Papers by Ayşe Nur İnci Kenar
PubMed, Aug 31, 2023
Objective: The aim of this study was to evaluate the efficacy and tolerability of the combination... more Objective: The aim of this study was to evaluate the efficacy and tolerability of the combination of two long-acting injectable antipsychotics (LAIA) in psychiatric disorders, especially in schizophrenia. Patients and methods: Eighty-three patients treated with dual LAIA were included in the study by retrospective screening from the hospital registration system. The present study was designed as an observational, retrospective, naturalistic mirror-image study. The number of hospitalizations before and after switching to dual LAIA was compared in patients who received oral antipsychotics and single LAIA during the study period. In addition, it was analyzed which was the preferred dual antipsychotic combination. Results: Of the patients, 44.6% had schizophrenia, 41.0% had schizoaffective disorder, and 14.4% had other psychiatric disorders. The number of patients receiving oral treatment prior to dual LAIA use was 80 (96.4%). Data on dual LAIA regimens showed that 31.3% were receiving paliperidone and aripiprazole, 24.1% were receiving paliperidone and flupenthixol, 18.1% were receiving paliperidone and zuclopenthixol, and 26.5% were receiving the other combinations. After dual LAIA treatment, there was a significant decrease in the number of hospitalizations compared to before (from 5.95 to 0.99, p<0.001). In addition, while the number of patients who did not require hospitalization in the pre-treatment period was 10.8%, it reached 48.1% in the post-treatment period (p<0.001). No significant adverse effect related to the use of dual LAIA was observed in any patient during the treatment period. Conclusions: The use of dual LAIA instead of oral antipsychotics or single LAIA in chronic psychotic patients with poor social support and irregular medication use is thought to reduce hospitalization and related treatment costs and regularize medication use.
European Psychiatry, 2015
Aim To present the treatment period of generalized anxiety disorder in a pregnant woman, and effe... more Aim To present the treatment period of generalized anxiety disorder in a pregnant woman, and effects of psychotropic drugs in the newborn and infancy period. Case report A 33-year-old female who has eight weeks of gestation, is diagnosed with generalized anxiety disorder according to DSM-IV-R. Psychotropic drugs are decided to use. She had sertraline 100 mg/day, olanzapine 10 mg/day, quetiapine XR 400 mg/day and clorpromazine 100 mg/day as the final medication in her second trimester. Her anxiety symptoms have regressed in clinical follow-up period. No obstetric problem during the pregnancy period and no clinical problem during the prenatal follow-up period was observed. Drugs were decreased gradually at the last month of the birth and the patient was followed up without all drugs in the last two weeks prior to the birth. Birth was by cesarean section on term and the birth weight of the baby was normal. His APGAR score was 5 and he has either respiratory or any clinic problem to be monitored in the couveuse. According to the information obtained from her mother, the infant has normal motor and mental development during his two years follow-up in regional healthcare center. Conclusion When anxiety disorders are not treated during pregnancy, it is reported that, pregnancy and obstetric complications can arise, health status of newborn can be effected negatively, and can result in preterm birth, low birth weight and intrauterin growth retardation. Therefore, clinicians should prefer the most confident treatment options and track individualized treatment and patient follow-up strategies.
Bulletin of Clinical Psychopharmacology, 2014
Anadolu psikiyatri dergisi, 2014
Amac: Dikkat eksikligi hiperaktivite bozuklugu (DEHB), noropsikiyatrik bir bozukluk olup etiyopat... more Amac: Dikkat eksikligi hiperaktivite bozuklugu (DEHB), noropsikiyatrik bir bozukluk olup etiyopatogenezinde frontostriatal dongu uzerinde durulmaktadir. Psikiyatrik bozukluklardaki beyin islev bozukluklarinin arastirilmasin- da kullanilan silik norolojik belirtiler, daha cok cocukluk cagi DEHB'de arastirilmistir. Bu calismada, eriskin DEHB'lilerin frontal bolge islevlerine duyarli noropsikolojik test performanslari ve silik norolojik belirtilerin duzey- lerinin arastirilmasi hedeflenmistir. Yontem: Calismaya DEHB tanisi konmus olan 18-60 yaslari arasinda 60 olgu ve 60 saglikli kontrol alindi. Her iki gruba Norolojik Degerlendirme Olcegi ve noropsikolojik testler (Sayi dizileri, sozel bellek, Stroop ve Wisconsin Kart Esleme Testi-WKET) uygulandi. Elli dokuz olgu ve 46 kontrol bireyinin noropsikolojik testleri ve norolojik degerlendirmesi gecerli kabul edilmis ve istatistiksel degerlendirmeye alinmistir. Sonuc: Eriskin DEHB grubunda sayi dizileri, sozel bellek ve stroop testlerinde kontrol grubuna gore anlamli duzeyde dusuk performans saptandi. WKET'de eriskin DEHB'liler ile kontrol grubu arasinda farklilik bulunmadi. Silik norolojik belirtilerde eriskin DEHB'lilerde motor koordinasyon ve alt test maddelerinden basparmak opozisyo- nunda kontrol grubuna gore anlamli duzeyde dusuk performans saptanmistir. Eriskin DEHB'lilerde duyusal butunlestirme alt testinde ve alt test maddelerinden isitsel gorsel butunlestirme ve sondurme testinde kontrol grubuna gore anlamli duzeyde dusuk performans saptanmistir. 'Diger' alt testlerinden bellek, sinkinezi ve bakisi sabit tutma guclugu alt test maddelerinde eriskin DEHB'lilerde kontrol grubuna gore dusuk performans saptan- mistir. Tartisma: DEHB'nin cocukluk caginda yaygin oldugu ve eriskin donemde belirtilerin azaldigi belirtilmek- tedir. DEHB'de eriskinlikte de frontal lobda, serebellumda, pariyetal lobda ve/veya bunlarin birbirleriyle baglanti- sini saglayan fronto-striatal yolaklarda bir islev bozuklugunun surdugu, bunun ise hastaligin gidisini ve tedaviyi etkileyebilecegi dusunulmektedir. (Anadolu Psikiyatri Derg 2014; 15:318-327) Anahtar sozcukler: DEHB, silik norolojik belirti, noropsikolojik islev Neuropsychologic functions and soft neurologic signs in adult ADHD ABSTRACT Objective: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric illness and etiopathogenetic studies focus on frontostriatal circuit. Soft neurologic signs that are used in the investigation of brain function disorders in psychiatric diseases were studied more in childhood ADHD. In the present study, it is aimed to study the neuropsychologic test performances that are sensitive to frontal lobe functions and soft neurologic signs in adult ADHD. Methods: Sixty subjects with ADHD and 60 control subjects aging between 18-60 years were included into the study. Neurological examination for soft signs and neuropsychologic tests (Digit span, verbal memory, Stroop task and Wisconsin card sorting test (WCST)) were performed to both groups. Neurological ex- amination for soft signs and neuropsychologic tests of 59 patients and 46 control subjects were regarded as ef- fective and were analyzed statistically. Results: Significantly low performance was determined in digit span,
Turkiye Klinikleri Child Psychiatry - Special Topics, 2015
Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, Feb 29, 2016
Objective: Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or mai... more Objective: Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years' observation with acute and maintenance ECT in a university hospital in Turkey. Methods: The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results: A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion: The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs.
Turkiye Klinikleri Psychiatry - Special Topics, 2016
European Psychiatry, 2013
Objective: To investigate the effects sex and age on the methylphenidate HCl treatment in adult A... more Objective: To investigate the effects sex and age on the methylphenidate HCl treatment in adult ADHD. Methods: Sixty ADHD subjects were included into the study aging between 18 and 60 years. Levels of N-acetyl aspartate (NAA), creatine and choline in anterior cingulate cortex, cerebellum, striatum and dorsolateral prefrontal cortex were measured with magnetic resonance spectroscopy. Then, 10 mg oral methylphenidate HCl was given to the subjects and the same metabolite levels were measured after an interval of 30 minutes. Results: Twelve (20%) of the subjects were women and 48 (80%) of them were men. Age distribution of subjects is as follows: 15 were between 18-24 years, 26 were between 25-30 years, 19 were older than 30 years. No difference was determined between NAA levels before and after methylphenidate in both sexes. Creatine levels were determined higher after methylphenidate in women in prefrontal cortex and in men in cerebellum. Choline levels were determined higher after methylphenidate in women in striatum. NAA levels were determined higher after methylphenidate in prefrontal cortex of 18-24 years old age group and in striatum and cerebellum of 25-30 years old age group. Creatine levels in striatum after methylphenidate were determined higher in 18-24 years old age group than 25-30 years old age group. No difference was determined between choline levels before and after methylphenidate in each age groups. Conclusion: It is thought that pharmacotherapy can be effective on brain metabolites and this effect can vary upon sex and age.
Psychiatry Investigation, 2014
The etiology of attention deficit hyperactivity disorder (ADHD) is not completely understood, but... more The etiology of attention deficit hyperactivity disorder (ADHD) is not completely understood, but it is well known that the genetic transmission is an important factor in ADHD etiology. 1 In particular, it is supposed to be a complex psychiatric disorder which also involves the interaction of gene and environment. 2 Despite the studies reporting association between ADHD and serotonergic system, genes of dopaminergic system are the mostly blamed system genes among the genetic factors. 3,4 However, recently, researchers suppose that the problem at the synaptic gap is not only limited to the dopamine, but also there may be problems in the modulation of neurotransmitter releasing and synaptogene-76 Copyright © 2014 Korean Neuropsychiatric Association sis, and they targetted their efforts towards the genes encoding presynaptic proteins having roles in those processes. 5 Vesicle-associated membrane protein 2 (VAMP2) (synaptobrevin 2) and syntaxin 1A along with The synaptosomalassociated protein, 25 kDa (SNAP-25) protein compose SNARE proteins that have roles in the modulation of neurotransmitter releasing. 6 Among these genes, the most frequently studied one is SNAP-25 gene and the relation between ADHD and two polymorphisms of (MnlI, DdeI) this gene was investigated in many studies. A relation between either or both DdeI and MnlI polymorphisms are found to be related with ADHD. 7-9 A relation between ADHD and SNAP-25 MnlI polymorphism was determined in a study which was performed in our country, Turkey. 10 In another study from Turkey, the changes in the brain bloodstream with single dose of psychostimulant in ADHD subjects were analyzed and they reported that brain bloodstream may be affected by SNAP-25 polymorphism after psychostimulant therapy. 11 All these studies have brought up the other proteins that have roles in the same function along with SNAP-25. However, no study was noticed investigating the relation between VAMP2 and syntaxin 1A genes and ADHD in the
Archives of Psychiatric Nursing
Dikkat eksikliği hiperaktivite bozukluğu çocukluk döneminde başlayan ve temel belirtileri dikkats... more Dikkat eksikliği hiperaktivite bozukluğu çocukluk döneminde başlayan ve temel belirtileri dikkatsizlik, aşırı hareketlilik ve dürtüsellik olan bir bozukluktur. DEHB'nin etiyolojisi henüz tam olarak aydınlatılamamıştır. Etiyolojide özellikle gen?çevre etkileşiminin ve prefrontal striatal serebellar dizgenin yapısal ve metabolik farklılığının rol oynadığı düşünülmektedir. Genetik araştırmalar daha çok dopaminerjik yolaklar ve dopamin reseptörleri üzerinedir. Bu çalışmada, erişkin DEHB ile presinaptik proteinleri kodlayan genlerden olan sinaptobrevin-2 (VAMP2), sinapsin III ve sintaksin 1A genlerinin ilişkisi ve bu genlerin nöropsikolojik test performansları üzerine etkisinin araştırılması hedeflenmiştir. Çalışmaya DEHB tanısı almış olan 18-60 yaş arası 139 olgu ve 106 sağlıklı kontrol alındı. Katılımcılardan kan örneği alınarak genetik analizler yapıldı. Her iki gruba Nörolojik Değerlendirme Ölçeği ve nöropsikolojik testler (Sayı dizleri, sözel bellek, stroop ve Wisconsin kart eşl...
Bulletin of Clinical Psychopharmacology, 2014
Psychiatry and Clinical Psychopharmacology, 2018
Objective: This study aims to examine the psychopathology, quality of life perception, eating beh... more Objective: This study aims to examine the psychopathology, quality of life perception, eating behaviors and self-image of children and adolescents who are diagnosed with obesity; as well as their parents' behaviour, coping skills and the relations between these conditions. Methods: In this study, 30 patients between the ages of 8-18 who have consulted the University of Akdeniz Pediatric Endocrinology Department and had BMI standard deviation above 2 and had no mental retardation or received no previous psychiatric consultations on the obesity were enrolled. Our control group included 30 healthy children and adolescents who were matching on the same demographic information (gender and age) with the treatment (patient) group, and they had no previous medical or psychiatric illnesses. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version was administered to both groups, and the Rosenberg Self Image Scale was used to determine their self-images. The Quality of Life Scale for Children was administered to the children and adolescents as well as to their parents. To determine the methods of child rearing and coping strategies with stress, parents were administered the Family Life and Child Rearing Demeanours Scale and the Coping Strategies Scale. Results: There were no significant sociodemographic differences between the two groups except for parents' educational level and socioeconomic status. As we found no differences on parenting styles and coping strategies, a higher percentage of psychiatric illnesses were detected in our study and the quality of life perception of parents was found lower in the obese group. Self-image scores were not varied between obese children and healthy controls. İt was observed that obese group children's mother have more likley high obesity rates than the mothers in the control group children. Conclusions: As a result of this study, psychiatric disorders were observed more frequently in obese children and adolescents. The perception of quality of life for obese children and adolescents seem alike with control groups' perception. However, the fact that obese children and adolescents' parents claim that their children's quality of life is not equal to other groups shows that obese children and adolescents are less aware of health condition and following problems they have and might possible attain in the future.
European review for medical and pharmacological sciences, 2016
OBJECTIVE The effects of certain genetic alterations in the brain function of patients with atten... more OBJECTIVE The effects of certain genetic alterations in the brain function of patients with attention deficit hyperactivity disorder (ADHD) remain unclear and, in fact, there is a limited amount of data in this field. For example, the relationship between the SNAP-25 polymorphism and brain metabolites in response to methylphenidate (MPH) has yet to be investigated. Thus, the present study aimed to determine the relationship between changes in creatine (Cr), choline (Cho), and N-acetyl aspartate (NAA) levels in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) of adults with ADHD and the SNAP-25 gene polymorphism following the use of MPH. PATIENTS AND METHODS The present study assessed 60 patients between 18 and 60 years of age who were diagnosed with ADHD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Genetic analyses were carried out using blood samples obtained from the ADHD patients and included a detailed...
Psychiatry Investigation, 2014
ObjectiveaaThe synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma m... more ObjectiveaaThe synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters. Previously, several studies reported association between SNAP-25 and attention deficit hyperactivity disorder (ADHD). We investigated whether these SNAP-25 polymorphisms (MnlI T/G and DdelI T/C) were also associated with ADHD in the Turkish population. MethodsaaOur study comprised unrelated 139 subjects who met DSM-IV criteria for ADHD and 73 controls and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with Wender-Utah Rating Scale and Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. ResultsaaSNAP-25 DdelI polymorphism was not associated with ADHD but there was a statistically significant difference between ADHD patients and controls for SNAP-25 MnlI polymorphism. For SNAP-25 MnlI polymorphism patients with G/G genotype of the SNAP-25 gene MnlI polymorphism had higher Wender-Utah scores and higher scores in the 1st and 3rd parts of adult ADD/ADHD Scale. ConclusionaaWe detected a significant association of the MnlI polymorphism in our ADHD sample which was similar to previous findings. Our study also revealed that SNAP-25 MnlI polymorphism was also associated with symptom severity of ADHD. This study is also, the first report on the association of SNAP-25 with ADHD in the Turkish population.
Psychiatry and Clinical Psychopharmacology, 2018
Grief mania that is evaluated as psychogenic mania in the literature is related to manic episode ... more Grief mania that is evaluated as psychogenic mania in the literature is related to manic episode that emerges after the loss of a loved one. There are not many cases that associate causality of beginning of mania and mourning in the literature. It is known that mania is induced by traumatic events but the cases that do not suit stages of development of grief process are evaluated as pathological grief. In this case, the woman who experienced manic episode after her son's death is presented. This case is prepared because mania should be considered as possible grief reaction. Case presentation: A patient who is 40 years old, married, mother of 4 children is brought by relatives because of aggressiveness, tension, insomnia for 4 days, fast and talk a lot and nonsense laughing attacks. She was presented to hospital for stressful life events 2 years ago and started to be on medication (escitalopram 10 mg) because of depression and fibromiyaliji diagnosis. She used medication for 1.5 years and she did not use any medication for the last 6months. There is no history for mental disorder in her family. Psychological examination: her interest for the environment was increased, self-care ability got better, her temperament was cheerful, her sociability was respectful, amount of talking and tone of voice increased, mimic and gesture was appropriate for her temperament, sleeping decreased, thought flow increased and achieved goal of conversation late. Moreover, there were grandiose delusions and hypervigilance, affect was close to euphoria, her psychomotor behaviours increased and social functioning decreased. According to biochemical and radiological workup, there was no pathological situation. The client started to use Lithium 900 mg/day and Olanzapin 10 mg/day because of the bipolar disorder diagnosis. The patient's blood lithium level was 0.8mEq/L and lithium was used 1200 mg/day and then 10 days later the patient's blood lithium level was 0.72 mEq/L. According to clinical observations, the patient's manic symptoms remained. Furthermore, the patient started to cry occasionally after 1 month and her grandiosity disappeared. The patient was discharged from the hospital after 45 days. The patient met the criteria for manic episode in DSM 5. The patient did not take any medication for last 6 months. Thus, it is considered that this situation was not induced by medication. It puts the patient into risk group because she was treated for depression before but it is not considered as bipolar depression because there were psychiatric history in the family and depression that experienced 2 years ago was related to stressful life events. It is considered that this case experienced grief/funeral mania because there was contiguity between loss of her son and manic episode, the patient did not react this way to previous challenging life events and the patient was outside of the ordinary 5 stages of grief process.
European review for medical and pharmacological sciences, 2017
OBJECTIVE This study investigated the relationship between the use of methylphenidate (MPH) and c... more OBJECTIVE This study investigated the relationship between the use of methylphenidate (MPH) and changes in creatine, choline, and N-acetyl-aspartate (NAA) in the dorsolateral prefrontal cortex (DLPFC), striatum, cerebellum, and anterior cingulate cortex (ACC) in adults with attention-deficit hyperactivity disorder (ADHD). PATIENTS AND METHODS The study enrolled 60 patients 18-60 years of age who met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for ADHD. The amounts of NAA, creatine, and choline in the ACC, cerebellum, striatum, and DLPFC were measured using magnetic resonance spectroscopy. After the first measurement, the patients were given 10 mg oral MPH, and the same metabolite levels were measured 30 minutes later. RESULTS No significant differences were observed in the NAA and choline levels in the DLPFC, ACC, cerebellum, and striatum after MPH. Although there were no significant differences in the creatine levels in the DLP...
European review for medical and pharmacological sciences, 2016
OBJECTIVE This study investigated the relationship between DAT1 gene polymorphisms and the effect... more OBJECTIVE This study investigated the relationship between DAT1 gene polymorphisms and the effects of methylphenidate (MPH) administration on N-acetyl aspartate (NAA), creatine (Cr), and choline (Cho) levels in the anterior cingulate cortex, prefrontal cortex, striatum, and cerebellum in adult patients with attention deficit hyperactivity disorder (ADHD). This was the first study to investigate the relationship between DAT gene variable number tandem repeat (VNTR) polymorphisms and the responses of brain metabolites to MPH. PATIENTS AND METHODS Samples in this study were collected from 60 patients aged between 18 and 60 years with ADHD according to DSM-IV criteria. Genetic analysis of DAT1 gene polymorphisms was carried out using blood samples obtained after a detailed clinical evaluation. Levels of NAA, Cr, and Cho were measured in the anterior cingulate cortex, prefrontal cortex, striatum, and cerebellum by magnetic resonance spectroscopy. After this evaluation, 10 mg of MPH was g...
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Papers by Ayşe Nur İnci Kenar