Aynur Görmez

Prescribing trends in treatment-resistant schizophrenia

ABSTRACT Objectives: Schizophrenia is a common mental health condition associated with significant morbidity and excess early mortality. Treatment-resistant schizophrenia (TRS) occurs in about one in three patients diagnosed with schizophrenia. The aim of this study was to identify attitudes of a nationally representative sample of psychiatrists towards pharmacotherapy of patients with TRS, the potential factors related to their choice of various regimens, and to investigate the clinical outcomes of different methods employed. Methods: Psychiatrists were contacted through national e-groups and various psychiatry conventions. They provided information about their professional and demographic characteristics. They were asked to describe clinical and demographic characteristics of an adult patient with TRS under their care for at least 3 months. They reported on the medication change they made and the effect of this intervention on the positive symptoms and functioning of the patient. Results: Among the 207 patients reported on, only 28.7% were on monotherapy for TRS immediately before the change in medication. With the change made in treatment regime, 40.1% were switched to a different antipsychotic agent as monotherapy, 40.6% received combination therapy with two or more antipsychotic agents, 1.4% received high-dose antipsychotics, and 4.8% had augmentation with antidepressants or mood stabilizers. 13.1% psychiatrists employed more than one method. Of the whole sample, 48.3% were put on clozapine either as monotherapy or with other medications. The monotherapy and combination groups were compared in terms of characteristics of patients and prescribers, which revealed no significant difference (p > .05). There was also no difference found on the outcome variables of two groups (p > .05). Conclusions: Although polypharmacy was found to be a common practice, there seemed to be a comparably good ratio of clozapine utilization and of attempts of switching to monotherapy among the prescribers. There were no significant patient- or prescriber-related factors in relation to preference of treatment regimens, which need further investigation on larger samples.

Iron metabolism and haematological changes in anorexia nervosa: an adult case report

23-year-old woman was admitted to our general psychiatry ward where she had presented with 2–3 week history of fatigue, muscle weakness and a recent episode of fainting. She had intentionally lost 30 kg in the last 2 years and had amenorrhea for the past 1 year. Two years ago, she was 60 kg in weight with body mass index (BMI) of 24.7. She was unhappy with her shape and started dieting. She initially had stopped snacking, but later on started feeding mainly on protein containing food. She also increased her physical activity. She developed rituals of using the same cutlery for all meal times. There was no binge eating or purgative behaviour. When her weight dropped to 38 kg (BMI of 15.6), she got admitted to medical ward where no medical cause or complications were found out, and she was referred to psychiatry. On her first psychiatric examination which was 7 months prior to her admission to our ward, she was diagnosed with AN. She refused to use any psychotropic medications and had six sessions of supportive therapy. She continued to lose weight until her BMI was 13. Her general condition deteriorated further leading her presentation to Emergency Department where she was asked to be seen by our team. The patient was restricting her energy intake relative to her requirements which had led to significantly low body weight. Despite her low weight, she had been displaying behaviour persistently interfering weight gain, and she never recognized the seriousness of her low weight. She Introduction

Avoidant/Restrictive Food Intake Disorder: An Adult Case Responding to Cognitive Behavioral Therapy

Avoidant/restrictive food intake disorder (ARFID) is a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) which replaces and extends the DSM-4 diagnosis of feeding disorder of infancy or early childhood. There is limited information as to the characteristics of the patients with ARFID, its course and prognosis and treatment. We aim to contribute to available literature on ARFID by presenting this case. We discussed a young lady with ARFID who responded well to cognitive behavioral therapy (CBT) with successful application of in vivo exposure, systematic desensitization, and cognitive restructuring techniques. After the 12 sessions of CBT as inpatient and eight sessions as outpatient, she gained 4 kg (8.81 lbs); her body mass index (BMI) rising from 16 to 17.5 kg/m2, Hamilton anxiety rating score dropped from 27 to 5. She continued to improve reaching the BMI of 18.3 kg/m2 6-month post-discharge. This case suggests that CBT can be a useful treatment modality in adults with ARFID.

The psychiatric assessment schedule for adults with developmental disability checklist: reliability and validity of Turkish version

ABSTRACT Aim/background: There is a lack of psychometric instruments to measure psychopathology in people with intellectual disabilities (ID). This may lead to underdiagnosis of treatable psychiatric comorbidities in this population. Psychiatric assessment schedule for adults with developmental disabilities (PAS-ADD) Checklist was developed as a screening tool designed for lay people. The PAS-ADD Checklist was created in English and was later on validated for other languages, including French and German. There is no psychometric measure available in Turkish to screen for or detect psychiatric symptoms in adults with ID. The aim of the present study was to present a psychometric evidence of the Turkish language version of the PAS-ADD Checklist. This is the first study aiming to present and validate a psychiatric screening instrument for adults with ID in Turkey. Methods: The Turkish version was developed by translation and back translation. The checklist and a structured purpose-designed socio-demographic form were administered to 151 adult individuals with ID of whom 71 were living in care homes, 80 at family home. They all underwent face-to-face psychiatric assessment through clinical examination. The Turkish version of the Checklist was compared with the original English and other language versions, and the psychometric properties were presented. Internal consistency, test–retest reliability, inter-rater reliability, factorial analysis and sensitivity/specificity were calculated. Results: The validity and reliability of the Turkish version seem acceptable with good psychometric properties. The item analysis of the total scale showed strong consistency with Cronbach’s alpha of 0.75. Test–retest reliability for different items (rs: between 0.50 and 0.69) was better than inter-rater reliability (rs: between −0.15 and 0.75) which could be expected given that raters are non-specialist people. Sensitivity and specificity were calculated for the number of participants who did and did not cross threshold and for whom a psychiatric disorder was or was not present. The sensitivity was 78.7% and specificity was 78.8%. An explanatory principal component factor analysis was conducted on the Turkish version of the Checklist revealed six factors. This six-factor solution explained 54% of variance. The likely reasons for the findings are discussed. Conclusion: Overall, the Turkish version of the PAS-ADD Checklist is an acceptable generic screening tool considering the difficulty of detecting mental health problems in people with ID and the lack of Turkish screening instrument. The Turkish version of the PAS-ADD Checklist can be recommended as a general screening tool for psychiatric disorders in adults with ID. It will contribute to early diagnosis and management of mental health problems and therefore improve the quality of life of those with ID and their family/care givers.

Down Syndrome and Dementia: Relationship and Clinical features -

Down syndrome (DS) is the most common genetic cause for Mental Retardation (MR). Many individuals with DS now are living into middle and older adulthood and experiencing age related health problems including dementia. People with Down syndrome have an increased risk of developing Dementia of Alzheimer Type (DAT) from middle age on. The comorbid picture of Down syndrome and Dementia of Alzheimer Type presents a unique challenge to the clinician in both diagnosis and management. The purpose of this article is to describe the relationship between DS and DAT and to present a framework for clinical assessment and management of dementia in people with DS.