Difference in Laterality of the Dorsal Striatum in Schizoaffective Disorder.

BACKGROUND: Recent research has demonstrated that the dorsal striatum is directly associated with the integration of cognitive, sensory-motor, and motivational/emotional data. Disruptions in the corticostriatal circuit have been implicated in the pathophysiology of psychosis. The dorsal striatum was reported to show lateralized pathology in psychotic disorders. In this study, we aimed to analyze the laterality of the dorsal striatum with texture analysis of T2-weighted magnetic resonance imaging (MRI) images from schizoaffective disorder (SAD) patients. METHODS: Twenty SAD patients, met the inclusion criteria and had available cranial MRI data were assigned as the patient group. Twenty healthy individuals were determined as the control group. Texture analysis values were obtained from striatum region of interests (ROI) generated from T2-weighted MRI images. Data are presented as mean and standard deviation. The suitability of the data for normal distribution was analyzed with the Kolmogorov-Smirnov test. Analysis of variance (ANOVA) test (Post Hoc TUKEY) was employed to compare the group data based on test findings. RESULTS: There was no significant difference between the groups in terms of gender and age. There were differences in the values of texture analysis parameters of both caudate and putamen nuclei in comparison to controls. We identified differences in the left dorsal striatum nuclei in SAD. The differences in the putamen were more and more pronounced than in the caudate. CONCLUSIONS: Texture analyses suggest that the left dorsal striatum nuclei may be different in SAD patients. Further studies are needed to determine the pathophysiology of SAD and how it may affect disease treatment.

Is the Caudate, Putamen, and Globus Pallidus the Delusional Disorder's Trio? A Texture Analysis Study.

BACKGROUND: The neurobiological basis of delusional disorder is less explored through neuroimaging techniques than in other psychotic disorders. This study aims to provide information about the neural origins of delusional disorder (DD) by examining the neuroanatomical features of some basal nuclei with magnetic resonance imaging (MRI) texture analysis. MATERIALS AND METHODS: Twenty DD patients and 20 healthy individuals were included in the study. Globus pallidus, putamen, and caudate nuclei were selected individually with a region of interest (ROI) on the axial MRI images. The entire texture analysis algorithm applied to all selected ROIs was done with an in-house software. Nuclei on both sides were taken as separate samples. RESULTS: There were no significant differences between groups in terms of age and gender. The average "mean, median and maximum" values of all three nuclei were decreased in DD patients. The small putamen area and the differences detected in different tissue parameters for all three nuclei in delusional disorder patients indicate that they differ in delusional disorder from normal controls (p < 0.05). CONCLUSION: The differences detected in the texture parameters for all three nuclei indicate that there is something different in the DD from in the normal controls. Neuroimaging studies with larger samples and different techniques in the future may shed light on the etiology of delusional disorder.

Association between non-penetrative sexual activities and depression in women with vaginismus: a cross-sectional study.

OBJECTIVE: This cross-sectional study aimed to explore the association between non-penetrative sexual activities (NPSA) and depression levels in women diagnosed with vaginismus. METHODS: A cross-sectional retrospective study was conducted between March 2016 and June 2019, after approval by the Firat University Faculty of Medicine ethics committee. Participants comprised married women referred to our female sexual dysfunction outpatient clinic with vaginismus. Diagnosis of vaginismus was established following comprehensive evaluations, including gynecological examination and psychiatric assessment. Sociodemographic data and Beck Depression Inventory (BDI) scores were collected. We compared depression levels between women who engaged in NPSA and those who did not. RESULTS: Of the 75 women with primary vaginismus included in the study, 18 did not engage in any NPSA and 57 engaged in at least one NPSA. The average BDI score of those who engaged in NPSA was significantly lower than those who did not. A negative correlation was found between the number of NPSA engaged in and BDI scores (r = -0.494). CONCLUSIONS: Women with vaginismus had high depression scores, but engaging in NPSA was associated with lower depression levels. The findings suggest that incorporating NPSA into clinical interventions may be beneficial for managing depression in women with vaginismus.

Retinal changes in generalized anxiety disorder patients.

OBJECTIVE: Optical coherence tomography (OCT) is a method that allows high-resolution cross-sectional imaging of biological tissues. It was suggested that changes in the cranial structure or functions would be reflected in the retina. OCT has been an important method in the diagnosis and follow-up of diseases via morphometric or quantitative retinal measurements. Free radicals, inflammatory processes, and neurotransmission disorders play a role in the etiology of generalized anxiety disorder (GAD). The study aimed to demonstrate the retinal changes in GAD patients due to neurodegeneration based on the comparison of the OCT data of the GAD patients and controls, and the differences between OCT findings of GAD patients and those of controls. METHODS: The study group included 21 GAD patients. The control group included 21 individuals without any known psychiatric or organic disease, including eye diseases. RESULTS: There was a statistically significant difference between the macular volumes (MV) of the GAD and control groups, the macular volume was lower in the GAD group. There were positive correlations between BDI scores and MV, GCLT, RNFLT-i, RNFLT-n, between BAE scores and (RNFLT-n), and between the CGI severity scale scores and MV, RNFLT-n, and RNFLT-t. CONCLUSION: OCT analysis of the GAD patients demonstrated that MV values were lower when compared to the control group. Patients with GAD should be screened for these retinal changes. OCT, a simple, non-invasive, and relatively inexpensive method could be employed as a supplementary method in the follow-up of GAD patients.

Statistical shape analysis of corpus callosum in delusional disorder.

Neurobiological foundations of delusional disorder (DD) have been studied less with neuroimaging techniques when compared to other psychotic disorders. The present study aimed to delineate the neural substrates of DD by investigating neuroanatomical characteristics of the corpus callosum (CC) with statistical shape analysis (SSA) conducted on magnetic resonance images (MRI). Twenty (female:male=1:1) DSM-5 DD patients and 20 age- and gender-matched healthy individuals were included. High-resolution 3D T1 Turbo Field Echo MRI images were scanned with a 1.5 T MR device. The landmarks that were selected to determine the shape differences in CC were identified based on previous studies. Furthermore, constructed landmarks were determined and employed to better assess regional shape differences. There was no significant difference in the CC area in the mid-sagittal images between the DD patients and controls. However, DD patients exhibited a pattern of structural CC changes in various regions. The study findings emphasizes the variable subregional nature of CC in DD patients. Future SSA studies with larger samples could shed further light on DD etiology, diagnosis, classification and treatment options.

Cortical Thickness of the Orbitofrontal Cortex in Patients with Alcohol Use Disorder.

AIMS: In the present study, it was hypothesised that compared to healthy control subjects, significant differences in the cortical thickness of the orbitofrontal cortex (OFC) region of the brain, which is relevant to both impulsivity and decision making, would be identified. METHODS: The subject groups included in the study were composed of 15 individuals who met the criteria for alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 (SCID), and were admitted to the Firat University School of Medicine Department of Psychiatry or were hospitalised, and 17 healthy control comparisons were made. The volumes of and cortical thickness of the OFC were measured in the subjects. RESULTS: It was found that patients with alcohol use disorder had reduced volumes of the OFC bilaterally and a thinner cortical thickness of the same region bilaterally compared to those of the healthy control comparisons. CONCLUSIONS: Consequently, it is suggested that the OFC region of the brain appears to be statistically significantly smaller in patients with alcohol use disorder, both in terms of cortical thickness and volume, compared to healthy controls. Future research should focus on the status of these relationships longitudinally and should assess the causality of the association with the treatment response.

Pituitary Volumes Are Reduced in Patients With Alcohol Use Disorder.

AIMS: To determine whether there is a difference in pituitary gland volumes in patients with alcohol use disorder compared to healthy people. METHODS: The subjects included in the study consisted of 15 individuals who met the criteria for alcohol use disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 and were admitted to Firat University School of Medicine, Department of Psychiatry, or were hospitalized, and 17 healthy controls. The volumes of pituitary were measured in subjects. RESULTS: Absolute pituitary gland volumes of patients with alcohol use disorder and healthy controls were compared in the analysis performed using the independent samples t-test. The mean volume of the patient group was significantly smaller than the healthy controls (58.02 ± 7.24 mm3 in patients with alcohol use disorder vs. 83.08 ± 12.11 mm3, P < 0.01), a difference which persisted after controlling for age, gender and total brain size. CONCLUSIONS: Patients with alcohol use disorder in this study had smaller pituitary gland volumes compared to those of healthy control subjects. However, this study has limitations including small sample size and not adjusting for previous or current medication use or current anxiety and depression.

Evaluation of Asymmetric Dimethylarginine, Malondialdehyde, and Vitamin Levels of Borderline Personality Disorder Patients With and Without Self-Mutilation.

OBJECTIVE: Believing that oxidative stress may be increased in borderline personality disorder (BPD) patients with self-mutilating behaviors (SMB), we aimed to measure serum asymmetric dimethylarginine (ADMA) and malondialdehyde (MDA) levels in these patients. METHODS: The study included 60 patients diagnosed with BPD and 30 healthy controls. BPD patients were divided into two groups: 30 female patients with SMB and 30 female patients with no-self-mutilating behavior (NSMB). ADMA, MDA, vitamin A, and vitamin E levels were analyzed. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were conducted with the participants. RESULTS: Serum ADMA and MDA levels were higher in SMB and NSMB group compared to control group. Serum vitamin E levels were also lower in the SMB group compared to the control group. Positive correlations were determined between both ADMA and MDA, and between BDI and BAI scores. Also, BAI scores were statistically higher in SMB group compared to NSMB group. CONCLUSION: It was discovered that levels of ADMA and MDA, which reflected oxidative stress, were elevated in patients with BPD who exhibited SMB. Accordingly, future studies should investigate the role of oxidative stress in a more comprehensive way in terms of the different mechanisms underlying and treatments involved in borderline personality disorder.

Thyroid functions in patients with hypochondriasis.

OBJECTIVE: No studies of thyroid-related hormone levels have been conducted in patients with hypochondriasis to date. The aim of this study is to examine thyroid-related hormones in patients with hypochondriasis. METHODS: Sixty patients with hypochondriasis and 138 healthy controls were included in this study. Patients with hypochondriasis who applied to the psychiatry outpatient clinic and met the study criteria and healthy controls were determined by chart analysis. RESULTS: According to the results of the comparisons, TSH, fT3, and fT4 levels did not show a statistically significant difference between hypochondriasis patients and healthy controls. CONCLUSION: Thyroid hormone levels are not associated with hypochondriasis.

Retinal Changes in Panic Disorder Patients.

AIM: Optical coherence tomography (OCT) is a novel method that allows high resolution cross-sectional imaging of biological tissues. It was suggested that changes in the cranial structure or functions would be reflected in the retina. OCT has been an important method in the diagnosis and follow-up of diseases via morphometric or quantitative retinal measurements. Panic disorder (PD) is an anxiety disorder, where free radicals, inflammatory processes and neurotransmitter transmission disorders play a role in the etiology. The present study aimed to demonstrate neurodegeneration in PD by the comparison of PD patient and control OCT data. MATERIAL AND METHOD: The study group included 21 PD patients who met the study criteria. The control group included 21 healthy individuals without any known psychiatric or organic disease, including eye disease, and gender-matched to the patient group. All participants underwent detailed psychiatric and eye examinations. Central macular thickness (CMT), macular volume (MV), mean and retinal nerve fiber layer thickness (RNFL), ganglion cell layer thickness (GCLT), and central choroidal thickness (CCT) were measured in both eyes of all participants with OCT. A sociodemographic data form, Clinical Global Impression Scale (CGIS), and Panic Disorder Severity Scale (PDSS) were administered to the participants. RESULTS: In the study, it was determined that the CMT values of the PD patients were lower when compared to the controls in the OCT examination. There was a statistically significant difference between the CMT of the PD patient group and the control group; the CMT was lower in the patient group. There were no significant differences between the groups based on GCLT, RNFL superior, RNFL inferior, RNFL nasal, RNFL temporal, and CCT. There was no significant correlation between CGIS, PDSS scores and OCT measurements. CONCLUSION: This is the first study in the literature where patients with a PD diagnosis were analyzed based on the OCT method. OCT, which is a simple, noninvasive and relatively inexpensive method that the patient could easily adapt to during imaging, could be employed as a supplementary method in the diagnosis and follow-up of PD patients.

Health Anxiety, Health Perception, and Healthy Lifestyle Behavior Among Psychiatric Patients During the COVID-19 Pandemic.

Objective: To compare the health anxiety and healthy lifestyle behavior experienced by psychiatric patients due to the coronavirus disease 2019 (COVID-19) pandemic with that of a control group.Methods: The study included 120 outpatients (aged 18-65 years) diagnosed with a psychiatric illness (DSM-5 criteria) who presented to a psychiatry outpatient clinic between June and August 2020. The control group included 120 healthy individuals with a similar age and sex distribution as the patient group. Data were collected with a questionnaire developed by the authors to determine the participants' adherence to COVID-19 hygiene rules and associated behavioral norms. The Health Anxiety Scale-Short Form, Health Perception Scale, and Health-Promoting Lifestyle Profile were completed by all participants.Results: The mean Health Anxiety Scale score was significantly lower in the patient group compared to the control group (P < .01). Health anxiety was high in 8% of the patients and 32% of the controls. Also, the mean Health-Promoting Lifestyle Profile score was statistically significantly lower in the patient group compared to the control group (P < .01). There was no significant difference between the groups based on health perception scores and adherence to hygiene rules.Conclusions: As expected, the healthy lifestyle behavior of individuals without psychiatric illness was higher compared to those with mental disorders. However, health anxiety about COVID-19 was higher among healthy individuals compared to those with a psychiatric disorder. Thus, it could be suggested that individuals without a psychiatric illness prior to the pandemic could need psychiatric assistance after the pandemic.

Evaluation of complete blood cell count parameters and lymphocyte-related ratios in patients with Opioid Use Disorder.

Complete blood count (CBC) parameters and lymphocyte-related ratios are found to be associated with inflammation and increased cytokine production. In Opioid Use Disorder (OUD), CBC parameters can be examined as the inflammatory (oxidative stress) biomarkers which could be used as an objective marker to support the OUD diagnosis and could be used as a disease severity marker. CBC parameters of 142 patients with OUD were examined. Lymphocytes, monocytes, basophiles, eosinophils and platelet counts (PLT), red blood cell levels (HGB), mean erythrocyte volume (MCV) and lymphocyte-related ratios were calculated. The control group consisted of 140 healthy individuals. WBC, neutrophil, lymphocyte, monocyte, platelet count, neutrophil, basophil percentage, neutrophil/ lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) values were significantly higher in OUD group. Lymphocyte, basophil percentage, basophile/lymphocyte ratio (BLR), red blood cell (RBC), hemoglobin were significantly higher in control group. Mean platelet volume (MPV), eosinophil/lymphocyte ratio (ELR), platelet/ lymphocyte ratio (PLR) values were not significant yet higher in the OUD group. CBC and related parameters (WBC, neutrophil, lymphocyte, monocyte, platelet count, neutrophil, basophil percentage, NLR, MLR) were found to be significantly higher in the OUD group. Evaluation of CBC parameters could be useful in treatment and follow-up of patients with OUD.

Texture analysis of dorsal striatum in functional neurological (conversion) disorder.

In this study, it was aimed to evaluate the dorsal striatum nuclei of patients diagnosed with Functional Neurological Disorder by texture analysis method from magnetic resonance imaging images and to compare them with healthy controls. Study groups consisted of 20 female patients and 20 healthy women. The brains of patients and controls were scanned for high-resolution images with a 1.5T scanner using the sagittal plane and 3D spiral fast spin echo sequence. Using the texture analysis method, mean, standard deviation, minimum, maximum, median, variance, entropy, size %L, size %U, size %M, kurtosis, skewness and homogeneity values of the dorsal striatum nuclei were calculated from the images. The data were compared with comparison tests according to Kolmogorov-Smirnov test results. There was no statistically significant difference between paired regions in terms of texture analysis findings in the cross-sectional images of the participants. In patients, mean, standard deviation, minimum, maximum, median, variance and entropy values for the putamen nucleus, and mean, standard deviation, minimum, maximum, median, variance, entropy and kurtosis values for the caudate nucleus were found significantly higher than controls. Additional receiver operating characteristic curve and logistic regression analyzes were performed. The implications of the results of the study are that there are significant microstructural changes in the dorsal striatum nuclei of patients and their reflection on brain images. Texture analysis is a useful technique to show tissue changes in the dorsal striatum of patients using images. It is highly recommended to use texture analysis to identify and evaluate potentially affected areas of the brain in new studies.

Suicidal Ideation, Self-esteem, and Hopelessness in Patients With Pulmonary Arterial Hypertension.

Objective: To investigate the frequency of suicidal ideation and its correlation with other clinical variables in patients with pulmonary arterial hypertension.Methods: Fifty patients with pulmonary arterial hypertension who presented to the cardiology department between 2018 and 2019 and 50 healthy controls were included in the study. A sociodemographic and clinical data form was completed by both the patients and controls, and the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSE), and Suicide Probability Scale (SPS) were administered. SPSS version 22 software was used in the statistical analysis.Results: The mean ± SD systolic pulmonary pressure of the patients was 47.48 ± 18.86 and the pulmonary artery pressure was 33.32 ± 19.69. BHS, BDI, and SPS total scores were statistically significantly higher in the patient group compared to the control group (P < .001, P = .001, P = .026, respectively). RSE scores were also higher in the patient group compared to the control group (P = .017).Conclusions: It is important to identify pulmonary arterial hypertension patients with intense feelings of hopelessness and depressive symptoms and to provide psychiatric treatment and psychotherapeutic interventions to improve their self-esteem.

1HMRS in the Hippocampus of the Female Patients with Conversion Disorder.

INTRODUCTION: Previously, we found a lower NAA (N-acetyl aspartate)/CRE (creatine) ratio in conversion disorder patients, when compared to healthy controls. In this context, the present study was designed to determine the changes in hippocampal NAA, CHO (choline), and CRE values in conversion disorder female patients, which has similar symptom basement and hypothesize that the patients with conversion disorder would have also changed neurochemicals in their hippocampal regions. METHOD: Twenty female patients and healthy controls were included in the study. Proton magnetic resonance spectroscopy (1HMRS) method was used to determine the NAA/CHO, NAA/CRE, and CHO/CRE ratios. RESULTS: The data were analyzed via age-controlled General Linear Model and it was found that the ratio of NAA/CHO was significantly lower in conversion disorder female patients when compared to healthy controls. However, NAA/CRE or CHO/CRE ratios were similar for conversion disorder patients and healthy controls. CONCLUSION: It was concluded that conversion disorder female patients might have reduced NAA/CHO ratio which implicates reduced neuronal viability, possibly related to anxiety and indirectly to somatoform symptoms.

Magnetic resonance imaging histogram analysis of corpus callosum in a functional neurological disorder

Background/aim: The aim of the present study was to examine and compare the corpus callosum (CC) via histogram analysis (HA) on T1-weighted MR images of patients diagnosed with Functional Neurological Disorder (FND) and healthy controls. Materials and methods: The study group included 19 female patients diagnosed with FND, and the control group included 20 healthy subjects. All participants were scanned with a 1.5 T MR scanner. A high-resolution structural image of the entire brain was obtained with sagittal 3D spiral fast spin echo T1-weighted images. Gray level intensity, standard deviation of the histogram, entropy, uniformity, skewness, and kurtosis values were determined with texture analysis. A student's t-test was used to compare the group data. P < 0.05 was accepted as statistically significant. Results: It was determined that the mean gray level intensity, standard deviation of the histogram, entropy calculated by the maximum, median and variance and size M percentage values were higher in patients with FND. Kurtosis and size U percentages values were lower in patients with FND. Conclusion: In the present study, analysis of CC with T1-weighted MR image HA demonstrated significant differences between FND patients and healthy controls. The study findings indicated that HA is a beneficial technique for demonstrating textural variations between the CCs of patients with FND and healthy controls using MR images.

Evaluation of arterial stiffness in patients with schizophrenia.

The aim of this study was to evaluate arterial stiffness in schizophrenia patients. 28 male patients were included. The intima-media thickness (IMT) of the vessels were taken using high-resolution ultrasonography system. The mean carotid IMT and the mean femoral IMT values of the study group were found to be statistically significantly higher than the values of the control group. As the duration of the disease increased, there was an increase in the carotid IMT, carotid elastic modulus and femoral IMT, whereas there was a decrease in carotid and femoral diastolic wall stress in patients. No statistically significant differences were observed between the groups' carotid and femoral compliance, distensibility and elastic modulus values. The mean systolic arterial blood pressure in the patient group was determined to be lower than that of the control group. The mean diastolic wall stress values in the carotid and femoral arteries were determined to be lower than those of the control group. There was no relationship between antipsychotic dose, blood pressure and arterial stiffness parameters. Schizophrenia patients are more prone to develop arterial stiffness by atherosclerosis either with the effect of the nature of the disease itself or antipsychotic treatment. But evaluation with more parameters (carotid and femoral compliance, distensibility and elastic modulus) did not indicate any difference from the control group in respect of arterial stiffness. Antipsychotic treatment may play a protective role in terms of arterial stiffness by causing a decrease in systolic arterial pressure and carotid and femoral diastolic wall stress.

The relationship between disease severity and defense mechanisms in fibromyalgia syndrome.

OBJECTIVES: The aim of the present study was to investigate the possible relationship between the disease severity and defense mechanisms in fibromyalgia syndrome (FMS) and to contribute to the clarification of the etiopathogenesis of FMS. PATIENTS AND METHODS: A total of 103 female patients (mean age: 42.6±10.0 years; range, 20 to 67 years) diagnosed with primary FMS based on the 2016 revised American College of Rheumatology (ACR) diagnostic criteria and without any psychiatric diagnosis were included in the study. A semi-structured sociodemographic and clinical data form was used. The Fibromyalgia Impact Questionnaire (FIQ), Defense Style Questionnaire-40 (DSQ-40), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied to all patients. Based on the FIQ scores, the patients were divided into two groups as mild-moderate (<70) and severe (≥70) FMS groups. RESULTS: There were 56 patients in the mild-moderate FMS group and 47 patients in the severe FMS group. As FIQ scores increased, sublimation (r=-0.204, p=0.030) and mature factor (r=-0.229, p=0.020) scores decreased, and projection (r=0.210, p=0.033) and somatization (r=0.287, p=0.003) scores increased. Pseudoaltruism (p=0.043), displacement (p=0.026), and somatization (p=0.021) scores were higher in the severe FMS group. The BDI and BAI scores were also higher in the severe FMS group, compared to the mild-moderate FMS group (p=0.001 and p=0.002, respectively). CONCLUSION: Our study results show that there is a significant correlation between the increased disease severity, decreased mature defense mechanisms, and increased immature defense mechanisms in FMS patients.

Self-Esteem and Defense Mechanisms in HIV-Positive and AIDS Patients.

Objective: To investigate the self-esteem and defense mechanisms in patients diagnosed with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Methods: This prospective, cross-sectional study included 29 patients diagnosed with HIV/AIDS admitted to inpatient or outpatient clinics between March 2018 and January 2019 and 29 healthy subjects. Participants were assessed using a sociodemographic and clinical data form, the Rosenberg Self-Esteem Inventory (RSEI), the Defense Style Questionnaire (DSQ), and the Beck Anxiety Inventory (BAI). Results: Patients with HIV/AIDS had significantly higher scores on the fantasy, psychosomatic symptoms, and parental interest subscales of the RSEI. There was no significant difference between the groups on the other subscales, including the self-esteem subscale. There was no correlation between the duration of the disease and self-esteem. The neurotic defense mechanism and immature defense mechanism subscale scores of the DSQ were significantly higher in the HIV/AIDS group compared to the control group (P < .01). Undoing and reaction formation scores in neurotic defense mechanisms and projection, devaluation, autistic fantasy, and splitting scores in immature defense mechanisms were significantly higher in the HIV/AIDS group compared to controls (P < .05). There was no significant difference between the groups based on the mature defense mechanisms subscale scores. Conclusions: No difference was found in the self-esteem scores of the HIV/AIDS and control groups, and this finding could be associated with the stability of the self-esteem concept. It was also determined that patient group members utilized neurotic and immature defense mechanisms more often compared to the healthy group, and there was no difference between the groups based on mature defense mechanisms.