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Needs of Individuals with Chronic Mental Disorder: A Systematic Review

Author(s): Gülsüm Zekiye Tuncer,Zekiye Çetinkaya Duman / Language(s): English / Issue: 2/2020

Keywords: Chronic mental disorder; need; need assessment;

This systematic review was undertaken to assess the needs of individuals with chronic mental illness and the investigations in the last decade that have identified the factors that affected them. The systematic review of the literature was conducted using the keywords "Pubmed", "Google Scholar", "Science Direct", "Medline", "Ebsco", "Cochrane". The studies were evaluated within the inclusion and exclusion criteria. As a result of the literature reviewed, between 2008 and 2018, 20 studies with patients with chronic mental disorders were included in the review. Nineteen of the investigated studies are descriptive and one is randomized controlled experimental work. The sample size of the studies studied is between 35 and 588. Psychosocial needs such as social and close relationships, physical health status, disease status and treatment information, daytime activities and psychological distress were mostly unmet. It was determined that the needs of the patients were affected by socio-demographic characteristics such as age, gender, ethnicity, disease diagnosis, disease duration and number of hospitalizations. In addition, it was found that the needs of patients were affected by socio-economic status and functionality and symptom severity. In this systematic review, it is seen that patients need many areas and socio-demographic and economic factors and disease characteristics affect the require-ments. The planning and implementation of interventions to meet the needs of individuals with chronic mental disorders is important for the survival of individuals in community.

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Use of Experience Sampling Method in the Assessment of Anxiety Disorders: A Systematic Review

Author(s): Büşra Yıldırım,Gizem Bozyel,Orçun Yorulmaz / Language(s): English / Issue: 2/2020

Keywords: Experience sampling; ecological momentary assessment; anxiety disorders;

The Experience Sampling Method (ESM), which makes possible to make momentary assessment during daily life by using portable devices and applications, has been actively used in clinical psychology research along with accelerating technological developments in recent years. The use of this method might be highly functional in some problems characterized with fluctuating symptom severity such as anxiety disorders. Because it is aimed to investigate the current literature findings about the use of this method in research on anxiety disorders and to make inferences about main study findings in this systematic review, current empirical studies particularly on anxiety disorder symptoms performed with the ESM were screened and examined. Taking the recent DSM-5 revisions into account, specific keywords were determined and scanned in 4 different databases (Web of Science, ProQuest, PsycINFO and PubMed). Following the screening processes, 14 articles that matched with inclusion criteria were involved in the present study. Firstly, it is seen that those studies were performed by using ESM generally included the adults and female participants and assessments with experience sampling measurements by electronic devices took 9 days in avarage. Moreover, it is also observed that among the different categories of psychological disorders, were evalutions on momentary affect changes, post-event processing and rumination that were usually studied. In sum, it is considered that ESM is a functional method that can be used in the field of scientific research, and it may be beneficial that recognizing and extending the utilization of this method.

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Attention Deficit Hyperactivity Disorder in the Elderly

Author(s): Çağatay Çavuşoğlu,Mehmet Emin Demirkol,Lut Tamam / Language(s): English / Issue: 2/2020

Keywords: Attention deficit hyperactivity disorder; elderly; diagnosis;

Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric syndrome which is hereditarily inherited, affected by environmental factors, and most commonly seen in childhood. It is a disorder that can continue in adulthood and is seen even in the geriatric population. ADHD, which may manifest itself with different symptoms in the geriatric population and the diagnosis of which is often overlooked, may sometimes present itself with dementia or depressive symptoms. Its prevalence is thought to be 3-4% in the elderly population. However, the diagnostic criteria of the ADHD in the elderly population are not yet available and the diagnosis is made based on the criteria found in the DSM-5 (Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition). Although some imaging and neurophysiological methods are utilized, there is no specific finding or image for ADHD. Defects in gray matter lesions in frontal and prefrontal areas can be demonstrated by magnetic resonance imaging (MRI). Some researchers think that functional MRI will provide more promising results in the future. Although the pathophysiology of ADHD has not yet been fully elucidated, clinical features are observed in a wide spectrum ranging from sleep disorders to dementia in the geriatric population. Therefore, ADHD should be examined in detail in the elderly population and new diagnostic criteria should be developed for the disorder by new studies. Because it is thought that the frequency of ADHD in the current literature is much less than that in real life.

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Malpractice in Psychiatry

Author(s): Melisa Bulut,Neşe Mercan,Çiğdem Yüksel / Language(s): English / Issue: 2/2020

Keywords: malpractice; psychiatry;practice error;

Medical malpractice is defined as medical practice errors caused by a lack of standard treatment and care due to neglect, carelessness, lack of knowledge and skills. Despite psychiatry is seen as a low-risk area for medical malpractice, it constitutes 3% of all medical malpractice lawsuits. The purpose of this review is to describe the content of malpractice lawsuits in psychiatry and to determine the measures to be taken for malpractice in psychiatry by reviewing the studies in the literature dealing with malpractice lawsuits in the field of psychiatry. As a result, the content of malpractice lawsuits in the field of psychiatry consists of suicide lawsuits, involuntary admission to psychiatric hospitals, failure to diagnose, psychopharmacologic agents prescribing errors, inadequate treatment, and boundary violation in professional practice. It was determined that suicide lawsuits took first place in these legal cases. Most of the studies focused on the measures to be taken for malpractice in psychiatry. It has been seen that these measures are related to psychiatric professionals, patients, patient relatives and management in hospital settings and need to be handled in cooperation. As a result, in order to avoid malpractice in mental health settings, the rights of patients and psychiatric professionals must be protected, involuntary or compulsory treatments and hospitalizations should be clearly identified, easy access to advocates of patients and health workers and a supervisory board should be established. In this respect, it is thought that an establishment of national legislation about mental health will guide this issue.

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Comorbid Psychiatric Disorders and Treatment Options in Temporomandibular Disorders and Bruxism

Author(s): Bahadır Geniş,Çiçek Hocaoğlu / Language(s): English / Issue: 2/2020

Keywords: Temporomandibular Disorders; Bruxism; depression;

Temporomandibular disorder (TMD) is a clinical condition affecting the masticatory muscles, the temporomandibular joint (TMJ) and the structures surrounding this joint.Bruxism is a parafunctional habit that occurs as a result of overloading of stomatognathic structures with tooth squeezing and grinding, which is included in the etiology of TMB.TMB is seen in approximately 10% of the population and bruxism is seen in 8-20%. Many factors are effective in the etiology of TMD and bruxism, and there are interactions between these factors. Biomechanical, neuromuscular, biopsychosocial and neurobiological factors contribute to the disease. The prevalence of psychiatric disorders is high in individuals with TMB and bruxism. Many psychiatric disorders, especially depression and anxiety disorders, accompany TMB and Bruxism. The antidepressants used in the treatment of these disorders cause bruxism. This is one of the important challenges in the treatment of TMB and bruxism.The first step in the treatment of TMB and bruxism is to address the basic prevention methods. While amitriptyline use is prominent in TMB pharmacotherapy, in bruxism, buspirone and clonazepam are two important drugs used.The study of these drugs in small samples and the fact that the available information is mostly based on case reports clearly shows the necessity of further studies. The widespread use of cognitive behavioral therapy in both disorders will be a solution and eliminate the side effects of medication.Regardless of the treatment option, both dentists and psychiatrists should be in a multidisciplinary working environment and should evaluate these diseases within the framework of the biopsychosocial model.

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Effects of Domestic Violence Against Women on Mental Health of Women and Children

Author(s): Behice Han Almış,Funda Gümüştaş,Emel Koyuncu Kütük / Language(s): English / Issue: 2/2020

Keywords: Domestic violence; woman; child; mental disorder; violence;

Domestic violence is violence or other abuse by one person against another in cohabitation or marriage. It isn’t surprise that women and children are world’s most victimized person due to domestic violence. Because, they are often powerless. In fact, domestic violence is not physical violence alone. Also women can be victimized by psychological, sexual or economical violence in marriage. Domestic violence, causes disturbance in mental health and life quality of women. Also exposure to violence increases use of medical services in these women, and even impairs long term mental development of their children. Children who witness to domestic violence may suffer from some behavioral and emotional disturbance. Furthermore these children may be the perpetration or experiencing of violence later in life. Domestic violence against women is risk factor for depression, anxiety, and posttraumatic stress disorder in these women. Therefore, questioning domestic violence in women who come to psychiatry clinic for getting help due to these reasons is crucial. The aim of this study was to review domestic violence against women, frequency, variables and the effect of domestic violence on women exposed to domestic violence and their children.

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A Neglected Field in Cancer Care: Identification and Management of Suicide Risk

Author(s): Sevda Öztürk,Duygu Hiçdurmaz / Language(s): English / Issue: 2/2020

Keywords: Suicide; cancer; oncology nursing; suicide risk; suicide risk prevention;

Suicide is on the agenda of a number of countries in the world. In this respect, studies on suicide prevention pay special attention to the risk groups among which there are also cancer patients. Physical and psychosocial difficulties experienced during the disease process and some demographic characteristics might be the predictors of suicidal ideation or attempt. Oncology nurses are the members of health care team who provide continuous care for physical and psychosocial needs of cancer patients, and thus they are the ones who can identify suicide risk. However, their lack of knowledge and skills in the assessment and evaluation of suicide, negative attitudes and false beliefs are among the important obstacles of nurses in this area. The aim of this work is to raise awareness on suicide risk in cancer patients and to reveal the roles, responsibilities, problems and needs of oncology nurses regarding this issue.

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Cognitive-Behavioral Approach in Marital Therapy

Author(s): Rojin Yazar,Özlem Tolan / Language(s): English / Issue: 1/2021

Keywords: Cognitive-behavioral therapy; marital therapy; psychotherapy;

Marital relationship is considered as a positive and life-enriching factor. Nevertheless, there exist disagreements and conflicts in marriage, which could also be serious stressors that affect the lives of the individuals. Effective solutions for prevailing problems ensure the functional continuity of the family. Cognitive-behavioral therapies developed to resolve marital problems were commonly intended to modify the unrealistic expectations, problematic cognitions and behaviors of the spouses and to improve their interaction, using direct skill-based methods such as problem-solving and communication skills. Certain objectives of cognitive-behavioral marital therapy, which focus on the feelings, behaviors, and cognitions of spouses, include decreasing problematic behavioral interactions and increasing mutual emotional support between the spouses. In recent years, cognitive-behavioral marital therapy was adapted to address a wide range of individual, psychological, and medical problems. Cognitive-behavioral marital therapy studies based on marital conflict and individual psychopathologies are expected to be effective both for relationship compliance and for the improvement of psychopathological symptoms of the spouses.

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Examining the Relationship between Attachment and Depression in Terms of Various Variables: A Theoretical Study

Author(s): Zeynep Set / Language(s): English / Issue: 1/2021

Keywords: Attachment; self-object; psyhchological symptoms; subjective well-being; emotion regulation;

Self-psychology concept, developed by Heinz Kohut, is now seen as one of the most fundamental psychoanalytic theories. Kohut’s theory of self psychology and Bowlby’s attachment theory emphasizes the importance of early care giving relationship and how this has a profound effect on the development of a healthy sense of self and relationship in adulthood. In this study, it is aimed to explain the concept of self-object in self-psychology and attachment theory in detail. In this context, in order to examine the effects of self-object and attachment dimensions, the literature findings related to attachment and self-object with depression, anxiety and subjective well-being and the possible mediator effect of emotion regulation in these relationships were investigated. Suggestions were made for future research.

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Effectiveness of Cognitive Behavioral Therapies in Women with Breast Cancer: A Systematic Review

Author(s): Aygül Tunç Aksan / Language(s): English / Issue: 1/2021

Keywords: Breast cancer; cognitive behavioral therapy; randomized controlled trials; systematic review;

Cognitive Behavioral Therapy (CBT) has been proven by systematic review and meta-analysis studies that it is an effective psychotherapeutic approach for women with breast cancer (WBC) having biological, psychological, and social distress. However, CBT consists of different waves. In recent years, it is found that third wave approaches such as Acceptance and Commitment Therapy (ACT) and Mindfulness Based Cognitive Therapy (MBCT) are used as psychological interventions in breast cancer. In the present study, the aim is to assess the effects of randomized controlled studies based on second and third wave Cognitive Behavioral Therapies on the bio-psycho-social distress of WBC by a systematic review. Literature review was conducted on 3 electronic databases, Google Academic, PubMed, and Ulakbim, by using English and Turkish keywords. Studies executed with second- or third-wave CBT in women with breast cancer and with randomized controlled research designs were included in the review. 21 studies complying with the eligibility criteria were found. Among these studies, 16 were categorized as the studies conducted based on CBT, 3 based on ACT, and 2 based on MBCT. CBT are effective in depression, insomnia, cognitive impairment, menopausal symptoms, fatigue related by cancer, physical adaptation, pain, life quality, psycho-social adaptation, self-esteem, and sexual dysfunction.

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Psychosocial Interventions for Individuals with Severe Mental Illness and Their Familes in Turkey: A Systematic Review

Author(s): Seval Bekiroğlu,Seda Attepe Özden / Language(s): English / Issue: 1/2021

Keywords: Individual with severe mental illness; family; psychosocial intervention;

The aim of this study is to describe the psychosocial interventions for individuals with severe mental illness and/or their families in Turkey, and evaluate their results. Turkish Psychiatry Index, Turkish Medline, Council of Higher Education National Thesis Center, Google Scholar, and TR Index databases were searched to identify the studies conducted with individuals with severe mental illness and/or their families between 2000 and 2019. As a result of the search, 2404 studies were obtained in total, and 36 of them were selected to be evaluated. 16 of the studies examined are published research articles, 10 are PhD theses, 6 are master’s theses, and 4 are medical dissertation. While the majority of the psychosocial intervention programs (47.2%) are psychoeducation studies, 11 (30.5%) are original skill trainings and 8 (22.2%) are problem- or symptom-oriented studies. The average number of samples of intervention programs mostly practiced by nurses is 30.5, and the average intervention period is 10.5 sessions. The results reveal that the positive effects of the applied programs on the areas such as social functionality, treatment compliance and quality of life for individuals with severe mental illness; and subjective burden, coping strategies, emotional expression and family functionality for caregivers. It is extremely important for individuals with severe mental illness and their families to extend these programs, which currently seem to be implemented in a limited way in Turkey, and to make them a part of routine clinical practice.

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Play Therapy Practices in Psychological and Developmental Disorders That Are Common in Preschool Period

Author(s): Murat Genç,Özlem Tolan / Language(s): English / Issue: 2/2021

Keywords: Child; preschool; play therapy;

Preschool period is a period when children start to get to know the environment and gain basic vital skills thanks to their developing cognitive, social, physical and emotional skills. During this period, when the child tries to get to know himself/herself and to control the environment, psychopathological results may occur from time to time. It is seen that the play therapies are getting more and more widespread with the addition of the game, which is the most important occupation of the child, to the treatment stages of the problems experienced in this period. Play therapies are defined as a therapy method in which children’s psychosocial problems are treated using the healing power of the game. The most preferred age group for play therapies that can be applied in different age groups such as baby, child, and adolescent is the 3-12 age range. Thus, it is aimed to improve the problem-solving skills of the children and to be reach their psychological well-being with the play therapy techniques prepared considering their current developmental periods. In addition to the above, play therapies are used in the treatment of many psychological disorders. In the current review article, the effectiveness of play therapy on disorders such as depression, attention deficit hyperactivity disorder, childhood period traumas, anxiety disorders, behavioral disorders, autism and learning disability that are common in pre-school period were evaluated in the pre-school period, and then it was concluded that play therapy was effective in the treatment of all disorders examined, especially behavioral disorders and depression.

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A Psychosocial Evaluation of the Coronavirus Pandemic

Author(s): Hilal Kaya,Elvan Kiremitçi Canıöz / Language(s): English / Issue: 2/2021

Keywords: Coronavirus; pandemic; global trauma; terror management theory; well-being;

In this study, the coronavirus pandemic process, which caused a global crisis, was evaluated in the framework of some psychological theories. This pandemic, in which the whole world goes through and is affected at the same time, has many consequences both on social and individual levels. The current age of technology seems to have opened new doors to humanity during the pandemic. Despite curfews and physical distance rules in many countries, people can continue their business, shop and socialize through virtual platforms. In this process, people are looking for new ways to adapt to existing conditions and try to cope with negative emotions such as fear, anxiety and stress created by the pandemic. Along with the Coronavirus pandemic causing a global crisis, it has been thought that there are similar tendencies in the behavior and attitudes of individuals and all humanity to cope with the process. Pandemic process is handled from the perspective of social trauma and in this study, explanations are given in terms of helping behavior, coping and well-being within the framework of terror management theory.

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Empiric Ethics Views in Mental Health and Psychiatric Care

Author(s): Beyhan Bag / Language(s): English / Issue: 2/2021

Keywords: Psychiatric nursing; ethics; empirics ethics;

The meaning of empirical knowledge in ethics has been debated from the past. Empirical ethics, which is a combination of social science and normative ethics, generally means social science research. Empirical ethics, which is also defined as an integrated form of ethical analysis and empirical research, enriches the discussions by clarifying the dilemmas faced by nurses in care services offered to individuals with mental health problems. In this context, studies combined with empirical ethics in mental health and psychiatric care are quite insufficient. In this article, it is aimed to define empirical ethics and discuss it in Turkey studies that can be defined as empirical ethical research conducted in the fields of psychiatric care.

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Effect of Transdiagnostic Psychological Intervention Programs on Depression and Anxiety Disorders: A Systematic Review

Author(s): Özge Erarslan İngeç,Orçun Yorulmaz / Language(s): English / Issue: 2/2021

Keywords: Cognitive behavioral therapy; unified protocol; emotional disorders; depression; anxiety disorders;transdiagnostic approach;

By considering the etiological similarities of depression and anxiety disorders with high lifetime coexistence rates, recent research has introduced a transdiagnostic approach applicable to a range of emotional disorders with these common features. This paper reviews empirical studies examining the effects of transdiagnostic intervention programs on depression and anxiety disorders. The literature search identified 18 randomized controlled and 12 non-randomized studies. These were examined in terms of their sample characteristics, methodological approaches, and findings. Overall, the reviewed transdiagnostic psychological intervention programs treat various anxiety disorders and depression effectively. In cases where anxiety and depressive symptoms are comorbid, the transdiagnostic approach has significant advantages over diagnosis-specific protocols. Future studies should investigate the effect of the transdiagnostic approach in different diagnostic groups compared to diagnosis-specific treatments. In Turkey specifically, it is important to investigate the effectiveness of transdiagnostic interventions and potential clinical and economic advantages compared to diagnostic specific protocols.

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A Life in Purgatory: Being the Mother of a Bone Marrow Transplant Child

Author(s): Esra Engin,Mahire Olcay Çam,Hacer Demirkol / Language(s): English / Issue: 2/2021

Keywords: Bone marrow transplantation; child; mother; psychiatric nurse; consultation liaison psychiatry nursing;

Bone marrow transplantation is a therapy used for children who have certain diseases with high rates of morbidity and mortality as hematologic malignancies, immune deficiency and bone marrow failure. Bone marrow transplantation increase the chances of success in the treatment of this diseases and prolongs lifespan of children, it may also cause some systemic complications as well. During this rather difficult process, particularly for children, it is reported that among the family members, it is often the mother who is affected the most. Long-term attentive care creates a great burden for the mother. Moreover, concerns about whether transplantation will be successful or not, recurrence of the disease, loss of child, how life will continue after loss cause uncertainty, resulting in separation anxiety and existential anxiety for the mother. It is reported that mental illnesses such as depression, anxiety disorder and post traumatic stress disorder are common among those mothers whose children underwent bone marrow transplantations. In this process, which is traumatic for both the child and the mother, the role of the consultant liaison psychiatry (CLP) nurse together with the primary treatment team is important. Therefore, this review was written to explain the experiences, multidimensional problems of mothers whose children underwent bone marrow transplantation and to describe the role of the consultant liaison psychiatry nurse in this process.

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Effectiveness of Third Wave Therapies for Treatment of Obsessive-Compulsive Disorder: A Review

Author(s): Gizem Onaral / Language(s): English / Issue: 2/2021

Keywords: Obsessive-compulsive disorder, acceptance and commitment therapy; mindfulness; meta-cognition;

In the treatment of obsessive-compulsive disorder, the effectiveness of two main treatment approaches, pharmacotherapy and cognitive behavioral therapy (CBT), has been proven. However, the high rates of drop out from treatment and the presence of residual symptoms after CBT direct researchers to look for different treatment approaches. Therefore, emerging developments show that Third Wave Therapies are promising. In this review; it is aimed to summarize the theoretical background of Third Wave Therapies used in the treatment of obsessive-compulsive disorder and to review the effectiveness of these approaches and examine these studies in terms of methodological perspective and therapy content. In accordance with this purpose, studies which examine the effectiveness of Acceptance and Commitment Therapy, Mindfullness-Based Therapy, Metacognitive Therapy, Schema Therapy and Dialectical Behavior Therapy which are published in English/Turkish between 2004-2020 years and accessed from 5 databases: Ebscohost, Ulakbim, Google Scholar, Science Direct and Web of Science are included. As a result of this review, it has been determined that Third Wave Therapies generally reduce obsessive-compulsive symptoms and result in both reductions on depression, anxiety and stress symptoms and improvements on skills such as self-compassion and mindfulness. Based on these results, it was concluded that the first evidences about the effectiveness of Third Wave Therapies in the adult population in the treatment of obsessive-compulsive disorder begin to accumulate, but there is a need for randomize clinical controlled trials which is performed with larger samples and compared with cognitive behavioral therapy, exposure and response prevention or pharmacotherapy.

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Use of Machine Learning Methods in Psychiatry

Author(s): İlkim Ecem Emre,Cumhur Taş,Çiğdem Erol / Language(s): English / Issue: 2/2021

Keywords: psychiatry; machine learning; psychiatric diseases;

Machine learning methods, which are becoming more and more popular in artificial intelligence and data analysis, provide learning from data in many different fields. In the studies conducted in the field of health, these methods support healthcare professionals and physicians. Psychiatry is one of these areas. Machine learning methods provide support to problems such as diagnosis, prediction of disease course or monitoring response to a treatment. In this study, machine learning studies in the field of psychiatry are examined.The aim of the study is to examine the studies of machine learning in the field of psychiatry and especially the studies conducted using electroencephalography (EEG) data. Accordingly, studies on machine learning in the field of psychiatry in SCOPUS and Google Scholar sources were examined. In order to reveal the general situation in the literature, studies using machine learning methods in the field of psychiatry were examined. Afterwards, studies using both machine learning methods and EEG data in psychiatry were examined. It is hoped that this study will be useful to researchers in terms of the publications about machine learning in psychiatry and especially the publications using EEG data.

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Lifespan Development of Gender Roles

Author(s): Bahar Bahtiyar Saygan,Nilay Pekel Uludağlı / Language(s): English / Issue: 2/2021

Keywords: Gender development; gender roles; gender streotypes; gender equality; lifespan development;

Today, almost every child is born into a society where gender roles are socially built and grows in such a gender-segregated world. With the influence of factors such as family, friends, and media, which play a role in the socialization process during infancy and childhood, children learn about gender roles determined by the society. In this context, from the perspective of gender differences, girls face more oppressive approaches and are expected to behave submissively, be more easy going, complier, relational, and show their emotions more deeply compared to their male peers. On the other hand, boys are rared as strong, independent, less emotional, and they are expected to behave in this way under all circumstances. Children who are socialized with these teachings from infancy to adolescence are also strongly influenced by the gender roles displayed by their parents and ultimately internalize those gender roles which has a lifetime effect on them. It is known that gender stereotypes cause pressure and stress on both women and men both concurrently and in the long-run, and the need to adapt to the gender-based expectations of the society adversely affects their psychological health. Although social consciousness about gender equality has increased in recent years, it is known that gender inequality still continues in many countries. As a result, psychology of gender affects each individual at every stage of their lives, as stated consistently in the related literature, which clearly demonstrates the importance of policies for gender equality.

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Misophonia: A Review

Author(s): Yavuz Yılmaz,Çiçek Hocaoğlu / Language(s): English / Issue: 2/2021

Keywords: Misophonia; decreased sound tolerance; phenomenology; diagnosis;

Misophonia is defined as a disproportionate emotional response to everyday sounds created by other people and sometimes to animal sounds. It can be severe enough to disrupt people’s professional and social functionality. The risk factors and etiology of the disease are not fully known. It can be seen together with some neurodevelopmental diseases and psychiatric disorders. Amsterdam Misophonia Scale and Misophonia Scale are scales developed to evaluate misophonia. Diagnostic criteria have not been fully determined and are not included in the current diagnostic classifications. In its treatment, methods such as cognitive behavioral therapy, mindfullnes, dialectical behavioral therapy and exposure are used, and no specific pharmacological treatment has been defined.

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