Poster Presentations

Turkish Association for Psychopharmacology th

International Congress on PSYCHOPHARMACOLOGY

2nd International Symposium on Child and Adolescent Psychopharmacology From Neuroscience to Clinical Practice: Tailoring Treatments

April 16th - 20th 2014 Susesi Hotel - ANTALYA / TURKEY www.psychopharmacology2014.org

Poster Presentations


[PP-001] Cultural psychiatry

The relationship of mental state, attitude and behaviors with colors Ahmet Ozturk1, Sayit Altikat2, Ali Emre Dursun3, Erdem Deveci3, Etem Soyucok1 Dumlupinar University, Faculty of Medicine, Department of Psychiatry, Kutahya-Turkey

1

Dumlupinar University, Faculty of Medicine, Department of Biyochemistry, Kutahya-Turkey

2

Bezmialem Vakif University, Faculty of Medicine, Department of Psychiatry, Istanbul-Turkey

3

e-mail address: [email protected]

Objective: Color is the effect of light on the eye depending on its core structure or spreading/absorbing object. It exists everywhere at the same moment; it is a primary and nonsocial aspect of human environment. There has been limited research published about connotations of colors on humans, the relationship between the colors of a person’s clothing and his/her mental state and what person percepts from colors when he/she designs own life. In this study, we aimed to measure the tendencies of a group of university students on this subject. Method: One hundred students (50 male, 50 female) from Dumlupinar University College of Healthcare Professionals participated in our study. The participants have been given a questionnaire developed by the researchers examining the attitude about colors. Results: While the most common colors preferred on clothes were black (%30) in females and blue (%32) in males, the least common colors were yellow (%28) and pink (%50), respectively. The question of comforting and soothing color has been mostly answered as green (%40) by females and white (%42) by males. While females and males preferred black (%52 and %36 respectively) on emotional and somber moments, the color representing peace was white (%40) in females and blue (%42) in males. The question about the color representing harmony, joy and cuteness has been mostly answered as pink (females: %65 and males: %62). While the most eye-catching color was red (females: %82 and males: %58), the color representing cleanness and honesty was white (females: %86 and males: %84). The color most relaxing on eyes and the body was blue as indicated by the participants (females: %32 and males: %34). The color elevating motivation has been found as red (females: %38 and males: %28), and the color elevating self-confidence was the same (females: %34 and males: %32). The color preferred when one is angry was black (%50) in females and red (%44) in males. The color preferred on uncertainty was black (%30) in females and white (%32) in males. While the participants usually preferred black (females: %54 and males: %34) when they are full of hatred, the color black was preferred by %38 of females and %42 of males on fear. Conclusion: The colors have a two-way relationship with participants’ mental state, attitude and behaviors. There are some studies suggesting that our color preference might reflect our personality or the color we prefer might have positive or negative effects on us. Taking color preferences of patients into account in mental state examinations would be beneficial. Keywords: color, preference, mental status Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S82

[PP-002] Schizophrenia and other psychotic disorders

Turner-syndrome and psychosis: a case report Hulya Ertekin, Basak Sahin, Ersin Turkyilmaz Canakkale State Hospital, Canakkale-Turkey e-mail address: [email protected]

Turner Syndrome is a genetic syndrome in which a woman lacks one X chromosome, giving a karyotype of 45XO, or, alternately, a mosaic genotype with both 45XO and normal 46XX cells. Physical features include short stature, failure or reduction in secondary sex characteristics development, gonadal dysgenesis, and superficial features including neck webbing, hair loss, and cubitus algus. Women with turner syndrome (TS) are of generally normal intelligence, but may have some specific defects in spatial orientation. Psychiatric condition has not been defined traditionally to TS, and TS is not mentioned in DSM-IV. Studies about the psychological aspects of TS have focused on the influence of the physical stigma of TS on psychological development in young female population, highlighting short stature, failure in sexual maturation compared to age peers, the issue of infertility, and how these issues relate to self-image and femininity. A “TS personality” characterized by immaturity, depressiveness, passivity, distractibility, and docility is suggested, although no rigorous scientific study has confirmed these claims. Psychosis is relatively rare, but some authors have hypothesized that psychosis could be associated with TS.

S82

Bulletin of Clinical Psychopharmacology, Vol: 24, Supplement: 1, 2014 - www.psikofarmakoloji.org

Poster Presentations We present here a case of 20 years old, single woman, who was diagnosed TS, and had psychosis. At the age of 19, she had social withdrawal, insomnia, decreased self care and auditory and visual hallucinations, delusions of persecution. After risperidone 1 mg treatment, extrapyramidal symptoms began. So her treatment changed to olanzapine, olanzapine dose was increased up to 20 mg. However, extrapyramidal symptoms began and psychotic symptoms didn’t decrease. Therefore olanzapine was stopped, and clozapine was started, clozapine dose was increased up to 100 mg. Extrapyramidal symptoms recovered, auditory and visual hallucinations, delusions of persecution decreased, communication with people was normalized, she returned to premorbid functionality. TS is a unique syndrome; it is important to identify it in order to avoid labeling patients with a more severe diagnosis, to determine its frequency and epidemiology, to understand its biological basis, and most importantly, to identify optimal treatment strategies. The majority of TS patients are of normal intelligence, social functioning and employment, yet the case reports of psychiatric disorders in this syndrome are similar and were considered unique enough to warrant description. Despite the descriptive information, the literature lacks rigorous, statistical analysis directed toward identifying the described syndrome in TS. Our case is about the treatment of a patient, who has both TS and psychosis. TS patients may have different sensitivity to antipsychotics, as observed with our patient. She had extrapyramidal symptoms with low dose risperidone and olanzapine, which we don’t expect in common. This case report suggests that the use of clozapine in TS following the recommended precautions could be safe and effective. Keywords: psychosis, turner syndrome, X-chromosome Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S82-S3

[PP-003] Obsessive compulsive disorder

Topiramate augmentation in resistant obsessive compulsive disorder: a double-blind placebo-controlled clinical trial Arash Mowla Shiraz University of Medical Sciences, Department of Psychiatry, Shiraz-Iran e-mail address: [email protected]

Objectives: Glutaminergic dysfunction has been shown to be related to the pathophysiology of obsessive-compulsive disorder (OCD). Topiramate is an antiepileptic that inhibits glutaminergic action. The aim of this study is to evaluate the efficacy of topiramate augmentation in patients with treatment resistant OCD. Methods: This augmentation trial was designed as a 12-week randomized, placebo-controlled, double-blind study. Forty-nine patients suffering from OCD, who had failed to respond to at least 12 weeks of treatment of an adequate and stable dose of a selective serotonin reuptake inhibitors (SSRI) were randomly allocated to receive topiramate or placebo plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Treatment response was defined as 25% or more decrease in scores of Y-BOCS. The mean dosage of topiramate was 180.15 mg/day (range 100-200 mg/day). Results: Forty-one patients (20 of 24 in topiramate group; 21 of 25 in placebo group) completed the trial. The topiramate group showed significant improvement over the study period (mean Y-BOCS score at week 12 as compared with baseline: p=0.0001). Those receiving topiramate experienced a mean decrease of 32.0% in Y-BOCS score, compared with 2.4% decrease for those receiving placebo. Twelve patients in the topiramate group versus no patient in the placebo group were rated as responder. Conclusion: The results of our study demonstrated that topiramate might augment the therapeutic effect of SSRIs in treatment-resistant OCD patients. However, it should be noted that our study was a preliminary one and larger double-blind studies are needed to confirm these results. Keywords: OCD, topiramate, clinical trial Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S83


S83


[PP-004] Dementia

Aripiprazole for the treatment of behavioral and psychiatric symptoms of frontotemporal dementia: a case report Lutfiye Sogutlu, Cenk Varlik, Ahmet Guler, Cagri Calci Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital, Department of Psychiatry, Istanbul-Turkey e-mail address: [email protected]

Frontotemporal dementia (FTD) is the second most common cause of early onset dementia and is clinically characterized by progressive behavioral change, executive dysfunctions, and language difficulties. Clinical features of FTD include changes of personality, restlessness, loss of inhibition, apathy, social withdrawal and impulsiveness. Most patients with FTD display socially inappropriate behaviors, compulsivelike acts, poor insight and psychiatric features including hallucinations and paranoid delusions. FTD has not any specific treatment yet. Treatments for control of behavioral symptoms constitute majority of treatment approaches. Slowing progression of the disease is aimed with neuroprotective treatments. The management of FTD, a disorder characterized by varied behavioral symptoms, primarily involves the use of psychoactive medications. Although there are no approved treatments for the disorder; selective serotonin receptor inhibitors such as sertraline, paroxetine, or fluoxetine can decrease disinhibition-impulsivity, repetitive behaviors, and eating disorders in FTD. Low doses of trazodone or an atypical antipsychotic such as aripiprazole can also help manage significantly disturbed or agitated behavior. Case reports and open-label studies reported that aripiprazole, risperidone and olanzapine exert positive effects to control behavioral symptoms of FTD. This is a case report of FTD in a 69-year-old man. His symptoms started 7 years ago and he has been using sertraline 100 mg/day, quetiapine 100 mg/day, donepezil hydrochloride 10 mg/day. His compulsive behaviors and paranoid delusions did not respond to this treatment. Aripiprazole was added on existing treatment and after 4 weeks his compulsive behaviors and psychiatric symptoms regressed. We reported a patient with behavioral and psychiatric symptoms successfully treated with aripiprazole. Keywords: frontotemporal dementia, aripiprazole, behavioral and psychiatric symptoms Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S84

[PP-005] Mood disorders

Is the onset of the psychotic depression later than nonpsychotic depression? Osman Ozdemir1, Adem Aydin1, Aysel Milanlioglu2, Pinar Guzel Ozdemir1, Zafer Tapanci1, Damla Kement Timucin1 Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van-Turkey

1

Yuzuncu Yil University, Faculty of Medicine, Department of Neurology, Van-Turkey

2


Objective: Although psychotic depression is very common among older depressed patients, studies have generally failed to find any socio-demographic differences between psychotic depression patients and nonpsychotic patients with depression. A comparison of the age related factors of psychotic depression and nonpsychotic depression could contribute to a better understanding of the clinical features of psychotic depression and its management as well. Methods: The sample comprised 42 inpatients, 21 unipolar major depression with psychotic features, and 21 unipolar major depression without psychotic features. The diagnosis made after consensus of two psychiatrists by means of Structured Clinical Interview for DSMIV Axis I Disorder (SCID-IV). Hamilton Depression Rating Scale (HDRS), and concomitantly Hamilton Anxiety Rating Scale (HARS) were performed to assess the severity of depression Results: The average age of the patients with psychotic depression (49.8 years) was higher than that of non-psychotic depression patients (31.8 years). There were no significant differences between the patient groups in number of episodes and duration of illness. Also, patients with psychotic depression had higher mean total HDRS and HARS scores. There were no significant differences in gender, suicide attempt, family history, and stressful life events between groups. Conclusion: These findings suggest that the onset of the psychotic depression was later than nonpsychotic depression. Keywords: psychotic depression, nonpsychotic depression, early onset, late onset Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S84

S84



[PP-006] Posttraumatic stress disorder

Relationship between posttraumatic stress disorder, dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors Osman Ozdemir1, Murat Boysan2, Pinar Guzel Ozdemir1, Ekrem Yilmaz2 Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van-Turkey

1

Yuzuncu Yil University, Faculty of Art and Science, Department of Psychology, Van-Turkey

2


Objective: Previous studies have shown that mental health disorders including posttraumatic stress disorder (PTSD), other anxiety disorders, and depression as well as poor health status and functional impairment are common after earthquake. In the present study, we examined relations of PTSD with dissociation, quality of life, hopelessness, and suicidal ideation among a community sample of which greater proportion experienced a severe earthquake. Method: Five hundred eighty-three subjects participated in the study, who were recruited from Van, Turkey which was hit by a 7.2 magnitude earthquake in October 2011. Subjects were administered a socio-demographic questionnaire, the Dissociative Experiences Scale (DES), Short Form Health Survey Questionnaire (SF-36), Posttraumatic Diagnostic Scale (PDS), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Scale for Suicide Ideation (SSI). Results: We found that being female, being single, experiencing earthquake; having dissociative disorders and suicidal ideation were significant antecedents of PTSD symptom severity. Role-Physical, Bodily-Pain, General Health and Role-Emotional subscales of the SF-36 were inversely associated with PTSD symptoms. Conclusion: Our findings suggest that pathological dissociation, poor quality of life and suicidal ideation were significantly linked to PTSD symptom severity. General health and perception of physical and emotional functioning seem to be preventive factors for PTSD symptom severity. Keywords: PTSD, dissociation, depression, hopelessness, suicidal ideation, quality of life Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S85

[PP-007] Psychosomatic medicine - Consultation liaison psychiatry

Affecting factors of depression in acute phase after stroke Baise Tikir1, Emine Merve Akdag1, Sahin Gurkan1, Songul Arslan1, Emine Yildizgoren1, Erol Goka1, Zeynep Nese Oztekin2 Ankara Numune Education and Research Hospital, Department of Psychiatry, Ankara-Turkey

1

Ankara Numune Education and Research Hospital, Department of Neurology, Ankara-Turkey

2


Objective: Stroke is one of the diseases, which cause morbidity mostly. In addition to impairment of motor function, there are problems with respect to mood changes especially depression, which frequently decreases participation of the rehabilitation process and functional improvement. In this study, we aimed to investigate affecting factors of depression in acute phase after stroke. Method: Hundred thirty-one patients in two weeks after stroke were included in the study. Beck Depression Scale (BDS), Mini-Mental State Examination (MMSE), Barthel Scale (BS), Rankin Disability Scale (RDS), National Institute of Health Scale (NIHS) were applied to patients. Beck Depression Scale and Beck Anxiety Scale (BAS) were applied to caregivers. Sociodemographic features of patients, history of chronic diseases, psychiatric diseases, stroke and delirium/agitation, intensive care unit treatment, type of lesion (ischemic/hemorrhagic) were also recorded. Results: Forty-nine of 131 patients (37.4%) were female and 82 (62.6%) were male. Mean age was 62.6±15.1 years and interval of age was 23-90 years. Mean of BDS scores was 14.72±11.2, mean of MMSE scores was 24.6±4.57. 35 percent of patients were depressed. Mean of BDS scores of females was higher than that of males. Economic status of depressed patients was lower than the others. Patients living alone and agitated after stroke were more depressed. MMSE scores were negatively correlated with BDS scores. BDS scores were positively correlated with BDS scores of caregivers. BS scores were higher than the others. Conclusion: According to these results, economic status, living alone, agitation, early impairment of cognition are risk factors for depression after stroke and mood status of caregivers are affected to mood status of stroke patients. Functional dependence facilitates Bulletin of Clinical Psychopharmacology, Vol: 24, Supplement: 1, 2014 - www.psikofarmakoloji.org

S85

Poster Presentations being depressed. Not only rehabilitation of motor function but also depressive symptoms and cognition must be handled as early and exactly as possible. Patients must be considered physically, psychologically and socially as a whole. Keywords: stroke, depression Bulletin of Clinical Psychopharmacology 2014;24(Suppl. 1):S85-S6

[PP-008] Psychosomatic medicine - Consultation liaison psychiatry

The relation between depression after acute stroke and lesion location Emine Merve Akdag1, Baise Tikir1, Sahin Gurkan1, Songul Arslan1, Emine Yildizgoren1, Makbule Cigdem Aydemir1, Fikri Ak2 Ankara Numune Education and Research Hospital, Department of Psychiatry, Ankara-Turkey

1

Ankara Numune Education and Research Hospital, Department of Neurology, Ankara-Turkey

2


Objectives: Stroke which is one of the major causes of morbidity, affects functional improvement negatively because of mood changes especially depression after stroke. There are articles in the literature about relationship between poststroke depression and lesion location. But this relationship is still unclear. In this study, we aimed to investigate the relation between depression after stroke and lesion location in acute phase after stroke. Method: A hundred thirty-one patients in two weeks after stroke were included in the study. Beck Depression Scale, Brief Symptom Inventory (BSI) were applied to recruited patients. Sociodemographic features of patients, side of lesion (right or left) and lesion location were also recorded. Results: 49 of 131 acute stroke patients (37.4%) were female and 82 of patients (62.6%) were male. Mean of age was 62.6±15.1 years and interval of age was 23-90 years. Mean of BDS points was 14.72±11.2. Depression levels of 49.6 percent of patients were mild to moderate, 13 percent of patients were severe according to BDS scores. 35.1 percent of patients were depressed according to the cut off score of BDS (cut off score=17). Left sided lesions and subcortical lesions were more in the depressed group. According to lobar location, patients who had frontal, temporal, parietal, occipital and caudal lesions had higher BDS scores. This relation was statistically significant for parietal lesions (p