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    Acute and Long Term Treatment of Manic Episodes in Bipolar Disorder
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2021) Atagun, Murat Ilhan; Oral, Timucin
    Bipolar disorder is a disabling psychiatric disorder which causes premature death and loss of quality of life. Despite the developments, novel treatments are partially effective and insufficient responses to treatment may cause loss of quality of life. Contemporary approaches to treatment planning involve taking the current symptoms and the personal treatment history of the patient into account and tailoring them for the treatment of each patient, i.e. individualized treatment. In this article, effects and side effects of antipsychotics, mood stabilizers and sedative hypnotic medications are reviewed and presented briefly for clinicians. Although novel developments have been observed in the literature about mixed states and psychotic symptoms, evidence-based options are still limited. Efficacy of mood stabilizers may be prolonged and additional medications may also be needed frequently in patients treated with mood stabilizers. Antipsychotics may cause several side effects and cannot be maintained for a long time in some of those patients. These factors may limit the use of mood stabilizers or antipsychotics. Therefore, the experience of the clinician and personal history of the patient still have importance in the procedure.
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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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    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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    Winter Sale on Lithium Levels: The Impact of Seasonality
    (Kure Iletisim Grubu A S, 2013) Bakim, Bahadir; Karaahmet, Elif; Altinbas, Kursat; Oral, Timucin
    Objective: Lithium is recognized worldwide as an effective prophylactic agent in mood disorders. Prophylactic efficacy of lithium in mood disorders has been established since the early seventies. Lithium has been and continues to be the mainstay of bipolar disorder (BD) pharmacotherapy for acute mood episodes, switch prevention, and suicide prevention. There are reports of seasonal variation in lithium levels from a few countries. Variability in the lithium level can lead to a lack of efficacy or to toxicity, making seasonal variation clinically relevant. We aimed to compare lithium levels of bipolar patients between summer and winter. Methods: Euthymic bipolar patients who were followed in the Rasit Tahsin Mood Clinic of the Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were recruited for the study, and lithium levels were measured in the second part of winter and summer (15th of June to 1st of September and 15th of January to 1st of March). A prospective case sheet audit was performed for 32 BD patients for recording plasma lithium level, age and gender for one year. Bipolar patients whose treatment dosage of lithium was changed for any reason during the study follow-up were excluded. Situations of lithium use other than for bipolar disorder were excluded. The presence of concomitant diagnoses of mental retardation or drug dependence constituted exclusion criteria, as did medication non-compliance detected by persistently low lithium plasma levels. The use of antihypertensive drugs, nonsteroidal anti-inflammatory drugs, theophylline, some antibiotics, topiramate, and diuretics that could cause an increase in plasma concentrations of lithium, and of theophylline that could reduce lithium concentrations constituted exclusion criteria. Sodium levels were also monitored due to their propable effect on lithium levels. Lithium levels were compared using the paired sample t-test. Correlation analysis was done for the parameters that could affect lithium levels. Results: The mean age of the patients was 35.75 +/- 9.59 years, the mean age of onset was 21.97 +/- 6.17 and the mean duration of disorder was 13.90 +/- 9.41 year. 15 out of 32 patients were male. The overall average dose of lithium taken by the patients was 1190.6 +/- 249.0 mg/day. The mean lithium plasma level was 0.75 +/- 0.12 mEq/L in winter, and the mean lithium plasma level was 0.83 +/- 0.12 mEq/L in summer (p=0.003). The overall serum sodium levels were 139.1 +/- 2.2 mEq/L in summer and 137.1 +/- 2.3 mEq/L in winter (p=0.001). The correlation between lithium and sodium levels was not significant in summer or in winter (respectively p=0.55, r=0.12 and p=0.49, r=0.14). Conclusions: The present study showed a significant variability of lithium levels when comparing summer and winter. Therefore, frequent plasma level monitoring and oral lithium dose adjustment to prevent situations of toxicity or lack of efficacy in bipolar disorder are suggested. Lithium levels may show a relative increase in summer due to dehydration. Prospective controlled studies are required to differentiate whether this seasonality is specific to bipolar disorders or not.