Background: Bipolar disorder is a chronic psychiatric disorder with depression and manic episodes. It is one of the leading causes of disease-related disability worldwide. Despite the presence of various alternative drug options for bipolar disorder, some patients do not adequately benefit from the treatment. Therefore, possible underlying mechanisms need to be clarified. Recently, studies on the relationship between bipolar disorder and vitamin D (Vit D) have attracted attention. Although many studies have found an association between depression and Vit D deficiency, little is known about the relationship between manic episodes and Vit D. The aim of this study was to compare Vit D and related metabolites of bipolar manic episodes prior to treatment, bipolar remission after treatment, and healthy control groups. Methods: This case–control study consisted of 34 bipolar manic episode patients and 34 healthy controls. Disease activity was evaluated with the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Firstly, serum 25-hydroxy vitamin D (25-OHD), calcium (Ca) and phosphorus (P) levels of patients in the bipolar manic episode were measured and compared with healthy control. Secondly, serum 25-OHD, Ca and P levels in the euthymic periods of the same patients were measured and compared with healthy control. Results: Bipolar manic episode Vit D levels were lower when compared to healthy controls; while there was no difference in terms of Ca and P levels. There was no significant difference between the bipolar euthymic period patients and the healthy control group in terms of 25-OHD, Ca and P levels. Conclusion: Our results demonstrated low serum Vit D concentrations in the acute manic episode of bipolar disorder. Decreased Vit D level may play a role in the onset of the manic episode, or malnutrition and insufficient sunlight during the manic episode may have caused Vit D deficiency. Future studies are needed to exclude potential confounding factors and to compare all mood episodes.

In this study, the relationship was examined of adverse childhood experiences (ACEs) with difficulties in emotion regulation and symptom severity in individuals with social anxiety disorder (SAD). The study included 71 patients diagnosed with SAD and a healthy control group of 73 subjects. Data for all the participants were collected using a sociodemographic data form, the Liebowitz Social Anxiety Scale, the Adverse Childhood Experiences-Turkish Form scale, and the Difficulties in Emotion Regulation Scale-16. The study results showed a higher probability of ACEs and difficulties in emotion regulation in the SAD group than in the control group. The difficulties in emotion regulation in the SAD group were correlated with symptom severity and these difficulties were found to play a mediating role between trauma and symptom severity. It was emphasized that emotion regulation skills were an important factor in the treatment of SAD patients. It can be suggested that therapies and interventions to develop emotion regulation skills could be effective in the management of SAD symptoms. It was thus concluded that ACEs and difficulties in emotion regulation are associated with SAD symptoms and should be taken into consideration in treatment. This study emphasizes the importance of emotion regulation skills for SAD treatment and can be considered to be of guidance for future studies.

Myoclonus, characterized by sudden involuntary muscle contractions, can occur in a variety of conditions, including as a side effect of clozapine, which is used in the treatment-resistant schizophrenia. This case study describes a 48-year-old female patient who developed negative myoclonus, manifested by knee flexion and falls, after starting clozapine. Despite dose reduction and the addition of valproic acid, symptoms persisted, highlighting the dose-dependent nature of clozapine-induced myoclonus and the need for clinicians to recognise this risk.

Aims: Maladaptive daydreaming (MD) is a condition characterized by excessive and immersive daydreaming, often linked to psychological distress and behavioral difficulties. This research examines the correlation between MD, academic procrastination, and psychological distress among medical students. Methods: A cross-sectional study was conducted with medical students who completed self-report questionnaires, including the MD scale (MDS-16), the Depression, Anxiety, and Stress Scale (DASS-21), and the Tuckman Procrastination Scale (TPS). Pearson correlation and multiple regression analyses were performed to assess associations between MD, academic procrastination, and psychological distress. Results: The findings revealed a significant positive correlation between MD and academic procrastination (r=.181, p

Objective: Medication adherence is a critical determinant of treatment outcomes in psychiatric disorders,yet the underlying factors remain unclear. This study aimed to examine the role of verbal mental capacityand clinical variables in predicting medication adherence among psychiatric outpatients.Methods: A total of 67 patients (aged 18-60 years) were assessed using the Medication Adherence RatingScale (MARS), Beck Anxiety Inventory, Beck Depression Inventory, Liverpool University Neuroleptic SideEffect Rating Scale (LUNSERS), and the Turkish version of the National Adult Reading Test (NART-TR).Participants were categorized into good adherence (n=33) and poor adherence (n=34) groups based onMARS scores. Comparative analyses between these groups, as well as correlation and multiple regressionanalyses, were conducted.Results: Patients with poor adherence had significantly higher anxiety, depression, side effect scores,and NART-TR errors than patients with good adherence (P < .05). Correlation analysis revealed negativeassociations between MARS scores and anxiety, depression, side effects, and NART-TR errors. Regressionanalysis identified NART-TR errors (β=−.342, P=.009) and LUNSERS scores (β=−.512, P=.022) asindependent predictors of medication adherence.Conclusion: Verbal mental capacity and medication side effects emerged as critical determinants ofadherence in psychiatric patients. Incorporating cognitive screening tools like NART-TR into routinepractice may help identify individuals at risk of nonadherence and guide tailored interventions.Cite this article as: Bakay H, Karaagac M, Yaman NÖ, Gica S. Verbal mental capacity and medication adherence inpsychiatric outpatients: the impact of verbal cognitive reserve and side effects. Neuropsychiatr Invest. 2025, 63, 0045,doi:10.5152/NeuropsychiatricInvest.2025.25045.

Objective Family accommodation, in which relatives facilitate obsessive-compulsive symptoms, is highly prevalent in obsessive-compulsive disorder (OCD) and associated with poor treatment outcomes. Although neuroticism and maladaptive coping have been linked to OCD severity, the mechanisms by which personality traits relate to family accommodation remain poorly understood. This study examined associations between neuroticism, coping strategies, symptom severity, and family accommodation in OCD, and tested whether maladaptive coping mediates the neuroticism–family accommodation association.Methods We conducted a cross-sectional study with 149 adults diagnosed with OCD via the Structured Clinical Interview for DSM-5 at a university hospital outpatient clinic. Participants completed the Family Accommodation Scale–Patient Version, Yale-Brown Obsessive Compulsive Scale Self-Report, Big Five Inventory-44, and Brief COPE. Hierarchical regression and bootstrap-based mediation analyses (PROCESS Model 4; 5,000 bootstrap samples) were performed, controlling for age, sex, education, and symptom severity.Results OCD symptom severity (β=0.342, p<0.001) and maladaptive coping (β=0.347, p<0.001) were significantly associated with family accommodation, explaining 26.6% of its variance. Neuroticism was not directly associated with family accommodation; however, mediation analysis revealed a significant indirect association through maladaptive coping (B=0.189, 95% confidence interval [0.034 to 0.399]).Conclusion These cross-sectional findings suggest that maladaptive coping may represent a potential behavioral pathway linking neuroticism to family accommodation in OCD. While the findings provide a theoretical rationale for further investigating coping mechanisms, longitudinal and experimental studies are needed to determine whether interventions targeting maladaptive coping lead to reductions in family accommodation.