Turk psikiyatri dergisi = Turkish journal of psychiatry, 2010
Some patients with pervasive developmental disorders develop unusual talents, which are character... more Some patients with pervasive developmental disorders develop unusual talents, which are characterized as savant syndrome. Herein we present neuropsychological examination and brain imaging (fMRI and brain SPECT) findings of an 18-year-old male with Asperger syndrome and highly unusual calendar memory. Neuropsychological evaluation of the case indicated mild attention, memory, and problem solving deficits, and severe executive function deficits that included conceptualization, category formation, and abstraction. Functional MRI findings showed activation above the baseline level (P<0.05) in the bilateral inferior parietal lobule, precuneus, superior and middle frontal gyri, and medial frontal cortex. Brain SPECT findings, in comparison to rest-SPECT findings, showed that there was hypoperfusion in some brain regions, including the right frontal cortex and right parietal cortex. Baseline blood perfusion in the left frontal cortex was also observed, as well as hypoperfusion in the r...
Objective: It has been proposed that anything does not kill you make you stronger. Although it mi... more Objective: It has been proposed that anything does not kill you make you stronger. Although it might be true in adult cases, children whose psychological life begin in the parental mind and shaped by the experiences during the early period of life are not as strong as adult against adverse effects of stressful events. Internalization of objects and emerging of internally working models, concept of normality and abnormality that will be the main ground for the understanding of the world in later life are emerged during childhood. That is why anything does not kill a child will shape its mind that might have everlasting effects on child.
... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Beha... more ... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Behaviour Change ... interview. Adaptation and reliability studies of SPC were carried out by Özer, Ulusoy, Kabakçı, and Ulusahin (2003). ...
Türk psikiyatri dergisi = Turkish journal of psychiatry, 2010
Some patients with pervasive developmental disorders develop unusual talents, which are character... more Some patients with pervasive developmental disorders develop unusual talents, which are characterized as savant syndrome. Herein we present neuropsychological examination and brain imaging (fMRI and brain SPECT) findings of an 18-year-old male with Asperger syndrome and highly unusual calendar memory. Neuropsychological evaluation of the case indicated mild attention, memory, and problem solving deficits, and severe executive function deficits that included conceptualization, category formation, and abstraction. Functional MRI findings showed activation above the baseline level (P<0.05) in the bilateral inferior parietal lobule, precuneus, superior and middle frontal gyri, and medial frontal cortex. Brain SPECT findings, in comparison to rest-SPECT findings, showed that there was hypoperfusion in some brain regions, including the right frontal cortex and right parietal cortex. Baseline blood perfusion in the left frontal cortex was also observed, as well as hypoperfusion in the r...
ABSTRACT Carbamazepine is an anticonvulsant and is extensively used in patients with bipolar diso... more ABSTRACT Carbamazepine is an anticonvulsant and is extensively used in patients with bipolar disorder as a mood stabilizer. Although carbamazepine affects dopamine, norepinephrine, and glutamic acid levels in neurons, it mainly shows its effect on sodium and potassium channels. Carbamazepine enhances dopamine release and turnover and leads to differential alterations of monoamine levels in discrete brain regions. The mechanism of the emergence of prolonged erection and priapism is related to α1 adrenergic blockage in corpus cavernosum, however the knowledge about the effects of carbamazepine on adrenergic receptors is very limited. Therefore, further studies are necessary to identify the risk for prolonged erection in patients treated with carbamazepine and to investigate the relationship between prolonged erection and carbamazepine.
Various neuropsychological domains, and P300 auditory event-related potentials (ERP) and mismatch... more Various neuropsychological domains, and P300 auditory event-related potentials (ERP) and mismatch negativity (MMN) exhibit abnormalities in schizophrenia patients and their first-degree relatives. The aims of this study were to compare cognitive and P300/MMN measurements in schizophrenia patients, their siblings, and controls, and to identify the degree of familial influence on each measure. Thirty patients diagnosed with schizophrenia according to DSM-IV, 20 unaffected siblings and 25 healthy controls were able to complete all neuropsyhological and neurophysiological assessments. All participants were administered SCID-I and the patients were also evaluated regarding symptom severity and functioning. Neuropsychological battery testing results and P300/MMN measurements were obtained for all the participants. Both schizophrenia patients and their siblings had lower working memory, as measured by the Auditory Consonant Trigram Test (ACT), and lower MMN amplitude scores than the controls. In addition, the patients had lower attention, verbal memory, executive function, visuomotor speed, and figural memory scores than both the siblings and controls, and lower verbal fluency scores than controls. MMN and P300 amplitudes were lower and P300 latency longer in the schizophrenia patients, as compared to controls. P300 latency was also longer in the schizophrenia patients as compared to siblings and, MMN amplitudes were significantly lower in the siblings compared to controls. Working memory performance measured by ACT significantly predicted inclusion in both the patient and sibling groups and showed significant familial influence. MMN amplitude significantly predicted inclusion only to the patient group and did not show significant familial influence. The schizophrenia patients exhibited impairment in various cognitive domains and P300/MMN measurements, versus impairment only in working memory and MMN amplitude in their siblings. Working memory seems to have a relatively strong familial influence among all the neuropsychological and neurophysiological parameters evaluated.
... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Beha... more ... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Behaviour Change ... interview. Adaptation and reliability studies of SPC were carried out by Özer, Ulusoy, Kabakçı, and Ulusahin (2003). ...
ABSTRACT:
Prediction of response to antipsychotic drugs in schizophrenia patients within the
earl... more ABSTRACT: Prediction of response to antipsychotic drugs in schizophrenia patients within the early phase of treatment Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a patient as non-responder. However, recent studies indicate that the response to antipsychotic medications starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of early improvement at 2 or 4 weeks for non-response at 6 weeks. Methods: Twenty seven in- and out-patients with a diagnosis of schizophrenia according to DSM-IV, between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative Syndrome Scale (PANSS) total score ≥ 75, with at least “moderate” level of severity / score>4 on at least 2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were receiving antipsychotic treatment for the first time, and 17 patients’ treatment was changed due to nonresponse to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication: “not minimally improved”, “not much improved” and “not remitted”. As previously described, “not minimally improved” and “not much improved” were defined as less than 28% and 53% improvement in the PANSS total scores, respectively. “Not remitted” was defined according to the criteria developed by “The Remission in Schizophrenia Working Group” without the time criterion. Signal detection methods using receiver operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value of cut-off points were calculated for predicting “not minimally improved”, “not much improved” and “not remitted” at endpoint. Results: The early response threshold for predicting “not minimally improved’ was less than 15.3% reduction in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for predicting “not much improved” was less than 22.1% reduction at week 2 and less than 44.3% reduction at week 4; for “not remitted” was less than 71.5% reduction at week 2 and less than 23.2% reduction at week 4. Specific thresholds of “much improvement” and “remission” were not identified at week 2, whereas thresholds calculated for week 4 had good discriminative power. Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead, the findings revealed that non-response could best be predicted at 4 weeks as in some other previous studies. The question of which time point for early prediction of response could be best predicted in schizophrenia patients needs to be further addressed in subsequent studies with larger sample size.
Turk psikiyatri dergisi = Turkish journal of psychiatry, 2010
Some patients with pervasive developmental disorders develop unusual talents, which are character... more Some patients with pervasive developmental disorders develop unusual talents, which are characterized as savant syndrome. Herein we present neuropsychological examination and brain imaging (fMRI and brain SPECT) findings of an 18-year-old male with Asperger syndrome and highly unusual calendar memory. Neuropsychological evaluation of the case indicated mild attention, memory, and problem solving deficits, and severe executive function deficits that included conceptualization, category formation, and abstraction. Functional MRI findings showed activation above the baseline level (P<0.05) in the bilateral inferior parietal lobule, precuneus, superior and middle frontal gyri, and medial frontal cortex. Brain SPECT findings, in comparison to rest-SPECT findings, showed that there was hypoperfusion in some brain regions, including the right frontal cortex and right parietal cortex. Baseline blood perfusion in the left frontal cortex was also observed, as well as hypoperfusion in the r...
Objective: It has been proposed that anything does not kill you make you stronger. Although it mi... more Objective: It has been proposed that anything does not kill you make you stronger. Although it might be true in adult cases, children whose psychological life begin in the parental mind and shaped by the experiences during the early period of life are not as strong as adult against adverse effects of stressful events. Internalization of objects and emerging of internally working models, concept of normality and abnormality that will be the main ground for the understanding of the world in later life are emerged during childhood. That is why anything does not kill a child will shape its mind that might have everlasting effects on child.
... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Beha... more ... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Behaviour Change ... interview. Adaptation and reliability studies of SPC were carried out by Özer, Ulusoy, Kabakçı, and Ulusahin (2003). ...
Türk psikiyatri dergisi = Turkish journal of psychiatry, 2010
Some patients with pervasive developmental disorders develop unusual talents, which are character... more Some patients with pervasive developmental disorders develop unusual talents, which are characterized as savant syndrome. Herein we present neuropsychological examination and brain imaging (fMRI and brain SPECT) findings of an 18-year-old male with Asperger syndrome and highly unusual calendar memory. Neuropsychological evaluation of the case indicated mild attention, memory, and problem solving deficits, and severe executive function deficits that included conceptualization, category formation, and abstraction. Functional MRI findings showed activation above the baseline level (P<0.05) in the bilateral inferior parietal lobule, precuneus, superior and middle frontal gyri, and medial frontal cortex. Brain SPECT findings, in comparison to rest-SPECT findings, showed that there was hypoperfusion in some brain regions, including the right frontal cortex and right parietal cortex. Baseline blood perfusion in the left frontal cortex was also observed, as well as hypoperfusion in the r...
ABSTRACT Carbamazepine is an anticonvulsant and is extensively used in patients with bipolar diso... more ABSTRACT Carbamazepine is an anticonvulsant and is extensively used in patients with bipolar disorder as a mood stabilizer. Although carbamazepine affects dopamine, norepinephrine, and glutamic acid levels in neurons, it mainly shows its effect on sodium and potassium channels. Carbamazepine enhances dopamine release and turnover and leads to differential alterations of monoamine levels in discrete brain regions. The mechanism of the emergence of prolonged erection and priapism is related to α1 adrenergic blockage in corpus cavernosum, however the knowledge about the effects of carbamazepine on adrenergic receptors is very limited. Therefore, further studies are necessary to identify the risk for prolonged erection in patients treated with carbamazepine and to investigate the relationship between prolonged erection and carbamazepine.
Various neuropsychological domains, and P300 auditory event-related potentials (ERP) and mismatch... more Various neuropsychological domains, and P300 auditory event-related potentials (ERP) and mismatch negativity (MMN) exhibit abnormalities in schizophrenia patients and their first-degree relatives. The aims of this study were to compare cognitive and P300/MMN measurements in schizophrenia patients, their siblings, and controls, and to identify the degree of familial influence on each measure. Thirty patients diagnosed with schizophrenia according to DSM-IV, 20 unaffected siblings and 25 healthy controls were able to complete all neuropsyhological and neurophysiological assessments. All participants were administered SCID-I and the patients were also evaluated regarding symptom severity and functioning. Neuropsychological battery testing results and P300/MMN measurements were obtained for all the participants. Both schizophrenia patients and their siblings had lower working memory, as measured by the Auditory Consonant Trigram Test (ACT), and lower MMN amplitude scores than the controls. In addition, the patients had lower attention, verbal memory, executive function, visuomotor speed, and figural memory scores than both the siblings and controls, and lower verbal fluency scores than controls. MMN and P300 amplitudes were lower and P300 latency longer in the schizophrenia patients, as compared to controls. P300 latency was also longer in the schizophrenia patients as compared to siblings and, MMN amplitudes were significantly lower in the siblings compared to controls. Working memory performance measured by ACT significantly predicted inclusion in both the patient and sibling groups and showed significant familial influence. MMN amplitude significantly predicted inclusion only to the patient group and did not show significant familial influence. The schizophrenia patients exhibited impairment in various cognitive domains and P300/MMN measurements, versus impairment only in working memory and MMN amplitude in their siblings. Working memory seems to have a relatively strong familial influence among all the neuropsychological and neurophysiological parameters evaluated.
... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Beha... more ... doubting. The test Elif Kabakcı, Basaran Demir, Hilal Demirel, and Ali Emre S¸ evik 172 Behaviour Change ... interview. Adaptation and reliability studies of SPC were carried out by Özer, Ulusoy, Kabakçı, and Ulusahin (2003). ...
ABSTRACT:
Prediction of response to antipsychotic drugs in schizophrenia patients within the
earl... more ABSTRACT: Prediction of response to antipsychotic drugs in schizophrenia patients within the early phase of treatment Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a patient as non-responder. However, recent studies indicate that the response to antipsychotic medications starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of early improvement at 2 or 4 weeks for non-response at 6 weeks. Methods: Twenty seven in- and out-patients with a diagnosis of schizophrenia according to DSM-IV, between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative Syndrome Scale (PANSS) total score ≥ 75, with at least “moderate” level of severity / score>4 on at least 2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were receiving antipsychotic treatment for the first time, and 17 patients’ treatment was changed due to nonresponse to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication: “not minimally improved”, “not much improved” and “not remitted”. As previously described, “not minimally improved” and “not much improved” were defined as less than 28% and 53% improvement in the PANSS total scores, respectively. “Not remitted” was defined according to the criteria developed by “The Remission in Schizophrenia Working Group” without the time criterion. Signal detection methods using receiver operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value of cut-off points were calculated for predicting “not minimally improved”, “not much improved” and “not remitted” at endpoint. Results: The early response threshold for predicting “not minimally improved’ was less than 15.3% reduction in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for predicting “not much improved” was less than 22.1% reduction at week 2 and less than 44.3% reduction at week 4; for “not remitted” was less than 71.5% reduction at week 2 and less than 23.2% reduction at week 4. Specific thresholds of “much improvement” and “remission” were not identified at week 2, whereas thresholds calculated for week 4 had good discriminative power. Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead, the findings revealed that non-response could best be predicted at 4 weeks as in some other previous studies. The question of which time point for early prediction of response could be best predicted in schizophrenia patients needs to be further addressed in subsequent studies with larger sample size.
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Papers by A. E . ŞEVİK
Prediction of response to antipsychotic drugs in schizophrenia patients within the
early phase of treatment
Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a
patient as non-responder. However, recent studies indicate that the response to antipsychotic medications
starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of
early improvement at 2 or 4 weeks for non-response at 6 weeks.
Methods: Twenty seven in- and out-patients with a diagnosis of schizophrenia according to DSM-IV,
between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative
Syndrome Scale (PANSS) total score ≥ 75, with at least “moderate” level of severity / score>4 on at least
2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were
receiving antipsychotic treatment for the first time, and 17 patients’ treatment was changed due to nonresponse
to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical
Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response
at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication:
“not minimally improved”, “not much improved” and “not remitted”. As previously described, “not minimally
improved” and “not much improved” were defined as less than 28% and 53% improvement in the PANSS
total scores, respectively. “Not remitted” was defined according to the criteria developed by “The Remission
in Schizophrenia Working Group” without the time criterion. Signal detection methods using receiver
operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse
at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value
of cut-off points were calculated for predicting “not minimally improved”, “not much improved” and “not
remitted” at endpoint.
Results: The early response threshold for predicting “not minimally improved’ was less than 15.3% reduction
in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for
predicting “not much improved” was less than 22.1% reduction at week 2 and less than 44.3% reduction
at week 4; for “not remitted” was less than 71.5% reduction at week 2 and less than 23.2% reduction at
week 4. Specific thresholds of “much improvement” and “remission” were not identified at week 2, whereas
thresholds calculated for week 4 had good discriminative power.
Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse
at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead,
the findings revealed that non-response could best be predicted at 4 weeks as in some other previous
studies. The question of which time point for early prediction of response could be best predicted in
schizophrenia patients needs to be further addressed in subsequent studies with larger sample size.
Prediction of response to antipsychotic drugs in schizophrenia patients within the
early phase of treatment
Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a
patient as non-responder. However, recent studies indicate that the response to antipsychotic medications
starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of
early improvement at 2 or 4 weeks for non-response at 6 weeks.
Methods: Twenty seven in- and out-patients with a diagnosis of schizophrenia according to DSM-IV,
between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative
Syndrome Scale (PANSS) total score ≥ 75, with at least “moderate” level of severity / score>4 on at least
2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were
receiving antipsychotic treatment for the first time, and 17 patients’ treatment was changed due to nonresponse
to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical
Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response
at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication:
“not minimally improved”, “not much improved” and “not remitted”. As previously described, “not minimally
improved” and “not much improved” were defined as less than 28% and 53% improvement in the PANSS
total scores, respectively. “Not remitted” was defined according to the criteria developed by “The Remission
in Schizophrenia Working Group” without the time criterion. Signal detection methods using receiver
operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse
at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value
of cut-off points were calculated for predicting “not minimally improved”, “not much improved” and “not
remitted” at endpoint.
Results: The early response threshold for predicting “not minimally improved’ was less than 15.3% reduction
in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for
predicting “not much improved” was less than 22.1% reduction at week 2 and less than 44.3% reduction
at week 4; for “not remitted” was less than 71.5% reduction at week 2 and less than 23.2% reduction at
week 4. Specific thresholds of “much improvement” and “remission” were not identified at week 2, whereas
thresholds calculated for week 4 had good discriminative power.
Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse
at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead,
the findings revealed that non-response could best be predicted at 4 weeks as in some other previous
studies. The question of which time point for early prediction of response could be best predicted in
schizophrenia patients needs to be further addressed in subsequent studies with larger sample size.