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Demans Tanısı Olan Kişilere Bakım Verenler ve Bilişsel Davranışçı Terapi: Sistematik Derleme

Yıl 2021, Cilt: 13 Sayı: 2, 170 - 191, 30.06.2021
https://doi.org/10.18863/pgy.732086

Öz

Demans her geçen gün artan sayılarda görülmektedir ve demans tanısı alan kişiler başka insanların bakımına ihtiyaç duymaktadırlar. Bakım verenler ise genelde kişinin aile üyeleri olmaktadır. Bakım verenler psikolojik sıkıntılar yaşayabilmekte ve psikolojik yardıma ihtiyaç duyabilmektedirler. Bu nedenle bu çalışmanın amacı demans tanısı olan kişiye bakım veren aile üyelerine uygulanan Bilişsel Davranışçı Terapi temelli müdahalelerin etkisinin incelenmesidir. Demans tanısı olan kişiye bakım veren aile üyelerine yönelik Bilişsel Davranışçı Terapi temelli müdahalelerinin gözden geçirilmesi amacıyla EBSCOHost (Medline dahildir), Web of Science ve Cochrane (PubMed ve Embase dahildir) veri tabanlarında 1990-2020 yılları arasında yayınlanmış araştırmalar, ilgili anahtar kelimelerle taranmıştır. Bu tarama ve raporlama sistematik derlemelerin rapor edilmesinde kullanılan PRISMA Bildirimi’ne uygun olarak yürütülmüştür. İlk belirlemede 819 çalışmaya ulaşılmıştır. Tekrar eden çalışmalar çıkarıldığında, dahil etme ve dışlama kriterleri göz önünde bulundurulduğunda 20 çalışma bu derlemeye dahil edilmiştir. Bilişsel Davranışçı Terapi temelli müdahalelerin bireysel ve grup olarak uygulanabildiği ve bu uygulamaların yüz yüze, telefon ve internet aracılığıyla yapıldığı tespit edilmiştir. Çalışmalarda seansların süresi, sıklığı ve yapılan değerlendirmeler farklılık gösterse de Bilişsel Davranışçı Terapi müdahalelerinin demans tanısı olan kişiye bakım veren aile üyelerine, bakım alan demans tanısı olan kişilere ve iletişimlerine olumlu katkılarının olduğu görülmektedir. Genel olarak değerlendirildiğinde, Bilişsel Davranışçı Terapinin demans tanısı olan kişilere bakım veren aile üyeleri için etkili olduğu sonucuna ulaşılmıştır. Çalışmaların bulguları ilgili alanyazın ışığında tartışılmış olup, gelecek çalışmalar için önerilerde bulunulmuştur.

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Kaynakça

  • Aboulafia-Brakha T, Suchecki D, Gouveia-Paulino F, Nitrini R, Ptak R (2014) Cognitive–behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer's disease. Aging Ment Health, 18(6): 801-808.
  • Akkerman RL, Ostwald SK (2004) Reducing anxiety in Alzheimer's disease family caregivers: the effectiveness of a nine-week cognitive-behavioral intervention. Am J Alzheimers Dis Other Demen, 19(2): 117-123.
  • Ali S, Bokharey IZ (2015) Efficacy of cognitive behavior therapy among caregivers of dementia: an outcome study. Pakistan Journal of Psychological Research, 30(2): 249-269.
  • Altuntaş O, Koç C (2015) Demanslı Hastaya Bakım Veren Aile Bireylerinin Aktivite Performanslarının İncelenmesi. Ergoterapi ve Rehabilitasyon Dergisi, 3(1): 35-44.
  • Alzheimer’s Association (2004) Families Care: Alzheimer’s Caregiving in the United States 2004. https://www.alz.org/national/documents/report_familiescare.pdf (19 Nisan 2020’de ulaşıldı).
  • Alzheimer's Disease International (2013) Policy Brief for Heads of Government. The Global Impact of Dementia 2013-2050. https://www.alz.co.uk/research/GlobalImpactDementia2013.pdf (20 Nisan 2020’de ulaşıldı).
  • Amerikan Psikiyatri Birliği (1994) Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, Dördüncü Baskı (DSM-IV) (Çeviri Ed. E Köroğlu). Ankara, Hekimler Yayın Birliği.
  • Barnes CJ, Markham C (2018) A pilot study to evaluate the effectiveness of an individualized and cognitive behavioural communication intervention for informal carers of people with dementia: the talking sense programme. Int J Lang Commun Disord, 53(3): 615-627.
  • Covinsky KE, Newcomer R, Fox P, Wood J, Sands L, Dane K et al. (2003) Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med, 18(12): 1006-1014.
  • Czaja SJ, Rubert MP (2002) Telecommunications technology as an aid to family caregivers of persons with dementia. Psychosom Med, 64(3): 469-476.
  • Dünya Sağlık Örgütü (1992) ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması (Çeviri Ed. MO Öztürk, B Uluğ). Ankara, Türkiye Sinir ve Ruh Sağlığı Derneği Yayını.
  • Dünya Sağlık Örgütü (World Health Organization) (2015) The Epidemiology and Impact of Dementia. https://www.who.int/mental_health/neurology/dementia/dementia_thematicbrief_epidemiology.pdf (20 Nisan 2020’de ulaşıldı).
  • Dünya Sağlık Örgütü (World Health Organization) (2019) Dementia. https://www.who.int/en/news-room/fact-sheets/detail/dementia (19 Nisan 2020’de ulaşıldı).
  • Fauth E, Hess K, Piercy K, Norton M, Corcoran C, Rabins P et al. (2012) Caregivers’ relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers’ physical health and psychological well-being. Aging Ment Health, 16(6): 699-711.
  • Gallagher-Thompson D, Coon DW (2007) Evidence-based psychological treatments for distress in family caregivers of older adults. Psychol Aging, 22(1): 37-51.
  • Gallagher-Thompson D, Gray HL, Tang PC, Pu CY, Leung LY, Wang PC et al. (2007) Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study. Am J Geriatr Psychiatry, 15(5): 425-434.
  • Gilhooly KJ, Gilhooly MLM, Sullivan MP, McIntyre A, Wilson L, Harding E et al. (2016) A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC Geriatr, 16(1): 106.
  • Glueckauf RL, Jeffers SB, Sharma D, Massey AJ, Davis WS, Wesley LM et al. (2007) Telephone-based cognitive-behavioral intervention for distressed rural dementia caregivers. Clin Gerontol, 31(1): 21-41.
  • Gonyea JG, López LM, Velásquez EH (2016) The effectiveness of a culturally sensitive cognitive behavioral group intervention for Latino Alzheimer’s caregivers. Gerontologist, 56(2): 292-302. Koydemir-Özden S (2010) Self-aspects, perceived social support, gender, and willingness to seek psychological help. Int J Ment Health, 39(3): 44-60.
  • Kwok T, Au A, Bel Wong II, Mak V, Ho F (2014) Effectiveness of online cognitive behavioral therapy on family caregivers of people with dementia. Clin Interv Aging, 9: 631-636.
  • Kwon OY, Ahn HS, Kim HJ, Park KW (2017) Effectiveness of cognitive behavioral therapy for caregivers of people with dementia: a systematic review and meta-analysis. J Clin Neurol, 13(4): 394-404.
  • Liu S, Li C, Shi Z, Wang X, Zhou Y, Liu S et al. (2017) Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. J Clin Nurs, 26(9-10): 1291-1300.
  • Losada A, Márquez‐González M, Romero‐Moreno R (2011) Mechanisms of action of a psychological intervention for dementia caregivers: Effects of behavioral activation and modification of dysfunctional thoughts. Int J Geriatr Psychiatry, 26: 1119-1127.
  • Mahoney R, Regan C, Katona C, Livingston G (2005) Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry, 13(9): 795-801.
  • Márquez-González M, Losada A, Izal M, Pérez-Rojo G, Montorio I (2007) Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme. Aging Ment Health, 11(6): 616-625.
  • Meichsner F, Theurer C, Wilz G (2018) Acceptance and treatment effects of an internet‐delivered cognitive‐behavioral intervention for family caregivers of people with dementia: A randomized‐controlled trial. J Clin Psychol, 75(4): 594-613.
  • Meichsner F, Töpfer NF, Reder M, Soellner R, Wilz G (2019) Telephone-based cognitive behavioral intervention improves dementia caregivers’ quality of life. Am J Alzheimers Dis Other Demen, 34(4): 236-246.
  • Meichsner F, Wilz, G (2018) Dementia caregivers’ coping with pre-death grief: effects of a CBT-based intervention. Aging Ment Health, 22(2): 218-225.
  • Oyebode J (2003) Assessment of carers' psychological needs. Adv Psychiatr Treat, 9(1): 45-53.
  • Pan Y, Chen R (2019) The effect of a nurse-led cognitive behavioral protocol on depressive symptoms and coping strategies of dementia caregivers. J Nurs Res, 27(6): e55.
  • Passoni S, Moroni L, Toraldo A, Mazza MT, Bertolotti G, Vanacore N et al. (2014) Cognitive behavioral group intervention for Alzheimer caregivers. Alzheimer Dis Assoc Disord, 28(3): 275-282.
  • Pillemer S, Davis J, Tremont G (2018) Gender effects on components of burden and depression among dementia caregivers. Aging Ment Health, 22(9): 1162-1167.
  • Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB et al. (2007) Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology, 29(1-2): 125-132.
  • Roth DL, Dilworth-Anderson P, Huang J, Gross AL, Gitlin LN (2015) Positive aspects of family caregiving for dementia: Differential item functioning by race. J Gerontol: Psychol Sci, 70(6): 813-819.
  • Schulz R, Mendelsohn AB, Haley WE, Mahoney D, Allen RS, Zhang S et al. (2003) End-of-life care and the effects of bereavement on family caregivers of persons with dementia. N Engl J Med, 349(20): 1936-1942.
  • Soner S, Aykut S (2017) Alzheimer Hastalık Sürecinde Bakım Veren Aile Üyelerinin Yaşadıkları Güçlükler ve Sosyal Hizmet. Ahi Evran Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 3(2): 375-387.
  • Stall NM, Kim SJ, Hardacre KA, Shah PS, Straus SE, Bronskill SE et al. (2019) Association of informal caregiver distress with health outcomes of community‐dwelling dementia care recipients: A systematic review. J Am Geriatr Soc, 67(3): 609-617.
  • Töpfer NF, Wilz G (2018) Tele. TAnDem increases the psychosocial resource utilization of dementia caregivers. GeroPsych, 31(4): 173-183.
  • Xiong C, Biscardi M, Nalder E, Colantonio A (2018) Sex and gender differences in caregiving burden experienced by family caregivers of persons with dementia: a systematic review protocol. BMJ Open, 8: e022779.
  • Wilz G, Meichsner F, Soellner R (2017) Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention. Aging Ment Health, 21(7): 74-781.
  • Wilz G, Reder M, Meichsner F, Soellner R (2018) The Tele. TAnDem intervention: telephone-based CBT for family caregivers of people with dementia. Gerontologist, 58(2): e118-e129.
  • Wilz G, Soellner R (2016) Evaluation of a short-term telephone-based cognitive behavioral intervention for dementia family caregivers. Clin Gerontol, 39(1): 25-47.
  • Wilz G, Weise L, Reiter C, Reder M, Machmer A, Soellner R (2018) Intervention helps family caregivers of people with dementia attain own therapy goals. Am J Alzheimers Dis Other Demen, 33(5): 301-308.

Dementia Caregivers and Cognitive Behavioral Therapy: A Systematic Review

Yıl 2021, Cilt: 13 Sayı: 2, 170 - 191, 30.06.2021
https://doi.org/10.18863/pgy.732086

Öz

Dementia is seen in increasing numbers, and people diagnosed with dementia need other people’s care. Caregivers are generally family members of the person and may experience psychological difficulties and may need psychological help. Therefore, the aim of this study is to investigate the effectiveness of Cognitive Behavioral Therapy (CBT) based interventions applied to family caregivers of people with dementia. In order to review CBT based interventions for family caregivers of people with dementia, researches published between 1990-2020 in EBSCHOHost (including Medline), Web of Science and Cochrane (including PubMed and Embase) databases were scanned. These screening and reporting were carried out in accordance with the PRISMA Statement used in reporting systematic reviews. In the first identification, 819 studies were obtained. When repeated studies were excluded, considering the inclusion and exclusion criteria, 20 studies were included for this review. It was determined that CBT based interventions can be applied individually and as a group, and these applications can also be carried out face-to-face, via telephone and the Internet. Although the duration, frequency and evaluations of the sessions differ in the studies, it is seen that CBT interventions have positive contributions to family caregivers of people with dementia, dementia patients receiving care, and communication between them. When evaluated in general, it is concluded that CBT is effective for family caregivers of people with dementia. The findings of the studies were discussed in the light of the related literature and suggestions were made for future studies.

Proje Numarası

Yok

Kaynakça

  • Aboulafia-Brakha T, Suchecki D, Gouveia-Paulino F, Nitrini R, Ptak R (2014) Cognitive–behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer's disease. Aging Ment Health, 18(6): 801-808.
  • Akkerman RL, Ostwald SK (2004) Reducing anxiety in Alzheimer's disease family caregivers: the effectiveness of a nine-week cognitive-behavioral intervention. Am J Alzheimers Dis Other Demen, 19(2): 117-123.
  • Ali S, Bokharey IZ (2015) Efficacy of cognitive behavior therapy among caregivers of dementia: an outcome study. Pakistan Journal of Psychological Research, 30(2): 249-269.
  • Altuntaş O, Koç C (2015) Demanslı Hastaya Bakım Veren Aile Bireylerinin Aktivite Performanslarının İncelenmesi. Ergoterapi ve Rehabilitasyon Dergisi, 3(1): 35-44.
  • Alzheimer’s Association (2004) Families Care: Alzheimer’s Caregiving in the United States 2004. https://www.alz.org/national/documents/report_familiescare.pdf (19 Nisan 2020’de ulaşıldı).
  • Alzheimer's Disease International (2013) Policy Brief for Heads of Government. The Global Impact of Dementia 2013-2050. https://www.alz.co.uk/research/GlobalImpactDementia2013.pdf (20 Nisan 2020’de ulaşıldı).
  • Amerikan Psikiyatri Birliği (1994) Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, Dördüncü Baskı (DSM-IV) (Çeviri Ed. E Köroğlu). Ankara, Hekimler Yayın Birliği.
  • Barnes CJ, Markham C (2018) A pilot study to evaluate the effectiveness of an individualized and cognitive behavioural communication intervention for informal carers of people with dementia: the talking sense programme. Int J Lang Commun Disord, 53(3): 615-627.
  • Covinsky KE, Newcomer R, Fox P, Wood J, Sands L, Dane K et al. (2003) Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med, 18(12): 1006-1014.
  • Czaja SJ, Rubert MP (2002) Telecommunications technology as an aid to family caregivers of persons with dementia. Psychosom Med, 64(3): 469-476.
  • Dünya Sağlık Örgütü (1992) ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması (Çeviri Ed. MO Öztürk, B Uluğ). Ankara, Türkiye Sinir ve Ruh Sağlığı Derneği Yayını.
  • Dünya Sağlık Örgütü (World Health Organization) (2015) The Epidemiology and Impact of Dementia. https://www.who.int/mental_health/neurology/dementia/dementia_thematicbrief_epidemiology.pdf (20 Nisan 2020’de ulaşıldı).
  • Dünya Sağlık Örgütü (World Health Organization) (2019) Dementia. https://www.who.int/en/news-room/fact-sheets/detail/dementia (19 Nisan 2020’de ulaşıldı).
  • Fauth E, Hess K, Piercy K, Norton M, Corcoran C, Rabins P et al. (2012) Caregivers’ relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers’ physical health and psychological well-being. Aging Ment Health, 16(6): 699-711.
  • Gallagher-Thompson D, Coon DW (2007) Evidence-based psychological treatments for distress in family caregivers of older adults. Psychol Aging, 22(1): 37-51.
  • Gallagher-Thompson D, Gray HL, Tang PC, Pu CY, Leung LY, Wang PC et al. (2007) Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study. Am J Geriatr Psychiatry, 15(5): 425-434.
  • Gilhooly KJ, Gilhooly MLM, Sullivan MP, McIntyre A, Wilson L, Harding E et al. (2016) A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC Geriatr, 16(1): 106.
  • Glueckauf RL, Jeffers SB, Sharma D, Massey AJ, Davis WS, Wesley LM et al. (2007) Telephone-based cognitive-behavioral intervention for distressed rural dementia caregivers. Clin Gerontol, 31(1): 21-41.
  • Gonyea JG, López LM, Velásquez EH (2016) The effectiveness of a culturally sensitive cognitive behavioral group intervention for Latino Alzheimer’s caregivers. Gerontologist, 56(2): 292-302. Koydemir-Özden S (2010) Self-aspects, perceived social support, gender, and willingness to seek psychological help. Int J Ment Health, 39(3): 44-60.
  • Kwok T, Au A, Bel Wong II, Mak V, Ho F (2014) Effectiveness of online cognitive behavioral therapy on family caregivers of people with dementia. Clin Interv Aging, 9: 631-636.
  • Kwon OY, Ahn HS, Kim HJ, Park KW (2017) Effectiveness of cognitive behavioral therapy for caregivers of people with dementia: a systematic review and meta-analysis. J Clin Neurol, 13(4): 394-404.
  • Liu S, Li C, Shi Z, Wang X, Zhou Y, Liu S et al. (2017) Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. J Clin Nurs, 26(9-10): 1291-1300.
  • Losada A, Márquez‐González M, Romero‐Moreno R (2011) Mechanisms of action of a psychological intervention for dementia caregivers: Effects of behavioral activation and modification of dysfunctional thoughts. Int J Geriatr Psychiatry, 26: 1119-1127.
  • Mahoney R, Regan C, Katona C, Livingston G (2005) Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry, 13(9): 795-801.
  • Márquez-González M, Losada A, Izal M, Pérez-Rojo G, Montorio I (2007) Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme. Aging Ment Health, 11(6): 616-625.
  • Meichsner F, Theurer C, Wilz G (2018) Acceptance and treatment effects of an internet‐delivered cognitive‐behavioral intervention for family caregivers of people with dementia: A randomized‐controlled trial. J Clin Psychol, 75(4): 594-613.
  • Meichsner F, Töpfer NF, Reder M, Soellner R, Wilz G (2019) Telephone-based cognitive behavioral intervention improves dementia caregivers’ quality of life. Am J Alzheimers Dis Other Demen, 34(4): 236-246.
  • Meichsner F, Wilz, G (2018) Dementia caregivers’ coping with pre-death grief: effects of a CBT-based intervention. Aging Ment Health, 22(2): 218-225.
  • Oyebode J (2003) Assessment of carers' psychological needs. Adv Psychiatr Treat, 9(1): 45-53.
  • Pan Y, Chen R (2019) The effect of a nurse-led cognitive behavioral protocol on depressive symptoms and coping strategies of dementia caregivers. J Nurs Res, 27(6): e55.
  • Passoni S, Moroni L, Toraldo A, Mazza MT, Bertolotti G, Vanacore N et al. (2014) Cognitive behavioral group intervention for Alzheimer caregivers. Alzheimer Dis Assoc Disord, 28(3): 275-282.
  • Pillemer S, Davis J, Tremont G (2018) Gender effects on components of burden and depression among dementia caregivers. Aging Ment Health, 22(9): 1162-1167.
  • Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB et al. (2007) Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology, 29(1-2): 125-132.
  • Roth DL, Dilworth-Anderson P, Huang J, Gross AL, Gitlin LN (2015) Positive aspects of family caregiving for dementia: Differential item functioning by race. J Gerontol: Psychol Sci, 70(6): 813-819.
  • Schulz R, Mendelsohn AB, Haley WE, Mahoney D, Allen RS, Zhang S et al. (2003) End-of-life care and the effects of bereavement on family caregivers of persons with dementia. N Engl J Med, 349(20): 1936-1942.
  • Soner S, Aykut S (2017) Alzheimer Hastalık Sürecinde Bakım Veren Aile Üyelerinin Yaşadıkları Güçlükler ve Sosyal Hizmet. Ahi Evran Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 3(2): 375-387.
  • Stall NM, Kim SJ, Hardacre KA, Shah PS, Straus SE, Bronskill SE et al. (2019) Association of informal caregiver distress with health outcomes of community‐dwelling dementia care recipients: A systematic review. J Am Geriatr Soc, 67(3): 609-617.
  • Töpfer NF, Wilz G (2018) Tele. TAnDem increases the psychosocial resource utilization of dementia caregivers. GeroPsych, 31(4): 173-183.
  • Xiong C, Biscardi M, Nalder E, Colantonio A (2018) Sex and gender differences in caregiving burden experienced by family caregivers of persons with dementia: a systematic review protocol. BMJ Open, 8: e022779.
  • Wilz G, Meichsner F, Soellner R (2017) Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention. Aging Ment Health, 21(7): 74-781.
  • Wilz G, Reder M, Meichsner F, Soellner R (2018) The Tele. TAnDem intervention: telephone-based CBT for family caregivers of people with dementia. Gerontologist, 58(2): e118-e129.
  • Wilz G, Soellner R (2016) Evaluation of a short-term telephone-based cognitive behavioral intervention for dementia family caregivers. Clin Gerontol, 39(1): 25-47.
  • Wilz G, Weise L, Reiter C, Reder M, Machmer A, Soellner R (2018) Intervention helps family caregivers of people with dementia attain own therapy goals. Am J Alzheimers Dis Other Demen, 33(5): 301-308.
Toplam 43 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Uygulamalı ve Gelişimsel Psikoloji
Bölüm Derleme
Yazarlar

Elçin Yorulmaz 0000-0001-8353-0952

Gülay Dirik 0000-0002-5748-9180

Proje Numarası Yok
Yayımlanma Tarihi 30 Haziran 2021
Kabul Tarihi 4 Temmuz 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 13 Sayı: 2

Kaynak Göster

AMA Yorulmaz E, Dirik G. Demans Tanısı Olan Kişilere Bakım Verenler ve Bilişsel Davranışçı Terapi: Sistematik Derleme. Psikiyatride Güncel Yaklaşımlar. Haziran 2021;13(2):170-191. doi:10.18863/pgy.732086

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