Iranian Journal of Psychiatry

Effects of Vitamin B12 and Folic Acid Supplementation on Negative Symptoms as the Primary Outcome and Positive and Cognitive Symptoms as Secondary Outcomes in Schizophrenia: A Randomized Controlled Trial

2026-06-07T11:52:52+0430

Objective: Persistent negative symptoms in chronic schizophrenia often show limited responsiveness to antipsychotic therapy. The present study evaluated whether supplementation with vitamin B12 and folic acid improves negative symptoms as the primary endpoint, while also examining effects on positive symptoms and global cognitive functioning as secondary outcomes.

Method: In this randomized, double-blind, placebo-controlled trial, 88 inpatients with chronic schizophrenia receiving stable risperidone therapy were assigned to one of four groups: vitamin B12 (1 mg/day), folic acid (1 mg/day), combined vitamin B12 plus folic acid (1 mg/day each), and placebo for eight weeks. Negative symptoms were measured using the Scale for the Assessment of Negative Symptoms (SANS), positive symptoms using the Scale for the Assessment of Positive Symptoms (SAPS), and cognitive function using the Mini-Mental State Examination (MMSE). Serum concentrations of vitamin B12 and folate were assessed at baseline and after the intervention.

Results: Supplementation with vitamin B12 and/or folic acid led to significant increases in serum concentrations of the corresponding vitamins (P < 0.001). All supplementation groups demonstrated significant and clinically meaningful reductions in negative symptom severity compared with placebo, with large effect sizes. In contrast, no significant changes were detected in positive symptoms or global cognitive performance.

Conclusion: Adjunctive vitamin B12 and folic acid supplementation significantly reduced negative symptom severity in chronic schizophrenia, without affecting positive symptoms or global cognition. Targeted correction of vitamin deficiencies may represent a valuable adjunctive approach for persistent negative symptoms.

Sociocultural Factors Influencing Prolonged Grief Disorder: A Scoping Review

2026-05-20T14:02:44+0430

Objective: Grief is a response to significant loss that may become prolonged and develop into prolonged grief disorder (PGD). Sociocultural factors can influence this process. This scoping review examined studies on sociocultural determinants of PGD.

Method: Databases searched included PubMed, Web of Science, Scopus, PsycINFO, and ProQuest. Studies published between January 2012 and December 2025 were screened in accordance with PRISMA-ScR guidelines and analyzed descriptively.

Results: From 877 identified papers, 19 met the inclusion criteria. Four key sociocultural factors emerged: religious beliefs, mourning customs, cultural beliefs, and social support. Religious beliefs functioned as both risk and protective factors depending on the context and coping style. Mourning customs promoted healing when upheld and intensified grief when disrupted; moreover, in some contexts, rituals may also maintain grief. Cultural beliefs shaped grief expression and understanding, sometimes conflicting with diagnostic criteria. Social support, especially when culturally congruent, moderated grief outcomes, while social withdrawal or isolation also emerged as an important predictor of prolonged grief (PG) symptoms.

Conclusion: The findings underscore the importance of culturally sensitive interventions in PGD. Understanding these sociocultural dynamics is essential for developing culturally tailored prevention and treatment strategies for PGD.

Effectiveness of Internet-Based Psychoeducation in Reducing Caregiver Burden in Dementia: A Clinical Trial

2026-05-12T13:13:52+0430

Objective: This study aimed to assess the impact of online psychoeducational training on reducing the psychological burden of caregivers of patients with moderate to severe dementia. Caring for such patients, especially by non-professional caregivers, poses significant mental and physical challenges. Internet-based interventions offer a practical and innovative solution to help alleviate this burden.

Method: This clinical trial was conducted in 2023 in Kashan, Iran, with 84 caregivers of patients with moderate to severe dementia. Participants were divided into two groups: an intervention group (n = 42) and a control group (n = 42). The intervention group received a 20-session online psychoeducational program over eight weeks, while the control group received routine care. Caregiver burden was measured using the Zarit Burden Interview (ZBI) before, immediately after, and three months after the intervention. Data analysis included independent t-tests and repeated measures ANOVA.

Results: Baseline characteristics of caregivers in both groups were homogeneous in most variables, except for education level, which differed significantly (P = 0.006). Repeated measures of the general linear model (GLM) analysis revealed a significant reduction in caregiver burden in the intervention group (P = 0.014). Within-group analysis showed that the burden significantly decreased immediately after the training. Although a slight increase was observed at the three-month follow-up, it remained lower than the baseline (P < 0.001).

Conclusion: Online psychoeducational training significantly reduces the psychological burden of dementia patient caregivers, with sustained effectiveness over a three-month follow-up. These findings support the integration of digital psychoeducation as a viable alternative or complement to traditional interventions, particularly in resource-limited or high-need settings.

A Narrative Review of Challenges and Management Strategies for Pediatric Clients with Neurodevelopmental Disorders in Non-Psychiatric Settings

2026-05-13T09:13:15+0430

Objective: The prevalence of Neurodevelopmental Disorders (NDDs), including Autism Spectrum Disorder (ASD), is increasing globally, driven largely by evolving diagnostic criteria, diagnostic substitution, and increased public awareness. While children with NDDs frequently visit Emergency Departments (EDs) for medical, non-psychiatric complaints, acute care environments are often ill-equipped to meet their unique sensory and communicative needs. This mismatch frequently leads to behavioral escalation, increased use of restraint, and caregiver dissatisfaction.

Method: This narrative review synthesizes current literature to examine the challenges facing pediatric clients with NDDs in non-psychiatric settings and identifies evidence-based strategies to optimize their management.

Results: Analysis reveals that the chaotic nature of the ED, characterized by sensory overload and unpredictable routines, acts as a significant barrier to care. Clinicians frequently report higher procedural difficulty for these clients, as measured by tools such as the Task Completion Index (TCI). Evidence indicates these patients are five times more likely to have difficulty with vital signs and eight times more likely to undergo physical or pharmacological restraint compared to neurotypical peers. Key management strategies identified include the implementation of “Health Passports” for communicating baseline needs, early identification via EMR flagging, and environmental modifications such as “Low-Stimulation Rooms” and sensory toolkits. Furthermore, adopting behavioral pain scales (e.g., r-FLACC) and “Tell-Show-Do” techniques are essential for accurate assessment and procedural success.

Conclusion: Current acute care models are often reactive rather than proactive regarding neurodiversity. Bridging the gap requires a systemic shift towards “support-first” methodologies. By integrating sensory-friendly protocols, leveraging caregiver expertise, and prioritizing staff training, healthcare systems can significantly reduce the reliance on coercive measures and improve clinical outcomes for this vulnerable population, which should be considered a core competency in pediatric emergency medicine.

Spiritual Health and Psychological Well-Being and their Relationship with General Self-Efficacy in Mothers of Children with Intellectual Disability and Autism Spectrum Disorders

2026-05-04T09:58:28+0430

Objective: Mothers of children suffering with autism spectrum disorder (ASD) and intellectual disability (ID) experience substantial psychological challenges that may affect their perceived self-efficacy. While psychological well-being and spiritual health are considered important protective factors, their relative contributions to general self-efficacy in this population remain insufficiently explored in Iran. This study aimed to investigate whether psychological well-being and spiritual health are correlated with the general self-efficacy of mothers of children with ID or ASD in Qom, Iran.

Method: This was a correlational cross-sectional study involving the participation of 100 mothers of children with ID (n = 49) and ASD (n = 51) who were enrolled via multi-stage cluster sampling method. The participants completed the Spiritual Health Questionnaire for the Iranian Population, the Ryff Psychological Well-Being Questionnaire, and the Sherer Self-Efficacy Questionnaire. Data were analyzed using Pearson correlation coefficients and stepwise multiple regression analysis in SPSS version 22, with the significance level set at P < 0.05.

Results: The study revealed that psychological well-being was positively and significantly correlated with general self-efficacy in both mothers of children with ASD (r = 0.62, P < 0.001) and mothers of children with ID (r = 0.65, P < 0.001).

In contrast, spiritual health showed no significant association with general self-efficacy in either group (P > 0.05). Regression analyses showed that psychological well-being explained 38% of the variance in general self-efficacy among mothers of children with ASD and 42% among mothers of children with ID (P < 0.001).

Conclusion: The findings highlight the importance of psychological well-being as a substantial predictor of general self-efficacy among mothers of children with ID and ASD. Thus, interventions to strengthen maternal self-efficacy are recommended to be considered a means of promoting self-efficacy, while the role of spiritual health requires further study.