ISSN 1302-0099 | e-ISSN 2146-7153
TURKISH JOURNAL CLINICAL PSYCHIATRY - Turkish J Clin Psy: 24 (1)
Volume: 24  Issue: 1 - 2021
EDITORIAL
1. Opening up new horizons in the field of bipolar disorder: power of observation, research, thinking and creativity (eng, tur)
Simavi Vahip
doi: 10.5505/kpd.2021.82542  Pages 1 - 4
Abstract |English PDF | Turkish PDF

RESEARCH ARTICLE
2. The evaluation of depression, anxiety and quality of life in children living with parental cancer: A case-control study (eng)
Ali Karayağmurlu, Muhammet Emin Naldan, Öztun Temelli, Murat Coşkun
doi: 10.5505/kpd.2020.87699  Pages 5 - 14
INTRODUCTION: Parental cancers may have adverse effects on children and adolescents. The majority of studies on this subject have been performed in Western societies, and few have investigated quality of life in children. The purpose of this study was to investigate quality of life, anxiety and depressive symptoms in children living with parental cancer.
METHODS: The case group consisted of 50 children, aged 8–16 years old, with a parent diagnosed with cancer. A group of 50 children, aged and gender matched, with healthy parents was included as the control group. All subjects were administered the Revised Child Anxiety and Depression Scale (RCAD-S) to assess the symptoms of anxiety and depression. Parents completed the Questionnaire for Quality of Life Assessment for Children and Adolescents: Parent Form to determine the child’s quality of life.
RESULTS: Depression (p=0.011) and anxiety (p=0.011) scores were significantly higher in the case group than in the control group. Among the anxiety disorder symptoms, symptoms of separation anxiety were more common in case group (p=0.032). Compared to the control group, the case group reported a significantly lower quality of life (p=0.045).
DISCUSSION AND CONCLUSION: Children of parents with cancer may suffer from anxiety and depression that may reduce their quality of life. Clinicians should collaborate with relevant disciplines and have a family-based, multidimensional view when evaluating patients with cancer who have children. Consulting or refering to child psychiatry may be considered when emotional and/or behavioral problems present in children.

3. 3-year data of the refugee child mental health unit (tur)
Hatice Ünver, Veysi Çeri, Onur Tugce Poyraz Findik, Ayşe Rodopman Arman
doi: 10.5505/kpd.2020.57614  Pages 15 - 22
INTRODUCTION: It is known that refugee children and adolescents are at risk in terms of susceptibility to mental illnesses. It will be important to recognize the mental problems of this disadvantaged group in an early period and to serve appropriate treatment approaches with addressing quicly the risk factors and develop necessary strategies. In our study, it was aimed to review the data of a specialized Refugee Child Mental Health Unit to provide mental health services to refugee children and adolescents.
METHODS: Data on sociodemographic characteristics, educational status, diagnoses made according to DSM-5 classification system, follow-up processes and treatments of children and adolescents who applied to the refugee outpatient clinic between 2017-2020 were analyzed.
RESULTS: The sample of our study consisted of 156 children and adolescents (n: 50, 32.1% girls; n: 106, 67.9% boys) with a mean age of 10.8 ± 2.9 years. It was learned that 104 of the children (66.7%) went to school, but 65.7% (n: 69) of those did not attend at school regularly. It was observed that almost half of the outpatient clinic applications (n: 68, 43.6%) did not come to the follow-up appointments given after the first interview. The most common diagnoses are attention deficit hyperactivity disorder (n: 42, 26.9%), posttraumatic stress disorder (n: 42, 26.9%), major depressive disorder (n: 39, 25%), and anxiety disorders (n: 36, 23.1%). It was observed that 13 (8.3%) patients applied to the outpatient clinic after exposure to sexual abuse.
DISCUSSION AND CONCLUSION: The results of our study showed that refugee children complain of many mental illnesses, and it was thought that increasing the health and education opportunities available to them and developing policies specific to our country in these areas would be protective in terms of mental health for this particular group.

4. The effects of social media news that users trusted and verified on anxiety level and disease control perception in COVID-19 Pandemic (eng)
Erman Şentürk, Bahadır Geniş, Burak Erman Menkü, Behcet Cosar
doi: 10.5505/kpd.2020.69772  Pages 23 - 32
INTRODUCTION: Since the beginning of the pandemic, social media users have been bombarded with news about the number of cases and deaths, virus origin, vaccine development process, symptoms, transmission ways, prevention and treatment methods of COVID-19. This study was planned considering that the type of news sources and verification of the news was considerable and these affect the anxiety level and COVID-19 disease control perception. It was considered that reliance on different types of social media accounts (official or unofficial), verifying social media posts with other news sources, frequency of exposure to negative COVID-19 social media contents may have effects on this state. The aim of this study was to reveal the effects of these three variables on anxiety level and COVID-19 disease control perception of participants.
METHODS: The sample consisted of 1516 adults. An online survey was used to minimize face to face interactions and to facilitate participation during this emergency period. Participants filled out instruments for sociodemographic data, verification/trust on posts of official/unofficial social media accounts, state anxiety, COVID-19 disease control perception, frequency of exposure to positive/negative COVID-19 social media contents.
RESULTS: It was detected that as trust in COVID-19 posts of official social media accounts increased, anxiety level decreased and COVID-19 disease control perception increased. It was observed that as exposure to negative COVID-19 social media contents increased, anxiety level increased and COVID-19 disease control perception decreased. There was no significant correlation between anxiety level and verifying the accuracy of social media posts with other news sources.
DISCUSSION AND CONCLUSION: While physical contact accelerates the spread of COVID-19 disease, it was thought that digital contact could be a tool that could decelerate individual and mass anxiety if used appropriately. It is obvious that posts that are reliable and verified will play a key role in controlling anxiety level and disease perception.

5. The effect of COVID-19 pandemic on the sleep quality of patients who have the diagnosis of Bipolar Disorder (tur)
Ünsal Aydınoğlu, Ece Yazla
doi: 10.5505/kpd.2020.26576  Pages 33 - 40
INTRODUCTION: It was aimed to investigate the changes in sleep quality of patients who have the diagnosis Bipolar Disorder during the COVID-19 pandemic process and its relation with the time spent at home, and to determine the effects of the process on patients by investigating the changes in patients' weight, the amount of smoking and alcohol use.
METHODS: The files of patients who have been regularly followed up for at least 1 year with the diagnosis of Bipolar Disorder at the Community Mental Health Center were examined. Patients who met working criteria and patients whose data for the Pittsburg Sleep Quality Index, Young Mania Rating Scale, and Hamilton Depression Rating Scale, which were applied within 3 months before the start of social isolation measures and at least 2 months after this date was complete in their file, were included in the study.
RESULTS: 42 patients aged between 21 and 60 were included in the study. It was found that subscales of PUKI except the "sleep time" and "habitual sleep efficacy" and the general sleep quality were significantly impaired during the pandemic process, but this impairement was not related to the number of days spent at home. It was determined that 52.4% of our patients put on weight, 7.1% of smokers increased smoking, and there was no significant change in depression and mania scale scores.
DISCUSSION AND CONCLUSION: Although they were in remission period, the sleep quality of the patients was negatively affected. These findings indicates the importance of Community Mental Health Center services.

6. The relationship between interpersonal emotion regulation, personality traits, and psychopathology symptoms (tur)
Ceren Gökdağ, Berk Naldöken
doi: 10.5505/kpd.2020.79106  Pages 41 - 52
INTRODUCTION: In recent years, it has been emphasized that emotion regulation is not only an internal process, but also has an interpersonal aspect that is associated with various variables. However, the relationship between interpersonal emotion regulation and personality traits has not been investigated yet. The aim of this study is to examine the relationships between interpersonal emotion regulation, personality traits, and psychopathology symptoms.
METHODS: Three hundred ninety-one undergraduate women students recruited this study. Five Factor Personality Inventory-Short Form, Interpersonal Emotion Regulation Questionnaire, and Brief Symptoms Inventory were used as measurement tools.
RESULTS: People with high scores of extraversion, agreeableness, openness to experience and conscientiousness use others more to enhance positive emotions and to regulate their negative emotions. People with high neuroticism use others more for social modelling and to be soothed. The correlation results showed that personality traits, interpersonal emotion regulation strategies, and psychological symptoms were associated with each other. Also, multiple mediation analysis revealed that only soothing as an interpersonal emotion regulation strategy had a mediating role in the relationship between extraversion personality trait and general psychopathology symptoms.
DISCUSSION AND CONCLUSION: Results showed that personality traits might affect using of interpersonal emotion regulation strategies. Some people seek out and use other people more to regulate their own emotions, which is associated with psychopathology symptoms. Extraverts easily reach others to be soothed when they feel negative emotions, and this might be protective from psychopathology.

7. The intermediating role of eating, shape and weight concerns between depressive symptoms and avoiding behavior in morbid obese patients seeking treatment (tur)
Selçuk Özdin, Gizem Gerdan, Miraç Barış Usta, Aytül Karabekiroğlu
doi: 10.5505/kpd.2020.15986  Pages 53 - 60
INTRODUCTION: Patients with obesity have more restrictive eating behavior than those of normal weight, and are thought to cause depressive symptoms by leading to avoidant coping strategies. In this study, it was aimed to investigate the mediating role of eating, shape and weight concern the relationship between restricted eating and depression in individuals applying to bariatric surgery.
METHODS: The study sample was composed of patients with morbid obesity who applied to Ondokuz Mayıs University Faculty of Medicine for bariatric surgery between 2016-2018. The sociodemographic data form, Beck Depression Scale and Eating Disorder Rating Scale were filled by the participants. The degree of representation of the observed variables to implicit variables was evaluated by the confirmatory measurement model. Then, the relationship pattern between variables was examined with the structural model test. Multiple fit indices were used in the confirmatory measurement model and the structural equation model.
RESULTS: The study group consisted of 224 participants (mean age 37.6 ± 12.9). The average BMI of the participants is 45.5 ± 5.9. Three implicit variables were created, namely depression, anxiety, and limited eating. After confirming the measurement model, the mediating role of anxiety between depression and limited eating behavior was examined by path analysis. When the variance relations between the variables were examined, it was seen that restricted eating explained 76% of the variance in anxiety and 25% of the variance in depression.
DISCUSSION AND CONCLUSION: Treating obesity from a psychiatric perspective, adopting an approach that takes into account the anxiety about eating, body weight and body image may increase the success of the treatment. A decrease in related anxiety can lead to reduced eating and depression levels.

8. Depression, anxiety, sleep problems and suicidal behavior among medical students: A cross-sectional comparison study between first and sixth year students (tur)
Murat Eyüboğlu, Damla Eyüboğlu, Onur Duran, Safa Buğra Karademir, Furkan Karaaslan, Furkan Melih Alyu
doi: 10.5505/kpd.2020.59365  Pages 61 - 68
INTRODUCTION: The aim of our study is to determine the frequeny of depression/anxiety, suicidal behaviour and sleep problems in the first and sixth year medical students and to compare the both groups in terms of specified parametres and evaluate the possible change during the course.
METHODS: This cross-sectional study included 205 first year and 81 sixth year medical students between January 2020 and March 2020 at Eskişehir Osmangazi University Faculty of Medicine. Data were collected using self-report questionnaire consist of sociodemographic data form, Hospital Anxiety Depression Scale and Pittsburg Sleep Quality Index.
RESULTS: While there was no significant difference in anxiety scores, depression scores of sixth year students were significantly higher. Among all students, the percentage of higher cut off depression and anxiety scores were 40% and 36%, respectively. Suicidal ideation and suicide plan were significantly higher in students with high depression score. Use of sleep medication and daytime dysfunction scores were higher in the sixth year. During the last year among all students, 3.5% (n = 10) had self-harm behavior, 9.2% (n = 26) had serious suicidal thoughts, 9.5% (n=27) had suicide plans and 1.1% (n = 3) of students had suicide attempt. There were no significant differences between the groups in terms of self-harm behavior, suicidal ideation, suicide plan and suicide attempt.
DISCUSSION AND CONCLUSION: Our findings suggest that medical school students is at risk for mood disorders, suicide and sleep problems. This risk, which is higher than the general population, appears to increase in the later years of education. Medical students who have depression, anxiety, and sleep problems will have negative consequences for both their career and daily life if they do not get the appropriate help. Medical schools should offer psychiatric support units, where confidentiality and confidence borders are well established, for the screening of mental problems carefully and appropriate intervention.

9. Temperament features, alexithymia, impulsiveness levels of patients with polycystic ovary syndrome (tur)
Filiz Özsoy, Asker Zeki Özsoy, Hatice Yilmaz Doğru
doi: 10.5505/kpd.2020.28190  Pages 69 - 76
INTRODUCTION: Objective: This study aims to investigate the temperament features, alexithymia and impulsivity levels of patients diagnosed with polycystic ovary syndrome (PCOS); which manifests itself with menstrual irregularity, chronic anovulation, hirsutism, infertility and hyperandrogenism.


METHODS: Method: The study included 105 female patients who applied to Obstetrics and Gynecology Clinic and diagnosed PCOS based on Rotterdam criteria. 100 healthy controls were also included in the study matched for the demographic data. All participants were evaluated using the sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Toronto Alexithymia Scale (TAS-20), Barratt Impulsiveness Scale (BIS-11), Temperament Evaluation of the Memphis Pisa Parisand San Diego Auto-questionnaire (TEMPS-A) and Ferriman-Gallwey Scale (mFG).

RESULTS: Results: The mean age of the patients was 23.94±4.64 and the control group was 24.54±6.77.
There was no statistical difference between the average age, marital status and education level of the participants. There was no difference between the groups in terms of HADS anxiety and depression scores (p>0.05). The emotional recognition sub-dimension and total alexithymia levels were higher for the TAÖ-20 than the healthy controls (p values, <0.001 and 0.018, respectively). Attention-related impulsivity and impulsivity total scores for BIS-11 were statistically significantly higher in the patient group (p values, respectively, 0.007, 0.004). Average TEMPS-A scores and all of its subscales were statistically higher in the patient group compared to controls (p<0.05).
DISCUSSION AND CONCLUSION: Discussion: Patients with polycystic ovary syndrome were more impulsive and alexithymic in certain dimensions and consequently had one or more dominant temperament features. Based on these differences, in order to help the patients more and, it is recommended that patients be supported psychiatrically in order to recognize and treat possible psychiatric symptoms and diseases.

10. Brief information module: The examination of psychology and medical students knowledge and attitudes toward Electro-Convulsive Therapy (ECT) (eng)
Samet Çelik, Nuray Atasoy, Seydahmet Ercan, Mustafa Oğuz
doi: 10.5505/kpd.2020.47135  Pages 77 - 85
INTRODUCTION: The purpose of this study is to compare knowledge and attitude towards ECT. For this purpose, we compared first, second and fifth-grade students of medical faculty and students of psychology MSc with thesis.
METHODS: In first part, 480 students participated in the pretest process. After that, 212 first and second-grade students had a training named ECT information module. 2 weeks later, these 212 participants were subjected to a posttest of their knowledge and attitudes towards ECT.
RESULTS: The pre-test results showed that the knowledge level of the participants about the ECT increased compatibly with their grade level. Additionally, while ECT knowledge level of clinical psychology students was higher than that of medical students, their attitudes towards ECT were more negative. An ECT semi-structured info module was presented to the experiment group. According to the results of ANOVA analysis, the level of knowledge about ECT increased equally among psychology and medical students.
DISCUSSION AND CONCLUSION: Pretest results revealed that students in higher grades have higher knowledge levels. However, when the departments were compared by grade levels, psychology students are found to have a much higher knowledge level than medical students, yet they have more negative attitudes. This result shows that although ECT knowledge level rises, attitudes do not
always rise.


11. Gender and age-related differences in sexually abused child and adolescents: Predictors of psychopathology (tur)
Özge Metin, Fevziye Toros, Canan Kuygun Karcı
doi: 10.5505/kpd.2020.82335  Pages 86 - 98
INTRODUCTION: The purpose of this study was to examine gender and age-specific differences in abuse experience and psychopathologies in sexually abused children and adolescents. Furthermore, it was aimed to determine the predictive factors for psychopathology.
METHODS: The study included children and adolescents who were evaluated for sexual abuse at the child and adolescent psychiatry clinic between 2001-2009. Of the 402 victims, 3 to 18 years, 78.1% were girls, and 21.9% were boys. Sociodemographic and sexual abuse characteristics, trait anxiety/depression scores, and psychiatric diagnoses have retrospectively evaluated.
RESULTS: The familiar abuser was significantly higher in girls, whereas the stranger abuser was significantly higher in boys. The abuse incident mostly occurred in the home environment in girls and the open fields in boys. The frequency of mental disorders did not differ between genders and age-groups. Post-traumatic Stress Disorder was higher in the presence of coercion (physical violence/use of force/threat) and in the 7-11 age group. In girls and also the 15-18 age group had a higher prevalence rate of Major Depressive Disorder, which was also found to be related to intra-familial abuse, the presence of coercion and repeated abuse. The increase in trait anxiety/depression scale scores and the presence of coercion increased the risk of psychiatric diagnosis in the post-abuse period.
DISCUSSION AND CONCLUSION: Childhood sexual abuse occurs in different ways, both contextually and qualitatively, for both sexes and age groups. Therefore, when planning preventive interventions, differences in gender and developmental period-specific abuse experiences should be considered. Our results showed that internalization symptoms and additional traumatic experiences were more important in the development of psychopathology than the abuse itself. The assumption that one gender or any developmental period is more vulnerable to psychopathology may not have a robust empirical basis. On the other hand, psychiatric disorder-specific differences regarding gender/developmental periods/abuse-characteristics will guide the provision of appropriate treatment services.

12. Evaluation of cases sent from family courts to university hospital during contentious divorce/custody process (tur)
Ferda Karadağ, Dilşad Foto Özdemir
doi: 10.5505/kpd.2020.76259  Pages 99 - 108
INTRODUCTION: In this study, it was aimed to draw attention to the challenges experienced in the regulation of custody / personal relationship, the effects on the child and the importance of multidisciplinary work in expert assessment of controversial divorce cases.
METHODS: The records of 90 judicial files sent to our clinic between January 2014 and January 2019 were analyzed retrospectively. Descriptive statistical analysis and logistic regression were used to evaluate the collected data, and categorical data were shown as numbers (n) and percentages (%).
RESULTS: According to the results of the research, only 34.4% of the children was found to be in regular contact with both parents, 15.5% of the children had an alienation syndrome to one of the parents, 26.6% of the parents claimed that their child has been abused during this process and they wanted to restrict the relationship with the other parent. It was found that expert opinions about custody were mostly given in favor of the mother.
DISCUSSION AND CONCLUSION: The custody / personal relationship decision that will be made for the child to survive the divorce process and the aftermath with the least harm is of great importance. While making decisions in the divorce process, it will be in the child's best interest to provide counseling and mediation services in order to ensure healthy cooperation between parents and cooperation of different occupational groups assessing the process according to objective and scientific criteria.



REVIEW
13. Are our thoughts important or actions? A literature review of thought-action fusion on morality (tur)
İlkyaz Kaya Yıldırım, Orçun Yorulmaz
doi: 10.5505/kpd.2020.13540  Pages 109 - 122
“Thought Action Fusion” can be described as a cognitive bias that is particularly observed in Obsessive Compulsive Disorder and it refers to appraisals of close association of thoughts in morality and likelihood dimensions and their real-life effects. Although empirical findings mostly highlighted the critical role of Thought Action Fusion in likelihood dimension in psychological problems, in recent years, it is remarkable that with its salient manifestations in individual and social levels, there are increasing number of scientific research on the Thought Action Fusion-Morality subtype in many aspects such as its relationship with superstition, religiosity, cultural values, emotions like guilt, contextual factors, psychological problems and intervention techniques. The current study reviewed literature for last 15 years since the last review article in order to integrate the current findings on about Thought Action Fusion-Morality, which has a different nature. By this way, in this review, it is aimed to have a better understanding of Moral Thought Action Fusion as a phenomenon, to provide an insight about developing psychological intervention programs specified for the concept by summarizing related findings, to present a coherence on scientific research trends for near future and draw attention to the subject. Generally speaking, the results of this review give an impression that Thought Action Fusion-Morality has been studied in terms of various factors such as religiosity, different religions, social and cultural factors, characteristics of object exposed to this fusion and psychological intervention techniques, and they given critical inferences in scientific, clinical and professional areas.

CASE REPORT
14. Asymmetric tremor due to possible valproic acid-aripiprazole interaction in a child with severe intellectual disability (eng)
Enes Sarıgedik, Neslihan Kara, Cigdem Yektas
doi: 10.5505/kpd.2020.32549  Pages 123 - 126
Intellectual disability is a neurodevelopmental disorder common. Treatment of behavioral problems in this group; antipsychotic drugs, mood stabilizers drugs are often used. Tremor as a symptom can develop due to the use of both valproic acid and aripiprazole which is usually manifested as symmetrical.When valproate and aripiprazole are administered together, there may be some change in plasma
concentrations of aripiprazole and its metabolite but this change is thought to be related to the displacement in plasma proteins thus effect of both drugs on changes to steady state levels is very small and not clinically significant We report the case of a 15-year-old girl is that asymmetric tremor, which occurs after valproic acid is added to treatment while using aripiprazole, and the disappearance of asymmetric tremor after reducing the dose of aripiprazole.

15. Capgras Syndrome in childhood: A case report (tur)
Berna Gündüz Çıtır, Sevcan Karakoç Demirkaya
doi: 10.5505/kpd.2020.25932  Pages 127 - 130
Capgras syndrome (CS) is a rare type of schizophrenia characterized by delusions that the patient is often replaced by their parents, relatives and sometimes even their identical twins. It is very rare in childhood. It has been reported that Capgras syndrome is frequently seen in schizophrenic cases, especially in paranoid schiphrenia and it can be observed in depression an mania. Although there is no single reason, biological and psychological factors are thought to play a role in its atiopathogenesis. While psychodynamic explanations were brought to the syndrome in may cases related to pscyhological factors, biological factors were reported to have widespread and localized brain lesions. Although this phenomenon is thought to play a role in psychological factors,detailed neuropsychiatric evaluations and axaminations should be carried out considering that an organic cause may also exist. In this case report, we aimed to discuss the case and treatment process of an adolescent Capgras Syndrome, which is accompanied by paranoid and persecutory delusions, who thinks that his parents are not real parents in the follow-up complaints of Child and Adolescent Mental Health and Diseases.

LETTER TO EDITOR
16. Methodological drawbacks of peripheral inflammatory marker studies in bipolar disorder: comment on article by Ekinci and Erkan Ekinci (eng)
Simge Seren Kirlioglu Balcioglu, Yasin Hasan Balcioglu
doi: 10.5505/kpd.2021.15985  Pages 131 - 132
Abstract |English PDF

LookUs & Online Makale