Iranian Journal of Psychiatry and Behavioral Sciences
Volume:16 Issue: 2, Jun 2022

Cleft Lip and Palate (CL/P) is the most common craniofacial malformation in the oral cavity, with a prevalence of “1 to 2in 1,000 live births worldwide. Parents with CL/P children are more prone to experience emotional disorders, especially depression, and have higher child-related stress than the parents of normal children. Due to the effect of the mental status of parents on children, the assessment of the psychological aspects of this problem and its effects on the patients and their parents is critical.

This systematic review was carried out to determine the quality of life (QoL) and emotional problems, including anxiety and depression, in the mothers of CL/P children. All the published studies were searched in three electronic databases, including MEDLINE, PubMed, and Web of Science, up to December 30, 2020, using the keywords "Orofacial Clefts” and “Cleft Lip and Palate” in combination with “Anxiety," "Stress," "Depression," and "Quality of Life” in addition to “Parents," "Mothers," "Fathers," and "Caregivers."

Finally, 29 articles met the eligibility criteria for this review. Due to the differences in health care and culture, controversial findings were obtained on the QoL of parents with CL/P children. Social support plays a vital role in the prevention, resolution, and treatment of psychological problems of parents with CL/P children. The majority of studies confirmed the higher levels of anxiety and depression in caregivers of children with CL/P than in normal individuals.

These findings emphasize the necessity of psychological screening in the first few months following the diagnosis to facilitate providing appropriate psychological support for parents with CL/P children.

Physician empathy is one of the fundamental factors involved in patient care and it can enhance the therapeutic effects of patient–clinician relationships. Attachment is defined as the tendency of human beings to make strong affectional bonds with some specific people.

This study are aimed to examine the possible relationship between secure and insecure attachment style with physician empathy among medical students.

A cross-sectional study was conducted on 268 medical students and residents at Mazandaran University of Medical Sciences, Iran in 2015. All participants voluntarily participated in this study and an informed consent was obtained. Data analysis was done through completing two questionnaires, including the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) and the Revised Adult Attachment Scale (RAAS). Data was analyzed using Pearson correlation coefficient and stepwise regression analysis and analyzed in SPSS (v. 18).

The highest frequency (n = 137; 51%) was related to individuals in the age range of 21 - 25 years. The empathy score of all students was 99.99. Among 268 participants, 76 (28.4%) and 192 (71.6%) students represented secure and insecure attachment styles, respectively. Married students had higher empathy scores than single students (P = 0.056). No statistically significant difference was found in the mean empathy scores by gender (P = 0.305) and different years of studying (P = 0.883). The mean ± standard deviation of empathy score in psychiatry residents was 113.4 ± 16.24, which was higher than the residents of other fields. Also, our results revealed no significant difference between the empathy scores in individuals with secure and insecure attachment styles (P = 0.945; 95% CI: -3.883 - 3.620).

Evaluating empathy in the educational courses of medical students, as future physicians, can offer valuable guidelines to improve the mental health of students and help them have a good relationship with patients.

Behcet’s disease (BD) is a chronic disease with adverse effects on sexual function and some likely effects on marital satisfaction, thereby posing some problems in family dynamics.

This study aimed to determine the effects of BD on sexual function in females and males and determine the relationship between the clinical manifestations of BD and sexual function.

Fifty-one patients with BD and 50 healthy controls were included in this study. Inclusion criteria were: being married, aged 18 - 55 years, being sexually active, and having sex during the past four weeks. Sexual function was assessed for the groups using the female sexual function index (FSFI) for women and the international index of erectile function (IIEF) for men.

Sexual dysfunctions were observed in 82.9% of the females with BD and 14.3% of the healthy females. The total score of sexual performance and its subscales were significantly lower in the female patients with BD than the controls. No significant difference was observed between the males with BD and the controls regarding the total score of the IIEF and its subscales.

Sexual dysfunction in BD patients seems to pose a significant problem; hence, it is recommended to be assessed by physicians during routine examinations.

Changes in cognitive profile, such as memory and other functions in patients with morbid obesity after bariatric surgery have been reported in the literature with inconsistent results.

This study aimed to evaluate cognitive changes, executive function and depression severity before and after bariatric surgery in patients with morbid obesity.

In this prospective cohort study, 70 patients with morbid obesity (40 patients undergoing bariatric surgery and 30 patients in the waiting list) referred to the Rasool Akram Medical Complex, obesity clinic, Tehran, Iran, in 2016 entered the study. The two groups were assessed using the Wechsler Memory Scale (WMS) (consists of 7 subscales and assesses memory), the Wisconsin Cart Sorting test (WCST) (includes 64 cards and assesses cognitive skills), the Hamilton Depression Scale (HAM-D) (for measuring depression) and bariatric analysis and reporting outcome system (BAROS) questionnaire (scale to report of the therapeutic results of bariatric surgery and including the three criteria of the weight loss percentage, the change in health state, and the quality of life) at the beginning of the study and three months after the surgery. Moreover, the Bariatric Analysis and reporting outcome system (BAROS) questionnaire was filled three months after surgery.

The average changes in WMS score (P = 0.043), working memory (P = 0.002), HAM-A (P = 0.032), weight, and BMI (P = 0.0001) in the surgery group were significantly higher than the control group. There was a significant positive correlation between change in the number of preservative errors in WCST within the surgery group with BAROS score (P = 0.004). Moreover, there was a significant correlation between changes in the score of WMS and those in BMI in the surgery group.

Bariatric surgery is associated with improvements in some cognitive functions and worsening of depressive scores in patients with morbid obesity.

Evolutionary perspectives have recently received significant attention for better understanding psychological disorders and providing effective interventions. Evolutionary perspectives have been very effective in studying psychological disorders to help consider the distal causes of such disorders.

This study aimed to investigate the psychometric properties of the Persian version of the Evolutionary Fitness Scale (EFS) among Iranian students.

The statistical population included students studying at the Iran University of Medical Sciences in 2019 - 2020. In total, 266 students were selected using a convenience sampling method. The participants completed the EFS, Depression, Anxiety, and Stress Scale (DASS-21), and Rosenberg’s Self-esteem Scale (RSES). The EFS reliability was assessed by internal consistency and test-retest. The validity was evaluated by convergent and divergent validity and confirmatory factor analysis (CFA). The data were analyzed using SPSS 24.0 and LISREL 8.80.

The CFA demonstrated that the two-factor model of the EFS (personal adaptedness and partner and offspring fitness) had a suitable fitting. This scale had significant negative and positive correlations with DASS and RSES, respectively. Internal consistency was obtained using Cronbach’s alpha: 0.96 for personal adaptedness, 0.94 for partner and offspring fitness, and 0.97 for the whole scale. Test-retest reliability was 0.81 for personal adaptedness, 0.80 for partner and offspring fitness, and 0.83 for the whole scale.

This study could complement the cross-cultural literature on EFS by examining its construct, convergent, and divergent validity and reliability. The EFS had good validity and reliability among students. Thus, it could be a suitable tool in research and clinics.

Physical restraint is an intervention, which is sometimes performed in psychiatric wards.

This study aimed to describe the lived experience of physical restraint in psychiatric inpatients.

In this qualitative study, in-depth unstructured interviews were conducted with 12 female and eight male psychiatric inpatients with experience of physical restraint. The participants were at the hospital at the time of the interview. The transcript of the interviews was analyzed using a phenomenological-hermeneutic method, based on Van Manen’s approach.

In this study, four main themes and 12 subthemes were extracted. The main themes included “captivity”, “insult”, “oppression”, and “punishment”. Based on the results, individuals hospitalized for mental disorders considered physical restraint as suffering. Hermeneutically and metaphorically, they felt as if they were “oppressed slaves”, who had been held captive and awaited freedom. This intervention could traumatize or re-traumatize the patients. However, the staff’s attitude, empathy, debriefing, and giving explanation to patients might reduce the traumatic effects.

Considering the significant number of negative experiences, alternative methods should be applied in hospitals as much as possible.

Mental training is based on the premise that psychological factors enhance or deteriorate performance and that these psychological factors can be optimized by training. Researchers have developed different methods to measure these factors, including behavioral tests and questionnaires. The Sport Mental Training Questionnaire (SMTQ) is a novel and multifaceted psychometric scale with 20 items developed to assess sports mental training across 5 dimensions, including foundational skills, performance skills, interpersonal skills, self-talk, and mental imagery.

The present study evaluated the validity and factor structure of the Persian version of SMTQ. It aimed to adapt SMTQ to Persian to present the validation of the scale in the sports context.

The original version of SMTQ was translated and back-translated into Persian based on the established guidelines, followed by a pilot study. A total of 364 athletes (mean age = 26.27 ± 9.27) participated in this research, of whom 218 (59.90%) were male, and 146 (40.1%) were female. The participants were recruited using a web-based survey. Descriptive statistics, Cronbach α coefficient for internal reliability, confirmatory factor analysis (CFA), and independent t test were used to evaluate psychometric properties.

None of the items of the 20-item questionnaire were removed. The results supported the reliability of the Persian version of SMTQ (Cronbach α = 0.84). CFA supported its validity, the model fitted the data well (χ 2 /df = 2.15; root mean square error of approximation (RMSEA) = 0.056, Tucker-Lewis index (TLI) and comparative fit index (CFI) > 0.9; parsimonious CFI (PCFI) = 0.751). We supported the Persian version criterion validity of SMTQ by showing that high-level athletes scored higher on all mental training subscales than low-level athletes.

The findings support that SMTQ is a reliable and valid instrument to assess mental training among Iranian athletes.

People with schizophrenia are more stigmatized than those with other mental illnesses. Stigmatization can be measured using the English version of Stigma Measurement Scale contained in the explanatory model interview catalogue (EMIC).

This study aimed to translate the English version of Stigma Measurement Scale into Berber language and validate the translated version.

This study was conducted in public hospitals in southern Morocco, which are predominantly Berber-speaking. The psychometric properties of the stigma scale contained in the EMIC were validated on a sample including 128 individuals.

According to the Cronbach’s alpha (α= 0.826) and the internal convergence calculated by Pearson’s statistic, that the interitem correlation was significant. Also, the intraclass correlation coefficient (ICC) was significant. The added item, concerning the COVID-19 situation has a similar psychometric value to the other items.

According to our results, the Berber version of the Stigma Measurement Scale is culturally acceptable and can be used in Moroccan society

Perceived loneliness has insinuation in both cognitive and well-being of individuals. Loneliness is a major risk factor for depressive disorder. Decreased executive function is a significant problem for older adults that plays an essential role in their psychological well-being.

This study aimed to investigate the role of executive functions in the loneliness and psychological well-being of the elderly.

The present correlational study with a survey research design used structural equation modeling. The sample size was 115 people selected using purposeful sampling. The Ryff’s psychological well-being questionnaire, executive function tests (including N-Back, Trail Making Test, quantitative calculations, London Tower, and Reaction Time), and the DiTomasso Social and Emotional Loneliness Scale for Adults were used to collect information required for this research.

Model fit indices showed that the conceptual model extracted based on theoretical foundations had an acceptable fit (RMSEA = 0.047). The analysis results showed that executive functions played a mediating role in the relationship between perceived loneliness and psychological well-being. The perceived loneliness showed a significant inverse relationship with executive functions and psychological well-being, but executive functions had a direct relationship with psychological well-being.

In the present study, it was found that executive functions played amediating role in the relationship between psychological well-being and the perceived loneliness of the elderly, and these findings are consistent with previous research and theoretical foundations. Further research is suggested to determine biological mechanisms underlying the relationship between perceived loneliness and executive functions with psychological well-being

Dimensional Anhedonia Rating Scale (DARS) is the best questionnaire for assessing anhedonia, but it is unavailable for the Iranian population. Anhedonia is common in ordinary people but is often neglected, leading to major depression.

This study examined the psychometric properties of (DARS) in the Iranian population.

This psychometric study was conducted on a sample of 474 general Iranian population in 2020 using the convenience sampling method. The participants completed the DARS and Beck Depression Inventory (BDI-II). The Pearson correlation coefficient was also used to determine convergent validity between DARS and BDI-II. Data were analyzed using SPSS software version 24.

Cronbach’s alpha (internal consistency) for the total score was 0.84. The relationship between DARS and depression (r = -0.37; P < 0.01) showed relevant convergent validity. The test-retest reliability coefficient (3-week interval) equaled 0.77. Exploratory factor analysis with a varimax rotation showed four factors. These four factors explained 0.64 of the total variance. Confirmatory factor analysis showed a good fitness for the 4-factor model construct.

DARS is useful in assessing anhedonia in the normal population. According to the results, this scale has acceptable validity and reliability in the Iranian population and can be implemented in therapeutic interventions and research.

Narrative ability is a critical component of social communication essential for participating in everyday activities. Children with autism spectrum disorder (ASD) demonstrate problems in the narrative discourse, but little is known about the features of their fictional stories.

This study compared fictional narratives between ASD children and they’re typically developing (TD) peers.

Fictional stories produced by 6- to-7-year-old males with high functioning autism (n = 14) were compared with language, sex, and age-matched TD children (n = 15). The stories were analyzed using the monitoring indicators of scholarly language. The macrostructure and microstructure elements, narrative complexity index, story knowledge index, and perspective-taking index were compared between the two groups by one-way analysis of variance (ANOVA) at the significance level of 0.05.

The scores of macrostructure andmicrostructure elements were lower in children with ASD. The ANOVA showed significant differences between ASD and TD children in three indices (P < 0.05). Moreover, the Pearson correlation coefficients between the total macrostructure and microstructure scores were close to one in both ASD (r = 0.89) and TD children (r = 0.93).

Despite obtaining scores in the average range in a standard language test, Farsi-speaking children with ASD experience limitations in fictional narratives.

Much remains unknown regarding the nature of the memory profile of individuals with amnestic mild cognitive impairment (aMCI). One of the questions is whether they first encounter an encoding/storage defect or retrieval memory profile difficulties.

The present study aimed to shed light on this by evaluating learning strategies and memory process deficits in individuals with aMCI and Alzheimer’s disease (AD).

The Shiraz Verbal Learning Test (SVLT) was used to assess and compare verbal memory performance and learning strategies among three groups of individuals, including patients with aMCI, AD cases, and healthy individuals. The study groups were compared using most indices of the SVLT.

A pattern of memory impairment was found in the aMCI group, and the indicators included defects in immediate learning, a poor learning slope, rapid forgetting, and a poor function in delayed recall. This was similar to the representations of the individuals with AD. However, the aMCI group acted differently from the AD and healthy groups when it came to learning strategies. Specifically, they mostly used serial clustering. Furthermore, the results of serial position effects showed no significant difference between the three groups in terms of primary/recency effects.

The findings of the present research suggested that individuals with aMCI, similar to patients with AD, initially develop defects in encoding and storage (to a lesser degree), followed by retrieval memory problems. Our results also supported that SVLT can be a reliable diagnostic tool to estimate aMCI progression or the prodromal stage of AD type dementia.

Dementia is a growing public health problem worldwide, and its early detection can help to manage the disease more effectively. This study aimed to validate the Persian version of the Telephone Interview for Cognitive Status-modified (TICS-m) questionnaire in older adults in the northeast of Iran.

This cross-sectional study was accomplished as part of the Neyshabur Longitudinal Study on Ageing (NeLSA) from January to May 2019. The translated Persian version of TICS-m was tested for content and face validity. The construct validity of the questionnaire was also assessed using exploratory factor analysis (EFA) with the extraction method of principal component analysis (PCA) and Oblimin rotation.

A total of 210 community-dwelling adults (aged ≥ 50; mean age: 59.6 ± 6.8 years) were registered in the NeLSA. The content validity ratio (CVR) of all items in the TICS-m questionnaire was higher than 0.62. The content validity index (CVI) of the three items was less than 0.78; so, these items were revised and replaced with alternative words. The face validity of the questionnaire was also confirmed. According to the results of EFA, the six extracted factors accounted for 68.8% of the total variance.

Our results revealed that the construct validity of the Persian version of the TICS-m is satisfactory.

Despite the high prevalence reported in the literature, there is a paucity of indigenous diagnostic tools to assess depression severities among the Nigerian population.

This study aimed to develop and validate a depression scale entitled Redeemer’s University Depression Scale (RUDS).

This research had four stages. The first stage involved the initial generation of 32 items based on a literature search. In the second stage, the items were reduced to 21 using content validity/expert assessments. In the third stage, the 21-item RUDS was administered to 86 University undergraduates and refined through an exploratory factor analysis (EFA). Also, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s Test of Sphericity (BTS) measured the factorability. At the fourth stage, 456 undergraduates responded to the 19-item RUDS, Center for Epidemiologic Studies Depression Scale (CES-D), and General Health Questionnaire (GHQ-12).

The observed KMO measure was .88, and a significant sphericity test was observed (χ2 = 1133.647, df = 210, P = 0.000). The principal component analysis (PCA) extracted four components from items whose eigenvalues exceeded 1. Nineteen of the 21 items loaded best in the first component, two in the second component, and one on the third and fourth components. The scree plot analysis retained one component (depressive symptoms). Item-total correlation further showed that the values of two items in the first component fell below the very good discrimination and were deleted from the scale. The RUDS had a Cronbach’s alpha of 0.91, concurrent validity of r = 0.787, P = 0.000. Also, r = 0.521 and P = 0.000 were observed between RUDS and CES-D, and between RUDS and GHQ-12, respectively.

The RUDS is gender-sensitive, has acceptable psychometric properties, and is recommended as a diagnostic tool for assessing depression in adolescents and adults.

Separation anxiety disorder is considered as the most common anxiety disorder in childhood. Failure to treat this disorder in early age can be converted into a risk factor for childhood and adolescent psychiatric disorders.

This study aimed at investigating the effect of parent-child interaction therapy on reducing the symptoms of separation anxiety disorder among the nurses' children aged between 3 and 6 years old working in educational hospitals in Qazvin.

The intervention was designed as pre- and post-test along with the control group. The sample included 67 children aged 3 - 6 years' old who were divided into intervention and control groups using the blocking method. The intervention consists of three steps: child directed interaction, bravery directed interaction and parent directed interaction which was performed for 8 sessions per weak. No intervention was performed for the control group. The obtained data were collected using the Spence questionnaire (parents' version) and the results were evaluated.

Intervention therapy significantly reduced the symptoms of separation anxiety in the intervention group at the post-test stage compared to the control group. The mean of separation anxiety decreased from 10.82 ± 0.62 to 7.69 ± 0.52 in the intervention group.

Parent-child interaction therapy can be used as an effective treatment plan to reduce the symptoms of separation anxiety disorder among preschool children.

The COVID-19 pandemic and the concomitant quarantine have significantly reduced old adults’ independence in doing daily or functional activities. Thus, they require more support and help at home. Because of the effect of the disease’s progression and the adverse effects of quarantine on patients’ functional status, old adults’ caregivers might have been affected too.

The present research aimed to explore the role of the caregiving burden in the relationship between old adults’ functional status and caregivers’ mental health.

The research population comprised caregiver families of old adults afflicted with chronic nervous diseases during the pandemic. To this aim, a sample of 249 caregiver families of old adults suffering from Alzheimer’s disease, Parkinson’s disease, or stroke participated in this study. Data were collected using three online questionnaires of Lawton’s instrumental activities of daily living scale (IADL), Novak’s caregiver burden inventory, and Goldberg’s mental health questionnaire. Data analysis was administered by Pearson’s correlation coefficient and structural equation modeling (SEM).

Correlation analysis and SEM results showed that the patients’ functional status and caregivers’ mental health had a significant, positive correlation, which was mediated by the caregiving burden variable.

It can be concluded that better functional status of old adults can lead to a lower caregiving burden. Also, it can significantly improve caregivers’ mental health and increase the old adults’ and caregivers’ quality of life.

The prevalence of the Coronavirus disease 2019 (COVID-19) pandemic, as one of the biggest global health threats, has had psychological impacts on healthcare workers (HCWs) and all aspects of their mental health, particularly resilience.

This study aimed to investigate the relationship between mental health and resilience in prehospital emergency medical services (EMS) practitioners.

This descriptive/analytical cross-sectional study was conducted in 2020 using a web-based questionnaire, wherein the data were collected from a total number of 115 EMS practitioners working in 115 EMS stations in Golestan province, northern Iran, selected using convenience sampling. The data collection tools were also the General Health Questionnaire-28 (score range: 0 - 84) and the Connor-Davidson Resilience Scale (score range: 0 - 100). The relationship between both questionnaires was then examined by structural equation modeling via maximum likelihood estimation. In addition, multiple linear regression (MLR) was applied to reflect on the factors affecting the resilience mean score.

The mental health and resilience mean scores in the EMS practitioners were 25.73 ± 8.90 and 72.25 ± 12.63, respectively. Furthermore, 43.5% and 49.6% of the subjects had good and mild mental health conditions, respectively. The correlation coefficient between both questionnaires (-0.51) revealed that mental health deterioration diminished resilience in the EMS practitioners. Additionally, the type of employment and mental health mean score had a significant effect on the resilience mean value (R2 in MLR = 0.54).

The study results demonstrated that more than half of the EMS practitioners had moderate mental health status, and their resilience mean score was high. Therefore, it is suggested to evaluate the prevalence of other common types of mental problems, such as anxiety, depression, and sleep disorders, in HCWs during the COVID-19 pandemic at the national level in future studies.

During the pandemic of COVID-19, some countries imposed lockdown restrictions on their cities to stop the outbreak of the virus. However, this mandatory lockdown was not imposed by all countries.

The purpose of this study was to investigate the effects of the induced-compliance situation generated by not imposing the lockdown restrictions during the COVID-19 pandemic on individuals' COVID-19 perceived risk and practicing the World Health Organization preventive actions, considering the moderating role of gender.

The research was conducted through a causal-comparative method. Participants were 320 social media users who were randomly selected to complete the justification of COVID-19 perceived risk and COVID-19 preventive action implementation questionnaires. Instruments' validity and reliability were confirmed through confirmatory factor analysis and Cronbach alpha.

The analysis of variance (ANOVA) showed significant interactive effects of gender and work attendance on the justification of COVID-19 perceived risk so that the highest rate of justification was applied by males who were required to attend their workplace physically. The ANOVA results showed the significant main effects of gender and work attendance on the action. Based on these findings, the lowest rate of preventive actions belonged to males and those who attended their workplace physically.

It is concluded that not imposing the lockdown restrictions, other than its direct role in increasing social contacts and the probability of virus spread, also lowers preventive actions implementation. This could happen due to belief modification to eliminate the undesirable state of cognitive dissonance that emerged from the induced-compliance situations.

Sleep quality and depression in late adulthood, especially in patients with diabetes mellitus (DM), may affect quality of life and active ageing.

This research aimed to examine the association between sleep quality, depression, and DM in older adults.

This case-control study is performed on people aged 60 years and over living in Amirkola, north of Iran. Participants were divided into two equal groups randomly, based on DM's status. Sleep quality was assessed using the Pittsburgh sleep quality index, and depression was evaluated using the Geriatric Depression Scale.

Totally, 800 older adults were examined. The results showed that in both groups, with or without DM, people with depression had poorer sleep quality (P < 0.001). Logistic regression analysis revealed the significant effect of female gender (OR = 2.36; 95% CI: 1.70 - 3.27) and depression (OR = 1.85; 95% CI: 1.37 - 2.51) on sleep quality of older adults (P < 0.001).

Older people with or without diabetes were more likely to present poor sleep if they had depression, and DM didn’t significantly affect sleep quality.

Misophonia is a disorder in which people show negative emotions such as anger, disgust, and anxiety about certain sounds, such as mouth and nose sounds, as well as some repetitive sounds. This disorder has a high prevalence and causes many problems for patients.

This study aimed to examine and compare the effectiveness of two therapies, including online group-mindfulness and acceptance‐based therapy (OG-MACT) and online group-cognitive-behavioral therapy (OG-CBT) in patients with misophonia.

This study was a two-group random assignment pretest-posttest design. Thirty-eight participants were recruited using convenience sampling and randomly assigned to OG-CBT (n = 19) and OG-MACT (n = 19) groups. The statistical population included patients with misophonia (a score higher than seven on the Misophonia Questionnaire) referred to the Tehran Institute of Psychiatry from October to December 2019. They were asked to respond to online self-report questionnaires evaluating misophonia, distress tolerance, quality of life, depression, anxiety, and stress scale in three stages, including before treatment sessions, one week after the end of sessions, and during a three-month follow-up.

The difference in the mean scores of the scales at different times did not differ according to the type of treatment group (OG-CBT versus OG-MACT). The results showed that the effect of time was significant on misophonia scores. Over time, this finding also applies to depression, anxiety, and stress subscales in the distress tolerance questionnaire. However, there was no significant difference in the quality of life over time. The changes in misophonia were clinically significant in 53% of OG-MACT members and 69% of OG-CBT members.

According to the findings, the two online group therapies of CBT and MACT effectively reduced the symptoms of misophonia.

An estimated 25% to 30% of patients presenting to family physicians have psychiatric disorders (PDs). Accurate diagnosis of various PDs requires valid and well-designed screening tools and psychiatric interviews. There is no rapid and low-cost tool for PD screening in primary health care (PHC).

To determine the validity and psychometric properties of the Iranian Rapid Assessment for Psychiatric Illness Screening Instrument (IRA-PISI) in PHC.

This psychometric study was performed among a convenience sample of 257 outpatients presenting to the first-line health services in Tabriz. Psychiatric interviews via DSM-5 were used as the gold standard. The validation process included the face validity (literature review and expert comments), content validity, estimating the best cutoff point, and measuring the sensitivity and specificity of the questionnaire compared to the psychiatric interview. Temporal and internal reliabilities were measured by test-retest and Cronbach's alpha coefficient, respectively.

The final questionnaire consisted of 14 items (with a score range of 14 to 70) after removing seven questions from the initial questionnaire (21 items) during the validation process. The sensitivity and specificity of the questionnaire compared to psychiatric interviews were 83.62% and 75.17%, respectively. The overall relevance and the best cutoff point (score) were 0.91% and 28, respectively. Interclass correlation coefficient (ICC) and Cronbach's alpha coefficient were 96% and 83%, respectively. The ICC of items/questions ranged from 89.3 to 100.

The IRA-PISI has appropriate validity and reliability for screening common PDs among outpatients presenting to first-line healthcare providers.

Adolescents do not have adequate safe traffic behaviors. This cross-sectional study investigated safe traffic behaviors of 414 male high school students of Hamadan, Iran, randomly selected using the multistage sampling method in 2020. This study used a researcher-made questionnaire based on the theory of planned behavior about safe traffic behaviors with Cronbach’s alpha coefficient of 0.95, content validity ratio of 0.70, and content validity index of 0.85. There was a strong positive correlation between safe traffic behaviors with perceived behavioral control and intention. Adolescents can be influenced to internalize behavioral safety precursors that can lead to a sustained increase in safe traffic behaviors and the prevention of road traffic injuries.

Cognitive-behavioral therapy (CBT) is one of the most important well-known treatments for obsessive-compulsive disorder (OCD), including the scrupulosity type. Technology-based interventions can increase the effects of CBT by different methods. The aim of this study was to examine the effectiveness of online cognitive therapy in a Muslim patient with scrupulosity employing in-vivo exposure, with the therapist virtually present and using a treatment application.

The patient was a 37-year-old female diagnosed with scrupulosity in OCD by a psychiatrist. The patient’s symptoms were measured at baseline for 6 weeks then underwent 12 sessions of CBT with the therapist present via video call. All the exposure sessions were conducted in real situations triggering thoughts and compulsions. The therapy application was also used between sessions as an assistive treatment tool.

The results of this treatment model showed a decrease in obsessive symptoms and beliefs and anxiety and depression symptoms at the end of treatment and after a 3-month follow-up. Moreover, the quality of life was improved in the patient.

Dear Editor, The COVID-19 pandemic has posed remarkable challenges to health care systems worldwide; hence, adaptation to the consequences of this pandemic requires novel treatment and prevention strategies. One of such challenges has been to manage opioid dependency during the COVID-19 pandemic. Individuals with substance use disorders (SUDs) are at greater risk for infection for several reasons, including clinical, psychological, and psychosocial conditions, socio-economic changes during the pandemic, and difficulties in access to treatment (1). Individuals with SUDs are stigmatized and marginalized populations with less access to health care, lower health status, and weaker immune system functions because of malnutrition, substance abuse, chronic infections, and various respiratory/ cardiovascular/ renal/ and metabolic problems. Moreover, they experience a wide range of psychiatric comorbidities and a higher rate of smoking and alcohol consumption, and are more likely to experience homelessness or incarceration. Such conditions may complicate superimposed infection with COVID-19 and higher COVID-19- related complications and death (2). Strategies such as social distancing or quarantine and the pandemic outbreak itself have been associated with negative emotions such as irritability, anxiety, and sadness. Moreover, economic stress and job loss during the pandemic have increased the prevalence of domestic and social violence. Further, reduced access to drugs/physicians/clinics has exacerbated drug use and led to a relapse of substance abuse, even in those abstained from drugs for a long time (3). On the other hand, individuals with opioid disorders are at risk for fatal intoxication during the COVID-19 pandemic for many reasons, including increased use of illicit drugs, social isolation, and increased likelihood of overuse, economic insecurity, and medical care disruption. A study in Kentucky showed that the number of emergency medical services for opioid overdose with and without transfer to the emergency department increased by 17 and 71%, respectively, and that the number of suspected cases of opioid overdose with deaths at the scene increased by 50% during the COVID-19 pandemic (3). Another study in Iran revealed that the COVID-19 pandemic was associated with the most frequent deaths from methanol toxicity. This study revealed that above 2,500 individuals referred to hospitals during a month due to toxic alcohols, above one thousand persons were hospitalized, about 500 patients lost their lives, and 60 survivors became blind (4). The early detection of COVID-19 infection is vital in people with SUDs for several reasons. Many homeless substance abusers live in crowded groups in shelters with minimal or no air conditioning. Moreover, poor hygiene, high-risk behaviors such as sharing drug consumption materials and equipment, and intoxication expose these individuals to a greater risk for COVID-19 infection. Since these people are scattered in the community, they are more likely to reveal transmission to others during the prodromal period (2). While the early detection of COVID-19 infection is vital in this population, it poses challenges for several reasons. As the substance withdrawal or intoxication may mimic COVID-19 symptoms, diagnosing COVID-19 in individuals using substances is not always straightforward. Furthermore, some laboratory tests in SUDs overlap with COVID-19 infection. For example, lymphopenia, leukopenia, elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT), eosinopenia, and decreased blood oxygen saturation are common COVID-19 symptoms in substance users with no COVID-19 infection. Accordingly, physicians should be aware of the possible overlap of symptoms and tests in substance users and patients with COVID-19 to avoid ignoring or over-diagnosing patients. Since COVID-19 does not affect the eye pupils, pupil size is the best guide to differentiate opioid withdrawal or intoxication symptoms from those of COVID-19 infection (2). Appropriate interventions for drug users can be classified into three main categories. The first category is to reduce the risk of providing care to drug users and includes the following measures: applying standard hygiene protocols in care settings with outstanding recommendations and equipment for hand washing and disinfection, preparing masks, hand gels, and essential information about COVID-19 for attendees at the centers, recommending drug users to avoid sharing cigarettes, pipes, water pipes, hookahs, and other equipment needed for drug use, providing clean needle and syringes, attending care centers only at pre-scheduled intervals and observing social distancing, having scheduled delivery of medicines at home for such individuals, teaching clinics to complete the tablet delivery process with minimal hand contact, and limiting the number of clients, observing social distancing in service offering places (5). The second major category is the application of protocols to provide opioid replacement therapy. Since achieving an adequate maintenance dose of buprenorphine is faster and safer than methadone, and the withdrawal symptoms of buprenorphine are milder than methadone, buprenorphine seems to be the best alternative treatment for those who want to initiate treatment. Furthermore, polypharmacy caused by COVID-19 infection has more negligible effects on buprenorphine metabolism than methadone; hence, the risk of its withdrawal or toxicity is lower, and there are fewer risks in overdose cases. However, switching to other opioids is not recommended for patients already on methadone treatment. Moreover, since the termination of methadone maintenance therapy (MMT) and buprenorphine maintenance therapy (BMT) arouses stress and requires more attendance at medical centers, it is not recommended during the COVID-19 pandemic (2). Moreover, a more flexible opioid replacement program is recommended during the COVID-19 pandemic, and medications can be provided for a more extended period. Prolonged-release buprenorphine (PRB) products such as long-acting (monthly) injectable or transdermal buprenorphine which provide effective therapeutic plasma levels of the drug by weekly or monthly injections are other alternative choices; such products not require frequent visits nor dispensing of large quantities of take-home medication. These options have been at the forefront of the COVID-19 risk response in some European and American countries (5). Patients should be informed as there is a risk of overdose with increasing access to medication at home, and, if necessary, naloxone can be prescribed at home for high-risk patients (6). The third main category of interventions for substance abusers is psychosocial interventions. Internet-based psychotherapy is highly recommended during the COVID-19 pandemic. Online counseling, including phone calls, video chats, and text messages, well provides the grounds for cost-effective psychological evaluation and treatment. Cognitive-behavioral therapy, including coping skill training and crisis intervention, has been introduced as an effective intervention for drug abusers. Since social and family support is an essential predictor of adherence to treatment and the main factor of psychological resilience to disaster, these individuals need more social support during pandemics (2). In conclusion, health care professionals dealing with SUDs should be aware of the risks and challenges they will face during and after the COVID-19 pandemic. Addiction care should be reinforced, not delayed to prevent the complications of SUD and COVID-19 and the transmission of the coronavirus.