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    A Systematic Review and Meta-Analysis of Arterial Spin Labeling Magnetic Resonance Imaging Studies in Psychosis Spectrum Disorders
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2025) Atagun, Murat Ilhan; Korkmaz, Sukru Alperen; Bicer, Ebrar Ozden; Ozaydin, Bilgehan
    Introduction: Alterations in cerebral blood flow (CBF) in subjects with psychosis spectrum disorders (PSD) and clinical high-risk (CHR) states may provide insights into the pathophysiologyofthese disorders. Arterial spin labeling (ASL) facilitated a more comprehensive examination of CBF in these subjects. This meta-analysis synthesizes findings on CBF in PSDs and CHR states, addressing literature gaps. Methods: A systematic literature search of the PubMed database was performed using a protocol based on the PRISMA statement and the recommendations of the MOOSE group. Studies eligible for inclusion in the review involved: I) individuals with PSD, first-episode psychosis or CHR state, II) had healthy controls for comparison, III) neuroimaging should be performed with MRI using the pseudo-continuous ASL method, IV) resting cerebral blood flow (rCBF) should be recorded. Information related to participants, CBF analyses, and results were systematically extracted. Results: The PubMed search for the meta-analysis identified 69 publications, including 24 articles that met the inclusion criteria for the meta-analysis, representing 491 SSD patients, 185 CHR states, and 554 controls. Studies included rCBFs for the whole brain, gray matter, and striatum. The meta-analysis results indicated that patients with PSD had decreased gray matter rCBF compared to controls (Hedge's g=0.33, 95% CI [0.08, 0.57]), but no difference in the whole brain (Hedge's g=0.09, 95% CI [-0.70, 0.88] and striatum rCBF (Hedge's g=0.38, 95% CI [-0.23, 1.00]). Additionally, subjects with CHR state showed no differences in the striatum rCBF compared to the controls (Hedge's g=-0.15, 95% CI [-0.80, 0.51]). Conclusions: This suggests that although perfusion changes in gray matter are present in PSD, they may not extend to wider brain regions or specific structures such as the striatum. Furthermore, the results imply that rCBF may be differentially regulated in subjects with PSD and CHR. Updated findings highlight hemodynamic correlations in PSD pathophysiology.
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    Attitudes Towards Homosexuality and Associated Factors Among Medical Students
    (Turkiye Sinir Ve Ruh Sagligi Dernegi, 2025) Betin, Berke; Korkmaz, Sukru Alperen; Gulec Oyekcin, Demet
    Objective: This study aimed to determine the psychosocial factors that may influence attitudes toward sexual orientation among medical students and to explore the relationship between attitudes regarding gender roles, sexual myths, and homophobia. Method: A total of 457 medical students from & Ccedil;anakkale Onsekiz Mart University in Turkiye were included in the study during the 2022-2023 academic year. Participants received the Sociodemographic Data Form, Hudson & Ricketts Homophobia Scale, Sexual Myths Scale, and Gender Role Attitudes Scale. Results: Homophobia scores were found to be lower among fifth-and sixth-grade medical students compared to first-year students. Lower rates of homophobia were observed in students receiving psychiatric treatment and those who identify as secular. Hierarchical regression analysis revealed a positive correlation between sexual myths and homophobia, and a negative correlation between gender role attitudes and homophobia. Predictors of homophobia include right-wing political orientation, conservatism, a high belief in sexual myths, and non-egalitarian attitudes toward gender roles. Finally, a mediation analysis demonstrated that attitudes toward gender roles serve as a partial mediating variable in the relationship between sexual myths and homophobia. Conclusion: The findings of our study highlight the significance of psychosocial and cultural factors in shaping attitudes toward sexual orientation and the need for accurate and comprehensive sexuality education in the medical curriculum. It is expected that thorough and equitable education will mitigate the stress associated with homophobia.
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    Development and Investigation into the Psychometric Properties of the Troy Sleep Scale
    (Galenos Publ House, 2025) Akinci, Erhan; Bolat, Nurullah; Korkmaz, Sukru Alperen; Toraman, Cetin
    Objective: A unique and comprehensive self-report scale to help assess sleep in Turkish is needed. This study aimed to develop the Troy Sleep Scale (TSS) and perform validity and reliability analyses. Materials and Methods: The study was conducted with 494 medical students and residents. The psychometric properties of the devised scale were evaluated through exploratory and confirmatory factor analyses, Cronbach's alpha and McDonald's omega reliability evaluations, and item analyses based on both classical test theory and item response theory (IRT). The reliability assessment of the TSS was carried out through test-retest, and criterion-referenced validity was employed to provide additional validation. Results: The TSS consists of 11 items with a 3-factor structure with eigenvalues greater than 2. The factors provided information about (I) dysfunction due to sleep problems, (II) affective symptoms due to sleep problems, and (III) sleep quality. The reliability levels of all three sub-factors and overall scale scores were 0.82 and above. The test-retest reliability level had a correlation value of >0.80. The item analyses conducted in line with the IRT proved that the scale items provided a high level of information and functioned together with the answer set. The correlation between the TSS and the Pittsburgh Sleep Quality Index was analyzed for criterion-referenced validity, yielding a correlation of 0.73. Conclusion: The psychometric properties of the TSS indicated that it was valid and reliable, making it suitable for use as a screening test for individuals with sleep-related complaints.
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    Difficulty in emotion regulation, psychological resilience, and depression are associated with Prolonged Grief Disorder in patients with breast cancer
    (Klinik Psikiyatri Dergisi, 2025) Er, Buket; Korkmaz, Sukru Alperen; Koral, Lokman; Oyekcin, Demet Gulec
    Objective: Grief is a natural reaction to potential losses faced by women with breast cancer. To our knowledge, no study has been conducted on prolonged grief disorder (PGD) in women with breast cancer. This study investigated the sociodemographic, cancer-specific, and psychological factors affecting PGD and the relationship between psychological resilience (PR), difficulty in emotion regulation (DER), and PGD in patients with breast cancer. Method: Breast cancer patients who met the inclusion criteria were included in the study (N=177). The Prolonged Grief Disorder Scale-Patient Form, Resilience Scale for Adults, Difficulties in Emotion Regulation Scale-Brief Form, and Hospital Anxiety and Depression Scale were administered to the patients. The DSM-5-oriented clinical interview was also conducted. Results: No significant relationships were found between PGD and clinical variables such as tumor stage, recurrence, or treatment types. Significant relationships were found between PGD and a history of mental illness and active psychotropic use. PGD was negatively correlated with age, total duration of cancer, and resilience. PGD was also positively associated with DER. DER was found to be a partial mediator variable (PR-DER-PGD), and depression score acted as a moderator variable in the relationship between PR and PGD, after adjusting for confounders. Discussion: The findings of our study indicate that DER, depression, and PR influence PGD in breast cancer patients. We believe that all patients with breast cancer for more than six months should be evaluated for prolonged grief and, if necessary, referred to grief psychotherapies that help them to accept their losses easily.
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    Placenta Previa is Associated with Maternal Psychological Distress: A Mediation Analysis of Depression, Anxiety, and Post-Traumatic Stress Symptoms
    (Dove Medical Press Ltd, 2025) Caliskan-Senay, Zumrut; Korkmaz, Sukru Alperen; Guler, Merve; Sahin, Dilek
    Background: Placenta previa (PP) is a major obstetric complication that can cause significant physical and emotional stress for expectant mothers. However, its psychological impact has received limited research attention. The purpose of this study was to examine perceived stress, depression, anxiety, post-traumatic stress symptoms, and sleep disturbances in patients diagnosed with PP. Methods: This cross-sectional study with prospectively collected obstetric outcomes included 70 cases of PP and 78 healthy pregnant women (HPs) in the third trimester of pregnancy. Depression, anxiety, post-traumatic stress symptoms, sleep disturbances, perceived stress, and resilience were assessed using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Impact of Events Scale-Revised (IES-R), Jenkins Sleep Scale (JSS), Perceived Stress Scale (PSS-10), and Brief Resilience Scale (BRS), respectively. Results: According to the cutoff scores of the scales, 50%, 42.9%, 62.9%, and 51.4% of those diagnosed with PP met the criteria for depression, anxiety, sleep disturbances, and post-traumatic stress disorder, respectively, which were significantly higher than those in the HP group. After controlling for maternal age, gravida, parity, and resilience, the PHQ-9, GAD-7, and IES-R scale scores were significantly higher in patients with PP than in the HP group. The mediation model indicated that depression and anxiety partially mediate the relationship between perceived stress and post-traumatic stress symptoms (PSS-10 -* GAD-7/PHQ-9 -* IES-R). Conclusion: The findings of this study suggest that women diagnosed with PP who are anticipating labor have a significantly increased likelihood of developing depression, anxiety, sleep disturbances, and post-traumatic stress symptoms. Raising awareness of the adverse psychological effects associated with PP may help facilitate the implementation of screening, assessment, and intervention strategies for these patients.
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    Psychiatric Presentation of Hereditary Coproporphyria with Coproporphyrinogen Oxidase Gene Mutation c.734 C>T: A Case Report
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2025) Senel, Mert; Cakmak, Isik Batuhan; Gurkan, Sahin; Korkmaz, Sukru Alperen; Catli, Bengisu; Ceylan, Ahmet Cevdet; Urey, Gulten Burcu Civelek
    Introduction: Porphyrias constitute a collection of hereditary metabolic disorders arising from disturbances in the enzymatic activities inherent to the heme biosynthetic pathway. Eight subtypes of porphyria, each associated with enzymes in the heme biosynthesis pathway, have been identified. Hereditary coproporphyria is one of the porphyria subtypes characterized by neuropsychiatric clinical features. It develops as a result of a deficiency in coproporphyrinogen oxidase enzyme activity. Consequently, an accumulation of coproporphyrin and its precursor metabolites is observed. Hereditary coproporphyria exhibits autosomal dominant inheritance. Following clinical suspicion, a diagnosis is made with biochemical and genetic tests. The presence of nonspecific symptoms and the lack of consideration for porphyria in differential diagnosis complicate the diagnosis. Case: An 18-year-old male patient was referred to our psychiatry clinic onlywith psychiatric complaints. The mental status examination revealed affective signs, along with visual hallucinations and delusions. Blood tests and cranial scans at admission showed no abnormalities. After initiating treatment with valproic acid and olanzapine for a presumptive diagnosis of bipolar I disorder, a manic episodewith psychoticfeatures, the patient's general medical condition worsened. During clinical observation, the appearance of neurological and gastrointestinal system findings led to a reconsideration of the diagnosis, and porphyria was considered. Urine tests revealed elevated levels of porphyrin intermediates. The diagnosis of hereditary coproporphyria was confirmed by genetic testing, which identified the c.734 C>T mutation in the coproporphyrinogen oxidase gene. Symptomatic relief was observed following a carbohydrate-rich diet without the need for psychotropic treatment. Conclusion: Although their subtypes exhibit distinct clinical features, porphyrias typically present with involvement of multiple systems. Cases that initially present with symptoms specific to a single system can pose diagnostic challenges. In our case report, we aimed to present the psychiatric onset of hereditary coproporphyria, a rare subtype of porphyria known for its potentially fatal attacks when untreated.
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    Psychometric properties of the Turkish version of the premenstrual dysphoric disorder questionnaire for DSM-5 (CTDP-DSM-5)
    (Springernature, 2025) Korkmaz, Sukru Alperen; Ertekin, Hulya; Yapar, Senem; Aperribai, Leire
    Introduction Premenstrual dysphoric disorder (PMDD) is a syndrome marked by severe mood and physical symptoms during the menstrual luteal phase. This study aimed to evaluate the validity and reliability of the Turkish CTDP-DSM-5 (CTDP-TR), developed by Aperribai et al. (2016), in response to the insufficient diagnosis of PMDD in clinical settings, as per the DSM-5 or ICD-11. Methods Data were collected from women through an electronic questionnaire. A total of 336 participants were included in the analysis. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Premenstrual Symptoms Screening Tool (PSST) scales were administered alongside the CTDP-TR; the data were analyzed for construct validity, internal consistency, test-retest reliability, convergent validity, and criterion validity. Results The CTDP-TR is a 25-item screening tool based on DSM-5. Confirmatory factor analysis of the CTDP-TR revealed a two-factor structure with acceptable fit indices (CFI = 0.903; TLI = 0.888; RMSEA = 0.057, SRMR = 0.056, chi 2/df = 2.08, p < 0.001). The total score of the scale demonstrated excellent internal consistency (alpha = 0.89), a strong correlation with PSST (r = 0.715), and excellent discrimination in ROC analysis (AUC = 0.943). CTDP-TR scores correlated significantly with PHQ-9 (r = 0.547) and GAD-7 scores (r = 0.510), effectively distinguishing individuals with depression from those without (Cohen's d = 1.171) and individuals with anxiety from those without (Cohen's d = 1.145). The rate of positive screening for PMDD was 43.5%. Conclusions The CTDP-TR is a straightforward, valid, and reliable screening tool aligned with DSM-5 for PMDD in Turkiye, providing a basis for early identification and referral, rather than a stand-alone diagnosis. The existence of this scale is crucial for public health, as it addresses the absence of a standard, DSM-5-oriented tool for PMDD screening in Turkiye.
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    The Effect of Brief Group Psychoeducation on Cognitive Distortions, Automatic Thoughts and Functioning in Major Depressive Disorder: A Randomized Controlled Trial
    (Wiley, 2025) Sagbas, Serap; Korkmaz, Sukru Alperen; Oyekcin, Demet gulec
    Major depressive disorder (MDD) causes significant impairment and reduced functioning, yet it remains undertreated. This study examined the effectiveness of a structured, brief group psychoeducation programme for individuals diagnosed with MDD. The randomized controlled trial involved 52 adults diagnosed with MDD according to DSM-5 criteria. Participants were divided into two groups: an experimental group (n = 29) that received psychoeducation during a 12-week follow-up and a control group (n = 23) that received only standard pharmacotherapy. The intervention included two interactive psychoeducation sessions, each lasting 90-120 min, conducted in a group setting. Levels of depression, anxiety, cognitive distortions, automatic thoughts and functioning were assessed using the Hamilton Depression and Anxiety Rating Scales (HAM-D/HAM-A), the Cognitive Distortion Scale (CDS), the Automatic Thoughts Scale (ATQ) and the Functioning Assessment Short Test (FAST), respectively. The findings indicated that depression and anxiety scores significantly decreased in both groups after 12 weeks, with no difference between them in this regard. However, the group receiving psychoeducation experienced greater improvements in cognitive distortions and automatic thoughts compared to the control group, especially in areas such as helplessness, negative self-concept and giving up/helplessness. Although functioning levels improved in both groups, there was no significant difference between them. Structured brief group psychoeducation resulted in significant improvements, particularly in reducing cognitive distortions and automatic thoughts in patients with MDD. Psychoeducation is a practical approach that emphasizes cognitive processes along with pharmacotherapy. Including a broader range of psychotherapeutic modalities in treatment plans may further enhance functional outcomes.