The burden of traumatic brain injury on caregivers: exploring the predictive factors in a multi-centric study

BACKGROUND

Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide. With survivors often exhibiting degrees of function loss, a significant burden is exerted on their caregivers. The purpose of this study was to explore the predictive factors of caregiver burden among caregivers of patients with TBI.

METHODS

Sixty-eight family members of individuals with a TBI who had been admitted to three hospitals were assessed in terms of caregiver burden using the Zarit Burden Interview. The association of caregiver burden with patients' baseline cognitive function according to the Montreal Cognitive Assessment (MoCA) test, as well as caregivers' sociodemographic characteristics, were evaluated using multiple regression analysis.

RESULTS

Based on the multiple regression model, the MoCA score of the patients (std β=-0.442, p < 0.001), duration of caregiving (std β = 0.228, p = 0.044), and higher education of the caregivers (std β = 0.229, p = 0.038) were significant predictors of caregiver burden.

CONCLUSION

Overall, our findings highlight the importance of taking caregivers' psychosocial needs into account. Long-term caregivers of TBI patients with cognitive impairment should be viewed as vulnerable individuals who could benefit from psychosocial intervention programs, to improve their well-being and enabling them to enrich their care of the TBI patient.

The effect of drug holidays on sexual dysfunction in men treated with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine: an 8-week open-label randomized clinical trial

INTRODUCTION

Selective serotonin reuptake inhibitors (SSRIs) are widely used for the treatment of various mental disorders. Sexual dysfunction is one of the most common side effects of SSRIs, and often leads to poor adherence and treatment discontinuation. While several strategies have been employed to manage SSRI-induced sexual dysfunction, drug holidays has not been extensively studied for this purpose. This clinical trial aims to assess the effect of drug holidays on sexual dysfunction in married men under treatment with SSRIs other than fluoxetine (as its long half-life makes drug holidays ineffective).

METHODS

This 8-week double-center, randomized, open-label, controlled trial was conducted in the outpatient clinics of Iran Psychiatric Hospital and Tehran Institute of Psychiatry, from January 2022 to March 2023. We included married men aged between18 and 50 years who had experienced sexual dysfunction during treatment with SSRIs, other than fluoxetine. The Male Sexual Health Questionnaire (MSHQ) and the 28-Question General Health Questionnaire (GHQ-28) were used for the assessment of sexual function and mental health status. The drug holidays group was instructed not to take their medications on the weekends. The control group was asked to continue their regular medication regimen without any changes. Both groups were assessed at baseline, and weeks 4 and 8.

RESULTS

Sixty-three patients were included and randomly assigned to the drug holidays group (N = 32) or the control group (N = 31). Fifty patients (25 in each group) completed the trial. Drug holidays significantly improved erection, ejaculation, satisfaction, and the overall sexual health of the participants (P < 0.001). No significant change was observed in their mental health status. No major side effects were recorded.

CONCLUSIONS

Drug holidays significantly improved the MSHQ scores in 'erection', 'ejaculation', 'satisfaction' and 'total' in married men with sexual dysfunction induced by SSRIs, other than fluoxetine, without causing any significant changes in their mental health status. Further research is needed to reach a certain conclusion.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials on 2021.10.25 ( www.irct.ir ; IRCT ID: IRCT20170123032145N6) before the trial.

A disastrous year that ends with corona outbreak: Effects on mental health of university students

ObjectiveWe aimed to evaluate depression, anxiety and stress in university students of a large university in Tehran. Iranians witnessed an extraordinary combination of natural and man-made disasters last year; the last of which was the outbreak of COVID-19. Participants: 234 students from Iran University of Medical Sciences. Methods: We designed an online survey to gather data related to General Health Questionnaire (GHQ)-28, Depression, Anxiety, and Stress Scale (DASS)-21, and demographic data. Results: The mean score of GHQ-28 was 34.4 (SD = 15.5, n = 195), and 73.8% (n = 144) of the sample had a score of higher than cut-point (23). According to DASS-21, varying degrees of depression, anxiety, and stress existed in 51%, 32%, and 56% of the students. Conclusions: Negative effects of stressful life events on mental health seems to be additive. More often than not, students need some kind of mental health care at the time of COVID-19 outbreak.

Safety and Efficacy of Drug Holidays for Women with Sexual Dysfunction Induced by Selective Serotonin Reuptake Inhibitors (SSRIs) Other than Fluoxetine: An Open-Label Randomized Clinical Trial

Selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of psychopharmacology. However, they cause side effects such as sexual dysfunction, leading to the discontinuation of treatment. We aimed to investigate the efficacy and safety of drug holidays for women experiencing sexual dysfunction Induced by SSRIs other than fluoxetine. This study was an 8-week randomized, open-label, controlled trial including married women aged between 18 and 50 years who had experienced sexual dysfunction while undergoing treatment with SSRIs. The intervention group implemented drug holidays by not taking medications on Thursdays and Fridays, while the control group continued regular medication use. The female sexual function index (FSFI) and the 28-question general health questionnaire (GHQ-28) were administered to assess sexual function and mental health, respectively. A total of 50 participants completed the trial. The drug holidays' group showed significant improvements in arousal (p < 0.001), desire (p = 0.001), orgasm (p < 0.001), satisfaction (p < 0.001), lubrication (p = 0.021), and overall sexual health (p < 0.001). The between-group difference of pain was significant (p < 0.001), despite no significant within-group change. Mental health improved in both groups, despite no significant between-group difference. No major adverse effects were reported. Drug holidays did not introduce immediate safety concerns or significant adverse effects during the timeframe of eight weeks, suggesting that it may be a safe and effective strategy for managing SSRI-induced sexual dysfunction in women, alongside improving mental health. Further research is needed to reach a definitive conclusion.

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial

BACKGROUND

As 40-60% of the patients with obsessive-compulsive disorder (OCD) do not adequately respond to the first-line treatment, finding an effective second-line treatment is required. Our aim was to assess the efficacy and safety of agomelatine (a selective melatonin receptor agonist and a 5-hydroxytryptamine (HT)2 C antagonist) augmentation of sertraline in the treatment of patients with moderate to severe OCD.

METHODS

In this 12-week randomized, double-blinded, placebo-controlled, parallel-group clinical trial, 65 patients with moderate to severe OCD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) criteria and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of over 21, were included. They were assigned with sertraline (100 mg/day for the first 4 weeks and 200 mg/day for the next 8 weeks) and either agomelatine (25 mg/day) or placebo. The primary outcome was OCD symptoms measured by the Y-BOCS.

RESULTS

Fifty patients (24 in agomelatine group and 26 in placebo group) completed the trial. The Y-BOCS scores in total (MD (95% CI) = 12.25 (11.00, 13.49) (P < 0.001) vs. MD (95% CI) = 12.46 (6.65, 15.74) (P < 0.001)), the obsession subscale (MD (95% CI) = 5.04 (4.19, 5.88) (P < 0.001) vs. MD (95% CI) = 5.00 (3.84, 6.16) (P = 0.0001)), and compulsion subscale (MD (95% CI) = 7.21 (6.34, 8.07) (P < 0.001) vs. MD (95% CI) = 7.460 (6.50, 8.42) (P < 0.001)) significantly decreased in both groups. Although, at the end of the trial, no significant difference was observed between the scores of the two groups in total (MD (95% CI) = 0.480 (-1.23, 2.19) (P = 0.78)), the obsession subscale (MD (95% CI) = 1.020 (-0.15, 2.19) (P = 0.38)), and the compulsion subscale (MD (95% CI) = 0.540 (-0.34, 1.42) (P = 0.54)). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups.

CONCLUSION

Agomelatine in augmentation with sertraline is safe and tolerable in patients with moderate to severe OCD. However, our study does not support its efficacy in improving OCD symptoms, compared to placebo.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials on 14/07/2020 ( www.irct.ir ; IRCT ID: IRCT20170123032145N5).

Raphe Nuclei Echogenicity and Diameter of Third Ventricle in Schizophrenia Measured by Transcranial Sonography

Introduction

Serotonergic system hyperactivity at 5-HT2A receptors on glutamate neurons in the cerebral cortex is one of the pathways that is theoretically linked to psychosis. In addition to neurotransmitter dysfunction, volumetric studies have revealed the loss of cortical gray matter and ventricular enlargement in patients with schizophrenia, although there is no case-control research on patients with schizophrenia to evaluate echogenicity of raphe nuclei (RN) or diameter of the third ventricle (DTV). To address these issues, the present study assessed midbrain RN, as the main source of brain serotonin, and DTV, as an index of atrophy, by transcranial sonography (TCS) in a group of patients with schizophrenia.

Methods

Thirty patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and DTV. TCS was done through a temporal bone window via a phased-array ultrasound using a 2.5 MHz transducer in a depth of 14-16 cm. RN echogenicity was assessed by a semi-quantitative visual scale and DTV was measured in the thalamic plane.

Results

Twenty-three patients (76.5%) and 15 controls (50 %) showed hypoechogenicity of RN, which was marginally significant (P=0.06). DTV was on average larger in the experimental group (0.388 cm vs 0.234 cm, P<0.001).

Conclusion

Increased DTV in patients with schizophrenia is consistent with previous neuroimaging findings. However, marginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.

Highlights

30 patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and diameter of the third ventricle (DTV).23 patients (76.5%) and 15(50 %) controls showed hypoechogenicity of RN which was marginally significant (P=0.06)DTV was in average larger in the patient's group (0.388 cm vs 0.234 cm, P<0.001).Increased DTV in the patients with schizophrenia is consistent with previous neuroimaging findingsMarginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.

Plain Language Summary

Schizophrenia is a disabling psychiatric disorder. Various neurotransmitters have a role in the pathophysiology of schizophrenia including Serotonin and dopamine. This study assessed the echogenicity of raphe nuclei (RN), as the main source of brain serotonin, and the diameter of the third ventricle (DTV), as an index of atrophy, by transcranial sonography (TCS) method in 30 patients with schizophrenia and 30 healthy controls. Based on the results, 23 patients (76.5%) and 15 controls (50%) showed decreased echogenicity of RN. There was a significant difference between the two groups in terms of the echogenicity of RN. Moreover, the DTV diameter was significantly larger in patients compared to controls.

Higher anxiety and perceived trauma among COVID-19 patients: a prospective comparative study

BACKGROUND AND PURPOSE

Psychiatric disorders such as anxiety, depression, and traumatic stress are not rare during infectious outbreaks, as the COVID-19 pandemic has posed a great concern to the general population. In this study, we aimed to investigate whether experiencing psychiatric symptoms during COVID-19 is the result of the burden of carrying an illness or the COVID-19 itself.

METHOD

Two hundred ten subjects and three different groups of participants (COVID-19 patients, university staff, and orthopedic patients) were recruited. They answered a demographic questionnaire, Yale-Brown Obsessive-Compulsive Scale (YBOCS) test for OCD symptoms, Impact of Event Scale-Revised (IES-R) for perceived trauma, Beck Anxiety Inventory (BAI) for anxiety, and Beck Depression Inventory (BDI) for depression assessments using phone or face-to-face interviews.

RESULT

At least one OCD symptom was observed in 85.7% of the subjects. However, there was no significant difference between the 3 groups (p = 0.2194). Perceived trauma was significantly higher among COVID-19 patients followed by university staff and orthopedic patients (23.73, 16.21, 11.51 mean IES-R scores respectively, p = 8.449e^-14). COVID-19 patients also showed higher anxiety (mean BAI score: 17.00) than the university staff and orthopedic patients' group (9.22 and 5.56 respectively) (p = 6.175e^-08). BDI score did not show much variation for depression, the mean score was 9.66, 9.49, and 6.7 for the COVID-19 patients, university staff, and orthopedic patients respectively, (p = 0.2735).

CONCLUSION

Perceived trauma and anxiety symptoms are significantly higher in COVID-19 patients and the symptoms of OCD and depression do not differ between COVID-19 and non-COVID-19 people, so the necessity of screening and following treatment of patients with COVID-19 should be kept in mind.

TRIAL REGISTRATION

IR.IUMS.FMD.REC.1399.761.

Limits on using the clock drawing test as a measure to evaluate patients with neurological disorders

BACKGROUND

The Clock Drawing Test (CDT) is used as a quick-to-conduct test for the diagnosis of dementia and a screening tool for cognitive impairments in neurological disorders. However, the association between the pattern of CDT impairments and the location of brain lesions has been controversial. We examined whether there is an association between the CDT scores and the location of brain lesions using the two available scoring systems.

METHOD

One hundred five patients with brain lesions identified by CT scanning were recruited for this study. The Montreal Cognitive Assessment (MoCA) battery including the CDT were administered to all partcipants. To score the CDT, we used a qualitative scoring system devised by Rouleau et al. (1992). For the quantitative scoring system, we adapted the algorithm method used by Mendes-Santos et al. (2015) based on an earlier study by Sunderland et al. (1989). For analyses, a machine learning algorithm was used.

RESULTS

Remarkably, 30% of the patients were not detected by the CDT. Quantitative and qualitative errors were categorized into different clusters. The classification algorithm did not differentiate the patients with traumatic brain injury 'TBI' from non-TBI, or the laterality of the lesion. In addition, the classification accuracy for identifying patients with specific lobe lesions was low, except for the parietal lobe with an accuracy of 63%.

CONCLUSION

The CDT is not an accurate tool for detecting focal brain lesions. While the CDT still is beneficial for use with patients suspected of having a neurodegenerative disorder, it should be cautiously used with patients with focal neurological disorders.

The Effects of an Empathic Communication Workshop on Internal Medicine Residents' Self-Perceived Empathy and Their Patients' Perception of Physician's Empathy: A Single-Group Experimental Study

Background: Empathetic communication improves the physician-patient relationship and enhances patient and physician satisfaction. This study aims to evaluate the impact of empathic communication skills training on physicians' self-perceived performance and patient satisfaction regarding the empathetic quality of their relationship with their physicians. Methods: In this single-group before-after experimental study, we recruited 50 internal medicine residents at a large teaching hospital. We assessed the residents' empathy using the Jefferson Scale of Empathy before and 3 weeks after an 8-hour workshop on empathic communication skills. We also recruited 50 of their patients before and another 50 patients 3 weeks after the training to assess the patient's perceptions of their physician's empathy using the Consultation and Relational Empathy scale. Physicians' and patients' mean scores on empathetic care at the beginning of the study were then compared using paired t-tests with their scores after the workshop. Results: The residents' mean score on Jefferson Empathy Scale increased from 81.1(95%CI:78.8-83.3) at baseline to 96.8(95%CI:93.6-100) following the workshop (p < 0.001). Before the empathetic communication skills training, patients assessed their doctors' empathy at 68.3(95%CI:63.5-73.2). After the intervention, this improved to 84.9(95%CI:82.2-87.5) (p < 0.001). Conclusion: In this study, both the residents and their patients stated that the residents' empathy skills had significantly improved after an empathetic communication workshop for internal medicine residents.

Designing the Application of Verbal Fluency Test in Persian for Neurocognitive Evaluations

Verbal fluency test is a useful method to evaluate cognitive executive functions. Studies have shown that both types of verbal fluency test (phonemic and semantic) are influenced by brain damage. This test is rarely used by clinicians because it takes too much time to perform. Therefore, we decided to increase its speed and accuracy by designing a verbal fluency test application in Persian language. The study on designing the application of verbal fluency test in Persian was published in the journal of Basic and Clinical Neuroscience entitled “Verbal fluency performance in normal adult population in Iran: norms and effects of age, education and gender”. To design the application, two software engineers, one programmer, and one graphic designer had cooperation with each other. First, the programming was done. During the programming, the programmer first implemented the tables related to the test. Then, by entering constant variables, an initial layout in the form of a look-up table was developed. Then, the graphic designs were added to the application. By testing 100 different scores with the relevant table and receiving the output, the accuracy of the initial version was confirmed. After designing the software, field tests were performed by 10 clinicians to evaluate the application in terms of ease of use and main structural errors. Finally, by testing 100 different scores, the accuracy of the final version was confirmed. The verbal fluency test application in Persian can increase the use of psychological and cognitive tests by Iranian clinicians by increasing the speed and accuracy of tests.

Attitude of Iranian medical specialty trainees toward providing health care services to patients with mental disorders

Introduction

The stigma of mental illness has a negative impact on the diagnosis and treatment of these disorders. Considering the high prevalence of mental illness, the attitude of medical specialists toward mental disorders, who are front liners in diagnosing and treating these patients, is critical. Therefore, we examined the attitude of Iranian medical specialty trainees toward providing health care services for patients with mental illness.

Methods

We included 143 residents in the fields that have the most interactions with patients with mental disorders, including internal medicine, surgery, neurology, cardiovascular diseases, and psychiatry. A demographic checklist, as well as the opening minds scale for health care providers stigma assessment questionnaire, was provided, which measures five dimensions of improvement, social responsibility, social distance, exposure, and other (such as risk) in health care providers toward delivering the healthcare services to patients with mental disorders.

Results

The mean score of stigma for mental illness in medical specialty trainees was 61.36 ± 4.83 out of 100. Psychiatric residents have the least stigmatizing attitude (58.38 ± 3.54), and internal medicine and cardiology residents have the highest score, respectively, (62.96 ± 6.05, 62.45 ± 3.80). As for comparing subscales between specialties, only the social responsibility subscale showed a significant difference, with psychiatry having less stigma toward social responsibility (12.93 ± 2.01) than cardiology (15.09 ± 1.50) trainees.

Conclusion

The attitude of medical specialty trainees toward providing health care services for patients with mental illness is not uniform; internal medicine and cardiology residents have more stigmatizing attitude, while psychiatric residents have less stigmatizing attitude. It seems that not every contact could be useful in making a better attitude toward mental illness, but it needs preconditions, like a structured contact that leads to positive outcomes. Anti-stigma interventions are needed to improve the attitude of medical specialty trainees toward providing health care services to patients with mental illness.

Iranian students' attitudes toward premarital sex, marriage, and family in different college majors

ObjectiveThis study is performed to examine the attitudes regarding marriage, family, and premarital sex among the students of different majors. Participants: Four hundred fifty-seven students from four majors studying Medical Sciences, Arts, Humanities, and Mathematics/Engineering within the age range of 18- to 24-year old. Method: Participants were selected from different universities in Tehran using stratified nonprobability sampling method. Attitudes of our participants were examined using the premarital sexual, marital, child-rearing, and family attitude Survey and demographic variables, including major, age, gender, religious beliefs, family socioeconomic level, and marital status were evaluated. Results: Most of the results of the survey showed significant differences between different majors. Art students were open to premarital sex more than other students and believed that premarital sex would cause no harm in reputation for females. By contrast, Medical sciences students had the highest agreement regarding the bad influence on the reputation of females because of premarital sex and also regarding men's tendency to virgin girls. Art students mostly approved the acceleration of the divorce process while the highest disapproval in this regard was reported from Medical sciences students. Conclusion: Art students' beliefs about premarital sex were more liberal, while Medical sciences students' beliefs in this matter were more conservative.

Repetitive Transcranial Magnetic Stimulation in Delirium: A Double-blind, Randomized, Sham-controlled, Pilot Study

INTRODUCTION

Delirium is a fatal but potentially reversible disorder of the central nervous system that imposes high costs on health systems. This study aims to evaluate the effect of intermittent theta-burst stimulation on the severity and course of delirium disorder.

METHODS

This is a double-blind, randomized, sham-controlled pilot study. The study participants were randomly allocated into the active (active intermittent theta-burst stimulation) and sham groups. The severity of delirium was assessed 15 minutes before the intervention and 15 minutes after that by the Neelon and Champagne (NEECHAM) confusion scale.

RESULTS

In the active group, total and subscale scores of NEECHAM significantly decreased after intervention (P<0.05). Although no statistical difference was found in the control group regarding the subscale scores of NEECHAM, the difference in the total scores before and after the sham intervention was statistically significant.

CONCLUSION

Carrying one session of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex can reduce the delirium severity in a short period, although it will not decrease the number of delirium cases three days after the intervention.

HIGHLIGHTS

Delirium is a CNS disorder;Delirium treatment is based on pharmacological and non-pharmacological;rTMS is quasi-modern treatment of neurocognitive disorders.

PLAIN LANGUAGE SUMMARY

Delirium is fatal but reversible disorder. regarding the restrictions of routine treatments of delirium and by considering the cognition disturbances as the core symptom of delirium, and the positive effect of rTMS on cognition functions. we hypothesized that rTMS could be effective in the treatment of delirium.

Memantine augmentation of sertraline in the treatment of symptoms and executive function among patients with obsessive-compulsive disorder: A double-blind placebo-controlled, randomized clinical trial

BACKGROUND

Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually decrease the severity of the symptoms by 20-30%; however, 40-60% of OCD patients do not achieve a satisfactory response. Our main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder.

METHODS

Seventy patients with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of more than 21 were recruited to the study. They received sertraline (100 mg daily initially followed by 200 mg daily after week 4) and either memantine (10 mg twice daily) or placebo in a placebo controlled, double-blinded, parallel-group, clinical trial of 12 weeks. The primary outcome was OCD symptoms measured by the Y-BOCS. Moreover, executive function of participants was measured by the Wisconsin Card Sorting Test (WCST).

RESULTS

The total score, and obsession and compulsion subscales of Y-BOCS significantly dropped in both groups with no significant difference between the two groups. However, memantine group showed a greater response in the number of completed categories subscale of the WCST (p value<0.001). We did not observe any major adverse effects in any of the groups.

CONCLUSION

Memantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials on 04/10/2019 ( www.irct.ir ; IRCT ID: IRCT20170123032145N4).

Developing an Educational Package to Improve Attitude of Medical Students Toward People With Mental Illness: A Delphi Expert Panel, Based on a Scoping Review

INTRODUCTION

The importance of stigma toward patients with mental illness in medical students as future physicians cannot be overemphasized. There is currently no formal training to reduce stigma toward mental illness in medical students in their educational curriculums in Iran like most other low and middle income countries. Therefore, aiming to provide a practical and effective training package focused on reducing stigma toward patients with mental illness in medical students, the current study conducted, as an expert panel with Delphi method, based on a scoping review, to develop an education package to improve attitude of medical students toward patients with mental illness.

MATERIALS AND METHODS

We surveyed the available international databases including PubMed, Google Scholar, Scopus, PsycINFO, Tripdatabase, Web of Science, Cochrane Database of Systematic Reviews as well as Persian databases including Iranmedex, SID, Irandoc and Magiran in February and March 2020. After an extensive review of related resources, 13 articles met our inclusion criteria. Then, we extracted the related data including type and duration of the interventions, sample size, mean and standard deviation of stigma scores before and after interventions. To develop the package among the included interventions, we asked 16 experts in psychology, psychiatry, and social medicine to rate the interventions based on a number of variables such as effectiveness, feasibility and applicability in a Delphi process.

RESULTS

The selected intervention in Delphi method with consensus of experts included a set of four sequential interactive interventions: showing a movie and discussing it, psychiatric training including contact with people who affected psychiatric disorders, social communication with people who affected psychiatric disorders, and group discussion on defining stigma and personal experiences.

CONCLUSION

In the present study, we recommend a set of interventions to reduce stigma toward patients with mental illness among medical students in the form of a package of combined, interactive and sequential interventions that have been previously been shown to be effective in reducing stigma related to mental illness. We expect that implementation of these interventions would reduce mental illness stigma in medical students; which needs further verification.

Verbal Fluency Performance in Normal Adult Population in Iran: Norms and Effects of Age, Education, and Gender

Introduction

Verbal fluency is a cognitive function that can be easily assessed at the bedside and provide valuable data for clinical assessment of various cognitive functions. We decided to provide a standardized test to assess verbal fluency in the Persian language, including both phonemic and semantic fluency subtests.

Methods

First, three phonemes (/p/, /d/, and /ʃ/) and three categories (animals, fruits, and kitchen appliances) were selected based on a pilot study and a panel of specialists. Then, we selected 500 Persian-speaking participants (47.8% male) aged 18 to 65 years via a convenient sampling method from the general population. Participants were grouped according to age, gender, and education. They performed the verbal fluency test.

Results

The Mean±SD number of generated words in letter fluency and semantic fluency was 8.3±4.1 and 18.0±5.5, respectively. Age, educational level, and mother tongue were associated with letter fluency. Semantic fluency was associated with age, gender, education level, and mother tongue.

Conclusion

For a more reliable clinical assessment, we suggest using all three letters (phonemes) and three semantic categories for each subject, calculating the mean of the produced words, and comparing them with the suggested cut-off points provided for each subcategory. Age was negatively correlated with the number of generated words in letter fluency (r=-0.33; P<0.001) and semantic fluency tasks (r=-0.26; P<0.001). In the letter fluency task, there was no statistically significant difference between males and females according to the number of generated words (P=0.057). However, in semantic fluency, female participants generated more words (P=0.005). Mother tongue (Farsi) showed a significant effect both on letter fluency (t=5.55, P<0.001) and semantic fluency (t=9.41, P<0.001). Level of education had a significant association with both letter fluency (F=117.23, P<0.001) and semantic fluency (F=64.48, P<0.001).

Highlights

The study subjects generated 8.3±4.1 words in one minute in the letter fluency test.Letter fluency was associated with educational level and mother tongue.The Mean±SD number of generated words in semantic fluency (18±5.5) was higher than letter fluency.Semantic fluency was associated with age, gender, education level, and mother tongue.

Plain Language Summary

Practitioners use neuropsychological tests to diagnose mental problems. Verbal fluency is a test in which participants have to generate as many words as possible from a specified category in a given time. This category can be phonemic (letter), which means words beginning with a specified letter or semantic, including objects such as animals or fruits. The number of words produced by participants is essential, and if it is fewer than normal, it shows psychological or neurological conditions such as Alzheimer disease. The norms are variable in different languages, cultures, and educational levels. We found that the Mean±SD numbers of generated words in letter fluency and semantic fluency were 8.3±4.1 and 18.0±5.5, respectively. These values can be used for neuropsychological testing in the Iranian population.

Comparison of empathy with patients between first-year and last-year medical students of Tehran University of Medical Sciences

PURPOSE

This study was conducted to assess the developmental factors of empathy among medical students of Tehran University of Medical Sciences (TUMS).

METHODS

To assess the empathy levels, 42 first-year and an equal number of last-year medical students were randomly selected. They answered a questionnaire including the medical student version of the Jefferson Scale, demographic, and some related variables. Statistical analyses were performed using the Chi-square test, T-test, univariate, and multivariate regressions.

RESULT

The study population consisted of 51 (60.7 %) men and 33 (39.3 %) women with a mean (SD) age of 22.24 (4.10) years. The Jefferson score was 110.19 ± 13.61 and 103.52 ± 20.00 in first- and last-year medical students, respectively. Moreover, medical students who completely passed at least one of the considered empathy courses of the TUMS curriculum had higher empathy scores compared to their counterparts (109.83 ± 15.54 vs. 103.68 ± 19.02). There was no significant association between empathy and gender, self-experience of illness, marital status, family history of chronic disease, and parents' education (all P-values > 0.05). After adjusting for the effects of confounders, the empathy scores were significantly associated with the academic year level (p = 0.04), level of interest in medicine (p = 0.001), and passing the empathy courses (p = 0.04).

CONCLUSIONS

The data provided from a top Iranian medical school indicated that the academic year level, level of interest in medicine, and passing the empathy courses were significantly associated with the empathy level. Further studies are recommended.

Development of a pre-hospital emergencies protocol for the management of suicidal patients in Iran

Background

Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation.

Method

We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks.

Results

The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered.

Conclusion

A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.

Iranian and American Moral Judgments for Everyday Dilemmas Are Mostly Similar

Moral judgment is a complex cognitive process that partly depends upon social and individual cultural values. There have been various efforts to categorize different aspects of moral judgment, but most studies depend upon rare dilemmas. We recruited 25 subjects from Tehran, Iran, to rate 150 everyday moral scenarios developed by Knutson et al. Using exploratory factor analysis (EFA), we observed that the same moral dimensions (except socialness dimension) were driven by the same moral cognitive factors (norm violation, intention, and social affect) in Iranian vs. American studies. However, there were minor differences in the factor loadings between the two cultures. Furthermore, based on the EFA results, we developed a short form of the questionnaire by removing eleven of the fifteen scenarios from each of the ten categories. These results could be used in further studies to better understand the similarities and differences in moral judgment in everyday interactions across different cultures.

Scoping Review of Questionnaires on Stigma of Mental Illness in Persian

bjectives: In order to plan according to the needs of psychiatric patients, there is a need to study different aspects of social stigma in target groups. Due to the limited access to questionnaires used for assessment of social stigma in Persian, this study aims to review all of the tools available for assessment of social stigma, which have been designed in Iran or have been translated to Persian. Methods: This is a conceptual review study. After extensive review of resources, articles related to social stigma in the health system and conducted on health care staff, students, caregivers or patientschr('39') families, psychiatric patients, mothers with children with autism, mothers with children with Down syndrome, and the general population were included in the study. We extracted the information of Persian questionnaires used in the reviewed articles. The questionnaires and additional information were collected by contacting the authors of the articles via E-mail. Results: There were 21 questionnaires for assessing social stigma in Persian language. Of these, 19 questionnaires could be accessed and analyzed. Most of the questionnaires were the translated version of other tools, and only 4 questionnaires had been developed and validated in Persian. Conclusion: Most of the questionnaires in Persian are used to measure social stigma in health care staff and students followed by caregivers or patientschr('39') families. There is limited number of questionnaires for the assessment of social stigma in general population and patients. This is in contrast to the other languages that have mainly focused on assessment of stigma in general population and patients. To date, no questionnaire in Persian exists for the assessment of social stigma in children and adolescents.

First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran

INTRODUCTION

This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands.

METHODS

The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems.

RESULTS

Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center).

DISCUSSION

This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.

Does watching a movie improve empathy? A cluster randomized controlled trial

BACKGROUND

We studied if watching a movie about the patient physician encounter alone or in combination with a communication skills training workshop could improve empathy score of medical students.

METHODS

One hundred and thirty three medical students participated in one of the following four groups of the study. Group A: a three hour workshop (42 students); group B: watching the movie "The Doctor" (23 students); group C: watching the movie "The Doctor", then, participating in a three hour workshop the next day (22 students); group D: control group with no intervention (46 students). Participants completed Jefferson Scale of Empathy (JSE), Student Version to assess empathy score before and after the intervention, and one month later. A linear mixed effect model analyzed the effect of intervention across groups considering the effects of other significant variables.

RESULTS

All of the three interventions had an immediate improving effect on empathy scores compared to control group. However, the improvement effect remained significant only in groups A (p=.015) and C (p=.001) one month later.

CONCLUSIONS

Watching selected movies has a significant but transient effect on empathy of students. Combining two methods of watching the movie and communication skills workshop, seems to add the beneficial effects.

Neuropsychological Functioning in Obsessive-Compulsive Washers: Drug-Naive Without Depressive Symptoms

INTRODUCTION

Obsessive-Compulsive Disorder (OCD) is a complex and heterogeneous neuropsychiatric syndrome. Contamination obsessions and washing/cleaning compulsions are the most frequent clinical OCD subtypes. The current study aimed at examining the neuropsychological impairments in drug-naive obsessive-compulsive (OC) washers without depressive symptoms and their association with the severity of symptoms.

METHODS

In the current causal-comparative study, 35 patients with diagnostic and statistical mental disorders class (DSM)-IV diagnosed with washing-subtype OCD and 35 healthy subjects were selected by the convenience sampling method and evaluated by computerized neuropsychology battery and clinical tests as Stroop Color-Word Test (SCWT), Wisconsin Card Sorting Test (WCST), Go/No-Go Test, Digits Forward (DF), Digits Backward (DB), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and General Health Questionnaire (GHQ)-28. The patients were matched to the comparison group with regard to age, gender, intelligence quotient (IQ), education, and handedness. All the tests were standardized in Iran. SPSS version 20.00 was used for descriptive and analytical data analysis.

RESULTS

There was no statistically significant different between the OCD washing and the control groups regarding socio-demographic variables or IQ. There were significant differences between the OC washer and the healthy control groups on the neuropsychological functioning. The obtained results suggested that OC washers performed significantly worse on neuropsychological measures than the controls. There was no significant association between the severity of OC symptoms and the neuropsychological functions in the OCD washing group.

CONCLUSION

It was concluded that executive function impairment, which is a core feature in OC washers was trait-like in nature.

Clinical Course of Methamphetamine-Induced Psychotic Disorder in a 3-Month Follow-Up

Objective

To assess the clinical course of patients with methamphetamine-induced psychotic disorder (MIPD) and any possible predictors of the clinical course in a 3-month follow-up.

Methods

This prospective cohort study included 50 patients (7 female, 43 male) with MIPD and was performed from September 2014 to October 2015. Patients were assessed during hospitalization and in a follow-up visit 3 months later. Diagnoses were made using interviews based on the Structured Clinical Interview for DSM-IV Axis I Disorders. Positive, negative, manic, and depressive symptoms were the main outcome measures that were assessed using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Young Mania Rating Scale, and Hamilton Depression Rating Scale, respectively. Paired t test and regression analysis were used to analyze the data.

Results

Forty-six patients (92%) were reassessed at follow-up. More than half of the patients relapsed to methamphetamine use, did not adhere to treatment, and were functionally impaired. Positive, negative, and manic symptoms, but not depressive symptoms, improved in abstinent patients (P < .001, P = .001, P < .001, and P = .395, respectively). The best predictor of depressive and negative symptoms at follow-up was the patients' respective baseline scores; but positive and manic symptoms were best predicted by reuse of methamphetamine during follow-up.

Conclusions

Various symptom categories do not always change in the same direction during the course of the disorder, especially depressive symptoms that do not improve with abstinence but aggravate with frequency of methamphetamine use. Negative symptoms at baseline also seem to have a possible role in prediction of methamphetamine reuse in patients with MIPD. Physicians should be advised to independently address all of the symptom categories of their patients with MIPD at each follow-up visit.

Predictors of physical restraint in a psychiatric emergency setting

BACKGROUND

Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible.

METHODS

This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group.

RESULTS

Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained.

CONCLUSION

Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients.

National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran: 1990 - 2013, study protocol

BACKGROUND

The measurement of population-based dimensions of mental disorders and their effects on the population health is one of the major public health concerns.  There is some evidence on the trend and point estimations of mental disease and substance abuse for many specific groups of Iranian population but there is a progressive requirement to documents on their exposure distribution at sub-national level, information about their trends, and their effects on the population health. 

METHODS

The present protocol is aimed to provide the standards of data collection and methodology processes for estimating the trends of selected mental disorders and their attributed burden at national and sub-national levels. For nine categories of mental disorders, we will estimate 1990 to 2013 trends of prevalence, Years of Life Lost due to premature mortality (YLLs), and Years Lived with Disability (YLDs) and Disability-Adjusted Life Years DALYs by sex, age group, and province. We will also quantify the uncertainty intervals for the estimates of interest.

CONCLUSION

The study of National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran provides valuable convincing evidences for policy makers and other stakeholders for more evidence-based priority setting, resource allocation, interventions, service providing, and evaluation at both national and sub-national levels. The results also could be used for future complementary global, regional, national, and sub national studies.

A pilot randomized controlled trial on the effectiveness of inclusion of a distant learning component into empathy training

BACKGROUND

Studies have shown a gradual decline in empathy of medical trainees with increasing years of education. METHODS to augment empathy show some promise, but the most effective methods are both expensive and time consuming. To assess effectiveness of communication skills training program as a distant learning method in improving empathy.

METHODS

Fourteen first year residents of psychiatry were randomly allocated to either participate in a two day workshop on communications skills (attending group) or to watch the videotape of the first day and participate in the second day (distance learning group). Assessments included Jefferson Scale of Empathy (JSE) and objective assessment of empathy (OAE) during a simulated interview, before and 3 months after the training.

RESULTS

The empathy was significantly increased in the attending group as measured by OAE. The score of JSE also increased in the attending group but did not reach a significance level. No increase in empathy was seen in the distance learning group.

CONCLUSION

Watching the videotape of the workshop is not effective in improving empathy of residents. More interactive methods should be sought if we plan to use distance learning methods in enhancement of empathy.

Cognitive functions in methamphetamine induced psychosis compared to schizophrenia and normal subjects

OBJECTIVE

The purpose of this research was to study the cognitive functions in patients with methamphetamine-induced psychosis (MIP) in comparison with schizophrenia patients and normal subjects.

METHOD

This was a cross-sectional study, 30 patients with MIP, 30 patients with schizophrenia and 30 normal individuals were selected via convenient sampling and were matched on age, sex and education. Wisconsin Cards Sorting, Stroop, Visual Search and Attention and Wechsler Memory Tests were used to assess the subjects.

RESULTS

The study showed that patients with MIP and schizophrenia have more deficits in executive functions, selective attention, sustained attention and memory than normal subjects. There were no significant differences in cognitive functions between patients with MIP and schizophrenia except for visual search and attention that showed more impairment in patients with schizophrenia.

CONCLUSION

Although, cognitive dysfunctions of patients with MIP are mostly similar to patients with schizophrenia, some differences seem to exist, especially in those functions that are not primarily dependent on frontal lobe.

Non-recurrence of carbamazepine induced vitiligo after rechallenge with carbamazepine

OBJECTIVE

Vitiligo is a rare side effect of carbamazepine whose exact mechanism is unknown. The aim of this report is to describe a single case of vitiligo induced by carbamazepine.

METHODS

The case was a patient with Bipolar I disorder whose medications were changed from valproate to carbamazepine and who developed vitiligo after a short while. We followed the case for about four years when he was rechallenged with carbamazepine.

RESULTS

When depigmentation occurred, we immediately discontinued carbamazepine after which the depigmented areas improved gradually. About three years later, he received carbamazepine again, but depigmentation did not recur.

CONCLUSION

Carbamazepine-induced vitiligo is not an absolute contraindication for the prescription of carbamazepine if other choices fail to respond or are not tolerated. The case has implications for the mechanism of medication induced vitiligo.

Quality of life in patients with bipolar I disorder: is it related to disorder outcome?

Bipolar I disorder (BID) and its treatments have shown to be associated with deep impacts on patients' subjective feelings and quality of life (QOL). There are also some comments about impact of these feelings on course and outcome of patients with BID. This study was aimed to evaluate quality of life in patients with BID and to assess its relationship with course of disorder. Fifty patients with BID were recruited based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) from May 2008 and followed for 12 months. Quality of life and mood disorder recurrence were assessed through World Health Organization Quality of Life and SCID-I tools respectively at baseline and after 6 and 12 months. Repeated measures analysis and logistic regression were used to analyze the independent effect of QOL and demographic factors on BID recurrence. Fifty patients (66% male; 48% never married; 48% in primary school level) with mean ± SE age and age of BID onset 33.8±1.5 and 26.6±1.1 years were studied. They had 3.4±0.6 episodes already. Twenty eight percent suffered from recurrences during the follow-up. The QOL scores at baseline, after 6 and 12 months were 70±1.8, 69.6±1.1 and 73±1.3 respectively. There were no significant change in QOL and its sub-domains during the follow-up (P=0.37). QOL showed no independent relationship with BID recurrences (P>0.1). No change in the QOL during the follow-up could denote lack of effectiveness of routine interventions on this factor. Also, short-term follow-up might be concerned as the possible reason. Of prime importance is to consider quality of life independently in treating patients with bipolar disorder.

Mania precipitated by opioid withdrawal: a retrospective study

OBJECTIVE

Little evidence is available on the occurrence of mania following opioid withdrawal. This is the first report on clinical and demographic characteristics of mania precipitated by opioid withdrawal in a relatively large sample.

METHOD

In this study, we assessed the files of the patients admitted to a large referral psychiatric hospital during a 3-year period with a presentation of manic episode shortly after opioid withdrawal. Forty-five relevant cases (one woman) were found, including 28 patients with their first manic episode, and 17 patients with a previous history of bipolar disorder.

RESULTS

Most of the identified cases had a long history (mean = 11.8 years) of opium dependence (24 cases used only opium and 16 cases opium and other opioids) and had recently experienced an intense withdrawal (25 cases). These associations were present in both first-episode patients and those with recurrent episodes.

CONCLUSION

Emergence of mania following opioid withdrawal could be partly explained by mood stabilizing effects of opioids. Other than the type of opioid, it seems that the duration of use and withdrawal method might play a role. Caution should be used while detoxifying patients with a long history of opioid use.

Clinical features of inpatients with methamphetamine-induced psychosis

BACKGROUND

An epidemic of methamphetamine use has begun in Iran in recent years and psychiatric emergency services are overloaded with patients with methamphetamine-induced psychosis (MIP).

AIMS

To define the clinical features of inpatients with MIP in a psychiatric hospital.

METHOD

The files of all MIP patients admitted to Iran Psychiatric Hospital located in Tehran from April 2008 to April 2010 were assessed. Data related to psychotic episode, substance use, previous psychiatric history and demographic data of 111 MIP patients were extracted and analyzed using descriptive statistical methods.

RESULTS

The most prevalent psychotic symptoms were persecutory delusion (82%), auditory hallucination (70.3%), reference delusion (57.7%), visual hallucination (44.1%), grandiosity delusion (39.6%) and jealousy delusion (26.1%). The mean duration of admission and psychotic episode was 21.43 and 17.37 days, respectively. In seven cases (8.75%), symptoms continued for more than one month.

CONCLUSION

Frequency of psychotic symptoms in this study is relatively similar to previous studies. However, some clinical determinants such as latency of psychosis from first use and the course of psychosis are more similar to the first epidemic of methamphetamine in Japan than to more recent epidemics; which could be due to the short history of methamphetamine use in Iran.

Suicide Risk Factors in Iranian Patients With Bipolar Disorder: A 21- Month Follow-Up From BDPF Study

OBJECTIVE

Bipolar disorder is strongly associated with suicidal ideations, attempts and commissions. Although several studies have been conducted on suicide risk factors in patients with bipolar disorder worldwide, a comprehensive study has not been reported from Iran.

METHODS

Patients with bipolar disorder type I, hospitalized in Iran Hospital of Psychiatry since May 2008 to August 2011 were sequentially enrolled. Patients were evaluated using Demographic and Clinical Variables Questionnaire, the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Young-Mania Rating Scale (Y-MRS), and Hamilton Depressive Rating Scale-7 (HDRS-7). One hundred patients were followed for 2 to 42 months (mean: 20.6 ± 12.5 months).

RESULTS

Only one patient attempted suicide during the follow-up period. 33% of the patients had history of previous suicide attempts. Female gender, divorce, and early age at onset of the disease were independently correlated with suicide attempt.

CONCLUSION

Suicide attempts rarely occur during systematic follow-up of patients with bipolar disorder type I. Larger samples and longer follow-ups are needed to confirm this finding.

DECLARATION OF INTEREST

None.

Empathy in Iranian medical students: measurement model of the Jefferson scale of empathy

BACKGROUND

Empathy is an important factor in patient-physician relationship that has beneficial effects in medical practice. Jefferson scale of empathy (JSE) has been specifically designed to assess empathy in health professionals (HP-version) and related students (S-version). Few validation studies have been performed on S-version of the scale.

AIMS

To examine empathy in a large sample of Iranian medical students, and also to study factor structure and psychometric properties of the Persian translation of the S-version of the JSE.

METHOD

1187 medical students (759 female) from 16 universities around the country participated in the study during 2009. Independent sample t-test, multivariate analysis of variance, and confirmatory factor analysis (CFA) were performed to analyze the data.

RESULTS

Female students outscored male students in empathy. The trend for empathy had a negative relationship with years of education. JSE showed an acceptable internal consistency and test re-test reliability. CFA upheld the original three-factor structure--Perspective taking, compassionate care, and standing in the patient's shoes--consisting 20 items.

CONCLUSION

The decrease in empathy during medical education is consistent with previous studies. The Persian version of JSE is a valid and reliable measure to tap empathy in a Persian-speaking medical student.

C677T Methylenetetrahydrofolate Reductase (MTHFR) Gene Polymorphism in Schizophrenia and Bipolar Disorder: An Association Study in Iranian Population

OBJECTIVE

The methylenetetrahydrofolate reductase (MTHFR) gene polymorphism C677T is suspected to be a risk factor for psychiatric disorders, but it remains inconclusive whether the MTHFR polymorphism C677T is imputed to vulnerability to schizophrenia and bipolar disorder.

METHOD

We prompted impetus to appraise this polymorphism in an Iranian population. Therefore, 90 patients with bipolar disorder type I (BID), 66 patients with schizophrenia diagnosed according to DSM-IV criteria, and 94 unrelated controls with no history of psychiatric disorders were recruited for this study. Genotype distribution and allelic frequencies of C677T polymorphism were investigated.

RESULTS

We found no robust differences between patients with BID and schizophrenia with control participants either for allele frequencies or genotype distribution of MTHFR C677T polymorphism. However, a trend toward an increased risk for T allele was observed in the BID patients [with odds ratio (OR) of 1.28(CI 95%: 0.8-1.31), p>0.05].

CONCLUSION

However, the present and some previous studies failed to elucidate possible interaction between MTHFR C677T polymorphism and vulnerability to schizophrenia and bipolar disorder; still some associations have been revealed in performed meta-analyses that warrant further studies.

Psychopathy in Iran: a cross-cultural study

Few cross-cultural studies have assessed psychopathy and none have included a sample from non-western countries. This study investigated the factor structure of the Psychopathy Checklist: Screening Version (PCL:SV) in an Iranian sample, and compared the results with a western sample. Three hundred fifty-one Iranian prisoners were compared with 405 participants of the standardization sample of the PCL:SV. Confirmatory factor analysis and item response theory method were used for data analysis. The Iranian data fitted well with the hierarchical three-factor model of psychopathy and neither two- nor four-factor models showed an adequate fit. Differential item functioning existed across samples, with discriminatory power of factor 1 (arrogant and deceitful interpersonal style) being lower in the Iranian sample that for factor 2 (deficient emotional experience) being greater in the Iranian sample than the standardization sample. Deficient emotional experience might be the most significant factor in diagnosing psychopathy, regardless of the studied culture. Other factors appear to be relatively culture-specific.

Empathy and its correlates in Iranian physicians: A preliminary psychometric study of the Jefferson Scale of Physician Empathy

BACKGROUND

Empathy is one of the fundamental factors in patient care that is beneficial to both patient and physician.

AIMS

To assess the psychometric properties of the Persian version of the Jefferson Scale of Physician Empathy (JSPE) in a sample of Iranian physicians and examine its correlates.

METHOD

Two hundred and seven general physicians completed the JSPE. The associations of empathy scores with demographic characteristics and practice-related variables were examined.

RESULTS

The scale showed an acceptable internal consistency (α = 0.78). Three of six extracted factors were considered as prominent based on the scree test, which were similar to those obtained in the US samples. Women scored higher than men. Empathy improved with increasing practice experiences. Other practice-related variables did not show a significant association with empathy.

CONCLUSIONS

Results support the construct and criterion-related validities and reliability of the Persian version of the JSPE. Score difference between Iranian and American samples may not reflect a genuine difference in empathy trait and can be explained by cultural factors.

Neurological soft signs in mentally disordered offenders

The study used the Neurological Evaluation Scale to assess neurological soft signs in 351 offenders and 80 healthy comparison subjects. Offenders were also interviewed using the Structured Clinical Interview for DSM-IV and the Hare Psychopathy Checklist. Neurological signs were significantly increased in offenders compared with healthy subjects. Offenders with repeated misdemeanors had higher rates of neurological signs than those with a single felony. Neurological scores were significantly predicted by lifetime diagnoses of psychotic, anxiety, and substance use disorders. Each diagnostic category was associated with a distinct pattern of neurological abnormalities.

The frequency of sexual abuse and depression in a sample of street children of one of deprived districts of Tehran

The purpose of this study was to determine the frequency of sexual abuse and depression among street children who live in a deprived district of Tehran. The researchers used the K-SADS questionnaire and a clinical interview were used to evaluate depression and sexual abuse in 87 street children in Tehran. Eighteen (20.9%) of the children had been sexually abused. Depressed children were 3.2 times more likely to be sexually abused than non-depressed children. Furthermore, 26 girls (86.7%) and 27 boys (48.2%) suffered from depression. The frequency of depression demonstrated a significant association with the father's or breadwinner's history of imprisonment or unemployment. Interventional programs providing education and support should be implemented for street children.

Psychiatric morbidity among sentenced prisoners: prevalence study in Iran

BACKGROUND

Information on psychiatric morbidity of prisoners has almost entirely been based on research in Western countries and it is uncertain whether these research findings are applicable to other settings.

AIMS

The primary objective was to investigate the prevalence of psychiatric disorders in Iranian prisoners.

METHOD

Through stratified random sampling, 351 prisoners were interviewed using the clinical version of the Structured Clinical Interview for DSM-IV Axis I Disorders and the Psychopathy Checklist: Screening Version.

RESULTS

The majority (88%) of prisoners met DSM-IV criteria for lifetime diagnosis of at least one Axis I disorder and 57% were diagnosed with current Axis I disorders. Opioid dependence (73%) had the highest prevalence among lifetime diagnoses, whereas major depressive disorder (29%) was the most common current diagnosis. Psychopathy was recorded in 23%. Prevalence rates of psychiatric disorders were significantly different among offence categories.

CONCLUSIONS

The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of Iran, with treatment challenges that appear to be different from those observed in inmates in Western countries.