Iranian Journal of Psychiatry and Behavioral Sciences
Year:2020 | Volume:14 | Issue:3|Papers Count:20

Dear Editor, A research paper written by Ghaderi and colleagues entitled “ The effects of vitamin D supplementation on withdrawal symptoms and the expression of inflammatory cytokines and insulin in patients under methadone maintenance treatment: a randomized, double-blind, placebocontrolled trial” has been recently published in your peerreviewed journal (1). In our view, the study is novel and important due to two main reasons: first, authors have highlighted the substantial effects of vitamin D supplementation on reducing the side effects of high doses of methadone administration and promoting the quality of life (QoL) in methadone patients (1). ...

Background: Epilepsy is a severe problem incorporating a high degree of the misconception that influences the quality of life of individuals suffering from the disease. Objectives: The purpose of the present study was to assess the knowledge and attitudes of patients with epilepsy toward the disease. Methods: A cross-sectional study was conducted on 155 individuals with epilepsy aged 18 years from August 2016 to Jun 2018 in an outpatient clinic of a medical university in Sari City, North of Iran. Thirty-four closed-ended questions were developed, including 14 items about knowledge, 11 items about attitudes, and nine questions about knowledge profile-personal toward epilepsy. Answers to the questions were either “ yes, ” “ no, ” or “ I do not know. ” The chi-square ( 2) test was used to explain the association between variables and demographic information. Results: The mean age of the participants was 31. 73  11. 06 years. Regarding the cause of epilepsy, 85. 8% of the participants reported that epilepsy is a brain disorder. Moreover, in terms of the knowledge score, 54. 8% of the participants had a fair knowledge of epilepsy. Accordingly, patients with university education had good knowledge about the disease (P = 0. 007). In terms of attitudes toward epilepsy, 82. 6% of the patients had a positive attitude toward the disease but had no good awareness of it. These positive attitudes were associated with a high education level (P = 0. 001). Conclusions: This study showed that despite the positive attitude toward epilepsy, good knowledge about the disease was still below 50%.

Dear Editor, Infertility is a global problem, defined as a failure to achieve pregnancy after one year of sexual intercourse with-out contraception (1). It is estimated that the global prevalence of infertility ranges from 8% to 12%, meanwhile, some infertile couples never seek treatment or remain unidentified (2). In many cultures, infertility is considering a deficiency and therefore is a kind of stigma (3). However, infertility is not a disease, and its treatment can affect all aspects of life, which may have various psychological problems or consequences, including depression, anxiety, hopelessness, guilt, and feelings of worthlessness. It is estimated that about 25% to 60% of infertile couples experience psychological problems (4). . . .

Dear Editor, The new coronavirus, as an acute and severe respiratory syndrome, was first identified in December 2019 in Wuhan, China, and rapidly spread to other parts of China and also other countries (1, 2). It commonly has the following symptoms: fatigue, fever, cough, shortness of breath, and headache (1) that normally appear after an incubation period of 4-6 days (3). COVID-19 has higher transmissibility than MERS and SARS, and each patient can infect about 5. 7 individuals (4). The World Health Organization (WHO) has made several recommendations to prevent the spread of COVID-19, including an emphasis on frequent cleaning of hands using soap and water that can effectively remove pathogens from the surface of the skin (4, 5). . . . .

Background: Some studies indicated that the study of stories in which physical or mental illnesses are described helps to better understand the patient and his/her sickness; but unfortunately, this approach is neglected in the Persian literature. Paying attention to this issue can increase the attractiveness of studying such literary works for the Iranian and non-Iranian audience and can grant new sights to readers, as well. Objectives: This research is conducted to describeandexplain thesymptomsof thePTSDin the characters of modernPersian fiction, based on the clinical symptoms. Methods: This is qualitative research. Seven characters from the seven stories were selected purposefully to fit the researcher’ s goals. Then, they were analyzed according to the DSM-5 criteria. Results: The results indicated that the selected stories represent individuals with PTSD consistent with the clinical criteria for the diagnostic of the disorder. In these stories, the authors, in addition to describing clinical symptoms, have considered inheritance, gender, and cultural factors to create characters in accordance with the specifications of the people who have been damaged in the real world. Conclusions: Reading these stories can be useful due to applying descriptions based on clinical criteria for the diagnosis of this disorder (PTSD), and thanks to the use of literary language in representing the victim’ s inner and spiritual status, are useful in creating an engagement resulting from a proper understanding of the person who is suffering from such disorder.

Context: The emerging 2019-nCoV outbreak has involved almost all countries worldwide. Although the timely dissemination of clear and accurate information on threats of the disease might cause panic, it is needed for rapid adoption and implementation of prevention and control measures. From the early stages of outbreaks, the behavioral responses and public risk perception should be carefully monitored for further policies and corrective measures. Evidence Acquisition: In the current narrative review article, the psychological and behavioral responses are reviewed after an introduction to the risk perception and role of social and personal behavioral changes in the 2019-nCoV outbreak. Additionally, the impact of public perception on mental health problems and containment of the outbreak is discussed. Results: The consequences of the outbreak affect both infected and non-infected people in communities. People may experience loneliness, fear of catching the disease, and loss of loved ones during the outbreak. The timely understanding of the situation, implementation of urgent psychological interventions, and emotional supports are necessary to encourage people to fight this long-term outbreak and prevent subsequent mental health problems. Conclusions: High self-control and public perception can mediate the associated psychological impacts of stressful conditions in outbreaks.

COVID-19 pandemic has had a tremendous impact on people’ s health conditions. Some studies show that mental health is also affected seriously by COVID-19 (1) and associated physical distancing measures (2). There are some mental health challenges, such as the availability of psychopharmacological and other treatments (3). Therefore, we need to apply evidence-based mental health interventions to help people deal with this pandemic situation. Fortunately, valuable guidelines for clinicians have started to release in this field (4). ...

Background: Obsessive-compulsive disorder (OCD) is known as a non-psychotic mental disorder resistant to treatment. It has been found that eye movement desensitization and reprocessing (EMDR) can increase the effectiveness of its standard treatments. Objectives: The current study aimed at evaluating the impact of exposure/response prevention (ERP) combined with EMDR as a treatment method on patients with OCD who had experienced stressful life events by comparison to ERP alone. Methods: The present randomized controlled trial was conducted among 60 OCD patients who experienced stressful life events and were resistant to medication treatment. The participants were randomly assigned to the ERP plus EMDR (n = 30) and ERP (n = 30) groups. The Yale-Brown Obsessive-Compulsive scale (Y-BOCS) and Beck Anxiety Inventory (BAI) were completed before and after the intervention, as well as, after a follow-up period of three months. The scores were compared using the chi-squared test, analysis of covariance (ANCOVA), and repeated measures analysis of variance (ANOVA). Results: ANOVA results demonstrated that both treatment protocols had a significant effect on the reduction of anxiety and severity of OCD symptoms, while the results of ANCOVA showed a significantly higher effect of ERP plus EMDR compared to the ERP protocol (P = 0. 001), and sample attrition was significantly higher in the ERP group (P < 0. 05). Conclusions: The ERP plus EMDR protocol compared to the ERP protocol showed a higher rate of completion and efficacy in OCD treatment.

Context: The COVID-19 outbreak was first experienced in China and rapidly spread to 212 countries/regions of the world, including Pakistan. It has affected both males and females, but the incidence is higher in males than in females worldwide. Evidence Acquisition: According to the Ministry of National Health Services, Regulation, and Coordination of Pakistan, the female infection rate is much lower than the male infection rate in Pakistan (3. 6% vs. 6. 7%, respectively). What are the main possible reasons that created gender disparity in COVID-19 incidence in Pakistan? We reviewed different factors that created gender disparity in COVID-19 Incidence in Pakistan. Results: The biological differences, social, professional, religious, psychological factors, cultural, and lifestyle aspects have created a gender disparity in COVID-19 incidence in Pakistan. Conclusion: This study mainly focused on the main possible reasons (mentioned above) that COVID-19 has affected men more than women worldwide, especially in Pakistan.

Background: The impact of personality traits such as type D personality on the development of psychosomatic illnesses such as cancer has been found by many researchers in the field of health psychology. Objectives: The purpose of this study was to investigate the status of the typeDpersonality trait and its relationship with perceived stress among women with breast cancer. Methods: This cross-sectional study enrolled 120 cancer patients during 2017. After applying the inclusion and exclusion criteria and obtaining informed consent, the patients were selected using the convenience sampling method and evaluated by the Type D Personality Scale (DS14) and Perceived Stress Scale (PSS). Results: In this study, 69. 2% of the patients obtained a score of  29 in the DS14 questionnaire. Correlation analysis between the components of DS14 and the final score of PSS showed that both social inhibition and negative affectivity had direct correlations with perceived stress (r = 0. 35 and r = 0. 6, respectively; P < 0. 001). Conclusions: One of the most important results of this study was a relatively high score of type D personality among patients with breast cancer and the high contribution of negative affectivity to the perceived stress by patients with this type of personality. The particular status of type D personality traits among cancer patients can be used to design psychotherapy programs for them to prevent disease progression.

Context: Hepatitis B is the most prevalent chronic viral infection in humans, which imposes limitations on patients and has many physical, psychological, and social consequences due to its chronic nature. The purpose of this study was to evaluate the physical, psychological, and social challenges of patients with hepatitis B virus (HBV). Evidence Acquisition: First, a set of keywords, including hepatitis B, challenge, physical, psychological, and social, were searched in databases, such as Google Scholar, PubMed, SID, Magiran, and IranMedex. Then, the articles published between 2009 and 2019 were reviewed according to the inclusion and exclusion criteria in two stages – the title and the abstract in the first stage and the whole paper in the second stage. Finally, 34 articles were selected out of 1426 articles. Results: The articles used in this study were as follows: descriptive and cross-sectional studies (10 articles), review studies (9 articles), qualitative studies (9 articles), cohort studies (3 articles), randomized controlled trials, mixed-methods studies, and field studies (one article each). Most studies had considered patients with hepatitis B with an emphasis on physical issues (10 articles), social stigma (7 articles), psychological reactions (5 articles), the discovery of patients’ experiences (3 articles), and discrimination (2 articles). In 25 studies, the samples were patients with HBV. Conclusions: It is necessary to understand and support the patients to treat them properly and help them live with minimum challenges and limitations. Therefore, it is necessary to consider educational and counseling programs to identify different aspects of this disease.

Background: The stigma associated with mental health disorders has an enormous impact on decisions concerning receiving mental health services. Objectives: The current qualitative study aimed to describe the stigma toward mental disorders in Tehran, Iran. Methods: The current grounded theory study conducted from 2013 to 2016 in Tehran (Iran). Fourteen participants were sampled using purposive and theoretical sampling techniques. Data were collected through face-to-face interviews, focused groups, and written narratives. The Corbin and Strauss coding paradigm (2008) was used to analyze data. Results: Three main categories of stigmatization toward patients with mental health diagnoses were extracted: (1) barriers to stigma reduction; (2) strategies to reduce stigma; and (3) outcomes of stigma reduction such as negative consequences of stigma toward mental disorders and positive impacts of stigma reduction toward mental disorders. Conclusions: To improve mental health services for patients in Tehran (Iran), it is imperative to reduce the stigma toward mental disorders, educate the community, including the general population and healthcare professionals, and remove existing barriers to receive mental health services.

Context: Neuroleptic malignant syndrome (NMS) has been introduced as a rare but lethal and idiosyncratic reaction to neuroleptics/ antipsychotics. Themostobvious risk of thissyndromeis the use of neuroleptics, especially high-potency ones. Metoclopramide is also known as an anti-nausea medication administered before surgery to manage digestive problems. Evidence Acquisition: Formerly, it had been assumed that metoclopramide was a type of chlorobenzamide that was not in the phenothiazine group but free of extrapyramidal side effects (EPSs). The sequential reports of complications indicate that metoclopramide can cause EPSs and drug-induced motor side effects. A total number of 5044 articles were obtained after the initial search. Then, two researchers independently screened out their titles, and abstracts and 20 articles were finally selected based on the inclusion criteria. Results: Of the 20 articles reporting metoclopramide-induced NMS, treatments had been successful in 16 (80%) cases, but it had led to death in four (20%) patients. There were 11 and 8 male and female patients, respectively, and gender was not mentioned for a patient in one article. The age range of the patients was from six months to 84 years, and the mean age was 50. 92 years. Conclusions: Although NMS following metoclopramide intake is reported very rarely, it should be considered for any psychiatric symptoms with unexpected mental changes, muscle rigidity, and fever after being treated with metoclopramide. The neuroleptic malignant syndrome can occur following multiple doses or just one dose of metoclopramide. Also, metoclopramide use in patients affected with kidney failure is accompanied by a higher risk of NMS. A previous history of NMS, a recent episode of catatonia, and severe agitation are all taken into account as risk factors in this domain.

Dear Editor, Recently, an important research report has been published by Saeedi et al. (1) in the Iranian Journal of PsychiatryandBehavioral Sciences. The authors conducted a study of COVID-19 in 93 hospitalized patients. The study findings indicated that 10. 8% of the infected patients were opiumdependent. Most importantly, the odds ratio related to death was found to be 3. 59%. Most participants were middle-aged (56. 3-years-old) and male (54. 8%) (1). While no significant gender differences were reported, the high rate of mortality highlighted the crucial role of comorbidities in increasing fatality in infected patients. . . .

Objectives: Addiction to pornography is one of the most important behavioral addictions among Iranian youth. The purpose of this study was to develop and validate a measurement scale of “ cravings for pornography” Iran. Methods: This Psychometric study was conducted on a 234 general Iranian population sample in 2017 with a random sampling method. In this study, the psychometric properties of the Persian version of the Pornography Craving Questionnaire were evaluated. Data were analyzed by exploratory factor analysis using SPSS version 23. The questionnaire was administered online (Telegram application and email). Results: The age range of 234 study participants was 13 to 51 years (mean = 29. 7); 97 females (41. 5%) and 135 males (57. 7%). To determine this questionnaire’ s cut-off value, we divided into three categories of low or no craving (12-36), average (36-60), and high (60-84). The result of exploratory factor analysis for these questions identified two factors (Psychological reactions and Desire). Cronbach’ s alpha was 0. 8. Conclusions: According to the results of this study, the Persian version of the “ the pornography craving questionnaire” has sufficient reliability and validity in Iranian society.

Background: The prevalence of risky behaviors, such as drug abuse, amongadolescents and young adults indicates the importance of investigating and recognizing such risky behaviors. Objectives: The present study aimed to examine the effect of loneliness and family communication on addiction potential. Methods: This cross-sectional study was conducted from 2015 to 2016. The current study had a sample of 452 students (242menand 210 women), who were studying at the University of Sistan and Baluchestan, in Zahedan, Iran. The participants were selected using a cluster sampling method. The Schmidt and Sermat Feeling of Loneliness Scale (1983), Fitzpatrick and Ritchie Family Communication Patterns Inventory (1994), and Weed, Butcher, McKenna, and Ben-Porath Addiction Potential Scale (1992) were used as data measurement tools. Data was analyzed in SPSS software, using Pearson’ s correlation coefficient and Stepwise multiple regression. Results: Results showed that loneliness and laissez-faire communication patterns were significantly and directly related to addiction potential; however, the consensual communication pattern was significantly and diversely correlated with addiction potential. In addition, results of the regression analysis indicated that, in the first step, loneliness predicted 0. 09 and, in the second step, loneliness together with the laissez-faire communication patter predicted 0. 11 of the variance in addiction potential (P 0. 001). Conclusions: Accordingly, university students and university students and educators are advised to pay attention to loneliness and family communication, as these factors play an important role in addiction potential. Thus, special programs should be introduced that focus on these specific factors.

Context: Worldwide outbreak of coronavirus has been declared by theWorld Health Organization as a global emergency. Quarantine, as one of the first important health measures to control and spread epidemic diseases, is the focus of health authorities and policymakers in most societies. This study was designed to obtain the psychological impact of quarantine and strategies to reduce it. Evidence Acquisition: This is a “ narrative review” study done through advanced search with the keywords Quarantine, Homeisolation, COVID-19, Coronavirus, Mental Health, Psychological effect in the Scopus, Pumped, Clinical Key, Google Scholar, ScienceDirect, Web of Science databases from 2019-2020. The articles were included in the study according to the inclusion and exclusion criteria. Systematic searching and screening of the titles resulted in 68 initial titles that decreased to 46 after reviewing the abstracts, and 19 articles were included in the final review. Results: Quarantine can lead to psychosocial problems from feeling lonely to depression and anxiety disorders. Certain counseling, as well as educational and supportive interventions, can make this situation tolerable. Conclusions: For acceptance and adherence to quarantine conditions, clear and transparent information about the disease and its prevalence and meeting the needs of people such as psychological, informational, and financial needs in each country are essential to reduce fear and anxiety.

Dear Editor, Subsidization refers to a well-established policy to increase the purchase and use of products and services and promote their affordability for people in need (1). Most importantly, subsidization is the money paid by a governmental sector to help drug treatment services reduce costs; therefore, they can provide services at affordable and/or reasonable prices (1). A paper by Ahmadian Moghaddam et al. (1) about the role of subsidization in increasing drug treatment entry in Iran has been recently published in your journal. In our view, illicit drug use poses significant financial, psychological, andsocial costs to individualsand families. Therefore, subsidization may play a significant role in increasing treatment entry. Furthermore, Ahmadian Moghadam and colleagues have highlighted a novel issue and how the trend of subsidization of drugtreatment has been used for treating illicit drug use in Iran (1). ...

Dear Editor, Illicit drug use is associated with multiple risks of harm to the users, their families, and social network in Iran, the most populous Persian Gulf country (1-3). A paper by Rezaee et al. (4) about newspaper advertisements related to drug treatment services in Iran has been recently published in the Iranian Journal of Psychiatry and Behavioral Sciences. The paper is important because drug treatment advertisements show the trend of demand for treating illicit drug use in Tehran, the capital city of Iran (4). . . .

Background: Oxytocin is a well-known central nervous system mediator in social-related behaviors and stress management. Oxytocin has also been shown to prevent withdrawal symptoms of opioids in animal studies. Group interactions with emotion sharing have been shown to result in an increase in endogenous oxytocin. Although abrupt discontinuation of methadone in opioid substitution therapy is not routinely recommended, it might result in severe withdrawal symptoms and relapse in cases that there is a clinical justification for quitting methadone. Objectives: To evaluate and compare the role of oxytocin and group interactions, combined or independently, in abrupt discontinuation of methadone in methadone maintenance treatment (MMT) cases, where there had been a reasonable clinical judgment to cease medication. Methods: In a double-blind randomized clinical trial, four groups of participantswhowere on methadone treatment for more than sixmonths received either oxytocin or placebo and marathon group therapy or routine group therapyuponabrupt discontinuation of methadone. The participants were monitored for opioid withdrawal symptoms, depression, and anxiety during a four-month follow-up program. The participants were also screened by urine tests for lapses. Results: Administration of oxytocin combined with marathon group activity, with highly emotional content, resulted in less craving (P < 0. 000) and withdrawal symptoms (P < 0. 000) compared to placebo and non-marathon group intervention in different combinations, irrespective of methadone dose and age. The same combination also resulted in continued participation in group therapy for a longer period (P < 0. 000). Additionally, the same combination was effective in improving mental health, as measured by the Beck Anxiety (P < 0. 002) and Beck depression (P < 0. 014) inventories. Conclusions: In order to prevent methadone craving and withdrawal symptoms and sustained abstinence, group therapy with a highly emotional theme appears to be an essential factor for the manifestation of oxytocin effects in the brain.