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ARCHIVES OF NEUROPSYCHIATRY
CİLT / VOLUME 52 SAYI / ISSUE 1 MART / MARCH 2015
52
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
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
www.noropsikiyatriarsivi.com
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
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
Haşmet Hanağası, İstanbul, Türkiye
Figen Karadağ, 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
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
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
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
Teknik Editörler /
Technical Editors
İstatistik Danışmanı /
Consulting Editor for Statistic
Genetik Danışmanı /
Genetic Advisor
Etik Danışmanı /
Ethical Advisor
Hacer Durmuş, İstanbul, Türkiye
Rahşan Erim, Balıkesir, Türkiye
Mustafa Ertaş, İstanbul, Türkiye
Bahar Tanyaş, İstanbul, Türkiye
Hande Çağlayan, İstanbul, Türkiye
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.
Yayıncı/Publisher
Mali İşler Koordinatörü/Finance Coordinator
Yayın Yönetmeni/Publication Director
Proje Koordinatörleri/Project Coordinators
İbrahim KARA
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
A-I
Veysel KARA
Hakan ERTEN
Zeynep YAKIŞIRER
Grafik Departmanı/Graphics Department
Ünal ÖZER
Neslihan YAMAN
Merve KURT
İletişim/Contact
Address/Adres: Büyükdere Cad.
No: 105/9 34394 Mecidiyeköy,
Şişli-İstanbul
Phone/Telefon: +90 212 217 17 00
Fax/Faks: +90 212 217 22 92
E-mail/E-posta: [email protected]
Yayın Türü: Yerel Süreli
Basım Tarihi: Mart 2015
ISSN: 1300-0667
Baskı
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Litros Yolu 2. Matbaacılar S. E Blok
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Tel : +90 212 567 12 42
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 MedlineUlusal 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
www.noropsikiyatriarsivi.com adresinden ulaşılabilmektedir. Dernek
üyeleri dışında dergiye abone olmak isteyen kişiler Türk Nöropsikiyatri
Derneği’ne başvurmalıdır.
Adres: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul
Telefon: +90 212 217 17 00
Faks: +90 212 217 22 92
E-mail:[email protected]
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Baskı izinleri için başvurular Türk Nöropsikiyatri Derneği’ne yapılmalıdır.
Yazılı izin alınmadan dergide yer alan yazılar ve görseller çoğaltılamaz.
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Telefon: +90 212 217 17 00
Faks: +90 212 217 22 92
E-mail:[email protected]
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Reklam ile ilgili başvurular yayınevine yapılmalıdır.
Yayıncı: AVES
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Telefon: +90 212 217 17 00
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Yazarlara Bilgi
Yazarlara Bilgi kısmına dergi sayfalarından ve www.noropsikiyatriarsivi.
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
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 ULAKBIM-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 www.noropsikiyatrarsivi.com. 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: +90 212 217 17 00
Fax: +90 212 217 22 92
E-mail:[email protected]
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: +90 212 217 17 00
Fax: +90 212 217 22 92
E-mail:[email protected]
A-III
Advertisement
Applications concerning advertisement should be made to the publishing house.
Publisher: AVES
Address: Büyükdere Cad. 105/9 Mecidiyeköy, Şişli, İstanbul
Phone: +90 212 217 17 00
Fax: +90 212 217 22 92
E-mail:[email protected]
Web Page: http://www.avesyayincilik.com
Instruction to Authors
The section on Instruction to Authors may be obtained from the
journal pages and www.noropsikiyatriarsivi.com
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.
İçindekiler
Editörden
1
Ciddi Ruhsal Hastalıklarda Süreç ve Sonuç Olarak İyileşme
Mustafa YILDIZ; Kocaeli
Gözden Geçirme Makalesi
4
Sosyal Anksiyete Bozukluğunda Dikkat Yanlılığı ve Eğitimi
Nurhan FISTIKCI, Ömer SAATÇİOĞLU, Ali KEYVAN, Volkan TOPÇUOĞLU; İstanbul
Araştırma Makaleleri
8
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
15
Canlı Vericili Karaciğer Nakli Sonrasında Erken Dönemde Gelişen Nörolojik Komplikasyonların Değerlendirilmesi
Emrah OTAN, Cemalettin AYDIN, Hüseyin YÖNDER, Cüneyt KAYAALP, Yüksel KAPLAN, Sezai YILMAZ; Malatya
19
İstanbul’da Bir Grup Lise Öğrencisinde Ebeveyn Tutumlarının
Burcu GÖKSAN YAVUZ, İlke YESER, Oğuz KARAMUSTAFALIOĞLU, Bahadır BAKIM, Aliye GÜNDOĞAR; İstanbul, Batman
24
Obstruktif Uyku Apne Sendromunda Nöropati ve Disotonomi
Ahmet EVLİCE, Burcu UĞUREL, Barış BAKLAN, İbrahim ÖZTURA; Adana, İstanbul, İzmir
29
Türkiye’de Genç Yetişkinlerde Kesi Anketi ve İçme Sıklığına Göre Madde ve Alkol Kullanımı
Hatice DEMİRBAŞ; Ankara
36
Dissosiyasyon ve Bilişsel Bozukluk Arasındaki İlişki
Osman ÖZDEMİR, Pınar GÜZEL ÖZDEMİR, Murat BOYSAN, Ekrem YILMAZ; Van
42
Obezitede Psikolojik Belirtiler ve İlişkili Etmenler
Taner DEĞİRMENCİ, Nalan KALKAN-OĞUZHANOĞLU, Gülfizar SÖZERİ-VARMA, Osman ÖZDEL, Semin FENKÇİ; Denizli
47
Epilepsili Çocuklarda Nöbet Öz-Yeterlik Ölçeği Geçerlik ve Güvenirlik Çalışması
Şerife Tutar GÜVEN, Ayşegül İŞLER; Antalya
54
Obsesif Kompulsif Bozukluklu Hastalarda Obsesif İnançlarin Belirtilerle İlişkisi
Selim TÜMKAYA, Filiz KARADAĞ, Nalan OĞUZANOĞLU; Denizli
59
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
64
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
69
Siyaloreli Parkinson Hastalarında Tekrarlanan Botulinum Toksini Tedavisinin Etkileri
Aysu ŞEN, Baki ARPACI; İstanbul
73
Travma Sonrası Stres Bozukluğunda Kortikal Eksitabilite ve Saldırgan Davranış
Abdullah BOLU, Adem BALIKCI, Murat ERDEM, Taner ÖZNUR, Cemil ÇELİK, Özcan UZUN; Eskişehir, Ankara
78
Türkiye’de Maternal Filisid Olgularının Adli Tıp Yönünden Analizi: Bir Klinik Araştırma
Salih Murat EKE, Saba BAŞOĞLU, Şafak TAKTAK, Gökhan ORAL; Kırıkkale, İstanbul, Kırşehir
83
Uyku Yoksunluğunun Duygudurum Profili ve Dissosiyasyon Üzerine Etkisi ve Biyokimyasal Değişimlerle İlişkisi
Yavuz SELVİ, Sultan KILIÇ, Adem AYDIN, Pınar GÜZEL ÖZDEMİR; Konya, Kahramanmaraş, Van
89
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
95
Türkiye’de Psikiyatri Makalelerinde Kadın Yazarların Katılımının Uzun Dönemli Bir Analizi
Özlem ERDEN AKİ, Elçin ÖZÇELİK EROĞLU, Ece USLU; Ankara, Lefkoşa
Olgu Sunumları
99
102
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
107
Nadir Bir Baş Dönmesi Nedeni Olarak Glomus Tümörü
Hasan Hüseyin KOZAK, Ali Ulvi UCA; Konya
A-VIII
Contents
Editorial
1
Recovery as a Process in Severe Mental Illnesses
Mustafa YILDIZ; Kocaeli
Review Article
4
Attentional Bias and Training in Social Anxiety Disorder
Nurhan FISTIKCI, Ömer SAATÇİOĞLU, Ali KEYVAN, Volkan TOPÇUOĞLU; İstanbul
Research Articles
8
15
19
24
29
36
42
47
54
59
64
69
73
78
83
89
95
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
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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
99
102
Modafinil-Induced Psychosis: A Case Report
Özgür AYTAŞ, Hayriye DİLEK YALVAÇ; Malatya, Ankara
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Letter to the Editor
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Glomus Tumor as a Rare Cause of Dizziness
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Editorial / Editörden
Arch Neuropsychiatr 2015; 52: 1-3 • DOI: 10.5152/npa.2015.0120148
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: +90 533 747 50 42 E-mail: [email protected]
©Copyright 2015 by Turkish Association of Neuropsychiatry / ©Telif Hakkı 2015 Türk Nöropsikiyatri Derneği
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
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.
2 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
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.
psychiatrists. Establishing the recovery orientation services must involve
multi-level systemic changes as well as changes in medical education (15).
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.
7.
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
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