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Öğe Agomelatin depresyon tedavisine ne getiriyor? güncel bir gözden geçirme(İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Psikiyatri Anabilim Dalı, 2013) Cerit, Cem; Yaluğ, İrem; Akpınar, Esma; Talas, Anıl; Tufan, Ali Evren; Özten, EylemBu çalışmada melatonin MT-1 ve MT-2 reseptör agonisti ve serotonin 5-HT2C antagonisti bir antidepresan olan agomelatinin depresyon tedavisine ne getirdiği sorusuyla, ilgili literatür gözden geçirilmiştir. Etkinlik açısından farklı sonuçlar olmakla birlikte agomelatinin günümüzde sık kullanılan antidepresanlarla en azından benzer bir etkinliğe sahip olduğu söylenebilir. Bunun yanında uyku üzerine olumlu etkileri ve etkinliğin erken başlaması tedaviye olumlu katkıda bulunabilir. Agomelatinin uyku-uyanıklık döngüsü, endokrin hormon salınımı, vücut ısısının ayarlanması gibi birçok biyolojik sistemi etkileyen sirkadiyen sistem üzerine olumlu etkileri ilgi çekici görünmektedir. Somnolans, agomelatin tedavisinde diğer antidepresanlardan daha fazla görülen bir yan etki olarak not edilmektedir. Bunun yanında kilo alımının ve cinsel yan etkilerin azlığı tedaviye uyumu olumlu yönde etkileyebilir. Agomelatin tedavisi alan hastalarda karaciğer enzimlerinde yükselme görülebilmektedir. Agomelatinin ani bırakılmasının belirgin kesilme belirtilerine yol açmadığı gözlenmiştir.Öğe Delusional parasitosis with hyperthyroidism in an elderly woman : a case report(2013) Özten, Eylem; Tufan, Ali Evren; Cerit, Cem; Sayar, Gökben Hızlı; Ulubil, İrem YalugIntroduction. Delusional parasitosis is a rare, monosymptomatic psychosis involving a delusion of being infested with parasites. It is commonly observed among female patients over the age of 50. It is classified as a 'delusional disorder' according to the 10§ssup§th§esup§ revision of the International Classification of Diseases and as a 'delusional disorder - somatic type' according to the Diagnostic and Statistical Manual, Fourth Edition. Delusional parasitosis was reported to be associated with physical disorders such as hypoparathyroidism, Huntington's chorea and Alzheimer's disease, among others. Other than vitamin deficiencies however, a causal relationship has not to date been identified. We present this case due to the rarity of Turkish patients with this condition, its duration of follow-up, and its temporal pattern of symptoms paralleling thyroid function tests. Case presentation. Our patient was a 70-year-old white Anatolian Turkish woman with primary school education who had been living alone for the past five years. She presented to our psychiatry department complaining of 'feeling large worms moving in her body'. The complaints started after she was diagnosed with hyperthyroidism, increased when she did not use her thyroid medications and remitted when she was compliant with treatment. She was treated with pimozide 2mg/day for 20 months and followed-up without any antipsychotic treatment for an additional nine months. At her last examination, she was euthyroid, not receiving antipsychotics and was not having any delusions. Conclusion: Although endocrine disorders, including hyperthyroidism, are listed among the etiological factors contributing to secondary delusional parasitosis, as far as we are aware this is the first case demonstrating a temporal pattern of thyroid hyperfunction and delusions through a protracted period of follow-up. It may be that the treatment of delusional parasitosis depends on clarifying the etiology and that atypical antipsychotics may help in the management of primary delusional parasitosis. Further studies on the relationship between thyroid hormones and dopaminergic neurotransmission may be warranted. © 2013 Ozten et al.; licensee BioMed Central Ltd.Öğe Dikkat eksikliği / hiperaktivite bozukluğu ve major depresif bozukluk tanılı erişkin hastalarda bağlanma biçimlerinin karşılaştırılması: Kontrollü bir ön çalışma(2015) Özten, Eylem; Tufan, Evren Ali; Hızlı, Gökben Sayar; Eryılmaz, Gül; Aloğlu, DilaraAmaç: Yapılmış çalışmaların sonucunda bağlanma örüntüsünün erişkinlerde hem dikkat eksikliği hiperaktivite bozukluğu (DEHB) hem de majör depresif bozukluk (MDB) gelişimi ve gidişinde önemli rol oynadığı gösterilmiştir. Bu araştırmada DEHB ve MDB tanısı alan erişkin bireylerde bağlanma biçimleri ve ilişkili etmenlerin karşılaştırılması amaçlanmıştır. Yöntem: Bu araştırma Haziran 2014 - Ekim 2014 tarihleri ara- sında İstanbul’da ikinci basamak bir tedavi merkezinin psikiyatri polikliniğinde yürütülmüştür. Belirtilen zaman aralıkları içerisinde ilk kez polikliniğe başvuran SCID-I (DSM-IV Eksen I Bozuklukları İçin Yapılandırılmış Klinik Görüşme) uygulanarak MDB tanısı konan 31, DEHB tanısı konan 33 kişi ve yaş, cinsiyet, eğitim ve medeni durumları bakımından eşlenmiş 31 sağlıklı kontrol araştırmaya dâhil edilmiştir. MDB ve DEHB tanılı gruplar klinisyen tarafından doldurulan Klinik Global Değerlendirme Ölçeği (CGI-S) puanlarına göre eşlenmiştir. Katılımcılara DSM-IV’e Dayalı Erişkin DEB/DEHB Tanı ve Değerlendirme Envanteri (E-DEHB) doldurtulmuştur. E-DEHB’de 1. veya 2. bölümdeki 9’ar sorudan en az altı tanesine 2 veya 3 puan verenlere tekrar klinik görüşme yapılarak DEHB tanısı araştırılmış ve DSM-IV-TR ölçütlerine göre erişkin DEHB tanısı konulmuştur. Ayrıca klinisyen tarafından Hamilton Depresyon Ölçeği (HAM-D) uygulanmıştır. Tüm katılımcılara Yakın İlişkilerde Yaşantılar Envanteri (YİYE) doldurtulmuştur. Bulgular: Üç grup arasında YİYE ile saptanan kaygılı bağlanma alt tipi puanları açısından anlamlı farklılık bulunmuştur. MDB grubunun sağlıklı kontrollerden kaygılı bağlanma puanlarında anlamlı fark gösterdiği ancak DEHB grubundan farklılık göstermediği saptanmıştır. Üç grupta kaygılı, kaçıngan ve güvenli bağlanan kişi sayıları arasında istatistiki olarak anlamlı farklılık saptanmamıştır. Kaygılı bağlanma oranları ile E-DEHB hiperaktivite alt ölçek (E-DEHB-HA) puanları (p= 0.007, r= 0.463) ve HAM-D puanlarının (p= 0.046, r= 0.361) anlamlı pozitif korelasyon gösterdiği görülmüştür. Buna karşılık kaçıngan bağlanma oranları ise E-DEHB dikkat eksikliği hiperaktivite bozukluğu ile ilişkili özellikler puanları (E-DEHB-İÖ) ile (p= 0.002, r= 0.402) anlamlı ve pozitif korelasyon göstermektedir. Sonuç: Bu araştırmada geçmiş çalışmaların aksine DEHB tanılı grup, MDB grubu ve sağlıklı kontrol grubundan bağlanma örüntüleri bakımından farklı bulunmamıştır. Bu bulgu kullanılan ölçeklere, seçilen yaş grubuna veya örneklemde kadınların baskınlığına bağlı olabilir. Ancak MDB grubunun sağlıklı kontrol grubuna göre kaygılı bağlanma örüntüsünü daha sık sergilediği sonucuna ulaşılmıştır. Güvensiz bağlanmanın MDB tanısının gelişimini kolaylaştırabileceği, gelişmiş olan bozukluğun devamını sağlayabileceği ve terapiyi olumsuz etkileyebileceği söylenebilir.Öğe Discerning the effects of psychopathology and antidepressant treatment on sexual dsyfunction(Informa Healthcare, 2013) Tufan, Ali Evren; Özten, Eylem; Işık, Sibel; Cerit, CemObjective. To compare the frequency and correlates of sexual dysfunction in patients with Major Depressive Disorder on SSRI treatment with those who are not. Methods. Patients diagnosed with Major Depressive Disorder, without comorbid psychopathology/medical disorder/alcohol/nicotine use for the past year with a CGI-S severity score of 4 were included. Two groups were formed, one using SSRIs at least for 6 weeks before the study, and another who were free of drugs for the last month. Arizona Sexual Experience Scale (ASEX) was given to determine sexual dysfunction. P was set at 0.05. Results. Thirty-three patients (25 female, 75.8%) were included. The study group was using sertraline (n = 10, 52.6%) and citalopram (n = 9, 47.4%). Fourteen patients on SSRIs (73.7%) and 12 controls (% 85.7) displayed sexual dysfunction with no difference between groups. Female gender was associated with sexual dysfunction, regardless of treatment (P = 0.04). Arousal sub-test of ASEX differed significantly in the group with dysfunction (P = 0.04). Conclusions. Female gender may be a risk factor for sexual dysfunction in the presence of depression, regardless of drug use. Arousal may be affected in patients, regardless of treatment, and this may reflect the effect of depressive cognitions on libido.Öğe The prevalence of adult separation anxiety disorder in a clinical sample of patients with attention-deficit/hyperactivity disorder(2016) Özten, Eylem; Tufan, Ali Evren; Eryılmaz, Gül; Hızlı Sayar, Gökben; Bulut, HüseyinObjective: Separation anxiety disorder (SAD) of adulthood was added to the group of anxiety disorders in the DSM-5. Attention-deficit/hyperactivity disorder (ADHD) displays elevated comorbidity with anxiety disorders. Aims of the present study are to determine a) the prevalence of SAD in a clinical, adult sample with ADHD and b) the correlates of SAD comorbidity in adults with ADHD. Methods: DSM-IV-Based Diagnostic and Evaluation Inventory for Adult ADD/ADHD to confirm ADD/ADHD diagnosis by the psychiatrist; Structured Clinical Interviews for the Symptoms of SAD (SCI-SAS); the Questionnaire for Adult SAD (A-SAQ); and the Inventory for Symptoms of SAD (SASI) were administered to ADHD patients and to the age, gender, marital status, and education-matched healthy controls. Results: Thirty adults with ADHD and 26 healthy controls were enrolled in the study. The ADHD group had significantly higher Adult Separation Anxiety Questionnaire (A-SAQ) and Separation Anxiety Symptom Inventory (SASI) scores than the control group. According to the Structured Clinical Interview for Separation Anxiety Symptoms (SCISAS), 53.3% of the ADHD group and 11.5% of the control group fulfilled the SAD criteria while 63.3% and 19.2%, respectively, fulfilled the childhood SAD criteria. Three patients with ADHD (10.0%) that did not fulfil the childhood SAD criteria had the diagnosis as adults, while six ADHD patients (20.0%) and four control patients (15.4%) had childhood SAD and recovered from it. Only one of the controls (3.9%) developed de novo SAD. We found signifycantly increased life-time, childhood, and adult prevalence of SAD in adult patients with ADHD. Conclusions: Due to the self-selected, clinical sample, this rate may not reflect the true population prevalence of SAD among Turkish adults; community studies evaluating SAD's prevalence are needed.Öğe The prevalence of adult separation anxiety disorder in patients with attention-deficit/hyperactivity disorder: a preliminary study from Turkey(Elsevier Science Bv, 2015) Özten, Eylem; Tufan, Ali Evren; Eryılmaz, Gül; Sayar, Gökben HızlıÖğe Transcranial magnetic stimulation during pregnancy(Springer Wien, 2014) Sayar, Gökben Hızlı; Özten, Eylem; Tufan, Ali Evren; Cerit, Cem; Kagan, GayeThe aim of the present study was to assess the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in pregnant patients with depression. Thirty depressed pregnant patients received rTMS over the left prefrontal cortex for 6 days in a week, from Monday to Saturday for 3 weeks. The rTMS intensity was set at 100 % of the motor threshold. A 25-Hz stimulation with a duration of 2 s was delivered 20 times with 30-s intervals. A session comprised 1,000 magnetic pulses. Depression was rated using the 17-item Hamilton depression rating scale (HAMD) before and after treatment. Response was defined as a 50 % reduction of the HAMD score. Patients with HAMD scores less than 8 were considered to be in remission. The mean HAMD score for the study group decreased from 26.77 +/- 5.58 to 13.03 +/- 6.93 (p < 0.001) after 18 sessions of rTMS. After the treatment period, 41.4 % of the study group demonstrated significant mood improvements as indexed by a reduction of more than 50 % on the HAMD score. In addition, 20.7 % attained remission (HAMD score < 8), 34.5 % achieved a partial response, and 3.4 % had worsening in HAMD scores at the end of treatment. Treatment was well tolerated, and no significant adverse effects were reported. rTMS was well tolerated and found to be statistically and clinically effective in pregnant patients with treatment-resistant depression. This study contributed to the existing evidence of the antidepressant effect of rTMS in the treatment of depression in pregnancy.Öğe What does agomelatine bring to treatment of depression?an up-to-date review(Istanbul Universitesi, 2013) Cerit, Cem; Yalu?, Irem; Akpinar, Esma; Talas, Anil; Tufan, Ali Evren; Özten, EylemIn this article literature related to the promises of agomelatine, an antidepressant with melatonergic MT-1 and MT- 2 receptor agonism and seratoninergic 5-HT2c receptor antagonism in the context of depression treatment is reviewed. Although the results of studies on the efficacy of agomelatine are contrary, it can be stressed that the efficacy of agomelatine should be at least similar to widely used antidepressants. Furthermore the favorable effect of agomelatine on sleep and the early onset of efficacy should contribute to the outcome of therapy. The favorable effect of agomelatine on the circadian rhythm which has influence on substantial biological systems like sleepwake cycle, endocrine hormone secretion and body temperature appears to be interesting. Somnolence should be noted as a more frequent adverse event of agomelatine than other antidepressants. Furthermore the absence of weight gain and sexual adverse events should influence the adherence to therapy. Liver enzyme elevations can emerge during agomelatine therapy. Abrupt discontinuation of agomelatine does not appear to bring about evident discontinuation symptoms.
