Iranian Journal of Psychiatry
Volume:1 Issue: 2, Spring 2006

Traditionally, schizophrenia was considered to be a severe psychiatric disorder, with a chronic course and an unfavorable outcome. Throughout history, there has been incidence of schizophrenia, roughly one percent of the population, consistently, in every culture. It is generally acknowledged that schizophrenia has multifactorial etiology, with multiple susceptibility genes interacting with environmental insults to yield a range of phenotypes in the schizophrenia spectrum. The discovery of antipsychotics in the 1950s revolutionized the treatment of schizophrenia and focused on the positive symptoms. By the 1960s, however, it became evident that the reduction in positive symptoms did not lead to recovery from schizophrenia and did not significantly improve the functional outcome. The advent of the novel antipsychotics during the last 15 years represents a significant improvement over the effectiveness of conventional antipsychotics. These agents are, however, not a magic bullet and bear their own side effects, such as weight gain, diabetes, hyperprolactinemia, and QTc prolongation. Nevertheless, at this point, they seem to be more effective and safer than the conventional antipsychotics. Moreover, advances in the treatment of schizophrenia have been and continue to be urgently needed.

The fact that some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms has caused growing interest in investigating noradrenergic function in obsessive-compulsive disorder (OCD). In light of the above, we undertook a trial to investigate whether the combination of citalopram with nortriptyline is more effective in treating obsessive-compulsive symptoms than citalopram alone. 40 patients who met the DSM-IV criteria for OCD were included in the study. Patients were allocated in a random fashion: 20 patients to citalopram 40mg /day plus nortriptyline 50mg /day, and 20 patients to citalopram 40mg /day plus placebo. Both protocols significantly decreased the scores of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) over the trial period, but the combination of citalopram and nortriptyline showed a significant superiority over citalopram alone in the treatment of OCD. As this study indicates, nortriptyline improves the efficacy of citalopram. In addition, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic– serotonergic hypothesis in OCD.

To study the prevalence and demographic characteristics of mood disorders among Iranian adults. In this cross-sectional population-based epidemiological study (age > 18) in Iran, 25180 individuals were selected through a randomized cluster sampling method for a diagnosis using the Schedule for Affective Disorders and Schizophrenia (SADS). They were then interviewed at home by 250 trained clinical psychologists. The estimated lifetime prevalence of Major Depressive Disorder (MDD) and Minor Depressive Disorder (mDD) were 3.1% and 0.3% respectively. Also, the estimated lifetime prevalence of Bipolar Mood disorder (BMD) type I and type II were 0.1% and 0.7% respectively. The current prevalence of MDD, mDD, BMD-I, and BMD-II were 1.8%, 0.2%, 0.04%, and 0.3% respectively. Mood disorders were associated with female gender, lower education, being married, being middle-aged, living in cities, and not being a homemaker. The prevalence of mood disorders was lower among Iranian adults than reported in Western studies, and a number of demographic associations differed from those reported in Western studies. Important cultural differences in the nature or manifestation of depression are implied by these results.

The aim of the present study was to examine the relationship between marital satisfaction with psychological health in women whose husbands had either suffered from psychiatric problems or been exposed to chemical warfare during Iraq-Iran imposed war. Participants were selected from the war-affected women in Mazandaran province in north of Iran whose husbands had either suffered from a psychiatric problem (psychiatric group) or had been exposed to chemical warfare (chemical group) during Iran-Iraq war (each consisted of 52 women). Women were requested to fill in The Evaluation & Nurturing Relationship Issues Communication and Happiness(ENRICH) questionnaire, Symptom Check List 90-Revised (SCL-90-R) as well as a demograhic form. We found significant negative relationships between SCL-90-R scores and the marital satisfaction scores in both groups. The results failed to indicate significant differences between the two groups on marital satisfaction and demograhic characteristics such as age, number of children, handicapped percentage, and educational level. it seems that wives whose husbands had either psychiatric problems or had been exposed to chemical warfare, suffered from diverse psychological problems and medical ailments.

Paid employment has become increasingly very important in the lives of women, as the rapid social changes in different classes of the Iranian Society affects roles and positions of women with great changes at a rapid pace. Hardiness as a predicting factor for mental health is selected in this study to evaluation the effects of employment on the women. 250 employed married and 250 unemployed married women were selected by stratified convenience sampling. Subjects aged 24–41 years; were from the lower, middle, and upper socioeconomic status groups; with a level of education of 10±2 grades and higher; and had at least one school-going child. The Personal View Survey (PVS), was used to collect data. The results showed that Professional employed married women scored significantly higher on hardiness and three of its dimensions (commitment, control, and challenge) than the unemployed. Among employed married women, professionals scored significantly higher on hardiness and the control dimension l than non-professionals. Professional and non-professional employed women did not differ significantly on commitment and challenge. Non-professional employed and unemployed women did not differ significantly on the scores of hardiness. Paid employment increases hardiness in the professional, employed women. Status of work is an important factor for creation of positive effects of working in women.

Reports of the prevalence of PTSD has been variable between 28-70% after the earthquake disaster in the city of Bam, among children. Several studies in adults have shown a high comorbidity of anxiety disorders as well. In this study we evaluated the frequency of PTSD and anxiety symptoms among adolescents in the period of 7-9 months after a large scale disaster (Bam earthquake). In an epidemiologic study, we evaluated the PTSD and the severity of general symptoms of anxiety in adolescent survivors of Bam earthquake who had been directly exposed to the traumatic event. We used DSM-IV criteria and Posttraumatic Stress Scale (PSS) for PTSD diagnosis and Hamilton Anxiety Rating Scale for evaluation of the anxiety symptoms. 284 adolescents at the ages of 11 to 18 with a mean age of 14.8 (SD=2.1) were recruited. 45.1% had PTSD and there were no statistical differences between boys and girls for PTSD symptoms. The girls had more anxiety symptoms than the boys. One half of the adolescent survivors of Bam earthquake had post traumatic stress disorder. The girls had more anxiety symptoms.

As psychiatrists or psychotherapists, many of us may have had contact with people by e-mail and/or through online ‘chat rooms’. These people may write to us about their various problems, especially in their interpersonal relationships; discuss their queries about conflicts with their spouse, partner, and friends; or complained of low self-esteem and problems at work. In this article, we will try to discuss certain considerations and opinions about the possibility of insight-oriented psychotherapy in the domain of ‘virtual reality''. This study was based on clinical observation of the first author. Two cases of ‘Cyberanalysis’ were described. The management of transference and countertransference, the analysis of defenses in this context, and possible reasons for success and failure of each case were discussed. We have witnessed the formation of a transferential relationship between the ‘client’ and the therapists after a matter of months. One of the client had a satisfactory outcome and the other represented a therapeutic failure. This type of psychotherapy may provide a novel opportunity for therapists to move toward the internal world of the patient Compared to ‘real world’ therapies. This modality of therapy also has its own advantages and shortcomings.

To report the case of a 28-year old hypercholesterolemic female with postpartum depression, whose triglyceride (TG) and total cholesterol (TC) levels decreased while being treated with fluoxetine. A 28-year old female, with a diagnosis of major depressive disorder with postpartum onset based on DSM-IV criteria, was hospitalized at a mental health hospital. Her past history included another episode of depression 4 months after giving birth to her second child, which was 12 years prior to her recent episode. Her serum total cholestrol and triglyceride levels were measured prior to the initiation of medication. Then fluoxetine was initiated at a daily dose of 20 mg and had been increased to 40 mg per day at the time of discharge. The lipid profile measurements was repeated at week 4 and 8 following treatment. Total cholesterol level was reduced from 242 mg/dL at baseline to 224 mg/dL at week 4 and to 202 mg/dL at week 8; triglyceride level was decreased from 516 mg/dL to 448 mg/dL at week 4 and to 404 mg/dL at week 8. Fluoxetine may be an appropriate treatment for hyperlipidemic women with postpartum depression..