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Öğe Comparison of Venlafaxine Alone Versus Venlafaxine Plus Bright Light Therapy Combination for Severe Major Depressive Disorder(PHYSICIANS POSTGRADUATE PRESS, 2015) Ozdemir, Pinar Guzel; Boysan, Murat; Smolensky, Michael H.; Selvi, Yavuz; Aydin, Adem; Yilmaz, EkremObjective: Phototherapy, ie, bright light therapy, is an effective and safe treatment of major depressive disorder (MDD). It exerts rapid mood-elevating activity, similar to antidepressant medications, most likely mediated through both monoaminergic and circadian system melatonergic mechanisms. We assessed the efficiency of bright light therapy as an adjuvant treatment to antidepressant pharmacotherapy in patients with severe MDD randomized by Hamilton Depression Rating Scale (HDRS) score to either (1) 150 mg venlafaxine hydrochloride daily at 7: 00 am or (2) 150 mg venlafaxine plus 60-minute light of 7000 lux the initial week of clinical management (venlafaxine + bright light therapy) daily at 7: 00 am. Method: 50 inpatients with severe MDD at the Psychiatry Clinic of Yuzuncu Yil University Training and Education Hospital participated. The study, which was conducted from January 2013 through June 2014, entailed patients diagnosed with severe MDD based on DSM-IV-TR for the first time. Mood states were assessed by the HDRS, Profile of Mood States (POMS), and Beck Depression Inventory (BDI) before treatment and at 1, 2, 4, and 8 weeks of treatment. Results: On the basis of the HDRS score as the primary outcome variable, both strategies significantly improved depression and negative mood states already at the first treatment week (P < .001). Differences in therapeutic effects by treatment strategy were remarkable at the second and fourth weeks of clinical management (P = .018 and P = .011, respectively), with beneficial effects continuing until trial Conclusion. Those treated with venlafaxine + bright light therapy evidenced significantly lower HDRS depression scores (P < .05) as well as BDI scores (P < .05) and POMS negative mood states scores (depression-dejection, tension-anxiety, anger-hostility, fatigue-inertia, and confusion-bewilderment subscales; all P < .05) after the second week. At week 4 of the trial, 19 (76%) of the 25 venlafaxine + bright light therapy patients versus just 11 (44%) of the 25 venlafaxine patients (P < .05) attained the target goal of treatment, a HDRS score = 13, indicative of mild depression, and, although not statistically significant in our small sample study (P = .36), at week 8, 76% of venlafaxine + bright light therapy patients (n = 19) versus just 64% of the venlafaxine patients (n = 16) experienced complete remission of depression (HDRS score = 7). Conclusions: Both venlafaxine and venlafaxine + bright light therapy treatment strategies significantly reversed the depressive mood of patients with severe MDD; however, the latter induced significantly stronger and more rapid beneficial effects. Future longer-term studies with large sample sizes, nonetheless, are required to confirm and generalize these results to patients of diverse ethnicities and cultures with both severe and mild MDD. (C) Copyright 2015 Physicians Postgraduate Press, Inc.Öğe Psychometric properties of the Turkish version of the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Turkish CAPS-5)(TAYLOR & FRANCIS LTD, 2017) Boysan, Murat; Ozdemir, Pinar Guzel; Yilmaz, Ekrem; Selvi, Yavuz; Ozdemir, Osman; Kefeli, Mehmet CelalBackground: In the subsequent revision of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) symptoms of diagnostic criteria for post-traumatic stress disorder (PTSD) are defined in four clusters and the number of PTSD symptoms was expanded to 20. The Clinician-Administered PTSD Scale (CAPS) is the most widely used structured clinical interview and recognized as the golden standard in PTSD diagnosis. The final revision of the clinical interview form as the CAPS for DSM-5 (CAPS-5) was advanced in line with the recent revisions in DSM-5 with regards to the PTSD definition. The aim of this study was to examine the psychometric properties of the Turkish version of CAPS-5 in clinical samples and healthy controls. Methods: In the present study, 30 inpatients with PTSD and 30 inpatients with major depressive disorder consecutively presented to the Psychiatry Outpatient Clinic Yuzuncu Yil University Research Hospital, and 30 healthy controls were enrolled. All participants were included if only they reported an index trauma in the Life Events Checklist for DSM-5 (LEC-5) that bothered them during the past month. Subjects were administered a socio-demographic questionnaire, the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) along with the LEC-5, CAPS-5 and PTSD Checklist for DSM-5 (PCL-5). We used confirmatory factor analysis to compare a structured clinical interview (CAPS-5) and a self-report measure, the PCL-5 and to examine DSM-5 implied four-symptom clusters and several factor structures proposed in the literature to understand which model best represents the latent factor structure of PSTD symptoms. Using multivariate analysis of covariance, concurrent validity of both self-report and structured clinical interview was evaluated. Receiver operating characteristics (ROC) curve was utilized to obtain an optimal cut-off value of the PCL-5 scores in order to use in demarcating cases with non-cases. Results: Even though DSM-5 implied four-factor model adequately fit to either data collected using self-report or clinician-administered measures of PTSD, the latent structure of PTSD symptoms measured by either CAPS-5 or PCL-5 were best represented by six-factor Externalizing Behaviors model, particularly compared to seven-factor Hybrid model. In comparison to depressive and control groups, PTSD patients reported greater scores on the PCL-5, DES, BDI, and BAI and McNemar.2 values between two applications with two weeks interval were unsubstantial. Additionally, PTSD patients exhibited greater symptom endorsement on B, C, D, E, F, G symptom clusters and dissociative subtype than depressive patients and controls. Using signal detection analysis, a significant area under the curve (AUC) was calculated for the PCL-5 (AUC = 0.87 p < 0.001 asymptotic 95% Confidence Interval = 0.798-0.942). The PCL-5 had excellent diagnostic utility with 0.90 sensitivity and 0.80 specificity on a cut-off score >= 47. Conclusion: Turkish versions of the CAPS-5 and PCL-5 are demonstrated to have very good psychometric properties. Implications regarding the findings are discussed.Öğe Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)(TAYLOR & FRANCIS LTD, 2017) Boysan, Murat; Ozdemir, Pinar Guzel; Ozdemir, Osman; Selvi, Yavuz; Yilmaz, Ekrem; Kaya, NurayObjective: The posttraumatic stress disorder (PTSD) Checklist is one of the most widely used screening tool in assessing PTSD symptomatology. Several changes to PTSD definition were made in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The aim of the study was to assess psychometric properties of the Turkish version of the PTSD Checklist for DSM-5 (PCL-5), the revised version conforming to the advances in DSM-5. Method: Psychiatric outpatients with PTSD (n = 29) and major depressive disorder (n = 73) and a community group (n = 360) included in the study. Respondents completed the PCL-5, Trauma Symptom Checklist-40, Life Events Checklist for DSM-5, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory and Posttraumatic Cognitions Inventory. Results: We found a four-factor solution best fit to the data providing support for the vast array of PTSD research. The PCL-5 demonstrated good reliability with composite reliability coefficients of re-experiencing (.79-.92), avoidance (.73-.91), negative alterations (.85-.90) and hyper-arousal (.81-.88) and temporal reliability with two-week test retest intra-correlation coefficients of .70, .64, .78, and .76, respectively. Strong associations of the total and sub-scale scores of the PCL-5 with other measures of trauma-related symptoms were indicative of construct validity of the screening tool. The current investigation suggested a cut-off score >= 47 for PTSD diagnosis, with .76 sensitivity and .69 specificity. Conclusion: The PCL-5 is a promising screening tool with sound psychometric properties.Öğe Psychometric properties of the Turkish version of the Sleep Hygiene Index in clinical and non-clinical samples(W B SAUNDERS CO-ELSEVIER INC, 2015) Ozdemir, Pinar Guzel; Boysan, Murat; Selvi, Yavuz; Yildirim, Abdullah; Yilmaz, EkremObjective: Sleep is one of the most significant of human behaviors, occupying roughly one third of human life. Sleep is a process the brain requires for proper functioning. Sleep hygiene can be described as practices to ease sleep and to avoid factors which decrease sleep quality. Inadequate sleep hygiene generally results in disturbance of daily life activities due to inability to sustain sleep quality and daytime wakefulness. Therefore, the importance of development and utilization of measures of sleep hygiene increases. The aim of the study was to assess psychometric properties of the Sleep Hygiene Index (SHI) in clinical and non-clinical Turkish samples. Method: Data were collected from 106 patients with major depression consecutively admitted to the psychiatry clinic of Yuzuncu Yil University School of Medicine and 200 were volunteers recruited from community sample who were enrolled at the university. The SHI, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) were administered to the subjects. Factor structure of the SHI was evaluated with explanatory and multi-sample confirmatory factor analyses. Pearson product-moment correlation coefficients of the SHI with the PSQI, IST and ESS were computed. Item analyses, internal consistency coefficients and intra-class correlations between two repeated applications in both patient and healthy subjects were calculated. Results: The Sill revealed a unidimensional factor structure. Significant strong partial associations of the SHI with depression, insomnia and poor sleep quality and a modest partial association with sleepiness were detected. Cronbach's alphas for the SHI in community sample and patients with major depression were 0.70 and 0.71, respectively. Additionally, we found acceptable three-week temporal reliability in terms of intra-correlation coefficients of r = 0.62, p < 0.01 for the community sample and of r = 0.67, p < 0.01 among patients with major depression. Conclusion: The SHI revealed adequate validity and reliability to be used by researchers in Turkish sample. Current results were discussed in light of previous findings and theoretical considerations. (C) 2015 Elsevier Inc. All rights reserved.
