Cem Atbasoglu

This review focuses on the differentiation of schizophrenia in the setting of adult psychiatry from neurodevelopmental disorders (NDD's) and psychosis due to other medical conditions (PDMC). Psychotic disorders in early adulthood are most frequently diagnosed with the schizophrenia spectrum or mood disorders. However, they may be the manifestation of neurologic, endocrine or immunologic disease. Individuals with NDD's such as the autism spectrum disorder (ASD) or intellectual developmental disorder (IDD) may also present initially in adulthood. Therefore it is not uncommon that the psychiatrist is the first physician to assess a psychotic patient with underlying medical illness or a NDD. Failure to identify the underlying cause will delay appropriate management. Overdiagnosis of primary psychiatric disorders may be misleading in planning the treatment, as evidence-based treatment algorithms relevant to psychosis are intended for primary psychotic disorders like schizophrenia, and symptomatic treatment may result in unnecessary exposure to antipsychotic drugs. Exclusion of other medical conditions and NDD's is essential before establishing a diagnosis of schizophrenia.

Objective: Defining job experience for a psychiatrist has always been a matter of debate and describing the work done by a psychiatrist is often challenging. Furthermore, cultural differences and variance in health policies across countries may complicate psychiatrists' subjective experiences of their work. The authors aimed to provide insight into the personal experience of those who become psychiatrists and are in active practice in academic settings. Methods: In-depth interviews were held with 16 psychiatrists working in various university and research health care services in Ankara, Turkey. Two questions were asked to the participants: a. How did you decide to become a psychiatrist? b. What can you tell us about your experiences as a psychiatrist throughout your career? Recordings were transcribed for coding and analysis; the encoding processes included the initial coding, separating the concepts into themes, editing the codes and themes, identifying the findings, and interpreting the results. Results: Intellectual curiosity (such as the desire to understand humanity or research how the brain works) was the most commonly reported reason for choosing the field. Helping psychiatric patients, the most common motive reported in previous questionnaire-based studies was the least mentioned theme in this study. Problems specific to the practice of psychiatry, such as etiological debates, were a less important factor in posi-tive or negative feelings about the profession; competency and the feeling of being autonomous were among the more important factors. Discussion: Personal curiosity seems to precede the basic need to practice medicine for those in academic psychiatry. One subjective experience that seems fairly widespread is developing modest atti-tudes towards psychiatry. Minimizing targets and learning to be satisfied with the limits of what psychiatry can do for certain patients seems to provide a solution for omnipotence anxiety.

AMAC: Diger anksiyete bozukluklarinda oldugu gibi sosyal anksiyete bozuklugunda (SAB) da ofke deneyiminin saglikli kisilerden fazla oldugu bilinmesine ragmen ofke duygusunun ve disa vurumunun niteliksel olarak diger anksiyete bozukluklarindan farklari yeteri kadar aciklanmamistir. Calismanin amaci; SAB olan hastalarin diger anksiyete bozuklugu olan hastalardan daha ofkeli oldugu, ofkenin niteliksel olarak diger anksiyete bozuklugu olan hastalardan farklilik gosterdigi ve sosyal anksiyetenin ofkeyle ilgili ozellikler ve yeti yitimiyle iliskili oldugu hipotezlerini test etmektir. Ayrica yeti yitimi ve klinik ozellikler acisindan farkliliklar da arastirilmaya calisilmistir.GEREC VE YONTEM: Calisma grubunu Ankara Universitesi Tip Fakultesi Psikiyatri Anabilim dali kliniginde ayaktan veya yatarak tedavi goren hastalarla, ogretim gorevlileri tarafindan calisma icin yonlendirilmis SAB hastalari (N=34) ve kontrol grubu olarak ayni merkezlerden gonderilen, ayni yas, cinsiyet, egitim ve sosyo...

Sunulan altyapi projesi ile Ankara Universitesi Beyin Arastirmalari Uygulama ve Arastirma Merkezi (AU-BAUM) kapsaminda ileri teknoloji ile insaasi gereken laboratuarlarin kurulmasi ve arastirmalarda kullanilacak arac ve gerecin saglanmasi amaclanmistir.AU-BAUM ulkemizde beyin arastirmalari merkezlerinin ilklerindendir. Merkezin Turkiye’de bir ilk ve dunyanin onde gelen cazibe merkezlerinden biri olmasini saglayacak ozellikleri ise uzaysal algi-dikkat, bellek, dil, duygulanim gibi yuksek beyin islevlerinin saglikli birey ve hasta gruplarinda, beyin goruntuleme, genetik materyal saklama, dilbilimsel analiz, noropsikiyatrik ve norolojik olcum ve degerlendirmelerle incelenebilmesine olanak saglayacak olmasidir. Bu amacla gerceklestirilen alt yapi projesi ile Elektroensefalografi (EEG), Dilbilim ve Near Infra Red Spectroscopy (NIRS) laboratuarlarinin yapilandirilmasi tamamlanmistir.

Akut akatizisi olan hastalarda kas ici biperiden uygulamasinin kisa vadedeki etkisi; randomize, cift kor, plasebo kontrollu bir calisma AMAC: Akatizi, antipsikotik ilaclarla ortaya cikan oznel bir huzursuzluk hissi ve buna eslik eden motor hareketlilik halidir. Ekstrapiramidal yan etkiler arasinda en sik olanidir. Tedaviye uyumun bozulmasindan ve nuks riskinin yukselmesinden sorumlu en onemli etmenlerdendir. Akatiziyi intihar egilimi ya da baska durtusel davranislarla iliskilendiren calismalar da mevcuttur. Calisma ilaci olan biperiden antikolinerjik bir ajandir ve antipsikotiklere bagli ekstrapiramidal yan etkilerin tedavisinde kullanilmaktadir. 1966-1999 yillari arasindaki yayinlar sistematik bir gozden gecirmeye tabi tutuldugunda, bu ilaclarin akatizi tedavisinde plaseboyla karsilastirildigi hicbir randomize kontrollu calismaya rastlanmamistir. Antikolinerjiklerin akut akatizideki etkinliginin cift-kor randomize ve plasebo kontrollu bir cahsma ile arastirilmasi, literaturdeki bir eksikligin giderilmesine katkida bulunacaktir. YONTEM: Iki paralel grup olusturacak sekilde biperiden (N=ll) ya da plaseboya (N=ll) randomize edilen noroleptik kullanimina bagli gelisen akatizi tanisi konulan hastalar, ilk enjeksyon oncesi ve iki saat araliklarla uc kez olmak uzere toplam 4 kez akatizi ve diger hareket bozukluklarinin derecesi ve genel psikiyatrik belirtilerin siddeti bakimindan degerlendirilmistir. Belirlenilen etkililik olcutleri cercevesinde gruplar biribiriyle uygun istatistiksel yontemler kullanilarak karsilastirilmistir. BULGULAR: Tedavi cevabi gozlenen hasta oram bakimindan gruplar arasinda istatistiksel olarak anlamli bir farklilik saptanmamistir (X= 0.79, p=0.66 ). Hem biperiden hem plasebo gruplari kendi iclerinde Barnes global akatizi puanindaki dusme bakimindan degerlendirildiginde, her iki grupta global akatizi puanindaki dusmeler anlamlidir. Gruplar arasinda ise 2. saatteki olcumler karsilastirildiginda gruplar arasindaki farklilik %10 guvenlik sinirinda anlamlidir (z=-1.91, p=0.065). 4. saatteki olcumlerde gruplar arasindaki farkliligin yine %10 guvenlik sinirinda anlamli oldugu gorulmustur (z=-1.80, p=0.088). 6 saatteki olcumler arasinda anlamli bir farklilik bulunmamaktadir (z=0.093, p=0.101). Genel psikiyatrik belirtilerdeki degisim dikkate alindiginda gruplar arasinda anlamli farklilik saptanmamistir. Her iki grupta da benzer yan etkiler gozlenmistir. TARTIŞMA: Bu calisma akatizi tedavisinde uzun suredir ve yaygin olarak kullanilan, antikolinerjik ajanlarin kullanimina iliskin literaturdeki ilk randomize, plasebo kontrollu calismadir. Bu yonuyle literaturdeki onemli bir boslugu doldurmaktadir. Calismanin sonuclan biperidenin plasebo uzerinde belirgin bir ustunlugunu ortaya koymadigi gibi biperidenin tamamen de etkisiz olmadigim gostermistir. Tedavi cevabinin 5 dereceli olcum sistemi olan bir olcekte en az iki puanlik dusme olarak tanimlandigindan, tedavi cevabi gozlenen hasta oram her iki grupta da goreceli olarak dusuktur. Konservatif bir cevap tanimi kullanilmasina ragmen plasebonun 11 hastadan ucunde tedavi cevabi saglamasi, daha onceki calismalarla uyumludur. Calismanin sonuclan literaturde akatizide biperiden kullanimina iliskin onceki calismayla uyumsuzdur. Bu calismanin birincil etkililik olcutleri, suna isaret etmektedir: Kas ici biperiden tedavi secenekleri arasinda ilk surada yer almamalidir. AbstractThe short term effectiveness of intramuscular biperiden in acute akathisia patients; a randomised, double blind, placebo controlled study OJECTTVE: Akathisia is a subjective restlessness accompanied by involuntary motor movements and it is mostly induced by antipsychotic drugs. As the most common extrapyramidal side effect akathisia is responsible for uncompliance for treatement, and relapse of the psychotic illness. Some studies mention that akathisa may be involved in suicide or impulsive behaviour. The present psychotrop, 'biperiden' is an anticholinergic, used to treat extrpyramidal side effects of antipsychotics. A stystematic review of the literature (1966-1999) fails to identify a randomised, placebo controlled study of biperiden for the treatment of akathisia. Thus a randomised, double blind, placebo controlled study of biperiden for the treatment of acute akathisia is an important contribution. METHOD: The patients diagnosed for acute neuroleptic induce akathisia (NIA) were randomised for im. biperiden (N=ll) or isotonic saline (N=ll) injections. The cases were evaluated before the injection and 3 times in two hour intervals after the injection(s). Each evaluation consisted of akathisia rating, ratings for other movement disorders and patinets' general psychiatric symptoms. The groups were compared by suitable statistical methods in terms of previously defined measures of effectiveness. RESULTS: There was not a statistically significant difference between the groups for the rate of responders (X= 0.79, p=0.66 ). The reduction of Barnes global akathisia score is significant…

IntroductionExposome is all nongenetic exposures from the prenatal period to death. Exposome score for schizophrenia (ES-SCZ) is a cumulative measure of environmental liability for schizophrenia. Our previous studies showed that the ES-SCZ is associated with mental and physical health outcome.ObjectivesThe aim of the study is to investigate the association of the ES-SCZ with metabolic parameters in individuals with schizophrenia and healthy controls.MethodsThis study obtained 124 individuals with schizophrenia and 440 healthy controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions, Work Package 6 (Vulnerability and Severity) Turkey dataset. The ES-SCZ was calculated by summing log-odds weighted environmental exposures (childhood adversities, winter birth, hearing impairment and cannabis use). Linear regression analysis was used to investigate the association between ES-SCZ and metabolic parameters. After that analysis age and sex ...

Huntington Hastalığı; kore ve distoni, koordinasyon bozukluğu, bilişsel performansta bozulmalar ve davranışsal sorunlar gibi farklıfenotipler ile ortaya çıkabilen, genetik olarak otozomal dominant geçiş özelliğine sahip, ilerleyici tipte bir nörodejeneratif hastalıktır. Bilişselve motor belirtilerin yanı sıra nöropsikiyatrik belirtiler de hastalığın çekirdek belirtileri arasında yer almaktadır. Huntington Hastalığı’ndanöropsikiyatrik belirtiler oldukça sık görülmekte ve hastalığın farklı dönemlerinde psikiyatrik bozuklukların görülme prevelansı %33-76 olaraktahmin edilmektedir. Nöropsikiyatrik belirtilerin görülme sıklığı hastalığın evrelerine göre farklılık gösterse de başlangıcının motor belirtilerbaşlamadan yıllar önce olabileceği de bilinmektedir. Huntington Hastalığı’nda sık görülen nöropsikiyatrik belirti ve bozukluklar depresyon,anksiyete, intihar, irritabilite, apati, obsesif-kompulsif belirtiler, perseverasyonlar, psikoz, uyku bozuklukları ve cinsel işlev bozuklukları olara...

S chizophrenia and bipolar disorder are two of the most important disorders in the clinical and scientific practice of psychiatry. As of September 2021, the date this supplement is complete, a search for the terms “schizophrenia” and “bipolar disorder” on the PubMed yield more than 150.000 and 55.000 entries, respectively. Those numbers would certainly be much higher with the inclusion of looser definitions like “psychosis” or “affective disorder”.

Background A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls. Methods This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate. Results ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disabilit...

Objective: To investigate the relationship between Expressed Emotion (EE) and working memory (WM) capacity in the caregivers of patients with psychosis, controlling for the potential confounds, namely, personality traits, subsyndromal psychotic symptoms, burden of care and the patient’s illness severity. Materials and Methods: The study covered 152 related caregivers of psychotic patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with a psychotic component. The study continued with 120 participants who met the recruitment criteria. Patients were assessed with a Structured Clinical Interview for Axis I Disorders (SCID-I), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression Scale (CGI). For related caregivers; SCID-I, Expressed Emotion Scale (EES), Temperament and Character Inventory (TCI); Magical Ideation Scale; Physical Anhedonia Scale; Social Anhedonia Scale; Zarit Caregiver Burden Scale (ZCBS), and Auditory Consonant Tri...

OBJECTIVE There is evidence suggesting that tryptophan (TRP)-kynurenine (KYN) pathway dysregulation is involved in the pathophysiology of schizophrenia and is regulated by inflammatory cytokines. The study investigate for the first time whether this dysregulation occurs in advanced stages of the disease as a byproduct or emerges as one of the early and inherited manifestations of schizophrenia. METHOD Sera of 148 patients with schizophrenia spectrum disorders (SCZ), 139 unaffected siblings (SIB) and 210 controls were investigated. Serum interleukin (IL)-1β levels were measured by ELISA, and TRP, KYN and kynurenic acid (KYNA) levels were measured by a high-performance liquid chromatography system. Also, we collected clinical data by applying Comprehensive Assessment of Symptoms and History in SCZ, and SIS-R in SIB and control groups. RESULTS Compared to controls, SCZ and SIB groups had lower TRP and higher KYNA levels. TRP levels showed significant differences only between SCZ and controls (p < 0.01). KYNA levels of both SCZ (p ≤ 0.001) and SIB (p < 0.05) were higher than controls. No statistical significance was found for KYN levels across groups. SCZ and SIB groups had higher serum IL-1β levels than controls (p ≤ 0.001). CONCLUSIONS Patients with SCZ and their siblings exhibited similar clinical features and TRP metabolite levels suggesting that TRP-KYN dysregulation may be an inherited component of the disease putatively conferring increased risk to schizophrenia. Elevation of IL-1β is one of the factors promoting overconsumption of the TRP-KYN pathway leading to increased production of neuroregulatory KYNA and presumably to neurodegeneration.

BACKGROUND Social cognition impairments, such as facial emotion recognition (FER), have been acknowledged since the earliest description of schizophrenia. Here, we tested FER as an intermediate phenotype for psychosis using two approaches that are indicators of genetic risk for schizophrenia: the proxy-genetic risk approach (family design) and the polygenic risk score for schizophrenia (PRS-SCZ). METHODS The sample comprised 2039 individuals with schizophrenia, 2141 siblings, and 2049 healthy controls (HC). The Degraded Facial Affect Recognition Task (DFAR) was applied to measure the FER accuracy. Schizotypal traits in siblings and HC were assessed using the Structured Interview for Schizotypy-Revised (SIS-R). The PRS-SCZ was trained using the Psychiatric Genomics Consortium results. Regression models were applied to test the association of DFAR with psychosis risk, SIS-R, and PRS-SCZ. RESULTS The DFAR-total scores were lower in individuals with schizophrenia than in siblings (RR = 0.97 [95% CI 0.97, 0.97]), who scored lower than HC (RR = 0.99 [95% CI 0.99-1.00]). The DFAR total score was negatively associated with SIS-R total scores in siblings (B = -2.04 [95% CI -3.72, -0.36]) and HC (B = -2.93 [95% CI -5.50, -0.36]). Different patterns of association were observed for individual emotions. No significant associations were found between DFAR scores and PRS-SCZ. CONCLUSIONS Our findings based on a proxy genetic risk approach suggest that FER deficits may represent an intermediate phenotype for schizophrenia. However, a significant association between FER and PRS-SCZ was not found. In the future, genetic mechanisms underlying FER phenotypes should be investigated trans-diagnostically.

Sunulan altyapi projesi ile Ankara Universitesi Beyin Arastirmalari Uygulama ve Arastirma Merkezi (AU-BAUM) kapsaminda ileri teknoloji ile insaasi gereken laboratuarlarin kurulmasi ve arastirmalarda kullanilacak arac ve gerecin saglanmasi amaclanmistir.AU-BAUM ulkemizde beyin arastirmalari merkezlerinin ilklerindendir. Merkezin Turkiye’de bir ilk ve dunyanin onde gelen cazibe merkezlerinden biri olmasini saglayacak ozellikleri ise uzaysal algi-dikkat, bellek, dil, duygulanim gibi yuksek beyin islevlerinin saglikli birey ve hasta gruplarinda, beyin goruntuleme, genetik materyal saklama, dilbilimsel analiz, noropsikiyatrik ve norolojik olcum ve degerlendirmelerle incelenebilmesine olanak saglayacak olmasidir. Bu amacla gerceklestirilen alt yapi projesi ile Elektroensefalografi (EEG), Dilbilim ve Near Infra Red Spectroscopy (NIRS) laboratuarlarinin yapilandirilmasi tamamlanmistir.

BackgroundFirst-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.MethodsWe conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.ResultsIn both discovery and replication sample, evidence for an association between...

Objective: Rado and Meehl proposed anhedonia as a main symptom and as a basis of other symptoms of schizotypy and schizophrenia. However, anhedonia was accepted as an important and standard symptom of schizophrenia after being classified as negative symptom by ...

Abstract: The objective of this study is to compare the course of metabolic effects of olanzapine and quetiapine, two atypical antipsychotics with similar structure and receptor binding affinities but clinically observed different metabolic ef-fects. This 6 week, single blind, randomized, controlled study was carried out during a structured treatment protocol in a female inpatient service, thus enabled to control effects of energy expenditure and other life style related factors. Subjects were randomly assigned into olanzapine (n=15) and quetiapine (n=15) groups. Weight and calorie intake (CI) were meas-ured daily. Symptom severity and serum leptin levels (SLL) were measured biweekly. Serum lipids were measured at baseline and 6th week. Olanzapine treatment was associated with more severe weight gain (F=11.2, p<0.01), increase in CI (F=8.1, p<0.01) and a more disturbed lipid profile than quetiapine. The course of SLL were similar between the groups (F=1.39, p=0.26). Weight, CI...

BackgroundThis study attempted to replicate whether a bias in probabilistic reasoning, or ‘jumping to conclusions’(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.MethodsData were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.ResultsJTC bias was positively associated not only with patient status but also with sibling status ...

BackgroundThere is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation.MethodsWe analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls.ResultsThe impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = ...

Exposures constitute a dense network of the environment: exposome. Here, we argue for embracing the exposome paradigm to investigate the sum of nongenetic “risk” and show how predictive modeling approaches can be used to construct an exposome score (ES; an aggregated score of exposures) for schizophrenia. The training dataset consisted of patients with schizophrenia and controls, whereas the independent validation dataset consisted of patients, their unaffected siblings, and controls. Binary exposures were cannabis use, hearing impairment, winter birth, bullying, and emotional, physical, and sexual abuse along with physical and emotional neglect. We applied logistic regression (LR), Gaussian Naive Bayes (GNB), the least absolute shrinkage and selection operator (LASSO), and Ridge penalized classification models to the training dataset. ESs, the sum of weighted exposures based on coefficients from each model, were calculated in the validation dataset. In addition, we estimated ES bas...

Recent years have seen considerable progress in epidemiological and molecular genetic research into environmental and genetic factors in schizophrenia, but methodological uncertainties remain with regard to validating environmental exposures, and the population risk conferred by individual molecular genetic variants is small. There are now also a limited number of studies that have investigated molecular genetic candidate gene-environment interactions (G × E), however, so far, thorough replication of findings is rare and G × E research still faces several conceptual and methodological challenges. In this article, we aim to review these recent developments and illustrate how integrated, large-scale investigations may overcome contemporary challenges in G × E research, drawing on the example of a large, international, multi-center study into the identification and translational application of G × E in schizophrenia. While such investigations are now well underway, new challenges emerg...

Type 2 diabetes (T2D) is more frequent in schizophrenia (Sz) than in the general population. This association is partly accounted for by shared susceptibility genetic variants. We tested the hypotheses that a genetic predisposition to Sz would be associated with higher likelihood of insulin resistance (IR), and that IR would be predicted by subthreshold psychosis phenotypes. Unaffected siblings of Sz patients (n = 101) were compared with a nonclinical sample (n = 305) in terms of IR, schizotypy (SzTy), and a behavioural experiment of "jumping to conclusions". The measures, respectively, were the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Structured Interview for Schizotypy-Revised (SIS-R), and the Beads Task (BT). The likelihood of IR was examined in multiple regression models that included sociodemographic, metabolic, and cognitive parameters alongside group status, SIS-R scores, and BT performance. Insulin resistance was less frequent in siblings (31.7...

Drug provocation tests (DPTs) are important in the treatment of patients with drug hypersensitivity (DH), but they carry certain hypersensitivity reaction risks, which lead to procedure-related concerns in patients. To investigate DPT-related anxiety and its effect on long-term use of tested drugs. The study included patients who underwent DPT from July 1, 2009, to July 1, 2012. After recording the patients' history and characteristics, a variety of psychiatric (Hospital Anxiety and Depression Scale, Panic and Agoraphobia Scale, and the Maudsley Obsessive-Compulsive Inventory) and quality-of-life (36-item Short Form Health Survey) tests were performed. DPT-related anxiety was also evaluated using a visual analog scale. The patients were requestioned about whether they had used the tested drug within 1 year. A total of 126 patients were included in the study. According to the Hospital Anxiety and Depression Scale, 23.4% and 30.6% of the patients had depression and anxiety symptoms, respectively. The mean (SD) visual analog scale anxiety scores after a negative DPT result were lower than those before DPTs (2 [2.5] after vs 5.2 [3.4] before; P < .001). In the long term, 15.9% of the patients did not use the drug because of ongoing anxiety related to drug reactions, despite negative DPT results and symptoms indicated for use of the drug. Our findings suggest that DPTs in themselves cause significant anxiety in patients with DH. Importantly, anxiety levels decreased after a negative test result. However, our results also suggested that a negative DPT result is not convincing enough for some patients to use the tested drug when needed in the future. Therefore, supporting strategies appear to be the most effective way to eliminate DH-related anxiety of patients.

Neuroleptic-induced acute akathisia (NIA) is a distressing condition and an important clinical problem because it is associated with treatment noncompliance and suicidal or impulsive behavior. Anticholinergics are among the treatment options; however, a review of the literature fails to identify a double-blind, randomized, placebo-controlled study of these medications in NIA. In a randomized, double-blind, placebo-controlled design, we studied the effectiveness of intramuscular biperiden (n = 15) or isotonic saline (n = 15) in the treatment of NIA diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Injections were repeated up to 3 times unless akathisia was completely treated (scored 0 for global akathisia with the Barnes Akathisia Rating Scale). Patients were assessed for akathisia, other movement disorders, and psychiatric symptoms at baseline and 3 times after the first injection at 2-hour intervals. Response was defined as at least a 2-point decline in the global akathisia score. The numbers of responders in the 2 groups were not significantly different (7 and 5 in the biperiden and placebo groups, respectively). The courses of individual items on the Barnes Akathisia Rating Scale were also similar. Our results suggest that intramuscular biperiden should not be considered as a first-line treatment of NIA.

Bipolar disorder is associated with cognitive dysfunction in several domains. Medication effect is a potential confounder that can only be statistically controlled in many studies. The cognitive profile in bipolar disorder during remission on maintenance antipsychotics or mood stabilizers medication has not been compared before. We compared the cognitive profile of bipolar disorder patients euthymic for 2 month or more on monotherapy with novel antipsychotics (AP) (n=16), lithium carbonate (Li) (n=25) or valproic acid (VPA; n=26). Forty-two individuals were assessed as controls. The cognitive battery included Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtests, the Wechsler Memory Scale (WMS), and Wisconsin Card Sorting Test (WCST). All three patient groups compared to controls performed poorly on the working memory and verbal memory tasks (F=3.59, df=3, p=0.02 for WAIS-R Arithmetic and F=123.64, df=3, p<0.01 for WMS Logical Memory). The differences remained significant a...

This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the effects of age, sex, psychiatric diagnosis and duration of illness on the severity and topographic distribution of dyskinesia, and to describe the topographic distribution of drug-induced dyskinesia (DID) and drug-induced parkinsonism (DIP) in detail by examining 170 consecutive inpatients on antipsychotic treatment. Age, sex, psychiatric diagnosis or total duration of exposure to antipsychotics had no significant effect on either the severity or the distribution of DID. Drug-induced dyskinesia and DIP did not show a conspicuous pattern of lateralisation. Progression of mild DID to TD may not be a rule and factors other than age, sex, psychiatric diagnosis or duration of antipsychotic exposure might be operating in the development of clinically significant TD. Gait abnormalities and falls might be frequent manifestations of DIP as well as other side effects in these patients.