Iranian Journal of Psychiatry
Volume:14 Issue: 1, Winter 2019

Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions.

Anxiety is a complex phenomenon on which culture has a prominent influence. The present study aimed to investigate the cultural aspects of social anxiety disorder (SAD) in an Iranian population. A qualitative content analysis research was done to answer the study question. A total of 16 individuals with social anxiety disorder (six men and 10 women) were selected using purposeful sampling method (M = 24.43, SD = 4.56). The study was conducted in Tehran, Urmia, and Sanandaj- Iran. Participants were from different ethnic backgrounds (LOR, FARS, TURK, and KURD). Data were analyzed by thematic analysis using an inductive method. Analysis of participants’ records yielded five distinct categories with some subcategories, which are as follow: (1) anxiety experiences; (2) core beliefs; (3) reasons of being anxious; (4) effects of SAD on life aspects; and (5) coping strategies. It seems that symptoms of social anxiety and its underlying beliefs, causes and effects and coping strategies are almost experienced and interpreted in a way that could be the same as DSM-5 clinical presentation of social anxiety, with the exception that somatic symptoms are experienced by almost all participants.

General medical degree (GMD) curriculum usually causes significant psychological distress for medical students, especially in transition periods between preclinical, clerkship, and internship periods. This study was conducted to assess the effect of curricular change in GMD program on mental health of medical students in internship period. This study evaluated mental health of 2 concurrent groups of medical students under reformed and non-reformed GMD curriculum. In this study, 120 out of 180 interns in the non-reform GMD program and 60 interns in the reformed GMD program were selected and their mental health status evaluated using Symptom Checklist-90-Revised (SCL-90-R) questionnaire. The cut-off point of 0.7 was used for Global Severity Index (GSI) score. SPSS software, version 14 (SPSS Inc, Chicago, Il, USA) was used for analysis. Chi-square, Fisher’s exact test, t student, Mann–Whitney U, one-way ANOVA, and Kruskal-Wallis tests were used when appropriate. Logistic regression was used to estimate odds ratios for various determinants of students’ mental health. About half of the participants in the 2 groups were male (P = 0.63), and the mean age of the students in the reformed and non-reformed programs was 24.8 (1.97) and 24.7(1.80), respectively (P = 0.9). About 20% of participants in the non-reformed and less than 2% of those in the reformed program had GSI score of more than 0.7. Medical students in the reformed program had lower scores in total GSI and 9 its dimensions (P<0.001). The results obtained from the logistic regression analysis indicated that reformed curriculum and good economic status were significant independent variables contributing to decreased psychological distress (OR = 0.016 and 0.11, respectively). The results revealed that curricular changes which were based on World Federation of Medical Education recommendation, could be associated with improvement in mental health status of medical students.

Thalassemia is one of the most frequent monogenic disorders, leading to impairment in the maturation and survival of red blood cells. The question examined here is whether, and if so, to what extent, people with beta-thalassemia might also be impaired in their cognitive functioning. Previous results in adults with beta-thalassemia showed cognitive impairment when compared to healthy controls. However, length of education was never taken into consideration as a possible confounder. Accordingly, the aim of the present study was to assess people with minor beta-thalassemia and compare them to healthy controls, while controlling for length of education. A total of 25 adults (mean age: 29.36 years; 56% females) with beta-thalassemia and 25 healthy controls (mean age: 27.84 years; 72% females) took part in this cross-sectional study. They underwent cognitive testing (executive functions, attention, working memory), and their haemoglobin levels were assessed. Cognitive performance did not significantly differ between patients with minor beta-thalassemia and healthy controls. Irrespective of group, higher cognitive performance was strongly associated with time spent in education. No gender differences were observed. Compared to healthy controls, cognitive performance was not impaired among patients with minor beta-thalassemia when length of education was introduced as a further co-variate. In both patients with minor beta-thalassemia and healthy controls, higher cognitive performance was associated with time spent for education. Health professionals should inform patients with minor beta-thalassemia that cognitive performance is related to the length of education and not to the health status of minor beta-thalassemia per se.

The present study aimed at estimating the case fatality rates of suicide acts in different marital status subgroups and to find interrelation with a population living in Bushehr province along the coastal region of the Persian Gulf coast in southwest of Iran. In this analytical and observational study, suicidal data were gathered in 5 successive years (2008–2012) in the population of Bushehr. Data were extracted from suicide registration forms provided by the Psychiatric Health Unit of Ministry of Health. Questions mainly focused on demographic characteristics, including age, sex, literacy, residency, marital status, birth rank, the number of previous suicide attempts, and probable reasons of suicide, such as family conflicts or/and psychiatric complications. Fatality rates in different subgroups (male/female; married/unmarried; etc.) were compared and odds ratios were computed. The main limitation of this study was the lack of a specific grouping for those who cohabited together (Those who live together and have a sexual relationship without being married). The logistic regression model was used in data analysis. Case mortality rates of suicides were found to be 3.5% for both sexes, 5.2% in males and 2.7% in females. However, among the single population, either divorced or widowed, the probability of death due to suicide was 3.5 times higher (95% CI: 1.5–2.9) as compared to the unmarried. Age as a confounding factor in fatality rates made a significant difference between married and unmarried people, and differences disappeared after adjusting for age. However, fatality rate was still higher in the widowed /divorced group compared to other groups even after adjusting for age. Fatality rate was higher in married people compared to the unmarried, however, after adjusting for age as a determinant factor, no significant difference was observed between the 2 groups. The highest death rate belonged to the age-specific widowed /divorced individuals as compared to all other marital status subgroups.

Bipolar disorder is a severe, disabling, and recurring disorder. Some studies have shown that the frequency of bipolar disorder in patients with medical diseases is higher than healthy controls. The aim of this study was to investigate the frequency of bipolar disorders in medically ill patients hospitalized in Iranian general hospitals. In this cross sectional study, 697 inpatients (342 men, 49.1%) from different wards of 3 general hospitals, with the mean age of 39.3+-10, were enrolled in the study using nonprobability sampling. Demographic questionnaire, Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) were used. Inclusion criteria were as follow: informed consent, age 18-65 years, ability to speak Persian, and having at least middle school education. The frequency of bipolar disorder was 12.1% and 20.8% based on BSDS and MDQ, respectively. The results of both tests were positive in 7.9% of hospitalized patients. The frequency of bipolar mood disorder was significantly higher in single patients and in those with comorbidity of alcohol and substance use disorders. Considering the high frequency of bipolar mood disorders in hospitalized medically ill patients and its probable effects on compliance and prognosis, early screening, diagnosis, and treatment of bipolar mood disorders is important in these patients.

This study was conducted to examine and compare the effectiveness of cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) in child victims of domestic violence (child physical abuse and/or witnessing parents’ conflicts). A total of 139 girls and boys, aged 8-12 years, were randomly assigned into CBT (n = 40), EMDR (n = 40), or control groups (n=59). All children received up to 12 individual treatment sessions over 4–12 weeks. Blind assessment was done before and 2 weeks after the treatment and on a variety of teacher-parent-rated and self-report measures of posttraumatic symptomatology, depression, anxiety, and behavior problems. CBT and EMDR were effective in ameliorating psychological sequelae of victims of domestic violence on the measured variables (p =.001). Comparison of the treatment and control groups suggested moderate to high practical significance in treatment groups vs controls. Both CBT and EMDR can help children to greatly recover from the outcomes of domestic violence in comparison with control group. Moreover, structured trauma treatments are strongly recommended and can be used for children.

The present study is a part of a larger study that aimed at developing a comprehensive model of service delivery for individuals with autism in Iran based on the local needs and characteristics. In this study, the status of the services provided to those with autism in Iran was investigated based on the perspectives of parents of children with autism. A semi-structured interview was used to qualitatively investigate the status of the services with regards to autism in Iran based on the perspectives of parents of children with autism. This study revealed several barriers, including shortness of eligible professionals, difficulty in access to care for families, high costs, and lack of formal and informal supports, in providing services to those with autism in Iran. Early detection and diagnosis are of prime importance. We also need to train our specialists to diagnose autism based on the standard protocols and tests. In sum, we need a comprehensive program that involves different sectors in charge of health and education in Iran.

There are evidence-based practices in the field of family and patient psychoeducation for patients suffering from severe mental disorders. However, given the variation in resources and cultural contexts, implementation of these services, especially in low- and middle-income countries is faced with challenges. This study aimed to review articles on family and patient psychoeducation of severe mental disorders in Iran and to find the characteristics of the main components necessary for the implementation of such practices in clinical settings. All published studies on family and patient psychoeducation for severe mental disorders (schizophrenia, schizoaffective, and bipolar disorder) conducted in Iran were searched up to May 2018; and key features and findings of each study were extracted and presented. Forty-eight studies were included in this review, of which 27 were randomized controlled trials, and 20 were quasi-experimental. One study was an implementation and service development report. The main findings of these studies were a significant decrease in relapse rate and/or rehospitalization rate and a significant decrease of burden and distress of families. Despite a wide diversity in approaches, this review showed that different psychosocial interventions in which psychoeducation is one of their core and main components have promising results, demonstrating the significance of this intervention in Iranian mental health research. In our opinion, based on evidence, even with limited resources, it is no longer acceptable to deprioritize some forms of psychoeducation for patients and their families in clinical settings.

Electroconvulsive therapy (ECT) is a major treatment of catatonia; and catatonia development during electroconvulsive therapy is a highly surprising phenomenon. We present a patient with bipolar disorder who developed catatonia during ECT. Case Reports: A 21-year-old woman, with a known case of bipolar disorder in manic phase without psychotic feature, history of long acting antipsychotic use, and severe B12 deficiency, was treated with ECT. Full catatonia syndrome developed after the fifth session of ECT. In rare cases, catatonia can develop during ECT course in the presence of some precipitating factors. Thus, these precipitating factors should be eliminated as much as possible before the start of ECT course to prevent catatonia development.