Vol 12 No 1 (2017)
Epidemiology of Psychiatric Disorders in Iranian Children and Adolescents and Its Relationship with Social Capital, Life Style and Parents' Personality Disorders: Study Protocol
Objective: We aimed at designing a cross sectional study to investigate the prevalence of psychiatric disorders in Iranian children and adolescents and to determine its relationship with social capital, life style, and parents' personality disorders.
Method: This cross sectional study was a national project implemented in all provinces of Iran. In this community-based study, using multistage cluster sampling method, we selected 1000 children and adolescents aged 6 to 18 years in each province. The total sample size reached to 31 000. We randomly collected 170 blocks. Then, of each cluster head, we selected 6 cases including 3 cases of each gender in different age groups (6- 9 years, 10- 14 years, and 15- 18 years). The clinical psychologists instructed the participants to complete the Persian version of Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). In addition, demographic data (gender, age, education, parent education, and economic situation) and information on lifestyle, social capital, and parents' personality disorders were obtained from the participants.
Discussion: This study presents a protocol for an epidemiological survey on the first estimates for the prevalence of psychiatric disorders in children and adolescents across the country. This large body of data, on a range of individual behavioural and emotional items and scores, allows us to compare the rates and patterns of deviance between urban and rural places of residence in 31 provinces of Iran with non Iranian samples surveyed with the same measures.
Objective: Electrophysiological studies have identified abnormal oscillatory activities in the cerebral cortex in schizophrenia and mood disorders. Biological and pathophysiological evidence suggests specific deficits in serotonin (5-HT) receptor function in schizoaffective disorder (SA), a clinical syndrome with characteristics of both schizophrenia and bipolar disorder. This study investigated alpha oscillations in patients with SA.
Method: Electroencephalography was used to measure ongoing and evoked alpha oscillations in 38 adults meeting Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM–IV) criteria for SA, and in 39 healthy controls.
Results: Spontaneous alpha power of the participants with SA was significantly lower than that of healthy participants [F (1, 75) = 8.81, P < 0.01]. Evoked alpha activity was also decreased in SA compared to controls [F (1, 75) = 5.67, P = 0.025].
Conclusion: A strong reduction of alpha power in the posterior regions may reflect abnormality in the thalamocortical circuits. It is shown that hypoxia and reduced cerebral blood flow is associated with reduced alpha activity among different regions of the brain. Therefore, it can be concluded that greatly decreased alpha activity, particularly in centro-parietal and occipital regions, is related to SA symptoms such as hallucinations.
Environmental Enrichment Prevents Methamphetamine-Induced Spatial Memory Deficits and Obsessive-Compulsive Behavior in Rats
Objective: This study was designed to examine the effect of environmental enrichment during methamphetamine (METH) dependency and withdrawal on methamphetamine-induced spatial learning and memory deficits and obsessive-compulsive behavior.
Method: Adult male Wistar rats (200 ± 10 g) chronically received bi-daily doses of METH (2 mg/kg, sc, with 12 hours intervals) for 14 days. Rats reared in standard (SE) or enriched environment (EE) during the development of dependence on METH and withdrawal. Then, they were tested for spatial learning and memory (the water maze), and obsessive-compulsive behavior as grooming behavior in METH-withdrawn rats.
Results: The results revealed that the Sal/EE and METH/EE rats reared in EE spent more time in the target zone on the water maze and displayed significantly increased proximity to the platform compared to their control groups. METH withdrawn rats reared in EE displayed less grooming behavior than METH/SE group.
Conclusion: Our findings revealed EE ameliorates METH-induced spatial memory deficits and obsessive-compulsive behavior in rats.
Investigation of Content and Face Validity and Reliability of Sociocultural Attitude towards Appearance Questionnaire-3 (SATAQ-3) among Female Adolescents
Objective: This study aimed to determine the psychometric properties of sociocultural attitude towards appearance questionnaire in female adolescents.
Method: This was a methodological study. The English version of the questionnaire was translated into Persian, using forward-backward method. Then the face validity, content validity and reliability were checked. To ensure face validity, the questionnaire was given to 25 female adolescents, a psychologist and three nurses, who were required to evaluate the items with respect to problems, ambiguity, relativity, proper terms and grammar, and understandability. For content validity, 15 experts in psychology and nursing, who met the inclusion criteria, were required. They were asked to assess the qualitative of content validity. To determine the quantitative content validity, content validity index and content validity ratio were calculated. At the end, internal consistency of the items was assessed, using Cronbach’s alpha method.
Results: According to the expert judgments, content validity ratio was 0.81 and content validity index was 0.91. Besides, the reliability of the questionnaire was confirmed with Cronbach’s alpha = 0.91, and physical and developmental areas showed the highest reliability indices.
Conclusion: The aforementioned questionnaire could be used in researches to assess female adolescents’ self-concept. This can be a stepping-stone towards identification of problems and improvement of adolescents’ body image.
Effectiveness of Psychoeducational Group Training on Quality of Life and Recurrence of Patients with Bipolar Disorder
Objective: Bipolar disorder (BD) is a disabling psychiatric disorder with frequent recurrences. Besides pharmacotherapy, psychoeducation could be helpful in reducing symptoms as well as recurrence of this disorder, leading to improvement of patients’ quality of life. This study aimed at investigating the effectiveness of a culturally adjusted structured program for training Iranian BD patients.
Method: In a 6-month course (spring and summer 2014), 24 BD patients, visiting the outpatient clinic of Ibn-Sina Hospital in Mashhad and experiencing euthymic phase, were allocated in to 2 groups of intervention and control. The intervention group received 8 sessions of psychoeducation in four weeks. Patients in the control group received the usual treatment. The patients were evaluated with Hamilton Depression Rating Scale, Young Mania Rating Scale, and Short Form 36 before the intervention and 4 weeks later, and the results were compared using independent t test. The patients were reexamined after 6 months for recurrence, hospitalization, treatment adherence, and visiting a psychiatrist, and were compared with patients in the control groups.
Results: There was a significant difference in the intervention group in improvement in quality of life before and after treatment (p<0.003). In addition, the difference was significant between the 2 groups in the number of recurrence (p<0.001) and hospitalization (p<0.000) in 6 months.
Conclusion: In addition to pharmacotherapy, psychoeducation of patients with BD can improve their quality of life and decrease the risk of disorder recurrence.
Psychiatric Comorbidities and Environmental Triggers in Patients with Chronic Daily Headache: A Lifestyle Study
Objective: Patients with chronic daily headache (CDH) suffer from several significant psychiatric comorbidities and have unhealthy lifestyle. We aimed at studying psychiatric comorbidities, environmental triggers, lifestyle factors, and intensity of CDH in patients referred by the department of neurology from 2011 to 2014.
Method: Through medical and psychiatric interviews and using 0 to 10 visual analogue scale (VAS), we assessed patients with CDH, using a checklist, to elicit psychiatric comorbidities, intensity of CDH, environmental factors, and lifestyle derangement.
Results: We interviewed 413 (age 16-80 years, mean 40 +/- 14.0) out of 548 patients; 312 (75.5%) were married, and 282 (68.1%) were female. Environmental triggers (374, 90.6%) were the most common cause of CDH, while 214 (51.8%) had no compliance to recommended nutrition. Exercise avoidance (201, 48.7%) was the less prevalent lifestyle factor. Of the patients, 372 (90.1%) were stressed and 162 (39.2%) had obsessive-compulsive disorder (OCD), which were the most and less prevalent psychiatric comorbidities, respectively. Intensity of pain was moderate to severe (mean score = 7.1+/- 1.9), while females reported higher VAS scores (p<0.02). Patients with previous history of psychotherapy reported higher score of VAS (p<0.001). Those patients living with a person suffering from head pain reported more VAS score (p<0.003).
Conclusion: Notable psychiatric comorbidities were found in patients with CDH, many of which are modifiable such as environmental triggers and unhealthy lifestyle. In heavily populated cities, these factors may double the burden of the CDH by precipitating new or exacerbating previous psychiatric comorbidities. We, thus, suggest conducting more studies on this subject.
Objective: This study proposed a model for provision of an effective universal coverage for mental health services based on global and national experiences, available resources and the nature of primary health care system of Iran to reduce the burden of mental health conditions.
Method: A framework with prioritized mental and social health services was devised through a review of literature and policy documents. It was then adapted using inputs from the stakeholders and experts.
Results: The new model included 2 basic and specialized service strata: a PHC-based infrastructure and essential requirements needed to establish the service. Our proposed socio-mental health approach is based on a WHO recommendation.
Conclusion: The key features of the model, which is going to be tested in a pilot study in 2015, are setting up a system for organized referrals to specialized mental facilities and compatibility with the existing primary health care system. Moreover, to achieve this goal, socio-mental health technicians should be employed.
Evaluation of Knowledge and Attitude of Parents of Attention Deficit/Hyperactivity Disorder Children towards Attention Deficit/Hyperactivity Disorder in Clinical Samples
Objective: Knowledge and attitude of parents about attention deficit/hyperactivity disorder (ADHD) is an important factor in management of the disorder in children. This study investigates the parents’ knowledge and attitude towards ADHD, its symptoms, diagnosis, treatment and prognosis.
Method: In this cross-sectional descriptive study, the subjects were 150 parents (120 mother and 30 father) of ADHD children who were referred to a child psychiatry clinic affiliated in university of social welfare and rehabilitation sciences in Tehran. The diagnosis was made by a child psychiatrist according to DSM-IV TR criteria. The parents completed a 40 items questionnaire that was prepared by the authors and assessed their knowledge and attitude towards ADHD and source of their information.
Results: The most common source of parent’s information about ADHD was TV. The parent’s knowledge about the symptoms of the disorder was relatively good. But in regard to diagnosis, treatment and prognosis of the disorder, they have very low knowledge and even incorrect beliefs. The parent’s knowledge significantly correlated with their educational level (p=0.01).
Conclusion: In general, knowledge of the parents was low and it can lead to misdiagnosis or mismanagement of this common and important disorder and need to further consideration in terms of educating parents about the disorder in media specially TV.
The Effect of Creative Tasks on Electrocardiogram: Using Linear and Nonlinear Features in Combination with Classification Approaches
Objective: Interest in the subject of creativity and its impacts on human life is growing extensively. However, only a few surveys pay attention to the relation between creativity and physiological changes. This paper presents a novel approach to distinguish between creativity states from electrocardiogram signals. Nineteen linear and nonlinear features of the cardiac signal were extracted to detect creativity states.
Method: ECG signals of 52 participants were recorded while doing three tasks of Torrance Tests of Creative Thinking (TTCT/ figural B). To remove artifacts, notch filter 50 Hz and Chebyshev II were applied. According to TTCT scores, participants were categorized into the high and low creativity groups: Participants with scores higher than 70 were assigned into the high creativity group and those with scores less than 30 were considered as low creativity group. Some linear and nonlinear features were extracted from the ECGs. Then, Support Vector Machine (SVM) and Adaptive Neuro-Fuzzy Inference System (ANFIS) were used to classify the groups.
Results: Applying the Wilcoxon test, significant differences were observed between rest and each three tasks of creativity. However, better discrimination was performed between rest and the first task. In addition, there were no statistical differences between the second and third task of the test. The results indicated that the SVM effectively detects all the three tasks from the rest, particularly the task 1 and reached the maximum accuracy of 99.63% in the linear analysis. In addition, the high creative group was separated from the low creative group with the accuracy of 98.41%.
Conclusion: the combination of SVM classifier with linear features can be useful to show the relation between creativity and physiological changes.
Objective: Multiple Sclerosis (MS) is a disease with a detrimental effect on functional status. The present study investigated the effect of a sexual therapy program on the quality of life (QOL) of women with multiple sclerosis.
Method: Women with multiple sclerosis and sexual dysfunction (n = 30) were selected, and were randomly assigned into the treatment (n = 15), or the control groups (n = 15). Participants of the treatment group (n = 15) received 12 weekly sessions of sexual therapy. Participants in both groups completed the Female Sexual Function Inventory (FSFI) and the MS Quality of Life- 54 (MSQOL-54) in the onset of the program and at the end of the program.
Results: ANCOVA(s) using pre-test scores as covariate(s) revealed that in comparison to the control condition, MS patients within the treatment group showed a significant improvement in their sexual desire (0.0001), arousal (0.022), lubrication (0.001), orgasm (0.001), satisfaction (0.0001), overall quality of life (0.001), energy (0.023), cognitive function (0.005), and social function (0.001) at the end of the program. In addition, they were less limited in their roles due to the emotional and health problems.
Conclusion: The present study revealed that addressing sexual dysfunction in MS patients could improve their quality of life. In the future, this research can extend its results, and apply the same method to men with MS to find whether sexual therapy enhances their quality of life.
Objective: Data on national rates of suicide is limited in Iran, preventing an action plan for health scope of suicide prevention. The current brief study was conducted to review available national published data on suicide and to interpret the probable discrepancies.
Method: We evaluated all 20-year recent published original articles on committed suicides searching Iranian scientific databases, PubMed, and Google Scholar with the keywords of suicide, mortality, and Iran.
Results: Articles showed an overall increased trend of suicidal deaths in Iran. Discrepancies existed regarding suicide rate and demographic characteristics among 9 English and Persian published articles. Although a suicide rate of 6.2 per 100 000 was reported in 2003, almost 31 times greater than 1991, an average suicide rate of 9.9 per 100 000 was calculated based on data interpretations.
Conclusion: Apparently, Iran has had the highest increase in suicide-related deaths among Eastern Mediterranean Region (EMR) and Islamic countries during the recent decades. National policies to prevent suicide have not been efficient enough, and urgent intervention is needed.