Turk Psikiyatri Dergisi最新文献

Objective: The aim of this study was to test the metacognitive model of depression in individuals diagnosed with major depressive disorder (MDD) and to investigate the relative contributions of cognitions and metacognitions about rumination to the explanation of depressive symptoms.

Method: The participants of the study consisted of 180 MDD patients not meeting the diagnostic criteria for other psychiatric disorders. The obtained data were analyzed through structural equation modelling (SEM) and hierarchical regression analyses.

Results: SEM results showed that positive beliefs about rumination increased the rumination level, and the higher levels of rumination significantly predicted the increase in depressive symptoms partly through the mediating effect of negative metacognitive beliefs about rumination regarding interpersonal and social consequences. However, negative metacognitive beliefs about the uncontrollability and danger of rumination were not found to be associated with symptoms of depression in the participants of this study. The power of dysfunctional attitudes for predicting depression was lost when hierarchical regression analysis was carried out by controlling the metacognitions about negative interpersonal and social consequences of rumination.

Conclusion: The results are consistent with the metacognitive model of depression, which was originally developed for better understanding of MDD, and point to the usefulness of considering positive and negative metacognitions about rumination in the processes of clinical evaluation and intervention for MDD.

Jerusalem syndrome is a mental illness rarely seen in people who visit Jerusalem, manifests itself with obsessive religious thoughts, delusions, psychotic symptoms, and some characteristic features. In clinical practice, it's uncommon to encounter patients displaying symptoms of the Jerusalem syndrome. In this paper, we report a case of a middle-aged woman who manifested psychiatric symptoms similar to the Jerusalem syndrome after a Mecca visit without any previous psychiatric history. After careful examination, religious delusions, auditory and visual hallucinations, racing thoughts, disorganized speech, and confusion were denoted, therefore the patient was hospitalized. Brain imaging and laboratory examination was unremarkable. After nine days of antipsychotic treatment, the patient's symptoms completely dissolved, and she was discharged. Antipsychotic treatment was ceased entirely after two months. The patient and her family members reported that the patient was symptom-free for the following two years. Keywords: Brief reactive psychosis, religion, travel, differential diagnosis.

Objective: The aim of this study was to determine DNA damage during euthymic and attack periods, and the oxidative metabolism states that may cause this damage in the pathophysiology of bipolar disorder. The role of DNA repair mechanisms in this process was also investigated.

Method: The study included a total of 90 patients aged between 18-65 years who were diagnosed with bipolar disorder according to DSM- 5 diagnostic criteria, with 30 patients in euthymic, 30 in manic and 30 in depressive periods. A control group was formed of 30 healthy subjects matched to the patients by age, gender, body mass index and smoking status and/or alcohol consumption. Oxidative metabolism was investigated using the Comet Assay technique to assess DNA damage, according to the oxidant/antioxidant status in the technique developed by Erel with the Rel ASSAY Diagnostics kit (Turkey). The control and patient groups were compared in respect of gene expression levels of OGG1 and NEIL1 repair genes at mRNA level with Real-Time PCR.

Results: Increased DNA damage was found in the euthymic and manic groups and decreased NEIL1 gene expression in the depressive group. The oxidative stress index was found to be decreased in the patient groups compared to the healthy control group.

Conclusion: Oxidative imbalance and DNA damage and repair disorders may be effective in the pathophysiology of bipolar disorder. Further studies on this subject are required to clarify the etiology and new treatment goals.

Antidepressants are known to cause sexual dysfunctions. Sexual side effects due to antidepressants negatively affect compliance with treatment. Modafinil is a stimulant drug used for narcolepsy and some other sleep disorders. It is also used in treatment of resistant depression, chronic fatigue syndrome, attention deficit hyperactivity disorder, and cocaine addiction syndrome. In this article, two female patients whose depressive complaints improved with antidepressant treatment, but who applied to the psychiatry outpatient clinic with complaints of sexual dysfunction and daytime sleepiness, will be presented. Both patients had loss of sexual desire, arousal and orgasm difficulties. The sexual histories obtained from the patients suggested that there was no sexual dysfunction in the period before they started using antidepressants. Both patients stated that they did not want to change the current antidepressant treatment. Modafinil 100 mg/day was prescribed to the patients for daytime sleepiness. One month after the initiation of modafinil 100 mg/day in the 39-yearold patient, there was a marked decrease in the complaints of loss of sexual desire, decreased sexual arousal and orgasm difficulties. In the other patient, 43 years old, a slight improvement in sexual functions was observed after the initiation of modafinil. In this case, after the modafinil dose was increased to 200 mg/day, there was a significant improvement in sexual dysfunctions. In both cases, the improvement in sexual dysfunctions and possible mechanisms as a result of the addition of modafinil to the treatment will be discussed. Keywords: Antidepressant, woman, sexual dysfunction, modafinil.

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition caused by dopamine modulating medications, particularly antipsychotics. First-line treatments of neuroleptic malignant syndrome are supportive care, discontinuation of the offending agent and pharmacotherapy. In drug-resistant and severe situations, electroconvulsive therapy (ECT) is recommended as well. In this paper we present a 23-year old male with bipolar disorder who was treated with multiple injections of zuclopenthixol long acting and depot forms for a recent manic episode and developed NMS. The patient was transferred to an intensive care unit, medical management was initiated including benzodiazepines, bromocriptine and dantrolene. Due to the inadequate response after several days, ECT (bitemporal electrode placement, briefpulse, on a daily basis) was initiated. After 17 sessions, NMS relieved and there was no need for maintenance ECT. The patient is under follow-up care for 3 years with no cognitive and physical sequela. Keywords: Electroconvulsive therapy, neuroleptic malignant syndrome, bipolar disorder.

Objective: In many clinics, calculation and interpretation of neuropsychological test results, along with reporting, data organization and archiving of the data are done manually. In this era where most of the similar processes are automated, manual application may result in excessive time consumption, unnecessary use of qualified work-force, and is also open to error. A software that automates these processes for neuropsychological tests used for dementia assessment may overcome these issues.

Method: We aimed to develop a free, open source software not requiring specialized training, which would optimise the calculation, preparation of personal reports and archiving processes of neuropsychological tests, hence would easily be incorporated in to the daily work of psychologists. We've used Python 3.6 as the programming language, and JSON was used as the data interchange format to allow for personal alterations in the content. The tests were selected among those which are in common use for neuropsychological evaluation of adults in Turkey, with available norm values. (Funding: TUBITAK 214S048).

Results: PsiNorm was developed, comprising widely used standardized tests for cognitive evaluation of adults in Turkey. The software is lightweight, compatible with most common operating systems, and easy-to-use. We've shown that Psinorm significantly reduced the time required for calculation of percentiles and norms as well as for producing a draft report. The reports are prepared in .txt format and the databases are prepared in MS Excel ve CSV formats. PsiNorm is available freely at psinorm.org.

Conclusion: PsiNorm is a free, open-source software which is available for researchers and clinicians who perform neuropsychological tests. PsiNorm provides significant time and labor-force benefits, is easy-touse and can be customized by the user.

Objective: In parallel with common usage areas, pesticide poisonings are encountered in the community due to reasons such as no wearing of protective clothing and masks during use, unintentional consumption and suicide-intended intake. In this study was aimed to examine the cases who applied to the emergency department with pesticide poisoning and share of suicide cases.

Method: This study is a retrospective record study based on the files of 234 patients who reported to the emergency department for pesticide and rodenticide poisoning between 2014 and 2018. The patients were compared in terms of sociodemographic, substance type, prognosis, and accident/suicide status. Chi-square test, Binary logistic regression analysis were used in the analysis of the data.

Results: Organophosphates was the most common substance recorded as a cause of poisoning, while rat poison placed second. 38% of the acute poisoning cases were suicide attempts. Poisoning among men was found to be prominently due to accident whiles among women suicidal poisoning was more prominent. While the mortality rate is 4.7% in all acute intoxication cases, the mortality rate in poisonings with suicidal purposes is 5.6%. Patients with psychiatric diseases have a 28-fold higher risk of intoxication of attempting suicide. The most common comorbid psychiatric disorders in acute pesticide poisoning are anxiety and depression.

Conclusion: A major proportion of pesticide poisoning cases is suicide attempts. Suicide attempt is at the forefront in women and death rates are higher in people with psychiatric illness. It may be advisable to avoid the easy accessibility of pesticides.

Objective: The aim of this study was to investigate the psychometric properties of the Turkish forms (TR) of the Quality of Relationships Inventory-Bereavement Version (QRI-B) and the Bereavement Guilt Scale (BGS).

Method: The sample consisted of 447 bereaved adults who lost a loved one due to death at least 6 months ago and within the past 5 years. Participants completed the QRI-B, BGS, Beck Depression Inventory (BDI), Prolonged Grief Inventory (PG-13), The Grief and Meaning Reconstruction Inventory (GMRI), Rosenberg Self-Esteem Scale (RSS) ve Life Satisfaction Scale (LSS).

Results: Results of the explanatory factor analysis showed a good fit between the BGS-TR and the original form of BGS consisting of a 5-factor and 14 items. Besides, the QRI-B-TR showed a similar fit with the original QRI-B consisting of a 2-factor and 13 items, except for item 1. The QRI-B-TR and BGS-TR had positive correlations with the PGI and BDI, and negative correlations with the RSS, LSS, and GMRI-growth subscale. These correlations supported the convergent validity. After controlling for demographic variables, the subscales of the QRI-B-TR and BGS-TR explained 49% of the variance in prolonged grief symptoms. Internal consistency values of the total scale and the subscales for both instruments ranged between 0.70 and 0.94.

Conclusion: The findings of the study demonstrated that the Turkish versions of the QRI-B-TR and BGS-TR were reliable and valid psychometric tools. Additionally, it was shown that quality of pre-death relation and grief related guilt were strong predictors of prolonged grief symptoms.

Objective: The most prominent functional magnetic resonance imaging findings about social anxiety disorder are increased activity in emotional regulation areas (amygdala, insula, hippocampus, dorsal anterior cingulate cortex) and fear circuit, and altered activity in prefrontal cortex. This study aims to investigate network abnormalities during resting state.

Method: Resting state functional magnetic resonance images of 21 drug-free patients with social anxiety disorder and 21 healthy controls (matched on age, gender, and years of education) were recorded. Resting state functional connectivity networks were obtained with independent component analysis, and were compared by using the voxel based t-test between the two groups.

Results: Patients with social anxiety disorder displayed decreased intrinsic functional connectivity in the anterior component of the salience network (left orbitofrontal cortex) and increased intrinsic functional connectivity in the posterior component of the salience network (left supramarginal gyrus).

Conclusion: Most of the studies about social anxiety disorder mainly focused on fear circuit and emotional regulation areas by using anxiety provoking tasks or by using seed based analysis of functional connectivity. By applying a whole-brain independent component analysis, we found altered functional connectivity in the salience network, but no significant difference was found in the fear circuit areas. Our results suggest that abnormal connectivity in the salience network might play a crucial role in the neurobiology of social anxiety disorder.