Faculty Bibliography

OBJECTIVE:To test the efficacy of a non-governmental psychosocial rehabilitation program (Psychosocial Rehabilitation Clubhouse), which was developed by the authors and thought to be easy to put into practice for patients with schizophrenia. METHOD/METHODS:Patients with schizophrenia (n: 14) were serviced at "Izmit Our Garden Solidarity Foundation of Families of Patients with Schizophrenia" for 8 months. Rehabilitation services were conducted wholly by families and volunteers, and run by a volunteer psychologist. Program included daily activities, cultural, leisure and social activities, one day in a week. Patients were assessed by using the Quality of Life Scale (QLS), Social Functioning Scale (SFS), Global Assessment Scale (GAS), and Positive and Negative Syndrome Scale (PANNS) at baseline and at the end of the study. RESULTS:All patients (n:14) completed the program with 73% mean presence in the activities. Increase of the social functioning and the good clinical outcome was observed in patients. The results of the scales were as follows: SFS at baseline 105.1+/-20.6, in the end 133.7+/-17.1, (p<0.001); GAS at baseline 53.4+/-10.5, in the end 66.0+/-8.1, (p<0.001); QLS at baseline 62.8+/-17.4, in the end 93.4+/-19.8, (p<0.001); and PANSS in the baseline 70.3+/-16.9, in the end 61.9+/-16.5, (p<0.002). CONCLUSION/CONCLUSIONS:Psychosocial clubhouse rehabilitation program run by patients' families and volunteers in a small foundation environment, which is the first trial in Turkey, has been carried out successfully.

BACKGROUND:The aim of this study was to compare the antidepressant efficacy of standard dose, dose optimization of antidepressant drug and buspirone augmentation strategies. METHODS:120 outpatients with a DSM-IV diagnosis of unipolar depression were randomised to 12-weeks of open label treatment with fluoxetine 20 (flx20) or 40 mg (flx40) daily or fluoxetine 20 mg plus buspirone 20 mg daily (flx20-plus-buspirone). The severity of depression was assessed by Hamilton Depression Rating Scale (HDRS). Response was defined as a 50% or greater reduction of the baseline HDRS total score. A response, which began at any time of the study and was maintained until the last visit, was defined as a sustained response. RESULTS:The proportion of responders was not significantly different among the treatment groups at the endpoint. Survival analysis showed, however, a significant faster response in the patients treated with flx20 or flx40 alone than flx20-plus-buspirone. The mean times to onset of a sustained response were 33, 24 and 40 days, respectively. LIMITATIONS/CONCLUSIONS:The lack of treatment-resistant group is a methodological limitation of this study. CONCLUSIONS:Adding buspirone to fluoxetine in the treatment of major depressive disorder may delay the time to onset of antidepressant efficacy. In order to accelerate and maximise the clinical response in depressive patients, clinician should prefer to optimize the fluoxetine dose instead of in combination with buspirone.

The aim of the present study was to determine the psychometric properties of the Turkish translation of both the observer-rated (P&Ao) and self-rated (P&As) versions of the Panic and Agoraphobia Scale (P&A). Discriminant and convergent validity of P&A were assessed in patients with panic disorder with or without agoraphobia (n = 119), by comparing the P&A with the Clinical Global Impression Scale (CGI), Hamilton Anxiety Scale (HAMA), Phobia and Anxiety sub-scales of Symptom Check List, Spielberger State and Trait Anxiety Inventory and the Beck Depression Inventory (BDI). Inter-rater and test-retest reliability were determined. Correlation coefficients between the CGI and the P&Ao and the P&As were .85 and .74, respectively, and .85 between the two versions of the P&A. Cronbach's alpha for the P&Ao, and the P&As was .88 and .86, respectively. The Turkish version of the P&A has yielded good psychometric properties and was found to be a reliable instrument for assessing severity in panic disorder.

Drug-metabolising enzymatic activities have been detected in tracheobronchiolar, bronchiolar and alveolar regions in the lungs. Induction of phospholipidosis by amine drugs such as clorphentermine has also been shown. This study aimed to investigate the effect of fluoxetine and maprotiline, which contain amine groups in their structure, on pulmonary epithelial membrane permeability. Twenty-seven patients (mean age 36+/-12 years) with various psychiatric problems, of whom 17 were treated with fluoxetine and 10 with maprotiline, were included in this study. Technetium-99m diethylene triamine penta-acetic acid (DTPA) aerosol inhalation scintigraphy was performed before and after 4-6 weeks of therapy. Following the inhalation of 1480 MBq 99mTc-DTPA for 3 min, lung images in a 64x64 matrix were obtained every minute for 30 min. Regions of interest were drawn around the periphery of the lungs and on the major airways. Clearance half-times (T 1/2) were calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was calculated on the first-minute image. There was no difference between the clearance rates of 99mTc-DTPA before and after therapy for either the fluoxetine or the maprotiline group. After therapy, a significant decrease in PI was found in patients treated with fluoxetine (PI values before and after therapy: 0.53+/-0.03 and 0.49+/-0.05 respectively, P< or =0.05). This finding might have been due to the induction of increased synaptic serotonin (5-HT) by fluoxetine, which acts by inhibiting the re-uptake of 5-HT on presynaptic membranes. Bronchoconstriction of small and medium airways may be caused by direct and indirect effects of 5-HT on smooth muscle contraction.