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.
Epidemiology of Psychotic Disorders Based on Demographic Variables in Iranian Children and Adolescents
Objective: Psychosis is still among the most debilitating and severe mental disorders. The main objective of the present study was to investigate the estimated prevalence of psychotic disorders and finding the main predictors of psychotic disorders among Iranian children and adolescents.
Method: Our total sample consisted of 30 553 individuals (49% males and 51%females) from 30 provinces of Iran, aged between 6 and 18 years, who were selected via cluster sampling method from urban and rural areas of all provinces. The data were analyzed using descriptive statistical analysis and multiple logistic regression method.
Results: The results of multiple regression analysis showed that prevalence estimate of psychotic disorders was 0.25%. It was 0.3% and 0.2% in males and females, respectively. The age of 10-14 (OR = 2.24; 95% CI, 1.11-4.55) and the age of 15-18 (OR = 3.42; 95% CI, 1.74-6.75) were significant positive predictors, whereas none of the demographic variables were predictors for psychotic symptoms.
Conclusion: This research highlights the main predictors of psychosis in children and adolescents. The study design also allowed a better understanding of predictors of psychotic disorders. The assessment of the prevalence of psychiatric disorders, particularly their comorbidities, may help to prevent mental illnesses in children and adolescents.
Mental Health Problems and the Associated Family and School Factors in Adolescents: A Multilevel Analysis
Objective: Mental health is one of the most important issues in adolescents’ life. Adolescents’ health is highly important, because of their role in the future. This study was conducted using multilevel analysis to investigate the risk factors at student and school levels.
Method: This was a cross sectional study for which 1740 students and 53 schools were selected between February and March 2018 in Qazvin, Iran. Multistage stratified cluster sampling was used for data collection. Mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ). Emotional symptom, conduct problem, hyperactivity, peer relationship problem, and prosocial behavior were the subscales. This study used multilevel analysis to determine the association between each of the questionnaire scales and students and schools variables.
Results: The prevalence of the mental health problems was 16.2%. Conduct problem was more prevalent than others (21.1%). Overall, the score of mental health problems was significantly lower in boys’ schools, in adolescents with physical activity, and in families with high socioeconomic status. Hyperactivity and emotional symptoms were significantly higher in girls’ schools. While prosocial behavior and peer relationship problems were significantly higher in boys’ schools. The association between variables and the scales of mental health problems was different.
Conclusion: Results indicated desirable physical activity and socioeconomic status are effective components in the adolescents’ mental health, and, mostly girls’ schools were more vulnerable than boys’ schools. Therefore, the educational authorities and health policymakers should consider this diversity to design interventional programs and pay more attention to the high-risk adolescents in different schools.
Efficacy of Acceptance and Commitment Therapy Compared to Cognitive Behavioral Therapy on Anger and Interpersonal Relationships of Male Students
Objective: The aim of the present study was to determine the efficacy of acceptance and commitment therapy (ACT) compared to cognitive-behavioral therapy (CBT) on anger and interpersonal relationships among male students. Method: In the present study, several universities were selected from the public universities in Tehran province, based on random cluster sampling. Then, 400 students from selected universities were selected randomly and Aggression Questionnaire (AGQ) was administered on them. After collecting information, among the participants who gained scores higher than the average, 30 were selected based on the lottery and randomly (sorting their names in alphabetical order and randomly selecting them) and then were placed randomly in ACT (n = 15) and CBT (n = 15) groups. Also, the Fundamental Interpersonal Relation Orientation- Behavior (FIRO-B) and Aggression Questionnaire (AGQ) was performed on both groups before and after intervention.
Results: The results indicated that at the end of treatment, there was a significant decrease in the degree of anger among the participants and a significant improvement in all subscales of interpersonal relationships. Also, a significant difference was found between the 2 groups of ACT and CBT in terms of anger changes. Considering that the anger changes in the ACT group were higher, it can be concluded that the ACT group had more changes than the CBT group, but there was no significant difference between the 2 groups of ACT and CBT in terms of FIRO-B subscales.
Conclusion: In some cases, such as anger, ACT has a better effect than CBT, and in others, such as interpersonal problems, it is as effective as CBT.
Investigating the Mediating Role of Procrastination in the Relationship between Positive and Negative Perfectionism and Mobile Phone Addiction in Gifted Students
Objective: Adolescence is a critical period in terms of development and education, in which there are numbers of high-risk behaviors that can negative effects on personal and educational life. One of these high-risk behaviors is mobile phone addiction that is a sociopsychological phenomenon, and the lack of control in the use of this technology by students can cause damage to various aspects of their personal and educational lives. The aim of the present study was to investigate the mediating role of procrastination in the relationship between positive and negative perfectionism and addiction to mobile phone in gifted students.
Method: This was a descriptive and correlational study in which 200 gifted students from gifted students’ high school of Meshghinshahr were selected using cluster sampling in 2020. Tri-Shot Perfectionism questionnaires, Tuckman Procrastination Scale, and Savari Mobile Phone Addiction questionnaire were applied to collect data. Descriptive statistics, correlation matrix, and path analysis (Structural Model) were used to analyze data.
Results: The findings revealed positive and negative perfectionism was not directly related to cell phone addiction. However, positive perfectionism through procrastination meditation had a negative and indirect relationship with mobile phone addiction (β = -0.18), and negative perfectionism through procrastination meditation had a positive and indirect relationship with mobile phone addiction (β = 0.17). In other words, procrastination is a complete mediation in the relationship between negative and positive perfectionism and cell phone addiction in students (β = 0.29).
Conclusion: The results emphasized the effect of procrastination on the relationship between positive and negative perfectionism and mobile phone addiction in gifted students. Therefore, these findings can help school and rehabilitation counselors to prepare programs for reducing students' addictive and avoidant behaviors.
The Association between Behavioral Problems with Self-Esteem and Self-Concept in Pediatric Patients with Thalassemia
Objective: High prevalence of behavioral and psychological disorders in children with thalassemia can be associated with a decrease in the self-esteem of patients and can completely alter the person's self-concept. The aim of this study was to determine the prevalence of behavioral problems and its relationship with self-esteem and self-concept in patients with thalassemia major aged 6 to 18 years.
Method: In a cross-sectional study, 30 patients with thalassemia major at the age of 6 to 18 years were enrolled. behavioral problems, self-esteem, and self-concept were evaluated by the child's behavioral check list at the ages of 6 to 18 years (CBCL 6-18), the Coopersmith's Self-Esteem Inventory, and the Piers-Harris Children's Self-Concept Scale.
Results: A total of 10.0% of patients had behavioral disorders, 3 (10.0%) desirable self-esteem, 15 (50.0%) moderate self-esteem, and 12 (40.0%) poor self-esteem. There was a strong but adverse correlation between behavioral disorder score and both self-esteem score (correlation coefficient equal to -0.886, p value = 0.001) and self-concept score (correlation coefficient equal to -0.498, p value = 0.001), and thus those patients with behavioral disorder had less appropriate self-esteem and self-concept.
Conclusion: The incidence of behavioral disorders is associated with decreased self-esteem and poor self-concept in these patients. Therefore, improvement in behavioral disorders can be expected by improving self-esteem and self-concept in such patients.
Objective: Millon Clinical Multiaxial Inventory (MCMI) is one of the most widely used clinical tools in research studies and clinical settings. MCMI was revised 4 times and its last version was published in 2015. All previous versions of MCMI have been translated to Persian and validated and have been frequently used by Iranian clinicians or researchers. Thus, this study provides the Persian version of the last version of this popular inventory for clinical or research purposes. Method: The participants of this psychometric study were selected by combining purposeful and convenience sampling methods among inpatients and outpatients who referred to Roozbeh hospital from 2018 to 2019. After data screening by statistical methods and Validity Scales based on MCMI-IV profile, 400 participants’ profiles were analyzed to estimate the psychometric properties of the Persian Version of MCMI-IV. MCMI-IV, the Structured Clinical Interview for DSM-5 (SCID-5), and the Brief Symptoms Inventory (BSI) were used for clinical data gathering. Content Validity Ratio (CVR), Correlational Coefficients, Kappa Agreement, Spearman Brown Coefficient, and Cronbach Alpha were performed for data analysis.
Results: According to the results of data analysis, the psychometric properties for MCMI-IV were estimated as follows: the content validity index (CVI, 0.29 to 0.99), criterion validity (0.13 to 0.40), convergent validity (-0.35 to 0.72), The Cronbach’s alpha for the personality scales was 0.48 to 0.90, the Spearman-Brown coefficient was from 0.49 to 0.90, and test-retest reliability was from 0.51 to 0.86.
Conclusion: The psychometric properties of the Persian version of MCMI-IV, including validity and reliability indexes, are appropriate and in line with the findings of its original version.
Efficacy of Gemfibrozil as an Adjunct to Sertraline in Major Depressive Disorder, A Double-Blind, Randomized, and Placebo-Controlled Clinical Trial
Objective: Major depressive disorder (MDD) is predicted to be the first cause of burden of disease. The antidepressant activity of gemfibrozil has been recently considered. This study was designed to evaluate the effectiveness of gemfibrozil as a sertraline adjunct in treating patients with MDD.
Method: A total of 46 patients with MDD based on the DSM-V criteria with a minimum score of 22 on the 17-item Hamilton Rating Scale for Depression (HAM-D) were randomized to receive either 300 mg daily gemfibrozil or placebo in addition to 100 mg sertraline for 8 weeks in a randomized, double-blind placebo-controlled trial. Patients were evaluated for response to treatment using the HAM-D score at baseline and weeks 2, 4, and 8.
Results: Forty-five patients completed the study and took part in all follow-up visits. Repeated measure ANOVA with a Greenhouse-Geisser correction showed a significant difference for time×treatment interaction on within-subjects HAM-D scores [p–value= 0.026]. A significant difference was seen in time [p–value < 0.001]. The test of between-subject effects also showed a significant effect of treatment on HAM-D scores at weeks 2, 4, and 8 [p–value = 0.07]. Using Kaplan-Meier estimate curves, time to remission periods were significantly different between the 2 trial arms [Log-Rank p–value = 0.003].
Conclusion: Gemfibrozil is an effective adjunctive treatment in MDD and can be used to reduce depression symptoms.
Implementation of the McMaster Model in Family Therapy: Effects on Family Function in Married Couples
Objective: Family function is one of the main effective factors on stability of the family. Family therapy can promote family function and performances. This study aimed to assess the effects of family therapy on family function among couples in Yazd province (Iran) based on the McMaster model.
Method: The research population was selected from volunteer couples in Yazd in 2017 who were invited by publicity announcement to participate in this research. Finally, 40 couples were selected and randomly divided into 2 intervention and control groups. Participants responded to the demographic and Family Assessment Device (FAD) questionnaires. The obtained information was investigated using inferential and descriptive statistics and SPSS 21 software.
Results: The results showed significant differences between the intervention and control groups in problem-solving (p = 0.01), communication (p < 0.0001), emotional responsiveness (p = 0.01), emotional involvement (p < 0.0001), and general function (p = 0.04). The roles and behavior control domains were improved after the intervention in 2 groups, but the differences were not significant.
Conclusion: Family therapy based on McMaster model can promote the skills of problem- solving, family communication, emotional responsiveness, emotional involvement, and general function in couples. Healthy family functioning is an important domain of interest for mental health professionals who provide family interventions. Our findings add substantially to family professionals’ knowledge about patterns of family function in Iranian families.
Objective: Recurrent events data is one of the most important types of survival data whose main feature is correlation between individual’s observations. The aim of this study was to analyze the time to bipolar disorder (BD) relapse and determine the related factors using recurrent events models.
Method: In this retrospective study, records of 104 BD patients with at least one relapse who were admitted for the first time (2001-2015) in Farabi hospital of Kermanshah were gathered to identify the factors influencing the time intervals between the recurrent survivals data using the Cox model with and without frailty (shared frailty), once with frailty gamma distribution and once with log-normal distribution frailty. All calculations were performed using R and SPSS software, versions 3.0.2 and 16 and the level of significance was considered at 0.05.
Results: Among the employed models, Cox model with lognormal shared frailty showed better fit for BD recurrent survival data. According to results of Cox model with lognormal frailty, 2 factors (marital status and history of veteran) were identified to affect the time intervals between relapses.
Conclusion: Because of the better fit of the models with the frailty effect on data, the correlation between the recurrent time intervals of each subject's relapse of BD was confirmed. Also, since the risk of subsequent relapses was less in married and veteran patients, marriage and emotional care supports can be considered as effective factors in reducing the risk of subsequent relapses of this disease.
Community Action Package in Iran's Comprehensive Mental and Social Health Services (the SERAJ Program)
Objective: The social component of health plays a significant role in improving the mental health of the people of a district. 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 determine its model for improving the indicators of the social component of mental health.
Method: This study is a system design for which a literature review, interviews with experts, and focused group discussions with stakeholders were used.
Results: Community action in promoting the mental health of the districts has three main components: strengthening intersectoral collaboration through the memorandum of understandings (MoU), increasing people's participation by establishing People’s Participation House (PPH) with the presence of the representative of current People’s network, and social protection of people suffering from mental disorders by establishing the Social Support Unit (SSU) for self-reliance activity. All three components are controlled by the governor and with supervision and technical consult of the health network of the district and stakeholder participation.
Conclusion: The model uses the inner capacities of the city instead of creating new structures. The prerequisites for the effective function of the main three components are educating departments, educating members of the PPH, and hiring a social worker at the SSU. The effective measures taken by the departments to reduce the risk factors for mental disorders are dependent on the technical and financial support of relevant organizations at the provincial and national levels.
Objective: The Iranian Mental Health Survey (IranMHS) in 2011 has demonstrated that almost 1 out of 4 adult individuals suffer from psychiatric disorders; however, more than two-thirds are left unrecognized and untreated and many of the services have poor quality of care. In this paper we present our experience in developing and employing community-based mental health services through community mental health centers (CMHCs), which has been incorporated in Iran's comprehensive mental and social health services (the Seraj program).
Method: The service model of the CMHCs was developed though an evidence-based service planning approach and was then incorporated as the specialized outpatient services model into the Seraj program in 2015.
Results: The CMHCs in the Seraj program provide mental health care to patients with common mental and severe mental disorders in a defined catchment area. The services include the collaborative care, the aftercare, and day rehabilitation. The collaborative care model works with primary care providers in the health centers to provide detection and treatment of common mental illnesses. In the aftercare, services are offered to patients with severe mental disorders following discharge from the hospital and include telephone follow-ups and home visits. Day rehabilitation is mostly focused on providing psychoeducation and skill trainings. During the first 4 years of implementation in 2 pilot areas, more than 6200 patients (10% having severe mental disorders) received care at CMHCs.
Conclusion: The main challenge of the implementation of the CMHC component in the Seraj program is to secure funds and employ skilled personnel. We need to incorporate Seraj in the existing national health system, and if successful, it can fill the treatment gap that has been so huge in the country.
Objective: In this systematic review, we aimed to evaluate the existing strategies and interventions in domestic violence prevention to assess their effectiveness.
Method: To select studies, Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched. Two authors reviewed all papers using established inclusion/ exclusion criteria. Finally, 18 articles were selected and met the inclusion criteria for assessment. Following the Cochrane quality assessment tool and AHRQ Standards, the studies were classified for quality rating based on design and performance quality. Two authors separately reviewed the studies and categorized them as good, fair, and poor quality.
Results: Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Different intervention methods had been used in these studies. Four studies focused on empowering women; 3, 4, and 2 studies were internet-based interventions, financial interventions, and relatively social interventions, respectively. Four interventions were also implemented in specific groups. All authors stated that interventions were effective.
Conclusion: Intervention methods should be fully in line with the characteristics of the participants. Environmental and cultural conditions and the role of the cause of violence are important elements in choosing the type of intervention. Interventions are not superior to each other because of their different applications.
Creutzfeldt-Jakob Disease after Dental Procedure Along with the Initial Manifestations of Psychiatric Disorder: A Case Report
Introduction: Creutzfeldt-Jakob disease (CJD) as a prion disease is an untreatable type of progressive neurodegenerative encephalopathy. Although no definitive case has been reported yet, here we report a case that given the history, course of symptoms, and recent dental practice, it is highly probable that it was caused by dental procedures.
Case Report: The patient was a 52-year-old woman who has had memory problems gradually with forgetting the names of family members since 6 weeks prior to the visit and shortly after the dental procedure. She experienced progressive visual hallucinations accompanied by a sharp decline in cognitive, verbal, and motor abilities in just a few weeks. Finally, the diagnosis of Creutzfeldt-Jakob was made for her based on the clinical history and typical brain MRI.
Discussion: Clinical evidence of this patient, along with positive brain MRI results, indicates the risk of prion transfer through dental procedures. Paying attention to the neurological aspects of psychiatric manifestations and increasing the awareness of dentists about how to deal with and act on the potential dangers of prion transfer is of paramount importance.
Objective: The purpose of this study was to introduce, present, and describe the self-review therapeutic method that was designed and presented by Pourhosein based on Beck's cognitive theory, Islamic philosophy, and the return to Iqbal-e-Lahouri's self-awareness to reduce the symptoms of depression and increase happiness.
Method: In this study in addition to a theoretical and methodological discussion about self-review intervention method browsing, an example of research done in this field is mentioned.
Results: The basic principles of this approach have been based on human integrity with a cognitive approach. The underlying principle in this method is the bareness and consciousness of the human being from the inner and outer features of the self in which as a human being becomes more aware of his internal and external traits and his emotional responses will become more realistic.
Conclusion: This method is presented in a systematic manner, which if goes well, the patients’ consciousness about their self is increased and their symptoms of depression will decrease. In this study, while explaining its theoretical and methodological foundations, some research examples suggest a decrease in these symptoms.
Objective: The Iranian Mental Health Survey (IranMHS) indicated that almost 1 in 4 people had one or more psychiatric disorders (23.6%); however, two-thirds of patients did not benefit from health interventions, many provided services were inadequate and imposed a high burden on Iranian families. Therefore, the development of a national program on providing comprehensive social and mental health services, entitled “SERAJ”, became necessary. The present study aims to develop and outline the protocol for the pilot implementation of SERAJ.
Method: This study is an action research with the collaborative mode. To compile the protocol, a broad review of the literature, interviews with experts and stakeholders, and focused group discussions were conducted.
Results: The pilot implementation should be divided into 4 phases: (1) preparing documentation and work team, (2) preparing the prerequisites for providing pilot services, (3) providing pilot services, and (4) implementation and evaluation.
Conclusion: SERAJ considered both preventive and treatment measures for mental and social health disorders and their risk factors. Moreover, the entire population can have access to primary and secondary services. Therefore, SERAJ is more comprehensive than the current situation in the country's mental health services. We suggest piloting and evaluating SERAJ in three districts of Iran.