We examine the effects of metformin on insulin resistance (IR) and mood including in adolescent and adult women with polycystic ovary syndrome (PCOS). This trial was conducted in 19 adolescents (age ≤18 years) and 25 adult (age >18 years) women with PCOS. Anthropometric and measurements including, serum glucose, endocrine panel, and lipid profile were performed at baseline. IR was measured by Homeostasis Model Assessment IR (HOMA-IR). Anxiety and depression were measured by Beck's Anxiety (BAI) and Depression Inventories (BDI-II). All tests were repeated after a 90-day treatment with metformin (1,500 mg/day). The severity of depression and anxiety decreased after 90-day treatment with metformin in women diagnosed with PCOS. The BAI scores were higher in adolescent group while BDI-II scores were higher in the adult group (p = .016). After 90-day metformin treatment, both BDI-II and BAI scores were decreased by 3.3 and 3.4, respectively (p < .001). Indicators of IR and obesity were improved with this therapy. Although the adolescents weighed lower than the adults, baseline HOMA-IR 5.5 ± 1.7 was higher in this group than 4.4 ± 1.2 in the adult women (p =.022). The findings suggest that metformin decrease IR and improve mood both in adolescent and adult women with PCOS.

Objective:To assess the relationships between the dissociative features of FMS and the pain, psychological status, and functional status.Methods:Twenty-seven women with fibromyalgia syndrome (FMS) and 24 controls from the Istanbul Physical Medicine and Rehabilitation Hospital (2013-2015) were included in this cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders Structured Clinical Interview for Axis I Disorders was used to evaluate the participants. A visual analogous scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to assess the levels of pain, quality of sleep and functional and psychological statuses. The Dissociative Experiences Scale (DES) was used to evaluate the dissociative features.Results:The BDI, BAI and DES scores were statistically significantly higher in the cases of FMS. There were remarkable associations between all but 2 of the DES and FIQ scores, while positive correlations were found between the DES and, VAS pain and sleep quality scores. The prevalences of current and lifelong dysthymia, and major depressive disorder; not otherwise specified, common anxiety and somatoform disorders were higher in the cases of FMS.Conclusion:Pain, physical function and emotional status appear to be associated with dissociative features in FMS. Further studies are required to define these relationships and improve treatment.

Factitious disorder is a psychologic problem which may cause symptoms of a disease which is non-compliance with patient physical exam. Some cases of brittle diabetes are because of underlying psychologic disorder such as factitious disorder or Munchausen syndrome. In this paper a 17-years old female is presented with factitious hyperglycemia and DKA-like symptoms such as nausea, vomiting and severe abdominal pain. Finally with subtle monitoring it was found that the cause of patient's hyperglycemia despite high dose insulin prescription was impregnating her finger into the date palm in the context of the factitious disorder. The patient had different deceptive behaviors depending on the method of treatment. She used every trick to mislead the medical team. In Munchausen syndrome, patient is unaware of his problem that mimic an episode of diabetic ketoacidosis. Thus psychotherapy is the main treatment of this factitious hyperglycemia. The main aim of this report is consideration of factitious hyperglycemia in patients with brittle diabetes mellitus.

Objectives: To evaluate the relationships between the serum levels of these parameters and mood disorders, including depression and anxiety. Methods: One hundred and fifty patients)77 with anxiety and 73 with depression), aged 18 to 79 years old, who were referred to the Neuro Psychiatry Clinic of Uskudar University in Istanbul, Turkey were included in this study from June 2018 to December 2018. According to the Beck Anxiety Inventory and Beck Depression Inventory II results, the anxiety patients met the mild and moderate anxiety criteria and the depression patients met the moderate and severe depression criteria, respectively. Venous blood samples were collected after overnight fasting, and the 25)OH)D and thyroid stimulating hormone)TSH) levels were measured. Results: The data showed a significantly higher TSH level in the females when compared to their male counterparts in the severe depression subgroup)p=0.011). Conclusion: A serum TSH evaluation may be considered as a useful biochemical marker for more efficient depression management.

Patients with anxiety spectrum disorders are a highly heterogeneous group, requiring new therapeutic strategies and individualized treatment monitoring. Today, there is a growing interest for implementing biological approaches to clinical practice in psychiatry. Quantitative EEG is an excellent tool in this regard, though it has been widely underestimated when compared to recent neuroimaging techniques. In this case series, we presented four cases with a different diagnosis of anxiety spectrum disorder and evaluated their qEEG changes before and after the treatment. In addition, we also calculated the so-called EEG cordance values as an index of cerebral perfusion and cingulate cortex activity. According to the results, there appears to be an increase in the frontal beta and theta band in our cases, which has responded to treatment. In regards to the cordance values, we found that there was a reduction in the prefrontal regions up to %38 percent following the treatment. Based on previous studies, this may also indirectly suggest reduction in the cingulate cortex activity. The possible implications of these findings were discussed. Taken together, this case series highlighted the potential use of qEEG power values, normative z-scores and cordance values in treatment response monitoring of anxiety spectrum disorders.