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Role of Cognitive Factors and Distortions in Adolescent Suicides

Yıl 2013, Cilt: 5 Sayı: 2, 232 - 245, 01.06.2013
https://doi.org/10.5455/cap.20130515

Öz

Suicide is one of the leading causes of adolescent death and is an important clinical problem. According to World Health Organisation, it is the third cause of death for ages 15-44 worldwide and is the second cause of death for ages 15-24 in Turkey . The presence of a psychiatric disorder and previous suicidal acts, social, cultural and family related factors are well known predictors of suicide. However, cognitive developmental level and schemes are as important as the other factors. For prevention and treatmeni it is essential to understand cognitive factors that lead adolescents to suicide. Cognitive factors and distortions that might have a role in adolescent suicides are hoplessness, problem solving deficits, cognitive rigidity, dichotomous thinking, perfectionism, personalising, catastrophising and time perspective. In this article, adolescent suicide and related cognitive factors are briefly reviewed.

Kaynakça

  • TÜİK. İntihar istatistikleri 2007. www.turkstat.gov.tr. (accessed 23.12.2012).
  • Sakarya D, Güneş C, Sakarya A. İnternette intiharı aramak: internet sitelerinin intihar ile ilişkili içeriklerine göre değerlendirilmesi. Turk Psikiyatri Derg 2012; 23 Baskıda. Hawton K, Saunders KEA, O’Connor RC. Self-harm and suicide in adolescents. Lancet 2012; 379:2373-2282.
  • Heron M. Deaths: leading causes for 2009 http://www.cdc.gov/nchs/ data/nvsr/nvsr61/nvsr61_07.pdf. (accessed 23.12.2012)
  • TÜİK.İntihar istatistikleri 2011 www.turkstat.gov.tr. (accessed 23.12.2012).
  • Epstein JA, Spirito A. Risk factors for suicidality among a nationally representative sample of high school students. Suicide Life Threat Behav 2009; 39:241-251.
  • Karaman D, Durukan İ. Çocuk ve ergenlerde özkıyım. Psikiyatride Güncel Yaklaşımlar 2013; 5: 30-47.
  • Levy JC, Deykin EY. Suicidality, depression, and substance abuse in adolescence. Am J Psychiatry 1989; 146:1462-1467.
  • Strang SP, Orlofsky JL. Factors underlying suicidal ideation among college studients: a test of Teicher and Jacobs’ model. J Adolesc 1990; 13:39-52.
  • Quintana H. Cognitive development.In Textbook of Adolescent Psychiatry (Ed R. Richard):171-180. New York: Oxford University Press, 2003.
  • Özçelik B, Karamustafalıoğlu O. Ergenlik dönemi ve ergenlerde suisid açısından risk faktörlerinin değerlendirilmesi. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2002; 15:68-76.
  • Vartanian LR. Revisiting the imaginary audience and personal fable constructs of adolescent egocentrism: a conceptual review. Adolescence 2000; 35:639-661.
  • Elkind D. Egocentrism redux. Dev Rev 1985; 5:218-226.
  • Everall RD. The meaning of suicide attempts by young adults. Can J Couns 2000; 34:111-125.
  • Türkçapar, H., Bilişsel Terapi, 3. Baskı. Ankara, HYB Basım Yayın, 2008.
  • Beck AT. Depression: Clinical, Experimental, and Theoretical Aspects. New York, Harper and Row, 1967
  • Beck, AT, Weissman A, Lester D. Trexler L The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol 1974; 42:861-865.
  • Pinto A, Whisman MA. Negative affect and cognitive biases in suicidal and nonsuicidal hospitalized adolescents. J Am Acad Child Adolesc Psychiatry 1996; 35:158-165.
  • Jekkel E, Tringer L. Suicide and cognitive distortions. Horizons of Psychology 2004; 13:139-150.
  • Ak M, Gülsün M, Özmenler KN. Özkıyım ve kişilik. Psikiyatride Güncel Yaklaşımlar 2009; 1:45-54.
  • Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999;156:181-189.
  • Mendonca JD, Holden RR. Interaction of affective and cognitive impairments in the suicidal state: a brief elaboration. Acta Psychiatr Scand 1998; 97:149-152.
  • Kurtaş Ö, Boşgelmez S, Yaluğ I, Birincioğlu I, Biçer Ü, Aker T et al. The evaluation of suicide letters in Turkey from a cognitive perspective. Crisis 2012; 33:73-79.
  • Durak BA. İntihar olasılığı: yaşamı sürdürme nedenleri, umutsuzluk ve yalnızlık açısından bir değerlendirme. Turk Psikiyatri Derg 2005; 16:29-39.
  • Aydemir C, Vedin TH, Göka E. Major depresyon ve özkıyımda kognitif ve emosyonel faktörler. Turk Psikiyatri Derg 2002; 13:33-39.
  • Eskin M, Akoğlu A, Uygur B. Ayaktan tedavi edilen psikiyatri hastalarında travmatik yaşam olayları ve sorun çözme becerileri: intihar davranışıyla ilişkisi. Turk Psikiyatri Derg 2006; 17:266-275.
  • Hammen C, Zupan BA. Self-schemas, depression, and processing of personal information in children. J Exp Child Psychol 1984; 37:598-608.
  • Neiger BL, Hopkins RW. Adolescent suicide: character traits of high-risk teenagers. Adolescence 1988; 23:469-475.
  • Haring C, Biebl W, Barnas C, Miller CH, Fleischhacker WW. Vulnerable phases in adolescence represented by means of committed suicide. Crisis 1991; 12:58-63.
  • Daniel SS, Goldston DB, Erkanli A, Franklin JC, Mayfield AM. Trait anger, anger expression, and suicide attempts among adolescents and young adults: a prospective study. J Clin Child Adolesc Psychol 2009; 38:661-671.
  • Deal SL, Williams JE. Cognitive distortions as mediators between life stress and depression in adolescents. Adolescence 1988; 23:477-490.
  • Miranda R, Gallagher M, Bauchner B,Vaysman R, Marroquín B. Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history. Depress Anxiety 2012; 29:180-186.
  • Spirito A, Esposito-Smythers C, Wolff J, Uhl K. Cognitive-behavioral therapy for adolescent depression and suicidality. Child Adolesc Psychiatr Clin N Am 2011; 20:191-204.
  • Lennings CJ. A cognitive understanding of adolescent suicide. Genet Soc Gen Psychol Monogr 1994; 120:289-307.
  • Esposito-Smythers C, Spirito Anthony. Adolescent substance use and suicidal behavior: a review with ımplications for treatment research. Alcohol Clin Exp Res 2004; 28:77-88.
  • Salkovskis P. Frontiers of Cognitive Therapy. New York, Guilford Press, 1996.
  • Donaldson D, Spirito A, Farnett E. The role of perfectionism and depressive cognitions in understanding the hopelessness experienced by adolescent suicide attempters. Child Psychiatry Hum Dev 2000;31:99-111.
  • Beautrais AL, Joyce PR, Mulder RT. Personality traits and cognitive styles as risk factors for serious suicide attempts among young people. Suicide Life Threat Behav 1999; 29:37-47.
  • Cole DA. Psychopathology of adolescent suicide: Hopelessness, coping beliefs, and depression. J Abnorm Psychol 1989;98:248–255.
  • Cottle TJ, Klineberg SL. The Present of Things Future: Explorations of Time in Human Experience. New York, Free Press, 1974.
  • Baumeister RF. Suicide as escape from self. Psychol Rev 1990; 97:90-113.
  • Hewitt PL, Newton J, Flett GL, Callander L. Perfectionism and suicide ideation in adolescent psychiatric patients. J Abnorm Child Psychol 1997; 25:95-101.
  • Pollock LR, Williams JMG. Problem-solving in suicide attempters. Psychol Med 2004; 34:163-167.
  • Rudd MD, Rajab MH, Dahm PF. Problem-solving appraisal in suicide ideators and attempters. Am J Orthopsychiatry 1994; 64:136-149.
  • Lewinsohn P, Rohde P, Seeley J, Fischer C. Age-cohort changes in the lifetime occurrence of depression and other mental disorders. J Abnorm Psychol 1993; 102:110-120.
  • Schotte DE, Clum GA. Problem-solving skills in suicidal psychiatric patients. J Consult Clin Psychol 1987; 55:49-54.
  • Pfeffer CR, Klerman GL, Hurt SW, Kakuma T, Peskin JR, Siefker CA Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adolesc Psychiatry 1993; 32:106-113.
  • Sadowski C, Kelley ML. Social problem solving in suicidal adolescents. J Consult Clin Psychol 1993;61:121-127.
  • McLaughlin J, Miller P, Warwick H. Deliberate self-harm in adolescents: Hopelessness, depression and problem-solving. J. Adolesc 1996: 18:523-532.
  • Fidan T, Ceyhun H, Kırkpınar İ. İntihar girişimi olan ve olmayan gençlerin başa çıkma tutumları ve aile işlevselliği açısından değerlendirilmesi Nöropsikiyatri Arşivi 2011; 48:195-200.
  • Marton P, Connolly J, Kutcher S, Korenblum M. Cognitive social skills and social self-appraisal in depressed adolescents. J Am Acad Child Adolesc Psychiatry 1993; 32:739-744.
  • Miranda R, Nolen-Hoeksema S. Brooding and reflection: rumination predicts suicidal ideation at one-year follow up in a community sample. Behav Res Ther 2007; 45:3088-3095.
  • Perrah M, Wichman H. Cognitive rigidity in suicide attempters. Suicide Life Threat Behav 1987; 17:251-255.
  • Sofronoff K, Dalgleish L, Kosky R. Out of Options A Cognitive Model of Adolescent Suicide and Risk Taking. New York, Cambridge University Press, 2004.
  • Withers LE, Kaplan DW. Adolescents who attempt suicide: a retrospective clinical chart review of hospitalized patients. Prof Psychol Res Pr 1987; 18:391-393
  • Klerman GL. Clinical epidemiology of suicide. J Clin Psychiatry 1987: 48(suppl):3338
  • Bourgeois M. Serotonin, impulsivity and suicide. Hum Psychopharmacol 1991; 6:31
  • Litman RE. Predicting and preventing hospital and clinic suicides. Suicide Life Threat Behav 1991; 21:56-73.
  • Eskin M. İntiharda bilişsel davranışçı sağatım yaklaşımları.Kriz Dergisi 2007; 15:15
  • Mukaddes MN. Çocuk ve ergenlerde bilişsel psikoterapilerin etkinlik düzeyleri ve kısıtlılıkları. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2012; 9:36-39. Bedriye Öncü, Doç. Dr., Ankara Üniv.Tıp Fakültesi Psikiyatri ABD,Ankara; Ayşegül Sakarya, Uzm. Dr., Dr. Münif İslamoğlu Devlet Hastanesi, Kastamonu. Yazışma Adresi/Correspondence: Ayşegül Sakarya, Dr. Münif İslamoğlu Devlet Hastanesi, Kastamonu, Turkey. E-mail: aysegulsakarya@gmail.com Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemişlerdir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol5/no2/ Çevrimiçi yayım / Published online 27 Şubat/February 27, 2013; doi:10.5455/cap.20130515

Ergen Özkıyımlarında Bilişsel Etmenler ve Çarpıtmaların Rolü

Yıl 2013, Cilt: 5 Sayı: 2, 232 - 245, 01.06.2013
https://doi.org/10.5455/cap.20130515

Öz

Özkıyım davranışı, ergen ölüm nedenleri arasında ilk sıralarda yer alan, önemli bir klinik sorundur. Dünya Sağlık Örgütü verilerine göre 15-44 yaş arası nüfusta üçüncü en sık ölüm nedeni özkıyımdır. Ülkemizde 15-24 yaş grubunun ölüm nedenleri arasında ikinci sıradadır. Özkıyımı öngörmede psikiyatrik bozukluk, önceden özkıyım girişimi varlığı, sosyal, kültürel ve ailesel özellikler bilinen risk etmenleridir. Ancak ergenin bilişsel gelişim düzeyi ve bilişsel şemaları da en az diğer etmenler kadar önemlidir. Ergenlerde özkıyım davranı-şına neden olan bilişsel etmenlerin anlaşılması, önleme ve tedavi için ciddi öneme sahiptir. Ergen özkıyımlarında rol oynayan bilişsel etmenler ve çarpıt-malar arasında; umutsuzluk, sorun çözme, bilişsel katılık, ya hep ya hiç biçi-minde düşünme, mükemmeliyetçilik, kişisel algılama, felaketleştirme ve za-man perspektifi sayılabilir. Bu yazıda ergenlerde özkıyım davranışı ve ilişkili bilişsel etmenler kısaca gözden geçirilmiştir.

Kaynakça

  • TÜİK. İntihar istatistikleri 2007. www.turkstat.gov.tr. (accessed 23.12.2012).
  • Sakarya D, Güneş C, Sakarya A. İnternette intiharı aramak: internet sitelerinin intihar ile ilişkili içeriklerine göre değerlendirilmesi. Turk Psikiyatri Derg 2012; 23 Baskıda. Hawton K, Saunders KEA, O’Connor RC. Self-harm and suicide in adolescents. Lancet 2012; 379:2373-2282.
  • Heron M. Deaths: leading causes for 2009 http://www.cdc.gov/nchs/ data/nvsr/nvsr61/nvsr61_07.pdf. (accessed 23.12.2012)
  • TÜİK.İntihar istatistikleri 2011 www.turkstat.gov.tr. (accessed 23.12.2012).
  • Epstein JA, Spirito A. Risk factors for suicidality among a nationally representative sample of high school students. Suicide Life Threat Behav 2009; 39:241-251.
  • Karaman D, Durukan İ. Çocuk ve ergenlerde özkıyım. Psikiyatride Güncel Yaklaşımlar 2013; 5: 30-47.
  • Levy JC, Deykin EY. Suicidality, depression, and substance abuse in adolescence. Am J Psychiatry 1989; 146:1462-1467.
  • Strang SP, Orlofsky JL. Factors underlying suicidal ideation among college studients: a test of Teicher and Jacobs’ model. J Adolesc 1990; 13:39-52.
  • Quintana H. Cognitive development.In Textbook of Adolescent Psychiatry (Ed R. Richard):171-180. New York: Oxford University Press, 2003.
  • Özçelik B, Karamustafalıoğlu O. Ergenlik dönemi ve ergenlerde suisid açısından risk faktörlerinin değerlendirilmesi. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2002; 15:68-76.
  • Vartanian LR. Revisiting the imaginary audience and personal fable constructs of adolescent egocentrism: a conceptual review. Adolescence 2000; 35:639-661.
  • Elkind D. Egocentrism redux. Dev Rev 1985; 5:218-226.
  • Everall RD. The meaning of suicide attempts by young adults. Can J Couns 2000; 34:111-125.
  • Türkçapar, H., Bilişsel Terapi, 3. Baskı. Ankara, HYB Basım Yayın, 2008.
  • Beck AT. Depression: Clinical, Experimental, and Theoretical Aspects. New York, Harper and Row, 1967
  • Beck, AT, Weissman A, Lester D. Trexler L The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol 1974; 42:861-865.
  • Pinto A, Whisman MA. Negative affect and cognitive biases in suicidal and nonsuicidal hospitalized adolescents. J Am Acad Child Adolesc Psychiatry 1996; 35:158-165.
  • Jekkel E, Tringer L. Suicide and cognitive distortions. Horizons of Psychology 2004; 13:139-150.
  • Ak M, Gülsün M, Özmenler KN. Özkıyım ve kişilik. Psikiyatride Güncel Yaklaşımlar 2009; 1:45-54.
  • Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999;156:181-189.
  • Mendonca JD, Holden RR. Interaction of affective and cognitive impairments in the suicidal state: a brief elaboration. Acta Psychiatr Scand 1998; 97:149-152.
  • Kurtaş Ö, Boşgelmez S, Yaluğ I, Birincioğlu I, Biçer Ü, Aker T et al. The evaluation of suicide letters in Turkey from a cognitive perspective. Crisis 2012; 33:73-79.
  • Durak BA. İntihar olasılığı: yaşamı sürdürme nedenleri, umutsuzluk ve yalnızlık açısından bir değerlendirme. Turk Psikiyatri Derg 2005; 16:29-39.
  • Aydemir C, Vedin TH, Göka E. Major depresyon ve özkıyımda kognitif ve emosyonel faktörler. Turk Psikiyatri Derg 2002; 13:33-39.
  • Eskin M, Akoğlu A, Uygur B. Ayaktan tedavi edilen psikiyatri hastalarında travmatik yaşam olayları ve sorun çözme becerileri: intihar davranışıyla ilişkisi. Turk Psikiyatri Derg 2006; 17:266-275.
  • Hammen C, Zupan BA. Self-schemas, depression, and processing of personal information in children. J Exp Child Psychol 1984; 37:598-608.
  • Neiger BL, Hopkins RW. Adolescent suicide: character traits of high-risk teenagers. Adolescence 1988; 23:469-475.
  • Haring C, Biebl W, Barnas C, Miller CH, Fleischhacker WW. Vulnerable phases in adolescence represented by means of committed suicide. Crisis 1991; 12:58-63.
  • Daniel SS, Goldston DB, Erkanli A, Franklin JC, Mayfield AM. Trait anger, anger expression, and suicide attempts among adolescents and young adults: a prospective study. J Clin Child Adolesc Psychol 2009; 38:661-671.
  • Deal SL, Williams JE. Cognitive distortions as mediators between life stress and depression in adolescents. Adolescence 1988; 23:477-490.
  • Miranda R, Gallagher M, Bauchner B,Vaysman R, Marroquín B. Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history. Depress Anxiety 2012; 29:180-186.
  • Spirito A, Esposito-Smythers C, Wolff J, Uhl K. Cognitive-behavioral therapy for adolescent depression and suicidality. Child Adolesc Psychiatr Clin N Am 2011; 20:191-204.
  • Lennings CJ. A cognitive understanding of adolescent suicide. Genet Soc Gen Psychol Monogr 1994; 120:289-307.
  • Esposito-Smythers C, Spirito Anthony. Adolescent substance use and suicidal behavior: a review with ımplications for treatment research. Alcohol Clin Exp Res 2004; 28:77-88.
  • Salkovskis P. Frontiers of Cognitive Therapy. New York, Guilford Press, 1996.
  • Donaldson D, Spirito A, Farnett E. The role of perfectionism and depressive cognitions in understanding the hopelessness experienced by adolescent suicide attempters. Child Psychiatry Hum Dev 2000;31:99-111.
  • Beautrais AL, Joyce PR, Mulder RT. Personality traits and cognitive styles as risk factors for serious suicide attempts among young people. Suicide Life Threat Behav 1999; 29:37-47.
  • Cole DA. Psychopathology of adolescent suicide: Hopelessness, coping beliefs, and depression. J Abnorm Psychol 1989;98:248–255.
  • Cottle TJ, Klineberg SL. The Present of Things Future: Explorations of Time in Human Experience. New York, Free Press, 1974.
  • Baumeister RF. Suicide as escape from self. Psychol Rev 1990; 97:90-113.
  • Hewitt PL, Newton J, Flett GL, Callander L. Perfectionism and suicide ideation in adolescent psychiatric patients. J Abnorm Child Psychol 1997; 25:95-101.
  • Pollock LR, Williams JMG. Problem-solving in suicide attempters. Psychol Med 2004; 34:163-167.
  • Rudd MD, Rajab MH, Dahm PF. Problem-solving appraisal in suicide ideators and attempters. Am J Orthopsychiatry 1994; 64:136-149.
  • Lewinsohn P, Rohde P, Seeley J, Fischer C. Age-cohort changes in the lifetime occurrence of depression and other mental disorders. J Abnorm Psychol 1993; 102:110-120.
  • Schotte DE, Clum GA. Problem-solving skills in suicidal psychiatric patients. J Consult Clin Psychol 1987; 55:49-54.
  • Pfeffer CR, Klerman GL, Hurt SW, Kakuma T, Peskin JR, Siefker CA Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adolesc Psychiatry 1993; 32:106-113.
  • Sadowski C, Kelley ML. Social problem solving in suicidal adolescents. J Consult Clin Psychol 1993;61:121-127.
  • McLaughlin J, Miller P, Warwick H. Deliberate self-harm in adolescents: Hopelessness, depression and problem-solving. J. Adolesc 1996: 18:523-532.
  • Fidan T, Ceyhun H, Kırkpınar İ. İntihar girişimi olan ve olmayan gençlerin başa çıkma tutumları ve aile işlevselliği açısından değerlendirilmesi Nöropsikiyatri Arşivi 2011; 48:195-200.
  • Marton P, Connolly J, Kutcher S, Korenblum M. Cognitive social skills and social self-appraisal in depressed adolescents. J Am Acad Child Adolesc Psychiatry 1993; 32:739-744.
  • Miranda R, Nolen-Hoeksema S. Brooding and reflection: rumination predicts suicidal ideation at one-year follow up in a community sample. Behav Res Ther 2007; 45:3088-3095.
  • Perrah M, Wichman H. Cognitive rigidity in suicide attempters. Suicide Life Threat Behav 1987; 17:251-255.
  • Sofronoff K, Dalgleish L, Kosky R. Out of Options A Cognitive Model of Adolescent Suicide and Risk Taking. New York, Cambridge University Press, 2004.
  • Withers LE, Kaplan DW. Adolescents who attempt suicide: a retrospective clinical chart review of hospitalized patients. Prof Psychol Res Pr 1987; 18:391-393
  • Klerman GL. Clinical epidemiology of suicide. J Clin Psychiatry 1987: 48(suppl):3338
  • Bourgeois M. Serotonin, impulsivity and suicide. Hum Psychopharmacol 1991; 6:31
  • Litman RE. Predicting and preventing hospital and clinic suicides. Suicide Life Threat Behav 1991; 21:56-73.
  • Eskin M. İntiharda bilişsel davranışçı sağatım yaklaşımları.Kriz Dergisi 2007; 15:15
  • Mukaddes MN. Çocuk ve ergenlerde bilişsel psikoterapilerin etkinlik düzeyleri ve kısıtlılıkları. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2012; 9:36-39. Bedriye Öncü, Doç. Dr., Ankara Üniv.Tıp Fakültesi Psikiyatri ABD,Ankara; Ayşegül Sakarya, Uzm. Dr., Dr. Münif İslamoğlu Devlet Hastanesi, Kastamonu. Yazışma Adresi/Correspondence: Ayşegül Sakarya, Dr. Münif İslamoğlu Devlet Hastanesi, Kastamonu, Turkey. E-mail: aysegulsakarya@gmail.com Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemişlerdir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol5/no2/ Çevrimiçi yayım / Published online 27 Şubat/February 27, 2013; doi:10.5455/cap.20130515
Toplam 59 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Derleme
Yazarlar

Bedriye Öncü Bu kişi benim

Ayşegül Sakarya Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 5 Sayı: 2

Kaynak Göster

AMA Öncü B, Sakarya A. Ergen Özkıyımlarında Bilişsel Etmenler ve Çarpıtmaların Rolü. Psikiyatride Güncel Yaklaşımlar. Haziran 2013;5(2):232-245. doi:10.5455/cap.20130515

Creative Commons Lisansı
Psikiyatride Güncel Yaklaşımlar Creative Commons Atıf-Gayriticari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.