Iranian Journal of Psychiatry and Behavioral Sciences
Volume:18 Issue: 4, Dec 2024

Context:

 Functional neurological disorder (FND) is common in neurology outpatient clinics, affecting approximately 6% of neurology patients. Functional neurological disorder is characterized by motor and sensory symptoms that cannot be explained by organic or structural neurological issues. These symptoms often mimic those of recognized neurological conditions, making diagnosis and treatment complex.

Evidence Acquisition: 

This study presents a comprehensive voxel-wise meta-analysis of structural brain changes in FND to explore potential quantitative measurements that could serve as biomarkers for different FND types. In this investigation, we systematically queried prominent academic databases using specific keywords: "FND", "somatization disorder", and "voxel-based morphometry (VBM) ". Additionally, we employed the BrainMap database to identify VBM data pertaining to FND. Our meta-analysis, performed using ES-SDM software, examined grey matter (GM) changes in FND patients. We also assessed the robustness of the results via Jackknife analysis and investigated unexplained variability using heterogeneity analysis.

Our meta-analysis revealed both positive and negative GM volumetric changes in different brain areas across various FND types. The robustness of the results was confirmed, and the assessment of bias and publication bias yielded no significant concerns.

These findings offer valuable insights into the neuroanatomical basis of diverse functional disorders, providing potential biomarkers. Moreover, the identified regions are associated with pain modulation, emotional processing, and cognitive functions, contributing to a better understanding of FND pathophysiology.

Family caregivers of stroke patients often experience a decline in quality of life (QOL) and resilience due to the challenges posed by the patient's disability, inadequate support systems, and difficulty adapting to the new circumstances.

This study investigated the impact of a self-care support program (SSP) for stroke patients and their family caregivers on improving their QOL and resilience.

This randomized controlled trial was conducted in Beesat Hospital, Hamadan, Iran, in 2022, involving stroke patients and their family caregivers. A total of 80 patients and 80 family caregivers were randomly assigned to either the intervention group or the control group. The intervention group received the SSP, which included four weeks of continuous face-to-face and telephone follow-up. The control group followed the routine care program provided by the neurology ward. The patients' quality of life was assessed using the stroke specific quality of life (SS-QOL) tool, while family caregivers' QOL and resilience were evaluated using the Short Form-12 and Sixbey 2005 tools, respectively, both before and after the intervention. Data were analyzed using descriptive and inferential statistics, including chi-square, paired t -tests, independent t -tests, and Fisher's exact test. The significance level was set at 0.05.

Among patients, the difference in the control group's total QOL score before and after the intervention was not statistically significant (P = 0.065), with scores of 83.77 ± 3.39 and 86.70 ± 8.25, respectively. Conversely, in the intervention group, the total QOL score significantly improved from 83.95 ± 1.43 to 119.72 ± 4.54 (P < 0.0001). For family caregivers, the total QOL score in the control group showed no significant improvement, increasing from 17.30 ± 1.60 to 18.17 ± 2.45 (P = 0.096). However, the intervention group experienced a significant increase in QOL scores, from 17.70 ± 1.11 to 25.37 ± 2.31 (P < 0.0001). Additionally, the resilience score in the control group slightly decreased from 129.15 ± 3.40 to 124.25 ± 5.31 (P = 0.12). In contrast, the resilience score in the intervention group increased significantly, from 130.25 ± 2.81 to 194.20 ± 2.15 (P < 0.0001).

The findings of this study demonstrate the effectiveness of the SSP in improving the QOL of stroke patients and their family caregivers while significantly enhancing the resilience of family caregivers. It is recommended that medical and treatment teams prioritize involving family caregivers in care plans for debilitating diseases such as stroke and consider integrating SSPs into standard care protocols.

Mental disorders, particularly schizophrenia, present significant challenges in modern medical and psychological sciences. Addressing these disorders effectively requires not only technical expertise but also continuous, strong family support. Despite the crucial role of familial support in maintaining treatment continuity for individuals with schizophrenia, this area faces numerous challenges that demand in-depth examination and strategic intervention.

This study explores the challenges involved in sustaining familial support for individuals with schizophrenia.

This qualitative study employed content analysis and gathered data through semi-structured interviews with 20 families of individuals diagnosed with schizophrenia and healthcare professionals at Roozbeh Psychiatric Hospital in Tehran, Iran. Participants were selected through purposive sampling, and data analysis followed the conventional content analysis principles of Lundman and Graneheim.

The analysis identified four main categories: (1) the nature of the disease; (2) care burden; (3) cultural barriers; and (4) challenges within the healthcare system.

Providing effective family support requires technical expertise in schizophrenia care, alongside ongoing policy measures aimed at addressing obstacles and enhancing familial involvement. These findings offer valuable insights for improving family support programs and mental health policies to better serve individuals with schizophrenia, thus contributing to overall community mental health.

The hierarchical taxonomy of psychopathology (HiTOP) aims to address the limitations of traditional nosologies. This model organizes borderline personality disorder (BPD) along two dimensions: The distress sub-factor of negative affectivity and antagonism.

For the HiTOP model to be effectively integrated into clinical practice, its clinical utility must be established. This study aimed to assess the clinical utility and diagnostic validity of HiTOP in diagnosing BPD.

This cross-sectional study included 113 inpatients with a primary diagnosis of BPD and 100 nonclinical individuals. The Structured Clinical Interview for diagnostic and statistical manual of mental disorders (DSM-5) Personality Disorders, Structured Clinical Interview for DSM-5-Screening Personality Questionnaire, Personality Inventory for DSM-5, and the Personality Assessment Inventory–Borderline Features Scale were used for BPD diagnosis and severity assessment. Multiple regression analyses were conducted on BPD-HiTOP-related and other maladaptive personality domains to identify the best predictive factors for BPD. Borderline personality disorder scales were created based on the regression algorithms. Receiver operating characteristic (ROC) analyses and diagnostic efficiency statistics were used to assess the relative diagnostic efficiency of these scales.

Regression analyses indicated that negative affectivity and disinhibition significantly predicted BPD severity, whereas antagonism did not. The ROC analysis demonstrated that both the HiTOP-BPD algorithm (antagonism/negative affectivity) and the proposed BPD algorithm (disinhibition/negative affectivity) showed excellent accuracy. Regarding diagnostic validity, the proposed BPD algorithm exhibited higher sensitivity and specificity levels compared to the HiTOP-BPD algorithm.

These findings support the clinical utility of the disinhibition-negative affectivity algorithm in diagnosing BPD.

Suicide, defined as the intentional act of self-inflicted death, constitutes a significant global public health burden. Every year, over 700,000 individuals worldwide die by suicide. Studies in Iran have reported an alarming prevalence of suicidal behavior among students, with estimates of suicide attempts ranging from 1.8% to 3.5%, and suicidal ideation rates fluctuating between 6.2% and 42.7%. This complex phenomenon is influenced by a wide array of factors. A major challenge to effective suicide prevention strategies is the limited understanding of the mechanisms that lead from suicidal ideation to actual suicide attempts.

This study aimed to investigate the relationships between suicidal ideation, suicidal behaviors, and the constructs of the three-step theory within a student population.

A cross-sectional design was employed, with convenience sampling enrolling 260 students from Zanjan University of Medical Sciences. Students consented to participate and completed various questionnaires, including the Beck Suicide Ideation Scale (BSSI), the Inventory of Motivations for Suicide Attempts (IMSA), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Symptom Checklist-25 (SCL-25), the Acquired Capability for Suicide Scale (ACSS), and a single-item suicide attempt question. The participants ranged in age from 18 to 52 years (mean: 23.62, standard deviation: 5.48), with 75% of the sample being female, and 85% single. Data analysis was conducted using SPSS 24 and AMOS 24 software.

Correlation analysis revealed that psychic pain, hopelessness, and low belongingness were significantly and directly correlated with both suicidal ideations and behaviors (all P-values < 0.05). Structural equation modeling results demonstrated that the combination of pain and hopelessness directly predicted suicidal ideation (β = 0.318, P < 0.001) and low belongingness (β = 0.867, P < 0.001). These factors indirectly predicted suicidal behavior through suicidal ideation, capability for suicide, and low belongingness (β = 0.406, P < 0.001). Additionally, suicidal ideation was a strong direct predictor of suicidal behavior (β = 0.556, P < 0.001), and low belongingness directly predicted suicidal behaviors (β = 0.226, P < 0.001). However, the capability for suicide did not statistically predict suicidal behavior within this student sample.

The findings support the validity of the three-step theory in a student population. Pain, hopelessness, and low belongingness were significant predictors of suicidal ideation and attempts among students, while the capability for suicide did not predict suicidal behavior in this context. These results provide a novel perspective by confirming the applicability of the three-step theory in a non-clinical student population, offering valuable insights into the interrelations of the model’s key components.

Dialysis patients frequently experience issues such as fear, reduced social activity, and hopelessness due to lifestyle changes and treatment requirements.

This study aimed to determine the effect of Fordyce happiness training on quality of life and life expectancy in hemodialysis patients.

This quasi-experimental intervention study involved 48 hemodialysis patients who were referred to Shahid Rahnemoun Hospital in Yazd, Iran, and selected through simple random sampling. Data collection tools included the Quality-of-Life Questionnaire for Kidney Patients (KDQOL-36) and the Miller Life Examination Questionnaire. Patients participated in ten 60-minute training sessions, held twice weekly. Data were collected at baseline and one month after the intervention and analyzed using SPSS 21 software.

Following Fordyce's happiness training, levels of potassium (K), creatinine (Cr), and blood urea nitrogen (BUN) in patients significantly decreased. Before the intervention, the mean scores for quality of life and life expectancy in dialysis patients were 51.9 ±28.27 and 169.75 ±11.95, respectively, which increased to 64.66 ±27.17 and 179.95 ±9.37 after the intervention. Paired t -test results indicated that Fordyce happiness training had a statistically significant positive effect on patients' quality of life (P < 0.05) and life expectancy (P < 0.05).

The Fordyce happiness training program can improve quality of life and life expectancy in dialysis patients. In other words, happiness training may serve as a preventive strategy against mental disorders such as depression, anxiety, and life dissatisfaction in dialysis patients.

Depression, anxiety, and stress are prevalent among medical sciences students globally and contribute to suicidal ideation. Many risk factors are associated with the mental health problems of medical sciences students.

This study aimed to estimate the prevalence of depression, anxiety, stress, and suicidal ideation, as well as their associated factors, among medical, dental, and pharmacy students in the aftermath of the COVID-19 pandemic.

In this cross-sectional study, we included 292 students. We collected background information and data on socioeconomic status (SES). We used the Depression, Anxiety, and Stress Scales-21 (DASS-21) and the Beck Scale for suicidal ideation (BSSI) to assess depression, anxiety, stress, and suicidal ideation. The data were analyzed using a linear regression model.

The prevalence of medium to high-risk suicidal thoughts among all students was 56.8%, with 6.5% of students reporting high-risk suicidal thoughts. The prevalence of mild to extremely severe depression, anxiety, and stress was 66.8%, 59.5%, and 52.1%, respectively. Factors significantly associated with the severity of suicidal thoughts included being single (β = -2.11), having a positive history of psychiatric illness (β = 2.64), having a positive history of chronic medical conditions (β = 4.23), and higher scores of depression (β = 1.97) and anxiety (β = 0.49). Additionally, a higher academic semester and greater interest in courses were significantly associated with lower scores of depression, anxiety, and stress.

The findings of this study revealed a higher rate of depression, anxiety, stress, and suicidal ideation among medical sciences students compared to the global prevalence. This underscores the urgent need for targeted interventions to improve students’ mental health. More specifically, recognizing the risk factors for suicidality and promoting access to counseling services and mental health awareness programs can help prevent suicidal thoughts.

Major depressive disorder is one of the most common causes of disability in people of the world, so it has imposed a heavy burden on society in terms of medicine and the economy. One of the important and valuable biomarkers in identifying major depressive disorder is the FKBP5 and SLC6A4 genes in depressed patients.

This study aimed to evaluate the sensitivity and specificity of FKBP5 and SLC6A4 genetic markers in distinguishing major depressive disorder (MDD) patients from healthy controls (HCs) and the responses to cognitive behavioral therapy (CBT) and fluoxetine therapy.

Forty patients diagnosed with MDD based on the diagnostic and statistical manual of mental disorders, fifth edition (DSM-V) criteria and 44 HCs were included in our study from patients of private clinics and Zare Hospital Sari from January 2022 to March 2022. Sampling was carried out from MDD patients and HCs. The patients were randomly assigned to CBT or fluoxetine therapy groups using a randomization block method. The CBT group (12 weeks/one session per week/90 minutes per session), the fluoxetine therapy group (3 months/20 mg daily/weekly follow-up), and relative gene expression alterations were calculated using the quantitative reverse transcription polymerase chain reaction (qRT-PCR) technique.

The receiver operating characteristic (ROC) curve analysis showed that FKBP5 [area under the curve (AUC) = 0.724, standard error = 0.054, P < 0.001] and SLC6A4 (AUC = 0.661, standard error = 0.092, P = 0.036) genes have acceptable sensitivity and accuracy in identifying MDD from HCs. After the therapeutic intervention, a significant decrease in the Beck Depression Inventory-II (BDI-II) scores was observed in both groups (CBT group, P < 0.001, fluoxetine group, P < 0.001). Comparing before and after treatment in the CBT group, a significant decrease in FKBP5 (P < 0.001) and SLC6A4 (P < 0.001) gene expression were observed. In the fluoxetine group, SLC6A4 (P = 0.44) gene expression did not show any significant changes, but FKBP5 (P < 0.001) gene expression decreased.

The present study showed that the FKBP5 and SLC6A4 genes are appropriate biomarkers for distinguishing MDD patients from HCs and treatment response. However, more research is required to identify biomarkers in distinguishing MDD patients from HCs and treatment response.

Adolescence is a period marked by significant changes, during which individuals face major emotional, cognitive, and behavioral challenges. Violence remains a significant global concern, and factors such as self-control and social skills play a crucial role in reducing and managing adolescent violence.

This study aimed to design, implement, and evaluate a training package for violence prevention (TPVP) in adolescents and assess its impact on self-control and social skills among students in Isfahan.

This study was conducted on sixty 13 - 15-year-old female students in Isfahan, Iran, during the 2022 - 2023 academic year. First, the TPVP was developed after reviewing relevant theories and existing training packages, then it was evaluated by a panel of faculty members from the Department of Social Medicine, psychiatrists, and clinical psychologists. The students were randomly divided into two groups: (1) an intervention group, and (2) a control group, with 30 students in each group. The intervention group received the TPVP and attended five training sessions. To assess social skills and self-control, the Inderbitzen and Foster Social Skills Questionnaire and the Tangney Self-control Questionnaire were administered to both groups before and three months after the intervention.

Sixty female students aged 13 - 15 participated in this study. The mean self-control score in the intervention group was significantly higher than in the control group after the intervention (46.33 ± 6.488 vs. 40.44 ± 7.307, P = 0.002). Prior to the training, there was no significant difference in social skills scores between the two groups. However, following the intervention, the mean social skills score in the intervention group was significantly higher than in the control group (118.38.726 vs. 102.913.468, P < 0.0001).

The violence prevention training package was effective in improving self-control and social skills among students. The study demonstrated that the implementation of a structured TPVP can enhance both self-control and social skills in adolescents.

The temporal reproduction paradigm is extensively used to study human time perception. Despite extensive behavioral and physiological research, the effect of click trains on different supra-second interval timings in the time reproduction task remains unclear. Event-related potentials (ERPs), such as contingent negative variation (CNV), might provide further insight into the underlying processes occurring at various timing stages.

In this study, constant and click trains stimuli were presented to the 33 participants in a time reproduction task. During the encoding phase, participants in each condition were given different click train interval timings (1400, 1600, 1800, and 2000 ms). In this original research, we examined the influence of click trains on time reproduction performance using behavioral and electrophysiological methods.

Findings revealed time dilation during the presentation of click trains in behavioral patterns (P-value = 0.001). Furthermore, electroencephalography (EEG) data revealed a distinct CNV during the encoding and reproduction of interval timings. In the reproduction phase, CNV amplitudes were more negative in the click trains condition compared with the constant auditory stimulation condition (P-value = 0.027). Statistically significant differences were also observed in the CNV amplitudes at various interval timings during the encoding phase, but the amplitude did not increase linearly.

Intriguingly, according to the proposed neural mechanism studies, the brain structures affected by the click train corresponded to the electrodes that CNV was observed in the time reproduction task. These findings contribute to our understanding of the striatal-beat frequency (SBF) timing model.

Skydiving anxiety varies according to individual personality traits. Identifying key factors influencing paratroopers' well-being and performance is essential.

To investigate the relationship between anxiety and personality traits in free-fall skydivers.

An analytical study was conducted at a military base in Guilan province, Iran, with free-fall paratroopers selected through random sampling. Data were collected using three questionnaires covering demographics, anxiety levels, and personality factors.

Fifty-eight paratroopers were assessed; 79.3% were under 30 years old. Free-fall paratroopers exhibited higher levels of extraversion and conscientiousness and lower levels of neuroticism. Trait anxiety was found to be higher among those with neuroticism. Experienced paratroopers displayed higher trait anxiety, with no significant relationship to state anxiety, experience level, or age.

High trait anxiety in neurotic paratroopers is meaningful in relation to personality traits examined in this study.

Despite the high prevalence of depressive and anxiety disorders among women with threatened abortion (TA), there is scant evidence regarding the efficacy of psychotherapies for this group.

This research aimed to assess the effectiveness, acceptability, and feasibility of specific internet-based cognitive behavioral therapy (iCBT-Specific) and unified protocol (iUP) for women with a TA.

In this semi-experimental study (from April to October 2023), after the treatment content was prepared, a total of 80 pregnant women with TA, over 18 years of age, having a gestational age of 5 - 12 weeks, from a hospital and two private clinics, who were diagnosed with depressive and anxiety disorders based on the short structured diagnostic interview (Mini-International Neuropsychiatric Interview), were selected. The participants were divided into two groups, undergoing iUP or iCBT-specific psychotherapies. All participants completed the Brief Symptom Inventory (BSI-18) to measure the levels of depressive and anxiety symptoms. Following eight weeks of internet-based therapy, consisting of eight 50-minute sessions, they completed the BSI-18 again, along with the Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Statistical analysis was performed using SPSS version 22 software, and t -test, paired t -test, and ANCOVA tests were used.

Both the iUP and iCBT-Specific models demonstrated high acceptability, and the average feasibility of treatment was above average for both models. In terms of acceptability and feasibility of treatment for women with TA, neither model proved to be superior (all P > 0.05). Both iUP and iCBT-Specific models were effective in reducing depression and anxiety in these women (effect size for within groups were respectively Eta = 0.370, Eta = 0.536). Also, in terms of improving depression and anxiety, there was no significant difference in the effectiveness of iUP and iCBT-Specific treatments (respectively P = 0.146, Eta = 0.027 and P = 0.221, Eta = 0.019)

The iUP treatment can be recognized as a reliable alternative to the iCBT-Specific method for alleviating depressive and anxiety symptoms in women with TA. Also, our results help gynecologists to use iUP as an alternative treatment when there is no definitive diagnosis of the type of disorder.

Stigma presents significant barriers to mental health treatment, influencing treatment decisions and recovery outcomes. Standardized rating scales play a crucial role in assessing Self-stigma, which is essential for intervention efforts aimed at improving mental health outcomes globally.

This study aims to investigate the internal consistency, face validity, content validity, and factor structure of the Persian version of the Self-stigma of Seeking Help (SSOSH) scale in a group of people with mental health disorders referred to the outpatient clinics of Roozbeh Psychiatry Hospital and several private clinics in Tehran, Iran.

First, a bilingual psychiatrist translated the scale into Persian. Content and face validity were then evaluated by six psychiatrists. A pilot test was conducted with ten patients to assess comprehensibility. A back translation into English was performed by a non-professional, and the result was compared to the original version by a bilingual psychiatrist. The final Persian version of the questionnaire was administered to 347 patients with various mental health disorders, recruited from Roozbeh Hospital, a referral psychiatry hospital, and several private clinics in Tehran. Demographic characteristics were collected via questionnaires, and the type of disorder was determined based on the specialist's evaluation. This process was conducted from October 2023 to May 2024. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated, and internal consistency was analyzed using Cronbach’s alpha and McDonald's Omega tests. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to explore and understand the data structure.

The Persian version demonstrated reasonable comprehensibility and translation equivalence, ensuring both semantic and content equivalence. The SSOSH achieved a CVI > 0.8 and CVR > 0.96. All items obtained an acceptable score (greater than 1.5) for face validity. The internal consistency of the total score was good (α = 0.733, ω = 0.818). The EFA revealed that the Persian version had three factors accounting for 57% of the total variance, and the CFA suggested this model fits the data reasonably well, though there is room for improvement.

The Persian SSOSH scale exhibits good internal consistency and acceptable face and content validity for use in Persian-speaking patients with mental health disorders. While the three-factor structure identified by the EFA requires further investigation, the application of this tool among other Iranians warrants additional evaluation.