Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerThe Impact of Artificial Intelligence on Psychiatry: Benefits and Concerns-An assay from a disputed ‘author’Yapay Zeka’nın Psikiyatri Üzerindeki Etkisi: Faydalar ve Endişeler - Tartışmalı bir ‘yazardan’ görüşler656710.5080/u27365ENTRYavuzAYHAN10.5080/u27365Artificial Intelligence (AI) has the potential to revolutionize the field of psychiatry, offering new possibilities for diagnosis, personalized treatment approaches, and enhanced therapeutic interventions. However, along with these advancements come important considerations and concerns that need to be addressed to ensure the responsible and ethical integration of AI in psychiatry. This essay explores the impact of AI on psychiatry, highlights its potential benefits, and discusses the major concerns surrounding its implementation. AI can significantly improve the accuracy and efficiency of psychiatric diagnosis. Machine learning algorithms can analyze large datasets of patient information, including clinical records, genetic data, and brain imaging scans, to identify patterns and risk factors associated with mental disorders (Plis et al., 2014). By integrating this wealth of data, AI systems can enhance diagnostic accuracy, assist clinicians in making informed decisions, and potentially enable early detection of mental health conditions. Personalized treatment approaches are another area where AI shows great promise. AI algorithms can analyze individual patient data, such as genetic profiles, treatment history, and response to interventions, to develop tailored treatment plans (Dwyer et al, 2018) (Dwyer et al., 2018). This personalized medicine approach allows clinicians to optimize treatment strategies, select the most appropriate medications, and minimize trial-and-error in finding the right treatment for each patient. Additionally, AI can monitor treatment progress in real-time, providing continuous feedback and allowing for timely adjustments to therapy. Therapeutic interventions can be enhanced through real-time feedback and monitoring using AI. Wearable devices equipped with AI algorithms can continuously track physiological and behavioral markers, providing clinicians with objective data on patients’ well-being and treatment response (Insel, 2017) (Insel, 2018). These devices can also detect early signs of relapse, allowing for timely interventions to prevent deterioration. Moreover, virtual reality and augmented reality technologies create immersive environments for exposure therapy by simulating controlled and safe scenarios that help individuals confront anxiety-inducing situations (Kim et al, 2009) (Han et al., 2015). Such technological advancements expand the range of therapeutic options available to clinicians and improve treatment outcomes. The integration of AI in psychiatry holds promise for risk assessment and suicide prevention. Natural language processing algorithms can analyze patients’ interactions, social media posts, and online forum discussions to identify patterns and emotional states associated with a higher risk of self-harm (Lejeune et al, 2022) (Kaur et al., 2021). Early detection of suicide risk enables prompt interventions, potentially saving lives. AI can also assist in predicting treatment outcomes and guide intervention adjustments. By analyzing large datasets, AI algorithms can identify response patterns, predict relapses, and suggest alternative treatment strategies (Dwyer et al, 2018) (Dwyer et al., 2018). This proactive approach enhances treatment planning, reduces hospital readmissions, and optimizes resource allocation within the mental health system. Despite the remarkable potential AI brings to psychiatry, several concerns must be addressed. One of the primary concerns is the protection of patient privacy. AI systems analyze and store vast amounts of health data, which may contain sensitive and personal information. Therefore, robust measures need to be implemented to ensure data security and privacy. Safeguarding against unauthorized access or misuse of data and implementing appropriate data storage and communication protocols are crucial (Luxton 2014) (Luxton & Hansen, 2019). Another concern is the potential for biases in AI algorithms. AI systems learn from extensive datasets, and if these datasets are biased or flawed, it can lead to biased or misleading outcomes. Diagnostic errors or incorrect treatment decisions may occur as a result. It is crucial to address biases in algorithms and ensure the development of fair and unbiased AI systems that provide equitable care for all individuals (Luxton, 2014) (Luxton & Hansen, 2019). Ethical considerations surrounding AI in psychiatry also encompass the reduction of human interaction. While AIsupported treatments or conversational agents can offer continuous support and guidance, the absence of human contact may impact certain patients negatively. Human interaction is a vital component of psychiatric care, and efforts should be made to strike a balance between AI-based interventions and the preservation of therapeutic relationships (Wang et al., 2021). Transparency and explainability of AI decision-making processes are additional concerns. AI algorithms operate in complex ways, taking multiple factors into account when making decisions. However, understanding how these decisions are made and the criteria they rely upon can sometimes be challenging. This lack of transparency can raise concerns regarding the reliability and ethical appropriateness of decisions made by AI systems (Luxton, 2014) (Luxton & Hansen, 2019). Lastly, there are legal and regulatory considerations to be addressed. As AI technologies advance and become integrated into psychiatric practice, appropriate laws and regulations need to be in place to govern their use. Ensuring compliance with existing regulations, developing new regulations specific to AI in psychiatry, and monitoring potential risks and ethical implications are necessary steps to safeguard patient wellbeing and protect against misuse or malpractice. In conclusion, the integration of AI in psychiatry holds immense potential to transform the field, offering improved diagnostic accuracy, personalized treatment approaches, enhanced therapeutic interventions, and risk assessment capabilities. However, careful attention must be given to address concerns related to patient privacy, biases, the reduction of human interaction, transparency, and legal and regulatory frameworks. By navigating these challenges responsibly, AI can be effectively integrated into psychiatric practice, complementing human expertise and ultimately improving mental healthcare outcomes. References (a) - Don’t skip the editor’s note! • Dwyer DB, Falkai P, Koutsouleris N (2018) Machine learning approaches for clinical psychology and psychiatry. Annual Review of Clinical Psychology, 14:91-118. • Han K, Lee Y, Kim J J (2015) Virtual reality for obsessivecompulsive disorder: past and the future. Psychiatry Investigation 12:217-24. • Insel TR (2018) Digital phenotyping: technology for a new science of behavior. JAMA 320:237-8. • Kaur H, Lakhani A, Ashrafian H (2021) The role of artificial intelligence in mental health and suicide prevention. Current Opinion in Psychiatry 34:236-42. • Luxton DD, Hansen RN (2019) Artificial intelligence in behavioral and mental health care. Elsevier. References (b) • Dwyer DB, Falkai P, Koutsouleris N (2018) Machine learning approaches for clinical psychology and psychiatry. Annual Review of Clinical Psychology 14:91-118. • Han M, Zhu J, Zhang J et al (2015) Virtual reality for psychiatric research and therapy. Cellular Biochemistry and Biophysics 73:687-92. • Kaur H, Singh A, Bali R et al (2021) Early diagnosis of depression using machine learning techniques: A review. IEEE Access 9:42714-35. • Luxton DD, Hansen RN (2019) Artificial intelligence for psychological practice: Current and future applications and implications. Professional Psychology: Research and Practice 50:354-62. • Plis SM, Sarwate AD, Wood D et al (2014) Machine learning for psychiatric imaging research: Challenges and opportunities. In Brain Imaging in Behavioral Medicine and Clinical Neuroscience (pp. 105-25). Springer. 67 EDITOR’S NOTE Artificial intelligence will transform the lives of the mental health professionals. The question is when, how and to what extent. For now, it may be limited to the topics mentioned in this article. The impact of AI on scientific publishing is also being actively discussed. Currently, many journals are defining strategies against the authorship of artificial intelligence (COPE: Committee on Publication Ethics 2023; Flanagin et al. 2023; Nature 2023; Thorp 2023). I would be curious about how the readers would perceive the authorship of AI. What would you think if you heard that the piece above was written by AI natural language processing (NLP) software? (OpenAI, 2023) Would you read the text with a different perspective if you had known from the beginning? Indeed that is the case. Add: Actually, I was planning to stop here. But you need to know the following: The assay above was originally prepared in English, then translated into Turkish by the same AI NLP (In the Turkish version, I made small changes that don’t alter the meaning). Based on my commands, the original text was prepared with five references. During the translation, I noticed that the references had actually changed! Also, some references were non-existent to me. I was not able to reach out to four references in both the original (English) and the Turkish text. In (a) above, you can see the references from the Turkish translation, and in (b), you can see the references in the English text. The italics are the ones that I was not able to access. I have replaced them with the most appropriate references that I’ve thought of. The original referances generated by the AI is underlined throughout the text, next to the ones that I’ve inserted. Additionally, you will notice that there are references in the text that are not included in the bibliography or references in the bibliography that are not mentioned in the text. Personally, I believe that these kinds of errors will soon disappear, but that’s the actual situation for now. REFERENCES COPE: Committee on Publication Ethics (2023) Authorship and AI tools. Retrieved from https://publicationethics.org/cope-position-statements/aiauthor at 16 June 2023. Dwyer DB, Falkai P, Koutsouleris N (2018) Machine learning approaches for clinical psychology and psychiatry. Annu Rev Clin Psychol 14:91–118. doi:10.1146/annurev-clinpsy-032816-045037 Flanagin A, Bibbins Domingo K (2023) Nonhuman “authors” and implications for the integrity of scientific publication and medical knowledge. JAMA 329:637–9. doi:10.1001/jama.2023.1344 Insel TR (2017) Digital phenotyping: technology for a new science of behavior. JAMA 318:1215–6. doi:10.1001/jama.2017.11295 Kim K, Kim CH, Kim SY et al (2009) Virtual reality for obsessive-compulsive disorder: past and the future. Psychiatry Investig 6:115–21. doi:10.4306/ pi.2009.6.3.115 Lejeune A, Le Glaz A, Perron PA et al (2022) Artificial intelligence and suicide prevention: a systematic review. Eur Psychiatry 65:1–22. doi:10.1192/j. eurpsy.2022.8 Luxton D (2015) Artificial intelligence in behavioral and mental health care. 1st Ed. Elsevier. doi:10.1016/C2013-0-12824-3 Nature (2023) Tools such as ChatGPT threaten transparent science; here are our ground rules for their use. Nature, 613:612. doi:10.1038/d41586-023- 00191-1 OpenAI (2023) ChatGPT (June 12 version) [Large language model]. Computer software. Thorp HH (2023) ChatGPT is fun, but not an author. Science 379:313. doi:10.1126/science.adg7879

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerExamination of the Relationship Between the Theory of Mind, Neurocognitive Functions and Thought-Language Features in the Schizophrenia and Bipolar Affective Disorder I GroupsŞizofreni ve Bipolar Afektif Bozukluk I Gruplarında, Zihin Kuramının Nörobilişsel İşlevler ve Düşünce-Dil Özellikleri ile İlişkisinin İncelenmesi687910.5080/u26401ENTRZehra GÜNAY YAĞCIMehmet HamidBOZTAŞ10.5080/u26401Objective: In this study, it was aimed to examine the relationship of ToM with face-emotion recognition, executive functions and thought disorders in the schizophrenia (SC) and bipolar affective disorder I (BAD I) groups. Method: 40 SC, 40 BAD I and 40 healthy control groups were included, matched for age, gender, and educational status. Dokuz Eylül Theory of Mind Scale (DEToMS)) and Reading Mind in Eyes (RMET) test, Benton face recognition test (BFRT), Ekman emotion recognition battery, Wisconsin Card Sorting Test (WCST), Stroop test, Thought and Language Index (TLI) were used. Positive and Negative Symptoms Rating Scale (PANNS) in the SZ group, Young Mania Rating Scale (YMRS) in the BAD I group were used. Results: The number of perseverative responses in WSCT was higher in the SC group than the BAD I group. Recognition of the fearful expression scores, DEToMS total and subscale scores except irony were higher and scores of TLI were lower in healthy controls more than patients group. Recognition of the fearful expression scores, DEToMS total and subscale scores except irony were higher and scores of TLI were lower in BAD I group more than SC group. There was no difference between SC and BAD I groups between BFRT, emotion recognition except fearful expression and RMET scores. The best predictors of DEToMS were executive functions and TLI total score in the SC group and was emotion recognition in the BAD I group. The best predictors of the RMET score were executive functions and emotion recognition for both groups. Conclusion: Our findings suggest that social cognition remains a biomarker in patients with SZ and BAD I. Keywords: Schizophrenia, bipolar disorder, theory of mind, emotion recognition

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerEffect of CBT on Metacognitive Beliefs in Depressive DisordersDepresif Bozukluklarda Bilişsel Davranışcı Terapinin Bilişüstü İnançlar Üzerindeki Etkisi88810.5080/u26398ENTRAarzoo GUPTASanthaKUMARI10.5080/u26398Metacognitive beliefs operate through cognitive attentional syndrome, where attention concentrated on negative automatic thoughts results in rumination. This perseverative thinking style manifesting in the form of rumination and worry intensifies depression. This study aims to assess the effect of cognitive behaviour therapy (CBT) on metacognitive beliefs, symptom severity, quality of life, and functionality. A pre-post study design comparing CBT-alone and CBT-with-medication was employed using purposive sampling to recruit 40 participants diagnosed with depressive disorders. All the participants received 10 sessions of CBT. Pre and post assessment measures were Beck Depression Inventory-II, Metacognitive Questionnaire-30, World Health Organization Quality of Life- Brief, and Global Assessment of Functioning. Paired t-test analysis revealed significant difference on outcome measures in both groups. Between-subject analysis revealed that the CBT-alone group was not significantly different in terms of improvement than CBT-withmedication group even when confounding variables were statistically controlled by way of testing analysis of covariance and propensity score match (nearest neighbour match). Keywords: Cognitive behaviour therapy, metacognition, depressive disorders, metacognitive beliefs, depression, quality of life.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerInvestigation of the Relationship between Inflammation and Oxidative Stress Markers and Treatment Response in First-Attack Major Depression Patients: A Follow-Up Studyİlk Atak Major Depresyon Hastalarında İnflamasyon ve Oksidatif Stres Belirteçleri ile Tedavi Yanıtı İlişkisinin İncelenmesi: Bir İzlem Çalışması899910.5080/u26698ENTRGizem EMEKDARHalil İbrahim TAŞHilalŞEHİTOĞLU10.5080/u26698Objective: There is a need to biomarkers for major depression (MD). The goals of this study are to compare serum levels of oxidative stress markers malondialdehyde (MDA) and F2-isoprostane and inflammation markers tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) between patients with first-episode MD and healthy controls, to investigate the change of these markers after treatment and to investigate the relationship between levels of these markers and treatment response. Method: Our study was performed in 30 first-episode MD patients and 30 healthy volunteers. During the clinical evaluation Hamilton Depression Rating Scale and Clinical Global Impression Scale were applied to the participants. Serum levels of markers were measured at the baseline and after 8 weeks of treatment. Results: Compared to the control group, first-episode MD patients had significantly higher IL-6, CRP and MDA levels and lower F2- isoprostane levels. There was no difference between the groups in terms of TNF-α levels. TNF-α, IL-6, MDA and F2-isoprostane levels decreased significantly after treatment, whereas there was no significant change in CRP levels with treatment. Baseline F2-isoprostane levels were found to be significantly higher in treatment responders than nonresponders (p<0.05). Conclusion: In our study, it was shown that there are irregularities related to inflammatory processes and oxidative stress in MD, even in patients who had their first-episode and did not take medication, and these irregularities can be resolved after treatment. While there was a relationship between treatment response and baseline F2-isoprostane levels, there was no relationship with other biomarkers. Keywords: Biomarkers, depression, inflammation, oxidative stress, treatment response

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerEffects of Problem Solving Therapy in Substance Use Disorder in AdolescentsErgenlerdeki Madde Kullanım Bozukluğunda Sorun Çözme Terapisinin Etkileri10010910.5080/u27075ENTRÖmer KARDAŞBurcu KARDAŞHozan SAATÇİOĞLUZekiYÜNCÜ10.5080/u27075Objective: In this study, it was aimed to examine the effects of problem solving therapy, which is a cognitive behavioral method, on adolescents diagnosed with alcohol and substance use disorder. Method: A semi-structured interview and intelligence test were administered to adolescents with diagnosis of substance use disorder to identify comorbidities. 46 adolescents who met the inclusion criteria were divided into two groups. Problem solving therapy was applied to the first group for 5 weeks, once a week, while the other group continued their routine controls in the center. Beck Depression Inventory, Screen for Child Anxiety Disorders, Revised Social Problem Solving Inventory, Addiction Profile Index and Treatment Motivation Questionnaire were administered to the groups at the beginning of the study and at the end of the 5th week and the results were analyzed. Results: Sociodemographic and substance use characteristics, comorbid psychopathologies and scale mean scores of the groups in the first evaluation were found to be similar to each other. Although the depression and anxiety scores decreased significantly in both groups, no significant difference was found between the groups. Problemsolving skills and treatment motivation increased in the therapy group and decreased in the control group. The difference between groups was found to be significant (p=0.045, 0.037 for problem solving and treatment motivation respectively). While the severity of addiction decreased in therapy group, it increased in control group, but the difference was not significant. Conclusion: This study is important in that it shows that psychosocial interventions strengthen the treatment of substance use disorder in adolescents. In our country, no other study was evaluating the effects of the intervention methods in addicted adolescents was found. Future studies with larger sample sizes and where the long-term results of substance use disorder are evaluated are needed. Keywords: Adolescent psychiatry, substance-related disorders, cognitive therapy, psychotherapy, group psychotherapy

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerValidity and Reliability Study of Mental Health Recovery Measure’s Turkish VersionRuh Sağlığı İyileşme Ölçeği’nin Türkçe Formunun Geçerlik ve Güvenirlik Çalışması11011710.5080/u26480ENTRRüveyda YÜKSELHülya ARSLANTAŞFerhan DEREBOYMehtap KIZILKAYASeherİNALKAÇ10.5080/u26480Objective: The present study aims to translate into Turkish and investigate the validity and reliability of the Mental Health Recovery Measure (MHRM). Method: The sample consisted of 343 outpatients - and in-patients under treatment for a variety of psychiatric diagnoses at a state hospital and a university research hospital. The MHRM along with the Subjective Recovery Assessment Scale (SRAS), Psychological Well Being Scale (PWBS), Emotional Eating Scale (EES), and The Internalized Stigma of Mental Illness Scale (ISMI). Results: The mean MHRM total score was estimated at 31.66 (sd=10.02). Exploratory factor analysis revealed one single robust factor explaining 64% of the variance of the total scores. Alpha internal consistency coefficient was calculated as 0.94 and corrected item-total correlation coefficients were entirely above 0.60. The MHRM scores showed positive and strong correlations with the PWBS (r=0.695; p<0.001) and SRAS (r=0.732; p<0.001), negative and strong correlation with the ISMI (r=-0.696; p<0.001) and no correlation with the EES scores (r=-0.021; p=0.703). Conclusion: Our data provides initial evidence supporting the validity and reliability of the Turkish MHRM in evaluating the tendency for recovery of mental health consumers for clinical and research purposes. Further studies addressing psychometric properties of the scale are warranted. Keywords: Mental Health Recovery Measure, validity, reliability.

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerValidity and Reliability of the Turkish Version of the Mentalization Scale (MentS)Zihinselleştirme Ölçeği’nin Türkçe Çevirisinin Geçerlik ve Güvenirlik Çalışması11812410.5080/u25692ENTRZulal TÖRENLİ KAYAEmre Han ALPAYŞerif TÜRKKAL YENİGÜÇGamze ÖZÇÜRÜMEZBİLGİLİ10.5080/u25692Objective: This study, aims to translate the Mentalization Scale (MentS) into Turkish and investigate the reliability and validity of the Turkish version. Method: The participants, consisting of 615 (310 female and 305 male) Turkish speaking adults, were asked to complete the MentS and the Emotional Intelligence Feature Scale-Short Form (EIFS) and the Borderline Personality Inventory (BPI). Results: The factor structure of the scale was investigated by exploratory and confirmatory factor analysis. Similar with the original scale, findings demonstrated a three-factor structure, namely, ‘the self,’ ’others’ and ’motivation’. Corrected total score correlations for each item were between 0.28 and 0.52. The MentS score showed positive correlations with the EIFS score (r=0.49; p<0.001); and negative correlations with the BPI score (r=-0.37; p<0.001). Cronbach’s alpha internal consistency coefficient was calculated as 0.84 for the total score, 0.78, 0.80, and 0.79 for MentS-S, MentS-O, and MentS-M, respectively. Conclusion: The findings show that the 25-item MentS Turkish form has sufficient psychometric properties. Our data supports the use of the Turkish version of MentS in future studies for assessment of mentalization capacity. Keywords: Mentalization, validity, reliability

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerAssociation Between Loneliness and Suicidal Behaviour: A Scoping ReviewYalnızlık ve Özkıyım Davranışı Arasındaki İlişkinin Kapsam Derlemesi12513210.5080/u27080ENTRSheikh SHOIBTan Weiling AMANDAFahimeh SAEEDRamadas RANSINGSamrat Singh BHANDARIAishatu Yusha’u ARMIYA’UAhmet GÜRCANMiyuruCHANDRADASA10.5080/u27080Objective: Suicide is a public health issue, and there are several factors leading to suicide, like mental illness and psychosocial stressors. Actual loneliness (living alone) and subjective loneliness (feeling of being alone) and different suicidal behaviors have been reported to have some link. This scoping review aimed to assess the association between loneliness and suicidal behaviour by exploring the existing literature. Methods: A scoping review was conducted implementing the appropriate framework and in accord with the PRISMA-ScR extension. A PubMed database search was made using a combination of terms to find publications in English from 2011 to 2021. Studies were included if they reported quantitative outcomes of the association between loneliness and suicidal experiences, including suicidal thoughts, plans, and/or attempts. Screening and data charting of the published literature was conducted by a panel of authors. The accuracy and clarity of extracted data was checked by three reviewers. Results: Among 421 articles found, 31 full texts were evaluated based on exclusion and inclusion criteria, out of which, 18 papers that reported quantitative outcomes of the association between loneliness and suicidal experiences were included. We found that association between loneliness and suicidal behaviour is determined by individual, social and cultural factors. Co-existing mental illness, substance use disorder and economic hardship play an important role for the completion of suicide. Conclusion: Loneliness is correlated with suicide, and the knowledge about this association could assist in the identification of suicidal individuals or those at elevated risk of suicidal behaviour. Future studies should focus on loneliness and its relation to suicidal ideation in individuals with different mental health disorders and personalities. Keywords: Suicide, loneliness, mental disorders, stress, psychological

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerSafety Profile of Aripiprazole During Pregnancy and Lactation: Report of 2 CasesGebelik ve Emzirme Döneminde Aripiprazol Kullanımının Güvenlik Profili: 2 Olgu Sunumu13313510.5080/u26681ENTRManoj Kumar SAHOOHarshita BISWASSandeepGROVER10.5080/u26681Aripiprazole, a second-generation antipsychotic (SGA) medication, is an efficacious treatment for schizophrenia and bipolar disorder. However, its effects on pregnancy and lactation are not yet fully documented. Despite aripiprazole being available since 2002, there is only limited information on the risks and benefits of this treatment during pregnancy. Most of the information is limited to populationbased studies examining malformation risk or case studies or small case series. The knowledge in this topic is still insufficient and there is a need to expand the literature. In this report, we present 2 cases exposed to aripiprazole during pregnancy and lactational period. In both our cases of aripiprazole exposure, no teratogenic effects were reported, and it was reassuring that the mothers did not develop gestational diabetes. However, both patients reported lactation failure. Keyword: Mental illness, antipsychotics, aripiprazole, pregnancy

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerEmergence Agitation with Earthquake-Related Traumatic Stress Symptoms After Intravenous Sedationİntravenöz Sedasyon Sonrası Depremle İlişkili Travmatik Stres Belirtileri ile Seyreden Derlenme Ajitasyonu13613910.5080/u27347ENTRArda BAĞCAZAsudeAYHAN10.5080/u27347Sedation 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 Kahramanmaraş earthquake on February 6 in Turkey. Keywords: Earthquakes, intravenous anesthetics, emergence, psychomotor agitation, acute stress disorder, post-traumatic stress disorder

Türkiye Sinir ve Ruh Sağlığı DerneğiTurk Psikiyatri Derg1300-21633422023SummerPSYCHOSOCIAL PERSPECTIVE AND SUGGESTIONS ON THE PENAL EXECUTION SYSTEM IN THE PANDEMIC: THE CASE OF TURKEYSALGINDA CEZA İNFAZ SİSTEMİNE PSİKOSOSYAL BAKIŞ VE ÖNERİLER: TÜRKİYE ÖRNEĞİ14014210.5080/u26946ENTRHüseyinNERGİZ10.5080/u26946Dear Editor, The COVID-19 pandemic, which rapidly surrounds our world and has important effects on all aspects of life (especially psychological, social and economic), also affects individuals living in closed prisons (imprisoned, convicted individuals and institution employees), which are physically and socially isolated in different ways. So much so that the World Health Organization (WHO) states that prisons are among the risky groups due to their limited opportunities (difficulty of accessing the diagnostic tests, physical distance as an inherent requirement of the very nature of the service itself, inability to comply with the call to stay at home, etc.) (WHO 2021). With the onset of COVID-19 cases in Turkey, as in many countries, the General Directorate of Prisons and Detention Houses (GDPDH) under the Ministry of Justice of the Republic of Turkey also applied various restrictions to prevent the spread of the virus in prisons. Such liberties as the ability to act autonomously, demonstrating skills and competencies and establishing relationships with others, which Deci and Ryan (2000) define as motivating needs, were/are still significantly restricted by COVID measures. This letter aims to draw the attention of mental health professionals and relevant administrators to the penal system (from the perspective of both service recipients and employees as well as the community) by discussing the COVID-19 restrictions and possible effects, which are thought to have significant effects on the psychosocial status of individuals. PSYCHOSOCIAL PERSPECTIVE AND SUGGESTIONS ON THE PENAL EXECUTION SYSTEM IN THE PANDEMIC: THE CASE OF TURKEY Open and closed visits by the families and relatives of detainees/convicts (D/Cs) were suspended during March- August 2020 and February-June 2021, except for these periods only closed visits with a maximum of 2 people were allowed twice a month (GDPDH 2021a). Like all individuals, being able to establish verbal and physical contact with their relatives is an important requirement for all D/Cs. In Fahmy’s (2021) research, it was seen that the general social support from family and friends as perceived by convicts and the consistency in general and emotional social support (empathy, sharing of feelings of joy and sadness, discussing about other problems encountered in life) positively predicted mental health. From this point of view, since the quality and quantity of communication opportunities of individuals in prisons are significantly restricted, they may have negative effects. At this point, GDPDH’s doubling the phone call rights and allowing D/C individuals to have 1 open and 2 closed visits a month with their 2 relatives and 1 child as of December 2021 are important initiatives to meet the need for social support (GDPDH 2021b). However, the impoverishment of individuals, especially those with poor socioeconomic status, due to the pandemic may prevent them from adequately benefiting from the right to make phone calls and visits. For this reason, supports (right to free or discounted telephone calls, right to free or discounted transportation for visitors, etc.) for D/C individuals with low income and their relatives are considered helpful. Family visits, which are an important protective and therapeutic element for delinquent children, who are more sensitive than adults, were also suspended during the pandemic. Studies conducted with delinquent children in institutions have shown that family visits helped reduce repetitive delinquency (Young and Turanovic 2021) and depressive symptoms significantly (Monahan et al. 2011). Considering the longitudinal study findings, the development, implementation and encouragement of different interview options (weekly video calls with families, open visits conditional with vaccination and negative test results) for children in institutions should be on the agenda to protect the mental health of children and adolescents in insttitutions. Many practices, especially psychosocial intervention, which is an important part of contemporary penal execution processes, is another aspect of the pandemic requiring further attention. Various studies conducted before the pandemic point out that such activities are very important for protecting the mental health of individuals, ensuring their development, and preventing criminal behavior. The program for convicts in Australia (which includes making job application interviews, avoiding harmful substances, adaptation after release, etc.) was seen to have a significant impact on reducing the rate of recidivism and re-sentencing after 2 years as well as the severity of the crime (injury instead of manslaughter) (Graffam et al. 2014). Woods et al. (2017) draw attention to the positive effects of sports-based interventions in prisons on individuals’ self-esteem, confidence, and prosocial behavior. Vocational training and public education courses, which also serve to reduce the possibility of recidivism and meet the need for socialization and adaptation of D/Cs, were suspended during the pandemic, and the study only of individuals staying in the same room by the psychosocial unit specialists (psychologists and social workers) and teachers in the institution were allowed (GDPDH 2020). Carrying out rehabilitation (rehabilitation) studies by taking necessary precautions while protecting the physical health of the individual in prisons would be beneficial in terms of protecting both the mental health of the individuals and the society after release. The pandemic creates significant difficulties and limitations for children aged 0-6 years who live in the prison with their mothers. Children who go to kindergarten or use the playgrounds within the institution cannot access these facilities during the pandemic. Since this situation may lead to delays in the physical, mental and cognitive development of children, it is recommended that mothers with children are accommodated in the same ward as much as possible, children in the same ward should be taken to playgrounds together, etc. With such interventions, children’s need for socialization and exposure to different stimuli can be partially met. In order to reduce the possibility of virus transmission to the prisons, the employees of the institution (especially the correction officers who are in contact with D/Cs most frequently and closely) started to work with a negative PCR test after 14 days of quarantine before they started to work, and without leaving the prison for 7 days, ensuring uninterrupted service provision (GDPDH 2021a). The practice to prevent prisons from the pandemic causes various stress factors (such as very limited communication with the families, no personal telephone, being in a closed working environment for a long time, and being in contact with COVID-positive individuals who are being treated in the institution) for the employees. For this reason, practices that will reduce the stress level of prison employees (video calls with their families, providing shelter outside the building during rest times, creating indoor recreational/resting opportunities/areas) and activities that will strengthen their stress management skills (distance education/seminars, booklets, counseling services etc.) can be executed. End of 2020, GDPDH’s psychological support services to its employees and their first-degree relatives is worthy (T.R. Ministry of Justice 2020). Another new application that COVID-19 measures entailed in prisons is that individuals who go to the court or hospital could return to their wards with a negative PCR test result after being kept in quarantine wards for 14 days. This practice, which is carried out to prevent transmission inside institution, can create further coping difficulties, especially for individuals with mental/psychiatric problems. In this way, giving the quarantined individuals the right to make phone calls instead of open/closed visits they were not allowed, will both reduce inequality and meet the social support needs of individuals to a certain extent. In addition, telemedicine etc. for individuals who need psychiatric follow-up would be beneficial to provide access to treatment. Offenders under probation are also considered on leave during the pandemic with Law No. 7242 in Turkey. In studies conducted in different countries (USA and Japan), it has been observed that structured and qualified probation services (close monitoring of the offenders by the officers, consultancy, training, etc.) postponed recidivism for about 1-4 years (Yokotani and Tamura 2017, Zortman et al. 2016). Based on these findings, another issue that should be carefully considered is that the convicts in open prison or on probation were released on leave or exempted from rehabilitation programs, with the legal regulations made to relieve overpopulation in institutions during the pandemic (Republic of Turkey Official Gazette 2020, Issue: 31100). Undoubtedly, physical health is a prerequisite for survival; it is a necessity for D/Cs to continue their improvement and monitoring processes of convicts especially those with a high risk of recidivism. Many points mentioned above indicate that the pandemic caught the penitentiary system unprepared, which was natural. With a biopsychosocial approach, we believe that the effectiveness and quality of the service provided to D/Cs can be increased by scientific studies and perspectives before, during and after the pandemic. Thus, it can be ensured that both individuals (service recipients and employees) in the penitentiary system and the society experience the pandemic with lesser damage. However, unfortunately, as in many institutions, scientific studies have been suspended in order to prevent contamination. Examining the psychosocial status of individuals with scientific methods and tools during the pandemic process will guide the employees of the institution in order to prevent negative reactions such as self-harm and suicide and to carry out studies that protect the mental health of individuals. For this reason, it will be beneficial for all parties that GDPDH allows scientific studies and increases cooperation with scientists by applying necessary physical precautions and regulations against contamination. REFERENCES Deci EL, Ryan RM (2000) The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychol Inq 11: 227-68. Fahmy C (2021) First weeks out: Social support stability and health among formerly incarcerated men. Soc Sci Med 282. Graffam J, Shinkfield AJ, Lavelle B (2014) Recidivism among participants of an employment assistance program for prisoners and offenders. Int J Offender Ther, 58: 348-63. Monahan KC, Goldweber A, Cauffman E (2011) The Effects of Visitation on Incarcerated Juvenile Offenders: How Contact with the Outside Impacts Adjustment on the Inside. Law Hum Behav 35: 143–51. TR Ministery of Justice (2020) Cezaevinde görev yapan personel ve ailelerine psikolojik danışmanlık hizmeti verilecek (Psychological counseling will be provided to the personnel working in the prison and their families). Retrieved September 22, 2021 from https://basin.adalet.gov.tr/ cezaevinde-gorev-yapan-personel-ve-ailelerine-psikolojik-danismanlikhizmeti- verilecek?fbclid=IwAR3_USxsXKc7Zt5AjUwkwiKsvjygkS_ HncUD3NJtWy7mOgg91h5J6PQF5nc. TR Ministery of Justice General Directorate of Prisons and Detention Houses (GDPDH) (2020) Kovid-19 Pandemi Sürecinde Ceza İnfaz Kurumları – 1 (Penal Institutions During the Covid-19 Pandemic Process – 1). Retrieved December 22, 2021 from https://cte.adalet.gov.tr/Home/SayfaDetay/ ceza-infaz-kurumlarinda-kovid-19-pandemi-surecine-dair-kamuoyuaciklamasi17062020045113. TR Ministery of Justice General Directorate of Prisons and Detention Houses (GDPDH) (2021a) Kovid-19 Pandemi Sürecinde Ceza İnfaz Kurumları – 4 (Penal Institutions During the Covid-19 Pandemic Process – 4). Retrieved December 22, 2021 from https://cte.adalet.gov.tr/Home/SayfaDetay/kovid- 19-pandemi-surecinde-ceza-infaz-kurumlari-iv28062021073737 TR Ministery of Justice General Directorate of Prisons and Detention Houses (GDPDH) (2021b) Ceza İnfaz Kurumlarında Covid-19 Pandemi Sürecinde Yapılacak Açık Görüşlerde Ziyaretçilere İlişkin Alınacak Tedbirler Hakkında Duyuru (Announcement on Measures to be Taken Regarding Visitors in Open Visits During the Covid-19 Pandemic Process). Retireved November 30, 2021 from https://cte.adalet.gov.tr/Home/SayfaDetay/ceza-infazkurumlarinda- covid-19-pandemi-surecinde-yapilacak-acik-goruslerdeziyaretcilere29112021052648 TR Official Gazette. 7242 sayılı Ceza ve Güvenlik Tedbirlerinin İnfazı Hakkında Kanun ile Bazı Kanunlarda Değişiklik Yapılmasına Dair Kanun (Law No. 7242 on the Execution of Penalties and Security Measures and Amending Some Laws). 15.04.2020. No: 31100. Retrieved September 22, 2021 from https://www.resmigazete.gov.tr/eskiler/2020/04/20200415-16.htm Woods D, Hassan D, Breslin G (2017) Positive collateral damage or purposeful design: How sport-based interventions impact the psychological well-being of people in prison. Ment Health Phys Act 13: 152-62. World Health Organization (2021) Why people living and working in detention facilities should be included in national COVID-19 vaccination plans: advocacy brief (2021). Retrieved September 15, 2021 from apps.who.int/ iris/bitstream/handle/10665/341497/WHO-EURO-2021-2569-42325- 58577-eng.pdf?sequence=1&isAllowed=y Yokotani K, Tamura K (2017) The effect of a social reintegration (parole) program on drug-related prison inmates in Japan: A 4-year prospective study. Asian Journal of Criminology 12: 127–41. Young B, Turanovic JJ (2021) What about the kids? Examining the visitationrecidivism relationship among incarcerated juveniles. Youth Soc. Early release. Zortman JS, Powers T, Hiester M et al. (2016) Evaluating reentry programming in Pennsylvania’s Board of Probation & Parole: An assessment of offenders’ perceptions and recidivism outcomes. Journal of Offender Rehabilitation, 55: 419–42.