2Background and purpose: Accompanying sleep disorders such as insomnia, delayed sleep, and wakefulness, as well as anxiety and depression with obsessive-compulsive disorder, are common in patients with OCD. However, not much research has been done on the relationship between sleep disorders and the severity of symptoms in patients with OCD. This article examines the frequency and relationship between sleep disorders, depression, anxiety, and the severity of obsessive-compulsive symptoms in patients with OCD. Materials and methods: Convenience sampling was used in this cross-sectional research. The participants in the study were those who were referred to the clinic of a psychiatric hospital and the central clinic complex in Sari. Obsessive-compulsive disorder diagnosis of the participants was confirmed by a psychiatrist based on DSM-5 diagnostic criteria. Eighty-eight patients participated in the study after obtaining informed consent. Demographic questionnaires, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), morning-evening questionnaire (MEQ), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), WHO-5 well-being (Depression) Index, and Generalized Anxiety Disorder-7 (GAD-7). Data analysis was done with SPSS version 20 software. Results: Out of 88 patients, 65 (73.86%) were women 23 (26.14%) were men, 71.59% were married, 57.95% had under diploma degree, and 94.22% had no history of drug use. The average age of the patients was 44.48 ± 11.51 years. The duration of OCD was 11.28±14.60 years In terms of the severity of OCD symptoms, 1.1% was very mild, 19.32% was relatively mild, 42.45% was moderate, and 37.50% was severe. In the type of sleep schedule, 17.03% were inclined to evening or relative evening type. Four patients (4.62%) had daytime sleepiness. Also, 52 patients (61.90%) had some degree of insomnia. In terms of the severity of insomnia, 23.86% were mild, 28.40% were moderate and 6.81% were severe. The frequency of depression was 68% and anxiety was 79%. No statistically significant relationship was found between the severity of obsessive-compulsive disorder and hypersomnia, evening chronotype, anxiety, and depression. But insomnia (P= 0.046) and duration of illness (P= 0.004) were related to it. The Pearson correlation coefficient between age, duration of obsessive-compulsive disorder, and severity of obsessive-compulsive symptoms was 0.169 (P= 0.116) and 0.377 (P=0.001), respectively. Spearman's correlation coefficient between the severity of obsessive-compulsive symptoms with depression and anxiety was 0.090 (P=0.403) and 0.044 (P=0.685), respectively. The average severity of obsessive-compulsive symptoms was 23.48±7.87 in women and 20.04±5.88 in men, and no significant difference was seen in both sexes (P=0.060). In linear regression, the two factors affecting the severity of obsessive-compulsive symptoms were the duration of the illness and the severity of insomnia. Conclusion: Considering the higher frequency of insomnia in patients with obsessive-compulsive disorder compared to the normal population and its role in the severity of obsessive-compulsive disorder symptoms, it is necessary to examine patients with obsessive-compulsive disorder in terms of insomnia. Also, older OCD patients should be examined more carefully in terms of the severity of obsessive-compulsive symptoms.

Letter to the Editor With interest, we read the review article by Ahmadabadi et al. on autism spectrum disorders (ASDs) in inborn errors of metabolism (IEM) (1). They reviewed 37 studies, and found that IEMs underlie autistic features in <5% of the patients, and that there is growing evidence on the association between ASDs and mitochondrial disorders (MIDs), including mitochondrial encephalopathy, lactic acidosis, stroke-like episodes (MELAS) syndrome, and respiratory chain complex III/IV deficiency (1). The authors concluded that the syndromic autism, a strong family history, or consanguinity suggest IEM (1). However, we have raised the following comments and concerns: We disagree with the idea that mitochondrial disorders (MIDs) have only two points of onset as they can occur at any age, and their broad variability, even in a family, results from the peculiarities of mitochondrial genetics. Due to mutations in mtDNA-located genes, MIDs are maternally transmitted, and the underlying mtDNA mutations may not occur in each mtDNA copy (heteroplasmy). Moreover, mtDNA copy number may considerably vary from one mitochondrion to another mitochondrion, particularly if the mutation is located in a nuclearly-encoded gene. MIDs frequently manifest in the central nervous system (CNS), and the CNS manifestations may include psychiatric or neurological diseases or both. The psychiatric diseases range from mild cognitive impairment and personality change to delirium and psychosis. Autism has been frequently reported in MIDs (2) and may or may not be associated with cerebral morphological alterations. We also disagree that ASD occurs only in MELAS and complex-III/ IV deficiency (1). ASD has also been reported in a patient carrying the mtDNA variant m. 8363G>A, whose sister was carrying the same variant and presented with Leigh syndrome (3), as well as in two Korean siblings carrying the variant c. 790C>T in TFB2M (4). In a study on 60 ASD patients, single mtDNA deletions were detected in 16. 6% of the patients (5). In the same study, the ten patients with mtDNA deletions also carried single nucleotide variants (SNVs) in ASD-associated genes (5). In a study on 95 ASD patients, the mtDNA content decreased in the ASD patients, and 49 putative pathogenic mtDNA variants were detected (6). In a study on 10 families with ASD, whole-exome sequencing revealed the variants of interest (VOIs) in the ND5 gene in one family and VOIs in ATP6 and NDUFS4 in another family (7). In a study on 24 Iranian ASD patients, mtDNA mutations 16126T>C, m. 14569G>A, and m., 1811A>G, all of which were located in non-coding regions, showed a significant relationship with ASD (8). In general, there is ample evidence indicating that the IEM, which is most frequently associated with ASD, is MID. According to the literature, the mtDNA variants but not the nDNA variants have been more frequently associated with ASD. Patients with an ASD should be first examined in terms of the presence or absence of MID.

Objective: This study investigates the prevalence of attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) among elementary students in Shiraz.Method: Utilizing a random cluster sampling method, 1300 students were recruited, and evaluated with CSI-4 (parents form).Results: Data analysis revealed that %17.5 of the students have these three disorders, and the boys had a greater ratio. It included attention deficit (%6.7), hyperactivity-impulsivity (%6), Combined ADHD (%5), CD (%5), ODD (%3.6).Conclusion: These findings stress that prevalence of disruptive disorders are considerable in Shiraz, and need to be emphasized in the therapeutic and educational policies.

Introduction: With attention to considered various cognitive beliefs in psychopathology of disorders, the purpose of this study was comparison of cognitive beliefs include; thought action fusion (TAF), responsibility and the overestimation of threat (RT), and overimportance and control thoughts (ICT), perfectionism and the intolerance of uncertainty (PC) in obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), major depression disorder (MDD) and normal group for more clarification psychopathology of these disorders. Materials and Methods: This study is causal-comparative research. The clinical samples include patients with OCD, GAD and MDD that referred to Sari Shahid Zareh hospital in 2015. From each of these clinical groups and normal people, 30 persons were selected available sampling method and accomplish obsessive beliefs questionnaire and thought action fusion scale. Data were analyzed by MANOVA. Results: The result of MANOVA and Tukey posthoc test showed that OCD group were significantly higher than other groups in TAF, RT and ICT (p<0/001), but in PC didn't show the significant difference between OCD and GAD groups (p<0/086). Also, the result was shown that in all of these cognitive beliefs OCD and GAD groups were significantly higher than depression and normal groups (p<0/001). Conclusion: According to this result it seems that TAF, RT, and ICT are more specific for OCD but about PC there isn't this specialty and it is a common cognitive vulnerability in OCD and GAD. Thus considering this result can be effective in designing more specific psychotherapeutic interventions.

Background and Aims: A significant part of infertility has been related to environmental conditions as well as acquired risk factors. Different environmental conditions emphasize the necessity of studying different etiologies of infertility in each region. The present study aimed to determine the etiologies of infertility in infertile couples. Materials and Methods: In this cross-sectional study, 583 infertile men and women referred to the infertility clinic from 2021 to 2022 were examined. In addition, sampling was performed using the census method. Information about patients was obtained from medical tests and laboratory findings. It is noteworthy that descriptive statistics, such as frequency and mean, were used to analyze the data. Results: According to the results, oligospermia was the most common cause of male infertility (44.72%), and ovulation disorder was the most prevalent reason for female infertility (66.17%). In general, ovulation disorder and sperm motility were the most common causes of infertility (36.73%). There was no significant relationship between women's underlying diseases and the causes of infertility (P>0.05). Conclusion: The etiology pattern of infertility is closely similar to that of many other regions reported by the World Health Organization (WHO). Despite this, the rate of ovarian disorders is higher than that in many other studies, which needs further studies.