Psychiatry

Psychiatry is the fundamental medical specialty concerned with the diagnosis, treatment, and prevention of mental disorders. Positioned at the intersection of brain and behavioral sciences, this branch covers a wide spectrum of illnesses such as depression, anxiety disorders, bipolar disorder, schizophrenia, addiction, and personality disorders. The Koru Hospital Psychiatry Department aims to improve patients' quality of life by offering comprehensive solutions to mental health problems through a biopsychosocial approach.

Definition and Importance of Psychiatry

Psychiatry, derived from the Greek words "psyche" (soul/mind) and "iatreia" (healing/treatment), is a specialty focused on the medical treatment of mental health disorders. Unlike other medical branches, psychiatry adopts a holistic approach that requires the simultaneous evaluation of biological, psychological, and social factors. Psychiatrists are physicians who have graduated from medical school and are distinguished from psychologists by their authority to prescribe medication.

According to World Health Organization data, one in four people worldwide experiences a mental disorder at some point in their life. Depression has become one of the leading causes of disability globally and leads to serious individual and societal losses if left untreated. These data clearly demonstrate the critical importance of psychiatry in terms of public health.

Mood Disorders

Mood disorders constitute one of the most common groups of diseases encountered in psychiatry. Major depressive disorder is a condition characterized by a depressed mood, loss of interest, decreased energy, sleep disturbances, appetite changes, and difficulty concentrating for at least two weeks. The most effective results in treatment are obtained when antidepressant medications and psychotherapy are used in combination.

Bipolar disorder is a chronic mood disorder characterized by alternating manic and depressive episodes. During a manic episode, excessive energy, decreased need for sleep, grandiose thoughts, and impulsive behaviors are observed, while during a depressive episode, all symptoms of major depression emerge. Mood stabilizers and atypical antipsychotics are the primary pharmacological agents in the treatment of bipolar disorder. Treatment adherence and regular follow-up are decisive factors in controlling the disease.

Anxiety Disorders

Anxiety disorders are among the most common psychiatric illnesses in society and manifest with different clinical presentations. Generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, and separation anxiety disorder are the main subtypes of this group. In these illnesses, the individual experiences a state of excessive and uncontrollable anxiety, which seriously affects daily life functions.

Panic disorder is defined by recurrent panic attacks characterized by sudden onset of intense fear and physical symptoms. Symptoms such as palpitations, shortness of breath, chest pain, dizziness, and fear of death constitute a serious clinical picture that leads patients to seek emergency care. In social anxiety disorder, the individual experiences a fear of being embarrassed, ridiculed, or negatively evaluated in public, leading to the development of avoidance behavior regarding social settings.

In the treatment of anxiety disorders, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used as first-line pharmacological treatment. Cognitive behavioral therapy is the psychotherapy method with the strongest level of evidence for anxiety disorders. Combining medication and psychotherapy yields superior results compared to either method alone.

Schizophrenia and Psychotic Disorders

Schizophrenia is a chronic psychiatric illness characterized by severe impairments in thought, perception, affect, and behavior. Positive symptoms (hallucinations, delusions, disorganized thinking), negative symptoms (emotional blunting, social withdrawal, loss of motivation), and cognitive symptoms (deficits in attention, memory, and executive functions) constitute the three main symptom clusters of the disease.

Antipsychotic medications form the cornerstone of schizophrenia treatment. First-generation (typical) and second-generation (atypical) antipsychotics are selected based on the patient's clinical presentation and side-effect profile. Long-acting injectable antipsychotics offer an important option for patients experiencing treatment adherence issues. In addition to medication, psychosocial rehabilitation programs, vocational rehabilitation, and family education play a critical role in reintegrating patients into society.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a disorder characterized by recurrent obsessions (persistent thoughts, urges, or images) and compulsions (repetitive behaviors or mental acts). Contamination obsessions and cleaning compulsions, checking, ordering, counting, and hoarding are the most common OCD subtypes. The disease severely restricts a person's daily life, leading to significant impairment in work, social, and family life.

High-dose SSRI treatment and cognitive behavioral therapy based on exposure and response prevention are the first-line treatment options for OCD. In treatment-resistant cases, clomipramine, antipsychotic augmentation strategies, and neuromodulation methods can be applied. With early diagnosis and appropriate treatment, significant symptom reduction is achieved in the vast majority of patients.

Addiction Psychiatry

Substance use disorders and behavioral addictions constitute an increasingly important subfield of psychiatry. Addiction to alcohol, tobacco, cannabis, cocaine, opioids, and synthetic substances leads to serious health, social, and legal problems. Gambling addiction, internet addiction, and gaming addiction are evaluated under the category of behavioral addictions.

In addiction treatment, motivational interviewing, cognitive behavioral therapy, 12-step programs, and pharmacological treatment are applied together. Naltrexone, acamprosate, and disulfiram for alcohol addiction; methadone and buprenorphine for opioid addiction; and varenicline and nicotine replacement therapies for tobacco addiction are pharmacologically proven options. At Koru Hospital, individual and group therapies are integrated into the treatment process for addiction with a holistic approach.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops following exposure to a natural disaster, war, sexual assault, serious accident, or a life-threatening event. Re-experiencing the traumatic event (flashbacks, nightmares), avoidance behaviors, negative alterations in cognition and mood, and hyperarousal symptoms constitute the four main symptom clusters of the disease.

Trauma-focused cognitive behavioral therapy and EMDR (Eye Movement Desensitization and Reprocessing) are the psychotherapy methods with the strongest level of evidence in PTSD treatment. In pharmacological treatment, sertraline and paroxetine are FDA-approved medications for PTSD. With early intervention and appropriate treatment, full recovery can be achieved in a significant portion of patients.

Eating Disorders

Eating disorders are serious psychiatric illnesses characterized by abnormal eating behaviors and body image distortion. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the primary diagnoses in this group. Anorexia nervosa has the highest mortality rate among psychiatric illnesses and can lead to serious complications such as cardiac arrhythmias, electrolyte imbalances, and organ failure.

The treatment of eating disorders requires a multidisciplinary approach. Coordinated work between a psychiatrist, psychologist, dietitian, and internist is a decisive factor in the success of treatment. Cognitive behavioral therapy, interpersonal therapy, and family-based treatment are evidence-based psychotherapy methods for eating disorders. In severe cases, hospitalization and nutritional rehabilitation may be required.

Sleep Disorders

Sleep disorders are conditions that frequently co-occur with psychiatric illnesses and seriously affect quality of life. Insomnia, hypersomnia, narcolepsy, sleep apnea, and parasomnias are the main sleep disorders. Insomnia appears as both a symptom and a risk factor in psychiatric illnesses. Untreated chronic insomnia increases the risk of developing depression and anxiety disorders.

Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment. Sleep hygiene education, stimulus control, sleep restriction, and relaxation techniques are the core components of CBT-I. Short-term non-benzodiazepine hypnotics, melatonin agonists, and low-dose sedative antidepressants can be used in pharmacological treatment.

Psychiatric Assessment and Diagnostic Methods

Psychiatric assessment begins with a comprehensive clinical interview. The patient's complaints, medical history, family history, psychosocial background, and mental status examination are evaluated systematically. Standardized psychometric tests, neuropsychological assessments, and personality inventories are used as tools to assist in diagnosis.

• Clinical interview: Structured or semi-structured interview techniques that form the basis of psychiatric diagnosis
• Psychometric tests: Standard scales such as the Beck Depression Inventory, Hamilton Anxiety Scale, and MMPI
• Neuroimaging: Brain MRI, functional MRI, and PET imaging are used to rule out organic pathologies
• Laboratory tests: Thyroid function tests, vitamin levels, and blood drug levels are an integral part of psychiatric assessment
• Electroencephalography (EEG): Used in the investigation of epileptic foci and the evaluation of organic brain pathologies

Treatment Approaches

In modern psychiatry, treatment is conducted with a holistic approach where biological, psychological, and social interventions are applied together. Pharmacotherapy is one of the fundamental components in the treatment of mental illnesses. Antidepressants, antipsychotics, anxiolytics, mood stabilizers, and psychostimulants are the main psychotropic drug groups. The patient's diagnosis, comorbid illnesses, side-effect profile, and individual response are taken into account when selecting medication.

Psychotherapy is the other fundamental component of psychiatric treatment. Cognitive behavioral therapy, psychodynamic therapy, schema therapy, dialectical behavior therapy, EMDR, and family therapy are widely applied psychotherapy methods. Neuromodulation techniques such as transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and vagus nerve stimulation offer important alternatives in treatment-resistant cases.

At the Koru Hospital Psychiatry Department, our specialist physicians provide current, evidence-based practices in the diagnosis and treatment of mental illnesses by creating treatment plans tailored to each patient within the biopsychosocial model. Comprehensive services are provided to help our patients regain their health in a safe and supportive therapeutic environment that strictly adheres to the principle of confidentiality.