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.

Evaluation of the Decision-making Capacity of Two Cases Planning to Undergo Uterine Evacuation.

Psychiatric disorders in the perinatal period can lead to a deterioration in one's judgment and decision-making ability. These disorders may cause sensitive and complex legal and ethical issues relating to psychiatric, obstetric, and neonatal care. Clinicians should ethically respect the autonomy of the individual, but at the same time, they must assess the individual's decision-making process with the use of forensic psychiatric and consultation-liaison psychiatric practice. While the literature related to mental disorders in pregnancy has been increasing, there is limited information regarding the medico-legal and ethical aspects of this topic. Herein, we present two cases who are pregnant and have psychiatric disorders, and we aim to discuss their evaluation process of uterine evacuation.

[Forensic Psychiatric Assessment with the Claim of Incitement, Solicitation, Assistance to Suicide, and Reinforcement of Suicide Decision: A Case Report]. / Intihara Azmettirme, Tesvik, Yardim ve Intihar Kararini Kuvvetlendirme Iddiasinda Adli Psikiyatrik Degerlendirme: Bir Olgu Sunumu.

Although the act of suicide is not considered a crime in Turkish Criminal Law, any contribution (incitement, solicitation, assistance and reinforcement of suicide decision) to the commitment of suicide is a crime according to the 84th item. However, the number of cases opened with respect to this item as well as request for forensic psychiatric expertise is very rare. In these cases, forensic psychiatric expertise depends on the psychiatric evaluation of the individual that committed suicide and the analysis of his/her relationship with the person that incited the suicide. If the suicide is completed, then the psychiatric process gains the qualification of a "psychological autopsy". In this paper, we examined a reporting process prepared for an individual that died as a result of suicide and the person accused of inciting him to suicide.Evidence and forensic aspects are discussed.

Levels of the Staff's Exposure to Violence at Locked Psychiatric Clinics: A Comparison by Occupational Groups.

This study explored the rates of exposure to violence among physicians, nurses, and other health care staff members working at the locked psychiatric clinics, to examine the quantity and types of violence exposed, and to compare occupational groups by the level of exposure to violence. In parallel with the existing literature, the present study supports the proposition that physicians and nurses working at psychiatric units represent a risky group in terms of exposure to violence. The survey found that 87.6% of staff members viewed security measures insufficient. It is considered by the authors that preventive actions should be taken to reduce the risk of exposure to violence against the staff members working at the locked psychiatric clinics.

The relationship of cognitive impairment with neurological and psychiatric variables in multiple sclerosis patients.

OBJECTIVE: Cognitive impairment (CI) in multiple sclerosis (MS) can develop any time. CI is associated with the degree of neuronal loss, but disease duration, fatigue, comorbid affective disorder, and drug dose may also affect cognition. Our aim was to assess which cognitive domain was disturbed primarily in mild MS patients and to see whether CI was related with clinical and psychiatric features. METHOD: Neurological and psychiatric evaluation of 31 MS patients and 31 age, sex, and education-matched healthy controls were made with Structured Clinical Interview for Axis I Disorders (SCID-I). Depression, anxiety, functionality, fatigue, and disability scoring were determined with Hamilton Depression-Anxiety scales, Global Assessment of Functionality, Fatigue Severity and Expanded Disability Status Scales. Cognitive functions were assessed using Mini Mental, Serial Digit Learning, Verbal and Nonverbal Cancellation, Stroop and Rey Auditory Verbal Learning tests. RESULTS: Retrieval from long-term memory and psychomotor speed were significantly worse in MS group. CI was correlated with disease duration, number of attacks, and physical disability but not with depression and anxiety severity. Disease duration predicted disturbances in recall and psychomotor speed, whereas fatigue and disability predicted depression. CONCLUSION: Psychomotor speed and memory were primarily impaired in MS patients, and CI was closely associated with clinical aspects of MS rather than with depression and anxiety.

The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation.

There is a high co-morbidity between chronic inflammatory disorders and depression. Proinflammatory cytokines like TNF-α seem to play a central role in the pathogenesis of these disorders, and its neutralization provides a potent treatment for inflammatory disorders. Few studies showed that TNF-α blockers also caused an improvement in depressive symptoms associated with these chronic inflammatory disorders. To evaluate the effectiveness of TNF-α blockers on symptoms of ankylosing spondylitis (AS), depression, anxiety and quality of life, 9 AS patients resistant to classical therapy were enrolled and followed-up at 2nd and 6th weeks after a TNF-α blocker was started. Hamilton Depression and Anxiety Scales (HAM-D, HAM-A), Hospital Depression and Anxiety Questionnaire (HAD), Quality of Life Scale (SF36) and AS severity index (BASDAI) were applied to the patients at weeks 0, 2 and 6. ESR and CRP were evaluated to monitor biological disease activity. There was a significant reduction in HAM-D (p = 0.00), HAM-A (p = 0.00), HAD anxiety scores (p = 0.02) and a significant improvement in SF36 physical function (p = 0.00), physical role limitations (p = 0.00), bodily pain (p = 0.05), general health (p = 0.01), vitality (p = 0.03) and emotional role limitations (p = 0.00) subscales, BASDAI scores (p = 0.00), ESR (p = 0.00) and CRP (p = 0.00). Change in clinical disease activity (BASDAI) was not correlated with change in depression-anxiety scores, while change in biological disease activity (CRP) was correlated with change in depression-anxiety scores. TNFα blockers may have a potential antidepressant effect besides its anti-inflammatory effect that seems to be independent of its clinical effect.

[Restraint variables in a regional mental health hospital in Turkey]. / Türkiye'de Bir Ruh Sagligi Bölge Hastanesindeki Hasta Baglama Uygulamalarinin Degiskenleri.

OBJECTIVE: To obtain a database to be used in the effort to reduce the use of restraint in mental health hospitals in Turkey, and to compare the data with results of similar studies. METHOD: The sociodemographic characteristics, history of violent or suicidal behavior, and BPRS scores of patients restrained during a 1-month period, and data concerning the number of beds and staff working during day and night shifts were collected. The restraint variables, number of restraints used and duration of restraint use, in all wards were determined and adult psychosis wards were compared according to these variables. RESULTS: Approximately 25% (194) of 810 hospitalized patients were restrained for a total of 1524.25 h (mean: 3.25 h) during 1 month. In all, 182 restrained patients were analyzed and most were male, elementary school graduates, never married, and living with first-degree relatives. There were no correlations between these variables, and the number of restraints used and the duration of their use. Mean age of the females (36.27 years) was higher than that of the males (32.46 years); the difference was significant. In all, 66.6% of restraint use was because of violent behavior or the probability of violent behavior. The rate of restraint use was lower during day shifts (43.82%). Patients on adult wards were not different in terms of diagnosis, BPRS score, rate of violent behavior, and reasons for using restraint, but were markedly different in terms of the number of restraints used and the duration of restraint. CONCLUSION: The number of restraints used and the duration of restraint was on average level. Restraint was associated with being female and older, and having more severe symptoms. Night and weekend shifts were more risky for amount and duration of restraint. Non-clinical institutional factors were a determining factor in the use of restraint.

[The impact of socioeconomic and sociodemographic factors on the criminal behavior of patients with a psychotic disorder]. / Sosyoekonomik Etmenlerin ve Sosyodemografik Ozelliklerin Psikotik Olgularin Suç Islemesinde Etkisi.

INTRODUCTION: The impact of socioeconomic and demographic factors on the criminal behavior of patients with a psychotic disorder was evaluated. METHOD: The study included 70 psychotic men hospitalized in the forensic psychiatry unit of the Bakirköy State Hospital for Psychiatric and Neurological Diseases for compulsory treatment who were compared to 70 psychotic disorder cases with no criminal history hospitalized in the acute wards in the same hospital. Socioeconomic and sociodemographic data were collected and statistical evaluations were made. RESULTS: The vast majority of all the patients (90.7%) in both groups were diagnosed with schizophrenia. The forensic group was significantly less educated than the control group (7.99+/-3.81 years vs. 9.37+/-3.62 years, P<0.05). More than 50% of the cases in both groups were never married ; when considering divorced and widowed patients together with these unmarried patients, the percentage rose to 83%. Fewer forensic cases lived in urban areas than did control cases (50% vs. 84.3%). Logistic regression analysis highlighted a relationship between unemployment and the lack of social insurance to the criminal behaviour of the forensic group. Of those in the forensic group, 48.6% had no social insurance, whereas only 15.7% of the control group had none. CONCLUSION: The data suggested that unemployment and the lack of social insurance are 2 independent variables that may contribute to the probability that patients with a psychotic disorder will engage in criminal behavior.

Civil commitment in Turkey: reflections on a bill drafted by psychiatrists.

Involuntary hospitalization of the mentally ill has been an issue that still remains outside the judicial system in Turkey. Despite the new Turkish Civil Code, which includes several articles relevant to involuntary psychiatric hospital admissions, there still appears to be a need for a comprehensive mental health law to address specific issues concerning civil commitment of the mentally ill. As a result of the lack of specific statutory regulation, an insufficient number of psychiatric hospital beds and limited appreciation of the safety risks involved in untreated mental illness, involuntary hospitalization remains an underutilized option by psychiatrists and the courts alike. In response to its concerned members, the Psychiatric Association of Turkey has appointed a task force to draft a proposed mental health law, entitled the "Psychiatric Patients' Bill of Rights." Although the draft suggests a model with emphasis on the right to psychiatric treatment, it also recommends close judicial oversight to prevent potential abuses of discretion by the system. However, this might present logistic problems in a country with already overburdened courts. Authors discuss the highlights of the draft within the context of Turkey's current cultural, social and judicial structure, and compare it to similar laws of other countries.