Iranian Journal of Psychiatry and Behavioral Sciences
Volume:12 Issue: 3, Sep 2018

Context: High levels of worries and stress in pregnancy result in negative pregnancy outcomes and postnatal depression. Despite recommendations for routine psychological evaluation of pregnant women, there is a lack of scales specifically designed to measure stress during pregnancy. Evidence Acquisition: PubMed, Medline, Scopus, ISI Web of Knowledge, ScienceDirect, PsycINFO, and Google Scholar databases were searched for English articles published during 1983 - 2016. The consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was used for assessing the methodological quality of the studies. A total of 27 studies were included, and 27 different instruments were identified. Validity and reliability assessments were performed in all the papers. According to the COSMIN checklist, the overall quality of the papers was fair to excellent. Among all the instruments, the pregnancy worries and stress questionnaire (PWSQ) and pregnancy-related anxiety questionnaire (PRAQ) showed moderate to strong evidence in most of the evaluated measurement properties. A few scales with acceptable theoretical and psychometric properties are available for the measurement of pregnancy worries. General tools previously adopted to assess worries and stress in pregnancy need further psychometric testing to confirm their reliability and suitability for the prenatal period. The results of this study indicated that while none of the evaluated tools was completely suitable for the assessment of worries and stress in pregnancy, the PWSQ and PRAQ showed moderate to strong evidence in most of the examined measurement properties.

Context: Depression is a common problem during pregnancy. Depression has several adverse effects on the mother and infant. Evidence Acquisition: The present study was conducted to investigate the prevalence of depression in pregnant women in Iran. This study was performed based on the Preferred Reporting Items for systematic reviews and meta-analyses (PRISMA) guidelines. We searched the literature in the national and international databases, including Magiran, Barakat knowledge network system, SID, RICST, Iranian National Library, IranDoc, Scopus, PubMed, Elsevier (Science Direct, Embase, and Scopus), Web of Science (ISI), and Google Scholar using Persian and English (MeSH) keywords. Cochran’s Q test and I2 index were used to assess the heterogeneity between studies. A random-effects model was used to estimate the pooled prevalence using comparative meta-analysis software ver. 2. Forty studies containing 15,870 Iranian pregnant women were included in the Meta-analysis. The heterogeneity of the studies was estimated to be high (I2 = 99.70%, P < 0.001). The prevalence of depression was estimated to be 41.22% (95% CI: 33.88 - 48.96). The prevalence of mild, moderate, and severe depression was estimated to be 23.71% (95% CI: 16.39 - 33.01), 10.67% (95% CI: 7.02 - 15.98), and 4.30% (95% CI: 2.33 - 7.80), respectively. The lowest and highest depression prevalence was estimated in the West of Iran (34.41% [95% CI: 17.38 - 56.67]) and the South of Iran (51.69% [95% CI: 37.32 - 65.78]), respectively, and the test result for subgroup analysis was not significant (P = 0.60). Based on the subgroup analysis, the prevalence of depression in the first, second, and third trimester of pregnancy was estimated to be 50.52% (95% CI: 39.91 - 61.08), 44.96% (95% CI: 26.92 - 64.42), and 48.33% (95% CI: 36.64 - 60.20), respectively, and the test result for subgroup analysis was not significant (P = 0.11). Most of the studies (57.5%) used the Beck’s questionnaire to survey the prevalence of depression in pregnant Iranian women and the prevalence of depression according to this questionnaire was estimated to be 45.84% (95% CI: 35.47 - 56.60). According to the high prevalence of depression in pregnant Iranian woman, identification and treatment of depression during pregnancy seem essential. Thus, program designing and implementation are recommended for improving the psychological health of pregnant women.

Cyberbullying is any kind of intentional harassment with the intent to harm others that is carried out via smartphones, the internet, and digital technologies. Emotional intelligence (EQ) and the ability to understand emotions play major roles in the emotional and social development of children. There may be a relationship between the roles of victim, bully, and bystanders in cyberbullying and EQ. This study aims to examine the prevalence of cyberbullying through new communication technology among high school students and the relation of EQ to the different roles assumed by the individuals involved in a cyberbullying event. In this study, 505 junior high school students who were in the 11th grade in Tehran (the capital city of Iran) in 2013 - 2014 were randomly selected. Their personal demographic data was collected using a demographic questionnaire. Their EQ was evaluated by a Bar-On questionnaire. To assess cyberbullying and the different roles of the participants, a self-designed questionnaire was used. Statistical analyses were conducted using SPSS statistical software, version 18 (SPSS Inc., Chicago, Illinois, USA). A P value less than 0.05 was considered to be statistically significant. To compare between groups, the chi-squared test (or Fisher’s exact test), the analysis of variance (ANOVA), the Kruskal-Wallis non-parametric ANOVA, and the Mann-Whitney U test were used. The total number of participants was 505. This included 293 boys (58%) and 212 girls (42%). In general, 34.2% of the participants were reported to be victims, 46% were bystanders, 27.3% were bullies, and 34% did not experience cyberbullying at all. The study showed that 26.6% of males were victims vis-à-vis 44.8% of females (P < 0.05), while 31.8% of males were bullies vis-à-vis 22.2% of females (P < 0.05). There was no significant relationship between the total EQ score of the individuals and the different roles they assumed in cyberbullying. But in a gender-stratified analysis, male victims had a higher EQ score. This study showed that the rate of cyberbullying was high among high school students in Tehran. In contrast to traditional bullying, the EQ score is not associated with playing different roles in cyberbullying. However, when considering gender, the male victims had higher EQ scores.

Diabetes mellitus is a medical disorder running a chronic course and often co-morbid with depressive disorders. Many physicians do not consider the presence of depressive symptoms per se to be adequate reason for further workup unless they are severe (e.g. suicidal thoughts). We aimed to assess depression in adult patients suffering from diabetes mellitus, to study the socio-demographic data associated with depression in patients suffering from diabetes mellitus, and to assess glycemic control in patients with and without co-morbid depression suffering from diabetes mellitus. This is a cross-sectional hospital-based study. The sample of the study comprised 100 outpatients with diabetes mellitus of either type-1 or type-2. After a semi-structured clinical interview, all patients were administered with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and Becks depression inventory-II. The Chi-square test was utilized for testing the association between variables. To examine the difference between the two or three variables, the Mann-Whitney U test and the Kruskal-Wallis test were used. Among the individuals recruited for the study, 72% had depression and 28% were not affected by depression. The results showed there was a positive correlation between glycemic control, the presence of complications, the type, and duration of diabetes mellitus and depression. The results clearly indicated a high rate of occurrence of depression in diabetes mellitus. Patients with a long duration of diabetes mellitus, poor glycemic control, and the presence of complications of diabetes mellitus were more likely to be severely depressed.

The women harassment at work is one of the examples of violence against them, which requires the attention of the society and politicians. The purpose of this study is to investigate and describe the women harassment in Iranian workplace. A qualitative design was used based on a content analysis approach to reach this study aim. 20 women who were worked in different places in Tehran, Iran, semi-structured interviews were carried out to gather data. From the data of this study, 52 cods and 9 sub category and 3 main themes were extracted. Three main themes emerged including “The perceived harassment by women”, “gender discrimination”, and “harassment facilitators”. According to the results of this study, the experience of harassment at the workplace occurs in a context where power relations between women and men are unequal. On the other hand, women believe their lifestyle is affecting the harassment. Female harassment brings many problems to them, including reducing self-esteem and reducing workplace performance. So, paying attention to this issue and more monitoring in work environments can partly reduce this issue.

To validate the Persian version of the “quality of life scale” (QLS) in assessing the quality of life of patients with schizophrenia. Clinically stable outpatients with schizophrenia referred to Roozbeh hospital, Tehran University of Medical Sciences, as well as 75 healthy participants from September 2016 to March 2017 were enrolled. The QLS was translated following the WHO guidance. To evaluate the face and content validity, a group of experts were gathered to examine the conceptual structure, translation, and back-translation. To evaluate the convergent and discriminant validity, the world health organization quality of life-bref (WHOQOL-BREF), and the global assessment of functioning (GAF) were administered to 85 patients with schizophrenia and 75 healthy controls. To evaluate inter-rater reliability, two independent raters simultaneously assessed 52 patients. Content validity index regarding relevance and clarity were 0.91 and 0.97, respectively. The discriminant validity assessment comparing the scores of the patients and the control group showed significant differences in all domains. The QLS scores had a positive correlation with GAF scores. No significant correlation was observed between the QLS and the WHOQOL-BREF domain scores among patients. Across different categories, Cronbach's alphas were 0.90 for the interpersonal relations, 0.43 for the instrumental role, 0.95 for intrapsychic foundations, and 0.86 for the common objects and activities. The intra-class correlation (ICC) coefficients were more than 0.98 within all four domains. The Persian version of the QLS possesses desirable validity and reliability indices. The scale seems to measure disease-specific aspects of quality of life when compared with more generic and self-rating instruments such as the WHOQOL-BREF.

A group of patients with depression do not show proper treatment response to merely biological interventions. The aim of this study was to investigate the effectiveness of add on acceptance and commitment treatment (ACT) and brief behavioral activation therapy for depression (BATD) to pharmacotherapy in treatment-resistant depression (TRD). The study was conducted in Sari and Babol (North of Iran), during year 2016. In this study, the method of multiple baseline was used. Twelve patients, including eight females and four males, having level 2 European staging model, were randomly selected and entered the study after an interview by a psychiatrist and conducting SCID-I -SCID-II and checking the inclusion and exclusion criteria. They were randomly entered in 12 sessions of ACT or BATD. The data obtained were analyzed through the method of visual outline, reliable change index (RCI), effect size, and improvement percentage formula. The results of this study showed that the ACT and BATD were useful for improving treatment targets. These results were statistically significant according to the RCI index. The earned effect size varied from 1 to 3.33. The results of this study provided greater evidence for ACT and BADT. Also, the present study supports the role of trans-diagnostic approaches as an add on to in TRD.

Chronic abuse of methamphetamine and morphine may result in cognitive impairment with negative consequences for patients’ treatment and rehabilitation. We applied Conner’s CPT II (continuous performance test) to determine the effect of methamphetamine and morphine use on patient performance in terms of type of substance use. The research was performed at the Tehran University of Medical Sciences, Iran, during the autumn and winter of 2014. Twenty-two male patients previously dependent on morphine, twenty-one former methamphetamine abusers, and nineteen healthy controls were assessed by Conner’s CPT II. The patients groups were pure consumers of their drug of choice in the last six months before treatment, and were in their abstinence period without intoxication or withdrawal symptoms. Initially, the potential depression and anxiety levels of volunteers were evaluated with the Hamilton questionnaire, and then a computerized CPT test was performed. Omission errors (P = 0.008) and variability (P = 0.02) in the methamphetamine group and variability in ex-morphine users were significantly higher in comparison with healthy controls (P = 0.004). Significant differences in CPT performance were observed between the methamphetamine group and the healthy control group.

Decision-making and its processes are the most important and most advanced levels of human cognitive abilities. This study aimed to develop and validate a task-based decision-making tool. After constructing the computer-based decision-making task, 232 individuals with high and low impulse disorders were selected using cluster analysis based on the scores of impulsivity and sensation seeking. In the next step, the task-based decision-making tool was performed individually on the participants. In order to determine the psychometric properties of the task-based decision-making tool, the validity of this tool was investigated by comparing the groups with high and low impulse disorders in the dimensions of decision-making, and criterion validity was investigated with impulsivity and sensation seeking scale, self-responsibility, and decision-making styles. The results of the comparison of individuals with impulse disorder represented the optimal discriminant validity of the task-based decision-making tool. The criterion validity with other measures indicated the good convergence and divergence validity of the tool. Overall, the findings suggested the task-based decision-making tool had good psychometric properties to be used in studies of assessing the overall decision-making.

Social cognitive theory is a suitable model that examines many factors associated with physical activity. Despite the importance of this issue, there is no evidence of a specific questionnaire for assessing physical activity in Iranian women. This article reports the development and psychometric evaluation process of a physical activity questionnaire among Iranian women. In 2016, this psychometric study was carried out on 400 women aged less than 50 years old from 10 health centers recruited by clustering sampling in Isfahan. After reviewing numerous texts, a questionnaire was developed and necessary reforms, in accordance with the principles of translation and cultural adaptation, were applied in a research committee. Then, content validity confirmed by an expert panel as well as face validity was evaluated in a pilot study. Construct validity was conducted using exploratory and confirmatory factor analysis. Reliability was also measured using Cronbach’s alpha coefficient and internal consistency method. Scales used in this study included self-efficacy, outcome expectations, social support, and self-regulation. Internal consistency was found 0.90. In the exploratory factor analysis, four-factor models with a total variance of 80.9% were identified (P < 0.001). The CFA results (CMIN = 276/874, DF = 166, P < 0.001, CFI = 0.967, RMSEA = 0.061) represent the suitability and acceptability of a model based on social cognitive theory. Due to good values of validity and reliability, the questionnaire was developed based on social cognitive theory, its use is recommended to assess physical activity in Iranian women.

Depression is a major health problem in old age that is closely related to cultural and social contexts. Studies have shown a higher prevalence of geriatric depression in Iran. This qualitative content analysis study aimed to explore the psychosocial factors related to the experience of late life depression in older people in Iran. This qualitative study with a directed content analysis approach was conducted in Tehran in 2015. First, a systematic search in major English and Persian data banks was carried out to develop an analysis matrix. The participants with maximum variations in demographic characteristics were recruited from psychiatric clinics, if they met inclusion criteria, which included: 1) age of 60 years and, and 2) diagnosis above of depression by a psychiatrist in the last six months. Semi-structured interviews were conducted up to reaching data saturation. The interviews were recorded, transcribed verbatim and transformed into meaning units and codes. The codes were then analyzing matrix and reviewed again to form new subcategories and categories. Twelve old people participated in this study. Analyzing the data, 534 codes in 42 subcategories and 17categories led to six main themes which included: 1) transition of value system, 2) role changes, 3) life concerns, 4) inadequacy of social relations, 5) regrets, and 6) impaired health and function. From the perspective of the depressed old people, recent changes in values and impaired social relations, made them feel lonely confronting life struggles and inevitable changes of roles, health status and function. Some context-based interventions such as community alertness and providing more formal support may be helpful in preventing late life depression.

Fear of contamination is one of the complex and powerful fears and is often seen in contamination/washing obsessive-compulsive disorder. Earlier researches have shown that this disorder is related to mental contamination and recent research showed that individuals with the fear of contamination are prone to experiencing disgust. This study aimed to investigate the mediating role of mental contamination between disgust propensity and fear of contamination. The sample consisted of 391 students of Shahed University in Tehran city, Iran. The participants were selected by cluster sampling in November and December in 2015. The tools used were Disgust Propensity and Sensitivity Scale-Revised (DPSS-R), Vancouver Obsessional Compulsive Inventory-Mental Contamination Scale (VOCI-MC), and Padua Inventory (PI). The proposed model was examined by Structural Equation Modeling Modeling (SEM), using Amos-22 software. Baron and Kenny as well as bootstrap methods were used for the analysis of the role of mental contamination as a mediator in this relationship. Goodness of fit indexes indicated that the proposed model had a good fit (GFI = 0.92, AGFI = 0.90, TLI = 0.93, CFI = 0.94 (all > 0.90), and RMSEA = 0.04 (CI (90%) = 0.04-.05). The results showed that disgust propensity caused the fear of contamination both directly (β = 0.35; SE = 0.05) and indirectly (β = 0.16; SE = 0.03) through mental contamination. The findings provided support for the proposed model and showed that disgust propensity played a role in increasing mental contamination which, in turn, leads to fear of contamination. As a result, it would seem that the assessment of disgust propensity and mental contamination is essential to treating the fear of contamination and washing behavior.

Cognitive-behavioral approach has been used to overcome many problems among pregnant women such as fear and anxiety, self-efficacy improvement, depression during pregnancy and after childbirth, traumatic childbirth, as well as stress management. The aim of this study was to determine the effect of cognitive-behavioral group counseling approach on self-efficacy on the choice of a normal vaginal delivery. In this randomized clinical trial study, 60 nulliparous pregnant women who had not chosen their method of delivery were randomly assigned into two intervention and control groups. The intervention group received three two-hour sessions of cognitive-behavioral group counseling between the 29 and 34 weeks of pregnancy, with weekly intervals. The control group received routine care provided in the health system. Before the intervention, immediately after the end of counseling and in the last month of pregnancy, self-efficacy questionnaire, with two dimensions of expected outcomes, as well as expected self-efficacy and sources of self-efficacy (outcome of past experiences of mastering a specific situation, vicarious experience provided by others, social persuasion and physiological and affective state (fear and anxiety)) were completed with the help of a collaborating midwife. The collected data were analyzed using a mixed analysis of variance. The results showed that after the intervention, 76.6% of mothers in the intervention group chose a normal vaginal delivery, however, there was no firm choice in the control group. There was a significant difference between the mean scores of expected outcome and expected self-efficacy of two groups immediately after and in the last month of the pregnancy; the difference increased with the passage of time. Cognitive-behavioral group counseling during prenatal care can reduce fear and anxiety and increase self-efficacy of nulliparous pregnant women in choosing normal vaginal delivery, which can ultimately reduce the amount of selective caesarean section.

In a revision on the measurement of the implicit theories of intelligence, the Self-Theory Scale is suggested. The main purpose of the present study was to examine reliability and validity of the Persian version of the Revised Implicit Theories of Intelligence (Self-Theory) scale in a sample of Iranian high school students. A sample of 450 unpaid students (255 females and 255 males), aged between 14 and 18 years old (16.73 ± 0.81 years) in the academic year of 2015 to 2016, were selected through multi-stage clustered sampling from the city of Ray, Iran. All participants were asked to complete a demographic form, the Revised Implicit Theories of Intelligence Scale, and the Implicit Theories of Intelligence Scale (ITIS). The findings from confirmatory factor analysis confirmed the factor structure of the Persian version of the Revised Implicit Theories of Intelligence Scale. The convergent validity of the scale was supported by an expected pattern of correlations between the Revised Scale and the ITIS (P < 0.05). The obtained internal consistency coefficients (Cronbach’s α) were reasonable. The results suggest that the Persian version of the Revised Implicit Theories of Intelligence (Self-Theory) Scale is a reliable and valid measure in high school students.

Obsessive-compulsive personality disorder (OCPD) is the most common personality disorder in the general population, with prominent features of inflexibility, excessive attention to details, extreme perfectionism, and excessive self-control and interpersonal control. This study aimed at assessing the experiences of daughters living with OCPD fathers. Fifteen daughters of fathers with obsessive-compulsive personality disorder were selected by purposive sampling method and were subjected to semi-structured in-depth interviews. Interviews were analyzed using qualitative content analysis. Analysis led to emergence of 17 subcategories and three main categories, which included experiences of negative emotions, disorientation, and fear. Children of these patients were found to be under severe mental pressure, requiring serious attention, and interventions as preventive measures.

The lack of couples’ intimacy is one of the main concerns of experts in the field of psychology and counseling. It is one of the most important causes of divorce. The 9th principle of International conference on population and development (ICPD) highlights the support of the family as the main unit of the society. The study aimed to determine the socio-demographic predictors of marital intimacy in couples. This was a cross-sectional study conducted on 118 couples referring to healthcare settings. A random sampling method was used to recruit the couples. Data were collected using the socio-demographic questionnaire, the Bagarozzi’s marital intimacy needs questionnaire, Barton’s communication skills questionnaire, the Hazan and Shaver’s adult attachment styles (1678) questionnaire, and the interpersonal conflict management style (ICMSI). The collected data were analyzed using inferential and descriptive statistics. A statistically significant positive correlation was found in the mean of marital intimacy between men and women. The predictors of marital intimacy in men were the attachment style and communication skills. The predictors of marital intimacy in women were marital satisfaction, communication skills, and conflict resolution styles. Future interventions to improve marital intimacy in couples should consider the following factors: marital satisfaction, marital conflicts, duration of the marriage, communication skills, conflict resolution styles, and the attachment style. It is noted that counselors should attempt to provide appropriate care for couples with the consideration of the above-mentioned factors influencing their interactions and behaviors.

Concomitant mental disorders may worsen the clinical conditions of patients with diabetes by affecting the quality of self-care regimens and treatment compliance. The aim of this study was to assess the relationship between obsessive-compulsive symptoms and glycemic control in patients under diabetes treatment. In this cross-sectional study, 390 adult patients with type I and II diabetes were recruited. The patients were interviewed using the Yale-Brown obsessive-compulsive scale to evaluate the existence of obsessive-compulsive symptoms and their type and severity. In order to measure the quality of glycemic control, patients were evaluated for average glucose levels over the past two to three months, using HbA1c. HbA1c of more than seven was considered as poor glycemic control. Overall, 50.8% of the participants had considerable obsessive-compulsive symptoms. No significant difference was seen between obsessive-compulsive symptoms and age (P = 0.443) or type of diabetes (P = 0.1.7). Obsessive-compulsive symptoms were significantly higher in patients, who had HbA1C levels of more than 7% (P < 0.001). Familial history of diabetes was more frequent in patients with more obsessive-compulsive symptoms (P = 0.016). Regression analysis showed that the chance of being afflicted with obsessive-compulsive symptoms was 2.9 times more in females compared with males, and 5.5 higher in those with HbA1C > 7% than less than 7%. As a preliminary study, this study shows that remarkable obsessive-compulsive symptoms in patients with diabetes may be associated with poor glycemic control and there is a relationship between glycemic control and obsessive-compulsive symptoms, which may be more complex than a simple mental reaction to a chronic stressful disease.

Insomnia and emotional disorders share common factors that underlie and perpetuate these disorders. The Unified Protocol (UP) for transdiagnostic treatment of emotional disorders is a new treatment approach designed to target core processes of emotional disorders. The present study examined the effects of UP on behavioral inhibition/behavioral activation, anxiety sensitivity, and emotion dysregulation as transdiagnostic factors, as well as cognition and behaviors specific to insomnia, in a small sample of patients (N = 6) with comorbid insomnia and emotional disorders. A multiple-baseline across subjects single-case experimental design with a 3-month follow-up was used. Participants were allocated to 2, 4, and 6 baseline periods and then received 14 weekly individual sessions of UP. The outcome measures were Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS), Anxiety Sensitivity Index-3 (ASI-3), Difficulties in Emotion Regulation Scale (DERS), Dysfunctional Beliefs and Attitudes about Sleep Scale-10 (DBAS-10), and Sleep-Related Behaviors Questionnaire (SRBQ). Data were analyzed using visual inspection, mixed model analysis, and reliable change index (RCI). Mixed model analysis showed significant changes in BIS/BAS, ASI-3, DERS, DBAS-10, and SRBQ from pre-treatment to post-treatment. Most participants achieved a reliable change in BIS, ASI-3, DERS, DBAS-10, and SRBQ at a 3-month follow-up. This preliminary study provides empirical evidence on the utility of UP for reducing common vulnerability and sleep-specific factors in chronic insomnia comorbid with emotional disorders. Further research is needed to test these findings in randomized controlled studies.

The current study aimed at investigating the relationships among three variables of sport attributional style, sport self-efficacy, and creativity to provide a theoretical model of relationships between these variables in elite team athletes based on the structural equation modeling. Providing theoretical model of relationships between sport attributional styles, sport self-efficacy, and creativity in elite team athletes using structural equation modeling. The statistical population consisted of 2853 elite team athletes. Out of the population, 192 elite team athletes were randomly selected as the sample from different sport clubs in Tehran, Iran, in 2014. The sport-confident questionnaire, sport attributional style scale, and the creativity questionnaire were employed to collect the data. Then, AMOS version 23 was used to apply structural equation modeling. The measurement and structural models (after success, after failure) of elite team athletes well fitted the data. Standard coefficients of all components and indices (questions) were significant (P < 0.05), except for direct coefficients between sport attributional style and creativity (P = 0.297 after success and P = 0.640 after failure). The current study results showed a positive significant relationship between sport self-efficacy and sport attributional styles. Moreover, sport self-efficacy had a mediating role between sport attributional styles and creativity. Thus, identifying structural relationships between these variables was of great benefit to promote athletes’ mental health.

A negative attitude toward treatment is a major obstacle to treat bipolar disorder. The current study aimed at assessing the reliability and validity of Persian version of drug attitude inventory (DAI-10) in patients with bipolar I disorder and finding its relationship with patients’ compliance in order to predict the disorder. To assess test-retest reliability, 30 outpatients with bipolar I disorder were selected. They were asked to answer the questions at the onset of the study and four to ten days later. Then, the relationship between DAI-10 scores of 82 patients in bipolar disorder patients’ follow-up (BDPF) study, and medication possession ratio (MPR) were investigated. The patients were divided into poor and good compliance, and cut off point of the tool was assigned. Positive and negative predictive value of DAI score was also calculated. Test-retest reliability was 0.805 and Cronbach’s α 0.787. Concurrent validity between DAI-10 score and that of the MPR at the study time was 0.676, and positive predictive value of DAI-10 score for medication compliance at assessment time was about 88.9%. Predictive validity of DAI-10 score for next six months was about 0.663 and cut off point +1, with the specificity of 81.5% and sensitivity of 89.1%; the positive predictive value of questionnaire score for medication compliance was 90.7%. The Spearman correlation coefficient between the two tests was 0.822 (95% confidence interval (CI): 0.652 - 0.901). DAI-10 is a reliable and valid tool to identify attitude of patients with bipolar disorder type I towards treatment with medications.

War-induced Post-Traumatic Stress Disorder (PTSD) and its complications can be passed on to patients’ family members. This study aims to investigate PTSD symptoms and sleep quality among chronic PTSD patients and their wives. PTSD symptoms were evaluated among 14 veterans with chronic PTSD and their wives by the PTSD checklist - Military version (PCL-M). Objective and subjective sleep data were collected by actigraphy and Pittsburgh Sleep Quality Index (PSQI), respectively. Data was analyzed using t - tests, χ2, and Pearson or Spearman correlation coefficient by SPSS software version 16. According to PCL-M, seven wives were diagnosed with PTSD while others reported high PCL scores. Total PCL-M scores did not differ significantly between veterans and wives: there was, instead, a significantly positive correlation between these two groups (r = 0.563; P = 0.036). Veterans with PTSD reported significantly poorer sleep quality compared to their wives on the PSQI (P < 0.05), however, not in the actigraphy. Veterans’ PSQI and actigraphy sleep indices differed significantly (P < 0.01). Subjective sleep latency (41.79 ± 29.65) was significantly higher than objective (11.38 ± 28.64) among wives (P < 0.01). A significant positive correlation was observed between the two groups’ subjective sleep efficiency (r = 0.569; P = 0.03) and between PTSD severity and PSQI total scores (r = 0.53; P < 0.01). The wives of persons with PTSD indicated some degree of PTSD. Veterans with PTSD reported poorer sleep quality than their wives. PTSD can negatively influence sleep quality.

Spouse-related abuse involves a wide range of behaviors by the partner and has many debilitating consequences for the victim, such as suicide attempt. The aim of this study was to predict the effect of resilience and stress coping styles on the likelihood of suicide attempt in females reporting spouse-related abuse. The present descriptive comparative study was conducted on 150 female victims of spouse-related abuse in the city of Ilam, Iran, during year 2016. They were matched in two groups with and without a history of suicide attempt over the past 12 months. Data collection tools included the world health organization violence against women instrument, the connor-davidson resilience scale, and the coping inventory for stressful situations. Purposive and snowball methods were used. The obtained data was analyzed using the SPSS-21 software. No significant differences were observed between the two groups in terms of the frequency and severity of exposure to different forms of violence. The mean scores of resilience (P < 0.001; -13.03 to -6.34) and problem-oriented coping style (P = 0.004, -7.65 to -1.46) were significantly higher in females without a history of suicide attempt compared to the other group. For every unit increase in the resilience score, the likelihood of not attempting suicide increased by 1.134, and for every unit increase in the avoidance style score, the likelihood of not attempting suicide decreased by 0.931. This effect remained significant with the addition of demographic variables. A high level of resilience and the use of problem-oriented coping have a major role in reducing the likelihood of suicide attempt in females subjected to violence. Introducing couples to coping strategies, problem solving, and anger management is an integral part of life skills education.

The migraine headache is one of the common chronic pains. Recent psychopathological approaches emphasized more on acceptance than the control of pain. Psychological inflexibility in pain scale (PIPS) is a tool to assess pain acceptance. The current study aimed at evaluating the psychometric properties of PIPS. The study sample comprised of 250 individuals with migraine headache. They were selected from patients admitted to neurological ward of Shahid Beheshti Hospital and private neurology clinics in Kashan, Iran in summer 2015. After preparation of the PIPS (translation and back-translation), participants completed the PIPS and chronic pain acceptance questionnaire (CPAQ). The factor structure and correlation of PIPS with CPAQ were examined. The results of exploratory factor analysis (EFA) showed two factors of pain avoidance (10 items) and cognitive fusion factor (six items) for this scale. The confirmatory factor analysis (CFA) confirmed the obtained model in comparison with the original model (group factor analysis (GFA), CFA, and the Tucker-Lewis index (TLI) ≥ 0.90; the root mean square error of approximation (RMSEA) 90% confidence interval (CI) = 0.03 - 0.06). Also, the convergent validity of this scale was confirmed with CPAQ (r =.66, P < 0.001). The reliability of the scale by internal consistency and test-retest method was good. The Persian version of PIPS has appropriate psychometric features in Iranian society and it can be used to measure this characteristic.

Depression and anxiety have been associated with type 2 diabetes in studies predominantly in high-income countries, but little is known about this association in Southeast Asia. The objective of this study was to investigate the prevalence of major depressive disorder (MDD), generalized anxiety disorders (GAD), and metabolic syndrome (MetS) and the relationship between these variables in Nakhon Pathom province in Thailand. A cross-sectional sample of temple members (35 - 65 years) from 12 randomly selected Buddhist temples in Nakhon Pathom province participated in the study in 2016. MetS components were assessed using blood chemistry and anthropometric measurements. MDD and GAD were assessed with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized anxiety disorder 7-item (GAD-7) scale, respectively. Logistic and linear regression was used to determine associations between MDD, GAD, and MetS. Of the 401 participants, 144 (35.9%) fulfilled MetS criteria. 61 (15.2%) participants screened positive for MDD and 25 (6.2%) for GAD. The prevalence of MDD (Odds Ratio, OR = 1.55, Confidence Interval, CI = 0.81-2.95) and GAD (OR = 1.20, CI = 0.53 - 2.75) was higher among participants with MetS than among those without MetS, but this was not significant. There are no significant relationships between MDD, GAD, and MetS among the Buddhist temples population in Nakhon Pathom in Thailand.

Fecal impaction (FI) is a disorder characterized by the inability to evacuate large mass of compacted faces at any level of lower GI tract. The population with highest risk for FI includes elderly patients with neuropsychiatric disorders such as Alzheimer disease, schizophrenia, Parkinson disease, dementia, and severe stroke. Clozapine is an antipsychotic drug that can cause constipation and in some cases, progress to bowel obstruction and finally FI. Opium is a well-known etiology for constipation and its’ concomitant use with clozapine can have an additive effect on this complication. We present a 63-year-old man who had been treated for schizophrenia with clozapine (100 mg/TDS for 30 years) and who was using opium for about 20 years. This patient was presented with a history of constipation for 4 weeks, characterized by lack of urge to defecate as well as hard stool. We used a combination of normal saline and glycerin in our patient. In this case, successful therapy was focused on keeping the mechanical balance of colon, to clear out FI. We concluded that in patients who take opioids or with a history of psychotic disorders who had been treated with antipsychotic drugs, especially low-potency, first generation antipsychotics and clozapine presenting with abdominal pain and constipation should raise immediate concern.

Angioedema is a serious reaction characterized by edema of the deep dermal and subcutaneous tissues. A 38-year-old woman was admitted to Ibn-e-Sina psychiatric hospital (Mashhad, Iran) in 2010, with amphetamine-induced mood disorder with onset during intoxication. She began taking sodium valproate, and later, risperidone treatment was started. On the 9th day of risperidone treatment, drug-induced angioedema occurred. Laboratory tests showed an elevated erythrocyte sedimentation rate and elevated C-reactive protein, with normal C3, C4, and C1 esterase inhibitor concentrations. The risperidone treatment was discontinued, and only hydroxyzine and a low dose of hydrocortisone were prescribed. The edema resolved completely within 4 days.

Neuroleptic malignant syndrome (NMS) is a rare and unpredictable adverse reaction associated with the use of first-generation and second-generation antipsychotics. Atypical antipsychotics may create atypical forms of NMS due to their different pharmacological characteristics. Decreased dopaminergic tone in the brain is coincided with a dysregulation of autonomic nervous system in this syndrome. This paper reports on an NMS case, in which current views and symptoms that occurred during the course of the disease were rare symptoms that are not usually found in NMS. The patient was a 43-year-old male with schizoaffective disorder under treatment with clozapine and risperidone. He had lead pipe muscle rigidity, stupor, fever and autonomic dysfunction, increased levels of creatinine phosphokinase, leukocytosis, and microglobulina. Levenson’s criteria is widely accepted for diagnosis of NMS. Six days after admission to the psychosomatic ward, the patient had ileus. Due to lack of response to neomycin and GI rest and embedding NG tube, the patient underwent therapeutic sigmoidoscopy and colonoscopy for decompression. Diagnosis of NMS is largely based on clinical history and the presence of specific clinical symptoms. Antipsychotics polypharmacy increases the NMS risk. Mechanisms underlying the development of ileus in the patient are speculative and multifactorial. Paralytic ileus can be one of the autonomic dysfunctions in NMS. Furthermore, NMS is categorized in differential diagnosis of acute abdomen caused by the pseudo-obstruction. All physicians should be aware of this possibility when faced with patients under treatment with neuroleptics.