Iranian Journal of Psychiatry
Volume:10 Issue: 1, Winter 2015

We aimed to conduct a review to investigate the prevalence of anxiety disorders among Iranian children and adolescents. We systematically reviewed the literature up to June 2014. We searched three Persian databases (Magiran, IranMedex and SID) and three English databases: PubMed, Scopus and PsycINFO. All original studies that investigated the current prevalence of anxiety in a sample of Iranian children and adolescents were entered into the study. All studies conducted on special samples or in special settings were excluded. By searching English databases, we obtained 124 original studies. After removing duplicate papers, 120 articles remained. In the next step, we screened the articles based on their title. In sum, 95 Persian and English articles had relevant titles. After screening based on the abstract and full text, 26 studies remained. After screening based on the full text, all selected studies were qualitatively assessed by two evaluators separately. Twenty five studies were eligible and reported different types of anxiety disorders (i.e., generalized anxiety, separation anxiety, obsessive-compulsive disorder, phobias and panic disorder). The samples varied from 81 to 2996 among studies and their age range was 5 to 18 years. These studies were conducted in different cities of Iran. SCL-90 is a frequently used questionnaire. All anxiety disorders were mostly investigated with the prevalence rates ranging from 6.8% in Saravan to 85% in Bandar Abbas. OCD was the second common study with prevalence rates ranging from 1% in Tabriz to 11.9% in Gorgan. Our findings revealed considerable amount of anxiety disorder among Iranian children and adolescents. Given the fact that anxiety disorder has negative effects on the well-being and function of individuals and can lead to severe problems, this disorder should be considered in mental health programs designed for children and adolescents.

The aim of this study was to compare the QEEG of adolescents affected by bipolar II disorder with age and gender matched healthy controls, and to extract the characteristics of the alpha frequency band to better understand this disorder. Twenty one adolescents affected by acute episodes of bipolar II disorder (BMD II), both hypomanic and depressive episodes, were selected via convenience sampling based on DSM IV criteria and child and adolescent psychiatrist diagnosis. Eleven patients were going through a hypomanic episode and 10 patients were going through a depression episode. Of the participants, 18 who were matched with the patient group participated in this study as a normal group. Any major comorbidities and intellectual disabilities were excluded through applying K-SADS-PL and Raven’s IQ test for all the patients and the healthy participants. Electroencephalogram signals were obtained according to 10-20 international system by 21 electrodes from participants in open and closed eyes in a resting state. We selected 40 seconds length segments from each recorded EEG signals that had minimal noise and artifacts. Power spectrum density (PSD) was estimated for each segment and extracted alpha band frequency. We used only referential (unipolar) montage for comparison. Eventually, data were analyzed by independent Mann-Whitney test and independent t test. We observed significant differences in the alpha frequency band in some brain regions. Alpha power increased in the fronto-central region and right parietal lobe in the patients (P < 0.05). In the patients with BMD II, entropy of alpha oscillations was larger than the normal participants in the central region and in the F3, F4 and P4 channels. Also, there were differences in the variance of alpha oscillations in these regions between the two groups (P < 0.05). In the occipital lobe, alpha wave had different skewness between the two groups (P < 0.05). Thalamus as a generator and modulator of at least a part of alpha oscillations may be involved in this disorder and hence this explains the major symptoms like distractibility and inattention in both hypomanic and depressive episodes of bipolar II disorder.

Deficits in the processing of facial emotions have been reported extensively in patients with schizophrenia. To explore whether restricted attention is the cause of impaired emotion processing in these patients, we examined visual attention through tracking eye movements in response to emotional and neutral face stimuli in a group of patients with schizophrenia and healthy individuals. We also examined the correlation between visual attention allocation and symptoms severity in our patient group. Thirty adult patients with schizophrenia and 30 matched healthy controls participated in this study. Visual attention data were recorded while participants passively viewed emotional-neutral face pairs for 500 ms. The relationship between the visual attention and symptoms severity were assessed by the Positive and Negative Syndrome Scale (PANSS) in the schizophrenia group. Repeated Measures ANOVAs were used to compare the groups. Comparing the number of fixations made during face-pairs presentation, we found that patients with schizophrenia made fewer fixations on faces, regardless of the expression of the face. Analysis of the number of fixations on negative-neutral pairs also revealed that the patients made fewer fixations on both neutral and negative faces. Analysis of number of fixations on positive-neutral pairs only showed more fixations on positive relative to neutral expressions in both groups. We found no correlations between visual attention pattern to faces and symptom severity in schizophrenic patients. The results of this study suggest that the facial recognition deficit in schizophrenia is related to decreased attention to face stimuli. Finding of no difference in visual attention for positive-neutral face pairs between the groups is in line with studies that have shown increased ability to positive emotional perception in these patients.

Loss of wife besides the phenomenon of aging could cause some psychological disorders and may shorten the duration of this stage of life. The aim of this study was to examine the efficacy of treatment reminders of life with emphasis on integrative reminiscence on self-esteem and anxiety in widowed old men. This was a clinical trial with pre-test and post-test design with a control group. The study population included All 60 to 80 year old men living in Meshginshahr; among whom, 34 participants were selected using convenience sampling method. They were randomly allocated into two equal groups (experimental and control). The experimental group participated in therapy sessions and the control group did not receive any intervention. The research instruments were Rosenberg Self-Esteem Scale and the General Anxiety Questionnaire. Data were analyzed using multivariable covariance analysis in SSPS-19. Statistical significance was set at P<0.05. MANCOVA results showed that the treatment positively affected the variables of self-esteem and anxiety in old widowed men (p<0.001). The reminders of life therapy with emphasis on integrative reminiscence may enhance self-esteem and reduce anxiety in widowed old men. This treatment gives better results compared to the traditional treatments and it is recommended to be implemented in nursing homes.

Despite the fact that the mobile phone has become a pervasive technology of our time, little research has been done on mobile dependency. Therefore, a valid and reliable instrument, conforming to Iranian culture seems essential. The aim of our study was to validate the Iranian version of MPPUS (Mobile Phone Problematic Use Scale). This was a cross-sectional research, in which data were collected from 600 students studying at Tehran universities. Stratified sampling method was used to collect data. All participants completed Demographic Questionnaire, Cellular Phone Dependency Questionnaire (CPDQ) anonymously. Finally, a clinical interview (based on DSM-IV-TR) was conducted with 100 participants. Data were analyzed using concurrent validity, factor analysis, internal consistency (Cronbachs’α), split half, test-retest and ROC Curve by SPSS18 Software. As a result of reliability analysis and factor analysis by principal component and Varimax rotation, we extracted three factors including preoccupation, withdrawal symptoms and overuse of mobile phones in both males and females. Internal consistency (Cronbach's alpha) of the MPPUS was. 91; Cronbach's alpha of the factors was. 87,. 70,. 82 respectively. The test-retest correlation of the MPPUS was. 56. The best cut off point for this questionnaire (MPPUS) was 160. The MPPUS proved to be a reliable questionnaire with adequate factor models to assess the extent of problems caused by the “misuse” of mobile phones in the Iranian society; however, further studies are needed on this topic.

The purpose of this study was to describe the moral distress among Iranian registered nurses. This was a descriptive –analytic study, in which 264 out of 1000 nurses were randomly selected as a sample group and completed the questionnaire. The nurse's moral distress was assessed using Corley’s 30-item Moral Distress Scale adapted for use in an Iranian population. The collected data were analyzed by SPSS version 19. In this study, no correlation was found between the level of moral distress and any of the demographic data. The mean moral distress score ranged from 3.56 to 5.83, indicating moderate to high levels of moral distress. The item with the highest mean score was “working with unsafe levels of nurse staffing”. The item with the lowest mean score was “giving medication intravenously to a patient who has refused to take it”. Nurses working in EMS and NICU units had the highest levels of moral distress. A higher degree of moral distress is observed among nurses who work in health care systems. The results of this study highly recommend practical and research-oriented evaluation of moral distress in the medical society in Iran. Our findings suggest that Iranian version of MDS is a reliable instrument to measure moral distress in nurses.

Psoriasis is a disease which may have a direct impact on the psychological and social aspects of the patient, particularly due to its visibility. To date, we are unaware of any study showing a relationship between psoriasis and psychological parameters such as psychological vulnerability and coping strategies. The aim of this study was to evaluate the effects of psoriasis on some psychological parameters in an Iranian population.Patients having histopathologically confirmed psoriasis for at least 6 months attending the Dermatology Clinic of Razi Hospital were included if they agreed to participate in the study. Patients with history of schizophrenia, major depression or other psychological disorders were excluded. All patients were at least 18 years old. The patients were then referred to the researchers for filling out the appropriate questionnaires under the guidance of an involved psychologist. To evaluate skin involvement, Psoriasis Area Severity Index (PASI) score was calculated and used for all patients. All data were stored in files for further analysis. There were 101 females and 99 males with the mean age of 43.2(±16.32). The mean PASI Score was 6.58 ± 6.04. Diffuse skin involvement was the commonest form of disease (133 patients, 66.5%). The highest score for Illness perception belonged to those with genitalia involvement (185.2, worst illness perception), and the lowest score for Illness perception belonged to those with nail involvement (168.2). Consistently, the lowest score of facing the problems (CISS: approach strategy to disease) belonged to those with hand involvement (50.5) whereas the highest score belonged to those with genitalia involvement (60.4). There was a significant correlation between psychological vulnerability vs. Illness perception score as well as psychological vulnerability vs. coping strategies score. Surprisingly, PASI score had an insignificant relationship with illness perception, coping strategies or psychological vulnerability score. PASI score as a representing factor of skin involvement has a limited role in predicting the effect of psoriasis on mental status and illness perception of psoriatic patients. Psychological vulnerability of the patients is the main predicting factor of illness perception and coping strategies (representing patients approach to their disease or their treatment beliefs).

Functional Dyspepsia (FD) is a common symptom of upper gastrointestinal discomfort. Few data are available on the role of psychotherapy in the treatment of dyspeptic syndromes. This study assesses whether brief core conflictual relationship theme (CCRT) psychoanalytic psychotherapy improves gastrointestinal and psychiatric symptoms in patients with functional dyspepsia. A randomized, controlled trial was planned in two educational hospitals in city of Babol. Forty-nine patients with FD were randomly assigned to receive standard medication treatment with CCRT psychotherapy (24 participants) or standard medication treatment alone (25 participants). The participants completed the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI-SYM) and Symptom Checklist-90-Revised (SCL-90-R) questionnaires before the trial, after the treatment and at 1 and 12-month follow-ups. The mixed-effects (regression) model was used to analyze the data. The results showed that CCRT psychotherapy improved all of the FD symptoms (heartburn/regurgitation, nausea/vomiting, fullness, bloating, upper abdominal pain, and lower abdominal pain) and many of the psychiatric symptoms (depression, anxiety, somatization, interpersonal sensitivity and paranoid ideation) after the treatment and at 1-month and 12-month follow-ups. Brief CCRT psychoanalytic psychotherapy can serve as an effective intervention for promoting gastrointestinal and psychiatric symptoms in patients with functional dyspepsia.

The aim of this study was to investigate the possibility of predicting psychological well-being based on spirituality and religiousness. A sample of 300 participants was selected from the whole entrants to Shiraz University of Medical Sciences and Shiraz University using a random cluster sampling. The tools of this study were the Spiritual Scale of Ironson, the Internal and External Orientations of Allport and Ross, Spiritual Religious Orientation of Betson and Showinerdand and the Psychological Well-Being Scale. To analyze the results of this study, we used the statistical method of Pearson correlation and we also performed the path analysis. Multiple regressions were used in a hierarchical simultaneous way in accordance with the stages of Barron and Kenny. The following results were obtained in this study:1)Spirituality positively predicted two religious orientations (question and internal) among which the internal spirituality possessed a higher degree of predictability; 2)Through intra-religious orientation, and in a direct way, spirituality predicted psychological well-being; 3)The internal orientation was the only strong mediator in the relationship between spirituality and psychological well-being. Spirituality and religiosity were significant determinants of mental health, and they had more shares in psychological well-being, and made religious beliefs profound and internalized them.

The aim of this study was to evaluate suicide probability in Iranian males with substance abuse or dependence disorder and to investigate the predictors of suicide probability based on trait mindfulness, reasons for living and severity of general psychiatric symptoms. Participants were 324 individuals with substance abuse or dependence in an outpatient setting and prison. Reasons for living questionnaire, Mindfulness Attention Awareness Scale and Suicide probability Scale were used as instruments. Sample was selected based on convenience sampling method. Data were analyzed using SPSS and AMOS. The life-time prevalence of suicide attempt in the outpatient setting was35% and it was 42% in the prison setting. Suicide probability in the prison setting was significantly higher than in the outpatient setting (p<0.001). The severity of general symptom strongly correlated with suicide probability. Trait mindfulness, not reasons for living beliefs, had a mediating effect in the relationship between the severity of general symptoms and suicide probability. Fear of social disapproval, survival and coping beliefs and child-related concerns significantly predicted suicide probability (p<0.001). It could be suggested that trait mindfulness was more effective in preventing suicide probability than beliefs about reasons for living in individuals with substance abuse or dependence disorders. The severity of general symptom should be regarded as an important risk factor of suicide probability.

Early screening of autism increases the chance of receiving timely intervention. Using the Parent Report Questionnaires is effective in screening autism. The Q-CHAT is a new instrument that has shown several advantages than other screening tools. Because there is no adequate tool for the early screening of autistic traits in Iranian children, we aimed to investigate the adequacy of the Persian translation of Q-CHAT. At first, we prepared the Persian translation of the Quantitative Checklist for Autism in Toddlers (Q-CHAT). After that, an appropriate sample was selected and the check list was administered. Our sample included 100 children in two groups (typically developing and autistic children) who had been selected conveniently. Pearson’s r was used to determine test-retest reliability, and Cronbach’s alpha coefficient was used to explore the internal consistency of Q-CHAT. We used the receiver operating characteristics curve (ROC) to investigate whether Q-CHAT can adequately discriminate between typically developing and ASD children or not. Data analysis was carried out by SPSS 19. The typically developing group consisted of 50 children with the mean age of 27.14 months, and the ASD group included50 children with the mean age of 29.62 months. The mean of the total score for the typically developing group was 22.4 (SD=6.26) on Q-CHAT and it was 50.94 (SD=12.35) for the ASD group, which was significantly different (p=0.00).The Cronbach’s alpha coefficient of the checklist was 0.886, and test-retest reliability was calculated as 0.997 (p<0.01). The estimated area under the curve (AUC) was 0.971. It seems that the total score equal to 30 can be a good cut point to identify toddlers who are at risk of autism (sensitivity= 0.96 and specificity= 0.90). The Persian translation of Q-CHAT has good reliability and predictive validity and can be used as a screening tool todetect18 to 24 months old children who are at risk of autism.