Choroidal fissure cyst (CFC), an intracranial space-occupying mass, is often incidentally identified and generally regarded not to present with overt clinical signs. The concurrence of space-occupying lesions with psychotic disorders have been reported in numerous cases; however, to the best of our knowledge, co-occurrent CFC and schizophrenia have not been published before in the literature. Electroconvulsive therapy (ECT) has been frequently considered relatively contraindicated in patients with spaceoccupying lesions in the brain; nevertheless, in the last few years, increased numbers of studies encourage clinicians to treat drugresistant psychiatric patients with ECT. Here we present 21-year-old male patient, who has been diagnosed with antipsychoticresistant schizophrenia with a coincidental CFC who have been clinically improved by bilateral and modified nine sessions of ECT. It is recommended to be deliberate if ECT will be applied to the patients with intracranial mass on the treatment phase. ECT may cause some side effects by increasing intracranial pressure on the patients, including rupture of cystic lesions. However, recent publications stated that ECT could be used safely in cysts, which do not cause edema or intracranial pressure increase. Our patient has not been presented any intracranial pressure signs nor neurological deficits. This report supports the safety and efficacy of ECT in the treatment of psychiatric disorders accompanied by intracranial structural lesions; nevertheless, all the risks ought to be taken into account cautiously when ECT becomes an issue for the psychiatric patients with intracranial mass and the opinion of neurosurgeons should be taken with calculating the benefit-loss ratio.

Diabetes Mellitus (DM) is chronic, metabolic disease characterized by hyperglycemia. It has been widely observed that large proportion of patients show psychological resistance to the initiation of insulin treatment, and as a result they are exposed to many complications of diabetes. It was aimed to identify the perceptions and beliefs that cause psychological insulin resistance among Type 2 DM diagnosed patients, to determine relationship between sociodemographic data and these perceptions & beliefs. In research, 120 patients diagnosed with type 2 DM were included followed by outpatient clinic of Bursa Þevket Yýlmaz State Hospital Internal Medicine Unit. Patients were evaluated with socio-demographic information form, diabetes-related problem areas scale (PAID), insulin treatment assessment scale (ITAS), state and trait anxiety inventory (STAI), beck depression inventory (BDI). The average PAID score of patients is 63.75±13.88, BDI scores: 15.16±8.25, State Anxiety Inventory (SAI) subscale scores: 41.96±3.74, Trait Anxiety Inventory (TAI) subscale scores: 46.80±5.52. Correlation was found between age, duration of diabetes, sex, marital status, education level, employment status, type of treatment, the level of importance of blood sugar regulation, the difficulty level of blood glucose adjustment,complications, currently treatment for depression and certain items of ITAS. Similarly, relationship was found between certain items of ITAS and total PAID scores, SAI subscale scores, TAI subscalescores. As a result, it has been found that patients have psychological resistant to start insulin therapy and this is caused by large number of negative perceptions and thoughts. Cognitive interventions for perceptions and thoughts can reduce psychological resistance to insulin therapy.

The importance of gender on phenomenology and course of bipolar illness has been an increased focus of study over recent years. The purpose of present study was to examine whether gender differences exist in the sociodemographic characterictics, age of onset, severity of disease, number & type of episodes, symptomatology and treatment response of bipolar disorder. The life charts of 300 (193 female; 107 male) patients with BD type-I were evaluated retrospectively. BD diagnosis of patients was given by two experienced clinicians in accordance with DSM-IV-TR criteria. A semi-structured chart which was developed to assess sociodemographic and clinical features of patients and “mirror design” method was utilized for the assessment of patients’ response patterns to maintenance treatment. Bipolar women were significantly more likely to have history of (at least one) any mood episode than bipolar men. However no significant gender differences emerged in number of manic or mix episodes; whereas, women had more depressive episodes. Frequency of psychotic episodes (at least one episode during lifetime) was higher for men than women.. There was also no significant gender difference in terms of response to lithium and anticonvulsant maintenance treatment, mean episode severity and age of onset. The results of the present study show that some gender differences may be evident in patients with BD-I. In the highlight of that investigators studying bipolar disorder may need to consider gender as a variable for assessment and treatment strategies.

Peripheric edema could be caused by various medical conditions as well as pharmacologic agents such as antihypertensives, nonsteroidal antiinflamatory drugs, endocrine agents and immunotherapies. Olanzapine is an atypical antipsychotic that is widely prescribed for the treatment of schizophrenia and bipolar affective disorder. Most common adverse reactions of olanzapine are weight gain, postural hypotension, constipation, dizziness, akathisia, sedation. Peripheral edema was reported as an infrequent side effect, which affected 3% of the olanzapine treated patients. In this report, we aim to draw attention of psychiatrists on this rare adverse effect by presenting a 56-year-old case, who applied to our hospital with severe depressive and obsessive-compulsive symptoms and hospitalized because of suicide risk. Before psychiatric admission, he wasn’t taking any medication. He was diagnosed as major depression with psychotic features and obsessive-compulsive disorder. He was started on olanzapine 10 mg/day, quetiapine 300 mg/day and fluoxetine 40 mg/day. Two weeks after initiation of olanzapine, he was found to have bilateral pedal edema without ulceration and temperature change but minimal redness was observed. He had no history suggestive of cardiac, renal and liver dysfunction or allergic reaction against to any drug that could explain his existing edema. Possible medical conditions which may cause edema were ruled out by laboratory tests and physical examination. Olanzapine was stopped immediately and the therapy was modified to risperidone 1 mg/day. After discontinuation of olanzapine, edema was gradually resolved within two weeks. Because olanzapine associated edema has been seen rarely, it could be overlooked by psychiatrists in comparison to its more common side effects. Although it shows self-limited and benign course, patients may feel discomfort and their compliance to treatment may decrease. Also, it may interfere with differential diagnosis of other medical conditions which may cause edema. In conclusion, we suggest that patients should be observed carefully for edema during olanzapine treatment.