Depression and anxiety in patients with hemophilia A and B.

OBJECTIVE: This study described the prevalence of and correlates of depression and anxiety in adult patients with hemophilia A and B. METHODS: In this cross-sectional study, we investigated patients with hemophilia who were being seen at an adult hemophilia center in Turkey. Participants were screened for depression and anxiety during their annual clinic visit, which included administration of the Beck Depression Inventory and State-Trait Anxiety Scale. RESULTS: Of the 90 patients, 22 (24.4%) met criteria for significant depressive symptoms and 67 (74.4%) met criteria for significant anxiety symptoms. There were no significant associations between depression and any psychosocial or clinical characteristics or adherence to hemophilia prophylaxis, except for educational status. No association was found between state and trait anxiety scores and psychosocial and clinical characteristics other than hemophilia type. After adjusting for confounding factors, multivariable analysis showed that high school education level was associated with depression (OR: 1.87, CI: 1.31-2.36, P = .010) and type B hemophilia was associated with anxiety (OR: 1.32, CI: 1.09-1.75, P = .042). CONCLUSION: Depression and anxiety are major psychiatric comorbidities in patients with hemophilia in Turkey. Routine evaluation for mood and anxiety disorders are important in the routine care of patients with haemophilia.

Burnout in Healthcare Professionals During the Covid-19 Pandemic in a Tertiary Care University Hospital: Evaluation of the Need for Psychological Support. / Üçüncü Basamak Bir Üniversite Hastanesinde Covid-19 Pandemisinde Saglik Çalisanlarinda Tükenmislik: Psikolojik Destek Ihtiyacinin Degerlendirilmesi.

OBJECTIVE: Anxiety, stress and burnout are observed in healthcare workers during the Covid-19 pandemic. This study aimed to determine the levels of anxiety and burnout and related risk factors in the healthcare workers and assistant personnel at a tertiary referral university hospital. METHOD: Hospital Anxiety Depression Scale (HADS), Maslach Burnout Inventory (MBI) and a sociodemographic questionnaire were delivered on-line to all employees of our hospital. 683 individuals were to the study who completed and returned the forms between April 15-30, 2020. RESULTS: Stress, depression and anxiety levels were significantly higher in nurses. Emotional burnout and depersonalization symptoms were higher and personal accomplishment scores were lower in resident physicians and nurses in comparison to the other groups. Being single, having a child and living away from home were factors underlying the burnout severity. Frontline work in the Covid-19 clinics did not affect the levels of anxiety, stress and depression. On the basis of the cut off points of the HADS scores; anxiety disorder (OR: 7.19) and depression (OR 3.43) were the most relevant risk factors for emotional exhaustion. Anxiety disorder was also the main risk factor for depersonalization. Depersonalization was 2.7-fold more among the nurses complaining of being overworked. Social support from the work environment and the family was protective against depersonalization. CONCLUSION: Covid-19 pandemic has adversely affected the wellbeing of healthcare workers. The presence of depression and anxiety increased the risk of burnout. Social support can be expected to protect against burnout. It is, therefore, of great importance to implement urgently effective psychosocial and organizational interventions in order to protect the mental health of healthcare workers and to prevent burnout.

The deep impact of the COVID-19 pandemic on medical students: An online cross-sectional study evaluating Turkish students' anxiety.

AIM: Coronavirus Disease 2019 (COVID-19) changed the delivery of medical education in Turkey by moving to an emergency remote teaching system and led to many challenges for future doctors. In this study, we aimed to explore the impact of the COVID-19 pandemic on medical students, to assess their anxiety level and their main anxiety sources related to this pandemic. METHODS: A Google Form was distributed to medical students using the virtual snowball sampling method. The form included the Beck Anxiety Inventory and additional 19 questions on sociodemographic characteristics, perceived level of knowledge about the epidemic, self-risk perceptions of COVID-19 and their anxiety levels about some other topics related to COVID-19. RESULTS: Overall, 3105 medical students with a mean age of 22.37 ± 2.46, took the survey. Amongst the participants, only 32% of the students defined their knowledge about the precautions that should be taken during an epidemic disease as acceptable. Students reported highest anxiety level for the continuing spread of COVID-19 in Turkey and transmitting coronavirus to another person. Clinically significant anxiety prevalence was 23.2%. Regression analysis revealed that factors that increased the risk of being anxious included being female, being other than a 5th-year student, thinking that being a medical student would increase the risk of coronavirus transmission or being uncertain about it, being exposed to a patient with COVID-19 or being uncertain about it, being anxious about the continuing spread of COVID-19 in Turkey, being anxious about acquiring COVID-19, being anxious for graduating and being on active duty, being anxious about a medical training interruption. CONCLUSION: Our results suggest that anxiety is prevalent amongst Turkish medical students during the COVID-19 pandemic and they have a weak preparedness for a pandemic such as COVID-19. Based on our results, new strategies should be implemented for medical education and for alleviating students' anxiety levels.

The effect of Attention Deficit and Hyperactivity Disorder on Antiretroviral Treatment and Appointment Adherence among adults living with HIV.

INTRODUCTION: The most prominent characteristic of adult attention deficit hyperactivity disorder (ADHD) is impulsive behavior and deficits in executive functions, which require long-term organization and discipline. This may have serious implications in terms of adherence to treatment among adults living with HIV (PLWH). This study aimed to determine the prevalence of ADHD among non-perinatally infected PLWH and its effect on adherence to antiretroviral treatment (ART) and scheduled appointments. METHODOLOGY: The PLWH admitted to our centers between January 2012 and February 2016 were invited to the study. ADHD diagnosis was made according to the novel criteria guided interviews. The first ART interruption for ≥ 6 days per month (≤ 80%) was defined as ''ART-event'' and the first non-attendance of any scheduled appointment was defined as ''appointment-event''. Kaplan-Meier plot with a Log-rank test was used for event-free adherence (EFA). RESULTS: Twenty-five patients out of 85 were diagnosed with ADHD (29.4 %) which was significantly higher than the highest percentage reported (7.3 %) for the general population (p < 0.0001). Both ART-event (p = 0.0002) and appointment-event (p = 0.02) were significantly higher among ADHD participants compared to those without. Additionally, both ART-EFA (p = 0.00014) and appointment-EFA (p = 0.023) were significantly shorter among ADHD participants compared to those without. CONCLUSION: ADHD is significantly higher in adult PLWH and people with ADHD had a significant tendency for non-adherence to ART and follow-up. Screening for ADHD as well as providing treatment when required would be beneficial to achieve and maintain virologic success.

[Case management based multidisciplinary care protocol in the palliative care of cancer patients]. / Kanser hastasinin palyatif bakiminda vaka yönetimine dayali multidispliner bakim protokolü.

Today, multifaceted approach is needed for the palliative care of advanced stage cancer patients. The main objective for these patients, elimination of pain and other symptoms, psychosocial and spiritual needs are met and to increase the quality of life. We are also faced with the challenge of meeting the physical and psychosocial needs of family members. The purpose of a holistic approach to patient and family who provide effective and quality care, care coordination and case management of a multidisciplinary team approach is based on cooperation. Care protocols specified patient care activities to be carried by the related disciplines to achieve results on a timeline that shows a certain, a multidisciplinary clinical management tool. A lot of care guidelines and protocols developed by a team of experts to contribute to the palliative care activities, and this is thought to be a guiding team members, working with patients.

Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis: a prospective, case-controlled study.

BACKGROUND: Longer dialysis sessions may improve outcome in haemodialysis (HD) patients. We compared the clinical and laboratory outcomes of 8- and 4-h thrice-weekly HD. METHODS: Two-hundred and forty-seven HD patients who agreed to participate in a thrice-weekly 8-h in-centre nocturnal HD (NHD) treatment and 247 age-, sex-, diabetes status- and HD duration-matched control cases to 4-h conventional HD (CHD) were enrolled in this prospective controlled study. Echocardiography and psychometric measurements were performed at baseline and at the 12th month. The primary outcome was 1-year overall mortality. RESULTS: Overall mortality rates were 1.77 (NHD) and 6.23 (CHD) per 100 patient-years (P = 0.01) during a mean 11.3 ± 4.7 months of follow-up. NHD treatment was associated with a 72% risk reduction for overall mortality compared to the CHD treatment (hazard ratio = 0.28, 95% confidence interval 0.09-0.85, P = 0.02). Hospitalization rate was lower in the NHD arm. Post-HD body weight and serum albumin levels increased in the NHD group. Use of antihypertensive medications and erythropoietin declined in the NHD group. In the NHD group, left atrium and left ventricular end-diastolic diameters decreased and left ventricular mass index regressed. Both use of phosphate binders and serum phosphate level decreased in the NHD group. Cognitive functions improved in the NHD group, and quality of life scores deteriorated in the CHD group. CONCLUSIONS: Eight-hour thrice-weekly in-centre NHD provides morbidity and possibly mortality benefits compared to conventional 4-h HD.

[The neurobiology of burnout: the hypothalamus-pituitary-adrenal gland axis and other findings]. / Tükenmisligin nörobiyolojisi: hipotalamus-pituiter-adrenal ekseni ve diger bulgular.

OBJECTIVE: This review aimed to present an overview of neurobiological research on the etiology of burnout and to evaluate the proposed arguments. METHOD: A retrospective literature review of the relevant studies conducted within the last 17 years. For this purpose a literature search was conducted via internet-based search engines, including PubMed, Science-Direct, Medline, GoogleScholar, ULAKBIM Turkish Medicine Index, and Turkish Psychiatry Index, using the key words, burnout, cortisol, the hypothalamus-pituitary-adrenal gland (HPA)-axis, stress, neurobiology, neurogenesis, BDNF, immunology, and etiology, in different combinations. RESULTS: The pioneering studies that focused on the relationship between burnout and dysregulation of the HPA-axis have yielded inconsistent results. Data from subsequent studies with improved designs suggest there is no HPA-axis dysregulation in burnout, but the results do not lead to more concrete interpretations. There is some evidence of impaired immunity function in burnout as compared with controls. Although there is strong evidence of a relationship between stress and impairment in hippocampal neurogenesis, there is no study of burnout in the field. Data about monoaminergic involvement in burnout, which is one of the probable pathways, is scarce. CONCLUSION: In future research the essential guidelines for evaluating HPA-axis functioning (i.e. timing of collecting samples from saliva or blood and controlling for possible influencing factors on HPA-axis functioning) in patients clinically diagnosed with burnout should be taken into account, and in addition to the HPA-axis, evaluation of hippocampal neurogenesis, neurotrophins, immunity functioning, and the monoaminergic system will provide more data on the neurobiology of burnout.

The role of BDNF and HPA axis in the neurobiology of burnout syndrome.

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.

[Psychosocial aspects of pain]. / Agrinin psikososyal yönü.

Though pain is a warning friend, it also is a life disturbing and hurting symptom. We need to consider psychological aspects of pain together with the physiological aspects, in order to be able to understand, to differentiate the etiology and to treat completely. In this review, we will discuss psychological aspects of pain patients, psychiatric patients who apply to pain clinics with pain symptoms, primarily psychological and psychiatric treatments of chronic pain patients.

[Effects of surgery type on body image, sexuality, self-esteem, and marital adjustment in breast cancer: a controlled study]. / Meme Kanserinde Ameliyat Tipinin Beden Algisi, Cinsel Islevler, Benlik Saygisi ve Es Uyumuna Etkileri: Kontrollü Bir Calisma.

OBJECTIVE: To examine the effects of surgery type on body image, sexuality, self-esteem and marital adjustment, and to determine the most frequent sexual dysfunction seen among breast cancer survivors. METHOD: A total of 75 breast cancer survivors (50 patients underwent total mastectomy alone and 25 underwent total mastectomy with breast reconstruction), and 50 healthy volunteers were recruited. All subjects were given the Rosenberg Self-esteem Scale (RS), Body Cathexis Scale (BCS), Golombok Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS) after the Structured Clinical Interview Diagnosis for DSM-III-R, Non-Patient Form (SCID-NP) had been applied. RESULTS: The mean scores obtained from GRISS and DAS were similar, but there was a significant statistical difference in terms of the mean scores of the RS and BCS between the three groups. The sexual functioning profile of the subjects was examined by transforming the subscales scores of GRISS into standardized stanine scores. A significant statistical difference in non- communication and avoidance areas of sexual relations was found between the subjects. CONCLUSION: Surgery type had no effect on sexual satisfaction or marital adjustment. Total mastectomy had a negative impact on breast perception and self-esteem. Avoidance and non-communication areas of sexual relations were the most frequent sexual dysfunctions seen among breast cancer survivors. Young patients preferred breast reconstruction more widely.

[Forty-six year old baby]. / Kirk alti yasindaki bebek.

In this paper, an extraordinary mother-son relationship involving 46 year-old, married, male patient with three children is discussed. He had never had any psychiatric complaint until his mother's death. However, he developed severe depressive and somatic symptoms following his 80 year-old mother's death. He showed no significant improvement after previous outpatient treatments and was admitted to the Psychiatric Department of Ege University School of Medicine with complaints of tension, insomnia, fatigue, anhedonia, hopelessness and pain all over his body. It was discovered that this man, who was loved and respected by both his family and his peers, used to suck his mother's breast twice daily. This act was no secret and was not considered a reason for seeking psychiatric help, a symptom of a disorder, or a source of distress for the son, mother, or any other family member. A phenomenon like this has never been reported in the literature before. We discuss this phenomenon through the dynamic formulation of the case using data from his psychiatric and developmental history as well as direct observation and psychological tests.