Objective: Delay-related processes refer to individuals' affective, cognitive, and behavioral responses to waiting situations, often characterized by impatience, frustration, and a preference for immediate rewards. The aim of this study was to evaluate the Turkish version's validity and reliability of the Quick Delay Questionnaire for Adults (QDQ-A), a self-report tool developed to assess delay-related characteristics in adults with ADHD. Method: The study included 109 adults diagnosed with ADHD (mean age = 26.30 +/- 7.19) and 79 controls (mean age = 29.85 +/- 6.95). Participants completed the Adult ADHD Self-Report Scale (ASRS), the Hospital Anxiety and Depression Scale (HADS), and the QDQ-A. Results: Confirmatory factor analysis revealed a two-factor structure consistent with the original version; delay aversion and delay discounting. Cronbach's alpha coefficients indicated good internal consistency: .85 for the delay aversion subscale and .70 for the delay discounting subscale. Test-retest analysis demonstrated acceptable reliability (p< .001). Within the ADHD group, QDQ-A subscale scores were positively correlated with ASRS subscales, a weak but statistically significant correlation was observed between the delay discounting subscale and HADS depression scores (rho =.193, p=.045). Discussion: The present findings support the Turkish version of the QDQ-A as a valid and reliable tool for use in adult populations.
Objective: Evaluating the quality of life and anxiety levels of parents of children diagnosed with anorectal malformations (ARM) and to examine the effect of psychodrama group therapy on anxiety levels. Method: The study was conducted with parents of children with ARM who participated in the ARM Expert Family Meeting organized in collaboration with Izmir University of Economics Faculty of Medicine. Participants were first administered a demographic information form, the Hamilton Anxiety Scale (HAM-A), and the EUROHIS Quality of Life Scale. Following these assessments, three structured psychodrama group therapy sessions, each lasting 60-90 minutes, were conducted. After the completion of the psychodrama sessions, the HAM-A scale was administered again to the participants to evaluate the effect of the intervention on anxiety levels. The data obtained were evaluated using the Wilcoxon signed-rank test and Spearman correlation analysis. Results: 22 parents (11 men, 11 women) participated in the study. The mean age of the participants was 35.2 +/- 11.7 (19-65). A statistically significant difference was found between anxiety levels before and after psychodrama group therapy (p<0.05). Furthermore, a moderate, negative, and significant correlation was found between EUROHIS quality of life scores and initial and final HAM-A anxiety levels (r=-0.53; p<0.05; r=-0.57, p<0.05, respectively). Discussion: Psychodrama group therapy was effective in reducing anxiety levels in parents of children with ARM and revealed a significant relationship between quality of life and anxiety level. These findings indicate that psychodrama can be an applicable and beneficial intervention method for this specific group.
Attention deficit hyperactivity disorder (ADHD) is a well-established risk factor for suicidal ideation, suicide attempts, and completed suicide. Methylphenidate, a first-line pharmacological treatment for ADHD, is being increasingly prescribed. Given the rising rates of methylphenidate use and the high prevalence of suicide among individuals with ADHD, it is anticipated that clinicians will increasingly encounter suicide attempts involving this easily accessible medication. However, there are limited case reports of suicide attempts involving methylphenidate in individuals with ADHD. In this case report, we present a comprehensive biopsychosocial evaluation of a 14-year-old adolescent girl with ADHD who attempted suicide by taking 900 mg of long-acting methylphenidate, while discussing potential underlying mechanisms and risk factors for suicidality. We also addressed the clinical management of high-dose methylphenidate ingestion in children and adolescents, a topic for which the literature provides limited guidance. This case highlights several risk factors for suicidal behavior in adolescents, including untreated ADHD, comorbid psychiatric disorder, dysof suicide and inadequate coping mechanisms. Our findings emphasize the importance of sustained ADHD treatment, routine suicidality screening in adolescents with ADHD and providing psychoeducation for families. Suicidal behavior is a complex and multifactorial process shaped by the interaction of biological, psychological, and environmental factors. A multidisciplinary approach grounded in the biopsychosocial model is essential for effective assessment and intervention.
Objective: Sedative psychotropic medications, such as olanzapine, quetiapine, mirtazapine, and trazodone, are commonly used in hospitalized patients to manage psychiatric symptoms, such as insomnia, restlessness, and agitation. Despite their widespread use, data on their short-term effects on vital signs in medically complex patients are limited. Understanding these effects is crucial for optimizing patient safety in acute care settings. This retrospective cohort study aimed to assess the effect of olanzapine, quetiapine, mirtazapine, and trazodone on vital signs (systolic and diastolic blood pressure, heart rate, oxygen saturation, and body temperature) in non-intensive care unit hospitalized patients. Method: Among 871 screened consultation episodes, 184 patients met eligibility criteria and were included in the final analysis. Vital signs were collected at six standardized time points, 24 h before and after medication initiation. Linear mixed-effects models with subject-specific random intercepts were used to examine the treatment group, phase (pre-post), time of the day, and group-by-phase interactions. Multiple tests across the five primary phase effects were conducted using the Holm correction. Results: Across all vital sign outcomes, fixed-effect estimates were small and indicated minimal physiological change. Heart rate showed a modest unadjusted decrease from pre- to post-exposure (beta =-1.72 beats/min, 95% CI -3.11 to -0.33; p =.017); however, this association did not remain statistically significant after adjustment for multiple comparisons (Holm-adjusted p =.083). No statistically significant phase effects or group-by-phase interaction effects were observed for systolic blood pressure, diastolic blood pressure, or oxygen saturation. Discussion: In this medically complex inpatient cohort, commonly used sedative psychotropic agents (olanzapine, quetiapine, mirtazapine, and trazodone) did not produce clinically meaningful short-term changes in the vital signs.These findings support the cautious but routine use of these agents in inpatients, with standard monitoring. Further prospective studies are recommended to explore the long-term outcomes and potential drug interactions.
Esketamine is a glutamatergic treatment option for major depressive disorder, particularly treatment-resistant depression, because of its rapid antidepressant effects. However, the expanding meta-analytic literature is characterized by methodological heterogeneity and partial overlap of primary trials, which complicates the clinical interpretation of efficacy and safety findings. A higher-level synthesis is therefore needed to contextualize the existing evidence. We conducted an umbrella review of published meta-analyses evaluating the efficacy and/or safety of esketamine in adults with MDD. PubMed/MEDLINE and Scopus were searched for meta-analyses published between December 2020 and December 2025. Given overlap of primary trials and heterogeneity in outcome definitions, findings were synthesized qualitatively. Outcomes included depressive symptom severity, response and remission rates, suicidality-related outcomes, relapse and maintenance effects, and safety and tolerability. Twenty-nine meta-analyses were included. Esketamine was associated with reductions in depressive symptom severity compared with placebo, with effects most pronounced at very early post-administration time points (hours to days). Reported effect sizes were generally small to moderate. Response and remission rates were higher in the acute phase, particularly at early assessments. Outcomes related to suicidal ideation were examined in a limited number of meta-analyses and were largely confined to acute post-dose evaluations. Relapse prevention and maintenance effects were reported in few meta-analyses and were mainly based on similar continuation-phase trials. Esketamine was associated with higher rates of non-serious adverse events, most commonly dissociation, dizziness, sedation, and gastrointestinal symptoms, while serious adverse events and all-cause discontinuation were not consistently increased. At the meta-analytic level, intranasal esketamine is associated with a rapid-onset antidepressant effect of modest magnitude that appears time-sensitive. Current evidence suggests that esketamine may be considered as an adjunctive option for early symptomatic relief in selected patients. However, evidence regarding long-term effectiveness, relapse prevention, and effects on suicidal ideation remains limited. Further independently funded studies with long-term outcomes are needed to better define its clinical role.
Objective: Alcohol Use Disorder (AUD) is a long-term mental health condition marked by alcohol use that is hard to regulate and accompanied by persistent cravings, both of which contribute to increased addiction severity and relapse risk. Psychological flexibility, a critical component of Acceptance and Commitment Therapy (ACT), has been shown to help individuals tolerate cravings without resorting to substance use. Method: This study investigated the hypothesis that psychological flexibility serves as a mediator in the relationship between alcohol craving and addiction severity in individuals with AUD. The sample consisted of 86 individuals diagnosed with AUD who completed the Penn Alcohol Craving Scale, the Acceptance and Action Questionnaire-Substance Abuse, and the Addiction Profile Index. The potential mediating effect of psychological flexibility was analyzed using a mediation model. Results: Craving was positively correlated with addiction severity and negatively correlated with psychological flexibility. Psychological flexibility significantly predicted lower addiction severity and partially mediated the relationship between craving and addiction severity, accounting for 29% of the total effect. Discussion: The findings indicate that psychological flexibility plays a mitigating role in the relationship between craving and addiction severity in AUD. The effectiveness of psychosocial interventions, particularly ACT-based treatments, may be enhanced by targeting psychological flexibility. Further longitudinal and multicenter studies are warranted to confirm these mechanisms and inform clinical practice.
Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by executive dysfunction, particularly in working memory, inhibitory control, and attention. Anxiety disorders frequently co-occur with ADHD and may exacerbate or obscure these deficits. This study aimed to retrospectively evaluate neuropsychological test performance in ADHD with and without comorbid anxiety. Method: This retrospective, cross-sectional study was conducted at the Child and Adolescent Psychiatry Outpatient Clinic of Kartal Dr Lutfi Kirdar City Hospital. Clinical records of patients aged 6-18 years presenting with inattention between January 2023 and April 2024 were reviewed. Performance on the Stroop Color-Word Test, d2 Test of Attention, Digit Span, and Porteus Maze Test was analyzed. Participants were categorized into six groups based on DSM-5 diagnoses: ADHD, ADHD + anxiety, ADHD + other diagnoses, anxiety only, other psychiatric diagnoses, and non-diagnosed. Results: A total of 159 participants (53.5% male; mean age = 14.07 +/- 2.42 years) were included. Digit Span scores were significantly higher in the non-diagnosed group compared with all diagnostic groups (p<0.01). d2 error rates were highest in the ADHD group (p<0.01). Stroop 4, Stroop 5, and total completion times were significantly longer in the ADHD and ADHD + anxiety groups (p<0.01). Stroop correction scores were elevated in ADHD groups. Discussion: Findings confirmed impairments in working memory, selective attention, and processing speed in ADHD and comorbid groups. Anxiety did not exert a protective effect on inhibitory control but appeared to impose additional burden on working memory. These results underscore the importance of considering anxiety when assessing executive dysfunction in ADHD.
Methylphenidate is the first-line pharmacological agent used in the treatment of children with Autism Spectrum Disorder (ASD) and comorbid Attention-Deficit Hyperactivity Disorder (ADHD); however, it may rarely cause movement disorders. This case report presents a 9-year-old male patient who developed acute orofacial and limb dyskinesia following the initiation of high-dose modified-release methylphenidate, four weeks after the abrupt discontinuation of aripiprazole treatment. The dyskinesia completely regressed upon cessation of the stimulant therapy and did not recur during subsequent gradual dose titration. The case is discussed in the context of the hypothesis that dopaminergic hypersensitivity resulting from antipsychotic withdrawal may lower the threshold for stimulant-induced dyskinesia. Furthermore, the importance of careful dose titration and close clinical monitoring when re-initiating stimulant therapy is emphasized, particularly in patients with neurodevelopmental disorders who have a history of recent antipsychotic discontinuation.
Objective: This study examined functional impairment, sleep disturbances, and chronotype characteristics in children with the Predominantly Inattentive Presentation of ADHD (ADHD-PI), the Restrictive ADHD phenotype (ADHD-R), and typically developing controls. Method: A cross-sectional study was conducted with 104 children aged 7-12 years: ADHD-PI (n=34), ADHD-R (n= 36), and Control group (n=34). Parent-rated measures included the CSHQ (The Children's Sleep Habits Questionnaire), CCQ ( Children's Chronotype Questionnaire) , and WFIRS-P (Weiss Functional Impairment Rating Scale - Parent Form). All participants had an IQ above 80 and were free of comorbid psychiatric or medical conditions. Subgroup analyses were performed based on functional impairment status, and group comparisons were made on sleep-related and chronotype variables. Results: Functional impairment was significantly more common in both ADHD groups (ADHD-PI: 67%, ADHD-R: 61%) compared to control group (5.9%) (p < .001). Both clinical groups showed greater daytime sleepiness. Although no statistically significant group differences were found in eveningness scores, the ADHD-R group exhibited higher eveningness tendencies compared to both the ADHD-PI and healthy control groups. In ADHD-PI, functional impairment was associated with delayed sleep onset, parasomnia, and sleep-disordered breathing. In ADHD-R, higher sleep disturbance, parasomnia, and longer sleep duration were observed in the impaired group. However, these variables did not significantly predict impairment. Oppositional defiant behavior scores significantly predicted functional impairment within the ADHD-R group. Discussion: Sleep problems-particularly parasomnias-are associated with greater functional impairment in ADHD. Addressing sleep disturbances may contribute to improving daily functioning and quality of life in affected children.
Delusional Procreation Syndrome (DPS) encompasses delusions involving various stages of reproduction, including pregnancy, childbirth, and parenthood. Although the delusion of pregnancy (DoP) is the most commonly reported phenomenon, simultaneous delusions spanning multiple reproductive stages are rare. We describe a 39-year-old woman with chronic schizophrenia who presented with concurrent delusions of quadruplet pregnancy, miscarriage, stillbirth, childbirth, and motherhood. This case highlights the broad clinical spectrum of DPS and underscores the importance of distinguishing DoP from related conditions such as pseudocyesis and Couvade syndrome. It further illustrates the role of psychosocial adversity in shaping delusional themes.
Chorea-acanthocytosis is one of the neuroacanthocytosis syndromes; a rare (1-5 per 1,000,000) and progressive neurodegenerative disorder characterized by abnormalities in the nervous system accompanied by erythrocyte acanthocytosis. Various neurological dysfunctions and psychiatric symptoms coexist, significantly reducing both quality of life and life expectancy. Due to the rarity of the disease, diagnosis can sometimes be delayed; the initial presentation may include vague cognitive or psychiatric symptoms, leading to prolonged misdiagnoses and incorrect management. In middle-aged adults presenting with chorea and tic-like involuntary movements alongside psychiatric disorders, neuroacanthocytosis syndromes should always be considered. A thorough neurological and psychiatric examination should be conducted, and necessary imaging and laboratory tests should be performed.In this case report, we present the detailed diagnostic evaluation process of a patient suspected of having chorea-acanthocytosis with neuropsychiatric symptoms, in light of the existing literature.
Objective: Sensation seeking is defined as the pursuit of varied, novel, complex, and intense experiences, accompanied by a willingness to take physical, social, legal, and financial risks to attain such experiences. The present study aims to examine the relationship between sensation seeking behavior and both the dimensions of psychopathology and clinical features in individuals diagnosed with Antisocial Personality Disorder (ASPD). Method: The study included 60 individuals diagnosed with ASPD according to DSM-5 criteria and 60 healthy controls. The level of sensation seeking was evaluated using the Zuckerman Sensation Seeking Scale (SSS). Clinical Reflections were assessed using the Novelty Seeking subscale of the Temperament and Character Inventory (TCI-NS), the Addiction Profile Index (API) and its Clinical Form (API-C), and the Criminal Thinking Scale (CTS). Data were statistically analyzed using appropriate methods. Results: The ASPD group showed significantly higher scores than the control group in the SSS subdimensions of disinhibition, experience seeking, boredom susceptibility, and total score. Additionally, in the ASPD group, the total SSS score was positively correlated with the total TCI-NS (novelty seeking) score, the total API (addiction severity) score, the API-C novelty seeking subscale score, and the entitlement and power orientation subscales of the CTS. Furthermore, the boredom susceptibility subscale of the SSS showed a positive correlation with the number of suicide attempts. Discussion: In individuals with antisocial personality disorder, sensation seeking behavior is positively associated with the number of suicide attempts, novelty seeking, severity of addiction, and criminal thinking patterns. These findings highlight the importance of considering sensation seeking in the clinical assessment of ASPD.
Objective: Somatic Symptom Disorder (SSD) and Functional Neurological Symptom Disorder (FNSD) are common presentations of somatic symptom and related disorders in adolescence. Despite shared emotional and functional impairments, these disorders differ in clinical and psychological characteristics. This study aimed to compare SSD and FNSD with each other and with healthy controls in terms of clinical profiles, psychopathology, quality of life, and alexithymia. Method: The sample consisted of 120 adolescents aged 12-17 years, equally divided into three groups: SSD (n = 40), FNSD (n = 40), and healthy controls (HC; n=40). All participants underwent comprehensive clinical assessment using the semi-structured diagnostic interview. Self-report measures included the Brief Symptom Inventory (BSI), Pediatric Quality of Life Inventory (PedsQL), and Toronto Alexithymia Scale (TAS-20). Clinical severity was rated using the Clinical Global Impression-Severity scale (CGI-S). Results: Compared to HCs, both SSD and FNSD groups showed significantly higher symptom burden, lower healthrelated quality of life, and elevated alexithymia. The SSD group demonstrated higher alexithymia total scores, partigroups. FNSD cases were more frequently associated with motor symptoms and neurological consultations, whereas SSD cases reported longer symptom duration and more extensive somatic evaluations. Discussion: Although SSD and FNSD share psychosocial risk factors such as reduced quality of life and increased alexithymia, SSD is characterized by greater psychological distress and emotional unawareness. Systematic assessment of alexithymia may help refine diagnosis and guide interventions in adolescents with somatic presentations.
Objective: Previous studies have shown that maladaptive cognitions following trauma are closely associated with post-traumatic stress symptoms and depression. The aim of the present study was to examine the psychometric proMethod: Data were collected from 338 adults (M age = 32.95, SD = 11.43; 56.2% female) residing in regions affected by the February 6, 2023 earthquakes in T & uuml;rkiye. Participants completed the PTMBS along with the International Trauma Questionnaire and the International Depression Questionnaire. Results: Confirmatory factor analysis indicated that the one-factor model showed poor fit, whereas the three-factor model (Threat of Harm, Self-Worth and Judgment, Reliability of Others) demonstrated good fit indices. Criterion validity was supported by significant positive correlations of the scale with post-traumatic stress and depressive symptoms. Reliability analyses, including Cronbach's alpha, item-total correlations, and Spearman-Brown split-half coefficients, indicated acceptable to high internal consistency for the total and dimension scores. Discussion: Findings demonstrate that the Turkish version of the PTMBS adequately reflects the original three-dimensional structure and shows the expected associations with PTSD and depression symptoms. In particular, the stronger associations of the Threat of Harm subscale with psychopathology highlight the clinical relevance of "shattered assumptions" following trauma. In conclusion, the Turkish PTMBS is a valid and reliable tool for assessing maladaptive cognitions after trauma and can be used for clinical diagnosis, treatment planning, and monitoring therapeutic progress.
The purpose of this case report was to explore the use of lorazepam, a benzodiazepine, for treating pre-meal anxiety in adolescent patients diagnosed with anorexia nervosa (AN). This study aimed to assess the effects of lorazepam on reducing anxiety, increasing food intake, and improving treatment adherence in these patients. Three cases of adolescent females with AN were presented, highlighting their clinical characteristics, treatment interventions, and outcomes. The patients received a combination of pharmacotherapy (fluoxetine, aripiprazole, and lorazepam) and psychotherapy (cognitive-behavioral therapy) as part of their treatment regimen. The dosage and duration of lorazepam administration varied for each patient based on individual needs. The introduction of lorazepam along with other medications resulted in a reduction in pre-meal anxiety and an increase in food intake among the patients. Furthermore, treatment compliance and motivation improved, leading to weight gain and resumption of menstrual cycles in all cases. Positive effects of lorazepam were observed even after discontinuation of the medication. This case report suggests that the use of lorazepam for treating pre-meal anxiety in adolescent patients with AN may be beneficial in reducing anxiety, enhancing treatment adherence, and facilitating healthy eating habits. However, due to the limited evidence available, benzodiazepines are not recommended as a first-line treatment for AN, and their usage should be cautious due to the potential risks of dependence and withdrawal. Further research is needed to evaluate the efficacy and safety of benzodiazepines, including different types and doses, for treating AN.
This case report describes a 41-year-old woman with a history of childhood immunoglobulin A vasculitis and adult-onset schizophrenia, to the best of our knowledge, representing the first clinical observation suggesting a potential link between these conditions. Although current serological evaluations showed no active vasculitis, the case highlights a possible association, in line with research indicating an increased risk of schizophrenia in individuals with autoimmune disorders, including vasculitis. Mechanistically, immunoglobulin A vasculitis could hypothetically influence neuroimmune processes through transient effects on the blood-brain barrier or microvascular function, potentially contributing to pathways relevant to psychosis. Certain antipsychotic treatments are also known to interact with immune responses, supporting the rationale for further investigation. While causality cannot be inferred from a single case, this report underscores the importance of exploring immunoglobulin A vasculitis as a factor in schizophrenia pathogenesis and encourages longitudinal and mechanistic studies to better understand the potential neuroimmune mechanisms involved.
