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Open access publishing is not without costs. Therefore, from the first of July 2022, “Iranian Journal of Psychiatry” is considering an article publication fee after acceptance.Read More Read more about Publication fee
Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views.
Method: The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes.
Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system).
Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.
Objective: The objective of this study was to determine the most effective coping mechanism to deal with auditory hallucinations that reduces the frequency of voice-hearing and associated distress. In the present randomized controlled trial, each of the three coping mechanisms of attentional avoidance, attentional focusing, and mindfulness were used in one group and the fourth group was the control group.
Method: A total of 64 patients with schizophrenia, categorized in three groups of attentional avoidance, attentional focusing and mindfulness and one control group, were asked to listen to an ambiguous auditory task depending on the type of their coping mechanism. After determining the baseline of distress, the task was performed in duplicate for each group. After playing the auditory task for the first time, participants were asked to rate out the level of their distress and compliance with instructions, and they were asked to estimate the likely number of words they had heard. After the second time, they were asked to note the words they hear during the task and rate out their distress and compliance with instructions again at the end of the task.
Results: There was a significant difference between groups in terms of distress with a medium effect size of 0.47. The post hoc analysis revealed that mindfulness group reported less distress compared to the attentional focusing group (P = 0.017) and the control group (P = 0.027). Also, a significant difference existed between groups in terms of the frequency of the identified words, with a moderately strong effect size of 0.59, and a very good statistical power of 0.99. The post hoc analysis showed that attentional avoidance (P = 0.013) and attentional focusing (P = 0.011) groups heard fewer words than the control group.
Conclusion: Attention is a good target for treating psychotic patients with auditory hallucinations. Also, manipulation of attention can affect the frequency of auditory hallucinations and associated distress.
Objective: Schizophrenia is known as a severe psychiatric disorder with a broad range of clinical indications and symptoms such as positive and negative symptoms. This study was conducted with the aim of investigating the effect of melatonin on positive and negative symptoms of inpatients with schizophrenia.
Method: This study was conducted as a randomized placebo-controlled trial (double-blind) in the population of patients with schizophrenia. Study samples were selected from inpatients with schizophrenia, according to the DSM-5 criteria, who had not been diagnosed with a depressive episode of schizophrenia based on the Calgary questionnaire and who also met the inclusion criteria. 46 patients with schizophrenia were randomly assigned to the intervention (6 mg melatonin per day as two 3 mg pills for six weeks) and placebo groups. The positive and negative symptom scale (PANSS) was used to assess the effect of treatment at T1 (before intervention), T2 (three weeks after beginning the intervention) and T3 (six weeks after beginning the intervention). To check the research hypotheses, multiple comparison statistics were used by the SPSS 22 software.
Results: The placebo and melatonin groups had no significant difference in terms of PANSS scores (negative, positive, general and total symptom scores) at T1. Also, there was no difference in PANSS scores between the two groups at T2. However, at T3, there was a significant difference between the two groups only in the score of negative symptoms of PANSS (P = 0.036), so that negative symptoms of schizophrenia were significantly reduced in the intervention group compared to the placebo group. Furthermore, based on within-group analyzes, all PANSS scores were significantly reduced in the two groups at T2 and T3 (P < 0.05).
Conclusion: Long-term use (at least six weeks) of melatonin can improve the negative symptoms of schizophrenia. Since antipsychotics can better affect the positive symptoms, the use of melatonin in combination with these drugs may perhaps further improve the patients’ symptoms.
Objective: Schizophrenia is a complex neurodevelopmental illness that is associated with different deficits in the cerebral cortex and neural networks, resulting in irregularity of brain waves. Various neuropathological hypotheses have been proposed for this irregularity that we intend to examine in this computational study.
Method: We used a mathematical model of a neuronal population based on cellular automata to examine two hypotheses about the neuropathology of schizophrenia: first, reducing neuronal stimulation thresholds to increase neuronal excitability; and second, increasing the percentage of excitatory neurons and decreasing the percentage of inhibitory neurons to increase the excitation to inhibition ratio in the neuronal population. Then, we compare the complexity of the output signals produced by the model in both cases with real healthy resting-state electroencephalogram (EEG) signals using the Lempel-Ziv complexity measure and see if these changes alter (increase or decrease) the complexity of the neuronal population dynamics.
Results: By lowering the neuronal stimulation threshold (i.e., the first hypothesis), no significant change in the pattern and amplitude of the network complexity was observed, and the model complexity was very similar to the complexity of real EEG signals (P > 0.05). However, increasing the excitation to inhibition ratio (i.e., the second hypothesis) led to significant changes in the complexity pattern of the designed network (P < 0.05). More interestingly, in this case, the complexity of the output signals of the model increased significantly compared to real healthy EEGs (P = 0.002) and the model output of the unchanged condition (P = 0.028) and the first hypothesis (P = 0.001).
Conclusion: Our computational model suggests that imbalances in the excitation to inhibition ratio in the neural network are probably the source of abnormal neuronal firing patterns and thus the cause of increased complexity of brain electrical activity in schizophrenia.
Objective: The objective of the present study was to determine the effectiveness of self-compassion-focused therapy on cognitive vulnerability to depression as one of the causes of the onset or recurrence of depressive episodes in people who were not depressed at the time of the research but were cognitively susceptible to depression.
Method: The statistical population included all students of Bu-Ali Sina University in 2020. The sample was selected through the available sampling method. First, 52 people were screened, and finally, by random assignment, 20 people were placed in the experimental group and 20 people in the control group. The experimental group underwent compassion-focused therapy for eight 90-minutes-long sessions. The instruments included the Attributional Style Questionnaire, the Dysfunctional Attitude Scale, the Cognitive Triad Inventory, the Self-Esteem Scale, and the 2ⁿᵈ edition Beck Depression Inventory.
Results: The results of multivariate analysis of covariance showed that self-compassion-focused therapy was effective in terms of cognitive vulnerability to depression (P < 0.01, F = 22.78), dysfunctional attitudes (P < 0.01, F = 15.53), self-esteem (P < 0.01, F = 30.07), general attribution style for negative events (P < 0.01, F = 11.41), stable attribution style for negative events (P < 0.01, F = 14.48) and internal attribution style for negative events (P < 0.01, F = 12.45).
Conclusion: Therefore, it can be concluded that self-compassion-focused therapy can reduce cognitive vulnerability to depression. It seems that this has been achieved through the regulation of emotional systems and the increase of mindfulness, which leads to the reduction of safety-seeking behaviors and the modification of cognitive patterns that take place around the axis of the compassionate mind.
Objective: In old age, people suffer from many mental and physical illnesses, which make it important for the elderly to pay attention to adapting to these diseases. So, the aim of this research was to study the role of perceived burdensomeness, thwarted belongingness, and giving meaning to life in psychosocial adjustment, as well as the mediating role of self-care in the elderly.
Method: This research was descriptive and correlational, conducted through available sampling of 200 elderly people who lived in the city of Ardabil. After the necessary assessments in terms of mental disorders and inclusion criteria, they were chosen to conduct this investigation in 2020. The Meaning in Life Questionnaire, Psychosocial Adjustment Scale, Self-Care Questionnaire for the Elderly, and Interpersonal Needs scale were used to gather the data. The data were analyzed using SPSS25 and Amos24 software.
Results: The findings showed that perceived burdensomeness and thwarted belongingness have a negative and direct effect on elderly self-care [β = -0.25, P < 0.01] [β = -0.20, P < 0.05] and psychosocial adjustment [β = -0.0, P < 0.05] [β = -0.12, P < 0.05]. Also, giving meaning to life has a positive and direct effect on elderly self-care [β = 0.32, P = 0.01] and psychosocial adjustment [β = 0.033, P < 0.01]. The variable of self-care can play a mediating role in the relationship between thwarted belongingness [β = -0.174, P < 0.05], perceived burdensomeness [β = -0.140, P < 0.05], and giving meaning to life [β = 0.223, P < 0.05] with psychosocial adjustment. Moreover, among the exogenous variables, thwarted belongingness and perceived burdensomeness by change in self-care have been able to reduce psychosocial adjustment. Giving meaning through self-care, however, has increased psychosocial adjustment.
Conclusion: The findings revealed that thwarted belongingness, perceived burdensomeness, and giving meaning to life are important variables in health and adaptability of the elderly, which draws attention to family-centered interventions and individual therapies.
Objective: The aim of this study was to determine the role played by psychological distress in the relation between personality dimensions and pregnancy outcome of women undergoing in vitro fertilization/Intra-Cytoplasmic Injections (IVF/ICSI) treatment.
Method: This prospective cohort study was conducted for 12 months on 154 infertile women who were receiving IVF/ICSI assisted reproductive treatment for the first time. Research instruments for measuring psychological distress included the Fertility Problem Inventory (FPI) and the Depression, Anxiety, and Stress Scale (DASS-21). One of these was completed prior to ovarian stimulation and the other during the embryo transfer stage. The temperament and Character Inventory-Revised (TCI-R 125) was employed once to assess personality dimensions prior to the ovarian stimulation stage. Independent t-test, Mann Whitney test, Repeated Measures and path analysis were performed for statistical analysis of data.
Results: The results of this study showed no significant difference between the pregnant and non-pregnant groups in personality traits (Harm avoidance and self-directness) and psychological distress (FPI and DASS scores). Repeated measures showed a significant difference in stress, anxiety, and depression levels between the two stages of ovarian stimulation and embryo transfer (P < 0.01). Path analysis showed no significant direct and indirect effect for harm avoidance on the pregnancy outcome when psychological distress was mediated.
Conclusion: The effect of psychological factors on IVF outcomes is more complicated than is generally assumed and more studies are mandatory to clarify the relationship between personality traits and infertility treatments.
Objective: Research has demonstrated that individuals with a history of depression engage in complicated strategies (e.g., thought suppression) that may mask the possible existence of major depression. Increasing the mental strain, such as retrieving a six-digit number, may reveal depressive thinking in previously depressed individuals. This study examined the hypothesis that thought suppression could mask a cognitive vulnerability to depression and illustrated how cognitive tasks disrupt mind control.
Method: This case-control study recruited 255 participants with a convenience sampling method conducted at the Razi Educational and Therapeutic Psychiatric Center (Tehran, Iran) in 2021. Participants were divided into five groups, then they were evaluated by a scrambled sentence test (SST) after random assignment to either mental load or no mental load conditions. The number of negative unscrambled statements was used as an index of negative interpretation bias. After gathering data, analysis of variance (ANOVA) for different group factors and conditions was carried out to test the main hypotheses.
Results: The effect of the intervention provided to each group on the score of the Hamilton Depression Rating Scale (HRDS) was signiﬁcant (F (4, 208) = 511.77, P < 0.001). A significant correlation (r = 0.36, P < 0.01) was found between depression (HDRS) and negative interpretive bias (SST). Analysis of ANOVA has revealed a signiﬁcant effect on the group (F (4, 412) = 14.94, P < 0.001). The effect of the mental load was not signiﬁcant (F (4, 412) = 0.09, P = 0.75), but the group × load interaction was signiﬁcant (F (4, 412) = 5.03, P < 0.001). Post hoc test was used to draw multiple comparisons between the five groups.
Conclusion: The results revealed that people who are vulnerable to depressive disorders are predominantly engaged in thought suppression, which can conceal their depressogenic thinking until cognitive requests consume their mind control efforts.
Objective: For a long time, it was held that narcissism had two aspects: narcissistic grandiosity and narcissistic fragility. The extraversion, neuroticism, and antagonism elements of the three-factor narcissism paradigm, on the other hand, have gained popularity in recent years. Based on the three-factor framework of narcissism, the Five-Factor Narcissism Inventory-short form (FFNI-SF) is a relatively recent invention. Therefore, this research aimed to assess the validity and reliability of the FFNI-SF in Persian among Iranians.
Method: Ten specialists (with Ph.D.s in psychology) were enlisted in this research to translate and evaluate the reliability of the Persian version of the FFNI-SF. The Content Validity Index (CVI) and the Content Validity Ratio (CVR) were then used to assess face and content validity. It was given to 430 students at Azad University, Tehran Medical Branch, once the Persian form was completed. The available sampling technique was used to choose the participants. Cronbach's alpha and the test-retest correlation coefficient were used to assess the reliability of the FFNI-SF. In addition, concept validity was obtained using exploratory factor analysis. In addition, correlations with NEO Five-Factor Inventory (NEO-FFI) and Pathological Narcissism Inventory (PNI) were employed to establish the convergent validity of the FFNI-SF.
Results: According to professional opinions, the face and content validity indices met expectations. With Cronbach's alpha and test-retest reliability, the questionnaire's reliability was also established. Cronbach's alphas varied between 0.7 and 0.83 for the FFNI-SF components. According to test-retest reliability coefficients, the components' values varied from 0.7 to 0.86. Additionally, three factors (extraversion, neuroticism, and antagonism) were recovered using the principal components approach and a straight oblimin rotation. According to an analysis of the eigenvalues, the three-factor solution accounted for 49.01 of the variation in the FFNI-SF. The eigenvalues for the three variables were 2.95 (M = 1.39), 2.51 (M = 1.3), and 1.88 (M = 1.24) respectively. The FFNI-SF Persian form's convergent validity was further verified by the association between its results and those from the NEO-FFI and PNI tests and the FFNI-SF. There was a substantial positive association between FFNI-SF Extraversion and NEO Extraversion (r = 0.51, P ≤ 0.001), as well as a strong negative correlation between FFNI-SF antagonism and NEO agreeableness (r = -0.59, P ≤ 0.001). As well as this, PNI grandiose narcissism (r = 0.37, P ≤ 0.001) was shown to be significantly associated with FFNI-SF grandiose narcissism (r = 0.48, P ≤ 0.001), as it was with PNI vulnerable narcissism (r = 0.48, P < 0.001).
Conclusion: with its solid psychometric qualities, we may utilize the Persian FFNI-SF to test the three-factor model of narcissism as an effective tool for research.
Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder.
Method: First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers.
Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers’ burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013).
Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.
Objective: suicide attempts and suicide death fall within a category of psychological disorders that is under the influence of economic, social, and cultural factors. Awareness of the prevalence of this phenomenon is essential for the adoption of preventive policies. Accordingly, the current study was carried out in order to determine the prevalence of suicide attempts and suicide deaths via Meta-analysis in Iran.
Method: This study is a systematic review and meta-analysis of articles published between 2010 and 2021 to estimate the prevalence of suicide attempts and suicide deaths in Iran. Accordingly, databases including Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, Google Scholar, SID, and Magiran were searched and all related articles were extracted by the statistical tests of random and fixed effects model, meta-regression, and funnel plot using the STATA software. These articles were then analyzed.
Results: A total of 20 studies were entered into the systematic review, with a total of 271,212 attempted suicides and 22,780 suicide deaths. Accordingly, the prevalence of suicide attempts in the whole population was 131.0 (CI 95%: 124.0 – 137.0) per 100,000 people (152 per 100,000 women and 128 per 100,000 men). Moreover, the prevalence of suicide death was 8.14 (CI 95% 7.8 – 8.5) per 100,000 people in the general population (5.0 per 100,000 women and 9.1 per 100,000 men).
Conclusion: According to these findings, Iran can be ranked among the countries with a low prevalence of suicide attempts and completed suicides (compared to the global average). Although the trend of completed suicides is declining, the trend of suicide attempts is increasing and has often affected young people.
Objective: Burnout is a psychological symptom characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. Several systematic reviews have examined the prevalence of burnout in some communities, including the communities of physicians, nurses, students, and teachers. Risk factors, consequences of burnout, and related interventions have also been evaluated in several systematic review studies. The purpose of this systematic review was to investigate the prevalence, risk factors, consequences, and interventions associated with burnout among military personnel in all types of studies.
Method: Studies that quantitatively examined burnout in military personnel after 2000 were identified through systematic searches in PubMed, Scopus, Web of Knowledge, Embase, PsychInfo, and PsycArticles databases.
Results: A total of 43 studies met the criteria for inclusion in this systematic review. Of these, 34 were cross-sectional, 7 were longitudinal, 1 was case-control and 1 was experimental. Half of the studies had more than 350 samples. The studies were from 17 different countries, among which the United States had the largest number with 17 studies. 33 studies were measured with one version of Maslach Burnout Inventory (MBI). Totally, only 10 studies reported a prevalence of burnout and/or its subscales. The prevalence of high emotional exhaustion ranged from 0% to 49.7% (median 19%), the prevalence of high depersonalization ranged from 0% to 59.6% (median 14%) and the prevalence of low personal accomplishment ranged from 0% to 60% (median 6.4%). In this systematic review, work environment factors (such as workload, shift work), psychological factors (anxiety, depression, stress), and duration and quality of sleep were shown as risk factors of burnout or its subscales. Also, psychological distress was observed as the consequence of burnout in more than one study.
Conclusion: The studies investigated in this systematic review showed a relatively moderate prevalence of burnout. In fact, burnout was associated with work environment factors and psychological variables.
Objective: Automatic diagnosis of psychiatric disorders such as bipolar disorder (BD) through machine learning techniques has attracted substantial attention from psychiatric and artificial intelligence communities. These approaches mostly rely on various biomarkers extracted from electroencephalogram (EEG) or magnetic resonance imaging (MRI)/functional MRI (fMRI) data. In this paper, we provide an updated overview of existing machine learning-based methods for bipolar disorder (BD) diagnosis using MRI and EEG data.
Method: This study is a short non-systematic review with the aim of describing the current situation in automatic diagnosis of BD using machine learning methods. Therefore, an appropriate literature search was conducted via relevant keywords for original EEG/MRI studies on distinguishing BD from other conditions, particularly from healthy peers, in PubMed, Web of Science, and Google Scholar databases.
Results: We reviewed 26 studies, including 10 EEG studies and 16 MRI studies (including structural and functional MRI), that used traditional machine learning methods and deep learning algorithms to automatically detect BD. The reported accuracies for EEG studies is about 90%, while the reported accuracies for MRI studies remains below the minimum level for clinical relevance, i.e. about 80% of the classification outcome for traditional machine learning methods. However, deep learning techniques have generally achieved accuracies higher than 95%.
Conclusion: Research utilizing machine learning applied to EEG signals and brain images has provided proof of concept for how this innovative technique can help psychiatrists distinguish BD patients from healthy people. However, the results have been somewhat contradictory and we must keep away from excessive optimistic interpretations of the findings. Much progress is still needed to reach the level of clinical practice in this field.
Objective: Emotional disturbances are the most common mental health problems in different populations and societies. We intend to provide the latest evidence related to the effectiveness of Acceptance and Commitment Therapy (ACT) on depression and anxiety by reviewing systematic review and meta-analysis studies published in the last three years.
Method: PubMed and Google Scholar databases were systematically searched between January 1, 2019 and November 25, 2022 with relevant keywords for English systematic review and meta-analysis articles reviewing the utilization of ACT to reduce anxiety and depression symptoms.
Results: 25 articles were included in our study: 14 systematic review and meta-analysis studies and 11 systematic reviews. These studies have investigated the effects of ACT on depression and anxiety in populations of children or adults, mental health patients, patients with different cancers or multiple sclerosis, people with audiological problems, parents or caregivers of children with mental or physical illnesses as well as normal people. Furthermore, they have examined the effects of ACT in individual, group, Internet, computerized, or combined delivery formats. Most of the reviewed studies reported significant effect sizes (small to large effect sizes) of ACT, regardless of the delivery method, compared to passive (placebo, waitlist) and active (treatment as usual and other psychological interventions except cognitive behavioral therapy (CBT)) controls for depression and anxiety.
Conclusion: Recent literature mainly agrees on the small to moderate effect sizes of ACT on depression and anxiety symptoms in different populations.
2021 CiteScore: 2.6
Mohammad Reza Mohammadi, MD.
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