فهرست مطالب

Psychiatry and Behavioral Sciences - Volume:13 Issue:3, 2019
  • Volume:13 Issue:3, 2019
  • تاریخ انتشار: 1398/07/15
  • تعداد عناوین: 17
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  • Samira Ebrahimzadeh Zagami, Robab Latifnejad Roudsari *, Ramin Sadeghi Page 1
    Contex

    tGender identity disorder (GID) or gender dysphoria is a disorder in which an individual identifies him/herself with the opposite sex. GID following sex reassignment surgery (SRS) is usually associated with severe distress and several limitations in the personal and social aspects of life as a transgender.

    Objectives

    The current systematic review and meta-analysis aimed at evaluating the quality of life (QoL) after SRS in transgender individuals. Data Sources: A search was conducted in English databases, including PubMed, Scopus, PsycINFO, ScienceDirect, and Google Scholar. In addition, the reference lists of the included articles were reviewed without any time limitations. The final literature search was performed on 12 June 2017. Study Selection: All relevant cross sectional and observational studies were evaluated in the current review. The keywords included sex, gender, reassignment surgery, reassignment operation, sex change, sex reversal, transpersonal, sexual transition, gender dysphoria, transsexual, transgender, gender identity, male-to-female transsexual, female-to-male transsexual, quality of life, QoL, quality adjusted, and wellbeing. Data Extraction: After screening 941 articles, 16 studies were reviewed systematically, six of which were included in the metaanalysis. Comprehensive Meta-Analysis Software version 2 was used for all meta-analyses.

    Results

    QoL improved after SRS in some dimensions, including bodily pain, emotional role, and mental health in male-to-female (MtF) transsexuals, and physical function and physical role in female-to-male (FtM) transsexuals. Physical role, vitality, and social function in MtF transsexuals were not significantly different from the general population. In other words, bodily pain, general health, social function, vitality, mental health, and emotional role in FtM transsexuals, as well as physical function and general health in MtF transsexuals, were lower than the general population.

    Conclusions

    Based on the findings, SRS could improve some dimensions of QoL, including bodily pain, emotional role, and mental health in MtF transsexuals, and physical function as well as physical role in FtM transsexuals. Nevertheless, further research is necessary in this area.

    Keywords: Gender Dysphoria, Quality of Life, Sex Reassignment Surgery, Systematic Review, Meta-Analysis
  • Mehdi Alizadeh Zarei , Mahsa Kheirollahzadeh *, Malek Amini Page 2
    Background

    One of the executive functions affected by autism spectrum disorder is set-shifting. Set-shifting leads to adaptive behaviors in different life situations, including school function.

    Objectives

    Accordingly, this study aimed to examine the relationship between set-shifting and school function in children with autism spectrum disorder.

    Methods

    In this cross-sectional (descriptive-analytic) study, a total of 52 students aged between 7 and 12 years old with autism spectrum disorder were selected through convenient sampling technique in schools specifically for the autistic children in Tehran, Iran (2017 - 2018). The required data were collected using school function assessment (SFA) and behavior rating inventory of executive function (BRIEF) and were analyzed using the Pearson correlation coefficient and regression analysis.

    Results

    The results showed that the shifting subscale of BRIEF has a significant reverse relationship with school function (P < 0.5). It should be noted that in BRIEF, the higher score indicates further damage. Also, the results of regression analysis revealed a predictive role for set-shifting in the school function of children with autism spectrum disorder (β = -0.67, P < 0.05).

    Conclusions

    Set-shifting is associated with the school function of children with autism spectrum disorders. Furthermore, setshifting can predict the school function and autistic children with problems in set-shifting are expected to have a weak school function.

    Keywords: Autism Spectrum Disorder, Executive Function, Social Participation, Occupational Therapy
  • Arash Nademi , Elham Shafiei *, Reza Valizadeh Page 3
    Background

    Nowadays, forecasting models based on nonparametric models have been developed in many branches of science such as mathematics and economics. However, the relatively complicated structure of these models has made them less practical in medical sciences.

    Objectives

    In this study, we investigated the application of a nonparametric regression model to predict the psychological symptoms appearing six months after mild traumatic brain injury. We also made a comparison between the performance of nonparametric regression and artificial neural network models in predicting the psychological symptoms.

    Methods

    In a six-month period during 2015 - 2017, information of 100 mild traumatic patients was included in a prospective cohort study. The data were then divided randomly into two groups of training (n = 50) and testing (n = 50) for 100 times. In the training group, the focus was on 100 artificial neural network and nonparametric regression models. However, in the testing group, a comparison was made between the values obtained using the two final models. To compare the models, the ROC curve and the accuracy rate were finally applied.

    Results

    According to the obtained results, the nonparametric regression model showed an accuracy rate of 91.25% while the neural network model had an accuracy rate of 85.34%. In the experimental set for both neural network and nonparametric regression models, the area under the ROC curve appeared to be 81.51% and 85.73 %, respectively.

    Conclusions

    The nonparametric regression model appeared to be more powerful than the neural network model in predicting psychological symptoms.

    Keywords: Neural Network, Statistics, Nonparametric, Forecasting, Brain Concussion, Behavioral Symptoms
  • Zahra Saffarian, Behrooz Dolatshahee *, Abbas Pourshahbaz , David Leland Roberts, NajmehRastikerdar Page 4
    Background

    Various investigations demonstrated social cognitive impairments in schizophrenic patients. The impairments in schizophrenia patients are also associated with an increase in paranoid symptoms. However, comparing multiple domains of social cognition in subtypes of schizophrenia has received less attention.

    Objectives

    The current study aimed at comparing multiple domains of social cognition in schizophrenic patients and the normal population as well as schizophrenic patients with and without paranoid symptom.

    Methods

    In this causal-comparative study, 44 schizophrenic patients with paranoid symptoms and 18 patients without paranoid symptom admitted to three schizophrenia care centers in Shiraz, from June 1st, 2017 to July 2nd, 2017 were evaluated. The control group included 38 staff of the studied centers. The research tools were the face emotion identification task, hinting task, and ambiguous intentions hostility questionnaire (AIHQ).

    Results

    We used the multivariate analysis of variance to compare the functioning of the sample groups. Based on the results, schizophrenic patients with/without paranoid symptoms exhibited worse performance than normal individuals in emotion perception (P = 0.01, P = 0.01) and theory of mind (P = 0.01, P = 0.01) tasks; however, patients with and without paranoid symptoms did not differ in these tasks. With respect to AIHQ, schizophrenia patients with/without paranoid symptoms inclined to use hostile (P = 0.01, P = 0.02, respectively) and blaming (P = 0.01, P = 0.02, respectively) attributions compared with normal subjects. Moreover, patients with paranoid symptoms inclined to use more hostile and blaming attributions compared to patients without paranoid symptoms.

    Conclusions

    Three variables of emotion perception, theory of mind, and hostile and blaming attributions were able to distinguish schizophrenia patients from healthy individuals, while only hostile and blaming attributions were able to distinguish patients with paranoid symptoms and those without paranoid symptoms.

    Keywords: Schizophrenia, Paranoia, Attributions, Theory of Mind
  • Fatemeh Ghaffari , Mehdi Rostami , Zahra Fotokian*, Mahmoud Hajiahmadi Page 5
    Background

    Continuing care of an elderly patient with Alzheimer’s disease may result in psychosocial and physical disorders in family caregivers, as well as limitations to providing complete care.

    Objectives

    The aim of the present study was to determine the effectiveness of resilience education in the mental health of family caregivers of elderly patients with Alzheimer’s disease.

    Methods

    This study followed a randomized, clinical trial design. The study population consisted of family caregivers of elderly patients with Alzheimer’s disease who referred to hospitals and neurologists’ offices located in the western cities of Mazandaran province, Iran. Data were collected between 2016 and 2017. Fifty-four family caregivers were recruited through convenience sampling and randomized into control and intervention groups (27 in each group). Demographic characteristics, Connor-Davidson Resilience Scale, and General Health Questionnaire were used for data collection. Resilience education was provided in eight sessions (45 min each) using PowerPoint presentations and educational pamphlets. The mental health scores were calculated using the indices including normality tests and analyzed using the independent and paired t-tests, analysis of variance (ANOVA), and Bonferroni test.

    Results

    An independent t-test showed improvements in the mental health status of those who received the educational intervention (mean difference: 23.8 ± 6.4; P < 0.001). The independent t-test also indicated statistically significant differences between the groups’ anxiety/insomnia (8.8±2.3 versus -0.12±2.5), somatic symptoms (7.2±2.2 versus -0.9±1.03), social dysfunction (4.5±2.9 versus 0.2 ± 1.3), and depression (3.2 ± 2.2 versus -0.08 ± 0.6; P < 0.001).

    Conclusions

    Resilience education successfully improved the mental health of family caregivers. Therefore, it is suggested that healthcare providers, Alzheimer’s associations, and NGOs provide educational interventions to help promote the caregivers’ mental health.

    Keywords: Alzheimer’s Disease, Resilience, Psychological, Family Caregivers
  • Maryam Faraji Emafti , Akbar Hedayatizadeh Omran, Asghar Noroozi , Ghasem Janbabai , MahinTatari, Mahnaz Modanloo * Page 6
    Background

    Cancer is one of the most important health problems, which cause anxiety. Owing to physical and psychological problems it may lead to thinking about impending death. Logotherapy is the most powerful method to treat problems that exist in nature.

    Objectives

    This study aimed to determine the effect of group logotherapy on spirituality and death anxiety in patients with cancer.

    Methods

    This randomized clinical trial study was done on patients with cancer referred to Imam Khomeini Hospital in Sari in 2017. Sixty-four eligible patients were selected from the oncology clinic using convenience sampling method. Patients were randomly allocated to the control and intervention groups (n = 32). Group logotherapy was done for the intervention group for five weeks. Data was gathered through a questionnaire, including demographic, Templer Death Anxiety Scale (DAS), and Spirituality Questionnaire (SQ) one week before and one week after the intervention. Data were analyzed in SPSS V. 16 software using independent t-test, Wilcoxon, and Mann-Whitney U test. The significant level was considered 0.05.

    Results

    There were no significant differences in death anxiety and spirituality scores between the two groups at baseline, indicating that the two groups were matched in terms of death anxiety and spirituality. Before the logotherapy, the mean score of death anxiety in both groups was high (more than 8). After the logotherapy, the mean and SD of death anxiety score in the intervention and control groups were 7.14 ± 4.12 and 9.76 ± 2.64, respectively, there were statistically significant differences in death anxiety scores between the groups (P < 0.05). There were statistically significant differences between the mean of spirituality score in the intervention group before and after the logotherapy (P < 0.05), but it was not significant in the control group, indicating that group logotherapy was effective in increasing the spirituality score.

    Conclusions

    Based on the findings, group logotherapy can increase the spirituality score of the patients. Moreover, the logotherapy may result in decreasing death anxiety, and spirituality-oriented meetings may be beneficial for patients.

    Keywords: Cancer, Spirituality, Anxiety, Logotherapy
  • Monir Baradaran Eftekhari , Masoumeh Dejman, Ameneh Setareh Forouzan, Katayoun Falahat, Mohsen Shati , Arash Mirabzadeh, Judy Bass, Zohreh Mahmoodi * Page 7
    Background

    Depression is a major public health concern that accounts for a high global disease burden.

    Objectives

    The aim of this study, developing a depression inventory for screening the Fars ethnicity in Iran.

    Methods

    The research was carried out using a combined (multi-stage) method in the Persian ethnicity between April 2016 and March 2017. Individual interviews were conducted in Tehran, Iran, with depressed patients, the patients’ relatives or friends and key informants. In the next stage, a 28-item tool was designed. The face, content, criterion and construct validity (confirmatory factor analysis) of the designed tool were assessed in order to determine its validity. Data were analyzed by Amos 24 and spss16.

    Results

    This study was conducted on 150 individuals, 55% female and 45% male, selected from the general public through convenience sampling with a mean age of 35.28±12. 38. The impact score for all the items was between 1.8 and 5, CVR was between 0.7 and 1 for all the items and S-CVI/Ave was 97.09 ± 0.63. Based on the results of the confirmatory factor analysis, all the components were approved as factors used to screen for depression. The model fit coefficients, the CMIN/DF was calculated as 1.93. NFI, CFI and GFI were 0.70, 0.54 and 0.73 respectively. For reliability, Cronbach’s alpha was calculated as 0.88 with an internal consistency coefficient that is 0.7.

    Conclusions

    This depression screening tool for the Fars ethnicity was designed based on the Fars ethnicity and the Iranian culture and appears to be an appropriate tool due to its good reliability, validity, simplicity and applicability in different situations.

    Keywords: Depression, Ethnicity, Inventory, Iran
  • Reza Rastgoo Sisakht, Rahimeh Negarandeh, Hamid Valizadegan, Shabnam Mousavi, Maryam Noroozian, Mehdi Tehrani Doost, Emran Razaghi* Page 8
    Background

    Studies related to decision-making and choice preference in substance use behavior have less commonly focused on decision-making processes per se. Those processes include decision-making time, task-based complexity, and decision-making strategies.

    Objectives

    The objectives of this study was the production of a culturallymodified version of theMouselab tool formeasurement of decision-making processes and to measure differences between decision-making processes in subjects with a positive and negative history of substance use.

    Methods

    Applying a snowball method for sampling, two groups, of individuals with a positive and negative history of substance use were recruited. The case and control groups consisted of 17 males with the mean age of 35.94 (± 12) and 33.8 (± 8.83) years, respectively. The measurement tool was a modified version of Mouselab computer game.

    Results

    Using repeated measurement analysis of variances ant t-test with non-paired groups for comparing the case and control groups, it was found that the group with a positive history of substance use had a longer time-lapse in the decision-making process (P = 0.029). The accuracy of choice, however, was not different between the groups (P = 0.172).

    Conclusions

    Subjects with a positive history of substance use were different in two stages of decision-making process, which are dependent on the ecology and conditions of decision-making process, namely, search for information and decision-making. Two other stages of decision-making process that were dependent on individual cognitive and logical properties, i.e., stop search and choice, were not different in subjects with a positive history of substance use compared to the control group. Although subjects with a positive history of substance use consumed more resources for decision-making, their accuracy of choice was not different from the control group, thereby, ruling out a decision-making-related cognitive deficit.

    Keywords: Decision-Making, Choice, Process Tracing, Substance Use, Decision-Making Software
  • Asghar Arfaie , Ali Reza Shafiee Kandjani *, Nazanin Jalali Motlagh, Aydin Arfaie , SalmanSafiKhanlou, Kowsar Tarvirdizade Page 9
    Background

    Bipolar disorder and borderline personality disorder have some similar symptoms that might confuse the diagnosis. Many experts defend the borderline pathology within the spectrum of bipolar illness.

    Objectives

    This study aimed to compare patients with borderline personality disorder and bipolar disorder from a novel perspective, i.e., personality traits defined by the five-factor model of personality.

    Methods

    This descriptive-analytical study was conducted in Psychiatry Clinics of Tabriz University of Medical Sciences. Consecutive patients diagnosed with borderline personality disorder and bipolar I disorder by a semi-structured clinical interview were enrolled excluding those with comorbidity. The NEO inventory was used to score on five major domains of personality.

    Results

    A total of 60 patients (40 males) completed the study with a mean age of 28.3 ± 8.1 years (range: 19 - 59). Regardless of the diagnosis, patients scored the highest on openness to experience and the least on conscientiousness. There was no significant difference between patients with bipolar mood disorder and patients with borderline personality disorder in terms of five personality dimensions. Males, in general, scored higher than females on conscientious, but male patients with bipolar disorder scored higher on agreeableness and extroversion.

    Conclusions

    This study showed a comparable personality profile between patients with bipolar disorder and borderline personality disorder.

    Keywords: Borderline Personality Disorder, Bipolar Mood Disorder, Personality, Big Five
  • Karl Peltzer *, Supa Pengpid Page 10
    Background

    Sedentary behavior may negatively affect sleep.

    Objectives

    This study aimed to assess the effects of sedentary behavior and its different domains on sleep duration in ASEAN university students.

    Methods

    A cross-sectional survey in 2015 included 3266 university students from Indonesia, Malaysia, Myanmar, Thailand and Vietnam, median age 20.0 years (interquartile range 3.0 years).

    Results

    Overall, 50.8% of university students had normal sleep (7 - 9 hours), 44.8% short sleep (≤ 6 hours) and 4.4% long sleep (≥ 10 hours); 24.2% engaged in < 4 hours overall sedentary time a day, 43.3% in 4 to < 8 hours, 21.8% in 8 to < 11 hours and 11.8% in 11 or more hours overall sedentary behavior a day. In multinomial logistic regression analysis, ≥ 11 hours and more overall sedentary behavior a day, ≥ 4 hours overall internet use a day, ≥ 2 hours internet use for study a day, ≥ 5 hours internet for leisure, and ≥ 7 hours smartphone use a day were associated with short sleep. In addition, ≥ 5 hours internet for leisure, 2 - 3 hours internet use for study and 3 - 6 hours smartphone use a day were associated with long sleep. Overall, sedentary behavior was negatively associated with long sleep.

    Conclusions

    The study showed that sedentary behaviors and its different domains were associated with short sleep, while smartphone use, internet use for study and for leisure were positively, while overall sedentary behavior negatively associated with long sleep.

    Keywords: Sedentary Behaviors, Sleep Duration, University Students, ASEAN
  • Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha *, Gholamreza Ghaedamini Harouni , SaraMakki Alamdari, Sajjad Sajjadi Page 11
    Background

    Alcohol use is one of the most complicated health problems. The understanding of risk and protective factors contributing to alcohol use could help deal with this problem more efficiently.

    Objectives

    The present study examined the risk and protective factors for alcohol use among homeless men living in Tehran, Iran.

    Methods

    This cross-sectional study was conducted from September to November 2015. A total of 193 homeless men were recruited using convenience sampling from Khavaran Shelter, the largest shelter for homeless people, in the south of Tehran. Data were analyzed using a logistic regression model to examine if using alcohol is associated with potential risk and protective factors. Conducting logistic regression, adjusted odds ratio (aOR) point estimate and 95% confidence interval (CI 95%) as the effect measures were reported. All tests were run using SPSS version 21.

    Results

    The prevalence rates of recent (past 7 days) and past-year alcohol use were 14.5% (95% CI: 9.50, 19.50) and 43.52% (95% CI: 36.50, 50.50), respectively. Hosmer-Lemeshow test (χ 2 (4) = 10.37, P = 0.17) indicated the goodness of fit of the model to the data. The results of the fitted logistic regression model explained that social support (OR = 0.63, CI 95%: 0.36-1.08) and being a local resident (OR = 0.32, CI 95%: 0.17 - 0.61) were the protective factors while the level of relationship with peer network (OR = 2.08, CI 95%: 1.19 - 3.63) and having a history of arrest (OR = 3.16, CI 95%: 1.34 - 7.46) were risk factors of alcohol use among Iranian homeless men during the last year. The predictors entered into the regression model could explain between 13% and 17.5% of the variance of the outcome (alcohol use).

    Conclusions

    This study contributes to the existing literature by examining risk and protective factors among a high-risk population. Our findings can be used in designing and implementing interventions that are more effective for the homeless group living in a non-Western context.

    Keywords: Alcohol Use, Homeless Persons, Protective Factors, Risk Factors, Social Support
  • Shiva Ahmadzadeh, Rokhsareh Badami *, Asghar Aghaei Page 12
    Background

    Regarding to the importance of positive effectiveness of psychological interventions on promoting mental skills and improving the performance and the important role of mental factors in improving athletes’ optimal performance, NLP techniques with claims of magical powers should not be overlooked. However, a few studies have been conducted to investigate the effectiveness of unique NLP evidenced-based practices on mental skills and performance in the sports fields, especially shooting.

    Objectives

    This study aimed to investigate the effectiveness of neuro-linguistic programming (NLP) techniques on shooters’ mental skills and their shooting performance.

    Methods

    This quantitative study is a semi-empirical research with the pretest-posttest design. The participants were 24 male Iranian skilled shooters in 10-meter air rifle discipline with an average age of 24±8 years. They were matched and divided into control and experimental groups. While the experimental group participated in 8, 2.5-hour sessions to receive NLP techniques, the control group did their routine activities. Before and after the intervention, shooters’ mental skills were measured by Ottawa Mental Skills Assessment Tool (OMSAT-3) and their performance in 2 different “ordinary” and “under pressure” conditions was measured based on the score recording rules of the Islamic Republic of Iran Shooting Sports Federation (IRISSF). Data were analyzed using a two-way (time × group) repeated measure MANOVA.

    Results

    The results of this study showed that NLP techniques improve shooters’ mental skills and their performance in both ordinary and under pressure conditions of the competition.

    Conclusions

    As there is a positive significant of the effectiveness of NLP on shooters’ mental skills and their performance, NLP techniques are suggested to be used to improve these two factors.

    Keywords: Athletic Performance, Mental Skills, Neuro-Linguistic Programming (NLP), Rifle, Shoot
  • Raheleh Rafaiee , Naghmeh Ahmadiankia , Seyed Abbas Mousavi , Leila Rezaeian, Mohammad Niroumand Sarvandani , Ahmad Shekari , Mehdi Forouzesh, Roohollah Valipour, HamidKalalian Moghadam * Page 13
    Background

    Methamphetamine (meth) is recognized as a highly addictive psychostimulant. Currently, there are no available treatments for meth abuse, and no animal model of meth self-administration has been proposed to represent human meth selfadministration.

    Objectives

    We aimed to develop a model to study meth self-administration through inhalation in rats.

    Methods

    Rats were placed in an inhaler apparatus (designed specifically for this purpose) for 15 min per day over two weeks. There were two levers in the cage. Pressing the passive lever had no outcomes. Whereas, for each active lever pressing, an infusion pump delivered 50 µL of meth or distilled water within two seconds. Meth was evaporated on a hot plate adjacent to the rat cage. After loading the drug over the hot plate, the blower fan was run, and the vaporized drug was blown by the fan into the rat cage. Then, meth-induced conditioned place preference and locomotor activity were assessed following 14 days of meth inhalation. The serum concentration of meth was also determined by gas chromatography-mass spectrometry.

    Results

    In this model, the self-administration of meth through inhalation significantly increased locomotor activity, conditioned place preference, and plasma level of meth.

    Conclusions

    We can conclude that the self-administration of meth through inhalation is a novel and effective route of selfadministration. Our new protocol presents a promising tool for examining drug-seeking/taking behaviors and neural consequences in a noninvasive approach to reduce the stress of surgery and injection in laboratory animals and increase the validity of animal experiments.

    Keywords: Drug Abuse, Animal Model, Self-Administration, Inhalation, Methamphetamine
  • Farnaz Zahedi Avval , Atefeh Soltanifar *, Fatemeh Moharreri , Maedeh Kamrani, MohamadMahdi Mohamadi Rad Page 14
    Background

    Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in both developed and developing countries. Deficiency of vital elements such as iron and zinc is thought to interrupt the function of dopaminergic pathways.

    Objectives

    This study aimed to assess the serum levels of iron and zinc among children with ADHD who referred to a psychiatric clinic in Mashhad, compared to healthy controls.

    Methods

    This case-control study was conducted on 51 subjects (36 ADHD cases and 15 healthy controls) aged 6 - 12 years. The serum levels of ferritin and zinc, total iron-binding capacity (TIBC), and hemoglobin were assessed and compared between the groups. P values of less than 0.05 were considered statistically significant.

    Results

    The mean age was 7.8 ± 2.12 and 8.4 ± 3.11 years in ADHD and control children, respectively. There were significant differences between the groups regarding mean corpuscular volume (MCV) (P = 0.003), mean corpuscular hemoglobin concentration (MCHC) (P = 0.002), and zinc level (P = 0.015). However, no significant difference was observed in hemoglobin, iron, TIBC, and ferritin between the two groups (P > 0.05).

    Conclusions

    The levels of serum iron and ferritin did not differ significantly between children with and without ADHD. Surprisingly, we found the serum zinc level to be higher in ADHD children than in healthy controls. Further studies with larger sample sizes are needed to draw reliable conclusions.

    Keywords: Attention Deficit Hyperactivity Disorder, DSM-IV-TR criteria, Iron, Ferritin, Zinc
  • Azadeh Memarian *, Seyed Hossein Moosavi Nezhad Baboli , Nahid Dadashzadeh Asl , NegarSeifi Moghadam, Fatemeh Noorian Zavareh, Zahra Torabi Goodarzi Page 15
    Introduction

    Selecting unusual and uncommon means for suicide may be rooted in psychiatric disorders.

    Case Presentation

    Herein, we report a case of suicide attempt occurring with a grinding stone as an unusual tool for suicide. After surgical repair of the injury and owing to a suspicion of psychological problems, psychiatric consultation was requested to rule out the possibility of borderline personality disorder, brief psychotic disorder, and major depression with psychotic features.

    Conclusions

    The presence of psychotic patterns and behaviors, especially auditory hallucination and depressed mood, influence suicide attempts. The selection of uncommon tools emphasizes the need for psychiatric consultants to prevent repeated suicide attempts effectively in the same conditions.

    Keywords: Unusual, Tool, Suicide, Psychological
  • Vajiheh Aghamollaii , Zahra Ahmadinejad, Fatemeh Mohammadian, Zahra Mirsepassi * Page 16
    Introduction

    Brucellosis is a zoonotic endemic disease, which is transmitted to the human through occupational exposure or ingestion of contaminated dairy products. Neurobrucellosis has been detected in 5% - 10% of patients with diverse manifestations.

    Case Presentation

    In this study, an atypical case of neurobrucellosis is reported. The patient was a 28-year-old man suffering from psychiatric symptoms and catatonic states. The CSF analysis was unremarkable but the diagnosis was made according to Enzymelinked Immune Sorbent Assay, other serology tests, and brain MRI findings.

    Conclusions

    It should be mentioned, one of the differential diagnoses in patients with unexplained neurological and psychiatric symptoms in endemic areas is neurobrucellosis and a multidisciplinary approach to these patients is essential.

    Keywords: Brucellosis, Neurobrucellosis, Psychiatry, Catatonia
  • Ali Reza Shafiee Kandjani *, Somayeh Emamizad, Mahmoud Farvareshi Page 17
    Introduction

    In factitious disorder (Munchausen syndrome), patients induce or aggravate symptoms of physical or psychological illness to receive attention and medical treatment. The motivation of these patients is merely getting a sick role and medical care, and entering the medical system; most of these patients have simultaneous mood disorders (especially depression), or personality disorders. Patients with factitious disorder have no secondary gain.

    Case Presentation

    Herein, we present a middle-aged Azerbaijani man from Sarab city, East Azerbaijan who referred to hospital with complaints of abdominal and leg pain. Based on examinations, he had undergone repeated surgical procedures (laparotomy and surgical removal of the external object from the leg) due to the presence of a foreign body (needle and nail) in the intestines and leg’s calf. The interview was done based on DSM-5 by a psychiatrist and after a two-month follow-up, the diagnosis was affirmed by a second opinion through a ground round session at the department of psychiatry, Tabriz university of medical sciences, Tabriz, Iran. He is under treatment with an SSRI along with cognitive psychotherapy.

    Conclusions

    Patients with atypical and unusual manifestations of an illness associated with frequent hospital admissions and receiving multiple therapies can lead us to the diagnosis of a factitious disorder. Although patients often deny their disease and evade treatment, he was ultimately diagnosed with factitious disorder and received psychiatric treatment. The treatment goal is to reduce mortality and morbidity and to treat the underlying psychiatric disorder.

    Keywords: Factitious Disorder, Munchausen Syndrome, Self-Injury, Foreign Bodies, Needle Ingestion