Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallEditorialA5A6TREmreBORA1219

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallAssessment of Mortality Rate in 10 Years and the Associated Risk Factors in SchizophreniaŞizofrenide 10 Yıllık Ölüm Oranı ve Risk Etmenlerinin Değerlendirmesi151−159ENTRHilmiYAŞARMustafaYILDIZ1220Objective: The aim of the study was to explore the mortality rate and the associated risks factors in patients with schizophrenia during a10- year follow up period. Method: We searched the records of patients with schizophrenia receiving treatment as outpatients and/or inpatients in the psychiatric clinic of a university hospital between 2004 and 2008 and determine the survival of these patients by the end of 2018. The results were compared with the all cause mortality rate in the general population during the same period. Also, the risk factors affecting the mortality rate among the patients were investigated. Results: Out of a total of 626 registered patients 506 were included in the study. The mortality rate within 10 years was found to be 10.6%, with a mean age of 53.1 years at the time of death. The overall expected life expectancy was 73.4 years; varying between 66.6 years among the males and 77.6 years among the females; and 64.7 and 76.5 years among smokers and non-smokers, respectively. The overall standardized mortality rate (SMR) was 3.7, being 3.9 among the males and 3.3 among the females. The risk factors that were associated with the death were old age, male gender, smoking, not working, and early age of disease onset. Conclusion: Smoking is a significant risk factor for mortality. Giving priority to programs for stopping smoking, and supporting rehabilitation services that enables patients to get involved in could help reducing the mortality risk.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallAssociation of Nicotine Use Disorder with Neurexin 3 Gene PolymorphismsNikotin Kullanım Bozukluğunun Neurexin 3 Gen Polimorfizmi ile İlişkisi160−166ENTRGülcanGÜLEÇDidem TURGUTCOŞANFezan MUTLUŞAHİNİbrahim UğurÇALIŞMelis DANIŞMANSONKURTFerdiKÖŞGERAltanEŞSİZOĞLU1221Objective: In this study, we aimed to investigate the Neurexin 3 gene (NRXN3) polymorphisms in the rs 221473, rs 221497, rs1004212 and rs11624704 regions in relation to nicotine use disorder (NUD) in the Turkish population. Method: Power analysis indicated that the NUD group and the control group of this study should each comprise 200 participants in the 18-65 year age range. The NUD group consisted of individuals without a psychiatric first axis disorder except for NUD, mental retardation, past head trauma or a neurological disorder, who had smoked minimally10 cigarettes per day for at least 1 year. The control group included individuals without a serious chronic physical illness, a previous psychiatric disorder or mental retardation and who responded “no” to the question “have you ever smoked?” A sociodemographic questionnaire and the Fageström nicotine dependence scale (FNDS) for the NUD group were utilized. Venous blood samples of all participants were taken into tubes containing EDTA (ethylene daimine tetra acetic acid) for DNA extraction. Duplex fluorescence melting curve analysis was used for genotype detection and differentiation. Results: The individuals carrying the AC allele and the AG allele at the rs11624704 and the rs1004212 regions respectively had a high risk of being addicted to cigarettes. Conclusion: This is first study investigating the relationship of the NRXN3 gene and nicotine addiction in the Turkish population. It was observed that the risk of NUD in the Turkish population may be related to the Neurexin gene.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallIconic Memory in Obsessive Compulsive DisorderObsesif Kompulsif Bozuklukta İkonik Bellek167−175ENTRMehmetMARTSelimTÜMKAYA1222Objective: In this study, we aimed to investigate whether there is a fast decay in the iconic memory of patients with Obsessive Compulsive Disorder (OCD) compared to healthy individuals by taking into consideration the clinical OCD subtypes. Method: The study included 74 patients diagnosed with OCD on the basis of the DSM 5 criteria and 63 healthy individuals. The OCD patients were grouped as washers, checkers, both washers and checkers, and non-washers and non-checkers. All participants took a partial report test (PRT) to compare iconic memory performance between the healthy control group and the OCD group as a whole and in OCD subgroups. Results: Loss of iconic memory did not differ between OCD group and the controls. The iconic memory scores, expressed as the d’ values, at specified time points correlated negatively with age and positively with education duration in all groups. When the subgroup data were analyzed by controlling for age, the d1’value showing formation of iconic information was lower in the washers subgroup in comparison to the checkers subgroup and the nonwashers and non-checkers subgroup. The d7’ value was also lower in the washers subgroup than in the the non-washers and non-checkers subgroup and the healthy control group. The iconic decay rate of the washers subgroup between the time points d6’ and d7’ was significantly higher in comparison to the healthy control group. The scores of OCD patients on the washing subscale of the Maudsley Obsessive Compulsive Inventory (MOCI) showed negative correlations with the iconic memory scores at all time points. Conclusion: This study showed that washer OCD patients may have impaired iconic formation and fast iconic decay, which could significantly affect the amount of information transferred to visual memory.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallRetinal Scan with Optical Coherence Tomography in Adult Attention Deficit Hyperactivity DisorderYetişkin DEHB Olgularında Optik Koherens Tomografi ile Retina Taranması176−182ENTRMünevverTÜNELNedime ŞAHİNOĞLUKEŞKEK1223Objective: In this study, the retinal nerve fiber layer (RNFL) thicknesses were compared between adult attention deficit hyperactivity disorder (ADHD) cases and healthy controls. Method: The study included adults diagnosed with ADHD based on the DSM-5 criteria and age and gender matched healthy controls. Spectral area optical coherence tomography (OCT) was performed on the 52 eyes of 26 participants with ADHD and the 52 eyes of the 26 healthy control individuals. Results: Comparing the data on the 52 eyes of 26 ADHD participants and the 52 eyes of 26 healthy control participants indicated that the central macular thickness (CMT) and the RNFL thicknesses, the ganglion cell complex (GCC), the mean inner macular ring (MIRAVG) and the mean outer macular ring (MOR-AVG) thicknesses were significantly lower in the ADHD group. Conclusion: This is the first study in the literature on the RNFL thickness in adult ADHD patients. Our findings demonstrated that RNFL thickness is lower in ADHD cases as the unmyelinated axons are reduced in ADHD. Hence, the quantitative and reproducible nature of Spectral Domain-OCT thickness measurements can be used as biomarkers to monitor disease progression in ADHD cases.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallTurkish Adaptation Study of the Perceived Devaluation Discrimination ScaleAlgılanan Değersizleştirme-Ayrımcılık Ölçeği’nin Türkçeye Uyarlama Çalışması183−191ENTRKutaySAÇAKDeniz CANELÇINARBAŞ1224Objective: The aim of this study is to adapt Perceived Devaluation- Discrimination (PDD) scale for Turkish language and culture. Method: Participants from clinical and community populations were included in the study. The community sample consisted of 145 healthy individuals from the general community and the clinical sample consisted of 85 individuals with chronic psychiatric disorders. Psychometric properties of the Turkish version of PDD were assessed in the general community and clinical samples. Exploratory factor analysis, confirmatory factor analysis, internal consistency analysis, convergent and discriminant validity analyses were conducted. Results: As a result of exploratory factor analysis, a two-factor structure for PDD emerged in both the general community and clinical samples. Confirmatory factor analysis also supported the two-factor structure in both samples. These factors were named as Perceived Discrimination and Negative Evaluation and Perceived Acceptance and Non-negative Evaluation subscales. Cronbach’s alpha values for PDD were 0.76 in the general community sample and 0.79 in the clinical sample. Alpha values of PDD subscales ranged between 0.72 and 0.77 in both samples. While convergent and discriminant validity tests provided partial support for construct validity of PDD in the general community sample, the convergent validity tests conducted with the clinical sample provided evidence for validity of PDD. Conclusion: Based on the results of the present study, it has been demonstrated that the Turkish version of PDD is reliable and valid and can be used with community and clinical samples to measure perceived devaluation and discrimination.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallThe Turkish Validity and Reliability Study of the Observable Social Cognition –A Rating Scale for Patients with SchizophreniaŞizofreni Hastalarında Gözlenebilir Toplumsal Bilişi Değerlendirme Ölçeği’nin Türkçe Geçerlik ve Güvenirlik Çalışması192−200ENTRZeynepÖZASLANMustafaYILDIZ1225Objective: The Observable Social Cognition–A Rating Scale (OSCARS) is an eight-item, interview-based psychometric tool that was developed by Healey et al. (2015) for evaluating social cognition with respect to the theory of mind, emotion perception, and attributional style in schizophrenia. The aim of this study is to determine the validity and reliability of the Turkish version of the scale. Method: The study was conducted with 50 patients with schizophrenia and schizoaffective disorder and 50 relatives of these patients using the OSCARS, the Face Emotion Discrimination/Identification Test (FEDT/FEIT), the Positive and Negative Symptoms Scale (PANSS), the Global Assessment of Functioning (GAF) and the Dokuz Eylül Theory of Mind Index (DEZIKO). The validity of the OSCARS was assessed by exploratory factor analysis and concurrent validity analysis, the reliability was demonstrated by the internal consistency coefficient, item-total item correlation, and test-retest comparisons. Results: The Cronbach’s alpha coefficient of the OSCARS-TR was 0.83. Explanatory factor analysis yielded a 2-factor structure explaining 64.2% of the total variance of the scale. The total score of the OSCARSTR correlated significantly with the DEZIKO (r=-0.49), the GAF (r=- 0.50), the PANSS (r=0.54) and the FEDT (r=-0.29) total scores but not with the FEIT scores. The total scores of the OSCARS-TR completed by the patients and by the relatives of the patients correlated with statistical significance (r=0.93). The test-retest reliability coefficient of OSCARS-TR was 0.95. Conclusion: The results demonstrated the validity and the reliability of the OSCARS-TR. The scale can be easily implemented on an interview basis as an appropriate tool for evaluating social cognition.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallKilling One’s Own Baby: A Psychodynamic Overview with Clinical Approach to Filicide CasesKendi Bebeğini Öldürmek: Filisid Olgularına Psikodinamik Bakış ve Klinik Yaklaşım201−210ENTRDilşad FOTOÖZDEMİRŞ. GülinEVİNÇ1226Objective: This review article discusses the multi-dimensional and complex pattern of filicide from a psychodynamic perspective with reference to the recent publications. Creating awareness to filicide among professionals will help to the correct assessment of the cases, recognition of and intervention on filicide before the act, and the development of preventive mechanisms. Method: Published articles between January 1960 and March 2020 were searched using the keywords ‘filicide, infanticide, neonaticide, mother/ parent/ maternal/ paternal, psychodynamics’ in the Google Scholar, EBSCHO-HOST, Science-Direct, PubMed and Web of Science databases. Results: The term filicide refers to the murder of the offspring by the parent. Although it is a common belief that the children are murdered boy strangers, the reported figures may not be representing the truth. No families are detected in one fourth of all murdered infants within the first 24 hours. The death of abondoned children are classified as ‘due to natural causes’. Some murders might not be reported properly and therefore, actual murders by own parents might have been missed on the records. It is known that filicide is a heterogeneous phenomenon requiring a multidimensional evaluation in being affected by cultural values, belief systems of the society as well as the bio-psycho-social and developmental variables. It is reported in the literature that filicide cases have a common profile and that training clinicians on this complex phenomenon would be effective on prevention strategies. Conclusion: The concept of filicide is controversial in many aspects and mental health professionals tend to distance themselves since the concept is associated with ‘crime’. However it is crucial to elucidate the psychodinamic background on violence and discuss the risk factors, triggers, background dynamics and psychopathologies underlying this phenomenon.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallSevere Nutritional and Psychosocial Deficits in Avoidant/ Restrictive Food Intake Disorder (ARFID): Case ReportKaçıngan/Kısıtlı Yiyecek Alımı Bozukluğunda (KKYAB) Görülen Ağır Beslenme Eksikliği ve Psikososyal Eksiklik: Olgu Sunumu211−213ENTRRupamDHIMANNitishaVERMAManushreeGUPTAKuldipKUMAR1227Avoidant/Restrictive food intake disorder (ARFID) is a diagnostic category that is included in the DSM 5 (American Psychiatric Association- APA 2013) and proposed by the ICD11 (The World Health Organisation-WHO 2019). Very few ARFID cases have been reported to date. This report aims to present the case of a 25-year-old female who was diagnosed with ARFID and thereby to discuss the challenges in diagnosing and managing the case.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallIsotretinoin Induced Psychotic Mania: A Case Reportİzotretinoin ile İlişkili Psikotik Mani Atağı: Olgu Sunumu214−218ENTRFarukKURHANGülsüm ZuhalKAMIŞ1228Biological, genetic and psychosocial factors may play a role in the aetiology of bipolar mood disorder (BPD). BPD episodes might be triggered by isotretinoin, a retinoid derivative of vitamin A with a role in cellular proliferation and differentiation. Due to its association with depression, suicidal ideation and suicide attempts, American Food and Drug Administration (FDA) issued a placement of a label warning for isotretionin. Personal or family history of psychiatric disorders was emphasized in the literature for the risk of mood episodes following isotretionin treatment. Here we aim to present the case of an 18- year old young male adult, without personal or family history of a psychiatric disorder, who developed psychotic mania within the first week of isoretinoin which was prescribed for acne vulgaris. Psychotic mania symptoms receded within one week after starting olanzapine (10 mg/day). We believe this case is significant in demonstrating the occurence of a manic episode after isoretinoin in individuals lacking a personal or family history of psychiatric diagnoses.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallLetter to the Editor: THE IMPACT OF THE COVID-19 PANDEMIC ON SCHIZOPHRENIA PATIENTSEditöre Mektup: COVID-19 SALGINININ ŞİZOFRENİ HASTALARINDAKİ ETKİSİ219221ENTREmine IlgınHoşgelenKöksalAlptekin1229Dear Editor, The Covid-19 pandemic affected human life globally, inducing much stress on daily living (Çakıroğlu et al. 2020). Although assessments of general mental health during the Covid-19 pandemic have been widely reported, there is not adequate research on how schizophrenia patients have been affected. According to the World Health Organization (2020), individuals with chronic diseases who do not pay attention to their personal hygiene and the rules of protection from COVID-19 have a higher risk of getting infected than the healthy individuals who observe these measures. It is well known that the risk of Covid-19 infection is raised among schizophrenia patients due to negligence on the requisite control of personal hygiene and health conditions related to smoking and diabetes ( Cohn et al., 2004; Dinan et al., 2004; Krieger et al. 2019). The cognitive impairment in this disorder which reduces the perceptions on the necessity of self protection and the awareness of the risks proposed to underlie this raised risk of COVID-19 positivity (Yao et al. 2020). These patients have difficulty in following the preventive regulations (Palomar-Ciria et al., 2020). Apart from the risk of infection, there is also the risk of pandemic related development of auditory or visual hallucinations and delusional symptoms by acute and chronic psychosis patients during and after the pandemic (Brown et al. 2020, Cowan 2020). Therefore, this survey has been organised to evaluate the reaction developed by schizophrenia patients to the pandemic conditions. The first Covid-19 case was reported in Turkey on 11 March 2020 (Anadolu Agency, 11.03.2020) which was followed by the gradual increase in case numbers. In order to prevent the spread of Covid-19 and maintain the existing public health, the Republic of Turkey Ministry of Health established a ‘Scientific Committee’’ and prepared effective strategies including social isolation, quarantine, school closures, social distancing and wearing face mask in the community. During this process, the approximately 250 schizophrenia and schizoaffective disorder patients followed up by the Psychosis Outpatient Unit of Dokuz Eylul University Hospital Psychiatry Department (DEUPD) were instructed to visit the outpatient unit only in emergency conditions. It was determined that there were 176 schizophrenia patients whose follow up visit appointments for the period of April 1 - June 22, 2020, scheduled before the announcement of the pandemic, were cancelled. Therefore, the survey reported here was conducted with the schizophrenia patients of the DEUPD online and by telephone connections during 10- 20 May, 2020, the 9th and the 10th weeks of the pandemic. Only 76 (43.19%) of the 176 patients joined the survey, since 4 (2.27%) refused to participate and 96 (54.4%) could not be contacted. The survey aimed to determine the incidence of Covid-19 diagnosis among these schizophrenia patients and their attitude to the preventive measures against the infection during the first 2 months of the pandemic, together with how they felt and their needs for psychiatric consultation on outpatient basis during this period. The surveyed 76 patients consisted of 49 (64%) males and 27 (35%) females, with 73 (96.1%) dwelling in urban and 3 (3.9%) in suburban areas; and only 11 (14.5%) employed while 65 (85.5%) were not working. Only two patients reported consulting emergency services for Covid-19 symptoms. The rest of the patients did not report consulting a healthcare facility for suspecting Covid-19 symptoms or   Table 1. Data on the demographic, clinical and social features of the schizophrenia patients during the COVID-19 pandemic   n=76           Mean SD   Gender (F/M) 27 (35.5%) / 49 (64.5%)     Age   44.54 12.21   Disease duration   16.62 9.96   Patients living /with         Alone   3 (3.9%)     Parent(s)   43 (56.6%)     Spouse/children 25 (32.9%)     Sibling (s) 1 (1.3%)     Relative(s) 2 (2.6%)     Friend(s)   2 (2.6%)           Yes No Need to see a psychiatrist     23 (30.3%) 53 (69.7%) Subjective psychiatric complaints     32 (42.1%) 44 (57.9%) Consultation with an emergency service     2 (2.6%) 74 (97.4%) Planning to go to the hospital in the post-quarantine period   58 (76.3%) 18 (23.7%) Wearing a mask in community     67 (88.2%) 4 (5.3%) Keeping social distancing     68 (89.5%) 3 (3.9%) Expressed feeling         Loneliness   26 (34.2%) 49 (64.5%) Depressed   31 (40.8%) 44 (57.9%) Despaired   22 (28.9%) 52 (68.4%) Anxious     25 (32.9%) 49 (64.5%) Difficulty of going to the hospital in the quarantine period   53 (69.7%) 23 (30.3%)   hospital admission for Covid-19 infection or psychotic attack or incidences of Covid-19 related hallucination or delusions. During this 2-month period, 4 patients had experienced fatigue, 2 had episodes of dry cough and 7 had experienced shortness of breath, which can be associated with the nature of schizophrenia, the sedentary life style.and cigarette smoking. Medication was prescribed by a psychiatrist for 10 patients and by a family doctor for 16 patients or supplied directly by pharmacies for 45 patients on the basis of prescriptions with 1-year validity issued by the hospital* (Table 1). Much as it had been aimed to contact all patients with cancelled appointments, this objective was not attainable The patients who were not reached are likely to include those with low awareness and difficulty of adapting to infection prevention strategies. On the other hand, regardless of the level of awareness of the pandemic and compliance with the rules, phone use by these patients might have been limited by economic and environmental reasons, as well as the difficulties imposed by the pandemic. In conclusion, it is possible to say that most of the patients with schizophrenia were aware of the risk of COVID-19 infection, and understood and mostly obeyed the general health rules and advices of healthcare professionals even if they had difficulty in doing so. This could also have resulted from the nature of schizophrenia with preference for social isolation even if this can worsen the prognosis. On the other hand, patients need to be in contact with a mental healthcare professional in extraordinary situations of a pandemic. This survey did not find a remarkable increase in positive symptom severity in association with COVID-19 as most patients included in the survey had not seen a psychiatrist or mental healthcare professional for two months with 53 patients stating that they did not have to need.   However, 58 patients also stated that despite planning to make a consultation after normalization of the quarantine measures, the anxiety of contagion outweighed the option of visiting outpatient clinics. This anxiety over Covid-19 infection, however, may make it difficult for patients to understand the level of the need to see a psychiatrist and may be associated with the assumption that the pandemic would be taken under control in the normalization process with a decrease in the risk of contagion. On the results of this survey, it may be concluded that strategies for prevention of COVID-19 spread were effective among schizophrenia patients and that there is need to develop a system that reaches all patients and keeps them socially connected during the COVID-19 pandemic. *In Turkey, prescription reports with 1-year validity are issued for patients with chronic disorders. The medications can only be prescribed by a specialist, and in the case of pyshchiatric disorders, by a consultant psychiatrist. When the report is confirmed by a hospital committee of specialists, a family doctor is able to issue prescriptions. According to the decision of the Ministry of Health, patients who have medication prescription reports valid for one year would be able to get their medicines directly from pharmacies without having to consult a psychiatrist or family doctor during the pandemic.               REFERENCES Anadolu Agency (2020, Mach 11). Sağlık Bakanı Koca Türkiye’de ilk koronavirüs vakasının görüldüğünü açıkladı, https://www.aa.com.tr/tr/kor onavir us/ saglik-bakani-koca-turkiyede-ilk-koronavirus-vakasinin-goruldugunu- acikladi/1761466. Accessed 28 May 2020.   Brown E, Gray R, Lo Monaco S et al (2020) The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophr Res 222:79-87. Cohn T, Prud’homme D, Streiner D et al (2004) Characterizing coronary heart disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Can J Psychiatry 49:753–60. Cowan, HR (2020) Is schizophrenia research relevant during the COVID-19 pandemic?. Schizophr Res 220:271–2. Çakıroğlu S, Ertaş E, and Alyanak B (2020) Letter To The Editor - The Covid-19 Pandemic And Mental Health As Issues Considered Within The Context Of Adjustment Disorder And Psychosocial Interventions. Turk Psikiyatri Derg 31:148-50. Dinan T, Holt R, Kohen D et al (2004) “Schizophrenia and diabetes 2003” expert consensus meeting, Dublin, 3-4 october 2003: Consensus summary. Br J Psychiatry 184 (Suppl. 47): 0–2. Krieger I, Bitan DT, Comaneshter D et al (2019) Increased risk of smoking- related illnesses in schizophrenia patients: A nationwide cohort study. Schizophr Res 212:121–5. Palomar-Ciria N, del Valle PB, Hernández-Las Heras MÁ et al (2020) Schizophrenia and COVID-19 delirium. Psychiatry Res 290:113137. Yao H, Chen JH, and Xu YF (2020) Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry 7: e21. World Health Organization (2020, Mart 25). Covid-19: Vulnerable and High Risk Group, Geneva, Switzerland: World Health Organization, https:// www.who.int/westernpacific/emergencies/covid-19/information/high-risk- groups. Accessed 28 May 2020.    

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633232021FallEditöre Mektup: ÇEVİRİDE ATLANAN ANLAMLAR: TÜRKÇE BİLİMSEL YAZILARDA YAPILAN ÇEVİRİ YANLIŞLARI VE BİTMEYEN TERİMLEME SORUNLARI ÜZERİNE222224TRMustafaYıldız1230