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Öğe Facial emotion recognition is associated with executive functions and depression scores, but not staging of dementia, in mild-to-moderate Alzheimer's disease(John Wiley and Sons Ltd, 2024) Buçgün, İsmail; Korkmaz, Şükrü Alperen; Güleç Öyekçin, DemetBackground: Although deficits in facial emotion recognition (FER) significantly affect interpersonal communication and social functioning, there is no consensus on how FER affects Alzheimer's disease (AD). In this study, we aimed to investigate the clinical and neuropsychological factors affecting the possible deficits in the FER abilities of patients with AD. Methods: This cross-sectional study included 37 patients with mild [clinical dementia rating (CDR) scale score = 1] or moderate (CDR = 2) AD, in whom vascular dementia and depression were excluded, and 24 cognitively normal (CDR = 0) subjects. FER ability was determined using the facial emotion identification test (FEIT) and facial emotion discrimination test (FEDT). All participants underwent mini-mental state examination (MMSE), frontal assessment battery (FAB), and geriatric depression scale (GDS). The neuropsychiatric inventory-clinician rating scale (NPI-C), Katz index of independence in activities of daily living, and Lawton instrumental activities of daily living were also administered to patients with AD. Results: The FEIT and FEDT total scores showed that patients with mild and moderate AD had significant FER deficits compared to healthy controls. However, no significant difference was observed between patients with mild and moderate AD in the FEIT and FEDT total scores. FEIT and FEDT scores were not correlated with the MMSE and NPI-C total and subscales scores in patients with AD. Linear regression indicated that FEIT and FEDT total scores were significantly related to age and FAB scores. The GDS score negatively moderated the relationship between FAB and FEDT. Conclusions: This study demonstrated a decreased FER ability in patients with AD. The critical point in FER deficits is the presence of dementia, not the dementia stage, in AD. It has been determined that executive functions and depression (even at a subsyndromal level), which have limited knowledge, are associated with FER abilities.Öğe In silico molecular docking and in vitro analysis of atomoxetine(Taylor & Francis Ltd, 2025) Bolat, Nurullah; Hız-Çelikliyurt, Merve Meliha; Akıncı, Erhan; Akkuş, Gülsüm; Günay, Melih; Korkmaz, Şükrü AlperenAlthough atomoxetine, a selective norepinephrine reuptake inhibitor, is widely used in the treatment of attention-deficit/hyperactivity disorder (ADHD), there is limited data on its cytogenetic effects. This study aimed to investigate the cytotoxicity and genotoxicity of atomoxetine in vivo and silico. Chromosome aberration and micronucleus assays were used to analyze the genotoxic effect of atomoxetine in human peripheral blood lymphocytes under culture conditions. The mitotic index was assessed for cytotoxic potential. For the docking analysis, DNA receptor (1BNA) was prepared with ChimeraX, and the Atomoxetine molecule was optimized by Avogadro2.0 software. In silico molecular docking analysis was carried out utilizing SwissDock online platform. The results obtained were visualized using ChimeraX and Pymol software. Atomoxetine doses of 9.6 mu g/mL (equal to about 1.2 mg/kg as a maintenance dose), 14.4 mu g/mL (equal about to 1.8 mg/kg as the highest dose systematically tested), 48.0 mu g/mL (equal about to 6 mg/kg as five times the maintenance dose) and 96.0 mu g/mL (equal about to 12 mg/kg as ten times the maintenance dose) were analyzed. The findings clearly indicate that atomoxetine has no genotoxic effect at the therapeutic dose. However, we observed genotoxic effects at 48.0 and 96.0 mu g/mL doses. No strong binding affinity occurs in silico analyses. As one of the initial inquiries into the in silico and in vivo appraisal of atomoxetine's genotoxic impacts, the research has established that atomoxetine does not significantly affect the frequency of chromosomal damage or micronucleus formation. Genotoxic effects should be kept in mind at doses above clinical practice.Öğe Prevalence and Influencing Factors of Body-focused Repetitive Behaviors in Turkish Medical Students(Selcuk University, 2024) Korkmaz, Şükrü AlperenObjective: Body-focused repetitive behaviors (BFRBs) such as skin-picking, trichotillomania, nail- picking, nail-biting, lip-biting and skin-biting have adverse physical and psychological effects. This study aimed to investigate the prevalence and associated factors of BFRBs in a sample of Turkish medical students. Material and Methods: An online survey was used to investigate the prevalence of six BFRBs — skin-picking, trichotillomania, nail-biting, nail-picking, lip-biting and skin-biting-- and psychological factors such as anxiety, depression, stress levels, impulsivity and difficulties in emotional regulation (DER) in a sample of 200 medical students. Skin Picking Scale-Revised (SPS-R), Massachusetts General Hospital Hairpulling Scale (MGH-HPS), Depression Anxiety Stress Scales-21 (DASS-21), Barratt Impulsiveness Scale–Short Form and Difficulty in Emotion Regulation Scale—Brief Form were applied, and specific questions for investigating four BFRBs (nail-picking, nail-biting, lip biting and skin biting) were administered. Results: The prevalence of at least one BFRB disorder was 28.0% (n=56). The most common diagnoses were skin-picking (17.0%) and trichotillomania (10.5%), followed by skin-biting (9.0%), lip biting (8.5%), nail-picking (7%) and nail-biting (5.0%). The gender difference was found only in skin-picking disorders (females=22.9%; males=8.5%). Students with BFRB disorder were found to have higher levels of anxiety, depression, stress, impulsivity and DER. Students in 2nd, 3rd and 5th grade are more likely to have BFRB disorders than interns. The mediation model indicated that DER partially mediates the relationship between impulsivity and the BFRB disorder. Conclusion: The findings of the study suggest that BFRBs are common among medical students and that these behaviors are associated with psychological factors such as depression, anxiety, stress levels, impulsivity and difficulties in emotion regulation. Screening programs and intervention strategies for BFRBs in medical students should be developed, and it is recommended that psychological factors should be considered in these interventions, emotion regulation and stress management skills should be significantly improved, and comorbid depression and anxiety should be treated.Öğe Psychiatric conditions and delirium in hospitalized patients with COVID-19 during the pandemic(2024) Ertekin, Hülya; Kettaş, Erdem; Korkmaz, Şükrü AlperenIntroduction: This study aimed to examine the patients who were consulted to psychiatry while receiving inpatient treatment due to COVID-19 infection based on sociodemographic data, medical history, diagnoses and treatments. Methods: This is a retrospective study in which the consultations were retrospectively reviewed using information obtained from electronic medical records. The consultant psychiatrists created a structured data collection form to evaluate the clinical and demographic features of the patients. Results: Ninety-nine of the psychiatry consultation results of patients were evaluated. The mean age of patients was 64.48 ± 18.82. The most common medical diagnoses are hypertension (n=32, 32.3%) and heart disease (n=21, 21.1%). The most common reason for consultation was agitation (n=27, 27.2%), and the most common diagnosis was delirium (n=25, 25.2%) and anxiety disorders (n=23, 23.2%). Increasing age, presence of hypertension and diabetes mellitus, and oxygen inhalation therapy were factors affecting the diagnosis of delirium. In contrast, the presence of heart disease or diabetes mellitus increased the risk of anxiety disorder, and antipsychotic use decreased this risk. Conclusion: It has been revealed that inpatients with COVID-19 were at risk of psychiatric disorders, especially delirium and anxiety disorders. Psychiatric conditions may notably influence the prognosis and treatment of COVID-19.Öğe Real-world effectiveness of long-acting injectable vs. oral antipsychotics in patients with bipolar I disorder: a 1-year retrospective observational study(Taylor & Francis Ltd, 2024) Korkmaz, Şükrü Alperen; Gürler, SümeyyeObjectiveLong-acting injectable (LAI) antipsychotics are recommended in the treatment non-adherence. Despite the widespread use of LAI antipsychotics, there is limited data on clinical outcomes in bipolar I disorder (BD-I) patients with real-world data. We aimed to compare BD-I patients treated with LAI and oral antipsychotics (OAP) in terms of treatment effectiveness in a 1-year follow-up period.MethodsThe study was conducted retrospectively with electronic health records of 116 BDI patients. The primary outcomes were whether patients in the LAI group and the OAP group differed in relapse, rehospitalization, emergency room (ER) visits, and all-cause treatment discontinuation at 1-year follow-up after a mania episode. Cox regression modeling was used to predict the recurrence of any mood episode and all-cause treatment discontinuation during follow-up. The secondary outcomes evaluated were the effects of sociodemographic and clinical parameters and concomitant psychotropic medications on the course of the illness and treatment adherence.ResultsOf all 116 patients, 33 (28.4%) were under LAI, and 83 (71.6%) were under OAP treatment. LAI users had a history of more hospitalizations and total mood episodes. Patients in the LAI group had more treatment non-adherence before the index hospitalization. At 1-year follow-up, there was no difference between the groups in terms of any mood relapse, rehospitalization, ER visits, and all-cause treatment discontinuation. As a secondary outcome, lithium users were found to have fewer new episodes and discontinuations of treatments.ConclusionsIn real-world data, there is no evidence that LAI antipsychotics (compared to OAP) are superior in the maintenance treatment of BD. These results are important in terms of reflecting clinical practices for the treatment of BD-I. These results do not devalue the use of LAI therapy in BD; however, more studies are needed to identify positive predictors for LAI treatments in BD.Öğe Real-World Evidence of Antipsychotic Monotherapy Versus Polypharmacy in the Treatment of Schizophrenia Spectrum Disorders(Lippincott Williams & Wilkins, 2024) Korkmaz, Şükrü Alperen; Koca, Esra; Yılmaz, Özge; Özbek, Tayfun; Güçlü, Muhammed Alperen; Kızgın, SadicePurpose/BackgroundIt is still not well known whether antipsychotic monotherapy versus polypharmacy differs in terms of efficacy in the emergency department (ED) utilization, presentation with agitation/aggression, and rehospitalization in schizophrenia spectrum disorders (SSD) patients. This study aimed to determine the effectiveness of antipsychotic monotherapy and polypharmacy for these outcomes in the real world.Methods/ProceduresThe study was conducted with electronic health records of 669 SSD patients admitted to the ED. Patients were evaluated in 4 groups according to antipsychotic use at the first admission to ED: antipsychotic noncompliance for more than 90 days, antipsychotic noncompliance for 15 to 90 days, antipsychotic monotherapy, and polypharmacy. All patients followed up for at least 1 year after index admission. The primary outcomes determined an association between antipsychotic monotherapy versus polypharmacy and all-cause psychiatric hospitalization between the groups after index admission in the SSD.Findings/ResultsThe groups, including patients with antipsychotic noncompliance, had higher ED visits, more hospitalizations, and more admissions with agitation/aggression compared with antipsychotic monotherapy or polypharmacy. However, no differences were found between monotherapy and polypharmacy groups regarding these outcomes. In addition, there was no difference in the risk of hospitalization in monotherapy antipsychotic users compared with polypharmacy users. Patients discharged with monotherapy or polypharmacy also had similar rehospitalization rates at follow-up.Implications/ConclusionsThere is no positive evidence that recommending polypharmacy over antipsychotic monotherapy is superior with regard to the resulting frequency of ED visits, ED admissions with agitation/aggression, hospitalization, and rehospitalization. In this context, antipsychotic monotherapy may be preferred over polypharmacy in patients who are not resistant to treatment.Öğe Reliability and Validity of the Turkish versions of the Davos Assessment of Cognitive Biases Scale (DACOBS) and Cognitive Biases Questionnaire for Psychosis (CBQp)(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2024) Korkmaz, Şükrü Alperen; Keleş Altun, İlkay; Sağbaş, Serap; Köksalan, Fatmagül Eda; Atagün, Murat İlhanIntroduction: Cognitive biases can be defined as dysfunctional patterns of thought formation that lead to incorrect conclusions and abnormal perceptions and are critical factors in the development and maintenance of psychosis. Two self-report measures assessing cognitive biases in psychosis spectrum disorder (PSD) have recently been developed: the Davos Assessment of Cognitive Biases Scale (DACOBS) and the Cognitive Biases Questionnaire for Psychosis (CBQp). This study aimed to validate the Turkish versions of the DACOBS and CBQp. Methods: The sample consisted of 171 patients with PSD and 162 age and sex-matched healthy controls (HC). We investigated I) the factor structure with confirmatory factor analysis (CFA), II) the reliability (internal consistency and test-retest reliability), III) discriminative power, IV) convergent validity, and V) the concurrent validity of DACOBS and CBQp. Results: The 7-factor solution for DACOBS, similar to the original study, and the 5-factor solution for CBQp provided the best fit. DACOBS and CBQp total and their subscale scores showed good internal consistency and test-retest reliability. DACOBS and CBQp total and their subscale scores could differentiate between PSD patients and HCs when controlling for age, sex, and education. DACOBS and CBQp showed a positively moderate correlation. DACOBS and CBQp scores were associated with psychotic symptoms in PSD patients and positive psychic experiences in HCs. Conclusions: Both the DACOBS and the CBQp have good psychometric properties and are suitable instruments for assessing cognitive biases in the Turkish population. The Turkish versions of the DACOBS and CBQp were as reliable and valid as the original.Öğe Successful treatment of severe alcohol withdrawal delirium with very high-dose diazepam (260-480 mg) administration(Taylor and Francis Ltd., 2024) Korkmaz, Şükrü Alperen; Aldemir, Ebru; Güleç Öyekçin, DemetIntroductionAlcohol withdrawal delirium, commonly known as "delirium tremens (DT)", is the most severe clinical condition of alcohol withdrawal syndrome (AWS). Symptoms of DT include changes in consciousness and cognitive and perceptual impairments that fluctuate during the day. Treatment includes general support, such as helping the patient to re-orientate, close monitoring of vital signs and adequate hydration, and symptomatic treatment for agitation, autonomic instability, and hallucinations. In symptomatic treatment of DT, benzodiazepines are most commonly preferred due to their GABA-ergic effects. Diazepam, a benzodiazepine, has a faster onset of action than other benzodiazepines when administered intravenously (iv) and effectively controls symptoms. Although low doses of diazepam usually relieve DT symptoms, very high doses may be required in some patients. This case series discusses patients receiving high doses of diazepam to relieve DT symptoms.Case reportFour male patients aged from 43 to 57 years who regularly consumed alcohol with a daily average of 20-100 standard drinks and developed DT afterwards and were followed up in the intensive care unit are presented. In these patients, the symptoms of DT were relieved, and somnolence was achieved with the administration of very high-dose IV diazepam (260-480 mg/day), contrary to routine treatment doses. All patients were successfully treated and discharged without any morbidity.ConclusionSevere AWS can potentially result in death otherwise managed quickly and adequately. Diazepam is a suitable agent for severe AWS or DT treatment. Clinicians should keep in mind that high-dose diazepam treatment may be required in the treatment of DT that develops after a long-term and high amount of alcohol consumption. Publications reporting the need for very high doses of diazepam in DT are limited and usually published long ago; in this context, our findings are significant. The evidence is often based on case reports and uncontrolled studies, so controlled trials are needed to determine optimal treatment doses in severe DT.Öğe Synopsis of Chemical and Drug-Related Agents That Cause Movement Disorders(Springer Science+Business Media, 2025) Korkmaz, Şükrü AlperenDrug-induced movement disorder (DIMD) is often reversible and secondary to the drugs and substances used. While Parkinsonism is the most common, other movement disorders such as akathisia, tremor, and acute dystonic reactions (ADRs) are also frequently seen due to many agents. DIMDs may be acute and fatal, such as neuroleptic malignant syndrome (NMS) or serotonin syndrome (SS), or maybe seen as tardive syndromes due to long-term exposure. DIMDs exhibit several characteristics that make them easily recognizable, including a well-defined relationship between the start of medication and the emergence of symptoms, a dose-dependent effect, and full recovery upon cessation of the causative substance (except for tardive syndromes). DIMDs are not uncommon and significantly impact on functionality but are often under-recognized or overlooked and not managed appropriately. Identification of risk factors and prevention for DIMDs, if not prevented, early diagnosis and management is a critical consideration in prescribing medications that can cause movement disorders. This chapter focuses on the clinical manifestations, epidemiology, pathophysiology, and treatment of ADRs, acute-subacute akathisia, drug-induced Parkinsonism, drug-induced tremor, tardive syndromes, NMS, and SS. © 2025 Springer Nature Switzerland AG.Öğe The Mental Health Status of Inpatients with Newly Diagnosed Hematological Cancer during the COVID-19 Pandemic: A Comparison Study(Gazi Üniversitesi, 2023) Korkmaz, Şükrü Alperen; Güney, Tekin; Akıncı, Sema; Çolak, Burgin; Can, FerdaObjective: This study is intended to evaluate the mental health statuses of hematological cancer (HC) inpatients diagnosed during the COVID-19 pandemic compared to the statuses of patients diagnosed with HC before the pandemic. Methods: A cross-sectional survey collected the mental health measurements of 77 inpatients with HC between March and May 2021 in Ankara, Turkey. The levels of depression, generalized anxiety, distress, sleep disorder, health anxiety, trait anxiety, corona phobia, and resilience in HC patients newly diagnosed during the pandemic (n=38) and before the pandemic (n=39) were compared. We then explored the relationships between predictive factors and cancer patients' mental health statuses. Results: Compared to HC patients diagnosed before the pandemic, depression (63.2% vs. 35.9%, p=0.017) and sleep disorder (67.8% vs. 38.5, p=0.016) were significantly higher, while comparison, generalized anxiety (57.9% vs. 38.5%, p=0.088) and distress (60.5% vs. 38.5%, p=0.053) were higher in a non-significant trend in patients newly diagnosed with HC during the pandemic. In contrast, health anxiety was more common in patients diagnosed before the pandemic (53.8% vs. 31.6%, p=0.048). Among the newly diagnosed patients, women had more generalized anxiety symptoms than men (76.5% vs. 42.9%, p=0.037). Being newly diagnosed increased the risk of more severe symptoms of depression (odds ratio [OR]: 3.178, p=0.036) and sleep disorders (OR: 4.73, p=0.018) but lowered the risk of health anxiety (OR: 0.14, p=0.003). Conclusion: Our data indicate that patients with HC are vulnerable to mental health problems during the COVID-19 pandemic. This vulnerability is higher in newly diagnosed HC patients than in patients diagnosed before the pandemic.Öğe Thiol-disulphide Homeostasis in Patients with Schizophrenia: The Potential Biomarkers of Oxidative Stress in Acute Exacerbation of Schizophrenia(Korean College of Neuropsychopharmacology, 2024) Korkmaz, Şükrü Alperen; Ulusoy Kaymak, Semra; Neşelioğlu, Salim; Erel, ÖzcanObjective: : Recent evidence suggests that oxidative stress contributes to the pathophysiology of schizophrenia. This study aimed to compare thiol-disulphide homeostasis in acute and stable phases of schizophrenia for the first time. Methods: : Among the patients with schizophrenia, 61 in the acute-phase and 61 in the stable phase of their illness were enrolled in the study. Native thiol (NT), total thiol (TT), disulphide (SS), disulphide/native thiol, disulphide/total thiol, and native thiol/total thiol for thiol-disulphide homeostasis were compared between the groups. The Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive/Negative Symptoms (SAPS/SANS), Clinical Global Impression-Severity Scale (CGI-S), Barnes Akathisia Rating Scale, and Simpson-Angus Scale were used to assess symptoms. Results: : After controlling for age, sex, body mass index, and smoking status there were significant differences in NT, TT, SS/NT, SS/TT, and NT/TT, but not SS. Thiol/disulphide homeostasis has shifted in favour of the oxidative side in patients with acute-phase compared to that in stable schizophrenia. BPRS, SAPS, and CGI-S scores were significantly correlated with all six thiol-disulphide parameters, but not SANS, when controlling for age and sex. Significant receiver operating characteristic (ROC) curves were obtained for all thiol-disulphide homeostasis parameters. Discriminant analysis was found to be statistically significant in discriminating between groups. Conclusion: : These results show that oxidative status increases thiol-disulphide homeostasis in patients with acute-phase schizophrenia compared to those with stable schizophrenia. These findings suggest that thiol-disulphide parameters can be used as biomarkers for the acute exacerbation of schizophrenia.Öğe Thiol-disulphide homeostasis, ischemia-modified albumin, complete blood count-derived inflammatory markers and C-reactive protein from acute mania to early remission in bipolar disorder(Elsevier, 2023) Korkmaz, Şükrü Alperen; Kızgın, Sadice; Fırat Oğuz, Esra; Neşelioğlu, Salim; Erel, ÖzcanObjectives There is much recent evidence that inflammation contributes to the pathophysiology of acute mania in bipolar disorder (BD). However, no study was evaluated in which the change in thiol-disulphide homeostasis, ischemia-modified albumin (IMA), complete blood count-derived inflammatory markers (CBC-IMs) and C-reactive protein (CRP) levels in bipolar patients was followed-up from acute mania to early remission. Methods Seventy-seven bipolar patients in acute mania and ninety-one HC were enrolled. We measured levels of thiol-disulphide parameters, IMA, and CBC-IMs such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red-cell-distribution-width (RDW)-to-platelet ratio (RPR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI), CRP and platelet-to-albumin ratio (PAR), after adjusting for age, gender, body-mass index (BMI) and smoking status, during acute mania to subsequent early remission. The results were compared with HC. Results The levels or ratios of all thiol-disulphide parameters except for disulphide, IMA and CRP of bipolar patients in both acute mania and early remission were significantly different from HC, after adjusting for confounders. The NLR, SII, CRP and PAR values of bipolar patients were significantly higher in only acute mania compared to HC. Significant changes in thiol-disulphide parameters and IMA levels were not found in early remission after acute mania. Limitations Short follow-up period and lack of drug-naive patients. Conclusions Our results suggest that thiol-disulphide parameters, IMA level and SIRI value might be a trait biomarkers of inflammation in BD. In addition, NLR, SII and PAR values and CRP level might be a state biomarker of inflammation in bipolar patients in a manic phase.
