Background: Recent evidence has suggested that low-grade systemic inflammation may contribute to the clinical expression of mood disorders, yet findings have differed considerably across studies. The present study compared several complete blood-count (CBC)-derived inflammatory indices among inpatients with bipolar disorder (BD), manic and depressive episodes, and major depressive disorder (MDD), and examined whether psychotropic medications influenced these inflammatory markers.Methods: This retrospective chart-review study included only inpatients hospitalized with a diagnosis of BD or MDD between January 1, 2019, and January 1, 2023. A healthy control (HC) group, matched by age and sex, was included for comparison. For data independence, only the first CBC obtained within 24 hours of admission was analyzed. Inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated from standardized fasting blood samples. Statistical analyses were performed using the Kruskal-Wallis test for group comparisons, followed by Bonferroni-corrected Mann-Whitney U tests. Additionally, analysis of covariance (ANCOVA) and regression models were employed to control for potential confounders such as age, sex, length of stay, and various psychotropic medications (lithium, antidepressants, and antipsychotics).Results: NLR and MLR ratios were consistently higher in all mood-disorder groups than in healthy individuals. PLR elevation appeared specific to the MDD group, and the SII was increased in depressive episodes but not in mania. These patterns remained statistically significant after adjustment for demographic covariates; male sex was negatively associated with PLR. Regression analyses adjusted for age and sex demonstrated a negative association between antidepressant use and PLR and MLR values.Conclusions: These results suggested that acute mood episodes are accompanied by measurable increases in certain inflammation-related hematologic markers. The inverse relationship between antidepressant use and PLR and MLR was consistent with an association between medication use and nonspecific systemic inflammatory markers observed in acutely hospitalized patients.

Clozapine is the most effective treatment for treatment-resistant schizophrenia, yet substantial interindividual variability in serum concentrations complicates dose optimization and therapeutic drug monitoring. While factors such as smoking and inflammation are known to influence clozapine metabolism, a substantial portion of the variability remains unexplained. Anticholinergic burden, reflecting cumulative exposure to anticholinergic medications, may be a clinically relevant yet underexplored factor associated with pharmacokinetic variability. This retrospective cross-sectional study included 93 patients diagnosed with schizophrenia spectrum and other psychotic disorders according to DSM-5 and receiving clozapine treatment at a tertiary psychiatric center. Serum clozapine and norclozapine concentrations were obtained under routine clinical conditions and used to calculate clozapine metabolic ratios, including the concentration-to-dose (C/D) ratio (serum concentration divided by daily dose) and the clozapine/norclozapine (C/N) ratio (serum clozapine concentration divided by serum norclozapine concentration). Anticholinergic burden was quantified using the Anticholinergic Cognitive Burden calculator. Clinical variables, including age, sex, smoking status, C-reactive protein, and neutrophil-to-lymphocyte ratio, were extracted from medical records. Associations between clinical variables and clozapine metabolic ratios were assessed using Spearman correlation analyses, and factors independently associated with metabolic ratios were identified using multivariate linear regression models. The mean anticholinergic burden score was 2.67 ± 2.02, and 52.7

OBJECTIVE:This study aimed to examine the relationship between intolerance of uncertainty (IU), psychological resilience (PR), and quality of life (QoL) in patients with obsessive-compulsive disorder (OCD). METHOD:A total of 144 participants (72 patients with OCD and 72 matched healthy controls) were included. Participants completed the Intolerance of Uncertainty Scale (IUS), the Resilience Scale for Adults (RSA), the Short-Form 36 (SF-36), the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the Yale- Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS:The groups were matched for age, gender, and socioeconomic status (p>0.05). The OCD group had significantly higher IU scores and lower QoL scores across all SF-36 domains compared to controls. In the OCD group, all QoL subscales showed a significant negative correlation with total IUS scores (strongest for vitality: r=-0.676, p<0.001) and a significant positive correlation with total RSA scores (strongest for vitality: r=0.619, p<0.001). Regression analyses indicated that PR, illness duration, and symptom severity (Y-BOCS) were significant predictors of QoL, explaining 15.9% to 55.3% of the variance in key mental health-related QoL domains. CONCLUSION:QoL in OCD patients is significantly impaired compared to healthy individuals. This impairment is strongly associated with higher IU, lower psychological resilience, and greater symptom severity.

Aim: Our study aimed to evaluate the sexual satisfaction levels and beliefs in sexual myths of Obsessive Compulsive Disorder (OCD) patients and control groups.Material and Methods: Our study involved 40 OCD patients, 40 Anxiety Disorder (AD) patients currently in remission, and 40 healthy controls (HC).Dimensional Obsessive Compulsive Scale (DOCS), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), Sexual Myths Scale (SMS), Hamilton Anxiety Rating Scale (HARS) were used as measurement tools.Results: Our study showed that OCD patients had lower sexual satisfaction and stronger beliefs in sexual myths than controls.Female OCD patients reported dissatisfaction in satisfaction, touch, avoidance, and anorgasmia, while male OCD patients struggled with frequency, avoidance, and touch.Female patients had significant relationships between sexual myths and satisfaction, communication, and avoidance.Male patients only showed a relationship with avoidance.Disease duration was the main predictor of satisfaction, while age and education influenced sexual myths.Discussion: These findings emphasize the need for targeted psychotherapeutic approaches for OCD patients' sexual behaviors and beliefs.

Background: Depression is one of the main diseases that cause disability. It is more common in various sociodemographic situations. Aims: This study investigated the risk factors associated with depressive symptoms and changes over the years based on data from a sample from the Republic of Türkiye. It was also intended to compare depressive symptoms and inflation rates by years. Method: Data for 2016, 2019 and 2022 from the Turkish Health Survey performed by the Turkish Statistical Institute were used in the study. Data for age, sex, marital status, education level, employment status, accompanying chronic health problems, restrictions in daily activities associated with health problems and problems accessing psychological treatment due to difficulty in paying were evaluated in terms of depressive symptoms. Results: Higher depressive symptoms were determined in women, the widowed and divorced, individuals with a low level of education, the unemployed, individuals with chronic health problems, those with restrictions in daily activities associated with chronic health problems and those with problems accessing psychological treatment due to difficulty in paying. Although inflation rates increased over the years, the severity of depressive symptoms decreased. A moderate positive correlation was observed between depressive symptoms and basic activities of daily living. Conclusions: Developing policies aimed at groups with high depressive symptoms may be important in combating depression.

Aim: Circadian rhythm dysregulation is one of the important mechanisms playing a role in the pathophysiology of bipolar disorder (BD). This study aims to examine the relationship between deterioration in circadian rhythm and psychosocial functionality among patients with BD, healthy first-degree relatives, and a control group. Material and Methods: We planned a cross-sectional study consisting of 64 BD patients, 64 healthy first-degree relatives, and 64 healthy controls. We used the Biological Rhythms Interview of Assessment in Neuropsychiatry to assess disruption in circadian rhythm, the Morningness-Eveningness questionnaire to determine chronotypes, and the Functioning Assessment Short Test to assess functionality. Results: In our study, it was found that the circadian rhythms of BD patients were more disrupted than those of the control group, while the BD group was found to exhibit higher rates of morningness and eveningness than patient relatives and healthy controls. It was determined that the circadian rhythms of BD patients with evening chronotype were more disrupted, whereas an association was noted between dysregulation circadian rhythm and deteriorated functionality in the patient group. Discussion: In light of the obtained data, it can be suggested that circadian rhythm disorder in BD patients may be an independent predictor of low psychosocial functioning. Our study supports that therapeutic interventions targeting circadian rhythm stability play an important role in the acute and long-term management of BD.

Objective: The readability of a text can be measured objectively using a series of mathematical formulas. Patients' proper understanding of a drug's effects and side effects is essential for treatment compliance in psychiatry. This study aimed to measure the readability level of the package leaflets of psychotropic drugs currently used in Turkey and to determine at what average age and education level were appropriate. Method: Four main psychotropic drug groups, which are thought to be used more frequently in adult psychiatry, were included in this study. The most recent package leaflets of the drugs in these groups were obtained from the official websites of the Ministry of Health, the Turkish Medicines and Medical Devices Agency (https://www.titck.gov.tr/kubkt) and the relevant companies in the market, and their readability level was determined. The formulas developed by Ate man and Bezirci-Y & imath;lmaz were used to evaluate readability levels in this study. Results: The average Ate man readability points were determined to be 48.2. From this, it was understood that an education at the level of the 13th-15th grade was necessary for the readability of the package leaflets. The average Bezirci-Yilmaz readability points were determined to be 13.2, indicating that an education at the level of 13th grade, or further education, was necessary for the readability of the package leaflets. Discussion: The level of education required for readability of the psychotropic drug package leaflets was seen to be extremely high when the average level of education in Turkey was considered. Improving package leaflets' readability can reduce patients' concerns about psychotropic drugs by facilitating their understanding of the treatment. It can increase treatment compliance, thereby helping the recovery of mental health.

Background and objectives: The study aims to compare individuals diagnosed with obsessive -compulsive disorder (OCD) and healthy individuals in terms of psychosis-like experiences (PLEs) and investigate the relationship between PLEs and OCD severity. Methods: Sociodemographic information form, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the positive dimension of Community Assessment of Psychic Experiences (CAPE-P), Hamilton Depres-sion Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were applied to 83 OCD patients and 83 healthy individuals. The 11th item of Y-BOCS (Y-BOCS-11) was used to evaluate the level of insight. The OCD group was compared with the healthy control group in terms of sociode-mographic information and CAPE-P score. In the OCD group, mediation analyses were performed to evaluate the factors affecting the relationship between OCD severity and PLEs. Results: The OCD group had higher CAPE-P scores than the healthy control group. CAPE-P scores were weakly correlated with Y-BOCS-11 and Y-BOCS total scores. It was found that the relation-ship between OCD severity and PLEs was mediated by poor insight; however, the scores of depression and anxiety did not. Conclusion: The results show that the level of insight is a determinative factor for PLEs in OCD. The fact that PLEs are common in the OCD group and healthy individuals support the concept of the psychosis continuum. We emphasize that being aware of PLEs in OCD can provide new under-standings of the phenomenon of OCD and psychosis. (c) 2023 Sociedad Espanola de Psiquiatria y Salud Mental. Published by Elsevier Espana, S.L.U. All rights reserved.

Background Transgender people experience violence in various forms, primarily domestic violence. The aim of this study was to examine transgender people's experiences of domestic violence and their coping methods. Materials and methods This study was conducted using the phenomenological method, one of the five basic qualitative research methods, with 20 transgender participants who applied to Ondokuz Mayıs University, Samsun, Turkey, to start the gender-affirming treatment process. The participants comprised 19 transgender men and 1 transgender woman. A semi-structured interview form was used for data collection. The average interview duration was 75.7 minutes. Audio recordings were used in the interviews, which were then transcribed. The obtained data set was subjected to content analysis. Results As a result of the content analysis, three themes emerged: being a transgender individual and the family, experiences of domestic violence, and methods of coping. According to the study results, the participants had experienced domestic violence of different dimensions, primarily psychological violence. Defined gender roles and societal expectations were determined to trigger violent behaviors. The most frequently used coping methods were giving a direct reaction, seeking instrumental-social support, and ignoring the incidents. Conclusion Our findings demonstrated that transgender people experience domestic violence at a high rate and that transphobic behaviors are triggered by societal norms. Our results are particularly noteworthy for clinicians regarding the importance of family support and accurate information for transgender people and the coping methods they use most.

Aim: This study aimed to examine the relationship between death anxiety in schizophrenia patients and the clinical characteristics of the disease and its functionality. Method: The study included 52 patients diagnosed with schizophrenia according to the DSM-5 diagnostic criteria and 52 healthy volunteers. Death anxiety scores were compared between the two groups using the Abdel-Khalek Death Anxiety Scale (ADAS). The functionality of the schizophrenia patients was evaluated with the Functional Remission of General Schizophrenia (FROGS) scale. Results: The mean ADAS total scores were statistically significantly higher in the schizophrenia patient group than in the control group. A low-level negative correlation was determined between the ADAS total points and the FROGS total points, the FROGS subscales of daily life skills and health. Conclusion: The results of this study showed higher death anxiety in schizophrenia patients than in the healthy control group. Patients with a higher level of functionality were determined to have a lower level of death anxiety. These results support our idea that interventions and therapeutic approaches to increase functionality in patients with schizophrenia can reduce their death anxiety. In order to reach more evident conclusions on this subject, prospective studies that deal with the causal relationship between death anxiety and functionality are needed.

Purpose: Treatment compliance is one of the most important variables that determine the disease course in psychotic disorders. This study evaluates after discharge compliance among patients with psychotic disorder hospitalized for treatment. It also compares groups classified on the basis of their treatment compliance. Materials and Methods: Thirty-nine patients hospitalized for treatment between 30.06.2018 and 30.06.2019 and with discharge diagnoses of psychotic disorder were included in the study. Information concerning patients' treatment compliance was elicited by telephone at least five months after discharge. The Morisky Medication Adherence Scale, the Functioning Assessment Short Test, and the Clinical Global Uyum Impressions Scale were completed during these interviews. Results: Treatment noncompliance was determined in 20 (51.3%) of the patients included in the study, partial compliancein 10 (25.6%), and total compliance in nine (23.1%). Patients with noncompliant to treatment experienced more frequent re-hospitalizations and poorer functionality, and possessed less knowledge concerning their disease. Conclusion: Since treatment noncompliance in psychotic disorder can result in an adverse disease course, interventions aimed at increasing compliance may be necessary.

Objectives The number of studies investigating inflammatory biomarkers in bipolar disorder has increased significantly in recent years. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) are inexpensive and easy to obtain values used to measure the level of inflammation. This study compared the NLR, PLR, and MLR values in the manic and euthymic phases of the same patients. Methods Patients who met the inclusion criteria and were hospitalized due to bipolar affective disorder manic episodes at the Ondokuz Mayis University Faculty of Medicine inpatient psychiatry clinic between 01.01.2013 and 01.01.2019 were enrolled in the study. One hundred thirteen patients undergoing manic episodes were included. White blood cells, neutrophil, lymphocyte, platelet, and monocyte counts were retrospectively recorded from complete blood count data collected during the hospital stay, and NLR, PLR, and MLR values were calculated from these. Results Neutrophil, platelet, and monocyte counts, as well as NLR, PLR, and MLR values were higher in the manic episodes of bipolar disorder compared to the control group. Decreased neutrophil and lymphocyte counts, and decreased NLR, PLR, and MLR were observed in the remission period after-treatment of the manic bipolar disorder episodes. In the euthymic phase of bipolar disorder, however, platelet and monocyte counts and MLR were higher than in the control group. Conclusions The study indicates that NLR and PLR may be used as state markers and that MLR may be used as a trait marker in bipolar disorder.

Amac: Tedavi uyumu psikotik bozukluklarda hastalik gidisini belirleyen en onemli degiskenlerden birisidir. Bu calismada yatarak tedavi goren psikotik bozukluk hastalarinin taburculuk sonrasi donemde tedavi uyumlari degerlendirilecektir. Ayni zamanda tedavi uyumlarina gore siniflandirilan gruplar arasinda da karsilastirmalar yapilacaktir. Gerec ve Yontem: Mevcut calismaya 30.06.2018-30.06.2019 tarihleri arasinda yatarak tedavi goren ve hastaneden cikis tanisi psikotik bozukluk olan 39 hasta dahil edilmistir. Hastalar taburculuklarindan sonra telefon ile aranarak mevcut durumlari ile ilgili bilgi alinmistir. Hastalarla yapilan bu gorusmede ayrica Morisky Tedavi Uyum Olcegi, Kisa Islevsellik Degerlendirme Olcegi ve Klinik Global Izlenim Olcegi doldurulmustur. Bulgular: Calismaya dahil edilen hastalarin 20’sinin (% 51.3) tedavi uyumu dusuk, 10’unun (% 25.6) tedavi uyumu orta ve dokuz hastanin (% 23.1) ise tedavi uyumu yuksek olarak bulunmustur. Tedavi uyumu dusuk olan hastalarin taburculuk sonrasi yeniden hastane yatislarinin daha sik oldugu, islevselliklerinin daha kotu oldugu ve hastaliklari ile ilgili daha az bilgi sahibi olduklari tespit edilmistir. Sonuc: Psikotik bozuklukta tedavi uyumundaki dusukluk hastalik seyrinin olumsuz olmasina neden olabilecegi icin tedavi uyumunu arttirmaya yonelik girisimler gerekebilir.

Objective: Patients with obesity have more restrictive eating behavior than those of normal weight, and are thought to cause depressive symptoms by leading to avoidant coping strategies. In this study, it was aimed to investigate the mediating role of eating, shape and weight concern the relationship between restricted eating and depression in individuals applying to bariatric surgery. Method: The study sample was composed of patients with morbid obesity who applied to Ondokuz Mayis University Faculty of Medicine for bariatric surgery between 2016-2018. The sociodemographic data form, Beck Depression Scale and Eating Disorder Rating Scale were filled by the participants. The degree of representation of the observed variables to implicit variables was evaluated by the confirmatory measurement model. Then, the relationship pattern between variables was examined with the structural model test. Multiple fit indices were used in the confirmatory measurement model and the structural equation model. Results: The study group consisted of 224 participants (mean age 37.6 +/- 12.9). The average BMI of the participants is 45.5 +/- 5.9. Three implicit variables were created, namely depression, anxiety, and limited eating. After confirming the measurement model, the mediating role of anxiety between depression and limited eating behavior was examined by path analysis. When the variance relations between the variables were examined, it was seen that restricted eating explained 76% of the variance in anxiety and 25% of the variance in depression. Discussion: Treating obesity from a psychiatric perspective, adopting an approach that takes into account the anxiety about eating, body weight and body image may increase the success of the treatment. A decrease in related anxiety can lead to reduced eating and depression levels.

Background and Purpose The purpose of this study was to investigate the prevalence of mortality during hospitalization among patients diagnosed with delirium at geriatric consultations requested in the previous one year, together with the factors affecting this. Methods The electronic medical records of geriatric consultations requested from the psychiatry department between January 1, 2019 and December 31, 2019 were examined from the automation system. The 200 geriatric delirium patients were included in the study. Patients' age, sex, length of hospital stay (LOHS), time between hospitalization and consultation, the department requesting consultation, reason for consultation request, psychiatric recommendations after consultation, reason for hospitalization, number of comorbid medical diseases, number of daily medications used, and history of psychiatric disease were retrieved from the electronic medical records in the automation system. Results LOHS and time from hospitalization to consultation were longer in the exitus group. Numbers of comorbid disease and daily medications used were higher in the died patients. Male gender, higher numbers of comorbid diseases, and daily medications were predictors of death. Conclusions Early detection of delirium may be important for short term results of disease. When evaluating these patients, reviewing the drugs used as much as possible can affect the outcome of the disease.

This study intended to observe mental symptoms among physicians in Turkey during the COVID-19 pandemic and to investigate the factors leading to such symptoms. The study participants were contacted via their smartphones between April 23 and 27, 2020, and invited to fill out an online questionnaire which included questions from the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). The mean age of the 406 physicians who participated in the study was 42.9 ± 10.1 years, and 53.4% were men (n: 217). During the pandemic, 66.7% had decreased working hours. Lack of COVID-related training, difficulty obtaining personal protective equipment (PPE), working in a COVID unit, and current psychiatric disease were found to be among the predictors of emotional burnout. Female gender, lack of COVID training, difficulty obtaining PPE, working in a COVID unit, and current psychiatric disease predicted desensitization. Facilitating continuous and comprehensive support mechanisms aimed at protecting physicians’ mental health is of great importance during epidemics.

Aim: To investigate the cognitive complaints and activities of daily living in patients with geriatric depression. Inter-group comparisons were performed by dividing geriatric depression patients into early- and late-onset subgroups. Materials and Methods: Ninety-four patients with geriatric depression and 39 individuals as a control group were included. Thirty-three of the geriatric depression patients had late-onset depression, and 61 had early-onset depression. All participants completed sociodemographic data, the Mini Mental Test, the Clock-Drawing Test, the Katz Activities of Daily Living Scale, and the Subjective Memory Complaints Questionnaire. Geriatric Depression Scale-15 was used to measure the severity of patients’ depression. Results: Late-onset depression patients exhibited significantly poorer performance on the Clock Drawing Test than the control group. Significantly greater subjective memory complaints were determined in patients with early- and late-onset depression than in the control group. A negative relationship was found between the severity of depression and activities of daily living in patients with geriatric depression. Conclusion: Geriatric depression may differ in terms of cognitive functions according to the age of onset.

PurposeTremendous physical and psychological pressure has been placed on health care workers because of the outbreak of novel coronavirus disease 2019. This study aimed to examine the anxiety and depression levels and related factors among health care professionals working in operating theaters (anesthetic technicians and nurses) during the coronavirus disease 2019 pandemic.DesignThe universe of this descriptive study consisted of health care professionals working in operating theaters in various health care institutions in Turkey.MethodsData were collected online between April 9, 2020 and April 12, 2020 using a SurveyMonkey Questionnaire (SurveyMonkey, San Mateo, CA) and health care workers who volunteered to participate in the study were contacted via the social media platforms Twitter, LinkedIn, and WhatsApp and asked to answer the questionnaire. Statistical analysis was performed using the SPSS version 22.0 software.FindingsA total of 702 health care professionals working in operating theaters participated in the study. The mean depression and anxiety scores of the participants were found to be 9.4 ± 4.6 (min 0 to max 21) and 10.0 ± 4.5 (min 0 to max 21), respectively. Depression scores were statistically significantly higher among females, single individuals, those who had children, those living with a person aged 60 years or older (P < .05). Meanwhile, anxiety scores were statistically significantly higher among females, single individuals (including widowed and divorced), university graduates, those with at least one chronic disease, and those whose workload increased (P < .05).ConclusionsThe present study showed that anxiety and depression symptoms were high among health care professionals working in operating theaters. To reduce these symptoms, psychological conditions of health care professionals can be followed continuously and regularly via standard procedures, and necessary interventions can be provided in the early period.

Objective: To compare neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) values as inflammation markers in patients with early- and late-onset geriatric depression. Method: Patients aged 60 and over who were hospitalized due to depressive disorder between 01.01.2012 and 01.01.2020 were included in this retrospective record review study. Only patients with unipolar depression were included. Results: No difference was found in terms of NLR, PLR or MLR was found between early- and late-onset depression. However, NLR and PLR values were higher in the early- and late-onset depression groups than in the control group. Lymphocyte and monocyte counts were higher in the control group compared to the early- and late-onset depression groups. Conclusion: NLR and PLR may be regarded as markers reflecting inflammation in geriatric depression patients rather than as markers that can differentiate geriatric depression patients in terms of disease onset time.

Objective: In this study, the clinical and sociodemographic characteristics and the factors affecting the duration of hospitalization in geriatric depression patients treated in a university hospital were evaluated. Method: Geriatric depression patients who were hospitalized between 2009-2019 were evaluated retrospectively. 76 geriatric depression patients were included in the study. Comparisons were made according to whether patients were resistant to treatment and the age of onset of the disease. Factors affecting the duration of hospitalization were evaluated. Results: 44 of 76 patients who participated in the study were male. Most of the patients (42/76) were admitted to the psychiatry clinic for the first time, and 20 of them were considered depressive disorder with psychotic features. ECT was applied to 10 of the patients, 28 of them had Magnetic Resonance Imaging and 23 of them had white matter hyperintensities in Magnetic Resonance Imaging. At the time of discharge, antipsychotics in 41 patients, benzodiazepines in 31 patients, and a mood stabilizer in seven patients were recommended in combination with antidepressants in 61 patients. Geriatric depressive patients who were resistant to treatment or had psychotic symptoms were hospitalized for a longer period of time. There was no difference between early and late onset geriatric depression groups in terms of gender, length of stay, psychotic feature, and treatment resistance. Discussion: According to the findings of the study, it was determined that most of the geriatric depression patients who received inpatient treatment were admitted to the psychiatry clinic for the first time, early and late onset did not differ in response to treatment, and the fact that depressive episode had a psychotic feature or was resistant to treatment was two variables that prolonged the hospitalization period.