Differential correlates of prolonged grief and depression after bereavement in a population-based sample.

Bereavement can lead to prolonged grief disorder (PGD) as well as episodes of major depression. Studies on the prevalence of PGD and its differences from postbereavement depression have not been conclusive. This study compared the correlates of depression and prolonged grief (PG) symptoms in a population-based random sample (N = 535) using the Beck Depression Inventory, Inventory of Complicated Grief-Revised, Anxiety Sensitivity Index (ASI), and Adult Separation Anxiety Questionnaire (ASAQ). Correlates of PG and depressive symptoms were examined using linear regression in 328 bereaved respondents. The prevalence of probable PGD based on PGD-2009 criteria was 3.0% among bereaved respondents and 1.9% in the total sample. PG was related to bereavement-related features including sex of the deceased, ß = - .110, p = .026; time since loss, ß = - .179, p = .001; the number of lifetime losses experienced, ß = .157, p = .016; and perceived closeness with the deceased, ß = .214, p < .001. Only lower income of the bereaved predicted depression, ß = - .139, p = .018. In women, but not in men, the loss of a male family member (i.e., brother or son) was a significant predictor of PG symptoms, ß = - .180, p = .006. The results confirm the qualitative distinction between depression and PG in a nonclinical sample and show that PG is mainly related to the intrinsic and extrinsic characteristics of the deceased or of death, whereas depression relates only to the characteristics of the bereaved person.

Emergence Agitation with Earthquake-Related Traumatic Stress Symptoms After Intravenous Sedation. / Intravenöz Sedasyon Sonrasi Depremle Iliskili Travmatik Stres Belirtileri ile Seyreden Derlenme Ajitasyonu.

Sedation with intravenous anesthetics is a sedation method that is often preferred during minor surgical procedures for anxious patients. Among the anesthetic agents used are drugs such as midazolam and ketamine, which can cause psychiatric symptoms such as loss of control over the behavior of the person (disinhibition) or dissociation. In people with high anxiety levels, a paradoxical rise of anxiety may rarely occur with midazolam, and emergence agitation or delirium may occur after anesthesia with ketamine. Post-traumatic stress disorder is a known risk factor for emergence agitation. Accompanying traumatic stress symptoms are reported to have persisted for a long time in the case reports of emergence agitation with a past history of trauma. It is aimed to discuss the importance of traumatic stress symptoms in sedation management in the post-earthquake period by presenting a case with increased anxiety and emergence agitation with acute stress symptoms such as re-experiencing the earthquake after sedation with intravenous anesthetics for a local surgical procedure immediately after experiencing the Kahramanmaras earthquake on February 6 in Turkey. Keywords: Earthquakes, intravenous anesthetics, emergence, psychomotor agitation, acute stress disorder, post-traumatic stress disorder.

Mirror-Image Comparison of Maintenance Electroconvulsive Treatment Effectiveness in Affective and Psychotic Disorders.

OBJECTIVES: The study aimed to investigate the effectiveness of maintenance electroconvulsive therapy (mECT) with respect to the hospitalization duration, number of hospitalizations, and major and minor treatment changes with a mirror-image study design. METHODS: Medical charts of patients who received at least a 3-month-long course of mECT were reviewed. The records of 36 patients (17 with psychotic disorders, 19 with affective disorders) were retrospectively examined for 2 periods with the same duration; during the mECT (post-mECT) and before the mECT (pre-mECT). The hospitalization duration, the number of hospitalizations, and major and minor treatment changes, which were assumed to provide information on the effectiveness of the interventions, were recorded and compared between these periods. Statistical analysis was performed using generalized estimating equation models conducted with age, diagnostic category, and observation time as covariates. In addition, the relapse and recurrence rates and time to relapse/recurrence were analyzed. RESULTS: Comparison of pre-mECT and post-mECT periods revealed that mECT, applied in an individualized schedule combined with pharmacotherapy, was associated with a lower frequency ( P < 0.001; rate ratio [RR], 0.161; 95% confidence interval [CI], 0.087-0.297), shorter duration of hospitalization ( P < 0.001; RR, 0.123; 95% CI, 0.056-0.271), and lower number of major treatment changes ( P = 0.007; RR, 0.522; 95% CI, 0.324-0.840), irrespective of diagnoses. The relapse/recurrence rates were similar in the 2 diagnostic categories ( P = 1.000; 26.3% vs 29.4%). CONCLUSIONS: Maintenance ECT should be increasingly considered an important treatment modality in patients with affective and psychotic disorders after an effective course of ECT.

[Chromosome Analysis in the Assessment for Gender Affirmation Process: A Retrospective Study]. / Cinsiyet Uyum Süreciyle Ilgili Degerlendirmede Kromozom Analizi: Geriye Dönük Arastirma.

OBJECTIVE: Gender dysphoria refers to the experienced discomfort related to the incongruence between gender identity and the sex assigned at birth. Current treatment approach for this clinical condition is gender affirmation procedures. International guidelines about gender affirmation do not recommend routine genetic evaluation. In Turkey, provision of health insurance for medical expenses incurred by these procedures requires genetic consultation which frequently involves chromosome analysis (karyotyping). However, the contribution of routine chromosome analysis to the assessment and management of gender dysphoria is not established. This study aims to assess the results of chromosome analysis and its effect on the management of gender dysphoria. METHOD: The completed chromosome analysis results and observational records of 217 individuals among a total of 281 evaluated for gender affirmation in the psychiatry polyclinic were investigated retrospectively. RESULTS: The chromosome analysis results of 213 (98.2 %) of the 217 individuals investigated were congruent with the sex assigned at birth. Variations were found in the karyotypes of 4 individuals with female sex assigned at birth, only 1 of whom had been diagnosed with a disorder of sex development. In the other cases, however, chromosome analysis did not affect the diagnosis or the clinical intervention. CONCLUSION: Finding that routine chromosome analysis during the assessment for gender affirmation process rarely affected the clinical diagnosis and the treatment was consistent with the reports of previous studies and supported the recommendation that chromosome analysis should be carried out only in cases where history, physical examination and the required imaging investigations suggested a disorder sex development.