فهرست مطالب قاسم صالح پور

Sleep and epilepsy are complex interactions and are completely interdependent, so that some patients experience seizures while asleep or deprived of sleep or when waking up, and for some they occur during the day or night (1). The American Psychiatric Association defines sleepiness as symptoms of excessive quantity of sleep (e.g., extended nocturnal sleep or involuntary daytime sleep), deteriorated quality of wakefulness (i.e., sleep propensity during wakefulness as shown by difficulty awakening or inability to remain awake when required), and sleep inertia (i.e., a period of impaired performance and reduced vigilance following awakening from the regular sleep episode or from a nap) (2). Its prevalence is higher in seizures than in the control group (3, 4) and in different groups seizures have been reported between 31 to 60% (5-7). According to common clinical beliefs, sleep disruption can have a significant effect on memory, as REM sleep or slow-wave sleep is essential for optimal cognitive function (3), and excessive daily sleepiness can increase seizures (8, 9) and pain (10) in patients; However, the exact function of sleep remains unclear, and the findings have not always been consistent. These discrepancies require the conduct of research in which, through a comprehensive look, a large number of parameters related to sleepiness are present in seizures. In other words, the heterogeneity of the previous findings highlights the variability of the course of the disease as a result of the interaction of sleepiness and seizures, which makes it necessary to conduct more research to better understand the problems of patients. Therefore, the aim of the present study was to investigate the comorbidity effect of sleepiness and epilepsy on cognitive functions, quality and severity of pain and disease severity markers in patients with epilepsy.

The present research was conducted as a case-control study in 2020 in Shiraz Namazi Hospital. The statistical population of this study included all patients with focal epileptic seizures (temporal lobe epilepsy) (n = 30) and generalized (idiopathic generalized epilepsy) (n = 21) and psychogenic non-epileptic seizures (n = 17) in Shiraz. Through their follow-up treatment process, they referred to the epilepsy and seizure ward of Shiraz Namazi Hospital, from which 68 patients with inclusion criteria were selected through purposive sampling method. According to the inclusion and exclusion criteria, each patient completed a comprehensive list of demographic and clinical variables, the Stanford Sleepiness Scale, the Montreal Cognitive Assessment, the McGill Pain Questionnaire, and the Visual Analogue Scale under the supervision of an on-site clinical psychology PhD student. After collecting research data, patients with seizures were divided into two groups with sleepiness (n = 45) and no sleepiness (n = 23) through a cut score equal to or greater than 3 on the Stanford Sleepiness Scale. Data were analyzed using parametric and non-parametric tests in version 24 of SPSS software.

Preliminary findings showed that there was a significant difference between the two groups of patients with epilepsy with and without sleepiness in terms of mean age and frequency of antiepileptic drugs (P <0.05); While there was no difference between the two groups in terms of type of seizure, education, gender, marital status and employment status. In order to investigate the effect of sleepiness on cognitive function and components related to pain quality, multivariate and univariate analysis of covariance was used to control age variables and use antiepileptic drugs. The results showed that patients with sleepiness in functions of language, Abstraction, delayed recall, as well as achieving the overall Montreal Cognitive Assessment score performed worse. These patients had higher sensory perception of pain experience, rated their pain higher, scored higher in pain quality, and chose more words to describe their pain (P<0.05). Evaluations of disease severity markers through nonparametric tests also showed that compared to patients without sleepiness, patients with epilepsy with sleepiness have experienced more pain, more seizures, a higher incidence of comorbid physical diseases, a longer history of psychiatric diagnoses, and they have more concomitant use of antiepileptic and psychiatric drugs (P<0.05).

The results showed that patients with epilepsy with sleepiness had lower mean scores on some cognitive subscales than their counterparts without sleepiness; However, the two groups did not differ in terms of spatial visual function, naming, attention, and orientation. Using a methodology similar to this study, Vascouto et al. Found that there was no difference between the two groups of patients with seizures with and without sleepiness in most cognitive components such as attention and spatial visual skills; Only from the point of view of the total score of auditory verbal learning, there is a significant difference (11) that is relatively consistent with the present study. Although more research is needed to draw more detailed discussions, the discrepancies in some findings can be explained by differences in the type of patient samples in the two studies and the reduction in attention and performance resulting from sleepiness. The results also showed that patients with epilepsy with sleepiness compared to their counterparts, evaluated the qualitative dimensions of their pain higher and experienced more severe pain. Consistent with these findings, Gutter et al. Found that sleepiness comorbidity in epileptic seizures leads to increased chronic pain in patients (10) and Jaussent et al. Also reported that chronic pain is a significant predictor of sleepiness (12). In this regard, potential underlying mechanisms such as structural and functional changes in the prefrontal cortex (13), anterior cingulate cortex (14), hippocampus (15), amygdala (16), insula (17), subcortical regions (17) and shock spinal cord passages (18); Neural-glial interactions; Abnormalities in autonomic function and hypothalamic-pituitary-adrenal axis and other biological factors may contribute to the relationship between sleepiness and pain. Finally, the results showed that the frequency of seizures, the presence of comorbidities of physical disease, the history of psychiatric diagnoses and the simultaneous use of antiepileptic and psychiatric drugs in patients with epilepsy with sleepiness were higher than their counterparts. In this regard, Pizzatto et al. (19) and Xu et al. (20) evaluated patients with epileptic seizures and did not find a relationship between daily sleepiness scores and the frequency of seizures. But Lee et al. Showed that the presence of psychiatric symptoms is an independent predictor of sleepiness in patients (21). It seems that sleepiness reduces the ability to control seizures in patients (22) and contributes to their recurrence and worsening of the disease. Disruption of patients' circadian rhythms can also be involved as a consequence of sleepiness; Because circadian rhythms affect the frequency of seizures depending on the epileptogenic region (23,24). According to the findings, measuring sleep habits, sleep hygiene and comorbidity of sleepiness is an unavoidable necessity. In particular, early diagnosis and treatment of comorbid sleepiness and seizures can improve the prognosis and reduce the negative health consequences in patients (25). Lack of objective measurements of sleepiness and self-reported nature of the data are the limitations of the present study. Future studies can complement these findings by using objective measures of sleepiness. Patients with epilepsy with sleepiness have a poorer cognitive and clinical status than their counterparts.

 Sleep and seizures can affect each other in different ways. Meanwhile, sleep disorders are among the most frequent complaints of patients with epileptic and non-epileptic seizures, with various health outcomes.
Objective This study aimed to investigate the psychological symptoms and clinical indicators in patients with/without sleepiness with epileptic/non-epileptic seizures.

 The present study was a fundamental and descriptive (causal-comparative) research. The study population included all patients with epileptic seizures (temporal and generalized) and non-epileptic psychogenic seizures in Shiraz City, Iran. A total of 68 patients (in two groups with sleepiness and without sleepiness) were selected by the purposive sampling method. The study data were collected using the clinical and demographic inventory, Stanford sleepiness scale, Beck depression and anxiety inventory, perceived stress, mood disorder, bipolar spectrum diagnostic scale, global assessment of the severity of epilepsy, and global assessment of disability-related directly to seizures. The obtained data were analyzed by univariate analysis of covariance, Fisher exact test, and Mann–Whitney U test.

 Analyses showed that patients with seizures who had sleepiness reported higher levels of depression, anxiety, and stress than patients without sleepiness (P<0.05). Also, patients with sleepiness suffer more than their counterparts from the symptoms of bipolar disorder I and II and assess the severity of disease and disability resulting from seizures as worse (P<0.05).

 Sleepiness in patients with epileptic and non-epileptic seizures is associated with increased psychological symptoms and disease severity.

Attention-Deficit / Hyperactivity Disorder (ADHD) can lead to high-risk behaviors, and the use of a tool that is capable of diagnosing ADHD symptoms in delinquent populations is inevitable. Therefore, the purpose of the present study was to investigate the diagnostic value and discriminant validity of the Wender-Utah Rating Scale (WURS-25) in a group of thieves with and without ADHD symptomology and normal individuals with a definite lack of ADHD diagnosis based on Connerchr('39')s Adult ADHD Rating Scale.

In a validation study in Rasht Central Prison, in 2015-2016, 100 prisoners committed theft, and 70 normal individuals were selected as the sample. Tools included WURS-25, Connerchr('39')s Adult ADHD Rating Scale, Social Adjustment Scale, and Perceived Stress Questionnaire. Data were analyzed using discriminant analysis, chi-square test, multivariate and univariate analysis of variance/covariance, and Fisherchr('39')s least significant difference test.

Discriminant analysis showed that WURS-25 could distinguish symptoms of ADHD in three groups of thieves with and without ADHD symptomology and normal individuals from each other, and its overall classification accuracy is equal to 64.1%; although a large proportion of thieves without symptomology were ignored. Also, after controlled analyzes, the mean of scores social adjustment components was significantly greater in thieves with symptomology than in other groups, and for stress in thieves with symptomology than in normal individuals, with considering cut-off points of 36, 39 and 46.

WURS-25 has an acceptable screening performance in thieves with ADHD symptomology Therefore, it can be used to identify susceptible individuals and evaluate the outcome of therapeutic interventions in delinquent populations.

Hospitalization is one of the outcomes of multiple sclerosis (MS) that can have different effects on the quality of life of patients. Therefore, the aim of the present study was to evaluate the consequences of hospitalization on physical and mental dimensions of quality of life in patients with MS.

In a cross-sectional study, 162 patients with MS (in three groups: non- hospitalization, 1-2 times of hospitalization, and ≥ 3 times of hospitalization) were selected by consecutive sampling and they were examined using clinical and demographic variables inventory and the Health Survey questionnaire (SF-36). The data were analyzed by multivariate analysis of variance (MANOVA), and post hoc test of Fisher least significant difference (LSD).

The analyses showed that the effects of hospitalization were significant in vitality, mental health, and mental component summary (P < 0.05). Following the difference between means in hospitalization groups showed that patients with ≥ 3 times of hospitalization in all identified significant variables have lower mean scores (P < 0.05). In the meantime, significant differences were not observed between different groups of hospitalization in terms of physical dimensions of quality of life (P > 0.05).

The consequences of hospitalization in MS patients leads to reduced psychological dimensions of quality of life in such patients and its effects in patients with high hospitalization rate is significant/noticeable.

Self-handicapping is any action or choice of performance setting that enhances the opportunity to externalize failure and to internalize success.

The aim of this study was to investigate the role of perfectionism and its various dimensions in predicting self-handicapping of Bojnourd university students.

The type of research was cross-sectional descriptive and a correlational type. The statistical population included undergraduate students of Bojnourd University in the academic year of 2013-2014. 200 people were selected by multistage cluster sampling and each of them answered to the Perfectionism Scale of Hill et al (2004) and the Self-Handicapping Scale of Jones and Rhodewalt (1982). Data were analyzed using Pearson correlation coefficient and multiple regression. SPSS v. 18 was also used in data analysis.

There was a significant positive and direct relationship between each of the eight dimensions of perfectionism and self-handicapping (P<0.05); In other words, with the increase of perfectionism, the use of self-handicapping strategies increases. None of the dimensions of perfectionism in the prediction model of self-handicapping were excluded from the regression and in the final model predicted 0.32 of the variance of self-handicapping (P<0.05).

Perfectionism is a multidimensional construct that can affect studentschr('39') self-handicapping. Therefore, interventions are needed to systematically manage the components of student perfectionism.

The birth order and the frequency of criminal record can be factors affecting on the stress and attention deficit / hyperactivity of the thieves.

The present study evaluates the stress and attention deficit / hyperactivity symptoms in a group of thieves in terms of birth order and frequency of criminal record.

This research was a causal comparative study in which 100 individuals commited theft who in the years 2015-2016 in Rasht central prison were punished by non-random targeted sampling were selected. Samples by the legal and demographic variables inventory, the stress scale, Conners’ adult attention deficit / hyperactivity disorder rating scale-self-report-screening version, and the Wender Utah rating scale were studied and data were analyzed using multivariate analysis of variance and univariate analysis of variance.

With the exception of the relationship between birth order with Conners’ attention deficit and the frequency of criminal record with Conners’ hyperactivity impulsivity (P>0.05), other components of Conners’ attention deficit hyperactivity and Wender childhood attention deficit hyperactivity in second and third children, and individuals with two, three or more criminal records is more than the first born and people with one criminal record (P<0.05). Meanwhile, none of these groups showed a difference in stress level (P>0.05).

The birth order and the frequency of criminal record can have a significant relationship with the representation of attention deficit / hyperactivity symptoms of thieves. Therefore, monitoring, evaluation and psychological intervention of these individuals with the aim of reducing impulsive behaviors will be recommended.

It seems rhinoplasty candidates have poorer body image and this can affect their decision to proceed with surgery. Present study assessed the body images of rhinoplasty candidates and control groups before surgery, according to sex them. This research was a case-control study in which 136 rhinoplasty applicants and 136 control subjects in Amir-Al-Momenin hospital/Rasht were chosen as available sampling and by Multi-dimensional self-body relationships questionnaire (MBSRQ) were studied. Data were analyzed by using multi-variable co-variance analysis (MANCOVA) in the form of 2×2 factorial. The main effect of group factor showed that in comparison with control group, rhinoplasty candidates have significantly higher scores mean in tendency to fitness and lower scores mean in satisfaction with body areas (P<0.05); In the meantime, main effect of gender factor was not the significant in any of aspects of body image. But, group × gender interaction effect showed that rhinoplasty candidate men have lowest satisfaction with body areas (P<0.05). Higher tendency rhinoplasty candidates to fitness and low satisfaction them of your body areas, especially the nose can push them to do the surgery. Therefore, monitoring, evaluation and psychological intervention to patients before surgery to improve the body image is recommended.

  Relapses are the most obvious clinical feature of multiple sclerosis (MS) that can have different effects on patients fatigue and quality of life. Therefore, the aim of present study was to evaluate pure effects of occurrence relapse on fatigue and quality of life in patients with MS. In a cross-sectional study, 162 patients with MS (in three groups: non-relapse, 1-2 times of relapses, and ≥ 3 times of relapses) were selected by consecutive sampling and using the clinical and demographic variables inventory, the Health Survey questionnaire (SF-36) and Fatigue Severity Scale (FSS) along with identical analog-spring balance were examined. The data were analyzed byChi-square test, one-way analysis of variance (ANOVA), multivariate analysis of variance (MANOVA), multivariate analysis of covariance (MANCOVA), and post hoc tests of Fisher least significant difference (LSD) and Scheffe. The adjusted analyses showed that effects of occurrence relapse was significant in physical functioning, vitality, social functioning, mental health, and physical and mental components (P < 0.05). The following of difference between means in relapse groups showed that patients with ≥3 times of relapses in all identified significant variables have lower mean scores (P < 0.05). In the meantime, significant differences were not observed between different groups of relapse in terms of fatigue level (P > 0.05). MS relapses leading to reduced quality of life in patients and its effects in patients with high relapse rate is highlight.

Aim: Theft is one of the most serious human crimes that can be found in various ways in different societies, and various factors can play a role in it. The attention deficit hyperactivity disorder that causes the trend to high-risk behaviors can be one of the factors associated with theft. The purpose of the present study was to investigate the perceived stress and attention deficit hyperactivity in men and women thieves and comparing them with normal people.
This causal-comparative research was carried out in Rasht Central Prison, Iran, in 2015-2016. Using non-random targeted sampling method, 100 individuals (50 males and 50 females) from the prisoners committed theft, and 100 individuals (50 males and 50 females) using available non-random sampling method were selected as samples. The legal and demographic variables inventory, perceived stress, Conners’ adult attention deficit hyperactivity disorder rating and the Wender Utah rating scales were used for data collection. Data were analyzed in SPSS 20 software using multivariate of variance (MANOVA) and univariate of variance (ANOVA) analyzes.
Findings: The stress and attention deficit hyperactivity disorder were significantly higher in prisoners committed theft than other groups (p0.05).
The level of perceived stress and attention deficit hyperactivity in childhood and adults are higher in prisoners committed theft than normal people. Therefore, must pay more attention to treatment interventions and creation or upgrade of public health services standard system of prisoners.

Worry is a common psychological construct in multiple sclerosis (MS). In previous studies, there is little data about the psychometric properties of the measurement tools in population of MS patients. Thus, the present study was performed to validate Penn State Worry Questionnaire (PSWQ) as a common tool for measuring worry.
The research design was cross-sectional for a validation study. It included two groups of MS patients (n=80) and their healthy counterparts (n=80) which were sampled by purposive method and matched by demographic factors. The study population consisted of all patients member of the MS Society of Guilan province in 2011-2012. The internal consistency reliability, construct, concurrent, predictive and differential validity of PSWQ was assessed Also the subjects were evaluated in terms of symptoms of depression, anxiety, obsessive compulsive and General Severity Index (GSI) in Symptom Checklist 90 Revised (SCL-90-R) and neuroticism in NEO Five Factor inventory (NEO-FFI).
The internal consistency of PSWQ was appropriate (α=0.74). The item-total correlation coefficient was better for general worry factor and was in range of 0.21 to 0.60. Results of concurrent validity indicated that PSWQ has a significant relationship with all constructs associated with research tools (P≤0.001). Moreover, PSWQ predicted a significant proportion of the psychopathological symptoms scores and neuroticism variance, even after controlling for confounders. Finally, discriminant analysis model showed that PSWQ can differentiate the two groups of patients and healthy counterparts according to worry level and its overall classification accuracy is 63.1%.
PSWQ have good psychometric properties in the studied MS patients and can be used in clinical settings and related research.

The aim of present study was the study of the effectiveness of existential approach trainings on increasing the psychological capitals and general health of the wives of military families of Shahr-e-Kord city. This study was conducted by a Quasi-experimental research method with the pre-test and post-test design and control group. The statistical society of the study consisted of the 1500 wives of military families of Shahr-e-Kord city. Among them, 30 peoples were selected by random sampling voluntarily and then, classified in two 15 peoples group by random assignment. The McGEE psychological capital questionnaire (2007), and GHQ28 general health questionnaire were used as measurement tools. The obtained data were analyzed by t-test, MANOVA, ANOVA and SPSS software. The results of analysis of variance showed that existential treatment in a group method has been effective in increasing the general health of the wives of military families. (>P0/05) In the next step, the effectiveness of the existential approach training were studied on the physical symptoms, reducing the anxiety, improving the social functions and finally reducing the depression of military families wives and then the sub-hypotheses of first hypothesis of the study were verified. Also, the results indicated that existential approach training had a positive effect on all the psychological capital components included “Resiliency, Hope, Optimism and Efficacy”. Thus, it can be said that existential approach training can promote the psychological capitals and general health of the wives of military families.

Body pain in multiple sclerosis (MS) is a common phenomenon that can create or exacerbate by different parameters of clinical, psychological and demographic. The aim of this study was to investigate the relationship between parameters of clinical (fatigue, clinical course, body mass index and duration), psychological (depression, anxiety and stress) and demographic (age, gender, marital status and education) characters with multiple sclerosis patient’s body pain.
This cross-sectional study has been performed in the Multiple Sclerosis Society of Guilan Province and Imam Reza Specialized and Sub-specialized Clinic, Rasht City, Iran during June to February 2010. In this study 162 patients with MS were selected by consecutive sampling. We used the clinical and demographic variables inventory, body pain subscale of the health survey questionnaire, depression, anxiety and stress scale and fatigue severity scale along with identical analog-spring balance. The data were analyzed by Pearson correlation coefficient and point bi-serial, one-way analysis of variance, Gabriel test and stepwise multiple regression.
The findings showed that patients who scored 3 or higher in relapses experienced significantly more body pain than patients who scored 1-2 times of relapses (P= 0.031). In the meantime, significant differences were not found between the two groups of patients with a score of 3 or higher in relapses and non-relapse and between non-relapse patients and with a score 1-2 times of relapses in terms of body pain. Also, significant differences were not found in different groups of hospitalization in terms of body pain. However, anxiety and fatigue together could explain significantly 25% of the shared variance of body pain (F= 26.29, P≤ 0.0009).
This study showed the effect of psychological and clinical factors on body pain exacerbation in MS patients. Therefore, it is necessary for clinicians to consider identifying these factors and the relationships of the factors with increasing pain in patients with MS.

Knowledge of the substance use outcomes on clinical-hospital characteristics in patients with traumatic brain injury (TBI) can be useful in preventing their long term complications. Therefore, this research was conducted to study interaction effects of TBI and substance use on Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS).
185 TBI patients with mean age 37.46±17.42 year in two groups of with (n=35) and without substance use (n=150) in emergency & neurosurgery and Intensive Care Unit (ICU) ward of Rasht Poursina hospital selected by consecutive sampling and were evaluated using GCS on admission and 72 hour later and GOS.
multivariate analysis of covariance (MANCOVA) showed that there is significant difference between the two groups of TBI patients with and without substance use according to GCS on admission (P=0.006) and 72 hour (P=0.005). In the meantime, the independent t-test results also showed that TBI patients with substance use have lower GOS than front group (P=0.038).
Present study highlighted be serious the effects of substance use in reduction GCS and GOS scores of TBI patients. The clinical implications of this study are discussed.

This study aimed to examine the effect of drug use on the length of hospitalization, impaired consciousness, levels of motor and cognitive independence in patients with traumatic brain injury.
A total of 185 patients with traumatic brain injury in the emergency, neurosurgery ward and ICU of Poursina Hospital was selected via purposive sampling. These participants who were within the age group 37.46 ± 17.42 years were divided into two groups, i.e. drug users (n = 35) and non-users (n = 150). Then, Demographic and Hospital Inventory and Functional Independence Measure were used for data collection purposes.
The results showed that the two groups of patients with or without drug use were significantly different from each other in terms of length of hospitalization in neurosurgery ward, total duration of hospital stay, and rates of cognitive independence (P .05). The results also showed that drug using patients experience higher states of impaired consciousness compared to the other group (P This study indicated the effect of drug use on the increased length of hospitalization, the intensification of impaired consciousness, and disturbance of cognitive independence in traumatic brain injury patients. The clinical implications of this study are discussed.

Quality of life assessment as an outcomes measure in multiple sclerosis (MS) can have a key role in identifying adverse effects of the disease and the impact of different treatments in the progress and improvement of patients; Hence, the aim of this study was to examine the psychometric characteristics Persian version of the health survey questionnaire (SF-36) in the MS. Subjects and One hundred and sixty two patients were selected by consecutive SF-36 was evaluated for its internal consistency reliability, construct validity, concurrent, predictive and differentiation. In order to achieve this aim, the Fatigue Severity Scale and the 21-question (DASS-21) of depression, anxiety and stress scale were used. Internal consistency of SF-36 subscales except social functioning and emotional problems (α= 0.42 to 0.93) were favorable. Analysis of the validity of the SF-36 showed that all of the questionnaire items had a strong positive correlation with subscales on their own (r=0.48 to 0.95); Each subscale had a strong and inverse correlation with the constructs of fatigue, depression, anxiety and stress (r= -0.27 to -0.71; P<0.001); SF-36 physical component predicted a significant proportion of the variance in score on fatigue (P<0.0001) and mental component also showed a significant proportion of the variance in scores on depression, anxiety and stress, even after controlling demographic confounding factors of age, sex, marital status and educational level (P<0.0001). The mean of all subscales was significantly greater in both groups of abnormal and fatigued patients than normal and nonfatigued patients. Persian version of the SF-36 has good validity and reliability and could be used to assess the impact of MS outcomes on quality of life of patients.

Multiple sclerosis (MS) is a chronic neurological disease that depression has been found in more than 40% of patients and due to a number of sub-clinical markers associated with disease the opportunity to the emergence of gains. The purpose of this study was to assess depression and markers of sub-clinical multiple sclerosis. In this analytical cross-sectional study, 162 patients with MS were selected by consecutive sampling and using the clinical and demographic variables inventory, Depression, Anxiety and Stress Scale, Short Form Health Survey questionnaire, and Fatigue Severity Scale along with identical analog-spring balance were examined. Data were analyzed using Pearson's correlation coefficient, one-way ANOVA, Tukey's test and stepwise multiple regression. Patients with 3 or more times of frequency and hospitalizations were experiencing received a significantly higher depression scores than patients with lower frequency of hospitalization. in addition to the markers of sub-clinical disease 30% of the common variance in depression could explained totaly. Generally in the final step due to limitations of physical problems, bodily pain, fatigue the depression scores in patients were able to be predicted significantly (p <0.0001). The impacts of sub-clinical markers in multiple sclerosis patients with depression were significant. Therefore it is necessary that the key predictors identified in this study were known as a possible predisposing factor in the development of depression associated with multiple sclerosis be exploited to manage the disease regularly.

Aim and Multiple Sclerosis is a chronic neurological disorder which is more prevalent in women than men. Therefore، the aim of present study was to evaluate the relationship physical functioning impairment (as criterion variable) with fatigue، psychological symptoms and body mass index (as predictive variables) in the women suffering from this disease. Methods and Materials: In a cross sectional study، sampling was performed on 114 patients by consecutive method who were evaluated by using demographic variables list، physical dimension of short form health survey questionnaire، fatigue severity scale، depression، anxiety، stress scale and body mass index. data were analyzed by Pearson correlation coefficient and hierarchical regression. The results indicated a significant، strong correlation of physical functioning with fatigue، depression، anxiety and stress variables (P<0. 0001). Body mass index had the lowest correlation coefficient with physical functioning (P<0. 05). The results of hierarchical regression showed the total variance of all variables in final step as 0. 58 (R2) (P<0. 0001; F=18. 20). Moreover، additional exclusive variance was 0. 39 at this step after controlling demographic variables such as age، education level and duration of the disease. Furthermore، in final step، variables of fatigue (β= - 0. 25; P<0. 0001) and anxiety (β= - 0. 44; P<0. 0001) could significantly predict physical functioning impairment of women. Results indicated that fatigue and anxiety can affect the physical functioning impairment in women. Thus، the screening of women with these symptoms and appropriate treatment is recommended.

Fatigue is a common symptom of Multiple Sclerosis (MS) for measurement of which، Fatigue Severity Scale (FSS) has many applications in these patients. Therefore، present study aimed at designing a psychometric research to assess the factor structure، diagnostic value and differential validity of the Persian version of FSS in patients with MS. This study was descriptive and validation type، in which 162 patients and 43 healthy individuals were selected by consecutive method and were matched in terms of demographic factors. Factor structure، diagnostic value and differential validity of this scale were examined. For this purpose، in addition to conducting FSS on subjects، they were further evaluated using the Short Form Health Survey (SF-36) and Depression، Anxiety and Stress Scale (DASS-21). Data were analyzed by factor analysis، discriminant analysis and independent t-test. FSS is a scale with one-factor structure. The findings from exploratory factor analysis (EFA) also confirmed the factor structure of the fatigue scale. Results of discriminant analysis showed that FSS could distinguish fatigue between two groups of healthy subjects and MS patients from each other. Its overall classification accuracy is equal to 74. 1%. Also، the mean of scores of all components related with quality of life and psychopathological symptoms in fatigued patients compared to non-fatigued patients was significantly greater with considering cut off point ≤ 4. Findings suggest that Persian version of FSS have acceptable screening performance in MS patients and can be used for patients in research situations and measures related with follow-up care.

Fatigue Severity Scale (FSS), due to its simple and clinical nature, is frequently used to measure fatigue level in patients. Since fatigue is a common symptom in multiple sclerosis (MS) disorder, the present study aimed at evaluating the psychometric properties of the Persian version of FSS in patients with MS. This study was descriptive and of a validation type, in which 162 patients were selected by consecutive sampling. Internal consistency reliability and construction, concurrent and predictive validity of this scale were examined. Subjects completed the Depression Anxiety Stress Scale (DASS-21) and Physical Dimensions of 36-item Health Survey Questionnaire (SF-36). Internal consistency of FSS was excellent (Cronbach's Alpha =0.93). Coefficient of item-total correlation for each item was in acceptable range of 0.43 to 0.85. Results of the concurrent validity showed that FSS has a good correlation with all structures associated with research tools, based on the expected directions (P< 0.0001). Also scores of fatigue scale predicted a significant proportion of the variance in scores on measures of depression, anxiety, and physical dimensions of quality of life, even after controlling confounding effects of age, sex, marital status and educational level. Findings suggest that Persian version of FSS has satisfactory psychometric properties and is applicable in research and clinical activities relating to MS patients.

Fatigue is a common symptom in multiple sclerosis (MS) and most MS patients are of two types; relapsing-remitting (RRMS) and secondary progressive (SPMS). Fatigue with regard to feeling of weakness, lack of energy and clinical course due to the establishment of a variable prognosis can influence psychological symptoms, functional ability and employment status of patients. Thus, the aim of the present study was to evaluate the effect of fatigue and clinical course on psychological symptoms, physical and psychological dimensions, and employment status. In this retrospective cross-sectional study, 152 patients were sampled by consecutive method. All patients were evaluated using fatigue severity scale (FSS), depression, anxiety, and stress scale (DASS-21) and short form health survey questionnaire (SF-36). Data were analyzed using multivariate variance analysis (MANOVA) and Fisher exact test. Mean of psychological symptoms and physical and psychological dimensions scores in fatigued and SPMS patients was worse than non-fatigued and RRMS groups. Also, un-employment was reported with higher frequency in fatigued patients. In this regard, no significant finding was observed between RRMS and SPMS. In addition, the difference between both groups of fatigued and non-fatigued, RRMS and SPMS patients was significant regarding the variables depression, anxiety, stress, and physical and psychological dimensions (p<0.05). This study explained the impact of fatigue and clinical course on psychological symptoms, physical and psychological aspects of life and employment status of MS patients. However, it seems that the influence of some variables on each other in a bidirectional relationship is also explainable. Clinical implications have been discussed in this report.