Nesrin Karamustafalioglu

Bio: Nesrin Karamustafalioglu is an academic researcher from Istanbul University. The author has contributed to research in topics: Bipolar disorder & Mania. The author has an hindex of 9, co-authored 47 publications receiving 305 citations.

Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflamma- tion markers for bipolar disorder

Abstract: In the present study we investigated the involvement of inflammatory cells and their ratios as inflammation markers in Bipolar Disorder. We have enrolled 61 manic, 55 euthymic patients and 54 control subjects to the study. Neutrophil-lymphocyte and platelet-lymphocyte ratios were found significantly higher in both manic and euthymic patients compared to control group. These findings suggest that the inflammatory cells have a role in the pathophysiology of bipolar disorder manic and even in euthymic state.

Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder

Abstract: In the present study we investigated the involvement of inflammatory cells and their ratios as inflammation markers in Bipolar Disorder. We have enrolled 61 manic, 55 euthymic patients and 54 control subjects to the study. Neutrophil-lymphocyte and platelet-lymphocyte ratios were found significantly higher in both manic and euthymic patients compared to control group. These findings suggest that the inflammatory cells have a role in the pathophysiology of bipolar disorder manic and even in euthymic state.

Comparison of Propofol, Etomidate, and Thiopental in Anesthesia for Electroconvulsive Therapy: A Randomized, Double-blind Clinical Trial.

Abstract: Objectives This study aimed to compare the effects of propofol, thiopental, and etomidate, which are routinely used in anesthesia for electroconvulsive therapy (ECT), on the cardiovascular system, seizure variables, recovery, cognitive functions, and response to treatment. Methods Male patients hospitalized at the Seventh Psychiatry Clinics of the Bakirkoy Teaching Hospital for Psychiatry, Neurology, and Neurosurgery who were treated with ECT were investigated prospectively. The effects on cardiovascular system parameters (heart rate, blood pressure, and blood oxygenation), seizure variables (duration and intensity of seizure), and recovery variables were recorded at every session, on prespecified time points, and the findings of the first session were used in this evaluation. In addition, clinical responses to treatment were evaluated with tests of cognitive functions before and after a course of ECT. Adverse effects were recorded. Results The sociodemographic characteristics of the 3 treatment groups were similar. There were no significant differences among the groups in terms of effects on cardiovascular system variables, seizure variables, and cognitive functions. The clinical response to ECT was good in all groups, without any significant differences. Conclusions Propofol, etomidate, and thiopental are associated with similar safety and efficacy profiles.

Predictive factors for time to remission and recurrence in patients treated for acute mania: health outcomes of manic episodes (HOME) study.

Abstract: Objective: To determine the time to remission and recurrence in patients treated for acute mania and the predictive factors associated with these outcomes. Method: This observational study, conducted in Turkey from April 2003 to January 2005, included patients with a DSM-IV diagnosis of bipolar I disorder, acute manic or mixed episode who were eligible to have an oral medication initiated or changed for the treatment of the episode. The patients were followed-up for 12 months. Results: A total of 584 patients (mean ± SD age = 33.9 ± 11.2, 55.2% outpatients) were enrolled in 53 centers. Eighty-five percent of patients had a manic episode at baseline, with a mean ± SD duration of 21.6 ± 24.4 days. The baseline mean ± SD Clinical Global Impressions scale for use in bipolar disorder and Young Mania Rating Scale (YMRS) scores were 4.9 ± 0.9 (median = 5.0) and 33.2 ± 9.3 (median = 33), respectively. 539 patients achieved remission and, of those, 141 patients had recurrence. One-year remission and recurrence rates were 99.0% and 35.7%, respectively. Mean ± SD times to remission and recurrence in descriptive statistics were 80.9 ± 73.8 (median = 50) and 159.0 ± 95.5 (median = 156) days, respectively. In Cox regression analysis, psychiatric comorbidities (p = .048), a higher YMRS score (p < .001), and a higher number of previous depressive episodes (p = .009) were statistically significant predictors of a longer time to reach remission. Index episodes of longer duration (p = .033) and mixed type (p = 0.49) were significant predictors of a shorter time to recurrence. Confounding factors like concomitant treatment, comorbidities, and lack of blinding and randomization were other limitations. Conclusion: Predictors for a longer time to remission were psychiatric comorbidities, a higher YMRS score, and a higher number of previous depressive episodes. Predictors for a shorter time to recurrence were episodes of longer duration and mixed type.

Level of plasma thioredoxin in male patients with manic episode at initial and post-electroconvulsive or antipsychotic treatment.

Abstract: Aim Oxidative stress is defined as exposure to excessive oxidants and/or decrease in antioxidant capacity. Several studies have shown the effects of free radicals and antioxidant defense systems in bipolar disorder. We aimed to investigate the role of thioredoxin (TRX), which is a novel oxidative stress marker in patients with bipolar disorder. Methods Sixty-eight hospitalized bipolar patients who were in manic episode were included in the study. As a control group, 30 healthy people were elected. Two groups were formed. The first group consisted of patients who were undergoing electroconvulsive treatment + antipsychotic treatment (haloperidol+quetiapine) and members of the other group were taking only antipsychotic treatment. Plasma thioredoxin levels were measured before and after treatment. Results Pretreatment plasma TRX levels of patients were significantly lower than the controls (P 0.05) and within groups (P > 0.05) we did not find any statistically significant difference. Conclusion Oxidative balance is impaired in bipolar disorder manic episode in favor of the oxidants. Decreased plasma TRX levels in the manic episode probably mean that antioxidant capacity is decreased in the bipolar disorder patients in the manic episode. Further studies in euthymic and depressive states are also needed to gain more insight into the role of TRX in bipolar disorder.

Research report Complex and rapid-cycling in bipolar children and adolescents: a preliminary study

Abstract: subjects aged 7-18 years were studied. Diagnoses of bipolar disorders were established using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present Episode Version-1986 modified for DSM-III-R criteria and for rating the number and duration of manic and hypomanic episodes, Complex cycling patterns were observed. These included numerous brief episodes suggesting continuous rapid-cycling in 80.8% of cases. Mean age of onset was early (8.5 k 4.4 years). Psychotic phenomena, suicidality, hyperactivity and 'mixed mania' were highly prevalent. Data in this report provide support for complex and rapid-cycling patterns in childhood onset bipolar disorder.

Peripheral brain-derived neurotrophic factor (BDNF) as a biomarker in bipolar disorder: a meta-analysis of 52 studies

Abstract: The neurotrophic hypothesis postulates that mood disorders such as bipolar disorder (BD) are associated with a lower expression of brain-derived neurotrophic factor (BDNF). However, its role in peripheral blood as a biomarker of disease activity and of stage for BD, transcending pathophysiology, is still disputed. In the last few years an increasing number of clinical studies assessing BDNF in serum and plasma have been published. Therefore, it is now possible to analyse the association between BDNF levels and the severity of affective symptoms in BD as well as the effects of acute drug treatment of mood episodes on BDNF levels. We conducted a systematic review and meta-analysis of all studies on serum and plasma BDNF levels in bipolar disorder. Through a series of meta-analyses including a total of 52 studies with 6,481 participants, we show that, compared to healthy controls, peripheral BDNF levels are reduced to the same extent in manic (Hedges’ g = −0.57, P = 0.010) and depressive (Hedges’ g = −0.93, P = 0.001) episodes, while BDNF levels are not significantly altered in euthymia. In meta-regression analyses, BDNF levels additionally negatively correlate with the severity of both manic and depressive symptoms. We found no evidence for a significant impact of illness duration on BDNF levels. In addition, in plasma, but not serum, peripheral BDNF levels increase after the successful treatment of an acute mania episode, but not of a depressive one. In summary, our data suggest that peripheral BDNF levels, more clearly in plasma than in serum, is a potential biomarker of disease activity in BD, but not a biomarker of stage. We suggest that peripheral BDNF may, in future, be used as a part of a blood protein composite measure to assess disease activity in BD.