Comorbidities of Major Depressive Disorder and Bipolar Disorders in Patients with Substance Use Disorder in Iran Psychiatric Hospital: A Cross-sectional Study

Background

Mood disorders are the most common psychiatric comorbidities in substance users. Mood disorders and substance use disorders are 2 intertwined processes in which treating one aid in treating the other. Depression and substance use disorder are now regarded as major mental health issues due to their widespread incidence. The study was designed to investigate the prevalence of major depressive disorder (MDD) and bipolar I and II disorders in patients with substance use disorder.

Methods

The participants of this cross-sectional study were 320 patients with substance use disorder based on the DSM-5 (diagnostic and statistical manual of mental disorders 5th edition) criteria in Iran Psychiatric Hospital in 2020, who were assessed using the SCID-5-CV (Structured Clinical Interview for DSM-5 disorders-clinician version), and the demographic and clinical variables questionnaire considering familial and substance use history. The chi-square, Fisher, independent t test, and logistic regression were used to analyze the data.

Results

Of the patients, 32.8% (n = 105) had mood disorders. The most common mood disorder was MDD (16.9%, n = 54), followed by bipolar I (12.5%, n = 40) and bipolar II (2.8%, n = 9) disorders. Methamphetamine was the most commonly used substance (47.5%, n = 152). Also, 62.5% (n = 200) of participants consumed 2 or more substances simultaneously. The chance of having a mood disorder in married and divorced patients was 2.12 and 2.04 times more than in single patients, respectively.

Conclusion

The lifetime prevalence of bipolar I disorder in patients with substance use disorders is several times more than the general population, thus psychiatrists should pay more attention to mood comorbidities diagnosis and treatment in substance users.

Comparison of Online Sexual Activity Among Iranian Individuals With and Without Substance Use Disorder: A Case-Control Study

The most important practical concerns in addiction medicine are the non-substance addiction and related addictive behaviors among individuals with substance use disorder. On the other hand, technological advances, and easy access have increased the frequency of online sexual activities (OSAs) as one of these behaviors. This study aimed to compare the prevalence of OSAs, based on the Internet Sex Screening Test (ISST) scores, among 60 patients with substance use disorder referred to Iran Psychiatric Hospital and 60 non-dependent individuals. The results showed significant negative correlations between the ISST scores and age, age at the onset of substance use, and substance use duration. There was a significant difference between the ISST scores of the case and control groups (P = 0.001). Patients who start using substances at an early age and have a great duration of substance use are more likely to engage in other addictive behaviors such as OSAs. Therefore, it is critical to consider OSAs and other addictive behaviors in patients with substance use disorder to provide better care for this vulnerable community.

Cognitive network reconstruction in individuals who use opioids compared to those who do not: Topological analysis of cognitive function through graph model and centrality measures

INTRODUCTION

Cognitive dysfunction related to opioid use disorder (OUD) requires investigation of the interconnected network of cognitive domains through behavioral experiments and graph data modeling.

METHODS

We conducted n-back, selective and divided attention, and Wisconsin card sorting tests and reconstructed the interactive cognitive network of subscales or domains for individuals who use opioids and controls to identify the most central cognitive functions and their connections using graph model analysis. Each two subscales with significant correlations were connected by an edge that incorporated in formation of interactive networks. Each network was analyzed topologically based on the betweenness and closeness centrality measures.

RESULTS

Results from the network reconstructed for individuals who use opioids show that in the divided attention module, reaction time and number of commission errors were the most central subscales of cognitive function. Whereas in controls, the number of correct responses and commission errors were the most central cognitive measure. We found that the subscale measures of divided attention module are significantly correlated with those of other tests. These findings corroborate that persons who use opioids show impaired divided attention as higher reaction time and errors in performing tasks. Divided attention is the most central cognitive function in both OUD subjects and controls, although differences were observed between the two groups in various subscales.

DISCUSSION

Although equal proportions of males and females may be used in future studies, divided attention and its subscales may be the most promising target for cognitive therapies, treatments and rehabilitation as their improvement can enhance overall cognitive domain performance.

The Comparison Between Positive & Negative Symptoms Severity in Prolonged Methamphetamine-Induced Psychotic Disorder and Schizophrenia

Introduction: This study aims to compare the positive and negative symptoms of schizophrenia in patients who had psychotic symptoms more than one month after discontinuation of methamphetamine abuse. These factors were analyzed by the PANSS (Positive and Negative Syndrome Scale) questionnaire. Materials and Methods: 60 participants were selected from patients referred to Iran Psychiatric Hospital with psychotic symptoms (delusions or hallucinations, disorganized behavior, and speech). The control group was 30 patients with schizophrenia based on a semi-structured interview according to DSM-IV-TR (SCID). 30 patients with the prolonged methamphetamine-induced psychotic disorder had been also placed in the case group. For both groups of patients, questionnaires of PANSS, BPRS, GAF was filled after obtaining the consent of the company. The scale scores were compared between groups. To evaluate the mean of PANSS, BPRS, and the GAF scores between the two groups we used the Mann-Whitney and the chi-square test. Results: There was no significant difference in terms of positive and general pathology scores between two groups but the total score of negative symptoms in the schizophrenia group was significantly higher than the group of prolonged methamphetamine psychotic disorders (P = 0.034). Average scores of Uncooperativeness (0.013), Unusual thought content (0.004), Motor retardation (0.011), unusual thought content (0.002) and, Hostility (0.001) in schizophrenia were significantly higher than prolonged methamphetamine psychosis. Conclusion: The results showed that most of the disturbances in patients with schizophrenia may be more influenced by the expression of cognitive disabilities in them compared to patients with methamphetamine psychosis. The difference in scores of negative symptoms suggesting that schizophrenia and prolonged methamphetamine psychotic disorder can be two different disorders.

Medication Adherence and Drug Attitude Amongst Male Patients with the Methamphetamine-Induced Psychotic Disorder After Discharge: A Three Months Follow Up Study

Medication adherence and attitudes toward psychiatric medication affect treatment outcome. The objective of this study was to evaluate the effect and interaction of psychotic symptoms, sociodemographic factors, and attitudes concerning medication use with a three-month follow-up among methamphetamine-induced psychotic male patients. In this prospective, descriptive study, 42 male patients diagnosed with a methamphetamine-induced psychotic disorder were selected on the last day of their admission period in Iran Psychiatry Hospital, Tehran, Iran. Each patient was evaluated using the Persian version of the Drug Attitude Inventory (DAI-10), Medication Possession Ratio (MPR), Positive and Negative Syndrome Scale (PANSS), as well as a sociodemographic questionnaire immediately, one month and three months after discharge. There was a significant difference in MPR between the first and third months. Moreover, the frequency of patients with a positive attitude toward their medications increased over time. Indeed, all participants stated a positive attitude at the last follow-up based on the DAI-10 cutoff. Based on our findings, medication adherence of male patients with methamphetamine-induced psychotic disorder should be an essential aspect of treatment after discharge from psychiatry inpatient wards, more specifically, through the first months.

Assessment of psychiatrists' approaches regarding disclosure of psychiatric disorders to their patients: a qualitative study

Background: Diagnosis disclosure is the result of a shift in medical approaches from traditional paternalism to participatory and patient-centered decision making. Disclosure of psychiatric diagnosis remained uncommon and controversial. Giving information about psychiatric illnesses is very complicated, and it is affected by several factors. While clinical guidelines provide a clear pathway for treating patients, in practice, the treatment of patients is influenced by cultural and social factors. The aim of the current study was a qualitative assessment of psychiatrists’ approaches regarding the disclosure of psychiatric disorders to their patients.

Methods: The current study was conducted with a qualitative approach. The participants were purposefully selected psychiatrists from three medical universities in Tehran, Iran. The data gathered using the semi-structured interview method. Sixteen interviews with 14 psychiatrists were conducted. Data were analyzed using thematic analysis.

Results: Psychiatrists decide to disclose the diagnosis based on several factors. We summarized these factors in a central theme, passive situational decision making based on paternalism and displacement of responsibility. It has two subthemes, including "passive and situational decision making" and "paternalism and displacement of responsibility." Each theme presented by detailed quotations.

Conclusion: The results of this study showed that psychiatrists did not actively disclose the diagnosis name to patients. Diagnosis disclosure was influenced by several factors, such as the certainty about the diagnosis and the severity of the disease. This passive approach does not respect the patient's rights. The paternalistic nature of this approach mandates psychiatrists to consider themselves as the responsible perosn for their patients’ welfare.

Validity and reliability of the Persian version of "drug-related knowledge and attitude questionnaire" among Iranian medical students

BACKGROUND

Promoting drug-related knowledge and improving relevant attitudes among students are of crucial importance toward the prevention of drug misuse. Objective: This study aimed to assess the validity and reliability of the "drug-related knowledge and attitude questionnaire" among Iranian medical students. Methods: The participants of this cross-sectional study were students of Iran University of Medical Sciences. The "drug-related knowledge and attitude questionnaire" and a socio-demographic questionnaire were used to gather the data. Content validity was assessed by a panel of 11 experts, and face validity was evaluated by 10 participating students. Item-total correlation and Cronbach's alpha coefficients were used as internal consistency estimates. Results: The face and content validity of the questionnaire were satisfactory. The overall content validity index was .82. Cronbach's alpha was .679, indicating an acceptable degree of internal consistency and homogeneity between the items. Overall, most of the students had adequate knowledge about the harmful effects of addictive substances (48.11 ± 3.26). Conclusions: The "drug-related knowledge and attitude questionnaire" has favorable validity and reliability to assess the knowledge and attitude of Iranian students toward drug misuse and may be used in clinical and epidemiological studies. Besides, our findings can provide a suitable starting point for the implementation of effective psychoeducational interventions aimed at the improvement of the students' knowledge and attitudes toward drug misuse.

Metabolic Syndrome in Patients with Bipolar Disorder Treated with Atypical Antipsychotics, their First-degree Relatives and Control Group

Introduction and objective

Patients with serious mental illness have lower life expectancy and higher prevalence of metabolic syndrome compared to normal population. Although, we have little evidence about their first-degree relatives.

Aims

To compare metabolic syndrome in patients with bipolar disorder treated with atypical antipsychotics, their first degree relatives and healthy subjects in two age groups: under and over 40.

Methods

This cross-sectional study was conducted on 100 patients with bipolar disorder treated with atypical antipsychotics, 50 first degree relatives and 135 healthy subjects. The prevalence of metabolic syndrome was assessed based on National Cholesterol Education Program (NCEP).

Results

Under the age of 40, the prevalence of metabolic syndrome was 15.4% in patients with Bipolar disorder, 17.6% in first degree relatives and 7% in healthy subjects. Systolic blood pressure was significantly higher in bipolar disorder patients (P = 0.004). In those over 40, the prevalence of metabolic syndrome was 31.8% in patients with bipolar disorder, 33.3% in first-degree relatives and 32.8% in healthy subjects. Serum levels of HDL were significantly lower in bipolar disorder patients (P = 0.002).

Conclusion

Patients with bipolar disorder and their first-degree relatives have greater chance for cardiovascular disease due to higher metabolic syndrome. Further investigations are needed for evaluating serious mental illness patients and their relatives.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

C-reactive protein and parathyroid hormone in acute severe psychotic disorders (schizophrenia, bipolar disorder and methamphetamine-induced psychotic disorder)

Introduction

and objectives Schizophrenia accompanies with elevated C-reactive protein (CRP) and vitamin D deficiency. However, there are scarce documentations regarding bipolar disorder and methamphetamine-induced psychotic disorder.

Aim

To compare serum levels of vitamin D, parathyroid hormone (PTH), calcium, phosphorus and CRP levels in psychotic disorder patients and control group.

Methods

A case-control study was conducted on four groups: acute phase of schizophrenia, acute manic episode of bipolar disorder, methamphetamine-induced psychotic disorder and healthy control subjects. Sample size was 45 in each group. Weekly duration of sun exposure, monthly vitamin D intake and serum levels of vitamin D, calcium, phosphorus, PTH and CRP were assessed. Brief Psychiatric Rating Scale (BPRS) was used to evaluate psychotic symptoms.

Results

Duration of sun exposure and monthly vitamin D intake were comparable among groups. Serum levels of vitamin D, calcium and phosphorus were not statistically different between groups (P = 0.463, P = 0.086 and P = 0.339, respectively). Serum levels of PTH were significantly higher in control group (P < 0.001). CRP levels were significantly lower in control subjects (P < 0.001). The levels of serum vitamin D and CRP did not show statistically significant difference among three groups of patients.

Conclusion

Acute psychotic disorders seem to be associated with higher CRP and lower PTH levels. Clinical importance of the findings and relation of these differences to the metabolic and inflammatory bases of psychosis are not clear yet.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

DNA hypermethylation of serotonin transporter gene promoter in drug naïve patients with schizophrenia

INTRODUCTION

Dysfunctional serotonin signaling has been linked to the pathogenesis of autism, obsessive compulsive disorder, mood disorders and schizophrenia. While the hypo-activity of serotonin signaling is involved in the pathogenesis of depression, anxiety and obsessive compulsive disorder; LSD, an agonist of serotonin type 2 receptor (5-HTR2A) induces psychosis. Therefore, anxiety and depressive disorders are treated by SSRIs which inhibit serotonin transporter (5-HTT) while psychotic disorders are controlled by drugs that block serotonin and/or dopamine receptors. Since genetic polymorphisms and epigenetic dysregulation of 5-HTT are involved in the pathogenesis of mental diseases, we analyzed DNA methylation of 5-HTT promoter in post-mortem brains and saliva samples of patients with schizophrenia (SCZ) and bipolar disorder (BD) to evaluate its potential application as a diagnostic and/or therapeutic biomarker in SCZ and BD.

METHODS

Whole genome DNA methylation profiling was performed for a total of 24 samples (including two saliva samples) using the Illumina 27K (for 12 samples) and 450K DNA methylation array platform (for another 12 samples), followed by bisulfite sequencing to identify candidate CpGs for further analysis. Quantitative methylation specific PCR (qMSP) was used to assess the degree of CpG methylation of 5-HTT promoter in 105 post-mortem brains (35 controls, 35 SCZ and 35 BD) and 100 saliva samples (30 controls, 30 SCZ, 20 BD and 20 first degree relatives of SCZ or BD). The U133 2.0 Plus Human Transcriptome array for a total of 30 post-mortem brain samples (each group 10) followed by quantitative real-time PCR was used to study 5-HTT expression in 105 post-mortem brain samples.

RESULTS

The qMSP analysis for 5-HTT promoter region showed DNA hypermethylation in post-mortem brain samples of SCZ patients (~30%), particularly in drug free patients (~60%, p=0.04). Similarly, there was a trend for DNA hypermethylation in antipsychotic free BD patients (~50%, p=0.066). qMSP analysis of DNA extracted from the saliva samples also exhibited hypermethylation of 5-HTT promoter in patients with SCZ (~30%, p=0.039), which was more significant in drug naïve SCZ patients (>50%, p=0.0025). However, the difference was not significant between the controls and unaffected first degree relatives of patients with SCZ (p=0.37) and versus patients using antipsychotic drugs (p=0.2). The whole genome transcriptome analysis of post-mortem brain samples showed reduced expression of 5-HTT in SCZ compared to the control subjects (~50%, p=0.008), confirmed by quantitative real-time PCR analysis (~40%, p=0.035) which was more significant in drug free SCZ patients (~70%, p=0.022).

CONCLUSION

A correlation between reduction in 5-HTT expression and DNA hypermethylation of the 5-HTT promoter in drug naïve SCZ patients suggests that an epigenetically defined hypo-activity of 5-HTT may be linked to SCZ pathogenesis. Furthermore, this epigenetic mark in DNA extracted from saliva can be considered as one of the key determinants in a panel of diagnostic and/or therapeutic biomarkers for SCZ.