Ali Keyvan

Geriatric psychiatry consultations in a Turkish university hospital

OBJECTIVE The size of the elderly population is growing rapidly in Turkey. We aimed to characterize geriatric psychiatry consultations to obtain the characteristic pattern of these patients for further interventions. METHOD A retrospective chart review was undertaken for each patient. RESULTS One hundred and sixty-six patients with a mean age (+/- S.D.) of 75.5 +/- 6.6 years were included in this study. Most referrals came from the Department of Internal Medicine (42.2%), with sleep problems (42.1%), depression (29.5%) and anxiety (28.3%) being the most common reasons for referral. Hypertension was the most frequent medical diagnosis (53.6%). The mean number +/- S.D.) of medications used by each patient was 4.4 +/- 2.0. The leading psychiatric diagnosis at the end of the assessment was adjustment disorder (31.3%). CONCLUSION Turkish geriatric psychiatry consultation patients display similar characteristics to elderly patients from other western countries. The main difference comes from diagnosis of adjustment disorder, which may be related to hospital conditions and strong family ties in developing countries.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study

INTRODUCTION Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis. METHODS Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups. RESULTS There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared. CONCLUSION The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.

Attentional Bias and Training in Social Anxiety Disorder

Cognitive behavioral therapy (CBT) is one of the most effective treatment modalities for social anxiety disorder (SAD), showing a high level of clinical evidence supporting its effectiveness. On the other hand, lack of the desired benefit from this treatment in some patients causes continuation of the search for new techniques. Recent research studies have focused on attentional bias and attention training in SAD. Attention processes in SAD have been a major target of interest and investigation since the introduction of the first cognitive models explaining SAD. In the first model, it was highlighted that attention was self-focused. The relationship between threatening stimuli and attention was considered in the subsequent models. Attentional bias towards threat may take place in several ways, such as facilitated processing of threat, difficulty in disengaging attention from the threat and avoidance of attention from the threat. After these descriptions regarding the phenomenology of the disorder, treatments to modify attention, processes were developed. In spite of conflicting results, investigations on attentional training are promising. Attention processes, attentional bias and attentional training in SAD are discussed in this review.

Clinical and sociodemographic characteristics of hospitalized psychiatric patients with intellectual disability

Abstract Objectives: Intellectual disability (ID) is a critical healthcare and social issue that requires more effective and efficient programmes to enhance the health, independence, and quality of life for these patients; this requires accurate assessment of the clinical and socio-demographic characteristics of both paediatric and adult patients with ID seeking medical treatment. However, little data regarding this are available in several countries, including Turkey. Methods: All patients with ID hospitalized between January 2012 and June 2012 because of any psychiatric complaint were enrolled. Data for this cross-sectional study were collected by retrospectively reviewing medical records. Case severity was determined on the basis of Wechsler Adult Intelligence Scale or Wechsler Intelligence Scale for Children conducted once patients were stabilized. Results: In total, 84 patients were included (mean age: 23·85±9·71 years; 28 females, 56 males). The most commonly reported symptoms during recent hospitalization in the study period were aggression or excitation (77·4%), disruptive behaviour (71·4%), sleep disturbances (38·1%), hallucinations (33·3%), and delusions (25·0%). The most common comorbidity was disruptive behaviour disorder ‘not otherwise specified’ (31·0%). Conclusions: Behavioural problems are common in hospitalized patients with intellectual disabilities, presenting unique challenges for diagnosis and treatment. The generally high rate of comorbid disorders ‘not otherwise specified’ suggests significant problems in accurate diagnosis of various psychiatric illnesses in this patient group.

Sosyal Anksiyete Bozukluğunda Bilişsel Davranışçı Terapi: Güncel Kavramlar

Ozet Bilissel davranisci terapiler halen sosyal anksiyete bozuklugunda yuksek kanit duzeyine sahip en onemli tedavi yontemlerindendir. Ancak buna ragmen bazi hastalarin tedaviden yeterince fayda gormemesi yeni arayislari surdurmektedir. Bu yazida yapilan sosyal anksiyete bozuklugunda bilissel davranisci terapiler konusunda yapilan calismalar gozden gecirilmis guncel kavramlar tartisilmistir. Guncel calismalarin bilgisayar teknolojisini cokca kullanmasi dikkat cekicidir. Son yillarda calismalar sosyal anksiyete bozuklugunda dikkat yanliligi, yanli bilgi isleme, dikkat egitimi, yargi yanliliklari, internet tabanli bilissel davranisci terapiler ve sosyal aksiliklere alistirma tedavisi uzerinde yogun- lasmaktadir. Internet tabanli bilissel davranisci terapiler ozellikle tedaviye ulasma olanagi olmayan kisiler icin iyi bir secenek gibi durmaktadir. Anahtar sozcukler: Sosyal anksiyete bozuklugu, bilissel davranisci terapiler. Abstract Cognitive behavioral therapy is still one of the most important treatment modalities in social anxiety disorder with a high level of evidence. However, some patients do not fully benefit from these therapies and this fact leads to ongoing search for new approaches. This paper reviews use of cognitive behavioral therapy in social anxiety disorder studies and discusses related updated concepts. The frequent use of computer-assisted therapy for most of recent studies was found noteworthy. Recent studies regarding social anxiety disorder focused on concepts such as attention bias, biased information processing, attention training, judgment biases, internet-based cognitive behavioral therapies and social mishap exposure. Internet-based cognitive-behavioral therapy seemed to be a good option for people who were unable to access face to face treatment.

The Concept of Insight in Psychiatric Disorders: A Review -

The concept of insight includes several components. Insight impairment is often a constant feature for psychotic disorders. Lack of insight can be described as a denial mechanism, neurocognitive deficit or just a symptom. Despite numerous researches, insight in psychiatric disorders is not adequately dealt. This review aims to summarize the studies performed on the concept of insight in different psychiatric disorders.

Yatarak tedavi görmüş geriyatrik unipolar depresyon ve bipolar bozukluk hastaların klinik ve sosyodemografik özelliklerinin karşılaştırılması

Comparison of Sociodemographic and Clinical Characteristics of Unipolar and Bipolar Geriatric Inpatients Objective: Bipolar disorder (BD) is a chronic disease of 1% in the population although the prevalence in the elderly is low as 0.1%. The prevalence and incidence of major depression doubled after the age of 70-85. The aim of this study was to investigate sociodemographic and clinical characteristics of geriatric inpatients with bipolar disorder and unipolar depression (UD). Methods: In the study, demographic and clinical characteristics of 65 years and older patients with BD and UD who hospitalized in Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were compared through medical records. Patients diagnosed with substance/medication-induced mood disorders, mood disorders due to another medical condition or dementia, delirium were excluded from the study. Results: The average age of patients is 69.3 years. The study included 93 patients; 51 patients (54.8%) are diagnosed BD, 42 of them (45.2%) are diagnosed UD. The age of onset was found 59.21 years for UD and 41.33 years for BD (p=0.000). Hospitalization ratio in the patients with suicidal ideation was 78.6% (n=33) in UD and 17.6% (n=9) in BD (p=0.000). While 20 of UD patients (47.6%) had suicide attempt at least once, 12 of BD patients (23.5%) attempted suicide before (p=0.03). The drug inadherence ratio in BB patients was found 51.0% (n=26), while it was significantly lower in UD patients (26.2%; n=11) (p=0.000). Antipsychotics were used in the treatment with 100% in BB group (n= 51) and 76.2% (n=32) in UD group (p=0.000). Conclusions: Important clinical differences were detected between geriatric unipolar and bipolar inpatients.

Sociotropic personality traits positively correlate with the severity of social anxiety

Sociotropy can be seen as the opposite of autonomy, as those with high levels of sociotropy are overly concerned with interpersonal relationships, whereas those with high levels of autonomy are mostly concerned with independence and do not prioritise social interactions and how they are evaluated by others. Both of these personality dimensions may be associated with increased susceptibility for depression, first suggested in 1999.

The Validity and Reliability of the Turkish Version of Miller Forensic Assessment of Symptoms Test (M-FAST).

INTRODUCTION The aim of this study was to show the validity and reliability of the M-FAST Turkish Version. METHODS Translation and back-translation of the M-FAST was done, then the M-FAST Turkish Version was created with linguistic equivalence. The study was performed with 97 detainees and convicts sent from penal institutions who were internalized at our hospital forensic psychiatry service. M-FAST Turkish Version was applied to evaluees and as a result of clinical interview according to DSM-IV-TR diagnostic criteria and various data explorations the evaluee was examined for malingering. To investigate the internal consistency of the scale, Cronbachs alpha and test-retest methods were used. In order to check the validity of the scale, in addition to the clinicians diagnosis, participants were requested to fill the Minnesota Multiphasic Personality Inventory (MMPI) F and K validity scales. RESULTS The mean age of participants was 31.8±9.3 (SD) years. 47 evaluees (48.5%) were diagnosed as malingering. In the internal consistency analysis, Cronbachs alpha Coefficient was found to be .93. Test-retest relationship that was applied to 22 evaluees was found to be highly significant and strong (r=.89, p<.001). M-FAST scores were significantly high at the malingering group (n=47) (z=-8.02, p<.001). ROC curve analysis suggested a score of ≥7 points as the optimal cut-off for a malingering level for the M-FAST. Kappa coefficients of malingering ± groups were found to be, M-FAST≥7 Kappa: .83; F>16 Kappa: .29; F-K>16 Kappa: .30. For diagnosis of malingering, M-FAST Scale and the MMPI inventory scales were evaluated with the Binary Logistic Regression analysis and only M-FAST scores were found to be significant in prediction of malingering. CONCLUSION The findings of this study support that, M-FAST Turkish Form represents the structure of the original scale and can be used as a reliable and valid instrument.

Huntington hastalığına bağlı psikotik bozukluk ve tedaviye dirençli obsesif kompulsif bozukluk

Huntington hastaligina bagli gelisen psikiyatrik sorunlarin basinda psikotik belirtiler, homisid ve ozkiyim gelmektedir. Bu olguda, Huntington hastaligina bagli psikotik bozukluk ve eslik eden tedaviye direncli obsesif kompulsif bozukluk tanisi olan bir hasta sunulmustur.