Pregabalin is a novel isomer of gamma-aminobutyric acid that functions as a major inhibitory neurotransmitter in the brain. It is used daily in medical practice for treating neuropathic pain, fibromyalgia, generalized anxiety disorder, and partial seizures. Due to its antiglutamatergic effects, it poses a potential addiction risk. For example, an abrupt discontinuation of this substance may cause patients to exhibit physical withdrawal symptoms, such as insomnia, nausea, headache, and diarrhoea. However, there is no information in the literature that addresses whether the rapid discontinuation of pregabalin can cause psychosis to occur. Here we presented a 20-year-old patient with his first episode of psychosis that was likely attributable to his withdrawal from a high dosage pregabalin. He lacked physical signs of withdrawal; however, a psychiatric examination was conducted. It was determined that the patient was experiencing paranoid ideation, auditory hallucinations, and mutism. Furthermore, he had engaged in self-mutilative actions and had attempted suicide. Due to the short time frame between the rapid discontinuation of a relatively large dose of pregabalin and the onset of the patient's first episode of psychosis, it is likely that the psychotic episode was triggered by the cessation of the medication. This is the first known case of psychosis that was caused by the rapid withdrawal of pregabalin to be discussed in the literature. The results of this clinical case may guide clinicians to recognize the symptoms of acute pregabalin withdrawal. ARTICLE HISTORY

Venlafaxine, which is often used for a number of psychiatric-related conditions such as the treatment of major depression, generalized anxiety disorder, social anxiety disorder and panic disorder, is generally a drug that is well tolerated and safe. The side effects of drugs can cause the treatment to prematurely terminate. Clinicians should prefer appropriate and low side-effects drugs to prevent this. This situation is also especially important for psychiatric patients. Prostatism, which impairs quality of life, is an important medical condition, with clinical and social implications. In the previous studies, prostatism was declared as a side effect of some antidepressant such as milnacipran, duloxetine and reboxetine. In our case, we discussed that venlafaxine-related prostatism developed in a male patient. As far as we know this is the first report of venlafaxine-induced prostatism.ARTICLE HISTORY

INTRODUCTION: Bipolar disorder (BD) and unipolar depression (UD) are complex and multifactorial mental disorders characterized by mood swings, disability, and impaired quality of life. In the present study, we researched the roles of inflammatory cells and their value as inflammation markers in BD and UD. OBJECTIVE: Sixty-nine manic, 60 euthymic, and 70 UD patients and 60 sex-matched healthy volunteers (control group) were retrospectively analysed. Platelet (PLT), platelet distribution width (PDW), and red cell distribution width (RDW) levels were measured in four groups. The aim of this study was to evaluate PLT, PDW, and RDW levels patient with UD and two different phases of BD: euthymic and manic. RESULTS: In our study, 199 patients and 60 controls were included. There were no differences between the patients and the healthy control group participants in terms of age and sex. The bipolar episodes and the UD patient group were statistically significantly different from the healthy controls in terms of PLT, PDW, and RDW. CONCLUSION: Our study is the first in the literature to compare blood PLT, PDW, and RDW levels in bipolar episodes, UD patients, and healthy control groups. We believe that the levels of PLT, PDW, and RDW can be used as novel markers of bipolar episodes and UD. More detailed and larger prospective clinical studies are required to confirm these findings.

Therapeutic single-dose mirtazapine-induced symptomatic bradycardia: a case report Cardiotoxicity is an important adverse effect of some psychotropic drugs. However, cardiac side effects with mirtazapine, which is used for an effective treatment of depression and anxiety, are rare. In this article, a forty-eight-year-old woman referred to psychiatric clinics with depressive symptoms. According to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria, major depressive disorder was diagnosed and mirtazapine 30mg/day was started. 30 minutes after the first dose of mirtazapine was brought to the emergency room with syncope, nausea, vomiting. She was examined in emergency service. Routine blood tests and ECG was studied. During the examination, the patient was followed up with a heart rate of 33 beats per minute, blood pressure arterial 80/50mmHg and a temperature of 36.1°C. 0.5mg atropine IV and theophylline inhaler were administered and cardiology consultation was requested. After atropine and theophylline administration, the heart rate was 48 beats/min in the second ECG. To the best of our knowledge, it is the first bradycardia developed after mirtazapine use in the literature. Bradycardia has been resolved after the half-life of mirtazapine has passed (37 hours for women). The initial heart rate of our patient was within normal limits prior to mirtazapine administration. There was no reason to explain bradycardia, we think that symptomatic bradycardine is caused by mirtazapine. In conclusion, this case report suggests that mirtazapine may cause bradycardia in patients. Risk factors for bradycardia caused by mirtazapine are unknown. Although in many patients this bradycardine does not cause a clinical outcome, clinicians should be aware of this and should perform ECG monitoring in patients with underlying cardiac disease, especially when prescribing mirtazapine.

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.