Mustafa Danışman

This letter presents observations and clinical experiences from psychiatric practice during the 2026 Hajj season in Medina and Mecca. The most common reasons for psychiatric consultation included adjustment difficulties related to environmental changes, sleep disturbances, and anxiety symptoms. In addition, several severe psychiatric conditions were encountered, including an acute psychotic episode associated with sleep deprivation and physical exhaustion, a manic episode, and a suicide attempt. Another notable observation was that some pilgrims failed to bring their regularly prescribed psychiatric medications or did not have a sufficient supply for the duration of the pilgrimage. These observations suggest that the unique characteristics of the Hajj, including intense physical exertion, sleep disruption, environmental changes, and emotionally significant spiritual experiences, may contribute to psychiatric decompensation in psychologically vulnerable individuals. More comprehensive assessment of psychiatric risk factors during pre-Hajj health evaluations, strengthening mental health education, and greater involvement of mental health professionals in the evaluation process when appropriate may help reduce potential psychiatric complications during the pilgrimage.

In this paper, clinical observations and implementation experiences regarding theatre-based psychosocial interventions in addiction treatment are presented. The high rates of relapse in the early period following detoxification highlight the need for structured rehabilitation approaches in alcohol and substance use disorders. In this context, theatre activities conducted in our unit aimed to support patients’ self-expression, emotion regulation, and social interaction skills. During the first performance, titled “Metamorphosis,” clinical and operational problems were observed, including safety issues, alcohol use, and related injury among patients who had been discharged on the day of the performance during the final rehearsal. Nevertheless, the performance was successfully completed through alternative solutions developed in response to the crisis. Following the intervention, an increased risk of relapse was observed particularly among patients discharged on the day of the performance, and group dynamics appeared to reinforce risky behaviors. Based on these findings, discharge timing and post-discharge clinical follow-up processes were revised in subsequent applications. In addition, increased interaction between patients and staff was found to potentially challenge the maintenance of professional boundaries. In conclusion, theatre-based interventions may provide therapeutic benefits in addiction treatment, while also posing clinical risks under certain conditions. Therefore, such interventions should be carefully planned and supported with structured programs.

Purpose: The global increase in the prevalence of substance use disorders (SUD) has resulted in higher mortality rates. While heroin use has decreased or stabilized, methamphetamine use is increasing, and the combined use of opioids and methamphetamine is becoming more common. FAAH is an enzyme that hydrolyzes endocannabinoid substances and plays a role in neurobehavioral processes. The aim of this study was to investigate the effect of the FAAH rs324420 polymorphism on SUD. Method: The study included 562 individuals who used methamphetamine (MUD, n = 148), opioids (OUD, n = 114), or both methamphetamine and opioids (OMCU, n = 150), as well as 150 healthy volunteers. The FAAH rs324420 polymorphism was analyzed by PCR‐RFLP. All participants completed the Barratt Impulsiveness Scale‐11 (BIS‐11), Clinical Opiate Withdrawal Scale (COWS), Substance Craving Scale (SCS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory‐II (BDI‐II). Finding: The frequencies of the variant allele (A) were 21%, 13%, 16%, and 19% in OUD, MUD, OMCU, and controls, respectively. Genotype frequencies in all four groups were in Hardy–Weinberg equilibrium ( p > 0.05). The CA genotype significantly reduced the risk of the disease compared to the reference genotype (OR = 0.578, 95% CI:0.343–0.973, adjusted p = 0.039). Craving scale score was higher in individuals who concurrently used opioids and methamphetamine (20.0; 13.0–28.0) than in those who only used opioids (18.0; 14.0–28.0) ( p = 0.009). Conclusion: This study showed that the rs324420 CA genotype of the FAAH gene may confer a protective effect against methamphetamine use disorder. Future studies with larger sample sizes and additional phenotypic traits are recommended to further explore these findings in other populations.

According to Freud, the human mind is characterised by a dynamic component, which he refers to as the “censoring agency”. This concept is also perceived by some to symbolise a certain authority. This agency is responsible for determining whether an emerging desire is suitable for entry into consciousness. It excludes anything that could potentially cause discomfort if the desire were to be realised or stimulated. In Freud’s view, the censor never entirely ceases to function during sleep; rather, it becomes less rigid and less effective. Consequently, certain distressing elements of repressed material are able to evade the still-active, though relaxed, censor through the utilisation of various mechanisms within dreamwork, such as displacement, condensation, and symbolism. This enables them to achieve a limited alternative form of satisfaction. Freud’s dream theory is not limited to individual therapy; it can also help analyze major figures like Atatürk. Atatürk’s fatal illness emerged in 1937, and he was diagnosed with liver disease in January 1938. As his condition worsened, he was moved to Dolmabahçe Palace. With the illness progressing, fluid had to be drained from his abdomen. Fearing intestinal perforation, Atatürk dictated his will on September 6. Paracentesis was performed on September 7 and repeated on September 22. A few days later, Atatürk had a dream, which he shared with his aide-de-camp Salih Bozok. In this review article, the concept of censorship in Freud’s dream theory is evaluated through the analysis of a historical dream of Atatürk, both in terms of the explanatory power of the theory and the criticisms directed at it

Background: The migration of educated professionals, particularly physicians, from developing to developed countries is a significant issue. This “brain drain” diminishes essential human resources in the healthcare sector of countries like Türkiye. Factors such as low income, poor working conditions, limited living conditions, and violence against healthcare workers drive this migration. This study compares the job satisfaction, life satisfaction, and psychological well-being of physicians who migrate abroad with those who remain in Türkiye. Methods: The study utilized a snowball sampling method to recruit 217 physicians who completed medical school in Türkiye, with 108 practicing in Türkiye and 109 abroad. Participants completed a sociodemographic data form and 5 scales: Job Satisfaction Index, Satisfaction with Life Scale, Psychological Well-Being Scale, Beck Anxiety Inventory, and Beck Depression Inventory. Data were analyzed by using t-tests for independent samples, and results were presented as mean ± SD. Results: Physicians practicing abroad reported significantly higher job satisfaction (18.52 ± 4.95) and life satisfaction (24.44 ± 6.41) compared to those in Türkiye (16.40 ± 4.58; 17.89 ± 7.32, respectively). Similarly, psychological well-being scores were higher among physicians abroad (32.61 ± 4.70) than in Türkiye (28.00 ± 5.96). Conversely, physicians in Türkiye exhibited higher levels of depression (12.39 ± 8.68) and anxiety (13.46 ± 11.38) compared to their counterparts abroad (6.43 ± 6.14; 8.81 ± 8.46, respectively). Conclusion: The results are consistent with the idea that work conditions, economic factors, and workplace violence on physician migration. Addressing factors such as violence against healthcare workers and poor working conditions is crucial to retaining healthcare professionals and improving their well-being in Türkiye. Self-selection bias and self-reported data are the limitations of the study.

Substance addiction is defined as a chronic and relapsing disorder in which the individual persistently engages in drug-seeking and drug-using behaviors despite harmful consequences. One of the most common challenges in the treatment process is relapse, which frequently occurs as a result of intense craving for substance use. In recent years, the concept of "drug dreams" has come to the forefront as a potential indicator that may contribute to the clinical monitoring of such cravings. These dreams, which often appear during periods of abstinence, contain various themes involving the use or attempted use of the addictive substance. The book “Drug Dreams” by Claudio Colace systematically addresses drug-related dreams from phenomenological, clinical, and theoretical perspectives. The author initially began examining these dreams—first noticed during psychotherapy sessions with heroin-dependent patients—with clinical curiosity and later deepened his investigation on both psychoanalytic and neuropsychoanalytic levels. The book is divided into three main sections: the first part discusses the definition, prevalence, and content of drug dreams; the second part explores their clinical use and prognostic value; and the third part offers theoretical evaluations in light of Freud’s dream theory and contemporary neuropsychoanalytic approaches. The book “Drug Dreams”stands out as a valuable resource that offers significant contributions to addiction treatment from both psychodynamic and neuropsychiatric perspectiv. It provides a unique and comprehensive perspective for clinicians working in addiction treatment and for those interested in dream studies. This article aims to present a comprehensive review of the aforementioned book.

Many individuals in Türkiye who completed their compulsory military service years ago report experiencing intense, vivid, and anxiety-provoking dreams in which they are suddenly summoned back to the military. From a cultural perspective, this phenomenon does not appear unique to Türkiye. Similar narratives of such dreams are frequently encountered in various English-speaking online forums . Future qualitative and quantitative research examining the frequency, narrative structures, accompanying emotions during dreaming and upon awakening, and connections with individuals’ psychosocial histories could greatly enhance our understanding of the psychological origins of these dreams.

Drug-Related Dreams (DRD) are dreams observed in individuals with substance use disorders during withdrawal or recovery periods, containing various substance-related themes. It is known that DRD may include themes such as searching for drugs, attempting to use them, seeing substances but not using or being unable to use them, rejecting an offer to use substances, or witnessing someone else using them. It is thought that when DRD are satisfying in terms of content and emotions (Type A, drug-use dreams), they can help alleviate and manage cravings, leading to a positive prognosis. On the other hand, if these dreams are not satisfying (Type B, failed drug-use attempts), they are believed to reignite and intensify the craving for substances. Instead of assuming that DRD with different content and emotions provide varying levels of satisfaction, analyzing these dreams through the lens of the censorship mechanism may reveal that they aim to satisfy distinct desires. In this paper, the dream and clinical course of a patient who experienced a drug-related dream during inpatient treatment at our clinic, was discharged voluntarily, and later relapsed into substance use, are discussed. When the patient reapplied for inpatient treatment after resuming substance use and was found carrying drugs, their admission could not be processed. The case is examined through the censorship mechanism in dreams. Although the patient was aware of our clinical rules, we interpreted their behavior of seeking admission to our clinic while under the influence of substances not as forgetfulness or an attempt to smuggle substances, but as an unconscious cry for help to overcome their desire to use substances.