The ımpact of compulsory health service on physicians and burnout in a province in eastern anatolia

Amaç: 2005 yılından bu yana uygulanmakta olan Devlet Hizmet Yükümlülüğünün (DHY) hekimler üzerindeki etkilerinin tükenmişlik ekseninde incelenmesi hedeflenmiştir. Yöntem: Kesitsel betimleyici epidemiyolojik özellikte bir araştırma olup örneklem grubu Muş il sınırları içinde çalışan tüm hekimlerden oluş- muştur. Deneklere ayrıntılı sosyodemografik ve mesleki bilgileri sorgu- layan form yanında Maslach Tükenmişlik Ölçeği (MTÖ), Beck Dep- resyon Ölçeği, İş Doyumu Ölçeği (İDÖ), Yaşam Doyumu Ölçeği, Ça- lışanlar için Yaşam Kalitesi Ölçeği (ÇYKÖ) ve Genel Sağlık Anketi-12 uygulanmıştır. Bulgular: Araştırmaya katılan 139 hekimin 100ü (%71) DHYyi yeri- ne getiren hekimlerden oluşmuştur. DHY olan hekimler olmayanlarla karşılaştırıldığında bu hekimlerde anlamlı olarak yaşam doyumu ve ya- şam kalitesinin daha düşük, tükenmişlik, genel psikiyatrik belirti ve psi- kolojik stres düzeylerinin daha yüksek olduğu tespit edilmiştir. DHY olan hekimlerde tükenmişlik düzeyi ile çalışmada kullanılan diğer öl- çek puanları arasında MTÖ-Kişisel Başarı alt ölçeği ile İDÖ ve ÇYKÖ- Eşduyum Yorgunluğu alt ölçeği dışında kalanlarda, istatistiksel olarak anlamlı bir ilişki bulunmuştur. Depresif belirti düzeyi ve günlük bakı- lan ortalama hasta sayısının tükenmişliğin üç alt boyutunu; iş doyumu düzeyinin duygusal tükenmişlik ve duyarsızlaşmayı; yaşam doyumu dü- zeyinin duygusal tükenmişliği; cinsiyetin (kadın) kişisel başarıyı yorda- dığı saptanmıştır. Sonuç: DHY olan hekimlerde tükenmişlik düzeyi yüksek bulunmuş olup başta DHY uygulaması ile ilgili faktörler olmak üzere çeşitli değiş- kenlerle ilişkisi ve yordayıcıları tartışılmıştır.Objective: The Compulsory Health Service (CHS) for physicians has been in place since 2005. The aim of this study was to investigate the impact of the CHS on physicians and the factors associated with burnout. Method: The sample group consisted of all physicians working within the province of Muş in this cross-sectional, descriptive, epidemiological study. All participants were assessed using the Maslach Burnout Inventory (MBI), the Beck Depression Inventory, the Job Satisfaction Scale (JSS), the Satisfaction with Life Scale, the Professional Quality of Life Scale (ProQOL) and the General Health Questiannaire-12, along with a detailed sociodemographic and professional data form. Results: A total of 139 physicians participated in this study, and 100 of them (71%) were fulfilling the CHS. Physicians who fulfilled the CHS were found to have lower levels of job satisfaction and professional quality of life. They also had higher levels of depression, general psychiatric symptoms, and psychological stress. The relationships between the level of burnout in physicians fulfilling the CHS and the scores from the scales used in the study were statistically significant except those between MBI-Personal Accomplishment, JSS, and ProQOL-Compassion Fatigue subscales. The extent of depressive symptoms and the daily number of patients were predictors of all three subscales of burnout. Job satisfaction was a predictor of both emotional exhaustion and depersonalization, while life satisfaction was a predictor of emotional exhaustion, and gender was a predictor of personal accomplishment. Conclusion: The level of burnout among physicians who had fulfilled the CHS was high. The factors and predictors associated with burnout were discussed

Quetiapine vs. risperidone in treating psychosis in neurosyphilis: a case report

Objective: A 44-year-old male patient presented with agitation, auditory hallucinations, and delusions of persecution was diagnosed as having neurosyphilis

The effect of permanent ostomy on body image, self-esteem, marital adjustment, and sexual functioning

Objective: The aim of this study was to investigate the effects of permanent ostomy on body image, sexual functioning, self-esteem, and marital adjustment

Childhood Trauma and Dissociation in Schizophrenia

Background: This study is concerned with relationships between childhood trauma history, dissociative experiences, and the clinical phenomenology of chronic schizophrenia. Sampling and Methods: Seventy patients with a schizophrenic disorder were evaluated using the Structured Clinical Interview for DSM-IV, Dissociative Experiences Scale, Dissociative Disorders Interview Schedule, Positive and Negative Symptoms Scales, and Childhood Trauma Questionnaire. Results: Childhood trauma scores were correlated with dissociation scale scores and dissociative symptom clusters, but not with core symptoms of the schizophrenic disorder. Cluster analysis identified a subgroup of patients with high dissociation and childhood trauma history. The dissociative subgroup was characterized by higher numbers of general psychiatric comorbidities, secondary features of dissociative identity disorder, Schneiderian symptoms, somatic complaints, and extrasensory perceptions. A significant majority of the dissociative subgroup fit the diagnostic criteria of DSM-IV borderline personality disorder concurrently. Among childhood trauma types, only physical abuse and physical neglect predicted dissociation. Conclusions: A trauma-related dissociative subtype of schizophrenia is supported. Childhood trauma is related to concurrent dissociation among patients with schizophrenic disorder. A duality model based on the interaction of 2 qualitatively distinct psychopathologies and a dimensional approach are proposed as possible explanations for the complex relationship between these 2 psychopathologies and childhood trauma. Copyright (C) 2009 S. Karger AG, Base

Dissociative Depression Among Women with Fibromyalgia or Rheumatoid Arthritis

The aim of this study was to inquire about the possible relations of childhood trauma, anger, and dissociation to depression among women with fibromyalgia or rheumatoid arthritis. Fifty female patients diagnosed as having fibromyalgia (n = 30) or rheumatoid arthritis (n = 20) participated in the study. The Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire (SDQ), Dissociation Questionnaire (DIS-Q), Beck Depression Inventory (BDI), Spielberger State-Trait Anger Expression Inventory, and Dissociative Disorders Interview Schedule were administered to all participants. Women with a lifetime diagnosis of depressive disorder had higher scores for somatoform and psychoform dissociation than the nondepressive patients. However, childhood trauma scores did not differ between the 2 groups. In regression analysis, current severity of depression (BDI) was predicted by psychoform dissociation (DIS-Q) and lower education, and lifetime diagnosis of major depression was predicted by somatoform dissociation (SDQ). Whereas childhood emotional neglect predicted somatoform dissociation, psychoform dissociation was predicted by childhood sexual abuse. Mental processing of anger seems to be 1 of the dimensions of psychodynamics in trauma-related depressive conditions. In the context of the perceived threat of loss of control due to expressed anger and mental disintegration, somatoform dissociation seems to contribute to overmodulation of emotions in dissociative depression. Among patients suffering from physical illness with possible psychosomatic dimensions, assessment of somatoform dissociation in addition to psychoform dissociation may be helpful to understand diverse psychopathological trajectories emerging in the aftermath of childhood adversities. The recently proposed category of "dissociative depression" (Sar, 2011) seems to be a promising concept for future research on psychosomatic aspects of traumatic stress

Psychiatric Epidemiology in Turkey: Main Advances in Recent Studies and Future Directions

Objective: To overview and evaluate the main findings, methodological shortcomings, and time trends of the recent psychiatric epidemiology studies in Turkey, as well as to provide areas prone for development in forthcoming research

Psychiatric Epidemiology in Turkey: Main Advances in Recent Studies and Future Directions

Objective: To overview and evaluate the main findings, methodological shortcomings, and time trends of the recent psychiatric epidemiology studies in Turkey, as well as to provide areas prone for development in forthcoming research