19 research outputs found
Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions
No full textOmar H Elsayed,1 Mete Ercis,2 Mehak Pahwa,1 Balwinder Singh2 1Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USACorrespondence: Balwinder Singh, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, Tel +1 507-255-9412, Fax +1 507-284-3933, Email [email protected]: Bipolar disorder (BD) is a chronic mental illness impacting 1– 2% of the population worldwide and causing high rates of functional impairment. Patients with BD spend most of their time in depressive episodes and up to one-third of patients do not respond to adequate doses of medications. Although no consensus exists for definition of treatment-resistant bipolar depression (TRBD), failure of symptoms improvement despite an adequate trial of two therapeutic agents is a common theme of TRBD. In this paper, we review the evidence base of therapeutic interventions, challenges, and potential future directions for TRBD.Methods: We conducted a literature search for randomized controlled trials on PubMed for the treatment of TRBD and ongoing trials for the treatment of TRBD/bipolar depression on clinicaltrials.gov.Results: Several therapeutic agents have been investigated for TRBD. Adjunctive pramipexole and modafinil have data supporting short-term efficacy in TRBD, along with limited data for racemic intravenous ketamine. Celecoxib augmentation of escitalopram and treatment with metformin in patients with insulin resistance showed promising results. Right unilateral electroconvulsive therapy displayed statistically significant response rate and improvement, but not remission compared to pharmacotherapy. Trials for transcranial magnetic stimulation (TMS) have failed to show a significant difference from sham treatment in TRBD.Future Trends: Pharmacological treatments with novel mechanisms of actions like brexpiprazole and vortioxetine are being investigated following successes in unipolar depression. Modified TMS protocols such as accelerated TMS are under investigation. Innovative approaches like psychedelic-assisted psychotherapy, interleukin-2, fecal microbiota transplantation and multipotent stromal cells are being studied.Conclusion: Evidence on current treatment modalities for TRBD is limited with low efficacy. More research is needed for successful treatment of TRBD. Effective therapies and innovative approaches to treatment are being investigated and could show promise.Keywords: TRBD, bipolar disorder, treatment-refractory depression, ketamin
Correlates of Patient Satisfaction in Psychiatric Inpatient Care: A Survey Study from a Tertiary Hospital in Turkey
No full textIn the current study, a questionnaire to evaluate satisfaction levels and related factors upon discharge was completed by 100 patients receiving care for mental illness in a tertiary care hospital in Turkey. The relationships among sociodemographic variables, nonpharmacological interventions, and participants' views about the treatment course and quality of care they received were investigated. Overall satisfaction levels of participants were good. Older participants reported more positive opinions. Involuntary hospitalization, use of restraints/seclusion, or electroconvulsive therapy did not change overall satisfaction. Participants who were hospitalized for the first time were more afraid of other patients, which may imply that this population needs special care from the treatment team. Spending an adequate amount of time and providing necessary information about their treatment plan impact patients' treatment experience positively
Reliability and validity of the Turkish versionof comprehensiveassessment of at risk mental states
No full textAims To perform the validation of the Comprehensive Assessment at Risk Mental State (CAARMS) in Turkish. Methods Sixty-five volunteers (15-24 years) were enrolled in this study. Concurrent validity was performed with Spearman's Correlation Test using Brief Psychiatric Rating Scale (BPRS). Median scores of the groups were compared using Mann-WhitneyUTest. Interrater reliability was assessed by intragroup correlation coefficient method. Internal consistency was studied by the calculation of Cronbach Alfa Coefficient. Results The correlation of the severity scores of the CAARMS with unusual thought content, suspiciousness, hallucinations and conceptual disorganization items of the BPRS showed that the concurrent validity was good. ROC analysis revealed that CAARMS could discriminate between individuals with UHR and healthy volunteers well. We found a good correlation between the raters. Internal consistency was at very high level. Conclusion Analyses of concurrent validity, criterion validity, interrater reliability and internal consistency indicate that the Turkish version is valid and reliable
Psychological Reactions of Turkish Healthcare Workers During Covid-19 Outbreak: The Impact of Stigmatization
No full textINTRODUCTION: The Coronavirus Disease 2019 (COVID-19) outbreak has resulted in huge psychological distress, especially for people working under risky conditions, such as healthcare workers. We aimed to investigate the psychological challenges of Turkish healthcare workers during the outbreak and discuss the factors that increase their burden, including stigmatization. METHODS: A cross-sectional online survey composed of sociodemographic data, questions about perceived stigma, and concerns about working conditions was completed. Depression Anxiety and Stress Scale-21 (DASS-21) was also used. RESULTS: 634 participants completed the survey and the prevalence of moderate to severe depression, anxiety, and stress-related symptoms were 36%, 35%, and 22%, respectively. Being female, working with close contact with patients with COVID-19 and having a psychiatric disorder history were risk factors for psychological distress. The healthcare workers with significantly higher depression, anxiety, and stress scores described having less amount of personal protective equipment, lower support from their supervisors, and more unsafe working conditions. Additionally, 7% of the participants stated that they perceived stigmatization by their families and close friends, 14% perceived stigmatization by their neighbours, relatives, and less intimate friends; and 7% perceived stigmatization by unfamiliar people. Healthcare workers who perceived other people as more dismissive had significantly higher depression and anxiety scores. CONCLUSION: Our study shows that healthcare workers are at risk of developing psychological disturbances during infectious outbreaks. To minimize the psychological impact, additional risk factors such as having a previous psychiatric disorder, working under unsafe conditions, and stigmatization should be taken into account and a more supportive and safer environment should be provided
Clinical profile of delusional disorder and its subtypes: a descriptive study from Turkey.
No full textSOCIAL SUPPORT PROMOTES MENTAL HEALTH DURING THE COVID-19 OUTBREAK: A CROSS-SECTIONAL STUDY FROM TURKEY
No full textBackground: Coronavirus-19 (COVID-19) has several negative effects on mental health, given its rapid transmission, hygiene and isolation measures and associated social and financial difficulties. In this study, we aimed to investigate the mental health burden of the Turkish population and vulnerable groups during the COVID-19 outbreak, especially exploring the effects of social support.
Subjects and methods: We assessed depression, anxiety, stress symptoms and perceived social support among 894 people all over Turkey, using the Depression Anxiety Stress Scales (DASS-21) and Multidimensional Scale of Perceived Social Support (MSPSS) two months after the declaration of the first COVID-19 case in Turkey.
Results: According to DASS-21 subscale scores, the findings showed that the prevalence of moderate to severe depression, anxiety and stress-related symptoms was 24.8%, 21.9% and 12.6%, respectively. Female gender, being single, having a lifetime psychiatric disorder, lower education level and financial concerns were significantly associated with higher DASS-21 scores. Also, there was a negative correlation between all subgroups of perceived social support, especially from the family, and the total DASS-21 score.
Conclusions: Vulnerable groups should be identified and protected to reduce adverse psychiatric outcomes of COVID-19. Besides, further strategies should be provided to maintain protective factors, such as social support, under stressful conditions
Sınır Kişilik Bozukluğunda Dürtüsellik ve Riskli Karar Verme Eğiliminin Sosyal Biliş Becerileriyle İlişkisi
No full textAmaç: Bu çalışma, Sınır Kişilik Bozukluğu (SKB) tanılı bireylerde karar verme süreçlerini nöropsikolojik testlerle değerlendirerek, SKB’ye özgü bilişsel özelliklerin karar verme süreçleriyle ilişkisini sağlıklı kontrollerle karşılaştırarak incelemeyi hedeflemektedir. Yöntem: Çalışmanın örneklemi SKB tanılı hasta grubu (n=27) ile psikiyatrik tanısı olmayan sağlıklı katılımcılardan (n=28) oluşmaktadır. Hastalık şiddetinin değerlendirilmesi için Borderline Kişilik Envanteri (BKE), nöropsikolojik değerlendirme için Iowa Kumar Testi (IKT), Stroop Testi, Benton Yüz Tanıma Testi, Gözlerden Zihin Okuma Testi, Dokuz Eylül Zihin Teorisi Ölçeği (DEZTÖ), WMS-R Sayı Menzili ve Mantıksal Bellek Alt Ölçeği uygulanmıştır. Bulgular: SKB grubu ile kontrol grubu arasında BKE puanlarında anlamlı düzeyde farklılık izlenmektedir (p=0,02). Stroop Testi’ndeki enterferans süresi ve hata sayıları açısından gruplar arası anlamlı bir fark izlenmezken, spontan düzeltme cevap sayılarının anlamlı düzeyde farklılık taşıdığı (p=0,02) gözlenmiştir. WMS-R Mantıksal Bellek alt testi A hikâyesinin anlık hatırlama puanlarında gruplar arasında fark olduğu (p<0,01) tespit edilmiştir. IKT’de ilk yarıda A destesinden (p=0,028) son yarıda ise B destesinden (p=0,03) seçme eğiliminde gruplar arasında fark izlenmektedir. Son olarak, DEZTÖ’de iki grup arasında toplam puanda (p<0,01) izlenen anlamlı farkın 2. derece yanlış inanç (p=0,024) ve empati (p=0,027) görevlerinde ortaya çıktığı görülmüştür. Sonuç: Çalışmamız örneklemini oluşturan SKB tanılı bireylerin uygunsuz cevabın inhibisyonunda minimal güçlüğe sahip oldukları, bu güçlüğün karar verme davranışında dezavantajlı seçimler yapmayla ilişkili olduğu sonucuna ulaşılmıştır. Ayrıca, SKB tanılı bireylerin dışsal ipuçlarından zihinsel durumları yordamada başarılı oldukları fakat sosyal bir örüntü dâhilinde ipuçlarını bütünleştirme ve uyumlu öyküleştirme yapmakta zorlandıkları görülmüştür.Science Citation Index Expande
Face Memory and Emotion Recognition in Individuals Diagnosed With Schizophrenia, Their Unaffected Siblings, Individuals With Ultra-High Risk for Psychosis and Healthy Controls
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