Is Every Thyroid Antibody a Bad Sign?: The Complex Relationship of Antithyroid Antibodies and Obsessive-compulsive Symptoms

Objective

: Several immunological factors are emphasized in the etiology of autoimmune thyroid diseases and obsessivecompulsive disorder. Obsessive-compulsive symptoms (OCS) are commonly seen in patients with autoimmune thyroid diseases. This study aims to evaluate the relationship between OCS and antithyroid antibodies.

Methods

: The study included 145 patients with Hashimoto thyroiditis or Graves' disease and 42 healthy controls. Thyroid function tests and serum thyroid autobody levels (anti-thyroglobulin [TG], anti-thyroid peroxidase [TPO], and anti-thyroid stimulating hormone [TSH]) of the patients were measured. The socio-demographic data and OCS of the participants were evaluated with Dimensional OCS (DOCS).

Results

: DOCS scores were higher in patients than in the control group. There was not found a significant relationship between free T3, free T4, and TSH levels and DOCS scores. Anti-TG positivity in females was associated with lower DOCS scores. Anti-TPO positivity in males had a positive correlation with DOCS scores. There was no correlation between sex and the presence of anti-TSH in terms of OCS severity. Univariate analysis found the highest OCS scores in anti-TPO positive, anti-TG, and anti-TSH negative patients. The group with the lowest OCS scores was found to be anti-TG positive, anti-TPO, and anti-TSH negative patients.

Conclusion

: OCS severity could be affected by different thyroid autoantibody profiles in patients with autoimmune thyroid diseases. While anti-TG serves a protective role against OCS in females, the presence of anti-TPO may worsen the OCS in men. Additionally, the co-existence of different antithyroid antibodies may affect the severity of OCS differently according to sex.

Could the Thyroid Gland Dominate the Brain in Obsessive-Compulsive Disorder?

Thyroid hormones have an essential role in brain maturation and neuronal functioning. The comorbidity of thyroid disorders and several mental disturbances is frequently reported. We aimed to evaluate the literature on the potential relationship between thyroid disorders and obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS). We searched the literature using PUBMED, ProQuest, Google Scholar, and PsycInfo electronic databases for original studies (cross-sectional, case series, case report) on the association between thyroid dysfunctions and OCD and OCS between 1977 and 2021. Eleven studies met the inclusion criteria. Despite some methodological limitations, the OCD rates in patients with autoimmune thyroid disorders were found to be higher than the normal population in two studies. The findings on thyroid dysfunction in OCD patients were inconclusive. In the light of available data, it could be proposed that there might be a possible association between thyroid disorders and OCD. Some shared immunological mechanisms could play a role in the pathophysiology of both thyroid diseases and OCD. New research is needed to confirm this association and elucidate the underlying common mechanisms between these disorders.

Interactions between Antidepressants and Warfarin: A Review

Background:

Since warfarin has a very narrow therapeutic index, the interaction between warfarin and antidepressants is very critical and has potentially severe consequences. It is unclear whether clinicians have sufficient knowledge about the risk of bleeding when warfarin and antidepressants are used concomitantly.

Objective:

In this systematic review, we discuss the main considerations when using warfarin with antidepressants.

Methods:

The information about warfarin-antidepressant interactions was obtained from Google Scholar®, PubMed/MEDLINE® and a hand search of the published literature. The following research terms which were systematically combined with each other to find articles: warfarin, anticoagulant, interactions, antidepressant (and each antidepressant name individually), SSRI, SNRI, TCA, MAOI.

Results:

Several possible mechanisms that can cause bleeding when antidepressants and warfarin are used concomitantly, have been discussed. According to the available data, sertraline and citalopram/ escitalopram are safer antidepressants to use with warfarin, whereas fluoxetine and fluvoxamine have a higher interaction potential with warfarin. The remaining antidepressants appear to lie somewhere in between and have little empirical data to guide the clinicians.

Conclusion:

It is recommended that when an antidepressant is prescribed to a patient using warfarin, patient’s international normalized ratio (INR) level should be checked regularly. In this review, the interaction between warfarin and antidepressants, including new ones, were evaluated inclusively and in detail.

Epidemiological Survey and Mspss Scores of 260 Suicide Attempters Presenting to Two Emergency Departments in Turkey

Introduction

The aim of this study was to determine the epidemiological characteristics of suicide attempt cases who were admitted to the emergency departments and to determine their level of social support and related factors by using multidimensional scale of perceived social support (MSPSS).

Methods

This study was conducted simultaneously in two different centres between February 23 and June 31, 2009. Totally 260 suicidal cases who were admitted to the emergency departments were included in the study after obtaining the consents. Related derived data were collected with a questionnaire. The questionnaire determined epidemiological characteristics of suicide attempters by using MSPSS derived data. The data were analysed with percentage, mean, t test, ANOVA, and Scheffe test.

Results

About 70% of all cases were female and 63.1% of them were between 16 and 25 years of age. The main causes leading to suicide attempts were family problems (41.9%), financial problems (11.2%), and peer suicide attempts (5.4%). Drug use was the most common suicide method both in males and females. The MSPSS score was 52.47±17.81 (mean±SD, range=12-84). While being a member of a broken family, being widow/divorced, previously diagnosed mental disorder affected social support scores negatively, being a student or having a high level of education affected scores positively.

Conclusion

Family problems, financial problems, 16-25 age group, female sex, being divorced/widowed, being a member of broken family, chronic physical and psychological problems, and lower level of perceived social support are main characteristics associated with suicide attempts. (Hong Kong j.emerg.med. 2011;18:412-420)

Clinical characteristics and HLA alleles of a family with simultaneously occurring alopecia areata

Alopecia areata (AA) is a T-cell-mediated autoimmune disease resulting in partial or total noncicatricial hair loss. HLA class II antigens are the most important markers that constitute genetic predisposition to AA. Various life events and intense psychological stress may play an important role in triggering AA attacks. We report an unusual case series of 4 family members who had simultaneously occurring active AA lesions. Our aim was to evaluate the clinical and psychiatric features of 4 cases of active AA lesions occurring simultaneously in a family and determine HLA alleles. The clinical and psychological features of all patients were examined. HLA antigen DNA typing was performed by polymerase chain reaction with sequence-specific primers. All patients had typical AA lesions over the scalp and/or beard area. Psychological examinations revealed obsessive-compulsive personality disorder in the proband's parents as well as anxiety and lack of self-confidence in both the proband and his sister. HLA antigen types were not commonly shared with family members. These findings suggest that AA presenting concurrently in members of the same family was not associated with genetic predisposition. Shared psychological disorders and stressful life events might be the major key points in the concurrent presentation of these familial AA cases and development of resistance against treatments.

Factors affecting treatment compliance in patients with bipolar I disorder during prophylaxis: a study from Turkey

OBJECTIVES

Treatment noncompliance is one of the most frequent causes of relapse and recurrence in patients with bipolar I disorder. Treatment compliance among patients with bipolar disorder is affected by individual patients' features, the disease itself, doctor-patient relationships and patients' socio-economic and cultural characteristics. This study aimed to determine the factors affecting treatment compliance during the treatment of bipolar disorder and contribute to current clinical strategies.

METHODS

Data were collected from 78 volunteers with bipolar I disorder in remission; all volunteers were being treated solely with mood stabilisers. Sociodemographic and clinical data were gathered through a semi-structured interview designed by researchers. The Hamilton Depression Rating Scale and the Young Mania Rating Scale were both administered to assess remission of bipolar I disorder, and a self-report scale, the Medication Adherence Rating Scale, was administered to assess medication adherence.

RESULTS

Treatment compliant patients reported that they had received adequate social support and had been sufficiently informed by their physicians about the illness and treatment. Treatment compliant individuals with higher rates of hospitalisations and the results indicate that the number of depressive episodes adversely affects treatment compliance. There was not a statistically significant difference in treatment compliance based on duration of illness, euthymia, time, total number of episodes, age of onset, predominant polarity, drug doses, number of daily medications, frequency of daily medications, or type of mood stabiliser used.

CONCLUSIONS

These results indicate that there are differences between compliant and non-compliant bipolar I disorder patients in terms of adequate social support, information provided by the physician about the illness and treatment, number of depressive episodes and number of hospitalisations.

Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients

The purpose of this study was to examine trait impulsivity in patients with bipolar disorder and explore the possible connections between impulsivity and clinical presentation of the illness. Diagnoses were based on the Structured Clinical Interview for DSM-IV. The sociodemographic and clinical properties of 71 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated by using the Barratt Impulsiveness Scale (BIS) and impulsivity subscale of the Temperament and Character Inventory, and the results were compared with 50 age- and sex-matched healthy controls and among patients with different clinical properties. All BIS-11 subscale scores were higher in bipolar than in comparison subjects. There were no effects of education and age. Elevated BIS-11 scores were associated with predominant depressive polarity, longer duration of illness and a history of psychotic mood episodes and suicide attempts. These relationships persisted when age, gender, and education were taken into account. These results show that after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with bipolar disorder than in nonbipolar comparison subjects and may vary according to different clinical presentations.

The correlation of childhood physical abuse history and later abuse in a group of Turkish population

Domestic violence is passed from one generation to the next, and it affects not only the victim but also the psychological states of the witnesses, and especially the psychosocial development of children. Studies have reported that those who have been the victim of or witnessing violence during their childhood will use violence to a greater extent as adults in their own families. This research examines the relationships between a history of childhood physical abuse, likelihood of psychiatric diagnoses, and potential for being a perpetrator of childhood physical abuse in adulthood among women who received psychiatric treatment and in the healthy population from Turkey. Estimates of the prevalence of childhood physical abuse vary depending on definition and setting. The frequency of witnessing and undergoing physical abuse within the family during childhood is much higher in the psychiatrically disordered group than the healthy controls. Childhood physical abuse history is one of the major risk factors for being an abuser in adulthood. The best indicator of physically abusing one's own children was found to be as physical abuse during the childhood period rather than psychiatric diagnosis. There is a large body of research indicating that adults who have been abused as children are more likely to abuse their own children than adults without this history. This is an important study from the point of view that consequences of violence can span generations. Further studies with different risk factor and populations will help to identify different dimensions of the problem.

The comorbidity of anxiety disorders in bipolar I and bipolar II patients among Turkish population

High rates of anxiety disorders have been reported in bipolar disorders. The study aimed to investigate prevalence of anxiety disorders in remitted bipolar subjects and their influence on the illness severity. Bipolar subjects with anxiety disorders were younger, had earlier age at onset of illness, and were overrepresented by female subjects and those with earlier onset illness compared to those without anxiety disorder. The study demonstrated that (1) anxiety disorders are highly prevalent in bipolar subjects, (2) individual anxiety disorders, particularly SP and PD seem to have an effect on illness severity, (3) bipolar subjects with comorbid anxiety tend to have a poorer course and are less responsive to treatment, and (4) anxiety tends to be associated with an earlier age at onset of bipolar disorder (BPD) and results in a more complicated and severe disease course.

Benefits of switching women schizophrenic patients to aripiprazole: a case study and brief review of the literature

Hyperprolactinemia, an adverse side-effect of the use of typical and some atypical antipsychotics, has both acute and chronic clinical consequences. When observed in schizophrenic patients, it may be treated by switching the patient to an antipsychotic agent with a lower liability for the induction of hyperprolactinemia. The effects of substituting aripiprazole for other antipsychotic agents on schizophrenic patients with antipsychotic-induced hyperprolactinemia have been previously reported in several studies. Many studies have also noted that aripiprazole can sometimes lead to increases in psychotic symptoms, especially in the period immediately following the switch or when aripiprazole is combined with a dopamine antagonist. Here, we report observations on five female patients who were experiencing symptomatic hyperprolactinemia and psychotic exacerbation while on antipsychotic treatment, yet improved in both conditions after being switched to aripiprazole monotherapy. We also provide a brief review of the existing studies that report the results of switching patients from other antipsychotics to aripiprazole.

Aripiprazole-induced rabbit syndrome: a case report

Rabbit syndrome (RS) is a rare side effect of prolonged neuroleptic administration characterised by rapid, fine, rhythmic movements of the mouth along a vertical axis. Long-term exposure to the first generation neuroleptics has clearly been associated with RS, but little is known regarding the risk of RS because of the exposure to the newer atypical antipsychotics. Aripiprazole is a new dopaminergic agent and has been reported to be clinically useful as an antipsychotic drug with reduced extrapyramidal motor side effects. In addition, there are some case reports concerning extrapyramidal side effects, which include tardive dyskinesia, parkinsonism and RS associated with aripiprazole. We present the case of a patient who developed RS during treatment with aripiprazole. Potential mechanisms, including D2 receptor occupancy, low anticholinergic properties and dopamine hypersensitivity theory, are discussed. Although studies with aripiprazole have shown a low liability for extrapyramidal side effects, the present case emphasises the need for caution when treating patients with aripiprazole.

Lamotrigine-induced obsessional symptoms in a patient with bipolar II disorder: a case report

Lamotrigine is an anticonvulsant that appears to have a mainly antidepressant effect and is indicated for the maintenance treatment of bipolar depression. Literature associated with obsessional symptoms related to lamotrigine treatment is limited. We report the emergence of obsessive symptoms during treatment with lamotrigine in a patient who subsequently experienced significant improvement after dose reduction and stopping of this medication. The obsessive symptoms associated with lamotrigine treatment were observed after the lamotrigine dose was increased to 100 mg/day. The possible mechanisms, including inhibition on the presynaptic release of glutamate and alteration of striatal dopamine uptake, are discussed. It is unclear why lamotrigine induces obsessions in some patients. Controlled studies are necessary to identify the population at risk for obsessionality in bipolar illness following treatment with lamotrigine and to investigate a possible dose-response relationship between obsessive symptoms and lamotrigine.