Aim: To investigate the association between menstrual cycle regularity in healthcare providers and COVID-19 pandemic-related anxiety, depression, stress. Methods: A cross-sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18-40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID-19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS-21). Results: A total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18-40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS-21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score. Conclusion:The current study showed the association between the COVID-19 pandemic-induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.

Pregabalin is a novel isomer of gamma-aminobutyric acid that functions as a major inhibitory neurotransmitter in the brain. It is used daily in medical practice for treating neuropathic pain, fibromyalgia, generalized anxiety disorder, and partial seizures. Due to its antiglutamatergic effects, it poses a potential addiction risk. For example, an abrupt discontinuation of this substance may cause patients to exhibit physical withdrawal symptoms, such as insomnia, nausea, headache, and diarrhoea. However, there is no information in the literature that addresses whether the rapid discontinuation of pregabalin can cause psychosis to occur. Here we presented a 20-year-old patient with his first episode of psychosis that was likely attributable to his withdrawal from a high dosage pregabalin. He lacked physical signs of withdrawal; however, a psychiatric examination was conducted. It was determined that the patient was experiencing paranoid ideation, auditory hallucinations, and mutism. Furthermore, he had engaged in self-mutilative actions and had attempted suicide. Due to the short time frame between the rapid discontinuation of a relatively large dose of pregabalin and the onset of the patient's first episode of psychosis, it is likely that the psychotic episode was triggered by the cessation of the medication. This is the first known case of psychosis that was caused by the rapid withdrawal of pregabalin to be discussed in the literature. The results of this clinical case may guide clinicians to recognize the symptoms of acute pregabalin withdrawal. ARTICLE HISTORY

No abstract

Venlafaxine, which is often used for a number of psychiatric-related conditions such as the treatment of major depression, generalized anxiety disorder, social anxiety disorder and panic disorder, is generally a drug that is well tolerated and safe. The side effects of drugs can cause the treatment to prematurely terminate. Clinicians should prefer appropriate and low side-effects drugs to prevent this. This situation is also especially important for psychiatric patients. Prostatism, which impairs quality of life, is an important medical condition, with clinical and social implications. In the previous studies, prostatism was declared as a side effect of some antidepressant such as milnacipran, duloxetine and reboxetine. In our case, we discussed that venlafaxine-related prostatism developed in a male patient. As far as we know this is the first report of venlafaxine-induced prostatism.ARTICLE HISTORY

Therapeutic single-dose mirtazapine-induced symptomatic bradycardia: a case report Cardiotoxicity is an important adverse effect of some psychotropic drugs. However, cardiac side effects with mirtazapine, which is used for an effective treatment of depression and anxiety, are rare. In this article, a forty-eight-year-old woman referred to psychiatric clinics with depressive symptoms. According to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria, major depressive disorder was diagnosed and mirtazapine 30mg/day was started. 30 minutes after the first dose of mirtazapine was brought to the emergency room with syncope, nausea, vomiting. She was examined in emergency service. Routine blood tests and ECG was studied. During the examination, the patient was followed up with a heart rate of 33 beats per minute, blood pressure arterial 80/50mmHg and a temperature of 36.1°C. 0.5mg atropine IV and theophylline inhaler were administered and cardiology consultation was requested. After atropine and theophylline administration, the heart rate was 48 beats/min in the second ECG. To the best of our knowledge, it is the first bradycardia developed after mirtazapine use in the literature. Bradycardia has been resolved after the half-life of mirtazapine has passed (37 hours for women). The initial heart rate of our patient was within normal limits prior to mirtazapine administration. There was no reason to explain bradycardia, we think that symptomatic bradycardine is caused by mirtazapine. In conclusion, this case report suggests that mirtazapine may cause bradycardia in patients. Risk factors for bradycardia caused by mirtazapine are unknown. Although in many patients this bradycardine does not cause a clinical outcome, clinicians should be aware of this and should perform ECG monitoring in patients with underlying cardiac disease, especially when prescribing mirtazapine.