H. Mihrimah Öztürk, Saadin Oyucu, Hüseyin Polat, Özgür Aydın, Erguvan Tuğba Özel Kızıl
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BACKGROUND AND AIM: Alzheimer’s disease (AD) is the
leading cause of dementia/major neurocognitive disorder in
the elderly. It is a neurodegenerative disease characterized by
progressive loss of cognitive functions, and short-term memory
impairment is considered as the core symptom. However, language
skills are also affected in AD (Ivanova,2024). Early diagnosis and
management of Alzheimer’s disease are very important for the
quality of life of both patients and caregivers (Sanz et.al.,2022).
Although screening tests used for neuropsychological assessment
help detect cognitive deficits at an early stage, their sensitivity is
limited, and they should be applied by trained specialists. In this
respect, speech and language disorders seem to be an important
tool for early diagnosis of AD. However, in recent years, advances
in the fields of classification, voice processing and speech to text
have made it possible to diagnose diseases even more easily (Vigo
et.al,2022). The diagnosis of AD based on linguistic features and
speech is a relatively new field and so far, from a computational/
algorithmic perspective, there is no established and widely
accepted method. There are a limited number and quality of
studies conducted in Turkish. Therefore, the results obtained
from this study, in which 108,169 seconds of speech recordings
of a total of 105 participants were analyzed, in which AH-MND,
MİND and healthy elderly were evaluated together with detailed
clinical, neuropsychological evaluation and language analysis, are
important. METHODS: The aim of this study was to investigate whether it
is possible to distinguish individuals with major neurocognitive
disorder due to Alzheimer Disease (AH-MND) (n=41) or minor
neurocognitive disorder (MiND) (n=29) from healthy elderly
(n=35) using speech analysis. In order to evaluate cognitive
functions, Standardized Mini Mental Test, Clock Drawing Test,
Montreal Cognitive Assessment Scale, Öktem’s Auditory Verbal
Learning Test, Verbal Fluency Test, Augmented Cued Recall Test
and Trail Making Test were applied to all participants. In order to
evaluate language functions, the participants were administered
the Cookie Theft Picture Description Test, which is a part of the
Boston Aphasia Test. In addition, for the evaluation of spontaneous
speech, three questions such as ‘Can you tell me about your
ordinary day?’, ‘Can you tell me about your happiest moment?’,
‘Can you tell me about your unhappiest moment?’ were asked
to the participants and the participants were asked to tell their
memories in a logical order of events. In this test, it was ensured
that the participants felt more comfortable without any visual
stimuli and without any restrictions, and it was aimed to reveal
their verbal expression skills more clearly. During the application
of the tests, one-to-one communication was established with the
participants and audio recordings were taken during the Verbal
Fluency tests, Cookie Theft Picture Description Test, Boston
Naming Test and spontaneous speech evaluations. The recordings
were analyzed in terms of prosodic, lexical and acoustic properties
using automatic speech recognition and PRAAT applications.
The recorded speech samples were transcribed both manually
and with the help of Automatic Speech Recognition (ASR)
system. The transcripts of the participants’ speech were used
to identify the most frequently used linguistic measures in the
literature that showed statistically significant differences (Word
count, Number of names/unique words/phoneme,Total speech
time, Speech rate (number of words/total time), Spontaneous
speech duration, Number of pauses, Speech tempo (number of
phonemes per second),Number of nouns/verbs, Number of filler
words/words, Pause time, Number of long pauses (≥2 seconds),
Number of short pauses (<2 seconds), Number of filler pauses,
Targeted speech/total speech). Ethics committee approval was
obtained from the AUTF human research ethics committee
(Decision No:İ05-280-22/ 12.05.2022). RESULTS: A total of 105 participants, including 41 AH-MND,
29 MiND and 35 healthy elderly, were included in the study.
When the groups were compared in terms of the scores of
MMSE, MOCA, CDT, ÖAVLT, ACRT, Trail Making Test B-A,
it was found that there was a significant difference between
the three groups. The total recording time of 105 participants
was 108.169 seconds. The speech parameters of the groups’
recordings are detailed in Table 1. The total pause duration of
the AH-MND group was significantly longer than that of the
MiND and healthy elderly groups. Although the number of
words, unique words, nouns and phonemes used by the healthy
elderly group during total speech is higher than the AH-MND
and MiND groups, this difference is not statistically significant.
AH-MND group used more filler words than MiND and
healthy elderly group, but it was not statistically significant.
There was a significant difference between AH-MND, MiND
and control groups in the parameters of speech duration,
storytelling duration, pause duration, number of long pauses,
number of long pauses in spontaneous speech; there was a
significant difference between AH-MND, MiND and healthy
elderly groups in the parameters of speaking rate and paused
speech rate in spontaneous speech; There was a significant
difference between AD-MND and healthy groups in the tempo
of speech during spontaneous speech (Table 2). CONCLUSIONS: The findings obtained indicated that
spontaneous speech characteristics were parallel to
neuropsychological test performances, impairments in various
components were observed in AH-MND and MiND cases, and
some components were preserved. The main finding of this study
was that the AH-MND group had significantly longer speech
durations, but the amount of targeted speech and speech tempo
were found to be lower. These findings support that speech-based
methods can be developed as a cost-effective, non-invasive, and
accessible diagnostic tool for the early diagnosis of Alzheimer’s
disease.
REFERENCES
Ivanova, O., Martinez-Nicolas, I. & Meilan, J.J.G. (2024, Jan-Feb).
Speech changes in old age: Methodological considerations for
speech-based discrimination of healthy ageing and Alzheimer’s
disease. Int J Lang Commun Disord, 59(1), 13-37. https://doi.
org/10.1111/1460-6984.12888
Sanz, C., Carrillo, F., Slachevsky, A., Forno, G., Gorno Tempini,
M.L., Villagra, R., Ibanez, A., Tagliazucchi, E. & Garcia, A.M.
(2022). Automated text-level semantic markers of Alzheimer’s
disease. Alzheimers Dement (Amst), 14(1), e12276. https://doi.
org/10.1002/dad2.12276
Vigo, I., Coelho, L. & Reis, S. (2022, Jan 11). Speech- and Language-
Based Classification of Alzheimer’s Disease: A Systematic
Review. Bioengineering (Basel), 9(1). https://doi.org/10.3390/
bioengineering9010027
Keywords: Alzheimer’s disease, mild cognitive impairment,
speech analysis
Elif Sen, Mehmet Cagdas Eker, Ali Saffet Gonul, Ömer Kitiş, Seda Eroglu
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BACKGROUND AND AIM: In the treatment of bipolar disorder
(BD), lithium has long been the primary option for managing acute
episodes, preventing recurrences, and reducing suicide risk. However,
while approximately one-third of BD patients respond to lithium, others
exhibit partial response or non-response. These differences in response
highlight the heterogeneity of the neurobiological underpinnings of BD
and emphasize the necessity of identifying reliable biomarkers at an early
stage. Neuroimaging techniques, particularly resting-state functional
magnetic resonance imaging (rs-fMRI) and structural MRI-based
cortical thickness analyses, provide valuable insights into biomarkers
that could predict lithium response. The primary objective of this study
is to investigate the neurobiological differences associated with lithium
response in BD patients through rs-fMRI and structural MRI data
obtained in resting-state conditions. METHODS: All participants were aged between 18 and 50
years, and their diagnoses were confirmed using the Structured
Clinical Interview for DSM-5 (SCID-5). A total of 50 BD
patients were included. Patients were categorized based on
the Alda Scale into lithium responders (BDLR, Alda score ≥7,
n=27) and non-responders (BDLNR, Alda score ≤4, n=23).
Among the lithium-responsive group, imaging was performed
on 23 patients, but MRI data from 21 were included in the
analysis due to structural pathology (n=1) and an incomplete
scan (n=1). In the lithium-nonresponsive group, imaging was
performed on 20 patients, with MRI data from 17 included
due to similar exclusions (n=1 structural pathology, n=1
incomplete scan, n=1 image distortion). Additionally, MRI
data from 21 healthy controls were included for comparison.
All BD patients had been in remission for at least one month prior
to participation, as determined by 17-item Hamilton Depression
Rating Scale (HAMD-17) and the Young Mania Rating Scale
(YMRS) scores within the euthymic range. Medication adherence
was assessed using the Medication Adherence Rating Scale
(MARS). For the lithium-responsive patients, therapeutic serum
lithium levels were confirmed with at least two measurements
within the past year. Imaging was performed using a Siemens
3.0 Tesla MRI scanner. High-resolution T1-weighted 3D
MPRAGE sequences were used to obtain structural data, while
resting-state fMRI scans were acquired using T2-weighted EPI
sequences, with participants instructed to remain still, keep
their eyes closed, and refrain from focusing on specific thoughts.
Structural MRI data were processed using BrainSuite software,
which involved removing non-brain tissues, segmenting gray
and white matter, and generating cortical surfaces for cortical
thickness measurements. Rs-fMRI data were preprocessed
using MATLAB-based SPM and CONN toolbox, following
standard procedures. Between-group differences were assessed
using a general linear model (GLM), incorporating age, sex, and
total hemisphere volume as covariates. Pairwise comparisons
were conducted with multiple comparison corrections applied
using Monte Carlo simulations and false discovery rate (FDR)
adjustments. Statistical analyses were performed using IBM
SPSS Statistics, with demographic and clinical data analyzed
using parametric or non-parametric tests as appropriate.
Ethical approval was obtained from the Ege University Faculty
of Medicine Clinical Research Ethics Committee under approval
number 23-5/68, dated May 9, 2023. RESULTS: Statistical analyses indicated that the groups were
demographically comparable in terms of age, sex, and years of
education. Euthymic status was confirmed in all groups based
on HAMD and YMRS scores. As expected, the Alda Scale scores
were higher in the lithium-responsive group. No significant
differences were observed between groups regarding medication
adherence, as measured by the MARS scale. The mean serum
lithium level in the BDLR group was 0.70 ± 0.15 mmol/L.
Resting-state functional connectivity analyses revealed no
significant differences between lithium responders and healthy
controls. However, lithium non-responders showed significantly
altered connectivity relative to both lithium responders (F(2,55)
= 9.58, p-unc = 0.00027, p-FDR = 0.046) and healthy controls
(F(2,55) = 11.31, p-unc = 0.00008, p-FDR = 0.013). In the
BDLNR, compared to the BDLR, decreased connectivity was
observed between the right insular cortex and right paracingulate
gyrus, the right planum polare and right superior frontal gyrus,
and the right planum temporale and right paracingulate gyrus.
Compared to healthy controls, the BDLNR exhibited increased
connectivity between the right superior temporal gyrus and
both the left caudate and left thalamus, as well as between the
right superior temporal gyrus and both the right caudate and
right thalamus. Additionally, increased connectivity was noted
between the left superior temporal gyrus and left thalamus.
Conversely, decreased connectivity was observed between the
left Heschl’s gyrus and the right orbitofrontal cortex, as well
as between the right supplementary motor area and the right
orbitofrontal cortex. Moreover, reduced connectivity was found
between the left superior temporal gyrus and the right temporal
pole. Structural MRI-based cortical thickness analyses revealed
significant differences between the BDLR and BDLNR groups.
The BDLR group exhibited significantly greater cortical thickness
in the right and left superior frontal gyrus, left pars opercularis,
right precentral gyrus, right and left paracentral lobule, right
postcentral gyrus, right superior temporal gyrus, and right
transverse temporal gyrus. These differences remained significant
after controlling for the number of past manic episodes and
illness onset age. No significant differences in cortical thickness
were observed between the lithium-responsive group and healthy
controls. However, in comparison to healthy controls, the
lithium-nonresponsive group demonstrated significant cortical
thinning in the frontal and parietal regions. CONCLUSIONS: The findings indicate that lithium-responsive
patients exhibit brain connectivity and structural features
comparable to those of healthy controls, whereas lithiumnonresponsive
patients demonstrate distinct neurobiological
differences. These results highlight the heterogeneity of bipolar
disorder and suggest that neuroimaging biomarkers could aid
in differentiating patient subgroups, reinforcing the need for
personalized treatment strategies. Future research including
healthy siblings, who share genetic risk factors but do not develop
BD, could help differentiate neural alterations due to the disorder
from those linked to genetic susceptibility without clinical
manifestation. Overall, this study suggests that lithium may exert
neuroprotective and regulatory effects; however, certain patient
subgroups (non-responders) exhibit more persistent structural
and functional brain alterations. Future large-scale, longitudinal
studies integrating genetic and epigenetic data may enable the
early identification of lithium responders and non-responders.
Such advancements could optimize treatment decisions,
minimize adverse effects, and reduce relapse risks, ultimately
contributing to the development of more effective personalized
therapeutic strategies for BD management.
REFERENCES
Gong JY, Chen G, Jia Y, Zhong S, Zhao L, Luo X ve ark. (2019)
Disrupted functional connectivity within the default mode network
and salience network in unmedicated bipolar II disorder. J Affect
Disord 246: 183-9.
Hajek T, Bauer M, Simhandl C, Rybakowski J, O’Donovan C, Pfennig
A ve ark. (2014) Neuroprotective effect of lithium on hippocampal
volumes in bipolar disorder independent of long-term treatment
response. Bipolar Disord 16: 418-29.
Hibar DP, Westlye LT, van Erp TGM, Rasmussen J, Leonardo CD,
Faskowitz J ve ark. (2018) Cortical abnormalities in bipolar disorder:
An MRI analysis of 6503 individuals from the ENIGMA Bipolar
Disorder Working Group. Mol Psychiatry 23: 932-42.
Spielberg JM, Matyi MA, Karne H, Anand A. (2019) Lithium
monotherapy associated longitudinal effects on resting state brain
networks in clinical treatment of bipolar disorder. J Affect Disord
249: 301-8.
Syan SK, Smith M, Frey BN, Remtulla R, Kapczinski F, Hall GBC ve
ark. (2018) Resting-state functional connectivity in individuals with
bipolar disorder during clinical remission: a systematic review. J
Psychiatr Res 102: 1-13.
Keywords: Bipolar Disorder, Cortical Thickness, Functional
Connectivity, Functional Magnetic Resonance Imaging, Lithium
Response, Neurobiological Marker
BACKGROUND AND AIM: In the diagnosis of depression,
traditional methods, primarily relying on self-reported symptoms
and clinician interviews, often suffer from biases and inaccuracies,
which can lead to misdiagnosis or underdiagnosis of depressive
disorders. In this study, audio and visual data captured during
patients’ semi-structured interviews and natural interactions are
analyzed to facilitate an objective diagnosis of depression. METHODS: The study included 44 patients with depression and
41 healthy controls, aged 18-55 years. Diagnosis was based on
DSM-5 criteria, and depressive symptoms were assessed using
the Beck Depression Inventory. Exclusion criteria included
neurological deficits, severe visual impairments, coexisting
psychiatric disorders, psychiatric medication use, and botox
treatment within the last 6 months. Semi-structured interviews
were recorded using POV glasses with audio and video
capabilities, capturing footage at 30 frames per second and
1920x1080 resolution. These took place in the same room, with
consistent lighting (400-600 Lux) and a 100 cm distance between
the researcher and participant. In these standard interviews, the
researcher asked the participant four different questions, with at
least 30 seconds of recording for each question. The questions
were as follows: ‘Can you describe how you feel during the last
days ?’, ‘Can you describe a typical day for you, starting from the
morning ?’, ‘Could you share a positive memory of yours with
me ?’, and ‘Could you share a negative memory of yours with
me ?’. The audio and video data were analyzed using computer
software, incorporating open-source tools such as OpenCV,
MediaPipe (Google n.d.) for facial landmark detection and
head movement analysis, PyFeat (Cheong et al. 2023) for facial
expression analysis, and Whisper AI for speech recognition and
transcription. Using the software, the following parameters were
measured: total eye gaze duration, gaze duration to the right and
left, duration of smiles, concurrent eye gaze and smile, duration
of neutral and happy faces expressed by the participant for all
questions, number of blinks, blink duration, eye openness, total
head movements, number of rapid head movements, response
time, silence ratio, and the number of words spoken by the
participant in response to the researcher for the second question.
The emotions expressed by the participants and their duration,
as well as the duration of smiles, were measured using the Facial
Action Coding System (FACS). With FACS, Ekman and Friesen
(1978) classified facial expressions of universal emotions based
on facial muscle movements and their various combinations. In
our study, the Py-Feat software was used for the analysis of FACS
data (Cheong et al. 2023). The method for measuring eye gaze
estimation, developed by Abdelrahman et al. (2023) using Deep
CNN (Deep Convolutional Neural Network), was used to assess
eye gaze estimation in images. Smiles were measured using Action
Unit AU12 from the FACS. In the software, the duration of
instances where both eye gaze and AU12 occurred simultaneously
was measured. Eye openness and the number and duration of
blink were measured using the Eye Aspect Ratio (EAR) (Devi C.
et al. 2022). EAR is a simple geometric measure that indicates
whether an eye is ‘open’ or ‘closed,’ and also measures the level of
eye openness. It uses six landmarks around each eye (e.g., p0–p5),
which are measured using MediaPipe. The EAR is then defined
as: EAR = (d(p1,p5) + d(p2+p4)/2) / d(p0,p3), where d(⋅) is the
Euclidean distance between two points. Then, a numerical cutoff
(blink_threshold = 0.2) is set, which is commonly used in the
literature. If EAR < blink_threshold, the eye is considered ‘closed’
for that frame. Head movements were quantified by measuring
the number of rapid head movements and the total amount
of head movement. A rapid head movement occurs when the
change in angle (Δθ) for any axis (pitch, yaw, or roll) exceeds 5°
between two frames. Total head movement is calculated as the
sum of the absolute angle changes for each axis. In our study, we
statistically compared all the parameters measured between the
groups. Subsequently, we applied machine learning techniques
to assess the ability of the model to make diagnostic predictions.
The ethical approval for this study was granted by the Ethics
Committee of Zonguldak Bülent Ecevit University, with decision
number 2024/21. RESULTS: There were no significant differences between the
groups in terms of age (depression mean = 37.8, control mean
= 37.1, p = 0.81) or gender (depression: 24 females, 20 males;
control: 21 females, 20 males, p = 0.75). Eye gaze duration
number of blinks, blink duration, duration of smiles, concurrent
eye gaze and smile, happy face, and neutral face had p values
≤ 0.05, while right and left gaze, rapid head movements, total
head movements, eye openness, response time, silence ratio, and
number of words had p values > 0.05 (Table 1). After applying
the Bonferroni correction (p < 0.0033), statistically significant
differences were observed in duration of eye gaze and duration
of happy faces between the two groups. We employed the
AdaBoost algorithm with decision trees after experimenting
with various machine learning techniques, including other treebased
models, nearest neighbor methods, and support vector
machines. Recursive feature elimination was used to discard
less relevant features, resulting in a more generalizable model.
The learning rate and number of estimators for the AdaBoost
algorithm were set to 0.5 and 100, respectively. Using leaveone-
out cross-validation, the model achieved 87.06% accuracy,
86.67% precision, 88.64% sensitivity, 85.37% specificity, and
an 87.65% F1-Score. CONCLUSIONS: Challenges associated with healthcare access
and cost persist as significant barriers to early disease detection,
primarily due to limited availability of essential diagnostic tests
and treatments. These constraints complicate the identification
of diseases at their initial stages. In this study, we developed an
innovative methodology to aid in the diagnosis of depression
without interfering with the natural progression of psychiatric
evaluations. Specifically, our approach facilitates an objective
assessment of depression through the analysis of audio and visual
data collected during patients’ semi-structured interviews and
natural interactions, achieving an accuracy rate of 87.06%. To the
best of our knowledge, this method represents a completely new
approach that has not been previously applied in the literature.
REFERENCES
A. A. Abdelrahman, T. Hempel, A. Khalifa et al. (2023) “L2CS-Net:
Fine-Grained Gaze Estimation in Unconstrained Environments”
2023 8th International Conference on Frontiers of Signal Processing
(ICFSP), Corfu, Greece, 2023, pp. 98-102, doi: 10.1109/
ICFSP59764.2023.10372944
Cheong, J.H., Jolly, E., Xie, T. et al. (2023) “Py-Feat: Python Facial
Expression Analysis Toolbox” Affec Sci 4, 781–796. https://doi.
org/10.1007/s42761-023-00191-4
Dewi C, Chen R, Jiang X et al. (2022) “Adjusting eye aspect ratio
for strong eye blink detection based on facial landmarks” PeerJ
Computer Science 8:e943
Ekman, P. & Friesen, W. (1978) Facial action coding system: a technique
for the measurement of facial movement. Palo Alto: Consulting
Psychologists
Google. (n.d.) “MediaPipe” https://google.github.io/mediapipe/
Keywords: Depression, Eye gaze, Machine learning, Point-of-
View Glasses
BACKGROUND AND AIM: Substance use disorder is a chronic
and relapsing disorder characterized by constant preoccupation
with substance use, compulsive access to and use of substances,
difficulty in limiting substance use, and negative affect when
access to substances is prevented(Evren et al. 2019). Executive
functioning is a term that encompasses the set of high-level
cognitive abilities required to evaluate and accomplish a goal.
These functions enable us to understand complex or abstract
concepts, solve problems we have never encountered before,
plan the next goal, and manage our relationships(Cristofori et al.
2019). Social cognition is defined as representing the relationship
between oneself and others and directing this representation
through social behaviors. Perceiving, interpreting and responding
to the goals, tendencies and behaviors of others are included in
social cognitive functions(Grady et al. 2002). Deficits in executive
functions have been found to be effective in the development and
maintenance of addiction as well as in the treatment of addiction.
Deficits in executive functions are associated with early relapses
and difficulties in treatment compliance(Rolland et al. 2019). In
various studies and meta-analyses, deficits in executive function
and social cognition have been shown in patients with substance
use disorders. In this study, we aimed to determine whether
executive functions and social cognition are impaired in patients
with substance abuse compared to healthy controls and the
factors associated with the duration of remission in follow-up.
Since impairment in these areas may be effective in patients social
relations, functionality, cessation of substance use and retention
in treatment, our study was aimed to contribute to the literature.
As far as we have searched, there is no study in the literature
comparing all of these functions and including two different
substance groups and controls. METHODS: Our study was conducted with 35 patients diagnosed
with methamphetamine use disorder(MUD) according to DSM-
5, 38 patients diagnosed with heroin use disorder(HUD) and
30 healthy controls(HC) without a diagnosis of substance use
disorder who were treated in the AMATEM outpatient clinic and
AMATEM service of Pamukkale University and who agreed to
participate in the study. Sociodemographic data form, Hamilton
Anxiety Scale(HAMA), Hamilton Depression Scale(HAMD),
Adult Attention Deficit Hyperactivity Disorder Scale(ASRS),
Barratt Impulsivity Scale(BIS), and Childhood Trauma
Scale(CTS) were applied to the participants. Stroop Test(ST),
Wisconsin Test(WT), Go/NoGo Test and Mind Reading
Through Eyes Test(MRT) for social cognition were applied as
neuropsychological tests to evaluate executive functions. Early
remission status of the patients was evaluated three months after
the tests and scales were performed. Sociodemographic data,
initial scales and tests were evaluated in the remission and nonremission
groups. Ethics committee approval was notified to us
by Pamukkale University Ethics Committee with the petition
numbered E-60116787-020-228479. RESULTS: Heroin, methamphetamine and control groups were
similar in terms of age, gender, years of smoking and alcohol use,
alcohol use status, presence of chronic disease, family history
of alcohol/substance abuse and psychiatric illness(p>0,05).
Statistically significant differences were found between the
groups in marital status, region of residence, employment
status, smoking and educational status of the participants
included in the study. (p=0,043; p=0,004; p<0,0001; p<0,0001;
p<0,0001). On the HAMA and HAMD; HUD and MUD
scores were significantly higher compared to HC(p<0,050).
In the total score, emotional abuse, physical abuse,sexual
abuse,physical neglect and emotional neglect sub-dimensions
of the CTS, HUD and MUD scores were higher compared
to HC(p<0.0001). In terms of the total score and inability to
make a plan sub-dimension of the BIS, the scores of HUD
and MUD were higher than HC.(p<0.0001). The total and
motor impulsivity score, ASRS total score and hyperactivity/
impulsivity subscale of MUD were higher than the scores of
HUD and HC(p<0,0001; p=0,001; p=0,004; p<0,0001). No
significant relationship was found between the groups with the
ST, which examines executive functions. In the WT, the number
of completed categories, correct responses and conceptual level
responses were lower in HUD and MUD compared to HC; the
total number of incorrect responses and perseverative errors were
higher in HUD and MUD compared to HC and a significant
difference was found between the groups(p=0,004;p<0,000
1;p<0,0001; p<0,0001;p=0,005). In the Go/NoGo test, the
total number of correct answers in HUD and MUD was lower
than in K(p=0.035).The MRTscore was significantly higher in
controls than in substance users(p=0.017). Years of substance
use was significantly higher in HUD than in MUD(p=0.037).
The ST test partC/D(high interference sensitivity) was
significantly higher in substance users who were not in early
remission compared to those who were(p=0.040). The substance
used and VSTC/D which were evaluated as significant in the
basic analyses, and Go/NoGo test scores in terms of age, gender,
education, marital status, employment status, years of substance
use and impulsivity, which are defined as risk factors for relapse
in substance use in the literature, were evaluated with logistic
regression model as independent variables. Staying in remission
for three months was included in the analysis as the dependent
variable. Accordingly, staying in early remission was affected by
education, employment status, substance used and VSTC/D
scores. Failure to remain in early remission was approximately
7,5 times lower in primary school graduates than in high school
and university graduates, and 8 times lower in non-workers than
in workers. It was found that each unit increase in interference
sensitivity increased the inability to stay in remission 14 times
and methamphetamine use 9 times more than heroin use. CONCLUSIONS: Scores in the HAMA, HAMD, CTS,
BDI, ASRS scales were found to be higher in substance users
compared to healthy controls.It was found that people with
HUD and MUD showed lower performance in social cognition
and executive functions compared to healthy individuals. It is
suggested that the type of substance used is effective in the case
of early remission, MUD are in less early remission and executive
functions may be related to their deficiencies,especially in the
field of cognitive flexibility. Considering the results of our study,
it is thought that it may contribute to the literature in terms of
planning pharmacological and cognitive treatment interventions
that can be applied and staying in treatment in people with
substance use.
REFERENCES
Cristofori I, Cohen-Zimerman S, Grafman J (2019) Executive functions.
Handb Clin Neurol 163:197–219.
Evren C, Türkiye Psikiyatri Derneği Alkol ve Madde Kullanım
Bozuklukları Çalışma Birimi (2019) Alkol ve Madde Kullanım
Bozuklukları Temel Başvuru Kitabı, Ankara, s.1.
Grady CL, Keightley ML (2002) Studies of altered social cognition
in neuropsychiatric disorders using functional neuroimaging. The
Canadian Journal of Psychiatry 47(4):327–36.
Rolland B, D’Hondt F, Montègue S et al (2019) A patient-tailored
evidence-based approach for developing early neuropsychological
training programs in addiction settings. Neuropsychol Rev.
29(1):103–15.
Keywords: executive functions, heroin, methamphetamine
Hasan Ali Güler, Fatih Ekici, Özge Tan Çamok, Mehmed Ediz Çelik, Ali Kandeğer
Page 10-12
Presentation preview
BACKGROUND AND AIM: Social cognition—the capacity to
perceive, interpret, and respond appropriately to social cues—is
central to psychosocial functioning. Autism Spectrum Disorder
(ASD) is characterized by marked impairments in social skills,
and its subclinical manifestations in relatives are described as the
Broad Autism Phenotype (BAP). Although several assessment
tools (e.g., the Autism Diagnostic Interview-Revised) are available
for ASD, their administration can be time consuming. In Türkiye,
the Wechsler Adult Intelligence Scale-Revised (WAIS-R) is
routinely used for cognitive assessment. Previous research has
examined WAIS-R profiles in ASD populations; however, no
study has specifically addressed whether the discrepancy between
the highest and lowest WAIS-R subtest scores—here defined
as the “range”—can serve as a proxy for social skill deficits
associated with BAP. Moreover, gender differences may be key,
as literature suggests that women are more likely to camouflage
autistic traits. The present study aims to determine whether the
verbal-performance discrepancy—and particularly the verbal
range score—predicts social skills deficits in parents of children
with ASD, with analyses performed separately for mothers and
fathers. METHODS: This case-control study included 24 parents of
children with ASD (BAP group) and 28 healthy controls matched
for age, gender, education, and IQ (all participants had WAIS-R
IQ scores >80). Parents were recruited from the Department of
Child and Adolescent Psychiatry at Selcuk University and from
the Selçuklu Foundation for the Education of Individuals with
Autism through an established collaboration, while controls
were recruited via public advertisement. All participants were
between 18 and 65 years old and literate. Exclusion criteria
included any psychiatric disorder (as determined by the
Structured Clinical Interview for DSM-5—Clinician Version),
neurological or systemic illnesses, sensory impairments, or a
history of substance use disorder. Each participant underwent a
diagnostic interview using the SCID-5-CV and completed the
Autism Spectrum Quotient (AQ) to assess autistic traits. The
WAIS-R was administered by the same clinical psychologist for
consistency. For each participant, the “total range” was calculated
as the difference between the highest and lowest subtest scores;
the same procedure was applied separately for the verbal and
performance scales, yielding “verbal range” and “performance
range” scores. Statistical analyses included Student’s t-tests (both
overall and stratified by gender), effect size estimation using
Cohen’s d, logistic regression analysis (controlling for age and
years of education), and receiver operating characteristic (ROC)
analysis to identify an optimal cutoff for the verbal range. A post
hoc power analysis confirmed an adequate sample size (power
= 0.80) for the verbal range comparisons. Ethical approval was
obtained from Selçuk University Local Ethics Committee,
Decision Number: 2025/91 RESULTS: AQ data revealed that parents of children with
ASD scored significantly higher on both the AQ social skills
subscale and the total AQ scores compared with healthy
controls (p <.05). When the results were stratified by gender,
a marked difference emerged: while no significant differences
in WAIS-R verbal range scores were observed among mothers,
the subgroup of fathers of children with ASD exhibited
significantly higher verbal range scores than their counterparts
in the control group (p <.05). Further statistical examination
using logistic regression analysis—adjusting for age and years
of education—provided additional insight into the relationship
between WAIS-R performance and autism spectrum features. It
was also found that each 1-point increase in verbal range was
associated with a 1.55-fold increased likelihood of being in the
fathers of children with ASD group (p =.032, Beta = 0.443, OR
= 1.557, 95% CI: 1.039–2.333). In addition, ROC analysis
was conducted specifically for the fathers’ subgroup to assess
the discriminative power of the verbal range score. The analysis
yielded an area under the curve (AUC) value of 0.74 (95%
CI: 0.554–0.934), indicating a good level of discrimination.
The optimal cutoff point for the WAIS-R verbal range was
determined to be 7.5, which provided a sensitivity of 58.3% and
a specificity of 71.4% for distinguishing fathers of children with
ASD from those in the healthy control group.These detailed
findings support the hypothesis that an elevated discrepancy
in WAIS-R verbal subtest performance—reflected by a higher
verbal range score—is associated with greater autism spectrum
features, particularly in fathers of children with ASD. This
observation underscores the potential of the WAIS-R verbal
range as a useful cognitive marker for identifying individuals
who may benefit from further evaluation of social skills deficits
and autism spectrum characteristics. CONCLUSIONS: The present findings suggest that the WAIS-R
verbal range score may serve as a practical, cost-effective cognitive
marker for flagging potential social skills deficits and autism
spectrum features in individuals undergoing the WAIS-R for any
reason. Although our study initially sampled parents of children
with ASD, the underlying principle—that an unusually wide
discrepancy between the highest and lowest verbal subtest scores
may reflect subtle impairments in social cognition—could have
broader clinical applications. In routine cognitive assessments, a
verbal range exceeding 7.5 may prompt clinicians to conduct a
more detailed evaluation of social communication abilities and
related autism spectrum features. A plausible neurobiological
explanation for this observation is that the verbal subtests of
the WAIS-R predominantly engage left hemisphere functions,
which are critically involved in language processing and social
cognition. Previous neuroimaging studies have documented lefthemisphere
dysfunction in individuals with ASD, supporting
the “left hemisphere dysfunction theory.” Therefore, an
expanded verbal range might reflect underlying neurocognitive
differences that contribute to social communication difficulties.
Although gender differences emerged—with male participants
exhibiting more pronounced verbal range discrepancies—the
potential utility of this screening measure should be explored in
more diverse samples, irrespective of gender or clinical referral
reason. This study has several strengths, including standardized
administration of the WAIS-R and thorough diagnostic
assessments. However, limitations such as the modest sample
size and cross-sectional design warrant caution. Future research
should replicate these findings in larger, more heterogeneous
samples and ideally incorporate neurobiological measures (e.g.,
functional neuroimaging) to further elucidate the relationship
between verbal range and social cognitive functioning. Moreover,
while our results indicate that a verbal range threshold of 7.5
could serve as a preliminary screening tool, prospective studies
are needed to determine its predictive validity in various clinical
populations.
BACKGROUND AND AIM: Treatment-resistant depression
(TRD) is a disabling illness that causes significant personal
suffering and economic costs. Approximately 44% of
patients with depression do not respond to two consecutive
antidepressant treatments. Furthermore, TRD is an important
clinical challenge due to its association with high suicide risk
and loss of functioning. Many methods have been used to assess
TRD. Intermittent theta burst stimulation (iTBS) targeting the
left dorsolateral prefrontal cortex (DLPFC) for up to 6 weeks has
been approved by the US Food and Drug Administration (FDA)
for the treatment of TRD. To reduce the financial and temporal
burden of iTBS, accelerated iTBS with higher doses and multiple
sessions per day have been developed. aiTBS protocol known as
Stanford neuromodulation therapy (SNT) has shown promising
results, with a response rate of 64.3% at 4-week follow-up in
TRD patients. The SNT involves 10 iTBS sessions per day (1800
pulses per session), delivered to the left DLPFC with 50-minute
inter-session intervals over 5 consecutive days. This has been
shown to be equivalent to 30 standard iTBS sessions per day.
In addition to iTBS, continuous TBS (cTBS) delivered to the
right DLPFC has shown therapeutic efficacy in patients with
TRD. Due to its inhibitory effect on the cerebral cortex, cTBS
is increasingly being investigated to manage anxiety symptoms.
It is noteworthy that anxiety shows a moderate covariance with
suicide risk. We predicted that both accelerated cTBS (a-cTBS)
and a-iTBS may be strong candidates for the treatment of suicidal
ideation and depression in individuals with TRD. In our study,
we compared the clinical efficacy of accelerated left DLPFC
iTBS and right DLPFC cTBS versus left DLPFC iTBS and right
DLPFC pseudo-cTBS in TRD patients with moderate to severe
suicidal ideation. Both of these protocols were administered
for 10 consecutive working days. It was hypothesized that both
protocols would reduce symptoms of depression, but bilateral
administration would potentially be more effective than in
the sham control group. This study also represents the first
comparison of bilateral and unilateral practice. METHODS: We conducted a double-blind randomized
controlled trial using a 1:1 ratio in a parallel design. The study
was prospectively registered in the US Clinical Trials Registry.
All procedures were performed in accordance with the ethical
standards stated in the Declaration of Helsinki. Our study was
approved by the Turkish Medicines and Devices Agency with the
registration number 24-AKD-135. All participants gave written
informed consent before participating in any study procedures.
Participants; Between 18 and 65 years of age, diagnosed with
Major Depressive Disorder (MDD) according to DSM 5, with a
severity of illness of 7 points or more according to the Maudsley
staging method, unresponsive to 2 different antidepressant,
Patients with Hamilton Depression Rating Scale-17 [HDRS-17]
and Montgomery Asberg Depression Rating Scale [MADRS]
scores of 20 or higher, right hand dominance, and who had used
the same antidepressant at the same dose for the last 4 weeks
were selected. In our study, left and right dorsolateral prefrontal
cortex (DLPFC) were targeted using scalp measurements.
A group of 20 patients (group A) received a total of 50 sessions,
5 sessions per day, 5 days a week for 2 weeks. At least 30 minutes
rest time was given between each session. One session in group
A consisted of a high-frequency (5 Hz) intermittent theta burst
(iTBS) protocol with 1800 pulses to the left DLPFC at 90%
motor threshold, followed by a continuous theta burst (cTBS)
protocol with 600 pulses at 5 Hz to the right DLPFC at 80%
motor threshold. The other patient group (Group B) consisting
of 20 people received a total of 50 sessions, 5 sessions per day,
5 days a week for 2 weeks. A minimum of 30 minutes of rest
was given between each session. One session applied to Group B
included first a application of high-frequency (5 Hz) intermittent
theta burst (iTBS) containing 1800 pulses at 90% motor
threshold to the left DLPFC, followed by a sham application
of continuous theta burst (cTBS) containing 600 pulses at 5
Hz frequency to the right DLPFC at 80% motor threshold.
Response to treatment was defined as ≥50% decrease in MADRS
score and remission as MADRS score ≤10; HDRS-17 score was
defined as ≥50% decrease in HDRS-17 score and remission as
HDRS-17 score ≤7. RESULTS: There were no significant differences in age, gender,
body mass index, years of education, age at onset of depression,
last depressive episode, history of suicide attempt, number of
suicide attempts, MSM, depression and anxiety scores and
functioning score. No serious side effects (epileptic seizures,
suicide attempts, etc.) were observed in patients in both groups
during treatment and follow-up. CONCLUSIONS: Bilateral application did not have a significant
difference in terms of depression, anxiety, suicidal thoughts
and functionality compared to unilateral application; The fact
that cTBS did not provide additional contribution in terms of
suicidal and anxiety scores was the most important different
result that we found in contrast to the recent study. It was
found that bilateral application did not make a significant
difference in terms of depression, anxiety, suicidal thoughts and
functionality compared to unilateral application; both bilateral
and unilateral application were found to be tolerable and safe.
The fact that cTBS was administered in 600 pulses, no sham
coil was used, and errors in the detection of the right DLPFC
region may have led to this result. There is a need for randomized
sham-controlled studies with larger samples, longer follow-ups
and increased number of cTBS pulses.
REFERENCES
Eleanor J Cole, Katy H Stimpson, Brandon S Bentzley et al. (2020)
Stanford Accelerated Intelligent Neuromodulation Therapy for
Treatment-Resistant Depression. Am J Psychiatry 177: 716-26.
Zhao H, Jiang C, Zhao M et al. (2024) Comparisons of Accelerated
Continuous and Intermittent Theta Burst Stimulation for
Treatment-Resistant Depression and Suicidal Ideation. Biol.
Psychiatry 96:26-33
Keywords: Treatment-Resistant Depression, Accelarated
Transcranial Magnetic Stimulation, Theta Burst Stimulation,
Response, Remission
Yasin Hasan Balcioglu, Melih Avci, Fatih Oncu, Mehmet Sinan Iyisoy, Sakir Gica, Jonas Forsman, Howard Ryland
Page 15-16
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BACKGROUND AND AIM: Inpatient violence and aggression are
critical concerns in forensic and general psychiatry, leading to
injuries, trauma, and care disruptions while also impacting secure
transitions and post-release violence risk, underscoring the need
for structured risk assessment tools. While static factors (e.g.,
criminal history, age) contribute to aggression, dynamic factors
(e.g., impulsivity, medication adherence) offer opportunities for
intervention. However, existing tools lack practicality, predictive
accuracy, or integration of modifiable factors, limiting their
clinical utility. The Forensic Oxford Web (FOxWeb) tool was
developed to systematically track dynamic risk factors, supporting
real-time risk assessment and intervention planning. However, it
lacks external validation in diverse forensic populations, and its
predictive accuracy across different healthcare systems remains
uncertain. Additionally, its applicability in non-Western settings
has not been established. In Türkiye, structured risk assessments
remain underutilized, and research on inpatient aggression risk
factors is limited. This study evaluates the association between
FOxWeb risk items and inpatient aggression in a Turkish forensic
psychiatric cohort, adapting the model (FOxWeb-TR) to address
sociocultural and healthcare system differences. METHODS: This prospective cohort study was conducted
in a forensic psychiatry inpatient unit, enrolling adults
under compulsory court-ordered treatment due to criminal
irresponsibility or diminished responsibility. Only patients with
psychotic disorders (ICD-10 F20-F29) were included, while
those without consent, an eligible diagnosis, or scheduled for
discharge within a month were excluded. The study assessed
static (e.g., age, history of violence, baseline anger, substance use)
and dynamic risk factors using the FOxWeb tool, translated into
Turkish and back-translated for accuracy. Dynamic factors were
recorded biweekly by trained nursing staff based on electronic
patient records and multidisciplinary ward rounds to track
meaningful changes over time. A researcher reviewed assessments
for consistency and accuracy. The primary outcome was any verbal
or physical aggression incident, verified through routine incident
reports. (IRB approval date: 24.03.2023, number: 23/129).
The relationship between static risk factors and aggression
outcomes (occurrence and frequency of incidents) was assessed
using univariable analyses. Univariable and multivariable multilevel
regression analyses examined the association between each dynamic
factor and aggression occurrence (logistic regression) and frequency
(negative binomial regression) across all assessments. Multivariable
models adjusted for age, high baseline anger—identified as
predictors in univariable analysis—and the round effect. A series
of models were developed to assess the clinical utility of the total
dynamic score in risk prediction, incorporating both static and
dynamic factors. Variables significantly associated with inpatient
aggression were included as covariates. Model performance was
evaluated using the area under the receiver operating characteristic
curve (ROC AUC) with a 95% confidence interval (CI). Model
1 employed fixed effects, including age, baseline anger, the round
effect, and the total dynamic score. Model 2 included the same
fixed effects but excluded the total dynamic score. Model 3 applied
random effects, incorporating age, baseline anger, the round effect,
and the total dynamic score. These models aimed to determine the
role of dynamic risk factors in aggression prediction and compare
their predictive accuracy. A calibration plot was generated to assess
how well predicted probabilities aligned with observed outcomes
across deciles. RESULTS: A total of 102 forensic psychiatric inpatients were
prospectively followed for 4 months, resulting in 811 separate
assessment rounds. The study sample had a mean age of 45.1 years,
with 67% diagnosed with schizophrenia and 86% having a history
of interpersonal violence. A total of 588 aggression incidents
were recorded, involving 43% of patients. Younger age and high
baseline anger were strongly linked to increased aggression risk.
Multivariable multilevel logistic regression analyses identified
non-adherence to medication, greater aggression, impulsivity,
anger related to psychotic symptoms, increased anxiety, and total
dynamic scores as significant predictors of both the occurrence and
frequency of aggressive incidents. While non-adherence to therapy,
paranoid/persecutory delusions, and hallucinations did not
predict the occurrence of aggression, they significantly predicted
the number of incidents. In univariable analysis, a total dynamic
score >0 predicted the number of aggressive incidents; however,
dichotomized scores (>0 vs. 0 or >4 vs. ≤4) were not predictive in
other analyses. Across all models, high baseline anger and the round
effect remained the strongest predictors of aggression, outweighing
the influence of age. The AUC of the main model for predicting
the occurrence of aggressive incidents was 0.84 (95% CI: 0.81 –
0.87), incorporating fixed effects such as age, baseline anger, the
round effect, and the total dynamic score. When the fixed-effects
model included only age, high baseline anger, and the round effect,
without the total dynamic score, the AUC decreased to 0.73 (95%
CI: 0.69–0.77). When the first model incorporated random effects
instead of fixed effects, the AUC was 0.95 (95% CI: 0.94–0.96).
Model calibration was deemed acceptable. For the main model,
the positive predictive value (PPV) and negative predictive value
(NPV) were 0.47 and 0.93, respectively. CONCLUSIONS: To our knowledge, this is the first study to
examine risk factors for inpatient aggression in a Turkish forensic
psychiatric population, integrating static and dynamic risk factors
into a structured risk prediction model. This study is also the first
to refit previously developed FOxWeb risk assessment models to
existing data exclusively from Turkish forensic psychiatric inpatients
with psychotic illness, establishing a new population-specific risk
assessment model. We evaluated the predictive accuracy of several
statistical models for both aggression occurrence and frequency.
The FOxWeb-TR model, incorporating fixed effects and the total
dynamic score, demonstrated strong discriminative ability and
robust calibration for predicting aggressive incidents. This model
also outperformed a version that excluded the total dynamic score,
reinforcing the importance of incorporating dynamic factors in
risk assessment. Key differences from the original study include
forensic-only patients, psychotic disorder specificity, and biweekly
assessment intervals (3). The continuous dynamic score provided
better predictive performance than dichotomized versions,
highlighting the importance of tracking incremental risk changes.
However, limitations such as sample size, lack of inter-rater
reliability, and absence of external validation underscore the need
for further research and larger studies to confirm FOxWeb-TR’s
clinical utility.
REFERENCES
Camus, D., Dan Glauser, E. S., Gholamrezaee, M., Gasser, J., & Moulin,
V. (2021). Factors associated with repetitive violent behavior of
psychiatric inpatients. Psychiatry Research, 296:113643.
Ramesh, T., Igoumenou, A., Vazquez Montes, M., & Fazel, S. (2018).
Use of risk assessment instruments to predict violence in forensic
psychiatric hospitals: a systematic review and meta- analysis.
European Psychiatry, 52, 47–53.
Fazel, S., Toynbee, M., Ryland, H., Vazquez-Montes, M., Al-Taiar, H.,
Wolf, A., Aziz, O., Khosla, V., Gulati, G., & Fanshawe, T. (2023).
Modifiable risk factors for inpatient violence in psychiatric hospital:
prospective study and prediction model. Psychological Medicine,
53(2), 590–596
Keywords: Inpatients, prediction, psychosis, riskassessment,
schizophrenia
Doğancan Danışman, Mehmet Hamid Boztas, Sule Aydin Turkoglu
Page 17-18
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BACKGROUND AND AIM: Parkinson’s disease (PD) is the most
common neurodegenerative movement dysfunction. As the
world’s population continues to age, the incidence of the disease
is expected to rise significantly, doubling in the next two decades
(Simon et al., 2020). Motor symptoms are at the forefront for
the diagnosis of PD. However, with recent developments, it is
now considered as a complex neuropsychiatric dysfunction
(Weintraub et al., 2022). Recognizing the non-motor symptoms
of PD is crucial, as it increases the likelihood of earlier treatments
to improve the prognosis of patients (Leite Silva et al., 2023).
PD is associated with a variety of neuropsychiatric disorders.
Neuropsychiatric symptoms are the most common nonmotor
symptoms in PD. At the time of PD diagnosis, the most
common neuropsychiatric symptoms accompanying PD are
depression and anxiety. Depression shows a more correlated
course with the severity of PD, whereas anxiety is more stable
in the course of PD compared to depression. There are recent
studies showing a genetic, transcriptional, ion channel, protein,
enzymatic, mitochondrial and ER level relationship between PD
and Bipolar Disorder(BD). There is increasing evidence that
BD may be a predictor of the development of PD later in life.
A study conducted in 2024 investigating whether BB patients
develop PD in the future found an increased risk (Xu et al.,
2024). Only the BD group was evaluated, and the relationship
with anxiety patients and PD was not examined. In addition,
the diagnosis of dementia was not excluded. In 2020, a metaanalysis
published in the Jama Network aimed to evaluate the
association of BD with a subsequent diagnosis of idiopathic
PD. It was found that a previous diagnosis of BD increased the
likelihood of a subsequent diagnosis of idiopathic PD (Faustino
et al., 2020). In this study, anxiety patients were not included
and comorbid anxiety depression dementia diagnosis was not
excluded in the group who developed PD. This study included
patients diagnosed with PD according to the British Parkinson’s
Disease Society Brain Bank clinical diagnostic criteria who were
admitted to the general neurology outpatient clinic, patients
diagnosed with anxiety according to DSM V in the psychiatry
outpatient clinic, and healthy controls. There are publications
indicating that Parkinson’s disease symptoms are increased in
patients with bipolar disorder and anxiety group before the onset
of Parkinson’s disease. However, the results of these publications,
which were not controlled for depression, age, and different
phenomenological features of bipolar disorder symptoms, are
inconsistent. We investigated whether the symptoms seen in
BD are frequently seen in PD by comparing them with anxiety
disorders and healthy control groups. METHODS: The study included 39 PD patients, 39 anxiety
patients and 30 healthy controls. Study groups were matched for
age, gender and years of education. Past diagnoses of depression,
anxiety and dementia were excluded in the PD group. In the
anxiety patients group, past depression and dementia diagnoses
were excluded. Sociodemographic data of the study groups were
evaluated with a sociodemographic data form. In addition, HAD
scale was applied for anxiety and depression levels of the study
groups. Young Mania Rating scale(YMRS), Brief Psychiatric
Rating Scale(BPRS), Nonmotor Symptoms Scale(NMSS) and
Symptom Checklist-90(SCL-90) scales were applied for mental
symptoms and nonmotor symptoms. Chi-square analysis was
used to compare non-numerical data between groups. In the
comparisons of numerical data, Kruskal-Wallis analysis was
used since there was no normal distribution. Mann Whitney U
was used to determine the source of the difference. Spearmann
Correlation analyses were performed separately for each group.
The results were compared between the groups. RESULTS: In the evaluation between Parkinson’s patients, anxiety
patients and healthy control groups, YMRS scores were found to
be statistically significantly higher in the PD group compared to
the other groups (p<0.001). In the Parkinson’s patients group, a
significant positive correlation was found between YMRS scores
and NMSS (p<0.05, r=0.378). In the anxiety and healthy control
groups, no correlation was found between YMRS scores and
NMSS (p>0.05). In the Parkinson’s disease group, a significant
positive correlation was found between CFS-A and NMSS
(p<0.05, r=0.537). The strength of this relationship was found
to be higher in the PD group than in the anxiety group (p<0.05,
r=0.495). In the healthy control group, no correlation was found
between CFS-A and NMSS (p>0.05). In the Parkinson’s patients
group, a moderate positive correlation was found between the
HAD-D and NMSS scores (p<0.05, r=0.461). In the correlation
analysis between the CFS-D and SCL-90 total score in the
Parkinson’s disease group, a moderate positive correlation was
found (p<0.05, r=0.431). In the PD group, positive correlations
were found between YMRS scores and somatization (p<0.05,
r=0.376), obsessive-compulsive features (p<0.05, r=0.353) and
paranoid ideation (p<0.05, r=0.498). In the Parkinson’s patients
group, although depression and anxiety diagnoses were excluded,
a moderate positive correlation was found between HAD-A and
HAD-D scores (p<0.05, r=0.453). CONCLUSIONS: To the best of our knowledge, our study is the
first study to compare the symptoms of BD in PD without a
psychiatric diagnosis compared to anxiety patients without a past
diagnosis of depression and healthy controls. Our hypothesis
that “Parkinson’s patients have more symptoms of BD than
patients with anxiety” was confirmed in more specific diagnostic
samples than in the literature. Based on our findings regarding
the relationship between anxiety and PD, further clinical
studies between these groups are needed. Our hypothesis that
“Parkinson’s patients have more symptoms of BD compared
to healthy controls” was confirmed and data were presented to
the literature. Recognizing the findings related to BB and PD
in the healthy population will contribute to the development of
treatment methods that will minimize the development of these
diseases in the future. Strong findings were found to support our
hypothesis that ‘In PD, BD symptoms are higher than anxiety
disorders and healthy controls even when depression symptoms
are controlled’. Significant associations for our hypothesis that
‘BD symptoms are associated with nonmotor symptoms in PD’
were found in PD, anxiety and healthy controls.
REFERENCES
Faustino, P.R., et al., Risk of Developing Parkinson Disease in Bipolar
Disorder: A Systematic Review and Meta-analysis. JAMA Neurol,
2020. 77(2): p. 192-198.
Leite Silva, A.B.R., et al., Premotor, nonmotor and motor symptoms of
Parkinson’s Disease: A new clinical state of the art. Ageing Res Rev,
2023. 84: p. 101834.
Simon, D.K., C.M. Tanner, and P. Brundin, Parkinson Disease
Epidemiology, Pathology, Genetics, and Pathophysiology. Clin
Geriatr Med, 2020. 36(1): p. 1-12.
Weintraub, D., et al., The neuropsychiatry of Parkinson’s disease:
advances and challenges. Lancet Neurol, 2022. 21(1): p. 89-102.
Xu, X., et al., Prospective study of bipolar disorder and neurodegenerative
diseases. NPJ Parkinsons Dis, 2024. 10(1): p. 184.
Keywords: Anxiety, bipolar, parkinson
Çağıl Aydın Çetiner, Deniz Deniz Özturan, Figen Ünal Demir, Gözde Yontar, Muhammet Sevindik
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BACKGROUND AND AIM:Fear of Missing Out (FoMO) refers to a type of anxiety arising from the fear of missing out on events or updates on social platforms. This can lead individuals to constantly check their social media accounts, disrupting their sleep patterns. Our study aimed to determine the levels of FoMO on social media and its relationship with their sleep patterns. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The online survey study was conducted on 258 medical students who voluntarily participated and had no axis 1 diagnosis. Participants completed the FoMO on Social Media and Pittsburgh Sleep Quality Index scales. The relationship between the level of FoMO on social media and sleep patterns was examined. Ethical approval was obtained from Tokat Gaziosmanpaşa University Ethics Committee (Approval number: 83116987-486). RESULTS:The mean FoMO score was 21.43±10.09 for females and 18.13±9.39 for males. Students with a sleep latency of more than 30 minutes in the past month had FoMO scores of 23.92±11.00, 19.29±9.41 for those with a sleep latency of less than 30 minutes. Those who usually woke up after 08:00 had FoMO scores of 21.05±9.91, 18.18±9.94 for those who woke up before 08:00. Students who rated their sleep quality as "poor" had FoMO scores of 23.51±10.95, those who rated their sleep quality as "good" scored 18.54±8.89. In our study, FoMO scores were significantly higher among females (p=0.013), students with a sleep latency of more than 30 minutes (p=0.002), those who woke up after 08:00 (p=0.05), and those who rated their sleep quality as "poor" (p<0.001). CONCLUSIONS:Our study revealed that individuals with higher levels of FoMO on social media had longer sleep latencies, rated their sleep quality as poorer, and generally woke up later in the morning. These findings indicate that FoMO on social media may negatively affect individuals' sleep patterns.
Meryem Betül Aydın Akça, Bengü Yücens, Selim Tümkaya
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BACKGROUND AND AIM:Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique that stimulates neural circuits in the brain without requiring anesthesia. Standard TMS with round and figure-of-eight (Fo8) coils has been shown to be effective in treating depression when applied to the dorsolateral prefrontal cortex (DLPFC). This study aims to evaluate the effectiveness of TMS in patients with unipolar and bipolar depression treated in our clinic. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):Retrospective analysis was conducted on sociodemographic data forms, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores collected before and after treatment from patients receiving TMS in our clinic. Data from 23 unipolar and 8 bipolar depression patients who completed the forms were included. TMS was applied to the DLPFC using an Fo8 coil. Wilcoxon Signed-Rank Test was used to assess treatment response. Ethical approval was obtained on 26/11/2024 (decision number: 615535). RESULTS:Among unipolar depression patients, 15 (65.2%) were female, and 8 (34.8%) were male, with a mean age of 47.56±17.57. TMS was applied at 10 hertz for 21 patients and 50 hertz for 2 patients, with a mean of 21.56±6.37 sessions. Pre-treatment BDI and BAI scores were 34.41±10.75 and 20.77±15.15; post-treatment scores were 25.13±12.2 and 16.68±13.42, respectively. Among bipolar depression patients, 4 (50%) were female, and 4 (50%) were male, with a mean age of 42.62±16. All received 10 hertz TMS with a mean of 19.75±0.7 sessions. Pre-treatment BDI and BAI scores were 31.13±13.06 and 9.57±7.02; post-treatment scores were 18.69±1.01 and 8.7±6.27, respectively. BDI scores significantly decreased in unipolar depression patients (p<0.001), while the reduction in bipolar depression patients was at the significance threshold (p=0.05). No significant decrease was observed in BAI scores for either group. CONCLUSIONS:TMS significantly reduced depressive symptoms in unipolar depression patients, while its effectiveness in bipolar depression patients was at the threshold of significance.
BACKGROUND-AIM: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among gym-goers and often coexists with psychological constructs such as eating disorders, narcissistic traits, and antisocial behaviors. This study aims to explore the interrelationships between these constructs in gym-goers in Turkey to identify predictive factors of MD. METHODS (Ethics Committee Approval must be obtained and the number should be specified.) METHODS: This cross-sectional study included 418 gym-goers (81.1% male) aged 1845, recruited from fitness centers in Turkey. Data were collected using the Muscle Dysmorphic Disorder Inventory (MDDI), Eating Disorder Examination Questionnaire (EDE-Q), Narcissistic Personality Inventory (NPI), and Antisocial Personality Questionnaire (APQ). Statistical analyses included descriptive statistics, Pearson correlations, and multiple regression to examine predictors of MD symptoms. Ethical approval was obtained from the Institutional Review Board of Istanbul Nişantaşı University (Approval Number: 2024/02). RESULTS: Participants demonstrated moderate levels of MD (M = 50.12, SD = 10.74), eating disorder symptoms (M = 49.83, SD = 11.48), narcissistic traits (M = 50.02, SD = 10.81), and antisocial behaviors (M = 50.39, SD = 11.58). MD symptoms were significantly correlated with eating disorders (r = 0.681, p <.001), narcissistic traits (r = 0.772, p <.001), and antisocial behaviors (r = 0.681, p <.001). Regression analysis revealed that narcissistic traits (? = 0.60, p <.001), eating disorders (? = 0.55, p <.001), and antisocial behaviors (? = 0.25, p <.001) significantly predicted MD symptoms.
CONCLUSION: The findings highlight the intricate connections between MD, eating disorders, narcissistic traits, and antisocial behaviors in gym-goers. Integrated psychological interventions are essential to address these co-occurring conditions, emphasizing the need for comprehensive assessments and targeted treatments.
BACKGROUND AND AIM:Anticipation of a major earthquake can significantly affect psychological well-being, increasing vulnerability to PTSD, anxiety, and depression. This study aimed to identify predictors of psychological distress and well-being among Istanbul residents, focusing on sociodemographic variables and psychiatric history. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):THODS This study has been approved by the İstanbul Nişantaşı University Ethical Committee, Number: 20240502-77. A cross-sectional survey was conducted with 814 participants (51.4% male, 48.6% female) residing in Istanbul. Validated scales, including the Beck Depression Inventory-II (Mean = 44.68, SD = 23.58), Beck Anxiety Inventory (Mean = 44.71, SD = 23.53), PTSD Checklist for DSM-5 (Mean = 51.22, SD = 12.89), Warwick-Edinburgh Mental Well-being Scale (Mean = 44.38, SD = 23.51), and ICD-10 Symptom Rating Scale (Mean = 46.39, SD = 23.55), were used. Structural Equation Modeling (SEM) and regression analyses identified significant predictors of psychological outcomes. RESULTS:Higher income (? = -0.15, p = 0.003) and education (? = 0.20, p < 0.001) predicted lower psychological distress. Psychiatric history correlated with increased PTSD (? = 0.08, p < 0.05), Anxiety (? = 0.09, p < 0.05), and Depression (? = 0.09, p < 0.05). Traumatic experiences strongly predicted PTSD (? = 0.60, p < 0.001) and Depression (? = 0.45, p < 0.001). Anxiety predicted higher depression (? = 0.35, p < 0.001) and lower well-being (? = -0.50, p < 0.001). CONCLUSIONS:The findings highlight the need for mental health interventions targeting vulnerable groups, including individuals with low socioeconomic status, psychiatric history, and traumatic experiences. Enhancing community resilience and improving access to psychological services are critical for mitigating earthquake-related distress.
BACKGROUND AND AIM:This study aimed to evaluate psychiatric consultations requested for patients presenting to the emergency department of Aydın Adnan Menderes University Hospital METHODS: (Ethics Committee Approval No:2024/225)Consultation requests 07.11.2023-07.11.2024 were retrospectively reviewed through the hospitals patient record system.Sociodemographic data, whether hospitalization was recommended,the purpose of the recommended hospitalization,the patients acceptance or refusal of hospitalization and whether the patient required another psychiatric consultation in the emergency department within three months were analyzed RESULTS: Psychiatric consultations were requested for 217 male and 326 female patients. Hospitalization was recommended for 367 patients, of whom 237 accepted the recommendation.52 of the 543 patients presented to the psychiatric outpatient clinic within three months. The mean age of female patients (39.44 ± 16.49) was significantly higher than that of male patients (36.03 ± 13.71)(p = 0.035).Hospitalization was recommended for 236 female and 131 male patients (p = 0.003), with 169 female and 68 male patients refusing hospitalization (p <0.0001).Overall 330 patients were consulted for suicide attempts, 117 for aggressive behavior, and 96 for other psychiatric reasons.Among the suicide cases, 79.7% refused hospitalization (p < 0.0001), while 79.1% of aggression cases (p = 0.003) and 61.5% of other cases (p < 0.0001) accepted hospitalization.Of the suicide cases,68.0% of women and 52.4% of men refused hospitalization (p = 0.006). CONCLUSIONS: The findings indicate that a substantial proportion of patients who received psychiatric consultations in the emergency department were recommended for hospitalization, yet many refused admission, particularly female patients and those presenting after a suicide attempt.Patients with suicide attempts exhibited the highest refusal rates compared to those with aggressive behavior or other psychiatric reasons. According to the results of this study, we may suggest that women are more likely than men to decline hospitalization. This high risk groups mayneed extra support, education, or intervention strategies to encourage them to accept hospitalization when necessary.
Koray Hamza Cihan, Elifsu Keser, Kazım Cihan Can, Erguvan Tuğba Özel Kızıl
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BACKGROUND AND AIM:This study aims to compare the levels of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and systemic inflammation response index (SIRI) in patients aged 65 and older with bipolar disorder and schizophrenia. To date, no studies have examined these biomarkers in this specific geriatric patient population. This research seeks to contribute to the literature by providing a better understanding of the role of inflammation in these psychiatric disorders. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This retrospective study included 166 patients (bipolar disorder: 87, schizophrenia: 79) aged 65 and older who presented to the Ankara University Geriatric Psychiatry Clinic between 01.01.2018-31.12.2024. All patients were diagnosed according to DSM-5 criteria and were in remission. NLR, MLR, PLR, SII, and SIRI values were calculated from routine hemogram results. Normality was assessed using the Kolmogorov-Smirnov test, group comparisons were performed using the Mann-Whitney U test, and Spearmans test was used for correlation analyses. Ethical approval was obtained from the Ankara University Medical Faculty Ethics Committee (Date: 29.01.2025, No: İ01-40-25). RESULTS:The schizophrenia group had significantly higher NLR (p=0.044) and PLR (p=0.002) values compared to the bipolar disorder group. Additionally, in bipolar disorder patients, a weak correlation was found between the number of depressive episodes in the past five years and PLR values (r=0.346; p=0.016), as well as between the number of manic episodes in the past five years and SIRI values (r=0.368; p=0.01). CONCLUSIONS:These findings suggest that inflammation plays a significant role in both schizophrenia and bipolar disorder in elderly patients, with a more pronounced effect in schizophrenia. The potential clinical utility of inflammatory biomarkers should be evaluated, and further studies are needed to confirm their prognostic value.
Background and Aim Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder frequently coexisting with psychiatric comorbidities, significantly influencing diagnosis and treatment. Gender differences in ADHD extend to comorbidity patterns, with men exhibiting more externalizing disorders while women present more internalizing disorders. This study examines the prevalence and distribution of psychiatric comorbidities in adult ADHD patients. METHODS: This retrospective study analyzed 70 adult ADHD patients (60% female, 40% male, aged 1860) from Koru Ankara Hospital (April 2022September 2023). Diagnoses were based on DSM-5 criteria, ASRS, and WURS-25, with psychiatric comorbidities classified as externalizing (alcohol/substance use, impulse control, personality disorders) or internalizing (anxiety, depression, eating, and OCD-related disorders). Patients' comorbidities were screened through electronic patient files, considering that the ICD diagnosis codes entered into the electronic record system might be incomplete or misleading. Statistical analyses included t-tests, Mann-Whitney U, and chi-square tests, with statistical significance set at p<0.05.The hospital's Ethics Committee approved the study on 13.10.2023 (No. 2413). RESULTS: 71.4% of patients had at least one psychiatric comorbidity (69% females, 75% males, ?²=0.292, p=0.589). Most common comorbidities: anxiety disorders (34.3%), mood disorders (20%), including major depressive disorder (15.4%), bipolar disorder (2.9%), and dysthymia (1.4%). Men demonstrated significantly higher rates of alcohol/substance use disorders and externalizing disorders (?²=6.404, p=0.011, ?²=7.202, p=0.007), while internalizing disorders showed no gender difference (?²=0.087, p=0.768). Patients with both internalizing and externalizing disorders were mostly male (?²=5.955, p=0.015).
CONCLUSION: Consistent with prior research, psychiatric comorbidities were highly prevalent in adult ADHD. Externalizing disorders were significantly higher in men, while internalizing disorders showed no gender difference, diverging from previous studies. The 11.4% prevalence of neurodevelopmental disorders, though lower than reported elsewhere, remains clinically relevant. Lower alcohol/substance use rates (11.4%) may reflect cultural differences. Study limitations, including small sample size and reliance on electronic records, highlight the need for larger prospective studies.
BACKGROUND AND AIM:Obsessive-Compulsive Disorder (OCD) is a psychiatric disorder characterized by obsessions and compulsions that affect the person's family, academic, occupational, and social functioning. Cognitive Behavioural Therapy (CBT) has been widely adopted in clinical practice, and there is strong evidence that it is an effective method in the treatment of OCD. However, data on the long-term efficacy of CBT are limited. Previous studies have shown that individuals with OCD perform poorer than healthy controls in various neuropsychological domains. Data on changes in neurocognitive functions after CBT in OCD are contradictory and limited. In the literature, OCD is associated with impaired theory of mind. This study aimed to investigate the long-term effects of Cognitive Behavioural Group Therapy (CBGT) on symptom severity, social and neurocognitive functions in individuals with OCD. Another aim of the study was to compare the long-term effects of CBGT on symptom severity, social cognition, neurocognitive functions, and quality of life in OCD patients who completed and did not complete CBGT. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The research group consisted of individuals diagnosed with Obsessive Compulsive Disorder who participated in Aybüke Aydın's medical specialty thesis study titled Relationship between Cognitive Behavioural Group Therapy and Neurocognitive Functions in Obsessive Compulsive Disorder completed in 2018. Six years after the therapy, 21 out of 37 participants were re-evaluated. They included 13 participants who finished CBGT and eight participants who did not finish CBGT. The Structured clinical interview for DSM-5 disorders (SCID-5), Yale-Brown Obsessive Compulsive Scale (YBOCS), Beck Depression Inventory (BDI), Obsessive Compulsive Inventory-Revised (OCI-R), Obsessive Beliefs Questionnaire-44 (OBQ-44), Short Form-36 (SF-36), Autism Spectrum Quotient (ASQ), Rey Auditory Verbal Learning Test (RAVLT), Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), Stroop Test and Reading the Mind in the Eyes Test were applied to the participants. Scale scores and test performances were compared with the data from Aybüke Aydın's study. Ethical approval for the study was obtained from the Ethics Committee of Medical Research at Ege University Faculty of Medicine with the decision number 23-12T/19, dated December 14, 2023. This study was supported by the Office of Scientific Research Projects at Ege University. Project Number: 32282. RESULTS:No statistically significant difference was found between the groups who completed and did not complete CBGT regarding sociodemographic characteristics, clinical characteristics, medical characteristics and characteristics during the follow-up period. The group that completed Cognitive Behavioral Group Therapy (CBGT) showed statistically significant changes in the obsessions, compulsions, and total scores of the YBOCS, the insight-
related 11th item of the YBOCS, the BDI scores, and the differences in hoarding, checking, obsessing, and washing subscale scores of the OCI-R, as well as the responsibility/threat estimation and importance/control of thoughts subscale scores of the OBQ-44, before therapy (T0), after finishing therapy (T1), and six years after therapy (T2). In the group that completed CBGT, no changes were found in social and neurocognitive tests at T0, T1, and T2 evaluations. When comparing the clinical assessment scales of participants who completed CBGT and those who did not, before therapy (T0) and six years after therapy (T2), the changes in obsessions, compulsions, total scores of the YBOCS, the OCI-R subscale scores, the OBQ-44 subscale scores, and the Beck Depression Inventory scores were found to be similar. When social and neurocognitive tests of the groups were compared at T0 and T2, no significant differences were found between the groups at the measurement times. CONCLUSIONS:This study shows that treatment gains obtained after CBGT in OCD patients are maintained in the long term. The fact that there were clinically significant improvements in the group that did not complete CBGT and that this group continued to use medication at a high rate suggests that long-term continuation of any treatment strategy in OCD patients may be associated with favorable outcomes. In OCD patients who completed CBGT, no change or improvement was observed in social and neurocognitive tests six years after the therapy. There was also no significant difference between the completion and non-completion groups. These findings suggest that CBGT has no effect on social and neurocognitive functions in the long term. REFERENCES:1. Aydın A, 2018, Obsesif Kompulsif Bozukluk Hastalarında Bilişsel Davranışçı Grup Terapisi ile Sosyal ve Nörobilişsel İşlevlerin İlişkisi, Tıpta Uzmanlık Tezi, İzmir, Ege Üniversitesi, Tıp Fakültesi. 2. Külz AK, Landmann S, Schmidt-Ott M, Zurowski B, Wahl-Kordon A, Voderholzer U, 2020, Long-Term Follow-up of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Symptom Severity and the Role of Exposure 810 Years After Inpatient Treatment. J Cogn Psychother;34(3):261 71 /34/3/261 3. Cabedo E, Belloch A, Carrió C, Larsson C, Fernández-Alvarez H, García F, 2010, Group Versus Individual Cognitive Treatment for Obsessive-Compulsive Disorder: Changes in Severity at Post-Treatment and One-Year Follow-up. Behavioural and Cognitive Psychotherapy;38(2):22732. 4. Braga DT, Manfro GG, Niederauer K, Cordioli AV, 2010, Full remission and relapse of obsessive-compulsive symptoms after cognitive-behavioral group therapy: a two year follow-up. Braz J Psychiatry; 32(2):1648. 5. Braga DT, Abramovitch A, Fontenelle LF, Ferrão YA, Gomes JB, Vivan AS, et al., 2016, Neuropsychological Predictors Of Treatment Response To Cognitive Behavioral Group Therapy In ObsessiveCompulsive Disorder. Depress Anxiety;33(9):848 61.
BACKGROUND AND AIM:Anxious distress (AD), rumination, and anger are associated with poor outcome in major depressive disorder (MDD). However, the relationship between anger and AD in MDD is not well understood. This study aims to investigate the relationship between anger, rumination, and AD. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study included 48 MDD patients [age=33±11.17 years, 62.5% females, 24 AD+] and age- and gender-matched 48 healthy controls (HCs) [age=29.21±8.95 years; 54.2% females]. All participants were administered Hamilton Depression Severity Scale (HDRS-17), Hamilton Anxiety Scale (HAMA), DSM-5 Anxious Distress Rating Scale (ADRS), Ruminative Responses Scale, and the State-Trait Anger Scale. Since the data were normally distributed, comparisons between MDD with AD (MDD-AD+), MDD without AD (MDD-AD-), and HCs were conducted with ANOVA. The effects of rumination, AD, and anger on depressive symptoms were assessed using multiple linear regression analysis. Then, causal mediation analysis examined AD's mediator role in the relationship between controlled anger (CA) and melancholic features (MF). Analyses were conducted with R-4.4.1. Ethics approval was obtained from Baskent University (Project no and date: KA24/254-18.09.2024). RESULTS:The total and subscale scores of HDRS-17 and HAMA were highest in the MDD-AD+ and lowest in the HCs. The CA [F(2,93)=8.86, p<0.001] and ADRS score [F(2,93)=135.4, p<0.001] were higher in the MDD-AD+, while there was no difference between the MDD-AD- and HCs. In patients, the ADRS score was significantly correlated with CA (r=0.455, p=0.001) and brooding (r=0.396, p=0.005). At the same time, ADRS (ß=0.83, t=7.69, p<0.001) and CA (ß=-0.73, t=-7.35, p<0.001) predicted MF. Mediation analysis showed that both direct (p<0.001) and total effect (p=0.002) of CA on MF were negative, while the indirect effect through AD was positive (p<0.001). CONCLUSIONS:Our findings indicate that anger control may have various effects on melancholic features through different mechanisms. Further studies are needed to investigate the confounding effects in the relationship between anger and depressive symptoms.
BACKGROUND AND AIM:Somatization can be frequently observed in patients with borderline personality disorder(BPD). BPD also presents with disruptions in the self and other dimensions of mentalization capacity. The aim of this study was to examine the effect of self- and other-mentalizing on somatization tendency in BPD where attachment insecurity is high. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):164 individuals (82 BPD patients, 82 healthy controls) participated in our study between August 2023 and March 2024. Somatization Scale(SS), Experiences in Close Relationships-Revised, clarity of feelings subscale(CF) of Trait Meta-Mood Scale, Reading the Mind in the Eyes Test(RMET) were used to assess somatization, dimensions of attachment insecurity, self-mentalizing, and other-mentalizing, respectively. Model 15 in the PROCESS v4.2 macro added to the SPSS v26.0 was used in the moderated mediation analysis. The study was approved by the Istanbul UniversityCerrahpasa Clinical Research Ethics Committee(No:743969). RESULTS:The significant positive effect of attachment anxiety(AA) on SS (B=1.500, SE=0.603, t=2.487, 95% CI=[0.308, 2.692], p=0.014) disappears due to moderation of BPD (t=-.032, p=0.974). The significant negative relationship between CF and SS (B=-0.264, SE=0.079, t=-3.361, 95% CI=[-0.419, -0.109], p=0.001) is not moderated by BPD. The nonsignificant relationship between RMET and SS (t=0.609, p=0.543) becomes a significant negative relationship in moderation of BPD (B=-0.493, SE=0.200, t=-2.471, 95% CI[-0.887, -0.099], p=0.015). The indirect effect of AA on somatization through CF is independent of BPD and is not moderated (B=-0.102, SE=0.333, 95% CI=[-0.765, 0.568]). The indirect effect of AA on somatization through RMET becomes significant in moderation of BPD (B=0.253, SE=0.153, 95% CI=[0.013, 0.605]). CONCLUSIONS:Our findings show that deficiencies in self- and other-mentalizing mediate increased somatization associated with attachment anxiety in BPD patients, whereas only self-mentalizing mediates this in healthy controls. Identity diffusion, impairments in self-other distinction and in the sense of self-agency/ownership, which are associated with disruptions in self- and other-mentalizing, may lead to increased somatization in BPD patients.
BACKGROUND AND AIM: Obsessive Compulsive Disorder and Autism Spectrum Disorder share similar characteristics. People with one disorder are more likely to meet the diagnosis of the other. This study investigated whether autistic traits predicted obsessive-compulsive symptom subtypes, controlling for demographic features and clinical variables. METHODS: This study included 460 students from two universities and their family members. Subjects completed a sociodemographic form, the Vancouver Obsessional Compulsive Inventory(VOCI), Autism-Spectrum Quotient(AQ), Beck Depression Inventory(BDI), and Beck Anxiety Inventory(BAI). The relationship between autistic and obsessive-compulsive symptoms was assessed using linear regression analysis, controlling for age, sex, depression, anxiety scores, and a history of frequent childhood upper respiratory tract infections (URTIs). Approval was obtained from Pamukkale University, Faculty of Medicine ethics committee on 22.02.2022 (number 185844). Written informed consent was obtained from all participants. RESULTS: The study group consisted of 55.7% women and 44.3% men. The mean age was 37.14 ± 14.79 years. The AQ attention-switching score was associated with hoarding, just-right, indeciveness and total VOCI scores(p<0,05). AQ subscale scores other than attention-switching were not associated with VOCI scores. Age was negatively associated with obsessions, just-right, indecisiveness, and total VOCI score(p<0,05). BDI and BAI total scores were positively associated with all VOCI scores(p<0,05). Checking, just-right, and total VOCI scores were higher significantly in the group with frequent childhood URTIs(p<0,05). CONCLUSIONS: Jiujias et al. reported that these disorders share common characteristics. Meier et al. reported that people diagnosed with ASD were twice as likely to be diagnosed with OCD, and people diagnosed with OCD were four times as likely to be diagnosed with ASD. Individuals with OCD symptoms may exhibit attention-switching deficits similar to those of individuals with ASD symptoms, suggesting a subgroup of OCD that shares features with ASD. Attention-switching deficits should be further investigated in terms of the relationship between ASD and OCD.
BACKGROUND AND AIM:In recent years, it has been reported that physicians' susceptibility to mental illnesses and suicide attempts have increased due to the increase in workload and psychosocial burdens of the medical profession. In this study, the psychiatric and occupational characteristics of physicians were analyzed. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The research was conducted with 315 physicians working in Denizli. Data were collected via online platforms. Physicians completed a sociodemographic data form and the Patient Health Questionnaire-4. The study was approved by the Ethics Committee (decision number E-60116787-020-510938). RESULTS:The rates of depression and anxiety were approximately 45% and 40% for residents, 38% and 32% for specialists, and 50% and 45% for academicians, respectively. The rate of seeking psychiatric help was 52% and antidepressant use was 23%. 42 physicians had suicidal ideation and 4 attempted suicide. There was a significant correlation between hesitation to seek psychiatric help and suicidal ideation, depression and anxiety (p=0.000, p=0.020, p=0.000). One-third of the physicians hesitated to consult a psychiatrist because of feelings of inadequacy and one-tenth of them because of fear of being recorded. 42% of the participants stated that they were thinking of quitting the medical profession, %21 were planning to go abroad, and %42.7 stated that they would not choose medicine if they had a second chance. Those who stated that they wouldnt choose medicine again had significantly higher depression and anxiety symptoms (p=0.000, p=0.010). It was reported that the most fundamental problems of medicine were poor working conditions with 34% and inadequate salaries with 25%. Almost 80% of the physicians stated that they had been subjected to verbal or physical violence by patients or their relatives. CONCLUSIONS:The mental health of physicians can be protected and public health strengthened by improving working and living conditions through appropriate health policies and by providing regular psychiatric support.
About this publication
Turkish Journal of Psychiatry
Turkish Journal of Psychiatry (Turk Psikiyatri Derg) is the scientific journal of Turkish Association of Nervous and Mental Health. The journal has been published on a subscription basis four issues annually in March, June, September and December since 1990. Turkish Journal of Psychiatry is indexed in PubMed, Index Medicus, TUBITAK Tıp, Psych-Info, Türkiye Atıf Dizini and has been ranked in Social Science Citation Index (SSCI) since 2005.
27th National Clinical Education Symposium Presentation Abstracts