Iranian Journal of Psychiatry and Behavioral Sciences
Volume:12 Issue: 1, Mar 2018

Poor oral health is part of co-morbidities and exposes patients suffering from schizophrenia to excess mortality. The purpose of this review is to make an up-to-date assessment on the oral health of these patients and make suggestions for improvement.

Based on a bibliographic search of Pub Med, we identified, using keywords, all the clinical studies up to 2015 conducted on the oral health of patients with schizophrenia.

From 81 articles chosen, we retained 23 clinical studies that met our inclusion criteria. These studies find higher dentaland periodontal indexes in patients with schizophrenia than in the general population. Access to healthcare is a problem for thesepatients. The level of research is insufficiently considered compared to other chronic pathologies. Many factors contribute to poor oral health in these patients such as their mental illness, side effects of psychotropic drugs, and any psychosocial factors they might encounter.

For these fragile patients with specific needs, simple measures can be implemented to improve their oral health. Better taken into account, the oral health of these patients should contribute to the overall improvement of quality of life and to the general health of these subjects.

Changes in sexual relations are common during pregnancy. These changes may affect couples negatively regarding marital and sexual satisfactions.
The current study aimed at investigating the effect of a sexual counseling project on females’ sexual satisfaction during pregnancy.
The current randomized, clinical trial was performed on a sample of 60 pregnant females referred to the prenatal care clinic of Fatemieh hospital of Hamadan, Iran, in 2014. Females were assigned to the intervention and control groups. A 3-part instrument was used including a demographic information form, an inventory of changes in sexual activities during pregnancy, and the Linda Berg sexual satisfaction scale. The intervention group was divided into 3 subgroups of 10, and each subgroup participated in 4 weekly educational sessions. Descriptive statistics, Chi-square test, the independent samples t test, and paired t test were used to analyze the data.
After education, excellent self-evaluation of the quality of sexual relations in the intervention group increased significantly (P The sexual education program implemented in the current study could significantly increase the females’ sexual satisfaction score in the intervention group.

Considering the importance of assessing the range of phenomena that can change in psychodynamic therapy, and lack of appropriate assessment scale in Persian language, the present study assessed the reliability of the Persian mastery scale. The mastery scale is a comprehensive research tool for assessing a patient’s mastery of transference-related interpersonal conflicts during the treatment process.
The aim of this research was to examine the psychometric properties of the Persian version of the Mastery Scale.
After preparing the Persian version of the mastery scale through the forward-backward translation process, a sample of 36 relationship episodes was rated by three independent judges. Data were collected in Mashhad, Iran in 2015. The psychometric properties of the instrument, including inter-rater reliability and test-retest analysis were assessed.
The test-retest correlations of the 3 judges were (0.80, 0.91 and 0.95), highly significant at P The current study has provided evidence that the Persian mastery scale is a reliable instrument for assessing changes in inner capacities and resources through psychodynamic treatments. However, further studies are required to investigate the validity of this scale.

Cerebral dominance, also known as lateralization of brain functions, is the neurologic phenomenon in which one hemisphere dominates over the other. In humans, the majority of people are of left cerebral dominance. This study aims to derive a statistical inference between determined parameters of cerebral dominance (handedness, gender, and language skills) and the 3-dimensional visual analytic skills.
To investigate the presence of a correlation between the lateralization of brain functions and visual analytic skills. This study is purely observationally and cross-sectional in design using survey tool. Despite purely observational, proper randomization and blinding were done for the participants, to prevent coverage and selection biases among participants.
This cross-sectional survey targeted an audience of undergraduate medical students, 103 of them replied and fully completed an electronic survey. All participants were blinded to the outcome and aims of the study. The survey was created via Google Forms, and made available online for three days, on the university intranet system. Compiled data resulted in 523 pages. Statistics were done using SPSS v.20, Microsoft Excel 2016, and Shodor-Interactivate software. Referencing for this paper were retrieved via a detailed systematic review of literature databases while carrying out critical evaluation of evidence. The databases included: PubMed, the Cochrane Library, Scopus, OpenGrey, and Google Scholar.
Males and females participated in the survey, 34 and 69 participants respectively. Approximately 88.4% of participants were right-handed. Mapped participants’ demographics included: age, gender, handedness, siblings’ and parents’ handedness, the number of siblings and birth order, and the number of spoken languages. Statistics have proven that there was no significant correlation between the 3D-visual skills and any of the tested parameters. Significance was considered at an alpha value of 0.05
The tested hypothesis regarding the presence of potential correlation between handedness (and other parameters of cerebral dominance) with the three-dimensional visual analytic skills, were proven to be non-existent.

In the recent decades, increasing number of females have been seeking de-addiction services yet data in this regard is very limited from across the globe as well as from India.
The aim of this research was to study the gender differences in demographic and clinical profile and psychiatric co-morbidity among patients with alcohol dependence syndrome (ADS).
This cross sectional study was conducted at Shridevi Institute of Medical Sciences and Research Hospital, a tertiary care center located in Tumkur, India, during year 2015 to 2016. Seventy male and 50 female subjects (aged 18 to 50 years) meeting the criteria for ADS, were assessed using socio-demographic and clinical proforma, severity of alcohol dependence questionnaire (SADQ), and mini international neuropsychiatric interview (MINI).
For females, mean age at presentation was 41.38 years (standard deviation, SD = ± 6.43), the majority belonged to a nuclear family (72%) (Parents and their children living together), had low socio-economic class (68%), and studied up to Seventh standard (86%) compared to males, whose mean age at presentation was 39.65 years (SD = ± 7.76), majority belonged to a joint family (54.28%) (three generation living together), middle socio-economic class (55.71%), studied to the eighth standard and above (52.85%). Females compared to males started alcohol use at a later age, drunk for shorter duration and lesser quantity per day. Stress was the foremost reason cited for initiation of drinking and physical sickness to seek medical treatment by both. Females have more co-morbid psychiatric problems compared to males.
A number of important gender differences with regards to alcoholism have been found, which have implications for planning gender sensitive, multi-dimensional treatment, and preventive programmers.

Patients with schizophrenia demonstrate visual processing impairments; however, the nature of these impairments remains undetermined.
The present study aimed at investigating the visual processing of unilateral compared to bilateral visual stimuli in these patients.
A group of 27 schizophrenia patients and a group of 27 matched controls (age, gender, education level and hand preference) (20 males in each group), were tested in 2 computerized tasks, namely circle and star and triangle. Unilateral and bilateral shapes were presented on the screen of a computer. In the circle task, stimuli were similar unilateral left, unilateral right and bilateral circles that appeared on a computer screen, whereas in the star and triangle task, there were different unilateral and bilateral stimuli. Participants were instructed to press the left key in unilateral and right key in bilateral trials.
In both tasks, the patients significantly detected bilateral displays more accurately than unilateral displays, and unilateral-left more accurately than unilateral-right trials. The similarity of stimuli on the star and triangle task, did not affect the patients’ performance. In contrast, individuals in the control group performed similarly across both unilateral and bilateral trials.
These findings provide evidences of hemineglect and anti-extinction in patients with schizophrenia, suggesting bilateral advantage in visuospatial processing in the patients.

An active intervention is necessary for the care and support of women who have experienced stillbirth.
The aim of the present study was to determine the impact of psychological counseling on the severity of grief symptoms in mothers after stillbirth.
We conducted a semi-experimental study on 100 women who had experienced stillbirth in their most recent delivery in a Central Maternity Hospital affiliated to the University of Medical Sciences, Zahedan, Iran. Participants were randomly assigned to two groups: intervention (n = 50) and control (n = 50). The intervention group received four sessions of small-group psychological counseling over 2 weeks and the control group received the routine postnatal care. We evaluated the severity of grief symptoms in both the groups before the first counseling session as well as at the end of the fourth week following the final session (and at equivalent times in the control group) using the Perinatal Grief Scale. Data were analyzed using independent and paired t-tests, chi-square test, and analysis of covariance.
The mean total grief symptom score and three subscale scores (active grief, difficulty coping, and despair) were significantly lower in the participants who received psychological counseling than in those who received the routine care (P Counseling significantly reduces grief symptoms, allowing for faster transition from grieving and preventing complicated grief. It is, therefore, necessary to integrate psychological interventions into the care system for mothers.

The anxiety of dental conditions is very common. Salivary alpha amylase (SAA) enzyme, as a non-invasive biomarker, is considered in assessing dental anxiety.
The present study aimed at investigating the relationship between salivary alpha amylase level and dental anxiety before and after dental restoration.
In this longitudinal study, which was performed in Babol dental faculty during 2015 and 2016, a total of 99 patients (50 females and 49 males) were selected using simple sampling method. To measure anxiety, the patients completed modified dental anxiety scale (MDAS) and demographic questionnaire. Unstimulated whole saliva was collected 3 times: at the day of dental examination in a stress- free condition; immediately before dental restoration; and 15 minutes after dental restoration. Salivary alpha amylase activity was measured by the Caraway starch-iodine modified method. SPSS 20 software and t test, chi square, Pearson correlation, and ANOVA repeated measurement were used for data analysis.
Levels of salivary alpha amylase increased before dental restoration and reduced after dental restoration (P value 0.05).
Salivary alpha amylase can be used as a reliable objective tool for measuring anxiety of dental treatment.

Children of anxious parents are at higher risk of asthma exacerbation.
Due to the high prevalence of anxiety and depression in parents of children with chronic diseases and also, because of the high prevalence of asthma, the present study was designed to evaluate the relationship between the parental anxiety intensity and the children's asthma severity.
It was a cross sectional study. Sampling was done continually among 134 parents of 5 to 15- years-old children with allergic asthma referred to allergy and asthma clinic in Sari during autumn and winter 2013. For checking parental anxiety we used Beck Anxiety Inventory and Global Initiative for Asthma (GINA) for assessing asthma severity in children. To evaluate the relationship between parental anxiety and severity of asthma in children Gamma and Kendall's Tau test was used.
Kendall Tau and Gamma test showed that there is a significant relationship between the number of admissions (P The results of present study indicate the relationship between the intensity of anxiety for parents and severity of asthma in their children. Therefore, it is recommended that specialists do some interventions in order to control asthma better so that can better control their parental anxiety.

Drug use has always been suggested as the first preventable agent of various diseases and deaths around the world. Nowadays, this problem is more prevalent among young people and students of universities that are at risk.
Due to the newness of the case and legal restrictions on psychoactive drugs use in Iran, there are no statistics regarding the prevalence of consuming these drugs; therefore, it was decided to determine the prevalence and causes of tendency towards psychoactive drugs use among students of Yazd Shahid Sadoughi University of Medical Sciences.
The present research was a cross sectional study, through which 250 students of Yazd University of Medical Sciences were selected using systematic random sampling and investigated in 2015. Data was collected through a self-made questionnaire and then analyzed using the SPSS software version 22 at a significance level of P = 0.05 using frequency tables, chart, Chi-square, and logistic regression test.
The prevalence of psychoactive drugs consumption was 5.6%. The most important factor of tendency towards consumption of psychoactive drugs among students has been failure to meet their emotional needs (35.7%), yet taking pleasure has been the mainspring for consuming these drugs in most cases (50%). There was a statistical significant relationship between psychoactive drugs consumption and age, place of residence, drug history in parents, and being exposed to cigarette smoke throughout the day (P Due to the relatively high prevalence of psychoactive drugs consumption in students of medical sciences as messengers of health, holding life skill workshops and consulting with students, providing appropriate recreational facilities seem essential in order to reduce the prevalence and prevent this dilemma.

There is a growing body of literature on the effectiveness of second and third wave psychotherapies for treating generalized anxiety disorder.
The aim of the present study was to compare the effectiveness of cognitive- behavior (CBT) group therapy (Borkovec model) and mindfulness based cognitive therapy (MBCT) on quality of life and parent-child relationship in generalized anxiety disorder (GAD) among female participants.
A semi experimental design using pre and post-test and a four-month follow up was used. The statistical population comprised of females with generalized anxiety disorder, who had at least one primary school-aged daughter in the first and third district of Tehran. The sample consisted of 36 females with GAD. Participants’ selection was based on availability and they were assigned randomly to 2 groups of CBT and MBCT. The research was conducted in the first half of 2014. The following measurement tools were used, GAD-7 questionnaire, world health o quality of life scale (WHO-QOL BREF), and Parent Child Relationship Scale (CPRS). Data were analyzed via Repeated measures analysis of variance test.
Although the results showed efficacy of CBT and MBCT after the intervention and during follow up (P 0.05).
It could be inferred from the results that MBCT could be utilized similar to CBT as an effective treatment in adjunct to pharmacotherapy for females with GAD.

Borderline personality disorder (BPD), which is highlighted by emotional dysregulation and high rates of comorbid emotional disorders, is one of the most challenging clinical conditions for mental health services in different communities. The Unified protocol for the transdiagnostic treatment of emotional disorders (UP) was designed to target common vulnerabilities across emotional co-occurring disorders.
The aim of the present study was to examine the preliminary efficacy of the UP in treatment of Iranian patients with BPD and comorbid emotional disorders.
By the purposeful sampling method, 6 participants (5 females and 1 male) with borderline personality disorder (BPD) and major depressive disorder (MDD), which met the inclusion criteria, participated in a multiple baseline experimental single case study. Each participant completed the borderline personality inventory (BPI) and difficulties in emotion regulation scale (DERS) during 3 baseline, 8 treatment modules, and 1 follow up assessment session. The unified protocol was carried out for 16 to 20 weekly sessions. Optical analysis and reliable change index (RCI) were used for determination of statistical significance. Remission rate was also applied to measure clinical significance.
Results showed that the unified protocol (UP) was effective on reduction of BPD and depressive symptoms as well as increase of emotion regulation skills.
The efficacy of UP was statistically and clinically significant in most of the participants. Results from this study provide preliminary evidence for the efficacy of the UP in the treatment of BPD with co-occurring unipolar depressive disorders in Iran, and provide additional support for the transdiagnostic approach in the treatment of emotional disorders.

Female Sex workers are at risk of obtaining sexually transmitted infections, particularly human immunodeficiency virus.
This study aimed at comparing the high-risk behaviours between regular and casual sex workers.
This was a cross-sectional study conducted on sex workers from February to December, 2015, in a city of northern Iran. The research recruited 184 sex workers, who had the inclusion criteria. Three sampling methods were used to recruit the subjects. The test was conducted at an error level of 5% using the SPSS software.
The average age of the casual sex workers (32.53 ± 7.39) was older than that of regular sex workers, with a significant difference (P value 0.05) between the 2 groups.
It is very essential to organize peer groups for outreach services for sex workers, which could be more appropriate and consequently decrease the relevant damage in these groups.

The ability of humans to recognise faces of countless individuals is unique and has an evolutionary basis. The cortical surface, responsible for this task, is significantly large in humans. The aim of this study was to analyze the face recognition abilities of a selected population of Iraqi students and to determine the correlation of these abilities with gender, handedness, and ethnicity.
To identify potential super-recognizers in a population of Iraqi medical students.
This cross sectional study started in October 2016. The participants included medical students (n, 309), aged 17 - 25 years, form 4 ethnic groups: Arabs (288), Kurds (12), Turks (7), and Christian ethnicities (2). The face recognition ability was quantitatively scored (0 - 14), using a face recognition test. The test was distributed electronically via bit-encrypted Intranet systems. Nonparametric and inferential statistics were measured to determine the correlation between the scores and gender, handedness, and ethnicity.
More than half of the participants (51.5%) were found to be potential super-recognizers. There was a significant difference between males and females (10.72 vs. 10.05; P = 0.027). However, there was no significant difference between right- and left-handed individuals (10.29 vs. 10.09; P = 0.394). On the other hand, there was a significant interethnic difference between Arabs and Kurds (10.19 vs. 11.5; P = 0.022).
Face recognition abilities had not been investigated in Iraqi populations before the present study. This study indicated the correlation of face recognition abilities with gender and ethnicity. Individuals with high scores on face recognition tests were known as super-recognizers. These individuals can be valuable to law-enforcement and intelligence agencies worldwide. Nonetheless, practical applications of this study are not limited to artificial intelligence, biometrics, or anthropometrics.

Pathological internet use may lead to serious psychosocial problems and dysfunction.
The purpose of the study was to investigate the prevalence of pathological internet use among undergraduate university students in five ASEAN countries in relation to sociodemographics, internet use variables, psychosocial factors, and comorbid symptoms.
In a cross-sectional survey in 2015 in Indonesia (Yogyakarta), Malaysia (Kuala Lumpur), Myanmar (Yangon), Thailand (MahaSarakham), and Vietnam (Hanoi), 3240 undergraduate university students (Mean age = 20.5 years, SD = 1.6), who were randomly selected,responded to a questionnaire including the “Young Diagnostic Questionnaire for Internet Addiction” (YDQ) and other measures.
Overall, the prevalences of pathological internet use were 35.9% (ranging from 16.1% in Myanmar to 52.4% in Thailand), maladaptive use 34.8% and adjusted Internet users 29.9%. In multivariate logistic regression analysis, internet use variables (heavy overall Internet use, heavy Internet use for recreational purposes, and heavy smartphone use), psychosocial factors (the experience of childhood physical abuse, childhood sexual abuse, lack of social support, and poor academic performance), and comorbid symptoms (having a self-classified gambling problem, hazardous or harmful alcohol use, past 12-month drug use, severe depression, sleeping problems, having attempted a suicide, and PTSD symptoms) were found to be associated with pathological internet use.
The study found a very high prevalence of pathological internet use; those students lacking psychosocial support and having comorbid symptoms were at the highest risk.

Drug dependency is one of the most important issues in any society and it is among the most widespread health risk factors.
This study was conducted to determine quality of life in drug- dependent individuals, who were under methadone treatment, and non-drug dependent persons in Shahroud (northeast of Iran).
In this comparative study, 266 drug dependent participants and 541 non-drug dependent participants were studied in 2014. The Persian version of SF-36 Quality of Life Questionnaire was used to collect data. The data were analyzed using chi square test, t test, and ANOVA.
The majority of the participants (77.1%) in both groups were male. The mean age of drug-dependent participants was 37.6 ± 10.7, the mean duration of drug dependency was 12.0 ± 9.3 years, and the mean duration of treatment in methadone maintenance treatment centers (MMT) was 24.6 ± 22.6 months. No significant difference (P > 0.05) was observed between the 2 groups in any aspects of quality of life other than the vitality (P = 0.001).
In this study, quality of life scores were not significantly different between drug dependent and non-dependent participants. It seems that treatment with the use of methadone and buprenorphine can play a good role in improving quality of life of addicts.

Hypersexual disorder is described as multiple unsuccessful attempts to control or diminish the amount of time spent on engaging in sexual fantasies, urges, and behaviors in response to dysphoric mood states or stressful life events.
This study aimed at evaluating difficulties in the regulation of emotion, psychological well-being, and socio-economic status in explaining the dimensions of hypersexuality in patients with substance use disorder.
The data presented here was obtained from a total of 285 individuals with substance use disorders, who were selected via a multi-cluster sampling method from residential treatment centers of drug abuse in the city of Tabriz, Iran, during years 2015 to 2016. Instruments used for collecting the required data were Hypersexual Behavior Inventory (HBI), Difficulties in Emotion Regulation Scale (DERS) as well as the Ryff Scale of Psychological Well-Being (RSPWB).
Findings showed there were significant relationships between hyper sexuality and difficulties in emotion regulation (r = 0.44, P Results of this study provided sufficient evidence to support this model to explain the behavior of hypersexuality in individuals with substance use disorder and clinical practice could be based on this evidence. Specific treatment programs for people with addiction should be designed to prevent problems associated with relapse.

Studies reported the strong link between Obstructive Sleep Apnea (OSA) and Major Depressive Disorder (MDD). However, the risk for OSA in patients with chronic treatment resistant depression (cTRD) is not well documented worldwide.
We assessed the risk for OSA and associated factors in cTRD patients.
The study recruited 140 Iranian patients with cTRD. All patients completed the Berlin questionnaire, which evaluates the risk of OSA. Additionally, demographic data and history of cardiovascular and metabolic diseases were collected. Pearson’s Chi-square test, Fisher’s exact test, and independent T-test were used to assess group differences, when appropriate.
The study found that 89 of 140 cTRD patients (64%) were at high risk for OSA. Group comparison between cTRD patients (high vs. low risk for OSA) demonstrated that at high risk OSA-cTRD patients had an elevated rate of hypertension, diabetes mellitus, and obesity. Also, age, duration of depression, and duration of treatment were significantly higher in cTRD patients with higher risk compared to those with lower risk OSA” for "Also, age, duration of depression, and duration of treatment were significantly elevated in high versus low risk cTRD patients.
The results suggest that a noticeable number of patients with cTRD are at high risk for OSA, which is larger than the reported magnitude in the general population. Moreover, hypertension, diabetes mellitus, and obesity are associated with a higher risk for OSA. Also, age, treatment duration, and depression duration could be considered as possible comorbid factors for OSA in patients with cTRD.

While waterpipe tobacco smoking is associated with several health-related risks, its prevalence is on the rise among young age individuals, including high school adolescents. Social aspects related to waterpipe smoking comprise a major reason for the initial orientation to its consumption.
This study aimed to investigate the application of prototype Willingness Model to predict waterpipe smoking among high school adolescents in Birjand, eastern Iran.
This cross-sectional study was undertaken on 432 high school students (239 boys and 193 girls) in Birjand, eastern Iran, in 2016 via multi-stage sampling. Inclusion criteria included residence in Birjand, being a high school student, and willingness to participate in the study. The data were collected by a researcher-made questionnaire and analyzed by SPSS (version 18) using descriptive statistical tests, Pearson correlation test, and linear and logistic regression analyses.
The results showed that 17.4% of the students had a history of tobacco use. Subjective norms were the main predictors of intention (B = 0.17, P The prototype willingness model is an appropriate theoretical framework for predicting waterpipe smoking among adolescents in Birjand, Iran. Since both behavioral willingness and the intention are contributory to waterpipe smoking among high school students, it would be necessary to adopt health promotion strategies in order to improve these constructs in preventive interventions.

The habit of hookah smoking is increasing among the youth, which requires more attention.
This study aimed to assess knowledge and attitudes of university students towards hookah smoking in Fasa, Iran, based on the theory of planned behavior (TPB).
This study was conducted on 157 university students in Fasa, Fars Province, Iran, in 2015. The data were collected using a questionnaire including demographic information and TPB constructs. Then, the data were entered into the SPSS version 19 statistical software and analyzed using descriptive and inferential statistics.
The results showed that 80% of the students had plans for the cessation of hookah smoking. Additionally, a significant difference was found among the students of different universities regarding the scores of attitude (P = 0.003) and behavioral intention (P = 0.005). Moreover, the results of Mann-Whitney test showed that the scores of behavioral intention and attitude were higher among male participants (P = 0.0001 and P = 0.004, respectively). However, females obtained significantly higher scores regarding peer opinion (P Interventions for the cessation of hookah smoking should be based on elimination of positive attitudes toward hookah smoking and promotion of refusal skills, relaxation, and skills to cope with the temptation of hookah smoking.

Doogh is a traditional dairy product, which is widely used as a popular drink in the Middle East, in general, and in Iran, in particular. There has been no research study regarding its effects on vigilance and mental-cognitive performance so far; the present study aimed at investigating this effect.
The current study aimed at objectively evaluating the effect of Doogh (Yogurt drink) on attention, reaction time and vigilance- sleepiness of healthy young adults.
In this repeated measurement study, participants included 17 healthy adults between 20 and 40 years old, with adequate night sleep and without any symptoms of daytime sleepiness that entered the clinical trial one at a time via public invitations. The intervention included drinking 250 cc of doogh or water in the morning or in the afternoon. Therefore, there were 4 interventions for each participant with random sequences, lasting 3 to 5 days. Right before and 1.5 to 2 hours after drinking each of the drinks, the participants were assessed using test of variables of attention (TOVA) and sleepiness test via the visual analogue scale (VAS). The data were analyzed by paired t test and Generalized Estimating Equation (GEE) model at the final stage.
Ten female and 7 male participants took part in the study. Doogh caused a significant increase in reaction time and commission error and reduced vigilance. These changes occurring after drinking doogh were significant in the afternoons, while they were insignificant in the mornings despite the fact that they lasted longer. There was no change regarding TOVA variables caused by water in any of the case. Although reduced level of vigilance was observed after drinking water, the differences were more significant with regards to doogh and its post intervention comparison with water was meaningful.
Doogh caused sleepiness in the afternoon time along with a significant increase in reaction time and commission and omission errors. Regarding the cognitive effects of doogh, the timing and activity type of the drinker should be taken into account. Positive effects of drinking doogh on sleepiness and the risk of accidents caused by drinking it should be studied in other research projects.

Adult separation anxiety disorder (ASAD) has been reported in the psychiatric literature with lifetime prevalence of 6.6%, which is associated with different comorbidities. Here, we report an adult Bangladeshi female presented with ASAD for her pets with superimposed superstitious beliefs.

A 27 year- old- female presented with excessive unusual preferences and preoccupation with her 2 cats for the last 4 years. She also presented with severe anxiety, fear, and sleep disturbances with bad dreamsrelated to her pets. She had persistent fear of losing her pets and suspected that people including her family members might harm them. She was increasingly unwilling to keep herself away from the cats, resulting in her social isolation and limitation in other activities. She married 2 years ago after long period of affairs, but refused to stay in her in-laws residence without her pets and she even avoided her husband. She behaves with pets as if they are her children and does not want to have children anymore.

Extreme pet preference with avoidance of usual family life contrasting the cultural belief encouraged the authors to draw the attention of scientific community.

Morgellons disease is a condition that falls within the same delusional complex of Ekbom Syndrome. Thomas Browne first described this psycho-cutaneous dermatosis in the 17th century, naming it “Morgellons disease”. It is characterized by delusional skin infestation with inanimate objects. To date, very little is known about Morgellons disease, and even less is known about its correlation with recreational substance abuse.
This is a rare case presentation of Morgellons disease of a 52 years old female from Hertfordshire-United Kingdom. She is an academic and a professorial researcher. Initially, the patient was wrongly diagnosed as a case of a dyshidrotic eczema. Afterwards, her lesions worsened and resulted in an impairment of social life and academic performance.Consequently, the patient consulted a psychiatrist who implemented a multidisciplinary approach. Comprehensive laboratory and radiological investigations, including MRI, confirmed the absence of any organic pathology, and the final diagnosis was settled to be an idiopathic case of Morgellons disease.
This case represents a cutaneous pathology in relation to the delusional spectrum of Ekbom’s syndrome and Delusional Infestation. In this once in a life time encounter with a Morgellons disease patient, the classic “physician Odyssey” was prevented. The attentive multidisciplinary approach towards the patient was critical for the successful diagnosis and management. The patient was soon to be treated with Olanzapine, a 2nd generation antipsychotic. Within less than a month, the distressed patient showed a remarkable improvement.

The phenethylamine derivative 25b-NBOMe is a potent hallucinogen and a serotoninergic agonist. Other forms of NBOMe also exist, including 25c-NBOMe and the more powerful 25i-NBOMe. 25b-NBOMe has been incriminated with cases of intoxication among teenagers and adults worldwide.
This manuscript is an analytic storytelling of a tragic case of death induced by the 25b-NBOMe substance abuse by a 17-year-old male who was completely healthy and a charismatic high school student. Recreationally, the patient had ingested three sublingual tablets of 25b-NBOMe. Unfortunately, this psychedelic trip has put an end to his life. The reason for death was reported to be cardiac arrest, because of the cardiac arrhythmia. The concentration of 25b-NBOMe detected in postmortem heart blood was 3.14 ng/mL.
This case represents one of the very few documented cases in the literature, which ended in death from the 25b variant. It is to be concluded that these death incidents can be attributed either to an idiosyncratic reaction or to the presence of an unknown mixture of different ingredients and contaminants in these designer drugs. This case report is the first in published literature to be also correlated with data from Google trends databases.