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    Aripiprazole treatment and one year follow up of an interictal psychosis patient
    (Kure Iletisim Grubu A S, 2011) Oyekcin, Demet Gulec; Yildiz, Deniz
    Aripiprazole treatment and one year follow up of an interictal psychosis patient Objective: The presence of chronic neurological functional deficits in epilepsy increases susceptibility to psychiatric diseases. Especially, complex partial seizures are associated with psychiatric symptoms commonly and as many as %10-30 of patients may have psychosis. The classification has been made according to the time interval of the psychotic symptoms; ictal psychosis psychotic symptoms occur only during a seizure; postictal psychosis occurs after a short period, and seizures arising from persistent psychotic symptoms of schizophrenia-like condition are referred as interictal psychosis. Methods: A 42 year old patient with epilepsy since age 7, who had psychotic symptoms, was differentiated from schizophrenia and diagnosed with interictal psychosis based on the clinical features (ICD-10 schizophrenia like psychosis). He was treated with aripiprazole and his treatment response and 1 year follow up were discussed. An epileptic focus was determined in the right hemisphere on EEG and in left parietal lobe on PET and also left mesial temporal sclerosis (MTS) was detected on MRI. Aripiprazole 10mg/day, which is known to reduce the seizure threshold and also lower and improve the negative symptoms, was started. Treatment response was assessed by SANS, SAPS, and social- occupational functioning assessment questionnaires. First evaluations were conducted in the second week and there were dramatic changes in the scale scores. She also had significant clinical improvement especially in negative symptoms and social functioning. She was called to assess response to treatment second time after 4 weeks. Conclusion: Our case has the following features: We have offered a 1-year follow-up period and reviewed the similarities and the differential diagnosis from schizophrenia and the clinical symptoms observed in follow up of patients with interictal psychosis. Finally, our case also has a unique feature due to treatment of schizophrenia-like psychosis of epilepsy with aripiprazole. The antipsychotic treatments are known to reduce the threshold for epileptic seizures. However psychosis associated with epilepsy needs two-way thinking. Therefore we thought the so-called third-generation antipsychotic aripiprazole might be a good option to use. The clinical similarities and differences between idiopathic schizophrenia and schizophrenia-like psychosis of epilepsy are important to know for differential diagnosis and treatment planning.
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    Depression and Anxiety in Obese Patients
    (Aves, 2011) Oyekcin, Demet Gulec; Yildiz, Deniz; Şahin, Erkan Melih; Gur, Savas
    Objectives: Epidemiologic data suggests an association between obesity and depression. However, a limited number of studies have investigated the prevalence of psychiatric symptoms among obese patients without a psychiatric diagnosis. The objective of this study was to determine psychiatric diagnosis in patients with obesity who applied to the endocrinology department and to determine the pattern of the depression and anxiety symptom levels in obese patients without a psychiatric diagnosis. Materials and Methods: 62 patients with obesity (obesity group) and 27 control subjects (control group) attending the endocrinology outpatient clinic were included in the study. Body mass index was calculated and diagnostic psychiatric assessment carried out for all patients. All participants were evaluated using the Hamilton Depression Rating Scale [HAM-D] and Hamilton Anxiety Rating Scale [HAM-A]. Results: Total scores obtained both from HAM-D and HAM-A were significantly greater in the obesity group than in the control group. The most common psychiatric diagnose among obese patients was depression. Nearly more than half of the obese patients without any psychiatric diagnosis marked one of the HAM-D items which describes depressed mood, guilt feeling, somatic anxiety, work and activity loss and general somatic symptoms as well as the items within the HAM-A scale which describes anxious mood, tension, cognitive difficulties, insomnia, depressed mood, somatic anxiety, cardiovascular, respiratory, gastrointestinal and autonomic symptoms. Conclusion: Most common psychiatric diagnosis in patients with obesity was major depressive disorder. Obese patients who have not been diagnosed with any psychiatric disorder also show certain anxiety and depressive symptoms. The presence of anxiety and depressive symptoms in patients having any psychiatric disorder may be due to the psychosocial effects of obesity and these symptoms should be followed up in obese patients so that psychiatric disorders can be determined earlier.
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    Pharmacotherapy of Personality Disorders
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2012) Oyekcin, Demet Gulec; Yildiz, Deniz
    Objective: Prevalence of personality disorders have been reported as 10-13% in general population, 30-50% in psychiatric patients, and 15% in psychiatric outpatients. The most common personality disorders are respectively borderline, antisocial, schizotypal, and avoidant. There has been no specific pharmacological approach for the treatment of personality disorders that have different clinical features with various co-morbid psychiatric disorders. The aim of this report is to review the efficacy of psychotropic medications used for the treatment of personality disorders. Methods: By using borderline, antisocial, schizotypal, narcissistic, obsessive compulsive, avoidant personality, and pharmacotherapy as keywords at the Pubmed database we primarily searched for the double blind, placebo controlled, randomized trials and also included some of the open label trials. Results: Most of the research on this topic was on pharmacotherapy of borderline personality disorder. Polypharmacy, that has been used widely in treatment of these cases, has been reported ineffective in most of the patients. The antidepressants have been replaced by mood stabilizers. The antidepressants and mood stabilizers have been reported to decrease mood symptoms like anger, depression, dysphoria, and to enhance adherence to psychotherapy. The most effective mood stabilizer was divalproex. The antipsychotics have been recommended to be used at psychotic and behavioral symptomatology. At the treatment of antisocial personality disorder CBT is recommended and there was no evidence based pharmacotherapy. In the treatment of schizotypal personality disorder, the antipsychotics have been reported effective. Pergolide and guanfacine have been reported to be useful in the treatment of cognitive disorders. The first line treatment options of avoidant personality disorder are venlafaxine and SSRIs. Conclusions: Most of the studies in literature have been focused at borderline personality disorder that has been difficult to treat. According to the guidelines, psychotherapy is the first line treatment for personality disorders. Pharmacotherapy has been reported to increase the efficiency of psychotherapy in BPD which presents with various symptoms of mood, cognition, and behavior. The studies in the literature report that Polypharmacy is not useful for these patients contrary to the popular belief. The research about other personality disorders is limited. More clear understanding of etiopathogenesis of personality disorders; would be helpful in development of more effective pharmacological agents in their treatment.