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    A multinational study to pilot the modified Hypomania Checklist (mHCL) in the assessment of mixed depression
    (Elsevier Science Bv, 2014) Altinbas, Kursat; Ozerdem, Aysegul; Prieto, Miguel L.; Fuentes, Manuel E.; Yalin, Nefize; Ersoy, Zeliha; Aydemir, Omer
    Background: Mixed depression is a common, dimensional phenomenon that is increasingly recognized in unipolar and bipolar disorders. We piloted a modified version of the Hypomania Checklist (mHCL-32) to assess the prevalence and clinical correlates of concurrent manic (hypo) symptoms in depressed patients. Methods: The mHCL-32, Young Mania Rating Scale (YMRS) and Hamilton Rating Scale for Depression (IAMD-24) were utilized in the assessment of unipolar (UP=61) and bipolar (BP=44) patients with an index major depressive episode confirmed by the Structured Clinical Interview for DSM-IV (SCID). Differential mHLC-32 item endorsement was compared between UP and BR Correlation analyses assessed the association of symptom dimensions measured by mHCL-32, YMRS and HAMD-24. Results: There was no significant difference between mood groups in the mean rnHCL-32 and YMRS scores. Individual mHLC-32 items of increased libido, quarrels, and caffeine intake were endorsed more in BP vs. UP patients. The mHCL-32 active elevated subscale score was positively correlated with the YMRS in BP patients and negatively correlated with HAMD-24 in UP patients. Conversely, the mHCL-32 irritable risk taking subscale score was positively correlated with HAMD-24 in BP and with YMRS in UP patients. Limitations: Small sample size and cross-sectional design. Conclusion: Modifying the HCL to screen for (hypo) manic symptoms in major depression may have utility in identifying mixed symptoms in both bipolar vs. unipolar depression. Further research is encouraged to quantify mixed symptoms with standardized assessments. (C) 2013 Published by Elsevier B.V.
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    Affective Temperament Profiles in Patients with Multiple Sclerosis: Association with Mood Disorders
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2016) Ozkan, Adile; Altinbas, Kursat; Koc, Emine Rabia; Sen, Halil Murat; Karaman, Handan Isin ozisik
    Introduction: The aim of the present study was to screen for bipolarity and to investigate the affective temperaments of patients with multiple sclerosis (MS) and the possible association between the clinical and demographic characteristics of MS patients and temperament profiles. Methods: A total of 65 patients with MS and 66 healthy volunteers completed the 32-item hypomania checklist (HCl-32), the Mood Disorder Questionnaire (MDQ), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) tests. The HCl-32, MDQ, and TEMPS-A scores were compared between the patients and healthy volunteers. Results: MS patients had significantly higher scores for the depressive, cyclothymic, irritable, and anxious domains of the TEMPS-A scale than the control group, whereas relapsing remitting MS (RRMS) patients had higher MDQ and TEMPS-A hyperthymia scores than secondary progressive MS patients. MS patients who were being treated with interferon beta 1-b therapy had significantly higher MDQ scores than those being treated with interferon beta 1-a, glatiramer acetate, or who were without medication. Expanded Disability Status Scale (EDSS) scores were positively correlated with TEMPS-A depressive and hyperthymic temperaments. Conclusion: Our results suggest that higher scores for affective temperament in MS patients indicate subclinical manifestations of mood disorders. Higher hyperthymia scores and manic symptoms detected in the RRMS group could shed light on the relationship between bipolarity and MS. Thus, the screening of bipolarity and affective temperament profiles in MS patients could help clinicians predict future mood episodes and decrease their impact on disease severity.
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    Affective Temperament Profiles of Overactive Bladder Patients
    (Aves, 2014) Saribacak, Ali; Altinbas, Kursat; Yilmaz, Hasan; Ozkan, Alp; Ozkan, Levend; Oral, Timucin
    Introduction: Overactive bladder (OAB) is generally characterized by urinary urgency with or without incontinence and increased frequency of voiding and nocturia. Although animal studies have demonstrated the relationship between defective serotonergic neurotransmission and OAB, its etiology is still unclarified. Temperament profiles are hypothesized to be related with serotonergic activity and are studied in many psychosomatic disorders. Thus, we assume that OAB is related with a certain type of temperament. Method: 29 patients, who were admitted to the urology outpatient clinic at Kocaeli University and clinically diagnosed with OAB syndrome, were recruited for the study. Temperament profiles were evaluated with the Temperament Evaluation of Memphis Pisa Paris and San Diego Autoquestionnaire (TEMPS-A). Depressive, hyperthymic, cyclothymic, anxious and irritable temperament scores in patients were compared with those in 25 healthy controls. Results: Patient and control groups were similar in terms of age (p=0.65), sex (p=0.64) and educational level (p=0.90). Anxious temperament scores were higher (p=0.02) and hyperthymic temperament scores were lower (p=0.02) in patients with OAB compared to controls. Depressive, cyclothymic and irritable temperament scores were similar in both groups. There was no significant differences between men and women in both groups in terms of different temperament profile scores. Conclusion: Hypothetically, there might be an association between anxious temperament and OAB syndrome reflecting serotonergic dysfunction. However, OAB syndrome must be considered from the aspect of the interdependence of psychosomatic implications in a narrow sense and psychosomatic dimensions due to the psychological predisposition in the individual case.
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    Affective Temperament Profiles of Overactive Bladder Patients Reply
    (Aves, 2016) Saribacak, Ali; Altinbas, Kursat; Yilmaz, Hasan; Ozkan, Alp; Ozkan, Levend; Oral, Timucin
    [Anstract Not Available]
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    An Unusual Case: The Comorbidity of Mood Disorder and 17-?-Hydroxylase Deficiency
    (Aves, 2013) Tunc, Serhat; Yigiter, Sera; Altinbas, Kursat; Kurt, Erhan; Oral, Timucin
    17-alpha-hydroxylase enzyme has a crucial role in the steroid biosynthesis and, deficiency of this enzyme is an autosomal recessive monogenic disorder which is one of the two hypertensive form of congenital adrenal hyperplasia. It is characterized with the deficiency in glucocorticoid, adrenal androgen, and sex steroid synthesis with concomitant mineralocorticoid excess due to genetic defect in steroid biosynthesis. The relationship of hormone system physiology with psychiatric signs and syndromes are complex. Any problem in the hypothalamo-pituitary axis may cause psychiatric syndromes. On the other hand, many psychiatric disorders, such as mood-anxiety symptoms, depression, mania, psychosis, and delirium can be seen secondary to the treatment of hormone deficiency. We present the case of a male patient with pseudohermaphroditism who has been followed and treated in Rasit Tahsin Mood Clinic with the diagnosis of mood disorder not otherwise specified and was diagnosed with 46,XY karyotype and 17-alpha-hydroxylase deficiency after referring to a hospital with delayed puberty. Considering the medical literature, 17-alpha-hydroxylase deficiency has been evaluated from the aspects of gender-related behavioral disorders, psychological developmental and anxiety disorders. To the best of our knowledge, in the medical literature, this is the first case of 17-alpha-hydroxylase deficiency associated with mood disorder. Here, the relationship between mood disorders and hypothalamo-pituitary axis is discussed in the light of the literature.
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    CLINICAL POTENTIAL OF CARIPRAZINE IN THE TREATMENT OF ACUTE MANIA
    (Medicinska Naklada, 2013) Altinbas, Kursat; Guloksuz, Sinan; Oral, Esat Timucin
    Cariprazine (RGH-188, trans-4-{2-[4-(2,3-dichlorophenyl)-piperazine-1-yl]-ethyl}-N,N-dimethylcarbamoyl-cyclohexyl-aminehydrochloride), is a novel antipsychotic with dopamine D2 and D3 receptors antagonist-partial agonist properties. Cariprazine has also moderate affinity for serotonin 5-hydroxytryptophan (5-HT) 1A receptors, high affinity for 5-HT1B receptors with pure antagonism and low affinity for 5-HT2A receptors. Randomized, double blind, placebo controlled, flexible-dose (3-12 mg/day) studies have demonstrated cariprazine is effective in both schizophrenia and acute manic episodes associated with bipolar disorder. The incidence of serious adverse events in cariprazine arm was no different than in placebo arm in these studies. The most common adverse events were extrapyramidal symptoms, headache, akathisia, constipation, nausea, and dyspepsia which can be explained with cariprazine's partial dopamine agonism. Although cariprazine treatment was associated with a higher incidence of treatment-emergent adverse events, particularly akathisia and tremor, common side effects of marketed second generation antipsychotics such as weight gain, metabolic disturbances, prolactin increase or QTc prolongation were not associated with cariprazine, probably due to its moderate to low binding affinity for histamine H1 and 5-HT2C receptors. Animal studies show that cariprazine may have additional therapeutic benefit on impaired cognitive functioning with D3 receptor activity, however clinical data is still scarce. The aim of this article is to review the potential use of cariprazine for the treatment of acute manic episodes in the light of the preclinical and clinical trials reported to date.
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    Comparison of sociodemographic and clinical characteristics of bipolar type 1 patients on single or double mood stabilizers treatment
    (Yerkure Tanitim ve Yayincilik, 2015) Yilmaz, Filiz Dere; Yavuz, Kaasim Fatih; Altinbas, Kursat; Lordoglu, Dilek Yesilbas; Kurt, Erhan
    Objective: Purpose of the current study is to compare the demographic and clinical characteristics, prognoses and episode characteristics between patients on a single mood stabilizer treatment and those on double mood stabilizer treatment. Methods: The follow-up files of 167 patients who met DSM-IV-TR criteria for bipolar-I disorder were examined retrospectively. Patients were divided into two groups, with 136 patients on a single mood stabilizer and 31 patients on double mood stabilizer treatment. Sociodemographic and clinical characteristics of the groups were evaluated. The data derived from the study were analyzed with SPSS (Statistical Package for Social Sciences) for Windows 17.0. The data were evaluated with chi-square and t test. Results: The number of women was significantly higher in the single mood stabilizer group. The total number of episodes and hospitalizations were higher in patients on double mood stabilizer treatment compared to the single mood stabilizer group. When comparing within the single medication group, the total number of episodes and hospitalizations in patients using Lithium were significantly lower than in patients on valproat. Conclusion: Patients medicated with double mood stabilizer may be more difficult to treat and have a poorer prognosis than patients medicated with a single mood stabilizer. The number of female patients was greater in the single mood stabilizer group, which may indicate a generally more positive outcome in women. However, this research was cross-sectional and had a relatively low sample size, making it rather difficult to come to a more definite conclusion. Therefore, follow-up studies with a greater number of patients on a single mood stabilizer over an extended period of time are required.
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    Comparison of temperament and clinical features of bipolar disorder patients with and without suicide attempt history
    (Cumhuriyet Univ Tip Fak Psikiyatri Anabilim Dali, 2014) Tunc, Serhat; Yenilmez, Yelda; Altinbas, Kursat
    Objective: Suicide attempt is quite frequently encountered in the course of bipolar disorder (BD). In recent years many studies were conducted for examining the relationship between temperamental characteristics and clinical characteristics of patients with BD. The aim of this study is to compare the specific temperament features and clinical features of BD patients with and without a history of suicide attempt (SA) to test the hypothesis that depressive, cyclothymic and irritable temperament scores are higher in bipolar patients with suicide history. Methods: We enrolled a total of 100 patients, 50 of them with a history of SA, 50 without at Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery. All patients were diagnosed according to DSM-IV-TR criteria for 'bipolar disorder in remission' and signed a written informed consent before study entry. Sociodemographic data were collected and temperament was assessed by the means of TEMPS-A. Results: Depressive, cyclothymic and irritable temperament scores were significantly higher in BD patients with SA than in those without. Moreover cigarette and alcohol consumption, family history for psychiatric illness, presence of other psychiatric disorders, history of childhood trauma, episode duration, history of hypo/manic switch were also significantly higher in the group with than without SA. Discussion: Our study confirmed other findings reported in the literature on risk factors associated with suicide behavior. In addition, we also found that depressive, cyclothymic and irritable temperament scores are higher in patients with SA. The assessment of temperament could be added in the evaluation of patients in order to predict possible suicide behavior.
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    Comparison of Temperamental Features, Anxiety, and Depression Levels Between Non-Cardiac Angina and Acute Coronary Syndrome
    (Aves, 2014) Gumuser, Fatih; Altinbas, Kursat; Caglar, Ilker Murat; Ungan, Ismail
    Introduction: In many studies that are aimed to determine the psychological profile of patients admitted to the emergency unit with non-cardiac angina (NCA), it was indicated that psychiatric problems, less effective problem-solving, and alexithymia are more common in NCA compared with acute coronary syndrome (ACS) patients. In this study, aiming to find predictive psychological clinical features, we compared the temperament, anxiety, and depression scores of patients with NCA and ACS. Methods: Sociodemographic variables of 63 patients (n=41 NCA, n=22 ACS) who were admitted to the emergency unit with chest pain were recorded. TEMPS-A scale was used for defining temperamental features, and Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression levels of patients in both groups. Sociodemographic variables and TEMPS-A and HADS scores were compared with chi(2) and independent-groups t-test between the NCA and ACS groups. Results: The NCA and ACS groups were similar in terms of sociodemographic variables. There was no statistical difference between groups in HDS (p=0.12) and HAS (p=0.39) scores and TEMPS-A scale depressive (p=0.41), cyclothymic (p=0.08), hyperthymic (p=0.06), and anxious (p=0.29) temperament scores. But, irritable temperament scores were significantly higher in the NCS group (p=0.04). Conclusion: We believe that our findings will provide a basis for further studies in the diagnosis and treatment of NCA by contributing to the definition of NCA patients' psychological profiles.
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    Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2020) Tas, Halil Ibrahim; Altinbas, Kursat
    Introduction: Depressive disorder with mixed features has been included in the official classification in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Hypothesizing that difficulties in emotion regulation and affective temperament scores are higher in mixed depression comparing to pure depression, we aimed to evaluate the relationship between these phenomena and mixed symptoms. Methods: Depressive patients diagnosed by a psychiatrist according to the DSM-5 and had not received any psychiatric treatment for the last 3 months, were included in the study. The Hamilton Rating Scale (HDRS), modified Hypomania Checklist (mHCL), Difficulties in Emotion Regulation Scale (DERS), and the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire) were applied to all participants. Results: Of the 63 participants, 40 (63.5%) were women. The mean age was 37.8 +/- 12.4 years while mean duration of education was 10.8 +/- 4.3 years. The proportion of mixed-depression assessed by the mHCL was 23.8% (n=15). No significant difference was found between the groups concerning gender, age, family history, age at onset of illness, the total number of episodes and temperament scores. Depressive patients with mixed features had significantly higher DERS nonacceptance subscale scores. Multiple regression analysis demonstrated that the cyclothymic temperament scale scores significantly affected the total mHCL scores. Conclusion: In mixed depression group, higher scores in nonacceptance subscale seems to reflect a tendency to fluctuations in the emotional reactions of a person to the stress. Association between mixed depression, DERS nonacceptance subscale and cyclothymic temperament support the spectrum view that mixed depression is placed between pure depression and bipolarity.
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    Delirious mania: Clinical course and treatment
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2015) Can, Aylin; Altinbas, Kursat; Kurt, Erhan; Uygur, Niyazi
    Delirious mania (DM) is a syndrome consists of both mania and delirium, generally with accompanying catatonic features. Symptoms occur in hours or days with or without autonomic symptoms and if it is not treated properly, the clinical course get worse even it may result with death. It is defined variously in the literature as a subgroup of mania, a severe form of mania or a catatonioform disease. There are many case reports on the treatment of DM with benzodiazepines, mood stabilizers or first and second generation antipsychotics although electroconvulsive therapy was reported as the most effective treatment. In this paper, we aimed to review and give detailed clinical information about DM by presenting clinical course of a patient with delirious mania.
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    Different patterns of manic/hypomanic symptoms in depression: A pilot modification of the hypomania checklist-32 to assess mixed depression
    (Elsevier, 2015) Prieto, Miguel L.; Youngstrom, Eric A.; Ozerdem, Aysegul; Altinbas, Kursat; Quiroz, Danilo; Aydemir, Omer; Yalin, Nefize
    Background: There are no self-report scales that assess manic/hypomanic symptoms in patients with depression. The aim of this study was to explore the use of a modified screening instrument for bipolar disorder to assess current manic/hypomanic symptoms in patients with a depressive episode. Methods: The study sample consisted of 188 patients with Structured Clinical Interview for DSM-IV-TR disorders (SCID) confirmed bipolar or major depressive disorder. We modified the Hypomania Checklist-32 (mHCL-32) to assess current instead of lifetime symptoms. An Exploratory Factor Analysis (EFA) was conducted to identify clusters of mHCL-32 items that were endorsed concurrently. A Latent Class Analysis (LCA) was carried out to identify groups of patients with similar mHCL-32 item endorsement patterns. Results: The EPA identified 3 factors: factor #1 (elation-disinhibition-increased goal directed activity), factor #2 (risk-taking-impulsivity-substance use) and factor #3 (distractibility-irritability). The LCA yielded 3 classes (2 showing manic/hypomanic features). While class #1 patients endorsed more items related to disinhibition and racing thoughts, class #2 patients recognized more items associated with irritability and substance use Limitations: Lack of an adequate gold standard measure of mixed depression to compare to, the cross-sectional design and the lack of a validation sample. Conclusions: The mHCL-32 scale allowed a comprehensive and convergent delineation of hypomanic/manic symptoms in depression. Further validation of these findings is needed. (C) 2014 Elsevier B.V. All rights reserved,
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    Electrocardiography changes in bipolar patients during long-term lithium monotherapy
    (Elsevier Science Inc, 2014) Altinbas, Kursat; Guloksuz, Sinan; Caglar, Ilker Murat; Caglar, Fatma Nihan Turhan; Kurt, Erhan; Oral, Esat Timucin
    Objective: Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group. Methods: The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M=0.76, S.D.=0.14, range=0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured. Results: Regression analyses revealed that QTdR (B=14.17, P=.001), TpTe (B=18.38, P<.001), Pmax (B=17.84, P<.001) and Pmin (B=25.10, P<.001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters. Conclusion: Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range. (C) 2014 Elsevier Inc. All rights reserved.
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    Evaluation of affective temperament and anxiety-depression levels of patients with polycystic ovary syndrome
    (Elsevier Science Bv, 2015) Asik, Mehmet; Altinbas, Kursat; Eroglu, Mustafa; Karaahmet, Elif; Erbag, Gokhan; Ertekin, Hulya; Sen, Hacer
    Background: Women with polycystic ovary syndrome (PCOS) are reported to experience depressive episodes at a higher rate than healthy controls (HC). Affective temperament features are psychiatric markers that may help to predict and identify vulnerability to depression in women with PCOS. Our aim was to evaluate the affective temperaments of women with PCOS and to investigate the association with depression and anxiety levels and laboratory variables in comparison with HC. Methods: The study included 71 women with PCOS and 50 HC. Hormonal evaluations were performed for women with PCOS. Physical examination, clinical history, Hospital Anxiety and Depression Scale (DADS) and TEMPS -A were performed for all subjecLs. Differences between groups were evaluated using Student's [-tests and Mann Whitney U tests. Correlations and logistic regression tests were performed. Results: All temperament subtype scores, except hyperthyrnic, and DADS anxiety, depression, and total scores were significantly higher in patients with PCOS compared to HC. A statistically significant positive correlation was found between EMI and irritable temperament, and insulin and DADS depression scores in patients with PCOS. Additionally, hirsutism score and menstrual irregularity were correlated with DADS depression, anxiety and total scores in PCOS patients. In logistic regression analysis, depression was not affected by PCOS, hirsutism score or menstrual irregularity. However, DADS anxiety score was associated with hirsutism score. Conclusions: Our study is the first to evaluate the affective temperament features of women with PCOS. Consequently, establishing affective temperament properties for women with PCOS may help clinicians predict those patients with PCOS who are at risk for depressive and anxiety disorders. (C) 2015 Elsevier B.V. All rights reserved.
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    Evaluation of Antidepressant Choices for The Treatment of Depressive Symptoms in Patients with Bipolar Disorder
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2012) Atagun, Murat Ilhan; Altinbas, Kursat; Yesilyurt, Sema; Yesilbas, Dilek; Guloksuz, Sinan; Oral, Timucin
    Objective: Antidepressants are thought to cause manic switches and accelerate cycling in the treatment of bipolar depression. On the other hand, other evidence suggests that antidepressant neither cause manic switches, nor are effective for the treatment of bipolar depression. This study aimed to assess clinicians' attitudes towards antidepressant choices for treatment of bipolar depressive episodes and subthreshold depression. Methods: Medical records of 784 patients with bipolar disorder were investigated retrospectively. Antidepressants were used in 55 of 263 depressive episodes (20.9%). Data regarding 78 episodes (23 subthreshold symptoms, 55 episodes) of 68 patients (54 female, 14 male; mean age: 39.64 +/- 10.99) were obtained. Descriptive statistics were the evaluation method. Results: In our department, antidepressants were used in 20.9% of the patients in the treatment of bipolar depression. One third of patients receiving antidepressant prescriptions had a history of manic switch, 5 (21.7%) of the patients with subthreshold symptoms receiving antidepressant prescriptions had a history of manic switch. However, manic switch occurred in only 5 (6.4%) patients. Selective serotonin reuptake inhibitors were the most common cause (58.3%) of the manic switch in patients with a history of manic switch. Discussion: Clinicians are still using antidepressants in the treatment of bipolar depression. Antidepressants targeting many neurotransmitter systems can be used in the first line treatments and antidepressants can be used even in patients with a history of manic switch. This controversial topic should be studied prospectively with larger samples and it must be clarified whether this phenomenon is a natural course of the disorder or triggered by antidepressant medications.
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    Evaluation of Assaults on Doctors in Canakkale within the Last Year
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2014) Karaahmet, Elif; Bakim, Bahadir; Altinbas, Kursat; Peker, Emel
    Objective: Violence against doctors and health professionals in the healthcare environment is thought to have increased in recent years. Although physical and verbal assaults in the health care system have been evaluated in many different aspects, a limited amount of research has been done in this field in our country. For this reason, we aimed to investigate assaults towards doctors working at the Canakkale State Hospital and Canakkale Onsekiz Mart University in Turkey. Method: A questionnaire was prepared by researchers assessing assaults within the last year on doctors working in the state and university hospitals. Data from 130 doctors who agreed to participation in the study were analysed with SPSS version 16. Descriptive statistics, independent sample T-test for normally distributed variables and Mann-Whitney U test for non-normally distributed variables were used to compare the groups. Results: We found that 59.2% (n=77) of the doctors were verbally and/ or physically assaulted at least once during the past year. The majority of attackers consisted of relatives of patients (40.8% verbal attack, n=31). The verbal assaults mostly occurred in outpatient clinics (61.5%), with half of the physical assaults occurring in the emergency department. The vast majority of doctors considered that poor health policies were the most important reason for assaults (83.3%, n=65), and nearly all of them thought that violence towards doctors has increased in recent years (97.4%). Conclusion: The fact that most of the doctors exposed to assaults, regardless of gender, institution, or work position, perceived health policies as being responsible for this violent atmosphere, is very striking. We believe that larger sample-size and comprehensive countrywide studies in this area would help to provide solutions for this problem.
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    Evaluation of Four-Year Stability of Unspecified Psychosis
    (Aves, 2019) Tas, Halil Ibrahim; Celik, Merve; Altinbas, Kursat
    Introduction: Unspecified psychosis, defined with the F29 code in the International Classification of Diseases (ICD) 10th version is commonly used if there is inadequate information to make the diagnosis of a specific psychotic disorder. There is a lack of data about the prevalence, incidence, diagnostic validity and stability of this diagnosis. Therefore, we aimed to evaluate the prevalence and diagnostic consistency of unspecified psychosis in the outpatient unit. Methods: Patients diagnosed with the ICD-10 F29 code at the first visit and interviewed at least three times between January 2012-2016 in the Psychiatry Outpatient Clinic were included (n= 138). Hospital records were reviewed retrospectively and data were analyzed with SPSS 19th version. Results: Mean duration of follow-up was 22.8 +/- 14.7 months. The diagnoses at the final follow-up were unspecified psychosis (43%), bipolar disorders (18%), schizophrenia (11%), major depression (7%), and anxiety disorders (4%). No significant difference was found between the follow-up diagnoses in terms of age, duration of follow-up, gender, educational status and marital status. Conclusion: The diagnostic stability of unspecified psychosis is low compared to other psychotic disorders. Follow-up studies with larger sample sizes are required to elucidate the the low diagnostic stability of unspecified psychosis.
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    Evaluation of the Association between Lithium Treatment and GSK-3? Polymorphism in Bipolar Disorder Patients
    (Turkiye Sinir Ve Ruh Sagligi Dernegi, 2018) Altinbas, Kursat; Yesilbas, Dilek; Ince, Bahri; Cansiz, Alparslan; Sılan, Fatma; Özdemir, Öztürk; Guloksuz, Sinan
    Objective: There is a lack of evidence regarding clinical predictors for the treatment response to lithium, which is the main stay treatment option for bipolar disorder. Studies that examined the mechanistic action of lithium revealed that glycogen synthase kinase 3 beta (GSK-3 beta) enzymeinhibition was important in regard to treatment responses. Based on this background, we aimed to investigate the association between responses to lithium treatment and five different polymorphisms of GSK-3 beta. Method: Lithium treatment response scale (LTRS) scores for 100 patients diagnosed with bipolar disorders type I were calculated according to the hospital records. Blood samples were collected and genomic DNA was obtained using the MagNA Pure Compact automatic isolation method. The GSK-3 beta: rs17183904, rs17183897, rs34009575, rs34002644, and rs17183890 polymorphisms were analyzed by real time PCR. Results: In this cohort, the mean age of patients was 41.1 +/- 10.3 years, the mean age of disease onset was 24.5 +/- 8.2, and the mean LTRS score was 4.9 +/- 1.8. There was no statistically significant difference for LTRS scores between groups in terms of gender, marital status, level of education, and the type of first episode. LTRS was significantly higher in only the patients harbouring GSK-3 beta rs17183890 AG genotype (p=0.008, t: 2.71). Interestingly, no differences were found for the remaining polymorphisms. Conclusion: The specific GSK-3 beta polymorphism that associated with lithium-response in our study may help to predict lithium responses and to develop individualized treatment. We presume that our pharmacogenomic findings may also provide important contributions to the clinical practice in regard to future evaluation of the treatment adherence and side effects. To obtain these goals, further genome-wide scanning studies conducted on larger sample cohorts are required.
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    Four Bipolar Cases Treated with Quetiapine During Pregnancy
    (Kure Iletisim Grubu A S, 2014) Degerli, Hatice Ezgi; Altinbas, Kursat; Deuce, Mehtap; Kurt, Erhan
    Bipolar disorder is a disease that typically begins in adolescence and early adulthood, namely during the reproductive period. The treatment of female cases during their reproductive years is very important because of the teratogenic effects of psychotropic drugs. It has been stated that the use of classical antipsychotics during pregnancy was not associated with congenital malformations or low birth weight. While all drugs pass through the placenta, quetiapine shows the lowest degree of placenta transit of all the antipsychotics. Studies with animals have not showed any teratogenic effect. Even though studies with humans are very limited with respect to embryonic/fetal risk assessment, recent studies have shown no increased risk of birth defects in quetiapine exposed babies and when compared to other treatment alternatives, quetiapine can be used safely in pregnancy. In this article, we report that no negative data has been found in terms of teratogenicity or perinatal complications in the cases of four pregnant women being treated with quetiapine in the manic and depressive episodes of bipolar disorder and it is also reported that quetiapine can reliably be used during pregnancy.
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    Health Related Quality of Life and the Quality of Sleep in School Aged Children with Functional Constipation
    (Taylor & Francis Inc, 2017) Yildirim, Sule; Kaymaz, Nazan; Tekin, Mustafa; Topaloglu, Naci; Binnetoglu, Fatih Koksal; Altinbas, Kursat; Asik, Zuhal
    The aim of the present study was to investigate the sleep quality and health related quality of life in children with functional constipation. Fifty patients (7-13 years) attended to our general pediatric outpatient clinic and diagnosed with functional constipation and 50 healthy controls were enrolled in this case-control study. Health-related quality of life was assessed by using Kid-KINDL inventory and sleep quality was assessed by using PSQI. Children with functional constipation had lower scores of quality of life compared to healthy controls. Although the total score was not statistically significant the physical well-being scores of constipated children was significantly lower than control group. The Pittsburgh Sleep Quality Index score for children with functional constipation was significantly higher than controls (2.5 +/- 2.4 and 0.5 +/- 0.6, respectively; p < 0.05). School-aged children with functional constipation had lower quality of life and quality of sleep compared to their healthy peers. Physical well-being was especially impaired in constipated children affecting daily activities negatively. Assessment of quality of sleep as well as quality of life should be a part of management of functional constipation in childhood.