Iranian Journal of Psychiatry最新文献

Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder. Method : First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers. Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers' burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013). Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.

Objective: suicide attempts and suicide death fall within a category of psychological disorders that is under the influence of economic, social, and cultural factors. Awareness of the prevalence of this phenomenon is essential for the adoption of preventive policies. Accordingly, the current study was carried out in order to determine the prevalence of suicide attempts and suicide deaths via Meta-analysis in Iran. Method : This study is a systematic review and meta-analysis of articles published between 2010 and 2021 to estimate the prevalence of suicide attempts and suicide deaths in Iran. Accordingly, databases including Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, Google Scholar, SID, and Magiran were searched and all related articles were extracted by the statistical tests of random and fixed effects model, meta-regression, and funnel plot using the STATA software. These articles were then analyzed. Results: A total of 20 studies were entered into the systematic review, with a total of 271,212 attempted suicides and 22,780 suicide deaths. Accordingly, the prevalence of suicide attempts in the whole population was 131.0 (CI 95%: 124.0 - 137.0) per 100,000 people (152 per 100,000 women and 128 per 100,000 men). Moreover, the prevalence of suicide death was 8.14 (CI 95% 7.8 - 8.5) per 100,000 people in the general population (5.0 per 100,000 women and 9.1 per 100,000 men). Conclusion: According to these findings, Iran can be ranked among the countries with a low prevalence of suicide attempts and completed suicides (compared to the global average). Although the trend of completed suicides is declining, the trend of suicide attempts is increasing and has often affected young people.

Objective: Schizophrenia is a complex neurodevelopmental illness that is associated with different deficits in the cerebral cortex and neural networks, resulting in irregularity of brain waves. Various neuropathological hypotheses have been proposed for this irregularity that we intend to examine in this computational study. Method : We used a mathematical model of a neuronal population based on cellular automata to examine two hypotheses about the neuropathology of schizophrenia: first, reducing neuronal stimulation thresholds to increase neuronal excitability; and second, increasing the percentage of excitatory neurons and decreasing the percentage of inhibitory neurons to increase the excitation to inhibition ratio in the neuronal population. Then, we compare the complexity of the output signals produced by the model in both cases with real healthy resting-state electroencephalogram (EEG) signals using the Lempel-Ziv complexity measure and see if these changes alter (increase or decrease) the complexity of the neuronal population dynamics. Results: By lowering the neuronal stimulation threshold (i.e., the first hypothesis), no significant change in the pattern and amplitude of the network complexity was observed, and the model complexity was very similar to the complexity of real EEG signals (P > 0.05). However, increasing the excitation to inhibition ratio (i.e., the second hypothesis) led to significant changes in the complexity pattern of the designed network (P < 0.05). More interestingly, in this case, the complexity of the output signals of the model increased significantly compared to real healthy EEGs (P = 0.002) and the model output of the unchanged condition (P = 0.028) and the first hypothesis (P = 0.001). Conclusion: Our computational model suggests that imbalances in the excitation to inhibition ratio in the neural network are probably the source of abnormal neuronal firing patterns and thus the cause of increased complexity of brain electrical activity in schizophrenia.

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views. Method : The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes. Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system). Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

Objective: Schizophrenia is known as a severe psychiatric disorder with a broad range of clinical indications and symptoms such as positive and negative symptoms. This study was conducted with the aim of investigating the effect of melatonin on positive and negative symptoms of inpatients with schizophrenia. Method : This study was conducted as a randomized placebo-controlled trial (double-blind) in the population of patients with schizophrenia. Study samples were selected from inpatients with schizophrenia, according to the DSM-5 criteria, who had not been diagnosed with a depressive episode of schizophrenia based on the Calgary questionnaire and who also met the inclusion criteria. 46 patients with schizophrenia were randomly assigned to the intervention (6 mg melatonin per day as two 3 mg pills for six weeks) and placebo groups. The positive and negative symptom scale (PANSS) was used to assess the effect of treatment at T1 (before intervention), T2 (three weeks after beginning the intervention) and T3 (six weeks after beginning the intervention). To check the research hypotheses, multiple comparison statistics were used by the SPSS 22 software. Results: The placebo and melatonin groups had no significant difference in terms of PANSS scores (negative, positive, general and total symptom scores) at T1. Also, there was no difference in PANSS scores between the two groups at T2. However, at T3, there was a significant difference between the two groups only in the score of negative symptoms of PANSS (P = 0.036), so that negative symptoms of schizophrenia were significantly reduced in the intervention group compared to the placebo group. Furthermore, based on within-group analyzes, all PANSS scores were significantly reduced in the two groups at T2 and T3 (P < 0.05). Conclusion: Long-term use (at least six weeks) of melatonin can improve the negative symptoms of schizophrenia. Since antipsychotics can better affect the positive symptoms, the use of melatonin in combination with these drugs may perhaps further improve the patients' symptoms.

Objective: Automatic diagnosis of psychiatric disorders such as bipolar disorder (BD) through machine learning techniques has attracted substantial attention from psychiatric and artificial intelligence communities. These approaches mostly rely on various biomarkers extracted from electroencephalogram (EEG) or magnetic resonance imaging (MRI)/functional MRI (fMRI) data. In this paper, we provide an updated overview of existing machine learning-based methods for bipolar disorder (BD) diagnosis using MRI and EEG data. Method : This study is a short non-systematic review with the aim of describing the current situation in automatic diagnosis of BD using machine learning methods. Therefore, an appropriate literature search was conducted via relevant keywords for original EEG/MRI studies on distinguishing BD from other conditions, particularly from healthy peers, in PubMed, Web of Science, and Google Scholar databases. Results: We reviewed 26 studies, including 10 EEG studies and 16 MRI studies (including structural and functional MRI), that used traditional machine learning methods and deep learning algorithms to automatically detect BD. The reported accuracies for EEG studies is about 90%, while the reported accuracies for MRI studies remains below the minimum level for clinical relevance, i.e. about 80% of the classification outcome for traditional machine learning methods. However, deep learning techniques have generally achieved accuracies higher than 95%. Conclusion: Research utilizing machine learning applied to EEG signals and brain images has provided proof of concept for how this innovative technique can help psychiatrists distinguish BD patients from healthy people. However, the results have been somewhat contradictory and we must keep away from excessive optimistic interpretations of the findings. Much progress is still needed to reach the level of clinical practice in this field.

Objective: The objective of the present study was to determine the effectiveness of self-compassion-focused therapy on cognitive vulnerability to depression as one of the causes of the onset or recurrence of depressive episodes in people who were not depressed at the time of the research but were cognitively susceptible to depression. Method : The statistical population included all students of Bu-Ali Sina University in 2020. The sample was selected through the available sampling method. First, 52 people were screened, and finally, by random assignment, 20 people were placed in the experimental group and 20 people in the control group. The experimental group underwent compassion-focused therapy for eight 90-minutes-long sessions. The instruments included the Attributional Style Questionnaire, the Dysfunctional Attitude Scale, the Cognitive Triad Inventory, the Self-Esteem Scale, and the 2ⁿᵈ edition Beck Depression Inventory. Results: The results of multivariate analysis of covariance showed that self-compassion-focused therapy was effective in terms of cognitive vulnerability to depression (P < 0.01, F = 22.78), dysfunctional attitudes (P < 0.01, F = 15.53), self-esteem (P < 0.01, F = 30.07), general attribution style for negative events (P < 0.01, F = 11.41), stable attribution style for negative events (P < 0.01, F = 14.48) and internal attribution style for negative events (P < 0.01, F = 12.45). Conclusion: Therefore, it can be concluded that self-compassion-focused therapy can reduce cognitive vulnerability to depression. It seems that this has been achieved through the regulation of emotional systems and the increase of mindfulness, which leads to the reduction of safety-seeking behaviors and the modification of cognitive patterns that take place around the axis of the compassionate mind.

Objective: In old age, people suffer from many mental and physical illnesses, which make it important for the elderly to pay attention to adapting to these diseases. So, the aim of this research was to study the role of perceived burdensomeness, thwarted belongingness, and giving meaning to life in psychosocial adjustment, as well as the mediating role of self-care in the elderly. Method : This research was descriptive and correlational, conducted through available sampling of 200 elderly people who lived in the city of Ardabil. After the necessary assessments in terms of mental disorders and inclusion criteria, they were chosen to conduct this investigation in 2020. The Meaning in Life Questionnaire, Psychosocial Adjustment Scale, Self-Care Questionnaire for the Elderly, and Interpersonal Needs scale were used to gather the data. The data were analyzed using SPSS25 and Amos24 software. Results: The findings showed that perceived burdensomeness and thwarted belongingness have a negative and direct effect on elderly self-care [β = -0.25, P < 0.01] [β = -0.20, P < 0.05] and psychosocial adjustment [β = -0.0, P < 0.05] [β = -0.12, P < 0.05]. Also, giving meaning to life has a positive and direct effect on elderly self-care [β = 0.32, P = 0.01] and psychosocial adjustment [β = 0.033, P < 0.01]. The variable of self-care can play a mediating role in the relationship between thwarted belongingness [β = -0.174, P < 0.05], perceived burdensomeness [β = -0.140, P < 0.05], and giving meaning to life [β = 0.223, P < 0.05] with psychosocial adjustment. Moreover, among the exogenous variables, thwarted belongingness and perceived burdensomeness by change in self-care have been able to reduce psychosocial adjustment. Giving meaning through self-care, however, has increased psychosocial adjustment. Conclusion: The findings revealed that thwarted belongingness, perceived burdensomeness, and giving meaning to life are important variables in health and adaptability of the elderly, which draws attention to family-centered interventions and individual therapies.

Objective: The aim of this study was to determine the role played by psychological distress in the relation between personality dimensions and pregnancy outcome of women undergoing in vitro fertilization/Intra-Cytoplasmic Injections (IVF/ICSI) treatment. Method : This prospective cohort study was conducted for 12 months on 154 infertile women who were receiving IVF/ICSI assisted reproductive treatment for the first time. Research instruments for measuring psychological distress included the Fertility Problem Inventory (FPI) and the Depression, Anxiety, and Stress Scale (DASS-21). One of these was completed prior to ovarian stimulation and the other during the embryo transfer stage. The temperament and Character Inventory-Revised (TCI-R 125) was employed once to assess personality dimensions prior to the ovarian stimulation stage. Independent t-test, Mann Whitney test, Repeated Measures and path analysis were performed for statistical analysis of data. Results: The results of this study showed no significant difference between the pregnant and non-pregnant groups in personality traits (Harm avoidance and self-directness) and psychological distress (FPI and DASS scores). Repeated measures showed a significant difference in stress, anxiety, and depression levels between the two stages of ovarian stimulation and embryo transfer (P < 0.01). Path analysis showed no significant direct and indirect effect for harm avoidance on the pregnancy outcome when psychological distress was mediated. Conclusion: The effect of psychological factors on IVF outcomes is more complicated than is generally assumed and more studies are mandatory to clarify the relationship between personality traits and infertility treatments.