Iranian Journal of Psychiatry

Montreal Cognitive Assessment (MoCA) Scale: Strengths, Limitations, and Implication for Clinical Practice

2025-12-09T11:09:36+0330

Objective: Mild Cognitive Impairment (MCI) is a transitional state between normal aging and dementia, with high risk of progression. Early detection is essential, and so the Montreal Cognitive Assessment (MoCA) has become a widely used screening tool. Despite its popularity, concerns remain about its psychometric limitations and cultural applicability.

This review aims to critically analyze the MoCA, focusing on the validity and limitations of its subtests, and to propose directions for refinement and clinical adaptation.

Method: We conducted a structured narrative review (2005–2024) using PubMed, Scopus, and Web of Science databases. Search terms included “Montreal Cognitive Assessment”, “MoCA”, “validity”, “psychometrics”, and “cultural adaptation”. Studies evaluating psychometric performance, cultural adaptations, and clinical applications of the MoCA were included. Case reports and studies lacking psychometric evaluation were excluded. An item-by-item critical appraisal was performed.

Results: The MoCA shows superior sensitivity for MCI detection compared to the Mini-Mental State Examination (MMSE), with strengths in brevity, multidomain coverage, and accessibility. However, limitations include: superficial executive function (EF) assessment, cultural and educational bias, lack of recognition/cueing in memory testing, simplistic binary scoring, and risk of floor/ceiling effects. These may affect diagnostic accuracy across populations.

Conclusion: The MoCA remains a valuable tool but should not be used in isolation. Clinicians must consider the cultural/educational context when interpreting results. Refinements such as weighted scoring, cued recall, and culturally adapted items, alongside digital versions, could improve accuracy and fairness. Further empirical validation of these modifications is needed.

A Qualitative Exploration of Stakeholder Perceptions of Schizophrenia

2025-12-08T11:17:35+0330

Objective: Schizophrenia is a severe mental disorder associated with substantial social stigma that impedes patients' access to quality care and social support. In Indonesia, where cultural and religious beliefs strongly influence mental health perceptions, stakeholders’ attitudes critically shape responses to this condition. This study explored how various stakeholder groups perceive schizophrenia in Indonesia.

Method: A phenomenological qualitative design was employed with 29 participants (families, healthcare workers, and policymakers) selected through purposive sampling in Yogyakarta, Indonesia. Data were collected through face-to-face semi-structured in-depth interviews (60-90 minutes), audio-recorded and supplemented by direct observations. Interview transcripts were analyzed using thematic analysis with triangulation and member checking to ensure data validity.

Results: Five main themes emerged: (1) healthcare workers demonstrated clinical understanding, while families showed experiential knowledge; (2) stakeholders recognized multifactorial causation combining genetic and environmental factors; (3) realistic expectations focused on symptom management rather than cure; (4) persistent cultural stigma, rooted in supernatural beliefs, hindered help-seeking; (5) and collaborative family-healthcare worker partnerships were essential for patient stability.

Conclusion: This study provides novel insights into Indonesian stakeholders’ perspectives on schizophrenia, revealing culturally-specific stigma patterns rooted in supernatural beliefs—a factor understudied in Southeast Asian contexts. Findings inform development of targeted anti-stigma interventions and integrated care models that leverage family-healthcare worker collaboration to improve patient outcomes in Indonesia's mental health system.

Autism and Human Papillomavirus (HPV) E6: A Comprehensive Review

2025-12-07T11:26:43+0330

Objective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication impairments, restricted interests, and repetitive behaviors. The etiology of ASD is complex, involving genetic and environmental factors. The HECT (Homologous to the E6-AP Carboxyl Terminus) family protein E6-associated protein (E6-AP), encoded by the UBE3A gene, is an ubiquitin ligase implicated in neurological disorders, including Angelman syndrome (AS) and potentially ASD. Dysregulation of E6-AP, influenced by environmental factors such as human papillomavirus (HPV) E6 protein, may contribute to neurodevelopmental abnormalities.

Method: This review synthesizes current literature to explore the potential link between HPV E6 protein and E6-AP dysfunction in the context of ASD. We analyzed 32 peer-reviewed studies, including 12 original research articles, 10 reviews, and 10 meta-analyses, retrieved from PubMed and Google Scholar, focusing on E6-AP’s roles in ubiquitin-mediated signaling pathways, its dysregulation in neurodevelopmental disorders, and the impact of HPV E6 on E6-AP function.

Results: E6-AP is critical in regulating signaling pathways associated with tumorigenesis and neurodevelopment. Dysregulation of E6-AP, potentially induced by HPV E6, has been implicated in AS and, to a lesser extent, ASD. As visually demonstrated in Figure 1, these complex relationships between HPV, neurodevelopmental disorders, and E6 protein underscore the need for cross-disciplinary research. Current findings indicate that HPV E6 may disrupt E6-AP’s ubiquitin ligase activity, potentially contributing to neurodevelopmental impairments observed in ASD.

Conclusion: The potential link between HPV E6 and E6-AP dysfunction underscores a novel avenue for understanding environmental contributors to ASD. Given the complexity of ASD, further research is essential to elucidate E6-AP’s role and to develop targeted therapeutic strategies. This review highlights the need for studies investigating HPV-related mechanisms in ASD to advance effective interventions and support systems.

Ideology in the Name of Science: Substituting Cultural Beliefs for Scientific Facts — A Critique of Quintana and Barrientos

2025-12-06T12:23:22+0330

Standardization of Developmental Indicators for the Assessment of Learning for Persian Children

2025-12-06T10:20:28+0330

Objective: The Developmental Indicators for Assessment of Learning–Fourth Edition (DIAL-4) is a widely used screening tool grounded in developmental theory, designed to identify potential delays across motor, language, conceptual, self-help, and socio-emotional domains prior to school entry. While the DIAL-4 has been standardized in several countries, its norms may not fully capture the cultural, linguistic, and environmental characteristics that shape developmental trajectories of Iranian children. To address this gap, the present study aimed to establish culturally appropriate norms for the DIAL-4 in Iran, providing a valid and reliable framework for early identification and intervention.

Method: This cross-sectional study standardized the Developmental Indicators for Assessment of Learning–Fourth Edition (DIAL-4) for Iranian children aged 2 years 6 months to 5 years 11 months. Districts in both cities were first selected using cluster sampling, considering socioeconomic and cultural diversity. Within these districts, kindergartens were randomly chosen. The final sample comprised 678 children. Trained examiners administered the Persian version of DIAL-4 individually. Raw scores on motor, concepts, and language subscales were converted into standardized developmental scores (M ₌100, SD ₌15), following established psychometric guidelines to generate culturally appropriate norms.

Results: The findings indicated that the motor, concepts, and language subscales differed significantly across age groups (p < 0.05). Based on standardized scoring criteria, values below 70 were classified as indicative of severe deficits or developmental delays, scores between 70 and 84 reflected mild delays, scores from 85 to 115 were considered within the normative range, scores between 115 and 129 indicated above-average performance, and scores of 130 or higher represented an advanced level of functioning. When comparing the standardized developmental scores of Iranian children with those of American children, the results demonstrated that Iranian children consistently obtained lower scores across all three subscales.

Conclusion: This study confirmed the suitability of the DIAL-4 for Iranian children and showed significant differences in motor, concepts, and language skills across age groups. Iranian children scored lower than American children on all subscales, highlighting the need for culturally specific norms to ensure accurate developmental assessment.