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Yayın Aripiprazole Augmentation Treatment in Treatment Resistant Bipolar Depression: Two Patient Reports(TURKIYE SINIR VE RUH SAGLIGI DERNEGI, 2011) Karadag, Figen; Tan, Devran; Unal, FeyzaIt is known that in patients with bipolar disorder, depressive episodes last longer than mixed or manic/hypomanic episodes and there are reports detailing the difficulties confronted in its treatment. The concept of treatment resistant depression in bipolar disorder has not been as well described as that in treatment resistant unipolar depression. Here we present two patients with treatment resistant bipolar depression. The first patient in our study is a 51 year old woman whose diagnoses were bipolar disorder, depressive episode and multiple sclerosis (in remission with interferon treatment) at the time of augmentation with aripiprazole. The second patient is a 43 year old woman with bipolar disorder, depressive disorder without any comorbid illness at the time of augmentation with aripiprazole. Aripiprazole was administered variably between 20-30mg/daily based on tolerability and efficacy,. In both cases, depression was assessed using the Hamilton Depression Rating scale (HDRS). Both patients responded to aripiprazole augmentation treatment. The effect of aripiprazole on bipolar depression needs to be further evaluated in double blind controlled studies. However, augmentation with aripiprazole in bipolar patients may be a future routine treatment for treatment resistant bipolar depression. In this report, treatment of refractory bipolar depression and the efficacy of aripiprazole augmentation treatment in bipolar depression are discussed through two patients in depressive episode who remitted with aripiprazole augmentationYayın Awareness of Sexually-Transmitted Diseases and Risky Sexual Behavior in Bipolar Patients: A Comparative Study with Healthy Controls(AVES, 2009) Hariri, Aytuel Guersu; Karadag, Figen; Gokalp, Peykan; Aksoy, Umut MertObjective: It is known that patients with bipolar mood disorder have a high risk of acquiring sexually-transmitted diseases (STD). The objective of this study was to evaluate bipolar outpatients regarding their knowledge on STD and possible high risk sexual behaviors, and to compare both sexes in patient group and patients with healthy controls. Method: A total of 129 outpatients with DSM-IV Bipolar Disorder (BP) in remission state and 98 healthy controls were included in the study. Participants were given a demographic questionnaire, an evaluation form about awareness of sexually-transmitted diseases, and a semi-structured form on risky sexual behavior to assess patients' sexual behavior during acute episodes of their illness. Results: In general, level of information about STD was very low. The most known STD was AIDS. 43% (n=55) of bipolar patients reported increased sexual activity during acute episodes. In BP group both sexes displayed high-risk sexual activity, but male patients especially seemed to have more risky behavior. Discussion: It is noteworthy that, although methods of protection from diseases were known to some degree, they were applied properly in neither groups nor sexes. It seems that not only BP patients but general population also need to be informed and educated on risky sexual behavior. (Archives of Neuropsychiatry 2009; 46: 52-60)Yayın Childhood emotional abuse, dissociation, and suicidality among patients with drug dependency in Turkey(WILEY-BLACKWELL, 2008) Tamar-Gurol, Defne; Sar, Vedat; Karadag, Figen; Evren, Cuneyt; Karagoz, MustafaAim: The aim of the present study was to determine the prevalence and correlates of dissociative disorders among patients with drug dependency. Methods: The Dissociative Experiences Scale (DES) was used to screen 104 consecutive patients at an addiction treatment center. Thirty-seven patients who had scores >= 30 were compared with 21 patients who scored < 10 on the DES. Both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders (SCID-D). The interviewers were blind to the DES scores. Results: Twenty-seven patients (26.0%) had a dissociative disorder according to the SCID-D. Dissociative patients were younger than the non-dissociative group. History of suicide attempt and/or childhood emotional abuse was significant predictors of a dissociative disorder. The majority (59.3%) of dissociative drug users reported that dissociative experiences had existed prior to substance use. More patients in the dissociative disorder than in the non-dissociative group stopped their treatment prematurely. Conclusion: A considerable proportion of drug users have a dissociative disorder, which may also interfere with treatment process. The relatively young age of this subgroup of patients and frequent reports of childhood emotional abuse underline potential preventive benefits of early intervention among adolescents with developmental trauma history and dissociative psychopathology.Yayın The Development, Validity, and Reliability of the Addiction Profile Index (API)(TURKIYE SINIR VE RUH SAGLIGI DERNEGI, 2012) Ogel, Kultegin; Evren, Cuneyt; Karadag, Figen; Tamar Gurol, DefneThe Development, Validity, and Reliability of the Addiction Profile Index (API) Objective: The objective of this study was to develop a practical questionnaire for multidimensional assessment of problems associated with alcohol and substance abuse that would also be useful for treatment planning. Materials and Methods: The Addiction Profile Index (API) is a self-report questionnaire consisting of 37 items and the following 5 subscales: characteristics of substance use; dependency diagnosis; the effects of substance use on the user; craving; motivation to quit using substances. The study included 345 alcohol and/or substance abusers from 2 addiction treatment clinics and a prison addiction service. The validity of the questionnaire was assessed using the Michigan Alcoholism Screening Test (MAST), Readiness to Change Questionnaire (SOCRATES), Penn Alcohol Craving Scale (PACS), Drug Craving Scale (DCS), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and Addiction Severity Index (ASI). Results: The Cronbach's alpha coefficient for the total API was 0.89 and for the subscales it ranged from 0.63 to 0.86. Item-total correlation coefficients ranged from 0.42 to 0.89. The Spearman Brown split-half method coefficient for the total API was 0.83. In all, 4 factors were obtained using explanatory factor analysis that represented 52.3% of the total variance. The API craving subscale was observed to be consistent with PACS and the API motivation subscale was consistent with SOCRATES. The API total score was strongly correlated with the mean MAST score, and the composite ASI medical status, substance use, legal status, and family social relations subscale scores. Based on ROC analyses, the area under curve was 0.90. With a total API cut-off score of 4, the scale's sensitivity and specificity 0.85 was 0.78, respectively. Conclusion: The findings show that the API is a valid and reliable questionnaire that can be used to measure the severity of different dimensions of substance dependency.Yayın Increase of Beta Response upon Application of Lithium in Euthymic Bipolar Patients(ELSEVIER SCIENCE INC, 2011) Tan, Devran; Ozerdem, Aysegul; Guntekin, Bahar; Atagun, Ilhan; Tulay, Elif; Karadag, Figen; Basar, Erol…Yayın Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy(SAGE PUBLICATIONS INC, 2016) Tan, Devran; Ozerdem, Aysegul; Guntekin, Bahar; Atagun, M. Ilhan; Tulay, Elif; Karadag, Figen; Basar, ErolThe effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P = .017) and drug-free patients (P = .015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P = .016) and right (T8; P = .031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder.Yayın Risky Sexual Behavior among Patients in Turkey with Bipolar Disorder, Schizophrenia, and Heroin Addiction(WILEY, 2011) Hariri, Aytul Gursu; Karadag, Figen; Gokalp, Peykan; Essizoglu, AltanAim. 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.Yayın 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 ErtanIntroduction: 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.
