Objective: Sleep disorders are associated with many health problems including anxiety, depression and coronary artery disease (CAD). This study investigated the prevalence, predictors and health impacts of insomnia and hypersomnia in southeastern Iran as well as the five-year incidence rate (IR) of these sleep disorders.

Method: The present study was a cross-sectional, single-stage, cluster sampling study examining nine CAD risk factors (KERCADR study phase two), including sleep disorders, carried out in Kerman on 9997 participants, 15 to 80 years old. Medical examination along with demographic, sleep status, Physical activity level (GPAQ), anxiety and depression status (Beck Inventories) were assessed and fasting blood sample was taken for blood glucose and lipids analysis. STATA v15 software was used for data analysis using survey data analysis package and a univariable survey logistic regression model.

Results: From 9997 participants, 59.4% were female. 45.3% of the participants were suffering from insomnia and hypersomnia, which was 15% more than the phase 1 prevalence (P < 0.001). Participants with insomnia had higher chance of being anxious, but participants with hypersomnia had higher chance of being depressed, be a cigarette smoker, opium user, and sedentary (P < 0.001). In regards to marital status, prevalence of hypersomnia was as follows in ascending order of prevalence: singles > married > widowed > divorced. While the IR of insomnia was higher in females, males had higher IR of hypersomnia. In addition, the IR of both sleep disorders was higher in participants with Low Physical Activity (LPA).

Conclusion: The results showed high current prevalence and increasing trends of sleep disorders in the past five years. If left unaddressed, burden of CVDs in the community will demonstrate a significant increase in the future as a result of sleep disorders and other associated risk factors.

Objective: Coronavirus disease 2019 (COVID-19) was first reported in Iran in February 2020 and then quickly spread to many cities. Different factors contribute to the numerous psychological problems of this pandemic in patients, healthcare workers and the community. This study investigated the prevalence of perceived stress, anxiety and depression in COVID-19 patients hospitalized between March and April 2020 and revealed associations of these factors with social support received from family.

Method: In this cross-sectional study, patients with COVID-19 admitted between 21st of March and 22nd of April 2020 were evaluated by three questionnaires: Anxiety and depression were evaluated using the hospital anxiety and depression scale (HADS), stress levels were evaluated using the four-item perceived stress scale (PSS-4) and family support was evaluated using the perceived social support scale-family (PSS-Fa). In addition to obtaining prevalence of the noted psychological disorders and their relationship with demographic details, relationship of stress, anxiety and depression with family support was also investigated using the Pearson’s correlation coefficient.

Results: Participants comprised 100 COVID-19 patients (38 females and 62 males). Findings suggested high levels of perceived stress in 26% of the participants, anxiety symptoms existed in 29% and borderline conditions existed in 17%. Moreover, depressive and its borderline symptoms were respectively observed in 17% and 23%. Family support was found to negatively and significantly correlated with anxiety (Pearson correlation = -0.249, P < 0.05) and depression. (Pearson correlation = -0.221, P < 0.05).

Conclusion: Given the high prevalence of anxiety and depression in hospitalized COVID-19 patients, it is recommended to further focus on non-clinical interventions, such as providing psychological first aids, boosting psychological resilience, and enabling greater family support, in efforts to prevent transformation of these psychological symptoms into long-term psychological disorders.

Objective: Majority of breastfeeding women experience changes in sexual function. The present study was designed to assess effectiveness of auriculotherapy on improving sexual function in breastfeeding women.

Method: In this randomized sham controlled trial, accomplished from January 2018 to May 2019 in a referral sexual health clinic in city of Qom, Iran, 60 eligible participants were assigned to either intervention and control groups via block randomization. In the intervention group, electrical stimulation was applied for 15 seconds on Shen Men, Zero, Thalamic, Master Cerebral, Libido, Relax, Excitement, Ovary, and Uterus points in 10 auriculotherapy sessions. Then, Vaccaria seeds were stuck on these points. The control group received the same procedure with the device off as a sham method. Data were gathered using the Female Sexual Function Index (FSFI) at three different time points.

Results: At baseline, mean scores of sexual function dimensions were not significantly different between the intervention and control groups except for orgasm. Post-intervention, the results showed significant differences in sexual desire (P = 0.002), sexual arousal (P = 0.008), lubrication (P = 0.001), sexual satisfaction (P = 0.001), and orgasm (P = 0.009). One month after the intervention, the results showed significant differences in sexual desire, sexual arousal, lubrication, sexual satisfaction (P = 0.001), orgasm (P = 0.006), and dyspareunia (P = 0.015). Differences in mean score of sexual function in post-intervention and one-month follow-up were only significant in the intervention group (P = 0.001).

Conclusion: Based on evidence from this study, auriculotherapy is an effective technique for improving sexual function in breastfeeding women.

Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020.

Method: In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant.

Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007).

Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients.

Objective: This study aimed to explore the structural relation of emotional schemas with psychological distress and evaluate the mediating role of resilience and cognitive flexibility in this relationship.

Method: Participants were 300 students that voluntarily completed a questionnaire package that included the Leahy Emotional Schema Scale (LESS-P), Connor-Davidson Resilience Scale (CD-RISC), Cognitive Flexibility Inventory (CFI), and Depression Anxiety Stress Scale (DASS-21). Then, we utilized the LISREL software for structural equation modeling.

Results: Structural equation modeling and path analysis revealed the direct effects of adaptive and maladaptive emotional schemas on psychological distress. The results indicated that maladaptive emotional schemas indirectly affected psychological distress via resilience and cognitive flexibility (P < 0.01). In contrast, adaptive emotional schemas indirectly affected psychological distress via cognitive flexibility rather than resilience (P < 0.05). Evaluation of the proposed structural model revealed an acceptable fit.

Conclusion: The present research findings show the effect of emotional schemas on psychological distress via resilience and cognitive flexibility. Furthermore, the results suggest that resilience partially mediates the relationship between emotional schemas and psychological distress. At the same time, cognitive flexibility mediated this relationship.

Objective: Early recognition of autism is important, but diagnosis age varies among children. Recent studies have aimed to identify factors affecting age of diagnosis and several studies have attempted to explore geographic variation in age at diagnosis of autism. However, there is a lack of research examining geographic variations with multiple models to find whether geographic differences can be explained by risk factors such as socioeconomic status and differences in child characteristics. This study aimed to address this gap of knowledge by comparing age at diagnosis of autism between the group of people living in the center of the province and the group of people living in the rest of the province, considering potential medical and socioeconomic confounders.

Method: The study population consisted of 50 autistic children born in East Azerbaijan Province between 2004 and 2016. Initially, univariate testing by ANOVA was performed to identify family and individual factors contributing to differences in age at autism diagnosis. Following this, the association between living in the center of the province and age at diagnosis in univariate and multivariate analyses was examined.

Results: Results from the initial univariate analysis indicate a significant association between living in the center of province and early diagnosis. However, inclusion of possible confounders in multiple model illustrates that these geographical disparities in age at diagnosis can be explained by differences in socioeconomic and medical status.

Conclusion: Although geographic variation in age at diagnosis of autism was observed, analyses show that differences in individual and family-level factors may contribute to geographic differences. In this study, most of the observed variation was accounted for by family-level factors rather than geographic policies. Findings prove that multiple strategies are required to identify targeted interventions and strategies.

Objective: One of the most common complications in general anesthesia is the Emergence delirium (ED). Many agents have been studied for prevention of ED, among which propofol has been successfully used. However, there is no information about the optimal dosage of this agent considering the ultimate outcome and the adverse effects; therefore, aimed to assess in this study.

Method: 70 children undergoing general anesthesia using propofol, fentanyl, and atracurium were assessed. Participants were allocated randomly to treatment with either propofol 1 mg/kg (n = 35) or 0.5 mg/kg (n = 35) by the end of the anesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) Scale, Face, Legs, Activity, Cry, Consolability (FLACC) scale, and the University of Michigan Sedation Scale (UMSS) were assessed by 10-minute intervals. Post-anesthesia care unit (PACU) stay and adverse effects were registered and compared as well.

Results: Duration of PACU stay (P < 0.001), PAED (P = 0.001), and UMSS (P = 0.003) were remarkably lower among low-dose propofol-treated children in the assessment at the 30th minute, while there were no significant differences in FLACC scores between the groups (P > 0.05). Apnea was found in a patient (2.85%) treated with high-dose propofol and decreased oxygen saturation was demonstrated in 5 (14.28%) and 2 (5.71%) participants in high- versus low-dose propofol. None of the patients experienced postoperative nausea and vomiting.

Conclusion: Based on the current study, propofol 0.5 mg/kg by the end of anesthesia could efficiently prevent ED incidence and reduce time of PACU stay and adverse effects compared to a high dose of 1 mg/kg.

Objective: Suicide is one of the most important health problems in the world. Financial, academic, social, and environmental difficulties along with genetic, physical, and mental disorders affect suicide attempts. This study aimed to find risk factors for completed suicide in Ilam province according to the suicide registry in Ilam province.

Method: This was a prospective study and was performed based on suicide case registration data, pre-determined checklist data, and death registration data in Ilam province from March 2019 to September 2020. Logistic regression models and the Chi-square test were used to determine the relationship between completed suicide and its risk factors.

Results: Among 1,410 attempted suicides, 66 (4.7 %) were executed. Rate of completed suicides was higher in men (6.5%) compared to women (4.5%), (p = 0.005), age groups over 65 years (P < 0.001), retirees and farmers (P = 0.009), illiterate people (P < 0.001), villagers (P = 0.02), people motivated due to physical problems (P = 0.016), suicide by physical methods (P < 0.001) and self-immolation (P < 0.001). Logistic regression showed that incidence of completed suicide was significantly higher in the age group over 65 years, illiterate people, people using physical methods, villagers, and men. Multivariate logistic regression also showed that men and individuals using physical methods of suicide were significantly more successful in suicide.

Conclusion: Men, the elderly, illiterates, villagers, and people who used physical suicide methods were in high-risk groups. Despite lower prevalence of suicide, a higher rate of completed suicide was demonstrated. To decrease completed suicide rates, we must pay attention to these groups.

Objective: Perceived social support (PSS) and emotional self-regulation have customarily been related to greater psychological well-being, but the pathways via which perceived social support and emotional self-regulation increase psychological well-being have not been revealed. We investigated how much self-compassion mediated the association between perceived social support and emotional self-regulation in psychological well-being of breast cancer sufferers.

Method: A cross-sectional study design was used. Participants were recruited from three oncology departments in Zanjan, Iran. Data was collected from breast cancer patients (n = 300). Participants completed self-report measures, the short Ryff scale Psychological Well-being (RSPWB), Emotion Regulation Questionnaire (ERQ), Multidimensional Scale of Perceived Social Support (MSPSS) and Self-Compassion Scale (SCS). Pearson correlation coefficient was used to assess association among the study variables and multivariable regression analysis was used to assess linear relationships among predictor variables (emotional self-regulation, perceived social support and self-compassion) and criterion variable (psychological well-being). Bootstrapping analyses were used to test the significance on indirect effects.

Results: Bootstrapping analyses revealed significant indirect effects of perceived social support (β = 0.055, SE = 0.45, P = 0.049, 0.95 CI: LL = 0.0092, UL = 0.1345) and emotional self-regulation (β = 0.079, SE = 0.079, P = 0.004, 0.95 CI: LL = -0.0331, UL = -0.1358) on psychological well-being through self-compassion.

Conclusion: These findings present new evidence that self-compassion may be a target for psychological interventions attempted at enhancing psychological well-being in cancer populations, particularly breast cancer survivors.

Objective: Available treatments of depression have limited efficacy and unsatisfactory remission rates. This study aims to review randomized controlled trials (RCTs) investigating effects of glutamate receptor modulators in treating patients with resistant depression.

Method: The study protocol was registered in PROSPERO (CRD42021225516). Scopus, ISI Web of Science, Embase, Cochrane Library, Google Scholar, and three trial registries were searched up to September 2020 to find RCTs evaluating glutamate receptor modulators for resistant depression. The difference between intervention and control groups in changing depression scores from baseline to endpoint was considered the primary outcome. Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the quality of the RCTs. No funding was received.

Results: Thirty-eight RCTs were included. Based on the included studies, compelling evidence was found for ketamine (with or without electroconvulsive therapy, intravenous or other forms), nitrous oxide, amantadine, and rislenemdaz (MK-0657); the results for MK-0657, amantadine, and nitrous oxide were only based on one study for each. Lithium, lanicemine, D-cycloserine, and decoglurant showed mixed results for efficacy, and, riluzole, and 7-chlorokynurenic acid were mostly comparable to placebo. A limited number of studies were available that addressed drugs other than ketamine.

Conclusion: The study cannot determine the difference between statistical and clinical significance between the agents and placebo due to high heterogeneity among the RCTs. Nevertheless, ketamine could be used as an efficacious drug in TRD; still, additional studies are needed to delineate the optimum dosage, duration of efficacy, and intervals. Further studies are also recommended on the effectiveness of glutamatergic system modulators other than ketamine on treatment-resistant depression.

Objective: Changes in cortical excitability and neuroplasticity are important parts of the neuropathology and pathophysiology of many neuropsychiatric disorders. Noninvasive brain stimulation is a high-potential therapeutic approach to modify cortical activities. One of the most popular of these techniques is transcranial direct current stimulation (tDCS). However, the biological and neurobiological effects of tDCS should be better clarified to enable its optimal use in clinical and therapeutic practices. In this paper, we summarize the neurophysiological and physiological effects and mechanisms of action of tDCS.

Method: An update literature review was conducted on the biological responses of tDCS reported in human, in vitro and in vivo studies, with a focus on cellular cascades related to neuroplasticity, neuronal reorganization and inflammation caused by applied direct current electric fields.

Results: The regulatory mechanisms of tDCS on motor and cognitive functions can be described by membrane polarization and transmembrane potential with a main subsequent effect on neurotransmission systems, neuronal excitability, synaptic microenvironment and neuronal connectivity to neuronal reorganization and neurogenesis in association with synaptic plasticity as well as inflammatory processes. In general, the effects of tDCS may include acute- or after-effects and direct or indirect effects and can be examined at different levels including the neurochemical, the neuroelectrical and the brain oscillatory levels.

Conclusion: A deep understanding of the molecular and cellular responses to tDCS is very important and crucial. This therapeutic technique can be utilized in various clinical trials with a perspective of being routinely suggested and presented to patients with different pathological conditions influencing the central or peripheral nervous system.

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