Metin Basoglu

Traumatic stress responses in earthquake survivors in Turkey.

This study examined the rates of posttraumatic stress disorder (PTSD) and depression and associated risk factors in earthquake survivors in Turkey. A group of 1,000 people from 3 camps and 2 prefabricated housing sites in the epicenter region was assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors. The estimated rates of PTSD and major depression were 43 and 31%, respectively. Traumatic stress symptoms related to more intense fear during the earthquake, female gender, having been trapped under rubble, death of a family member, past psychiatric illness, having participated in rescue work, and lower education. Avoidance of trauma reminders was the most common symptom and needs special attention in survivor care because of its mental health, social, and economic implications.

Predictors of improvement in obsessive-compulsive disorder☆

Abstract Forty-nine obsessive-compulsive ritualizers had clomipramine and live exposure therapy in a randomized controlled design. 29 pretreatment demographic, clinical, and psychophysiologic variables were examined as predictors of outcome using multiple regression analysis. Severity of rituals, social disability, male sex, checking rituals, bizarre and fixed obsessions, and severe and uncontrollable obsessions predicted poorer outcome. Patients who had been initially more severely ill habituated less to ritual-evoking stimuli in the laboratory and showed less improvement at all assessment points. Plasma desmethylclomipramine predicted improvement only during the active phase of treatment.

Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey.

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey. The estimated rates of PTSD and major depression were 39% and 18%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, older age, participation in rescue work, having been trapped under rubble, and personal history of psychiatric illness. More severe depression symptoms related to older age, loss of close ones, single marital status, past psychiatric illness, previous trauma experience, female gender, and family history of psychiatric illness. These findings suggest that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure. These findings lend further support to the need for long-term mental health care policies for earthquake survivors. Outreach service delivery programs are needed to access non-treatment-seeking survivors with chronic PTSD.

Obsessive-compulsive beliefs and treatment outcome

Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as a rational and felt that their rituals warded off some unwanted or feared event (the content of their obsessions). The more bizarre the obsessive belief the more strongly it was defended and 12% of cases made no attempt to resist the urge to ritualize. Neither fixity of belief nor resistance to compulsive urges were related to duration of illness. Patients with bizarre and fixed obsessive beliefs responded as well to treatment (all but three received exposure), as did patients whose obsessions were less bizarre and recognized as senseless. There was no difference in outcome between patients who initially found it hard to control their obsessions or never resisted the urge to ritualize and those who initially could control obsessions or resist rituals. One year after starting treatment, patients whose obsessions and compulsions had improved with treatment recognized their irrationality more readily and controlled their compulsive urges more easily. Beliefs appeared to normalize as a function of habituation.

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey.

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.

A Study of the Validity of a Screening Instrument for Traumatic Stress in Earthquake Survivors in Turkey

The validity of a Traumatic Stress Symptom Checklist (TSSC), which was developed as part of a Screening Instrument for Traumatic Stress in Earthquake Survivors (SITSES), was examined in 130 survivors of the recent earthquake in Turkey. Data were obtained on the TSSC, which consists of 17 DSM-IV posttraumatic stress disorder (PTSD) items and 6 symptoms of depression. The Clinician-Administered PTSD Scale and the Major Depressive Episode module of the Semistructured Clinical Interview for DSM-IV were used for comparison with the TSSC. The results indicated that the TSSC has high internal consistency and satisfactory sensitivity and specificity in predicting the diagnosis of PTSD and major depression. The SITSES appeared to be a useful instrument in screening earthquake survivors for PTSD, major depression, illness severity, and risk factors associated with traumatic stress responses.

Pre-treatment predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure

Pre-treatment predictors of treatment outcome were examined in a group of 144 patients with panic disorder and agoraphobia randomly allocated to alprazolam+exposure (AE), placebo+exposure (PE), alprazolam+relaxation (AR), and placebo+relaxation (PR). First-time psychotropic medication use, severity of agoraphobic disability, and longer duration of illness predicted less global improvement at post-treatment. Pre-treatment severity of agoraphobia predicted less improvement both in the short- and the long-term. Predictors of poorer outcome at 6-month follow-up were older age, past history of depression, severity of phobia targets, and longer duration of illness. Sex, source of referral, pre-treatment depression-anxiety-panic, and expectancy from treatment did not relate to outcome.

Torture and Mental Health

Over the last two decades, much work has been done on various forms of extreme trauma, particularly after the recognition in the early 1980s of posttraumatic stress disorder (PTSD) as a diagnostic entity. Since then, significant progress has been made in the diagnosis, assessment, and treatment of trauma survivors. Such progress, however, has not been paralleled by work specifically on the trauma of torture despite the widespread evidence of torture in the world and its mental health implications.

Psychological effects of earthquakes in children: prospects for brief behavioral treatment

BackgroundTreatment of child earthquake survivors is a relatively less investigated issue in disaster research. A review of the evidence on the mental health effects of earthquakes, risk factors, and findings from treatment studies may provide useful insights into effective treatment of traumatized children.Data sourcesStudies of child and adolescent earthquake survivors included the PILOTS database (electronic index for literature on psychological trauma) and relevant evidence from various studies of adult earthquake survivors.ResultsEvidence points to elevated rates of posttraumatic stress disorder (PTSD), depression, and earthquake-related fears in children and adolescents. Traumatic stress appears to be mediated by loss of control over fear induced by exposure to unpredictable and uncontrollable earthquakes. This implies that interventions enhancing sense of control over fear are likely to be most effective. Recent studies indeed show that a control focused behavioral treatment (CFBT) involving mainly encouragement for self-exposure to feared situations is highly effective in facilitating recovery from earthquake trauma. Evidence also suggests that CFBT can be delivered through booklets and similar media.ConclusionsPilot studies suggest that CFBT has promise in effective treatment of PTSD in children. Further research is needed to confirm these preliminary findings and to develop self-help tools for children.

Are anxiety symptoms and catastrophic cognitions directly related

Abstract The relationship between catastrophic cognitions and anxiety symptoms was examined in 140 phobic patients. In contrast to previous studies, which examined correlations between single symptoms and cognitions, the present study investigated the relationship between combinations identified by principal components analysis. In multiple regression analyses, cardiorespiratory symptoms and paresthesia were related to cognitions about physical illness, but not about psychosocial consequences of anxiety. Depersonalization was linked to cognitions about psychosocial consequences of anxiety but not about physical illness. Catastrophic cognitions thus directly reflected threat-relevant anxiety symptoms.