Investigation of the datas of psychometric measures, opti̇cal coherence tomography results and sociodemographic features of patients followed by the diagnosis of bipolar, in the Adiyaman University Education and Research Hospital psychiatry clinic

In recent years, in order to investigate neuronal degeneration; optical coherence tomography (OCT) has been used in many areas, which is non-invasive, easy to apply and enables reliable and rapid evaluation of the retina. As a result of the researches; some changes have been detected in retinal structures of bipolar disorder (BD) patients according to healthy controls, however; the effects of drugs such as lithium, valproic acid and antipsychotic, which are frequently used in the treatment of bipolar disorder (BD) on optical coherence tomography (OCT) parameters are not yet known. In this study, we aimed to investigate the effects of drugs (lithium, valproic acid and antipsychotic) on OCT parameters of patients diagnosed with bipolar disorder. In addition, the patient group was divided into 3 subgroups according to the regular use of lithium, valproic acid (VPA) and antipsychotic (AP) medication. The sociodemographic data form and psychometric scales obtained from the patient registration system were used. Retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and choroid layer thickness data of both eyes measured with a spectral OCT device were examined. People who were not diagnosed with the disease and who did not use drugs were taken as the healthy control group. SPSS 21 package program was used to evaluate the data and the statistical significance level (p value) was set at 0.05 or below. Considering socio-demographic data; 100 patients (48 women, 52 men) and 50 healthy controls (32 women, 18 men) were included. In drug subgroups, female and male ratios were similar (p> 0.05). The rate of being married was significantly lower, and the percentage of single and widow was higher than the control group (p <0.05). When we look at the drug subgroups, there was no significant difference between them in terms of marital status (p> 0.05). The rate of not working in the patient group was higher than the control group, and we found a significant difference between them (p <0.05). In the occupational evaluation of the patient group in the drug subgroup, we found that the rate of working people who use lithium and antipsychotic is higher than those who use valproic acid and there is a significant difference between them (p <0.05). The education level of the patient group was significantly lower than the control group (p <0.05). In the comparison between patient drug subgroups, no difference was found in terms of educational status (p> 0.05). It was found that the total number of hospitalizations of individuals using lithium, VPA and AP in the drug subgroups was close to each other and there was no significant difference between them. When the drug use time (years) of the individuals using lithium, VPA and AP in the drug subgroups was examined, the drug use time of patients using AP was shorter, while the use of lithium was longer and there was a significant difference between them (p <0.05). When we evaluate the OCT parameters; ın RNFL sub parameters; ıt was found that there were partial thinning in the patient group compared to the control group and even in some subtypes (left N, left NI, right NI, right TS, left TS, right TI, left TI), this thinning was significant (p <0.05). It was found that choroidal thickness measured in both eyes in BD patients without systemic disease increased significantly compared to the control group (p <0.05). In this study, when we compare OCT parameters of drug subgroups; The mean RNFL, RNFL sub parameters, NS, N, NI, TS, T, TI mean values were found to be higher in the right and left eye lithium users than in those using VPA, AP (p <0.05). The GCL thickness was higher in the right and left eye lithium users than in those using VPA and AP and found a significant difference between them (p <0.05). In IPL thickness, it was found that those using lithium in the right and left eyes were higher than those using VPA and AP and there was a significant difference between them (p <0,05). When the choroid layer thickness was examined, no significant difference was found between the drug subgroups (p> 0,05). Although OCT parameter values of smokers in the patient group were lower than non-smokers; There was a significant difference in the right eye T, TI, RNFL mean and left eye T thickness only from the RNFL sub parameters (p <0,05). In the control group, the values of smokers in OCT parameters were lower than those who did not, but; There was no significant difference between them (p> 0,05). The median values of OCT parameters of those using lithium, VPA and AP were lower in the patients who smoked cigarettes in the right-left eye than those who did not smoke. A significant difference was found between the smokers and non-smokers in favor of thinning in the mean and T median of the right-left eye RNFL only in lithium users (p <0,005). When our findings are evaluated in accordance with the literature information; sociodemographic variables were found to be compatible with the literature. In our patients diagnosed with BD; with RNFL mean, some subtypes of RNFL (Left N, left NI, right NI, right TS, left TS, right TI, left TI) were found to be significantly thinner and this situation was interpreted in favor of axonel degeneration in the retinal nerves. Degeneration is more prominent in GCL and IPL, and there are thinning of some sub-parameters in RNFL; shows that this degeneration started in the GCL and IPL regions in the early period. The progressive thinning in RNFL (with the contribution of factors such as disease severity, number of attacks, etc.) suggests that RNFL is also affected by the disease and axonal degeneration has occurred. In other words, it suggests that degeneration in the RNFL can progress as neuronal destruction increases. It was found that choroidal thickness measured in both eyes significantly increased in BD patients compared to the control group. It is thought that the main reason for this situation may be due to the increased inflammatory process involved in BD. When we compare the effects of lithium, VPA and AP on OCT; According to the patients who use lithium using VPA and AP; The mean RNFL, some sub parameters of RNFL, significantly thicker GCL and IPL values were associated with the neuroprotective effect of lithium on the retinal nerves. In our study, it was concluded that, although there was not a significant increase in RNFL, GCL and IPL values in the smoking and control groups, it was concluded that smoking may affect OCT parameters. In addition, the patients who take lithium and smoke have relatively thick RNFL, GCL and IPL values compared to those who use VPA and AP; He suggested that lithium may be an indication that the protective effect of the cigarette on the retinal nerves continues despite its thinning (degenerative) effect on the retinal nerves. Keywords: Bipolar disorder, Lıthıum, Optical coherence tomography, Neurodegeneration, Neuroprotective effect