BACKGROUND AND AIM:Problematic alcohol use in university students is a critical
public-health issue because it is associated with academic disruption, high-risk
behaviors, and psychological burden. While established tools (e.g., AUDIT, CAGE,
RAPS4-QF) are widely used, student populations may exhibit early functional harms
(academic decline, dangerous situations, financial strain, mood and sleep problems)
before classical dependence patterns become apparent. Therefore, a brief,
multidimensional, and practically implementable risk score that reflects both
consumption intensity and real-world impairment may improve early detection and
targeted intervention.
We aimed to develop and validate an AI-assisted Alcohol Risk Score for university
students, and to examine its reliability, convergent validity with established instruments,
and machine-learning (ML) classification performance for actionable risk stratification. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):A cross-sectional survey was conducted in collaboration with a university
Center for Combating Addiction. The questionnaire captured a wide range of alcoholrelated domains, including demographics and contextual variables, alcohol use
patterns (lifetime, past year/month/week; weekly frequency; standard drink amount;
binge drinking), and alcohol-related psychosocial/health factors (e.g., academic impact,
dangerous situations, help-seeking, mood changes, perceived harms, and intention to
quit). The overall conceptual framework deliberately extended beyond consumption to
include functional impairment, psychological correlates, and readiness-to-change
indicatorsdimensions particularly salient in student populations. Ethics approval was
obtained from the institutional ethics committee (05.06.2024, 2024/05-08).AI-assisted item selection and model construction:
The initial candidate pool included 72 raw items, consolidated and refined into 59
unique items after removing conceptually duplicate or non-informative candidates.
These items were evaluated using an AI-assisted scoring approach (OpenAI ChatGPT 4.5
API) based on predefined criteria reflecting screening suitability, clinical relevance,
clarity, and discriminatory potential. From this AI-ranked pool, a preliminary set of 20
items was created, followed by expert review by four authors; items with strong
consensus and relevance were retained, resulting in a final 15-item risk score model.
Scoring and risk stratification:
The model includes binary (0/1) items and two frequency/intensity items scored from 0
4, generating a total score range of 027. Risk categories were defined as 05 (low risk),
612 (moderate risk), and 1327 (high risk), designed to create actionable strata for
screening and triage.
Validation and machine learning evaluation:
Convergent validity was assessed via associations with established screening tools
(AUDIT, CAGE, and RAPS4-QF). Internal consistency reliability was tested using
Cronbachs alpha and McDonalds omega. For classification performance, multiple ML
algorithms were evaluated (logistic regression, support vector machines, random forest,
and k-nearest neighbors). Models were assessed using accuracy and class-wise F1
scores; additional evaluation included cross-validation and ROC-AUC estimates via a
one-vs-rest strategy. Feature contributions were examined using permutation
importance to identify the most informative items in final risk score. RESULTS:A total of 599 university students were included (mean age 20.84 ± 3.27 years),
with 66.8% women; 37.2% were first-year students and 42.6% were enrolled in medical
school. Past-month alcohol consumption was reported by 45% of participants; 9.8%
consumed alcohol three or more days per week during same period. Binge drinking (?5
standard drinks at a time; ?4 for women) was observed in 6.7% overall, with a
significantly higher rate in men than women.
Risk score distribution and clinical gradients:
The new 15-item risk score produced a mean of 3.65 ± 3.64, with men scoring higher
than women (4.37 ± 3.75 vs 3.27 ± 3.54, p<0.001). Based on predefined thresholds,
74.6% (n=447) were classified as low risk, 22.9% (n=137) as moderate risk, and 2.5% (n=15) as high risk. Proportion of women was higher in the low-risk category, while men
were relatively more represented in the moderate-risk group; the high-risk category
proportion was similar across genders.
Crucially, risk categories demonstrated meaningful clinical differentiation:
moderate/high-risk students reported more psychological complaints, higher smoking
rates, and greater family alcohol consumption (all p<0.001). The high-risk category
showed striking elevation in harm-related outcomes, including academic impairment,
alcohol-related medical needs, dangerous situations or legal issues, inability to attend
classes, missing exams/assignments, neglecting professional responsibilities, financial
difficulties, sleep disturbances, alcohol-related mood changes, and perceiving alcohol
as a serious problem (all p<0.05). Notably, binge drinking in the last month was 80% in
the high-risk group vs 4.9% in the low-risk group (p<0.001), supporting the models
ability to detect a clinically severe subgroup despite its small prevalence.
Reliability and convergent validity:
The risk score demonstrated strong internal consistency (Cronbachs alpha = 0.811;
McDonalds omega = 0.831). Convergent validity was robust, with high correlation to
AUDIT (r = 0.861, p<0.001) and substantial correlations to RAPS4-QF (r = 0.793, p<0.001)
and CAGE (r = 0.631, p<0.001), indicating alignment with established screening
constructs while preserving broader functional coverage.
Machine learning performance:
Among tested algorithms, logistic regression achieved the best overall performance,
with 93.5% accuracy and strong class discrimination (F1 low = 0.97; F1 moderate = 0.94;
F1 high = 1.00). Other algorithms also performed well but were consistently lower (SVM
accuracy 90.9%; random forest 88.3%; KNN 80.5%). ROC-AUC analyses demonstrated
high separability, particularly for low risk (AUC=0.96), while maintaining strong
discrimination for moderate (AUC=0.88) and high risk (AUC=0.93). Permutation
importance highlighted the models most influential indicators: feelings of guilt/regret,
average drinking amount, financial difficulties, and physical health impact, supporting
both interpretability and face validity. CONCLUSIONS:This study developed and validated a brief, AI-assisted 15-item alcohol
risk score that captures multidimensional nature of problematic alcohol use among
university students by combining consumption intensity with functional, psychosocial,
and harm-related indicators. The model demonstrated high reliability, strong convergent
validity with established tools, and excellent ML classification performance, particularly using logistic regression. Importantly, risk categories were not merely statistical strata;
they mapped onto clinically meaningful gradients of academic impairment, dangerous
behaviors, psychological complaints, and other adverse outcomesfeatures that are
central to early intervention in student populations.
Because the tool is concise, interpretable, and grounded in real-world consequences, it
offers a pragmatic pathway for scalable screening, early detection, and triage in
university health services. Beyond identifying severe dependence signals, this model is
positioned to detect earlier-stage risk profiles where prevention and brief interventions
may yield the highest impact. Future research should test external validity across
diverse universities and longitudinally examine whether baseline risk scores predict
incident harms and service utilization.
Keywords: risky alcohol use, alcohol use disorder, artificial intelligence, machine
learning, logistic regression, screening
Nilay Bilgin, Ali Saffet Gonul, Cemre Candemir, Kaya Oğuz, Yiğit Erdoğan
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BACKGROUND AND AIM:Major Depressive Disorder (MDD) has long been associated
with low self-esteem in the existing literature (Beck, 1967; Sowislo & Orth, 2013).
Although cognitive models of MDD propose low self-esteem as a risk factor for the onset
and persistence of depression (Beck, 1967), recent studies emphasize the importance
of self-esteem stability rather than merely its level (Kernis, 2005; Franck & De Raedt,
2007). This research is grounded in Hierometer Theory, which conceptualizes selfesteem functions as a gauge that enables individuals to effectively navigate social
hierarchies by also motivating adaptive status-seeking behavior (Mahadevan et al.,
2019). Within this framework, environmental factors such as social comparison and
performance feedback induce dynamic shifts in self-evaluation. Although the cognitive
model of depression posits a negative bias in information processing (Beck, 1967), there
has been a notable lack of research using objective, experimental tasks to examine how
MDD patients update their expectations in response to social-hierarchy-based
feedback. Previous studies often relied on self-report measures, which are susceptible
to social desirability bias and fail to capture automatic or unconscious regulatory
processes. Therefore, this study aimed to investigate how receiving positive and negative
social performance feedback affects self-esteem dynamics in MDD patients compared
to healthy controls using a novel computational analysis. Consistent with the negative
bias framework of the cognitive model, we hypothesized that patients with depression
will exhibit significantly higher sensitivity to negative rather than positive social
performance feedback compared to healthy controls. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study procedure was initiated with the clinical characterization of 90
participants, comprising 60 patients diagnosed with Major Depressive Disorder (MDD)
and 30 healthy controls. To ensure diagnostic accuracy, clinical statuses were validated
using the Structured Clinical Interview for DSM-5 (SCID-5), while depressive symptom
severity was quantified via the Hamilton Depression Rating Scale (HAM-D) and the Beck
Depression Inventory (BDI). Simultaneously, baseline self-esteem levels were
established through the Rosenberg Self-Esteem Scale (RSES) to provide a comparative
psychological baseline. Subsequently, participants were transitioned to a computerbased setting to participate in an in-house developed digital paradigm. At the beginning
of the experiment, to reinforce the social-competitive environment, eleven AI-generated
competitors were introduced, and participants were asked to report their initial rank
expectations (g_(t=0)) regarding their performance in the task. The experiment was
structured into 24 blocks, each consisting of a total of 6 trials. Each trial sequence
comprised a question screen where participants viewed various dice combinations,
followed by a response screen where they identified the frequency of a specific target
number. Upon completion of each 6-trial block, participants received ranking feedback
(r_t) on a vertical scale ranging from 1 (highest) to 12 (lowest), indicating their
performance in that block. Immediately following the feedback screen, participants
were queried regarding their expected rank for the subsequent block (g_(t+1)). In the
analysis phase, the discrepancy between this feedback and the participant's prior
expectation was formalized as a prediction error, ?_t=g_t-r_t. Expectation updating was
modeled as g_(t+1)=g_t-?_t, where the update magnitude (?_t) is the product of the
prediction error (?_t) and an individual-specific sensitivity coefficient (k), defined as
?_t=k×?_t. To account for asymmetries in belief updating, separate sensitivity
parameters (k_positive) and (k_negative) were estimated for feedback better or worse
than expected. Within an active inference framework, these coefficients reflect the
precision of self-related beliefs and their susceptibility to environmental input. Ethical
approval was obtained from the Ege University Faculty of Medicine Clinical Research
Ethics Committee under approval number 23-2.1T/43, approval date February 23, 2023. RESULTS:The MDD and control groups were statistically comparable regarding age, sex,
and education duration (Table 1). While the MDD group demonstrated significantly lower
baseline self-esteem, as measured by the Rosenberg Self-Esteem Scale (RSES), and
lower initial rank expectations compared to controls, objective task performance
metricsincluding accuracy and reaction timesshowed no significant intergroup
differences (Table 2). Regardless of feedback direction, the sensitivity coefficient (k_mean) at which MDD patients updated their performance predictions based on
feedback was significantly higher than that of healthy controls (U = 1435.0, p = 4.76 ×
10??, r = -0.594). When receiving positive feedback better than their prediction, the MDD
group exhibited a significantly higher coefficient for updating performance expectations
compared to controls (U = 1096.5, p = 0.0009, r = -0.450). The MDD group also
demonstrated a significantly higher update coefficient compared to controls when
receiving negative feedback worse than expected (U = 1374.5, p = 4.97 × 10??, r = -
0.527). Examination of the within-group distribution revealed that k_positive values in
the MDD group showed a right-skewed distribution, with some patients developing
extreme sensitivity (outliers) to feedback. While patients differed from controls in both
feedback types, the effect size for k_negative (r = -0.53) was stronger than for k_positive
(r = -0.45). CONCLUSIONS:This study demonstrates that self-esteem in Major Depressive Disorder
is marked by instability in response to environmental feedback. Our findings suggest
that MDD treatment should not solely aim to raise self-esteem levels but must also
focus on regulating hypersensitivity to external stimuli and promoting self-esteem
stability. Psychotherapeutic interventions that train patients to attribute feedback to
specific task conditions rather than viewing it as a reflection of personal inadequacy
may be effective in achieving stability and lasting remission. Future research should
validate these computational findings in larger clinical cohorts.
REFERENCES:1. Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical
aspects. Harper & Row.
2. Franck, E., & De Raedt, R. (2007). Self-esteem reconsidered: Unstable self-esteem
outperforms level of self-esteem as vulnerability marker for depression. Behaviour
Research and Therapy, 45(7), 15311541. https://doi.org/10.1016/j.brat.2007.01.003
3. Kernis, M. H. (2005). Measuring self-esteem in context: The importance of stability of
self-esteem in psychological functioning. Journal of Personality, 73(6), 15691605.
https://doi.org/10.1111/j.1467-6494.2005.00359.x
4. Mahadevan, N., Gregg, A. P., & Sedikides, C. (2019). Is self-regard a sociometer or a
hierometer? Self-esteem tracks status and inclusion, narcissism tracks status. Journal
of Personality and Social Psychology, 116(3), 444466.
https://doi.org/10.1037/pspp0000189
5. Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety?
A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213240.
https://doi.org/10.1037/a0028931
Keywords: Major Depressive Disorder, Self-Esteem, Self-Esteem Instability,Performance
Feedback Abbreviations: MDD: Major Depressive Disorder; N: Sample size; SD: Standard
Deviation; HAM-D: Hamilton Depression Rating Scale; BDI: Beck Depression Inventory;
SSRI: Selective Serotonin Reuptake Inhibitor; SNRI: Serotonin-Norepinephrine Reuptake
Inhibitor; NDRI: Norepinephrine-Dopamine Reuptake Inhibitor; NA: Not Applicable.
Yasin Hasan Balcioglu, , Ibrahim Sabri Akyuzu, , Fatih Oncuu, , Howard Ryland
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BACKGROUND AND AIM:Violence after discharge from psychiatric services represents a
major clinical and public safety concern, and in forensic psychiatry violent reoffending is
particularly salient during the early- to mid-post-discharge period when risk is highest.
Accurate violence risk assessment is essential to inform discharge decisions, postdischarge management, and resource use (1). In Turkiye, although the number of
forensic psychiatric institutions has increased, the inflow of patients has risen
disproportionately, leading to greater clinical heterogeneity and high patient turnover,
with premature discharge constituting the main practical challenge rather than the
avoidance of prolonged hospitalisations. Despite these pressures, structured risk
assessment tools are not routinely used in Turkish forensic psychiatric practice, leaving
clinicians with substantial challenges in assessing violence risk and making empirically
informed discharge decisions. To address this gap, this study examines violent
reoffending over 24 months after discharge in a forensic psychiatry cohort using a
structured actuarial approach based on the Forensic Psychiatry and Violence tool
Oxford (FoVOx), a brief and freely available risk assessment tool developed using large
national Swedish register data (2), to evaluate its performance in a Turkish sample and
support risk-informed clinical practice. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This retrospective cohort study was conducted in a forensic psychiatry
inpatient unit in Istanbul and included adult patients under compulsory court-ordered
treatment due to criminal non-responsibility or diminished responsibility who were
discharged from the hospital within a six-month inclusion period. Patients were
excluded due to incomplete records, interruption of the index admission because of
transfer to prison, absconding, or death, death within two years after discharge, inability
to contact the patient or their relatives, or lack of consent. Data were collected
retrospectively from clinical records, institutional databases, and through contact with
patients or their relatives (IRB approval date: 21.08.2025; approval number: 16/30). The primary outcome was violent reoffending within 24 months after discharge, with 12-
month outcomes also examined, defined as the occurrence of any recorded violent
offense during fixed follow-up periods and analyzed as a binary outcome (yes/no).
Violence risk was assessed using the FoVOx model, and individual risk estimates were
calculated as percentage probabilities using the original online FoVOx calculator (3).
Risk factors included in the model were age at discharge; male sex; prior violent and
serious violent offending; primary diagnosis at discharge; drug and alcohol use disorder
at hospitalisation or discharge; personality disorder at discharge; employment status
before admission; ?5 previous inpatient episodes; lifetime drug use disorder; and length
of inpatient stay ?1 year. Discriminative performance was evaluated using the area
under the receiver operating characteristic curve (AUC). In addition, clinically relevant
FoVOx risk thresholds of 5% and 20% were applied to calculate sensitivity, specificity,
positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence
intervals. RESULTS:The study sample consisted of 273 forensic psychiatric patients discharged
from inpatient care. The majority were male (82.4%), with a mean age at discharge of
39.8 ± 11.1 years. Schizophrenia spectrum disorders were the most common primary
diagnosis (67.8%). Violent reoffending occurred in 5.9% of patients within 12 months
and in 17.6% within 24 months after discharge. In binary comparisons, patients who
reoffended within 24 months were more likely to be male, younger at discharge, and to
have a history of substance use disorder at or prior to admission, personality disorder,
and previous violent offending. FoVOx-calculated original risk estimates ranged from 0%
to 51% for the 24-month horizon (mean 12.39%) and from 0% to 33% for the 12-month
horizon (mean 7.35%). When violent reoffending rates were examined across FoVOx risk
categories, no violent reoffending was observed in the low-risk group (?5%) at either 12
or 24 months, whereas reoffending rates reached 38.5% at 12 months and 55.8% at 24
months in the high-risk group (?20%) (Table 1). At 24 months, the FoVOx model showed
good discrimination (AUC = 0.87, 95% CI: 0.830.92). Sensitivity, specificity, PPV, NPV
and AUC at the 5% and 20% risk thresholds for both follow-up periods are presented in
Table 2. At 24 months, calibration was acceptable, with predicted risk (12.4%) lower
than observed outcomes (17.6%; Brier score = 0.118). CONCLUSIONS:In this forensic psychiatry cohort, violent reoffending occurred within 12
months and increased at 24 months after discharge, confirming the post-discharge
period as a clinically critical window for violence risk management. Violent reoffending
was more common among younger male patients and those with substance use
disorder, personality disorder, and prior violent offending, consistent with existing
evidence. FoVOx risk estimates showed a clear gradient, with no reoffending in the lowrisk group (?5%) and markedly higher rates in the high-risk group (?20%), reaching 55.8%
at 24 months, consistent with the original model development study (2). These findings highlight the models strong discriminative power, particularly in reliably
identifying very low-risk individuals, and its potential utility in informing less restrictive
discharge and follow-up strategies. However, the higher false-positive rate at the upper
end of the risk spectrum suggests that contextual model updating may be needed to
balance public safety with patient rights (4). Limitations include the retrospective singlecentre design, potential under-ascertainment of outcomes due to limited access to
official judicial records, and the use of fixed follow-up periods rather than time-to-event
data. The findings suggest that FoVOx, as an actuarial approach, shows promising
clinical utility in a Turkish forensic psychiatry context. In settings where structured
violence risk assessment tools are not routinely used and clinicians face increasing
pressure due to high patient turnover and unclear discharge thresholds, a simple,
feasible, and clinically relevant model may provide meaningful support, particularly
given the recent introduction of regulations for high-security forensic psychiatry centers
in Turkiye. When applied alongside clinical judgment, it may promote more consistent,
transparent, and risk-informed discharge decisions. Model updating and practical
integration into routine forensic psychiatric practice in Turkiye remain important
considerations.
REFERENCES:1- Ramesh T vd. Eur Psychiatry 2018;52:4753.
2- Wolf A vd. Eur Psychiatry 2018;47:8893.
3- http://oxrisk.com/fovox/
4- Ogonah MGT vd. Lancet Psychiatry 2023;10:780789.
Keywords: actuarial risk models, forensic psychiatry, offending, violence risk
assessment
BACKGROUND AND AIM:In conflict areas, mental health disorders such as depression,
anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and schizophrenia
impact approximately onMaltepe123.e in five individuals, emerging as a critical global
concern in the past decade.(WHO 2025) The psychological impact of conflict varies
significantly across populations, for instance women experience higher levels of
psychological distress and health issues driven by physiological, hormonal, and social
factors.(Türkkan 2026; Jain et al. 2022) Despite widespread trauma, few studies focus
on the effects of war on Palestinian womens mental health.(Jain et al. 2022, Ahmed et
al. 2024) This study investigates the impacts of the cumulative trauma exposure on the
prevalence and severity of psychiatric symptoms including anxiety, depression, and
PTSD - among Palestinian women in Gaza and the West Bank after the 7 October 2023
escalation. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This cross-sectional study (Nov 2025-Jan 2026) included 438 Palestinian
women (aged ? 18) from the West Bank and Gaza. Data were collected using
sociodemographic questions and standardized scales (PHQ-9, GAD-7 and PCL-5).
Participants were also assessed on nine conflict-related trauma items, including direct
exposure to life-threatening situations (e.g. shooting, shelling, or injury); experiences of
torture or physical assault; witnessing others being killed and injured; loss of a loved;
loss of personal property or home; displacement; loss of income; lack of access to food
or water; and exposure to sexual violence. (Carpiniello 2023) Validated Arabic versions
were administered via online interviews. Due to security concerns and the participants'
reluctance to share personal information in the conflict zone, surveys were completed
anonymously, and verbal informed consent was obtained. The study was approved by
the Maltepe University Clinical Research Ethics Committee (No. 2025/21-12). Data were analyzed using SPSS 30.0. Descriptive statistics summarized the sample; the
variables between the West Bank and Gaza were compared using independent samples
t-tests or the Mann-Whitney U test were utilized based on distribution. Spearmans
correlation assessed relationships between trauma types and the clinical scores, as
well as correlations between scales. RESULTS:Of the 438 participants: 61.9% were from the West Bank and 38.1% from Gaza.
Most were aged between 18 and 40 (73.3%), university-educated (55.7%) and had
middle-income (73.3%). Marital status was evenly split between single (45.2%) and
married (44.7%). In terms of residential setting, 58.4% lived in cities, 27.2% in villages or
towns, and 14.4% (n=63) in refugee camps.
The mean scores of the sample were 14.89 on the PHQ-9 (moderate-to-severe
depression), 13.55 on the GAD-7 (moderate anxiety), and 44.74 on the PCL-5 (high
probability of PTSD). Participants in Gaza had notably higher mean scores (PHQ-9:
17.56; GAD-7: 16.24; PCL-5: 54.4) compared to those in the West Bank (PHQ-9: 13.24;
GAD-7: 11.9; PCL-5: 38.78). Gazan women scored significantly higher on all measures (p
<.001).
A focused subgroup analysis was conducted on participants residing in refugee camps
(n=63; Gaza n=51, West Bank n=12). Within this group, women in Gaza exhibited
significantly higher symptom severity across all measures. Mean scores in Gaza camps
vs. West Bank camps were 19.37 vs. 13.66 for depression (PHQ-9; p=.007), 16.72 vs.
12.41 for anxiety (GAD-7; p=.004), and 56.05 vs. 36.50 for PTSD (PCL-5; p<.001). These
findings highlight a particularly severe psychological burden among refugee camp
residents in the Gaza Strip compared to their counterparts in the West Bank.
In study population, Spearman correlation analysis revealed significant positive
correlations among psychiatric scales (p<.001), indicating common depression, anxiety
and PTSD symptoms. Regarding the trauma exposure, 73.1% of participants reported
witnessing the injury or death. Significant proportions of the sample also faced
deprivation and displacement, with 66% reporting difficulty accessing food and water,
65.7% experiencing loss of employment or income, and 39.3% being forcibly displaced.
In terms of direct life-threatening attacks, 54.4% of the women had lost a loved one
during the conflict and 47.6% had survived a direct life-threatening attack. Furthermore,
47% had lost their homes or personal property. In addition a notable number of women
reported physical assault or torture (10.2%) and sexual assault (6.3%). CONCLUSIONS:The study findings reveal the substantial psychological burden among
Palestinian women. Our sample primarily consisted of young, educated, and middleincome urban residents, nearly all of whom reported chronic trauma exposure, resulting in moderate-to-severe psychiatric symptoms. Reflecting conflict severity, Gazans
women exhibited significantly higher psychopathology scores across all measures
compared to those in the West Bank (p<.001).
Due to communication difficulties in conflict zones, reaching women living in refugee
camps was challenging, leading to a limited sub-sample size (n=63). Despite this
limitation, our findings revealed that women in refugee camps experienced significantly
higher trauma and more severe symptoms of depression, anxiety, and PTSD than those
living in cities or villages. Although half of the sample were urban residents, over 50%
reported witnessing severe trauma, job loss, unable to meet basic needs. That indicates
the widespread impact of modern warfare on urban life beyond active conflict zones.
In conclusion, our analysis confirms that chronic trauma exposure contributes to the
persistent psychiatric symptoms observed in these women. These findings require
urgent social interventions to prevent a long-term mental health crisis. Additionally,
further analyses on the predictors of symptom severity are ongoing and will be shared in
our future presentations.
REFERENCES:Odacı H, Türkkan T (2026) Gender and mental health: challenges faced by
women and a feminist perspective. Psikiyatride Güncel YaklaşımlarCurrent Approaches
in Psychiatry 18(2): 400413.
World Health Organization (2025) Mental health in emergencies. World Health
Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-inemergencies on January 24, 2026.
Ahmed SH, Zakai A, Zahid M et al. (2024) Prevalence of post-traumatic stress disorder
and depressive symptoms among civilians residing in armed conflict-affected regions: a
systematic review and meta-analysis. General Psychiatry 37: e101438.
Jain N, Prasad S, Czárth ZC, et al. (2022) War Psychiatry: Identifying and Managing the
Neuropsychiatric Consequences of Armed Conflicts. Journal of Primary Care &
Community Health 13:1-11.
Carpiniello, B. (2023) The Mental Health Costs of Armed ConflictsA Review of
Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War
Zones. International Journal of Environmental Research and Public Health, 20(4).
Keywords: Armed conflict, Palestinian women, Post-traumatic stress disorder,
BACKGROUND AND AIM:Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by attentional difficulties, impulsivity, and hyperactivity that begins in childhood and often persists into adulthood. ADHD symptoms may change over time, and their presentation can become less evident with age. Thus, identifying secondary features in adult ADHD that are not fully reflected in standard diagnostic criteria is important. Although motor hyperactivity often becomes less apparent in adulthood, attentional deficits may manifest as difficulty sustaining attention, task completion problems, poor time management, and procrastination (Kooij et al., 2019). The presence of time-related difficulties in the daily lives of individuals with ADHD suggests a potential deficit in time perception. Accordingly, studies have suggested that time perception deficits are a significant component of the cognitive profile of ADHD and may represent a focal symptom (Noreika et al., 2013). Children with ADHD have consistently been shown to perceive time with lower accuracy, systematically overestimate or underestimate durations, and exhibit significant impairments in time discrimination (Ptacek et al., 2019). In contrast, research assessing time perception in adult ADHD samples remains limited, and the persistence and specific characteristics of these deficits in adulthood are still unclear (Mette, 2023). Meanwhile, procrastinationa common and functionally impairing problem in adult ADHDmay also be related to similar underlying cognitive mechanisms associated with time perception (Bolden & Fillauer, 2020). In this context, the present study aimed to assess time perception impairments in adults with ADHD using time estimation (TE) and time reproduction (TR) tasks, to examine their relationship with procrastination, and to compare the findings with healthy controls. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study was approved by the Clinical Research Ethics Committee of Erenköy Mental and Neurological Diseases Training and Research Hospital (Approval No: 2024/11; April 19, 2024). The study included 54 adults aged 1845 whose ADHD diagnosis was confirmed using the DIVA-5 structured clinical interview, and 50 age- and sex-matched healthy controls with no history of psychiatric disorders. Psychiatric comorbidities were ruled out via structured clinical interviews using SCID-5. Time perception was assessed using TE and TR tasks. Procrastination behavior was
evaluated using the General Procrastination Scale and the Tuckman Procrastination
Scale, while emotional symptoms were assessed with the Depression Anxiety Stress
Scale-21 (DASS-21), and ADHD symptom severity with the Adult ADHD Self-Report
Scale (ASRS). RESULTS:While no significant differences were found between groups on the TE task,
the ADHD group exhibited significantly lower accuracy and higher deviation scores on
the TR task, particularly at longer intervals (8 and 10 seconds) (p < 0.01). They also
systematically underestimated these durations compared to controls. Both general and
academic procrastination scores were significantly higher in the ADHD group (p < 0.01).
A meaningful association was observed between time perception impairments and
procrastination behavior, especially at longer intervals. Among emotional variables,
academic procrastination was significantly associated with stress levels. In subgroup
analyses, non-medicated ADHD participants showed significantly greater estimation
errors in TE tasks at longer durations, whereas no significant differences were found in
TR task performance. CONCLUSIONS:This study demonstrates that time perception deficits persist in adult
ADHD and suggests that TR tasksparticularly at longer durationsmay serve as a
more sensitive measure for detecting these impairments. Furthermore, procrastination
behavior is highlighted as a clinically relevant feature in adult ADHD beyond
conventional diagnostic criteria. The observed association between impaired time
perception and increased procrastination offers novel insight into potential shared
cognitive mechanisms. Although these findings offer valuable clinical implications,
future studies with larger samples and more refined variable analyses are needed to
substantiate and elaborate on the observed relationships. REFERENCES:1. Bolden J, Fillauer JP. Tomorrow is the busiest day of the week:
Executive functions mediate the relation between procrastination and attention
problems. J Am Coll Health. 2020;68(8):854-63.
2. Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated European
Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019
Feb;56:14-34.
3. Mette C. Time Perception in Adult ADHD: Findings from a Decade-A Review. Int J
Environ Res Public Health. 2023 Feb 10;20(4):3098.
4. Noreika V, Falter CM, Rubia K. Timing deficits in attention-deficit/hyperactivity
disorder (ADHD): evidence from neurocognitive and neuroimaging studies.
Neuropsychologia. 2013 Jan;51(2):235-66.
5. Ptacek R, Weissenberger S, Braaten E, Klicperova-Baker M, Goetz M, Raboch J, et al.
Clinical Implications of the Perception of Time in Attention Deficit Hyperactivity Disorder
(ADHD): A Review. Med Sci Monit. 2019 May 26;25:3918-24.
Keywords: Adult ADHD, Time Perception, Time Reproduction, Time Estimation,
Procrastination
Caner Yeşiloğlu, , Sinem Çetin Demirtaş, , Lut Tamam, , Süleyman Cansun Demir2 , Mehmet Emin Demirkol, , Özge Keleş Bayer, , Aslı Sena Alagöz, , Çağla Boyvadoğlu
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BACKGROUND AND AIM:Postpartum depression (PPD) is one of the most common
mental health problems affecting women in the perinatal period, causing adverse
effects on mother-infant bonding, breastfeeding duration, and early child development.
In community-based studies, the prevalence of PPD is reported to be between 21-28%.
PPD results from the interaction of biological changes with psychosocial resources and
perinatal stressors. Perceived social support, psychological resilience, and depressive
symptoms during pregnancy are significant predictors of postpartum depression risk.
Pain catastrophizing and perceived empathy in the physician-patient relationship are
also thought to play a role in perinatal mental health. Obstetric factors, especially
cesarean delivery and pregnancy complications, have also been associated with the risk
of postpartum depression. The aim of this study is to examine the relationship between
antenatal psychological and obstetric factors and clinically evaluated postpartum
depression in a prospective design. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This study is a prospective cohort study conducted in a tertiary university
hospital. Participants were evaluated during pregnancy and followed up until the sixth
week postpartum. Antenatal psychological, psychosocial, and obstetric data were
collected before delivery, and PPD status was determined by a structured clinical
psychiatric interview at the sixth week.One hundred pregnant women aged 18 and over,
who spoke Turkish and gave written consent, participated in the study. Four individuals
receiving active psychiatric treatment, seven who did not complete the antenatal
scales, and four who could not be reached for postpartum follow-up were excluded from
the study. Consequently, 85 women completed the antenatal and postpartum follow-up
assessments.PPD was defined as a binary outcome diagnosed according to a
structured clinical psychiatric interview at the sixth week. Antenatal depressive
symptoms were assessed with the Beck Depression Inventory (BDI), perceived stress
with the Perceived Stress Scale (PSS), social support with the Multidimensional Scale of
Perceived Social Support (MSPSS), psychological resilience with the Resilience Scale for
Adults (RSA), pain catastrophizing with the Pain Catastrophizing Scale (PCS), and physician-patient empathy with the Consultation and Relational Empathy (CARE)
Measure. Obstetric data were obtained from medical records.Data were analyzed using
IBM SPSS 25.0 (p<0.05). Comparisons between groups were made using the
independent t-test for normally distributed variables, the Mann-Whitney U test for nonnormally distributed variables, and the chi-square test for categorical variables.
Variables found to be significant at the p<0.10 level in univariate analyses and clinically
important obstetric factors were included in the multivariate logistic regression model.
(This study was approved by the Research Ethics Committee of the Faculty of Medicine,
Çukurova University.(Meeting No.157, Decision No.53, 18/07/2025). RESULTS:Of the 85 women participating in the study, 30% (n=25) were diagnosed with
PPD. Women who developed PPD had a significantly higher rate of cesarean delivery
(p=0.036) and obstetric comorbidity(p=0.048), while there was no difference in terms of
neonatal outcomes.
When antenatal psychological scales were compared, women who developed PPD
showed higher depressive symptoms (BDI: 14 [9-19] vs. 8 [5-13],p<0.001), higher
perceived stress(24 [19-29] vs. 18 [14-24], p=0.041), higher pain catastrophizing (23 [12-
35] vs. 13 [5-24], p=0.032),lower social support (60 [52-68] vs. 72 [65-78], p=0.006),
lower psychological resilience(16.1±5.2 vs. 19.9±5.0, p=0.009), and lower perceived
empathy(43 [37-48] vs. 47 [42-52], p=0.048).In univariate analyses, perceived social
support(OR=0.50, p=0.014) and psychological resilience(OR=0.59, p=0.043) were found
to be protective factors, while cesarean delivery(OR=2.20, p=0.036) and obstetric
comorbidity(OR=2.75, p=0.048) were risk factors. In the multivariate model, antenatal
depressive symptoms(aOR=1.72, p=0.046), cesarean delivery(aOR=2.12, p=0.047), and
obstetric comorbidity (aOR=2.63, p=0.049) increased the risk of postpartum depression,
while perceived social support(aOR=0.48, p=0.019) and psychological resilience
(aOR=0.61, p=0.047) reduced the risk. The model showed good discrimination
(AUC=0.78) and calibration (Hosmer-Lemeshow p=0.64). CONCLUSIONS:This prospective study demonstrates that antenatal psychological and
obstetric factors are independent predictors of clinically diagnosed postpartum
depression. Our findings reveal that antenatal depressive symptom severity, cesarean
delivery, and obstetric comorbidities significantly increase the risk of postpartum
depression, while perceived social support and psychological resilience serve as robust
protective factors. The vulnerability-buffer framework provides a compelling theoretical
lens for understanding these findings. Rather than viewing postpartum depression as
solely determined by symptom burden, our results emphasize that psychosocial
resources fundamentally shape how antenatal emotional vulnerability translates into
clinical outcomes. Women with higher perceived social support and psychological
resilience demonstrate substantially lower odds of meeting diagnostic criteria for
postpartum depression, even when controlling for baseline depressive symptoms and obstetric complications.From a clinical perspective, these findings have important
implications for perinatal mental health practice. First, comprehensive antenatal
screening should integrate both vulnerability indicators (depressive symptoms, stress,
pain catastrophizing) and protective factors (social support,resilience, empathetic
clinical relationships). Second, interventions targeting resilience enhancement and
social support optimization may effectively reduce postpartum depression risk in
vulnerable populations. Third, the association between cesarean delivery and
postpartum depression warrants attention to the subjective birth experience and
psychological processing of delivery events.The models good discrimination
(AUC=0.78) and calibration suggest clinical utility for risk stratification. Early
identification of women with high antenatal depressive symptoms, limited social
support, or low resilience enables timely preventive interventions. Furthermore,
recognizing that obstetric factors interact with psychological vulnerability underscores
the importance of integrated perinatal care that bridges obstetrics and psychiatry.Future
research should employ longitudinal designs with detailed birth experience measures
and explore mechanisms through which psychosocial resources buffer against
postpartum depression. Implementation of psychosocial resource assessment into
routine perinatal screening represents a practical step toward reducing the burden of
postpartum depression and improving maternal and infant outcomes.
REFERENCES:OHara MW, McCabe JE (2013) Postpartum depression: current status
and future directions. Annu Rev Clin Psychol 9:379407.
Dennis CL, Letourneau N (2007) Global and relationship-specific perceptions of support
and the development of postpartum depressive symptomatology. Soc Psychiatry
Psychiatr Epidemiol 4 2(5):389-95.
Smorti M, Ponti L, Pancetti F (2019) A Comprehensive Analysis of Post-partum
Depression Risk Factors: The Role of Socio-Demographic, Individual, Relational, and
Delivery Characteristics. Front Public Health 24(7):295.
Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J (2014) Non-psychotic
mental disorders in the perinatal period. Lancet 384:17751788.
Hajure M, Alemu SS, Abdu Z, Tesfaye GM, Workneh YA, Dule A, Adem Hussen M, Wedajo
LF, Gezimu W (2024) Resilience and mental health among perinatal women: a
systematic review. Frontiers in Psychiatry 15:1373083.
Keywords: cesarean delivery, postpartum depression, pregnancy, psychological
resilience, social support
BACKGROUND AND AIM:Agomelatine is a widely used antidepressant; however, robust
cytogenetic safety data remain limited, particularly regarding potential dose-dependent
genotoxicity at therapeutic and supra-therapeutic exposures. To address this gap, we
performed a dual in vitro cytogenetic evaluation in human peripheral blood lymphocyte
culturescombining the cytokinesis-block micronucleus (CBMN) assay and the
chromosomal aberration (CA) assayand integrated these findings with in silico
docking analyses to explore plausible molecular interactions with DNA and ?-tubulin.
The primary aim was to determine whether agomelatine induces (i) chromosomal
breakage or missegregation (micronuclei), (ii) structural chromosome damage
(chromosomal aberrations), or (iii) cell-cycle suppression/cytotoxicity, across a range of
clinically relevant to high concentrations, and to triangulate biological outcomes with
mechanistic docking signals. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):We conducted a controlled experimental study using human lymphocyte
cultures with donors treated as biological replicates (n = 10 per group; total N=60), and
two technical replicates per donor per condition (averaged before analysis).
Agomelatine was tested at therapeutic doses (25 and 50 mg/L), a lower dose (10 mg/L),
and a higher dose (100 mg/L), alongside a negative control and a positive control
(mitomycin C), allowing assay validity checks and benchmarking of clastogenic
response. Cytokinesis-block micronucleus assay (CBMN): Micronuclei frequency (MN%) and
micronucleated binucleated cell ratio (MNBN%) were quantified as core indicators of
chromosomal damage, supported by parallel assessment of proliferation-related
indices (e.g., CBPI/cytostasis) and nuclear abnormalities.
Chromosomal aberration assay (CA): Structural aberrations were evaluated via the
chromosomal aberration index (CA index) and aberrant cell percentage, with additional
reporting of aberration subtypes (e.g., chromatid breaks/fragments), and mitotic
activity/dividing cell counts used to contextualize potential cytostatic effects.
In silico analyses: DNAagomelatine docking and ?-tubulinagomelatine docking were
performed to examine whether agomelatine shows energetically plausible binding
consistent with intercalation-like genotoxicity or microtubule disruption. Binding
affinities and interaction patterns (hydrogen bonds, electrostatic contacts) were
compared against canonical reference ligands (ethidium bromide for DNA; colchicine
for ?-tubulin).
Ethics Committee of Canakkale Onsekiz Mart University, Medical Sciences approved
study (10.02.2021, decision No. 2020-02). RESULTS:Micronucleus-related endpoints (genotoxicity screening): Across all
agomelatine concentrations (10100 mg/L), there was no statistically significant
increase in micronuclei frequency (MN%) (H=9.71, p = 0.0839; ?² = 0.087), indicating no
detectable elevation in chromosomal breaks or missegregation under the tested
conditions. The positive control group showed a significant increase, confirming assay
sensitivity and internal validity.
For MNBN%, an overall group difference was detected (H=22.926, p = 0.000349; ?² =
0.332); however, this effect was driven by the positive control: post-hoc testing
demonstrated that MNBN% in the 25, 50, and 100 mg/L agomelatine groups was
significantly lower than the positive control (adjusted p-values reported), while no
significant differences emerged among agomelatine doses. Taken together, the CBMN
profile supports a non-genotoxic pattern for agomelatine in this lymphocyte model,
especially when benchmarked against the strong clastogenic response of the positive
control.
Cell division/cytostasis-related endpoints: Total dividing cells differed between groups
(H=49.997, p = 1.39 × 10??; ?² = 0.833). As expected, dividing cells were markedly
reduced by the positive control, reflecting mitotic suppression from the clastogenic
agent. In agomelatine conditions, values were close to negative control at 10 and 25 mg/L, with only a slight decrease at 50 and 100 mg/L, while remaining significantly
higher than positive control at all agomelatine dosessupporting the interpretation that
agomelatine does not induce major cytokinesis inhibition, even at the highest
concentration.
The tetranucleated cell ratio also differed between groups (H=31.219, p = 8.48 × 10??; ?²
= 0.486): it increased significantly in the positive control, whereas all agomelatine
groups remained close to negative control and significantly lower than the positive
control, supporting preserved cytokinesis integrity under agomelatine exposure.
Chromosomal aberration (CA) outcomes (structural damage): A strong overall group
difference was observed for the CA index (H=54.008, p = 2.09 × 10?¹?; ?² = 0.908).
Relative to negative control, no difference was detected at 10 or 25 mg/L, while
significant increases emerged at 50 mg/L (Adj. p = 0.011) and 100 mg/L (Adj. p < 0.001).
Notably, despite this rise, aberration values in agomelatine groups remained well below
the positive control. Similarly, aberrant cell percentage differed between groups
(H=52.800, p = 3.70 × 10?¹?; ?² = 0.885); differences versus negative control were evident
only at 50 and 100 mg/L, while 10 and 25 mg/L were comparable to negative control.
When aberration subtypes were examined, the most frequent abnormalities in
agomelatine groups were chromatid breaks and fragments. A dose-related increase was
noted at 50100 mg/L, while chromosomal breaks and dicentrics remained low,
indicating that observed damage at higher concentrations was limited in magnitude and
pattern compared with classical clastogenic exposure.
In silico docking triangulation (mechanistic plausibility): DNA docking yielded an
agomelatine binding affinity of ?7.309 kcal/mol, notably weaker than the reference
intercalator ethidium bromide (?9.5 kcal/mol). Agomelatine formed multiple hydrogen
bonds (ADE17, CYT9, GUA10; 2.322.56 Å), consistent with moderate, likely transient
DNA binding rather than classic intercalation. Structural inspection supported minor
groove residence without base-pair separation, contrasting with ethidium bromides
intercalative distortion. For ?-tubulin, agomelatine showed a binding affinity of ?7.389
kcal/mol, similar to colchicine (?7.365 kcal/mol), with stabilizing hydrogen-bonding and
electrostatic interactions. CONCLUSIONS:In this integrated in vitroin silico evaluation, agomelatine
demonstrated a reassuring cytogenetic safety profile in human lymphocytes across
clinically relevant to high concentrations. The CBMN assay showed no significant
increase in micronuclei frequency, while MNBN% findings primarily reflected separation
from the positive control rather than dose-dependent damage among agomelatine groups. In contrast, the chromosomal aberration assay detected a dose-linked signal at
?50 mg/L, with small increased CA index and aberrant cell percentage versus negative
control, yet still far below the clastogenic reference condition. Mechanistically, docking
results support non-intercalative minor-groove DNA binding with weaker affinity than
classical DNA intercalators, aligning with the absence of a robust micronucleus signal.
Overall, the data suggest that therapeutic-range exposure is unlikely to confer
meaningful genotoxic risk, whereas supra-therapeutic concentrations may modestly
increase structural chromosomal aberrations, warranting attention in contexts such as
overdose, impaired clearance, or extreme exposure scenarios. This dual-platform
approach provides a strong, award-competitive framework for resolving real-world
safety questions by aligning cytogenetic endpoints with mechanistic docking evidence.
Keywords: micronucleus assay, chromosomal aberration, peripheral blood
lymphocytes, OECD TG 487, OECD TG 473, molecular docking
Key findings in the Cytokinesis-Block Micronucleus (CBMN) test: No increase in MN in
agomelatine groups
Nisa Nur Yıldırım, , Hasan Mervan Aytaç, , Sacide Pehlivan, , Fatıma Ceren Tunçel
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BACKGROUND AND AIM:Panic disorder (PD) is a clinically heterogeneous anxiety disorder characterized by recurrent and unexpected panic attacks accompanied by persistent concern about having additional attacks and avoidance behaviors related to these attacks (1). Although family and twin studies indicate that PD has a substantial genetic component, the biological determinants of the disorder and the specific genetic factors associated with disease subtypes have not yet been clearly identified (2). In recent years, the effects of metabolic hormones on the central nervous system have attracted increasing interest in the biology of anxiety disorders. Leptin, a neuropeptide involved in energy homeostasis, has been suggested to exert regulatory effects on brain regions associated with anxiety and affective processes (2). However, the number of studies directly investigating the relationship between leptin (LEP) and leptin receptor (LEPR) gene polymorphisms and PD and its subtypes remains limited. In this study, the associations of LEP ?2548G/A and LEPR 668A/G gene polymorphisms with PD, clinical characteristics, and disease subtypes were investigated. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study was approved by the Basaksehir Cam and Sakura City Hospital Ethics Committee (Protocol no: 2025.06.251). This study included 102 patients diagnosed with PD according to DSM-5 diagnostic criteria and followed at Basaksehir Cam and Sakura City Hospital, as well as 102 healthy control individuals without any psychiatric diagnosis. Diagnostic assessments were conducted using the Structured Clinical Interview for DSM-5 (SCID-5-CV). Sociodemographic and clinical characteristics of the participants were recorded, and the Panic Disorder Severity Scale, Panic Agoraphobia Scale, Hamilton Depression Rating Scale, and StateTrait Anxiety Inventory were administered. PD subtypes were classified based on clinical characteristics (respiratory subtype, nocturnal subtype, and agoraphobia). For genetic analyses, DNA was isolated from peripheral blood samples, and LEP ?2548G/A and LEPR 668A/G gene polymorphisms were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. Group comparisons and association analyses were performed for statistical evaluation. RESULTS:With respect to the LEP 2548G/A polymorphism, the frequency of the AAgenotype was significantly higher in the patient group compared with the control group,
and similarly, the A allele frequency was also higher in the patient group. Regarding the
LEPR 668A/G polymorphism, the AG genotype frequency was significantly higher and
the AA genotype frequency was significantly lower in the patient group compared with
the control group. While no statistically significant association was detected between
the presence of agoraphobia and the LEP ?2548G/A gene polymorphism, the AA
genotype and A allele frequency distributions of the LEPR ?668A/G gene polymorphism
were found to be significantly higher in the group with agoraphobia compared with the
group without agoraphobia. In addition, no significant differences were observed in LEP
and LEPR gene polymorphisms according to the presence of the respiratory subtype or
nocturnal panic attacks. Mean scores on the StateTrait Anxiety InventoryTrait (STAI-2),
Panic Disorder Severity Scale, and Panic Agoraphobia Scale were found to be
significantly higher in patients with panic disorder accompanied by agoraphobia
compared with patients without agoraphobia. CONCLUSIONS:In our study, the frequency of the AA genotype for the LEP 2548G/A
polymorphism was significantly higher in the patient group compared with the control
group. Similarly, the higher frequency of the A allele in the patient group suggests that
the A allele may confer susceptibility to PD. Although serum leptin levels were not
measured in this study, previous studies have reported an association between lower
leptin levels and increased anxiety symptoms (3).
While no statistically significant association was found between the presence of
agoraphobia and the LEP ?2548G/A gene polymorphism, the AA genotype and A allele
frequency distributions of the LEPR ?668A/G gene polymorphism were significantly
higher in patients with agoraphobia compared with those without agoraphobia. This
finding suggests that leptin signaling at the receptor level, rather than leptin production
itself, may play a more prominent role in agoraphobia. While the LEP ?2548G/A
polymorphism primarily affects leptin expression, the LEPR ?668A/G polymorphism
directly influences receptor function and downstream signaling in brain regions involved
in anxiety and fear regulation. Consequently, LEPR variation may have a stronger impact
on agoraphobia susceptibility by altering central leptin receptormediated signaling,
whereas variation in LEP alone may be insufficient to produce behavioral effects in the
absence of receptor-level dysfunction (4).
Overall, our results highlight the potential importance of leptin receptormediated
signaling in PD and agoraphobia. Future studies integrating genetic, biochemical, and
functional approaches are needed to elucidate the role of leptin pathways in anxiety
disorders.REFERENCES:
1. K C, N W, J Z, X H, H X, X Z, et al. Is the Val66Met polymorphism of the brain-derived
neurotrophic factor gene associated with panic disorder? A meta-analysis. Asia-Pacific
Psychiatry: Official Journal of the Pacific Rim College of Psychiatrists. June 2017;9(2).
2. Ww E, Rc K, Hu W, Wj M. Panic and panic disorder in the United States. The American
Journal of Psychiatry. March 1994;151(3).
3. Vg M, C P, M M. Associations of plasma leptin to clinical manifestations in
reproductive-aged female patients with panic disorder. Psychiatry Research. September
2017;255.
4. Aytac HM, Oyaci Y, Aytac E, Pehlivan M, Alptekin FB, Pehlivan S. Evaluation of leptin
and leptin receptor gene polymorphisms in bipolar disorder: focus on depressive
episodes with atypical features. Archives of Physiology and Biochemistry. 2025:1-9.
Keywords: Panic disorder, leptin, leptin receptor, single gene polymorphism
BACKGROUND AND AIM:Major depressive disorder (MDD) is frequently accompanied by
anger regulation difficulties and prominent somatic symptoms, increasing overall
clinical burden. Although repetitive transcranial magnetic stimulation (rTMS) is an
established treatment for depression, its relationship with anger expression styles and
somatic symptom severity remains unclear. This study aimed to evaluate clinical
changes following rTMS in patients with MDD and to examine the associations between
anger expression styles, particularly suppressed anger (anger-in), somatic symptoms,
and treatment response. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This prospective observational study included 30 patients diagnosed with
unipolar MDD according to DSM-5 criteria. All patients received 20 sessions of rTMS
targeting the left dorsolateral prefrontal cortex (20 Hz, 100% motor threshold, 2000
pulses per session). Depression (HAMD), anxiety (HAMA), somatic symptoms (PHQ-15),
pain severity (VAS), quality of life (SF-12), and anger dimensions (STAXI-2) were assessed
before and after treatment. Ethical approval was obtained from the institutional ethics
committee. (30.05.2024/26). RESULTS:The mean age of the participants was 42.9 ± 12.9 years, and 70% were female.
rTMS was associated with significant reductions in depressive symptoms (HAMD: 16.63
± 4.56 to 10.13 ± 6.28, p < 0.001), with remission observed in 33.3% and clinical
response in 40% of patients. Anxiety, somatic symptoms, and pain severity also
improved significantly (all p ? 0.001). State anger did not change following treatment.
Baseline anger-in levels were not associated with changes in somatic symptoms, and
baseline PHQ-15 scores were not related to antidepressant response (p > 0.05). Higher
trait anger and lower anger control were associated with greater reductions in pain
severity. CONCLUSIONS:rTMS was associated with significant improvements across affective,
somatic, and pain-related domains in MDD. Anger expression styles did not predict
overall treatment response but showed a symptom-specific association with pain
outcomes, suggesting that anger-related traits may represent relatively stable
Keywords: depression, pain, rTMS, quality of life, anger, somatic symptoms
BACKGROUND AND AIM: The global rise in the elderly population is increasing the
number of older adults in forensic psychiatric systems. This study aimed to evaluate the
sociodemographic/clinical/criminal characteristics and barriers/needs related to
hospitalization of this special group. METHODS: In this retrospective descriptive study, 1,650 male patients hospitalized in a
high-security forensic psychiatry unit were examined. Thirty patients diagnosed with
dementia (ICD-10: F00F03, G30) who had prescribed medications in their electronic
medical records were included. Sociodemographic/criminal/clinical characteristics,
family attitudes toward hospitalization, individualized care needs, and hospitalization
conditions of dementia patients were assessed based on detailed examination of
nursing/physicians observation notes. Ethical approval was obtained (Date: 2025;
Decision number: 922). RESULTS: The prevalence of dementia was 1.81%. The mean age was 75.23 ± 9.92 years.
56.7% had one general medical disorder, 20% had two, and 20% had three or more.
According to offense severity, 30% were non-violent or minimal-violent, 60% were
moderate-severity, and 10% were moderate-to-severe or severe-violent. Family
reluctance to hospitalize was 76.7% of cases; maintenance medications were
unavailable at the hospital pharmacy in 40%; 93.3% required individualized care. The
length of hospitalization was 5.8±10.14 days. 17 patients were discharged on the same
day. CONCLUSIONS: Dementia is an uncommon diagnosis for the forensic psychiatry
population. Our findings indicate that the length of hospitalization was markedly shorter
than the previously reported mean length for forensic psychiatric admissions. In the
general literature, it is well known that hospitalization tends to be short in forensic psychiatry practice when multiple comorbidities are present. In the study population,
lack of access to medication, the need for accompanyng person, and families
reluctance toward hospitalization may have influenced this outcome. It is important to
develop arrangements in forensic psychiatric practice for patients with dementia that
maintain a balance between care needs and safety.
Keywords: Forensic psychiatry, dementia, elderly offenders, criminal responsibility,
care needs, high-security units
BACKGROUND AND AIM Non-suicidal self-injury (NSSI) is defined as deliberate and repetitive acts of direct bodily harm without suicidal intent. Previous studies implicate MAO-A and microRNAs in psychiatric disorders. The aim of this study was to investigate the relationship between NSSI and the monoamine oxidase A (MAO-A) gene, and the microRNAs miR132-3p and miR-330-3p, in adolescents diagnosed with NSSI. METHODS The study included 42 adolescents aged 1218 years with NSSI and 42 age- and sexmatched healthy controls. Ethics approval was obtained from the İzmir Bakırçay University Non-Interventional Clinical Research Ethics Committee (Decision No: 2249, 14.05.2025). To determine MAO-A gene, miR-132-3p and miR-330-3p expression levels, 5 mL of venous blood samples were collected from all participants. The miRNAs investigated in this study were selected based on data obtained from the miRDB database (https://mirdb.org/mirdb/index.html) and evidence from previous studies in the literature. RESULTS The results demonstrated that MAO-A gene expression levels were significantly higher in the NSSI group compared to the control group, whereas miR-132-3p and miR-330-3p expression levels were significantly lower in the NSSI group. DISCUSSION The elevated MAO-A expression observed in adolescents with NSSI supports existing evidence implicating monoaminergic dysregulation in affective instability and impulsive behaviors. Previous studies have emphasized the interaction between MAOA-related vulnerability and environmental stressors in self-injurious behavior, and our findings extend this perspective at the expression level. The decreased levels of miR-132-3p and miR-330-3p suggest disrupted post-transcriptional regulation, consistent with literature linking these microRNAs to stress response, neuroplasticity, and mood-related psychopathology. Together, these findings support a biologically informed model of NSSI
vulnerability. CONCLUSIONS
The findings highlight the importance of addressing NSSI as a multidimensional
phenomenon and integrating biological markers into clinical assessments. Such
integration may enhance risk prediction and support the development of personalized
preventive and therapeutic strategies.
Keywords: Adolescent, MAO-A, miR-132-3p, miR-330-3p, Non-suicidal self-injury
Ali Tarık Altunç, , Melike Nur Altunç, , Yusuf Çiçek, , Ahmet Torun, , Sarp Yoldas, , Burç Çağrı Poyraz
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BACKGROUND AND AIM:Precise coil positioning is critical for optimal TMS efficacy. While MRI-guided neuronavigation is effective, its high cost limits widespread clinical use. Heart-Brain Coupling (HBC), based on heart rate deceleration during stimulation, has been proposed as a biomarker for accurate targeting, specifically relying on the connectivity between the DLPFC and the subgenual anterior cingulate cortex (sgACC). We aimed to investigate HBC in the DMPFC, hypothesizing that DMPFCdue to stronger anatomical connectivity with the ACCwould exhibit higher HBC values than the DLPFC and that these values would predict treatment response. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):Thirty patients with treatment-resistant major depression were recruited. HBC was measured using a Polar H10 heart rate monitor and the HeartBrainConnect app at four sites: left/right DMPFC and left/right DLPFC. Patients underwent an accelerated iTBS protocol targeting the bilateral DMPFC (600 pulses left, 600 right per session; 4 sessions/day). Response was defined as a ?50% reduction in HAMD-17 scores after 2030 sessions. The study protocol was approved by the Clinical Research Ethics Committee of Istanbul UniversityCerrahpaşa (Approval No: E-83045809-604.01- 1014334, June 12, 2024). RESULTS:19 patients responded to treatment, while 11 were non-responders. HBC values were significantly higher in the Left DMPFC compared to the Left DLPFC (t(df)=29(2.76), p=0.01) and in the Right DMPFC compared to the Right DLPFC (t(df)=29(2.17), p=0.038). However, no significant correlation was found between HBC values and HAMD-17 reduction. Furthermore, ROC analysis revealed that HBC values failed to distinguish responders from non-responders (AUC = 0.575, p = 0.509). CONCLUSIONS:This study confirms that the DMPFC exhibits stronger heart-brain coupling than the DLPFC, reflecting its robust anatomical and functional connectivity
with autonomic control networks. However, despite its physiological relevance, HBC did
not serve as a predictive biomarker for clinical response to accelerated iTBS in this
cohort. Future studies might investigate whether dynamic changes in HBC during
treatment offer better predictive value.
Keywords: DMPFC, DLPFC, Heart Brain Coupling, iTBS, TMS
BACKGROUND AND AIM:Evidence for inflammations role in suicidal behavior is growing, with peripheral inflammatory markers linked to suicide risk across psychiatric disorders. This study examined the relationship between suicidal behavior and clinically accessible, cost-effective inflammatory markers in individuals with prior suicide attempts. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):Among patients aged ?18 presenting to the Emergency Department with a suicide attempt between 01.01.2020 and 01.07.2025, the association between attempt severity and routine hematological and biochemical parameters was investigated. Hemogram values from the prior six months, including WBC, RBC and indices, platelets, WBC differential counts, iron, TIBC, ferritin, and lipid profiles, were collected retrospectively. NLR, PLR, MLR, and MHR were calculated. The study was approved by the institutional ethics committee (E-70632468-050.01-1054662). RESULTS:Of the 132 patients, 59% were female (n = 78), mean age 32.45 ± 12.89 years. The most common method was drug-overdose (56%, n = 74), followed by cutting (20.5%, n = 24) and jumping from height (9.1%, n = 12). Cutting, jumping, hanging, and firearm use were classified as lethal methods, whereas drug overdose was classified as non-lethal. Lethal attempts were more frequent among males (p = 0.09; ?² = 9.73); hanging more common in males, drug-overdose more common in females (p = 0.022; ?² = 13.53). In the lethal group, MLR (p = 0.013) and MCHC (p = 0.019) were higher, whereas TIBC (p = 0.053) and platelet levels (p = 0.016) were higher in the non-lethal group. Logistic regression controlling for age and sex showed lower platelet count associated with lethal attempts (p = 0.038; OR = 0.989; 95% CI = 0.980.99), explaining 23.6% of the variance. CONCLUSIONS:Markers derived from routine laboratory tests are cost-effective and may offer insight into biological mechanisms. However, their clinical utility in suicide risk assessment remains limited without concurrent psychosocial evaluation and requires validation in large prospective studies. Keywords: Suicide attempt, Peripheral inflammatory markers, Neutrophil-tolymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Monocyte-to-HDL ratio (MHR), Inflammation
BACKGROUND AND AIM Fibromyalgia is a chronic pain syndrome characterized by widespread pain and multisomatic symptom burden and is frequently accompanied by psychological distress. Within the ICD-11 framework, Complex Post-Traumatic Stress Disorder (CPTSD) includes core Post-Traumatic Stress Disorder (PTSD) symptoms together with disturbances in self-organization (DSO), reflecting affective dysregulation and negative self-concept. While PTSD symptoms have been examined in fibromyalgia, the potential contribution of CPTSD-related self-organization disturbances remains unclear. This pilot study examined probable ICD-11consistent PTSD and CPTSD symptom profiles and their associations with fibromyalgia symptom severity, hypothesizing that DSO domains would demonstrate additional associations beyond core PTSD symptoms. METHODS Adults with fibromyalgia (N = 34; age 1865 years) completed the Symptom Severity Scale (SSS), International Trauma Questionnaire (ITQ), Patient Health Questionnaire-4, and a sociodemographic form. The ITQ assessed PTSD and CPTSD symptom clusters using validated ICD-11aligned scoring algorithms. Classifications represented probable symptom profiles rather than formal clinical diagnoses, as structured diagnostic interviews were not conducted. Pearson correlation analyses and hierarchical linear regression predicting fibromyalgia symptom severity were performed. Ethical approval was obtained from the Scientific Research Ethics Committee of Kartal Dr. Lütfi Kırdar City Hospital (Approval: 27.08.2025;20251010.99.1913). RESULTS Probable ICD-11consistent PTSD and CPTSD symptom profiles were identified in 14.7% of participants. Fibromyalgia symptom severity correlated with reexperiencing (r =.397), avoidance (r =.363), affective dysregulation (r =.498), and negative self-concept (r =.461). PTSD symptoms explained 13.8% of variance in symptom severity (R² =.138), whereas addition of DSO symptoms produced a modest but non-significant increase (R² =.189; ?R² =.051, p =.172). CONCLUSIONS Trauma-related symptom dimensions were associated with
fibromyalgia severity. Although CPTSD-related disturbances showed limited additional
explanatory value beyond PTSD symptoms, findings highlight the potential clinical
relevance of trauma-informed psychiatric assessment in fibromyalgia and require
confirmation in larger studies using structured diagnostic evaluation.
Keywords: complex, post-traumatic stress disorder, fibromyalgia
BACKGROUND AND AIM:Smartphone addiction (SA) is a form of behavioral addiction that has become widespread with technological developments and is associated with negative psychological, physical, and cognitive effects. This study aimed to evaluate the relationship between SA, increased screen time, and attention performance. METHODS:The study included 123 healthy volunteers aged 1835 years with no known psychiatric disorders. Participants were divided into three groups based on their daily average smartphone screen time and clinical diagnosis of addiction: low screen time (3 hours), and SA group. All participants completed the Smartphone Addiction ScaleShort Form (SAS-SF), Smartphone Overuse Screening Questionnaire (SOS-Q), Depression Anxiety Stress Scales-21 (DASS-21), Barratt Impulsiveness ScaleShort Form (BIS-11-SF), Adult ADHD Self-Report Scale (ASRS), and Maslach Burnout Inventory (MBI). Attention performance was assessed using the Stroop Test TBAG Form, Trail Making Test, Cancellation Test, and Digit Span Test. Objective smartphone usage data, including daily average screen time and number of phone unlocks, were recorded. Ethical approval was obtained from Bursa City Hospital Ethics Committee (Decision Number: 2024-21/15). RESULTS:No significant differences in attention performance were observed among the groups. However, the SA group showed significantly higher daily screen time(pKeywords: addiction medicine, addictive behavior, attention, smartphone, smartphone
addiction, technology addiction
AuthorToEditor: Bursa Yüksek İhtisas E.A.H Dörtçelik Ruh Sağlığı ve Hastalıkları Ek
Hizmer Binası'nda uzman hekim olarak çalışmaktayım. Hastanemiz personel işleri birimi
ana binada ve kurumumuzdan uzak olduğu için bur başvurusunda çalışma belgesi
yerine doktor bilgi bankasından uzmanlık tescil tarihimi (28/10/2025) içeren belgeyi
yükledim. İhtiyaç duyulması halinde kurumdan da belge alabileceğimi belirtmek isterim.
Teşekkürler
Mehmet Avan, , Hayriye Dilek Hamurcu, , Begüm Pekiyi Avan, , Ali Çayköylü
Page 67
Presentation preview
BACKGROUND AND AIM: Major depressive disorder (MDD) is common in schizophrenia. Metabolic syndrome (MetS) is also frequent, but its independent association with comorbid MDD is uncertain. We estimated comorbid MDD prevalence in remitted schizophrenia and tested whether MetS is independently associated with MDD. METHODS: This cross-sectional study evaluated 218 individuals with DSM-5 schizophrenia (July 2022July 2023). Remission required ?6 months of stability, PANSS item scores ?3 for P1, P2, P3, N1, N4, N6, G5, and G9, and no psychiatric hospitalization within the past year. MDD was defined as CDSS ?7 with DSM-5based clinical confirmation in the same encounter by a psychiatrist; ambiguous cases were reviewed with a senior clinician and resolved by consensus. MetS was defined per NCEP ATP III (?3): waist circumference >102 cm (men) or >88 cm (women); triglycerides ?150 mg/dL; HDL CONCLUSIONS: MDD is frequent in remitted schizophrenia and shows an independent
association with MetS. Screening for depression and cardiometabolic risk is warranted;
longitudinal studies should clarify temporality and mechanisms.
Keywords: Schizophrenia, Major depressive disorder, Metabolic syndrome, Calgary
Depression Scale, Cardiometabolic risk
BACKGROUND AND AIM:Nasal septal deviation(NSD) is a common condition that may
lead to chronic nasal obstruction.Sleep disturbances,reduced quality of life,and
persistent somatosensory stimulation associated with chronic nasal blockage have
been reported to be related to psychological symptoms,particularly anxiety and
depression.However,studies simultaneously evaluating psychological symptoms,body
image,and self-esteem in patients with NSD are limited.This study aimed to investigate
the relationship between anxiety and depressive symptoms,body image,selfesteem,and perceived severity of nasal obstruction in patients with NSD. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This cross-sectional study included 60 patients diagnosed with NSD through
clinical and endoscopic examination at an otorhinolaryngology outpatient clinic and 60
healthy controls without NSD.Participants completed a sociodemographic data form,
the Turkish Nose Obstruction Symptom Evaluation(T-NOSE) scale,the Hospital Anxiety
and Depression Scale(HADS),the Rosenberg Self-Esteem Scale,and the Body Image
Scale. Statistical analyses were performed using the MannWhitney U test,independent
samples t-test, chi-square test,and Fishers exact test,as appropriate.Statistical
significance was set at p<0.05.Ethical approval was obtained from the faculty ethics
committee(Approval No: 2023/189). RESULTS:T-NOSE scores were significantly higher in the NSD group compared to
controls(9.97±5.33vs.2.12±3.41; p<0.001).Mean HADS-Anxiety scores were significantly
higher in patients with NSD(7.00±3.90 vs.5.07±3.73; p=0.004),and clinically elevated
anxiety levels were more frequent in the NSD group(28.3%vs.10.0%; p=0.011).Although
mean HADS-Depression scores were higher in the NSD group(5.95±3.35vs.4.65±3.28;
p=0.040),no significant difference was observed regarding the proportion of individuals
above the clinical cutoff(38.3%vs.28.3%; p=0.245).Mean self-esteem scores did not
differ significantly between groups(22.30±5.01vs.23.90±4.88; p=0.063).Body image
scores were significantly lower in the NSD group(154.88±24.60vs.164.88±24.30; p=0.033), and low body image was more frequent among patients with
NSD(21.7%vs.8.3%; p=0.041). CONCLUSIONS:Patients with NSD exhibited greater perceived nasal obstruction,higher
anxiety levels, and lower body image satisfaction.These findings suggest that the
psychological impact of NSD is particularly pronounced in relation to anxiety and
subjective body image processes.Considering psychiatric dimensions in the evaluation
of patients with NSD may contribute to a more comprehensive clinical approach.
Keywords: Anxiety, Body perception, Nasal septal deviation
BACKGROUND AND AIM
Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral
vertigo and is characterized by brief episodes triggered by head movements. Vestibular
dysfunction constitutes its primary pathophysiological mechanism. BPPV has been
associated with reduced quality of life as well as anxiety and depressive symptoms.
However, studies investigating anhedonia, anxiety sensitivity, and bodily sensation
amplification in individuals with BPPV remain limited. This study aimed to compare
anhedonia, anxiety sensitivity, and bodily sensation amplification between patients
diagnosed with BPPV and individuals in whom BPPV was excluded. METHODS
This cross-sectional study included 30 patients diagnosed with BPPV based on clinical
evaluation and positional maneuver tests in an otorhinolaryngology outpatient clinic
and 30 individuals in whom BPPV was excluded. Psychological assessments were
conducted using the Body Sensations Amplification Scale (BSAS), the Anxiety Sensitivity
Index-3 (ASI-3), and the Turkish version of the SnaithHamilton Pleasure Scale
(SHAPS).Stress-triggered exacerbation of vertigo was evaluated through a yes/no
response to the question: Do your dizziness symptoms increase during periods of
stress?Independent samples t-test and MannWhitney U test were used for continuous
variables, and Pearsons chi-square test or Fishers Exact test for categorical variables.
Statistical significance was set at p < 0.05 (Ethics Approval No: 2023/280). RESULTS
A history of previous psychiatric admission was more frequent in the BPPV group
(?²(1)=9.77, p=0.002). Total ASI-3 scores were significantly higher (U=245.00, p=0.010),
and the physical concerns subscale was elevated (U=170.00, p<0.001). Stress-related
symptom exacerbation was reported more frequently in the BPPV group (?²(1)=28.84,
p<0.001). Some patients referred to psychiatry reported subjective improvement. CONCLUSION
Psychological characteristics were higher in individuals with BPPV. However, given the
cross-sectional design, causality cannot be determined. The absence of structured
psychiatric assessment in the comparison group, reliance on subjective improvement
reports, and lack of control for concurrent vestibular treatment changes limit
interpretability.
Keywords: Anxiety sensitivity,Benign paroxysmal positional vertigo,Bodily sensations
BACKGROUND AND AIM:Social media use is widespread among young adults, and
excessive use may lead to social media addiction, negatively affecting academic
performance, well-being and social functioning. Individual factors such as impulsivity
and difficulties in emotion regulation may contribute to problematic use by reducing
behavioral control and increasing reliance on online platforms for coping. Increased
exposure to online interactions may also be associated with higher levels of
cyberbullying and cyber-victimization. This study aimed to examine the relationship
between social media addiction, impulsivity, emotion regulation difficulties and
cyberbullying among medical students. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This descriptive, cross-sectional study was conducted among Selçuk
University Faculty of Medicine students. Participants completed a sociodemographic
form, the Hospital Anxiety and Depression Scale (HADS), Social Media Addiction Scale,
Cyberbullying and Cyber-victimization Scales for University Students, Barratt
Impulsiveness Scale, and the Difficulties in Emotion Regulation ScaleShort Form
(DERS-16). Ethical approval was obtained from the Selçuk University Local Ethics
Committee. (Decision no:2025/542) Data were analyzed using SPSS; descriptive
statistics, group comparisons, correlation and regression analyses were performed. RESULTS:Students with emotion regulation difficulties had significantly higher
impulsivity scores (p=0.03, r=0.192). Age was positively correlated with cybervictimization scores (p=0.048, r=0.127). Cyberbullying scores were positively correlated
with cyber-victimization scores (p<0.001, r=0.341). Depression scores were also
positively correlated with cyberbullying scores. CONCLUSIONS:Findings suggest that emotion regulation difficulties are related to
higher impulsivity, which may increase vulnerability to problematic online behaviors.
The strong association between cyberbullying and cyber-victimization indicates that
these roles may overlap in online environments. In addition, the relationship between
depressive symptoms and cyberbullying highlights the potential contribution of
emotional distress to maladaptive digital interactions. These results emphasize the importance of preventive interventions targeting emotion regulation skills, self-control
and digital awareness among university students.
Keywords: Cyberbullying, emotion regulation, impulsivity, social media addiction
BACKGROUND AND AIM Major Depressive Disorder (MDD) is a chronic condition where
full remission remains elusive for a significant portion of patients despite standard
interventions. The objective of this study was to examine the efficacy of high-frequency
Repetitive Transcranial Magnetic Stimulation (rTMS) applied to the left dorsolateral
prefrontal cortex (DLPFC) on depressive symptoms in patients with treatment-resistant
MDD, and to evaluate the impact of factors such as age, gender, and duration of illness
on treatment response. METHODS Approved by the Ondokuz Mayıs University Clinical Research Ethics
Committee (Decision No: 2026/29), this retrospective study included 24 patients (18
female, 5 male; mean age: 47.65 ± 11.29 years) diagnosed with treatment-resistant
MDD. Patients underwent 20 rTMS sessions (5 days/week for 4 weeks). Treatment
efficacy was analyzed by comparing Hamilton Depression Rating Scale (HAM-D) scores
assessed immediately before the first and after the final session. All patients received
concurrent psychopharmacological treatment. However, due to the retrospective design
and heterogeneity/missing data regarding medication usage, between-group
comparisons based on dose equivalence were not performed. RESULTS The mean pre-treatment HAM-D score was 15.62 ± 5.59, which significantly
decreased to 7.75 ± 6.39 following rTMS treatment (p<0.001), representing a mean
improvement of 7.87 points. No statistically significant relationship was found between
treatment response and age (p=0.41), duration of illness (p=0.08), gender (p=0.87), or
marital status (p=0.37). CONCLUSIONS Our results confirm that high-frequency rTMS applied to the left DLPFC
is highly effective in reducing symptom severity in treatment-resistant depression.
Crucially, treatment response was not influenced by age, gender, or illness duration.
This suggests that rTMS remains a robust therapeutic option even for chronic, longstanding cases, supporting its use across a diverse patient demographic
Keywords: Major depressive disorder, Treatment-resistant depression, Repetitive
transcranial magnetic stimulation (rTMS), Sociodemographic factors, Duration of illness,
Treatment efficacy
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.
