Addictive smartphone use in the elderly: relationship with depression, anxiety and sleep quality.

BACKGROUND: The aim of the present study was to explore the relationship between addictive smartphone use (ASU) and depressive symptoms, anxiety and sleep quality in elderly adults. METHODS: The study sample included smartphone users over the age of 65 years. The research data were obtained from social networking sites via a Google survey link. In addition to filling out a sociodemographic data form, the participants were also assessed with Smartphone Addiction Scale (SAS), Geriatric Depression Scale, Beck Anxiety Inventory and Pittsburgh Sleep Quality Index tools. RESULTS: The correlation analysis revealed the SAS score to be positively correlated with depression and anxiety, and negatively correlated with sleep quality. In the regression analysis, depressive symptoms, anxiety level and sleep quality were all found to have an effect on the SAS total score. Furthermore, the SAS score was found to have an effect on depressive symptoms, anxiety and sleep quality. CONCLUSIONS: Our findings reveal a bidirectional relationship between ASU and depressive, anxiety symptoms and impaired sleep quality in elderly adults. It is important to question smartphone use patterns in people with sleep problems, symptoms of depression or anxiety.

Effects of Beliefs, Conspiracy Theories, and Vaccine Hesitancy on the Vaccination Status of Patients with Severe Mental Illness in a Tertiary Psychiatric Care Hospital in Türkiye.

Background: The aim of the study was to investigate the relationship between the vaccination rates and vaccine hesitancy and the adoption of conspiracy theories by patients with severe mental illness in Türkiye. Methods: Ninety-eight outpatients with schizophrenia and 105 outpatients with bipolar disorder were included. A sociodemographical data form, a survey on beliefs and conspiracy theories on vaccines and Vaccine Hesitancy Scale were obtained. Vaccinated and unvaccinated groups were compared and evaluated separately for patients with schizophrenia and bipolar disorder. Results: Sixty-one (62.24%) patients in the schizophrenia group and 86 (81.90%) patients in the bipolar disorder group were vaccinated, and the vaccination rate in the schizophrenia group was significantly lower (P = .002). There was no significant difference in terms of Vaccine Hesitancy Scale scores or adoption of any particular conspiracy theory between patients with schizophrenia and bipolar groups. However, vaccinated and unvaccinated patients of schizophrenia and bipolar disorder groups differed in terms of adopting beliefs and conspiracy theories on vaccines. Sixty-five (75.58%) of the vaccinated patients in the bipolar group agreed with the statement "vaccines are safe," while this rate was 8 (42.11%) in the unvaccinated patients (P = .004). In the schizophrenia group, however, the main difference between the vaccinated and unvaccinated patients was adopting the beliefs that "vaccines have serious side effects" and "vaccines may cause homosexuality" (P = .0341 and P = .003, respectively). Conclusion: The vaccination status of patients with schizophrenia might be under the stronger influence of conspiracy theories and specialized mental health interventions may be needed to ensure vaccination in patients with schizophrenia.

Preventive and Therapeutic Mental Health Care after the Earthquake- Expert Opinion from the Psychiatric Association of Turkey. / Deprem Sonrasi Erken Dönemde Koruyucu ve Tedavi Edici Ruh Sagligi Hizmeti-Türkiye Psikiyatri Dernegi Uzman Görüsü.

Two major earthquakes hit Turkey at the Kahramanmaras region on February 6th 2023. The earthquakes affected almost 15 million individuals, resulting in more than forty thousand deaths, thousands of wounded and the destruction of ancient cities of humankind. Immediately after the earthquakes, the Psychiatric Association of Turkey organized an educational event to address the needs for a guidance on how to approach a trauma of such a big scale. The experts in this educational event summarized their presentations and prepared this review to guide the mental health professionals serving victims of this disaster. The review summarizes the early symptoms of trauma, and puts a framework on the principles of psychological first aid, the approach at the initial stages of the disaster, principles of planning, triage, and psychosocial support systems and the proper use of medications. The text covers the evaluation of the impact of trauma, aligning psychiatric practice with psychosocial interventions, the improvement of counseling skills and methods to better understand the mind during the acute post trauma phase. A set of presentations highlight the challenges in child psychiatry, brings a systematic overview to the earthquake and discuss the symptomatology, first aid and intervention principles in children and adolescents. Last, the forensic psychiatric perspective is presented, followed by a piece on the essentials of delivering bad news and the review is concluded with the emphasis on burnout, a syndrome to avoid particularly for field professionals, and possible preventive measures. Keywords: Disaster, trauma, psychosocial support, psychological first aid, acute stress disorder, post traumatic stress disorder.

Persistent genital arousal disorder misdiagnosed because of Islamic religious bathing rituals: a report of three cases.

Persistent genital arousal disorder is not well known or adequately understood by physicians. The disorder is characterized by a persistent and highly unwanted state of genital arousal and orgasm-like feelings. Ghusl is an ablution in Islamic culture, which is an obligatory ritual wherein the body is washed thoroughly after exposure to religious contaminants such as sexual intercourse, menstruation, and childbirth. Muslim women suffering from the disorder may bathe frequently because of their religious beliefs. The authors summarize the case histories of 3 patients with persistent genital arousal disorder who were initially misdiagnosed with obsessive-compulsive disorder. All 3 patients presented with complaints of unwanted, persistent orgasms or orgasm-like arousals, and as a result, they performed ghusl several times a day. At previous interviews, the genital arousal was diagnosed as a sexual and somatic obsession, and repeatedly performing ghusl was considered a cleansing compulsion. Physicians' lack of awareness or knowledge of persistent genital arousal disorder, combined with the unwillingness of patients to discuss sexual problems, can lead to a focus on the repetitive bathing, and thus, a misdiagnosis of the problem as obsessive-compulsive disorder. These cases are presented to highlight the possible pitfalls in the diagnosis of persistent genital arousal disorder cases in Islamic countries where ghusl is common.

The Relationship of Theory of Mind and Attachment Characteristics with Disease Severity in Social Anxiety Disorder.

INTRODUCTION: The aim of our study is to compare the attachment characteristics and the theory of mind abilities measured by the Eyes Test between social anxiety disorder (SAD) patients and healthy controls. Another aim of our study is to investigate the relationship between attachment characteristics, theory of mind abilities and disease severity in patients with SAD. METHOD: 47 consecutive patients with SAD and 50 healthy controls were recruited for the study. Sociodemographic data form, SCID-I Structured Clinical Interview form Patient Version, Beck Depression Inventory (BDI), Reading Mind in the Eyes Test (Eye Test), Liebowitz Social Anxiety Scale (LSAS), Experiences in Close Relationship Inventory (ECR) and State-Trait Anxiety Inventory (STAI) were administered to all participants. RESULTS: The BDI, LSAS anxiety and avoidence, ECR and anxiety and avoidance, STAI state and trait anxiety scores of the SAD group were higher than the controls, but the Eyes Test scores were lower. It was observed that the Eyes Test score difference between the two groups survived when controlled for BDI and STAI state and trait anxiety scores. In the SAD group, both ECR anxiety and avoidance scores were associated with LSAS anxiety and avoidance scores. Eyes Test scores were associated with LSAS anxiety and avoidance scores. In regression analysis, it was observed that the Eyes Test, ECR anxiety and avoidance scores effected both the LSAS anxiety and the LSAS avoidance scores. CONCLUSION: In SAD patients, the theory of mind functions was impaired when compared to healthy controls, and this difference has been found to be independent of anxiety or depression levels. Attachment anxiety and avoidance dimensions have negative effects on SAD disease severity. The fact that the theory of mind ability is inversely related with SAD severity suggests that interventions to improve social cognition might have a potential to decrease the severity of disease in SAD.

[Editorial: Telepsychiatry Throughout and Thereafter The Pandemic].

COVID-19 pandemisinin iki yili boyunca saglik hizmetlerine erisimin zorlasmasi saglik alanindaki tüm aktörlerin baslica gündem maddelerinden birini olusturdu. Pandemi sirasinda tüm toplu alanlarin, özellikle de saglik merkezlerinin riskli oldugu anlasildi. Ardindan psikiyatrik hastaligi olanlarin COVID-19 enfeksiyonuna yakalandiklarinda daha yüksek ölüm riski altinda olduklari da anlasildi (Nemani ve ark. 2021). Dolayisiyla bu grubun saglik merkezlerinde bulunmasi daha da büyük risk olusturacakti. Saglik hizmeti sunmak üzere kurulmus karmasik bir hizmet yapisinin saglik açisindan ciddi riskler barindirmasi gibi bir paradoks karsisinda hekimler ve meslek örgütleri temel etik ilkelere dönerek karar almak durumundaydilar: " zarar vermeme" ilkesi çerçevesinde acil ve ciddi saglik sorunlari haricinde saglik merkezlerine basvurulmamasi önerildi. Bu durum saglik hizmetlerinde ciddi aksamalara neden olacagi için, bu kez "yararlilik" ilkesi çerçevesinde telesaglik hizmetleri küresel çapta hizla yayginlasti. Telesaglik uygulamalari gerekli altyapidan yoksun ve saglik alaninda deneyim kisitli oldugu için saglik çalisanlari bir bakima el yordamiyla da olsa saglik hizmetlerini sürdürme yönünde inisiyatif aldilar. Tarihi, kavramsal olarak Sigmund Freud'un Küçük Hans vakasi, pratik anlamda ise 1964 yilinda Nebraska Üniversitesi ile 112 mil uzakliktaki Norfolk Kamu Hastanesi arasinda kurulan çift yönlü televizyon yayini ile baslatilabilecek olan telepsikiyatri (Artvinli ve Senyürek 2021), teknolojinin yayginlasmasina paralel olarak pandemi öncesinde de gittikçe yayginlasmaktaydi (Barnett ve ark. 2018). Pandemi basladiktan sonrasinda ise birçok ülkede telepsikiyatri görüsmeleri psikiyatri hizmetlerinde temel uygulama biçimini olusturmaya basladi (Mishkind ve ark. 2020). Ülkemizde de, bu yönde literatür verisi olmasa da, özellikle özel saglik hizmetlerinde telepsikiyatri uygulamalarinin yüz yüze görüsmelerinden daha yaygin biçimde kullanildigi gözlemlendi. Bunun yaninda kurumsal olarak Saglik Bakanliginin dr.enabiz.gov.tr sitesi üzerinden görüntülü görüsme uygulamasi, saglik çalisanlarina yönelik Türkiye Psikiyatri Derneginin Ruhsal Destek Hatti (Çapraz ve ark. 2020) ve Saglik Bakanliginin RUHSAD projesi (Hacioglu 2020), Istanbul Il Saglik Müdürlügü tarafindan koordine edilen KORDEP (Bilici 2020) gibi telepsikiyatri projeleri gerçeklestirildi.. Telepsikiyatride ideal uygulamanin nasil olacagi ile ilgili pandemi sirasinda çesitli kilavuzlarin gerekliligine vurgu yapildi ve birçok ülkede kilavuzlar yayinlandi ya da güncellendi (Li ve ark. 2021). Türkiye Psikiyatri Dernegi de meslektaslara yönelik kilavuzlar hazirlamanin sorumlulugu ile pandemiden önce yayinladigi telepsikiyatri metinlerine ek olarak, genis kapsamli Telepsikiyatri Uygulama Rehberini internet sitesinde açik erisimli olarak yayinladi (Karas ve ark. 2022). Vaka sayilarinin son zamanlarda azalmasi ve mortalitenin düsüse geçmesi ile birlikte kisitlamalar da Türkiye dahil olmak üzere çogu ülkede hafifletildi. Dolayisiyla telepsikiyatriye olan gereksinim pandemi disindaki gerekçelerle devam ediyor olsa da pandemi dönemindeki düzeyde degildir. Çalismalar her ne kadar telepsikiyatri ile ilgili hasta ve hekim memnuniyetinin yüksek ve etkinligin yüz yüze uygulamalara denk oldugunu gösterse de uygulama ile ilgili kuskular henüz tamamen ortadan kalkmis degil. Bu konuda meslek örgütleri yüz yüze görüsmenin altin standart oldugu ve yararlilik ilkesi geregince öncelikli olarak tercih edilmesi gerektigini vurgulamaktadir (Dünya Tabipler Birligi 2018, Türk Tabipleri Birligi 2021). Dolayisiyla telepsikiyatrinin pandemi sonrasinda hangi Gelis Tarihi: 27.05.2022, Kabul Tarihi: 07.06.2022, Çevrimiçi Yayin Tarihi: 16.06.2022 1 Dr. Ögr. Üyesi, Istanbul Gelisim Üniv. Psikoloji Bl., Istanbul, 2 Uzm., Serbest Hekim, Istanbul. HK: https://orcid.org/0000-0002-9391-5415, IK: https://orcid.org/0000-0002-9073-0079 Dr. Hakan Karas, e-posta: hakankaras@yahoo.com https://doi.org/10.5080/u27177 A4 durumlarda uygulanabilecegi sorusu üzerine daha çok düsünmemiz gerekiyor. Telepsikiyatrinin pandemi sonrasindaki kullanimini etik açidan gözden geçirirken "yararlilik" ilkesine farkli baglamlarda deginmek gerekecektir. Yüz yüze hizmetin altin standart oldugu göz önüne alindiginda telepsikiyatri hizmetinin yüz yüze psikiyatrik hizmete erisebilen hastalara önerilmesinin "yararlilik" ilkesi ile çelisebilecegi akilda tutulmalidir. Yine, "yararlilik" ilkesi çerçevesinde özellikle saglik hizmetlerine erisimi sinirli olabilen engelli bireyler, peripartum dönemdeki kadinlar ve hastalara bakim veren kisiler için potansiyel kullanim alani olabilir. Ayrica kirsalda cografi nedenlerle psikiyatriste yeteri kadar ulasamayan kisiler veya Toplum Ruh Sagligi Merkezleri gibi toplum temelli uygulamalarda daha etkin ulasim için telepsikiyatri olanak sunmaya devam edebilir. Afet ve travmaya iliskin bilgi ve deneyim birikimi sonraki kitlesel travmalara da aktarilabilir. Ayrica istemli ya da istemsiz biçimleriyle göçün oldukça yayginlastigi bir dönemde ve cografyada bulunma sebebiyle, ana dilde hizmet alma gereksiniminin oldugu durumlarda da telepsikiyatri önemli bir seçenek olabilir. Bundan sonraki süreçte "özerklik" ilkesi de göz ardi edilmemelidir. Hastanin fiziksel durumu veya konumu ne olursa olsun telepsikiyatri hizmetinin dayatilmamasi ve ancak bir seçenek olarak sunulabilir olmasi gerekmektedir. Özerklik ilkesi tersi durum için de geçerlidir. Telepsikiyatri uygulamalarinin avantaj ve dezavantajlari tarif edilip, yüz yüze uygulamanin altin standart oldugu net biçimde belirtildikten sonra karar verme yetisine sahip her hasta telepsikiyatri hizmetini tercih edip etmeyecegi konusunda özerk biçimde karar alabilmelidir. Yine bu ilke dogrultusunda telepsikiyatri hizmetinden yararlanma karari vermis bir hastanin kararini herhangi bir asamada degistirmis olmasindan dolayi bir hak kaybina ugramayacaginin da temin edilmesi gerekmektedir. "Zarar vermeme" ilkesini gözetirken hastanin görüsme sirasinda hem teknoloji hem de fiziki kosullar açisindan mahremiyetini koruma kapasitesinin olup olmadigi degerlendirilmelidir. Bu gibi durumlarda kurum içi telepsikiyatri uygulama olanaklari göz önüne alinabilir. Örnegin afet durumlarinda çadir kentlerde saglik görüsmeleri için ses izolasyonu saglanmis görüsme odalari bu amaçla kullanilabilmektedir. Ayrica teknolojik temalari içeren sanrilari olan hastalarda telepsikiyatrik hizmetlerin bu sanrilari alevlendirme riski de göz önünde bulundurulmalidir. Hekimligin diger bir temel ilkesi olan "adalet" de telepsikiyatri uygulamalarini degerlendirmede bir unsur olmalidir. Telepsikiyatrik hizmetle ilgili karar verme sürecinde hastanin saglik hizmetine hiç ulasamamasi kadar "yeterince" ulasamama durumu da göz önünde bulundurulmalidir. Kirsalda yasayan bir hastanin hastaneye ulasimi olsa da yeterince sik olamayisi, örnegin taburculugunda bir hafta sonra ayaktan kontrolüne gelebilen sehirde yasayan bir hastaya göre daha kötü hizmet almasi ve belki de daha fazla ilaç yan etkisi yasamasi ile sonuçlanabilir. Bu gibi durumlarda telepsikiyatri uygulamalari ile yüz yüze görüsmeleri birlikte barindiran, yapilandirilmis melez modeller ile saglik hizmeti sunumunda adalet ilkesi kismen de olsa tesis edilebilir. Bu dogrultuda bir telepsikiyatri uygulamasi yapilandirilirken de hedef kitlenin saglik hizmetine ulasmakta zorlanan dezavantajli gruplardan seçilmesi gerekmektedir. Yine de bu dezavantajli gruplarin saglik hizmetine ulasmakta zorlandiklari gibi telepsikiyatri uygulamalarinda gerekli teknolojiye de ulasmakta (örnegin kirsal bölgelerde bant genisligi ve internet baglanti hizlarinin düsük olusu) ya da kullanmakta da (örnegin bedensel engellilik nedeniyle teknolojik cihazlari kullanmakta zorlanma) zorlanabilecekleri akilda tutulmali, uygulamalar bu unsurlari da göz önüne alarak hazirlanmalidir. Sonuç olarak telepsikiyatri uygulamalari pandemi döneminde bir zorunluluk olarak mesleki pratigimize girmis olsa da pandeminin bitmesi ile telepsikiyatriye olan gereksinim ortadan kalkmamistir. Bu yeni ve uzun vadede sonuçlari henüz tam olarak bilinmeyen uygulama alaninda psikiyatristler temel etik ilkeleri gözönüne almaya devam ettikleri sürece güvenli ve etkili biçimde hizmet sunmaya devam edebilirler. KAYNAKLAR Artvinli F, Senyürek G (2021) Yakin gelecegin uzak geçmisi: Telesaglik tarihi. Telesaglik Temel Basvuru Kitabi içinde (Küçükparlak I, Karas H., Editörler), Nobel Tip Kitabevleri, s. 3-29 Barnett ML, Ray KN, Souza J ve ark. (2018) Trends in telemedicine use in a large commercially insured population, 2005­2017. JAMA 320:2147­79. Bilici R (2020) Istanbul Koronavirüs Ruhsal Destek Programi: KORDEP'e bir bakis. TPD Bülteni, 23:1 Capraz N, Erim BR, Kucukparlak I ve ark. (2020) A specific mental health intervention for healthcare workers in Turkey. Asian J Psychiatr 54: 102315. Dünya Tabipler Birligi (2018) Teletip Etigiyle Ilgili Dünya Tabipler Birligi Açiklamasi. 27 Mayis 2022'de https://www.ttb.org.tr/userfiles/files/dtb_ teletip.pdf adresinden indirildi Hacioglu Yildirim M (2020) RUHSAD: Saglik Bakanligi Saglik Çalisanlari ve Çocuklari Için Ruhsal Destek Sistemi. TPD Bülteni, 23:1 Karas H, Küçükparlak I, Erkan A ve ark. (2022) Telepsikiyatri Uygulama Rehberi. Türkiye Psikiyatri Dernegi Yayinlari Li H, Glecia A, Kent-Wilkinson A ve ark. (2022) Transition of mental health service delivery to telepsychiatry in response to COVID-19: a literature review. Psychiatr Q 93: 181-97. Mishkind M, Shore JH, Bishop K ve ark. (2020) Rapid conversion to telemental health services in response to COVID-19: experiences of two outpatient mental health clinics. Telemed e-Health 27: 778-84 Nemani K, Li C, Olfson M ve ark. (2021) Association of Psychiatric Disorders With Mortality Among Patients With COVID-19. JAMA Psychiatr 78:380­86. Türk Tabipler Birligi (2021) Teletip Uygulamalarina Yönelik Türk Tabipleri BirligiEtik Kurulu Görüsü. 27 Mayis 2022'de https://www.ttb.org.tr/ haber_goster.php?Guid=c0766012-4f83-11eb-b1e9-666ef27369b5 adresinden indirildi

Investigation of the reliability of the "reading the mind in the eyes test" in a Turkish population.

OBJECTIVE: The "Reading the Mind in the Eyes Test"(RMET) is one of the most widely used tasks for examining the Theory of Mind. In this study, the goal was to determine the reliability of a Turkish version of the RMET and the distribution of the results in a healthy population. METHOD: The original test is made up of 36 pictures of solely the eye region of different individuals. Subjects are asked to choose the option that best describes the mental state of individual in the picture. After 3 piloting studies each conducted with different sets of 8 people, 2 items (25 and 35) in which most of the subjects consistently replied to foil words, were excluded in final step. 117 healthy volunteers were given the test, and 70 of these individuals were re-tested two weeks later. The Bland and Altman method was used to examine test re-test reliability RESULTS: The mean value of the number of correct responses was 24.46 (SD=3.44) for the test and 24.13 (SD=4.36) for the re-test. No significant difference was shown between test and re-test results (p=0.815). After excluding items 19 and 21 which failed to show reliability, the mean correct response rates were 23.64 (SD=3.38) and 23.40 (SD=4.32), respectively. The educational level significantly affected the correct response rates. CONCLUSION: The Turkish version of the RMET was found to be reliable in a healthy population. The educational level should be taken into account. The 32-item version of the Turkish RMET can be used to evaluate the social, cognitive and emotional processes in adults.