STRESS AND BURNOUT IN PSYCHIATRISTS IN TURKEY DURING COVID-19 PANDEMIC

Background: Clinicians working in mental health (MH) services seem to be at increased risk of burnout. This study aimed to investigate the stress and burnout levels of psychiatrists working in MH services in Turkey and determine the relationship between stress, workload, and support during the COVID-19 pandemic. Subjects and methods: An online questionnaire was sent to child and adult psychiatrists registered with Turkish professional mail groups. 217 psychiatrists replied, with equal numbers from child (n=108) and adult (n=109) MH services. The Copenhagen Burnout Inventory and study-specific questionnaire were used. Results: 60.8% of psychiatrists (n=132) experienced medium-or high-intensity work-related burnout, 49.8% (n=108) experienced patient-related burnout, and 31.8% (n=69) experienced medium-or high-intensity personal burnout. Patient-related burnout scores were significantly higher in the child psychiatry group than in the adult psychiatry group. The majority (n=126, 58.1%) reported either moderate or higher stress levels linked to the COVID-19 pandemic. Turnover intention, reluctance to retrain in psychiatry and sense of lack of value in the job are all associated with higher levels of burnout. Conclusions: The current COVID-19 pandemic is likely to bring additional stressors to psychiatrists. This study shows that psychiatrists in Turkey already exhibit high levels of work-related stress. Organizational interventions to ameliorate psychiatrists’ wellbeing and work conditions are required

Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety

High comorbidity of anxiety and depression poses challenges to research and treatment in clinical settings. The current study was set out to investigate whether respondents can be separated into discrete depressive and anxious subgroups or reveal a continuous distribution throughout the population based on the symptoms of depression and anxiety. In addition, we also explored the role of rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors. Psychometric instruments including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale-Revised (DAS-R), Ruminative Response Scale – Short Form (RRS-SF), and White Bear Suppression Inventory (WBSI) were completed by 310 undergraduates. Item responses to the BDI and BAI were subjected to latent class analysis (LCA). The LCA showed that three homogenous subgroups exist: normal, subclinical, and psychopathology latent classes. Findings supported the dimensional model rather than the categorical distinction between anxiety and depression. Strong covariances between anxious and depressive symptoms across latent subgroups were observed. Having controlled for age and gender, automatic thoughts, dysfunctional thinking, rumination, and thought suppression were all found significant transdiagnostic factors. Anxiety and depression, as frequently co-occurring clinical conditions, can be best understood in a continuum rather than taxonomic classifications. Individuals more prone to use maladaptive cognitive emotional regulation strategies seem to be at greater risk of psychopathology. © 2020, Springer Science+Business Media, LLC, part of Springer Nature

Cognitive-Behavioral Theory and Treatment of Antisocial Personality Disorder

Antisocial personality disorder (ASPD) has a distinct cognitive profile according to cognitive theory of personality disorders. Antisocial individuals’ view of the world is personal rather than interpersonal. They cannot accept another’s point of view over their own. As such, they cannot take on the role of another. Their actions are not based on choices in a social sense because of this cognitive limitation. Cognitive theory of personality disorders conceptualizes personality disorder including the ASPD, according to their basic beliefs or schemas. The content of beliefs can vary in different personality disorders. Antisocial patients view themselves as loners, autonomous, and strong. Some of them see themselves as having been abused and mistreated by society and therefore justify victimizing others because they believe that they have been victimized. Their view about other people is very negative; they see others as exploitative and thus deserving of being exploited in retaliation. In this chapter, after overviewing general features of ASPD, we aim to give an explanation how cognitive behavioral therapy (CBT) conceptualizes personality disorders in general and ASPD in particular and highlight the important implementations of CBT and schema therapy

İhmal ve İstismar Mağduru Ergenlerde Psikolojik Destek Alma Tutumları ve Terapötik İşbirliğinin Psikopatolojik Özellikler ve Şemalarla İlişkisi

u çalışmada, ihmal ve istismar mağduru gençlerin psikolojik destek almaya yönelik tutum ve terapötik işbirliği ile psikopatolojik özellikleri ve erken dönem uyumsuz şemaları arasındaki ilişki araştırılmıştır. Nicel yöntemlerden korelasyonel desene göre tasarlanan bu çalışmaya 12-18 yaşlarında ihmal ve istismar mağduru 65 kız çocuğu katılmıştır. Örnekleme “Belirti Tarama Testi (SCL90-R)”, “Psikolojik Destek Almaya Yönelik Tutum Ölçeği-Kısa Form (PYAİTÖ-KF)”, “Terapötik İttifak Ölçeği-Hasta Formu (TİÖ-HF)” ve “Young Şema Ölçeği-Kısa Form 3 (YŞÖ-KF3)” ölçekleri uygulanmıştır. Yapılan ilişki analizleri sonucunda; “Kişilerarası Duyarlılık”, “Anksiyete”, “Somatizasyon”, “Paranoid Düşünceler” ve “Obsesif Kompulsif Belirtiler” arttıkça psikolojik yardım alma tutumlarının ve terapötik işbirliğinin olumsuz etkilendiği ortaya çıkmıştır. “Young Şema Ölçeği-Kısa Form3 (YŞÖ-KF3)” ile PYAİTÖ-KF ve TİÖ-HF ölçekleri arasında uygulanan diğer bir ilişki analizi sonucunda; “Onay Arayıcılık/Tanınma Arayıcılık” şemasının ve “Cezalandırıcılık/Acımasızlık” şemalarının psikolojik destek tutumlarını olumlu etkilediği; “Duygusal Yoksunluk” şemasının terapide ortak amaçların belirlenmesine yardımcı olduğu; “Cezalandırıcılık/Acımasızlık” şemasının da, terapötik amaç, bağ ve görev işbirliğinin her birinde artışa yol açtığı; “Onay Arayıcılık/Tanınma Arayıcılık” şemasının da terapötik bağı arttırdığı sonuçlarına ulaşılmıştı

The relationship between temperament and character features, and social problem solving in psychiatric patients who attempted suicide with drugs: preliminary results

Objective: In order to gather information in a broader sample, the aims of this preliminary study were: 1) to identify psychiatric diagnoses and any history of suicidal thoughts and attempts in people who attempt suicide with drugs, 2) to evaluate the temperament and character features, social problem solving skills of these patients in relation to sociodemographic data and 3) to analyze the correlations between these factors. Methods: Sixty patients between 16 and 49 years old participated in this study. A Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), a Sociodemographic Data Form, the Beck Depression Inventory (BDI), Temperament and Character Inventory (TCI) and Social Problem Solving Inventory (SPSI) were administered to the participants. Results: According to the SCID-I, 23 (38.3%) of the participants had a major depressive disorder, and 39 (65%) of the participants had a history of previous suicide attempts before this admission. There was a significant relationship between self-esteem scores and the incidence of previous suicide attempts. There were significant (negative) correlations between the harm avoidance, reward dependence, self-directedness and cooperativeness dimensions of the TCI and the problem orientation and problem solving skills subscales of the SPSI. Conclusion: Psychiatric disorders are common in individuals who attempt suicide with drugs. These individuals may have a history of one or more suicide attempts before admission. In addition to differences in temperament and character features, this study found significant disorders of cognition and behavior in individuals that had attempted suicide. This result may indicate that dimensions of temperament and character can provide significant indications for cognitive and behavioral disorders. (Anatolian Journal of Psychiatry 2014; 15:31-38

Parental psychological distress associated with COVID-19 outbreak: A large-scale multicenter survey from Turkey

Aims: Pandemics can cause substantial psychological distress; however, we do not know the impact of the COVID-19 related lockdown and mental health burden on the parents of school age children. We aimed to comparatively examine the COVID-19 related the stress and psychological burden of the parents with different occupational, locational, and mental health status related backgrounds. Methods: A large-scale multicenter online survey was completed by the parents (n = 3,278) of children aged 6 to 18 years, parents with different occupational (health care workers—HCW [18.2%] vs. others), geographical (İstanbul [38.2%] vs. others), and psychiatric (child with a mental disorder [37.8%]) backgrounds. Results: Multivariable logistic regression analysis showed that being a HCW parent (odds ratio 1.79, p <.001), a mother (odds ratio 1.67, p <.001), and a younger parent (odds ratio 0.98, p =.012); living with an adult with a chronic physical illness (odds ratio 1.38, p <.001), having an acquaintance diagnosed with COVID-19 (odds ratio 1.22, p =.043), positive psychiatric history (odds ratio 1.29, p <.001), and living with a child with moderate or high emotional distress (odds ratio 1.29, p <.001; vs. odds ratio 2.61, p <.001) were independently associated with significant parental distress. Conclusions: Parents report significant psychological distress associated with COVID-19 pandemic and further research is needed to investigate its wider impact including on the whole family unit. © The Author(s) 2020

Validity and Reliability of Mobility Inventory-Turkish Version

The Mobility Inventory (MI; Chambless et al. 1985) assesses the degree to which respondents avoid 26 typical agoraphobic situations, when alone and when accompanied. The aim of this study is to investigate the validity and reliability of Mobility Inventory-Turkish Version.Method: Mobility Inventory was administered to 92 patients (male33, female59) with agoraphobia or panic disorder with agoraphobia. Analysis were applied to &quot;when alone&quot; and &quot;when accompanied&quot; subscales. Reliability of MI was analyzed by test-retest correlation, split-half technique, Cronbach's alpha coefficient. Construct validity was evaluated by factor analysis performed with principal component analysis and varimax rotation after the Kaiser-Meyer-Olkin (KMO) and Bartlett test had been performed. Results: &quot;when alone&quot; subscale: Cronbach coefficient was found as 0.93. In analysis performed by split-half method reliability coefficients of inventory halves were found as 0.892 and 0.878. Again spearmen-brown coefficient was found as 0.879 by the same analysis. Factor analysis revealed six basic factors. These six factors explained 70.4 %of the total variance. &quot;when accompanied&quot; subscale: Cronbach coefficient was found as 0.906. In analysis performed by split-half method reliability coefficients of inventory halves were found as 0.865 and 0.850. Again Spearmen-Brown coefficient was found as 0.766 by the same analysis. Factor analysis revealed seven basic factors. These seven factors explained 73.4 %of the total variance. Conclusion: Analysis demostrated that ME-Turkish version had a satisfactory level of reliability and validit

Psikiyatri Polikliniği: Şizofreni Tedavisi Bağlamında Kesitsel Bir Çalışma

Amaç: Bu çalışmanın amacı; Eğitim ve Araştırma Hastanesi Psikiatri Polikliniğinebaşvuran hastaların sosyodemografik özelliklerini araştırmak ve Şizofreni tanısı alanhastaların tedavi ve takip sonuçlarını değerlendirmektir.Gereç ve Yöntem: Psikiyatri polikliniğine yapılan 2707 başvuru değerlendirildi. Ayrıca şizofreni hastalarına poliklinik şartlarında uygulanan tedaviler incelendi.Bulgular: Araştırma süresince psikiyatri polikliniğine toplam 2707 başvuruyapılmıştır. Çalışmaya alınan hastaların 649’u (%24) şizofreni ve diğer psikotik bozukluklar,506’sı (%18,7) depresif bozukluklar, 389’u (%14,4) anksiyete bozuklukları,117’si (%4,3) bipolar bozukluklar tanısı almıştı. Şizofreni hastalarının 347’si (%62) tekilaç kullanıyordu. Bu hastaların 287’si (%51,3) atipik antipsikotik, 60’ı (%10,7)ise tipikantipsikotik almaktaydı. Hastaların 205’i (%36,6) kombine antipsikotik kullanmaktaydı. Çalışmamızda şizofreni hastalarının %77,5’ine, tek başına veya kombinasyonşeklinde atipik antipsikotik reçetelendiğini saptadık.Sonuç: Psikiyatri poliklinikleri, psikiyatrik tedavinin en önemli çalışma alanlarıdır. Belirgin yeti yıkımına yol açan kronik hastalıkların, hastalığa özelleşmiş rehabilitasyonalanlarında değerlendirilmesi, psikiyatri polikliniklerinin hem hizmet hem de araştırmaalanlarında daha etkin kullanımını sağlayacaktır. Şizofreni tedavisinde, literatüre uygun ancak tedavi protokollerine uymayan sonuçlar saptadık. Şizofreni tedavisinde,ilaç dışı tedavileri de içeren bütüncül tedavi yaklaşımına daha fazla dikkat çekilmelidir.Aim: The aim of this study was to investigate the sociodemographic characteristics of patients who applied to the Psychiatry Outpatient Clinic of Education and Research Hospital and to evaluate the treatment and follow-up results of patients diagnosed with schizophrenia. Material and Methods: 2707 applications whiche were received to the psychiatric outpatient clinic were evaluated . Also the treatments of schizopherina patients in polyclinic were analysed. Results: During the study period, 2707 applications were made to the psychiatry polyclinic. 649 (24%) of the patients were diagnosed with schizophrenia and other psychotic disorders. 506 (18.7%) of the patiens were diagnosed with depressive disorders. 389 (14.4%) of the patients were diagnosed with anxiety disorders and 117 (4.3%) of the patients were diagnosed with bipolar. 347 (62%) of the schizophrenic patients were on a single medication. 287 (51.3%) of these patients were taking atypical antipsychotics and 60 (10.7%) of them were taking typical antipsychotics. 205 (36.6%) of all patients were taking combined antipsychotic medication. We found that 77.5% of patients with schizophrenia were prescribed atypical antipsychotics alone or in combination. Conclusion: Psychiatric polyclinics are the most important fields of study for psychiatric treatment. Evaluation of chronic diseases which cause significant loss of competence in disease specialized rehabilitation units will provide more effective use of psychiatric polyclinics in both service and research areas. For schizophrenia treatment, we found results that were in accordance with the literature but not with the treatment protocols. Holistic treatment approach, including non-pharmacological treatments for schizophrenia should be pushed forward

A Technique: Examining the Evidence

Introduction: Cognitive therapy is based on the realistic epistemology which exerts that there is an objective reality beyond human experience. Cognitive models of psychopathology stipulate that the processing of external event or internal stimuli is biased and therefore systematically distorts the individual’s construction of his or her experiences, leading to a variety of cognitive errors. These distorted cognitions predispose or perpetuates mental disorders. If this bias that is also manifested in the automatic thoughts during specific instances can be attenuated by weakening the belief in these thoughts, it may lead into change in the accompanying emotion and dysfunctional behaviour. Objective: The aim of this review is to describe the basic technique of cognitive therapy namely “examining the evidence” and also present the clinical application of this technique. In order to perform this technique, first situation must be detailed. Then assessed emotion is graded according to its severity. After that, key automatic thought must be identified and phrased accordingly. After grading belief in the thought, evidence for and against the thought can be generated using appropriate questioning. In the end by using this evidence, the belief in the automatic thought and the emotion must be reviewed. Examining the evidence can also be used as a homework assignment to be done between sessions. In this text, steps of examining the evidence, which questions to be asked, and the points that must be attendant is reviewed and a sample interview is included. Conclusion: By its empirical nature “examining the evidence” is the most valuable technique of cognitive therapy and when it is applied properly long lasting change can occur in client

Adaptation, Validity and Reliability of the Body Sensations Questionnaire Turkish Version

Objective: In this study, it is aimed to evaluate the validity and reliability of Body Sensations Questionnaire (BSQ). Method: BSQ was administered to 122 patients with panic disorder. BSQ Turkish version completed by translation, back-translation and pilot assessment. Socio-demographic Data Form and BSQ Turkish version were administered to participants. Construct validity was assesed by factor analysis after Kaiser-Meyer-Olkin (KMO) and Bartlett tests applied. Principal component analysis and varimax rotation used for factor analysis. Results: 66% (n=80) of the participants were female and 34% (n=42) were male. The mean age of participants was 31,7±10,8 years and age range was 18-58 years. Internal consistency of the questionnaire was calculated 0,921 by Cronbach alpha. In analysis performed by split-half method reliability coefficients of half questionnaire were found as 0,889 and 0,850. Again spearmen-brown coefficient was found as 0,849 by the same analysis. Factor analysis revealed five basic factors. 75,2% of the total variance was explained with these five factors. Conclusion: The results of this study show that the Turkish version of BSQ is a reliable and valid scale for measuring the fear of the bodily sensations associated with panic