Turk psikiyatri dergisi = Turkish journal of psychiatry最新文献

Objective: The objective of this study is to determine the prevalance of Hepatitis C Virus (HCV) in patients with Opioid Use Disorder and to investigate both the sociodemographic and psychological differences between patients with or without Hepatitis C Virus.

Method: Blood samples were taken from patients diagnosed with Opioid Use Disorder (OUD) who applied to Mersin Provincial Health Directorate Toros State Hospital Alcohol and Drug Addiction Treatment Center (AMATEM) between 01.09.2019-01.09.2020 and hepatitis virus markers, complete blood count and basic biochemistry were assessed. Sociodemographic Evaluation Form, Barratt Impulsivity Scale, Childhood Traumas Scale, Drug Use Disorders Identification Test (DUDIT), Temps-A Temperament Scale, Difficulty in Emotion Regulation Scale were applied to 107 patients with HCV and 101 patients without HCV who were selected by systematic sampling and the findings obtained were compared.

Results: Of the 1190 patients diagnosed with Opioid Use Disorder, 340 (28.5%) were found to be HCV positive. 107 HCV-positive and 101 HCV- negative patients who were selected for comparison were similar in terms of sociodemographic characteristics. Among HCV positive patients, the rate of intravenous drug use and needle sharing were significantly higher (p<0.001, p<0.001). Overall duration of substance use and intravenous substance use were significantly higher in HCV positive patients (p=0.024 and p=0.017). Similarly, HCV positive group were significantly more likely (p<0.001) to have heard of HCV before and significantly more likely (p=0.009) to know that HCV causes cirrhosis and liver cancer. Regarding the scores of Barratt Impulsivity Scale, Childhood Traumas Scale, Substance Use Disorder Recognition Test, DUDIT, Temps -A Temperament Scales applied to HCV positive and HCV negative patients with Opioid Use Disorder, no difference was found. The scores of the 'Non-Acceptance' factor of the Difficulties in Emotion Regulation Scale were found to be significantly higher in HCV positive patients with Opioid Use Disorder (p=0.020).

Conclusion: Patients diagnosed with Opioid Use Disorder (OUD) have higher rates of HCV positivity compared to general public. Intravenous drug use significantly increases this risk. Half of HCV-positive patients were unaware that they have the virus and only a very small proportion received treatment. Therefore, examining each patient with OUD for HCV, treating positive patients in an effective referral system seems to be the an important step in the eradication of this disease in this population.

Objectives: The COVID-19 pandemic may be considered as a shared source of uncertainty. Prolonged engagement with social media regarding this uncertainty could present as a risk factor for anxiety. We sought to investigate the relationship between intolerance of uncertainty, dimensions of resilience, uncertainty source (pandemic)-related social media use, and the risk of anxiety and depression in patients with cancer.

Method: Patients with solid organ cancer (n=113) completed the sociodemographic data form, the Intolerance to Uncertainty Scale-12 (IUS-12), the Resilience Scale for Adults (RSA) and the Hospital Anxiety and Depression Scale (HADS) between May and August 2020.

Results: Depression scores were high at 17.7% of the patients while anxiety scores were high at 49.6%. RSA and its dimensions significantly differ between the Anxiety and Depression groups determined by the HADS. Time spent on social media about the COVID-19 pandemic (SMT) was associated with higher HADS-Anxiety scores (r=0.26, p<0.01), whereas higher resilience was associated with lower HADS- Anxiety (r=-0.42, p<0.01) and HADS-Depression (r=-0.52, p<0.01) scores. In addition to high levels of intolerance of uncertainty, low levels of the social resources were found to be a risk factor for depression, and low levels of self- and future-perception dimensions were found to be a risk factor for anxiety, regardless of the patients' social media use.

Conclusion: As the factors that fuel uncertainty will always have an affect on cancer patients and cancer care, promoting the patients' resilience resources should be one of the main priorities for cancer patients.

Familial hemiplegic migraine (FHM) is a rare, autosomal dominant subtype of migraine characterized by transient hemiparesis and neurological symptoms. It is primarily associated with mutations in the CACNA1A, ATP1A2, and SCN1A genes, which disrupt neuronal excitability and contribute to complex clinical presentations. Although psychotic symptoms accompanying migraine attacks in FHM are exceedingly rare, they have been documented in a limited number of cases. This article presents a case of FHM diagnosed in a patient who exhibited transient psychotic symptoms during a migraine attack, with a focus on diagnostic and therapeutic approaches. The case is discussed in comparison to other rare instances reported in the literature. Psychotic symptoms in FHM are thought to arise from mechanisms such as cortical spreading depression and cerebral hypoperfusion. These symptoms are typically short-lived and respond rapidly to antipsychotic treatment. However, careful evaluation is essential to differentiate these episodes from primary psychotic disorders, thereby avoiding unnecessary prolonged antipsychotic use. This case underscores the importance of a thorough clinical assessment in FHM patients presenting with atypical psychiatric manifestations. The article aims to contribute to the understanding and management of psychotic symptoms in FHM, emphasizing the need for a multidisciplinary approach to diagnosis and treatment. Further research is warranted to elucidate the pathophysiology of psychosis in FHM and to optimize therapeutic strategies for this rare but clinically significant presentation. Keyword: Case report, cortical spreading depression, familial hemiplegic migraine, psychotic disorders.

Objective: The aim was to determine the relationship between secondary traumatic stress, anxiety, depression, and coping styles in healthcare workers following the devastating 2023 Kahramanmaraş earthquakes.

Method: A total of 243 healthcare workers aged 18-65 years working at Ankara Bilkent City Children’s Hospital between April 2023 and June 2023 were included in our study. Participants were assessed with the Brief Symptom Inventory, Ways of Coping with Stress Scale and Secondary Traumatic Stress Scale.

Results: Anxiety, depression and secondary traumatic stress were positively correlated with ineffective coping styles and negatively correlated with effective coping styles. Younger age and female gender were associated with higher levels of anxiety and depression, while secondary traumatic stress was more prevalent among those involved in treating earthquake-affected patients. Regression analysis revealed that ineffective coping styles were associated with anxiety, depression and secondary traumatic stress. Additionally, time spent treating earthquakeaffected patients was linked to secondary traumatic stress, and the loss of a relative was associated with anxiety.

Conclusion: Healthcare workers relying more on ineffective coping styles may face a greater risk of anxiety, depression and secondary traumatic stress.

Clozapine is a unique antipsychotic primarily indicated for treatmentresistant schizophrenia, recurrent suicidal behavior in schizophrenia or schizoaffective disorder, and psychotic disorders in Parkinson’s disease. It is also prescribed off-label in selected patients with mood disorders, personality disorders, or post-traumatic stress disorder. Despite its efficacy, clozapine is underprescribed due to concerns regarding adverse effects, particularly agranulocytosis. This narrative review aims to summarize the reported results regarding the off-label use of clozapine and analyze the potential risks and benefits of these practices. Offlabel prescribing, which involves using medications for unapproved indications, is common in psychiatry due to the insufficient effectiveness of many approved treatments. Clozapine, even at relatively low doses, has shown potential clinical benefits in patients with bipolar disorder, borderline personality disorder, and post-traumatic stress disorder. However, its off-label use remains limited due to safety concerns. The safety concerns associated with clozapine include agranulocytosis, myocarditis, cardiomyopathy, seizures, and metabolic syndrome. The prevention of agranulocytosis, a severe reduction in white blood cells, requires regular monitoring of blood counts. Myocarditis and cardiomyopathy necessitate careful cardiological monitoring, especially during the first month of treatment. Seizures can occur, particularly at higher doses, and metabolic syndrome, including weight gain, diabetes, and hyperlipidemia, requires ongoing management. Other adverse effects such as constipation, hypersalivation, and sedation can also impact patient compliance and quality of life. Despite these risks, with careful patient selection, individualized dosing, and continuous monitoring, the therapeutic potential of clozapine in off-label indications warrants further exploration in clinical trials. Keywords: Adverse effects, clozapine, mood disorders, off-label prescribing, personality disorders, post-traumatic stress disorder.

Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic. This case report presents a patient who did not respond adequately to pharmacotherapy, highlighting the effects of repetitive transcranial magnetic stimulation (rTMS) and the outcomes of longitudinal follow-up. The patient is a 25-year-old male with no history of other physical illnesses. His symptoms began 17 years ago with simple motor tics, which gradually progressed to include complex motor and vocal tics. Over time, he also developed irritability and a persistent sense of impending doom. Clinical evaluation led to diagnoses of Tourette Syndrome comorbid with generalized anxiety disorder. Pharmacological treatment included escitalopram (10 mg/day), followed sequentially by pimozide (4 mg/day), tetrabenazine (3*25 mg/day), and aripiprazole (10 mg/day). Pimozide and aripiprazole showed no effect on the tics, and tetrabenazine was discontinued due to intolerable gastrointestinal side effects. Escitalopram, which effectively managed the patient’s anxiety, was continued at 10 mg/day. The patient then underwent 40 sessions of rTMS over eight weeks, targeting the bilateral supplementary motor area. Each session consisted of 1 Hz stimulation at 110% of the resting motor threshold, delivering 1200 stimuli per day over 20 minutes, five days a week. Following the treatment, significant improvements were observed: a 75% reduction in the general functionality score and a 59.7% reduction in the total tic severity score. This report suggests that rTMS may be a promising alternative for TS patients with psychiatric comorbidities, particularly those who cannot tolerate medications or achieve sufficient symptom control through pharmacotherapy alone. Keywords: Tourette’s Syndrome, Repetitive Transcranial Magnetic Stimulation, Supplementary Motor Area.

Gender minority stress refers to the form of stress experienced by individuals who identify as trans or within the spectrum of gender diversity due to discriminatory discourses and actions in society. This type of stress can negatively affect both mental and physical health and may even result in the loss of one's most fundamental right—the right to life. Therefore, it is crucial for professionals to remain sensitive to gender minority stress when working clinically with this population. This article aims to raise awareness among mental health professionals about gender minority stress and to provide a practical example of an intervention in this area. To this end, group therapy models addressing gender minority stress were reviewed through a systematic literature search. In addition, the experiences of eight individuals who participated in a group therapy designed and facilitated by the authors using an affirmative cognitive behavioral approach were shared. The findings indicate that the most prominent intervention models in the literature targeting gender minority stress are based on cognitive behavioral group therapy. Furthermore, it was observed that members who participated in the group therapy developed psychosocial empowerment through gaining awareness, solidarity, and cognitive and behavioral skills related to self-regulation.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) is typically treated with medications however psychological and psychosocial interventions are recommended for symptoms that persist despite pharmacological treatment. This study aims to review randomized controlled trials focusing on the psychological and psychosocial interventions in the treatment of ADHD.

Method: Eight databases were searched using keyword pairs "ADHD" and "therapy", "ADHD" and "psychological treatment", "ADHD" and "psychosocial treatment", "ADHD" and "CBT", "attention deficit" and "therapy", "attention deficit" and "psychological treatment", "attention deficit" and "psychosocial treatment", "attention deficit" and "CBT". The search was conducted at March 2022.

Results: Forty-five studies met the inclusion criteria. Of these studies, 51% included the child and adolescent age group, 49% included the adult age. In 87% of these studies, psychosocial interventions, when implemented in addition to medication, resulted in significant improvements in ADHD symptoms.

Conclusion: The results indicate that the use of psychosocial interventions, in addition to medical approaches, makes significant contributions to the treatment of ADHD. There is a need for studies investigating the effectiveness of psychosocial interventions in the treatment of ADHD in Turkiye.

Objective: Schizophrenia is a neuropsychiatric disorder with a high risk of suicide, arising from the interplay between genetic predisposition and environmental factors. The Sirtuin 1 (SIRT1) gene, an NAD⁺- dependent deacetylase, is involved in cellular stress response, apoptosis, and mitochondrial functions, as well as neuroprotection and circadian rhythm regulation. SIRT1 is thought to influence neurobiological mechanisms related to cognitive and affective regulation. This study aimed to investigate the association between specific SIRT1 gene polymorphisms and suicide attempts in patients with schizophrenia.

Methods: This cross-sectional, observational genetic association study included only a case group comprising 100 patients diagnosed with schizophrenia. Targeted sequencing of the SIRT1 gene, encompassing all coding exons and their exon-intron junctions, was performed. Based on minor allele frequency and technical quality criteria, 10 single nucleotide polymorphisms (SNPs) were selected for further analysis. Linkage disequilibrium (LD) assessment, haplotype structure, and genetic modeling were conducted using the SHEsis software platform.

Results: The rs10997870 GG genotype (p=0.017) and the rs7896005 AA genotype (p=0.033) were associated with suicide attempts, whereas the rs2236318 A allele (p=0.015) and the rs41299232 GG genotype (p=0.027) were found to be protective. The C-T-A-G haplotype (p=0.005) was associated with an increased risk, while the G-A-G-T haplotype (p=0.032) showed a protective effect.

Conclusion: Certain polymorphisms and haplotypes within the SIRT1 gene may be associated with suicide risk among patients with schizophrenia. These findings point to the potential role of genetic profiling in identifying high-risk individuals. Further large-scale studies are warranted to increase the generalizability of the findings and to elucidate the underlying mechanisms in greater detail.

COVID-19 may affect central nervous system. The symptoms related to the CNS may occur through the direct neuroinvasion of the virus, inflammation, autoimmunity, psychosocial stressors and treatment side effects. COVID-19 can increase the severity of existing mental illnesses and also trigger the onset of a new mental illness. In this case report, we present a 52-year-old male patient with no previous psychiatric history as well as no family history of mental illness. The patient's manic symptoms began while he was hospitalized due to severe COVID-19 pneumonia. The patient, who self-discharged himself from the hospital was brought to the emergency department involuntarily by his relatives 14 days later and was admitted to the psychiatry service. In this case report, possible etiological factors were discussed and the treatment course during the hospitalization and one year follow-up were presented. Our aim is to contribute to the literature by discussing possible etiological factors and management of mania that started during the treatment of COVID-19. COVID-19 can affect the central nervous system and be associated with psychiatric symptoms. Keywords: COVID-19, Mania, Bipolar Disorder, Central Nervous System.