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Depression in Cancer Patients

Year 2014, Volume: 6 Issue: 2, 186 - 198, 06.11.2014
https://doi.org/10.5455/cap.20131009062433

Abstract

It is not enough to consider treatment and care depression in the oncology that is the most common psychiatric illness in cancer patient affects of cancer treatment and the patient`s quality of life negatively, which is determined through researches in the field. With development of psycho-oncology it has been demonstrated to establish an important link between the cancer patient`s treatment as well as psycho-social support for the patient and psychiatric treatment and care for the if it is needed. With this connection between them it has been proposed to use of bio-psycho-social-model in cancer patient to improve their care. To achieve this goal, it is expected from medical personnel to realize patients psychosocial need und if he/she has a psychiatric disorders or syndromes. For the medical personnel that work in oncology services, it is inevitable to organize in order to raise the awareness of depression in the cancer patients. In the present study, it is focused on raising the awareness of depression in cancer patient for the medical personnel.

References

  • Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15:357–376.
  • Jacobi F, Wittchen HU, Holting C, Höfler M, Pfister H, Müller NC et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 2004; 34:594–611.
  • Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617–627.
  • Nutt DJ, Kessler RC, Alonso J, Benbow A, Lecrubier Y, Lépine JP et al. Consensus statement on the benefit to the community of ESEMeD (European Study of the Epidemiology of Mental Disorders) survey data on depression and anxiety. J Clin Psychiatry, 2007; 68:42–48.
  • Erol N, Kılıç C, Ulusoy M, Keçeci M, Şimşek Z. Türkiye Ruh Sağlığı Profili Raporu. Ankara, Eksen Tanıtım, 1998.
  • Katon WJ, Lin E, Russo J, Unutzer J.Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 2003; 60:897–903.
  • T.C Saglık Bakanlığı Tedavi Hizmetleri Genel Müdürlüğü. Türkiye Onkoloji Hizmetleri Yeniden Yapılanma Programı 201020 Ankara, T.C. Sağlık Bakanlığı, 2010.
  • Bag, B. Psiko-onkoloji, psikososyal sorunlar ve ölçümyöntemleri. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2012; 4:449-464.
  • Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry, 1990; 51 [l]:12–17.
  • McDaniel JS, Musselman DL,Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer: diagnosis, biology,and treatment. Arch Gen Psychiatry 1995; 52:89–99.
  • Arolt V, Rothermundt M. Depressive störungen bei körperlich kranken. Nervenarzt 2003; 74:1033–1054.
  • Beutel ME, Schulz H. Epidemiologie psychisch komorbider Störungen bei chronisch körperlichen Erkrankungen. Bundesgesundheitsbl 2011; 54:15–21.
  • Frasure-Smith N, Lespérance F, Gravel G, Masson A, Juneau M, Talajic M et al. Depression and health-care costs during the first year following myocardial infarction. J Psychosom Res 2000; 48:471–478.
  • First M, Spitzer R, Gibbon M, Williams J. Structured clinical interview for DSM-IV Axis I Disorders, Research Version, NonPatient Edition (SCID-I/NP). New York, Biometrics Research New York State Psychiatric Institute, 2002.
  • Kessler R, Ustun T. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121.
  • Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370:851–858.
  • Aydoğan Ü, Doğaner YÇ, Borazan E, Kömürcü Ş, Koçak N, Öztürk B et al. Kanser hastalarında depresyon ve anksiyete düzeyleri ve hastalıkla başa çıkma tutumlarının ilişkisi. Türkiye Aile Hekimliği Dergisi 2012; 16:55-60.
  • Singer S, Das-Munshi J, Brahler E. Prevalence of mental health conditions in cancer patients in acute care – a metaanalysis. Ann Oncol 2010; 21:925–930.
  • Beutel M. Psychotherapie bei somatischen Erkrankungen aus psychodynamischer Sicht. In Psychotherapie bei somatischen Erkrankungen (Ed H Faller):122-140. Stutgart, Thieme, 2005.
  • Kelleci M, Aydın D, Sabanciogullari S, Dogan S. Hastanede yatan hastaların bazı tanı gruplarına göre anksiyete ve depresyon düzeyleri. Klinik Psikiyatri Dergisi 2009; 12:90-98.
  • Kersting A, Reutemann M,Ohrmann P, Schütt K, Wesselmann U, Rothermundt M et al. Traumatische trauer -ein eigenständiges krankheitsbild? Psychotherapeut 2001; 46:301–308.
  • Yazgan C. Yaşlılıkta yas. Anadolu Psikiyatri Dergisi 2006; 7:179-184.
  • Horowitz MJ. Stress Response Syndromes. New Jersey, Jason Aronson, 1997.
  • Prigerson HG, Shear MK, Jacobs SC, Reynolds CF 3rd, Maciejewski PK, Davidson JR et al. Consensus criteria for traumatic grief. a preliminary empirical test. Br J Psychiatry 1999; 174:67–73.
  • Karabulutlu Y E, , Bilici M, Çayır K, Tekin B S, Kantarcı R. Coping, anxiety and depression in Turkish patients with cancer. Eur J Gen Med 2010; 7:296-302.
  • Schaefer M. Depressionen bei Tumorpatienten; richtig diagnostizieren, pharmakologisch behandeln. Onkologie 2007; 6:50Schneider C. Psychoonkologische aspekte bei gynäkologischen malignomen. Gynäkologe 2007; 40:865–871.
  • Ronson A. Psychiatric disorders in oncology: recent therapeutic advances and new conceptual frameworks. Curr Opin Oncol 2004; 16:318–323.
  • Butow PN, Coates AS, Dunn SM. Psychosocial predictors of survival in metastatic melanoma. J Clin Oncol 1999; 17:2256– 22
  • Mehnert A, Lehmann C, Koch U. Prävalenz und diagnostik psychischer störungen in der onkologie . Onkologe 2006;12:18– 26
  • Ateşçi FÇ, Oguzhanoglu NK, Baltalarli B, Karadağ F, Özdel O, Karagöz N. Kanser hastalarinda psikiyatrik bozukluklar ve ilişkili etmenler. Turk Psikiyatri Derg 2003; 14:145-152.
  • Sellick SM, Crooks DL. Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology 1999; 8:315–333.
  • Kissane DW, McKenzie M, McKenzie DP et al. Psychosocial morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Focused Grief Therapy controlled trial. Palliat Med 2003; 17:527–537.
  • Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review part 1 prevalence and case finding. Palliat Med 2002; 16:81–97.
  • Ly KL, Chidgey J, Addington-Hall J, Hotopf M .Depression in palliative care: a systematic review. part 2. treatment. Palliat Med 2002; 16:279–284.
  • Wilson KG, Chochinov HM, Skirko MG, Allard P, Chary S, Gagnon PR et al.Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage 2007; 33:118–129.
  • Goldstein D, Bennett B, Friedlander M, Davenport T, Hickie I, Lloyd A. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study. BMC Cancer 2006; 6:240.
  • Holland JC. American Cancer Society Award lecture. Psychological care of patients: psycho-oncology‘s contribution. J Clin Oncol 2003; 21:253–265.
  • Tschuschke V. Psychoonkologie. Stuttgart, Schattauer, 2002.
  • Davidson KW, Kupfer DJ, Bigger JT, Califf RM, Carney RM, Coyne JC et al. Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosom Med 2006; 68:645–650.
  • Akdemir A, Örsel S, Dağ İ, Türkçapar MH, İşçan N, Özbay H. Hamilton depresyon derecelendirme ölçeği (HDDÖ)’nin geçerliliği, güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 1996; 4:251-259.
  • Torun F, Önder E, Torun SD, Tural Ü, Şişmanlar ŞG. Montgomery-Asberg Depresyon Derecelendirme Ölçeği Türkçe formunun geçerlik ve güvenirliği. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 2002; 10:319-330.
  • Hisli N. Beck Depresyon Envanteri’nin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji Dergisi, 1989; 6(23):3-13. Gençdoğan B. Zung depresyon ölçeğinin üniversite öğrencileri için geçerlik güvenirliği ile faktör yapısı (Yüksek lisans tezi). Erzurum, Atatürk Üniversitesi Sosyal Bilimler Enstitüsü, 2001.
  • Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane anksiyete ve depresyon ölçeği Türkçe formunun geçerlilik ve güvenilirliği. Turk Psikiyatri Derg 1997; 8:280-287.
  • Rodin G, Lloyd N, Katz M, Green E, Mackay JA, Wong RK et al. The treatment of depression in cancer patients: a systematic review. Support Care Cancer 2007; 15:123–136.
  • Bauer M, Whybrow PC, Angst J, Versiani M, Möller HJ; World Federation of Societies Biological Psychiatry Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, part 1: acute and continuation treatment of major depressive disorder. World J Biol Psychiatry 2002; 3:5-43.
  • Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry 2006; 28:396–402.
  • Baghai TC, Volz HP, Moller HJ. Drug treatment of depression in the 2000 s: an overview of achievements in the last 10 years and future possibilities. World J Biol Psychiatry 2006; 7:198–222.
  • Tuncer AM. Cancer Report. Ankara, Asian Pacific Organization for Cancer Prevention, 2010. Beyhan Bag, Psikiyatri Hemşireliği, Giessen, Almanya. Yazışma Adresi/Correspondence: Beyhan Bag, Karl-Follen Strasse 5, 35394, Giessen, Germany. E-mail: beyhanbag@yahoo.com Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no2/ Çevrimiçi yayım / Published online 09 Ekim/October 09, 2013; doi: 10.5455/cap.20131009062433

Kanser Hastalarında Depresyon

Year 2014, Volume: 6 Issue: 2, 186 - 198, 06.11.2014
https://doi.org/10.5455/cap.20131009062433

Abstract

Onkoloji hastalarında en sık görülen psikiyatrik hastalıklardan olan depresyonun hastalığın seyrine ve hastanın yaşam kalitesine olumsuz etkilerinin olduğu araştırmalarla belirlenmesine karşın tedavi ve bakımda bu etken yeterince göz önünde bulundurulmuyor. Psiko-onkoloji son yıllarda göstermiş olduğu gelişimiyle birlikte hastaların tıbbi tedavinin yanı sıra ve hastanın psiko-sosyal desteklenmesi ve gerektiğinde psikiyatrik tedavi ve bakım alması arasında önemli bir bağ kurulmuştur. Kurulan bu bağla birlikte tedavi ve bakımın önemli koşulu olan biyo-psiko-sosyal modelin kanser hastalarında uygulanması amaçlanır. Bu hedefe ulaşılabilmesi için tüm sağlık personelinin kanser hastalarında olası olan psikiyatrik hastalıklara karşı duyarlı olmasıyla olasıdır. Bu duyarlılığı artırmada sağlık personeline yönelik onkolojik hastalarda en çok görülen depresyonla ilgili hizmet içi eğitim programlarının düzenlenmesi başlangıcı oluşturabilir. Bu yazıyla da onkoloji hastalarında görülmesi olası depresyonla ilgili bir duyarlılığın oluşturulması amaçlanmıştır.

References

  • Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15:357–376.
  • Jacobi F, Wittchen HU, Holting C, Höfler M, Pfister H, Müller NC et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 2004; 34:594–611.
  • Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617–627.
  • Nutt DJ, Kessler RC, Alonso J, Benbow A, Lecrubier Y, Lépine JP et al. Consensus statement on the benefit to the community of ESEMeD (European Study of the Epidemiology of Mental Disorders) survey data on depression and anxiety. J Clin Psychiatry, 2007; 68:42–48.
  • Erol N, Kılıç C, Ulusoy M, Keçeci M, Şimşek Z. Türkiye Ruh Sağlığı Profili Raporu. Ankara, Eksen Tanıtım, 1998.
  • Katon WJ, Lin E, Russo J, Unutzer J.Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 2003; 60:897–903.
  • T.C Saglık Bakanlığı Tedavi Hizmetleri Genel Müdürlüğü. Türkiye Onkoloji Hizmetleri Yeniden Yapılanma Programı 201020 Ankara, T.C. Sağlık Bakanlığı, 2010.
  • Bag, B. Psiko-onkoloji, psikososyal sorunlar ve ölçümyöntemleri. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2012; 4:449-464.
  • Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry, 1990; 51 [l]:12–17.
  • McDaniel JS, Musselman DL,Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer: diagnosis, biology,and treatment. Arch Gen Psychiatry 1995; 52:89–99.
  • Arolt V, Rothermundt M. Depressive störungen bei körperlich kranken. Nervenarzt 2003; 74:1033–1054.
  • Beutel ME, Schulz H. Epidemiologie psychisch komorbider Störungen bei chronisch körperlichen Erkrankungen. Bundesgesundheitsbl 2011; 54:15–21.
  • Frasure-Smith N, Lespérance F, Gravel G, Masson A, Juneau M, Talajic M et al. Depression and health-care costs during the first year following myocardial infarction. J Psychosom Res 2000; 48:471–478.
  • First M, Spitzer R, Gibbon M, Williams J. Structured clinical interview for DSM-IV Axis I Disorders, Research Version, NonPatient Edition (SCID-I/NP). New York, Biometrics Research New York State Psychiatric Institute, 2002.
  • Kessler R, Ustun T. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121.
  • Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370:851–858.
  • Aydoğan Ü, Doğaner YÇ, Borazan E, Kömürcü Ş, Koçak N, Öztürk B et al. Kanser hastalarında depresyon ve anksiyete düzeyleri ve hastalıkla başa çıkma tutumlarının ilişkisi. Türkiye Aile Hekimliği Dergisi 2012; 16:55-60.
  • Singer S, Das-Munshi J, Brahler E. Prevalence of mental health conditions in cancer patients in acute care – a metaanalysis. Ann Oncol 2010; 21:925–930.
  • Beutel M. Psychotherapie bei somatischen Erkrankungen aus psychodynamischer Sicht. In Psychotherapie bei somatischen Erkrankungen (Ed H Faller):122-140. Stutgart, Thieme, 2005.
  • Kelleci M, Aydın D, Sabanciogullari S, Dogan S. Hastanede yatan hastaların bazı tanı gruplarına göre anksiyete ve depresyon düzeyleri. Klinik Psikiyatri Dergisi 2009; 12:90-98.
  • Kersting A, Reutemann M,Ohrmann P, Schütt K, Wesselmann U, Rothermundt M et al. Traumatische trauer -ein eigenständiges krankheitsbild? Psychotherapeut 2001; 46:301–308.
  • Yazgan C. Yaşlılıkta yas. Anadolu Psikiyatri Dergisi 2006; 7:179-184.
  • Horowitz MJ. Stress Response Syndromes. New Jersey, Jason Aronson, 1997.
  • Prigerson HG, Shear MK, Jacobs SC, Reynolds CF 3rd, Maciejewski PK, Davidson JR et al. Consensus criteria for traumatic grief. a preliminary empirical test. Br J Psychiatry 1999; 174:67–73.
  • Karabulutlu Y E, , Bilici M, Çayır K, Tekin B S, Kantarcı R. Coping, anxiety and depression in Turkish patients with cancer. Eur J Gen Med 2010; 7:296-302.
  • Schaefer M. Depressionen bei Tumorpatienten; richtig diagnostizieren, pharmakologisch behandeln. Onkologie 2007; 6:50Schneider C. Psychoonkologische aspekte bei gynäkologischen malignomen. Gynäkologe 2007; 40:865–871.
  • Ronson A. Psychiatric disorders in oncology: recent therapeutic advances and new conceptual frameworks. Curr Opin Oncol 2004; 16:318–323.
  • Butow PN, Coates AS, Dunn SM. Psychosocial predictors of survival in metastatic melanoma. J Clin Oncol 1999; 17:2256– 22
  • Mehnert A, Lehmann C, Koch U. Prävalenz und diagnostik psychischer störungen in der onkologie . Onkologe 2006;12:18– 26
  • Ateşçi FÇ, Oguzhanoglu NK, Baltalarli B, Karadağ F, Özdel O, Karagöz N. Kanser hastalarinda psikiyatrik bozukluklar ve ilişkili etmenler. Turk Psikiyatri Derg 2003; 14:145-152.
  • Sellick SM, Crooks DL. Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology 1999; 8:315–333.
  • Kissane DW, McKenzie M, McKenzie DP et al. Psychosocial morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Focused Grief Therapy controlled trial. Palliat Med 2003; 17:527–537.
  • Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review part 1 prevalence and case finding. Palliat Med 2002; 16:81–97.
  • Ly KL, Chidgey J, Addington-Hall J, Hotopf M .Depression in palliative care: a systematic review. part 2. treatment. Palliat Med 2002; 16:279–284.
  • Wilson KG, Chochinov HM, Skirko MG, Allard P, Chary S, Gagnon PR et al.Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage 2007; 33:118–129.
  • Goldstein D, Bennett B, Friedlander M, Davenport T, Hickie I, Lloyd A. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study. BMC Cancer 2006; 6:240.
  • Holland JC. American Cancer Society Award lecture. Psychological care of patients: psycho-oncology‘s contribution. J Clin Oncol 2003; 21:253–265.
  • Tschuschke V. Psychoonkologie. Stuttgart, Schattauer, 2002.
  • Davidson KW, Kupfer DJ, Bigger JT, Califf RM, Carney RM, Coyne JC et al. Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosom Med 2006; 68:645–650.
  • Akdemir A, Örsel S, Dağ İ, Türkçapar MH, İşçan N, Özbay H. Hamilton depresyon derecelendirme ölçeği (HDDÖ)’nin geçerliliği, güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 1996; 4:251-259.
  • Torun F, Önder E, Torun SD, Tural Ü, Şişmanlar ŞG. Montgomery-Asberg Depresyon Derecelendirme Ölçeği Türkçe formunun geçerlik ve güvenirliği. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 2002; 10:319-330.
  • Hisli N. Beck Depresyon Envanteri’nin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji Dergisi, 1989; 6(23):3-13. Gençdoğan B. Zung depresyon ölçeğinin üniversite öğrencileri için geçerlik güvenirliği ile faktör yapısı (Yüksek lisans tezi). Erzurum, Atatürk Üniversitesi Sosyal Bilimler Enstitüsü, 2001.
  • Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane anksiyete ve depresyon ölçeği Türkçe formunun geçerlilik ve güvenilirliği. Turk Psikiyatri Derg 1997; 8:280-287.
  • Rodin G, Lloyd N, Katz M, Green E, Mackay JA, Wong RK et al. The treatment of depression in cancer patients: a systematic review. Support Care Cancer 2007; 15:123–136.
  • Bauer M, Whybrow PC, Angst J, Versiani M, Möller HJ; World Federation of Societies Biological Psychiatry Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, part 1: acute and continuation treatment of major depressive disorder. World J Biol Psychiatry 2002; 3:5-43.
  • Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry 2006; 28:396–402.
  • Baghai TC, Volz HP, Moller HJ. Drug treatment of depression in the 2000 s: an overview of achievements in the last 10 years and future possibilities. World J Biol Psychiatry 2006; 7:198–222.
  • Tuncer AM. Cancer Report. Ankara, Asian Pacific Organization for Cancer Prevention, 2010. Beyhan Bag, Psikiyatri Hemşireliği, Giessen, Almanya. Yazışma Adresi/Correspondence: Beyhan Bag, Karl-Follen Strasse 5, 35394, Giessen, Germany. E-mail: beyhanbag@yahoo.com Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no2/ Çevrimiçi yayım / Published online 09 Ekim/October 09, 2013; doi: 10.5455/cap.20131009062433
There are 48 citations in total.

Details

Primary Language Turkish
Journal Section Review
Authors

Beyhan Bag This is me

Publication Date November 6, 2014
Published in Issue Year 2014 Volume: 6 Issue: 2

Cite

AMA Bag B. Kanser Hastalarında Depresyon. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. June 2014;6(2):186-198. doi:10.5455/cap.20131009062433

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