Iranian Journal of Psychiatry
Volume:8 Issue: 1, Winter 2013

Bipolar spectrum disorders may often go undiagnosed or unrecognized. The aim of this study was to determine the proportion of bipolar disorder symptoms in Iranian patients with a major depressive episode. 313 patients with a current DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders 4th ed. Text rev.) diagnosed with a major depressive episode entered this cross-sectional study. Thirty two items revised Hypomania/ mania Symptoms Checklist (HCL-32) was used to determine the frequency of bipolar episodes. Considerable proportion of patients (53.9%) previously diagnosed as major depressive disorder fulfilled the criteria for bipolar disorder by Bipolarity Specifier. The Bipolarity Specifier additionally identified significant association for manic / hypomanic states during antidepressants therapy (p<0.0003) and current mixed mood symptoms (p<0.0001) Bipolar symptoms meeting the criteria for bipolar disorders in depressed patients who have not been previously diagnosed with bipolar disorder are frequent. Current DSM criteria may not be sufficient to diagnose more subtle or atypical forms of bipolar disorders.

Quality of life measures can provide an important source of medical information for promoting the health status of chronically ill patients. The purpose of the present study was to evaluate health related quality of life in psychiatric veterans of the Iraq- Iran war of the 1980s. They were out patients diagnosed with various psychiatric symptoms.The present study used a cross sectional design, in which 971 psychiatric veterans were selected by Systematic-randomized sampling and evaluated using the SF36 questionnaire. Findings revealed that veterans who suffered from one or more chronic conditions/illnesses reported significantly more bodily pain and significantly less vitality, mental and general health compared to those veterans without chronic conditions. Moreover, specific aspects of poor quality of life were more salient in specific chronic conditions/illnesses than others. Based on these findings, chronic conditions, especially respiratory problems, can have a detrimental effect on the quality of life in psychiatric war veterans.

In many jurisdictions, psychiatric problems are intended for commutation. Therefore, a forensic psychiatrist has an important role in detection of malingering. While several studies evaluate diagnostic tests, it is less known what symptoms are more likely to be imitated by malingerers. In a prospective study [t1] 45 [t2] malingerers, who were diagnosed according to interviews by two forensic psychiatrists, from defendants [t3] with a judicial order for evaluation of mental status and criminal responsibility during a period of eighteen months were examined in legal medicine center of Tehran.[t4] [t5] Participants were assessed in another interview to determine symptoms. Dichotomous symptoms in felony and misdemeanor groups were analyzed using fisher’s exact test. The level of statistical significance was set at P<0.05. [t6] Thirty-eight malingerers were charged with misdemeanors and seven with felonies. Behavioral symptoms were most frequently faked by 35 participants (77.8%). Participants charged with criminal accusation had a significantly lower mean age (P=0.032) and a higher level of education (P=0.008) than other non-criminal defendants. A statistically significant increase in memory function problems was demonstrated in the misdemeanor group (P=0.040). With regard to dual symptom imitation, statistically significant correlations were observed between thought content and perceptual symptoms (P=0.048) for felonies and mood & affect and thought process symptoms (P=0.034), mood & affect and behavioral symptoms (P=0.000) and cognitive function and behavioral symptoms (P=0.039) for misdemeanors. In general, many simulators attempted to mimic simple symptoms of behavioral disorders. Probably felony offenses need less accurate programming; therefore, their rates are higher in older, less educated participants. This study demonstrated that differences between presenting symptoms among different offenses may not be useful in detection of malingering,; however, unusual dual symptom imitations may be useful, particularly when standard tests are not performed.

Teachers often experience burnout and challenges during their active career. Different studies have shown that those directly involved with teaching children with special needs are more subject to burnout. Due to advance screening tools, more children with autism are now diagnosed and involved in special education. The aim of the present study was to investigate the professional burnout in teachers of children with autism compared to teachers of other children with special needs. Casual Comparative study design was used for this research. Three self-reported measures (Maslach Burnout Inventory, Job Descriptive Index, and General Health Questionnaire) were distributed; clustered sampling selection was conducted to select participants. Ninety three female teachers (32 teachers of children with autism, 30 teachers in schools for deaf and 31 for teachers of children with mental retardation) from 12 schools located in 4 districts of Tehran were selected. Pearson’s and Spearman’s correlation statistical tests, analysis of variances and regression were used to analyze the results. Results of the current study revealed a significant difference in criterion validity between the three groups of teachers The three groups were different in terms of general health (p=0.010), emotional exhaustion (p=0.005) and depersonalization (p<0.001); however considering other variables no significant differences were observed. Comparison between groups showed that the average scores of teachers of children with autism were significantly higher than teachers of deaf and hard of hearing and mentally retarded children in general health, fatigue, and depersonalization variables. No significant differences were observed in average scores of teachers for mentally retarded and deaf children. Female teachers’ of children with autism are experiencing significantly higher levels of burnout and general mental health problems compared to teachers of children with other disabilities requiring special education.

It is important to consider the health concerns of adolescents before developing and implementing public health promotion or health education curriculum programs aimed at ameliorating priority health problems experienced by adolescents. The aim of this study was to test the psychometric properties of the original Adolescent Health Concern Inventory (AHCI) for use with an Iranian population. This was a methodological study in which 50 adolescents with age range of 14-18 years were selected using convenience sampling. The translation and cultural adaptation process of The AHCI followed recognized and established guidelines. The face and content validity was established by analyzing feedback solicited from teenagers and professionals with expertise in health, sociology and psychology. Reliability was examined using test-retest and Cronbach’s alpha for internal consistency reliability. Kappa and McNemar tests were used to examine test-retest reliability for each item. Minor cultural differences were identified and resolved during the translation process and determining the validity of the checklist. Results from Kappa and McNemar tests indicate a high degree of test-retest reliability. Internal consistency reliability as measured by Cronbach’s alpha for the subscales were between 0.68 and 0.87 with total instrument reliability of 0.96 indicating considerable overall reliability. The Persian version of the AHCI appears valid and reliable. Hence, it can be used for filling a gap in identifying the adolescents'' health concerns in the research and community settings and school health education programs in Iran to design appropriate interventions.

We aimed to compare the medical students’ attitude towards psychiatry before and after psychiatry clerkship, and to examine the association of choosing psychiatry as a future career with some personal characteristics. In a self-controlled, quasi-experimental study, all of the medical students entering the psychiatry clerkship in three major medical schools of Iran located in Tehran (Tehran, Shahid Beheshti, and Iran University of Medical Sciences) were asked to participate anonymously in the study on the first and the last 3-days of their psychiatry clerkship. From 346 invited 4th-5th year medical students, 225 (65%) completed anonymous self-report questionnaires before and after a 4-week psychiatry clerkship. Positive response to choose psychiatry as a career was seen in 13.3 % and 18.3 % before and after psychiatry rotation, respectively. However, the difference was not statistically significant; about one-quarter of the students were turned on to psychiatry and 25% were discouraged during the clerkship. Individual pair wise comparisons revealed significant improvements only in two out of 13 measured aspects of psychiatry. Seventeen out of 38 (47.7%) students who identified psychiatry as the career of choice or strong possibility reported that one of their family members or close friends’ mental illness had an impact on their choice. Those students who considered psychiatry as the strong possibility claimed that they are more interested in humanities (OR = 2.96; 95% CI: 1.17, 7.49), and playing a musical instrument (OR = 2.53; 95% CI: 1.15, 5.57). It may be concluded that exposure to psychiatry clerkship could influence medical students’ opinion about psychiatry positively, or negatively. Personal characteristics and individual interests of students may play an important role in choosing psychiatry as their future career.

The aim of this study was to examine reality testing in schizophrenic children and compare it with normal children using minus responses subcomponent in ego impairment index of the Rorschach test. In a descriptive design, 20 accidentally sampled children, including 10 schizophrenic and 10 normal children, were recruited in to two groups and were compared in terms of reality testing subcomponent of Ego Impairment Index (EII). After initial interview, the Rorschach inkblot test was administered on the two groups, and Distorted Quality responses (FQ-) were calculated. The results were then analyzed by independent t-test and Cohen’s d for effect size. The result of independent t-test revealed that the mean of minus responses in schizophrenic children was significantly higher than that of normal children. In addition, the usefulness of the Rorschach ego impairment index (EII) in evaluating reality testing in schizophrenic children was confirmed. In addition, it was found that defect in reality testing is one of the prominent characteristics of schizophrenic children. The higher minus responses in schizophrenic children indicate that schizophrenic children have weaker functioning in reality testing compared with normal children.

Screening is one of the ways to combat Tuberculosis (TB) and should be mostly concentrated on groups showing some symptoms of the disease. Tuberculosis can be transferred from person to person in laboratories, prisons and psychiatry hospitals. The purpose of this study was to survey pulmonary TB in patients with schizophrenia in Rasht. In this descriptive-cross sectional, Two hundred fifty seven consecutive patients with chronic psychotic disorder hospitalized in psychotic hospitals underwent purified protein derivative (PPD) test. PPD test was done with the unit 5T which was injected subcutaneously on anterior surface and at the top of left forearm. The results of the test were interpreted by the pen technique method and based on transverse diameter of induration of about 48-72 hrs. Induration size due to hypersensitivity to PPD more than 10mm was considered positive. Patients with positive PPD test underwent complementary sputum smear. Data were analyzed using chi- square and T test. The mean age of patients was 45±10 years; 75.5% were male, 74.7% were single, 10.5% married, 7.8% divorced, and 68.1% were smokers. These patients suffered from chronic psychotic disorder at the mean time of 15±7.9 years. In 74 patients (28%) positive PPD test were recorded, but active pulmonary TB was not found in complementary experiments of PPD sample. Based on data analysis, only age and gender showed a significant relationship with the results of the PPD test (P < 0.05). This study showed that patients with positive PPD test are much more than the normal population, but active pulmonary TB was not observed in our samples. Since these patients are in clinical and closed places, more programs for screening are required

While Parkinson’s disease (PD) has traditionally been defined by motor symptoms, many researches have indicated that mild cognitive impairment is common in non-demented PD patients. The purpose of this study was to compare verbal fluency performance in non-demented Parkinson’s disease patients with healthy controls. In this cross-sectional study thirty non-demented Parkinson’s disease patients and 30 healthy controls, matched by age, gender and education, were compared on verbal fluency performance. Verbal fluency was studied with a Phonemic Fluency task using the letters F, A, and S, a semantic fluency task using the categories animals and fruits. The independent t-test was used for data analysis. Overall, participants generated more words in the semantic fluency task than in the phonemic fluency task. Results revealed significant differences between patients and controls in semantic fluency task (p<.05). In addition, PD patients showed a significant reduction of correctly generated words in letter fluency task. The total number of words produced was also significantly lower in the PD group (p<.05). Verbal fluency disruption is implied in non-demented PD patients in association with incipient cognitive impairment.

Donepezil, a member of the acetylcholinesterase inhibitor family, is approved for management of cognitive impairments as well as behavioral complications in patients with neurodegenerative Alzheimer''s disease. Generally, donepezil is regarded as a safe medication in patients with Alzheimer’s disease although there have been reports of several minor adverse events including gastrointestinal disturbances. Herein we describe a patient with Alzheimer’s disease who demonstrated delirious behavior upon treatment with donepezil.