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Objective: A new type of coronavirus appeared in Wuhan, China, in December 2019, spreading rapidly and causing a pandemic. Healthcare professionals were at the front line fighting the pandemic. The aim of this study is to examine the effects of the Covid-19 pandemic on physicians in Turkey, including anxiety levels and other possible contributing variables. Method: The questionnaire prepared by the researchers was administered to the participants over the internet. The questionnaire was anonymized and contained questions about variables such as sociodemographic and professional characteristics, recent history of traveling abroad, presence of a chronic disease history, level of knowledge about Covid-19, ways of obtaining information, and measures taken in their daily and professional lives. The Hospital Anxiety and Depression Scale (HADS) was administered following the information form. Results: In the specified timeframe, 1249 doctors who completed the questionnaire in full were included in the study. Of the study participants, 50.4% reported that they were psychologically affected by current events related to Covid-19. The mean score of the HADS anxiety subscale was 7.342 (standard deviation [SD]=4.756) and the mean score of the depression subscale was 5.64 (SD=4.236). It was observed that physicians who state being affected psychologically have lower levels of knowledge and higher anxiety and depression scores than physicians who declare not to be affected. In addition, it was found that being of the female gender, having a mental illness, having a family member with a chronic illness, and living with one's family are associated with increased levels of anxiety and depression. Conclusion: The anxiety levels of physicians in Turkey having to deal with the Covid-19 pandemic increase significantly as is the case in other parts of the world. It will be beneficial to take necessary precautions for physicians with characteristics that may be related to anxiety. It is important to create and maintain psychosocial support programs for all physicians. [ABSTRACT FROM AUTHOR]

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The aim of the study reported here was to examine the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in elderly patients with depression. Patients and methods: Sixty-five depressed elderly patients received rTMS over their left prefrontal cortex for 6 days per week, from Monday to Saturday, for 3 weeks. The rTMS intensity was set at 100% of the motor threshold and 25 Hz stimulation with a duration of 2 seconds and was delivered 20 times at 30-second intervals. A full course comprised an average of 1000 magnetic pulses. Depression was rated using the Hamilton Depression Rating Scale (HAMD) before and after treatment. Response was defined as a 50% reduction in HAMD score. Patients with HAMD scores , 8 were considered to be in remission. Results: The mean HAMD score for the study group decreased from 21.94 ± 5.12 before treatment to 11.28 ± 4.56 after rTMS (P , 0.001). Following the treatment period, 58.46% of the study group demonstrated significant mood improvement, as indexed by a reduction of more than 50% on the HAMD score. Nineteen of these 38 patients attained remission (HAMD score , 8), while 41.54% of all study patients achieved a partial response. None of the patients had a worsened HAMD score at the end of the treatment. Treatment was generally well tolerated and no serious adverse effects were reported. Conclusion: In this study, rTMS was found to be a safe, well-tolerated treatment, and a useful adjunctive treatment to medications in elderly treatment-resistant depressed patients. This study contributes to the existing evidence on the antidepressant effect of rTMS in the treatment of depression in patients over 60 years of age. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the ethical issues involving the use of neuromodulation and brain stimulation techniques in treating psychiatric disorders.

Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). The purpose of our study was to compare the dose of propofol in valproateusing patients with valproate free patients. In an open study, 17 patients with bipolar affective disorder manic episode who were to be treated with valproate and ECT combination, compared with 16 manic episode patients who were to be treated with ECT but not valproate. Two groups were compared on the basis of electroencephalography-registered seizure duration and propofol dosage required to induce anesthesia. Valproate, as compared with valproate free group, results in a decrease in propofol dose necessary to induce anesthesia. In valproate group, seizure duration was significantly shorter than valproate free group. In recent studies during the ECT of patients with schizophrenia, propofol was shown to possess significant seizure-shortening properties. When the clinician needs to prolong seizure length in patients under valproate treatment, interruption of valproate treatment or using an anesthetic agent other than propofol should be considered. The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episode. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. [ABSTRACT FROM AUTHOR]

The response of individual patients to the same drug given in the same dose varies considerably. Many patients will experience the desired drug effect, others may experience no effects, yet others may suffer from well-known adverse drug reactions, and very rarely individual patients will die from severe side effects. TDM is based on the principle that for some drugs there is a close relationship between the plasma level of the drug and its clinical effect. If such a relationship does not exit TDM is of little value. Like any diagnostic test, the measurement of plasma level is justified only when the information provided is of potential therapeutic benefit. The clinical value of plasma level monitoring depends on how precisely the treatment outcome can be defined. the extent and rate of drug absorption, distribution, tissue binding, biotransformation, and excretion, which can vary markedly between individual patients due to differences in gender, age, morbidity, smoking or eating habits, differential expression of drug metabolizing enzymes or drug transporters or other factors. Therefore drug concentrations in blood resulting after a given dose differ by tenfold or more between individual patients. The pharmacokinetic phenotype of an individual can be measured by analysis of drug concentrations in blood plasma or serum, by TDM. TDM is well established for mood stabilizers, especially for lithium. For other neuropsychiatric drugs, routine TDM is rare. TDM will be useful if the following criteria are met: 1) the drug in question has a narrow therapeutic range, 2) a direct relationship exists between the drug or drug metabolite levels in plasma and the pharmacological or toxic effects, 3) the therapeutic effect cannot be readily assessed by the clinical observation, 4) large individual variability in steady state plasma concentration exits at any given dose 5) appropriate analytic techniques are available to determine the drug and metabolite levels. TDM is a method used to provide optimal pharmaceutical therapy. Knowing the plasma concentration of psychoactive medication helps monitor the side effects of the medication in order to prevent toxicity and increase the responsiveness of the medication. In therapeutic drug monitoring, psychoactive drugs are divided into 4 groups: 1. The most recommended group consists of: lithium and carbamazepine. Monitoring the levels of valproic acid is important in order to prevent toxicity from occurring. 2. Clozapine and similar medications are considered one group of medication whose side effects should be monitored. 3. On the other hand, medications that should be closely observed but have an elapsed response rate are included into the group monitored for response time. 4. This group of medication is often monitored in order to place a pre-diagnosis for treatment-resistant patients who may have genetic polymorphism and choose the correct medication. More studies with adequate design are still required to obtain more data on plasma concentrations and therapeutic response relationships. [ABSTRACT FROM AUTHOR]

Transcranial direct stimulation is a noninvasive brain stimulation method. Although exact mechanism is not known; depolarization and increase in spontaneous neuronal activity in the cell membrane occurs by anodal stimulation; decrease in neuronal activity occurs by cathode stimulation. In this study, files of the hospitalized and outpatient patients on whom transcranial direct stimulation was performed in a psychiatry hospital between December 2011 and September 2012 were evaluated. The mean age of the patients was 45,7 years. 14 of the cases were males (48,3%) and 15 were (51,7%) females. The mean duration of disease history was 7,8 years. Diagnostic distribution was as follows; major depressive episode (n=8 cases); dementia comorbid with depression (n=5); bipolar affective disorder-depressive episode (n=5); panic disorder (n=4); bipolar affective disorder -hypomanic episode (n=3); obsessive compulsive disorder comorbid with depression (n=2); alcohol addiction comorbid with depression with psychotic features (n=1). Response to treatment with tDCS was evaluated with brief psychiatric rating scale in all patients. Hamilton depression rating scale (HAM-D) was used for the evaluation of those patients with depression in addition to BPRS. A paired-samples t test was performed to evaluate the effectiveness of tDCS yielding a significant decrease in post treatment BPRS scores (p= .001) and HAM-D scores (p=.003). Patients were also receiving pharmacotherapy and psychotherapy which might have been responsible for the clinical improvement, however the aim of this study is not to evaluate clinical efficacy. Generally, transcranial direct stimulation is considered an option in cases in whom additional brain stimulation treatments such as electroconvulsive therapy is needed but at the same risky for the patient or in cases unresponsive to these therapies. [ABSTRACT FROM AUTHOR]

Hypotension is a known effect of atypical antipsychotics. However, there is little information on acute hypertension resulting from antipsychotic drugs. Aripiprazole is a potent partial dopamine D2 agonist, a serotonin 5-HT1A agonist and a 5-HT2A antagonist. It also displays high affinity for the α-1B, -2A, -2C and β1, -2 adrenergic receptors. Many studies underline the role of α-1A adrenergic receptors in malignant hypertension. Here we present a case of a 38-years old male patient with psychotic depression. Aripiprazole was initiated at 10 mg/d and 36 hours after the first dose the patient complained of headache and palpitation. His physical examination revealed that he developed a hypertensive crisis with arterial hypertension (170/95 mmHg) and tachycardia (118 beats/minute). His blood pressure returned to normal 3 days after the interruption of aripiprazole. Although the mechanism underlying the rise in blood pressure remains unclear, careful monitoring of blood pressure variations when administering aripiprazole to patients previously treated for high blood pressure is necessary. [ABSTRACT FROM AUTHOR]

Objective: A significant revision in criteria related to bipolar disorder in DSM-5 has been done. This study evaluated the impact of these changes on diagnosis and reviewed the challenges that clinicians and researchers will encounter in the use and implementation of DSM-5 criteria for bipolar disorder. Methods: The sample consisted of a total of 82 patients (50 women and 32 men) with a diagnosis of bipolar disorder according to DSMIV, with an average age of 36.9±10.8 years. All participants had been monitored in our outpatient department for at least 2 years and during that time had received a diagnosis of bipolar disorder. Their last episodes were reviewed according to DSM-5 criteria and changes in diagnosis are evaluated. Results: When using the DSM-5 criteria, there was an increase in the number of cases diagnosed with manic episode compared to using the DSM-IV TR criteria (43 vs. 24 cases). As DSM-5 does not include a mixed episode diagnosis, a portion of the cases (69.3%) diagnosed with mixed episode according to DSM-IV TR were diagnosed with manic episode/additional feature by DSM-5, with the remaining cases 30.7% described as undefined/additional feature Conclusion: Our results suggest that an additional 18.2% of bipolar disorder patients met the diagnostic threshold for manic episode when using DSM-5 criteria, compared to previous criteria. Clinical trials may now also need to focus on treatment effects in patient groups with or without mixed features. Medications that are efficient in treating mixed episodes defined according to DSM-IV TR may also be useful in treating mixed features as defined by DSM-5, but further studies will be required to assess this assumption. [ABSTRACT FROM AUTHOR]