Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Non-suicidal Self Injury: Relationship with Attachment, Childhood Trauma and Dissociation İntihar Amacı Olmaksızın Kendine Zarar Verme Davranışı: Bağlanma, Çocukluk Çağı Travması ve Disosiasyon İlişkisi 1 1 10.5080/u27163 EN TR Beste Dila EREN SARIKAYA Çağatay ERMİŞ Hüseyin Burak BAYKARA Burcu SERİM DEMİRGÖREN Journal Article 1375 10.5080/u27163 Objective: This study aimed to investigate the relationship between non-suicidal self injury (NSSI), dissociative experiences, types of childhood traumas, and attachment styles in adolescents. Method: Adolescents aged 14-18 with a diagnosis of NSSI and a psychiatric disorder (NSSI, n=40), a clinical comparison group which have any psychiatric disorder without NSSI (CCG, n=40) and a healthy control group (HC, n=40) were included. The diagnosis of NSSI were confirmed as per the research criteria of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition. All participants were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version. Childhood Trauma Questionnaire (CTQ), the short form of the Inventory of Parent and Peer Attachment (IPPA), and the Adolescent Dissociative Experiences Scale (ADES) were used. Results: The dissociation scores were higher in the NSSI group compared to the CCG group (4.8±2.0 and 2.9±2.2, p<0.001) NSSI group also had higher trauma levels but the difference was not statistically significant (48.0±14.2 and 41.4±5.0, p=0.062). Similarly, the NSSI group yielded higher scores of CTQ (48.0±14.2 and 33.8±6.8, p<0.001) and ADES (4.8±2.0 and 1.8±1.6, p<0.001) compared to HC group. Also, compared to the HC group, the NSSI group had more impaired attachment to father (42.0±19.7 vs. 53.0±21.7, p=0.056) and more frequently reported physical and emotional abuse. Finally, there were negative correlations between attachment levels to mother and CTQ total scores (r=-0.70, p<0.001) and between father attachment subscale and ADES scores (r=-0.33, p=0.047). Conclusion: Our study supports the notion that dissociation, trauma and insecure attachment are more common in individuals with NSSI. Psychotherapeutic approaches based on current findings will provide more benefits to patients. Keywords: Non-Suicidal Self İnjury, Childhood Trauma, Dissociation, Attachment

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Adaptation of the Short-form 6-item UCLA Loneliness Scale (ULS-6) into Turkish UCLA Yalnızlık Ölçeği-6 Maddeli Kısa Formu’nun Türkçe’ye Uyarlanması 2 2 10.5080/u27219 EN TR Hüseyin ELBİ Aynur ÇETİNKAYA Seval CAMBAZ ULAŞ Ekin ATAY Ömer AYDEMİR Journal Article 1376 10.5080/u27219 Objective: The short-form 6-item UCLA Loneliness Scale is a brief assessment scale developed to determine the level of loneliness from a one-dimensional perspective while preserving psychometric properties equivalent to the original 20-item version. This study aimed to adapt the short-form 6-item UCLA Loneliness Scale into Turkish and to analyze its validity and reliability. Method: The convenience sampling method was preferred for this methodological study, in which 411 clinical and non-clinical individuals were included. The clinical group included 41 patients with major depressive disorders attending the psychiatric outpatient ward. The study’s data were collected with the Descriptive Information Form, short-form 6-item UCLA Loneliness Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory, and Trait Anxiety (A-Trait) Scale. Results: The Cronbach’s alpha value of the UCLA Loneliness Scale-6 Item Short Form was calculated as 0.884, and the scale’s internal consistency level was quite high. For the UCLA Loneliness Scale-6 Item Short Form, the variability level of the items constituting the one- dimensional structure produced from the explanatory factor analysis was 63.411%, and it could distinguish patients with descriptive features and clinical diagnosis (p<0.05). The scores of the UCLA Loneliness Scale-6 Item Short Form and other scales assessing loneliness showed a significant correlation (r=-0.476 - 0.618). Conclusion: The short-form 6-item UCLA Loneliness Scale is a simple, easy-to-apply, reliable, and valid scale that can be used in studies assessing loneliness. Keywords: Loneliness, Validity, And Reliability

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Early Maladaptive Schemas and Coping Styles, Reasons for Drinking, Craving and Remission in Patients with Alcohol Use Disorder Alkol Kullanım Bozukluğu Hastalarında Erken Dönem Uyumsuz Şemalar ve Başa Çıkma Biçimlerinin, İçme Nedenleri, Aşerme ve Remisyon Öyküsü ile İlişkisi 17 26 10.5080/u27144 EN TR Ekin Revşan PARLAK Başak ÜNÜBOL Engin Emrem BEŞTEPE Journal Article 1377 10.5080/u27144 Objective: Alcohol Use Disorder (AUD) is a serious mental disorder that affects the individual, family, environment and society as a whole. In this study, we aimed to analyze the relationship between early maladaptive schemas and coping styles, with craving, reasons for consumption and finally remission history. Method: This is a cross sectional study. We included 90 Erenköy Mental Health and Neurological Diseases Training and Research Hospital AMATEM patients with AUD according to DSM-5. AUD diagnosis is confirmed by SCID-5 CV. Subjects with additional psychiatric conditions are excluded. Subjects without withdrawal symptoms by CIWA-Ar are included. Sociodemographic data form, Young Schema Questionnaire Short form-3, Young Rygh Avoidance Inventory, Young Compensation Inventory, Drinking Motives Questionnaire-Revised, Obsessive Compulsive Drinking Scale was applied. Results: Our findings show that male subjects who have early maladaptive schemas, especially in Impaired autonomy and performance; Failure, Disconnection and rejection; Social İsolation/alienation, Impaired Limits; Insufficient Self-Control/Self-Discipline domains, experience more cravings. Individuals coping with the Psychosomatism, Activity and Distraction, and Rebellion schemes experienced more craving. Those who coped with ‘schema avoidance’ tended towards alcohol consumption with Coping Motivation, and those who coped with ‘schema compensation’ with Impact Enhancement and Social motivations. There was no significant difference between the scores of the scales and the craving levels between the groups with and without a history of permanent remission. Conclusion: The data in our study showed that early maladaptive schemas and ways of coping with schemas are associated with craving. In the early stages of treatment, it is important to consider cognitive intervention focused on schemas and coping styles. Keywords: AUD, early maladaptive schemas, coping styles, drinking motives, craving

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Myths Regarding Gender Differences in Eating Disorders in Adolescents Ergenlerde Yeme Bozuklukları ile İlgili Cinsiyet Farklılıkları Temelinde Bilinmeyenler 4 4 10.5080/u27259 EN TR Ayşe Burcu ERDOĞDU YILDIRIM Ümmügülsüm GÜNDOĞDU Mehtap EROĞLU Journal Article 1378 10.5080/u27259 Objective: Factors predicting eating disorder (ED) may vary among genders. This study investigated the gender specific influence of adolescents’ social media use, body perception, depression and anxiety symptoms on eating disorder risk. Method: The sample consisted of 183 adolescents aged 14 to 18 years (mean: 15.65±0.89). Sociodemographic information and data from the, Children’s Depression Inventory (CDI), Social Media Attitude Scale (SMAS), Eating Disorder Examination Scale (EDES), Eating Attitudes Test (EAT), Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED), and Body Cathexis Scale (BCS) were collected. Results: In this study, women have higher scores in SCARED (p<0.001), and lower scores in social competence subscale of SMAS (p=0.008) in comparison to men. Adolescents at risk for eating attitudes had higher scores in the CDI, the BCS, and the SMAS-Social Competence subscale, while adolescents at risk for eating disorder had higher scores in all scales except the SMAS-Relationship with Teachers subscale. Although depression and body perception influence women’s’ eating attitudes directly, social media revealed its effect on ED by the mediation of depressive symptoms. In men, social isolation, anxiety, and depression directly predicts ED, while social media enhanced the risk of ED by aggravating anxiety. Conclusion: It is important to know the factors that influence the risk of ED in terms of gender, and effectively address adolescence’s psychological and medical burden. Keywords: Social media, gender, eating disorder, body perception, depression

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Conceptualization of Grazing: The Psychometric Properties of The Repetitive Eating Questionnaire (Rep[eat]-Q) Turkish Form Çöplenme Tarzı Yeme Tutumunun Kavramsallaştırılması: Tekrarlı Yeme Ölçeği (Rep[eat]-Q) Türkçe Formu Psikometrik Özellikleri 5 5 10.5080/u27276 EN TR Meltem ANAFARTA ŞENDAĞ Arcan TIĞRAK Derya ÖZBEK ŞİMŞEK Journal Article 1379 10.5080/u27276 Objective: Grazing, defined as the unplanned and repetitive consumption of small or moderate amounts of food without feeling hungry, has been particulary investigated in relation to insufficient weight loss or early weight regain following bariatric surgery in recent years. The aim of this study was to investigate the psychometric properties of the Turkish form of the Repetitive Eating Scale (Rep[eat]-Q), which assesses grazing within a standardized framework. Method: The sample of the study consisted of a total of 491 adults, including 334 females and 157 males, with ages ranging from 17 to 62 participated in the study. The data were collected using the Rep[eat]-Q Turkish Form, Three-Factor Eating Questionnaire (TFEQ-R21), CES-D Depression Scale (CES-D), and Generalized Anxiety Disorder Scale-7 (GAD-7). Results: Results of the confirmatory factor analysis revealed that the structure of the Rep[eat]-Q Turkish Form aligns with the original form, indicating that the scale consists of two factors named Compulsive Grazing (CG) and Repetitive Eating (RE). The internal consistency coefficients were found to be 0.93 for the total scale score, 0.91 for the RE subscale, and 0.88 for the CG subscale. The test-retest reliability ranged from 0.73 to 0.83 (p<0.001). It was found that the total score of the Rep(eat)-Q is strongly positively correlated with Emotional Eating and Uncontrolled Eating subscales of the TFEQ-R21, and moderately positively correlated with the CES-D (depression) and the GAD-7 (anxiety). Conclusion: The findings of the study demonstrated that the Turkish version of the Rep(eat)-Q is a reliable and valid measure to assess grazing. Keywords: Grazing, compulsive grazing, repetitive eating

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Comparison of Attachment Styles of Individuals with Opioid Use Disorder and Individuals with Obesity Opioid Kullanım Bozukluğu Olan Bireyler ile Obezitesi Olan Bireylerin Bağlanma Biçimlerinin Karşılaştırılması 6 6 10.5080/u27003 EN TR Ahmet Buğra ACIDERE Ömer ASAN Şafak YALÇIN ŞAHİNER İsmail Volkan ŞAHİNER Erol GÖKA Journal Article 1380 10.5080/u27003 Objective: The aim of this study is to identify the attachment style displayed by obese individuals and to compare it with the attachment style of individuals diagnosed with opioid use disorder (OUD) and a healthy control group. Method: A total of 201 participants were included in the study, consisting of 66 individuals diagnosed with obesity, 62 diagnosed with OUD and 73 healthy controls. Sociodemographic Data Form and Adult Attachment Style Scale were administered to all participants, the Addiction Profile Index (API) was administered to participants diagnosed with OUD and the Yale Food Addiction Scale was administered to those diagnosed with obesity. Results: The results of the study revealed that the attachment styles of individuals diagnosed with obesity showed a similar distribution to those diagnosed with OUD, and the distribution of attachment styles in both groups was found to be different from that of the healthy control group. The mean scores for ambivalent/anxious attachment style and secure attachment style were found to be similar for the obesity group and the OUD group, while the OUD group had significantly higher avoidant attachment score. The avoidant attachment style score of OUD group increase as the severity of dependency increases. Additionally, 42.4% of the group was found to be food addicted, and in this group, the mean scores for ambivalent/anxious attachment style were found to be significantly higher. Conclusion: In the study, significant similarities were obtained in terms of attachment styles among participants diagnosed with obesity and OUD. The differentiation of these similarities from the control group has increased the strength of the study. Keywords: Attachment, obesity, opioid dependence

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 COVID-19 and Mania: A Case with a One-year Follow UP COVID-19 ve Mani: Bir Yıldır Takip Edilen Bir Olgunun Sunumu 7 7 10.5080/u27284 EN TR Hamdi YILMAZ Journal Article Case Reports 1381 10.5080/u27284 COVID-19 may affect central nervous system. The symptoms related to the CNS may occur through the direct neuroinvasion of the virus, inflammation, autoimmunity, psychosocial stressors and treatment side effects. COVID-19 can increase the severity of existing mental illnesses and also trigger the onset of a new mental illness. In this case report, we present a 52-year-old male patient with no previous psychiatric history as well as no family history of mental illness. The patient’s manic symptoms began while he was hospitalized due to severe COVID-19 pneumonia. The patient, who self-discharged himself from the hospital was brought to the emergency department involuntarily by his relatives 14 days later and was admitted to the psychiatry service. In this case report, possible etiological factors were discussed and the treatment course during the hospitalization and one year follow-up were presented. Our aim is to contribute to the literature by discussing possible etiological factors and management of mania that started during the treatment of COVID-19. COVID-19 can affect the central nervous system and be associated with psychiatric symptoms. Keywords: COVID-19, Mania, Bipolar Disorder, Central Nervous System

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 UPPS-P Impulsive Behavior Scale for Children: Turkish Adaptation, Reliability and Validity Study Çocuklar için UPPS-P Dürtüsel Davranış Ölçeği: Türkçeye Uyarlama, Güvenirlik ve Geçerlik Çalışması 35 35 10.5080/u27468 EN TR Uğur TEKEOĞLU Esra ÇÖP Hanife AVCI Journal Article 1409 10.5080/u27468 Objective: In this study we aimed to examine the Turkish validity and reliability of the UPPS-P Impulsive Behavior Scale for Children (UPPSP- C) and to investigate whether there is a relationship between the UPPSP- C subscales and Attention Deficit Hyperactivity Disorder (ADHD). Method: A total of 575 children aged 10-14 years were included in the study. The clinical sample of the study consisted of 50 children with ADHD who had not received treatment for at least 1 month and 525 children living in Sinop as the community sample. In order to investigate the test-retest reliability, UPPS-P-C was re-administered to 50 different children selected from the community sample. Results: Factor analysis displayed a five-factor model for the test. ‘Lack of premeditation’ and ‘Lack of perseverance’ had the highest ability to distinguish children with ADHD. The Cronbach α coefficient was found to be 0.894 for the UPPS-P-C. For the test-retest reliability of the UPPS-P-C, the correlation between the total and subscales of the two tests was examined using ICC, the Spearman’s Rank Correlation Coefficient and Bland Altman graphs, and the reliability was good. Conclusion: Our findings show that the Turkish version of the UPPSP- C has good validity and reliability and is successful in screening for features related to impulsivity. It has been shown that the UPPS-P-C can be used for symptom profiling and severity assessment. Keywords: Impulsivity, Reliability, UPPS-P, Validity, , Attention Deficit Hyperactivity Disorder

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Factors Affecting Recidivism in Children Drawn into Crime Suça Sürüklenen Çocuklarda Suç Tekrarı Üzerine Etkili Faktörlerin İncelenmesi 36 36 10.5080/u27546 EN TR Mutlu Muhammed ÖZBEK Ekin ATAY Tuğçe CANOL ÖZBEK Doğa SEVİNÇOK Mehmet Akif CANSIZ Ömer AYDEMİR Journal Article 1410 10.5080/u27546 Objective: Forensic psychiatry is an intersection where the fields of law and psychiatry perform joint functions. It is observed that children and adolescents are involved in forensic cases at significant rates both in our country and globally. This study aims to explore the differences between children drawn into crime and victims, as well as the factors influencing recidivism, by evaluating forensic cases over a three-year period. Method: This study evaluated the records of 232 patients, who met the study criteria and had detailed data, from a total of 257 forensic cases seen at the child psychiatry clinic between October 2020 and October 2023. Results: Regression analysis was conducted to identify factors most strongly associated with recidivism. The following variables were found to be significantly related to repeat offending, independent of other factors: parental separation (b=1.607, Exp (b)=4.988, p=0.005), presence of drug use (b=2.255, Exp (b)=9.536, p=0.009), and a history of crime among first-degree relatives (b=3.279, Exp (b)=26.551, p<0.001). No significant differences were observed in psychiatric diagnoses between children with repeat offenses and those undergoing their initial forensic evaluations. Conclusion: Drug use, a history of crime in first-degree relatives, and parental separation were significant factors in the occurrence and continuation of criminal behavior. To address child crime—a pressing social issue—it is essential to investigate the factors contributing to recidivism. Future research should focus on larger, long-term studies that incorporate diverse cultural and regional characteristics to develop more effective prevention and intervention strategies. Keywords: Juvenile Delinquency, Forensic Psychiatry, Substance Abuse, Criminal Behavior

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Effectiveness of 40-Session Repetitive Transcranial Magnetic Stimulation in Tourette Syndrome: A 6-Month Follow-Up Case Report Tourette Sendromunda Kırk Seanslık tTMS’nin Etkinliği: 6 Aylık Takip İçeren Bir Olgu Sunumu 37 37 10.5080/u27551 EN TR Elif ÖZCAN TOZOĞLU Nilifer GÜRBÜZER Journal Article Case Reports 1411 10.5080/u27551 Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic. This case report presents a patient who did not respond adequately to pharmacotherapy, highlighting the effects of repetitive transcranial magnetic stimulation (rTMS) and the outcomes of longitudinal follow-up. The patient is a 25-year-old male with no history of other physical illnesses. His symptoms began 17 years ago with simple motor tics, which gradually progressed to include complex motor and vocal tics. Over time, he also developed irritability and a persistent sense of impending doom. Clinical evaluation led to diagnoses of Tourette Syndrome comorbid with generalized anxiety disorder. Pharmacological treatment included escitalopram (10 mg/day), followed sequentially by pimozide (4 mg/day), tetrabenazine (3*25 mg/day), and aripiprazole (10 mg/day). Pimozide and aripiprazole showed no effect on the tics, and tetrabenazine was discontinued due to intolerable gastrointestinal side effects. Escitalopram, which effectively managed the patient’s anxiety, was continued at 10 mg/day. The patient then underwent 40 sessions of rTMS over eight weeks, targeting the bilateral supplementary motor area. Each session consisted of 1 Hz stimulation at 110% of the resting motor threshold, delivering 1200 stimuli per day over 20 minutes, five days a week. Following the treatment, significant improvements were observed: a 75% reduction in the general functionality score and a 59.7% reduction in the total tic severity score. This report suggests that rTMS may be a promising alternative for TS patients with psychiatric comorbidities, particularly those who cannot tolerate medications or achieve sufficient symptom control through pharmacotherapy alone. Keywords: Tourette’s Syndrome, Repetitive Transcranial Magnetic Stimulation, Supplementary Motor Area

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Impulse Control, Emotional and Cognitive Regulation Mechanisms and Heart Rate Variability Dürtü Denetimi, Duygu ve Bilişsel Düzenleme Mekanizmaları ile Kalp Hızı Değişkenliği Arasındaki İlişki 38 38 10.5080/u27525 EN TR Gülizar YAKUT Hayri Can ÖZDEN Yusuf Ziya ŞENER Uğur CANPOLAT Necla ÖZER Jale KARAKAYA Başaran DEMİR Journal Article 1412 10.5080/u27525 Objectives: The study aims to compare heart rate variability (HRV) in borderline personality disorder (BPD) with healthy individuals and to investigate the relationships between HRV parameters and impulsivity, emotion regulation, and neurocognitive performances. Method: Twenty-one female patients with the diagnosis of BPD and twenty healthy women were enrolled in this study. All participants were assessed by a structured clinical interview for DSM-IV Axis I Disorders and the Minnesota Impulse Control Disorder Interview Scale. They were asked to fill out a sociodemographic information form, a Borderline Personality Inventory, the Barratt Impulsivity Scale-11, the UPPS Impulsive Behavior Scale, and the Difficulties in Emotion Regulation Scale. The trial-making test, the Wisconsin card sorting test, the verbal fluency test, the Stroop test-TABG form, and the continuous performance test were applied. Holter recordings were taken from the participants at rest and while they watched emotion-evoking videos, and HRV parameters were calculated. Results: While watching neutral and fear videos, the low-frequency band/ high-frequency band ratio (LF/HF) was found to be higher in the patient group compared to the control group, and no difference was found in the other parameters. A number of differences in terms of impulse control, affect regulation, and neurocognitive skills have been determined (p<0.05). However, there was no correlation between HRV and self-report scales and neurocognitive test scores. Conclusion: Contrary to our hypothesis, HRV is found to be similar between BPD patients and healthy subjects. HRV was not associated with impulse control, affect regulation or cognitive functions. Keywords: Borderline Personality Disorder, Emotion Regulation, Heart Rate Variability, İmpulsivity

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Effect of Psychopathology and Cognitive Functions on Caregiver Burden in Patients with Schizophrenia Şizofreni Hastalarında Psikopatoloji ve Bilişsel İşlevlerin Bakım Veren Yüküne Etkisi 8 8 10.5080/u27337 EN TR Aykut KARAHAN Ezgi SELÇUK ÖZMEN Filiz CİVİL ARSLAN Journal Article 1382 10.5080/u27337 Objective:  The caregiver burden in the relatives of patients with schizophrenia increases mental health problems in patients, complicates coping with the illness for families, and adversely affects the course of the illness. This study aims to investigate the effects of patients’ psychopathology severity and cognitive functions on caregiver burden. Method:  Forty-four patients diagnosed with schizophrenia according to DSM-5 and their primary caregivers were included in this cross- sectional descriptive study. The severity of the caregiver burden in the relatives of the patients was evaluated using the Zarit Caregiver Burden Scale (ZCBS). Symptom severity of the patients was evaluated with the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). Wisconsin Card Sorting Test (WCST), Stroop Test, Trail Making Test (TMT), and Rey Auditory Verbal Learning Test (RAVLT) were applied to assess the cognitive functions of the patients. Results: The mean ZCBS score was 47.7±26.9 in the primary caregivers of the patients. There was a significant negative correlation between ZCBS and patients’ education level, time since recent hospitalization, and RAVLT scores, and a significant positive correlation between TMT, Stroop Test, and SANS scores. Conclusion: To reduce the caregiver burden, psychosocial interventions for cognitive dysfunction and negative symptoms involving patients and their families should be considered a priority. Keywords: Schizophrenia, Caregiver Burden, Psychopathology, Cognitive Functions

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 A Psychopathological Reading of the Blood Sweat Phenomenon and Religious Stigmas: The Case of Blessed Elena Aiello Kan Terleme Fenomeni ve Dini Stigmaların Psikopatolojik Bir Okuması: Kutsal Elena Aiello Olgusu 9 9 10.5080/u27342 EN TR Francisco PÉREZ-FERNÁNDEZ María PEÑARANDA-ORTEGA Journal Article Case Reports 1383 10.5080/u27342 Around 300 cases of stigma have been described since the 13th century. Hematidrosis, hemolacria, bloody otorrhea, vicarious menstruation, and Gardner-Diamond syndrome are dermatological manifestations that are also observed in cases of stigma. This paper presents the disconcerting circumstances in the life of the Blessed Elena Aiello. From 1923 until her death, she suffered severe hematidrosis blood sweating on her forehead, hands, feet and knees, just as stigmata appear at the crucifixion of Jesus Christ. Stigmas, in Christian tradition, are marks corresponding to those left on Christ’s body by the torture and the Crucifixion, it’s said that are impressed on the person body by divine favor. These episodes, among the few recognised as authentic by the Catholic Church would appear each Friday in Lent, particularly on Good Friday. In this unique case study, doctors Fabrizio and Turano performed a medical study where the origin of the sores was unclear. Neurologist and psychiatrist Vincenzo Bianchi, on assessing the case, raised the possibility of simulation or mere suggestion on the part of the patient. Keywords: Elena Aiello, Autosuggestion, Psychology, Stigmata, Psychopathology, Malingering, Factitious Disorder

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Psychological and Psychosocial Interventions in Attention Deficit Hyperactivity Disorder: A Systematic Review Dikkat Eksikliği Hiperaktivite Bozukluğu’nda Psikolojik ve Psikososyal Müdahaleler: Sistematik Bir Derleme 10 10 10.5080/u27201 EN TR Burcu KAHVECİ ÖNCÜ Müjgan İNÖZÜ Journal Article Review 1384 10.5080/u27201 Objective: Attention Deficit Hyperactivity Disorder (ADHD) is typically treated with medications however psychological and psychosocial interventions are recommended for symptoms that persist despite pharmacological treatment. This study aims to review randomized controlled trials focusing on the psychological and psychosocial interventions in the treatment of ADHD. Method: Eight databases were searched using keyword pairs “ADHD” and “therapy”, “ADHD” and “psychological treatment”, “ADHD” and “psychosocial treatment”, “ADHD” and “CBT”, “attention deficit” and “therapy”, “attention deficit” and “psychological treatment”, “attention deficit” and “psychosocial treatment”, “attention deficit” and “CBT”. The search was conducted at March 2022. Results: Forty-five studies met the inclusion criteria. Of these studies, 51% included the child and adolescent age group, 49% included the adult age. In 87% of these studies, psychosocial interventions, when implemented in addition to medication, resulted in significant improvements in ADHD symptoms. Conclusion: The results indicate that the use of psychosocial interventions, in addition to medical approaches, makes significant contributions to the treatment of ADHD. There is a need for studies investigating the effectiveness of psychosocial interventions in the treatment of ADHD in Turkiye. Keywords: Attention Deficit Hyperactivity Disorder, Therapy, Psychosocial İntervention

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Hepatitis C Prevalence, HCV awareness and Certain Psychological Factors in Patients with Opioid Use Disorder Opioid Kullanım Bozukluğu Olan Hastalarda Hepatit C Virüs Prevalansı, HCV Farkındalığı ve Bazı Psikolojik Özellikler 11 11 10.5080/u27182 EN TR Oğuzhan DOĞAN Yasemin OLGUN SUNAN Fatma DURU Gülten KARTEPE Esra ERDOĞAN YARIKKAYA Betül ÖZSOY Gökhan ÖZ Şerif KAHRAMAN Gökhan TATLI Hidayet ÖNER Journal Article 1385 10.5080/u27182 Objective: The objective of this study is to determine the prevalance of Hepatitis C Virus (HCV) in patients with Opioid Use Disorder and to investigate both the sociodemographic and psychological differences between patients with or without Hepatitis C Virus. Method: Blood samples were taken from patients diagnosed with Opioid Use Disorder (OUD) who applied to Mersin Provincial Health Directorate Toros State Hospital Alcohol and Drug Addiction Treatment Center (AMATEM) between 01.09.2019-01.09.2020 and hepatitis virus markers, complete blood count and basic biochemistry were assessed. Sociodemographic Evaluation Form, Barratt Impulsivity Scale, Childhood Traumas Scale, Drug Use Disorders Identification Test (DUDIT), Temps-A Temperament Scale, Difficulty in Emotion Regulation Scale were applied to 107 patients with HCV and 101 patients without HCV who were selected by systematic sampling and the findings obtained were compared. Results: Of the 1190 patients diagnosed with Opioid Use Disorder, 340 (28.5%) were found to be HCV positive. 107 HCV-positive and 101 HCV- negative patients who were selected for comparison were similar in terms of sociodemographic characteristics. Among HCV positive patients, the rate of intravenous drug use and needle sharing were significantly higher (p<0.001, p<0.001). Overall duration of substance use and intravenous substance use were significantly higher in HCV positive patients (p=0.024 and p=0.017). Similarly, HCV positive group were significantly more likely (p<0.001) to have heard of HCV before and significantly more likely (p=0.009) to know that HCV causes cirrhosis and liver cancer. Regarding the scores of Barratt Impulsivity Scale, Childhood Traumas Scale, Substance Use Disorder Recognition Test, DUDIT, Temps -A Temperament Scales applied to HCV positive and HCV negative patients with Opioid Use Disorder, no difference was found. The scores of the ‘Non-Acceptance’ factor of the Difficulties in Emotion Regulation Scale were found to be significantly higher in HCV positive patients with Opioid Use Disorder (p=0.020). Conclusion: Patients diagnosed with Opioid Use Disorder (OUD) have higher rates of HCV positivity compared to general public. Intravenous drug use significantly increases this risk. Half of HCV-positive patients were unaware that they have the virus and only a very small proportion received treatment. Therefore, examining each patient with OUD for HCV, treating positive patients in an effective referral system seems to be the an important step in the eradication of this disease in this population. Keywords: Hepatitis C Virus, Opioid Use Disorder, İntravenous Opioid Use

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Ukraıne, Crısıs And Mental Health Resources Ukrayna, Kriz ve Ruh Sağlığı Kaynakları 12 12 10.5080/u27153 EN TR Amnuay KEEBAYOON Pathum SOOKAROMDEE Viroj WIWANITKIT Letter 1386 10.5080/u27153 The current situation in Ukraine once more raised the issue on the management of mental health problems during war. Some experts have already proposed recommendations on this issue with specific reference to the present Ukraine crisis (Shevlin et al. 2022). We write this commentary in regards to this article to share experiences of the Indochina conflict. There has been very few published reports on the availability of mental health services in this conflict. (Jegannathan et al. 2015).

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Turkish Version of the Psychotropic Related Sexual Dysfunction Questionnaire (PRSEXDQ-T): Validity and Reliability in Patients Using Selective Serotonin Reuptake Inhibitor Psikotrop İlişkili Cinsel İşlev Bozukluğu Ölçeğinin Türkçe Versiyonu (PİCİB-Türkçe): Seçici Serotonin Gerialım İnhibitörü Kullanan Hastalarda Geçerlik ve Güvenilirlik Çalışması 13 13 10.5080/u27318 EN TR Yasir ŞAFAK Simge Nur KURT KAYA Rıza Gökçer TULACI Journal Article 1387 10.5080/u27318 Objective: Sexual dysfunctions (SD) are very common in patients with psychiatric disorders and may be due to the side effects of the disease or medications used. Current scales cannot distinguish whether SDs are due to psychiatric illness or medications use. The Psychotropic Associated Sexual Dysfunction Questionnaire (PRSexDQ) is a customized scale for screening SD due to drug use. Our aim is to conduct a validity and reliability study of PRSexDQ in patients using selective serotonin reuptake inhibitors (SSRIs). Method: One hundred patients who applied to psychiatry outpatient clinic and received SSRI treatment for at least 1 month were included in the study. These patients were evaluated by a psychiatrist, and completed the PRSexDQ-T, Arizona Sexual Experience Scale (ASEX), Golombok Rust Inventory Sexual Satisfaction (GRISS). Result: The Cronbach’s Alpha coefficient was calculated as 0.906 for the analysis performed to evaluate the internal consistency of the PRSexDQ-T. In the item-total score analysis, the correlation of all items with the total score was found to be quite high (above 0.7). Correlation coefficients were found between 0.939 and 0.985, which was used to determine the test-retest correlation for each item, and all values were statistically significant (p<0.01). In the Pearson correlation analysis performed for validity analysis, a large positive correlation was found between PRSexDQ-T and ASEX and GRISS male-female total and subscale scores. Conclusion: The Turkish version of PRSexDQ is a valid and reliable measurement tool in the sample of patients using SSRIs to evaluate the level of sexual dysfunction. Keywords: Sexual dysfunctions, psychotropic drugs, serotonin reuptake inhibitors, validity, reliability

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Suicide Risk Among the Octogenarians: A Comparative Study Oktojeneryan Yaş Grubunda İntihar Riski: Karşılaştırmalı Bir Çalışma 14 14 10.5080/u27354 EN TR Cengiz CENGİSİZ Selman BÖLÜKBAŞI Journal Article 1388 10.5080/u27354 Objective: We aimed to investigate the factors that affect the likelihood of suicide in the elderly, with a focus on individuals aged 80 and older. Method: This is a cross-sectional study conducted in 7 nursing homes in the Manisa province, Turkiye. The data has been collected through face-to-face using a socio-demographic data form, the life satisfaction scale, and the suicide probability scale. Data were analyzed using IBM SPSS Statistics 26.0, non-parametric statistical methods have been employed. Results: The study included 278 elderly participants, 5 outliers were removed from the analysis. Among the included elderly participants (n=273), the anger score averages of males were higher. Low, high, and moderate income were found to have a higher suicide probability respectively. Those who resided in a nursing home for 3 years or more had higher anger scores. Elderly individuals residing in publicly funded nursing homes had higher averages in suicide probability, negative self, exhaustion, and anger scores. Further analyses were performed among the octogenarian population (n=149). Octogenarian males had higher scores in Suicide Probability, Disconnection from Life, and Anger Scale than the female octagenarian participants. Octogenarians with low income were found to experience a lack of attachment to life and higher levels of anger. In publicly funded nursing homes, octogenarians had higher suicide probability and anger scores compared to those in private nursing homes. Conclusion: The risk of suicide in octogenarians should be taken seriously. Factors such as gender, income level, and type of nursing home can influence this risk. Keywords: Octogenarians, Suicide, Probability, Geropsychiatry, Aging

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Association between Symptom Dimensions and Psychosis Risk Factors with Functioning in First Episode Psychosis: A Six Months Prospective Study İlk Atak Psikozda Belirti Boyutları ve Psikoz Risk Faktörlerinin İşlevsellik ile İlişkisi: 6 Aylık İzlem Çalışması 15 15 10.5080/u27345 EN TR Sakine AKTAŞ Umut KIRLI Journal Article 1389 10.5080/u27345 Objective: This study aims to assess the associations of the severity of different symptom dimensions and psychosis risk factors with the overall functioning levels in first-episode psychosis (FEP) patients over a 6-month follow-up period. Method: Psychosis symptom dimensions (positive, negative, depression, mania, attention and other cognitive), sociodemographic characteristics and environmental risk factors (alcohol-substance use, childhood traumas, current stressful life events) were prospectively assessed in 32 patients who were hospitalized for FEP during the six-month follow-up period. The associations of these variables with the longitudinal Global Assessment of Functioning (GAF) scores of these patients were analyzed using linear regression or repeated measures ANOVA. Results: The severity of positive, negative, depression and mania dimensions reduced (p<0.001) during the follow-up period, while no significant change was found in Stroop interference effect scores (F=0.4, p=0.53). FEP patients with substance or alcohol use had significantly worse functioning during the follow-up period (F=11.2, p=0.001; F=5.3, p=0.02, respectively), and those patients’ functioning improved significantly less (F=10.0, p=0.002; F=4.3; p=0.04, respectively). Stroop test performance detected at the first month of the follow-up period significantly predicted the final general functioning scores of the follow- up [Stroop test word reading time (sec): B=-0.58 (-1.13-0.03); color telling speed (sec): B=-0.35 (-0.59-0.1); interference effect: B=-0.28 (-0.57-0.01)]. Conclusion: The stable course and prognostic value of attention and other types of cognitive functioning in FEP patients is remarkable. Interventions for alcohol-substance use in FEP patients should be a part of routine practice. Keywords: First Episode Psychosis, Psychosis Dimensions, Alcohol, Substance, Cognitive Functioning

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Relationship Between the use of Mobile Applications and Social Functioning in Patients with Schizophrenia Şizofreni Hastalarında Mobil Uygulama Kullanımı ve Sosyal İşlevsellik Arasındaki İlişki 16 16 10.5080/u27385 EN TR Emine Ilgın HOŞGELEN Berna Binnur AKDEDE Köksal ALPTEKİN Journal Article 1390 10.5080/u27385 Objectives: The aim of this study is to examine the prevalence of digital technology tool use in individuals with schizophrenia or schizoaffective disorder in Turkey, as well as evaluating the association between the use and psychosocial functionality and clinical symptoms. Method: Data were collected from 100 patients who were diagnosed with schizophrenia or schizoaffective disorder based on the DSM-5 criteria. The use of technology was evaluated with a questionnaire developed for this study. The level of psychosocial functioning was assessed using the Personal and Social Performance Scale (PSP), and the positive and negative symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS). Results: The digital technology users were significantly younger than the non-users. The majority of patients own a mobile phone (86%) and a computer (67%). Furthermore, 61% of patients used mobile applications, with Facebook and WhatsApp being the most popular social media platforms (48%). Patients who used digital technology tools had higher PSP scores. Furthermore, patients who used digital technology tools had significantly lower scores in PANSS negative subscale. There was no difference in PANSS positive subscale scores between digital technology tool users and non-users. Conclusion: Patients diagnosed with schizophrenia may benefit from mobile applications and social media tools that can help them participate in daily activities and improve their overall well-being. Keywords: Schizophrenia, Social Functioning, Negative Symptoms, Digital Technology, Social Media, İnternet

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Prevalence and Determinants of Mental Health Problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare Workers Lübnan’da Ruh Sağlığı Sorunlarının Yaygınlığı ve Belirleyici Etkenler: 3957 Sağlık Çalışanı ile Gerçekleştirilen Bir Meta-Analiz Çalışması 17 17 10.5080/u27427 EN TR Maher GHANDOUR Najwa EL GERGES Nancy ZEAITER Journal Article Review 1391 10.5080/u27427 Objective: Healthcare workers are continuously exposed to challenging environments, making them liable for poor mental health. The COVID-19 pandemic exacerbated this problem, however available data in Lebanon is scarce. We conducted this investigation to provide comprehensive evidence on the mental health of Lebanese healthcare workers. Methods: In this systematic review, we analyzed 3957 workers reported in 15 cross-sectional studies (10 during and five before the pandemic), identified after searching four databases. Examined mental health problems included depression, anxiety, stress, posttraumatic stress disorder (PTSD), and poor sleep quality. STATA software was used to pool the prevalence across studies. Subgroup analyses were performed based on the pandemic status, severity of mental health problems, and healthcare worker type. Gender and marital status were analyzed as potential risk factors. The methodological quality of all included studies was good as per the National Institute of Health risk of bias tool. Results: Anxiety, depression, stress, PTSD, insomnia, and poor sleep quality were reported in 50%, 52%, 50%, 35%, 45%, and 41% of the population, respectively. Most cases had mild anxiety (40%), mild depression (45%), but severe stress (27%). Depression and anxiety were highest among pharmacists (69% and 56%) and nurses (49% and 45%), respectively. Compared to the pre-pandemic period, depression (36% vs. 62%) and anxiety (30% vs. 56%) rates were higher during the pandemic, while stress levels were lower (62% vs. 45%). Both gender and marital status were insignificant predictors of depression, anxiety, stress, or PTSD. Conclusions: Depression, anxiety, posttraumatic stress, insomnia, and poor sleep quality are experienced by approximately one in every two Lebanese healthcare workers. The rate of depression and anxiety almost doubled during the pandemic with higher rates among pharmacists and nurses than physicians and residents. Both gender and marital status were deemed insignificant predictors of reported mental health problems. Keywords: COVID-19, Health Personnel, Lebanon, Mental Health

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Validity and Reliability of the Affective Lability Scale-18 (ALS-18) Turkish Form in the Non-Clinical Group Duygulanımda Değişkenlik Ölçeği-18 (DDÖ-18) Türkçe Formunun Klinik Olmayan Grupta Geçerlik ve Güvenilirliği 18 18 10.5080/u27329 EN TR Veysel DOĞAN Ömer ŞENORMANCI Journal Article 1392 10.5080/u27329 Objective: Affective lability, which is an important aspect of mood dysregulation, is seen in many psychiatric conditions. The aim of this study is to examine the psychometric properties of the Affective Lability Scale-18 in the Turkish sample of the non-clinical group. Method: A total of 615 individuals (312 females and 303 males) who did not have a past or current psychiatric disorder were included in the study. The participants were administered sociodemographic data form, Affective Lability Scale-18, Difficulties in Emotion Regulation Scale, and Beck Depression Inventory. The participants were divided into 4 groups; a pilot group, EFA (exploratory factor analysis) group, CFA (confirmatory factor analysis) group and test-retest group. Results: The factor analysis conducted for the construct validity of the scale, revealed similar results to that of the original scale. The Cronbach’s alpha internal consistency coefficient was 0.92 for the EFA group and 0.92 for the CFA group. The test-retest reliability coefficient was 0.82. Difficulties in Emotion Regulation Scale (DERS) and Beck’s Depression Inventory (BDI) were used tp measure validity. The correlation between the total scores of participants on the ALS-18 and their scores on the DERS and BDI was determined to be positive and moderate (r=0.38, r=41). Conclusion: The Affective Lability Scale-18 in the Turkish sample, three sub-dimensions, anxiety/depression, depression/elevation, anger and the general factor all have sufficient internal consistency and it has been demonstrated that the scale can be applied in our country to evaluate the situations in which affect variability is evaluated. Keywords: Affective Lability, Emotion Dysregulation, Validity, Reliability, Turkish, Affective Lability Scale

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Relationship Between Emotion Regulation Difficulties and Gambling Tendencies of University Students Üniversite Öğrencilerinin Duygu Düzenleme Güçlükleri ile Kumar Oynama Eğilimi Arasındaki İlişki 19 19 10.5080/u27412 EN TR Dilek AYAKDAŞ DAĞLI Nesrin ÇUNKUŞ  KÖKTAŞ Hülya ARSLANTAŞ Leyla BAYSAN ARABACI Journal Article 1393 10.5080/u27412 Objective: This study aims to examine the relationship between university students’ difficulties regulating emotions and their tendency to gamble. Method: The population of this cross-sectional and correlational study consisted of 69,000 undergraduate level students studying at three state universities in three different provinces in Turkey between February- September 2022. Based on the calculation using the sampling method of the known population, study data were collected face-to-face from 750 students. The data were collected using three tools: a descriptive information form, the South Oaks Gambling Screening Test (SOGS), and the Difficulties in Emotion Regulation Scale-Brief Form (DERS- 16). Descriptive statistics, Pearson correlation and Multiple Linear Regression analysis were used to analyze the relationship among the scales’ mean scores. Results: Of the participating university students, 51.6% were female and 48.4% were male. Of these students, 42% stated that they had gambled at least once in their lives and 25.3% of them were still gambling. The mean DERS score was 38.14±14.37, which indicated a moderate difficulty in emotional regulation, and the mean SOGS score was 5.12±3.18. A positive and significant correlation was found between DERS SOGS (r=0.304, p<0.05). It was determined that university students’ tendency to gamble was predicted by the three sub-dimensions of the DERS (Clarity (β=0.258, p=0.001), Purpose (β=0.156, p=0.021) and Non-Acceptance (β=1.768, p=0.001)), being male and gambling status in the family (p<0.05). Conclusion: Emotional regulation difficulties in university students may play an important role in their gambling tendencies. Keywords: Emotion Regulation, Gambling, Students

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 And What About Secondary Catatonıa? Peki Ya İkincil Katatoni? 20 20 10.5080/u27453 EN TR João GAMA MARQUES Letter 1394 10.5080/u27453 I have read an interesting article recently published in your journal regarding the Turkish adaptation, validity and reliability study of the Bush Francis Catatonia Rating scale (BFCRS) and the Katatonia, Autism, Neuropsychiatric and Neuromovement Examination Rating (KANNER) Scale (Erdoğan et al. 2023). The article delighted me as catatonia is, in my opinion, the most fascinating syndrome of neuropsychiatry, if not of entire medicine. Catatonia needs further and deeper studies. I feel these scales and others such as Northoff Catatonia Scale (NCS) need to be adapted all around the world. Only then clinicians and researchers will be able to collaborate closer in better and stronger studies.

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Candidate Genetic Markers for Post Traumatic Stress Disorder Within the Scope of Forensic Psychiatry Adli Psikiyatri Bağlamında Travma Sonrası Stres Bozukluğu Tanısı için Aday Genetik Belirteçler 21 21 10.5080/u27445 EN TR Sertaç AK Lale ŞATIROĞLU TUFAN Esen AĞAOĞLU Ebru TURGUT ŞENEL Şeref Can GÜREL Aysun BALSEVEN ODABAŞI Gürol CANTÜRK Journal Article 1395 10.5080/u27445 Objective: This study was conducted to investigate the role of two candidate polymorphisms to improve the diagnosis of Post-Traumatic Stress Disorder (PTSD) in forensic psychiatry settings. Methods: Individuals who applied to our unit with PTSD symptoms following a traffic accident were included. The control group consisted of people who had experienced a similar accident without any symptoms. Sociodemographic data-form, Hamilton Depression Rating Scale and Anxiety Sensitivity Index-3 (ASI 3) were applied to the patients and controls, and the frequencies of the rs8042149 polymorphic allele of the RORA gene and the rs717947 polymorphic allele (4p15) were investigated. Results: A total of 103 people were included (54 case, 49 control). The rates of polymorphisms were not different between the groups. Higher education levels were associated with lower PTSD incidence while higher scores in the Social Subscale of ASI strongly predicted the occurrence of PTSD. Conclusion: The polymorphisms assessed did not help to differentiate the groups in the current sample. The potential of the Social Subscale of ASI-3 in predicting the occurrence of PTSD following a trauma should be evaluated in a longitudinal design. Keywords: PTSD, Road Traffic Accident, Genetics Anxiety Sensitivity, Polymorphism

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Social Media Use, Intolerance of Uncertainty, and Resilience with Anxiety and Depression Symptoms in Cancer Patients Kanser Hastalarında Sosyal Medya Kullanımı, Belirsizliğe Tahammülsüzlük ve Psikolojik Dayanıklılık ile Anksiyete ve Depresyon Belirtilerinin İlişkisi 22 22 10.5080/u27431 EN TR Gonca AŞUT Selvi CERAN Gamze ÖZÇÜRÜMEZ BİLGİLİ Journal Article 1396 10.5080/u27431 Objectives: The COVID-19 pandemic may be considered as a shared source of uncertainty. Prolonged engagement with social media regarding this uncertainty could present as a risk factor for anxiety. We sought to investigate the relationship between intolerance of uncertainty, dimensions of resilience, uncertainty source (pandemic)-related social media use, and the risk of anxiety and depression in patients with cancer. Method: Patients with solid organ cancer (n=113) completed the sociodemographic data form, the Intolerance to Uncertainty Scale-12 (IUS-12), the Resilience Scale for Adults (RSA) and the Hospital Anxiety and Depression Scale (HADS) between May and August 2020. Results: Depression scores were high at 17.7% of the patients while anxiety scores were high at 49.6%. RSA and its dimensions significantly differ between the Anxiety and Depression groups determined by the HADS. Time spent on social media about the COVID-19 pandemic (SMT) was associated with higher HADS-Anxiety scores (r=0.26, p<0.01), whereas higher resilience was associated with lower HADS- Anxiety (r=-0.42, p<0.01) and HADS-Depression (r=-0.52, p<0.01) scores. In addition to high levels of intolerance of uncertainty, low levels of the social resources were found to be a risk factor for depression, and low levels of self- and future-perception dimensions were found to be a risk factor for anxiety, regardless of the patients’ social media use. Conclusion: As the factors that fuel uncertainty will always have an affect on cancer patients and cancer care, promoting the patients’ resilience resources should be one of the main priorities for cancer patients. Keywords: Anxiety, Cancer, Depression, Resilience, Social Media, Uncertainty

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Prevalence of Depressive Symptoms and Related Factors in Türkiye: Results of the 2016 and 2019 Turkish Health Survey Türkiye’de Depresif Belirtilerin Yaygınlığı ve İlişkili Etmenler: 2016 ve 2019 Türkiye Sağlık Araştırması Sonuçları 23 23 10.5080/u27341 EN TR Kemal AYDIN Nadire Gülçin YILDIZ Halide Z. AYDIN Hasan Aykut KARABOĞA Fatma KAHRAMAN GÜLOĞLU Yohane V.A. PHIRI Hatice YILDIZ Journal Article 1397 10.5080/u27341 Objective: We investigated the prevalence and distribution of depressive symptoms in individuals aged 15 and older, as well as the relationship between depressive symptoms and sociodemographic characteristics, chronic diseases, health status and health behaviors. Method: The analysis of data collected from the Türkiye Health Surveys conducted by Turkish Statistical Institute (TURKSAT) in 2016 and 2019 involved using the Chi-Square independence test. Effect sizes were evaluated using Phi or Cramer’s V coefficients. Patient Health Questionnaire-8 (PHQ-8) module was used to scan the depressive symptoms. Results: The adult population’s point of prevalence of depressive symptoms was 4.7%±0.24 in males and 8%±0.19 in females, with a population  total of 6.3%±0.21. The yearly prevalence of depressive symptoms was 6.1%±0.45 in males,  13.2%±0.53 in females and  a population total of 10%±0.49. Age, gender, income, education, social support, health status, disability, and chronic illnesses were found to be significant predictors of the incidence of depressive symptoms (p<0,05). The results indicated that the rate of people with depression getting help from psychologists, psychotherapists, and psychiatrists was low. Conclusion: Age, gender, income, education, marital status, self-rated health status, social support, number of chronic illnesses, and disability were the most important risk factors for depressive episodes. In addition to such  self-reported research completed before the pandemic and Kahramanmaraş earthquakes in Türkiye, further studies based on structured diagnostic interviews are required. Keywords: Behavioral Symptom Health Status, Chronic Diseases, Depressive Symptoms, PHQ-8, Prevalence, Socioeconomic Factors, Türkiye Health Survey

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Mediating Role of Social Comparison Between Parental Self-Efficacy and Sharenting Ebeveyn Öz-Yeterliği ile Paylaşan-Ebeveynlik Arasındaki İlişkide Sosyal Karşılaştırmanın Aracı Rolü 24 24 10.5080/u27387 EN TR Fatih BAYRAKTAR Dilek ÇELİK Journal Article 1398 10.5080/u27387 Objective: The aim of this study was to examine the relationship of sharenting with variables that are theoretically related with the concept. Sharenting includes the basic motivation to share parental practices with others and can be associated with social comparison and parental self-efficacy. In this context, we hypothesized that the social comparison could be a mediating variable between parental self-efficacy and sharing. Method: The participants were 558 parents (456 mothers 81.7% and 102 fathers 18.3%) from Türkiye and Northern Cyprus. The age range was 19 to 53 (M=33.59, SD=5.98). Sharenting Questionnaire, Parental Social Comparison Orientation Measure and The Self-Efficacy for Parenting Tasks Index were used as measurement tools. The data was collected online by using convenience sampling method. Results: In two separate Hierarchical Regression Analyses (HRA) parental social comparison predicted sharenting and perceived parental emotional availability predicted parental social comparison significantly. Mediation analysis indicated that parental social comparison mediated between parental emotional availability and sharenting. Conclusion: Sharenting can be used to strengthen the parent-child relationship. Our research indicated that the parents who compare themselves with other parents were less available emotionally in their relationship with their children. Keywords: Parent-Child Relations, Parenting, Self Efficacy, Social Comparisons

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 A Case of Pseudotumor Cerebri Associated with Lithium Use Lityum Kullanımına Bağlı Psödotümör Serebri Olgusu 25 25 10.5080/u27484 EN TR Özge TÜRKOĞLU Hafize Nalan GÜNEŞ Ayşe Elif ANIL YAĞCIOĞLU Journal Article Case Reports 1399 10.5080/u27484 Pseudotumor cerebri (PC), also known as idiopathic intracranial hypertension, is characterized by increased intracranial pressure in the presence of normal brain imaging and cerebrospinal fluid analysis. Papilledema, headache and visual loss are frequently observed clinical signs and symptoms. Although the pathogenesis of pseudotumor cerebri is not known exactly, different risk factors have been identified. Drugs such as growth hormone, tetracycline and retinoic acid have been reported to be associated with PC. Additionally, in the literature, there are case reports indicating the development of PC associated with lithium use. The aim of this case report is to discuss a 26-year-old patient who was started on lithium with a diagnosis of bipolar disorder and presented to the emergency service with complaints of headache and visual loss 4 months after the initiation of treatment and was diagnosed with PC associated with lithium use. It is important to be aware of the risk of PC development in patients treated with lithium and to rapidly evaluate patients in this respect in case of clinical symptoms such as headache and vision problems because of the risk of permanent vision loss. Keywords: Intracranial Hypertension, Lithium, Papilledema, Pseudotumor Cerebri

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Neuroleptic Malignant Syndrome with Low-dose Quetiapine After Venlafaxine Withdrawal: A Case Report Venlafaksin Kesilmesinin Arkasından Düşük Dozda Ketiyapin Kullanımı ile Gelişen Gürültülü Nöroleptik Malign Sendrom: Olgu Sunumu 26 26 10.5080/u27497 EN TR Hayri Can ÖZDEN Şeref Can GÜREL Journal Article Case Reports 1400 10.5080/u27497 Neuroleptic Malignant Syndrome (NMS) is an idiosyncratic and potentially life-threatening drug reaction. Although uncommon, NMS cases induced by oral quetiapine have been reported. Most reports have predisposing risk factors such as an organic brain disorder, concomitant use of other antipsychotics or lithium, overdose or rapid titration. NMS with low doses of quetiapine is a much rarer clinical picture. Venlafaxine is commonly associated with withdrawal upon discontinuation sometimes as soon as the next day. In this case report, a 40-year-old man treated with venlafaxine for generalized anxiety disorder with symptoms of full-blown NMS after venlafaxine withdrawal, induced by low-dose quetiapine (50 mg), is presented. In accordance with the previous reports, we speculate that venlafaxine withdrawal was a predisposing factor in our case however we also discussed other possible risk factors for NMS. Acknowledging the risk of NMS, even with low doses of quetiapine in patients devoid of known risk factors, is of paramount importance for prompt diagnosis and mitigating morbidity and mortality. To our knowledge, this is the first case of NMS with such a low dose of quetiapine without any other known risk factors or substances. Keywords: Antipsychotics, NMS, Quetiapine, Venlafaxine, Consultation Liaison Psychiatry

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Effect of the COVID-19 Pandemic on Psychiatric Service Use Among Psychiatric Outpatients COVID-19 Pandemisinin Farklı Psikiyatrik Tanı Gruplarında Ruh Sağlığı Hizmeti İhtiyacı ve Başvuru Oranlarına Etkisi 27 27 10.5080/u27455 EN TR Cengiz KILIÇ Özge TÜRKOĞLU Kezban Burcu AVANOĞLU PSİDEMİ Çalışma Grubu Elif ANIL YAĞCIOĞLU Berna Diclenur ULUĞ Journal Article 1401 10.5080/u27455 Objective: Both general medical and mental health services were disrupted during the pandemic. It is unclear how these disruptions played out for people with various mental health diagnoses. We compared change in mental health status and use of mental health services between four psychiatric groups: schizophrenia spectrum disorders, bipolar disorder, unipolar depression, and anxiety/obsessive- compulsive disorder (OCD). Method: Using a semi-structured interview, 492 outpatients with psychiatric disorders who had used psychiatric services at a university hospital before the pandemic were assessed on the phone during the pandemic. Results: About half of the sample reported a need for contact with mental health services during the pandemic, half of whom actually used services. Need for contact was much lower in the schizophrenia group than other diagnostic groups, whereas actual use of services was lower in the unipolar depression and anxiety/OCD groups. Conclusions: Patients with severe mental disorders, such as schizophrenia or bipolar disorders, may not be in a more disadvantageous position in terms of psychiatric service use during the pandemic. The pandemic response structure of mental health services should be modified to fit the needs of anxiety/depression spectrum patients. Keywords: COVID-19, Mental Health, Pandemic, Outpatient, Services Use

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Examining the Role of Type D Personality Traits in Predicting Depression and Anxiety Symptoms in Postpartum Women Doğum Sonrası Dönemdeki Kadınlarda Depresyon ve Anksiyete Belirtilerini Öngörmede D Tipi Kişilik Özelliklerinin Rolünün İncelenmesi 28 28 10.5080/u27482 EN TR Nesrin ÇUNKUŞ KÖKTAŞ Gülay TAŞDEMİR Journal Article 1402 10.5080/u27482 Objective: This study aimed to examine the role of type D personality traits in predicting depression and anxiety symptoms in women in the postpartum period. Method: The study is correlational and case-controlled. The sample consisted of 319 women in the postpartum period living in a province in western Türkiye. Type D Personality Scale (DS14), Edinburgh Postpartum Depression Scale (EPDS), and State-Trait Anxiety Inventory (STAI) were administered. Data were collected via Google Forms between January and February 2022. Results: 62.4% of women in the postpartum period had type D personality characteristics. Postpartum depression and state-trait anxiety levels of women with type D personality were significantly higher (p<0.05). Additionally, the negative affect subscale of the Type D Personality Scale was the most significantly associated variable with postpartum depression (β=0.548, p<0.05) and state-trait anxiety (β=0.709, p<0.05). Conclusion: Personality traits can play an important role in the emergence of depression, anxiety and stress. Improving the coping and interpersonal skills of women with type D personality traits can help them to manage pregnancy, birth and motherhood related mental problems. Keywords: Anxiety, Depression, Postpartum, Type D Personality, Women

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Post-earthquake Trauma Levels and Sleep Quality in University Students: A Cross-Sectional Study Üniversite Öğrencilerinde Deprem Sonrası Travma Düzeyleri ile Uyku Kaliteleri Arasındaki İlişki: Kesitsel Bir Çalışma 29 29 10.5080/u27374 EN TR Rukuye AYLAZ Fidan BALKAYA Fatoş UNCU Journal Article 1403 10.5080/u27374 Objective: This study aimed to examine the relationship between the level of trauma experienced after the earthquake and sleep. Method: In this cross-sectional study, data were collected from 773 nursing students studying at two state universities located at the earthquake-affected provinces. Post-Earthquake Trauma Level Determination Scale, and Pittsburgh Sleep Quality Index were used in the study. Results: The average score on the Post-Earthquake Trauma Level Determination Scale was 56,81±17,68 for female students and 50.84±16.98 for male students (p<0.001). The students who had a history of a psychiatric disorder, whose houses were severely damaged and whose relatives were trapped under rubble were more affected by the earthquake (p<0.001). It was found that the students with low income, heavily damaged residences, and whose relatives were trapped under rubble had worse sleep quality (p<0.001). A weak positive correlation was determined between the Post-Earthquake Trauma Level Determination Scale and the Pittsburgh Sleep Quality Index (r=0.444, p<0.001). Conclusion: In this study, it was revealed that female students, who were trapped under the rubble and whose houses were heavily damaged, were greatly affected by the earthquake. These students should be identified by school administrations and receive psychological support. Their trauma levels and sleep qualities should also be assessed following the earthquake. ​Keywords: Earthquakes, Trauma, Sleep, Students

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Remıssıon And Follow-Up In Bıpolar Depressıon Wıth Accelerated Intermıttent Theta Burst Stımulatıon Protocol Hızlandırılmış Aralıklı Teta Patlayıcı Stimülasyon Protokolü ile Bipolar Depresyonda Remisyon ve Takip 30 30 10.5080/u27553 EN TR Sercan SİVLİM Hayri Can ÖZDEN A. Elif ANIL YAĞCIOĞLU Ş. Can GÜREL Letter 1404 10.5080/u27553 Transcranial Magnetic Stimulation (TMS) is used in the treatment of many mental illnesses, as well as for research in mental illnesses (Altınbaş et al. 2007, Yıldız et al. 2015). Intermittent Theta Burst Stimulation (iTBS) is a treatment protocol that is applied with 10 - 20 Hz and has a similar effect to Repetitive Transcranial Magnetic Stimulation (rTMS) (Blumberger et al. 2018). The FDA approved the standard iTBS protocol in 2018 to treat treatment-resistant depression.

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Changes in ICD-11 Related to Sexual Health and Dysfunction and Their Implication for Clinical Practice ICD-11’de Cinsel Sağlık ve İşlev Bozuklukları ile İlgili Değişiklikler ve Değişikliklerin Klinik Uygulamaya Etkileri 31 31 10.5080/u27559 EN TR Koray BAŞAR Journal Article Review 1405 10.5080/u27559 The classification of sexual health-related conditions was reformulated in 11th revision of International Classification of Diseases (ICD-11) following current evidence, best practice, and taking human rights into consideration, which is expected to reflect and provide guidance for more integrative clinical approaches. Overcoming the artificial, yet historical, distinction between “organic” and “non-organic” conditions, sexual dysfunctions classified in the “Mental and Behavioral Disorders” and “Disorders of Genitourinary System” in ICD-10 were listed in a new chapter called “Conditions Related to Sexual Health.” In practice, this approach has been consistently recommended. However, diagnostical clasification was not congruent with the recommendation. Dysfunctions, defined with a non-normative but individual-based threshold, are categorized according to different stages of the sexual response cycle, similar to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5). However, similarities and distinctions in the clinical presentation of the dysfunction in men and women were also considered, resulting in differences from the DSM-5 approach. Gender Incongruence is classified in this newly formed “Conditions Related to Sexual Health” chapter, not with mental disorders as in the earlier version, reflecting the current non-pathologizing understanding of gender diversity. Furthermore, the criteria for these conditions were revised to embrace the variability in the experience of gender identity. In addition, the residuals of sexual orientation-related diagnostic categories were removed. Paraphilic disorders categories replaced “Disorders of sexual preference” in ICD-10, with significant modifications in conceptualization and classification. Keywords: ICD-11, Gender Incongruence, Paraphilic Disorders, Sexual Dysfunctions

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Discrimination of Speech Content in Unipolar Depression and Bipolar Mania: A Computer-Based Analysis with “General Inquirer” Unipolar Depresyon ve Bipolar Manide Konuşma İçeriğinin Ayırt Ediciliği: “Genel Çözümleyici” Bilgisayar Programı Temelli Bir İnceleme 32 32 10.5080/u27618 EN TR Aslı Tuğba ESEN Ahmet Levent METE Necip ÇAPRAZ Almıla EROL Journal Article 1406 10.5080/u27618 Objective: Speech disorders in mental illnesses are usually chronic and associated with poorer outcome. Recently, different types of speech features in mental illnesses can be examined by computer technology. The aim of our study is to examine the content of speech in depression and mania and to investigate the themes that differentiate the diagnostic groups. Method: 30 patients diagnosed with depression, 30 patients diagnosed with bipolar disorder manic episode and 30 healthy control were included in the study. All participants were performed with the Structured Clinical Interview for DSM-IV Axis I Disorders. The participants were asked to speak free for ten minutes and then their speech content was analyzed with the “General Inquirer” computer program. This program analyzes the participants’ use of a total of 4919 words in the Harvard Psychosocial Dictionary, which are categorized in 83 themes on topics related to psychosocial, emotion, behavior, thought, natural and cultural environment. Results: The diagnostic groups were identified by speech content categories with an accuracy rate of 81%. Patients in mania and depression groups were clustered in the same direction in discriminant analysis by the themes of speech content. ‘’self’’ and ‘’academic’’ themes were the most discriminative categories between the patient and control groups. Conclusion: The content of speech in mania and depression is different from individuals without mental disorders and that computer-assisted analysis tools can distinguish diagnostic groups from each other and from healthy group. Future studies in which structural, vocal and content features of speech are evaluated together and used more advanced computer technologies will contribute to the literature. Keywords: Bipolar Disorder, Depression, General Inquirer, Language, Linguistics, Speech

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Scope Of Authorıty For Securıty Personnel In Addıctıon Rehabılıtatıon Centers: An Ongoıng Issue Madde Bağımlılığı Arındırma Merkezlerinde Güvenlik Görevlilerinin Yetkileri: Süregelen Bir Sorun 33 33 10.5080/u27558 EN TR Mustafa DANIŞMAN Gamze ZENGİN İSPİR Kübra SEZER KATAR Zehra UÇAR HASANLI Letter 1407 10.5080/u27558 Based on our experiences over the past years, individuals who either apply for outpatient services or are receiving inpatient treatment at Alcohol and Substance Abuse Treatment Centers (AMATEM) may attempt to bring in narcotic drugs or substances for purposes such as drug use or drug trafficking to these clinics (Ögel 2010).

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Theory of Mind, Attachment and Metacognitive Functions in Depression Depresyonda Zihin Kuramı, Bağlanma ve Üstbilişsel İşlevler 34 34 10.5080/u27544 EN TR Kadriye Ece DEMİRAY Gözde BACIK YAMAN Journal Article 1408 10.5080/u27544 Objective: Theory of mind (ToM) is a foundational ability for social functioning and interpersonal relationships. This study aims to examine theory of mind components in major depressive disorder and its relationship with metacognitive functions and attachment styles. Method: The study enrolled 64 patients with major depressive disorder and 64 healthy controls. The control group was selected to match the patient group regarding age, gender, marital status, and educational level. Every participant completed the sociodemographic data form, the Hinting Test, the Reading the Mind in the Eyes Test, the Adult Attachment Style Scale, and the Metacognition Questionnaire. The severity of depression symptoms was evaluated using Hamilton Depression Rating Scale-17. Results: The average overall score of the metacognition questionnaire was substantially greater in the patient group (p<0.001) compared to the control group. The average score for the Hinting Task was substantially lower in the patients compared to the control group (p<0.001). The severity of depressive symptoms showed a strong negative correlation with the Hinting Task score (r=-0.759; p<0.001), and a moderate negative correlation with the Reading the Mind in the Eyes Test score (r=-0.589; p<0.001). Conclusion: This study showed that depressed individuals have impairments in reading the minds of others’ around them and in their metacognitive functions. The findings above highlight the need to integrate techniques centered on enhancing fundamental theory of mind reasoning into current therapy interventions in order to enhance the comprehension and interpretation of social information among individuals experiencing depression. Keywords: Attachment, Depression, Metacognition, Theory of Mind

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Assesment of Clinical Reasoning in Psychiatric Education: Development of Multiple-Choice Questions with Automatic Item Generation in Turkish Psikiyatri Eğitiminde Klinik Akıl Yürütmenin Değerlendirilmesi: Türkçe Otomatik Soru Üretimi ile Çoktan Seçmeli Soruların Geliştirilmesi 336 343 10.5080/u27540 EN TR Esra EMEKLİ Emre EMEKLİ Yavuz Selim KIYAK Yasemin HOŞGÖREN ALICI Özlem COŞKUN Işıl İrem BUDAKOĞLU Journal Article 1416 10.5080/u27540 Objective: This study aims to evaluate the suitability of the automatic item generation (AIG) for producing Turkish case-based multiplechoice questions (MCQs) in psychiatry. Method: The study was planned as a descriptive study. In the first stage, topics were determined and a cognitive model was created by subject matter experts. In the second stage, a question template was created, variables were determined, the format of answer options was organized, and two equivalent templates of question content with different combinations were created. In the final stage, questions were generated using Python-based software based on these models. Following the question generation, random samples were selected and evaluated by experienced educators using a structured form. Results: A total of 1189 questions were generated, with 11 questions sampled for each diagnosis. In the evaluation conducted by experts, six of the questions were deemed appropriate for each parameter, while minor corrections were suggested for five questions. It was stated that all the questions assess clinical reasoning skills rather than factual recall. Conclusion: The template-based AIG method allows for the rapid and effective production of high-quality questions needed in medical education. The study demonstrated that AIG in the Turkish language for generating MCQs that assess clinical reasoning is applicable in the field of psychiatry. This method enables the production of a large number of questions in a short time, enriched with various combinations. Keyword: Automated item generation, clinical reasoning, medical education, multiple choice question, psychiatry education

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between the Level of Sexual Desire Reported in the Clinical Interview and Sexual Development Characteristics, Sexual Functions, and Clinical Diagnosis in Women Kadınlarda Klinik Görüşmede Bildirilen Cinsel İstek Düzeyinin Cinsel Gelişim Özellikleri, Cinsel İşlevler ve Klinik Tanı ile İlişkisi 344 352 10.5080/u27375 EN TR Abdülkadir Sencer TABAKCI Münevver HACIOĞLU YILDIRIM Ejder Akgün YILDIRIM Hasibe Rengin GÜVENÇ Sevilay UMUT KILINÇ Duru ÖREL Journal Article 1417 10.5080/u27375 Objective: This study aimed to understand the significance of reported sexual desire levels during clinical interviews. We investigated the relationship between sexual desire, sexual developmental characteristics, and scale results, and the predictive effect of adequate sexual desire on clinical diagnoses. Method: The medical records of patients who consecutively applied to a Specialized Sexual Dysfunctions (SD) clinic were screened for reported sexual desire. We compared 101 patients who reported adequate sexual desire with 94 patients who reported inadequate desire with an interview. The groups were compared based on their sociodemographic and clinical characteristics, sexual behaviors and the Golombok-Rust Sexual Satisfaction Scale (GRISS). Results: When the group with adequate sexual desire was compared with the group with inadequate sexual desire, significant differences were found between the two groups. The group with inadequate sexual desire was more likely to have had an arranged marriage, to have no source of sexual information, to view masturbation as natural to a lesser extent and as a sin to a greater extent, to have less frequent marital intercourse, to have higher rates of negative experiences related to sexuality, to have higher rates of negative changes in sexual life after having children, to have higher rates of comorbid SD, and to have higher GRISS frequency, satisfaction, avoidance, touching, anorgasmia subscale and total scores. The source of sexual information and negative experience about sexuality predicted a decrease in sexual desire. Those with reduced sexual desire were diagnosed with an SD 8.5 times more often than those with adequate sexual desire. Conclusion: Our findings showed the importance of sexual desire adequacy reported in the clinical interview in women in evaluating women’s sexual health and functions, and the need for sexual health education. Keywords: Diagnostic evaluation, female sexual dysfunctions, sexual desire

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Reliability and Validity of the Newly Developed Hacettepe-Computer Based Theory of Mind (Hacettepe-CBToM) Battery Yeni Geliştirilen Hacettepe-Bilgisayar Temelli Zihin Kuramı (Hacettepe-BTZK) Bataryasının Güvenirlik ve Geçerlik Çalışmaları 353 363 10.5080/u27454 EN TR Müge KADEMLİ Banu CANGÖZ TAVAT Journal Article 1418 10.5080/u27454 Objective: With the rise in popularity of the theory of mind (ToM), defined as the ability to understand that others’ beliefs, desires, and intentions may differ from one’s own, numerous tools have been developed since the 1990s. However, the use of disparate tasks to measure the same construct, the lack of a standardized task battery, and the inadequate validity/reliability of existing TOM measures have contributed to inconsistent research findings. This study developed the HACETTEPE-Computer Based Theory of Mind Battery (HACETTEPE CBToM), which utilizes three-dimensional colored animations, focuses on social interactions, and integrates cognitive/ affective dimensions. Comprehensive validity and reliability studies were conducted. Method: The validity and reliability studies of the battery, which consists of eight scenarios (four second-order false belief tasks: two cognitive/ two affective, and four irony tasks: two cognitive/two affective), were carried out with 214 healthy adults aged 18-36. Results: Construct validity was evaluated through confirmatory factor analysis, and the fit indices indicated an excellent model fit [χ2(19, N=214) =26.14, p>0.05, χ2/df=1.38, RMSEA=0.042, SRMR=0.05, GFI=0.97, AGFI=0.95, CFI=0.98, TLI(NNFI)=0.97]. For criterion validity, a positive and significant correlation was found between the scores of the HACETTEPE-CBToM Battery and the Dokuz Eylül Theory of Mind Scale (r=0.32, p<0.05). The inter-rater reliability and internal consistency coefficients were r=0.94 and r=0.72, respectively. Conclusion: The HACETTEPE-CBToM Battery is a culturally appropriate, ecologically valid, and psychometrically robust tool for detailed assessment of ToM. Keywords: Cognitive sciences, neuropsychologic test, reliability and validity, theory of mind

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Frequency of Eating Disorders, Associated Factors, and Quality of Life in Patients with Bipolar Disorder: An Investigation in the Context of Behavioral Inhibition/Activation Systems Bipolar Bozukluğu Olan Bireylerde Yeme Bozuklukları Sıklığının, Yeme Davranışları ile İlişkili Faktörlerin ve Yaşam Kalitesinin Davranışsal İnhibisyon/Aktivasyon Sistemleri Eşliğinde İncelenmesi 364 373 10.5080/u27340 EN TR Ayşe KÖKSAL Demet SAĞLAM AYKUT Ezgi SELÇUK ÖZMEN Journal Article 1419 10.5080/u27340 Objective: This study aimed to examine the frequency of eating disorders (ED) in patients with bipolar disorder (BD) compared to healthy controls, and to investigate potential relationships between eating attitudes, quality of life, and personality traits as measured by the Behavioral Inhibition System and Behavioral Activation System (BIS/ BAS) Method: The study was designed as a cross-sectional study in the psychiatry outpatient clinic. We included 76 BD patients and 74 controls who were similar in terms of gender, age, and education level. We utilized Behavioral Inhibition System/Behavioral Activation System Scale (BIS/BASS), Night Eating Questionnaire (NEQ), Eating Attitude Test (EAT), Eating Disorders Examination Questionnaire (EDE-Q), and Quality of Life Scale Short Form (SF-36). Results: The frequency of ED was 18.4% in participants with BD and 1.3% in the control group. Compared with the control group; the physical function subscales scores, role difficulty physical subscales scores, social function and role difficulty emotional subscale scores of SF-36 were lower in BD patients; while the BAS, the EAT, the NEQ scales and eating concern, body concern and weight concern subscales and mean scores of the EDE-Q were found to be higher. Conclusions: The frequency of ED is increased in BD patients. Our study is one of very few in the literature to examine the comorbidity of BD and ED, and the factor associated with the presence of ED. The data obtained will hopefullly contribute to better diagnosis and treatment Keywords: Bipolar disorder, behavioral activation systems, behavioral ınhibition system, eating attitude test, eating disorder

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Validity and Reliability of the Turkish Version of the Food Neophobia Scale in Adolescents Ergenler için Yeni Besin Korkusu Ölçeğinin Türkçe Formunun Geçerlilik ve Güvenirlilik Çalışması 374 382 10.5080/u27536 EN TR Merve YAZICI Mehmet KIVRAK Meltem PUŞUROĞLU Çiçek HOCAOĞLU Journal Article 1420 10.5080/u27536 Objective: Food neophobia is an aversion or reluctance to eat new or unfamiliar foods. The aim of this study was to establish the Turkish validity and reliability of the Food Neophobia Scale, which is used to measure the fear of trying new foods, in the adolescent age group. Method: The study was conducted with high school students in the province of Rize during the 2023-2024 academic year. The sample of the study was comprised of 466 students in 13-18 age range. Data were collected using a questionnaire containing demographic characteristics and the Food Neophobia Scale. To assess the validity and reliability of the scale, Exploratory Factor Analysis, Confirmatory Factor Analysis, and Cronbach’s alpha internal consistency coefficient were used. Results: The mean age of the students included in the study was 15.4±1.1 years 50.6% were male. The items in the scale used in the study were found to have sufficient correlation and the dataset was suitable for factor analysis (KMO=0.747; Bartlett’s sphericity test, p<0.001). The Confirmatory Factor Analysis revealed that the scale had a good model fit (χ²=3.78, p<0.001). The Cronbach α internal consistency coefficient for the scale integrity was 0.71. Conclusion: The Turkish Food Neophobia Scale is a valid and reliable measurement tool. The scale can determine food neophobia in adolescents aged 13-18. Keywords: Adolescent, food neophobia, scale, validity and reliability

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Psychometric Properties of the Turkish Version of the Reflective Functioning Questionnaire in Men on Probation for Substance Use and a Healthy Control Group Yansıtıcı İşleyiş Ölçeği Türkçe Versiyonunun Psikometrik Özelliklerinin Madde Kullanımı Nedeniyle Denetimli Serbestlik Sürecinde Olan Erkekler ve Sağlıklı Kontrol Gruplarında Değerlendirilmesi 383 394 10.5080/u27424 EN TR Seval BİRDAL ALTUN Patrick LUYTEN Vahap KARABULUT Cüneyt EVREN Stephan BONGARD Journal Article 1421 10.5080/u27424 Objective: Mentalization is defined as the capacity to reflect on one’s own mental state and the mental states of others. The primary aim of this study is to translate the Reflective Functioning Questionnaire (RFQ), which measures mentalization, into Turkish and evaluate its psychometric properties. In addition, reflective capacities of male adults on probation due to substance use were investigated and compared with the control group. Methods: The questionnaire was translated into Turkish using a forward-backward-forward method and administered to 219 adults with no prior psychiatric history, as well as 205 substance-using male adults. Participants also completed a battery of self-report questionnaires measuring empathy, mindfulness, theory of mind, alexithymia, and impulsivity. Additionally, the substance-using group completed the Drug Use Disorders Identification Test to assess the severity of their drug use. Results: The results indicate configural invariance of the original twofactor structure of the RFQ across the Turkish-speaking healthy control group and substance-using male adults, as well as satisfactory reliability and construct validity for the two subscales. The reflective functioning scores of the substance-using group were not significantly different from those of the control group. Discussion: This study demonstrates the reliability and validity of the Turkish version of the RFQ. Despite no significant differences in RF scores between the groups, the findings highlight the significance of further exploring reflective functioning in individuals with substance use. Keywords: Mentalization, reflective functioning, reflective functioning questionnaire, substance use disorder, validity, reliability

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Secondary Traumatic Stress, Anxiety, Depression, and Coping Styles in Healthcare Workers After the Kahramanmaraş 2023 Earthquakes Kahramanmaraş 2023 Depremlerinden Sonra Sağlık Çalışanlarında İkincil Travmatik Stres, Anksiyete, Depresyon ve Başa Çıkma Tarzları Arasındaki İlişki 395 403 10.5080/u27571 EN TR Merve ONAT Metin YİĞİT Neslihan KAYADEMİR Hanife AVCI Gülser ŞENSES DİNÇ Esra ÇÖP Journal Article 1422 10.5080/u27571 Objective: The aim was to determine the relationship between secondary traumatic stress, anxiety, depression, and coping styles in healthcare workers following the devastating 2023 Kahramanmaraş earthquakes. Method: A total of 243 healthcare workers aged 18-65 years working at Ankara Bilkent City Children’s Hospital between April 2023 and June 2023 were included in our study. Participants were assessed with the Brief Symptom Inventory, Ways of Coping with Stress Scale and Secondary Traumatic Stress Scale. Results: Anxiety, depression and secondary traumatic stress were positively correlated with ineffective coping styles and negatively correlated with effective coping styles. Younger age and female gender were associated with higher levels of anxiety and depression, while secondary traumatic stress was more prevalent among those involved in treating earthquake-affected patients. Regression analysis revealed that ineffective coping styles were associated with anxiety, depression and secondary traumatic stress. Additionally, time spent treating earthquakeaffected patients was linked to secondary traumatic stress, and the loss of a relative was associated with anxiety. Conclusion: Healthcare workers relying more on ineffective coping styles may face a greater risk of anxiety, depression and secondary traumatic stress. Keywords: Anxiety, earthquake, depression, healthcare workers, secondary traumatic stress

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Adaptation of Anxiety Scale for Children-Autism Spectrum Disorder-Parent Version (ASC-ASD-P-TR) to Turkish Culture and Examination of Psychometric Properties Otizm Spektrum Bozukluğu Olan Çocuklar için Anksiyete Ölçeği- Ebeveyn Versiyonu’nun (OSB-ÇAO-E-TR) Türk Kültürüne Uyarlanması ve Psikometrik Özelliklerinin İncelenmesi 404 413 10.5080/u27513 EN TR Aydan AKKURT YALÇINTÜRK Elçin BABAOĞLU Yalçın KANBAY Tuğba KARAKUŞ TÜRKER Journal Article 1423 10.5080/u27513 Objectives: Accurate assessment of anxiety symptoms in children diagnosed with Autism Spectrum Disorder (ASD) can be challenging due to the lack of appropriate assessment tools. This study aimed to adapt the Anxiety Scale for Children with Autism Spectrum Disorder- Parent Version into Turkish (referred to as ASC-ASD-P-TR) to enable parents to assess anxiety in children with ASD. Methods: This methodological study was conducted between October 2023 and March 2024 with parents of children diagnosed with ASD aged 8-15 years. 371 parents participated in the study. Data were collected online. Content validity, construct validity, internal reliability and split-half reliability. were examined. Results: The construct of the ASC-ASD-P-TR, which consists of four dimensions (Performance, Separation, Arousal, and Uncertainty) and 24 items, was validated in Turkish. The scale has a score range between 24 and 96, and an increase in score means an increase in anxiety. The total variance explained by the scale is 61%. Cronbach’s alpha reliability coefficient for the overall scale is 0.94. In the sub-dimensions of the scale, Cronbach’s alpha value was between 0.66 and 0.80. Conclusion: The ASC-ASD-P-TR is a valid and reliable measurement tool for assessing anxiety in children with ASD in Turkiye. Keywords: Anxiety, autism spectrum disorder, parent report, reliability, validity

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Psychometric Properties of Turkish Instruments Assessing Social Cognition in Psychiatry and Neurology: A Systematic Review Psikiyatride ve Nörolojide Sosyal Bilişi Değerlendiren Türkçe Araçların Psikometrik Özellikleri: Dizgeli Gözden Geçirme 414 426 10.5080/u27665 EN TR Doğukan KOÇYİĞİT Mehmet Eren KILINÇ Rana Nüve YILMAZ Emre MUTLU Yavuz AYHAN Journal Article Review 1424 10.5080/u27665 Objective: Social cognitive processes are shaped by cultural norms, necessitating cultural adaptation and psychometric validation. This review systematically examines Turkish tools used to assess social cognition in neurology and psychiatry, summarizing their procedures and psychometric properties. Method: Following PRISMA 2020, we searched MEDLINE, Web of Science, Scopus, and YOKSIS for studies up to May 2024. Using SRAccelerator’s Polyglot, we developed database-specific keywords and applied a PICOS-based search strategy. From 3,115 identified records, 157 studies met inclusion criteria. Among the Turkish tools used to assess social cognition in psychiatric disorders or neurological diseases, those with established validity and reliability, we extracted (i) task characteristics and (ii) psychometric properties. Results: A total of 31 tests and 15 scales were used across 157 studies, covering 37 diagnoses, 9 studies with family members, and 2 with highrisk groups. Psychometric properties were reported for 13 tests (41.9%) and 8 scales (53.3%). Four tools were developed in Turkish: The Humor Comprehension and Appreciation Test, the Test of Perception of Affect via Nonverbal Cues, the Dokuz Eylül Theory of Mind Index, and the Child- Adolescent KA-SI Empathic Tendency Scale. The most frequently used test was the Reading the Mind in the Eyes Test (52.2%), while the Dokuz Eylül Theory of Mind Index (45.8%) was the most used scale. The Faux Pas Test and the Observable Social Cognition Scale had stronger psychometric support. Internal consistency, test-retest, and inter-rater reliability were assessed in 75%, 55%, and 30% of tools, respectively, while various validity measures ranged from 45% (known-group validity) to 5% (ecological validity). No test assessed social perception. The only tool that uses moviebased material in Turkish was the Test of Perception of Affect Via Nonverbal Cues. Conclusion: This systematic review provides a comprehensive approach to Turkish social cognition tools in neuropsychiatry. Nearly half lack robust psychometric validation, and there is a critical gap in Turkish tools measuring social perception. Keywords: Neurology, psychiatric disorder, psychometrics, social cognition, systematic review

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Group Therapies for Gender Minority Stress: Systematic Review and Affirmative Cognitive Behavioral Group Therapy Process PresentationGender minority stress refers to the form of stress experienced by individuals who identify as trans or within the spectrum of gender diversity due to discriminatory discourses and actions in society. This type of stress can negatively affect both mental and physical health and may even result in the loss of one’s most fundamental right—the right to life. Therefore, it is crucial for professionals to remain sensitive to gender minority stress when working clinically with this population. This article aims to raise awareness among mental health professionals about gender minority stress and to provide a practical example of an intervention in this area. To this end, group therapy models addressing gender minority stress were reviewed through a systematic literature search. In addition, the experiences of eight individuals who participated in a group therapy designed and facilitated by the authors using an affirmative cognitive behavioral approach were shared. The findings indicate that the most prominent intervention models in the literature targeting gender minority stress are based on cognitive behavioral group therapy. Furthermore, it was observed that members who participated in the group therapy developed psychosocial empowerment through gaining awareness, solidarity, and cognitive and behavioral skills related to self-regulation.Keywords: Cognitive behavioral therapy, gender identity, group therapyCinsiyet Kimliği Azınlık Stresine Yönelik Grup Terapileri: Sistematik Gözden Geçirme ve Olumlayıcı Bilişsel Davranışçı Grup Terapi Süreci Sunumu2Koray BAŞAR1, Halil PAK2, K. Can EREN3427Atıf için: Başar K, Pak H, Eren KC. (2025) Cinsiyet Kimliği Azınlık Stresine Yönelik Grup Terapileri: Sistematik Gözden Geçirme ve Olumlayıcı Bilişsel Davranışçı Grup Terapi Süreci Sunumu. Turk Psikiyatri Derg 36:427−438. https://doi.org/10.5080/u27670428 www.turkpsikiyatri.comark. 2016), kimlikle gurur duyma, sosyal destek (Başar ve Öz 2016; Başar ve ark. 2016), akran teması (Tüzün ve ark. 2022) önemli koruyucu etkenler arasındadır (Perrin ve ark. 2019). Bu bağlamda, söz konusu etkenleri kapsayan bir uygulama biçimi olarak grup terapilerinin trans+’larla çalışmada etkili bir yöntem olduğu düşünülmektedir.Trans+’lar cinsiyetleriyle uyumlu gördükleri bedensel ve sosyal özellikleri edinmelerine yönelik cinsiyet uyum süreci (CUS) ile ilgili tıbbi destek talep ettiklerinde erişimle ilgi-li zorluklarla karşılaşmaktadır (Berrian ve ark. 2024). Hem uyum süreci hem de genel ruhsal destekle ilgili erişim engel-leri arasında eğitimli ve deneyimli uzman sayısı ve bu hiz-metlerin sunulduğu kurum sayısındaki azlık önemli sıradadır (Safer ve ark. 2017, Renner ve ark. 2021, Skuban-Eiseler ve ark. 2023). Klinik ortamlarda çalışan uzmanlara, trans+’lara ruh sağlığı hizmeti sunarken cinsiyet kimliği azınlık stresiy-le başa çıkmanın önemine ilişkin bir farkındalık oluşturmayı ve bir uygulama örneği oluşturmayı amaçlayan bu yazıda, ilk olarak cinsiyet kimliği azınlık stresine yönelik geliştirilen grup terapisi modellerine ilişkin alanyazın sistematik bir yaklaşımla değerlendirilecektir. Ardından, yazarlarca olumlayıcı bilişsel davranışçı perspektiften planlanan ve uygulanan bir grup te-rapisi süreci ve tedaviyi sürdüren sekiz üye sunulacaktır.CİNSİYET KİMLİĞİ AZINLIK STRESİNE YÖNELİK GRUP TERAPİLERİCinsel kimlikle ilgili çeşitliliğin tanı sistemlerinde ruhsal bo-zukluk olarak değerlendirildiği geçmiş dönemlerdeki terapi uygulamalarının aksine, olumlayıcı psikoterapi yaklaşımı, kişilerin cinsel yönelim ve cinsiyet kimliği ile ilgili ifadeleri-ne saygı göstererek, azınlık gruplarının psikososyal zorlanma deneyimlerinin farkında olarak, kişilerin ihtiyaçlarını des-teklemeye, güçlendirmeye öncelik vermektedir (American Psychological Association 2015, Başar 2025). Trans+’lara yönelik olumlayıcı terapiler kapsam, yöntem, süre ile ilgi-li önemli değişkenlikler gösterse de giderek artan şekilde bu grubun deneyimlediği sağlık eşitsizliklerine ve bunun altında yatan toplumsal yapılara odaklanmaktadır (Singh ve Dickey 2017). Azınlık stresinin tanımlanması, araştırma ve klinik uygulamalarda yer verilmesiyle psikoterapiler stres etkenle-rinin kişilerin başa çıkma biçimlerini, düşünsel, duygusal ve davranışsal tepkilerini, bunların esnek olmayan ve işlevselliği bozan şekilde yinelenmesini hedef olarak belirlemiştir. Birçok psikoterapi yaklaşımı içinde öncelikle bilişsel davranışçı te-melli yaklaşımlar dikkat çekmektedir (Exposito-Campos ve ark. 2023). Burger ve Pachankis (2024)’a göre olumlayıcı yaklaşımlar arasından bilişsel davranışçı psikoterapiler, azınlık stresini kişisel yetersizliklerden çok toplumsal yapılarla ilişki-lendirmesi ve böylelikle kişiye günlük yaşamında uyumu art-tıracak başa çıkma stratejileri geliştirmesi ve bilişsel esneklik kazandırması nedeniyle öne çıkmaktadır. Bir başka ifadeyle GİRİŞCinsiyeti doğumda bedensel özelliklerine dayanarak atandı-ğı cinsiyetle örtüşmeyen, kendini trans ve cinsiyet çeşitliliği içinde tanımlayanlar (trans+1), toplum içinde dışlanan grup-lar arasındadır. Cinsiyet kimlikleri üzerinden deneyimlenen önyargı, damgalanma ve ayrımcılık bu grubu daha stresli bir sosyal çevre içinde yaşamaya zorlamaktadır. Meyer (2003), cinsel kimlikleri nedeniyle toplumda gruplar arası hiyerarşide aşağıda kalan grupların deneyimlediği bu stres biçimini dış ve iç kaynaklardan oluşan “azınlık stresi” olarak tanımlamıştır. Azınlık stresi, kişinin kimliği ve özelliklerinden değil ama top-lumsal kaynaklardan köken alan, süreğen, yaygın ve kendine özgü bir stres çeşididir. Dış kaynaklar, cinsiyet kimliği üzerin-den yaşanan damgalanma, ayrımcılık, ret, haklardan yoksun bırakılma, mağdur edilme ve kimliğin olumlanmaması, ta-nınmamasıdır. “İçselleştirilmiş damgalanma”, cinsiyetin ikili olarak kabul edildiği ve doğumda atanan cinsiyetle az ya da çok örtüşmeyen cinsiyet kimliği ve ifadesinin dışlandığı top-lumlarda (örn., cisseksizim ideolojisi) bireyin bu kalıp yargı-ları benimseyerek hem kendisine hem de grubuna karşı olum-suz inançlar geliştirmesidir. (Hatzenbuehler ve Pachankis 2016). Bu yolla kişinin cinsiyet kimliği üzerinden kendisine dair olumsuz düşünce, duygu ve davranışlar geliştirmesi iç stres kaynağı olarak değerlendirilmektedir. Bu durum, kişinin sürekli ayrımcılığa uğrayacağına dair bir beklentiye girmesine ve yoğun bir şekilde gizlenme çabaları ile yaşamasına neden olabilmektedir. Genel toplumda deneyimlenen stresörlere ek olarak, kendine özgü nitelikleri olup süreğen seyreden azınlık stresine maruz kalmak, kişinin stres yükünü arttırarak hem bedensel hem de ruh sağlığını olumsuz yönde etkileyebilmek-tedir (Hatzenbuehler ve Pachankis 2016).Meyer (2003), azınlık stresi modelini öncelikle cinsel yöne-limle ilgili homofobik deneyimler üzerinden geliştirmiştir. Hendricks ve Testa (2012), “cinsiyet kimliği azınlık stresi”nin cinsiyet çeşitliliğine yönelik ayrımcı duygu, düşünce ve tutumlarla, transfobiyle de ilişkili olduğunu göstermiştir. Trans+’larda, cinsiyet kimliği azınlık stresiyle ilişkili olarak bazı ruhsal sağlık sorunları genel toplumdan daha yüksek oranda görülmektedir (Helsen ve ark. 2022, Moe ve ark. 2023). Bu sorunlar arasında depresyon, anksiyete, yüksek stres düzeyi öne çıkmaktadır (Mezza ve ark. 2024). Bu grupta özkıyım ve özkıyıma yönelik olmayan kendine zarar verme davranışı da toplum genelinden yüksek yaygınlıkla görül-mektedir (Aparicio-García ve ark. 2018, Surace ve ark., 2021, Bränström ve ark. 2022, de Lange ve ark. 2022). Azınlık stre-siyle başa çıkmakta ve psikolojik dayanıklılığın artışında umut (Meyer 2003, Moe ve ark. 2023), topluluğa aidiyet (Barr ve 1Bu terim, Türkçe alanyazında yaygın kullanılan bir ifade olmamak-la birlikte bu yazıda kendini trans ve cinsiyet çeşitliliği içinde tanım-layanların (İng. trans and gender diverse people) kısaltması olarak kullanılmaktadır.429 www.turkpsikiyatri.combilişsel davranışçı terapiler, diğer olumlayıcı yaklaşımların terapötik uygulamalarında benimsediği cinsiyet kimliğinin olumlanması ilkesine ek olarak, danışanlarında cinsiyet kim-liği temelli baskı ve ayrımcılığa ilişkin deneyimlerin toplum-sal nedenlerine dair farkındalık oluşturmayı ve bu farkında-lık zemininde bilişsel ve davranışsal beceriler kazandırmayı önceliklendirir.Azınlık stresine yönelik öğelere yer veren olumlayıcı psikote-rapiler sadece cinsel yönelim azınlık gruplarına, sadece cinsi-yet kimliği azınlık gruplarına ya da tüm cinsel kimlik azınlık gruplarına yönelik planlanıp, etkinlikleri araştırılmaktadır (Pachankis ve ark. 2019, Pachankis ve ark. 2020, Pachankis ve ark. 2022). Azınlık stresine yönelik bireysel olumlayıcı bilişsel davranışçı psikoterapi uygulamalarında daha yüksek yapısal ayrımcılığa maruz kalmanın, içselleştirilmiş damgalanmanın daha yüksek olmasının tedavi etkinliğiyle ilişkisi gösterilmiş-tir (Pachankis ve ark. 2023, Yi ve ark. 2024). Son dönemde erişilebilirlik avantajını da kullanarak teletıp temelli psiko-terapi modelleri geliştirilmekte, etkinlikleri bildirilmektedir (Craig ve ark. 2021, Pachankis ve ark. 2023, Nieder ve ark. 2024, Yi ve ark. 2024). Kendini trans ve cinsiyet çeşitliliği içinde tanımlayan kişilere yönelik olumlayıcı psikoterapiler bireysel veya grup formatın-da uygulanabilmektedir. Heck (2017) trans+’larda grup tera-pilerinin tercih edilmesini birkaç nedene bağlamıştır: birey-sel terapiyle karşılaştırılabilir etkinlikleri; özellikle yalıtılmış hisseden gruplarda tatmin edici kişiler arası ilişkiler geliştir-me olanağı sağlaması; tedavi formatına özgü ilave terapötik etkenler içermesi; maliyet etkinlik açısından uygun olması. Grup terapi uygulamalarının sağladığı avantajlar bilişsel dav-ranışçı temelli uygulamalarla sınırlı değilse de (Mastropaolo ve ark. 2020), bilişsel davranışçı terapi uygulamaları tedavi etkinliğiyle ilgili araştırmaların ötesinde düzenleyici ve aracı değişkenlerle de ilgili değerlendirme yapılmasına uygundur (Burger ve Pachankis 2024). Sadece trans+ kişilere yönelik farklı kapsam, terapötik hedef ve bileşenleri olan grup terapileri bildirilmişse de (Yüksel ve ark. 2000, Özgen ve ark., 2024), son 10 yılda grup psikote-rapi ile ilgili alanyazın ağırlıklı olarak azınlık stresine yönelik uygulamalara odaklanmıştır.Alanyazın Tarama YöntemiCinsiyet kimliği azınlık stresine yönelik geliştirilen grup tera-pisi modellerini değerlendirmek amacıyla ilgili alanyazın, sis-tematik bir yaklaşımla PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) ilkeleri (Liberati ve ark. 2009) doğrultusunda değerlendirilmiştir. Veri tabanla-rı olarak Web of Science, Scopus, PubMed ve Türk Psikiyatri Dizini kullanılmıştır. Taramada anahtar kelimeler şu şekilde belirlenmiştir: “gender diverse” (cinsiyet çeşitliliği) YA DA “gender dysphoria” (cinsiyet disforisi) YA DA “transsexual” (transseksüel) YA DA “transgender” (trans) VE “gender mi-nority stress” (cinsiyet kimliği azınlık stresi) YA DA “mino-rity stress” (azınlık stresi) VE “group therapy” (grup terapisi) YA DA “group therapies” (grup terapileri). Tarama, 28 Şubat 2025’ten geriye dönük yapılmıştır. Çalışma türü olarak ise olgu sunumları, protokol ve araştırma makaleleri belirlenmiş olup derlemeler, kitaplar ve kitap bölümleri dışarıda tutulmuş-tur. Anahtar kelimelerle yapılan tarama sonucunda 22 çalış-maya (Web of Science = 8, Scopus = 10, PubMed = 3, Türk Psikiyatri Dizini = 1) ulaşılmıştır. Diğer kaynaklardan beş ça-lışma daha belirlenmiştir. Tekrar eden çalışma sayısı dokuzdur. Kalan 18 çalışma incelendikten sonra 13 makalenin tarama stratejisine uygun olduğu sonucuna varılmıştır. Bu 13 makale arasında ise iki derleme ve bir kitap bölümü bulunmaktadır. Ayrıca, bir çalışmanın tam metnine ulaşılmamıştır. Bu eleme-ler sonucunda bu yazıda cinsiyet kimliği azınlık stresine yöne-lik grup terapisi modellerine ilişkin dokuz çalışma (Craig ve Austin 2016, Austin ve ark. 2018, Poquiz ve ark. 2022, Pipkin ve ark. 2022, Ouellette ve ark. 2023, Sessions ve ark. 2023, Hatchard ve ark. 2024, Chinsen ve ark. 2024a, Chinsen ve ark. 2024b) değerlendirmeye alınmıştır (bkz. Şekil 1).BULGULAROlumlayıcı Bilişsel Davranışçı Başa Çıkma Becerileri Grup Müdahalesi (Affirmative Cognitive Behavioral Coping Skills Group Intervention (AFFIRM)) (Craig ve Austin 2016), Şekil 1. PRISMA Akış Diyagramı430 www.turkpsikiyatri.comalanyazında cinsiyet kimliği azınlık stresine yönelik grup te-rapilerine öncülük eden bir modeldir. Bu model, yazarların klinik deneyimleri, katılımcı araştırmaları ve geribildirimleri-ne (Austin ve Craig 2015) dayalı olarak genç lezbiyen, gey, bi-seksüel, trans, interseks ve kimlik çeşitliliğinin diğer öğeleriyle kendini tanımlayanların (LGBTİ+) başa çıkma becerilerini geliştirme, depresyon düzeylerini azaltma ve böylelikle biliş (öz-farkındalık, riskleri tanımlama), mod (düşünce ve duy-gular arasında bağ kurma) ve davranışlarını (güçlü özellikleri ve başa çıkma şekillerini tanımlama) anlama ve düzenlemeleri amacıyla geliştirilmiştir. Sekiz seanstan oluşan bu yapılandırıl-mış model, olumlayıcı bilişsel davranışçı yaklaşıma dayalı yüz yüze yürütülen bir grup müdahalesidir. Bu modelin çevrimiçi versiyonu (AFFIRM Online) da bulunmaktadır (Craig ve ark. 2021). Bu modelde ilk seansta (1) grup kuralları, beklenti ve hedefler ele alınır ve üyelere program, bilişsel davranışçı te-rapi (BDT) ve azınlık stresi tanıtılır. Sonraki seanslarda ise sırasıyla (2) homo/transfobik tutumlar ve davranışların stres üzerindeki etkileri, (3) düşüncelerin duyguları nasıl etkilediği, (4) duyguları değiştirmek için düşüncelerin kullanımı, (5) et-kinliklerin duyguları nasıl etkilediği, (6) zarar veren düşünce ve olumsuz duygularla başa çıkma planları, (7) azınlık stre-si ve homo/transfobinin sosyal ilişkiler üzerindeki etkileri ve (8) güvenli, destekleyici ve kimlik olumlayıcı sosyal ilişkiler geliştirme konuları ele alınır. Bu modelin uygulanabilirliği-ni değerlendirmek için pilot bir çalışma yapılmıştır. Bu ça-lışmada AFFIRM modelinin uygulandığı üç ayrı grup terapi süreci iki terapist ve 15-18 yaş arasında 10 Kanadalı LGBTİ+ genç üye ile yürütülmüştür (Craig ve Austin 2016). Bu terapi gruplarına katılan ve 16-18 yaş arasında olan sekiz trans üyeye dair bulgular, trans-olumlayıcı uygulama önerileriyle birlikte, başka bir makalede (Austin ve ark., 2018) detaylı olarak su-nulmuştur. Bu makalede sekiz trans üyenin depresyon düzey-lerinin azaldığı bildirilmiştir. Ayrıca trans üyeler, yaşamlarıyla ilişkili olması, stresle başa çıkma ve problem çözme becerileri öğrenmeleri, terapistlerin destekleyici ve yardımcı olmaları nedeniyle bu programdan memnun olduklarını ve bu prog-ramı başkalarına önereceklerini bildirmişlerdir. Kesişimsellik; cinsiyet, etnisite, ırk ve sosyal sınıf gibi farklı azınlık temelli kimliksel özelliklere dayalı baskı ve ayrımcılığa ilişkin deneyimlerin ayrı olarak ele alınmasından ziyade bu özelliklerin birleşiminin oluşturduğu deneyime odaklanılması gerektiğine vurgu yapmaktadır (Crenshaw 1991). Örneğin, trans+’lar için cinsiyet kimliği temelli baskı ve ayrımcılık kendi başına bir stres kaynağı oluşturur. Fakat beyaz ırktan olmayan bir trans+’nın kimliğine ilişkin stres deneyimi tek başına cinsiyet kimliği ile açıklanamaz. Bu kişi, cinsiyet ve ır-kın kesiştiği bir yerden katmanlı bir şekilde azınlık kimliği temelli bir stres deneyimi yaşar -ki bu kişinin yoksul, engel-li, yaşlı olması bu stresin yükünü artıracaktır. Bu bakış açı-sından Poquiz ve arkadaşları (2022), cinsiyet kimliği ve ırk temelli azınlık stresini kesişimsel bir yerden ele aldıkları, beş seanstan oluşan kısa süreli, teletıp temelli bir grup çalışması modeli geliştirmişlerdir. Gururu, Aktivizmi, Dayanıklılığı ve Topluluğu Desteklemek (Supporting Pride, Activism, Resiliency, and Community (SPARC)) isimli bu modelin seanslarının içerikleri ise sırasıyla şu şekildedir: (1) dış ve iç etkenler üze-rinden deneyimlenen ırkçılık ve cinsiyet kimliği azınlık stres-leri, beden ve ruh sağlığı üzerine etkileri, kimliklerin kesi-şimleri ve ayrımcılıkla olan ilişkisi, (2) ırksal kimlik gelişimi ve sosyalizasyonu, (3) yüz yüze ve dijital ortamlarda ırkçı ve transfobik söylemlere tepki gösterme ve başa çıkma strateji-leri, (4) tarihsel ve güncel aktivizm, (5) dayanıklılık inşa et-mek adına aktivizm ve toplulukla bağ kurma. İlk üç seansta üyeler, ırkçı ve transfobik sosyal medya paylaşımlarına maruz bırakılır ve bu maruziyetlere dayalı olarak duygu düzenleme uygulama becerileri ele alınır. Burada amaç, üyelerin bu tür durumlarla başa çıkma ve problem çözme becerilerini geliştirmektir. Dördüncü seansta sosyal medya ve dijital alanlardaki aktivizme ilişkin sosyal medya örnekleri izletilir ve üyelerin sosyal adaletteki rolü ve yapabilecekleri ele alınır. Son seansta ise üyelerden toplulukla bağ kurmalarını arttıracak bir yol tanımlamaları istenir. Araştırmada iki klinik psikolog, ABD’de yaşayan 15-22 yaş arasında altı üye ile seansları yü-rütmüştür. Üyeler, genel anlamda grubun yapısı, içeriği ve uy-gulama şeklinden (teletıp) memnun kalsalar da seans sayısının daha fazla olduğu, yüz yüze bir uygulamayı tercih edebilecek-lerini bildirmişlerdir.Ouellette ve arkadaşlarının (2023) geliştirdikleri Transcending (Aşma), travmatik deneyimlerle sonuçlanan cinsiyet kimliği azınlık stresiyle başa çıkmada beceri geliştirmeyi, bu beceriler-le ruhsal dayanıklılığı geliştirmeyi amaçlayan, travma-odaklı, bilişsel davranışçı protokole dayanan, grup terapisi temel-li, ikişer saatlik 12 seanstan oluşan bir modeldir. Seansların içerikleri sırasıyla şu şekildedir: (1) azınlık stresine psikoeği-tim temelli bir giriş ve cinsiyet kimliklerine ilişkin mitlerin (örn., “bu bir hastalık”, “bu geçici bir dönem”, “sen gerçek bir kadın/erkek değilsin”) çürütülmesi, (2) bilişsel davranışçı modelin azınlık stresi bağlamında ele alınması, (3) bilişsel ye-niden yapılandırmanın tanıtılması, (4) problemli inanç ve dü-şüncelerin tanımlanması, (5) içselleştirilmiş trans-negatiflik, (6) olumsuz gelecek beklentileri, (7) cinsiyet kimliğiyle ilgili açılamamanın yarattığı benlik ve başkalarıyla ilişkili inanç ve düşüncelerin yeniden yapılandırılması, (8) yardımcı olmayan davranışların değiştirilmesi, (9) cinsiyet kimliğinin çevrimi-çi ve yüz yüzeyken açıkça ifade edilmesi, (10) öz-güçlenme adına kendine güvenin ele alınması, (11) engelleri aşmak için problem çözme becerilerinin geliştirilmesi ve (12) tedavi kazanımlarının (kabul ve beceriler gibi) değerlendirilmesi ve devamının planlanması. İlk ve son seanstan önce üyeler, grup sürecini değerlendirebilmeleri için cinsiyet kimlikleri üzerine çevrelerinden aldıkları tepkileri ve bu tepkilerin kişisel inanç-larını nasıl etkilediklerine dair değerlendirmeler yaptıkları bir yazılı uygulama ödevi yaparlar. Ayrıca beşinci seansta kimlik431 www.turkpsikiyatri.comolumlama uygulaması yapılırken; 8., 9. ve 10. seanslarda ma-ruz bırakma teknikleri uygulanır. Yani üyeler grup sırasında ve ev ödevleriyle kamusal alanda davranışlarını değiştirmele-ri için çeşitli uygulamalara maruz bırakılır. Yazarlara göre bu tekrar eden maruz kalmalarla üyelerin özellikle dış stresörle-re dayanan korku temelli kaçınma davranışları azalacak ve iç stresörlerle yaşam memnuniyeti arasındaki ilişkiyi zayıflatan bilişsel esneklikleri artacaktır. Hatchard ve arkadaşları (2024), bu modelin etkililiğini değerlendirmek adına üçü çevrimiçi, üçü yüz yüze olmak üzere altı grup terapisi uygulaması yap-mışlardır. Her bir terapi, üç terapistle ve 17-25 yaş arasındaki beş Kanadalı trans+’la yürütülmüştür. Modelin içselleştirilmiş trans-negatiflik, gelecek hakkında olumsuz beklenti, çevreye açılamama ve anksiyetede azaltıcı; umut, kimliğinden gurur duyma ve toplulukla bağ kurmada artırıcı etkileri gösterilmiş-tir. Katılımcılar bu modeli azınlık stresiyle başa çıkmada etkili bulduklarını ve önereceklerini belirtmişlerdir.Şefkatli Zihin Eğitimi (Compassionate Mind Training (CMT)) programı, sorunları kronikleşme eğiliminde olan, öz-şefkati ve öz-kabulü zor ve/veya korkutucu bulan, yüksek utanç duygu-su ve benlik eleştirisine sahip kişiler için geliştirilmiş bir grup terapisidir. (Gilbert ve Procter 2006). Sessions ve arkadaşları (2023) CMT’yi, benzer düşünce ve duyguları cinsiyet kimliği azınlık stresi üzerinden deneyimleyen trans+’lara uyarlamış-tır. Bu model sekiz seanstan oluşmaktadır: (1) grup kuralları, şefkat kavramı ve bilinçli farkındalığın ele alınması, (2) trans ayrımcılığı ve damgalanmanın şefkat önündeki engellerinin değerlendirilmesi ve rahatlatıcı nefes ritminin öğretilmesi, (3) şefkat akışının üç boyutunun ele alınması, (4) güvenlik stratejilerinin tartışılması ve bazı tekniklerin (örn., güvenli alan imgeleme) uygulanması, (5) trans ayrımcılığı ve içselleş-tirilmiş transfobiye dair şefkat odaklı egzersiz uygulamaları-nın oluşturulması ve topraklanma tekniğinin aktarılması, (6) üyelerin şefkatli içsel diyalog geliştirmeleri adına yüzleşme, duygu yönetme, içselleştirilmiş damgalanma öyküleriyle başa çıkmanın ele alınması ve şefkatli arkadaş imgelemi uygula-masının yapılması, (7) öz-şefkate ilişkin içsel diyalogları oluş-turmak adına üyelerin kendilerine mektup, diğer üyelere yo-rum yazmaları, (8) şefkati sürdürecek planların geliştirilmesi ve grupça şefkat egzersizinin yapılması. Bu model, 18-73 yaş arasında İngiltere’de yaşayan 10-11 katılımcıyla haftalık ola-rak, çevrimiçi ortamda, iki saatlik seanslar halinde üç terapist-le ve bir süpervizörle yürütülen iki grup terapisi uygulaması üzerinden değerlendirilmiştir. Hem birey hem de grup düze-yinde üyelerin kendilerine ve başkalarına şefkat puanlarında artış gözlemlenmiştir. Ayrıca grup düzeyinde onur hissinde artma ve içselleştirilmiş trans-negatifliğe ilişkin yabancılaşma hissinde azalma görülmüştür. Pipkin ve arkadaşları (2022) bu terapi grubuna katılan altı transla yarı-yapılandırılmış görüş-meler yapmıştır. Katılımcılar bu uygulamanın damgalanma deneyimlerini anlamada faydalı olduğunu, başka translarla bir araya gelmenin birbirlerini karşılaştırma ve incinme korkusu gibi bazı kaygıları artırsa da öz-kabulü olumlu yönde etkiledi-ğini ve her ne kadar çevrimiçi görüşmelerin zorlukları olsa da grubun faydalı olduğunu belirtmişlerdir.Chinsen ve arkadaşları (2024a) trans gençlere yönelik bir grup terapisi modeli geliştirmek amacıyla nitel bir araştırma yürütmüşlerdir. Çevrimiçi üç çalıştaydan oluşan bu araştır-maya, 15-21 yaş arasında Avustralyalı sekiz trans katılmıştır. Katılımcıların trans gençlerle yürütülecek grup terapilerinin yapısı, formatı, amaçları ve müdahale içeriği açısından öne-rilerinde iki tema öne çıkmaktadır. İlki, trans topluluklarla bağ kurma, destekleyici, pozitif ve umut verici terapötik ala-nın oluşturulması ve translar arasındaki çeşitliliğin tanınma-sından oluşan “trans topluluğuyla bağ kurma, pozitiflik ve umut” temasıdır. “Çeşitli deneyim, bakış açıları ve ihtiyaçlara uyum sağlamak” isimli ikinci tema ise katılımı kolaylaştıran erişilebilirlik, esneklik, pozitif grup dinamiği ve hoş karşılan-ma unsurlarını içermektedir. Bu temalar ışığında geliştirilen Azınlık Stresini Azaltmaya Yönelik Trans Ergen Grup Terapisi (Trans Adolescent Group ThErapy for Alleviating Minority stress (TAG TEAM)), trans gençlerin gereksinim ve isteklerini ve cinsiyet kimliği azınlık stresini merkeze alan, bilişsel davranış-çı yaklaşıma dayalı bir grup terapisi modelidir. Altı seanstan oluşan bu uygulamada her hafta bir önceki seansta öğreni-lenler ve ödevler değerlendirilir, seansın temasına ilişkin trans yetişkinlerin videoları izlenir ve bir sonraki seans için ödev-ler açıklanır. İlk seansta (1) grup kuralları, program bilgisi, cinsiyet kimliği azınlık stresi ve BDT’ye giriş yapılır ve bu seans stres giderici bir oyuncağın yapıldığı grup etkinliğiyle sonlanır. Sonraki dört seansta (2) toplulukla olan ilişkiler, (3) ayrımcılık ve reddedilme, (4) içselleştirilmiş damgalanma ve kendini olumlama, (5) hak, eşitlik, görünürlük gibi temalar-dan oluşan onur konuları değerlendirilir; bu konularda üye-leri güçlendirici psikoeğitim ve BDT uygulamaları yapılır. Son seansta (6) “gelecekteki ben”e mektup yazılır, program değerlendirilir, stratejileri günlük hayata katma planlanır ve vedalaşılır. Bir süpervizör, bir terapist ve bir trans akranın ko-laylaştırıcılığıyla yürütülen seansların iki saat sürmesi öneril-mektedir. Chinsen ve arkadaşları (2024b) bu modelin uygu-lanabilirliğinin ve etkilerinin nasıl incelenebileceğine dair bir protokol yayımlamışlardır. Fakat bu modelin etkililiği, henüz herhangi bir ampirik çalışmayla değerlendirilmemiştir.GRUP TERAPİSİ PLANLAMA VE UYGULAMA SÜRECİ Grup Terapisi Kapsamı, Bileşenleri ve SüreciGrup terapisi için AFFIRM modelinin (Austin ve Craig 2015, Craig ve Austin 2016, Austin ve ark. 2018) bir süpervi-zör, iki terapist ve 18-25 yaş arasında, 10 trans+ genç yetişkin üye ile yürütülmesi planlanmıştır. Terapi grubunda, BDT ala-nında eğitimli, deneyimli, cinsiyet kimliği ve CUS alanında klinik deneyime sahip bir psikiyatrist (KB) süpervizör olarak,432 www.turkpsikiyatri.combir psikolojik danışman (KCE) ve bir sosyal hizmet doktora adayı (HP) da terapist olarak görev üstlenmiştir. Terapistler, CUS ile ilgili değerlendirme, izlem ve karar süreçlerinde rol almamaktadır. Grup için kliniğin mekan olanakları kullanıl-mamıştır. Böylece grup terapisi, CUS ile ilgili talep ve işlem-lerle ilişkilendirilmemiştir. Grup terapisine katılım için duyuru metni bir devlet üniver-site hastanesi psikiyatri kliniğine ve iki LGBTİ+ dayanışma derneğine iletilmiştir. İlk başta, başvuru yapan 23 kişiyle tele-fonla görüşülerek birer değerlendirme görüşmesi planlanmış-tır. Adayların sağlık durumları (örn., ruhsal ya da bedensel akut hastalık döneminde olmaması), grup terapisine katılım motivasyonları ve uygunlukları terapistlerce (KCE, HP) gö-rüşmelerde ele alınmış ve süpervizörle (KB) birlikte değer-lendirilerek çalışmaya 10 kişi davet edilmiştir. İki aday hiçbir seansa katılmamıştır.Yasal kayıtlarda cinsiyet değişikliği yapmamış olan sekiz üyeyle ilgili sosyodemografik, CUS ve katılınan oturum sayısı ile ilgili bilgiler Tablo 1’de sunulmuştur. Helsinki ilkelerine bağlı kalınarak toplanan tüm verilerin anonim olarak bilimsel mesleki yayınlar ve meslektaşlar arası paylaşımlarda kullanıl-masıyla ilgili üyelerden bilgilendirilmiş onam alınmıştır.İlk seansa ısınma uygulaması, grup kuralları ve sözleşmesi, ki-şisel ve grup hedeflerinin tanımlanması, üyelere grup terapisi boyunca hislerini ve öğrendiklerini kayıt altına almaları için günlük tutmaları için defter dağıtımı ile başlanmış, BDT ve azınlık stresi kavramları tanıtılmıştır. Bunu takiben, üyelerin günlük yaşamda stres deneyimleri ele alınmıştır. İkinci seansta trans+’lara karşıt tutum ve davranışların stres üzerindeki etki-leri tartışılmıştır. Toplumsal cinsiyetle ilişkili ayrımcılık ideo-lojileri (örn., cisseksizm) ve azınlık stresi kuramı ele alınmış-tır. Sonrasında üyelerin cinsiyet kimliği azınlık stresini yoğun olarak hissettikleri durumları ve bu durumlarla başa çıkma, mücadele etme stratejilerini tanımlamaları istenerek bu se-ans sonlandırılmıştır. Üçüncü seansta ABC modeli üzerinden düşüncelerin duygu ve davranışları nasıl etkilediği ele alınmış-tır. İlk olarak düşünce ve duygu ayrımına ilişkin psikoeğitim temelli bir uygulama yapılmıştır. Seansın ikinci oturumunda ele alınan durumlar üzerinden olumsuz düşünce kayıt formu uygulaması yapılmıştır. Grup üyelerini cinsiyet kimlikleri ne-deniyle strese sokan durumlara ilişkin düşünce-duygu-davra-nış kayıtlarından örnekler Tablo 2’de sunulmuştur.Dördüncü ve beşinci seanslar, düşünceleri kullanarak duygu-sal deneyimleri değiştirmek üzerinedir. Bunun için düşünce kayıt formu üzerinden bilişsel çarpıtmalar, bilişsel yeniden yapılandırma tekniği üzerinden de alternatif düşünceler ele alınmıştır. Altıncı seansta davranışsal alternatifler değerlen-dirilmiştir. Bu seansta üyelerden kendilerini iyi hissettiren, kimlik olumlayıcı ve destekleyici davranışlardan bahsetmeleri istenmiştir. Bu noktada topluluk ilişkilerinin önemi ve bil-giye erişim kaynakları değerlendirilmiştir. Ardından, cinsiyet kimliği azınlık stresiyle ilişkili durumlarda olumlu hissettire-cek alternatif davranışlar üzerine bir uygulama yapılmıştır. Yedinci seansta, zarar veren düşünce ve olumsuz duygularla başa çıkmak adına BDT tekniklerinden nefes egzersizleri ve trafik ışıkları teknikleri öğretilmiştir. Sonrasında ise cinsiyet kimliği azınlık stresini azaltacak, daha iyi hissettirecek yaşam koşulları için kişisel güçlü özellikler üzerinden kısa, orta ve uzun dönem hedefler tanımlanmıştır. Son seansa, üyelerin haklarını savunma becerilerini geliş-tirmek adına, öz-savunuculuk üzerine bir eğitimle başlanıl-mıştır. Ek olarak, iyi hissettirecek sosyal destek sistemlerini keşfetmeleri için bir uygulama yapılmıştır. Bir aradan sonra sonlanım oturumu gerçekleştirilmiştir. Bu oturumda, grubun sonlanmasına ilişkin duygular, birey ve grup hedeflerinin ne ölçüde gerçekleştiği, kişisel kazanımlar, grup terapisinin uy-gulanmasına ilişkin değerlendirmeler yapılmıştır. Grup tera-pisi sonlandıktan 10 hafta sonra çevrimiçi ortamda her biri 20 dakika süren bireysel izlem görüşmelerine altı üye katılmıştır.Tablo 1. Katılımcıların Sosyodemografik, Cinsiyet Uyum Süreci ve Katıldıkları Oturum Sayısına İlişkin BilgileriÜyeYaş Cinsiyet KimliğiDAC Eğitim Meslek Seçilmiş İsim KullanımıHormon Terapisi*Cerrahiİşlem*Katılınan Oturum SayısıÜ1 19 Trans erkekK Lise Serbest meslek Evet Hayır Hayır 8Ü2 21 Trans erkekK Lise Üniversite öğrencisi Evet Hayır Hayır 6Ü3 25 Trans erkekK Üniversite Öğretmen Evet Hayır Hayır 4Ü4 24 Trans kadınE Lise Üniversite öğrencisi Evet Hayır Hayır 8Ü5 20 Trans erkekK Lise Eğitmen Evet Hayır Hayır 8Ü6 19 Non-binary K Lise Çalışmıyor Evet Hayır Hayır 8Ü7 22 Trans erkekK Lise Üniversite öğrencisi Evet Evet Evet 5Ü8 21 Trans erkekK Lise Üniversite öğrencisi Evet Hayır Hayır 4DAC: Doğumda atanan cinsiyet; K: Kadın; E: Erkek*Cinsiyet uyum sürecine ilişkin433 www.turkpsikiyatri.comSeanslar, 25 Mayıs–20 Temmuz 2023 tarihleri arasında hafta-da bir (Perşembe günleri), 18.30–20.30 saatlerinde yapılmış-tır. Her seans 10 dakika arayla gerçekleştirilen iki oturumla gerçekleştirilmiştir. Seanslara üyelerin o haftayla ilgili değer-lendirmeleri (duygu, düşünce, deneyim paylaşımları) ve bir önceki seansın gözden geçirilmesi ile başlanılmıştır. Seanslar, seansın özetlenmesi ve üyelerin seans hakkındaki değerlendir-meleri alınarak sonlandırılmıştır. Ortalama 120 dakika süren süpervizyonlar, her seansın ardından yüz yüze ya da çevrimi-çi gerçekleştirilmiştir. Süpervizyonlarda seansa ilişkin içerik, terapötik uygulamalar gözden geçirilmiş, üyeler ve bütün grupla ilgili değerlendirmeler yapılmış ve bir sonraki seans planlanmıştır.Grup terapisi sürecinin analizi, süpervizör ve terapistlerin ortak değerlendirmeleriyle yapılmıştır. Bu değerlendirme-ler terapistlerin seans notları, gözlemleri ve üyelere uygula-nan özbildirime dayalı araçlara (bkz. Ekler) dayanmaktadır. Üyelerin ilk, son ve izlem seanslarındaki bireysel özbildirim ölçek puanları Ek Şekil 1’de, grup ortancaları Ek Tablo 1’de sunulmuştur. Grup Terapisine İlişkin Bulgularİlk kez akran topluluğuyla, yani başka trans+’larla, tera-pi grubunda bir araya gelen Ü1, gruba sıklıkla bedeninden hoşnutsuzluğu, aile ilişkileri ve tıbbi uyum sürecine ilişkin konuları açmıştır. Başlarda kendini gruba açma konusunda daha çekimserken; giderek daha fazla katılım gösterdiği göz-lemlenmiştir. “Yeterince erkek” olmama düşünceleriyle başa çıkmaya çalışan Ü1’in bu nedenle bazı isteklerini (örn., ro-mantik ilişki kurmak, spora gitmek, üniversiteye başlamak) ertelediği görülmüştür. Grup terapisine katılmanın kişisel ve ilişkisel düzeylerde Ü1’i güçlendirdiği gözlemlenmiştir. İzlem görüşmesinde terapi grubuna katıldıktan sonra özgüveninin arttığını (“İlk topluluk deneyimim sayesinde kendimi daha özgüvenli ve bilgili görüyorum.”), stres altında “sorunun be-nim translığım olmadığına odaklanıyorum” diye düşünerek öz-düzenlemeye yönelik nefes egzersizlerini kullanmaya de-vam ettiğini, grup üyeleriyle CUS ile ilgili tıbbi işlemler konu-sunda yardımlaştığı ve terapi grubunda ertelediğini belirttiği spor salonuna yazılma hedefini gerçekleştirdiğini bildirmiştir.“Kimsenin onu anlayamayacağı” düşüncesiyle kendini yakın sosyal çevresine ve bir terapiste açmaktan kaçınan, bu neden-le yapay zeka araçlarıyla konuşarak psikolojik destek almaya çalışan Ü2 için bu terapi grubu, başkalarına kendini açma ko-nusunda yeni bir deneyimdi. Terapi grubundan tıbbi uyum sürecine ilişkin bilgi edinmeyi ve başka translarla bir araya gelmeyi bekliyordu. Bu gruba katılmanın ve cinsiyet kimliği azınlık stresine ilişkin geliştirdiği içgörülerin gelecek umudu, özgüven ve öz-savunuculuk becerisini geliştirdiği gözlemlen-miştir. Bir oturumda isim değişikliği süreciyle ilgili kaygı ya-şadığını belirtirken, izlem görüşmesinde terapi grubuna ka-tıldıktan sonra üniversitedeki hocalarıyla kendisine atanmış ismiyle seslenmemeleri için konuşabildiğini, CUS için tıbbi ve yasal süreçleri başlattığını, stres altında nefes egzersizlerini kullanmaya devam ettiğini ve grup üyelerinden Ü1’in deste-ği ile terapi grubunda “orta vadeli hedef” olarak tanımladığı mastektomi ameliyatı olduğunu aktarmıştır.Sosyal anksiyete bozukluğu tanısı olan Ü3, grup süreciyle daha iyi hissetmeyi beklemekteydi. Gruba aile, beden imgesi, yanlış cinsiyetlendirilmek ve çoğunlukla işyerinde gizlenmeye ilişkin deneyimlediği stresi açmıştır. Gruba kendini en az açan üyeydi. İzlem görüşmesinde terapi grubuna katıldıktan sonra şehir ve iş değiştirdiğini, azınlık stresine ilişkin farkındalığının arttığını, alternatif düşünce uygulamalarına ve trans daya-nışma derneklerinin etkinliklerine katılmaya devam ettiğini Tablo 2. Üyeleri Cinsiyet Kimliği Azınlık Stresine Sokan Durumlara İlişkin Düşünce-Duygu-Davranış Kayıtlarından ÖrneklerÜyeDurum Düşünce Duygu (Derecesi)DavranışÜ1Vücutta doğumda atanan cinsiyete ilişkin bölgelerin belli olması“Çevreme doğumda atanan cinsiyetteki gibi görüneceğim.”Üzüntü (%70) Göğüs korsesi kullanmak ya da bedeni gizleyecek kıyafetler giymekÜ2Otobüste biniş kartı okuturken cihazın kadın sesi çıkarması“Şoför beni anlamayacak ve onunla tartışacağım.”Öfke (%80) Cihazın sesini bastırmak için öksürerek kart okutmakÜ3Kamusal alanda başkalarının yanlış cinsiyetlendirerek konuşması“Görüntüm sebebiyle erkek olduğumu söylemem başkalarınca sahtekarca bulunacak.”Kaygı (%80) Kimseyle konuşmamakÜ4Romantik ilişkilerde partnerin cinsiyeti sorgulaması“Asla tam olarak sevilmeyeceğim, kabul görmeyeceğim.”Utanç (%100) Partnerle yakın ilişki kurmaktan kaçınmakÜ5Kamusal alandaki tuvaletleri kullanmak“Başıma kötü bir şey gelecek.”Korku (%100) Tuvalettekilerle göz göze gelmemek için sürekli yere bakmakÜ6Ailenin doğumda atanan cinsiyet rollerini gerçekleştirmeye zorlaması“Ailemin beni anlamayacağını kabul etmeliyim.”Üzüntü (%80) Aileden uzaklaşmakÜ7Regl olmak “Doğumda atanan cinsiyetimden hiçbir zaman kurtulamayacağım.”İğrenme (%100)Sigara içmekÜ8Mağazadan cinsiyetine uygun kıyafet satın almak“Mağazadaki herkes bana bakacak.”Gergin (%100)Kimseyle göz teması kurmamak434 www.turkpsikiyatri.combildirmiştir. Cinsiyet kimliği azınlık stresinin konuşulduğu seanslarda tuvalet kullanımına ilişkin kaygılarından bahse-den üye, yeni taşındığı şehirde ve iş yerindeki erkek tuvaletini kullanmaya başladığını belirtmiştir. CUS’ne taşındığı şehirde devam etmektedir.Ü4 grupla genellikle aile, romantik ilişki ve beden imgesine ilişkin konuları paylaşmıştır. İlk haftalarda cinsiyet kimliği azınlık stresine ilişkin farkındalığın Ü4’te ümitsizlik, öfke oluşturduğu gözlemlense de son haftalara doğru bu strese iliş-kin içgörünün kendisinde umut ve meydan okuyan bir tavır geliştirdiği gözlemlenmiştir. Terapi grubundaki tek trans ka-dın olan Ü4, bu konuda kendini yalnız hissettiğini ve gruba kişisel deneyimlerini, özellikle bedenine ilişkin hislerini ak-tarırken grubu rahatsız etme düşüncelerinin ortaya çıktığını dile getirmiştir. Grup terapisinin kendisini daha özgüvenli, desteklenmiş hissettirdiğini ve bedenine dair daha olumlu bir bakış açısı kazandırdığını bildirmiştir. İzlem görüşmesinde terapi grubuna katıldıktan sonra alternatif düşünce uygula-malarına ve stres altındayken nefes egzersizlerini kullanmaya devam ettiğini aktarmıştır. Seanslarda “Kendi başıma kaldı-ğımda hayatımda hiçbir şey değiştirmek istemediğimi fark ettim. Anlamlı ilişkiler kurmak istiyorum.” diye belirten üye, izlem görüşmesinde trans dayanışma derneklerinin etkinlikle-rine katılmaya ve sosyal destek mekanizmalarını geliştirmeye devam ettiğini ifade etmiştir. “Kendi hedeflerim yolunda daha çok ilerledim. Kendi yolculuğumda bu hedeflere ulaşmak bir anda olmayacak, ancak azınlık stresine ilişkin becerilerle ilgili teknik temelleri attım diye düşünüyorum.” demiştir.Göçmen bir trans erkek olan Ü5, terapi grubuna genellikle cinsiyet kimliğine ilişkin sorgulamalarını, annesi ve toplu-lukla olan ilişkisini açmıştır. Gruba katılmak ona iyi gelse de depresyon tanısı ve ilaç kullanımı, annenin cinsiyetçi baskıları ve toplulukta ırkının ve cinsiyet kimliğinin kapsanmadığına ilişkin yetersizlik düşünceleri (“yeterince trans olamamak”) hakkında gruba açılmanın ve gruptaki cinsiyet kimliği azınlık stresi temelli travmatik deneyimleri duymanın etkisiyle dep-resyon ve kaygı belirtilerinin arttığı gözlemlenmiştir. Grup içinde deneyimlediği olumsuz duyguları da dışa vurmaktan kaçınma eğilimi yüksekti. Terapi grubuna katılmayı “daha mutlu, heyecanlı ve nefes almış hissediyorum” şeklinde ta-nımlayan Ü5’in, cinsiyet kimliği azınlık stresine ilişkin artan farkındalığı ve grup terapisinde kurduğu sosyal ilişkiler üze-rinden kişisel ve ilişkisel ölçekte güçlendiği söylenebilir. Ön görüşmede bu terapi grubuna katılma amacını “Translığımla ve kendi içimde barışık olmadığım özelliklerle barışmak isti-yorum.” şeklinde ifade eden üye, izlem görüşmesinde terapi grubuna katıldıktan sonra içselleştirdiği transfobiyi artık aş-tığını, sosyal çevresiyle daha sağlıklı iletişim kurabildiğini ve trans dayanışma derneklerinin etkinliklerine katılmaya devam ettiğini bildirmiştir.Gruptaki tek non-binary olan (erkek/kadın ikiliği dışında cin-siyetini tanımlayan) Ü6, cinsiyet kimliğine ilişkin farkındalık kazanma ve başka trans+’larla bir araya gelme amacıyla terapi grubuna katılmıştır. Dikkat eksikliği ve hiperaktivite ve sos-yal anksiyete bozukluğu tanıları olan, her hafta psikiyatrına uğradıktan sonra terapi saatinden oldukça çok erken bir sa-atte ofise gelen Ü6, kullandığı ilaçlar nedeniyle bazen gruba dikkatini vermekte zorlandığını dile getirmiştir. Genellikle ai-lesiyle ilişkilerini gruba açan Ü6, grupta paylaşılan kişisel de-neyimleri anlamakta zorlandığını sıklıkla dile getirmesi, diğer üyelerle ilişkilerini etkilemiştir. Seans aralarında ve sonrasında diğer üyeler birbirleriyle yakın ilişkiler geliştirirken, Ü6’nın genellikle tek başına vakit geçirdiği gözlemlenmiştir. Ü6’nın kendini açma, alternatif düşünce ve davranışları ele almada direnç gösteren bir üye olduğu söylenebilir. İzlem görüşme-sinde terapi grubuna katıldıktan sonra cinsiyet kimliğine ilişkin farkındalığının arttığını, başka bir eve taşınma ve üni-versite sınavına hazırlanma planını uygulamaya geçirdiğini, stres altındayken nefes egzersizlerini kullanmaya ve trans da-yanışma derneklerinin etkinliklerine katılmaya devam ettiğini söylemiştir. Grup terapisinin özellikle sosyalleşme becerilerini olumlu etkilediğini ifade etmiştir.Gruptaki trans+ haklarıyla ilgili mücadele eden oluşumlar-da etkin görev alan tek kişi olan Ü7, grupla genellikle CUS ve aktivizm etkinliklerine ilişkin deneyimlerini paylaşmıştır. Kişisel deneyimlerini genelleme ve entelektüelize etme eğilimi içerisinde olan Ü7’nin aktivizm ve mücadelenin psikososyal güçlendirici etkilerini göstermek adına gruba katkıları olmuş-tur. Özellikle beden hoşnutsuzluğu, dışlanma deneyimleriyle alkol ve sigara kullanarak başa çıkmaya çalışan Ü7, özkıyım düşüncelerini de gruba açmıştır. Terapi grubuna katılmanın etkisiyle “yer kaplamaya hakkım var gibi hissediyorum” diyen Ü7’nin cinsiyet kimliği azınlık stresine ilişkin farkındalığın özgüvenine olumlu etkileri olduğu gözlemlenmiştir. Son de-ğerlendirme ve izlem çalışmalarına katılmamıştır. Açılma sürecinin başında olan, terapi grubundan beklentisi-nin aileye açılma ve tıbbi uyum sürecine ilişkin hislerini pay-laşma ve başkalarının deneyimlerinden bu konuda bir şeyler öğrenme olduğunu aktaran Ü8, gruba genellikle romantik ilişkisinde kendisini “yeterince erkek” hissetmeme ve beden hoşnutsuzluğu konularını açmıştır. İlk dört seansa katılmış-tır ve sonrasında gruptan ayrılmıştır. Bu durum grupta ele alındığında diğer üyeler merak, endişe, üzüntü içinde geride kalmış ve eksik hissettiklerini belirtmişlerdir. Kendisine tera-pistlerce ulaşılamamış, grup sürecinden sonra ailevi ve ekono-mik nedenlerle şehirden ayrıldığı öğrenilmiştir. Grup düzeyinde süreci değerlendirmek gerekirse; terapi gru-bunun, üyelerce tanımlanan beklentiler (sosyalleşmek, yeni arkadaşlıklar kurmak ve dayanışma ilişkileri geliştirmek, kişi ve grup deneyimlerinden öğrenmek, cinsiyet kimlikleri hak-kında farkındalık kazanmak, cinsiyet kimliğine bağlı olarak deneyimlenen psikososyal sorunlar hakkında başa çıkma ve öz-savunuculuk becerileri kazanmak) üzerinde olumlu yönde etkileri olduğu gözlemlenmiştir. BDT uygulamaları435 www.turkpsikiyatri.comçerçevesinde grup için genel bir değerlendirme yapmak ge-rekirse; seanslarda üyeleri cinsiyet kimliklerinden ötürü strese sokan durumlarda beliren otomatik düşüncelerin kusurluluk (örn., beğenilmeyen fiziksel özellikler), değersizlik (örn., yete-rince trans olamamak) ve duygusal yoksunluk (örn., sevilme-yeceğine dair güçlü inanç) şemaları ile ilişkili olduğu görül-mektedir. Bu otomatik düşüncelerin cinsiyet kimliği azınlık stresinin iç ve dış kaynaklarla olan ilişkisi üzerine verilen psi-koeğitim temelli uygulamalar ile üyelerde bu düşüncelere şe-kil veren baskı ve ayrımcılık temelli toplumsal yapılar hakkın-da farkındalık oluşturulmaya çalışılmıştır. Böylelikle üyeler, bu tür düşüncelerin toplumsal yapılarla olan bağını kurmaya başlayabilmişlerdir. Farkındalık temelli bu bağ ile üyelerin cinsiyet kimliği azınlık stresiyle başa çıkmalarını sağlayacak alternatif düşünceler (örn., “seçilmiş ailemi kurabilirim ve bu ailede kabul, sevgi görebilirim”, “kötü bir şey olduğunda kendimi savunabilirim”, “cinsiyet kimliğime dair toplumdan ve topluluğumdan farklı, kendime özgü normlarım olabilir”) geliştirdikleri gözlemlenmiştir.Ayrıca üyelerin birbirleri ve toplulukla bağ kurmaları ve her konuda birbirlerine destek olmalarıyla ilişkili dayanışma iliş-kileri geliştirdikleri gözlemlenmiştir. Yani üyeler terapi gru-buna katılarak kendilerini güçsüz kılan, baskılayan, güvensiz bir sosyal çevreden mikro ölçekte güçlenmelerini sağlayan, kabul gördüğü, desteklendiği, güvenli bir sosyal çevre dene-yimlemişlerdir. Terapi sürecinde ve sonrasında üyelerin hem birbirleriyle hem de toplulukla daha güçlü ilişkiler geliştir-dikleri gözlemlenmiştir. Terapi seansları araları ve sonrasında birbirleriyle sosyalleştikleri ve ihtiyaç duydukları konularda birbirlerine destek oldukları görülmüştür. Örneğin, Ü3, Ü4, Ü5 ve Ü7 trans+’larla ilişki içinde olan, dayanışma dernekleri-nin faaliyetlerini yakından takip eden üyelerdi. Ü1, Ü2 ve Ü6 ise dijital olmayan ortamlarda, yüz yüze başka trans+’larla ilk defa bu grup terapisi programı ile bir araya gelmişlerdi. Terapi sürecinde üyelerin, birbirlerini dijital ve yüz yüze ortamlarda-ki sosyal çevrelerine dahil etmeye çalıştıkları gözlemlenmiştir. Örneğin, Ü1 diğer üyelere bir trans yardımlaşma WhatsApp grubundan bahsederek üyelerin bu gruba dahil olmalarını sağlamıştır.Grubun büyüklüğü istatistiksel karşılaştırmaya olanak verme-se de terapi sürecinde aidiyet, umut, sosyal destek kullanımı ve planlama ile ilgili gelişme olduğu, bu değişimin izlemde de kısmen korunduğu söylenebilir (Ek Şekil 1 ve Ek Tablo 1). Klinik düzeyde olmayan depresyon, anksiyete ve stres belirti düzeyleri ise çok heterojen seyretmiştir. Grup terapisinin et-kileriyle ilişkili olduğu öne sürülen bileşenler (Tasca ve ark. 2016), sonlanım oturumunda ele alınmış, grup üyelerinin grubu sosyal öğrenme, güvenli duygusal ifade, umut aşılama ve ilişkisel etki açısından genel olarak etkili buldukları anla-şılmıştır. Grubun uygulama sürecinde bir bütünlük geliştir-diği söylenebilir. Fakat trans erkek üyeler arasında daha fazla yakınlık, dayanışma ilişkileri gözlemlenirken; trans kadın ve non-binary üyeler, grup içinde geri durma örüntüleri gös-termişlerdir. İzlem görüşmelerinde, terapi grubunda tanışıp yakınlık ilişkisi kuran bazı üyeler arasında bu ilişkilerin hala devam ettiği, hatta geliştiği görülmüştür. Terapistler, grup terapisinin tüm aşamalarında (üyelerin belirlenmesi, grup terapisinin uygulanması, izlem) trans+ olumlayıcı bir perspektiften üyelerle ilişki kurmuşlardır. Bu durumun üyelerle terapistler arasında güven ilişkisinin kurul-masında önemli etkileri olduğu söylenebilir. Grubun sonla-nım aşaması ve izlem çalışmalarında da üyelerden bu konuda olumlu geribildirimler alınmıştır. Ayrıca, terapistlerin cinsiyet kimliklerinin üyelerce süreci nasıl etkilediği de ele alınmış-tır. Üyeler, trans olmadığını varsaydıkları terapistlerce başta anlaşılmama düşünceleri geliştirdiklerini ama süreç içerisinde bu düşüncelerinin olumlu yönde değiştiğini bildirmişlerdir. Diğer taraftan, cinsiyet kimliği azınlık stresine ilişkin farkın-dalığın oluşturduğu olumsuz hislerin (örn., öfke, ümitsizlik), terapistlere ve terapi grubuna yansıtıldığı durumlar da (örn., BDT uygulamalarını yapmak istememek, kendini ifade et-mekten kaçınmak) yaşanmıştır. Bu durumlar, terapistlerce empatik yansıtma yoluyla ele alınmıştır. TARTIŞMAYaşanan sorunlarda yalnız olmadığını görmek, uygun başa çıkma yolları geliştirmek, birbirlerine rol model oluşturmak ve sosyal destek almak adına grup düzeyindeki müdahaleler, trans+’ların psikososyal açıdan güçlenmelerinde oldukça et-kili bir uygulamadır (Pak ve Cankurtaran, 2024). Bu yazıda, cinsiyet kimliği azınlık stresine yönelik geliştirilen grup tera-pisi modellerine ilişkin alanyazın sistematik bir yaklaşımla de-ğerlendirilmiştir. Bu terapi modellerinin 10 yıl kadar oldukça yeni bir geçmişe sahip olduğu, Anglosakson ülkelerde geliş-tirildiği ve değerlendirildiği görülmektedir. Modellerin çoğu bilişsel ve davranışçı yaklaşıma dayanmaktadır. Katılımcılara göre çevrimiçine kıyasla yüz yüze uygulamalar daha faydalı bulunmaktadır. Bu modellerin etkilerinin değerlendirildi-ği çalışmalar ise cinsiyet kimliği azınlık stresine dair oluşan farkındalıkla olumlu yönde seyreden düşünce ve davranış de-ğişikliklerinin trans+’larda psikososyal açıdan tedavi edici et-kileri olduğunu göstermektedir. Ayrıca ilgili alanyazında, her ne kadar cinsiyet kimliği azınlık stresine yönelik olmasa da trans-olumlayıcı bir yaklaşımla Gestalt (Kolmannskog 2014) ve pozitif psikoloji (Hernandez 2021) gibi farklı ekollerden grup terapisi uygulamaları da bulunmaktadır. Ayrıca bu yazıda, cinsiyet kimliği azınlık stresine yönelik olumlayıcı bilişsel davranışçı grup terapisine katılan sekiz üyenin süreci sunulmuştur. Terapi grubuna katılan üyelerin farkındalık, dayanışma ve öz-düzenleme temelli bilişsel ve davranışsal beceriler geliştirerek psikososyal açıdan güçlen-dikleri gözlemlenmiştir. Bu konuya ek olarak üyeler, terapi sürecinde aidiyet, umut, sosyal destek kullanımı ve planlama436 www.turkpsikiyatri.comile ilgili ilerleme kazanmışlardır. Bu grup terapisinde gözlem-lenen gelişmelerin alanyazında azınlık stresiyle başa çıkmada sosyal destek (Meyer 2003), umut (Meyer 2003, Moe ve ark. 2023), topluluğa aidiyet (Barr ve ark. 2016), kabul ve bece-ri kazanmanın (Craig ve Austin 2016, Austin ve ark. 2018) önemini desteklemektedir. Bu nedenle klinik uygulamalarda trans+’larla çalışırken, bireysel terapilere ek olarak cinsiyet kimliği azınlık stresini temel alan olumlayıcı grup terapile-rinin yürütülmesinin etkili bir yaklaşım olacağı söylenebilir. Öncül olarak kabul edilebilecek bu uygulama denemesi üze-rine, geribildirimlerle geliştirilecek grup terapisi modelleri-nin etkinliğinin daha büyük örneklemlerle sınanması uygun olacaktır. Bu çalışmadan elde edilen dikkat çekici bir göz-lem, katılımcıların günlük yaşamlarındaki önemli değişim-lerin terapi sürerken olduğundan daha çok terapiyi izleyen erken dönemde gerçekleştiğidir. Müdahalenin etkililiğini değerlendiren gelecek çalışmalarda, uygulamanın tamam-lanmasından bir süre sonra gerçekleştirilecek izlem (takip) değerlendirmesini sonuç ölçümlerine dahil etmek gereklidir. Diğer taraftan, gruba katılan bazı üyeler, BDT yaklaşımı-nın etkili olduğuna inanırken, bazıları bu yaklaşıma ilişkin uygulamaların fazla birey merkezli ilerleyebildiğini ve bu nedenle grup etkileşimlerinin daha sınırlı olabildiğini bil-dirmiştir. Bu geribildirim ve süpervizyon görüşmeleri çer-çevesinde, bilişsel davranışçı grup terapilerinde grup üyele-rinin ortak deneyimlediği durumların (örn., kamusal alanda tuvalete girmek) belirlenmesinin ve uygulamaların bu ortak durumlar çerçevesinde yapılmasının grup terapisinin etkili-liğini arttıracağına inanılmaktadır. Buna ek olarak, yukarıda da bahsedildiği üzere, bazı üyeler grup içerisinde kendileri-ni yalnız hissetmişlerdir. Bu nedenle, grup yapısındaki üye çeşitliliğine de dikkat edilmelidir. Hem terapistler hem de grup üyeleri, 120 dakikalık seansların yeterli olmadığını dü-şünmüşlerdir. Üye geribildirimleri ve süpervizyon değerlen-dirmeleri ışığında seansların 150-180 dakika arasında yürü-tülmesi önerilebilir. BDT uygulamalarının odağında bilişsel yeniden yapılandır-ma yer almaktadır. Yani işlevsel olmayan, hatalı otomatik düşüncelere dair kanıt ve alternatifler ele alınarak danışanın sorununa ilişkin bakış açısı yeniden şekillendirilmeye ve böy-lelikle duygusal ve davranışsal değişikliklere ulaşılmaya çalı-şılır. Trans+’larla cinsiyet kimliği azınlık stresinin iç kaynak-ları üzerine (örn., “ben hastayım”, “kimse beni sevmeyecek” gibi içselleştirilmiş transfobiye ilişkin düşüncelerle) çalışırken bu tür bilişsel yeniden yapılandırma teknikleri uygulanabi-lir. Fakat trans+’ların dış kaynaklarla ilişkili belirli durum/olaylar karşısında geliştirdikleri otomatik düşüncelerin (örn., “başıma kötü bir şey gelecek”) gerçeklik payı olabilmektedir. Terapistler, böyle durumları ele alırken zarar veren düşün-ce ve olumsuz duygularla başa çıkmak için uygulanabilecek tekniklere (örn., nefes egzersizleri ve trafik ışıkları teknikleri) ve sosyal bağlamla ilgili dayanıklılığı arttıracak dayanışma ve destek mekanizmalarını da içeren davranışsal alternatiflere (örn., güvenli ortamlarda vakit geçirmek, toplulukla ilişki-leri güçlendirmek, öz-savunuculuk becerilerini geliştirmek) odaklanmalıdır.SONUÇSistematik bir yaklaşımla cinsiyet kimliği azınlık stresine yöne-lik grup terapileriyle ilgili araştırma bulguları ve bu yöntemin kullanıldığı uygulama örneği, cinsiyet kimliği azınlık stresine odağına bilişsel davranışçı grup terapilerinin trans+’lar üze-rinde olumlu yönde etkileri olduğuna işaret etmektedir. 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J Sex Med 19: 650-60. Williams DR, Yu Y, Jackson JS ve ark. (1997) Racial differences in physical and mental health: socioeconomic status, stress, and discrimination. J Health Psychol 2: 335–51. Yi M, Li X, Chiaramonte D ve ark. (2024) Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: a randomized controlled trial among sexual minority men in China. Behav Res Ther 181:104605.Yüksel Ş, Kulaksizoğlu IB, Türksoy N ve ark. (2000). Group psychotherapy with female-to-male transsexuals in Turkey. Arch Sex Behav 29: 279–90. Cinsiyet Kimliği Azınlık Stresine Yönelik Grup Terapileri: Sistematik Gözden Geçirme ve Olumlayıcı Bilişsel Davranışçı Grup Terapi Süreci Sunumu 427 439 10.5080/u27670 EN TR Koray BAŞAR Halil PAK K. Can EREN Journal Article Review 1425 10.5080/u27670 Gender minority stress refers to the form of stress experienced by individuals who identify as trans or within the spectrum of gender diversity due to discriminatory discourses and actions in society. This type of stress can negatively affect both mental and physical health and may even result in the loss of one’s most fundamental right—the right to life. Therefore, it is crucial for professionals to remain sensitive to gender minority stress when working clinically with this population. This article aims to raise awareness among mental health professionals about gender minority stress and to provide a practical example of an intervention in this area. To this end, group therapy models addressing gender minority stress were reviewed through a systematic literature search. In addition, the experiences of eight individuals who participated in a group therapy designed and facilitated by the authors using an affirmative cognitive behavioral approach were shared. The findings indicate that the most prominent intervention models in the literature targeting gender minority stress are based on cognitive behavioral group therapy. 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Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Effect of Repetitive Transcranial Magnetic Stimulation on Neurocognitive Functions in Moderate and Severe Depression: A Follow-up Study Orta ve Şiddetli Depresyonda Tekrarlayıcı Transkranial Manyetik Stimülasyonun Nörobilişsel Fonksiyonlara Etkisi: Bir İzlem Çalışması 47 47 10.5080/u27539 EN TR Gökçe KAVAK SİNANOĞLU Özkan GÜLER Zeynep ÇALIŞ Journal Article 1426 10.5080/u27539 Objective: We aimed to investigate the effects of transcranial magnetic stimulation (TMS) on depressive symptoms and neurocognitive functions during treatment and follow-up. Methods: A total of 65 patients diagnosed with major depressive disorder, with a >16 scores in Hamilton Depression Rating Scale (Ham-D) and a >18 scores in Beck Depression Inventory (BDI), participated in the study. The Ham-D, BDI, Beck Anxiety Inventory (BAI), Trail Making Tests A and B, Stroop Colour and Word Test, Number Sequence Test, Öktem Verbal Memory Processes Test, and Verbal Fluency Test were administered at baseline, 1st-, and 3rd-month for both treatment and control groups. Results: A total of 65 patients were enrolled in the study, of whom 25 in the TMS group and 26 in the non-TMS group completed the followup. At the first month, 73.5% of patients in the TMS group showed a full treatment response, compared to 29.03% in the non-TMS group (p=0.001). At the third month, the treatment response rate decreased to 40% in the TMS group, whereas it was 42.3% in the non-TMS group, and the significant difference between the groups disappeared (p=0.918). In terms of cognitive functions, no significant changes were observed in either group at the first- and third-month follow-ups compared to baseline. Conclusion: TMS had a strong acute antidepressant effect; however, this effect diminished over time during the follow-up period. Although partial improvement was observed in cognitive functions, this improvement did not reach statistical significance. Keywords: Cognitive functions, major depressive disorder, transcranial magnetic stimulation

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Turkish Adaptation of the Revised Version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R): A Validity and Reliability Study Psikosomatik Araştırmalar için Tanı Kriterleri Revize Formunun (PATK-R) Türkçeye Uyarlaması: Bir Geçerlilik ve Güvenilirlik Çalışması 48 48 10.5080/u27635 EN TR Muhammed Hakan AKSU Damla ERBİL İrem EKMEKÇİ ERTEK Buket KOPARAL Doğa YÖNTEM AYKURT İhsan YELLİ Fatma YAPRAK Gökçenur ŞİMŞEK AVCI Çağatay Haşim YURTSEVEN Meltem ÇINAR BOZDAĞ Bahadır GENİŞ Behcet COŞAR Ömer AYDEMİR Journal Article 1427 10.5080/u27635 Objective: This study aimed to adapt the Diagnostic Criteria for Psychosomatic Research-Revised Semi-Structured Interview (DCPR-R-SSI) into Turkish and assess its psychometric properties. Method: This study was conducted with two separate samples of patients diagnosed with psychosomatic disorders between the ages of 18-65 at Gazi University Psychiatry Clinic. For inter-rater reliability analysis, a sample of 100 participants was evaluated by two raters and kappa coefficient was calculated. Validity analysis used samples from both patient and community groups. For criterion validity, the relationship between DCPR diagnoses and the Hospital Anxiety Depression Scale (HADS), Patient Health Questionnaire 15 (PHQ- 15), Health Anxiety Inventory (HAI) and Toronto Alexithymia Scale (TAS) was analyzed with the Point Biserial Correlation Coefficient. The distribution of DCPR diagnoses in the community and hospital samples was analyzed. Results: The mean age of the sample for inter-rater reliability analysis was 33.5±13.0 years and 55% were female. Kappa values for 14 DCPR-R diagnoses were between 0.823-0.964. The hospital and community samples included 110 people from the community and 100 from the hospital. In the validity analyses, Allostatic Overload showed a significant relationship with HADS-Depression, HADS-Anxiety, PHQ-15 and HAI. Demoralization and Demoralization with Hopelessness showed a significant relationship with all scales. Type A Behavior was weakly correlated with all scales, whereas Alexithymia was strongly correlated with the TAS. The five most common DCPR-R diagnoses were Allostatic Overload (55.2%), Demoralization (36.1%), Alexithymia (29.0%), Type A Behavior (27.6%), Irritable Mood (15.7%), Persistent Somatization (11.9%) and Health Anxiety (10.9%). Conclusion: This study demonstrated that the Turkish version of DCPR-R is a valid and reliable measurement tool. Keywords: Alexithymia, consultation liason psychiatry, conversion, health anxiety, psychosomatic medicine, somatization

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Cognitive and Metacognitive Determinants of Psychopathology in Individuals with Physical Disabilities: A Comparative Study with a Healthy Control Group Bedensel Engelli Bireylerde Psikopatolojinin Bilişsel ve Üstbilişsel Belirleyicileri: Sağlıklı Kontrol Grubuyla Karşılaştırmalı Bir Çalışma 49 49 10.5080/u27562 EN TR Sare AYDIN İlker GÜNEYSU Burcu ESER Journal Article 1428 10.5080/u27562 Objective: Disability extends beyond physical limitations, impacting individuals’ mental health and psychosocial adjustment. This study aimed to investigate the underlying cognitive and metacognitive processes contributing to psychopathological symptoms in individuals with physical disabilities. Method: We included 164 individuals with physical disabilities and 149 healthy controls. Psychopathology was measured using the 21 item Depression, Anxiety, and Stress Scale (DASS21). Cognitive and metacognitive processes were assessed using the Negative Core Beliefs Inventory (NCBI), Cognitive and Behavioural Processes Questionnaire (CBP-Q), and Cognitive Attentional Syndrome 1 Scale (CAS-1). Results: Comparative analyses showed no significant difference in DASS21 total scores (p>0.05). The CAS-1 total score was significantly lower in individuals with physical disabilities (p<0.05). Moderate, positive, and significant correlations were found between DASS21 and NCBI, CBP-Q, and CAS-1 (p<0.05). Multiple linear regression analysis revealed that NCBI and CAS-1 significantly influenced depression levels (p<0.05), while CBP-Q had no effect (p>0.05). Conclusion: Psychopathology in individuals with physical disabilities is associated with cognitive and metacognitive processes. Our results could inform the development of psychosocial interventions and improve health policies for this population. Keywords: Anxiety, cognition, depression, mental health, metacognition, physical disability

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Familial Hemiplegic Migraine (FHM) with Transient Psychotic Symptoms: A Case Report and Literature Review Geçici Psikotik Belirtiler ile Seyreden Familyal Hemiplejik Migren: Olgu Sunumu ve Kısa Bir Gözden Geçirme 50 50 10.5080/u27678 EN TR Tayfun ÖZ Şeref Can GÜREL Journal Article Case Reports 1429 10.5080/u27678 Familial hemiplegic migraine (FHM) is a rare, autosomal dominant subtype of migraine characterized by transient hemiparesis and neurological symptoms. It is primarily associated with mutations in the CACNA1A, ATP1A2, and SCN1A genes, which disrupt neuronal excitability and contribute to complex clinical presentations. Although psychotic symptoms accompanying migraine attacks in FHM are exceedingly rare, they have been documented in a limited number of cases. This article presents a case of FHM diagnosed in a patient who exhibited transient psychotic symptoms during a migraine attack, with a focus on diagnostic and therapeutic approaches. The case is discussed in comparison to other rare instances reported in the literature. Psychotic symptoms in FHM are thought to arise from mechanisms such as cortical spreading depression and cerebral hypoperfusion. These symptoms are typically short-lived and respond rapidly to antipsychotic treatment. However, careful evaluation is essential to differentiate these episodes from primary psychotic disorders, thereby avoiding unnecessary prolonged antipsychotic use. This case underscores the importance of a thorough clinical assessment in FHM patients presenting with atypical psychiatric manifestations. The article aims to contribute to the understanding and management of psychotic symptoms in FHM, emphasizing the need for a multidisciplinary approach to diagnosis and treatment. Further research is warranted to elucidate the pathophysiology of psychosis in FHM and to optimize therapeutic strategies for this rare but clinically significant presentation. Keyword: Case report, cortical spreading depression, familial hemiplegic migraine, psychotic disorders

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Attitudes Towards Homosexuality and Associated Factors Among Medical Students Tıp Öğrencilerinde Eşcinselliğe İlişkin Tutumlar ve İlişkili Etkenler 51 51 10.5080/u27527 EN TR Berke BETİN Şükrü Alperen KORKMAZ Demet GÜLEÇ ÖYEKÇİN Journal Article 1430 10.5080/u27527 Objective: This study aimed to determine the psychosocial factors that may influence attitudes toward sexual orientation among medical students and to explore the relationship between attitudes regarding gender roles, sexual myths, and homophobia. Method: A total of 457 medical students from Çanakkale Onsekiz Mart University in Turkiye were included in the study during the 2022- 2023 academic year. Participants received the Sociodemographic Data Form, Hudson & Ricketts Homophobia Scale, Sexual Myths Scale, and Gender Role Attitudes Scale. Results: Homophobia scores were found to be lower among fifth- and sixth-grade medical students compared to first-year students. Lower rates of homophobia were observed in students receiving psychiatric treatment and those who identify as secular. Hierarchical regression analysis revealed a positive correlation between sexual myths and homophobia, and a negative correlation between gender role attitudes and homophobia. Predictors of homophobia include right-wing political orientation, conservatism, a high belief in sexual myths, and non-egalitarian attitudes toward gender roles. Finally, a mediation analysis demonstrated that attitudes toward gender roles serve as a partial mediating variable in the relationship between sexual myths and homophobia. Conclusion: The findings of our study highlight the significance of psychosocial and cultural factors in shaping attitudes toward sexual orientation and the need for accurate and comprehensive sexuality education in the medical curriculum. It is expected that thorough and equitable education will mitigate the stress associated with homophobia. Keywords: Gender role, homosexuality, medical student, mental health, sex education

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Off-label Prescribing of Clozapine and Safety Klozapinin Endikasyon Dışı Kullanımı ve Emniyeti 53 53 10.5080/u27655 EN TR Nevena DİVAC Igor JAKOVČEVSKİ Journal Article Review 1431 10.5080/u27655 Clozapine is a unique antipsychotic primarily indicated for treatmentresistant schizophrenia, recurrent suicidal behavior in schizophrenia or schizoaffective disorder, and psychotic disorders in Parkinson’s disease. It is also prescribed off-label in selected patients with mood disorders, personality disorders, or post-traumatic stress disorder. Despite its efficacy, clozapine is underprescribed due to concerns regarding adverse effects, particularly agranulocytosis. This narrative review aims to summarize the reported results regarding the off-label use of clozapine and analyze the potential risks and benefits of these practices. Offlabel prescribing, which involves using medications for unapproved indications, is common in psychiatry due to the insufficient effectiveness of many approved treatments. Clozapine, even at relatively low doses, has shown potential clinical benefits in patients with bipolar disorder, borderline personality disorder, and post-traumatic stress disorder. However, its off-label use remains limited due to safety concerns. The safety concerns associated with clozapine include agranulocytosis, myocarditis, cardiomyopathy, seizures, and metabolic syndrome. The prevention of agranulocytosis, a severe reduction in white blood cells, requires regular monitoring of blood counts. Myocarditis and cardiomyopathy necessitate careful cardiological monitoring, especially during the first month of treatment. Seizures can occur, particularly at higher doses, and metabolic syndrome, including weight gain, diabetes, and hyperlipidemia, requires ongoing management. Other adverse effects such as constipation, hypersalivation, and sedation can also impact patient compliance and quality of life. Despite these risks, with careful patient selection, individualized dosing, and continuous monitoring, the therapeutic potential of clozapine in off-label indications warrants further exploration in clinical trials. Keywords: Adverse effects, clozapine, mood disorders, off-label prescribing, personality disorders, post-traumatic stress disorder

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Depressive Symptoms, Alexithymia, Emotion Regulation and Empathy in Adolescents with Social Anxiety Disorder Sosyal Anksiyete Bozukluğu Olan Ergenlerde Depresif Belirtiler, Aleksitimi, Duygu Düzenleme ve Empati Arasındaki İlişki 55 55 10.5080/u27657 EN TR Merve ONAT Ayda Beril NAS ÜNVER Hanife AVCI Gülser ŞENSES DİNÇ Esra ÇÖP Aynur PEKCANLAR AKAY Journal Article 1432 10.5080/u27657 Objective: The aim of our study was to determine the relationship between depressive symptoms, alexithymia, emotion regulation difficulties and empathy in adolescents with social anxiety disorder and to compare the findings with healthy controls. Method: Our study included a total of 100 adolescents aged 12-18 years, consisting of 50 with social anxiety disorder (SAD) who applied to the child and adolescent psychiatry outpatient clinic between June 2022 and November 2022, and 50 healthy controls. Participants were evaluated with Beck Depression Inventory, Social Anxiety Scale for Adolescents, Toronto Alexithymia Scale, Difficulties in Emotion Regulation Scale and Basic Empathy Scale. Results: Alexithymia, depressive symptoms and emotion regulation difficulties were significantly higher in adolescents diagnosed with social anxiety disorder compared to healthy controls, but no significant difference was found in empathy skills. The severity of social anxiety disorder was significantly related to depressive symptoms, alexithymia, and emotion regulation difficulties. Logistic regression analysis revealed maternal age, depressive symptoms, and alexithymia as the factors associated with social anxiety disorder in adolescents. Conclusion: Our study shows that depressive symptoms, alexithymia, and emotion regulation difficulties may be observed in adolescents with social anxiety disorder, and it is important to consider these factors in clinical assessment and intervention processes. Keywords: Adolescent, alexithymia, depression, empathy, emotion regulation, social anxiety disorder

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Validity and Reliability of the Turkish Adaptation of the Situational Feature Recognition Test-2 in Schizophrenia Patients Durumsal Özellikleri Tanıma Testi-2’nin Türkçe Uyarlamasının Şizofreni Hastalarında Geçerlik ve Güvenilirlik Çalışması 56 56 10.5080/u27625 EN TR Özge TÜRKOĞLU Hanife AVCI Ayşe Elif ANIL YAĞCIOĞLU Journal Article 1433 10.5080/u27625 Objective: Social cognition deficits are well known in schizophrenia patients. This study aims to conduct the validity and reliability study of the Turkish adaptation of the Situational Feature Recognition Test-2 (SFRT-2), which was developed to assess social knowledge, an area of social cognition, in schizophrenia patients. Method: In the study, 100 schizophrenia patients and 60 healthy controls were administered the Reading the Mind in the Eyes Test, the Hinting Task, the Facial Emotion Identification Test, the Facial Emotion Discrimination Test and the SFRT-2. The reliability of the test was analyzed with Intraclass Correlation Coefficient (ICC) and Bland-Altman plots by performing a retest two days later in 16 patients. Divergent validity was examined between the composite scores of the test and other social cognition test scores using the Spearman correlation coefficient. Known-groups validity was evaluated with the Mann-Whitney U test, while discriminant validity was examined using ROC analysis. Results: In the test-retest reliability analyses, the correlations between the pre-test and post-test scores were found to be good and significant for all sub-scores and composite scores (ICC=lowest 0.833-highest 0.941), except for SFRT5 (ICC=0.634). In the divergent validity analyses, positive correlations were found between SFRT-2 hits scores and the Reading the Mind in the Eyes Test (rs=0.338, p<0.001), the Hinting Task (rs=0.225, p=0.001), and the Facial Emotion Identification Test scores (rs=0.270, p<0.001). In contrast, negative correlations were found between SFRT-2 false positive scores and the Reading the Mind in the Eyes Test (rs=-0.157, p=0.026) and the Hinting Task scores (rs=- 0.194, p=0.006). In ROC analysis, the area under the curve was 0.744 (95% CI 0.665-0.823, p<0.001) with 81.0% sensitivity and 61.67% specificity. Conclusion: The Turkish adaptation of the SFRT-2 has been shown to be a reliable and valid instrument for assessing social knowledge deficits in schizophrenia patients. Keywords: Reliability and validity, schizophrenia, social perception

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Role of Illness Representations and Metacognitive Beliefs in Mood in People with Type 2 Diabetes: A study from the COVID-19 Period Tip 2 Diyabet Tanılı Hastaların Duygudurumunda Hastalık Temsilleri ve Üstbilişsel İnançların Rolü: Koronavirus Hastalığı 2019 (COVID-19) Döneminde Bir Araştırma 58 58 10.5080/u27707 EN TR Didem ACAR Özlem SERTEL BERK Journal Article 1434 10.5080/u27707 Objective: Diabetes poses a significant global health threat due to its increasing prevalence and associated comorbidities, straining healthcare systems worldwide. Depression and anxiety are frequent comorbidities in individuals with diabetes, and their underlying mechanisms have been a subject of research. This study investigated the influence of metacognitions and metacognitions about symptom control (MaSC) on depression and anxiety in people with type 2 diabetes (T2D), specifically examining their effects beyond illness representations. Method: Conducted during the COVID-19 pandemic, this study involved 153 T2D patients. Participants completed the Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (B-IPQ), Metacognitions Questionnaire-30 (MCQ-30), Metacognitions about Symptom Control Scale-Revised (MaSCS-R), and the Protection Motivation Theory Scale for COVID-19 Preventive Behaviors. Results: Hierarchical regression analysis showed that after controlling for socio-demographic variables, fear of COVID-19, and illness representations, negative metacognitions about symptom control predicted 2% of anxiety and 4% of depression; metacognitions predicted 10% of anxiety and 9% of depression. Conclusion: Metacognitions predicted both depression and anxiety, supporting the Self-Regulatory Executive Function (S-REF) model. Metacognitive therapy could be an alternative for managing emotional distress in T2D patients and may contribute to future research. Keywords: Anxiety, depression, diabetes, illness representations, metacognitions

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Brief Affect and Emotion Recognition Test: Development of an Original and Culture-Specific Measurement Tool Kısa Duygulanım ve Duygu Tanıma Testi: Özgün ve Kültüre Özgü Ölçme Aracının Geliştirilmesi 59 59 10.5080/u27600 EN TR Elvin DOĞUTEPE Emel ERDOĞAN BAKAR Caner İNCEKAŞ Sirel KARAKAŞ Journal Article 1435 10.5080/u27600 Objective: Culture plays a prominent role in recognition and rating of emotions. This study aims to develop a standardized measurement tool specific to Türkiye for assessing affect and recognizing emotions. The tool is designed to be brief and practical for use as a bedside test in clinical settings. Methods: Data were collected from 610 university students (psychology majors). The scale consisted of 500 black-and-white photographs taken under standard conditions by a professional photographer, depicting seven emotions (anxiety, fear, anger, joy, surprise, disgust, and sadness). Through four selection/elimination stages, the initial 500 photographs were reduced to 22. Expert opinions were gathered to assess the content validity of the test. Item reliability was assessed using the test-retest method, and the reliability coefficient was calculated using the Gwet AC1 technique. Following these stages, the final 20 photographs formed the Brief Affect and Emotion Recognition Test (BAET). Results: The normative emotion recognition percentages for the 20 items ranged between 42.2% and 95.6%. Normative affect intensity scores ranged from 2.3 to 4.8. The Gwet AC1 reliability coefficient of the BAET was calculated as 73.2. Conclusion: In this study, a culture-specific test was developed to measure affect and emotion recognition processes, and its content validity and reliability were assessed. The findings indicate that the Brief Affect and Emotion Recognition Test (BAET) is a valid and reliable measurement tool, introducing a brief and practical test to the field. Keywords: Affect, facial expression emotion recognition, rating scale

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Relationship of Autistic Traits with Cognitive Flexibility and Other Executive Functions in Adolescents with Social Anxiety Disorder Sosyal Anksiyete Bozukluğu Olan Ergenlerde Otistik Özelliklerin Bilişsel Esneklik ve Diğer Yürütücü İşlevler ile İlişkisi 57 57 10.5080/u27671 EN TR Börte GÜRBÜZ ÖZGÜR Gizem Buket YAYLA COŞGUN Buket CANLAN ÖZAYDIN Journal Article 1436 10.5080/u27671 Objective: The aim of this study was to compare cognitive flexibility and executive functions in adolescents diagnosed with social anxiety disorder (SAD) who have autistic traits with those who do not, and to investigate whether there is a significant difference compared to healthy controls. Method: The study included 36 adolescents diagnosed with SAD and 36 healthy controls. All participants completed the Cognitive Flexibility Scale (CFS), and the Liebowitz Social Anxiety Scale was administered to the SAD group. Neuropsychological tests including the Stroop Test TBAG Form, the Wisconsin Card Sorting Test (WCST), Raven’s Standard Progressive Matrices Test, and Visual-Auditory Digit Span Test-B were applied. Autistic traits were assessed using the Autism Spectrum Quotient-Adolescent’s Version (AQ-Adolescent) and the Childhood Autism Rating Scale. Results: There was no statistically significant difference in CFS scores between the social anxiety disorder and control groups. The SAD group showed poorer performance in the subdomains of the WCST. Additionally, in all subtestes of the Stroop test, the SAD group took significantly longer to complete the test. The AQ-Adolescent scores were significantly higher in the SAD group compared to the controls. In 25% (n=9) of the cases, autistic traits were above the cutoff. There were no significant difference in neuropsychological test results between the groups who have and do not have autistic traits within the case group. A weak negative correlation was found between the Liebowitz total and avoidance subscale scores and the AQ-imagination and attention to detail scores, while no correlation was found between the Liebowitz dimensions and CFS scores. Conclusion: This is the among the first studies to examine autistic traits and executive functions among adolescents with SAD. While no difference was found in cognitive flexibility scale scores between the SAD and control groups, the SAD group showed poorer performance in tests measuring other executive functions. However, this difference was not significantly influenced by the presence of autistic traits. Keywords: Adolescent, autistic traits, cognitive flexibility, executive function, neuropsychological test, social phobia

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Investigation of Anhedonia, Emotional Expression, and Emotion Regulation Difficulties in Individuals Diagnosed with Fibromyalgia Fibromiyalji Tanılı Bireylerde Anhedoni, Duygu İfade ve Duygu Düzenleme Güçlüğünün İncelenmesi 62 62 10.5080/u27576 EN TR Ezgi SELÇUK ÖZMEN Aslı Enzel KOÇ Çiçek HOCAOĞLU Erdal AKGÖL Journal Article 1437 10.5080/u27576 Objective: This study aimed to examine the relationships between anhedonia, emotional expression ability and emotion regulation difficulties in individuals diagnosed with fibromyalgia (FM). Methods: 82 patients with FM and 80 age, gender, and educationmatched healthy controls were included in this cross-sectional, descriptive study. Participants completed the Sociodemographic Data Form, Expressing Emotions Scale (EES), Difficulties in Emotion Regulation Scale–Short Form (DERS-16), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the Clinician-Administered Turkish version of the Snaith-Hamilton Pleasure Scale (SHAPS-C-TR). Results: Higher SHAPS-C-TR scores (OR=1.836, 95% CI: 1.501– 2.245; p<0.001) and BAI scores (OR=1.120, 95% CI: 1.020–1.230; p=0.017) were significantly associated with FM diagnosis. Conversely, higher EES scores were negatively associated with FM diagnosis (OR=0.941, 95% CI: 0.896–0.988; p=0.015). Even after controlling for depression, individuals with FM exhibited significantly higher anhedonia scores (F (1.159)=295.10, p<0.001, η²=0.623). Conclusion: Elevated levels of anhedonia and anxiety were significantly associated with FM, whereas greater emotional expressiveness appeared to be a protective factor. These findings underscore the importance of psychological assessment and interventions in FM management. Keywords: Anhedonia, emotional expression, emotion regulation difficulty, fibromyalgia

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Association Between Sirtuin 1 (SIRT1) Gene Polymorphisms and Suicide Attempts in Schizophrenia: An Exploratory Study Sirtuin 1 (SIRT1) Gen Polimorfizmlerinin Şizofreni Hastalarında İntihar Girişimleri ile İlişkisi: Keşifsel Bir Çalışma 64 64 10.5080/u27771 EN TR Ekrem Furkan UÇAK Memduha AYDIN Nadir KOÇAK Journal Article 1438 10.5080/u27771 Objective: Schizophrenia is a neuropsychiatric disorder with a high risk of suicide, arising from the interplay between genetic predisposition and environmental factors. The Sirtuin 1 (SIRT1) gene, an NAD⁺- dependent deacetylase, is involved in cellular stress response, apoptosis, and mitochondrial functions, as well as neuroprotection and circadian rhythm regulation. SIRT1 is thought to influence neurobiological mechanisms related to cognitive and affective regulation. This study aimed to investigate the association between specific SIRT1 gene polymorphisms and suicide attempts in patients with schizophrenia. Methods: This cross-sectional, observational genetic association study included only a case group comprising 100 patients diagnosed with schizophrenia. Targeted sequencing of the SIRT1 gene, encompassing all coding exons and their exon-intron junctions, was performed. Based on minor allele frequency and technical quality criteria, 10 single nucleotide polymorphisms (SNPs) were selected for further analysis. Linkage disequilibrium (LD) assessment, haplotype structure, and genetic modeling were conducted using the SHEsis software platform. Results: The rs10997870 GG genotype (p=0.017) and the rs7896005 AA genotype (p=0.033) were associated with suicide attempts, whereas the rs2236318 A allele (p=0.015) and the rs41299232 GG genotype (p=0.027) were found to be protective. The C-T-A-G haplotype (p=0.005) was associated with an increased risk, while the G-A-G-T haplotype (p=0.032) showed a protective effect. Conclusion: Certain polymorphisms and haplotypes within the SIRT1 gene may be associated with suicide risk among patients with schizophrenia. These findings point to the potential role of genetic profiling in identifying high-risk individuals. Further large-scale studies are warranted to increase the generalizability of the findings and to elucidate the underlying mechanisms in greater detail. Keywords: Haplotypes, schizophrenia, single nucleotide polymorphism, sirtuins, suicide attempt

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 The Relationship Between Childhood Trauma and Physical and Mental Quality of Life in Patients with Severe Mental Disorders Ağır Ruhsal Bozukluğu Olan Hastalarda Çocukluk Çağı Travmalarının Fiziksel ve Ruhsal Yaşam Kalitesi ile İlişkisi 67 67 10.5080/u27790 EN TR Irmak POLAT Ezgi İNCE GULİYEV Journal Article 1439 10.5080/u27790 Objective: We investigated the relationship between health-related quality of life (HRQoL), childhood trauma (CT), sociodemographic factors, and clinical characteristics in patients with severe mental disorders. Method: A total of 158 patients diagnosed with schizophrenia spectrum disorders or bipolar disorder were evaluated. Data were collected using the Short Form-12 (SF-12), Childhood Trauma Questionnaire, Clinical Global Impression-Severity Scale, and sociodemographic information form. Results: CT was reported in 62.7% of participants. SF-12 physical component scores were lower in women (p=0.012), married individuals (p=0.002), and patients with comorbidities (p=0.005). SF-12 mental component scores were lower in patients who smoked (p=0.013) and used substances (p=0.030), treated with long-acting injectable antipsychotics (p=0.008), and had a history of suicide attempts (p=0.014). Physical HRQoL scores were negatively correlated with age (r=-0.222, p=0.006), body mass index (r=-0.277, p=0.002) and illness duration (r=-0.215, p=0.010); mental HRQoL scores were negatively correlated with antipsychotic dose (r=-0.166, p=0.041) and CGI-S scores (r=-0.376, p <0.001). Emotional neglect (β=0.220, p=0.018) and physical abuse (β=0.252, p=0.006) were associated with lower physical HRQoL scores; emotional neglect (β=0.212, p=0.019) and sexual abuse (β=0.299, p<0.001) were associated with lower mental HRQoL scores. Conclusion: CT was found to be a key factor contributing to lower HRQoL in individuals with severe mental disorders. Our findings emphasize the importance of screening for CT and trauma-focused care approaches in mental healthcare services. Keywords: Childhood trauma, community mental health services, health-related quality of life, severe mental disorder

Türkiye Sinir ve Ruh Sağlığı Derneği Turk Psikiyatri Derg 1300-2163 36 2025 Adaptation, Validity, and Reliability Study of the Generalized Anxiety Disorder Stigma Scale into Turkish Yaygın Anksiyete Bozukluğu Damgalama Ölçeğinin Türkçeye Uyarlama, Geçerlik ve Güvenirlik Çalışması 63 63 10.5080/u27654 EN TR Umut ÇIVGIN Journal Article 1440 10.5080/u27654 Objectives: The aim of the study is to adapt the Generalized Anxiety Disorder Stigma Scale to Turkish and to determine its psychometric properties. This scale, which can be used for anyone showing generalized anxiety symptoms, has two sub-scale consisting of 9 statements (personal stigma and perceived stigma). Method: After the translation, 659 participants were included in the study via convenience sampling. The demographic information form, the Generalized Anxiety Disorder Stigma Scale, the Internalized Stigma of Mental Illness Scale, and the Depression Anxiety Stress Scale-21 were presented to the participants as a questionnaire set. Results: Cronbach’s alpha coefficient, test-retest and item total correlation findings were obtained for reliability. Cronbach’s alpha values of the scale were 0.78 for the personal stigma sub-scale and 0.87 for the perceived stigma sub-scale. In the analyses conducted for testretest reliability, the findings showed that the Spearman correlation coefficients were 0.70 for the personal stigma sub-scale and 0.79 for the perceived stigma sub-scale. The results indicated that the scale possesses reliability. Confirmatory factor analysis was applied for validity. Similar to the original scale, it was observed that the factor loadings were clustered in two sub-dimensions, but it was decided to remove 2 items from the scale, making it a form consisting of 18 items in total. Conclusion: As a result, the findings obtained show that the scale has reliable and valid psychometric properties. The scale can be used in both research and clinical applications to measure stigma specifically for generalized anxiety symptoms. Keywords: Anxiety, generalized anxiety disorder, scale, stigma