Management of psychiatric treatments of patients diagnosed with bipolar disorder in the COVID-19 pandemic: A one-year evaluation in the pandemic.

OBJECTIVE: The course of bipolar disorder (BD) is sensitive to factors that may disrupt biological and social rhythms. It is important for patients diagnosed with BD to continue their follow-up and treatment during the pandemic due to personal and social effects. This study aimed to evaluate the disease course and treatment compliance of individuals diagnosed with BD during the pandemic. METHODS: A total of 267 patients with BD were included in the study. The scales were applied by phone calls. A sociodemographic data form was filled out during the phone interviews. Diagnostic criteria for hypomanic, manic, and depressive episodes in DSM-5 were questioned and recorded through the created form. RESULTS: During the first of the pandemic, a total of 72 (27.0%) patients had a mood episode, of which 56 (21.0%) were manic/hypomanic episodes and 16 (6.0%) depressive episodes. Also, 54.7% of the patients were able to obtain their medications thanks to the extended medication reports. Being unable to use their medications regularly, having a seasonal pattern of disease, and using an increased number of psychotropics were significant predictors of a new episode. While 74.5% of the patients wanted to talk to their psychiatrists online, only 1.1% could reach the psychiatrist online. DISCUSSION: The effects of the COVID-19 pandemic are particularly evident in patients with a seasonal pattern. Telepsychiatry practices should be actively included in clinical practice, and government policies developed for treatment compliance seem important.

Association of BDNF Gene Val66Met Polymorphism with Suicide Attempts, Focused Attention and Response Inhibition in Patients with Schizophrenia.

Introduction: The relationship between BDNF gene Val/Met polymorphism and clinical symptoms, attention and executive functions in patients with schizophrenia was investigated in this study. Also, BDNF Val66Met gene polymorphism was compared between patients and healthy controls. Thus, genetic factors that may affect both the etiology and cognitive functions in schizophrenia were evaluated. Methods: BDNF Val66Met gene polymorphism was investigated in 102 patients with schizophrenia and 98 healthy controls. Cognitive functions were evaluated by the Wisconsin Card Sorting Test (WCST) and Stroop Test. Results: There was no difference in terms of the genotypic or allelic distribution of BDNF Val66Met polymorphism between patients and healthy controls. A significantly higher percentage of suicide attempts were found in the patients having Met allele (Val/Met and Met/Met). Met allele was associated with failure in focused attention and response inhibition in patients with schizophrenia. Conclusion: The presence of the Met allele could be associated with the risk of suicide attempts in patients with schizophrenia. Impairment in executive function areas such as focused attention and response inhibition appears to be related to the Met allele.

The effects of working and living conditions of physicians on burnout level and sleep quality.

BACKGROUND: Burnout is a multidimensional syndrome associated with intense working conditions and negative psychosocial factors in physicians. The purpose of this study is to investigate the effects of living and working conditions of physicians on burnout level and sleep quality in Turkey. METHODS: In this internet-based questionnaire study, 1053 physicians [General Practitioners (n=233); Basic Medical Sciences (n=26); Internal Medical Sciences (n=530), and Surgery Sciences (n=264)] were included in the study, filling the forms consisting of study conditions, Maslach Burnout Inventory (MBI) and the Pittsburgh Sleep Quality Index (PSQI) questions. RESULTS: Negative occupational factors such as physicians having a night shift, high number of patients who are cared for daily, short examination period, low financial gain, exposure to violence, and mobbing were associated with poor sleep quality and burnout. Factors such as being subjected to violence, mobbing, and age are predictive of increasing burnout in women. Working on night shifts or being on-call were associated with all aspects of burnout. The proportion of those with poor sleep quality was significantly higher in those working night shifts (74.6%) than those working daytime shifts (67.2%) and those who were exposed to violence (75.1%) compared to those who were not exposed to violence (43.2%) (p=0.013, p<0.001, respectively). CONCLUSIONS: Impaired sleep quality, violence, mobbing, young age, excessive night shifts, short examination period, and low income may play a role in physician burnout. Our study data suggest that it is important to improve physicians' unfavorable working conditions and to prevent violence against burnout.

Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women

Objective: To compare the psychological resilience and anxiety levels of patients diagnosed with hyperemesis gravidarum (HG) and healthy pregnant women. Materials and Methods: A sociodemographic data form and the Resilience scale for Adults (RSA) and the State-Trait Anxiety Inventory (STAI) were administered. The sociodemographic data form was completed by the physician, and the RSA and STAI were completed by the participant. The sample of the study consisted of 60 pregnant women with HG and hospitalized and 97 healthy voluntary pregnant women with similar characteristics to the research group without any pregnancy complications. Data were evaluated using descriptive statistical analyses, the independent samples t-test, the Mann-Whitney U test and Pearson's correlation analysis. Results: The age range was 18-42 years for HG group and 20-43 years for control group. The average age of the HG group was 28.17±5.96 years and that of the control group was 29.45±5.83 years. There was no statistically significant difference between the groups in terms of pregnancy week. Regarding the prevalence of state and trait anxiety between the groups, it was found that 66.7% of the HG group had a high level of trait anxiety and 51.7% had a high level of state anxiety. It was found that 61.9% of the control group had a high level of trait anxiety and 38.1% had a high level of state anxiety. There was no difference between the healthy pregnant group and the HG group in terms of anxiety (p=0.125). It was found that there was a significant difference between the groups in terms of only sub-dimensions of RSA, which were perception of self (U=2385.00, p=0.044) and perception of future (U=2350.50, p=0.030). The perception of self and perception of future scores of the healthy control group were higher. Conclusion: There was no difference between the healthy pregnant group and the HG group in terms of anxiety. It was observed that the HG group had a lower perception of self and future. Apart from the usual increase in anxiety levels during pregnancy, HG accompanied by stubborn nausea and vomiting does not create an extra psychological burden, either as a cause or a result.

From predictions to evidence: Treatment compliance, disease progression and social compliance of patients with schizophrenia in the COVID-19 pandemic.

PURPOSE: This study explored how patients with schizophrenia were provided with social support and treatment compliance during the pandemic. DESIGN AND METHODS: A total of 396 patients with schizophrenia and their relatives were interviewed by telephone calls. FINDINGS: Multiple antipsychotic use and depot antipsychotics were not superior in preventing relapse. A total of 70.2% of the patients wanted to meet with their psychiatrist online but only 7.1% of them were reached online. A total of 59% of patients were able to take their medication thanks to the extension of their drug prescriptions. PRACTICE IMPLICATIONS: Active inclusion of telepsychiatry applications in clinical practice is necessary for patients with schizophrenia. Government policies developed for treatment compliance seem important.

Determination of the Relationship Between Craving and 4-repeat Allele of DRD4 Gene Polymorphism in the Early Withdrawal Period of Alcohol Use Disorders.

Objective: Alcohol use disorder (AUD) is a disease with chronic relapses. Risk factors of craving, which is thought to be one of the predictors of relapse, have been studied for a long time. The DRD4 gene is located on chromosome 11p and has a 48-base pair variable number of tandem repeat (VNTR) polymorphisms in the 3rd exon. This study aimed to investigate if a relationship existed between craving and DRD4 VNTR polymorphism and to determine the predictors of craving. Methods: A total of 125 patients with AUD were included in the study. The sociodemographic data form, the Michigan Alcoholism Screening Test (MAST), the Obsessive Compulsive Drinking Scale (OCDS), and the Penn Alcohol Craving Scale (PACS) were applied to the patients. Polymerase chain reaction (PCR) was used to determine the DRD4 VNTR variant of all participants in the peripheral blood sample. Results: In the 4R/4R homozygous group, it was found that the age at first alcohol use was higher and the scores of the OCDS on the seventh day were lower, but this relationship could not be demonstrated in further statistical analyses. In the stepwise linear regression model, the age at first alcohol use, MAST score, duration of AUD, and delirium tremens history were found to be the predictors of craving. Conclusion: DRD4 VNTR polymorphism does not play a role as a predictor of craving. A decrease in age at first alcohol use, an increase in the MAST score, and the presence of delirium tremens were found to be the predictors of craving among the participants of this study.

Evaluating the Relationship Between Post Traumatic Stress Disorder Symptoms and Psychological Resilience in a Sample of Turkoman Refugees in Turkey.

Turkey has witnessed an increase in migration of people belonging to neighboring countries due to civil war. Traumatic life events experienced by refugees bring along mental problems. Their psychological resilience enables them to cope with these difficulties. In this study, 101 Iraqi Turkoman refugees who migrated to Turkey following the increasing civil war events in their country were evaluated psychologically. Sociodemographic data form Resilience Scale for Adults (RSA) and Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) were used for psychological evaluation. The prevalence of lifetime post-traumatic stress disorder (PTSD) among the refugees was 25.7%. There was no significant difference between the psychological resilience of the patients who developed PTSD and those who did not (p = 0.709). As the severity of trauma decreased, psychological resilience increased in the people who developed PTSD (p = 0.001, r = -0.622). Considering the psychological resilience of refugees, the area with the highest resilience is access to social resources, while the area with the lowest is the planned future. It was observed that the basic needs of refugees after migration could not be met clearly compared to the ones before migration. It was noteworthy that in cases diagnosed with PTSD, CAPS scores increased (p = 0.011, r: 0.251) and resilience decreased (p < 0.001, r: -0.376) as the inability to reach basic needs increased. Our study is very important in terms of defining how refugees are mentally affected after settling in another country and what determines their psychological resilience.

Publication Rate of Abstracts Presented at the Psychiatry National Congresses Held by the Psychiatric Association of Turkey. / Türkiye Psikiyatri Dernegi Ulusal Psikiyatri Kongrelerinde Sunulan Bildirilerin Yayina Dönüsme Oranlari.

OBJECTIVE: In this study we aimed to investigate the frequency and the factors determining the conversion rate of the oral and poster presentations into articles. Five consecutive national psychiatry congresses held by the Psychiatric Association of Turkey (PAT) between 2012 and 2016 were evaluated. METHOD: The manuscripts published in peer-reviewed journals were identified using the Web of Knowledge, PubMed and Google Scholar databases. The identified manuscripts were classified according to the type of the publication, the duration until publication, the impact factor and the index of the journal. RESULTS: Out of the total 1372 reports presented at the five consecutive National Congress of Psychiatry events, a total of 297 abstracts (21.6%), comprising 201 of the 1104 posters and 96 of the 268 oral presentations, were converted in to publications. A significantly higher percentage of the oral presentations (p<0.001) compared to the poster presentations were converted into publications; and more of the publications consisted of research reports as compared to case reports. The mean time taken from presentation at the congress to publication was 19.04 (±12.47) months. The mean impact factor of the journals at the time of publication was 1.45 (±1.49). CONCLUSION: Although the publication percentage of the presentations made in National Congress of Psychiatry events held by the PAT is similar to that of other studies conducted in Turkey, they are below the percentage reported by similar research in the international literature. There is a need in the mental healthcare institutions of Turkey for time allocation to make research and for creating units that can support researchers in the difficult process of publishing research results. Also, a more selective approach should be adopted when evaluating the congress presentations, and research that is considered to be of high academic value should be encouraged for submission as oral presentations.

Multiple antipsychotics use in patients with schizophrenia: Why do we use it, what are the results from patient follow-ups?

In this study, the rates of antipsychotic polypharmacy, factors affecting combined drug use, the relationship between antipsychotic polypharmacy as it relates to duration of hospitalization and re-hospitalization, and treatment compliance were evaluated in schizophrenia patients. The study data was obtained between January 1, 2017 and December 31, 2017 by examining the files of all patients who were hospitalized in Ondokuz Mayis University Faculty of Medicine Hospital, Ankara Numune Training and Research Hospital, Ankara Gulhane Training and Research Hospital psychiatric services. The inpatients' drug prescriptions at discharge and after one-year outpatient follow-up, as well as treatment compliance and re-hospitalization, were examined. The mean duration of illness was 109.3 ± 109.7 months, and the mean duration of hospitalization was 24.6 ± 19.1 days. For a total of 599 patients, multiple antipsychotic medication was used in 21.2% of hospitalizations. 11.2% of patients using single antipsychotic and 14.2% of patients using multiple antipsychotics were re-hospitalized within one year (X 2 :0.830, p:0.362). Disease duration (Z:-3.654, p < 0.001) and duration of hospitalization (Z:-3.333, p < 0.001) were found to be longer in multiple antipsychotic users. 37.8% of the patients used a depot antipsychotic. There was no significant difference between depot antipsychotic use and oral antipsychotic use as it related re-hospitalization rates. As a conclusion, multiple antipsychotic use has reduced in Turkey. Contrary to popular belief, the use of multiple antipsychotics does not shorten, but rather may prolongs hospitalization, and it has no effect in reducing re-hospitalization. Drug combinations are generally used together with a depot treatment, clozapine treatment is preferred less frequently in combinations, clinicians have proven effectiveness of the drug combination they prefer, and they should give priority to the treatments recommended in treatment guidelines.