MY APPROACH
My perspective which I call the bio-humanistic approach is based on solid scientific research and on studies of diagnostic concepts integrating guidelines of medication efficacy within an humanistic approach to the person.
Depression is a symptom -its an experience; sometimes this experience can be an an expression of a disease but sometimes its not part of a disease but occurs as a reaction to a life event . However in both cases we can clinically diagnose depression and it should be treated.
Clinical depression is a way of psychomotor slowing in thinking ,movement, in feeling ,lack of interest ,feeling of emptiness ,absence of feeling, apathy of feeling ,accompanied with sadness and sometimes as in the case of somatic depression just with bodily symptoms .
The disease version of depression are recurrent, severe and repeated in course of illness but even these depressions can be and are mostly triggered by negative live events, thus to distinguish between non disease and disease depression always an analysis on course genetics and other underlying factors are needed and necessary .
Negative life events ( divorce , medical illness , accidents , loss) can cause depressive experience but not all people that have negative life experiences have depressive episodes thus even here an evaluation of genetic biological and predisposing factors are needed .
If a depressive epizode is not related to these factors than we can talk of a non disease depression. İn both depressions antidepressants work well to eliminate the symptoms of depression but in the disease version modifying drugs and mood stabilizers had to be added . Thus antideperssants are helpfull for depression but they are not helpful for a long term solution ,mood stabilizers like lityum and lamotrigine are proven to be helpfull for prevention of mood epizodes .
Anxiety and Stress
Anxiety is the “fever” of psychiatry. Fever is a completely nonspecific symptom, which happens in many illnesses, and frequently without any illness. Fever “disorders” are meaningless. Similarly, anxiety is a nonspecific symptom, which is quite common, sometimes related to other illnesses, and sometimes just part of one’s personality. Most anxiety “disorders” are not scientifically valid illnesses.
In other words, the key concept here is a diagnostic hierarchy. If anxiety happens as part of other illnesses, then anxiety is not itself a separate illness. (Just as fever occurring with pneumonia is not a separate fever “disorder”).
The most common anxiety treatment approach is to simply use serotonin reuptake inhibitors or benzodiazepines, which can have some symptoms benefits. But, unless other diagnoses are treated first as explained below, this symptom-oriented anxiety treatment causes more harm than good.
Psychoendocrinology
Endocrine dysfunctions plays a critical role in the development and persistence of various mental disorders, including depression , anxiety , bipolar disorder and cognitive impairment. Alterations in Hormonal levels interacts closely with neurotransmitter systems brain function and stress responses. Dysregulation of hormones such as cortisol thyroid hormones , insulin sexhormones and oxytocin has been implicated in psychological processes. There is growing evidence that insulin levels and insulin resistance play a significant role in the development and peristence of depression.
Panic Disorder
Panic disorder involves panic attacks, defined as sudden extreme anxiety that is unprovoked, happening “out of the blue.” These panic attacks often awaken someone from sleep (despite the absence of nightmares) or can occur in otherwise innocuous situations (while calmly watching television on a couch). They can be associated with “agoraphobia”, or fear of being crowds or in public spaces. In the vast majority of cases, panic attacks happen in the context of depression, sometimes mania, and sometimes psychosis. In those cases, there is no panic “disorder” that needs independent anxiety treatment with SRIs, but rather panic attack symptoms will improve once the underlying mood or psychotic illness is treated. It is often helpful to use short-term benzodiazepine medication (like lorazepam) for immediate relief of panic attack symptoms when they occur. In the small minority of cases where no mood illness is present, panic attacks can be managed with longer-term SRI treatment, but this is usually not necessary, since panic attacks are brief and intermittent. They do not continue indefinitely throughout life without some other underlying illness, and thus indefinite SRI treatment long-term is inappropriate.
Trauma Dissociation
Psychological trauma refers to psychological injury, wound, and pain. The physical response to overwhelming threat to homeostasis, the psychological response to traumatic stress comprises protection of vital parts of the psychobiological system, even at the cost of other parts, until the threat is over. Thus psychosocial adjustment, in developmental periods of life in particular, may constitute arrest or delay in realization of one’s unique and authentic potentials which necessarily leads to a division of mind. The consequence is disavowal of or inability to develop one’s integrated self-identity with the possibility to subsequently reclaim it under favorable conditions.
Much of the trauma-related dysfunctions as we see in dissociative phenomena are “attempted solutions to dilemmas which are more focused on survival than recovery” (Briere, 2002). For instance, when confronted with an imminent lifethreat for which flight-or-fight is no longer an option to counter danger, the organism may shift to immobility. To escape the threatening situation as well as the internal distress and arousal, the response of “shutdown dissociation” may be adaptive for survival (Schalinski et al., 2015) leading to freezing or submission.
Many traumatized patients continuously wish to “forget” their disturbing experiences without being able to do so. In fact, intrusion and avoidance constitute a vicious cycle rather than totally independent phenomena. Healing of the psychologically wounded individual is based on the congruent sequence of discourse, theory, model, technique, and application, where none of these can replace any of the others.
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety condition which arises after severe and often repeated trauma, usually of violent nature (physically or sexually).We recommend limiting the diagnosis to those conditions of severe and uncommon trauma, rather than to the kinds of common life experiences that happen to the entire population. Again here the concept of a diagnostic hierarchy is central, and this condition should not be diagnosed when apparent PTSD symptoms only happen in the context of depressive, manic, or psychotic episodes. In general, PTSD symptoms do not need to be treated pharmacologically, because there is no underlying disease to treat; modest symptomatic benefit has been reported with SRI, benzodiazepines, and dopamine blockers (antipsychotics). But such benefit is limited, and thus we recommend short to medium-treatment at the lowest doses possible, not routine long-term treatment, which has never been shown to be effective in randomized trials.
Obsessive Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a legitimate anxiety disease. It can happen with medical illnesses, like streptococcal infection in childhood. It can be inherited genetically reasonably strongly. It can exist on its own, without any presence of other illnesses like manic-depressive illness or schizophrenia. On the other hand, it often occurs as part of mania or depression, and is not itself an independent illness in those settings. The problem of bipolar/OCD “comorbidity” is a frequent occurrence leading to increased symptom severity, treatment challenges and higher rates of mood instability. Schizophrenia can also cause OCD. In those settings, treating mood illness or schizophrenia will cure the OCD symptoms that are caused by those other diseases. Early diagnosis is crucial as OCD is often a chronic and treatment resistant in a significant subset of patients. Treatment strategies for OCD involve serotonin reuptake inhibitor (SRI) treatment, sometimes high dose, is the standard treatment. Dopamine blocker (antipsychotic) augmentation of SRIs is also proven effective. 40-60 % of OCD patients do not achieve full symptom remission with standard treatment thus augmentation strategies and adding additional psychotherapeutic interventions are advised.Attention Problems Adolescents / Adults
Assessment of attention problems, diagnose on ADD or ADHD , Evaluation and Assessment of comorbidities in patients that present attention problems or complaints. Careful assessment of Anxiety, Cyclothymia and other mood related cognitive deficits is important before initiation of pharmacological management for cognitive problems. Again in alliance to key concept of diagnostic hierarchy we aim to detect validated and diagnostically proven ADD or ADHD cases.Our pharmacotherapeutic approach is to limit stimulant use to those cases where diagnosis is validated while assessing in follow up settings safety efficacy and long term outcome. Exit strategies are goaled to prevent long term useOriginal Artwork by Rahsan Duren
Psychotherapies Interventions
Existential Psychotherapy,
Brief Psychodynamıc Psychotherapy
Resilience Psychiatry
Systemic Family Consultations
Solution based Strategies
Moderation and Mediation of Change
My aim is to provide an hermeneutic approach to the mind of a human being within the knowlegde of a skilled scientist trained in medicine enriched with in depth education in humanities and experience in art
Interventions for Adoslescents and Adults.
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Personal Growth Based Approaches
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Arts and Creative Therapies
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Creativity Fostering interventions
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Resilience Enhancing strategies
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Psychological assessments ( multidisciplinary team of mental health workers in child and adolescent psychology )
