How is variability in physiological responses to social stress related to punishment and reward sensitivities? Preliminary findings from the revised reinforcement sensitivity theory of personality perspective.

OBJECTIVE: Although personality traits are assumed to have biological/physiological foundations, research has yielded mixed evidence regarding the relationship between personality and physiological stress responses. Moreover, the field has often overlooked the contemporary neuroscience-based personality approach, known as the Reinforcement Sensitivity Theory (RST) of Personality, in stress research. METHOD: The present study examined the relationship between the revised RST's personality dimensions and heart rate and skin conductance level (SCL) in response to the Trier Social Stress Test in a sample of 61 healthy university students. RESULTS: Piecewise latent growth curve analysis controlling for the participants' current life stress, smoking use, and caffeine intake revealed that individuals with higher behavioral inhibition exhibited higher physiological reactivity, whereas those with high reward sensitivity showed smaller heart rate reactivity. The behavioral disengagement facet of the behavioral inhibition scale was associated with reduced sympathetic arousal during the stress task. Additionally, reward interest was associated with a larger recovery of SCL. CONCLUSION: Results were generally in line with the revised theory. The study findings were discussed within the paradigm of the approach-avoidance conflict and highlighted the importance of reward sensitivity in stress resilience.

Prevalence of Personality Disorder Diagnosed with SCID-II Among Psychiatry Patients in Turkey: Systematic Review and Meta-Analysis. / Türkiye'de Psikiyatri Hastalarinda SCID-II ile Tanilanan Kisilik Bozuklugunun Prevalansi: Sistematik Gözden Geçirme ve Metaanaliz.

OBJECTIVE: To review and summarize data on the prevalence of overall personality disorder extracted from SCID-II (Structured Clinical Interview for DSM-III Axis II Disorders) studies conducted in Turkey with samples consisting of mental health consumers, and also to elaborate on the level and sources of heterogeneity. METHOD: MEDLINE, WOS, PsycINFO, ScienceDirect databases as well as the Turkish Psychiatric Database have been systematically searched. Relevant studies conducted with samples composed of psychiatric inpatients or outpatients receiving psychiatric treatment were included. The diagnostic rate of any personality disorder was regarded as the valid indicator of the overall personality disorder prevalence; therefore, papers presenting data not conducive to this goal were excluded. RESULTS: A total of 311 papers were identified, and 55 studies were included in the qualitative synthesis. Following a critical appraisal of the quality of the data involving point prevalence rates ranging from 20% to 100%, we decided to include 35 studies in the quantitative synthesis. A random-effects meta-analysis followed by a subgroup analysis yielded a summary estimate of 52% [46 - 58%] for the prevalence of overall personality disorder. A high level of overall heterogeneity 84.8 % [80.0 - 88.4] was found to persist in each diagnostic subgroup with a particular primary diagnosis. CONCLUSION: The prevalence estimates derived from the meta-analysis of the SCID-II studies conducted in Turkey support the notion that personality disorder is present in nearly half of the mental health service consumers. That the level of heterogeneity across studies originating from Turkey alone was as high as those observed in previous reviews covering studies originating from various countries suggests that the very source of such heterogeneity might be questionable validity and reliability of SCID-II diagnoses.

Validation of the DSM-5 Alternative Model Personality Disorder Diagnoses in Turkey, Part 1: LEAD Validity and Reliability of the Personality Functioning Ratings.

This study addresses longitudinal, expert, all data (LEAD) validity and reliability of the personality functioning ratings in Turkey, which are essential in assessing Criterion A for the entire DSM-5 alternative model for personality disorders (AMPD) diagnoses. A total of 120 consenting patients recruited at a university psychiatry clinic were rated by individual clinicians with respect to DSM-III-R and AMPD criteria. Subsequently, a LEAD panel consisting of 3 senior clinicians convened to reach a consensus personality disorder diagnosis for each participant. Blind personality functioning ratings of a subgroup of 20 participants by the same set of 4 clinicians were obtained for test-retest reliability investigation. Concordance between the LEAD and AMPD diagnoses was as good as that between the LEAD and DSM-III-R diagnoses (kappas = .68). The personality functioning scores correlated strongly (r > .50) with the sum of specific DSM-III-R diagnoses. Reliability estimates pertaining to the personality functioning scores and resultant AMPD Criterion A decisions were mostly in the good range. In conclusion, DSM-5 alternative model-oriented personality functioning ratings yield total or composite scores that are evidently valid and reliable tools to diagnose general personality disorder and to estimate its global severity.

[The Relationship Between Childhood Traumas, Identity Development, Difficulties in Emotion Regulation and Psychopathology]. / Çocukluk Çagi Travmalarinin, Kimlik Gelisimi, Duygu Düzenleme Güçlügü ve Psikopatoloji ile Iliskisi.

OBJECTIVE: The present study aimed to explore the relationship between traumatic experiences, difficulties in emotion regulation, identity confusion and psychopathology. METHOD: Six hundred and thirty five university students volunteered to participate to the first step of the study (460 (72.4%) females and 175 (27.6%) males). The mean age was 20.57 (17-29) years. The participants who scored above the group mean (X=44) on the Childhood Trauma Questionnaire- Short Form (CTQ-SF) were invited for a diagnostic interview. A total of 69 participants, consisting of 46 females (66.7%) and 23 males (33.3%), with a mean group age of 20.93 (17-29) years, were included in the second step of the study. All participants completed the General Information Form, the CTQSF, the Difficulties in Emotion Regulation Scale (DERS), the Sense of Identity Assessment Form (SIAF), SCID-I and SCID II. RESULTS: Prevalence of childhood traumas in the study group was 31.3%. Participants who came from low income groups, who were using psychotropic medications, who had family or personal history of self harm behaviour and who attempted suicide had significantly higher CTQ-SF scores. The SIAF scores of the subgroup diagnosed with psychiatric disorders were significantly higher than those of the undiagnosed. However, they did not differ with respect to their CTQ-SF and DERS scores. Results showed that difficulties in emotion regulation played a partial mediating role in the association of childhood traumatic events, in particular emotional abuse, with identity confusion. CONCLUSION: The present study demonstrated that childhood traumatic events not only have effects on emotion regulation and the development of sense of identity, but also may be associated with self harm behaviours in the later stages of life. For prevention studies, enhancing parenting skills and raising community awareness to this issue would be beneficial.

Psychotherapy: Playing the Three Monkeys in Mental Health Service Provision?

INTRODUCTION: The purpose of the present study was to investigate the effect of sociodemographic variables on the knowledge of, demand for, and reception of psychotherapy as a treatment modality among psychiatric outpatients. METHODS: Participants of the study were 240 psychiatric outpatients (170 females and 70 males). Data for mental health services were collected from a subgroup of 103 "experienced" patients (42.9%) having had received psychiatric help previously. All participants were administered a questionnaire containing questions about various forms of psychiatric services. RESULTS: Of all participants, 40.83% reported having heard of psychotherapy a few of times before, mostly (44.58%) from the media and only 3.33% from a mental health professional. Most participants with previous applications to psychiatric outpatient clinic had first received mental health service from a psychiatrist (93.2%) and at a state hospital (72.8%), and a small minority (17.4%) had subsequently received care from a psychologist. None had demanded to, but 5 patients (4.86%) had been recommended to receive psychotherapy by mental health professionals. Of these experienced patients, 20 (19.41%) have an idea that the interviews they had previously at the outpatient clinics were sort of psychotherapeutic interviews; yet, only 7 (6.79%) retained the same idea after reading the definition of appropriate psychotherapy written on the questionnaire. All of these patients declared that they have received both their medication and psychotherapy at the same time. Thus, only 2.91% of 240 participants received psychotherapy that corresponds to the given definition. CONCLUSIONS: Findings from this study suggest that mental health care is mostly performed by psychiatrists alone, with a limited contribution by psychologists. Consequently, the choice of treatment is solely pharmacotherapy for most patients, while psychotherapy as a treatment modality is neither offered nor demanded in routine practice.

Personality disorders in a community sample in Turkey: prevalence, associated risk factors, temperament and character dimensions.

BACKGROUND: Data from Turkey on prevalence of personality disorders (PD) in the normal population are sparse. AIMS: The present study conducted in a community sample aimed to investigate personality disorders in terms of prevalence, associated risk factors and personality dimensions. METHODS: A stratified sampling procedure allowed us to compose a sample consisting of 774 participants residing in Aydin, Turkey. The DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) and the Temperament and Character Inventory (TCI) were used to assess PDs and personality dimensions, respectively. RESULTS: Roughly 20% of the participants received a PD diagnosis. Among the individual PD categories, schizotypal and obsessive-compulsive PDs were the most prevalent diagnoses. Participants with PD were more likely to have lower [corrected] self-directedness and cooperativeness scores. These risk factors and personality dimensions were most strongly associated with the cluster B disorders. CONCLUSION: New versions of the diagnostic systems should include schizotypal, obsessive-compulsive and cluster B PDs as separate diagnostic categories, and impaired self-directedness as well as cooperativeness as a general diagnostic criterion for the sake of backward and forward compatibility of the research in this field.

[How is quality of life affected in women in the presence of anxiety and depression symptoms?]. / Kadinlarda yasam kalitesi anksiyete ve depresyon belirtilerinin varliginda nasil etkileniyor? kesitsel bir alan çalismasi.

OBJECTIVE: To assess how quality of life is affected among reproductive age women from the presence of anxiety and depression symptoms and the risk factors related to both. METHOD: A cross sectional analytic study was performed in person with 461 women. General Health Questionnarie-12 and WHOQOL-BREF were used. RESULTS: 35.5% of the women displayed symptoms of anxiety and depression and those who had experienced domestic violence had a 2.61-fold increase in symptom frequency and those with an income below 500 TL had a 2.49-fold more frequent occurrence of symptoms compared to others. General health quality mean score was 3.33 ± 0.804, the mean overall quality of life was 3.62 ± 0.791; Physical Health Domain: 15.95 ± 2.422; Psychological Health Domain: 14.70 ± 2.337; Social Relations Domain 14.64 ± 3,027; Environmental Domain 14:27 ± 2.20; National Domain 14:29 ± 2.144l. The total score of GHQ-12 and the first two questions of WHOQOL-BREF had a negative, moderate and highly significant correlation, whereas the Psychological HD score had a a negative,, strong and significant correlation All other domains and the total score of GHQ-12 had negative, moderate and significant correlations. CONCLUSION: Screening with GHQ-12 as well as offering the possibility of early diagnosis and treatment, is also important to prevent impairment in all areas of quality of life among women. Early diagnosis and treatment of psychological problems of women with risk factors such as exposure to domestic violence and low socio-economic status are the intervention areas with priority.

[Comparison of the effectiveness of cognitive restructuring and systematic desensitization in reducing high-stakes test anxiety]. / Yüksek Riskli Sinav Kaygisinin Azaltilmasinda Sistematik Duyarsizlastirma ile Bilissel Yeniden Yapilandirmanin Etkililiginin Karsilastirilmasi.

OBJECTIVE: This study aimed to compare the effectiveness of systematic desensitization (behavioral therapy and cognitive restructuring (cognitive therapy) in reducing high-stakes test anxiety. We hypothesized that cognitive restructuring would be superior to systematic desensitization in reducing the severity of the cognitive symptoms of anxiety, whereas systematic desensitization would be superior to cognitive restructuring in reducing the severity of the physiological symptoms of anxiety. MATERIALS AND METHOD: The study included 50 (36 female and 14 male) high school graduates and high school seniors aged 16-22 years (mean:18.3 years) that experienced test anxiety while taking their university entrance exam. Participants were randomly assigned to the behavior therapy or cognitive therapy groups. Participants in both groups received 9 sessions of structured group therapy with the same therapist. Each participant's level of anxiety and depression, psychiatric symptoms, and dysfunctional thoughts were measured throughout the therapy process. RESULTS: Statistical analysis showed that there was a significant decrease in the score of each outcome measure employed in both groups. There weren't any significant differences in terms of the alleviation of the cognitive symptoms of anxiety, as measured with the Dysfunctional Attitudes Scale, or physiological symptoms, as assessed with the Beck Anxiety Inventory between the 2 groups. The 2 therapy methods resulted in statistically significant reductions in the level of test anxiety, as well as state anxiety, trait anxiety, self-reported depression, and general symptom levels. CONCLUSION: The behavioral and cognitive therapies were equally effective in reducing the severity of the cognitive and physiological components of test anxiety.

[Identity confusion and psychopathology in late adolescence]. / Gençlerde Kimlik Bocalamasi ve Psikopatoloji.

OBJECTIVE: The aim of this study was to investigate the relationship of identity confusion with clinical diagnoses and personality pathology. METHOD: Participants in the first part of the study were 950 high school students or graduates. The participants were 484 males and 466 females ranging in age between 16 and 25 years of age (X = 18.3, sd = 0.8). We first administered the Instrument for Assessing Identity Confusion (IFAIC), and following a random sampling procedure we selected 30 participants with an IFAIC score > or = 1 standard deviation above the mean score to constitute the identity confusion group, and 30 participants with an IFAIC score < or = 1 standard deviation below the mean score to constitute the non-confusion group. The 60 participants included in the second part of the study were clinically assessed by means of SCID-I and SCID-II interviews. FINDINGS: The percentage of the participants receiving at least one axis I diagnoses was 73.3 % in the identity confusion group as opposed to 6.6 % in the non-confusion group. Likewise, participants in the identity confusion group fulfilled more personality disorder criteria than those in the non-confusion group. When the groups were compared for each personality disorder criteria, significant differences were observed in terms of avoidant, dependent, obsessive-compulsive, self-defeating, borderline and schizotypal personality disorders. CONCLUSION: Findings of the present study do not support the view that identity confusion is a condition emerging exclusively in adolescents with borderline or psychotic personality organization.

[Prevalence of and factors related to depression in high school students]. / Lise ögrencisi ergenlerde depresyonun yayginligi ve iliskili oldugu etmenler.

OBJECTIVE: The study aimed at investigating the prevalence of and factors related to depression in high school students. METHOD: A total of 805 (n = 367 girls; n = 438 boys) first year students from three high schools in the city of Aydin filled in a self-report questionnaire that contained questions about socio-demographics, academic achievement and religious belief. It included also a depression rating scale, social support scale, problem solving inventory and an assertiveness scale. T-tests, chi-square tests, Pearson moment products correlation coefficients, and logistic regression analysis were used to analyze the data. RESULTS: 141 students (17.5%) scored on and above the cut-off point on the Children Depression Inventory (CDI). In the first regression analyses low self-esteem, low grade point average (GPA) and low perceived social support from friends in boys, and low self-esteem, low paternal educational level and low social support from friends were the predictors of girls' depression. When self-esteem scores were excluded, low GPA, low perceived social support from friends and family, and inefficient problem solving skills were predictors of depression in boys; low perceived social support from friends and family, low paternal educational level, and inefficient problem solving skills were the independent predictors of depression in girls. CONCLUSION: Depression is prevalent in high school students. Low self-esteem, low perceived social support from peers and family, and inefficient problem solving skills appears to be risk factors for adolescent depression. Low GPA for boys and low paternal education for girls were gender specific risk factors. Psychosocial interventions geared for increasing self-esteem, social support and problem solving skills may be effective in the prevention and treatment of adolescent depression.

Risk factors for and protective factors against adolescent suicidal behavior in Turkey.

This study investigated the possible role of depression, self-esteem, problem solving, assertiveness, social support, and some socioeconomic factors on adolescent suicidal behavior in youth in a small city located in the southwestern part of Turkey. Participants in the study were 805 (367 girls) first-year high school students between the ages of 13-18 years. Some 23% of participants reported having thought of killing themselves during the past 12 months or their lifetime. The percentage of students who said that they had attempted to kill themselves was 2.5. Suicidal ideation during one's lifetime or during the past 12 months was more frequent among girls than among boys but suicidal attempts were equally common in girls and boys. Girls scored significantly higher on depression and the Suicide Probability Scale (SPS) but also on assertiveness and perceived social support from friends than boys. Boys tended to score higher on self-esteem than girls. Depression and low self-esteem were the most consistent and independent predictors of suicidal thoughts, attempts, and SPS scores in both girls and boys. The results are discussed in terms of relevant literature with special reference to developmental and sociocultural issues. The implications of findings for the assessment and treatment of suicidal youths are highlighted.

[Validation of the Turkish versions of the short-form Conners' teacher and parent rating scales]. / Conners Kisa Form Ogretmen ve Ana Baba Derecelendirme Olçeklerinin Geçerligi.

OBJECTIVES: To investigate factorial and criterion validity as well as reliability of the Turkish translations of the 28-item Conners' Teacher Rating Scale (CTRS) and 48-item Conners' Parent Rating Scale (CPRS), which both measure attention deficit, hyperactivity, and conduct problems in children, through a series of studies conducted with either normal or clinical samples. METHOD: Normal sample data for the teacher and parent rating scales were collected at several elementary schools in Ankara through 2 different studies. The teacher rating scale sample consisted of 1539 pupils rated by their teachers, and the parent scale sample consisted of 954 pupils rated by their parents. The clinical sample consisted of 270 children diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ADD), and/or conduct disorder (CD), who were rated by a child psychiatrist on a DSM-IV criteria form, as well as by their parents and teachers on the respective Conners' rating scales (CRS). The patients' clinical criteria scores related to these diagnostic categories were used to evaluate, and if necessary, to modify item content of the corresponding subscales. RESULTS: Turkish versions of the CTRS and CPRS demonstrated good internal consistency as indicated by Cronbach's alpha coefficients of .95 and .90, respectively. Factor analytical data from the normal sample studies supported the construct validity of both Turkish CRS despite non-differentiation of the conduct factor from the hyperactivity factor on the teacher scale. The clinical criteria scores suggested the necessity of adapting the item content of all the subscales, except the hyperactivity subscale. CONCLUSION: The adapted and original subscales of the CRS Turkish forms demonstrated such psychometric properties that they could be employed in assessing attention deficit and disruptive behavior disorders in Turkish children.

Androgenetic alopecia: does its presence change our perceptions?

BACKGROUND: The aim of this study was to evaluate the effects of androgenetic alopecia on males with and without hair loss and to delineate the level of stress gained by this type of alopecia. METHODS: Two hundred and 52 males (175 with hair loss, 77 without hair loss), between 16 and 72 years of age, participated in the study. A hair loss form (five questions for sociodemographical features, eight questions for dermatological features, eight questions for psychological evaluation) and a list of stressful life events were used. RESULTS: Desire for treatment was significantly different between the participants with and without androgenetic alopesia (AGA; chi(2) = 5.877, d.f. = 1, P = 0.015). Regardless of the presence of AGA, 61.4% accepted AGA as a natural condition with a solution that should be sought, 38.5% as a cause for increased attention, and 56.2% thought that the psychological effects of AGA would mostly be negative. The negative effects of their AGA on other family members, relationships with the opposite sex and occupation/academic life were considered by 37.1%, 43.0% and 36.3% of the participants, respectively. None of the psychological parameters differed significantly between the participants with and without AGA. A small portion (5%) of the variance in perception of stress (0.22(2) = 0.048) might be explained by the degree of alopecia. CONCLUSION: Social and cultural differences might alter perceptions concerning AGA regardless of its presence in an individual.

[Teaching empathy in medical education]. / Tip Egitiminde Esduyumu Ogretmek.

OBJECTIVES: To determine whether there is any difference in empathic tendencies and attitudes towards communication in medical practice among the first-year students of Adnan Menderes University Medical School, and to determine the effect of education and the relation between these two features. METHOD: The Empathic Tendency Scale and Attitudes Towards Communication in Medical Practice Questionnaire were used to collect data from 36 (55.3 % of the total) students (65.7 % female; mean age: 18.3). RESULTS: Students are clustered into two groups for both scales using K-means analysis, which was used to see whether the students were homogeneous regarding empathy and communication attitudes at the beginning of the teaching period. According to the Empathic Tendency Scale results 25% of students have a high empathic tendency (HET) and 75% have a low empathic tendency (LET) and the results of the Attitudes Towards Communication in Medical Practice Questionnaire indicated that 56% have positive and 44% have negative attitudes towards communication. However, the difference between the pre-and post-teaching results of either group seems to show a tendency towards change (p< 0.10). The change has a negative and a positive tendency in the HET and LET groups, respectively. CONCLUSION: Our results seem to verify the predicted differences among the students in their empathic tendencies and attitudes towards communication in medical practice. It seems that empathic tendency is more likely to be changed by an appropriate teaching technique when change within the groups is concerned.