Introduction: Electroconvulsive therapy (ECT) is known to be an effective option in the treatment of mood disorders, especially resistant depression. However, the remission achieved by ECT was reported to be not long lasting enough. The aim of the present study was to investigate the relapse/recurrence rates and associated risk factors during the first year after ECT in patients diagnosed with mood disorders.Methods: In a naturalistic observation, patients diagnosed with unipolar depressive disorder or a depressive episode of bipolar disorder and who had achieved remission by ECT were followed up for at least one year. The patients were evaluated with structured interviews during the follow-up period. The relapse/recurrence rates were the primary outcome measurements, while hospitalization and suicide attempts were the secondary outcome measurements. The remitted and non-remitted patients were compared regarding the clinical features, ECT, and pharmacological variables.Results: Fifty of 62 patients who had achieved remission with ECT completed the one year follow-up period. Thirty-three patients (66%) had relapse/recurrence, while 17 (34%) patients remained in remission. The relapse rates were similar in patients with unipolar depression and bipolar disorders. The mean number of ECT sessions was higher in relapsed patients with bipolar disorders. Multiple episodes were more frequent in non-remitted patients with unipolar depression. Comorbid psychiatric diagnosis was higher in non-remitted patients with unipolar and bipolar disorders. Conclusion:The relapse/recurrence rate was found to be fairly high in the first year of follow-up in patients who had achieved remission with ECT. ECT decisions should be made carefully in patients with comorbid psychiatric diagnosis and multiple episodes as these are more risky. The ECT application procedure and successive maintenance treatment (maintenance ECT, pharmacotherapy, and psychotherapy) should be planned to sustain the remission for patients with mood disorders in long-term follow-up.Keywords: Electroconvulsive therapy, mood disorders, relapse, remission, major depression Arch Neuropsychiatry 2017; 54: 196-201 • DOI: 10.5152/npa.2016.14845 Electroconvulsive ABSTRACT INTRODUCTONThe efficacy of pharmacotherapy in mood disorders is not satisfactory, and the desired remission rates are not currently achieved in either unipolar (UD) or bipolar disorders (BP) (1,2,3). Electroconvulsive therapy (ECT) has been used for a long time with successful response and remission rates; 80-90% of patients experience an improvement, and the efficacy of ECT has been established to be between 60% and 90% regarding acute response in treatment-resistant depression (3,4,5,6,7). ECT is also considered to be an effective treatment in bipolar depression and is indicated to be equally effective in unipolar and bipolar depression (8,9,10). The effectiveness of ECT in the treatment of UD and BP has also been reported, and it is recommended by guidelines (11,12,13,14). However, the literature data...

Aim: Negative symptoms and cognition are related with functioning in schizophrenia. However, it is not clear whether they have a similar effect in individuals at ultra-high risk (UHR) for psychosis. In this study, we aimed to explore relationship of negative symptoms with cognition and functioning cross-sectionally in people with UHR for psychosis.Methods: In total, 107 people participated in this study. We assessed negative symptoms with Scale for Negative Symptoms (SANS). We applied a cognitive battery including seven tests. We evaluated functioning by using Global Assessment of Functioning Scale and work/study status as an indicator of role functioning.Results: SANS scores were correlated to global functioning cross-sectionally. SANS total score was correlated to cognitive test scores related to cognitive flexibility and attention. Only Trail Making Test B (TMT B) was negatively correlated to global functioning. SANS-affective blunting and SANS-avolition scores were independently related to global functioning. There was a significant indirect effect of the TMT B and composite attention scores on global functioning through negative symptoms indicating a complete mediation. Conclusion:Our findings suggest that negative symptoms, particularly avolition have an impact on functioning and the association of cognition with functioning was mediated by negative symptoms in UHR.

Aims: To perform the validation of the Comprehensive Assessment at Risk Mental State (CAARMS) in Turkish.Methods: Sixty-five volunteers (15-24 years) were enrolled in this study. Concurrent validity was performed with Spearman's Correlation Test using Brief Psychiatric Rating Scale (BPRS). Median scores of the groups were compared using Mann-Whitney U Test. Interrater reliability was assessed by intragroup correlation coefficient method. Internal consistency was studied by the calculation of Cronbach Alfa Coefficient.Results: The correlation of the severity scores of the CAARMS with unusual thought content, suspiciousness, hallucinations and conceptual disorganization items of the BPRS showed that the concurrent validity was good. ROC analysis revealed that CAARMS could discriminate between individuals with UHR and healthy volunteers well. We found a good correlation between the raters. Internal consistency was at very high level. Conclusion:Analyses of concurrent validity, criterion validity, interrater reliability and internal consistency indicate that the Turkish version is valid and reliable.

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Psikiyatri stajını tamamlamış tıp fakültesi öğrencilerinin staj eğitimi hakkındaki görüşleri Amaç: Tıp fakültelerinde psikiyatri eğitimine az önem verilmiş ve müfredata çok iyi entegre edilmemiş gibidir. Bu çalışmada psikiyatri stajını bitirmiş öğrencilerin stajın hemen bütün safhaları hakkında düşüncelerini geri bildirimle bize aktarmalarını amaçladık. Yöntem: Bu çalışmaya fakültemizde okuyan, psikiyatri stajını bitiren ve çalışmaya katılmayı kabul eden tıp öğrencilerin bilgilendirilmiş onamı alındıktan sonra, sosyodemografik özellik anketinin ardından, ekibimizin hazırladığı 31 sorudan oluşan, psikiyatri stajına öğrencilerin bakışını araştıran bir anket verildi. Bulgular: Çalışmaya 208 öğrenci katılmayı kabul etmiştir. Bu öğrencilerin 114'ü kadın iken 94'ü erkekti ve ortalama yaşları 22.7±1.02 idi. Öğrenciler, en yüksek oranda eğitimcilerden saldırgan hasta karşısında neler yapabileceğinin öğretilmesini beklemekteydi (%89). Yüzde 76 öğrenci psikiyatrik belirtilerin genel tıbbi durumlarda da görülebileceğine inandığı için eğitimde konsültasyon ve liyezona ağırlık verilmesi gerektiğini belirtmişti. Yüzde 70 öğrenci standart hasta video kayıtlarını izlemek ve tartışmak istediklerini bildirmişti. Yüzde 53 öğrenci psikiyatri sınavının yalnızca bilgiyi ölçtüğüne ve beceriyi ölçmediğine vurgu yapmıştı. Öğrencilerin %78'i araştırma görevlisi ile ve %64'ü bir hocayla hasta takip etmek istediğini söylemişti. Ayrıca, %54 öğrenci daha önceki sınıflarda iken psikiyatri ile ilgili (nöroimmünoloji, nöroanatomi, psikoendokrinoloji gibi) seminer/araştırma projelerine katılmayı doğru bulmuştu. Sonuç: Psikiyatri stajyer eğitiminde ilgiyi ve verimi artırma çabaları giderek önem kazanmaktadır. Bu çalışma ülkemizde bu amaçla yapılan ilk çalışma olması nedeniyle önemlidir. Ancak eğiticiler eğitimde verim almak için öğrencilerin görüşünü göz önünde bulundururuken, deneyimli bir klinisyen olarak da öğretilmesi gerekenler arasında dengeyi gözetmelidir.