فهرست مطالب عباس مسعودزاده

Accompanying sleep disorders such as insomnia, delayed sleep, and wakefulness, as well as anxiety and depression with obsessive-compulsive disorder, are common in patients with OCD. However, not much research has been done on the relationship between sleep disorders and the severity of symptoms in patients with OCD. This article examines the frequency and relationship between sleep disorders, depression, anxiety, and the severity of obsessive-compulsive symptoms in patients with OCD.

Convenience sampling was used in this cross-sectional research. The participants in the study were those who were referred to the clinic of a psychiatric hospital and the central clinic complex in Sari. Obsessive-compulsive disorder diagnosis of the participants was confirmed by a psychiatrist based on DSM-5 diagnostic criteria. Eighty-eight patients participated in the study after obtaining informed consent. Demographic questionnaires, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), morning-evening questionnaire (MEQ), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), WHO-5 well-being (Depression) Index, and Generalized Anxiety Disorder-7 (GAD-7). Data analysis was done with SPSS version 20 software.

Out of 88 patients, 65 (73.86%) were women 23 (26.14%) were men, 71.59% were married, 57.95% had under diploma degree, and 94.22% had no history of drug use. The average age of the patients was 44.48 ± 11.51 years. The duration of OCD was 11.28±14.60 years In terms of the severity of OCD symptoms, 1.1% was very mild, 19.32% was relatively mild, 42.45% was moderate, and 37.50% was severe. In the type of sleep schedule, 17.03% were inclined to evening or relative evening type. Four patients (4.62%) had daytime sleepiness. Also, 52 patients (61.90%) had some degree of insomnia. In terms of the severity of insomnia, 23.86% were mild, 28.40% were moderate and 6.81% were severe. The frequency of depression was 68% and anxiety was 79%. No statistically significant relationship was found between the severity of obsessive-compulsive disorder and hypersomnia, evening chronotype, anxiety, and depression. But insomnia (P= 0.046) and duration of illness (P= 0.004) were related to it. The Pearson correlation coefficient between age, duration of obsessive-compulsive disorder, and severity of obsessive-compulsive symptoms was 0.169 (P= 0.116) and 0.377 (P=0.001), respectively. Spearman's correlation coefficient between the severity of obsessive-compulsive symptoms with depression and anxiety was 0.090 (P=0.403) and 0.044 (P=0.685), respectively. The average severity of obsessive-compulsive symptoms was 23.48±7.87 in women and 20.04±5.88 in men, and no significant difference was seen in both sexes (P=0.060). In linear regression, the two factors affecting the severity of obsessive-compulsive symptoms were the duration of the illness and the severity of insomnia.

Considering the higher frequency of insomnia in patients with obsessive-compulsive disorder compared to the normal population and its role in the severity of obsessive-compulsive disorder symptoms, it is necessary to examine patients with obsessive-compulsive disorder in terms of insomnia. Also, older OCD patients should be examined more carefully in terms of the severity of obsessive-compulsive symptoms.

Child abuse refers is a wide range of destructive behaviors include not meeting emotional needs, physical punishment, sexual abuse, malnutrition, and neglect of child health. The aim of this study was to determine the status of child abuse and mental health in children of psychiatric patients.

This descriptive cross-sectional study investigates child abuse in the children of patients with psychiatric disorders admitted to Zare Hospital in Sari, Iran in 2020. The questionnaires used in the study were SDQ and the CASRS. All data analysis was performed using SPSS software version 25. Significance level is considered P<0.05.

Patient’s age were 22-61 with mean and SD of 34±6.7 years and children were 12.1±2.6 years. 182(51.9%) children were girls and 169 (48.1%) were boys. The highest frequency of psychiatric disorder in patients was mood disorder 144 (41%), and schizophrenia 127 (36.2%). According to the CASRS scale, the mean and standard deviation of the subscales were 7.0±5.4 for physical abuse, 0.4±0.9 for sexual abuse, 8.5±2.1 for emotional absuse, and 8.8±5.0 for neglect. The scores of the SDQ of a healthy parent and the child themselves had a mean and standard deviation of 15.4±5.8 and 15.8±5.4, respectively.

The results of this study showed that the incidence of child abuse in the children of patients with psychiatric problems is high and this group needs social support as a shield and protective factor against the negative consequences of abuse that can prevent violence cycle and the occurrence of psychological disorders to victims.

Genital warts are one of the most common sexually transmitted infections, 1% of sexually active population have anogenital warts (AGWs). According to previous studies, the disease affects people's quality of life and imposes financial costs on health systems. The present study is a case-control study at spring of 2018. The quality of life of 65 patients with anogenital warts that were referred to Boali-sina Hospital in Sari, Iran compared with 65 control subjects. The World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaires was used. According to the results, among the patients with anogenital warts, the quality of sexual contact in majority them were not affected by the disease (70%). The total cost of treatment was less than the monthly income of the family until the time of participating in the study (92%). There was no significant difference between the mean and standard deviation of physical health scores and mental health scores in the control and patient groups. (Respectively P=0.14, P=0.93). There was no significant relationship between the mean of physical health scores with disease severity. However, there was a significant difference between the mental health score in the two groups of patients with low and high levels of severity (P=0.01). Physical health scores in the whole sample have a significant relationship with gender, so that, in women, physical health score was lower than that of male, but the mean score of mental health in both male and female patients was not significantly different (P=0.18). In the control group the score of mental health was lower in women (P=0.041). In patients with anogenital wart, quality of life doesn’t change significantly, although, mental health scores directly related with disease severity.

Background and

Metabolic syndrome includes a series of risk factors for cardiovascular diseases. The aim of this study was to identify the changes in various indicators of this syndrome during hospitalization in a psychiatric department. Identifying these changes could help in reducing the risk of this syndrome.

A cross-sectional study was conducted in 152 patients with psychiatric disorders who were admitted in Sari Zare Hospital, winter 2016. Fasting blood glucose (FBS), HDL-cholesterol, triglyceride (TG), weight, waist circumference, and blood pressure were recorded at the time of hospital admission and discharge.

Compared to the time of hospital admission, significant changes were seen in waist circumference (p=0.000) and TG (p=0.010) among schizophrenic patients at the time of hospital discharge. In patients with bipolar disorder, significant changes were found in waist circumference, TG, and also HDL at the time of hospital discharge (p= 0.017, 0.004, 0.045). Moreover, we found significant changes in FBS and waist circumference in patients with schizoaffective disorder (p=0.013 and p=0.018, respectively). In patients with substance use, no significant changes were seen in any of the indicators when being discharged from hospital. But patients with brief psychotic disorder showed significant changes only in waist circumference (p=0.005).

Changes in the indicators of metabolic syndrome are much more common than the prevalence of metabolic syndrome. Indicators that are more likely to change during hospitalization and could be used in screening for prevention of metabolic syndrome include waist circumference and TG levels

Since mindfulness may be effective in basic mechanisms of panic disorder, this study aimed to evaluate the effectiveness of mindfulness-based cognitive therapy as an adjunct to drug treatment in patients with panic disorder.
This pre-experimental study included pre-test/post-test control group (waiting list) and follow-up. Thirty panic patients were selected and randomly assigned into experimental and control groups. Both groups had the same type and dose of medication. The experimental group received MBCT and the control group were on a waiting list. The panic belief inventory, Beck Anxiety Inventory, and the Beck Depression Inventory were used to collect the data and then the data were analyzed using covariance analysis.
After treatment, scores of the experimental group patients revealed significant reduction in severity of symptom, anticipatory anxiety, body catastrophizing, emotional catastrophizing and self-discontent subscales of panic disorder (p Therefore, mindfulness-based cognitive therapy, by affecting cognitive mechanisms and components that are involved in panic disorder, can be effective in improvement of patients with panic disorder.

Depression is a possible side effect associated with antiviral therapy for chronic hepatitis B (CHB) and chronic hepatitis C (CHC). The objective of this study was to evaluate the prevalence of depression in patients receiving different anti-viral medications before، during and after treatment. This descriptive cross-sectional study was undertaken on 248 CHB or CHC patients referred to two clinics of Mazandaran University of Medical Sciences between March 2011 and April 2012. Those who received alpha interferon، another antivirus medication or combination of them were evaluated by Hospital Anxiety and Depression Scale (HADS) and clinical psychiatric interview before initiation of the medications، 12 and 24 weeks after the initiation of the treatment and 6 weeks after termination of antiviral therapy. The prevalence of depression in patients with either hepatitis B or C was higher than general population، but similar to each other. During the 12 and 24 week of the antiviral therapy، the prevalence of depression was increased especially in whom were receiving alpha-interferon. Six weeks after the termination of medical therapy، the prevalence of depression in whom received alpha interferon was decreased statistically. However، this event did not happen in the group that did not use interferon. It is suggested that patients receiving alpha-interferon should be psychologically assessed in the course of treatment. Displaying the symptoms of depression، doctors should apply the prophylactic and therapeutic measures as soon as possible.

One of the responsibilities of community education and training، is recognition of stress for parents of deaf children and their impact on children growing up، in this way be able to provide training required for consults and guide them in nurturing their children. This study aims to determine the relationship between parental stress and parenting style، deaf and normal children parents. This research is a applied study، that was done the correlational method. The sample included all students and parents of elementary students in second district of sari education office. The sample size was 3639 person in 1391- 92 academic year. The morgan table was used to select sample. The stratified sampling method was used in sample selection. To data gathering، the researcher used from parenting style questionnaire (PAQ). Bam lind (1373) stress index (PSI)، Abiding (1967) were used. Data collected through questionnaire was analyzed by statistical software SPSS 16 by descriptive and inferential statistical methods. using Pearson correlation test showed a significant negative relationship between parental stress and parenting style authoritarian parents are deaf and normal، because of the significance level α =0. 01). The positive relationship between authoritative parenting style and a is smaller، i. e. (P=0 > parental stress levels parents of deaf children and ordinary negligence is involve، because of the α =0. 01). significance level a is smaller، i. e. (P=0) > In conclusion، to reduce parental stress authoritarian parenting style can be adopted for deaf children and normal.

Background and EEG is used as a diagnostic tool in the diagnosis and prognosis of disease spread. Among the psychiatric illnesses that can utilize EEG to measure response to treatment، schizophrenia can be noted. Many investigations on the application of data EEG as a predictor of treatment response in patients with schizophrenia refractory to clozapine has been done in order to resolve contradictions and the limitations of previous studies. We studied the response to treatment with clozapine، with the PANSS greater number of samples making them prior studies have examined. In a cross-sectional study، 70 patients with schizophrenia resistant to treatment with candidates receiving clozapine were selected from those EEG and PANSS baseline was patient during twelve weeks of treatment with clozapine were again patients PANSS was used and EEG raw patients with a good response to treatment and disease with poor response to treatment were compared with each other. After data collection، descriptive statistics software SPSS17 square test was used for the analysis of EEG data from a linear regression to examine the relationship between the indicators of response to clozapine treatment. The results showed that there is coherence of EEG and the treatment response to clozapine significant correlation was (P= 0. 00). The results showed that there is presence of asymmetry in EEG and the treatment response to clozapine significant correlation was (P= 0. 8). The EEG abnormalities include coherence of EEG in predicting response to treatment in patients with treatment-resistant schizophrenia to clozapine which is effective.

The recent studies showed that the prevalence of psychiatric disorders and Neurological Soft Signs in aggressive persons and murderers are more than general populations. The aim of this study was to determine the frequency of prisoners’ Neurological Soft Signs (NSS) and its association with crime subgroups in Rudsar prison. In a cross sectional study 161 prisoners in Rudsar general prison number 1 and 2 in 2006, were studied. The prisoner demographic characteristics were taken and after matching with prison records regarding NSS, were examined based on NSS checklist. Data were analyzed by SPSS 16 and ANOVA, MCT (Multiple Comparisons Test), Tukey test and Chi Square tests. The maximum frequency of NSS scores was seen in addiction and related offences and misdeed subgroup (P=0.02). The history of previous number of condemnations was higher in addiction and related offences, misdeed and fraud and financial offences subgroups respectively. Also there were not significant differences among subgroups regarding medical, neurological, psychiatric disorders and substances use history (P=0.65). There were significant differences between NSS scores and history of neurological disorders and psychiatric drug abuse (P=0.04). But there were not significant differences between NSS scores and history of medical disorders and substances use (P=0.81). According to results of this study, we cannot state a constant pattern regarding association between NSS scores and different types of crime. Contrary to findings of this study, in the previous studies NSS scores were higher in the group of violent offenses, which may be due to lack of execution in those countries. Therefore, comprehensive studies in this field is recommended.

Background and Both the condition of infertility and its treatment cause stress in couples. ÏN-Vitro Fertilization (ÏVF) is a stressful procedure for patients. Ëvidence has shown that, in addition to biomedical factors (such as age and history of pregnancy), psychological factors are related to the outcome of ÏVF treatment. This cohort study was performed in 2008 on 70 patients (35 patients in case group and 35 patients in control group) that were candidate for ÏVF in two infertility clinics in Sari. Psychiatric assessment of patients was done before Gonadotropine injection for ÏVF by a psychiatrist with standard questionnaires. Ânxiety and depression questionnaires were completed by patients. Based on the results drawn from the questionnaires, the control group was formed from individuals with no anxiety or depression or individuals suffering mild anxiety and depression or either of the them. Ïndividuals suffering moderate to severe anxiety and depression or either of the them were classified as case group. Mean age of patients was 30.25 ± 4.63 year in case group and 30.37 ±4.67 year in control group. Pregnancy rate was 31.42% in case and 54.54% in control group. Relative risk for not becoming pregnant in individuals suffering moderate to severe anxiety and depression was1.5 and Âttributable risk was 33%.Çonclusion: Pregnancy rate in normal individuals or individuals suffering mild anxiety and depression or either of the them, was higher.

Ten thousand people undergo cosmetic surgery of their bodies or faces to making themselves more beautiful each year. The primary aim of such surgeries is to increase the individual's self-esteem and satisfaction due to their new look, which can be a special psychological pattern. The aim in this study is to compare the personality pattern and general health condition of the cosmetic surgery volunteers and the control group.

This was a descriptive study, performed in Zarre Hospital in Iran in 2007. There were 50 subject the experimental group (volunteers for rhinoplasty) and the control group were their family members who matched them in age, gender and educational level but did not intend to undergo rhinoplasty. "NEO-five factor inventory" (NEO-FFI) was used for personality inventory and "General Heath questionnaire (GHQ-28) was used to assess general health status, and the economical status was evaluated through Delphi questionnaire. Data were analyzed with standard t-test and chi-square test.

There were greater openness and extraversion trait but lower neuroticism and agreeableness trait in group the experimental compared to the control group. There were significant differences concerning inventory between the experimental and control groups (P= 0.011). General health condition greater in the experimental group than the control group. However, there were also no differences of economical status between was and control groups.

This study indicated the experimental that high obsession trait and low self-esteem were detected in cosmetic surgery volunteers indeed imbalance in other personality traits were also observed. Therefore, it is more recommend able for the patient to consult a psychiatrist before undergoing cosmetic surgery.

Atypical antipsychotic drugs are first line treatment for psychotic disorders and well tolerated by the patients because of less extra pyramidal side effects and better efficacies. But there are different reports about metabolic dysfunctions that are associated with use of these drugs. So the aim of this study was to compare these side effects among atypical antipsychotic drugs (clozapine, olanzapine, risperidone) and haloperidol.METHODS In this cohort study psychotic patients (according to DSM IV criteria) due to their response to previous treatment regiment or new onset of disorder were received clozapine, olanzapine, risperidone (atypical group) and haloperidol (typical group). Patients who were resistant to other drugs treated with clozapine and bipolar patients received olanzapine. Fasting blood level of glucose, cholesterol and triglyceride of all patients were measured before initiating and six weeks after drug administration.

75 inpatients or out patients with variety of psychotic disorders enrolled the study, as 45 patients were in atypical and 30 in typical drug groups. Two groups were matched by age and sex. The mean level of fasting blood glucose, triglyceride and cholesterol of patients in atypical drug group before treatment was 90.7%±16.2, 144±35.5 and 163±25.1 mg/dl, respectively and in typical group it was 88.6±27, 162.3±38.5 and 164.2±25 mg/dl, respectively. The mean level of fasting blood glucose, triglyceride and cholesterol of patients in atypical drug group after treatment was 94.4±13.1, 168±50.8 and 168.6±33.5 mg/dl, respectively and in typical group was 92.9±27, 175.3±45.9 and 164±26.5 mg/dl, respectively that showed no significant difference.

Antipsychotic drugs (either typical or atypical) didn’t increase fasting blood level of glucose, cholesterol and triglyceride in psychotic patients.

Background and One of the important problems in diagnosis and treatment of psychiatric disorders is its accompaniment with substance abuse. In addition to substance abuse symptoms which are present in all addicts, in psychiatric patients it cause special problems in main diagnosis, slow reaction to therapy and even non effectiveness of the therapy and also poor prognosis.Considering its different prevalence in studies and also considering the point that a similar work has never been done in Iran, this study is designed to find out the abundancy of disorders and pattern and type of substances used by the referred patients to psychiatric clinic of zare hospital. In this descriptive research study, 782 referrals to psychiatric clinic of zare hospital in a period of one year were evaluated D. S.M. IV interview. The self made Questionnaire which is filed by a psychologist and then referred to a psychiatric for the diagnosis of the disease, includes the time of Commencement, amount and type of substance used. The results obtained, showed that 79.1% were men, 20.9% were women, 54.4% were urban and 45.5% were from rural areas. 4.8% were referred for substance – withdrawal and 95.2% for psychiatry problems. and also the 28% were smokers, 68.4% never smoked and 3.8% were smokers in the past. 12.7% were substance abuse at persent 3.3% had a history if substance abuse in the past and 84% had no history of substance abuse ever. Substance dependency and nondependency were 8.6% and 91.4% respectively. The percentages for the first consumed substance were as follow:60.8 opium, 6.4 alcohal, 26.4 hashish, 4 heroin and 2.4 other substances. From psychiatry diagnostic point of view 28.7% suffered from schizophrenia, 41% had mood disorders, 14% had personality disorders and 4% suffered from anxiety. There has been a statistically significant relationship between the variables such as sex, residential areas, occupation, education, marital status, history of cigarette smoking and age of commence ment of smoking with substance dependency (p<0.05). Considering the high prevalence of Substance usage by the patients referred to psychiatric clinics, the Concurrency of substance usage and psychiatry problems are important in history taking and treatment of the patients. On the other hand to have a high success Coefficient, a simultaneous psychiatric diagnosis for the patients referred for withdrawal, should be kept in mind.

Background and Death anxiety is defined as anxiety caused by conscious and unconscious fear of death that has relations with several variables. The aim for this study is to estimate the prevalence of death anxiety among a hospital staff in Sari This is a descriptive study and data was collected through a questionnaire. The number of cases was 576. The questionnaire (Templer’s Death Anxiety Scale) includes 15 True-False questions. After data collection processing was done through spss.16 and analyzing performed through T-test and Chi-square test. The age range was 20-53. 42.2% of cases had low death anxiety and 57.8% had high death anxiety. The mean of scores achieved by cases through questionnaire was 7.70 ± 3.133 by women and 6.19 ± 2.552 by men. The degree of death anxiety has had significant correlation with variable of sex while has had no relation with age, marriage condition, having or lack of child, level of graduation and career condition. The results of this study shows that the most cases have had high degrees of death anxiety that can be because of the special condition of working or the combination of cases's sex and age. With caution to results, it is recommended to Mental Health interventions to the same population to improve the mental health Quality additionally perform more comprehensive studies in more generally populations.

Background and The aim of this study was to investigate the Iranian psychiatrist's knowledge, attitude and practice about compulsory admission and its related laws. The target group of this descriptive prospective study was the entire Iranian psychiatrists whose addresses were available in Iranian psychiatry association. Assessment was performed through a self-report questionnaire, which contained 52 evaluating questions. Questionnaires were mailed to psychiatrists and assessed after they returned the answers. We obtained responses from 116 psychiatrists. Twelve and a half percent of them had been complained against due to compulsory admission. More than 50% of them had studied literature crowing psychiatric health laws, and 12.1% of them had a poor knowledge reyording this literature. About 70% of them believed that the present law is not befitting with current needs. Majority of them reported that they hospitalize their patients involuntarily and they prefer their opinion on compulsory admission rather than other resources in most situations. These findings suggest that the present law about compulsory admission of psychiatric patients is deficient and not befitting with current needs. Furthermore, lack of education in this view is obvious and prominent.

In spit of high prevalancey of the Obsessive-Compulsive Disorder in anxity diseases. It shows the least therapeutic responses. This study was done to determine The comparison of therapeutic effect of Naltrexone and Flouxetine on Obsessive-Compulsive Disorder (O.C.D). This double-blind clinical trial study was done on 30 patients aged 18 to 60 years referring to the clinics of psychiatry at Zareh hospital in Sari-Iran during 2006. Patients in three groups, treated with flouxetine 53.9mg/d (group A) Naltrexone 64.4mg/d (groupe B) & Pelacebo (group C) in the same shape capsula respectively. The severity of O.C.D was evaluated at 4 steps with Yale-Brown scale.the obtained data were analyzed using parametric & nonparametric tests. Naltrexone reduced the severity of O.C.D symptoms significantly (45.01%) at the end of week 8th (p<0.05). Same result (45.81%) was observed using Flouxetine (P=0.79). The rate of efficaey in both drugs significantly was higher than pelacebo (P<0.05). This study showed thant, Naltrexone has the same level of reducting symptome of OCD but even with faster therapeutic effect than Flouxetin.

Background and Obsessive-Compulsive Disorder (OCD) is a disease that appears to be under-diagnosed and under-treated despite the evidence for effective treatments. There are variable estimates of OCD prevalence (many studies reported that its prevalence is betwent 2% and 3% in general population). It is dependented to age, sex, marital status, socio-economic & educational state, in population. This method was a cross sectional descriptive study on high school girl students in Sari city. 3104 girls were selected and interviewed through randomized systematic & cluster sampling method from all high school girl students. The assessment was done by Muadsley obsession compulsive inventory & demographic inventory. After the data were analized by descriptive and qualitative methods. 108 students were excluded then 2996 girls were entered in this study, 31.2% (936 individuals) had OCD and mean of their age was 16.22 ± 3.4. 30.7% of girls was first child, 35.1% of mothers & 34.7% of fathers had low educational class and low socio economic state. Prevalence of OCD in high school girl students was significant in sari city, and it was related to number of birth, family size, and low socio-economic and educational level.

Background and Sleepiness is a major public health problem. Several reasons such as shift work, long time studying, etc, are the cause of sleepiness in medical students, which affect their academic performance. The aim of this study was to assess the level of daytime sleepiness in medical students. Â descriptive study designed to evaluate the daytime sleepiness of 100 medical students (25 from each group of basic science, physiopathology, stager and intern) by using Ëpworth sleepiness scale (ËSS) questionnaire. The collected data were analyzed using SPSS 10, and analytic tests. From 100 participants, 48% male, 81% single and 58% living in their own house, with mean age of 23.3 ± 3.3 and 8% were drug addicts. Ït revealed that, 53% of the students had enough sleep (score up to 6), 23% had moderate daytime sleepiness (scores 7,8) and 24% had daytime somnolence (scores 9 and over 9), 53 % were sleeping less than 8 hours at night. There was no statistically significant correlation between the level of sleepiness and age, sex, marital status, education and accomodation condition. However significant relationship was observed between sleepiness and substance abuse (p<0/05). Çonclusion: Âlmost half of the students suffered daytime somnolence. Therefore further investigations with more cases in order to find the other possible factors are recommended.

Background and In spite of discovering new antipsychotics in the past years, many patients of schizophrenia don’t response to none of them and are resistance to treatment. In this case, clozapine, ECT or some combination of drug mostly be used, but there are many patients of schizophrenia who are resistance to them. In recent years, of combination of ECT and clozapine has been suggested for these patients with promising results in primary studies. The purpose of this study was to evaluate the effects of a combination of ECT clozapine in treatment of resistance schizophrenia in comparison with clozapine and ECT administered reparately and double blind. Eighteen resistance schizophrenia patients were selected and divided into three groups. The first group took clozapine, the second group took ECT, and third group took a combination of ECT and clozapine. The responses to treatment evaluated with PANSS and analysed with ANOVA and t-test. The rate of decrease of PANSS scale in three groups of clozapine, ECT and combination both of them were 46%, 40%, 71% respectively, with significant difference (p<0.05). Combination of ECT and clozapine showed faster response than ECT and clozapine alone. Combination of ECT and clozapine was effective and safe in treatment of resistance schizophrenia.

Background and Pre-eclampcia is one of the most important factors of mortality and morbidity in mother, fetus and neonate. The exact causative factors are yet unclear. Ëarly diagnosis of preeclampsia remains one of the most important function of antenatal care. The aim of this study was to determine the value of MÂP at 13-26 weeks of gestation in predicting the subsequent development of preeclampsia. Ïn a prospective and longitudinal study, 240 pregnant women seen at the health care centers for prenatal care were registered in the study by random selection, from Ôct 2000 to Sep 2003 in Baboul, Mazandaran. Ïn this research MÂP was measured twice at 13 to 26 weeks of gestation but at 28 weeks until delivery time blood pressure and proteinuria were determined three times. Women were followed up to check the occurance of pre-eclampcia 24 hours after delivery. Women who had history of any disease and taking medicine were excluded from this study. Â significant relationship between the mean MÂP (>90 and>85) and incidence of pre-eclampcia was found in this study (p<0.001). For MÂP>85, negative and positive prediction values were %96.2, and %41.4, respectively, the sensitivity and specificity were %66.7 and %89.9. For MÂP>90, negative and positive prediction values were %95.3, and %58.5, the sensitivity and specificity were %55 and %95.9. Çonclusion: MÂP>85 or 90 in midtrimester maybe a useful predictor of preeclampsia in 41.4 % and 58.5 %(respectively). More research is needed to establish an ideal predictive test for preeclampsia that allows its prevention or management.

Background and The way of referring the patients to health service centers of the country is one of the main issues in researches and is announced by Ministry of health and medical education of Ïran as a research priority. Çonsidering the presence of direct relationship between on time and quick recognition of problem and reduction in the remained side effects of the diseases, this study was performed in order to recognize the ways through which the psychiatric patients pass to receive their medical services to the consultant psychiatrist. Ïn this yearly descriptive study which was done on 400 patients of their first referral to the zareh psychiatric hospital. Samples were collected by simple method of data collection on a questionnri comprised of 15 items and by clinical interview, according to DSM-ÏV. The obtained data were analyzed descriptively with the help of squars test. Ôf the 400 patients under study, 69.5 were male. 37.5% female, 61.8% married, 35.8 unmarried, 39.5% urban, 60% of the patients in the age group of 21-40 years old, 20.3% uneducated, 37.3% unemployed 49.6% were referred by their family or friends, 28.4% by medical personal, 9% self referral, 6.5% through law inforcement forces, and 35% were referred by force, First source of treatment in 61.9% were the medical personals 20.3% without previous referring and 18% were local therapists and bibliomancers 43% of the patients had been at least once referred to these therapists, 45.7% with two year of delay from the onset of problem and 52.3% spended more than 30 thousand tomaan till their first referance. Mood disorder with 37%, psychotic disorders with 33.5% first and 13.7% with anxiety were the first most commom identified cases. Çonclusion: Çonsidering the presence of existing ways of referring psychiatric patients, improper awareness of medical health personels, high hazardous interferance of local therapists.Ïnterferance of non psychiatrist consultants and non proffesional individuals, non referring of great numbers of the patients. Many patients, refere to psychiatrists with the complications remained from malady and affording the expenses of treatment which in this condition the patients will be prone to prognosis and improper mal therapy response.