It is known that especially glomerular side effects of lithium lead to serious consequences such as end-stage renal disease. Therefore, it is critical to evaluate patients on long-term lithium therapy for glomerular pathologies. The present study investigated the changes in renal functions, prevalence of renal failure and progress in patients have been followed up for at least six years with bipolar disorders (BD) and on regular lithium treatment. 51 patients with BD and 38 age and sex matched healthy controls were enrolled for the study. The serum blood urea nitrogen (BUN), creatinine, uric acid, electrolytes, calcium (Ca), phosphorus (P), vitamin D (25-OH D3), parathyroid hormone (PTH) and eGFR levels were measured to compare the kidney functions of patients and control group. The relation between the renal functions and mean serum lithium levels and duration of lithium treatment were also investigated. Mean eGFR level, 25-OH D3 and urine density of patients with were significantly lower whereas creatinine, uric acid, Ca and PTH were significantly higher than that of controls.. The duration of lithium treatment and mean lithium levels were negatively correlated with eGFR level. Eight of 51 patients have critical eGFR level as lover than 60ml/minute thus further nephrological investigation was needed. The study revealed that the renal functions of the patient group was significantly lower than controls. The findings suggested that both duration of lithium treatment and high serum lithium levels may have a negative impact on renal functions. These findings suggest that it is important to clarify the response type to lithium in patients who are on long term treatment with lithium and maintain the treatment with the lowest possible therapeutic serum levels and carefully monitoring the renal functions in patients with good response to lithium.
Objective Retinal structural changes which were investigated by optical coherence tomography (OCT) have been reported in schizophrenia. Since cognitive dysfunction is a core feature of schizophrenia, the correlations between retinal findings and cognitive functions of patients and their healthy siblings may provide insight into the pathophysiological processes of the disorder. We aimed to investigate the relationship between neuropsychiatric tests and retinal changes in schizophrenia patients and their healthy siblings.Methods We measured OCT parameters and cognitive performance (via Trail Making Tests, verbal fluency tests, and The Digit Span Tests) of 72 participants (36 patients with schizophrenia and 36 healthy siblings) and disease severity (with Positive and Negative Syndrome Scale, Global Assessment of Functioning, and Clinical Global Impression scales) in patients with schizophrenia and evaluated the relationship between retinal findings and clinical parameters, especially neurocognitive tests.Results We found decreased ganglion cell layer-inner plexiform layer thickness and macular volume in the patient group. There were strong correlations between neurocognitive tests and OCT findings in both groups. On the other hand, there was not any correlation between retinal findings and disease parameters.Conclusion The cognitive symptoms of schizophrenia may be more closely related to structural changes in the retina.
Amaç: Son yıllarda sayıları giderek artan toplum ruh sağlığı merkezleri, şizofreni başta olmak üzere ağır psikiyatrik hastalıkların tedavi ve rehabilitasyonunda önemli bir konumda bulunmaktadır. Hasta bireylerin yanında ailelere de destek sunan bu merkezlerde bakımevinde yaşayan hastalar da izlenmektedir. Araştırmamızda, aynı toplum ruh sağlığı merkezinden takipli psikoz hastalarının bakımevi ve evde yaşama durumlarına göre sosyodemografik ve klinik özelliklerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Sultanbeyli Toplum Ruh Sağlığı Merkezi’nden takipli 62’si evde 79’u bakımevinde yaşamakta olan 141 psikoz hastası dâhil edilmiştir. Düzenli takibi olan hastaların tıbbi kayıtları geriye dönük olarak incelendi ve bu veriler formlara kaydedilerek gruplar arasındaki farklar istatistiksel yöntemlerle araştırıldı. Bulgular: Çalışmaya 47’si (%33.3) kadın 94’ü erkek (%66.6) olmak üzere 141 psikoz hastası dâhil edilmiştir. Katılımcıların ortalama yaşı 43.76±13.76 olarak saptandı. Klinik Global İzlenim Şiddet Ölçeği puanları bakımevinde yaşayanlarda ortalama 5.07±0.75, evde yaşayanlarda ortalama 4.61±0.79 olarak saptandı (p=0.002). İşlevselliğin Global Değerlendirmesi puanları bakımevi grubunda ortalama 43.60±12.98, evde yaşayanlarda ortalama 54.91±12.42 idi. Hastane yatış (p=0.005) ve EKT sayıları (p=0.013) bakımevinde yaşayanlarda anlamlı derecede yüksek saptandı. Toplam psikotrop ve antipsikotik ilaç sayısı, depo enjeksiyon ve klozapin kullanımı açısından iki grup arasında fark saptanmadı. Sonuç: Bakımevinde kalan hastaların hastalık şiddeti daha yüksek görünmekle birlikte ilaç kullanım özellikleri evde kalan hastalarla benzerdi. Çoklu antipsikotik ilaç kullanımı, sınırlı literatür desteğine rağmen oldukça yüksek görünmektedir. Klozapin kullanım oranlarının düşüklüğü, bu tedaviye geçiş konusundaki zorlukları ortaya koymaktadır. Hastalara daha düzenli takip imkanı sunan toplum ruh sağlığı merkezlerinde ilaç tedavileri konusunda tedavi algoritmalarının önerileri ışığında yeni düzenlemelerin yapılması uygun görünmektedir.
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