Iranian Journal of Psychiatry
Volume:5 Issue: 2, Spring 2010

Postpartum depression (PPD) is a major depressive disorder that most often emerges within 6 to 12 weeks of delivery, but can happen any time up to 1 year after birth. In developed countries, the incidence of postnatal depression about 10-15% in adult women depending upon the diagnostic criteria, timing of screening and screening instruments used. Mothers with depressive symptoms have been found to have more complex behavioral contacts with their children; this situation can damage family relationships, and even leads to infanticide. Various pathophysiologies are proposed for postpartum depression: Nutritional deficiencies, iron deficiency anemia, rapid decrease in the levels of reproductive hormones following delivery, alterations in hypothalamic-pituitary-adernocortical mechanism and alterations in neurotransmitter levels. Among pathophysiologies of postpartum depression, the role of trace elements is highlighted. The purpose of this review is to assess the role of trace elements including zinc, magnesium, iron and copper PPD. Zinc as a trace element has the second highest concentration of all transition metals in the brain, and its deficiency is associated with behavioral disturbances. Lower zinc blood concentration was found in women with postpartum depression. Another trace element, magnesium, also influences the nervous system via its actions on the release and metabolism of neurotransmitters. Various studies have focused on antidepressant-like effects of magnesium and its deficiency has been reported in depression. Depletion of magnesium stores during pregnancy is hypothesized to be the cause of postpartum depression. Iron deficiency is the most common single nutrient deficiency in the world. There is an association between anemia and depressive disorders. Copper has been recognized as an essential element for many years. Iron also plays a vital role in neurological disorders and its levels are relevant to postpartum depression. Involvement of trace elements can be seen in pathophysiologies of PPD in different ways. Therefore, trace element upplementation can be an alternative treatment for patients with PPD.

Premenstrual syndromes (PMS) affecting 20-40% of women of reproductive age. The aim of this double blind and placebo controlled trial was to investigate whether femicofort a supplement contains Vitamin B6, Vitamin E and evening primrose oil could relieve symptoms of PMS. This was a randomized and double blind clinical trial. The trial was conducted between November 2009 and April March 2010. Women aged 20 to 45 years with regular menstrual cycles and experience of PMS symptoms (According to the current diagnostic criteria proposed by the American College of Obstetrics and Gynecology) for at least 6 months were eligible for the study. Patients were randomized to receive femicomfort or placebo in a 1: ratio using a computer-generated code. The assignments were kept in sealed, opaque envelopes until the point of analysis of data. In this double-blind, patients were randomly assigned to receive capsule of femicomfort (Group A) or capsule placebo for two menstrual cycles (cycles 3 and 4). The primary outcome measure was the Daily Symptom Report, a checklist of 17 premenstrual symptoms rated from 0 to 4 according to their severity throughout the menstrual cycle. Secondary outcome measure was Hamilton Depression Rating Scale (17-item).Femicomfort at this dose was found to be effective in relieving symptoms of PMS. The difference between the femicomfort and placebo in the frequency of side effects was not significant. The results of this study indicate the efficacy of femicomfort in the treatment of PMS.

The aim of this study was to assess the mental health of patients admitted in Internal medicine، Surgery and Gynecology wards of Imam Khomeini Hospital of Tehran in 2009. The symptom chec klist-90-R (SCL-90-R) questionnaire was administered for 93 patients in internal، surgical and gynecological wards of Imam Khomeini hospital in 2009. In this study، the mean age was (32. 89 ± 12. 69) with a range of 14 to 70 years old. 42 patients (44. 7%) were male and 52 (59. 6%) were female; 56 patients (59. 6%) were married and 37 (40. 4%) were single. There is a significant relationship between gender& marital status (P<0. 04). According to cut of point of Global Severity Index (GSI) which was reported in a study (0. 7)، 58. 1 percent of the patients have different levels of psychiatric problems (GSI>0. 7). In psychiatric symptoms، somatization has the highest prevalence (90. 5%)، and depression (77. 9%) and anxiety (71. 6%) have a higher prevalence than other symptoms among patients who suffer from psychiatric problems. According to the result of the current study، there is a high prevalence of psychiatric problems among the admitted patients in Internal medicine، Surgery and Gynecology wards of a general hospital according to SCL-90-R questionnaire. This study advises that more attention be given to mental health in general hospitals.

To evaluate the frequency of different psychiatric disorders among 7 to 12 years old children in urban areas of Tehran. A sample of 799 children (6 to 11 years old) were selected from 250 clusters of the entire 22 municipality areas of Tehran using a multistage sampling method from 250 clusters from the entire 22 municipality areas of Tehran.. After responding to a Persian version of the Strengths and Difficulties Questionnaire (SDQ) parent-report form, the Persian version of Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL) was administered to 241 children and their families. The frequency of child psychological disorders was determined using the results of K-SADS-PL. The overall frequency of any psychological disorders in the sample of children was 17.9 percent. Among the interviewed children childrenwho were interviewed, the most prevalent diagnoses were Attention-Deficit/ Hyperactivity Disorder (ADHD) (8.6 percent)8.6%, Oppositional Defiant Disorder (ODD) (7.3 percent)7.3%, and separation anxiety disorder (SAD) (5.9 percent)5.9%. There were not any statistically significant differences between sexes in the frequency of psychological disorders except enuresis that was more frequent in the boys and anorexia nervosa that was observed more frequently in the girls. Higher frequency of ADHD and ODD and SAD among the studied children warrantswarrants more specific evaluation of frequency and possible causes of these high frequency rates. The frequency of psychological disorders in the studied children was comparable to the that of other studies.

The purpose of this study was to investigate the effectiveness of emotional regulation training group therapy, based on Dialectical Behavioral Therapy(DBT) and Cognitive Therapy, on improving emotional regulation and distress tolerance skills and relapse prevention in addicts. In a quasiexperimental study, 39 patients with the diagnosis of opioid dependence based on DSM-IV criteria were randomly assigned in to two experimental and one control groups. The experimental groups took 10 ninety-minute sessions of group therapy. The subjects were evaluated using the Opiate Treatment Index (OPI), General Health Questionnaire-28 (GHQ-28), and Distress Tolerance and Difficulties in Emotion Regulation Scales prior to the start of treatment, and at the sixteenth session. The control group did not take group therapy and was merely treated with naltrexone. Data were analyzed using repeated measures ANOVA and ÷ 2 test. Scheffe test showed that both emotion regulation training and cognitive therapy were more effective than naltrexone increasing distress tolerance, emotion regulation enhancement, and decreasing the amount of drug abuse, health improvement, social functioning, somatic symptoms, anxiety, social dysfunction and depression enhancement(P<0.05). In addition, emotion regulation training was more effective than cognitive therapy, increasing distress tolerance and emotional regulation enhancement (p<0.05). It seems that DBT skill training increase the effectiveness of pharmacotherapy and is more effective than cognitive therapy.

The aim of this study was to compare overall life satisfaction, subjective well-being, family stress, and stress symptoms of wives of three groups of Iranian disabled veterans. Participants included 97 wives of three groups of disabled veterans (Group 1with 25-49% disability; Group 2 with 50-69% disability; and Group 3 with larger or equal to 70% disability). The participants were selected randomly by computers of Iranian Martyrs and Veterans Foundations. Personal Well-being Index-Adult, Family Inventory of Life Events and Changes and Stress-related Symptoms Inventory were used to measure overall life satisfaction, family resources of stress and stress symptoms. Data were analyzed by ANOVA and linear multivariate regression analysis. Results showed that there are no differences in stress symptoms among the 3 groups. However, the wives of group 2 showed less stress and more global life satisfaction and subjective well-being; whereas, wives of group 3 showed more family stress and less global life satisfaction and subjective well-being. However, the wives of group 1 showed less global life satisfaction, subjective well-being and less family stress. Based on other studies, the results of group 1 is abnormal. This abnormality in results is due to two reasons: first, the participants tried to show poorer quality of life. Second, these women have not received enough facilities and services. Therefore, they lost their natural homeostasis. It seems that the last reason is more real because of equality in stress symptoms between the 3 groups.

Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety.Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation (<6 hours of sleep per 24h for 5 consecutive days and nights). The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: (a) the Wisconsin Card Sorting Test (WCST) to assess abstract reasoning and prefrontal cortex performance; (b) the Time Perception Task (TPT) to assess time estimation and time reproduction skills; and (c) the Iowa Gambling Task (IGT) to assess decision-making ability. The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately (all ps >. 05). These results may have emerged for several possible reasons: (a) chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; (b) fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or (c) our research may have suffered from poor statistical power. Future research is recommended.

Neuroleptic Malignant Syndrome (NMS) is unusual but could be a lethal reaction associated with neuroleptic drugs. It occurs in almost 0.07-2.2% of patients under treatment with neuroleptics. There are some medical treatments that may also be helpful for its treatment, including dopamine agonists, muscle relaxants, and electroconvulsive therapy (ECT). We present this case to alert the clinicians to the potential for inducing afebrile NMS. Our case is a 41-year-old man with a history of schizophrenia showing signs and symptoms in accordance with NMS, 2 weeks after receiving one dose of 12.5 mg fluphenazine decanoate, abruptly following the 3rdsession of ECT. The patient presented with decreased level of consciousness, muscular rigidity, waxy flexibility, mutism, generalized tremor, sever diaphoresis and tachycardia which progressed during the previous 24 h. Laboratory data indicated primarily leukocytosis, an increasing level of creatinine phosphokinase and hypokalemia during the next 72h. In patients receiving antipsychotics, any feature of NMS should carefully be evaluated whether it is usual or unusual particularly in patients receiving long acting neuroleptics.