Turk Psikiyatri Dergisi最新文献

In recent years we have witnessed a rebirth of interest in the field of subjectivity and its disorders, particularly the severity and quality of non-psychotic abnormal subjective experience. Contemporary research on abnormal subjective experiences in schizophrenia has used several different theoretical frameworks. The most common of these is the phenomenological approach. A prominent example of the phenomenological approach is the minimal self disorder model. In this article, we will discuss, prominent theories on the concept of 'self ', historical background of the minimal self disorder model in schizophrenia and the current approach to this model. According to this model, self disorders have been hypothesized to be an underlying and trait-like core feature of schizophrenia. The model suggests that this minimal self is disturbed in three ways in people with schizophrenia: hyperreflexivity, diminished self-affection (diminished self-presence) and disturbed grip or hold on the cognitive-perceptual world. Hyperreflexivity is defined as the excessive attention to processes that would ordinarily be implicitly experienced. Diminished self-affection (diminished self-presence) refers to an experience of a loss of self-agency. Disturbed grip or hold on the cognitive-perceptual world refers to the disturbances of spatio-temporal structuring of the experiential field. These three aspects are intimately interlinked, and should be understood more as the components of a single entity. Finally, clinical symptoms that may indicate minimal self disorder and the abnormal self experiences of two patients with a diagnosis of schizophrenia are discussed. Keywords: Schizophrenia, phenomenology, self-disorders, hyperreflexivity, diminished self-affection.

In this review, it is aimed to discuss neuropsychiatric symptoms as prodromal symptoms of dementia syndromes, to define the concept of 'Mild Behavioral Impairment', and to introduce the 'Mild Behavioral Impairment Checklist'. Neuropsychiatric symptoms (NPS) represent non-cognitive symptoms and behaviors in dementia patients. The frequency of NPS accompanying dementia increases as the disease progresses. Studies reveal that NPS are seen in patients with dementia as well as in the elderly without cognitive complaints, individuals with subjective cognitive complaints, and individuals diagnosed with mild cognitive impairment. Based on these findings, identifying and detecting these symptoms were thought to be useful in predicting the development of dementia in cases where cognitive symptoms have not yet appeared. 'Mild Behavioral Impairment' was first defined by Taragano and Allegri, and it was introduced as a concept that includes neurobehavioral symptoms seen in elderly people for at least 6 months and that do not meet the diagnostic criteria of any other psychiatric syndrome. Mild Behavioral Impairment Checklist (MBI-C) has been developed recently which consists of 34 questions including apathy, mood, impulse dyscontrol, social inappropriateness, abnormal thinking, and perception. Studies on the neurobiological basis of these sub-domains and their relationship with biomarkers gained momentum with the definition of the concept and the development of MBI-C. However, the concept is still very new and it is possible for people to be over-diagnosed and to face the risk of stigmatization during the evaluation. Therefore, studies with large samples are needed. Demonstrating the validity of this concept will also serve the purpose of identifying the subjects with a neurodegenerative disease without any cognitive complaints yet at a very early stage in clinical studies. Keywords: Mild behavioral impairment, neuropsychiatric symptoms, prodromal dementia.

Dear Editor, In this paper, it is aimed to raise awareness about the stepped care model as an approach in the organization of mental health services related to the protection, development, care and treatment of mental health. Concerning mental health, World Health Organization emphasizes that "Mental Health is more than mental disorders. It is a state of well-being that includes using one's own abilities, self-realization, coping with the stresses in the natural flow of life, learning to be well and trying to heal, working efficiently and contributing to the society in which they live." (World Health Organization 2022a). It has been reported that the disease burden of common mental disorders (depression, anxiety, post-traumatic stress disorder, psychoactive substance use disorders, suicide, etc.) is gradually increasing (World Health Organization 2021). Especially in the last century, the importance and seriousness of endemic and pandemic events (HIV, SARS virus, and still continuing Covid-19, etc.) or non-communicable diseases (cancer, heart diseases, diabetes, etc.), climate changes, economic, socio-political dynamics and wars are noteworthy as a predisposition and/or precipitating factors in terms of mental health (World Health Organization 2022a, World Health Organization 2022b). Protection and improvement of mental health, together with individual, social, and structural mental health determinants, predict interventions that reduce risks, increase resilience, and create a supportive environment for mental health. These interventions are recommended to be designed individually, in a way to be disseminated to special groups across the community. Globally, one person dies by suicide every 40 seconds, and more than 18 million health workers are needed in terms of human resources.

Rapid physical, psychological and sexual changes in adolescents due to the developmental process differentiate the approach to adolescents with gender dysphoria (GD) from the approach to adults. In this article, two adolescents who applied for GD and followed up for a long time are presented. The first case was assigned male at birth and defined herself as female. At the age of fifteen, a gonadotropin-releasing hormone analog was started for puberty suppression, and sex hormone was started in the follow-up. The second case's assigned sex was female and defined himself as male. At the age of sixteen years and six months, puberty suppressive treatment was started, followed by sex hormones. Both cases were able to continue their psychosocial development without any problems after the psychiatric and physical treatments they could reach on time. Although GD in adolescents cannot be resolved with puberty suppression alone, it creates time to resolve the acute problems and to search for appropriate treatment approaches in the future. Puberty suppression partially relieves and prevents the exacerbation of the dysphoria experienced by the youth diagnosed as GD, and creates time to search appropriate treatment approaches in the follow-up. Through these two cases, it is aimed to introduce the gender affirmation processes of adolescents with GD, to discuss the medical interventions in adolescence and the psychosocial effects of the process on individuals. Keywords: Gender dysphoria, gender incongruence, adolescence, gender affirmation process, puberty supression, puberty blockers.

Doxylamine succinate, one of the antihistamines available without a prescription for patients suffering from insomnia, is also an antihistamine with the potential for abuse. Although there are case reports about the addictive potential of antihistamines, there are not many studies on doxylamine succinate addiction in the literature. To our knowledge, there have been no case reports on doxylamine succinate addiction in Turkey. This case report presents a patient (43, M), who started using over-the-counter doxylamine succinate at 25 mg/day due to insomnia, gradually increased to 125 mg/day for the last 3 years continuing his doxylamine succinate intake for 5 years uninterrupted, as well as his treatment process. In addition, possible causes and consequences of doxylamine succinate and the potential for abuse of antihistaminic drugs are discussed through the case. Keywords: Antihistamines, drug dependence, doxylamine.

Objective: This study aimed to evaluate the validity and reliability of the Turkish version of Client Attachment to Therapist Scale (CATSTR) which provides a framework for measuring and conceptualizing the relationship between the therapist and the client.

Method: The study included 191 individuals with a mean age of 24.41 years who had received a minimum of 5 and a maximum of 15 sessions of therapy for different psychological problems. All participants completed the CATS-TR, the Early Close Relationships-R (ECR-R), the Bell Object Relations Inventory (BORRTI), and the Working Alliance Inventory (WAI-SF), and a Client Information Form handed to the clients in a closed envelope by their respective therapists.

Results: Exploratory and Confirmatory Factor Analysis results indicated an acceptable fit for the CATS-TR which comprised the Secure, Fearful/Avoidant and Preoccupied/Merger subscales, with internal consistency levels ranging between 0.71 and 0.85. Criterion validity analyses showed that the scores on the CATS-TR Fearful/Avoidant and Preoccupied/Merger subscales correlated with the scores on the ECR-R Avoidance/Anxiety subdimesnions and the BORRTI Object Relations subdimension in the expected directions. Also, the mean score on the CATS-TR Secure Attachment subscale was a significant predictor of the therapeutic alliance assessed by the WAI-SF and its subscales.

Conclusion: This study has demonstrated that the CATS-TR has an acceptable level of validity and reliability with results indicating its usefulness for research and clinical settings in Turkey investigating the common factors bringing about change in psychotherapy.

Objective: This study aims to investigate the relationship between suicide possibilities, defense mechanisms, and eating awareness of patients who have undergone bariatric surgery.

Method: The study sample consisted of 101 patients who had bariatric surgery in a private hospital. People who had at least six months from the date of surgery, who had no pregnancy, and who did not give birth after surgery were included in the study. The Mindful Eating Questionnaire, Suicide Probability Scale, and the Defense Style Questionnaire were applied to the participants.

Results: While the average age of the sample was 52.46±9.72, 54.5% (n=55) were male. Within one year after the operation, 33.7% of (n=34) patients had lost weight between 21-30 kg, while 21.8% (n=22) had lost weight between 11-20 kg. Suicide probability scale scores are predicted by emotional eating (β=0.272, p=0.004), neurotic defense mechanism (β=0.284, p=0.003) and current body mass index (β=0.258, p=0.008).

Conclusion: The possibility of suicide after bariatric surgery is closely related to emotional eating, neurotic defense mechanisms, and body mass index. The solution to the problem of emotional eating rather than decreasing the body mass index may be more effective in decreasing the suicide possibilities of the patients. Therefore, in patients undergoing bariatric surgery, emotional eating is one of the problems that should be handled both before and after surgery.