Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Thiol/Disulphide Homeostasis in Bipolar Disorder(2018) Erzin, Gamze; Kotan, Vahap Ozan; Topcuoglu, Canan; Ozkaya, Guven; Erel, Ozcan; Yuksel, Rabia Nazik; Urer, Emre; Aydemir, Makbule Cigdem; Goka, Erol; 29329041Bipolar disorder (BD) patients have increased oxidative stress, which can disturb thiol/disulphide homeostasis, causing disulphide formation. The aim of the study is to investigate dynamic thiol/disulphide (SH/SS) homeostasis in BD patients, which is a novel evaluation method of oxidative status. Ninety-four BD patients (50 in the manic episode and 44 in remission) and 44 healthy controls were included in the study. Blood serum native thiol (SH) and total thiol (ToSH) concentrations were measured in a paired test. The half value of the difference between native thiol and total thiol concentrations was calculated as the disulphide (SS) bond amount. Serum native thiol levels of the mania group were found to be lower than the remission and the control groups. There was a significant difference between the remission group and the control group in terms of native thiol. Serum total thiol level was lower in mania group than the control group. Detection of oxidative molecules for BD could be helpful, especially in treatment, follow-up periods and reducing morbidity. The results of our study besides the data available in the literature support that thiol and disulphide levels are useful markers for BD and promising therapeutic targets in terms of future pharmacological modulation.Item Differences in Sociodemographic Characteristics, Clinical Features and Serum Liver Function Tests of Male Cannabis and Synthetic Cannabinoid Users(2017) Kotan, Vahap Ozan; Yucens, Bengu Baz; Kotan, Zeynep; Ozkaya, Guven; Okay, Ihsan Tuncer; Tikir, Baise; Goka, ErolObjective: Synthetic cannabinoid (SC) use has recently become a growing substance abuse problem, with serious harmful clinical effects. Young males, especially cannabis (C) users, are at great risk of SC use. The aim of this study is to determine sociodemographic characteristics, clinical features and serum liver function tests of SC users and compare with those of C users. Methods: Out of 118 SC users applied to outpatient clinic of Ankara Numune Training and Research Hospital Alcohol and Substance Addiction Treatment Center, 74 males included in this cross-sectional study. Patients with a concurrent use of any medication or substance other than C/SCs or patients with any physical illness which could affect serum liver function tests were excluded. 44.6% (n=33) of 74 patients were only SC users at least for last three months and 55.4% (n=41) were combined C and SC (C&SC) users. SC users were compared with 34 age and BMI-matched only C using males. Results: Rates of being single and divorced; rates of living with friends and alone were found to be higher in SC users. Adverse effects and withdrawal sypmtoms were found to be similar in C users and SC users. According to serum liver function test results, levels of gama-glutamil transpeptidase, alkaline phosphatase, total/direct bilirubin, albumin, prothrombin time and international normalized ratio were similar. Serum aspartate aminotransferase levels (31.2 +/- 22.0 IU/L and 41.5 +/- 21.5 IU/L respectively, p=0.026) and serum alanine aminotransferase levels (28.4 +/- 18.9 IU/L and 44.3 +/- 25.9 IU/L respectively, p=0.015) differed between C users and C&SC users. Results in this study revealed that increased serum levels of aminotransferases were especially associated with combined use of C and SCs. Conclusions: C abuse seems to be a precursor of SCs abuse, and risk of starting SCs use could be bigger for C users, who live alone or with friends, whereas living together with a family could be preventative. Combined use of C and SCs seem to increase the risk of hepatocellular injury compared to either C or SCs alone.Item Association between treatment motivation, addiction characteristics, craving and temperament traits in male patients with alcohol addiction(2020) Erzin, Gamze; Kilincel, Oguzhan; Kokurcan, Ahmet; Yirun, Merve Cingi; Okay, Ihsan Tuncer; Dalgar, Ilker; Goka, ErolPurpose: The aim of this study is to investigate the relationship between the treatment motivation, addiction characteristics, craving and temperament traits in male patients with alcohol addiction having inpatient treatment. Materials and Methods: Male patients diagnosed with alcohol addiction according to DSM-IV-TR having inpatient treatment at Ankara Numune Training and Research Hospital's Alcohol and Substance Abuse Treatment and Training Center (AMATEM) were included in the study. The patients were evaluated by sociodemographic data form, Penn Alcohol Craving Scale (PACS), Addiction Profile Index (API), The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Results: 85 male patients were included in the study. The mean age of the participants was 46.36 +/- 9.66. The mean of the years of using alcohol was 23.32 +/- 10.33. A positive correlation was found between API total score and PACS total score according to the study. Conclusion: Increasing craving severity aligned with increasing addiction severity may suggest that patients with high addiction severity should be given more care in terms of craving. The relationship between having a dominant temperament and craving, motivation and severity of addiction could not be determined in our study.Item Quality of life and pain perception in alcohol dependence: A comparative examination of patients, their relatives, and healthy controls(2019) Ertek, Irem Ekmekci; Taner, Mustafa Ender; Yuksel, Rabia Nazik; Kotan, Vahap Ozan; Goka, ErolObjective: The aim of this study was to investigate how quality of life and the perception of pain are affected by patients with alcohol dependence and their relatives compared with healthy controls. Methods: Fifty patients with alcohol dependence, 50 first-degree relatives of patients with alcohol dependence, and 50 healthy controls were included. Participants were evaluated with a questionnaire form of sociodemographic characteristics, and the World Health Organization Quality of Life-Bref-Turkish form (WHOQOL-BREF-TR). They were then given a noxious stimulus using a transcutaneous electrical nerve stimulation (TENS) device. After that, pain threshold, pain tolerance, and visual analog scale (VAS) scores of the participants were measured. Results: Patients' quality of life was poorer than the relative and control groups. The age of first alcohol use was found to be positively associated with quality of life. Pain tolerance was found to be higher in the patients than in the controls. We found no relationship between pain perception and characteristics of addiction. Conclusions: In this study, pain tolerance was found to be higher in patients with alcohol dependence, and the characteristics of addiction did not seem to affect pain perception.Item The severity of dissociative symptoms among patients with cannabis and synthetic cannabinoid use disorder: association with substance use characteristics and suicide(2019) Yucens, Bengu; Kotan, Vahap Ozan; Okay, Ihsan Tuncer; Goka, ErolOBJECTIVE: Cannabis (C) and synthetic cannabinoids (SCs) are commonly used substances. Pharmacodynamic and pharmacokinetic differences predict that SCs involve a greater risk of dependence than C. Dissociative symptoms and suicidality are also frequent in treatment-seeking substance users, however, there is not enough data about the dissociative effects of C and SCs. The present study aimed to examine SC users in terms of demographic features and severity of dissociative symptoms in comparison to C users. It was also aimed to explore the relationships between dissociation and suicide attempts. METHODS: The study was performed at the Alcohol and Substance Research, Treatment, and Training Centre of Ankara Numune Training and Research Hospital, Turkey. 84 patients with C or SC use disorder included in the study and all the participants were administered a sociodemographic data form assessing also substance use features and suicide attempts and Dissociative Experiences Scale (DES). The patients were separated into three groups as only C users (CU), only SC users (SCU) and both C and SC users (C&SCU) and also categorized as DES score <30 as the low dissociation level and DES score of >= 30 as the high dissociation level. Correlations between variables were tested using Spearman correlation coefficients and the predictors of high dissociation level were evaluated using logistic regression analysis. A value of p<0.05 was considered statistically significant. RESULTS: DES mean score was 28.82 in all participants. Dissociation levels (rho = 0.058) and high dissociator rates (rho = 0.443) were similar among CU, SCU, and C&SCU groups. Age at onset of substance use was negatively correlated with the severity of dissociative symptoms (r = -0.22, rho = 0.042). DES mean score of patients with a history of suicide attempt was 40.51, significantly higher than that of those without (23.47). Age at onset of substance use, lifetime years of substance use, type of substance used (C, SC, and C&SC usage) were not significant predictors, only the history of suicide attempt was the significant predictor of high dissociation level (B = 1.886, S.E. = 0.542, Wald = 12.104, df = 1, rho = 0.001, OR = 6.596, 95% CI = 2.279-19.089). CONCLUSIONS: The findings support that dissociation levels are high in C and SC users as in other substance users, however, dissociative effects of C and SCs do not differ from each other. Besides the dissociative effects of C and SC use, there is also a significant effect of the suicide attempt history on the severity of dissociative symptoms. Although the relationship between dissociation and type of substance used is not clear, there is an association between dissociation and the history of suicide attempt. C and SC users are also concerned with dissociative symptoms that should be considered by the clinician since it affects the treatment modality and treatment response.Item Reversible cycloplegia caused by duloxetine: a case report(2017) Kotan, Vahap Ozan; Yuksel, Rabia Nazik; Goka, ErolA Duloxetine is a balanced and potent dual reuptake inhibitor of serotonin and norepinephrine (SNRI) that has previously been shown to be effective in the treatment of major depressive disorder (MDD), generalized anxiety disorder, and diabetic peripheral neuropathic pain (DPNP). Cycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Here, we present a reversible cycloplegia case caused by duloxetine use. The patient was a 24 years-old woman with MDD diagnosis. Patient had somatic symptoms like fatigue, myalgia, and headache, besides her depressive symptoms for the last two months. Escitalopram and sertraline were used for her MDD before and she had to quit both owing to side effects such as nausea and drowsiness. Duloxetine 30mg/day treatment was started in our outpatient clinic. In her first follow-up exam, she reported light sensitivity and increased visual impairment. The visual impairment led dizziness and an increase in headache. She was consulted to ophthalmology unit of our hospital and cycloplegia was detected in her eye examination. Duloxetine was stopped in the ninth day of treatment but cycloplegia negatively affected the patient's daily life for almost 4 weeks and impaired her functionality. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects. Eye pain, changes in vision and swelling or redness in or around the eye are mentioned as possible visual side effects in the medication of duloxetine. The ocular and visual side effects from a patient's systemic medication can range from mild to severe. These side effects may or may not be serious enough to warrant discontinuing treatment. Cycloplegia seems as a rare adverse effect in antidepressant treatment and may take a long time to wash out. Recognition of ocular and visual side effects is important to prevent and minimize serious complications. In such visual disturbances, eye examination of the patient should be performed and the responsible drug should be discontinued as early as possible.Item Thiol/Disulphide Homeostasis in Men with Heroin Addiction(2017) Kotan, Vahap Ozen; Yilmaz, Fatma Meric; Neselioglu, Salim; Erel, Ozcan; Okay, Ihsan Tuncer; Kiral, Serkan; Bakirhan, Abdurrahim; Goka, ErolObjective: Heroin addicts have increased oxidative stress which can disturb thiol/disulfide (SH/SS) homeostasis, causing disulfide formation. No study has determined the serum thiol amount and blood disulfide amount in heroin addicts. The aim of the study was to investigate dynamic SH/SS homeostasis in heroin addicts. Methods: Serum SH/SS statuses of 31 heroin addicts and 31 healthy controls were compared to determine the changes in SH/SS homeostasis in heroin addicts. Blood serum native thiol and total thiol (ToSH) levels were measured and the disulfide bond amount was calculated as the half value of the difference between native thiol and ToSH levels. For comparison t-test was used. Results: SH and ToSH levels were significantly lower (p<0.001 for both) in heroin addicts than in the healthy group whereas disulfide levels were significantly higher (p<0.001). Heroin addicts had significantly higher SS/ToSH and SS/SH ratios and significantly lower SH/ToSH ratios than healthy individuals. Conclusion: The results showed that SH and ToSH levels were decreased in heroin addicts and SH/SS homeostasis was also disturbed with a shift to the disulfide bond formation side. Results of this study could contribute to the knowledge about pathogenesis of heroin addiction and also to its management. We suggest that replacement of the thiol gap and reduction of excess SS might have positive effects in treatment results.Item Serum glial cell line-derived neurotrophic factor levels and impulsivity in heroin addiction: a cross-sectional, case-control study of 129 heroin addicts(2018) Kotan, Vahap Ozan; Yuksel, Rabia Nazik; Kotan, Zeynep; Okay, Ihsan Tuncer; Topcuoglu, Canan; Ozkaya, Guven; Bayram, Senol; Goka, ErolOBJECTIVE: Glial cell line-derived neurotrophic factor (GDNF), being a protective of dopaminergic neurons, is reported to modulate addictive behaviours and have a role as a negative regulator for biochemical and behavioural adaptations to drug abuse. We aimed to reveal impulsivity and serum GDNF levels in patients with heroin addiction and investigate their relationships in order to contribute to the understanding of behavioural aspects and biological mechanisms in heroin addiction via this study. METHODS: This study was performed at the Department of Psychiatry of Ankara Numune Training and Research Hospital, Turkey. We recruited 129 heroin-dependent patients and 90 age, sex, and smoking-matched healthy controls with no major psychopathology. Barratt Impulsivity Scale-11, Hospital Anxiety and Depression Scale (HADS) and sociodemographic data form were applied to all participants. Laboratory analysis for serum GDNF levels was performed for each participant's blood sample. RESULTS: Total impulsivity scores and scores of Attentional Impulsivity, Motor Impulsivity, and Unplanned Impulsivity subscales were all higher in heroin addicts compared to the controls. Heroin addicts had also lower serum GDNF levels and lower GDNF levels were associated with high impulsivity and high HADS scores in heroin addicts. CONCLUSION: Decrement in GDNF levels in heroin addiction seems as to be an important data which could be associated with impulsivity, anxiety, and depressive symptoms. GDNF could find a prominent place among the target molecules in the treatment of heroin addiction.Item The relationship between internalized stigma and treatment motivation, perceived social support, depression and anxiety levels in opioid use disorder(2018) Akdag, Emine Merve; Kotan, Vahap Ozan; Kose, Samet; Tikir, Baise; Aydemir, Makbule Cigdem; Okay, İhsan Tuncer; Goka, Erol; Ozkaya, GovenOBJECTIVE: This study aims to examine how internalized stigma differs in opioid use disorder (OUD) based on sociodemographic and clinical variables, and to what extent internalized stigma is related to treatment motivation, perceived social support, depression, and anxiety levels. METHODS: One hundred forty-five individuals with OUD included. Sociodemographic and clinical data form, the Internalized Stigma of Mental Illness Scale (ISMI), Treatment Motivation Questionnaire (TMQ), Multidimensional Scale of Perceived Social Support, the Beck Depression Inventory, and the Beck Anxiety Inventory were utilized in the study to collect data. Bivariate and partial correlation coefficients between variables were computed. ISMI and TMQ scores were compared between patients with depressive symptoms and patients without depressive symptoms by using t-test and Mann Whitney U test. RESULTS: Internalized stigma was high among male patients with heroin use disorder. There was a positive correlation between internalized stigma score and treatment motivation, depression, and anxiety levels. On the other hand, there was a negative correlation between internalized stigma score and multidimensional perceived social support. CONCLUSION: Internalized stigma occupies an important place in the treatment of OUD, which occurs with frequent relapses and which is hard to treat. Not only application for treatment but also adherence to treatment and treatment motivation at maintenance phase bestow a complicated relationship with depression and anxiety. In the struggle against internalized stigma, it plays a vital role to mobilize people's social support systems, to educate families on the issue and to get in touch with support units exclusive to heroin users.