Public opinions and beliefs about the treatment of depression in urban Turkey

Background Although attitudes towards psychiatric illness influence its presentation, detection, recognition, treatment adherence and rehabilitation, the lay public's opinions and beliefs about the treatment of depression have not been investigated sufficiently. Objective The aim of this study was to determine public opinions and beliefs about the treatment of depression and the influence of perception and causal attributions on attitudes towards treatment of depression in urban areas. Methods This study was carried out with a representative sample in Istanbul, which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of 32 items rating attitudes towards depression. Results The public believes that psychological and social interventions are more effective than pharmacotherapy, and that the medicines used in treatment of depression are harmful and addictive. There was a general reluctance to consult a physician for depression, and psychiatrists were felt to be more helpful than general practitioners. The public viewed depression as treatable. A high educational level and perceiving depression as a disease is associated with positive beliefs and opinions about the treatment of depression; but the perception of depressive patients as aggressive is associated with negative beliefs and opinions about the treatment of depression. Conclusion The beliefs that “psychological and social interventions are more effective than pharmacotherapy” and “antidepressants are harmful and addictive” must specifically be taken into account in clinical practice and in anti-stigma campaigns. Additional studies are needed to understand the public's tendency to conceptualise depression as a psychosocial problem. In clinical practice, depression should be introduced as a bio-psychosocial disease whatever its cause: biological, psychological or social. In addition, the differences between extreme worry and disease, and the lack of aggressiveness of depressive patients, must be emphasised.     

Controlled sleep restriction for rhythmic movement disorder

Rhythmic movement disorder is a parasomnia that is difficult to treat. In our study, 3 weeks of controlled sleep restriction with hypnotic administration in the first week resulted in almost complete resolution of the movements in 6 children. This therapeutic success suggests that rhythmic movement disorder results from a voluntary self-soothing behavior.     

Effectiveness of the Oka/GSK attenuated varicella vaccine for the prevention of chickenpox in clinical practice in Israel

BACKGROUND: The varicella Oka/Merck vaccine has been shown to be very effective in clinical practice; however, several recent studies reported reduced effectiveness. The varicella Oka/GSK vaccine (Varilrix; GlaxoSmithKline Biologicals), which has been subjected to fewer effectiveness studies, was licensed in Israel for voluntary use in 2000. This study was planned to estimate the effectiveness of the varicella Oka/GSK vaccine among children 1-5 years of age. METHODS: Recent reports of varicella were retrieved from the Tel Aviv Health District. Two age-matched control subjects who attended the same day-care center and/or resided in the same neighborhood and had not contracted varicella in the past were recruited for each varicella case. The parents of case and control subjects were interviewed regarding the history of varicella vaccination and the severity of illness. RESULTS: A total of 151 case subjects (mean age, 2.9 +/-1.1 years) and 298 control subjects (mean age, 3.0 +/-1.1 years) were recruited. Vaccination rates for case and control subjects were 6.6% and 38.3%, respectively (P < 0.001). Disease among vaccinated children was significantly milder, as measured by several indices, including parental perception of the illness, presence of fever, time until the lesions dried and days of day care missed. Vaccine effectiveness against varicella of any severity with these figures was 88% (95% confidence interval, 77-94%), and effectiveness against moderate/severe illness was 100%. CONCLUSIONS: Our data demonstrate that the varicella Oka/GSK vaccine used in clinical practice is highly effective in prevention of varicella (especially moderate/severe disease) among children, including those attending day-care centers.     

Rasagiline: neurodegeneration, neuroprotection, and mitochondrial permeability transition

Mitochondria are involved directly in cell survival and death. The assumption has been made that drugs that protect mitochondrial viability and prevent apoptotic cascade-induced mitochondrial permeability transition pore (MPTp) opening will be cytoprotective. Rasagiline (N-propargyl-1R-aminoindan) is a novel, highly potent irreversible monoamine oxidase (MAO) B inhibitor anti-Parkinson drug. Unlike selegiline, it is not derived from amphetamine, and is not metabolized to neurotoxic L-methamphetamine derivative. In addition, it does not have sympathomimetic activity. Rasagiline is effective as monotherapy or adjunct to levodopa for patients with early and late Parkinson's disease (PD) and adverse events do not occur with greater frequency in subjects receiving rasagiline than in those on placebo. Phase III controlled studies indicate that it might have a disease-modifying effect in PD that may be related to its neuroprotective activity. Its S isomer, TVP1022, is more than 1,000 times less potent as an MAO inhibitor. Both drugs, however, have neuroprotective activity in neuronal cell cultures in response to various neurotoxins, and in vivo in response to global ischemia, neurotrauma, head injury, anoxia, etc., indicating that MAO inhibition is not a prerequisite for neuroprotection. Their neuroprotective effect has been demonstrated to be associated directly with the propargylamine moiety, which protects mitochondrial viability and MTPp by activating Bcl-2 and protein kinase C (PKC) and by downregulating the proapoptotic FAS and Bax protein families. Rasagiline and its derivatives also process amyloid precursor protein (APP) to the neuroprotective, neurotrophic, soluble APP alpha (sAPPalpha) by PKC- and MAP kinase-dependent activation of alpha-secretase. The identification of the propargylamine moiety as the neuroprotective component of rasagiline has led us to development of novel bifunctional anti-Alzheimer drugs (ladostigil) possessing cholinesterase and brain-selective MAO inhibitory activity and a similar neuroprotective mechanism of action.     

Postnatal phenotype and localization of spinal cord V1 derived interneurons

Developmental studies identified four classes (V0, V1, V2, V3) of embryonic interneurons in the ventral spinal cord. Very little is known, however, about their adult phenotypes. Therefore, we characterized the location, neurotransmitter phenotype, calcium-buffering protein expression, and axon distributions of V1-derived neurons in the adult mouse spinal cord. In the mature (P20 and older) spinal cord, most V1-derived neurons are located in lateral LVII and in LIX, few in medial LVII, and none in LVIII. Approximately 40% express calbindin and/or parvalbumin, while few express calretinin. Of seven groups of ventral interneurons identified according to calcium-buffering protein expression, two groups (1 and 4) correspond with V1-derived neurons. Group 1 are Renshaw cells and intensely express calbindin and coexpress parvalbumin and calretinin. They represent 9% of the V1 population. Group 4 express only parvalbumin and represent 27% of V1-derived neurons. V1-derived Group 4 neurons receive contacts from primary sensory afferents and are therefore proprioceptive interneurons. The most ventral neurons in this group receive convergent calbindin-IR Renshaw cell inputs. This subgroup resembles Ia inhibitory interneurons (IaINs) and represents 13% of V1-derived neurons. Adult V1-interneuron axons target LIX and LVII and some enter the deep dorsal horn. V1 axons do not cross the midline. V1-derived axonal varicosities were mostly (>80%) glycinergic and a third were GABAergic. None were glutamatergic or cholinergic. In summary, V1 interneurons develop into ipsilaterally projecting, inhibitory interneurons that include Renshaw cells, Ia inhibitory interneurons, and other unidentified proprioceptive interneurons.     

Stress-related responses after 3 years of exposure to terror in Israel: are ideological-religious factors associated with resilience?

BACKGROUND: The inhabitants of 3 different types of population centers in Israel were assessed as to stress-related symptomatology during 2003 and 2004. These centers have been exposed to 2 distinct forms of violence-sporadic, large-scale terror attacks in the metropolitan areas in the heart of Israel and daily "war-zone" conditions in the settlements beyond the 1967 borders of Israel. METHOD: A semistructured interview and questionnaire survey of a random sample of 314 inhabitants of a suburb of Tel-Aviv, a settlement in the West Bank (Kiryat-Arba), and the Gush-Katif settlement cluster in the Gaza Strip was performed. Symptoms of acute stress and chronic (posttraumatic) stress as well as symptoms of general psychopathology and distress were assessed. RESULTS: The inhabitants of Gush-Katif, in spite of firsthand daily exposure to violent attacks, reported the fewest and least severe symptoms of stress-related complaints, the least sense of personal threat, and the highest level of functioning of all 3 samples. The most severely symptomatic and functionally compromised were the inhabitants of the Tel-Aviv suburb, who were the least frequently and least directly affected by exposure to violent attacks. Because the Gush-Katif population is exclusively religious, the data were reassessed according to religiousness. The religious inhabitants of Kiryat-Arba had almost the same symptom profile as the Gush-Katif population, whereas secular inhabitants of Kiryat-Arba reported faring worse than did either population in the Tel-Aviv suburb. CONCLUSION: Deeply held belief systems affecting life-views may impart significant resilience to developing stress-related problems, even under extreme conditions. Religiousness combined with common ideological convictions and social cohesion was associated with substantial resilience as compared to a secular metropolitan urban population.     

Human embryonic stem cells as a model for early human development

Although, the study of human development--from fertilized egg to mature embryo--is extremely important, the early differentiation of human tissues remains an enigma. Moreover, the relatively high percentage of unexplained pregnancy loss--a major concern of human embryologists and gynaecologists--emphasizes the need for an appropriate model for studying early human development. The availability of human pluripotent stem cells might allow us to study previously inaccessible basic processes that occur during human embryogenesis, such as gastrulation and organogenesis.     

Oncocytic parathyroid adenoma: problem in cytological diagnosis

Parathyroid lesions, which may occur within the thyroid, may clinically simulate thyroid nodules. Fine-needle aspiration (FNA) of these presumably "thyroid nodules" can lead to misinterpretation of cytomorphological findings because of similarities in cytological features of neoplastic and nonneoplastic parathyroid and thyroid lesions. This might be true especially for oncocytic parathyroid adenomas and parathyroid adenomas with prominent oncocytic component that, although rare, tend to be large and often are associated with minimal hyperparathyroidism. We report two cases of this type of clinically "silent" parathyroid adenomas that on FNA were diagnosed as Hurthle cell thyroid neoplasm.