Sibel Örsel

The validity of diagnosis of melancholic depression according to different diagnostic systems

BACKGROUND Melancholic versus nonmelancholic depression dichotomy is perhaps the most widely accepted distinction in categorization of depression. This research aims to compare RDC, DSM-III, DSM-III-R, DSM-IV and ICD-10 melancholic/endogenous/somatic and nomelancholic/nonendogenous/nonsomatic depressive patients with regards to biological variables thyroid stimulating hormone (TSH), basal and post dexamethasone cortisol levels, age, age of onset of depression, psychosocial stressors, and severity of depression. METHODS Sixty-five patients who had been diagnosed as having major depression according to DSM III-R, using SCID were included in this study. Patients were divided into melancholic and nonmelancholic subtypes using RDC, DSM-III, DSM III-R, DSM-IV and ICD-10 criteria and groups were compared on the basis of biological variables, as well as age, psychosocial stressors and the severity of depression. RESULTS RDC endogenous depressives were older, more severely depressed and had higher cortisol levels then RDC nonendogenous depressives. DSM III-R melancholics were older, more severely depressed, reported fewer numbers of psychosocial stressors and had lower levels of TSH than nonmelancholics. DSM-IV melancholics were more severely depressed, had higher basal and post dexamethasone cortisol levels and lower TSH levels. The ICD 10 somatic depression group contained more severe, older depressives with lower TSH levels. CONCLUSION The results of this research show that different criteria may identify different groups of patients as having melancholic depression. They also partly support the hypothesis that endogenous or melancholic depression have a biological basis. LIMITATIONS OF STUDY: The study involved a relatively small sample size from a single centre and the results are based on this relatively small sample.

The validity and reliability study of the Turkish version of the Brief Social Phobia Scale

ABSTRACT OBJECTIVES: Social anxiety disorder (SAD) can be described as a clear and constant fear of the individual for being judged by others in the social milieu and being mocked by others. Although SAD is a treatable disorder, there is a diagnostic confusion due to many factors such as the difficulty in recognizing the symptoms of the disease. There are several scales currently available for SAD symptom measurement; however, some of them are long scales and should be answered by the patient and do not include physiologic manifestations. The Brief Social Phobia Scale (BSPS), which is a scoring system scored by the clinician, has an important place among these scales. There are three different subscales, which are fear, avoidance, and physiological symptoms on the BSPS. The aim of this study is to test the validity and reliability of the Turkish version of the BSPS. METHODS: The BSPS, sociodemographic data form, Liebowitz Social Anxiety Scale (LSAS), Spielberger State-Trait Anxiety Inventory (STAI I–II), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Global Assessment of Functioning (GAF) Scale were applied to 55 patients with social phobia (31 males, 24 females) who met the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Internal consistency of the scale was measured and the factor analysis was performed after applying Kaiser Meyer Olkin and Bartlett tests to assess the construct validity. To test the concurrent validity of the scale, Pearson correlation coefficient was computed between the BSPS and the LSAS. Its correlation with STAI I–II, BDI, BAI, and GAF was also investigated. RESULTS: The Turkish version of the BSPS showed sufficient internal consistency. As a result of the factor analysis, a five-factor structure that accounts for 71.4% of the total variance was obtained and the loading of factors differs from the original study. Moderately strong correlation was found between the BSPS and the LSAS scores. There was a mild correlation between the total score of the BSPS and the STAI-I and BDI. There was a moderate correlation between the total scale score of the BSPS and the STAI-II and BAI scores. CONCLUSIONS: As a result of the validity and reliability studies, it has been determined that the Turkish version of the BSPS can be used as a valid and reliable measurement tool in detecting SAD. It was found that there were unique anxiety findings that distinguish SAD from the other anxiety disorders. It is thought that the inclusion of such important symptoms within the applied scale will also benefit clinical practice.

Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: a cross-sectional study

ABSTRACT OBJECTIVE: The aim of this study was to assess sociodemographic and clinical correlates of poor treatment adherence among outpatients with bipolar disorder (BD) in remission period. METHODS: This was a cross-sectional study carried out in a University Hospital in Turkey, and 117 outpatients with BD according to DSM-IV-TR criteria were included. All participants were administered a sociodemographic form, the SCID-I, the Morisky 8-item Medication Adherence Questionnaire, the Hamilton Depression Scale, the Young Mania Rating Scale, Schedule for Assessing the three components of insight, and Global Assessment of Functioning Scale. Collected data were analysed via descriptive statistics and logistic regression was used to determine significant variables. RESULTS: Patients with poor treatment adherence were low educated, were more likely to be not married, and had a greater prevalence of anxiety disorder comorbidity. The patients with poor adherence also showed more subsyndromal depressive symptoms but no significant differences were seen in terms of age, gender, living status, social support, or number of episodes between patients with good and poor adherence. Logistic regression analyses revealed that comorbid anxiety disorder, lower education level, and duration of depression period were the main predictors of poor adherence. CONCLUSION: This outcome is consistent with previous studies, and assuring complete adherence in all bipolar patients is difficult, but increasing the number of adherent patients is possible and substantial for sufficient outcome. Improving subsyndromal symptoms and awareness of the patient about the features of the disorder may provide better adherence to treatment and greater functionality of the patient. Psychotherapeutic interventions and psychoeducation should be implemented along with the medical treatment to improve subsyndromal symptoms and to avoid treatment maladherence in advance. Further research is needed to assess the role of interventions in treatment adherence of patients with BD.

A General Look at Women Taking Shelters: What are they living through? What can we do?

Violence is an important social issue to which the women are exposed the most. Women shelters are one of the responsive services for the women experiencing violence. In this research, we planned to make situational detection on sociodemographic characteristics and the properties related to the violence they experienced and origin families for the women taking shelters and search for feasible additional social support and protective precautions in light of the analysis. By interviewing 46 cases living in Ankara Women Shelter face to face, a socidemographic form, SCID-1, Childhood Trauma Questionnaire (CTQ-28) were applied. The average age of cases is 31.46±8.36 years. By CTQ-28, it is detected emotional in %75, physical in % 65.4 and sexual abuse in % 51, other than that %69.2 physical and % 55.8 emotional neglect story. There were behaviour of violence in mothers of %28.8, fathers of %36.5 and siblings of %15.4 of the cases. Duration of marriageis 10.52±9.96 years, marriage age is 18.48±4.29 years and the average duration of getting exposed to violence in their marriage is 11.44±8.27 years. It is declared that the cases were exposed to % 96.2 physical, % 84.6 emotional, %92.3 verbal, % 25 sexual and %78.8 economicalviolence, %65.4 of them experienced violence also in pregnancy and for %35.3 pregnancy was effected from the violence. In %54.2 of the cases there were detected suicide attempt history and the most (% 65.4) major depression primary diagnosis. It can be said with our current findings that the women taking shelters has been facing violence since their childhood, couldn’t get enough economical and social support from their families and experienced several mental illnesses with their trauma. Individual strengthening, supporting, providing the psychiatrist applications and pharmacotheraphy treatments in necessary conditions, appyling group and individual theraphies will provide women to be strengthened psychologically until they leave the shelters. On the other hand, providing educational-professional development and labor facilities will enable women to survive after they leave the shelter. Keywords: women’s shelter, violence, women