Iranian Journal of Psychiatry and Behavioral Sciences
Volume:16 Issue: 3, Sep 2022

Difficult life experiences in adulthood, such as caregiving of an individual with traumatic spinal cord injury (TSCI), constitute a challenge to the self and identity.

This study aimed to explore self-perception from the viewpoints of informal caregivers of individuals with TSCI.

Twelve informal caregivers of individuals with TSCI participated in this qualitative study. The researchers purposively selected the participants and conducted in-depth semi-structured interviews for data collection. They recorded the interviews and transcribed them verbatim. The researchers analyzed the data according to the qualitative content analysis method.

The findings included “the self-being” as the main category and “self-essence” and “self-possession” as higher-level subcategories and their 25 related lower-level subcategories.

The participants might perceive themselves as an eternal and granted “self-essence” or may perceive it as perishable and unstable “self-possessions.” Depending on self-perception, self-confidence and self-worth were maintained under any circumstances or fluctuated according to defects or lack of self-possessions.

Currently, in addition to the undeniable impact of cultural factors on mental health problems’ diagnosis and treatment methods, the use of rapid, short, and intervention-based instruments can be effective in the accurate diagnosis of mental health problems, especially in the health system of developing countries.

This study aimed to validate an instrument developed for screening patients with common mental health problems using item response theory (IRT).

The study was conducted in Semnan province (with Persian ethnicity), Iran, from August 2017 to February 2018. A 101-item tool consisted of district common mental health problems (i.e., depression, anxiety, and obsession), along with a functional checklist. The development of the instrument involved a pilot study and psychometric testing. The IRT-based analysis was used as the item-reduction method to evaluate the shortened tool as an appropriate screening tool. The participants were healthy individuals and patients with depression, anxiety, and obsessive-compulsive disorder (OCD). The data were analyzed using Stata software (version 15.1).

The study participants were 160 individuals (58.2% male) with a mean age of 36.3 ± 11.2 years. All item impact factors were within the range of 1.8 - 5. The mean values of clarity, simplicity, relevance, and scale-level content validity index/averaging calculation method of the instrument were 96.73 ± 0.70, 97.64 ± 0.61, 98.2 ± 1.9, and 97.09 ± 0.63, respectively. Cronbach’s alpha and internal consistency coefficient were 0.88 and 0.7. Moreover, 13, 5, and 12 items were excluded using IRT from depression, anxiety, and OCD dimensions based on the threshold criteria, respectively.

Iranian screening tools for mental health problems can provide qualified information with the least error and the most precision in appropriate early diagnosis and decrease the burden of mental health problems in the national healthcare system.

According to the literature, pre-hospital emergency medicine clinicians’ mental health has most likely been ignored during the COVID-19 outbreak.

This study aimed to investigate the correlation between mental health and corona anxiety among pre-hospital emergency medicine clinicians during the COVID-19 outbreak in Isfahan, Iran.

A cross-sectional study was conducted in Isfahan, Iran, from May to July 2020. All participants voluntarily participated in this study, and an informed consent was obtained. Data collection was done through completing two questionnaires, including the Corona Disease Anxiety Scale (CDAS) and the General Health Questionnaire (GHQ). Data were analyzed with SPSS version 18 using the Pearson correlation test and multivariate linear regression.

A preliminary data analysis of CDAS and GHQ showed a significant correlation between the total score of COVID-19 anxiety and general health (r = 0.6, P < 0.001). Also, multivariate analysis showed that field of study (B = 0.13; P-value = 0.005) and COVID-19 anxiety were significant predictors for general health (B = 0.6; P-value < 0.001).

According to the findings, the higher the anxiety score, the poorer one’s general health and the more likely they are to have mental disorders. Therefore, it is recommended to provide mental health services for pre-hospital emergency medicine clinicians during the COVID-19 pandemic.

The precise differentiation of schizophrenic patients with positive and negative symptoms is still challenging; hence, psychiatrists mainly focus on diagnosing schizophrenic patients with positive symptoms. However, schizophrenic patients with negative symptoms have revealed remarkably poor outcomes.

This study aimed to differentiate schizophrenic patients with positive and negative dominant symptoms quantitatively by classifying their electroencephalography (EEG) features.

In this study, 36 patients with schizophrenia and 26 age-matched control subjects voluntarily participated. Their EEG signals were captured and characterized by elicited multiscale entropy to decode the number of irregularities captured in each EEG channel. The principal component analysis (PCA) was deployed to decrease the dimension of elicited features, and the reduced features were applied to three Gaussian Naive Bayes classifiers, each of which was trained for a specific class.

The classification of the three groups resulted in 77.86% accuracy, while this accuracy in the schizophrenic groups provided 65% accuracy. In the resting state, the normal and schizophrenic subjects were differentiated by a high rate (95.43%).

Exploiting information-theoretic features of the EEG signals over the scalp and automatic classification of these features, we can well-differentiate schizophrenic patients with different dominant symptoms. Moreover, better classification results can be achieved by passing the EEG features through PCA.

Suicidal ideation, as a risk factor for psychopathology, has diverse psychological and social impairments. Suicidal ideation and perfectionism are closely related to self-criticism.

In the present study, we investigated how self-criticism mediated the relationship between suicidal ideation and perfectionism.

This descriptive study was performed on 300 students selected from the University of Science and Culture. The data collection tools were the Beck Scale for suicide ideation (BSS), the Multidimensional Perfectionism Scale (MPS), and the Self-criticism Scale (FSCRS). Data were analyzed using Pearson’s correlation coefficient and path analysis.

The results showed that suicidal ideation had a significant direct effect on self-oriented perfectionism (β = 0.18, P < 0.01) and socially prescribed perfectionism (β = 0.23, P < 0.01). Also, perfectionism had a significant indirect effect on suicidal ideation through mediating role of self-criticism.

According to the findings, both perfectionism and self-criticism play an important role in suicidal ideation. The inability to accept shortcomings or flaws and having rigid, unrealistic standards along with self-blame or self-criticism caused by a sense of incompleteness and deficiency feeling in various situations can provide ground for emerging suicidal thoughts and behaviors.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Various factors can delay the timely diagnosis of adult ADHD. The brown attention deficit disorder scales (BADDS) is a consistent measure of attention deficit disorder (ADD) across the life span.

This article aims to examine the reliability and validity of a Persian version of the BADDS.

A total of 100 participants were enrolled in this descriptive study by convenience sampling. Cases were recruited from the adult ADHD outpatient clinic of Roozbeh psychiatry hospital in 2019. Controls were from the caregivers of patients presenting to Roozbeh general psychiatry outpatient clinic. The conners' adult ADHD rating scale was used to measure concurrent validity.

Cronbach's Alpha was 0.979 for the test, ranging from 0.888 to 0.942 for the clusters. Also, the intra-class coefficient (0.977) confirmed strong internal stability. For the cut-off point of 55, the sensitivity was 96%, and the specificity was 74%. Our study demonstrated a significant relationship between the C scale and the D scale of the Conners' test and the total score of the BADDS questionnaire (r = 0.61 and r = 0.64, respectively), verifying the concurrent validity of the instrument. Construct validity was evaluated by the t-test. All five clusters' total and subtotal scores were significantly higher in the patients compared to the controls.

The Persian version of BADDS is reliable and valid and can be used in clinical settings.

Substance use disorders (SUDs) are associated with high burdens for countries. It has been shown that the integration of SUD services into primary health care (PHC) can improve the early identification and treatment of people with SUDs. However, there are many barriers, including negative attitudes of health professionals about SUDs contributing to suboptimal care.

This study aimed to investigate the effectiveness of a training program on physicians’ attitudes toward providing SUD services in PHC.

Physicians working in community health centers (CHCs) of Khorasan-e-Razavi Province in Iran were purposefully recruited to participate in a 10-hour in-person training program providing education on understanding the nature of SUDs, basic communication skills, motivational interviewing, and evidence-based SUDs interventions between October and December 2018. Knowledge and attitudes of participants were measured before and after training workshops.

The knowledge of physicians was significantly increased after completion of training. Moreover, participants’ attitudes toward the integration of SUD services into PHC significantly improved from 96.23 ± 0.90 to 109.22 ± 0.60 at the end of the workshop. In the multivariable linear regression, previous SUDs’ training experiences, being female, and years of work experience in PHC were significantly associated with more favorable attitudinal changes among the participants.

Our results suggest the effectiveness of the training intervention in improving the attitudes toward SUD services among PHC physicians in Iran. Further controlled studies are needed to investigate the effectiveness of training on the attitudes of PHC professionals in the long term and its role in their practice.

A number of studies have found a possible linkage between obsessive-compulsive symptoms (OCS) and schizotypy. Inferential confusion (IC) can explain the reasoning processes behind both of them. The mechanisms by which some people become more or less inferentially confused are unknown. Dissociation is one of the variables that may contribute to these mechanisms.

This study aimed to examine the fitness of the proposed model about the effect of dissociative experiences on the relationship between OCS and schizotypy by considering the mediating role of IC and moderating role of negative affect (NA).

Our study sample consisted of 341 students, selected using cluster sampling method. Data were analyzed using Amos-22 software by structural equation modeling (SEM).

The study results showed that the data were fitted with the proposed model. Findings about the negative affect’s moderating role indicated that among all paths in the model, only the IC path to OCS was moderated by negative affect.

It was concluded that a tendency to experience dissociative states may have increased the vulnerability of individuals to IC. Inferential confusion, in turn, may have developed unusual ways of thinking about reality, which is a common feature of obsessive-compulsive spectrum and schizotypal personality traits.

Coronavirus disease 2019 (COVID-19) is associated with a number of psychiatric problems in patients; however, mental healthcare in these patients does not appear to be adequate.

This study aimed to evaluate the extent of psychological care provided to COVID-19 patients admitted to the hospital and the most common reasons for psychiatric counseling.

This study examined the electronic medical records of all COVID-19-positive patients admitted to Rasoul-e-Akram hospital in Tehran, Iran, within April 1 and September 30, 2020 (approximately 2200 cases).

Psychiatric consultation was requested for 5.45% of admitted patients with COVID-19 diagnosis based on a positive real-time reverse transcription-polymerase chain reaction. More than half of those who received psychiatric counseling had a previous psychiatric disorder. The most common reason for requesting psychiatric counseling in patients with a previous psychiatric disorder was the patient’s evaluation and management; the most common reason in patients without a psychiatric disorder was agitation and lack of cooperation. The most common diagnosis in patients with a positive history of psychiatric disorder was bipolar disorders (33.9%), followed by opioid use disorder (29%). Adjustment disorder (54%) and delirium (26%) were the most common diagnoses in patients without a history of psychiatric disease.

The current study showed that psychiatric counseling in COVID-19 patients was limited to a small number, including those with a positive history of psychiatric illnesses and prominent psychiatric symptoms.

Despite the importance of the parents’ role in socializing children, there is no specific tool in this field in Iran. The Coping with Children’s Negative Emotions Scale (CCNES) is a tool to assess the parents’ responses to children’s emotions.

This study evaluated the reliability and factor structure of a Persian version of the CCNES.

This study assessed the psychometrics of the CCNES with 400 mothers after translation/back-translation and adaptation into Persian. Mothers were recruited if they had a child aged 3 - 6 years old, lived in municipal district 6 of Tehran and scored less than 25 in the General Health Questionnaire.

The results revealed the internal consistency and confirmed the test-retest reliability of the Persian version of CCNES. The exploratory factor analysis yielded a model with six-subscales. The Cronbach's alpha coefficients of the obtained factors ranged from moderate to good/very good: Distress reactions (DR, 0.65), punitive reactions (PR, 0.80), minimizing reactions (MR, 0.80), ignoring reactions (IR, 0.8), expressive encouragement (EE, 0.84), emotion-problem focused reactions (EPFR, 0.88).

According to the results, the Persian version of CCNES is a reliable and valid instrument for mothers to assess their responses to children’s emotions. Similar research is recommended for fathers.

Toxoplasma gondii is a neurotropic parasite with lifelong persistence in the host brain. Many researchers suggested toxoplasmosis as a risk factor for the development of Alzheimer's disease (AD); however, the link between them has not been fully elucidated.

The present study was designed to investigate the effects of chronic toxoplasmosis infection with Types I (RH), II (PRU), and III (VEG) strains alone and in combination on cognitive impairments in Alzheimer's rat model.

Seven months after the inoculation of the strains, AD was induced bilaterally in rats by injecting human amyloid beta 1-42 (Aβ1-42) peptide into the brain hippocampus. Behavioral tests, including the elevated plus maze (EPM) and Morris water maze (MWM) were conducted 10 days after the AD induction.

Our findings showed that chronic infection with RH strain increased anxiety-like behavior in the Alzheimer's rats in the EPM. In agreement with EPM findings, rats infected with the RH strain exacerbated spatial learning disorders in the MWM test; however, it did not affect the spatial memory. Conversely, infection with the PRU strain significantly enhanced spatial learning without being able to improve memory impairments in the Alzheimer's rat model. Improvement in spatial learning and memory impairments were also observed in rats infected with PRU and VEG strains in combination.

Taken together, our findings suggest that chronic infection with PRU strain, as well as PRU and VEG strains in combination, can significantly improve cognitive deficits induced by Aβ1-42 in Alzheimer's rats, while RH strain plays a detrimental role in AD pathogenesis.

The high prevalence of insomnia in children and its adverse consequences on children and their family indicate that investigation about treatment of insomnia is necessary.

This research was conducted to compare the effectiveness of cognitive-behavioral therapy program for insomnia, named the KiSS program (Kinder mit Schafstörungen Programm) and reflexotherapy on insomnia in children.

The method of the present research was quasi-experimental in which a pretest, posttest and follow-up design was used in two experimental and two control groups. In order to perform this study among children of 8 to 10 years with insomnia referring to Medical & Psychology Clinic of Shokoufeh in, Tehran, Iran, within July to October 2021, 80 children were selected through the convenience sampling method based on inclusion and exclusion criteria and were assigned randomly into two experimental and two control groups. The Personal Information Questionnaire, Sleep Disturbance Scale for Children (SDSC), Child Symptoms Inventory-4 (CSI-4) were used to collect data. In the experimental groups, the KiSS program and reflexotherapy were performed. In the control groups, the interventions of watching cartoon in group and watching cartoon individually were performed. The data were analyzed with SPSS 22 using descriptive statistical indicators including mean and standard deviation as well as inferential statistics indicators, including mixed-design analysis of variance (ANOVA) method.

The results of data analysis showed that the KiSS program reduced mean scores of insomnia in the posttest stage significantly compared to the first control group and the changes in the follow-up stage remained stable. The mean scores of insomnia in reflexotherapy group also decreased significantly in the posttest stage than second control group. However, the effectiveness of the reflexotherapy intervention is temporary, and after two-months follow-up, the insomnia reappear in children.

Both the KiSS program and reflexotherapy can be used as uncomplicated and safe nondrug intervention to improve insomnia in children of 8-10 years. Nevertheless, the KiSS program showed more promising results.

The circumstances and needs of children with autism spectrum disorder (ASD) affect children and their families.

This study aimed to explore the challenges and needs of parents caring for children with ASD.

An exploratory qualitative method and the conventional content analysis method were employed in the present study. Participants were 18 parents with children with ASD in Tehran who were recruited by the accessible sampling method. To collect data, semi-structured, face-to-face, and in-depth interviews were used. The interviews were audio-recorded and transcribed verbatim into Microsoft Word software. Qualitative analysis was performed using the content analysis approach.

Parents had three main needs in caring for their children: (1) first, issues and problems related to diagnosis, treatment, and rehabilitation, including three categories (issues and problems of diagnosis and treatment, issues and problems of rehabilitation, and inadequate therapeutic support); (2) second, issues and problems related to parents, including four categories (parents’ lack of knowledge and awareness about ASD, lack of life skills, daily problems of parenting, and familial & marital issues); and (3) third, financial, cultural, and social issues, including two categories (financial problems and social & cultural problems).

The needs and challenges mentioned by the parents of children with ASD highlighted the need for medical, educational, and counseling services and emotional and material support from the community and the government. Planning and implementing support programs enable parents to face problems strategically, which ultimately improves their quality of life.

The complexities of the health care system have imposed complex ethical issues on nurses, resulting in moral distress in all categories of nurses with various specialties. Psychiatric nurses are also exposed to moral dilemmas because they care for vulnerable patients with delusions and suicidal ideation problems. Due to the different experiences of moral distress in different cultures, settings, and wards, we studied this phenomenon in Iranian psychiatric nurses.

We conducted this study to investigate the causes of moral distress in Iranian psychiatric nurses.

This qualitative study was conducted based on a conventional content analysis on 12 psychiatric nurses selected by the purposive sampling method in 2020 in Shiraz, Iran, considering the maximum diversity. Data were collected through semi-structured interviews with participants for an average of 40 - 60 minutes per interview until data saturation.

We obtained causes of moral distress from 7 categories and 20 subcategories. The categories included “lack of professional competence”, “organizational culture”, “individual factors”, “environmental and organizational factors”, “management factors”, “weaknesses in professional and effective communication”, and “observation of moral dilemmas by nurses”.

This study demonstrated various causes of moral distress that managers should consider by providing a safe environment and appropriate facilities for psychiatric nurses.

The coronavirus disease 2019 (COVID-19) pandemic can lead to psychological issues; however, few studies have evaluated the mental health status of COVID-19 patients after discharge from the hospital.

This study aimed to assess the psychological status of COVID-19 survivors and determine the risk factors associated with adverse psychological outcomes.

Through a web-based cross-sectional survey, the data were collected from 158 COVID-19 survivors one month after discharge from the hospital using demographic information, the Hospital Anxiety and Depression Scale (HADS), and the Posttraumatic Stress Disorder Checklist for the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (PCL-5). Data analysis was conducted in SPSS software (version 24) using logistic regression modeling.

The mean age of the participants was 42.02 ± 10.56 years, and the majority of patients were male (58.2%) and married (79.1%). According to the HADS, 32 (20.3%) and 21 (13.3%) patients had anxiety and depression, respectively. Using the PCL-5, 45 (28.5%) patients experienced posttraumatic stress disorder (PTSD) after discharge from the hospital. A positive history of psychiatric disorders, substance abuse, and smoking were the related risk factors for depression, anxiety, and PTSD (P < 0.05).

Based on the results, it might be concluded that COVID-19 survivors, especially the aforementioned groups, need more targeted interventions regarding psychological health during and after discharge to avoid COVID-19-related psychiatric injuries.

The pandemic of COVID-19 quarantined most of the world’s population, which severely impacted daily life, especially academic activities.

This study aimed to evaluate the sleep quality before and during COVID-19 quarantine and its relationship with family social support among university students.

This cross-sectional study was performed on 283 university students in Mashhad in 2020. A web-based questionnaire, including demographic information, Pittsburgh sleep quality index (PSQI) and Procidano Perceived Social Support from Family (PSS-Fa) questionnaires were sent to all students.

The prevalence of PSQI > 5 among students before the quarantine was 80.6% and reached 82.7% during the quarantine. The mean score of PSQI before the quarantine was 10.00 ± 4.30 and reached 12.30 ± 5.53 during the quarantine (P-value < 0.001). PSQI score before and during quarantine showed a significant inverse correlation with the PSS-Fa score. The sleep quality in those who did not leave quarantine at all was significantly higher than in those who did.

This study shows decreased sleep quality in the students during the quarantine. In addition, students with more family social support had higher sleep quality, which could indicate the high impact of family social support on the students’ quality of life.