LGBTI Healthcare in Medical Education.

ABSTRACT: Our aim is to reveal the interaction of cultural and religious influences with professional equipment by determining the level of knowledge, sexual attitudes, and homophobia of medical students about LGBTI+ individuals. The study included 324 students from our faculty of medicine. The Hudson and Ricketts Homophobia scale, the Attitudes Towards Lesbians and Gay Men scale, and the Hendrick Sexual Attitudes scale were used with the sociodemograpic data form. Data were collected and analyzed using descriptive and inferential statistical tests. The mean score of the students from the Hudson and Ricketts Homophobia scale was 58.50. The findings of our study support that medical students consider that the education they receive in this regard is inadequate. One of the goals of undergraduate medical education is the provision of health services to all segments of society; therefore, it is recommended to make improvements in the curriculum in this regard.

Is abnormal metabolism in the olfactory bulb and amygdala associated with bipolar disorder?

Accumulated evidence has demonstrated abnormal amygdala activation in bipolar disorder (BD). The olfactory bulb (OB) has vigorous connections with the amygdala. Although odor-related functions of the OB decreased during the evolutionary process, we hypothesized that an evolved OB with increased activation in emotion regulation may be one of the main factors affecting amygdala functions in BD. Our aim was to investigate metabolism in the OB and amygdala in patients with BD. Twenty-six patients diagnosed with BD according to DSM-5 diagnostic criteria were included in this cross-sectional study. Metabolism in the OB and amygdala was assessed using fluorodeoxyglucose positron emission tomography/CT in patients with BD. The OB and amygdala metabolism was compared with the patients' Z scores. Both OB and amygdala metabolic activities were significantly higher than in the controls. A positive correlation was detected between right/left amygdala metabolism and right OB metabolism (p < 0.05, r:467 and r:662, respectively). This study increased our understanding of the etiopathogenesis of BD. In BD, the main cause of hypermetabolism in the amygdala may be increased metabolism in the OB. During evolution, the OB may have assumed a dominant role in emotional processing rather than olfactory functions.

THE EFFECT OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION AND PHARMACOTHERAPY ON SERUM PROTEIN S100B IN TREATMENT-RESISTANT DEPRESSION.

BACKGROUND: Transcranial magnetic stimulation (TMS) is considered an effective and fast option for treating patients with major depressive disorder. With the increase in treatment options, the determination of biomarkers that predict which treatment will benefit patients the most has been a matter of curiosity for researchers. SUBJECTS AND METHODS: In this study, we aimed to determine the changes in serum concentrations of S100B, a neurotrophic factor thought to play a role in psychiatric disorders after repetitive TMS (rTMS) and anti-depressant drugs (AD) therapy in patients with major depressive disorder(MDD).In this cohort study, rTMS was applied to the left dorsolateral prefrontal cortex(DLPFC) of drug-resistant MDD patients, while another group of MDD patients was treated with AD for three weeks. Patients were evaluated by psychometric tests and serum S100B concentration at baseline and following intervention. There was also a healthy control group in which patients' S100B values were compared at baseline. RESULTS: There is a population with a total of 48 participants.(16 healthy controls,16 anti-depressant treatment groups, 16 individuals who received rTMS in addition to anti-depressant ) A total of 48 participants completed the study, and the S100B levels of the rTMS group and the anti-depressant drug group were found to be significantly higher than the healthy control group. S100B values, which were higher in the anti-depressant and rTMS groups compared to healthy controls, showed a significant reduction in group time interaction (start and end of treatment). CONCLUSION: rTMS of DLPFC demonstrated an effective complementary treatment for treatment-resistant patients with MDD, especially for patients with relatively high serum S100B concentrations.

Psychological impact of COVID-19 outbreak on health workers in a university hospital in Turkey.

We investigated the psychological impact of the COVID-19 outbreak in terms of stress, anxiety, depression, sleep quality and affecting factors on healthcare workers (HWs) without secondary trauma thus far in the period between the first cases in Turkey and the arrival of the first case in ahospital. This descriptive cross-sectional study included 169 HWs. We used Impact of Event Scale (IES-R), Depression Anxiety Stress Scale and Pittsburgh Sleep Quality Index (PSQI) for assessment. The mean age of HWs was 33.9±6.9 years and 56.2% were males. Of the HWs; 20.7% were nurses, 33.7% doctors and 45.6% staff members. IES-R classified the HWs as follows: 15.4% of them were affected mildly, 4.7% moderately and 9.5% of them were affected severely. 42.6% of HWs had apoor sleep quality. This study shows that how HWs were affected when the outbreak had not yet reached the hospital in which they work. In total, 29.6% of the HWs were psychologically affected by mild to severe levels from the outbreak in this period. The most prevalent psychological impact was poor sleep quality. Psychological impact on HWs may have begun before the outbreak reached the hospitals; therefore, necessary measures should be taken as early as possible.

The effects of methamphetamine on electrocardiographic parameters in male patients.

OBJECTIVE: We aimed to compare the electrocardiographic parameters in patients with methamphetamine use to healthy controls. METHODS: The study is a cross-sectional case-control study. Sixty-eight patients diagnosed with methamphetamine use disorder (MUD) according to DSM-5 criteria and 65 subjects in healthy control group who can match the patient group with demographic data were included in the study. Heart rate, P wave dispersion, QT dispersion, QTc and Tp-e/QTc ratios were calculated in the ECGs of all participants. RESULTS: The mean age of the patients was 25.60 ± 5.70 and of the control group was 27.43 ± 6.10 (p = 0.076). There was no statistically significant difference between the blood pressure, body mass index, HDL-LDL-total cholesterol and triglyceride values of the participants (p > 0.05). Although QT dispersion was 13.68 ± 9.12 in patients with methamphetamine use disorder, it was calculated as 9.08 ± 7.85 in the control group (p = 0.002). Finally, the Tp-e/QTc ratio of the patients was higher than the healthy controls (p = 0.014). CONCLUSION: In our study, we found a significant deterioration in QT dispersion and Tp-e/QTc ratio in the MUD group. Therefore, it should be kept in mind that there is a risk of malignant arrhythmia in this patient group and care should be taken in terms of arrhythmic events during follow-up in this patient group.Key pointsPatients with methamphetamine use showed significant deterioration in QTd and Tp-e/QTcMethamphetamine users have prolonged Tp-e/QTc ratio and QTdCaution should be exercised in terms of arrhythmic events in methamphetamine users.

Effects of electroconvulsive therapy on nitrosative stress and oxidative DNA damage parameters in patients with a depressive episode.

BACKGROUND: Few studies have investigated the relationship between electroconvulsive therapy (ECT) and markers of nitrosative stress and oxidative DNA damage. OBJECTIVE: The aim of this study is to examine changes in nitrosative stress and oxidative DNA damage in patients with a depressive episode treated with ECT. METHODS: The current study included 48 patients with a depressive episode treated with ECT and 30 healthy control participants. First, the serum nitrosative stress markers of nitric oxide (NO•), nitric oxide synthase (NOS), and peroxynitrite (ONOO-) and the oxidative DNA damage marker 8-hydroxy-2'-deoxyguanosine (8-OHdG) were compared between the study and control groups. These parameters were also compared pre- and post-treatment for the study group. RESULTS: NO•, NOS, and ONOO- levels were significantly higher in patients with depressive disorder (DD) than in the control group. NO• and NOS levels significantly decreased in the ECT group after treatment while 8-OHdG levels significantly increased. CONCLUSIONS: The study findings suggest that ECT may have reduced nitrosative stress levels while increasing oxidative DNA damage. More research is now needed to better understand the issue.KEY POINTSNitrosative stress levels can increase in patients with depressive disorder.Electroconvulsive therapy may reduce nitrosative stress while increasing oxidative DNA damage.These results suggest that nitrosative stress plays an important role in the mechanism of action of electroconvulsive therapy.

Gender Differences in the Symptomatology of Posttraumatic Stress Disorder among Syrian Refugees Settled in a Camp in Turkey.

BACKGROUND: This study firstly described gender differences in traumatic experiences and the symptomatology and posttraumatic stress disorder (PTSD), among Syrian refugees settled in a camp in Turkey. Secondly, we aimed to discuss the reasons for gender differences, by comparing with the studies conducted on these Syrian refugees of the same culture who are the victims of the same war in their new settlement where they had been forced to migrate. SUBJECTS AND METHODS: This cross-sectional study was carried out on 352 refugees, randomly selected from a single settlement. The diagnosis of PTSD was performed using face-to-face psychiatric interviews according to the DSM-IV-TR criteria. The Stressful Life Events Screening Questionnaire and a sociodemographic history form were administered to all participants. We compared our results with other PTSD studies on Syrian Refugees. RESULTS: Men were exposed to traumatic events 1.29 times more frequently than women. However, the prevalence of PTSD was significantly higher in women (44.1%) than in men (18.1%), with a prevalence of 30.7% in the overall sample. While symptoms of intrusion and avoidance/numbing were more prevalent in women with PTSD, there was no difference in symptoms of hypervigilance between genders. However, women reported a higher prevalence of fear response to traumatic events. CONCLUSIONS: Female refugees may be more prone than men to develop PTSD, although both genders shared the same traumatic environment in the early post-traumatic periods. The higher frequency of intrusion and avoidance/numbing may originate from an increased tendency of anxiety structural dissociation among women, alongside possibly higher peritraumatic dissociation, which may be also boosted by the higher ongoing perception of threat among female refugees. The possible role of peritraumatic and ongoing dissociation in PTSD should be taken into consideration for further research, particularly among populations under ongoing threat.

The Effects of Maintenance Electroconvulsive Therapy on Hospitalization Rates.

ABSTRACT: This study aimed to study the effect of maintenance electroconvulsive therapy (mECT) on hospitalization rates in patients who had been readmitted after acute courses of electroconvulsive therapy (ECT), and determine the most frequently used treatment schedules in mECT. Patients who had undergone mECT treatment for the last 5 years were retrospectively reviewed. Seventy patients were included in the study. The control group of 70 patients was selected from patients who received only acute ECT. Of the patients in the mECT group, 55.8% (39) were female, and 41.4% (29) were diagnosed with major depressive disorder. The mean number of patients hospitalized who received mECT after acute ECT was 0.55 ± 0.87, whereas it was 1.13 ± 1.31 in patients who received only pharmacotherapy after ECT in a covariant analysis adjusted for age and diagnosis. The most commonly used initial treatment protocol of mECT was weekly × 4, biweekly × 2, and monthly × 6. mECT is more effective in reducing hospitalization after acute ECT treatments than using psychotropic drugs alone for maintenance therapy.

Substance use profile, treatment compliance, treatment outcomes and related factors in probation: a retrospective file review.

OBJECTIVE: In this study, we aimed to investigate the sociodemographic characteristics of the individuals who mandated to the probation unit as the substances they use, their compliance with the programs, treatment outcomes and the relationships between these parameters. Secondly we aimed to determine the predictive factors that guide in taking protective measures. METHODS: The files of the individuals who applied to probation clinic of Gaziantep 25 Aralik State Hospital between 01.01.2019-31.12.2019 were examined retrospectively. SPSS 22.0 program was used to statistical analysis. RESULTS: Totally 1024 cases were included in the study. Most of the cases were between the ages of 16-35 (84.1%) and 68.3% of individuals were primary school graduates. Most (n: 607, 59.3%) were single in terms of marital status. Substance was detected in the urine of 30.3% of the applicants (n: 311). Among the substances detected in urine, amphetamine-methamphetamine was in the first place with 13.6%. In terms of treatment compliance levels of probation, it was seen that 593 (57.9%) reports were prepared as "no treatment required", 117 (11.4%) were "compliant to treatment" and 303 (29.6%) were "noncompliant to treatment". A statistically significant difference was found between working status and treatment outcomes (p = 0.001). When the first urine result of the patients were grouped as negative and positive; A statistically significant difference was found between the first urine test and the treatment outcomes and criminal score (for both p = 0.001).There was a statistically significant difference between the status of being a probation measure previously and the outcome of treatment (p = 0.019). CONCLUSION: In our study, the most used substance type was found to be amphetamine-methamphetamine (13.6%). Prevalence in substance use appears to be changing. This is an important finding about the prevalence of use of amphetamine-methamphetamine in Turkey. We suggest that those who have irregular jobs in the probation process, those with substance metabolites detected in the first urine, and those who have previously had probation precautions may have a poor prognosis and that it may be more effective to apply to those profiles in a general program that includes social and occupational fields.

Efficacy and Safety of Electroconvulsive Therapy in Adolescents: A Retrospective Chart Review Study From Turkey.

OBJECTIVE: The aim of this study was to report the efficacy and safety of electroconvulsive therapy (ECT) in manic, depressed, psychotic, and catatonic adolescent patients. METHODS: Medical records of 78 adolescents who had received ECT in Department of Psychiatry, Gaziantep University Medical Faculty, during 2011 to 2017 were reviewed. Sixty-two subjects in this sample were identified to have complete records and met the study inclusion criteria. RESULTS: The mean ± SD age of subjects was 17.11 ± 1.04 years and female sex was 53.2% (n = 33). Primary the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses were bipolar mood disorders (n = 33, 53.2%), major depressive disorder (n = 16, 25.8%), schizophrenia (n = 8, 12.9%), and schizoaffective disorders (n = 5, 8.1%). Electroconvulsive therapy was significantly effective in treating manic, depressive, psychotic, and catatonia symptoms as evidenced by significant differences in pretreatment and posttreatment scores in outcome measures including Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression-Severity Scale (P < 0.001). Presence of comorbidity adversely affected treatment response (P = 0.001). However, ECT was also effective in those with comorbid diagnoses (P < 0.001). Depressive symptoms in patients with bipolar depression responded better than those with unipolar depression (P = 0.012). Electroconvulsive therapy was generally safe with subjective memory complaints (85%), headache (69%), and prolonged seizure (8%) as the reported adverse effects possibly related to ECT. Four subjects (6%) developed a manic switch during ECT. CONCLUSIONS: Electroconvulsive therapy is an effective and a safe treatment option in adolescent patients with severe and resistant psychopathology. Although comorbidity may decrease treatment response, ECT seems to be effective even in the presence of multiple psychiatric diagnoses.

The Use of Lorazepam and Electroconvulsive Therapy in the Treatment of Catatonia: Treatment Characteristics and Outcomes in 60 Patients.

OBJECTIVES: Lorazepam and electroconvulsive therapy (ECT) are effective treatments for catatonia. However, systematic data on these treatments in catatonia are limited. In the present study, we aimed to investigate the clinical and treatment-related characteristics of patients with catatonia who underwent lorazepam and/or ECT. METHODS: Between January 2012 and December 2016, we received 60 patients with catatonia hospitalized in the Gaziantep University Faculty of Medicine Clinic of Psychiatry. Lorazepam and/or ECT were used in the patients' treatment schedule. Treatment results were evaluated using the Bush-Francis Catatonia Rating Scale and Clinical Global Impression-Improvement. RESULTS: Thirty-five patients (58.3%) in the sample were in their first catatonic episode. The most common comorbidity was mood disorder (n = 34, 56.7%), whereas the most frequent catatonic sign was mutism (n = 43, 71.7%). Moreover, 31 patients (51.7%) had some form of medical comorbidity. Cerebral abnormalities were detected in computed tomography/magnetic resonance imaging in 22 patients (36.7%). Furthermore, 95% of the patients (n = 57) fully recovered after administration of the treatment. CONCLUSIONS: Lorazepam is a reasonable initial choice in the treatment of catatonia, with rapid consideration for ECT if there is no rapid response to lorazepam.

Evaluation of oxidative metabolism and oxidative DNA damage in patients with obsessive-compulsive disorder.

AIMS: There are limited published data about the role of oxidative stress in the pathophysiology of obsessive-compulsive disorder (OCD). In addition, oxidative stress and oxidative DNA damage have not been investigated together in OCD. In this study, we aimed to evaluate oxidative stress and oxidative DNA damage in patients with OCD. METHODS: Forty-two patients with OCD who were diagnosed in the Psychiatry Clinic of Gaziantep University and 38 healthy volunteers were enrolled in the study. Serum 8-hydroxideoxiguanosine (8-OHdG), total antioxidant status, total oxidant status evaluation and oxidative stress index calculation were conducted in Gaziantep University Biochemical Laboratory. RESULTS: There were no significant differences in the total antioxidant status, total oxidant status and oxidative stress index levels between the patients and control group. However, 8-OHdG levels were significantly higher in OCD patients than controls (P = 0.022). In addition, 8-OHdG levels were significantly lower in patients who took treatment than in patients who were newly diagnosed (P = 0.016). CONCLUSIONS: In our study, we found that oxidative DNA damage increased in OCD patients even though oxidative stress was normal. In addition, DNA damage was lower in patients who were treated compared to those without treatment.

Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study.

OBJECTIVE: Refugees have had major challenges to meet their health care needs throughout history especially in war zones and natural disaster times. The health care needs of Syrian refugees have been becoming an increasingly important issue. We aimed to examine the prevalence of post-traumatic stress disorder (PTSD) and explore its relation with various socioeconomic variables among Syrian refugees, who sought asylum in Turkey. METHODS: This cross-sectional study was conducted in a tent city. Sample size calculation yielded 352 and the participants of the study were determined randomly. Experienced and native Arabic speaking, psychiatrist evaluated the participants. RESULTS: The frequency of PTSD was 33.5%. Through the binary logistic regression analysis, we calculated that the probability of having PTSD among Syrian refugees in our sample was 71%, if they had the following features: with female gender; being diagnosed with psychiatric disorder in the past; having a family history of psychiatric disorder; and experiencing 2 or more traumas. CONCLUSIONS: The findings of our study suggest that PTSD among Syrian refugees in Turkey might be an important mental health issue in refugee camps especially among female refugees, who were exposed to 2 or more traumatic events and had a personal or family history of psychiatric disorder.

Are oxidative stress markers useful to distinguish schizoaffective disorder from schizophrenia and bipolar disorder?

OBJECTIVE: Schizoaffective disorder is a disease with both affective and psychotic symptoms. In this study, we aimed to compare oxidative metabolism markers of schizoaffective disorder, bipolar disorder and schizophrenic patients. Furthermore, we also aimed to investigate whether schizoaffective disorder could be differentiated from schizophrenia and bipolar disorder in terms of oxidative metabolism. METHODS: Total oxidant status (TOS) and total antioxidant status (TAS) were measured in the blood samples that were collected from schizoaffective patients (n = 30), bipolar disorder patients (n = 30) and schizophrenic patients (n = 30). Oxidative stress index (OSI) was calculated by dividing TOS by TAS. RESULTS: TOS and OSI were found to be higher in patients with schizoaffective disorder compared with those in schizophrenia and bipolar disorder patients. TAS was not significantly different between the groups. CONCLUSION: Schizoaffective disorder was found to be different from bipolar disorder and schizophrenia in terms of oxidative parameters. This result may indicate that schizoaffective disorder could differ from bipolar disorder and schizophrenia in terms of biochemical parameters. Increased TOS levels observed in schizoaffective disorder may suggest poor clinical course and may be an indicator of poor prognosis.