Speaking Up: Exploring Mental Health Care Workers' Patient Safety Concerns

PURPOSE

To explore the perspectives and experiences of mental health care workers (MHCWs) when speaking up about patient safety concerns.

METHOD

A qualitative study was performed at Farshchian (Sina) Hospital in Iran, involving the purposive sampling of MHCWs from three inpatient psychiatric wards. From July to October 2022, semi-structured interviews were conducted with 23 participants. Data were analyzed using conventional content analysis.

RESULTS

Three major patient safety themes were identified: (a) Voicing Concerns for Daily Safety (subthemes: daily safety check-ins and speaking up to prevent patient harm); (b) Speaking Up to Save Future Lives (subthemes: whistleblowing, leadership, and being open to communication); and (c) Hesitating to Speak Up (sub-themes: ineffectiveness of raising one's voice and whispering).

CONCLUSION

MHCWs have various concerns about speaking up or staying silent. Failure to communicate can result in adverse events and missed opportunities to address patient safety. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

The Association between Depression Severity, Prosody, and Voice Acoustic Features in Women with Depression

The aim was to define the association between the severity of depression, prosody, and voice acoustic features in women suffering from depression and its comparisons with nondepressed people. Prosody and acoustic features in 30 women with major depression hospitalized in a psychiatric ward and 30 healthy women were investigated in a cross-sectional study. To define the severity of depression, the Hamilton Rating Scale for Depression (HRS-D) was applied. Acoustic parameters such as jitter, shimmer, cepstral peak prominence (CPP), standard deviation of fundamental frequency (SD F0), harmonic-to-noise ratio, and F0 and also some speech prosodic features including the speed of speech, switching pause duration means, and durations of produced sentences with different modals were measured quantitatively. Also, six raters judged the patient's prosody qualitatively. SPSS V.28 was used for all statistical analyses (p < 0.05). There was a significant correlation between HRS-D with jitter, SD F0, speed of speech, and switching pause means (p ≤ 0.05). The means of CPP and duration of producing emotional sentences differed between the depression and control groups. The HRS-D scores were significantly correlated with switching pauses in patients (Pearson coefficient = 0.47, p=0.05). The results of the perceptual evaluation of prosody judged by six raters showed an 85% correlation between them (p ≤ 0.001). Some acoustic and prosodic parameters are different between healthy women and those with depression disorder (e.g., CPP and duration of emotional sentences) and may also have an association with the severity of depression (e.g., jitter, SD F0, speed of speech, and switching pause means) in women with depression disorder. It was indicated that the best sentence modal to assess prosody in patients with depression would be exclamatory ones compared to declarative and interrogative sentences.

Balance-energy of resting state network in obsessive-compulsive disorder

Stability of the brain functional network is directly linked to organization of synchronous and anti-synchronous activities. Nevertheless, impact of arrangement of positive and negative links called links topology requires to be well understood. In this study, we investigated how topology of the functional links reduce balance-energy of the brain network in obsessive-compulsive disorder (OCD) and push the network to a more stable state as compared to healthy controls. Therefore, functional associations between the regions were measured using the phase synchrony between the EEG activities. Subsequently, balance-energy of the brain functional network was estimated based on the quality of triadic interactions. Occurrence rates of four different types of triadic interactions including weak and strong balanced, and unbalanced interactions were compared. In addition, impact of the links topology was also investigated by looking at the tendency of positive and negative links to making hubs. Our results showed although the number of positive and negative links were not statistically different between OCD and healthy controls, but positive links in OCDs' brain networks have more tendency to make hub. Moreover, lower number of unbalanced triads and higher number of strongly balanced triad reduced the balance-energy in OCDs' brain networks that conceptually has less requirement to change. We hope these findings could shed a light on better understanding of brain functional network in OCD.

Gender and age differences in suicide attempt: A large population study in the West of Iran

Present study was to evaluate the relationship between suicide attempt, gender and age. We used all of suicide attempt entered in Hamadan Suicide Registry Program (2016-2017). Finding revealed that suicide attempt was lower among elderly patients. Using poison and self-immolation was more common in elder patients. Suicide attempt in females against males was higher in married. In males the higher rate of suicide attempt was in autumn, while in females was in summer. Using of drug was more frequent in females, while self-harm was more common in males. Gender and age are important risk factors of suicide attempts.

Exploring the return-to-work process in working people with serious mental illness

BACKGROUND

Few studies examined the return-to-work (RTW) process in working people after recovery from serious mental illness (SMI).

PURPOSE

The RTW process was explored in working people with SMI.

METHOD

A qualitative study was conducted using the grounded theory. Twenty seven interviews were analyzed using Corbin and Strauss's approach (2015).

RESULTS

The core category "syncing with an ordinary workstream" emerged with three categories: "proceeding RTW strategies," "staying at work strategies," and "relative adaptation with work."

CONCLUSION

"Syncing with an ordinary workstream" can help researchers develop a new practice model to facilitate the RTW process in working people with SMI.

Facilitators and Barriers of Return to Work in Working People with Serious Mental Illness: A Qualitative Study

BACKGROUND

Among working people with serious mental illness (WPSMI), return to work (RTW) is controlled by several factors. Identifying these factors can help prevent long-term sick leave absence and work disability. We aimed to identify facilitators and barriers of RTW in WPSMI admitted to a psychiatric hospital and clinic affiliated with the Hamadan University of Medical Sciences, Iran.

METHODS

This qualitative study was conducted in 2020 on 27 participants with SMI and their families, supervisors, coworkers, managers, and mental health professionals (MHPs). The participants were selected through purposive sampling and subjected to semi-structured interviews. Forty interviews were conducted and analyzed using conventional content analysis.

RESULTS

Nine hundred initial codes were extracted and categorized into 34 subcategories and eight categories. Categories that emerged as facilitators of RTW include emotional availability, information availability and use, practical assistance of others, employment facilitation by the society, and supervisor's flexibility. Categories identified as barriers are imposed effects of mental illness, poor self-concept, and social obstacles.

CONCLUSION

WPSMI experience some facilitators and barriers in RTW. Therefore, MHPs and politicians are recommended to consider these factors in vocational rehabilitation plans.

Identifying factors associated with the hospital readmission rate among patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is a common recurrent mental disorder and one of the leading causes of disability in the world. The recurrence of MDD is associated with increased psychological and social burden, limitations for the patient, family, and society; therefore, action to reduce and prevent the recurrence of this disorder or hospital readmissions for depression among the patients is essential.

METHODS

The data of this retrospective cohort study were extracted from records of 1005 patients with MDD hospitalized in Farshchian hospital in Hamadan city, Iran (2011-2018). The hospital readmissions rate due to depression episodes was modeled using generalized Poisson regression (GPR). Demographic and clinical characteristics of the patients were considered as explanatory variables. SAS v9.4 was used (P < 0.05).

RESULTS

A majority of the patients were male (66.37%). The mean (standard deviation) of age at onset of MDD and the average number of hospital readmissions were 32.39 (13.03) years and 0.53 (1.84), respectively (most patients (74.3%) did not experience hospital readmissions). According to the results of the GPR, the lower age at the onset of the disease (IRR = 1.02;P = 0.008), illiteracy (IRR = 2.06;P = 0.003), living in urban areas (IRR = 1.56;P = 0.015), history of psychiatric illnesses in the family (IRR = 1.75;P = 0.004), history of emotional problems (IRR = 1.42;P = 0.028) and having medical disorders (IRR = 1.44;P = 0.035) were positively associated with the number of hospitalizations.

CONCLUSION

According to our findings, urbanization, early onset of the disease, illiteracy, family history of mental illness, emotional problems, and medical disorders are among major risk factors associated with an increased number of hospital readmissions of MDD.

Identifying Return to Work Perception in People With Serious Mental Illness: A Qualitative Study

The current qualitative study sought to identify return to work (RTW) perception among people with serious mental illness (SMI) referred to a psychiatric hospital affiliated with Hamadan University of Medical Sciences. In total, 24 individuals were recruited, including working people with SMI, families, employers, and mental health team members who participated in in-depth, semi-structured interviews. Forty interviews were conducted. Interviews were analyzed based on the conventional content analysis approach. Accordingly, two themes were found, including The Need to Continue Working and Flexible and Supportive Strategies. The first theme included two categories: personal obligations and socioeconomic necessities. The second theme included three categories: coping with mental illness, requesting support from others, and coping with work conditions. Findings revealed that the need to continue working has a significant effect on RTW perception among people with SMI. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Predictors of completed suicide: Results from the suicide registry program in the west of Iran

Suicide is a crucial public health problem with a serious harmful impact on individuals, families, and societies. Therefore, the current study aimed to evaluate the predictors of death or serious injury related outcome regarding this lethal phenomenon in Hamadan Province. In this registry-based study we used all of suicide attempt entered in Hamadan Suicide Registry Program from January 2016 to the end of 2017. Serious injury and death were considered as suicide worse outcome and its prognostic factors were examined using logistic regression model. From 2493 patients with suicide attempts in 5.61 % and 4.09 % of them, suicide behaviour led to serious injury and death, respectively. Males had 2.83 times higher odds of the worse suicide outcomes ([OR = 2.83, 95 % CI: 1.71, 4.68)], P < 0.001). Moreover, the odds of worse outcomes of suicide in individuals with low level of education, advanced age and with the history of suicidal ideation was significantly higher (P < 0.05). Among different suicide methods, the highest odds of suicide worse outcomes were related to self-immolation, falls, hanging, self-harm, poisoning, and drugs (P < 0.001). We found that the increase odds of suicide worse outcomes were associated with individuals advance age, low level of education, time of suicide attempt, previous history of suicidal ideation and choosing self-immolation, falls, hanging, self-harm, poisoning, and drugs as a suicide method.

Complexity of information processing in obsessive-compulsive disorder based on fractal analysis of EEG signal

The human brain is considered as a self-organizing system with self-similarities at various temporal and spatial scales called "fractals". In this scale-free system, it is possible to decode the complexity of information processing using fractal behavior. For instance, the complexity of information processing in the brain can be evaluated by fractal dimensions (FDs). However, it is unclear how over-elaboration of information processing impacts the dimensionality of its fractal behavior. In this study, we hypothesized that FDs of electroencephalogram (EEG) in obsessive-compulsive disorder (OCD) should be higher than healthy controls (HCs) because of exaggeration of information processing mainly in the frontal regions. Therefore, a group of 39 OCDs (age: 34.76±8.22, 25 female, 3 left-handed) and 19 HCs (age: 31.94±8.22, 11 female, 1 left-handed) were recruited and their brain activities were recorded using a 19-channel EEG recorder in the eyes-open resting-state condition. Subsequently, fractal dimensions of the cleaned EEG data were calculated using Katz's method in a frequency band-specific manner. After the test of normality, significant changes in the OCDs as compared to the HCs were calculated using a two-sample t-test. OCDs showed higher FDs in the frontal regions in all frequency bands as compared to HCs. Although, significant increases were only observed in the beta and lower gamma bands, mainly at the high beta. Interestingly, neurophysiological findings also show association with severity of obsessive behaviors. The results demonstrate that complexity of information processing in the brain follows an intimate nature of structural and functional impairments of the brain in OCD.

Comparing the Effect of Grape Fermentative Product and Fresh Red Grape Juice on Antioxidant Biomarkers of Liver Mitochondria Isolated From Rats in Vitro

Background: Mitochondria are a source of reactive oxygen species (ROS), and several natural compounds are used as antioxidant agents. This study aimed to investigate and compare the effects of fresh grape juice red wine on oxidative stress biomarkers in rat liver mitochondria. Materials and Methods: In this regard, mitochondria were isolated from the liver of 27 male Wistar rats (220-250 g). The isolated mitochondria were cultured in different doses of red wine and fresh red grape juice for 24, 48, and 72 h. After treatment, total antioxidant capacity, lipid peroxidation, total thiol groups, and catalase activity were determined in the isolated mitochondria of the rat liver. Results: The results confirmed the oxidant/antioxidant effects of red wine and fresh red grape juice at different times. Conclusion: According to the results, the fresh red grape juice showed higher antioxidant properties than red wine in the liver mitochondrial samples.

Pharmacokinetics and brain distribution studies of perphenazine-loaded solid lipid nanoparticles

BACKGROUND

Perphenazine (PPZ) is a typical antipsychotic that is mainly administrated for the treatment of schizophrenia. Due to its highly lipophilic nature and extensive hepatic first-pass metabolism, its oral bioavailability is low (40%).

OBJECTIVE

The novel nanocarriers like solid lipid nanoparticles (SLN) have been reported to be highly effective for improving the therapeutic effect of drugs. Therefore the main scope of the present investigation was the evaluation of in vivo characteristics of PPZ-SLN in terms of pharmacokinetic parameters and brain distribution.

METHODS

The PPZ-SLN was prepared by the solvent-emulsification and evaporation method. The storage stability of PPZ-SLN and empty SLN powders was studied for 3 months. In vivo pharmacokinetic studies and brain distribution evaluations were performed following a single oral dose administration of PPZ and PPZ-SLN suspensions on male Wistar rats. An HPLC method was established and validated for the quantitative determination of PPZ in plasma and brain samples.

RESULTS

The storage stability studies revealed the good storage stability of the both PPZ-SLN and empty SLN at 4 °C. Compared to PPZ suspension, the relative bioavailability and the brain distribution of PPZ-SLN were increased up to 2-fold and 16-fold, respectively. Mean residence time (MRT) and half-life (t_1/2) of PPZ-SLN were significantly (p value < 0.01) increased in both plasma and brain homogenate compared to PPZ suspension.

CONCLUSION

The significant improvement in the pharmacokinetic properties of PPZ following one oral dose indicates that SLN is a promising drug delivery system for PPZ and shows a high potential for successful brain delivery of this antipsychotic.

Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students

BACKGROUND

College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD).

METHODS

A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05).

RESULTS

The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05).

CONCLUSIONS

Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.

A qualitative inquiry of sexuality in Iranian couples using the Information-Motivation-Behavioral skills paradigm

Background

Sexuality is interwoven with individuals’ information, motivation, and behaviors.

Objective

To explore sexually related information, motivation, and behaviors that Iranian newly married couples utilized through their marital lives.

Methods

We employed in-depth face-to-face interviews with 22 couples between the ages of 21 and 35 years to collect rich qualitative data. Content analysis was used to analyze the data. Our data analysis process was guided by the Information-Motivation-Behavioral skills (IMB) model as a potential framework for understanding of the participants’ sexual and marital lives.

Results

IMB’s conceptual bases were adequately reflected in the participants’ sexual narratives. The participants highlighted information needs related to their sexual relationships and services that should be provided by the relevant programs in the educational and national health system. Fulfillment of each other’s sexual needs was identified as the most important motivation of the participants. Sexual needs of husband, love, and liking were the main motivations for women’s sexual submission. The main behaviors found included couples’ communication skills and performing using feminine traits by women in order to fit the role of a sexually skillful wife.

Conclusion

Our data analysis revealed that couples shared a proper comprehension of each other’s means of sexual behaviors. A dominance of religious discourse, non-verbal, mostly physical means of communication was employed by the couples to express or initiate sexual interactions. Furthermore, our findings support the utility of IMB as a potential basis for understanding married couples’ sexual lives. Our data highlight an implication to expand the motivation structure of the IMB model to incorporate an individual’s sexual understandings and the sexual needs to promote mutual and pleasurable sexual life within the Iranian culture.

Crocus Sativus L. (saffron) versus sertraline on symptoms of depression among older people with major depressive disorders-a double-blind, randomized intervention study

BACKGROUND

While there is sufficient evidence that Crocus Sativus L. (saffron) improves symptoms of depression in young and middle-aged adults, research on older people are missing. The purpose of the double-blind, randomized intervention study was to compare the effect of saffron and sertraline on MDD among a sample of older people.

METHODS

A total of 50 older out-patients with MDD (mean age = =65 years; 70% males) were randomly assigned either to the saffron condition (60 mg/d) or to the sertraline condition (100 mg/day) for six consecutive weeks. Experts employed the Hamilton Depression Rating Scale (HDRS) to rate participants' degree of depression. Timepoints were baseline, week 2, week 4 and week 6, the end of the study.

RESULTS

Symptoms of depression decreased over time, with no advantages or disadvantages for the saffron or sertraline condition.

CONCLUSION

The pattern of results suggests that both saffron and sertraline have the potential to significantly decrease symptoms of depression. The results are clinically relevant, because major depressive disorders in older people is a health concern. The results are further relevant, because saffron appears to be a powerful antidepressant for older people, who might be more reluctant to the use of synthetic drugs.

Randomized controlled trial protocol to evaluate the effect of an educational intervention using information, motivation and behavioral skills model on sexual satisfaction of new couples in Iran

Background

Sexual satisfaction is considered as one of the key factors in assessing a person’s quality of life and the quality and continuity of marital relationships. According to the results of reports in Iran, many couples are dissatisfied with their sexual lives. Sexuality education is one of the important strategies to prevent early sexual problems and improve sexual satisfaction. The aim of this randomized controlled trial is to compare the efficacy of sexual and marital enrichment package using information, motivation and behavioral skills model on sexual satisfaction of new couples in Iran to routine sexual care program that provided at governmental health centers.

Methods

This is a randomized, controlled, superiority trial with two parallel groups. One hundred new couples (n = 200) will be recruited and randomized with simple randomization method and a 1:1 allocation. Recruitment will be from governmental health centers and calling on social networks. Couples will be randomized to intervention which will receive Sexual and Marital Enrichment package and control group (routine care at health centers). Couples will be followed up for 4 months. Then primary outcomes (mean score of couples’ sexual information, motivation and behavior skills) and secondary outcome (mean score of couples’ sexual satisfaction) of study will be measured through the online questionnaire.

Discussion

This trial will be examined the impact of the sexual and marital skills training package tailored to the values and norms governing the sexual life of Iranian couples on their sexual satisfaction. If the trial is effective, its results will be presented to policy makers for implementation at national level.

Trial registration

(Iranian Registry of Clinical Trials (IRCT) number): IRCT20181211041926N1. Date of registration: March 2, 2019.

Comparative Analysis of Spouse’s Burden and Quality of Life in Major Depressive Disorder and Bipolar I Disorder

Background:

Spouses of patients with bipolar disorder may experience a different quality of life and burden than seen with major depressive disorder.

Objective:

This study was conducted to comparatively analyse spouse’s burden and quality of life in major depressive and bipolar disorders.

Methods:

This cross-sectional study was conducted on 220 spouses of patients with major depressive and bipolar disorders in the city of Hamadan in Iran, in 2018. Data collection tools included Zarit Burden and QOL-BREF questionnaires. Data were analyzed by a t-test using SPSS -16.

Results:

The findings showed that 11.8% of spouses of patients with depression and 85.5% of spouses of patients with bipolar disorder experienced severe burden (P < 0.001). The quality of life of spouses of patients with bipolar disorder was lower than with depressive disorder (P < 0.05). In both the groups, a negative correlation was found between burden and QOL.

Conclusion:

The spouses of patients with bipolar disorder experience more burden and lower quality of life than depression. In both the groups, burden has a negative impact on the quality of life. Professional help and supportive intervention can be provided to the spouses of patients with major depressive and bipolar I disorders to reduce their burden, strengthen their coping skill and thus improve their QOL.

Effects of crocin in reducing DNA damage, inflammation, and oxidative stress in multiple sclerosis patients: A double-blind, randomized, and placebo-controlled trial

Multiple sclerosis (MS) is an autoimmune disease in which the immune system attacks the nerve cells, resulting in neurological disorders. Oxidative stress, free radicals, and neuritis have important roles in MS pathogenesis. Here, we aim to evaluate the effect of crocin on inflammatory markers, oxidative damage, and deoxyribonucleic acid (DNA) damage in the blood of patients with MS. A total of 40 patients were divided into two groups, drug and placebo-treated groups, using random assignment. Participants of the intervention and control groups received two crocin capsules or placebo per day for 28 days, respectively. Findings revealed a significant decrease in the level of important pathogenic factors in MS, including lipid peroxidation, DNA damage, tumor necrosis factor-alpha, and interleukin 17 as well as a significant increase in the total antioxidant capacity in the serum of patients treated with crocin compared with the placebo group. Our results suggest the beneficial and therapeutic effects of crocin in MS.

Examining the Effectiveness of a Web-Based Intervention for Depressive Symptoms in Female Adolescents: Applying Social Cognitive Theory

BACKGROUND

Depression is a serious mental health illness among adolescents especially girls. Web-based treatment can possibly become a solution for reducing mental health problems in adolescents. This study is one of the first trials aimed to evaluate the efficiency of web-based depression improvement program among female adolescents based on the Social Cognitive Theory (SCT).

STUDY DESIGN

Randomized Controlled Trial.

METHODS

A six-month randomized controlled trial based on the SCT was implemented in female schools in Hamadan City, west of Iran in 2018 on 128 female students with mild to moderate depressive symptoms (CES-D =10-45). They were randomly assigned to either intervention or control group (n= 64 in each group). Depression improvement program was implemented through the website via short videos, animations and Power-Point slides. Depression was evaluated using Center for Epidemiologic Depression Scale. A researcher-made questionnaire based on the sheerer and Perceived-Social-Support-Scale-Revised (PSSS-R) questionnaires were used to evaluate the SCT constructs. The data were analyzed using SPSS software.

RESULTS

The intervention program resulted in the improvement of depression in 12 wk based on Intent-to-treat analyses. Nevertheless, these achievements seem to have decreased by 24 wk in intervention group. The intervention increased the mean scores of the constructs of social support and self-regulation from baseline to 12 wk in the intervention group (P<0.05). The intervention had no effect on outcome expectations and self-efficacy. There were no statistically significant associated between theory constructs changes and changes in depression (P>0.05).

CONCLUSION

The web-based intervention improved depression in female students. Future training using strategies for the sustainable improvement of depression in female students are needed.

An Exploratory Mixed Method Study for Developing and Psychometric Properties of the Sexual Information, Motivation and Behavioral Skills Scale (SIMBS) in Iranian Couples

BACKGROUND

This study was designed to construct and assay the psychometric properties of a scale in order to recognize sexual information, motivation and behavioral skills of Iranian couples.

STUDY DESIGN

a mixed method study.

METHODS

This was an exploratory mixed method investigation conducted in two stages from Sep 2017 to Jun 2018 in Isfahan, Iran. First, qualitative methods (individual interviews with 22 couples) were applied to generate items and develop the questionnaire. Second, psychometric properties of the questionnaire were assessed. Reliability was evaluated by composite reliability, Interclass Correlation Coefficient (ICC) and internal consistency. Moreover, Exploratory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA) were carried out to examine construct validity. To evaluate content validity were performed CVI and CVR.

RESULTS

An item pool comprising 107 statements related to couple 'sexual information, motivation and behavioral skills were generated in the first stage. In the second stage, item reduction was exerted and the final issue of the questionnaire including 51 items was expanded. The evaluation of the psychometric properties of the final version displayed that the scale had good reliability and structure. The results from exploratory factory analysis demonstrated a 9-factor solution for the scale that jointly reported for the 39.5% of the observed variance. The mean scores of the CVI and CVR were 0.92 and 0.90, respectively. Additional analyses indicated acceptable results for composite reliability for the subscale of instrument ranging from 0.78 to 0.95.

CONCLUSION

The sexual information, motivation and behavioral skills scale is a reliable and valid instrument that can be used in future studies on Iranian couples.

Effectiveness of a Peer-Led Behavioral Intervention Program on Tobacco Use-Related Knowledge, Attitude, Normative Beliefs, and Intention to Smoke among Adolescents at Iranian Public High Schools

BACKGROUND

Theory-based tobacco use prevention programs in schools were implemented to evaluate the effectiveness of this peer-led intervention on tobacco use-related knowledge, attitude, normative beliefs, and intention to tobacco use of school children aged 14-17 years old.

METHODS

A school-based cluster randomized controlled intervention study was conducted among 1st, 2nd, and 3rd grade high school children in Sanandaj City, Iran. 4-h integrated tobacco use prevention program comprising of four structured modules was developed and delivered to the intervention group by trained peer educator. Outcome measures comprised changes in students' smoking-related knowledge, attitude, normative beliefs, and intention to tobacco use from baseline to 6-month follow-up through validated anonymous questionnaire.

RESULTS

The present study showed an intervention effect on tobacco use-related knowledge, normative beliefs, and intention to tobacco use but not attitude. The results indicated that there was significant decrease in intention to tobacco use (P ≤ 0.013) observed after 6-month postintervention. The intervention module was also effective in improving smoking knowledge (P ≤ 0.001), normative beliefs with regard to perceived prevalence of cigarette smoking and water-pipe use among adults and adolescents (P ≤ 0.001) in intervention group 6-month postintervention.

CONCLUSIONS

Participation in the peer-led education program to tobacco use prevention may have improvement in knowledge, normative beliefs, and intention to tobacco use. An implementation of the peer-led behavioral intervention components in the school setting may have a beneficial effect on public health by decreasing intention to tobacco use among nonsmoker adolescents.

Relationship between dental plaque formation and salivary cortisol level in pregnant women

Purpose:

Understanding how increased level of salivary cortisol contributes to the development of dental biofilm during pregnancy can help inthe prevention of dental caries and periodontal diseases. This study aims to evaluate the relationship between salivary cortisol level and dental biofilm formation in pregnant women.

Patients and methods:

This descriptive-analytic study was conducted in Hamadan, Iran in 2011. Forty consecutive pregnant women with no history of abortion, stillbirth, or any known physical or psychological disorders at weeks 25 and 33 of gestation were included. Salivary samples were collected for measurement of cortisol levels by Enzyme Linked Immunoabsorbent Assay (ELISA) method. The amount and extension of dental biofilms were determined by using a disclosing agent. Data were analyzed using descriptive and analytical statistics in SPSS version 16.

Results:

The mean levels of salivary cortisol at weeks 25 and 33 of gestation were respectively, 2.45 ± 1.56 μg/dl and 5.24 ± 4.07 μg/dl which demonstrates a significant difference (P<0.001). Evaluation of dental biofilm at two time intervals revealed a significant increase in amount of dental biofilm at week 33 of gestational period (34.65 ± 10.9% vs. 42.45 ± 12.35%, P<0.001). Elevated levels of dental biofilm were significantly correlated with salivary cortisol levels at week 33 (r=0.494, P=0.001),however, it was not significant at week 25 of gestation (r=0.148, P=0.361).

Conclusion:

The findings suggested that increased levels of salivary cortisol can predict dental biofilm formation and accumulation in pregnant women in the last weeks of gestation.

Prevalence of depression and its associated sociodemographic factors among Iranian female adolescents in secondary schools

Background

Across the globe, depression is a common psychiatric disorder and is the main cause of disability among adolescents. To this end, this study was conducted to screen for the prevalence of depression among secondary school female students in the city of Hamadan, in western Iran.

Methods

In this cross-sectional study, a total of 670 secondary school female students, within the age range of 15–18 years were investigated using multistage random sampling method. Moreover, the Persian version of Center for Epidemiologic Studies Depression Scale (CES-D) and a researcher-designed questionnaire containing demographic variables were employed as research instruments. Analyses of the findings were made using SPSS version 16 software followed by stratified logistic regression model, which was performed for correlation analysis.

Results

The mean (standard deviation) age of students was 16.2 (0.68) years. The prevalence of severe depression in female students estimated by the Center for Epidemiologic Studies Depression Scale (CES-D) was equal to 52.6%. A statistically significant relationship was also observed to exist between prevalence of depression and type of school (P < 0.001), family income (P < 0.001), living in the suburbs (P < 0.001), and field of study at school (P < 0.001). However, no statistically significant correlation was found between depression among students and school grade, type of living with parents, father’s education and occupation, mother’s education and occupation, and family size.

Conclusion

Depression was prevalent among the secondary school female students examined and it significantly correlated with socioeconomic status. Therefore, periodic screening, psychological training programs, proper diagnosis of high-risk individuals in secondary schools, and early intervention among secondary school female students are urgently needed.

Cognitive Process in Patients With Obsessive-Compulsive Disorder: A Cross-Sectional Analytic Study

Introduction:

In recent studies, deficit in cognitive process has been investigated as one of the etiological hypotheses in a wide range of Obsessive-Compulsive Disorder (OCD). This research aimed to compare cognitive process in patients with OCD and healthy groups.

Methods:

In the current cross-sectional analytic study, 43 patients with OCD and 43 healthy individuals matched with gender, age, educational and marital status were selected by convenience sampling method and assessed by Wisconsin Cart Sorting Test (WCST), Paced Auditory Serial Addition Test (PASAT) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The obtained data were analyzed with Chi-square, Independent t test, Mann-Whitney U test and Pearson correlation in SPSS version16.

Results:

There was no difference between the patients with OCD and the healthy group in demographic characteristics (P>0.05). There was a significant differences between two group on the all subscale of WCST test and PASAT3, PASAT2 tests (P<0.01). These findings indicate that the OCD patient’s performance in cognitive process was significantly worse than the healthy controls.

Conclusion:

The findings indicate that individuals with OCD suffer from a deficiency in various aspects of cognitive processes. Therefore, paying attention to these deficiencies can make an important contribution to the treatment of these patients.

The Prevalence of Psychiatric Disorders in Children and Adolescents in Hamadan Province, West of Iran

BACKGROUND

There are numerous reports regarding increasing childhood and adolescent mental health problems. The aim of this study was to determine the prevalence of psychiatric disorders in Hamadan Province, west of Iran from July 2016 to May 2017.

STUDY DESIGN

A cross-sectional study.

METHODS

The sample included 1025 Hamadan residents selected using multistage cluster sampling. Psychiatric disorders were assessed by semi-structured psychiatric interview Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). The data were analyzed using the SPSS software. We used the multivariable logistic regression to predict the Odds Ratios (ORs).

RESULTS

The prevalence of total psychiatric disorder was 8.6%. Psychiatric disorders in boys were higher than girls (12.6% and 4.9%, respectively). The psychiatric disorders were most prevalent in 6-9 yr old age group (11%). The prevalence of behavioral disorder was 3.8% with attention deficit hyperactivity disorder (ADHD) as the most prevalent case (2.0%). The prevalence of anxiety disorder was 2.8% in which the highest prevalence belonged to separation anxiety disorder (SAD) (1.1%). The prevalence of neurodevelopment disorder was 1.5% with the highest prevalence of 1% observed in epilepsy. The prevalence of mood disorder was 1.1% with the depressive disorder as the most prevalent one (1.0%). The prevalence of enuresis was 2.7%. The most common comorbidities were anxiety and mood disorders 5(50.0%).

CONCLUSION

The prevalence of these disorders in Hamadan was less than the prevalence in other cities of Iran. These findings can be helpful for large-scale planning for children and adolescents.

Differential pattern of brain functional connectome in obsessive-compulsive disorder versus healthy controls

Researchers believe that recognition of functional impairment in some of brain networks such as frontal-parietal, default mode network (DMN), anterior medial prefrontal cortex (MPFC) and striatal structures could be a beneficial biomarker for diagnosis of obsessive-compulsive disorder (OCD). Although it is well recognized brain functional connectome in OCD patients shows changes, debate still remains on characteristics of the changes. In this regard, little has been done so far to statistically assess the altered pattern using whole brain electroencephalography. In this study, resting state EEG data of 39 outpatients with OCD and 19 healthy controls (HC) were recorded. After, brain functional network was estimated from the cleaned EEG data using the weighted phase lag index algorithm. Output matrices of OCD group and HCs were then statistically compared to represent meaningful differences. Significant differences in functional connectivity pattern were demonstrated in several regions. As expected the most significant changes were observed in frontal cortex, more significant in frontal-temporal connections (between F3 and F7, and T5 regions). These results in OCD patients are consistent with previous studies and confirm the role of frontal and temporal brain regions in OCD.

Executive functions, selective attention and information processing in patients with obsessive compulsive disorder: A study from west of Iran

Obsessive-compulsive disorder (OCD) is associated with cognitive dysfunction. Deeper and wider knowledge of the cognitive components of these patients can play an important role in better understanding of this disorder. This study aimed to compare executive function, selective attention and information processing in OCD patients and healthy controls. The current study was performed on 54 patients meeting DSM-5 criteria for OCD and 54 healthy subjects who matched with patients in gender, age, marital and educational status. The cognitive functions were assessed by The Stroop test, Wisconsin Cart Sorting Test (WCST), Paced Auditory Serial Addition Test (PASAT) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The performance of the OCD group was significantly worse than the healthy group in comparison with the all subscales of the Stroop and WSCT tests. Also, functions in information processing among two groups were statistically significant for 3- and 2-second PASAT. The results demonstrated that OCD patients have deficits in several aspects of cognitive functions. Hence, the treatment of these patients can be contributed by paying more attention to these deficits.

Homesickness, Depression and Happiness in University Students of Hamadan, Iran

Background and aims: Students are exposed to multiple various mental disorders. One of the most important difficulties the students encounter are homesickness and depression the occurrence of which cause less happiness in the students. This study was conducted to investigate the relationship among 3 factors of homesickness, depression, and happiness in dormitory students of Hamedan University of Medical Sciences. Methods: A cross-sectional study was carried out on 387 dormitory students of Hamedan University of Medical Sciences from January to April 2016. The participants of the study were selected through stratified random sampling technique with proportional allocation. Data were collected through self-reporting and four questionnaires including demographic data questionnaire, homesickness Benfleet questionnaire, University Students Depression Inventory (USDI), and Oxford happiness questionnaire. A quantitative analysis of the inquiry was performed using SPSS software, version 23. Results: The results showed that depression had an indirect relationship (-0.6) with happiness. That is, by increasing the depression scores happiness will decrease. In addition, depression had a significantly direct relationship (0.3) with homesickness. It implies that an increase in homesickness score leads to an increase in depression score. Moreover, homesickness had a significantly indirect relationship (-0.2) with happiness. Namely, an increase in homesickness, results in a decrease in happiness. Conclusion: In view of the results obtained and given the importance of mental health of the students in dormitories, it seems that the reasons related to homesickness and depression should be recognized and included in intervention and prevention programs. Besides, appropriate interventions must be designed and implemented in this regard.

Comparison of the Clusters and Non-Clusters Areas of Attempted Suicide Cases in Hamadan Province, Western Iran: Findings from a Pilot Study (2016-2017)

BACKGROUND

Suicide behaviors are complex and multifactorial problems that in the most of the societies are considered as the public health challenge. However, its underlying reasons and spatial pattern remain unclear in Hamadan Province, western Iran.

STUDY DESIGN

Secondary analysis of existing data.

METHODS

We assessed the spatial pattern pre-city regarding some influencing factors by scan-statistics and logistic regression to detect clusters areas and its comparison with other areas for the period of 2016-2017. All of the registered cases of attempted suicide in a quality registry system of suicide in Sina (Farshchian) Hospital affiliated to Hamadan University of Medical Sciences, Hamadan, Iran were enrolled.

RESULTS

Two significant clusters were detected in study areas, formed with relative risk at 5.28 (P=0.001) and 6.33 (P=0.017), and with the centrality of Asadabad and Razan, respectively. Clusters and non-clusters areas were differed in terms of location (OR=0.15, 95%, CI: 0.07, 0.31), self-harms methods (OR=0.28, 95%, CI: 0.9, 0.88) and education. Residents of rural areas, illiterate people and non-drug user cases have more likely to be in a cluster.

CONCLUSIONS

Clusters were not formed equally among cities of Hamadan Province. Accordingly, we suggest the implementation of appropriate, long-term and evidence-based educations for high-risk and vulnerable groups through the intersectoral interventions in different parts of Hamadan Province (considering the cluster and non-clusters areas) to avert deaths and related injuries from attempted suicide.

Palmitoylethanolamide as adjunctive therapy in major depressive disorder: A double-blind, randomized and placebo-controlled trial

BACKGROUND

Experimental studies provide evidence for antidepressant effects of Palmitoylethanolamide (PEA) in animal models of depression. We aimed to evaluate the efficacy and tolerability of PEA add-on therapy in treatment of patients with major depressive disorder (MDD).

METHODS

In a randomized double-blind, and placebo-controlled study, 58 patients with MDD (DSM-5) and Hamilton Depression Rating Scale (HAM-D) score ≥ 19 were randomized to receive either 600 mg twice daily Palmitoylethanolamide or placebo in addition to citalopram for six weeks. Patients were assessed using the HAM-D scale at baseline and weeks 2, 4, and 6.

RESULTS

Fifty-four individuals completed the trial. At week 2, patients in the PEA group demonstrated significantly greater reduction in HAM-D scores compared to the placebo group (8.30 ± 2.41 vs. 5.81 ± 3.57, P = .004). The PEA group also demonstrated significantly greater improvement in depressive symptoms [F (3, 156) = 3.35, P = .021] compared to the placebo group throughout the trial period. The patients in the PEA group experienced more response rate (≥ 50% reduction in the HAM-D score) than the placebo group (100% vs. 74% respectively, P = .01) at the end of the trial. Baseline parameters and frequency of side effects were not significantly different between the two groups.

LIMITATIONS

The population size in this study was small and the follow-up period was relatively short.

CONCLUSIONS

Palmitoylethanolamide adjunctive therapy to citalopram can effectively improve symptoms of patients (predominantly male gender) with major depressive disorder. PEA showed rapid-onset antidepressant effects which need further investigation.

Genes Encoding GABA-β and HT1D Receptors in Bipolar I (Manic Phase) Patients

Introduction:

According to the cumulative evidence, genes encoding GABA receptors inhibit neurotransmitters in CNS and are intricately involved in the pathogenesis of mood disorders. Based on this hypothesis, these genes may be expressed in bipolar patients. As a result, we evaluated the gene expressions of GABA-β3 and HT1D receptors to assess their associations with bipolar mood disorder.

Methods:

In this study, 22 patients with bipolar I disorder (single manic episode) and 22 healthy individuals were enrolled. All participants were older than 15 years and had referred to Farshchian Hospital, Hamadan, Iran. They were diagnosed based on DSM IV–TR criteria and young mania rating scale in order to determine the severity of mania by a psychiatrist as bipolar Type 1 disorder in manic episode. We evaluated the expression of GABA–β3 and HT1D receptor genes in peripheral blood mononuclear cells, using real-time RT-PCR analysis.

Results:

In our study, a reduction in the gene expression of GABA–β3 and HT1D receptors was observed in peripheral blood mononuclear cells of the patients with bipolar disorders compared to the healthy controls.

Conclusion:

The results of this study supports the hypothesis that the gene expression for serotonin and GABA receptors can be employed in elucidating the pathogenesis of bipolar disorders.

Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression

Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

Acetaminophen as Adjuvant to Risperidone in Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Objective: Although the pathogenesis of schizophrenia is still uncertain, a variety of predisposing mechanisms have been implicated including inflammatory cascades. The present study was conducted to investigate the effectiveness of acetaminophen as a cyclooxygenase inhibitor in treating patients with schizophrenia. Method: A double-blind clinical trial was performed on 52 patients with chronic schizophrenia. Patients received risperidone (up to 6 mg/day) plus either acetaminophen (975mg/day) or placebo. Psychotic symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS) at the onset of the trial, and at 2, 4, 6, and 8 weeks post therapy. Results: Compared to the placebo group, the acetaminophen group showed no significant difference in any subtypes of PANSS. Moreover, the side effect profiles of the 2treatment regimens were not significantly different. Conclusion: Acetaminophen adjuvant to risperidone showed no significant effect in ameliorating symptoms of schizophrenia.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials (registration number: IRCT201410251556N67).

Evaluation of Bipolar Disorder in Several Relapses over Time Using Generalized Estimating Equations

Objective: Bipolar disorder is defined as a common and severe chronic disorder that causes several problems in a person's psychosocial functioning. This study aimed at modeling the development of bipolar disorder episodes using its determinant risk factors over time. Method: This retrospective cohort study was conducted in Hamadan province, the West of Iran, from April 2008 to September 2014. In this study, 124 patients with bipolar disorder (both Type I and Type II) participated. All patients had experienced 4 relapses. Generalized Estimating Equation (GEE) was used to model bipolar disorder episodes, and significance level was set at 0.05. Results: The mean (±SD) age of the patients was 33.2 (±11.55). Males were more likely to experience mania than depression compared to females (odds ratio = 2.30, 95% CI (1.37-3.86)). Patients who received psychotherapy plus medicine were less likely to experience mania than depression compared to drug receivers (odds ratio = 0.39, 95% CI (0.18-0.88)). In the spring, patients were more likely to experience mania than depression compared to the winter (OR = 2.22, 95% CI (1.18-4.19)). Conclusion: The results of the present study revealed that among bipolar disorder patients in the West of Iran, mania was much more prevalent than depression and mixed episodes. Moreover, it was found that sex, treatment, and season can determine the episodes of bipolar disorder.

Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae

Objective:

Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched.

Methods:

A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs.

Results:

Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support.

Conclusions:

The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.

Synaptosome-Associated Protein 25 (SNAP25) Gene Association Analysis Revealed Risk Variants for ASD, in Iranian Population

Autism spectrum disorder (ASD) is a common, complex neurological condition, affecting approximately 1% of people worldwide. Monogenic neurodevelopmental disorders which showed autistic behavior patterns have suggested synaptic dysfunction, as a key mechanism in the pathophysiology of ASD. Subsequently, genes involved in synaptic signaling have been investigated with a priority for candidate gene studies. A synaptosomal-associated protein 25 (SNAP25) gene plays a crucial role in the central nervous system, contributing to exocytosis by targeting and fusion of vesicles to the cell membrane. Studies have shown a correlation between aberrant expression of the SNAP25 and a variety of brain diseases. Single nucleotide polymorphisms (SNPs) in this gene are associated with several psychiatric diseases, such as bipolar, schizophrenia, and attention-deficit/hyperactivity disorder. The aim of the present study was to investigate whether polymorphisms (rs3746544 and rs1051312) in the regulatory 3'-untranslated region (3'UTR) of the SNAP25 gene have an association with ASD in unrelated Iranian case (N = 524)-control (N = 472) samples. We observed robust association of the rs3746544 SNP and ASD patients, in both allele and haplotype-based analyses. Our results supported the previous observations and indicated a possible role for SNAP25 polymorphisms as susceptibility genetic factors involved in developing ASD.

Minocycline as Adjunctive Treatment to Risperidone in Children with Autistic Disorder: A Randomized, Double-Blind Placebo-Controlled Trial

OBJECTIVE

This is an investigation of minocycline efficacy and safety as an adjuvant to risperidone in management of children with autism.

METHODS

Forty-six children with diagnosis of autistic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) criteria and a score of ≥12 on the Aberrant Behavior Checklist-Community (ABC-C) irritability subscale, who were already drug-free for at least 6 months participated in a randomized controlled trial and underwent 10 weeks of treatment with either minocycline (50 mg twice per day) or placebo in addition to risperidone titrated up to 2 mg/day (based on bodyweight). Patients were evaluated using ABC-C at baseline and at weeks 5 and 10.

RESULTS

General linear model repeated measures showed significant effect for time × treatment interaction on the irritability [F(2, 88) = 3.94, p = 0.02] and hyperactivity/noncompliance [F(1.50, 66.05) = 7.92, p = 0.002], but not for lethargy/social withdrawal [F(1.61, 71.02) = 0.98, p = 0.36], stereotypic behavior [F(1.34, 58.80) = 1.55, p = 0.22], and inappropriate speech subscale scores [F(1.52, 66.88) = 1.15, p = 0.31]. By week 10, 21 (91.3%) patients in the minocycline group and 15 (65.5%) patients in the placebo group achieved at least partial response (p = 0.03). Frequencies of adverse events were not significantly different between groups.

CONCLUSIONS

Minocycline seems to be a safe and effective adjuvant in management of patients with autistic disorder. Future studies with larger sample sizes, longer follow-ups, and inflammatory cytokine measurements are warranted to confirm these findings and provide insight into minocycline mechanism of action in autistic disorder.

Crocus sativus L. versus Citalopram in the Treatment of Major Depressive Disorder with Anxious Distress: A Double-Blind, Controlled Clinical Trial

Introduction: Saffron (Crocus sativus L.) has demonstrated antidepressant effects in clinical studies and extensive anxiolytic effects in experimental animal models.

Methods: 66 patients with major depressive disorder accompanied by anxious distress were randomly assigned to receive either saffron (30 mg/day) or citalopram (40 mg/day) for 6 weeks. Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) were used to assess treatment effect during the trial.

Results: 60 participants finished the study. Patients who received either saffron or citalopram showed significant improvement in scores of the Hamilton Rating Scale for Depression (P-value<0.001 in both groups) and Hamilton Rating Scale for Anxiety (P-value<0.001 in both groups). Comparison of score changes between the 2 trial arms showed no significant difference (P-value=0.984). Frequency of side effects was not significantly different between the 2 groups.

Discussion: The present study indicates saffron as a potential efficacious and tolerable treatment for major depressive disorder with anxious distress.

Riluzole in augmentation of fluvoxamine for moderate to severe obsessive-compulsive disorder: Randomized, double-blind, placebo-controlled study

AIM

The aim of the present randomized, double-blind, placebo-controlled, 8-week trial was to assess the efficacy and tolerability of riluzole augmentation of fluvoxamine in treatment of patients with moderate to severe obsessive-compulsive disorder.

METHODS

Patients were randomized into two parallel groups to receive fluvoxamine plus placebo or fluvoxamine plus riluzole (50 mg twice daily). All patients, regardless of their treatment group, received fluvoxamine at 100 mg/day for the initial 4 weeks of the study followed by 200 mg/day of fluvoxamine for the rest of the trial course. A total of 50 patients (25 in each group) were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at weeks 4, 8 and 10. Side-effects were recorded using predesigned checklists in each visit. Repeated-measure analysis of variance showed a significant effect for time × treatment interaction in the Y-BOCS total score and a significant effect for time × treatment interaction in the Y-BOCS Compulsive subscale score between the two groups.

RESULTS

Repeated-measure analysis of variance showed a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.07, d.f. = 1.22, P = 0.04) in the Y-BOCS total score and a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.45, d.f. = 1.33, P = 0.028) in the Y-BOCS Compulsive subscale score between the two groups. Riluzole augmentation therapy demonstrated higher, partial or complete treatment response according to the Y-BOCS total scores.

CONCLUSION

Riluzole may be of clinical use as an adjuvant agent to fluvoxamine in treatment of moderate to severe obsessive-compulsive disorder.

Predictors of Fear Related to Childbirth among Iranian Primigravidae

<p>Fears related Pregnancy-and childbirth are common psychological concerns and the main reasons for requesting cesarean section (CS). The current study aimed at describing the association between fear of childbirth and social, demographic and psychological factors and examines the predictors of maternal fear in a 342 healthy primigravidae women with uncomplicated singleton pregnancies. In this cross-sectional study, the participants (n=342 primigravidae) was randomly selected in 12 health care centers in Iran. The data was obtained by valid and reliable self-administered questionnaires that included questions on socio-demographic, psychological characteristics (self esteem, perceived stress, quality of marital relationship, perceived social support), fear related to childbirth and childbirth and analyzed by SPSS19. All primigravidae reported some degree of fear, i.e., 48.2% presented severe fear, and 62.6% requested a CS because of childbirth-related fear. Age, employment, level of education and medical insurance were associated with fear related to childbirth, as well as plan of pregnancy, self esteem and perceived stress. In combination, HBM subscales and the psychosocial factors accounted for a significant 68% of the variability in fear related to childbirth, <em>R²</em>=0.68, adjusted <em>R²</em>=0.67, <em>F</em>(12, 326)<strong>=</strong>69.4, p&lt;0.001. Fears related to pregnancy and childbirth was frequently experienced by all low-risk primigravidae. Better strategies to address women’s psychological needs during pregnancy are necessary.</p>

Celecoxib adjunctive therapy for acute bipolar mania: a randomized, double-blind, placebo-controlled trial

OBJECTIVES

Recent research has focused on the inflammatory cascade as a key culprit in the etiology of bipolar disorder. We hypothesized that celecoxib, via its anti-inflammatory properties, may have a therapeutic role in mood disorder.

METHODS

Forty-six inpatients with the diagnosis of acute bipolar mania without psychotic features participated in a parallel, randomized, double-blind, placebo-controlled trial, and underwent six weeks of treatment with either celecoxib (400 mg daily) or placebo as an adjunctive treatment to sodium valproate. Patients were evaluated using the Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS). The primary outcome measure with respect to efficacy was the mean decrease in YMRS score from baseline to the study endpoint, which was compared between the two groups.

RESULTS

A significant difference was observed in the change in YMRS scores on Day 42 compared to baseline in the two groups (p < 0.001). The changes at the endpoint compared to baseline were -29.78 ± 21.78 (mean ± standard deviation) and -21.78 ± 7.16 for the celecoxib and placebo groups, respectively. A significantly higher remission rate was observed in the celecoxib group (87.0%) than the placebo group (43.5%) at Week 6 (p = 0.005). General linear model repeated measures demonstrated a significant effect for the time × treatment interaction on the YMRS scores [F(2.27,99.98) = 6.67, p = 0.001].

CONCLUSIONS

Celecoxib is an effective adjuvant therapy in the treatment of manic episodes (without psychotic features) of bipolar mood disorder. The mood-stabilizing role of the drug might be mediated via its action on the inflammatory cascade.

Oral loading of sodium valproate compared to intravenous loading and oral maintenance in acutely manic bipolar patients

BACKGROUND

In patients suffering from bipolar disorders (BPD), we explored to what extent oral loading of sodium valproate (SV) leads to more rapid symptom improvement compared to intravenous loading and oral maintenance administration.

METHODS

Ninety patients (mean age: 35.00 years) with BPD and currently in an acute manic state were randomly assigned to one of three study conditions: oral loading (20 mg/kg oral single-dose SV on the first day, then 10-15 mg/kg SV daily, divided dose), intravenous loading (20 mg/kg SV intravenous injection on the first day, then 10-15 mg/kg orally, divided dose), or oral maintenance administration (15-20 mg/kg SV daily from the beginning) over the first 7 days of treatment. SV plasma levels, side effects and symptoms were evaluated at baseline and on days 1, 3, and 7 after commencing treatment.

RESULTS

There were significant Time-by-Group interactions for symptom improvements, symptom severity, and SV plasma levels, with positive values in the oral and intravenous loading conditions, compared to the oral maintenance condition. Post hoc analyses showed that oral and intravenous conditions led to similar improvements.

CONCLUSIONS

Both oral and intravenous loading of SV led to quicker and more efficient improvement and SV plasma levels as compared to an oral maintenance regimen.