ISSN 1302-0099 | e-ISSN 2146-7153
TURKISH JOURNAL CLINICAL PSYCHIATRY - Turkish J Clin Psy: 23 (1)
Volume: 23  Issue: 1 - 2020
EDITORIAL
1. Effects of forced migration on child mental health
Sevcan Karakoç Demirkaya
doi: 10.5505/kpd.2020.39206  Pages 5 - 6
Abstract |Turkish PDF

RESEARCH ARTICLE
2. The effect of psycho-education about maternal attitudes on childhood obsessive compulsive disorder symptoms (eng)
Ecem Akıncı, Oya Mortan Sevi
doi: 10.5505/kpd.2020.82612  Pages 7 - 22
INTRODUCTION: The primary goal of the present study is to investigate relationship between maternal attitudes and subclinical childhood Obsessive Compulsive Disorder (OCD) in Turkish sample. Study also investigates the effectiveness of 8-sessions psycho-education program about maternal attitudes.
METHODS: Sample consisted of 97 mother-child pairs and children's age ranged between 8 to 10. Parental Attitudes Research Instrument (PARI), Leyton Obsessional Inventory Child Version (LOI-CV), State-Trait Anxiety Inventory for Children (STAI-CH) and Children’s Depression Inventory (CDI) were used as assessment tools. After initial assessments, fifteen mothers randomly assigned either to group psycho-education condition (n=8) or waiting-list control condition (n=7).
RESULTS: Marital conflict was positively correlated with total interference score in LOI-CV, total score in LOI-CV and A-Trait anxiety symptoms (r =.23, r =.24 and r =.24, respectively). Authoritarianism positively correlated with A-Trait anxiety symptoms (r =.25). Findings also indicated that there was a statistically significant difference in total scores of negative attitudes (Z= -2.201, p=.028), and posttest scores of these variables showed significant decrease after psycho-education program. There were statistically significant change in interfere (Z= -2.371, p=.018) and total (Z= -2.366, p=.018) score of OCD symptoms after psycho-education program.
DISCUSSION AND CONCLUSION: Marital conflict has a significant relationship with subclinical OCD symptoms. Marital conflict and authoritarian attitude also have significant relationship with trait anxiety symptoms in children. Furthermore, psycho-education program was effective in reducing negative maternal attitudes and children’s subclinical OCD symptoms

3. Examination of impulsiveness and aggression in substance abuse (tur)
Berrak Köksal, Semra Karaca, Serhat Çıtak
doi: 10.5505/kpd.2020.46693  Pages 23 - 33
INTRODUCTION: The use of addictive substances is usually related with many problems physical, mental and social aspects. The present study aims to examine levels of impulsiveness and aggression and the relationships between impulsiveness and aggression in substance abuse.
METHODS: This cross-sectional study was conducted in an alcohol and addiction treatment center of a psychiatric hospital in Istanbul. In order to conduct this study, ethical committee permission was obtained from the Ethics Committee of Marmara University and official permission was obtained from hospital. The sample size was calculated using a statistical formula and the study was conducted with 126 patients. Data was collected by Demographic Information Form, Barrat Impulsivity Scale (BIS-11) and Buss Pery Aggression Scale (BPAS). The data was analyzed using descriptive statistical analysis Shapiro-Wilk test, Student’s t test, Mann-Whitney U, One-way ANOVA, Kruskal Wallis and Pearson correlation analysis.
RESULTS: 92.9 % male of patients, 58.7 % were single, 40.5% high school graduates and mean age was 29.53 ± 8.20. BIS-11 total score of the patients was 63.86 ± 8: 47. BPAS total score of the patients was 50.70 ± 20.77. Statistically significant positive peer relationships were found between averages of BIS-11 total scores, BPAS total scores and all sub-scale scores (between BIS-11 total scores and BPAS total scores r=0.299, p=0.001; physical aggression r=0.225; p=0.012; verbal aggression r=0.212, p=0.018; anger r=0.191, p=0.033; hostility r=0.373, p=0.001).
DISCUSSION AND CONCLUSION: In this study, the majority of participants was male. Of substance abuse, it is seen that increased impulsivity, aggression increases overall score.

4. The comparison between the socio-demographic characteristics and the problematic internet use between gamblers and non-gamblers among university students (eng)
Mehmet Çakıcı, Yağmur Fırat, Asra Babayiğit, Meryem Karaaziz
doi: 10.5505/kpd.2020.93685  Pages 34 - 42
INTRODUCTION: The purpose of this study is to investigate the differences between the socio-demographic characteristics and the problematic internet use (PIU), and between problem and pathologic gamblers (PPG) and non-problem gamblers (NPG).
METHODS: The study was administered to 299 Near East University psychology students in April-May 2015. The questionnaire includes a socio-demographic form, South Oaks Gambling Screening Scale (SOGS) and Problematic Internet Usage Scale (PIUS). Descriptive, chi-square, t-test and Pearson correlation statistical methods were used.
RESULTS: According to the study more than half of the PPG participated in gambling on the Internet. Moreover, men tended to gamble more than women. It is also found that single and high income level participants are gambling more frequently. Students attending university for more than 5 years were found to have more PPG. However, this study shows that problem and pathological gambling is seen more prevalent among students who have high income level. In this study, it is illustrated that the highest frequency of gambling occurs at casinos (77.7%), which is followed closely by betting offices (70.8%). It is also observed that gambling on games such as horse-racing and dog-racing were seen higher in people with PPG.
DISCUSSION AND CONCLUSION: PIU has been seen as one of the leading causes of PPG. These studies showed that university students who had PIU were more prone to PPG problems. In order to prevent the inter-related problems of PPG and PIU, effective public health policies, awareness and consciousness programs are needed.

5. Assessing depression with anxious distress and mixed features: The validity and reliability of the Turkish version of the clinically useful depression outcome scale (tur)
Zekiye Çelikbaş, Sedat Batmaz, Özgür Ahmet Yüncü, Mehmet Öztürk, Esma Akpınar Aslan
doi: 10.5505/kpd.2020.31932  Pages 43 - 55
INTRODUCTION: The aim of this study was to determine the validity and reliability of the Clinically Useful Depression Outcome Scale (CUDOS) in the Turkish population.
METHODS: 408 participants were included in the study. Exploratory factor analysis, internal consistency, Quick Inventory of Depressive Symptoms, State Trait Anxiety Inventory and Self-Report Tool for Mania were used to analyze the correlation between the scales and the discriminitave properties of the CUDOS was investigated.
RESULTS: As a result of the exploratory factor analysis, “Depression and Anxiety” and “Atypical and Mixed Feature Depression” factors were determined. It was observed that the CUDOS had convergent validity with other relevant scales. It was demonstrated that the CUDOS had distinctive validity. Internal consistency was found to be high. According to clinician evaluation and scale scores, there was no difference in the detection of depression subtypes.
DISCUSSION AND CONCLUSION: The CUDOS can be completed by patients in a short time and provides a quick and easy evaluation opportunity for clinicians. This validity and reliability study in the Turkish population showed that these scales were suitable for clinical use.

6. Investigation of childhood traumas in inpatient adults with major depression and with or without attention deficit hyperactivity disorder comorbidity (eng)
Esin Erdoğan, Dursun Hakan Delibaş, Emel Pasa Baskin
doi: 10.5505/kpd.2020.54765  Pages 56 - 63
INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and a significant number of symptoms continue in adulthood. Depression is very common in the daily practice of psychiatrists whereas patients with ADHD comorbidity could not be considered by the clinicians. One of the less studied aspects of adult ADHD is its association with childhood traumas. The aim of this study was to compare adults with major depression (MD) with or without ADHD comorbidity (MD-ADHD) in terms of childhood traumas and the severity of psychopathology.
METHODS: 33 inpatients with MD-ADHD and 30 inpatients with MD were included in the study. The diagnoses were made according to DSM-V criteria, and sociodemographic evaluation scale, Wender Utah Rating Scale (WURS), Adult Attention Deficit Hyperactivity Disorder Scale (A-ADHDS), Hamilton Depression Scale (HDS), Childhood Trauma Questionnaire (CTQ), and Personal Social Performance Scale (PSPS) were applied to the patients.
RESULTS: The mean HDS scores of MD-ADHD patients during hospitalization were higher (p=0.007), total CTQ scores were higher (p=0.006), and mean PSPS scores were lower than the MD group (p=0.012). The mean scores of emotional abuse, physical neglect, and physical abuse were higher in MD-ADHD patients (p=0.013; p=0.017; p=0.016; respectively). All trauma scores except emotional neglect and sexual abuse were higher in combined type ADHD than the other two groups.
DISCUSSION AND CONCLUSION: Depression patients with comorbid ADHD had more severe depression level and lower functionality compared to those with depression alone. It is important to investigate the history of childhood traumas in adults with depression and ADHD comorbidity.

7. The effects of the frequency of participation to the community mental health center on insight, treatment adherence and functionality (eng)
Şengül Şahin, Gülçin Elboğa, Abdurrahman Altındağ
doi: 10.5505/kpd.2020.49369  Pages 64 - 71
INTRODUCTION: Community Mental Health Centers (CMHC) were established to provide psychosocial support services for patients with severe mental disorders such as bipolar disorder, schizophrenia, unspecified schizophrenia spectrum and other psychotic disorder. The aim of our study was to determine the effects of participation frequency in a CMHC on insight, treatment adherence and functionality in severe mental disorders.
METHODS: 362 patients diagnosed with bipolar disorder and psychosis according to the DSM–5 criteria and treated in CMHC were included in this retrospective study. The participation frequency of patients benefited from CMHC services for a year was retrospectively screened. The patients had been evaluated with Clinical Global Impression Scale (CGI), Medication Adherence Rating Scale (MARS), Global Assessment of Functioning (GAF), and Schedule for Assessing the Three Components of Insight (SATCI), and Functional Remission of General Schizophrenia Scale (FROGS). Patients were divided into two groups as bipolar disorder and psychosis (schizophrenia, schizoaffective and USS&OPD).
RESULTS: The patients had been participated in CMHC services in 6 different frequency groups: 68 (18.8%) once in six months, 62 (17.1%) once in three months, 68 (18.8%) once in two months, 98 (27.1%) once/twice a month, 34 (9.4%) once/twice a week, 32 (8.8%) three/four times a week, respectively. There were significant differences between GAF, CGI, SATCI, MARS, FROGS scores in terms of participation frequencies of psychosis group and there were significant differences between GAF, CGI, MARS scores in terms of participation frequencies of bipolar disorder group at the end of one year.
DISCUSSION AND CONCLUSION: In general, as the participation frequency increased, insight, treatment adherence and functionality increased. In addition to individual factors, our results will also contribute to determine the frequency of participation in CMHC.

8. Evaluation of long acting, oral and combination antipsychotic treatments in patients with psychotic disorder (tur)
Yasir Şafak, Süheyla Doğan Bulut, Hasan Karadağ, Sibel Orsel
doi: 10.5505/kpd.2020.42103  Pages 72 - 82
INTRODUCTION: The aim of this study was to evaluate the clinical progress, the drug side effects and the relationship between clinical variables and the clinical progress of patients with psychotic disorder who use oral antipsychotic (OA), long-acting antipsychotic (LAA) and combination of two forms (OA+LAA).

METHODS: The variables of 250 patients with schizophrenia and other psychotic disorders were analyzed retrospectively from the patient database. The Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning (GAF) measurements, clinical variables related to the disease and adverse effects were recorded in the database. The analysis was performed between three groups according to antipsychotic use as OA, LAA (2-4 weeks), OA+LAA with parametric and non-parametric statistical methods.

RESULTS: In OA+LAA users, BPRS scores were higher than those using OA or LAA. In OA users, the SAPS and SANS scores were lower and GAF scores were higher than those using OA+LAA. In 4-week LAA users, BPRS scores were higher than those using OA and 2-week LAA. Those with OA had lower SANS, SAPS scores than those with 4-week LAA, and GAF scores were higher than those using LAA for 2 weeks and 4 weeks.


DISCUSSION AND CONCLUSION: In our study, it was found that combination therapy with LAA was more preferred in clinically severe cases. The use of LAA may lead to the use of multiple and high-dose drugs, unlike the intended use. Evidence-based data are needed in treatment algorithms in cases with low treatment response, including the use of long-acting forms.


9. Evaluation of the parental attitudes, competency and attachment styles of the mothers of the children at preschool period who were admitted to child psychiatry services (tur)
Öznur Bilaç, Arif Önder, Canem Kavurma, Yakup Doğan, Gülçin Uzunoğlu, Yetis Isildar, Şermin Yalın Sapmaz
doi: 10.5505/kpd.2020.07078  Pages 83 - 91
INTRODUCTION: In this study we aimed to evaluate attitudes, attachment styles to their husbands and competence perceptions of the mothers towards their children’s problems whose children were at pre-school period with no cognitive developmental delay.
METHODS: 40 children and their mothers were included into the study. The children were chosen among those who were aged between 0-72 months and had no developmental delay which was found out as a result of developmental test. As the control group, another 40 children and their mothers were included into the study. Child Adjustment and Parent Efficacy Scale (CAPES-TR) and Parent Attitude Research Instrument(PARI) were handed out to mothers in both groups. Finally, Experiences in Close Relationship Revised (ECC-R) was applied to mothers of both groups. SPSS 20 was used for statistical analysis.
RESULTS: It was found that the most common reasons for admission were hyperactivity and bad-temper. It was found that peer-relationship problems and elimination disorders were more common in sample group compared to control group. According to CAPES-TR results, emotional, behavioural and social problems in the group that were admitted to psychiatry clinic were significantly higher than control group (p<0.05). According to same scale, mothers’ self-confidence was found significantly lower (p<0.05). According to PARI reuslts, the score of the group that applied to clinic for over-motherhood reasons was found significantly higher(p<0.05). Likewise, authoritative attitude score was found significantly higher in patient group(p<0.05). As a result of assessment of ECC-R, no significant difference was found among the groups.
DISCUSSION AND CONCLUSION: The results of this study share similarities with other studies that found out that parental child-rearing attitude presents a risk factor for behavioural problems among children. There are limited number or studies that investigate the relationship between parental child-rearing attitute,parental competence perceptions, mothers attachment styles and children’s behavioral problems at pre-school ages.

10. Investigation of the relationship between psychiatric disorders and suicide: A retrospective research based on records for 2013-2018 (tur)
Burak Mete, Vedat Söyiler, Erkan Pehlivan
doi: 10.5505/kpd.2020.35582  Pages 92 - 100
INTRODUCTION: A suicide attempt results in serious psychological and health problems that result in death or not. The aim of this study was to investigate cases of suicide attempts in the province of Bingöl and to identify risk groups and groups with repeated suicide risk.
METHODS: This is a retrospective study based on records. The study was carried out on the files of 550 suicide attempts that occurred in 2013-2018. Binary logistic regression test and Chi-square test were used for data analysis.
RESULTS: Suicidal death rates tend to fall. 91% of those attempting suicide are under 35 years old, 75% are women and 36% are students. The most important suicidal causes were mental illness (18%) and familial problems (16%). The most common mental disorder is depressive disorder.The most commonly attempted suicide attempt for both sexes is drug-toxic intake. The risk of repeated suicide attempts in patients with mental disease: 7,7 (CI: 4,51-13,26) times, the risk of repeated suicide in patients with unintended psychiatric consultation after suicide OR: 1,9 (CI: 1,16-3,22) increase.
DISCUSSION AND CONCLUSION: Multisectoral social policies to reduce suicide attempts in mental patients, women and students should be carried out.

BRIEF REPORT
11. Could neutrophil-to-lymphocyte ratio be an important parameter in children and adolescents with obsessive compulsive disorder? (eng)
Aylin Deniz Uzun, Şermin Yalın Sapmaz, Burak Çakır, Hasan Kandemir
doi: 10.5505/kpd.2020.02359  Pages 101 - 105
Objective: The number of studies that suggest the possible role of immune abnormalities in the pathogenesis of obsessive-compulsive disorder(OCD) are increasing. Our aim here is to determine the relationship between neutrophil lymphocyte ratio(NLR) and children and adolescents with OCD.NLR and platelet lymphocyte ratio(PLR) are new, inexpensive, easily reproducible indicators used for the determination of low grade inflammation.
Method: In this study, retrospective records of 32 children and adolescents with OCD were screened, and the NLR, PLR,monocyte lymphocyte ratio (MLR) data obtained from the pre-treatment complete blood count were compared with the same data of the healthy control group with similar characteristics.
Results: The NLR was found lower in children and adolescents with OCD compared to the control group; yet PLR and MLR were not significantly different.
Conclusion: Inflammation might play a role in the etiopahogenesis of OCD. The NLR may be potential inlammation markers for OCD in children.

CASE REPORT
12. Rapid effect of eye movement desensitization and reprocessing (EMDR) in treatment of psychogenic vomiting: Case report (tur)
İbrahim Gündoğmuş, Mikail Burak Aydın, Dilek Sarı, Alişan Burak Yaşar
doi: 10.5505/kpd.2020.00821  Pages 106 - 110
Psychogenic vomiting is an uncommon medical condition that usually occurs with severe and recurrent vomiting without an underlying organic cause. Although various pharmacological and therapeutic methods have been tried in the treatment of this condition, there is no clear treatment method. Eye Movement Desensitization and Reprocessing (EMDR) can be considered a good treatment alternative if there is a traumatic event in the underlying formation of psychogenic vomiting. To the best of our knowledge, there are no cases of efficacy of EMDR in psychogenic vomiting in the literature. The aim of the present case was to investigate the clinical usefulness of EMDR due to the presence of traumatic memories which may be associated with the symptom of psychogenic vomiting. As a result; as seen in our case, it should be considered that EMDR may be a treatment alternative in cases with psychogenic vomiting of traumatic origin.

13. A rarely known topic ‘Delusional Parasitosis’: A case report (tur)
Burak Okumuş, Cicek Hocaoglu, Nursel Dilek
doi: 10.5505/kpd.2020.99815  Pages 111 - 115
Delusional parasitosis (DP) is a delusional disorder with a false belief that the person is infected by parasites or living small creatures, although there is no medical evidence. Although DP has been named as Ekbom disease and psychogenic parasitosis for more than 100 years, the clinic features still remains unclear. Most of the patients with delusional parasitosis are 50-70 years old, married and well educated women. DP’s etiology can be classified as primary or secondary. Symptoms in secondary delusional parasitosis occur due to general medical, neurological and psychiatric disorders. Although delusional parasitosis has insidious onset and chronic course, it is sometimes seen in acute onset. Although DP is a psychiatric disease, patients mostly appeal to dermatologists, family physicians and infectious diseases specialists. DP should be evaluated by psychiatrists but unfortunately they are usually evaluated by dermatology and infectious diseases and because of this reason, diagnosis and treatment are delayed.

14. Treatment with eye movement desensitization and reprocessing (EMDR) for an adolescent patient with comorbidty of attention deficit hyperactivity disorder (tur)
Hüsna Kaan, Ali Karayağmurlu, Nusret Soylu
doi: 10.5505/kpd.2020.19327  Pages 116 - 120
Eye movement desensitization and reprocessing (EMDR) is an effective treatment method used in posttraumatic stress disorder that combines well-knownelements of the different approaches such as psychodynamic, cognitive, behavioral and client-centered approach. Posttraumatic stress disorder (PTSD) can be seen with neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder and Intellectual Disability and may be difficult to treat in the presence of comorbidity. In this paper, it will be discussed how to successfully treat with EMDR a 16-year-old male patient with the diagnosis of ADHD and Borderline Mental Capacity who had been sexually abused by his two friends six years ago and had symptoms of PTSD such as, flashcbacks, nightmares and not enjoying life.

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