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    Affective distress and fibromyalgia
    (2004) Sayar K.; Gulec H.; Topbas M.; Kalyoncu A.
    Principles: Elevated rates of lifetime and current psychiatric disorders, elevations of psychological self-report measures assessing depression, anxiety and hypochondriasis have been reported in fibromyalgia syndrome (FMS) patients as well as studies refuting these findings. Studies comparing FMS patients with rheumatoid arthritis (RA) patients provide discrepant data. The aim of this paper is to compare FMS patients with RA patients and healthy controls with respect to psychological measures in a case control design. Methods: Fifty subjects with FMS, 20 with RA and 42 healthy controls were assessed with respect to anxiety, depression, pain intensity and disability. Three logistical regression models were performed to test whether higher levels of a psychological measure (disability, depression or anxiety) are associated with one disease rather than another, or with one disease rather than with healthy controls. For each regression model, the best exploratory covariates were determined using receiver operating characteristic (ROC) curves. Results: In the logistic regression, anxiety scores were the most important covariate determining the likelihood of having FMS whereas depression scores increased the chances of being an RA patient. Age and disability scores did not differ between FMS and RA. Conclusions: Affective distress is not specific to FMS patients, but the manner in which affective distress is incorporated into the patient's life is worth studying. FMS seems to be associated with anxiety rather than depression.
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    Delirium-associated disulfiram and ethanol interactions
    (Physicians Postgraduate Press Inc., 2005) Mirsal H.; Yalug I.; Tan D.; Stern T.A.; Kalyoncu A.; Pektas O.; Erdogan G.; Beyazyürek M.
    Background: Disulfiram, an agent used for the treatment of alcohol dependence, can exacerbate psychiatric syndromes (including psychosis, catatonia, delirium, depression, and mania) after extended use. However, delirium has yet to be reported following the short-term use of disulfiram in the setting of alcohol use. Objectives: We report a case with a neuropsychiatric presentation and discuss the prevention and the progression of delirium associated with an interaction of disulfiram and ethanol. Case Report: We report the case of a 51-year-old woman who developed disorganized speech, diminished communication, a decrease in appetite, and thoughts of suicide 10 days after she began taking disulfiram (250 mg/day), to which she added 1 glass of alcoholic beverage for 2 days. Delirium developed in association with an interaction between disulfiram and alcohol. The patient met DSM-IV criteria for major depressive disorder, alcohol dependence, and delirium. Discussion: Neuropsychiatric manifestations may develop in association with co-administration of disulfiram and alcohol; timely recognition and treatment are recommended. © Copyright 2005 Physicians Postgraduate Press, Inc.
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    Olanzapine augmentation in elderly patients with treatment-resistant major depression: An open trial [Tedaviye dirençli majör depresyonu olan yaşli hastalarda olanzapin ekleme tedavisi: Bir açik çalişma]
    (2003) Mirsal H.; Kalyoncu A.; Pektaş Ö.; Tan D.; Beyazyürek M.
    Objective: Multiple therapeutic approaches are available for the treatment of patients who are not responding to standard antidepressant medications. One of them is drug augmentation. The effectiveness of olanzapine augmentation treatment for refractory or treatment-resistant major depression in patients over 60 years of age was studied. Methods: An 6-week open label study was conducted in 23 patients with recurrent major depression without psychotic features. The refractory or treatment-resistant depression was defined retrospectively by history of failure to respond to antidepressants at an acceptable therapeutic doses and duration and, patients were required to score >20 on the 17-item Hamilton Depression Rating Scale (HDRS). Subjects were assigned to two phases of treatment; optimization with antidepressant monotherapy at two weeks, and then augmentation with olanzapine (10mg/day). Results: The study subjects were 15 female patients (65.2%), 8 male patients (34.8%). The mean age of the study group was 65.5 years (SD=5.6). The mean HDRS score before and after optimization was 25.6 (SD=3.1) and 25.2 (SD=5.6), respectively. The mean HDRS score at the end of one week of olanzapine augmentation treatment was 15.8 (SD=1.9), at the end of 4 weeks 12.6 (SD=2.1) and at the end of 6 weeks 11.3 (SD=2.7). The differences between the means were statistically significant (p<0.001). HDRS scores for 65.2% of patients (n=15) at the end of 6 weeks of olanzapine augmentation treatment decreased more than 50%. Conclusions: Olanzapine plus standart antidepressant treatment demonstrated superior efficacy for treating refractory or treatment-resistant depression in over 60 age patients.