Mustafa Karaağaç

Objective Family accommodation, in which relatives facilitate obsessive-compulsive symptoms, is highly prevalent in obsessive-compulsive disorder (OCD) and associated with poor treatment outcomes. Although neuroticism and maladaptive coping have been linked to OCD severity, the mechanisms by which personality traits relate to family accommodation remain poorly understood. This study examined associations between neuroticism, coping strategies, symptom severity, and family accommodation in OCD, and tested whether maladaptive coping mediates the neuroticism–family accommodation association.Methods We conducted a cross-sectional study with 149 adults diagnosed with OCD via the Structured Clinical Interview for DSM-5 at a university hospital outpatient clinic. Participants completed the Family Accommodation Scale–Patient Version, Yale-Brown Obsessive Compulsive Scale Self-Report, Big Five Inventory-44, and Brief COPE. Hierarchical regression and bootstrap-based mediation analyses (PROCESS Model 4; 5,000 bootstrap samples) were performed, controlling for age, sex, education, and symptom severity.Results OCD symptom severity (β=0.342, p<0.001) and maladaptive coping (β=0.347, p<0.001) were significantly associated with family accommodation, explaining 26.6% of its variance. Neuroticism was not directly associated with family accommodation; however, mediation analysis revealed a significant indirect association through maladaptive coping (B=0.189, 95% confidence interval [0.034 to 0.399]).Conclusion These cross-sectional findings suggest that maladaptive coping may represent a potential behavioral pathway linking neuroticism to family accommodation in OCD. While the findings provide a theoretical rationale for further investigating coping mechanisms, longitudinal and experimental studies are needed to determine whether interventions targeting maladaptive coping lead to reductions in family accommodation.

Background: Social Anxiety Disorder (SAD) and hikikomori share characteristics of social withdrawal. While childhood trauma is a known risk factor for both conditions, the specific mechanisms linking early trauma to hikikomori through cognitive pathways remain unclear. Aims: This study aimed to compare childhood trauma, cognitive distortions, and hikikomori levels in individuals with and without SAD and to examine the mediating role of cognitive distortions in the relationship between childhood trauma and hikikomori. Methods: A total of 171 participants were included in the study: 78 patients with SAD and 93 healthy controls (HCs). All participants completed the Childhood Trauma Questionnaire (CTQ-28), Cognitive Distortions Scale (CDS), and 25-item Hikikomori Questionnaire (HQ-25). Group comparisons were performed using t -tests and chi-square tests. Mediation analysis was conducted using the PROCESS macro (Model 4), controlling for age, sex, marital status, education level, and SAD. Results: The SAD group had significantly higher CTQ-28, CDS, and HQ-25 scores than the HCs group ( p < .001). Mediation analysis revealed that childhood trauma was associated with hikikomori levels both directly ( B = 0.33, p = .007) and indirectly through cognitive distortions (Effect = 0.15, 95% bootstrap CI [0.06, 0.26]). The total effect of childhood trauma on hikikomori was also statistically significant ( B = 0.48, p < .001). The model, which controlled for age, sex, marital status, education, and SAD status, explained 42% of the variance in hikikomori severity ( R ² = .42). Conclusions: Our findings suggest that childhood trauma is associated with greater hikikomori symptoms, both directly and through the mediating effect of cognitive distortions. Therefore, cognitive distortions may be a potential intervention target for socially withdrawn individuals with a history of childhood trauma.

Maladaptive daydreaming (MD) has been conceptualized as an immersive, compulsive form of fantasy engagement often linked to emotional avoidance. Although c

Objective: Medication adherence is a critical determinant of treatment outcomes in psychiatric disorders,yet the underlying factors remain unclear. This study aimed to examine the role of verbal mental capacityand clinical variables in predicting medication adherence among psychiatric outpatients.Methods: A total of 67 patients (aged 18-60 years) were assessed using the Medication Adherence RatingScale (MARS), Beck Anxiety Inventory, Beck Depression Inventory, Liverpool University Neuroleptic SideEffect Rating Scale (LUNSERS), and the Turkish version of the National Adult Reading Test (NART-TR).Participants were categorized into good adherence (n=33) and poor adherence (n=34) groups based onMARS scores. Comparative analyses between these groups, as well as correlation and multiple regressionanalyses, were conducted.Results: Patients with poor adherence had significantly higher anxiety, depression, side effect scores,and NART-TR errors than patients with good adherence (P < .05). Correlation analysis revealed negativeassociations between MARS scores and anxiety, depression, side effects, and NART-TR errors. Regressionanalysis identified NART-TR errors (β=−.342, P=.009) and LUNSERS scores (β=−.512, P=.022) asindependent predictors of medication adherence.Conclusion: Verbal mental capacity and medication side effects emerged as critical determinants ofadherence in psychiatric patients. Incorporating cognitive screening tools like NART-TR into routinepractice may help identify individuals at risk of nonadherence and guide tailored interventions.Cite this article as: Bakay H, Karaagac M, Yaman NÖ, Gica S. Verbal mental capacity and medication adherence inpsychiatric outpatients: the impact of verbal cognitive reserve and side effects. Neuropsychiatr Invest. 2025, 63, 0045,doi:10.5152/NeuropsychiatricInvest.2025.25045.

Aims: Maladaptive daydreaming (MD) is a condition characterized by excessive and immersive daydreaming, often linked to psychological distress and behavioral difficulties. This research examines the correlation between MD, academic procrastination, and psychological distress among medical students. Methods: A cross-sectional study was conducted with medical students who completed self-report questionnaires, including the MD scale (MDS-16), the Depression, Anxiety, and Stress Scale (DASS-21), and the Tuckman Procrastination Scale (TPS). Pearson correlation and multiple regression analyses were performed to assess associations between MD, academic procrastination, and psychological distress. Results: The findings revealed a significant positive correlation between MD and academic procrastination (r=.181, p

OBJECTIVE: Domestic violence can lead to many psychological and physical problems. To prevent violence, it is important to identify all situations and risk factors that lead to and are related to it. When the causes of domestic violence are identified and necessary measures are taken, the number of individuals who are victims of violence will decrease. In this study, it was aimed to determine the risk groups that perpetrate violence by evaluating the psychiatric diagnostic histories and the presence of drugs/stimulants in the laboratory of the people who were sent to the psychiatry clinic in Karaman province and who were given a health caution decision with the law no. 6284. MATERIAL AND METHODS: The study group consisted of people who were given a health caution decision by Law No. 6284 between September 2019 and September 2023 and sent to Karaman Training and Research Hospital Psychiatry Clinic for diagnosis and treatment. Psychiatric diagnoses and urine analyses were investigated. RESULTS: A total of 99 individuals were included in the study. 98.0% of the individuals were male and 2.0% were female. The mean age of the individuals was 35.3±11.5. 64.6% of the individuals had a history of psychiatric diagnosis. The most common diagnosis was depression (42.2%). 57.6% of the individuals had alcohol use disorder and 42.5% had substance use disorder. The most common substance detected in urine was cannabinoid (41.9%), followed by amphetamine (37.2%). CONCLUSIONS: This study shows that some psychiatric disorders such as depression, anxiety disorder, personality disorder, alcohol, and substance use disorder are associated with violent behavior in perpetrators of violence. This study may help to screen individuals who are at risk of violence and take essential precautions for the prevention of violence and necessary treatments and may serve as an example for new studies.

In this study, the relationship was examined of adverse childhood experiences (ACEs) with difficulties in emotion regulation and symptom severity in individuals with social anxiety disorder (SAD). The study included 71 patients diagnosed with SAD and a healthy control group of 73 subjects. Data for all the participants were collected using a sociodemographic data form, the Liebowitz Social Anxiety Scale, the Adverse Childhood Experiences-Turkish Form scale, and the Difficulties in Emotion Regulation Scale-16. The study results showed a higher probability of ACEs and difficulties in emotion regulation in the SAD group than in the control group. The difficulties in emotion regulation in the SAD group were correlated with symptom severity and these difficulties were found to play a mediating role between trauma and symptom severity. It was emphasized that emotion regulation skills were an important factor in the treatment of SAD patients. It can be suggested that therapies and interventions to develop emotion regulation skills could be effective in the management of SAD symptoms. It was thus concluded that ACEs and difficulties in emotion regulation are associated with SAD symptoms and should be taken into consideration in treatment. This study emphasizes the importance of emotion regulation skills for SAD treatment and can be considered to be of guidance for future studies.

Aim: This article aims to assess Mental Health Literacy (MHL) in dialysis patients and examine their impact on anxiety, depression and physical health. Material and Method: The study was conducted in the Hemodialysis Unit of Karaman Training and Research Hospital between March and June 2024. A total of 87 patients who met the inclusion criteria and agreed to participate were included in the study. Data were collected using a semi-structured sociodemographic form, Mental Health Literacy Scale, Hamilton Depression Scale and Hamilton Anxiety Scale. Biochemical parameters were obtained from electronic patient records. Results: The frequency of depression was 45%. There was no significant difference in MHL points among individuals with and without depression. Furthermore, no correlation was found between MHL and duration of disease or dialysis. A significant relationship was found between Total and Resource subscale scores of MHL and estimated glomerular filtration rate (eGFR). Conclusion: The frequency of depression was higher in dialysis patients than in the general population. Albeit no significant difference in MHL was observed between patients diagnosed with depression and those without, the significant relationship between MHL and eGFR suggests that interventions to increase MHL may have positive effects on disease progression.

Myoclonus, characterized by sudden involuntary muscle contractions, can occur in a variety of conditions, including as a side effect of clozapine, which is used in the treatment-resistant schizophrenia. This case study describes a 48-year-old female patient who developed negative myoclonus, manifested by knee flexion and falls, after starting clozapine. Despite dose reduction and the addition of valproic acid, symptoms persisted, highlighting the dose-dependent nature of clozapine-induced myoclonus and the need for clinicians to recognise this risk.