Web Survey of Turkish Pharmacy Students Comparing First and Fifth Years' Antidepressant Awareness and Stigmatizing Attitudes Regarding Depression and Anxiety.

The prevalence of depression and anxiety has increased day by day. Prejudice, self-stigma, and public stigma, on the other hand, continue to prevent patients from seeking adequate treatment, particularly in traditional communities. In this web-based, cross-sectional study, both the presence of depression and anxiety, and the knowledge, attitude, and awareness of first- and fifth (final)-year pharmacy students were examined via an online survey. The aim was to demonstrate the potential impact of public information and five years of pharmacy school on knowledge, attitude, and awareness. Our study population consisted of first- and fifth-year pharmacy students enrolled in one faculty of pharmacy during the spring semester of 2022-2023. The Beck Depression Inventory and Beck Anxiety Scale were utilized to measure the presence of depression and anxiety, while the Depression and Antidepressant Awareness and Knowledge Scale (DAKAS) was applied to assess their knowledge, attitude, and awareness. Fifth-year participants (n = 101) exhibited noticeably fewer stigmatizing attitudes than first-year participants (n = 104) (p < 0.05). There was no statistically significant difference between the mean Beck Depression Inventory and Beck Anxiety scores in first- and fifth-year pharmacy students. Being in the fifth class (OR: 3.690; p = 0.025), being of female gender (OR: 4.653; p < 0.001), and having a relationship with someone who took a psychotropic (OR: 3.060; p = 0.008) were associated with a lower overall stigma score by multiple linear regression analysis. The students' awareness of antidepressants and familiarity with mental health issues at the end of their pharmacy education were higher and stigmatization behavior was lower than in first-year students. The positive attitudes at the end of their training towards depression will reduce the likelihood of future pharmacists' patients from being exposed to stigmatization, prevents the formation of an additional stress factor, and likely will improve pharmacy practices.

Safety of lorlatinib in ALK-positive non-small-cell lung cancer and management of central nervous system adverse events.

The use of tyrosine kinase inhibitors has made a breakthrough in the treatment of non-small-cell lung cancer (NSCLC). Recently, lorlatinib, a third-generation tyrosine kinase inhibitor, has demonstrated significant systemic and intracranial activity in both first-line and subsequent-line therapy in ALK-positive NSCLC patients. In this review, general characteristics of lorlatinib, its efficacy in the treatment of ALK-positive NSCLC patients and the safety of lorlatinib, particularly addressing central nervous system adverse events, are discussed. Management of central nervous system adverse events, which seem to be specific to lorlatinib therapy, is outlined.

Lung cancer is a common disease and affects patients badly. Lorlatinib is a new and useful drug for this disease. But this drug has also some undesirable effects for the brain. These effects are generally mild and can be treated. This article discusses the undesirable effects of this drug on the brain and how to cope with these effects.

Valproate, obesity and other causes of clozapine poor metabolism in the context of rapid titration may explain clozapine-induced myocarditis: A re-analysis of a Turkish case series.

INTRODUCTION: Clozapine-induced myocarditis or any clozapine-induced inflammation may be a hypersensitivity reaction due to titration that was too rapid for the patient's clozapine metabolism. Clozapine metabolism is influenced by ancestry, sex, smoking and the presence of confounders including obesity, infections, and inhibitors (e.g., valproate) causing the patient to behave as a clozapine poor metabolizer (PM). A published study in a Turkish hospital identified 1 case of clozapine-induced pancreatitis and hepatitis and 9 cases of clozapine-induced myocarditis. To explore the hypothesis that the 10 patients were clozapine PMs, their serum clozapine concentrations were investigated using concentration-to-dose (C/D) ratios and their titrations carefully reviewed. METHODS: Dividing the trough serum concentration by the dose produces the clozapine C/D ratio. The dose required to reach 350ng/ml was considered the minimum therapeutic dosage and was used to classify patients according to clozapine PM status. Titration speed was assessed. RESULTS: All 10 patients were possibly clozapine PMs (3 of them had as minimum therapeutic doses: 72, 82 or 83mg/day). Nine of the 10 patients may have behaved as clozapine PMs due to obesity and/or valproate co-prescription during titration. One also had an undiagnosed infection. Of the 10 patients, 9 had at least 1 of 3 factors: too-rapid titration in the first or second weeks, or a final dosage that was too high. CONCLUSIONS: Future studies using clozapine levels and considering the role of clozapine PM status should explore whether or not all cases of clozapine-induced inflammation could be explained by lack of individualized titration.

Do Changes in Body Shape Due to Pregnancy Lead to Cosmetic Surgery? A Cross-Sectional Study.

OBJECTIVE: Pregnants and puerperas show different perceptions of their body image and appearance, so authors investigated their perceptions related to pregnancy and puerperium, evaluating their views on cosmetic surgery, by a cross-sectional study. MATERIALS AND METHODS: 5-item questionnaires were administrated to women at first pregnancy and puerperas. Patients were submitted also to Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Body Image Inventory (BII) analysis, indicating the level of anxiety, depression and body dissatisfaction for somatic changes during pregnancy and after childbirth. RESULTS: 186 healthy women, aged between 25-35 years, equally divided in pregnancy and puerperium, were compared in terms of body image, with no significant difference between groups. Analyzing the item "cosmetic surgery is required after all pregnancies", there was a significant difference in puerperas and the item "cosmetic surgery is necessary for postpartum" was the principal. The comparison of BII, BDI, BAI values between pregnants and puerperas showed a significant difference between groups (p<0.00), with higher scores in postpartum patients. CONCLUSION: Body shape and physical dissatisfaction during pregnancy is linked with increased risk of depression in pregnancy and puerperium, pushing women to opt for cosmetic surgery, especially in puerperium.

Antidepressant awareness and stigmatizing attitudes toward depression and antidepressants, a comparison between first and sixth-year medical students.

BACKGROUND AND AIM: Psychiatric disorders and antidepressant usage rates have increased over the years. However, prejudice, self, and public stigma continue to impede patients from receiving appropriate treatment, especially in traditional societies. In this study, the views of first and sixth-year medical students were examined. We aimed to show the potential effect of public information and 6 years of medical education on knowledge and awareness. METHOD: Our target population was first and sixth-year medical students at the Faculty of Medicine at Hacettepe University in Ankara, Turkey, during the semester 2018-2019. For measurement, widely used scales such as the Beck Depression Inventory, Beck Anxiety Inventory were administered. In addition, scales formed specifically by our research team: Sociodemographic information form and Depression and Antidepressant Awareness and Knowledge Scale were used. RESULTS: Compared to first-year participants, sixth-year participants had significantly less stigmatizing views on individual statements. The overall stigma score of sixth-year participants was significantly lower (p < .05) than first-year participants. Linear Regression Analysis showed that the only predictor of overall stigma score was the depression score (p < .05, beta = -0.36), which acted as a negative predictor. DISCUSSION: Sixth-year participants had higher rates of diagnosed psychiatric illness and psychiatric drug usage. Interestingly, the score was not a predictor of the overall stigma score. However, in the responses to individual statements, we observed an overall increase in knowledge and decreased stigma among the sixth-year participants compared to first-year participants. The effects of medical education on knowledge are significant overall. On the other hand, the level of knowledge and beliefs of our first-year participants, which are similar to the public, show a worrisome situation indicating that broader public education efforts are needed. Our study shows an encouraging perspective, indicating that public awareness campaigns can be very effective in increasing knowledge and decreasing misconceptions.

The Validity and Reliability of the Turkish Version of MacArthur Competence Assessment Tool for Treatment Decision: Correlates of Competence in Schizophrenia Patients.

INTRODUCTION: Informed consent is an indispensable condition of the clinical practice for the provision of health care. The main objective of this study is to translate the MacArthur competence assessment tool for treatment (MacCAT-T) into Turkish and evaluate the validity and reliability of the Turkish version in schizophrenia patients and healthy control subjects. METHODS: In this cross-sectional study, 30 hospitalized schizophrenia patients and 25 healthy subjects were assessed with MacCAT-T, Mental Competence Evaluation Form for Assessment of Competency (MCEF), Positive and Negative Syndrome Scale, Beck Depression Inventory, Mini Mental State Examination, Wechsler Adult Intelligence Scale (WAIS) - Similarities subtest and the Schedule for Assessing the Three Components of Insight. Psychometric properties of MacCAT-T were examined by intra-class correlation coefficients and Cronbach's alpha values. RESULTS: Intra-class correlations ranged between 0.83 and 0.99 for four subscales of the tool. Cronbach alpha value of MacCAT-T was found 0.89. Severity of psychopathology and indices of insight were found to be negatively correlated with the subscales of the tool. WAIS-Similarities subtest scores were found to be positively correlated with understanding and reasoning subscales of MacCAT-T. CONCLUSION: The Turkish version of MacCAT-T is a valid and reliable instrument for Turkish patients. The severity of psychopathology, insight and executive functions were shown to be significantly related to the decision making capacity in patients with schizophrenia.

[A Forensic Psychiatric Perspective on the Draft Mental Health Act of Turkey in Light of Similar Laws and Practice in a Foreign Jurisdiction]. / Ruh Sagligi Yasasi Taslaginin Yurt Disi Bir Uygulama Örnegi Isiginda Adli Psikiyatrik Açidan Gözden Geçirilmesi.

OBJECTIVE: Designated Acts for issues related to mental health are in force in many countries throughout the world. A mental health act is also expected to be approved in Turkey soon. Under the leadership of the Psychiatric Association of Turkey, non-governmental organizations operating in the field of mental health has contributed to the emergence of a comprehensive draft. The current draft, after extensive discussion and reiterations for almost a decade, was brought to a state close to its final form and accepted as a draft bill, ready to be legislated in the Turkish Grand National Assembly. This review will discuss the potential impact of the law in matters involving Forensic Psychiatry, and present our recommendations. METHOD: Current draft, which has not yet been finalized, was compared to similar statutes in Massachusetts, USA, and potential benefits and pitfalls were discussed in light of experience with these laws in this jurisdiction. RESULTS: The draft introduces several new concepts and practices which have never existed in Turkey before. It also attempts to organize some of the existing de facto clinical practices in a uniform manner. As a whole, it appears to be in compliance with human rights and related international treaties. However, it is likely that some of the sections might have compliance issues in daily practice. CONCLUSION: In this review, we aimed to draw attention to a number of issues, based on our experience in Massachusetts, USA, where similar laws have been in force for a very long time. Rather than literally comparing the statutes in both jurisdictions, we attempted to emphasize positive aspects as well as likely problems that we might encounter should Turkish draft be legislated in the present form.

Anxiety, depression and concerns of pregnant women during the COVID-19 pandemic.

PURPOSE: In December 2019, the emerging of a novel coronavirus (COVID-19) has influenced the whole world. The current pandemic also triggers several psychological changes. Uncertainties and changes in health practices may cause anxiety, depression, and concerns on vulnerable populations such as pregnant. This study aims to survey the pregnant women to capture the psychological impact and perceptions during the pandemic. METHODS: A total of 297 pregnant women aged ≥ 18 years were enrolled in May 2020. We evaluated the hard-copy survey included questions about demographic and clinical information of patients, 95% confidence intervals of a COVID-19-related questionnaire in a Likert scale and 14-item Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 297 pregnant women were included in this study with a mean age of 27.64. Most patients (82.5%) had concerns about infecting their babies during delivery. The fear of infection of the fetus during delivery revealed elderly age and having anxiety as the unique significant risk factors. Mean HADS-A and HADS-D scores were 7.94 (± 4.03) and 7.23 (± 3.84), respectively. Multivariate analysis showed having anxiety was associated with a high HADS-D score and concern about the inability to reach obstetrician, and being in advanced age, having a high HADS-A score, and concern about the inability to reach obstetrician demonstrated significant effects on HADS-D score. CONCLUSION: We conclude that in future pandemics, communications and reassurance of the patients should be prioritized upon their routine ante-natal care to avoid increased levels of anxiety and even depression.

Perspectives, fears and expectations of patients with gynaecological cancers during the COVID-19 pandemic: A Pan-European study of the European Network of Gynaecological Cancer Advocacy Groups (ENGAGe).

BACKGROUND: The impact of the COVID-19 pandemic on European gynaecological cancer patients under active treatment or follow-up has not been documented. We sought to capture the patient perceptions of the COVID-19 implications and the worldwide imposed treatment modifications. METHODS: A patient survey was conducted in 16 European countries, using a new COVID-19-related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations. FINDINGS: We collected 1388 forms; 592 online and 796 hard-copy (May, 2020). We excluded 137 due to missing data. Median patients' age was 55 years (range: 18-89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID-19, only 17.5% were more afraid of COVID-19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow-up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID-19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3-12) and 8.1 (range: 3.8-13.4), respectively. Multivariate analysis identified high HADS-depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients' anxiety. INTERPRETATION: Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID-19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients' communication and education.

The Effect of Life Skills Training on Functioning in Schizophrenia: A Randomized Controlled Trial. / Sizofrenide Yasam Becerileri Egitiminin Islevsellige Olan Etkisi: Seçkisiz Kontrollü Bir Çalisma.

OBJECTIVE: Psychosocial approaches including occupational therapeutic interventions constitute an important part of mental health treatments. This research was planned to investigate the effects of individualized life skills training on the functionality of individuals diagnosed with schizophrenia. METHOD: A total of 32 individuals diagnosed with schizophrenia were assigned randomly to the study (n=15) and the control groups (n=17). The participants were evaluated with the Positive and Negative Syndrome Scale for symptom severity, the Clinical Global Impression Scale for illness severity and improvement and response to treatment, the Katz Index of Independence in Activities of Daily Living and the Lawton - Brody Instrumental Activities of Daily Living Scale for adequacy of performance of basic activities and tasks of daily living, the Functioning Assessment Short Test and Social Functioning Scale for assessing the level of functionality before and after the scheduled interventions for both groups. The control group received a singlesession awareness training to increase independence in daily living activities and the study group received individualized life skills training in 2 sessions per week for 8 weeks (=16 sessions). RESULTS: At the end of the research program, improvements were observed in the negative symptoms, general psychopathology, severity of illness and independence in basic and instrumental activities of daily living and functioning in the study group as compared to the control group. CONCLUSION: On the basis of the obtained results, we believe that the individualized life skills training may be an effective therapeutic method for the rehabilitation of individuals diagnosed with schizophrenia. The results of our study should be supported by long-term follow-up studies.

A comparative study of detection of myocarditis induced by clozapine: With and without cardiac monitoring.

The aim of this study was to investigate and compare the incidence of suspected or definite cases of clozapine induced myocarditis (SDM) and clinical factors which could influence its onset in two different time periods, defined by pre- and post-cardiac monitoring at an inpatient setting, during the initiation phase of clozapine treatment. Hospital records of patients started on clozapine in the inpatient unit between 2011 and 2018 were investigated. Eight in 38 patients (11.3%) were classified as SDM after the initiation of the monitoring protocol, whereas only 1 in 33 patients (1.4%) was classified as SDM, before. Monitored and non-monitored patient groups were similar with regard to demographic and clinical variables. Diagnosis of schizoaffective disorder and use of concominant lithium, valproic acid and atypical antipsychotics were higher in patients with SDM, while clozapine dose titration was similar compared to the rest of the patients. Cardiac monitoring seems to be the main factor leading to the increase in the detection of clozapine induced myocarditis (CIM). If not monitored, the outcome of CIM can be fatal without any warning signs and symptoms. Concominant use of mood stabilizers including valproic acid and lithium, are important risk factors for the development of CIM.

Compliance in schizophrenia spectrum disorders: the role of clinical pharmacist.

The inability of patients with psychiatric illness to achieve full compliance with treatment during the postdischarge period is a major problem. In this study, our aim was to evaluate whether drug education provided by a clinical pharmacist during discharging period has an effect on compliance. Forty adult patients diagnosed with psychotic disorders were included. A number of scales were used to evaluate the severity of illness, medication adverse effects and compliance. At time of discharge, it was emphasized to patients by a clinical pharmacist that medication compliance was important to prevent exacerbation or hospitalization. Six to eight weeks after discharge, patients were invited to be reevaluated using the same scales as those applied during hospitalization. There was a statistically significant increase in compliance after drug education (P < 0.001). A decrease in the baseline compliance score was associated with an increase in the total number of hospitalizations and the number of psychotropic drugs used. When the risk factors that may affect compliance were evaluated, akathisia was found to have the highest impact on compliance (P = 0.012). It is necessary to take advantage of counseling on medication use and to develop strategies in order to improve compliance in psychiatry.

Do Antiepileptic Drugs Used During Electroconvulsive Therapy Impact Treatment Process?

PURPOSE: Whether the antiepileptic agents used by patients before the treatment should be discontinued after the initiation of the electroconvulsive therapy (ECT), which is one of the most effective treatment options in psychiatry, is a dilemma frequently faced by clinicians. Recently, there has been an increased interest in this subject. This study aimed to determine the impact of antiepileptic agents on ECT process in the event of continued use in the course of the therapy. METHODS: From among the patients on an ECT therapy in the Psychiatry Clinic of Hacettepe University Hospital since 2010, a total of 39 patients who continued to use the antiepileptic agent they were taking prior to the ECT therapy were determined and included in the study. As for the control group, on the list of ECT patients, the 39 patients coming immediately after the patients using antiepileptics were taken up in the study. The patients using antiepileptics were compared with the control subjects on the basis of their sociodemographic characteristics, number of active sessions, energy levels of the past seizures, seizure durations, some clinical outcomes, and characteristics of the first and the last seizures. RESULTS: There were no differences between the control subjects and those using the antiepileptics in terms of average age, body mass index, Clinical Global Impression scores, and sex distribution. Energy levels required to induce the first and the last seizures and total amounts of energy used in active seizures were significantly higher in patients taking the antiepileptics than the control group. Besides, the durations of the first peripheral and central seizures were significantly less in patients using the antiepileptics as compared with the control subjects. When sociodemographic variables and numeric data about the seizures were brought into the equation in the binary logistic regression analysis for determination of being included in either the group of patients taking antiepileptics or the control group, the only meaningful variable was found to be "duration of the first central seizure." CONCLUSIONS: Continued use of the antiepileptics during ECT by the patients to undergo ECT may lead to an increased dose of energy to be used during the therapy. When all variables are taken into consideration, it was determined that the use of antiepileptic significantly shortened purely the duration of the first seizure. In the light of the present results, it does not seem meaningful to suggest as a conclusive requirement to discontinue the antiepileptics used before ECT prior to the commencement thereof.

Does Gender Affect the Relationship Between Anxiety Sensitivity and Social Anxiety?

OBJECTIVE: Although there are studies on the effects of gender and time on social anxiety and anxiety sensitivity, there is no consensus on how these variables moderate the relationship between the two. The aim of this study was to examine the effect of the last year of medical school on social anxiety and to determine the predictors of social anxiety, focusing mainly on gender and anxiety sensitivity. METHODS: The study was conducted at two time points. Demographic Information Questionnaire, Liebowitz Social Anxiety Scale and Anxiety Sensitivity Index (ASI) were given to medical school students at Time 1 (n=153): beginning of 6th year of medical school; and at Time 2 (n=130): end of the 6th year. RESULTS: Male gender predicted social anxiety at Time 1 but not at Time 2. Maternal education negatively predicted social anxiety in males; no prediction was observed for females. Psychiatric illness in the family and ASI scores predicted social anxiety. The total scores of social anxiety and anxiety sensitivity did not change over a course of 10 months. ASI subscale scores were not uniform in predicting social anxiety. CONCLUSIONS: Our results have confirmed the strong relationship between anxiety sensitivity and social anxiety. Higher maternal education appeared to be a protective factor against social anxiety among males but not among females. It is apparent that a whole educational year of internship does not lead to a significant reduction in social anxiety. We also showed that the physical sensations scale of ASI is sufficient to explain the relationship between anxiety sensitivity and social anxiety.

Columellar Scar Perception in Open Rhinoplasty. Interplay of Scar Awareness, Body Cathexis and Patient Satisfaction.

INTRODUCTION: Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however, the resultant columellar scar of the open approach is directly considered as a disadvantage. This study focuses on the columellar scar awareness and its implications on overall satisfaction of the patients after open rhinoplasty. PATIENTS AND METHODS: A total of 91 patients who have undergone open rhinoplasty were included in this study. A written questionnaire algorithm consisting of 4 sequential questions was applied. Except for the first question [Do you have any scar(s) caused by any trauma, operation or any other reason on your face?], every question was answered on a scale from 1 to 5. The respondents were given the 25-question "Modified Body Cathexis Scale (MBCS)"and their scars graded using the "Columellar Scar Assessment Scale" (CSAS). The data were statistically interpreted. RESULTS: Of the 91 open rhinoplasty patients, 12 of them responded with a "yes" to the first question reporting their columellar scars. There was no significant difference with regards to patient satisfaction regarding these patients (p > 0.05). However, those who reported the scar yielded a significantly lower MBCS scores. 9 patients declared that they exerted effort to conceal their scars. Those who concealed their scars and those who did not yielded a significant difference in patient satisfaction. The CSAS scores of those who reported the columellar scar were significantly higher than those who did not. CONCLUSION: Our study suggests that MBSC can be a valuable tool for determining the impact of outcomes from the patient's standpoint, and awareness of the columellar scar is not related to patient satisfaction but with bodily perception. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .