Tamer Aker

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.

EMDR for Syrian refugees with posttraumatic stress disorder symptoms: results of a pilot randomized controlled trial

Background The most common mental health problems among refugees are depression and posttraumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD. However, no previous randomized controlled trial (RCT) has been published on treating PTSD symptoms in a refugee camp population. Objective Examining the effect of EMDR to reduce the PTSD and depression symptoms compared to a wait-list condition among Syrian refugees. Method Twenty-nine adult participants with PTSD symptoms were randomly allocated to either EMDR sessions (n=15) or wait-list control (n=14). The main outcome measures were Impact of Event Scale-Revised (IES-R) and Beck Depression Inventory (BDI-II) at posttreatment and 4-week follow-up. Results Analysis of covariance showed that the EMDR group had significantly lower trauma scores at posttreatment as compared with the wait-list group (d=1.78, 95% CI: 0.92–2.64). The EMDR group also had a lower depression score after treatment as compared with the wait-list group (d=1.14, 95% CI: 0.35–1.92). Conclusion The pilot RCT indicated that EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees located in a camp. Larger RCTs to verify the (cost-) effectiveness of EMDR in similar populations are needed.

Public attitudes to depression in urban Turkey - the influence of perceptions and causal attributions on social distance towards individuals suffering from depression.

BackgroundThe aim of this study was to determine public attitudes towards patients with depression and the influence of perception and causal attributions on social distance towards individuals suffering from depression in urban areas.MethodsThis study was carried out with a representative sample in Istanbul which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of ten items screening the demographic features and health status of the participants, and 32 items rating attitudes towards depression.ResultsThe respondents’ attitudes towards depression were very negative and nearly half of the subjects perceived people with depression as dangerous. More than half of the subjects stated that they would not marry a person with depression, and nearly half of the subjects stated that they would not rent their house to a person with depression. One-quarter of the subjects stated that depressive patients should not be free in the community. The subjects who considered depression as a disease and who believed that weakness of personality and social problems cause depression had negative attitudes towards depression.ConclusionsIn Istanbul, people recognise depression well, but their attitudes towards it are fairly negative. The urban public has unfavourable attitudes towards depression and a tendency to isolate patients from the society. Notwithstanding the high prevalence, there is still considerable stigmatisation associated with depression.

Public opinions and beliefs about the treatment of depression in urban Turkey

BackgroundAlthough attitudes towards psychiatric illness influence its presentation, detection, recognition, treatment adherence and rehabilitation, the lay publics opinions and beliefs about the treatment of depression have not been investigated sufficiently.ObjectiveThe aim of this study was to determine public opinions and beliefs about the treatment of depression and the influence of perception and causal attributions on attitudes towards treatment of depression in urban areas.MethodsThis study was carried out with a representative sample in Istanbul, which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of 32 items rating attitudes towards depression.ResultsThe public believes that psychological and social interventions are more effective than pharmacotherapy, and that the medicines used in treatment of depression are harmful and addictive. There was a general reluctance to consult a physician for depression, and psychiatrists were felt to be more helpful than general practitioners. The public viewed depression as treatable. A high educational level and perceiving depression as a disease is associated with positive beliefs and opinions about the treatment of depression; but the perception of depressive patients as aggressive is associated with negative beliefs and opinions about the treatment of depression.ConclusionThe beliefs that “psychological and social interventions are more effective than pharmacotherapy” and “antidepressants are harmful and addictive” must specifically be taken into account in clinical practice and in anti-stigma campaigns. Additional studies are needed to understand the publics tendency to conceptualise depression as a psychosocial problem. In clinical practice, depression should be introduced as a bio-psychosocial disease whatever its cause: biological, psychological or social. In addition, the differences between extreme worry and disease, and the lack of aggressiveness of depressive patients, must be emphasised.

Correlations between alexithymia and pain severity, depression, and anxiety among patients with chronic and episodic migraine.

Aims:  Some studies have found elevated alexithymia among patients with chronic pain, but the correlations between alexithymia and the severity of pain, depression, and anxiety among migraine patients are unclear. The aims of the present study were to investigate whether individuals suffering from episodic migraine (EM) differ from those with chronic migraine (CM) in regards to depression, anxiety, and alexithymia measures and to investigate the association of alexithymia with the results of depression and anxiety test inventories and illness characteristics.

Do Psychiatrists Examine Sexual Dysfunction in Schizophrenia Patients

Patients with schizophrenia may experience problems that have sexual content or sexual implications and these problems may be best managed by the combined effort of a team of sexual medicine specialist and psychiatrists [1,2]. Patients may feel that sexual problems in the context of disease are not important enough to be mentioned to their physicians, and physicians may feel uncomfortable and sometimes ill-equipped to address these issues [3]. Sexual dysfunction (SD) in schizophrenia is rated as significantly more distressing than sedation, extrapyramidal or vegetative side effects of antipsychotics [4]. However, a recent report stated that psychiatrists significantly underestimate the presence of SD despite patient complaints [5]. The aim of the present study was to explore whether psychiatrists question the SD in patients with schizophrenia. We studied 827 (547 men) outpatients with a Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) diagnosis of schizophrenia from 50 centers in Turkey. Inclusion criteria were: (i) aged between 18–45 years; (ii) received the adequate doses of the same antipsychotic drug for at least 3 months; (iii) no history of hospitalization, exacerbation, or electroconvulsive therapy application in the last 3 months; (iv) CGI < 5; and (v) enough intellectual capacity to answer the scale questions. Exclusion criteria were: (i) use of drugs that are known to cause SD (antidepressants, antiepileptics, antihypertensives, antidiabetic drugs, etc.); (ii) presence of a systemic medical disease that might cause SD; (iii) pregnant or lactating women; and (iv) history of alcohol and/or drug addiction or abuse. Presence of SD was measured based on patient scores on The Arizona Sexual Experience Scale [6] (ASEX). English [7] and Turkish [8] versions of ASEX also have been used in patients with schizophrenia. Written informed consent was obtained from each patient. Methodology and other findings of the study have been discussed in our previous article [9]. We want to discuss the answers given to the question: “Has your psychiatrist(s) ever asked you any questions about your sexual life or functions in any of your previous psychiatric consultations?” Mean age was 33.1 7.4 years. Mean duration of illness was 8.7 6.3 years. Atypical, conventional, and combination antipsychotics were used by 503, 172, and 152 of the patients, respectively. Drugs in the atypical antipsychotic group consisted of risperidone (N = 233), olanzapine (N = 187), clozapine (N = 135), and quetiapine (N = 125). The most frequently used conventional antipsychotics were haloperidol (N = 99), zuclopenthixol (N = 87), chlorpromazine (N = 55), and flupenthixol (N = 43). As patients were in stable status, antipsychotic doses equivalent to 5–15 mg/ day haloperidol were accepted as the adequate dose interval. One hundred and forty-nine patients (17.8%) were using additional anticholinergic drugs (biperidene or bornaprine). Of the patients, 66% were not married or did not have a partner, 30.5% were married, and an additional 3.5% had a partner for at least 1 month. We have found that 52.6% of the patients had SD. 73.5% of the patients indicated that they have never been asked about their sexual functioning in a psychiatric consultation. The percentage of the patients who never have been asked about their sexual functioning was more in SD (+) group, compared to others (76.9% vs. 69.6%, P = 0.02). In SD (+) group, the percentage of women who have been asked about their sexual functioning was lower than men, however, this difference was in trend level (18.7% vs. 26.5%, P = 0.06). The likelihood of being asked about sexual functioning in previous psychiatric consultations was not found to be related to gender, marital status, economic level, severity of the illness, illness subtype (paranoid vs. nonparanoid), type of the antipsychotic (atypical or typical), and whether the patient lives in a rural or an urban area. Similarly, the gender of the physician was not related to this variable. The interesting fact about our findings is that although nearly half of the patients have SD, only one-quarter of the group were asked about this in their previous consultations. Even if the possibility of patients not being able to recall the details of their previous consultations is taken into consideration, it can still been seen that SD has been disregarded by psychiatrists. It is interesting that paradoxically the patients with SD have been asked less about this. Although the attention given to SD in schizophrenia has been increasing, the problem 2000 Letters to the Editor

Posttraumatic stress disorder and risk factors in parents of children with a cancer diagnosis.

The purpose of this study was to determine the prevalence of posttraumatic stress disorder (PTSD) in parents of children with cancer. Five questionnaires were administered to 104 parents, including a sociodemographic questionnaire, a traumatic events check list, the Structured Clinical Interview for DSM-IV PTSD and Major Depressive Disorder modules, and the self-rating instrument General Health Questionnaire-12. The prevalence of PTSD was 34.6%. The statistically significant tendency to develop PTSD were found in the female gender, better educational status, death of a loved one, previous history of psychiatric disorder, having a child with poorer prognosis, and the presence of radiotherapy in childs treatment. The vulnerable parents must receive psychosocial support.

Assessment of Lifetime History of Exposure to Traumatic Stressors by Incarcerated Adults with the Turkish Version of the Traumatic Events Screening Instrument for Adults (TESI-A): A Pilot Study

Objective: To determine the prevalence of Criterion A traumatic events and current posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in prisoners in Kocaeli Closed Prison. Method: The study was conducted in Kocaeli Closed Prison in Turkey. The sample consisted of 30 female and 30 male prisoners who had been in prison for at least 1 month. The PTSD and MDD section of the Structured Clinical Interview for DSM–IV and the Traumatic Events Screening Instrument for Adults were used by experienced clinicians. Results: Most (n = 52, 86.7%) participants reported lifetime exposure to at least 1 Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD Criterion A event. Although the August 17, 1999, earthquake was the most prevalent traumatic event (n = 31, 51.7%), it was not related to the risk of current PTSD in prisoners. Current PTSD was rare among men (n = 2, 6.7%) and women (n = 3, 10%) but more prevalent than in community surveys of adults. Traumatic events that were relatively unique to the incarcerated population (e.g., committing murder) were identified. Moreover, 17% of women (n = 5) and men (n = 5) were diagnosed with MDD. Traumatic events that had the strongest conditional probabilities of association with a diagnosis of PTSD and MDD were identified. Conclusion: Exposure to traumatic stressors was highly prevalent among prisoners. Ongoing interpersonal traumatic events were particularly likely to be experienced as traumatic and related to PTSD and MDD, and violent criminal acts may be highly traumatic for the perpetrator.

The Evaluation of Suicide Letters in Turkey From a Cognitive Perspective

BACKGROUND Different methods are used to understand the suicidal mind. Suicide note analysis may be most direct way to do this. AIMS To study the content of suicide letters under forensic evaluation in terms of psychological and cognitive aspects. METHODS A total of 51 letters were referred to The Council of Forensic Medicine from different cities of Turkey and analyzed by a research group with ten members including forensic medicine specialists and psychiatrists. The Questionnaire of Content Analysis of Suicide Letters (The Q-CAS), developed by researchers, was used to analyze the cognitive and cultural themes of suicide letters. The cognitive distortions about the self, the world, and the future as well as cultural phenomena were evaluated including sociodemographic features. RESULTS Financial problems in males and relationship problems in females were the most frequent life events related to suicide. Hopelessness, weakness, loneliness--in decreasing order--were the most predominant cognitions and emotions. The total score of females were higher than that of males (p=.002). CONCLUSIONS These negative cognitions should be taken into consideration when therapeutic interventions are planned on individuals with suicidal thoughts.

Prevalence and predictors of posttraumatic stress and depression symptoms among Syrian refugees in a refugee camp

Abstract Turkey is hosting the majority of Syrian refugees. The current study investigates the prevalence of probable posttraumatic stress disorder (PTSD) and depression among adult Syrians residing in a camp (N = 781) and potential predictors. The Impact of Event Scale–Revised was used to measure PTSD and the Beck Depression Inventory depression. Probable PTSD prevalence was 83.4%, with predictors being female sex (odds ratio [OR], 4.1), previous mental health problems (OR, 4.5), life threat (OR, 3.0), and injury of a loved one (OR, 1.8). Probable depression prevalence was 37.4%, with predictors being female sex (OR, 5.1), previous mental health problems (OR, 2.9), having a loved one who was tortured (OR, 1.7), and not being satisfied at the camp (OR, 1.7). The current study reveals high rates of probable PTSD and depression among Syrian refugees and highlights vulnerabilities such as great risk for women of having psychopathology.