Bakırköy Psychiatric Hospital

Background/Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) shows substantial cognitive heterogeneity, complicating individualized clinical formulation. This study examined whether Cognitive Disengagement Syndrome (CDS), anxiety, and ADHD symptom severity are associated with memory functions and visuospatial skills in children with ADHD. Methods: The sample included 120 children aged 6-12 years with ADHD (ADHD + CDS: n = 40; ADHD-only: n = 80). Memory was assessed with the Oktem Verbal Memory Processes Test (OVMPT) and Wechsler Memory Scale-Visual Reproduction (WMS-VR), and visuospatial skills with WISC-IV Block Design and Judgment of Line Orientation (JLO). ADHD symptoms were rated using combined parent-teacher Turgay-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Based Disruptive Behavior Disorders Scale (T-DSM-IV-S) scores; CDS symptoms with the Barkley Child Attention Scale; and anxiety with the SCARED-Child Form. Group comparisons, correlation analyses, and multivariable linear regression models were conducted. Results: The ADHD + CDS group performed worse on WISC-IV Block Design than the ADHD-only group (p = 0.005). In the ADHD + CDS group, inattention severity showed a strong negative association with WMS-VR short-term memory (r = -0.560, p < 0.001). In the ADHD-only group, inattention severity was negatively associated with OVMPT Spontaneous Recall (ρ = -0.319, p = 0.004) and JLO total score (ρ = -0.348, p = 0.002). Anxiety severity in the ADHD-only group was positively associated with OVMPT Total Learning (ρ = 0.350, p = 0.001), Highest Learning (ρ = 0.370, p = 0.001), and WMS-VR short-term memory (ρ = 0.304, p = 0.006). In regression analyses, the presence of CDS independently and negatively predicted WMS-VR short-term memory (β = -0.187, p = 0.018) and Block Design performances (β = -0.226, p = 0.016). Inattention symptom severity was also independently and negatively associated with Block Design performance (β = -0.243, p = 0.013). Conclusions: CDS status and symptom dimensions contribute to cognitive variability in pediatric ADHD, with CDS showing independent associations with timed visuospatial construction and short-term visual memory. Inattention severity emerged as a robust dimensional predictor of cognitive inefficiency across domains, supporting the clinical utility of symptom-based cognitive profiling in ADHD diagnostic evaluations. In addition, mild anxiety symptoms demonstrated meaningful associations with some learning and memory performances within the ADHD-only group, indicating that affective factors may modulate cognitive outcomes in ADHD. Taken together, these findings support considering CDS status and symptom dimensions jointly when characterizing cognitive variability in ADHD.

ABSTRACT Background and Purpose Chronic pain affects approximately 63% of people with multiple sclerosis (pwMS), contributing to fatigue, depression, anxiety, poor sleep, reduced quality of life, and cognitive decline. Within the biopsychosocial model, music therapy has emerged as a promising intervention to address these complex symptoms. This study aims to examine the effects of heart rate‐synchronized music therapy combined with motor imagery practice on pain, autonomic and cognitive functions, and psychosocial outcomes in patients with pwMS. We hypothesize that the combined intervention will lead to greater improvements than music therapy alone or routine care. Methods A double‐blind, randomized, and three‐arm parallel trial will be conducted with 45 patients with pwMS experiencing chronic pain. Participants will be randomly assigned to one of three groups: (1) heart rate‐synchronized music therapy combined with motor imagery, (2) heart rate‐synchronized music therapy alone, or (3) a control group receiving routine care. Interventions will be delivered twice weekly for 8 weeks, with each session lasting 20–30 min. The experimental groups will receive music therapy via videoconferencing. Assessments will be conducted at baseline, post‐intervention (week 8), and follow‐up (week 12). The primary outcome is pain intensity. Secondary outcomes include neuropathic pain, central sensitization, heart rate variability, anxiety, depression, fatigue, sleep quality, quality of life, and cognitive function. Sample size was calculated using G*Power; HRV data will be analyzed with Kubios software. Statistical analyses will be performed using SPSS and GraphPad Prism 10. Results Following randomization, baseline data will be collected. Blinded assessors will evaluate all outcomes at follow‐up points. An independent researcher will perform statistical analyses to assess changes across time and between groups. Discussion This study may provide evidence supporting a novel, non‐pharmacological, and telehealth‐compatible intervention for chronic pain in pwMS. Trial Registration NCT06800144, 24th January 2025

ABSTRACT Fear extinction processes are central to the pathology and treatment of anxiety disorders. Emerging evidence implicates rapid eye movement (REM) sleep in the consolidation of extinction memory. Separately, converging theory and empirical work suggest that vagally mediated heart rate variability (VmHRV) serves as a peripheral index of cortico–subcortical regulatory capacity relevant to extinction circuitry. On this basis, we tested the hypothesis that VmHRV during REM sleep would be associated with the retention of extinction memory in individuals with generalized anxiety disorder (GAD). Participants underwent a validated two-day fear conditioning and extinction paradigm. Subjective extinction retention (sERI) was quantified during a recall test 24 hours after learning and ambulatory polysomnography was recorded on the intervening night. As hypothesized, higher REM VmHRV was significantly associated with better extinction retention. This association remained robust after controlling psychotropic medication use and REM density. In contrast, VmHRV during SWS or wakefulness, as well as other REM sleep measures, were not associated with extinction retention. These findings identify REM VmHRV as a significant predictor of extinction memory retention in GAD, extending prior findings in trauma-exposed individuals. We propose that reduced vagal tone indexes compromised prefrontal inhibitory control over amygdala and noradrenergic circuits, thereby impairing REM sleep-dependent consolidation. These results position VmHRV during REM sleep as a potential transdiagnostic biomarker of extinction memory processing and suggest that interventions enhancing vagal tone could improve treatment outcomes in anxiety disorders.

Metacognition refers to the awareness and regulation of one's cognitive processes, including self-monitoring, planning, and controlling thoughts. In individuals with attention deficit hyperactivity disorder (ADHD), although research is limited, deficits in metacognitive skills are commonly observed, which contribute to difficulties in attention, task completion, and self-regulation. The aim of this study is to identify metacognitive characteristics in adolescents diagnosed with ADHD and to explore the relationship between these characteristics and the metacognitions of their parents. The study included 107 adolescents, aged 12-18 years, who were newly diagnosed with ADHD, as well as 100 healthy control participants. A sociodemographic form, The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime version for DSM-5 (K-SADS-PL DSM-5), Metacognitions Questionnaire for Children (MCQ-C) were applied, while their parents completed the Metacognitions Questionnaire-30 (MCQ-30), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale Form (T-DSM-IV-S) and the Adult ADHD Self-Report Scale for DSM-5 (ASRS-5). Based on ASRS-5 scores, parents were categorized into two groups: those at increased risk of ADHD (ASRS ≥ 14) and those at low risk of ADHD (ASRS < 14). Group differences were examined using multivariate analyses (MANCOVA/MANOVA), while associations between adolescent and parental variables were assessed using correlation analyses. In adolescents with ADHD, scores on the negative meta-worry, superstitious, punishment and responsibility beliefs and cognitive monitoring subscales -as well as the MCQ-C total score- were significantly higher compared to the control group, while no difference was found for positive meta-worry, regardless of subtype. On the parental MCQ-30, all subscale and total scores were significantly higher in the ADHD group. Parents categorized as being at increased risk of ADHD had significantly higher MCQ-30 total scores compared to those at low risk. Furthermore, the severity of ADHD symptoms in adolescents, particularly inattention and hyperactivity-impulsivity, was positively and weakly correlated with the MCQ-C total score. In addition, a weak negative correlation was observed between adolescents' positive meta-worry and parents' cognitive confidence. Our study suggests that metacognitive impairment is prevalent among adolescents with ADHD and their parents. Enhancing metacognitive awareness in individuals with ADHD may facilitate their adaptation to treatment and preparedness for alternative forms of therapeutic intervention.

IntroductionPituitary metastasis from a solid tumour is an extremely rare condition and is generally associated with a poor prognosis. Spontaneous regression is not typically expected, which further worsens the outlook. Here, we present a case of a patient with small-cell lung cancer (SCLC) who developed a pituitary mass. The marked regression of the lesion following chemotherapy strongly supported the likelihood of pituitary metastasis in this case.Clinical CaseA 59-year-old female patient, diagnosed with SCLC one month ago, was receiving radiotherapy and she also had a chemotherapy plan. When visual impairment and ptosis developed, cranial MRI was performed. She was referred to our outpatient clinic due to pituitary lesion. On physical examination blood pressure was 130/70 mmHg and a heart rate was 92/min. She was mildly dyspneic, had no signs of endocrine hyperfunction, nor polyuria or polydipsia. Obesity was also noted. Her medical history included hypertension and ischemic heart disease. In laboratory examination;ParameterResultReference RangeNa⁺140 mmol/L135–145 mmol/LK⁺4.9 mmol/L3.5–5.0 mmol/LBasal Cortisol30.3 μg/dL6.2–19.4 μg/dLACTH164 ng/L7.2–63.3 ng/LIGF-1471 μg/L62–186 μg/LTSH1.52 mIU/L0.27–4.8 mIU/LfT41.26 ng/dL0.79–1.59 ng/dLFSH9.6 IU/L3.5–12.6 IU/LLH4.08 IU/L2.4–12.6 IU/LProlactin20.3 μg/L2.8–29.2 μg/L1 mg Dexamethasone Suppression Test (DST)15.7 μg/dL—4 mg Dexamethasone Suppression Test (DST)18 μg/dL—Liver and Renal FunctionsNormal—Pituitary MRI revealed a 17×15×12 mm suprasellar mass lesion compressing the optic chiasm (Figure 1A-B). PET-CT demonstrated intense FDG uptake in the pituitary region, as well as involvement in the right lung’s lower, middle, and upper lobes, the left adrenal gland, and multiple lesions in the skeletal system. The patient was evaluated by a multidisciplinary pituitary board, and no clinical signs of acromegaly or Cushing’s syndrome were identified. Due to the high surgical risk given her condition, chemotherapy was promptly planned. Cisplatin and etoposide chemotherapy protocol was started, and the patient's visual impairment subsided following treatment. At the 3-month follow-up her visual complaints and ptosis completely resolved, basal cortisol decreased to 20 μg/dL, ACTH to 60 ng/L, and IGF-1 normalized. Control pituitary MRI releaved significant regression of the lesion (Figure 1C-D). In the first year of chemotherapy, during the pulmonology and oncology follow-up, she was hospitalized because of confusion following radiotherapy for brain metastases. It was later reported that the patient had passed away.ConclusionThe approach to pituitary metastases is generally palliative. On the other hand, if the primary tumor is expected to respond well to chemotherapy and surgery is considered high-risk, close monitoring may be considered to allow chemotherapy to be effective.Figure 1:A-B: Sagittal and coronal pituitary MRI images of the patient before chemotherapy. C-D: Sagittal and coronal pituitary MRI images of the patient 3 months after chemotherapy. Table 1:The patienteGFR: Estimated glomerular filtration rate, ACTH: Adrenocorticotropic hormone, IGF-1: Insulin-like growth factor 1, TSH: Thyroid stimulating hormone, fT4: Free thyroxine, FSH: Follicle-stimulating hormone, LH: Luteinizing hormone, E2: Estradiol, DST: Dexamethasone suppression test

This study examined the relationship between obsessive-compulsive disorder (OCD) symptom severity and psychological resilience within the framework of dominant depressive temperament (DDT). A total of 129 patients with OCD were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Resilience Scale for Adults (RSA), and the TEMPS-A questionnaire for temperament evaluation. Participants were classified as having DDT based on both established cut-off scores and standardized z-scores for the depressive subscale. Depression and anxiety levels were measured with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Patients with DDT showed significantly higher depression, anxiety, and obsession scores than those without DDT. They also displayed significantly lower scores in most RSA subdimensions (perception of future, structured style, social competence, family cohesion, and social resources), while perception of self did not differ. Interestingly, some resilience subdimensions such as structured style were relatively higher in the DDT group despite greater symptom severity, indicating a paradoxical pattern. Partial correlation analyses controlling for depressive symptoms revealed that, in the DDT group, higher OCD symptom severity was inversely associated with several resilience resources—particularly family cohesion. The presence of DDT is linked to greater emotional vulnerability and reduced resilience resources, which may exacerbate OCD severity. These findings indicate that the interplay between affective temperament and resilience in OCD remains significant even after accounting for depressive symptoms, underscoring the importance of incorporating temperament profiling and resilience assessment into clinical evaluation. Interventions that target resilience may be particularly beneficial for OCD patients with DDT. Not applicable.