BACKGROUND AND AIM:Panic disorder (PD) is an anxiety disorder characterized by sudden and unexpected panic attacks that manifest with both physical and cognitive symptoms. These attacks can be debilitating, leading to increased distress and avoidance behaviors. Sleep disturbances frequently accompany PD, negatively impacting quality of life and exacerbating anxiety symptoms. Studies indicate that PD patients often report difficulty falling and staying asleep, as well as experiencing fragmented sleep patterns, which contribute to heightened emotional distress and cognitive impairment. Additionally, chronic sleep disturbances may lead to greater emotional instability, increased stress sensitivity, and long-term neurocognitive deficits. Executive functions are complex cognitive processes that enable goal-directed behavior, including planning, working memory, inhibition control, cognitive flexibility, reasoning, and problem-solving. Impairments in sleep quality have been associated with deficits in these cognitive abilities. Sleep deprivation or poor sleep quality may reduce the brain's ability to regulate emotions and make adaptive decisions. Studies indicate that individuals with PD experience impairments in visuospatial memory, verbal memory, short-term memory, working memory, and executive functioning. These cognitive impairments not only affect daily functioning but may also contribute to the persistence of anxiety symptoms and hinder effective coping mechanisms. PD is not limited to anxiety symptoms but is closely related to neurocognitive dysfunctions and sleep disturbances, which can significantly impact overall
functionality. This study aims to evaluate the relationship between sleep quality and cognitive function impairments in PD patients. Additionally, it investigates whether cognitive deficits persist despite symptomatic improvement after treatment and whether functional recovery occurs alongside symptom resolution. The findings may contribute to an improved understanding of cognitive impairments in PD and highlight the importance of sleep management in the treatment of anxiety disorders. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The ethical approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of Balıkesir University Rectorate, Republic of Turkey, on August 15, 2023, with decision number 2023/75. The study included 81 volunteer patients diagnosed with PD and 81 healthy control. To be included in the patient group, individuals had to be between 18-65 years old and voluntarily participate in the studyThey were required to meet the DSM-5 diagnostic criteria for panic disorder, not have used psychotropic medication for at least one month before the study, and possess adequate physical and mental capacity to complete the assessments. The treatment process of the patients was monitored in accordance with the routine procedures of the psychiatry outpatient clinic at our hospital. No modifications or interventions were made to the treatment protocols within the scope of this study. At the initial assessment, patients were administered the Sociodemographic Data Form, Pittsburgh Sleep Quality Index (PSQI), Panic Disorder Severity Scale (PDSS), Montgomery-Asberg Depression Rating Scale (MADRS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Over the three-month psychiatric treatment and follow-up period, 43 patients discontinued participation for various reasons. Consequently, PSQI, PDSS, MADRS, WCST, and IGT were re-administered to the remaining 38 PD patients who continued treatment and follow-up. RESULTS:Correlation analyses revealed a significant positive correlation between PSQI and MADRS and between MADRS and PDSS (p<0.001). However, no statistically significant correlation was found between PSQI and PDSS scores (p=0.079). PDSS scores showed a significant negative correlation with WCST parameters, including total correct responses, total categories completed, and conceptual level response percentage (p<0.05). In contrast, PDSS was positively correlated with total errors, perseverative responses, perseverative errors, and perseverative error percentage (p<0.05). After treatment, WCST results showed an increase in total correct responses and a significant decrease in total errors and perseverative errors (p<0.001). However, no significant changes were observed in the number of trials to complete the first category, failure to maintain set, or learning-to-learn scores (p>0.05). Post-treatment IGT scores increased significantly. A significant positive correlation was found between post-treatment PSQI and MADRS scores and between PSQI and PDSS scores (p<0.001). Generalized Estimating Equations (GEE) modeling indicated that PSQI significantly affected IGT performance, with each one-point decrease in PSQI associated with a 0.156-point increase in IGT score (p=0.013). CONCLUSIONS:Comparison of WCST results between PD patients and healthy controls revealed that the patient group exhibited lower performance in executive functions, including cognitive flexibility, problem-solving, and abstract thinking. PD patients demonstrated impaired decision-making abilities, favoring disadvantageous choices and struggling to avoid long-term negative outcomes. Additionally, PD severity was found to significantly impact cognitive functioning, with increased PD severity associated with diminished executive functions, particularly cognitive flexibility, set-shifting, abstraction, and inhibition. Poor sleep quality was
associated with increased depression severity, which in turn exacerbated PD severity. Post-treatment assessments indicated improvements in sleep quality, depressive symptoms, and PD severity. Patients demonstrated enhanced problem-solving skills, cognitive flexibility, and adaptation to new rules. Improved abstraction skills and rule-following success suggested increased conceptual thinking and overall cognitive understanding. The observed reduction in perseverative errors indicated enhanced attention and executive function organization. Post-treatment, a decrease in risky decision-making tendencies and an improvement in long-term gain-focused decision-making were noted. A one-point decrease in PSQI score corresponded to an average increase of 0.156 points in IGT score. GEE analysis confirmed that the effect of sleep quality on IGT scores was independent of other variables. Failure to recognize and treat sleep disorders not only negatively affects cognitive functions and decision-making but also leads to a decline in overall functioning. However, the absence of direct acknowledgment of sleep disturbances in the DSM-5 diagnostic criteria for PD may cause this critical issue to be overlooked in clinical practice. Greater awareness and structured interventions targeting sleep disturbances in PD may enhance overall treatment outcomes and long-term cognitive stability. Regular assessment and management of sleep quality in outpatient and inpatient settings are essential for improving the quality of life and cognitive processes in individuals with PD. This study highlights the significance of treating sleep disturbances not only for managing PD symptoms but also for enhancing cognitive performance and decision-making processes. Addressing sleep disorders in PD patients may contribute to a broader approach in clinical psychiatry, promoting better patient outcomes and reducing the long-term functional impairments associated with cognitive decline. REFERENCES:1. Amerikan Psikiyatri Birliği (2022) Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, Beşinci Baskı (DSM-V-TR) (Çev. ed.: E Köroğlu). Ankara, Esenkal Yayıncılık, 2022. 2. Sheehan DV, Ballenger J, Jacobsen G (1983) Treatment of Endogenous Anxiety With Phobic, Hysterical, and Hypochondriacal Symptoms. Arch Gen Psychiatry 40: 203-9. 3. Cristofori I, Cohen-Zimerman S, Grafman J (2019) Executive functions. Handbook of Clinical Neurology, vol. 163, Elsevier B.V., pp. 197219. doi: 10.1016/B978-0-12-804281-6.00011-2. 4. Fortier-Brochu É, Beaulieu-Bonneau S, Ivers H, Morin CM (2012) Insomnia and daytime cognitive performance: A meta-analysis. Sleep Med Rev 16: 8394. doi: 10.1016/j.smrv.2011.03.008. 5. O'Sullivan K, Newman EF (2014) Neuropsychological impairments in panic disorder: A systematic review. J Affect Disord 166: 201214. doi: 10.1016/j.jad.2014.06.024.
BACKGROUND AND AIM:Pterygium, a degenerative fibrovascular disease, can cause redness, reduced visual acuity, psychological distress, and aesthetic concerns. This study aims to assess the severity of social anxiety, depression, functionality, and health-related quality of life in patients with pterygium, and to compare their mental health with a control group. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This case-control study was conducted between March 20, 2024, and August 20, 2024, involving 35 patients with pterygium and a control group of 35 age-, gender-, and chronic disease-matched individuals. All participants completed a sociodemographic data form, the Liebowitz Social Anxiety Scale (LSAS), the Sheehan Disability Scale (SDS), the Beck Depression Inventory (BDI), and the Short Form-36 questionnaire. The study was approved by the Adıyaman University Non-Interventional Clinical Research Ethics Committee (Decision number: 2024/3-9, dated 19/03/2024). RESULTS:The patient group was found to have significantly lower scores in energy, vitality, and mental health compared to the control group (t = 2.71, p = 0.008; t = 1.79, p = 0.05, respectively). Additionally, the patient group experienced significantly higher levels of social anxiety than the control group (t = 1.97, p <0.05). A positive correlation was observed in the patient group between the SDS social life scores and both the total LSAS scores (r = 0.428, p = 0.01) and BDI scores (r = 0.616, p <0.001). CONCLUSIONS:This study highlights that patients with pterygium exhibit significantly higher levels of social anxiety compared to the control group, along with notably lower quality of life scores in terms of energy, vitality, and mental health. Furthermore, the findings suggest that the degree of disability may increase the risk of social anxiety and depression. These results underscore the importance of incorporating psychological evaluation and support into the clinical management of pterygium patients to improve their overall well-being.
Sena Çağlayan, Selcuk Aslan, Merve Çöldür, Selim Yasin Boğa, Zafer Günendi
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BACKGROUND AND AIM:Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain, sleep disturbances, mood disorders, and cognitive difficulties. Pharmacological treatments alone are often insufficient; therefore, multidisciplinary approaches are recommended. This study aimed to evaluate the effects of an online MBSR program in FMS patients. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This parallel-group, randomized controlled trial included 94 FMS patients (1865 years) and was approved by the Ethics Committee of Ankara Training and Research Hospital (23.11.2023, No: E-93471371-514.99-229969354). Participants were equally randomized into intervention (N=47) and control (N=47) groups. Only the intervention group completed the original 8-week MBSR program developed by Kabat-Zinn via an online platform, while both groups continued their standard treatments. Baseline and post-intervention assessments included validated clinical scales and somatosensory temporal discrimination threshold (STDT) measurements. Randomization and STDT evaluations were conducted in a blinded manner RESULTS:Baseline sociodemographic and clinical characteristics, including BMI, MoCA scores, pain duration, FMS diagnosis duration, and medication use, did not differ significantly between the groups. Compared to the control group, the intervention group showed significant improvements in HADS, FIQ, PCS, VAS, and SSS scores (P <0.001 for all). Mindfulness subscales significantly increased in the intervention group (P <0.001 for all), except for Acting with Awareness. While no significant change was observed in STDT values in the control group, the intervention group exhibited significant improvement in STD ability. A moderate positive correlation was found between changes in STDT and PCS scores (r = 0.300,P <0.05). CONCLUSIONS:Online MBSR positively influenced clinical symptoms, functionality, and pain catastrophizing in FMS patients. Significant improvements in depression, mindfulness, and pain severity were observed after completing at least seven sessions. Moreover, the reduction in pain catastrophizing was associated with enhanced STD ability. Online MBSR appears to be an effective and safe adjunctive treatment for FMS patients.
Merve Şahin Can, Rıza Gökçer Tulacı, Çiğdem Kaçkan
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BACKGROUND AND AIM: Iron deficiency may play a role in the aetiology of psychiatric disorders due to its role in neurotransmitter synthesis.Major depressive disorder is associated with low serum transferrin and iron levels.When the literature studies are analysed, there are few studies conducted in the adult male population.Generally, children, women and elderly populations have been focussed on.Therefore, with this study, we aimed to obtain data on young and middle-aged male individuals who are less studied. METHODS:In our study, the files of 1348 male patients aged 25-60 years who applied to Balıkesir University Mental Health and Diseases Outpatient Clinic with various complaints between 01/01/2023 and 01/01/2024 were retrospectively scanned, 460 of them were diagnosed with depressive disorder and serum iron level was requested from 123 of them. Patients for whomFe levels were requested were divided into young age (25-44) and middle age (45-60) as defined by WHO (2015) and compared in terms of the rates of concomitant low serum Fe levels.(Ethicscommittee approval: 02/04/2024-2024/56) RESULTS:The rate of being diagnosed with depressive disorder in young and middle-aged male patients admitted to psychiatry outpatient clinic was 34.1%(460/1348),and the rate of low Fe level was 39.8%(48/123) in 123 patients in whom Fe level was requested.This rate was 32% (24/32) in the 25-44 age group and 50% (24/48) in the 45-60 age group. There was no statistically significant difference between the groups in terms of the rate of iron deficiency (P>0.05). CONCLUSIONS:In our study in which we examined the relationship between depressive disorder diagnosis and iron deficiency in adult men, iron deficiency was found to be 40% and this rate was higher than the literature.In addition,it is noteworthy that there was no significant difference between the young male age group and the middle-aged male group.Therefore, it is recommended to add iron supplementation to the treatment in appropriate patients.
BACKGROUND AND AIM:Inflammatory processes play a role in the pathogenesis of bipolar disorder. Our study aimed to investigate the relationship between systemic inflammatory markers and lithium response in individuals with bipolar 1 disorder in remission. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):A total of 90 individuals who were being followed up at Prof. Dr. Timuçin Oral Mood Center, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, were diagnosed with bipolar 1 disorder according to DSM-5 diagnostic criteria, were taking lithium medication, and were in remission were included in the study and the Sociodemographic and Clinical Data Form, Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), ALDA Lithium Response Scale (ALDA) were applied. White blood cell count, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR) values were measured. Bakırköy Dr. Sadi Konuk Training and Research Hospital Clinical Research Ethics Committee Decision No: 2023-09-18. RESULTS:MLR value of poor lithium responders (n: 59, mean ± sd:0,22 ± 0,058) was higher than good lithium responders (n: 31, mean ± sd:0,18 ± 0,059) (t:3,10, df:88, p:0,003). A significant negative correlation was found between ALDA score and MLR value in the whole sample (r:-0,26, p:0,012). A positive correlation was found between the total number of past episodes and the number of past hypomanic episodes and MLR values (r:0,23, p:0,028; r:0,27, p:0,009). CONCLUSIONS:In bipolar 1 disorder in remission, good response to lithium was found associated with low MLR values, and MLR values were also associated with the number of total and hypomanic episodes. This study shows that the effect of lithium on inflammatory system may play a role in longitudinal lithium response.
BACKGROUND AND AIM:ADHD is a neurodevelopmental disorder characterized by various symptoms such as hyperactivity, inattention, and impulsivity. In this study,it was aimed to examine the potential relationship between ADHD symptoms and time perspective perception and suicide in university students. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):79 university students who were accessed through the snowballing method on online platforms were included in the study. Sociodemographic data form, Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale (ASRS), Zimbardo Time Perspective Scale (ZTPS), Suicide Probability Scale (SPS), and Depression Anxiety Stress Scale-21 (DASS-21) were applied. Approval was obtained from the ethics committee (2024-TBEK 2024/07-03) of our hospital. RESULTS:The mean age of the participants was 22.97 years (SD=5.33). In the correlation analysis, a significant positive correlation was found between the SPS total and all scales. In the hierarchical regression analysis, Model 1 showed that the ASRS significantly predicted SPS scores (? = 0.582, p < 0.001). In Model 2, with the addition of the DASS-21 sub-dimensions, anxiety (? = 0.525, p = 0.001) and depression (? = 0.370, p = 0.002) significantly predicted SPS scores. In Model 3, with the addition of the TPS sub-dimensions, anxiety (? = 0.396, p = 0.010), past negative time perspective (? = 0.364, p = 0.004), and future time perspective (? = -0.255, p = 0.016) were found to be variables that significantly predicted SPS scores. CONCLUSIONS:Present hedonistic and past negative time perceptions were found to be associated with ADHD symptoms.Individuals with suicidal ideation and suicide attempts were found to have high scores in past negative time and present fatalistic time perception. Psychotherapeutic interventions for time perspective perceptions are thought to be effective in preventing suicide in ADHD.
BACKGROUND AND AIM:Forensic psychiatry is a specialized branch of psychiatry that evaluates individuals guided by laws and institutional regulations, aiming to diagnose and treat mental disorders, provide medical opinions on criminal responsibility and legal capacity and contribute to public welfare.This study retrospectively examines the diagnoses, demographic characteristics, referral reasons and decisions made in cases presented to the forensic psychiatry outpatient clinic of a tertiary-level-non-high-security hospital. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This study included 512 cases referred to the forensic psychiatry outpatient clinic of our hospital between January 1, 2022-June 1, 2024. These cases were retrospectively analyzed in terms of demographic characteristics, clinical diagnoses, referral reasons and the decisions made.Descriptive statistical methods were applied.Ethical approval was obtained from the hospital's ethics committee(2024-TBEK2024/08-05). RESULTS:Among the 512 cases, 85.9%(n=440) were male and 14.1%(n=72) were female, with a mean age of 35.80±12.20 years.A history of substance use was present in 52.3% of the cases, with 94.8% of these being male.The most common referral reason was the evaluation of involuntary hospitalization under Article 432 of the Turkish Civil Code(TMK)(69.3%), followed by the assessment of guardianship necessity(36.5%) and the evaluation of criminal responsibility under Article 32 of the Turkish Penal Code(TCK)(16.2%).Requests for the evaluation of involuntary hospitalization and guardianship under Article 432 of TMK were most frequently associated with substance use disorders and related psychiatric conditions. The most common diagnoses made during the study included substance use disorders and associated psychopathologies, atypical psychosis, mood disorders.Among individuals evaluated for criminal responsibility, 32.5% were deemed fully responsible, while 33.7% were determined to require further forensic psychiatric observation. CONCLUSIONS:Substance use and related psychiatric disorders occupy an important place in forensic psychiatry.Our study highlights the need for more comprehensive assessment processes in criminal responsibility evaluations. The development of early intervention and treatment programs for substance use disorders may contribute to improvements in both legal and clinical procedures.
BACKGROUND AND AIM:Aging is associated with increased illness prevalence and healthcare utilization. Geriatric patients often present with complex medical comorbidities, prolonged hospitalizations, and unique treatment requirements. The aim of this study is to evaluate the sociodemographic and clinical characteristics of geriatric patients who were admitted to a psychiatric clinic. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This retrospective study analyzed the records of 163 patients aged 65 years and older who were hospitalized in Zonguldak Bülent Ecevit Universitys psychiatric clinic between 2012 and 2022. Sociodemographic data, medical history, psychiatric diagnoses, treatment modalities, and length of stay (LOS) were examined. All data were obtained retrospectively from the hospital's electronic system records. Due to repeated admissions, 219 hospitalizations were reviewed. It was approved by the Zonguldak University Clinical Studies Ethical Committee on 28/12/2022, with approval number 2022/23. RESULTS:The mean age of patients was 70.9(±5.2) years, with 49.7% female and 50.3% male participants. Most patients lived with their spouses and children(85.9%). Physical illnesses were present in 62% of patients, with cardiovascular diseases (52.1%) being the most common comorbidity. The most frequent psychiatric diagnoses were mood disorders (48.9%), psychotic disorders (16.4%), and cognitive impairments (11.0%). The mean LOS was 19.9(±13.4) days, with over 26% staying more than 25 days. Electroconvulsive therapy (ECT) was administered to 16.4%,primarily for mood and psychotic disorders. However, no significant relationship was found between ECT and LOS. Medication use included antipsychotics (65.0%),antidepressants (64.4%), anxiolytics (23.9%), and mood stabilizers (12.9%). CONCLUSIONS:Geriatric patients present with complex medical and psychiatric profiles, requiring tailored care approaches. The findings highlight the need for enhanced planning and resource allocation to address prolonged LOS and diverse treatment needs. Future research should focus on interventions that optimize care and improve outcomes for this growing population.
BACKGROUND AND AIM:Depression is a common psychiatric disorder affecting emotional,cognitive, and motor functions,leading to changes in facial expressions and mouth movements.These oral movements reflect emotional states and cognitive processes.Recently,techniques like multiscale entropy (MSE) have become valuable tools for analyzing the complexity of biological systems.This study aims to assess the entropy of oral movements in depression patients using MSE,offering preliminary insights into the motor symptoms of depression. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):A total of 21 participants were included in both the depression and control groups.Oral movements were measured using MediaPipe (Google, n.d.)from images captured by POV glasses during natural interactions.Participants described their daily routine,allowing for the capture of spontaneous facial expressions and mouth movements.The complexity of these movements was quantified using MSE,a method for analyzing the irregularity of time series data at multiple scales.The study was approved by the Ethical Committee for Clinical Studies of Zonguldak Bülent Ecevit University,with approval number 2024/21. RESULTS:There was no significant difference in age between the two groups (mean age for the depression group: 42.4,mean age for the control group: 41.2, p = 0.751),nor in gender distribution (depression group: 10 males,11 females; control group: 9 males,12 females,p = 0.757). However, the MSE analysis of oral movements revealed a statistically significant difference between the two groups (p = 0.016).The depression group had a mean rank of 16.95,while the control group had a mean rank of 26.05, indicating a greater complexity in the motor patterns of the control group compared to the depression group. CONCLUSIONS:This preliminary study shows that there is a significant difference in the complexity of oral movements between the two groups,as assessed through MSE analysis.These findings provide valuable insight into the potential use of MSE as a tool for evaluating motor symptoms in depression, though further research with larger samples is needed to confirm these results and explore their clinical implications.
BACKGROUND AND AIM:Gambling disorder (GD) is a psychiatric disorder that has increased in frequency in recent years and brings with it serious psychiatric and social problems. GD is associated with many etiological causes. In this study, some of these possible factors, impulsivity, personality traits and underlying cognitions, will be evaluated, and their relationship with the severity of gambling disorder will be assessed. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study included 43 patients with GD who applied to Ondokuz Mayıs University Faculty of Medicine Psychiatry Clinic and Samsun Mental Health and Diseases Hospital AMATEM Clinic between 01.10.2024 and 01.02.2025. The participants included in the study completed the sociodemographic data form prepared for the study, South Oaks Gambling Screening Test, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 Test (GAD-7), Gambling-Related Cognitions Scale (CRGS), Barratt Impulsivity Scale Short Form (BIS) and Eysenck Personality Inventory. Approval for the study was received from the Ondokuz Mayıs University Clinical Research Ethics Committee with the number 2025/27. RESULTS:Most participants (40/43) were male. The mean age of the participants was 32.7±8.5, 24 of them were single and 16 of them were self-employed. The mean age at which the participants started gambling was 26.7±8.3. A low positive correlation (r: 0.326, p: 0.040) was found between the severity of gambling disorder and the CRGS- interpretative control/bias subscale. A low negative correlation was found between the age of GD onset and the GRCS- gambling-related expectancies (r: -0.427, p: 0.006) subscale and the BIS lack of planning (r: -0.341, p: 0.031) subscale. CONCLUSIONS:The age of onset in GD may be related to different clinical features of GD. GD seen at an older age is considered a more isolated type of addiction. Since cognitions are the underlying and sustaining factors of GD, they are also one of the critical targets in treatment.
BACKGROUND AND AIM:Schizophrenia is a chronic psychotic disorder affecting approximately 1% of the population. This study aims to analyze the sociodemographic and clinical
characteristics of individuals diagnosed with schizophrenia and related disorders. METHODS: A retrospective file review was conducted on 176 inpatients diagnosed with schizophrenia and related disorders at the Psychiatry Clinic of Ankara Etlik City Hospital between January 2023 and June 2024. Clinical data, such as age of onset, disease duration, level of insight, substance use history, comorbid diagnoses, family history, hospitalization duration, medication adherence, and treatment characteristics, were recorded using a sociodemographic and clinical evaluation form. Descriptive statistical analyses frequency and percentage for categorical variables and mean and standard deviation for continuous variables. Ethical approval was granted by the Ankara Etlik City Hospital Ethics Committee (Decision Number: AEŞH-BADEK-2024-864,dated5.09.2024). RESULTS:The mean age of the patients was 35.19±11.15 years. 39.2% had completed highschool, 78% were single, 74.4% lived with their parents, 65.9% were unemployed. Clinical characteristics revealed that 80.7% had a diagnosis of schizophrenia, with a mean onset age of 23.95±7.94 years, 68.2% had repeated hospitalizations, 24.4% had a comorbid psychiatric disorder, most commonly personality disorders or alcohol/substance addiction. Voluntary hospitalizations accounted for 54.5% of cases, while 58.5% of patients lacked insight into their illness. Substance use history was reported in 64.2% of cases. The mean duration of current hospitalization was 26.02±15.68 days. Prior poor treatment adherence was noted in 83% of patients. During hospitalization, 80.1% were treated with second-generation antipsychotics, 62.5% received monotherapy, 39.7% were prescribed oral medication, 33.0% received long-acting injections, and 26.7% underwent combined treatment. CONCLUSIONS:Studies have shown that schizophrenia usually occurs in males in early adulthood and that these individuals experience a more chronic disease progression, social isolation and reduced functionality. This epidemiological data from male patients gathered will contribute to the development of more targeted and effective treatment strategies.
BACKGROUND AND AIM:Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neuropsychiatric disorder that persists from childhood into adulthood. While psychiatric comorbidities in ADHD present major clinical and public health challenges, somatic comorbidities are also prevalent but less studied. These may stem from shared etiological mechanisms or ADHD-related lifestyle factors. The limited research on somatic conditions in
ADHD creates a gap in diagnosis and treatment, despite evidence linking ADHD to early mortality and reduced life expectancy. This study aims to assess the prevalence of somatic comorbidities in adults with ADHD and their associations with clinical characteristics. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):We retrospectively reviewed medical records of 358 adults diagnosed with ADHD at the Adult Neurodevelopmental Disorders Clinic, Department of Psychiatry, Selçuk University. Demographic and clinical data were extracted and statistically analyzed. The study was approved by the Selçuk University Ethics Committee (Decision No: 2024/425). RESULTS:Of the patients, 51.1% were female and 48.9% male, with a mean age of 23.7 ± 6.01 years (range: 1649). ADHD was diagnosed before age 18 in 29.7% and in adulthood in 70.3%, with a mean diagnosis age of 20.7 ± 8.07 years. Somatic comorbidities were present in 22.3%, most commonly obesity (10.3%) and asthma, followed by allergies, migraines, celiac disease, and thyroid disorders. Cardiac, metabolic, and allergic/autoimmune conditions were found in 3.4%, 5.3%, and 8.7% of cases, respectively. Somatic comorbidities were significantly more frequent in females and in those diagnosed at a younger age. CONCLUSIONS:This study underscores the strong link between ADHD and somatic comorbidities, highlighting the need for an integrated clinical approach. Obesity and asthma were most common, likely influenced by shared etiology, ADHD-related lifestyle factors, or high comorbidity rates. Somatic conditions may affect treatment decisions, requiring careful monitoring of stimulant use. Routine screening in both directions could improve clinical outcomes.
Ugur Cikrikcili, Thomas Nickl Jockschat, Björn Schott, Ulaş Ay, René Lattmann5, David Berron, Emrah Duzel
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BACKGROUND AND AIM: This study aims to explore the relationship between anxiety scores and amygdala novelty responses across different stages of preclinical AD. METHODS (Ethic Committee: 20190327_SOP-DM-14_A01_V01_Antrag_auf_Abgabe_von_Daten_Biomaterialproben Page):The study included 185 participants categorized into Healthy Controls (n = 56), Subjective Cognitive Decline (n = 86), and Mild Cognitive Impairment (n = 43). SCD and MCI diagnoses were made according to Jessen et al. 2014 and NIAA-AA 2011 diagnostic criterias, respectively. Anxiety levels were assessed using the short form of the Geriatric Anxiety Inventory (GAIS-SF), while functional MRI (fMRI) measured amygdala responses to novel stimuli. Every groups in the study were divided into two; the first group consisted of people with a GAI-SF score of 0; the second group consisted of people with a score of 1 and above. Cerebrospinal fluid (CSF) biomarkers, including p-Tau and t-Tau, were used to classify tau pathology. Preclinical Alzheimers Cognitive Composite 5 (PACC5) designed to detect subtle cognitive changes in the preclinical stage of Alzheimers disease. RESULTS:Anxiety symptoms were significantly elevated in the SCD and MCI groups compared to healthy controls (p < 0.001). Despite this, there was no significant association between anxiety severity and amygdala novelty responses across diagnostic groups. Furthermore, tau pathology (p-Tau, t-Tau) did not show a significant interaction with anxiety symptoms in predicting amygdala activity. The absence of a clear relationship may be influenced by the generally low severity of anxiety symptoms within the study cohort, potentially limiting the detection of neural alterations. CONCLUSIONS: This study suggests that how anxiety scores do not significantly alter amygdala novelty responses. The low anxiety scores are due to the fact that people with major psychiatric disorders were not included in the study. This narrows the scope of the study and can be considered as a limitation. It's thought that this situation will shed light on future studies.
BACKGROUND AND AIM:Evidence for a relationship between substance use disorder (SUD), insecure attachment, and aggression has been presented. Recent studies have examined factors that may predict aggression in individuals with SUD. In this study, we aimed to investigate the relationship between addiction severity and attachment style, aggression, and
inflammatory markers in SUD. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):Ethical approval for the study was obtained from Kütahya Health Sciences University Non-Interventional Clinical Research Ethics Committee (17.05.2024, 2024/07-22). The study included 86 male and 12 female patients aged 18-65 years with a diagnosis of SUD who agreed to participate. Sociodemographic Information Form, Addiction Profile Index, Experiences in Close Relationships Scale-Revised, and Buss-Perry Aggression Questionnaire (BPAQ) were administered to the participants. In addition, the patients' test results were evaluated for systemic inflammation. RESULTS:As a result of statistical analyses, patients with SUD were classified into three groups as low, moderate, and high severity according to total BPAQ scores. When the groups were compared in terms of total BPAQ scores, a significant difference was found between the three groups (p=0.001). It was concluded that there was no significant difference between the groups in terms of anxious and avoidant attachment dimensions (p>0.05). Correlational analysis revealed that there was a positive relationship between attachment severity and physical aggression, anger, and total aggression scores (p=0.008, p=0.006, p=0.031). There was also a positive relationship between the anxious attachment dimension and scores on the physical aggression, anger, hostility, and total aggression scales (p=0.043, p=0.003, p<0.001, p=0.002). No difference was found between the groups with regard to inflammatory parameters (p>0.05). CONCLUSIONS:Anger and aggression may increase with the severity of addiction in individuals with SUD. Insecure attachment, particularly anxious attachment, may play a role in increasing anger and aggression. Addressing both attachment styles and anger control may play a positive role in the treatment process.
Mehmet Akif Dündar, Fatmanur Akgün Kılavuz, Hasan Bakay, Mehmet Ak
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BACKGROUND AND AIM:Vertigo, defined as a feeling of dizziness and imbalance, is a symptom that can significantly affect an individual's quality of life. It is known that patients with vertigo may also suffer from various psychological problems. The aim of this study was to investigate perceived stress, anxiety levels and coping strategies in patients with vertigo. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):The study included 270 patients who applied to Necmettin Erbakan University (NEU) otorhinolaryngology outpatient clinic with vertigo symptoms and 73 healthy controls. The participants were administered sociodemographic data form, perceived stress scale (PSS), state-trait anxiety inventory (STAI), ways of coping inventory (WCI) and anxiety sensitivity index (ASI). Ethical approval was obtained from NEU Ethics Committee (204-2024/5201). RESULTS:Compared to the control group, trait-anxiety (48.87±7.06 p=0.003), ASI (25.58±15.7 p<0.001), optimistic coping (14.89±2.58 p=0.003), confident coping (22.15±3.48 p<0. 001), helpless coping (19.1±4.56 p=0.039), submissive coping (14.18±3.23 p<0.001), problem-focused coping (48.62±6.34 p<0.001) and emotion-focused coping (33.31±6.68 p=0.004) scores were significantly higher in patients with vertigo. Medication use was 56.3% among the patients. In the patient group, there were positive correlations between PSS and trait-anxiety score (r=0.200 p<0.001), emotion-focused coping score (r=0.348 p<0.001) and ADI (r=0.372 p<0.001). There was a negative correlation between PSS and problem-focused coping score (r=-0.164 p=0.007). A strong positive correlation was also demonstrated between the emotion-focused coping score and the trait-anxiety score (r=0.443 p<0.001) and the ASI score (r=0.505 p<0.001). Regression analyses revealed that being married predicted emotional coping mechanisms in the patient group (ExpB=1.079 p=0.014). CONCLUSIONS:Anxiety sensitivity and anxiety symptoms have been shown to be high in patients with vertigo. Perceived stress was associated with anxiety and maladaptive coping strategies. Addressing psychological factors is of great importance in managing treatment and improving the quality of life of individuals with vertigo.
Furkan Çınar, Ömer Bayırlı, Zehra Eratıcı, Memduha Aydin
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BACKGROUND AND AIM:Obesity is a disease with increasing prevalence that negatively affects quality of life, shortens life expectancy, and poses a threat to public health. Previous studies have shown that increased impulsivity in individuals with obesity makes it harder to control eating behavior. However, studies evaluating impulsivity and reward-related eating together are limited. This study aims to examine the relationship between obesity, impulsivity, and reward-related eating. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):A total of 46 obese individuals evaluated before bariatric surgery at the Consultation-Liaison Psychiatry Clinic of Selçuk University Faculty of Medicine between January 1, 2024, and
January 1, 2025, were included in the study. As part of the routine assessment battery for bariatric surgery candidates, participants completed the Sociodemographic Data Form, Reward-Related Eating Scale (RED-13), and UPPS-P Impulsive Behavior Scale. This study presents preliminary findings from an ongoing research project. Statistical analyses were performed using SPSS. The study was approved by the Ethics Committee (Approval number: 2025/56). RESULTS:Among the participants, 73.9% were female (n = 34), with a mean age of 32.35 ± 9.53 years and a mean BMI of 41.90 ± 6.95. Of the participants, 58.7% (n = 27) were morbidly obese, and 39.1% (n = 18) had a history of psychiatric disorders. The analyses revealed no significant relationship between the RED-13 and the total UPPS-P score (p = 0.880); however, a significant positive correlation was found between the RED-13 and the UPPS-P premeditation subscale (r = 0.29; p = 0.049). CONCLUSIONS:Findings suggest that impulsivity and reward-related eating levels may play a crucial role in the assessment of individuals with obesity. In particular, impairments in the "premeditation" dimension of impulsivity may lead to an increased tendency to engage in reward-related eating by disregarding long-term consequences, thereby elevating the risk of obesity. Further studies with larger sample sizes are needed to better elucidate these relationships.
BACKGROUND AND AIM:Schizophrenia and bipolar disorder are serious mental illnesses that also increase the risk of cardiovascular disease (CVD). CVD is a leading cause of mortality and morbidity worldwide, with atherosclerosis as its primary factor. Carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) are key clinical markers for early detection of atherosclerotic changes. This study aims to assess atherosclerosis risk by comparing CIMT and ABI values in schizophrenia and bipolar disorder patients with dizziness and syncope but no known CVD, to those of healthy individuals. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This prospective, cross-sectional study was conducted at a university hospital with ethics committee approval (reference: 2023/4-7). The study included 29 schizophrenia patients, 29 bipolar disorder patients, and 32 healthy individuals aged 1840 years. The patient group
consisted of individuals followed in psychiatry and referred to neurology for dizziness and syncope. Inclusion criteria required the absence of cardiovascular and cerebrovascular disease. CIMT and ABI were measured, and routine biochemical and hemogram parameters were evaluated. Statistical significance was set at p<0.05. RESULTS:Schizophrenia patients were older than healthy controls (p=0.014). Their education level was lower than that of bipolar and healthy controls (p=0.024), and their employment rate was significantly lower (p<0.001). Schizophrenia patients had lower platelet levels (p=0.031), while neutrophil-to-lymphocyte ratio (NLR) was significantly higher in schizophrenia and bipolar groups (p=0.017). However, CIMT, ABI, arterial flow, and blood pressure showed no significant differences among groups (p>0.05). CONCLUSIONS:No significant differences in CIMT and ABI were found between schizophrenia and bipolar disorder patients and healthy controls. However, the higher NLR in schizophrenia and bipolar patients suggests inflammations role. The study is limited by its small sample size and cross-sectional design. Future large-scale studies will better clarify the relationship between these disorders and cardiovascular risk factors.
Ümmü Nur Kaya Tan, Büşra Başer Özkoç, Ali Erdoğan, Sercan Karabulut, Buket Cinemre, Burak Kulaksızoğlu
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BACKGROUND AND AIM:Celiac disease (CD) is an autoimmune disease that develops as a result of sensitivity to gluten and generally progresses with absorption problems. Patients must follow a strict gluten-free diet for life (1). In this study, we aimed to compare the eating behaviors, orthorexia, self-esteem and life satisfaction of individuals with CD with healthy controls (HC). METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This cross-sectional study included 387 individuals with CD and 402 HC. All participants completed Eating Disorder Examination Questionnaire-Short Form (EDE-Q-13), Eating Attitudes Test (EAT-40), Ortho-15 Test (O-15), Self-Esteem Evaluation Scale-Short Form (SERS-SF), and Satisfaction with Life Scale (SWLS). Ethical approval was obtained on 02.01.2025 with decision number TBAEK-44. RESULTS:The mean age was similar between individuals with CD (30.13±8.92 years) and HC (29.57±10.30 years) (p=0.068). Among individuals with CD, 94.8% were female, compared
to 91.8% in the HC group (p=0.088). Individuals with CD had significantly lower scores in O- 15 (p<0.001), EDE-Q-13 weight concern (p=0.006), EDE-Q-13 restrained eating (p=0.029), O-15 emotional eating (p<0.001), and SWLS (p=0.009), whereas their EAT-40 (p=0.002) and positive SERS-SF scores (p=0.002) were significantly higher. Correlation analysis showed that as the duration of CD diagnosis increased, O-15 scores (r=-0.184, p<0.001) and negative SERS-SF scores (r=-0.115, p=0.023) significantly decreased. Regression analysis indicated that CD was associated with SWLS (OR=1.062, 95% CI: 1.023-1.102, p=0.001), positive SERS-SF (OR=0.982, 95% CI: 0.968-0.996, p=0.011), and O-15 emotional eating (OR=1.336, 95% CI: 1.129-1.581, p<0.001). CONCLUSIONS:Our findings suggest that individuals with CD have a higher risk of orthorexia and experience difficulties in certain eating behaviors. Previous studies have also reported that orthorexia is a significant concern among individuals with CD (2). Additionally, issues related to quality of life and self-esteem have been documented in this population (3). In line with the existing literature, our study found lower life satisfaction and self-esteem in individuals with CD.
Betül Yildirim, Irene París-Gómez, Paola Fuentes-Claramonte, Maria Angeles Garcia Leon, Peter McKenna, Edith Pomarol-Clotet
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BACKGROUND AND AIM:Delusions in schizophrenia have been linked to probabilistic reasoning bias ('jumping to conclusions', JTC), but experimental support has been mixed. Recently, Ward and Garety have proposed a broader abnormality in use of Kahnemans 'fast' thinking (ie using simplifying heuristics) and 'slow' (ie based on full consideration of evidence) underlies delusions. Specifically, they argue that an overreliance on fast thinking and/or reduced engagement of slow thinking underlies the initial development of delusional interpretations of everyday events, and also makes them harder to be corrected. To develop a task to investigate the fast vs slow thinking theory of delusions for use in behavioural and functional imaging studies of schizophrenia. METHODS :A battery of 137 experimental questions (where fast thinking leads to incorrect answers) was generated from multiple sources, including examples of the base rate and conjunction fallacies, the cognitive reflection test (CRT, three types), trick questions, and syllogisms. The questions were administered online to 176 healthy volunteers using PsychoPy
software, with 15 experimental and 15 control questions randomly assigned to each participant. Next, similar sets of 15 experimental and control questions were administered to DSM-5 schizophrenia patients (N=15) on laptop computer. All participants gave written informed consent prior to participation. The study was approved by the ethics committee for the relevant hospitals (PR-2023-25, 31/01/2023). RESULTS:Both the healthy controls and the patients showed markedly more errors to experimental questions than to control questions (p < 0.001 in both cases). In the healthy controls, response latency for the experimental questions was also higher than for the control questions by approximately 1-3 secs (p =.004), apart from in one category (CRT3). The same pattern was observed in the patients with schizophrenia (p =.003). CONCLUSIONS:Results from a large sample of healthy participants indicate that a battery of questions can be feasibly developed to reliably detect fast thinking.
BACKGROUND AND AIM:White matter hyperintensities (WMH) are small, non-mass effect hyperintensities detected on MRI in T2 or FLAIR sequences. Their prevalence increases with age, vascular risk factors, cardiovascular disease, stroke, and dementia. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This study was approved by the Ethics Committee of Elazığ Fethi Sekin City Hospital (2025/2-1). Articles indexed in Web of Science (WoS) on schizophrenia (SCZ), schizoaffective disorder (SAD), and bipolar disorder (BD) in relation to WMH were analyzed using bibliometric methods. The sample included studies from 1990 to 2025 indexed in SCI-E, SSCI, and ESCI. Reviews, case reports, letters, book chapters, and conference proceedings were excluded. RESULTS:As of 09/02/2025, a search for WMH in WoS yielded 6,878 results, with 5,358 research articles. Research in this field has grown significantly since 2008 but declined in 2024. In 2022, 483 studies were published, 450 in 2023, and 472 in 2024. There were 66 studies on SCZ, 98 on BD, and only one on SAD. A total of 602 studies addressed psychiatric disorders. The most prolific author was Howard J. Aizenstein, the leading institution was the University of California System, and the U.S. had the highest number of publications. CONCLUSIONS:Research on WMH in psychiatric disorders increased after 2008 but declined in
2024. SCZ and BD have received more attention, while SAD remains underexplored. BD studies may be more frequent due to its pronounced neurovascular changes. In SCZ, WMH is linked to cognitive decline and disease progression. Future studies should use larger samples and robust methodologies to clarify WMHs role in these disorders.
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