Treated incidence of first episode psychosis in Sinop, Turkey: results of a 4-year admission-based study - SINOPsy.

BACKGROUND: The incidence of psychotic disorders varies in different geographic areas. As there has been no report from Turkey, this study aimed to provide the treated incidence rate of first-episode psychosis (FEP) in a defined area. METHODS: All individuals, aged 15-64 years, presenting with FEP (ICD-10 F20-29, F30-33) to mental health services in a defined catchment-area in Sinop which is located in the Black Sea region of the northern Turkey were recorded over a 4-year period (2009 to 2012). Incidence rates of psychotic disorders and their 95% confidence intervals (CIs) were estimated. Poisson regression was applied to estimate the differences in incidence rate ratio (IRR) by age, sex, and urbanicity. RESULTS: One hundred and fifteen FEP participants were identified during the 4 years. Crude incidence rates of all psychoses, schizophrenia, other psychotic disorders, and affective psychotic disorders were respectively 38.5 (95% CI 27.1-49.9), 10.7 (95% CI 6.6-14.8), 10.0 (95% CI 5.7-14.3) and 17.7 (95% CI 11.3-24.2) per 100 000 person-years. After age-sex standardisation the rates increased slightly. There were no gender differences in the incidence rates. IRR of any psychotic disorder was highest in the youngest age group (15-24 years) compared to the oldest age group (55-64 years), 7.9 (95% CI 2.8-30.5). In contrast with previous studies, the incidence rate of any psychotic disorder was not significantly increased in urban areas compared with rural areas. CONCLUSIONS: The current study, the first of its kind from Turkey, indicates that the risk of schizophrenia and other psychotic disorders in a lowly urbanised area of Turkey is comparable to those reported in Western European cities.

The association of social inequality with the onset, persistence, and progression of psychotic experiences along the extended psychosis phenotype: a 6-year follow-up study in a community-based sample.

PURPOSE: This paper aims to investigate associations between early childhood and current indicators of socioeconomic inequality and the onset (incident), persistence and progression (increase in severity) of psychotic experiences (PEs) in a longitudinal follow-up of a community-based population. METHODS: Households in the metropolitan area of Izmir, Turkey were contacted in a multistage clustered probability sampling frame, at baseline (T1, n = 4011) and at 6-year follow-up (T2, n = 2185). Both at baseline and follow-up, PEs were assessed using Composite International Diagnostic Interview 2.1. The associations between baseline socioeconomic features and follow-up PEs were analysed using logistic regression models. Indicators of social inequality included income, educational level, current socioeconomic status (SES), social insurance, the area resided, ethnicity, parental educational level, and SES at birth. RESULTS: The risk of onset of PEs was significantly higher in lower education, lower SES, and slum-semi-urban areas. The persistence of PEs was significantly associated with the lowest levels of education and current SES, and rural residency. Persistent PEs were significantly and negatively associated with paternal SES at birth. Progression of PEs was significantly higher among respondents with educational achievements lower than university level and lower levels of SES, who have no social insurance and who reside in slum-semi-urban areas. Parental education and paternal SES at birth were not associated with the persistence of PEs. CONCLUSION: Indicators of social inequality (low education, low SES, low income, and poverty in the neighbourhood) were associated with the onset and persistence of PEs and progression along the extended psychosis phenotype. The early indicators seem to have a modest life-long impact on the psychosis phenotype.

A 6-year follow-up study in a community-based population: Is neighbourhood-level social capital associated with the risk of emergence and persistence of psychotic experiences and transition to psychotic disorder?

BACKGROUND: Social capital is thought to represent an environmental factor associated with the risk of psychotic disorder (PD). This study aims to investigate the association between neighbourhood-level social capital and clinical transitions within the spectrum of psychosis. METHODS: In total, 2175 participants, representative of a community-based population, were assessed twice (6 years apart) to determine their position within an extended psychosis spectrum: no symptoms, subclinical psychotic experiences (PE), clinical PE, PD. A variable representing change between baseline (T1) and follow-up (T2) assessment was constructed. Four dimensions of social capital (informal social control, social disorganisation, social cohesion and trust, cognitive social capital) were assessed at baseline in an independent sample, and the measures were aggregated to the neighbourhood level. Associations between the variable representing psychosis spectrum change from T1 to T2 and the social capital variables were investigated. RESULTS: Lower levels of neighbourhood-level social disorganisation, meaning higher levels of social capital, reduced the risk of clinical PE onset (OR 0.300; z = -2.75; p = 0.006), persistence of clinical PE (OR 0.314; z = -2.36; p = 0.018) and also the transition to PD (OR 0.136; z = -2.12; p = 0.034). The other social capital variables were not associated with changes from T1 to T2. CONCLUSIONS: Neighbourhood-level social disorganisation may be associated with the risk of psychosis expression. Whilst replication of this finding is required, it may point to level of social disorganisation as a public health target moderating population psychosis risk.

DSM outcomes of psychotic experiences and associated risk factors: 6-year follow-up study in a community-based sample.

BACKGROUND: Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators. METHODS: Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis. RESULTS: In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness. CONCLUSION: The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.

Psychotic experiences and mood episodes predict each other bidirectionally: a 6-year follow-up study in a community-based population.

BACKGROUND: Psychotic experiences (PEs) are not exclusive to psychotic disorders and highly correlated with mood episodes. In this representative general population-based study, longitudinal bidirectional associations between the extended psychosis phenotype and mood episodes were investigated, accounting for other possible causes. METHODS: Households were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011) and at 6-year follow-up (n = 2185). Participants were interviewed with the relevant sections of the composite international diagnostic interview both at baseline and at follow-up. Sociodemographic, familial and environmental risk factors associated with the extended psychosis phenotype and mood episodes were assessed. Logistic regression and cross-lagged panel correlation models were used for the associations between the extended psychosis phenotype and mood episodes. RESULTS: PEs were associated with subsequent depressive and manic episodes. There was bidirectionality in that mood episodes were associated with subsequent PEs, and PEs were associated with subsequent mood episodes. The associations occurred in a sub-additive pattern. There were substantial synchronous and cross-lagged correlations between these psychopathology domains, with reciprocally similar cross-lagged correlations. Familial risk and adverse life events were associated with both psychopathology domains, whereas some sociodemographic risk factors and alcohol/cannabis use were associated with only one domain. CONCLUSION: The sub-additive bidirectional associations between PEs and mood episodes over time and the similarity of cross-lagged correlations are suggestive of mutually causal connections between affective and psychotic domains of psychopathology.

Is BDNF-Val66Met polymorphism associated with psychotic experiences and psychotic disorder outcome? Evidence from a 6 years prospective population-based cohort study.

There is little research on genetic risk for the extended psychosis phenotype ranging from psychotic experiences (PEs) to psychotic disorders (PDs). In this general population-based prospective cohort study, the longitudinal associations between BDNF-Val66Met polymorphism and the different levels of the extended psychosis phenotype were investigated. Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighborhoods at baseline (n = 4011). A nested case-control study (n = 366) recruited individuals with PEs and PDs as well as individuals with no psychotic symptoms. In this subgroup, blood sampling for genetic analysis and assessment of environmental exposures were carried out, followed by clinical re-appraisal at follow-up 6 years later (n = 254). The BDNF-Val66Met polymorphism was significantly associated with the extended psychosis phenotype. The pattern of the association was that the BDNF-Val66Met polymorphism impacted in a dose-response but extra-linear fashion, with stronger impact at the PD end of the extended psychosis phenotype. Associations were still significant after adjusting for sociodemographic factors and environmental exposures including life events, childhood adversity, socioeconomic status, urbanicity, and cannabis use. The BDNF-Val66Met polymorphism may index susceptibility to expression of psychosis along a spectrum.

The epidemiology of alcohol use in Izmir, Turkey: drinking pattern, impairment and help-seeking.

PURPOSE: There is no report on various patterns of alcohol drinking and related impairment, help-seeking in Turkey. We investigated the 12-month prevalence and correlates of drinking patterns and alcohol use disorders in the general population of Izmir-Turkey, with further analyses on role impairment and help-seeking. METHOD: A multi-stage clustered area probability sample of adult household residents in the Izmir Metropolitan Area was assessed using the Composite International Diagnostic Interview 2.1 (n  = 4011). Estimation focused on prevalence and correlates of 12-month drinking pattern and DSM-IV alcohol use disorders. The 12-month drinking pattern included groups of non-regular users, regular non-heavy drinkers, regular heavy drinkers, and alcohol abuse disorder and alcohol dependence. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, and were assessed with Short Form-36 for functional impairments. Multinomial logistic regression was used for underlying associations between the covariates and the drinking patterns. RESULTS: The rate of lifetime alcohol abstinence was 52.3% while the prevalence of past-year users was 14.8%. The 12-month prevalence estimates of regular heavy drinkers, and alcohol abuse disorder and dependence were 2.5%, 3.2 and 1.6%, respectively. Any of the drinking patterns and alcohol use disorders was associated with male gender, and higher levels of education, monthly income and socioeconomic status. Alcohol dependence was associated with mental health impairment but not with physical impairment. The 12-month rates of help-seeking in alcohol abuse and dependence were 11.6 and 16.5%. CONCLUSION: Although alcohol use disorders are lower than estimates of Western countries, alcohol use constitute a major reason of disability with prominent treatment gap.

Methamphetamine as the most common concomitant substance used with pregabalin misuse.

BACKGROUND AND AIM: Non-medical use of Pregabalin (PGB) is a growing concern in many countries because of the serious consequences associated with their abuse. Judicial cases within the probation system, multiple drug users, and patients in treatment programs administered PGB at higher doses than suggested, commonly without prescription. For this reason, it is important to analyze PGB by adding it to the routine analysis scale in determining whether PGB is used for medical purposes or abuse. In this study, PGB analyzed (single or multiple substance use, concomitant substances) in urine samples of forensic and clinical cases by liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition to the sociodemographic and clinical characteristics of pregabalin-positive cases, the results were evaluated separately from a clinical and forensic perspective. METHODS: All urine samples which was admitted to Addiction Toxicology Laboratory from 'drug abuse probation system' (forensic cases, n = 640) and from various departments of our hospital (clinical cases, n = 371) between December 2022 and April 2023. Screening analysis were carried out by immunoassay in total 1011 cases. LC-MS/MS method simultaneously analyzed amphetamine, benzoilecgonine, cocaine, codeine, metamphetamine, morphine, 3,4-metilenedioksi-N-metilamfetamin (MDMA), 11-nor-9-karboksi-Δ9-tetrahidrokannabinol and pregabalin in urine samples. PGB was added to the our routine substance screening analysis scale in December 2022 to detect pregabalin use. RESULTS: PGB was detected in 12.3% of probabition cases and 13.2% of clinical cases. The mean age of PGB positive cases was 26.55 ± 7,52 years old, predominantly males (%85,9). Single PGB was detected in 53.2% of forensic cases (n = 42), and 38.7% of clinical cases (n = 19). The most common substance detected concomitantly with PGB was amphetamine type stimulants (ATSs:amphetamine, methamphetamine, ecstasy/MDMA etc.) (22.8% of forensic cases and 46.9% of clinical cases), followed by concomitant cannabis use (24.1% of forensic cases and 26.5% of clinical cases). Concomitant opioid use was rare (1.3% of forensic cases and 4.1% of clinical cases). Detection of PGB was significantly different across months on which the samples were collected (x2 = 82.8, df=4, p < 0.001). CONCLUSION: Inconsistently with previous studies suggesting opioids as the most prevalant substances concominant with PGB, our results showed that stimulants (especially ATSs) were the most prevelant substances concominant with PGB, followed by cannabis. High proportion of PGB detection in probabition cases, frequently as a single substance abuse takes attention. These results suggest that PGB, may be used to avoid legal consequences. It is important for laboratories to be aware that they need to make changes as addition of newly abused substances in their analysis panels, when necessary, as differences between regions and cultures affect substance use patterns.

The mediating effect of attachment insecurity on circadian consequences of childhood trauma.

Circadian preferences have been associated with mental health as well as social and physical health in recent years. However, factors associated with circadian preferences have not been fully elucidated. The main aim of this study is to investigate the associations of childhood trauma and attachment styles with circadian preferences. A total of 673 participants were evaluated using the Morningness-Eveningness Questionnaire (MEQ), the Childhood Trauma Questionnaire 28 (CTQ-28), and the Experiences in Close Relationships-Revised (ECR-R) questionnaire. The results indicated that 14.9% (n = 100) of the participants were morning type, 20.6% (n = 139) were evening type, and 64.5% (n = 434) were intermediate type. Both childhood trauma and attachment-related anxiety/avoidance scores were associated with being evening type (p < .01). Moreover, attachment-related anxiety and avoidance fully mediated the association between childhood trauma and circadian preferences. The present study showed that attachment styles might be associated with circadian preferences. Further studies are needed to replicate these results and to infer explanatory mechanisms for these cross-sectional associations.

An innovative approach to lifelong delayed ejaculation: does attachment style play a role?

PURPOSE: To examine whether there is a correlation between attachment styles, which is a developmental psychology theory, and lifelong DE. METHODS: The research was planned as prospective, multi-centric and cross-sectional study. Thirty patients who were consecutively admitted to the urology outpatient clinic and diagnosed with lifelong DE and 30 age-matched healthy controls were included in the study. All participants gave a detailed medical history and underwent a complete physical examination, and their laboratory and endocrine (prolactin and testosterone) results were evaluated. Additionally, all patients had to fill out socio-demographic information form, the Experiences in Close Relationships-Revised (ECR-R) Questionnaire, Arizona Sexual Experiences Scale (ASEX), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). RESULTS: The mean age of the DE patients was 33.5 ± 7.5 years. In the DE group, insecure attachment (both anxious and avoidant attachment), anxiety and depression scores were found to be significantly higher (p < 0.001, effect size medium or large) than the control group. Ejaculation times (both for vaginal intercourse and masturbation) were correlated with both insecure (anxious and avoidant) attachment types, as well as their anxiety and depression scores (p < 0.001). The ASEX satisfaction, ejaculation and total scores were found to be higher in DE patients (higher scores indicating greater sexual dysfunction) than in the control group. CONCLUSION: The large and significant relationships found between lifelong DE and attachment insecurities point to childhood developmental processes. The findings may help us better understand lifelong DE. There is a need for further extensive research on this subject.

Pharmacotherapy of Schizophrenia in Acute and Maintenance Phase.

Schizophrenia is one of the leading disorders causing impairment in society. Therefore, it is crucial to review evidence-based treatment approaches which are both effective and causing minimum side effects. In this paper, treatment recommendations for first episode schizophrenia, patients in acute phase with a history of multiple episodes, and patients in the maintenance phase will be discussed in light of the Psychiatric Association of Turkey Guideline for Treatment of Schizophrenia, other recent national and international guidelines as well as expert consensus reports in the literature. Finally, practical considerations will be suggested.

The Mental Health of Healthcare Professionals During the COVID-19 Pandemic. / Covid-19 Pandemisinde Saglik Çalisanlarinin Ruh Sagligi.

OBJECTIVE: The aim of this study is to investigate the anxiety, depression, insomnia and post traumatic stress disorder (PTSD) symptoms and the assocaited sociodemographic, clinical and professional factors during the COVID-19 pandemic in healthhcare workers. METHOD: A total of 509 participants joined an online survey to complete the data acquisition tools consisting of a Sociodemographic and Clinical Questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Insomnia Severity Index (ISI) and the Post Traumatic Stress Disorder- Short Scale (PTSD-SS). RESULTS: The 509 participants of the study consisted of physicians (69.2%) and nurses (30.8%). On the basis of the scores above the cut-off points of the pscyhometric scales used, the mental symptoms of the participants were ranked as 54.2% on depression, 26.3% on anxiety, 20.8% on insomnia and 8.8% on PTSD. The corresponding scores of the 20-30 year old, the female and the nursing participants were significantly higher as compared to the others (p<0.001, for all). Significant differences were not found in these scores with respect to working or not working directly with COVID-19 patients, or having a family member with or without COVID-19 infection (p>0.05). Having a history of suspected COVID-19 infection was significantly associated with insomnia (p=0.026 and PTSD (p=0.008). Also, the anxiety and PTSD scores of the participants with a history of mental disorder diagnosis were significantly higher in comparison to the others (p<0.001). CONCLUSION: The results indicated that females, nurses, participants in the 20-30 year age group and with a history of mental disorder diagnosis were in the high risk group for impaired mental health, irrespective of their professional positions. Close monitoring and early intervention are essential for these high-risk individuals.

The Relationship between Alcohol-Cannabis Use and Stressful Events with the Development of Incident Clinical Psychosis in a Community-Based Prospective Cohort. / Toplum Tabanli Bir Örneklemin Ileriye Dönük Izleminde, Alkol- Esrar Kullaniminin ve Stresli Yasam Olaylarinin Klinik Psikoz Gelisimi ile Iliskisi.

OBJECTIVE: The aim of this study is to evaluate the associations between alcohol-cannabis use and forensic/stressful events with the risk of incident clinical psychosis during follow-up. METHOD: A community-based sample (n: 2142) was screened for clinical psychosis (schizophrenia and other psychotic disorders, affective disorders with psychotic features) at baseline and follow-up. Thus, incident clinical psychosis cases to develop during follow-up (individuals with no clinical psychosis at the baseline assessment and with clinical psychosis at the follow-up assessment) were detected (n: 27). These cases and the controls who did not report any psychotic symptoms at the follow-up assessment (n: 1691) were compared for exposure to environmental risk factors during follow-up (total n: 1718). RESULTS: Individuals reporting heavy alcohol drinking or cannabis use during follow-up had significantly higher risk of incident clinical psychosis. The monthly frequency of drinking and cannabis use was also associated with the risk. Higher number of stressful life events exposed predicted higher risk of incident clinical psychosis. The risk of incident clinical psychosis was significantly higher in case of coexistence of two risk factors (heavy drinking, cannabis use, ≥3 stressful events), in comparison with the existence of a single risk factor (17.7 vs. 1.6%, p<0.001). CONCLUSION: Heavy drinking, cannabis use, forensic events and stressful events were associated with the risk of incident clinical psychosis. The coexistence of multiple stressful events and disorders related to abuse of alcohol/cannabis should be considered as a warning for the development of clinical psychosis.

Izmir Mental Health Cohort for Gene-Environment Interaction in Psychosis (TürkSch): Assessment of the Extended and Transdiagnostic Psychosis Phenotype and Analysis of Attrition in a 6-Year Follow-Up of a Community-Based Sample.

Objective: TürkSch is a prospective, longitudinal study in a representative community sample (Izmir, Turkey), consisting of several data collection stages, to screen and follow-up mental health outcomes, with a special focus on the extended and transdiagnostic psychosis phenotype. The aim of the present paper is to describe the research methodology, data collection results, and associations with noncontact and refusal in the longitudinal arm. Methods: Households were contacted in a multistage clustered probability sampling frame, covering 11 districts and 302 neighborhoods at baseline (n = 4,011) and at 6-year follow-up (n = 2,185). Both at baseline and at follow-up, participants were interviewed with the Composite International Diagnostic Interview. Participants with probable psychotic disorder were reinterviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID)-I either at the hospital or at the participant's residence. Relevant neighborhood-level measures were assessed in a separate sample (n = 5,124) in addition to individual-level measures. Candidate gene-by-environment interactions were investigated using two nested case-control studies. Results: Individuals with a mental health problem had lower refusal rates. Older and lower educated individuals had a lower probability of noncontact. Discussion: The TürkSch study has an advanced design to meet the challenges of evaluating the multidimensional etiological and phenomenological nature of the extended and transdiagnostic psychosis phenotype.

[The Association between the Extended Psychosis Phenotype and COMT val158met and BDNF val66met polymorphisms]. / Genis Psikoz Fenotipinin COMT val158met ve BDNF val66met Polimorfizmleri ile Iliskisi.

OBJECTIVE: Psychotic disorders were previously associated with catechol- O-methyltransferase (COMT) val158met (rs4680) and brain-derived neurotrophic factor (BDNF) val66met (rs6265) polymorphisms. This article evaluates the association between COMT/BDNF polymorphisms and the extended psychosis phenotype which covers not only schizophrenia but also subclinical expressions of psychotic experiences. METHOD: The participants of this study were part of the TürkSch (Izmir Mental Health Survey for Gene-Environment Interaction in Psychoses), a longitudinal study Psychotic experiences and disorders were screened 437. The extended psychosis phenotype was grouped into four: (1) no psychotic experiences (n: 194), (2) subclinical psychotic experiences (n: 87), (3) clinically relevant psychotic experiences (n: 104), and (4) schizophrenia-like disorders (n: 52). BDNF rs6265 was genotyped occurred in every participant whereas COMT rs4680 genotyping could be done on 366 individuals. RESULTS: There was no association between the extended psychosis phenotype and BDNF rs6265/COMT rs4680 polymorphisms. The frequency of met carriers in the BDNF rs6265genotype was slightly higher in individuals with subclinical psychotic experiences than in the group with no psychotic experiences, which was just below the significance level (p=0.08). CONCLUSION: The lack of an association between different expression levels of the extended psychosis phenotype and the BDNF rs6265/ COMT rs4680 polymorphism might be related to sample characteristics, underlying gene-gene, gene-environment and gene-environment-gene interactions.

Rapporteur summaries of plenary, symposia, and oral sessions from the XXIIIrd World Congress of Psychiatric Genetics Meeting in Toronto, Canada, 16-20 October 2015.

The XXIIIrd World Congress of Psychiatric Genetics meeting, sponsored by the International Society of Psychiatric Genetics, was held in Toronto, ON, Canada, on 16-20 October 2015. Approximately 700 participants attended to discuss the latest state-of-the-art findings in this rapidly advancing and evolving field. The following report was written by trainee travel awardees. Each was assigned one session as a rapporteur. This manuscript represents the highlights and topics that were covered in the plenary sessions, symposia, and oral sessions during the conference, and contains major notable and new findings.

The role of thought suppression in conversion disorder in relation to depression, symptom interpretation and sleep hygiene: a case-control study

Abstract Background Thought suppression has been associated with a number of psychiatric disorders. However, the association with conversion disorder (CD) has not been investigated yet. Objective To investigate the role of thought suppression in CD. Methods Eighty consecutive outpatients with a diagnosis of CD and sixty age, sex and neighborhood-similar controls were evaluated using Beck Depression Inventory-I (BDI-I), White Bear Suppression Inventory (WBSI), Symptom Interpretation Questionnaire (SIQ) and Sleep Hygiene Index (SHI). Cases and controls were compared in regard to thought suppression scores considering their status of high depression scores via a logistic regression model. The reciprocal associations of thought suppression with other clinical dimensions in CD were assessed. Finally, structural equation modelling was applied to untangle the possible connections. Results CD patients had significantly higher scores of thought suppression than the control group. However, the difference was below the significance level when CD patients without comorbid high depression scores were taken into account. Thought suppression was associated with the clinical severity of CD. According to the structural equation model, older age and somatic attributions to the common bodily sensations were the significant correlates of thought suppression among CD patients. Discussion Thought suppression may be considered as a non-specific marker of clinical severity in CD.