ISSN 1302-0099 | e-ISSN 2146-7153
TURKISH JOURNAL CLINICAL PSYCHIATRY - Turkish J Clin Psy: 23 (3)
Volume: 23  Issue: 3 - 2020
EDITORIAL
1. COVID-19 and Community Mental Health
Meram Can Saka
doi: 10.5505/kpd.2020.27167  Pages 246 - 247
Abstract |Turkish PDF

RESEARCH ARTICLE
2. Evaluation of dsyfunctional attitudes, distress and discomfort tolerance levels in patients with premenstruel dysphoric disorder (tur)
Gamze Erzin, Oğuzhan Kılınçel, Şenol Bayram, Osman Hasan Tahsin Kılıç, Vahap Ozan Kotan, Güven Özkaya, Erol Göka, Kadir Özdel
doi: 10.5505/kpd.2020.09216  Pages 248 - 255
INTRODUCTION: Distress tolerance and Discomfort tolerance are well-established psychological constructs that are related but distinct. Distress tolerance is defined as an individual’s perceived capacity to withstand negative emotional states or the capacity to continue goal-directed behavior in the context of negative affect. As for discomfort tolerance, it mainly is about the capacity to withstand negative bodily sensations. Premenstrual dysphoric disorder (PMDD) which consists of bodily and psychological symptoms is a DSM-5 diagnosed disease determined under the category of depressive disorders.In this research article, we investigated the possible effects of premenstrual dysphoric disorder on distress and discomfort tolerance levels as well as dysfunctional attitudes on individuals with this disorder.

METHODS: In our study, 218 people were interviewed in total. People who could possibly have PMDD according to Premenstrual Symptoms Screening Tool (PSST) were monitored for 8 weeks and 31 people were diagnosed with PMDD. People without PMDD and having under threshold symptoms for PMDD according to PSST who have matching age and BMI were also included in the study. Distress Tolerance Scale (DTS), Discomfort Intolerance Scale (DIS), Dysfunctional Attitude Scale-short forms (DAS-sf) were filled for each sample.
RESULTS: DTS self-efficacy scores were found to be higher in group without PMDD than the groups with PMDD and having under threshold symptoms. DAS-total score was found to be higher in group with PMDD than the groups without PMDD group and having under threshold symptoms group. Discomfort avoidance subscale score of distress tolerance scale was found to be higher compared to participants without PMDD and participants having below threshold symptoms.
DISCUSSION AND CONCLUSION: Women with PMDD may benefit from preventive treatment modalities that minimize discomfort and avoidance behaviours and facilitate their coping with negative bodily sensations of premenstrual syndrome and prevent the development of dysfunctional attitudes toward these bodily and mental disturbing sensations.


3. Clinical features, comorbid mental disorders and treatment outcomes in female patients with alcohol and drug use disorder admitted to an outpatient treatment unit: A retrospective study (eng)
Ebru Aldemir
doi: 10.5505/kpd.2020.20438  Pages 256 - 265
INTRODUCTION: The studies on alcohol/drug addiction have historically neglected female patients and the results of most studies exclusively conducted on male patients have been generalized to include female population. This study aims to retrospectively investigate the sociodemographic characteristics, alcohol/drug consumption characteristics, comorbid mental illnesses, treatment and follow-up results in female patients who applied to an outpatient addiction clinic for the treatment of alcohol/drug use disorder.
METHODS: The patient files of the consecutive 68 women who visited Ege University Outpatient Addiction Clinic between May 1, 2013 and August 31, 2018 and were diagnosed with alcohol/drug use disorder according to DSM-5 were analyzed.
RESULTS: The findings revealed that 60.3% of patients had alcohol, 39.7% had drug use disorder. The drug mainly used by the ones diagnosed with drug use disorder was polydrug with a ratio of 44.4%. The duration of problematic alcohol use in the women diagnosed with alcohol use disorder was 8.3±7.8 years, the duration of problematic drug use in the women diagnosed with drug use disorder was 7.6±5.4 years. The age of onset of problematic alcohol use in the group with alcohol use disorder was higher than the age of onset of problematic drug use in the group with drug use disorder (t=3.643, p=0.001). Depressive disorder was observed in 54.2% of all patients. 70.5% of patients attended outpatient clinic follow-up at least for a period of 1 month, 47.9% of the patients who attended follow-up appointments at least for a period of 1 month received maintenance treatment and 37.5% of those maintained complete abstinence during that period.
DISCUSSION AND CONCLUSION: The findings of this study with the largest sample in our country where sociodemographic and clinical characteristics are evaluated in a group of female patients diagnosed with alcohol/drug use disorder should be developed and supported by controlled and longitudinal follow-up studies.

4. Examination of the relationship between depression, future expectations, and several executive function variables (tur)
Hasan Ergüler, Ayşegül Durak Batıgün
doi: 10.5505/kpd.2020.41033  Pages 266 - 273
INTRODUCTION: The aim of this study was to study the possible relationships between depressive symptoms, future expectations (i.e. prospections), and prefrontal functions. More specifically, the potential mediating effects of future expectations in the relationship between depressive symptoms and prefrontal functions were investigated.
METHODS: Data collection tools included Beck Depression Inventory, Prefrontal Functions Scale based on Interpersonal Neurobiology, and Subjective Probability Task – Turkish Version. Study sample included 401 undergraduate students, where 235 (58.6%) of those were female and 166 (41.4%) were male. Participants had an age range of 18-31, and the mean age was found to be 21.44 (sd = 2.33).
RESULTS: Statistical analyses revealed that as depression symptoms strengthen, there appears to be a corresponding decrease in the ratings for positive prospection, and a counter increase in the ratings for negative prospection (i.e. how likely they think such events will happen to them in the future). Furthermore, prefrontal functioning suffered a significant decline as depression scores increased. The mediated regression model further indicated that positive as well as negative prospections did indeed have partial mediating effects in regulating the relationship between depression scores and prefontal functioning.
DISCUSSION AND CONCLUSION: Results of the study are considered to be of possible value for the aim of structuring specific psychotherapy interventions. Identification of strictly held attitudes of clients, for instance, alongside with the inability to identify alternative solutions to problems encountered, strict reliance on specific explanations as causes behind them, or weakening cognitive flexibility, can be prioritized earlier in therapy and the following progress can, hence, be planned accordingly. Investigation of prospective thoughts can also be informative in this respect.

5. Evaluation of depression and anxiety levels in school dropout adolescents (tur)
Mehmet Karadağ
doi: 10.5505/kpd.2020.72324  Pages 274 - 279
INTRODUCTION: The aim of this study was to determine the distribution of psychiatric diagnoses and anxiety / depression levels of adolescents who applied to a child and adolescent psychiatry department.
METHODS: The study included adolescents aged 12-18 years who applied the Child and Adolescent Psychiatry Department of Mardin State Hospital. The psychiatric diagnoses of the patients were determined by clinical interview according to DSM-V. Besides, sociodemographic data form, Children's Depression Inventory and Spielberger State-Trait Anxiety Inventory were filled to the patients.
RESULTS: 54 adolescents were included in the study. The mean age of the patients was 15.7 years old. According to DSM-V Attention Deficit Hyperactivity Disorder (ADHD) was found the most common diagnosis (n: 16, 29.6%). This was followed by Depressive Disorders (n: 12, 22.2%) and Anxiety Disorders (n: 9, 16.6%). The most common diagnosis is ADHD in boys and Depressive Disorders in girls. The mean depression score was 21.8 and 27 (58.7%) were above the cut-off score. The mean of the State Anxiety Scale found 48.1 and the mean of the Trait Anxiety Scale found 50.8. According to the cut-off scores, 36 (78.3%) of the patients had a high level of situational anxiety and 35 (76.1%) had a high level of trait anxiety.
DISCUSSION AND CONCLUSION: Psychopathology rates and depression / anxiety levels are high peers in adolescents who drop out of school.

6. Recognition of violence and being affected by violence in psychiatric outpatients (tur)
Elif Nurgül Sungur, Ezgi Hancı Yenigün, Nalan Kalkan Oğuzhanoğlu, Bengü Yücens
doi: 10.5505/kpd.2020.43926  Pages 280 - 289
INTRODUCTION: Violence continues to be an important public problem and has negative effects on mental health. In this study, it was aimed to determine the recognition of violence by psychiatric outpatients, the prevalence of violence against psychiatric outpatients and how they are affected by violence.
METHODS: The study included 199 patients who admitted to the general psychiatry outpatient clinic and accepted to participate in the study. The sociodemographic features and detailed assessments of patients on violence were examined with the questionnaire prepared by reviewing the literature on violence.
RESULTS: 78.9% of females and 75.5% of males participated in the study recognized violence physically. Both female and male patients mentioned that "disobedience / irritating behavior" was the most common cause of violence and, “education” was the most obvious factor that can prevent violence. It was found that 56% of the patients (56.8% of females and 55.9% of males) were subjected to violence and, females were subjected to sexual violence more frequently than males. There was no significant difference between patients subjected to violence and those who were not in terms of gender, educational status, occupation, and psychiatric diagnosis. The social functionality, personal and social performances of the patients who were subjected to violence were lower than those who were not subjected to violence.
DISCUSSION AND CONCLUSION: Violence is a common problem among psychiatric outpatients. Because violence is associated with psychiatric disorders and disrupts functionality, clinicians should routinely screen violence during psychiatric evaluation.

7. Validity and reliability of the Turkish version of the Glasgow antipsychotic side effect scale (tur)
Esma Akpınar Aslan, Sedat Batmaz, Özgür Ahmet Yüncü, Neslihan Sevil, Burcu Erkek
doi: 10.5505/kpd.2020.94547  Pages 290 - 301
INTRODUCTION: Regular and comprehensive follow-up of the side effects of antipsychotic drugs is an essential part of the treatment process. Self-report scales which are user friendly and which do not take too much time to complete are required. The aim of this study was to adapt the Glasgow Antipsychotic Side Effect Scale (GASS) into Turkish, and to evaluate its validity and reliability.
METHODS: For this study, patients over the age of 18 presenting to the outpatient psychiatry clinics of secondary healthcare facilities in three different cities were recruited. Two hundred and ninety-seven of these patients who were on at least one antipsychotic drug except for clozapine for at least three months and who were diagnosed with any psychiatric disorders, and fifty-six patients of them were not on any antipsychotic drug treatment. The patients completed the GASS and the Systematic Monitoring of Adverse events Related to TreatmentS (SMARTS). The clinicians completed a demographic and clinical data form and the Clinical Global Impression Scale (CGI). Exploratory factor analysis was undertaken and concurrent validity, discriminating validity, internal consistency, test – retest reliability, and responsiveness of the GASS were calculated.
RESULTS: Results demonstrated that the GASS consisted of seven factors,that it had concurrent validity with the SMARTS and the CGI (rho=0.706 & 0.381 respectively,p's<0.001),that it could discriminate between patients who were on and who were not on antipsychotics(U=14357.50,p<0.001),that it had internal consistency(Cronbach’s α=0.775) and test–retest reliability(intraclass correlation coefficient=0.964,p<0.001),that it had responsiveness,and that the minimal clinically important difference was 5 points.
DISCUSSION AND CONCLUSION: In conclusion, the Turkish version of the GASS was shown to be a valid and reliable scale. The GASS may enable clinicians to question the side effects experienced by patients who are on antipsychotic drugs comprehensively and systematically in a short time and to identify and follow-up the severity of the symptoms and their response to treatment.

8. The association between anxiety sensitivity, perceived stress and impulsive behaviors in bipolar disorder (tur)
Mehmet Emin Demirkol, Lut Tamam, Zeynep Namlı, Kerim Uğur, Mahmut Onur Karaytuğ
doi: 10.5505/kpd.2020.65882  Pages 302 - 312
INTRODUCTION: Impulsive behaviors that adversely affect prognosis in bipolar disorder may persist in the euthymic period. Anxiety sensitivity is a protective factor for impulsive behaviors. In this study, we aimed to investigate the relationship between anxiety sensitivity and impulsive behaviors in bipolar disorder and the clinical features that may be effective in this relationship.
METHODS: Seventy euthymic bipolar patients, according to the DSM-5 criteria, and 69 healthy volunteers with no comorbid mental disorders were included in the study. Sociodemographic data form, the Hamilton Depression Scale, Young Mania Rating Scale, Perceived Stress Scale, Anxiety Sensitivity Index-3, and UPPS Impulsive Behavior Scale were filled out.
RESULTS: The perceived stress level, social and cognitive sub-dimensions, and total scores of the Anxiety Sensitivity Index-3, and scores of the urgency and sensation seeking subscales of the Impulsive Behavior Scale were higher in patients than in healthy controls (p<0.001 for each). The perceived stress level was correlated with the total score of the Anxiety Sensitivity Index-3 and three sub-dimensions (p <0.001 for each). The perceived stress was a full mediator in the relationship between anxiety sensitivity and sensation seeking.
DISCUSSION AND CONCLUSION: In this study, we found that euthymic bipolar patients showed different characteristics in terms of perceived stress, anxiety sensitivity, and impulsive behaviors than healthy controls. The mediating effect of perceived stress on the relationship between anxiety sensitivity and sensation seeking supports the hypothesis that impulsive behaviors will decrease with increased anxiety sensitivity and perceived stress levels.

9. The mediating role of emotional exhaustion on mobbing perception and job satisfaction of academicians (tur)
Ayfer Öztürk
doi: 10.5505/kpd.2020.16023  Pages 313 - 325
INTRODUCTION: The aim of the study is to analyze the effect of perceived mobbing of academicians on job satisfaction and to reveal the moderating effect of emotional exhaustion in this relation.
METHODS: In this research, which we try to determine the relationship between perceived mobbing, emotional exhaustion and job satisfaction, a theoretical framework was first drawn and In the theoretical part, emotional exhaustion, job satisfaction and organizational commitment have been respectively described and explained. Next, studies dealing with the relationship among variables have been analyzed and accordingly research model and hypothesis have been formed. Survey technique was used in the research. Data were collected from 90 academician participated in state university. The data were collected by using the Personal Information Form, Academicians Mobbing Scale (AMS), Minnesota Job Satisfaction Scale (MJSS) and the Emotional Exhaustion Scale (EES) of the Maslach Burnout Inventory (MBI). The questionnaire was applied to the collection of data and SPSS program was used in the analysis of the data. Corelation, simple and multiple regression analyzes were used to determine the mediating role of emotional exhaustion in the effect of perceived mobbing on job satisfaction.
RESULTS: According to results, it was determined that there is a relationship between, perceived mobbing, emotional exhaustion and job satisfaction and in the effect of perceived mobbing on job satisfaction, emotional exhaustion partly mediated.
DISCUSSION AND CONCLUSION: As a result, the emotional exhaustion levels of the academicians who perceive mobbing in work place are increasing. Job satisfaction levels decrease with increasing emotional burnout. Additionally,. The mediator role of emotional exhaustion in the relationship between mobbing and job satisfaction indicates the presence of other mediating variables in this relationship. For this reason, in addition to the model in this research, it can be suggested to investigate the mediator effect of other variables in future research.

10. Investigating the mediating role of thought-action fusion in the relationship between alexithymia and trait anxiety levels in an adolescent population (tur)
Mesut Yavuz, Burak Akdeniz, Armağan Akyol, Hicran Çağla Kurt, Cemile Bilgis, Aslı Çolak, Doğukan Akbay, Beyza Ekiz, Muhammed Tayyib Kadak
doi: 10.5505/kpd.2020.83435  Pages 326 - 332
INTRODUCTION: To investigate the mediation effect of thought action fusion (TAF) in the relationship between the alexithymia and trait anxiety levels.
METHODS: 985 adolescents ( %55.2 female, n=544, %44.8 male, n=441) between the ages of 11-17 were included in this study. The socio-demographic questionnaire, 20 item Toronto alexithymia scale (TAS-20), thought action fusion inventory for children (TAFIC) and trait anxiety inventory for children (TAI-C) were used. In terms of gender, the mean scores of the scales were compared by independent sample t test. The correlations between the scales were analyzed by Pearson product moment correlation analysis. The mediation effect of TAFIC scores on the relationship between the alexithymia and trait anxiety levels were tested by mediation analyis. The gender and age variables were included in the model as covariants.
RESULTS: The mean scores of TAS-20 and TAI-C were higher in females than males, significantly. There were strong correlations between TAS-20 total scores and TAI-C scores. There were weak correlations between TAS-20 and TAFIC total scores; and TAFIC total and TAI-C scores. The mediation analysis indicated that alexithymia levels are directly associated with high anxiety levels. TAF has mediation effect on the relationship between the alexithymia and anxiety levels.
DISCUSSION AND CONCLUSION: The alexithymia personality traits may improve anxiety levels in adolescent population, and TAF plays a mediator role in this relationship. It is suggested that, using associated therapeutic interventions focusing on TAF problems may improve the anxiety problems in adolescents presenting with alexithymia personality traits.

11. Evaluating individual differences in patients with major depressive disorder focused on nine types temperament model (tur)
Mehmet Fatih Üstündağ, Enver Demirel Yılmaz, Kerim Uğur, Özge Ünal, Ahmet Herdem, Orkun Aydın, Omer Aydemir
doi: 10.5505/kpd.2019.50470  Pages 333 - 342
INTRODUCTION: The aim of this study is to investigate the relationship of Major Depressive Disorder (MDD) and MDD specifiers with temperament and personality traits with a perspective focused on Nine Type Temperament Model (NTTM).
METHODS: 203 healthy participants who are matched with the 208 MDD participants group between 18-60 years old and in at least eight weeks remission period and treatment in progress, without an additional diagnosis were included in the study. Socio-demographic data form, Nine Types of Temperament Scale (NTTS) and Temperament Character Inventory (TCI) were applied to all participants, and in addition, Hamilton Depression Rating Scale (HDRS) were applied to the subjects with MDD. MDD specifiers were evaluated using follow-up data files.
RESULTS: According to results, both Nine Type Temperament (NTT) Model’s types, which are NTT1, NTT2, NTT3, NTT4, NTT6 and NTT8, and Psychobiological Personality Model’s dimensions which are consisted of the cooperation, persistence, harm avoidance and self-management were found to be associated with MDD. From the point of MDD determinants; anxiety-distressing characteristics are associated with NTM2, NTM3, NTM6, NTM9; melancholy characteristics is concerned with NTT1, NTT5 and NTT6; seasonal characteristics are related to NTT4; mixed features are relevant with NTT4 and NTT7; and atypical features are associated with NTT5, NTT7, NTT9. As a result, MDD determinants are found to be associated with temperament types which are coming from NTTM.
DISCUSSION AND CONCLUSION: It is seen that temperament, which constitutes the structural basis of personality, is an effective parameter both in the diagnosis and in the individual-specific recognition of symptomatology in MDD patients. In addition, it can be said that temperament can be a discriminating factor in defining MDD specifiers. The development of temperament-oriented diagnosis and treatment strategies in future studies may be beneficial for the practice.

12. The effect of hypnotherapy on depression and anxiety levels in obesity patients (tur)
Erdal Erşan
doi: 10.5505/kpd.2020.41196  Pages 343 - 351
INTRODUCTION: The purpose of the present study was to investigate the effect of hypnotherapy on depression and anxiety levels of obese patients who were admitted to hypnotherapy sessions for healthy and balanced diet.

METHODS: Methods: The study sample consisted of 60 individuals who presented to the Psychiatry Polyclinic of Numune Hospital, who volunteered to participate in the study, whose Body Mass Index was 30 and above and who completed 10-week hypnotherapy session. Firstly, the participants’ body mass indexes were determined after their “personal information forms” were filled in. Before the hypnotherapy sessions were started, the Beck Depression Inventory and Beck Anxiety Inventory were administered to each participant. After that, hypnotherapy sessions were performed for 10 weeks, one session per week. At the end of a 10-week hypnotherapy session, the participants’ Body Mass Indexes were determined again, and the Beck Depression Inventory and Beck Anxiety Inventory were re-administered. Then the effectiveness of hypnotherapy was evaluated by comparing the pre- and post-therapy Body Mass Indexes, and the scores obtained from the Beck Depression Inventory and Beck Anxiety Inventory.

RESULTS: The comparison of the pre- and post-therapy Body Mass Indexes, and the scores obtained from the Beck Depression Inventory and Beck Anxiety Inventory demonstrated significant differences (p<0.001). There was a significant positive correlation between the scores obtained from the Beck Depression Inventory and those obtained from Beck Anxiety Inventory (p <0.001).

DISCUSSION AND CONCLUSION: The present study demonstrated that the use of hypnotherapy in the treatment of obesity was effective in reducing depression and anxiety levels of obese patients. It is recommended that future studies should be performed to investigate the long-term effects of the hypnotherapy and consist of larger samples including a control group.


REVIEW
13. Psychometric properties of compulsive internet use scale (CIUS): A systematic review and meta-analysis (eng)
Masumeh Ghazanfarpour, Hossein Dabiriyan Tehrani, Nasrin Khajeali, Abbas Keshtkar, Masoudeh Babakhanian
doi: 10.5505/kpd.2020.81489  Pages 352 - 363
Introduction: This article performs a systemic review of psychometric properties and factor structure of Compulsive Internet Use Scale (CIUS), the scale for assessing Internet addiction behavior in clinic and research fields.
Methods: Studies measuring psychometric properties and factor structure of CIUS (original version) were searched through MEDLINE in PubMed, SCOPUSE, Pub Psych, google scholar and SID & Iranmedex (Iranian database). A total of 18 studies(24samples) including 44,198subjects were reviewed in our study.
Results: Based on meta-analysis for internal consistency, the pooled Cronbach’s alpha coefficient from all study was 0.47(95percent confidence interval [CI], 0.46-0.49). Based on meta-analysis for internal consistency adolescence subgroup was 0.48 (95percent confidence interval [CI], 0.45–0.51), and addicted to behavior addiction subgroup was 0.48 (95 percent CI, 0.44–0.51), in general population subgroup was 0.47(95percent confidence interval [CI], 0.42-0.53), in university student subgroup was 0.47(95percent confidence interval [CI], 0.43-0.51), in internet user was 0.45(95percent confidence interval [CI], 0.43-0.47), by cultural of country for collectivistic society was 0.49(95percent confidence interval [CI], 0.46-0.52), and individualistic societies was 0.46(95percent confidence interval [CI], 0.44-0.47) and based quality assessment subgroup for study was 0.47(95percent confidence interval [CI], 0.46-0.49).
Conclusion: future studies should be conducted on multiethnic population and cross-cultural designee. Future studies should be developed and reported based on COSMIN checklist.

14. The concept of schizotypy and schizotypal personality disorder (tur)
Emre Mısır, Koksal Alptekin
doi: 10.5505/kpd.2020.27576  Pages 364 - 374
Schizophrenia is a disorder that consists of positive, negative symptoms, cognitive impairment, disorganization and various dimensions and manifested as several clinical appearances because of different intersections of these dimensions at different levels. The description of the schizophrenia-like clinical picture is based primarily on the finding that psychosis-like symptoms have accumulated in families of patients with schizophrenia. The following studies have examined paranoid, schizoid and schizotypal personality disorders in this spectrum by comparing them to schizophrenia. The idea intensely becomes more dominant in the literature that especially schizotypal personality disorder (SPD) is a non-progressive schizophrenia spectrum disorder in which different dimensions of schizotypy are seen together rather than a personality disorder. Among the personality disorders, SPD has the strongest genetic relationship with schizophrenia. The term schizotypy was first described as a schizophrenia-like psychosis phenotype. To date, studies have shown schizotypy has different dimensions, such as schizophrenia, and that reflections of these dimensions are common in non-clinical populations and individuals at risk for psychosis. At the same time, several studies found related dimensions of schizophrenia and schizotypy have similar neurobiological bases. As per the definiton of prodrome is a condition can only be defined retrospectively in patients with schizophrenia. Therefore, schizotypal personality disorder and high schizotypy are predisposition indicators within the spectrum rather than reflecting the schizophrenia prodrome. Identifying of these borderline cases is important for uncovering etiopathogenesis of psychosis, early diagnosis of schizophrenia, intervention to predisposing factors and prevention of psychotic break.

15. Placebo-controlled pharmacological trials in child and adolescents with bipolar disorder manic episode (BPD-ME): Systematic review, meta-analysis and a meta-regression on placebo response (eng)
Remzi Oğulcan Çıray, Pelin Hançer, Mustafa Tunçtürk, Neslihan İnal Emiroğlu
doi: 10.5505/kpd.2020.45822  Pages 375 - 385
Objective: Randomized placebo controlled trials (RCT) are very important for testing efficacy and safety of a medical treatment. There is no too much RCT`s in childhood bipolar disorder manic episode. In these trials, high placebo response poses a problem for the definition of real drug responses in practice. Therefore, analysis of predictors of drug and placebo response are important for conducting more reliable RCT`s in the future.
Method: Comprehensive search conducted in PubMed, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL) and some other electronic databases. Studies including participants with Bipolar Disorder manic episode and associated symptoms (e.g ADHD, irritability) included. There was no restriction in terms of sex, ethnicity or initial severity. Participants over age 18 were excluded. Random effect size model was used for calculate effect sizes for placebo and drugs.
Results: A total of 1974 participants and 11 studies were included in the meta-analysis. Risperidone was highest effect size among drug arms. Number of the sites and number of the participants were associated with higher placebo response in meta-regression. We did not find any variable had an impact on drug response. There was no any publication bias in this meta-analysis.
Conclusion: We found similar results as adult studies. Modifying number of the sites or ramdomized sample size may limit placebo response and could improve the efficacy of RCT`s and enhance drug-placebo contrasts.

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