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    Could Weight Loss During Clozapine Therapy be an Indicator of Poor Response?: A Case Report
    (Turkiye Sinir Ve Ruh Sagligi Dernegi, 2021) Kök Kendirlioğlu, Burcu; Hariri, Aytul Gursu
    Even though effectiveness of clozapine on treatment resistant schizophrenia has been repeatedly demonstrated, it is also associated with many adverse effects including weight gain. Curiously, significant weight loss may occur in some patients. In this case report we discussed whether the observed weight loss could be a negative prognostic factor. The 56 year-old male patient, followed up with the diagnosis of schizophrenia for 20 years, had persistent positive and negative symptoms despite concurrent use of different antiypsychotics. He was diagnosed with treatment-resistant schizophrenia and started on clozapine with dose titration to 500 mg/day over 3 months. He was observed to have lost 17.6% of his initial body weight after 7 months of therapy. The Positive and Negative Syndrome Scale (PANSS) score of the patient did not change significantly. There are a few case reports in the literature on weight loss during clozapine therapy. Some proposed that the weight loss could be a sign of weak response to treatment which is based on the observation that the clinical response might be poor when there is a weight loss and no change in blood triglyceride levels is observed with the treatment. There is a need for more case-control and preclinical studies to explain the mechanisms underlying weight loss and weak response to clozapine therapy in schizophrenia.
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    Dissociation in bipolar disorder: Relationships between clinical variables and childhood trauma
    (ELSEVIER SCIENCE BV, 2015) Hariri, Aytul Gursu; Gulec, Medine Yazici; Orengul, Fatma Fariha Cengiz; Sumbul, Esra Aydin; Elbay, Rumeysa Yeni; Gulec, Huseyin
    Objective: The dissociative experiences of patients with bipolar disorder (BD) differ from those of patients with other psychiatric disorders with regard to certain features. The primary goal of this study was to evaluate the relationship between the clinical variables of BD and childhood trauma using the factor structure, psychometric features, and potential subdimensions of the Dissociative Experience Scale (DES). Method: This study included 200 BD patients who were in a remission period and 50 healthy volunteers. The BD patients were recruited from two psychiatry clinic departments in Turkey. The sociodemographic data of the two groups and their scores on the DES and Childhood Trauma Questionnaire (CTQ)-28 were compared. Results: The overall DES scores and the scores for each DES item accurately and reliably measured dissociation in the BD patients (item total correlation r scores: > 0.20, Cronbach's alpha: 0.95), and a factor analysis revealed two subdimensions of the DES for BD: identity confusion/alteration (SubDES-1) and amnesia and clepersonalizaLion/clerealizaLion (SubDES-2). Although age at onset of ED was significantly correlated with both subdimensions, illness duration was significantly correlated only with the SubDES2. 01 all the subjects, 19.5% (39/200 patients) were identified as having dissociative experiences by the DES-Taxon (DES-T), and subjects in this subscale (DES-T-positive) had significantly higher total scores on the CTQ-28 as well as higher scores on each subgroup of this scale. The highest CTQ-28 subgroup score was emotional neglect, which was followed by emotional abuse and physical neglect and then sexual abuse and physical abuse. There was a significant correlation between total scores on the CTQ-28 and SubDES-2 but none of the CTQ-28 subscale scores was significantly correlated with either SubDES-1 or Sub DES-2. Conclusion: The DES sufficiently and reliably identified the experience of dissociative symptoms on the part of BD patients, and a factor analysis revealed two subdimensions of BD on this scale. In particular, DES-T-positive subjects experienced a greater amount of childhood trauma and, as a result, had an earlier age at onset of BD. Additionally, SubDES-2, which was associated with amnesia and depersonalization/derealization, was closely related to illness duration. (C) 2015 Elsevier B.V. All rights reserved.
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    The effect of cluster B personality disorder comorbidity on the coping styles in patient with bipolar disorder
    (CUMHURIYET UNIV TIP FAK PSIKIYATRI ANABILIM DALI, 2015) Usta, Haluk; Gulec, Huseyin; Hariri, Aytul Gursu; Gulec, Medine
    Objective: The effect of the presence of cluster B personality disorders which are frequent comorbidities with bipolar I disorder on the coping strategies was investigated and also it was studied whether there was a different profile. Methods: The patients who were in remission period and had bipolar disorder were included in the study. All things considered, we included 50 male and 50 female patients who had bipolar I disorder in remission period with cluster B personality disorder, and 50 male and 50 female patients without cluster B personality disorder. SCID-I and SCID-II were used respectively. The COPE scale was also given to determine patients' coping styles. Results: In terms of coping styles, the patients with cluster B personality disorder had higher dysfunctional coping styles scores. There were no significant differences for problem-focused coping scores, and emotion-focused coping scores among those patients. When the subscales were examined, the scores of focusing on emotions and expressing emotions, denial, retraining, and substance use subscales were higher among the patients with cluster B personality disorder. Conclusion: When the coping styles of bipolar patient groups those were divided according to having cluster B personality disorder or not were compared, it was seen that the group with cluster B personality disorder were using more dysfunctional coping styles. These findings can be important with regards to psychosocial interventions. Our findings must be replicated with larger and different comorbidity groups.
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    Intracellular Adhesion Molecule (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1) and E-Selectin Levels in First Episode Schizophrenic Patients
    (KURE ILETISIM GRUBU A S, 2013) Kavzoglu, Semine Ozdogan; Hariri, Aytul Gursu
    Objectives: The aim of this study was to compare the levels of intracellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (V-CAM-1) and E-selectin, which are considered as possible biological determinants in prognosis and progression of atherosclerosis, in schizophrenia patients pre-and post-treatments and healthy controls. Methods: In Erenkoy Research and Training Hospital for Mental and Neurological Disorders, drug naive 50 patients with a diagnosis of first episode schizophrenia according to the DSM-IV-TR diagnostic criteria, and a control group consisting of 50 healthy volunteers were enrolled in this study. Plasma levels of ICAM-1, VCAM-1, E-selectin, fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides of the patients were measured at the beginning of the study (n = 50) and at the end of the third month (n = 39), and compared. The same biochemical parameters of the controls were measured at only the beginning of the study. In order to assess the termination of the acute episode, the Positive Symptoms Assessment Scale (SAPS) and Negative Symptoms Assessment Scale (SANS) were applied to the patients at the beginning of the study and at the end of the third month. Results: The average age of patients experiencing their first episode of schizophrenia was 30.14 +/- 7.50. The initial ICAM-1 levels of the patients were lower than those of the control group (t= 3.41, p=.001), and increased after treatment (t=-6.73 p< .001), while there was no difference in the VCAM-1 and E-selectin levels of the patients and controls (t=-1.23, p=.223; t=-0.32 p=.750, respectively). Also, post-treatment VCAM-1 levels were lower than the initial levels (t=7.17, p<.001). The average levels of fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were similar in the control and patient groups, while a significant increase was observed in triglyceride levels of patients with schizophrenia after treatment (t=-3.19, p=.003). Conclusion: The levels of cellular adhesion molecules of individuals experiencing a first episode of schizophrenia were not different from controls, with the exception of the levels of ICAM-1. Cellular adhesion molecules were observed to act differently, as reflected by the recorded plasma levels during treatment. The antipsychotics used in the treatment of schizophrenia increased ICAM-1 and decreased VCAM-1. This study is limited by the size of the patient population, the lack of treatment control, the possibility that the disease may not have a homogeneous structure and other possible unknown confounding factors.
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    Risky Sexual Behavior among Patients in Turkey with Bipolar Disorder, Schizophrenia, and Heroin Addiction
    (WILEY, 2011) Hariri, Aytul Gursu; Karadag, Figen; Gokalp, Peykan; Essizoglu, Altan
    Aim. Risky sexual behavior associated with such sexually transmitted infections (STIs) as hepatitis B and C, herpes, Treponema pallidum, and Neisseria gonorrhoeae, is more frequent among psychiatric patients and parenteral drug abusers than the general population. The aim of this study was to investigate risky sexual behavior in psychiatric outpatients diagnosed with schizophrenia (SCH), bipolar disorder, and heroin addiction (HA), and to compare them with those observed in healthy controls. Methods. The study group (N = 485; 234 females and 251 males) consisted of patients that consecutively presented to Bakirkoy State and Training Hospital for Psychiatric and Neurological Diseases in Istanbul and normal healthy controls. Main Outcome Measures. The chi-squared test was used for comparisons between groups and categorical variables. One-way analysis of variance (post-hoc Bonferroni test) was used for demographic data. A 22-item questionnaire for collecting demographic, illness history, and sexual activity data, and a structured 23-item form for collecting data on risky sexually behavior were administered to the participants. Results. In all, 10% of the participants had a positive history for STIs. The majority of risky sexual behaviors was observed among the HA patients. The frequency of being sexually assaulted and having homosexual acts among the SCH group were higher. None of the patients had a positive human immunodeficiency virus (HIV) test result. The frequency of positivity for hepatitis B and C markers was highest among the HA patients. Conclusions. The provision of information and training about all STIs and risky sexual behavior should become routine in the treatment of mentally ill patients, especially those that abuse drugs. Hariri AG, Karadag F, Gokalp P, and Essizoglu A. Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction. J Sex Med 2011;8:2284-2291.
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    Sexual problems in a sample of the Turkish psychiatric population
    (W B SAUNDERS CO-ELSEVIER INC, 2009) Hariri, Aytul Gursu; Karadag, Figen; Gurol, Defne Tamar; Aksoy, Umut Mert; Tezcan, Ahmet Ertan
    Introduction: Sexual functioning has received little attention as an important aspect of patient care for those who have severe mental disorders. Aim: The aim of this study is to compare sexual difficulties seen in Turkish psychiatric patients and healthy control subjects. Methods: Study group consisted of outpatients in remission with schizophrenia (n = 84), bipolar affective disorders (n = 90), heroin addiction (n = 88), and healthy control group (n = 98). A sociodemographical data form and the Golombok Rust Inventory of Sexual Satisfaction were applied to all groups (N = 360). Results: Half ol the patient groups and 72.8% of control subjects reported that they had regular sexual life. The patients with heroin addiction complained about more problems in their sexual life than in the other groups. Controls (86,.2%)) felt more satisfied with their sexual life. Female patients with heroin addiction had statistically significant higher scores in nonsensuality subscale of Golombok Rust Inventory of Sexual Satisfaction. Female patients with schizophrenia and bipolar disorder had statistically significant higher scores in vaginismus subscale than in control group. Between the groups, male patients with bipolar disorder had higher score in most of the items except noncommunication and erectile dysfunction and also had higher total score than in the controls. More men (especially with heroin addiction) thought that their illness and drugs were responsible for their sexual problems, knew the effect of the illness and drugs on their sexual life. and asked questions to their psychiatrists about the problems more than women. Conclusion: patients with bipolar disorders and schizophrenia were unaware of effects of their medication on their sexual life. Finally. it was also found that clinicians in our country do not pay sufficient attention to the sexual problems of psychiatric patients. (C) 2009 Elsevier Inc. All rights reserved.