turkey)
Difficulties in forensic psychiatry, Sakir Ozen (Turkey)
SCIENTIFIC PROGRAM
NOVEMBER 1, 2013
HALL C
JS-9: TAP - ISNP
Schizophrenia: Focus on Special Aspects
Discussant moderators: Konstantinos N Fountoulakis (Greece) - Ozcan Uzun (Turkey)
09:00-10:30
Neurological soft signs in schizophrenia, Vaggelis Karavelas (Greece)
Insight and attitudes towards the disease and treatment, Konstantinos N. Fountoulakis (Greece)
The prodromal phase of schizophrenia: what do we really know? Jelena Vrublevska (Latvia)
In the aftermath of the large pragmatic trials in schizophrenia. Have we learned anything? Filippos Kouniakis (Greece)
10:30-11:00
COFFEE BREAK
12:00-13:00
LUNCH
S-11: Are Current Biological Data Valid in Psychiatric Classifications?
Discussant moderators: Norbert Muller (Germany) - Glen Baker (Canada)
13:00-15:00
Current data of biomarker studies: Are valid the classification of psychiatric disorders? Selcuk Kırlı (Turkey)
Medical imaging: limitations and difficulties, Suheyla Cetin (Turkey)
What to expect from neuroimaging data classification of psychiatric disorders? A. Saffet Gonul (Turkey)
New alternatives to the DSM classification system and biopsychosocial approach, Ulas Camsari (USA)
15:00-15:30
COFFEE BREAK
16:30-17:00
COFFEE BREAK
JS-11: TAP - Indian Psychiatric Society
19:00-20:30
Bipolar Disorder: Treatment Towards Symptom Recovery vs Functional Recovery
Discussant moderators: Indira Sharma (India) - Haluk Savas(Turkey)
The challenge of treating bipolar depression, Indira Sharma (India)
Therapeutic interventions and oxidative stress markers in bipolar disorder, Gokay Alpak (Turkey)
Monitoring drug therapy in bipolar disorder, Manaswi Gautam (India)
Why sleep hythm is important for bipolar disorder? Ibrahim Eren (Turkey)
SCIENTIFIC PROGRAM
NOVEMBER 2, 2013
POSTER SESSION
Poster Area-A: The Candidates of TAP Outstanding Research Awards.
(It will be exhibited continuously in the Poster Area-A between October 31 to November 2, 2013).
Poster Area-B (Amphitheatre): Poster Session for Group-3 (17:30-19:30)
Modertors: Feyza Aricioglu, Nazan Aydin, Ilhan Yargic. Haluk Savas, Tumer Turkbay, Pelin Kilic
HALL A
S-14: Unmet Needs in Psychopharmacology
Discussant moderators: Nicol Ferrier (UK) - Ali Saffet Gonul (Turkey)
09:00-10:30
New advances in the treatment of depression/mania/psychosis, Dost Ongur (USA)
Pharmacotherapy of acute mania; An update, David Osser (USA)
Bilateral relationship between pain and depression; Implications for therapeutics, Serdar Dursun (Canada)
09:00-11:00
ORAL PRESENTATIONS (COURSE ROOM 1)
Moderators: Selim Kilic - Alpay Ates
10:30-11:00
COFFEE BREAK
11:00-12:00
ISS - 5
12:00-13:00
13:00-14:30
14:30-15:30
15:30-16:00
16:00-17:30
LUNCH
JS-12: TAP - CCNP
Potential New Biomarkers and Drug Targets in Depression and Schizophrenia
Discussant moderators: Glen Baker (Canada) - Mesut Cetin (Turkey)
Neuroactive steroids, Glen Baker (Canada)
Synaptic and intracellular signaling pathway dysfunctions in depression, Feyza Aricioglu (Turkey)
Ketamine and sodium nitroprusside, Serdar Dursun (Canada)
New frontiers in schizophrenia and bipolar disorders, Dost Ongur (USA)
ISS- 6
COFFEE BREAK
JS-14: TAP - Orthopsychiatry & American Association for Social Psychiatry
Substance Abuse and Preventive Issues in Adolescents
Discussant moderators: Ismail Ak (Turkey) - Andres Pumariega (USA)
Findings and Insights from Substance Abuse Surveys of High School Youth in Istanbul, Andres Pumariega (USA)
Interventions to decrease substance abuse demand among youth in Turkey, Ugur Evcin (Turkey)
Interventions to promote mental health and prevent substance abuse in adolescents, Alican Dalkilic (USA)
Psychiatric problems in substance abusing adolescents and treatment of co-morbid conditions, Andres Pumariega (USA)
17:30-18:00
COFFEE BREAK
17:30-19:30
ORAL PRESENTATIONS (COURSE ROOM 4)
Moderators: Nazan Aydin - Ayhan Algul
S-20: Phase Studies in Psychiatry, Quo Vadis? Challenges and Benefits of Phase Studies
Discussant moderators: Aytekin Sir (Turkey) - Yasin Bez (Turkey)
18:00-19:30
19:30-20:00
Status of psychiatric phase studies with examples from the world, Mahmut Bulut (Turkey)
Clinical Studies (Phase Studies): Benefits of Turkey, Sule Mene (Turkey)
Clinical research process and challenges, Yasin Bez (Turkey)
Place of using placebo in psychiatric studies, Abdullah Atli (Turkey)
COFFEE BREAK
S-22: Cerebral Blood Flow - The Relationship Between Cognitive Functions and Pathologies
Discussant moderators: Halise Ozguven (Turkey) - Tumer Turkbay (Turkey)
20:00-21:30
Cerebral blood flow measurements and psychiatric practices associated with it, Halise Ozguven (Turkey)
Attention, stimulants and cerebral blood flow, Ozgur Oner (Turkey)
Imaging of the jumping to conclusions bias in early schizophrenia with Near Infrared Spectroscopy, Bora Baskak (Turkey)
Neuroimaging by Functional Near Infrared Spectroscopy in patients with Alzheimer’s disease, Erguvan Tuğba Özel Kızıl (Turkey)
SCIENTIFIC PROGRAM
NOVEMBER 2, 2013
HALL B
S-15: Tailored Treatments in Psychiatry and Methods Used in Laboratories
Discussant moderators: Nevzat Tarhan (Turkey) - Feyza Aricioglu (Turkey)
09:00-10:30
Personalized treatment in psychiatry, Esra Saglam (Turkey)
Genetic methods used on personalized treatments in psychiatry (DNA extraction, genotyping), Korkut Ulucan (Turkey)
Therapeutic drug monitoring of personalized therapy in psychiatry (TDM) applications, Gokben Hizlisayar (Turkey)
Phenotyping applications of tailor treatment in psychiatry, Gul Eryilmaz (Turkey)
09:00-11:00
ORAL PRESENTATIONS (COURSE ROOM 1)
Moderators: Selim Kilic - Alpay Ates
10:30-11:00
COFFEE BREAK
12:00-13:00
LUNCH
13:00-14:30
JS-13: TAP - BAP
From Pathophysiology to Treatment: Treatment Refractory Depression (TRD)
Discussant moderators: Nicol Ferrier (UK) - Kemal Sayar (Turkey)
TRD, epidemiology, biology, and management, Nicol Ferrier (UK)
Does chronic inflammation contribute to TRD? A consideration of the evidence, Brian Leonard (UK)
Pharmacotherapy options in TRD, Cemil Celik (Turkey)
TMS applications in TRD, Adem Balikci (Turkey)
15:30-16:00
COFFEE BREAK
S-18: ECT in Clinical Practice
Discussant moderators: Haluk Savas (Turkey) - Osman Virit (Turkey)
16:00-17:30
The practice of ECT in patients with catatonic, Ahmet Unal (Turkey)
The practice of ECT in pregnancy, Feridun Bulbul (Turkey)
ECT practice bipolar disorders, Mahmut Bulut (Turkey)
Maintenance ECT, Gokay Alpak (Turkey)
17:30-18:00
COFFEE BREAK
17:30-19:30
ORAL PRESENTATIONS (COURSE ROOM 4)
Moderators: Nazan Aydin - Ayhan Algul
S-21: Strategies to Manage Challenges in Psychopharmacological Treatments in Children and Adolescents-IV
Discussant moderators: Kemal Sayar (Turkey) - Ozgur Oner (Turkey)
18:00-19:30
19:30-20:00
The differential diagnosis of pharmacological characteristics of child and adolescent inpatients, Esra Cop (Turkey)
Distinguishing bipolar disorders from psychotic disorders in adolescents and subtleties of undistinguishable cases,
Nese Fis (Turkey)
Treatment update in elimination disorders based on new scientific findings, Ozden Uneri (Turkey)
Impulse Control Disorder: Neurodevelopmental Problems from Infancy to Adulthood, Koray Karabekiroglu (Turkey)
COFFEE BREAK
SCIENTIFIC PROGRAM
NOVEMBER 2, 2013
HALL B
JS-16: TAP - MPA
20:00-21:30
Improved Choices of Services Delivery: Better Mental Health Outcomes: A Malaysian Experience in the Integration of
Psychiatric Services
Discussant moderators: Abdulkadir Abubakar (Malaysia) - Hulya Ensari (Turkey)
Delivering evidence based psychosocial interventions in low resourced areas, Abdulkadir Abubakar (Malaysia)
Is antidepressant really effective? The role of pharmacological approach in improving service delivery,
Mohamad Fadzilah Abdul Razak (Malaysia)
Psycho-oncology services for cancer patients: an experience in a teaching hospital in Malaysia, Nor Zuraida Zainal (Malaysia)
Hospital-based community psychiatric services in Malaysia, Marhani Midin (Malaysia)
NOVEMBER 2, 2013
HALL C
S-16: Evidence-Based Therapies in Psychiatry
Discussant moderators: Serhat Citak (Turkey) - Hakan Turkcapar (Turkey)
09:00-10:30
Acceptance and Commitment Therapy, Fatih K. Yavuz (Turkey)
Interpersonal Therapy, Oguz Omay (France)
Metacognitive therapy, Erhan Ertekin (Turkey)
09:00-11:00
ORAL PRESENTATIONS (COURSE ROOM 1)
Moderators: Selim Kilic - Alpay Ates
10:30-11:00
COFFEE BREAK
12:00-13:00
LUNCH
S-17: Sleep and Psychiatric Disorders
Discussant moderators: Mustafa Bilici (Turkey) - Mustafa Gulec (Turkey)
13:00-14:30
15:30-16:00
Psychopharmacological approach to the problems of sleep on aging and dementia, Yavuz Selvi (Turkey)
Psychopharmacological approach to sleep problems during pregnancy and lactation, Mustafa Gulec (Turkey)
Psychopharmacological approach to chronic physical diseases with sleep disorders, Adem Aydin (Turkey)
COFFEE BREAK
S-19: New Addictions: Internet Addiction
Discussant moderators: Lut Tamam (Turkey) - Omer Gecici (Turkey)
16:00-17:30
Where does internet addiction fit psychiatry? Conceptual and etiological discussions about internet addiction,
Fatih Canan (Turkey)
Is internet addiction a kind of an OCD? Lut Tamam (Turkey)
Internet addiction clinic, Abdullah Akpinar (Turkey)
Internet addiction: is it the visible side of an iceberg or a comorbidity? Murat Semiz (Turkey)
Could internet addiction be treated? Osman Yildirim (Turkey)
17:30-18:00
COFFEE BREAK
17:30-19:30
ORAL PRESENTATIONS (COURSE ROOM 4)
Moderators: Nazan Aydin - Ayhan Algul
SCIENTIFIC PROGRAM
NOVEMBER 2, 2013
HALL C
JS-15: TAP - Societa Italiana di NeuroPsicoFarmacologia
18:00-19:30
19:30-20:00
20:00-21:30
Psychopathology During Pregnancy and Post Partum Period
Discussant moderators: Faruk Uguz (Turkey)
Neurobiology of depression during pregnancy and postpartum, Giovanni Biggio (Italy)
Psychopathology in perinatal period, Mauro Mauri (Italy)
Is Hyperemesis Gravidarum only a medical condition? What is the relevance with psychiatric disorders?
Bilge Burcak Annagur (Turkish Marce Society)
Anxiety Disorders in Pregnancy, Faruk Uguz (Turkish Marce Society)
COFFEE BREAK
BS: Brain Storms in Psychopharmacology: (COURSE ROOM 2)
Case-Based Therapeutic Options for Refractory Schizophrenia and Depression
Serdar Dursun (Canada), Moderator: Ozcan Uzun (Turkey)
S-23: Post-Traumatic Stress Disorder (PTSD) and Associated Sleep Disorders
Discussant moderators: Ali Caykoylu (Turkey) - Alpay Ates (Turkey)
20:00-21:30
PTSD’s sleep-related symptoms and their clinical significance, Sarper Ercan (Turkey)
Polysomnography findings in patients with PTSD, Murat Erdem (Turkey)
Pharmacotherapy of sleep disorders on PTSD, Abdullah Bolu (Turkey)
Psychotherapy of sleep disorders on PTSD, Taner Oznur (Turkey)
SCIENTIFIC PROGRAM
NOVEMBER 3, 2013
HALL A
S-24: Rational Drug Use in Psychiatry
Drug Metabolism Rates and Results in Turkey: Pharmacogenetics to Clinical Practice
Discussant moderators: Cem Sengul (Turkey) - Ahmet Ayer (Turkey)
09:00-11:00
Drug interactions and outcomes, Hanefi Ozbek (Turkey)
Is there a drug overuse/ misuse in Turkey? With SSI data, Dr. Halil Akçe (Social Security Institution, Head of the Health
Technologies Evaluation Administration)
What should the national health policy be, in the light of scientific and social developments? Examination of the
results of the Health Transformation Policy, Dr. Akif Akbulat (Ministry of Health, Head of the Pharmacoeconomics
Administration )
HALL B
S-25: Social Cognition and Emotion Recognition from Facial Expressions in Psychiatry
Discussant moderators: Sakir Ozen (Turkey) - Murat Emul (Turkey)
09:00-11:00
I could tell your lies by your face, Erhan Yuksek (Turkey)
Social cognition and recognizing emotions thru facial expression on psychiatric disorders, Erman Bagcioglu (Turkey)
Social cognition and emotion recognition from aggression and facial expression, Ismail Ozver (Turkey)
Social cognition and emotion recognition from facial expressions, Mihriban Dalkiran (Turkey)
HALL C
S-26: Achilles Heel of Psychiatry: Suicide Behaviors
Discussant moderators: Servet Ebrinc (Turkey) - Mecit Caliskan (Turkey)
09:00-11:00
Suicidal behavior in Turkey in the last 20 years, Tunay Karlidere (Turkey)
What does the genes say about suicidal behavior? Recep Tutuncu (Turkey)
Do psychopharmacological drugs play a role of provocation in suicidal behavior, Kamil Nahit Ozmenler (Turkey)
Psychopharmacological drugs role in the prevention of suicidal behavior, Cicek Hocaoglu (Turkey)
HALL A
11:00-11:15
BREAK
11:15-12:00
Presentations of Winners of TAP Outstanding Research Awards
Moderators: Cengiz Basoglu- Cengiz Han Acikel
12:00-12:30
Award Ceremony & Closing
Announcer: Gokay Alpak ( Scientific Secretary of Congress)
COURSES
OCTOBER 30, 2013
08:30-12:30
19:00-21:00
C-1: Psychoeducation in Bipolar Disorders (HALL A)
Ian Jones (UK)
C-2: EMDR (COURSE ROOM 1)
Onder Kavakci (Turkey)
C-3: Beyond Talk, into Action: Working with Users’ Associations in Perinatal Psychiatry (COURSE ROOM 2)
Jane Honikman (USA) - Oguz Omay (France)
OCTOBER 31, 2013
C-4: Bipolar Disorders in Child and Adolescents and Management of their Comorbidities (COURSE ROOM 1)
Aynur Akay (Turkey) - Neslihan Emiroglu (Turkey)
07:30-09:00
C-5: DSM 5 orientation and training (COURSE ROOM 2)
Dost Ongur (USA)
C-6: Mastery in Pharmacotherapy Plus Psychotherapy Combinations (COURSE ROOM 3)
Hakan Turkcapar (Turkey)
C-7: Experimental Animal Models of Schizophrenia (COURSE ROOM 4)
Osman Metin Ipcioglu (Turkey) - Huseyin Gunay (Turkey)
C-8: Suicidality in Youth: Risk Factors, Screening, Assessment, and Intervention (COURSE ROOM 1)
Andres J. Pumariega (USA) - Alican Dalkilic (USA)
19:00-20:30
C-9: Fundamentals of Child and Adolescent Psychopharmacology-I (COURSE ROOM 2)
John T Walkup (USA)
C-10: Rehabilitation in Severe Mental Illnesses and Its Role in Operation of Community
Mental Health Centers (COURSE ROOM 3)
Hulya Ensari, (Turkey) - Mehtap Arslan (Turkey)
NOVEMBER 1, 2013
C-11: Voluntary and Involuntary Admissions in Substance Use Disorders. What Would You Do? (COURSE ROOM 1)
Nesrin Dilbaz (Turkey) - Asli E.Darcin (Turkey) - Serdar Nurmedov (Turkey)
C-12: Pharmacologic Treatment of Autistic Spectrum Disorder from Childhood to Adulthood (COURSE ROOM 2)
Yanki Yazgan (Turkey) - Senem Basgul (Turkey)
C-13: The Scales and Tests Used in ADHD (COURSE ROOM 3)
07:30-09:00
Yasemen Isik Taner (Turkey) - Tumer Turkbay (Turkey)
C-14: Acceptance and Commitment Therapy (COURSE ROOM 4)
Fatih K. Yavuz (Turkey) - Hasan T. Karatepe (Turkey)
C-15: OCD: From diagnosis to treatment (COURSE ROOM 5)
OCD: Diagnostic features, Hakan Balibey (Turkey)
OCD: Assessment, Yasin Bez (Turkey)
OCD: Pharmacological therapies, Barbaros Ozdemir (Turkey)
OCD: Somatic non-pharmacological treatments, Ali Doruk (Turkey)
C-16: Fundamentals of Child and Adolescent Psychopharmacology-II (COURSE ROOM 1)
19:00-20:30
John T. Walkup (USA)
C-17: Cognitive Behavioral Therapy in OCD Resistance to Treatment and Management in OCD (COURSE ROOM 2)
Murad Atmaca (Turkey)
COURSES
NOVEMBER 2, 2013
C-18: Minnesota Model for Addiction Treatment (COURSE ROOM 1)
Glynis Read (UK)
C-19: How to Write Scientific Articles? (COURSE ROOM 2)
Murad Atmaca (Turkey) - Hasan Herken (Turkey)
07:30-09:00
C-20: Psychiatric Semiology Course (COURSE ROOM 3)
Ismet Kirpinar (Turkey)
C-21: From Childhood to Adulthood Management of Treatment-Resistant ADHD (COURSE ROOM 4)
Mucahit Ozturk (Turkey) - Bengi Semerci (Turkey)
C-22: Psychiatric Emergencies, Violence, and Violence Approach (COURSE ROOM 5)
Psychiatric approach to the patient with violence risk, Ayhan Algul (Turkey)
Emergency medicine in terms of psychiatric emergencies, Ali Osman Yildirim (Turkey)
20:00-21:30
C-23: How to Read Scientific Articles Correctly? Critical Reading Techniques of Scientific Papers (COURSE ROOM 1)
Selim Kilic (Turkey) - Cengiz Han Acikel (Turkey)
NOVEMBER 3, 2013
C-24: Schema Therapy (COURSE ROOM 1)
Alp Karaosmanoglu (Turkey)
C-25: Psychopharmacology Course in General Medical Practice (COURSE ROOM 2)
Discussant Moderators: Sedat Özkan (Turkey) - İsmet Kırpınar (Turkey)
09:00-11:00
General principles of pharmacothearpy in consultation-liaison psychiatry
Sedat Özkan (Turkey)
Drug interactions and psychotropic drug use in organ failure
Serap Oflaz (Turkey)
Psychotropic drug use in pregnancy and postpartum period
Mine Özkan (Turkey)
Psychotropic drug use in oncology patients
Hülya Güveli (Turkey)
INDUSTRY SUPPORTED SYMPOSIA
OCTOBER 31, 2013
11:00-12:00
15:00-16:00
(HALL A) Industry Supported Symposium - 1
Previous 15 years, today and the future of schizophrenia treatment and atypical antipsychotics
Dr. Nesrin Dilbaz: Future Aspects in treatment of schizophrenia and atypical antipsychotics
Dr. Baybars Veznedaroğlu: What we have in treatment of schizophrenia and atypical antipsychotics.
Dr. Oğuz Karamustafalıoğlu: Last 15 years in treatment of schizophrenia and atypical Antipsychotics.
(HALL A) Industry Supported Symposium - 2
A new perspective in the treatment of negative symptoms: Glutamate Theory and Glycine Reuptake Inhibition
Moderator: Dr. Mesut Çetin
Speakers: Dr. Nesrin Dilbaz
Dr. Ali Saffet Gönül
NOVEMBER 1, 2013
11:00-12:00
(HALL A) Industry Supported Symposium - 3
New Approaches in the Anxiety-depression continuum
Moderator: Dr. Oğuz Karamustafalıoğlu
Speaker: Dr. Ali Saffet Gönül
(HALL A) Industry Supported Symposium - 4
15:30-16:30
Update of treatment of Schizophrenia and Bipolar Disorder: Asenapine
Speakers:
Dr. Erdal Işık
Dr. Haluk Savaş
NOVEMBER 2, 2013
11:00-12:00
14:30-15:30
(HALL A) Industry Supported Symposium - 5
Moderator: Doç. Dr. Serhat Çitak
Dr. Mesut Çetin: Unmet Needs in the Treatment of Schizophrenia: How to increase treatment compliance?
Dr. Nazan Aydın: Effective Intervention Strategies in the Treatment with Haloperidol Decanoate
Dr. Hasan Herken: Sharing Clinical Experiences
(HALL A) Industry Supported Symposium - 6
Treatment of Bipolar Depression
Moderator: Dr. Oğuz Karamustafalıoğlu
Speaker: Dr. Mauricio Tohen
Contents
Author(s)
Tit­le
Scientific Program Abstracts
1
Honikman JI
How to build efficient and sustainable community networks for new families
S1
2
Omay O, Stuart S
Interpersonal Psychotherapy (IPT) in the perinatal context
S2
3
Omay O, Stuart S
Interpersonal Psychotherapy (IPT): a short introduction
S2
4
Babić D, Babić R
Complementary medicine in antidepressant treatment
S2
5
Burgic RM, Burgic S
Type of traumatic experience and depression in adolescents
S3
6
Seredenin SB
Neuroprotective properties of the sigma-1 ligand afobazole
S4
7
Valdman E
Novel antiparkinsonian and neuroprotective drug: hemantane
S4
8
Alptekin K
Smoking and beyond in schizophrenia patients
S5
9
Turkcapar MH
Coping with adherence problems in longterm psychiatric treatments
S6
10
Yuksel G
Code of ethics, obligations and specific points in the perinatal psychiatry
S6
11
Sahingoz M
How to approach bipolar disorder patients who plans pregnancy?
S7
12
Freudenthal NMCG, ALS Dallay,
Impact of maternal treatments on the infant during the perinatal period
S8
Dallay D, Gurrutxaga MLI
Symposium of the Marcé Society
13
Altynbekov S
Psychiatric service of republic of Kazakhstan: tasks and prospects
S8
14
Geleishvili G
Can pharmaceutical firms support mental health reforms?
S9
15
Khodjaeva NI, Sultanov Sh.Kh. Ashurov Z.Sh.
Correction of astenoadinamic option of post abstinence disorders
S9
16
Morozov PV
Psychiatry and psychopharmacotherapy in Post-Soviet space
S11
17
Galako T
Irrational use of antipsychotic drugs as one of the problems of emotional burnout syndrome
S11
18
Jelena V
The prodromal phase of schizophrenia: what do we really know?
S12
19
Yasar U
Pharmacogenomics of treatment response in depression
S13
20
Stingl JC, Viviani R
Neuroimaging as a tool to observe impact of CYP2D6 on neural activation in humans
S13
21
Alpak G
Therapeutic interventions and oxidative stress markers in bipolar disorder
S14
22
Baker GB, Dursun SM
“NMDA-Nitric Oxide-cGMP” pathway modulation in schizophrenia and depression:
S14
focus on sodium nitroprusside and ketamine
23
Aricioglu F
Synaptic and intracellular signaling pathway dysfunctions in depression
S15
24
Ferrier N
Treatment refractory depression: epidemiology, biology and management
S15
25
Midin M
Hospital-based community psychiatric services in Malaysia
S16
26
Annagur BB
Is hyperemesis gravidarum only a medical condition? what is the relevance
S16
with psychiatric disorders?
27
Uguz F
Anxiety disorders in pregnancy
S17
28
Yargic I
Synthetic cannabinoids: more dangerous than marijuana
S18
Contents
Author(s)
Tit­le
Scientific Program Abstracts
29
Kadak MT
Are psychotherapeutic approaches always superior to psychopharmacological treatments in childhood?
S19
30
Yorbik O
The importance of therapeutic drug monitoring in child and adolescent psychiatry
S19
31
Mutlu C
Pharmacokinetic, pharmacodynamic and pharmacogenetic approach in the field
S20
of child and adolescent psychiatry in Turkey and the world
32
Akca OF
Is it necessary to use antidepressant medication in treatment of depressive disorders
S21
in children and adolescents?
33
Herguner S
Different approaches for treatment of social anxiety in adolescents
S22
34
Kilincaslan A
Emergency situations in child and adolescent psychiatry and its management
S22
35
Tanidir C
Current treatment modalities for tic disorders in children and adolescents
S23
36
Isiten N
Importance of pharmagenetics in the psychiatry of child and adolescent
S24
37
Sevincer GM
Psychiatric evaluation and follow-up of bariatric surgery patients
S24
38
Hoek HW
Classification and epidemiology of eating disorders in the DSM-5
S25
39
Dalkilic A
Psychopharmacological treatments in eating disorders & comorbid conditions
S26
40
Ak M
Role of hypothalamic neuropeptides and atypical antipsychotics effects on the regulation
S26
of eating behavior
41
Akarsu S
Possible mechanisms of atypical antipsychotic induced weight gain and preventive treatment options
S27
42
Ersan EE
Properties of antipsychotics in patients with schizophrenia in care centers
S28
43
Turgut H
Rational drug use in schizophrenia
S28
44
Yildiz M
Psychosocial rehabilitation for schizophrenia
S29
45
Dogan O
Adherence to treatment in patients with schizophrenia
S30
46Bilgic A
Management of the antidepressants usage risks in children and adolescents
S31
47
Cetin S
Challenges in medical imaging and medical image analysis
S31
48
Bakim B
From perspective of impulse-eating disorders
S32
49
Karaahmet E
ADHD: perspective from impulse
S32
50
Altinbas K
Impulsivity and psychiatric disorders
S33
51
Pazvantoglu O
Obsessive compulsive disorder from the perspective of impulse control disorders
S33
52
Baran-Tatar Z
From the perspective of impulse control disorders: adult ADHD and comorbidities
S34
53
Mirsal H
Current issues in addiction psychiatry
S35
54
Gulec H
Current issues in inpatient services
S36
55
Ozen S
Current difficulties in forensic psychiatry
S36
56
Osser D
Unmet needs in psychopharmacology. pharmacotherapy of acute mania: an update
S37
57
Dursun SM
Bilateral relationship between pain and depression: implications for therapeutics
S38
Contents
Author(s)
Tit­le
Scientific Program Abstracts
58
Saglam E
Personalized medicine in psychiatry
S38
59
Sayar GH
The use of therapeutic drug monitoring (TDM) in psychiatry
S39
60
Eryilmaz G
Phenotyping: applications of tailoring treatment in psychiatry
S40
61
Aydin A
Psychopharmacological approach to sleep problems with chronic physical diseases
S42
62
Eren I
Why sleep rhythm is important for bipolar disorder?
S43
63
Alpak G
Maintenance ECT
S44
64
Akpinar A
New addictions: internet addiction
S44
65
Canan F
Where does Internet addiction fit psychiatry? Conceptual and etiological discussions
S45
about Internet addiction
66
Yildirim O
Could internet addiction be treated?
S45
67
Semiz M
Internet addiction: Is it the visible side of an iceberg or comorbidity?
S46
68
Karabekiroglu K
Regulation disorders of sensory processing: neurodevelopmental problems
S47
from infancy to adulthood
69
Uneri OS
Treatment update in elimination disorders based on new scientific findings
S48
70
Oznur T
Psychotherapy of sleep disturbances in posttraumatic stress disorder
S48
71
Hocaoglu C
The role of psychopharmacological drugs in the prevention of suicidal behaviors
S49
72
Honikman J, Omay O
Beyond talk, into action: working with users’ associations in perinatal psychiatry
S50
73
Pekcanlar-Akay A
Frontiers between attention deficit hyperactivity disorder and bipolar disorder
S50
74
Pumariega AJ, Dalkilic A
Suicidality in youth: risk factors, screening, assessment, and intervention Workshop Proposal
S51
Enez-Darcin A, Nurmedov S
75
Dilbaz N
Management of substance use disorders; voluntary versus involuntary admissions
S52
76
Read G
The Minnesota Model: flexible, relevant and adapted in Scotland
S52
77
Semerci ZB
Resistance and resolutions in adult attention deficit hyperactivity disorder
S53
78
Guveli H
Psychotropic drug use in oncology patients
S54
79
Ozkan M
Psychotropic drug use in pregnancy and lactation
S55
80
Ozkan S
Pharmacotherapy principles in consultation-liaison psychiatry
S55
81
Oflaz S
Drug interactions and psychotropic drug use in organ failures
S56
82
Osser D
DSM-5: How do the changes affect decision-making in psychopharmacology
S57
83
Osser D
Psychopharmacology, quo vadis? Teaching evidence-based medicine and
S58
psychopharmacology algorithms
84
Madsen TM
The future and new horizons of psychopharmacology
S58
85
Steckler T
Recent advances in drug development: the Janssen perspective
S59
Contents
Author(s)
Tit­le
Candidates of TAP Outstanding Research Awards
1
Hong J, Novick D, Haro JM, Treuer T,
Factors associated with time to pharmacotherapy in patients with Attention-Deficit/Hyperactivity
Montgomery W, Wu S, Altin M, Haynes VS
Disorder (ADHD) symptoms in Central Europe and East Asia
2
Unaldi N, Yargic LI
Reasons for seeking psychiatric support among patients diagnosed with attention-deficit/
S61
S62
hyperactivity disorder in adulthood and differences from early diagnosed patients
3
Kokurcan A, Altunoz U, Gogus AK
Burnout in caregivers of patients with schizophrenia
S62
4
Ozdemir O, Guzel-Ozdemir P, Boysan M,
The effect of dissociation on academic performance and attention processes
S63
Yilmaz E
5
Findikli E, Atmaca M
The frequency of metabolic syndrome in psychiatric patients taking antidepressant medication
S64
6
Camkurt MA, Acar S, Killi Y, Gunes S,
MicroRNAs as potential biomarkers for major depressive disorder
S64
Yildirim V, Tamer L, Yilmaz MF, Gorur A
7
Akarsu S, Uzun O, Torun D, Bolu A,
Mitochondrial complex I-III mRNA levels in schizophrenia: relationship between gene expressions
S65
Erdem M, Kozan S, Akar H
and psychotic symptomatology
8
Coskun M, Hocaoglu S, Zoroglu S
A family based association study of Mn-superoxide dismutase gene polymorphism in autism
S66
spectrum disorders
9
Akkisi-Kumsar N, Altunsoy-Sen N, Dilbaz N
Frequency of antipsychotic polypharmacy in schizophrenic outpatients
S66
10
Elbozan-Cumurcu B, Cumurcu T, Keser S,
Refraction and anterior segment parameters in patients with schizophrenia
S67
Gunduz A, Kartalci S
11
Ersan EE, Yildirim G, Kilic C
Exposure to violence in staff members of Sivas Numune Hospital
S68
12
Ersan EE, Yildirim G, Binici B, Kilic C
Distribution of applications to the Patients Rights Council of Sivas Numune Hospital and Sivas State
S68
Hospital for the last one year
13
Ozdil E, Tekin A, Akansel V, Ozer OA,
Karamustafalioglu O
14
Depression, sexual dysfunction and childhood trauma in patients with post traumatic stress disorder
S69
Kokut S, Atay IM, Uz E, Akpinar A,
The polymorphisms of Ser49Gly and Gly386Arg in Beta-1-Adrenergic Receptor in
S69
Demirdas A
beta-1-adrenergic receptor gene in major depression: a pilot study
15
Atay IM, Erturan I, Demirdas A,
The impact of personality on quality of life and disease activity in patients with Behcet’s disease:
Bacik-Yaman G, Yurekli VA
a pilot study
16
Turan CC, Kesebir S
Are the levels of ICAM, VCAM and E-Selectin levels different in the first manic episode and
S70
S71
subsequent remission?
17
Topal Z, Demir N, Tuman TC, Tufan AE
Tolerability of OROS methlyphenidate in Turkish children and adolescents with attention-deficit/
S71
hyperactivity disorder may not be affected by dose or augmentation with risperidone: a preliminary
study
18
Coskun M, Zoroglu S
Prevalence and patterns of psychiatric disorders in a clinical sample of preschool children in Turkey
S72
19
Gogcegoz-Gul I, Elbozan-Cumurcu B,
Ghrelin-lipid levels in panic disorder before and after treatment and their relationship with
S73
Karlidag R, Turkoz Y
agoraphobia
20
Kaya I, Coskun M, Zoroglu S
A family based association study of COX-2-765G→C and COX-2-1195A→G genes polymorphism
S73
in autism spectrum disorders
21
Hadjkacem I, Ayadi H, Khemekhem K,
Walha A, Cherif L, Moalla Y, Ghribi F
Neurodevelopmental factors in adolescent’s bipolar disorders: a Tunisian study
S74
Contents
Author(s)
Tit­le
Candidates of TAP Outstanding Research Awards
22
Kokurcan A, Altunöz U, Ozel-Kizil ET,
Kirici S
23
Gundogdu U, Orengul C, Benk F, Arman A
Comparison of death anxiety between young and elderly patients with generalised anxiety disorder
S75
Reversible autistic features following dietary restriction in a recently diagnosed phenylketonuria
S75
case
24
Khemakhem K, Ayadi H, Cherif L,
Moalla Y, Hadjkacem I, Walha A, Yaich S,
Dammak J, Ghribi F
25
Ghribi F
26
Tas-Torun Y, Isik-Taner Y, Sener S,
Investigation of iron deficiency, thyroid function abnormalities and deficiency of folate and vitamin
Cetin FH
B12 in children with attention deficit hyperactivity disorder
27
Chodzaoglou S, Coskun M, Zoroglu SS
A family based association study of neuronal nitric oxide synthase gene polymorphism in autism
Attention deficit hyperactivity disorder at schools in Sfax, Tunisia
S76
Khemakhem K, Ayadi H, Boussaid N,
Evolution in the prescription of psychotropic drugs in child psychiatry department of Sfax
S77
Hadjkacem I, Cherif L, Walha A, Moalla Y,
(2005 - 2009): about 232 children and adolescents
S77
S78
spectrum disorders
28
Guzel-Ozdemir P, Karadag AS, Selvi Y,
Assessment of the effects of antihistaminic drugs on mood, sleep quality, sleepiness, and dream
Boysan M, Gunes-Bilgili S, Aydin A,
anxiety
Onder S
29
Bilgen AE, Ozdemir B, Zincir S, Ak M,
Effects of electroconvulsive therapy on serum brain-derived neural factor and nerve growth factor in
Aydemir E, Cayci T
treatment resistant major depression
30
Orsel ES, Yigit H, Karayilan S, Ozten M,
Efficacy of clozapine in treatment-resistant schizophrenia
S80
Erol A
31
Ersan EE, Yildiz M
Antipsychotic use pattern in people with psychotic disorder living in board and care facilities
S81
32
Unal A, Virit O, Alpak G, Bulbul F,
Low serum copper and ferro oxidase levels in adults with Attention-Deficit and Hyperactivity
S82
Selek S, Bulut M, Savas HA
Disorder
33
Camkurt MA, Killi Y, Acar S, Gunes S,
Relationship of plasma microRNAs with nicotine use and disease status among depressed patients
S82
Yildirim V, Gorur A, Tamer L, Yilmaz MF
34
Annagur BB, Secilmis-Kerimoglu O,
Are there any differences in psychiatric symptoms and eating attitudes between pregnant women
S83
Gunduz S, Tazegul A
with hyperemesis gravidarum and healthy pregnant women?
35
Ucar HN, Kocael O, Kirtil IY, Dagdelen F,
Evaluation of the interrelationships between complaints, diagnoses, and drug usage in an outpatient
Kole IH, Vural AP
clinic of pediatric, and adolescent psychiatry
36
Tuman TC, Demir N, Topal Z, Tuman BA,
Three months prevalence and correlates of symptoms of trichotillomania, onychophagia and skin
Tufan AE, Yazgan Y
excoriation disorder in a clinical child psychiatric population and the effects of treatment choices on
S79
S80
S84
S84
symptoms
37
Tekin U, Oflaz S, Abali O, Soyata AZ
Acute dystonic reaction following methylphenidate medication in a neurologically healthy
S85
adolescent patient with ADHD
38
Gul H, Ugur C, Gurkan CK
Autism in spinal muscular atrophy: comorbidity or a coincidental state?
S86
39
Gogcegoz-Gul I, Karlidag R, Ozcan C
P50 sensory gating in patients with primary vaginismus
S87
40
Aydin-Sunbul E, Sunbul M, Cengiz FF,
Association between neutrophil to lymphocyte ratio and severity of depression in patients with
S87
Yanartas O, Gulec H
depressive disorders
41
Yigit H, Orsel ES, Karayilan S, Ozten M,
The relationship between weight change and obsessive thoughts in patients with anorexia nervosa
Erol A
S88
Contents
Author(s)
Tit­le
Candidates of TAP Outstanding Research Awards
42
Unal GA, Kenar ANI, Herken H, Kiroglu Y
Association of adult ADHD subtypes and response to methylphenidate treatment: a MRS study
S88
43
Soylu E, Soylu N, Yildirim YS,
Psychiatric morbidity in patients with adenotonsillar hypertrophy before and after
S89
Sakallioglu O, Polat C, Orhan I
adenotonsillectomy
44
Ates FE, Cangoz B, Ozel-Kizil ET, Baskak B,
Emotional working memory in Alzheimer’s disease: a functional near-infrared spectroscopy study
S90
Baran Z, Devrimci-Ozguven H
45
Cetin FH, Isik-Taner Y, Tas-Torun Y,
Atomoxetine and methylphenidate for the treatment of attention deficit hyperactivity disorder: a six-
S90
Tunca H
month follow-up study
46
Nalbant A, Burhan HS, Can A, Cansiz A,
Tardive dyskinesia in long term hospitalized patients with schizophrenia
S91
Yavuz KF, Arslan-Delice M, Kurt E
47
Bolu A, Aydemir E, Akarsu S,
The relationship between antioxidant capacity and attack properties in bipolar disorder patients
S92
Bozkurt-Zincir S, Kurt YG, Erdem M,
Uzun O
48
Demir N, Topal Z, Tufan AE
The relations between vitamin B12, folate and ferritin levels and clinical features of Turkish children
S93
and adolescents with ADHD and ADHD-NOS: a preliminary study
49
Baris-Usta M, Cakir M, Karabekiroglu K
Comparison of short-acting and osmotic releasing form of methylphenidate in children diagnosed
S93
with attention deficit and hyperactivity disorder
50
Annagur BB, Uguz F, Apiliogullari S,
Is there an association between psychiatric disorders and quality of sleep, quality of life,
Kara I, Gunduz S
demographic and clinical characteristics in patients with chronic pain?
51
Ayaz AB, Ayaz M, Senturk E, Soylu N,
Factors related with unintentional injuries in attention-deficit/hyperactivity disorder
Akgul M, Yuksel S, Yulaf Y
S94
S95
Contents
Author(s)
Tit­le
Oral Presentations
The comparison of anxiety and depression levels among cardiology patients with palpitations
S97
Dissociative disorders in an outpatient clinical sample
S97
Lithium enhances alpha and beta oscillations in cognitive networks
S98
Bolu A, Erdem M, Balikci A, Bilgen AE,
The relationship between serum levels of haptoglobin and neopterin and the number of episodes in
S99
Akgul EO, Uzun O, Oztosun M
patients with major depression
Perdahli-Fis N
Distinguishing bipolar disorders from psychotic disorders in adolescents and subtleties of
1
Abatan E, Yildirim O, Erdem A,
Boztas MH, Arisoy O, Tuman TC,
Sercan M
2
Yanartas O, Akar-Ozmen H, Citak S,
Bozkurt-Zincir S, Aydin-Sunbul E
3
Atagun MI, Guntekin B, Tan D, Tulay EE,
Basar E
4
5
S99
indistinguishable cases
6
Kircelli EF, Kircelli F
Lamotrigine induced extrapyramidal side effects: a case report
S100
7
Altynbekov S
The concept of development of mental health services in the republic of Kazakhstan
S101
8
Hodzhaeva N, Sultanov S, Ashurov Z
Treatment of the asthenoadynamic variant of post withdrawal disorders in opioid addiction
S101
9
Oznur T
Psychotherapy of sleep disturbances in posttraumatic stress disorder
S102
10
Kilincaslan A, Mutluer T, Pasabeyoglu B,
Treatment of children with autism spectrum disorders and co-existing attention deficit
S103
Tutkunkardas MD, Mukaddes NM
hyperactivity disorder, with atomoxetine: a retrospective study
11
Dallay ALS, Bales M, Pambrun E,
Influence of psychotropic drug exposure during pregnancy on neonatal infant outcome
S103
Freudenthal NMCG, Verdoux H,
12
Erşan EE
Properties of antipsychotics in patients with schizophrenia in care centers
S104
13
Sertcelik M, Gurkan CK
Fluoxetine and aripiprazole treatment for OCD in a child with Wolfram syndrome
S105
14
Benk F, Gundogdu U, Calisir-Murat D,
‘Everybody looks at my nose’: a case report of an adolescent patient with body dysmorphic disorder
S105
Rodopman-Arman A
Contents
Tit­le
Author(s)
Poster Presentations
1
Degerli HE, Altinbas K, Delice M, Kurt E
Four bipolar patients treated with quetiapine during pregnancy
S108
2
Dirik N, Arslan M, Oflezer O, Kurt E
Chronic otitis media frequency in schizophrenia patients
S108
3
Oztav T, Arslan M, Oflezer C, Canbek O,
Safety of electroconvulsive therapy in pregnancy
S109
Kurt E
4
Budakli AA, Ates MA, Oner I, Cetin M,
Aripiprazole induced tardive dyskinesia: a case report
S109
Basoglu C, Algul A, Balibey H, Ebrinc S
5
Yancar-Demir E, Sayin A
A patient with prolonged hyperprolactinemia caused by clozapine: a case report
S110
6
Yancar-Demir E, Sutcigil L
Secondary delusional parasitosis
S110
7
Percinel I, Yazici KU, Erermis S, Ozbaran B,
The importance and efficiency of clozapine treatment in early-onset and very early onset
S111
Kose S, Zemla1, Tugba Donuk JM, Idris B
schizophrenia cases: discussion over the observation process of five cases
8
Ozer E, Enginyurt O, Yancar-Demir E
Evaluation of criminal responsibility for children between 2005-2009 in Corum
S111
9
Karabulut S, Yargic LI
A case report of benzodiazepine dependence
S112
10
Ertekin H, Aydin M, Yardim-Ozayhan H,
Very early onset schizophrenia treated with a combination of clozapine and risperidone:
S113
Akpinar A
a case study
11
Tuman TC, Topal Z, Demir N, Tufan AE
Possible exogenous growth-hormone induced mood disorder with mixed features in a child:
S113
a case presentation
12
Tikir B, Caglar N, Aydemir MC, Goka E
A Fahr’s disease case presented with psychotic manic epizode
S114
13
Yancar-Demir E, Gozlukaya O,
Dose related hyperprolactinemia with venlafaxine: a case report
S114
Olgun-Yazar H
14
Alpaslan AH, Soylu N, Avci K, Guzel HI,
The association between problematic internet use, suicide probability, alexithymia and loneliness
S115
Ozbulut O
among Turkish medical students
15
Tuman TC, Asdemir A, Basturk M
Delusional disorder probably induced by bupropion
S116
16
Nebioglu M, Yuksel G, Ozer U, Eroglu Y
Depression, anxiety and sociodemographic features in first degree female psychiatric outpatient
S116
relatives of alcohol abusers
17
Unver H, Cakin-Memik N, Simsek E
Priapism associated with addition of risperidone to methylphenidate monotherapy: a case report
S117
18
Karadere ME, Yazla E
Antipsychotic treatment of patients who are recorded in Corum Community Mental Health Center
S117
with the diagnosis of psychotic disorders117
19
Donuk T, Percinel I, Baytunca B,
Aripiprazole agumentation in treatment-resistant obsessive compulsive disorder in child and
Kacamak D, Bildik T, Erermis S
adolescent: case series
20
Bahali K, Ipek H, Yalcin O, Orum O
Atomoxetine-induced mydriasis in a child
S119
21
Bahali K, Yalcin O, Avci A
Atomoxetine-induced bruxism
S119
22
Semiz M, Pazarci O, Kavakci O,
Post-operative psychiatric findings after orthopedic surgery
S119
Oztemur Z, Bulut O
23
Semiz M, Kavakci O, Peksen H,
Post-traumatic stress disorder, alexithymia and somatoform dissociation in patients with
S120
Tuncay MS, Ozer Z, Aydinkal-Semiz E,
fibromyalgia
Kaptanoglu E
S118
Contents
Author(s)
Tit­le
Poster Presentations
S121
24
Sahin S, Yalcin I, Senel S, Ataseven H,
Assessment life quality of familial mediterranean fever patients by short form-36 and its relationship
Uslu A, Yildirim O, Semiz M
with disease parameters
25
Sahan E, Zengin-Eroglu M, Akpinar E,
Olanzapine and tardive dyskinesia: a case report
S121
Talas A
26
Alpaslan AH, Soylu N, Avci K,
Association between premenstrual syndrome and alexithymia among Turkish university students
S122
Uzel-Tas H, Ozbulut O
27
Yanartas O, Akar-Ozmen H, Citak S,
Dissociative disorders in an outpatient clinical sample
S123
Bozkurt-Zincir S, Aydin-Sunbul E
28
Ozyurt G, Oztura I, Alkin T, Ozerdem A
Anxiety disorders due to epilepsy: a case report
S123
29
Alpaslan AH, Soylu N, Guzel HI
Assessment of parental punishment among children and adolescents with elimination disorders
S124
30
Dere-Yilmaz F, Kurt E, Yesilbas-Lordoğlu D,
Comparison of sociodemographical properties and clinical course in bipolar disorder patients
S124
Yavuz KF
provided with single and double mood stabilizer in maintenance treatment
31
Percinel I, Donuk T, Kose S, Ozbaran B,
Efficacy and tolerability of aripiprazole on pervasive development disorders
S125
Erermis S, Kacamak D, Celenay S, Tekin U,
Bildik T, Aydin C
32
Atilan U, Karababa IF, Kati M, Asoglu M,
Depression with psychotic features due to hypothyroidism: a case report
S126
Bayazit H
Psychotic depression and obsessive compulsive disorder after head trauma: a case report
S127
Colloid cyst in third ventricule and catatonic depression: a case report
S127
33
Acar G, Izci F, Ergun F, Bilici R,
Bozkurt-Zincir S, Semiz UB
34
Ergun F, Izci F, Acar G, Bozkurt-Zincir S,
Bilici R, Semiz UB
35
Findikli E, Orhan FO, Askar A, Oksuz AN
Tramadol induced status epilepticus in an old woman with polydrug abuse
S128
36
Kraineva VA, Kotelnikova SO, Gudasheva TA
Evaluation of the ”therapeutic window” of GK-2 in intracerebral posttraumatic hematoma
S128
model in rats
Repetitive transcranial magnetic stimulation in the treatment of auditory hallucinations: a case report
S129
Oner I, Yilmaz O, Budakli AA, Balibey H,
Clinical approach to tardive dyskinesia associated with combination of atypical-typical antipsychotic
S129
Ates MA
medication: A case report
39
Oner I, Yilmaz O, Budakli AA, Balibey H,
Schizophrenia-like psychosis induced by a single dose of cannabis: a case report
S130
Ates MA
40
Tekin A, Kayran Y, Ozdil E, Yukcu B,
Munchausen syndrome by proxy: a case report
S131
Dalgic-Karabulut N, Kenar J, Ozer OA
41
Findikli E, Orhan F, Yalcin-Yetisir N
Comorbid obsessive compulsive disorder and mood disorder in a SLE patient: a case report
S131
42
Buyukdeniz A, Yusufoglu C, Yilanli M
An adolescent with Sanfilippo type 3B and effect of aripiprazole and atomoxetinetreatment:
S132
37
Oner I, Yilmaz O, Budakli AA, Balibey H,
Ates MA
38
a case report
43
Yilmaz ED, Deveci E, Kadioglu H,
Dursun AE, Kirpinar I
Anxiety, depression and personality in patients with mastalgia
44
Yilmaz ED, Deveci E, Gulec H, Kirpinar I
Correlation between anxiety and personality in caregivers for patients with schizophrenia
45
Yilmaz ED, Deveci E, Gulec H, Kirpinar I
Is anxiety and depression related with personality in caregivers for patients with bipolar disorder?
S132
133
S133
S133
Contents
Author(s)
Tit­le
Poster Presentations
46
Deveci E
Neurocognitive functioning in acne vulgaris
S134
47
Canpolat S, Deveci E, Kirpinar I, Aksoy H,
Relationship of asymmetrical dimethylarginine, nitric oxide and cognitive functions in patients with
S135
Bayraktutan Z, Eren I, Demir R, Aydin N,
major depressive disorder
Selek S
48
Kandeger A, Akdemir A, Annagur BB
Klinefelter’s syndrome concurrent to psychosis: a case report
S135
49
Ayaz AB, Imren SG, Gumustas F, Ayaz M
Autistic spectrum symptoms in subtypes of attention deficit hyperactivity disorder
S136
50
Akman O, Orhan FO, Ozturk P, Ozer A,
The psychiatric profile of chronic pruritus patients
S137
Akman Y, Karaaslan MF
51
Oksuz AN, Orhan FO, Ekerbicer HC,
Night eating syndrome and binge eating disorder in depression
S137
Karaaslan MF, Findikli E
52
Balci-Sengul C, Kalkanci O, Karadag F,
Antipsychotics and metabolic syndrome: a naturalistic six-month follow-up study
S138
Sengul C
53
Keskin U, Erdem M, Akarsu S, Bolu A
The effect of polycystic ovary syndrome phenotypes on quality of life, depression and anxiety levels
S139
54
Pan E, Bolu A, Ay SA
Impaired glucose tolerance metabolism after the use of antidepressants: a case report
S139
55
Bolu A, Erdem M, Parlak A, Oz O
Epileptic story and coping attitudes
S140
56
Bolu A, Balikci A, Erdem M, Bozdemir M,
The relationship between the levels of anxiety and coping attitudes of nurses working at a training
S140
Balibey H, Bozkurt-Zincir S
hospital
57
Pan E, Bolu A
Acquired stuttering starts due to the usage or exposure to volatile substances: two case reports
S141
58
Erdem M, Bolu A, Oz O, Unlu AG
Lesion localization and depressive symptoms in patients with multiple sclerosis
S142
59
Erdem M, Bolu A, Balikci A, Aydemir A,
Frequency of head trauma history in patients with narcolepsy
S142
Alper M
60
Erdem M, Bolu A, Balikci A, Aydemir A,
Serum neopterin levels in patients with narcolepsy
S143
Alper M
61
Bolu A, Pan E
Escitalopram-induced oligomenorrhea: two cases
S143
62
Bolu A, Erdem M, Oz O, Uzun O
Physical injury and cortical excitability in patients with posttraumatic stress disorder
S144
63
Bolu A, Erdem M, Akarsu S, Celik C, Uzun O
Clinical severity and neural excitability in posttraumatic stress disorder
S144
64
Bolu A, Erdem M, Balikci A, Oznur T,
Aggression and cortical excitability Iin patients with posttraumatic stress disorder
S145
Celik C, Uzun O
65
Erdem M, Bolu A, Develi A, Aydemir E,
The ratio of the second to fourth fingers (2D:4D) in schizophrenia
S145
Alper M
66
Erdem M, Unlu G, Akarsu S
Methylphenidate treatment in a patient with bipolar disorder and attention deficit hyperactivity
S146
comorbidity: a case report
67
Oznur T, Erdem M, Unlu G
Treatment resistant monosymptomatic hypochondriac psychosis: a case report
S146
68
Inanc L, Bezgin CH, Semiz UB
Sertraline induced vaginal hemorrhage: a case report
S147
69
Oznur T, Erdem M
Efficacy of eye movement desensitization and reprocessing (EMDR) technique in a patient with
S147
posttraumatic stress disorder (PTSD) and secondary enuresis diurna: a case report
Contents
Author(s)
Tit­le
Poster Presentations
70
Oznur T, Erdem M
Treatment of chronic phantom pain with Eye Movement Desensitization and Reprocessing (EMDR)
S148
method: a case report
71
Maden O, Oznur T, Erdem M, Kosem R
Coprophagia that occur during dissociative episodes: a case report
S148
72
Oznur T, Kosem R, Erdem M, Maden O
Epilepsy and brief psychosis: a case report
S149
73
Erdem M, Gulsun M
Relationship between symptom distribution and severity of generalized anxiety disorder
S149
(GAD) with gender and marital status
74
Oznur T, Erdem M, Durmus M
Delirium due to electrical injury: a case report
S150
75
Oznur T, Erdem M
Prolonged exposure (PE) application in a case of posttraumatic stress disorder with dissociation:
S150
indication or contraindication?
76
Erdem M, Gumus S, Aydogan M, Alper M
Sociodemographic characteristics of patients who admitted to smoking cessation clinic of a university
S151
hospital
77
Semiz UB, Inanc L, Bezgin CH
The role of trauma and dissociation in treatment resistant obsessive compulsive disorder
S151
78
Budakli1 AA, Ulcay A, Karagoz E,
Moxifloxacin induced brief psychotic episode: a case report
S152
Tutuncu1 R
79
Alasehirli B, Oguz E, Gokcen C, Erbagci AB,
The relationship between soluble intercellular adhesion molecules and attention deficit hyperactivity
S152
Orkmez M, Demiryurek AT
disorder
80
Oznur T, Akarsu S, Karaahmetoglu B, Doruk A
Management of the spontaneous ejaculation emerging after traumatic event: a case report
S153
81
Sahin S, Yuce M, Alacam H,
Effects of methylphenidate treatment on appetite and leptin, ghrelin, adiponectin, brain-derived
S153
Karabekiroglu K, Say GN, Salis O
neurotrophic factor levels in children with attention deficit hyperactivity disorder
82
Balci-Sengul C, Karadag F, Sengul C,
The factors related to the development or reversal of metabolic syndrome in the patients
Kalkanci O, Karakulah K, Akin F
schizophrenia and schizoaffective disorder: a naturalistic follow-up
83
Kara K, Congologlu MA, Durukan I, Karaman D
Psychogenic polydipsia in an adolescent with eating disorder: a case report
S155
84
Karayagmurlu A, Kutuk MO, Coban N,
Clonidine treatment in a tuberous sclerosis case with behavioral problems associated with mental
S155
Gokcen C
retardation
85
Pekcanlar-Akay A, Capa-Kaya G, Baykara B,
Tc-99m TRODAT-1 brain spect changes in adolescents with attention deficit hyperactivity disorder:
Demir Y, Ozek H, Alsen S, Sencan-Eren M,
after 2-month -OROS-methylphenidate therapy
Inal-Emiroglu N, Ertay T, Ozturk Y,
Miral S, Durak H
86
Annagur BB, Akbaba N
A case of the development of neuroleptic malignant syndrome following the hyponatremia
S157
87
Pekcanlar-Akay A, Capa-Kaya G, Baykara B,
Pre-treatment and post-treatment Tc-99m TRODAT-1 brain spect findings in three patients with
S158
Demir Y, Ozek H, Alsen S, Sencan-Eren M,
attention deficit and hyperactivity disorder, who were treated by 2-month- atomoxetine treatment
Inal-Emiroglu N, Ertay T, Ozturk Y, Miral S,
Durak H
88
Semiz M, Yildirim O, Canan F, Demir S,
Hasbek E, Tuman TC, Kayka N, Tosun M
89
S154
S156
Red cell distribution width (RDW) in patients with schizophrenia
S159
Guney E, Uneri OS, Arhan EP, Karalok ZS
Psychotic symptoms improved with antiepileptic therapy in childhood: a case with ictal psychosis
S159
90
Taymur I, Aypak C, Ozdel K, Turedi O,
Complicated grief and depressive disorder among elderly patients who applied to psychiatrists and
S160
Duyan V, Akgul AI
family physicians
Contents
Author(s)
Tit­le
Poster Presentations
91
Askar A, Orhan FO, Findikli E, Gokce M
Huntington’s disease misdiagnosed as schizophrenia: a case report
S161
92
Karaman D, Durukan I, Erdem M
Childhood narcolepsy: a case report
S161
93
Karaman D, Durukan I, Erdem M, Kara K
The practice of pharmacological treatment in a child and adolescent psychiatry outpatient clinic
S162
94
Akarsu S, Torun D, Bolu A, Kozan S,
The relationship between mitochondrial complex I-III gene mRNA levels and clinical features of the
S162
Akar H, Uzun O
patients with schizophrenia
95
Murat D, Poyraz-Findik OT, Gundogdu U,
Pisa syndrome during aripiprazole treatment in an autistic patient
S163
Arman A
96
Guzel-Ozdemir P, Ozdemir O
Hirsutism due to mirtazapine treatment
S164
97
Ceylan MF, Cetinkaya M
Does treatment-resistant obsessive compulsive disorder and attention deficit hyperactivity disorder
S164
comorbidity have any risk for bipolar disorder? two case reports
98
Annagur BB, Kandeger A
A case of Klinefelter’s syndrome: a 18 years old male with antisocial personality disorder
S165
99
Akkin-Gurbuz HG, Poyraz BC
Frontal lobe syndrome or attention deficit hyperactivity disorder? diagnosis of impulsivity and
S166
hyperactivity symptoms after traumatic brain injury and its treatment
100
Tuman TC, Asdemir A, Basturk M
Hypothyroidism induced psychosis: a case report
S166
101
Durmaz O
Trifluoperazine induced stuttering: a case report
S167
102
Bulbul F, Alpak G, Unal A, T. Kilic OH,
Knowledge and attitudes of resident trainees regarding electroconvulsive therapy
S167
Ermis B, Savas HA
103
Bulbul F, Alpak G, Unal A, T. Kilic OH,
Misuse of methylphenidate and level of knowledge about methylphenidate among resident
S168
Ermis B, Savas HA
physicians
104
Bulbul F, Copoglu US, Alici D, Tastan MF,
Relationship between diagnosis, drug addiction and crime in forensic psychiatry
S169
Unal A, Alpak G, Savas HA
105
Tuman TC, Topal Z, Demir N, Tufan AE
A probable case of very early onset schizophrenia managed with risperidone
S169
106
Cetinkaya M, Sahin M, Kara H,
A case of adolescent bipolar disorder presented with catatonic picture
S170
Demircan-Tulaci O, Eraslan AN, Bodur SN
107
Murat D, Demir N, Benk F, Gundogdu U,
Drug induced behavioral disinhibition in children treated with selective serotonin reuptake inhibitors
S170
Irmak MY, Perdahli-Fis N, Arman A
108
Tuman TC, Altunay-Tuman B,
Urticaria and angioedema associated with bupropion: three cases
S171
Goksugur N, Kayka N, Yildirim O
109
Erbilgin S, Coskun M
Atypical Rett syndrome in a young boy with c.316c>T mutation in MECP2 gene
S172
110
Berk SS, Karaaslan MF, Tuncel D,
Depression and assessment of the life quality among patients with obstructive sleep apnea syndrome
S172
Ekerbicer HC, Orhan FO, Findikli E, Berk E
111
Akkus M, Kok B, Karamustafalioglu N,
A case report of sexual dysfunction due to hyperprolactinemia associated with increased dose of
S173
Kalelioglu T
paliperidone palmitate injection
112
Tuman TC, Kayka N, Eroglu T, Yildirim O
Huntington’s disease, concurrent to dementia: a case report
S173
113
Ozyurt G, Yalin-Sapmaz S, Inal-Emiroglu N
Neuroleptic malign syndrome during antipsychotic treatment with lithium: two adolescent patients
S174
with bipolar disorder
Contents
Author(s)
Tit­le
Poster Presentations
114
Yancar-Demir E, Enginyurt O, Ozer F,
Aydemir-Ozcan T, Cankaya S
Restless legs syndrome prevalence and depression-anxiety disorder association in anemic patients
S175
Is paroxetine effective in the treatment of premature ejaculation?
S176
115
Turkoglu-Dikmen SN, Safak Y, Tulaci RG,
Kilinc S, Kuru E
116
Tuman TC, Kayka N, Eroglu T, Yildirim O
Psychosis in Huntington’s disease: a case report
S176
117
Babadagi Z, Karabekiroglu K
Factors that influence approval to psychiatry clinics in early childhood: 669 cases in a community
S177
and clinical sample
Dissociation and childhood trauma in patients with bipolar disorder
S178
The relationship between sleep quality and nitric oxide in healthy volunteers
S178
Factors affecting the quality of sleep in healthy population
S179
Kutuk MO, Bacaksizlar-Sari F, Kutuk O,
Aripiprazole treatment combined with methylphenidate in a 46,XY, YQ+ case with borderline mental
S180
Kaytanli U
capacity and multiple psychiatric disorders
122
Toz HI, Ozen S, Tasdemir DM, Ozer U,
Bilateral pedal edema with olanzapine treatment: a case report
S181
Toz B, Ozgen G
123
Eray S, Colpan M, Vural AP
Perspectives of residents on psychiatric drugs
S181
124
Ozcan A, Cikili-Uytun M, Uytun S,
Dystonia due to sertraline use: a case report
S182
Poyrazoglu G, Ergul AB, Altuner-Torun Y
125
Gunes A, Kilincaslan A, Zoroglu SS
Evaluation of antipsychotic treatment in pediatric OCD cases
S182
126
Karaarslan D, Inal-Emiroglu N,
Family treatment in child and adolescents with bipolar disorder: two case samples
S183
Miklowitz DJ
127
Hizli-Sayar G, Ozten E, Eryilmaz G,
Aripiprazole induced hypertension: a case report
S184
Gogcegoz-Gul I, Erkmen H
128
Eryilmaz G, Hizli-Sayar G, Unsalver BO,
A retrospective review assessing the safety of transcranial direct current stimulation (tDCS) as a
S184
Gogcegoz-Gul I, Ozten E, Saglam E
method of non-invasive brain stimulation in psychiatry
129
Ermis A, Solmaz-Turkcan A, Dasdemir S,
The relationship between Cathecol-O-Methyltransferase enzyme Val158Met polymorphism and
Cakmakoglu B
premorbid cannabis use in male patients with schizophrenia
130
Kara H, Cetinkaya M, Sahin M,
Priapism-like erection during the treatment with risperidone: a case with childhood dissociative
Demircan-Tulaci O, Eraslan AN,
disorder
Ersoz-Alan B, Bodur S
131
Babalioglu M, Maner AF, Cetinkaya ZO,
Alici S
132
Evren C, Karabulut V, Can Y, Bozkurt M
118
Tekin A, Ozdil E, Guleken MD, Bakim B,
Ozer OA, Karamustafalioglu O
119
Bolu A, Ozkisa T, Aydogan M, Ay SA,
Akarsu S, Uzun O
120
Ozkisa T, Bolu A, Aydogan M, Unlu AG,
Ozmenler KN
121
S185
S185
Arachnoid cyst in two patients with first episode psychosis: case reports
S186
Factorial structure and reliability of Bakırköy opioid withdrawal scale among heroin dependent
S186
patients
133
Dalkiran-Varkal M, Turan S, Dikmen B
Phantom limb pain treatment with duloxetine:a case report
S187
134
Sevincer GM
Night eating syndrome: report of a family case
S188
Contents
Author(s)
Tit­le
Poster Presentations
135
Walha A, Hadjkacem I, Turki M, Jalouli S,
Cherif L, Khemakhem K, Moalla Y, Ayadi H,
Ghribi F
136
Comorbidity between anxiety and somatic disorders in children and adolescents: Tunisian study
S188
Lin K, Xu G, Lu W, Ouyang H, Dang Y,
The predictive values of neuropsychological performance on antidepressant response in three
S189
Seva UL, Guo Y, So KF, Lee TMC
subtypes of major depression: a 6-week longitudinal study
137
Gules Z, Aksu H, Avcil S, Gurbuz-Ozgur B
The side effect profiles and efficacy of aripiprazole in patients with autism spectrum disorder
S190
138
Eryilmaz G, Hizli-Sayar G, Semieoglu S,
Influence of valproate on propofol dose in manic episode patients receiving electroconvulsive
S190
Gogcegoz-Gul I, Ozten E
therapy
139
Guney E, Uneri OS
Atomoxetine induced hypomania-like symptoms in a pre-adolescent patient
S191
140
Zabun S, Sertcelik S, Nebioglu M,
A case report of valproate-induced hyperammonemic encephalopathy
S192
Erkiran G, Eroglu M, Topbas E
141
Taymur I, Sari S, Gungor B, Inel A,
Interferon treatment leading to depression with psychosis: a case report
S192
Dagli O, Burcu AN, Askin R
142
Taymur I, Ozdel K, Duyan V, Sargin AE,
Relationship between temperamental and character features and suicide attempts with drugs
S193
Demiran G, Gungor B, Turkcapar MH
143
Aydin R, Yuncu Z
Determinant factors on positive or negative course in adolescents presented by probation in a
S194
substance abuse treatment center
144
Yusufoglu C, Yaman-Aslan Z,
Mydriasis after initiating therapy with atomoxetine in a boy with juvenile osteopetrosis: a case
Buyukdeniz A
report
145
Uygun E, Bestepe EE
Bupropion-induced psychosis: a case report
S195
146
Oge C, Tutuncu R, Basoglu C
Suicidality in Klinefelter’s syndrome: a case report
S195
147
Olam N, Tayfur E, Bez Y
Cerebellar agenesia and schizophrenia: a case report
S196
148
Yuksek E, Sakalli-Kani A, Ceri V,
The attitudes of patients toward the presence of students in psychiatry outpatient clinical practice
S196
Toprak M, Yildiz E, Aksoy-Poyraz C,
Emul M
149
Oncu M, Tutuncu R, Ates A, Algul A
Lightning and psychiatric results: a-3-year-follow-up case report
S197
150
Sogutlu L, Karacetin G
Agitation associated with methylphenidate in a child: a case report
S197
151
Guncu H, Uguz F
Gastrointestinal side effects in the baby of breastfeeding woman treated with low-dose fluvoxamine:
S198
S194
a case report
152
Tekin G, Acikel SB, Uguz F, Kaya N
Clinical improvement in Korsakoff’s syndrome with donepezil usage: a case report
S198
153
Akbaba N, Annagur BB
Can lithium routinely used for the treatment of antipsychotics-induced neutropenia?
S199
S200
154
Levent M, Tutuncu R, Balibey H,
Daily repetitive transcranial magnetic stimulation (RTMS)may improve mood in depression: a case
Basoglu C
report
155
Ipekcioglu D, Akkus M,
Safety and efficacy of combined clozapine-colchicine treatment in a case of schizophrenia with
Karamustafalioglu N, Kok B, Ilnem MC
Behçet’s disease: a -6-mounth follow-up
156
Ucok-Demir N, Irmak MY, Benk F,
A 10-case series of selective mutism: an emphasis on comorbidity
Ayranci G, Perdahli-Fis N
S200
S201
Contents
Author(s)
Tit­le
Poster Presentations
Prevalence of learning disorders in the region of Sfax, Tunisia
S201
Olfactory reference syndrome: two case reports
S202
Treatment with atomoxetine: a case with Williams syndrome
S202
Thalamic hematoma with psychotic symptoms: a case report
S203
Oral health among outpatients with bipolar disorder
S204
Romanov D, Smirnova D
The diagnosis of “psychopathy” through the prism of ICD-10
S204
163
Gurok MG, Mermi O, Kilic F, Canan F,
Psychotic episode during use of hypericum perforatum
S205
Kuloglu MM
164
Gunes T, Zengin-Eroglu M, Nebioglu M,
A case report of attempted suicide with subcutaneous cyanide injection
S205
Zabun S, Topbas E, Yuce S
165
Mermi O, Atmaca M, Kilic F, Gurok MG,
Fluoxetine induced hair loss: a case report
S206
Kuloglu M
166
Nasiroglu S, Kadak MT, Bektas MS, Gulsen S
Delirum induced with escitalopram: a case report
S207
167
Sahin-Can M, Yilmaz EG, Baykan O,
Assessment of neutrophil - Iymphocyte ratio in Alzheimer’s disease and major depressive disorder
S207
Baykan H, Karlidere T
patients
168
Metin H, Ozer U, Ozen S, Ozgen G
Amisulpride-induced maculopapular rash: a case report
S208
169
Karayilan S, Yigit H, Orsel ES, Ozten M,
ECT treatment during the manic episode a treatment-resistant patient with bipolar disorder and
S208
Erol A
comorbid epilepsy
170
Bilginer C, Duran B, Ince C,
Changes in the preference of the psychotropic drugs in child and adolescent psychiatry outpatient
Tural-Hesapcioglu S, Kandil S
practice in five years
171
Basoglu E, Simsek Y, Ozdilek B
The use of clozapine for the treatment of Parkinson’s disease
S210
172
Yalcin-Yetisir N, Orhan FO, Findikli E
An epileptic psychosis associated with self-injurious behavior, a possible new syndrome: a case
S210
157
Chérif L, Ayedi H, Khemekhem K,
Hadjkacem I, Mchirgui R, Walha1 A,
Moalla F, Moalla Y, Triki C, Ghribi1 F
158
Subasi N, Yanartas O, Sonmez HE,
Arican SA, Sayar K
159
Gundogdu U, Benk F, Bahadir AT,
Arman A
160
Akdag EM, Paltun SC, Akdag H,
Aydemir MC, Goka E
161
Oflezer O, Altinbas K, Arslan-Delice M,
Kurt E
162
S209
report
Worsening of psychotic symptoms due to abuse of modafinil: a case report
S211
Sahingoz M, Turgut K, Sonmez EO
Mania in Cushing’s syndrome: a case report
S212
175
Sonmez EO, Sahingoz M
Aripiprazole-induced exanthematous rash
S212
176
Sahingoz M, Sonmez EO
Ecchymoses related to paroxetine and sertraline
S213
177
Sonmez EO, Aksoy F, Kaya N
Priapism caused by amisulpiride
S213
178
Gelegen V, Cakmak S, Tamam L
Clozapine-associated weight loss: a case report
S214
173
Erzin G, Tatlidil-Yaylaci E, Cingi-Kuluk M,
Atguden N, Aydemir MC, Goka E
174
Contents
Author(s)
Tit­le
Poster Presentations
179
Bildik H, Ozkorumak E, Tiryaki A
The comparison of neurocognitive functions in psychiatric patients with and without attention deficit
S214
hyperactivity disorder comorbidity and healthy volunteers
180
Baykan H, Baykan O, Ustunsoy S, Aydin D,
Yargic I
181
Kayka N, Ocak T, Arisoy O, Tekce H,
Tuman TC, Yildirim O
182
Oflaz S, Yildizhan E, Baran-Tatar Z,
Akyuz F, Kurt E
183
Can plasma nesfatin-1 level predict major depressive disorder?
S215
Suicide attempt with clozapine in a schizophrenia patient
S216
Recurrent hypomania induced by lamotrigine
S217
Akyuz F, Oflaz S, Alatas G, Yanik M
Health care workers attitudes toward electroconvulsive therapy
S217
184
Gokcen C, Isik M, Karayagmurlu A,
The relationship between traumatic orthopedic injuries and attention deficit hyperactivity disorder
S218
Pamukcu U
symptoms in children
185
Akpinar A, Ceyhan MA, Yaman RA
Bupropion-induced psoriasis in patient with major depression: a case report
S218
186
Akpinar A, Kaplan-Basal F, Kidir V,
Nephrocalcinosis associated with diuretic and laxative abuse in anorexia nervosa
S219
Ozdamar-Unal G, Sezer MT
187
Chérif L, Ayedi1 H, Khemekhem K,
Comorbid psychiatric disorders in children with learning disorders
S219
Hadjkacem I, Walha1 A, Mchirgui R,
Moalla F, Moalla Y, Triki C, Ghribi F
188
Gurbuz-Ozgur B, Altinyazar V, Ozdemiroglu F
Use of N-acetyl cysteine in treatment-resistant schizoaffective patient with tardive dyskinesia: a case
S220
report
189
Gumustas F, Yulaf Y
A case report of sexual side effect with sustained release methylphenidate
S221
190
Yulaf Y, Gumustas F, Ayaz M
School starting age: parent’s views about school readiness and children’s emotional and behavioral
S221
characteristics
191
Yusufoglu C, Gokce S, Buyukdeniz A, Kayan E
Deep vein thrombosis in Klinefelter syndrome with aripiprazole treatment
S222
192
Arguz D, Guvenir T, Alptekin K, Eresen C
The pedigree of schizophrenic patient
S222
193
Akbaba N, Selvi Y, Sayin AA, Akdemir A
Periheral edema associated with sertraline and olanzapine combination: a case report
S223
194
Poyraz-Findik OT, Benk F, Perdahli-Fis N,
Delay in diagnosis of a Prader-Willi Syndrome, until the age of ten: a case report
S223
Rodopman-Arman A
195
Gencoglan S, Dogru H, Akguc L,
Pimozide treatment for child with Tourette syndrome: a case report
S224
Ozatalay E
196
Bulbul F, Alici D, Aksoy I, Alpak G,
Maintenance electroconvulsive therapy in a patient with Parkinson’s disease and comorbid bipolar
S225
Unal A, Savas HA
disorder
197
Ugur C, Gurkan CK
Treatment resistance in a child with autism spectrum disorder who has a late phenylketonuria
S225
diagnosis
198
Akguc L, Gencoglan S, Kanal M,
Relationship between treatment of selective serotonin reuptake inhibitors and alexithymia in patients
Erkan M, Eryilmaz M
with major depressive disorder
199
Dogan-Bulut S, Tulaci RG, Turkoglu SN,
Hypersexuality after modafinil treatment: a case report
S227
Bulut S, Orsel S
200
Dogru-Kosker S, Aydin-Sunbul E, Cengiz FF,
Risperidone-induced enuresis: a case report
S227
Aksoy-Etlik A, Yeni-Elbay R, Gurdal S
S226
Contents
Author(s)
Tit­le
Poster Presentations
201
Keskin N, Cakmak S, Tamam L
Comorbidity of bipolar disorder and multiple sclerosis: a case report
S228
202
Inanli I, Kirac AS, Arslan M, Eren I
Manic episode after abrupt termination of 36-years of lithium usage
S228
203
Carpar E, Fistikci N
Delusion or corrosion? esophageal stricture presenting as delusion of supernatural beings in the
S229
gastrointestinal tract
S230
204
Ayranci G, Ucok-Demir N, Murat D,
Reviewing the cutaneous serotoninergic/melatoninergic system: a depressed adolescent with
Irmak MY, Rodopman-Arman A
sertraline induced rash
205
Cikili-Uytun M, Behice-Oztop D
EMDR therapy in an adolescent with posttraumatic stress disorder
S230
206
Inanli I, Kurkcu A, Ozbek S, Varsak N, Eren I
Severe extrapyramidal symptoms associated with the use of aripiprazole
S231
207
Annagur BB, Gunduz S, Tazegul A
Do psychiatric disorders continue during pregnancy in women with hyperemesis gravidarum?
S232
208
Donuk T, Idris B, Yilmaz E, Erdem H,
Efficacy and tolerability of aripiprazole in a daily practice outpatient population of child and
S232
Irmak R, Bulut MH, Bildik T, Erermis S
adolescent
209
Gokcen C, Coskun S, Coban N,
The comparison of pre-treatment and post-treatment depression and burnout levels of mothers of
Karayagmurlu A, Kutuk MO
children with ADHD
210
Aslan M, Hocaoglu C, Bahceci B, Kandemir G
Investigation of the relationship between hopelessness and reasons for living with suicidal ideation
S233
S233
in the elderly
211
Bozkurt-Zincir S, Dogru-Kosker S,
Suicidal behavior and its relationships with clinical features and sociodemographic variables in
Aydin-Sunbul E, Etlik-Aksoy A, Elbay R,
psychiatric inpatients
Cengiz FF, Gurdal S, Zincir S
212
Pusuroglu M, Hocaoglu C, Gulluce1 F,
Kandemir G, Bahceci B
S234
Hoarding disorder in adults: a case report
S235
Medical and cognitive behavioral therapy in a patient with pathological gambling
S235
Pentazocine abuse in a health care professional: acase report
S236
S237
213
Kuru E, Safak Y, Guriz SO, Tulaci RG,
Dikmen S, Ozdemir I
214
Enez-Darcin A, Nurmedov S, Dilbaz N,
Mordag O
215
Ozver I, Ozen S, Unal E, Saygili S, Koral F,
Criminal acts and psychopharmacologic medication: criminal act and their relation with criminal
Demir F
responsibility for psychiatric observation
216
Yilmaz S, Akca OF
Effectiveness of methylphenidate in the treatment of encopresis in a non-attention deficit/
S237
hyperactivity disorder subject
S238
217
Aslan H, Calisir1, Poyraz-Findik OT,
Effects of verbal/performance IQ discrepancies and language-based skills on reading performance in
Carkaxhiu G, Yazici Z, Eyilikeder-Tekin S,
dyslexia
Tokol ZO, Arman A, Zaimoglu S
218
Enez-Darcin A, Nurmedov S, Dilbaz N,
Hallucinogen induced psychotic disorder, 4-bromo-2,5-dimethoxyphenethylamine(2C-B) abuse: a
Mordag O
case report
A case report: tardive dyskinesia with aripiprazole
S240
S240
219
Tulaci RG, Turkoglu-Dikmen SN, Kuru E,
Safak Y, Dogan-Bulut S
220
Kalelioglu T, Genc A, Genc ES,
Comparison of clinical features between manic patients treated with/without electroconvulsive
Karamustafalioglu N, Akkus M, Tasdemir A,
therapy
Gungor FC, Emul M
221
Kocak MB, Pazvantoglu O, Cengiz N
A case report: psychosis after vagal nervus stimulation
S239
S241
Contents
Author(s)
Tit­le
Poster Presentations
222
Tetik DC, Buyukdeniz A, Yilanli M
Hyperthyroidism induced manic episode in a patient with bipolar affective disorder: a case report
S242
223
Gul A, Gul H, Erberk-Ozen N
Pseudocyesis in a case with anorexia nervosa
S242
224
Sakalli-Kani A, Yazici-Akkas S,
Electroconvulsive therapy in a patient with multiple sclerosis and depression: a case report
S243
Sevincer GM, Altintas A, Konuk N
225
Kayhan F, Kucuk A, Gungor T, Balkarli A,
Alexithymia, depression, anxiety levels and quality of life in patients with ankylosing spondylitis
S244
Karahan AY, Ozhan N, Kucuksen S
226
Sahiner IV, Karslioglu EH, Caykoylu A,
The correlations of negative symptoms with serum folic acid and cobalamin levels in patients with
S245
uncu OZ, Aydin S, Ozturk M, Albayrak MN,
schizophrenia
Aydin S, Ozalp E
227
Bozkurt-Zincir S, Zincir S, Ozdilek B
S246
Montreal cognitive assessment (MOCA) scale for the assessment of cognition in schizophrenia and
comparison with mini mental state examination (MMSE)
S246
228
Sener EF, Oztop DB, Korkmaz K, Zararsiz G,
Taheri S, Cikili-Uytun M, Ozkul Y
229
Akpinar A, Yaman AR
Dystonia secondary to increasing dosage of bupropion: a case report
S247
230
Oge C, Tutuncu R, Ates A, Basoglu C,
Electroconvulsive treatment of conversion disorder in a patient with Dandy Walker syndrome
S247
Cetin M
231
Kocael O, Hasar S, Vural AP
A case presentation: bipolar disorder with an early onset
S248
232
Akguc L, Gencoglan S, Erkan M
Monosymptomatic Kleine-Levin syndrome: a case report
S249
233
Goksan-Yavuz B, Ogel K
The prevalence and the impact of symptoms of attention deficit and hyperactivity disorder among
S249
The association of TNF-α and NOS3 gene expressions in autism
university students
234
Dagdelen F, Vural AP
Clinical manifestations in a patient with a diagnosis of depression, and an impulse control disorder
S250
comorbidity who had been exposed to sexual, and physical abuse: a case report
235
Alici S, Babalioglu M, Maner AF,
Ulukaya S, Girit-Cetinkaya O, Ersen H
236
Boz G, Balaban OD, Senyasar K, Yazar MS,
Eradamlar N
237
Gundogdu OY, Cakin-Memik N,
Tarakcioglu C, Cimen ID, Vatansever Z
238
Sari S, Taymur I, Gungor B, Burcu AN,
Askin R
239
Familial Mediterranean Fever and psychiatric disorders: three case reports
S251
Olfactory reference syndrome treated with escitalopram: a case report
S251
Evaluation of ADHD treatment impacts on functional impairment
S252
Psychotic depression associated with hyperthyroidism: report of two cases
S253
Ozdemir M, Eseroglu T, Karacetin G,
Treatment of early-onset schizophrenia in child and adolescent psychiatry inpatient clinic of
S253
Elagoz-Yuksel M, Erdogan A
Bakirkoy Mental Hospital
240
Sari S, Gungor B, Taymur I, Burcu AN,
Severe urinary retention associated with combined use of duloxetine and quetiapine in an elderly
Askin R
patient: a case report
241
Aldemir E, Ender-Altintoprak A,
Pregabalin dependence: a case report
S254
Kuman-Tuncel O
242
Sar S, Sahingoz M, Cicekci A, Cilli AS,
The assessment of the neuropsychological functions of siblings of patients with bipolar disorder
S255
Askin R
S254
Contents
Author(s)
Tit­le
Poster Presentations
243
Dogru H, Gencoglan S, Ozatalay E
Methylphenidate treatment for child with narcolepsy-cataplexy syndrome: a case report
S255
244
Akca OF, Yilmaz S
The effectiveness of methylphenidate in the treatment of encopresis independent from attention
S256
deficit/hyperactivity symptoms
Bipolar disorder and obsessive compulsive disorder comorbidity: a case report
S257
Is it ADHD or bipolar disorders? A case report
S257
Altintas E, Fatma Y, Taskintuna N
Psychiatric comorbidity and quality of life in cardiac syndrome X
S258
248
Yilmaz S, Colak-Sivri R, Akca OF
Oligomenorrhea related to fluoxetine use an adolescent with major depressive disorder: a case report
S259
249
Brandt L, Köchl B, Fischberger S,
Neonatal outcomes as a function of maternal opioid maintenance therapy: methadone versus
S259
Jagsch R, Fischer G
buprenorphine
250
Soylu N, Leblebisatan G
Investigation of the relation between intraarticular bleedings and symptom severity of ADHD in
245
Ulgen V, Irmak MY, Ayranci G,
Yanartas O, Dadali Z, Sayar K
246
Aydemir H, Oztop DB, Cikili-Uytun M,
Ozdemir-Demirci E
247
S260
children and adolescents with hemophilia
251
Soylu N, Carman KB, Daskaya H
Acute mercury poisoning with dissociative symptoms: a case report
S261
252
Uygur H, Aydin M, Eren I
Clozapine-induced leukocytosis: a case report
S261
253
Selvi Y, Tekinarslan E
Pramipexole use in treatment-resistant bipolar depression
S262
254
Kartal P, Zincir S, Tiyekli U,
Tardive dyskinesia and akathisia secondary to multiple drug use: a case report
S263
Bozkurt-Zincir S, Hariri AG
255
Eryilmaz G, Saglam E, Gogcegoz-Gul I
Paroxysmal atrial fibrillation and depression syndrome: a case report
S263
256
Tuncnan G, Emiroglu N, Aras S
Follow-up of a treatment resistant adolescent suffering from early-onset bipolar disorder responding
S264
to lithium
A schizophrenic case developing physical deformities
S265
Comparison of neurocognitive functions of offspring of schizophrenic, bipolar and controls
S266
Usta NG, Aksoy-Poyraz C, Duran A
Clozapine use during chemotherapy
S266
Yaci1 H, Kenar J, Gulec H
Reliability and validity of the Sexual Myths Questionnaire in vaginismus patients in Turkey:
S267
257
Ozbek S, Turkoglu-Ekmen S, Goktas D,
Eren I
258
Kenar J, Citak S, Ceylan ME, Yesilyurt S,
Yilmazer E
259
260
a preliminary study
261
Cinar MA, Aydemir K
How delirium affects physical rehabilitation outcomes? Case series
S268
262
Cinar MA
Examination of consultation liaison psychiatry referrals at a rehabilitation setting: one-year
S268
experience
Prolidase activity and oxidative stress in patients with schizophrenia
S269
Cinar MA
TBI and PTSD comorbidity among trauma survivors in a rehabilitation setting
S269
265
Ozdemir A, Aksoy-Poyraz C, Usta NG,
A case of levetiracetam induced psychosis presented with prominent disorganized behavior
S270
Erten E
266
Ozcan S, Kenar J, Tamam L, Gulec H
The Turkish version of the why sex (YSEX?) questionnaire
S270
263
Bahceci B, Bagcioglu E, Kokacya MH,
Dilek AR, Bahceci I, Selek S
264
Contents
Author(s)
Tit­le
Poster Presentations
267
Sayin AA, Selvi Y, Tekinarslan E
Carbamazepine treatment of psychogenic polydipsia in the presence of alcohol dependence: a case
S271
report
268
Cikili-Uytun M, Ozdemir-Demirci E,
Oztop DB
Angioedema induced by atomoxetine: a case report
S271
269
Bagcioglu E, Bahceci B, Helvaci-Celik F,
Obsessive beliefs in patients with major depressive disorders
S272
Polat S, Koroglu A, Kandemir G, Hocaoglu C
270
Sahin N, Altun H
Hiccup caused by aripiprazole use: a case report
S273
271
Gurgen A, Aksoy S, Yildiz D, Altinbas K
Are mood stabilizers harmful during pregnancy? a case report
S273
272
Gunay G, Adaletli H, Mutlu C, Tanidir C,
The characteristics of child and adolescent inpatients in a mental health hospital
S274
Ozdemir M, Gunes H, Metin H,
Elagoz-Yuksel M, Yalcin O, Kilicoglu AG,
Uneri OS
Role of nesfatin-1 on impaired appetite in patient with major depressive disorder
S274
Tardive dyskinesia in long term hospitalized patients with mental retardation
S275
The axis I disorders and family functioning in mothers of children admitting to the child psychiatry
S276
273
Bahceci B, Bagcioglu E, Dilek AR,
Helvaci-Celik F, Bahceci I, Asik AH
274
Can A, Burhan HS, Nalbant A, Cansiz A,
Yavuz KF, Arslan-Delice M, Kurt E
275
Sahingoz M, Gokcen C, Inanli I
clinic with temper tantrum
276
Poyraz-Findik OT, Zaimoglu S, Turkdogan D,
Mazlum B, Rodopman-Arman A
Impact of EEG abnormalities on attention and executive functions in ADHD
S276
Bupropion induced hypomania: a case report
S277
277
Budakli AA, Tutuncu R, Oner I, Ates MA,
Algul A, Basoglu C
278
Simsek Y, Basoglu E, Yaksi N, Yatkin I
The out-of-body experiement: a case report
S278
279
Bolu A, Aydin E, Aydin C, Atis G
Anger in patients with psoriasis
S278
280
Karacetin G, Varol-Tas F, Cakin-Memik N,
The characteristics of child and adolescent inpatient psychiatry services in Turkey
S279
Senturk B, Bayrak A, Uneri OS, Ozbaran B,
Soylu N, Erdogan A, Guvenir T, Vural P,
Cop E, Kose S
281
Batas-Bilgec S, Tanidir C, Kurban S,
Possible prenatal and genetic factors in the etiology of attention deficit hyperactivity disorder:
S280
Toz HI, Maner AF, Cetinkaya O, Uneri OS
a Turkish referred sample
282
Aydin E, Bolu A, Aydin C, Atis G,
Comparison of social anxiety levels in dermatological disorders with facial involvement
S280
Karabacak E
283
Dogru-Kosker S, Aydin-Sunbul E,
Priapism associated with trazodone therapy
S281
Cengiz FF, Ergin-Toktas H
284
Karayilan S, Orsel ES, Yigit H, Ozten M,
Case report: schizophrenia and periventricular leukomalacia
S281
Erol A
285
Karabacak E, Aydin E, Bolu A, Uzun O
Self-esteem in vitiligo patients with facial involvement
S282
286
Selvi Y, Kandeger A
A case report of sleep related eating disorder that responded to trazodone
S283
287
Bolu A, Ozselek S, Celik C, Doruk A
Gender difference in response to repetitive transcranial magnetic stimulation (rTMS) in patients with
S283
depression
Contents
Author(s)
Tit­le
Poster Presentations
288
Bolu A, Aydin E, Aydin C, Balikci A
Self-esteem in patients with psoriasis
S284
289
Yulaf Y, Gumustas F, Yazgan Y
A case report of persistent hyperkinetic movement disorder treatment with combination of
S285
tetrabenazine, clonazepam and aripiprazole
Mannerism or choreatetoid movements: a case report
S285
A case of avoidant/restrictive food intake disorder (ARFID): a new conceptual approach in DSM 5
S286
Ozen S, Liman Z, Es H, Ozer Y, Sanli AN,
Psychiatry cases alleged as malpractice that were evaluated by the 3rd Speciality Board of Council of
S287
Ozver I, Cagdir S
Turkish Forensic Medicine; an archival research between the years 2005-2010
293
Atabay E, Orengul AC, Ayranci G,
Treatment of skin picking behavior with atomoxetine: a case with corpus callosum agenesis and
Bahadir AT, Arman A
ADHD
294
Bolu A, Ozselek S, Doruk A, Uzun O,
Cortical excitability and response to rTMS treatment
S288
Ozmenler KN
295
Karslioglu EH, Ozalp E, Sahiner IV,
Does the combined antipsychotic treatment provide better control on the symptoms in schizophrenia
S289
Ozturk M, Albayrak MN, Aydin S, Aydin S,
patients than the monotherapy?
Yuncu OA, Caykoylu A
296
Tanidir C, Tanidir IC, Akdeniz C, Tuzcuoglu V
290
Eviz E, Cetinay-Aydin P, Yuksel G,
Emircan B, Erkoc S, Aydin N
291
Eviz E, Yuksel G, Cetinay P, Emircan B,
Erkoc S, Aydin N
292
Effectivity and safety of mirtazapine in an adolescent with a cardiac disease, arrhythmia and
S287
S289
depression: a case report
297
Sahingoz M, Inanli I, Ozyardim H, Eren I
Quetiapine induced mania: a case report
S290
298
Ozselek S, Bolu A, Doruk A, Ozmenler KN
The effects of rTMS treatment on anxiety symptomes in patients with depressive disorder
S291
299
H Gulec, Yazici-Gulec M, Usta H
Psychometric properties of the Udvalg for Kliniske Undersøgelser Side Effect Rating
S291
Scale (UKU-SERS) in patients with schizophrenia: a preliminary study
300
Ensari H, Koc A, Karatatar H
The use of therapeutic alliance portal to increase the compliance of schizophrenic patients
S292
Turkish Association for Psychopharmacology (TAP)
5thInternational Congress on
Psychopharmacology
&
International Symposium on
Child and Adolescent Psychopharmacology
Improved choices of psychotropic medications:
better mental health outcomes
October 30 - November 3, 2013
Cornelia Diamond Hotel, Antalya, Turkey
www.psychopharmacology2013.org
Scientific Program Abstracts
Scientific Program Abstracts
JOINT SYMPOSIA
[JS-1]
How to build efficient and sustainable community networks for new families
Jane I. Honikman
Postpartum Support International & Marcé Society
e-mail address: [email protected]
This presentation will explain the process that is essential to establish successful community based social support networks. There are
many different cultures in our world but they all include families, parents and children. Community support networks are designed to
strengthen them. They act as a safety net for new families. Families need and deserve supportive communities to bond with their peers
as well as reach out to professional services. Over the decades, studies consistently show that for good health and emotional well-being
we need each other. We know that social interactions are needed for optimum physical and mental health. The baby and the parents will
build lasting friendships, strong personal relationships, and social ties in a community that offers this opportunity. This talk provides the
history and background of the maternal mental health social support movement. The definition of a parent support network is broad
and there are many examples of successful networks. In general, networks are collaborations of agencies, consumers, and professionals
which provide social support, information, education, resources, and referrals. To build this network a framework format is required.
A format that consists of six major stages and many steps will be explained in this presentation. This pragmatic approach encourages
individuals to create a team of community stakeholders. The group will brainstorm, investigate community gaps in services, make plans,
initiate implementation, evaluate, and make long range plans for the future. It is crucial to create a structure that will be efficient, produce
measurable outcomes, and be sustained. The common bond among the organizers is the commitment to assist new families. Pregnancy
and the postpartum period are optimum times to assess for psychosocial issues, build trusting relationships, and speak frankly about
the risk factors of maternal mental illness. It is possible to confront the stigma and myths surrounding mental illness and parenthood by
building efficient and sustainable community support for new families.
Keywords: new family mental wellness, community support, social networks
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S1
[JS-1]
Interpersonal Psychotherapy (IPT) in the perinatal context
Oguz Omay1, Scott Stuart2
1Psychiatrist, La Teppe Medical Center, France
2Professor of Psychiatry and Psychology, University of Iowa, USA
e-mail address: [email protected]
Interpersonal Psychotherapy (IPT) is an Evidence-Based Psychotherapy for adults and adolescents. It has demonstrated efficacy for
affective disorders, anxiety disorders, eating disorders, PTSD and perinatal depression. IPT has also been demonstrated to be efficacious
as a maintenance treatment to prevent relapse of depression. IPT has been demonstrated to be effective when delivered in a variety of
settings, including mental health clinics and school-based clinics.
IPT is based on an attachment model, in which distress is tied to difficulty in interpersonal relationships. The targets of IPT are not only
symptoms, but also improvement in interpersonal functioning and relationships as well as improved social support. Therapy focuses on
one or more interpersonal problem areas, including Interpersonal Disputes, Role Transitions, and Grief and Loss Issues. IPT is time-limited,
and typical courses of therapy last from 8-20 sessions, which are tapered over time.
IPT has several advantages in addition to its well-established efficacy. It is intuitively appealing both to clients and therapists. This is largely
because interpersonal problems are nearly always what lead people to seek or be referred to treatment. Having a therapy that addresses
these issues directly is a strength of IPT.
The evidence base for IPT is vastly more extensive than any treatment aside from CBT, with over 250 published studies now demonstrating
IPT’s efficacy. IPT is efficacious for the ages ranging from 9 to the very elderly; there is more data and literature demonstrating the efficacy
of IPT with geriatric patients than any other psychotherapy.
IPT is now widely used for the treatment of mood disorders during the perinatal period. IPT is recommended as a first line treatment for
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
S1
Scientific Program Abstracts
perinatal women, both because of its efficacy and because of concerns about medication usage during pregnancy and breastfeeding.
Clinicians working with perinatal women and their families should be familiar with IPT in order to provide the highest quality treatment.
During this panel, we will present the use of IPT in pregnant and postnatal women, for whom it is an empirically validated treatment
of choice for depression. During the Congress, the theoretical basis of IPT and its techniques will be presented at another panel, in
comparison with other psychotherapies.
Keywords: interpersonal psychotherapy, evidence-based psychotherapies, perinatal psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S1-S2
[JS-1]
Interpersonal Psychotherapy (IPT): a short introduction
Oguz Omay1, Scott Stuart2
1Psychiatrist, La Teppe Medical Center, France
2Professor of Psychiatry and Psychology, University of Iowa, USA
e-mail address: [email protected]
Interpersonal Psychotherapy (IPT) is an Evidence-Based Psychotherapy for adults and adolescents. It has demonstrated efficacy for
affective disorders, anxiety disorders, eating disorders, PTSD and perinatal depression. IPT has also been demonstrated to be efficacious
as a maintenance treatment to prevent relapse of depression. IPT has been demonstrated to be effective when delivered in a variety of
settings, including mental health clinics and school-based clinics.
IPT is based on an attachment model, in which distress is tied to difficulty in interpersonal relationships. The targets of IPT are not only
symptoms, but also improvement in interpersonal functioning and relationships as well as improved social support. Therapy focuses on
one or more interpersonal problem areas, including Interpersonal Disputes, Role Transitions, and Grief and Loss Issues. IPT is time-limited,
and typical courses of therapy last from 8-20 sessions, which are tapered over time.
IPT has several advantages in addition to its well-established efficacy. It is intuitively appealing both to clients and therapists. This is largely
because interpersonal problems are nearly always what lead people to seek or be referred to treatment. Having a therapy that addresses
these issues directly is a strength of IPT.
The evidence base for IPT is vastly more extensive than any treatment except for CBT, with over 250 published studies now demonstrating
IPT’s efficacy. IPT is efficacious for the ages ranging from 9 to the very elderly; there is more data and literature demonstrating the efficacy
of IPT with geriatric patients than any other psychotherapy.
Early in its development, IPT was largely confined to research settings. An extensive effort to disseminate IPT for clinical use opens new
possibilities as clinicians use it extensively in their real world practices. IPT’s unique interpersonal focus enriches the toolbox of clinicians
who are trained in other psychotherapy methods.
During this panel, we will present the theoretical basis of IPT and its techniques, in comparison with other psychotherapies. In another
panel during the congress, we will present the use of IPT in pregnant and postnatal women, for whom it is an empirically validated
treatment of choice for depression.
Keywords: Interpersonal psychotherapy, evidence-based psychotherapies
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S2
[JS-2]
Complementary medicine in antidepressant treatment
Dragan Babić, Romana Babić
University Clinical Hospital Mostar, School of Medicine, Department of Psychiatry, University of Mostar, Mostar, Bosnia and Herzegovina
e-mail address: [email protected]
In recent decades, many scientific discoveries have made great contributions in the advancement of medicine and psychiatry. This is
mostly expressed in the treatment of various forms of depressive disorders. The synthesis of very high quality, antidepressants that
are significantly improved treatment options for depressed patients. However, evidence based medicine after big bliss faced a lot of
S2
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
Scientific Program Abstracts
disappointments and attitude that some natural drugs were unnecessary thrown out of use step by step came along. On the other hand,
more and more scientific evidence on the effectiveness of natural remedies to treat depression, a large number of patients with natural
herbal medicines used in the just treatment of various psychiatric disorders, including depression.
Numerous controlled clinical trials showed bigger effectiveness of natural psychoactive drugs comparing to placebo and equal effectiveness
comparing to some other psychoactive chemical substances. They showed indisputable effect, good tolerance, known mechanism of action
and active substance and very rare side effects so they can be used in every day practice and treatment of depression.
And around the world there are more psychiatrists who complementary medicine perceived as acceptable and complementary, and less
of those who have excluded it. There are an increasing number of psychiatrists who advise patients and prescribe antidepressants and
other natural methods of complementary medicine, including various forms of massage, aromatic baths, yoga, spirituality, acupuncture,
etc. Complementary medicine should not be considered as an alternative but should be wisely used to treat depression and other mental
disorders wherever it is possible and whenever it is based on scientific evidence. There is strong scientific evidence that the preparations of
St. John’s wort (hypericum perforatum), omega 3 fatty acids, ginkgo bilobae etc. undoubtedly help in the treatment of depressive disorders.
In some countries, the official doctors and complementary medicine work closely and supplemented, all for the purpose of better treatment.
Due to the growing public interest in complementary medicine and their increasing use in the treatment it is necessary that doctors not
only know, but also properly prescribe them and advise. We recommend methods of complementary medicine that have been proven
safe, thoroughly studied, and their effects are scientifically validated. They are not a substitute for standard psychoactive drugs neither
their appropriate application diminished the seriousness of the treatment of mental disorders. They should be prescribed with caution to
persons suffering from mental disorders who do not like or do not accept the “chemical” medicines. It is necessary to continue research
and fully clarify the mechanism of action and effectiveness of methods of complementary medicine.
The aim of this paper is to encourage reflection on the meaning of complementary medicines in the treatment of depression and attempt
to prevent their throwing into oblivion whenever justified and based on scientific facts.
Keywords: complementary medicine, depression, treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S2-S3
[JS-2]
Type of traumatic experience and depression in adolescents
Burgic Radmanovic M¹, Burgic S²
University Banja Luka, Faculty of Medicine, Department of Psychiatry, Bosnia and Herzegovina
1
2University Banja Luka, Faculty of Medicine, Clinical Center, Department of Child and Adolescent Psychiatry, Banja Luka, Bosnia and Herzegovina
e-mail address: [email protected]
Objective: Adolescents are especially vulnerable to the effects of trauma, and trauma can have a significant impact on their development.
Typical reactions to traumatic experiences include fear and anxiety, sleep disturbances, physical complaints (such as headaches or
stomach pain), antisocial behavior, depression and sadness, and fear of separation from loved ones. The way an adolescent adapts to
stressors has a lot to do with how well his or her family is functioning. Aim of this study was to show relations between presence of
depression and psychosocial stress factors in adolescent anamnesis.
Method: In research 536 adolescents took part, in age between 15 and 18. By using BDI and RADS we found that 12-18% of adolescents
confirm clinical level of depression symptoms. On LSCL-R questionary 415 adolescents (77,4%) had stress life events, most of them had death
of close person, catastrophe, or had been witness of catastrophe or severe accident, small number of them had severe accident, or were
witness of violence in family, experienced divorce of parents, emotional torture, physical and sexual torture, severe financial difficulties etc.
Results: There strong connection between type of trauma and depression. The deepest at adolescents was caused by physical and sexual
tortures, death and illness of family member, violence, conflicts and heavy disagreement in family. It is important to seek and discover
adolescents who are under the influence of various stress factors, because it decreases risk of developing depression disorders. Support
and help of family members defend adolescent of depressive answers on various stress factors. It has been found that when adolescents
lack parental support, they are more likely to have behavioral problems and emotional distress.
Conclusion: There are strong connection between type of trauma and depression in adolescents.
Keywords: adolescents, stress, depression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S3
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
S3
Scientific Program Abstracts
[JS-3]
Neuroprotective properties of the sigma-1 ligand afobazole
Sergey B. Seredenin
Zakusov Institute of Pharmacology RAMS, Moscow-Russia
e-mail address: [email protected]
Afobazole 5-ethoxy-2-[2-(morpholino)-ethylthio]benzimidazole] is an anxiolytic drug which was developed in Zakusov Institute of
Pharmacology RAMS and is currently in clinical use in Russia.
In ex vivo experiments it was established that afobazole is able to prevent stress induced decrease in brain benzodiazepine receptor
binding in animals exposed to different fear conditions – brightly lighted open field, odor of predator etc.
Receptor profile study revealed that afobazole interacts with sigma σ1 (Ki= 5.9x10-6 M), melatonin МТ1 (Ki= 1,6x10-5 М) and МТ3 (Ki=
9,7x10-7 М) receptors as well as with regulatory site of monoaminooxidase MAO-А (Ki= 3,6x10-6 М). Afobasole (10-8 М) was found
to promote mobilization of σ1- receptors to the plasma membrane from endoplasmic reticulum in HT-22 cells, which is also proving
afobazole-σ1-receptors interaction.
σ1-receptors are known to modulate various processes that contribute to neuroprotection during pathophysiological states, in particular
neuronal ischemia. Based on these several in vitro and in vivo experiments were performed to investigate neuroprotective properties of
afobazole.
In vitro in HT-22 neuronal cells afobazole (10-8 - 10-6M) was shown to decrease neuronal death in response to oxidative stress and
glutamate excitotoxicity. Afobazole decreased caspase-3 activity in the model of glutamate excitotoxicity and increased BDNF (brain
derived nerve factor) and NGF (nerve growth factor) levels in HT-22 cells.
Ex vivo afobazole prevented stress-induced decrease in BDNF level in brain structures of BALB/c mice, reduced NO production and
increased the activity of succinate dehydrogenase in ischemic brain.
Several studies proved afobazole to be neuroprotective ex vivo and in vivo in stroke models. In rats undergoing photothrombosis of
vessels in the prefrontal cortex application of afobazole 1 h after the ischemic stroke and for 8 days thereafter reduced stroke volume
by 50%. In the stroke model of middle cerebral artery occlusion treatment with afobazole at the dose range of 0.1-5.0 mg/kg which
started 6-24h after surgery also significantly decreased lesion volume. In hemorrhagic stroke models (acute and repeated posttraumatic
hematoma) afobazole when administered 3 to 6 h after the onset of stroke and then twice daily for two weeks increased survival, declined
the neurological deficits scores and improved recovery of cognitive functions.
The in vitro data suggests afobazole activation of σ1- receptors may contribute to its properties to enhance neuronal survival and
neuroprotective effects in stroke models.
The results obtained provide evidence to extend the indications for treatment with afobazole in clinical practice.
Keywords: afobazole, neuroprotection, sigma ligand
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S4
[JS-3]
Novel antiparkinsonian and neuroprotective drug: hemantane
Elena Valdman
Zakusov Institute of Pharmacology RAMS, Moscow-Russia
e-mail address: [email protected]
Hemantane (N-2-adamantyl hexamethylenimine hydrochloride) - the novel antiparkinsonian drug in doses 10-20 mg/kg was shown
to reduce tremor, rigidity and oligokinesis in animal models of parkinsonism. Hemantane was more effective than reference drug
amantadine. In clinical study in patients with early stages of Parkinson’s disease hemantane reduced main parkinsonian symptoms in daily
dose 25 mg. Nowadays clinical study of hemantane continues.
Complex mechanism of action of hemantane was revealed. Hemantane is low affinity NMDA glutamate receptors ion channel inhibitor,
similar to amantadine. Hemantane has properties of moderate reversible MAO B inhibitor, antioxidant activity, modulates dopaminergic
and serotonergic receptors and monoamine transporters. The data obtained allows to suppose possible multi-targeting the pathogenesis
of neurodegeneration.
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The purpose of the experimental studies of the last years was to evaluate neuroprotective potential of hemantane. 6-hydroxydopamine
(6-OHDA)-induced injury in human neuroblastoma SH-SY5Y cell line and was used as an in vitro model of dopaminergic neurons for
Parkinson’s disease research. Hemantane in concentrations 10-6 – 10-8 M prevents cytotoxic effect of 6-OHDA being administered in cell
medium as before as well as after 6-OHDA. Preclinical (nonmotor) stage of Parkinson’s disease was modeled in rats by intranigral bilateral
injections of neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (100 μg in 2 μl Ringer’s solution). Three weeks after surgery
rats demonstrated cognitive deficit and depressive-like behavior without definite motor impairment. Pretreatment with hemantane (10
mg/kg) 5 days before MPTP and further administration during 3 weeks after MPTP preserve cognitive function and prevented depressive
disturbances.
To assess the influence of hemantane on the neuroinflammation model of Parkinson’s disease induced by lipopolysaccharide (LPS)
was used. LPS (10 μg LPS in 2 μl Ringer’s solution) was injected into left substantia nigra pars compacta (SNc) according to stereotaxic
coordinates. Hemantane (10 mg/kg) was administrated i.p. daily starting one day before the operation.
Hemantane prevents induced by LPS weight loss, development of forepaw akinesia contralateral to the operation side and olfactory
disturbance in rats.
Anti-inflammatory effects of hemantane were confirmed in the models of peripheral inflammation – acetic acid peritonitis, carrageenan
and concanavalin-A - induced paw edema.
Effects of hemantane (10 mg/kg) and amantadine (20 mg/kg) were studied in the rat model of intracerebral posttraumatic hematoma.
Drugs were administered first at 3,5 hours after surgery and then for 4 consecutive days. Effects were registered on days 1, 3, 7 and 14
after surgery. It was shown that both drugs significantly decreased mortality and improved motor activity, exploratory behavior and
memory. Amantadine was more effective in tests for motor activity and exploratory behavior. Hemantane 5 mg/kg i.p. demonstrated
more pronounced activity in restoring memory. All these data taken together allows concerning hemantane as antiparkinsonian drug
with neuroprotective and neurorestorative potential with the ability for possible disease modifying activity.
Keywords: Parkinson’s disease, animal models, neuroprotection
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S4-S5
[JS-4]
Smoking and beyond in schizophrenia patients
Koksal Alptekin
Dokuz Eylul University, School of Medicine, Department of Psychiatry, Izmir-Turkey
e-mail address: [email protected]
Schizophrenia patients have approximately 20% shorter life period compared to normal population. They generally lose more than 25
years of normal life span. There are many risk factors regarding shorter life expectancy in schizophrenia patients including metabolic
syndrome and medicines. One of the important risk factors causing early death issue in patients with schizophrenia is smoking cigarettes.
Comorbid nicotine dependence is very common among schizophrenia patients showing prevalence rates of %60 - %80 which is 2-4 folds
higher than in the general population. Also they smoke “harder” with significantly higher plasma nicotine levels, more puffs per cigarette,
shorter puff intervals, and larger puff volumes. Smoking habit may be the result of self medication for negative symptoms or cognitive
deficits in schizophrenia. There is clear evidence that cigarette smoking increase mortality risk in patients with schizophrenia. However
patients have lower appreciation for health risks of smoking. Up to date many study results have found modest efficacy of bupropion,
varenicline, nicotine replacement therapy, cognitive-behavioral therapy and psychosocial interventions. Bupropion or varenicline
treatment combined with nicotine replacement treatment may be effective especially in the first 6-months of treatment compared
to placebo in schizophrenia patients, but treatment effect generally decreases with time. Therefore new treatment strategies to stop
smoking in patients with schizophrenia are needed to be developed.
Keywords: smoking, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S5
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
S5
Scientific Program Abstracts
[JS-4]
Coping with adherence problems in longterm psychiatric treatments
M. Hakan Turkcapar
Hasan Kalyoncu University, Department of Psychology, Gaziantep-Turkey
e-mail address: [email protected]
Adherence to the treatment regime is an important issue for all disciplinces of medicine but especially in Psychiatric treatments rate
of treatment non- adherence especially high. Chronic psychiatric patients with psychotic symptoms (schizophrenia, bipolar disorder
e.q.) treatment non-adherence is not an exception but as a rule. 80% of schizophrenic patients who were being treated as outpatients
with, and up to 50% of bipolar patients will have trouble in compliance to drug regime. On the other hand physicians’ awareness of this
condition is very low. in controlled trials 55% of clinicians’ estimates regard to drug compliance were found to be incorrect.
The ineffectiveness of treatment, lack of insight, failure to establish a good therapeutic relationship, complex treatment regimens are the
main causes of failure to comply with the treatment regimes. Among the factors associated with psychopathology craving for mania is
an important factor in patients with bipolar diorder. On the other hand lack of insight is the most important factor in psychotic patients.
Medication non adherence in patients with psychotic illness (bipolar or schizophrenic patients), has a very negative impact, on the disease
process and cause to exacerbations and frequent hospitalizations.
Factors associated with the clinician, the patient’s physician confidence in the patient, to listen, to understand, encouraging collaboration
and open discussion of speech-pharmacological approach as a holistic approach to the patient than important.
In this panel talk my main focus will be on lack of insight which is a most important and patient related factor in drug adherence.
Motivational techniues and cognitive behavioral approach in combination can improve to adherence to treatment regime. I will also
discuss how clinicians can handle this issue of non adherence with cognitive behavioral therapeutic techniques.
Key words: insight, treatment adherence, cognive behaviour theray, motivational interview
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S6
[JS-6]
Code of ethics, obligations and specific points in the perinatal psychiatry
Goksen Yuksel
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
e-mail address: [email protected]
As psychiatric diseases are far from ‘desperate and untreated’; more female psychiatric patients come across the perinatal period. Codes
of ethics in the perinatal period are mostly determinate by obstetricians but when it comes to the perinatal psychiatric group there is
tremendous divergence of opinions. Different ways of psychiatric treatments are restricted by obstetric and fetal risks. But sometimes
even the cultural perceptions are the most limiting via remedy.
Involuntary mental hospitalization in the perinatal period sounds to be suspension of fundamental rights of the patient and mostly
neglected by the clinicians. Mental hospitalization of a pregnant women or a postpartum one may think to be catastrophe by her siblings.
Utility, that the clinician must target first, requires seeking for the best options of treatment for not only the patient but also the baby she
is carrying. The efficacy of treatment versus the risk of harm to baby must be balanced. Following the up-to-date literature can be a part of
gathering the knowledge about the topic but not only the personal clinical experiences but also the ones rooted in the specific institutes
specially designed to hospitalize perinatal women and the newborn.
Respect to autonomy attain it’s meaning mostly in gynecology and also psychiatry. The perinatal psychiatry can be called as ‘intersection
point’ of them, needed to be respected to the patient’s values, beliefs and her rights to choose between the alternatives from her
educational and cultural point of view. But, what if the patient’s choice causes to harm the baby? Should the clinician respect for her
autonomy or give priority to baby? If the choose of the patient is potent to harm the baby, and if the evaluation of the patient comes to
the fact that she is mentally competent, the choose must be supported by ethical reasons.
Privacy in the perinatal psychiatric group, contains all the same regulations as it does in the other patients. Beyond any life-threatening
statements such as homicidal or suicidal ones, the clinician must keep any personal information as a secret that the patient herself
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Scientific Program Abstracts
chooses to be kept as so. Basic and maybe the most popular ethical obligation is informed consent, originating from self determination
right, must include possible complications, risks and benefits of the psychiatric treatment not only for the patient but also for the baby.
Especially in the perinatal psychiatric group, it is vital to repeat the items and demand to repeat them from the patient aiming to detect
the ones not understood properly. If the consent is about a more invasive procedure, like abortion, sterilization or a legal document about
the custody of her children; the clinician must wait until she is non-psychotic.
Paying attention to possible quality of life of the perinatal patient and targeting to increase as possible will not only effect the life of the
mother but also the baby’s as well. Perinatal psychiatric women should have as great right to privacy, bodily integrity and autonomy as
other perinatal women.
Keywords: ethics, perinatal psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S6-S7
[JS-6]
How to approach bipolar disorder patients who plans pregnancy?
Mine Sahingoz
Konya Meram Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Bipolar disorder presents special challenges to women of childbearing age as well as to their families and clinicians. Problems include
lower fertility rates, strong genetic loading, and potential fetal teratogenic risks from medication to control the condition as well as high
rates of premature mortality due largely to suicide but including also the effects of accidents, substance abuse, and general medical
disorders. A common misconception is that pregnancy is protective against psychiatric symptoms. The majority of recent studies
suggest that pregnancy is a period of substantial risk for recurrence with estimates of recurrence as high as 50%. Identifying and treating
women prior to pregnancy might prevent negative outcomes. Illness history and reproductive safety of medications are the most
important factors to consider when planning treatment. Factors associated with a higher risk of relapse during pregnancy include abrupt
discontinuation of mood stabilizers, a history of four or more prior mood episodes, and prior intrapartum mood episode. Currently,
a common clinical practice is to stop ongoing mood stabilizing treatment during pregnancy in order to avoid potential adverse fetal
developmental effects and purported associated liability risk. However, some progress has been made lately in applying the limited
information available to develop treatment guidelines for the clinical management of women with bipolar disorder during pregnancy.
Women with more severe risk of relapse are recommended to continue medications. Medications used to treat BD (including valproate,
carbamazepine, and lithium) are associated with increased risk of fetal anomalies and neurobehavioral abnormality. Compared with
lithium, anticonvulsants such as carbamazepine and valproic acid may pose even greater risks, including high rates (1%–5%) of neuraltube defects such as spina bifida as well as craniofacial anomalies, cardiac anomalies, microcephaly, and growth retardation. Despite the
dearth of data, folic acid supplementation (4 mg daily) is recommended to prevent neural tube defects for patients being treated with
anticonvulsants. Reproductive safety information about other, newer agents used to treat bipolar disorder remains very limited, leaving
lithium as a plausible first-line option, especially during mid-to-late pregnancy. The American Congress of Obstetricians and Gynecologist
(ACOG), in an April 2008 Practice Bulletin, recommend that the use of valproate and carbamazepine during pregnancy should be avoided,
when possible, particularly during the first trimester. They further recommend that a fetal echocardiogram should be considered in
women exposed to lithium during the first trimester. Atypical antipsychotics are widely used in the treatment of BD; however, there are
limited data about their use during pregnancy. High potency antipsychotics could be used if needed. In the other hand, in women with
low risk of relapse, medication should be tapered slowly over the course of 6 weeks. It is also important to address the consumption of
caffeine, nicotine, illicit drugs, and alcohol, as well as poor nutrition and the general level of stress and sleep deprivation.
In conclusion, women of reproductive age with BD should be counseled that pregnancy is a time of substantial risk of relapse, particularly
following discontinuation of ongoing mood stabilizing maintenance treatment. A relapse prevention and management strategy for
bipolar disorder should be outlined before the patient attempts conception.
Keywords: bipolar disorder, perinatal psychiatry, pregnancy, lithium, carbamazepine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S7
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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Scientific Program Abstracts
[JS-6]
Impact of maternal treatments on the infant during the perinatal period
Symposium of the Marcé Society
Nine M C Glangeaud Freudenthal1, Anne Laure Sutter Dallay2, Dominique Dallay3, María Luisa Imaz Gurrutxaga4
1INSERM, UMRS 953; UPMC University Paris 06, UMR S 953, Paris-France
2Univ. de Bordeaux, U657, Bordeaux; INSERM, U657, Bordeaux; CH Charles Perrens, Bordeaux-France
3Univ. Hospital Bordeaux Segalen University, Department of Gynaecology and Obstetrics, Bordeaux-France
4Perinatal Psychiatry and Gender Research Program Department of Psychiatry and Psychology, Institut of Neuroscience (ICN), Hosp. Clínic, Barcelona-Spain
e-mail address: [email protected]
The Marcé Society is a multidisciplinary professional association dedicated to supporting research and assistance surrounding prenatal
& post-partum mental health for mothers, fathers and their babies. The perinatal period is a very sensitive period for the women with
psychological difficulties or psychiatric disorders but also for the foetus and the infant. Maternal treatment during pregnancy should take into
account at the same time the mother’s health and the foetus health and development. The benefice and risk has to be considered for both.
Results from a database from a multicentric national cohort study over thousand mother and infant inpatient joint admissions in France
presented by Anne Laure Sutter-Dallay (past president of the Francophone group of the Marcé Society and secretary on the international
Marcé Society) will bring important information to the discussion of the benefit /risk of maternal prenatal drug treatment for the infant.
Dominique Dallay (member of the Marcé Society and executive member of the Francophone Marcé Society) will bring the obstetrician’s
point of view on maternal treatment for addiction during pregnancy.
Maria Luisa Imaz Gurrutxaga (member of the Spanish Marcé Society) will give information on the impact of the lithium treatment on the
obstetrical and neonatal outcomes.
The discussion will be open with the participants on this important question of benefice and risk to be considered at the same time for
the mother’s improvement and child development but also for the early mother-child interaction and bonding support of early infant
development and security.
Keywords: perinatal psychiatry, prenatal drug treatment, maternal treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S8
[JS-7]
Psychiatric service of republic of Kazakhstan: tasks and prospects
Sagat Altynbekov
The Republican Scientifically-Practical Centre of Psychiatry, Psychotherapy and Narcology of HCMOf RK, Kazakhstan
e-mail address: [email protected]
The report is devoted a current condition of service of mental health of Republic Kazakhstan. Despite on substantial improvement of the
general condition of system of psychiatric service, which is marked for last 20 years, there are more many unresolved problems. Thereupon
professional associations of psychiatrists and the state structures of public health services make efforts for introduction of optimum forms
of the organization of service of mental health which on the one hand, would correspond to modern requirements of a society, and, on
the other hand, have kept the best that has got to us from former generations of domestic psychiatrists.
Now in our country the program is developed, cores of whole which are:
1. Increase of level of understanding of a role of mental health in aspect of national safety of a society and the state.
2. Decrease, and in the long term, destruction of such phenomenon, as stigmatization and discrimination of persons with mental disorders
3 Perfection of system of primary, secondary and tertiary preventive maintenance of mental disorders, including the strengthening of its
scientific basis.
4. Perfection of intersectoral interaction concerning diagnostics, treatments and rehabilitations of persons with mental disorders.
5. Development of personnel potential of all sectors and branches in accordance with modern approaches to the decision of problems
of mental health
6. Creation of effective information system concerning mental health
Keywords: psychiatric service, task
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S8
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Scientific Program Abstracts
[JS-7]
Can pharmaceutical firms support mental health reforms?
Giorgi Geleishvili
Society of Georgian Psychiatrists, Georgia
e-mail address: [email protected]
Services providing psychiatric care in Georgia need change. In October 2010 ministry of labor, health and social affairs (MOLHSA) proclaimed
about starting mental health reform and made several maneuvers, like selling territory of the institute of psychiatry at a fashionable place
and opening psychiatric departments in general clinics. The methodology and amount of financing of treatment changed too. At the
same time, no improvements have been made to the outpatient clinics, and no steps have been made to build community based services.
On the contrary, some outpatient clinics where sold and changed to psychiatric cabinets. 70% of the state financing remains for hospitals
and 30% for outpatient treatment. This resulted in increased number of hospitalizations, hence more money is spent in most expensive
of the services – hospital treatment. After discharge from the psychiatric hospital a patient gets 50 times less money for treatment at
the outpatient clinic, 20 times less is spent on pharmacotherapy. Huge disbalance between budgets of hospitals and outpatient clinics
causes relapses and rehospitalization. For years specialists and service users are talking about the necessity to shift psychiatric system
to a mental health system better suited to the needs of the society. Improving quality of psychopharmacotherapy in outpatient facilities
is one big issue. From almost 80000 patients officially registered as users of psychiatric services (in fact the estimated number is much
higher), only 1300 (maximum number of psychiatric beds in Georgia) stay in hospitals. Others are being treated by psycho-neurological
dispensaries (psychiatric outpatient clinics). As a result of the actual situation all members of the system have problems: 1. MOLHSA has
to pay more for in hospital treatment if they do not increase budget of the outpatient treatment; 2. Service users and their families have
big discomfort because of inability to get quality treatment in community and avoid hospitalization; 3. Specialists have big concern how
to keep remission without having possibility to prescribe the necessary medication. Many users of psychiatric services have low income
and are not able to buy medication themselves. Insurance companies refuse to pay for psychiatric treatment. And the state financing is
enough for only limited amount and variety of medication. Here comes the major issue – how to persuade MOLHSA officials to change
something i.e. dare increase funds for treatment in communities. This is the point of the possibility of synergy between MOLHSA, mental
health specialists, service users and pharmaceutical companies. The last have money which is often spent on advertisements and work
with physicians, but not for increasing competence of decision makers. Usually MOLHSA representatives avoid direct contact with
pharmaceutical companies, as they are afraid to seem corrupted. For them it is easier to contact professional societies. There have been
cases when some officials willingly attended conferences and trainings organized and financed by NGOs. To solve the problem a unique
cooperation must be set between all parties. And the result will be win-win situation.
Keywords: pharmaceutical firms, mental health reforms
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S9
[JS-7]
Correction of astenoadinamic option of post abstinence disorders
Khodjaeva Nazire I., Sultanov Sh.Kh. Ashurov Z.Sh.
Tashkent Medical Academy, Department of Psychiatry, Tashkent-Kazakhstan
e-mail address: [email protected]
For opiate (heroin) addiction literature data are ambiguous. There have been reports about the possibility of forming psychoorganic
disorders in opiate addiction. Currently, the main number of drugs used opioid is heroin, which combines a variety of highly toxic
ingredients: strychnine, quinine, chlorine derivatives. The use of opium treated with acetic anhydride, promotes the formation of toxic
encephalopathy with intellectual disabilities. Some authors deny the decline of intelligence in these patients and suggest that intelligence
remains intact for a long time from the start of anesthesia. Because of narcotic destruction of the cerebral hemispheres are largely violated
mental disorders, attention, psychomotor coordination, speech, gnosis, praxis, the bill, thinking, orientation, planning and control of
mental activity. With long-term substance abuse appears fatigue, exhaustion of attention, lack of ability to concentrate, inability to intense
mental activity. The patient becomes irritable, dysphoric, and evil. Develops overall emotional brutalization, deceit, lack of a sense of
shame, they become indifferent; they do not care about losing a job or a family, and even their own health.
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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Scientific Program Abstracts
Cerebrolysin - peptidergicnootropic drug has low molecular weight, biologically active neuropeptides, which overcome the blood-brain
barrier and enter directly to the nerve cells. In particular, it reduces the concentration of lipid peroxidation products, which increased
in heroin addiction. A very important aspect of the action cerebrolysin is that it shows a positive effect on cognitive function, improves
concentration, the processes of memorizing and reproducing information associated with short-term memory, increases the ability to
maintain skills that will intensify the process of mental activity, improves mood, promotes the formation of positive emotions, i.e. has
a neuroprotective effect, acting as proof of cognitive impairment. Furthermore, it has such important characteristics as antiastenic,
antidepressant and psychostimulant. Very important is the brain-specific adaptogenic effect Cerebrolysin associated with increased
stability of the nerve cells to the damaging effects of different nature.
Due to its properties Cerebrolysin found extremely wide application in the treatment of various cognitive disorders, including mnemonic
arising from hypoxia, intoxication, and various degenerative diseases of the brain.
The aim of the study was evaluation of cognitive disorders and neurotic disorders in Cerebrolysin therapy in patients with heroin addiction.
The study involved 26 patients with heroin dependence during inpatient treatment, mean age 31.5 years, disease duration of 3.5 years,
the daily dose of drugs used intravenously 0.5 g Patients were divided into study and control groups are not statistically different.
Cerebrolysin treatment was started on day 7-9 after the last use of the drug. Cerebrolysin dose was 5 mL intramuscularly - 1 time a day. In
the control group, patients received placebo 5.0 ml physiological solution. Total per patient was 20 injections.
Clinical follow-up procedure was performed “Short-term memory”, “correction test” and the syndrome of anhedonia on Krupitsky E.M. et
al. The duration of clinical follow-up was 20 days.
The positive results of the subjective assessment of the treatment given 8 - (57.1%) patients. In the 4 - (28.6%) of the effect of treatment,
patients rated as minor, and 2 - (14.3%) reported no effect. Analysis of the results of cognitive tests showed a statistically significant
improvement in cognitive function compared to baseline by the end of Cerebrolysin therapy was observed in all tests treatment.
When testing the ability to repeat the words, patients in the 1-day treatment called on average 4-5 words, to the 20th day of therapy
Cerebrolysin - repeated 8-9 words.
Volume attention was assessed by the number of scanned characters, the concentration by number of errors made. After treatment with
Cerebrolysin significantly improved the quality of attention
Neurosis-like disorders were expressed in postabstinence period and characterized by dysphoric, dreary or apathetic depression and
other ipohondric disorders. Long retained affective lability, hypochondriacal, fatigue, inactivity, the inability to do any work. Patients were
inactive, carefree, careless, and cheeky. On the 20th day of treatment Cerebrolysin was an increase in total physical activity, the revival of
interest. Significantly decreased dysphoria, irritability, anxiety, and to a lesser extent - the lability of affect, hypochondriacal, inherent to
many patients during the deprivation of the drug. Anxiety levels also declined.
Clearly reduce the appearance of asthenic disorders with 2.15 points before treatment cerebrolysin to 1.0 points on the 10 th day and
0.63 points on the 20-day treatment. The same applies to apatico-abulic disorders. Patients become much more active, decreased fatigue,
weakness, apathy, indifference.
Patients become less distracted, they have decreased confusion and aspontaneous, purposeful activity and increased productivity in the
work. The behavior of patients became more orderly and organized, improved mood, much less irritation reactions occurred with negativity
and violence. Patients improved further opportunities and interest in simple intellectual activity expanded scope performs everyday
activities. Many patients return to the lost work due to illness, they have improved activity, health and mood. In the control group, was set
a positive therapeutic effect (usually minimal), it was limited to improved mood and increased activity in some daily activities.
The most noticeable effect of Cerebrolysin recorded for asthenia, interest in the environment, emotional liveliness, a sense of comfort,
sleep disorders. A distinct positive dynamics of these complaints under the influence of drugs suggests that their genesis in the main role
played by organic brain damage.
It is important that the treatment of patients with Cerebrolysin not marked deterioration craving for drugs, which often occurs when using
nootropics. Components of the syndrome of anhedonia decreased during treatment equally in primary and in the control group, which
was also due to the ongoing psychotherapy in both groups.
The majority of patients treated with Cerebrolysin, noted during treatment no side effects.
Thus, Сerebrolysin provided a positive effect on cognitive function, as well as disorders such as rapid exhaustion, fatigue, apatic-abulistic
syndrome, anxiety. All the above points to the desirability of placing on Cerebrolysin a therapeutic treatment program for heroin addicts.
Thus, the exchange rate Cerebrolysin therapy reduced the severity of disorders of attention and memory, improving overall cognitive
status of patients. Cerebrolysin therapy did not increase the craving for the drug.
Application of Cerebrolysin along with improvements in cognitivefunction accompanied by a reduction of concomitant psychiatric
symptoms - depression and other disorders.
Keywords: cerebrolysin, abstinence
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S9-S10
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[JS-7]
Psychiatry and psychopharmacotherapy in Post-Soviet space
Petr Victorovich Morozov
Russian National Medical Research University, Department of Psychiatry, Moscow-Russia
e-mail address: [email protected]
The Soviet Union collapsed 20 years ago. Split and unified health system, medical care, including mental health. Before psychiatrists newly
formed states one question: which way to go, what new model of care to choose, how to overcome the stigma and how to use the latest
methods of prevention and treatment of mental illness?
All these years, the country’s accumulated experience, positive and negative, and now is the time to compare it with the experience of
their colleagues and neighbors to share their results, analyze what has been achieved and what could not be done.
To this end, together with the Presidents of the National psychiatric societies of the former Soviet Union, we conduct a series of symposia and
conferences of psychiatrists in these countries, and not in a narrow circle, and taking out our problems on the discussion of representatives
of the world of psychiatry: the structure of services, training issues, stigma, research, prevention and treatment of mental illness. Today’s
symposium is one in the series and we are grateful to our Turkish colleagues for the opportunity to spend it on this hospitable land.
25 years ago we did not have significant experience in combating drug abuse (the Soviet Union was a closed country), now we,
unfortunately, there is something to discuss. There are other important new issues: the effects of PTSD, mental manifestations of AIDS,
gambling, etc. Increasingly in our field of psychologists, neurologists “rob” in our epilepsy and Alzheimer’s disease.
We replaced gradually comes a new generation of young psychiatrists: they are armed with the latest technology, they know foreign
languages and is easy to establish professional contacts with their peers from other countries, carry out joint research is a new
phenomenon in recent years in the former Soviet space.
And today we present to your court those issues that affect the representatives of the participating countries of this symposium:
Professor A.Altynbekov talk about the changes in mental health services in Kazakhstan, professor N.Hodzhaeva from Uzbekistan share
the experience of the effects of treatment of heroin addiction, a professor T. Galako from Kyrgyzstan talk about the irrational use of
psychotropic drugs and, finally, Dr. G. Geleyshvili will try to answer the question of whether drug companies to promote health care
reform in Georgia. Dr. D. Smirnova (Russia), President of the Young Psychiatrists Council of Asia, will talk about the issues that concern the
new generation of professionals starting their academic careers.
Keywords: psychiatry, psychopharmacotherapy, Post-Soviet Space
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S11
[JS-7]
Irrational use of antipsychotic drugs as one of the problems of emotional burnout syndrome
Tatiana Galako
Kyrgyz State Medical Academy, Department of Psychiatry, Psychotherapy and Addiction, Bishkek-Kyrgyzstan
e-mail address: [email protected]
One of the most important aspects of the optimal use of financial resources aimed to improve the functioning of the health system is the
rational use of medicines.
The problem of the adequate use of medicaments is of particular interest at this time for psychiatric service of the Kyrgyz Republic (KR),
where the budget financing is inadequate, however, the inefficient and outdated medicines are still in the use. This problem results in an
increase in the number of patients resistant to therapy and, consequently, in an increase in readmissions, invalidation, and deterioration
in the quality of patient’s life. An important factor that influences the effectiveness of the treatment of patients having mental disorders
is a professional deformation of doctors, in particular, emotional burnout syndrome (EBS).
The purpose of our study was to identify the correlation between the irrational use of antipsychotic drugs in patients suffering from
schizophrenia-related disorders and emotional burnout syndrome among the psychiatrists of KR.
The following tasks were determined:
1. To reveal the emotional burnout syndrome and dependence of intensity of its phases on the age and length of service in psychiatrists
of the specialized hospitals in KR.
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2. To determine the efficiency of using the antipsychotic drugs procured under budgetary financing in patients suffering from
schizophrenia-related disorders at the specialized medical institutions of KR.
3. To identify the correlation of the emotional burnout syndrome and its phases with the irrational use of antipsychotic drugs.
A study of the emotional burnout syndrome was carried out using the technique developed by V.V.Boyko, which allowed assessing the
formation of the EBS in accordance with the stages of general adaptation syndrome (stress, resistance, exhaustion).
A correlation analysis has revealed the dependence of the emotional burnout syndrome phases on the age and length of service in
psychiatrists of the specialized hospitals in KR.
An analysis of the annual receipts and expenditures of the antipsychotic drugs, as well as budgetary funds spent to procure those drugs,
has allowed revealing an inadequate supply of these drugs to the patients and their irrational use.
At the final stage a correlation was identified between the applied antipsychotic drugs and their doses, on the one hand, and the intensity
of the EBS phases, on the other hand.
Conclusions:
1. The symptoms of the emotional burnout syndrome in KR occur in 50.7% of psychiatrists working in hospitals, and 24% of psychiatrists
have the formed EBS.
2. There is a dependence of the intensity of the EBS phases on the age and length of service of psychiatrists in all of the specialized
hospitals of KR.
3. Inadequate budgetary provision of psychiatric hospitals in KR with antipsychotic drugs, combined use of psychotropic drugs, and
predominant use of typical antipsychotic drugs lead to the irrational use of antipsychotic drugs.
4. The emotional burnout syndrome is one of the factors of irrational use of antipsychotic drugs by psychiatrists of KR – the more intensive
the manifestations of EBS are, the less adequate the choice and doses of antipsychotic drugs become.
Keywords: irrational use, antipsychotics, emotional burnout syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S11-S2
[JS-10]
The prodromal phase of schizophrenia: what do we really know?
Vrublevska Jelena
Riga Stradins University, Department of Psychiatry and Narcology; Riga Centre of Psychiatry and Addiction Disorders, Latvia
e-mail address: [email protected]
The period of time leading to the first episode of schizophrenic psychosis is described as the prodrome, that refers to the early symptoms
and signs that precede the characteristic manifestations of the acute, fully developed illness. The prodromal period of schizophrenia
can last from weeks to years, and most frequently its duration is more than a year. Cameron (1938) was the first who studied the mean
duration of untreated psychosis and reported that 32.4% of the patients experienced the first psychotic symptoms within 6 months of first
admission for schizophrenia, 17.6% within 6 months to 2 years and 48.1% 2 years or more before first admission for schizophrenia. The
clinical features of the prodrome are highly heterogeneous but the premorbid cognitive decline is a major feature. Studies have shown
that elevated dopamine system activity might be evident in the prodrome and increases further with the development of psychosis.
Moreover, abnormal dopamine synthesis might be associated with prefrontal dysfunction, linking these to neurocognitive impairment
observed during this phase. Therefore, the psychotic prodrome is potentially important for the early diagnosis and management of
psychotic disorders, detection of high-risk individuals and the overall prognosis. In order to identify these patients, diagnostic criteria
have been developed, based on the presence of attenuated positive symptom criteria; brief limited intermitted psychotic symptoms,
schizotypal personality or a first-degree relative with a psychotic disorder and significant decrease in functioning during one month. It
has been reported that 40% of persons who met these criteria transitioned to full-blown psychosis within one-year period. A number
of retrospective studies despite numerous of shortcomings indicated that identification of the prodrome in certain clinical populations
is possible and that the earlier the interventions are given, the more effective they appear to be. However the interventions available,
such as crisis oriented interventions, symptomatic treatment and close monitoring have raise important ethical issues. The data of follow
up studies encourage the use of second-generation antipsychotics, however, the problem of false positives who were never at risk of
psychosis is ever increasing and it seems that the presence of prodrome does not guarantee the development of a full blown psychosis.
Many of persons meeting the prodromal criteria, suffer from nonpsychotic disorders and have significant social, vocational, and cognitive
problems. The challenge is to identify the minority of patients who are on the way to schizophrenia, as they might very well respond to
early interventions. Several aspects that need to be carefully considered are the nature of symptoms, the degree of impairment, the side
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effects of pharmacological interventions, and also the stigma associated with prodrome of schizophrenia.
Keywords: prodrome, schizophrenia, psychosis, early detection, prevention
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S12-S3
[JS-11]
Pharmacogenomics of treatment response in depression
Umit Yasar
Hacettepe University, Faculty of Medicine, Department of Pharmacology, Ankara-Turkey
e-mail address: [email protected]
Genetic predictors of treatment response in depression have been studied for more than 30 years. The first studies included pharmacogenetic
variations in the drug metabolizing enzymes, especially cytochrome P450 2D6 (CYP2D6) that is responsible for the metabolism of most
of the antidepressant drugs. More than 100 variants of CYP2D6 have been reported in different populations (www.cypalleles.ki.se).
Pharmacogenetics-guided dose modifications of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) have been
recommended for different variants of CYP2D6 and 2C19. Beside to genetic variations in drug metabolism, pharmacogenetics of drug
disposition and pharmacodynamic factors have been recently studied. Genetic polymorphisms in the upstream regulatory region of the
serotonin transporter gene (SLC6A4), 5-HTR2A, BDNF, and GNB3 are other associated polymorphic genes related with the treatment response.
The ten million single nucleotide polymorphisms (SNPs) data that is present in human genome databases provide a big source of genetic
variation. In the last 10 years, microarray technology has become a widely used molecular biology method in many laboratories. Besides
to hundreds of small scale pharmacogenetic studies, however, there are limited number of genome-wide association studies such as
‘STAR*D (Sequenced Treatment Alternatives to Relieve Depression study), MARS (Munich Antidepressant Response Signature study)
and GENDEP (Genome-based Therapeutic Drugs for Depression study)’. These studies address novel genes that may be associated with
treatment response in depression such as ubiquitin protein ligase E3C, the bone morphogenic protein 7, RAR-related orphan receptor
alpha gene. GENDEP study also report novel markers, one in the interleukin-11 gene associated with nortriptyline response and the other
one in the uronyl 2- sulphotransferase gene associated with citalopram response.
In today’s research, major challenge is to identify the functional importance of these genetic polymorphisms and develop a dose
modification strategy considering all these genetic variants. Large prospective studies are warranted for the assessment of role of
pharmacogenomics related with drug response in depression.
Keywords: pharmacogenomics, treatment response, depression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S13
[JS-11]
Neuroimaging as a tool to observe impact of CYP2D6 on neural activation in humans
Julia C Stingl1,2, Roberto Viviani3
1Federal Institute for Drugs and Medical Devices, Bonn-Germany
2University Bonn Medical Faculty, Translational Pharmacology, Bonn-Germany
3University of Ulm, Department of Psychiatry, Ulm, Germany
e-mail address: [email protected]
CYP2D6 is the major drug metabolizing enzyme involved in psychotropic metabolism. It is genetically polymorphic with 7% in the
Caucasian population being poor metabolizers without any activity of this enzyme and 3% ultra rapid metabolizers with higher activity
due to a gene duplication.
Beside its expression in the liver, CYP2D6 was also shown to be active in several regions of the brain such as the hippocampus, thalamus,
hypothalamus, and the cortex, There, CYP2D6 may be directly involved in the local metabolism of xenobiotics that cross the blood-brain barrier,
as well as in the metabolic pathways of endogenous compounds such as regulatory substances like monoamines, neurosteroids, and endorphins.
Brain-expressed CYP2D6 may play a role in the protection of the central nervous system from endogenous or exogenous neurotoxins and
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a possible association between environmental toxins and the genetics of sporadic Parkinson’s disease has been reported.
The biotransformation of endogenous regulatory substances may constitute a possible genetic effects on personality and mental
disorders. Prompted by early reports of shared affinity for ligands of the dopamine transporter, several studies investigated the association
of the CYP2D6 polymorphism with schizophrenia, but mostly obtaining null results.
Perhaps the most consistent data associating the CYP2D6 polymorphism and behavioral abnormalities are those linking it to suicide.
To uncover the mechanisms behind gene-phenotype associations, it is important to acquire knowledge of the intermediate stages of the causal
chain leading to the clinical manifestations of disease. Potential insights have been gained through the use of imaging genetics, and its recent
application to the investigation of the effects of CYP2D6 polymorphism on brain function. We studied the genetic modulation of brain perfusion
levels at rest, which may reflect an ongoing biological processes regulating the reactivity of the individual to emotional stimuli and the detection
of signals evoking fear. These results suggested involvement of CYP2D6 in regions associated with alertness or serotonergic function. As a
confirmation of these results, the function of the CYP2D6 genotype on brain activation during a working memory and an emotional face matching
task was measured with fMRI. We confirmed a central nervous system effect of CYP2D6 activity in a large independent sample using a different
imaging modality, and provide evidence that basic cognitive processes related to such as alertness may be impacted.
A better understanding of these mechanisms will clarify in what situations pharmacogenetic testing may have practical implications not
only for planning pharmacological therapy, but also to assess risk and vulnerability for mental disorders.
Keywords: CYP2D6, fMRT, neuroimaging, brain
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S13-S4
[JS-12]
Therapeutic interventions and oxidative stress markers in bipolar disorder
Gokay Alpak
Gaziantep University, School of Medicine, Department of Psychiatry, Gaziantep-Turkey
e-mail address: [email protected]
Bipolar disorder is a major mood disorder characterized by manic, depressive, and mixed episodes and affecting an estimated 1–3% of the
population. Ethio-pathogenesis of the disorder not clear yet. Biomarker reliability of oxidative stress markers in bipolar disorder has not
been revealed. There are many reports that supports the idea of oxidative stress markers might have a role in the pathophysiology of bipolar
disorder. Results of the studies about the antioxidant enzyme levels performed in bipolar patients were not constant enough to make a
conclusion about this topic. In this presentation we will discuss the therapeutic interventions and oxidative stress markers in bipolar disorder.
Keywords: therapeutic intervention, oxidative stress, bipolar disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S14
[JS-13]
“NMDA-Nitric Oxide-cGMP” pathway modulation in schizophrenia and depression:
focus on sodium nitroprusside and ketamine
Glen B Baker, Serdar M Dursun
Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
e-mail address: [email protected]
There is growing evidence demonstrating rapid effectiveness onset of action (within hours) of intravenous administration of ketamine in
depression, treatment-resistant depression and bipolar depression. Published review in Science (2012) by Duman & Aghajanian calls this
“perhaps the most important discovery in half a century.”
There is recent evidence published in JAMA Psychiatry (2013) by Hallak and colleagues provide evidence that sodium nitroprusside (SNP)
given by intravenous route to patients diagnosed with schizophrenia improved psychosis within hours.
Although the “precise” mechanism of action of both ketamine (in depression) and SNP (in schizophrenia) remain unclear but there is
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evidence indicating for the possible involvement of the “NMDA-Nitric Oxide-cGMP” pathway in mechanisms of action of these two rapidonset effective therapeutic interventions.
Keywords: NMDA-Nitric Oxide-cGMP pathway, modulation, schizophrenia, depression, sodium nitroprusside, ketamine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S14-S5
[JS-13]
Synaptic and intracellular signaling pathway dysfunctions in depression
Feyza Aricioglu
Marmara University, School of Pharmacy, Department of Pharmacology and Psychopharmacology Research Unit, Istanbul-Turkey
e-mail address: [email protected]
Despite extensive research, the neurobiology of major depressive disorder (MDD) remains poorly understood. A significant number of patients
with depression do not respond to currently available medications, such as selective serotonin reuptake inhibitors, and even in cases of successful
treatment, these compounds typically take weeks or months to trigger an antidepressant response. This delay in onset is a major drawback to
current antidepressant therapies, leaving a crucial need for the development of faster-acting antidepressants, especially in patients at risk of
suicide. There are consistent reports of decreased size of brain regions implicated in depression, as well as neuronal atrophy, including loss of
synapses in MDD. Accumulating evidence suggests that the glutamatergic system plays an important role in the neuropathology and treatment
of MDD. Antidepressant drugs promote many forms of neuronal plasticity, including neurogenesis, synaptogenesis and neuronal maturation in
hippocampus. Recent evidences indicate that neurotrophic factors may regulate neuronal plasticity bidirectionally, meaning they may play role
in pathophysiology and treatment of depression. Recently it has been shown that ketamine has a rapid and long lasting antidepressant activity
after a single dose. Ketamine has been used as a human and animal anesthetic. It acts on the human brain by blocking the N-methyl-D-aspartate
receptors (NMDARs), which receive nerve signals carried by glutamate; the exact mechanism of ketamine’s action has been identified. In studies
with rats, basic researchers demonstrated that ketamine rapidly activates the so called “mammalian target of rapamycin” (mTOR) pathway, one
of many such pathways that perform signal transduction in neurons. The involvement of mTOR signaling in dendritic protein synthesis has been
recently characterized. Several components of this pathway are present in dendrites and are enriched at postsynaptic sites. mTOR function is
influenced by the activity of neuronal surface receptors including NMDAR, mGluR5, and neurotrophic tyrosine kinase receptors (TrkB) which are
vital for the induction of synaptic plasticity. It is generally accepted that mTOR acts as a node of convergence downstream of the aforementioned
receptors and several signaling pathways, including phosphoinositide dependent kinase-1 (PDK1), phosphoinositide-3-kinase (PI3K), and Akt/
protein kinase-B (Akt/PKB). This new approach may be a revolutionary break-through in the treatment of depression and it might lead to novel
therapeutic targets for antidepressant drug development. The main hypothesis is depression caused by disruption of homeostatic mechanisms
that control synaptic plasticity, resulting in destabilization and loss of synaptic connections in mood and emotion circuitry. A major thrust of future
drug discovery in MDD will enhance efforts to identify the molecular basis of rapid and sustained antidepressant actions, thereby minimizing
disorder morbidity and mortality during the critical weeks between initial symptom expression and drug efficacy.
Keywords: NMDA, depression, m-TOR, synaptic dysfunction
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S15
[JS-14]
Treatment refractory depression: epidemiology, biology and management
Nicol Ferrier
Academic Psychiatry and Regional Affective Disorders Service Newcastle University Wolfson Research Centre Campus for Ageing and Vitality Newcastle upon Tyne NE4 5PL, UK
e-mail address: [email protected]
Treatment Refractory Depression (TRD) is a very common clinical problem. This paper will review the various definitions of TRD and give
an account of the major concepts underlying this clinical syndrome. Recent evidence from a number of large European cohorts which
have investigated the clinical features and psychosocial and psychological underpinnings of TRD will be discussed. Results from a large
study of TRD patients carried out by our group will also be presented. We showed that the TRD patients had increased rates of childhood
physical neglect, childhood emotional abuse, increased ruminations and neuroticism and each of these factors were associated with
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higher baseline depression scores. Childhood trauma and ruminations were associated with discrepancies on depression rating scales
that were in turn related to outcome. The implication of these findings for clinical care and future research will be explored.
While the phenotype is very complex there have been some advances made in understanding the underlying neurobiology of this
disorder which will be reviewed. Dysregulation of the hypothalamic pituitary adrenal axis is common in such patients and the impact
of this on cognition and response to treatment will be outlined. Our group have carried out two recent large studies looking at the
impact of anti glucocorticoid therapy on the outcome of TRD. Addition of a GR receptor antagonist to antidepressants in bipolar TRD
improved cognition but not clinical outcome and a similar pattern of results was seen in unipolar TRD with a cortisol synthesis inhibitor.
The implications of these findings will be discussed. Recent research has also shown changes in the integrity of white matter in affective
disorders and the impact of this on clinical features, cognition and response to treatment will be discussed. The paper will finish with a
synopsis of the main treatment modalities for TRD including a review of recent advances in psychopharmacology in this area. There has
also been a recent welcome interest in intensive psychotherapy for this condition and the results of such studies will also be discussed.
Keywords: treatment refractory depression, neurobiology, cortisol dysregulation, white matter integrity
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S15-S6
[JS-16]
Hospital-based community psychiatric services in Malaysia
Marhani Midin
University Kebangsaan Malaysia, Faculty of Medicine, Department of Psychiatry, Kuala Lumpur-Malaysia
e-mail address: [email protected]
Psychiatric services have undergone a paradigm shift since the 1950s towards providing care in the community away from the mental
institutions, a process called deinstitutionalization. In Malaysia, deinstitutionalization started in the 1970s, with decentralization of
services from mental institutions to general hospital and primary health care settings. The mission was to downsize mental hospitals,
expand services at the general hospitals with psychiatric facilities and empower staff at other hospitals and primary health centers (PHCs)
to develop services for clients at their localities. Since then, hospital-based community psychiatric service (HCPS) at the general hospital
setting has been a developing intervention targeted for patients with severe mental illnesses (SMIs). These services include the delivery
of medications and a variety of psychosocial interventions at or nearest to the patients’ homes.
Up to date, the services, even though faced with challenges, have been implemented in many hospitals with different levels of resources
and therefore different outcomes. In a few different hospitals, these services have been proven to reduce rate of psychiatric hospitalization,
rate of transfer of patients to mental hospitals, rate of hospitalization among patients with previous multiple hospitalization, and to
improve the rate of symptom remission and quality of life among patients receiving the services. The number of occupied psychiatric
beds in mental hospitals has also reduced with different extents between mental hospitals. In conclusion, HCPS is an important service
component in the whole picture of deinstitutionalization which deserves better support in terms of budget and manpower.
Keywords: community, psychiatry, hospital
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S16
[JS-16]
Is hyperemesis gravidarum only a medical condition? what is the relevance
with psychiatric disorders?
Bilge Burcak Annagur
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Hyperemesis gravidarum (HG) affects 0.5–2% of pregnant women, and 10% of those diagnosed will require at least one inpatient
hospitalization. HG characterized by intractable nausea and vomiting (NV), begins in the first trimester and causes weight loss during
pregnancy, dehydration, electrolyte disturbance and nutrition deficiency. HG is differentiated from the NV common during pregnancy
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that affects approximately 75% of pregnant women by the need for hospitalization.
The pathogenesis of HG has not yet been clearly identified. Some endocrine factors (such as human chorionic gonadotropin, estrogens,
progesterone and thyroid hormone), gastrointestinal dysfunction, hepatic abnormalities, autonomic nervous dysfunction and
psychosomatic causes may play a role in this medical condition. Despite the common psychiatric symptoms observed in women with
HG, in these subjects, the psychiatric etiology is unclear. Many studies have evaluated the relationship between HG and psychiatric
disturbances; however, most studies evaluated psychiatric symptoms based on self-report measures and had many limitations. Mazzotta
et al. suggested that depressive symptoms in pregnant women were associated with more severe NV. Tan et al. showed that anxiety and
depressive symptomatology is common in HG and that risk factors can be identified. However, psychiatric symptom scales were used in
these studies, and these scales have low clinical value. A retrospective study reported that women with HG had more frequent psychiatric
diagnoses preceding the pregnancy compared to the control subjects. In a clinic-based study, Uguz et al. reported that the prevalence of
any mood disorder and any anxiety disorder in women with HG was 15.4% and 36.5%, respectively. Moreover, the researchers determined
that 36.5% of the patients with HG had at least one personality disorder.
In a recent prospective study based on psychiatric interviews, Annagur et al. reported that psychiatric disorders continued throughout
the pregnancy in two thirds of the women who had HG and a psychiatric diagnosis. Moreover, the researchers suggest that psychiatric
disorders may play a significant role in the etiology of HG. They presented a potential connection between HG and anxiety disorders and
major depressive disorder. Additionally, the NV symptoms in women with HG and a psychiatric disorder may persist during pregnancy.
In conclusion, HG is a medical condition that has a psychiatric etiology as much as a genetic and hormonal etiology. Recent studies’
findings show that psychiatric disorders may play a significant role in the etiology of HG. We can say that there are a potential connection
between HG and anxiety disorders and MDD. Despite the common belief that NV is a phenomenon of early pregnancy, NV symptoms can
persist into the third trimester. Additionally, the NV symptoms in women with HG and psychiatric disorder may persist during pregnancy.
Women with persistent NV during pregnancy should be evaluated in terms of psychiatric disorders as much as their medical conditions.
Psychiatric liaison is important in these women to promote optimal management, care and support for these women. Further study
should focus on the effective treatment measures and the neonatal outcomes of women with HG and psychiatric disorders.
Keywords: hyperemesis gravidarum, psychiatric etiology
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S16-S7
[JS-16]
Anxiety disorders in pregnancy
Faruk Uguz
Necmettin Erbakan University, Meram School of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Epidemiological studies indicated that anxiety disorders are more frequently observed in women compared to men. Anxiety disorders
are usually occur in reproductive period of women. Pregnancy, an important reproductive event, may affect course or occurence of these
disorders in women. The prevalence rate of anxiety disorders were reported to be 15-20%. Panic disorder, obsessive-compulsive disorder
and posttraumatic stress disorder have been more studied compare to other anxiety disorders.
There is no specific guidelines for treatment of anxiety disorders during pregnancy. However, psychotherapy methods, particularly cognitivebehavioral therapy, seem to be appropriate treatment option in mild or moderate conditions. Selective serotonin reuptake inhibitors are generally
recommended as first-line pharmacotherapy method, although we have some minimal concerns about their usage during pregnancy.
Keywords: anxiety disorders, pregnancy, women
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S17
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SYMPOSIUM
[S-2]
Synthetic cannabinoids: more dangerous than marijuana
Ilhan Yargic
Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
E-mail address: [email protected]
Natural cannabis (Δ9-THC, tetrahidrokannabinol) is derived from the plant called Cannabis Sativa. Acute effects of cannabis include
euphoria, relaxation, subjective slowing in time perception, dizziness, analgesia, difficulties in memory and problem solving, ataxia,
tachycardia, systolic hypertension, postural hypotension, increased apatite, anxiety, paranoid thoughts and depression.
Cannabis can cause dependence and withdrawal. DSM-5 lists withdrawal symptoms as: anger, irritability or feelings of aggression;
depressed mood; feelings of restlessness; loss of appetite; insomnia; feelings of anxiety or nervousness; physical symptoms of withdrawal,
such as headache, stomach pains, increased sweating, fever, chills or shakiness.
Cannabis is also known to have some therapeutic effects such as antiemetic in cancer patients, spasmolytic in multiple sclerosis (MS),
appetizer in AIDS, anti-inflammatory in rheumatoid arthritis, antidiarrheal in Crohn’s disease and also useful in neuropathic pain,
glaucoma and movement disorders.
Cannabis acts on cannabinoid receptors (CB1 and CB2). Main endogen cannabinoids are anandamide and arachidonilglyserol. Marijuana
contains approximately 60 cannabinoids. Δ9-tetrahydrocannabinol which is the most effective one activates mesolimbic dopaminergic
system so that it affects reward and reinforcement mechanism.
Today there are a few medications containing cannabinoids used for medical purposes: Dronabinol (Marinol®), Nabilone (Cesamet ®),
Nabiximols (Sativex®) and medical marijuana. Nabiximols (Sativex® oral spray) was approved for decreasing stress, muscle rigidity and
pain in MS. It can be used in moderate to severe cases that are refractory to other spasmolytic medications. Good results have also been
reported with neuropathic pain, overactive bladder, cancer pain and Tourette syndrome.
Medical uses of cannabis have led investigators to search for synthetic cannabinoids (SC). These compounds which were initially used for
analgesia have THC like effects. They were not marketed as medicine due to their psychoactive properties, however, their abuse spread
rapidly. These compounds are marketed on the street with names such as Spice, K2, Genie in Europe and USA. In Turkey they have street
names such as Bonzai, Jamaica and Jamaican Gold.
Their chemical structure is quite different than THC. They are designated with chemical formulas like JWH-018, JWH-073, HU-210, CP-47,
CP-497, JWH-018 and a new one is added every day. They were officially registered as illegal substances on 13.02.2011 in Turkey.
Their cannabinoid receptor (CB1R) affinity and activity is higher than those of THC. They have a larger effect size and more frequent and
more severe adverse effects compared to THC. Their effect starts more rapidly but lasts shorter. There is risk of intoxication depending
on amount and degree of purity. Their adverse effects which are not seen or less frequently seen with natural THC include convulsions,
anxiety, aggressiveness, muscle rigidity and confusion. Their abuse has been popular rapidly due to their easy access and being
undetectable in routine urine screens. SC’s have been reported to cause dependence and physiological withdrawal.
Poison Control Center data in USA report agitation, confusion, hallucination, hypertension, myocardial ischemia, heart attack linked to
the use of SC. Toxic effects usually resolve in 3-4 hours. There are many case reports of convulsions due to SC. They are generalized tonic
clonic (GTC), usually multiple and don’t leave sequel. Emergency department physicians should suspect from SC abuse in young males
who apply with first time GTC seizure. In cases of new and sudden onset psychosis that are on urine drug screen follow-up or in cases
who demonstrate signs of cannabis abuse but give negative urine test, SC abuse should be suspected. SC has also been reported to cause
some other serious medical adverse effects like acute kidney failure, acute loss of vision and Wernike Syndrome.
Keywords: synthetic cannabinoids, marijuana, adverse effect, cannabis, medical marijuana
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[S-3]
Are psychotherapeutic approaches always superior to psychopharmacological
treatments in childhood?
Muhammed Tayyib Kadak
Istanbul University, Cerrahpasa Medical School, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Psychiatric disorders in children and adolescents have a high prevalence worldwide and are often associated with substantial psychosocial
impairments. Most of these disorders have a high likelihood of persistence or recurrence of symptoms. More over these are risk factors
for other psychiatric disorders in adulthood. Because of the potential risk of untreated psychiatric illnesses, several treatment approaches
are developed and suggested for child and adolescent such as psychopharmacotherapy family intervention and psychotherapy etc.
Psychotherapy can be a very effective tool for management of mental health disorders with children and adolescents, especially for
parents and patients who may object to the use of pharmacotherapy. Physiological intolerance to medications, conditions resistant to
medication such as emotional component or environmental cause for the child’s behavioral responses (e.g. family conflict) and parent’s
suspicion for psychopharmacology are obstacles to prescribing medication in child and adolescent psychiatry.
Psychotherapy is divided into modalities (e.g. individual, group, and family) and theoretical approaches (e.g. behavioral, cognitive, eclectic,
existential, interpersonal, psychoanalytic, and psychodynamic). However, in this era of evidence-based medicine, only behavioral, cognitive–
behavioral and interpersonal psychotherapies have large numbers of studies that meet the requirements to be called empirical studies.
Evidence-based studies focus on the relative efficacy of treatments for specific subtypes of disorders and different intervention techniques for
the same disorder. Studies revealed that evidence-based treatments for children and adolescents could be applicable to several diagnostic
categories. Cognitive behavior therapy (CBT) is the most researched form of psychotherapy. It is revealed that CBT has significant effects
on depression, anxiety, disruptive behavior problems, posttraumatic stress disorder (PTSD), and substance abuse in child and adolescents.
Likewise, psychodynamic psychotherapy studies concluded that there were significant effects with all treatments such as conduct problems,
anxiety disorders. Studies also investigated combined effects of psychopharmacologic and psychotherapeutic interventions. Empiric
evidence supports that a combination of pharmacotherapy and psychotherapy is more beneficial to children and adolescents
Keywords: pharmacotherapy, psychotherapy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S19
[S-3]
The importance of therapeutic drug monitoring in child and adolescent psychiatry
Ozgur Yorbik
Uskudar University, Istanbul-Turkey
e-mail address: [email protected]
Objective: Drug treatment of children and adolescent is disadvantaged by lack of evidenced based efficacy and safety for many
indications. For that reason, many psychoactive drugs in children and adolescent are not approved for use until now. Because
pharmacokinetics and pharmacodynamics properties of children and adolescent are different from adults, and these properties change
during development, therapeutic drug monitoring (TDM) is recommended in these groups. However, there is still lack of sufficient studies
to illustrate age and indication specific therapeutic ranges of serum or plasma concentrations in these groups. The aim of this study is
to investigate relationship between doses of various psychoactive drugs and plasma concentrations in children and adolescents with
attention deficit hyperactivity disorder ADHD, and to review TDM in the literature.
Materials and Methods: The literature on TDM in children and adolescent with psychiatric disorders was reviewed. The study group was
consisted of children and adolescents with ADHD. Plasma methylphenidate and other psychoactive drug concentrations of children and
adolescents with ADHD were determined by using high-pressure liquid chromatography coupled to mass spectrometry (LC-MS/MS). The
relationship between drug dose and plasma drug concentration of children and adolescents was determined by using Pearson correlation
test. The effect of other drugs on methylphenidate plasma level was also tested. In addition, the effect of age, sex, and body mass index
on plasma concentration of drugs at usual therapeutic doses was investigated.
Results: TDM may be a valuable tool for qualification of serum or plasma concentrations of drugs for optimal dose, and to illustrate
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uncertain drug adherence, non-response at therapeutic doses, tolerability problems, and drug-drug interactions. Because drug
treatments of psychiatric disorders take a long time, TDM may ensure lower risk for toxicity and cost effective treatment. According
to Arbeitsgemeinschasft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Consensus Guidelines, TDM is strongly
recommended for the typical antipsychotics (e.g. haloperidol, perphenazine and fluphenazine), atypical antipsychotics (e.g. amisulpride,
clozapine, olanzapine, and risperidone), mood stabilizing or antimanic drugs (e.g. lithium, valproic acid, and carbamazepine), and most
tricyclic antidepressants. Typical indications for measuring plasma concentrations of psychoactive drugs may include dose optimization
after initial prescription or after dose change, drugs that TDM is mandatory for safety reasons (e.g. lithium), suspected complete or partial
non-adherence (non-compliance) to medication, lack of clinical improvement under recommended doses, adverse effects and clinical
improvement under recommended doses, combination treatment with a drug known for its interaction potential or suspected drug
interaction, relapse prevention under maintenance treatment, recurrence under adequate doses, presence of a genetic particularity
concerning drug metabolism (genetic deficiency, gene multiplication), pregnant or breast feeding patients, children and adolescents
patients, elderly patients, individuals with intellectual disabilities, patients with pharmacokinetically relevant comorbidities (hepatic or
renal insufficiency, cardiovascular disease), forensic patients, problems occurring after switching from an original preparation to a generic
form (and vice versa), and TDM in pharmacovigilance programs (Hiemke et al 2011).
Conclusions: Limited studies are investigated relationship between clinical doses and plasma levels of psychoactive drugs in children
and adolescents with psychiatric disorders. More studies are needed to use evidence based usage of TDM in children and adolescents
with psychiatric disorders.
Keywords: therapeutic drug monitoring, TDM, children, adolescents, psychiatry, attention deficit hyperactivity disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S19-S20
[S-4]
Pharmacokinetic, pharmacodynamic and pharmacogenetic approach in the field
of child and adolescent psychiatry in Turkey and the world
Caner Mutlu
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
e-mail address: [email protected]
Objective: The proportion of children and adolescents having psychiatric disorders increases and treatment options are developed.
Pharmacological intervention is an important option to treat psychiatric disorders of childhood and adolescence. Clinicians generally
decide a drug according to the information about the patient’s illness process, target symptoms, and family medication experiences
within the context of their experience, subspecialty practice guidelines, and results of pharmaceutical trials. Although this approach is
effective for many patients, significant number of patients develops serious side effects/adverse events or does not respond sufficiently
to psychotropic drugs given. Because there is significant inter-individual variability among children and adolescents on the clinical
response (i.e., improvement of symptoms and occurrence of side effects/adverse events) to the same psychotropic drug. Also, the
clinical response to the same agent may differ through time, because the affinity, functional capacity, and expression of the targets
(enzymes, transporters etc.) of medications vary along development. This variability in individual response to psychotropic drug
partly depends on well-known and easily assessable factors like age, sex, liver and renal function, co-medication, heterogeneity in the
disease. Moreover, inherited variants in pharmacokinetics (which are related to absorption, distribution, metabolism and excretion)
and pharmacodynamics (which are related to receptors and enzymes involved in the mechanism of action) components that are under
genetic control affect to some extent the clinical response to a psychotropic drug. The influence of genetic factors on clinical response
(drug efficacy and side effects/adverse events) is defined as pharmacokinetics/pharmacogenomics. Pharmacogenetics is focused on
pharmacological consequences of a single gene mutation, whereas pharmacogenomics tries to simultaneously consider numerous
genes and their mutual interaction. Over the past few years, pharmacogenetic tests have been applied to clinical psychiatric practice.
Aim of this presentation is to review the literature of the pharmacokinetic, pharmacodynamic and pharmacogenetic approach in the
field of child and adolescent psychiatry, and to discuss the findings.
Materials and Methods: The literature of the pharmacokinetic, pharmacodynamic and pharmacogenetic approach in the field of child
and adolescent psychiatry was searched via PubMed and Google Academic, and reviewed.
Results: By searching the literature, few studies that evaluated pharmacokinetic, pharmacodynamic and pharmacogenetic approach
in the field of child and adolescent psychiatry have been found while most psychiatric pharmacokinetic, pharmacodynamic and
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pharmacogenetic studies have focused on the adult population. Psychiatric pharmacogenetic approach is divided into two primary
categories: pharmacokinetic approach (including metabolic enzymes, for example the cytochrome P-450 enzyme system); and
pharmacodynamic approach (including genes that effect neuronal function, for example the dopamine transporter and receptor genes).
Many of these psychiatric pharmacogenetic target genes have also been studied in relation to their influence on disease vulnerability.
The majority of the studies focused on pharmacogenetic approach of psychiatric disorders in children and adolescents were associated
with response to psychotropic drugs like methylphenidate, atomoxetine and SSRIs. Cytochrome P-450 enzymes are the most commonly
tested genes in pharmacogenetic practice, especially in adult population. Pharmacogenetics has arrived in clinical psychiatric practice
with a test those genotypes for two cytochrome P450 2D6 and 2C19 genes.
Conclusions: Relatively few studies on pharmacokinetic, pharmacodynamic and pharmacogenetic approach in the field of child and
adolescent psychiatry have been performed to date. Currently available pharmacokinetic, pharmacodynamic and pharmacogenetic
technology offers patients and prescribers an opportunity to move closer to the ultimate goal of truly individualized prescriptions.
Pharmacokinetic, pharmacodynamic or pharmacogenetic testing may be suggested when a patient or their family is reporting minimal
response to typically therapeutic doses in two or more unsuccessful medication, or if there is a clear report of significant side effects.
In fact, while pharmacogenetic tests focused on pharmacokinetic genes are in clinical practice especially in non-psychiatric field, those
focused on pharmacodynamic genes are far from ready for clinical application.
In recent several years, pharmacogenetic testing has become far more cost-effective. As the cost of pharmacogenetic testing decreases, it
will become more applicable in clinical psychiatric practice for children and adolescents. Probably in the next decades, pharmacogenetic
testing will routinely be ordered to guide the selection and dosing of psychotropic medications.
In conclusion, considering the significant burden associated with psychiatric disorders in children and adolescents, and the
necessity to identify effective (with high efficacy and low side effects) pharmacological interventions, the field of pharmacokinetics,
pharmacodynamics and pharmacogenetics of childhood psychiatric disorders will be further developed.
Keywords: pharmacokinetics, pharmacodynamics, pharmacogenetics, children, psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S20-S1
[S-4]
Is it necessary to use antidepressant medication in treatment of depressive disorders
in children and adolescents?
Omer Fauk Akca
Necmettin Erbakan University, Meram Medical School, Department of Child and Adolescent Psychiatry, Konya-Turkey
e-mail address: [email protected]
Depressive disorders are common in children and adolescents, with suggested overall prevalence rates for children (under 13 years)
2.8% and for adolescents (13 to 18 years) 5.7%. If left untreated, depressive disorders in the younger years are likely to continue into
adulthood, and can be increasingly difficult to treat as time goes on. Psychological therapies and antidepressant medication can be used
to treat depression in children and adolescents. Psychological therapies in common use are cognitive behavioural therapy, interpersonal
psychotherapy and psychodynamic therapy. A systematic review indicated that overall, psychotherapy is more effective than control
comparisons immediately post-intervention, although this benefit is no longer evident at six months and 12 months follow-up. Subgroup
analysis suggested that psychotherapy might be more effective than control for adolescents (13 to 19 years) but not for younger children
(six to 12 years). There are many different types of antidepressant medication, all of which have been developed specifically to work on
chemicals in the brain that are believed to be linked to depression. The majority of guidelines on the treatment of depressive disorders
in young people recommend selective serotonin reuptake inhibitors (SSRIs). The SSRI for which there is the most consistent evidence of
a statistically significant reduction in depressive symptoms compared with placebo is fluoxetine. National Institute for Health and Clinical
Excellence (NICE) guidelines state specifically that fluoxetine should be the first antidepressant medication option. In TADS, fluoxetine
alone was superior to CBT alone, and the combination of fluoxetine and CBT was statistically significantly better than either alone in the
short-term. However, the difference between SSRI and combination therapy is stated to be insignificant in long term follow-up studies.
As a conclusion, evidence about the relative effectiveness of psychological interventions, antidepressant medication and a combination
of these interventions is limited. Further studies are needed to establish a guideline on this topic.
Keywords: antidepressant medication, depressive disorders, child and adolescent psychiatry
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[S-4]
Different approaches for treatment of social anxiety in adolescents
Sabri Herguner
Necmettin Erbakan University, Meram School of Medicine, Department of Child and Adolescent Psychiatry, Konya-Turkey
e-mail address: [email protected]
Objective: Social anxiety disorder (SAD) is a marked and persistent fear of social situations characterized by pervasive social inhibition
and timidity. The average age of onset is early to middle adolescence (11.3 – 12.7 years-old). It was estimated that about % 1 – 2 of the
general child population suffered from SAD. Children with SAD report distress in a broad range of interpersonal encounters including
joining in on and starting a conversation, writing, reading and speaking in front of the class, and musical or athletically performances.
Also they frequently report physical symptoms such as heart palpitations, shakiness, sweating, and nausea. Furthermore, a substantial
proportion of individuals have comorbid psychiatric conditions such as generalized anxiety disorder, selective mutism, separation anxiety
disorder and depression. Children and adolescents with SAD exhibit deficient social skills. Several retrospective studies showed that the
majority of those with a history of SAD recovered from the disorder. The strongest predictor of recovery was later age of onset of social
fears. The aim of this review is to discuss the treatment approaches for SAD in adolescents. Recommendations and suggestions for future
research will also be presented.
Materials and Methods: Studies were collected through searching PubMed using the search words social phobia or social anxiety,
treatment, pharmacotherapy, psychotherapy, children, adolescents, social skills training, group therapy and antidepressants. The article
included published after 1995 with adolescent participants (age < 18 years) with SAD.
Results: Few studies have focused specifically to the treatment of SAD in adolescence. There are mainly three treatment approaches that
this review will focus on: 1- Cognitive behavioral treatment (CBT), 2- Pharmacotherapy and 3- Family treatment. Several studies reported
that adolescents treated with individually CBT had significantly lower general anxiety and enhanced coping abilities and improved on
parents’ ratings of anxiety, depression, and social competence. The Group Cognitive-Behavioral Treatment for Adolescents (GCBT-A),
a 12-week group therapy that consists of psychoeducation, skill building, cognitive restructuring and behavioral exposure to social
distressing situations, was also reported to be an effective treatment program for adolescents with SAD. Similarly Social Effectiveness
Therapy for Children (SET-C), a multifaceted behavioral treatment that includes group social skill training, peer-generalization
experiences, and individual in vivo exposure, was found that children were less anxious, less avoidant, more skillful and engaged in more
social discourse at post-treatment. Selective serotonin reuptake inhibitors (SSRIs) are usually considered as the first-line pharmacological
agent with the advantages of minimal side effects and high tolerance levels. Several studies showed that children with only one anxiety
disorder responded to lower doses of SSRIs than did children with comorbid disorders. The addition of family component to the CBT,
either individually or in groups, was superior to CBT alone, especially in preadolescents.
Concussions: As SAD has been found to be an early-onset, comorbid, and chronic disorder, early detection and intervention could help
avert a lifetime of personal distress and social maladjustment. Psychopharmacological and psychotherapeutic interventions are found to
be effective in the treatment of adolescents with SAD.
Keywords: social anxiety disorder, childhood, adolescence, pharmacotherapy, psychotherapy, social skills training
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S22
[S-5]
Emergency situations in child and adolescent psychiatry and its management
Ayse Kilincaslan
Istanbul University, Istanbul Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
The incidence of mental health disorders in children has dramatically increased for the past decade in both primary care and emergency
department settings. Although there is no universally accepted definition for the emergency nature of a child or adolescent psychiatric
condition, severity and urgency of the potential threat to the child’s and family’s safety and wellbeing, as well as available resources of the
family and community determine its boundaries. Some situations such as aggressive and homicidal outbursts, acute psychotic or anxious
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states, serious suicide attempts, ingestions and intoxications, usually require emergency psychiatric attention for immediate medical and
psychiatric diagnostic and therapeutic interventions. Also inadequacy of mental health resources in the community or inability of the
family to use these resources may cause more chronic and less urgent presentations become a complete emergent condition.
The psychiatric emergency visit may be the only interaction that a caretaker and child have with the mental health care system. Therefore,
the emergency referral represents an important health care setting for the identification of mental illness and intervention in children.
This presentation will focus on key issues that should be included in a thorough assessment and management of children and adolescents
referred for the emergency psychiatric evaluation.
Keywords: emergency, child, adolescent, psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S22-S3
[S-5]
Current treatment modalities for tic disorders in children and adolescents
Canan Tanidir
Erenkoy Mental and Neurological Diseases Training and Research Hospital, Child and Adolescent Psychiatry Clinic, Istanbul-Turkey
e-mail address: [email protected]
Objectives: Tic disorders are characterized by the presence of involuntary contractions of muscle groups, either resulting in motor
movements, or in verbal utterances and sounds. Tic disorders are neuropsychiatric disorders with higher prevalence rates than previously
thought, of up to 3–4% for chronic motor or vocal tic disorders and 1% (range 0.05–3%) for Tourette syndrome, which is the combination
of chronic motor and vocal tics persisting for at least one year. In some cases tics highly effect the quality of life and demand behavioral
treatment, pharmacotherapy or combined treatments. It is difficult to develop guidelines for pharmacological treatment of tic disorders
for a number of reasons. But in this presentation it was aimed to make a summary of the current consensus on pharmacological treatment
options and indications for tic disorders and to briefly review the evidence-based behavioral interventions and other treatment options.
Method: Latest original articles, reviews and guidelines about the treatment of tic disorders were searched on PubMed published after
year 2008. Current treatment modalities were summarized based on especially two recent guidelines (European Guidelines and Canadian
Guidelines) about the pharmacotherapy, behavioral interventions and other treatment options for tic disorders
Results: Many children and adolescents with tic disorders do not require treatment for their tics, since their tics do not interfere with
daily life or recreational activities. Many patients do well with a watch and wait strategy after psychoeducation and reassurance.
Psychoeducation which aims to improve the tolerance for symptoms and to support stress reduction is the first step in the treatment of
tics. Although education, reassurance, and a watch-and-wait approach are often the primary treatment modality, drug treatment is the
most common active intervention. Haloperidol, pimozide, atypical antipsychotics (e.g., risperidone) and alpha-2 adrenergic agonists
such as clonidine and guanfacine are generally considered to be the most effective medications for the treatment of tic disorders.
Beside pharmacotherapy, several different behavioral therapies have been examined for treatment of tics, each showing varying
levels of efficacy. The data suggest that behavioral interventions, particularly habit reversal training (HRT) and exposure and response
prevention (ERP), are effective in the treatment of tic disorders. Deep brain stimulation (DBS) is a surgical treatment reserved for severe
cases of Tourette syndrome that have not responded to other behavioral or pharmacological treatments. Majority of the studies on DBS
show significant tic reduction, but not complete symptom remission. Although some studies describe successful outcomes with DBS
in adolescents patients, due to lacking of randomized controlled studies, at present time DBS is recommended only in adult, treatment
resistant, and severely affected patients.
Conclusion: All pharmacological treatment options are symptomatic that alleviate, but do not cure the tics. And the evidence of the effect
that pharmacological treatment has on the prognosis of the disorder is still lacking. Behavioral interventions like habit reversal training
(HRT) and exposure and response prevention (ERP) seems to be effective treatment methods for tic disorders.
Keywords: Tourette syndrome, tic disorders, pharmacotherapy, behavioral therapy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S23
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[S-5]
Importance of pharmagenetics in the psychiatry of child and adolescent
Nuket Isiten
Uskudar University, Istanbul, Turkey
e-mail address: [email protected]
Nowadays, many drugs are widely used for toddlers and children without approval. But those drug formulations prepared for adults may
not be appropriate for child patients.
The drug levels in blood (TDM) are measured periodically in our clinics. Advanced investigations (phenotyping/genetics etc.) are carried
out manly if incorrelations exist between the drug levels in blood and the clinical responses, and if required for other reasons. The results
of our investigations show that bulk of our clinical population have results differing from the average.
In several countries, TDM measurements and phenotyping are widely used for pediatric population. Unfortunately this is not valid for our
country. This presentation aims to share our relevant clinical data, and to have discussed the matter in a scientific platform.
Drug use for children; there are pharmacogenetic and pharmacodynamic differences among children due to the physiological differences
at their development stages. Therefore it is essential to consider the development stage of a child when any drug is used. Newborn stage,
toddler stage, childhood stage and adultery stage are different for their biological benefit from the drug which changes pharmacogenetic
and pharmacokinetics of a drug so that the main and side effects will change.
Determining the pharmacogenetic differences amongst various communities and ethnical groups is another area of implementation of
this approach. Due to the wide existence of some polymorphic variants in some communities that may be more sensitive to the pogress
of illness and drug treatment. Dividing the patients into different genotypical groups and applying different sausages or even drugs for
the same illness is a treatment in clinical practice today.
In near future, several new indications are expected to be on the agenda. Emerging of the ultra quick technologies, such as Microerey
and chip technologies, may soon take place in routine clinical applications in determining the polymorphic genetical characters of the
patients prior to their medical treatment.
Keywords: pharmagenetics, child and adolescent psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S24
[S-6]
Psychiatric evaluation and follow-up of bariatric surgery patients
Guzin Mukaddes Sevincer
Istanbul Gelisim University, Department of Psychology, Istanbul-Turkey
e-mail address: [email protected]
Mental health specialists have an essential role in evaluating bariatric surgery patients. Because arguments about how to measure the
success of the surgical operations show that weight loss is no longer the sole criteria and the psychiatric, psycho-social and patient’s wellbeing are important also criteria for defining the success of the surgical operation.
Bariatric surgery is not a cosmetic procedure. The selection a candidate for a bariatric surgery must be done with qualification. However,
there is still no clear consensus regarding what constitutes selection criterion. Whether presence of psychopathology is contraindication
to bariatric surgery is also a matter of dispute. Furthermore, whether psychological health specialists should be present in the selection
candidates for bariatric surgery is not defined in the legislation.
Just as there is not standard in psychiatric evaluations before surgery, there is not consensus about which psychological interventions
will be most suitable and influential towards a positive outcome for the surgery. Along with this, pre-operational evaluation often
encompasses behavioral, cognitive, emotional and developmental fields. Furthermore, the current stresses in the life of the patient, the
motivation and expectations for the surgery should be evaluated. Comorbid psychiatric disorders, weight history, previous weight-loss
attempts, social influences, and other environmental factors that might influence the operational outcomes should be investigated. The
designation and finding remedies for these problematic fields of pre-operational problematic psychosocial factors and treatment of
psychiatric disorders increase the benefit the patient will obtain from the surgery. Also, psychiatric evaluation is important since it will lead
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to a consciousness of the surgeon about this matter, to better understand to patient, and to be able to manage the treatment process.
The results of the researches about the prevalence of psychopathology among patients who look for bariatric surgery clearly show
that the proportions of psychopathology in this group are higher. Mood disorders, anxiety disorders, eating disorders and personality
disorders are among the most commonly observed psycho-pathologic conditions.
Although which psychopathologic states induce contraindication is being disputed, it is expressed that conditions such as dementia,
mental retardation, drug addiction, severe obsessive-compulsive disorder, which is resistant to treatments, and borderline personality
disorder are cases that should be evaluated more cautiously.
The evaluation of bariatric surgery shouldn’t be limited to the pre-operational period and patients should also be follow-up. Because
the undertaken research shows that the presence of a psycho-pathology effect both the results related to weight lost and also the post
surgical well-being and functioning. Besides the bariatric surgery itself may influence psychopathologies in a negative or positive way.
When psychiatric problematic fields are designated, the interventions may be one or more of the below Methods:
Psychopharmacological treatments, psycho-education, psychotherapy to handle potential post-operational obstacles, dietary counseling,
post-surgical close monitoring and encouraging involvement in an obesity surgery support group. When all these are taken into
consideration, the evaluation and follow up of bariatric surgery patients should be done with a multi-disciplinary team that also includes
mental health professionals.
Keywords: psychiatric evaluation, bariatric surgery
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S24-S5
[S-6]
Classification and epidemiology of eating disorders in the DSM-5
Hans W. Hoek
The University Medical Center Groningen, The Netherlands
e-mail address: [email protected]
In May 2013 the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been published, which includes
a substantially revised section on feeding and eating disorders. Throughout the DSM-5 the influence of development, gender and
culture on the presentation of psychiatric disorders has been given more weight than any previous edition of the DSM ever did, and
wherever possible it seeks to adhere to a lifespan appro. One of the consequences of the lifespan approach is the elimination of the
prior DSM-IV chapter “Disorders Usually First Diagnosed During Infancy, Childhood or Adolescence.” As a result of the removal of this
chapter, the two separate categories “Feeding Disorders” and “Eating Disorders” from DSM-IV are integrated into a single category
called “Feeding and Eating Disorders” in DSM-5 This DSM-5 chapter “Feeding and Eating Disorders” includes the following diagnoses:
pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa (AN), bulimia nervosa (BN) and binge eating
disorder (BED).
Eating Disorders Not Otherwise Specified (EDNOS) was a major concern for the DSM-5 Eating Disorders Work Group, because it was by
far the most common DSM-IV eating disorder diagnosis not only in community samples, but it also accounted for more than half of the
eating disorder cases in clinical settings. The use of DSM-5 criteria will result in a large reduction in the proportion of EDNOS diagnoses
by lowering the threshold for AN and BN and adding BED as a specific eating disorder. In consequence the prevalence rates for AN and
BN will increase, but course and outcome studies of both AN and BN indicate no significant differences between DSM-5 and DSM-IV
definitions. The lifetime prevalence of DSM-5 anorexia nervosa among women might be up to 4%, and of bulimia nervosa 2%. In a crossnational survey, average lifetime prevalence of binge-eating disorder was 2%. Community studies show that most people with eating
disorders do not receive any treatment at all, either because they are not detected or because they refuse treatment due to shame or
denial of their illness.
Keywords: eating disorder, epidemiology, classification, prevalence.
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S25
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[S-6]
Psychopharmacological treatments in eating disorders & comorbid conditions
Alican Dalkilic
Cooper Medical School of Rowan University, Department of Psychiatry, NJ, USA
e-mail address: [email protected]
The prevalence of eating disorders (ED) has been increasing around the globe and among the minority populations in industrialized
countries along spread of Western life style and cultural values emphasizing physical appearance and fashion behavior. The Internet and
new social media tools such as Facebook, Twitter, Instagram, etc. would likely exacerbate negative impact of media on dieting behavior,
body image, orthorexia, etc. and relationship of individuals with food overall. From another perspective video game, Internet, and other
screen based addictions, gambling, and compulsive buying share some characteristics with ED in terms of behavioral addictive nature.
It has been difficult to develop and test efficacy of biological agents, and seek Federal Drug Administration (FDA) approval for them due
to complicated nature of eating disorders, limited diagnostic criteria, and concurrent conditions. The Fifth Edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) has brought significant changes and specificity to classification of eating disorders. Despite
the lifetime prevalence of ED is estimated to reach 5.9% among women (2), fluoxetine still remains to be only FDA approved medication
for treatment of an ED.
Although the evidence for pharmacological interventions to treat ED has been limited, most ED patients end up needing treatment with
various psychopharmacological agents due to co-occurring mood, anxiety, trauma, and substance use disorders (3).
Hence we will review psychopharmacological treatment options for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder
(BED), and common comorbid conditions including major depressive, bipolar, posttraumatic, generalized anxiety, obsessive compulsive
disorders, and alcohol use disorder.
Since EDs have high rates of comorbid conditions in addition to sharing similar characteristics with behavioral addictions, it is important
for clinicians to be aware of psychopharmacological agents that can be effective in treating EDs, even they are not FDA approved.
Furthermore investigating new agents, that would be effective in treating ED, might result in potentially beneficial agents for treatment
of concurrent conditions and behavioral addictions.
Keywords: eating disorder, psychopharmacological, pharmacological treatment, behavioral addictions, concurrent conditions
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S26
[S-7]
Role of hypothalamic neuropeptides and atypical antipsychotics effects
on the regulation of eating behavior
Mehmet Ak
Medicana Hospital, Konya-Turkey
e-mail address: [email protected]
Objective: Principally, neurohormones synthesized and released from the arcuate nucleus of the hypothalamus that are proopiomelanocortin (POMC), cocaine and amphetamine-regulated transcript (CART), neuropeptide Y (NPY), Aguti related peptide (AgRP)
regulate eating habits, body weight, energy metabolisms in human. Besides the appetite reducing effects of POMC and CART, the eating
trigger functions of AgRP and NPY were shown. Synthesis and secretion of these neurohormones are controlled by the insulin hormone
secreted by the beta cells in the islets of Langerhans of the pancreas and leptin hormone synthesized and released in adipose tissue.
After the secretion from the adipose tissue, leptin passes through the blood-brain barrier as insulin, bind to receptors (leptA and leptB)
on the hypothalamus, reduces the synthesis of neuropeptides that increase appetite such as NPY, AgRP and increases the synthesis of
neuropeptides that reduce appetite such as POMC, CART. Recently, in the studies, it has been initiated to emphasize that the weight
gain effect of atypical antipsychotics might be originated from the deterioration in the hypothalamic regulation system. Neurons in the
hypothalamic arcuate nucleus include serotonin and GABA receptors and regulation mechanisms may be disturbed due to the effects of
atypical antipsychotics on these receptors. For instance, in a study that investigated the relationship between serotonergic system and the
eating mechanism through carbohydrate metabolism, body weight as well as food cravings predominantly of carbohydrates had been
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shown to increase by 5-HT2A and 5-HT2C receptor antagonism of olanzapine administered to the rats.
Method: To examine olanzapine and risperidone weight gain effects, we accepted first episode psychotic patients with no medication
(pre-treatment) and the healthy control group in this study. After patients´ diagnosis, they were hospitalized and then treated for four
weeks with olanzapine and risperidone (post-treatment). We used case-control association design to test body mass index (BMI) and
biochemical changes in each group. We also investigated peripheral leptin and neuropeptides/hormones namely, pro-opiomelanocortin
(POMC), cocaine and amphetamine regulated transcript (CART), and neuropeptide Y (NPY) levels. These neuropeptides which are
synthesized/secreted from arcuate nucleus of hypothalamus affect food intake and therefore, body weight.
Results: After 4 weeks of olanzapine and risperidone treatment; BMI (body mass index), waist circumference, blood triglyceride, total
cholesterol, and very low density lipoprotein (VLDL) levels were increased significantly in patients compared to their pre-treatment baseline.
Leptin levels were markedly high after the treatment in the risperidone and olanzapine groups. NPY level was significantly increased in
patients after the treatment of olanzapine. Circulating levels of those neurohormones were not significantly changed between before and
after risperidone treatment of the patients.
Conclusion: We may presume that the antagonist effect of olanzapine on the serotonin (5HT2CR and 5HT1BR) receptors of the arcuate
hypothalamic neurons may be a basis for a deregulation of the neurohormones secretion. These data demonstrate that peripheral α-MSH
and NPY, although reflecting only secretion from peripheral organs, nevertheless, may provide an insight into the patients’ sympathetic
tone and also suggest change of their appetite regulation. α-Melanocyte-stimulating hormone, NPY, and CART plasma levels may be used
as a predictor of weight gain in the early treatment of the patients along with the leptin levels.
Keywords: antipsychotic drugs, hypothalamus, neuropeptide
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S26-S7
[S-7]
Possible mechanisms of atypical antipsychotic induced weight gain
and preventive treatment options
Suleyman Akarsu
Gulhane Military Academy of Medicine, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Antipsychotic induced weight gain is regarded as more than 7% weight gain after the initiation of the drug. Weight gain takes place in
a very high degree with clozapine and olanzapine, high degree with quetiapine, zotepine, chlorpromazine and tioridazine, moderate
degree with risperidone and sertindole, low degree with ziprasidone, amisulpride, haloperidol, fluphenazine, pimozide, and molindone.
Patients receiving antipsychotic usually gain a large part of their body weight in the first 12-month period. Patients with low body mass
index prone to gain weight than those with high body mass index. On the other hand, it seems to be no significant effect of drug dose
on weight gain.
The underlying mechanisms of the antipsychotic induced weight gain are not exactly known. Environmental, genetic and behavioral
factors have been implicated in the development of this side effect. Carbohydrate starvation and reduction in metabolic rate due to
sedation have been blamed for antipsychotic induced weight gain. Especially eating behavior was investigated in this regard. In the
hypothalamus, the interactions between arcuate nucleus, paraventricular nucleus, neuropeptides in the dorsomedial area and peripherally
acting leptin, ghrelin, cholecystokinin, orexin, melanin stimulating hormone are responsible for the behavior of eating in general. Among
the genes associated with antipsychotic induced weight gain, leptin, tumor necrosis factor alpha (TNF α), brain-derived neurotrophic
factor (BDNF), dopaminergic system, serotonergic system, histaminergic system, adrenergic system, Peroxisome proliferator activated
receptor (PPAR), Insulin Receptor Substrate-1 (IRS–1), cytochrome P450 system, G-protein system and synaptic signal transduction genes
come to the forefront.
The effects of antipsychotic drugs on receptor affinities such as serotonin receptors that are 5 - HT1A and 5-HT2C, 5-HT6, 5-HT7, histamine
receptors that are H1, H2, H3, muscarinic acetylcholine receptors, dopaminergic receptor that is D2, adrenoceptors that are α1, α2 may
play a role in weight gain.
If the patients have risk factors like obesity, family history of diabetes, hyperglycemia care should be taken in the choice of antipsychotic
drugs. In case of risk factors, principally, weight monitoring at regular intervals is required in the patients who started treatment
with atypical antipsychotics. Determination of weight gain provide to give attention to the other side effects. Fasting blood glucose,
liver enzymes, cholesterol levels, thyroid hormones, prolactin and insulin levels should be examined at baseline, 3, 6, 12 months and
measurements of height, weight, blood pressure, breast circumference recommended to be repeated in monthly controls. The follow-up
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of male and elderly patients’ blood glucose and weight need to be maintained more carefully. In case of an increase in weight, clinical
follow-up strategies like transition to a lower risk of psychotropic drug, the implementation of a healthy diet regime, doing 30–60 minutes
of exercise a day, should be performed. Family members and other persons involved in the care of the patient must be informed and given
the necessary training about the risk of weight gain. Orlistat, sibutramine, fluoxetine, topiramate, amantadine, nizatidine, cimetidine,
metformin, and modafinil have been implicated to be effective in the studies investigating the drugs that can be used in the treatment
of weight gain.
Keywords: antipsychotic agents, weight gain
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S27-S8
[S-8]
Properties of antipsychotics in patients with schizophrenia in care centers
Etem Erdal Ersan
Sivas Numune Hospital Psychiatry Clinic, Sivas-Turkey
e-mail address: [email protected]
Objective: The aim of this is to analyze the relation between individual or multiple drug administration patterns of persons residing in
care centers for disabled persons in Turkey and the population characteristics as well as the diagnoses.
Method: The target population of this study included those patients referring to psychiatric clinic for examination or control, and those
residing in care centers, and those diagnosed with a psychotic disorder according to DSM-IV and those individuals receiving antipsychotic
medications. As an antipsychotic drug administration, use of these medications in efficient treatment dose was evaluated. More than one
antipsychotic drug administration was considered to be multiple antipsychotic drug administration. Data acquired were analyzed with
SPSS 16.0 software. For digital comparison of groups, chi-square test was applied while for mean comparisons, t test was applied. P<0.005
was considered to be significant.
Results: 200 individuals residing in care centers were contacted. Single antipsychotic drug administration ratio was 38%, while double
antipsychotic drug administration ratio was 34%, and more than three antipsychotic drug administration ratio was 28%. As single
antipsychotic drug administration most frequently olanzapine was used, and for double antipsychotic drug administration olanzapinequetiapine combination was most frequently used. Depot antipsychotic drug administration was most frequently applied with the other
antipsychotic drugs combination. Single depot antipsychotic drug use is less. Use of multiple antipsychotic was detected to be more in
those patients presenting with schizophrenia and schizoaffective disorder, in young patients, and those attempting suicide as well as
those with higher clinic level.
Conclusion: Despite the fact that use of multiple antipsychotics is suggested in treatment directions as last option in patients resisting
the treatment, and that they could be used in short terms during the antipsychotic change, they are frequently administrated. In addition,
there are not any studies concerning the use of antipsychotics in care centers in our country, and this condition is generally neglected.
Severity of disease is extremely high in the group using multiple antipsychotic drug. Even if it is reported that use of antipsychotics
enhances the mortality, morbidity, adverse effect risk and treatment cost, it is gradually increasing today.
Keywords: antipsychotics use, schizophrenia, care centers
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S28
[S-8]
Rational drug use in schizophrenia
Hulya Turgut
Bilecik State Hospital, Psychiatry Clinic, Bilecik-Turkey
e-mail address: [email protected]
Schizophrenia is a psychiatric disorder that is chronic course and has influence on thought, behavior, and affect in various forms. It is a
heterogeneous clinical picture from the point of view of onset, course, and clinical aspect. Its clinical picture and course were determined
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with positive, negative, cognitive, depressive, anxiety, and agitation-aggression symptoms.
The psychopharmacology of schizophrenia is a developing field rapidly. Many researches have been done in this field and the novel
drugs have been gone in using to the treatment. But schizophrenia keeps on still being a psychiatric disorder has not successful medical
treatment in spite of these developments, and an expectation of ideal drug (antipsychotic) has been continued. At present, the classical
(typical) and new generation (atypical) antipsychotic drugs have been used in treatment of schizophrenia.
STEPS rules must be used in which drug will choose for treatment. Safety (S) includes the therapeutic index of drug, drug-drug interaction,
pharmacodynamics and pharmacokinetic characteristics of drug. Tolerability (T) is concerned with side effects of the drug. Efficacy (E)
shows the effect fields, response ratio to treatment, the usable of maintenance and prophylactic treatment of drug. Payment (P) includes
the direct and indirect effects to expenses of the drug. Simplicity (S) means in single dose the application of the drug, being various forms
of the drug, such as oral, parenteral, long action.
The main rule of drug choosing is minimum side effects and maximum efficacy. In drug choosing, the response to former drug, the
sensitivity to the side effects of drug, and clinical picture of disorder must be taken into consideration. It is suggested that the members
of family also participated in drug choosing.
There is no enough evidence to give preference to new generation antipsychotic drugs. There are some main principles in related to
the antipsychotics used in schizophrenia treatment: a) identifying target symptoms, b) to use antipsychotic drug, c) observation the first
reaction, and d) to continue the using antipsychotic drug in sufficient dose and period of time. If this trial is useless,an antipsychotic from
different class must be chosen, at the sometimes it is favorable that to look for comorbid disorders.
In the treatment process of patients with schizophrenia, the maintenance treatment is one of the most important difficulties. Fifty and
eighty percent of patients with schizophrenia do not believe that they are ill. There is the lack of insight in them, and they reject to take
medicine, especially oral. As a result, they are not adherence to treatment. Depot or long action antipsychotic drugs can be a starting
point to take medicine as oral. Depot or long action antipsychotic drugs have some advantages, such as a) non-adherence is noticed
easily, b) what cause is related to relapse that is realized, c) relapse risk is decreased, d) using simple, e) regularly interview with patient
and his family, f ) gives opportunity for psycho-education, g) more stable plasma concentration than fast action forms, h) more efficacy
for a long time.
Although non-pharmacological approaches have positive effects to provide adherence, but only it is not sufficient. In schizophrenia
treatment, the characteristics of chosen drug and the guarantee to be found the drug in plasma are an important issue in patient
adherence and it’s continue.
Keywords: schizophrenia, antipsychotic agents
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S28-9
[S-8]
Psychosocial rehabilitation for schizophrenia
Mustafa Yildiz
Kocaeli University, School of Medicine, Department of Psychiatry, Kocaeli-Turkey
e-mail address: [email protected]
Schizophrenia mostly causes the patients to have a disability and a poor quality of life. Besides the pharmacological treatments,
psychosocial rehabilitation aims a continuous and well programmed healthcare for the chronic and disabled patients to teach how they
live healthier and independently in the community with less help and to enhance their quality of life. All attempts to remove of the effect
of disability due to the illness were appreciated at content of psychosocial rehabilitation.
Psychosocial rehabilitation techniques that researches provide the strongest support for schizophrenia will be presented in this panel
speech. These are: illness self-management, skills training, psycho-education for family members, case management, vocational
rehabilitation, assertive community treatment, social supports, and sheltering.
Keywords: schizophrenia, psychosocial rehabilitation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S29
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[S-8]
Adherence to treatment in patients with schizophrenia
Orhan Dogan
Professor of Psychiatry, Uskudar University, Istanbul-Turkey
e-mail address: [email protected]
Non-adherence to treatment is one of the most important problems in treatment of chronic illnesses. This condition is also valid for
schizophrenia. In general, non-adherence in chronic illnesses is approximately 60%. The patients with schizophrenia and bipolar disorder
do not believe that they are ill. They have lack of insight; therefore they reject to take medication.
In treatment, perfect adherence to treatment is rare; non-adherence to treatment is a common condition. If the patient misses the drug
dose small than 25%, he (she) is adherent. If the patient misses the drug dose between 25% and 65%, he (she) is partially adherent. If the
patient misses the drug dose more than 65%, he (she) is non-adherent.
Partially adherence to treatment is 25% in the first 10 days after discharge, 50% after one year, and 75% two years. If the adherence to
treatment is increased, the ratio of remission is increased. If the patients do not use their medications regularly, some disadvantages
are seen as follows: a) relapse ratio increases, the period and the number of admitted in hospital increases, suicide risk increases, the
possibility of remission decreases, all of social functionalities go bad, substance use, and financial problems. Non-adherence to treatment
can be dependent on characteristics of patient, environment, clinician, and medication.
The causes of not taking medication can be those: lack of insight, lack of efficacy of treatment, lack of social support, worries about side
effects, a poor doctor-patient relationship, cognitive losses, substance use, and comorbid psychiatric disorders.
How are formed adherence to treatment between doctor and patient? The answers are as follows: a) Non-pharmacological approaches,
b) pharmacological approaches, c) multidimensional approaches.
Non-pharmacological approaches include motivational interview techniques and similar approaches, cognitive behavior therapy, and
psycho-education approaches. The LEAP technique is a motivational interview technique. The phases of LEAP are as follows: Listen,
Empathy, Agree, and Partnership. Cognitive behavior therapy has been neglected for schizophrenia because of some causes. However, it
has been increased gradually that evidences about efficacy of cognitive behavior therapy in schizophrenia treatment. Psycho-education
can apply both patients and their families. A psycho-education program must include those issues: the symptoms and the causes of
schizophrenia; medications used for schizophrenia, their side effects, and their mechanisms; the manner of family; lawful rights and
responsibilities; emergency conditions and follow-up.
Pharmacotherapy is efficacy on schizophrenia treatment, especially on positive symptoms. Depot or long action antipsychotics increase
the adherence to treatment, decrease suicide risk and the number of admitting in hospital. To provide and continue the adherence
to treatment is suggested those strategies: to apply optimal antipsychotic treatment, to encourage the patients and their families for
psycho-education, to determine the patients’ motivations, to treat substance abuse, to include family members in treatment process, to
identify and remove the barriers to treatment.
There are common problems seen in the adherence to treatment. These can be concerned with patients, patients’ relatives, presenting
services.
Multidimensional approach contains a good doctor-patient relationship, accepting the adherence problem, favorable antipsychotic
treatment, forming a good atmosphere, applying motivational interview techniques and psycho-education.
Keywords: adherence, schizophrenia, motivational interview techniques, cognitive behavior therapy, psycho-education
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S30
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[S-09]
Management of the antidepressants usage risks in children and adolescents
Ayhan Bilgic
Konya Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya- Turkey
e-mail address: [email protected]
Antidepressants are nowadays used not only in the treatment of depressive symptoms, but in diverse child psychiatric disorders, such as
obsessive compulsive disorder, social phobia, generalized anxiety disorder, posttraumatic stress disorder and eating disorder. Although
these drugs are frequently used “off-label” in children and adolescents, increased amount of studies has supported the positive effects of
selective serotonin reuptake inhibitors (SSRIs) on depression and anxiety disorders in this age group. Therefore, the use of antidepressants
in young patients has increased markedly.
SSRIs are the most preferred antidepressants in children and adolescents. Because, they are generally well-tolerated and adverse effects
usually subside after approximately a week of treatment. However, clinicians should take into account some rare side effects of these
drugs including suicidality, increasing bleeding, manic symptoms, serotonin syndrome, discontinuation syndrome and behavioral
activation. Drug interactions should also always be considered in patients taking SSRIs, because some of them are moderate to potent
inhibitors of various CYP enzymes. Additionally, there is lack of long-term safety data about the effects of antidepressant exposure on
physical growth and the developing brain.
In conclusion, clinician who prescribe antidepressants should keep in mind their potential risks. Future research to identify which pediatric
patients may not be safely treated with antidepressants is warranted.
Keywords: antidepressants, risk
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S31
[S-11]
Challenges in medical imaging and medical image analysis
Suheyla Cetin
Faculty of Engineering and Natural Sciences Sabanci University, PhD Candidate, Istanbul-Turkey
e-mail address: [email protected]
In the recent health care, medical imaging plays a significant role throughout the entire clinical process from diagnostics and treatment
planning to surgical procedures and follow up studies. During the acquisition of medical images, medical images in the most imaging
modalities typically suffer from one or more of the following challenges regarding (i) low resolution (in the spatial and spectral
domains), (ii) high level of noise, (iii) low contrast, (iv) geometric deformations, and (v) presence of imaging artifacts. Low resolution
and low contrast imperfections can be avoided by finer spatial sampling, which may be obtained through a longer acquisition time.
Nevertheless, that would also increase the probability of geometric transformations, e.g. patient movement, and thus cause blurring
in the image.
The imaging artifacts also end up the challenging problems in the analysis of medical images. The first problem is the size of the medical
image datasets. Due to the large datasets of medical images, image processing and visualization algorithms have to be adjusted with
advanced parallelization techniques using supercomputers with graphical processing units.
The second problem is segmentation. Segmentation is the problem of extracting anatomical structures for quantitative shape analysis or
visualization. Segmentation should be fast, easy to use, robust with regards to image artifacts, and as automatic as possible in the ideal
clinical application. The ultimate goal of segmentation is to create structured visual representation from an unstructured raw data.
Final problem is registration, which aims fusing images of the same region acquired from different modalities (e.g. MRI and CT) or putting
in correspondence images of one patient at different times or of different patients. In surgery, for example, images are acquired before
(pre-operative), as well as during (intra-operative) surgery. Due to time constraints, the real-time intraoperative images have a lower
resolution than the pre-operative images obtained before surgery. Moreover, geometric deformations which occur naturally during
surgery make it difficult to relate the high-resolution pre-operative image to the lower-resolution intra-operative anatomy of the patient.
By the help of image registration, surgeons are able to relate the two sets of images.
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In conclusion, medical image analysis remains a vital field of research. None of the problem areas above are satisfactorily solved and the
problems are still open to improvement.
Keywords: medical imaging, medical image analysis, segmentation, registration
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S31-S2
[S-12]
From perspective of impulse-eating disorders
Bahadir Bakim
Canakkale Onsekiz Mart University, Faculty of Medicine, Psychiatry Clinic, Canakkale-Turkey
e-mail address: [email protected]
Impulsivity is the possible predictor of relapse in obesity treatment and considered as a predicting factor among patients who quit the
treatment. Research has shown that obese people are more impulsive than other people. Impulsive features are especially found to be
higher with those who have binge eating disorder. Impulsive people appear to have no control over their behaviors on eating and they
have more interest towards food with higher calories. Suicide attempts are common in obesity and in eating disorders.
Aggression and anger are among the major psychopathological features in patients with eating disorders. Some researchers correlated
that disordered eating behavior in eating disorders with highself-directed hostility. It was found that these individuals have difficulty in
disclosing their anger; on the other hand explosive outbursts might be occurring. Depression and anxiety disorders were found higher
in patients with eating disorders with impulse control disorders, in addition ,the cluster B personality trait personality traits(especially
borderline personality), and avoidant personality traits were higher in the same group. Wilma et al found elevated rate of childhood ADHD
in patients with h BN (23.5%). The only previous study to have examined adult ADHD in BN found that 9% of inpatients were comorbid.
Two studies found an association between childhood impulsivity and the development of BN. Cortese et al. observed a combined
association between inattentiveness and impulsivity and a higher likelihood of developing bulimic behaviors. Wonderlich et al. found
that impulsivity increases vulnerability for BN in general. The importance of identifying whether binge eating or purging behaviors are
more closely associated with impulsivity rests on research demonstrating the negative effect of impulsivity on the course and outcome
of eating disorders).
Binge eating has been associated with impulse control disorders in AN, but others found that purging, not binge eating, predicted
impulsive behavior in individuals with AN and bulimia nervosa (BN) , and both binge eating and purging were associated with alcohol
abuse/dependence and drug abuse/dependence in a large sample of women with AN . Patients with BN clinically show increased
impulsive behavior such as loss-of-control bingeing and purging. Forty percent of patients with BN also suffer from deficits in impulse
control in areas other than eating, such as difficulties in managing negative emotions and sensation seeking.
Comorbidity with impulse control disorder and eating disorder described as having a poor outcome. The presence of unrecognized and
untreated impulse control disorders will fail the treatment of eating disorders treatment will fail.
Keywords: drive, impulse control, eating disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S32
[S-12]
ADHD: perspective from impulse
Elif Karaahmet
Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Psychiatry, Canakkale-Turkey
e-mail address: [email protected]
Attention-deficit/hyperactivity disorder (ADHD) is characterized by impulsive behavior, increased behavioral problems, social adaptation
problems. Impulsivity, broadly defined as action without foresight, is a component of numerous psychiatric illnesses.
Both the attentional and impulse control deficits can be illustrated by ADHD patients performance of the CPT. ADHD subjects make more
errors of omission indicative of poor attentional ability. ADHD subjects have slower and more variable reaction times, and make more
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errors of omission indicative of poor attentional ability and similarly fail to cancel their “ go ” response on the “ no-go ” trials in go/no-go
task. Furthermore, it has also been reported that ADHD children make more errors of commission on a choice reaction time version of the
task (i.e. choose the wrong response on the go trials), and omit more trials (i.e. do not respond at all).
ADHD patients also choose more impulsively in delay-discounting tasks, preferring the smaller but more immediate rewards to the larger
more delayed rewards. However, if the selection of a smaller immediate reward does not reduce the total length of the time the subject
spends engaged in the experimental task, it has been reported that ADHD patients are able to wait for rewards. It has been suggested
that this pattern of impulsive choice is indicative of enhanced motivation to escape or avoid delay, and that the inattentive, overactive
and impulsive behaviors in which ADHD patients engage are functional expressions of delay-aversion.
İnhibition controlled the weakness and increased impulsive choices are core symptoms of ADHD .
Keywords: ADHD, impulse
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S32-S3
[S-12]
Impulsivity and psychiatric disorders
Kursat Altinbas
Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Psychiatry, Canakkale-Turkey
e-mail address: [email protected]
Impulsivity can be defined as a tendency to react rapidly, little or no mature forethought and plan to a stimulus without the consideration
of the possible negative consequences of these reactions. Impulsivity as a dimension has been studied in many different psychiatric
disorders and there is a growing body of evidence in recent years. Among the various mood disorders, impulsivity was found to be
particularly associated with bipolar disorders. Most of the studies indicated high levels of impulsivity during acute phase of illness and
some in remission. For instance, siblings of bipolar patients showed higher impulsivity scores comparing with healthy controls that may
be interpreted as an endophenotype and vulnerability marker for bipolar disorders. Some of the common clinical features of bipolar
disorders were also found to be associated with impulsivity among patients with bipolar disorders such as suicidality, alcohol and/or
substance use, anxiety, cigarette smoking, aggressive behaviors and criminality. However, it is still unclear whether impulsivity is a trait or
state phenomenon in bipolar disorders. Lack of evidence on the etiology of bipolar disorders makes it difficult to answer this question.
Nevertheless, the possible role of impulsivity on nature of the bipolar spectrum disorders is remarkable and should be investigated in
future researches including genetic and neuroimaging techniques among bipolar patients, their unaffected siblings and healthy controls.
Keywords: impulsivity, psychiatry, disorders
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S33
[S-12]
Obsessive compulsive disorder from the perspective of impulse control disorders
Ozan Pazvantoglu
Ondokuz Mayis University, School of Medicine, Department of Psychiatry, Samsun-Turkey
e-mail address: [email protected]
Impulsivity is defined as a tendency to give quick and unplanned responses to internal or external stimuli, irrespective of adverse
outcomes, and this is a key element of impulse-control disorders as well as many psychiatric disorders. ICDs are characterized by difficulty
in resisting certain impulses or actions that arouse a desire but have the capacity to damage the individual or others, and by a feeling of
increasing tension prior to the action and satisfaction, pleasure or relief during the action or once it is completed. Obsessive compulsive
disorder (OCD) involves intrusive and persistent anxiety-creating thoughts (obsessions) and behavior (compulsions) performed in order
to suppress that anxiety.
OCD and ICDs have traditionally been conceptualized as being at opposite ends of a maladaptive behavior continuum, with high harm
avoidance at one end and risk-seeking at the other. However, there is evidence that ICDs also have compulsive characteristics and
OCD impulsive aspects. Impulsivity and compulsivity are therefore thought to share common psychopathological and neurobiological
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mechanisms. Although compulsivity and impulsivity are conceptualized as mutually opposed in appearance, the relationship seems
to be more complex than that. Compulsivity and impulsivity may be present simultaneously in the same disorder, or they can be seen
separately at different times. The uncontrolled behaviors that are characteristic features of ICDs bear similarities to the undesired,
excessive and unnecessarily frequent rituals in OCD. Additionally, the high levels of impulsivity frequently reported in individuals with
ICDs are also reported in OCD patients. However, there are some differences between OCD and ICDs. For example, individuals with ICDs
are generally people with impulsive characteristics who constantly seek exciting and hedonic activities, while individuals with OCD tend
to avoid harm and not take risks. In addition, impulsive disorders are generally perceived as ego-syntonic and compulsive disorders as
ego-dystonic. Moreover, the repetitive behaviors in ICDs may change with time and, similarly to those in OCDs, may become less pleasure
seeking/more anxiety relief focused. Studies to date show a high level of comorbidity between OCD and ICDs (particularly pathological
skin picking and trichotillomania).
The obsessive-compulsive (OC) spectrum concept is one that has been considered and discussed for the last 20 years. The O-C spectrum
contains a disorder group characterized by repetitive thoughts and behaviors different from, but also related to OCD. Indeed, in DSMV, OCD and some ICDs (compulsive skin picking and trichotillomania) are classified together on the basis of similar pathophysiology,
etiology and comorbidity features (Obsessive-Compulsive and Related Disorders).
This presentation will be considered OCD from a perspective of impulsivity and ICDs in the light of the information summarized above.
Keywords: impulse control disorders, obsessive-compulsive disorder, obsessive-compulsive and related disorders
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S33-S4
[S-12]
From the perspective of impulse control disorders: adult ADHD and comorbidities
Zeynep Baran Tatar
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
e-mail address:[email protected]
This presentation shall discuss on the concept of impulsivity in Attention Deficit Hyperactivity Disorder (ADHD), neurobiology of
impulsivity in ADHD and disorders significant for differential diagnosis and comorbidity in adult ADHD due to the impulsivity symptom.
A literature review shall be made in light of the concepts of impulsivity and impulse control disorder, impulsivity in and neurobiology of
adult ADHD, differential diagnosis and comorbidity with other psychiatric disorders with impulsivity symptoms.
ADHD is a chronic, developmental psychiatric disorder which begins in early childhood, with continuing basic symptoms of which are
inattention, hyperactivity and impulsivity, throughout adulthood as well. In DSM-V, 18 symptoms are listed for attention deficit and
hyperactivity/impulsivity areas just as in DSM-IV, and meeting of minimum six symptoms in one area is required for an ADHD diagnosis.
Among these symptoms, those stating as “Usually replies before the question is completed”, “Usually experiences difficulty as to waiting
for his/her turn” and “Usually interrupts other people’s speeches or interferes in what they are doing” point out to impulsivity symptoms.
There are 3 subtypes of ADHD: predominantly Inattentive, predominantly Hyperactive-Impulsive, or the two Combined. Combined
subtype is the most frequently observed during childhood, where hyperactivity and impulsivity symptoms are reported to be significantly
decreased compared to attention deficit during adolescence and young adulthood. Executive functions such as sustaining concentration
and attention, perseveration, resistance to interfering impacts, ability to change categories, sustaining goal oriented behavior, ability to
suppress/inhibit the tendency to react which is inconvenient for the moment are known to be impaired in children and adults with ADHD
as compared to the healthy population. Executive function disorders lead to impulsive behavior and indifferent attitudes lacking empathy.
Executive functions are defined as the functions of frontal area. Dorsolateral prefrontal cortex (DLPFC) is responsible for attention,
working memory, planning, organization of a task, functions related to processing new information, whereas orbitofrontal cortex (OFC)
ensures regulation of emotional stimuli and inhibitor control. In DLPFC, the damage leads to apathy, lack of motivation, disinterest,
insufficiency in planning and behavioral flexibility, where in OFC, it leads to symptoms such as socially inappropriate behavior, increase
in motor activities, being inconsiderate to others, being affected by environmental stimulants and removal of sexual inhibition. In many
cases where orbitofrontal lesions are involved, impulsive and antisocial behaviors are observed. It has been reported that OFC dysfunction
can exist in predominantly hyperactive-impulsive subtype of ADHD, and DLPFC dysfunction in predominantly inattentive subtype of
ADHD. Although impulsiveness can be observed in anybody, whether a DSM-V axis I or II diagnosis exists, it is likely to be more frequently
observed in people associated with specific psychiatric diagnosis such as ADHD, substance addiction, personality disorders, etc. The
relation between these disorders and impulsivity can be related with behavioral inhibition deficit, which is partially a part of the foregoing
disorders. Impulsivity can be described as a process including a rapid action without a conscious judgment, acting without adequate
consideration and a tendency to act with less common sense despite the existence of a normal intelligence level. Impulse control disorder
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is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, urge or impulse that may harm oneself or
others. ADHD differential diagnosis together with bipolar disorder, substance abuse, behavioral addictions, cluster B personality disorders,
where impulsivity appears as a symptom, as well as impulse control disorder is significant. Comorbid cases with these disorders can lead to
overlook an ADHD diagnosis. Lifetime expansion of bipolar disorder type II & I have been found to be 10% in people in both genders who
has an adult ADHD. Bipolar disorder and ADHD can demonstrate similar symptoms such as hyperactivity, inattention, emotional lability,
impulsivity etc. Symptoms such as excessive spending, deliriums and other psychotic symptoms, grandiosity, acceleration in thinking and
decrease in sleep need assist differentiation of mania or hypomania cases from ADHD. There exist evidence as to increase of borderline
personality disorders in adults with ADHD and existence of ADHD as a co-diagnosis in the subgroup of people with borderline personality
disorder. Borderline personality disorder is characterized with impulsivity, mood lability and hostility such as in ADHD, however, these
symptoms are episodic, shorter and less serious in persons with ADHD. Moreover, ADHD is not characterized with dichotomic thoughts,
fears of abandonment and self mutilating behavior as in borderline personality disorder. Anti-social personality disorder can be seen with
a frequency of 10-23%. Hyperactive-impulsive and combined ADHD types can be associated with aggression, committing crimes, being
opponent-opposing, and anti social behavior. Antisocial personality disorder shares the impulsivity and effective liability symptoms with
ADHD. Behaviors observed in antisocial personality disorder such as a history of arrest, lack of empathy and lack of prick of conscience
might be of help to distinguish between the two disorders. ADHD double folds substance addiction risks compared to society in general.
Co-diagnosis of substance addiction in ADHD is 40-50% whereas co-diagnosis of ADHD in substance addicts remains at 15-25% level.
Higher ADHD symptoms have been detected in adolescents with internet addiction. There are studies available showing associations
between pathological gambling and childhood ADHD symptoms as well as adult ADHD symptoms. In such a study, an ADHD history
was found in 25% of people who have pathological gambling and at-risk gambling and people with an ADHD history have more serious
gambling problems, higher level of gambling-related cognitions, more frequent psychiatric comorbidity and increased suicide risks. It
was shown that higher impulsivity proposes a risk factor for ADHD comorbidity. Higher ADHD symptoms were reported in people with
compulsive buying disorder as compared to control group.
Frequent association with other psychiatric disorders might lead to overlook ADHD. Being aware of the comorbid conditions with
psychiatric disorders with which it shares similar symptoms such as impulsivity and differential diagnosis against these disorders are
significant factors for efficient treatment of these so called disorders.
Keywords: attention deficit hyperactivity disorder, comorbidity, impulse control disorders, impulsivity, neurobiology
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S34-S5
[S-13]
Current issues in addiction psychiatry
Hasan Mirsal
Balikli Greek Hospital, Istanbul-Turkey
e-mail address: [email protected]
Dependence or addiction is a life-style disorder (Modus Vivendi). All of things related to life are related to dependence disorder also.
Addiction psychiatry is a relatively young field that encompasses the causes, characteristics, diagnosis, treatment, and prevention of drug
or alcohol dependence--in addition to the specific mental disorders that frequently co-occur with substance use. Generally, drug use can
cause signs and symptoms of depression, anxiety, psychosis, and antisocial behavior, both during intoxication and during withdrawal. At
times, these symptoms and signs cluster, last for weeks, and mimic frank psychiatric disorders (i.e., are drug–induced syndromes). These
drug–related conditions usually disappear after several days or weeks of abstinence. Prematurely labeling these conditions as major
depression, panic disorder, schizophrenia, can lead to misdiagnosis and inattention to a patient’s principal problem—the drug harmful
use or dependence. With knowledge of the different courses and prognoses of drug–induced psychiatric disorders, an understanding of
the comorbid independent disorders one needs to rule out, an organized approach to diagnosis. Current issues about “addiction”, which
is relatively new as a specific field in psychiatry, may be classified and defined from various points of view.
I-The point of disorders
1-Disease: Issues from perspective of specialists and therapists; objective criteria of description, treatment etc..
2-Illness: Issues from perspective of dependent people who are directly facing the issue; subjective feelings of dependents etc.
3-Sickness: Issues from perspective of cultural, moral, social etc. In this perspective, many of factors are determined the disorder.
II- The point of biopsychosocial
In this area, there are many different ıssues. For example; medicines, withdrawal management, psychoeducations, researches, social and
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ethical problems etc.…
III- The point of stages (phenomena of disorder)
1-Intervention; this stage includes many of difficulties. Authorized intervention needs knowledge and experience.
2-Treatment; we need biopsychosocial “treatment programs”
3-Prevention; we need “relapse prevention network programs” also.
IV-Others; medico-legal, forensic, consultation, new drugs use issues etc.…
In this presentation; issues experienced directly and indirectly biologically, psychologically and socially in all such problems will be
discussed in the context of daily practice.
Keywords: addiction psychiatry, dependence
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S35-S6
[S-13]
Current issues in inpatient services
Huseyin Gulec
Erenkoy Psychiatry Hospital, Istanbul-Turkey
e-mail address: [email protected]
The importance of psychiatric services in medical settings continues to date.
Interestingly, current problems of the psychiatric services do not differ to date. Still, a lack of mental health law may contribute to this
situation.
In this presentation, except the problems caused by legal regulations, institutional issues, patient’s or/and patient’s treatment issues, and
general issues will be tried to uncover.
Keywords: inpatient, psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S36
[S-13]
Current difficulties in forensic psychiatry
Sakir Ozen
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
e-mail address: [email protected]
Forensic psychiatry serves as an expert witness to courts and other governmental institutions. It also carries out essential procedures
related with people who are under protection-treatment or the probation. Leading occupational topics of forensic psychiatry in recent
years are as follows; criminal responsibility, legal capacity, employee disability, detection and management of substance use, impact of
torture and trauma on survivors, degree of comprehension of moral evil among sexual crime victims, whether he/she could resist against
perpetrator or not, whether he/she tells reasonable in the court or not, whether there is a need for postponement of execution of the
prisoners or convicts, evaluation of malpractice lawsuits of psychiatrists, and etc ...
Since the forensic psychiatric examinations are made within the framework of the laws and the boundaries of questions asked by the
court, they have unique characteristics and are different from other psychiatric examinations.
According to laws in Turkey, the mentaI state of a person is generally evaluated in three categories (may be for convenience of psysicians?)
and arrangement of the reports based on these categories is required; (I-healthy, II-mild-moderate ill, III-severe ill):
I-Person was not ill during the event, in good health, criminal and full legal competence. For example, the borderline mental capacity,
alcohol-substance abuse, personality disorders ...
II-Person had partial-mild illness during the event. For example, hypomania, mild mental retardation, organic personality disorder ...
III-Person was seriously ill during the event. For example, mania, schizophrenia and so on active state of psychosis, depression with
psychotic features, moderate - severe mental retardation, dementia …
Current difficulties of forensic psychiatry can be listed as follows:
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1-Sometimes a detailed description of the criminal events may be absent in the judicial files.
In the files, there may be either incomplete documents and reports or misleading reports and informations. Inconsistent information
about the health of the perpetrator may be declared by different parties.
2-Scarcity of experienced psychiatrists, psychologists and other support staff who are sensitive to simulations and dissimulations, and
existance of communication gaps between them, as well.
3-Mental status of the cases may show discrepancies between the criminal event and psychiatric evaluation. According to the results
of our unpublished study, it has been shown that psychiatric examination and observation of the defendants is made 20.3 ± 29.5
months (2-192 months) after the date of crime in average and they have stayed under observation for 8.6 ± 5.7 days in the Department
of Psychiatric Observation in Forensic Medicine Institute. As seen in this study, months even years may pass from the criminal event.
In this process, psychiatric sypmtoms of the defendants may heal with medication or spontaneously. Less commonly, the defendant
with especially chronic disease may be worse during psychiatric examination than the date of event. Arrangement of the reports by
considering all of these variables are important.
4-Another topic is the discrepancy of the opinions among the physicians. In such a situation, minority of them write the dissenting
opinion with the reasons. For example, different opinions occasionally may occur about the criminal responsibility during alcohol or drug
induced psychotic states.
5-Establishing a causal relationship between criminal incident and disease is an another problematic topic. For example; If a person who
had been previously hospitalized with the diagnosis of schizophrenia, frauds at his job, can he be assumed to be responsible for his crime?
Can a person with the diagnosis of mild dementia or mild cognitive impairment, be kept responsible for the crime of making electric
powermeter dysfunctional in his home and using illegal electricity? If a person, diagnosed with paranoid or antisocial personality disorder,
commit a murder because of jealousy and sexual unfaithfulness then will he be additionally diagnosed with delusional disorder and will
he be kept responsible for his crime? This issue may also raise discrepant opinions among the physicians.
6-Differences observed in the diagnoses appearing in the reports that are present in the forensic file: Complexity of psychiatric diagnoses,
identification of comorbid situations and how to report them also may cause problems. Because, some traditions are present in forensic
psychiatry practices. Different diseases are handled in different articles of law.
7-Different opinions about the upper and lower limits of being aware of the laws and the results of criminal behavior may appear. This
problem is especially encountered during the evaluation of sexual behavior of children and adolescents.
8-Changes of the laws from time to time: For example, probation practices faced with obstruction currently. 95% of the people who
benefited from the law of probation are cannabis users.
Psychiatrists are reluctant to deal with people who are involved especially in substance use and related crimes. This situation causes
huge amount of admissions and accumulation of the patients in alcohol-substance treatment unites like AMATEM, alcohol-substance
rehabilitation unite in Bakirkoy Mental Health Training and Research Hospital (BMHH). Previously in BMHH, these people were clinically
followed-up biweekly; however, now they are seen once in every three months due to this accumulation. Because, in this unit 200-250
people are serviced and examined each day.
9-Insufficiency of physical conditions and lack of staff are one of the major problems in the hospitals and institutions serving forensic
psychiatric practices.
As a result, we can say that current problems of forensic psychiatry can be reduced by training programs and meetings among experts
and managers.
Keywords: current difficulties, experienced staff, forensic psychiatry, physical conditions
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S36-S7
[S-14]
Unmet needs in psychopharmacology. pharmacotherapy of acute mania: an update
David Osser
Harvard Medical School at the VA Boston Healthcare System, Brockton Division, Department of Psychiatry, 940 Belmont Street, Brockton, MA 02301, USA
e-mail address: [email protected]
This is a new algorithm for the pharmacotherapy of acute mania developed by the Psychopharmacology Algorithm Project at the Harvard
South Shore Program. The authors conducted a literature search in PubMed and reviewed key studies, other algorithms and guidelines, and
their references. Treatments were prioritized considering 3 main considerations: 1) effectiveness in treating the current episode, 2) preventing
potential future relapses to mania or depression, and 3) minimizing side effects over the short and long term. After accurate diagnosis, managing
contributing medical causes including substance misuse, discontinuing antidepressants, and considering the patient’s child-bearing potential, we
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propose different algorithms for mixed and non-mixed mania in response to the new classification of bipolar mania in the DSM-5. Patients with
mixed mania may be treated first with a second generation antipsychotic (SGA) of which the first choice is quetiapine because of adequate efficacy
in acute mania but greater efficacy (than other SGAs) for depressive symptoms and episodes in bipolar disorder and evidence of ability to prevent
future episodes of depression. For the second choice SGA in mixed mania, aripiprazole and ziprasidone may be preferred over risperidone and
olanzapine. Valproate or carbamazepine, and lithium, in that order, may be added to the SGA for unsatisfactory control of symptoms.
For non-mixed mania, lithium is the first-line recommendation. Next, an SGA can be added, and again quetiapine is favored because it is the
best at treating and preventing depression. If quetiapine is unacceptable, risperidone is the next choice for non-mixed mania because of
better efficacy for this mood state. Olanzapine, though almost as effective in acute mania as risperidone in meta-analysis, is not considered
a first-line SGA due to its long term side effects, but it could be a second choice SGA. Valproate is a third-line choice for acute non-mixed
mania to consider after lithium and one or two SGAs. Its lack of efficacy in recent randomized controlled trials in mania and lack of known
effectiveness for preventing future mood episodes result in it having a lower placement in this algorithm than in other guidelines.
If the patient, whether mixed or non-mixed is still refractory despite the suggested medication sequences, then depending on what has
already been tried, consider valproate, risperidone, olanzapine, haloperidol, and carbamazepine as first-tier, aripiprazole, ziprasidone,
and asenapine as second-tier, and clozapine as third-tier because of its weaker evidence base and greater side effects. Electroconvulsive
therapy may be considered at any point in the algorithm if there is a history of positive response or intolerance of medications.
Keywords: unmet needs, psychopharmacology,pharmacotherapy, acute mania
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S37-S8
[S-14]
Bilateral relationship between pain and depression: implications for therapeutics
Serdar M Dursun
Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
e-mail address: [email protected]
There is growing evidence indicating that there is very complex bilateral relationship exists between pain syndromes and depression.
During depressive episode it is often that patients suffer from unexplained physical and somatic painful symptoms such headaches and back pain.
It is also possible that such painful symptoms may be the initial expression of depressive episode. It is also well documented that painful
syndromes can lead to depression.
This presentation will discuss this complex relationship between pain and depression with implications to therapeutic options.
Keywords: pain, depression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S38
[S-15]
Personalized medicine in psychiatry
Esra Saglam
Uskudar University, Istanbul-Turkey
e-mail address: [email protected]
Response to specific psychotropic medications treatments varies widely among individuals. Understanding and predicting that variation
could have great benefits for people living with psychiatric problems. The central theme of personalized medicine is the premise that an
individual’s unique physiologic characteristics play a significant role in both disease vulnerability and in response to specific therapies.
The major goals of personalized medicine are therefore to predict an individual’s susceptibility to developing an illness, achieve accurate
diagnosis, and optimize the most efficient and favorable response to treatment. Individual’s unique characteristics play a significant
role in tailoring their therapies. Such characteristics include: genetic alterations and epigenetic modifications, clinical symptomatology,
observable biomarker changes, and environmental factors.
When studying drug action in individuals, researchers focus on two major determinants: 1. Pharmacokinetics: how much of a drug is
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needed to reach its target in the body, and 2. Pharmacodynamics: how well the target cells, such as heart tissue or neurons, respond to the
drug. The scientific terms for these two determinants are pharmacokinetics and pharmacodynamics, and both are critical considerations
in the field of pharmacogenomics.
At psychiatric diseases; many genes are implicated in determining variability at pharmacokinetic and pharmacodynamics level. Only 35-45%
of the patients respond to psychotropic therapies and return to functional level 30-50% of the patients will not respond sufficiently.
Pharmacodynamic factors of Personalized Medicine In Psychiatry
One major expectation of personalized medicine is the ability to determine susceptibility or protective factors imparted through genetic
change. Major depressive disorder (MDD) has a strong genetic component, with an estimated 40 to 70% of the risk for developing MDD
thought to be genetic. Prominent findings in susceptibility studies of MDD include several polymorphisms in the serotonergic system,
and in various elements of the hypothalamicpituitary-adrenocortical axis. Genes that have an effect on serotonin signaling have been a
major focus of study for the pharmacogenomics of depression.
Evidence from family, twin, and adoption studies show that bipolar disorder (BD) is highly heritable, with genetic variables estimated to
account for 60 to 85% of risk. With estimates of heritability of 50 to 80% schizophrenia (SZ) Numerous studies have begun to pinpoint
associations between genetic variants in some individuals with SZ and the tolerability and therapeutic efficacy of antipsychotic
medications.
Pharmacokinetic factors of Personalized Medicine In Psychiatry
Pharmacokinetics encompasses four processes: absorption, distribution, metabolism, and excretion. Beyond the effects specific to
particular illnesses or drugs are the genetic changes in drug-metabolizing genes that underlie differential response to pharmacologic
agents. The important area for consideration in determining the relationship between genes and drug response in psychiatric disorders
is the contribution of genetic polymorphism in drug-metabolizing genes.
The most studied group of drug-metabolizing enzymes in psychiatry are the cytochrome P450 (CYP) enzyme family. CYP enzymes are
expressed predominantly in the liver, although they are also found in many extra-hepatic locations, including in the brain, where their
levels are approximately 0.5 to 2% of those in the liver. Moreover, the genes coding for the CYP enzyme family are highly polymorphic, and
the effects of many of the genetic differences contribute to differential metabolism of psychotropic agents. DME phenotypes are broadly
grouped into four categories based on genotype effect on enzyme activity: 1) poor metabolizers (PM), 2) intermediate metabolizers (IM),
3) extensive metabolizers (EM), and 4) ultra-rapid metabolizers (UM). CYP2D6 is an important member of the CYP enzyme family, because
it is responsible for metabolizing nearly 50% of the most commonly prescribed psychotropics, and evidence in animal models indicates its
involvement in the biosynthesis of dopamine and 5-HT. Common substrates metabolized by CYPD26 are tricyclic antidepressants, many
SSRIs, venlafaxine, and antipsychotics.
Pharmacogenomic developments hold promise for personalized medicine in psychiatry with adjusted therapeutic doses, predictable
responses, reduced adverse drug reactions, early diagnosis, and personal health planning. The prospect of personalized medicine in
psychiatry more or less reflects ideals still largely unrealized. Currently, the field is at the information-gathering infancy stage. The goal of
achieving personalized medicine in psychiatry is a laudable one, because its attainment should be associated with a marked reduction
in morbidity and mortality.
Keywords: personalized medicine, psychiatry, pharmacogenomics
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S38-S9
[S-15]
The use of therapeutic drug monitoring (TDM) in psychiatry
Gokben Hizli Sayar
Uskudar University, NPIstanbul Hospital, Department of Psychiatry, Istanbul-Turkey
E-mail address: [email protected]
The response of individual patients to the same drug given in the same dose varies considerably. Many patients will experience the
desired drug effect, others may experience no effects, yet others may suffer from well-known adverse drug reactions, and very rarely
individual patients will die from severe side effects.
TDM is based on the principle that for some drugs there is a close relationship between the plasma level of the drug and its clinical effect.
If such a relationship does not exit TDM is of little value. Like any diagnostic test, the measurement of plasma level is justified only when
the information provided is of potential therapeutic benefit. The clinical value of plasma level monitoring depends on how precisely the
treatment outcome can be defined. the extent and rate of drug absorption, distribution, tissue binding, biotransformation, and excretion,
which can vary markedly between individual patients due to differences in gender, age, morbidity, smoking or eating habits, differential
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expression of drug metabolizing enzymes or drug transporters or other factors. Therefore drug concentrations in blood resulting after a
given dose differ by tenfold or more between individual patients.
The pharmacokinetic phenotype of an individual can be measured by analysis of drug concentrations in blood plasma or serum, by TDM.
TDM is well established for mood stabilizers, especially for lithium. For other neuropsychiatric drugs, routine TDM is rare.
TDM will be useful if the following criteria are met:
1) the drug in question has a narrow therapeutic range,
2) a direct relationship exists between the drug or drug metabolite levels in plasma and the pharmacological or toxic effects,
3) the therapeutic effect cannot be readily assessed by the clinical observation,
4) large individual variability in steady state plasma concentration exits at any given dose
5) appropriate analytic techniques are available to determine the drug and metabolite levels.
TDM is a method used to provide optimal pharmaceutical therapy. Knowing the plasma concentration of psychoactive medication helps
monitor the side effects of the medication in order to prevent toxicity and increase the responsiveness of the medication. In therapeutic
drug monitoring, psychoactive drugs are divided into 4 groups:
1. The most recommended group consists of: lithium and carbamazepine. Monitoring the levels of valproic acid is important in order to
prevent toxicity from occurring.
2. Clozapine and similar medications are considered one group of medication whose side effects should be monitored.
3. On the other hand, medications that should be closely observed but have an elapsed response rate are included into the group
monitored for response time.
4. This group of medication is often monitored in order to place a pre-diagnosis for treatment-resistant patients who may have genetic
polymorphism and choose the correct medication.
More studies with adequate design are still required to obtain more data on plasma concentrations and therapeutic response relationships.
Keywords: therapeutic drug monitoring, drug interactions, psychopharmacology
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S39-S40
[S-15]
Phenotyping: applications of tailoring treatment in psychiatry
Gul Eryilmaz
Uskudar University, NPIstanbul Hospital, Istanbul-Turkey
e-mail address: [email protected]
The response of individual patients to the same drug given in the same dose varies considerably. Many patients will experience the
desired drug effect, others may experience no effects, yet others may suffer from well-known adverse drug reactions, and very rarely
individual patients will die from severe side effects.
Phenotyping
The rapid advances in pharmacogenetic knowledge and genotyping methodology however provide a basis and challenge for clinical
studies on the role and usefulness of pharmacogenetic testing in clinical psychiatry. Using modern DNA amplification techniques,
genotyping allows characterization of many significant CYP genes with only a single venous blood sample. However, genotyping is only
clinically relevant to the degree with which it predicts phenotype. Consequently, the optimal method of describing real-time enzyme
activity is phenotyping, where metabolism of a carefully selected probe compound is used to estimate the activity of one or more of the
enzymes involved in its metabolism. Although it is often more cumbersome than genotyping, phenotyping provides the most clinically
relevant information because it is a reflection of the combined effects of genetic, environmental, and endogenous factors on CYP activity.
Several potential phenotyping probes have been proposed for most CYP enzymes, each with unique advantages and disadvantages.
The pharmacogenetic tools available are phenotyping, i.e. measurement of a specific enzyme activity by use of a probe drug, and
genotyping, analysis of functionally important mutations in the gene coding for the specific enzyme.
* Numerous CYP enzymes involved in the metabolic processing of psychotropic medications have genetic variants or polymorphisms.
These polymorphisms result in a wide range of metabolic capacity across patients, and can substantially alter the metabolism of specific
drugs in certain patients. A genetically poor metabolizer who was not exposed to a CYP inhibitor would have the same phenotype
for metabolism as that of a regular metabolizer who was taking a CYP inhibitor. Interestingly, in a poor metabolizer, the effects of a
CYP inhibitor would be less important as the enzyme is already deficient. Clinical studies have shown that in patients with CYP 2D6
polymorphism, treatment with the atypical antipsychotic risperidone is associated with an 3-fold risk of adverse effects because of the
inability to metabolize the drug adequately in poor metabolizers.
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* Alternatively, a genetically “super” metabolizer (due to gene amplification) who was not exposed to a CYP inducer would exhibit the
same phenotype as a regular metabolizer administered a CYP inducer; thus, administration of a CYP inducer to a genetically extensive
metabolizer would result in particularly rapid removal of substrate drugs from the system. For many of the phenotypes (e.g., poor,
intermediate, wild-type-extensive, and super metabolizer), there is a wide range of capacities due to heterozygous alleles. For some there
are commercial tests available to determine genotype.
CYP2D6 phenotyping
CYP2D6 plays a pivot role in metabolism of xenobiotics, especially psychotropic drugs. Predicting its metabolic activity in patients may
help to personalize pharmacotherapy. Eight-hour urinary ratio of dextromethorphan/dextrorphan molar concentrations serves as a
measure of CYP2D6 activity with 0.3 as a cut-off value separating poor and extensive metabolizers.
Unfortunately, collecting of urine for 8 hours may be difficult in psychiatric patients. The assessment of dextromethorphan/dextrorphan
molar concentrations in serum is less used since correlation with urine dextromethorphan/dextrorphan molar concentrations and cutoff value in serum is not well established Previous studies showed that metoprolol can be used as the CYP2D6 probe for determining
the polymorphism of CYP2D6. Debrisoquine hydroxylation polymorphism is by far the most thoroughly studied polymorphism
genetic hydroxylation phenotype has been the most used test in humans to evaluate CYP2D6 activity. Two debrisoquine hydroxylation
phenotypes have been described: poor and extensive metabolizers. A group with a very low debrisoquine metabolic ratio within the
extensive metabolizers, named ultra rapid metabolizers, have also been distinguished. This CYP2D6 variability can be for a large part
alternatively determined by genotyping, which appears to be of clinical importance given CYP2D6 involvement in the metabolism of
a large number of commonly prescribed drugs. CYP2D6 pharmacogenetics may then become a useful tool to predict drug-related side
effects, interactions or therapeutic failures of the CYP2D6 drug-metabolizing
*CYP1A2 phenotyping
Caffeine (1,3,7-trimethylxanthine [137X]) is one of the most commonly ingested compounds throughout the world. The metabolic
pathways of caffeine are complex but involve the formation of three principal metabolites: theobromine (3,7-dimethyl xanthine [37X]),
theophylline (1,3-dimethylxanthine [13X]), and paraxanthine (1,7-dimethylxanthine [17X]). Each of these metabolites is primarily formed
by cytochrome CYP 1A2. Caffeine has become popular as a metabolic probe for CYP1A2 activity in humans. It is one of the major P450
cytochromes in the liver and accounts for 15% of the total P450 content. If a CYP1A2 phenotyping needed, subjects were asked to comply
with a diet free of caffeine, ethanol, and grapefruit juice/products for 48 h, and come to the hospital for an overnight stay of approximately
12 h prior to the initiation of the sample taking. After eating a standardized breakfast, subjects received 200 mg of caffeine. Immediately
after caffeine administration, subjects began to collect their urine and continued to do so over the next 8 h.
CYP2C9 phenotyping
Despite the few reports to the contrary, significant evidence supports the use of tolbutamide as a selective in-vivo CYP2C9 probe. Isolated
reports also support the use of the 6 h DPH/HPPH ratio, but more clinical data are required before recommending it’s widespread use.
Concerns over the extremely narrow therapeutic index and possible need for steady-state sampling will have to be addressed prior to
more widely applied use of warfarin as a CYP2C9 probe. Alternately, the use of warfarin as a probe may be limited to those requiring
warfarin therapy for a medical indication. The metabolic pathways of losartan and its metabolite need to be further elucidated prior to
its use for CYP2C9 phenotyping.
CYP3A4 phenotyping
Several methods of phenotyping CYP3A activity have been proposed, and identification of the ideal probe has been difficult. The most
widely accepted and tested CYP3A probes are erythromycin and midazolam. However, in their current form, neither phenotyping
procedure is ideal.
Cocktail approach
Marker or probe drugs have been widely used for phenotyping various individual cytochrome P450 (CYP) activities, and this approach
has been widely used in many clinical investigations in the field of drug metabolism and pharmacogenetics. A practical limitation of such
phenotyping has been the inability to test the activity of several enzymes simultaneously, because a separate probe drug is generally
required for each enzyme. As a result, attempts have been made to permit concurrent administration of probes so that multiple enzymes
can be tested at once. Thus the cocktail approach was developed, involving the administration of multiple probe drugs simultaneously
and the measurement of plasma kinetics and/or urinary excretion of unchanged parent compound and metabolites. Genetic
polymorphisms have been described for most drug-metabolizing enzymes, including CYP2C19 and CYP2D6, that give rise to distinct
subgroups in the population that differ in their ability to perform certain drug biotransformation reactions. The functional importance of
genomic variability in CYP1A2, CYP2E1, and CYP3A remains unclear, but it was found that genetic polymorphisms of CYP1A2 were related
to the inducibility of CYP1A2 in vivo. CYP3A accounts for up to 25% of the total CYP present in adult human liver and is the major CYP
present in the human intestine. The importance of the CYP3A enzymes is most established with respect to the metabolism of xenobiotics
and medications. CYP2E1 has received much attention because of its ability to bioactivate a number of potentially harmful compounds,
including some toxins and carcinogens. Therefore phenotyping individuals with respect to CYP3A, CYP1A2, CYP2C19, CYP2E1, and
CYP2D6 activities is of clinical relevance.
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*complications that should be avoided in a cocktail approach are mutual interactions between the probe drugs, low doses need to be
used. Another consideration is that several drugs and metabolites must be analyzed in the same biologic sample, which requires an
appropriate degree of selectivity and sensitivity of the analytic methods.
Keywords: phenotyping, tailoring treatment, personalized medicine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S40-S2
[S-17]
Psychopharmacological approach to sleep problems with chronic physical diseases
Adem Aydin
Selcuk University, Meram Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Sleep disorders include a wide range of disorders that impair health and quality of life. Clinicians must efficiently identity individuals with sleep
disorders and direct effective treatment. Management requires the identification and treatment of the underline medical and psychiatric disorder.
We recognize that sleep disruption may exacerbate symptoms of other diseases. Neurologic disorders, cardiovascular disease, pulmonary
disease, chronic kidney disease gastrointestinal conditions, endocrine conditions have been associated with poor sleep.
Parkinson Disorder (PD):As many as 60% patients with PD suffer from insomnia, 15%-59% from REM sleep behavior disorder (RBD) and
30% four excessive daytime sleepiness (1). Unlimited trial of zolpidem, clozapine, quietapine has shown a benefit on insomnia in PD.
Clonazepam and melatonin is effective in RBD cases. Modafinil is well tolerated in sleepiness patient.
Restless legs syndrome (RLS) and periodic limb movement: These disorders have a major impact on nocturnal sleep and daytime functioning.
Treatment of sleep complaint is concerned four categories; Dopaminergic agents, opioids, anticonvulsants and benzodiazepines.
Alzheimer’s disease and other dementias: Sleep is usually more fragmented, slow-wave sleep is decreased and REM sleep may be reduced.
Trazodone, quetiapine, zolpidem for the insomnia, modafinil for the excessive daytime sleepiness, Donepezil, atypical antipsychotics and
anticonvulsants for the nocturnal agitation may be considered. Neurologic conditions with extensive brain damage such as multiple
sclerosis, traumatic brain injury, and infectious encephalitis can extensively alter sleep-wake schedules and sleep stages. Clinicians must
efficiently effective treatment in individuals with sleep complaint.
Asthma and Chronic Obstructive Pulmonary Disease (COPD): Nocturnal cough, wheeze and breathlessness are problems for sleep.
Treatment is by optimizing inhaled steroids and beta agonists. Patients with COPD exhibit Oxyhemoglobin desideration alluring sleep
especially during REM sleep, which produces greater alveolar hypoventilation in COPD. The treatment choice is oxygen therapy.
Cardiovascular Disorders (CD): CD is very common, affecting 26% of the population (3). American population one of the most significant
recent developments in the field has been the recognition that sleep disorders such as sleep apnea can cause or worsen CD and further
more that CD can cause sleep disorders. Treatment of obstructive sleep apnea must be with nasal continuous positive airway pressure
(CPAP) devices and avoidance of benzodiazepines, alcoholic beverages.
Cancer patients: Fatigue is a major complaint in patients with cancer, one hypothesis is that some of the cancer related fatigue may be related
to disturbed sleep or to disturbed sleep- wake rhythms(4). Pharmacologic treatment (e.g., sedative-hypnotics for insomnia psychostimulants
for fatigue) and psychological treatments (e.g., activity-based interventions, and bright light therapy) may be considered.
Fibromyalgia And Chronic Fatigue Syndromes (CFS): These patients present with persistent tiredness or physical fatigue accompanied by
unrefreshing sleep. Traditional hypnotic agents do not provide restorative sleep or reduce pain. Two recently approved medications for
the treatment of fibromyalgia are the SNRI duloxetine and the neuromodulator agent pregabalin. Nonspecific treatments of patient with
fibromiyalgia include behavioral approaches to improve sleep hygiene.
Endocrine Disorders: (ED): Sleep disorders, particularly sleep apnea, are common in many endocrine conditions. Androgens appear to
exacerbate sleep apnea. Hypothyroidsm is a risk factor for sleep related disorders. Some evidence supports a role of sleep disorders
in the pathogeneses of metabolic disturbances associated with obesity. Management requires treatment of the underline endocrine
dysregulation and CPAP therapy in patient with sleep apnea.
Gastrointestinal Disorder (GD): Sleep disturbance has been described as a common occurrence in patients with gastroesophagial reflux
disease (GERD) and irritable bowel syndrome (IBS). Powerful acid suppression is the most common treatment for GERD. Studies have
documented that sedating drugs prolong clearance during sleep at GERD and IBS.
Chronic Kidney Disease (CKD): A significant percentage of passions with CKD report hypersomnolance, insomnia, snoring and witnessed
apneas. Sleep apnea may be treated with CPAP devices or with a change in the type of dialysis. One approach to managing insomnia in
CKD is to optimize sleep hygiene and use hypnotics.
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As a result, the basic treatment of sleep disorders in chronic physical diseases, to treat an underlying chronic disease, sleep hygiene,
organizing and editing will be provided with the appropriate medical treatment.
Keywords: sleep problems, physical disease, psychopharmacological treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S42-S3
[S-17]
Why sleep rhythm is important for bipolar disorder?
Ibrahim Eren
Konya Training Research and Hospital Beyhekim Psychiatry Service, Konya-Turkey
e-mail address: [email protected]
Most episodes of bipolar patients are cross-sectionally associated with sleep rhythm abnormalities. Insomnia and hypersomnia are
both found in bipolar depression and mania. Mania is strongly associated with decreased need for sleep. Changes in sleep–wake
cycle, and in sleep structure can be occurred in course of bipolar disorder (BD). The short sleep duration is associated with more severe
symptomatology, while both short and long sleep duration are associated with poorer function and quality of life in BD. Episodes of
BD have been associated with sleep polysomnographic changes. The most common finding is abnormalities of rapid eye movement
(REM) sleep typically shorter latency and increased density in both manic and depressive episodes. Previous studies showed prospective
evidence of a complex association between sleep length and mood change in BD.
Reduced sleep is recognized as a part of diagnostic criteria as well as a trigger of manic episodes. Episodes of BD can be precipitated
by zeitgeber challenges, such as seasonal change and time-zone travel. Sleep disturbance is regarded as the most common prodromal
symptoms of mania and bipolar depression, and often precedes deterioration in clinical state and worsens further during an episode.
Manipulation of sleep (sleep deprivation) is also one of the most effective antidepressant. Indeed abnormalities of sleep rhythms
proposed to endophenotypes or marker of bipolar disorders.
The sleep may have a particular importance for emotional processing and emotion regulation. The sleep disturbance considerably increases
negative mood, irritability, and affective volatility. The investigations show evidence for circadian and the same brain regions subserve sleep
dysfunction as a causal path­way to BD. Sleep functions and neurotransmitters are implicated in mood disorder. Symptoms of BD have been
associated with polymorphisms in circadian genes in animal and human studies. Effective treatments for acute episodes moderate circadian
parameters, while relapse can be precipitated by zeitgeber challenges, such as light manipula¬tion. Related data suggest that ‘circadian instability’
may act as a trait-like vulnerability to BD. At least two neurotransmitter systems (dopaminergic and serotonergic systems) are crucial in the link
between sleep rhythms and emotion. Dopaminergic system regulates sleep-wake and mood disorders while serotonergic pathways are involved in
sleep function. It is particularly notable that an independent literature argues for dopaminergic and serotonergic systems as critical pathways in BD.
Apart from the immediate clinical implications of poor sleep, evidence also suggests that biological rhythm disturbance is etiologically
involved in BD. Besides prospective data linking sleep to mood in BD, sleep changes precede episodes (especially mania) and correlate
with symptom severity. Most particularly, manipulation of sleep improves bipolar depression and can induce mania in patients. This
conclusion is consistent with present clinical practice, in which sleep is a fundamental relapse prevention strategy.
Stabilization of daily rhythms is accepted as therapeutic in consensus treatment guidelines. There is consensus that biological rhythms
have a crucial role in the emotion dysregulation in BD. Clinical studies also suggest that disturbed sleep reduces quality of life in BD.
Therefore evidence suggests that outcomes in BD can be improved by dealing with sleep difficulties across phases of the disorder.
Studies on circadian rhythms and sleep have led searching nonpharmacological therapies of mood disorders that can be used in daily
practice. These therapies (chronotherapeutics) demonstrate good efficacy in the treatment, and are based on controlled exposures to
environmental stimuli that act on biological rhythms. Chronotherapeutics include manipulations of the sleep–wake rhythm such as
partial and total sleep deprivation, and sleep phase advance as well as manipulations of the exposure to the light–dark cycle such as light
therapy and dark therapy. Sleep deprivation is a same-day powerful treatment for bipolar and unipolar depression. Using combinations
of zeitgeber manipulation and pharmacotherapy is the most common and the most resistant manifestation in treatments of BD.
Maintenance of the therapeutic effect beyond the next sleep phase is a target of current research. Combined sleep deprivation, sleep
phase advance, and timed light are suggested as an effective adjunctive intervention for bipolar depression in a recent study.
Stabilization of sleep rhythm is a core component in most adjunctive psychosocial treatments for BD, including cognitive behavioral
therapy. Improvement of sleep quality is an important compo¬nent of rhythm stabilization, and has functional benefits in its own right.
Management of the sleep-wake cycle is a frequently reported well-being strategy amongst people with BD. Therefore; chronotherapeutic
interventions are an important topic for further research. Future studies into these interventions should seek to determine moderators
(e.g., light sensitivity, severity and diagnosis, temperament, gender) and media¬tors (e.g., light-dark cycle exposure, sleep quality, sleep
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structure, circadian rhythm, and daytime arousal) of treatment outcome in BD.
In conclusion; sleep disturbances are central to the pathophysiology of BD. They are not only a key symptom of bipolar patients, but also
the earliest indicator of new mood episode. Continuing research in this area is the priority for future research between sleep and BD.
Keywords: sleep rhythm, bipolar disorder, circadian rhythm, sleep disturbances
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[S-18]
Maintenance ECT
Gokay Alpak
Gaziantep University, School of Medicine, Department of Psychiatry, Gaziantep-Turkey
e-mail address: [email protected]
Electroconvulsive therapy (ECT) is an effective and safe therapeutic modality used in the treatment of various mental disorders. Despite
its efficacy for acute episodes of disorders is unquestionable, ECT is frequently discontinued after the acute symptoms have revealed.
When a patient has a remission with ECT, the continuation ECT treatments are commonly termed as either Continuation-ECT (C-ECT) or
Maintenance-ECT (M-ECT). The differantiation of these two treatment modalities are not clear in the litreture. In this presentation we will
discuss mainly the M-ECT procedures and the practice in the world especially in Turkey.
Keywords: maintenance electroconvulsive therapy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S44
[S-19]
New addictions: internet addiction
Abdullah Akpinar
Suleyman Demirel University, Faculty of Medicine, Department of Psychiatry, Isparta-Turkey
e-mail address: [email protected]
Internet is involved in many of the people’s routine activities, by facilitating information access and promoting communication; thus,
it has been crucial in changes in social development. Internet has developed very fast with a great impact on young people. Among
some websites, that is the latter with the largest number of users. Internet has several advantages, but the excessive use of this kind
of internet might cause several consequences including misuse, dependence and addiction. Problematic internet use, wherein an
individual’s inability to control his or her use of the internet causes marked distress and/or functional impairment, has been described
in the psychological literature as ‘internet addiction’ and ‘pathological internet use’, based on the DSM-IV definition for substance
dependence and pathological gambling, respectively. Problematic internet use may represent a clinically important syndrome that is
associated with distress, functional impairment and psychiatric disorders. A more precise understanding of the psychopathology and
psychiatric comorbidity of problematic internet use would help delineate whether it is a distinct disorder, a symptom of an already
characterized psychiatric illness, or both. Internet addiction symptoms were observed in clinical practice show a great deal of overlap with
the symptoms commonly associated with behavioral addictions. However, it still unclear to this day whether the underlying mechanisms
responsible for the addictive behavior are the same in different types of internet addiction (online sexual addiction, gaming, and excessive
surfing). The different shapes of internet addiction fit in one category, due to various internet specific commonalities (anonymity and
riskless interaction), commonalities in the underlying behavior (avoidance, fear, pleasure and entertainment) and overlapping symptoms
(the increased amount of time spent online, preoccupation and other signs of addiction).
Keywords: internet, addiction
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[S-19]
Where does Internet addiction fit psychiatry? Conceptual and etiological discussions
about Internet addiction
Fatih Canan
Akdeniz University, Faculty of Medicine, Department of Psychiatry, Antalya-Turkey
e-mail address: [email protected]
The Internet is an integral and inescapable part of many individuals’ daily lives. However, some people may develop a pathological pattern
of Internet use, which is popularly known as ‘Internet addiction’. The condition has attracted increasing attention in the popular media
and among researchers for more than a decade. Internet addiction is characterized by excessive preoccupations, urges, or behaviors
regarding Internet use that lead to impairment or distress. Excessive gaming, text messaging, and sexual preoccupations are the most
extensively investigated types of Internet addiction. All of these types share the following components: Withdrawal, including feelings
of tension and/or anger when the Internet is inaccessible; tolerance, associated with the need for more hours of use; excessive use, often
associated with a loss of sense of time or a neglect of basic duties; and adverse consequences, including lying, progressive deterioration
in work, and social and family functioning.
Although a considerable amount of literature published so far on Internet addiction reveals that it is a worldwide phenomenon,
prevalence rates are inconsistent due to the variability of diagnostic criteria used. The concept of Internet addiction as a diagnosis,
however, is controversial. While some experts claim that Internet addiction could not be regarded as a psychiatric disorder, others agree
that trivializing this condition might hamper the treatment of affected individuals. Non-substance-related patterns of excessive behavior
have gained interest over recent years.
For some researchers, not only Internet addiction but also hypersexual disorder, pathological gambling, and eating pathologies are
considered as behavioral addictions. A debate has begun about how these phenomena might best be conceptualized. Some categorize
excessive behavioral patterns as addictive disorders, whereas others suggest they should be classified as obsessive-compulsive spectrum
disorders or as impulse control disorders. Pathological gambling, as a behavioral addiction, served as the model for the concept of
Internet addiction in DSM-5. It was renamed as ‘gambling disorder’ and moved from ‘impulse-control’ cluster to ‘substance-related and
addictive disorders’ category. Internet addiction was also considered for inclusion into the same category, however, the term ‘Internet use
disorder’ was preferred and proposed to be classified in Section 3 of the DSM-5 and thereby recommended for further study. At this time,
the criteria for this condition are limited to ‘Internet gaming’ and do not other types of Internet addiction.
While some mental health professionals accept Internet use disorder as an independent entity, others see excessive Internet use as a
symptom of another disorder such as major depression or generalized anxiety disorder. Furthermore, there is not a consensus about the
psychiatric cluster of Internet use disorder. Although the debate over whether Internet use–related problems should be classified as an
addiction, an impulse-control disorder, or an obsessive–compulsive disorder continues, there is strong overlap of the symptoms mainly
associated with behavioral addictions.
According to a growing body of evidence, excessive Internet use is one of the most rapidly increasing mental health problems. Further
research is needed to investigate whether Internet addiction is a distinct psychiatric disorder or not. Additionally, consistent diagnostic
criteria are essential for diagnosing different types of Internet use disorders.
Keywords: behavioral addictions, classification, diagnosis, Internet addiction.
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[S-19]
Could internet addiction be treated?
Osman Yildirim
Abant Izzet Baysal University, School of Medicine, Department of Psychiatry, Bolu-Turkey
e-mail address: [email protected]
Internet represents one of the most important productions of the mass media in the last two decades. It has affected many individuals’
lives not only positively but also negatively. Many people have reported negative consequences of excessive or problematic Internet use,
such as deterioration of work and/or school performance, diminished interpersonal connections, decreased physical activity, obesity,
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physical complaints, as well as increased psychiatric comorbidity.
The term “Internet addiction” was first used in 1996. Since then, hundreds of papers have been published about this controversial concept.
Diagnostic criteria and assessment questionnaires used for diagnosis vary between countries and studies, hence, the prevalence rates
of Internet addiction has been reported to range from 0.3% to 38%. Although Internet addiction appears to be an expanding problem
worldwide, researchers and clinicians still argue about its existence, classification and how to assess this condition reliably and accurately.
Although some researchers claim that Internet use problems should be classified in impulse-control disorders or in obsessive-compulsive
spectrum disorders, most insist that problematic internet use is a type of non-substance or behavioral addictions. Regardless of the
classification of Internet addiction, most of the researchers and clinicians agree that this problem does affect many individuals and
deserves appropriate management strategies. Hence, several kinds of treatment modalities have been proposed for the treatment of
Internet addiction. Treatment approaches to Internet addiction can be divided into two categories; pharmacological treatment and
psychotherapy.
Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are the most widely studied pharmacological agents in
Internet addiction treatment. This is because of the aminergic systems’ role in the suppression of inhibitory responses and the control
of compulsive repetition as well as data indicating a high lifetime prevalence of major depression in Internet addicts. Escitalopram and
bupropion, a norepinephrine/dopamine reuptake inhibitor, are shown to exhibit long-term benefits in patients with Internet addiction,
especially in the co-presence of depressive mood.
Opioid receptor antagonists are used in the treatment of substance dependence. Owing to the strict association of Internet addiction
with other substance use disorders and to similar neurobiological findings between Internet addiction and substance dependence, opioid
receptor antagonists are also suggested to diminish Internet addiction symptoms. However, there is only case study which reported
successful treatment with naltrexone, an opioid agonist.
Although antipsychotics are shown to be effective in the treatment of behavioral addictions such as pathological gambling, compulsive
shopping, and physical exercise addiction, literature about the use of antipsychotics in the treatment of Internet addiction is currently
limited to a single case study that reported the successful use of quetiapine in a subject with Internet addiction.
There is a high comorbidity between Internet addiction and attention-deficit/hyperactivity disorder (ADHD). In a study which included
adolescents with ADHD and online game addiction, methylphenidate was shown to reduce Internet usage time and Internet addiction
scale scores.
Several psychological approaches have been proposed in the treatment of Internet addiction. These include cognitive behavioral therapy,
acceptance and commitment therapy, psycho-education, family therapy, and the twelve-step support groups. All these psychotherapy
modalities have proved to be effective in the treatment of Internet addiction.
In conclusion, there are several options including psychopharmacological agents and psychotherapies in the treatment of Internet
addiction. An individual-based approach may offer a valuable perspective when helping patients with Internet use disorders.
Keywords: internet addiction, psychopharmacology, psychotherapy, treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S45-S6
[S-19]
Internet addiction: Is it the visible side of an iceberg or comorbidity?
Murat Semiz
Sivas State Hospital, Psychiatry Clinic, Sivas-Turkey
e-mail address: [email protected]
There is no doubt that the Internet has become the most useful tool for the young and adult people. It has an opportunity for people to explore
knowledge and to be in touch within the contacts all over the world, as its usage is quite easy and is fast. However, the overuse of Internet,
namely spending most of time on the Internet, has some cons on daily activities in respect to the interfamily communication and emotional
stability. Nowadays, the Internet addiction is a widely spreading problem. This disorder has been reported both among Western and Eastern
societies containing adults and adolescents. Researchers report that Internet addiction is related to a variety of psychiatric disorders.
The results several studies show that the adolescents, who are addicted to the Internet, have more deficiency in attention rather than
normals, and have symptoms of attention deficiency and hyperactivity disorder (ADHD), depression, social phobia, and hostility.
The comorbidity between two disorders shows a higher relationship by chance than expected. Hence, it indicates an existing mechanism
or mechanisms to provide affiliation. It is prominent to perceive such mechanisms to have an effective treatment for both disorders.
In order to explain the affiliation between addiction and a psychiatric disorder, four possible mechanisms have been specified; firstly,
the psychiatric disorder results in the symptoms of the other psychiatric disorder. Following, firstly, the psychiatric disorder results in,
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contributes to, or deteriorates the symptoms or course of the addictive disorder. Secondly, the addictive disorder leads to, contributes
to, or further deteriorates the symptoms or course of other psychiatric disorders. Third, there are fundamentally shared biological,
psychological, or sociological mechanisms by addictive and psychiatric disorders. Other components associated to sampling, evaluation,
investigation, study conceive, or analysis outcome in inappropriate over-estimation of the comorbidity.
The most well-known comorbid conditions of Internet addiction are mood disorders. Internet addiction is shown to be significantly associated
with depression and suicidal ideation. In adolescents, Internet addiction may lead to depression and/or suicidal ideation. In the other hand,
adolescents with depression or suicidal ideation may develop Internet addiction to cope with stressful life events. It is, therefore, important
to understand such mechanisms; there may be a complex transactional relationship between Internet addiction and depressive symptoms.
An association between Internet addiction and social anxiety has also been found among Asian adolescents. Internet use may help
to adolescents with social phobia in avoiding to face-to-face interplay with peers. Researchers suggest that hostility is associated with
Internet addiction in adolescents. Moreover, adolescents with Internet addiction are more likely to manifest aggressive behaviors. Studies
demonstrated that adolescents with Internet addiction had higher ADHD symptoms. Treatment of ADHD symptoms could provide a
decrease in the deteriorating effect of co-morbid symptoms with Internet addiction. Moreover, depression, ADHD symptoms and social
anxiety should be carefully appraised and treated in adolescents with Internet addiction. Although the effects of the treatment strategies
of comorbidities was beyond the scope of this presentation, it appears reasonable to suggest that effective treatment for comorbidities
are required for patients with internet addiction.
Keywords: internet addiction, psychiatric comorbidity, treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S46-S7
[S-21]
Regulation disorders of sensory processing: neurodevelopmental problems
from infancy to adulthood
Koray Karabekiroglu
Ondokuz Mayis University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun-Turkey
e-mail address: [email protected]
Self-regulation refers to the process of regulating an emotional state and organizing a behavioral response to experiences. Infants begin
to develop self-regulatory skills in the first months of life, when they interact with the others and learn to regulate arousal and responses
to sensory stimulation. Self-regulatory skills include abilities to maintain attention, self-console, and change emotional states. Although
early problems in self-regulation (e.g., excessive crying or sleep disturbances) may resolve with maturity, 7% of young children persist
in displaying maladaptive responses to sensory stimulation and develop regulation disorders of sensory processing (RDSP). Infants with
RDSP can be defined as children having some behavioral and/or emotional problems, observable over time and across settings, that
interfere with normal neuropsychological development. The few studies that have been published on children with regulatory problems
suggest that early RDSP may lead to later emotional and behavioral disorders. However, yet little is known about the development of early
regulation problems from preschool age to middle childhood and adolescence.
The findings show that regulatory symptoms and related problems may well persist beyond infant and toddler age. The diagnostic
classification and psychiatric terminology differ as the child grows, however the core symptoms (e.g., affect and attention regulation,
impulse control problems) mostly do not change. Previous studies so far reported that a high percentage of toddlers with RDSP are
diagnosed with attention and oppositional disorders in childhood. Children with attention and behavior disorders are mostly diagnosed
with personality, anxiety, and affective disorders in adulthood. Therefore, RDSP can be assumed a very early predictor of adulthood
psychopathologies and it is a target for later research. More longitudinal research is needed to understand the developmental
psychopathological importance of regulatory symptoms of infants and toddlers.
Keywords: infant, regulatory disorder, sensory processing, outcome
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[S-21]
Treatment update in elimination disorders based on new scientific findings
Ozden S Uneri
Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Child and Adolescent Psychiatry Outpatient Clinic, Ankara-Turkey
e-mail address: [email protected]
Elimination disorders are very common in children; 10% of seven year-old wet at night (nocturnal enuresis), 2-3% during daytime (diurnal
urinary incontinence) and 1-3% soil (encopresis). They are associated with significant comorbid psychopathology and are distressing for
children and parents.
Nocturnal enuresis is the intermittent involuntary loss of urine at night, in the absence of physical disease, at an age when a child could
reasonably be expected to be dry (by consensus, at a developmental age of five years). Many different types of drugs have been used to
treat children with nocturnal enuresis. Alarms triggered by wetting, desmopressin and tricyclic drugs have been shown to work during
treatment. According to the International Children’s Continence Society, alarms and desmopressin are recommended as first-line nocturnal
enuresis therapies for monosymptomatic enuresis. Desmopressin is safe and acts quickly, especially on nocturnal polyuric enuresis, but
does not cure the disorder and results in a high relapse rate. Enuresis alarms support dryness in approximately two-thirds of children
with enuresis and result in low relapse rates after successful therapy; however, long-term therapy is required to achieve complete success.
Although drug therapies other than desmopressin or tricyclics have been tried for nocturnal enuresis[non-steroidal anti-inflammatory
drugs (indomethacin and diclofenac), psychoactive drugs (e.g. amphetamine, diazepam, meprobamate, hydroxyzine, ephedrine sulphate),
anticholinergics (oxybutynin) and other drugs (methylphenidate, atomoxetine, sertraline)], little is known of their impact. Behavioral and
other interventions include enuresis alarm therapy and overlearning, complex behavioral interventions (e.g. dry bed training), multidimensional behavioral training and simple behavioral interventions (e.g. retention control training, fluid deprivation). Other interventions
include complementary and miscellaneous interventions such as acupuncture, hypnosis, chiropractic and homeopathy.
Encopresis is defined as a disorder characterized by repeated passage of feces into inappropriate places in a child who is at least four
years old. DSM-IV also acknowledges two subtypes of encopresis: with or without constipation and overflow incontinence. The former
corresponds to what has generally been referred to as retentive encopresis, while the latter would correspond to nonretentive encopresis.
A child should be at least 4 years of age with faecal incontinence younger children do not require treatment. Comorbid emotional
and behavioral disorders should be treated separately according to evidence-based recommendations. Change in toileting habits or
augmenting oral fluids can be very effective. Toilet training (regular sitting on the toilet after mealtimes) is the main component in the
treatment of encopresis. Medication can be indicated in faecal incontinence with constipation (polyethylene glycol). Comorbid behavioral
and emotional disorders require additional treatment.
Keywords: elimination disorders, treatment, children
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S48
[S-23]
Psychotherapy of sleep disturbances in posttraumatic stress disorder
Taner Oznur
Gulhane Military Academy of Medicine, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Sleep Disturbances are the most frequently experienced symptom of post-traumatic stress disorder (PTSD) patients. Compared to healthy
controls, PTSD patients have problems such as falling asleep, maintaining sleep, waking up due to the nightmares. Patients often state
that their sleep is not restful and they wake up even more tired. Polysomnographic studies showed that patients with PTSD experienced
more than one disturbances among the sleep problems listed above. Some psychotherapeutic interventions were developed other
than pharmacological approaches for sleep disturbances experienced by PTSD patients. However, nowadays it cannot be said that any
psychotherapy approach could able to produce a completely solution to sleep disturbances observed in PTSD. Therefore, combination
therapies are the basic approach for sleep disturbances. The main approaches for the sleep disturbances observed in PTSD are Cognitive
Behavioral Therapy (CBT), Image Rehearsal Therapy (IRT), Hypnosis and Creative Arts Therapies. Although the successes of each method
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are variant, CBT and IRT are the most widely practiced and found relatively effective methods.
Keywords: psychotherapy, sleep disturbances, posttraumatic stress disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S48-S9
[S-23]
The role of psychopharmacological drugs in the prevention of suicidal behaviors
Cicek Hocaoglu
Recep Tayyip Erdogan University, Faculty of Medicine, Department of Psychiatry, Rize-Turkey
e-mail address: [email protected]
There is considerable controversy about the possible link between suicidal behaviors and psychotropics (especially antidepressants).
Since ethical and methodological problems prevent direct research, discussion has to draw largely on indirect evidence. Treatment
with SSRIs (selective serotonin reuptake inhibitors does not increase the risk of suicide in adults, but it is difficult to make a firm
pronouncement about the effect of SSRIs on suicidal behavior (ideation and suicide attempts). The findings suggest that SSRI treatment
has a protective effect in all adult age groups. Studies suggest that antidepressants may increase suicidal risk in bipolar disorder; this
possibly being related to the induction of broadly defined mixed states. There is no evidence that antiepileptic drugs as a class increase
suicidal risk in patients with bipolar disorder. Only lithium provides convincing data that it reduces the risk of suicide over the long term.
There is little known regarding the effects of antipsychotics, as well as anti-anxiety and hypnotic drugs, on suicidal behavior. Studies
suggest that antidepressants may increase suicidal risk in bipolar disorder; this possibly being related to the induction of broadly defined
mixed states. There is no evidence that antiepileptic drugs as a class increase suicidal risk in patients with bipolar disorder. Only lithium
provides convincing data that it reduces the risk of suicide over the long term. Clozapine reduces suicide attempts and hospitalizations
for suicidality in schizophrenia and schizoaffective disorder. There is little known regarding the effects of antipsychotics, as well as antianxiety and hypnotic drugs, on suicidal behavior.
Keywords: psychotropic drugs, prevention, suicidal behavior
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COURSES
[C-3]
Beyond talk, into action: working with users’ associations in perinatal psychiatry
Jane Honikman1, Oguz Omay2
1Postpartum Parent Support Consultant from Santa Barbara, California, USA
2Psychiatrist, La Teppe Medical Center, France
e-mail address: [email protected]
Jane Honikman is a Postpartum Parent Support Consultant from Santa Barbara, California. In 1977, she co-founded Postpartum Education
for Parents (PEP). She founded Postpartum Support International (PSI) in 1987.
« I was pregnant, single and alone. I gave birth in a foreign country, and never saw my baby. I had no emotional support ». « I was married,
and was finally pregnant. I gave birth, away from my extended family, but with a supportive husband. We had no emotional support »
It is these contrasting, yet similar experiences, which have motivated Jane Honikman to become passionate about improving the
outcomes for babies and their parents. After the birth of her second child, she co-founded, with some of her friends, Postpartum
Education for Parents (PEP). It was conceived from their own needs as struggling young parents, removed from their families, and
inundated with professional advice. It was about making friends, learning about community resources, and gaining confidence as new
parents. The first ever warm line, staffed entirely by trained parent volunteers, 24 hours per day, 7 days per week was launched and it has
been available since July 1, 1977.
Communities are human systems where we live, work, learn, pray, and play together. We tend to gather together based on our cultural
values and with a common purpose. It is during pregnancy that the first shift in emotional needs occurs. The arrival of the newborn
does interrupt a new parent’s existing community, as well as a good night’s sleep. Social connections, our networks, exist within each
community, yet how do expectant and new families find or create them? In general, our networks help us find employment, friendship,
and provide emotional support and comfort. We may relish these natural human interactions, take them for granted, or in some cases,
ignore them. Then, the new baby arrives. The need for community support takes on a different meaning.
During this interactive course, Oguz Omay will interview Jane Honikman on how to build efficient and sustainable community networks
for new families. The presenters will explore how best a perinatal psychiatry team may work with users’ associations and the participants
will be called to comment on challenges they perceive in their own cultural context.
Keywords: perinatal psychiatry, psychotherapy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S50
[C-4]
Frontiers between attention deficit hyperactivity disorder and bipolar disorder
Aynur Pekcanlar-Akay
Dokuz Eylul University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Balcova, Izmir-Turkey
e-mail address: [email protected]
This presentation aimed to describe and discuss the comorbidity between pediatric bipolar disorder (BD) and attention deficit hyperactivity
disorder (ADHD) and difficulties in management in terms of discrimination. These two conditions would be distinct and unrelated; these
conditions may be manifestations of the same disorder. There may be a complex relationship between these two extremes.
ADHD comorbidity has become a popular discussion topic in academic circles and many journals for children and youths with BD. Studies
report presence of comorbid ADHD in as much as 98% of children with BD.
Irritability is a common and disabling symptom in pediatric BD, and the presence of irritability and motor disinhibition in both pediatric BD
and ADHD has been one cause of the diagnostic confusion between these two illnesses. A discussion of how “none overlapping with ADHD”
Diagnostic and Statistical Manual of Mental Disorders (4th ed.) mania symptoms can be useful in the differential diagnosis of irritability
is also provided. Five symptoms (i.e., elation, grandiosity, flight of ideas/racing thoughts, decreased need for sleep, and hypersexuality)
provided the best discrimination of BD subjects from ADHD. Irritability, hyperactivity, accelerated speech, and distractibility were very
frequent in both BD and ADHD groups and therefore were not useful for differential diagnosis. High levels of irritability and aggression,
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along with presence of high levels of mania non-specific mood dysregulations, are reported by numerous studies to be a result of presence
of comorbid ADHD. This supports the notion that there may be a subtype of BD/ADHD disorder which presents in early childhood and
which has BD features different to those of classical adult onset BD. ADHD has become the biggest focus in the controversy about whether
hyperactive, inattentive, emotionally labile children are really manic or really ‘just ADHD’. However, the history of ‘the hyperactive child’
syndrome reveals that it was initially designated with emotional lability, sleep disturbance, and variation in behavior.
In conclusion; recent studies showing substantial comorbidity between ADHD and Bipolar Disorder in childhood are consistent. Comorbid
ADHD and Bipolar Disorder may be a separate subtype of ADHD or Bipolar Disorder, similar to the situation with hyperkinetic conduct
disorder which is recognized as a subtype of hyperkinetic disorders within ICD 10.
The similarity between symptoms of ADHD and Bipolar Disorder supports the notion of a relationship between the symptoms. However,
it is also possible that it is simply an artifact of the diagnostic systems.
Keywords: attention deficit hyperactivity disorder, bipolar disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S50-S1
[C-8]
Suicidality in youth: risk factors, screening, assessment, and intervention Workshop Proposal
Andres J Pumariega, Alican Dalkilic
1Cooper Medical School at Rowan University and Cooper Health System Department of Psychiatry, Camden, NJ, US
2Temple University School of Medicine, Philadelphia, PA, US
e-mail address: [email protected]
Suicide is rapidly becoming a significant cause of worldwide mortality. Youth suicide is a major social and health problem worldwide.
According to the World Health Organization, in 2004 the global mean rates of suicide in youth ages 15 to 19 were estimated to be 7.4
per 100,000, with rates being higher for males (10.5) than females (4.1). The rates varied widely, from 46.5 per 100,000 in Sri Lanka to a
reported 0.02 per 100,000 in Egypt, with 13 countries (including Russia, New Zealand, the Baltic states, Kazakhstan, Norway, Canada, and
Slovenia) reporting suicide rates of 1.5 times the mean or more (Wasserman, Cheng, & Jiang, 2005). In the United States (U.S.), suicide was
the third leading cause of death for young people ages 10 to 24 in 2007, and suicide rates for youth ages 15 to 19 were 6.9 per 100,000.
A nation-wide survey of youth in grades 9–12 in public and private schools in the U.S. found that 16% of students reported seriously
considering suicide, 13% reported creating a plan, and 8% reporting trying to take their own life in the 12 months preceding the survey
(Centers for Disease Control and Prevention, 2012). The risk factors that have been associated with suicide in the U.S. are depression and
other mental disorders, substance-abuse disorders (often in combination with other mental disorders), with more than 90 percent of
people dying by suicide having these risk factors. Other risk factors include prior suicide attempt, family history of mental disorder or
substance abuse, family history of suicide, family violence, including physical or sexual abuse, and firearms in the home, the method used
in more than half of suicides.
Turkey has not been immune from this worldwide trend. In the WHO/EURO Multicenter study of suicidal behavior, the rates of completed
suicides in people over 15 years old were reported for the Ankara/Istanbul catchment area, and the rates of completed suicides were
reported to be 9.9 for males and 5.6 for females (Sayil, Demirci-Ozguven 2002), significantly higher than the worldwide rates. In Turkey,
completed suicides were more common among teenagers and young adults (15-24 age group), while in European countries completed
suicides were more common among 40 year olds and older. We need to keep in mind that suicides might be under-reported amongst
Turkish youth because of greater social and religious stigma compared to the U.S.
In this workshop, we will first discuss the epidemiology and risk factors for youth suicide worldwide, in the US, and in Turkey, with an
analysis of the interactive phenomenology of these risk factors. We will then review data from recent epidemiological studies examining
suicidality (suicidal ideation and attempts) amongst youth from Turkey and the U.S, including one involving over 30,000 youth in Istanbul
published by the presenters. The workshop will then shift focus to suicide screening in risk populations of youth and its potential benefits.
We will then present and provide brief interactive training (including vignettes) on the use of one of the best evidence-based tools for
suicide screening, the Columbia Suicide Severity Ratting Scale (Posner & et al, 2011). We will provide data on its predictive validity and
reliability, including the use by one of the presenters (AJP) in the general hospital setting in two institutions. Finally, we will present
practical clinical approaches for the clinical evaluation of suicidality and effective approaches to intervention and follow-up treatment.
Keywords: suicidality in youth, risk factors, screening, assessment, intervention
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[C-11]
Management of substance use disorders; voluntary versus involuntary admissions
Asli Enez Darcin, Serdar Nurmedov, Nesrin Dilbaz
NPISTANBUL Hospital, Uskudar University, Istanbul-Turkey
e-mail address: [email protected]
Addiction is a complex disease process of the brain that results from repetitive drug intoxication and is associated with genetic,
developmental, experiential, and environmental factors. Substance abuse is recently seen as a disease, as well as a social problem and
problem of public. A substance use disorder is an important and clinically challenging aspect of the management of patients in psychiatric
hospitals. Patients with substance abuse are reported to have a higher risk of violent behavior and to be hospitalized, homeless, or in jail.
These factors can affect the treatment process and the patients with substance use disorder often being sent between addiction units
and general psychiatry clinics.
In general psychiatry clinics, caregivers primarily try to treat patients voluntarily but sometimes patients with certain circumstances (such
as having psychotic symptoms, having violent behavior like suicidality or homicidally) need to be restricted and taken into an involuntary
treatment. The ethical questions related to the use of involuntary treatment are a growing concern.
Although freedom of choice and rights of patients are important ideals in today’s Western society, compulsory practices are still needed
and common in mental health care systems. Involuntary treatment is ethically problematic because it is an act against to an individual’s
autonomy. In the other hand, autonomy is generally understood to refer to the capacity to be one’s own person, to live one’s life according
to reasons and motives that are taken as one’s own and not the product of manipulative or distorting external forces. It is the ability of the
individual to make his/her own choices has been perceived as the basic foundation of social freedom and moral responsibility.
Standard definitions of substance use disorders point the loss of control about using of the substance. Patients with substance use
disorders may not often have the full capacity to be self-determining or autonomous at all times. Therefore, involuntary treatment may
be justified, even for only a short period, if the loss of control caused by the compulsive drug-taking habits consequent to substance use
disorder is considerable in admission.
In addiction treatment internal motivation for change increases the treatment success as two-times. Also external motivators such as
justice pressure, family consent and presumably coercion, are often associated with positive treatment outcomes. Given that intrinsic
motivation for change is the primary distinction between voluntary and involuntary patients in addiction treatment. The legal institution
of restriction of freedom for protection purpose entered into our legislation by means of the new Turkish Civil Code. The aim of such
institutionalization is to provide seclusion of the people who cause danger to the community by the reason of their mental or inflicting
grievous bodily troubles and whose protection cannot be otherwise provided to a convenient institution for their education and
rehabilitation. Reason of restrictions have been specified as limited in the article 432 of Turkish Civil Code which are mental illness, mental
defect, alcohol or drug addiction, serious and dangerous contagious disease or vagrancy.
In this course we will discuss unmet needs of patients with substance use disorders who need to be treated and challenges that health
caregivers and families suffered.
Keywords: management, substance abuse, involuntary admissions
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[C-18]
The Minnesota Model: flexible, relevant and adapted in Scotland
Glynis Read
Head of Training and Eating Disorders Specialist, Castle Craig Hospital, Scotland
e-mail address: [email protected]
The Minnesota Model of addiction treatment developed in the 1950s when little help was available for alcoholics and addicts. The
model emphasizes the disease of alcoholism as a primary, chronic and complex illness which is treatable, not curable. Dignity and
respect for patients are core principles of the model. Treatment is for the whole person; body, mind and spirit. It is abstinence-based
and utilizes the Twelve Step self-help groups. The team is multi-disciplinary, consisting of a range of professionals that are able to
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meet the needs of the patients. This begins at the first enquiry, through the assessment, detoxification, treatment and aftercare
phases. The Minnesota Model offered a completely new way of treating alcoholics and addicts at its inception in 1949. Today it
continues to be relevant, appropriate and flexible for a wide range of patients. The flexibility enables adaptation to needs, new
ideas and interventions without losing the core perspectives. Castle Craig Hospital, Scotland, has adapted the Minnesota Model in
Europe with an eclectic, cross cultural group of patients. Adjunct therapies (for example trauma, drumming and equine therapy),
the treatment of process addictions (for example gambling) and use of a hyperbaric chamber are but a few of the innovations
resulting in successful treatment.
Keywords: twelve steps, abstinence, recovery, disease, multi-disciplinary team
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S52-S3
[C-21]
Resistance and resolutions in adult attention deficit hyperactivity disorder
Z. Bengi Semerci
Istanbul, Turkey
e-mail address: [email protected]
As in children and adolescents, medicinal treatment is the first choice in the treatment of adult Attention Deficit Hyperactivity Disorder
(ADHD). However, in adults, the rate of success of medicinal treatment is 50% or less. The reason for this is that whilst medicinal treatment
is effective for main symptoms (attention deficit, restlessness, impulsivity), it is not very effective for functional symptoms (time
management, organization, planning etc.). For the same reason, the rate of continuation of treatment is also lower for adults. The patient
who thinks that treatment is not delivering the expected results will not continue treatment. To prevent this, before commencing with
medicinal treatment, the symptoms for which the treatment may be effective are described and possible treatment methods for other
issues are explained. Another reason for the decrease of patients’ compliance with treatment is the symptoms of the illness itself, such
as lack of concentration, forgetfulness. Because of their habits, groups who suffer from more substantial attention deficit, obtain less
benefit from medicines. In adult patients, other treatments are therefore applied besides medicinal treatment. These other treatments
may be listed as follows: psychotherapy, cognitive behavioral treatment, family treatment, consultancy on the issue of Attention Deficit
Hyperactivity Disorder, education oriented on self control.
For the large part of patients, treatment of adult Attention Deficit Hyperactivity Disorder is started with stimulants or Atomoxetine.
If there is no response through the appropriate dose of medicine, a different medicine is tried. In the event of cardiac side-effects,
tic disorders, mood dysregulation, medicine is not continued. For some side-effects, the decrease of dosage of medicine or the
addition of other medicine will solve the problem. If the problem is not resolved despite this, another group of medicines will be
reverted to.
Despite all available medicines, some patients will not respond to treatment or symptoms will worsen. It is necessary in such situations
to alter the dosage of medicine. Depending on the condition of the patient and the symptoms, the dosage will either be decreased
or increased. Another manner of changing effectiveness is the alteration of the moment of administration of medicine. If there is no
improvement despite this, the most correct thing to do is to revert to another group of medicines and cognitive behavioral treatment,
giving the patient individual, guiding, support.
If side effects are the reason for the lack of effectiveness of treatment, the relation between these side effects and the
medicine is evaluated. Sometimes, altering the moment of administration of medicine can decrease the side effects. If not, the
medicine should be changed and therapies must be added. If symptoms reoccur during treatment, altering the moment of the
administration of medicine, the frequency of the administration of medicine, may resolve the problem. If not, it is necessary to
alter treatment.
In approximately one fourth of adult Attention Deficit Hyperactivity Disorder patients, one or more additional disorders are manifest.
Anxiety disorders, depression and anti-social personality disorders are most frequently to be seen. In treatment, the response to
stimulants is good. In about only 30% of patients is an adequate response not achieved or is no use made because of side effects. If serious
mental problems arise during treatment, irrespective of the medicine, the effectiveness of treatment will decrease. In these situations, a
careful evaluation must be made as to whether or not an additional disorder is manifest. Because if the problem is related to the other
illness, the alteration of the dose of medicine or the medicine will not resolve the problem.
Two important groups are to be observed in relation to the medicinal treatment of adult ADHD patients. The first group is the group,
which encounters difficulties in treatment because of additional disorders, intolerable side effects; the other is the group, which shows
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no response to any medicinal treatment. The resistant group which does not respond to treatment more often regards patients who
have other mental problems besides ADHD. In these situations, with the discontinuation of medicine, the application of other treatments
comes to the fore. Furthermore, problems in the cure of functionally oriented symptoms, despite the cure of main symptoms in those
who benefit from treatment, are also a reality. For this reason, in the treatment of adult ADHD, extra-medicinal treatments become more
important. Cognitive behavioral therapy, individual therapy support and giving guidance to the patient with regards to ADHD are the
most applied and advised psychological treatment methods.
Keywords: adult, attention deficit hyperactivity disorder, resistance, treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S53-S4
[C-25]
Psychotropic drug use in oncology patients
Hulya Guveli
Istanbul University Institute of Oncology, Department of Psychosocial Oncology, Istanbul-Turkey
e-mail address: [email protected]
Psychiatric disorders affect about half of the cancer patients. A majority of oncology patients suffer psychosocial distress and
chemotherapy-induced nausea and vomiting during the course of their disease, 50% and 75%, respectively. Adjustment disorder is
the most frequent diagnosis, followed by major depression. In cancer patients, the choice of a psychotropic drug is a challenge that
must target ‘not to harm’. Indeed, those patients are more vulnerable to drug interactions because of their physical fragilities (poor
nutrition, weight loss, other medical conditions, young or advanced age), multimedication and possible enzyme deficit due to genetic
polymorphisms or iatrogenic causes. Therefore, the choice of psychotropic drugs must be cautious, minimizing the possible increase in
adverse side effects and the decrease in the efficacy of drugs which are crucial to the treatment of cancer. Antipsychotics are frequently
used for the treatment of delirium and for the prevention of chronic nausea due to chemotherapy while antidepressants and anxiolytics
are used for cancer-related mood and anxiety disorders. Haloperidol is often used sedative drug, particularly in the treatment of nausea,
vomiting and delirium, including terminal agitation. In addition olanzapine is safe and highly effective in controlling acute and delayed
nausea and vomiting in patients receiving highly emetogenic and moderately emetogenic chemotherapy. The pharmacokinetic drug
interactions with antidepressants are unlikely with busulfan, chlorambucil, estramustine, mechlorethamine, melphalan, temozolomide,
5-fluorouracil, gemcitabine, mercaptopurine, thioguanine, cisplatin, carboplatin, oxaliplatin, daunorubicin, doxorubicin, epirubicin and
vorinostat. Among the chemotherapeutic agents, tamoxifen is the one more extensively studied for drug interactions with antidepressants.
Tamoxifen is a selective modulator of estrogen receptors. In women with breast cancer and at the initial stage, the use of tamoxifen has
been associated with a reduced risk of recurrence at about 1/2 and death risk by breast cancer at about 1/3. Because both tamoxifen
and selective serotonin reuptake inhibitors (SSRI) are metabolized by CYP2D6, SSRI inhibition of CYP2D6 activity could reduce tamoxifen
prevention of breast cancer recurrence. Paroxetine, fluoxetine and bupropion are strong CYP2D6 inhibitors which should be avoided in
tamoxifen users. Venlafaxine, mirtazapine, citalopram and escitalopram are small inhibitors of CYP 2D6, therefore being a safe choice
when using tamoxifen. Most of the other anticancer drugs subjected to metabolization by CYP 450 3A4 should be used with caution
concomitantly with inhibitors of this isoenzyme such as fluoxetine, sertraline, paroxetine and fluvoxamine. Escitalopram, citalopram,
venlafaxine, mirtazapine and milnacipran are antidepressants with minimal CYP 450 inhibitory potential and are therefore safer in these
patients. Venlafaxine is also efficacious for the treatment of hot flashes in combination with tamoxifen. Gabapentin is also efficacious in
treating tamoxifen-induced hot flashes and, since it does not interact with cytochrome P450 system, is likely safe to use in patients using
tamoxifen. Pregabalin may be alternatives to venlafaxine and gabapentin, respectively, in this population. Tricyclic antidepressants are
used in the management of neuropathic pain. Benzodiazepines may be treated simultaneously nausea, pain, and anxiety. As they treat
anticipatory anxiety and phobia, they mitigate anticipatory nausea and a component of post-treatment nausea.
Keywords: psychotropic drugs, oncology, medical
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[C-25]
Psychotropic drug use in pregnancy and lactation
Mine Ozkan
Istanbul University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Psychiatric disease in the pregnant or breastfeeding woman presents a significant challenge. Untreated mental illness during pregnancy
carries unfavorable impression for the mother, the child, the mother–child relationship and the family. Risks to the mother include selfharm/suicide, self neglect and reduced compliance with pre and post-natal care. Fetal underdevelopment, evidenced by low birth weight
and small head circumference, is associated with antenatal maternal depression and anxiety. Short and long term consequences to the
child may arise, including impaired bonding and attachment, cognitive disturbances, emotional problems and behavioral abnormalities.
On the contrary treating the mother with psychotropic agents carries the risks of teratogenicity, toxicity and possible long-term
neurobehavioral problems for fetus. Maternal medication during the first trimester of pregnancy, particularly between the third and
eighth weeks of gestation, is most relevant with regard to morphological teratogenesis, whilst that during the second and third trimesters
may have deleterious effects on growth and/or functional development and toxic effects.
Clinical management is complex, involving competing risks to mother and offspring; the challenge lies in effectively treating mental
illness, whilst minimizing exposure of the child to harmful medication. Several factors must be considered, including possible teratogenic
effects of medication, the safety of medication during labor and delivery, possible long-term neurobehavioral effects and the effects of
ongoing exposure during breast feeding. In the already pregnant women, the opportunity to reduce the dose of medication with a view
to a (relatively) drug-free first trimester is often lost. Indeed by the time of presentation, pregnancy is often well progressed, with resultant
exposure of the unborn child to potentially teratogenic medication. Maternal risks associated with drug withdrawal or reduction may
predispose the unborn or breast-feeding child to more harm than the drugs themselves, mandating continued pharmacotherapy. No
drug is absolutely safe; indeed the FDA has not approved any psychotropic medication for use during pregnancy or lactation.
The clinician faced with the pregnant or breastfeeding woman therefore requires undertaking a risk-benefit assessment, tailored to the
individual patient, with regard to the continuance or commencement of psychotropic medication. Relevant issues in such an analysis
include the severity of the underlying psychiatric disorder, the consequences of leaving it untreated, and potential adverse effects of
medication on both mother and child and the stage of pregnancy / breastfeeding. Treatment options and their risks and benefits should
be discussed with the patient and care givers, and the possibility of delaying medication until the second trimester may be considered.
Non-pharmacological interventions in the form of individual or group psychotherapy and enhanced psychosocial support should
be considered before prescribing medications, particularly if the patient has mild symptoms or is in the early stages of pregnancy. If
treatment is deemed appropriate, the smallest number of medications at the lowest possible dose consistent with control of the mental
illness should be prescribed.
Keywords: psychotropic agents, lactation, pregnancy
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[C-25]
Pharmacotherapy principles in consultation-liaison psychiatry
Sedat Ozkan
Istanbul-Turkey
e-mail address: [email protected]
Consultation-liaison psychiatry is the subspecialty of psychiatry concerned with medically and surgically ill patients. The consultant
needs to have knowledge of psychotherapeutic and psychopharmacological interventions as well as knowledge of the wide array of
medicolegal aspects of psychiatric and medical illness and hospitalization. Psychopharmacological interventions are an essential part
of the management of the medically ill. Numerous physical conditions may cause, exacerbate or first present themselves as psychiatric
syndromes, and appropriate use of psychopharmacology necessitates a careful consideration of the underlying medical illness, drug
interactions, and contraindications. In addition, many medications used in the treatment of medical/surgical illness are associated with
psychiatric syndromes. Therefore, the consultant must be knowledgeable about the psychiatric effects of medications as well as the
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specific indications for psychopharmacological interventions. Pharmacotherapy of the medically ill often involves modification in dosage
(e.g., to account for older patients with an increased volume of distribution, a decreased rate of metabolism, and an increased physiologic
reactivity). Furthermore, modifications may be necessary because of liver, kidney, or cardiac disease, or because of potential for multiple
drug–drug interactions. Pregnancy presents another challenge, with concerns regarding potential teratogenicity.
Keywords: pharmacotherapy principles, consultation-liaison psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S55-S6
[C-25]
Drug interactions and psychotropic drug use in organ failures
Serap Oflaz
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
e-mail address: [email protected]
Drug interactions occur when the effect and/or concentration of a drug is modified by another substance, including a concomitant
treatment, over-the-counter medication. Drug interactions can be classified as pharmacokinetic or pharmacodynamic in nature. A
pharmacokinetic drug interaction occurs when a drug alters the absorption, distribution, metabolism or excretion of another drug.
Pharmacodynamic interactions occur when two drugs act on interrelated receptor sites resulting in either additive or antagonistic effects.
The liver is the primary site for metabolism of psychotropic drugs. The processing and elimination of drugs from the body occurs through two
phases of metabolism: phase 1 reactions, during which CYP 450 enzymes convert the parent compound to metabolites through processes
of oxidation, reduction, or hydrolysis and phase 2 reactions, which couple the metabolites with endogenous substances rendering them
more water-soluble for excretion from the body. Drug-drug interactions involving psychotropics are initiated primarily by the CYP family
of enzymes, and these drugs and metabolic enzymes can interact in a variety of ways . Regarding antidepressant metabolism, the CYP 2D6
and CYP 3A4 systems may be the two most important metabolic pathways, as most antidepressants are eliminated via these pathways.
Clinically significant drug interactions are defined as events in which the safety or effectiveness of one medication is substantially
altered by another drug or substance. These interactions can result in potentially dangerous, and sometimes fatal, adverse events. In
addition, drug interactions can result in reduced effectiveness of treatment or can lead to adverse events that, although not serious, are
bothersome for patients. There are numerous known interactions involving psychotropic drugs. Many interactions have minor clinical
significance; however, there are many potentially hazardous interactions that should always be considered. The significance of a drug
interaction can also vary between individuals depending on factors such as comorbidities, gender or age.
Drug interactions with psychotropics can result in poor tolerability or reduced efficacy, or both, which can negatively impact patient
outcomes. Clinicians can improve outcomes for patients by considering the potential for drug-drug interactions when selecting a specific
psychotropic, and when evaluating patient progress, compliance, and the incidence of adverse events throughout the course of treatment.
Keywords: psychotropic agents, drug interaction
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KEYNOTE ADDRESS
[KA]
DSM-5: How do the changes affect decision-making in psychopharmacology
David Osser
Harvard Medical School at the VA Boston Healthcare System, Brockton Division, Department of Psychiatry, 940 Belmont Street, Brockton, MA 02301, USA
e-mail address: [email protected]
In this presentation, there will be a demonstration of how changes in the DSM-5 classification have affected the decision-making process
for choosing medications, focusing on the problem of differentiating schizophrenia with mood symptoms, schizoaffective disorder, and
bipolar disorder with psychosis. In the DSM-5, an important change occurred in the D criterion for schizophrenia, which describes how
this differentiation is to be made. The new criterion states that “if mood episodes have occurred during active-phase symptoms, they have
been present for a minority of the total duration of the active and residual periods of the illness.” In DSM-IV, the duration of such episodes
had to “be brief” relative to the total duration of the illness. The text gave an example of what is meant by “brief” and offered a patient
who has been ill for 4 years but had a 5 week period of major depression superimposed on the psychotic symptoms. This is about 10%
of the total duration of the illness. In the new criterion, the change to the word “minority,” which implies up to 50% of the time, will result
in many patients with mood episodes being diagnosed with schizophrenia who previously would have been diagnosed schizoaffective
disorder. Please note that in both DSM-IV and DSM-5, patients meeting the A, B and C criteria with significant and even continuous mood
symptoms short of meeting criteria for a major depressive or manic episode were and still are diagnosed with schizophrenia.
Consistent with the above, the C criterion for schizoaffective disorder has also changed. In DSM-5, the major mood episode must be
present for a “majority” of the total duration of active and residual phases of the illness. In DSM-IV, they only had to be present for a
“substantial” portion of the time.
Schizoaffective disorder had questionable construct validity as defined by the older criteria. Also, there had been very little treatment
research focused on patients meeting those criteria. Not enough evidence exists to enable the development of a plausible treatment
algorithm. Available evidence indicates that patients meeting these criteria seem to comprise a heterogeneous population of individuals
most if not all of whom have variants of either schizophrenia or bipolar disorder. Yet, schizoaffective disorder continues to be an extremely
popular diagnosis in the records of patients with combined mood and psychotic symptoms. Many clinicians employ idiosyncratic criteria
and treat by clinical experience and improvisation.
The Psychopharmacology Algorithm Project at the Harvard South Shore Program has evidence-derived algorithms for the pharmacotherapy
of schizophrenia and bipolar disorder. With DSM-5, more patients with mood symptoms will meet criteria for schizophrenia, where the
algorithm (in accordance with the evidence-base) recommends minimal use of antidepressants and mood stabilizers.
The current algorithms for schizophrenia and for bipolar disorder will be shown and it will be suggested that patients meeting DSM-5
criteria for schizoaffective disorder should be evaluated as to which of these two main diagnoses comes closest to describing them. Then,
apply the relevant algorithm. If the algorithm selected is producing an unsatisfactory response, one would consider switching to the
other algorithm.
Keywords: DSM-5, psychopharmacology, algorithms
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Scientific Program Abstracts
ROUNDTABLE
[RT-01]
Psychopharmacology, quo vadis? Teaching evidence-based medicine and
psychopharmacology algorithms
David Osser
Harvard Medical School at the VA Boston Healthcare System, Brockton Division, Department of Psychiatry, 940 Belmont Street, Brockton, MA 02301, USA
e-mail address: [email protected]
“When I started my first job after residency I initially felt insecure because I hardly had any clinical experience compared to the other
psychiatrists in the hospital who had been taking care of patients there for many years. I soon realized that I had a solid understanding
of the evidence-base that was important for decision-making, and that I knew how to look up things that I didn’t know. Soon, I became
aware that other doctors were using weird and strange combinations of multiple medications in mega-doses. It was all against what I
had learned in my residency. I felt increasingly secure in staying glued to the evidence, even in cases with complex comorbidity when the
evidence would at least give me a starting point for taking an organized approach trying one thing at a time. Soon my superiors noticed
the good outcomes I was getting in reducing seclusion and restraint usage in patients whose regimens I cleaned up and simplified. Some
of these were high profile cases. Then, I was promoted to unit chief and, later, associate director of residency training in the affiliated
medical school department of psychiatry. I was truly grateful for the training I had and only regretted that at times we students had been
somewhat resistant to learning the evidence-informed way of thinking. ” (MB, as told to DNO on August 6, 2013)
An important direction for the future in psychopharmacology is to find ways to reduce unproductive practice variation that results
from failure to attend to the evidence available regarding best practice. Best practice includes using treatments with the best acute and
maintenance efficacy combined with the best safety and best cost-effectiveness. Evidence-derived algorithms and guidelines have much
promise as resources for training new practitioners and for improving the performance of even the most seasoned clinicians. The evidence
supporting these statements will be presented and the significant problems with these concepts delineated. The development of such
syntheses of evidence by appropriately qualified authors combined with peer review of initial drafts of these syntheses that addresses
potential misinterpretations of the literature and various biases is increasingly becoming an endeavor respected in the academic world.
Financial support for the development and implementation of such algorithms and guidelines is desperately needed.
Keywords: psychopharmacology, directions
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S58
[RT-02]
The future and new horizons of psychopharmacology
Torsten Melgaard Madsen
Divisional Director, H. Lundbeck A/S, Copenhagen, Denmark
e-mail address: [email protected]”
Over the last decade, a large number of companies have terminated drug development in CNS disorders. This will lead to lower availability
to society of novel drugs and new treatment approaches within psychiatric and neurological disorders. This shrinking pipeline is occurring
while data from epidemiological studies indicate that CNS disorders will constitute the largest unmet need in most parts of the world in
the near future. It is a major societal challenge to close the gap between increasing need and demand for treatment options within CNS
disorders, and the availability of more efficient treatment options. This will require collaboration between academia, regulatory bodies,
patients, and drug development industry. In addition, the conditions for reimbursement and market access are placing an increasing
demand on bringing drugs to the market which already have demonstrated differentiation at the time of approval.
The presentation will provide a perspective on development of new treatments for CNS disorders, and discuss strategies for innovation
within CNS drug development with examples from recently approved medicines, and from late phase research.
Keywords: drug development, psychopharmacology, pipeline, innovation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S58
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Scientific Program Abstracts
[RT-03]
Recent advances in drug development: the Janssen perspective
Thomas Steckler
Janssen Research and Development, Beerse, Belgium
e-mail address: xxxxxxx
Probability of success in neuroscience drug development is considered low, while at the same time drugs targeting the CNS are the
most expensive to develop. Consequently, a number of pharmaceutical companies have exited this area of drug development. However,
there remains a major unmet medical need, with many patients suffering from CNS disorders showing no, partial or delayed response,
suffering from side effects associated with current medication, or being faced with a lack of therapeutic opportunities. At the same time,
our understanding of brain function and pathophysiology of CNS diseases is an area of tremendous advancement and there have been
substantial technological developments that can help drug development in this area. To further enhance our probability of success, the
Neuroscience Therapeutic Area at Janssen acts on a few key principles: 1. Focus on a few therapeutic indications and development of
in-depth expertise. 2. Better understanding of the neurobiological basis of complex neuropsychiatric illnesses and symptom clusters,
co-development of biomarkers and diagnostics. 3. A translational approach to enhance predictability of drug effects in patients. 4.
Enhancement of target tractability by development of biologics in addition to small molecules and exploration of alternative delivery
methods. 5. Early proof-of-concept trials. 6. Tapping into multiple sources for innovation, including external research. Points will be
illustrated with specific examples.
Keywords: recent advances, drug development, pipeline
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Turkish Association for Psychopharmacology (TAP)
5thInternational Congress on
Psychopharmacology
&
International Symposium on
Child and Adolescent Psychopharmacology
Improved choices of psychotropic medications:
better mental health outcomes
October 30 - November 3, 2013
Cornelia Diamond Hotel, Antalya, Turkey
www.psychopharmacology2013.org
Candidates of TAP Outstanding
Research Awards
Candidates of TAP Outstanding Research Awards
[PP-001] Childhood and adolescence disorders
Ref. No: 0109
Factors associated with time to pharmacotherapy in patients with Attention-Deficit/
Hyperactivity Disorder (ADHD) symptoms in Central Europe and East Asia
Jihyung Hong1, Diego Novick1, Josep Maria Haro2, Tamas Treuer3, William Montgomery4, Shenghu Wu5, Murat Altin6, Virginia Sutton Haynes7
Eli Lilly and Company, Windlesham, Surrey-UK
1
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona-Spain
2
Eli Lilly and Company, Neuroscience Research, Budapest-Hungary
3
Eli Lilly Australia Pty Ltd, West Ryde-Australia
4
Eli Lilly China, Shanghai-China
5
Eli Lilly Turkey, Istanbul-Turkey
6
Eli Lilly and Company, Indianapolis, IN-US
7
e-mail address: [email protected]
Objective: ADHD is a neuro-behavioral disorder and one of the most common chronic health problems in school-aged children. While
data on the prevalence of ADHD in non-Western countries, Central Europe and East Asia for example, are limited, they suggest that
prevalence rates in these regions are similar to those in Western countries. Treatment options for ADHD include both behavioral and
pharmacological therapies. Non conventional interventions such as complementary and alternative medicine (e.g. herbal medicine and
homeopathy) are also available in some cultures. There is, however, lack of information on treatment practices and treatment decision
process for ADHD, particularly in non-Western countries. This study aimed to explore factors associated with time to medication initiation
during follow-up among patients who were newly diagnosed with ADHD symptoms and did not initiate pharmacotherapy at baseline in
Central Europe and East Asia.
Method: Data were taken from a 1-year prospective, observational study that included a total of 1,068 newly diagnosed paediatric
patients with ADHD symptoms from eight countries/areas in Central Europe (Czech Republic, Hungary, Romania, Slovakia and
Turkey) and East Asia (China, South Korea and Taiwan). This post-hoc analysis included all patients with at least one post-baseline
visit (n=977). Clinical severity was measured using the Clinical Global Impression (CGI) scale and the Child Symptom Inventory-4
(CSI-4) Checklist. A Kaplan-Meier survival curve was used to depict the proportion of patients remaining on no medication during
follow-up. Cox-regression was employed to explore baseline patient characteristics associated with time to medication initiation
during follow-up.
Results: Of the 977 patients analyzed, about two-thirds of patients (67%, n=651) initiated pharmacotherapy with/without psychotherapy
at baseline. The remaining 316 patients (33%) received psychotherapy (9%), other treatments (e.g. herbal therapy and homeopathy) (8%),
or no treatments (17%) at baseline. Of these, 71% (n=231) started pharmacotherapy soon after baseline, with a median time of 44 days.
The KM survival curve also confirmed a prompt shift from no medication-to-medication during follow-up. The percentage of patients who
remained on no medication at 400 days was 23.4% (KM survival estimate). Having other children living at home was found to be the most
important predictor of medication initiation during follow-up (HR=1.47; 95% CI=1.03, 2.10), followed by increased patient age (HR=1.13;
95% CI=1.06, 1.21) and higher clinical severity at baseline (higher CSI-4 scores) (HR=1.02; 95% CI=1.00, 1.04).
Conclusion: Pharmacotherapy was fairly common in the treatment of newly diagnosed paediatric patients with ADHD symptoms in
Central Europe and East Asia. Although one in three of these patients did not initiate pharmacotherapy at baseline, the majority of them
were quickly switched to pharmacotherapy during follow-up. Having other children living at home, older age of the patient, and having
higher clinical severity were associated with time to medication initiation. Given the observational design however, the associations found
in our study do not imply causal relationships.
Keywords: ADHD, pharmacotherapy, Central Europe, East Asia
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Candidates of TAP Outstanding Research Awards
[PP-002] Childhood and Adolescence Disorders
Ref. No: 0143
Reasons for seeking psychiatric support among patients diagnosed with
attention-deficit/ hyperactivity disorder in adulthood and differences from early diagnosed patients
Nurdan Unaldi1, Lutfi Ilhan Yargic2
Istanbul University, Faculty of Medicine, Departmant of Child and Adolecent Psychiatry, Istanbul-Turkey
1
Istanbul University, Faculty of Medicine, Departmant of Psychiatry, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: The purpose of this study was to determine the reasons for seeking psychiatric support among patients, who were diagnosed
with attention-deficit/ hyperactivity disorder (ADHD) for the first time in adulthood and to compare them with adult ADHD patients, who
had been diagnosed in childhood in terms of symptoms, functionality and comorbid psychiatric disorders.
Method: We utilized a questionnaire consisting of both open-ended and multiple-choice questions, which were filled in by the patients,
who applied to the ADHD outpatient clinic at the Department of Psychiatry, Istanbul Faculty of Medicine. The questions inquired about
age, education/job status, age during the first psychiatric application, application reasons and age of onset of the current complaints
which are related to ADHD. The onset age of the current complaints related to ADHD were defined based on the patients’ statement. This
could be different from the clinician’s point of evaluation. Participants were divided into two groups according to their age at which they
were first clinically diagnosed to have ADHD. The group of patients who were diagnosed at age of 18 or later was named as adulthood
diagnosed group while the others were classified as childhood diagnosed group. These two groups were also compared in terms of
comorbid psychiatric disorders, pharmacotherapeutic outcomes, the effects of ADHD on Work/School Life and the impacts on Daily Life
and Social Relationships.
Results: 35 patients (24 male and 11 female) participated to this study. 19 of them had been diagnosed to have ADHD during adulthood.
The mean (m) age of all participants was 24.4 with a standard deviation (SD) of 9.2. The patients were also classified based on ADHD subtype. In the adulthood diagnosed group, 13 patients had inattentive type and six of them had combined type, while in the childhood
diagnosed group seven patients had inattentive type and nine of them had combined type. Half of the childhood diagnosed group
stated that their complaints started before the age of seven and the other half reported an age of onset between ages of 8 and 15. In the
adulthood-diagnosed group, eight of the 19 patients stated that their complaints started before the age of 7, five of them between the
ages of 8 and 15 and the rest of them reported ages of 16 or later.
The severity of the symptoms, comorbid disorders and subtype of ADHD were similar in adulthood diagnosed and childhood diagnosed
patients. The consequences of ADHD and benefits from medication were similar in both groups but adulthood diagnosed patients
expressed more depressive complaints.
Conclusion: Although ADHD symptoms appear in early life, some patients may discern the effects of the disorder in older ages. The
patients who are diagnosed to have ADHD for the first time in adulthood shows similar clinical features and symptom severity in patients
who are diagnosed earlier and they have comparable benefits out of medical treatment.
Keywords: attention deficit hyperactivity disorder, adulthood/childhood, comorbidity
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S62
[PP-003] Schizophrenia and other psychotic disorders
Ref. No: 0148
Burnout in caregivers of patients with schizophrenia
Ahmet Kokurcan, Umut Altunoz, Ali Kemal Gogus
Ankara University Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Objective: Schizophrenia is a severe and chronic psychiatric disorder, which has multiple challenges in its management for both patients
and their caregivers. Burnout is a common issue in caregivers of patients with schizophrenia. However, several aspects of that issue have
not been clearly understood. Previous results about the effect of clinic variables and caregiver characteristics on burnout have been
conflicting. The purpose of the present study was to identify characteristics and correlates of burnout in caregivers of patients with
schizophrenia.
Method: The study sample consisted of 76 caregivers of schizophrenia patients (according to DSM-IV-TR criteria), who has been suffering
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the disease for at least two years and admitted to a psychiatry clinic of the university hospital. Sociodemographic form, Scale for the
Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were applied to the patients and
Maslach Burnout Inventory (MBI) and Multidimensional Scale of Perceived Social Support (MSPSP) were applied to the caregivers. MBI
consists of 22 items and 3 subscales. Subscales assess emotional exhaustion, depersonalization and personal accomplishment. Higher
scores at emotional exhaustion and depersonalization, but lower scores at personal accomplishment represent increased severity of
burnout.
Results: According to the clinical data of the patients (67.1%) of the caregivers were female. Mean age of them were 50.6±13.7. Thirty
nine (51.3%) of the caregivers were unemployed. Duration of care was 23.9±11.9. The caregivers were spouses (23.7%), children (47.4%),
siblings (19.7%) or parents (7.9%) of the patients. According to the mean scale scores of the caregivers there was no gender difference for
any of the MBI scores (p>0.1).
Conclusion: The results of the present study revealed that most of the caregivers of patients with schizophrenia had high levels of
burnout. Gender, duration of illness, duration of care and the SAPS scores had not been related with the burnout. The SANS scores had
significant but weak correlations with MBI emotional exhaustion and personal accomplishment scores. MSPSP scores were correlated with
all subtypes of burnout. These results were consistent with those of other studies, which emphasized negative symptoms of the patients
and inadequate social support of the caregivers as major factors for burnout (Dyck 1999, Gulseren 2010). Social programs and daily
rehabilitation units can be applied to improve negative symptoms and psychotherapeutic interventions (group therapies or supportive
therapies) should be considered for caregivers. Future studies to investigate efficiency of these interventions on burnout of the caregivers
might be beneficial.
Keywords: schizophrenia, burnout, maslach
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S62-S3
[PP-004] Memory and cognitive disorders
Ref. No: 0150
The effect of dissociation on academic performance and attention processes
Osman Ozdemir1, Pinar Guzel Ozdemir2, Murat Boysan3, Ekrem Yilmaz1
University of Yuzuncu Yil Faculty of Medicine, Department of Psychiatry, Van-Turkey
1
Ipekyolu State Hospital, Department of Psychiatry, Van-Turkey
2
University of Yuzuncu Yil Faculty of Science, Department of Psychology, Van-Turkey
3
e-mail address: [email protected]
Objective: Dissociation seems to be associated with deviations in motor, cognitive and neurobehavioral abilities. In this study, our aim
was to examine the effects of dissociative experiences on academic performance and attention processes among undergraduate students.
Methods: Participants were 317 undergraduates recruited from various faculties of Yuzuncu Yil University. Their mean age was 22.53
(SD±2.27) years; range: 18-38). Subjects were administered a socio-demographic questionnaire, the Posttraumatic Diagnostic Scale (PDS),
Dissociative Experiences Scale (DES), Adult ADHD Self-Report Scale (ASRS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).
Results: 209 participants (65.93%) were the survivors of the 2011 Van earthquake. Earthquake survivors made significantly higher scores
on PTSD global and three sub-scales of the PDS than participants without prior earthquake experience. Earthquake survivors also made
greater scores on the DES total, amnesia, depersonalization/derealization sub-scales, but mean absorption scores did not differ between
groups. Moreover, severity of depression symptoms was significantly higher among participants, who experienced earthquake than
participants who experienced no earthquake. Attention deficit and hyperactivity/impulsivity sub-scales of the ASRS as well as anxiety
scores did not significantly differ between groups. Overall and sub-scale scores of the DES were significantly correlated with PTSD global
and sub-types of posttraumatic symptoms in terms of re-experiencing, avoidance, and hyper arousal.
Conclusion: Our results provide evidence that dissociative experiences do not only impair cognitive functions, but also they cause
poor academic performance. This can lead to trouble with learning. These results will help parents and educators more profoundly in
evaluating academic learning disabilities.
Keywords: dissociation, cognition, academic performance
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Candidates of TAP Outstanding Research Awards
[PP-005] Clinical psychiatry
Ref. No: 0178
The frequency of metabolic syndrome in psychiatric patients taking
antidepressant medication
Ebru Findikli1, Murad Atmaca2
1Kahramanmaras Sutcu Imam University, School of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
2Firat University, Firat Medical Center, Department of Psychiatry, Elazig-Turkey
e-mail address: [email protected]
Objective: The aim of this study was to examine the prevalence of metabolic syndrome (MS) and related factors in psychiatric patients
taking antidepressants at an outpatient clinic.
Method: The study comprised a total of 70 (17 male, 53 female) outpatients with depressive disorder, panic disorder, obsessive
compulsive disorder, generalized anxiety disorder that had been diagnosed according to the criteria of DSM-IV, between 01 December
and 31 December 2008. Fasting blood glucose (FBG), triglyceride, cholesterol levels, body mass index, blood pressure, waist circumference
measurements (WCM) of the patients, who met the study criteria were obtained.
Results: In our study MS frequency was 32,8% in total according to NCEP ATP III, criteria. The higher MS frequency was found in drug
groups as; clomipramine (50%), paroxetine (40%), venlafaxine (40%), in patient groups as; panic disorder (42,8%), obsessive compulsive
disorder (%40). The lowest MS frequency and WCM was found in fluoxetine group. The highest WCM and FBG levels were in the
venlafaxine and the clomipramine groups, respectively.
Discussion: Antidepressant medications are often associated with weight gain and metabolic abnormalities in vulnerable patients.
It is well known that obesity, insulin resistance and diabetes are associated with a large number of deaths all over the world. Patients
with psychiatric disorders such as depression and anxiety are at higher risk for cardiac mortality compared with the general population.
Next to appropriate choice of an antidepressant, WCM, FBG, lipid profile, blood pressure monitoring, is of vital importance not to
neglect deaths.
Keywords: antidepressant, depressive disorder, metabolic syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S64
[PP-006] Psychiatric genetics
Ref. No: 0196
MicroRNAs as potential biomarkers for major depressive disorder
Mehmet Akif Camkurt1, Senel Acar1, Yunus Killi3, Serkan Gunes3, Veli Yildirim3, Lulufer Tamer4, Mehmet Fatih Yilmaz2, Aysegul Gorur4
Mersin University Training Hospital, Department of Psychiatry, Mersin-Turkey
1
Ardahan State Hospital, Ardahan-Turkey
2
Mersin University Training Hospital, Department of Child and Adolescent Psychiatry, Mersin-Turkey
3
Mersin University Training Hospital, Department of Biochemistry, Mersin-Turkey
4
e-mail address: [email protected]
Objective: Objective of this study is to identify whether microRNAs could be potential biomarkers for major depressive disorder (MDD).
Method: The blood samples of 50 patients and 41 healthy controls were collected from individuals, who were admitted to Mersin
University Teaching Hospital Psychiatry Department. To identify better diagnosis and eliminate deficiency of Hamilton Depression
Rating Scale (HDRS) (such as higher scoring of somatic and sleep items), we used both HDRS and Montgomery-Åsberg Depression
Rating Scale (which is focused on core symptoms of depression). For accurate phenotyping, patients who met diagnostic criteria for
major depression according to DSM IV, made a HDRS score above 17, has no comorbid psychiatric and medical condition, never used
psychiatric drugs before and didn’t take any medication for 1 month prior to blood sample taking period included. Subtypes like
psychotic, melancholic, anxious, seasonal and atypical were excluded. Control group was also consisted of individuals who have no
history of psychiatric and chronic medical condition, didn’t take any drugs for 1 month prior to blood sample taking period and made
a HDRS score under 7. We identified microRNAs related with genes that have been shown to be expressed similary in both prefrontal
cortex and peripheral blood. We hypothesized that some of these microRNAs should be expressed differentially between MDD
patients and controls and could be a biomarker for MDD. Blood samples which were drawn into EDTA tubes were accomplished by
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centrifugation at 4000 rpm for 15 min for plasma separation. Supernatant of plasma was recovered and stored at -80⁰C until analysis.
RNA was isolated using the High Pure miRNA Isolation Kit following the manufacturer’s protocol. cDNA and preamplification protocols
were obtained from the isolated plasma microRNAs. The BioMark™ 96.96 Dynamic Array for real-time qPCR was used to simultaneously
quantify the expression of 372 microRNAs. Mann Whitney U test was used for statistical analysis.
Results: Mir320a was significantly down regulated and mir451a was significantly up regulated among MDD patients.
Conclusion: MicroRNAs are small non-coding 16-22 nucleotide long RNA transcripts and they usually point mRNA’s to degrade and
provide them from translation. To our current knowledge, it is the first study investigating microRNAs as potential biomarkers for MDD.
We found mir320a down regulated between MDD group and controls. Mir320a is predicted to be related with lots of genes which include
GRIN2A and DISC1. Previous studies showed that GRIN2A was upregulated in both MDD patients and suicidal patients. Down regulation
of mir320a is predicted to be related with upregulation of GRIN2A. A genetic linkage study demonstrates DISC1 as a potential target
for MDD. According to our findings and previous literature, plasma mir320a levels could be an indicator of GRIN2A related processes
in prefrontal cortex of depressed patients. We found mir451a upregulated among depressed patients. A previous study showed that
ketamine treatment reduced mir451a levels. In recent years ketamine is predicted to be one of the rapid acting potential antidepressant
treatments. Based on acting mechanism of ketamine mir451 could be a marker for treatment response. Our study demonstrates the
possibility of microRNAs as diagnostic and prognostic biomarkers for depression.
Keywords: microRNA, blood, major depressive disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S64-S5
[PP-007] Psychiatric genetics
Ref. No: 0225
Mitochondrial complex I-III mRNA levels in schizophrenia: relationship between
gene expressions and psychotic symptomatology
Suleyman Akarsu1, Ozcan Uzun1, Deniz Torun2, Abdullah Bolu3, Murat Erdem1, Salih Kozan2, Hatice Akar2
Gulhane Military Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
1
Gulhane Military Faculty of Medicine, Department of Medical Genetics, Ankara-Turkey
2
Flight Crew Health Research and Education Center, Eskisehir-Turkey
3
e-mail address: [email protected]
Objective: Schizophrenia is a chronic psychiatric disorder with unclear etiology. Mitochondrial electron transport chain (ETC) complex
dysfunctions had been reported in patients with schizophrenia. Neuronal plasticity and brain circuits are affected by impaired function
of mitochondria. Consequently behavioral abnormalities and cognitive deficits seen in the clinical course of schizophrenia may occur.
The relationship between psychotic symptoms and mRNA levels of certain genes located in the mitochondrial ETC of schizophrenia
cases were researched in this study.
Method: 158 male patients with psychotic symptoms hospitalized in the psychiatric clinic of Gulhane Military Medical Academy were
enrolled to the study. 84 of 158 patients had been followed up with schizophrenia diagnosis at least one year prior to the study. These
patients were defined as chronic schizophrenic. 74 patients without any previous psychiatric history and showing schizophrenia-like
psychotic symptoms for the first time have been followed for six months. At the end of the six-months follow-up, 54 of 74 patients
met Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria for schizophrenia. These cases are defined as first-episode
schizophrenia. 42 healthy male with similar socio-economic characteristics of the patients constituted the control group. Diagnostic
interview and the disease severity of patients were evaluated by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and
Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Brief Psychiatric Rating
Scale (BPRS). mRNA levels of genes from peripheral blood samples of the patients were investigated by relative quantification method
in the genetic laboratory.
Results: mRNA levels of all of the genes representing subunits of complex I (NDUFV1, NDUFV2, NDUFS1) was significantly higher in schizophrenic
cases than the control subjects. Statistically significant difference was observed between first-episode schizophrenia and control subjects in mRNA
levels of complex I genes. There was statistically significant difference between chronic schizophrenia and control subjects in mRNA levels of
NDUFV2 gene. There was positive correlation between mRNA levels of NDUFV2 gene and BPRS, SAPS scores in first-episode schizophrenia cases.
Negative correlation was detected between the mRNA levels of NDUFV2 gene and SANS scores in chronic schizophrenia cases.
Conclusion: We suggested that mRNA levels of mitochondrial complex I genes could be used as a peripheral marker in the diagnosis
of schizophrenia. Additionally, the results showed that there was a positive correlation between gene mRNA levels and psychotic
symptomatology especially positive symptoms. The unclear etiology of schizophrenia reveals the need for peripheral biological marker
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Candidates of TAP Outstanding Research Awards
in schizophrenia. Therefore, clinical and experimental studies related to dysfunctions of mitochondria are thought to make an important
contribution to the confirmation of the schizophrenia diagnosis.
Keywords: schizophrenia, mitochondrial complex, gene mRNA levels
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S65-S6
[PP-008] Childhood and adolescence disorders
Ref. No: 0257
A family based association study of Mn-superoxide dismutase gene
polymorphism in autism spectrum disorders
Murat Coskun, Sevgi Hocaoglu, Salih Zoroglu
Istanbul Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: Autism is a neurodevelopmental disorder characterized by impairments and abnormalities in verbal and non-verbal
communication and socialization alongside with restricted-stereotyped interests and behaviors. Several factors have been implicated in
the etiology of autism, including genetic, environmental and autoimmune factors however the underlying etiology of autism is unknown.
There is some evidence that free oxygen radicals play an important role in the pathophysiology of neuropsychiatric disorders, including
autism. The aim of this study is to investigate Mn-Superoxide Dismutase, an important enzyme in anti-oxidant defense mechanisms, gene
polymorphism in autism spectrum disorders (ASD).
Method: Subjects in this study were children and adolescents aged 2-18 years old, who were referred and followed up with diagnosis
of DSM-IV ASD in Istanbul Faculty of Medicine, Child and Adolescent Psychiatry Department. Childhood Autism Rating Scale (CARS) was
used to assess the severity of autism symptoms. 10 cc blood sample of affected child and biological mother and father trios were taken
into sterile test tube with EDTA for DNA isolation. Polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) and
agarose gel electrophoresis were carried out to assess Mn-Superoxide Dismutase gene polymorphism in DNA samples. Genetic analysis
was conducted in Istanbul University, Institute of Experimental Medicine (DETAE), and Molecular Medicine Department. Family based
approaches like transmission disequilibrium test (TDT) and haplotype-relative-risk (HRR) were used in data analysis. Correlation between
inherited alleles and quantitative analysis scores like CARS and IQ , and age of mother was investigated using ANOVA.
Results: 101 subjects (16 females, 15,8%; 85 males, 84,4%) with diagnosis of ASD and their biological parents, a total of 303 subjects, were
included in the study. We found significant association between Mn-SOD gene and ASD (p: 0, 0001) (X2:29,438). There was no correlation
between inherited alleles, quantitative analysis results like CARS score, IQ score, and age of mother as revealed by ANOVA.
Conclusion: The findings of this study suggest that Mn-SOD might appear to be a viable candidate gene for the pathogenesis of autism
and have a role in development of ASD phenotype. Further genetic and molecular studies are needed in this area.
Keywords: autism, superoxide dismutase, polymorphism
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S66
[PP-009] Psychopharmacology
Ref. No: 0263
Frequency of antipsychotic polypharmacy in schizophrenic outpatients
Neslihan Akkisi Kumsar1, Neslihan Altunsoy Sen2, Nesrin Dilbaz3
Sakarya University Training And Research Hospital, Psychiatry Clinic, Sakarya- Turkey
1
Ankara Numune Training and Research Hospital, Psychiatry Clinic, Ankara-Turkey
2
Uskudar University, NP Hospital, İstanbul-Turkey
3
e-mail address: [email protected]
Objective: With an increase in the new generation of antipsychotic drugs and resulting antipsychotic polypharmacy, treatment
of schizophrenic patients has again become a current issue. In spite of the annual increase of these new drugs in recent years no
expected benefit in the treatment of patients has been observed. A lack of alternative treatments of schizophrenia and the increase
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of polypharmaceutical approaches to treatment have led to desperation among clinicians; especially as schizophrenia is known to be
treatment resistant over the time and is often subject to poor prognosis. According to the treatment algorhythm, the application of
antipsychotic polypharmacy can be the choice of treatment for treatment-resistant patients but only through following a program of
sufficient monotherapy. For a short period, antipsychotic polypharmacy can ease the transition from the use of one antipsychotic to that
of another. However it is thought that this approach is often over used in clinical experiments and observations. In this study, it is aimed
to determine the prevalence of polypharmacy, rates of treatment adherence and disease severity in schizophrenic patients admitted to
the psychiatry policlinic at Ankara Numune Training and Research Hospital.
Method: The patients admitted to psychiatry polyclinic of Ankara Numune Training and Research Hospital in June 2010- September 2010
period with the diagnosis of schizophrenia, were reviewed and 122 patients were included in the study. Participants were evaluated for
their treatment compliance, use of polypharmacy, drug doses, and severity of the disorder.
Results: The rate of polypharmacy was 49,2%. The polypharmacy and monotherapy groups were not statistically different in terms of
comorbidity, disorder and treatment duration, number of previous hospitalizations, type of admission and general medical condition.
However, the monotherapy and polypharmacy groups were statistically different in terms of the use of antipsychotic type. 8.2% of
patients with polypharmacy number of concurrently used antipsychotics were found to be the three. When introduced for the first time
in life, 25.4% (n= 31) of patients were started olanzapine , 18% (n= 22) risperidone, 18% (n= 22) clozapine, 10.7% (n= 13) quetiapine, 8.2%
of typical antipsychotics, and 4.9% (n= 6), amisulpiride-sulpiride. When we had a look at drugs added on the existing therapy, 26.7% (n=
16) of patients were given amisulpiride-sulpiride, 25% (n= 15) risperidone consta, 15% (n= 9) depot antipsychotics, 10% (n= 6) typical
antipsychotics, 8%, 3 (n= 5) quetiapine, 5% (n= 3) risperidone, 3.3% (n= 2) olanzapine and 3.3% (n= 2) were given clozapine.
Conclusion: Use of polypharmacy is limited in good clinical practice guidelines but surveys on clinical practices show that the use of
polypharmacy is more frequent than the suggested levels in the guidelines.
Keywords: antipsychotic, polypharmacy, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S66-S7
[PP-010] Schizophrenia and other psychotic disorders
Ref. No: 0268
Refraction and anterior segment parameters in patients with schizophrenia
Birgul Elbozan Cumurcu1, Tongabay Cumurcu2, Sinem Keser2, Abuzer Gunduz2, Sukru Kartalci1
Inonu University, Faculty of Medicine, Department of Psychiatry, Malatya-Turkey
1
Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya-Turkey
2
e-mail address: [email protected]
Objective: To evaluate whether there is a difference in terms of refractive errors and anterior segment parameters between the patients
with schizophrenia and healthy volunteers.
Method: In the study, 70 patients (48 male, 22 female) who were diagnosed with schizophrenia according to DSM IV-TR criteria were
compared with control group of 60 (35 male, 25 female) patients who were similar in terms of age, gender, education and socioeconomic
level. A complete ophthalmologic examination was performed in both e groups. Then an anterior segment examination was performed
via Pentacam-Scheimflug (Oculus®, Pentacam, Germany) and the axial length of the eye and lens thickness were measured using optic
biometry (Lenstar 900 LS; Haag Streit Köniz, Switzerland). The psychiatric patient group received BPRS, SAPS and SANS.
Results: Both in the schizophrenics and the control group, mild myopic shift was detected however there was not a statistically significant
difference (p>0.005). The cornea volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD) values were lower and
there was a statistically significant difference (p=0.026, p=0.014, p=0.048 and p=0.005 respectively). The lens thickness was greater in
schizophrenics and it was found statistically significant (p=0.006). A statistically significant negative correlation between the scores of the
scale for the assessment of positive symptoms (SAPS) and cylindrical values was detected (p=0.008). The axial eye length, cylindrical value,
pupil diameter, mean keratometric value and the anterior chamber angle revealed no statistical difference between the groups (p>0.05).
Conclusion: Therefore no statistically significant difference was detected in terms of refraction disorders between schizophrenics and
healthy control group, some differences in terms of anterior chamber parameters were found between schizophrenics and control group.
These results demonstrate that schizophrenics might exhibit clinical and structural differences in the eye.
Keywords: schizophrenia, refraction disorder, anterior chamber parameters
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[PP-011] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0273
Exposure to violence in staff members of Sivas Numune Hospital
Etem Erdal Ersan1, Gulay Yildirim2, Cagla Kilic1
Psychiatry Service of Numune Hospital, Sivas-Turkey
1
Cumhuriyet University, Faculty of Medicine, Department of Medical Ethics and History of Medicine, Sivas-Turkey
2
e-mail address: [email protected]
Objectives: Our aim is to attach importance upon the violence against the healthcare professionals and to suggest some solutions for
the violence in healthcare services.
Method: The statistical data from the department of patient and healthcare professional safety in 2012 were examined and the
application forms dated for the same year in Sivas Numune Hospital Department of Healthcare Professional Safety were checked. Of those
exposed to violence within the last one year, the information forms were delivered to 540 people, who accepted to participate the study.
Results: 35 applications were sent to the healthcare professional department of Sivas Numune Hospital in 2012. The highest number of
applications was done by the emergency room (ER) non-physician staff members for oral violence. Number of applications to the state
hospitals of Ministry of Health in 2012 was 3879. Most of these applications were done by ER physicians for oral violence. The mean age
of the study participants was 34,68±7,54. The highest percentages were of 25-34 years old females, married ones, undergraduate degree
holders, nurses/midwives, workers of the department and those working since 6-10 years to date. Within the last 1 year, 50.7% of the
healthcare professionals were exposed to violence, of these 62.4% were the victim of oral violence, and 27.4% were exposed to violence
while working in ER and most of them called the security staff. Such violence was mostly performed by the relatives of the patients.
In terms of existence of violence, it was detected that there were significant differences among the gender, educational background,
profession, department and years of working, while there were no differences between age groups and marital status. Most of the
participants were aware of the existence of security staff in our hospital but only 21.5% of the healthcare professionals stated that the
security measures were adequate.
Conclusions: Violence against the healthcare professionals in health sector has been gradually increasing. We can describe the precautions
to be taken against the violence as training of staff, applying the deterrent legal arrangements, developing the security measures, public
education, supporting the healthcare professionals by institutional managements, , and advertising the public by mass media tools.
Keywords: violence, health, employee safety
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S68
[PP-012] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0274
Distribution of applications to the Patients Rights Council of Sivas Numune Hospital
and Sivas State Hospital for the last one year
Etem Erdal Ersan1, Gulay Yildirim2, Basak Binici1, Cagla Kilic1
Psychiatry Service of Numune Hospital, Sivas-Turkey
1
Cumhuriyet University, Faculty of Medicine, Department of Medical Ethics and History of Medicine, Sivas-Turkey
2
e-mail address: [email protected]
Objectives: In this study, we have examined the applications made to the Patients Rights Council of Sivas Numune Hospital and Sivas
State Hospital in a year time to date. We tried to establish a base for taking the possible measures in reference to the acquired results.
Method: Our study was performed by examining the application forms submitted to Sivas Numune Hospital Patient Rights Department
in 2012 as well as analyzing the statistical data available in the Department of Patient and Workers’ Rights of Ministry of Health.
Results: 47 (43%) of the 110 applications made to the patient rights department of our hospital in 2012 were solved on site while the
remaining 63 cases (77%) were analyzed in board. In the state hospitals of Sivas, 177.277 (88%) cases were solved on site and 23.370
(12%) cases were analyzed in board. Of these applicants 60% were male; 25 (39.7%) were between 26-30 years old and 23 (36.5%) were
undergraduates, 18 (28.6%) were housewives and 37 (58.8%) complained for lack of benefit from outpatient clinical services and 37
(38.8%) from specialist physician and 33 (52.4%) from the service provided and it was detected that in 7 cases (11.1%) breach was available
while in 27 cases (42.9%) no breach was detected. In the state hospital of Sivas, of the applicants 58% were, 30.6% over 41 years old while
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37.5% were high school graduates, 19.6% were housewives and that 47.1% applied for lack of benefit from outpatient clinical services and
38.5% from specialist physician and 40.1% from the service provided and it was detected that in 1882 cases (8.5%) breach was available
while in 14.010 cases (63.2%) no breach exists.
Conclusion: As a consequence, in the healthcare services, which are the most significant representative of service sector, patient and
workers’ rights have been gradually attaching importance. Although the number of relevant studies has increased in recent years, the
applications submitted to the patient rights department are also progressively increasing. It will be appropriate to educate the public as
well as the healthcare professionals.
Keywords: patient rights, state hospital, health
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S68-S9
[PP-013] Anxiety disorders
Ref. No: 0278
Depression, sexual dysfunction and childhood trauma in patients with post
traumatic stress disorder
Esra Ozdil1, Atilla Tekin1, Veysel Akansel1, Omer Akil Ozer1, Oguz Karamustafalioglu2
Sisli Etfal Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
1
Uskudar University, NPI Hospital, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: To observe depression and sexual dysfunction comorbidity and evaluate the effect of childhood trauma in posttraumatic
stress disorder (PTSD) patients.
Method: 28 patients, applied to Sisli Hamidiye Etfal Training and Research Hospital anxiety disorders outpatient clinic between February 2008
and March 2011, who had been diagnosed as PTSD according to DSM-IV-TR were evaluated with SCID-I (The structured Clinical Interview for
DSM-IV Axis I Disorders), ASEX (Arizona Sexual Experience Scale), childhood trauma questionnaire and a sociodemographic form.
Results: Depression ratio in PTSD patients determined as %57.1 (n=16). In PTSD patients with depression, there have been statistically
significant higher rates in physical abuse, emotional abuse and emotional neglect, compared to PTSD patients with no depression
(respectively p=0.037, p=0.002, p=0.024). On the other hand, there has been no significant difference in physical neglect and sexual abuse
between two groups. Also there was no significant difference between the ASEX scores of two groups.
Conclusion: There is at least one childhood trauma in %71.4 of PTSD patients. Also depression is the most frequent comorbid disorder
in patients with childhood trauma. Thus, in management of PTSD patients with comorbid depression, childhood trauma should be
considered more carefully.
Keywords: childhood trauma, depression, posttraumatic stress disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S69
[PP-014] Psychiatric genetics
Ref. No: 0286
The polymorphisms of Ser49Gly and Gly386Arg in Beta-1-Adrenergic Receptor in
beta-1-adrenergic receptor gene in major depression: a pilot study
Suleyman Kokut1, Inci Meltem Atay2, Efkan Uz3, Abdullah Akpinar2, Arif Demirdas2
Serik Public Hospital, Antalya-Turkey
1
Suleyman Demirel University, Department of Psychiatry, Isparta-Turkey
2
Suleyman Demirel University, Department of Biochemistry, Isparta-Turkey
3
e-mail address: [email protected]
Objective: It was reported that the genetic susceptibility of Major Depressive Disorder (MDD) would be related with genetic
polymorphisms. The aim of this study was to investigate the possible association of the genotype and allele frequencies of Ser49Gly and
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Arg389Gly polymorphisms in MDD by comparing with healthy subjects.
Method: A total of 144 patients with major depression diagnosed according to DSM-IV criteria and 105 healthy controls were included
in the study. Polymerase Chain Reaction (PCR) with Restriction Fragment Length Polymorphism (RFLP) was used for both genotyping.
Results: Of the 144 participants in MDD group, 77 (53.5%) had homozygous wild type (AA), 57 (39.6%) had heterozygous type (AG) and
10 (6.9%) had mutant (GG) genotype for Ser49Gly; and 75 (52.1%) had homozygous wild type (GG), 59 (41.0%) had heterozygous (GC)
type and 10 (6.9%) had mutant homozygous (CC) genotype for Gly386Arg.There were no significant differences in the allele and genotype
frequencies of the Beta-1-Adrenergic Receptor (ADRB1) gene for Ser49Gly and ADRB1 Arg389Gly polymorphisms after comparing with
healthy controls (p= 0.626; p= 0.863)(p= 0.625; p= 0.914).
Conclusion: The results of our study did not reveal a major effect for the polymorphism of Ser49Gly and Gly389Arg in ADRB1 gene in
MDD. Further studies with larger sample size are required to elucidate the role of other Beta-1 Adrenergic Gene polymorphisms in major
depressive disorder.
Keywords: beta-1-adrenergic receptor, depression, polymorphism
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S69-S70
[PP-015] Clinical psychiatry
Ref. No: 0287
The impact of personality on quality of life and disease activity in patients with
Behcet’s disease: a pilot study
Inci Meltem Atay1, Ijlal Erturan2, Arif Demirdas1, Gozde Bacik Yaman1, Vedat Ali Yurekli3
Suleyman Demirel University, Department of Psychiatry, Isparta-Turkey
1
Suleyman Demirel University, Department of Dermatology, Isparta-Turkey
2
Suleyman Demirel University, Department of Neurology, Isparta-Turkey
3
e-mail address: [email protected]
Objective: The aim of this study was to examine the personality traits of patients with Behcet’s Disease (BD) using the Temperament and
Character Inventory (TCI) compared with healthy control subjects and to investigate the relationship between the temperament and
character properties and quality of life, disease activity, depression and anxiety in Behcet’s patients.
Method: A total of 46 BD patients and 40 healthy subjects were included in the study. All patients and controls were determined using the
TCI, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Clinical Version for Axis I disorders (SCID-CV),
Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Quality of life (QOL) Instrument for Skin Disorders and Behcet’s Disease
Current Activity Form (BDCAF).
Results: BD patients demonstrated significantly lower reward dependence, exploratory excitability, and shyness with strangers,
attachment, spiritual acceptance and higher self-acceptance compared to control subjects. Decreased quality of life and increased
disease activity of the patients were correlated with increased anxiety and depression. Responsibility, self-forgetfulness, transpersonal
identification and self-transcendence were associated with quality of life while responsibility was the major factor effecting QOL. Disease
activity was not found to be related with TCI properties.
Conclusion: Temperament and character traits of BD patients were different from healthy group that might be due to many factors like
genetics, biological or socio-cultural differences. BD patients were demonstrated as materialistic, self-contained, self-confident, introvert
and reserved although they are not shy. Considering the different personality traits of BD patients in psychotherapeutic approaches, they
may have a positive impact on QOL and comorbid major depressive disorder.
Keywords: Behcet’s disease, temperament and character, disease activity
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S70
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[PP-016] Mood disorders
Ref. No: 0288
Are the levels of ICAM, VCAM and E-Selectin levels different in the first
manic episode and subsequent remission?
Cetin Cetin Turan, Sermin Kesebir
Erenkoy Mental and Neurological Disease Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: It is known that mortality rates in bipolar disorder are twice higher than other diseases. Cell adhesion molecules feature in the
formation of aterosclerosis. Some of the adhesion molecules reveal the risks of cardiovascular disease and atherosclerosis: Intracellular
adhesive molecule (ICAM), vascular cell adhesive molecule (VCAM), and E-selectin. The aim of this study is to compare ICAM, VCAM,
E-selectin levels between first manic episode and subsequent remission and, to obtain whether differentiated from healthy controls.
Methods: In Erenköy Training and Research Hospital for Mental and Neurological Diseases , 50 patients who are diagnosed as first episode
mania according to DSM-IV-TR and never received an antipsychotic treatment before as well as a control group consisting of 50 healthy
volunteers were enrolled in the study. At the beginning of the study (n= 50) and after the remission (n= 40), ICAM, VCAM and E-selectin,
Fasting Blood Glucose, Total Cholesterol, LDL Cholesterol, HDL Cholesterol, and Triglyceride levels were assessed and compared. For the
control group, only the same biochemical parameters at the beginning of the study were investigated. In order to detect the termination
of acute episode, the patient group was given Young Mania Rating Scale and Hamilton Depression Rating Scale.
Results: First manic episode ICAM and VCAM levels were higher than subsequent remission and healthy controls (F= 3.388, p= 0.037 ve F=
108.030, p<0.001). It was found that there was a weak correlation between ICAM and cholesterol (total and LDL) in the first manic episode
(r= 0.315, p= 0.029 and r= 0.279, p= 0.055). In the same period, a weak correlation was found between adhesion molecules and BMI (r=
0.238, p= 0.054; r= -0. 278, p= 0.049 and r= 0.298, p= 0.046).
Conclusion: Proinflamatuar and protrombic situations, which were known as risk factors for metabolic syndrome and cardiovascular
disease were firstly investigated in this study. It was found that, ICAM and VCAM levels were higher in the first episode mania than the
subsequent remission group and healthy controls. There is no perpetual influence of the psychotropics use, because our experimental
group involved the first episode mania patients. The cardiovascular risk in the bipolar disorder cases, which was represented by the
elevated ICAM and VCAM levels was existent from the beginning of the disease. Secondly, in manic episode, increased ICAM and VCAM
levels turned into normal ranges during the subsequent remission period. After the recurrent episodes of illness, differentiation ofthe
levels of ICAM and VCAM from healthy people in the remission period cannot be explained with our findings.
Keywords: bipolar disorder, intracellular adhesive molecule, vascular cell adhesive molecule
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S71
[PP-017] Childhood and adolescence disorders
Ref. No: 0340
Tolerability of OROS methlyphenidate in Turkish children and adolescents with
attention-deficit/ hyperactivity disorder may not be affected by dose or
augmentation with risperidone: a preliminary study
Zehra Topal1, Nuran Demir1, Taha Can Tuman2, Ali Evren Tufan1
Abant Izzet Baysal University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
2
e-mail address: [email protected]
Objective: Attention- Deficit/ Hyperactivity Disorder (ADHD) is one of the most common neuro-psychiatric disorders of childhood with
a global prevalence of 5-10%. Methylphenidate (MPH) is widely used in pharmacological management of ADHD. It is available in both
immediate (IR) and osmotic-release (OROS) forms. Previous studies, both from our country and others reported that the efficacy and
tolerability of OROS MPH is equal to IR form. A previous study from Turkey reported that the side effect of weight loss may be dependent
on dose of OROS MPH. A common practice in pharmacological management of ADHD is augmentation with risperidone to target
irritability, aggression insomnia and impulsivity. However, as far as the authors are aware, no study from Turkey up to now compared the
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side effect profiles of patients with ADHD using OROS MPH augmented with risperidone with those being managed with OROS MPH only.
Materials Methods: This study was conducted at the outpatient department of Child and Adolescent Psychiatry in Abant Izzet Baysal
University Medical Faculty. The records of 6074 patients who applied to the study center in between January 2012 and 2013 were
screened for presenting complaints and those applying for “inattention” and “hyperactivity” were recorded. It was found that 332 patients
were referred for those two complaints. A second review for missing data, records of laboratory values and diagnoses changed in
subsequent interviews as well as side effect forms resulted in 51 patients. Side effects of stimulant drugs and risperidone were evaluated
with Side effect forms from Connor 2013.
Results: The records of 51 patients (84.3 % male) with a mean age of 10.0 (S.D. 2.7) were analyzed. The mean scores for Turgay’s Scales
completed by parents and teachers were 36.0 (S.D. 16.9) and 33.1 (S.D. 20.1), respectively. The mean scores for inattention, hyperactivity,
oppositionality and conduct symptoms endorsed by parents were; 13.4 (S.D. 6.3), 12.8 (S.D. 8.8), 9.0 (S.D. 5.8) and 1.6 (S.D. 2.9); respectively
while those endorsed by teachers were 13.3 (S.D. 5.9), 11.2 (S.D. 10.3), 7.8 (S.D. 6.8) and 1.9 (S.D. 3.3); respectively. It was found that patients
using higher doses of OROS MPH tended to have higher total scores as reported by parents (Chi square 7.6, dF=3, p=0.06) and that they
also tended to be older (p=0.07). They also tended to have higher inattentive symptoms as reported by teachers (p=0.06) while they had
significantly elevated hyperactive-impulsive symptoms as reported by parents (p=0.04, all Mann-Whitney U test). No side effect apart
from onychophagia was found to differ with OROS MPH dose (Chi Square= 7.9, dF=3, p=0.05). As for risperidone, only sexual side effects
seem to increase with dose (p=0.03). No difference in tolerability between patients using OROS MPH only and those using OROS MPH
and risperidone could be found.
Conclusion: Augmentation with risperidone does not seem to affect tolerability of OROS MPH in children and adolescents with ADHD.
Our results should be supported with future studies.
Keywords: ADHD, methylphenidate, side effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S71-S2
[PP-018] Childhood and adolescence disorders
Ref. No: 0341
Prevalence and patterns of psychiatric disorders in a clinical sample
of preschool children in Turkey
Murat Coskun, Salih Zoroglu
Istanbul University, Istanbul Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: To investigate prevalence and patterns of psychiatric disorders in referred preschool children Method: Preschool children
consecutively referred to a state hospital child psychiatry clinic in Trabzon, Turkey were included. Subjects were assessed for reasons for
referral, and prevalence and patterns of psychiatric disorders. Diagnostic assessment was conducted using a semi-structured instrument,
Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and included major
psychiatric disorders that could be relevant to preschool children; externalizing, developmental, anxiety, elimination, mood and tic disorders
Results: 200 preschool children (122 male, 61%; 78 female, 39%) with an age range of 17-72 months (48.52±13.44 months) were included.
K-SADS-PL was administered to subjects who were above 36 months of age. More than half of the subjects (n=130; 65%) received at least
one psychiatric diagnosis. Of the children 34% (68/200) met criteria for two or more diagnoses. Of males 71 percent (87/122), and of girls 55
percent (43/78) received at least one diagnosis. Most frequent diagnoses were attention deficit hyperactivity (27%), language and speech
(17%), anxiety (16%), and oppositional defiant disorders (10.5%). There were significant differences between boys and girls in regards to rates
of overall psychopathology (p=0,0309) and rates of comorbidity (p=0,0022). Conclusions: Preschool children presented to psychiatry clinics
may have high rates of psychopathology and comorbidity. Externalizing disorders may be most common reason for referral and diagnoses
in referred preschool children. Preschool boys may exhibit more frequent psychopathology and comorbidity than girls.
Keywords: children, preschool, psychopathology
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S72
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[PP-019] Anxiety disorders
Ref. No: 350
Ghrelin-lipid levels in panic disorder before and after treatment and their
relationship with agoraphobia
Isil Gogcegoz Gul1, Birgul Elbozan Cumurcu2, Rifat Karlidag2, Yusuf Turkoz3
Uskudar University, NP Istanbul Hospital, Istanbul-Turkey
1
Inonu University, Faculty of Medicine, Department of Psychiatry, Malatya-Turkey
2
Inonu University, Faculty of Medicine, Department of Biochemistry, Malatya-Turkey
3
e-mail address: [email protected]
Objective: We aimed to evaluate the serum ghrelin (GHR) levels and lipid profile in patients diagnosed with panic disorder (PD) and
in patients with and without the PD agoraphobia subtypes, and to compare these parameters before and after treatment in patients
diagnosed with PD in this study.
Method: The GHR, triglyceride (TRG), total cholesterol (total-C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein
cholesterol (HDL-C), and very low density lipoprotein (VLDL-C) levels were measured in blood samples taken from 32 PD patients with
agoraphobia, 22 PD patients without agoraphobia and 53 control group subjects in our study. Body mass indexes (BMI) was recorded in all
groups. 23 of 53 patients who were started 20 to 40 mg/day paroxetine, a selective serotonin reuptake inhibitor (SSRI), continued treatment.
The GHR levels and serum lipid profiles of the 23 patients who continued treatment were measured again at the end of twelve weeks.
Results: When the three groups of PD with agoraphobia, PD without agoraphobia and the control group were compared, the serum
GHR, TRG, Total-C, LDL-C and VLDL-C levels were statistically significantly different between the groups (p<0.05). There was no statistically
significant difference for HDL-K and BMI levels (p>0.05). The GHR and TRG, Total-C, LDL-C, and VLDL-C levels were found to be statistically
significantly higher in the PD with agoraphobia group than the PD without agoraphobia and control groups in the comparison we
conducted to determine the group that created the difference (p<0.05). However, there was no significant difference between the PD
without agoraphobia and control groups in terms of the same parameters (p>0.05). When the serum GHR levels and the lipid profile of
the 23 patients that continued their paroxetine 20- 40 mg/day treatment for twelve weeks were re-evaluated, the serum GHR, Total-C
and BMI levels after treatment were found to be statistically significantly decreased compared to the values before treatment (p<0.05).
A statistically significantly decrease was found in serum GHR, Total-C and BMI levels in the PD with agoraphobia group after treatment
compared to the values before treatment (p<0.05). A statistically significant decrease was found in serum GHR and Total-C levels in the
PD without agoraphobia group after treatment (p<0.05). Other parameters did not change significantly after the treatment (p>0.05).
Conclusions: There may be a pathophysiological relationship between the GHR and lipid profiles that interact with each other in PD In
fact, this relationship was found to be more marked in PD with agoraphobia than in PD without agoraphobia. Neurobiological differences
can therefore be used in addition to clinical symptoms for the differentiation of PD with and without agoraphobia. A reduction in these
parameters with treatment may be effective in identifying disease activity and response to treatment.
Keywords: agoraphobia, ghrelin, lipid
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S73
[PP-020] Psychiatric genetics
Ref. No: 354
A family based association study of COX-2-765G→C and COX-2-1195A→G genes
polymorphism in autism spectrum disorders
Ilyas Kaya, Murat Coskun, Salih Zoroglu
Istanbul University, Istanbul Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: Autism is a neurodevelopmental disorder characterized by impairments and abnormalities in verbal and non-verbal
communication and socialization alongside with restricted-stereotyped interests and behaviors. Several factors have been implicated in
the etiology of autism, including genetic, environmental and autoimmune factors however the underlying etiology of autism is unknown.
Cyclooxygenases (COX) play a central role in the inflammatory cascade by converting arachidonic acid (AA), released from membrane
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phospholipids by a phospholipase A2 (PLA2), into bioactive prostanoids. Because COX-2 is typically induced by inflammatory stimuli in
the majority of tissues, it was thought to be the only isoform responsible for propagating the inflammatory response and thus, considered
as the best target for anti-inflammatory drugs. Recent findings suggest that COX-2-derived products can mediate a protective effect in the
progression and/or the resolution of inflammation in the brain after endotoxin activation of brain innate immunity. There have been some
reports on the role of COX-2 in pathophysiology of neurodegenerative (i.e. Alzheimer disease, multiple sclerosis) and neuropsychiatric
disorders (i.e autism spectrum disorders). Several lines of evidence have been suggested between COX-2 and autism spectrum disorders
(ASD). The aim of this study is to investigate COX-2 gene polymorphism in autism spectrum disorders.
Method: Subjects in this study were children and adolescents aged 2-18 years old who were referred and followed up with diagnosis of
DSM-IV ASD in Istanbul Medical Faculty, Child and Adolescent Psychiatry Department. Childhood Autism Rating Scale (CARS) was used
to assess the severity of autism symptoms. 10 cc blood sample of affected child and biological mother and father trios were taken to
sterile EDTA test tube for DNA isolation. Polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) and agars
gel electrophoresis are used to assess COX-2-765G→C and COX-2-1195A→G genes polymorphism in DNA samples. Genetic analysis was
conducted in Istanbul University, Institute of Experimental Medicine (DETAE), Molecular Medicine Department. Family based approaches
like transmission disequilibrium test (TDT) and haplotype-relative-risk (HRR) were used in data analysis.
Results: 101 subjects (16 girls, 15,8%; 85 boys, 84,4%) with diagnosis of ASD and their biological parents, a total of 303 subjects, were
included in the study. We found significant association between COX-2-1195A gene and autism spectrum disorders (p: 0,0262). There is
no significant association between COX-2-765G gene and ASD (p:0,2248).
Conclusion: The findings of this study may suggest that COX-2 genes, particularly COX-2-1195A might appears to be a viable candidate
gene for the pathogenesis of autism and have a role development of ASD phenotype. Further genetic and molecular studies are needed
on this area.
Keywords: autism, genetics, cyclooxygenases
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S73-S4
[PP-021] Mood disorders
Ref. No: 0365
Neurodevelopmental factors in adolescent’s bipolar disorders: a Tunisian study
Imen Hadjkacem, Hela Ayadi, Khaoula Khemekhem, Adel Walha, Leila Cherif, Yosr Moalla, Farhat Ghribi
Child psychiatry department at Hedi Chaker hospital University Centar of Sfax; Tunisia
e-mail address: [email protected]
Objective: Neurodevelopmental origin of bipolar disorders in adolescents has recently become a topical question of research. The
objective of our survey was to study the neurodevelopmental factors associated to the adolescent’s bipolar disorders.
Material and Methods: We conducted a retrospective and descriptive study on 30 files of adolescents who were followed in the child
psychiatry department of Sfax (Tunisia) for bipolar disorders diagnosed according to the DSM-IV TR criteria during a period of 5 years
(from January 1st 2003 till December 31st 2007)
Results: We have noted antecedents of delay in psychomotor development in 26.6% of cases, low birth weight in 20% of cases and
neonatal Suffering in only one case.
A neurological disease or minor neurological sign were found in 33.3 % of cases, each in 16.6% of cases.
Neurological disease was as type of epilepsy in 10% of Cases, leucoencephalomyelitis in 3.3% of cases, Muscular dystrophy in 3.3% of
cases and Down’s syndrome in 3.3% of cases.
Neurological signs were as type of strabismus, trembling, myoclonus and pyramidal syndrome.
Conclusion: Throughout our study, we notice the high frequency of neurological pathology and anomalies in bipolar disorders.
However, the small sample size in our study is a limitation on the generalizability of our findings. That’s why, further study, including a
larger population, is required in order to confirm our results. In addition, using electrophysiological and neuroimaging assessments are
imperative in order to enrich knowledge on the etiology of bipolar disorders.
Keywords: bipolar, disorder, neurodevelopment
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[PP-022] Anxiety disorders
Ref. No: 370
Comparison of death anxiety between young and elderly patients with
generalised anxiety disorder
Ahmet Kokurcan, Umut Altunöz, Erguvan Tugba Ozel Kizil, Sevinc Kirici
Ankara University, School of Medicine, Department of Psychiatry, Geriatric Psychiatry Unit, Ankara-Turkey
e-mail address: [email protected]
Objective: Death anxiety is abnormal or persistent fear of one’s own death or the process of his/her dying. Age, gender, religiousity and
physical/mental illnesses are the main predictors of death anxiety. However, previous research reported conflicting results both in clinical
and non-clinical samples. Death anxiety in elderly group was higher than young adults in some studies (Galt 1998) while lower in others
(Singh 2003). Death anxiety in mental illnesses was not very well studied either (Abdel-Khalek and Kuwait, 2005). The purpose of the
present study was to compare death anxiety between young and elderly patients with generalised anxiety disorder (GAD) and to identify
the correlates of death anxiety in these patients.
Method: The study sample consisted of 53 elderly (>=65 years old) and 99 younger patients (18-65 years old) who were admitted to
the outpatient Psychiatry clinic of a university hospital and diagnosed as generalised anxiety disorder (GAD) according to the DSMIV-TR criteria between September 2012- June 2013. A sociodemographic form, Hamilton Depression Rating Scale (HAM-D), Hamilton
Anxiety Rating Scale (HAM-A) and Templer Death Anxiety Scale (DAS) were applied to the participants. The DAS which was developed
by Templer (1970) consists of 15 “yes or no” items and total scores range between 0 and 15. Higher scores represent increased severity of
death anxiety. The reliability and validity of the Turkish form of the DAS was performed by Akca and Kose (2008). For statistical analysis,
group comparisons were done by the independent samples t test and the ANOVA. Pearson correlation test was used for the analysis of
correlations between the DAS scores and the other variables. All statistics were carried out by SPSS.
Results: Mean HAM-A scores and the education of the young patients were significantly higher than the elderly patients. The DAS scores
were negatively correlated with education and positively correlated with the HAM-A and the HAM-D scores. When ANOVA was used, the
DAS scores of elderly patients with GAD were found to be significantly higher than the young patients (F=7.15, p=0.008). That difference
between two groups was associated with anxiety symptoms but not with sex, education or depressive symptoms.
Conclusions: To our knowledge, this is the first study comparing the severity of death anxiety between young and elderly patients with
GAD. The results of the present study revealed that most of the patients with GAD had high death anxiety and death anxiety seems to
be associated with older age, lower education, higher anxiety and depression. Although anxiety scores of elderly patients were lower
than the young patients, death anxiety was higher in the elderly group. Therefore, especially in elderly patients with GAD, death anxiety
should be handled and further studies investigating the effects of therapeutic interventions targeting death anxiety in elderly patients
are needed.
Keywords: death anxiety, templer death anxiety scale, generalised anxiety disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S75
[PP-023] Childhood and adolescence disorders
Ref. No: 0371
Reversible autistic features following dietary restriction in a recently
diagnosed phenylketonuria case
Ummugulsum Gundogdu, Cahit Orengul, Fatma Benk, Ayse Arman
Marmara University. Faculty Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Phenylketonuria (PKU) is one of the aminoacid metabolism disorder, which affect functioning of the phenylalanine hydroxylase enzyme
and cause increasing level of phenylalanine. This excessive level may cause reduction of myeline, neuronal loss and decreased levels
of interneuronal connections and neurotransmitter density, damaging the brain. Consequently, PKU is frequently associated with
intellectual disability, seizures, delayed development, behavioral problems, and psychiatric disorders autistic symptoms.
We report a case of PKU presenting with neurological impairments including autistic behaviors:
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A 9-month-old girl was admitted our outpatient clinic by her mother with complaints of inability to sit supported. At the first clinical
evaluation she had poor eye contact, she did not smile reciprocally. She could not follow object by eye gaze, could not return to the side.
She had seizures. The patient was consulted to neurology and she was diagnosed as PKU. Neonatal screening was performed but her
blood sample confused with other girls’ whose name was same. 2 Months later, at the second clinical assessment after she was started
phenylalanine restricted diet, she began to follow object by eyes, had longer eye contact and could smile reciprocally. She had no seizure.
The number of phenylketonuria cases are declining recent years because of newborn screening but in some the diagnosis may miss due
to several reasons including births outsides hospitals, too early screening. Physicians should be aware of PKU when confronted with case
with neurologic impairments and autistic behavior, so if the the treatment starts early enough, a normal neuropsychological development
would be caught, preventing presentation of brain dysfunction in the child, which sometimes include the autistic features.
Keywords: autism, phenylketonuria-induced
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S75-S6
[PP-024] Childhood and adolescence disorders
Ref. No: 0378
Attention deficit hyperactivity disorder at schools in Sfax, Tunisia
Khaoula Khemakhem1, Hela Ayadi1, Leila Cherif1, Yousr Moalla1, Imen Hadjkacem1, Adel Walha1, Sourour Yaich2, Jamel Dammak2, Farhat Ghribi1
Child Psychiatry Department of Hedi Chaker Hospital Sfax, Tunissia
1
Preventiv Medicine Department of Hedi Chaker Hospital Sfax, Tunissia
2
e-mail address: [email protected]
Introduction: Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder among school children.
It may persist into adulthood and affect performance in the academic, social and familial spheres. The prevalence rate is a controversial
matter.
Objective: The aim of this research was to determinate the prevalence of ADHD and its distribution according to subtypes, gender and
age in school children from Sfax, Tunisia.
Methods: A cross sectional descriptive study was carried out from first April 2008 to first October 2008. 513 pupils, 240 boys and 273 girls,
aged between 6 and 12 years, from primary arbitrarily chosen schools from Sfax were subject to this study.
Measurements were carried out in two steps: parents and teachers of each child filled in separately Conners questionnaire, then children
with a score in subscales in attention, hyperactivity impulsivity higher than 70 were selected for psychiatric interview that was intended
to confirm or to invalidate the ADHD diagnosis. The diagnoses were made according to DSM-IV-TR.
Results: We have noticed that 109 pupils having at least one pathological score of the Conners questionnaire. After interviewing these
109 pupils, the results have shown that 51 among them fulfilled criteria of ADHD. Prevalence of ADHD was found to be 9.94%.
The combined subtype was the most frequent with 5.26% then inattention predominantly subtype in 2.7% of cases and hyperactivity
impulsivity predominantly subtype in 1.94% of cases.
Higher prevalence was fond among boys. ADHD tends to decrease with age with a higher prevalence in the age bracket 7- 8ans
The inattentive subtype was greater in girls and the hyperactive subtype was more prevalent among boys.
Conclusions: Prevalence of ADHD in the school population in Sfax is high. The most subtype was the combined type in boys and
inattentive predominantly subtype in girls. Programs must be developed for the detection of this problem and subsequent intervention
in the school population.
Keywords: ADHD, schoolchildren, Tunisia
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[PP-025] Psychopharmacology
Ref. No: 0379
Evolution in the prescription of psychotropic drugs in child psychiatry
department of Sfax (2005 - 2009): about 232 children and adolescents
Khaoula Khemakhem, Hela Ayadi, Narjess Boussaid, Imen Hadjkacem, Leila Cherif, Adel Walha, Yosr Moalla, Farhat Ghribi
Child Psychiatry Department of Sfax, Tunissia
e-mail address: [email protected]
Objective: The objective of our work was to study the evolution of the prescription of psychotropic drugs in middle child psychiatry and
discuss the current state of knowledge.
Materials-Methods: Our study was retrospective, comparative, of 232 children and adolescents followed in child psychiatry department
of Sfax in the years 2005 and 2009.
The cases were randomly selected and divided into two groups matched for age, sex and diagnosis nosographic.
Results: The prescription of psychotropic drugs in the two groups was observed in respectively 36.2% and 33.62 % of cases.
This requirement was to type:
• Antidepressants in 18.96% of cases in the first group against 15.68% of the second group.
• Neuroleptics classic in 6.9% in the first group against 13.72 % in the second group.
• Atypical antipsychotics were prescribed in 4.31% of cases in the first group and 13.72% in the second group.
• Psychostimulants, prescribed in 1.72% of cases in the first group and in 3.9% of cases in the second group.
• Mood stabilizers in 2.58% of cases in the first group and 7.84% of cases in the second group.
Conclusions: Our study shows significant changes in the prescription of psychotropic drugs in children and adolescents: use of new
molecules characterized by their better tolerance such as atypical antipsychotics.
Keywords: evolution, psychotropic drugs, children and adolescents
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S77
[PP-026] Childhood and adolescence disorders
Ref. No: 0381
Investigation of iron deficiency, thyroid function abnormalities and deficiency
of folate and vitamin B12 in children with attention deficit hyperactivity disorder
Yasemin Tas Torun, Yasemen Isik Taner, Sahnur Sener, Fatih Hilmi Cetin
Gazi University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Objective: Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed psychiatric disorder in the childhood and it has been
suggested that both environmental and genetic factors take place in the etiology. Therefore, it is important to determine metabolic and
endocrine abnormalities that accompanies with ADHD in order to understand the pathophysiology of ADHD and in order to develop new
treatment strategies. The aims of this study were to evaluate serum TSH, vitamin B12, folate abnormalities and iron deficiency in children
with ADHD and investigate the association between iron deficiency and subtypes of ADHD.
Methods: Patients who applied to Gazi University Medicine Faculty Child and Adolescent Psychiatry Out-Patient Clinic diagnosed with
ADHD as per DSM-IV-TR diagnoses criteria between time period May 2012-Feb 2013 were involved in this study. Records and laboratory
results of patients were retrospectively collected and evaluated.
Results: This study included 199 children age between of 6-16 years (mean age 9.43±2.2) with ADHD whose 87.2% were boys (n=174)
and 12.6% of children (n=25) were girls. 80.9% of children (n=161) were combined type ADHD while 19.1% of children (n=38) were
predominantly inattentive type. 52.8% of children (n=105) had iron deficiency while 2.5% of children (n=5) had subclinical hypothyroidism
and 3% of children (n=6) had vitamin B12 deficiency. It was determined that 59% of children with combined type ADHD had iron
deficiency while in children with predominantly inattentive type rate was 26.3%. There was statistically significant relation between iron
deficiency and subtypes of ADHD (p<0.001).
Conclusion: Iron deficiency and thyroid function abnormalities which are known to have important roles on neurocognitive functions
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are frequently accompanies with ADHD in childhood. In addition, accompanying iron deficiency affects the clinical status of the ADHD.
In resent literature several studies published about the relationship between iron deficiency and subtypes of ADHD but results are
inconsistent. According to results of this study, iron deficiency is more frequent in children with combined type ADHD with respect to
predominantly inattentive type; it is suggested that iron metabolism considered to have more important effects on symptoms related
with hyperactivity and impulsivity.
Keywords: ADHD, iron deficiency, thyroid function abnormalities
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S77-S8
[PP-027] Childhood and adolescence disorders
Ref. No: 0396
A family based association study of neuronal nitric oxide synthase gene
polymorphism in autism spectrum disorders
Sevgki Chodzaoglou1, Murat Coskun2, Suleyman Salih Zoroglu2
Medipol University Hospital, Department of Child and Adolescent, Istanbul-Turkey
1
Istanbul University, Faculty of Medicine, Department of Child and Adolescent, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: Autism is a neurodevelopmental disorder characterized by impairments and abnormalities in verbal and non-verbal
communication and socialization alongside with restricted-stereotyped interests and behaviors. Several factors have been implicated in
the etiology of autism, including genetic, environmental and autoimmune factors however the underlying etiology of autism is unknown.
Nitric oxide (NO), is generated from L-arginine by the enzyme nitric oxide synthase (NOS), is an important signaling molecule that affects
neurodevelopmental processes in the central nervous system. It has been implicated in the development of certain psychiatric disorders,
including autism spectrum disorders. In addition, NO is a free oxygen radical that plays a key role in immune-mediated neurotoxicity
via mitochondrial inhibition. The aim of this study is to investigate neuronal nitric oxide synthase (NNOS) gene polymorphism in autism
spectrum disorders (ASD).
Method: Subjects in this study were children and adolescents aged 2-18 years old who were referred and followed up with diagnosis of
DSM-IV ASD in Istanbul Medical Faculty, Child and Adolescent Psychiatry Department. Childhood Autism Rating Scale (CARS) was used
to assess the severity of autism symptoms. Ten cc blood sample of affected child and biological mother and father trios were taken to
sterile EDTA test tube for DNA isolation. Polimerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) and agars
gel electrophoresis are used to assess neuronal nitric oxide synthase (NNOS) gene polymorphism in DNA samples. Genetic analysis was
conducted in Istanbul University, Institute of Experimental Medicine (DETAE), Molecular Medicine Department. Family based approaches
like transmission disequilibrium test (TDT) and haplotype-relative-risk (HRR) were used in data analysis. Correlation between inherited
alleles and quantitative analysis like CARS score, IQ score, age of mother was assessed using ANOVA.
Results: 101 subjects (16 girls, 15,8%; 85 boys, 84,4%) with diagnosis of ASD and their biological parents, a total of 303 subjects, were
included in the study. We found significant association between NNOS 276 gene and autism spectrum disorders (p:0,0077) (X2:5.846).
There is no significant association between NNOS 84 gene and autism spectrum disorders. Also there is no correlation between inherited
alleles and quantitative analysis like CARS score, IQ score, age of mother according to ANOVA.
Conclusion: The findings of this study suggest that NNOS might appear to be a viable candidate gene for the pathogenesis of autism and
have a role in development of ASD phenotype. Further genetic and molecular studies are needed on this area.
Keywords: autism, genetics, nitric oxide
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[PP-028] Psychopharmacology
Ref. No: 0406
Assessment of the effects of antihistaminic drugs on mood, sleep quality,
sleepiness, and dream anxiety
Pinar Guzel Ozdemir1, Ayse Serap Karadag2, Yavuz Selvi3, Murat Boysan4, Serap Gunes Bilgili5, Adem Aydin6, Sevda Onder5
Ipekyolu Public Hospital, Department of Psychiatry, Van-Turkey
1
Istanbul Medeniyet Unversity, Faculty of Medicine Department of Dermatology, Goztepe Research and Training Hospital, Istanbul-Turkey
2
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
3
Yuzuncu Yil University, School of Science and Arts, Department of Psychology, Van-Turkey
4
Yuzuncu Yil University, Faculty of Medicine, Department of Dermatology, Van-Turkey
5
Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van-Turkey
6
e-mail address: [email protected]
Objective: Antihistaminics are mainly used to threat chronic pruritus or to affect sleep quality and mood. However, there are limited
prospective and comprehensive comparative studies about both classic and new-generation antihistaminics. The purpose of this study
was to determine and compare the effects of classical and new-generation antihistaminics on sleep quality, daytime sleepiness, dream
anxiety and mood states.
Method: 92 patients with chronic pruritus participated in the study, who were consecutively admitted to the dermatology outpatient
clinic of Dursun Odabas Research Hospital. Treatments with regular recommended therapeutic doses were as follows: 15 patients were
given pheniramine maleate three times a day, 16 patients were given hydroxyzine 25 mg/day, 15 patients were given cetirizine 10 mg/
day, 15 patients were given desloratadine 5 mg/day, 15 patients were given levocetirizine 5 mg/day, and 16 patients were given rupatadin
10 mg/day. Influences of antihistaminic drugs on mood, daytime sleepiness, dream anxiety and sleep quality in the first day and 1 month
after the treatment were evaluated. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS),
Van Dream Anxiety Scale (VDAS), Profile of Mood States (POMS), and UKU (Udvalg für Kliniske Undersogelser) before the treatment.
We evaluated with ESS, POMS and psychological side effects with UKU on day 1 and ESS, PSQI, VDAS, POMS and UKU were filled and
compared again one month after treatment.
Results: The six drugs were separately compared with each other and it was found that outpatients who received cetirizine treatment
reported higher scores on depression, anxiety and fatigue subscales of the POMS than outpatients, who received desloratadine,
levocetirizine and rupatadin treatment. Hydroxyzine and cetirizine did not differ from each other. Sleep latency was significantly improved
among patients medicated with levocetirizine. Daytime sleepiness was predicted by rupadatin and pheniramine treatments. The UKU
scores significantly increased among outpatients receiving pheniramine treatment. Antihistaminics regardless of being a first or second
generation increased daytime sleepiness and decreased the scores of subjective sleep quality, showed no significant influence on mood.
Antihistaminic drugs reduced sleep latency, increased daytime sleepiness and subjective sleep quality. There were no differences in sleep
and affective characteristics between classic and new generation antihistaminic drugs before the treatment, on the first day and one
month after the treatment. The global PSQI scores significantly decreased after one month in both groups that means improvement in
subjective sleep quality. However, the dream anxiety scores of outpatients, who were medicated with new generation drugs as compared
to outpatients, who were medicated with first generation drugs were significantly lower after one month.
Conclusion: According to the results of the study; either classical or new generation antihistaminics significantly increased daytime
sleepiness as well as nocturnal sleep quality. As far as the remarkable differences between drugs are concerned, cetirizine and hydroxyzine
seem to have negative influences on mood states; pheniramine and rupatadin appear to be related to more daytime sleepiness and better
nocturnal sleep quality. Since the small sample size of each drug group, the current results should be confirmed in further studies with
larger patient groups.
Keywords: sleep, mood, antihistaminics
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[PP-029] Mood disorders
Ref. No: 0417
Effects of electroconvulsive therapy on serum brain-derived neural factor and nerve
growth factor in treatment resistant major depression
Ali Emrah Bilgen1, Barbaros Ozdemir1, Serkan Zincir2, Mehmet Ak1, Emre Aydemir1, Tuncer Cayci3
Gulhane School of Medicine, Department of Psychiatry, Ankara-Turkey
1
Golcuk Military Hospital, Department of Psychiatry, Golcuk, Kocaeli-Turkey
2
Gulhane School of Medicine, Department of Clinical Biochemistry, Ankara-Turkey
3
e-mail address: [email protected]
Objective: Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), two important neurotrophic factors that are wellknown to play a role in neuroplasticity. Neurotrophic factors are thought to play a role in the pathogenesis of several neuropsychiatric
diseases including major depression. Major depression with low serum levels of neurotrophic factors compared to healthy controls and
increased plasma level with treatment have been shown in previous studies.
Method: In this study, we aimed to investigate the change in serum levels of BDNF and NGF levels with ECT treatment in patients with
treatment-resistant major depression.
30 patients with treatment-resistant major depression completed the study. Data of the patients were compared with 30 healthy subjects
who had similar sociodemographic characteristics. Serum BDNF and NGF levels of the patients were measured before treatment, when
clinical response occurred and at the end of treatment. Severity of the disease was assessed by the 17-items HAM-D scale. Data analysis
was performed using SPSS version 15.00.
Results: In the study, baseline serum BDNF and NGF levels in patients with major depression were lower than the control group (p<0,05).
Significant increases in serum BDNF levels with ECT treatment were lower than the control group; serum NGF levels didn’t display a statistically
significant increase. There was no relationship between the clinical severity of the disease with serum BDNF and NGF levels (p>0.05).
Conclusion: It is evaluated to be the role of neurotrophic factors particularly including BDNF in the etiopathogenesis of major depression.
In the future, new studies to investigate the relationship between neurotrophic factors with neuroendocrine and genetic processes are
thought to make an important contribution to understand the psychobiology and treatment of mental disorders especially including
major depression.
Keywords: major depression, brain-derived neurotrophic factor, nerve growth factor
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S80
[PP-030] Psychopharmacology
Ref. No: 0428
Efficacy of clozapine in treatment-resistant schizophrenia
Ertac Sertac Orsel, Hilal Yigit, Semra Karayilan, Mustafa Ozten, Atila Erol
Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya-Turkey
e-mail address: [email protected]
Objective: Treatment-resistant schizophrenia is observed in %15-20 of all cases. It is an important and difficult issue for clinicans and
patients as it causes occupational and social problems. It is known that patients have to stay in hospital and severe and high dose
medicine cause complication. Many drugs have been used in the treatment of resistant cases, but clozapine has also been shown to
provide the best results. Clozapine is still the gold standart in these cases. In schizophrenia dominance of positive symptoms in the clinical
interest causes the neglect of negative symptoms. Criteria for treatment-resistance schizophrenia although more positive symptoms are
established by considering, nowadays the negative symptoms are more heeded and attracting more attention. Aim of this study is to
determine the efficacy of clozapine in treatment resistant schizophrenia over both positive and negative symptoms.
Method: Schizophrenia patients who were taking two or more treatment trials of at least two groups of conventional antipsychotics for
at least 4-6 weeks, and had no response to treatment, have been evaluated. A total of 60 cases, 40 male and 20 female were accepted. The
average age of male patients was 36,3 and female patients was 35,1. SCID, Scales for the assessment of positive symptoms (SAPS) and
scales for the assessment of negative symptoms (SANS) have been used just before switching to clozapine treatment and after clozapine
treatment. Electroconvulsive therapy has been used in combination with clozapine to the clozapine-resistant patients.
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Results: Proportion of respondents to clozapine treatment was found %93,3 (n=56). The rate of clozapine resistant schizophrenia patients
was found %7,6 (n=4). According to the SAPS scores %62,6 percent reduction in positive symptoms and according to the SANS scores
%42,9 percent reduction in negative symptoms were achieved. Scale for the assessment of positive symptoms in hallucinations section
expect olfactory hallucinations, in delusion section expect thought withdrawal, in bizarre behavior section and in positive formal thought
disorder section expect clanging were statistically significantly decreased. Scale for the assessment of negative symptoms in all sections
(affective flattening or blunting, alogia, avolition/apathy, anhedonia/asociality, attention) was statistically significantly decreased.
Conclusion: Clozapine has been found effective on both positive and negative symptoms of treatment-resistant schizophrenia. While
conventional antipsychotics have limited effect on negative symptoms, clozapine provides an effective improvement in these symptoms.
The most important reason for the lack of effect is persistent negative symptoms for patients with schizophrenia and use of clozapine in
treatment-resistant schizophrenia becomes more important.
Keywords: clozapine, schizophrenia, treatment-resistant
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S80-S1
[PP-031] Schizophrenia and other psychotic disorders
Ref. No: 0450
Antipsychotic use pattern in people with psychotic disorder living in board
and care facilities
Etem Erdal Ersan1, Mustafa Yildiz2
Psychiatry Clinic of Numune Hospital, Sivas-Turkey
1
Kocaeli University, Faculty of Medicine, Department of Psychiatry, Kocaeli-Turkey
2
e-mail address: [email protected]
Objective: The aim of this survey is to determine the pattern of antipsychotic drug use in patients with psychotic disorders, living in board
and care facilities and to investigate the related factors.
Method: We evaluated the antipsychotic drug use pattern in outpatients with psychotic disorders according to DSM-IV, living in board
and care facilities. Patients using polypharmacy at least one month were compared with patients using monotherapy in terms of clinical
and demographic characteristics.
Results: Antipsychotic polypharmacy (with two: 34%, with more than two: 28%) was identified in 62% of the patients. The most frequently
prescribed combination was the olanzapine+quotiapine (13%), the rate of first and second generation combination was 50%, the rate
of second generation antipsychotic combination was 44%, and the rate of first generation anytipsychotic combination was 4% in the
two antipsychotic drugs combination group. The rate of clozapine use was 3%. Use of polypharmacy was associated with the diagnosis
of schizophrenia and schizoaffective disorder, young age, suicidal behavior, multiple hospitalizations, clinical severity, and also need of
anticholinergic drug.
Conclusion: The ratio of using more than two antipsychotic drug combination is high (28%) in psychotic patients living in board and care,
and low rate of clozapine use, which show that clinical practice is inconsistent with the treatment guidelines recommendations. It seems
to be needed for further education to rationale antipsychotic drug use in psychiatric practices.
Keywords: psychotic disorder, schizophrenia, antipsychotics, polypharmacy, monotherapy, outpatient, board and care facility
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Candidates of TAP Outstanding Research Awards
[PP-032] Neuroscience
Ref. No: 0451
Low serum copper and ferro oxidase levels in adults with Attention-Deficit
and Hyperactivity Disorder
Ahmet Unal1, Osman Virit1, Gokay Alpak1, Feridun Bulbul1, Salih Selek2, Mahmut Bulut3, Haluk A. Savas1
Gaziantep University, Faculty of Medicine, Department of Psychiatry, Gaziantep-Turkey
1
Medeniyet University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
2
Dicle University, Faculty of Medicine, Department of Psychiatry, Diyarbakir-Turkey
3
e-mail address: [email protected]
Objective: The etiologies of attention-deficit and hyperactivity disorder (ADHD) have not been fully clarified, yet. Genetic and nongenetic factors may contribute to development of ADHD. Recently, role of the elements such as magnesium, lead and zinc in etiology
of pediatric ADHD has been investigated. In this study, we aimed to investigate relationship between serum ceruloplasmin, copper and
ferroxidase levels and A-ADHD.
Method: 50 A-ADHD patients, who were diagnosed according to Turgay’s Turkish version of A-ADHD DSM IV-Based Diagnostic Screening
and Rating Scale (ASRS) at the outpatient clinic of Gaziantep University, Medical Faculty, and Psychiatry Department were enrolled in this
study. The control group consisted of 27 healthy subjects in similar age and gender with the patients. Blood samples were collected at
8:00 am and serum samples were stored at -70 ºC after immediate centrifugation (1000xg, 10 min). Erel’s ceruloplasmin assay method that
is based on the enzymatic oxidation of ferrous ions to ferric ions was used.
Results: There was no significant difference in serum ceruloplasmin levels between the two groups (p>0.05), however serum copper
and ferro-oxidase levels in A-ADHD group was significantly lower than the control group (p<0.01and p=0.024, respectively). According
to ADHD subtypes, there was no significant difference in serum ceruloplasmin, copper and ferro-oxidase levels (p=0.662, p=0.062 and
p=0.426, respectively). Serum copper levels were significantly positively related to a number of criteria met in ADHD attention scale (ro=
0.349, p=0.014).
Conclusion: This research has revealed that there was copper and ferro-oxsidase deficiency in adult ADHD. It is clear that further studies
are needed in order to confirm the results of this study and to understand the roles of ferro-oxidase and copper in the pathophysiology
of A-ADHD.
Keywords: attention-deficit and hyperactivity disorder, ceruloplasmin, copper
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S82
[PP-033] Psychiatric genetics
Ref. No: 0455
Relationship of plasma microRNAs with nicotine use and disease status among
depressed patients
Mehmet Akif Camkurt1, Yunus Killi2, Senel Acar1, Serkan Gunes2, Veli Yildirim2, Aysegul Gorur3, Lulufer Tamer3, Mehmet Fatih Yilmaz4
Mersin University Teaching Hospital, Department of Psychiatry, Mersin-Turkey
1
Mersin University Teaching Hospital, Department of Child and Adolescent Psychiatry, Mersin-Turkey
2
Mersin University Teaching Hospital, Department of Biochemistry, Mersin-Turkey
3
Ardahan State Hospital, Ardahan-Turkey
4
e-mail address: [email protected]
Objective: Objective of this study is to identify relationship of microRNAs with nicotine use and disease status of major depression.
Method: The blood samples of 50 patients who were admitted to Mersin University Teaching Hospital Psychiatry Department and
41 healthy controls (HC) were collected. To establish better diagnosis and eliminate deficiency of Hamilton Depression Rating Scale
(HDRS) (such as higher scoring of somatic and sleep-related items) we used both HDRS and Montgomery-Åsberg Depression Rating
Scale (which is focused on core symptoms of depression). For accurate phenotyping, patients, who met diagnostic criteria for major
depression according to DSM IV, HDRS score above 17, has no comorbid psychiatric and medical condition, never used psychiatric drugs
before and has not take any medication for 1 month prior to blood sampling period were included. Subtypes like psychotic, melancholic,
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anxious, seasonal and atypical were excluded. HC was also consisted of individuals, who have no history of psychiatric and chronic
medical condition, has not take any medications for 1 month prior to blood sampling period and whose HDRS score was under 7. All of
the participants were asked whether they smoke or not. Patients were asked if they had previous episodes and any triggering stressor
and previous episodes. Our microRNA analysis method is described in our poster named “MicroRNAs as Potential Biomarkers for Major
Depressive Disorder”. Mann Whitney U test was used for statistical analysis.
Results: Results of the first part of our study results are presented elsewhere (poster name: MicroRNAs as Potential Biomarkers for Major
Depressive Disorder). We didn’t find any significant relationship with nicotine use and microRNA levels. Stressor related microRNAs were
mir320a and mir451a. Among patients, who had a history of previous episode, statistically significant microRNAs were mir17-5p, mir2233p, mir320a and mir451a.
Conclusion: The other poster of us identified mir320a, mir451a, mir17-5p and mir223-3p as potential biomarkers for depression. Here we
demonstrate that these mentioned microRNAs were related also with previous episodes. This result should be verified with also further
studies. We didn’t find any relationship between nicotine use and peripheral microRNA levels. Probably, Evaluation of both depressed
and healthy individuals caused this confusion. Further studies investigating nicotine use only, among healthy controls could be helpful to
understand nicotine-related peripheral microRNAs.
Keywords: microRNA, nicotine, plasma
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S82-S3
[PP-034] Eating disorders
Ref. No: 0466
Are there any differences in psychiatric symptoms and eating attitudes between
pregnant women with hyperemesis gravidarum and healthy pregnant women?
Bilge Burcak Annagur1, Ozlem Secilmis Kerimoglu2, Sule Gunduz1, Aybike Tazegul2
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
1
Selcuk University, Faculty of Medicine, Department of Obstetrics and Gynecology, Konya-Turkey
2
e-mail address: [email protected]
Objective: Hyperemesis Gravidarum (HG) affects 0.5–2% of pregnant women, and 10% of those diagnosed require at least one inpatient
hospitalization. In previous studies on the relationship between eating disorders and nausea and vomiting, women with eating disorders
have been reported to have a higher rate of maternal and fetal complications, and pregnancy is known to be a time for increased risk for
both remission from and re-emergence of eating disorder symptoms.
We aimed to determine the relationship between eating attitudes and psychiatric symptoms in women with HG and to compare these
women with healthy control subjects.
Methods: The study sample included 48 females with HG, and the control group had 44 pregnant women. The patients were selected
among women with HG hospitalized in the obstetric inpatient clinic. All of the participants were in the first trimester of pregnancy. The
participants’ socio-demographic and clinical characteristics were recorded in the obstetric clinic. All of the participants completed a Beck
Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Eating Attitudes Test (EAT) and Body Image Scale (BIS).
Results: Women with HG were more likely to have had a history of HG during their previous pregnancy (P<0.05). There was no significant
difference between the study and control groups regarding obstetric history. Women with HG were more influenced by food that induced
nausea. There was no significant difference between the study and control groups for pre-pregnancy nausea, food craving, and the initial
BMI (P>0.05). Depression and anxiety scores were significantly higher in women with HG (P<0.05). However, there was no significant
difference between the study and control groups for body image score and eating attitude test scores (P>0.05).
Conclusions: We suggest that HG appears to be associated with depression and anxiety symptoms rather than deterioration of eating
attitudes and body image. However, these results should be confirmed by prospective and clinical studies.
Keywords: eating attitudes, hyperemesis gravidarum
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S83
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Candidates of TAP Outstanding Research Awards
[PP-035] Childhood and adolescence disorders
Ref. No: 0473
Evaluation of the interrelationships between complaints, diagnoses, and drug usage
in an outpatient clinic of pediatric, and adolescent psychiatry
Halit Necmi Ucar, Omer Kocael, Ismail Yasir Kirtil, Fatih Dagdelen, Ismail Hasan Kole, Ayse Pinar Vural
Uludag University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa-Turkey
e-mail address: [email protected]
Objective: To investigate interrelationships between complaints, diagnoses, and psychotropic drug usage in ambulatory health care
services provided in the outpatient clinics of pediatric and adolescent psychiatry.
Method: In this study, medical files of the patients, who had been examined for the first time between July 2012, and December 2012 in
Outpatient Clinics of Pediatric and Adolescent Psychiatry of Uludag University Hospitals of Medical Faculty were evaluated. Medical files
of a total of 953 patients [403 (42.3%) female, and 550 (57.7%) male patients] examined during a period of 6 months were retrospectively
assessed at the end of 6, and 12 months after referrals. Manifestations, and diagnoses, and also drugs used in the treatment of the
patients classified according to their therapeutic groups (antipsychotics, antidepressants etc.), active ingredients and their usage (if any)
in combination regimens were entered into standard relevant sections of on-line medical files.
Results: Majority of the cases was of male gender (57.7%), and 35% of the patients were in the age bracket of 7-12 years. The most
frequently encountered complaints were determined as naughtiness, and disobedience (19.7%), nervousness (19.5%), hyperactivity
(16.2), distraction (14.6%), unhappiness, pessimism, reluctancy, and crying (14.1%). The most frequently detected DSM IV TR diagnoses
were attention deficit hyperactivity disorder (ADHD)(18.8%), depression (17.4%), mental health restriction disorder (14.6%), and
generalized developmental retardation (11.1%). When diagnoses were evaluated by gender, ADHD, and generalized developmental
disorder were more frequently encountered in males, while depression, and generalized anxiety disorder were more often recognized
in female patients, which all were statistically significant. Psychotropic drugs were prescribed for 43.4% of the cases. Mostly selective
serotonin reuptake inhibitors (21.8%), atypical antipsychotics (14.8%), and psychostimulants (8.3%) were recommended in descending
order of frequency. Besides in 98 (10.3%) patients, more than 2 psychotropic drugs were used.
Conclusion: Recognition of frequently detected complaints, and diagnoses, determination of differences in diagnoses between
genders, and age groups, evaluation of the drugs used, and their relationship with relevant diagnoses will contribute favourably to the
improvement of health care services provided in the outpatient clinics of pediatric and adolescent psychiatry.
Keywords: pharmacotherapy, child and adolescent psychiatry, outpatient treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S84
[PP-036] Childhood and adolescence disorders
Ref. No: 0474
Three months prevalence and correlates of symptoms of trichotillomania,
onychophagia and skin excoriation disorder in a clinical child psychiatric population
and the effects of treatment choices on symptoms
Taha Can Tuman1, Nuran Demir2, Zehra Topal2, Bengu Altunay Tuman3, Ali Evren Tufan2, Yankı Yazgan4
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu-Turkey
2
Abant Izzet Baysal University, Faculty of Medicine, Department of Dermatology, Bolu-Turkey
3
Guzel Gunler Health Sevices Ltd., Istanbul-Turkey
4
e-mail address: [email protected]
Objective: Interest on body-focused repetitive behaviors (BFRB) such as hair pulling and skin picking has been increasing recently.
DSM-5 classifies Trichotillomania and Skin Picking disorder among Obsessive Compulsive and Related Disorders. Onychophagia, on the
other hand is not listed separately within DSM-5. The prevalence of pathological skin picking may vary between 0.2-5.4% while that of
trichotillomania may be 0.5-3.5%. The prevalence of onychophagia is not known. As far as we are aware, there is no study conducted on
body-focused repetitive behaviors in our country. In this study, it was aimed to investigate the prevalence of body-focused body-focused
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repetitive behaviors in a clinical sample evaluated at a tertiary Child and Adolescent Psychiatry outpatient department, determine
treatments chosen and to clarify the changes in behaviors and functionality during 2 months.
Methods: The study was conducted at the outpatient department in between March and June 2013. Patients who were between 9-17
years old at the time of application, who complained for onychophagia, skin picking, trichotillomania, obsessions/ compulsions and who
did not have Body Dysmorphic Disorder, Psychotic Disorders or Mental Retardation were enrolled in the study. The complaints should
not have started after a drug or substance use for enrollment. Mental Retardation was ruled out with WISC-R while comorbidities were
evaluated with interviews according to DSM-IV-TR. Clinical Global Impressions, Childhood Global Assessment Scale, Children’s Depression
Inventory, Screen for Anxiety and Related Disorders and Maudsley Obsessive-Compulsive Checklist were used for evaluations. Treatment
choices were naturalistic after baseline evaluations and involved Habit Reversal, SSRIs, Antipsychotics and their combinations. Follow-up
visits were conducted on the 4th and 8th weeks. Evaluations at follow-up visits also involved CGI, CDI, SCARED and MOCCL.
Results: Sixty seven patients (56.9% male) with a mean age of 12.5 years (S.D. 2.3) were enrolled in the study. Mean duration of bodyfocused behaviors was 44.7 months (S.D. 23.0). The prevalence of body-focused behaviors in the sample was 3.8% while prevalences for
Trichotillomania and Skin Picking Disorder as defined by DSM-5 were 0.6% and 1.2%, respectively. 30.9% of the patients had at least 1
comorbid disorder (ADHD being most common, 30.9%). Subjective distress, dysfunction, social avoidance and change in appearance due
to behavior were most commonly reported for onychophagia. The most common treatment choice in our sample was antipsychotics
(50.0%) with SSRIs being the second (32.4%). 14.7% of the patients received a combination of both while 2.9% were managed with habit
reversal. Patients using combinations of SSRIs and antipsychotics had significantly higher levels of anxiety (p=0.03, Mann-Whitney U test).
A multivariable variance analysis for repeated measures showed that psychometric evaluations at 4th and 8th weeks did not differ in terms
of treatment choices.
Conclusion: The prevalence of body-focused repetitive behaviors in our clinical sample was similar to those reported for community
while differing treatments seemed not to have an effect on symptoms. Our results should be replicated with further studies.
Keywords: OCD, trichotillomania, skin picking
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S84-S5
[PP-037] Psychopharmacology
Ref. No: 0477
Acute dystonic reaction following methylphenidate medication in
a neurologically healthy adolescent patient with ADHD
Ugur Tekin1, Serap Oflaz2, Osman Abali3, Ahmet Zihni Soyata2
Ege University, Department of Child and Adolescent Psychiatry, Izmir-Turkey
1
Istanbul University, Istanbul Medical Faculty, Department of Psychiatry, Istanbul-Turkey
2
Istanbul University, Istanbul Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
3
e-mail address: [email protected]
Dystonic reactions are complication of medications that act on dopaminergic pathways. Dystonic reactions occur often as a side effect
following administration of medications that block dopamine receptors like antipsychotics. But rarely, drugs that increase dopaminergic
activity like methylphenidate may also cause dystonic reactions. This has been previously reported only in patients who took dopamine
antagonists or, less commonly, in children with developmental abnormalities. There is also a case report about a patient, who is only under
methylphenidate treatment and has dyskinesia.
We report here on a child treated with methylphenidate, who experienced an acute dystonic reaction.
H.S. is a 15-years-old female with ADHD. She had been received 27 mg extended-release methylphenidate for nine days. She complained
for spasmodic muscular contractions of extensor side of his right hand and wrist. The parents of the child also observed the same. She
was admitted to emergency service with involuntary extensor contraction, tension and severe pain. She was diagnosed as acute dystonic
reaction in assessment by psychiatrist. The patient was treated with biperiden 2 mg oral tablet and intramuscular 5 mg diazepam.
In psychiatric history, the patient disclosed that this adverse effect had occurred on one occasion previously when she had taken
short-acting methylphenidate several years ago. She told that the muscular contractions had occurred in her feet and toes. She had no
preexisting movement disorder, central nervous system injury, developmental abnormalities or any other previously reported risk factors
for this side effect. In examination the patient had normal general and neurological features. Also the cranial MRI and EEG were normal.
Detailed assessment showed her to be within the normal range for gross motor, fine motor, social, and language development. Family
members had no movement or psychiatric disorders.
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Methylphenidate is a commonly used agent effective in the treatment of attention-deficit hyperactivity disorder (ADHD). There has been
one case report about dyskinesia during methylphenidate treatment, so far. There are a few case reports of extrapyramidal side effects
during methylphenidate treatment in patients who has been on concomitant antipsychotic medication or having neurodevelopmental
abnormalities. There are also case reports of patients, who used aripiprazole and methylphenidate combined and had dyskinesia after
cessation of methylphenidate. The mechanism of this side effect is unclear. We think that our case is the first dystonia that occurred during
methylphenidate treatment, so we came up with the idea that, shifts in dopamine by methylphenidate might rarely cause childhoodonset movement disorders like dystonia or dyskinesias as a side affect.
Keywords: methylphenidate, ADHD, dystonia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S85-S6
[PP-038] Childhood and adolescence disorders
Ref. No: 0481
Autism in spinal muscular atrophy: comorbidity or a coincidental state?
Hesna Gul, Cagatay Ugur, Cihat Kagan Gurkan
Ankara University, School of Medicine, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Autism is a highly heritable, genetically heterogeneous developmental neuropsychiatric disorder characterized by basic impairments in
reciprocal social interaction, delayed-onset and deviant forms of language, and stereotypic behaviors and/or highly restricted interests.
While the specific genetic contributors to Autism Spectrum Disorders (ASD) remain largely an arcanum, increasing attention has been
paid recently to the etiological role of rare genetic variation. One particularly fruitful area of research has focused on the increased risk for
ASD among individuals with single gene disorders including, fragile X, tuberous sclerosis and neurofibromatosis type 1. Spinal muscular
atrophy (SMA) is an autosomal recessive neurodegenerative disease characterised by degeneration of spinal cord motor neurons, atrophy
of skeletal muscles, and generalised weakness. It is caused by homozygous disruption of the survival motor neuron 1 (SMN1) gene by
deletion, mutation, or conversion. Although no medical treatment is available, investigations have enlightened possible mechanisms
underlying the molecular pathogenesis of the disease. Treatment strategies have been developed to use the unique genomic structure
of the SMN1 gene region.
Here we report a child, initially ascertained for SMA, who was later evaluated for ASD. This observation adds support to the emerging
evidence of phenotypic overlap between these conditions and highlights the importance of further study into the neurodevelopmental
mechanisms at play in SMA. I.G is a 4 years old Turkish child. She was born at 38 week of gestation with a birth weight of 2.650 grams.
Her early motor development wasn’t considered within normal limits, including walking by age of 30 months. At the age of 24 months,
she was noted by her mother to show markedly delayed speech; uttering only single words, and only in a repetitive fashion. She was
referred to our clinic for detailed evaluation. At the time of this assessment, she displayed cognitive retardation with motor impairment
including mild difficulty in walking that worsened when she attempted to stand up from sitting position. Physical examination was
normal. Deep tendon reflexes were normal too. On laboratory examination, serum creatinine kinase was 100 U/L. EMG showed chronic
anterior horn cell involvement following a pattern of reinnervation. The definitive diagnosis of SMA was made based on the clinical and
laboratory examination. At that time, the patient was re-evaluated for her autistic symptomatology. She continued to show limited eye
contact and little interest in people. She did not speak at all and demonstrated repetitive behaviors and severe reactions to changes in
her environment. She fulfilled diagnostic criteria for atypical autism according to the DSM-IV. There was no history of muscular disease or
autism or mental retardation in her family.
While the co-occurrence of SMA and cognitive delay has been long appreciated, there is not any recognition of an association with
autism. It should be noted that additional investigation will be needed to confirm these observations as well as the hypothesis that CNS
involvement is a direct consequence of disruption of SMN, or are these conditions caused from the same genetic defect, that we cannot
identify.
Keywords: autism, comorbidity, spinal muscular atrophy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S86
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[PP-039] Sexual behavior and disorders
Ref. No: 0490
P50 sensory gating in patients with primary vaginismus
Isil Gogcegoz Gul1, Rifat Karlidag2, Cemal Ozcan3
Uskudar University, NP İstanbul Hospital, Istanbul-Turkey
1
Inonu University, Faculty of Medicine, Department of Psychiatry, Malatya-Turkey
2
Inonu University, Faculty of Medicine, Department of Neurology, Malatya-Turkey
3
e-mail address: [email protected]
Objective: Vaginismus (VGN) is defined as recurrent or persistent involuntary spasm in muscles of the outer one third of the vagina that
prevents coitus, using the diagnostic criteria of DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders). VGN is classified as
primary (P-VGN) if it has been present since the start of sexual function and secondary VGN if it follows a normal sexual function period.
Based on the hypothesis that a neurobiological predisposition might be the cause of P-VGN, P-VGN-diagnosed patients and a healthy
control group were compared in terms of P50 sensory gating.
Method: A total of 35 patients between the ages of 17-38, who were diagnosed to have P-VGN and 29 healthy volunteers matched for
age and gender underwent P50 recording in the neurophysiology laboratory and the results were compared.
Results: When the P-VGN group and control group were compared in terms of the P50 sensory gating values, the P-VGN group’s P50
gating ratio (p= 0.047), p50 amplitude difference (p= 0.0001) and S1 amplitude (p= 0.002) were significantly lower than the control group.
Conclusions: Sensory gating is required in filtering the stimuli transmitted to brain and the reduced formation of an appropriate
behavioral response in the P-VGN group can lead to a perception of excessive and unrelated stimuli coming from internal and external
environments during sexual activity and interpreting these as a stress factor exceeding the “capacity to cope”.
Keywords: p50, sensory gating, vaginismus
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S87
[PP-040] Clinical psychiatry
Ref. No: 0496
Association between neutrophil to lymphocyte ratio and severity of depression
in patients with depressive disorders
Esra Aydin Sunbul1, Murat Sunbul2, Fatma Fariha Cengiz1, Omer Yanartas3, Huseyin Gulec1
Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul-Turkey
1
Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul-Turkey
2
Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
3
e-mail address: [email protected]
Objective: Previous studies have shown that chronic inflammation is associated with lots of chronic disease such as malignancy, diabetes
mellitus, hypertension, connective tissue disease, chronic kidney disease, coronary artery disease and psychiatric disorders. White blood
cell count and C-reactive protein are some of the predictors of chronic inflammation. Neutrophils and leukocytes play an important role
in inflammatory processes. Neutrophil to lymphocyte ratio (NLR), which can be derived from the white blood cell count is an inexpensive,
reproducible test and has been investigated as a new predictor for systemic inflammatory response. The aim of this study was to explore
the association between NLR and severity of depression in patients with depressive disorders. To the best of our knowledge, this is the
first study in literature to evaluate association between NLR and severity of depression in depressive disorders.
Methods: The study population consisted of 256 patients with depression. All patients were evaluated with Hamilton Rating Scale for
Depression (HAM-D). Patients were classified into four groups in reference to their HAM-D score such as mild, moderate, severe, and very
severe depression (HAM-D scores 8-13, 14-18, 19-22, and >= 23, respectively).
Results: Baseline characteristics and clinical data were shown in table 1. Patient characteristics and usage of antidepressant drugs were
similar between groups. Patients with higher HAM-D score had significantly higher NLR values compared to patients with lower HAM-D
score. Correlation analysis revealed that severity of depression was associated with NLR (r= -0.333, p<0.001) in patients with depressive
disorders.
Conclusion: We demonstrated that higher HAM-D scores were associated with higher NLR values in patients with depressive disorders
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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and severity of depression was also correlated with NLR values in these patients. A simple cheap white blood cell count may also give idea
about severity of depression and should be included in psychiatric evaluation of these patients.
Keywords: depression, inflammation, neutrophil to lymphocyte ratio
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S87-S8
[PP-041] Eating disorders
Ref. No: 0507
The relationship between weight change and obsessive thoughts in patients
with anorexia nervosa
Hilal Yigit, Ertac Sertac Orsel, Semra Karayilan, Mustafa Ozten, Atila Erol
Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya-Turkey
e-mail address: [email protected]
Objective: The genetic and family studies of eating disorders (ED) and obsessive compulsive disorder (OCD) were defined that there
may be a relationship and a common biological predisposition between these two diseases. Similarities in symptomatology and extreme
struggles with weight and eating that can be obsessional were shown in many studies. OCD patients also exhibit a high rate of disordered
eating attitudes as reported. Obsessions are the most common symptom cluster after depressive symptoms in anorexia nervosa) patients.
Obsessive symptoms were shown to continue before and after anorexia nervosa. Psychology and physiology of hunger is considered to
increase the obsessive structure. Aim of this study is to compare the obsessive thoughts of anorexia nervosa patients with low BMI (body
mass index) at admission to hospital with obsessive thoughts of the same anorexia nervosa patients after weight gain.
Method: Twelve patients were evaluated. Eleven of them were female, one of them was male and the mean age was 24.58. At the
beginning and at the end of the treatment BMI was measured and Maudsley Obsessive Compulsive Inventory (MOCI) was applied.
Results: Average BMI at baseline (body mass index): 14.86 (SD=2.12) and average BMI at the end: 18.35 (SD=1.5). Averages of obsessive
thoughts of patients were compared. While MOCI checking, cleaning, doubt and rumination subscale scores at the initiation of treatment
and at the end of treatment had no significant difference in test scores, MOCI slowness subscale was statistically significantly higher at
low BMI than the scores recorded after weight gain.
Conclusion: It was claimed that the obsessive symptoms of anorexia nervosa fluctuated with BMI changes. In our study, it was found that
only MOCI slowness subscale score significantly changed while BMI was increasing.
Keywords: anorexia nervosa, obsessive thoughts, weight change
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S88
[PP-042] Neuroimaging
Ref. No: 0510
Association of adult ADHD subtypes and response to methylphenidate
treatment: a MRS study
Gonca Ayse Unal1, Ayse Nur Inci Kenar2, Hasan Herken3, Yilmaz Kiroglu4
Kilis State Hospital, Department of Psychiatry, Kilis-Turkey
1
Denizli State Hospital, Department of Psychiatry, Denizli-Turkey
2
Pamukkale University, School of Medicine, Department of Psychiatry, Denizli-Turkey
3
Pamukkale University, School of Medicine, Department of Radiology, Denizli-Turkey
4
e-mail address: [email protected]
Objective: It is aimed to investigate the relation between adult ADHD (attention deficit hyperactivity disorder) subtypes and methylphenidate
(MPH) treatment in adult ADHD patients and the changes in N-acetyl aspartate (NAA), creatine and choline levels in anterior cingulate cortex
(ACC), cerebellum, striatum and dorsolateral prefrontal cortex (DLPFC) measured by magnetic resonance spectroscopy (MRS).
Methods: Sixty ADHD subjects were included into the study aging between 18 and 60 years. Levels of NAA, creatine and choline in ACC,
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cerebellum, striatum and DLPFC were measured with MRS. Then, 10 mg oral MPH was given to the subjects and the same metabolite
levels were measured after an interval of 30 minutes.
Results: Distribution of the patients according to the ADHD subtypes was as follows: 21 of them (35,0%) were in the inattentive type,
11 of them (18,3%) were in the hyperactive type and 28 of them were (46,7%) in the combined type. NAA levels in striatum after MPH
administration in the inattentive type were statistically higher than the ones in the hyperactive type. No difference was determined
between the ADHD subtypes in terms of the changes of NAA levels in other brain areas. The difference between ADHD subtypes in terms
of the changes of creatine and choline levels before and after MPH was not statistically significant. The decrease of creatine levels after
MPH compared to the levels of creatine before MPH in ACC in the hyperactive type patients was statistically significant. The increase
of choline levels after MPH compared to the levels of choline before MPH in cerebellum and striatum in the combined type patients
were statistically significant. Conclusion: Consequently, no clear association was found between ADHD subtypes and changes of brain
metabolites with use of MPH in adult ADHD.
Keywords: ADHD subtype, methylphenidate, MRS
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S88-9
[PP-043] Clinical psychiatry
Ref. No: 0527
Psychiatric morbidity in patients with adenotonsillar hypertrophy before and
after adenotonsillectomy
Erkan Soylu1, Nusret Soylu2, Yavuz Selim Yildirim3, Oner Sakallioglu4, Cahit Polat4, Israfil Orhan1
Medipol University Hospital, Head and Neck Surgery, Department of Otolaryngology, Istanbul-Turkey
1
Inönü University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya-Turkey
2
Bezmialem Vakif University Hospital, Head and Neck Surgery, Department of Otolaryngology, Istanbul-Turkey
3
Elazig Training and Research Hospital, Head and Neck Surgery, Department of Otolaryngology, Elazig-Turkey
4
e-mail address: [email protected]
Objective: The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric
symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after
adenotonsillectomy.
Method: The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy
volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and
tympanometry were carried out. The patients’ parents were informed about the study protocol following the indication of adenoidectomy
or adenotonsillectomy. The same procedures were applied to the control group. In order to determine frequency of psychiatric disorders
and severity of psychiatric symptoms, the parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the
Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and
their parents were required to fill out the same forms. Windows SPSS 16.0 program was used in the statistical evaluation.
Results: Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common
in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of
disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy
and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of
anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit
hyperactivity disorder problems, behavioural problems and peer problems confirmed with the Strengths and Difficulties Questionnaire
parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity
of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the
Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms
between the adenotonsillar hypertrophy group and the control group at postoperative month six.
Conclusion: Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the
symptoms and the severity of these disorders in most cases.
Keywords: adenotonsillectomy, psychiatric disorder, psychiatric symptoms
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S89
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Candidates of TAP Outstanding Research Awards
[PP-044] Neuroscience
Ref. No: 0531
Emotional working memory in Alzheimer’s disease: a functional near-infrared
spectroscopy study
Fatma Ebru Ates1, Banu Cangoz1, Erguvan Tugba Ozel Kizil2, Bora Baskak2, Zeynel Baran1, Halise Devrimci Ozguven2
Hacettepe University, Department of Psychology, Ankara-Turkey
1
Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey; Ankara University, Brain Research and Applications Center (BAUM), Ankara-Turkey
2
e-mail address: [email protected]
Objectives: Working memory (WM) deficit is present even at the early phase of Alzheimer’s Disease (AD), and considered to be originated
from the failure of central executive functioning. Emotional working memory (EWM) is suggested as a WM type with specific cortical
representations, distinguished to processes emotional stimuli, and may or may not be spared in AD. Therefore we aimed to study WM and
EWM performance and accompanying prefrontal activations in AD. Methods: Twenty AD patients were recruited from Ankara University,
Faculty of Medicine, Geriatric Psychiatry Unit, along with 20 healthy elderly individuals (HE). One-back task was administered in three
conditions; by employing a neutral and two emotionally charged (positive and negative) word lists as stimuli (6 target and 14 non-target
words in blocks for each condition). Oxyhemoglobin (Hb02) concentrations were measured simultaneously in the prefrontal region with
a 24 channel Hitachi-ETG-4000 fNIRS device. Mixed ANOVA with repeated measures was used for the analysis: 2 (group: HE and AD) x 3
(emotional valance: positive, negative or neutral).
Results: Correct response rates were similar in AD patients and HE subjects in all conditions. Reaction time was longer in AD compared to
HE (F(1,37) = 4.17, p = 0.048). In HE, emotional words had no significant impact on working memory, there was no significant correlation
between the reaction times, prefrontal activations and different emotional words. However, in the AD group, emotionally positive
compared to neutral stimuli led to greater activations in two channels (Ch. 20 and 23) located at the right antero-lateral prefrontal area
(z=-1.85, p= 0.03, z= -2.24, p= 0.01, respectively). When compared to HEs, Ch.23 activation was significantly higher in AD patients during
the EWM-positive condition (U= 134 z= -1.78, p= 0.38).
Conclusion: Although, reaction time was prolonged in neutral (WM) and negative-EWM conditions, it was comparable to HE when
positive stimuli were administered. Therefore, it is plausible to think that positive stimulus may have an increasing effect on EWM in AD.
The activation of the right antero-lateral prefrontal area may be involved in processing emotionally positive stimuli, enhancing the WM
performance in AD. The ‘positivity effect’ can be utilized to facilitate psychosocial and cognitive interventions in AD patients.
Keywords: Alzheimer’s disease, emotional working memory, functional near-infrared spectroscopy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S90
[PP-045] Psychopharmacology
Ref. No: 0540
Atomoxetine and methylphenidate for the treatment of attention deficit
hyperactivity disorder: a six-month follow-up study
Fatih Hilmi Cetin, Yasemen Isik Taner, Yasemin Tas Torun, Huseyin Tunca
Gazi University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Objective: The aim of this study was to compare the efficacy and side effects of metylphenidate (MPH) and atomoxetine (ATX) for
treatment of Attention Deficit Hyperactivity Disorder (ADHD).
Method: 147 patients between ages 7-16 years with ADHD and without other comorbid psychopathologies were included to the study.
Out of 147, 98 patients completed the study. 32 patients used ATX and 66 patients used MPH in the study. Choice of medication was
made randomly and patients were assessed at 1st,3rd and 6th month with Conners Teacher Rating Scale (CTRS) and clinic assessment. Efficay
was defined as a decrease of 40% or more from baseline CTRS score at month 6. Side effects and safety were assessed at each visit by
questionnaires.
Results: Medication groups had similar characteristics in terms of sociodemographic data and initial CTRS scores. Average drug doses
were 0,68 mg/kg/day for MPH and 1,17 mg/kg/day for ATX. While efficacy rates in patients using MPH were 47% in hyperactivity symptom,
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65,3% in attention deficit symptoms and 54,5% in conduct disorder symptoms; these rates were respectively 40,6%; 53,1% and 37,5% in
patients using ATX. Side effect rates were 33,3% (n=22) in MPH group and 43,8% (n=14) in ATX group. There was no significant difference
between the treatment groups in terms of efficacy and side effect rates (p>0.05). Also; there was no significant difference on CTRS scores
between two medications as a function of time.
Conclusion: In this study, ATX and MPH were compared based on efficacy and side effects and no significant differences were found.
It’s noteworthy that clinical improvement could be observed from first month with both of drugs. In summary, ATX and MPH had similar
treatment profiles for ADHD.
Keywords: attention deficit hyperactivity disorder, atomoxetine, methylphenidate
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S90-S1
[PP-046] Psychopharmacology
Ref. No: 0557
Tardive dyskinesia in long term hospitalized patients with schizophrenia
Ahmet Nalbant, Huseyin Sehid Burhan, Aylin Can, Alparslan Cansiz, Kasim Fatih Yavuz, Mehtap Arslan Delice, Erhan Kurt
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
e-mail address: [email protected]
Objective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders of various phenomenology caused by
dopamine receptor-blocking agents. This phenomenon can be seen while using such agents as well as after a short-term discontiniuation.
TD, characterized by oro-buccal-lingual stereotype, can manifest in the form of akathisia, dystonia, tics, tremor, chorea, or as a combination
of different types of abnormal movements. Tardive syndromes were first defined after first antipsychotics were introduced. TD prevalence
is estimated to be 20–50% of all patients treated with neuroleptics, but it varies among different age groups, with prevalence increasing
with advanced age. This study aims to research tardive dyskinesia in long-term hospitalized schizophrenic patients at Bakırköy Research
and Training Hospital for Psychiatric and Neurological Diseases.
Method: Socio-demographic data were obtained from both case records and interviews. We recorded age, gender, duration and type
(first/second generation or mix) of medication both at the time of interview and over the preceding year. Dyskinesia was assessed using
the Abnormal Involuntary Movements Scale (AIMS). Dyskinesia was defined as probably present (Schooler & Kane, 1982) if movements
were ‘mild’ in at least two of seven body areas or ‘moderate’ in at least one. We also used the Simpson–Angus Rating Scale (Simpson &
Angus, 1970) for the severity of the cases. Akathisia was measured using the Barnes Akathisia Rating Scale (BARS) and was said to be
present if the score was 2 (‘mild’) or more on the global scale (Barnes, 1989).
Results: Of the 80 patients included this study 45 (56.3%) were males, 35 (43.8%) were females; mean age was 59 years; mean duration
of current antipsychotics was 100.4 months and mean duration of the most used antipsychotics was 206.6 months. Current antipsychotic
medication status was first generation; 20(25%), second generation; 43 (53.8%), mix; 15 (18.8%) and none; 2 (2.5%). The most used
antipsychotic medication status was first generation; 67 (83.3%) second generation; 11 (13.8%), mixt; 2 (2.5%). 77 (96.3%) patients have
received any of first generation drugs during their long term treatment. Probable tardive dyskinesia was found as 18 (22.5%). None of
the patients had tardive akathisia. There were no significant gender differences in the prevalence of TD. Also there were no significant
differences in the type and duration of current or most used treatment for the prevalence of TD. There were significant differences
between age and TD. There were weak correlation without significant difference between duration of current or most used medication
and SAS points.
Conclusion: Regarding the long term and regular use of antipsychotics, it is surprising that duration of medication wasn’t associated
with the prevalence of TD. We found no differences for TD between first or second generation antipsychotics; and there were no gender
differences. Age seemed to be the most prominent factor for TD.
Keywords: dyskinesia, tardive dyskinesia
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Candidates of TAP Outstanding Research Awards
[PP-047] Mood disorders
Ref. No: 0596
The relationship between antioxidant capacity and attack properties in
bipolar disorder patients
Abdullah Bolu1, Emre Aydemir2, Suleyman Akarsu2, Selma Bozkurt Zincir3, Yasemin Gulcan Kurt4, Murat Erdem2, Ozcan Uzun2
Turkish Air Force Aircrew’s Health Research and Training Center, Eskisehir-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
Erenkoy Psychiatry Education and Research Hospital, Istanbul-Turkey
3
Gulhane Military Medical Academy, Department of Medical Biochemistry, Ankara-Turkey
4
e-mail address: [email protected]
Objective: The relationship between psychiatric disorders and oxidative stress has been a current issue discussed recently. Increased
oxidative stress and in parallel increased antioxidant capacity were shown in bipolar disorder. These increases in oxidative stress and
antioxidant capacity could return to normal with treatment. The preliminary results of the study that aimed to examine the oxidative
stress capacity of patients with bipolar disorder will be presented.
Methods: Total oxidant and antioxidant capacity of 82 patients admitted to the psychiatric clinic with a diagnosis of bipolar disorder,
manic or hypomanic episode according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) diagnostic criteria
were determined. The data of 42 patients who completed follow-up were analyzed and evaluated in detail. The relationship between
oxidative stress levels and number of attacks and their properties of bipolar patients hospitalized due to mania or hypomania episode
were determined.
Results: Total oxidative levels (TOL) and total antioxidant levels (TAL) of the patients were higher than control group (p<0.05). TOL of
patients with a single episode was 2.37±2.22 μmol H2O2 Eqv/L, and TAL was 2.05±0.29 mmol Trolox Eqv./L. In the patients with more
than one episode, TOL was 1.72±1.59 μmol H2O2 Eqv/L, and TAL was 2.51±1.63 mmol Trolox Eqv./L. There were significant differences
in the level of TAL (Z= 2.184, p= 0.029) between patients with a single episode and patients with more than one episode. There was no
statistically significant difference in the levels of TAS and TOS between patients hospitalized for mania or hypomania. There was positive
correlation between TAL and the number of attacks (Rho=0.393, p=0.022).
Discussion: Although our findings coincide with the literature findings, differed in some aspects. In response to oxidative stress,
antioxidant systems were expected to be activated. Our results did not fully verify this information. Systematic studies with broad
participation are needed about this issue.
Keywords: antioxidant capacity, bipolar disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S92
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[OP-001] Childhood and adolescence disorders
Ref. No: 0146
The relations between vitamin B12, folate and ferritin levels and clinical features of
Turkish children and adolescents with ADHD and ADHD-NOS: a preliminary study
Nuran Demir, Zehra Topal, Ali Evren Tufan
Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu- Turkey
e-mail address: [email protected]
Objective: It is thought that some psychiatric symptoms may have a relevance with the importance of roles played by vitamin
B12 and folate in carbon transfer metabolism (i.e. methylation), required for production of serotonin, dopamine, other monoamine
neurotransmitters and catecholamines. Also, methylenetetrahydrofolate reductase (MTHFR) is thought to act directly on dopamine
neurons to prevent oxidative damage. Dopamine, itself stimulates methylation of phospholipids in the neuronal membrane and this
reaction depends on single carbon folate pathway, thereby underlining the importance of the relationship between dopaminergic
neurotransmission and single carbon metabolism . Basal ganglia may especially be vulnerable to deficiencies of vitamin B12 as well as
folates and those structures are thought to play a role in Attention-Deficit/Hyperactivity Disorder (ADHD).
Methods: This cross-sectional, retrospective study was conducted at the outpatient clinics of Child and Adolescent Psychiatry in the
Faculty of Medicine of Abant Izzet Baysal University.. The records of 6074 patients who applied to the study center in between January
2012 and January 2013 were screened for their presenting complaints and those applying for “inattention” and “hyperactivity” were
recorded. It was found that 332 patients were referred for those two complaints and with initial diagnosis of ADHD or ADHD-NOS.
To be eligible for ADHD or ADHD-NOS, the patients should be diagnosed with semi-structured interviews. MR should be ruled out
with Wechsler Intelligence Scale for Children (Revised) or clinical interviews. Patients who were diagnosed in interview to have ADHD
according to DSM-IV-TR criteria formed the ADHD group. The ADHD-NOS group was consisting of children and adolescents, who fulfilled
ADHD criteria according to symptom counts and dysfunction while reporting an age of onset of 7 or more years or those who did not
fulfill the DSM-IV-TR criteria.
Results: It was found that patients diagnosed to have ADHD and ADHD-NOS predisposed to differ in terms of age and TSH concentrations
(both being lower in ADHD-NOS), although the differences did not reach significance. In the second step of the analyses, it was found
that among the whole sample, IBC correlated negatively with baseline scores on the Turgay-DSM-IV-Based Scale for Disruptive Behavior
Disorders (Rho=- 0.59, p=0.03) while Folate levels leaned to correlate negatively with baseline scores on Child Depression Inventory (Rho=
-0.43, p=0.06) although not reaching significance. Interestingly, baseline folate levels correlated positively with scores on Scale for Anxiety
and Related Disorders (Rho=0.44, p=0.03).
Conclusion: Subtle abnormalities of folate, Vitamin B12 and iron metabolism may correlate with clinical features both among patients
with ADHD and ADHD-NOS. Our results should be supported with future studies.
Keywords: vitamin B12, folate, ADHD
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S93
[OP-002] Psikofarmakoloji
Ref. No: 0298
Comparison of short-acting and osmotic releasing form of methylphenidate
in children diagnosed with attention deficit and hyperactivity disorder
Mirac Baris Usta, Mahmut Cakir, Koray Karabekiroglu
Ondokuz Mayis University, Department of Child Psychiatry, Samsun-Turkey
1
e-mail address: [email protected]
Objective: Attention deficit-hyperactivity disorder effects children’s home and school life quality also academic performance and
relationships with their friends and teachers if treated inappropriately. In treatment of ADHD, that is combined pharmacological and
behavioral treatment; and most common used pharmacological agent is methylphenidate. In this study we aimed to compare Shortacting and osmotic releasing form of methylphenidate’s differences between periods of usage, before and after Family and Teacher
Scores, clinical assessment points and prognosis.
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Candidates of TAP Outstanding Research Awards
Method: Participants were 81 children with diagnosed ADHD who participated in a longitudinal study from age 7 to 17 (mean:10,6).In the
beginning of treatment ADHD Parent Rating Scale and Teacher Rating Scale was completed by their parents and teachers and repeated
after 12 weeks. Clinical assessment done with Clinical Global Impression (CGI) at the week of 6th and 12th of treatment.
Results: In the beginning of treatment there were no differences between two groups in age, gender, comorbidity and start-up
CGI, Family, Teacher scores. After clinical assessment OROS is used 18-36mg (mean 27,5) SAM is used 15-30 mg (24,3). Our findings
demonstrated in both groups CGI scores improved significantly in the week of 6th and 12th. Compared to OROS, SAM group CGI improved
better with mean differences (p:0,038). On the other hand there were no differences between improvement of Family scores, but Teacher
scores slightly better in SAM group and our study found no correlation between Family, Teacher scores and CGI scores.
Discussion: In our study demonstrates a slight preference towards OROS or SAM on certain core symptoms, we found SAM more effective
on clinical assessment also showed no significant differences between SAM and OROS in family and teacher scores. Education level of the
family showed correlation with improvement of CGI, Teacher and Family scores. OROS can cost up to 20 times more than SAM without
evidence of greater compliance and for children with ADHD symptoms are affecting their school performance, family life quality, SAM
will be found to be effective by teachers.
Keywords: ADHD, methylphenidate
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S93-S4
[OP-003] Clinical psychiatry
Ref. No: 0389
Is there an association between psychiatric disorders and quality of sleep, quality
of life, demographic and clinical characteristics in patients with chronic pain?
Bilge Burcak Annagur1, Faruk Uguz2, Seza Apiliogullari3, Inci Kara3, Sule Gunduz1
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
1
Necmettin Erbakan university, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
2
Selcuk University, Faculty of Medicine, Department of Anesthesia and Intensive Care, Konya-Turkey
3
e-mail address: [email protected]
Objective: Chronic pain (CP) is a common medical condition for which patients seek care from various health-care providers. CP is
defined as pain that persists for longer than the expected time frame for healing or pain associated with progressive, nonmalignant
disease. Patients with CP commonly experience depression, anxiety, sleep disturbance, fatigue, and decreased overall physical and mental
functioning. Psychiatric comorbidity is high among these patients. There are limited data about the effect of Axis I psychiatric disorders in
patients with CP despite their frequent existence. There are also an inadequate number of studies based on a structured clinical interview.
We aimed to determine Axis-I psychiatric disorders in patients with chronic pain (CP) and compare control subjects determined by a
structured clinical interview. Another objective of the study was to examine whether there is an association between psychiatric disorders
and quality of sleep, quality of life, demographic and clinical characteristics in patients with CP.
Method: The study sample was comprised of 108 patients with CP and 54 control subjects without pain. Psychiatric interviews were
conducted with the Structured Clinical Interview for DSM-IV (SCID-I). Also used were Visual analogue scale (VAS), Hospital Anxiety and
Depression Scale, Hamilton Depression Inventory, Short Form (SF-36), and Pittsburgh Sleep Quality Index.
Results: The rate of any Axis I psychiatric disorder stood at 66.7% (any mood disorder, 50%; any anxiety disorder, 33.3%; any somatoform
disorder, 20.4%; any substance use disorder, 16.6%), significantly more common in the patients’ group compared to the control group.
The most common psychiatric disorder was major depression (49.1%) in subjects with CP. Female gender, numbers of localization and,
neck and back localizations were significantly higher in the SCID (+) group than the SCID (-) group. A statistically significant difference
was observed between the SCID (+) and SCID (-) groups regarding VAS, depression and anxiety scores, mental component summary score
(MCS) and global PSQI scores.
Conclusion: The most prevalent disorders were MDD (49.1%), GAD (21.3%), panic disorder (8.3%), somatization disorder (17.6%), and
analgesic prescription abuse (16.6%). The prevalence rates are higher than in the general population. Results of this study suggest that
psychiatric morbidity in patients with CP is frequently seen and may adversely affect quality of sleep and quality of life of the patients.
Therefore, the patients with CP should be examined with respect to their mental status.
Keywords: chronic pain, depression, anxiety
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S94
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[OP-004] Childhood and adolescence disorders
Ref. No: 0553
Factors related with unintentional injuries in attention-deficit/hyperactivity disorder
Ayse Burcu Ayaz1, Muhammed Ayaz1, Ekrem Senturk2, Nusret Soylu3, Merve Akgul4, Serhat Yuksel5, Yasemin Yulaf5
Sakarya University Training and Research Hospital, Child and Adolescent Psychiatry Clinic, Sakarya-Turkey
1
Izmit Pediatrics Hospital, Child and Adolescent Psychiatry Clinic, Kocaeli-Turkey
2
Inonu University, Faculty of Medicine, Child and Adolescent Psychiatry Clinic, Malatya-Turkey
3
Sakarya Public Health Organisation, Sakarya-Turkey
4
Private Practise, Sakarya-Turkey
5
e-mail address: [email protected]
Objective: Unintentional injuries are the leading cause of morbidity and mortality in children and adolescents. Unintentional injuries are
common in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). This study aims to explore frequency and risk factors
for serious unintentional injuries in children and adolescents diagnosed with ADHD.
Method: The present study consists of 1430 children and adolescents between the ages of 6-18 that were referred to Sakarya University
Research and Training Hospital, and Izmit Pediatrics Hospital Child and Adolescent Psychiatry Department outpatient clinics and diagnosed
to have ADHD for the first time. Children who were diagnosed with mental retardation, pervasive developmental disorders, psychosis,
bipolar disorder, and drug abuse or drug addiction were excluded from the study. Information on sociodemografic characteristics,
developmental steps, chronic physical illness, comorbid mental disorders, scores of Turgay DSM-IV based Child and Adolescent Behavior
Disorders Screening and Rating Scale (parents form) at the time of diagnosis were assessed retrospectively. The study group includes
187 children and adolescents with serious unintentional injury history, and the control group consisted of 1247 children and adolescents
without serious unintentional injury.
Results: The study group had higher rates of at least one comorbid mental disorder (p<0.001), conduct disorder (p<0.001), and
oppositional defiant disorder diagnosis (p<0.001) than the control group. There were no significant differences between the groups in
terms of other comorbid mental disorders. The group with an unintentional injury had all higher scores of Turgay DSM-IV based Child and
Adolescent Behavior Disorders Screening and Rating Scale subscale than the group without unintentional injury: inattention (p=0.007),
hyperactivity/impulsivity (p<0.001), opposition-defiance (p<0.001), and conduct disorder (p<0.001). Males had more unintentional
injuries than the females (p<0.001). The mean age at the time of diagnosis was higher in the study group than the control group (p=0.002).
The maternal education was lower in the study group (p=0,042). There were no significant differences between the groups in term of
marital status of parents, paternal education, developmental steps, and chronic physical illness.
Conclusion: Comorbid conduct disorder, comorbid oppositional defiant disorder, and symptom severity of ADHD are related to
serious unintentional injuries in children and adolescents with ADHD. The results of the present study underline the importance of
early diagnosis, intervention, and treatment of comorbid mental disorders in the prevention of unintentional injuries in ADHD. Injury
prevention strategies should be planned in the treatment of children and adolescents diagnosed with ADHD.
Keywords: injury, ADHD, children
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Turkish Association for Psychopharmacology (TAP)
5thInternational Congress on
Psychopharmacology
&
International Symposium on
Child and Adolescent Psychopharmacology
Improved choices of psychotropic medications:
better mental health outcomes
October 30 - November 3, 2013
Cornelia Diamond Hotel, Antalya, Turkey
www.psychopharmacology2013.org
Oral Presentations
Oral Presentations
[OP-001] Anxiety disorders
Ref. No: 0134
The comparison of anxiety and depression levels among cardiology patients
with palpitations
Eren Abatan1, Osman Yildirim2, Alim Erdem3, Mehmet Hamid Boztas2, Ozden Arisoy2, Taha Can Tuman2, Mustafa Sercan2
Nusaybin State Hospital, Department of Psychiatry, Mardin-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
2
Abant Izzet Baysal University, Faculty of Medicine, Department of Cardiology, Bolu-Turkey
3
e-mail address: [email protected]
Objective: Palpitations, are one of the most common symptoms that prompt patients to consult general practitioners, cardiologists or
emergency services. Although palpitation can be observed as a common symptom among cardiac diseases and psychiatric disorders, the
previous studies have shown that the palpitation is seen often among psychiatric disorders (%25-50), particularly panic disorder. In this
study, we aim to compare anxiety sensitivity, perception of bodily sensations, anxiety and depression levels among cardiology outpatient
clinic patients with complaints of palpitations, who were applied EPS and were not applied EPS and healthy controls.
Method: According to the cardiac examination and test results, the patients who had cardiac arrhythmia findings or considered as
to suffer arrhythmia and/or requiring definitive diagnoses made up the EPS applied group (n=37) and patients who had no cardiac
arrhythmia comprised the EPS non-applied group (n=38). Any healthy individuals with no history of cardiac disease or psychiatric
disorder was accounted for the control group (n=32). All the participants were evaluated by The Structured Clinical Interview for DSM-IV
Axis I Psychiatric Disorders. Hamilton Anxiety Rating Scale, Hamilton Anxiety Rating Scale and Global Assessment of Functioning scale
were performed by the investigator. Panic Agoraphobia Scale, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory,
Somatosensory Amplification Scale, Anxiety Sensitivity Index-3 and, Liebowitz Social Anxiety Scale were performed by all participants.
Results: In this study, 62.2% of the patients, who were applied EPS were found to have a cardiac arrhythmia, and 85.7% of these patients’
psychiatric evaluation was normal. 62.2% of the patients, who were applied EPS had a comorbid psychiatric disorder and this ratio was
76.3% in the patients, who were not applied EPS. Panic disorder was observed in 51.3% of the patients, who were applied EPS and 54.7%
of the patients, who were not applied EPS. Anxiety sensitivity, perception of bodily sensations, anxiety and depression levels were higher
on both who had no arrhythmia with EPS and who were not applied EPS than the patients who had arrhythmia with EPS. There was not
significant difference in terms of depressive symptoms.
Conclusion: In this study, the relationship between cardiac diseases and psychiatric disorders is also shown clinically. The requirement for
detailed assessment of this common complaint in patients is emphasized with this study for both the patient and the clinician.
Keywords: anxiety sensitivity, panic disorder, electrophysiology studyies
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S97
[OP-002] Clinical psychiatry
Ref. No: 0160
Dissociative disorders in an outpatient clinical sample
Omer Yanartas1, Hulya Akar Ozmen2, Serhat Citak2, Selma Bozkurt Zincir2, Esra Aydin Sunbul2
Marmara University, Faculty of Medicine, Istanbul-Turkey
1
Erenkoy Mental Health and Neurology Training and Research Hospital, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: In this study we aimed to investigate the diagnostic distribution of dissociative disorder and subgroup of dissociative disorder
not otherwise specified (DD-NOS).
Method: Our study was performed in two phases. In the first phase the patients were screened with DES (dissociative experience scale)
and SDQ (somatoform dissociation questionnaire). The patients whose test score were above cut off (DES>30 and/or SDQ>40), were
asked to leave their phone number for the second phase. After the first phase the patients were called for the second phase and DDIS
(dissociative disorder interview scale) was performed to the same resident.
Results: In the first phase, we planned to reach about 2000 patients between the dates 01.12.2010-01.09.2011, but there were 534
cases excluded from the study due to exclusion criteria, while 152 cases didn’t admit filling out the scales of the study; thus we
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could have reached 1314 cases in this phase. Of the 1314 participants who completed the DES, there were 272 participants (20.70%)
with scores above the cutoff. Although five of the participants refused to complete the SDQ, there were 202 participants (15.43%)
whose scores were above the cutoff. In the second phase of the study, we aimed to obtain a total of 272 participants whose test
scores were above the cut-off scores for the DES and SDQ but we could have reached by phone number 190 of them (190 in 272
participants, 69.8%). The most prevalent dissociative disorder group was DD-NOS (62.8%).
Conclusion: The high prevalence of DD-NOS was consistent with other studies’ result. This high prevalence was pointed out in
DSM 5 discussion; thus in DSM 5 criteria authors aimed to reduce this high proportion. In DSM 5, patients with possession were
categorized in the subgroup of dissociative identity disorder group.
Key words: dissociative disorder, outpatient, dissociative experience scale, somatoform dissociation questionnaire
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S97-S8
[OP-003] Neuroimaging
Ref. No: 0192
Lithium enhances alpha and beta oscillations in cognitive networks
Murat Ilhan Atagun1, Bahar Guntekin2, Devran Tan3, Emine Elif Tulay2, Erol Basar2
1Yildirim Beyazit University, Faculty of Medicine, Ankara-Turkey
2Kultur University, Brain Dynamics, Cognition and Complex Systems Research Center, Istanbul-Turkey
3Maltepe University, Faculty of Medicine, Istanbul-Turkey
e-mail address: [email protected]
Background: Different research modalities have consistently shown structural and functional changes in patients on lithium therapy.
Previous resting-state EEG studies have shown that lithium enhances delta and theta oscillations in default-mode networks. However,
cognitive task-based networks differ from resting state networks and no previous study has investigated the effects of lithium on brain
physiology in cognitive task-based networks. It is aimed to investigate the effects of lithium on brain physiology under auditory cognitive
task.
Methods: The study included euthymic bipolar patients either on lithium monotherapy (n=15; mean age=36.0±9.55, female: 9), or
medication-free (n=22; mean age=29.10±7.87, female: 15), and twenty-one healthy controls (mean age=30.82±6.46, female: 16). EEG was
recorded at 30 electrode sites upon application of auditory oddball paradigm. The maximum peak-to-peak amplitudes were measured
for each subject’s averaged alpha (8–13 Hz) and beta (14–28 Hz) responses to target stimuli. Repeated measures of ANOVA and Turkey
tests were used for statistical analysis.
Results: There were significant differences between groups in alpha (p<0.001) and beta (p=0.005) responses to target stimuli. Post-hoc
comparisons showed that lithium-treated patients had significantly higher alpha responses than both medication-free patients (p<0.001)
and healthy controls (p=0.004); similarly, patients under lithium monotherapy had significantly higher beta responses than medicationfree bipolar patients (p=0.006) and healthy controls (p=0.015).
Discussion: Lithium rearranges brain physiology by stimulating neuroplastic cascades and beta oscillations become prominent during
neuroplastic changes. Excessively enhanced alpha- and beta oscillatory responses in the lithium-treated patient group may indicate
excessive activation of the neuron groups during a cognitive task. It remains to be elucidated whether this activation is associated with
mood stabilization or an adverse effect on cognitive functioning.
Keywords: bipolar disorder, event-related oscillations, lithium
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[OP-004] Mood disorders
Ref. No: 0302
The relationship between serum levels of haptoglobin and neopterin and
the number of episodes in patients with major depression
Abdullah Bolu1, Murat Erdem2, Adem Balikci2, Ali Emrah Bilgen2, Emin Ozgur Akgul3, Ozcan Uzun2, Muzaffer Oztosun4
Flight Crew Health Research and Education Center, Eskisehir-Turkey
1
Gulhane Military, Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
2
Gulhane Military, Faculty of Medicine, Department of Biochemistry, Ankara-Turkey
3
TSK Health Command, Health Services Command, Ankara-Turkey
4
e-mail address: [email protected]
Objective: At studies trying to explain the association between depression and immune system, pro-inflammatory cytokines have
come to the fore and there appears to be an increase in particular at the cellular immune response. In this study, we aimed to
investigate the effects of depressive episodes on serum levels of neopterin and Hp by comparing serum haptoglobin and neopterin
levels of the depressive patients at their first attack with depression patients suffering from recurrent attacks and with the healthy
control group.
Method: Eighty patients who admitted to the outpatient psychiatry clinic of Gulhane Military Medical Academy (GMMF), Ankara, Turkey
were included in the study. 44 individuals were being followed up with a diagnosis of first episode depression. There were 36 patients in
the recurrent major depression (MD) group. The control group consisted of 41 healthy individuals
Results: At the recurrent MD group serum Hp and neopterin levels were higher than the first episode MD patients and the control group.
HAM-D scores of MD patients (both first-episode MD and recurrent MD group) were correlated with serum levels of Hp, but there was no
correlation between serum neopterin levels and HAM-D scores.
Conclusion: The independent factor affecting the neopterin and Hp levels in patients with MD was found as the number of episodes of
depression. Unlike the first episode patients, recurrent episodes have resulted with increased levels of both markers.
Keywords: depression, neopterin, haptoglobins
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S99
[OP-005] Childhood and adolescence disorders
Ref. No: 0305
Distinguishing bipolar disorders from psychotic disorders in adolescents
and subtleties of indistinguishable cases
Nese Perdahli Fis
Marmara University, School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
In a typically developing brain, continuing myelination of certain cortical areas and pruning of the previously established synapses
represent the two most important developmental changes during the adolescence. There are several behavioral and emotional
consequences of these changes. The most common projection is the turmoil of typically developing youth including the interpersonal
conflicts and the task of identity formation. For some others, when the developmental trajectory shows derailment, several psychiatric
clinical outcomes may emerge, necessitating professional assistance. Bipolar Disorder (BPD) and Schizophrenia share this, so called
neurodevelopmental, model with a typical onset in late adolescence or early adulthood. In addition to having a similar etiological model,
the two disorders may show overlapping symptom profiles especially in early onset cases. Pediatric BPD is associated with higher rates
of psychosis than the adult onset form (Carlson et al. 2000). In some cases, where the psychotic features are predominant, it is difficult
to differentiate the BPD and Psychotic Disorders in adolescents. It is critical, because the outcome and the psychopharmacological
interventions differ in two disorders. The differentiation is based on type of the symptoms and the course of the illness. A thorough
evaluation, including a detailed psychiatric history and mental status examination, is of great value. The chance of an accurate diagnosis
is increased by sticking to the diagnostic criteria and by taking the characteristics of delusions and hallucinations into account. The
overall course of the disorder and the patient’s level of function are, as well, the other possible indicators. The aim of this presentation is
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to highlight the possible indicative variables in distinguishing the pediatric BPD from Early Onset Psychotic Disorders and to review the
management processes in undistinguishable cases.
Keywords: adolescence, bipolar disorder, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S99-S100
[OP-006] Psychopharmacology
Ref. No: 0327
Lamotrigine induced extrapyramidal side effects: a case report
Ergul Fidan Kircelli1, Fuat Kircelli2
Kanuni Sultan Suleyman Training and Research Hospital, Istanbul-Turkey
1
Council of Forensic Medicine, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: Lamotrigine is an anticonvulsant drug, a sodium channel blocker and inhibitor of glutamate release, effectively used in
bipolar disorder treatment especially in depressive episodes of bipolar disorder. It is recommended by certain therapy guidelines as a
first-line agent for acute and maintenance therapy in bipolar depression. It is generally a well tolerated agent and most common side
effect is simple dermatological eruptions, but sometimes fatal side effects can be seen like toxic epidermal necrosis and Steven Johnsons
Syndrome. Rarely neurological side effects are reported like ataxia and incoordination, but as we know there isn’t any lamotrigine induced
extrapyramidal syndrome reported.
Case: A 48-year-old male patient appealed to our out patient clinic with depressive symptoms like anhedonia, unhappiness, and
hopelessness. He was diagnosed as bipolar disorder twenty years ago. He was entered to inpatient clinic four times and took electro
convulsive treatment in one of them. He had four suicide attempts. When he appealed to our outpatient clinic he was taking olanzapine
10 mg/day and lithium carbonate 900 mg/day. Because of his depressive complaints we added lamotrigine to his present treatment.
Lamotrgine titrated as 12.5 mg/day first week, 25 mg/day second week and 50 mg/day third week. After one month usage as the
lamotrigine dosage was 50 mg/day extrapyramidal symptoms like tremor, bradykinesia, rigidity appeared. Patient and his family said
that these symptoms happened fort he first time. At first, we measured blood lithium level, routine biochemical markers, hemogram,
sedimentation and thyroid function tests, but all of them was in optimum level. Patient was taking olanzapine and lithium carbonate
treatment for twenty years so that we associated the extrapyramidal symptoms to lamotrigine treatment. Patient wanted to maintain the
lamotrigine treatment because he said that the depressive symptoms decreased after lamotrigine therapy and he felt himself better. So
we added to treatment biperiden 2 mg/day. The extrapyramidal symptoms regressed an then biperiden dosage is raised to 4 mg/day and
all of the symptoms disappeared. The lamotrigine treatment maintained as 100 mg/day.
Conclusion: The patient was using olanzapine and lithium carbonate approximately twenty years and he didn’t describe similar
symptoms before, so it points that extrapyramidal symptoms must be associated with lamotrigine treatment. Lamotrigine don’t
have any drug interaction with olanzapine and lithium carbonate that can explain this situation. Extrapyramidal symptoms induced
lamotrigine treatment is an unexpected side effect. If the clinician decides to begin lamotrigine treatment, these side effects must be
kept in mind.
Keywords: lamotrigine, extrapyramidal side effects
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[OP-007] Psychosocial and other non biological therapies and interventions
Ref. No: 0336
The concept of development of mental health services in the republic of Kazakhstan
Sagat Altynbekov
Kazakh National Medical University named after S.D. Asfendiyarov, Psychotherapy and Addiction, Department of Psychiatry, Almaty-Kazakhstan
e-mail address: [email protected]
There is a need of reforming mental health services in Kazakhstan. The basis of the concept of reforming mental health services lies in the
following focus areas and activities:
Focus Area 1. Strengthening of mental well-being:
activities in the ante-perinatal period; promoting mental health in schools; promoting mental health at workplace; conducting public
awareness campaigns and participation of staff of psychiatric ambulance services in this work.
Focus Area 2. Ensuring the significant role of mental health.
Focus Area 3. Reducing stigmatization and discrimination.
Focus Area 4. Organization of services to support and adapt to different stages of life.
Focus Area 5. Prevention of preventable mental health problems: adopt a state program on suicide prevention among the population of
the RK; revise qualifications of specialists as relates to vesting them with responsibilities to identify mental health problems.
Focus Area 6. Ensuring availability of rendering assistance to persons with mental health problems at all levels: ensure access to mental
health services within PAS and provide care based on protocols of prevention, treatment and diagnosis.
Focus Area 7. Ensure the opportunity to offer effective services to people with severe mental health problems in a variety of conditions:
arrange alternative types of specialized mental health care; develop training programs for family members and persons who look after
mentally ill people.
Focus Area 8. Organization for Cooperation among different industries and sectors: develop joint orders for various departments in the
field of mental health; review the mechanism of granting preferential treatment to employers who employ persons registered with a
psychiatrist.
Focus Area 9. Human resource development in all industries: train specialists in the field of mental health in countries with best
practices in the provision of care to people with mental disorders; promote cooperation and partnerships between researchers in
various countries.
Focus Area 10. Creating an effective information system for mental health issues: deploy a register on mental health; develop new
indicators to assess the state of mental health; measure baseline indicators and prevalence of key psychiatric disorders.
Focus Area 11. Ensuring fair and adequate funding for: assess effective distribution of financial resources; centralize medical supply of
psychotropic drugs at country level.
Focus Area 12. Ensuring R&D activities in the area of mental health: study the burden of mental disorders; develop and select priority
research programs; enhance international cooperation in the area of scientific research.
Keywords: mental health services, mental health, reform
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S101
[OP-008] Substance abuse and dependence
Ref. No: 0383
Treatment of the asthenoadynamic variant of post withdrawal disorders
in opioid addiction
Nazira Hodzhaeva, Shohruh Sultanov, Zarif Ashurov
Tashkent Medical Academy, Department of Psychiatry and Addiction, Tashkent-Uzbekistan
e-mail address: [email protected]
Objective: The development of organic brain disorder in opioid addiction is still discussed. Recent studies demonstrated the presence
of psychoorganic disorders in patients with opioid addiction. Treatment and rehabilitation measures for correction of neurocognitive
disturbances and prevention of degenerative processes in central nervous system (in particular, so called neurometabolic stimulants,
nootropics) are required in addition to the specialized substance abuse therapy of opioid addiction.
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The aim of the study was to evaluate the dynamics of cognitive disturbances and neurotic disorders in patients with asthenic-adynamic
variant of post withdrawal disorders in opioid addiction during the treatment with Cerebrolysin.
Methods: Sixty two patients with heroin addiction were studied after the period of detoxication.
Group 1 included 36 patients with the manifest stage of the disease (disease duration was since 4 months till 5 years). Group 2 included
26 patients with the disease duration more than 5 years. Organic brain changes were observed in MRT in almost 50% of patients. Though,
the data ratio demonstrated significant differences between the groups. Normal brain MRT data prevailed in Group 1 in comparison to
Group 2.
Results: Regarding neuropsychological data, the symptoms of mild exhaustion without any significant neuropsychological syndromes
were found in Group 1. However, in Group 2 decreased concentration, rapid exhaustion, memory impairment, emotional and behavioral
disorders were observed. Average MMSE cognitive function score was 24,3±0,4 which corresponded to cognitive impairment and
dementia status.
Early diagnostics of brain disturbances is important both from theoretical and practical point of view because treatment and prevention
measures are really effective at this stage.
The treatment with Cerebrolysin (5ml intramuscularly per day, the course of 20 injections) was started since the 7th-9th day after the last
drug use. Affective lability, hypochondriacal, fatigue, inactivity, the inability to do any work persisted after the relief of acute abstinent
syndrome.
Comparative analysis of the dynamics of cognitive function data demonstrated that in Group 1 the abilities and interest to perform
simple intellectual activity appeared and the spectrum of everyday activities significantly enhanced after the treatment with Cerebrolysin.
Patients regained the activity and work and reached good well-being and mood which were damaged because of the disease. We suggest
that this kind of positive dynamics after treatment confirms the influence of organic brain damage on the genesis of patients’ complaints.
In Group 2 the positive therapeutic response observed but was limited by the improvement of mood and every day activities.
Conclusions: In our study the craving for drugs was not observed in patients after the treatment with Cerebrolysin as it was already
described as a frequent effect of nootropic therapy.
Thus, the treatment with Cerebrolysin caused the improvements in cognitive function as well as the decrease of asthenic-adynamic
symptoms, such as rapid exhaustion, asthenia, apathy, adynamia. Cerebrolysin is recommended to be included into the therapeutic
programme for patients with heroin addiction during early stages of disease.
Keywords: heroin addiction, withdrawal symptoms, cerebrolysin
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S101-S2
[OP-009] Anxiety disorders
Ref. No: 0391
Psychotherapy of sleep disturbances in posttraumatic stress disorder
Taner Oznur
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Sleep disturbances are the most frequently experienced symptom of post-traumatic stress disorder (PTSD) patients. Compared to healthy
controls, PTSD patients have problems such as falling asleep, maintaining sleep, waking up due to the nightmares. Patients often state
that their sleep is not restful and they wake up even more tired. Polysomnographic studies showed that patients with PTSD experienced
more than one disturbance among the sleep problems listed above. Some psychotherapeutic interventions were developed other
than pharmacological approaches for sleep disturbances experienced by PTSD patients. However, nowadays it can not be said that any
psychotherapy approach could able to produce a completely solution to sleep disturbances observed in PTSD. Therefore, combination
therapies are the basic approach for sleep disturbances. The main approaches for the sleep disturbances observed in PTSD are Cognitive
Behavioral Therapy (CBT), Image Rehearsal Therapy (IRT), Hypnosis and Creative Arts Therapies. Although the successes of each method
are variant, CBT and IRT are the most widely practiced and found relatively effective methods.
Keywords: cognitive behavioral therapy, image rehearsal therapy, hypnosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S102
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[OP-010] Childhood and adolescence disorders
Ref. No: 0405
Treatment of children with autism spectrum disorders and co-existing attention
deficit hyperactivity disorder, with atomoxetine: a retrospective study
Ayse Kilincaslan, Tuba Mutluer, Basak Pasabeyoglu, Mustafa Deniz Tutkunkardas, Nahit Motavalli Mukaddes
Istanbul University, Istanbul Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: The present study examined the effects of atomoxetine (ATX) on attention deficit/hyperactivity disorder (ADHD) symptoms
and autistic features in children with autistic spectrum disorders (ASD).
Method: The files of children with confirmed ASD and ADHD, who had been on ATX treatment, were examined. Fourty-two individuals
(33 males and 9 females, age range 6-17 years, mean: 10.0±3.5) were selected. Thirty-three of the children have already been taking other
psychotrophic medications, which were not changed during the ATX treatment. All patient files provided information about severity of
symptoms, improvement in clinical features and observed side effects using the Clinical Global impressions-improvement scale (CGI-I),
DSM-IV based ADHD rating scale (ADHDRS-IV), Aberrant Behavior Checklist and Barkley Stimulant Side Effect Rating Scales at baseline, in
week 4 and week 12. Autistic symptoms were rated via the Childhood Autism Rating Scale. ATX was started with a dose of 0.3-0.5 mg/kg/
day, titrated slowly to 1-1.2 mg/kg/day in 4 weeks, and the dose was adjusted to 1-1.4 mg/kg/day according to clinical opinion.
Results: ATX was well tolerated with the exception of 6 patients (14%), who stopped medication after the 4th week visit. Among these
subjects efficacy data were treated by using the last observation carried forward model. Twenty-two subjects (52.4%) were considered
responders to treatment with a CGI-improvement of “very much improved” or “much improved”. On the parent rated ADHDRS-IV, there
was significant reduction from baseline to week 4 and from week 4 to week 12 in inattention, hyperactivity and impulsivity. Fifty percent,
42.9% and 50% of the patients showed >=25% improvement in inattention, hyperactivity and impulsivity by week 12, respectively.
Decrease was significant in the hyperactivity and social withdrawal subscales of the parent reported ABC and 52.4% and 45.2% of
the patients showed >=25% improvement, respectively. No significant change was reported for stereotypic, self-mutilative and other
problem behaviours. Responders (n=22) were not significantly different from non-responders (n=20) in terms of age, gender, ASD type,
intellectual and language level, baseline CGI severity, level of autistic symptoms and presence of epilepsy. The most common side effects
were irritability, decrease in appetite, drowsiness, sleep problems, moodiness. Six patients stopped taking medications due to lack of
efficacy, increased motor activity and talkativeness, irritability, temper outbursts and increased blood pressure.
Conclusions: ATX appears to be safe and effective for the core symptoms of ADHD as well as withdrawal in children with ASD. None of
those clinical and demographic parameters helped to predict the responders in our sample.
Keywords: autism spectrum disorders, attention deficit hyperactivity disorder, atomoxetine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S103
[OP-011] Psychopharmacology
Ref. No: 0408
Influence of psychotropic drug exposure during pregnancy on neonatal infant outcome
Anne Laure Sutter Dallay1, Mélanie Bales1, Elodie Pambrun1, Nine M C Glangeaud Freudenthal2, Hélène Verdoux1, Smf Mbu Working Group2
Pôle Universitaire de Psychiatrie Adulte, Réseau de Psychiatrie Périnatale, CH Charles Perrens, Bordeaux; EA 4139, France
1
INSERM, UMRS 953, Paris, France; UPMC University Paris 06, UMR S 953, 75005, Paris, France
2
e-mail address: [email protected]
Objective: To assess in a sample of dyads admitted in mother-baby units (MBUs) whether prenatal exposure to psychotropic drugs is
associated with poor neonatal outcome.
Method: We used the database collected by the French Network of Mother-Baby units (MBUs) (Société Marcé Francophone group) over
10 years (2001-2010) in 13 French psychiatric MBUs. Data about exposure to psychotropic drugs (antipsychotics, antidepressants, mood
stabilizers, anxiolytics-hypnotics) and trimester of exposure (never exposed, 1st and/or 2nd trimesters, 3rd trimester) were available for
993 dyads. We considered the 3 following neonatal infant outcomes: low birth weight (< 2500g), prematurity (< 37 weeks of gestation)
and neonatal hospitalization during the first month of life. Multivariate logistic regressions giving adjusted OR (aOR) were performed to
explore the independent associations between prenatal exposure to the different classes of psychotropic drugs and infant outcomes,
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after adjustment for a priori selected confounding factors (mother’s social and demographic characteristics, pregnancy tobacco use,
maternal psychiatric diagnoses (ICD-10 criteria) and type of MBUs unit (child /adult psychiatry).
Results: About half of the mothers (43.3%) used at least one psychotropic drug during pregnancy. Analyses’ exploring the impact of
exposure irrespective of trimester of exposure showing an association at trend level was found between low birth weight and exposure
to mood stabilizers (aOR=1.94, 95%CI=0.98-3.84, p=0.06). No association was found between exposure to psychotropic drugs and
prematurity. The risk of neonatal hospitalization increased in infants prenatally exposed to anxiolytics/hypnotics (aOR=1.90, 95% CI=1.302.77, p=0.001) or to antipsychotics (aOR=1.84, 95% CI=1.25-2.70, p=0.002), and at trend level with antidepressants (aOR=1.49, 95%
CI=0.97-2.27, p=0.06). Analyses exploring the impact of exposure according to the trimester showed that the risk for low birth weight
increased significantly in infants exposed during the 3rd trimester to mood-stabilizers (aOR=2.82, 95% CI=1.34-5.96, p=0.01) or anxiolytics/
hypnotics (aOR=1.59, 95% CI=0.99-2.56, p=0.05). The risk of neonatal hospitalization increased in infants exposed during 3rd trimester to
antipsychotics (aOR=1.89, 95% CI=1.23-2.91, p=0.004), mood stabilizers (aOR=2.11, 95% CI=1.04-4.30, p=0.04) or anxiolytics/hypnotics
(aOR=2.36, 95% CI=1.56-3.58; p=<0.0001).
Conclusion: As low birth weight is a risk factor for occurrence of a range psychiatric disorder, increasing the frequency of this risk factor in
a potentially genetically vulnerable population is challenging. So, the use of mood stabilizers and anxiolytics/hypnotics during pregnancy,
especially during the 3rd trimester, must be evaluated for each patient, through a detailed risk-benefit strategy. The increased risk for
infant’s neonatal hospitalization, when exposed to psychotropic drugs, and again especially in the 3rd trimester, enhance the need for
specialized care for women needing psychotropic treatments during pregnancy.
Keywords: psychotropic drug, pregnancy, infant outcome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S103-S4
[OP-012] Psychopharmacology
Ref. No: 0447
Properties of antipsychotics in patients with schizophrenia in care centers
Etem Erdal Erşan
Numune Hospital Psychiatry Clinic, Sivas-Turkey
e-mail address: [email protected]
Objective: The aim of this is to analyze the relation between individual or multiple drug administration patterns of persons residing in
care centers for disabled persons in Turkey and the population characteristics as well as the diagnoses.
Method: The target population of this study included those patients referring to psychiatric clinic for examination or control, and those
residing in care centers, and those diagnosed with a psychotic disorder according to DSM-IV and those individuals receiving antipsychotic
medications. As an antipsychotic drug administration, use of these medications in efficient treatment dose was evaluated. More than one
antipsychotic drug administration was considered to be multiple antipsychotic drug administration. Data acquired were analyzed with
SPSS 16.0 software. For digital comparison of groups, chi-square test was applied while for mean comparisons, t test was applied. P<0.005
was considered to be significant.
Results: Two hundreds individuals residing in care centers were contacted. Single antipsychotic drug administration ratio was 38%, while
double antipsychotic drug administration ratio was 34%, and more than three antipsychotic drug administration ratio was 28%. As single
antipsychotic drug administration most frequently olanzapine was used, and for double antipsychotic drug administration olanzapinequetiapine combination was most frequently used. Depot antipsychotic drug administration was most frequently applied with the other
antipsychotic drugs combination. Single depot antipsychotic drug use is less. Use of multiple antipsychotic was detected to be more in
those patients presenting with schizophrenia and schizoaffective disorder, in young patients, and those attempting suicide as well as
those with higher clinic level.
Conclusion: Despite the fact that use of multiple antipsychotics is suggested in treatment directions as last option in patients resisting
the treatment, and that they could be used in short terms during the antipsychotic change, they are frequently administrated. In addition,
there are not any studies concerning the use of antipsychotics in care centers in our country, and this condition is generally neglected.
Severity of disease is extremely high in the group using multiple antipsychotic drug. Even if it is reported that use of antipsychotics
enhances the mortality, morbidity, adverse effect risk and treatment cost, it is gradually increasing today.
Keywords: antipsychotics, multiple drug administration, care centers
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[OP-013] Childhood and adolescence disorders
Ref. No: 0459
Fluoxetine and aripiprazole treatment for OCD in a child with Wolfram syndrome
Mehmet Sertcelik, Cihat Kagan Gurkan
Ankara University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Wolfram syndrome (WS) is a condition characterized by diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy and deafness.
DM symptoms appear first, than optic atrophy develops in the first decade, and DI and sensorineural deafness occur in the second
decade. Etiopathology of the syndrome is not clear, however, inheritance of the syndrome is autosomal recessive. Generally, mutations
of WFS1, placed on the 4th chromosome, are responsible of the syndrome. Main diagnostic criteria of the syndrome are juvenile DM and
optic atrophy. Atony of urinary tract, ataxia, hypoflexia, mental retardation and psychiatric disorders are other defined clinical features.
Although the co-existence of other type of psychopathology was documented in the literature, there is no report of co-existence of WS
and Obsessive Compulsive Disorder (OCD). Here we report a child with WS with co-existent OCD, whose OCD symptoms responded
fluoxetine plus aripiprazole treatment.
Case Report: A ten years old female is referred by pediatric endocrinology department with complaints of obsessions, irritability, peer
problems and aggression. Previously, the child was diagnosed as DM, after applying the hospital with recurrent urinary tract infections.
She also had bilateral optic atrophy diagnosis. Genetic analysis was performed and a mutation on WFS1 gene was identified. After
psychiatric assessment, we made diagnosis of OCD according to DSM-IV and started medical treatment with fluoxetine 10 mg/day and
gradually increased to 30 mg/day. There has been no response to the treatment for 2 months. Hence, we started aripiprazole 5 mg/day.
Fluoxetine 30 mg/day and aripiprazole 5 mg/day treatment led to partial remission in 2 months. She is followed up with partial remission
with these treatment modalities.
In the literature, some psychiatric disorders include aggressive behaviours, increased suicide risk, paranoid delusions, schizophrenia,
resistant depression are identified in patients with WS, and genetic studies documented a weak linkage between psychopathology and
exon 8. The co-existence of WS and OCD may be meaningful in terms of shared etiological factors. On the other hand co-existent OCD
seems to respond usual psychotropic medications.
Keywords: obsession, treatment, wolfram
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S105
[OP-014] Clinical psychiatry
Ref. No: 0479
‘Everybody looks at my nose’: a case report of an adolescent patient with body
dysmorphic disorder
Fatma Benk, Ummugulsum Gundogdu, Duygu Calisir Murat, Ayse Rodopman Arman
Marmara University, Faculty of Medicine, Deparment of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Body dysmorphic disorder (BDD), is characterized by a distressing or impairing preoccupation with an imagined or slight defect in
appearance. The preoccupation with perceived appearance flaws (which usually focus on the face or head) typically occurs for many hours
a day, and most patients perform repetitive behaviors such as mirror checking, excessive grooming, and skin picking. BDD is associated
with markedly impaired psychosocial functioning, notably poor quality of life, and a high rate of suicidal ideation and suicide attempts
they often have needless dermatological treatment and cosmetic surgery. The condition is easily trivialised and stigmatised.
We report a case that was diagnosed as body dysmorphic disorder and his medical treatment was planned accordingly. The 16-yearsold male has been suffering for about 2 years from the belief that his nose was like a pig nose, such that everyone would stare at and
talk about it. The boy could not remember a particular occurrence which had brought the symptoms to the surface and had no insight
about its psychological nature. He was totally convinced that he could only be helped by a surgical correction of his nose. Appearance
concerns have affected his life dramatically by often upsetting him a lot, often getting in the way of doing things with friends and dates.
This situation affected his school and led him to avoid social activities. We prescribed Fluoxetine 40 mg a day as a starting dose and
titrated up by 40 mg increments in two weeks. Two months later his symptoms relieved by %70 and he gave up the idea of surgical
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Oral Presentations
operation. His pharmacotherapy has been ongoing successfully for 6 months. No cognitive behavioural therapy was required; supportive
psychoeducation about his body image and his own identity is maintained.
In recent years it is known that BDD rapidly responds to pharmacotherapy as it is in our case. Selective serotonin reuptake inhibitors
(SSRIs) are often efficacious for this disorder. Approaching treatment-resistant BDD have received little investigation, but available data
indicate that switching to another SSRI and several SSRI-augmentation strategies may be helpful.
Keywords: body dysmorfic disorder, fluoxetine, psychoeducation
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Turkish Association for Psychopharmacology (TAP)
5thInternational Congress on
Psychopharmacology
&
International Symposium on
Child and Adolescent Psychopharmacology
Improved choices of psychotropic medications:
better mental health outcomes
October 30 - November 3, 2013
Cornelia Diamond Hotel, Antalya, Turkey
www.psychopharmacology2013.org
Poster Presentations
Poster Presentations
[PP-001] Psychopharmaclogy
Ref. No: 0092
Four bipolar patients treated with quetiapine during pregnancy
Hatice Ezgi Degerli1, Kursat Altinbas2, Mehtap Delice1, Erhan Kurt1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, 5th Psychiatry Department, Istanbul-Turkey
1
Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Psychiatry, Canakkale-Turkey
2
e-mail address: [email protected]
Bipolar disorder is a disease typically starts at adolescence and early adulthood, namely reproductive period. Thus, the treatment of
women at reproductive period is very important because of the teratogenic effects of psychotropic drugs. It is informed that use of
classical antipsychotics in the course of pregnancy was not associated with congenital malformation and birth weight. While all drugs are
transferred to placenta, among antipsychotics quetiapine is the least transported one. Animal studies have not showed any teratogenic
effect. Even though human studies about the embryonic/fetal risk assessment are very limited, recent studies have shown no increased
risk of birth defect in quetiapine-exposed newborns and when compared to others, quetiapine can be a safe option in pregnancy. In this
report, on the treatment of quetiapine, there were not any teratogenicity and perinatal complication in four pregnant women, who have
bipolar disorder in depressive or manic episode.
Keywords: bipolar disorder, pregnancy, quetiapine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S108
[PP-002] Schizophrenia and other Psychoses
Ref. No: 0096
Chronic otitis media frequency in schizophrenia patients
Nalan Dirik1, Mehtap Arslan2, Ozlem Oflezer3, Erhan Kurt2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Otolaryngology, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Dentistry, Istanbul-Turkey
3
e-mail address: [email protected]
Objective: In this study, it is aimed to determine the frequency of chronic otitis media (CAM) in schizophrenia patients, and to examine
whether there is a correlation between schizophrenia and CAM.
Methods: Ninety seven patients, who are monitored with the diagnosis of schizophrenia, according to DSM-IV, receiving outpatient care
in a center, specialized on the treatment of schizophrenia, have been assessed. The findings were compared with those of 96 subjects in
the control group, consisting of healthy individuals, without psychiatric conditions. In addition, Positive and Negative Syndrome Scale
(PANSS) and Edinburgh Hand Preference Test (EHP) have been applied to schizophrenia group and EHP test to control group.
Results: No statistically significant difference with respect to the frequency of CAM has been recorded between schizophrenia and control
groups (p=0.3). Likewise, no significant difference was found with respect to the frequency of right CAM (p=0.2) and left CAM (p=0.9)
between schizophrenia and control groups.
Conclusion: Our hypothesis, concerning the possible correlation between schizophrenia and CAM or possible greater incidence of CAM
in schizophrenia patients, hasn’t been confirmed with the findings of this study.
Keywords: schizophrenia, chronic otitis media, Edinburgh Hand Preference Test
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Poster Presentations
[PP-003] Nonpharmacological Therapies
Ref. No: 0097
Safety of electroconvulsive therapy in pregnancy
Tugba Oztav1, Mehtap Arslan1, Ceyhan Oflezer2, Ozge Canbek1, Erhan Kurt1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Anesthesiology, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: Our objective in this study is to investigate the safety and the probable complications associated with the treatment of
electroconvulsive therapy (ECT) in pregnant patients either concurrent with or following the treatment.
Methods: In this study, all 25 inpatient cases, where ECT has been implemented during the years 2006-2012 at Bakirkoy Training and
Research Hospital for Psychiatry Neurology and Neurosurgery, have been included. These patients have been interviewed and their
clinical histories have been studied. Both maternal and fetal complications have been investigated. One out of the 25 incidences was
stillbirth.
Results: No pregnancy related complications have been observed during ECT. However, following ECT until the delivery, one case of early
amniotic membrane rupture and one case of premature birth were observed.
Conclusion: In our study, no findings were obtained regarding safety complications associated with the use of ECT during pregnancy.
Keywords: ECT, pregnancy, safety
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S109
[PP-004] Psychopharmacology
Ref. No: 0101
Aripiprazole induced tardive dyskinesia: a case report
Alparslan Asil Budakli, Mehmet Alpay Ates, Ibrahim Oner, Mesut Cetin, Cengiz Basoglu, Ayhan Algul, Hakan Balibey, Servet Ebrinc
GATA Haydarpasa Training Hospital, Psychiatry Service, Istanbul-Turkey
e-mail address: [email protected]
Tardive dyskinesia is a movement disorder after the long-term usage of antipsychotics. This clinical chart is characterized by involuntary
movements mainly on the muscles of mouth, lips, tongue and then face, neck and jaw muscles. Pharmaceutically, aripiprazole is an
atypical antipsychotic, which is partial agonist of D2 and D3, and 5-HT1A and a modest antagonist of 5-HT2A receptors. In this case report,
we aimed to discuss occurrence of tardive dyskinesia during the long-term use of aripiprazole.
A 71 years old male patient was admitted with reference delusions, auditory hallucinations, social isolation and involuntary movements
on his mouth and tongue. He has been an outpatient treated with antipsychotics for schizophrenia since 15 years. 2 years ago, aripiprazole
10 mg/day treatment has been started. It has been reported by the patient’s relatives that, he has not been going to his outpatient checks
regularly, repetitive involuntary movements have started approximately 5 months ago on his mouth and tongue, and he has remained
untreated within the last month. He was diagnosed to have tardive dyskinesia and schizophrenia based on his medical history and clinical
evaluation with PANSS (score: 82) and Abnormal Involuntary Movements Scale (score: 16). A treatment was planned with clozapine and
vitamin E under strict monitoring of white blood cell count. Patient has been scheduled for weekly checks.
Extrapyramidal findings like akathisia, tardive dyskinesia, acute dystonia, parkinsonism can be seen in patients, who are using
antipsychotics. Due to antipsychotic use, tardive dyskinesia with high potency (especially first generation) is observed more often. So
many cases in the literature show that even atypical antipsychotics might cause tardive dyskinesia. Although there was a case series
revealing positive results by switching to aripiprazole on tardive dyskinesia cases associated with the use of first or second generation
antipsychotics; As seen in our case, tardive dyskinesia can develop even after the long-term use of aripiprazole.
Keywords: aripiprazole, tardive dyskinesia, side-effect
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Poster Presentations
[PP-005] Psychopharmacology
Ref. No: 0102
A patient with prolonged hyperprolactinemia caused by clozapine: a case report
Esra Yancar Demir1, Aslihan Sayin2
Ordu Univeristy School of Medicine, Ordu-Turkey
1
Gulhane Military Medical Academy, Ankara-Turkey
2
e-mail address: [email protected]
Prolactin (PRL) is a pituitary hormone synthesized by lactotroph cells located in anterior pituitary gland, whose release is inhibited by
dopamine. Clozapine has a mild effect on nigrostriatal and tuberoinfundibular D2 receptors. Clozapine attaches to D2 receptors loosely,
and causes a transient and low level occupation of D2 receptors, and this has been proposed as the underlying mechanism of low risk of
hyperprolactinemia (HP) and extrapyramidal system symptoms (EPS) caused by clozapine.
Mrs. A.B. is a 29-year-old, divorced, mother of one child, housewife. She was married at the age of 18 and got pregnant after 7 months.
The first symptoms of schizophrenia had begun during her pregnancy, which were auditory hallucinations and disorganized speech and
behavior related to these hallucinations. During this hospitalization, her galactorrhea was noticed, her PRL level was found to be high
(4640.68 uIU/ml, normal range 102-496 uIU/ml) and amisulpiride was switched to clozapine. Despite this change, her galactorrhea still
continued. Her PRL level was 6117 uIU/ml. A pituitary MR (with contrast) was performed, which showed normal results. An endocrinology
consultation was made; it was thought that clozapine (she was receiving 300 mg/day at that moment) was causing her HP, and it was
recommended that it was stopped and was switched to quetiapine. Her PRL level was checked twice after switching to quetiapine, which
returned to almost normal levels (550.2 uIU/ml), and her galactorrhea stopped.
We think that HP in our case was primarily caused by amisulpiride. But we may say that HP and galactorrhea was prolonged by clozapine.
Switching to clozapine among other “prolactin-sparing” antipsychotics, is usually recommended after antipsychotic induced HP. Adding or
starting aripiprazole can be another management strategy, since it is the first potent D2 partial agonist among antipsychotics. Aripiprazole is
called “dopamine regulator” since it acts as a D2 antagonist in hyperdopaminergic condition, but as an agonist in hypodopaminergic conditions.
Keywords: clozapine, hyperprolactinemia, prolactin
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S110
[PP-006] Schizophrenia and other Psychoses
Ref. No: 0103
Secondary delusional parasitosis
Esra Yancar Demir1, Levent Sutcigil2
Ordu Univeristy School of Medicine, Ordu-Turkey
1
Gulhane Military Medical Academy, Department of Psychiarty, Ankara-Turkey
2
e-mail address: [email protected]
Delusional parasitosis which is also known as Ekbom syndrome is a very rare psychological disorder. This disorder is characterized by
patient, who has a static and false belief of having his or her body being covered by insects. This delusion is persistent even though
no scientific evidence can be found. The disorder is divided as primary or secondary according to etiology, primary being classified
under somatic type delusional disorders. The secondary reasons that may cause delusional parasitosis include psychological disorders
like dementia, psychosis, schizophrenia, obsessive compulsive disorder, bipolar disorder as well as organic disorders like DM, HT, CVD,
vitamin deficiencies and endocrine disorders. Even though delusional parasitosis is a psychiatric disorder, which is treated with atypical
and typical anti-psychotics, at doses being lower than those used in schizophrenia, patients usually refer to family practitioners, internal
medicine specialists and dermatologists. As these patients have weak insight, it may be hard referring them to a psychiatrist that leads to
elevated costs because of unnecessary laboratory examinations and improper treatment as well as grievances of the patient and relatives.
This paper is a report of a patient with secondary/secondary functional delusional parasitosis, who also has DM and HT with ongoing
depressive episodes with anxiety. The object of the paper is to review the clinic, etiology and treatment of Ekbom syndrome, which is a
rare disease that may accompany organic disorders.
Keywords: Ekbom syndrome, delusional disorder, pathogenesis
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Poster Presentations
[PP-007] Psychopharmacology
Ref. No: 0104
The importance and efficiency of clozapine treatment in early-onset and very
early onset schizophrenia cases: discussion over the observation process of five cases
Ipek Percinel1, Kemal Utku Yazici2, Serpil Erermis1, Burcu Ozbaran1, Sezen Kose1, Johanna Maria Zemla1, Tugba Donuk1, Bulent Idris1
Ege Univeristy, Faculty of Medicine, Child and Adolescent Psychiarty of Department, Izmir-Turkey
1
Firat Univeristy, Faculty of Medicine, Child and Adolescent Psychiarty of Department, Elazig-Turkey
2
e-mail address: [email protected]
Schizophrenia is a serious mental disorder emerging at early ages, characterized by significant breakdowns in thought, perception and
behavioral processes, alienation to common manners of perception and interpretation, a unique type of isolation and withdrawal from
human relations. It is defined as very early onset schizophrenia (VEOS) when the symptoms occur before the age of 13; and as early onset
schizophrenia (EOS) when they occur before the age of 18. Psychopharmacologic and psychosocial approaches should be combined
for the treatment of schizophrenia. Although the effects and side effects of both typical and atypical antipsychotics from the field of
psychopharmacology have been studied for adult patients in detail, the studies made for child and adolescent age group are inadequate.
Children and adolescents are more susceptible to side effects than the adults. Atypical antipsychotics have been proven to be more
efficient on negative and cognitive symptoms compared to typical antipsychotics. Clozapine is a prototype of atypical antipsychotics and
the first antipsychotic to be defined as atypical. Clozapine is a HT2A/D2 antagonist. Clozapine is effective on cases, on which typical and
other atypical antipsychotics having the most efficiency yet the most side effects fail, and is accepted as “gold standard” in the treatment
of schizophrenia. The most serious side effect of the drug is agranulocytosis, which may cause death and are observed approximately 1%
of the cases. The risk of seizures increases especially in high doses. In addition it may cause intensive sedation, hyper-salivation, weight
gain and myocarditis.
In this paper, the effects and side effects of clozapine in five adolescent cases diagnosed to have VEOS and EOS are discussed. The
clinical evaluations of the cases during the process have been made as follows: the side effects have been assessed with Extrapyramidal
Symptoms Rating Scale (ESRS); the severity of the disorder has been assessed with “Clinical Global Impression Scale/Severity” (CSI-S);
improvement rate during the observation process has been assessed with “Clinical Global Impression Scale/Improvement” (CSI-I); level of
functionality has been assessed with “Global Assessment Scale” (GAS); and the psychotic symptoms have been assessed with “Scale for
the Assessment of Negative/Positive Symptoms” (SAPS/SANS).
Four cases showed a quite good response to the treatment and tolerated clozapine, the last case (Case IV) showed apparent decreasing
trend in neutrophil count.
In this case report, evaluates the efficiency and the side effect profile of clozapine treatment on five adolescent cases in total, one case
with VEOS diagnosis and four cases with EOS diagnosis. The clinic examination results of four cases (Case I-II-III-V) showed that clozapine
is effective on childhood schizophrenia. While these four cases showing a quite good response to the treatment tolerate clozapine well,
the last case (Case IV) showed apparent decreasing trend in neutrophil count a short while after starting the treatment and consequently
the treatment was stopped. Follow-up process and other findings were discussed accompanied by the literature.
Keywords: childhood onset schizophrenia, clozapine, management
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S111
[PP-008] Forensic psychiatry
Ref. No: 0106
Evaluation of criminal responsibility for children between 2005-2009 in Corum
Erdal Ozer1, Ozgur Enginyurt2, Esra Yancar Demir2
Gaziosmanpasa University, Department of Forensic Medicine, Tokat-Turkey
1
Ordu University, Department of Family Medicine, Department of Psychiatry, Ordu-Turkey
2
e-mail address: [email protected]
Objective: The aim of this study was to examine the juvenile criminal cases brought to the district office of forensic medicine and to
emphasize if the psychiatric interventions which were carried out in early age affected the adulthood psychopathology and recidivism
rate decline.
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Poster Presentations
Method: This study was conducted retrospectively between June 1st 2006 and June 31st 2010 at a four-year-period by examining the data
of children those brought to the district office of forensic medicine for a claim of crime. Patients were examined in terms of gender, age,
education level, number of siblings, type of offense, type of family with whom the child lives and mental status.
Results: A total of 246 patients were recruited in this study; 217 of them were male and 29 of them were female. The age distribution of 204
patients were between 14 - 15 years old. 108 of them were 14 years old, 96 of them 15 years old and 38 of them 13 years old. Accounting
on the distribution patterns of criminal behavior among children between ages and chi-square analysis of the results of analysis of crime
patterns among children aged 13 to 14 (all), no significant differences were detected (p>0.05). Among 15 years old children, significantly
different crimes against sexual inviolability have been seen according to the other age groups (P <.05). 12 years old children showed
significant differences for crimes against the assets compared to other age groups (P <.05). All of the children in this age group have
committed crimes against the assets. The highest rate of crimes against bodily integrity (25%) was found in the age group of 14.
Conclusion: Juvenile delinquencies indicate a significant increase in our country, as well as all over the world and appears as a major
public health problem. The important factors that affect juvenile delinquency are social environment, family and living conditions as
well as the child’s intelligence and psychiatric status. In our study, crimes against sexual inviolability were seen at the age group of 15
significantly more than the other age groups. A number of studies determined that many adult who committed a sexual crime have
started this at a young age. For this reason, evaluation for psychiatric and implementation of the necessary treatment strategies on
individuals with early age onset of sexual crimes can prevent the transfer of these behaviors to adulthood period.
Keywords: juvenile delinquency, forensics psychiatry, psychiatric evaluation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S11-S2
[PP-009] Substance abuse and dependence
Ref. No: 0107
A case report of benzodiazepine dependence
Sercan Karabulut, Lutfi Ilhan Yargic
Istanbul University, Istanbul Faculty of Medicine, Psychiatry of Department, Istanbul-Turkey
e-mail address: [email protected]
Since their introduction in 1950s, benzodiazepines appear to be used for the treatment of anxiety disorders while it is recommended that
they should not be prescribed as the first line treatment. The wide use of benzodiazepines could be explained, at least in part, by their
good clinical efficacy in terms of reduction or control of anxiety-related symptoms and in terms of decreased risk of suicide because of
their low toxicity. However, there is strong evidence suggesting that benzodiazepines could have a dependence potential, that chronic
use is associated with adverse effects and that withdrawal might produce a definite abstinence syndrome.
In this case we present a 33 year-old man, who admitted to the outpatient clinic because of clonazepam dependency. He had been
working as a medical doctor and had used clonazepam for 9 years regularly (up to 4 mg per day). After recovering from Pott disease 12
years ago, he was recommended to use clonazepam for chronic back pain. Increased self-esteem, euphoria and lack of dizziness were the
main motivators for the patient for continuous use. Although he was recommended to decrease the dosage, he did not quit or taper the
drug. His maximum abstinence period was 10 days. Patient stated that he was using the drug to “improve his performance”. He reported
taking clonazepam before important social and occupational activities. He believed that it was impossible to express himself or to talk
to his supervisor without taking this medication. The former psychiatrist had planned a gradual tapering of clonazepam but the patient
found that schedule difficult to continue.
He was euthymic, expressed anxiety about doing his daily activities without clonazepam and risk of insomnia. He did not have any other
substance abuse or dependency or other psychiatric disorders, and was followed and treated with a tapering protocol. The first step was
to fix the dose of clonazepam at certain times, as decided by the patient (2 mg at morning and 2 mg at noon). With this step, increase
of drug dosages to improve performance was prevented. Patient started to notice that social performance was better without taking an
extra dose of clonazepam. After 2 months, clonazepam was tapered down gradually (0.25 mg per month). Anxiety to reduce the drug and
distractibility were significant at the beginning, but decreased within a few months.
Treatment of psychological dependency is important and must be the first target before tapering. In addition to this, low dose tapering
and psychotherapeutic relationship based on empathy have a key role in treatment process.
Keywords: benzodiazepine, dependence
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S112
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Poster Presentations
[PP-010] Schizophrenia and other psychotic disorders
Ref. No: 0108
Very early onset schizophrenia treated with a combination of clozapine and risperidone:
a case study
Hulya Ertekin1, Memduha Aydin1, Hatice Yardim Ozayhan1, Abdullah Akpinar2
Konya Training and Research Hospital, Department of Psychiatry, Konya-Turkey
1
Suleyman Demirel University, Department of Psychiatry, Isparta-Turkey
2
e-mail address: [email protected]
Childhood onset schizophrenia is a rare disorder, whose prognosis is generally worse than the adult onset type of schizophrenia.
Schizophrenia, which the psychotic symptoms appear after the age of 13 years is called early onset schizophrenia (EOS), and the
schizophrenia with the psychotic symptoms which are present before the age of 13 is called very early onset schizophrenia (VEOS). There
is a consensus about the treatment of the childhood and adolescent onset schizophrenia that second generation antipsychotics might
be more successful in the treatment. Risperidone was more often prescribed than clozapine. Although these patients seem to be more
resistant to the treatment, the use of clozapine is not common.
We present here, a case of a 16 years old, single woman, who was diagnosed to have schizophrenia when she was 12 years old.
Risperidone 2 mg was given to her for the treatment. After a while, her treatment was switched to olanzapine. After one year treatment
with olanzapine, because of the side effects of olanzapine, her treatment was changed to amisulpiride 200mg. But after one year on
amisulpiride, delusions of persecution and irritability had begun; her treatment has finally be redesigned with clozapine 200 mg and
risperidone 2 mg. After this treatment, delusions of persecution and irritability decreased, communication with her family members has
been normalized.
The diagnosis of VEOS requires a multidisciplinary approach, a detailed and careful differential diagnosis, with particular attention to risk
factors for developing VEOS, exclusion of other neuropsychiatric disorders and a close long term follow up. The treatment of VEOS should
include psychopharmacological, social and educational approaches. This case report suggests that the use of clozapine and risperidone
combination in childhood onset schizophrenia following the recommended precautions can be safe and effective.
Keywords: diagnosis, treatment, very early onset schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S113
[PP-011] Childhood and adolescence disorders
Ref. No: 0127
Possible exogenous growth-hormone induced mood disorder with mixed
features in a child: a case presentation
Taha Can Tuman1, Zehra Topal2, Nuran Demir2, Ali Evren Tufan2
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu-Turkey
2
e-mail address: [email protected]
Growth Hormone (GH) deficiency incidence in infants is reported to be 1 in 3800 live births, and although adequate data are missing, it
is thought to be rising among older children due to increased survival after childhood malignancies. The main effect of GH deficiency in
childhood is growth failure and it is treated with exogenous growth hormone replacement. Treatment with GH in childhood is generally
without serious complications and the most common side effects reported are listed as headache, joint/muscle pains, fluid retention, mild
hypertension, visual problems, nausea/ vomiting, paresthesia, antibody formation, reactions at injection site and rarely, being intracranial
hypertension. Here, we report a case of mood disorder with mixed features in a pre-pubertal child, which was possibly related with
exogenous GH replacement.
The patient was an 11-year-old male, who was brought to our department with complaints of “insomnia, talkativeness, increased energy
and spending”. Upon questioning, it was learnt that the complaints were present for the last 3 months. He was inattentive, hyperactive,
euphoric and it was reported that “he felt he could do anything”. His grades suffered and within the last month he verbalized suicidal
ideations to his teachers. Mental status examination revealed auditory hallucinations, grandiose delusions alternating with depressive
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ruminations and limited insight.
The medical and psychiatric history was unremarkable except growth failure, which led to a referral to the pediatrics department
4 months ago. The patient was diagnosed with GH deficiency and GH injections were commenced 3 months ago. Apart from mild
memory problems and irritability, no depressive episode was reported prior to treatment with GH. Family history was negative for
psychopathology. A neurological examination ruled out papillary edema and no signs or symptoms of intracranial hypertension were
reported. Psychometric evaluation with the Childhood Mania Scale as completed by the parents revealed a score of 35 (chief complaints:
auditory hallucinations, paranoid ideations, impulsivity, grandiosity, pressured speech, insomnia, increased energy, euphoria and
irritability). The baseline evaluation with Young Mania Rating Scale yielded a score of 38. Childhood Depression Inventory and other
measures could not be completed due to excessive hyperactivity. The patient was moderately impaired due to his symptoms as rated
with Children’s Global Assessment Scale (CGAS) revealing a score of 45. Consequently, the patient was diagnosed to have Mood Disorder
with Mixed Features due to Exogenous GH, according to DSM-IV criteria and treatment was started with risperidone 0.5 mg/ day, later
titrated to 1 mg/day. A follow-up visit after 2 weeks revealed a YMRS score of 24 and a CGAS score of 55 (Variable functioning). Because
of persisting grandiose delusions and depressive ruminations, valproate 200 mg/ day was added on and a follow- up visit is planned.
Here we report a case of mood disorder with mixed features in a pre-pubertal child. An evaluation with the Naranjo Algorithm yielded a score
of 4 (Possible Adverse Drug Reaction, 3) and the patient responded partially to a trial of antipsychotics and mood-stabilizers. As a result, it can
be said that exogenous GH in children may lead to secondary mood disorders. Our results should be confirmed with future studies.
Keywords: exogenous growth hormone, mood disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S113-4
[PP-012] Neuroscience
Ref. No: 0132
A Fahr’s disease case presented with psychotic manic epizode
Baise Tikir, Nazmi Caglar, Makbule Cigdem Aydemir, Erol Goka
Ankara Numune Education and Research Hospital, Psychiatry Clinic, Ankara-Turkey
e-mail address: [email protected]
Fahr’s disease is bilateral, symmetric, and idiopathic calcifications in basal ganglia. Calcification is one of the three basic features.
The others are psychiatric symptoms and movement disorders. Psychiatric symptoms are mood changes, psychosis, obsessions, and
personality changes. These symptoms appear not only with neurological symptoms but also are rarely isolated. Cummings and friends
described two types of Fahr’s disease. Presentation with psychosis is “early-onset type” and typically manifested dementia with motor
system disorders is called “late-onset type”. In this case report, we discussed a case that had begun with obsession followed by manic
episode with psychotic symptoms, that is considered to be of organic etiology because of its atypical psychiatric clinical appearance,
diagnosed as Fahr’s disease as a result of neuroimaging techniques and further investigations. We think that this case will contribute to
literature about psychiatric aspects of basal ganglia and approach to the psychiatric patients.
Keywords: Fahr’s disease, basal ganglia calcification, manic episode
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S114
[PP-013] Psychopharmacology
Ref. No: 0133
Dose related hyperprolactinemia with venlafaxine: a case report
Esra Yancar Demir1, Ozgul Gozlukaya2, Hulya Olgun Yazar3
Ordu Universty, Faculty of Medicine Resarch Hospital Clinic of 1Psychiatry, 2Biochemistry, 3Neurology, Ordu-Turkey
e-mail address: [email protected]
Venlafaxine is a serotonin and noradrenaline reuptake inhibitor (SNRI) agent. Besides serotonin and noradrenaline reuptake inhibition
effect it has also little effect on dopamine reuptake inhibition. The power of reuptake inhibition is dose dependent. The serotonin and
noradrenaline reuptake inhibitors like venlafaxine have very rare side- effects on reproductive and endocrine systems. The literature
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reveals only one case about venlafaxine causing galactore and 2 cases of dose related rise in prolactin levels. In this paper, we report a
70 years old female patient with vascular dementia. She had received 20 mg/day escitalopram treatment because of depressive mood
but had no benefit. We changed the medical treatment to 75 mg/day venlafaxine and not having proper answer, we raised the dose to
150 mg/day. As soon as the dose was titrated up, the patient started to have symptoms like nausea, vomiting, weight loss and sleepiness
that were progressive day by day. Upon investigation of the possible cause of the symptoms, hyperprolactinemia was identified and the
mechanisms leading to hyperprolactinemia were further investigated. Magnetic Resonance (MR) imaging for adenomas were free of
proof. Then the drugs used by the patient were evaluated. Venlafaxine was the only possible suspect as the symptoms started after its
administration and the dose of the drug was reduced to 75 mg/day and the laboratory showed a decrease in prolactin levels to normal.
Data presented in this report is consistent with the previous case reportings about dose related elevations of prolactin levels. With this
case report, we wanted to attract the attention to a very rare adverse effect of venlafaxine that is believed to be dose related and try to
find answers about the possible mechanisms.
Keywords: venlafaxine, hyperprolactinemia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S114-S5
[PP-014] Nosology and classification
Ref. No: 0137
The association between problematic internet use, suicide probability,
alexithymia and loneliness among Turkish medical students
Ahmet Hamdi Alpaslan1, Nusret Soylu2, Kadriye Avci3, Halil Ibrahim Guzel4, Omer Ozbulut4
Afyon Kocatepe University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Afyonkarahisar-Turkey
1
Inonu University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya-Turkey
2
Afyon Kocatepe University, Faculty of Medicine, Department of Public Health, Afyonkarahisar-Turkey
3
Afyon Kocatepe University, Faculty of Medicine, Department of Psychiatry, Afyonkarahisar-Turkey
4
e-mail address: [email protected]
Backgrounds: Internet is a communication tool commonly used throughout the world and is increasingly enlarged as time passes. It is
known that the prevalence of internet use is higher among adolescents and the young adults all over the world. It was reported that the
age group, which uses internet most commonly is in the age group of 16-24 years. Although internet has many important advantages, its
adverse effects may also arise especially in relation to its aim, mode and duration of use. Internet dependence is also called as problematic
internet use (PIU) in the literature and is defined as “the inability of the individual to control him/herself impulsively in relation to duration
or aim of activity and experiencing physical, social and psychological difficulties in consequence’’.
Objectives: The aim of the present study was to investigate the prevalence of problematic internet use (PIU) among the students of
Faculty of Medicine and to evaluate the relation between PIU and some socio-demographic characteristics, loneliness, alexithymia and
probability of suicide.
Methods: A total of 328 (42,3% male, 57,7% female) subjects completed four instruments: Young Internet Addiction Test (YIAT), UCLA
loneliness scale (UCLA-LS), The 20-item Toronto Alexithymia Scale (TAS-20) and Suicide Probability Scale (SPS).
Results: PIU was detected in 6,4% of the participants. Its prevalence was higher in males than females (p=0.009). We found significant
correlation between UCLA, TAS-20, SPS and PIU. In the evaluation of the correlation between PIU and subscales of SPS, no significant
relation was found between PIU and Negative Self-Evaluation subscale (r=0.046, p=0.409), while significant relation was found with
Hopelessness, Suicide Ideation and Hostility.
Conclusions: PIU was found at a higher rate in male sex and was found to be associated with loneliness, alexithymia and probability of
suicide among the students of faculty of medicine. It is thought that, as internet has become an ubiquitous device that everyone can
have access to easily, life style and personality characteristics are important in PIU rather than socio-economic factors. We believe that
recognition of these factors related to problematic internet use will help the clinicians working on this issue.
Keywords: alexithymia, problematic internet use, suicide
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S115
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[PP-015] Schizophrenia and other psychotic disorders
Ref. No: 0139
Delusional disorder probably induced by bupropion
Taha Can Tuman1, Akif Asdemir2, Mustafa Basturk2
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Erciyes University, Faculty of Medicine, Department of Psychiatry, Kayseri-Turkey
2
e-mail address: [email protected]
Bupropion is an agent, which is used in treatment of depression and smoking addiction. It effects by blocking re-uptake of
dopamine and noradrenalin. At the same time, it antagonizes nicotinic acetylcholine receptors. The most common side effects
are insomnia, headache and dry mouth. It is considered that bupropion might trigger or worsen psychosis due to dopaminergic
effect. Patients with history of psychosis and actively using dopaminergic agents are particularly under risk. In this letter we
report a case with psychotic attack, which occurred in a patient who was started on bupropion treatment based on diagnosis
of depression.
The 45-year old female patient was admitted to our outpatient clinic due to complaints of sadness, poor energy, aversion and
hypersomnia. Bupropion was started at a dose of 150 mg/day based on preliminary diagnosis of depression. Dose was increased
to 300 mg/day a week later. Patient had complaints of insomnia, bad temper and abnormal thoughts (such as neighbors will
harm her, her meals are poisoned, she is followed by others and others wants to her) ten days after dose of drug was increased.
Based on those complaints, relatives of the patient referred her to our hospital and psychiatric assessment of the patient,
cooperation and orientation were intact; affection was irritable. Persecutory delusions were found in though content. No
perception defect could be found. Attention, memory, abstract thinking, knowledge and calculation were normal. Personal
history indicated no particularity, excluding depression attacks. Familial history indicated no specific finding. Laboratory test
values were within normal ranges. Cranial imaging results were also normal. Bupropion (300 mg/day) was discontinued and
risperidone (1 mg/day) was added to current treatment. It was observed that paranoid delusions and irritability complete
disappeared two weeks later. One should keep in mind that bupropion might trigger psychosis in patients without history of
psychosis, while it is considered that psychosis could worsen in patients with personal history of psychosis if the patient is
going to be started on bupropion.
Keywords: psychosis, bupropion, adverse effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S116
[PP-016] Clinical psychiatry
Ref. No: 0142
Depression, anxiety and sociodemographic features in first degree female
psychiatric outpatient relatives of alcohol abusers
Melike Nebioglu1, Goksen Yuksel2, Urun Ozer2, Yuksel Eroglu3
Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
2
Uludag University, Faculty of Education, Bursa-Turkey
3
e-mail address: [email protected]
Objective: The aim of this study was to investigate depression, anxiety, suicide, exposure to violence and forensic history in female first
degree relatives of alcohol abusers as psychiatric outpatient.
Method: Depression and anxiety was evaluated in adult-first degree relatives of affected probands and control subjects
using Beck Depression and Anxiety Rating Scale. 40 relatives of alcohol abusers and 40 control individuals, who admitted
to attend the research were counted. These female psychiatric outpatient populations were diagnosed in accordance to
DSM-IV-TR.
Results: The results indicated that the prevalence of depression was higher in first degree relatives of affected probands compared with
control subjects. The chi-square results indicated significant differences in forensic history, suicide, and exposure to violence among firstdegree relatives of affected probands.
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Conclusion: Although most researches focus on the psychiatric situation of the dependent population, the first-degree relatives were
ignored. However, studies showed that the women who reported any dependency in their first-degree relatives are a part of a high risk
population and should be closely monitored for the outcoming psychiatric risks.
Keywords: alcohol abusers, anxiety, depression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S116-S7
[PP-017] Psychopharmacology
Ref. No: 0144
Priapism associated with addition of risperidone to methylphenidate monotherapy:
a case report
Hatice Unver1, Nursu Cakin Memik1, Emrah Simsek2
Kocaeli University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli-Turkey
1
Kocaeli University, Faculty of Medicine, Department of Urology, Kocaeli-Turkey
2
e-mail address: [email protected]
Priapism is a state of prolonged and unwanted erection, which is not associated with sexual stimulation or sexual desire. Priapism may
occur in many medical diseases or as a side effect of certain medications. Immediate diagnosis and treatment is essential for priapism,
because ischemia of cavernous tissues would result in erectile dysfunction.
In this article, we report a 12-year-old male patient who has priapism associated with the addition of risperidone on methylphenidate
monotherapy. After drug therapy was discontinued and the implementation of the cavernous drainage, priapism drew back and
disappeared.
This is the first report of priapism associated with the addition of risperidone on methylphenidate monotherapy in literature, to our
knowledge. This issue entails to get attention that these two psychopharmacologic agents, which are often used concomitantly, could
lead to priapism.
Keywords: methylphenidate, priapism, risperidone
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S117
[PP-018] Psychopharmacology
Ref. No: 0149
Antipsychotic treatment of patients who are recorded in Corum Community
Mental Health Center with the diagnosis of psychotic disorders
Mehmet Emrah Karadere, Ece Yazla
Hitit University Corum Education and Research Hospital, Corum- Turkey
e-mail address: [email protected]
Objective: Polypharmacy which means treatment with multiple drugs is commonly practiced by psychiatrists worldwide because of
the reasons like treatment resistant cases, minimizing the side effects of medications and the fact that most psychiatric disorders are
syndromes. Rational pharmacotherapy primarily considers mono pharmacy and aims to treat patients in an effective and reliable way
based on evidence with a minimum number of drugs. Since we do not have any sufficient evidence concerning the effectiveness and
reliability of polypharmacy, it seems that doctors recognize their own clinical experiences more than they consider published evidence.
Studies about combined antipsychotic practices in Turkey seem to include patients, who had mostly the diagnosis of schizophrenia and
were hospitalized in psychiatric wards of Mental Health and Diseases Hospitals, where more treatment resistant cases are hospitalized.
A significant variation was found across three different Community Mental Health Centers, which took place in the same region of New
Zealand in the prescription of antipsychotics to the recorded patients related to dosage, type of antipsychotics and method of practice. In
this study antipsychotic usage of patients, who were recorded in Corum Community Mental Health Center with the diagnosis of psychotic
disorders was evaluated.
Methods: Files of the patients who had been recorded in Corum Community Mental Health Center with the diagnosis of psychotic
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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disorders (schizophrenia, schizoaffective disorder, non-organic psychosis) since it was established in 28th of October in 2011 were
evaluated, retrospectively. Out of those of 127 patients who met those criteria, only 113 files whose data could be reached in full were
included in the study.
Results: Forty (35,4%) women and 73 (64,6%) men with an average age of 41±11,6 years and average education period of 7±4,2 years
participated in our study. Amongst 113 patients 49, (43,4%) were single, 44 (38,4%) were married, 8 (7,1%) were widowed and 12 (10,6%)
were divorced. 23 (20,35%) patients were given only single drug treatment. Number of patients who were given combination drug
treatment were 38 (33,63) % for two, 37 (32,74%) for three, 12 (10,2%) for four, 3 (2,65%) for five drugs combinations, respectively. It was
found that 17 (15,4%) were using typical antipsychotics orally, while 5 (4,42%) were using typicals in depot form, 106 (93,81%) were using
atypicals orally and 16 (14,16%) were using atypicals in depot form. 21 patients who were using depot antipsychotics were found to
include 5 (23,81%) patients using only depot antipsychotics and 16 (76,19%) patients using both depot and oral antipsychotics.
Conclusion: Administration practices of typical antipsychotics and multiple drug treatment are common in our community mental health
center as consistently reported in the literature. After the evaluation of patients, who are recorded in other similar centers, presentation
of the variations across those centers will be possible.
Keywords: schizophrenia, polypharmacy, psychiatric practice
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S117-S8
[PP-019] Childhood and adolescence disorders
Ref. No: 0151
Aripiprazole agumentation in treatment-resistant obsessive compulsive disorder
in child and adolescent: case series
Tugba Donuk, Ipek Percinel, Burak Baytunca, Duygu Kacamak, Tezan Bildik, Serpil Erermis
Ege University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bornova, Izmir-Turkey
e-mail address: [email protected]
Objective: Pediatric obsessive compulsive disorder (OCD) is a common and debilitating disorder, which can cause substantial impairment
in academic, social, and family functioning. Adjunctive medications are frequently used in ordinary clinical settings, as augmenting
strategies for unsatisfactory response to SRI monotherapy, and/or to manage comorbid mental disorders. Aripiprazole is a newer
antipsychotic with a more specific mode of action, as a partial dopamine agonist, which acts as an antagonist at D2 dopamine receptors in
hyperdopaminergic conditions, and displays agonist properties under hypodopaminergic conditions. The aim of this study was to assess
efficacy of aripiprazole augmentation of serotonin reuptake inhibitor (SRI) treatment in child and adolescents with obsessive compulsive
disorder (OCD) who did not respond to initial trials with SRI and augmentation with other atypical antipsychotics.
Methods: The case series of 6 patients (4 females and 2 males; age range, 12 to 16 years) with OCD diagnosed based on a for Schoolage Children-Present and Lifetime Version (K-SADS-PL) Kiddie-Schedule for Affective Disorders and Schizophrenia and according to the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, were included. Aripiprazole was initiated at a starting dose
of 2.5 or 5 mg daily and optimal dosages ranged from 5 to 15 mg daily. In this process clinical evaluation of patients; grade of obsessions
and compulsions “Yale-Brown Obsessive Compulsive Scale” (Y-BOCS), the side effects of drugs ‘Extrapyramidal Symptom Rating Scale’
(ESRS), the severity of the disease, “Clinical Global Impression Scale / Violence” (CGI-S), the degree of improvement during follow-up
“Clinical Global Impression Scale / recovery” (CGI-I), level of functionality “Global Assessment Scale” (GAS) are used.
Results: Aripiprazole was significantly better-tolerated and more effective
Conclusion: All patients appeared to benefit from aripiprazole. Neither extrapyramidal side effects nor agitation was observed in any case.
Aripiprazole was well tolerated and effective in our cases and appears to be a safe and efficacious alternative in the child and adolescents.
Keywords: aripiprazole, obsessive compulsive disorder, child and adolescent
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S118
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[PP-020] Psychopharmacology
Ref. No: 0152
Atomoxetine-induced mydriasis in a child
Kayhan Bahali1, Hamiyet Ipek1, Ozhan Yalcin1, Ozgur Orum2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
1
Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul-Turkey
2
Email: [email protected]
Atomoxetine is the first nonstimulant medication for the treatment of attention deficit/hyperactivity disorder. It has been approved as a
treatment for children and adolescents with ADHD in the United States, throughout Europe, and in other countries. The efficacy of atomoxetine
has been documented in short and long- term studies. It is a generally safe and well tolerated drug. Most common adverse reactions include
nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence. We report a case of mydriasis induced by atomoxetine, which
was observed in a child with pervasive developmental disorder not otherwise specified and attention deficit/hyperactivity disorder.
Keywords: atomoxetine, child, mydriasis, ADHD
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S119
[PP-021] Psychopharmacology
Ref. No: 0153
Atomoxetine-induced bruxism
Kayhan Bahali1, Ozhan Yalcin1, Ayse Avci2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
1
Cukurova University, Faculty of Medicine, Adana-Turkey
2
e-mail address: [email protected]
Atomoxetine is the first nonstimulant medication for the treatment of attention deficit/hyperactivity disorder. It has been approved as
a treatment for children and adolescents with ADHD in the United States, throughout Europe, and in other countries. The efficacy of
atomoxetine has been documented in short and long- term studies. It is a generally safe and well tolerated drug. Most common adverse
reactions include nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence. We report a case of bruxism induced
by atomoxetine, which was observed in a child with ADHD.
Keywords: atomoxetine, bruxism, ADHD
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S119
[PP-022] Anxiety disorders
Ref. No: 0154
Post-operative psychiatric findings after orthopedic surgery
Murat Semiz1, Ozhan Pazarci2, Onder Kavakci3, Zekeriya Oztemur2, Okay Bulut2
Sivas State Hospital, Department of Psychiatry, Sivas-Turkey
1
Cumhuriyet University Faculty of Medicine, Department of Orthopaedics and Traumatology, Sivas-Turkey
2
Cumhuriyet University Faculty of Medicine, Department of Psychiatry, Sivas-Turkey
3
e-mail address: [email protected]
Objective: We aimed to evaluate the depression, anxiety disorder and acute stress disorder after surgery in patients in an orthopedics
and traumatology (O&T) department.
Methods: We applied Hospital Anxiety-Depression Scale (HAD) and Impact of an Event Scale-Revised (IES-R) to the patients whom were
operated sometime between 01 August 2011 – 01 August 2012 in our O&T department, one week after their operation.
Results: 132 patients (89 male (67%)) were included. 87 (66%) patients were found to have anxiety disorder according to HAD and the
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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mean anxiety scale score was 11.6±3.1. 111 (85%) patients were found to have depressive disorder according to HAD and the mean
depression scale score was 9.9±2.3. And 102 patients (77%) were found to have acute stress disorder according to IES-R and the mean
trauma scale score was 47.7±12.9.
Conclusion: Psychiatric disorders were found at a high incidence after operation in O&T departments, independent of the type of the
operation; so cooperation should be established with psychiatrists during the perioperative period.
Keywords: orthopedic surgery, depression, anxiety
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S119-S20
[PP-023] Anxiety disorders
Ref. No: 0155
Post-traumatic stress disorder, alexithymia and somatoform dissociation
in patients with fibromyalgia
Murat Semiz1, Onder Kavakci2, Halil Peksen3, Mehmet Siddik Tuncay3, Zafer Ozer3, Esra Aydinkal Semiz3, Ece Kaptanoglu3
Sivas State Hospital, Department of Psychiatry, Sivas-Turkey
1
Cumhuriyet University School of Medicine, Department of Psychiatry, Sivas-Turkey
2
Cumhuriyet University School of Medicine, Department of Physical Medicine and Rehabilitation, Sivas-Turkey
3
e-mail address: [email protected]
Objective: Fibromyalgia (FM) is a common disorder that is associated with a high rate of psychiatric co-morbidity (depression, anxiety
disorders), its association with post-traumatic stress disorder (PTSD), alexithymia and dissociative symptoms has not been sufficiently
investigated. The present study evaluated three hypotheses: 1- That a high frequency of traumatic experiences and PTSD would be
observed in patients with FM. 2- That FM would be associated with symptoms of alexithymia and somatoform dissociation. 3- That trauma
negatively affects the clinical parameters of FM.
Methods: Fifty-six consecutive patients with FM admitted to the outpatient department were enrolled in this study after providing
informed consent. Forty-six patients with rheumatoid arthritis (RA) were enrolled as controls. Participants completed the Somatoform
Dissociation Questionnaire (SDQ), the Post-traumatic Diagnostic Scale (PDS), the Toronto Alexithymia Scale (TAS), and The Childhood
Trauma Questionnaire (CTQ). The impact of FM was measured with the Fibromyalgia Impact Questionnaire (FIQ).
Results: The number of patients reporting at least one traumatic event was higher in the FM (19, 33.9%) than in the RA (6, 13%) (x2= 5.9,
p= 0.015) group. Post-traumatic stress disorder (PTSD) was found in six (10.7%) out of 56 subjects with FM. In the RA group, no patients
met the criteria for PTSD. Current PTSD prevalence was higher in the FM than in the RA group. Among those with FM group and traumatic
experiences, FIQ scores were higher in patients with than without PTSD (p= 0.02). FM patients had significantly higher scores than did RA
patients on the CTQ, SDQ and TAS.
Conclusion: PTSD, alexithymia, and somatoform dissociative symptoms are common in FM patients. It is important to identify and treat
PTSD, alexithymia, and dissociative symptoms in FM patients as these can affect the patients’ health. Taken together, results from previous
studies with adults and those from the present study suggest that treatment of PTSD, alexithymia and dissociative symptoms positively
influences the levels of pain and FM-related disability in FM patients. Our findings support the idea that trauma-oriented approaches are
important in the treatment of FM.
Keywords: fibromyalgia, post-traumatic stress disorder, somatoform disorders, dissociation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S120
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[PP-024] Clinical psychiatry
Ref. No: 0156
Assessment life quality of familial mediterranean fever patients by short
form-36 and its relationship with disease parameters
Safak Sahin1, Ilker Yalcin2, Soner Senel3, Hilmi Ataseven4, Ali Uslu5, Osman Yildirim6, Murat Semiz7
Gazi Osmanpasa University, Faculty of Medicine, Department of Internal Medicine, Tokat-Turkey
1
Internal Medicine, Gurun State Hospital, Sivas-Turkey
2
Erciyes University, Faculty of Medicine, Department of Rheumatology, Kayseri-Turkey
3
Cumhuriyet University, Faculty of Medicine, Department of Gastroenterology, Sivas-Turkey
4
Cumhuriyet University, Faculty of Medicine, Department of Internal Medicine, Sivas-Turkey
5
Abant Izzet Baysal University, Department of Psychiatry, Faculty of Medicine, Bolu-Turkey
6
Sivas State Hospital, Department of Psychiatry, Sivas-Turkey
7
e-mail address: [email protected]
Objective: Familial Mediterranean fever (FMF) is an auto- immune disorder. Long-term complications of the disease include decreased
quality of life. The measurement of quality of life in the patients with chronic disease has become an important research topic during the
last years. We aimed to evaluate life quality of the FMF patients the short form 36 health survey questionnaire (SF-36), and examine its
relationship with the disease parameters.
Methods: One hundred voluntary patients (69 female, 31 male) admitted to the rheumatology clinic were included in the study. The
control group consisted of 100 healthy individuals. All subjects in the study were asked to completeSF-36. Age of onset of FMF, age at
diagnosis, age at the beginning of colchicine therapy, number of attacks per month, family history of FMF and dialysis were inquired to
FMF patients. Disease severity was rated using the FMF severity score.
Results: The mean age of the patient group was 31±12 years and that of the control group was 29±9. Sixty-nine patients (69%) were
female, and 31 patients were male (31%) in both groups. The mean scores of the physical function, physical role function, emotional
role function, mental health, and general health parameters of the patients were statistically significantly lower than those of healthy
volunteers (p<0.05). The difference in social function and vitality between two groups was found to be insignificant (p>0.05).
Conclusion: We have shown that FMF had a negative impact on SF-36. FMF reduces quality of life both in physical and mental dimensions.
Keywords: familial mediterranean fever, the short form 36 health survey questionnaire (SF36)
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S121
[PP-025] Psychopharmacology
Ref. No: 0157
Olanzapine and tardive dyskinesia: a case report
Ebru Sahan, Meliha Zengin Eroglu, Esma Akpinar, Anil Talas
Haydarpasa Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Tardive dyskinesia is a serious and common motor side-effect of treatment with neuroleptics, with an unknown pathophysiological basis.
The essential features of neuroleptic-induced tardive dyskinesia (TD) are abnormal, involuntary movements of the tongue, jaw, trunk or
extremities that emerge in a patient predisposed to antipsychotic medication. Although the exact pathogenesis of TD is unclear, there is
some evidence that dopamine supersensitivity in the nigro-striatal pathway due to antipsychotics could contribute to these dyskinetic
movements. Although it has been suggested that olanzapine can improve tardive dyskinesia in some patients, few reported cases have
shown that the prolonged use of olanzapine can instead be associated with tardive dyskinesia/dystonia. Here we report a case that
experienced tardive dyskinesia after 12 years of treatment with olanzapine.
A 66 years old man, admitted to our clinic with complaints of involuntary movements involving his tongue, jaw, right arm and leg. He
had also social withdrawal, negativity, insomnia, anhedonia and feelings of guilt.. He was taken to a psychiatrist, diagnosed as major
depressive disorder with psychotic features and prescribed fluoxetine 20 mg/day + olanzapine 10 mg/day. Olanzapine dose could not be
reduced for 12 years rather 2 years ago with the remission of depressive symptoms fluoxetine treatment was ceased.
Two months before the admission, his family noticed repeated involuntary movements in his right arm and olanzapine was stopped.
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Although he was medication free for one month; mild choreic movements continued in the right upper limb also involuntary movements
of tongue, jaw and rare choreic movements in the right lower limb emerged.
Choreic movement in the right lower limb was becoming more apparent when he walked but extremity movements were not causing
so much functional loss. A diagnosis of drug-induced tardive dyskinesia was thus made, other causes of dyskinesia excluded and therapy
with clozapine 12,5 mg/day initiated.
In this case, the tardive dyskinesia was most likely a result of olanzapine administration. As olanzapine is increasingly being used in
elderly subjects, our report underlines the need for judicious use and a careful assessment for tardive dyskinesia or other movement
disorders in patients taking this atypical neuroleptic. More intensive research and long term studies in the future are needed for dilemma
of olanzapine both causing TD and being used for treatment of TD raised by case reports.
Keywords: olanzapine, tardive dyskinesia, atypical antipsychotic, adverse effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S121-S2
[PP-026] Mood disorders
Ref. No: 0159
Association between premenstrual syndrome and alexithymia among Turkish
university students
Ahmet Hamdi Alpaslan1, Nusret Soylu2, Kadriye Avci3, Hanife Uzel Tas3, Omer Ozbulut4
Afyon Kocatepe University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Afyonkarahisar-Turkey
1
Inonu University, Faculty of Medicine, Department of Child and Adolescent Psychiatry Malatya-Turkey
2
Afyon Kocatepe University, Faculty of Medicine, Department of Public Health, Afyonkarahisar-Turkey
3
Afyon Kocatepe University, Faculty of Medicine, Department of Psychiatry, Afyonkarahisar-Turkey
4
e-mail address: [email protected]
Objective: Menstruation is a physiological event that starts with adolescence and continues until menopause and covers about 35-40
years of a woman’s life. Premenstrual syndrome (PMS) is a heterogeneous disorder including physical, cognitive, affective and behavioral
symptoms. At present, the number of women complaining of PMS constantly increases. Premenstrual Syndrome may influence the lives,
daily activities and academic achievement of young girls to an important extent. As far as we know, there is no study in our country
evaluating the relation between PMS and alexithymia. The aim of the present study was to investigate the relation between PMS and
alexithymia, the prevalence of PMS and risk factors associated with the severity of PMS.
Method: 308 female students, whose ages ranged between 19-25 (20,7±1,9), were included in the study. Data were collected using a
demographic questionnaire, Toronto Alexithymia Scale (TAS-20), and Premenstrual Assessment Form (PAF).
Results: Prevalence of PMS in our sample was 66.6%. PMS was found at higher rates in those who smoke (p=0.049), have history of
psychiatric treatment (p=0.049), and whose mother or sister has PMS symptoms (p=0,017). PMS group showed higher scores on all rating
scales of Toronto Alexithymia Scale and its three factors (p<0.05), when we divided all participants into two groups, termed alexithymic
(who scored 61 or more on TAS) and Non-alexithymic, Alexithymic group had higher scores on almost all PAF subscales (p<0.05).
Conclusion: Alexithymia reflects cognitive deficits in processing emotions because alexithymic individuals are psychologically poorly
equipped. Premenstrual syndrome is a heterogeneous disorder including physical, cognitive, affective and behavioral symptoms.
Alexithymia also has cognitive and affective factors. The etiology and pathophysiology of PMS remain unknown. Further studies need to
determine the probable role of alexithymia in the pathogenesis of PMS.
Keywords: adolescence, alexithymia, premenstrual syndrome
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[PP-027] Clinical psychiatry
Ref. No: 0160
Dissociative disorders in an outpatient clinical sample
Omer Yanartas1, Hulya Akar Ozmen2, Serhat Citak2, Selma Bozkurt Zincir2, Esra Aydin Sunbul2
Marmara University, Faculty of Medicine, Istanbul-Turkey
1
Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: In this study we aimed to investigate the diagnostic distribution of dissociative disorder and subgroup of dissociative disorder
not otherwise specified (DD-NOS).
Method: Our study was performed in two phases. In the first phase the patients were screened with DES (dissociative experience scale)
and SDQ (somatoform dissociation questionnaire). The patients whose test score were above cut off (DES>30 and/or SDQ>40), were
asked to leave their phone number for the second phase. After the first phase the patients were called for the second phase and DDIS
(dissociative disorder interview scale) was performed to the same resident.
Results: In the first phase, we planned to reach about 2000 patients between the dates 01.12.2010-01.09.2011, but there were 534 cases excluded
from the study due to exclusion criteria, while 152 cases didn’t admit filling out the scales of the study; thus we could have reached 1314 cases in
this phase. Of the 1314 participants who completed the DES, there were 272 participants (20.70%) with scores above the cutoff. Although five of
the participants refused to complete the SDQ, there were 202 participants (15.43%) whose scores were above the cutoff. In the second phase of
the study, we aimed to obtain a total of 272 participants whose test scores were above the cut-off scores for the DES and SDQ but we could have
reached by phone number 190 of them (190 in 272 participants, 69.8%). The most prevalent dissociative disorder group was DD-NOS (62.8%).
Conclusion: The high prevalence of DD-NOS was consistent with other studies’ result. This high prevalence was pointed out in DSM 5
discussion; thus in DSM 5 criteria authors aimed to reduce this high proportion. In DSM 5, patients with possession were categorized in
the subgroup of dissociative identity disorder group.
Keywords: dissociative disorder, outpatient, dissociative experience scale, somatoform dissociation questionnaire
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S123
[PP-028] Anxiety disorders
Ref. No: 0161
Anxiety disorders due to epilepsy: a case report
Gonca Ozyurt1, Ibrahim Oztura2, Tunc Alkin3, Aysegul Ozerdem3
Dokuz Eylul University, Medical School, Department of Child and Adolescent Psychiatry, Izmir-Turkey
1
Dokuz Eylul University, Medical School, Department of Neurology, Izmir-Turkey
2
Medical School, Dokuz Eylul University, Department of Psychiatry, Izmir-Turkey
3
e-mail address: [email protected]
Epileptic patients present psychiatric disorders more frequently than general population and patients with other chronic medical
conditions. Psychiatric disorders may co-occur with epilepsy and also they may be due to epilepsy. Personality changes, as well as
psychosis, mood or anxiety disorders may occur in relation to epilepsy. Anxiety disorders due to epilepsy may appear as generalized
anxiety disorder, panic disorder, phobia or obsessive compulsive disorder. The risk of having anxiety disorder is very high in focal epilepsy
especially temporal lobe epilepsy but anxiety disorder can also be concurrent to frontal lobe epilepsy or generalized tonic-clonic epilepsy.
Here we present a forty one years old, female patient with co-occurring anxiety disorder and epilepsy, who improved after initiation of
an antiepileptic medication. The patient’s EEG had abnormalities especially in frontal lobe. In this case epileptic activation associated with
anxiety disorder emerged as fear of swallowing, a specific phobia and carried features of generalized anxiety disorder. Upon initiation of
antiepileptic medication, seizures stopped and symptoms of anxiety disorder disappeared in a short time. The patient’s psychiatric visits
were once a fortnight. The patient stayed asymptomatic during the next two-year follow-up. This case report underlines the importance
of differential diagnosis for underlying epilepsy in acutely occurring severe anxiety cases and efficacy of the proper medication, which is
given for the underlying pathology on anxiety symptoms.
Keywords: anticonvulsants, anxiety disorder, epilepsy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S123
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[PP-029] Childhood and adolescence disorders
Ref. No: 0162
Assessment of parental punishment among children and adolescents with
elimination disorders
Ahmet Hamdi Alpaslan1, Nusret Soylu2, Halil Ibrahim Guzel3
Afyon Kocatepe University, Faculty of Medicine, Department of Child and Adolescent Psychiatry Afyonkarahisar-Turkey
1
Inonu University, Faculty of Medicine, Department of Child and Adolescent Psychiatry Malatya-Turkey
2
Afyon Kocatepe University, Faculty of Medicine, Department of Psychiatry, Afyonkarahisar-Turkey
3
e-mail address: [email protected]
Objective: Genetic and neurobiological factors interact with environmental influences in the pathogenesis of enuresis and encopresis.
Control over bladder and bowel movements is an important developmental milestone at childhood. Parents’ expectations play a very
important role in this process, since parents believe that their children should achieve continence at a younger age than that of the natural
history of human continence. This belief makes the child’s toilet training phase a stressful period for the child, the parents and the teachers,
which may result in severe punishments and traumas. The aims of the present study are to describe the types and to determine the rate of
parental punishment among children and adolescents with elimination disorders and also to investigate the parents’ psychological and
socio-cultural factors associated with punishment.
Method: We carried out a cross-sectional study involving 112 patients aged from 5.20-14 years. Enuresis and encopresis diagnoses were
defined according to the Diagnostic and Statistical Manual for Mental Disorders (DSM V). A semi-structured interview was done with
the patients and their parents by two child and adolescent psychiatrists, to collect information about the medical history of patients
and characteristics of the parental reactions to the child’s enuresis and/or encopresis were widely investigated. Also caregiver parents
completed the Turkish version of Symptom Check List 90-R (SCL-90-R).
Results: The study sample consisted of 112 patients (28 females, 84 males) with a mean age of 8.23±2.09 years. It was determined that there
was enuresis in 92.0% (n=103) of these cases and encopresis in 22.3% (n=25). Comorbid psychiatric disorder was found in 50.9% of the cases (n=
57). Among all patients, the rate of being exposed to verbal punishment was 42.0% (n=47); the rate of being exposed to physical punishment
without physical contact was 9.8% (n= 11) of the cases while the rate of being exposed to physical punishment with physical contact was
21.4% (n= 24). Of the cases, 26.8% (n= 30), were not exposed to any type of punishment. It was established that punishment and violence
were at a higher rate in cases with low socioeconomic status and in cases with living in a large or divorced family (p<0.05). When comparing
caregiver parents on SCL-90-R and the subscales scores, the punitive parents had significantly higher scores on somatization, depression, anxiety,
obsessive-compulsive disorder, interpersonal sensitivity and hostility subscales of the SCL-90 than the non-punitive parents.
Conclusion: Elimination disorders are associated with high levels of distress for both children and parents. The rate of punishment of almost
75% found in the present study is alarming and it suggests that both physical and verbal aggression against children and adolescents, as an
educational measure and a training method are common and culturally accepted among the Turkish families. In the assessment of enuretic
or encopretic children, features of family and parents are must be evaluated carefully and these features must be considered in treatment.
Keywords: elimination disorders, parents, punishment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S124
[PP-030] Mood disorders
Ref. No: 0163
Comparison of sociodemographical properties and clinical course in bipolar disorder
patients provided with single and double mood stabilizer in maintenance treatment
Filiz Dere Yilmaz, Erhan Kurt, Dilek Yesilbas Lordoğlu, Kasim Fatih Yavuz
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Bakirkoy, Istanbul-Turkey
e-mail address: [email protected]
Objective: In our clinical observations, single mood stabilizer and demographical properties of the patients, who received maintenance
treatment and episode pattern, course and episode properties; are found discrepant than the patients, who experienced single mood
stabilizer in association with maintenance treatment. Moreover, a clear research data is not available in literature. In the present study,
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demographical and clinical properties and disease course and disease progress and episode features among the patients with an
anticipated single mood stabilizer and double mood stabilizer are anticipated to be investigated.
Method: In Bakırkoy Professor Mazhar Osman Mental and Neurological Diseases Hospital, Rasit Tahsin Mood Center unit, and outpatient
follow-up files of 167 patients over 18 years of age, followed by Bipolar I Diagnosis in association with DSM-IV-TR diagnostic criterions and
administered at least one year mood stabilizer are investigated retrospectively. Mental retardation, overall medical conditional disorder
and associated other patients with psychiatric disorders were excluded from the study. The patients were divided into groups as single
mood stabilizer (lithium (Li) or valproic acid (VPA) or carbamazepine) and double mood stabilizer (lithium and valproic acid) administered
patients. There were 136 patients using single medication and 31 patients using double medications. Sociodemographical features such
as gender, marital status, employment status, family bipolar disorder history, age and duration of education were inspected. In terms of
clinical features initial episode form, episode number, episodes psychotic natures, seasonality features, medication convenience, number
of hospital treatment, correlation with suicide attempt situations were all examined. Data derived from the research were analyzed by
SPSS (Statistical Package for Social Sciences) for Windows 17.0 program. When the date were assessed Chi-square and t-tests were applied.
Results: When the cohorts were compared as per sociodemographic properties, significantly important variations were detected only in
terms of gender (x2=5.869; p=0.014 < 0.05). Among the patients receiving maintenance treatment based on single medication, female
gender was found in higher magnitude. Entire episode number of the patients whom are administered double medications (x=6.030) were
found higher than the total episode number of the patients who were given single medication (x=3.680) and the difference was found
to be statistically significant (p=0,001 <0,05). Hospital enrollment volume of the patients who received double maintenance treatment
(x=3.260) was found higher than the patients receiving single maintenance treatment (x=1.770) and the variation between group mean
ratios was statistically significant (p=0,006 <0,05). When compared inside themselves, entire episode numbers of patients from single
medication groups who used VPA type medication (x=4.650) were found higher than the patients using Li type medication (x=3.370) and
the variation were statistically significant (p=0,019 <0,05). Hospitalization number of the patients using VPA type medications (x=2.680)
was found higher than the hospitalization number of the patients using Li type medications (x=1.510).
Conclusion: Among the patients possessing single mood stabilizer and the patients using double medication,remarkable
sociodemographical differences were not detected. In terms of clinical properties, among the double treatment patients, except
hospitalization and intensified episode numbers, no significant variation was found.
Keywords: bipolar disorder, mood stabilizers, lithium maintenance treatment, valproic acid
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S124-S5
[PP-031] Psychopharmacology
Ref. No: 0164
Efficacy and tolerability of aripiprazole on pervasive development disorders
Ipek Percinel, Tugba Donuk, Sezen Kose, Burcu Ozbaran, Serpil Erermis, Duygu Kacamak, Senay Celenay, Ugur Tekin, Tezan Bildik, Cahide Aydin
Ege Univeristy, School of Medicine, Department of Child and Adolescent Psychiarty, Izmir-Turkey
e-mail address: [email protected]
Objective: Autism Spectrum Disorders (ASD) are early onset neurodevelopmental disorders defined in terms of abnormalities in social
and communication development in the presence of marked repetitive behavior and narrow interests (American Psychiatric Association,
2000). Risperidone and aripiprazole are the two atypical neuroleptics approved by FDA for the treatment of irritability associated with
autism. We aimed to investigate the efficacy, tolerability and side effects of aripiprazole in children with ASD.
Method: The records of ASD outpatients were analyzed by retrospective scanning of the registry in our clinic. The severity of the disorder
was evaluated with “Clinical Global Impression Scale/Severity” (CSI-S), the degree of improvement during the observation with “Clinical
Global Impression Scale/Improvement” (CSI-I) and the adverse effect of the drug with “Clinical Global Impression Scale/Adverse Effect
Severity”.
Results: Among the patients diagnosed with ASD, data for 101 were reached. In 15 cases (14%), transitions from alternative antipsychotic
treatments to aripiprazole were observed. 86,7% (n=13) of the 15 cases were male and 13,3% (n=2) were female. The average age of the
cases was found as 9,50±3,87. 66.7% (n=10) of the cases had at least one and 26.7% (n=4), had more than one comorbid disorders. The
most common comorbid disorder was observed as Attention Deficit Hyperactivity Disorder. 80% (n=12) of the cases had Autism Disorder,
13,3% (n=2) had Asperger Disorder and 6,7% (n=1) had Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) diagnoses.
Reasons for switching to aripiprazole during the treatment were identified as; 73,3% (n=11), getting no benefit out of the treatment,54,3%
(n=8), significant weight gain, 40% (n=6) development of gynecomastia, 26,7% (n=4) increase in prolactin levels. The mean dose of
aripiprazole was 4,61±3,80. At the beginning of aripiprazole treatment, according to the CGI-S scores, cases showed the following
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distribution: 53,3% (n=8) of the cases were at the significant level, 40,0% (n=6) were at the moderate level and 6,7% were at severe level.
(n=1). According to the assessment of CGI-I, the degree of improvement of the cases were found as: 13,3% (n=2) “improved very well”,
26,7% (n=4) “quite improved”, 33,5% (n=5) “slightly improved”, 20,0% (n=3) “ no improvement”, 6,7% (n=1) “ worsened considerably”. While
73,3% (n=11) of the cases showed no adverse effects during the treatment, 20,0% (n=3) of them showed some irritability that does not
affect the functionality significantly. In only one of the cases (6,7%) some irritability and agitation affecting the functionality considerably
occurred, and for this case, aripiprazole treatment was ended.
Conclusion: In PDD outpatients, it is observed that aripiprazole is tolerated well and as an alternative to other antipsychotics; it can
be used safely and effectively. New patient recruitment for the study is ongoing. Findings should be supported with controlled studies
having more samples.
Keywords: autism spectrum disorders, aripiprazole, efficacy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S125-S6
[PP-032] Mood disorders
Ref. No: 0165
Depression with psychotic features due to hypothyroidism: a case report
Ulker Atilan, Ibrahim Fatih Karababa, Mahmut Kati, Mehmet Asoglu, Huseyin Bayazit
Harran University, School of Medicine, Department of Psychiatry, Sanliurfa-Turkey
e-mail address: [email protected]
Recent studies suggest that disorders related to endocrine system, particularly thyroid diseases are the most common factor for initiating
or deteriorating psychiatric complaints. Psychiatric symptoms are reported to be earliest and most significant signs and symptoms in
thyroid disorders. Thyroxin addition to anti-depressant prescriptions of the patients having both hypothyroidism and depression is also
recommended. Here we present a hypothyroidism case along with psychotic, cognitive and depressive disorders. Patient’s complaints rapidly
improved after thyroid hormone replacement under anti-psychotic/anti-depressant therapy; however, therapy was cut upon symptoms that
re-emerged after thyroid hormone replacement. A 25-year-old single male with a history of previous total thyroidectomy for papillary thyroid
microcarcinoma but without any psychiatric history applied to our outpatient clinic for fatigue, anhedonia, suicidal thoughts, insomnia,
seeing strange figures in people’s faces, hearing laughter, false and irrelevant inference on conversations and thoughts of harm to himself.
Symptoms occured one month after surgery. Psychiatric examination showed decreased psychomotor activity, husky and slow speech,
blunt affect, depressed mood, auditory perception flaws, slowed thought process, persecution delusion and suicidal thoughts. Depression
with psychotic features was diagnosed and patient was admitted to inpatient service. Lab findings were as follows: free T3 was 0,58 pmol/L,
free T4 was 0,14 pmol/L, and TSH was 150 mIU/L. HAM-D(The Hamilton Rating Scale for Depression) score was 31. Milnacipran 100 mg/d,
risperidone 1mg/d and lorazepam 1mg/d as well as 0.15mg/d levothyroxine sodium was administered and remission was achieved. HAM-D
score dropped to 5. Discontinuing thyroxin therapy caused relapse, HAM-D score increased to 21. Levothyroxine sodium administration
after radioactive iodine uptake therapy improved symptoms and HAM-D score decreased to three on third day of therapy. Thyroid disorders
have a wide range of neuropsychiatric disorders. Hypothyroidism may easily be ignored among these various physical and psychiatric
symptoms. Therefore, routine thyroid functions screening is essential in patients presented with depression, psychosis and cognitive
disorders. Underlying cause should be targeted in organic causes of psychiatric disorders. In our case; symptoms exacerbated at the end
of thyroid hormone replacement therapy eventhough antidepressant/antipsychotic treatment was still being administered and improved
when replacement therapy was restarted.
Keywords: depression, hypothyroidism, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S126
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[PP-033] Mood disorders
Ref. No: 0167
Psychotic depression and obsessive compulsive disorder after head trauma: a case report
Guler Acar, Filiz Izci, Ferzan Ergun, Rabia Bilici, Selma Bozkurt Zincir, Umit Basar Semiz
Erenkoy Mental Health and Neurology Training and Research Hospital, Istanbul-Turkey
e-mail address: [email protected]
A case diagnosed psychotic depression and obsessive compulsive disorder that were emerged simultaneously after head trauma is
discussed in this report.
A 34-year-old male patient had the complaints of anhedonia, malaise, intense suicidal ideations, visual hallucinations, sleeplessness,
tearfulness, symmetry and contamination obsessions had started 6 months ago after he had a head trauma because of an industrial
accident. He had got treatments in inpatient and outpatient clinics but no improvement was observed. After a suicidal attempt by
hanging, he was admitted to our hospital. It was learned that his brain CT, MRI and EEG did not confirm head trauma. Psychiatric
examination revealed anhedonia, depressive and anxious affect and mood, irritability, suicidal ideations, visual hallucinations, reference
perceptions, symmetry and contamination obsessions, arranging and cleaning compulsions and insomnia. SCID-I was performed to the
patient. Major depression and obsessive compulsive disorder were diagnosed. HAM-D and Y-BOCS scores were 20 and 43 , respectively.
Oxcarbamazepine 600 mg/day, fluoxetine 40 mg/day and quetiapine 200 mg/day were ordered. Standardized Mini mental state scale
score was 25/30. Bender- Gestald test reported as “related to obsessive style but no meaningful finding pointing to organicity.” Benton test
reported as “attention, perception and immediate memory functions were fair average.” Mean of score was 11/15. Neurocognitive battery
reported as “executive functions, judgement-explication, arithmetic abilities ‘very good’, verbal and visual memory ‘good’, logical memory
‘’average’, attention ‘low’. Depressive and obsessive symptoms were decreased, suicidal ideations were dissolved . He was discharged
under outpatient follow up. Mood, anxiety and psychotic disorders might be emerged after head trauma. In this case, no premorbid
psychiatric story and no findings in the scans were recorded but intense depressive and obsessive symptoms and suicidal ideations were
seen after trauma. Even no findings in the scans after head trauma was detected, severe psychiatric disorders can be seen in this group
of patients.
Keywords: head trauma, depression, obsession
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S127
[PP-034] Mood disorders
Ref. No: 0169
Colloid cyst in third ventricule and catatonic depression: a case report
Ferzan Ergun, Filiz Izci, Guler Acar, Selma Bozkurt Zincir, Rabia Bilici, Umit Basar Semiz
Erenkoy Mental Health and Neurology Training and Research Hospital, Istanbul-Turkey
e-mail address: [email protected]
After psychiatric treatment and neurosurgical operation, rapidly ameliorated clinical symptoms in a patient who had severe depression
with catatonic features is discussed in this paper.
A 64 years old male has had symptoms, which were appetite, alogia, anhedonia, decreased self care and incontinence for two months.
After medical assessment, it had been said that there was no organic illness and he had been referred to psychiatry. After psychiatric
assessment, he has not taken his medications regularly and complaints with urinary and fecal incontinence continued and he was
admitted to emergency service and thereafter hospitalization was completed. In his psychiatric examination, self-care was decreased,
psychomotor activity was decreased, he was alogic, only his eye movements were observed communicative. Conscious state was clear,
he was cooperating. Affect and mood were depressed. He was insensitive time to time. HAM-D and Mini mental state scale scores were 34
and 16, respectively. ECT was planned after internal medicine and anesthesia consultation and venlafaxine 75 mg/day and quetiapine 50
mg/day treatment was started. After neurological consultation in which cranial MRI was carried out, a colloidal cyst was detected in third
ventricule. Neurosurgical consultation was made thereafter. His symptoms except urinary and fecal incontinence has gone better with
psychiatric treatment and he was expedited to neurosurgery for operation. Two weeks after cystectomy, he was seen in outpatient clinic.
A clear-cut improvement was there in his symptoms as he was taking own medications by himself and caring himself.
Cyst-like compositions in brain might exaggerate psychiatric scene in psychiatric disorders. In this case, after neurosurgery, the complaints
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of urinary and fecal incontinence were ameliorating in the patient, who had progressive severe depression with catatonic features. In
psychiatric disorders, regardless of pathological compositions in brain, the importance of cranial scanning was stressed in this case.
Keywords: colloid cyst, catatonic depression, surgery
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S127-S8
[PP-035] Substance abuse and dependence
Ref. No: 0170
Tramadol induced status epilepticus in an old woman with polydrug abuse
Ebru Findikli, Fatma Ozlem Orhan, Ali Askar, Ali Nuri Oksuz
Kahramanmaras Sutcu Imam University, School of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
e-mail address: [email protected]
Tramadol hydrochloride is a synthetic analogue of codeine, centrally acting analgesic used for the treatment of moderate to severe pain.
Tramadol might cause seizures by stimulating the opioid receptors and possibly via an opioid dependent gamma-aminobutyric acid
inhibitory pathway.(Rehni et al). Recent studies suggest that benzodiazepins (BZDs) are capable of inhibiting the metabolism of some
opioid drugs, by competitive inhibition of CYP3A4. Codeine users are significantly more likely to be co-administrating large amounts
of BZDs. In the literature there are several cases about epileptic attacks due to tramadol. In our report, we emphasise the multiple
benzodizepine, tramadol and mirtazapine abuse in an elderly women.
In this report; a 64 years old female patient had been treated for postoperative orthopedic surgery pains in the previous 2 years with
300 mg/day tramadol. She also abused alprazolam 6mg/day, lorazepam 7,5 mg/day, midazolam 45 mg/day, bromazepam 9 mg/day, and
mirtazapine 30 mg/day for twenty years due to insomnia. She had a status epilepticus seizure after intake of 400 mg tramadol. We treated
her with valproate 1000 mg/day, diazepam 40 mg/day, quetiapin 50 mg/day and duloxetine 30 mg/day successfully. Her treatment is
still going on. Clinicians are advised to consider the potential for BZD abuse and adverse sequelae of tramadol, particularly in the elderly.
Keywords: benzodiazepine, addiction, status epilepticus
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S128
[PP-036] Neuroscience
Ref. No: 0172
Evaluation of the ”therapeutic window” of GK-2 in intracerebral posttraumatic
hematoma model in rats
Valentina A Kraineva, Svetlana O. Kotelnikova, Tatyana A. Gudasheva
Zakusov Institute of Pharmacology RAMS Baltiyskaya str. 8, 125315, Moscow-Russia
e-mail address: [email protected]
Objective: GK-2 - hexamethylendiamide bis-(N-monosuccinil-L-glutamyl-L-lysine) - a novel low-molecular mimetic of nerve growth
factor. In previous studies it was shown that GK-2 being administered 4 h after surgery completely prevents mortality in experimental
model of intracerebral posttraumatic hematoma (IPH) in rats. The purpose of the study was to evaluate the «therapeutic window» of GK-2
in IPH model.
Method: IPH was simulated by the destruction of brain tissue in the area of internal capsule according to Makarenko AN et al. Animals
were divided into 7 groups: sham-operated; animals with IPH treated by saline; and 5 groups of rats with IPH treated by GK-2 (1 mg/kg,
intraperitoneally) with first administration 6, 9, 12, 18 or 24 hours after surgery, and then every 48 hours during 2 weeks.
Results: In sham-operated rats within the first day after surgery death-rate was 0%, and by day 14 increased up to 10%. In rats with IPH
within the first day death-rate was 10%, and by day 14 increased up to 50%. In rats which received GK-2 within 6 hours after surgery
survival rate increased, mortality by the 14th day was only 17%. Tendency to decrease in mortality was registered when GK-2 was injected
first within 9 hours as well as within 12 hours after surgery (mortality was 30%). In rats with IPH treated by GK-2 with first administration
18 hours or 24 hours after surgery no protective effect of GK-2 was registered.
Conclusion: Thus, the results obtained show that GK-2 when administered firstly from 4 to 6 hours after surgery is able to increase survival
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in experimental animals in the model of intracerebral posttraumatic hematoma.
Keywords: nerve growth factor, mimetic, posttraumatic hematoma
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[PP-037] Schizophrenia and other psychotic disorders
Ref. No: 0174
Repetitive transcranial magnetic stimulation in the treatment of auditory hallucinations:
a case report
Ibrahim Oner1, Onat Yilmaz2, Alparslan Asil Budakli1, Hakan Balibey1, Mehmet Alpay Ates1
1GATA Haydarpasa Training Hospital, Department of Psychiatry, Istanbul-Turkey
2Golcuk Military Hospital, Department of Psychiatry, Kocaeli-Turkey
e-mail address: [email protected]
Growing data suggests that repetitive transcranial magnetic stimulation(rTMS) to the temporoparietal cortex might be a safe and effective
treatment method for auditory hallucinations in schizophrenia. We report the case of a patient with low adherence to treatment suffering
auditory hallucinations who had received rTMS.
A 47-year-old male patient was admitted to our outpatient clinics with complaints of auditory hallucinations and delusions of persecution
with the diagnosis of schizophrenia for approximately 25 years. He had been hospitalized four times and underwent various treatment
regimens but he himself stopped taking his medication a month before his admittance. He had been taking aripiprazole 10mg/day and
suffering for auditory hallucinations for almost a year. The patient assented to TMS therapy and was admitted after signing his informed
consent. Psychotropic medication with aripiprazole was not changed during the treatment. The patient underwent 20 sessions of
consecutive TMS stimulation with one session per day, In each of the sessions, 1000 stimulations were administered in an order of 50
trains of 20 seconds each at 1 Hz. During the last week of treatment he reported a marked decrease in the frequency and intensity of the
hallucinations. The patient reported no adverse effects of the treatment and within 3 months after his treatment no recurrence was seen.
Using rTMS directed at the left temporoparietal cortex to treat auditory hallucinations might be an alternative therapeutic role. Further
studies with large samples are needed to examine this therapeutic effect.
Keywords: auditory hallucinations, rTMS, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S129
[PP-038] Psychopharmacology
Ref. No: 0175
Clinical approach to tardive dyskinesia associated with combination of atypical-typical
antipsychotic medication: A case report
Ibrahim Oner1, Onat Yilmaz2, Alparslan Asil Budakli1, Hakan Balibey1, Mehmet Alpay Ates1
1GATA Haydarpasa Training Hospital, Department of Psychiatry, Istanbul-Turkey
2Golcuk Military Hospital, Department of Psychiatry, Kocaeli-Turkey
e-mail address: [email protected]
Tardive dyskinesia(TD) can be basically described as involuntary hyperkinetic abnormal movements that vary in localization and form.
Olanzapine, as an atypical antipsychotic, posseses a significantly lower risk for TD compared with typical agents. And also, it has a
therapeutic effect on TD. We present a case who had been using a combination of olanzapine and flupentixole depot for more than 1,5
years and developed involuntary movements upon his presentation and the management of the patient is discussed.
Mr. A is a 45-year-old single male with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnosis of schizophrenia, for
approximately 27 years. He had been mainly maintained on amisulpiride and quetiapine until 1,5 years ago. After a psychotic relapse, the
treatment was switched to flupentixole depot 200mg/15 days and olanzapine 20mg/day. He applied to our outpatient psychiatric service
with the complaints of involuntary movements in his hands, named as “crab claw” by himself. He was started on aripiprazole 10mg/day
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and olanzapine and flupentixole was gradually discontinued. After 3 weeks, aripiprazole dosage was set to 15mg per day and he was free
of psychotic symptoms and involuntary movements. After 5 months, he consulted with the same movement. It was learned from the
patient that, 2 months before his presentation, he discontinued his medication, after a psychotic exacerbation characterized by delusions;
he started flupentixole again and the movements started on. The typical antipscyhotic was discontinued and aripiprazole was gradually
tapered up to 30mg per day. In the course of his 6-months follow-up, he was free of psychotic movements and dyskinetic movements.
Recent data underlines the risk of developing TD, even using atypical antipsychotics. Early detection of extra-pyramidal side effects, in
particular TD, is critical to its management and clinicians should be aware of these rare conditions. Although aripiprazole might be taken
into account as a reasonable choice for the treatment of TD and psychotic sypmtoms, larger controlled studies are needed to confirm
this opinion.
Keywords: tardive dyskinesia, combination treatment, atypical antipsychotics, typical antipsychotics, adverse effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S129-S30
[PP-039] Schizophrenia and other psychotic disorders
Ref. No: 0176
Schizophrenia-like psychosis induced by a single dose of cannabis: a case report
Ibrahim Oner1, Onat Yilmaz2, Alparslan Asil Budakli1, Hakan Balibey1, Mehmet Alpay Ates1
1GATA Haydarpasa Training Hospital, Department of Psychiatry, Istanbul- Turkey
2Golcuk Military Hospital, Department of Psychiatry, Kocaeli- Turkey
e-mail address: [email protected]
Being the most available illicit substance all around the world, growing evidence is pointing out that cannabis use carries an increased
risk for the development of mental disorders. Although cannabis is abused for its euphoric effects, it may also cause depersonalization,
psychosis, panic attacks and mood disorders. Such clinical conditions are usually acute, transient but persisting or recurring symptoms
with continued use of cannabis are documented as well. In this case report, an individual who developed schizophrenia after a single use
of cannabis, is described.
A 36-year-old single male pilot was fetched to our psychiatry outpatient service by his friends with the complaints of disorganised speech
and behaviors, paranoid and mystic identity delusions starting a week ago. His vital signs were normal and physical examination was
unremarkable. Results of extensive blood work, including complete blood count, electrolytes, as well as hepatic and renal function tests
were normal. Urinal toxicological analysis was negative for cannabis. His medical history and family history revealed nothing significant.
He believed that he had a special mission given by the prophet and was being chased by some people he did not know. He was started
on olanzapine 20mg/day and discharged after twelve days. After the resolution of symptoms he told that he had a single dose of cannabis
mixed with tobacco, a week before his admittance. During the first three months he visited for follow-up regularly, but he discontinued
the medication after then. Six months later, he was rehospitalized with delusions and agitation. After 20 days, he was discharged and due
to metabolic side effects of prior treatment, aripiprazole 15mg/day was prescribed. With a gradual improvement, aripiprazole was tapered
down to 5mg/day by the end of first year. He is still free of psychotic symptoms and working as a flight instructor.
In animal studies, cannabis enhances dopaminergic neurotransmission in brain regions known to be implicated in psychosis. Studies also
show that genetic vulnerability might add to increased risk of developing psychosis. In this case report, we would like to show that a single
dose of cannabis can precipitate schizophrenia.
Keywords: cannabis, schizophrenia
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[PP-040] Nosology and classification
Ref. No: 0177
Munchausen syndrome by proxy: a case report
Atilla Tekin1, Yusuf Kayran2, Esra Ozdil1, Bekir Yukcu3, Nazan Dalgic Karabulut3, Julide Kenar1, Omer Akil Ozer1
1Sisli Etfal Training and Research Hospital, Department of Psychiatry, Istanbul- Turkey
2Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, Istanbul-Turkey
3Sisli Etfal Training and Research Hospital, Department of Pediatrics, Istanbul-Turkey
e-mail address: [email protected]
Munchausen Syndrome by Proxy (MSBP) is a form of child abuse which is seen rarely and diagnosed very hardly. Perpetrators are frequently
the mothers in this disorder and the most important diagnostic feature is that the symptoms which are fabricated by perpetrators, not
having a purpose of any profit. In this article, a 19-month-old male, who was contaminated by his mother through catheterization, is
reported. In this disorder which is frequently overlooked, early diagnosis is possible with multidiciplinary approach.
Keywords: child abuse, factitious disorder, Munchausen syndrome by proxy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S131
[PP-041] Mood disorders
Ref. No: 0179
Comorbid obsessive compulsive disorder and mood disorder in a SLE patient:
a case report
Ebru Findikli, Fatma Ozlem Orhan, Nur Yalcin Yetisir
1Kahramanmaras Sutcu Imam University, School of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
e-mail address: [email protected]
SLE (Systemic Lupus Eritamatosus) is a chronic and multisystemic autoimmune disease associated with different clinical symptoms.
Involvement of the central nervous system by SLE causes neurologic and psychiatric manifestations (Bruns et al. 2006). These psychiatric
problems include psychosis, mood disorder, anxiety and obsessive compulsive disorder (OCD). The most common psychiatric disorders
are suffering major depression and anxiety disorder. Approximately 3/4 of female patients with SLE have at least one psychiatric disorder
during their lifetime. The reasons for the high prevalence of psychiatric disorders in SLE patients are poorly understood. Potential
explanations include the high doses of corticosteroids commonly used in SLE treatment, the psychological stress of having a major
chronic systemic disease and autoimmune phenomena related to SLE itself, specifically autoantibodies against neuronal tissues.
In this case report, a 24 years old female SLE patient with both mood disorder and OCD was presented. Her obsession was thinking about
a man (i.e.. I must see M.) and compulsion was meeting with him. She exposed to sexual abuse because of her compulsions. She had also
impulsive telephone calls and runaways from home, irritability. Her EEG and MRI was normal. We treated her with clomipramine 225 mg/
day, olanzapine 10 mg/day successfully. We reported here a case of comorbid OCD and mood disorder as a rare manifestation of SLE.
Keywords: systemic lupus eritamatosus, obsessive compulsive disorder, mood disorder
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[PP-042] Childhood and adolescence disorders
Ref. No: 0181
An adolescent with Sanfilippo type 3B and effect of aripiprazole and atomoxetine
treatment: a case report
Ayse Buyukdeniz1, Canan Yusufoglu2, Musa Yilanli3
1Marmara University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
2Erenkoy Mental Health and Neurology Training and Research Hospital, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
3Yale School of Medicine Connecticut Mental Health Center, Department of Psychiatry, Connecticut-USA
e-mail address: [email protected]
Inborn errors of metabolism represent rare but important causes of psychiatric disorders in adoles- cents or adults.The mucopolysaccharidoses
(MPSs) are a group of seven inherited metabolic disorders within the larger lysosomal storage disease (LSD) family. Sanfilippo type B is
an autosomal recessive mucopolysaccharidosis (MPSIIIB) caused by deficiencyof N-acetyl-a-D- glucosaminidase, a lysosomal enzyme
involved in the degradation of heparan sulfate. The birth prevalence of the disease ranges from 0.28 to 4.1 per 100,000. Affected subjects
show developmental delay, attention deficit disorder, uncontrollable hyperactivity, and aggressive behaviour, followed by progressive
dementia with death usually among late teens.
A 15 years old mild mentally retarded adolescent with a diagnosis of Sanflippo type 3B (MPS 3B) presented with behavioural problems
to our outpatient clinic. His parents reported that he was consulted by child and adolescent psychiatry department to genetic diseases
department due to macrocephaly, abnormal EEG findings, syndromic facial appearence, hyperactivity and aggresive behaviours that
were resistant to methlyphenidate and thioridazine and then diagnosis of MPS 3B was made by urine analysis at the age of six. During
our assessment, his parents noted uncontrollable crying, his concentration was poor, he had marked hyperactivity. He had been taking
risperidone and chlorpromazine at that time. We first changed antipsychotic treatment to aripiprazole 5 mg once daily then increased
dose up to 10 mg/day, which reduced his aggression and episodic cryings. Then we added atomoxetine 40 mg once daily, targeting
hyperactivity and inattention and also in order to alleviate anxiety. One month after commencement of these medications there was a
significant clinical improvement in his hyperactivity, inattention and aggressive behaviours.
Our case is notable because conventional treatment, including behavioural modification and pharmacotherapy including stimulants and
most of antipsychotics has achieved limited success managing these symptoms.
Keywords: Sanflippo Syndrome, behavioural problems, aggression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S132
[PP-043] Clinical psychiatry
Ref. No: 0182
Anxiety, depression and personality in patients with mastalgia
Enver Demirel Yilmaz1, Erdem Deveci1, Huseyin Kadioglu2, Ali Emre Dursun1, Ismet Kirpinar1
1Bezmialem Vakif University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
2Bezmialem Vakif University, Faculty of Medicine, Department of General Surgery, Istanbul-Turkey
e-mail address: [email protected]
Objective: Psychiatric backgrounds of mastalgia have been an intriguing subject for authors for many years. Anxiety disorders, especially
generalized anxiety disorder, depressive disorders and somatization disorder have been commonly reported in women with mastalgia. It’s
been shown that patients with poor response to treatment had more severe anxiety, depression and there is a powerful and significant
relationship between the severity of mastalgia and severity of anxiety and depression. One of the major causes of disability in the
patients with psychogenic chronic pain is exaggerated perception of pain due to anxiety. To be excessively afraid of pain may aggravate
perception of pain and further lead to restriction of physical activities and increasing disability. Predispositions to anxiety differs largely
among individuals. One of the important factors that explain these differences is personality. In this study, we planned to evaluate the
personality features, anxiety and depression levels of the patients with mastalgia by comparing them to a healthy control group.
Method: Sixty premenopausal patients without an organic cause that explains mastalgia and 53 healthy premenopausal women, who
were admitted to the Breast Diseases Polyclinic of our university have been included in the study. Both groups had been evaluated with
Sociodemographic Data Form, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Cloninger’s Temperament and Character
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Inventory (TCI).
Results: Subjects were matched on age, education and marital status. Anxiety and depression scores in BAI and BDI were significantly
higher in the mastalgia group (p<0.001). While harm avoidance, self-directedness and self-transcendence scores were significantly higher
in the mastalgia group (all p<0.001); cooperativeness scores were significantly lower (p<0.001). We found correlations between anxiety
scores and harm-avoidance (r=0.46, p<0.001), self-directedness (r=0.46, p<0.001), and self-transcendence scores (r=0.39, p<0.001); and
also between depression scores and harm-avoidance (r=0.33, p<0.001), self-directedness (r=0.32, p<0.001), and self transcendence scores
(r=0.30, p<0.001). Negative correlations were found between anxiety scores and cooperativeness (r=-0.46, p<0.001); and also between
depression level and cooperativeness (r=-0.33, p<0.001).
Conclusion: Our study demonstrated that mastalgia is associated with personality features; it can lead to anxiety and depression,
therefore psychiatric consultation is important in the patients with mastalgia.
Keywords: anxiety, mastalgia, personality
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S132-S3
[PP-044] Clinical psychiatry
Ref. No: 0184
Correlation between anxiety and personality in caregivers for patients with schizophrenia
Enver Demirel Yilmaz1, Erdem Deveci1, Huseyin Gulec2, Ismet Kirpinar1
1Bezmialem Vakif University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
2Erenkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: The objective of this study is to analyses the correlation between state and trait anxiety, depression and personality traits in
caregivers of patients diagnosed with schizophrenia.
Method: The study sample consists of care-givers of 34 patients diagnosed with schizophrenia according to the DSM IV-TR criteria, and
37 healthy voluntary subjects demographically matched. The Temperament and Character Inventory (TCI), Hamilton Depression Rating
Scale (HDRS) and State-Trait Anxiety Inventory (STAIX I-II) scales have been applied to the subjects.
Results: In this study, it has been found that STAIX-I and STAIX-II anxiety scores were higher in caregivers. The comparison between the
groups has revealed that persistence (P) scores were higher in caregivers (P=0.036). A statistically significant correlation has been found
between the STAIX –I score and harm avoidance (HA) (r=0.64, P<0.001); self-transcendence (ST) (r=0.44, P=0.01) and self-directedness
(SD) scores (r=-0.58, P<0.001); STAIX-II score and harm avoidance (HA) (r=0.62, P<0.001); self-transcendence (ST) (r=0.47, P=0.005) and
self-directedness (SD) scores (r=-0.58, P<0.001) of TCI.
Conclusion: Our results suggest that, by also taking into account their personal traits, caregivers of patients with schizophrenia should
be assessed by clinicians more carefully and comprehensively in respect of anxiety.
Keywords: caregiver, personality, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S133
[PP-045] Clinical psychiatry
Ref. No: 0185
Is anxiety and depression related with personality in caregivers for patients
with bipolar disorder?
Enver Demirel Yilmaz1, Erdem Deveci1, Huseyin Gulec2, Ismet Kirpinar1
1Bezmialem Vakif University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
2Erenkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: The objective of this study is to analyses the correlation between state and trait anxiety, depression and personality traits in
caregivers of patients diagnosed with bipolar disorder.
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Method: The study sample consists of care-givers of 34 patients diagnosed with bipolar disorder according to the DSM IV-TR criteria, and
37 healthy voluntary subjects demographically matched. The Temperament and Character Inventory (TCI), Hamilton Depression Rating
Scale (HAM-D) and State-Trait Anxiety Inventory (STAIX I-II) scales have been applied to the subjects.
Results: In this study, it has been found that STAIX-I and STAIX-II anxiety scores are higher in caregivers. The comparison between the
groups has revealed that persistence (P) scores are higher in caregivers (p<0.001). A statistically significant correlation has been found
between the STAIX –I score and harm avoidance (HA) score (r=0.36, p=0.04); STAIX-II score and harm avoidance (HA) (r= 0.57, p<0.001);
self-transcendence (ST) (r=0.41, p=0.01) and self-directedness (SD) scores (r=-0.60, p<0.001); HAM-Dscore and harm avoidance (HA)
(r=0.47, p=0.01) of TCI.
Conclusion: Our results suggest that, by also taking into account their personal traits, caregivers of patients with bipolar disorder should
be assessed by clinicians more carefully and comprehensively in respect of anxiety.
Keywords: bipolar disorder, caregiver, personality
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S133-S4
[PP-046] Memory and cognitive disorders
Ref. No: 0186
Neurocognitive functioning in acne vulgaris
Erdem Deveci
Bezmialem Vakif University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
Email: [email protected]
Objective: It has long been known that patients with depression, social anxiety disorder and social phobia show neuropsychological
symptoms and these disorders are common causes for impaired neurocognitive functions such as memory, attention, psychomotor speed
and executive functions. Emotional stress can exacerbate acne, and conversely patients may experience psychological and psychiatric
problems because of acne. Attention, memory, verbal-linguistic ability and executive functions were assessed in acne vulgaris patients in
comparison with healthy controls.
Methods: Treatment naïve 52 acne patients and 47 controls were recruited. The groups were well-matched for age, gender and years
of education. The neuro-cognitive battery used was Rey Auditory Verbal Learning and Memory Test, Auditory Consonant Trigram Test,
Controlled Word Association Test, Digit Span Test, Trail Making Test, and Stroop Test. Structured Clinical Interview for DSM-IV Axis I
Disorders (SCID-I), Hospital Anxiety and Depression Scale (HADS), Liebowitz Social Anxiety Scale (LSAS) were applied.
Results: The acne group demonstrated impairments in verbal episodic memory, learning, working memory and phonemic verbal fluency.
No group difference was found in attention or executive functions.
Conclusion: Further studies particularly investigating cognitive functioning and oxidative parameters together are necessary for verifying
our results and bring to light the underlying mechanisms.
Keywords: acne vulgaris, neurocognition
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S134
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[PP-047] Clinical psychiatry
Ref. No: 0187
Relationship of asymmetrical dimethylarginine, nitric oxide and cognitive functions
in patients with major depressive disorder
Serpil Canpolat1, Erdem Deveci2, İsmet Kirpinar2, Hulya Aksoy3, Zafer Bayraktutan3, Ibrahim Eren4, Recep Demir5, Nazan Aydin6, Salih Selek7
1Cumra State Hospital, Department of Psychiatry, Konya- Turkey
2Bezmialem Vakif University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
3Atatürk University, School of Medicine, Department of Biochemistry, Erzurum-Turkey
4Konya Training and Research Hospital, Department of Psychiatry, Konya-Turkey
5Atatürk University, School of Medicine, Department of Neurology, Erzurum-Turkey
6Atatürk University, School of Medicine, Department of Psychiatry, Erzurum-Turkey
7Medeniyet University, School of Medicine, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: In this study, we aimed to investigate the relationship of serum nitric oxide (NO) and asymmetrical dimethylarginine (ADMA)
levels with cognitive function in patients with major depressive disorder.
Method: Forty-one patients diagnosed as major depressive disorder (MDD) according to DSM-IV criteria and also had at least 17 points
in Beck Depression Scale were included to the study. A healthy matched group with similar age, gender, smoking habits, and education
level served as control. Correlation between NO and ADMA levels and cognitive function was evaluated in both groups.
Results: Neuropsychologic test battery (Rey Verbal Learning and Memory Test, Auditory Consonant Trigram Test, Digit Span Test,
Winsconsin Card Sorting Test, Continuous Performance Task (TOVA) and Stroop Test) scores were worse in patients with major depressive
disorder when compared to healthy controls. There was no significant difference between patient and control groups in terms of serum
NO (p=0.21) and ADMA (p=0.60). Serum NO levels were correlated with TOVA test error scores (Commission errors r=0.20, p=0.001) and
Stroop test time scores (r=0.21, p=0.04), whereas serum ADMA levels were negatively correlated with TOVA test error scores (Omission
errors r=-0.12, p=0.0001, Comission errors r=-0.06, p=0.04). Based on these results, patients with major depressive disorder showed
deficits in cognitive functions such as learning, memory, attention, verbal fluency and executive functioning.
Conclusion: Metabolic detriments especially in relation with NO metabolism in frontal cortex and hypothalamus, psychomotor
retardation or loss of motivation may explain these deficits.
Keywords: cognition, depression, dimethylarginine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S135
[PP-048] Schizophrenia and other psychotic disorders
Ref. No: 0188
Klinefelter’s syndrome concurrent to psychosis: a case report
Ali Kandeger, Asena Akdemir, Bilge Burcak Annagur
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Klinefelter’s syndrome (KS) with the classic 47, XXY karyotype is the most frequent chromosomal aneuploidy, with a prevalence of 1 in 700
men and is the most common genetic form of male hypogonadism.
Men with KS have an increased prevalence of psychiatric disturbances, ranging from attention deficit disorder in childhood to
schizophrenia and severe affective disorders during adulthood. 47, an XXY aneuploidy is found in about 0.8–1% of men hospitalized for
schizophrenia, representing a four-folds to five-folds excess over the incidence at birth of Klinefelter Syndrome. We want to present a case
report of KS who concurrently suffer psychosis.
A 23 year-old, single man was admitted to the outpatient clinic of psychiatry because of acute stress disorder symptoms such as terror,
insomnia, social detachment, irritability, 3 days after the Reyhanlı terrorattack. He was diagnosed to have mild Mental Retardation due
to behavioral problems such as aggression, irritability in childhood and also diagnosed Klinefelter’s Syndrom (47, XXY) with cytogenetic
study and tricuspid regurgitation with detailed cardiological examination when he was 13. He was diagnosed to have psychosis because
of persecutory delusions when he was 18 and Olanzapine treatment was started. His past psychiatric history was significant for a diagnosis
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of paranoid schizophrenia with several psychiatric hospitalization and olanzapine treatment increased to about 30 mg/day. Currently, he
is under control with olanzapine 10 mg/day and there is no psychotic symptom. His affect was depressed and he also appeared anxious
and irritable. Physical examination indicated that he has long arms and legs relatively. All other investigations, including blood count,
renal and hepatic function, electroencephalogram, and serum testosterone levels were all within normal limits.
KS is associated with multiple psychiatric comorbidities. Bruining et al. found that language disorder has a comorbidity of 65% as the
most prevalent disorder followed by attention deficit hyperactivity disorders (63%) and autism spectrum disorder (27%) in KS. Behavioral
impairment was most evident among cases classified as autism spectrum disorder and psychotic disorder (12%). A survey of hospital
admissions and discharge diagnoses among individuals with XXY in Denmark and a randomly selected age-matched control group found
that individuals with XXY had an increased relative risk of being hospitalized for psychiatric disorders, particularly for psychoses.
The psychological symptoms were very similar to those cases mentioned in other reports of KS, associated with schizophrenia-like
symptoms. Some reports about the relationships between sex hormones and schizophrenia including other psychotic disorders suggest
that the X-chromosome plays an important part in the mechanism of psychosocial symptoms and in the prognosis in KS.
Keywords: Klinefelter’s syndrome, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S135-S6
[PP-049] Childhood and adolescence disorders
Ref. No: 0190
Autistic spectrum symptoms in subtypes of attention deficit hyperactivity disorder
Ayse Burcu Ayaz1, Sebla Gokce Imren2, Funda Gumustas3, Muhammed Ayaz1
1Sakarya University Training and Research Hospital, Child and Adolescent Psychiatry Outpatient Clinic, Sakarya-Turkey
2Erenkoy Psychiatric and Neurologic Research and Training Hospital, Child and Adolescent Psychiatry Outpatient Clinic, Istanbul-Turkey
3Adiyaman University Training and Research Hospital, Child and Adolescent Psychiatry Outpatient Clinic, Adiyaman-Turkey
e-mail address: [email protected]
Objective: Some children suffering attention deficit/hyperactivity disorder (ADHD) have similar social interaction and communication
problems as those diagnosed to have autistic spectrum disorders (ASDs). This study aimed to compare autism spectrum symptoms in
children according to ADHD subtypes and children without ADHD.
Method: ADHD and comorbid diagnoses were made using the Schedule for Affective Disorders and Schizophrenia for School-Age
Children. The Social Responsiveness Scale (SRS), Childhood Behavior Checklist (CBCL), and ADHD Rating Scale (ADHD-RS) were used to
evaluate symptoms.
Results: This study included 387 children: 238 in the ADHD group and 149 in the control group. Among those in the ADHD group, 28.6%
were diagnosed to have ADHD inattentive subtype, 13.0% to be ADHD hyperactive/impulsive subtype, and 58.4% ADHD combined
subtype. All the ADHD patients had higher SRS total and subscale scores than the control group (p<0.001). The SRS total and the social
subscale scores were higher in the ADHD combined subtype than in the ADHD H/I subtype (p<0.05). After controlling for age, gender,
and CBCL social withdrawal score, the difference in autism spectrum symptoms between the three ADHD subtypes was not significant.
Assessment of the relationship between the ADHD-RS subscale scores and the SRS total and subscale scores based on Pearson’s
correlation analysis showed that there was not a significant correlation between ADHD-RS subscale scores and any SRS score in any of
the three ADHD subtypes.
Conclusion: The present study’s findings show that social withdrawal symptoms in those with ADHD might have effects on ASSs.
However, no significant differences were found in ASSs between the ADHD subtypes when this effect was removed, all ADHD subtypes
had a similar risk of ASSs, and ASSs might be accompanied by ADHD regardless of the symptoms of ADHD. To our own clinical experience,
children with a combination of ADHD symptoms and ASSs are generally much more difficult to treat than children with ADHD alone. The
present findings indicate the importance of evaluating ASSs, planning, and implementing treatment modalities such as early social skill
training and interpersonal psychotherapy oriented for ASSs regardless of ADHD subtypes in all children with ADHD.
Keywords: children, attention deficit-hyperactivity disorder, autism spectrum symptoms
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[PP-050] Clinical psychiatry
Ref. No: 0191
The psychiatric profile of chronic pruritus patients
Oguz Akman1, Fatma Ozlem Orhan2, Perihan Ozturk3, Ali Ozer4, Yasemin Akman3, Mehmet Fatih Karaaslan2
1Necip Fazil City Hospital, Department of Psychiatry, Kahramanmaras-Turkey
2Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
3Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Dermatology, Kahramanmaras-Turkey
4Inonu University, Faculty of Medicine, Department of Public Health, Malatya-Turkey
e-mail address: [email protected]
Objective: Itching or pruritus is an uncomfortable sensation leading to the urge to scratch. Chronic pruritus may be seen in many skin
and systemic diseases as well as in psychiatric disorders. The aim of the present study was to assess the sociodemographic characteristics
of patients with chronic pruritus due to reasons other than primary skin diseases or systemic diseases that may cause itching, and to
investigate itching features, psychiatric disorders and depressive symptoms.
Method: One hundred twenty six patients with chronic pruritus were included in the study. Sociodemographic data and disease-related
features were recorded on a form. Psychiatric diagnoses were established based on the Diagnostic and Statistical Manual of Mental
Disorders-IV-Text Revision (DSM-IV-TR) criteria by using the Structured Clinical Interview for DSM-IV, Clinical Version (SCID-I/CV). The Beck
Depression Inventory (BDI) was applied.
Results: Of chronic pruritus patients, 70.6% had psychiatric disorders ranging 1-3. The most common psychiatric disorders were
depressive disorders with a rate of 34.1%. The rate of female patients was higher among chronic pruritus patients both with and without
a psychiatric diagnosis. The generalized itching and BDI scores were significantly higher in patients with a psychiatric diagnosis as
compared to those without (p<0.05). Among all chronic pruritus patients, 62% had depressive symptoms, ranging mild to severe. Among
patients with a psychiatric disorder, 57.3% had no skin lesion, while 42.7% had skin lesions secondary to itching such as excoriation, lichen
simplex chronicus and prurigo nodularis.
Conclusions: The high rate of psychiatric disorders and particularly the presence of concomitant depressive symptoms in patients with
chronic pruritus without a primary skin or systemic disease indicate the importance of psychiatric evaluation in such patients.
Keywords: chronic pruritus, depressive symptoms, psychiatric disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S137
[PP-051] Eating disorders
Ref. No: 0193
Night eating syndrome and binge eating disorder in depression
Ali Nuri Oksuz1, Fatma Ozlem Orhan2, Hasan Cetin Ekerbicer3, Mehmet Fatih Karaaslan2, Ebru Findikli2
1Kahramanmaras Necip Fazil City Hospital, Department of Psychiatry, Kahramanmaras-Turkey
2Kahramanmaras Sutcuimam University, Faculty of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
3Sakarya University, Faculty of Medicine, Department of Public Health, Sakarya-Turkey
e-mail address: [email protected]
Objective: The connection between night eating syndrome (NES) and binge eating disorder (BED) with depression has been
demonstrated in many studies. However, there is no study conducted on ratios of both NES and BED major depressive patients. The main
purpose of this study is to determine ratios of NES and BED in major depressive patients and healthy controls and to identify risk factors
which affect development of NES and BED.
Method: This study comprised of 168 depressed patients and 165 healthy participants. The Beck Depression Inventory and Eating
Attitudes Test were applied.
Results: 27 (16.4%) depressed patients and 7 (4.2%) healthy controls fulfilled the NES criteria. On the other hand, 33 (19.6%) depressed
patients and 7 (4.2%) healthy controls meet the BED criteria. Of the participants who had NES, 41.2% was also diagnosed with BED.
According to the regression analysis; it is determined that being in the 18-29 age group, obesity and existence of depression are the
risk factors, which affect development of NES. Obesity and existence of depression were also identified as the risk factors, which affect
development of BED.
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Conclusions: This study concludes that NES and BED are observed more in patients with major depressive disorder in comparison to
healthy individuals. Such abnormal eating behaviors, which are related with obesity, contribute to weight gain in patients and may lead
to increase in psychopathology level. It is recommended that patients with depression should be screened for symptoms of night eating
and binge eating.
Keywords: binge eating disorder, depression, night eating syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S137-S8
[PP-052] Psychopharmacology
Ref. No: 0194
Antipsychotics and metabolic syndrome: a naturalistic six-month follow-up study
Ceyhan Balci Sengul1, Ozgur Kalkanci3, Filiz Karadag2, Cem Sengul2
1Denizli State Hospital, Denizli-Turkey
2Pamukkale University, Faculty of Medicine, Denizli-Turkey
3Servergazi State Hospital, Denizli-Turkey
e-mail address: [email protected]
Objective: The aim of this naturalistic follow-up study is to investigate the metabolic syndrome (MetS) frequency according to ATP III A criteria and
its natural course in the patients with schizophrenia and schizoaffective disorder treated with typical and atypical antipsychotics.
Method: This prospective naturalistic follow-up study enrolled the inpatients and outpatients between 18–65 years of age, diagnosed to
have schizophrenia or schizoaffective disorder according to the DSM-IV classification, who had been receiving antipsychotics for at least
12 weeks. This study was supported by Pamukkale University Scientific research committee (project No: 2008 TPF 029).
Results: At the baseline, 50,80% of patients (n: 123) were on atypical antipsychotics medication as monotherapy, 7.90% (n=17) were on
typical antipsychotics as monotherapy, 16,70% (n= 40) were on typical and atypical combinations and, 25,43% (n= 51) were on atypical
combinations. During six months treatment changes were evident in 46 (23.58%) patients, in total. They were mostly (69.50%) the
patients receiving different combinations of antipsychotics. A typical antipsychotic was added on the treatment of five patients receiving
atypical antipsychotics as monotherapy at the baseline. In addition to their ongoing treatment, one patient had received ziprasidone
and five patients had received aripiprazole. Aripiprazole treatment was ceased in two patients; they were still under antipsychotic
treatment in combination. The total number of received antipsychotic and antipsychotic monotherapy or its combinations were not
significantly related to baseline and follow-up MetS frequency. The frequency of MetS was not different across antipsychotic regiment
groups (typical, atypical or their combinations) at the follow-up visit. However, the frequency of MetS was slightly lower in the patients
receiving ziprasidone or ariprazole (either monotherapy (p=0.082) or its combination (p=0.063)) than that of other patients at the follow
up evaluation. Patients using depot antipsychotics alone or combined with other antipsychotic gained more weight (p=0.041).
Conclusion: Metabolic syndrome is an important issue in schizophrenia treatment. Understanding solely and combination effects of
antipsychotics might help us to find correct medications for our patients.
Keywords: antipsychotic, metabolic syndrome, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S138
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[PP-053] Clinical psychiatry
Ref. No: 0195
The effect of polycystic ovary syndrome phenotypes on quality of life,
depression and anxiety levels
Ugur Keskin1, Murat Erdem2, Suleyman Akarsu2, Abdullah Bolu3
Gulhane Military Medical Faculty, Department of Obstetrics and Gynecology, Ankara-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
Flight Crew Health Research and Education Center, Eskisehir-Turkey
3
e-mail address: [email protected]
Objective: Low psychological profile in polycystic ovary syndrome (PCOS) reduces the quality of life. Considering the diagnostic criteria
for PCOS, comes to the forefront in three phenotyping as classic, ovulatory and normoandrogenic. The aim of this study was to compare
quality of life, depression and anxiety levels between PCOS phenotypes and a control group.
Method: One hundred and six patients and control subjects under current examination in Gulhane Military Medical Faculty, obstetrics
and gynecology outpatient clinic were included in the study. PCOS patients were divided into 3 groups according to their phenotypes
as classic (n = 27), ovulatory (n= 27), normoandrogenic (n= 27). The control subjects (n= 27) took part in the fourth group. Quality of life,
depression, and anxiety levels were evaluated by quality of life scale for polycystic ovary syndrome, Beck Depression Inventory and Beck
Anxiety Inventory respectively.
Results: Normoandrojenik phenotype was less affected than the others in terms of depression and quality of life scores. There was
no difference in quality of life subscales for hirsutism, over weight and ovulatory dysfunction between PCOS phenotypes. Emotional
impairment occurred most at classic phenotype. Normoandrogenic phenotype becamedistinguished from the other two phenotypes in
the subscale of infertility.
Conclusion: Determination of mood changes and the associations between these changes and PCOS symptoms are considered to be
a positive contribution to the improvement of symptoms in PCOS. Assessment of the impact of symptoms on phenotypes of PCOS will
facilitate the management of treatment.
Keywords: polycystic ovary syndrome, phenotype, quality of life
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S139
[PP-054] Psychopharmacology
Ref. No: 0197
Impaired glucose tolerance metabolism after the use of antidepressants: a case report
Erdal Pan1, Abdullah Bolu2, Seyit Ahmet Ay2
Eskisehir Military Hospital, Eskisehir-Tukey
1
Turkish Air Force Aircrew’s Health Research and Training Center, Eskisehir-Turkey
2
e-mail address: [email protected]
Side effects of drugs used in psychiatry has been a subject of debate. This issue is to be discussed after use of atypical antipsychotics.
Long-term use of atypical antipsychotics and some antidepressants may lead to especially deterioration of glucose homeostasis and side
effects such as weight gain.
Case: The patient, a 42-year-old female applied to our out-patient clinic with severe anxiety and restlessness. There were no pathological
findings on physical and neurological examination. Biochemical tests were within normal limits. Generalized Anxiety Disorder was
diagnosed according to the DSM IV TR. Fluoxetine 20mg/day treatment was initiated. Sweating, trembling, palpitations and hunger
attacks were detected at the examination after two weeks. Upon consultation in the Internal Medicine Clinic, impaired glucose tolerance
was determined. Fluoxetine treatment was stopped and citalopram 20 mg/day was initiated. The patient’s psychiatry symptoms were
decreased while some other physical symptoms were setting on. In the same day, fasting blood glucose was 122 mg/dl thus citalopram
treatment was stopped. Sertraline 50 mg/day was started. One month after starting with sertraline, both psychiatric symptoms and
biochemical tests regressed.
There are conflicting results that antidepressants increase the risk of diabetes mellitus. As in this case, disorders of glucose metabolism
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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occurs after the use of different antidepressant, suggesting that individual genetic variations in drug metabolism is important.
Keywords: antidepressant, glucose, impairment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S139-S40
[PP-055] Neuroscience
Ref. No: 0198
Epileptic story and coping attitudes
Abdullah Bolu1, Murat Erdem2, Adem Parlak3, Oguzhan Oz4
Aircrew’s Health Research and Training Center, Eskisehir-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
Agrı Military Hospital, Department of Family Medicine, Agrı-Turkey
3
Gulhane Military Medical Faculty, Department of Neurology, Ankara-Turkey
4
e-mail address: [email protected]
Objective: Coping attitudes play an important role in ensuring compliance with the person challenging with life situations. Resistance
to the event or factors that cause stress on individual and showing cognitive, emotional and behavioral reactions to withstand all these
conditions are defined as coping attitudes. Whereas syncope can be a symptom of epileptic seizure; it may be a form of self defense
mechanism or coping attitude. The differential diagnosis of the two is often difficult. In this study, we aimed to investigate coping
attitudes of patients with epileptic or nonepileptic seizures.
Methods: This study was made in Gulhane Medical Faculty, Neurology Outpatient Clinic, in Turkey. We aimed to compare coping attitudes
of a control group (n=98) with those of study groups with epilepsy history, which were enrolled and sub-classified as nonepileptic (n=147)
and epileptic (n=112) patients. Participants’ socio-demographic (age, gender, education level, marital status) and clinical characteristics
were recorded by using a data collection form. COPE Inventory was applied to measure for coping attitudes. ANOVA test was used to
compare groups in terms of age, education levels and COPE score. Also Turkey test was used for Post hoc analysis. Sex, smoking and
marital status was compared with chi-square test. P value under or equal to 0.05 was accepted as significant.
Results: There was a statistically significant difference between three groups in terms of total scores of dysfunctional coping attitudes
(p<0.05). Religious coping subscale scores were higher than emotion focused coping attitudes, problem focused coping attitudes were lower
than joke pounding subscale scores and other occupations suppression subscale scores were higher in epileptic and nonepileptic patients.
Discussion: This study showed that patients with epileptic and non epileptic syncope (nonepileptic more) used dysfunctional coping
attitudes more than control group. These patients used functional coping strategies less often whereas they mostly applied religious
focused coping attitudes, which is subset of the emotional focused attitudes.
Keywords: coping attitudes, epilepsy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S140
[PP-056] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0199
The relationship between the levels of anxiety and coping attitudes of nurses
working at a training hospital
Abdullah Bolu1, Adem Balikci2, Murat Erdem2, Mesude Bozdemir1, Hakan Balibey3, Selma Bozkurt Zincir4
Aircrew’s Health Research and Training Center, Eskisehir-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
Ankara Military Hospital, Department of Psychiatry, Ankara-Turkey
3
Erenkoy Training Hospital, Erenkoy, Istanbul-Turkey
4
e-mail address: [email protected]
Objective: “Coping” is defined as resistance against stress full events or situations and all cognitive, emotional and behavioral responses
of the individual in order to withstand these conditions. Previous studies have shown that nursing is a demanding profession, and stress
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due to workplace is common among nurses. In this study, we aimed to assess coping attitudes of nurses working in a university hospital
according to their anxiety levels and to reveal the relationship between them.
Method: Eighty nurses working in various clinics of Gulhane Military Faculty of Medicine and Training Hospital, who has no psychiatric
complaints were enrolled. In this questionnaire study, as the first step, the sociodemographic data collection form and the Beck Anxiety
Inventory (BAI) were applied to participants, then the study group was divided into two sub-groups according to their anxiety scores. Both
groups were compared in terms of Coping Attitudes Scale (COPE) scores.
Results: It was found that nurses with higher levels of anxiety used denial and focusing on the problem and revealing the feelings as
dysfunctional methods more often and they used active coping as problem-focused coping methods lesser.
Conclusion: The findings of the study shows that nurses with higher levels of anxiety use active coping as problem-focused coping
methods less than those with normal levels of anxiety and they use denial and focus on and venting of emotions as dysfunctional
methods more often. Our study shows that dysfunctional coping attitudes can be associated with anxiety symptoms.
Keywords: anxiety, coping, nurses
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S140-S1
[PP-057] Substance abuse and dependence
Ref. No: 0200
Acquired stuttering starts due to the usage or exposure to volatile
substances: two case reports
Erdal Pan1, Abdullah Bolu2
Eskisehir Military Hospital, Eskisehir-Turkey
1
Turkish Air Force Aircrew’s Health Research and Training Center, Eskisehir-Turkey
2
e-mail address: [email protected]
Adult-onset stuttering stems from many reasons predominantly; neurological factors, medications, and psychological reasons. In this
study, acquisition of stuttering by exposure to volatile substance will be discussed in two cases.
Case 1: A 25-year-old patient, who is -working as a shoe worker for five-years, applied to our out-patient clinic complaining about loss of
speech fluency, phoneme extension and reiteration as uttering sounds. A year ago the patient’s complaints began with slip of the tongue
and diminishing speech fluency over the time.
Case 2: A 19-year-old patient was brought to our service because of using volatile substance (thinner, bally, etc.) and stuttering. As learned
from the patient, he has been using a variety of psychoactive volatile substances for three years. In recent times, he augmented the usage
of volatile substances and his speech was impaired for the last six months.
Discussion: The causes of adult-onset stuttering may be listed as neurological diseases such as cerebrovascular event, traumatic brain
injuries, migraine, neurodegenerative diseases and psychiatric causes such as depression, anxiety and psychoactive substance usage.
Chronic usage of toluene is known to cause toxic damage at the myelin sheath and white matter. For adolescents, myelinization has
an important place in neuro development process. In this case, exposure to volatile substances can lead to many psychopathological
disorders. Accordingly, too many preventive precautions should be taken on this subject.
Keywords: stuttering, substances
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S141
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[PP-058] Neuroimaging
Ref. No: 0201
Lesion localization and depressive symptoms in patients with multiple sclerosis
Murat Erdem1, Abdullah Bolu2, Oguzhan Oz3, A. Gazi Unlu2
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
1
Aircrew’s Health Research and Training Center, Eskisehir-Turkey
2
Gulhane Military Medical Faculty, Department of Neurology, Ankara-Turkey
3
e-mail address: [email protected]
Objective: Like other neurological diseases, which influence the brain tissue psychiatric symptoms usually accompany multiple sclerosis (MS).
Depression is one of the most common psychiatric conditions in patients with MS. Lifetime prevalence of depression in these patients is 27-54%.
Method: MRI findings of 45 patients with MS were examined and at the same time the severity of depressive symptoms were determined
by applying the Beck Depression Inventory. Patients were divided into four groups as supratentorial, supratentorial + infratentorial,
supratentorial + spinal and diffuse involvement according to their MR imaging findings. These four groups were compared with each
other according to the severity of the depressive symptoms.
Results: Depression scores were measured as 25.63±8.23 at the supratentorial + infratentorial involvement group, 12.72±10.15 at
widespread involvement group, 9:25±6.40 at supratentorial + spinal involvement group and 8.85±6.44 at supratentorial involvement
group. Depression score in the supratentorial + infratentorial involvement group was significantly higher than the other three groups.
Other differences between the groups were not significant.
Conclusion: It is known that lesion localization of the diseases related to the brain tissue have an effect on psychiatric symptoms. Despite
opposing views, studies have suggested that plaque localization has an effect on depressive symptoms in MS patients. Our study supports
this idea. Large trials are needed in this regard.
Keywords: depressive symptoms, multiple sclerosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S142
[PP-059] Sleep
Ref. No: 0202
Frequency of head trauma history in patients with narcolepsy
Murat Erdem1, Abdullah Bolu2, Adem Balikci2, Emre Aydemir2, Mustafa Alper2
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
1
Aircrew’s Health Research and Training Center, Eskisehir-Turkey
2
e-mail address: [email protected]
Objective: Several etiological factors such as genetic factors, pregnancy, infections, lymphoma and head trauma have been thought to play a
role in the etiology of narcolepsy. In this study, we aimed to investigate the prevalence of head trauma in patients diagnosed with narcolepsy.
Method: The diagnosis of narcolepsy was made at sleep laboratory of a university hospital by polysomnographic studies (PSG) and
multiple sleep latency (MSLT) tests. A form was filled with patients to determine the frequency of head trauma in their medical history.
Results: A total of 45 patients were included in the study. 17 patients had a history of head trauma previously. This ratio was greater than
normal population and was statistically significant (p<0.05).
Conclusion: It was shown that damage occurs at hypocretin neurons after traumatic brain injury and decreased CSF hypocretin levels
may cause narcolepsy. The results of this study confirm the previous findings in the literature.
Keywords: head trauma, narcolepsy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S142
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[PP-060] Sleep
Ref. No: 0203
Serum neopterin levels in patients with narcolepsy
Murat Erdem1, Abdullah Bolu2, Adem Balikci1, Emre Aydemir1, Mustafa Alper1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
1
Aircrew’ s Health Research and Training Center, Eskisehir-Turkey
2
e-mail address: [email protected]
Objective: Narcolepsy is a clinical syndrome of unknown etiology that is characterized by uncontrollable and repetitive sleep attacks,
the sudden temporary loss of muscle tone limb and trunk muscles that often occur during emotional reactions such as laughing, fear, or
crying (cataplexy), sleep paralysis and hypnagogic or hypnopompic hallucinations. Neopterin is a pteridine derivative, which is produced
by T cells as a result of the activation of the cellular immune system, primarily with IFN-γ stimulation.
Methods: In this study, we aimed to compare the serum neopterin levels of 45 patients, who were diagnosed to have narcolepsy with
healthy control group that consists of 42 individuals.
Results: Both groups were similar in terms of socio-demographic features. The mean serum neopterin level was 8.73±7.04 nmol / L in the
patient group and 5.94±1.76 nmol / L in the control group. It was found that, the difference of serum neopterin levels between the patient
group and control group was statistically significant (p<0.05).
Conclusions: Previous studies on immune-genetic aspects of narcolepsy have shown significant progress in this regard. Although
the etiology of the disease is still not clearly known, there is evidence that immune system induced pathologies might be a possible
etiological factor. Our finding of high levels of neopterin in narcolepsy group supports this idea.
Keywords: narcolepsy, neopterin
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S143
[PP-061] Psychopharmacology
Ref. No: 0204
Escitalopram-induced oligomenorrhea: two cases
Abdullah Bolu1, Erdal Pan2
Turkish Air Force Aircrew’s Health Research and Training Center, Eskisehir-Turkey
1
Eskisehir Military Hospital, Eskisehir-Turkey
2
e-mail address: [email protected]
Some SSRI’s have a fewer side effects profile compared to the other group of antidepressant drugs. The main side effects of these drugs
are known as agitation, sleep disturbances, tremor, serotonin syndrome, galactorrhea, sexual dysfunction, headache, bruxism, arthralgia,
lymphadenopathy, antidiuretic syndrome, agranulocytosis and hypoglycemia. In this article, two oligomenorrhea cases associated with
the use of escitalopram will be discussed.
Case 1: A 38-years-old female patient applied to our out-patient clinic with signs of anxiety. With a diagnosis of generalized anxiety
disorder, she was given treatment with escitalopram 10 mg/per-day. After the first month of treatment, the patient’s alleviation of
complaints were inspected at the examination. Oligomenorrhea was diagnosed in the second month of the treatment. No pathology was
detected in the physical and biochemical tests.
Case 2: A 30-years-old female patient applied to the neurology policlinic with complaints of headache. Thus, she was given treatment with
escitalopram 10 mg/per-day. Because of the persistence of her complaints, she was rerouted to consultation. Subsequently, she was diagnosed
with comorbid “depressive disorder”. For that reason the treatment dosage was increased to 20 mg/per-day. In one month period, although
the clinical symptoms were lessened, a development of oligomenorrhea was observed. Further tests yielded no findings of organic origin.
It’s predominantly known that antidepressants which include SSRIs -especially escitalopram- might bring about hyperprolactinemia. On
the other hand hyperprolactinemia impedes uterine bleeding irregularities stemmed from menstrual cramps. In this case, the selection
of SSRIs should be determined with great care among women patients in particular.
Keywords: case, escitalopram, oligomenorrhea
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S143
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[PP-062] Neuroscience
Ref. No: 0205
Physical injury and cortical excitability in patients with posttraumatic stress disorder
Abdullah Bolu1, Murat Erdem2, Oguzhan Oz3, Ozcan Uzun2
Aircrew’ s Health Research and Training Center, Eskisehir-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
Gulhane Military Medical Faculty, Department of Neurology, Ankara-Turkey
3
e-mail address: [email protected]
Objective: Cortical excitability is simply defined as excitability of brain tissue. It can electro physiologically be measured by transcranial
magnetic stimulation (TMS). In this study, we aimed to investigate the effect of physical injuries on cortical excitability in patients
diagnosed with post-traumatic stress disorder (PTSD).
Method: Thirteen PTSD patients with physical injury (injuries that disrupts the body integrity other than central and peripheral nervous
system injuries that affect MEP measures; such as muscular and/or skeletal injuries) and 24 PTSD patients who did not have a physical
injury were included in the study. Patient groups were compared by means of motor evoked potentials.
Results: Motor stimulation threshold was lower at physically injured patients than in patients without physical injury but the difference
was not statistically significant. Measured cortical amplitudes were greater at patients with injury. In particular, the amplitudes measured
from the right abductor pollicis brevis muscle (APB) and left APB were significantly greater (p<0.001). In patients with injury; right
contralateral cortical silent period (CSP), the left contralateral CSP and right ipsilateral CSP were found to be shorter (p; 0.049, 0.019 and
0.003, respectively)
Conclusion: The findings of lower motor stimulation threshold and higher measured MEP amplitudes show that cortical excitability was
affected more in PTSD patients with physical injuries than in patients without injury. CSP is considered as a sign of GABA dysfunction.
Deterioration of the function of GABA, the main inhibitory neurotransmitter, may be the main reason for these excitability changes.
Keywords: posttraumatic stress disorder, motor evoked potential, excitability
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S144
[PP-063] Neuroscience
Ref. No: 0206
Clinical severity and neural excitability in posttraumatic stress disorder
Abdullah Bolu1, Murat Erdem2, Suleyman Akarsu2, Cemil Celik2, Ozcan Uzun2
Flight Crew Health Research and Education Center, Eskisehir-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
e-mail address: [email protected]
Objective: Post-traumatic stress disorder (PTSD) may disrupt the social functioning of the patients and clinical severity of this disorder
might be influenced by many factors. In this study, we aimed to investigate the effect of neural excitability on clinical severity of PTSD.
Method: 37 patients diagnosed with PTSD according to DSM-IV-TR criteria were enrolled to the study. Neural excitability of the patients
was measured by transcranial magnetic stimulation (TMS). To evaluate the clinical severity in patients with PTSD, clinician-administered
PTSD scale-2 (CAPS-II) was used.
Results: Left Motor threshold (MUE) and CAPS total (r=-0401, p=0.019), CAPS avoidance (r=-0346, p=0.045) and CAPS excessive arousal
(r=-0426, p=0.012) subscale scores were negatively correlated. There were negative correlation right-left contralateral cortical silent period
(CSP) and CAPS total, intrusiveness, avoidance, excessive arousal subscale scores. Left-right ipsilateral CSP and CAPS total intrusiveness
subscale scores; right ipsilateral CSP and CAPS avoidance subscale scores were found to be negatively correlated.
Conclusion: In a general sense, MUE and CSP are two TMS findings of neural excitability. The studies in this area suggest GABA dysfunction
may be the underlying cause of these two findings. GABA dysfunction should be considered for the meaningful steps to elucidate the
etiology and treatment of PTSD.
Keywords: posttraumatic stress disorder, motor evoked potential, excitability
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S144
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[PP-064] Neuroscience
Ref. No: 0207
Aggression and cortical excitability Iin patients with posttraumatic stress disorder
Abdullah Bolu1, Murat Erdem2, Adem Balikci2, Taner Oznur2, Cemil Celik2, Ozcan Uzun2
Aircrew’ s Health Research and Training Center, Eskisehir-Turkey
1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
2
e-mail address: [email protected]
Objective: Hyperarousal and alertness play an important role in the clinical picture of post-traumatic stress disorder (PTSD). Based on
the idea that there is a relationship between some subtypes of hyperarousal symptoms and aggression in patients with PTSD, we aimed
to examine the relationship between electrophysiological measurements that was measured through transcranial magnetic stimulation
(TMS) and aggression scale scores of PTSD patients.
Methods: The study included 37 patients with a diagnosis of PTSD according to DSM-IV criteria and 25 healthy volunteers.
Electrophysiological measurements of participants were made with TMS. Buss Perry Aggression Questionnaires was administered to
patients and control group.
Result: A positive correlation was found between scores of aggression in patients and arousal symptoms. Motor excitability threshold,
which is a sign of cortical excitability, one of TMS measurements, was significantly lower in the patient group than the control group. There
was a negative correlation between aggression scale scores and the parameters of motor excitability threshold and cortical silent period
which both shows cortical excitability of the patients.
Conclusion: We concluded that there was an increase in cortical excitability in PTSD patients and this increase was indirectly associated
with hyperarousal symptoms and aggressive behavior.
Keywords: aggression, excitability, post-traumatic stress disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S145
[PP-065] Schizophrenia and other psychotic disorders
Ref. No: 0208
The ratio of the second to fourth fingers (2D:4D) in schizophrenia
Murat Erdem1, Abdullah Bolu2, Sedat Develi3, Emre Aydemir2, Mustafa Alper2
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
1
Aircrew’s Health Research and Training Center, Eskisehir-Turkey
2
Gulhane Military Medical Faculty, Department of Anatomy, Ankara-Turkey
3
e-mail address: [email protected]
Objective: According to the neurodevelopmental model, schizophrenia is a developmental disorder that begins to occur during the brain
development. Factors that cause developmental disorder in the brain are unclear. As a result of prenatal androgen exposure, the ratio of
the second to fourth fingers (2D:4D) changes and it has been studied for many diseases. In this study, we aimed to examine 2D:4D ratio
and the ratio of the length of the forearm and hand in patients with schizophrenia and its difference with golden ratio and by comparing
with the control group.
Methods: The study was consisted of 103 patients with schizophrenia, who were hospitalized at a university hospital and a healthy
control of 100 subjects. Finger, hand and forearm measurements was made and compared with healthy controls and golden ratio.
Results: Right 2D:4D ratio was measured as 0.9717 in the patient group and 0.9595 in the control group. The difference between the two
groups was statistically significant (p= 0.018). The right forearm: right hand ratio was 1.3815 for the patients, while it was measured as
1.4146 in the control group. The difference between the two groups was also statistically significant (p= 0.004).
Conclusions: There has not been much work on this issue about the golden ratio. Our findings were compatible with those of the earlier
studies and support the neurodevelopmental hypothesis.
Keywords: fingers, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S145
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[PP-066] Clinical psychiatry
Ref. No: 0209
Methylphenidate treatment in a patient with bipolar disorder and attention
deficit hyperactivity comorbidity: a case report
Murat Erdem, Gazi Unlu, Suleyman Akarsu
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Attention deficit hyperactivity disorder (ADHD) and mania show a broad overlap of symptoms and a high comorbidity. This situation
moots questions about common neurobiological and pathological mechanisms and treatments. We report efficacy of additional
methylphenidate treatment in a patient with bipolar disorder and ADHD comorbidity.
A 32-year-old married man. He was admitted to outpatient clinic with complaints of inability to control his behaviors, inattention,
hyperactivity and mood variability. His first psychiatric admission was ten years ago. He discontinued treatment because of lack of benefit.
He had depressive episodes in 2006 and 2007, after than he was diagnosed with bipolar disorder. Mood stabilizer treatment was started
in 2007. He experienced hypomanic and depressive episodes for 3-4 times, but he did not receive a regular treatment. In the mental
examination at the time of hospitalization, his affect was observed as elevated and showed signs of mania. Young mania scale score was
10; Wender-Utah test result was compatible with the diagnosis. He was treated with valproic acid and quetiapine, initially. As he did not
show improvement by means of attention deficits in the follow-up period, methylphenidate has been added on actual treatment. Patient
has got significant benefit from treatment.
Many symptoms of ADHD and mania share some pathogenetic routes. There is a consensus that stimulants should be used carefully in
mania. This case indicated that stimulant can be use full in comorbid states and there is not much risk in the presence of mood stabilizers
and close follow up.
Keywords: bipolar disorder, attention deficit hyperactivity disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S146
[PP-067] Clinical psychiatry
Ref. No: 0210
Treatment resistant monosymptomatic hypochondriac psychosis: a case report
Taner Oznur, Murat Erdem, Gazi Unlu
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Monosymptomatic hypochondriacal psychosis is defined as delusional hypochondriacal symptoms without any other behavioral
abnormalities. As a rare condition it is usually missed in differential diagnosis. Suicide can be an important complication of this disease.
We aimed to discuss a patient with recurrent suicidal attempts.
He was a forty-six years old, male, married patient. His complaints have begun as suffering from AIDS even after a protected sexual
intercourse about two years ago. Because of engaging continuously with this idea and the loss of the functionality, sertraline 50 mg/day
was started by family physician. The patient’s complaints have increased over time and he compulsively began to have HIV tests dozens
of times. About a year ago he attempted a suicide attempt via oral intake of insecticide. Then, six months ago and one week before
hospitalization, he repeatedly attempted suicide by oral intake of rodenticides. His thoughts were evaluated as delusional in the follow up
period. Combined high-dose antidepressant and antipsychotic treatment was used for a period of about six weeks, but because of lack of
response to treatment, ECT was initiated. His depressive symptoms were improved but the delusional thoughts persisted.
This case with monosymptomatic hypochondriacal psychosis showed once more that this disorder is often missed by general physicians.
This case has undergone to a lot of unnecessary medical interventions and become important for having recurrent suicidal attempts and
being resistant to various treatment modalities.
Keywords: monosymptomatic hypochondriacal psychosis, delusional, treatment
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S146
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Poster Presentations
[PP-068] Psychopharmacology
Ref. No: 0211
Sertraline induced vaginal hemorrhage: a case report
Leman Inanc, Cigdem Hazal Bezgin, Umit Basar Semiz
Istanbul Erenkoy Psychiatry and Neurology Research Hospital, Istanbul-Turkey
e-mail address: [email protected]
Sertraline is a selective serotonin reuptake inhibitor (SSRI) widely used drug for the treatment of depression and anxiety disorders.
Although SSRIs are known as safety drugs, some case reports and studies associate SSRIs with increased risk of bleeding events. Sertraline
causes a decrease in platelet serotonin leading to a defect in platelet aggregation. This depletion of serotonin can potentially lead to a
higher risk of bleeding. In this report we will discuss a case, who has depression and vaginal hemorrhage due to sertraline treatment, is
reported for its rare occurrence.
Keywords: sertraline, platelet disfunction, vaginal hemorrhage
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S147
[PP-069] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0212
Efficacy of eye movement desensitization and reprocessing (EMDR) technique in
a patient with posttraumatic stress disorder (PTSD) and secondary enuresis diurna: a case report
Taner Oznur, Murat Erdem
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Post-Traumatic Stress Disorder (PTSD) can occur after the traumatic life events, and is characterized by hyperarousal, avoidance and
emotional numbing, re-experiencing symptoms. Continuous elevated levels of anxiety in patients with PTSD rarely may result with
secondary diurnal enuresis (ED). We aimed to present a patient, who was diagnosed with acute PTSD and ED and showed a significant
and rapid response by eye movement desensitization and reprocessing (EMDR) therapy.
Our case is a forty-one years old, married, female patient. She experienced an earthquake about 1.5 years ago. Her symptoms were
insomnia, feeling like re-experiencing the earthquake, constant crying and enuresis 5-6 times a day (day and night). The physical
examination and laboratory tests did not show any related pathology. Paroxetine 30 mg / day was initiated, but her complaints were
persistent during the control examinations. In the psychometric evaluation, her IES-R, BDI, BAI scores were 58, 39, 31, respectively. The
patient underwent three sessions of EMDR. After the therapy IES-R, BDI, BAI scores were found as 22, 13 and 15, respectively. These results
and clinical examination provided evidence for a significant improvement in PTSD symptoms. In addition the first and the third month
follow upsrevealed complete resolution of ED, after treatment with EMDR.
ED can be comorbid with PTSD and it can be a very worrying symptom. Organic causes of enuresis should be excluded. PTSD is sometimes
resistant condition and different treatment approaches should be applied. Our case displayed the effectiveness of EMDR on both PTSD
and ED.
Keywords: eye movement desensitization and reprocessing technique, enuresis, PTSD
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S147
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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Poster Presentations
[PP-070] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0213
Treatment of chronic phantom pain with Eye Movement Desensitization and
Reprocessing (EMDR) method: a case report
Taner Oznur, Murat Erdem
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Chronic phantom pain is defined as pain and feelings of the presence of the limb, which was amputated due to an accident or surgery.
We aimed to present this case for the treatment of chronic phantom limb pain with EMDR method due to the small number of related
literature.
Our case was a twenty-four years old, married, male patient. His left leg was amputated from the level of the knee about 3 years ago
as a result of a mine explosion. About a week after the traumatic amputation, he started to feel severe pain at his broken limb. While
hospitalized in the orthopedic clinic, antidepressant and pregabalin treatment was initiated for insomnia, severe pain, re-experiencing
the explosion of the mine and extreme nervousness. Because he did not show any improvement, the patient was admitted to psychiatry
clinic. In the psychometric evaluation; the scores of Impact of Event Scale (IES-R), Beck Depression Inventory (BDI), Beck Anxiety Inventory
(BAI), the Visual Analogue Scale (VAS) were 65, 43, 37, 9, respectively. While continuing to the pharmacological treatment, nine sessions
of EMDR were applied to the patient. He showed a marked improvement clinically and his IES-R, BDI, BAI, VAS scores were 13, 5, 9, 0, after
the therapy and were 7, 5, 10, 0 at the 3th month follow up visit, respectively.
In our case, both of the pain and the psychiatric symptoms improved significantly with EMDR. EMDR may be an effective method for the
treatment of post-amputation phantom pain and psychiatric problems.
Keywords: eye movement desensitization and reprocessing technique, phantom pain
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S148
[PP-071] Clinical psychiatry
Ref. No: 0214
Coprophagia that occur during dissociative episodes: a case report
Ozgur Maden, Taner Oznur, Murat Erdem, Recai Kosem
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Coprophagia is a very rare behavior usually defined as eating dirt or feaces. It can be seen in patients with pervasive developmental
disorder, mental retardation, organic brain damage and dementia. In this article, we present a case of coprophagia during dissociative
episodes.
Our case is a twenty years old, primary school graduate, single, man. Three years ago, he began to experience short-term periods of
dissociation triggered by family stressors. After these episodes, he found himself as washing his hands and face that were contaminated
with feaces. The frequency of these episodes was variable and associated with the level of anxiety. While he was in military service, his
friends observed the coprophagic behaviour and he was referred to our outpatient clinic. Biochemical analysis, electroencephalography
and brain imaging was performed. No organic pathology was detected. His IQ score (WAIS) was rated as 89. Other psychometric
evaluations revealed dependent personality traits and findings of anxiety and depression. Dissociative Experiences Scale score was 39.
Overt coprophagia behavior was observed by a lot of people in our case. Due to immature and dependent personality traits and low IQ,
we thought that our case was unable to tolerate distressing events and could experience a serious anxiety and dissociation according to
the severity of the stressors.
Keywords: coprophagia, dissociation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S148
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Poster Presentations
[PP-072] Clinical psychiatry
Ref. No: 0215
Epilepsy and brief psychosis: a case report
Taner Oznur, Recai Kosem, Murat Erdem, Ozgur Maden
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Psychosis is characterized by loss or damage of contact with reality. Psychosis can occur spontaneously as well as secondary to an
underlying organic disease. Determining objective signs of related illness and using appropriate laboratory techniques will help the
management. We aimed to present a brief psychotic disorder case underlying organic pathology.
Twenty one -year-old, male, patient. He was rarely fainting during childhood but no specific diagnosis was made. He had a traffic accident
about 3 months ago and had symptoms such as dizziness, loss of consciousness but these symptoms did not persist and no abnormalities
were found in brain imaging. Two months after, a clinical picture composed of disorganized speech and behavior was begun. He was
hospitalized with psychotic symptoms. During hospitalization he was referred to our university hospital because his symptoms were
being exacerbated. Antipsychotic treatment was initiated. Low intellectual level was observed and an IQ test (WAIS-R) score was 75. While
fainting was described in the anamnesis neurology consultation has taken. EEG examination of the patient was defined as abnormal focal
(left significant bitemporal slow, sharp waves) and sleep deprived EEG has shown generalized spike-wave paroxysms. He was diagnosed
to have epilepsy and antiepileptic treatment was initiated. In the follow up period his psychotic symptoms began to improve rapidly and
symptoms regressed completely.
Especially in patients with intellectual deficiency, atypical and short-term psychotic symptoms should be evaluated for the presence of
organic causes. Neurological symptoms and signs are important for the differential diagnosis and treatment.
Keywords: psychosis, epilepsy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S149
[PP-073] Anxiety disorders
Ref. No: 0216
Relationship between symptom distribution and severity of generalized
anxiety disorder (GAD) with gender and marital status
Murat Erdem, Murat Gulsun
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Objective: It was reported that women with Generalized Anxiety Disorder (GAD) had experienced more marital problems than men with
GAD. In this article, we aimed to investigate the relationship between the sociodemographic features and symptom distribution in GAD.
Method: A total of 60 patients were included in the study. All participants were asked to complete SCL-90, Beck Depression Inventory,
Beck Anxiety Inventory and sociodemographic data form.
Results: Significant differences were found between male and female patients with GAD at subscales of SCL-90 (GSI) (phobic (p<.01),
paranoid (p<0.05), anger (p<0.01), depression (p<0.01), anxiety (p<0.05), and somatization (p<0.01)) and the Beck depression scale
scores (p<0.05). Age and level of education shows significant difference between married singles. The average age of the patients who
was married was higher. In contrast, the average education level of the singles was higher than married people. The married and single
patients showed no significant difference in terms of GSI. Anger subscale of the SCL-90 was found to be higher in married patients.
Conclusion: Severity of symptoms of GAD may be different between genders as well as different sets of symptoms can vary according to
the gender. In addition, the distribution of symptoms varies among different age groups (i.e. anger). Gender should be considered as a
factor that can affect the prognosis of GAD. This cross-sectional study has shown that symptoms in women may be more severe than men.
Keywords: anxiety, marital status
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S149
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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Poster Presentations
[PP-074] Clinical psychiatry
Ref. No: 0217
Delirium due to electrical injury: a case report
Taner Oznur1, Murat Erdem1, Muzaffer Durmus2
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
1
Bursa Military Hospital, Department of Plastic Surgery, Bursa-Turkey
2
e-mail address: [email protected]
Psychiatric symptoms can be observed in up to 57 to 87.5% of the patients after electrical injuries. These symptoms may be temporary as
well as permanent. Although delirium is an expected condition after these injuries, it was rarely reported.
Fifty-six years old, married, primary school graduate, male patient. The patient was hospitalized in surgical intensive care unit after a
high-voltage shock while working at an electric company. A total of 28% burned areas at 2nd or 3rd degrees that consisted of both arms,
shoulders and upper half of the body was established. Consultations were received from cardiology, neurology, nephrology and infectious
diseases departments. Laboratory studies confirmed no pathology. A week later, inappropriate speech and behavior were emerged;
pathologies about consciousness, orientation and attention were observed in mental examination. He was diagnosed to have delirium.
Haloperidol 3 mg/day was initiated. Psychiatric symptoms have totally disappeared with treatment. Debridement and grafting surgeries
were performed in the course of follow up period. At the end of the second month, he was discharged without psychiatric and surgical
problems. Control visit at the sixth month revealed no psychiatric sequel.
Various neuropsychiatric symptoms have been reported after electrical burns but no reports are available regarding the development of
delirium. In our case, no metabolic or systemic causes that can explain delirium were detected.
Keywords: delirium, electrical injury
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S150
[PP-075] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0218
Prolonged exposure (PE) application in a case of posttraumatic stress
disorder with dissociation: indication or contraindication?
Taner Oznur, Murat Erdem
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Prolonged exposure (PE) is a method of psychotherapy, which has shown to be effective in the treatment of PTSD. In this article, a patient
who developed psychotic disorder after being diagnosed with PTSD, undergoing PE therapy is presented.
A 25 years old man had a gunshot injury on the right shoulder six months ago. While he was being treated in a rehabilitation center, he
had complaints of anger mismanagement, re-experiencing an event in the form of dissociative episodes and antidepressant treatment
and PE therapy was started. The therapy often failed due to severe dissociative seizures of the patient. At the second admission of the
patient to the rehabilitation center, similar symptoms and the same treatment have been continuing. He was referred to our clinic due to
behavioral abnormalities and severe dissociative symptoms. Persecutive delusions and Schneiderian findings were added in the clinical
picture and combined antipsychotic and antidepressant treatment with the diagnosis of Psychotic Disorder and PTSD was initiated. In his
psychometric examination, the scores were measured as CHANCE: 30 SAPS: 53 BPRS: 46, respectively.
In the PE guidelines, the application of PE is stated to be contra-indicated in the cases that dissociation is at the forefront. Our case showed
that PE therapy, the patient’s symptoms should be held carefully before PE.
Keywords: prolonged exposure, posttraumatic stress disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S150
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[PP-076] Clinical psychiatry
Ref. No: 0219
Sociodemographic characteristics of patients who admitted to smoking
cessation clinic of a university hospital
Murat Erdem1, Seyfettin Gumus2, Mehmet Aydogan2, Mustafa Alper1
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
1
Gulhane Military Medical Faculty, Department of Chest Diseases, Ankara-Turkey
2
e-mail address: [email protected]
Objective: World Health Organization defines smoking as the leading preventable cause of diseases. In this study, socio-demographic
characteristics of patients admitted to smoking cessation clinic, causes of initiation of smoking, reasons that increase the request for
smoking, the reasons for eagerness to quit smoking and difficulties in this process were investigated.
Method: Sociodemographic data form and a questionnaire were filled in by patients. Of the 159 patients included in the study, 31.4%
were female and 68.6% were male. 75.8% of the patients were married and 24.2% were single.
Results: The most common reason for starting to smoking was defined as emulation (56%), followed by curiosity (34.6%), stress (22%),
sadness (12.6%), environmental pressure (11.9%), reaction to prohibitions (9.4%) and self-proving (6.3%). The most common reasons for
smoking cessation were fear of future illness (72.3%). Other reasons include feeling of giving damage to environment (32.1%), economic
reasons (29.6%), current illness (24.5%), bad smell (22.6%), doctor’s recommendation (16.4%), to be a good example to the environment
(13.2%), social pressure (13.2%), being ashamed (6.3%) and personal beliefs (3.8%). The most common causes that increases patients’
desire to smoke were request after meal (72.3%), stress (53.5%), tea (50.3%), coffee (32.1%) and alcohol (17%). 78.3% of the cases had
tried to quit previously. Most common difficulties for cessation were extreme desire for smoking (62.3%), irritability (51.6%) and impaired
concentration (29.6%).
Conclusion: Reasons for initiation of smoking was similar to other studies. However, the reasons for requesting to quit smoking have
shown some variances with higher rates of economic reasons harming the environment.
Keywords: smoking cessation clinic, sociodemographic characteristics
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S151
[PP-077] Anxiety disorders
Ref. No: 0220
The role of trauma and dissociation in treatment resistant obsessive
compulsive disorder
Umit Basar Semiz, Leman Inanc, Cigdem Hazal Bezgin
Erenkoy Research and Training Hospital for Psychiatric and Neurological Diseases,Psychiatry Clinic, Istanbul-Turkey
e-mail address: [email protected]
Objective: Previous research has indicated a relation between obsessive-compulsive disorder (OCD), childhood traumatic experiences
and higher levels of dissociation that appears to relate negative treatment outcome for OCD. The aim of the present study is to investigate
whether childhood trauma and dissociation are related to severity of OCD in adulthood. We also intend to examine the association
between treatment resistance, dissociation, and each form of trauma
Method: Study group included 120 individuals diagnosed with OCD. 58 (48.3%) of them met the criteria for treatment-resistant OCD
(resistant group) whereas 62 (51.7%) were labeled as responder group. The intensity of obsessions and compulsions was evaluated
using Yale-Brown Obsessive Compulsive Scale (YBOCS). All patients were assessed with the Traumatic Experiences Checklist, Dissociative
Experiences Scale, Beck Depression Inventory, and Beck Anxiety Inventory.
Results: Controlling for clinical variables, resistant group had significantly higher general OCD severity, anxiety, depression, trauma,
and dissociation scores than the responders. Correlation analyses indicated that Y-BOCS scores were significantly related to severity of
dissociation, anxiety, depression, and traumatic experiences. In a logistic regression analysis with treatment resistance as a dependent
variable, high dissociation levels, long duration of illness, and poor insight emerged as relevant predictors, but gender, levels of anxiety,
depression, and traumatic experiences did not.
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Poster Presentations
Conclusion: Our results suggest that dissociation might be a predictor of poorer treatment outcome in patients with OCD; therefore, a
better understanding of the mechanisms that underlie this phenomenon may be useful. Future longitudinal studies are warranted to
verify if, this variable represents predictive factors of treatment nonresponse.
Keywords: obsessive-compulsive disorder, childhood trauma, dissociation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S151-S2
[PP-078] Schizophrenia and other psychotic disorders
Ref. No: 0221
Moxifloxacin induced brief psychotic episode: a case report
Alparslan Asil Budakli1, Asim Ulcay2, Ergenekon Karagoz2, Recep Tutuncu1
GATA Haydarpasa Training Hospital, Department of Psychiatry, Istanbul-Turkey
1
GATA Haydarpasa Training Hospital, Department of Infectious Diseases, Istanbul-Turkey
2
e-mail address: [email protected]
Quinolones are broad-spectrum antibiotics used for the treatment of several infectious diseases. Although they are frequently used due
to high bioavailability and good safety, they may have psychiatric and neurological side effects such as depression, delirium, psychosis
and convulsions. There have been published reports of delirium related with ciprofloxacin, gatifloxacin, yet according to our knowledge,
there is no report implicating moxifloxacin as a contributor to psychosis.
We present a 60 years old female patient, who was admitted to hospital with high fever, cough and fatigue. Moxifloxacin treatment was
started with the diagnosis of atypical pneumonia. Disorganised speech, disturbances in perception and thought occurred on moxifloxacin
treatment and resolved 3 days after withdrawal of moxifloxacin.
Keywords: moxifloxacin, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S152
[PP-079] Childhood and adolescence disorders
Ref. No: 0222
The relationship between soluble intercellular adhesion molecules and attention deficit
hyperactivity disorder
Belgin Alasehirli1, Elif Oguz2, Cem Gokcen1, Ayse Binnur Erbagci1, Mustafa Orkmez1, Abdullah Tuncay Demiryurek1
Gaziantep University, School of Medicine, Department of Psychiatry, Gaziantep-Turkey
1
Harran University, School of Medicine, Department of Psychiatry, Sanliurfa-Turkey
2
e-mail address: [email protected]
Objective: Attention deficit hyperactivity disorder (ADHD) is a common childhood-onset psychiatric disease, characterised by
excessive overactivity, inattention and impulsiveness. It is suggested that prefrontal dopamine deficiency and central dopaminergic
dysfunction could be the main factors for ADHD, but the mechanism of this deficiency and dysfunction and so the etiopathology of
the disease is not fully understood. Although it is showed that inflammatory processes are involved in neurological and psychiatric
disorders, such as depression and Parkinson’s disease, the studies for ADHD are very limited. In this study, we aimed to investigate
whether there are associations between ADHD and changes in serum levels of serum soluble intercellular adhesion molecules
(s-ICAMs), which have an important role in inflammatory diseases. We also measured the levels of these molecules after treatment
with oros-methylphenidate.
Method: Twenty-five patients diagnosed with ADHD according to DSM-IV-TR criteria and eighteen healthy volunteer controls were
included in this study. The levels of sICAMs were measured in the serum of the patients and healthy volunteers by ELISA kit as described.
Results: The levels of ICAM-1 and ICAM-2 were significantly higher in patients compared with controls. The level of ICAM-1 was decreased
in treated group, but this decrease was not significant. ICAM-2 levels decreased significantly after treatment by oros-methylphenidate
compared with untreated group.
Conclusion: This is the first study pointing out the relationship between ICAM molecules and ADHD. ICAM-1 and 2, the molecules involved
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Poster Presentations
in inflammatory processes, are associated with ADHD. The changes in sICAM-2 level may have a therapeutic value in ADHD treatment
Keywords: attention deficit hyperactivity disorder, inflammatory, intercellular adhesion molecules
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S152-S3
[PP-080] Psychopharmacology
Ref. No: 0223
Management of the spontaneous ejaculation emerging after traumatic event: a case report
Taner Oznur, Suleyman Akarsu, Bulent Karaahmetoglu, Ali Doruk
Gulhane Military Medical Faculty, Department of Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Sexual dysfunctions had been reported to be more in posttraumatic stress disorder (PTSD) patients than the general population. Until
now, a case with spontaneous ejaculation coexisting with PTSD has not been reported. A case with spontaneous ejaculation concurrent
to the exacerbation of PTSD symptoms was mentioned in this report.
A 25 years old, single man was admitted to psychiatric polyclinic because of PTSD symptoms, and concurrently spontaneous ejaculations
began after a traumatic event. He was diagnosed PTSD after the clinical interviews. Organic pathology was not detected to explain
spontaneous ejaculations. Paroxetine treatment was begun and decreases in PTSD symptoms, frequency of spontaneous ejaculations
were observed in the clinical follow-up.
In this case, adrenergic activation system might have been increased with anxiety symptoms specific to PTSD and this increase might lead
to spontaneous ejaculation without a sexual stimulus. The reducing effect of the paroxetine on the frequency of spontaneous ejaculation
was evaluated to occur through the controlling of the PTSD symptoms and side effects on ejaculation (Figure 1). Assay of metabolites in
plasma, cerebrospinal fluid, corporal catecholamines and unchanged serotonin should help to enlighten the underlying neurophysiology
of sexual dysfunctions in PTSD patients. Making the treatment choice considering both PTSD symptoms and autonomic instability would
increase the benefit out of the treatment in PTSD patients with sexual dysfunctions.
Keywords: posttraumatic stress disorder, spontaneous ejaculation, paroxetine
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S153
[PP-081] Psychopharmacology
Ref. No: 0226
Effects of methylphenidate treatment on appetite and leptin, ghrelin, adiponectin,
brain-derived neurotrophic factor levels in children with attention deficit hyperactivity disorder
Serkan Sahin1, Murat Yuce2, Hasan Alacam3, Koray Karabekiroglu2, Gokce Nur Say2, Osman Salis3
Ataturk State Hospital, Child and Adolescent Psychiatry Clinic, Balikesir-Turkey
1
Ondokuz Mayis University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun-Turkey
2
Ondokuz Mayis University, Faculty of Medicine, Department of Biochemistry, Samsun-Turkey
3
e-mail address: [email protected]
Objective: Anorexia is one of the most common adverse events seen with methylphenidate used for the treatment of attention deficit
hyperactivity disorder (ADHD). The aim of this study is to investigate neurobiological processes underlying the side effects such as anorexia
and/or weight loss that develope associated with extended release methylphenidate used to treat children and adolescents with ADHD.
Method: We included 30 cases (patient group) between the ages of 6 and 18 years old, who had recently been diagnosed with ADHD and
20 healthy children (control group), who were at the same age and gender as in the patient group. The patients with ADHD were assessed
with Barkley Stimulant Side Effect Assessment Form after they had received extended release methylphenidate for two months. The levels
of leptin, ghrelin, adiponectin and brain-derived neurotrophic factor (BDNF) were measured in blood samples of healthy control group
and in blood samples of patients with ADHD collected before and after extended release methylphenidate (after two-month treatment).
Results: There were no significant differences in leptin, ghrelin, adiponectin and BDNF levels between the healthy control group and the
untreated patients, who had recently been diagnosed with ADHD. The most common adverse events occurred in the ADHD group after
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2-months treatment included loss of appetite (70%), weight loss (66.7%), difficulty in falling asleep (53.3%), and headache (46.7%). No significant
difference was observed in leptin levels but significant differences in ghrelin (p<0.05), adiponectin (p<0.001) and BDNF (p<0.05) levels were
found between the measures performed after methylphenidate treatment and before methylphenidate treatment of patients with ADHD.
Conclusion: As a result, no significant differences were found in levels of biomolecules that are known to be responsible for regulating
appetite and nutrition of patients with ADHD, who did not receive treatment compared to healthy control group. Extended release
methylphenidate treatment has been shown to affect levels of biomolecules that are responsible for regulating appetite and nutrition
of patients with ADHD. The changes in adiponectin levels is thought to be underlying neurobiological mechanism of decreased appetite
and/or weight loss due to methylphenidate treatment. Studies to be performed after longer term treatments with large sample groups
and investigation of these findings will present new data about neurobiological mechanisms underlying anorexia and/or weight loss that
are associated with extended release methylphenidate.
Keywords: attention deficit hyperactivity disorder, methylphenidate, appetite
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S153-S4
[PP-082] Psychopharmacology
Ref. No: 0227
The factors related to the development or reversal of metabolic syndrome
in the patients schizophrenia and schizoaffective disorder: a naturalistic follow-up
Ceyhan Balci Sengul1, Filiz Karadag2, Cem Sengul2, Ozgur Kalkanci3, Kamuran Karakulah2, Fulya Akin4
Denizli State Hospital, Department of Psychiatry, Denizli-Turkey
1
Pamukkale University School of Medicine, Department of Psychiatry, Denizli-Turkey
2
Servergazi State Hospital, Department of Psychiatry, Denizli-Turkey
3
Pamukkale University School of Medicine, Department of Endocrinology, Denizli-Turkey
4
e-mail address: [email protected]
Objective: The aim of this prospective naturalistic follow-up study is to investigate the factors related to the development or reversal of
metabolic syndrome in patients suffering schizophrenia and/or schizoaffective disorder.
Method: Our sample constituted of 240 patients with schizophrenia or schizoaffective disorder (according to the DSM-IV criteria) at the
onset, whereas 195 patients were evaluated at the follow-up visit after six months.
The blood levels of fasting glucose, triglyceride, High Density Lipoprotein (HDL) cholesterol, insulin and, blood pressure, waist
circumference, body weight, body mass index, HOMA index and physical activity level were evaluated.
This study was supported by Pamukkale University Scientific Research Committee (project No: 2008 TPF 029).
Results: It was found that 94 patients (48.20%) had MetS and 100 (51.80%) patients were free of MetS at the follow-up visit. Out of 94
patients, 69 patients (73.4%) had MetS at the baseline whereas 25 patients (26.6%) developed MetS during follow-up period. The means
of baseline weight, BMI, waist circumference, triglyceride and insulin levels, blood pressure and HOMA index of the patients with recently
developed MetS were significantly higher compared to the patients free of MetS at both visit (n:84). The first group had also significantly
lower HDL levels than the second group at the baseline. We found that overweight patients (BMI>25) and the patients who met the
individual MetS criteria for blood pressure and HDL levels and treated with depot antipsychotics have higher risk for MetS development
(odss ratios; 38.878, 15.547, 4,285 and 3.277, respectively). Seventeen patients (19.80%), who had MetS previously did not met MetS
criteria at the end of sixth months. Reversal rate was found to be 16.83% (17/101). Mean weight, BMI, waist circumference, fasting glucose
and insulin level, HOMA index and the change of total physical activity scores of reversed MetS (n:17) group at baseline were significantly
different from those suffering MetS at both visit. No increase of physical inactivity level and the presence of insulin resistance were related
to significantly lower chance for reversal of MetS. (odds ratios; 21.042, 8.229, respectively). We did not find any relationship between the
type of antipsychotic treatment and reversal of MetS (p>0.05).
Conclusion: Our study has suggested that overweight patients treated with injectable antipsychotic medications should be closely
monitorized for metabolic parameters. Our results also have indicated the importance of physical activity and insulin resistance to deal
with metabolic syndrome in schizophrenia patients. Reversal of MetS is an important issue in continuous antipsychotic treatment and
factors associated with reversal and development of MetS should be investigated in more detail.
Keywords: antipsychotic, metabolic syndrome, schizophrenia
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Poster Presentations
[PP-083] Childhood and adolescence disorders
Ref. No: 0228
Psychogenic polydipsia in an adolescent with eating disorder: a case report
Koray Kara, Mehmet Ayhan Congologlu, Ibrahim Durukan, Dursun Karaman
Gulhane School of Medicine, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Psychogenic polydipsia (PPD), a clinical disorder characterized by polyuria and polydipsia, is a common occurrence in patients with
psychiatric disorders. Hyponatremia (as a result of polydipsia) can progress to water intoxication that is characterized by confusion,
lethargy, psychosis, and seizures. There are a number of studies shows that uncomplicated polydipsia and compulsive water consumption
are frequently seen in anorexia nervosa (AN), also hyponatremia is infrequently reported in the constellation of metabolic abnormalities
in patients with eating disorders.
In this case report, we will discuss an adolescent with AN, who had water intoxication after excessive water consumption for the use of
weight loss.
A 15 years old girl was referred because of excessive water consumption, polyuria and food restriction. Her complaints started after she
decided to set dieting as she thought she had put on too much. After reading information about dieting by drinking water, she had
increased water consumption. Especially at the evening hours she was drinking 10-12 liters of water and that has continued for 3 months.
In 3 months she has lost weight to 42 kg from 55 kg.
One month before she was referred to Child and Adolescent Psychiatry Clinic, after she had been referred to an emergency service
due to symptoms of dizziness, headache and syncope after consuming 10 liters of fluid in 6 hours. She was hospitalized in an intensive
care unit with prediagnosis of PPD, hyponatremia and diabetes insipidus as her sodium level was 116 mmol/L (normal limits: 135–145
mmol/L). Fluid consumption was monitored throughout hospitalization and after normalization of her serum sodium level, she had
referred to the child and adolescent psychiatry clinic as her clinical, biochemical and radiological examinations were all in normal
levels.
She was eating beggarly and only once a day and drinking at least 2 liters of water at the evening hours. The patient was prediagnosed
as anorexia nervosa and PPD, and had decided to be followed as outpatient. Some behavioral targets were determined like decreasing
the amount of fluid intake. Fluoxetine treatment was started. She has been followed up for a year at monthly intervals and in due course
dietary harmonization and amount of fluid intake returned to normal.
It has been stated that the main reasons of polydipsia in patients with AN, are appeasement of hunger, detoxifying, decreasing the
amount of calorie intake and hiding the body weight. PPD is a situation that is not rare in AN but rarely causes clinical complications;
seizures and death due to cerebral edema are reported.
In conclusion, patients with eating disorders may differ in fluid consumption quantitavely. Early recognition of polydipsia in these patients
is important because of its lethal complications. Therefore observation of the amount of fluid consumption should be an integral part of
clinical examination in patients with eating disorders. There is a need for further studies about the triggering environmental, biological
and genetic factors of polydipsia in eating disorders.
Keywords: adolescent, anorexia nervosa, psychogenic polydipsia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S155
[PP-084] Childhood and adolescence disorders
Ref. No: 0231
Clonidine treatment in a tuberous sclerosis case with behavioral problems
associated with mental retardation
Ali Karayagmurlu1, Meryem Ozlem Kutuk2, Nurdan Coban1, Cem Gokcen1
Gaziantep University, School of Medicine, Gaziantep-Turkey
1
Malatya State Hospital, Malatya-Turkey
e-mail address: [email protected]
Tuberous sclerosis is a multi-system-genetic disease occurring early in life with the classic triad of seizures, intellectual disability, and
cutaneous angiofibroma. One of the most important psychiatric comorbidities in tuberous sclerosis is aggressive/disruptive behavior
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disorder. In this case report, treatment of a 14-years-old male with tuberous sclerosis, who was referred with severe behavioral problems
secondary to mental retardation using clonidine is presented.
Keywords: behavioral problems, clonidine, tuberous sclerosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S155-S6
[PP-085] Childhood and adolescence disorders
Ref. No: 0232
Tc-99m TRODAT-1 brain spect changes in adolescents with attention deficit
hyperactivity disorder: after 2-month -OROS-methylphenidate therapy
Aynur Pekcanlar Akay1, Gamze Capa Kaya2, Burak Baykara1, Yusuf Demir2, Handan Ozek1, Sevay Alsen1, Mine Sencan Eren2,
Neslihan Inal Emiroglu1, Turkan Ertay2, Yesim Ozturk3, Suha Miral1, Hatice Durak2
Dokuz Eylul University, School of Medicine, Department of Child and Adolescent Psychiatry, Izmir-Turkey
1
Dokuz Eylul University, School of Medicine, Nuclear Medicine, Izmir-Turkey
2
Dokuz Eylul University, School of Medicine, Department of Pediatrics, Izmir-Turkey
3
e-mail address: [email protected]
Objective: Tc-99m TRODAT-1 has high affinity and specifity as an agent for presynaptic DAT in the striatum dopamine nerve terminal.
Effectivity of Tc-99m TRODAT-1 for qualifying DAT in striatum was assessed in many of those studies published in the past. Although
some studies found increase of DAT receptor attachment in patients with attention deficit hyperactivity disorder (ADHD) compared to
the normal controls, some of them did not find any significant increase. Methylphenidate as first line treatment of ADHD blockades DAT
receptors strongly. In Tc-99m TRODAT-1 brain SPECT studies, some patients had more frequent DAT attachment compared to the controls.
The aim of this study is to assess Tc-99m TRODAT-1 brain SPECT changes in adolescents with ADHD after 2 months methylphenidate
(MPH) therapy.
Method: Eighteen adolescents aged between 13-18 years, diagnosed with ADHD participated in the study. None of them had comorbid
neurological disease or psychiatric disorders other than oppositional defiant disorder. All patients were right handed. ADHD diagnoses
were made by two experienced child psychiatrists, based on ADHD criteria listed in the 4th edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV-TR). For inclusion of the patients in this study, K-SADS-PL semi-structured clinical interview was carried out
and confirmed ADHD diagnosis as well as CGI-ADHD-severity scale score >=3 at visit 1 were compulsory. DuPaul ADHD Questionnaire and
Conner’s Teacher Rating Scale-Short Form were used. OROS-Methylphenidate treatment was applied orally on daily basis. After the baseline
SPECT scan, each subject’s dose was individually titrated in accordance with the clinical response in CGI-ADHD-severity scale (DuPaul, 1991).
OROS-MPH starting dose was 18 mg and within 4 weeks, it was titrated up to 54-72 mg (average dose is 1 mg/kg/day). Tc-99m TRODAT-1
was obtained by the Institute of Nuclear Energy Research (INER-Taipei, Taiwan). Regions of interest (ROIs) were drawn on the right basal
ganglia, left basal ganglia and the localization of cerebellum as the background. The two consecutive transverse slices showing the highest
uptake in the basal ganglia were selected. Mean counts per pixel were used. While comparing cerebellar activity, mean corrected activity in
the basal ganglia was calculated as follows: (basal ganglia-background)/background. Pre-treatment and post-treatment results of clinical
parameters and striatal DAT density in patients diagnosed with ADHD were compared analysis of Wilcoxon test.
Results: There was a statistically significant decrease in pre-treatment availability of DAT assessed by brain SPECT and after 2 months MPH
treatment in both right and left basal ganglia (pre; 1.23±0.29 and post; 0.49±0.36, p=0.000, for right, pre; 1.15±0.27 and post; 0.49±0.35, p=0.000
for left). The mean score on the CGI was 5.1±0.6 (range: 4-6) at baseline, 3.4±1.0 (range: 2-5) at the second visit (p=0.000 for visit 1-2). Also, there
was a statistically significant improvement in behavior at the second visit, as indicated by the scores in DuPaul and Conner’s Rating scales.
Conclusion: The decreased availability of DAT in basal ganglia under treatment with MPH correlates well with the improvement in clinical
parameter in conformance to the findings of previous studies.
Keywords: attention deficit hyperactivity disorder, methylphenidate, Tc-99m TRODAT-1 SPECT
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[PP-086] Psychopharmacology
Ref. No: 0233
A case of the development of neuroleptic malignant syndrome following the hyponatremia
Bilge Burcak Annagur, Nursel Akbaba
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening idiosyncratic reaction secondary to antipsychotic medications. NMS is
characterized by muscular rigidity, fever, autonomic instability, and an altered level of consciousness and it is usually accompanied by
rhabdomyolysis. This syndrome is supposed to result from an excessively rapid blockade of postsynaptic dopamine receptors. It is well
known that severe hyponatremia can cause neurologic complications such as stupor, seizures, and even coma. Hyponatremia frequently
develops in elderly patients and also psychiatric patients.
We have reported an elder patient with recurrent depression taking venlefaxine and olanzapine therapy, who developed overt NMS
following hyponatremia.
A 64-years-old male was admitted to the Emergency Department of a State Hospital due to symptoms including changes in mental
status, nausea-vomiting, fever and loss in eating function. Patient’s hyponatremia (serum Na: 121 mEq/l) was confirmed and treated in the
hospital. However, the symptoms started again immediately after discharge and was gradually intensified. Progressively, he had lethargy.
He was admitted to our hospital because of unconsciousness, fever, marked muscle rigidity and motor immobility.
His psychiatric history revealed that he was diagnosed to have recurrent depression 6 years ago. He was regularly given oral venlefaxine
150 mg daily and oral olanzapine 2,5 mg daily. He received 10 mg daily olanzapine due to insomnia 5 days before admission.
At admission, his body temperature was 36.7 °C and the blood pressure was 160/95 mm Hg. He was extremely rigid and unresponsive.
On admission, laboratory tests revealed: total leukocytes count 10.77 K/uL, Serum muscle enzymes were markedly elevated: CPK 431 u/L
(normal up to 200).
Antipsychotic drugs were withdrawn after admission; bromocriptine 7.5 mg daily was initiated.
Ten days later, the patients’ muscle rigidity and other symptoms resolved, and serum CPK level was normalized (37 u/L). The treatment of
bromocriptine was gradually stopped. The patient was discharged on the 19th day after admission.
We presented a case of neuroleptic malignant syndrome secondary to hyponatremia. The development of hyponatremia has been
facilitated because of the patient’s being an elderly person. Hyponatremia associated with neuroleptic malignant syndrome has been
described as a syndrome of inappropriate secretion of antidiuretic hormone. It was known that patients with psychiatric disorders such
as psychosis and depression have a propensity to develop hyponatremia. Psychogenic drugs such as haloperidol, fluphenazine and
thioradazine cause hyponatremia by unknown mechanisms. This patient has used venlefaxine and low dose olanzapine for the last 6
years. NMS developed after increasing the dose of olanzapine.
In conclusion, this report shows that NMS may occur following hyponatremia; therefore this combination needed to be used with caution
in patients with depression. Metabolic changes in elderly patients with depression may lead to life-threatening problems. Clinicians
should inform their patients sufficiently about the use of drugs and drug dose.
Keywords: hyponatremia, neuroleptic malignant syndrome
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[PP-087] Childhood and adolescence disorders
Ref. No: 0234
Pre-treatment and post-treatment Tc-99m TRODAT-1 brain spect findings in
three patients with attention deficit and hyperactivity disorder, who were
treated by 2-month- atomoxetine treatment
Aynur Pekcanlar Akay1, Gamze Capa Kaya2, Burak Baykara1, Yusuf Demir2, Handan Ozek1, Sevay Alsen1, Mine Sencan Eren2,
Neslihan Inal Emiroglu1, Turkan Ertay2, Yesim Ozturk3, Suha Miral1, Hatice Durak2
Dokuz Eylul University, School of Medicine, Department of Child and Adolescent Psychiatry, Izmir-Turkey
1
Dokuz Eylul University, School of Medicine, Department of Nuclear Medicine, Izmir-Turkey
2
Dokuz Eylul University, School of Medicine, Department of Pediatrics, Izmir-Turkey
3
e-mail address: [email protected]
Objective: Tc-99m TRODAT-1 has a high affinity and specifity as an agent for presynaptic DAT in the striatal dopamine nerve terminal.
Effectivity of Tc-99m TRODAT-1 for qualification of striatal DAT has been studied in a majority of related publications. Although some
studies found the increase of DAT receptor binding in patients with attention deficit hyperactivity disorder (ADHD) compared to
the normal controls, some of them did not find any increase. Atomoxetine is a selective inhibitor of the presynaptic norepinephrine
transporter, with minimal affinity for other neurotransmitter transporters and receptors.
We have planned to report post-treatment changes in Tc-99m TRODAT-1 brain SPECT of 3 adolescents (13-17 years), who were followed
up for the diagnosis of ADHD and received atomoxetine treatment for 2 months.
Method: All patients were right handed. ADHD diagnosis were made by two experienced pediatric psychiatrists, based on the ADHD
criteria listed in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). K-SADS-PL semi-structured clinical
interview had been carried out. ADHD diagnosis had to be confirmed and CGI-ADHD-severity scale had to be >=3 at visit 1. DuPaul ADHD
Questionnaire and Conner’s Teacher Rating Scale-Short Form were used. Neurological examinations and ECG records of all patients were
normal without any severe anatomic pathology in brain MRIs. IQ values were over 80. Except specific learning disorder and oppositional
defiant behavior disorder, other psychological disorders have been excluded. Tc-99m TRODAT-1 brain SPECT images have been obtained
before and after the treatment. Brain SPECT imaging has been performed 3 hours after the I.V. injection of 740 MBq Tc-99m TRODAT-1
(Nuclear Energy Institute, Taiwan); which was in lyophilized form and was radio-labelled with Tc-99m pertechnetate (radiochemical purity
%90 and over). Tc-99m TRODAT-1 brain SPECT images were evaluated.
Results: Tc-99m TRODAT-1 involvements were evaluated semiquantitatively as above the scalp activity, equivalent to scalp activity and
below the scalp activity in the basal ganglion. Decreases especially in DuPaul total and DuPaul attention scales have been observed
among postoperative scales. Tc-99m TRODAT-1 involvement in the basal ganglion has decreased in all 3 subjects in SPECT.
Conclusion: Tc-99m TRODAT-1 demonstrates high affinity and specificity to presynaptic DAT receptors in striatal dopaminergic nerve
terminals. Its efficacy in identification of striatal DAT has been demonstrated in previous studies. After 2-month- chronic treatment with
atomoxetine, decreased involvements in basal ganglion in all 3 subjects have indicated that atomoxetine might indirectly affect striatal
dopaminergic pathways. Despite the limited number of patients, we believe that this finding is significant since there is no information
about basal ganglion imaging in patients receiving atomoxetine.
Keywords: atomoxetine, attention deficit and hyperactivity disorder, Tc-99m TRODAT-1 brain SPECT
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[PP-088] Schizophrenia and other psychotic disorders
Ref. No: 0236
Red cell distribution width (RDW) in patients with schizophrenia
Murat Semiz1, Osman Yildirim2, Fatih Canan3, Suleyman Demir4, Ekrem Hasbek1, Taha Can Tuman2, Nefise Kayka2, Mehmet Tosun5
1Sivas State Hospital, Clinic of Psychiatry, Sivas-Turkey
2Abant Izzet Baysal University, School of Medicine, Department of Psychiatry, Bolu-Turkey
3Akdeniz University, School of Medicine, Department of Psychiatry, Antalya-Turkey
4Dicle University, School of Medicine, Department of Psychiatry, Diyarbakir-Turkey
5Abant Izzet Baysal University, School of Medicine, Department of Medical Biochemistry, Bolu-Turkey
e-mail address: [email protected]
Objective: Inflammatory mechanisms are reported to play important roles in the pathophysiology of schizophrenia. Red cell distribution
width (RDW) has been studied as a surrogate marker in systemic inflammatory response. Higher RDW levels are suggested to be
associated with negative clinical outcomes in patients with diabetes mellitus, cardiac failure, pulmonary hypertension, coronary artery
disease and stroke. Our goal was to investigate whether RDW was higher in patients with schizophrenia than in healthy subjects, similar
in age, sex, and body mass index.
Methods: In this multicenter cross-sectional study, we analyzed 156 non-obese patients with schizophrenia and 89 healthy control
subjects for complete blood count. The Brief Psychiatric Rating Scale was used to determine the severity of clinical pathology.
Results: The mean±standard deviation RDW of patients with schizophrenia was significantly higher than that of healthy controls
(14.1±1.5 vs. 13.0±0.7, respectively, p<0.001). RDW correlated positively with severity of pathology (r=0.242; p<0.01) and duration of
schizophrenia (r=0.338; p<0.01).
Conclusion: Our findings suggest that RDW levels are increased in physically healthy, non-obese, patients with schizophrenia, when
compared with physically and mentally healthy individuals. Moreover, increased levels of RDW are associated with the duration of the
disorder and severity of psychotic symptoms. To our knowledge, this is the first study that demonstrated the association between RDW
and schizophrenia.
Keywords: inflammation, red cell distribution width, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S159
[PP-089] Childhood and adolescence disorders
Ref. No: 0237
Psychotic symptoms improved with antiepileptic therapy in childhood:
a case with ictal psychosis
Esra Guney1, Ozden Sukran Uneri1, Ebru Petek Arhan2, Zeynep Selen Karalok2
Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Child and Adolescent Psychiatry, Ankara-Turkey
1
Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Neurology, Ankara-Turkey
2
e-mail address: [email protected]
This paper aimed to discuss diagnostic and therapeutic processes in a rare pediatric case with psychotic episodes characterized by vivid
hallucinations and sleep-activated electroencephalogram (EEG) findings consistent with epilepsy, who improved with antiepileptic
therapy without the need for any antipsychotic treatment.
A male pediatric case of 11 years of age, who was under state protection presented with seeing tiny creatures in his dreams and behavioral
changes. On his interrogation, he told that he saw, especially at evening hours, undefined tiny creatures resembling human beings,
which scratched his hands and told him to do evil things like “hurting others”. He stated that this continued for approximately 5 minutes
each time. During psychiatric examination, these creatures, which considered as independent from dream content, were explained
by the patient as “dreaming”, and he thought he was possessed by an evil spirit. Institution employees stated that he had behavioral
alterations that began within the same time period. The patient had a suspicious diagnosis of epilepsy and luminaletten use at the
age of 4. Considering the episodic course and the past history of epilepsy, he was referred to neurology clinic for detailed assessment.
Sleep-activated EEG revealed focal epileptic disorder starting from centrotemporal part of the left hemisphere and showing secondary
generalization. In line with history and examination findings, he was diagnosed to have epilepsy for which valproate 10 mg/kg/day was
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begun and increased to 20 mg/kg/day one week later. A marked improvement was detected in psychotic symptoms one week after dose
increase. He had no active clinical findings after an 8-weeks follow-up. His control EEG was normal.
Epileptic psychosis involves a group of disorders closely associated with epileptic seizures. Interictal psychosis, postictal psychosis, ictal
psychosis, and alternative psychosis are in this diagnostic group. The rarer ictal form of psychotic episode is considered as a distinct
diagnosis from other epileptic psychoses. Ictal psychosis is associated with visual and auditory hallucinations accompanied by affective
changes such as agitation, fear, or paranoia. Insight to psychotic symptoms and short attacks helps differentiate ictal psychosis from
interictal psychoses. It has also been reported that psychotic signs arising during seizure activities in this disorder are, unlike those in
other psychoses, stereotypic and exhibit no differences between seizures. Ictal psychosis is generally short-lived, lasting for hours or days.
Many partial seizures terminate in below 3 minutes. Likewise, short-lived psychotic symptoms that are experienced “especially at evening
hours” for “approximately 5 minutes” and stereotypically described as “seeing undefined humanoid tiny creatures” are quite decisive for
ictal psychosis. A short symptom history, normal functionality between attacks, an active impairment in EEG and absence of clinically
observed seizure attacks led us to the diagnosis of ictal psychosis.
In this case, unlike other forms of epileptic psychosis, a marked improvement in patient symptoms with antiepileptic therapy without the
need of any antipsychotic treatment is striking. Thus, as a result of differences in treatment protocol and prognosis, a detailed assessment
prior to medications is important in cases presenting with atypical symptoms.
Keywords: child, epilepsy, ictal psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S159-S60
[PP-090] Mood disorders
Ref. No: 0239
Complicated grief and depressive disorder among elderly patients who applied to
psychiatrists and family physicians
Ibrahim Taymur1, Cenk Aypak2, Kadir Ozdel3, Ozlem Turedi2, Veli Duyan4, Almila Ikra Akgul1
Sevket Yilmaz Training and Research Hospital, Department of Psychiatry, Bursa-Turkey
1
Diskapi Yildirim Beyazit Training and Research Hospital, Department of Family Medicine, Ankara- Turkey
2
Diskapi Yildirim Beyazit Training and Research Hospital, Department of Psychiatry, Ankara-Turkey
3
Ankara University, Faculty of Health Sciences, Department of Social Work, Ankara-Turkey
4
e-mail address: [email protected]
Objective: To determine the rates of prolonged bereavement and depression among elderly patients who experience the loss of a
significant other. Also, to determine whether there are significant differences between those patients, who apply to psychiatrists and to
family physicians.
Method: A total of 103 subjects were selected from both the psychiatry and family medicine units at a Training and Research Hospital
in Turkey. Subjects were administered a socio-demographic data form, the Geriatric Depression Scale (GDS) and the Core Bereavement
Items (CBI) scale. All subjects were screened for cognitive impairment and psychiatric diagnoses using the Standard Mini Mental State
Examination (S-MME) and the Structured Clinical Interview for DSM- IV Axis I Disorders (SCID-I).
Results: In the family medicine group and the psychiatry group, prolonged bereavement rates were 23.1% (nine of the thirty-nine
patients) and 34.4% (twenty-two of the sixty-four patients), respectively. Thirty-one patients (48.4%) in the psychiatry group were
diagnosed to have major depressive disorder and an additional twenty-one (32.8%) were diagnosed to have major depressive disorder
plus prolonged bereavement. Six patients (15.4%) in the family medicine group were diagnosed with a major depressive disorder and an
additional five (12.8%) were diagnosed with major depressive disorder plus prolonged bereavement.
Conclusion: Elderly patients may apply to medical departments other than psychiatry with complaints that require careful management
to reduce the potential for pathology from prolonged bereavement.
Keywords: depression, geriatric psychiatry, grief
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Poster Presentations
[PP-091] Schizophrenia and other psychotic disorders
Ref. No: 0240
Huntington’s disease misdiagnosed as schizophrenia: a case report
Ali Askar1, Fatma Ozlem Orhan1, Ebru Findikli1, Mustafa Gokce2
Kahramanmaras Sutcuimam University, Faculty of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
1
Department of Neurology, Kahramanmaras-Turkey
2
e-mail address: [email protected]
Huntington’s disease (HD), an autosomal dominantly inherited neurodegenerative disorder, is characterized by the gradual onset
and progression of motor, cognitive and psychiatric symptoms. In this report, we present a case with HD who was misdiagnosed as
Schizophrenia.
A 41-years old, female patient had been treated for the diagnosis of schizophrenia for 10 years. She was admitted to our psychiatry
department with the symptoms of jealousy and somatic delusions, chorea, dystonia, parkinsonian features, apathy, irritability and
depressive features. She thought there were worms in her throat. She had used olanzapine, chlorpromazine, zuclopenthixol depot
and escitalopram at different times. It was clarified that her disease process started 10 years ago with psychotic symptoms and chorea
symptoms were added on later. Minimal frontoparietal cortical atrophy and ventricular dilation were seen in the Cranial MRI. DNA
analysis supported the clinical diagnosis of HD with higher number of CAG repeats. Clozapine was started and other drugs were stopped.
Delusions and hallucinations were improved dramatically and movement disorder partially resolved. During the interview her affect
was anxious and irritable. Her orientation was normal. Her thought process was perseverative with a content of somatic and jealousy
delusions. She reported tactile hallucinations.
Patients with HD can exhibit psychotic symptoms with movement symptoms. In this case, we aimed to emphasize that HD should always
be included in the differential diagnosis of psychotic disorders.
Keywords: Huntington’s disease, psychosis, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S161
[PP-092] Childhood and adolescence disorders
Ref. No: 0242
Childhood narcolepsy: a case report
Dursun Karaman1, Ibrahim Durukan1, Murat Erdem2
Gulhane Military Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara-Turkey
1
Gulhane Military Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
2
e-mail address: [email protected]
Narcolepsy is characterized by the excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. The symptoms
of narcolepsy can appear all at once or they can develop slowly over many years. The four most common symptoms are excessive daytime
sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. In some cases, excessive daytime sleepiness is the only symptom.
An-8-years-old boy applied to our hospital due to excessive daytime sleepiness, sleep attacks which have occurred at last 3 months when
he was eating, watching TV. Furthermore, at once he slept and fell down when he was biking. His first complaints started 3 months ago
as excessive tiredness and falling asleep after play. The patient was suddenly collapsing, with knobs on falling asleep when he laughed
or cried. He had bitten his tongue so as to stop laughing. After the evaluation of the medical history and physical examination, he was
diagnosed to have narcolepsy. Imipramine treatment was started.
Here we point out that people with narcolepsy often exhibit a sudden loss of muscle tone in response to emotional stimuli. For example,
surprise might result in buckling of the knees and sudden collapse. This symptom may occur in 60 percent of people with narcolepsy.
Keywords: narcolepsy, childhood, collapse
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S161
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Poster Presentations
[PP-093] Childhood and adolescence disorders
Ref. No: 0243
The practice of pharmacological treatment in a child and adolescent psychiatry
outpatient clinic
Dursun Karaman1, Ibrahim Durukan1, Murat Erdem2, Koray Kara1
Gulhane Military Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara- Turkey
1
Gulhane Military Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
2
e-mail address: [email protected]
Objective: Important progress have been made in psychopharmacology whereby mechanisms of psychotropic drugs have been
better understood and new psychotropic drugs with netter selectivity thus less side effects have been developed. Beyond supportive
psychotherapy, cognitive-behavioral therapy, family therapy and play therapy, pharmacological treatment options have important roles
in clinical practice of child and adolescent psychiatry. In this study it was aimed to determine the psychotropics and non-pharmacological
treatment options used in treatment of children and adolescents applied in a child and adolescent psychiatric outpatient clinic.
Method: Medical records of 538 patients referred to the Children and Adolescent Psychiatry outpatient clinic between January 2009 and
June 2009 were studied retrospectively.
Results: More than half of the cases were prescribed psychotropic medications. The most commonly prescribed medications in descending
order of frequency were antidepressants, psychostimulants, antipsychotics and anxiolytics. Selective serotonin reuptake inhibitors (SSRI)
were the most common choice within antidepressants. Sertraline and fluoxetine were the most common prescribed SSRIs. Short acting
methylphenidate was the most common prescribed stimulant and risperidone was the most common antipsychotic prescribed. About
half of the cases were given non-pharmacological treatment options. Giving counseling was the most common treatment choice among
non-pharmacological treatment options.
Conclusion: To know the most common treatment choices will help child and adolescent psychiatrists in treatment applications. The
results of this study need to be supported with investigations which include larger subgroups.
Keywords: psychopharmacology, treatment, child and adolescent
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S162
[PP-094] Psychiatric genetics
Ref. No: 0244
The relationship between mitochondrial complex I-III gene mRNA levels and clinical
features of the patients with schizophrenia
Suleyman Akarsu1, Deniz Torun2, Abdullah Bolu3, Salih Kozan2, Hatice Akar2, Ozcan Uzun2
Gulhane Military Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
1
Gulhane Military Faculty of Medicine, Department of Medical Genetics, Ankara-Turkey
2
Flight Crew Health Research and Education Center, Eskisehir-Turkey
3
e-mail address: [email protected]
Objective: Schizophrenia is a psychiatric disorder characterized with heterogeneous symptoms. This feature of this disorder is the
most important underlying reason of not finding a biomarker that can be used in the diagnosis of schizophrenia. Some of the features
of patients diagnosed with schizophrenia may vary. So, the clinical features of the cases must be well defined in the studies searching
biomarkers. The enzyme activation of mitochondrial complexes located in the electron transport chain has been identified as a potential
biomarker for schizophrenia. In this study, the relationship between mitochondrial complex I-III gene mRNA levels and clinical features of
the schizophrenia patients were investigated.
Method: 84 chronic schizophrenic and 54 first-episode schizophrenia patients in the psychiatric clinic of Gulhane Military Medical
Academy were enrolled to the study. The clinical features of the patients such as duration of disease, age of onset of disease, duration of
hospitalization, family history, history of suicide attempt, smoking habits and alcohol use were investigated. mRNA levels of mitochondrial
complex I-III genes (NDUFV1, NDUFV2, NDUFS1, UQCR10) from peripheral blood samples of the patients were tested in the genetic
laboratory. The relationship between the clinical features and gene mRNA levels of the patients were analyzed by Pearson’s correlation test.
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Results: Positive correlation was detected between the mRNA levels of NDUFV1 gene and age of onset of the disease (r=0, 21; p=0, 04).
In first-episode schizophrenia patients, there was a negative correlation between duration of the disease and NDUFV2 gene mRNA levels
(r=-0, 33, p=0, 02). There was no correlation between other clinical features and mRNA levels of researched genes.
Conclusion: Today, schizophrenia diagnosis is still being put on the basis of clinical criteria. Biomarkers have been tried to be found
to confirm the objectivity of the diagnosis. But it should be considered that schizophrenia cases might exhibit disparate clinical
features. Disparate clinical features might alter the peripheral findings. Investigation of the peripheral parameters by the separation of
schizophrenia cases into groups based on clinical features may increase the specificity of biological markers for schizophrenia.
Keywords: schizophrenia, clinical features, biomarker
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S162-S3
[PP-095] Psychopharmacology
Ref. No: 0245
Pisa syndrome during aripiprazole treatment in an autistic patient
Duygu Murat, Onur Tugce Poyraz Findik, Ummugulsum Gundogdu, Ayse Arman
Marmara University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Drug-induced Pisa syndrome (DIPS) or pleurothotonus, characterized by tonic flexion of the trunk and head to one side and slight
rotation of the body. Pisa syndrome occurs mainly during medication with typical, but sometimes also with atypical antipsychotics. The
pathophysiology of Pisa syndrome is complex; a dopaminergic-cholinergic imbalance or serotonergic or noradrenergic dysfunction might
be a possible explanation. Some cases of induction of the condition by neuroleptics and improvement with anticholinergic agents may
suggest that a dopaminergic-cholinergic imbalance might be the main factor.
Aripiprazole is an atypical antipsychotic, acting as partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist
at 5-HT2A. Aripiprazole appears to be associated with low extrapyramidal side effect (EPS) rates in pediatric patients. Aripiprazole may
alter the dopaminergic–cholinergic balance, which is supposed to be the main underlying pathogenetic factor in Pisa syndrome. But the
underlying pathophysiological mechanisms of DIPS are still unclear.
In the literature, there was no DIPS condition in pediatric population following the psychiatry treatment. We report a case of Pisa
Syndrome caused by short term use of aripiprazole in an autistic child. A 12-years-old male child with autism had been treated with
aripiprazole 5 mg/day for aggression during the last 2 months. When the dose of aripiprazole was increased from 5 mg to 7.5 mg the
patient demonstrated a tilting of his trunk toward right side. Within a couple of days of being taken off the treatment, the patient no
longer exhibited the symptoms of Pisa syndrome.
As indicated by previous reports, reduction in dose or discontinuation of the antipsychotic drug remains to be the first-line treatment for
Pisa syndrome. In some researches, it is suggested that aripiprazole could improve DIPS because of its partial dopamine agonist effects
without complete blocking of dopaminergic activity in the nigrostriatal pathway. Physicians should be aware of Pisa syndrome in children
and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create
awareness among clinicians as it is a reversible condition, which responds to removal of the offending drug.
Keywords: aripiprazole, Pisa syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S163
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Poster Presentations
[PP-096] Psychopharmacology
Ref. No: 0250
Hirsutism due to mirtazapine treatment
Pinar Guzel Ozdemir1, Osman Ozdemir2
Ipekyolu Public Hospital, Department of Psychiatry Van-Turkey
1
Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van-Turkey
2
e-mail address: [email protected]
Hirsutism is defined as the presence of excess terminal hair in females in a male-like pattern. There are many factors involved in the
etiology of hirsutism. Multiple medications have been associated with hirsutism. We report here a case of rapid onset of hirsutism
following administration of mirtazapine.
A 24-year-old, single, female patient applied to our outpatient clinic with depression symptoms of unwillingness, malaise, sadness,
insomnia and loss of appetite. She did not explain psychosocial stress factors. She was diagnosed to have major depressive disorder
according to SCID-I and prescribed mirtazapine 30 mg once a day. When she came to follow-up after one month, the patient dwelled
upon the abnormal hair growth and menstrual irregularity. She consulted to the obstetrics clinic top of the legs. Thyroid-stimulating
hormone (TSH), Luteinizing hormone (LH), Follicle stimulating hormone (FSH), testosterone, progesterone and estradiol levels were within
normal ranges. Mirtazapine treatment was discontinued and trazodone was started. The terminal hair growth and menstrual irregularity
stopped after discontinuation of mirtazapine.
Mirtazapine is an alpha- 2 antagonist antidepressant that has complex mechanisms in releasing noradrenalin and serotonin. In our case,
the patient had no complaints of male pattern hair growth before mirtazapine treatment and improved after discontinuation of the
medication suggests that it is a drug-induced hirsutism. Hirsutism is usually caused by increased androgen production furthermore it
can also be seen in normal serum androgen levels. The other antidepressants associated with hirsutism are bupropion, fluoxetine and
venlafaxine. Case series are needed to verify the mirtazapine-induced hirsutism.
Keywords: depression, hirsutism
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S164
[PP-097] Childhood and adolescence disorders
Ref. No: 0251
Does treatment-resistant obsessive compulsive disorder and attention deficit
hyperactivity disorder comorbidity have any risk for bipolar disorder? two case reports
Mehmet Fatih Ceylan, Miray Cetinkaya
Dr. Sami Ulus Women’s-Children’s Training and Research Hospital, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Pediatric bipolar disorder (PBD) has a course that is more serious than adult onset bipolar disorder (BD) and has a poorer prognosis. In
this paper, two adolescent patients, who had obsessive–compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD)
comorbidity and their following diagnosis “BD” are described. These cases were interestingly resistant to the treatment.
Case 1: The seventeen-years old patient was brought to our clinic by his father with restlessness, distractibility and nervousness as well
as serious obsessions of cleanliness and sanitation. He was diagnosed with OCD and ADHD according to the DSM-4 TR criteria. Fluoxetine
20 mg/day and methylphenidate 40 mg/day were started as the initial treatment for the obsessions of the patient. Upon lack of response,
fluoxetine dosage was increased to 40 mg/day; however, there was no reduction in the obsessions. During the follow-up period of two
months, the behavioral problems of the patient in the school increased, while his sleep decreased. The patient, who displayed serious
mood fluctuations, was diagnosed to have BD type-1. Fluoxetine was stopped. In the follow-up visits, risperidone was increased to 6 mg/
day and valproic acid was increased to 1000 mg/day.
Case 2: The sixteen-years old male was brought to our clinic with the behavioral problems at school, obsessions of cleanliness and
sanitation, religious obsessions and repeated kissings on his father. He was diagnosed with OCD and ADHD according to the DSM-4
TR criteria. Sertraline 50 mg/day was started as the initial treatment for the obsessions of the patient, and the dosage of sertraline was
increased to 100 mg/day in the course of follow-up visits. During this period, the patient was also given methylphenidate and risperidone
treatment for ADHD and behavioral problems. The patient, who displayed serious mood fluctuations about 1 year after the beginning of
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treatment, was diagnosed to have BD type-2. Sertraline was stopped, and risperidone and valproic acid treatment was started.
Contrary to the adult-onset BD, the PBD has rapid cycles and irritability picture is dominant. In addition, co-morbid psychiatric disorders
are more frequently seen in the PBD. It is notable that these cases were interestingly resistant to the treatment that was diagnosed as
BD afterwards. The fact that OCD patients who do not benefit from the treatment with SSRIs can benefit from the added antipsychotics
suggest that functional abnormalities of dopamine receptors play a role in the etiopathogenesis of OCD. The overlapping signs seen in BD
and ADHD patients including excessive talking, restlessness and impulsivity and frequent togetherness of these two suggest the presence
of a relationship between those two disorders. PBD is diagnosed with ADHD by 60-90%. There are many studies involving ADHD and PBD.
Although a high rate of co-morbidity of OCD has been shown in children and adolescents suffering BD , the numbers of studies are few.
In conclusion, the PBD is frequently associated with ADHD and anxiety disorders. An increased risk for BD can be suspected in co-morbidity
of treatment-resistant OCD and ADHD.
Keywords: pediatric bipolar disorder, obsessive–compulsive disorder, attention deficit/hyperactivity disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S164-S5
[PP-098] Personality disorders
Ref. No: 0253
A case of Klinefelter’s syndrome: a 18 years old male with antisocial personality disorder
Bilge Burcak Annagur, Ali Kandeger
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Klinefelter’s syndrome, 47, XXY, is the most common chromosomal aberration among men and the incidence of the syndrome is 2.0
per 1,000 live-born males. Individuals with XXY may have hypogonadism, fertility problems, tall stature, gynecomastia, language based
learning disabilities, and disorders of executive function. It is found that language disorder is seen in 65% as the most prevalent disorder
followed by attention deficit disorders in 63% and autism spectrum disorder 27% of all cases suffering this syndrome. Behavioral
impairment is most evident among cases classified as autism spectrum disorder and psychotic disorder with a rate of 12%. Although
there are more reports about Klinefelter’s syndrome associated with psychiatric disorders in literature, there are limited reports regarding
personality traits. We present here a case report of Klinefelter’s syndrome, who has been suffering antisocial personality disorder.
A 17-year-old male was admitted to the emergency ward because of aggressive behavior, substance use and self mutilation. He started
using alcohol since he had been 8 years old. He started to use cannabis when he was 11 years old. He has had impulsive behaviors since
childhood. He reportedly had multiple self-inflicted injuries. His psychiatric history was significant for the diagnosis of attention deficit
and hyperactivity disorder and conduct disorder. Physical examination indicated that he was a tall (200 cm) and overweight (110 kg) boy
with long arms and legs. We was suspected to have Klinefelter’s syndrome due to his physical appearance. Cytogenetic studies showed
a 47, XXY karyotype. All other investigations gave results within normal limits. His intellectual function scores on the Wechsler scale were
77 for performance, 86 for verbal skills and 83 in full scale.
Klinefelter’s syndrome is associated with multiple psychiatric comorbidities. Recent studies on the genetics of alcoholism have suggested
an association between antisocial behaviors and the MAO-A gene. It is found that the rate of MAO-A promoter polymorphism was 3%
among type 2 alcoholics. They suggest that MAO-A is X linked; the heterozygotes are probable cases of Klinefelter’s syndrome (47, XXY)
suggesting that X-chromosome aneuploidy might increase the risk for developing type 2 alcoholism. Previous studies consistently
demonstrate that for men, and probably for women, a history of conduct disorder in childhood and adulthood might be an indicator of
predisposition to the development of an alcohol misuse.
Keywords: Klinefelter’s syndrome, antisocial personality disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S165
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[PP-099] Psychopharmacology
Ref. No: 0254
Frontal lobe syndrome or attention deficit hyperactivity disorder? diagnosis of
impulsivity and hyperactivity symptoms after traumatic brain injury and its treatment
Hatice Gozde Akkin Gurbuz1, Burc Cagri Poyraz2
Istanbul University, Cerrahpasa Faculty of Medicine, Department of Child Psychiatry, Istanbul-Turkey
1
Istanbul University, Cerrahpasa Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey
2
e-mail address: [email protected]
We present a case that was brought by parents after the brain damage and we aimed to present the path we followed during the
treatment. A 22-year-old male had a car accident that caused multiple brain damage and compelled him to stay in an intensive care
unit. In his history, he was taken to child and adolescent psychiatry clinic and was diagnosed by attention deficit hyperactivity disorder
(ADHD) due to his hyperactivity, risky behavior, difficulty in attention and concentration. After six years of methylphenidate treatment, the
patient’s symptoms had decreased and the family considered him as “normal”. However his parents stated that the patient had regressed
to his childhood state after the accident.
After traumatic brain injury, several cognitive and behavioral damages can occur. The great majority of individuals with a mild injury report
cognitive, somatic and emotional problems. Although the majority of individuals report improvement after several weeks of the injury,
some individuals may have persistent symptoms that could be attributed to the injury. The pharmacotherapy for treating psychiatric
symptoms after brain injury has not been defined clearly. Aripiprazole, a new generation antipsychotic, is a promising alternative for the
treatment of conduct problems and mood instabilities, with its cognitive recovery effect.
Keywords: attention deficit hyperactivity disorder, aripiprazole, frontal lobe syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S166
[PP-100] Schizophrenia and other psychotic disorders
Ref. No: 0258
Hypothyroidism induced psychosis: a case report
Taha Can Tuman1, Akif Asdemir2, Mustafa Basturk2
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Erciyes University, Faculty of Medicine, Department of Psychiatry, Kayseri-Turkey
2
e-mail address: [email protected]
Thyroid diseases may lead to occurrence of psychiatric symptoms and psychiatric disorders. Hypothyroidism is a condition, which is
often seen during clinical practice, and the condition is associated with various clinical pictures. Hypothyroidism is often associated
with psychiatric symptoms. Anxiety, apathy, cognitive disorder and depression are commonly observed, but psychosis and mania are
rare.
This case report will present a patient with psychosis resulting from hypothyroidism. This case addresses a 56-years old female
patient, who had diagnosis of hypothyroidism 4 years ago and has had psychotic symptoms for 6 months. Patient was referred
by relatives to our outpatient clinic due to complaints of insomnia, auditory hallucinations and abnormal thoughts (her husband
is cheating her and she is bewitched) and talking to herself. On psychiatric assessment, it was found that her self-care was poor.
Periorbital edema was noted. Skin was dry and hair was not tidy. Patient had an apathic appearance. Orientation was intact. Affect
was inappropriate. Mood was irritable. Thought content indicated mystic, jalusic and persecutory delusions. On blood analyses, T3
and T4 were low, while TSH and thyroid auto-antibodies were high. Personal history indicated that diagnosis of hypothyroidism was
made 4 years ago, but patient had poor compliance and she did not regularly return for control visits. Familial history indicated no
specific finding. Most possible diagnosis was hypothyroidism-induced psychosis and patient was started on hormone replacement
therapy and risperidone (1 mg/day). Self-care improved and delusions regressed. Psychotic and cognitive symptoms completely
disappeared 1 week after thyroid parameters were restored to normal range. Psychotic symptoms occurred when clinical picture of
hypothyroidism enhanced; on the contrary, complaints regressed when the patient had euthyroid status. Late onset of psychotic
picture and absence of psychosis in personal and familial histories further support the possibility that psychosis is secondary to
overall state of health.
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Thyroid diseases may lead to a wide spectrum of psychiatric disorders. Therefore, thyroid function tests should be routinely ordered for
psychiatric patients.
Keywords: hypothyroidism, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S166-S7
[PP-101] Psychopharmacology
Ref. No: 0264
Trifluoperazine induced stuttering: a case report
Onur Durmaz
Van Military Hospital, Van-Turkey
e-mail address: [email protected]
Stuttering is a condition characterized by prolongations and involuntary repetitions of sounds, phrases or words and silent periods that
disrupts flow of speech. The prevalence of this condition is about 1% of general population. Stuttering can be idiopathic or acquired. Drug
induced speech problems are one of the secondary etiological factors in development of stuttering. Psychotropic drugs, such as SSRIs, TCAs
and some of antipsychotics like clozapine, risperidone, aripiprazole and haloperidol have been reported to be responsible for acquired
stuttering. Conversely some psychotropic medications like haloperidol, fluoxetine, olanzapine and risperidone are involved in treatment of
this clinical condition. The mechanism of action of these medications remains unclear. Although pathophysiology of stuttering is not well
understood, several data indicate that it is related to dysfunction of dopaminergic pathways. In this report, we present a case with anxiety
disorder who had stuttering developed while taking trifluoperazine, a typical antipsychotic and a member of phenothiazine group.
Our case is a 21 years-old male, admitted to outpatient clinic with anxiety symptoms. He had been suffering from unpleasant feelings
about something unlikely to happen, difficulty in sleeping, visual pseudohallucinations, uneasiness, paresthesia and non-epileptic
psychogenic seizures. His symptoms had been for one year. He had used paroxetine 20 mg/day plus quetiapine 25 mg/day for 5 months
and paroxetine 40 mg/day plus mianserin 10 mg/day for 2 months. His complaints were more severe at night. His neurological evaluation
with EEG and cranial MRI was performed and no etiological factor was found. His last medication was switched to paroxetine 40 mg/day
plus trifluoperazine 1 mg/day due to inadequate response to current medication and to relieve his severe anxiety symptoms. The patient
reported stuttering during the first week follow up while some of his anxiety symptoms alleviated mildly with trifluoperazine as well. Due
to his speech difficulty trifluoperazine medication was stopped. His stuttering resolved spontaneously after cessation of trifluoperazine.
He reported no other motor and sensory complaint during and after treatment. He had no conversion disorder symptoms during
trifluoperazine administration as well.
Trifluoperazine is a neuroleptic used in treatment of psychotic disorders but thanks to its anxiolytic effect, this agent can be preferred
in some forms of anxiety disorders. There are some reports about its efficacy in anxiety disorders. We concluded that although
extrapyramidal symptoms are the most prominent adverse effects of typical antipsychotics, and it should be kept in mind that stuttering
could be present as a side effect of trifluoperazine.
Keywords: trifluoperazine, stuttering, side-effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S167
[PP-102] Nonpharmacological biological therapies
Ref. No: 0269
Knowledge and attitudes of resident trainees regarding electroconvulsive therapy
Feridun Bulbul1, Gokay Alpak1, Ahmet Unal1, Osman Hasan T. Kilic1, Berna Ermis2, Haluk A. Savas1
Gaziantep University, Faculty of Medicine, Department of Psychiatry, Gaziantep-Turkey
1
Bitlis State Hospital, Bitlis-Turkey
2
e-mail address: [email protected]
Objective: The aim of our study was to determine whether there were any differences between resident trainees in basic medical science,
internal medical science, and surgical medical science regarding their knowledge of and attitudes towards electroconvulsive therapy.
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Method: The study consisted of 176 graduates of faculty of medicine under residency training at the Medical School of Gaziantep
University.
Results: Of the participants, 47 of the internal medicine residents (47%), 32 of surgery residents (56.1%), and 11 of the basic medical
science residents (57.8%) had never observed the application of ECT. There were no significant differences in attitudes between the
residents in three groups (p>0.05) except in response to the question, “Do you want your relative to undergo ECT if medical indications
for ECT were present?”. The basic medical science and internal medicine residents answered as “yes” significantly more often than those
studying surgery (p=0.02).
Conclusion: In this study, there were no significant differences between residents in internal medicine, surgery, and basic medical
sciences in terms of their knowledge and attitudes toward ECT except the item mentioned above.
Keywords: electroconvulsive therapy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S167-S8
[PP-103] Psychopharmacology
Ref. No: 0270
Misuse of methylphenidate and level of knowledge about methylphenidate
among resident physicians
Feridun Bulbul1, Gokay Alpak1, Ahmet Unal1, Osman Hasan T. Kilic1, Berna Ermis2, Haluk A. Savas1
Gaziantep University, Faculty of Medicine, Department of Psychiatry, Gaziantep-Turkey
1
Bitlis State Hospital, Bitlis-Turkey
2
e-mail address: [email protected]
Objective: The tendency of misuse of methylphenidate (MPH) has been increasing in young individuals. The MPH abuse is especially
higher among college students. In the present study, we aimed to evaluate the frequency of misuse of MPH and knowledge level about
this agent among resident physicians.
Method: Two hundred and twelve resident physicians working in Gaziantep University Faculty of Medicine Hospital were enrolled in our
study. Of these, 176 (83%) physicians accepted to participate. Participants asked to complete a questionnaire and a sociodemographic
data sheet designed by Department of Psychiatry. Twelve questions were asked to participants.
Results: Of the participants, 124 (70.5%) were men and 52 (29.5%) were women. Mean age was 29.25±3.04 (range: 24-44) years. Of the
participants, 100 were resident physicians in internal medicine, whereas 57 in surgical specialties and 19 in basic sciences. It was found
that 39 participants (22.2%) had previously used MPH without a medical indication. Of the participants who reported misuse of MPH, 19
participants indicated that they started using MPH by recommendation of their colleague, whereas 20 participants indicated that they
started using MPH with their own decision. 28 participants (15.9%) cited that they used MPH during the preparation period of Medical
Specialty Exam, while 11 participants (6.25%) cited that they used MPH in a period other than Medical Specialty Exam. No significant
difference was detected between male (n=30; 24.2%) and female participants (n=9; %17.3) regarding the frequency of misuse of MPH.
Conclusion: This study shows that the frequency of misuse of MPH is higher among resident physicians. Multi-centered studies are
needed to generalize this conclusion.
Keywords: methylphenidate, misuse, physicians
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S168
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[PP-104] Forensic psychiatry
Ref. No: 0271
Relationship between diagnosis, drug addiction and crime in forensic psychiatry
Feridun Bulbul1, Umit Sertan Copoglu2, Demet Alici1, Mehmet Fatih Tastan1, Ahmet Unal1, Gokay Alpak1, Haluk A. Savas1
Gaziantep University, Faculty of Medicine, Department of Psychiatry, Gaziantep-Turkey
1
Ceylanpınar State Hospital, Sanliurfa-Turkey
2
e-mail address: [email protected]
Objectives: The aim of the study is to investigate whether there is a relationship between psychiatric diagnosis, substance use conditions,
sociodemographic and clinical characteristics and the crime type in the patients referred from forensic medicine to our forensic psychiatry clinic.
Method: In this study, archive files and reports of 411 cases referred from forensic medicine to Gaziantep University Faculty of Medicine
Forensic Psychiatry Clinic between 2007-2011, were investigated retrospectively.
Results: Cases in which substance use and dependence were evaluated, cannabis was found to be substance of interest in %57.1 of cases,
heroin %14.6, multiple substances %13.1 and other drugs in %0.5. Among cases that were evaluated in relevance to TCK 32, multiple
substances were found to be the substance of interest in %7.7 of cases, cannabis %6.9, and heroin %3.8. Male sex was found to be
significantly higher and educational levels were found to be significantly lower in cases in terms of crime, substance use and dependence,
evaluated for criminal liability. In our study, cases involved in crime, had the psychiatric diagnoses in order of frequency as substance
dependence, psychotic disorders and mood disorders.
Conclusion: People suffering substance use and dependence are too much involved in crime directly or indirectly depending upon the
substance used. These people are frequently enrolled in the judicial system and in this process they are subjects of forensic psychiatry.
Keywords: forensic psychiatry, substance use and dependence, crime
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S169
[PP-105] Schizophrenia and other psychotic disorders
Ref. No: 0276
A probable case of very early onset schizophrenia managed with risperidone
Taha Can Tuman1, Zehra Topal2, Nuran Demir2, Ali Evren Tufan2
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu-Turkey
2
e-mail address: [email protected]
Cases of schizophrenia that arise prior to 18 years of age are defined as “Early Onset Schizophrenia” (EOS) while those that commence prior
to 13 years of age are called “Very Early Onset Schizophrenia” (VEOS). Approximately 10% of all cases of schizophrenia is EOS while VEOS is
even rarer. Information on VEOS is mostly provided via case reports. The youngest case of VEOS reported is 3 years and there is also a case
from Turkey with an onset at 5 years 4 months. Here, we report a case of VEOS, who was 5 years old and was followed-up for 12 months.
The patient was a 5 years-old preschool child, who was brought to our department with complaints of “regression in speech, inappropriate
behaviors, fears, insomnia and aggression”. Upon questioning it was learned that the complaints started a year ago and continued without
remission for the last year, that he laughed for no reason, was afraid of darkness and lavatories, was irritable and damaged his toys. He
was also reported to injure himself by scratching, to be afraid of cartoons and to decline to watch them. He pointed to the environment
and told that “they” were coming, “hit them” and that “they” were here. His peer relationships deteriorated and he stopped playing with
his friends in the kindergarten, became resistant to speak and started mumbling to himself instead. Medical history was normal and
developmental milestones were on time. In particular of family history, his mother was being followed up for schizophrenia while his
father was diagnosed with Learning Disability. Baseline evaluations with Clinical Global Impressions- Severity score was 6. Neurological
and laboratory investigations revealed no abnormalities. EEG was normal. As a result of history, examinations and tests the patient
received a preliminary diagnosis of VEOS and risperidone 0.75 mg/day in divided doses was started. Subsequent evaluations revealed that
the visual hallucinations were reduced but remained present while insomnia and self-injurious behaviors remitted. The final evaluation
revealed a CGI-S score of 3. Here, a case of probable VEOS that was managed with risperidone was presented. As a consequence of the
developmental features of early childhood presence of ego syntonic animistic thoughts and pseudo-hallucinatory behavior may be
deemed normative. However, the symptoms in our patient were pervasive, ego-dystonic and impairing. Neither presence of affective
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symptoms for a significant duration of history could be elicited nor a stressor that might have triggered the complaints be found ruling
out early onset mood disorders and dissociation. The onset and clinical features were not appropriate for Autism Spectrum Disorders and
no loss of bowel/ bladder control and neurological abnormalities could be found that might support Childhood Disintegrative Disorder.
Therefore, the patient was diagnosed to have VEOS and was followed up under risperidone. It is known that VEOS have more severe
symptoms compared to adult onset schizophrenia and that they have less response to treatment. It may be argued that earlier diagnosis
and more aggressive treatment of VEOS might lead to better prognosis.
Keywords: very early onset schizophrenia, risperidone
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S169-S70
[PP-106] Mood disorders
Ref. No: 0279
A case of adolescent bipolar disorder presented with catatonic picture
Miray Cetinkaya, Mehmet Sahin, Halil Kara, Ozge Demircan Tulaci, Ayse Nihal Eraslan, Sahin Bodur
Dr. Sami Ulus Women’s-Children’s Training and Research Hospital, Ankara-Turkey
e-mail address: [email protected]
When catatonia, which is included in DSM-IV-TR as a characteristic of the disorders related to general medical status, schizophrenia,
bipolar affective disorder and major depressive disorder, is considered as a spectrum, it is the picture seen in motor immobility with a
course of catalepsy or stupor, excessive motor activity, extreme negativism or mutism, adoption of posture, waxy flexibility, stereotypical
movements or purposeless movements not affected from external stimuli, echolalia or echopraxia frequently seen together with mood
disorders. Catatonia, of which the cause is not clearly known, can be lethal if treated erroneously. The research on catatonia in children and
adolescents are limited; and this picture can be frequently seen in the course of Pervasive Developmental Disorders and Mood Disorders.
Its incidence in the adolescent psychiatric incidence is estimated in the range of 0.6 to 17%. Its rarity in children as compared to adults
and possibility of confusion with the signs of other psychiatric diseases makes the research difficult. In this case report, an adolescent case
will be discussed, who was evaluated as excited catatonia picture and gave dramatic response to lorazepam. The discussed case highlights
the requirement of more careful consideration of symptoms in children and adolescents, who apply with this type of presentation, and
that catatonia must be kept in mind in the differential diagnosis.
Keywords: adolescent, catatonia, lorazepam
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S170
[PP-107] Psychopharmacology
Ref. No: 0280
Drug induced behavioral disinhibition in children treated with selective serotonin
reuptake inhibitors
Duygu Murat, Nagehan Demir, Fatma Benk, Ummugulsum Gundogdu, Mustafa Yasin Irmak, Nese Perdahli Fis, Ayse Arman
Marmara University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: Behavioral disinhibition is more commonly seen than (hypo)manic reaction during treatment with Selective Serotonin
Reuptake Inhibitors (SSRIs). It is differentiated from (hypo)manic reaction by the absence of more specific manic symptoms such as
elevated mood and grandiosity. Symptoms reported to be associated with drug induced behavioral disinhibition (DIBD) include increased
oppositional behaviors, hyperactivity, excessive talking, irritability, socially inappropriate behavior(swearing, and obscene gesture), verbal
and/or physical aggression, increased euphoria, akathisia or agitation, and self injurious behavior. We aimed to examine ten children, who
developed behavioral disinhibition after the initiation of SSRI treatment.
Method: In this 10-case series, drug induced disinhibition was examined. Several sociodemographic and clinical parameters such as,
distribution of disinhibition symptoms, DSM-IV diagnoses that necessitate antidepressant treatment, the comorbid conditions, and the
time of emergence of symptoms, were evaluated.
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Results: The age range of the children was 6-11 years (mean age 8.1±1.4 years). Of the children, 6 were male. The behavioral disinhibition
symptoms were aggression, impulsivity, socially inappropriate behavior, hyperactivity, and excessive talking. In all cases, the symptoms
diminished with the SSRI discontinuation. The most common diagnoses that require antidepressant treatment were obsessive compulsive
disorder (n=4), depression (n=2), selective mutism (n=2) separation anxiety disorder (n=1), generalized anxiety disorder (n=1). In 7 of the
cases, 4 of which are Attention Deficit Hyperactivity Disorder, a comorbid psychiatric diagnosis was present. The most common SSRI was
fluoxetine (n=8/10) (10-30 mg/day). The remaining 2 were given sertraline (25 mg/day). The onset of disinhibition symptoms occurred
within a range of 1 to 12 weeks, in half of the cases occurring within the first 4 weeks.
Conclusion: In our series, the onset of DIBD was observed typically 1 month after the SSRI exposure, similar to previous studies. We found
that, fluoxetine, especially when used in the treatment of anxiety disorders and OCD, appeared to increase the risk of DIBD. As a result, the
clinicians are advised to be more cautious, when using SSRIs in children for the treatment of anxiety disorders
Keywords: children, disinhibition, SSRI
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S170-S1
[PP-108] Psychopharmacology
Ref. No: 0282
Urticaria and angioedema associated with bupropion: three cases
Taha Can Tuman1, Bengu Altunay Tuman2, Nadir Goksugur2, Nefise Kayka2, Osman Yildirim1
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Dermatology, Bolu-Turkey
2
e-mail address: [email protected]
Bupropion is a norepinephrine and dopamine reuptake inhibitor, which is used to treat depression and to alleviate withdrawal symptoms
of tobacco addiction. Most common side effects are loss of appetite, dry mouth, insomnia, headache and constipation. In addition,
although rare, severe side effects include decreased threshold of seizure, urticaria and angio-edema, which require attention. Here, three
cases are presented who developed urticaria and angio-edema secondary to use of bupropion.
Case 1: A 33-year-old male patient was admitted due to facial swelling and generalized erupted hyperemic plaques on body for 3 days. On physical
examination, edema was noted on bilateral eye lids and lips, while generalized urticarial plaques were observed on body. There was no particularity
in personal and familial histories. It was understood that patient has been using bupropion at a dose of 300 mg/day for 15 days to quit smoking.
There were no other medications. Results of laboratory tests were normal and no infectious focus was found. Bupropion was discontinued and the
patient was started on prednisolone and pheniramine parenterally. Regression was noted during follow-up period and no new lesion developed.
Case 2: A 32-year-old male patient was admitted due to facial swelling and generalized erupted and hyperemic plaques, which have been
persisting for 3 days. It was understood that patient was admitted to emergency medicine due to same complaints 3 days ago and there
was no regression in lesions, although patient was started on prednisolone and pheniramine. Personal history indicated no particularity,
excluding hemorrhoidectomy. Medical history demonstrated that patient was using bupropion at a dose of 150 mg/day for 10 days due
to preliminary diagnosis of unipolar depression. Bupropion was discontinued and current treatment was maintained for urticaria and
angio-edema. During follow-up, lesions regressed and clinical picture of angio-edema improved.
Case 3: A 31-year-old female patient was admitted due to complaints of generalized erupted plaques and periocular swelling for 4 days.
Laboratory tests were ordered to identify etiology and total IgE level was high; no infectious focus was noted. Personal history of the
patient indicated no particularity, excluding endometrial polyp excision. Medical history demonstrated that patient was using bupropion
at a dose of 300mg/day for 3 weeks due to preliminary diagnosis of major depression. Bupropion was discontinued and the patient was
started on pheniramine and prednisolone. Lesions started to regress and complete recovery was observed at Day 5 of treatment.
Etiology of urticaria and angio-edema often involves infections and use of medications. Dermatological side effects often occur
since psychotropic drugs are more commonly used. Bupropion rarely leads to urticaria and angio-edema, which are severe reactions.
Respiratory edema and severe anaphylactic reactions may threaten life. Drug use within last one to two weeks is an important finding in
medical history. It may require discontinuation of questionable agent and starting steroids and antihistamines. Clinicians should assess
skin reactions in detail and switch patients to another drug and patients should be informed about dermatological side effects.
Keywords: urticaria, angioedema, bupropion
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S171
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[PP-109] Childhood and adolescence disorders
Ref. No: 0284
Atypical Rett syndrome in a young boy with c.316c>T mutation in MECP2 gene
Seda Erbilgin, Murat Coskun
Istanbul University, Istanbul Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Mutations in MECP2 gene have been implicated in the etiology of Rett syndrome, a neurodevelopmental disorder that primarily affects
females, and affect 90% to 95% patients with classical Rett syndrome. MECP2 mutations, once thought to be lethal in males, now present
a broad spectrum of clinical manifestations in males. Here we report a 3-years-old male, who displayed autistic symptoms, and eventually
diagnosed to have Rett syndrome after genetic analysis revealing a c.316C>T mutation in MECP2 gene.
Keywords: genetics, Rett syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S172
[PP-110] Sleep
Ref. No: 0285
Depression and assessment of the life quality among patients with obstructive
sleep apnea syndrome
Sule Sirin Berk1, Mehmet Fatih Karaaslan2, Deniz Tuncel3, Hasan Cetin Ekerbicer4, Fatma Ozlem Orhan2, Ebru Findikli2, Ejder Berk5
Necip Fazil City Hospital, Department of Psychiatry, Kahramanmaras-Turkey
1
Sutcuimam University, Faculty of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
2
Sutcuimam University, Faculty of Medicine, Department of Neurology, Kahramanmaras-Turkey
3
Sakarya University, Faculty of Medicine, Department of Public Health, Sakarya-Turkey
4
Necip Fazil City Hospital, Department of Physical Therapy and Rehabilitation, Kahramanmaras-Turkey
5
e-mail address: [email protected]
Objective: Respiratory disorder during sleep is an important public health issue. The majority of these disorders are mainly made up
of obstructive sleep apnea syndrome (OSAS). Concentration disorder, loss of memory, depression, psychosis, impotence and decreased
libido are the most commonly neuropsychiatric disorders seen with OSAS. Too much sleepiness observed in OSAS patients worsens the
life quality of these individuals. The number of studies revealing the rate of depression with applied structured clinical interview for DSMIV disorders (SCID) in OSAS patients is limited.
Method: This study was carried out in 101 patients with polysomnographic (PSG) records. PSG was done to all participants and all of
them were classified according to Apnea-Hipopnea index (AHI). Groups were classified as; Simple Snore (n=20, 15<=AHI<30), mild OSAS
(n=27, 5<=AHI<15), moderate OSAS (n=20, 15<=AHI<30), and severe OSAS (n=34, AHI>=30). Simple snore group was accepted as a
control group. We investigated mainly the differences between groups. We applied SCID, Hamilton Depression Rating Scale (HAM-D), Beck
Depression Inventory (BDI), Epworth Sleepiness Scale, Pittsburg Sleep Quality Index (PSQI) and SF 36 Life Quality Survey to all participants.
Results: Without discriminating the gender, according to comparison of HAM-D scores, we found that the depression rate was the
highest and statistically meaningful among moderate OSAS group. This was followed by severe OSAS group and then mild OSAS group,
respectively. Depression rate was the lowest (p=0.015) in Simple Snore group when compared with other apnea groups. No difference
was found between groups when EUS, PSQI and BMI scores were compared. We found lower scores of Social Function, subdivision of SF
36 Life Quality Survey, in severe OSAS group versus other groups especially when compared with simple snore. When we assessed other
subdivisions of SF 36 Life Quality Survey no difference was found between groups. Subtracting simple snore (control group) from all
participants we have OSAS group. We found depression a rate of 67% (n=54) among patients with OSAS (n=81) according to SCID applied
HAM-D scores. When neck circumference, EUS and PSQI scores were compared, no difference was found between OSAS patients with
and without depression. We found a high BMI among OSAS patients with depression (p<0.05). When we compared SF 36 subdivisions, all
subdivision scores were lower in OSAS patients with depression versus OSAS patients without depression (p<0.05).
Conclusion: These results show that depression rate is higher among OSAS patients. OSAS negatively affects the life quality. In our study
all 8 subdivisions of life quality scores were lower among OSAS patients with depression, when compared with OSAS patients without
depression. This result supports the thesis that life quality was affected more negatively with OSAS and depression comorbidity. The
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severity of OSAS is not related with decreased quality of life as shown in previous studies. Therefore, mood and depressive state should
be assessed carefully in order to improve the quality of life of severe OSAS patients.
Keywords: obstructive sleep apnea syndrome, depression, SF-36
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S172-S3
[PP-111] Psychopharmacology
Ref. No: 0289
A case report of sexual dysfunction due to hyperprolactinemia associated with
increased dose of paliperidone palmitate injection
Mustafa Akkus, Burcu Kok, Nesrin Karamustafalioglu, Tevfik Kalelioglu
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Sexual dysfunction and hyperprolactinemia are significant adverse effects, which may occur due to use of antipsychotic drugs. In this
case report, our aim is to present sexual dysfunction due to hyperprolactinemia after administration of 150 mg/month IM paliperidone
palmitate (PP).
A 22-year-old, single, male university student was hospitalized with a diagnosis of psychosis. He was not using alcohol or other psychoactive
substances at that time. Fasting blood glucose, lipid profile, complete blood count, thyroid function tests were all within normal range.
The patient has never used antipsychotic drugs previously. We planned to begin PP treatment via IM route. Recommended initiation doses
(150 mg day 1 and 100 mg day 8) were applied into deltoid muscle. In addition to that, 150 mg/day quetiapine was used. The patient did
not describe any sexual complaint during hospitalization and he was discharged at the end of the three weeks with clinical remission. The
treatment was continued with 100 mg/month PP injection for 3 months, and no sexual adverse effects were observed in the course of his
follow-up. Psychotic symptoms were relapsed at the end of the third month; therefore fifth dose of PP was applied into the gluteal region as
150 mg/month. This dose was continued for two months. In this period; psychotic symptoms were regressed, but the patient complained
about sexual aversion and erectile dysfunction. In this period; serum prolactin level was 60.98 ng/ml (normal prolactin interval: 4.04-15.2 ng/
ml) and the patient was assessed with Arizona Sexual Experiences Scale and a sexual dysfunction was found in all subitems.
Sexual dysfunction is a significant side effect of antipsychotic medications due to hyperprolactinemia. In a study assessing the potential
changes in prolactin levels and sexual function after switching from long-acting injectable risperidone to PP, it was found that there was
a significant reduction in prolactin levels and improvement in Arizona Sexual Experience Scale scores .It is mentioned that there is no
dose-response relationship between paliperidone and prolactin. Also some other investigations have found no relationship between
blood concentrations of paliperidone and related adverse events. In contrast to studies mentioned above, sexual dysfunction in our case
occurred after increasing the monthly dose of IM Paliperidone Palmitate.
Keywords: hyperprolactinemia, paliperidone palmitate, sexual dysfunction
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S173
[PP-112] Dementia
Ref. No: 0290
Huntington’s disease, concurrent to dementia: a case report
Taha Can Tuman1, Nefise Kayka1, Tarik Eroglu2, Osman Yildirim1
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Neurology, Bolu-Turkey
2
e-mail address: [email protected]
Huntington’s disease is a hereditary neurodegenerative disorder, which is associated with movement disorders, psychiatric findings and
dementia. Underlying cause is a mutation of Huntington gene, which is located on short arm of Chromosome 4. The mutation leads to
expansion of CAG trinucleotide repeat. Onset is usually around 4th decade of life and usually, patient is presented with motor coordination
problems. Parkinsonism is found in almost all the patients. Cognitive findings may precede movement disorders. Cognitive impairment
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aggravates and clinical picture of dementia becomes remarkable as the disease progresses.
This report will address a patient with Huntington’s disease, which was associated with depression and frontal dysfunction at baseline,
progressed into dementia with movement disorders added into the clinical picture at advanced stage. The thirty nine years old female
patient was admitted to our outpatient clinic due to complaints of loss of motivation, malaise, inability to do daily activities, tendency
to sleep continuously, short temper and aggressive behaviors associated with onset of bad temper. It was understood that complaints
started 10 years ago, patient had treatment based on diagnosis of depression and patient had no benefit from treatment. It was also
understood that complaints aggravated within 2 years, patient could carry out no daily work at home, memory impairment progressed,
patient was less motivated and patient could not cook. Patient was hospitalized. On psychiatric examination, she had poor self-care.
Attention loss was observed. Orientation was intact. Instant and short- and long-term memories were poor. Patient had difficulties on
perceiving time flow. Speed and content of speech were poor. Reaction time prolonged. She had short answers to questions. Affection
was limited. Thought content was inappropriate. Associations and psychomotor activity decreased. Patient did not have delusion,
hallucination and illusion. Abstract thinking, calculation and knowledge were not sufficient. Sleep quality was poor. Speed of movements
was remarkably slow. Patient was lurching and repetitive hand and lip movements were observed. Medical history was obtained
from family and it was understood that involuntary movements have been persisting for 2 years and frequency gradually increased.
Patient had difficulty in understanding instructions and had no interpersonal communication. It was observed that the currently used
antidepressant offered no benefit. Familial history indicated that speech and movement disorders, behavior changes and involuntary
movements had been observed in grandfather, father and aunt, resulting with bedridden life and death. Patient had 22 points in Mini
Mental test. Cranial MRI resulted with non-specific changes. Patient was consulted to neurology department due to poor frontal functions
and involuntary movements and Huntington’s disease and dementia secondary to former one were considered. Trinucleotide repeat was
16/44 in Huntington gene, which is located on Chromosome 4, as indicated by DNA fragment analysis. Based on current clinical history,
familial history and genetic analysis, diagnosis of “Huntington’s disease and dementia secondary to Huntington disease” was confirmed.
Donepezil and tetrabenazine were added onto current antidepressant therapy. Calmness slightly regressed during follow-up. Patient
started to achieve simple daily activities at home. A very slight improvement was noted in involuntary movements.
Keywords: Huntington’s disease, dementia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S173-S4
[PP-113] Childhood and adolescence disorders
Ref. No: 0291
Neuroleptic malign syndrome during antipsychotic treatment with lithium:
two adolescent patients with bipolar disorder
Gonca Ozyurt1, Sermin Yalin Sapmaz2, Neslihan Inal Emiroglu1
Dokuz Eylul University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir-Turkey
1
Celal Bayar University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Manisa-Turkey
2
e-mail address: [email protected]
Neuroleptic malignant syndrome (NMS) was first identified in 1968 and it is one of the most feared complications of neuroleptic drugs.
Case reports of NMS development in children and adolescents following the use of antipsychotic drugs have increased in recent years. In
this article we aimed to present two bipolar adolescent cases that had NMS while they were using antipsychotics and lithium, and they
were treated with bromocriptine, successfully.
The treatment follow-up of two cases was presented in this section.
Case I: A 15-year-old female, who applied to a psychiatry centre with aggression, talking too much, insomnia, irritation and was
diagnosed as bipolar disorder, She was administered 1200 mg lithium per day and zuclopenthixol accuphase twice a week; after two
days she had dryness of the mouth, prolonged sleeping and then failure in talking; five days later she had tremor in her hands, rigidity
in her legs and neck then she could not walk. Because of these complaints her family had decided to stop using these drugs. Two
days after discontinuation since her complaints resisted, they applied to emergency service. In psychiatric examination; somnolence,
dystonia, diffuse muscular rigidity, fluctuation of autonomic functions was observed, so NMS was thought as an initial diagnosis. She was
monitorized in intensive care unit and she was treated with bromocriptine and biperiden.
Case 2: A 16-year-old male, who applied to Dokuz Eylul Faculty of Medicine, Child and Adolescent Psychiatry Outpatient Unit with the
symptom of talking too much, increasing energy, motor hyperactivity, grandiosity, visual and auditory hallucinations and insomnia.
He was diagnosed with psychotic mania. Risperidone treatment was initiated. His symptoms were resistant and he was hospitalized.
Lithium treatment was started at a dose of 300 mg per day and the cross titration from risperidone to aripiprazole was made because of
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high prolactin levels. On the twenty sixth day of his hospitalization, his body temperature was measured as 38,5 C; blood pressure was
between 80/50 and 100/60 mmHg. He had dystonia, diffuse muscular rigidity, mutism, tremor, tachycardia, and diaphoresis. His leukocyte
count was 11700/mm3, CK: 419 U/L. Diagnosis of NMS was judged; antipsychotics and lithium were stopped, he was administered
bromocriptine, i.v. hydration, antipyretics; his leukocyte level and CK was controlled on daily basis.
We diagnosed NMS during antipsychotic and lithium treatment in two bipolar adolescents. Some adolescents with affective disorders
might be more vulnerable to the development of NMS. More importantly, bipolar disorder is one of the most common serious psychiatric
disorders of adolescence and it can be complicated by psychotic symptoms. Therefore, the use of neuroleptics may be introduced early
in the management of psychotic symptoms in adolescents with primary affective disorder. According to our experiences, diagnosis and
treatment of NMS in early stages lead to less complications and bromocriptine is useful in bipolar adolescents with NMS.
Keywords: adolescent bipolar disorder, neuroleptic malignant syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S174-S5
[PP-114] Neuroscience
Ref. No: 0292
Restless legs syndrome prevalence and depression-anxiety disorder
association in anemic patients
Esra Yancar Demir1, Ozgur Enginyurt2, Feriha Ozer3, Tuba Aydemir Ozcan3, Soner Cankaya4
Ordu University, Faculty of Medicine, Department of Psychiatry, Ordu-Turkey
1
Ordu University, Faculty of Medicine, Department of Family Medicine, Ordu-Turkey
2
Ordu University, Faculty of Medicine, Department of Neurology, Ordu-Turkey
3
Ordu University, Faculty of Medicine, Department of Biostatistics, Ordu-Turkey
4
e-mail address: [email protected]
Objective: Restless Legs Syndrome (RLS) is a disorder in which the person experiences a strong urge to move their legs or other
extremities during rest. This urge to move is associated with tingling, pulling or other unpleasant and uncomfortable feelings; it usually
slowly increases in the affected limb and often affects sleep. The incidence in general population is 5-15%. Although the pathophysiology
is not fully understood, it was thought to result from the iron and dopamine metabolism irregularities and also has a genetic component.
There are publications that show the frequency of disease in patients with iron deficiency or renal failure reaches up to 80%. In this study,
we investigated the incidence of restless leg syndrome in anemic patients without any other organic disease or drug use, which can cause
restless legs syndrome. We also tried to find out if there is a relation between restless legs syndrome, ferritin levels, anxiety and depression.
Method: Our retrospective, cross sectional study was made in The Ministry of Health and family medicine, neurology and psychiatry outpatient
clinics of Ordu University Education and Research Hospital. 47 patients who were admitted to above mentioned clinics whose ferritin levels were
under 50 ng/ml without any other disease and were not on medication (including those indicated for iron deficiency anemia) was included in
to the study. All patients were given the Beck depression inventory and Beck anxiety inventory. The patients were questioned in terms of the
basic diagnostic criteria established by International Restless Legs Syndrome Study Group. Definitive diagnosis could be established by the
patients that meet the four criterias for the diagnosis. International Restless Legs Scale applied to patients diagnosed with RLS.
Results: Of 47 patients, 39 were female and 8 were male. 28 (%59.6) of the patients met the criteria of RLS. 28 patients with a diagnosis
of RLS; 4 of them mild, 11 of them moderate, 8 of them severe and 5 of them experienced very severe symptoms of RLS. The relationship
between the RLS and ferritin levels were checked and there was no statistically significant difference between them. A significant
difference was not found in Beck depression scores between patients with and without RLS, but when the groups were compared in terms
of Beck anxiety score, there were a significant difference. There was no significant relationship between RLS severity and Beck depression
or Beck anxiety scores.
Conclusion: RLS can be seen in %5-15 of general population and it is much more likely to emerge in the presence of an organic problem
such as iron deficiency anemia. The diagnosis of the disorder is set clinically and RLS had a different significance because it may cause
sleep disturbances and psychiatric disorders. If not questioned, this problem, which is not easily noticeable, can lead to misdiagnosis and
misinterpreted as an anxiety disorder or a primary sleep disorder. Therefore the symptoms that could be corrected only by iron deficiency
treatment, could be inflamed further by giving antidepressants and hypnotics.
Keywords: restless legs syndrome, anemia, anxiety
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[PP-115] Sexual behavior and disorders
Ref. No: 0293
Is paroxetine effective in the treatment of premature ejaculation?
Sema Nur Turkoglu Dikmen, Yasir Safak, Riza Gokcer Tulaci, Sevilay Kilinc, Erkan Kuru
Diskapi Yildirim Beyazit Training and Research Hospital, Ankara-Turkey
e-mail address: [email protected]
Premature ejaculation (PE) is a common male-type sexual dysfunction. According to DSM-IV criteria PE is defined as, persistent or
recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. Various
drugs and sexual therapies are used in the treatment of PE. The most widely drugs used are topical analgesics and SSRIs. Paroxetine
is the most effective SSRI for prolonging the ejaculation time. Despite its strong effect, recurrence is observed very quickly right after
termination of treatment. Here we discuss a premature ejaculation case, who doesn’t accept sexual therapy. However benefited from oral
paroxetine treatment but suffered premature ejaculation symptoms after cease of treatment.
A 35-year-old, male patient, who was an employee, graduated from primary school. He has been married for seven years and has a child.
He applied our clinic for sudden and uncontrolled ejaculation during intercourse . He married after a 6 years period of engagement,
since his first sexual intercourse ejaculation time was less than 1 minute. The frequency of sexual intercourse was biweekly and foreplay
time was 5 minutes. After the assessment, we suggested sexual therapy for this patient. His wife refused sexual therapy and he started
20 mg oral paroxetine treatment. After two months the patient had 40% subjective improvement in his ejaculation time and was asked
to continue oral paroxetine treatment. He observed an ejaculation time of 1-2 minutes. In first application his Arizona Sexual Experience
Scale score was 15, Glombock Rust Inventory of Sexual Satisfaction raw score was 45, premature ejaculation subscale score was 13 out of
16, and satisfaction subscale score was 12 out of 16. After two months of oral paroxetine treatment his Arizona Sexual Experience Scale
score was 15, Glombock Rust Inventory of Sexual Satisfaction raw score was 34, premature ejaculation subscale score was 13, satisfaction
subscale score was 12. 1 month after drug cessation ejaculation time was less than 1 minute.
Paroxetine is a quick and available option in premature ejaculation treatment. Although paroxetine is an effective way of extending
ejaculation time, 3 weeks after the drug release premature ejaculation symptoms come back with the rate of 90%. In this case Glombock
Rust Inventory of Sexual Satisfaction raw score was better when the premature ejaculation symptoms improved, but there was no
improvement in premature ejaculation, satisfaction subscores and Arizona sexual experience scale score. These findings may point that
this improvement was symptomatic and not permanent. For this reason premature ejaculation treatment studies that evaluate long term
effects of pharmacotherapy could be beneficial.
Keywords: paroxetine hydrochloride, sexual dysfunctions
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S176
[PP-116] Schizophrenia and other psychotic disorders
Ref. No: 0295
Psychosis in Huntington’s disease: a case report
Taha Can Tuman1, Nefise Kayka1, Tarik Eroglu2, Osman Yildirim1
Abant Izzet Baysal University, Faculty of Medicine, Department of Psychiatry, Bolu-Turkey
1
Abant Izzet Baysal University, Faculty of Medicine, Department of Neurology, Bolu-Turkey
2
e-mail address: [email protected]
Huntington’s disease is a neurodegenerative disease, which is caused by autosomal dominant mutation. Underlying cause is a mutation
of IT15 gene, which is located on short arm of Chromosome 4. The mutation leads to expansion of CAG trinucleotide repeat. On cranial
imaging, neuronal loss is particularly remarkable in striatum. Symptoms usually occur at age of 30-50 years and rapidly progress. At
baseline, the disease is characterized with motor symptoms, such as chorea and dystonia, psychiatric symptoms and progressive
dementia. Common psychiatric symptoms of Huntington’s disease include depression, irritability, anxiety disorders, obsessive behavior,
suicide thoughts and behavior and personality changes. Psychosis is relatively rare. Here, a patient is present, who has Huntington’s
disease, which is associated with psychotic symptoms.
A 71-year-old male patient. Patient is followed up for 25 years for Huntington’s disease. Patient is taking tetrabenazine to treat involuntary
movements. Complaints of bad temper, aggressiveness and refusal of eating developed 6 months ago, when the patient thought that
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relatives were attempting to poison him. Sleep quality decreased. On psychiatric assessment, patient is conscious, cooperating and
oriented. Speech is dysarthric. Affection is agitated. Persecutory delusions are noted in thought content. Patient was specifying visual
perception defects. Finding of dementia could not be noted. Patient was started on olanzapine at dose of 5 mg/day. Agitations regressed,
as observed in control visits. Persecutory delusions and auditory hallucinations disappeared. Although rare, psychotic symptoms can be
seen in Huntington’s disease, resulting impair the patient’s compliance. Neuroleptic treatment will be required when psychotic symptoms
occur. However, atypical neuroleptic agents should be preferred and patient is frequently controlled since typical neuroleptic agents
aggravate dystonia and involuntary movements, which are secondary to Huntington’s disease.
Keywords: Huntington’s disease, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S176-S7
[PP-117] Childhood and adolescence disorders
Ref. No: 0299
Factors that influence approval to psychiatry clinics in early childhood:
669 cases in a community and clinical sample
Zehra Babadagi1, Koray Karabekiroglu1
Ondokuz Mayis University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun-Turkey
1
e-mail address: [email protected]
Objective: The importance of preventive mental health services in child psychiatry (esp. in the infant psychiatry) is better understood day
by day. Similar to whole world, in our country, the causes, prevalence and distribution of the psychiatric and developmental problems in
early childhood are not adequately investigated yet. In this study, we aimed to investigate the distribution and frequency of psychiatric
complaints and the factors that affect psychiatric approval in a clinical and community sample of 1-4 year of children.
Methods: The Clinical sample (n:207) and randomized and stratified community sample (n:462) are assessed in terms of presence and
frequency of psychiatric and developmental problems. All complaints are collected and classified into 20 groups of symptoms and
reassessed for absence or presence. Sociademographic Assessment Form, Child Behavior Checklist (CBCL) and Brief Infant andToddler
Social Emotional Assessment (BITSEA) are completed.
Results: In the community sample 37.7% of mothers and 27.5% of fathers replied as “Yes” to the item “Does your child have any psychiatric
and/or developmental problem?”. In the clinical sample the rate of “Yes” was found to be 95.2% for mothers. In the community sample,
in the decreasing order, most prevalent complaints were reported to be “sleep problems” (9.7%), “fears” (9.5%), “harm to others” (5.8%),
“language and speech problems” (5.0%). On the other hand, in the clinical sample most prevalent complaints were “language retardation”
(40.3%), “hyperactivity” (20.9%), “aggressive behaviors” (19.9%), “harm to others” (18.4%), “stubbornness” (16.0%). While there were no
statistical difference between clinical and community sample in terms of “fears”, “language problems”, “sleep problems”, “inpatience”,
“jealousy” and “poor attention”, all other 14 groups of symptoms were found to be significantly more in the clinical sample. Logistic
regression analysis to assess predictive factors of psychiatric approval revealed that some factors [esp, “male gender” (p<0.05), “denial
of orders” (p<0.01), “language retardation” (p<0.01), “aggresiveness” (p<0.01), and “hyperactivity” (p<0.01)] significantly predict the
psychiatric approval.
Conclusion: Previous studies1,2,3 report that 15-45% of the 1-4 year old children have psychiatric and/or neurodevelopmental problems
and only a small part of them are brougth to the psychiatry clinics. Our study reveal that mothers are more sensitive to these problems
and report more compared to fathers. On the other hand, some symptoms increase the possibility of approval. In addition, similar rates
of some symptoms between the community and clinical sample were interesting and need further investigation.
Keywords: xxxxxx xxxxxxx xxxxx
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[PP-118] Mood disorders
Ref. No: 0300
Dissociation and childhood trauma in patients with bipolar disorder
Atilla Tekin1, Esra Ozdil1, Mehmet Diyaddin Guleken1, Bahadir Bakim2, Omer Akil Ozer1, Oguz Karamustafalioglu3
Sisli Etfal Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
1
Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Psychiatry, Canakkale-Turkey
2
Uskudar University, NPI Hospital, Istanbul-Turkey
3
e-mail address: [email protected]
Objective: To determine the frequency of dissociation and childhood trauma among bipolar disorder and the effects of dissociation and
childhood trauma on the prognosis.
Method: This study comprises of a group of 51 people attending to Sisli Etfal Training and Research Hospital outpatients department
who had been diagnosed as bipolar disorder according to DSM-IV-TR and not in an episode of mania, depression or mixed state on the
assessment. The patients were recruited between March and December, 2012. SCID-I (The Structured Clinical Interview for DSM-IV Axis
I Disorders), SCID-D (The Structured Clinical Interview for DSM-IV Dissociative disorders), DES (Dissociative Experiences Scale ) and CTQ
(Childhood Trauma Questionnaire) were administered to all participants with a sociodemographic form.
Results: The mean DES score was 20.73±15.09 and the frequency of any dissociative disorder was 35.4% among patients with bipolar
disorder. The prevalence of dissociative disorders were as follows: 17.6% was depersonalization disorder, 7.8% was dissociative amnesia
and 5.8% was dissociative disorder not otherwise specified. Furthermore, 49% of patients has had a childhood trauma. Frequency of
more than two types of childhood trauma among the patient group was 31.3%. DES scores from patients with bipolar disorder had a
negative correlation with the number of years of formal education and age at onset of disease. DES scores had a positive correlation with
the number of suicide attempts (respectively p=0,016; 0,017; 0,043). Also in patients with bipolar disorder, CTQ total score had a negative
correlation with the number of years of formal education and the number of suicide attempts (respectively p=0,006; 0,038). Among the
bipolar patients, patients with high DES and CTQ total scores had earlier disease onset and more suicide attempts, and interestingly had
lower education level.
Conclusion: Findings of 35.4% of dissociation and 49% of childhood trauma in bipolar disorder patients are main evidences of this study.
Considering above findings, it can be saved that there is a positive correlation between existence of dissociation and childhood trauma
and a poor prognosis of bipolar disorder. Moreover, more severe cognitive impairment among those patients can be seen.
Co-existence of dissociation and childhood trauma with bipolar disorder is not rare and it can predict the prognosis of the disorder.
Studies with more participants will help us to understand the comorbidity of dissociative disorders and the role of childhood trauma in
patients with bipolar disorder.
Keywords: bipolar disorder, childhood trauma, dissociation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S178
[PP-119] Sleep
Ref. No: 0303
The relationship between sleep quality and nitric oxide in healthy volunteers
Abdullah Bolu1, Tuncer Ozkisa2, Mehmet Aydogan2, Seyid Ahmet Ay1, Suleyman Akarsu3, Ozcan Uzun3
Turkish Air Force Aircrew’s Health Research and Training Center, Eskisehir-Turkey
1
Gulhane Military, Faculty of Medicine, Department of Pulmonary Medicine, Ankara-Turkey
2
Gulhane Military, Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
3
e-mail address: [email protected]
Objective: Nitric oxide is a molecule which is synthesized by the oxidation of L-arginine and considered to be effective in the
pathophysiology of many diseases such as cardiovascular diseases. The aim of this study is to investigate the effect of expiratory nitric
oxide (FENO) levels on the quality of sleep and its relationship with smoking.
Method: Healthy volunteers participated in the study were divided into three groups. The first group consisted of 269 persons who are
non-smokers. The second group consisted of 59 volunteers who stopped smoking but smoked for a long time. The third group consisted
of 371 volunteers who are current smokers. The Quality of sleep in patients was measured by Pittsburgh sleep quality index, expiratory
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nitric oxide (FENO) levels were measured by chemiluminescence analyzer (Nioxin-MINO, Aerocrine AB, Stockholm, Sweden).
Results: FENO values of non-smoker group, ex-smoker group, and current smokers group were 24±9 ppb (parts per billion), 23±9 ppb,
and 19±8 ppb, respectively. FENO values between the groups were statistically different (p<0,05). There was a negative correlation
between FENO levels of population and Pittsburgh sleep quality index scores (r= 0.093). Pittsburgh sleep quality index scores of nonsmoker group, ex-smoker group, and current smokers group were 5.17±2.85, 4.68±2.50, and 4.38±2.68, respectively. Pittsburgh sleep
quality index scores between the groups were statistically different (p<0,05).
Conclusion: It is known that FENO values are low in patients with OSA and they are normalized after CPAP therapy. However, the
relationship between FENO and sleep quality is still not clear in healthy population. Can FENO be the indication of the sustainability of
a physiological process rather than a pathological process in sleep disorders? It is interesting that quality index scores of smokers were
lower than ex-smokers and nonsmokers group in the study.
Keywords: nitric oxide, quality, sleep
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S178-S9
[PP-120] Sleep
Ref. No: 0304
Factors affecting the quality of sleep in healthy population
Tuncer Ozkisa1, Abdullah Bolu2, Mehmet Aydogan1, Abdulvahhap Gazi Unlu3, Kamil Nahit Ozmenler3
Gulhane Military, Faculty of Medicine, Department of Pulmonary Medicine, Ankara-Turkey
1
Turkish Air Force Aircrew’s Health Research and Training Center, Eskisehir-Turkey
2
Gulhane Military, Faculty of Medicine, Department of Psychiatry, Ankara-Turkey
3
e-mail address: [email protected]
Objective: Good sleep quality is an important requirement for biological, psychological and social health. Sleep quality is affected by
many factors. The effects of many of the disease on sleep quality and possible negative factors have been studied so far. We aimed to
examine sleep quality in a large number of the healthy group, and explain the factors affecting the sleep quality in this study.
Method: Seven hundred and thirty healthy volunteers were included in this study. The Beck Depression Inventory, Beck Anxiety Inventory,
the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Score, pre-sleep arousal scale, Berlin questionnaire, and
sociodemographic data form were applied to each case. Linear regression analysis was performed to determine the effect of several
factors on sleep quality index scores.
Results: The average scores of the Beck Depression Inventory and the Beck Anxiety Inventory of patients, were 13:28±8:55 and
9.84±11:12, respectively. The average scores of Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Score were
6.78±4.73, 4.88±2.79 and 7.88±4.85, respectively. When the factors affecting the quality of sleep index scores (the Epworth Sleepiness
Scale, insomnia severity scale, pre-sleep arousal scale, Beck Depression Inventory, Beck Anxiety Inventory, body mass index, age) were
examined, it was seen that the scores of berlin questionnaire, Beck Depression Inventory scores were decisive in this regard.
Conclusion: As a result of various studies; pains, physical fatigue, smoking habits are shown to be effective on the quality of sleep. In
our study, depressive symptoms and OSAS-like pathologies were shown to be effective. Studies are needed to investigate the somatic
symptoms and social impacts as well.
Keywords: quality, sleep
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[PP-121] Childhood and adolescence disorders
Ref. No: 0307
Aripiprazole treatment combined with methylphenidate in a 46,XY, YQ+ case
with borderline mental capacity and multiple psychiatric disorders
Meryem Ozlem Kutuk1, Ferda Bacaksizlar Sari2, Ozgur Kutuk3, Umut Kaytanli4
Malatya State Hospital, Department of Child and Adolescent Psychiatry, Malatya-Turkey
1
Tarsus State Hospital, Department of Radiology, Mersin-Turkey
2
Inonu University, Department of Molecular Biology and Genetics, Malatya-Turkey
3
Private Practice, Child and Adolescent Psychiatry Clinic, Istanbul-Turkey
4
e-mail address: [email protected]
Mental retardation is diagnosed before age of 18 that includes below-average general intellectual function and a lack of the skills
necessary for daily living. It is also characterized with impairment of environmental adaptation and behaviors. Approximately, it affects
1-3 % of the general population. Studies have also shown a male preponderance for all types of mental retardation (MR) and males are
1.6-1.7 times more vulnerable as compared with females. Relative to the general population, people with MR are more likely to show
psychosis, autism and attention-disruptive disorders and less apt to be diagnosed with substance abuse and affective disorders. Rates of
Attention Deficit Hyperactivity Disorder (ADHD) range from 7% to 15% in children with MR. Behavioral problems are frequently detected
and communication disorders are seen nearly 50% of people with MR. No data so far about the rate of suicide attempts in this group have
been published.
Aripiprazole’s mechanism of action is different from the other FDA-approved atypical antipsychotics (e.g., clozapine, olanzapine,
quetiapine, ziprasidone, and risperidone). Rather than antagonizing the D2 receptor, aripiprazole acts as a D2 partial agonist. Aripiprazole
is also a partial agonist of 5-HT1A receptor and like the other atypical antipsychotics displays an antagonist profile of 5-HT2A receptor.
Aripiprazole is used increasingly for the treatment of ADHD, mood disorders, schizophrenia, conduct disorder, tic disorders, pervasive
developmental disorders and anxiety disorders at child and adolescent psychiatry clinics. Aripiprazole is thought to be useful for
psychiatric disorders affecting cognitive functions like ADHD because of its unique receptor binding profile. Aripiprazole has shown less
adverse effects compared with other typical and atypical antipsychotics. Studies pointed that it causes minimal sedation, lesser metabolic
side effects like weight gain and no alteration in prolactin serum levels.
Here, we present a male case with 46,XY, YQ+ with borderline mental capacity, ADHD, Oppositional Defiant Disorder, Phonological
Disorder and two suicide attempts while on the treatment with OROS methylphenidate at the dose of 18 mg/day. He was obese and
had bilateral gynecomastia and some genetic stigmas like brachydactyly, clinodactyly, synophrys and low frontal hairline. He had used
risperidone, haloperidole and quetiapine intermittently combined with methylphenidate since he was 5 because of his temper tantrums,
impulsivity and stereotypic hand movements. All of these medications caused him weight gain and sedation during daytime; thereby his
family discontinued these treatments due to these side effects. Of note, he has used methylphenidate for ADHD and found it useful for
his attention at the school. We prescribed aripiprazole 5 mg/day treatment adjunctive to methylphenidate to control his temper tantrums,
impulsivity and other behavioral problems. After starting aripiprazole he did not gain weight and feel sleepy at school. Moreover, his
cognitive functions, social relationships and temper management were better than before as defined during routine controls at our clinic.
His hand movements were not altered.
In conclusion, it is likely that aripiprazole will be used in child and adolescent psychiatry clinics for many of the same target symptoms
described earlier for risperidone.
Keywords: ADHD, aripiprazole, child and adolescent psychiatry
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[PP-122] Psychopharmacology
Ref. No: 0308
Bilateral pedal edema with olanzapine treatment: a case report
Hamiyet Ipek Toz1, Sakir Ozen2, Dilek Meltem Tasdemir2, Urun Ozer2, Bahtiyar Toz3, Guliz Ozgen2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, 6th Psychiatry Unite, Istanbul-Turkey
2
Istanbul University, Istanbul University School of Medicine, Department of Internal Medicine, Istanbul-Turkey
3
e-mail address: [email protected]
Edema is defined as a clinically apparent increase in the interstitial volume. Peripheric edema could be caused by various
medical conditions, such as obstruction of venous or lymphatic drainage, congestive heart failure, nephrotic syndrome and other
hypoalbuminemic states, cirrhosis and medication. Common pharmacologic agents known to cause edema are antihypertensives,
nonsteroidal antiinflamatory drugs, endocrine agents and immunotherapies. Olanzapine is an atypical antipsychotic that is widely
prescribed for the treatment of schizophrenia and bipolar affective disorder. Most common adverse reactions of olanzapine are weight
gain, postural hypotension, constipation, dizziness, akathisia, sedation. According to premarketing trials, peripheral edema was reported
as an infrequent side effect, which affected 3% of the olanzapine treated patients. In this report, we aim to draw attention of psychiatrists
on this rare adverse effect.
A 56-year-old single, college educated male, was presented to our hospital with severe depressive symptoms for four months and
obsessive-compulsive symptoms comorbid with hypochondriac concerns for two years. He was hospitalized to inpatient unit because of
suicide risk on the same day. Before psychiatric admission, he wasn’t taking any medication. He was diagnosed as major depression with
psychotic features and obsessive-compulsive disorder with poor insight. He was started on olanzapine 10 mg/day, quetiapine 300 mg/day
and fluoxetine 40 mg/day. Two weeks after initiation of olanzapine, he was found to have bilateral pedal edema without ulceration and
temperature change but minimal redness was observed. He had no history suggestive of cardiac, renal and liver dysfunction or allergic
reaction against to any drug that could explain his existing edema. Possible medical conditions which may cause edema were ruled out
by laboratory tests and physical examination. Olanzapine was stopped immediately and the therapy was modified to risperidone 1 mg/
day. Informed consent was obtained from the patient for this case report.
After discontinuation of olanzapine, edema was gradually resolved within two weeks. Because olanzapine associated edema has been
seen rarely, it could be overlooked by psychiatrists in comparison to its more common side effects. Although it shows self-limited and
benign course, patients may feel discomfort and their compliance to treatment may decrease. Also, it may interfere with differential
diagnosis of other medical conditions which may cause edema. In conclusion, we suggest that patients should be observed carefully in
terms of edema during olanzapine treatment.
Keywords: olanzapine, peripheral edema, side effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S181
[PP-123] Psychopharmacology
Ref. No: 0309
Perspectives of residents on psychiatric drugs
Safak Eray, Merve Colpan, Ayse Pinar Vural
Uludag University, Faculty of Medicine, Bursa-Turkey
e-mail address: [email protected]
Objective: In this study, the knowledge and attitudes of the resident about psychiatric drugs were aimed to investigate.
Methods: The survey study included 100 residents who were receiving specialization training in Uludag University Faculty of Medicine.
Participants completed a questionnaire containing 17 true–false items about psychiatry and psychopharmacology.
Results: According to the results of the questionnaire survey, 58% of participating residents who stated that psychiatric diseases can be
treated with medications. 40% of the participants thought that antidepressant drugs had dependency potential, 42% of them indicated
that antidepressants cause attention deficit, and concentration loss in patients. 32% of the physicians thought that antidepressant drugs
makes an artificial happiness and effective in people without depression and 27% of them conceive that taking an antidepressant drug at
the time of acute distress, effects immediately and reduce anxiety and depression. More than fifty percent of the survey participants (58%)
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stated that antiepileptic drugs just used for reducing comorbid epileptic attacks in psychiatry clinic and %27 of the physicians thought
that mood stabilizers (lithium) is used for balancing reduced lithium in human body.
Conclusion: In our study, it has seen that the mistaken belief about psychopharmacology which comes up frequently in the media is
widespread among physicians. Based on these findings, it has seen that firstly psychiatrists and all physicians has important role in the
treatment of psychiatric disorders, which is often, require long-term medication.
Consequently outcomes of our study seem to emphasize activities performed so as to provide recognition of pharmacotherapy in
psychiatry by the physicians of other disciplines and patients.
Keywords: psychopharmacology, psychiatric disorders, psychiatric drugs
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S181-S2
[PP-124] Psychopharmacology
Ref. No: 0313
Dystonia due to sertraline use: a case report
Alper Ozcan1, Merve Cikili Uytun2, Salih Uytun1, Gamze Poyrazoglu1, Ayse Betul Ergul1, Yasemin Altuner Torun1
Research and Education Hospital, Department of Pediatrics, Kayseri-Turkey
1
Erciyes University, Department of Child and Adolescent Psychiatry, Kayseri-Turkey
2
e-mail address: [email protected]
Case: A 17-years old girl presented to emergency department with spasm at neck and upwards shifting in her eyes. The patient who
presented to emergency department later in the evening at the same day was given 0.04 mg/kg biperiden and admitted to hospital
for further follow-up. In her detailed anamnesis, it was found she had been using sertraline over one year with a diagnosis of major
depression. She reported that she had taken four pills including 50 mg sertraline 2 days before presentation, as she felt bad. During followup, biperiden administration was repeated as the spasm at neck and shifting in eyes were recurred; after biperiden administration, it was
observed that contraction was regressed. It was recommended to maintain current therapy. The patient with a good health status who
had no dystonia during follow-up was discharged by the recommendation of follow-up in pediatric psychiatry.
Discussion: Movement disorder due to use of selective serotonin reuptake inhibitor is a rare adverse event. It occurs lower than 1 per
1000 patients using SSRI. Dystonic reactions related to antidepressants can onset within hours to several weeks after dose escalation.
Antidepressant-related EPS adverse events aren’t dose depended and can occur by both short- and long-term use. There was a long-term
antidepressant use in our patient. The dystonia developed 2 days after acute dose escalation. Dystonia was manifested as oculogyric crisis
and spasm at neck. Given the patient had no comorbid disease and normal laboratory evaluations, it was suggested that the condition
was related to drug use. We presented this case as it is rarely encountered in the literature.
Keywords: dystonia, sertraline
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S182
[PP-125] Psychopharmacology
Ref. No: 0315
Evaluation of antipsychotic treatment in pediatric OCD cases
Adem Gunes, Ayse Kilincaslan, Suleyman Salih Zoroglu
Istanbul University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: To evaluate indications and effectiveness of antipsychotic use in pediatric obsessive compulsive disorder (OCD) patients and
the relation between the treatment response and characteristics of the disorder.
Method: Fifteen patients between the ages of 12 and 17, who were followed for at least 1 year in our department with the diagnosis of
OCD and received antipsychotic treatment, were evaluated retrospectively. Patients with pervasive developmental disorders and mental
retardation were excluded. The response to treatment was evaluated with Clinical Global Impression (CGI) scale. The symptomatology,
age of onset, comorbid conditions and psychiatric history of the patients were also examined.
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Results: Mean age at the admission was 12.03±2.63 years and follow-up period was 2.8±2.14 years. Four of the patients were receiving
antipsychotics primarily due to co-morbid conditions (2 tic disorder, 1 anorexia nervosa, 1 conduct disorder) and 11 of them used them
for augmentation. The obsessional symptoms were contamination (n=11), religious (n=8), symmetry- order (n=6), sexual (n=4) and
aggression (n=3) related obsessions. Compulsions were repetition (n=13), clearance (n=12), sorting/organizing (n=4) and counting
compulsions (n=1). All but three patients had comorbid diseases, which were attention deficit/hyperactivity disorder (n=5), anxiety
disorders (n=4), tic disorder (n=2), major depression (n=2), conduct disorder (n=1), anorexia nervosa (n=1) and stereotypic movement
disorder (n=1). Eight and two patients had familial history of OCD and tic disorder, respectively. The average severity of the disorder (CGIS) in the initial evaluation was 4.27±0.77. After treatment with a SSRI, CGI improvement scores (CGI-I) were 3.47±0.51, and after adding
an antipsychotic mean CGI-I was 2.6±0.98. Nine patients had significant improvement (CGI-I<=2) for OCD symptoms with antipsychotics;
7 of them were using it for augmentation and 2 of them for the comorbid disorder. During the initial assessments 4 patients were
considered as being in the prodromal period of psychosis but following examinations revealed that they had OCD with poor insight.
Aripiprazole (n=9), risperidone (n=7), quetiapine (n=1) and olanzapine (n=1) were used for the antipsychotic treatment. The clinically
improved patients with antipsychotic medication (CI group, n=9) did not differ statistically from the non-improved patients (NCI group,
n=6) with respect to age of onset, type of the OCD symptoms and pretreatment CGI-S scores. There was statistically near significance
(p=0.054) between two groups for the follow up period and it was longer in the CI group. The CGI-I with SSRI was correlated with CGI-I
with antipsychotic treatment (r=.721, p=0.002). Six of the 7 patients who had family history of OCD and 3 of the 8 patients who did not
have family history of OCD had clinically significant improvement with antipsychotics but this data did not have statistical significance.
Conclusion: In this retrospective study we found that the patients who received antipsychotic treatment for OCD due to lack of adequate
response to SSRI treatment or comorbidity had significant response to antipsychotics.
Keywords: antipsychotics, augmentation, pediatric obsesive compulsive disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S182-S3
[PP-126] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0317
Family treatment in child and adolescents with bipolar disorder: two case samples
Dilay Karaarslan1, Neslihan Inal Emiroglu1, David J. Miklowitz2
Dokuz Eylul University, School of Medicine, Department of Child Psychiatry, Izmir-Turkey
1
UCLA Semel Institute for Neuroscience and Human Behavior Division of Child and Adolescent Psychiatry, Los Angeles-United States
2
e-mail address: [email protected]
Bipolar disorder has a chronic course and causes functional impairment and decreased quality of life. Several studies have been
conducted focusing on holistic, biopsychosocial approaches to the treatment of children and adolescents. Psychosocial treatments for
children and adolescents with bipolar disorder focus on decreasing affective morbidity, achieving functional recovery and enhancing
the ability to regulation emotions when faced with environmental stressors, including those within the family context. One of these
approaches, Family Focused Treatment (FFT) was developed in the US and was recently adapted in Turkey for use with adolescents with
bipolar disorder. It is composed of three parts: psychoeducation, communication enhancement training, and problem-solving skills
training. We discuss two FFT cases that had been treated within an open trial in our outpatient unit. An upcoming randomized trial of FFT
will test the generalizability of this approach across cultural contexts.
Keywords: adolescent, bipolar disorder, family
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S183
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Poster Presentations
[PP-127] Psychopharmacology
Ref. No: 0318
Aripiprazole induced hypertension: a case report
Gokben Hizli Sayar, Eylem Ozten, Gul Eryilmaz, Isil Gogcegoz Gul, Husnu Erkmen
Uskudar University, NPIstanbul Hospital, Istanbul-Turkey
e-mail address: [email protected]
Hypotension is a known effect of atypical antipsychotics. However, there is little information on acute hypertension resulting from
antipsychotic drugs. Aripiprazole is a potent partial dopamine D2 agonist, a serotonin 5-HT1A agonist and a 5-HT2A antagonist. It also
displays high affinity for the α-1B, -2A, -2C and β1, -2 adrenergic receptors. Many studies underline the role of α-1A adrenergic receptors
in malignant hypertension. Here we present a case of a 38-years old male patient with psychotic depression. Aripiprazole was initiated
at 10 mg/d and 36 hours after the first dose the patient complained of headache and palpitation. His physical examination revealed that
he developed a hypertensive crisis with arterial hypertension (170/95 mmHg) and tachycardia (118 beats/minute). His blood pressure
returned to normal 3 days after the interruption of aripiprazole. Although the mechanism underlying the rise in blood pressure remains
unclear, careful monitoring of blood pressure variations when administering aripiprazole to patients previously treated for high blood
pressure is necessary.
Keywords: aripiprazole, hypertension
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S184
[PP-128] Nonpharmacological biological therapies
Ref. No: 0319
A retrospective review assessing the safety of transcranial direct current
stimulation (tDCS) as a method of non-invasive brain stimulation in psychiatry
Gul Eryilmaz, Gokben Hizli Sayar, Baris Onen Unsalver, Isil Gogcegoz Gul, Eylem Ozten, Esra Saglam
Uskudar University, NPIstanbul Hospital, Istanbul-Turkey
e-mail address: [email protected]
Transcranial direct stimulation is a noninvasive brain stimulation method. Although exact mechanism is not known; depolarization and
increase in spontaneous neuronal activity in the cell membrane occurs by anodal stimulation; decrease in neuronal activity occurs by
cathode stimulation. In this study, files of the hospitalized and outpatient patients on whom transcranial direct stimulation was performed
in a psychiatry hospital between December 2011 and September 2012 were evaluated. The mean age of the patients was 45,7 years. 14
of the cases were males (48,3%) and 15 were (51,7%) females. The mean duration of disease history was 7,8 years. Diagnostic distribution
was as follows; major depressive episode (n=8 cases); dementia comorbid with depression (n=5); bipolar affective disorder-depressive
episode (n=5); panic disorder (n=4); bipolar affective disorder -hypomanic episode (n=3); obsessive compulsive disorder comorbid with
depression (n=2); alcohol addiction comorbid with depression with psychotic features (n=1). Response to treatment with tDCS was
evaluated with brief psychiatric rating scale in all patients. Hamilton depression rating scale (HAM-D) was used for the evaluation of those
patients with depression in addition to BPRS. A paired-samples t test was performed to evaluate the effectiveness of tDCS yielding a
significant decrease in post treatment BPRS scores (p= .001) and HAM-D scores (p=.003). Patients were also receiving pharmacotherapy
and psychotherapy which might have been responsible for the clinical improvement, however the aim of this study is not to evaluate
clinical efficacy. Generally, transcranial direct stimulation is considered an option in cases in whom additional brain stimulation treatments
such as electroconvulsive therapy is needed but at the same risky for the patient or in cases unresponsive to these therapies.
Keywords: transcranial direct current stimulation, side effect, safety
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S184
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[PP-129] Psychiatric genetics
Ref. No: 0320
The relationship between Cathecol-O-Methyltransferase enzyme Val158Met
polymorphism and premorbid cannabis use in male patients with schizophrenia
Aysegul Ermis1, Ayse Solmaz Turkcan2, Selcuk Dasdemir3, Bedia Cakmakoglu3
Esenyurt State Hospital, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
2
Istanbul University, Institute for Experimental Medicine Research (DETAE) Department of Molecular Medicine, Istanbul-Turkey
3
e-mail address: [email protected]
Objective: Schizophrenia is a one of multifactorial and complex disorders that arise from a combination of genetic and environmental
factors. It has been well known that cannabis use is one of the environmental factors that increase the risk of psychotic disorder in
individuals whom predisposed. Cathecol-O-Methyltransferase (COMT) enzyme plays an important role in dopamine metabolism. The
functional polymorphism that causes a substation of Val by Met at codon 158 of the COMT protein has been shown in many studies to
predispose the schizophrenia. In this study our aim was to investigate whether there is an interaction between premorbid cannabis use
and COMT Val158Met polymorphism in the etiology of schizophrenia.
Method: Male schizophrenic patients with history of premorbid cannabis use (n=36) and non users (n=38) who had been followed in our
service were recruited for the study. Clinical diagnoses were determined by SCID-I (The Structured Clinical Interview for DSM-IV-I). Patients
were evaluated by sociodemographic form, PANSS (Positive and Negative Syndrome Scale), Calgary (The Calgary Depression Scale for
Schizophrenia) and COMT enzyme Val158Met polymorphisms were defined from the isolated DNA of the patients by Polymerase Chain
Reaction (PCR) and restriction Fragment Length Polymorphism (RFLP) analyses, as defined in literature.
Results: The main finding of the study was the statistically significant interaction with the carriers of COMT Val158Met Val/Val genotype
(%88.9) and premorbid cannabis use in the etiology of schizophrenia. Val/Met+Met/Met carriers were less likely to develop schizophrenia
with premorbid cannabis use. Schizophrenic patients with Val/Val genotype had statistically significant higher PANSS total scores than
patients with Val/Met+Met/Met genotype and with Calgary as well.
Conclusion: The findings from this study confirm the association between COMT Val158 Met polymorphism and premorbid cannabis use
in the cause of schizophrenia. Gene-environment interaction in terms of COMT Val158Met polymorphism and premorbid cannabis use
plays an important role in schizophrenia and genetic polymorphism influences some clinical features as well.
Keywords: schizophrenia, Cathecol-O-Methyltransferase, Val158Met, cannabis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S185
[PP-130] Psychopharmacology
Ref. No: 0323
Priapism-like erection during the treatment with risperidone: a case with childhood
dissociative disorder
Halil Kara, Miray Cetinkaya, Mehmet Sahin, Ozge Demircan Tulaci, Ayse Nihal Eraslan, Burcu Ersoz Alan, Sahin Bodur
Dr. Sami Ulus Children’s Hospital, Department of Child And Adolescents Psychiatry, Ankara-Turkey
e-mail address: [email protected]
The case of longer lasting erections like priapism, which has come out with treatment of risperidone 2 mg/day in 12-year-old male patient
with a diagnosis of dissociative disorder, is referred. The use of atypical antipsychotics in children and adolescents is becoming widespread
in recent years. In our case, it is related to priapism dose and has emerged over time. In our case, prolonged erection like priapism has not
come out with risperidone treatment 1mg/day whereas it has emerged with risperidone treatment 2mg/day.
Additionally, the situation of priapism in children and adolescents is emphasized that constitute sexual problems in adulthood. Priapismlike situation are underdiagnosed drug side effects in children and adolescents. The affinities which antipsychotics react to alpha-1
adrenoceptor are different from each other. Risperidone has high affinity to alpha-1-receptor.
Keywords: priapism, erection, risperidone
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S185
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[PP-131] Schizophrenia and other psychotic disorders
Ref. No: 0324
Arachnoid cyst in two patients with first episode psychosis: case reports
Merve Babalioglu, Ayse Fulya Maner, Zekiye Ozlem Cetinkaya, Soner Alici
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, 4th Psychiatry Clinic, Istanbul-Turkey
e-mail address: [email protected]
The etiology of psychosis varies; it may be due to a functional or an organic condition. Psychosis in an organic basis can be caused
by space occupying lesions in CNS, endocrine reasons, nutritional deficiencies, infections and substance and/or alcohol abuse and
dependence. Arachnoid cysts are rare space occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid. They
are congenital, mostly asymptomatic and diagnosed accidentally by neuroimaging. Recently the coexistence of arachnoid cysts with
psychosis has captured the popular attention about possible relevancy. In our case report, we present two patients with first episode
psychosis who have never sought a psychiatric consult before. Case 1 is a 36 years old male who presented with delusions of persecution
and reference about his family and resulting aggressiveness towards them. In magnetic resonance imaging of his central nervous system,
there was an arachnoid cyst in anterior pole of right temporal lobe about 2.5x4.5 cm in size. Case 2 is a 52 years old male who presented
with intense delusion of jealousy about his wife. In magnetic resonance imaging of his central nervous system, the was an arachnoid cyst
in the posterior of the midline of the posterior cranial fossa about 3x4.5 cm in size. Both cases revealed no pathologic neurological signs.
The MRI of the both cases are consulted with neurosurgery, no surgical intervention was needed. In this study, we discuss the treatment
to these cases and the relevancy of arachnoid cysts with first episode psychosis.
Keywords: psychosis, arachnoid cyst, neuroimaging
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S186
[PP-132] Psychosocial and other nonbiological therapies and interventions
Ref. No: 0325
Factorial structure and reliability of Bakırköy opioid withdrawal scale
among heroin dependent patients
Cuneyt Evren, Vahap Karabulut, Yesim Can, Muge Bozkurt
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Research, Treatment and Training Center for Alcohol and
Substance Dependence (AMATEM), Istanbul-Turkey
e-mail address: [email protected]
Objective: Measuring the presence and the severity of opioid withdrawal is important for both making the dependency diagnosis,
deciding the dose of the medicine that is going to be use and to follow detoxification process. Since buprenorphine /naloxone
combination was introduced for treatment, it is even more important to evaluate severity of withdrawal with a scale, because patient has
to show withdrawal symptoms to start the medicine.
Bakırkoy Opioid Withdrawal Scale (BOWS) is a clinician rated scale that has been used since 1995 in Bakırkoy AMATEM. BOWS includes 13 symptoms
of opioid withdrawal and simply rated as present or absent. Thus the total score of the scale is 13 which shows the most severe withdrawal.
The psychometric properties of the BOWS, developed to screen severity of opioid withdrawal symptoms among Turkish patients with
heroin dependency.
Method: The data were gathered from the Bakırkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery Istanbul.
Total of 392 heroin dependent patients (105 inpatient and 287 outpatients) entered to buprenorphine /naloxone maintenance treatment
were randomized taken from the Alcohol and Drug Research Training and Treatment Center (AMATEM).
Results: To explore the factorial structure of the BOWS, a principal component analysis (PCA) was performed using all participants (N=392).
Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. Criteria for retaining extracted
components on the PCA were: (a) visual inspection of the scree plot to note breaks in size of Eigenvalues between the components, (b)
Eigenvalues greater than one, and (c) percentage of variance accounted for by components retained.
A visual inspection of the scree plot revealed two components accounting for the majority of variance before components started to level
off. Two components on the BOWS reached the criterion of an Eigenvalue greater than one (3.98 and 1.40) and the variance accounted for
by these components were 30.61% and 10.76% respectively.
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Analyses for the factor structure of the BOWS suggests that it has a 2-factor structure accounting for 41.37% of the variance; the first factor
consisted of general withdrawal symptoms (Dysphoric mood, Muscle aches, Lacrimation, Rhinorrhea, Dilated pupils, Piloerection, Sweating,
Excessive yawning, Fever) and the second factor consisted of gastro intestinal symptoms (Nausea, Vomiting, Stomachache, Diarrhea).
All item-component loadings were in the “good” to “excellent” range. Thus, results from the PCA suggest that the BOWS assesses a two
dimensional construct.
Internal consistency reliability for the BOWS, examined by Cronbach’s alpha, was also very high (coefficient α=0.805).
Conclusion: The BOWS was developed to classified individuals on a continuum from low to high withdrawal severity among individuals
in clinical settings who are likely to meet criteria for a opioid use disorder. Overall, the BOWS was found to have satisfactory psychometric
characteristics as an opioid withdrawal scale. The BOWS had high internal consistency reliability (0.81).
In conclusion, the present support the use of the BOWS in clinical settings and encourage continued research into its use in Turkey.
Keywords: opioid, withdrawal, scale
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S186-S7
[PP-133] Psychopharmacology
Ref. No: 0328
Phantom limb pain treatment with duloxetine:a case report
Mihriban Dalkiran Varkal1, Senol Turan2, Besir Dikmen3
Necip Fazil City Hospital of Kahramanmaras, Department of Psychiatry, Kahramanmaras-Turkiye
1
Istanbul University, Medical School of Cerrahpasa, Department of Psychiatry, Istanbul-Turkiye
2
Necip Fazil City Hospital of Kahramanmaras, Department of Ortopedics, Kahramanmaras-Turkiye
3
e-mail address: [email protected]
Case: A 19-year-old male who was referred to our clinic from orthopedics department with a complaint of PLP has applied to our
outpatient clinic, 2 months after a below-the-knee amputation without prior psychiatric history. He described a sensation of shooting
pain and itching in his right foot and toe. He initially rated the PLP a 9 on the visual analog scale (VAS) of 0 to 10. His pain was worse in the
evenings and sometimes disrupted his sleep. He didn’t suffered from depression as decided clinically, except loss of appetite examination.
Although he was very angry with the driver who had crushed him while he was riding motorcycle, and was ruminating about revenge all
day. He said that occasionally he couldn’t get calm without self-mutilation.
He was started on duloxetine 30 mg/day for his pain, and olanzapine 2,5 mg/day for his self-mutilating behavior. Fifteen days after initial,
he scored 4 on VAS, his appetite and sleep was better. Self-mutilation was decreased but he was still suffering from feeling anger almost
all day. The treatment has been re-arranged as duloxetine 30mg/day and risperidone 1 mg/day while olanzapine was quitted. A month
later, he reported feeling very well and he scored 1 on VAS.
However, in the third month, recurrence of PLP was detected because of not taking the drugs because of feeling very well. Due to
particular complaint was pain, he was started on only duloxetine and he is uneventful while under the duloxetine treatment since two
months.
Discussion: Various therapeutic approaches have been used in the treatment for PLP and TCAs have been used with some success. The
serotonin-norepinephrine reuptake inhibitors (SNRIs) are popular for neuropathic pain, migraines, and fibromyalgia due to fewer side
effects and efficacy.
In literature there are case reports of successful use with milnacipran and mirtazapine in PLP. Additionally there is a case report of
duloxetine and pregabalin combination. This is the first report of duloxetine being successfully used as monotherapy in PLP. We propose
that duloxetine could have beneficial effects in treating PLP.
Keywords: duloxetine, phantom limb pain
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S187
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[PP-134] Eating disorders
Ref. No: 0330
Night eating syndrome: report of a family case
Guzin Mukaddes Sevincer
Istanbul Gelisim University, Department of Psychology, Istanbul-Turkey
e-mail address: [email protected]
Objective: Night eating syndrome is characterized by evening overeating (hyperphagia) and/or nocturnal awakenings with ingestion of
food conceptualized as a delay in the circadian pattern of food intake. In this syndrome morning anorexia, insomnia, depressed mood
that worsens in the evening are also observed. Although the etiology of NES is unknown; it’s thought that genetic factors may involve.
However, a small number of study is conducted about this subject. A first step in understanding potential genetic and environmental
influences is a study of familial aggregation. It is aimed to show the existence and importance of genetic inheritance factors involved in
the etiology of the NES reported by a case of familial aggregation of NES.
Method: Three individuals from same family who referred to a psychiatry clinic are diagnosed with NES by psychiatrists with clinical
examination and scales. As remarkable findings on this case are discovered, first degree relatives of this family are invited for an interview.
The family tree (pedigree) below is generated by psychiatric diagnose records of participant family members and the information
obtained from them about the other family members. The doubtful information obtained from family members are ignored, definite
diagnosis by a psychiatrist is recorded with the confirmation of participant family members.
Pedigree: Family members with or without NES or with other psychiatric disorders are shown below according to this method.
Discussion: A family study conducted by Lundgren et al. found the risk of NES is five times greater in relatives of individuals with NES
than in unaffected individuals. Similar findings of Lamerz et al. study showed that risk for NES among children of mothers with NES is 7.8
times greater than among children of mothers without NES. Also a twin study reported moderate heritability for both males and females.
Our family case report provides suggestive evidence that a familial hereditary transmission may play a role in the development of NES.
Like other eating disorders, NES is comorbid with psychiatric disorders. It’s remarkable that we found high co-existence of mood disorders
such as depression, dysthymia, bipolar disorder with NES in the family case that we reported. The association of bipolar disorder with
other eating disorders as bulimia nervosa, binge eating and also with NES is not clearly known. More studies on this subject will contribute
to a better understanding etiology of NES. This study was limited for certain inferences in the following ways, first the diagnoses are made
from the family history method, rather than the family interview method, second the familial hereditary transmission is also observed in
other psychiatric disorders.
Results: This case report provided that NES is an entity that should be cautiously consider in psychiatry practice when the heritability,
frequency, the association with other psychiatric disorders are kept in mind. It is obvious that genotype studies concerning the
chronobiology that can be involve disorders such as sleep, eating and mood disorders will contribute to better understanding of etiology
of NES and other psychiatric disorders.
Keywords: familial aggregation, genetic, night eating syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S188
[PP-135] Anxiety disorders
Ref. No: 0331
Comorbidity between anxiety and somatic disorders in children and adolescents:
Tunisian study
Adel Walha, Imen Hadjkacem, Mariem Turki, Sonia Jalouli, Leila Cherif, Khaoula Khemakhem, Yousr Moalla, Hela Ayadi, Farhat Ghribi
Child Psychiatry, Department of Sfax, Tunisia
e-mail address: [email protected]
Objective: The objective of our survey was to study the comorbidity between somatic disorders and anxiety disorders in children and
adolescents.
Materials and Methods: We conducted a descriptive and retrospective study of 97 cases of children and adolescents who were consulted
the child psychiatry department of Sfax, during the years 2007 and 2008. They were diagnosed for anxiety disorders (Axis I of DSM-IV TR).
We studied the somatic comorbid anxiety disorders and their types among the different anxiety disorders.
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Poster Presentations
Results: Somatic comorbidity was noted in 15.5% of cases: Epilepsy was noted in 3% of cases, severe refractive disorder in 2% of cases,
bilateral deafness in 1% of cases, ulcerative colitis in 1% of cases and asthma in 1% of cases. The comorbidity was noted with generalized
anxiety disorder in 16.66% of cases, with separation anxiety disorder in 11.1% of cases and with specific phobia in 4.8% of cases.
Conclusion: This study shows that comorbidity between somatic and anxiety disorders is quite common in children and adolescents,
which compels an early detection because this association interferes with the treatment of anxiety disorders.
Keywords: comorbidity, anxiety, somatic disorders
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S188-S9
[PP-136] Clinical psychiatry
Ref. No: 0332
The predictive values of neuropsychological performance on antidepressant
response in three subtypes of major depression: a 6-week longitudinal study
Kangguang Lin1, Guiyun Xu2, Weicong Lu2, Huiyi Ouyang2, Yamei Dang2, Urbano Lorenzo Seva3, Yangbo Guo2, Kwok Fai So4, Tatia M. C. Lee5
1
The University of Hong Kong, Laboratory of Neuropsychology, Hong Kong-China; The University of Hong Kong, Laboratory of Cognitive Affective Neuroscience,
Hong Kong-China; Guangzhou Psychiatric Hospital, Department of Psychiatry, 36 Mingxin Load, Fangcun District, Affiliated Hospital of Guangzhou Medical University,
Guangzhou, Guangdong Province 510370, China
Guangzhou Psychiatric Hospital, Department of Psychiatry, 36 Mingxin Load, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangzhou,
2
Guangdong Province 510370, China
Rovira i Virgili University, Research Centre for Behavioral Assessment, Department of Psychology, Tarragona-Spain
3
4
The University of Hong Kong, Department of Anatomy, Hong Kong SAR, PR China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong
Kong, Hong Kong-China; GMH Institute of CNS Regeneration, Jinan University, Guangzhou-China
5
The University of Hong Kong, Laboratory of Neuropsychology, Hong Kong-China; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong
Kong-China; Institute of Clinical Neuropsychology, The University of Hong Kong, Hong Kong-China
e-mail address: [email protected]
Objective: Several studies showed that neuropsychological performance might service as predictor of antidepressant response, but
other studies did not. A main contributing factor for the inconsistency could be the heterogeneous samples in terms of different
clinical depressive subtypes that have preferential response to antidepressants; in this study, we attempted to assess the predictive
values of domains of cognitive function on antidepressant response in three depressive subtypes including melancholic, atypical and
undifferentiated depression (defined as have neither melancholic nor atypical features). Additionally, we generated multiple regression
models in order to evaluate the impacts of illness course factors (e.g. age of onset, number of episodes, and depressive symptoms) on
neuropsychological performance.
Method: The study was a 6-week prospective, longitudinal, semi-naturalistic design. The sample comprised of 142 melancholic, 76
atypical, and 91 undifferentiated depression according to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition
(DSM-IV_TR). A comprehensive battery of neuropsychological tests was administered to all participants, assessing seven cognitive
domains, including processing speed, attention, shifting, planning, verbal fluency, and verbal and visual spatial memory. Given the fact
that the potential predictors of cognitive measures and clinical variables are highly correlated, in the regression model we calculated the
relative weighs (RW) instead of relative importance (RI); the former could be interpreted as estimates of RI of the original set of predictors
but are not correlated. We considered the neuropsychological measures at the baseline as potential predictors while improvement in
HAM-D scores after six weeks of treatments was the dependent variable in our regression models; the HAM-D scores at the baseline was
controlled for due to its well-known impacts on treatment outcome.
Results: The three regression models (each for a subtype) explained a significant proportion of variance of the criterion (for atypical
depression: R2=0.564, F=4.00, p=0.001; for melancholic depression: R2=0.376, F=4.66, p<0.001; for undifferentiated depression: R2=0.597,
F=7.96, p<0.001). We then computed the RW, and the corresponding significance tests. However, only the depressive symptoms at
baseline (i.e., HAM-D scores) had a significant contribution in the prediction of antidepressants response (HAM-D scores improvement).
We once recomputed the three regression analyses removing the depression at baseline (i.e., HAM-D scores). However, none of the three
models managed to explain a significant proportion of variance of the criterion (i.e., significant tests suggested that R2 was zero in the
population).
Among the tested clinical variable—age at onset, duration, number of episodes, HAM-A, HAM-D, YMRS, psychotic symptoms and years
of education—, only age at onset demonstrated a predictive power in the domain of processing speed (measured by symbol coding of
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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Poster Presentations
WAIS-RC) in atypical depression (R2=0.447, p<0.001; RW=26.0, p=0.01).
Conclusion: our data do not lead support, at least at the practical level, to the notion that neuropsychological performance be able to
predict antidepressant treatment outcome. Apart from age at onset, we did not find significant impacts of the illness course variables on
neuropsychological performance in the three subtypes of major depression.
Keywords: neuropsychological performance, antidepressant response, major depression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S189-S90
[PP-137] Childhood and adolescence disorders
Ref. No: 0333
The side effect profiles and efficacy of aripiprazole in patients with autism spectrum disorder
Zafer Gules, Hatice Aksu, Sibelnur Avcil, Borte Gurbuz Ozgur
Adnan Menderes University, Department of Child and Adolescent Psychiatry, Aydin-Turkey
e-mail address: [email protected]
Objective: Approximately 20% of patients with Autism Spectrum Disorder (ASD) display from moderate to severe levels of aggression,
anger outbursts and self-injurious behavior. Evidence from randomized controlled trials suggests that aripiprazole can be effective in
treating irritability and other disruptive behaviors in children with ASD. In this study we evaluated 12 of patients following-up in our clinic
with a diagnosis of ASD and using aripiprazole in terms of efficacy and side-effect profile.
Method: The files of 12 of patients who were diagnosed with ASD and using aripiprazole were analyzed retrospectively. The Clinical
Global Impression Severity Scale (CGI-S) was used to evaluate the level of illness before the aripiprazole treatment and after changes in
terms of the aggression, anger outbursts, and self-injurious behavior in the clinical observation.
Results: The patients were between the ages of 5 to 17-year-olds, whom of 10 boys and 2 girls. Mean treatment period was 14.1 months
(7-26 months) and the average used aripiprazole dose was 7.2 mg/day (4-15mg/day). The mean CGI severity of the disease before
treatment was 6 (severely ill), and the mean CGI improvement scale after treatment was 2 (quite improved). Alongside with the drug
therapy all patients were getting special education at the same time. Weight gain was appeared in 2 of 12 (16.6%) patients, and the tremor
appeared in 1 (8.3%). But these side effects weren’t at the level to cause discontinuation of treatment; furthermore they didn’t effect the
functionality of patients significantly.
Conclusion: The studies about the pharmacologic treatment of ASD reveal that atypical antipsychotics can be effective in treating
irritability, aggression, and self-injurious behavior. In our sample, there was significant difference between the level of disease in terms
of the average duration of treatment with aripiprazole, and CGI scores, aggression, irritability, and self-mutilating behavior. Limitation of
our study is that the data obtained cannot be generalized because of the limited sample of the patients. Studies with larger samples and
broader spectrum might contribute to this field.
Keywords: aripiprazole, autism, child and adolescent
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S190
[PP-138] Psychopharmacology
Ref. No: 0334
Influence of valproate on propofol dose in manic episode patients receiving
electroconvulsive therapy
Gul Eryilmaz, Gokben Hizli Sayar, Siban Semieoglu, Isil Gogcegoz Gul, Eylem Ozten
Uskudar University, NPIstanbul Hospital, Istanbul-Turkey
e-mail address: [email protected]
Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). The purpose of our study was to compare the dose
of propofol in valproateusing patients with valproate free patients. In an open study, 17 patients with bipolar affective disorder manic
episode who were to be treated with valproate and ECT combination, compared with 16 manic episode patients who were to be treated
with ECT but not valproate. Two groups were compared on the basis of electroencephalography-registered seizure duration and propofol
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Poster Presentations
dosage required to induce anesthesia. Valproate, as compared with valproate free group, results in a decrease in propofol dose necessary
to induce anesthesia. In valproate group, seizure duration was significantly shorter than valproate free group. In recent studies during the
ECT of patients with schizophrenia, propofol was shown to possess significant seizure-shortening properties. When the clinician needs
to prolong seizure length in patients under valproate treatment, interruption of valproate treatment or using an anesthetic agent other
than propofol should be considered. The results suggest that valproate reduces the dose of propofol required for anesthesia during
ECT treatment in patients with bipolar affective disorder manic episode. Although propofol is a safe and efficacious anesthetic for ECT
treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment.
Keywords: electroconvulsive therapy, propofol, valproate
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S190-S1
[PP-139] Psychopharmacology
Ref. No: 0335
Atomoxetine induced hypomania-like symptoms in a pre-adolescent patient
Esra Guney, Ozden Sukran Uneri
Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Child and Adolescent Psychiatry, Ankara-Turkey
e-mail address: [email protected]
Introduction: Atomoxetine, a selective noradrenaline reuptake inhibitor, is the first non-stimulant drug approved by the Food and
Drug Administration for the treatment of attention deficit hyperactivity disorder (ADHD). It has been reported that atomoxetine can be
safely used in comorbid anxiety disorder and tic disorders. In this paper it was aimed to report hypomania-like symptoms triggered by
atomoxetine in a case with ADHD and social anxiety disorder.
Case Report: A 10-year-old male patient was evaluated with complaints of attention deficit, forgetfulness, difficulty in memorizing, and
low school success. It was determined that the patient could not express himself properly in social setting, avoided activities requiring
performance such as attending classes due to fear of making mistakes, was usually quiet and shy, and therefore, his daily functions were
unfavorably affected by his condition.
According to clinical evaluation of the patient based on DSM IV diagnostic criteria, he was determined to fulfill the diagnostic criteria of ADHDattention deficit subtype and social anxiety disorder-common type. He was begun on atomoxetine 10 mg/day with gradual dose increments.
The patient was brought to our polyclinic with nervousness, defiance to parents, and over-activity on 7th day of atomoxetine treatment. A repeat
evaluation revealed that his self-esteem increased; he also developed behavioral and emotional changes in the form of occasional anxiety and
irritability, and sometimes excessive joy, restlessness, impatience, pugnaciousness, pressured speech, speech interruption behavior, tendency to
commit violence to friends, very frequent and irritating kissing behavior toward his mother. His sleep time and appetite, on the other hand, did
not change significantly. According to above mentioned findings, he was considered to have a hypomanic shift, and atomoxetine treatment was
stopped. Upon cessation of treatment, his behavioral changes abated in psychiatric evaluation performed 5 days later.
The case had no family history of any psychiatric diseases.
Discussion: Hypomania-like symptoms in this case were related to atomoxetine use since this case had previously no clinical symptoms
or signs of mania or hypomania-like disorder, no similar history of a different drug use, and of hypomania-like symptoms started shortly
after beginning of atomoxetine treatment and improved shortly after stopping the treatment. It has been concluded that the factor most
closely related to “an increased risk of mania or hypomania induction or mood dysregulation” is the presence of personal or family history
of a mood disorder. In our case, on the other hand, there was no personal or family history with a risk for bipolar disorder.
Our patient also had social anxiety disorder accompanying ADHD diagnosis. It has been suggested that co-occurrence of anxiety disorders
and bipolar disorder is quite common and the rate of anxiety disorder is higher in bipolar disorder compared to general population.
Analysis of our patient under the light of literature data suggests that presence of comorbid social anxiety disorder in addition to ADHD
and development of hypomania-like symptoms during atomoxetine treatment may be interrelated.
Keywords: atomoxetine, hypomania
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[PP-140] Psychopharmacology
Ref. No: 0337
A case report of valproate-induced hyperammonemic encephalopathy
Sonay Zabun, Sencan Sertcelik, Melike Nebioglu, Gonca Erkiran, Meliha Eroglu, Elif Topbas
Haydarpasa Numune Training and Research Hospital, Istanbul-Turkey
e-mail address: [email protected]
Objective: Hyperammonemia is a rare side effect of valproate(1,2). Carnitin deficiency has pointed as a predisposing factor at valproateinduced hyperammonemic encephalopathy in some articles (3). In this case report, we aimed to present a case of L-carnitine treatment
in valproate-induced hyperammonemic encephalopathy.
Case: A 36-year-old woman, graduated from secondary school, married with two children, previously diagnosed as bipolar disorder (10
years ago) and hypothyroidism, hospitalized because of mixed episode of bipolar disorder that induced by not using her medication.
We started valproate 1000 mg and risperidone 3 mg daily. Lethargy, apathy, confusion and orientation disorder occured at 7th day of
treatment and diagnosed as hypoactive delirium. Potassium: 2.8mEq/L, chlorine: 110mEq/L, ammonia: 72µmol/L, pH:7.48 found at
blood tests. Serum valproate level couldn’t determine because of technical issues. Due to high ammonia level at blood, she diagnosed
as valproate-induced hyperammonemia and hypokalemic alkolozis, which is a rare side effect of valproate. Valproate treatment stopped
and she cosulted to internal medicine. Serum potassium levels stabilized with replacement treatment. The day after, ammonia level was
197 µmol/L and L-carnitine 1000 mg in 100 cc isotonic sodium chloride, 4 times a day, added to the intravenous treatment. After 24 hours
of L-carnitine infusion, ammonia level was 35 µmol/L. Symptoms of delirium has disappeared at the third day of L-carnitine treatment.
Conclusion: Our case report showed that treatment with L-carnitine in valproate-induced hyperammonemic encephalopathy improved
the symptoms of delirium. In the light of this case, further studies are needed.
Keywords: hyperammonemic encephalopathy, l-carnitin, valproate
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S192
[PP-141] Psychopharmacology
Ref. No: 0339
Interferon treatment leading to depression with psychosis: a case report
Ibrahim Taymur1, Serap Sari1, Buket Gungor1, Ahmet Inel1, Ozgur Dagli2, Ayse Nur Burcu1, Rustem Askin1
Sevket Yilmaz Training Research Hospital, Department of Psychiatry, Bursa-Turkey
1
Sevket Yilmaz Training Research Hospital, Department of Clinic for Infectious Disease, Bursa-Turkey
2
e-mail address: [email protected]
Introduction: Hepatitis B virus is one of the leading factor of liver paranchyme damage which is important for morbidity and mortality.
Interferon treatment is related to many psychiatric side effects like depression, depressive mood, suicidal thoughts, irritability, tiredness,
cognitive impairement, mania and psychosis.
Case: A 17-year-old student in high school male patient, He was diagnosed as hepatitis B infection one year ago.After treatment with
interferon and lamivudine in 8th week he became depressive and had suicidal thoughts and feeling of guiltiness 2 days before application
to our clinic. In his thought content there were having delusions of harm and guiltines, which were compatible with his affect. He had
low psychomotor activity, depressive and sometimes dysphoric affect. He had normal physical and norological examination and routine
biochemical tests. He had no pathology in cranial MR and EEG. His treatment with interferon and lamivudine was stopped. Citalopram
10 mg/day and risperidone 3mg/day were started. Due to development of incontinans, rigidity, bradykinesia and tremor, risperidone
was stopped and biperiden and lorazepam were started. In the first week of his hospitalization signs of Parkinsonism disappeared and
5mg olanzapine was started for the psychotic symptoms. But as a result of development of extrapyramidal signs it was stopped and
aripiprazole 5 mg/day was started. In the 3rd week of his hospitalization aripiprazole increased to 10 mg/day and essitalopram 15mg/day
was added to treatment. With the treatment he had increased wilingness to conversation and better thought content. But he had nihilistic
mystic and harm delusions. He also had fluctuations of affect. In the 4th week of his hospitalization psychotic symptoms significantly
decreased and essitalopram dose for the depressive symptoms increased to 20 mg/day. In the 7th week of his hospitalisation he was sent
home who had normal liver function tests and healed depression.
Discussion: It was reported that 23.2%-39% of patients had depression in case of interferon usage as a side effect. Depressive symptoms
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due to interferon alpha is seen generally in 8th week significantly. It is known that interferon affects central nervous system directly.
Extrapyramidal side effects were reported in some cases although low doses of antipsychotics were used for the psychosis developed
after the use of interferon. In our case although antipsychotic was used in a low dose extrapyramidal side effects related to dopaminergic
systems like Parkinsonism was seen. In literature presence of similar cases shows that in the treatment of psychotic symptoms related with
interferon use low dose antipsychotics with little dopaminergic effect is important.
Keywords: interferon, depression with psychosis, antipsychotics
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S192-S3
[PP-142] Personality disorders
Ref. No: 0342
Relationship between temperamental and character features and suicide attempts with drugs
Ibrahim Taymur1, Kadir Ozdel2, Veli Duyan3, Ahmet Emre Sargin4, Gokce Demiran2, Buket Gungor1, Mehmet Hakan Turkcapar5
Sevket Yilmaz Training and Research Hospital, Department of Psychiatry, Bursa-Turkey
1
Diskapi Yildirim Beyazid Training and Research Hospital, Department of Psychiatry, Ankara-Turkey
2
Ankara University, Health Science, Ankara-Turkey
3
NP Istanbul Hospital, Istanbul-Turkey
4
Hasan Kalyoncu University, Istanbul-Turkey
5
e-mail address: [email protected]
Objective: Disorders and handicaps in personality among people with suicide attempt are shown significantly higher than people with
no attempt. Cloninger’s Temperament and Character Inventory intends to describe the personality as consisting of temperament and
character dimensions. In the current study we aimed to determine the relationship between temperament &character features of the
suicide attempters with drugs and their numbers of attempts.
Method: A total of 65 patients consisting of 48 women and 17 men who presented to Emergency Room of Diskapi YB Training and
Research Hospital with a suicide attempt with drug were included. Control subjects were recruited from people with no psychiatric
diagnosis and no history of suicide attempt (N=76, F=%56,5). Clinical evaluation was performed using SCID-I (Structured Clinical Interview
for DSM-IV Axis I Disorders). Alongside, sociodemografic data form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and
Temperament & Character Inventory (TCI) were administered to all participants.
Results: Of 65 patients who attempted suicide, 23 attempted first and 42 had at least one more attempt before.
Mean scores of BDI and BAI were significantly higher in the suicide attempter group than control subjects (p=0,000 and p=0,000). Results
from Temperament Dimension of TCI were as follows; scores on Novelty Seeking and Harm Avoidance were significantly higher in the
attempter group (P=0,001 and P=0,000 respectively). Scores on Self Directedness and Cooperation dimensions of TCI were significantly
lower in the attempter group when compared with controls (p=0,000 and p=0,024, respectively). When patients with more than one
suicide attempt were compared to who attempted suicide only once, in the former group scores on Reward Dependence of TCI were
significantly higher and scores on Self-Directedness of TCI were significantly lower (p=0,025 and p=0,002, respectively).
Conclusion: Findings from our study are consistent with the findings from previous studies conducted with suicide attempters using TCI.
A study in this domain revealed that people with high Harm Avoidance traits, low Cooperation and Self Directedness traits had some
disturbances in their cognitive executive functions (e.g., attention, visual memory and planning). Additionally some authors see the
disturbances of cooperativeness and self directedness as general reflections of psychopathology.
In this study we found a significant relationship between the repetition of the suicide attempts and Reward Dependence & Self
Directedness. Accordingly previous studies argued sensitiveness to negative life events, emotional lability and impulsiveness as risk
factors to repeated suicide attempts.
In summary, people who attempt suicide seem to have some temperamental traits such as novelty seeking and harm avoidance more
than healthy controls. Besides, repetition of suicide attempts is more possible in people with character traits such as low self directedness
and/or high reward dependence.
Keywords: temperamental, character, suicide
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[PP-143] Substance abuse and dependence
Ref. No: 0346
Determinant factors on positive or negative course in adolescents presented
by probation in a substance abuse treatment center
Rezzan Aydin, Zeki Yuncu
Ege University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir-Turkey
e-mail address: [email protected]
Objective: Illicit drug use began to rise all over the world and has become a major public health problem. In most countries, substance
abusers, producers, sellers and substance abusers involved in crime under the influence of drug or while trying to ensure drug are taken
to obligatory treatment programs. “Probation” is one of these practices. Probation increased awareness that addiction is a treatable disease
and brought in the principle: ‘Drug addicts should be treated, monitored and reintegrated to society’. By probation, drug addicts who do not
accept that, untreated in this area or discontinued the treatment -a group which is very close to criminal behavior has been able to achieve. In
this study, adolescents referred to an addiction treatment unit by Probation between the years of 2005-2013 were investigated whether there
is a determinant in ensuring their sobriety due to sociodemographic characteristics, drug use, other crime stories and family characteristics.
Method: All patients admitted to an adolescent substance abuse treatment center between the years 2005-2013 were examined
retrospectively. The data from files of the cases were transferred to the data sheet prepared by researchers including the first age of onset
of substance use, the age of first contact, drugs and psychotropic substances used, the completed years of education, whether mother and
father alive/dead and self/step. Except these questions criminal records, working experience and street life experience were examined from
file records. The presence of street life experience was evaluated by questioning the category of conduct disorder in the DSM-IV TR criteria:
has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy
period). Those admitted in a way other than family or probation (social services, health measures, school etc.) were excluded from the
research and thus the sample was composed of 1528 patients. 455 (29,8%) of these cases were directed by probation offices to our treatment
center. 1073 (70,2%) patients applied via family. SPSS 16.0 program has been used for the statistical assessment. Quantitative variables were
compared by t test and chi-square test was used to compare categorical variables. The statistical significance was adopted as p<0.05.
Results: The difference between the two groups in terms of age of onset substance use is statistically significant and the earliest age of
onset of substance use was in adolescents applied via family. In terms of cannabis, inhalants and ecstasy use, a significant difference was
determined statistically between family and probation groups. 46.1% of patients who applied via family previously have been treated
in other treatment services. The presence of street life, substance preferences and completed academic year were significantly different
between the groups of probationers. Adolescent probationers living with both of the self parents had more positive features.
Conclusion: Family group show different characteristics to the probationers in terms of substance use characteristics, family and
individual features. Probationers who show positive results tend to have more positive features of substance choices, street life
experience, completed academic year and family characteristics.
Keywords: addiction, adolescent, probation
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S194
[PP-144] Childhood and adolescence disorders
Ref. No: 0347
Mydriasis after initiating therapy with atomoxetine in a boy with juvenile
osteopetrosis: a case report
Canan Yusufoglu1, Zeynep Yaman Aslan1, Ayse Buyukdeniz2
Erenkoy Mental Health and Neurology Training and Research Hospital, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
1
Marmara University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
2
e-mail address: [email protected]
Introduction: Atomoxetine is the first and only non-stimulant approved by the Food and Drug Administration for the treatment of Attention
Deficit and Hyperactivity Disorder (ADHD) in children, adolescents, and adults and the first medication approved for the treatment of adult
ADHD. Atomoxetine hydrochloride, a selective presynaptic norepinephrine-reuptake inhibitor, is thought to have little affinity for other
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neurotransmitter systems or specific noradrenergic receptors, thus minimizing adverse effect. Clinical trial data indicate that atomoxetine
is safe and well tolerated for the treatment of ADHD; however, safety data about long-term use (greater than 1 year) are unavailable. Typical
side effects of atomoxetine are upset stomach, nausea and vomiting, decreased appetite, constipation, headache, dry mouth, urinary
hesitance, and insomnia. Mydriasis, dilation of the pupil caused by a shift in muscle tone, has been reported with atomoxetine more than
placebo in clinical trials and more so in 2% of poor metabolizers of CYP2D6 versus 1% of extensive metabolizers of CYP2D6.
Case: 9-year old boy with ADHD (attention deficit type) was prescribed 20 mg of atomoxetine orally once daily for 10 days.The dose was
then increased to 25 mg. After 15 days,the boy developed mydriasis.Since there was neither concomitant drug use nor the ophthalmologist
noted mydriasis stemming from his genetic disease, a relationship between atomoxetine and development of midyriasis was suggested.
Discussion: This case is considerable because being aware of the possibility of mydriasis before starting treatment with atomoxetine,
especially among adults who are prone to develop angle-closure glaucoma is important.
Keywords: atomoxetine, adverse effects, juvenile osteopetrosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S194-S5
[PP-145] Psychopharmacology
Ref. No: 0349
Bupropion-induced psychosis: a case report
Ersin Uygun1, Engin Emrem Bestepe2
Bakirkoy Mental and Neurological Diseases Hospital, Istanbul-Turkey
1
Erenkoy Mental and Neurological Diseases Hospital, Istanbul-Turkey
2
e-mail address: [email protected]
Introduction: Clinically bupropion has FDA approval of indications such as depression and tobacco addiction and widely used in
psychiatric patients. Among frequent side effects of bupropion such as insomnia, constipation, headache, dry mouth; there are also less
frequent ones like, alteration in attention, memory and perception, vivid dreams, visual hallucinations, delusions and catatonia.
Case: A 28-year-old female patient presented to psychiatry outpatient clinic with fatigue and loss of interest. Following a diagnosis of
major depression according to DSM 4TR criteria, 150 mg/g bupropion was given. Starting from the 7th day of treatment, she has the
complaints of having nightmares, suspiciousness, and hallucinations of bugs climbing on the wall, hypnopompic auditory hallucinations,
reference and persecutory delusions. After cessation of bupropion, on consequential 12 days, psychotic symptoms regressed completely.
In literature, relationship between bupropion and psychosis was first mentioned by Becker et al.a wide symptomology spectrum ranging
from alterations in perception to catatonia. In 2011, Sanjeev and Kumar et al. published a review indicating that susceptible persons and
high dose were related to onset of psychosis with a high probability. Liver cytochrome enzyme p450 2B6 which has role in metabolizing
bupropion, displays variations according to age and genetics might predict this priority to psychosis amount different people.
Bupropion is an agent commonly used in the treatment of depression and smoking cessation. Even low doses of bupropion can induce
psychosis in people which don’t have any risk factors. Psychotic symptoms should be questioned at the first control after starting
bupropion.
Keywords: bupropion, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S195
[PP-146] Childhood and adolescence disorders
Ref. No: 0351
Suicidality in Klinefelter’s syndrome: a case report
Cem Oge, Recep Tutuncu, Cengiz Basoglu
GATA Haydarpasa Training Hospital, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Klinefelter’s Syndrome is usually characterized by 47 XXY genotype, hypogonadism, tallness and infertility. In the literature it is estimated
that 64% of Klinefelter’s Syndrome is undiagnosed and many patients have variety of psychiatric disorders. In this case report, we present
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Poster Presentations
a 17-year-old Klinefelter’s Syndrome patient who had been hospitalized because of multiple impulsive suicidal acts. Our aim is both to
review the psychiatric presentations of this syndrome and to emphasize the importance of impulsivity and suicidal acts, which might be
etiologically related with X-chromosome anomalies.
Keywords: suicide, Klinefelter’s syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S195-S6
[PP-147] Schizophrenia and other psychotic disorders
Ref. No: 0352
Cerebellar agenesia and schizophrenia: a case report
Naci Olam, Eda Tayfur, Yasin Bez
Dicle University, Department of Psychiatry, Diyarbakir-Turkey
e-mail address: [email protected]
Introduction: Cerebellum, which is related to regulation of motor coordination, has shown to be related with high cortical functions as
well according to latest studies. Studies focused on schizophrenia patients showed functional and structural changes in the cerebellum.
In this study we presented a schizophrenia case with right cerebellar hemiatrophy.
Case: A 21-year- old male patient with known diagnosis of schizophrenia from five years and has dominant audial and visual hallucinations
has showed complete right cerebellar atrophy except for right cerebellar peduncle on MRI. Anti psychotic therapy of sufficient dose and
time could not lead particular improvement of symptoms. Positive and negative symptoms were improved after additional clozapine and
valproate therapy to the paliperidone depot regimen.
Discussion: Cerebellar pathologies are found to be related with early started schizophrenia, positive psychotic symptoms and drug
resistance. Clinicians must keep in mind the presentation with positive psychotic symptoms and drug resistance in schizophrenia cases
with concomitant cerebellar pathologies.
Keywords: cerebellum, drug resistance, schizophrenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S196
[PP-148] Clinical psychiatry
Ref. No: 0358
The attitudes of patients toward the presence of students in psychiatry outpatient
clinical practice
Erhan Yuksek1, Ayse Sakalli Kani1, Veysi Ceri2, Mesut Toprak3, Emrah Yildiz3, Cana Aksoy Poyraz1, Murat Emul1
Istanbul University, Medical School of Cerrahpasa, Department of Psychiatry, Istanbul-Turkey
1
Istanbul University, Medical School of Cerrahpasa, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
2
Istanbul University, Medical School of Cerrahpasa, Istanbul-Turkey
3
e-mail address: [email protected]
Objective: Observation of doctor-patient relationship by students is quite important in medical training. But patients’ awareness about
their rights effects their attitude about medical students attendance to their examination. In this research we aim to assess patients
reaction about attendance of medical students to their examination.
Methods: The participants were enrolled in the study after giving informed consent who applied to outpatient psychiatry clinics and
whom was between 16-60 years old. After filling a sociodemographic inquiry the patients were asked to fulfill an inquiry, which was
consisted of 11 questions that was prepared by our team.
Results: The data belonging to 473 patients were obtained. The mean age of the participants was 33.00±11.90 (male 31.58±11.56 and
female 33.70±11.98, p=0.047). The 45.7% of participants preferred “doctors wearing with white coat” while 42.7% of participants indicated
that it is not important whatever the doctors dressed and 9.7 percent of participant preferred their doctors dressed with daily clothes
(jeans and t-shirt). The 29.6% of participants indicated that they allow to be mentally examined by medical students if they are under
supervision of clinician while 46.1 of them do not. The 44.5% of participants agreed that the presence of medical students in mental
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examination might let the clinician “act fastidious to obey their professional rules” while 22% of them disagreed. The 48.2% of participants
answered “I could not tell myself enough” and 27.9% of them answered ‘’ my privacy what I will tell’’ to the proposal of “in what reasons do
you think the presence of medical students should influence your interview?”
Conclusion: Finally this research is important because it is the first research that investigates what psychiatric patients think about
attendance of medical students to their interview. A significant proportion of patients give importance to the presence of medical
students and wish to contribute to the education. However, this willingness was comparable to the willingness of patients in general
surgery or obstetrics and gynecology.
Keywords: psychiatry outpatients, attitude, psychiatry internship
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S196-S7
[PP-149] Memory and cognitive disorders
Ref. No: 0359
Lightning and psychiatric results: a-3-year-follow-up case report
Murat Oncu, Recep Tutuncu, Alpay Ates, Ayhan Algul
GATA Haydarpasa Training Hospital, Istanbul-Turkey
e-mail address: [email protected]
Our aim is to discuss the relationship between diffuse neurologic damage and psychiatric consequences in lightning patients. Lightning
injuries affect 800 to 1000 persons per year. Lightning current may flow internally for an incredibly short time and cause short-circuiting
of the body’s electrical systems. It seldom causes any significant burns or tissue destruction. Long-term problems are sleep disturbances,
anxiety attacks, pain syndromes, peripheral nerve damage and phobias. In this case we report a patient who has been followed up in a
psychiatry clinic for three years due to psychiatric signs and symptoms after a lightning.
Keywords: lightning injury, psychiatry
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S197
[PP-150] Childhood and adolescence disorders
Ref. No: 0361
Agitation associated with methylphenidate in a child: a case report
Lutfiye Sogutlu1, Gul Karacetin2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
2
e-mail address: [email protected]
Agitation is a severe anxiety associated with motor restlessness. This physical and mental motor overactivity is usually nonproductive and
is associated with a feeling of inner turmoil.
Stimulants are the first choice in the treatment of attention deficit hyperactivity disorder (ADHD). In this report, a case of a 12 years old
boy who developed acute psychomotor agitation and irritability with methylphenidate 27mg/day (0.5mg/kg) treatment for ADHD is
presented. According to our knowledge, this is the first report of psychomotor agitation related to methylphenidate use in the literature
(except overdose).
Keywords: agitation, attention deficit hyperactivity disorder, methylphenidate
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S197
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[PP-151] Psychopharmacology
Ref. No: 0362
Gastrointestinal side effects in the baby of breastfeeding woman treated with
low-dose fluvoxamine: a case report
Hatice Guncu, Faruk Uguz
Necmettin Erbakan University, Department of Psychiatry, Meram Faculty of Medicine, Konya-Turkey
e-mail address: [email protected]
Introduction: Antidepressant drugs are used frequently in psychiatric disorders. It has been reported that almost all antidepressant
agents can pass into human breast milk. However, the information concerning the clinical use in breastfeeding woman of these agents is
limited. This case report presents the gastrointestinal side effects in an infant of mother treated with low-dose fluvoxamine.
Case: A 40-year-old breastfeeding woman was admitted to the psychiatry outpatient clinic of a university hospital with complaints severe
anxiety, decreased sleep, anhedonia and depressive mood. She had a 5-month year-old baby. She had a history of use of venlafaxine 75
mg/day due to major depressive disorder during 6 months prior to the last pregnancy. A psychiatrist discontinued the treatment, because
the patient did not have marked depressive symptoms during pregnancy. The patient described that depressive symptoms occurred again
at postpartum 6th week. Eight weeks later the patient has applied to a psychiatrist for her depressive symptoms. Paroxetine 20 mg/day
and sertraline 50 mg/day were administered to the patient respectively, but, these were discontinued, because it was observed several
side effects in the patient (e.g, tachycardia, marked increase in anxiety, nausea, vomiting and complete loss in sleep). She described no
side effect in baby due to these drugs. Psychiatric interview performed by the Structured Clinical Interview for DSM-IV (SCID-I) indicated
that the patient had currently Major Depression. We started 50 mg/day fluvoxamine. Two days later, she reported that severe diarrhea
and mild vomiting were emerged in her baby following fluvoxamine use. There was no any side effect in mother. The examination of baby
by a pediatricianand laboratuary tests including hemogram, analysis of stooland biochemistry suggested that the baby did not have any
illness related to the gastrointestinal symptoms. Following discontinue of fluvoxamine; the gastrointestinal symptoms observed in baby
were completely resolved without any specific treatment within 48 hours.
Discussion: According to ACOG Practice Bulletin, the SSRIs including fluvoxamine, sertraline and paroxetine are safer than venlafaxine in
breastfeeding women . Paroxetine and sertraline are intolerable for the present mother, therefore, we started low-dose fluvoxamine but
severe gastrointestinal side effects emerged in baby. Although available limited data reported that there is no marked adverse effect of
fluvoxamine on baby of breastfeeding women , the present case suggests that some babies may be influenced adversely by maternal use
of fluvoxamine. Clinical trials with large sample highlighting the importance of this subject are required.
Keywords: breastfeeding, fluvoxamine, SSRI
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S198
[PP-152] Memory and cognitive disorders
Ref. No: 0363
Clinical improvement in Korsakoff’s syndrome with donepezil usage: a case report
Gonca Tekin1, Sadettin Burak Acikel2, Faruk Uguz1, Nazmiye Kaya1
Necmettin Erbakan University, Meram Faculty of Medicine, Department of Psychiatry, Konya-Turkey
1
Necmettin Erbakan University, Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya-Turkey
2
e-mail address: [email protected]
Introduction: Alcohol-induced persisting amnestic disorder (Korsakoff’s syndrome) is generally defined as an irreversible and important
clinical condition. There is not enough information about its treatment. In this report, a case has been reported about effect of donepezil
in Korsakoff syndrome is presented.
Case report: A 51-year-old male patient was admitted to psychiatry outpatient clinic of Necmettin Erbakan University Meram Medical
Faculty with insomnia, disable to eat, a strange speech, forgetfulness, difficulty in recognize his relatives for a month. The patient had
a history of alcohol use since nearly 30 years, separated from her wife six years ago. On his mental examination there was decreased
self-care, corrupted orientation, impaired close memory, confabulation, retrograde and anterograde amnesia, labile affect, psychomotor
restlessness, insufficient insight. Physical examination was normal. It was found, nystagmus, hypoesthesia on right lower extremity, ataxia
in neurological examination. After examination and clinical interview, the patient was diagnosed Alcohol-induced persisting amnestic
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syndrome according to DSM-IV(Diagnostic and statically manual of mental disorders IV edition) diagnostic criteria. In magnetic resonance
imaging, there was sulcus expansion and atrophy of the mammillary bodies. Serum level of GGT 103 U/L, total protein, 5 g/dl, albumin 2.6
g/dl, fT4 0.59 ng/dl, other biochemistrical and hematological values were normal. The point of the standardized mini-mental test (SMMT)
was 18.
Treatment of patient was started as thiamine 100 mg/day, quetiapine 100 mg/day and levotiron 50 mg/day. Because of no clinical
improvement during first week, donepezil 5 mg/day treatment was started additionally. After 1 weeks donepezil dosage increased 10
mg/day. Minimal improvement in clinical status of the patient was observed within 3 weeks following donapezil initiation. Six weeks later,
confabulation, disorientation and memory impairment showed moderate improvement and SMMT was 21. Total time of hospitilitation
was 50 days. The patient was followed up 3 months after discharge. His relatives said that there is significant improvement in patient’s
symptoms such as orientation, confabulation and memory, at that time, MMSE was 25. No side effects were observed during treatment
of donepezil.
Discussion: In the literature, there are several cases and a small study about usage of donepezil in Korsakoff’ssyndrome. Although Şahin et
al. Reported that donepezil does not seem to provide marked beneficial effect in patient with Korsakoff’s syndrome, their study had only
7 subjects and relatively short follow up period. Also, they are statically significant improvements some subtypes of neuropsychologic
evaluations.
On the other hand, there are several case reports in the literature and this reports emphasizes that donepezil usage is beneficial in
Korsakoff’ssyndrome. Mayes et al. has suggested cholinergic involvement in Korsakoff’ssyndrome. More double-blind, randomized
controlled study must be done about this subject.
Keywords: Korsakoff’s syndrome, donepezil, acetyl cholinesterase inhibitor
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S198-S9
[PP-153] Psychopharmacology
Ref. No: 0364
Can lithium routinely used for the treatment of antipsychotics-induced neutropenia?
Nursel Akbaba, Bilge Burcak Annagur
Selcuk University, Faculty of Medicine, Department of Psychiatry, Konya-Turkey
e-mail address: [email protected]
Introduction: Leukopenia and neutropenia may be associated with a range of antipsychotics, mood stabilizers, and selective serotonin
reuptake inhibitors, especially clozapine. The same effect has been reported in association with risperidone, olanzapine, quetiapine,
ziprasidone and aripiprazole. However, neutropenia and agranulocytosis are serious adverse effects that may lead to drug discontinuation
and, consequently, psychotic exacerbation. We present a patient with severe refractory schizophrenia that developed a large number of
antipsychotic induced neutropenia, which was successfully reversed after lithium onset.
Case: A 43-year-old woman with a 16-year history of schizophrenia was admitted to our hospital because of irregular drug adherence and
severe psychiatric symptoms. She evolved with prominent positive symptoms such as paranoid delusions and auditory hallucinations.
She had Capgras syndrome. She has believed that her husband and her baby have been died and replaced by ‘lookalikes’. She reported
that her daughter was not really her daughter.
She had been hospitalized on four occasions due to exacerbation of psychotic symptoms. She had been treated with several
antipsychotics such as, haloperidol, zuclophentixol, risperidone, aripiprazole, clozapine and quetiapine. It has been changed after the
start of antipsychotic drugs due to leukopenia in each hospitalization.
The patient had no previous medical history of leukopenia, and her baseline WBC count before initiation of antipsychotics was 5.11 K/uL
(4-10). In the beginning of this admission, we started haloperidol 10 mg/day but her WBC count dropped to 3,63 K/uL. Therefore, during
this hospitalization, the patient was treated with electroconvulsive therapy (ECT). A total of 5 ECTs were administered. She continued to
receive 5 mg/day haloperidol along with ECT. After ECT therapy, we started lithium 300 mg/day and quetiapine 300 mg/day in addition
haloperidol 5 mg/day. Her WBC count increased to 5.74 K/uL on 11 days of the lithium treatment. She was discharged on hospital day 32
with recovery and a follow up psychiatry appointment arranged.
Discussion: In this case, a patient who had previously been treated with several antipsychotics with no related medical problems
experienced leucopenia. Leukopenia was not present before initiating treatment with antipsychotics.
Lithium can increase neutrophils right after its introduction since it has leukopoietic bone marrow effects. Even low serum doses of lithium
can reverse antipsychotic-induced neutropenia; used lithium (at an average serum level of 0.59 mEq/L) in 100 chemotherapy induced
neutropenia patients and such treatment reversed neutropenia in 86% of cases, with neutrophils increase observed 3 days after lithium
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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onset. Therefore, lithium might pose as a potential treatment of antipsychotic-induced neutropenia in severe schizophrenia cases in
which antipsychotic treatment is the essential.
Keywords: antipsychotics, lithium, neutropenia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S199-S200
[PP-154] Mood disorders
Ref. No: 0366
Daily repetitive transcranial magnetic stimulation (RTMS)may improve mood
in depression: a case report
Mustafa Levent, Recep Tutuncu, Hakan Balibey, Cengiz Basoglu
Gata Haydarpasa Training Hospital, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Current literature points to hypofunction of the lprefrontal cortex in depression. Repetitive transcranial magnetic stimulation (rTMS)
activates cortical neurons.
In our case, we report a-53-year-old female patient with the diagnosis of depression. she was on various antidepressant medications
for 3 years and her symptoms were partially remitted. After 10 sessions of rTMS, depression scores significantly improved. (Hamilton
Depression Scores decreased from 20 at baseline to 4 after treatment). We questioned whether daily left prefrontal rTMS might improve
mood in resistant depressed subjects and report a case that depression symptoms completely remitted for the first time in 3 years. Daily
left prefrontal rTMS appears to be safe, well tolerated and may alleviate depression.
Keywords: repetitive transcranial magnetic stimulation, depression
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S200
[PP-155] Psychopharmacology
Ref. No: 0367
Safety and efficacy of combined clozapine-colchicine treatment in a case of
schizophrenia with Behçet’s disease: a -6-mounth follow-up
Derya Ipekcioglu, Mustafa Akkus, Nesrin Karamustafalioglu, Burcu Kok, Mehmet Cem Ilnem
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul-Turkey
e-mail address: [email protected]
Behçet’s disease is a recurrent inflammatory disorder involving multisystem of the body. The classical triad of Behçet’s disease are recurrent
oral and genital ulcers and uveit. Neurological symptoms are observed as initiation of symptom only on three percent (%3) of cases. The
clinical aspect of disease is often like Neuro-Behçet Syndrome with focal neurological signs. In our case, 25-years-old man patient with
schizophrenia that using clozapine is observed after diagnosed Behçet’s disease in 6 month. Colchicine is used in this period at the same time.
We observed the using of combined clozapine-colchicine,without developing agranulocytosis or other severe adverse side effects during a
6-mounth follow-up. We used to total blood count. There were not any blood parameters in abnormal range during 6 month The initiation
of Behçet’s disease can be only with the psychiatric symptoms This can cause inaccurate diagnosis and treatment(2).Neuropsychiatric
symptoms, like psychosis and depression,often occur in Behçet’s disease. The safety and efficacy of combined clozapine-azathioprine
treatment is researched,previously. But the safety and efficacy of combined clozapine-colchicine treatment have never been assessed.
Keywords: schizophrenia, clozapine, colchicine, Behçet’s disease
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S200
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[PP-156] Childhood and adolescence disorders
Ref. No: 0368
A 10-case series of selective mutism: an emphasis on comorbidity
Nagehan Ucok Demir, Mustafa Yasin Irmak, Fatma Benk, Gulseda Ayranci, Nese Perdahli Fis
Marmara University, Department of Child and Adolescent Psychiatry, Faculty of MedicineIstanbul-Turkey
e-mail address: [email protected]
Objective: Selective mutism is a relatively rare and multidimensional childhood disorder that typically affects school age children. It
is characterized by the persistent failure to speak in some selected social settings despite possessing the ability to speak comfortably
in more familiar settings. Selective mutism is associated with a number of comorbid disorders that complicate the child’s clinical
presentation. Around 70% of the parents of the cases with selective mutism show characteristics of social phobia or avoidant personality
trait. In this study, we aimed to investigate several sociodemographic and clinical correlates of the patients with selective mutism, such as
the co-occurring psychiatric disorders, parental psychiatric history, and the medication used.
Methods: We retrospectively examined the hospital files of the cases with the diagnosis of selective mutism, which admitted to Marmara
University Child and Adolescent Psychiatry Clinic between May 2011-May 2013. Statistical analyses were done using SPSS 18.0 for
Windows.
Results: The sample was composed of 10 children. Sixty percent (n=6) were male. The mean age was 8.10±1.8 years. The most common
comorbid psychiatric diagnosis was social phobia (n=9), followed by attention deficit hyperactivity disorder (n=5), generalized anxiety
disorder (n=3), depression (n=3), and obsessive compulsive disorder (n=1).
As for the parental psychiatric history, only one mother had a history of Major Depression. Among fathers 4 had avoidant personality
traits,and 1 had a history of major depression. Majority of the children were on fluoxetine treatment (n=8).
Conclusion: In our series of selective mutism all of the cases had at least one comorbid psychiatric diagnosis. However, for a great number
of cases establishment of the comorbid conditions can be challenging, due to the scarceness of verbal communication. In our opinion, a
thorough evaluation is necessary during the assessment of comorbid psychiatric diagnoses.
Keywords: comorbidity, selective mutism, social phobia
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S201
[PP-157] Learning disabilities
Ref. No: 0369
Prevalence of learning disorders in the region of Sfax, Tunisia
Leila Chérif1, Héla Ayedi1, Khawla Khemekhem1, Imen Hadjkacem1, Radhouan Mchirgui1, Adel Walha1, Foued Moalla2, Yousr Moalla1, Chahnez
Triki3, Farhat Ghribi1
UH Hédi Chaker, Sfax, Departement of Child psychitry, Tunisie
1
Department of Regional school health, Sfax, Tunisie
2
UH Hédi Chaker, Sfax, Departement of Child neurology, Tunisie
3
e-mail address: [email protected]
Objective: In Tunisia, learning disabilities (dyslexia, dysgraphia, dyscalculia) are unknown by physicians, education professionals and the
wider public. School-age children do not yet receive a systematic screening for learning disabilities, as in other countries. Until then, there
are no screening or diagnosis tests and prevalence figures are missing. For this, the present study was carried out in order to explore
prevalence of learning disabilities in the region of Sfax.
Methods: This is a study conducted in the context of a federated search at the national level. It was a cross-sectional and descriptive study,
covering 687 students aged 7 to 9 years old. A screening of children with learning difficulties was done by teachers and school doctors
based on academic performance in the global and in reading, written expression and mathematics. Children identified as having learning
difficulties benefited from pedopsychiatric semi-structured interview, based on the DSM-IV-TR in the presence of one or both parents and
from a neurological examination (coordination, search of abnormal movements, minor signs). The assessment of intelligence quotient
was made by the EDEI-A Arabized and standardized in Tunisia. The speech and language assessment was used to evaluate temporal
and spatial orientation, laterality, spoken language and written language (reading, graphics and dictation, and mathematics). Meetings
between child psychiatrists, neurologists, speech therapists and psychologists who participated in this study helped confronting the
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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different data. As exclusion criteria, we selected: a severe psycho-educational deficiency, an IQ below 50, a neurological disease or a
mental disorder that can explain the learning disabilities. Considering the unavailability of appropriate tests in Tunisia to carry diagnoses
of learning disorders, the diagnosis was based clinically. The child psychiatric interview and neurological clinical examination with the
refinement by speech and language assessment and psychological evaluation were our inclusion criteria and the support of our diagnosis.
Results: The prevalence of learning disorders was 8.15%, The prevalence of reading disorder was 7.6%. The prevalence of the disorder of
written expression was 7.6%.The prevalence of the mathematics disorder was 2.8%.
Conclusions: The results of this study are consistent with those of the literature and show that learning disorders are common in Tunisia.
The achievement of screening and diagnosis tests is a crucial step to achieve. Awareness of the health and education professionals is
essential.
Keywords: reading disorder, mathematics disorder, written expression disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S201-S2
[PP-158] Clinical psychiatry
Ref. No: 0372
Olfactory reference syndrome: two case reports
Nilufer Subasi, Omer Yanartas, Hikmet Ekin Sonmez, Sureyya Aysun Arican, Kemal Sayar
Marmara University, Faculty of Medicine, Istanbul-Turkey
e-mail address: [email protected]
Introduction: Olfactory reference syndrome is a somatic delusional disorder characterized by erroneous believes on emitting a foul odor
and therefore displeasing other people. Here we present two cases diagnosed with olfactory reference syndrome.
Case-1: Thirty-year-old single male, applied to our outpatient clinic complaining of a foul body odor. His complaints started nine months
ago while attending to a seminar. He stated that a man sitting next to him asked him a question and had an unpleased expression on his
face then after. The patient had a belief that he might be emitting a foul odor, which caused this response, and this belief turned stronger,
which finally started to effect his daily life and occupational performance negatively. Fluoxetine 60 mg/day and aripiprazole 15 mg/day
were prescribed and a follow-up visit was planned.
Case-2: Seventeen-year-old single female patient claimed to smell irritating. She admitted that she didn’t sense the smell herself but
understood it from other peoples’ reactions. Her complaints are said to start at the age of 13 when she was distressed by the problems at
school and she became more reserved in time. The patient was treated with a combination of sertraline and aripiprazole and responded
well, with significant improvement of her delusional symptoms.
Discussion: We presented this subtype of delusional disorder to raise the awareness of clinicians as it is reported to be characterized by
high morbidity and seeking of nonpsychiatric treatment.
Conclusion: As it is a rarely noticed condition and not included in the DSM-IV-TR as a separate disorder, studies presenting such cases will
contribute to the familiarity of this disorder.
Keywords: olfactory reference syndrome, delusional disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S202
[PP-159] Childhood and adolescence disorders
Ref. No: 0373
Treatment with atomoxetine: a case with Williams syndrome
Ummugulsum Gundogdu, Fatma Benk, Aliye Tugba Bahadir, Ayse Arman
Marmara University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Williams Syndrome (WS) is a rare neurodevelopmental disorder characterized by elfin facial appearance, along with a low nasal bridge,
an unusually cheerful demeanor and ease with strangers; developmental delay coupled with strong language skills; and cardiovascular
problems such as supravalvular aortic stenosis, and transient hypercalcemia. Williams syndrome is associated with some neurological
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problems such as poor coordination, mental retardation and hypersensitivity to sound.
We report a case of Williams syndrome presenting with neurological impairments and attention deficit and her treatment with
atomoxetine.
A 7-year-old girl was admitted to our outpatient clinic by her mother with complaints of irritability, coordination problems, she was
afraid of mild volume sounds. In the first clinical evaluation it was revealed that she had problems with comprehension, inattention,
hyperactivity and impulsiveness. Her anxiety level was high. She was diagnosed with Williams syndrome at age 2. She was diagnosed with
Attention Deficit Hyperactivity Disorder (ADHD) and Separation Anxiety Disorder (SAD), Specific Phobia (SP), and prescribed atomoxetine.
Before treatment she was consulted to pediatric cardiologist because she had supravalvular aort stenosis. Pediatric cardiologist approved
the use of ADHD medications and recommended to control her blood pressure and heart rate routinely. After 2 months of treatment her
SAD, SP and ADHD symptoms diminished but coordination problems and hypersensitivity to sound did not change at all.
Williams syndrome is associated with ADHD and related symptoms such as poor concentration, hyperactivity, and social disinhibition. It is
also associated with higher anxiety levels as well as phobia development, which may be associated with hyperacusis. Patients with Williams
syndrome experience challenges in visual-motor skills and visuospatial construction and many of them have intellectual problems. In our
case clinically significant improvement was achieved in ADHD symptoms and anxiety when treated with atomoxetine. It is known that
atomoxetine may affect blood pressure and heart rate especially in patients with cardiac problems. Although our case had supravalvular
aort stenosis her blood pressure and heart rate did not change. Atomoxetine is a treatment alternative in patients with WS and ADHD.
Keywords: atomoxetine, Williams syndrome
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S202-S3
[PP-160] Schizophrenia and other psychotic disorders
Ref. No: 0375
Thalamic hematoma with psychotic symptoms: a case report
Emine Merve Akdag1, Salih Cihat Paltun1, Hilmi Akdag2, Makbule Cigdem Aydemir1, Erol Goka1
Ankara Numune Education and Research Hospital, Department of Psychiatry, Ankara-Turkey
1
Ankara Numune Education and Research Hospital, Department of Emergency Medicine, Ankara-Turkey
2
e-mail address: [email protected]
Objective: A systemic disorder that affects brain functions may cause psychotic symptoms that is known as Psychotic Disorder Due to
General Medical Condition or Secondary Psychosis. Psychotic symptoms in cerebrovascular disorders is informed between %14-60.
The aims of this paper is; to emphasize the importance of calling the general medical conditions to mind in a patient with first episode
psychotic symptoms and investigating organic ethyologies, to revise primary and secondary psychosis cases.
Case: A-51-year-old, married, right-handed, male with no history of epilepsy, trauma or substance abuse. The patient is brought tor the
emergency ward of our hospital by his parents because of showing strange behaviors, absurd speech and saying that he is seeing some
people and hearing their voices and feeling frightened of being harmed by other people. After first examination the patient was consulted
to psychiatry department. Psychotic Disorder Due to General Medical Condition is thought as prediagnosis and to prove this; cranial CT,
blood tests were planned. CT was reported as “left thalamic hematoma 14x10 mm sized, spreaded to ventricular system”. Then the patient
hospitalized in neurology department. Blood glucose level and blood tension is regulated in the follow-up as inpatient. Medical treatment
for hematoma resorptionapplicated at the same time. Improvement in clinical examination was observed as compatible with hematoma
resorption in control cranial CT. Although no treatment applicated specific as antpsychotics, psyhcotic symptoms relieved significantly
and the patient discharged from hospital with medical advices after hospitalization for a week. In the control cranial CT after 3 week;
hematoma was observed minimally and there were no psychotic symptoms in psychiatric examination.
Conclusion: The prevalence of clinical table called “Psychotic Disorder Due to General Medical Condition” in DSM-IV and also known as Secondary
Psychosis is not known definitely. In clinical practice it is known that symptoms like schizophrenia could be seen in the cerebrovascular,
degenerative, traumatic and metabolic diseases that affects functions of brain especially, in frontal, temporal and limbic parts. Although the
literature data is limited it is advocated that the decreased or disrupted connections between the thalamus, limbic system and frontal lobe neurons
is a risk factor or precipitant of psychotic disorder. Clinical observations also supports the disconnectivity syndrome model.
Atypical clinical table as undulation in consciousness, disruption in cognitive functions, late-onset of first psychotic symptoms, absence
of psychosis in family history in the case we presented caused the choice of advanced radiological screening methods and the thalamic
hematoma is detected. In the cases with atypical clinical symptoms comprehensive differential diagnosis should be made including
neurological, psychiatric and general medical disorders.
This case is presented to emphasize the importance of calling the general medical conditions to mind in a patient with first episode
Bulletin of Clinical Psychopharmacology, Vol: 23, Supplement: 1, 2013 - www.psikofarmakoloji.org
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psychotic symptoms, the role of the cerebrovascular events in this clinical table, and the importance of radiological screening methods.
Especially in emergency outpatient psychiatry policlinics secondary psychosis should be thought in differential diagnosis.
Keywords: psychosis, thalamus
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S203-S4
[PP-161] Mood disorders
Ref. No: 0386
Oral health among outpatients with bipolar disorder
Ozlem Oflezer1, Kursat Altinbas2, Mehtap Arslan Delice3, Erhan Kurt3
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Dentistry, Istanbul-Turkey
1
Canakkale Onsekiz Mart University, Department of Psychiatry, Canakkale-Turkey
2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
3
e-mail address: [email protected]
Objective: The objective of this study is to evaluate the oral health in a group of bipolar patients as compared to control subjects without
psychiatric illness and to study the possible relationship between oral health and clinical variables.
Methods: Two hundred forty-two patients with bipolar disorders (BP) were examined and compared with 187 healthy individuals as
a control group (C). The DMF-T Index (sum of decayed, missing and filled teeth) and the CPI (Community Periodontal Index) and OHI
(Simplified Oral Hygiene Index) were assessed. Sociodemographic and clinical data were retrieved from hospital records.
Results: Fifty-seven percent of (n=139) of the BP patients were female, with a mean age of 35.83±9.65 years, while the proportion was
52.4% in control group, with a mean age of 37.30±8.99 years. Mean DMFT index in patient group was 10.02±5.74 for BP and 8.14±5.21
in the control group (P= 0.002). The component of the DMFT index that exhibited the greatest difference between the two groups
was decayed (D) teeth. Mean number of decayed teeth (4.58±3.57) was higher in bipolar patients than controls (2.36±2.95) (P <0.001).
However, the mean number of missing teeth were 2.72±2.54 and 3.01±2.44 in BP and C respectively, the difference was not statistically
significant (P=0.1). Dry mouth was more common among 62.8% of the BP patients compared with 6.4% of C group (P<0.001). The mean
CPI score was found to be 2.38±0.92 for study group and 1.52±1.01 for control group. The mean OHI-S score was found to be 3.04±1.29 for
study group and 2.05±1.08 for control group. CPI and OHI-S score differences between two groups are statistically significant (P<0.001).
The present study also revealed a higher prevalence of severe periodontal diseases particularly shallow pockets of 37.2% for bipolar
patients compared with 13.9% of the control group and deep pockets 9.9% for bipolar patients compared with 2.7% of the control
group (P < 0.001). D, M, F, DMFT, CPI and OHI scores were compared in different pharmacological treatment groups (mood stabilizer
monotherapy, mood stabilizer + antipsychotic combination, polypharmacy) among BP patients. The number of decayed teeth was lower
in mood stabilizer monotherapy group comparing with the polypharmacy groups (p=0.01) while the other parameters were similar in
different treatment groups (P>=0.05).
Conclusion: This study has shown that bipolar outpatients population has more carious teeth, similar extracted and filled teeth, more
advanced periodontal disease, poorer oral hygiene, and more frequent xerostomia than general population.
Keywords: oral health, bipolar disorder, periodontal disease
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S204
[PP-162] Clinical psychiatry
Ref. No: 0387
The diagnosis of “psychopathy” through the prism of ICD-10
Dmitry Romanov, Daria Smirnova
Samara State Medical University, Psychiatry, Narcology, Department of Psychotherapy and Clinical Psychology, Samara-Russia
e-mail address: [email protected]
Objective: Until 90s in the Soviet Union rubric “psychopathy” was used regarding all variants of personality disorders (PD).
Methods: 100 patients with the diagnosis of “psychopathy”, placed in a psychiatric hospital in 1970, were investigated. Clinical picture
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was considered in definitions of ICD-10.
Results: Ten patients were identified as non-suffering from PD (4 cases–schizophrenia, schizoaffective disorders; 3–disorders of sexual
preferences; 2-alcoholism; 1-mental retardation). The other patients met criteria of PD, amongst the variants the most common were the
borderline, histrionic, dissocial and avoidant PD (23.5%; 23.5%; 22%; 15%).
Manifestations of hetero/autoagression were the most common reasons of hospitalization and related to dissocial and borderline PD
accompanied by alcohol abuse and multiple violations of adaptation. Unstable ideas of persecution were found only in borderline and
paranoid PD, short-term hallucinatory states related to psychic trauma - in histrionic PD.
Conclusions: The similarity of mono axial diagnostic systems of ICD-10 and the classifier used in the USSR allows to estimate the clinical
features of patients with PD receiving inpatient treatment in 1970 from the contemporary perspective.
Keywords: ICD-10, personality disorders, psychopathy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S204-S5
[PP-163] Psychopharmacology
Ref. No: 0388
Psychotic episode during use of hypericum perforatum
Mehmet Gurkan Gurok1, Osman Mermi2, Faruk Kilic2, Fatih Canan3, Mehmet Murat Kuloglu3
Mental Health Hospital, Department of Psychiatry Clinic, Elazig-Turkey
1
Fırat University, School of Medicine, Department of Psychiatry, Elazig-Turkey
2
Akdeniz University, School of Medicine, Department of Psychiatry, Antalya-Turkey
3
e-mail address: [email protected]
In recent years, herbal therapies are gaining popularity as alternatives to prescribed drugs. St. John’s Wort (SJW), which is also named as
hypericum perforatum, is one of the most frequently used herbal agents in the treatment of psychiatric disorders. SJW has been shown
to be efficacious in treating mild to moderate depression, insomnia, and anxiety disorders. Although exact mechanism of action is not
completely understood, its active components are suggested to have antidepressant properties. Despite its beneficial therapeutic effects,
SJW can also cause unexpected side effects. Herein, we present a case of a 47-year-old female who developed a psychotic episode after
taking St. John’s wort extract. The patient had been previously well, with no previous medical or psychiatric history. Following a one-week
period of disorganized speech, bizarre behavior, delusions of reference, visual and auditory hallucinations, social/emotional withdrawal,
and self-neglect, she was admitted to psychiatry outpatient clinic. Neurological examination, electroencephalogram (EEG) and cranial
magnetic resonance imaging (MRI) were normal. The symptoms were interpreted as a psychotic episode, associated with SJW. Therefore,
SJW was stopped and intramuscular haloperidol, 10 mg/day, was started. By the seventh day of treatment, a significant improvement in
his symptoms was observed and intramuscular haloperidol was changed to oral olanzapine, 5 mg/day. The 3-month follow-up revealed
no psychotic symptoms. This case suggests that sudden onset psychotic disturbances inpatients in the absence of other known organic
factors could be related to treatment with St. John’s wort, and that cessation of this can markedly improve psychiatric morbidity.
Furthermore, treatment with antipsychotic medication can lead to alleviation of St. John’s wort associated psychotic symptoms
Keywords: herbal therapy, psychosis, St. John’s wort
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S205
[PP-164] Mood disorders
Ref. No: 0390
A case report of attempted suicide with subcutaneous cyanide injection
Tufan Gunes, Meliha Zengin Eroglu, Melike Nebioglu, Sonay Zabun, Elif Topbas, Servet Yuce
Haydarpasa Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
e-mail address: [email protected]
Objective: Suicidal behavior defined as in favor of death, in dilemma of life and death. Lethal and non-lethal suicidal behaviors are quite
a close relationship; and many people that killed himself have suicide attempts or the notion of self-harm in the past. Suicidal attempts
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Poster Presentations
with drug intoxications, organic phosphorus, corrosive substances, hanging, gunshot, jumping from high, cutting and penetrating stab
are considered as serious suicidal attempts. Similarly, suicide attempts with cyanide take place in this group. In this report, we present a
case of attempted suicide with subcutaneous injection of cyanide, which is an uncommon method.
Case: A 91-year-old male patient was evaluated in the emergency department due to attempted suicide, the patient has tried to inject
potassium cyanide. A few hours after attempt, tissue swelling has occurred and the patient admitted to an emergency room. In psychiatric
interview; its learned, the complaints of the patient were loneliness, saddieness, unhappiness, and thoughts of death. The patient was
admitted to our clinic with a diagnosis of depressive disorder.
In mental status examination; external appearance was observed to be compatible age and socio-economic level. The patient had
thoughts of worthlessness due to disease. His affect was depressed. Person, place, and time orientation were normal.
On physical examination; fever, pulse rate, blood pressure values were within normal limits. Blurred vision in his eyes. There is a
hemorrhagic necrosis of tissue in size 3 cm x 5 cm in the inner side of the left forearm. In clinical follow-up; the liver enzymes slightly
elevated in first three days. 15 mg/day doses of mirtazapine was started on fourth day and increased to 30 mg/day. Beck Depression
Rating Scale score was 29, Hamilton Depression Rating Scale score was 17. Mini-mental test score was 29 points. in the second week,
depressive symptoms decreased. The patient followed closely by the dermatology clinic. In the third week, the patient was discharged
from clinic due to the general improvement in the psychiatric statement
Conclusion: Cyanide is fast-acting poison. Cyanide disrupts the cytochrome oxidase system and thus shows toxic effects in the body. As
a result, a table of increased anion gap metabolic acidosis and normal PaO2 levels are occurs. The emergence of clinical signs of acute
intoxication varies depending on route of the drug into the body, received cyanid type and concentration. Our case reported that chosen
this suicide method to get the exact result and not to hurt anyone. In addition, the patient said that he applied injection method because
if he take cyanide orally, it may impact on other people touching him.
Our case is important because of showing that lethal methods of suicide attempt can occur in elderly patients with depression.
Keywords: cyanide injection, suicide attempt
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S205-S6
[PP-165] Psychopharmacology
Ref. No: 0393
Fluoxetine induced hair loss: a case report
Osman Mermi1, Murad Atmaca1, Faruk Kilic1, Mehmet Gurkan Gurok2, Murat Kuloglu3
Fırat University, School of Medicine, Department of Psychiatry, Elazig-Turkey
1
Mental Health Hospital, Department of Psychiatry Clinic, Elazig-Turkey
2
Akdeniz University, School of Medicine, Department of Psychiatry, Antalya-Turkey
3
e-mail address: [email protected]
Hair loss is a frequent adverse effect that may occur by psychotropic drug use and that can remit by its cessation. It may be observed
some side effects such as skin rush, urticaria, and skin eruptions induced by Selective Serotonin Re-uptake Inhibitors (SSRIs). In addition
to these dermatologic side effects, hair loss conditions extending to alopecia have been reported. In this paper, we report a case who had
fluoxetine-induced pervasive hair loss returning after its discontinuation.
Keywords: fluoxetine, hair loss, side effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S206
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[PP-166] Psychopharmacology
Ref. No: 0397
Delirum induced with escitalopram: a case report
Serhat Nasiroglu1, Muhammet Tayyib Kadak2, Mehmet Selcuk Bektas3, Suleyman Gulsen3
Van Women’s and Children’s Hospital, Department of Child and Adult Psychiatry, Van-Turkey
1
Istanbul University, Cerrahpasa Medical Faculty, Department of Child and Adult Psychiatry, Istanbul-Turkey
2
Van Women’s and Children’s Hospital, Department of Child and Adult Psychiatry, Van-Turkey
3
e-mail address: [email protected]
Delirium is described as a sudden onset organic brain syndrome characterized by a disturbance of consciousness with reduced ability
to focus, sustain, or shift attention resulted from physical or pathophysiological reasons. The important causes of delirium in the central
system diseases, pharmacological and non-toxic materials, or poisoning or starvation. Here, we report a case of 9 years old children who
developed escitalopram-induced delirium. 9 year-old girl was admitted to emergency with difficulty in breathing, inability to remember her
family and delusion because of received three escitalopram 10 mg pills accidentallly. On psychiatric examination, she had disorientation,
hallucinations and inappropriate responses to the questions. Her physical and neurological examinations were unremarkable. Laboratory
results were normal. Therefore, her diagnosed was considered as delirium and patient improved with haloperidol. Selective Serotonin
Reuptake Inhibitor (SSRI), group of antidepressants, increases the rate of pre-and postsynaptic via serotonin transporter inhibition. It was
suggested that delirium may result from interaction between monoaminergic and cholinergic system. Excess or deficiency of serotonin
may be associated with cholinergic deficiency and predispose to delirium.
Keywords: escitalopram, delirium, child
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S207
[PP-167] Dementia
Ref. No: 0398
Assessment of neutrophil - Iymphocyte ratio in Alzheimer’s disease and major
depressive disorder patients
Merve Sahin Can1, Elif Gulsah Yilmaz1, Ozgur Baykan2, Hayriye Baykan1, Tunay Karlidere1
Balıkesir University, School of Medicine, Department of Psychiatry, Balikesir-Turkey
1
Marmara University, School of Medicine, Department of Biochemistry, Istanbul-Turkey
2
e-mail address: [email protected]
Objective: The Blood Neutrophil-Lymphocyte Ratio (NLR) is an inexpensive and easily applicable method for the determination of
inflammation. The recent studies often focused on the effect of inflammation in the etiology of neurological and psychiatric diseases.
In a study investigating the role of inflammation in the pathogenesis of Alzheimer’s Disease (AD), NLR had 69.3% sensitivity and 79.4%
specificity for the prediction of AD with a cutoff value of 2.48. In another study, increased leukocyte count was showed in stress-related
suicidal behavior and this was independent of the drugs. In this study, we aimed to evaluate if there is a relationship between inflammation
and Major Depressive Disorder (MDD) and AD via NLR, also to assess if this relationship can be used in the differential diagnosis of retarded
depression and AD in geriatric population.
Method: In this study, we used retrospectively the blood test results of 21 retarded MDD patients and 26 AD patients over 55 age who
attended in Balikesir University School of Medicine Department of Psychiatry Outpatient Clinic, between June 2012 and June 2013. The
SPSS 15.0 statistical package program was used for statistical analyses of the data and statistical significance level of p<0.05 was considered.
Results: In this study, NLR was 2.74±1.20 in patients with AD and 2.09±0.75 in patients with MDD and the difference between them was
statistically significant (p= 0.03).
Conclusion: According to this preliminary study, NLR may play a role as a biological indicator for distinguishing old age retarded MDD and
AD patients. There are limited studies in this area and as far as we know this is the only one comparing AD and MDD patients. Therefore,
it would be better to confirm those results with further studies of larger samples having control groups.
Keywords: neutrophil - lymphocyte ratio, major depressive disorder
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S207
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[PP-168] Psychopharmacology
Ref. No: 0399
Amisulpride-induced maculopapular rash: a case report
Handan Metin1, Urun Ozer2, Sakir Ozen2, Guliz Ozgen2
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
1
Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Psychiatry, Istanbul-Turkey
2
e-mail address: [email protected]
Antipsychotic agents have been reported to cause cutaneous side effects in 5% of patients. The most common ones were skin
pigmentation changes and photosensitivity. Although rash has been known to caused by antipsychotics infrequently, risperidone and
olanzapine have been associated with a rate of rash in %2-5 and %1 of patients respectively. Amisulpride is an atypical antipsychotic
approved for the treatment of schizophrenia. Cutaneous side effects of amisulpride are very rare and there are only few cases which have
been reported. We hereby report the following case of amisulpride-induced maculopapular rash in a psychotic patient.
A 27- year-old male, with a history of psychotic symptoms for four years, was admitted and hospitalized to our clinic because of somatic
and persecutory delusions, olfactory hallucinations and negative symptoms. He was put on haloperidol 20 mg/day and biperidene 10 mg/
day IM, thereafter he was given haloperidol 20 mg/day and biperidene 4 mg/day p.o in the eighth day of his admission. Due to the lack of
any clinical improvement, haloperidol gradually reduced as 15, 10 and 5 mg/day and stopped, while amisulpride was started as 400 mg/
day and gradually increased to 600 and 800 mg/day in twentieth day. Seven days after the initiation of amisulpride, the patient developed
maculopapular rash on his arms and shoulders bilaterally with itching. Hydroxyzin was added to treatment in the dose of 50 mg twice
daily. Three days later, when the rash increased and spread to his face (his nose and forehead), amisulpride was stopped immediately and
the treatment was switched to risperidone 6 mg/day. Three days after the discontinuation of amisulpride, the rash started to decrease and
disappeared on the face. Within a week a significant improvement was obtained. There was no previous medical illness and the patient
denied the recent use of new soaps, creams or different foods. General physical and neurological examinations were unremarkable except
cutaneous lesions. His laboratory tests and cranial MRI findings were normal. With the exception of cutaneous side effects the patient
tolerated amisulpride well, no other side effects were observed and he had a good clinical response.
Cutaneous side effects are very rarely seen with amisulpride and to our knowledge there are only three cases which have been reported
in the literature. Bhatia and Chaudhary (2007) have reported amisulpride induced pityriasiform eruption. Misra et al. (2012) have reported
flagellate erythema followed by pigmentation and photosensitivity. Another case with photosensitivity has been also reported. In our
case, the maculopapular rash has been probably associated with amisulpride due to the appearance of rash shortly after the initiation of
drug and rapid disappearance after discontinuation. The rechallenge could not be given due to ethical grounds. Discontinuation of the
drug and switching to an alternative treatment could be beneficial in similar cases. The case is significant to describe a cutaneous side
effect of amisulpride and to be the first case report to indicate a maculopapular rash induced by amisulpride.
Keywords: amisulpride, rash, side effect
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S208
[PP-169] Clinical psychiatry
Ref. No: 0400
ECT treatment during the manic episode a treatment-resistant patient with
bipolar disorder and comorbid epilepsy
Semra Karayilan, Hilal Yigit, Ertac Sertac Orsel, Mustafa Ozten, Atila Erol
Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya-Turkey
e-mail address: [email protected]
In recent studies it is pointed out that manic or hypomanic symptoms are not rare in epilepsy. In a study revealed that 11.8% of 143
adult outpatients with epilepsy had DSM-based diagnosis of BD, but only 2 patients (1.4%) of whom could be considered as having ‘‘pure
BD”, when excluded BD symptoms such as interictal dysphoric disorder of epilepsy, postictal manic or hypomanic states, and preictal
dysphoria. There are similarities between epilepsy and BD with regard to both of them are episodic end chronic. In addition, antiepileptic
drugs are used in treatment of both two disorders. While in 30% of epilepsy patients, a drug-resistant course of the illness develops,
40% of bipolar patients do not respond sufficiently to lithium and need alternative treatments. Although ECT is used in BD rarely, ECT
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remains as an important option for resistant patients. For acut mania, two prospective-controlled studies have compared ECT to lithium
and lithium+haloperidol and in both two studies ECT was found more effective than medical treatment. According to a review ECT is
associated with remission or marked clinical improvement in 80% of those treated.
Case: A 28 year-old female patient was brought to our clinic with complaints of irritability, talking too much, insomnia, thinking of an
important one and people talk about herself on television, auditory hallucinations and consequently delusions of reference, persecutory
and erotomanic. It is learned despite of her regular treatment (valproatee, paliperidone and quetiapine), she had manic episodes almost
every year and residual manic symptoms continued in intervals of episodes. Valproatee used as a mood stabilizer was stopped because
of not seen effectively and lithium 900 mg and 1200 mg quetiapine was started for manic syndromes. Due to unresponsiveness to the
treatment aripiprazole and haloperidol were added and respectively upgraded 30mg and 20 mg. Nevertheless, effective response could
not occurred for 5 weeks with oral therapy. For this reason, electroconvulsive therapy (ECT) was planned for the patient. After seven
sessions of ECT, the symptoms markedly reduced. We decided to stop ECT and the drug therapy of patient was arranged as lithium 1200
mg, quetiapine 1200 mg, haloperidol 20 mg, risperidone 8mg. But one week later, due to recurrence of manic symptoms, three sessions
of ECT were performed to the patient again. The patient with highly resistant antipsychotics and mood stabilizers was kept under
observation for one more week, after complete remission related with the total of ten sessions of ECT. Then her maintenance therapy was
prescribed and she was discharged proposed frequent follow-up.
In our case, valproatee also an antiepileptic and lithium very effective mood stabilizer in mania were found failed. In addition the patient was
resistant to typical and atypical antipsychotics such as haloperidol, quetiapine and aripiprazole. Previously, a case of drug-resistant and ECTresponded BD mania comorbid with epilepsy was not reported in the literature, in this context we think that discussed above the case is important.
Keywords: treatment-resistant bipolar disease, epilepsy
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S208-S9
[PP-170] Childhood and adolescence disorders
Ref. No: 0403
Changes in the preference of the psychotropic drugs in child and adolescent
psychiatry outpatient practice in five years
Cilem Bilginer, Busra Duran, Canan Ince, Selma Tural Hesapcioglu, Sema Kandil
Karadeniz Technical University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Trabzon-Turkey
E-mail : [email protected]
Objective: Our aim is to evaluate the distribution of psychiatric diagnoses and the changes in preferred psychotropic medication in
patients who are admitted to the child and adolescent psychiatry outpatient clinic of a university hospital at two different time periods,
including the years of 2007 and 2012.
Methods: The files of patients who were admitted to the child and adolescent psychiatry outpatient clinic between January 2007-June
2007 and January 2012- June 2012 were examined retrospectively. Data of cases including diagnosis and treatments, for a period of 1 year
from the first examination, were entered to a database and required statistics were applied by using SPSS 13.0.
Results: The records of 733 patients in 2007 (n= 257 female, n= 476 male) and 968 patients in 2012 (n= 440 female, n= 528 males) were
examined in the study. The mean age of the patients was 7.1±2.5 years in 2007, and 8.8±3.9 years in 2012. Differences of ages were
statistically significant (p<0.05, t= -10.31). At least one drug was preferred for 43, 8% of patients in 2007, this ratio was increased 45.7% (n=
442) in 2012. While 86.1% of the patients (n = 631) in 2007 were diagnosed to have at least one psychiatric disorder; this ratio in 2012 was
89.8% (n = 869). In addition, while the most preferred drugs for initial therapy were antidepressants, antipsychotics and anxiolytics in 2007,
it was antidepressants, antipsychotics and stimulants in 2012. Also, in ADHD treatment, antidepressants, stimulants and antipsychotics
were the primarily preferred group in 2007, but in 2012, stimulants, antipsychotics and atomoxetine were the most preferred drugs.
Conclusions: In this study, changes in distribution of diagnoses and treatment choices in child and adolescent psychiatry practice
in five-years period were investigated. In the observed period, the changes in treatment practices in child and adolescent psychiatry
were thought to be associated with the emergence of new treatment options and the beginning of significant changes in previous
pharmacotherapeutic interventions.
Keywords: child and adolescent psychiatry, outpatient practice, psychotropic medication
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[PP-171] Treatment guidelines
Ref: No: 0404
The use of clozapine for the treatment of Parkinson’s disease
Emel Basoglu1, Yasemin Simsek2, Betul Ozdilek1
Erenkoy Training and Research Hospital for Psychiatry, Department of Psychiatry, Istanbul-Turkey
1
Haydarpasa Numune Training and Research Hospital, Istanbul-Turkey
2
e-mail address: [email protected]
Idiopathic Parkinson Disease (PD) is a motor system disease, which is resulted in loss of dopaminergic neurons in substantia nigra and
clinically demonstrated by resting tremor, bradykinesia, rigidity, and postural reflex disturbance. Levodopa, COMT enzyme inhibitors,
MAO inhibitors, amantadine, anticholinergics are used for treatment of PD. Recently; atypical psychoticantipsychotic drugs are used
for resistant cases and psychotic symptoms that are potentially caused by PD treatment. It is aimed to report a a nonresponder case to
antiparkinson treatment and whose psychotic symptoms have not regressed with other atypical antipsychotics but with clozapine.
A 67-year-old male, who lives with his family. He applied neurology policlinic with symptoms such bradykinesia, akinesia, tremor,
walking difficulty, suspicious thoughts, thought of being followed and harmed by people. The patient has had suspicious thoughts for
10 years, whereas tremor and bradykinesia at right hand for 7.5 years. Levodopa-carbidopa-entacapone treatment was started as first
line treatment in an external clinic. The patient’s bradykinesia started to decrease but amantadine was added on the existing treatment
due to contractions around mouth and right toe. Rasagiline and ropirinole was added to treatment 2 years before but the result was
limited. The patient was treated at psychiatry clinic for persecution and reference delusions at 2011 and discharged on aripiprazole
30 mg/day. The patient was hospitalized to neurology clinic in September 2012 due to onset of bradykinesia and his treatment was
redesigned as levodopa-carbidopa-entacapone 750mg/day, rasagiline 1mg/day, ropirinole 14mg/day and quetiapine 100mg/day. The
patient’s neurological picture under this treatment involved resting tremor at upper extremities, 2+ rigidity at right upper extremity, 1+
rigidity at left upper extremity, 1+ bradykinesia at both upper extremities and bradimimia. He had ortostatic hypotension. The patient
was transferred to psychiatry clinic due to paranoid and persecutive delusions had appeared and olanzapine 5 mg/day was started and
its dose was increased to 10 mg/day but delusions didn’t regress and motor disfunctions worsened. Then olanzapine was stopped and
clozapine was started. The patient was transferred to neurology clinic again due to regression of psyhcotic symptoms. The patient was
discharged with bradykinesia and akinesia on levodopa-benserazide 1500mg/day and clozapine 50mg/day. The patient was stabile
during his policlinic controls.
The patient’s suspicious thoughts and persecutive delusions started 10 years before and increased in time. Bradykinesia started 4 years
ago. About 1% of patients with newly diagnosed PD have psychotic symptoms in recent studies. Research proved that clozapine was
useful for Parkinson’s patient with resistant visual hallucinations and motor symptoms were deteriorated by using olanzapine and
quetiapine. The researchers also proved that clozapine is the most effective treatment in 10-year survey of 32 Parkinson’s patients with
psychotic symptoms.
Keywords: Parkinson’s disease, clozapine, psychosis
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S210
[PP-172] Clinical psychiatry
Ref. No: 0407
An epileptic psychosis associated with self-injurious behavior, a possible
new syndrome: a case report
Nur Yalcin Yetisir, Fatma Ozlem Orhan, Ebru Findikli
Kahramanmaras Sutcuimam University, Faculty of Medicine, Department of Psychiatry, Kahramanmaras-Turkey
e-mail address: [email protected]
Psychosis in epilepsy is mainly distinguished from the affective, schizophrenic, and cognitive domains by symptoms such as mood
instability, anxiety, hallucinations and delusions, and confusion. Though its being rare, self-injurious or mutilating behavior is seen in
seizure cases. In this report, we present an epileptic psychosis case with self-injurious behaviour. The patient was a 27-year-old primary
school graduate, unemployed, single female, who had been admitted to our Psychiatry Clinic because of self injurious behaviors as well
as visual and auditory hallucinations. Self-injurious behavior was reported to happen once a year for 3 years, suddenly begins, repeats the
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same word, and continues 1-2 hours. She carves up her arms with knife or a razor blade; she says a white-bearded man says he wants to
do it. During such episodes, which lasted for one hour, she could not be influenced and she manifested restlessness.
Furthermore she had mental and developmental retardation, retinitis pigmentosa, ventricular septal defect and hypogonadotropic
hypogonadism. During the interview, she was speaking slowly. Her mood was low; affect was appropriate to her mood. Extensive
neurological, somatic, and laboratory examination and magnetic resonance imaging of the brain, revealed no abnormalities.
Electroencephalogram showed bilateral generalized sharp wave activity (left was more pronounced than right). The purpose of this
report to discuss clinic aspect of psychosis in epilepsy with self-injurious behavior with the related literature and to emphasize that in all
psychiatric patients, who were suspected for organic etiology, complete history, physical and neurological examinations and appropriate
testing are essential for primary diagnosis. We also aimed to collect attention to a possibly new syndrome associated with other medical
conditions accompanying epileptic psychosis.
Keywords: epileptic psychosis, self-injurious behavior
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S211-S2
[PP-173] Schizophrenia and other psychotic disorders
Ref. No: 0410
Worsening of psychotic symptoms due to abuse of modafinil: a case report
Gamze Erzin1, Elif Tatlidil Yaylaci1, Merve Cingi Kuluk1, Neslisah Atguden2, Makbule Cigdem Aydemir1, Erol Goka1
Ankara Numune Training and Research Hospital, Department of Psychiatry, Istanbul-Turkey
1
Erenkoy Training and Research Hospital for Psychiatry, Department of Psychiatry, Istanbul-Turkey
2
e-mail address: [email protected]
Several studies reported that it causes alterations in mood, thinking and feelings as seen with other central nervous system stimulants,
although modafinil has gained popularity among clinicians due to its low abuse potential. There is a case related to abuse of modafinil
in supratherapeutic doses. The data with regard to its use in toxic doses are also limited. Modafinil toxicity levels vary widely among
species. In clinical trials on humans, taking up to 1200 mg/day for 7 to 21 days or one-time doses up to 4500 mg did not appear to cause
life-threatening effects, although a number of adverse experiences like agitation, insomnia, anxiety, irritability, tremor and cardiovascular
changes were observed. In addition to this, there have been concerns about possible psychosis inducing properties of supratherapeutic
doses of modafinil. Modafinil induced psychosis may be related to its indirect dopaminergic action through inhibition of GABA secretion
and direct dopaminergic action through inhibition of dopamine reuptake. It is plausible that modafinil could exacerbate psychosis. A
case report about a 61-year-old patient on clozapine treatment suggested worsening of psychotic symptoms due to modafinil use and
improving of those symptoms with cessation of modafinil. Also in a study which was investigating modafinil effects on schizophrenic
patients, while most patients appear to tolerate the drug well, several cases have been reported where patients, who received modafinil
suffered from psychotic relapse or worsening of already existing psychotic symptoms. In this case presentation, we intend to emphasize
that modafinil might have an aggravating effect on psychotic symptoms and attention must be paid to modafinil abuse in clinical practice.
A 29-year-old male patient, started to use modafinil 9 months ago because of hypersomnia and continued to use it at a dose of 200 mg/d
for 5 months. After 5 months, since he was feeling angry, slumbery and he had difficulty to concentrate, the patient increased his daily
modafinil use up to 2000-3000 mg/d without consulting any physician. When patient applied to our clinic, he hadn’t been using modafinil
for 4 days; delusions of reference and jealousy were noticed in his examination. Psychotic symptoms of the patient, who was treated with
olanzapine 20 mg/d for 28 days of hospitalization, subsided in a few weeks. In his outpatient follow-up, he continued to get 10mg/d of
olanzapin treatment. In further follow up, patient stated that he used 800 milligrams of modafinil 20 days ago, and aggravation of his
psychotic symptoms were observed while he was treated with olanzapine 10 mg/d. He is still in our clinic’s follow-up programme with
the diagnosis of psychotic disorder.
It is known that substance and drug abuse is higher in individuals with psychotic disorder than the general population. In our case, in
addition to abuse of modafinil; it was seen that there were increase in psychotic symptoms due to abuse of modafinil even while using
antipsychotic medication. Clinicians should bear in mind that there may be abuse of modafinil in patients with psychotic disorder and
this abuse may cause worsening of psychotic symptoms.
Keywords: modafinil, psychotic disorder
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[PP-174] Psychopharmacology
Ref. No: 0411
Mania in Cushing’s syndrome: a case report
Mine Sahingoz, Keziban Turgut, Erdem Onder Sonmez
Necmettin Erbakan University, Konya-Turkey
e-mail address: [email protected]
Cushing’s syndrome, characterized by hypercortisolism, must be considered in the differential diagnosis of such common clinical problems
as hirsutism, hypertension, diabetes mellitus, and obesity and psychiatric disorders. Cushing’s syndrome patients often suffer from major
psychiatric syndromes, most often depression. Neuropsychiatric abnormalities are frequently associated with Cushing’s syndrome.
A 52-year-old woman was referred to our clinic in 2012, because of night-time sleeplessness, psychomotor excitation, hyperactivity,
distractibility, flight of ideas, and grandiose delusions. She had been diagnosed as diabetes mellitus and hypertansion on the course of
her first manic episode when she was 48 years old in 2009. She has central obesity, facial plethora, hirsutism, abdominal striae, moon
face. Investigations showed sodium 137 mmol/L, potassium 2,5 mmol/L. Plasma glucose was 223 mg/dL and hemoglobin A1C 7,9%.
Substantially increased values for 24-hour urinary free cortisol (1957 µg/d; reference range, <50), serum cortisol (40 µg/dL; reference range,
8 to 25), and plasma ACTH (178 pg/mL; reference range, 6 to 59) were found, and a diagnosis of ectopic Cushing syndrome was made.
This case was diagnosed as Cushing’s syndrome on the course of her second manic episode. Cushing’s syndrome is frequently
accompanied by mood disorders, which may be the predominant symptom, and can take many forms, ranging from mania to severe
depression. A study reported that, Cushing’s syndrome might refer to clinic only by manic episodes, without any typical symptom. It
should be considered that manic or depressive episodes of acute onset might be caused by Cushing’s syndrome.
Keywords: Cushing’s syndrome, mania
Bulletin of Clinical Psychopharmacology 2013;23(Suppl. 1):S212
[PP-175] Psychopharmacology
Ref. No: 0412
Aripiprazole-induced exanthematous rash
Erdem Onder Sonmez, Mine Sahingoz
Necmettin Erbakan University, Konya-Turkey
e-mail address: [email protected]
Dermatologic side effects of drugs are very common in clinical practice. Although dermatological side effects are commonly associated
with psychotropic drugs like lamotrigine and lithium, other psychotropic drugs such as antidepressants and antipsychotics may also
cause dermatological side effects. While these side effects can be treated by simple interventions; in some cases more serious side effects
can be seen like Steve Johnson and Dress syndrome that have high mortality risk. Herein we present a case of exanthematous rash seen
after aripiprazole usage.
A 21-year-old, unemployed, single male patient. His first complaints were persecution and guiltiness delusions and auditory hallucinations
about 5 years ago. He was diagnosed to have schizophrenia and hospitalized. After ECT (Electroconvulsive therapy) treatment, he was
discharged with Risperdal Consta 50 mg and Solian 200 mg/day and remission is obtained by this treatment. Since the patient didn’t take
his pills regularly, aripiprazole 15mg/day was added to his treatment. After the patient started to take Aripiprazole, exanthematous rash
arised on the dorsum of his hand and got worsened in the following 15 days. He was consulted by dermatology clinic for this complaint.
As this exanthematous rash was though to be associated with aripiprazole, aripiprazole treatment was discontinued. At the tenth day of
discontinuation of aripiprazole, total recovery was seen on the exanthematous rash. His treatment was arranged with quetiapine 800mg/
day, lithium 1800mg/day, Risperdal Consta 50mg and his symptoms remitted with this treatment.
A literature search based on the key words “aripiprazole”, “exanthematous”, “eczema”, “rash” yields no case report about exanthematous
rash associated with aripiprazole usage. In one case, papulopustular rash on the nose and forehead associated with aripiprazole usage
was reported. There are few reports about aripiprazole associated hypersensitivity reactions as anaphylactic reaction, angioedema, nettle
rash and pruritus. In anoth