Is early marriage practice a problem for women living in Istanbul? A qualitative study.

Early marriages (EM) adversely affect women's physical and mental health, education, and social status. The current study aimed to analyze effects of EM through the thoughts, experiences, and suggestions of women who were married under the age of eighteen in Istanbul, Turkey, and the key informants (e.g., social worker, psychologist, obstetrician) who have encountered EM. In-depth interviews were conducted with fifteen women who were married before age 18, recruited from psychiatry outpatient department and eleven key informants. Thematic analysis was used. Low educated, poor family environment with domestic violence and neglect of children, loss of parents, lack of access to education, and traditional social structure were stated as causes for EM. Families' attitudes about EM were characterized as their daughter's reputation would be tarnished which implied the daughter's premarital relationships would be perceived as immoral by community. All women experienced traditional, aggressive rituals for the first night of marriage, husbands were mostly insensitive, and coercive resulting a traumatic experience. Women were subjected to physical, sexual, psychological, and emotional violence; most of them were socially isolated after marriage with restrictions imposed by their spouses and spouses' family that limited communication with their loved ones. The women generally felt unprepared for adult sexual life and motherhood. In order to prevent EM, raising parents' awareness about EM, supporting girls' education, and enforcing legitimate regulations were recommended. Early marriages violate human rights, cause negative consequences for health both physically and mentally, and deepen social inequality for women. All the participants suggested a better functioning legislative arrangement. The male dominated society that legitimizes child marriages and other harmful traditional practices should be addressed.

The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil-lymphocyte and platelet-lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder.

BACKGROUND: As non-specific markers of immune dysregulation, neutrophil-lymphocyte and platelet-lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear. AIM: The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). METHODS: NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences. RESULTS: Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC. CONCLUSION: These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.

Endocrine-disrupting effects of bisphenol-A, thiamethoxam, and fipronil in hormone-naïve transmen compared to cis-women.

BACKGROUND: Current evidence suggests that the etiology of gender dysphoria (GD) is multifactorial: this, however, remains unclear. Endocrine-disrupting chemicals (EDCs) are one of the etiological hypotheses. OBJECTIVES: In this study, we aimed to evaluate the urinary levels of bisphenol A (BPA), thiamethoxam, and fipronil in hormone-naïve transmen compared with case-matched cis-women as well as the relation between sex hormone levels and EDCs. METHODS: Drug-naïve transmen diagnosed with GD and who were referred from the psychiatry outpatient clinic to the outpatient clinic of the Department of Endocrinology, Marmara University Hospital, were included in the study. These individuals were assessed for eligibility; 38 drug-naïve transmen and 22 cis-women were recruited as the control group. After anthropometric evaluation laboratory tests for FSH, LH, total testosterone, and estradiol were carried out, spot urine samples were collected to evaluate the urine metabolic excretion of BPA, thiamethoxam, and fipronil. RESULTS: We found that androgens, total testosterone, androstenedione, and DHEAS levels were significantly higher in transmen than in cis-women. Thiamethoxam was considerably higher in cis-women than in transmen, whereas fipronil and BPA levels were similar in both groups. A negative correlation was found between thiamethoxam and testosterone and between thiamethoxam and BPA levels. CONCLUSION: The available data suggest that the EDCs that we are most exposed to in our lives are not the only factor in GD development. Even transmen who have not taken hormone replacement have high testosterone levels; however, the mechanism has not as yet been elucidated. The challenge is to determine whether this is a factor leading to GD or a condition that develops in common with GD.

Oxidatively-induced DNA base damage and base excision repair abnormalities in siblings of individuals with bipolar disorder DNA damage and repair in bipolar disorder.

Previous evidence suggests elevated levels of oxidatively-induced DNA damage, particularly 8-hydroxy-2'-deoxyguanosine (8-OH-dG), and abnormalities in the repair of 8-OH-dG by the base excision repair (BER) in bipolar disorder (BD). However, the genetic disposition of these abnormalities remains unknown. In this study, we aimed to investigate the levels of oxidatively-induced DNA damage and BER mechanisms in individuals with BD and their siblings, as compared to healthy controls (HCs). 46 individuals with BD, 41 siblings of individuals with BD, and 51 HCs were included in the study. Liquid chromatography-tandem mass spectrometry was employed to evaluate the levels of 8-OH-dG in urine, which were then normalized based on urine creatinine levels. The real-time-polymerase chain reaction was used to measure the expression levels of 8-oxoguanine DNA glycosylase 1 (OGG1), apurinic/apyrimidinic endonuclease 1 (APE1), poly ADP-ribose polymerase 1 (PARP1), and DNA polymerase beta (POLß). The levels of 8-OH-dG were found to be elevated in both individuals with BD and their siblings when compared to the HCs. The OGG1 and APE1 expressions were downregulated, while POLß expressions were upregulated in both the patient and sibling groups compared to the HCs. Age, smoking status, and the number of depressive episodes had an impact on APE1 expression levels in the patient group while body mass index, smoking status, and past psychiatric history had an impact on 8-OH-dG levels in siblings. Both individuals with BD and unaffected siblings presented similar abnormalities regarding oxidatively-induced DNA damage and BER, suggesting a link between abnormalities in DNA damage/BER mechanisms and familial susceptibility to BD. Our findings suggest that targeting the oxidatively-induced DNA damage and BER pathway could offer promising therapeutic strategies for reducing the risk of age-related diseases and comorbidities in individuals with a genetic predisposition to BD.

Unveiling Gender Dysphoria Experiences in Turkish Young Adults: Challenges, Perspectives, and Implications in Health Care Settings.

Purpose: Gender dysphoria (GD) emerged as a focal area in child and adolescent development research. While the intricacies of diagnosis and interventions for GD intertwine with diverse socio-cultural challenges, a notable dearth of knowledge exists about the experiences of transgender (TG) individuals during their formative years in Turkey. This study aims to unveil these experiences, shedding light on the challenges, perspectives, and implications in health care settings. Patients and Methods: Our study encompassed 125 participants: 62 TGs under clinical follow-up, and a control group of 63 cisgender individuals. Surveys tailored to TG participants addressed early GD experiences, gender-typed activity participation, and psychosocial challenges from childhood through adolescence. Additionally, both cohorts contributed to a survey on attitudes towards community-based interventions, allowing for a comparative analysis of their perspectives. Results: TGs identified their GD around age 10.77. Female-to-male TGs showed more involvement in traditionally male-associated activities, whereas male-to-female engaged more in female-associated domestic role-plays (p<0.001). Over a third (37.09%) faced ostracization or bullying due to GD, 45.16% encountered verbal abuse, and 12.90% reported physical violence. Additionally, 40.32% had undergone treatment for depression and anxiety disorders. Most participants supported awareness initiatives, advocating for open gender expression, and normalizing the experiences of TG youth. Furthermore, 88.71% of TGs emphasized the importance of enhancing the expertise of professional groups, such as medical and mental health practitioners, in GD matters, a sentiment echoed by 68.25% of cisgender participants (p=0.030). While medical interventions were the least favored strategy at 32.80% overall, 46.78% of TGs supported it, compared to 19.05% of controls (p=0.010). Conclusion: Our study underscores the challenges faced by TG individuals during development. Early recognition, societal awareness, enhanced training in professional healthcare environments, and comprehensive support are crucial for fostering acceptance and reducing adversity among children and adolescents navigating GD.

Hyperandrogenism-related metabolic changes in drug-naïve transmen compared to cisgender women: a case-controlled study.

INTRODUCTION: The aetiology of gender dysphoria is still unclear. Although prior studies have shown that trans men have higher androgen levels than cisgender women, they all concluded unselected populations. Our reason for performing this study is to evaluate trans men's hormone profile and metabolic status to compare with cisgender women in a more selected population. This is the first case-controlled study to compare anthropometric, metabolic, and endocrinological parameters of drug-naïve trans men with those of cisgender women. MATERIAL AND METHODS: We designed this study as a single-centre observational cohort study. We included 70 drug naïve trans men, and the control group comprised 34 healthy cisgender women. We measured and compared hormone profiles and metabolic parameters in the 2 groups. RESULTS: Of the 70 trans men individuals, 16 (22.85%) met the Rotterdam criteria and were diagnosed with polycystic ovary syndrome (PCOS); 4 individuals in the control group met the criteria (11.7%). Although we matched body mass index in the groups, total testosterone, free androgen index, androstenedione, 17 hydroxyprogesterone, muscle strength, triglyceride, and homeostatic model assessment of insulin resistance levels were significantly higher in the trans men than in the cisgender women (p < 0.05). Even after were excluded PCOS patients, hyperandrogenaemia was apparent in the trans men. CONCLUSION: Our study showed that trans men have clearly higher androgen levels, which may have been the reason for metabolic changes compared to cisgender women. However, the main reason for hyperandrogenism in drug-naïve trans men is still not known, and more comprehensive studies are needed.

Efficacy of bright light therapy in perinatal depression: A randomized, double-blind, placebo-controlled study.

BACKGROUND: Uncertainties and difficulties associated with the current treatment modalities for perinatal depression (PND) may cause some mothers to avoid treatment. Raising awareness about the effectiveness and safety of bright light therapy (BLT) may help to alleviate the challenges of PND. The main goal of this study was to evaluate the efficacy and safety of BLT versus placebo in PND. METHOD: A total of 30 women who were either pregnant or in first year postpartum and diagnosed with major depressive disorder were enrolled; 23 completed the study. Patients were randomly assigned to either the BLT (10,000 lux) or placebo (<500 lux) group. BLT and placebo light were applied for 45 min in the morning every day for a 3-week period. The Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), and Edinburgh Postnatal Depression Scale (EPDS) were administered weekly to evaluate response and remission rates and depression scores. RESULTS: There was no significant difference between the two groups in terms of baseline depression scores. At the end of the study, the response rates assessed according to MADRS were 75% for BLT and 18.2% for placebo (p = .006), and remission rates were 41.7% vs. 0% (p = .016), respectively. There was no significant difference between the groups (p > .05) in terms of treatment-related side effects. The main limitation of this study is its small sample size, which limits the generalizability of the study's findings. CONCLUSION: The results indicate that BLT is more effective than placebo and is reliable in terms of side effects in PND patients. In order to expand the use of BLT in PND, new studies with larger sample sizes are needed.

Impact of COVID-19 on the Life of Higher-Education Students in Istanbul: Relationship Between Social Support, Health-Risk Behaviors, and Mental/Academic Well-Being.

Objective: This study aimed to draw a general picture of the impact of the coronavirus disease 2019 (COVID-19) -pandemic on the life of higher-education students in Istanbul, with specific emphasis on the relationship between students' social support systems, health-risk behaviors, and mental/academic well-being. Methods: A total of 2583 higher-education students from different fields of study participated in an online survey gathering information from several domains, including available social networks, support-seeking attitudes, substance use patterns, physical activity levels, academic stress, academic satisfaction, and psychological well-being during the pandemic. Results: Our findings pointed to major changes in students' life circumstances and daily routines during COVID-19, including a significant decrease in contact with friends, overall substance use, and physical activity as well as high levels of depression, academic stress, and academic dissatisfaction. Depressive symptoms were significantly predicted by the loneliness score (OR = 2.08, 95% CI = 1.88-2.29), female gender (OR = 1.65, 95% CI = 1.21-2.24), frequency of binge drinking (OR = 1.4, 95% CI = 1.06-1.86), and level of academic stress (OR = 1.15, 95% CI = 1.1-1.19), whereas the number of people to easily borrow money from was found to be a protective factor against depression (OR = 0.95, 95% CI = 0.92-0.99). Conclusion: Our results highlight the need for higher-education institutions to take the appropriate social and mental health interventions, tailored to fit the specific requirements of the COVID-19-related measures.

An Analysis of the Psychosocial Challenges Faced by the University Students During COVID-19 Pandemic, and the Students' Knowledge, Attitudes, and Practices Toward the Disease.

INTRODUCTION: The aims of the present study were 1) to identify the major psychosocial challenges faced by students of a university in Istanbul, during the initial period of the COVID-19 outbreak, 2) to assess how these interacted with their level of knowledge, attitudes, and practices toward COVID-19 and the related health measures in place. METHODS: As part of an international research, a total of 2583 university students from Istanbul participated in an online survey, which included questions in several domains including their studies and daily life before and after the outbreak, their concerns and worries about the pandemic, their level of knowledge on COVID-19, their views on the policies implemented by the government and their institution, their attitude and practices toward the protective measures. RESULTS: Majority of the students reported to suffer from financial adversities due to the outbreak. The closure of residential facilities and the cancellation of face-to-face lectures resulted in the vast majority of the students moving back to their family home. Their daily routines were largely replaced by individual home activities, and social interactions shifted almost totally to digital platforms. They also reported high levels of anxiety and worries concerning a wide range of the possible detrimental outcomes of COVID-19, which were in close association with their knowledge, attitudes, and practices towards the disease, as well as their adherence to the policy measures and their satisfaction with the policies of the government. CONCLUSION: These results may help policymakers in better understanding the psychosocial impacts of COVID-19 on the life of university students, and to develop more comprehensive strategies to address their multifaceted struggles, as well as to improve their compliance with the health measures in the future.

A Case of Chronic Functional Parkinsonism Treated Over 10 Years for the Diagnosis of Juvenile Parkinsonism. / Juvenil Parkinsonizm Tanisiyla 10 Yili Askin Süre Tedavi Gören Kronik Bir Fonksiyonel Parkinsonizm Olgusu.

Functional (psychogenic) movement disorders (FMD) constitute a cluster of heterogeneous diagnoses involving motor symptoms that cannot be explained by organic pathology and are often associated with underlying psychological problems. In psychiatry, patients with FMD are often placed within the scope of somatoform disorders and conversion disorders. Functional Parkinsonism (FP) is a rare form of FMD seen in 1.5% of all patients presenting with symptoms of parkinsonism. Although almost all symptoms of parkinsonism can be present in FP, clinical features such as sudden onset and a nonprogressive course, inconsistent response to pharmacotherapy, and atypical findings in neurological examination are considered as important clues of psychogenic aetiology. Limited data in the literature on FP indicate that the average age of onset is between 37-53 years of age, whereas the average onset age of Idiopathic Parkinson's Disease (IPD) is around 60; and Juvenile Parkinsonism, a rare condition presenting before the age of 21, is often familial and more closely related to genetic mutations. Here, we present the case of a female patient, who, after the diagnosis of Juvenile Parkinsonism at the age of 17, had been treated with antiparkinsonian medications for about 14 years in the neurology clinic. Even though the age of onset of this case was far earlier than expected for both IPD and FP and the symptoms became chronic despite close monitoring, it is believed that this case is a striking example for the importance of the recognition of FP and early intervention.

Validity and reliability of the Turkish version of the adult ADHD Self-Report Screening Scale for DSM-5.

BACKGROUND: Approximately half of the children with attention-deficit hyperactivity disorder continue to meet diagnostic criteria in adulthood. The prevalence of adult attention-deficit hyperactivity disorder is reported between 2.5% and 4.4% and is associated with significant impairment in quality of life and increased psychiatric comorbidity. Attention-deficit hyperactivity disorder in adults remains mostly undiagnosed and/or untreated despite the availability of effective treatments. The majority of people who do not receive necessary treatment are in the nonclinical or nonpsychiatric clinical population. Screening is an important step for diagnosing adults with attention-deficit hyperactivity disorder. Yet, there are no valid and reliable screening questionnaires calibrated for the Diagnostic and Statistical Manual for Mental Disorders-5 in Turkish. AIMS: We aimed to test the reliability and the validity of the Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 screening questionnaire designed according to DSM-5 in the Turkish population. STUDY DESIGN: Methodological and cross-sectional study. METHODS: The translation was carried out according to the World Health Organization Composite International Diagnostic Interview translation guide using a linguistic adaptation approach. We used a convenience sampling method to recruit an individual with adult attention-deficit hyperactivity disorder (n = 68) and a control group (n = 68). The participants completed a sociodemographic form, 6-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, and the previous version 18-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 for the concurrent validity analysis. For the diagnostic validity, clinical diagnosis made by psychiatrists according to the Diagnostic and Statistical Manual for Mental Disorders-5 criteria was used. Internal consistency and item-total correlation coefficients, exploratory factor analyses, correlation with Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1, and receiver operating characteristic curve analysis were conducted. RESULTS: The internal consistency measured by Cronbach alpha was 0.869. Item-total correlation coefficients were calculated to be between 0.602 and 0.717, and the correlations were statistically significant (P < 0.0001). The Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 showed to have a unidimensional factor structure explaining 60.54% of the variance. The correlation between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 total score was calculated as 0.992 (P < 0.0001), and that between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 attention-deficit subdimension was 0.868 (P < 0.0001). In the receiver operating characteristic analysis of Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, the area under the curve was found to be 0.916. The cut-off score was calculated as 9 of 10 with a sensitivity of 85.2% and specificity of 89.7%. CONCLUSION: Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 is a valid and reliable self-report measure to assess and screen attention-deficit hyperactivity disorder in the Turkish population. It may be useful for both clinical and population studies.

[Optical Coherence Tomography Findings in Cannabis Users]. / Kannabis Kullanan Olgularda Optik Koherens Tomografi Bulgulari.

OBJECTIVE: In this study, we aimed to evaluate the effects of cannabis use on the retinal nerve fiber layer (RNFL) and the macular ganglion cell - inner plexiform layer GCL-IPL using optical coherence tomography (OCT). METHOD: This prospective, comparative study included 26 cannabis users who were evaluated at the Psychiatry Outpatient Unit of Mus State Hospital and 27 age and gender matched healthy controls. OCT was performed on both groups. The RNFL and GCL - IPL thicknesses, measured automatically by OCT, were recorded and compared between the groups. RESULTS: The sociodemographic parameters of the two groups did not differ. The mean retinal nerve fiber thickness and thickness at the superior, nasal, inferior quadrants were not significantly different; but there was a significant difference at the temporal quadrant (p=0,022). In the analysis of macular ganglion cell - inner plexiform layer, the mean values as well as the infetotemporal, inferior, inferonasal and superonasal quadrants did not show significant differences. But there was a statistically significant decrease in the superior and superotemporal quadrants (p=0,006, p=0,027). CONCLUSION: These findings suggest that cannabis use leads to the thinning on retinal layers. As it is an easily observable part of the brain, evaluating retinal nerve fiber and ganglion cell layer with OCT may be important for monitoring toxic and degenerative effects in cannabis users.

The relationship between hyperemesis gravidarum and maternal psychiatric well-being during and after pregnancy: controlled study.

OBJECTIVE: Psychiatric symptoms of varying degrees that accompany hyperemesis gravidarum (HG) may continue throughout the pregnancy or after, and these psychological problems may cause morbidity. In this study, we aimed to evaluate the relationship between the HG and psychiatric symptoms in the first trimester and postpartum depression. METHODS: Two hundred and seven pregnant who were diagnosed as HG and 177 healthy pregnant women included in this prospective study. All cases were assessed with SCL-90-R in first trimester and with ED in postpartum period. Factors related to postpartum psychiatric symptoms were investigated with bivariate logistic regression analysis. RESULTS: SCL-90-R and ED scores were statistically significant at HG group (p < 0.05). In cases who diagnosed as postpartum depression, the rates of HG and SCL-90-R results were higher (p< 0.05). In the bivariate analysis, the high rates of HG and high SCL-90-R scores were determined to be related to postpartum depression (p < 0.05). CONCLUSIONS: The results show that mental health is negatively affected by HG at pregnancy, and in this case, psychiatric symptoms may continue even after discontinuation HG.

[Deleterious Results of Safety Seeking Behaviours in Panic Disorder: Polydipsia and Diabetes Mellitus Type 2]. / Panik Bozuklugunda Güvenlik Saglama Davranislarinin Medikal Sonuçlari: Polidipsi ve Tip 2 Diabetes Mellitus.

Panic disorder is an anxiety disorder that involves recurrent panic attacks, which emerge when a harmless stimulus is interpreted as "catastrophic". In an attempt to avoid the panic attack or prevent confrontation, the patient exhibits a dysfunctional attitude and behavior, such as evasion and safety-seeking behavior (SSB). Dysfunctional behavior leads to an increase in the recurrence of panic attacks and affects the patient's life in a negative way. According to the cognitive behavioral therapy model, SSB contributes to the continuation of unrealistic beliefs (e.g. physical experiences) regarding and prevents the patient from grasping new information that may potentially contradict the unrealistic cognitions. In this paper, we present a case with a primary diagnosis of panic disorder. Interestingly, this patient developed diabetes mellitus (DM) type 2 and psychogenic polydipsia (PPD) as a consequence of his SSB. PPD is a common occurrence in patients with psychiatric disorders, especially in schizophrenia. Up to now, no case of a panic disorder with either DM or PPD has been reported in the literature. While it is accepted that major depression poses a risk for DM type 2, panic disorder may also increase this risk. Treatment of the panic disorder with cognitive behavioral therapy (CBT) resulted in improvement of PPD and DM type 2. In conclusion, the role of SSB in medical disorders accompanied by psychiatric disorders should be kept in mind when treating these patients.