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Caner Ye&scedil;ilo&gbreve;lu,1 Lut Tamam,2 Mehmet Emin Demirkol,2 Zeynep Naml&inodot;,2 Mahmut Onur Karaytu&gbreve;2 1Department of Psychiatry, K&inodot;r&scedil;ehir Training and Research Hospital, K&inodot;r&scedil;ehir, Turkey; 2Department of Psychiatry, Çukurova University, School of Medicine, Adana, TurkeyCorrespondence: Mehmet Emin Demirkol, Department of Psychiatry, Çukurova University, School of Medicine, Adana, Turkey, Email emindemirkol@gmail.comPurpose: Patients with major depressive disorder (MDD) may experience more frequent and severe psychological and physical pain complaints compared to those without depression. As the tolerance to psychological pain decreases in patients with MDD, the severity of suicidal ideation tends to increase. Furthermore, the tolerance for physical pain (TPP) has been related with suicidal behavior. We aimed to demonstrate the impact of TPP on suicidal ideation in patients with MDD in the presence of psychological pain.Patients and Methods: We included 123 patients with MDD and 114 healthy volunteers who had no previous psychiatric diagnosis. Sociodemographic data form, Psychache Scale (PS) and Tolerance for Mental Pain Scale (TMPS) were used to assess psychological pain. Beck Scale for Suicide Ideation (BSIS) and Beck Depression Inventory (BDI) were administered to participants. To assess the TPP, we used a device based on the principle of electronic dynamometry.Results: The mean BDI, BSIS, PS, and TPP scores in the MDD group were higher, and the mean TMPS score was lower than those in the control group (p < 0.001 for each, p = 0.03 for TPP). We found statistically significant correlations between BDI, TMPS, BSIS, PS, and TPP scores (p < 0.05 for each). TPP was a partial mediator in the relationship between TMPS and BSIS scores (β = − 1.814; p < 0.001).Conclusion: We found that tolerance of psychological pain was a strong predictor of suicidal ideation, and TPP was mediating this relationship. These findings suggest that considering both tolerance to psychological pain and TPP may be beneficial when assessing the risk of suicide in individuals with MDD.Keywords: depression, tolerance of psychological pain, tolerance of physical pain, psychache, suicide

Mahmut Onur Karaytu&gbreve;,1 Lut Tamam,1 Mehmet Emin Demirkol,1 Zeynep Naml&inodot;,1 Mahmut Gürbüz,2 Caner Ye&scedil;ilo&gbreve;lu3 1Department of Psychiatry, Faculty of Medicine, Çukurova University, Adana, Turkey; 2Clinic for Psychiatry and Psychotherapy, St. Elisabeth Hospital, Gelsenkirchen, Nordrhein Westfalen, Germany; 3Department of Psychiatry, Ahi Evran University, K&inodot;r&scedil;ehir, TurkeyCorrespondence: Mehmet Emin Demirkol, Mahmut Onur Karaytu&gbreve;, Faculty of Medicine, Çukurova University, Balcal&inodot; Campus, Sar&inodot;çam, Adana, 01330, Turkey, Tel +90 322 338 60 60, Fax +90 322 338 65 72, Email emindemirkol@gmail.com; mokaraytug@gmail.comBackground: Childhood trauma and anxiety disorders are common in individuals with schizophrenia. This study aimed to investigate the effects of childhood trauma and adult separation anxiety disorder on the quality of life of individuals with schizophrenia.Methods: This cross-sectional study included 111 individuals with schizophrenia and 85 control subjects. The separation anxiety symptom inventory (SASI), adult separation anxiety questionnaire (ASAQ), Positive and Negative Syndrome Scale (PANSS), childhood trauma questionnaire (CTQ), and World Health Organization quality of life questionnaire (WHOQoL-BREF) were administered to the participants.Results: More individuals with schizophrenia than control subjects were unemployed and single (p< 0.05). Individuals with schizophrenia scored significantly higher on the SASI, ASAQ, and CTQ (p< 0.05), whereas the control subjects scored significantly higher on the WHOQoL-BREF (p< 0.05). ASAQ scores had mild positive correlations with total PANSS and PANSS subscale scores, and moderate positive correlations with total CTQ, CTQ emotional subscale scores, and CTQ physical abuse subscale scores. A negative moderate correlation was found between ASAQ and total WHOQoL-BREF scores. Mediation analysis revealed that CTQ scores significantly affected total WHOQoL-BREF and ASAQ scores. The model pathway for ASAQ scores showed a significant direct and indirect effect of CTQ on the total WHOQoL-BREF scores.Conclusion: Childhood trauma predicts adult separation anxiety disorder, which partially mediates the impact of childhood trauma on quality of life in individuals with schizophrenia. Therapeutic interventions for adult separation anxiety disorder in individuals with schizophrenia and a history of childhood trauma may help increase their quality of life.Keywords: schizophrenia, adult separation anxiety disorder, childhood trauma, quality of life

Mehmet Emin Demirkol,1 Zeynep Namlı,1 Özge Eriş Davul,2 Mahmut Onur Karaytuğ,3 Lut Tamam,1 Hamdi Yılmaz1 1Deparment of Psychiatry, Çukurova University School of Medicine, Adana, Turkey; 2Department of Psychiatry, Hatay State Hospital, Hatay, Turkey; 3Department of Psychiatry, Dr Ekrem Tok Hospital for Mental and Nervous Disease, Adana, TurkeyCorrespondence: Lut Tamam; Mehmet Emin DemirkolDepartment of Psychiatry, Çukurova University School of Medicine, Adana, TurkeyTel + 90 533 6306006; +90 535 5849684Fax +90 322 3386204Email ltamam@gmail.com; emindemirkol@gmail.comPurpose: Suicide is an important cause of death in patients diagnosed with obsessive-compulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psychological pain (also known as psychache) on suicide has been shown in various disorders but has not been investigated in patients with OCD. In this study, we aimed to show the relationship between psychological pain and other clinical variables and suicide in OCD patients.Patients and methods: This cross-sectional study consisted of 67 patients diagnosed with OCD according to DSM-5 criteria with no comorbid psychiatric diagnosis who applied to the psychiatric outpatient clinic of Çukurova University Faculty of Medicine and 63 healthy controls. Among the OCD patients, 12 had previous suicide attempts. In addition to the sociodemographic data form, participants filled out the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Psychache Scale (PS), the Beck Scale for Suicidal Ideation (BSIS), and the Hamilton Depression Scale (HDS).Results: OCD group’s median obsession, compulsion, and the total scores of YBOCS, and the mean PS scores were higher than the control group. There was no difference between the sociodemographic variables of OCD patients with and without previous suicide attempts such as age, gender, years of education, place of residence, marital, and occupational status. The median scores of obsession, avoidance, global severity, and indecisiveness subdimensions of YBOCS, the mean BSIS and PS scores, the rates of current aggressive, current contamination, and the past religious obsessions were higher in the suicidal group. There were moderately significant relationships in the same direction between the PS, BSIS, and total YBOCS scores. Multivariate regression analysis demonstrated that only the PS scores predicted previous suicide attempts.Conclusion: Our results demonstrated that current aggressive, current contamination, past religious obsessions, and the higher psychological pain are related to previous suicide attempts in OCD patients. Our regression analysis supports Shneidman’s hypothesis: there would be no suicide without psychache. Relieving psychache in OCD patients may reduce suicide attempts even if there is no diagnosis of comorbid depression.Keywords: obsessive compulsive disorder, suicide, psychological pain, psychache

Suicide is a leading cause of death and disability worldwide. Psychache (psychological pain) and diminished tolerance of psychaches are important risk factors for suicide. People experiencing psychaches of similar severity may not demonstrate the same levels of tolerance because of various coping skills. This study aimed to determine the relationship between psychache, tolerance for psychache, and coping skills in individuals with depression and healthy controls. We included 73 patients with depressive disorders without comorbid mental disorders and 65 healthy controls. We applied beck depression inventory, beck hopelessness scale, beck suicidal ideation scale, psychache scale, tolerance for mental pain scale (TMPS), and coping attitudes evaluation scale (COPE) to all participants. People with depression had significantly higher COPE dysfunction scores than those in the control group did. Patients who had previously attempted suicide attempt(s) previously had significantly higher beck hopelessness scale, beck depression inventory, COPE dysfunction, and psychache scale scores, and lower TMPS-10 scores than those who did not attempt suicide. Mediation analyses revealed that dysfunctional coping skills played a partial mediating role in the relationship between psychache and the TMPS. The study revealed that dysfunctional coping skills were related to suicidal ideation and previous suicide attempts. These findings suggest that improving coping skills could help reduce the severity of suicidal ideation., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

(1) Background: Spouses of individuals with bipolar disorder (BD) experience significant burdens, and the perception of the burden may affect dyadic adjustment. We aimed to investigate the sexual functions, alexithymic traits, marital satisfaction, and burden in patients with BD and their spouses. We also aimed to assess the mediating role of sexual functions and alexithymia in the relationship between burden and dyadic adjustment. (2) Methods: We included 81 patients with BD type 1 (40.69 ± 8.55 years, 65.4% female, and 34.6% male) and their healthy spouses (40.95 ± 7.30 years, 34.6% female, and 65.4% male) and 78 healthy controls (38.90 ± 5.88, 48.7% female, and 51.3% male). The participants were evaluated using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), Dyadic Adjustment Scale (DAS), Hamilton Depression Rating Scale (HDRS), Toronto Alexithymia Scale-20 (TAS-20), and Burden Assessment Scale (BAS). (3) Results: The GRISS scores of the control group were significantly lower than the spouses and BD groups. The DAS total score of the control group was significantly higher than that of the spouses and BD groups. Regression analyses revealed that TAS, GRISS, and HDRS scores were associated with DAS scores in the BD group. In the spouse group, TAS and BAS scores were associated with DAS scores. The GRISS scores partially mediated the relationship between dyadic adjustment and burden in the spouses of patients with BD. (4) Conclusions: Mental health professionals should regularly scan caregivers' perceptions of burden. Appropriate psychosocial interventions could help spouses of patients with BD to cope better with the burden and improve dyadic adjustment.

(1) Background: Suicide in patients with bipolar disorder (BD) is related to the chronotype of the person from a biological perspective. However, it is not known whether there is a relationship between suicide and psychological time in BD. The aim of our study was to evaluate the relationship between time perspective (TP) and suicide and the effect of TP on the relationship between suicide and chronotype in euthymic patients with BD. (2) Methods: We included 150 BD patients and 84 healthy controls in this cross-sectional study. We administered the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Beck Scale for Suicidal Ideation (BSSI), Zimbardo Time Perspective Inventory (ZTPI), and Morning−Evening Questionnaire (MEQ). (3) Results: There was a statistically significant difference between the median scores of past negative TP, present fatalistic TP, future TP, and MEQ total score (p < 0.001, p < 0.001, p = 0.010, and p = 0.020, respectively). There was a significant correlation between past negative TP, future TP, MEQ scores, and BSSI scores in the patient group (p < 0.001, p = 0.018, and p = 0.028, respectively). An inverse and significant relationship between the MEQ total score and BSSI score and TP types had a mediator role in this relationship. (4) Conclusions: Our study shows that TP, which evaluates time from a psychological perspective, has a direct relationship with suicidal ideation and a mediating role in the relationship between chronotype and suicide. According to our results, we can conclude that ZTPI can also be used to evaluate the risk of suicidality in patients with BD. Appropriate therapy methods for TP may help to prevent some suicide attempts.