Background: Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment.

In the late-stage idiopathic Parkinson's disease (IDP), comorbid conditions such as depression and drug-induced psychosis may be observed. A patient with Parkinson disease, major depression, and paranoid psychosis who developed neuroleptic malignant syndrome (NMS) as the result of the sudden termination of high-dose (1200 mg/d) levodopa treatment is presented in this report. Because the patient did not respond to other treatment modalities, electroconvulsive therapy (ECT) was applied, and a rapid improvement was observed both in the patient's NMS and also in Parkinson's and psychiatric symptoms, with no additional side effects other than transient post-ictal confusions. The application of ECT allowed the patient to remain stable for a 5-year period with a quite low dose of levodopa (300 mg/d). Later, the patient had two episodes of depressive and psychotic symptoms, which were again successfully treated with the ECT. We suggest that ECT might be an effective and life-saving therapy in patients with severe, drug-resistant NMS.

Predictors for a longer time to remission were psychiatric comorbidities, a higher YMRS score, and a higher number of previous depressive episodes. Predictors for a shorter time to recurrence were episodes of longer duration and mixed type.

No abstract

P-glycoprotein (P-gp), an efflux transporter protein, is an ABC transporter encoded by the multidrug resistance 1 gene (MDR1, ABCB1). The common synonymous C3435T polymorphism in exon 26 is reported to associate with lower P-gp functional expression and drug uptake. Many extended pharmacogenomics, functional, and complex disease association studies focused mainly on this polymorphism. We investigated the association of exon 26 C3435T genetic variants of MDR1 gene with susceptibility to bipolar disorder and serum valproic acid concentration. Totally, 104 patients meeting DSM-IV criteria for bipolar disorder and 169 controls were admitted to the study. There was statistically significant difference between the genotypes of bipolar patients (CT 91.2%, TT 6.8%, and CC 2%) and controls (CT 52.7%, TT 26%, CC 21.3%) although their allelic distribution was similar. The serum valproic acid concentrations of the patients with CT, TT and CC genotypes were 72.92 +/- 20.55, 80.47 +/- 14.01 and 68.29 +/- 12.17 microg/ml, respectively, and there was no significant difference between the C3435T genotypes.

BackgroundThe 'double-diamond copy' task is a simple paper and pencil test part of the Bender-Gestalt Test and the Mini Mental State Examination (MMSE). Although it is a widely used test, its method of scoring is crude and its psychometric properties are not adequately known. The aim of the present study was to develop a sensitive and reliable method of administration and scoring.MethodsThe study sample included 93 normal control subjects (53 women and 40 men) aged 35.87 ± 12.62 and 127 patients suffering from schizophrenia (54 women and 73 men) aged 34.07 ± 9.83.ResultsThe scoring method was based on the frequencies of responses of healthy controls and proved to be relatively reliable with Cronbach's α equal to 0.61, test-retest correlation coefficient equal to 0.41 and inter-rater reliability equal to 0.52. The factor analysis produced two indices and six subscales of the Standardised Copy of Pentagons Test (SCPT). The total score as well as most of the individual items and subscales distinguished between controls and patients. The discriminant function correctly classified 63.44% of controls and 75.59% of patients.DiscussionThe SCPT seems to be a satisfactory, reliable and valid instrument, which is easy to administer, suitable for use in non-organic psychiatric patients and demands minimal time. Further research is necessary to test its psychometric properties and its usefulness and applications as a neuropsychological test.

Amaç: Lityum duygudurum bozukluklarının koruma tedavisinde etkili bir ilaç olarak tüm dünyada tanınmaktadır. Lityumun bipolar bozukluk profilaksisindeki etkinliği yetmişli yılların başından beri kanıtlanmıştır. Lityum bipolar bozuklukta akut duygudurum epizodları farmakoterapisi, döngülerin önlenmesi, önleyici tedavi ve intiharın önlenmesinde dayanak noktası olmuş ve olmaya devam etmektedir. Bazı ülkelerde lityum düzeylerinin mevsimsel değişiklikleri olduğu şeklinde yayınlar mevcuttur. Winter sale on lithium levels: the impact of seasonality 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 Raşit Tahsin Mood Clinic of the Bakırköy 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 (15 th of June to 1st of September and 15 th of January to 1 st 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 i...

BackgroundAlthough the 'copy of cube test', a version of which is included in the Short Test of Mental Status (STMS), has existed for years, little has been done to standardize it in detail. The aim of the current study was to develop a novel and detailed standardized method of administration and scoring this test.MethodsThe study sample included 93 healthy control subjects (53 women and 40 men) aged 35.87 ± 12.62 and 127 patients suffering from schizophrenia (54 women and 73 men) aged 34.07 ± 9.83 years. The psychometric assessment included the Positive and Negative Symptoms Scale (PANSS) the Young Mania Rating Scale (YMRS), and the Montgomery-Åsberg Depression Rating Scale (MADRS).ResultsA scoring method was developed based on the frequencies of responses of healthy controls. Cronbach's α was equal to 0.75 and inter-rater reliability was 0.90. Three indices and five subscales of the Standardized Copy of the Cube Test (SCCT) were eventually developed. They included the Deficit Index (DcI), which includes the Missing Elements (ME) Mirror Image (M) subscales, the Deformation Index (DfI) which includes the Deformation (D) and the Rotation (R) subscales and the Closing-In Index (CiI).DiscussionThe SCCT seems to be a reliable, valid and sensitive to change instrument for the testing of psychiatric patients. The great advantage of this instrument is the fact that it only requires paper and a pencil, and is this easily administered and brief. Further research is necessary to test its usefulness as a neuropsychological test.