BACKGROUND AND AIM:Gender roles, molded by natural and social elements, influence individuals responsibilities and behaviors in society. From an early age, socialization processes build up gender norms, often leading to inequalities. Masculinity is frequently associated with physical strength and aggression, which can contribute to the normalization of violence against women (VAW). Empathy, the ability to understand and internalize another persons emotions and experiences, has been linked to more egalitarian gender perceptions and a lower tolerance for VAW.This study examines the relationship between empathy, gender perceptions, and attitudes toward VAW among resident physicians. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study surveyed resident physicians at Atatürk University Research Hospital through an online questionnaire.The dependent variable empathy was measured using the Toronto Empathy Scale, gender perceptions through the Perceptions of Gender Scale and attitudes toward VAW via the ISKEBE Violence against Women Attitude Scale. Multivariate regression analysis tested the associations between these variables, controlling for age, gender, marital status, and medical specialty. This study was approved by the Atatürk University Ethical Board (Decision Date: 31/01/2025/ Decision Number:10). RESULTS:This study included 100 participants (76 women, 24 men), aged 24-50, Mean ±SD (31.17±5.01). Specialties: 6 surgical, 89 internal medicine, 5 basic sciences. Marital status: 39 single, 58 married. Preliminary findings show positive and statistically significant relations between gender perceptions and empathy scores (?=0.211,p= 0.017). However, the lower tolerance toward VAW has a negative and insignificant impact on empathy scores (p =0.076). Additionally, we observed a strong correlation between gender perception and lower acceptance of violence against women. (p<0.001, r=0.851). CONCLUSIONS:These results suggest that physicians with more progressive gender attitudes exhibit stronger empathetic tendencies, which may influence their professional attitudes.
Investigation of the Prevalence of Possible Comorbid Night Eating Syndrome and the Effect of Night Eating Syndrome Comorbidity on Clinical Course in Patients Treated in a Psychiatric Inpatient Ward: A Preliminary Study Background and OBJECTIVE: Night Eating Syndrome(NES) is a psychiatric disorder that has been included in the diagnostic system with DSM-5 and needs to be examined in different patient populations. This study aimed to determine the prevalence of probable NES among psychiatric inpatients and examine its association with clinical parameters. METHODS: The sample size for the study was calculated to be at least 237 participants considering the prevalence of night eating syndrome in psychiatric population as 19.8%. However, in this oral presentation, the data of the first 38 patients taken as a preliminary study was presented. A total of 38 patients with 10 psychosis, 9 bipolar disorder, 9 major depression, 5 anxiety disorder, and 5 other psychiatric diagnoses were included in the study. Clinical variables, including disease severity, duration of hospitalization, Generalized Anxiety Disorder-7(GAD-7), Patient Health Questionnaire-9(PHQ-9), Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-Panic Disorder(PHQ-P5) and Night Eating Questionnaire(NEQ) were analyzed. Necessary permissions for the study were obtained from the local ethics committee (IRB: 05.04.2024- 195) RESULTS: Probable NES was identified in 39% of the inpatients. However, no significant differences were found between patients with and without probable NES regarding disease severity(CGI) (p= 0,281), length of hospitalization (p= 0,674), GAD-7 (p= 0,447), PHQ-9 (p= 0,501), PHQ-15 (p= 0,940), and P5 scores (p= 0,733). Similarly, no significant correlations were detected between NES scores and these clinical variables. CONCLUSION: While NES was relatively common among psychiatric inpatients, it did not
demonstrate a significant relationship with disease clinical course and characteristics. Future research with larger sample sizes is needed to further explore the potential clinical implications of NES in psychiatric populations
BACKGROUND AND AIM:ADHD, a prevalent childhood neurodevelopmental disorder, is marked by inattention, impulsivity, and hyperactivity. Adults with ADHD often face higher rates of psychiatric comorbidities, with depression affecting up to 50%. This co-occurrence significantly reduces quality of life and complicates treatment. Understanding ADHD-depression comorbidity is vital for effective clinical management. This study examines the frequency and factors associated with depression in adults with ADHD. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study included 358 individuals diagnosed with ADHD at Selçuk University's Adult Neurodevelopmental Disorders Clinic. Sociodemographic and clinical data were collected, and diagnoses were confirmed through the Structured Clinical Interview for DSM-5. Participants completed the Adult ADHD Rating Scale, Wender Utah Rating Scale, Hospital Anxiety and Depression Scale, Mind Excessively Wandering Scale, and Suicidal Ideation Scale. Ethical approval was obtained from Selçuk University's Local Ethics Committee.(2025/83) RESULTS:The mean age of participants was 23.78 years, with 51.1% (n=183) being female, and an average education level of 14.68 years. Depression comorbidity was present in 28.5% (n=102) of adults with ADHD, with a higher prevalence among females (55.9%, n=57) than males (44.1%, n=45). ADHD patients with depression comorbidity showed significant associations with smoking (?2=4.8, p<0.05), additional psychiatric comorbidities (?2=65.7, p<0.001), and suicide attempts (?2=19.7, p<0.001). No significant relationships were found with alcohol use, substance use, or other medical conditions. Additionally, no differences were observed in self-report scales or other scale evaluations between those with and without depression comorbidity. CONCLUSIONS:This study highlights the prevalence of depression comorbidity in individuals with ADHD, particularly among women, aligning with existing literature. Depression comorbidity is linked to psychiatric disorders, smoking, and suicide attempts, suggesting that emotional regulation difficulties and impulsivity may foster maladaptive coping strategies. The cross-sectional design limits causal inferences, necessitating future longitudinal studies.
Muhammed Can Altınay, Fatma Nur Meral, Fatih Ekici
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BACKGROUND AND AIM:Evaluating treatment response in inpatients diagnosed with major depressive disorder is crucial for clinical management. This study aimed to identify sociodemographic, clinical, and biochemical factors associated with changes in Hamilton Depression Rating Scale (HAM-D) scores in patients hospitalized at the Selçuk University Psychiatry Department. The findings are expected to contribute to understanding the course of depression and developing personalized treatment strategies. METHODS :A retrospective analysis was conducted on 78 patients aged 18 years and older, hospitalized for depression between January 131, 2024. Due to missing data, 57 patients were included in the final analysis. Data included sociodemographic characteristics, psychiatric and medical history, laboratory findings, and treatment protocols. HAM-D scores at admission and discharge were the primary outcome measure. Variables associated with HAM-D score reduction were examined through bivariate analyses, and significant factors were further analyzed using multivariate linear regression. Ethics committee approval number 2025/107 was obtained. RESULTS:Of the included patients, 52.6% were female, with a mean age of 34.8±14.9 years and an average of 3±1.4 depressive episodes. Suicide attempts were reported in 47.4% of the sample, comorbid psychiatric disorders in 41.4%, and a family history of depression in 26.3%. The mean HAM-D score decreased from 22.9±6.4 at admission to 8.9±5.35 at discharge, reflecting a 61.1% reduction in depression severity. Bivariate analyses identified associations between HAM-D score reduction and depression severity, past suicide attempts, psychotic symptoms, comorbid conditions, and certain biochemical parameters. However, multivariate regression analysis revealed that only the number of previous depressive episodes was significantly associated with HAM-D score reduction(p=0.015,t=-2.573). CONCLUSIONS:This study assessed factors related to HAM-D score reduction in inpatients with depression and found that only the number of depressive episodes was a significant predictor of treatment response. These findings suggest that recurrent episodes may limit treatment efficacy, highlighting the importance of considering clinical history in depression management.
BACKGROUND AND AIM:Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, impulsivity, and executive functioning difficulties. Developmental Coordination Disorder (DCD) is another neurodevelopmental disorder involving motor coordination impairments, making common motor tasks challenging. ADHD is the most frequent comorbidity of DCD, and even when not reaching diagnostic levels, DCD symptoms can impact daily functionality. This study aims to explore the relationship between DCD symptoms, ADHD severity, and executive functions in children and adolescents diagnosed with ADHD but without a DCD diagnosis. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study sample included children aged 7-15 years diagnosed with ADHD, evaluated at the Child and Adolescent Psychiatry outpatient clinic of Selçuk University. Exclusion criteria included medical conditions requiring physical therapy, neurological disorders, diagnosed DCD, tic disorders, movement disorders, autism spectrum disorder, and intellectual disability. ADHD severity was assessed using the Turgay Disruptive Behavior Disorders Screening and Evaluation Scale based on DSM-IV. Executive functions were evaluated using the Stroop Test. The Revised Developmental Coordination Disorder Battery was used to assess DCD symptoms. Ethical approval was granted by the Selçuk University Faculty of Medicine Local Ethics Committee (2024/411). RESULTS:The study included 31 girls and 41 boys (mean age: 10.39±2.49 years). DCD symptoms correlated with the Turgay total scale (p=0.020, r=-0.403) and Stroop Test errors in stage five (p=0.043, r=-0.359). CONCLUSIONS:This study examined the relationship between ADHD severity, executive functions, and DCD symptoms in children and adolescents with ADHD. Findings suggest that DCD symptoms may be associated with ADHD severity rather than executive functioning difficulties. However, the single-center design and small sample size limit generalizability. Future research with larger samples is necessary to further investigate these associations.
BACKGROUND AND AIM:The Type D personality is characterized by a tendency to experience negative emotions and inhibit their expression. Depression, on the other hand, is a common mood disorder marked by negative affectivity. Sleep problems are frequently observed in both individuals with depression and those with Type D personality traits. This study aims to examine the relationship between Type D personality traits, bedtime procrastination behavior, and insomnia response to stress in individuals diagnosed with depression, as well as to investigate the effects of these factors on sleep quality. METHODS :All outpatients aged 18-65 with depression were invited, and 40 participated. Participants completed a sociodemographic data form, the Type D Personality Scale (DS-14), the Bedtime Procrastination Scale (BPS), the Ford Insomnia Response to Stress Test (FIRST), the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Ethics committee approval number 2025/107 was obtained. RESULTS:The mean age of participants was 31.6 years, and 60% were female. Type D personality traits were observed in 65% of participants. Bedtime procrastination was positively correlated with depression severity (r=0.19, p<0.05). Type D personality traits were significantly associated with social isolation (r=0.28, p<0.05) and stress-related insomnia response (r=0.45, p<0.01). Increased bedtime procrastination and stress-related insomnia response were linked to lower sleep quality (r=-0.28, p<0.05; r=-0.31, p<0.05). No significant relationship was found between depression and anxiety levels and sleep quality (p>0.05). CONCLUSIONS:Individuals with Type D personality traits exhibit higher bedtime procrastination and stress-related insomnia responses, which are associated with poorer sleep quality. However, no direct relationship was found between Type D personality and sleep quality, suggesting that depression and stress response may act as mediators. These findings emphasize the importance of addressing Type D personality traits and sleep hygiene in depression treatment. Further studies with larger samples are needed to establish causal relationships.
BACKGROUND AND AIM:The challenges in the transplantation process have made left ventricular assist devices (LVADs) an important therapeutic option in HF management. In this context, a multidisciplinary approach is crucial. Psychiatric issues such as depression, anxiety, and cognitive impairments, which are frequently observed in HF patients, can negatively impact the course of the disease and complicate treatment adherence. Psychiatry plays a key role in identifying harmful behaviors, providing psychotherapeutic interventions, assessing social support systems, facilitating adherence to treatments like LVAD or transplantation, delivering psychoeducation, and offering supportive interventions when needed. The presence of cognitive function impairments, psychiatric issues such as anxiety and depression, and deteriorations in quality of life in patients with heart failure (HF) has been extensively examined in the literature. However, the findings regarding the changes in these symptoms over time and the effects of treatments such as LVAD on these processes are still limited and inconsistent.This study aims to evaluate and monitor the cognitive functions, quality of life, anxiety, and depression in patients with heart failure who are under follow-up and are planning to undergo left ventricular assist device (LVAD) implantation or heart transplantation by the cardiology or cardiovascular surgery unit. Another objective of the study is to retrospectively identify the medical factors affecting cognitive functions, anxiety, depression, and quality of life during the follow-up period. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):A total of 37 heart failure patients, who were referred for psychiatric evaluation to the Consultation-Liaison Psychiatry unit for consideration of LVAD implantation or heart transplantation by the cardiology or cardiovascular surgery unit, and who met the inclusion criteria, were included in the study. Of these, 22 patients were followed for six months (initial visit (T0) and 1, 3, and 6 months after the initial visit (T1-T2-T3)), while 12 patients completed the three-month follow-up. Since all 22 patients had threemonth data, the analyses for the three-month follow-up were conducted with a total of 34 patients, and the six-month follow-up analyses were performed with 22 patients. SCID-5 was administered for diagnostic psychiatric assessments at the initial assessment. Self-report scales, including the Hospital Anxiety and Depression Scale (HADS), Short Form 36 (SF-36), Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Multidimensional Scale of Perceived Social Support (MSPSS), were completed by the participants at each follow-up visit. Additionally, the Montreal Cognitive
Assessment (MoCA) test was performed at all time points to assess cognitive functions. At the end of the study, all data on the patients' medical and psychiatric conditions over the six-month follow-up period were retrospectively collected from their medical records, and their relationship with the neuropsychological test results was analyzed. In this study, statistical analyses were conducted as follows: Categorical variables were presented as frequencies and percentages, while continuous variables were reported using mean and standard deviation, as well as median with minimum and maximum values. For the comparison of more than two repeated measurements, Repeated Measures ANOVA was employed, and in cases where a significant difference was detected, Bonferroni correction was applied as the post hoc test. The Students t-test was used to compare the means of continuous variables between two independent groups, whereas One-Way ANOVA was conducted for comparisons involving more than two independent groups. To evaluate the interaction between time and LVAD status, Two-Way Repeated Measures ANOVA was applied. The relationships between continuous variables were assessed using Pearsons correlation coefficient. A p-value of <0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics 25.Ethical approval for the study was obtained from the Ethics Committee of Ege University Faculty of Medicine with the decision number 24-3T/75, dated 07.03.2024. RESULTS:The mean age of our sample was 48.1±12.5 years, with 81.1% being male, 64.9% married. The majority were classified in NYHA stage II and III. The mean ejection fraction was 20.51±8.42%, the 6-minute walk test distance was 386.58±89.74 meters, and peak VO2 was 11.53±3.19 ml/kg/min. At the beginning of the study, it was observed that the mean values of biochemical parameters, except for LDH and direct bilirubin, were within the reference range. At the end of six months, all patients who were approved for LVAD and/or transplantation were listed for transplantation, and 37.1% underwent LVAD implantation. At the initial assessment, 48.6% of patients were diagnosed with a psychiatric disorder according to SCID-5 (27% major depressive disorder, 16.2% anxiety disorder). During the three-month follow-up of 34 patients, no significant changes were observed in the scale scores over time. Similarly, no significant changes were found during the six-month follow-up of 22 patients.Temporal analyses were repeated by grouping patients according to whether they underwent LVAD implantation. In the three-month follow-up, LVAD-implanted patients had lower SF-36 social function and physical role limitation scores at T1 compared to those without LVAD, but this difference disappeared in the subsequent follow-up period. In the six-month follow-up of 22 patients, significant group-time interactions were found in the quality of life scales between the LVAD and non-LVAD groups. This difference was particularly observed at T3. The SF-36 social function scale was similar at both three and six months, but when the LVAD group was evaluated within itself at six months, a significant increase in social function was observed. In the MLHFQ and HADS scores, the non-LVAD group showed almost no change between T0 and T3, while the LVAD group showed a downward trend, although not statistically significant. Similarly, while the scores of the non-LVAD group remained stable over time, the MoCA scores of the LVAD group showed an increasing trend, although no statistically significant group-time interaction was observed. Significant correlations were also found between biochemical parameters and functional capacity indicators with the scales during the follow-up period. CONCLUSIONS:No patients underwent transplantation during the study period, but those who received LVAD showed better quality of life outcomes at six months compared to those who did not. Although clinical improvements were observed in anxiety, depression levels, and cognitive functions, these improvements did not reach statistical significance. This suggests that larger sample sizes and longer follow-up periods are needed to more clearly demonstrate emotional and cognitive improvements.
REFERENCES:1-Aloisi G, Zucchelli A, Aloisi B, Romanelli G, Marengoni A. Depression and heart failure: an intricate relationship. Monaldi Arch Chest Dis. 2019;89(3):10.4081/monaldi.2019.1029. Published 2019 Sep 11 2-Brouwers C, Denollet J, de Jonge N, Caliskan K, Kealy J, Pedersen SS. Patient-reported outcomes in left ventricular assist device therapy: a systematic review and recommendations for clinical research and practice. 3-Connors EJ, Hauson AO, Barlet BD, et al. Neuropsychological Assessment and Screening in Heart Failure: a Meta-Analysis and Systematic Review. Neuropsychol Rev. 2021;31(2):312-330 4-Davis KK, Allen JK. Identifying cognitive impairment in heart failure: a review of screening measures. Heart Lung. 2013;42(2):92-97 5-Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443
Canberk Emri, Koray Hamza Cihan, Kazım Cihan Can, Rifat Serav İlhan
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BACKGROUND AND AIM:The role of the immune system in psychotic disorders dates back to 1967, with several studies showing its involvement.Inflammatory ratios like NLR and LMR are useful and inexpensive biomarkers.No studies have explored the relationship between NLR and LMR in hospitalized psychosis cases.This study examines the association between these immune markers and the need for acute intervention due to agitation, hypothesizing that this will be reflected in the equivalent doses of antipsychotics and benzodiazepines.Thus, it is hypothesized that immune biomarkers could help determine the optimal drug dose for pharmacological intervention in acute agitation in psychiatric patients, thereby preventing the administration of unnecessarily high doses of medication. METHODS :The study included 100 patients admitted to psychiatric wards between July-December 2024, diagnosed with schizophrenia or non-organic psychosis and requiring acute pharmacological intervention.Blood samples were analyzed for hemogram parameters; NLR and LMR were calculated.The study protocol was approved by the Ankara University Faculty of Medicine Ethics Committee (Date:29.01.2025 No:İ01-58-25) and conducted following the Declaration of Helsinki. Statistical analyses were performed using SPSS, with normality assessed via skewness and kurtosis tests.For the correlation and comparison of the data, t-test and Pearson tests were used for parametric cases, while Mann-Whitney-U and Spearman tests were applied for nonparametric cases. RESULTS:No statistically significant correlation was observed between LMR and Equivalent Antipsychotic Dose (p=0.388) or Equivalent Benzodiazepine Dose (p=0.136).Similarly, the correlation between NLR and Equivalent Antipsychotic Dose (p=0.960) or Equivalent
Benzodiazepine Dose (p=0.356) was not found to be statistically significant.There was no statistically significant difference in NLR (p=0.826) and LMR (p=0.136) values between psychotic cases requiring acute intervention and those not requiring it. CONCLUSIONS:The correlation between NLR, LMR, and equivalent antipsychotic and benzodiazepine doses on the first day of hospitalization was evaluated.Findings were inconclusive, highlighting the need for further studies on immunity in acute agitation during psychotic episodes.
Introduction and Aim Psychiatric emergencies are conditions that require urgent intervention and involve thought, emotion, and behavior disorders that may pose a threat to individuals or their surroundings. Consultation-liaison psychiatry (CLP) plays a crucial role in the holistic management of psychiatric disorders. The aim of our study is to examine the demographic characteristics, psychiatric diagnoses, and reasons for hospitalization of patients who presented to the emergency department of our hospital and were referred for psychiatric consultation. METHODS: This retrospective, single-center study analyzed the medical records of 1,288 patients referred to psychiatry from the emergency department over two years (20212023). Ethical approval was obtained on 12.04.2023 (No: 2023/514/247/10). Results The analysis revealed that 660 (51.2%) of cases were female and 628 (48.8%) were male. The most common age group was 2535 years (27.02%), and the majority (40.83%, n=526) were high school graduates. Among those referred from the emergency department to psychiatry and recommended for hospitalization, Major Depressive Disorder was the most common diagnosis (28.1%, n=83), followed by Bipolar Disorder (24.8%, n=73) and Schizophrenia (8.1%, n=24). Of the 171 patients hospitalized after a suicide attempt, Major Depressive Disorder was the most frequent diagnosis (37.4%, n=64). Drug ingestion was the most common suicide method in all groups and genders, with women using it more frequently (34%, n=58), while sharp object injuries were more common in men.
Discussion and CONCLUSION: The review showed that 660 (51.2%) of the cases were female
and 628 (48.8%) were male. According to our findings, the consultation rate among women was higher than that of men. The higher number of female patients may be associated with gender roles, as women tend to seek psychiatric support more frequently. Systematizing CLP practices and strengthening collaboration between medical specialties can help prevent unnecessary hospitalizations and contribute to more effective healthcare planning.
BACKGROUND AND AIM:Sleep deprivation has been widely linked to the exacerbation of dissociative symptoms. Insufficient sleep weakens cognitive control, making individuals more prone to negative thoughts.This study aimed to explore the relationship between sleep quality, dissociation, and ruminative thoughts in young adults. METHODS:This field study at Selçuk University involved 647 volunteer students from 36 faculties, selected through random sampling. Using a descriptive research design, participants completed a semi-structured sociodemographic questionnaire and self-report measures, including the Dissociative Experiences Scale (DES), the Ruminative Thinking Style Questionnaire (RTSQ) and the Pittsburgh Sleep Quality Index (PSQI). Ethical approval was granted by the Selçuk University Local Ethics Committee (2024/63). RESULTS:Correlation analyses revealed significant positive associations between RTSQ and DES (r = 0.441, p < 0.001), RTSQ and PSQI (r = 0.338, p < 0.001), and DES and PSQI (r = 0.309, p < 0.001). Logistic regression identified RTSQ (OR = 1.031, p = 0.000) and PSQI (OR = 1.145, p = 0.000) as significant predictors of DES. Among PSQI subscales, sleep disturbance (OR = 1.889, p = 0.001) was particularly significant. Mediation analysis showed that PSQI had both direct (? = 2.019, p = 0.000) and indirect (? = 0.982, p = 0.01) effects on RTSQ via DES. CONCLUSIONS:Our findings suggest that dissociative experiences may result from involuntary transitions between waking and sleep-related consciousness due to emotional stress. Poor sleep quality not only increases dissociation but also contributes to rumination, both directly and indirectly. Sleep disturbances play a central role in this effect. However, limitations exist: childhood trauma, depression, and anxietyfactors strongly linked to dissociationwere not assessed. Those with psychiatric illness were not excluded. The study also relied on self-reports
and had a cross-sectional design, limiting causal inferences. Future research should investigate these relationships prospectively.
BACKGROUND AND AIM The presence of various myths and beliefs about sexuality in individuals with erectile dysfunction creates a predisposition for the development of the difficulty experienced. Psychogenic causes are performance anxiety, negative cognitive beliefs, anxiety disorders, and psychotic disorders. These beliefs can affect sexuality by influencing individuals' attitudes and behaviors. This study aimed to evaluate the relationship between obsessive beliefs, anxiety, and sexual dysfunction in men with psychogenic erectile dysfunction. METHODS Twenty-three individuals evaluated at the Urology outpatient clinic were referred to the Psychiatry outpatient clinic when there was no organic reason for erectile dysfunction. Sociodemographic data form, International Index of Erectile Function-15 (IIEF-15), Obsessive Beliefs Questionnaire-44 (OBQ-44), and State-Trait Anxiety Inventory (STAI) were applied to all participants with correlation analysis. Approval was received from the ethics committee with the date 28.12.2023 and decision number 2023/112. RESULTS The mean age of the men included in the study was 35.61±4.51 and the mean years of education was 19.26±3.68. There is a negative relationship between the two sub-dimensions of IIEF-15 and OBQ-44, namely increased perception of responsibility/exaggerated perception of threat (OBQ-RT) (p=0.02, r=-0.64), giving importance to thoughts/control of thoughts (OBQ-ICT) (p=0.03, r=-0.61) and STAI (p=0.02, r=-0.55). CONCLUSIONS In studies, one of the factors underlying male sexual functions is cognitive beliefs and myths. In a study conducted in our country, sexual beliefs about sexual intercourse and orgasm were found to be higher in men with erectile dysfunction than in those without. Our findings show that state anxiety and obsessive beliefs may be related to sexual dysfunction in men with psychogenic erectile dysfunction. It can be suggested that understanding the role of sexual
dysfunctions, obsessive beliefs, and anxiety in individuals with psychogenic erectile dysfunction is important for the development of psychotherapeutic interventions.
BACKGROUND AND AIM:BACKGROUND: Somatic symptoms(SB) are common in the geriatric population.While the world population is aging rapidly, older adults constitute 10.0% of the world population and 10.3% of the population of Turkey.Considering the sociodemographic data of the increasing elderly population in our country, treatment options and follow-up for cognitive or somatic symptoms were analysed. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):Ethics Committee approval has been made (2025-YÖNP-0100). The symptoms of patients over 65 years of age with primary complaint of SB who applied to the geriatric psychiatry outpatient clinic of COMU Hospital between 2024- 2025 were evaluated with DSM-5-oriented psychiatric interview and their data were analysed as retrospective archive review.Diffuse body aches, headaches with no organic cause, numbness and gastrointestinal symptoms were accepted as SB.Patients diagnosed with Alzheimer's dementia, bipolar disorder, psychotic disorders and depression with psychotic features and patients with no SB were excluded from the study.Due to exclusion criteria, 271 patients over 65 years of age who applied to the outpatient clinic were not included in the study.A total of 60 patients were included in the study and their subsequent outpatient clinic visits were recorded. RESULTS:Follow-ups were performed for a mean of 5.00 ± 4.14 months and patients had a mean of 3.00 ± 2.67 follow-up visits.SSRIs were used in 69.4%, SNRIs in 33.2%, antipsychotics in 6% and atypical antidepressants in 18.3% of the patients.When the diagnoses of the patients were analysed, 55.7% were diagnosed with depressive disorder, 32.7% with anxiety disorder.Dementia accompanying depressive symptoms was considered in 8.4%of the patients. CONCLUSIONS:Somatic complaints are the main symptom of depression and anxiety disorders in geriatric patients. It is important to evaluate geriatric patients with SB as their primary complaint from a psychiatric point of view, not to overlook these symptoms in CLP applications, and to screen these complaints routinely even if the patient doesnt report somatic complaints.
Hakan Emre BABACAN, Ömer faruk uygur, Oğuz Erçelik, Halil Ozcan
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BACKGROUND AND AIM:Transcranial magnetic stimulation (TMS) is a non-invasive, well-tolerated treatment modality that does not require anesthesia and has no serious side effects.TMU has been indicated in depression and obsessive-compulsive disorder, but its use in schizophrenia, post-traumatic stress disorder and substance use disorder is under investigation.In this study, we aimed to present one-year TMU treatment experiences in a university hospital. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The files of patients who received TMU treatment in our TMU unit in the last one year were reviewed.Descriptive analyses of sociodemographic, clinical and TMU protocol information were performed.Our study was approved by Atatürk University Faculty of Medicine Ethics Committee (07.06.2024/100). RESULTS:175 TMU application files were accessed, but 9 of these files were excluded from the study because they were re-application to the same patient, and a total of 166 patient files were included in the study.The mean age of the patients was 39.50±14.42 years(min-max:18-83),62.7% were female(s=104) and 37.3% were male(s=62).The most common diagnoses of patients who underwent TMU were unipolar depression(s=88,53%),obsessive-compulsive disorder (s=36,21.7%),and bipolar depression(s=15,9%),respectively.In 31.3%(s=52) of patients who underwent TMU,TMU was administered during hospitalization.The most common TMU protocol was intermittent theta burst to the left dorsalateral prefrontal cortex (DLPFC) with continuous theta burst to the right DLPFC (s=48,28.9%) and TMU was most commonly applied to the left and right DLPFC regions(s=81,48.8%).Accelerated TMU treatment of more than one session per day was applied to 42.8% of patients(s=71).During TMU treatment,67.8%(s=61) of the patients who were followed up with clinical scales responded to the treatment.44 patients(26.5%) discontinued TMU treatment and the most common side effect during TMU treatment was headache(s=19,11.4%). CONCLUSIONS:In our clinic, short-term sessions and TMU treatment to DLPFC were preferred in order to reach more patients. Considering that TMU is applied to resistant patients, it is another important result that the response rate to treatment was quite high in our study.
ANAS HAVARI, Mine Özkan, Nerses Bebek, Ayse Deniz Elmali, Candan Gurses, İrem Erkent, Irmak Polat
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BACKGROUND AND AIM:Functional Neurological Symptom Disorder (FNSD) is characterized by motor, sensory or cognitive changes that do not correspond with existing neurological or medical conditions. These changes may include symptoms such as non-epileptic seizures, abnormal movements or loss of strength. Since the beginning of the millennium, the focus on neurobiological causes in the etiology of FNSD has begun to expand old psychological theories and investigate new psychological factors (Edwards et al. 2012, Fobian and Elliott 2019). In our study, we aimed to examine attachment styles, interpersonal relationships and problems, which are some of the areas where there is not enough data in the literature in patients with FNSD. In addition, taking into account the close relationship of this disorder with diseases characterized by other psychosomatic symptoms, we aimed to contribute to the FNSD literature with additional findings on the psychosomatic profiles of FNSD patients with the Diagnostic Criteria for Psychosomatic Research (DCPR), which was developed by an international group of researchers working in the field of psychosomatics and which transforms psychosocial variables into individual diagnostic tools. In this context, studies on subgroups of FNSD, especially Psychogenic Non-Epileptic Seizures (PNES) and other forms of PNSD are usually compared in clinical basis (Erro et al. 2016). However, in our study, we aimed to examine PNES and non-PNES patients from a multidimensional perspective by evaluating not only clinical differences but also psychosocial factors. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):65 patients who were referred to Istanbul University Istanbul Faculty of Medicine (İUFOM) Department of Psychiatry, Division of Consultation-Liaison Psychiatry (CLP) by İUFOM Department of Neurology; who had been followed up for a while with a diagnosis of FNSD at the CLP or general psychiatry outpatient clinic, who were referred to İUFOM Department of CLP for further examination by Koç University Faculty of Medicine, Department of Neurology, who were diagnosed with FNSD by a psychiatrist or neurologist; and 65 healthy controls were included. Participants were assessed using sociodemographic and clinical data, Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV), Experiences in Close Relationships-Relationship Structures (ECR-RS), and Inventory of Interpersonal Problems- Circumplex Scales Short Form (IIP-32). Psychosomatic diagnoses were examined by the Diagnostic Criteria for Psychosomatic Research (DCPR) only in the patient group. Statistical analyses in the study were performed with NCSS 2007 (Number Cruncher Statistical System) software. Descriptive statistics (mean, standard deviation, median, IQR) were calculated and
normality was evaluated by Shapiro-Wilk test. Independent t-test was used for normally distributed data, Mann-Whitney U test was used for non-normally distributed data, Chi-square and Fisher reality test were used for qualitative data, and Pearson correlation was used for relationships between variables (p<0.05 was considered significant). Ethical Approval: Ethical approval was obtained from the İstanbul University İstanbul Faculty of Medicine Clinical Research Ethics Committee (Protocol number: 2023/2344). RESULTS:In the patient group, the rate of females and males was 80% and 20%, respectively. The mean age of the patient group was 35.54 ± 11.47 years. Forty-seven patients (72.3%) were diagnosed with psychogenic non-epileptic seizures (PNES), while the remaining 18 patients (27.7%) had other types of FNSD (14 patients were diagnosed with functional movement disorder, 2 patients with psychogenic vertigo and 2 patients with functional speech disorder). At least one active psychiatric comorbidity was detected in 61.54% of FNSD patients. The most common comorbidities were major depressive disorder (29.23%), anxiety disorders (24.62%) and somatic symptom and related disorders other than FNSD (20%). Comorbidity rate of PNES and epilepsy was 44.62% (27 patients). A number of differences were found between the patients with FNSD and the control group. The rate of individuals with a past psychiatric history was significantly higher in the patient group compared to the control group (p=0.0001). According to the DCPR results, the most common DCPR diagnoses in the patient group were conversion symptoms (87.7%), persistent somatization (63.1%), type A behaviour (41.5%), lack of resistance (40%) and alexithymia (38.46%). In general, attachment anxiety in relationships was found to be significantly higher in the patient group, and anxiety and avoidance levels related to the partner were also found to be higher compared to the control group. In terms of interpersonal problems, dominant controlling, vindictive egocentric, intrusive needy and cold distant interpersonal patterns were more prominent in the patient group, and the levels of social inhibition and inability to defend oneself were also higher. In addition, certain correlations were found between the scales. In the patient group, the number of DCPR diagnoses showed significant positive correlation with the total score and various subscale scores of the IIP-32, and with the scores of the maternal anxiety dimension (r=0.317, p=0.010) and the partner anxiety dimension (r=0.379, p=0.002) of the ECR-RS. Partner anxious attachment dimension stands out as the attachment dimension showing the strongest relationship with interpersonal problems. Significant positive correlations were found especially with the cold distant, socially withdrawn, unassertive and overly agreeable subscales of the IIP-32, and it was also positively correlated with the total score. As a result of the comparison of PNES and non-PNES subgroups, the rate of complaint-free periods lasting at least three months was found to be significantly higher in PNES patients than in non-PNES patients (p=0.002). No significant difference was found between the two subgroups in terms of attachment dimensions and styles, interpersonal problems and psychosomatic profiles. CONCLUSIONS:In this study, it was determined that problems in interpersonal relationships and high levels of attachment anxiety were observed together in patients with FNSD. The prevalence of conversion symptoms, persistent somatization and type A behavior, according to the DCPR diagnoses, indicates that FNSD has a complex structure based on a psychosomatic basis. In the comparison between PNES and non-PNES subgroups, no significant difference was found in terms of interpersonal problems, attachment styles and dimensions, and psychosomatic profiles, suggesting that different subtypes of FNSD may share a common psychopathological background. Our results reveal that FNSD patients have significant problems in their interpersonal relationships. Therefore, taking psychosomatic diagnoses into account and focusing on the effects of interpersonal problems on symptoms in the clinical
evaluation and treatment processes of FNSD patients may increase treatment success. REFERENCES:1. Edwards, M. J., Adams, R. A., Brown, H., Parees, I., & Friston, K. J. (2012). A Bayesian account of hysteria. Brain, 135(11), 34953512. https://doi.org/10.1093/brain/aws129 2. Erro, R., Brigo, F., Trinka, E., Turri, G., Edwards, M. J., & Tinazzi, M. (2016). Psychogenic nonepileptic seizures and movement disorders: A comparative review. Neurology Clinical Practice, 6(2), 138149. https://doi.org/10.1212/CPJ.0000000000000235 3. Fobian, A. D., & Elliott, L. (2019). A review of functional neurological symptom disorder etiology and the integrated etiological summary model. Journal of Psychiatry & Neuroscience.
OBJECTIVE:Methylphenidate is widely used in the treatment of Attention-deficit and hyperactivity disorder(ADHD). However, it is known to cause psychotic symptoms even at therapeutic doses. Furthermore, diagnostic confusion can arise due to the overlap in symptoms between ADHD and schizophrenia. This case report discusses a patient who was previously diagnosed with ADHD, treated with methylphenidate, and subsequently experienced recurrent psychotic episodes. Written and verbal informed consent was obtained from the patient. CASE (The patient consent must be provided and specified with appropriate terms.):A 27-year-old male patient was admitted to our inpatient unit with hallucinations, delusions, and disorganized behavior. Upon admission, he presented with irritability and euphoria The patients first psychiatric consultation occurred in 2012, at a child psychiatry clinic, due to hyperactivity and inappropriate behaviors. He was diagnosed with ADHD and started on methylphenidate. However, he never achieved full remission. In 2015, he experienced his first psychotic episode and was diagnosed with atypical psychosis. Since 2016, he has had four psychiatric hospitalizations due to recurrent psychotic episodes and was treated with various antipsychotics, both as an inpatient and outpatient. In 2024, he was admitted to our unit again due to a psychotic episode. DISCUSSION:Studies have shown that ADHD is the most frequent comorbid condition in children and adolescents with schizophrenia. The neuropsychological changes hypothesized for these two disorders partially overlap, leading to diagnostic confusion in early stages. Methylphenidate, a commonly used medication in ADHD treatment, requires careful consideration. Its effects on the brain are similar to those of cocaine, as it rapidly penetrates the brain and stimulates dopamine release. Dopamine plays a significant role in the development of psychosis. In summary, ADHD should be diagnosed with caution, particularly in childhood, and medication choices should be made with sensitivity. For mild to moderate cases, alternative medication options should be considered before initiating psychostimulants.
OBJECTIVE:The postpartum period predisposes women to various psychiatric disorders(1). Postpartum psychiatric conditions such as postpartum blues, postpartum depression, and postpartum psychosis (PP) can emerge during this period. PP, though rare in the general population (0.89-2.6 per 1000 births), is a psychiatric emergency requiring prompt evaluation and intervention due to its severe outcomes(2,3). This paper discusses a case of PP, analyzed with informed consent and in light of the literature. CASE (The patient consent must be provided and specified with appropriate terms.):A 32-year-old woman, 38 weeks pregnant, was referred for psychiatric evaluation on the second postpartum day. The patient exhibited symptoms including withdrawal, refusal to care for her baby, nonsensical speech, and visual hallucinations starting on the first postpartum day. Her history revealed epilepsy treated with 800 mg/day carbamazepine during pregnancy, hypertensive progression, and emergency cesarean delivery due to eclampsia. On psychiatric examination, she presented with distressed affect, irritable mood, visual, auditory, and tactile hallucinations, persecutory delusions, circumstantial speech, and aggression for the past week. Routine laboratory tests and EEG results were normal. The patient was admitted to the psychiatric ward with a preliminary diagnosis of PP. Treatment with 10 mg/day olanzapine was initiated. By the 14th day, her hallucinations subsided, but persecutory delusions persisted. At the 40-day follow-up, she showed no positive psychotic symptoms. DISCUSSION:PP typically manifests within the first two weeks postpartum(4). In this case, symptoms began on the second postpartum day. Cesarean delivery is a known risk factor for PP, and emergency cesarean due to eclampsia was a contributing factor in this case(5,6). Eclampsia has been reported as a significant risk factor for PP development(7). Literature highlights olanzapine, quetiapine, and risperidone as primary treatments for PP(8). Consistent with this, 10 mg/day olanzapine effectively alleviated psychotic symptoms in our patient.
OBJECTIVE:Anorexia Nervosa (AN) is frequently comorbid with mood disorders such as Bipolar Disorder and depression. Suicide ideation should be routinely assessed in patients with comorbid disorders, regardless of the severity of eating disorder or depressive symptoms. This study presents a case of a patient with Bipolar Affective Disorder Type II (Bipolar II) and comorbid AN, who had recurrent suicide attempts, with consent obtained. The case is discussed in light of current literature, emphasizing the increased suicide risk and the need for a multidisciplinary treatment approach. CASE (The patient consent must be provided and specified with appropriate terms.):Consent has been obtained from the patient. A 19-year-old female with a history of AN and Bipolar II presented with depressive symptoms and recurrent suicide attempts. She had received initial AN treatment in 2020, followed by the diagnosis of Bipolar Disorder. Upon admission, the patient exhibited one month of depressive symptoms and restrictive eating behaviors. Treatment was initiated, leading to improvements in both depressive and eating disorder symptoms. After discharge, however, the patient made a second suicide attempt and was readmitted. Psychotherapy and pharmacotherapy continued, and the patient showed improvement. DISCUSSION:The comorbidity of eating disorders and Bipolar Disorder suggests shared pathophysiological mechanisms. Patients with both conditions tend to experience higher rates of depression, suicide attempts, and other psychiatric comorbidities. In this case, childhood sexual abuse was considered a significant factor in triggering suicidal behavior. Mood stabilizers such as lamotrigine and lithium were effective in treating both disorders. In conclusion, treatment and psychotherapy strategies for comorbid Bipolar Disorder and eating disorders must be carefully planned, considering the unique clinical characteristics of both conditions.
Koray Hamza Cihan, Kübra Özçelik, Kazım Cihan Can, Erguvan Tuğba Özel Kızıl
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OBJECTIVE:Alzheimers disease(AD) is the most common cause of dementia and is typically characterized by progressive memory loss.However, behavioral variant AD(bvAD) is a rare clinical subtype that manifests with prominent behavioral symptoms and executive
dysfunction.This variant is often confused with the bvFTD.Neuropsychological assessment, imaging techniques, and CSF biomarkers play a crucial role in diagnosis.This presentation discusses a case highlighting the importance of biomarkers in the diagnosis of bvAD. CASE (The patient consent must be provided and specified with appropriate terms.):A 73-year-old-female patient presented to our clinic in October-2024 with symptoms of irritability, forgetfulness, inappropriate social behaviors, and food hoarding.Her daughter reported that, over the past year, the patient had been giving her phone number to strangers and inviting them home, engaging in socially inappropriate speech, mistaking olives for raisins and boiling them, and collecting bird food in the house.Before these symptoms, she had no history of such behaviors, but she had begun experiencing increasing difficulties in remembering dates, forgetting names, and exhibiting short-term memory loss, especially in the last six months.Neuropsychological evaluation revealed MMSE:19/30, CDT:2/5, and FAB:10/18.Brain MRI showed medial temporal atrophy classified as stage 2(MTA2).Brain PET imaging demonstrated reduced glucose metabolism in the left medial temporal lobe (Z-score:-3.48).CSF analysis revealed elevated phosphorylated-Tau181(41.66pg/ml), increased total-Tau(475pg/ml), elevated phosphorylated-Tau181/AmyloidBeta42 ratio(0.0369), and increased total-Tau/AmyloidBeta42 ratio(0.4207).These CSF biomarkers provided neuropathological support for the diagnosis of bvAD.During follow-up, the patients treatment regimen was adjusted to sertraline200mg/day, trazodone50mg/day, donepezil10mg/day, and memantine20mg/day.Verbal informed consent for the case presentation was obtained from the patient and her relatives. DISCUSSION:This case demonstrates that bvAD can be mistaken for other neurodegenerative disorders.CSF biomarkers enhance diagnostic accuracy.While MTA and increased total-Tau/AmyloidBeta42 ratio are indicative of typical AD, the lateralized PET findings, behavioral symptoms, and frontal lobe dysfunction suggest atypical variant.The use of advanced biomarkers, such as CSF analyses, plays a critical role in the accurate diagnosis and management of atypical cases.
Mehmet Eren Yaşaran, Soner Akar, Cansu Bak, Aslıhan Özdemir Yaşaran, Figen Ünal Demir
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OBJECTIVE:Myositis is a chronic inflammation of the skeletal muscle, leading to muscle weakness. Clozapine-induced myositis is a rare side effect reported in the literature. We present a schizoaffective disorder patient followed-up for 19 years, who has used clozapine for one year. After reporting lower extremity weakness, elevated creatine kinase (CK) levels led to a neurology
consultation. Upon myositis diagnosis, this rare side effect was documented to contribute to the literature. CASE (The patient consent must be provided and specified with appropriate terms.):The patient was a 53-year-old male with schizoaffective disorder for the past 19 years. His initial symptoms included apathy, lack of motivation, and fear of harm, with psychotic episodes. He had multiple depressive episodes requiring hospitalization. Despite treatment with various psychotropics, he showed only partial improvement. In February 2024, clozapine was initiated and increased to 200 mg/day, leading to functional improvement and reduced depressive symptoms. In November 2024, he reported leg weakness. Blood tests revealed CK: 1939 U/L, CK-MB: 62.08 U/L, C-reactive protein: 5.03 mg/L, alanine aminotransferase: 77.5 U/L, and aspartate aminotransferase: 97.8 U/L. Recent infections, cardiac pathologies, and acute conditions like neuroleptic malignant syndrome were excluded. Neurology consultation and electromyography found no alternative cause for the myositis. The clozapine was gradually tapered and transitioned to olanzapine. CK levels were monitored: ? 200 mg/day: CK 1939 U/L ? 150 mg/day: CK 1847 U/L ? 100 mg/day: CK 1193 U/L ? One month after discontinuation: CK 248 U/L (within normal range) Written informed consent was obtained from the patient and his relatives for the case report. DISCUSSION:To confirm clozapine-induced myositis, other causes must be excluded. As a dose-independent effect, CK normalization after discontinuation strongly supports a drug-induced etiology. Though rare, clinicians should consider myositis in clozapine-treated patients with musculoskeletal symptoms.
OBJECTIVE:We aimed to evaluate mood disorder and obsessive-compulsive disorder accompanying Tourette syndrome and to present the effects of Aripiprazole treatment in a patient with these two comorbidities. CASE (The patient consent must be provided and specified with appropriate terms.):A 28-year-old female patient presented to the psychiatric emergency department following thoughts of
death and a suicide attempt with medication. After evaluation in the emergency department, she was admitted to the hospital due to the risk of suicide. Through a psychiatric interview, the patient's psychiatric history was identified. She had been diagnosed with Tourette Syndrome due to motor and vocal tics that began at the age of six. It was learned that she had also been followed up with a diagnosis of obsessive-compulsive disorder in her psychiatric history. In this patient, auditory and visual hallucinations accompanied depressive symptoms at the time of admission. Additionally, distractibility, insomnia, flight of ideas, increased speech and speed, and psychomotor agitation were observed, leading to the consideration of a bipolar mixed episode. Therefore, the previously prescribed Aripiprazole 30 mg/day was discontinued, and treatment was switched to Haloperidol 20 mg/day and Quetiapine 200 mg/day.While the patient was receiving haloperidol treatment, depressive symptoms improved; however, an increase in tics as well as a worsening of obsessive thoughts was observed.Therefore, the decision was made to resume treatment with aripiprazole 30 mg/gün. During follow-up with aripiprazole therapy, a significant reduction in tics and a significant notable decrease in obsessive thoughts were observed. Informed consent was obtained from patient. DISCUSSION:This case illustrates the critical need for personalized treatment in TS, particularly when intertwined with OCD and mood disorders. Aripiprazoles partial dopamine agonist properties effectively addressed the wide range of neuropsychiatric symptoms, unlike traditional dopamine antagonists like Haloperidol, which worsened specific symptoms.Further research is recommended to explore Aripiprazoles broader applications in TS with psychiatric comorbidities.
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