Prevalence of body dysmorphic disorder, its clinical characteristics and psychiatric comorbidities in patients admitted to a plastic surgery outpatient clinic.

PURPOSE: The present study aimed to determine the prevalence of body dysmorphic disorder (BDD), its clinical features, and comorbidities in patients applying for plastic and reconstructive surgery. METHOD: Five-hundred and seventy nine participants who applied to the plastic and reconstructive surgery outpatient clinic completed a sociodemographic data form, and were subjected to the Body Perception Scale (seventy-nineBPS), Social Appearance Anxiety Scale (SAAS), TEMPS-A Temperament Scale, and Beck Depression Inventory (BDI). Participants who scored 135 or more on the BPS were included in a psychiatric interview. Next, the participants diagnosed with BDD were compared with participants with a high BPS scores but without a BDD diagnosis, along with a control group. RESULTS: The prevalence of BDD among all patients attending the plastic surgery outpatient clinic was found to be 4.7%, whereas the prevalence was 8.6% among those specifically seeking cosmetic procedures. The mean SAAS, BDI, TEMPS-A depressive, and anxious scores were higher in the BDD group compared to the controls (p < 0.001). The difference in the mean SAAS, BDI, TEMPS-A depressive, and anxious scores of the patients with a high BPS scores and the control group was comparable to the difference observed between the BDD and control groups. A regression analysis revealed that the SAAS and depressive temperament scores have an effect on the BPS score. CONCLUSION: The significantly high comorbidity of BDD in patients seeking plastic and reconstructive surgery underscores the importance of identifying these patients to prevent unnecessary surgical procedures.

Eveningness chronotype influences social functioning by deteriorating depressive symptoms in remitted patients with schizophrenia.

Sleep and circadian rhythm disruption (SCRD) is common in schizophrenia patients, who also typically experience impaired social functioning. While various factors influence social functioning in schizophrenia, the specific impact of sleep and circadian rhythm disruption remains unclear. This study aimed to investigate the connection between chronotype and social functioning in remitted schizophrenia patients, examining the mediating roles of depression and sleep quality. The study included 185 patients diagnosed with schizophrenia based on DSM-5 criteria. After categorizing the patients into morningness, eveningness, or intermediate chronotypes using the Morningness-Eveningness Questionnaire(MEQ), they were assessed with the Positive and Negative Syndrome Scale(PANSS), Calgary Depression Scale for Schizophrenia(CDSS), Personal and Social Performance Scale(PSPS) and Pittsburgh Sleep Quality Index(PSQI). The eveningness chronotype group showed higher CDSS and PSQI scores and lower PWBS and PSPS-Total scores than the other groups (p < 0.05). A hierarchical linear regression model assessed MEQ, PSQI, and CDSS scores' effects on PSPS total scores. MEQ scores' significance diminished when CDSS scores were included. Eveningness chronotype, particularly with increased depressive symptoms, negatively impacts social functioning in remitted schizophrenia patients.These findings contribute to the understudied area of chronotype in schizophrenia and its impact on social functioning, including its interaction with sleep..

P300 parameters in major depressive disorder: A systematic review and meta-analysis.

OBJECTIVES: Event-related potential measures have been extensively studied in mental disorders. Among them, P300 amplitude and latency reflect impaired cognitive abilities in major depressive disorder (MDD). The present systematic review and meta-analysis was conducted to investigate whether patients with MDD differ from healthy controls (HCs) with respect to P300 amplitude and latency. METHODS: PubMed and Web of Science databases were searched from inception to 15 January 2023 for case-control studies comparing P300 amplitude and latency in patients with MDD and HCs. The primary outcome was the standard mean difference. A total of 13 articles on P300 amplitude and latency were included in the meta-analysis. RESULTS: Random effect models indicated that MDD patients had decreased P300 amplitude, but similar latency compared to healthy controls. According to regression analysis, the effect size increased with the severity of depression and decreased with the proportion of women in the MDD samples. Funnel plot asymmetry was not significant for publication bias. CONCLUSIONS: Decreased P300 amplitude may be a candidate diagnostic biomarker for MDD. However, prospective studies testing P300 amplitude as a monitoring biomarker for MDD are needed.

Correction: Psychometric Properties of Questionnaire of Cognitive and Affective Empathy (QCAE): Reliability and Factor Analysis Study in Turkish Sample.

[This corrects the article on p. 228 in vol. 58, PMID: 34526847.].

The effect of chronotypes on follow-up outcomes of patients with substance use disorder.

Substance use disorder (SUD) can have circadian characteristics and individuals with evening chronotype are more prone to addiction. In this study, the effect of chronotypes on the treatment outcomes of SUD was investigated. The study included 66 patients who were diagnosed with SUD according to DSM-5. Two clinical interviews were conducted at 6-month intervals, and remission/relapse status was evaluated at the second interview. The Structured Clinical Interview Form for DSM-IV Axis I Disorders (SCID-I), Addiction Profile Index Practitioner Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburg Sleep Quality Index and Morningness-Eveningness Questionnaire (MEQ) were applied to the patients. MEQ scores of relapsed patients were found to be different in terms of eveningness than those in remission (45.62 ± 8.70 versus 49.75 ± 7.60, p = 0.045). As the craving and addiction profile index total scores (addiction severity) increased, eveningness chronotype scores also increased (r = - 0.387 and r = - 0.286, respectively). The mean scores of craving and BDI were higher in relapsed patients compared to those in remission (p = 0.003 and p = 0.015, respectively). Our results suggest that patients with SUD had a lower morningness chronotype than the general population; additionally, more relapsed patients had an eveningness chronotype. Thus, chronotypes may play a role in the onset, prevention, and treatment outcome of SUD.

REM parameters in drug-free major depressive disorder: A systematic review and meta-analysis.

Previous studies revealed that rapid eye movement (REM) parameters, such as REM latency (RL) and REM density (RD) could be used as electrophysiological markers of depression. Yet these finding should be re-tested in a comorbid-free and drug-free sample. The present systematic review and meta-analysis was conducted to investigate whether drug-free and comorbid-free patients with unipolar depression differentiate from controls with respect to the RL and RD. The PubMed and Web of Science databases were screened from inception to 23 January 2023 for case-control studies comparing RL and RD of patients with unipolar depression and controls. The primary outcome was the standard mean difference. The data were fitted with a random-effects model. Meta-regressions were conducted to investigate patient characteristics and effect size. Publication bias assessment was checked by Egger's Regression and funnel plot asymmetry. Among 43 articles accepted as eligible, 46 RL and 22 RD measurements were included in the meta-analysis. The results indicated shortened RL and increased RD in the patient group than controls. Neither Egger's regression nor funnel plot asymmetry were significant for publication bias. In conclusion, our results tested within drug-free and comorbid-free samples are in line with the literature.

Evening type negatively affects semen quality by deteriorating sperm morphology: Results from an infertility clinic.

OBJECTIVE: The effect of sleep-related variables on the reproductive system has garnered attention in recent years. One of the mediators that reportedly plays an important role in the relationship between sleep disorders and the reproductive system is a disruption of the circadian rhythm. The aim of curent study is to investigate the effect of chronotype on morning semen quality. STUDY DESIGN: Three-hundred and fourteen patients who applied to the infertility clinic were included in the study. The patients filled a socio-demographic data form. The "Pittsburg Sleep Quality Index (PSQI) was used to evaluate the sleep quality while the chronotypes of the patients were evaluated with the "Morningness -Eveningness-Questionnaire (MEQ)". Semen analyses and biochemical analysis for testosterone serum plasma level of all patients were performed. RESULTS: Twenty-one patients were assigned as evening, 187 patients were assigned as intermediate, and 106 were assigned as morning chronotype. No statistically significant difference was identified in the comparison of the mean MEQ scores between patients with low and normal sperm concentrations(p = 0.884). A correlation analysis indicated the presence of a significant positive correlation between normal morphology and MEQ scores (r = 0.13, p < 0.05) and a negative corelation between the hours spent in bed and sperm concentration (r = -0.13, p < 0.05). A general linear model created with independent variables suggested that the presence of varicocele and MEQ scores had a significant effect on normal morphology. CONCLUSION: The results of present study support that evening type could negatively affect sperm morphology; additionally, the time spent in bed also negatively affected sperm concentration.

Effects of Beliefs, Conspiracy Theories, and Vaccine Hesitancy on the Vaccination Status of Patients with Severe Mental Illness in a Tertiary Psychiatric Care Hospital in Türkiye.

Background: The aim of the study was to investigate the relationship between the vaccination rates and vaccine hesitancy and the adoption of conspiracy theories by patients with severe mental illness in Türkiye. Methods: Ninety-eight outpatients with schizophrenia and 105 outpatients with bipolar disorder were included. A sociodemographical data form, a survey on beliefs and conspiracy theories on vaccines and Vaccine Hesitancy Scale were obtained. Vaccinated and unvaccinated groups were compared and evaluated separately for patients with schizophrenia and bipolar disorder. Results: Sixty-one (62.24%) patients in the schizophrenia group and 86 (81.90%) patients in the bipolar disorder group were vaccinated, and the vaccination rate in the schizophrenia group was significantly lower (P = .002). There was no significant difference in terms of Vaccine Hesitancy Scale scores or adoption of any particular conspiracy theory between patients with schizophrenia and bipolar groups. However, vaccinated and unvaccinated patients of schizophrenia and bipolar disorder groups differed in terms of adopting beliefs and conspiracy theories on vaccines. Sixty-five (75.58%) of the vaccinated patients in the bipolar group agreed with the statement "vaccines are safe," while this rate was 8 (42.11%) in the unvaccinated patients (P = .004). In the schizophrenia group, however, the main difference between the vaccinated and unvaccinated patients was adopting the beliefs that "vaccines have serious side effects" and "vaccines may cause homosexuality" (P = .0341 and P = .003, respectively). Conclusion: The vaccination status of patients with schizophrenia might be under the stronger influence of conspiracy theories and specialized mental health interventions may be needed to ensure vaccination in patients with schizophrenia.

Can the Imbalance between Neurotrophic and Apoptotic Proteins Be the "Beware the Ides of March" for Unaffected Relatives of Schizophrenia Patients?

Schizophrenia (SZ) is a mental disorder with a strong genetic basis as well as epigenetic aspects. Siblings of patients with SZ can share certain endophenotypes with the patients, suggesting that siblings may be important for distinguishing between trait and state markers. In the current study, we aimed to characterize the balance between pro-BDNF/mature BDNF and its receptors p75NTR/TrkB, which are tPA-BDNF pathways proteins and are thought to play a role in synaptic pruning, as a possible endophenotype of schizophrenia. Forty drug-naïve patients with first-episode psychosis (FEP) matched for age, gender, and level of education, 40 unaffected siblings (UAS) of patients with FEP, and 67 healthy controls (HC) were included in the study. Blood samples were collected from all participants to determine BDNF, pro-BDNF, TrkB and p75NTR, PAI1, tPA, ACTH, and cortisol levels. We showed that levels of proteins of the tPA-BDNF pathway as well as the pro-BDNF/m-BDNF and p75NTR/TrkB ratios could successfully differentiate FEP and their siblings from the HCs by using ROC analysis. Plasma levels of m-BDNF were found to be the lowest in the healthy siblings and highest in the HCs with statistically significant differences between all 3 groups. The plasma level of pro-BDNF in the HC group was similar to the FEP patients, the same in the healthy siblings of the FEP patients. Our data support the hypothesis that imbalance between neurotrophic and apoptotic proteins might occur in SZ and this imbalance could be an endophenotype of the disease.

Emotional Information Processing and Assessment of Cognitive Functions in Social Anxiety Disorder: An Event-Related Potential Study.

The aim of our study was to determine deficits in cognitive areas, including social cognition such as emotion recognition capacity, theory of mind, and electrophysiological alterations in patients with social anxiety disorder (SAD) and to identify their effects on clinical severity of SAD. Enrolled in our study were 26 patients diagnosed with SAD and 26 healthy volunteers. They were administered the Liebowitz Social Anxiety Scale (LSAS), Reading Mind in the Eyes Test (RMET), and Cambridge Neuropsychological Test Automated Battery. EEG monitoring was performed for electrophsiologic investigation. In the patient group, total reading the mind scores were lower (P = .027) while P300 latencies and emotion recognition latency during the Emotion Recognition Task (ERT) were longer (P = .038 and P = .012, respectively). The false alarm scores in the Rapid Visual Information Processing Task (RVP) were higher in the patient group (P = .038). In a model created using multivariate linear regression analysis, an effect of ERT and RVP scores on LSAS scores was found. Results of our study confirm that particularly impairment of cognitive functions such as sustained attention and emotion recognition may seriously affect the clinical presentation negatively. P300 latency in the parietal region may has the potential to be a biological marker that can be used in monitoring treatment.

Prevalence of probable attention-deficit/hyperactivity disorder in inmates and its relationship with recidivism.

The aim of the current study was to determine the prevalence of probable attention-deficit/hyperactivity disorder (ADHD) in prisoners and to assess the relationship between ADHD and recidivism. We studied 356 inmates, who were evaluated using the Wender Utah Rating Scale and Adult ADHD Self-Report Scale. Type of crime and other crime-related data were compared between inmates with and without ADHD. The group with probable ADHD had a higher average number of convictions compared to the group without ADHD. The probable ADHD group also demonstrated higher incidence of extortion crime, drug trade, disciplinary action at school, and military service than the group without ADHD. Linear regression analysis revealed that the presence of probable ADHD was effective on the number of convictions. The findings of our study support that the presence of probable ADHD carries a potential risk of being prone to certain crimes and demonstrate a correlation between the presence of probable ADHD and early involvement in crime and the number of convictions.

Comparison of the Clinical and Treatment Characteristics of Patients Undergoing Electroconvulsive Therapy for Catatonia Indication in the Context of Gender.

The aim of this study was to compare in the context of gender both clinical diagnosis and disease-related differences and electroconvulsive therapy (ECT)-related differences in data and efficacy in hospitalized patients with catatonic signs and symptoms. Data from 106 patients who received ECT with catatonia indication were retrospectively analyzed. Clinical data of male (n = 58) and female (n = 48) patients were compared. Hospitalization documents and outpatient files, sociodemographic and clinical data form, Clinical Global Improvement scores used by the ECT unit in the follow-up of patients who received ECT were used in the study. It was seen that the mean age of women at the onset of ECT was higher than in men and the presence of prolonged seizures was more common than men. In men, it was found out that the average number of sessions with the onset of clinical response to treatment was higher than the average of women. The distribution of diagnoses by gender showed that the presence of schizophrenia diagnosis in men and of bipolar disorder in women were significantly more frequent compared to the opposite sex. It was found out that there were no significant differences between genders in terms of response rate to ECT. Our study is important for being the first study in the literature investigating the gender differences in ECT used for catatonia. However, gender is not a distinctive factor in the effectiveness of treatment, there are some important differences between male and female patients showing signs and symptoms of catatonia and undergoing ECT.

Sleep Interventions in the Treatment of Schizophrenia and Bipolar Disorder.

Due to the effects of sleep on the central nervous system, it is thought that sleep disorders have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice. This may be related to the fact that patients underreport their complaints for various reasons, insufficient examination time, and clinicians' lack of knowledge about the importance of the subject. Pharmacotherapy, psychological and behavioral interventions are options among the therapeutic approaches to sleep problems. But, it seems that clinicians tend to prefer pharmacological approaches for the treatment of sleep problems. However, it is important to choose the appropriate treatment option with considering the method preferred by the patients, who already use many and high doses of pharmacological agents, the nature of the psychiatric disorder and the sleep problem. In this context, chronotherapeutic approaches such as bright light, sleep deprivation, interpersonal relations and social rhythm therapy, and cognitive behavioral therapy techniques adapted for patients with bipolar disorder can be used in the treatment of suitable patients. In this article, the current literature about sleep-related problems observed in patients with schizophrenia and bipolar disorder is reviewed comprehensively with presenting clinical phenotypes and treatment approaches.

Psychometric Properties of Questionnaire of Cognitive and Affective Empathy (QCAE): Reliability and Factor Analysis Study in Turkish Sample.

INTRODUCTION: The Questionnaire Cognitive and Affective Empathy (QCAE) scale is a tool that is widely used because of its multi-dimensional assessment of ability for empathy and is currently available in many languages. The aim of the current study was to examine the psychometric properties of the Turkish version of QCAE, which evaluates cognitive and emotional empathy with its multi-dimensional structure, and to bring it into the Turkish. METHODS: The study was carried out in a Turkish population of 412 healthy volunteers. Internal consistency, confirmatory factor analyses and gender comparisons of the Turkish version of the scale were performed. RESULTS: The Turkish version of QCAE had good construct validity and reliability for the five-correlated factors model (i. e., Emotion Contagion, Proximal Responsivity, Peripheral Responsivity, Perspective Taking and Online Simulation). Temporal reliability was high with a two week test-retest intra-correlation coefficient range of 0.69-0.79. A total of 3 models were tested with confirmatory factor analyses, including the models of the original investigation. Cognitive-Affective distinction was not supported by the pattern of correlations between the factors. CONCLUSION: Our results support that it is appropriate to compute and interpret the 5 sub-dimensions of the Turkish version of QCAE separately and totally, but the limitations in its use in the Cognitive Empathy and Affective Empathy sub-dimensions should be heeded.

A novel commentary: Investigation of the role of a balance between neurotrophic and apoptotic proteins in the pathogenesis of psychosis via the tPA-BDNF pathway.

OBJECTIVE: Many hypotheses have put forward to better understand the pathogenesis of schizophrenia (SZ), such as synaptic pruning, stress-diathesis, neurodevelopment, neurodegeneration and neurotransmitter hypothesis; nonetheless, this pathogenesis still remains a mystery. The current study was designed with the hypothesis that impairment of a balance between pro-BDNF/mature BDNF and their receptors p75NTRK/TrkB may cause synaptic pruning in the pathogenesis of psychotic disorders. METHODS: Sixty-five drug-naïve patients with first-episode psychosis (FEP) who applied to outpatient clinics and were diagnosed according to DSM-5 as well as 65 healthy controls (HC) were included in the study. Symptoms at the time of evaluation were assessed with the PANSS scale by an experienced psychiatrist. Blood samples were collected from all participants to determine BDNF, pro-BDNF, TrkB and p75NTR, PAI1, tPA, ACTH and cortisol levels. RESULTS: Mature BDNF, TrkB and PAI-1, tPA levels were significantly lower while the levels of ACTH and cortisol were significantly higher in FEP patients compared to HC. No significant difference was found in pro-BDNF and p75NTR levels between the two independent groups. The pro-BDNF/mature BDNF and the p75NTR/TrkB ratios were significantly higher in FEP patients compared to HC. Moreover, the pro-BDNF/mature BDNF and the p75NTR/TrkB ratios were found to be significantly associated with the pathogenesis of SZ in a hierarchical regression model. DISCUSSION: Imbalance between neurotrophic and apoptotic proteins such as pro-BDNF/mature BDNF and p75NTR/TrkB may be take part pathogenesis of synaptic pruning in psychotic disorders.

Evaluation of IGF-1 as a novel theranostic biomarker for schizophrenia.

OBJECTIVE: In the current study, we aimed to investigate fasting plasma levels of glucose, insulin, growth hormone, IGF-1, and lipid profile in remission schizophrenia patients, treatment resistant schizophrenia patients and healthy controls and to determine whether IGF-1 levels can be used as a theranostic biomarker in schizophrenia. METHODS: Sixty-two patients under remission from schizophrenia, sixty-five treatment-resistant patients with schizophrenia and sixty-two healthy controls were included in the study. All patients were recruited and evaluated over 11 months. Symptoms at the time of evaluation were assessed twice using BPRS, PANSS, CGI, and GAF scales by an experienced psychiatrist in accordance with Andreaseen's remission criteria and TRIPS group resistance criteria. Blood samples were collected from all participants to determine fasting glucose, LDL, HDL, Triglyceride, Total Cholesterol, fasting, insulin, GH and IGF-1 levels. RESULTS: Fasting blood glucose levels were found to be higher in patients with schizophrenia than in healthy controls. Moreover, LDL levels of the treatment sensitive group were higher than that of the treatment resistant group while they were not significantly different from the healthy controls. IGF-1 levels were lower in the treatment sensitive group than in both treatment resistant and healthy control groups. IGF-1, LDL and age of disease onset were found to be significantly associated with treatment resistance in a regression model. DISCUSSION: In the present study, remitted patients with schizophrenia could be distinguished from treatment-resistant patients and healthy controls with serum IGF-1, fasting glucose and LDL levels. In addition, we found that smoking and age of disease onset together with IGF-1 levels could significantly predict resistance to treatment.

Evaluation of the effect of shift working and sleep quality on semen parameters in men attending infertility clinic.

We aimed to evaluate the effect of shift work on semen parameters together with the effect of sleep quality in men attending infertility clinic. The participants were divided into two groups as follows: 104 shift worker men (Group 1) and 116 nonshift worker men (Group 2). Groups were compared in terms of semen parameters, Depression Anxiety Stress Scale-21 (DASS-21), and Pittsburg Sleep Quality Index (PSQI) scores. A higher rate of oligozoospermia and poor sleep quality and a lower mean normal morphology percentage was observed in shift workers than nonshift workers (p = .006, .039 and .036 respectively). In addition, a positive correlation was seen between sleep duration and sperm concentration, while a negative correlation was found between sleep latency and total sperm count. Shift working together with high PSQI score was also a significant association with oligozoospermia when controlling for the other variables of age, total testosterone, DASS-21 stress score, smoking and varicocele (OR = 2.11, 95% CI 1.03-4.34 and OR = 1.18, 95% CI 1.01-1.39 respectively). In this study, infertile shift workers had a lower percentage of normal morphology and higher rates of oligozoospermia and poor sleep quality. Considering that shift workers have lower sleep quality, it seems that shift working negatively affects the circadian rhythm.

Investigation of auditory P50 sensory gating with sexual visual stimuli in patients with vaginismus.

OBJECTIVES: The aim of the study was to investigate sensory information processing induced by visual sexual stimuli and to assess its relationship with sexual behaviors and symptoms in patients with vaginismus. METHODS: Twenty-one patients with vaginismus and 20 controls were included in the study. The sociodemographic information and sexual life history of the patients with vaginismus and controls were examined and electrophysiological measurements related to auditory P50 sensory gating were obtained using a double click paradigm during by sexual/horror visual stimulation, which was thought to be related to the pathophysiology of the disease. RESULTS: P50 suppression ratios during visual sexual stimuli were lower in vaginismus group compared to the control group. There was no difference in P50 suppression ratios during visual horror stimuli when the two groups were compared. The P50 suppression of the vaginismus group with visual sexual stimuli was found to be lower than P50 suppression with visual horror stimuli. A positive moderate correlation was found between the duration of foreplay and P50 suppression ratio during visual sexual stimuli in vaginismus group. CONCLUSION: Our study revealed that patients with vaginismus had sensory gating impairment during visual sexual stimuli. Increase in the duration of foreplay in vaginismus patients may improve sensory gating impairment by affecting sensory gating functions.

Effects of the COVID-19 pandemic on psychology and disease activity in patients with ankylosing spondylitis and rheumatoid arthritis

Background/aim: The COVID-19 outbreak is known to increase stress levels of most patients with chronic diseases. Patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are highly susceptible to environmental stress. In the current study, we aimed to determine how the COVID-19 pandemic psychologically affected patients with chronic progressive diseases such as AS and RA and the effects of these psychological factors on disease activity. Materials and methods: Age and sex-matched patients with AS (n = 80), RA (n = 80), and healthy controls (n = 80) were included in the study. All participants were evaluated with the "Perceived COVID-19 Threat Form (PCTF)", "Suicide-Ideation Scale (SIS)", "Hospital Anxiety and Depression Scale (HADS)", "The Ability to Cope with Trauma (PACT)", and "Psychological General Well-Being Index (PGWB)" scales. BASDAI was used in patients with AS, and DAS28 was used in patients with RA to assess disease severity. Results: Compared to healthy individuals, patients with RA and AS had lower PGWB scores and higher HADS depression and anxiety subscale scores. Almost all psychometric assessment test scores were worse in AS patients with high-disease activity compared to those in low-disease activity. PACT scores were higher in patients with moderate RA compared to patients with mild RA (p = 0.006). While a positive correlation was identified between BASDAI and most of the psychometric assessment test scores (r = 0 .36 for PCTF, r = 0.53 for depressive scores, r = 0.54 for anxiety scores, r = 0.57 for suicidal ideation), DAS28 scores were found to be associated only with PACT total and PACT perceived forward-focused subscale scores (r = ­.26 and r = .33, respectively). Conclusion: Psychologically, AS and RA patients were found to be worse off compared to healthy controls. The perceived COVID threat and psychological status were associated with disease activity in AS, but not RA patients. Patients with chronic illnesses may be more vulnerable to the psychological effects of the pandemic, which can worsen disease activity.