Turk Psikiyatri Dergisi最新文献

Clozapine is an important treatment option in patients with treatmentresistant schizophrenia and bipolar disorder. Clozapine has multiple systemic side effects with myocarditis and cardiomyopathy being considered as serious cardiovascular outcomes. Although the aetiology of myocarditis is still unknown, its frequent occurrence in the early stages of clozapine use suggests that type 1 drug hypersensivity may underlie. Although rare, the cardiovascular side effects can be lifethreatening and must be recognized and treated promptly. The nonspecific clinical presentation of these conditions makes risk evaluation and identification of the affected patients difficult. A consensus has not yet been formed on following up the patients without the suspected clinical cardiac symptoms. In this article we presented two cases of myocarditis associated with clozapine. We aimed to emphasize that C-Reactive Protein and troponin monitoring, in accordance with the current clozapine guidelines, was practical and useful for early detection of myocarditis in asymptomatic patients. We also wanted to draw attention to the factors that may increase the cardiovascular risk such as polypharmacy and concomitant use of lithium and valproate with clozapine.

Objective: The Observable Social Cognition-A Rating Scale (OSCARS) is an eight-item, interview-based psychometric tool that was developed by Healey et al. (2015) for evaluating social cognition with respect to the theory of mind, emotion perception, and attributional style in schizophrenia. The aim of this study is to determine the validity and reliability of the Turkish version of the scale.

Method: The study was conducted with 50 patients with schizophrenia and schizoaffective disorder and 50 relatives of these patients using the OSCARS, the Face Emotion Discrimination/Identification Test (FEDT/FEIT), the Positive and Negative Symptoms Scale (PANSS), the Global Assessment of Functioning (GAF) and the Dokuz Eylül Theory of Mind Index (DEZIKO). The validity of the OSCARS was assessed by exploratory factor analysis and concurrent validity analysis, the reliability was demonstrated by the internal consistency coefficient, item-total item correlation, and test-retest comparisons.

Results: The Cronbach's alpha coefficient of the OSCARS-TR was 0.83. Explanatory factor analysis yielded a 2-factor structure explaining 64.2% of the total variance of the scale. The total score of the OSCARSTR correlated significantly with the DEZIKO (r=-0.49), the GAF (r=- 0.50), the PANSS (r=0.54) and the FEDT (r=-0.29) total scores but not with the FEIT scores. The total scores of the OSCARS-TR completed by the patients and by the relatives of the patients correlated with statistical significance (r=0.93). The test-retest reliability coefficient of OSCARS-TR was 0.95.

Conclusion: The results demonstrated the validity and the reliability of the OSCARS-TR. The scale can be easily implemented on an interview basis as an appropriate tool for evaluating social cognition.

Avoidant/Restrictive food intake disorder (ARFID) is a diagnostic category that is included in the DSM 5 (American Psychiatric Association- APA 2013) and proposed by the ICD11 (The World Health Organisation-WHO 2019). Very few ARFID cases have been reported to date. This report aims to present the case of a 25-year-old female who was diagnosed with ARFID and thereby to discuss the challenges in diagnosing and managing the case.

Objective: Clozapine is considered to be a gold standard antipsychotic in treatment resistant schizophrenia. This study aims to investigate clozapine augmentation METHODS utilized in schizophrenia and compare the sociodemographic characteristics, clinical features and remission states of patients whose treatments are augmented and not.

Method: This study included 122 outpatients diagnosed with DSMIV schizophrenia. Patients were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, Positive and Negative Syndrome Scale, Clinical Global Impression Scale, Global Assessment of Functioning, Calgary Depression Scale for Schizophrenia, Panic Agoraphobia Scale, Yale-Brown Obsessive Compulsive Scale and the World Health Organization Disability Assessment Schedule II. The remission state of the patients was assessed utilizing the Remission in Schizophrenia Working Group criteria for schizophrenia.

Results: Combined antipsychotic drug use was the most prevalent method utilized for clozapine augmentation. Patients on augmentation treatment were on higher daily clozapine doses and their remission rates were lower. In addition, the severity of psychopathology related with schizophrenia and comorbid symptoms, the level of functioning and disability were worse in this particular patient group. History of antipsychotic combination use prior to clozapine was found to predict the future use of clozapine augmentation.

Conclusion: Adding a second antipsychotic seems to be the most common method of augmenting clozapine treatment in schizophrenia. The group of patients whose clozapine treatment is augmented appears to represent a "more difficult to treat" patient group before clozapine is initiated.

Objective: The aim of the study was to explore the mortality rate and the associated risks factors in patients with schizophrenia during a10- year follow up period.

Method: We searched the records of patients with schizophrenia receiving treatment as outpatients and/or inpatients in the psychiatric clinic of a university hospital between 2004 and 2008 and determine the survival of these patients by the end of 2018. The results were compared with the all cause mortality rate in the general population during the same period. Also, the risk factors affecting the mortality rate among the patients were investigated.

Results: Out of a total of 626 registered patients 506 were included in the study. The mortality rate within 10 years was found to be 10.6%, with a mean age of 53.1 years at the time of death. The overall expected life expectancy was 73.4 years; varying between 66.6 years among the males and 77.6 years among the females; and 64.7 and 76.5 years among smokers and non-smokers, respectively. The overall standardized mortality rate (SMR) was 3.7, being 3.9 among the males and 3.3 among the females. The risk factors that were associated with the death were old age, male gender, smoking, not working, and early age of disease onset.

Conclusion: Smoking is a significant risk factor for mortality. Giving priority to programs for stopping smoking, and supporting rehabilitation services that enables patients to get involved in could help reducing the mortality risk.

Objective: In this study, we aimed to investigate whether there is a fast decay in the iconic memory of patients with Obsessive Compulsive Disorder (OCD) compared to healthy individuals by taking into consideration the clinical OCD subtypes.

Method: The study included 74 patients diagnosed with OCD on the basis of the DSM 5 criteria and 63 healthy individuals. The OCD patients were grouped as washers, checkers, both washers and checkers, and non-washers and non-checkers. All participants took a partial report test (PRT) to compare iconic memory performance between the healthy control group and the OCD group as a whole and in OCD subgroups.

Results: Loss of iconic memory did not differ between OCD group and the controls. The iconic memory scores, expressed as the d' values, at specified time points correlated negatively with age and positively with education duration in all groups. When the subgroup data were analyzed by controlling for age, the d1'value showing formation of iconic information was lower in the washers subgroup in comparison to the checkers subgroup and the nonwashers and non-checkers subgroup. The d7' value was also lower in the washers subgroup than in the the non-washers and non-checkers subgroup and the healthy control group. The iconic decay rate of the washers subgroup between the time points d6' and d7' was significantly higher in comparison to the healthy control group. The scores of OCD patients on the washing subscale of the Maudsley Obsessive Compulsive Inventory (MOCI) showed negative correlations with the iconic memory scores at all time points.

Conclusion: This study showed that washer OCD patients may have impaired iconic formation and fast iconic decay, which could significantly affect the amount of information transferred to visual memory.

Biological, genetic and psychosocial factors may play a role in the aetiology of bipolar mood disorder (BPD). BPD episodes might be triggered by isotretinoin, a retinoid derivative of vitamin A with a role in cellular proliferation and differentiation. Due to its association with depression, suicidal ideation and suicide attempts, American Food and Drug Administration (FDA) issued a placement of a label warning for isotretionin. Personal or family history of psychiatric disorders was emphasized in the literature for the risk of mood episodes following isotretionin treatment. Here we aim to present the case of an 18- year old young male adult, without personal or family history of a psychiatric disorder, who developed psychotic mania within the first week of isoretinoin which was prescribed for acne vulgaris. Psychotic mania symptoms receded within one week after starting olanzapine (10 mg/day). We believe this case is significant in demonstrating the occurence of a manic episode after isoretinoin in individuals lacking a personal or family history of psychiatric diagnoses.

Objective: This review article discusses the multi-dimensional and complex pattern of filicide from a psychodynamic perspective with reference to the recent publications. Creating awareness to filicide among professionals will help to the correct assessment of the cases, recognition of and intervention on filicide before the act, and the development of preventive mechanisms.

Method: Published articles between January 1960 and March 2020 were searched using the keywords 'filicide, infanticide, neonaticide, mother/ parent/ maternal/ paternal, psychodynamics' in the Google Scholar, EBSCHO-HOST, Science-Direct, PubMed and Web of Science databases.

Results: The term filicide refers to the murder of the offspring by the parent. Although it is a common belief that the children are murdered boy strangers, the reported figures may not be representing the truth. No families are detected in one fourth of all murdered infants within the first 24 hours. The death of abondoned children are classified as 'due to natural causes'. Some murders might not be reported properly and therefore, actual murders by own parents might have been missed on the records. It is known that filicide is a heterogeneous phenomenon requiring a multidimensional evaluation in being affected by cultural values, belief systems of the society as well as the bio-psycho-social and developmental variables. It is reported in the literature that filicide cases have a common profile and that training clinicians on this complex phenomenon would be effective on prevention strategies.

Conclusion: The concept of filicide is controversial in many aspects and mental health professionals tend to distance themselves since the concept is associated with 'crime'. However it is crucial to elucidate the psychodinamic background on violence and discuss the risk factors, triggers, background dynamics and psychopathologies underlying this phenomenon.