Effect of COVID-19 Pandemic on Sleep Quality and Mental State of Frontline Pulmonologists.

Introduction: This study aims to determine the sleep quality and its relationship with anxiety and depressive symptoms, working conditions and other factors among the frontline pulmonologists on active duty during the COVID-19 pandemic. Method: An online survey was conducted among pulmonologists in Turkey. The survey link was e-mailed to the members of the professional societies of pulmonologists. The volunteers were asked to fill in questions about their sociodemographics, medical and psychiatric history, working and housing conditions, perceived levels of support during the pandemic, as well as the sleep habits before the pandemic. Also, questions investigating the severity/level of their worries were inquired and they were asked to fill in two scale forms (the Hospital Anxiety Depression Scale and Pittsburgh Sleep Quality Index-PSQI). Results: The sample consisted of 179 pulmonologists who were divided into two groups according to PSQI as good sleepers (PSQI ≤5) and poor sleepers (PSQI >5). It was observed that 59.2% of the participants had poor sleep quality during the pandemic. Being anxious (p<0.0001, Odds ratio [OR]=0.139, 95% Confidence Interval [CI] [0.052-0.372]), working in intensive care unit (p=0.046, OR=2.363, 95% CI [1.015-5.497]), worry level about excessive increase of the number of patients above the capacity of the institution they worked in (p=0.018, OR=1.755, 95% CI [1.102-2.794]) and being dissatisfied with ones' sleep before the pandemic (p<0.016, OR=0.272, 95% CI [0.094-0.786]) were found to be the main factors that negatively affected the quality of sleep of pulmonologists during the pandemic. Conclusion: More than half of the pulmonologists in our sample group had low sleep quality during the pandemic. For establishing a good sleep regime for clinicians, its crucial to consider certain interventions on the affecting factors.

Training the trainers: Finding new educational opportunities in the virtual world.

The COVID-19 pandemic has disrupted scientific gatherings and conferences, opening up opportunities for virtual learning platforms. Realizing the potential of online academic exchanges, the World Psychiatric Association (WPA) also developed virtual avenues and information systems for capacity building of mental health professionals across the world. Among its first such initiatives, the WPA organized a virtual Train the Trainers workshop, where 123 psychiatrists, psychiatric trainees, and educators from 45 countries participated. The innovative and interactive workshop allowed participants to get to know each other, exchange educational and professional experiences, and ask questions or receive advice from experts. Keynote speakers, including WPA President Prof. Afzal Javed and Prof. Norman Sartorius, stressed upon the importance of finding innovative solutions in psychiatry training and the need to improve teaching and training in the field of psychiatry, especially in the provision of leadership and communication skills. Online training methods can provide easy access to academics and students while reducing the organizational and logistical costs. They have the potential to improve educational equality and allow the voice of the underprivileged scientists to be heard across the globe. The devastating impact on access to mental health services during COVID-19 underscores the urgent need for online training, particularly in countries where the ratio of psychiatrists to patients is inadequate and doctors concentrate more on treatment than on research and education. Virtual educational interventions could prove incredibly useful in the future just as they are being successfully utilized in local and regional contexts during the pandemic.

Burnout in Healthcare Professionals During the Covid-19 Pandemic in a Tertiary Care University Hospital: Evaluation of the Need for Psychological Support. / Üçüncü Basamak Bir Üniversite Hastanesinde Covid-19 Pandemisinde Saglik Çalisanlarinda Tükenmislik: Psikolojik Destek Ihtiyacinin Degerlendirilmesi.

OBJECTIVE: Anxiety, stress and burnout are observed in healthcare workers during the Covid-19 pandemic. This study aimed to determine the levels of anxiety and burnout and related risk factors in the healthcare workers and assistant personnel at a tertiary referral university hospital. METHOD: Hospital Anxiety Depression Scale (HADS), Maslach Burnout Inventory (MBI) and a sociodemographic questionnaire were delivered on-line to all employees of our hospital. 683 individuals were to the study who completed and returned the forms between April 15-30, 2020. RESULTS: Stress, depression and anxiety levels were significantly higher in nurses. Emotional burnout and depersonalization symptoms were higher and personal accomplishment scores were lower in resident physicians and nurses in comparison to the other groups. Being single, having a child and living away from home were factors underlying the burnout severity. Frontline work in the Covid-19 clinics did not affect the levels of anxiety, stress and depression. On the basis of the cut off points of the HADS scores; anxiety disorder (OR: 7.19) and depression (OR 3.43) were the most relevant risk factors for emotional exhaustion. Anxiety disorder was also the main risk factor for depersonalization. Depersonalization was 2.7-fold more among the nurses complaining of being overworked. Social support from the work environment and the family was protective against depersonalization. CONCLUSION: Covid-19 pandemic has adversely affected the wellbeing of healthcare workers. The presence of depression and anxiety increased the risk of burnout. Social support can be expected to protect against burnout. It is, therefore, of great importance to implement urgently effective psychosocial and organizational interventions in order to protect the mental health of healthcare workers and to prevent burnout.

A longitudinal study of lateral ventricle volumes in deficit and non-deficit schizophrenia.

Although it is generally accepted that negative symptoms of schizophrenia are associated with larger lateral ventricles, this general assumption could not be validated in patients with primary negative symptoms. To elucidate this issue, we conducted a five-year longitudinal study, including deficit (n = 13) and non-deficit (n = 26) schizophrenia patients with healthy controls (n = 18). Analysis with linear mixed effects modeling showed that both the left and the right lateral ventricles of the deficit patients enlarged more than the non-deficit patients. Our results suggest that structural alterations in deficit patients might follow a different trajectory than those in non-deficit patients.

Testing an Internet-Based Turkish Obesity Behavioral Therapy Program: A Randomized Study. / Internet Tabanli Türkçe Obezite Davranisçi Terapi Programinin Test Edilmesi: Bir Seçkisiz Çalisma.

OBJECTIVE: Behavioral treatment is recommended as the first line intervention for the prevention of health problems pertaining to obesity. Internet-based programs are used to provide cognitive behavioral therapy for psychiatric disorders and systemic diseases to a large number of patients at low cost. The aim of this study is to develop the first internet based Turkish obesity behavioral therapy program and test its short-term effectiveness. METHOD: A Turkish web-based behavioral therapy program based on the behavioral strategies employed in the Diabetes Prevention Program was generated. In order to test the effectiveness of this internet-based program an eight week randomized study was conducted. A total of 101 overweight participants with body mass index in the 25-40 range were randomly assigned to an eight-week weight loss program using either the Internet Behavior Therapy (IBT, n=51) or e-mail education (EE, n=50). The participants in the IBT group were provided access to an Internet program that provided videos teaching behavioral weight-loss skills as well as a self-monitoring platform to calculate the daily calorie balance. The participants in the EE group received weekly e-mails with information on healthy eating, physical exercises and weight loss for eight weeks. The primary outcome measure was the observed weight change at the end of the 8 weeks. RESULTS: In the analyses wherein baseline weight was carried forward for missing data, the IBT produced significantly larger mean weight loss in comparison to the EE at the end of the 8 weeks [2.28 kg (2.11) vs. 0.74 kg (1.57), p=0.001]. The participants in the IBT group, when compared to the EE group, were also more likely to achieve a clinically significant weight loss of 5% of their initial body weight at the end of the 8-week study period (17.6% vs. 2%, p=0.016). CONCLUSION: The participants who received a structured IBT intervention lost significantly more weight after two months, compared to those who received weekly informational emails regarding weight loss. Internet-based behavioral therapy programs may have the potential to serve as a low-cost alternative for obese patients.

Investigating Connectivity of Orbitomedial Prefrontal Region in a Patient with Traumatic Brain Injury. / Bir Travmatik Beyin Hasari Olgusunda Orbitomedial Prefrontal Bölge Baglantilarinin Incelenmesi.

The majority of the research studying the prefrontal region has focused on gray matter injury. However, recent studies show that damage to white matter also contributes to the development of cognitive impairment after traumatic brain injury (TBI). Through the use of diffusion tensor imaging (DTI), it is now possible to assess the white matter fiber pathways between brain regions. With Diffusion Tensor Tractography (DTT), fibers of interest can be three dimensionally reconstructed and associated measurements can be performed. In this paper, we present the case of an individual that suffered from panic attacks, behavioral changes, auditory hallucinations and disturbing bodily sensations after traumatic brain injury. The patient was evaluated with a detailed clinical and neuropsychological assessment, magnetic resonance imaging (MRI) and DTI. MRI revealed cystic encephalomalasia with a diameter of 3.4 cm in the left orbitomedial frontal region. With DTT, major white matter tracts of the traumatized area were compared with symmetrical tracts in the contralateral side. Streamline count for the right inferior fronto-occipital fasciculus (iFOF) was 54 while no streamlines could be found for the left iFOF. For the left uncinate fasciculus and the left cingulum, streamline counts were significantly lower compared with the right side (62% and 34% lower; respectively). White matter damage in TBI can cause dysfunction of different brain regions through disruption of connections with the traumatized area. In this case report, we emphasized that symptoms were not limited with dysfunction of the traumatized region and the regular functions of other brain regions were also affected via the disturbance of connection pathways.