Ekrem Yilmaz

Comparison of Venlafaxine Alone Versus Venlafaxine Plus Bright Light Therapy Combination for Severe Major Depressive Disorder

OBJECTIVE Phototherapy, ie, bright light therapy, is an effective and safe treatment of major depressive disorder (MDD). It exerts rapid mood-elevating activity, similar to antidepressant medications, most likely mediated through both monoaminergic and circadian system melatonergic mechanisms. We assessed the efficiency of bright light therapy as an adjuvant treatment to antidepressant pharmacotherapy in patients with severe MDD randomized by Hamilton Depression Rating Scale (HDRS) score to either (1) 150 mg venlafaxine hydrochloride daily at 7:00 AM or (2) 150 mg venlafaxine plus 60-minute light of 7000 lux the initial week of clinical management (venlafaxine + bright light therapy) daily at 7:00 AM. METHOD 50 inpatients with severe MDD at the Psychiatry Clinic of Yüzüncü Yıl University Training and Education Hospital participated. The study, which was conducted from January 2013 through June 2014, entailed patients diagnosed with severe MDD based on DSM-IV-TR for the first time. Mood states were assessed by the HDRS, Profile of Mood States (POMS), and Beck Depression Inventory (BDI) before treatment and at 1, 2, 4, and 8 weeks of treatment. RESULTS On the basis of the HDRS score as the primary outcome variable, both strategies significantly improved depression and negative mood states already at the first treatment week (P < .001). Differences in therapeutic effects by treatment strategy were remarkable at the second and fourth weeks of clinical management (P = .018 and P = .011, respectively), with beneficial effects continuing until trial conclusion. Those treated with venlafaxine + bright light therapy evidenced significantly lower HDRS depression scores (P < .05) as well as BDI scores (P < .05) and POMS negative mood states scores (depression-dejection, tension-anxiety, anger-hostility, fatigue-inertia, and confusion-bewilderment subscales; all P < .05) after the second week. At week 4 of the trial, 19 (76%) of the 25 venlafaxine + bright light therapy patients versus just 11 (44%) of the 25 venlafaxine patients (P < .05) attained the target goal of treatment, a HDRS score ≤ 13, indicative of mild depression, and, although not statistically significant in our small sample study (P = .36), at week 8, 76% of venlafaxine + bright light therapy patients (n = 19) versus just 64% of the venlafaxine patients (n = 16) experienced complete remission of depression (HDRS score ≤ 7). CONCLUSIONS Both venlafaxine and venlafaxine + bright light therapy treatment strategies significantly reversed the depressive mood of patients with severe MDD; however, the latter induced significantly stronger and more rapid beneficial effects. Future longer-term studies with large sample sizes, nonetheless, are required to confirm and generalize these results to patients of diverse ethnicities and cultures with both severe and mild MDD. TRIAL REGISTRATION ANZCTR.org.au registration number: ACTRN12614001061628.

Relationships between posttraumatic stress disorder (PTSD), dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors

Researches have demonstrated that Posttraumatic stress disorder (PTSD) is one of the most common stress reactions in the face of disasters and significantly associated with a broad range of trauma-induced sequelaes including anxiety, depression, suicidality as well as functional impairments. To date, though many aspects of risk factors with respect to the development and maintenance of PTSD have been addressed, mediating role of dissociation has received relatively less attention. In the present study, we examined relations of PTSD with quality of life, hopelessness, suicidal ideation, and mediational effect of pathological dissociation in these connections. 583 subjects most of whom experienced a severe earthquake participated in the study after two years of the disaster. We found that being female, being single, earthquake exposure, and having greater suicidal ideation were significant predictors of PTSD symptom severity. Role-Physical, Bodily-Pain, General Health and Role-Emotional subscales of the SF-36 were inversely associated with PTSD symptom severity. Pathological dissociation significantly mediated the substantial associations between predictors and PTSD symptom clusters. Chronic dissociation appears to put trauma exposed individuals in jeopardy of prolonged posttraumatic reactions by mediating the negative influences of risk factors in the face of experienced earthquake.

Psychometric properties of the Turkish version of the Sleep Hygiene Index in clinical and non-clinical samples

OBJECTIVE Sleep is one of the most significant of human behaviors, occupying roughly one third of human life. Sleep is a process the brain requires for proper functioning. Sleep hygiene can be described as practices to ease sleep and to avoid factors which decrease sleep quality. Inadequate sleep hygiene generally results in disturbance of daily life activities due to inability to sustain sleep quality and daytime wakefulness. Therefore, the importance of development and utilization of measures of sleep hygiene increases. The aim of the study was to assess psychometric properties of the Sleep Hygiene Index (SHI) in clinical and non-clinical Turkish samples. METHOD Data were collected from 106 patients with major depression consecutively admitted to the psychiatry clinic of Yüzüncü Yıl University School of Medicine and 200 were volunteers recruited from community sample who were enrolled at the university. The SHI, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) were administered to the subjects. Factor structure of the SHI was evaluated with explanatory and multi-sample confirmatory factor analyses. Pearson product-moment correlation coefficients of the SHI with the PSQI, ISI and ESS were computed. Item analyses, internal consistency coefficients and intra-class correlations between two repeated applications in both patient and healthy subjects were calculated. RESULTS The SHI revealed a unidimensional factor structure. Significant strong partial associations of the SHI with depression, insomnia and poor sleep quality and a modest partial association with sleepiness were detected. Cronbachs alphas for the SHI in community sample and patients with major depression were 0.70 and 0.71, respectively. Additionally, we found acceptable three-week temporal reliability in terms of intra-correlation coefficients of r=0.62, p<0.01 for the community sample and of r=0.67, p<0.01 among patients with major depression. CONCLUSION The SHI revealed adequate validity and reliability to be used by researchers in Turkish sample. Current results were discussed in light of previous findings and theoretical considerations.

The relationship between atypical depression and insülin resistance in patients with polycystic ovary syndrome and major depression

In this study, we aimed to examine the relationship between atypical depression and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) and major depression. A total of 176 subjects (69 patients with PCOS, 58 patients with depression, and 49 healthy controls) were included in the study. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Beck Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered. Data concerning their height, weight, fasting a.m. serum levels of insulin, glucose level, and total testosterone level were collected from all participants. The body mass index (BMI) and the Homeostasis Model Assessment Insulin Resistance index (HOMA-IR) were both calculated. 34 (49.3%) of the PCOS patients met the criteria for depression. 26 (76.5%) of them had atypical depression, 8 (23.5%) had non-atypical depression. 27 (46.6%) of the 58 depressed patients had atypical depression. Insulin resistance was higher in the PCOS patients than in the control subjects and the depression patients. There was no association between atypical depression and IR in patients with PCOS and depression. We concluded that there is no relationship between IR and atypical depression.

Relations between Posttraumatic Stress Disorder (PTSD), Dissociation, and Attention Deficit/Hyperactivity Disorder (ADHD) among Earthquake Survivors

INTRODUCTION There is a burgeoning interest in relations between post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD). Although few studies were conducted, weak evidence was found supporting the hypothesis that ADHD may be a risk factor for the development of PTSD. In addition, there is a paucity of research addressing the relations between dissociation and ADHD. In this study, our aim was to examine the relations between PTSD and ADHD combined with the mediating effect of dissociative psychopathology. METHODS The participants were 317 undergraduate students, a greater proportion of whom experienced the 2011 Van earthquake (66%). The participants were administered the Posttraumatic Diagnostic Scale, Dissociative Experiences Scale, Adult ADHD Self-Report Scale, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS We found that ADHD symptoms and dissociation were significantly associated with PTSD. Considering the multivariate relations between ADHD, PTSD and dissociation, significant associations between PTSD and ADHD resulted from symptom overlaps. However, pathological dissociation mediated the relations between PTSD and ADHD. CONCLUSION We concluded that ADHD comorbidity was not a predominant vulnerability factor for the development of post-traumatic stress response but may be an exacerbating factor after the development of PTSD.

The Relationships Between Dissociation, Attention, and Memory Dysfunction

INTRODUCTION Dissociation is a disruption in the integrated functions of consciousness, memory, identity, and perception. Dissociative symptoms include derealization/depersonalization, absorption, and amnesia. These experiences can cause a loss of control over mental processes, including memory and attention. In literature, there is a paucity of research concerning the relationships between dissociation and memory performance. In this study, our aim was to investigate the relationships between dissociative experiences, attention, and memory performance in a non-clinical community sample. METHODS In this study, we examined the relationship between dissociation and cognitive dysfunction among 60 healthy volunteers. We administered the Wechsler Memory Scale-Revised, Auditory Verbal Learning Test, Stroop Color Word Interference Test, and Dissociative Experience Scale. Here we examined the relationships between the subtypes of dissociation and memory performance as assessed by neuropsychological tests. RESULTS We found that verbal memory was negatively associated with dissociative experiences. Pathological dissociation, particularly amnesia and depersonalization/derealization, was reversely linked to general memory performance and long-term memory. Moreover, low dissociators reported higher scores on verbal memory, general memory performance, and long-term memory but lower scores on recognition than high dissociators. CONCLUSION The results of our study suggested that there are significant linkages between dissociative experiences and memory performance.

Dissociative experiences in patients with epilepsy

A few studies have explored dissociative experiences in epilepsy patients. We investigated dissociative experiences in patients with epilepsy using the dissociative experiences scale (DES). Ninety-eight patients with epilepsy and sixty healthy controls were enrolled in this study. A sociodemographic questionnaire and the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to the participants. The DES scores were significantly higher for the patients with epilepsy than the healthy individuals. The number of individuals with pathological dissociation (DES ≥ 30) was higher in the epilepsy group (n = 28) than in the control group (n = 8). Also, higher levels of dissociation were significantly associated with frequency of seizures, but were not associated with duration of epilepsy and age at onset of the disorder. These findings demonstrate that patients with epilepsy are more prone to dissociation than controls. The high rate of dissociative experiences among patients with epilepsy suggest that some epilepsy-related factors are present.

Psychometric properties of the Turkish version of the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Turkish CAPS-5)

ABSTRACT Background: In the subsequent revision of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) symptoms of diagnostic criteria for post-traumatic stress disorder (PTSD) are defined in four clusters and the number of PTSD symptoms was expanded to 20. The Clinician-Administered PTSD Scale (CAPS) is the most widely used structured clinical interview and recognized as the golden standard in PTSD diagnosis. The final revision of the clinical interview form as the CAPS for DSM-5 (CAPS-5) was advanced in line with the recent revisions in DSM-5 with regards to the PTSD definition. The aim of this study was to examine the psychometric properties of the Turkish version of CAPS-5 in clinical samples and healthy controls. Methods: In the present study, 30 inpatients with PTSD and 30 inpatients with major depressive disorder consecutively presented to the Psychiatry Outpatient Clinic Yüzüncü Yıl University Research Hospital, and 30 healthy controls were enrolled. All participants were included if only they reported an index trauma in the Life Events Checklist for DSM-5 (LEC-5) that bothered them during the past month. Subjects were administered a socio-demographic questionnaire, the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) along with the LEC-5, CAPS-5 and PTSD Checklist for DSM-5 (PCL-5). We used confirmatory factor analysis to compare a structured clinical interview (CAPS-5) and a self-report measure, the PCL-5 and to examine DSM-5 implied four-symptom clusters and several factor structures proposed in the literature to understand which model best represents the latent factor structure of PSTD symptoms. Using multivariate analysis of covariance, concurrent validity of both self-report and structured clinical interview was evaluated. Receiver operating characteristics (ROC) curve was utilized to obtain an optimal cut-off value of the PCL-5 scores in order to use in demarcating cases with non-cases. Results: Even though DSM-5 implied four-factor model adequately fit to either data collected using self-report or clinician-administered measures of PTSD, the latent structure of PTSD symptoms measured by either CAPS-5 or PCL-5 were best represented by six-factor Externalizing Behaviors model, particularly compared to seven-factor Hybrid model. In comparison to depressive and control groups, PTSD patients reported greater scores on the PCL-5, DES, BDI, and BAI and McNemar χ2 values between two applications with two weeks interval were unsubstantial. Additionally, PTSD patients exhibited greater symptom endorsement on B, C, D, E, F, G symptom clusters and dissociative subtype than depressive patients and controls. Using signal detection analysis, a significant area under the curve (AUC) was calculated for the PCL-5 (AUC = 0.87 p < 0.001 asymptotic 95% Confidence Interval = 0.798–0.942). The PCL-5 had excellent diagnostic utility with 0.90 sensitivity and 0.80 specificity on a cut-off score ≥47. Conclusion: Turkish versions of the CAPS-5 and PCL-5 are demonstrated to have very good psychometric properties. Implications regarding the findings are discussed.

Psikiyatride Parlak Işık Tedavisi

Parlak isik tedavisi duygudurumda kalkinmaya ve buna bagli olarak depresif belirtilerde duzelmeye yol acan, sirkadiyen ritimde duzenleyici etkisi olan, antidepresan ilaclarin etkisini artiran ve uyku kalitesinde duzelmeye yol acan bir tedavi seklidir. Parlak isik tedavisi mevsimsel ozellikli depresyonda yuksek yanit oranlari nedeniyle birinci sira tedavi secenegi olarak kabul edilir. Ayrica parlak isik tedavisi mevsimsel olmayan duygudurum bozukluklari, Alzheimer hastaligi, sirkadiyen ritim uyku bozukluklari, yeme bozukluklari, dikkat eksikligi hiperaktivite bozuklugu ve diger davranissal durumlarda calisilmistir. Yan etkileri siklikla gecicidir ve genellikle maruziyet suresini azaltarak giderilir. Bu yazida parlak isik tedavisinin etki mekanizmasini, etkinligini, kullanim alanlarini, uygulama seklini ve yan etkilerinin gozden gecirilmesi amaclanmistir.

Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)

ABSTRACT Objective: The posttraumatic stress disorder (PTSD) Checklist is one of the most widely used screening tool in assessing PTSD symptomatology. Several changes to PTSD definition were made in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The aim of the study was to assess psychometric properties of the Turkish version of the PTSD Checklist for DSM-5 (PCL-5), the revised version conforming to the advances in DSM-5. Method: Psychiatric outpatients with PTSD (n = 29) and major depressive disorder (n = 73) and a community group (n = 360) included in the study. Respondents completed the PCL-5, Trauma Symptom Checklist-40, Life Events Checklist for DSM-5, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory and Posttraumatic Cognitions Inventory. Results: We found a four-factor solution best fit to the data providing support for the vast array of PTSD research. The PCL-5 demonstrated good reliability with composite reliability coefficients of re-experiencing (.79–.92), avoidance (.73–.91), negative alterations (.85–.90) and hyper-arousal (.81–.88) and temporal reliability with two-week test retest intra-correlation coefficients of .70, .64, .78, and .76, respectively. Strong associations of the total and sub-scale scores of the PCL-5 with other measures of trauma-related symptoms were indicative of construct validity of the screening tool. The current investigation suggested a cut-off score ≥47 for PTSD diagnosis, with .76 sensitivity and .69 specificity. Conclusion: The PCL-5 is a promising screening tool with sound psychometric properties.