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.

Effects of the Tell Me About Me Program: Perception of Social Support, Self-Esteem, and Self-Compassion in Older Adults.

The aim of the current quasi-experimental study was to investigate the effect of the Tell Me About Me program on the perception of social support, self-esteem, and self-compassion among 44 older adults in a nursing home in Turkey. Data were collected from May 2015 to May 2016 via a sociodemographic characteristics form, the Multidimensional Scale of Perceived Social Support, Coopersmith Self-Esteem Inventory, and Self-Compassion Scale. The difference found between the mean scores of participants' perceived social support and self-esteem on the pretest, posttest, and retest was statistically significant (p < 0.01), but the difference in their mean scores in self-compassion on the pretest, posttest, and retest was not significant (p > 0.05). It is recommended that this program be used for improving social support and self-esteem among older adults. [Journal of Gerontological Nursing, 45(10), 39-46.].

Determinants of Mental Disorders in Syrian Refugees in Turkey Versus Internally Displaced Persons in Syria.

OBJECTIVES: To compare frequencies of some mental health disorders between Syrian refugees living in Turkey and internally displaced persons in Syria, and to identify factors associated with posttraumatic stress disorder and major depressive disorder. METHODS: We carried out a field survey in May 2017 among 540 internally displaced persons in Syria and refugees in Turkey. RESULTS: The study revealed that mental disorders were highly prevalent in both populations. Major depressive disorder was more frequent among refugees in Turkey than among internally displaced persons in Syria; other mental disorders, including posttraumatic stress disorder, were more prevalent in the latter than in the former. Posttraumatic stress disorder was also associated with postmigration factors. Major depressive disorder was more likely among refugees in Turkey. In addition, the likelihood of major depressive disorder was predicted by stopping somewhere else before resettlement in the current location. CONCLUSIONS: The resettlement locus and the context and type of displacement seem to be important determinants of mental health disorders, with postmigration factors being stronger predictors of conflict-related mental health. Internally displaced persons may benefit more from trauma-focused approaches, whereas refugees may derive greater benefit from psychosocial approaches.

Neurotrophic factors and hippocampal activity in PTSD.

Although numerous studies have investigated the neurotrophic factors and hippocampal activity in posttraumatic stress disorder (PTSD) separately each other, it is unclear whether an association between neurotrophic factors and hippocampal activity is present. The aim of this study was to evaluate the functional changes in hippocampus before and after treatment with escitalopram and to associate these changes with peptides related to neuronal growth in patients with chronic PTSD and trauma survivors without PTSD. Fifteen earthquake survivors with chronic PTSD and thirteen drug naïve trauma exposed individuals without PTSD underwent fMRI scans in a block design. Serum levels of Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF) were measured before and after 12 weeks treatment with escitalopram. Baseline median serum level of NGF was significantly lower in patients with chronic PTSD than trauma survivors; however, 12 weeks of treatment with escitalopram significantly increased it. Higher activation was found both in left and right hippocampus for chronic PTSD group than trauma survivors. Treatment with escitalopram was significantly associated with suppression of the hyperactivation in left hippocampus in patients with chronic PTSD. Bilateral hyperactivation in hippocampus and lowered NGF may associate with neurobiological disarrangements in chronic PTSD. Treatment with escitalopram was significantly associated with both improvement in the severity of PTSD symptoms and biological alterations. Patients diagnosed with PTSD may have further and complicated deteriorations in hippocampal networks and neurotransmitter systems than individuals who had not been diagnosed with PTSD following the same traumatic experience.

Social Aspect of Functioning Deteriorates More Than Individual Aspect in Patients with Remitted Bipolar Disorder.

INTRODUCTION: Many studies have demonstrated that patients with bipolar disorder (BD) suffer from significant functional impairment, even during remission periods. This study aimed to assess the levels of overall functioning and specific areas of functioning in remitted patients with BD compared with those in healthy controls. METHODS: Eighty completely remitted patients with BD and 80 healthy controls were included in the study. The Bipolar Disorder Functioning Questionnaire (BDFQ), Young Mania Rating Scale, and Beck Depression Inventory were used. RESULTS: There were fewer married and employed cohorts in the BD group than in the control group. Compared with healthy controls, patients with BD exhibited a worse functioning in terms of intellectual and sexual functioning, feelings of stigmatization, social withdrawal, household relationships, relationships with friends, and participation in social activities. There was no difference between the groups in terms of emotional functioning, daily activities and hobbies, taking initiative and self-sufficiency, and occupation. The total BDFQ scores of patients were lower than those of healthy controls. A better functionality was observed in patients using only a mood stabilizer than in patients using three or more drugs. CONCLUSION: Remarkably, remitted patients with BD tended to perform daily activities well when these activities were not in a social context. Stigma-oriented interpersonal approaches can be particularly beneficial for these patients.

[Developing an attitude scale towards attempted suicide cases for evaluating emergency medical teams (ASETSA)]. / Intihar girisiminde bulunan olgulara yönelik acil saglik çalisanlarinin tutumlari ölçegi'nin (IGYTÖ) gelistirilmesi; geçerlik ve güvenilirlik.

OBJECTIVE: Suicide attempt is one of the most important risk factors for completed suicide, and generally, the first intervention is performed in the emergency department. The attitudes of health professionals towards suicide attempt cases affect their treatment and medical care. There is no related attitude assessment scale for health professionals in Turkey. The aim of this study was to develop a scale for assessing the attitudes of emergency medical teams towards cases of attempted suicide. METHODS: In this methodological, epidemiological study, a pool of 140 items was compiled using a previously developed similar scale available in the literature, as well as, testimonies of health professionals. Two hundred and fifty-one doctors, nurses and emergency medical technicians from 14 local hospitals in Sanliurfa were included in this study. Surface validity was determined using the Lawshe content validity index and ratio. Factor analysis (principal components) was used to evaluate structural validity and internal consistency (Cronbach's alpha), and test-retest reliability was analyzed. RESULTS: The mean age of the study cohort was 27.9 ± 5.15 years, and 50% of the participants were female. A 28-entry attitude scale, which explained 58.5% of the total variance, was developed, including subscales for prevention and protection, individual help, institutional help, triggers and psychopathology, casual attributions, and medical help. The Cronbach's alpha parameter of the scale was 0.84. In test-retest analysis; there is no significant difference between point averages of the first and last application of the scale. CONCLUSION: The psychometric features of the developed scale were determined to be acceptable.

Preliminary Turkish study of psychiatric in-patients' competence to make treatment decisions.

INTRODUCTION: Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases. METHODS: This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). RESULTS: The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups. DISCUSSION: These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders.

Personality, posttraumatic stress and trauma type: factors contributing to posttraumatic growth and its domains in a Turkish community sample.

BACKGROUND: Posttraumatic growth (PTG) is conceptualized as a positive transformation resulting from coping with and processing traumatic life events. This study examined the contributory roles of personality traits, posttraumatic stress (PTS) severity and their interactions on PTG and its domains, as assessed with the Posttraumatic Growth Inventory Turkish form (PTGI-T). The study also examined the differences in PTG domains between survivors of accidents, natural disasters and unexpected loss of a loved one. METHOD: The Basic Personality Traits Inventory, Posttraumatic Diagnostic Scale, and PTGI-T were administered to a large stratified cluster community sample of 969 Turkish adults in their home settings. RESULTS: The results showed that conscientiousness, agreeableness, and openness to experience significantly related to the total PTG and most of the domains. The effects of extraversion, neuroticism and openness to experience were moderated by the PTS severity for some domains. PTG in relating to others and appreciation of life domains was lower for the bereaved group. CONCLUSION: Further research should examine the mediating role of coping between personality and PTG using a longitudinal design.

Metabolic syndrome with different antipsychotics: a multicentre cross-sectional study.

OBJECTIVE: High prevalence of metabolic syndrome (MS) and related metabolic disturbances in patients with schizophrenia and bipolar affective disorder have been in main focus of interest in recent years since the introduction of second-generation antipsychotics. This study aims to examine these questions: 1) Is there a relation between antipsychotic treatment and MS prevalence? 2) Which antipsychotic users have higher MS prevalence? 3) Do patients on antipsychotic polytherapy have higher rates of MS than patients on antipsychotic monotherapy? 4) Which metabolic parameters are considerably disturbed on which antipsychotic users? METHODS: 242 Patients with schizophrenia, schizoaffective disorder and bipolar disorder without any other psychiatric comorbidity according to DSM-IV and using the same antipsychotic(s) and/or mood stabilizers at least for the last 6 months included to the final assessment. RESULTS: The sample was divided into 7 drug groups. The MS prevalence was highest in the combined antipsychotic (AA) group (48.1%) according to ATP III criteria. According to IDF criteria clozapine (C) group had the highest MS prevalence (74%). CONCLUSIONS: When metabolic parameters evaluated overall, metabolic risk with antipsychotics is found to be highest in clozapine group, followed by combined AP group. Olanzapine and risperidone have intermediate risk while zuclopentixole has lowest.

Posttraumatic stress disorder and major depressive disorder is common in parents of children with epilepsy.

OBJECTIVE: The purpose of the study was to determine the prevalence of posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), and major depressive disorder (MDD) in parents of children with epilepsy. METHODS: Parents (77 mothers and 3 fathers) of children with epilepsy were administered the Structured Clinical Interview for DSM-IV (SCID), PTSD and MDD modules, and the General Health Questionnaire (GHQ). RESULTS: The prevalence of both PTSD and MDD was 31.5%. Fifty-six percent (n = 14) of the participants with PTSD had a diagnosis of MDD. PTSD symptom clusters were very prevalent in the parents of children with epilepsy. Reexperiencing and arousal symptom clusters were more frequent (88.8 and 80% respectively) than the avoidance and numbing symptom cluster (32.5%). CONCLUSION: These findings suggest that a significant proportion of parents of children with epilepsy experience PTSD and MDD. Increased awareness of the clinical presentations of these disorders may help clinicians to develop preventive and intervention strategies for parents of children with epilepsy.