BACKGROUND AND AIM:Psychiatric presentations to emergency departments (EDs) constitute a heterogeneous, high-risk group associated with prolonged waiting times compared to general medical presentations. Understanding their characteristics is essential for effective service planning. This study aimed to describe the profiles of patients referred for ED psychiatric consultation and identify factors associated with psychiatric inpatient admission and treatment refusal. METHODS:This retrospective descriptive study included all patients aged 18 years and older referred for ED psychiatric consultation between 6 October 2022 and 1 March 2024 (n = 2,146). Presentations on different days by the same patient were counted separately, whereas multiple visits for the same clinical episode were analyzed as a single presentation. Diagnoses were established via structured clinical interviews according to DSM-5 criteria. Data extracted from hospital records included sociodemographic variables, clinical characteristics, consultation reasons, and treatment outcomes. Descriptive statistics and multivariable logistic regression analyses were performed. The study was approved by the Ankara Etlik City Hospital Ethics Committee(AEŞH-BADEK-2024-838). RESULTS:Women comprised 53.9% of the sample, and 70.7% of consultations occurred outside regular working hours. The most common consultation reason was suicide attempt (21.0%), predominantly via drug overdose (81.1%). Psychotic disorders(22.9%), depressive disorders (19.3%), and anxiety disorders(16.9%) were the most frequent diagnoses. Overall, 4.5% of patients were admitted to a psychiatric ward, while 5.6% were discharged following treatment refusal. Psychiatric admission was more likely among patients with psychotic disorders, bipolar disorder in manic or hypomanic episodes, and drug-related suicide attempts. Management without psychotropic medication predicted lower admission rates. Treatment refusal was significantly higher among patients with an unclear psychiatric history and lower among those with documented diagnoses. CONCLUSIONS:Emergency psychiatric consultations involve a clinically complex
population requiring rapid risk assessment and coordinated care. Strengthening
communication-focused and person-centered interventions may be worth exploring and
could be considered in future interventions to improve emergency psychiatric
outcomes.
Keywords: Emergency Departments, Emergency Psychiatric Services, Hospital
Admission, Treatment Refusal, Suicide
Melike Düzgün, Emel Şafak, Gizem Anıl Yunusoğlu, Müge Topçuoğlu, Mustafa Nogay Coşkun, Ali Erdoğan, Sercan Karabulut
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BACKGROUND AND AIM: Substance use disorder (SUD) negatively affects individuals ability to cope with stress and regulate emotions. Dysfunctional coping strategies may contribute to the initiation and maintenance of substance use. Intolerance of uncertainty has also been associated with maladaptive coping and emotional regulation difficulties across various psychiatric conditions. However, its role in SUD remains insufficiently clarified. This study aimed to compare coping attitudes and intolerance of uncertainty between individuals with SUD and healthy controls. METHODS: This cross-sectional study included 78 patients with SUD and 90 healthy volunteers. Coping attitudes were assessed using the COPE Inventory, and intolerance of uncertainty was evaluated with the Intolerance of Uncertainty Scale (IUS). Ethical approval was obtained from the Akdeniz University Scientific Research Ethics Committee (TBAEK-787, 28.08.2025). Group comparisons were performed using appropriate statistical analyses. RESULTS: The SUD group was younger than controls (32.49 ± 7.74 vs. 39.8 ± 10.79 years, p < 0.001), and males were overrepresented (86.3% vs. 45.6%, p < 0.001). Controls scored higher on COPE self-help, approach, adaptation subscales, and total COPE scores (all p ? 0.001), indicating stronger functional coping strategies. No differences were observed in avoidance or self-punishment. Prospective anxiety scores were higher in controls (p = 0.030), whereas inhibitory anxiety and total IUS scores did not differ significantly. Given demographic differences between groups, this finding should be interpreted cautiously. CONCLUSIONS: Individuals with SUD exhibit weaker functional coping than healthy controls, supporting the role of maladaptive coping in substance use maintenance. Overall intolerance of uncertainty levels were comparable between groups. Higher prospective anxiety in controls may reflect greater future-oriented cognitive processing rather than increased psychopathology, whereas impulsivity and present-focused decision-making in SUD
may attenuate anticipatory concern. Ongoing data collection and planned adjusted
analyses are expected to strengthen the robustness and generalizability of these
findings.
Keywords: Coping Behavior, Intolerance of Uncertainty, Substance-Related Disorders
BACKGROUND AND AIM: Low-grade systemic inflammation has been implicated in major psychiatric disorders. Hematological inflammatory markers derived from routine complete blood count (CBC) parameters provide accessible indices of inflammatory burden. We aimed to compare NLR (neutrophil-to-lymphocyte ratio), MLR (monocyte-to lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), SII (platelet×neutrophil/lymphocyte), and SIRI (neutrophil×monocyte/lymphocyte) across primary diagnostic categories in psychiatric inpatients hospitalized over one year. In the absence of a contemporaneous healthy control group, we evaluated the prevalence of values above published population-based upper reference thresholds (97.5th percentile). METHODS: This retrospective observational study included all adult patients hospitalized in a university psychiatry clinic between January 1 and December 31, 2025, classified by primary discharge diagnosis. Admission CBC results obtained within the first 24 hours were analyzed. Patients with active infection, autoimmune disease, malignancy, acute inflammatory conditions, or systemic corticosteroid use were excluded where documented in records. Diagnostic-group comparisons were performed using KruskalWallis tests. Ethics Committee Protocol Number: 2026/45. As a limitation of routine retrospective data, comorbidities, medication exposure, illness duration, and standardized symptom severity measures were not uniformly documented and were therefore not analyzed. RESULTS: A total of 423 patients were included: major depressive disorder 29.8%, bipolar disorder manic episode 18.2%, bipolar depressive episode 11.8%, psychotic disorders 11.6%, anxiety disorders 10.6%, substance use disorder 7.8%, obsessive compulsive disorder 3.5%, bipolar mixed episode 2.6%, and other diagnoses 4.0%. No statistically significant differences were observed among diagnostic groups in NLR, MLR, PLR, SII, or SIRI (p=0.767, 0.404, 0.145, 0.287, 0.360). Using published upper reference thresholds, 57.7% had ?1 index above the 97.5th-percentile threshold; SIRI showed the highest exceedance (56.7%).CONCLUSION: Hematological inflammatory markers did not differ by diagnosis,
supporting a transdiagnostic inflammatory pattern in psychiatric inpatients. Elevated
indicesparticularly SIRIsuggest substantial inflammatory burden and warrant
prospective studies with standardized clinical severity and comorbidity/medication
assessment.
Keywords: Inflammations, lymphocyte, neutrophil, pychopathology
BACKGROUND AND AIM:Systemic inflammation is increasingly recognized as a core
component of the pathophysiology and neuroprogression of bipolar disorder (BD). Novel
composite hematologic indices, including the systemic immune-inflammation index
(SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value
(PIV), offer accessible measures of the inflammatory burden. However, the effects of
mood stabilizers on these parameters remain unclear. This study aimed to examine the
association between lithium and/or valproate (VPA) treatment and systemic
inflammatory burden in euthymic patients with BD. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):A total of 520 euthymic patients with DSM-5diagnosed BD were included
and classified into four groups: no lithium/VPA, VPA, lithium, and lithium+VPA.
Sociodemographic and clinical variables, complete blood count parameters, and
derived inflammatory indices (SII, SIRI, and PIV) were compared. This study was
approved by the Ethics Committee of Necmettin Erbakan University (IRB: 2025/5925). RESULTS:The groups were largely comparable in terms of sociodemographic features.
The lithium+VPA group exhibited a more severe illness course, including longer disorder
duration and higher episode and hospitalization counts (all p?.001). The VPA group
demonstrated significantly lower neutrophil counts and reduced SII, SIRI, and PIV values
than the lithium and no lithium/VPA groups (all p<.001). In the regression analysis, VPA
use independently predicted lower SII levels (?=0.168, p=.021), whereas lithium use
showed no significant association (p=.481). Inflammatory indices were not correlated
with illness duration, number of episodes, or hospitalization history. CONCLUSIONS:Valproate treatment was associated with a reduced systemic
inflammatory burden in euthymic BD, independent of clinical severity. In contrast,
lithium was not associated with lower inflammatory indices. These findings suggest that
VPA may exert an anti-inflammatory effect beyond mood stabilization, highlighting the
relevance of immuno-inflammatory mechanisms in treatment selection and the long
term course of BD.
Keywords: Systemic inflammation, bipolar disorder, valproate
BACKGROUND AND AIM
Methamphetamine exerts strong sympathomimetic and direct cardiotoxic effects,
whereas the electrophysiological impact of cannabis remains less clearly defined. This
study aimed to compare electrocardiographic markers of cardiac depolarization and
repolarization among individuals with methamphetamine use disorder, cannabis use
disorder, and healthy controls. METHODS
This cross-sectional study included 53 patients with methamphetamine use disorder, 54
with cannabis use disorder, and 51 healthy controls without substance use. The study
was approved by the Institutional Ethics Committee (Approval No: 2023-15142 ). All
participants underwent standard 12-lead electrocardiography. Analyzed parameters
included corrected QT interval (QTc), QT dispersion (QTd), corrected JT interval (JTc), JT
dispersion (JTd), Tpe interval, Tpe/QTc ratio, P-wave dispersion, frontal QRS axis, heart
rate, PR interval, and fragmented QRS complexes (fQRS). Continuous variables were
expressed as median (interquartile range) and analyzed using the KruskalWallis test
with Bonferroni-adjusted post hoc comparisons. Categorical variables were compared
using chi-square or Fishers exact tests. RESULTS
Significant intergroup differences were observed in ventricular repolarization
parameters. QTc values were significantly higher in the methamphetamine group
compared with both cannabis users and controls (p = 0.004). QT dispersion was increased in methamphetamine users compared with controls (p = 0.006). JT dispersion
showed the most pronounced difference, with significantly higher values in the
methamphetamine group than in the other groups (p < 0.001). The prevalence of
fragmented QRS complexes was also higher in methamphetamine users compared with
controls (p = 0.032). CONCLUSIONS
Methamphetamine use is associated with prolonged QTc, increased QT dispersion,
elevated JT dispersion, and a higher prevalence of fragmented QRS complexes,
indicating increased arrhythmogenic potential. Cannabis use was not associated with
significant electrocardiographic alterations compared with controls, although a trend
toward greater repolarization heterogeneity was observed.
Keywords
Methamphetamine use disorder; Cannabis use disorder; Electrocardiography;
Ventricular repolarization; QT interval; JT dispersion; Arrhythmia risk
BACKGROUND: Bipolar disorder (BD) is associated with high suicidality, decreased
psychological resilience, and an increased prevalence of metabolic syndrome (MetS).
However, the combined role of metabolic parameters and psychological resilience in
suicidality remains underexplored. The aim of this study was to compare psychological
resilience and suicidality between BD patients with and without metS, and to evaluate
the predictive value of metabolic markers for suicide risk. METHODS: A total of 174 patients with BD were included (87 with MetS, 87 without) in
the study. Sociodemographic and clinical data, metabolic parameters (TG, HDL, LDL,
total cholesterol, fasting blood glucose [FBG], waist circumference, systolic and
diastolic blood pressure), Hamilton Depression Rating Scale, Young Mania Rating Scale
Columbia Suicide Severity Rating Scale, and Resilience Scale for Adults (RSA) were
assessed.Lifetime suicide attempts were present in 19 patients with MetS and 17
without MetS. Group comparisons were conducted using ?² and MannWhitney U
tests.Correlation analyses were performed using Pearson or Spearman coefficients, as
appropriate.Two logistic regression models (enter method) were performed:Model 1
examined associations between metabolic parameters and suicidal ideation; Model 2
evaluated RSA subscales and metabolic parameters as predictors of lifetime suicide
attempts.The protocol of the study was approved by the Institutional Ethics Committee
of the University of Health Sciences Bakirkoy Sadi Konuk Training and Research Hospital
(Number 2023/71,2023/06/02). RESULTS: MetS status was not associated with suicidality or overall RSA scores. In the
MetS group, patients with suicide attempts had higher LDL levels (p=0,031, Z=-2,153).
Higher FBG was independently associated with lower odds of suicidal ideation (p=0.019,
OR=0,983).Higher Structured Style (p=0.025, OR=1,163) and lower Perception of Self
scores (p=0.006, OR=1,248) predicted lifetime suicide attempts. CONCLUSIONS: Although MetS was not directly associated with suicidality, specific
metabolic parameters and resilience dimensions demonstrated significant
relationships.These findings should be interpreted with caution given the possibility of
medication-related confounding.Keywords: bipolar disorder, resilience, suicidality, metabolic syndrome, biomarkers
BACKGROUND AND AIM:Major depressive disorder (MDD) is associated with a
substantially increased risk of suicide. Although sleep quality, chronotype, and
psychological resilience have each been linked to suicide risk in MDD, their combined
effects remain unclear. This study examined the associations of these factors with
suicide risk and their potential direct and indirect effects. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):Two hundred patients with MDD were consecutively recruited from inpatient
and outpatient clinics.Written informed consent was obtained from all participants (IRB:
2025.03.98). Sociodemographic and clinical data were collected, and depression
severity and suicide risk were assessed using the Hamilton Depression Rating Scale and
the ColumbiaSuicide Severity Rating Scale. Sleep quality, chronotype, and
psychological resilience were evaluated using the Pittsburgh Sleep Quality Index (PSQI),
MorningnessEveningness Questionnaire, and ConnorDavidson Resilience Scale.
Multivariable linear regression analyses were performed to identify independent
predictors of suicide risk. Mediation and moderation analyses were conducted using
GLM-based models with 5,000 bootstrap resamples. Statistical significance was set at p
< 0.05. RESULTS:Most participants (89.5%) had poor sleep quality (PSQI > 5). Poor sleep quality
was associated with greater depression severity and lower resilience. An evening
chronotype was linked to earlier illness onset, higher depression severity, poorer sleep
quality, and reduced resilience. In multivariable analyses, number of hospitalizations
and depression severity independently predicted suicide risk (Adj. R² = 0.215). Sleep
quality had a direct effect on suicide risk, while resilience did not mediate but
significantly moderated the relationship between depression severity and suicide risk. CONCLUSIONS:These findings highlight sleep disturbance and chronotype as clinically
relevant features associated with suicide risk in MDD. Importantly, higher psychological
resilience attenuated the adverse impact of depression severity on suicide risk,
suggesting that resilience-enhancing interventions, alongside systematic assessment of
sleep and chronotype, may offer meaningful clinical benefit, particularly in patients with
severe depressive symptoms.
Keywords: Depression, Suicide, Sleep Quality, Chronotype, Psychological Resilience
Nisa Nur Yıldırım, Hasan Mervan Aytaç, Sacide Pehlivan, Fatıma Ceren Tunçel
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BACKGROUND AND AIM:
Panic disorder (PD) has a substantial genetic component, yet specific biological
markers remain unclear.Leptin, a neuropeptide regulating energy balance, influences
neuroplasticity and anxiety-related behaviors through limbic brain regions and
interactions with the hypothalamicpituitaryadrenal axis.Although LEP and LEPR
variants have been linked to several psychiatric disorders, their role in PD has not been
directly examined. This study compared the genotype and allele distributions of LEP
?2548G/A (rs7799039) and LEPR 668A/G (rs1137101) polymorphisms between
individuals with PD and healthy controls and evaluated associations with PD subtypes
and clinical parameters. METHODS: The study was approved by the Başakşehir Çam and Sakura City Hospital
Ethics Committee (Protocol no: 2025.06.251). A total of 204 participants(102 PD
patients;102 controls) were included. Diagnoses were established using SCID-5
CV.PDSS, PAS, HDRS, and STAI were administered. Genotyping was performed using
PCRRFLP.Categorical variables were analyzed using chi-square or Fishers exact tests,
and continuous variables using appropriate parametric or nonparametric tests.Odds
ratios (OR) with 95% confidence intervals (CI) were calculated.A p value <0.05 was
considered statistically significant. RESULTS: For LEP ?2548G/A, the AA genotype was more frequent in PD patients
(OR=2.435; p=0.018), and the A allele frequency was also higher (p=0.046).For LEPR
668A/G, the AA genotype was less frequent (OR=0.396; p=0.001), whereas the AG
genotype was more frequent (OR=2.238; p=0.006). Clinical variables and scale scores
did not differ by genotype.No differences were observed for respiratory or nocturnal
subtypes; however, patients with agoraphobia had higher frequencies of the LEPR AA
genotype (OR=2.417; p=0.030) and A allele (OR=1.928; p=0.029). CONCLUSIONS:
LEP and LEPR gene polymorphisms were associated with PD in this sample.The LEP AA
genotype was associated with increased PD risk, whereas the LEPR AA genotype was
associated with reduced PD risk.Agoraphobia was also associated with the LEPR AA
genotype and A allele. Replication in larger and independent samples is warranted.
Keywords: Panic disorder, leptin, leptin receptor, single gene polymorphism
Duçem Selena İşmar, Gamze Burhan, Güneş Devrim Kıcalı
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INTRODUCTION AND AIM
Patient adherence in psychiatric treatment depends on the provision of clear and
comprehensible written information. Although drug package inserts are the primary
written source of information for patients, complex language may negatively affect
treatment adherence and patient safety. This study aimed to objectively evaluate the
readability levels of package inserts of frequently prescribed antidepressant and
antipsychotic medications in Türkiye using the Ateşman Readability Index. METHODS
This cross-sectional descriptive study included 20 active substances, comprising 10
antidepressants and 10 antipsychotics commonly prescribed in Türkiye. As nationwide
prescribing data were not accessible, medications were identified based on the most
frequently prescribed drugs in our outpatient clinic.
For each active substance, one original product was selected. To ensure methodological
standardization, 100-word text samples were extracted from the How to Use section of
the most up-to-date patient information leaflet available on the official website of the
Turkish Medicines and Medical Devices Agency (TİTCK). This section was chosen
because it directly relates to treatment adherence and appears under a standardized
heading in all inserts.
A starting sentence was determined using a random number generator, and a
consecutive 100-word text segment was analyzed. Readability levels were calculated
using the Ateşman Readability Index formula (Score = 198.825 [40.175 × L] [2.610 ×
S]). Ethics committee approval was not required, as only publicly available documents
were analyzed. RESULTS
The mean readability score corresponded to the Moderate Difficulty category.
Approximately a high school level of education was required to understand both
antidepressant and antipsychotic package inserts. CONCLUSION
Consistent with studies in Turkey, findings align with research from the United Kingdom,
Ireland, the United States, Iran, and Qatar using Flesch Reading Ease and Flesch
Kincaid Grade Level, indicating antidepressant and antipsychotic leaflets remain
difficult for lower-educated patients.
Keywords: Psychopharmacology, Ateşman Readability Index, Patient Adherence
Keywords: Psychopharmacology, Ateşman Readability Index, Patient Adherence
BACKGROUND AND AIM:Bipolar mania has been linked to peripheral immune activation
and low-grade inflammation, while the mechanisms of ECT remain unclear. Hemogram
derived indices(e.g., NLR,PLR,MLR) and composite measures such as SII,SIRI,PIV are
practical, low-cost surrogates of systemic inflammation(1). We compared these indices
between manic bipolar patients and healthy controls and assessed prepost ECT
changes. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):The study included 34 patients with bipolar disorder who received ECT during
the manic phase and 42 healthy controls. Pre- and post-ECT blood samples were
collected to assess Hemogram-Derived Inflammatory Indices including neutrophil
lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR), monocyte-lymphocyte
ratio(MLR), neutrophil-platelet ratio(NPR), systemic immune-inflammation index(SII),
systemic inflammation response index (SIRI) and pan-immune-inflammation value(PIV).
Clinical outcomes were measured using the Young Mania Rating Scale(YMRS) and
Clinical Global Impression(CGI) scale (Ethics Committee Approval No:2011-KAEK-25
2019/04-19). RESULTS:Before ECT, the bipolar mania group differed significantly from healthy
controls in terms of NLR(p = 0.015), NPR(p = 0.018), MLR(p=0,001), SII(p=0.024), SIRI
(p<0,001), and PIV(p=0,001). Following ECT, no significant changes were detected in
NLR (p=0.122), PLR(p=0.149), NPR(p=0.185), MLR(p=0.713), SII(p=0.139), SIRI(p=0.675)
or PIV(p=0,884) within the bipolar mania group. CONCLUSIONS:Despite marked clinical improvement after ECT, hemogram-derived
indices showed no significant prepost change. Consistent with our null prepost
changes in hemogram-derived indices, prior bipolar ECT casecontrol data likewise
found no significant change in NLR or PLR and reported that NLR remained higher than
in healthy controls after ECT (1-3). The stronger statistical separation between the mania
and healthy control groups observed for monocyte-inclusive indices (MLR, SIRI, and PIV)
may indicate a predominantly monocyte-driven inflammatory signal in bipolar mania
and suggest that these composite measures are more sensitive to casecontrol differences than classical ratios such as NLR or PLR. Future studies should standardize
timing, use multiple time points, and add CRP- and monocyte- based measures.
Keywords: Bipolar disorder, electroconvulsive therapy, inflammation, inflammatory
indices
fatma KARTALKırıkkale University Faculty of Medicine, Department of Psychiatry, Kırıkkale, Türkiye, Berk Arı ?ca, hatice polat
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BACKGROUND AND AIM:Phubbing is defined as an individual's act of paying attention to a smartphone, engaging with a smartphone, and withdrawing from interpersonal communication while interacting with another person or persons (1). The concept of phubbing is referred to as "Sociotelism" in our national literatüre (2). In the long term, this situation triggers psychological problems at the individual level and increases the risk of conflict and disconnection in social relationships (2). The aim was to examine sociotelism, which has become a significant problem among medical students today with the prevalence of technology, according to the level of psychological symptoms. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):Between December 2025 and January 2026, the Sociodemographic Data Form, Brief Symptom Inventory (BSI), and General Sociotelism Scale (GSS) were administered online to 175 medical students aged 18-30. Statistical analysis of the data was performed using the SPSS-25 program. Ethical committee approval was obtained from the Kırıkkale University Non-Interventional Research Ethics Committee at its meeting dated 10.12.2025, numbered 2025/17, with decision number 2025.12.10. RESULTS:In participants whose scores on all global and subscales of the KSE were above the cutoff value, it was found that the GSE level was statistically significantly higher. (Table 3), (for all global and sub-scales p-value
BACKGROUND AND AIM
Thyroid hormones play a critical role in the proper development and functioning of
multiple tissues, particularly the brain. Thyroid dysfunction has been associated with
several psychiatric disorders, especially mood disorders. However, data regarding the
prevalence of thyroid disease among psychiatric inpatients and its relationship with
clinical and treatment-related variables remain limited. This study aimed to determine
the prevalence of thyroid disease in hospitalized psychiatric patients and to examine its
associations with age, psychiatric diagnosis, psychotropic treatment, and medical
comorbidities. METHODS
In this retrospective study, 187 psychiatric inpatients hospitalized between January 1
and August 1, 2025 were analyzed. Patients with and without thyroid disease were
compared in terms of sociodemographic and clinical variables. Recorded variables
included age, sex, length of hospital stay, primary psychiatric diagnosis based on DSM-5
criteria, psychotropic medications used during hospitalization (antidepressants,
antipsychotics, mood stabilizers, anxiolytics), and medical comorbidities
(cardiovascular and other endocrine disorders). Ethical approval was obtained
(Approval No: 2026/01). Statistical comparisons were performed using appropriate
tests, and p<0.05 was considered statistically significant. RESULTS
Thyroid disease was identified in 36 patients (19.3%). Patients with thyroid disease were
significantly older than those without (50.31±15.48 vs. 43.86±14.17 years; p=0.017). No
significant differences were found regarding sex distribution, length of stay, or diagnostic
categories; depression was the most common diagnosis in both groups. Thyroid disease
was more frequent among patients receiving mood stabilizers and anxiolytics (p<0.05).
Cardiovascular (p=0.037) and other endocrine comorbidities (p<0.001) were
significantly more prevalent in the thyroid disease group. CONCLUSIONS
Approximately one-fifth of psychiatric inpatients had thyroid disease. Thyroid disorders
were associated with older age, medical comorbidities, and the use of mood stabilizers
and anxiolytics. However, due to the retrospective design, causal relationships cannot
be established. Prospective longitudinal studies are needed to clarify the direction and
underlying mechanisms of these associations.
Keywords: Thyroid disease, Psychiatric disorders, Comorbidity oup.
Fatma Kartal, Koray Yarız, Gulsen Teksin, Metehan Baykal, Department of Psychiatry, Kırıkkale, Türkiye, Hayriye Mihrimah Öztürk, Department of Psychiatry, Kırıkkale, Türkiye
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BACKGROUND AND AIM:Medical students are reported to have higher estimated rates
of suicide attempts compared with the general population, highlighting the need for
studies examining suicide-related risk factors in this group. Autistic traits have been
associated with suicidality among medical students; however, psychological
pain/psychachea construct with strong explanatory value for suicidalityand
tolerance for mental pain have not been sufficiently examined regarding autistic traits
and anger rumination. We aimed to evaluate the relationship between psychache and
tolerance for mental pain, autistic characteristics, and anger rumination in medical
students. METHODS :This cross-sectional study was conducted between December 2025 and
January 2026 and included medical students aged 1830 years. Sociodemographic Data
Form, Orbach and Mikulincer Mental Pain Scale8 (OMMP-8), Tolerance for Mental Pain
Scale10 (TMPS-10), Anger Rumination Scale (ARS) and Adult Autism Spectrum Quotient
(AQ) were administered as online questionnaires. Statistical analyses were performed
using SPSS version 25. Ethical committee approval was obtained from the Kırıkkale
University Non-Interventional Research Ethics Committee at its meeting dated
14.01.2026, numbered 2026/01, with decision number 2025.12.42. RESULTS:The presence of psychiatric disorder is 8,4%, 10,2% had history of psychiatric
disorder and 2,7% history of suicide attempts (Tablo1). There is a positive correlation
between ARS and AQ scores (r=0.185, p<0.001). OMMP-8 scores are negatively
correlated with TMPS-10 at a low-to-moderate level (r=?0.447, p<0.001), positively
correlated with ARS at a moderate level (r=0.581, p<0.001) and AQ at a low level
(r=0.247, p<0.001). TMPS-10 scores are negatively correlated at a low level with both
ARS and AQ (AQ: r=?0.224, p<0.001). CONCLUSIONS:Increased autistic traits and anger rumination are associated with
increased psychache and decreased tolerance for menthal pain. Our results highlight
the importance of early identification of suicidal risk factors such as autistic traits and
anger rumination in medical students. Our results provide a scientific basis for
developing intervention programs for suicide among medical students.
Keywords: Tolerance for Psychological Pain, Psychological Pain, Pychache, Anger
Rumination, Autistic Traits
Fatma Karta, Muhammed Mesut Avcı, Merve Karataş, Selim Yalçın, Hayriye Mihrimah Öztürk
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BACKGROUND AND AIM:Cancer and suicide are major public-health concerns, with
suicide risk among cancer patients at least 1,5 times higher than in the general
population. The Interpersonal Psychological Theory of Suicide (IPTS) suggests that
thwarted belongingness, perceived burdensomeness, and acquired capability increase
suicide risk. However, studies evaluating suicidal behavior in cancer patients using the
full IPTS framework are limited. This study investigated all IPTS components in
advanced-stage cancer patients METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):A total of 89 patients aged 1865 years with advanced-stage cancer were
assessed using the Sociodemographic Data Form, Beck Anxiety Inventory (BAI), Beck
Depression Inventory (BDI), Interpersonal Needs Questionnaire (INQ), and Acquired
Capability for SuicideFearlessness About Death Scale (ACSS-FAD). Data were analyzed
with SPSS-25. (Ethical committee approval was obtained from the Kırıkkale University
Non-Interventional Research Ethics Committee no:2026.02.31) RESULTS:There were no participants who had previously applied to psychiatry
outpatient clinic. Among the participants, 68.5% and 56.2% exceeded the BAI and the
BDI cut-off value (Table2). ACSS-FAD scores were significantly higher with patients
higher BAI cut-off values. (p=0,002). Correlation analyses showed moderate positive
relationships between BDI and ACSS-FAD (r=0,468, p<0,001) and INQ (r=0,317,
p=0,003), as well as between BAI and ACSS-FAD (r=0,358, p=0,001) and INQ (r=0,320,
p=0,002). ACSS-FAD also showed low positive correlations with BAI (r=0,224, p=0,05),
perceived burdensomeness (r=0,259, p=0,014), and INQ total scores (r=0,259, p=0,014), CONCLUSIONS:Although none of the participants had a previous psychiatric-outpatient
visit, more than 50% of them were found to have high levels of anxiety and depressive
symptoms. This may indicate a low rate of psychiatric help-seeking among patients with
advanced-stage cancer. Anxiety and depression correlate with perceived
burdensomeness, with higher anxiety specifically associated with the acquired
capability for self-harm. Consequently, integrating early psychosocial assessments and
interventions into holistic palliative care is essential for mitigating suicide risk in this
population.
Keywords: Advanced-stage Cancer, İnterpersonal Theory of Suicide, thwarted
belongingness, perceived burdensomeness
Erdi Arıkan, Ahmet Üzer, Ekrem Furkan Uçak, Betül Kurtses Gürsoy, Hayrunnisa Hanne Dağlı Arıkan
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BACKGROUND AND AIM:Internet Gaming Disorder (IGD) is a multifaceted behavioral
condition influenced by psychological and individual difference factors. While
associations with personality traits and mood symptoms are well documented, the
relative contributions of chronotype, self-esteem, and loneliness remain unclear. This
cross-sectional study examined the independent associations of chronotype, self
esteem, loneliness, and gender with IGD severity, while statistically adjusting for anxiety
and depressive symptoms. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This cross-sectional investigation included 211 healthy adult volunteers (123
women, 88 men), who completed the MorningnessEveningness Questionnaire (MEQ),
Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale (HADS), UCLA
Loneliness ScaleVersion III, and the Internet Gaming Disorder ScaleShort Form
(IGDS9-SF). Hierarchical linear regression analyses were conducted to identify variables
independently associated with IGD severity. The study was approved by the
Afyonkarahisar Health Sciences University Non-Interventional Ethics Committee
(03.05.2024, No: 111/2024-3). RESULTS:The final regression model explained a significant proportion of the variance in
IGD severity (R² = 0.224, F = 19.89, p < 0.001). Eveningness was the strongest variable
associated with higher IGD scores, accounting for approximately 15% of the variance (?
= ?0.353, p < 0.001), followed by male gender (4%; B = 3.468, p < 0.001) and lower self
esteem (2%; ? = ?0.179, p = 0.006). After including these variables, anxiety, depressive
symptoms, and loneliness were no longer independently associated with IGD severity. CONCLUSIONS:In this cross-sectional sample, greater IGD severity was independently
associated with an evening-oriented chronotype, male gender, and lower self-esteem,
while mood-related variables showed no independent association after adjustment.
These findings suggest that IGD severity may be more closely linked to relatively stable
individual traits than to current emotional symptoms. Future longitudinal studies are
needed to clarify the temporal and potentially causal relationships among chronotype,
self-esteem, and problematic gaming behavior.
Keywords: Behavioral addiction, chronotype, eveningness, gender, internet gaming
disorder, self-esteem
Zülal BulanKarabük Training and Research Hospital, Department of Mental Health and Diseases, Karabük, Nefise Demir
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BACKGROUND AND AIM:Recently, the importance of inflammatory processes in the
etiology of psychotic disorders has been increasingly emphasized.In this context, this
study aimed to compare the values of accepted inflammatory markers, including
neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet
lymphocyte ratio (PLR), among patients with initial diagnosis of psychosis, patients with
chronic psychotic disorders, and a healthy control group. METHODS :(Karabük University Faculty of Medicine Ethics Committee Application
Number: 2026/2711).The retrospective study included 215 patients in total: 52 patients
admitted to the psychiatry ward of Karabük Training and Research Hospital between
January 1, 2021, and December 31, 2025, who had no prior antipsychotic use and were
diagnosed with psychosis for the first time; 163 patients with chronic psychotic
disorders who had been followed up for at least one year; and 215 healthy control
subjects who applied to the family medicine outpatient clinic for health
screening.Participants with a history of alcohol or substance use, chronic or
inflammatory disease, and cancer were excluded.NLR, MLR, and PLR levels obtained
from complete blood count samples taken on the date of admission were compared
with a healthy control group of 215 individuals matched for age and gender RESULTS:Of the participants, 243(56.5%) were male, with an average age of 40.1±11.9
years. In three-group comparison, patients with initial diagnosis of psychosis had lower
lymphocyte counts and higher NLR, MLR, and PLR values compared to the control
group(p<0.05).Patients with chronic psychotic disorder had lower platelet counts and
higher MLR values compared to the control group(p<0.05).PLR levels were higher in
patients with initial diagnosis of psychosis compared to those with chronic psychotic
disorder (p=0.019). CONCLUSIONS:The significantly higher values of peripheral markers of inflammation,
such as NLR and MLR, in psychotic patients compared to a healthy control group
suggest that inflammation may play an important role in the etiopathogenesis of the
disease.
Keywords: Psychosis, inflammation, monocyte-lymphocyte ratio, neutrophil
lymphocyte ratio, platelet-lymphocyte ratio;
BACKGROUND AND AIM:This study examined relationships among body image, quality
of life, and depression in trans men followed at the Gender Identity Clinic of Kocaeli
University and identified variables predicting depressive symptom severity. It also aimed
to clarify the role of body image in psychological and functional outcomes within
gender-affirming treatment. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This cross-sectional study included 51 trans men receiving follow-up care at
the Gender Identity Clinic of Kocaeli University. Data were collected using the Body
Image Scale for Transsexuals, the World Health Organization Quality of LifeBrief Form,
and the Beck Depression Inventory. Ethical approval was obtained from the Kocaeli
University Faculty of Medicine Ethics Committee (Project No: KÜ GOKAEK 2026/39). RESULTS:Employment, hormone use, longer duration of hormone therapy, and having
undergone mastectomy and total abdominal hysterectomy with bilateral salpingo
oophorectomy were associated with lower body imagerelated distress. Older age,
partner presence, hormone use, longer hormone exposure, mastectomy, and longer
real-life experience in the affirmed gender were positively associated with quality of life.
Depressive symptom severity was lower among participants who were older, employed,
and had longer smoking histories and real-life experience. Total body image scores were
negatively correlated with total quality of life scores, while quality of life scores were
negatively correlated with depression scores. Quality of life strongly predicted
depressive symptom severity, whereas body image predicted depression indirectly
through quality of life. CONCLUSIONS:Depressive symptoms in trans men appear to be shaped primarily
through perceived quality of life rather than directly by medical interventions. Hormone
therapy and surgical procedures may contribute indirectly to improved quality of life by
alleviating body imagerelated distress. These findings underscore the need for
treatment approaches extending beyond symptom reduction and prioritizing
comprehensive strategies that enhance overall quality of life. Such an approach may
improve long-term psychosocial functioning and support sustained wellbeing across life
domains.
Keywords: Body image, depression, gender-affirming treatment, quality of life, trans
men
BACKGROUND AND AIM:Beyond a neurovascular condition, migraine is conceptualised
as a complex biopsychosocial disorder involving altered pain processing, limbic system
dysregulation, and psychosocial vulnerabilities. Pain catastrophising is one of the
strongest predictors of migraine-related disability. Mentalisation, defined as the
capacity to understand bodily and emotional experiences in terms of mental states, may
play a key role in shaping maladaptive pain appraisals. We hypothesised that,
hypomentalisation would be associated with higher pain catastrophising and migraine
related disability. This study aims to examine whether hypomentalisation is associated
with migraine-related disability through pain catastrophising as a potential mediator. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):This cross-sectional study was conducted at a neurology outpatient clinic in
Sincan Education and Research Hospital between July and October 2025. The study was
approved by the hospital's ethics committee
(02.06.2025-BAEK-2025-21). A total of 196 participants were aged 1865 and diagnosed
with migraine according to ICHD-3 criteria. Reflective functioning was assessed using
the RFQ-6, pain catastrophising using PCS-13, and migraine-related disability using the
HIT-6. Pearson correlations were calculated, followed by bootstrapped mediation
analyses (5,000 resamples) controlling for age and gender. RESULTS:Higher RFQ-6 score was significantly associated with greater pain
catastrophising (r =.35) and migraine-related disability (r =.26). PCS-13 score correlated
with HIT-6 (r =.52), with the Helplessness subscale the strongest correlation (r =.57).
Mediation analyses indicated that PCS-13 significantly mediated the relationship
between hypomentalisation and migraine-related disability (ACME = 0.57), accounting
for 71% of the total effect. When PCS-13 Helplessness was tested as the mediator, the
indirect effect increased (ACME = 0.69), explaining 87% of the total effect, while direct
effects remained non-significant. CONCLUSIONS:These findings support a process-based model of migraine-related
disability in which hypomentalisation may be associated with functional impairment
primarily through pain catastrophising, particularly perceived helplessness.
Keywords: hypomentalisation, migraine, pain catastrophising
Sarp Yoldas, Merve Rana Altunel Ülkü, Yasin Kavla, Nazife Gamze Usta Sağlam
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BACKGROUND AND AIM:Gambling disorder is a behavioral addiction that affects
individuals, and it has become an increasing public health concern. The widespread
use of internet and mobile technologies has led to an increase in online gambling,
resulting in earlier onset and a higher rate of clinical presentations. This study aimed to
describe the sociodemographic and clinical characteristics of individuals presenting
with gambling-related problems to the Cerrahpaşa Department of Psychiatry, including
active gamblers and first-degree relatives of gamblers. METHODS: This study was conducted with approval from the Ethics Committee
(Decision No:1566935; Date:03.02.2026). A total of 20,545 initial psychiatric evaluations
between 2023 and 2025 were screened. Cases were identified through electronic record
searches for gambling and related terms in clinical notes. RESULTS:Among 20,545 psychiatric evaluations, 112 patients presented with gambling
related problems, of whom 92 met diagnostic criteria for gambling disorder and
included in the analysis. The sample was predominantly male (93.5%). The proportion of
gambling disorder cases increased over time, accounting for 0.28% of all psychiatric
admissions in 2023, 0.45% in 2024, and 0.67% in 2025. Most patients had completed
high school (56.6%) or higher education (30.3%). Nearly half (48.9%) had no psychiatric
comorbidity, while depression (28.3%) and anxiety disorders (12.0%) were the most
frequent comorbid conditions. Online gambling was reported by 88.7%, and gambling
related debt was present in 85.1%. Follow-up attendance was observed in 43.2% of
patients, while 56.8% did not return for follow-up. Among individuals who presented for
psychiatric evaluation because a first-degree relative was engaged in gambling behavior
(n = 51), the majority were female (%84.1). Depression and anxiety disorders were the
most frequently identified diagnoses. CONCLUSIONS:Gambling-related psychiatric presentations have increased over time,
particularly among active online gamblers. These findings highlight the substantial
clinical and familial burden of gambling disorder and emphasize the need for early
identification, targeted interventions, and family-oriented treatment approaches.
Keywords: Gambling Disorder, Addiction, Pathological Gambling
Ahmet Selim Başaran, Nur Nihal Türkel, Hande Gazey, Behcet Coşar
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BACKGROUND AND AIM:Major depressive disorder (MDD) is characterized by pervasive
dysfunction in reward and motivation systems. Time Perspective theory provides a
framework for understanding cognitive-emotional orientations along the past-present
future axis. A crucial distinction exists between Future-Positive (FP) and Future-Negative
(FN) orientations. This study investigated how these orientations relate to MDD severity
through distinct anticipatory and consummatory hedonic mechanisms. METHODS (Ethics Committee Approval must be obtained and the number should be
specified.):A total of 135 medication-naïve MDD outpatients (Mean age: 33.29±9.95
years) participated in this cross-sectional study. Participants completed the Beck
Depression Inventory (BDI), GAD-7, Temporal Experience of Pleasure Scale, and Short
Zimbardo Time Perspective Inventory. Mediation models were tested using structural
equation modeling in R, specifically adjusting for anxiety as a covariate. The protocol
was approved by the Gazi University Ethics Committee (No: 2025-1143). RESULTS:The mean BDI score was 29.64±10.18. FP orientation significantly predicted
higher anticipatory pleasure (?=0.419,p<0.001). Anticipatory pleasure partially mediated
the relationship between FP and lower depression (indirect effect:
?=?0.089,p=0.024,95%CI[?0.165,?0.013]). Conversely, FN orientation showed a direct
positive association with depression severity (?=0.179,p=0.017). Consummatory
pleasure demonstrated no significant mediation effects (p>0.05). CONCLUSIONS:Our findings distinguish the "valence of the future" as two separate
cognitive-emotional axes in depression. The protective role of FP orientation is driven by
positive mental simulation, which channels motivational energy specifically into the
"wanting" (anticipatory) component of reward processing. This enhances the capacity to
imagine and emotionally invest in rewards, acting as a critical cognitive-motivational
defense line. Conversely, FN orientation functions through threat-based avoidance
pathways and rumination rather than primary motivational deficits. Clinically, future
oriented cognitive techniques specifically targeting positive prospection may restore
anticipatory motivation and help disrupt the maintenance of depressive pathology.
Keywords: anhedonia, anxiety, depression, reward processing, time perspective
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.
