Psychopathology, biological psychiatry, cross-cultural psychiatry, psychopharmacology, social & community psychiatry, epidemiology, child & adolescent psychiatry, psychotherapy, neuropsychiatry, psychology, spiritual therapy , as well as animal studies in psychiatry and psychology.
The scope is to act as an international forum for dissemination of science in the above-mentioned fields. It accepts submissions presented as original articles, short communication, case report, review article (invited), and letter to editor.
Child-Free Lifestyle and the Need for Parenthood and Relationship with Marital Satisfaction among Infertile Couples
Objective: Marital satisfaction is considered as satisfaction with a marital relationship on which the presence of a child has different effects. Concerns about a childfree life and its effect on marital satisfaction in infertile couples are very critical. Therefore, this study was intended to characterize and compare concerns about a childfree lifestyle and the need for parenthood and their relationship with marital satisfaction in infertile couples.
Method: A total of 200 men and 200 women who referred to fertility centers in Tehran participated in this cross-sectional study. Convenience sampling method was used for sampling. Demographic survey, ENRICH Marital Satisfaction Scale, and Fertility Problem Inventory were used for data collection. The resulting data were analyzed using descriptive and analytical statistical tests (Pearson Correlation Coefficient and Stepwise Regression).
Results: The mean scores for concern about a childfree lifestyle and the need for parenthood in women were significantly higher than in men. The variables rejection of a childfree lifestyle and the need for parenthood were respectively predictors of marital satisfaction in women and men.
Conclusion: Since marital satisfaction in infertile couples is affected by their feelings about having a child and becoming a parent, it is therefore suggested that appropriate counseling be provided in supportive healthcare programs for infertile couples to promote their marital satisfaction.
Objective: COVID-19, which is an international concern by far, had fundamental impacts on mental health of medical staff. Healthcare workers are the high-risk group to endure the emotional outcomes brought about by the outbreak. This study assesses the mental consequences of healthcare workers during the acute phase of COVID-19 pandemic in Tehran.
Method: We conducted a cross-sectional study on healthcare workers from two tertiary referral hospitals in Tehran province. A total of 222 of the staff participated in the study. Our questionnaires comprised Impact of Event Scale-Revised (IES-R) and 12-item General Health Questionnaire (GHQ-12), which were handed to participants to obtain data on their general mental problems in addition to the psychological impacts of the evolving virus on this particular group. Epidemiologic and sociodemographic information of participants, level of perceiving exposure to disease, and underlying diseases of each of them were gathered during the recruitment period.
Results: Results showed high probabilities (98.2%) in mental disorders among healthcare workers. Since our study was done during the initial phase of the pandemic, development of mental issues due to the newly emerged infectious virus was expected. However, we recorded mild (41.4%) to moderate (31.5%) impact of this novel virus. The possibility of having mental problems was much higher in females, assistant nurses, individuals with lower education, and those who provided care for COVID-19 patients.
Conclusion: COVID-19 has brought about increased distress among healthcare workers. Noticeably, the forefront group in combating this virus bear the most emotional complications. Thus, efforts should be taken into practice to provide proper psychological support for this vulnerable group.
The Effectiveness of Group Hope Therapy Training on the Quality of Life and Meaning of Life in Patients with Multiple Sclerosis and Their Family Caregivers
Objective: Multiple sclerosis is a chronic, progressive neurological disease that, due to its special nature, has various physical and mental influences on the patients and their family's lives, decreasing the quality of life and threatening the meaning of life. The purpose of the present study was to evaluate the effectiveness of the group hope therapy training on the quality and the meaning of life in patients with multiple sclerosis and their family caregivers.
Method: This quasi-experimental study was performed using pretest-posttest and control group. Thirty patients with multiple sclerosis along with 30 family caregivers who got low to medium scores on the Meaning in Life questionnaire by Steger (MLQ), Multiple Sclerosis Impact Scale (MSIS-29), and the Iranian Quality of Life questionnaire (IRQOL) for the caregivers were selected purposively. Then, the patients were randomly divided into two groups of 15 individuals in experimental and 15 individuals in control groups. The caregivers were grouped in the same manner. The protocol of group hope therapy training was carried out through eight two-hour sessions in two weeks separately on two experimental groups (the patients and the caregivers), and finally the posttest was given to four experimental and control groups.
Results: The results of the data showed that the meaning of life in both the patient and the caregiver experimental groups increased significantly (P < 0.001), but there was no significant change in the patient and the caregiver control groups.
Conclusion: Group hope therapy training is an effective intervention for improving the meaning of life and the quality of life in patients with multiple sclerosis. Also, any psychological intervention that aims to improve the quality of life in patients in an advanced stage of the disease requires attention to both the physical and the mental issues at the same time. Although group hope therapy training has improved the meaning of life in such patients, it did not have a significant impact on the quality of life. Therefore, paying attention to the stages of multiple sclerosis and the physical condition of the patients during the therapeutic intervention and adopting necessary complementary interventions seems to be essential.
Efficacy of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy for Anxiety, Depression, and Fatigue in Cancer Patients: A Randomized Clinical Trial
Objective: Cancer is associated with some psychological problems that play an important role in the severity and continuity of cancer. Cancer may lead to maladaptive psychological reactions such as anxiety, depression, and fatigue. Depression and anxiety are highly prevalent in cancer patients. This study aimed to compare the efficacy of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) for anxiety, depression, and fatigue in cancer patients.
Method: The present study was a randomized clinical trial (RCT). Of the 100 patients diagnosed with cancer, 60 patients were eligible to participate in this study according to the inclusion / exclusion criteria. They were randomly assigned into 3 groups: MBCT, CBT, and wait-list group (WLG). Afterward, the experimental groups received 8 weekly treatment sessions. All the participants fulfilled the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Cancer-Related Fatigue Scale (CFS) before and after the intervention. Data were analyzed using SPSS-16 software by Analysis of Covariance (ANCOVA).
Results: The results indicated a significant reduction in depression, anxiety, and fatigue scores in CBT and MBCT groups. There was a significant difference between both treatment groups with WLG in the anxiety and depression, but no significant difference was found between MBCT and CBT groups. Additionally, there was only a significant difference between the CBT group and WLG in terms of fatigue (P = 0.01).
Conclusion: CBT and MBCT performed equally well in decreasing anxiety and depression in cancer patients, and they were significantly better than WLG. It seems that MBCT is a good alternative to CBT for decreasing emotional symptoms in cancer patients. As a result, CBT and MBCT could be considered a good addition to pharmacological treatment of cancer patients with comorbid psychological symptoms. However, CBT was preferable to MBCT in decreasing fatigue.
The study was registered at the irct.ir database under registration number IRCT20180503039509N1.
The Mediating Effects of Self-Esteem and Harm Avoidance on the Association between Social Anxiety Symptoms and Adult Attention Deficit Hyperactivity Disorder Symptom Severity in Turkish Inpatients with Alcohol Use Disorder
Objective: The first objective of this research was to examine the association of the symptom severity of social anxiety with the adult attention deficit hyperactivity disorder (ADHD) symptom severity in Turkish patients with alcohol use disorder (AUD). The second objective was to examine if harm avoidance and self-esteem mediated this relationship.
Method: This cross-sectional analysis was performed among 151 inpatients with AUD at the Bakirkoy/AMATEM, a treatment center for substance use disorder, in Istanbul. Patients were examined with the Liebowitz Social Anxiety Scale (LSAS), the Adult ADHD Self-Report Scale (ASRS), the Rosenberg Self-Esteem Scale (SES), and the temperament dimension of Harm Avoidance (HA). Using SPSS-20 software, the data was analyzed using Pearson correlations, multivariate analysis of covariance (MANCOVA), and multiple linear regressions.
Results: The scales scores were mildly correlated with each other. The low self-esteem and high HA were related with the inattentive (IN) dimension of ADHD, whereas low self-esteem solely predicted hyperactivity/impulsivity (HI) dimension of ADHD in MANCOVA. In the linear regression analysis, the severity of social anxiety, particularly avoidance dimension, was associated with the symptom severity of ADHD. In the second step of the analysis, together with the avoidance dimension of social anxiety, self-esteem was associated with the symptom severity of ADHD. However, in the third step, after including HA as an independent variable in the analysis, the avoidance dimension of social anxiety was no longer associated with the severity of adult ADHD symptoms, whereas self-esteem together with HA (particularly “anticipatory worry and pessimism” [HA-1], and “asthenia and fatigability” [HA-4]) predicted.
Conclusion: Findings of the present study shows that although the symptom severity of social anxiety is associated with the severity of ADHD symptoms among inpatients with AUD, among dimensions of social anxiety, the avoidance dimension plays a main role in this relationship. Also, while the self-esteem partially mediates this relationship, HA seems to have a full mediator effect on this relationship.
Educational Needs for Implementing Iran’s Comprehensive Mental and Social Health Services at the District Level
Objective: A national program on providing comprehensive social and mental health services, entitled “SERAJ”, was developed and piloted in three districts of Iran. The present study aims to thoroughly explain the educational needs for implementing the provision of comprehensive mental and social health services in districts of Iran (SERAJ).
Method: In this study, we have interviewed service providers, held focused group discussions (FGDs) and used the knowledge, attitude, and practices (KAP) model for analyzing the duties of the service providers.
Results: To implement SERAJ, Mental and Social Health Professionals and Healthcare professionals should be trained on various contents in the fields of mental health, social health, and addiction to provide primary care services in Iran. Such training materials and schedules are necessary for providing secondary, and community action care services as well.
Conclusion: The educational program resulting from this study should be piloted and after removing the barriers and solving the limitations, it should be expanded throughout the country.
A Social-Cognitive Educational Protocol for Parents with Adolescents at Risk of Substance Use: Impact on Adolescents' Life Skill
Objective: The aim of this study was to instruct social cognitive protocol based on life skills and parenting skills to parents with teenagers at substance use risk and also to investigate its effectiveness among teenagers.
Method: The present study is a quasi-experimental study with a pretest, posttest, and follow-up approach with a group in 3 stages of measurement. The statistical population included 70 adolescents at risk of substance abuse who were selected using the available sampling method. The survey consisted of 40 questions about adolescents' life skills in four subscales of self-control skills, assertiveness and saying no skills, decision-making skills, and problem-solving skills, and the reliability of the entire questionnaire was estimated to be 0.98 using the Cronbach's alpha method. In this study, adolescents were first given a test, and after two weeks, their parents learned the social cognitive protocol over a 12-week period and were asked to impart these skills to their adolescents at home. After that, the adolescents gave the same test after the intervention (posttest). Two months after the posttest, the follow-up test was performed without any training.
Results: Comparison of the mean of the three stages of measurement showed that the effect of the overall life skills score, according to the value of Wilkes Lambda multivariate test (0.666) with degrees of freedom two and 40, can be rejected as a null hypothesis (P <0.01). In addition, in the subscales of decision-making skills (0.781), problem-solving (0.688), and self-control (0.816), the mean score of the participants in the three measurements was simultaneously different; and in the follow-up stage, the scores were significantly different than the pretest. However, in terms of assertiveness and the skill of saying no, the scores did not differ simultaneously in the three measurements (0.986).
Conclusion: These scores show that teaching social cognitive protocol to parents of adolescents who are at risk of substance abuse is effective.
Effects of Melatonin on Salivary Levels of Cortisol and Sleep Quality of Hemodialysis Patients: A Randomized Clinical Trial
Objective: The aim of this study was to investigate the effects of exogenous melatonin on the quality of sleep in patients undergoing dialysis and to investigate its mechanism for the regulation of total circadian rhythm and salivary levels of cortisol in hemodialysis patients admitted to Pange Azar hospital in Gorgan in winter of 2017.
Method: This was a double-blind randomized clinical trial. Samples were transferred to the laboratory by maintaining the cold chain. Then, the patients were divided into two groups. In a double-blind trial, one group received three mg melatonin and another group received placebo for two weeks at 10 PM. At the end of two weeks, sampling was performed to investigate the salivary level of cortisol under the same conditions. The research instrument was Pittsburgh questionnaire. Data were analyzed before and after intervention using SPSS 16 software.
Results: Salivary levels of cortisol decreased significantly after the intervention in the melatonin group (melatonin: 1.40 ± 1.82 and placebo: 4.94 ± 4.43; P = 0.008). Salivary levels of cortisol in the morning after intervention were also lower in the melatonin group, but were not statistically significant (melatonin 3.99 ± 3.45 and placebo: 5.35 ± 4.9; P = 0.93). Also, the difference in salivary levels of cortisol at night and before and after intervention significantly decreased in melatonin group. PSQI difference (interventional dimension) and PSQI (before intervention) were significantly decreased in melatonin group (P = 0.0001). The rate of change in the subscales of sleep latency, sleep efficiency, and sleep disorders in the melatonin group than in the placebo group was significantly higher.
Conclusion: Melatonin can be used as a safe and cost-effective treatment to improve sleep quality and can also reduce salivary cortisol increased in hemodialysis patients at night.
Objective: Sexual dysfunction is a side effect of methadone maintenance therapy (MMT). Opium Tincture (OT) has been used as a maintenance treatment. This study aimed to determine and compare the trend of sexual function and its related factors during treatment with both drugs.
Method: An observational study was designed to measure the blood tests including free and total testosterone, prolactin, and sex hormone-binding globulin and a battery of questionnaires, including demographics and drug use history, in 42 and 53 patients entering MMT and OT treatment before and 1 and 3 months after the treatment.
Results: Significant changes in testosterone levels were observed in the MMT but not the OT group. The difference between the two groups was not significant. Neither between nor within changes in the sexual function and premature ejaculation scores were significant (P =0.370& 0.698). Anxiety levels were significantly different (P= 0.001) within and between groups. There was a considerable difference in the trend of depression changes in the OT group, but not different in MMT group and between the two groups.
Conclusion: No difference was found between MMT and OT effects on sexual function variables. The decrease in Testosterone during the three months of MMT, was not associated with diminished sexual function. In the MMT group, anxiety levels diminished during treatment. It seems that decreased testosterone in the MMT group was compensated by improved anxiety. Gonadotropin levels may not be the sole determinant in sexual activity, and complex interaction of mood and anxiety, agonist levels, and gonadotropins are involved.
Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented
Method: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed.
Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed.
Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.
Correlation between Spiritual Intelligence and Clinical Competency in Students Who Are Children of War Victims
Objective: Providing effective and correct care to patients requires clinical competence. One of the important components in clinical competence is spiritual intelligence the purpose of the study was to consider the correlation between clinical competence and spiritual intelligence in students who are children of victims of war of Hamadan University of Medical Sciences in 2019.
Method: The cross-sectional study was carried out on 145 Martyrs' and War Veterans' Students of medical, nursing, midwifery, and paramedical schools. Sampling was done through census of students of operating room, anesthesia, medicine, nursing, midwifery, laboratory science, and radiology. The data collection tools were Kazdin et al’s (1986) Spiritual Intelligence questionnaire and Liu et al’s (2009) Clinical Competency Assessment questionnaire. Data were analyzed by SPSS 23 software.
Results: The results of data analysis showed a direct, positive, and significant linear relationship between spiritual intelligence and clinical competence of all students (P < 0.05). According to the students' self-report, the highest mean score of clinical competency of the students was related to medical students with a mean score of 37 and the lowest to the laboratory students with a mean score of 30 (P =0.012). In addition, the results showed that the highest mean score of spiritual intelligence belonged to nursing students with a score of 48 (good spiritual intelligence) and the lowest to radiology students with a score of 39 (moderate spiritual intelligence) (P =0.019).
Conclusion: We found that there is a direct and positive correlation between spiritual intelligence and clinical competence, so it seems that promoting spiritual intelligence may be associated with an increase in clinical competence.
The Possible Direct Correlation between Cognitive Impairment and Fear of Catching COVID-19 among Patients with Multiple Sclerosis
Objective: The prevalence of cognitive impairment in multiple sclerosis (MS) is significant and it is estimated that 40% to 70% of patients with MS suffer from this impairment. COVID-19 is also a new infectious disease. The symptoms of this disease, which include fever, shortness of breath, and cough, can be mild to severe and can even lead to death. Due to the use of immunosuppressive drugs by Patients with MS, they might be at greater risk of catching COVID-19. Thus, patients with MS may be more afraid of catching the virus. One of the important factors is the relationship between cognitive deficit and the increase in patients' fear of COVID-19. The aim of this study was to assess the relationship between fear of catching COVID-19 and cognitive impairment in patients with MS.
Method: This cross-sectional study was conducted at the MS Clinic, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran. Our participants in this project were Patients with MS who were over 18 years old and had no history of other neurological and psychiatric diseases. In addition to obtaining demographic and clinical information, we measured the fear of catching the COVID 2019 via Fear of COVID-19 Scale (FCV-19S), which is 7-item questionnaire. We also used Multiple Sclerosis Neuro Psychological Screening Questionnaire (MSNQ) to assess memory and information processing speed in Patients with MS.
Results: After adjustment for age, gender, disease duration, highest level of education, MS type, and EDSS in linear regression model, as well as the MSNQ total score and fear score of catching coronavirus, the results demonstrated a significant positive correlation with P value of 0.00 and β: 0.024.
Conclusion: The present study showed a direct relationship between cognitive disorder and level of fear regarding COVID-19. Patients with more cognitive disorders were more afraid of COVID-19.
Risk Factors Associated with Cyberbullying, Cybervictimization, and Cyberbullying-Victimization in Iran’s High School Students
Objective: This study aimed at finding the risk and protective factors of cyberbullying.
Method: A total of 425 high school students (199 boys and 226 girls) were selected using a cluster randomized procedure. The risk and protective factors included gender, internet use, self-esteem, dark triad traits (Machiavellianism, narcissism and psychopathy), school bullying perpetration, school bullying victimization, interparental conflict, and school climate.
Results: The results of multinomial logistic regression showed that being male, school bullying perpetration, and school bullying victimization can significantly increase the chances of being a cyberbully-victim and spending one hour or less on the internet can significantly decrease the chances of being a cyberbully-victim.
Conclusion: This study provides important implications for any prevention and intervention programs for cyberbullying, which must consider the roles of traditional bullying, gender differences, and internet use in cyberbullying behavior.
Internal Consistency and Item Analysis of the Persian Version of the Child Sensory Profile 2 in Vulnerable Populations
Objective: The purpose of the present study was to establish the item analysis and internal consistency of the Persian version of the Child Sensory Profile 2 in 2 groups of typical and atypical children (autism spectrum disorder and learning disabilities) aged 3 to 14 years.
Method: The sample of this study included 120 typical and atypical children aged 3 to 14 years who referred to schools and rehabilitation centers in Tehran were selected using multistage sampling method. To collect data, the Child Sensory Profile 2 questionnaire was used, which is a set of questionnaires of the Sensory Profile 2. To analyze the data, the discrimination index was used to determine the discriminant validity of the Child Sensory Profile 2, and the Cronbach's alpha coefficient was used to determine the reliability in terms of internal consistency.
Results: Discrimination index was satisfactory for all the items of the Child Sensory Profile 2. The values of Cronbach's alpha ranged from 0.795-0.919 in typical children and 0.617-0.901 in autistic children, and 0.792-0.920 in children with learning disabilities.
Conclusion: The Persian version of the child sensory profile 2 is a valid (discrimination with vulnerable populations) and reliable (internal consistency) tool for assessing sensory processing.
Objective: The recent escalated numbers of subjected COVID-19 patients and mortality rates have alerted the general population and authorities to its effects not only on physical health but also on different aspects of the society such as mental health. This study assesses the general mental health and immediate psychological impacts in hospitalized patients with COVID-19.
Method: In this cross-sectional study, 88 patients from two tertiary hospitals in Tehran agreed to complete the surveys. The Impact of Event Scale-Revised (IES-R) and 12 item General Health questionnaire (GHQ-12) were used to evaluate mental health and impact of disease. Epidemiological and sociodemographic information entailing underlying diseases was assess by a researcher-made questionnaire.
Results: We found that the psychological impact of the current pandemic is mild to moderate. During the initial phase of the pandemic, the intellectual engagements, inducing post event stress is not yet entirely developed. However, patients had a moderate to high probability of psychiatric morbidity with 63.6% and 28.4%, respectively.
Conclusion: The effect of such viral pandemic on mental health is inevitable. As we conducted the study in the dire times of the outbreak, patients showed a high probability of psychiatric morbidity. On the other hand, since the study was done in the initial phase of the epidemic, we detected mild effects of the epidemic on PTSD in COVID-19 patients. Furthermore, several psychosocial protective programs should be implicated to address the mental complications.
Can Neutrophil-Lymphocyte Ratio Be a Useful Criterion for Neuroleptic Malignant Syndrome in the Absence of Leukocytosis?
Objective: Neuroleptic malignant syndrome (NMS) is a rare but severe side effect of antipsychotic medication. Neutrophil-lymphocyte ratio (NLR) is a simple marker used to measure systemic inflammation.
Method: In this case report we explore the relationship of inflammation in the etiology of NMS. In our case involving NMS, although there was no leukocytosis, the NLR was increased up to systemic infection levels.
Conclusion: We hypothesized that systemic inflammation may take a role in developing NMS. If so, NLR could be a new marker of NMS that may be able to provide more sensitive results than leukocyte levels.