ARCHIVES OF NEUROPSYCHIATRY

Transkript

1 ARCHIVES OF NEUROPSYCHIATRY CİLT / VOLUME 52 SAYI / ISSUE 1 MART / MARCH Şizofreni Tedavisinde Antidepresan Kullanım Sıklığının Şizofreni Hastalarının Hastalık Özellikleriyle İlişkisi ve Sonuçları Relationship between Antidepressant Prescription Rates and Features of Schizophrenic Patients and Its Outcome in Schizophrenia Treatment Nurhan Hancı, ve ark.; Bursa, Türkiye Obstruktif Uyku Apne Sendromunda Nöropati ve Disotonomi Neuropathy and Dysautonomia In Patients With Obstructive Sleep Apnea Syndrome Ahmet Evlice, ve ark.; Adana, İstanbul, İzmir, Türkiye Klinik Opiyat Yoksunluk Ölçeği (Clinical Opiate Withdrawal Scale-COWS) Türkçe Sürümünün Güvenilirliği ve Geçerliliği Reliability and Validity Study of the Turkish Version of the Clinical Opiate Clinical Scale A. Ender Altıntoprak, ve ark.; İzmir, İstanbul, Manisa, Türkiye Vascular Ischemia as a Cause of Transient Global Amnesia: A Patient Series Geçici Global Amnezi ye Neden Olan Vasküler İskemi: Hasta Serisi Özlem Güngör Tunçer, et al. İstanbul, Turkey Türk Nöropsikiyatri Dernegi nin Bilimsel Yayın Organıdır Turkish Neuropsychiatric Society s Scientific Publication Organ

2 Kurucusu / Founder İhsan Şükrü Aksel Türk Nöropsikiyatri Derneği adına Sahibi, Dernek Başkanı Owner on behalf of Turkish Neuropsychiatric Society, President Mustafa Sercan, İstanbul, Türkiye Yayın Yönetmenleri / Editors-in-Chief Betül Baykan Baykal, İstanbul, Türkiye Ömer Saatçioğlu, İstanbul, Türkiye Yardımcı Yayın Yönetmenleri /Associate Editors Feryal Çam Çelikel, İstanbul, Türkiye Figen Karadağ, İstanbul, Türkiye Haşmet Hanağası, İstanbul, Türkiye Zeliha Matur, İstanbul, Türkiye Ulusal Danışma Kurulu / National Advisory Board Ercan Abay, Edirne, Türkiye Gülden Akdal, İzmir, Türkiye Fisun Akdeniz, İzmir, Türkiye Tunç Alkın, İzmir, Türkiye Ayşe Altıntaş, İstanbul, Türkiye Murat Atmaca, Elazığ, Türkiye Ömer Aydemir, Manisa, Türkiye Semih Ayta, İstanbul, Türkiye Ebru Aykutlu Altındağ, İstanbul, Türkiye Işın Baral Kulaksızoğlu, İstanbul, Türkiye Deniz Belen, Ankara, Türkiye Başar Bilgiç, İstanbul, Türkiye Ömer Böke, Samsun, Türkiye Hayrünisa Bolay, Ankara, Türkiye Can Cimilli, İzmir, Türkiye Raif Çakmur, İzmir, Türkiye Feza Deymeer, İstanbul, Türkiye Murat Emre, İstanbul, Türkiye Ali Saffet Gönül, İzmir Türkiye Hasan Herken, Denizli, Türkiye Tülay Kansu, Ankara, Türkiye Derya Karadeniz İstanbul, Türkiye Necdet Karlı, Bursa, Türkiye İsmet Kırpınar, İstanbul, Türkiye Ali Emre Öge, İstanbul, Türkiye Öget Öktem Tanör, İstanbul, Türkiye Aynur Özge, Mersin, Türkiye Yeşim Parman, İstanbul, Türkiye Serap Saygı, Ankara, Türkiye Aksel Siva İstanbul, Türkiye Vedat Şar, İstanbul, Türkiye Lut Tamam, Adana, Türkiye Raşit Tükel, İstanbul, Türkiye Erdem Tüzün, İstanbul, Türkiye Aylin Uluşahin, Ankara, Türkiye Alp Üçok, İstanbul, Türkiye Simavi Vahip, İzmir, Türkiye Elif Anıl Yağcıoğlu, Ankara, Türkiye Nilüfer Yeşilot Barlas, İstanbul, Türkiye Uluslararası Danışma Kurulu / International Advisory Board Zohar Argov, Jerusalem, Israel Ian Anderson, Manchester, UK Claude Robert Cloninger, Missouri, USA Kirk Dafner, Boston, USA Jack Danon, New York, USA Yeşim Erim, Essen, Germany Şölen Gökhan, New York, USA David Greenberg, Tel Aviv, Israel Teknik Editörler / Technical Editors Hacer Durmuş, İstanbul, Türkiye Rahşan Erim, Balıkesir, Türkiye Alla Guekht, Moscow, Russia Toshi Furukawa, Kyoto, Japan Helen Herrman, Melbourne, Australia Şakir Hümayun Gültekin, Oregon, USA Vasilis Kimiskidis, Thessaloniki, Greece Amos Korcyzn, Tel Aviv, Israel Mario Maj, Naples, Italy Maria Hélène Marion, London, UK İstatistik Danışmanı / Consulting Editor for Statistic Mustafa Ertaş, İstanbul, Türkiye Bahar Tanyaş, İstanbul, Türkiye Charles B. Nemeroff, Florida, USA Fügen Neziroğlu, New York, USA Jim van Os, Maastricht, Netherlands Bruce H. Price, Boston, USA Gerard Said, Paris, France Norman Sartorius, Geneva, Switzerland Duygu Selcen, Rochester, USA José M Serratosa, Madrid, Spain Genetik Danışmanı / Genetic Advisor Hande Çağlayan, İstanbul, Türkiye Timothy Steiner, London, UK Pasquale Striano, Genova, Italy Mustafa Şahin, Boston, USA Graham Thornicroft, London, UK MauricioTohen, Texas, USA Bedirhan Üstün, Genava, Switzerland Marc Valenti, Barcelona, Spain Etik Danışmanı / Ethical Advisor Güher Saruhan Direskeneli, İstanbul, Türkiye Nöropsikiyatri Arşivi Türk Nöropsikiyatri Derneği yayın organıdır. Basım öncesi teknik hazırlık, basım, dağıtım ve reklam rezervasyon hizmetleri AVES tarafından yürütülmektedir. Dergide yer alan yazı, şekil, tablo ya da resimlerin telif hakkı (Copyright ) Türk Nöropsikiyatri Derneği ne aittir. Bir bölümü ya da tamamı izinsiz kopyalanamaz ya da basılamaz. Dergiden alıntı yapacak tıbbi dergi ve kitapların, dergiyi kaynak olarak belirtmesi gereklidir. Yayımlanan yazıların bilimsel ve etik sorumluluğu yazarlara aittir. Dergimiz ve derneğimiz yayımlanan yazılarda belirtilen görüşlere resmen katılmaz, dergideki hiçbir ürün veya servis reklamı için güvence vermez. Üç ayda bir yayınlanır. Nöropsikiyatri Arşivi kapağı Merhum Prof. Dr. Süleyman Velioğlu tarafından yapılmıştır. The Neuropsychiatry Archive is the publishing organ of the Turkish Neuropsychiatry Association. Preublishing technical preparations, printing, distributing and advertisement reservation services are carried oft by AVES. Copyright for papers, figures, tables or photographs in the Journal belongs to the Turkish Neuropsychiatry Association. No paper, either complate or in part, may be copied or printed without permission. Authors are responsible for the academic and ethic contents of published papers. Our Journal and Association do not officially participate in the views expressed in the published papers, and the journal does not give any guarantee for advertised products or services. It is published three monthly. The front cover of the Neuropsychiatry Archive was prepared by the late artist Prof. Dr. Suleyman Velioğlu. A-I Yayıncı/Publisher İbrahim KARA Yayın Yönetmeni/Publication Director Ali ŞAHİN Yayın Yönetmeni Yardımcıları/Deputy Publication Directors Gökhan ÇİMEN Yayın Koordinatörleri/Publication Coordinators Esra GÖRGÜLÜ Ebru MUTLU Betül ÇİMEN Saniye İNGİN Nihan GÜLTAN İrem Naz GÜVEL Dilşad GÜNEY Mali İşler Koordinatörü/Finance Coordinator Veysel KARA Proje Koordinatörleri/Project Coordinators Hakan ERTEN Zeynep YAKIŞIRER Grafik Departmanı/Graphics Department Ünal ÖZER Neslihan YAMAN Merve KURT İletişim/Contact Address/Adres: Büyükdere Cad. No: 105/ Mecidiyeköy, Şişli-İstanbul Phone/Telefon: Fax/Faks: /E-posta: info@avesyayincilik.com Yayın Türü: Yerel Süreli Basım Tarihi: Mart 2015 ISSN: Baskı ADA Ofset Matbaacılık Tic. Ltd. Şti., Litros Yolu 2. Matbaacılar S. E Blok No: (ZE2) 1. Kat Topkapı, İstanbul Tel :

3 Amaç ve Kapsam Nöropsikiyatri Arşivi nin hedefi; psikiyatri, nöroloji, nöroşirürji, nörobilim ve klinik psikoloji alanlarında bilimsel açıdan yüksek nitelikli araştırma makalelerini yayınlamaktır. Bunun yanında derleme, editör görüşü, editöre mektup ve olgu sunumları da kabul edilmektedir. Dergide ayrıca, nöroloji ve psikiyatri tarihçesiyle ilgili yazılar, kongre izlenimleri, haberler, duyurular ve kitap-tez tanıtımı da yayınlanır. Nöropsikiyatri Arşivi nin hedef kitlesi; Nöroloji, Psikiyatri ve Nöroşirurji uzmanları ile ruh sağlığı ve davranış bilimleri alanında çalışan diğer uzmanlar ve akademisyenlerdir. Yayın dili hem Türkçe hem İngilizce olan, bağımsız ve önyargısız çift-kör hakemlik (peer-review) ilkelerine göre yayın yapan uluslararası açık erişimli bir dergidir. Nöropsikiyatri Arşivi, Science Citation Index-Expanded (SCI-E), Journal Citation Reports/Science Edition, Excerpta Medica/EMBASE, ProQuest Health & Medical Complete, ProQuest Psychology, SCOPUS, EBSCO Database, PSYCHinfo, CINAHL, Gale/Cengage Learning, Index Copernicus, DOAJ, British Library Direct, Türk Psikiyatri İndeksi, Türk Medline- Ulusal Atıf İndeksi ve TÜBİTAK/ULAKBİM Türk Tıp Dizini, Türkiye Atıf Dizini, ve ULAKBİM-Ulusal Atıf Sistemi tarafından indekslenmektedir. Abone İşlemleri Nöropsikiyatri Arşivi, Türk Nöropsikiyatri Derneği üyelerine dağıtılmaktadır. Tüm makalelerin içerik, özet ve tam metinlerine adresinden ulaşılabilmektedir. Dernek üyeleri dışında dergiye abone olmak isteyen kişiler Türk Nöropsikiyatri Derneği ne başvurmalıdır. Adres: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul Telefon: Faks: Baskı İzinleri Baskı izinleri için başvurular Türk Nöropsikiyatri Derneği ne yapılmalıdır. Yazılı izin alınmadan dergide yer alan yazılar ve görseller çoğaltılamaz. Adres: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul Telefon: Faks: Reklam Reklam ile ilgili başvurular yayınevine yapılmalıdır. Yayıncı: AVES Adres: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul Telefon: Faks: Web adresi: Yazarlara Bilgi Yazarlara Bilgi kısmına dergi sayfalarından ve com adresinden ulaşılabilir. Materyal Sorumluluk Reddi Nöropsikiyatri Arşivi nde yayınlanan tüm yazılarda görüş ve raporlar yazar(lar)ın görüşüdür ve Dernek, Editörler, Yayın Yönetmenleri, Bilimsel Danışma Kurulu ya da Yayıncı nın görüşü değildir. Türk Nöropsikiyatri Derneği, Editör, Yayın Yönetmenleri, Bilimsel Danışma Kurulu ve Yayıncı bu yazılar için herhangi bir sorumluluk kabul etmemektedir. Dergimizde asitten arınmış (acid-free) kağıt kullanılmaktadır. A-II

4 Aims and Scope The aim of the Archives of Neuropsychiatry is to publish academically high standard research articles in Psychiatry, Neurology, Neurosurgery, Neuroscience and Clinical Psychology. In addition, reviews, editorial views, letters to the editor and case reports are accepted. Articles on the history of neurology and psychiatry, impressions of congresses, news, notices and book-thesis introductions are also published. The target groups of the Archives of Neuropsychiatry are specialists in Neurology, Psychiatry and Neurosurgery, together with other specialists and academicians in mental health and behavioral sciences. It is an international open-access journal publishing both in Turkish and English languages, and is based on independent, unbiased, double-blind peer-review principles. The Archives of Neuropsychiatry is indexed in Science Citation Index-Expanded (SCI-E), Journal Citation Reports/Science Edition, Excerpta Medica/EMBASE, ProQuest Health & Medical Complete, ProQuest Psychology, SCOPUS, EBSCO PSYCHinfo, CINAHL, Gale/Cengage Learning, Index Copernicus, DOAJ, British Library Direct, Turkish Psychiatry Index, Turkish Medline-National Citation Index, TUBITAK/ULAKBIM Turkish Medical Index, Turkiye Citation Index and ULAK- BIM-National Indexing System databases. Procedure for Subscription The Archives of Neuropsychiatry is distributed to members of the Turkish Association of Neuropsychiatry. The contents of all papers, summaries and full texts may be reached at Nonmembers who wish to subscribe to the journal should apply to the Turkish Association of Neuropsychiatry. Address: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul Phone: Fax: Permissions Requests for permission for reproduction of materials should be made to the Turkish Association of Neuropsychiatry. Papers and illustrations included in the journal may not be reproduced without obtaining written permission. Address: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul Phone: Fax: Advertisement Applications concerning advertisement should be made to the publishing house. Publisher: AVES Address: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul Phone: Fax: Web Page: Instruction to Authors The section on Instruction to Authors may be obtained from the journal pages and Rejection of Responsibility for Material The opinions and reports in all articles published in the Archives of Neuropsychiatry are those of the author(s), and not of the Association, Editors, Publishing Directors, Scientific Information Committee or Publisher. The Turkish Association of Neuropsychiatry, Editor, Editorial Publishing Directors, Scientific Information Committee and Publisher do not accept any responsibility whatever for these papers. Our Journal is printed on acid-free paper. A-III

5 İçindekiler Editörden Ciddi Ruhsal Hastalıklarda Süreç ve Sonuç Olarak İyileşme Mustafa YILDIZ; Kocaeli Gözden Geçirme Makalesi Sosyal Anksiyete Bozukluğunda Dikkat Yanlılığı ve Eğitimi Nurhan FISTIKCI, Ömer SAATÇİOĞLU, Ali KEYVAN, Volkan TOPÇUOĞLU; İstanbul Araştırma Makaleleri Kendini Yaralama Davranışlarında Çocukluk Dönemi İstismarı ve İhmali ile Duygu Düzenleme Güçlüğü Arasındaki İlişki: Alkol ve/ya Madde Bağımlısı Bir Grupta Kendini Yaralama Davranışının İncelenmesi Başak KARAGÖZ, İhsan DAĞ; Ankara Canlı Vericili Karaciğer Nakli Sonrasında Erken Dönemde Gelişen Nörolojik Komplikasyonların Değerlendirilmesi Emrah OTAN, Cemalettin AYDIN, Hüseyin YÖNDER, Cüneyt KAYAALP, Yüksel KAPLAN, Sezai YILMAZ; Malatya İstanbul da Bir Grup Lise Öğrencisinde Ebeveyn Tutumlarının Burcu GÖKSAN YAVUZ, İlke YESER, Oğuz KARAMUSTAFALIOĞLU, Bahadır BAKIM, Aliye GÜNDOĞAR; İstanbul, Batman Obstruktif Uyku Apne Sendromunda Nöropati ve Disotonomi Ahmet EVLİCE, Burcu UĞUREL, Barış BAKLAN, İbrahim ÖZTURA; Adana, İstanbul, İzmir Türkiye de Genç Yetişkinlerde Kesi Anketi ve İçme Sıklığına Göre Madde ve Alkol Kullanımı Hatice DEMİRBAŞ; Ankara Dissosiyasyon ve Bilişsel Bozukluk Arasındaki İlişki Osman ÖZDEMİR, Pınar GÜZEL ÖZDEMİR, Murat BOYSAN, Ekrem YILMAZ; Van Obezitede Psikolojik Belirtiler ve İlişkili Etmenler Taner DEĞİRMENCİ, Nalan KALKAN-OĞUZHANOĞLU, Gülfizar SÖZERİ-VARMA, Osman ÖZDEL, Semin FENKÇİ; Denizli Epilepsili Çocuklarda Nöbet Öz-Yeterlik Ölçeği Geçerlik ve Güvenirlik Çalışması Şerife Tutar GÜVEN, Ayşegül İŞLER; Antalya Obsesif Kompulsif Bozukluklu Hastalarda Obsesif İnançlarin Belirtilerle İlişkisi Selim TÜMKAYA, Filiz KARADAĞ, Nalan OĞUZANOĞLU; Denizli Geçici Global Amnezi ye Neden Olan Vasküler İskemi: Hasta Serisi Özlem GÜNGÖR TUNÇER, Bahar AKSAY KOYUNCU, Zeynep VİLDAN OKUDAN, Ebru ALTINDAĞ, Reha TOLUN, Yakup KRESPİ; İstanbul Şizofreni Tedavisinde Antidepresan Kullanım Sıklığının Şizofreni Hastalarının Hastalık Özellikleriyle İlişkisi ve Sonuçları Nurcan HANCI, Özlem ÇETİN EKER, Özlem MİRALOĞLU, Meral ARGUN USLU, Güven ÖZKAYA, Salih Saygın EKER; Bursa Siyaloreli Parkinson Hastalarında Tekrarlanan Botulinum Toksini Tedavisinin Etkileri Aysu ŞEN, Baki ARPACI; İstanbul Travma Sonrası Stres Bozukluğunda Kortikal Eksitabilite ve Saldırgan Davranış Abdullah BOLU, Adem BALIKCI, Murat ERDEM, Taner ÖZNUR, Cemil ÇELİK, Özcan UZUN; Eskişehir, Ankara Türkiye de Maternal Filisid Olgularının Adli Tıp Yönünden Analizi: Bir Klinik Araştırma Salih Murat EKE, Saba BAŞOĞLU, Şafak TAKTAK, Gökhan ORAL; Kırıkkale, İstanbul, Kırşehir Uyku Yoksunluğunun Duygudurum Profili ve Dissosiyasyon Üzerine Etkisi ve Biyokimyasal Değişimlerle İlişkisi Yavuz SELVİ, Sultan KILIÇ, Adem AYDIN, Pınar GÜZEL ÖZDEMİR; Konya, Kahramanmaraş, Van Klinik Opiyat Yoksunluk Ölçeği (Clinical Opiate Withdrawal Scale-COWS) Türkçe Sürümünün Güvenilirliği ve Geçerliliği A. Ender ALTINTOPRAK, E. Cüneyt EVREN, Ömer AYDEMİR, Aslıhan YAPICI ESLEK, Yeşim CAN, Elif MUTLU, Levent TOKUÇOĞLU, Artuner DEVECİ, Hakan COŞKUNOL; İzmir, İstanbul, Manisa Türkiye de Psikiyatri Makalelerinde Kadın Yazarların Katılımının Uzun Dönemli Bir Analizi Özlem ERDEN AKİ, Elçin ÖZÇELİK EROĞLU, Ece USLU; Ankara, Lefkoşa Olgu Sunumları Modafinil e Bağlı Psikoz: Bir Olgu Sunumu Özgür AYTAŞ, Hayriye DİLEK YALVAÇ; Malatya, Ankara Olgular Işığında Nörosarkoidoz: Tanı ve Tedavi Yaklaşımları Gökçen GÖZÜBATIK-ÇELİK, Uğur UYGUNOĞLU, Derya ULUDÜZ, Ersan ATAHAN, Benan MÜSELLİM, Sabahattin SAİP, Aksel SİVA; İstanbul Editöre Mektup Nadir Bir Baş Dönmesi Nedeni Olarak Glomus Tümörü Hasan Hüseyin KOZAK, Ali Ulvi UCA; Konya A-VIII

6 Contents A-IX Editorial Recovery as a Process in Severe Mental Illnesses Mustafa YILDIZ; Kocaeli Review Article Attentional Bias and Training in Social Anxiety Disorder Nurhan FISTIKCI, Ömer SAATÇİOĞLU, Ali KEYVAN, Volkan TOPÇUOĞLU; İstanbul Research Articles The Relationship between Childhood Maltreatment and Emotional Dysregulation in Self Mutilation: An Investigation among Substance Dependent Patients Başak KARAGÖZ, İhsan DAĞ; Ankara Evaluation of Early Postoperative Neurological Complications Following Living Donor Liver Transplantation Emrah OTAN, Cemalettin AYDIN, Hüseyin YÖNDER, Cüneyt KAYAALP, Yüksel KAPLAN, Sezai YILMAZ; Malatya Effects of Parental Attitudes among a Group of High School Students in İstanbul Burcu GÖKSAN YAVUZ, İlke YESER, Oğuz KARAMUSTAFALİOĞLU, Bahadır BAKIM, Aliye GÜNDOĞAR; İstanbul, Batman Neuropathy and Dysautonomia in Patients with Obstructive Sleep Apnea Syndrome Ahmet EVLİCE, Burcu UĞUREL, Barış BAKLAN, İbrahim ÖZTURA; Adana, İstanbul, İzmir Substance and Alcohol use in Young Adults in Turkey as Indicated by the CAGE Questionnaire and Drinking Frequency Hatice DEMİRBAŞ; Ankara Association between Dissociation and Cognitive Dysfunction Osman ÖZDEMİR, Pınar GÜZEL ÖZDEMİR, Murat BOYSAN, Ekrem YILMAZ; Van Psychological Symptoms in Obesity and Related Factors Taner DEĞİRMENCİ, Nalan KALKAN-OĞUZHANOĞLU, Gülfizar SÖZERİ-VARMA, Osman ÖZDEL, Semin FENKÇİ; Denizli Validity and Reliability of the Seizure Self-efficacy Scale for Children with Epilepsy Şerife Tutar GÜVEN, Ayşegül İŞLER; Antalya Relationship between Obsessive Beliefs and Symptoms in Patients with Obsessive Compulsive Disorder Selim TÜMKAYA, Filiz KARADAĞ, Nalan OĞUZANOĞLU; Denizli Vascular Ischemia as a Cause of Transient Global Amnesia: A Patient Series Özlem GÜNGÖR TUNÇER, Bahar AKSAY KOYUNCU, Zeynep VİLDAN OKUDAN, Ebru ALTINDAĞ, Reha TOLUN, Yakup KRESPİ; İstanbul Relationship between Antidepressant Prescription Rates and Features of Schizophrenic Patients and Its Outcome in Schizophrenia Treatment Nurcan HANCI, Özlem ÇETİN EKER, Özlem MİRALOĞLU, Meral ARGUN USLU, Güven ÖZKAYA, Salih Saygın EKER; Bursa Effects of Repeated Botulinum Toxin Treatment for Sialorrhea in Patients with Parkinson s Disease Aysu Şen, Baki Arpacı; İstanbul Cortical Excitability and Agressive Behavior in Post-Traumatic Stress Disorder Abdullah BOLU, Adem BALIKCI, Murat ERDEM, Taner ÖZNUR, Cemil ÇELİK, Özcan UZUN; Eskişehir, Ankara Analysis of the Maternal Filicide in Terms of Forensic Medicine in Turkey: A Clinical Research Salih Murat EKE, Saba BAŞOĞLU, Şafak TAKTAK, Gökhan ORAL; Kırıkkale, İstanbul, Kırşehir The Effects of Sleep Deprivation on Dissociation and Profiles of Mood, and Its Association with Biochemical Changes Yavuz SELVİ, Sultan KILIÇ, Adem AYDIN, Pınar GÜZEL ÖZDEMİR; Konya, Kahramanmaraş, Van Reliability and Validity Study of the Turkish Version of the Clinical Opiate Clinical Scale A. Ender ALTINTOPRAK, E. Cüneyt EVREN, Ömer AYDEMİR, Aslıhan YAPICI ESLEK, Yeşim CAN, Elif MUTLU, Levent TOKUÇOĞLU, Artuner DEVECİ, Hakan COŞKUNOL; İzmir, İstanbul, Manisa Longitudinal Analysis of Female Authorship of Psychiatry Articles in Turkey Özlem ERDEN AKİ, Elçin ÖZÇELİK EROĞLU, Ece USLU; Ankara, Nicosia Case Reports Modafinil-Induced Psychosis: A Case Report Özgür AYTAŞ, Hayriye DİLEK YALVAÇ; Malatya, Ankara Diagnosis and Treatment in Neurosarcoidosis Gökçen GÖZÜBATIK-ÇELİK, Uğur UYGUNOĞLU, Derya ULUDÜZ, Ersan ATAHAN, Benan MÜSELLİM, Sabahattin SAİP, Aksel SİVA; İstanbul Letter to the Editor Glomus Tumor as a Rare Cause of Dizziness Hasan Hüseyin KOZAK, Ali Ulvi UCA; Konya

7 Editorial / Editörden Arch Neuropsychiatr 2015; 52: 1-3 DOI: /npa Recovery as a Process in Severe Mental Illnesses Ciddi Ruhsal Hastalıklarda Süreç ve Sonuç Olarak İyileşme Mustafa YILDIZ Department of Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey Disability is where we start, recovery is our destination, and rehabilitation is the road we travel. Robert Paul Liberman Approaches to the treatment of severe mental illnesses (SMIs), such as schizophrenia, schizoaffective disorder, bipolar disorder, obsessive-compulsive disorder, and substance use disorder, have moved beyond the mere control of symptoms and prevention of relapse to include functional recovery, social and vocational reintegration, and enhancement of the quality of life of the patients (1,2,3). In each of these illnesses, the absence of symptoms does not indicate return to a fully normal life. Therefore, recovery from any severe mental illnesses, besides achieving symptom remission, should include participation in work or school and in social, family, and recreational activities. Because patients with SMI mostly suffer from a long lasting disability and are often dependent on family members or assisted-living facilities and are poorly integrated into the community, low functional capabilities of these patients can cause a significant burden to their families and society. Although there is no concise definition or consensus on the concept of recovery, there are two perspectives for recovery. One is a clinical, service-based, or objective definition, and the other is a user-based, subjective, or personal recovery. The first perspective comes from the concept of remission as an improvement in symptoms and other deficits to a degree that they would be considered within normal range and implies a long-term goal of psychosocial functioning with fever or no relapses. The second perspective focuses on a personal growth and development, regaining control, and establishing a personally fulfilling and meaningful life with a mental illness (4,5). The service-based definition of recovery reflects the state of people who return to a premorbid functioning at least for some time. In this context, recovery is seen as a long-term goal of remission (6). The user-based definition of recovery includes symptom remission or a return to normal functioning to some extent. However, recovery is seen as a process of personal growth and development and involves overcoming the effects of being a mental patient, with all its implications, to regain control and establish a meaningful life (4). This definition refers to the achievement of a personally acceptable quality of life regardless of the state of their illness or health and that people with SMI can have hope, feel capable of expanding their personal abilities, and make their own choices. As Liberman and Kopelowicz pointed out, the recovery from SMI is the process of recovering and not recovery as an outcome. The processes and stages of recovering are seen as preparations for recovery. Individuals can take many pathways to recover depending on the varied factors that influence the process, such as personal attributes, economic conditions, social environment, continuity and quality of treatment, and subjective experiences (2). In the process of recovery, the greater the person s symptomatic and functional improvement, the more would be expected subjectively experienced qualities such as hope, optimism, empowerment, self-responsibility, self-esteem, and life satisfaction. For a patient, participation in daily activities, routines, and normative life processes, such as going to work, taking a course, taking part of any activity, are frequently considered as both facilitators and indicators of recovery. Dimensions of recovery The main dimensions of recovery, substantially based on the optimal effective treatment of the illness and rehabilitation of a patient, are knowledge about mental illness and services, independent living, life satisfaction, hope and optimism, empowerment, and employment. As depicted in Figure 1, these dimensions should be evaluated and carefully considered when designing comprehensive, coordinated, and community-based services and service systems for people with severe mental illness to recover from disability because all these dimensions are reciprocally related to each other (7,8). Knowledge about mental illness and services Patients knowledge about their mental illness and multiple types of conventional services, including day hospitals, community mental health 1 Correspondence Address/Yazışma Adresi: Dr. Mustafa Yıldız, Department of Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey Phone: myildiz60@yahoo.com Copyright 2015 by Turkish Association of Neuropsychiatry / Telif Hakkı 2015 Türk Nöropsikiyatri Derneği

8 Yıldız M. Recovery as a Process in Severe Mental Illnesses Arch Neuropsychiatr 2015; 52: 1-3 Figure 1. Recovery from disability as a process of recovering 2 centers, crisis intervention services, assertive community treatment services, legal services, and having a social worker and case manager who are available to them in their needy conditions is an important dimension for recovery (2,7). Not only having knowledge about mental illness and services, but also having an opportunity to easily access the services routinely and as necessary is an important factor leading to recovery in patients with SMIs. The ways for recovery should always be open for patients and their caregivers. Independent living Independent living includes being productive in work or school, social relations, family life, and recreational activities. The main aspect of this dimension is the ability to take care of one s personal needs without assistance. Whether or not the individual is living apart from the family, independent functioning could be defined as managing one s own medication, health, and money without regular supervision (2). All treatment and rehabilitation services to reach the achievement of the level of living independently should be available and ready for patients. Life satisfaction A strong relationship between symptoms and quality of life has been consistently represented. The severity of symptoms and side effects of medication are obstacles on the way to recovery. Thus, recovery orientation services should emphasize the aggressive treatment of symptoms and side effects of medications for obesity, diabetes, and other comorbid medical conditions. Other psychosocial variables related to life satisfaction, such as family, social network, living arrangements, community, and safety, should also be taken into considered (7). Hope and optimism Greater risks for a sustainable recovery are hopelessness and pessimism. Resulting from the debilitating course of the illness, these psychological components are found to be related to increased risk of poor outcome of vocational rehabilitation, and decreased quality of life (7,9). An important component of the journey of recovery is the fostering of hope for the future, hope for achieving one s goals, and being surrounded by a reliable treatment team, peers, and family members who share realistic optimism and hope (7). Hope can serve to fuel motivation for change and active participation in clinical services or self-help groups, which are stepping stones toward recovery (10). Empowerment Empowerment refers to an empowered feeling to take responsibility of making one s own decisions and to take responsibility for treatment as well as feeling that one s treatment and treatment providers are in concordance with one s own treatment goals (7). Empowered patients can manage their sense of powerlessness and dependence resulting from traditional treatment approaches. Employment Employment is a primary goal for a majority of unemployed patients with SMI. Sustained employment is associated with reduced health care use and cost and increased levels of self-esteem and satisfaction (11,12). As traditionally known, work may play an important role in the process of recovering by engaging a person into a feeling of being able to work as a sort of existence (13). Recovery-oriented services Recovery-oriented approaches currently appear to be the dominant expression in psychiatry with regard to a patients functionality in society. They are independent from the medical model and focus on the integrity and strengths of an individual rather than on the illness. Patients with SMI, even though they have some residual symptoms, generally want to live

9 Arch Neuropsychiatr 2015; 52: 1-3 Yıldız M. Recovery as a Process in Severe Mental Illnesses independently, be in society with dignity, have a job with self-esteem, have a partner for love and affection, have a house for safety, hope for a future, and having all civil rights like all other individuals. In this sense, the main purpose of recovery-oriented services is to provide an effective treatment for the patients with SMI that makes them obtain satisfaction in the following areas: continuing symptom relief, daily functioning, social relations, family relations, occupational or academic functioning, independent living and autonomy, goal attainment, satisfaction, and possession of common objects (14). By implementing recovery-oriented services in community settings, besides improving a patients wellness, it is expected to decrease the burden of illness (lost income, stigma, disordered social relations, re-hospitalizations, family stress, treatment expenses, etc.) on families, caregivers, and friends, health care systems, and society as a whole. Unfortunately, all treatment and rehabilitative services and approaches that foster recovery are not routinely available in many places. For recovery to become completely integrated into a mental health care system, widespread systemic changes may need to be done. These include the implementation of services that promote financial, residential, and personal independence, as well as normative adult roles, such as employment and social connectedness (3). Clearly, a clinician cannot manage all problems related to sustain the recovery of patients with SMI alone and will need to look for additional resources to become a partner of the patient and to coordinate and maximize the clinical effectiveness of the treatment and rehabilitation. It is arguable that systemic factors, such as high patient loads, time constraints in clinical encounters, lack of or limited availability of ancillary professionals, management resistance to change, and most importantly, lack of training in recovery, can act as impediments toward a recovery orientation in psychiatry. As such, currently integrating a recovery orientation into psychiatry involves much more than attitudinal shifts among individual psychiatrists. Establishing the recovery orientation services must involve multi-level systemic changes as well as changes in medical education (15). REFERENCES 1. Lebowitz BD, Rudorfer MV. Treatment research at the millennium: from efficacy to effectiveness. J Clin Psychopharmacology 1998; 18:1. 2. Liberman R, Kopelowicz A. Recovery from schizophrenia: a concept in search of research. Psychiatr Serv 2005; 56: Drake RE, Whitley R. Recovery and Severe Mental Illness: Description and Analysis. Can J Psychiatry 2014; 59: Davidson L, Lawless MS, Leary F. Concepts of recovery: competing or complementary. Curr Opin Psychiatry 2005; 18: Schrank B, Slade M. Recovery in psychiatry. Psychiatr Bull 2007; 31: Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005; 162: Resnick SG, Fontana A, Lehman AF, Rosenheck RA. An empirical conceptualization of the recovery orientation. Schizophr Res 2005; 75: Liberman RP. Recovery from disability. Manual of Psychiatric Rehabilitation. Washington DC., American Psychiatric Publishing, Inc., Hoffmann H, Kupper Z, Kunz B. Hopelessness and its impact on rehabilitation outcome in schizophrenia: an exploratory study. Schizophr Res 2000; 43: Deegan PE. Recovery: the lived experience of rehabilitation. Psychosocial Rehabilitation Journal 1996; 11: Polak P, Warner R. The economic life of seriously mentally ill people in the community. Psychiatr Serv 1996; 47: Mueser KT, Becker DR, Torrey WC, Xie H, Bond GR, Drake RE, Dain BJ. Work and nonvocational domains of functioning in persons with severe mental illness: a longitudinal analysis. J Nerv Ment Dis 1997; 185: Pachoud B, Plagnol A, Leplege A. Outcome, recovery and return to work in severe mental illnesses. Disabil Rehabil 2010; 32: Nasrallah HA, Targum SD, Tandon R, McCombs JS, Ross R. Defining and measuring clinical effectiveness in the treatment of schizophrenia. Psychiatr Serv 2005; 56: Whitley R. Introducing recovery. Can J Psychiatry 2014; 59: