Iranian Journal of Psychiatry and Behavioral Sciences
Volume:9 Issue: 2, Jun 2015

Iran is suffering from the 2nd most severe addiction to opioids in the world. While the explanation of this enormous drug problem is refutably related to drug trafficking, the drug dilemma also illustrates the chain reaction of the imposed war with Iraq in 1980 - 88; the problems of poverty, unemployment, urbanization, homelessness, adultery, family crises, divorce, domestic violence, and runaway children. Although opium addiction often linked to these factors, drug use is common among all social classes. It seems that a positive traditional attitude is another reason for widespread raw opium use in this country. A survey in Iranian literature reveals that famous Iranian poets, who have a substantial contribution on cultural attitude formation of Iranian population, have used the phrase “Teriac” (raw opium) as a means of “antidote” a substance that treats every disease. It seems that a concrete deduction from the literature has been leaden to a positive attitude towards opium consumption in Persian culture. Recent research also supports this idea. Many patients use raw opium as a pain killer or for treating hyperlipidemia, hypertension, diabetes and other chronic diseases; most of them had started the use after developing the disease and the remaining had increased the consumption after developing the disease. Regarding this superstitious common belief, drug control headquarters should focus on education and correction of the faulty unhealthy attitude toward opium consumption.

There are many antidepressant medications with different side-effects and efficacy profiles. In this study, we compared the efficacy of citalopram and venlafaxine in major depression, which has not yet been studied in Iran. Patients and In this double-blind, randomized controlled trial study, 3 patients aged 18-54 year old with major depressive disorder were randomly allocated into two groups in Yazd City, Iran, between March 201 and December 2012. A total of 16 patients were treated with velafaxine and 23 patients were treated with citalopram for 8 weeks. Hamilton Depression Rating Scale (HDRS) questionnaire was used for monitoring depression severity. Data were analyzed by SPSS version 20.0 software using Mann Whitney U test and chi-square statistical tests. The HDRS scores were decreased significantly in each group after 8 weeks of treatment (P = 0.001). However, there was no significant difference considering the score of HDRS (P = 0.110). Ten patients in the venlafaxine group and two patients in the citalopram group stopped using medication, all due to nausea or vomiting, or both, and the rate of these two side-effects was significantly higher in the venlafaxine group (P = 0.010). The efficacy of venlafaxine and citalopram are almost the same, but compliance for the use of medication, such as nausea and vomiting, in patients using venlafaxine is much higher than the citalopram group. Therefore, this implies that citalopram could be a safer antidepressant for patients suffering from major depression.

Patients with mixed anxiety-depressive disorder (MADD) suffer both anxiety and depression. Antidepressants, especially, selective serotonin reuptake inhibitors are among agents of choice for treating this condition. This study compared the efficacy of Cipram® with its generic, citalopram.Patients and Forty adult outpatients (between 18 to 55 years of age) with a diagnosis of MADD who met the trial criteria, entered this double-blind, randomized study. Subjects were assigned to receive either generic citalopram or Cipram® for 8 weeks. Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) were utilized to assess depression and anxiety at baseline, weeks 4 and 8 of the study. Statistical analysis was performed using SPSS 14.0. Twenty patients received citalopram (mean dosages of 22 mg/day during the first 4 weeks and 33 mg/day during weeks 4 to 8) and 20 received Cipram® (mean dosages of 22 mg/day during the first 4 weeks and 29 mg/day during weeks 4 to 8). Both treatments were noted to be effective in improving the symptoms of MADD at weeks 4 and 8. The mean differences of HAM-D and HAM-A between Citalopram and Cipram® groups were significantly different at the end of week 4 (HAM-D: P = 0.038, HAM-A: P = 0.025), but not at the end of week 8 (HAM-D: P = 0.239, HAM-A: P = 0.204). Both medications were tolerated well by the patients. This study suggests that the efficacy of citalopram is similar to that of Cipram® in the treatment of MADD after 8 weeks. Meanwhile, Cipram® may reduce depression and anxiety quicker than its generic, citalopram.

Selective serotonin reuptake inhibitors (SSRIs) and exposure with response prevention for treatment of obsessive-compulsive disorder (OCD) have demonstrated empirical support; however, a substantial number of patients remain with clinically significant OCD symptoms after such treatments. The aim of this study was to compare the effectiveness of acceptance and commitment therapy (ACT), selective serotonin reuptake inhibitors (SSRIs) and combination of ACT and SSRIs in the treatment of adults with obsessive-compulsive disorder (OCD).Patients and Thirty-two outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for OCD were randomly assigned to one of the three treatment conditions: ACT, SSRIs and combined treatment. The Yale-Brown Obsessive-Compulsive Scale and Acceptance and Action Questionnaire were administered at pre-treatment and post-treatment. Twenty-seven patients completed the study. Data was analyzed using one-way analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA), clinically significant change (CSC) and complete remission status. ANCOVA revealed that patients treated with ACT and combined treatment experienced a significantly greater improvement in obsessive-compulsive (OC) symptoms and experiential avoidance (EA) at post-treatment compared to those treated with SSRIs alone. However, there were no significant differences between ACT and combined treatment on OC symptoms and EA. CSC and complete remission status results showed that unlike SSRI, ACT and combined treatment led to more improvement in OC symptoms. ACT and combined treatment are more effective than SSRIs alone in treating OC symptoms and EA. However, it appears that adding SSRIs to ACT does not increase the effectiveness of ACT in the treatment of adults with OCD in the short-term.

A few studies on short-term psychodynamic approach have been conducted on social phobia. In this study, the effectiveness of short-term psychodynamic psychotherapy on the treatment of social phobia has been compared to the effectiveness of sertraline and waiting list. In this randomized-controlled trial study, 13 male students were treated with short-term dynamic psychotherapy (McCullough method) lasting 25 sessions, 11 students received sertraline for 12 weeks, and 14 students, as the waiting list, received no intervention for 8 weeks. Participants completed the Social Phobia Inventory (SPIN) as primary efficacy variable 4 times, and were rated with Clinical Global Impression scale (CGI) and Global Assessment of Functioning (GAF) as secondary efficacy variables. The data were analyzed with analysis of variance (ANOVA), analysis of covariance (ANCOVA), general linear model repeated measures analysis of variance and Fisher exact test. ANCOVA showed significant differences between groups based on SPIN scores (F = 23.51, Sig. = 0.001) and Bonferroni test, as post hoc compression, showed means of both short-term dynamic therapy and sertraline therapy groups were significantly different from waiting list mean (STDP-WL: ¯xdif = 15.76, Sig. = 0.001), (MED-WL: ¯x = 15.91, Sig. = 0.001). Mean of SPIN scores was not significantly different between short-term dynamic psychotherapy and pharmacotherapy groups. In both treatment groups, means of SPIN scores significantly decreased in posttest, but not in waiting. These results repeated with GAF and CGI scores. The results indicated that short-term dynamic psychotherapy sertraline are effective in decreasing social phobia symptoms and were superior to control group.

Families play an essential role in maintaining children’s mental, social, and physical health. The family provides the first and the most important social context for human development. The present study aimed to predict early maladaptive schemas using Baumrind’s parenting styles (root development).Patients and A total of 357 undergraduate students of Islamic Azad University, Urmia Branch, Iran, were selected through random cluster sampling during 2013 and 2014. The students were assessed using the Schema Questionnaire-Short Form (SQ-SF) and the Baumrind’s parenting styles inventories. The result of regression analysis showed that Baumrind’s parenting styles are significant predictors of early maladaptive schemas (P < 0.001). The authoritative parenting style has some features such as showing high levels of warmth or encouraging kids to express their own possibly divergent opinions. The authoritarian parenting style, however, possesses traits such as heartlessness, impassiveness, strictness, and lack of attention to the children’s developmental needs, which is not acceptable.

Diabetes Mellitus (DM) imposes restrictions on physical, emotional and social functioning of children and adolescents. The aim of this study was to determine the impact of acceptance and commitment therapy (ACT) on perceived stress and special health self-efficacy in seven to fifteen-year-old children with DM.Patients and The present study was a clinical trial with a pretest-posttest control group design. The study population included all seven to fifteen-year-old patients who had referred to the Diabetes Mellitus Association of Tabriz, Iran, of whom 40 participants were selected using convenient sampling. They were randomly allocated to two matched groups (experimental and control). The experimental group participated in therapy sessions, while the control group did not receive any interventions. The research instruments were perceived stress and special health self-efficacy scales. The multiple analysis of covariance (MANCOVA) results showed that the treatment was effective on variables of perceived stress and special health self-efficacy (P < 0.001). The ACT is effective for reducing perceived stress and increasing special health self-efficacy in children with DM.

Sychotropic agents (alcohol, drugs, and illicit substances) have an important effect on the occurrence or exacerbation of psychological and behavioral derangements such as criminal activity and mental abnormalities. The objective was to assess the relationship between psychiatric distress and criminal history among abusers of intravenous drugs, including heroin, benzodiazepine, codeine, cannabis, opium, and ecstasy. Criminal activity history and psychiatric distress were evaluated among intravenous drug abusers in drop-in centers (DIC) (141 subjects) and an outpatient service to delivery methadone to the addicts located in Razy Hospital (Baghdad, Iraq) (120 subjects). Logistic regression analyses using the SPSS for Windows 18.0 were used for analyzing the data. About 86% of the intravenous drug abusers had psychiatric distress and 48.2% had criminal activity history. DIC addicts group had a better mental well-being compared to the other group, but criminal history rate was similar in two groups. In multiple logistic regression, addiction to heroin (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.1 - 4.1), mental disorders (β = 0.060, P = 0.026), and low level of education was highly related with criminal activity (OR = 0.17, 95% CI: 0.03 - 0.89). Higher scores in mental well-being questionnaire of DIC addicts suggest the positive effects of psychological interventions. There is a possibility of the involvement of heroin in occurrence of mental disorders and criminal activity. This finding needs further investigations by larger cohort studies.

In recent years, there has been an increasing interest in performing research on drug use and sex work among at-risk women. Although there is a well-documented literature of the initial reasons associated with drug use and sex work among women, there is, however, a paucity of information in this area in Iran. This study aimed to explore the initial reasons associated with drug use and sex work in a group of female treatment seekers, who presented health-related risk behaviors, in Tehran, Iran. Patients and Thisqualitative study enrolled a total of 65 at-risk women, from five women-specific drug clinics, who participated in the study in 2011. Individual in-depth interviews were conducted. Focus group interviews were conducted with 10 key informants. All interviews were audio-taped and thematically written. The recorded data were analyzed using ATLASti qualitative research software version 10. The median age of the sample was 34 years. In addition, 44.6% of subjects were opiate users, and 55.4% were users of opiates and methamphetamine. Sex work was the main source of income for almost half of the sample. The most frequently reported reasons, associated with initial drug use, were extrinsic motivations, including the drug-using family, friends or social networks. Intrinsic motivations, including curiosity and individual willingness to use drugs, were other initial reasons. The most frequently reported reasons, associated with initial sex work, included the need to purchase drugs and financial problems. The study findings demonstrated a number of reasons associated with initial drug use and sex work. The role of sex work in providing drugs necessitates education and prevention. Special treatment programs should be implemented to prevent sex work among at-risk women in Iran.

Female drug users are more likely to transmit human immunodeficiency virus (HIV) to their sexual partners. Little is known about HIV, sexually transmitted diseases (STDs), cervicitis, and drug abuse among female sex workers in Iran. Therefore, this study was conducted at a drop-in center (DIC) in Iran to investigate the prevalence of HIV associated risk factors, the prevalence of drug use, high-risk sexual behaviors, and the relationship between the associated factors in women.Patients and This quantitative cross-sectional study was conducted on 190 female sex workers (SW) in a DIC in Sari, Mazandaran, Northern Iran, in January and February 2014. The study sample was selected through census sampling. In the end, 190 female SWs referring to the DIC participated in our study. There was no limitation in sampling. The self-administered questionnaire was completed via an interview. The results showed that 39% of the female SWs were less than 30 years old and 64% had elementary school education. In addition, 59% of the participants took some type of illegal drugs and 1.1% of them were reportedly injecting drug users. Moreover, 43% of them had substance dependent husbands, and 39% were reportedly regular condom users. They had 1 - 10 sexual partners on average per week. The overall prevalence of HIV infection was 4%. A significant relationship was found between the type of drugs used and factors such as having a substance dependent husband, use of condom during the last sexual contact, regular condom use, and the number of sexual acts per week. A significant correlation exists between using psychiatric drugs and factors like regular condom use, education, cervicitis, and the number of sexual conducts per week. Female sex workers often engage in sex for financial reasons and are at high risk of drug abuse, HIV, and cervicitis. In addition, the rate of cervicitis among females with high-risk sexual behavior is considerable in Mazandaran, Iran. Therefore, the state authorities should provide sex workers with health care services and help them acquire a good job to support their life.

Patients’ characteristics influence the disorders outcome, so it is valuable to compare mood disorders and inpatients’ attributes in different large samples. This study was designed to assess demographic and diagnostic characteristics of 3000 Iranian inpatient with bipolar disorders.Patients and We collected the information of demographic, clinical, and therapeutic characteristics of the patients who were hospitalized in Iran Hospital of Psychiatry, a university affiliated hospital in Tehran, during the 5 years from 2006 to 2011. About 66.1% of the subjects were males and 33.9% were females. Iranian patients are characterized by a higher rate of unemployment, being more single, having health insurance and lower rate of divorce and education compared to the other clinical samples. In the majority of the patients, the disorder had begun with manic phase. Clinical and therapeutic features of Iranian patients are different from patients in western countries.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder, which has been shown to affect 2 - 3.5% of people, during their lifetimes. Identification of familial more homogenous characteristics of OCD may help to define relevant subtypes and increase the power of genetic and neurobiological studies of OCD. This case report describes an adult woman suffering from symptoms of energy loss, insomnia, lack of appetite, and depressed mood. The patient history was positive for counting coercion. The patient’s genogram revealed counting coercion in three generations of her family. This case highlights the issue whether counting can be a distinctive feature among inflicted and not inflicted individuals, such as hoarding. Also, it is still unclear what is it really transferred; the vulnerability to disease, which is transferred among three generations, or the symptoms of counting itself, by genes. Further studies are required to answer the debates on this issue.