INTRODUCTION: Alcohol Use Disorder (AUD) is a long-term mental health condition marked by alcohol use that is hard to regulate and accompanied by persistent cravings, both of which contribute to increased addiction severity and relapse risk. Psychological flexibility, a critical component of Acceptance and Commitment Therapy (ACT), has been shown to help individuals tolerate cravings without resorting to substance use.
METHODS: This study investigated the hypothesis that psychological flexibility serves as a mediator in the relationship between alcohol craving and addiction severity in individuals with AUD. The sample consisted of 86 individuals diagnosed with AUD who completed the Penn Alcohol Craving Scale, the Acceptance and Action Questionnaire–Substance Abuse, and the Addiction Profile Index. The potential mediating effect of psychological flexibility was analyzed using a mediation model.
RESULTS: Craving was positively correlated with addiction severity and negatively correlated with psychological flexibility. Psychological flexibility significantly predicted lower addiction severity and partially mediated the relationship between craving and addiction severity, accounting for 29% of the total effect.
DISCUSSION AND CONCLUSION: The findings indicate that psychological flexibility plays a mitigating role in the relationship between craving and addiction severity in AUD. The effectiveness of psychosocial interventions, particularly ACT-based treatments, may be enhanced by targeting psychological flexibility. Further longitudinal and multicenter studies are warranted to confirm these mechanisms and inform clinical practice.

INTRODUCTION: To evaluate the quality of life and anxiety levels of parents of children diagnosed with anorectal malformation (ARM) and to examine the effect of psychodrama group therapy on anxiety levels.
METHODS: The study was conducted with parents who attended a family meeting with anorectal malformation specialists organized in collaboration with the Izmir University of Economics Faculty of Medicine. Participants initially completed a demographic information form, the Hamilton Anxiety Scale (HAM-A), and the EUROHIS Quality of Life Scale. This was followed by a single, 3-hour structured psychodrama group therapy session. Following the psychodrama, participants were re-administered the HAM-A. Data were analyzed using the Wilcoxon signed-rank test and Spearman correlation analysis.
RESULTS: Twenty-two parents (11 male, 11 female) participated in the study. The mean age of the participants was 35.2 ± 11.7 (19-65). A statistically significant difference was found between pre- and post-psychodrama anxiety levels (p<0.05). Additionally, a moderate, negative, and significant correlation was found between EUROHIS quality of life scores and pre- and post-test HAM-A anxiety levels (r=-0.53; p<0.05; r=-0.57, p<0.05, respectively).
DISCUSSION AND CONCLUSION: Psychodrama group therapy was effective in reducing anxiety levels in parents of children with ARM, demonstrating a significant relationship between anxiety levels and quality of life. These findings suggest that psychodrama may be a feasible and useful intervention method for this specific group.

INTRODUCTION: Delay-related processes refer to individuals’ affective, cognitive, and behavioral responses to waiting situations, often characterized by impatience, frustration, and a preference for immediate rewards. The aim of this study was to evaluate the Turkish version’s validity and reliability of the Quick Delay Questionnaire for Adults (QDQ-A), a self-report tool developed to assess delay-related characteristics in adults with ADHD.
METHODS: The study included 109 adults diagnosed with ADHD (mean age = 26.30 ± 7.19) and 79 controls (mean age = 29.85 ± 6.95). Participants completed the Adult ADHD Self-Report Scale (ASRS), the Hospital Anxiety and Depression Scale (HADS), and the QDQ-A.
RESULTS: Confirmatory factor analysis revealed a two-factor structure consistent with the original version; delay aversion and delay discounting. Cronbach’s alpha coefficients indicated good internal consistency: .85 for the delay aversion subscale and.70 for the delay discounting subscale. Test–retest analysis demonstrated acceptable reliability (p <.001). Within the ADHD group, QDQ-A subscale scores were positively correlated with ASRS subscales, a weak but statistically significant correlation was observed between the delay discounting subscale and HADS depression scores (ρ =.193, p =.045).
DISCUSSION AND CONCLUSION: The present findings support the Turkish version of the QDQ-A as a valid and reliable tool for use in adult populations.

INTRODUCTION: Sedative psychotropic medications, such as olanzapine, quetiapine, mirtazapine, and trazodone, are commonly used in hospitalized patients to manage psychiatric symptoms, such as insomnia, restlessness, and agitation. Despite their widespread use, data on their short-term effects on vital signs in medically complex patients are limited. Understanding these effects is crucial for optimizing patient safety in acute care settings. This retrospective cohort study aimed to assess the effect of olanzapine, quetiapine, mirtazapine, and trazodone on vital signs (systolic and diastolic blood pressure, heart rate, oxygen saturation, and body temperature) in non-ıntensive care unit hospitalized patients.
METHODS: Among 871 screened consultation episodes, 184 patients met eligibility criteria and were included in the final analysis. Vital signs were collected at six standardized time points, 24 h before and after medication initiation. Linear mixed-effects models with subject-specific random intercepts were used to examine the treatment group, phase (pre–post), time of the day, and group-by-phase interactions. Multiple tests across the five primary phase effects were conducted using the Holm correction.
RESULTS: Across all vital sign outcomes, fixed-effect estimates were small and indicated minimal physiological change. Heart rate showed a modest unadjusted decrease from pre- to post-exposure (β = −1.72 beats/min, 95% CI −3.11 to −0.33; p =.017); however, this association did not remain statistically significant after adjustment for multiple comparisons (Holm-adjusted p =.083). No statistically significant phase effects or group-by-phase interaction effects were observed for systolic blood pressure, diastolic blood pressure, or oxygen saturation.
DISCUSSION AND CONCLUSION: In this medically complex inpatient cohort, commonly used sedative psychotropic agents (olanzapine, quetiapine, mirtazapine, and trazodone) did not produce clinically meaningful short-term changes in the vital signs.These findings support the cautious but routine use of these agents in inpatients, with standard monitoring. Further prospective studies are recommended to explore the long-term outcomes and potential drug interactions.

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by executive dysfunction, particularly in working memory, inhibitory control, and attention. Anxiety disorders frequently co-occur with ADHD and may exacerbate or obscure these deficits. This study aimed to retrospectively evaluate neuropsychological test performance in ADHD with and without comorbid anxiety.
METHODS: This retrospective, cross-sectional study was conducted at the Child and Adolescent Psychiatry Outpatient Clinic of Kartal Dr Lutfi Kirdar City Hospital. Clinical records of patientspatients aged 6–18 years presenting with inattention between January 2023 and April 2024 were reviewed. Performance on the Stroop Color–Word Test, d2 Test of Attention, Digit Span, and Porteus Maze Test was analyzed. Participants were categorized into six groups based on DSM-5 diagnoses: ADHD, ADHD + anxiety, ADHD + other diagnoses, anxiety only, other psychiatric diagnoses, and non-diagnosed.
RESULTS: A total of 159 participants (53.5% male; mean age = 14.07±2.42 years) were included. Digit Span scores were significantly higher in the non-diagnosed group compared with all diagnostic groups (p<0.01). d2 error rates were highest in the ADHD group (p<0.01). Stroop 4, Stroop 5, and total completion times were significantly longer in the ADHD and ADHD + anxiety groups (p<0.01). Stroop correction scores were elevated in ADHD groups.
DISCUSSION AND CONCLUSION: Findings confirmed impairments in working memory, selective attention, and processing speed in ADHD and comorbid groups. Anxiety did not exert a protective effect on inhibitory control but appeared to impose additional burden on working memory. These results underscore the importance of considering anxiety when assessing executive dysfunction in ADHD.

Esketamine is a glutamatergic treatment option for major depressive disorder, particularly treatment-resistant depression, because of its rapid antidepressant effects. However, the expanding meta-analytic literature is characterized by methodological heterogeneity and partial overlap of primary trials, which complicates the clinical interpretation of efficacy and safety findings. A higher-level synthesis is therefore needed to contextualize the existing evidence.
We conducted an umbrella review of published meta-analyses evaluating the efficacy and/or safety of esketamine in adults with MDD. PubMed/MEDLINE and Scopus were searched for meta-analyses published between December 2020 and December 2025. Given overlap of primary trials and heterogeneity in outcome definitions, findings were synthesized qualitatively. Outcomes included depressive symptom severity, response and remission rates, suicidality-related outcomes, relapse and maintenance effects, and safety and tolerability.
Twenty-nine meta-analyses were included. Esketamine was associated with reductions in depressive symptom severity compared with placebo, with effects most pronounced at very early post-administration time points (hours to days). Reported effect sizes were generally small to moderate. Response and remission rates were higher in the acute phase, particularly at early assessments. Outcomes related to suicidal ideation were examined in a limited number of meta-analyses and were largely confined to acute post-dose evaluations. Relapse prevention and maintenance effects were reported in few meta-analyses and were mainly based on similar continuation-phase trials. Esketamine was associated with higher rates of non-serious adverse events, most commonly dissociation, dizziness, sedation, and gastrointestinal symptoms, while serious adverse events and all-cause discontinuation were not consistently increased.
At the meta-analytic level, intranasal esketamine is associated with a rapid-onset antidepressant effect of modest magnitude that appears time-sensitive. Current evidence suggests that esketamine may be considered as an adjunctive option for early symptomatic relief in selected patients. However, evidence regarding long-term effectiveness, relapse prevention, and effects on suicidal ideation remains limited. Further independently funded studies with long-term outcomes are needed to better define its clinical role.

Methylphenidate is the first-line pharmacological agent used in the treatment of children with Autism Spectrum Disorder (ASD) and comorbid Attention-Deficit Hyperactivity Disorder (ADHD); however, it may rarely cause movement disorders. This case report presents a 9-year-old male patient who developed acute orofacial and limb dyskinesia following the initiation of high-dose modified-release methylphenidate, four weeks after the abrupt discontinuation of aripiprazole treatment. The dyskinesia completely regressed upon cessation of the stimulant therapy and did not recur during subsequent gradual dose titration. The case is discussed in the context of the hypothesis that dopaminergic hypersensitivity resulting from antipsychotic withdrawal may lower the threshold for stimulant-induced dyskinesia. Furthermore, the importance of careful dose titration and close clinical monitoring when re-initiating stimulant therapy is emphasized, particularly in patients with neurodevelopmental disorders who have a history of recent antipsychotic discontinuation.

Attention deficit hyperactivity disorder (ADHD) is a well-established risk factor for suicidal ideation, suicide attempts, and completed suicide. Methylphenidate, a first-line pharmacological treatment for ADHD, is being increasingly prescribed. Given the rising rates of methylphenidate use and the high prevalence of suicide among individuals with ADHD, it is anticipated that clinicians will increasingly encounter suicide attempts involving this easily accessible medication. However, there are limited case reports of suicide attempts involving methylphenidate in individuals with ADHD. In this case report, we present a comprehensive biopsychosocial evaluation of a 14-year-old adolescent girl with ADHD who attempted suicide by taking 900 mg of long-acting methylphenidate, while discussing potential underlying mechanisms and risk factors for suicidality. We also addressed the clinical management of high-dose methylphenidate ingestion in children and adolescents, a topic for which the literature provides limited guidance. This case highlights several risk factors for suicidal behavior in adolescents, including untreated ADHD, comorbid psychiatric disorder, dysfunctional family dynamics, emotional dysregulation, impulsivity, social stressors, academic difficulties, family history of suicide and inadequate coping mechanisms. Our findings emphasize the importance of sustained ADHD treatment, routine suicidality screening in adolescents with ADHD and providing psychoeducation for families. Suicidal behavior is a complex and multifactorial process shaped by the interaction of biological, psychological, and environmental factors. A multidisciplinary approach grounded in the biopsychosocial model is essential for effective assessment and intervention.