The effectiveness of psychoanalytic psychotherapy in individuals diagnosed with PTSD due to torture and severe human right violations

Abstract Introduction: Various psychotherapies have been applied to individuals who have been subjected to torture and severe human rights and to patients with PTSD, however, studies assessing the effectiveness of such therapies are limited. Psychoanalytic psychotherapy is said to be used frequently in practice for these patient groups. Yet, there are scarcely any studies assessing its efficacy. In this study, we aim to assess the effectiveness of psychoanalytic psychotherapy in patients with PTSD associated with torture and severe human rights violations. Additionally, the study seeks to monitor the continuity of therapy within the first year and its relationship with overall clinical change. Methods: 70 patients with PTSD related to torture and severe human rights violations who applied to the Human Rights Foundation of Turkey were given psychoanalytic psychotherapy. CGI-S and CGI-I scales were applied to the patients (in Months 1, 3, 6, 9, and 12); and the patients' continuity of therapy and the changes in their recovery during the one-year psychotherapy period were assessed. Results: 38 (54.3%) of the patients were female. Their mean age was 37.7 years (SD = 12.25), while their mean baseline CGI-S score was 4.67. The mean length of treatment was 21.9 sessions (SD = 20.30). As the number of sessions increased, the final CGI-I scores of the patients improved significantly (p <.001) towards recovery. The change towards recovery became more evident particularly in the patients who had continued the therapy for more than 12 sessions. Mean scores for CGI-I scale were 3.46, 2.95, 2.23, 2.00, and 1.54 for months 1, 3, 6, 9 and 12 respectively. In addition, the drop-out rate was 34% (24 patients) for those who dropped out of therapy prematurely without any CGI-I assessment (9 patients) and those who dropped out of therapy with no improvement in their CGI-I scores –i.e. with CGI-I scores of 4-7 (15 patients). Conclusions: Considering the limited literature in the field, this study has provided significant data on the effectiveness of the use of psychoanalytic psychotherapy in individuals diagnosed with PTSD related to torture and severe human rights violations, despite its limitations –including not involving a control group. Furthermore, the findings might offer important clues regarding the relationship between continuity of therapy and clinical change

Sosyal anksiyete bozukluğunda aleksitimi: Özgül bir ilişki mi, yoksa majör depresyon eş tanısının bir özelliği mi?

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Objective: Alexithymia has been extensively studied in the literature regarding its relationship with major depreşsion. However, patients with anxiety related problems also have high alexithymic traits. Our study aimed to assess the presence of alexithymia and clinical variables associated with it in a specific subset of patients with anxiety, namely social anxiety disorder (SAD). Methods: 140 patients with generalized type SAD were assessed by using Toronto Alexithymia Scale-20 (TAS-20), Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Global Assessment of Functioning Scale (GAF). Participants with TAS-20 scores ≥61 were considered as alexithymic and they were compared with non-alexithymic (TAS-20 <61) participants in terms of rating scale scores, clinical characteristics and comorbidity profiles. Results: 46 patients were alexithymic (32.9%) and 94 patients constituted the non-alexithymic group. In comparisons between the two groups, alexithymic group was characterized by a lower mean age at onset of SAD, higher BDI, BAI, LSAS scores and total number of comorbid diagnoses and lower mean current and previous year GAF scores. However, there appears to be a weaker relationship between SAD and alexithymia after controlling for depression. Discussion: Our results suggest that alexithymia is associated with a more severe symptomatology, higher comorbidity and functional impairment in patients with SAD. However, this association may be stronger in patients who have current comorbid majör depression than in other patients with SAD.Amaç: Aleksitimi majör depresyon ile ilişkisi açısından literatürde geniş bir biçimde araştırılmıştır. Bununla birlikte anksiyete ile ilgili sorunları olan hastalarda da aleksitimik özellikler sık görülmektedir. Çalışmamızda anksiyete bozuklukları arasında özgül bir alt grup olan sosyal anksiyete bozukluğu (SAB) hastalarında aleksitiminin varlığı ve onunla ilişkili klinik değişkenlerin değerlendirilmesi hedeflenmiştir. Yöntem: Yaygın tip SAB tanılı 140 hasta Toronto Aleksitimi Ölçeği-20 (TAÖ-20), Liebowitz Sosyal Anksiyete Ölçeği (LSAÖ), Beck Depresyon Ölçeği (BDÖ), Beck Anksiyete Ölçeği (BAÖ) ve İşlevselliğin Genel Değerlendirilmesi (İGD) ile değerlendirildi. TAÖ-20 skoru ≥61 olan katılımcılar aleksitimik olarak değerlendirildi ve ölçek skorları, klinik özellikleri ve eş tanı profilleri aleksitimik olmayan (TAS-20 <61) katılımcılarla karşılaştırıldı. Bulgular: 46 hasta aleksitimikti (%32.9) ve 94 hasta da aleksitimik olmayan grubu oluşturdu. İki grup arası karşılaştırmalarda aleksitimik grupta ortalama SAB başlangıç yaşı daha düşüktü, BDÖ, BAÖ, LSAÖ skorları ile eş tanı sayısı daha yüksekti, şimdiki ve önceki yıldaki İGD skorları daha düşüktü. Bununla birlikte depresyon açısından kontrol edildiğinde SAB ile aleksitimi arasındaki ilişki daha zayıf görünüyordu. Tartışma: Bulgularımız aleksitiminin SAB hastalarında belirtilerin daha şiddetli olması, daha yüksek eş tanı oranı ve daha fazla yeti yitimi ile ilişkili olduğunu düşündürmektedir. Öte yandan bu ilişki halen aktif bir majör depresif episod içerisinde olan hastalarda diğer SAB hastalarına göre daha güçlü olabilir

Suicide attempts and clinical features of bipolar patients

Objectives: To identify clinical predictors of suicide attempts in patients with bipolar disorder. Methods: This study included bipolar patients who were treated in the Psychiatry Department, Haseki Training and Research Hospital, Istanbul, Turkey, between 2013 and 2014; an informed consent was obtained from the participants. Two hundred and eighteen bipolar patients were assessed by using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis-I (SCID-I) in order to detect all possible psychiatric comorbid diagnoses. Clinical predictors of suicide attempts were examined in attempters and non-attempters. The study design was retrospective. Results: The lifetime suicide attempt rate for the entire sample was 19.2%. Suicide attempters with bipolar disorder had more lifetime comorbidity of eating disorder. Female gender and family history of mood disorder were significant predictors for suicide attempts. There was no difference between groups in terms of bipolar disorder subtype, onset age of bipolar disorder, total number of episodes, first and predominant episode type, suicide history in first degree relatives, severity of episodes, and hospitalization and being psychotic. Conclusion: Our study revealed that female gender, family history of mood disorder, and eating disorder are more frequent in bipolar patients with at least one suicide attempt

Comparison of clinical and sociodemographic features of bipolar disorder patients with those of social anxiety disorder patients comorbid with bipolar disorder in Turkey

Objectives: To assess the impact of social anxiety disorder (SAD) comorbidity on the clinical features, illness severity, and response to mood stabilizers in bipolar disorder (BD) patients. Methods: This retrospective study included bipolar patients that were treated at the Department of Psychiatry, Haseki Training and Research Hospital, Istanbul, Turkey in 2015, and who provided their informed consents for participation in this study. The study was conducted by assessing patient files retrospectively. Two hundred bipolar patients were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition axis-I (SCID-I) in order to detect all possible comorbid psychiatric diagnoses. The sample was split according to the presence of SAD comorbidity and the groups were compared. Results: The SAD comorbidity was detected in 17.5% (35/200) of the BD patients. The SAD comorbid bipolar patients were more educated, had earlier onset of BD, lower number of manic episodes, and more severe episodes. There was no difference between groups in terms of total number of episodes, hospitalization, suicidality, being psychotic, treatment response to lithium and anticonvulsants. Conclusion: Social anxiety disorder comorbidity may be associated with more severe episodes and early onset of BD. However, SAD comorbidity may not be related to treatment response in bipolar patients

Usage of Riot Control Agents and other methods resulting in physical and psychological injuries sustained during civil unrest in Turkey in 2013

Turkey has experienced a wave of demonstrations in the summer of 2013, called Gezi Park Demonstrations. Between 31 May and 30 August, 297 people who had been subjected to trauma by several methods of demonstration control and Riot Control Agents applied to the Human Rights Foundation of Turkey Rehabilitation Centers to receive treatment/rehabilitation and/or documentation