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 of Domestic Violence Against Women With Sociodemographic Factors, Clinical Features, and Dissociative Symptoms in Patients Who Receive Services From Psychiatric Outpatient Units in Turkey(2020) Kotan, Zeynep; Kotan, Vahap Ozan; Yalvac, Hayriye Dilek; 29294725Domestic violence (DV) against women is a serious problem with its negative effects on all family members and the society. Women exposed to DV not only have physical but also psychological damage. This study investigates prevalence of DV and its relations with some descriptive and clinical features in a psychiatric outpatient population in Turkey. A total of 277 female outpatients were included in the study. After a semistructured clinical interview, they were assessed by sociodemographic data form, DV questionnaire, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Prevalence of exposure to DV by intimate partner is found to be 58.8% (n= 163). The current study provided strong evidence that occupation status of the woman, education level of the partner, and family type are predictors of DV. Another predictor of DV exists where the child is battered by either parent. Prevalence of depression, conversion disorder, and other somatoform disorders are higher in women exposed to DV. These women also have higher scores from HDRS, HARS, DES, and SDQ compared with female patients who have not experienced DV (p< .001). Number of women scoring above cutoff levels for DES and SDQ were significantly higher in women exposed to DV (p< .001).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 Intensive Care Psychological Assessment Tool (IPAT): Turkish validity and reliability study(2019) Duman, Berker; Kotan, Zeynep; Kotan, Vahap Ozan; Mutlu, Nevzat Mehmet; Doganay Erdogan, Beyza; Sayar Akaslan, Damla; Tatli, Safiye Zeynep; Kumbasar, Hakan; 31408296Background/aim: It is of crucial importantance to be able to detect acute psychological distress in patients. 'the Intensive Care Psychological Assessment Tool (IPAT) was developed for this purpose in intensive care units. This study aims to evaluate the validity and reliability of the Turkish version of IPAT. Materials and methods: In total, 98 patients were included. To assess concurrent validity, the Intensive Care Experiences Scale (ICES) and the Hospital Anxiety Depression Scale were performed. Cronbach's alpha coefficient was used to estimate internal consistency. Interitem and item-total score correlations were also performed. Sensitivity and specificity were derived for concurrent anxiety and depression. Results: The internal reliability was good. Cronbach's a = 0.85. Items were well-correlated, with an average interitem correlation of 0.38. The concurrent validity of IPAT was good. Correlation between IPAT scores, anxiety, depression, ICES, and the diagnosis of delirium were as follows, respectively: r = 0.61, P < 0.01, r 0.54, P < 0.01, r = -0.66, P < 0.01, r = 0.37, P < 0.01. With a cutoff score of > 6, IPAT showed 85% sensitivity and 61% specificity to detect concurrent anxiety, and 74% sensitivity and 82% specificity to detect concurrent depression [AUC = 0.77 (95% CI, 0.68-0.87) and 0.84 (95% CI, 0.76-0.92), respectively). Conclusion: The Turkish version of IPAT was found to be a valid and reliable tool to assess acute psychological distress among patients in intensive care units.Item Is restless legs syndrome related with depression/anxiety disorders or medications used in these disorders? A cross-sectional, clinic-based study(2019) Ocak, Davut; Kotan, Vahap Ozan; Paltun, Salih Cihat; Aydemir, Makbule CigdemObjective The aim of this study is to investigate the frequency and severity of restless legs syndrome (RLS) in patients diagnosed with depression or anxiety disorder and the relationship of RLS with medications used in these disorders and clinical/sociodemographic characteristics of the patients. Methods Four hundred and fifty-four consecutive patients who were treated with medication for ?Depressive Disorder? or ?Anxiety Disorder? in our outpatient clinic were included in the study. Subjects were screened by International Restless Legs Syndrome Study Group (IRLSSG) scale, Hospital Anxiety Depression Scale. Patients who met the criteria of RLS diagnosis due to the RLS screening scale (n?=?104) were interviewed in detail. Patients? laboratory tests were performed to investigate medical conditions other than antidepressant/antipsychotic use known to be related with RLS and 40 (8.8%) of 104 patients were excluded from the study. The main study group consisted of 414 patients. Results The mean IRLSSG score of 64 patients diagnosed with RLS was 18.95???5.11 (min: 7?max: 29), 7.8% of whom had mild and 55.1% had severe RLS. The incidence of RLS in patients receiving antidepressant treatment (n: 414) was significantly higher than the general population (15.5%). There were no significant difference neither between diagnostic groups (anxiety/ depression) nor individual antidepressants by means of RLS. Patients receiving combined treatment like SSRI?+?quetiapine, SSRI?+?mirtazapine or SSRI?+?trazodone scored 4.7 times higher on RLS scale. Discussion There was no significant difference by means of RLS diagnosis or severity of RLS in patients with a diagnosis of anxiety/depressive disorder. However antidepressant using patients? RLS prevalence was higher than general population?s. It was noticed that patients who received combined drug treatment had a 4.7-fold increase in RLS. In conclusion; beginning with as possible as the least number and dose of psychotropic drugs when treating a patient with depression or anxiety disorder does not increase RLS risk as well as providing advantages such as reduced risk of drug interaction and side effects.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 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 Assessing the validity and reliability of the Turkish versions of craving beliefs and beliefs about substance use questionnaire in patients with heroin use disorder: demonstrating valid tools to assess cognition-emotion interplay(2018) Kotan, Vahap Ozan; Kucukkarapinar, Melike; Eser, Hale Yapici; Yalcinay-Inan, Merve; Tarhan, Rifat; Arikan, Zehra; 30134921Background: Cognitions associated with craving and substance use are important contributors for the psychological theories of Substance use disorders (SUD), as they may affect the course and treatment. In this study, we aimed to validate Turkish version of two major scales 'Beliefs About Substance Use'(BSU) and 'Craving Beliefs Questionnaire'(CBQ) in patients with heroin use disorder and define the interaction of these beliefs with patient profile, depression and anxiety symptoms, with an aim to use these thoughts as targets for treatment. Methods: One hundred seventy-six inpatients diagnosed with heroin use disorder and 120 participants in the healthy comparison group were evaluated with CBQ, BSU, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and sociodemographic data questionnaire. Patient group was also evaluated with Addiction Profile Index. Reliability and validity analysis for scales were conducted. Linear regression analysis was conducted to evaluate the determinants of BSU and CBQ scores. Results: Cronbach alpha level was 0.93 for BSU and 0.94 for CBQ. Patient group showed significantly higher CBQ, BSU, BAI and BDI scores (p < 0.001). BSU score significantly correlated with API-substance use profile score, API-diagnosis, BAI, BDI and CBQ (p < 0.005), whereas CBQ scores significantly correlated with API-diagnosis, API-impact on life, API-craving, API-total score, BSU, BAI, BDI and amount of cigarette smoking (p < 0.002). Number of previous treatments and age of onset for substance use were not correlated with either BSU or CBQ. BAI and BDI scores significantly predicted BSU score, however only BDI score predicted CBQ score (p < 0.003). Conclusions: Craving beliefs were highly correlated with addiction profile. Anxiety and depression are significant modulators for patients' beliefs about substance use and depression is a modulator for craving and maladaptive beliefs, validating emotion-cognition interplay in addiction.