FGF2 gene's antisense protein, NUDT6, plays a depressogenic role by promoting inflammation and suppressing neurogenesis without altering FGF2 signalling.

Fibroblast growth factor-2 (FGF2) is involved in the regulation of affective behaviour and shows antidepressant effects through the Akt and extracellular signal regulated kinase (ERK) 1/2 pathways. Nudix hydrolase 6 (NUDT6) protein is encoded from FGF2 gene's antisense strand and its role in the regulation of affective behaviour is unknown. Here, we overexpressed NUDT6 in the hippocampus and investigated its behavioural effects and the underlying molecular mechanisms affecting the behaviour. We showed that increasing hippocampal NUDT6 results in depression-like behaviour in rats without changing FGF2 levels or activating its downstream effectors, Akt and ERK1/2. Instead, NUDT6 acted by inducing inflammatory signalling, specifically by increasing S100 calcium binding protein A9 (S100A9) levels, activating nuclear factor-kappa B-p65 (NF-κB-p65), and elevating microglia numbers along with a reduction in neurogenesis. Our results suggest that NUDT6 could play a role in major depression by inducing a proinflammatory state. This is the first report of an antisense protein acting through a different mechanism of action than regulation of its sense protein. The opposite effects of NUDT6 and FGF2 on depression-like behaviour may serve as a mechanism to fine-tune affective behaviour. Our findings open up new venues for studying the differential regulation and functional interactions of sense and antisense proteins in neural function and behaviour, as well as in neuropsychiatric disorders. KEY POINTS: Hippocampal overexpression of nudix hydrolase 6 (NUDT6), the antisense protein of fibroblast growth factor-2 (FGF2), increases depression-like behaviour in rats. Hippocampal NUDT6 overexpression triggers a neuroinflammatory cascade by increasing S100 calcium binding proteinA9 (S100A9) expression and nuclear NF-κB-p65 translocation in neurons, in addition to microglial recruitment and activation. Hippocampal NUDT6 overexpression suppresses neurogenesis. NUDT6 exerts its actions without altering the levels or downstream signalling pathways of FGF2.

Mirror-Image Comparison of Maintenance Electroconvulsive Treatment Effectiveness in Affective and Psychotic Disorders.

OBJECTIVES: The study aimed to investigate the effectiveness of maintenance electroconvulsive therapy (mECT) with respect to the hospitalization duration, number of hospitalizations, and major and minor treatment changes with a mirror-image study design. METHODS: Medical charts of patients who received at least a 3-month-long course of mECT were reviewed. The records of 36 patients (17 with psychotic disorders, 19 with affective disorders) were retrospectively examined for 2 periods with the same duration; during the mECT (post-mECT) and before the mECT (pre-mECT). The hospitalization duration, the number of hospitalizations, and major and minor treatment changes, which were assumed to provide information on the effectiveness of the interventions, were recorded and compared between these periods. Statistical analysis was performed using generalized estimating equation models conducted with age, diagnostic category, and observation time as covariates. In addition, the relapse and recurrence rates and time to relapse/recurrence were analyzed. RESULTS: Comparison of pre-mECT and post-mECT periods revealed that mECT, applied in an individualized schedule combined with pharmacotherapy, was associated with a lower frequency ( P < 0.001; rate ratio [RR], 0.161; 95% confidence interval [CI], 0.087-0.297), shorter duration of hospitalization ( P < 0.001; RR, 0.123; 95% CI, 0.056-0.271), and lower number of major treatment changes ( P = 0.007; RR, 0.522; 95% CI, 0.324-0.840), irrespective of diagnoses. The relapse/recurrence rates were similar in the 2 diagnostic categories ( P = 1.000; 26.3% vs 29.4%). CONCLUSIONS: Maintenance ECT should be increasingly considered an important treatment modality in patients with affective and psychotic disorders after an effective course of ECT.

Social Connectedness Matters: Depression and Anxiety in Transgender Youth During the COVID-19 Pandemic.

BACKGROUND: Gender-affirming and supportive relations for transgender youth are considered protective in terms of mental health. AIM: To describe how transgender youth perceived changes in their gender expression, in the course of the gender-affirming path, and the effect of social connectedness and social support on depression and anxiety during the pandemic. METHODS: In this cross-sectional study, transgender youth completed an online survey developed to evaluate the perceived changes in gender expression and affirmation path that occurred during COVID-19 and the age-stratified lockdown. Furthermore, we aimed to investigate the effect of social connectedness and social support on depression and anxiety in this population during the pandemic. The participants completed the following scales: Social Connectedness Scale Revised (SCS-R), Multidimensional Scale of Perceived Social Support (MSPSS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI). The effect of lockdown on life conditions, gender expression, social and medical gender-affirming path, social connectedness, social support, depression, and anxiety levels were examined. Linear regression analyses were performed to evaluate the relationships between BDI and STAI scores and other variables. OUTCOMES: The relationship between the levels of perceived social connectedness, and social support, the pandemic-related changes in living conditions and depression and anxiety scores were calculated. RESULTS: A total of 49 transgender youth with a mean age of 20.53 ± 1.86 years were enrolled. Participants reporting discomfort at the place they live and who had difficulties concerning gender expression and affirmation had higher depression and anxiety scores and perceived lower social support from their family. Social connectedness score was a significant negative predictor of depression severity, whereas social connectedness and social support were both significant negative predictors of anxiety severity. CLINICAL IMPLICATIONS: Our results show increased adversity for transgender youth when connectedness with supportive people is diminished. During the COVID-19 pandemic, social connectedness and social support perceived by transgender youth are associated with better mental health. STRENGTHS AND LIMITATIONS: This is one of the first studies to evaluate the changes that occurred during the COVID-19 pandemic in transgender youth with relation to social support and connectedness, during an age-stratified lockdown. The main limitations were the small study size, skewed gender ratio and that the study sample came from a single gender clinic. CONCLUSION: As social connectedness and social support are significant predictors of depression and anxiety severity, special attention is needed to increase contact and support for transgender youth during the pandemic. Tüzün Z, Basar K, Akgül S. Social Connectedness Matters: Depression and Anxiety in Transgender Youth During the COVID-19 Pandemic. J Sex Med 2022;19:650-660.

Gender Dysphoria and Perceived Social Support: A Matched Case-Control Study.

BACKGROUND: In people diagnosed with Gender Dysphoria (GD), low perceived social support from their families and society has been suggested to be associated with poor quality of life and mental well-being. AIM: To compare the perceived social support in individuals with GD with that in individuals without GD matched for age and gender. METHODS: The study group (n = 50) consisted of individuals diagnosed with GD via psychiatric evaluation. A control group (n = 50) was created by matching volunteers without GD by age and gender. Sociodemographic data form, Structured Clinical Interview Form for DSM-IV TR Axis I Disorders (SCID-I), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to gather data from participants. OUTCOMES: comparing the perceived social support, the total and subscale MSPSS scores of groups were calculated. RESULTS: The presence of at least 1 psychiatric disorder was significantly higher in the GD group than in the control group, either lifetime or during evaluation (P < .001 and P = .025, respectively). The total MSPSS and family support subscale scores were found to be significantly lower in the GD group than in the control group (P = .001 and P ≤ .001, respectively). When the groups formed on the basis of gender identity (32 trans men vs 32 cis men and 18 trans women vs 18 cis women) were compared, only the family support subscale score was found to be lower in trans men than cis men (P = .005). In addition, comparisons within the groups formed based on sex assigned-at-birth revealed lower total, friend, and family support in those assigned female-at-birth and lower total and family support in those assigned male-at-birth in the GD group. A multiple linear regression analysis revealed that the presence of GD was significantly associated with total and family support MSPSS subscale scores. CLINICAL IMPLICATIONS: The findings show that perceived social support in people diagnosed with GD is lower, even when the presence of psychiatric disorders is included in the analysis. STRENGTHS AND LIMITATIONS: The matched case-control design was the major study strength, whereas the sample size was the major limitation. CONCLUSION: Clinical care of people diagnosed with GD should include the evaluation of diverse sources of social support, efforts to strengthen family and friend support, maintenance of interpersonal relationships, and support of mental well-being. Kaptan S, Cesur E, Basar K, et al. Gender Dysphoria and Perceived Social Support: A Matched Case-Control Study. J Sex Med 2021;18:812-820.

Perceived Discrimination, Social Support, and Quality of Life in Gender Dysphoria.

INTRODUCTION: Transgender individuals experience discrimination in all domains of their personal and social life. Discrimination is believed to be associated with worse quality of life (QoL). AIM: To investigate the relation between QoL and perceived levels of discrimination and social support in individuals with gender dysphoria (GD). METHODS: Individuals with GD who attended a psychiatry clinic from January 2012 through December 2014 were recruited. Demographic, social, and medical transition features were collected with standardized forms. MAIN OUTCOME MEASURES: Self-report measurements of QoL (Turkish version of the World Health Organization's Quality of Life-BREF) that included physical, psychological, social, and environmental domains, perceived discrimination with personal and group subscales (Perceived Discrimination Scale [PDS]), and social support (Multidimensional Scale of Perceived Social Support) were completed. RESULTS: Ninety-four participants (76.6% trans men) adequately completed the study measurements. Regression models with each QoL domain score as a dependent variable indicated a significant predictor value of personal PDS in social and environmental QoL. Social support from family was associated with better QoL in psychological QoL, whereas perceived support from friends significantly predicted all other domains of QoL. There was a tendency for group PDS to be rated higher than personal PDS, suggesting personal vs group discrimination discrepancy. However, group PDS was not found to be a predictor of QoL in the multivariate model. CONCLUSION: Perceived personal discrimination and social support from different sources predicted domains of QoL with a non-uniform pattern in individuals with GD. Social support and discrimination were found to have opposing contributions to QoL in GD. The present findings emphasize the necessity of addressing discrimination and social support in clinical work with GD. Moreover, strategies to improve and strengthen friend and family support for individuals with GD should be explored by clinicians. Further research with larger and community-based samples is required.

Etomidate is associated with longer seizure duration, lower stimulus intensity, and lower number of failed trials in electroconvulsive therapy compared with thiopental.

OBJECTIVE: Induction agents used for electroconvulsive therapy (ECT) may alter seizure parameters. In this study, we aimed to investigate the effects of etomidate and thiopental on seizure-related variables. METHODS: Registries of patients who received ECT between 2010 and 2013 in a tertiary psychiatry clinic were evaluated retrospectively. The information of patients who were on the same induction agent and muscle relaxant during the whole treatment course was assessed. Primary outcome measures were total number of ECT sessions, mean peripheral and central seizure duration, cumulative stimulus intensity, and the number of adequate seizures per total number of stimuli. Secondary measures were maximum systolic-diastolic and mean blood pressure, peak heart rate, and the frequency of antihypertensive drug use during the sessions. RESULTS: Although the total number of ECT sessions is similar between the etomidate (n = 43) and thiopenthal (n = 31) groups, the mean seizure duration per stimuli was significantly longer whereas the cumulative stimulus intensity was lower in the etomidate group. The number of adequate seizures obtained in relation with the number of stimuli was also significantly higher, indicating increased probability of eliciting an adequate seizure with etomidate. During threshold determination, the number of stimuli needed to provide an adequate seizure was marginally less with etomidate. No group difference was observed in hemodynamic changes and the frequency of antihypertensive use. CONCLUSIONS: Etomidate use, compared with thiopental as an induction agent, is associated with longer seizure duration with less cumulative intensity. The use of etomidate reduces the number of failed trials and may prevent the application of unnecessary electrical stimuli with a possibly safe hemodynamic profile.

The Impact of Chest Binding on Pulmonary Functions of Trans and Gender Diverse Youth.

PURPOSE: There is a scarcity of information regarding the health consequences of chest binding and its effects on pulmonary functions (PFs). This study aimed to evaluate binding practices, physical outcomes, and effects on PFs of trans or gender diverse (TGD) youth who bind. METHODS: The TGD and control groups underwent pulmonary function tests (PFTs), with the TGD group undergoing testing both with their binder and after removal. We additionally evaluated binding practices and its physical outcomes. RESULTS: 33 TGD participants with a mean age of 20.15 ± 2.76 and 31 controls with a mean age of 20.74 ± 2.95 years were included. A large majority reported physical side effects, back pain being the most common. The comparison of PFTs of the TGD group with and without binder showed that vital capacity , forced vital capacity, and forced expiratory volume in 1 second values were significantly lower in the presence of a binder (both % predicted and L) (p < .005). Binding duration (both lifetime and weekly) did not correlate with PFTs, however, the ratio of change in forced expiratory volume -1/ forced vital capacity induced by binding correlated with weekly binding duration. When we separately compared the PFTs of the TGD group with and without binder to the control group, we found no significant difference. DISCUSSION: Despite the abundance of physical side effects, comparison with the control group does not support long-lasting effects of binding on PF; however, it indicates acute restrictive impairment without a significant effect on airflow obstruction in youth who bind. These findings hold significance in facilitating well-informed decision-making processes pertaining to binding practices.

Exploring the Relationship Between Acoustic Measurements and Self-Perception of Voice in Trans Women.

OBJECTIVE: This study aimed to explore the strength and direction of the relationship between spectral cepstral-based, time-based acoustic measures and the self-perception of voice in trans women. METHODS: Forty-eight trans women were included in the study. Analysis of the sustained vowel phonation was performed using Multidimensional Voice Profile Analysis (MDVP), and spectral-cepstral analyses of the sustained vowel phonation, all-voiced weighted sentence, and spontaneous speech were made via Analysis of Dysphonia in Speech and Voice (ADSV) software. For self-perceptual evaluations, the Trans Woman Voice Questionnaire (TWVQ) and the Self-perception of Voice Femininity Scale (SPVF) were used. The correlation between MDVP, spectral-cepstral parameters, and TWVQ and SPVF scores was calculated. RESULTS: The present study found a positive relationship between F0, SPVF, and TWVQ. Among the perturbation parameters, the jitter was the only one found to correlate with SPVF and TWVQ. The CPPF0 parameter was found to be associated with a more feminine voice perception and a higher voice-related quality of life in all speech samples in the present study. In addition, higher CPP values achieved from vowel phonation were associated with less feminine voice perception and lower voice-related quality of life. The present study also suggests a weak correlation with the SPVF and Cepstral Peak Prominence Standard Deviation (CPPF0 SD) of the spontaneous speech sample in a negative direction. CONCLUSIONS: This study found weak and moderate levels of correlations between F0, jitter (%), CPP, CPPF0, CPPF0 SD parameters, and self-perceptual measures. These findings suggested that such a level of relationship is attributable to the fact that these tools evaluate different aspects of voice in accordance with the International Classification of Functioning System. According to this pioneering study, it would be beneficial to incorporate spectral-cepstral measures into the objective assessment protocol for trans women's voices.

Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries.

BACKGROUND: Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS: The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS: About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS: Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.

Effects of acute and chronic electroconvulsive shocks on glycogen synthase kinase 3ß level and phosphorylation in mice.

OBJECTIVES: Glycogen synthase kinase 3ß (GSK-3ß) is recently proposed as a novel target in the treatment of mood disorders. Recent evidence has suggested that acute and chronic administration of antidepressants led to inhibition of GSK-3ß via phosphorylation of Serine9 residue. Acute electroconvulsive shock (ECS) has been reported to increase GSK-3ß phosphorylation transiently. In this study, the changes in the level of GSK-3ß and its phoshorylated form (phospho-Ser9-GSK-3ß) following chronic ECS (cECS) were investigated in mice. METHODS: Mice were given daily ECS via bilateral corneal electrodes for 10 consecutive days in the chronic group and a single ECS in the acute group. Electrodes were applied without stimulation in corresponding sham groups. Immunoblotting for GSK-3ß and phospho-Ser9-GSK-3ß was performed with the frontal cortex and hippocampus samples, extracted 10 minutes after single ECS, and 24 hours after the last ECS in the chronic group. The optical densities of the bands obtained were compared between the active treatment and sham groups for each condition separately. RESULTS: The level of phospho-Ser9-GSK-3ß was not different following chronic ECS, but significantly higher following acute ECS, compared with the corresponding sham group, in the hippocampus and frontal cortex. The level of GSK-3ß was similar to sham following both acute and chronic ECS, in both regions. CONCLUSIONS: The transient increase in GSK-3ß phosphorylation observed following acute ECS in the mice hippocampus and frontal cortex was not found to persist 24 hours following chronic ECS. The mechanism of action of ECS does not seem to involve persistent change in the level and phosphorylation of GSK-3ß.

Impulsivity in Depression: Its Relation to Suicidality.

OBJECTIVE: Impulsivity is an important risk for suicidality, which is common in patients with major depressive disorder (MDD). The goal of this study was to examine multiple facets of impulsivity in depressed patients compared with healthy controls and to assess their relationship to suicidality. METHOD: Outpatients diagnosed with MDD using the Structured Clinical Interview for DSM-IV were recruited. Two groups were constituted as "MDD in remission" (n=32) and "MDD" (n=71). The "healthy control" group (n=30) consisted of individuals who had never been diagnosed with any psychiatric disorder. Impulsivity was assessed with the Barratt Impulsivity Scale (BIS), a self-rating measure, and with the following behavioral tasks: Go/No-go Task, Iowa Gambling Task, and Balloon Analogue Risk Task. The scores of the 3 groups (n=133) were compared to evaluate the effect of MDD. The scores were also analyzed and compared in the patients in the 2 MDD groups (n=103) with respect to their current and lifetime suicidality. RESULTS: There was no difference in the 3 groups in task scores, but nonplanning BIS was correlated with the severity of depressive symptoms. Patients with suicidal ideation (SI) had higher BIS total and attention impulsivity scores and more commission errors on the Go/No-go Task, reflecting failure in response inhibition, compared with the patients without SI. CONCLUSIONS: Failure to show differences in impulsivity-related tasks suggests that there might be no relationship between the state of depression and impulsivity. However, these findings confirm that there is an association between SI and response inhibition and the attention facet of impulsivity in depression.

How the COVID-19 pandemic affects transgender health care - A cross-sectional online survey in 63 upper-middle-income and high-income countries.

Background: Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. Methods: As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. Results: 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Discussion: Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality.

Clinical Follow-up of Two Adolescents Diagnosed with Gender Dysphoria. / Cinsiyetinden Hosnutsuzlugu Olan Iki Ergenin Klinik Izlem Süreci.

Rapid physical, psychological and sexual changes in adolescents due to the developmental process differentiate the approach to adolescents with gender dysphoria (GD) from the approach to adults. In this article, two adolescents who applied for GD and followed up for a long time are presented. The first case was assigned male at birth and defined herself as female. At the age of fifteen, a gonadotropin-releasing hormone analog was started for puberty suppression, and sex hormone was started in the follow-up. The second case's assigned sex was female and defined himself as male. At the age of sixteen years and six months, puberty suppressive treatment was started, followed by sex hormones. Both cases were able to continue their psychosocial development without any problems after the psychiatric and physical treatments they could reach on time. Although GD in adolescents cannot be resolved with puberty suppression alone, it creates time to resolve the acute problems and to search for appropriate treatment approaches in the future. Puberty suppression partially relieves and prevents the exacerbation of the dysphoria experienced by the youth diagnosed as GD, and creates time to search appropriate treatment approaches in the follow-up. Through these two cases, it is aimed to introduce the gender affirmation processes of adolescents with GD, to discuss the medical interventions in adolescence and the psychosocial effects of the process on individuals. Keywords: Gender dysphoria, gender incongruence, adolescence, gender affirmation process, puberty supression, puberty blockers.

Reliability and Validity of the Snaith-Hamilton Pleasure Scale Clinician Administered Turkish Form. / Klinisyen Tarafindan Uygulanan Snaith-Hamilton Zevk Alma Ölçegi Türkçe Uyarlamasinin Geçerlik ve Güvenilirlik Çalismasi.

OBJECTIVE: Anhedonia, which is defined as diminished capacity of having pleasure, is a common symptom in many mental disorders. It has been aimed in this study to adapt to the Turkish language the Snaith- Hamilton Pleasure Scale Clinician Administered Form (SHAPS-C) and examining reliability and validity of Snaith-Hamilton Pleasure Scale Clinician Administered Turkish Form (SHAPS-C-TR) which measures anhedonia in clinical and healthy samples. METHOD: Two groups consisting of 63 participants consulting the psychiatry clinic and 67 non-clinical participants were included in the study. Data were collected with the Turkish version of the SHAPS-C (the SHAPS-C-TR), the Beck Depression Inventory (BDI), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Positive Negative Affect Scale (PANAS). RESULTS: The Kuder-Richardson internal consistency coefficient for the entire participants, the clinical and the non-clinical group were, 0.765, 0.813 and 0.657 respectively. The intra-class coefficient for test-retest reliability was 0.732. The total score on the SHAPS-C-TR significantly correlated with the scores on the anhedonia items of the BDI and the MADRS but not the scores on anxiety items. The PANAS positive symptoms scores were negatively correlated with the SHAPSC- TR total score. In the clinical group, the participants followed up with depression had significantly higher SHAPS-C-TR score than the rest of the participants. A similar difference was not demonstrated by the scores of the clinical group participants followed up with anxiety disorder. Scores on the SHAPS-C-TR did not vary with respect to the demographic characteristics of the participants. CONCLUSION: The SHAPS-C-TR is a valid and reliable measurement tool to assess anhedonia in both clinical and non-clinical individuals irrespective of differences in demographic features.

Investigating Validity and Reliability of the Turkish Version of Transsexual Voice Questionnaire (Male to Female).

OBJECTIVE: The problems faced by trans women with regard to their voice may affect their quality of life. For the evaluation of trans women's voice, tools assessing their self-perception are very important, with the Transsexual Voice Questionnaire (TVQMtF ) being one of the most frequently used. The purpose of this study was to investigate the validity and reliability of the Turkish version of the TVQMtF (TVQMtF -TR), which was previously translated into 12 languages. STUDY DESIGN: Cross-sectional study. METHOD: A total of 41 trans women participated in this study. The participants filled out the TVQMtF -TR, the self-perceptions of voice femininity questionnaire, and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF-TR). Additionally, 58.5% of the participants filled out the TVQMtF -TR again two weeks after the first interview. RESULTS: The total Cronbach's-α value of the TVQMtF -TR was 0.972, and the item-total correlation values were found to be between 0.323 and 0.876. The intraclass correlation coefficient value was 0.931. There was a strong negative correlation between TVQMtF -TR and self-perceptions of voice femininity. There was a significant negative correlation between TVQMtF -TR and the psychological and environmental domains of WHOQOL-BREF-TR. However, there was no significant relationship found between the social and physical domains. CONCLUSION: According to the results of the study, the Turkish version of TVQMtF -TR was considered a valid and reliable tool.

The Reliability and Validity of The Turkish Form of Berger HIV Stigma Scale.

OBJECTIVE: HIV-related stigma towards people living with HIV/AIDS (PLWHA) creates a barrier in access to quality health care, affects mental health and leads to poor treatment adherence. Assessment of different components of HIV-related stigma is needed to develop appropriate strategies for prevention and intervention. The aim of this study was to translate and adapt Berger HIV Stigma Scale to Turkish and assess its reliability and validity. METHOD: The Turkish version of the 40 item, 4-point Likert-type self-report HIV Stigma Scale, as well as Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES) and sociodemographic data form were administered to 95 PLWHA. RESULTS: The items of the scale whose face validity was found to be sufficient, were loaded on four factors in the explanatory factor analysis: Internalised Stigmatization (16 items); Concerns with Public Attitudes (12 items); Negative Self Image (9 items); and Disclosure Concerns (8 items). This structure explained 46.71% of the variance after an item was removed based on the analysis. All subscales had acceptable internal consistency with Cronbach's alpha coefficients .802-.934. BDE scores had moderate positive correlations with Internalized Stigmatization; Concerns with Public Attitudes; Disclosure Concerns subscale scores (rs=0.214, p=0.047; rs=0.295, p=0.006; rs=0.353, p=0.001), and strong positive correlations with Negative Self Image score (rs=0.617, p<0.001). A moderate positive correlation was found between RSES and Negative Self Image subscale score (rs=0.434; p<0.001). CONCLUSION: Our findings showed that the Turkish form of Berger HIV Stigma Scale is a reliable and valid tool for measuring HIV-related stigma in PLWHA.

Bi-temporal electroconvulsive therapy efficacy in bipolar and unipolar depression: A retrospective comparison.

AIM: Although electroconvulsive therapy (ECT) has been extensively used for depressive episodes in bipolar disorder (BDD), it has received less interest in research compared with major depressive disorder (MDD). Studies comparing the efficacy of ECT in BDD and MDD have been contradictory. This study aimed to compare the effectiveness of ECT in BDD and MDD, analyzing the influence of clinical features on outcome. METHODS: The medical charts and electronic records of 107 patients (MDDn = 75 [70.1 %], BDD n = 32 [29.9 %]) receiving bi-temporal ECT were investigated retrospectively. Features of the index episode, such as the time elapsed until ECT and the effect of diagnosis on efficacy evaluated by the Hamilton Depression Rating Scale (HAM-D), were analyzed. RESULTS: The diagnostic groups were alike concerning clinical features of the index episode, such as the presence of psychotic symptoms and suicidality. Patient age and the number of previous affective episodes were significantly different between the groups. The time elapsed until ECT in the examined episode was significantly longer in the MDD group. Compared with the MDD group, the BDD group had a significantly higher remission rate with ECT. Regression analysis revealed that BDD diagnosis, older age, and shorter time until ECT were significantly associated with remission. CONCLUSION: The significant relationship observed between greater time elapsed until ECT and worse outcome is noteworthy in terms of clinical practice. This finding further challenges the widely accepted place of ECT as the "last resort" for the treatment of depression in bipolar and unipolar affective disorders.

The effect of clozapine on regional cerebral blood flow and brain metabolite ratios in schizophrenia: relationship with treatment response.

The purpose of this study was to investigate the effect of clozapine on regional cerebral blood flow (rCBF) and its relationship with response to treatment. In addition, we aimed to study the influence of clozapine on proton magnetic resonance spectroscopy ((1)H-MRS) findings in the dorsolateral prefrontal cortex (DLPFC) in a subgroup of patients. Psychopathology, neurocognitive functioning, and SPECT imaging of 22 patients were assessed at the baseline and 8 weeks after the initiation of clozapine treatment. In 10 of these patients intermediate-echo (TE: 135 ms) single-voxel (1)H-MRS was also performed at the baseline and after 8 weeks. Clozapine treatment increased the right frontal (superior and medial)/caudate perfusion ratio in the whole group, while it increased bilateral frontal (superior and medial)/caudate perfusion ratios in treatment responders. In addition, percentage changes in left and right frontal (superior and medial)/caudate perfusion ratios compared to the baseline were higher in treatment responders than in non-responders. The improvement in attention was related to the increase in percentage change in the right frontal (superior and medial)/caudate perfusion ratio, while the improvement in verbal fluency was related to the increase in percentage changes in both right and left frontal (superior and medial)/caudate perfusion ratios and to right frontal (superior and medial)/thalamus perfusion. Baseline frontal (superior and medial)/thalamus perfusion could explain 32% of the variability of percentage improvements in psychopathology. (1)H-MRS showed that the baseline PANSS general psychopathology score was inversely correlated with the baseline NAA/Cre ratio. An increased NAA/Cre ratio in DLPFC after 8 weeks of clozapine treatment was also revealed by (1)H-MRS. Our SPECT imaging results suggest the presence of an imbalance in fronto-striato-thalamic circuitry that changes with clozapine, especially in the responders, while (1)H-MRS results indicate a supportive effect of clozapine on neuronal integrity.