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    Cognitive functions in schizophrenia: the interplay between blood viscosity, serum osmolarity, and symptom severity
    (Bmc, 2025) Unal, Ipek Ozonder; Aytac, Miray Pirincci; Aker, Derya Adali; Duymaz, Tomris; Berkol, Tonguc Demir
    Objective Cognitive impairments-especially in executive function and attention-are core features of schizophrenia and major barriers to functional recovery. Although systemic physiological factors such as blood viscosity and serum osmolarity have been implicated in schizophrenia, their association with cognitive deficits remains largely unexplored. This study aimed to investigate these relationships in male patients with schizophrenia in remission. Methods A total of 247 male patients diagnosed with schizophrenia in remission were recruited. Cognitive performance was assessed using the Frontal Assessment Battery (FAB), Stroop Test, and Trail Making Test (TMT). Hemorheological parameters, including whole blood viscosity (WBV) at low and high shear rates (LSR and HSR), and serum osmolarity were calculated. Regression analyses were conducted to determine predictors of cognitive outcomes. Results In the multivariate analysis, higher WBV at HSR (beta = 0.122, beta = 0.037) was positively associated with executive function (FAB scores) and inversely associated with Stroop 5 time (beta = -0.134, p = 0.025), TMT-A (beta = -0.134, p = 0.032), and TMT-B (beta = -0.137, p = 0.028) completion times, reflecting better cognitive performance. While higher serum osmolarity showed a positive correlation with FAB scores in univariate analysis, it did not remain an independent predictor in the multivariate model. The multivariate regression identified WBV at HSR, depressive symptoms, negative symptoms, use of long-acting injectable antipsychotics (LAI), and living arrangements as significant predictors of FAB scores, collectively explaining 16.9% of the variance (F(8,238) = 7.252, p < 0.001). Conclusion This study highlights the potential contribution of systemic physiological factors to cognitive function in schizophrenia. Higher WBV, within a physiological range, may support cerebral perfusion and be associated with better executive performance. Although serum osmolarity showed a positive association with executive function in univariate analysis, it was not an independent predictor in multivariate models, and its cognitive relevance remains to be clarified. These findings point to a possible role of physiological parameters in cognitive variability, but further studies are needed before drawing firm clinical implications.
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    The relationship between psychological flexibility, self-compassion, and posttraumatic growth in cancer patients in the COVID-19 pandemic
    (Springer, 2023) Unal, Ipek Ozonder; Unal, Caglar; Duymaz, Tomris; Ordu, Cetin
    PurposeThe COVID-19 pandemic may have an important long-term emotional impact on patients with cancer diagnosis, as they are in the high-risk group. We aimed to evaluate the relationship between self-compassion, psychological flexibility, and posttraumatic growth, and to examine whether psychological flexibility may serve as a mediator between self-compassion and posttraumatic growth.MethodsTwo hundred fifty-three patients with cancer were included in the study. Sociodemographic and Clinical Features Data Form, Self-Compassion Scale (SCS), Freiburg Mindfulness Inventory (FMI), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Posttraumatic Growth Inventory (PTGI) were applied to all patients.ResultsThe multivariate analysis with independent variable SCS, FMI, AAQ-II, and CFQ scores explains 49% of the variance in PTGI (F(4,248) = 60,585, p < 0.001). SC and FMI scores were found to have a positive and AAQ-II and CFQ scores a negative predictive effect on PTGI scores. The partial mediational effect of psychological flexibility on the relationship between self-compassion and posttraumatic growth was found to be statistically significant.ConclusionIn traumatic life events such as pandemics, the importance of self-compassion for posttraumatic growth and the mediator role of psychological flexibility in this relationship should be considered in order to manage the treatment process in cancer patients. These patients are more affected by the pandemic due to the nature of their malignancy and the strict protective measures they must follow as members of a high-risk group. The significance of therapies focused on psychological flexibility should be emphasized in comprehensive biopsychosocial approaches for the management of cancer patients.