OBJECTIVE: Psychological pain has been accepted as one of the most critical psychological risk factors underlying suicidal ideation and behaviour. Suicide is chosen as a way to get rid of intense, painful and unbearable psychological pain. Since the level of tolerance rather than the intensity of psychological pain was considered to be more predictive for suicide, we aimed to investigate the validity and reliability of the Turkish version of Tolerance for Mental Pain Scale-10 (TMPS-10). METHODS: A total of 121 patients diagnosed with depression in 62 of them had previous suicide attempts and 105 healthy controls who applied to the outpatient clinics of Çukurova University Faculty of Medicine Psychiatry Department were included in the study. Beck Depression Inventory (BDI), Beck Scale for Suicidal Ideation (BSIS), Beck Hopelessness Scale (BHS), Psychache Scale (PS) and TMPS-10 were applied to participants. RESULTS: In the internal consistency analysis, Cronbach's alpha coefficient was 0.96 for enduring the pain, 0.96 for managing the pain, 0.98 for the whole scale, and item-total correlation coefficients were found to be between 0.87 and 0.93. The scale fit well to both the two-factor and single-factor structure in the confirmatory factor analysis. The multi-group confirmatory factor analysis showed that both the depressive patients and the control group interpreted the scale items in the same way. In convergent validity analysis, there was a negative, linear, high and statistically significant relationship between TMPS-10 scores and PS, BSIS, BDI and BHS scores (r = −0.935; −0.779; −0.890; −0.808; p < .0.001, respectively). In discriminant function analysis, TMPS-10 successfully differentiated the depressive group and the control group, as well as the depressive patients who did or did not attempt suicide (96.5%, 88.1%, respectively). CONCLUSION: The Turkish version of TMPS-10 is valid and reliable, and may be useful in research and clinical practices about suicide. ARTICLE HISTORY

Purpose The term orthorexia nervosa is used to describe the pathological fixation associated with consuming healthy food. It is assumed that orthorexia nervosa shares some phenomenological features with anorexia nervosa, obsessive-compulsive disorder (OCD), and other mental disorders. Individuals with orthorexic tendencies may have high physical activity as well as a healthy diet. This study aimed to investigate the relationship of orthorexia nervosa with obsessive-compulsive symptoms, eating attitudes, and several sociodemographic features. Patients and Methods We included 63 patients diagnosed with OCD, 63 healthy volunteers who perform physical exercises at least three days a week, at least 30 minutes a day, and 63 healthy volunteers who do not perform physical exercises regularly. Sociodemographic data form, Yale-Brown Obsessive Compulsive Scale, ORTO-11 Scale, Eating Attitude Test, Hamilton Anxiety Scale, and Structured Clinical Interview for DSM-5 Disorders (SCID-5 CV) were administered to all participants. OCD data form was also applied to patients with OCD diagnosis. Results We found a statistically significant relationship between current order-symmetry obsessions and orthorexic tendencies in patients with OCD (p<0.05). There was no relationship between the severity of the disorder and orthorexia nervosa in patients with OCD (p>0.05). Orthorexic tendencies were found to increase as impaired eating attitudes increased in participants who regularly performed physical exercises and patients with OCD (p<0.05). The orthorexic tendencies of participants who regularly performed physical exercises were higher than those diagnosed with OCD and healthy individuals who did not perform physical exercises. Conclusion The absence of a significant relationship between disorder severity and orthorexia nervosa in patients diagnosed with OCD and the increase in orthorexic tendencies as the deterioration in eating attitudes increases in both patients with OCD and the participants who regularly perform physical exercises suggest that orthorexia nervosa may be closer to the eating disorders group than obsessive-compulsive spectrum. Studies with large samples and different diagnoses are needed to determine the place of orthorexia nervosa in diagnosis and classification systems.

Suicide is a leading cause of death in patients with schizophrenia. Previous studies have mostly investigated the association between suicide and sociodemographics, positive and negative symptoms, and depressive symptoms. This study evaluated psychache and alexithymia in patients with schizophrenia, which have both been associated with suicide attempts and thoughts in patients with other psychiatric disorders. Positive and Negative Syndrome Scale (PANSS), Psychache Scale (PAS), Beck Scale for Suicidal Ideation (BSSI), Calgary Depression Scale for Schizophrenia (CDSS), and Toronto Alexithymia Scale (TAS) scores were obtained in 113 patients with schizophrenia, including 50 with suicide attempts. PANSS positive symptoms and general psychopathology subscale, CDSS, BSSI, TAS, and PAS scores were significantly higher in patients with suicide attempts. In multivariate logistic regression analysis, only the PAS score was an independent predictor of attempted suicide. Mediation analysis demonstrated that psychache (both directly and indirectly) and alexithymia (indirectly) might be associated with the risk of suicide in these patients.

Purpose: Suicide is an important cause of death in patients diagnosed with obsessivecompulsive 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.

Correlation of anxiety and depression levels with attitudes towards coping with illness and sociodemographic characteristics in patients with a diagnosis of breast cancer Objective: The aim of this study was to investigate the relationship of anxiety and depression levels of breast cancer patients that had completed a year since receiving the diagnosis with their sociodemographic characteristics and attitudes towards coping with their disease. Method: This study was conducted with 94 female patients between the ages of 35 and 65 years who had been diagnosed with breast cancer and who were treated at the Oncology Department of Cukurova University's Faculty of Medicine between June 5 and July 31, 2017. Data were collected via a personal information form prepared by the investigator, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and COPE inventory. Results: It was found that 27.7% and 16.0% of patients with breast cancer who had completed one year of treatment and had not presented or been referred to psychiatry experienced clinically relevant anxiety symptoms and depressive symptoms, respectively. A positive relationship was found between depression and anxiety in breast cancer patients (p<0.05, r=0.68). The level of anxiety was higher in patients who were not sufficiently informed about the disease (p=0.014) and who thought that the partner was behaving more distant (p=0.019). Patients between the ages of 35 and 44 years were found to be more depressive and anxious than those at age 55-65 (p=0.006 and p=0.010, respectively). It was found that primary school graduates were more likely to use "religious coping" (p=0.02) and university graduates were more likely to use "humor" (p=0.04). In addition, "positive reinterpretation" and "planning" attitudes were found to be more common in those with sufficient knowledge of the disease (p=0.045 and p=0.01, respectively). There was a negative correlation between depression and "mental disengagement" (p=0.011) and "active coping" (p=0.008). There was a positive relationship between anxiety and "use of emotional social support" (p=0.038). Conclusion: In our study, sufficient information about the disease and the partner's behavior were found to be associated with anxiety in breast cancer patients, and coping attitudes were found to be effective regarding depression and development of anxiety. Addressing the psychological effects of breast cancer and giving importance to psychosocial interventions and coping attitudes have been considered preventive factors in the development of depression and anxiety.