Sosyal anksiyete bozukluğunda dikkat yanlılığı ve eğitimi

PubMed ID: 28360667Cognitive behavioral therapy (CBT) is one of the most effective treatment modalities for social anxiety disorder (SAD), showing a high level of clinical evidence supporting its effectiveness. On the other hand, lack of the desired benefit from this treatment in some patients causes continuation of the search for new techniques. Recent research studies have focused on attentional bias and attention training in SAD. Attention processes in SAD have been a major target of interest and investigation since the introduction of the first cognitive models explaining SAD. In the first model, it was highlighted that attention was self-focused. The relationship between threatening stimuli and attention was considered in the subsequent models. Attentional bias towards threat may take place in several ways, such as facilitated processing of threat, difficulty in disengaging attention from the threat and avoidance of attention from the threat. After these descriptions regarding the phenomenology of the disorder, treatments to modify attention, processes were developed. In spite of conflicting results, investigations on attentional training are promising. Attention processes, attentional bias and attentional training in SAD are discussed in this review.Bilişsel davranışçı terapi (BDT) sosyal anksiyete bozukluğunda (SAB ) kanıt düzeyi yüksek, en iyi sonuç alınan tedavi yöntemlerinden biridir. Öte yandan, bazı hastalarda bu tedaviden istenilen yararın elde edilememesi, yeni teknikler arayışının devamına neden olmaktadır. SAB'da son araştırmalar dikkat yanlılığına ve dikkat eğitimine odaklanmıştır. SAB'da dikkat süreçleri rahatsızlığın bir bilişsel bozukluk olarak açıklandığı ilk modellerden bu yana araştırmaların hedefi olmuştur. İlk modelde, dikkatin kişinin kendi üzerine odaklı olduğu vurgulanmıştır. Tehdit edici uyaranlar ve dikkat arasındaki ilişki daha sonraki modellerde kabul edilmiştir. Tehdite yönelik dikkat yanlılığı tehditin kolaylaştırılmış işlenmesi, dikkatin tehditten uzaklaştırılmasında zorlanma, dikkatin tehditten kaçırılması şeklinde oluşabilir. Hastalık süreci-ne getirilen bu açıklamalar sonrasında, dikkat süreçlerini değiştirmek için tedaviler geliştirilmiştir. Çelişkili sonuçlara rağmen, dikkat eğitimi araştırmaları ümit vericidir. Bu derlemede SAB'da dikkat süreçleri, dikkat yanlılıkları ve dikkat eğitimi konuları tartışılmıştır.Publisher's Versio

A clinical case of treatment-resistant schizophrenia: 60 hospitalizations and 342 ECT sessions in 36 years; lack of social support or undertreatment?

It is reported that between 20% and 25% of patients have schizophrenia that is resistant to treatment. The treatment resistance in schizophrenia is defined by many authorities. One of the generally accepted definitions is inadequate response despite treatment with different atypical antipsychotics, two or three times at least four-six weeks; the other acceptable one is although the use of two different typical or atypical antipsychotics in monotherapy during four-six weeks, inadequate treatment response is obtained. Duratian of hospitalization in treatment resistant cases is longer. In addition, when considering all the expenses and loss of functions, the cost of resistant cases to society is higher. 60 years old, women patient. She was hospitalized from emergency department where she came with his son, because of denial of treatment and homicidal intent. It is learned that age of onset was 24, disease began in a postpartum period, she was diagnosed with schizophrenia and she had 60 hospitalizations. Although clozapine, haloperidol, amisulpiride, risperidone, olanzapine, aripiprazole, quetiapine, chlorpromazine, sulpiride, zuclopenthixol, fluphenazine, lithium and valproate were used adequate doses and time; a total of 342 ECT sessions were administered; response or partial response was achieved, she had not achieved long-term functioning and well-being. In the most recent admission, she had significant improvement with clozapine 275 mg/day and valproat 1000 mg/day. Despite all treatment efforts, schizophrenic patient with excessive admissions and frequent recurrences is discussed.Publisher's Versio

Withdrawal-emergent dyskinesia and supersensitivity psychosis due to olanzapine use

PubMed ID: 28360793Tardive dyskinesia (TD) usually appears after years of antipsychotic drug use and appears to be related to the total lifetime medication dose. In withdrawal-emergent dyskinesia (WE-D), which is considered to be a subtype of TD, dyskinetic symptoms often appear shortly after a rapid reduction in antipsychotic drug dose or sudden discontinuation of the drug. Supersensitivity psychosis, which is frequently observed along with TD and is considered to have a similar etiology as TD, is a psychotic relapse phenomenon that occurs after the withdrawal of an antipsychotic drug or a rapid reduction in the drug dosage. In general, atypical antipsychotics tend to be associated with less propensity to cause TD when compared with typical antipsychotics. Furthermore, olanzapine and clozapine may have a therapeutic potential in improving or totally curing TD. In this study, a case of WE-D because of discontinuing olanzapine use and supersensitivity psychosis is discussed.Tardiv diskinezi sıklıkla yıllar boyu antipsikotik ilaç kullanımından sonra ortaya çıkmaktadır ve yaşam boyu tedavi dozu ile ilişkili görünmektedir. Tardiv diskinezinin bir alt tipi olarak kabul edilen çekilme diskinezisi tablosunda diskinezi belirtileri ilaç dozunun hızlı azaltılması veya ani kesilmesinden kısa bir süre sonra ortaya çıkar. Sıklıkla tardiv diskineziyle birlikte görülen ve oluşumunda tardiv diskineziyle benzer mekanizmaların rol oynadığı öne sürülen bir durum olan süpersensitivite psikozu, kullanılan antipsikotiğin hızlı azaltılması veya ani kesilmesine bağlı olarak oluşan psikotik relaps durumudur. Genel olarak atipik antipsikotikler tipik olanlarla kıyaslandığında tardiv diskineziye daha az yatkınlık oluş- turma ile ilişkilendirilir. Bunun da ötesinde klozapinin ve olanzapinin tardiv diskinezi bulgularında düzelme veya tamamen iyileşme sağlama potansiyeli olduğu bildirilmiştir. Bu yazıda olanzapin tedavisinin kesilmesine bağlı olarak çekilme diskinezisi ve supersensitivite psikozu olgusu tartışılmıştır.Publisher's Versio

Executive functions and thyroid volumes in bipolar patients on lithium treatment

Aim: The purpose of this study was to investigate the relationship between executive functions and thyroid ultrasound parameters in remitted bipolar patients who were on lithium treatment. Methods: In the current study, 25 remitted patients with diagnoses of Bipolar I Disorder having blood lithium, and thyroid hormone levels within the normal range were consecutively enrolled. Healthy control group consisted of 25 euthyroid people matched as an age, sex and education level with the patients. Semi-structured sociodemographic and clinical form, the Structured Clinical Interview for DSM-IV Axis I Disorders, the Montreal Cognitive Assessment (MoCA), the Hamilton Depression Scale, Young Mania Rating Scale, thyroid ultrasonography and the Wisconsin Card Sorting Test (WCST) were applied to both groups. Within the patient group, correlation analysis was performed between WCST performance and thyroid volume. Results: In the present study, no significant difference was found between the bipolar and the healthy control groups regarding the executive functions as measured via WCST. In the bipolar patients, there were no statistically significant correlations among WCST scores and thyroid volumes. Conclusion: Thyroid volumes are not appeared to be associated with executive functions in euthymic bipolar patients.Publisher's Versio

Comparison of sociodemographic and clinical characteristics of unipolar and bipolar geriatric inpatients

Amaç: Bipolar bozukluk, toplumda %1 oranında görülen kronik bir hastalık olmakla beraber, yaşlılardaki yaygınlık oranı % 0.1 kadar düşüktür. Major depresyonun ise 70-85 yaşından sonra prevalans ve insidansı iki kat artmaktadır. Çalışmanın amacı, yatarak tedavi gören bipolar bozukluk(BB) ve unipolar depresyon(UD) tanılarıyla izlenen geriyatrik hastaların sosyodemografik ve klinik özelliklerinin araştırılmasıdır.Yöntem: Çalışmada Bakırköy Ruh ve Sinir Hastalıkları Hastanesi’nde yatmış olan, 65 yaş ve üzeri BB ve UD hastalarının sosyodemografik ve klinik özellikleri tıbbi kayıtları üzerinden karşılaştırılmıştır. Madde/ilaç, başka bir sağlık durumuna bağlı duygudurum bozukluğu tanısı olanlar ya da demans, deliryum tanısı olan hastalar çalışmaya dahil edilmemiştir. Bulgular: Tüm hastaların yaş ortalaması 69,3’tür. Çalışmaya dahil edilen 93 hastanın 51 tanesinde (%54,8) BB, 42 tanesinde(%45,2) UD tanısı bulunmaktadır. Hastalığın başlangıç yaşı BB için 41,33 iken UD için 59,21 bulunmuştur(p=0,000). UD hasta grubunun yatışındaki intihar fikri oranı %78,6 olup BB hasta grubununki %17,6’dır(p=0,000). UD grubundan 20(%47.6) kişi daha önce en az bir kere intihar girişiminde bulunmuşken bu sayı bipolar hasta grubunda 12(%23.5) olarak saptanmıştır(p=0,03). BB hastalarının ilaç uyumsuzluğu %51,0 iken UD hastalarında (%26,2) anlamlı derecede düşüktür (p=0,000). BB grubunun tedavisinde antipsikotikler (%100), depresyon hastalarına (%76,2) oranla daha sık kullanılmıştır(p=0,000). Sonuçlar: Yatarak tedavi görmüş unipolar ve bipolar geriyatrik hastalarda önemli klinik farklar saptanmıştır.Objective: Bipolar disorder (BD) is a chronic disease of 1% in the population although the prevalence in the elderly is low as 0.1%. The prevalence and incidence of major depression doubled after the age of 70-85. The aim of this study was to investigate sociodemographic and clinical characteristics of geriatric inpatients with bipolar disorder and unipolar depression (UD). Methods: In the study, demographic and clinical characteristics of 65 years and older patients with BD and UD who hospitalized in Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were compared through medical records. Patients diagnosed with substance/medication-induced mood disorders, mood disorders due to another medical condition or dementia, delirium were excluded from the study. Results: The average age of patients is 69.3 years. The study included 93 patients; 51 patients (54.8%) are diagnosed BD, 42 of them (45.2%) are diagnosed UD. The age of onset was found 59.21 years for UD and 41.33 years for BD (p=0.000). Hospitalization ratio in the patients with suicidal ideation was 78.6% (n=33) in UD and 17.6% (n=9) in BD (p=0.000). While 20 of UD patients (47.6%) had suicide attempt at least once, 12 of BD patients (23.5%) attempted suicide before (p=0.03). The drug inadherence ratio in BB patients was found 51.0% (n=26), while it was significantly lower in UD patients (26.2%; n=11) (p=0.000). Antipsychotics were used in the treatment with 100% in BB group (n= 51) and 76.2% (n=32) in UD group (p=0.000). Conclusions: Important clinical differences were detected between geriatric unipolar and bipolar inpatients.Publisher's Versio

Relationship between metabolic syndrome and clinical features, and its personal-social performance in patients with schizophrenia

PubMed ID: 26174109The aim of this study was to evaluate the metabolic syndrome (MS) criteria and also to investigate the effects of MS on medical treatment, clinical course and personal and social performance in patients with schizophrenia. One hundred-sixteen patients with schizophrenia were included in the study. Measurements of MS were calculated in all patients. Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia, Personal and Social Performance Scale (PSP) were applied. The frequency of MS according to IDF criteria was 42.2 % among the patients. There was no significant difference between patients with and without MS in terms of age. The ratios of MS were 62.5 % for the group taking typical and atypical antipsychotics together and 35.7 % for the group taking two or more atypical antipsychotics together. The duration of disorder in patients with MS was higher than those without MS. Furthermore there was no significant difference between the schizophrenic patients with and without MS, in terms of PSP scores. Our findings showed that the duration of illness, high scores of BMI, use of clozapine or concurrent use of typical and atypical antipsychotics, depressive and negative symptoms of schizophrenia were significant risk factors for the development of MS.Publisher's Versio