ISSN 1302-0099 | e-ISSN 2146-7153
TURKISH JOURNAL CLINICAL PSYCHIATRY - Turkish J Clin Psy: 20 (4)
Volume: 20  Issue: 4 - 2017
EDITORIAL
1. Draft mental health law
Burhanettin Kaya
Pages 253 - 254
Abstract |Turkish PDF

RESEARCH ARTICLE
2. Addiction Profile Index-Family (BAPİ-A): The Study of Validity and Reliability
Kültegin Ögel, Hande Çelikay, Aslı Başabak
doi: 10.5505/kpd.2017.46220  Pages 255 - 262
INTRODUCTION: Addiction is a disease that affects the family and also requires family’s participation on treatment. Therefore, determination of the family property will contribute to organize the treatment.
METHODS: Addiction Profile Index-Family (BAPİ-A) was developed as a scale consisting of 10 questions to asess family’s abilities to set rules, give responsibility, resolve conflict, family bond and the attitude of the family towards the addict. BAPİ-A developed on practiced with parents, spouces and their relatives of addicts applied the Addiction Clinic and Family Assessment Device (ADÖ) were applied. The application was repeated after 15 days.
RESULTS: Cronbach Alpha coefficient of the scale was found as 0.82. 4 factors explained %30.81 of the total variance were obtained on explanatory factor analysis. These factors were named “establish relationship”, “family bonds” and “attitude towards the addict”. A correlation of 0.52 (p<0.01) was found between the average total scores of ADÖ and BAPİ-A. The correlation of between pre-test and post-test of BAPİ-A was found 0.67 (o<0.01). When comparing the scale scores of families that have an addict member and not, the variance between average total scores was found statistically significant. And also similar findings were obtained when parents, spouces and other relatives were evaluated.
DISCUSSION AND CONCLUSION: Thus, the Addiction Profile Index-Family (BAPİ-A) can be used as a valid and reliable instrument to asses family’s abilities to set rules, give responsibility, resolve conflict, and establish relationship, family bonds and the attitude towards the addict.



3. Factors Effecting Length of Stay in Child Psychiatry Hospital Setting
Miraç Barış Usta, Emre Ürer, Armağan Aral, Gökçe Nur Say, Koray Karabekiroğlu
doi: 10.5505/kpd.2017.28290  Pages 263 - 267
INTRODUCTION: Due to the low number of children and adult psychiatric clinics serving in our country, there is limited data in this age group in the literature. In this study, it was aimed to determine the factors affecting the duration of admission in children and adolescents receiving treatment in Samsun Ondokuz Mayıs University Medical Faculty Psychiatry Clinic.
METHODS: Hospital records of 194 children and adolescents aged between 11 and 18 years who were hospitalized at Ondokuz Mayıs University Psychiatric Service between January 2013 and December 2015 were retrospectively reviewed. ANOVA and logistic regression analyzes were performed for clinical and sociodemographic data that could effect hospitalization times and multiple admission.
RESULTS: 138 of the patients were female and 56 were male. Major depressive disorder patients (n: 79, 41.1%) and the average duration of hospitalization were 8.43 days. The group with the longest mean duration of admission was the Psychotic Disorder group (n: 17, mean: 19.92 days, p: 0.01). In logistic regression analysis for multiple risk factors, Female gender (OR: 2.02) and MDD diagnosis (OR: 1.51) were found to be risk factors for multiple admission.
DISCUSSION AND CONCLUSION: In our study, it was observed that the presence of Major Depresive Disorder and female gender was a risk factor for multiple admission. Clinical and sociodemographic features of the disease can be predictive of hospitalization within the treatment plan.

4. Evaluation of Treatment Costs Invoiced to the Social Security Institution for Inpatients Hospitalized In Psychiatric Ward of Gazi University Hospital
Cemal Koçak, Mustafa Necmi İlhan, Aslı Kuruoğlu
doi: 10.5505/kpd.2017.66588  Pages 268 - 275
INTRODUCTION: Psychiatric illnesses could cause disability due to their commonly occuring, tendency to recur and chronic character.Thence, psychiatric patients’ treatment costs are high.In this study we aimed to evaluate treatment costs for patients who were hospitalized into Gazi University Hospital Psychiatric Ward in 2015.
METHODS: Quantitative data analysis was executed using software program SPSS 21.0 descriptive values were given such as frequency, percent, mean±standard deviation.A Pearson Chi-square Test was used for cathegorical variables, a Mann-Whitney U and a Kruskal Wallis Test was used in independent groups lacking normal distribution.Hospital stay time and treatment costs predictions of different features were assessed with logistic regression.The relationship between variables was measured using Spearmen Correlation Test.Statistical significance level was set as p<0.05.
RESULTS: There are 389 patients in the study.Schizophrenia (%38.8) was the mostly encountered disease in the patient group, followed by depression (%26.1) and bipolar disorder (%16).Among male schizophrenia patients(%47.6) was the most while depression patients(%31.8) was the most among female patients.Average cost per inpatient day was 120.4 TL(44.7 USD), average cost of hospitalization was 3181.0 TL(1182.6 USD).Average cost of hospitalization for men was 2922.0 TL, for women was 3495.3 TL (p=0.005).Bipolar disorder hospitalization cost was the highest costing 3757.6 TL(1397,0 USD), alcohol and drug use disorder hospitalization cost was the least costing 1864.7 TL(693.2 USD) (p=0.024).Depression disorders reduce 2.56 times, somatoform disorders 6.25 times reduces the cost of hospitalization than schizophrenia.Average cost per inpatient day in neurocognitive disorders costing 130.7 TL(48.5 USD) was the highest and in eating disorders was the least, costing 107.5 TL(39.9 USD).
DISCUSSION AND CONCLUSION: Payment package applications, as though they provide an ease of calculation, make it harder to discriminate which facility costs for how much.Not every patient is same thus none of their treatment costs could expected to be the same.Setting standard payments for patient treatment is argumentative.More transparent systems are needed.

5. Psychological Maltreatment of Women Inventory Short Form - Turkish adaptation
Nevra Cem Ersoy, Olga Selin Hünler, Yudit Namer
doi: 10.5505/kpd.2017.76588  Pages 276 - 286
INTRODUCTION: This study aims to adapt a short form of Psychological Maltreatment of Women Inventory (Tolman 1989) to Turkish and to examine the psychometric properties of the Turkish short form.
METHODS: Participants were 852 women between the ages of 23-55 (M=32; SD=1.32), who were either married (48%) or in a romantic relationship (47%) during data collection. The questionnaire was comprised of Psychological Maltreatment of Women Inventory (PMWI), Submissive Acts Scale (SAS) and demographic information form. Principal Components Analysis was used for confirmatory construct validity, and Pearson correlation coefficients between SAS and PMWI total scores were calculated for discriminatory validity. Cronbach-Alpha internal consistency coefficients and split-half reliability were measured to establish internal consistency.
RESULTS: The three-factor (Restriction/Blaming/Threat; Emotional-Verbal Violence; Responsibility) structure explained 64.3% of variance. Internal consistency coefficient (Cronbach-Alpha) was found to be.93; split half reliability was found to be.90 and.87 for the first and second halves, respectively, and the correlation between the two halves were found to be.71.
DISCUSSION AND CONCLUSION: The Turkish short form of Psychological Maltreatment of Women Inventory is a valid and reliable tool to measure psychological maltreatment experienced by married women, or women in romantic relationships.

6. Evaluation of Child and Adolescent Psychiatry Consultations
Özge Gözaçanlar Özkan, Şermin Yalın Sapmaz, Hasan Kandemir
doi: 10.5505/kpd.2017.43513  Pages 287 - 293
INTRODUCTION: This study was conducted to evaluate child psychiatry consultations of patients which were stayed in different clinics in a university hospital.
METHODS: The records of the patients who were consulted in between 01.07.2016 and 31.12.2016 and was made diagnosis according to DSM5 was scanned restrospectively. The sociodemographic information of the patients, the diagnosis of physical illness, the clinic requested for consultation, the reason for the consultation, the psychiatric diagnoses determined in the consultation result and the psychiatric treatment process were analyzed by using the SPSS 15.0 program.
RESULTS: : Psychiatric consultation was requested for 55 inpatient children within a six-month period. %63.6 of consulted cases was a girl, %36.4 of them was a boy and the average age was found as 13.2 ± 3.6. When the consultations were evaluated, it was determined that the 23.6% of the patients were consulted for suicide attempt and 83.6% of them had at least one mental disorder. The most common diagnosis was major depression in the rate of 36.4% and psychotropic treatment was recommended to 38.2% of evaluated cases because of the psychiatric disorder.
DISCUSSION AND CONCLUSION: In our study, it was found that the consultation rates were low despite the rate of psychopathology (83.4%) was rather high in consulated children and adolescents. This suggests that the doctors who are working in non-psychiatric areas are having difficulty understanding and evaluating the psychiatric symptoms in children and that the cooperation among physicians should be increased so that psychiatric illnesses can be better recognized.

7. ECT practice in a research and training hospital
Murat Açar, Almıla Erol
doi: 10.5505/kpd.2017.17363  Pages 294 - 300
INTRODUCTION: Electroconvulsive therapy (ECT) is a treatment method for many psychiatric disease, mood disorders particularly. ECT indications and practice differs among countries, even among clinics in the same country.
METHODS: We aim to investigate 10 years of ECT indications, practice and complications of 75 patients files with our retrospective study in our hospital.
RESULTS: The most common ECT indication was major depression with psychotic features. Clinical Global Impression Scale (CGI) improvement was 1,9 ± 0.9. Schizophrenia patients statistically had better CGI improvement scores compared to depression patients. No side effect was observed in 64,3% of the patients and the most common side effect was prolonged seizure. There was no ECT practice and side effect difference between different age and gender groups.
DISCUSSION AND CONCLUSION: ECT is a safe and effective treatment strategy for different age and gender groups who have mood disorders or schizophrenia. We believe our clinic's ECT data which proves to be with low side effect and effective will contribute ECT practice in our country.

8. The Influence of Duration of Disease on Clinical Characteristics in Schizophrenia Patients
Demet Sağlam Aykut
doi: 10.5505/kpd.2017.50479  Pages 301 - 307
INTRODUCTION: Schizophrenia affects 1% of the population and the clinical course is highly variable. In this study, we aimed to compare the clinical characteristics of patients with schizophrenia longer than 10 years and longer than 15 years in order to contribute to the identification of the clinical appearance of schizophrenia in the prolonged disease process.
METHODS: 71 patients who were diagnosed with schizophrenia for a short period of 10 years and 53 patients who were followed for a period of 15 years were included. All of the patients were assessed by the Positive and Negative Syndrome Scale (PANSS), the Calgary Schizophrenia Depression Scale (CSDS), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Extrapyramidal Symptom Rating Scale The UKU (UgvalgforKliniskeUndersgelser) Side Effect Rating Scale, the Schedule for Assessing the Three Components of Insight and the Morisky Treatment Compliance Scale (MCQS) were administered.
RESULTS: The scores of PANSS Negative symptoms subscale, CBSS, BPRS and MTUS scores were statistically significantly higher in the patient group with a disease duration of 15 years or more than in the group with a disease duration of 10 years or less. When the neurological subscale scores of the UKU side effect assessment scale were compared between the two groups; they were statistically significantly higher in the patient group with a disease duration of 15 years or longer.
DISCUSSION AND CONCLUSION: As a result of this study, it has been shown that, in patients with schizophrenia, the longer the illness is, the more negative and depressive symptoms increase, as well as the insight into the patient's illness and the increased drug compliance. It is seen that there is a need for larger scale, prospective planned studies for schizophrenic patients with prolonged disease duration, to understand what is going on schizophrenia and for factors to be taken into account in such cases.

9. The role of group psychotherapy and psychodrama in the treatment of depression
Gülfizar Sözeri-Varma, Filiz Karadağ, Nalan Kalkan-Oğuzhanoğlu, Osman Özdel
doi: 10.5505/kpd.2017.86158  Pages 308 - 317
INTRODUCTION: Psychodrama enables a formulation related with the factors causing depression while contributing to the patients to acquire insight and get well. With psychodrama group psychotherapy applications, the patients can benefit from the treating factors of group study as well as the specific technique and interventions of psychodrama. The objective in this study was to summarize the psychodrama psychotherapy application process on depression patients with antidepressant use and to discuss the points which are thought to contribute to recuperation.
METHODS: A total of 15 patients with mild-moderate level of depression participated in the study and 9 patients completed the group process. In addition to medications, a total of 16 sessions of group psychotherapy and psychodrama studies were applied on the patients with 3 hours of each per week. The severity of depression was assessed via Hamilton Depression Rating Scale (HAM-D17). Expectations of the patients from group therapy were asked during the first session and a common list was prepared using the recorded responses. It was evaluated in the final session whether these expectations have been met or not.
RESULTS: The initial HAM-D17 score average of the patients was determined as 13.33 (±2.39), whereas it was determined as 5.88 (±4.01) at the end of the treatment. A statistically significant decrease was determined in the severity of depressive symptoms after treatment (z=2.677, p=0.007, Wilcoxon test). The expectations of the patients from group psychotherapy and psychodrama were revised. It was determined at the end of the treatment that anger control of the patients increased, fears and irritability decreased, that they received support from the group and that they understood themselves better.
DISCUSSION AND CONCLUSION: Our results lead us to think that psychodrama group psychotherapy contributes to recovery in depression treatment. Psychodrama has contributed to understanding which factors have played a role in the formation of depression and the changing of these factors realized by the patient as well.

REVIEW
10. Unperceived Pregnancies: A Review
Nazan Aydin, Oğuz Omay, Esra Yazici, Melike Dönmez, Yüksel Kıvrak, Hazal Yavuzlar Cıvan, Çağla Cenker, Hilal Uslu Yuvacı
doi: 10.5505/kpd.2017.72681  Pages 318 - 331
"Unperceived pregnancy" is defined as a pregnancy noticed after the 20th week of gestation, sometimes not until birth. Women may not notice the physiological manifestations of pregnancy, may not know the existence of the growing baby and not take on the role of motherhood, neither emotionally nor socially. Despite its tragic consequences, this condition observed in women of all ages, races, cultures and socioeconomic levels in the world is unfortunately not well known and the women concerned are suffer misunderstandings. They may be exposed to negative judgments, accusations and even legal sentences. Furthermore, even health workers may not fully understand unperceived pregnancies and not consider it in their differential diagnosis. In extreme cases, this may lead to maternal and infant deaths. It is crucial for health workers who encounter unperceived pregnancies to refer these patients for mental health support, and for mental health professionals to be fully aware of the condition and provide appropriate support. When it comes to legal considerations, it is vital to understand the situation of these women and provide the appropriate forensic approach. This multidimensional review approaches unperceived pregnancies in their medical, psychological, legal and ethical aspects. We aim to raise awareness regarding unperceived pregnancies and help future developments on this issue.

LETTER TO EDITOR
11. Paliperidone Metabolic Effects in Children and Adolescents: A Case Report
Meltem Inci Kefal, Hasan Kandemir, Şermin Yalın Sapmaz, Masum Öztürk, Yekta Özkan, Özge Gözaçanlar Özkan
doi: 10.5505/kpd.2017.70288  Pages 332 - 333
The use of atypical antipsychotics in children and adolescents has increased in recent years. A 16-year-old male patient reported that he had used paliperidone for 3 years and had gained weight during this period. Various laboratory tests were performed when the patient started treatment in our clinic. It is evident from the test result that 3-year use of paliperidone dramatically increased fasting blood sugar, total cholesterol, low-density lipoprotein, triglycerides and prolactin levels in the patient. The metabolic parameters of the patient decreased into the normal range once the medication was stopped. Thus, paliperidone should be used carefully based on the side effects for patients under 18 years of age.

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