The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses ... more The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses to steal items, even though those items are not needed for personal use or for their monetary value. The individual experiences an increasing sense of tension just prior to the theft and feels pleasure, gratification, or relief when committing the theft. These patients are usually referred to psychiatry for the evaluation of criminal liability by a court order. The content of the court file as well as the act defined by the subject and the presence of a mental disorder should be taken into account. In case of shoplifting, malingering must be ruled out first even if the subject has a previously confirmed diagnosis of kleptomania. Here we present a different case of a patient with kleptomania who was referred to us by a court order to determine her criminal liability for shoplifting.
ÖZ Kleptomani tanısının konulabilmesi için esas nokta, kişisel kullanım için ya da parasal değeri nedeniyle olmadığı halde kişinin bir şeyleri çalma dürtüsüne tekrarlayan şekilde karşı koyamamasıdır. Kişi hırsızlık olayından hemen önce giderek artan bir gerginlik, olayı gerçekleştirirken ise rahatlama, haz yada mutluluk hisseder. Bu hastalar sıklıkla psikiyatriye mahkeme emri ile ceza sorumluluklarının değerlendirilmesi amacıyla yönlendirilirler. Bu durumlarda kişinin tanımladığı olay ve kişide bir ruhsal hastalık olması kadar mahkeme dosyasının içeriği de dikkate alınmalıdır. Eğer olgu bir aşırma olayı nedeni ile yönlendirilmişse, öncesinde kleptomani tanısı konulmuş olsa dahi temaruz olasılığı atlanmamalıdır. Burada aşırma sonrasında mahkeme emriyle ceza ehliyetinin değerlendirilmesi için yönlendirilmiş bir olgu sunulacaktır.
Background: Recently, a growing number of publications have suggested that the immune-inflammator... more Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflam mation in BD.
Background: Recently, a growing number of publications have suggested that the immune-inflammator... more Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflam mation in BD.
– Background and Objectives: Some clinicians use different psychotherapeutic methods in combinati... more – Background and Objectives: Some clinicians use different psychotherapeutic methods in combination in their practice. These combinations reflect the need for more rigorous research on the common pathways which these different therapy orientations may be utilizing, and one way to identify these pathways would be to investigate some core assessment tools or conceptual foundations of these two different approaches. Aim: The aim of the present study was to evaluate the relationship between defense mechanisms and cognitive distortions, and to identify the mediating role of cognitive distortions between defense styles and depression. Methods: A total of 342 female psychiatric outpatients aged 18 and older were recruited. A diagnostic interview and rating of the depression severity were undertaken, and the Cog-nitive Distortion Scales and the Defense Style Questionnaire were completed by the participants. Hierarchical regression analyses were conducted to test for the direct and indirect effects of the defense styles. Results: Cognitive distortions and defense mechanisms were both correlated with the severity of depression, but the correlations were stronger for the former. Conclusions: The findings are suggestive of the mediating effect of cognitive distortions between defense mechanisms and the severity of depression.
Cognitive behavioral approaches have been able to demonstrate some of
the underlying and perpetua... more Cognitive behavioral approaches have been able to demonstrate some of the underlying and perpetuating factors of depression such as cognitive reactivity (CR). The association of CR and the severity of depression is yet to be reported. We aimed to compare the CR of a group of outpatients based on their self-reported severity of depression (SRSD), and to identify the role of specific CR vulnerability markers in depression. The study population consisted of 221 outpatients diagnosed with Major Depressive Disorder. We used the Mini International Neuropsychiatric Interview, and completed a demographic and clinical data form. The participants completed the Leiden Index of Depression Sensitivity-Revised (LEIDS-R), and the Hospital Anxiety and Depression Scale. To identify how well CR, as measured by the scores of the LEIDS-R, could discriminate the groups based on the SRSD, oneway analysis of variance was used. To examine the unique associations between the CR and the SRSD, a hierarchical linear regression analysis was performed. To identify group membership to severe depression, the scores of the LEIDS-R were entered in a logistic regression model. Large, and small group differences emerged on the rumination, and control scores, respectively. The other group differences were all in the medium range. The control, risk aversion, and rumination scores were the subscales which explained a significant proportion of the variance in the SRSD. Overall, the logistic regression model classified 93.7 % of the severely depressed patients correctly. These results indicated that rumination, risk aversion, and perfectionism were particularly associated with severe depression.
Öz Purpose: This study aims to identify the demographic and clinical data of patients presenting ... more Öz Purpose: This study aims to identify the demographic and clinical data of patients presenting for mental health disability reports from these boards. Material and Methods: In this study, the records of the patients presenting to the medical board for disability due to mental health problems in 2014 were retrospectively investigated.
Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has be... more Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nevre fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration.. Decreases in RNFL and ganglion cell iner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not diferent from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.
Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety diso... more Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders.We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients, and healthy controls (HC) in terms of EE, and to investigate the effect of EE on quality of life in patients with PD. Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion Scale (LEE) and the SF-36 Quality of Life Scale. Further, the Expressed Emotion Scale (EE) was completed by the participant’s key relatives. Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD, and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the quality of life (QOL) in patients with PD. Conclusions: EE was not different in PD compared to MD and HC. Additionally, EE was not related to QOL in PD.
Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety diso... more Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD. Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant’s key relatives. Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QOL in patients with PD. Conclusion: EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.
Dysfunctional attitudes are considered to be important risk factors in the onset and
maintenance ... more Dysfunctional attitudes are considered to be important risk factors in the onset and maintenance of depression. Thus, a psychometrically reliable and valid measure is necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is widely used and has good psychometric properties, but there is no consensus about its factor structure. To examine its psychometric properties and factor structure, a total of 885 individuals consisting of patients with depression and healthy controls were evaluated. After the sample was randomly divided into two subsets, exploratory and confirmatory factor analyses were performed. Then the DAS was abbreviated according to the factor profiles and theoretical background. Analyses indicated two factors, named Perfectionism/Achievement and Need for Approval/Dependency for the revised DAS. Reliability analyses revealed a good internal consistency, and the concurrent validity indicated significant correlations with the Beck Depression Inventory and the Automatic Thoughts Questionnaire.
Background: There are very limited data about the cognitive structure of bipolar depression when ... more Background: There are very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim 11 of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of 12 Beck's cognitive theory.
Background: There are very limited data about the cognitive structure of bipolar depression when ... more Background: There are very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim 11 of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of 12 Beck's cognitive theory.
Background: Immunologic mechanisms may be responsible for the development and
maintenance of schi... more Background: Immunologic mechanisms may be responsible for the development and maintenance of schizophrenia symptoms. Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumor necrosis factor-alpha receptor II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine their relationship with the symptoms of schizophrenia. Methods: Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. Positive and Negative Syndrome Scale (PANSS) was administered in patients with schizophrenia (n = 35), and the results were compared with healthy controls (n = 30). Hierarchical regression analyses were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII. Results: No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF- αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII levels were found to be negatively correlated with the negative subscale score of the PANSS, and sTNF-αRI levels were also negatively correlated with the total score of the PANSS. Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor levels. Conclusions: These results suggest that there may be a change in antiinflammatory response in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also supports low levels of TNF activity in schizophrenia patients with negative symptoms.
Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is c... more Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly.
Amaç:Beck’in geliştirdiği bilişsel kurama göreçökkünlüğün ortaya çıkması ve
devametmesinde bilişs... more Amaç:Beck’in geliştirdiği bilişsel kurama göreçökkünlüğün ortaya çıkması ve devametmesinde bilişsel çarpıtmalar önemli aracılar olarak görülmektedir. Bu çarpıtmaların olumsuz otomatik düşüncelere benzer şekilde çökkünlük dönemi süresince mi yüksek kaldığı, yoksa işlevsel olmayan tutumlara benzer şekilde süreklilik arz ederek çökkünlük dönemi dışında da sebat mı ettiği araştırılmamıştır. Bu çalışma ile bu eksikliğin kapatılması amaçlanmıştır. Çalışmanın varsayımı, çökkünlük dönemi gerileyip de yeniden iyilik haline dönüldüğünde bilişsel çarpıtmaların sıklık ve şiddetinde bir gerileme olacağıdır. Yöntem:Araştırma için Mart 2012 – Mart 2013 tarihleri arasında Balıkesir Devlet Hastanesi,Atatürk Eğitim ve Araştırma Hastanesi ve Mersin Devlet Hastanesi Ruh Sağlığı ve Hastalıkları Bölümleri’ne ayaktan başvuran ve çalışmaya katılmayı kabul eden kadın hastalar ve onlara eşlik eden kadın yakınlarına MINI yapılandırılmış tanı görüşmesi uygulanmıştır. DSM-IV-TR tanı ölçütlerine göre yüz yetmiş sekiz Majör Depresif Bozukluk, yüz altmış sekiz iyileşme döneminde olan Majör Depresif Bozukluk tanılarını karşılayan hasta ve herhangi bir eksen – I tanısı almayan yüz yetmiş yedi sağlıklı gönüllüden oluşan toplam beş yüz yirmi üç katılımcı sayısına ulaşılmıştır. Katılımcılara görüşmeciler tarafından çökkünlük belirtilerinin şiddetini sorgulayan Depresif Belirti Envanteri – Klinisyen Versiyonu uygulanmış ve katılımcıların Bilişsel Çarpıtmalar Ölçeği’ni doldurmaları istenmiştir. Ayrıca katılımcıların demografik verilerini sorgulayan bir form görüşmeciler tarafından doldurulmuştur. Toplanan veriler SPSS for Windows v17.0 kullanılarak istatistiksel olarak incelenmiştir. Bulgular:Araştırmaya dahil edilen gruplar yaş, medenî durum ve eğitim düzeyi açısındanfarklılaşmadı. Çökkünlük şiddeti puanları açısından gruplar birbirinden ayırt edilebildi, en yüksek puanı değerlendirme anında çökkünlük dönemi içerisinde olanlar, en düşük puanı ise sağlıklı gönüllülerin oluşturduğu grup aldı. Bilişsel çarpıtmaları sorgulayan ölçek puanları açısından da, kendini suçlama alt ölçeği ortalama puanları hariç olmak üzere, benzer sıralama elde edildi. Bilişsel çarpıtmaların (kendini suçlama ile ilgili olanlar hariç) çökkünlük dönemi dışında da iyileşme dönemine girmiş bile olsalar çökkünlük yaşamış hastaları sağlıklı gönüllülerden ayırt ettiği görüldü. Kendini suçlamayla ilgili çarpıtmalarda ise çökkünlük dönemleri dışında sağlıklı gönüllülerle benzer puan alındığı, dolayısıyla çökkünlük dönemine bağımlı bir yükseklik görüldüğü anlaşıldı. Sonuç:Araştırmanın sonuçları bilişsel çarpıtmalardan kendini suçlama alt ölçeği dışındakiçarpıtmaların bir kişilik özelliği olarak çökkünlük dönemi dışında da yüksek kaldığını, bu açıdan terapide benlik algısı, çaresizlik, umutsuzluk ve yaşamı tehlikeli görmeyle ilgili çarpıtmaların özellikle ele alınması ve iyilik hali sağlanması sonrasında da bu alanlardaki çarpıtmaların yakından takip edilmesi gerektiğini düşündürmektedir. Kendini suçlamayla ilgili çarpıtmalar ise çökkünlük dönemine bağımlı olarak yüksek kalmakta ve iyilik hali sağlanmasıyla birlikte düzeyinde düşme ortaya çıkmaktadır. Araştırmanın bu kısmında klinik uygulamaya dair olası yansımalar da tartışılmıştır.
The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses ... more The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses to steal items, even though those items are not needed for personal use or for their monetary value. The individual experiences an increasing sense of tension just prior to the theft and feels pleasure, gratification, or relief when committing the theft. These patients are usually referred to psychiatry for the evaluation of criminal liability by a court order. The content of the court file as well as the act defined by the subject and the presence of a mental disorder should be taken into account. In case of shoplifting, malingering must be ruled out first even if the subject has a previously confirmed diagnosis of kleptomania. Here we present a different case of a patient with kleptomania who was referred to us by a court order to determine her criminal liability for shoplifting.
ÖZ Kleptomani tanısının konulabilmesi için esas nokta, kişisel kullanım için ya da parasal değeri nedeniyle olmadığı halde kişinin bir şeyleri çalma dürtüsüne tekrarlayan şekilde karşı koyamamasıdır. Kişi hırsızlık olayından hemen önce giderek artan bir gerginlik, olayı gerçekleştirirken ise rahatlama, haz yada mutluluk hisseder. Bu hastalar sıklıkla psikiyatriye mahkeme emri ile ceza sorumluluklarının değerlendirilmesi amacıyla yönlendirilirler. Bu durumlarda kişinin tanımladığı olay ve kişide bir ruhsal hastalık olması kadar mahkeme dosyasının içeriği de dikkate alınmalıdır. Eğer olgu bir aşırma olayı nedeni ile yönlendirilmişse, öncesinde kleptomani tanısı konulmuş olsa dahi temaruz olasılığı atlanmamalıdır. Burada aşırma sonrasında mahkeme emriyle ceza ehliyetinin değerlendirilmesi için yönlendirilmiş bir olgu sunulacaktır.
Background: Recently, a growing number of publications have suggested that the immune-inflammator... more Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflam mation in BD.
Background: Recently, a growing number of publications have suggested that the immune-inflammator... more Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflam mation in BD.
– Background and Objectives: Some clinicians use different psychotherapeutic methods in combinati... more – Background and Objectives: Some clinicians use different psychotherapeutic methods in combination in their practice. These combinations reflect the need for more rigorous research on the common pathways which these different therapy orientations may be utilizing, and one way to identify these pathways would be to investigate some core assessment tools or conceptual foundations of these two different approaches. Aim: The aim of the present study was to evaluate the relationship between defense mechanisms and cognitive distortions, and to identify the mediating role of cognitive distortions between defense styles and depression. Methods: A total of 342 female psychiatric outpatients aged 18 and older were recruited. A diagnostic interview and rating of the depression severity were undertaken, and the Cog-nitive Distortion Scales and the Defense Style Questionnaire were completed by the participants. Hierarchical regression analyses were conducted to test for the direct and indirect effects of the defense styles. Results: Cognitive distortions and defense mechanisms were both correlated with the severity of depression, but the correlations were stronger for the former. Conclusions: The findings are suggestive of the mediating effect of cognitive distortions between defense mechanisms and the severity of depression.
Cognitive behavioral approaches have been able to demonstrate some of
the underlying and perpetua... more Cognitive behavioral approaches have been able to demonstrate some of the underlying and perpetuating factors of depression such as cognitive reactivity (CR). The association of CR and the severity of depression is yet to be reported. We aimed to compare the CR of a group of outpatients based on their self-reported severity of depression (SRSD), and to identify the role of specific CR vulnerability markers in depression. The study population consisted of 221 outpatients diagnosed with Major Depressive Disorder. We used the Mini International Neuropsychiatric Interview, and completed a demographic and clinical data form. The participants completed the Leiden Index of Depression Sensitivity-Revised (LEIDS-R), and the Hospital Anxiety and Depression Scale. To identify how well CR, as measured by the scores of the LEIDS-R, could discriminate the groups based on the SRSD, oneway analysis of variance was used. To examine the unique associations between the CR and the SRSD, a hierarchical linear regression analysis was performed. To identify group membership to severe depression, the scores of the LEIDS-R were entered in a logistic regression model. Large, and small group differences emerged on the rumination, and control scores, respectively. The other group differences were all in the medium range. The control, risk aversion, and rumination scores were the subscales which explained a significant proportion of the variance in the SRSD. Overall, the logistic regression model classified 93.7 % of the severely depressed patients correctly. These results indicated that rumination, risk aversion, and perfectionism were particularly associated with severe depression.
Öz Purpose: This study aims to identify the demographic and clinical data of patients presenting ... more Öz Purpose: This study aims to identify the demographic and clinical data of patients presenting for mental health disability reports from these boards. Material and Methods: In this study, the records of the patients presenting to the medical board for disability due to mental health problems in 2014 were retrospectively investigated.
Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has be... more Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nevre fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration.. Decreases in RNFL and ganglion cell iner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not diferent from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.
Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety diso... more Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders.We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients, and healthy controls (HC) in terms of EE, and to investigate the effect of EE on quality of life in patients with PD. Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion Scale (LEE) and the SF-36 Quality of Life Scale. Further, the Expressed Emotion Scale (EE) was completed by the participant’s key relatives. Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD, and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the quality of life (QOL) in patients with PD. Conclusions: EE was not different in PD compared to MD and HC. Additionally, EE was not related to QOL in PD.
Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety diso... more Objective: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD. Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant’s key relatives. Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QOL in patients with PD. Conclusion: EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.
Dysfunctional attitudes are considered to be important risk factors in the onset and
maintenance ... more Dysfunctional attitudes are considered to be important risk factors in the onset and maintenance of depression. Thus, a psychometrically reliable and valid measure is necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is widely used and has good psychometric properties, but there is no consensus about its factor structure. To examine its psychometric properties and factor structure, a total of 885 individuals consisting of patients with depression and healthy controls were evaluated. After the sample was randomly divided into two subsets, exploratory and confirmatory factor analyses were performed. Then the DAS was abbreviated according to the factor profiles and theoretical background. Analyses indicated two factors, named Perfectionism/Achievement and Need for Approval/Dependency for the revised DAS. Reliability analyses revealed a good internal consistency, and the concurrent validity indicated significant correlations with the Beck Depression Inventory and the Automatic Thoughts Questionnaire.
Background: There are very limited data about the cognitive structure of bipolar depression when ... more Background: There are very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim 11 of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of 12 Beck's cognitive theory.
Background: There are very limited data about the cognitive structure of bipolar depression when ... more Background: There are very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim 11 of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of 12 Beck's cognitive theory.
Background: Immunologic mechanisms may be responsible for the development and
maintenance of schi... more Background: Immunologic mechanisms may be responsible for the development and maintenance of schizophrenia symptoms. Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumor necrosis factor-alpha receptor II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine their relationship with the symptoms of schizophrenia. Methods: Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. Positive and Negative Syndrome Scale (PANSS) was administered in patients with schizophrenia (n = 35), and the results were compared with healthy controls (n = 30). Hierarchical regression analyses were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII. Results: No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF- αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII levels were found to be negatively correlated with the negative subscale score of the PANSS, and sTNF-αRI levels were also negatively correlated with the total score of the PANSS. Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor levels. Conclusions: These results suggest that there may be a change in antiinflammatory response in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also supports low levels of TNF activity in schizophrenia patients with negative symptoms.
Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is c... more Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly.
Amaç:Beck’in geliştirdiği bilişsel kurama göreçökkünlüğün ortaya çıkması ve
devametmesinde bilişs... more Amaç:Beck’in geliştirdiği bilişsel kurama göreçökkünlüğün ortaya çıkması ve devametmesinde bilişsel çarpıtmalar önemli aracılar olarak görülmektedir. Bu çarpıtmaların olumsuz otomatik düşüncelere benzer şekilde çökkünlük dönemi süresince mi yüksek kaldığı, yoksa işlevsel olmayan tutumlara benzer şekilde süreklilik arz ederek çökkünlük dönemi dışında da sebat mı ettiği araştırılmamıştır. Bu çalışma ile bu eksikliğin kapatılması amaçlanmıştır. Çalışmanın varsayımı, çökkünlük dönemi gerileyip de yeniden iyilik haline dönüldüğünde bilişsel çarpıtmaların sıklık ve şiddetinde bir gerileme olacağıdır. Yöntem:Araştırma için Mart 2012 – Mart 2013 tarihleri arasında Balıkesir Devlet Hastanesi,Atatürk Eğitim ve Araştırma Hastanesi ve Mersin Devlet Hastanesi Ruh Sağlığı ve Hastalıkları Bölümleri’ne ayaktan başvuran ve çalışmaya katılmayı kabul eden kadın hastalar ve onlara eşlik eden kadın yakınlarına MINI yapılandırılmış tanı görüşmesi uygulanmıştır. DSM-IV-TR tanı ölçütlerine göre yüz yetmiş sekiz Majör Depresif Bozukluk, yüz altmış sekiz iyileşme döneminde olan Majör Depresif Bozukluk tanılarını karşılayan hasta ve herhangi bir eksen – I tanısı almayan yüz yetmiş yedi sağlıklı gönüllüden oluşan toplam beş yüz yirmi üç katılımcı sayısına ulaşılmıştır. Katılımcılara görüşmeciler tarafından çökkünlük belirtilerinin şiddetini sorgulayan Depresif Belirti Envanteri – Klinisyen Versiyonu uygulanmış ve katılımcıların Bilişsel Çarpıtmalar Ölçeği’ni doldurmaları istenmiştir. Ayrıca katılımcıların demografik verilerini sorgulayan bir form görüşmeciler tarafından doldurulmuştur. Toplanan veriler SPSS for Windows v17.0 kullanılarak istatistiksel olarak incelenmiştir. Bulgular:Araştırmaya dahil edilen gruplar yaş, medenî durum ve eğitim düzeyi açısındanfarklılaşmadı. Çökkünlük şiddeti puanları açısından gruplar birbirinden ayırt edilebildi, en yüksek puanı değerlendirme anında çökkünlük dönemi içerisinde olanlar, en düşük puanı ise sağlıklı gönüllülerin oluşturduğu grup aldı. Bilişsel çarpıtmaları sorgulayan ölçek puanları açısından da, kendini suçlama alt ölçeği ortalama puanları hariç olmak üzere, benzer sıralama elde edildi. Bilişsel çarpıtmaların (kendini suçlama ile ilgili olanlar hariç) çökkünlük dönemi dışında da iyileşme dönemine girmiş bile olsalar çökkünlük yaşamış hastaları sağlıklı gönüllülerden ayırt ettiği görüldü. Kendini suçlamayla ilgili çarpıtmalarda ise çökkünlük dönemleri dışında sağlıklı gönüllülerle benzer puan alındığı, dolayısıyla çökkünlük dönemine bağımlı bir yükseklik görüldüğü anlaşıldı. Sonuç:Araştırmanın sonuçları bilişsel çarpıtmalardan kendini suçlama alt ölçeği dışındakiçarpıtmaların bir kişilik özelliği olarak çökkünlük dönemi dışında da yüksek kaldığını, bu açıdan terapide benlik algısı, çaresizlik, umutsuzluk ve yaşamı tehlikeli görmeyle ilgili çarpıtmaların özellikle ele alınması ve iyilik hali sağlanması sonrasında da bu alanlardaki çarpıtmaların yakından takip edilmesi gerektiğini düşündürmektedir. Kendini suçlamayla ilgili çarpıtmalar ise çökkünlük dönemine bağımlı olarak yüksek kalmakta ve iyilik hali sağlanmasıyla birlikte düzeyinde düşme ortaya çıkmaktadır. Araştırmanın bu kısmında klinik uygulamaya dair olası yansımalar da tartışılmıştır.
OBJECTIVE: Major depression is associated with cellular loss in key brain regions1,2.Optical cohe... more OBJECTIVE: Major depression is associated with cellular loss in key brain regions1,2.Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases3. Since the axons in retinal nevre fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell iner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia4,5. To date, there is no clinical research investigating OCT parameters in patients with MD. METHODS: The sample consisted of 58 depressed participants, and 57 healthy control subjects Socio-demographic data was collected by using a questionnaire and all participants were given Quick Inventory of Depressive Symptoms – Self Report, 16 Item (QIDS). We compared the RNFL thickness, GCIPL thickness, total and mean macular volume (MV) in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression; such as age at onset, total number of episodes, total number of suicide attempts, duration of the latest episode and QIDS total score. RESULTS: The groups did not differ significantly in terms of age, sex, marital status, SES or smoking status. About 70 % of depressed patients were in their first episode, 51 (88 %) of them were female, 15 patients (25 %) were using antidepressant treatment and the mean QIDS score for the depressed grup was 12.43 ± 4.91. Depressed patients were not diferent from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. The GCIPL thickness was significantly associated with a positive family history of psychiatric disorder, and the duration of the latest depressive episode. Finally, the total RNFL thickness was significantly associated with both a family history of psychiatric disorder, and the total QIDS score. DISCUSSION: Patients with MD were not diferent from the healthy controls with regard to OCT parameters.The low score of QIDS scale and and the low rate of the history of previous suicide attempts (0.12 %) in our depressed grup indicates a mild level of depression. The female prepondarence in the depressed group, and the heterogeneity of the depressed group might have played a role on the results, as well. The duration of the latest episode was negatively and weakly correlated with the GCIPL and nasal RNFL thickness. Decreased GCL and IPL thickness was determined in patients with schizophrenia both parameters were correlated with disorder parameters such as disorder duration5. The small sample size of the present study, and having mild depression in the depressed group were two important limitations of this study. Since, it was demonstrated that antidepressant treatment changed some retinal parameters6, antidepressant treatment might have a confounding effect on our
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Papers by Sedat Batmaz
ÖZ
Kleptomani tanısının konulabilmesi için esas nokta, kişisel kullanım için ya da parasal değeri nedeniyle olmadığı halde kişinin bir şeyleri çalma dürtüsüne tekrarlayan şekilde karşı koyamamasıdır. Kişi hırsızlık olayından hemen önce giderek artan bir gerginlik, olayı gerçekleştirirken ise rahatlama, haz yada mutluluk hisseder. Bu hastalar sıklıkla psikiyatriye mahkeme emri ile ceza sorumluluklarının değerlendirilmesi amacıyla yönlendirilirler. Bu durumlarda kişinin tanımladığı olay ve kişide bir ruhsal hastalık olması kadar mahkeme dosyasının içeriği de dikkate alınmalıdır. Eğer olgu bir aşırma olayı nedeni ile yönlendirilmişse, öncesinde kleptomani tanısı konulmuş olsa dahi temaruz olasılığı atlanmamalıdır. Burada aşırma sonrasında mahkeme emriyle ceza ehliyetinin değerlendirilmesi için yönlendirilmiş bir olgu sunulacaktır.
the underlying and perpetuating factors of depression such as cognitive reactivity
(CR). The association of CR and the severity of depression is yet to be reported. We
aimed to compare the CR of a group of outpatients based on their self-reported
severity of depression (SRSD), and to identify the role of specific CR vulnerability
markers in depression. The study population consisted of 221 outpatients diagnosed
with Major Depressive Disorder. We used the Mini International Neuropsychiatric
Interview, and completed a demographic and clinical data form. The participants
completed the Leiden Index of Depression Sensitivity-Revised (LEIDS-R), and the
Hospital Anxiety and Depression Scale. To identify how well CR, as measured by
the scores of the LEIDS-R, could discriminate the groups based on the SRSD, oneway
analysis of variance was used. To examine the unique associations between the
CR and the SRSD, a hierarchical linear regression analysis was performed. To
identify group membership to severe depression, the scores of the LEIDS-R were
entered in a logistic regression model. Large, and small group differences emerged
on the rumination, and control scores, respectively. The other group differences
were all in the medium range. The control, risk aversion, and rumination scores
were the subscales which explained a significant proportion of the variance in the
SRSD. Overall, the logistic regression model classified 93.7 % of the severely
depressed patients correctly. These results indicated that rumination, risk aversion,
and perfectionism were particularly associated with severe depression.
Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion Scale (LEE) and the SF-36 Quality of Life Scale. Further, the Expressed Emotion Scale (EE) was completed by the participant’s key relatives.
Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD, and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the quality of life (QOL) in patients with PD.
Conclusions: EE was not different in PD compared to MD and HC. Additionally, EE was not related to QOL in PD.
investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD),
to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls
(HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD.
Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the
Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was
completed by the participant’s key relatives.
Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no
significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale
scores. It was also demonstrated that EE had no effect on the QOL in patients with PD.
Conclusion: EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.
maintenance of depression. Thus, a psychometrically reliable and valid measure is
necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is
widely used and has good psychometric properties, but there is no consensus about
its factor structure. To examine its psychometric properties and factor structure, a
total of 885 individuals consisting of patients with depression and healthy controls
were evaluated. After the sample was randomly divided into two subsets, exploratory
and confirmatory factor analyses were performed. Then the DAS was abbreviated
according to the factor profiles and theoretical background. Analyses indicated
two factors, named Perfectionism/Achievement and Need for Approval/Dependency
for the revised DAS. Reliability analyses revealed a good internal consistency, and the
concurrent validity indicated significant correlations with the Beck Depression
Inventory and the Automatic Thoughts Questionnaire.
maintenance of schizophrenia symptoms.
Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor
necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumor necrosis factor-alpha receptor
II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine
their relationship with the symptoms of schizophrenia.
Methods: Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. Positive and
Negative Syndrome Scale (PANSS) was administered in patients with schizophrenia (n = 35),
and the results were compared with healthy controls (n = 30). Hierarchical regression analyses
were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII.
Results: No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF-
αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII
levels were found to be negatively correlated with the negative subscale score of the PANSS,
and sTNF-αRI levels were also negatively correlated with the total score of the PANSS.
Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor
levels.
Conclusions: These results suggest that there may be a change in antiinflammatory response
in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also
supports low levels of TNF activity in schizophrenia patients with negative symptoms.
devametmesinde bilişsel çarpıtmalar önemli aracılar olarak görülmektedir. Bu çarpıtmaların
olumsuz otomatik düşüncelere benzer şekilde çökkünlük dönemi süresince mi yüksek kaldığı,
yoksa işlevsel olmayan tutumlara benzer şekilde süreklilik arz ederek çökkünlük dönemi
dışında da sebat mı ettiği araştırılmamıştır. Bu çalışma ile bu eksikliğin kapatılması
amaçlanmıştır. Çalışmanın varsayımı, çökkünlük dönemi gerileyip de yeniden iyilik haline
dönüldüğünde bilişsel çarpıtmaların sıklık ve şiddetinde bir gerileme olacağıdır.
Yöntem:Araştırma için Mart 2012 – Mart 2013 tarihleri arasında Balıkesir Devlet
Hastanesi,Atatürk Eğitim ve Araştırma Hastanesi ve Mersin Devlet Hastanesi Ruh Sağlığı ve
Hastalıkları Bölümleri’ne ayaktan başvuran ve çalışmaya katılmayı kabul eden kadın hastalar
ve onlara eşlik eden kadın yakınlarına MINI yapılandırılmış tanı görüşmesi uygulanmıştır.
DSM-IV-TR tanı ölçütlerine göre yüz yetmiş sekiz Majör Depresif Bozukluk, yüz altmış
sekiz iyileşme döneminde olan Majör Depresif Bozukluk tanılarını karşılayan hasta ve
herhangi bir eksen – I tanısı almayan yüz yetmiş yedi sağlıklı gönüllüden oluşan toplam beş
yüz yirmi üç katılımcı sayısına ulaşılmıştır. Katılımcılara görüşmeciler tarafından çökkünlük
belirtilerinin şiddetini sorgulayan Depresif Belirti Envanteri – Klinisyen Versiyonu
uygulanmış ve katılımcıların Bilişsel Çarpıtmalar Ölçeği’ni doldurmaları istenmiştir. Ayrıca
katılımcıların demografik verilerini sorgulayan bir form görüşmeciler tarafından doldurulmuştur. Toplanan veriler SPSS for Windows v17.0 kullanılarak istatistiksel olarak
incelenmiştir.
Bulgular:Araştırmaya dahil edilen gruplar yaş, medenî durum ve eğitim düzeyi
açısındanfarklılaşmadı. Çökkünlük şiddeti puanları açısından gruplar birbirinden ayırt
edilebildi, en yüksek puanı değerlendirme anında çökkünlük dönemi içerisinde olanlar, en
düşük puanı ise sağlıklı gönüllülerin oluşturduğu grup aldı. Bilişsel çarpıtmaları sorgulayan
ölçek puanları açısından da, kendini suçlama alt ölçeği ortalama puanları hariç olmak üzere,
benzer sıralama elde edildi. Bilişsel çarpıtmaların (kendini suçlama ile ilgili olanlar hariç)
çökkünlük dönemi dışında da iyileşme dönemine girmiş bile olsalar çökkünlük yaşamış
hastaları sağlıklı gönüllülerden ayırt ettiği görüldü. Kendini suçlamayla ilgili çarpıtmalarda
ise çökkünlük dönemleri dışında sağlıklı gönüllülerle benzer puan alındığı, dolayısıyla
çökkünlük dönemine bağımlı bir yükseklik görüldüğü anlaşıldı.
Sonuç:Araştırmanın sonuçları bilişsel çarpıtmalardan kendini suçlama alt ölçeği
dışındakiçarpıtmaların bir kişilik özelliği olarak çökkünlük dönemi dışında da yüksek
kaldığını, bu açıdan terapide benlik algısı, çaresizlik, umutsuzluk ve yaşamı tehlikeli
görmeyle ilgili çarpıtmaların özellikle ele alınması ve iyilik hali sağlanması sonrasında da bu
alanlardaki çarpıtmaların yakından takip edilmesi gerektiğini düşündürmektedir. Kendini
suçlamayla ilgili çarpıtmalar ise çökkünlük dönemine bağımlı olarak yüksek kalmakta ve
iyilik hali sağlanmasıyla birlikte düzeyinde düşme ortaya çıkmaktadır. Araştırmanın bu
kısmında klinik uygulamaya dair olası yansımalar da tartışılmıştır.
ÖZ
Kleptomani tanısının konulabilmesi için esas nokta, kişisel kullanım için ya da parasal değeri nedeniyle olmadığı halde kişinin bir şeyleri çalma dürtüsüne tekrarlayan şekilde karşı koyamamasıdır. Kişi hırsızlık olayından hemen önce giderek artan bir gerginlik, olayı gerçekleştirirken ise rahatlama, haz yada mutluluk hisseder. Bu hastalar sıklıkla psikiyatriye mahkeme emri ile ceza sorumluluklarının değerlendirilmesi amacıyla yönlendirilirler. Bu durumlarda kişinin tanımladığı olay ve kişide bir ruhsal hastalık olması kadar mahkeme dosyasının içeriği de dikkate alınmalıdır. Eğer olgu bir aşırma olayı nedeni ile yönlendirilmişse, öncesinde kleptomani tanısı konulmuş olsa dahi temaruz olasılığı atlanmamalıdır. Burada aşırma sonrasında mahkeme emriyle ceza ehliyetinin değerlendirilmesi için yönlendirilmiş bir olgu sunulacaktır.
the underlying and perpetuating factors of depression such as cognitive reactivity
(CR). The association of CR and the severity of depression is yet to be reported. We
aimed to compare the CR of a group of outpatients based on their self-reported
severity of depression (SRSD), and to identify the role of specific CR vulnerability
markers in depression. The study population consisted of 221 outpatients diagnosed
with Major Depressive Disorder. We used the Mini International Neuropsychiatric
Interview, and completed a demographic and clinical data form. The participants
completed the Leiden Index of Depression Sensitivity-Revised (LEIDS-R), and the
Hospital Anxiety and Depression Scale. To identify how well CR, as measured by
the scores of the LEIDS-R, could discriminate the groups based on the SRSD, oneway
analysis of variance was used. To examine the unique associations between the
CR and the SRSD, a hierarchical linear regression analysis was performed. To
identify group membership to severe depression, the scores of the LEIDS-R were
entered in a logistic regression model. Large, and small group differences emerged
on the rumination, and control scores, respectively. The other group differences
were all in the medium range. The control, risk aversion, and rumination scores
were the subscales which explained a significant proportion of the variance in the
SRSD. Overall, the logistic regression model classified 93.7 % of the severely
depressed patients correctly. These results indicated that rumination, risk aversion,
and perfectionism were particularly associated with severe depression.
Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion Scale (LEE) and the SF-36 Quality of Life Scale. Further, the Expressed Emotion Scale (EE) was completed by the participant’s key relatives.
Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD, and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the quality of life (QOL) in patients with PD.
Conclusions: EE was not different in PD compared to MD and HC. Additionally, EE was not related to QOL in PD.
investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD),
to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls
(HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD.
Methods: Our study involved a total of 150 participants (50 patients in each group). All participants were given the
Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was
completed by the participant’s key relatives.
Results: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no
significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale
scores. It was also demonstrated that EE had no effect on the QOL in patients with PD.
Conclusion: EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.
maintenance of depression. Thus, a psychometrically reliable and valid measure is
necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is
widely used and has good psychometric properties, but there is no consensus about
its factor structure. To examine its psychometric properties and factor structure, a
total of 885 individuals consisting of patients with depression and healthy controls
were evaluated. After the sample was randomly divided into two subsets, exploratory
and confirmatory factor analyses were performed. Then the DAS was abbreviated
according to the factor profiles and theoretical background. Analyses indicated
two factors, named Perfectionism/Achievement and Need for Approval/Dependency
for the revised DAS. Reliability analyses revealed a good internal consistency, and the
concurrent validity indicated significant correlations with the Beck Depression
Inventory and the Automatic Thoughts Questionnaire.
maintenance of schizophrenia symptoms.
Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor
necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumor necrosis factor-alpha receptor
II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine
their relationship with the symptoms of schizophrenia.
Methods: Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. Positive and
Negative Syndrome Scale (PANSS) was administered in patients with schizophrenia (n = 35),
and the results were compared with healthy controls (n = 30). Hierarchical regression analyses
were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII.
Results: No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF-
αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII
levels were found to be negatively correlated with the negative subscale score of the PANSS,
and sTNF-αRI levels were also negatively correlated with the total score of the PANSS.
Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor
levels.
Conclusions: These results suggest that there may be a change in antiinflammatory response
in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also
supports low levels of TNF activity in schizophrenia patients with negative symptoms.
devametmesinde bilişsel çarpıtmalar önemli aracılar olarak görülmektedir. Bu çarpıtmaların
olumsuz otomatik düşüncelere benzer şekilde çökkünlük dönemi süresince mi yüksek kaldığı,
yoksa işlevsel olmayan tutumlara benzer şekilde süreklilik arz ederek çökkünlük dönemi
dışında da sebat mı ettiği araştırılmamıştır. Bu çalışma ile bu eksikliğin kapatılması
amaçlanmıştır. Çalışmanın varsayımı, çökkünlük dönemi gerileyip de yeniden iyilik haline
dönüldüğünde bilişsel çarpıtmaların sıklık ve şiddetinde bir gerileme olacağıdır.
Yöntem:Araştırma için Mart 2012 – Mart 2013 tarihleri arasında Balıkesir Devlet
Hastanesi,Atatürk Eğitim ve Araştırma Hastanesi ve Mersin Devlet Hastanesi Ruh Sağlığı ve
Hastalıkları Bölümleri’ne ayaktan başvuran ve çalışmaya katılmayı kabul eden kadın hastalar
ve onlara eşlik eden kadın yakınlarına MINI yapılandırılmış tanı görüşmesi uygulanmıştır.
DSM-IV-TR tanı ölçütlerine göre yüz yetmiş sekiz Majör Depresif Bozukluk, yüz altmış
sekiz iyileşme döneminde olan Majör Depresif Bozukluk tanılarını karşılayan hasta ve
herhangi bir eksen – I tanısı almayan yüz yetmiş yedi sağlıklı gönüllüden oluşan toplam beş
yüz yirmi üç katılımcı sayısına ulaşılmıştır. Katılımcılara görüşmeciler tarafından çökkünlük
belirtilerinin şiddetini sorgulayan Depresif Belirti Envanteri – Klinisyen Versiyonu
uygulanmış ve katılımcıların Bilişsel Çarpıtmalar Ölçeği’ni doldurmaları istenmiştir. Ayrıca
katılımcıların demografik verilerini sorgulayan bir form görüşmeciler tarafından doldurulmuştur. Toplanan veriler SPSS for Windows v17.0 kullanılarak istatistiksel olarak
incelenmiştir.
Bulgular:Araştırmaya dahil edilen gruplar yaş, medenî durum ve eğitim düzeyi
açısındanfarklılaşmadı. Çökkünlük şiddeti puanları açısından gruplar birbirinden ayırt
edilebildi, en yüksek puanı değerlendirme anında çökkünlük dönemi içerisinde olanlar, en
düşük puanı ise sağlıklı gönüllülerin oluşturduğu grup aldı. Bilişsel çarpıtmaları sorgulayan
ölçek puanları açısından da, kendini suçlama alt ölçeği ortalama puanları hariç olmak üzere,
benzer sıralama elde edildi. Bilişsel çarpıtmaların (kendini suçlama ile ilgili olanlar hariç)
çökkünlük dönemi dışında da iyileşme dönemine girmiş bile olsalar çökkünlük yaşamış
hastaları sağlıklı gönüllülerden ayırt ettiği görüldü. Kendini suçlamayla ilgili çarpıtmalarda
ise çökkünlük dönemleri dışında sağlıklı gönüllülerle benzer puan alındığı, dolayısıyla
çökkünlük dönemine bağımlı bir yükseklik görüldüğü anlaşıldı.
Sonuç:Araştırmanın sonuçları bilişsel çarpıtmalardan kendini suçlama alt ölçeği
dışındakiçarpıtmaların bir kişilik özelliği olarak çökkünlük dönemi dışında da yüksek
kaldığını, bu açıdan terapide benlik algısı, çaresizlik, umutsuzluk ve yaşamı tehlikeli
görmeyle ilgili çarpıtmaların özellikle ele alınması ve iyilik hali sağlanması sonrasında da bu
alanlardaki çarpıtmaların yakından takip edilmesi gerektiğini düşündürmektedir. Kendini
suçlamayla ilgili çarpıtmalar ise çökkünlük dönemine bağımlı olarak yüksek kalmakta ve
iyilik hali sağlanmasıyla birlikte düzeyinde düşme ortaya çıkmaktadır. Araştırmanın bu
kısmında klinik uygulamaya dair olası yansımalar da tartışılmıştır.