فهرست مطالب

Iranian Journal of Psychiatry and Behavioral Sciences
Volume:12 Issue: 4, Dec 2018

  • تاریخ انتشار: 1397/09/12
  • تعداد عناوین: 36
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  • Nourrollah Yadegari , Kourosh Sayehmiri , Mona Zamanian Azodi , * , Fatemeh Sayehmiri , Farhad Modara Page 1
    Context: Attention deficient hyperactivity disorder (ADHD), diagnosed in psychiatric outpatient clinics, is the most common psychiatric disorder among schoolchildren. The purpose of this study is to conduct a meta-analysis on subscales related to ADHD examined on schoolchildren. Moreover, it is tried to evaluate meta-analysis of ADHD and its subscales in primary school students in Iran. Evidence Acquisition: Searching through the databases of Magiran, SID, Google Scholar, etc. a total of 16 articles were collected and weighted based on the number of cases and prevalence in binomial distribution. By using a random effects model meta-analysis (I2 = 96.5%), data were analyzed by the use of R and STATA software (version 11.2).
    Results
    In this analysis, 27 articles published between the years of 2001 and 2016 were used. The total sample size was 15124 students whose ages ranged from six to 14 years old. The prevalence of ADHD based on parents and teachers’ consensus was 12% (CI 95%: 9.0 - 15), from parents’ perspective 15.6% (CI 95%: 9.8 - 21.5), and from teachers’ perspective 17.2% (CI 95%: 12.7 - 21.8). The subgroups’ prevalence rates based on parents and teachers’ consensus were as follows: Attention deficit (AD) = 4.2%, hyperactive impulsive (HI) = 4.1%, and combined type (CT) = 3.5%. ADHD was more prevalent in boys than girls (7.9% versus 5.5%).
    Conclusions
    The results indicated that the prevalence of ADHD among schoolchildren is moderate; therefore, considering the importance of students’ mental health, the needs for identification, prevention, and treatment of high-risk groups by responsible institutions become obvious.
    Keywords: Attention Deficient, Hyperactivity, Prevalence, Meta-Analysis, Iran
  • Marzieh Azizi, Ensieh Fooladi, Fatemeh Abdollahi, Forouzan Elyasi * Page 2

    Context: As the most common psychiatric disorder associated with menopause, depression is associated with significant morbidity and mortality consequences. Given the importance of identifying risk factors of depression in the menopausal period, this study aims to determine bio psychosocial risk factors of depression during the menopausal transition.Evidence Acquisition: For this narrative review, electronic databases including Google Scholar, Magiran, Scientific Information Database (SID), PubMed, Web of Science, Scopus, Ovid, Science Direct, and ProQuest were searched. Articles published between 1978 and 2017 were retrieved, and an abstract and full-text appraisal was conducted. A total of 71 articles were selected for this review. The inclusion criteria included articles focusing on depression in menopausal-aged women that were published in scientific journals and English and Farsi language articles conducted in menopausal aged women.

    Results

    The bio psychosocial risk factors of depression were divided into three major categories: biological, psychological, and social risk factors.

    Conclusions

    Given the important role of psychological health in menopausal-aged women, it is recommended that mental health and risk factors of psychiatric disorders in menopause are evaluated at menopause clinics and that every high-risk woman is referred to a psychiatrist for pharmacological or non-pharmacological intervention

    Keywords: Biological, Depression, Menopause, Psychiatric Disorders, Psychosocial Factors
  • Banafsheh Gharraee , Komeil Zahedi Tajrishi , * , Abbas Ramezani Farani , Jafar Bolhari , Hojjatollah Farahani Page 3
    Background
    One of the most common anxiety disorders is the social anxiety disorder (SAD), which is characterized by intolerable anxiety and self-consciousness in daily social situations. A large body of study is conducted on the treatment of this disorder, though further studies are required on new psychological therapies.
    Objectives
    The present study aims to evaluate the effectiveness of compassion focused therapy (CFT) on patients with SAD.
    Methods
    The present randomized controlled trial study, which is along with pre-test, post-test, and follow-up with control group, 34 subjects who based on the structured clinical interview for DSM (SCID) had the criteria for social anxiety disorder on the basis of DSM-IV-TR, and had no other severe psychiatric disorders, were assigned completely randomly and equally into experimental and control groups. The experimental group was treated with 12 one-weekly CFT sessions, whereas the control group did not receive any treatment. At the beginning of the research, after 12 weeks and after a follow-up period of 8 weeks, all subjects were evaluated with acceptance and action questionnaire (AAQ-II), mindful attention awareness scale (MAAS), levels of self-criticism scale (LOSC), self-compassion scale (SCS), World Health Organization quality of life-BREF (WHOQOL-BREF), and Liebowitz social anxiety scale (LSAS) instruments. In addition to descriptive statistics, repeated measure analysis of variance (RM-ANOVA) was used in order to analyze the findings and using SPSS-21 software all analyzes were conducted.
    Results
    Based on the RM-ANOVA, CFT was significantly more effective than non-treatment in reducing psychological inflexibility, self-criticism, and severity of social anxiety symptoms (P < 0.001) in both post-test and two months’ follow-up. Moreover, CFT was able to significantly increase the mindfulness levels, self-compassion, and quality of life in patients with social anxiety (P < 0.01).
    Conclusions
    Compassion-focused interventions apparently play a quite effective role in reducing symptoms and increasing the quality of life of patients with social anxiety disorder
    Keywords: Compassion, Mindfulness, Psychotherapy, Self-Criticism, Shame, Social Anxiety Disorder
  • Massumeh Koochaki , Zohreh Mahmoodi , * , Sara Esmaelzadeh–Saeieh , Kourosh Kabir , Mahrokh Dolatian Page 4
    Background
    Pregnancy and childbirth are among the most stressful experiences in women. This study was conducted to determine effects of cognitive-behavioral counseling on posttraumatic stress disorder in mothers with infants hospitalized in neonatal intensive care units.
    Methods
    The present randomized, controlled, clinical trial was conducted during year 2016. A total of 90 eligible females, attending Kowsar Hospital (Qazvin, Iran), were recruited through convenience sampling and allocated to the intervention and control groups, using random blocks of four. A total of eight counseling sessions were held for the two groups. The post traumatic stress disorder (PTSD) symptom scale was distributed among the participants before, immediately after, and three weeks after the intervention. The collected data were analyzed using the SPSS 19.0 software.
    Results
    The two groups were not significantly different in terms of baseline PTSD scores. According to the generalized estimation equation model, the two groups had significant differences in terms of the mean PTSD scores immediately and three weeks after the intervention (P = 0.002) and the mean scores were significantly lower in the intervention group on both occasions. Friedman test results confirmed the reducing trend in the intervention group’s mean PTSD scores at all three occasions (P = 0.000).
    Conclusions
    Counseling had a positive effect on reducing PTSD symptoms in mothers with special conditions. This method can, hence, be recommended for improving the health status of these mothers
    Keywords: Counseling, Cognitive Behavior Therapy, Infants, Neonatal Intensive Care Units, Posttraumatic Stress Disorders
  • Somayeh Haddadi, Siavash Talepasand *, Isaac Rahimian Boogar Page 5
    Background

    Social anxiety disorder, one of the most common anxiety disorders, is known as a chronic psychiatric disorder.

    Objectives

    The present study is aimed at investigating the effects of computer-based attention training on attention bias modification for social anxiety disorder.

    Methods

    This randomized controlled trial was performed on 30 students who suffered from social anxiety disorder. All of them filled out the social phobia inventory (SPIN; Connor et al.), Hamilton depression rating scale (HDRS), and social anxiety disorder severity questionnaire (SCSQ) and attended a clinical interview. The participants were randomly assigned to an experimental group (n = 15) and a control group (n = 15), and then they took part in a computer-based pretest program of attention bias measurement (ABM). The experimental group attended 10 sessions of computer-based attention control training program. Both of the groups participated in a computer-based posttest program of ABM. The data were analyzed using the analysis of covariance.

    Results

    Our findings indicated that the computer-based attention control training contributed to reducing attention bias towards the angry (Eta Square = 0.34), surprised (Eta Square = 0.23), and happy (Eta Square = 0.19) expressions, while it did not have any effects on disgusted, fearful, and sad expressions.

    Conclusions

    Attention training program is an effective method to modify attention bias towards some of the emotional effects and can be employed in therapeutic interventions

    Keywords: Attention, Anxiety, Phobia, Social
  • Leila Amirpour, Banafsheh Gharaee, Behrooz Birashk * Page 6
    Background

    Studies have introduced anxiety as a key factor in the formation and development of paranoid thoughts. Transdiagnostic cognitive behavioral therapy is specifically used for the treatment of emotional disorders, with its particular emphasis on anxiety that can be applied in the treatment of paranoia.

    Objectives

    The purpose of this study is to determine whether transdiagnostic cognitive behavioral therapy is effective in reducing the subclinical symptoms of paranoia.

    Methods

    Participants were recruited from female students in Mashhad universities, Iran, during an eight-month period between October 2016 to May 2017. Healthy participants (n = 30) with subclinical paranoia (assessed with SCID-I, SCL-90-R and paranoia scale) were randomly assigned to two groups (GTCBT = 15 and waiting list = 15). Before and after the intervention, paranoid thoughts and their effects in individuals’ mental and social performance were assessed by paranoid scale and work and social adjustment scale.

    Results

    The results of this study support the effectiveness of group trans-diagnostic therapy in decrease paranoid ideation (P = 0.003) and improve general function (P = 0.001).

    Conclusions

    This study can be considered as a starting point for further research on the treatment of paranoia

    Keywords: Cognitive Therapy, Group Psychotherapy, Paranoid Disorders, Students, Therapy
  • Abdollah Omidi, Sajedeh Hamidian * Page 7
    Background

    Comorbidity of anxiety and mood disorders is rather common, making the treatment of each disorder more difficult. Posttraumatic stress disorder (PTSD) is one of the anxiety disorders with a high degree of association with depression; PTSD-depression comorbidity can significantly affect the quality of life of the ones affected. Hence, using the best way to deal with each of these disorders is highly recommended.

    Objectives

    The current study aimed at evaluating the effectiveness of a combined treatment of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on PTSD and comorbid depression in combat veterans.

    Methods

    Among patients referring to Kashan Veterans Counseling Center, 62 patients diagnosed with comorbid PTSD and depression according to diagnostic and statistical manual of mental disorders-fourth edition-text revision (DSM-IV-TR) were selected, and randomly assigned into the two groups of case and control. The study was conducted in 2012.

    Results

    Statistical analysis showed that after the intervention, the depression scores of the case group significantly decreased, while the similar trend was not observed in the control group (P < 0.05). Furthermore, the total score and the scores of "mental health" and "social functioning" subscales of quality of life significantly increased in the case group.

    Conclusions

    According to the observed results, it seems that the combined treatment administered to the case group could aid the participants overcoming depression symptoms and subsequently raised their quality of life

    Keywords: Cognitive Therapy, Depression, Mindfulness, Posttraumatic Stress Disorder, Veterans
  • Roheila Seyedtabaei, Reza Seyedtabaei, Seyed Davood Mohammadi *, Mehdi Tehranidust Page 8
    Background

    Diverse cognitive functions and behaviors have been monitored in the two sub-types of attention deficit/hyperactivity disorder (ADHD) including the combined type and the inattentive type.

    Objectives

    Previous studies have shown that ADHD children have problems in visual memory, and short and long-term use of methylphenidate (MPH) improves these functions, but fewer studies have been done on the inattentive subgroup, namely attention deficit disorder (ADD). Due to the different cognitive functions in these two ADHD subgroups, this study was done to investigate the long-term use of MPH on the visual memory of ADD children.

    Methods

    A 4-week experimental clinical trial using MPH (1 mg/kg/dose) was conducted. Participants were 20 children aged 6 - 11 years with ADD that came to the Rouzbeh Clinic in Tehran in 2010. Cambridge neuropsychological test automated battery (CANTAB) tests of visual memory were used for assessment.

    Results

    The long-term use of MPH improved 12 aspects of paired associated learning (PAL) such as first-trial memory score, the number of mean mistakes to success and mean efforts to success (P < 0.05). However, MPH did not improve the stages completed in the first trial, the total errors, and the total errors adjusted in the three-shape step of PAL (P > 0.05). MPH also improved all aspects of pattern recognition memory (PRM) (P < 0.05) and the mean correct latency of spatial recognition memory (SRM) (P < 0.05). However, MPH had no effect on delayed matching to sample (DMS) (P > 0.05).

    Conclusions

    MPH improved performance on the PAL, PRM, and SRM visual evaluating tests of ADD patients. Nevertheless, the patients did not show any improvement in the DMS test. In comparison with previous studies, our results would suggest that MPH has similar effects on the visual memory of ADD and ADHD patients

    Keywords: Attention Deficit Disorder, Drug Therapy, Methylphenidate, Visual Memory
  • Valiollah Akbari , Parvin Rahmatinejad , * , Seyed Davood Mohammadi , Amene Rudhelle Page 9
    Background
    Recently, more evidence has been presented regarding the role of behavioral activation/inhibition systems as predictors of substance use disorders. In fact, these systems are regarded as potentially important factors in the development of this complex psychiatric problem.
    Objectives
    This study aimed to determine how behavioral activation/inhibition systems, namely behavioral activation, behavioral inhibition, and fight-flight freezing systems, affect substance abuse in bipolar patients.
    Methods
    A total of 79 patients with bipolar disorder were selected among hospitalized patients in the psychiatric ward of Kamkar-Arabnia Hospital in Qom, Iran. The participants completed the Gray-Wilson personality questionnaire, Hamilton Rating Scale for Depression, Mood Disorder Questionnaire, and a sociodemographic questionnaire.
    Results
    Behavioral activation and behavioral inhibition systems emerged as significant predictors of substance abuse in bipolar patients (χ2 = 52.511; df = 3; P < 0.0005). Gender and type of bipolar disorder (I or II) showed no significant association with the scores of behavioral activation, behavioral inhibition, or fight-flight freezing systems. Also, the behavioral inhibition system scores could predict manic mood (χ2 = 7.067; df = 3; P < 0.070).
    Conclusions
    The findings of the current study provide further evidence regarding the role of behavioral activation and inhibition systems as predictors of substance abuse in bipolar patients
    Keywords: Addiction, Behavioral Activation, Inhibition Systems, Bipolar Disorder, Substance Abuse
  • Yousef Moghadas Tabrizi, Shahrzad Mazhari * Page 10
    Background

    Spatial working memory (SWM) and mental imagery involve the processes of encoding, maintaining, and transforming spatial information. Patients with schizophrenia show impairments in both SWM and mental imagery. Yet, there is scarce evidence on the relationship between impairment in the two cognitive functions in the patients.

    Objectives

    The goal of the present study was to investigate motor imagery ability and SWM function and their relationship in schizophrenic patients.

    Methods

    The present case-control study compared the performance of 18 schizophrenic patients and 18 normal persons. The motor imagery was evaluated with the mental hand rotation task (HRT) and SWM was examined with the Dot test of visuospatial working memory (VSWM) across the three delays.

    Results

    The comparison of HRT results between the patients and the controls showed a slower and less accurate performance of the patients. On the Dot test of VSWM, performance was significantly less accurate at the three delays in schizophrenic patients relative to the controls. Moreover, there was a negative significant correlation between mental rotation accuracy and distance inaccuracy across the three delays in schizophrenic patients.

    Conclusions

    These results provide further evidence that impaired passive maintenance of internal representation might be the underlying mechanism of motor imagery dysfunction in patients with schizophrenia

    Keywords: Mental Rotation, Working Memory, Schizophrenia
  • Solmaz Joekar, Sanaz Joekar, Fahime Fathali Lavasani *, Behrouz Birashk Page 11
    Background

    Previous studies show high rates of trauma and post-traumatic stress disorder (PTSD) among women seeking treatment for substance use disorders (SUDs). Comorbid PTSD can adversely influence and complicate the clinical profile of SUD patients, and have implications for management and treatment of patients with SUD.

    Objectives

    To investigate the prevalence of comorbid PTSD, rate and nature of traumatic experiences in a sample of Iranian women with SUD, and to compare clinical profile of SUD patients with and without comorbid PTSD.

    Methods

    A cross-sectional study was conducted with 72 patients in a residential treatment center in Karaj (Vardavard) since January to March 2017. Measures included the trauma history questionnaire (THQ), PTSD check list (PCL), brief symptom inventory (BSI), and addiction severity index (ASI). Data analysis was done through t-test and Chi-square test.

    Results

    A total of 93.5% of patients reported at least one traumatic event in their life, and the prevalence of current PTSD was 30.5%. Women with PTSD/SUD showed significantly more psychological symptoms in seven dimension of BSI (P < 0.05). They also had significantly higher scores in several subscales of ASI including psychiatric (P < 0.001), family relationship (P < 0.003), as well as legal and substance/alcohol use (P < 0.05). Multiple drug use was also higher in women with SUD/PTSD (P < 0.01).

    Conclusions

    This study highlights the importance of considering trauma and PTSD in assessment and treatment plan of women with SUDs in general, and those with complicated clinical profile and psychiatric comorbidities in particular.

    Keywords: Comorbidity, Post-Traumatic Stress Disorder, Substance Use Disorders
  • Ali Morad Heidari Gorji , Misagh Shafizad , Aria Soleimani , * , Morteza Darabinia , Amir Hossein Goudarzian Page 12
    Background
    Mental health of medical students can be affect by quality of services in hospitals; therefore, it is essential to evaluate its effective factors. However, according to the available data, there were no similar published studies that assess the possibility of linkage between these factors with mental health, in Iranian medical students.
    Objectives
    The aim of this study was to identify the pathways applied by self-efficacy, critical thinking skills, and emotional intelligence, which influences the mental health of medical students.
    Methods
    This cross-sectional study was implemented in 2016. The population of the study consisted of medical students in Mazandaran University (Sari, Iran). Self-efficacy questionnaire of Sheerer, critical thinking skills of California (Form B), standard emotional intelligence questionnaire of Petridis, and general health questionnaire of Goldberg were used for data collecting. The data were analyzed in SPSS 18.0 for Windows (SPSS Inc., Chicago, IL, USA) by descriptive and inferential statistic operations (path analysis).
    Results
    The results showed that the average age of students participating in the study was 22.68 (SD = 1.12; 95% CI = 21.56 - 23.87). The direct path coefficient for critical thinking of mental health was -0.25, which was negative and significant (P < 0.001). In addition, a direct relationship between the emotional intelligence and mental health was found (path coefficient = -0.39).
    Conclusions
    Generally, the results showed that both emotional intelligence and critical thinking play an important role in the mental health of self-reliant students. In addition to a direct effect, emotional intelligence had an impact on self-efficacy mediated mental health
    Keywords: Medical Students, Self-Efficacy, Emotional Intelligence, Mental Health, Path Analysis
  • Mahdi Kheradmand , Shahrbanoo Ghahhari Page 13
    Background
    The family is the most important institution in identifying the personal coping strategies and emotion regulation skills of the individual.
    Objectives
    This study aimed to evaluate the role of emotion regulation and mindfulness modulators in the relationship of parenting stress and parenting styles with coping strategies.
    Methods
    The sample was composed of 400 adolescents in 2016 who were selected from different districts of Tehran by multistage cluster sampling. They completed the adolescent coping scale, the Baumrind parenting style questionnaire, an emotion regulation checklist, and a mindfulness assessment tool for children and adolescents. Data were analyzed using SPSS software.
    Results
    The results showed that mindfulness and emotion regulation are modulators in the relationship between parenting stress and coping strategies (P < 0.0001) and parenting styles and coping strategies (P < 0.0001). There were improper parenting stress and parenting styles but if adolescents developed emotion regulation and mindfulness skills, they would reduce the undesirable effects of bad parenting.
    Conclusions
    Emotion regulation and mindfulness skills along with coping strategies in adolescents can modulate the relationship between parenting stress and parenting style
    Keywords: Parenting Stress, Coping Strategy, Parenting Style, Emotion Regulation, Mindfulness
  • Masoud Moghimi , Nafiseh Esmaeilpour , * , Zohreh Karimi , Mohammad Zoladl , Mohammad Ali Moghimi Page 14
    Background
    Caring of mentally retarded children at home is a challenging event and negatively affects family mental health.
    Objectives
    Therefore, this study aimed to determine the effectiveness of resilience teaching via short message service (SMS) on stress of mothers of educable mentally retarded children.
    Methods
    In this field trial study, 70 mothers with educable mentally retarded children were selected through the convenience sampling method. They were then assigned into two groups of intervention and control through block random allocation. Mothers in the intervention group received four text messages each day, totally 180 messages within 1.5 months. The Abidin Short Form Parenting Stress Index and the Connor-Davidson Resilience Scale were filled out by mothers in both groups of intervention and control at baseline and one month after the intervention. Data were analyzed using SPSS21, by descriptive and inferential test, considering the 95% confidence interval.
    Results
    The mean of stress scores was 126 ± 23.9 and 129.3 ± 21.8 in the SMS and control groups, respectively before the intervention, and 86.08 ± 18.5 and 135.2 ± 23.1, respectively after the intervention (P < 0.05). In addition, the mean of resilience scores was 28.17 ± 10.82 and 25.89 ± 10.3 in the SMS and control groups, respectively before the intervention, and 57.62 ± 7.42 and 22.2 ± 8.17, respectively after the intervention (P < 0.05).
    Conclusions
    Teaching of resilience via short message service can reduce stress in mothers of educable mentally retarded children. In addition, since, the purposeful communication of client and nurse is a main issue in nursing, nurses can benefit from this education method for clients
    Keywords: Mental Retardation, Mothers, Psychological Resilience, Psychological Stress, Short Message Service
  • Vahid Farnia , Seyyed Bagher Mousavi , Faezeh Tatari , Safora Salemi , Sanobar Golshani , Mostafa Alikhani , Shima Heydari , Sara Hookari Page 15
    Background
    The high comorbidity of psychiatric disorders and substance dependence has been reported in children clinical and epidemiological as a study.
    Objectives
    The aim of this study was to determine the prevalence of childhood attention-deficit/hyperactivity disorder (ADHD) among methamphetamine dependence.
    Methods
    This study was a descriptive cross - sectional study that has been done in 2015 - 2016. The study population consisted of individuals referred with methamphetamine dependence to Kermanshah Farabi hospital. Among them, 960 patients were chosen through access selection to collect data the epidemiological characteristics questionnaire and the Wender Utah rating scale for ADHD children were used. Data were analyzed through SPSS 18 software descriptive statistical methods and chi-square test.
    Results
    The prevalence of childhood ADHD was 29.9%. In the study population 155 patients (16.17) had hyperactivity disorder, 402 patients (41.9%) had attention deficit disorder, and 141 patients (14.7%) had hyperactivity and attention deficit disorders simultaneously. In addition, data analysis reveals the meaningful relationship between childhood ADHD and gender marital status education as well as age range (P < 0.001). For participants, job and age of first methamphetamine use, which P = 0.484 and P = 0.453, respectively, no meaningful relationship was found to ADHD.
    Conclusions
    Behavioral disorders, especially ADHD, can make a background for methamphetamine dependence tendency. ADHD treatments may prevent this disposition towards methamphetamine dependence
    Keywords: Attention Deficit - Hyperactivity Disorder_Childhood_Substance - Related Disorders
  • Asghar Arfaie , Ali Reza Shafiee, Kandjani , * , Aydin Arfaie , Salman Safikhanlou , Hossein Dadashzadeh , Kowsar Tarvirdizade Page 16
    Background
    Personality characteristics, health status, clinical course and prognosis of patients with panic disorder affect pharmacological and psychological treatment of these patients. The purpose of this study was to study personality patterns of patients with panic disorder (PD) by grouping them according to an important condition, that is, agoraphobia.
    Objectives
    As little data exists in the filed of personality profiles and it's potential impact on the course of panic disorder, we conducted the study in an Iranian population in Tabriz city during 2015 - 2016.
    Methods
    A total of 120 patients with panic disorder were selected and evaluated using psychiatric interviews, as well as NEO Five-Factor Inventory and Millon Clinical Multiaxial Inventory-III (MCMI).
    Results
    From 96 patients who completed the study, 10.42% were diagnosed to have panic disorder with agoraphobia. The mean age of the patients was 35.12 ± 9.50 years old. The most common comorbid psychiatric condition was major depressive disorder in both groups of with and without agoraphobia. None of the patients exceeded from the cutoff point described for MCMI. Patients with agoraphobia scored higher in borderline personality, anxiety, and post-traumatic stress scales. Patients without agoraphobia had higher scores for narcissistic personality. There was no significant difference in scores of NEO-FFI with regard to the presence of agoraphobia, and all the patients scored high in agreeableness and conscientiousness.
    Conclusions
    Despite comparable scores of NEO between PD patients with and without agoraphobia, they scored significantly different in MCMI for borderline and narcissistic personalities, anxiety, and post-traumatic stress disorder
    Keywords: Panic Disorder, Agoraphobia, Personality Profiles, Comorbidity
  • Nadereh Memaryan , Shahrbanoo Ghahhari Page 17
  • Masoumeh Shohani , Hamed Tavan , * Page 18
  • Forouzan Elyasi , Marzieh Azizi , Sina Sabourian Joubari , Seyyed Hessam Mirani Page 19
    Background
    Although there is a high prevalence of psychiatric comorbidities in patients in general medical hospitals, they have remained undiagnosed in some cases.
    Objectives
    This study was conducted to determine the psychiatric disorders comorbidity of patients in two general medical hospitals in Iran.
    Methods
    This cross-sectional descriptive study was conducted in Imam Khomeini and Bu Ali Sina general university hospitals, in Sari, Northern Iran, and included 1,688 patients from different wards of these hospitals. Data were collected via a demographic questionnaire.
    Results
    With regard to frequency distribution, according to age group and gender, the most consultations (393; 23.3%) were in the 20 - 29 year’s age group and 935 (55.4 %) cases were female. The highest number of consultation cases had been referred from the emergency wards (34%), followed by the neurosurgery (14.2%) and internal medicine wards (14.2%). Psychological assessment was the most common reason for requesting a consultation (26.8 %). In addition, the results indicated that mood disorder (22.3%) was the most prevalent psychiatric diagnosis.
    Conclusions
    In order to improve the trend of psychiatric diagnosis in general hospitals, psychiatric liaison staff should be trained in multiple consulting roles, and must improve their skills in addressing inpatient and outpatient treatment. Moreover, other non-psychiatric physicians should increase their knowledge of attitude toward and psychosocial aspects of medical disorders.
    Keywords: Consultation-Liaison Psychiatry, General Hospital, Psychiatric Consultation, Psychiatric Disorders
  • Amin Ajalli , Masoud Fallahi, Khoshknab , Mohammad Ali Hosseini , Eesa Mohammadi , Masoud Sirati Nir Page 20
    Background
    Patient's safety is the foundation of health qualified to care, which in the inpatient psychiatric wards, is a different but important and challenging issue.
    Objectives
    This study focused on nurses' opinions and experiences about patient safety in inpatient psychiatric wards.
    Methods
    This was a qualitative study based on conventional content analysis and inductive method. Thus, 19 psychiatric nurses were selected from three hospitals using purposive sampling. Data were collected using in-depth semi-structured interviews.
    Results
    Analysis of the data revealed the main theme “intelligent care and protection from risk creators” and two themes including ‘vigilant care' and ‘close observing' with eight related categories.
    Conclusions
    This study adds a unique insight into patient safety in acute psychiatric wards. The findings suggest that the nurse should take vigilant care and be sensitive to any change in behavior and suspicious behaviors of patients. Continuous observation and objective observation, specific and appropriate intervention, and curious attention are essential. Safety access should be closely monitored.
    Keywords: Inpatients, Nurses, Patient Safety, Psychiatry
  • Ashraf Kazemi , Maryam Ghaedrahmati , Gholam Reza Kheirabadi , Amrollah Ebrahimi , Masoud Bahrami Page 21
    Background
    Postpartum depression is a common disease with serious consequences for the mother and child. However, a few qualitative studies have been conducted on the lived experiences of mothers.
    Objectives
    This study is aimed at exploring the experiences of mothers with the depression from pregnancy and childbirth.
    Methods
    This qualitative study has been conducted on 16 women with a history of depression after childbirth. To collect data, 16 semi-structured interviews were conducted. The data collected were analyzed using content analysis suggested by Graneheim and Lundman.
    Results
    The data analysis led to the development of 821 inductive codes categorized into three themes: ‘experienced problems’, ‘unmet expectations’, and psychological distresses. The experienced problems comprised socioeconomic factors and complications during pregnancy and childbirth. The unmet expectations comprised conditions and reactions women expected to occur during interactions with others such as social support and marital relationship. Further, psychological distress was the women’s reaction to pregnancy-related events and relative interactions, including psychological reactions and inefficiency in playing roles and fulfilling responsibilities.
    Conclusions
    The findings emphasize the need for exploration of the psychological processes during pregnancy. Women felt they needed support that was not easily available and were worried about lack of privacy and loss of control over their private life, causing psychological distress for women. Couples should receive the education necessary for the risk of post-partum depression.
    Keywords: Depression, Postpartum, Qualitative, Research
  • Parisa Samadi , Raziyeh Maasoumi , Mehrdad Salehi , Mohammad Arash Ramezani , Shahnaz Kohan Page 22
    Background
    Some researchers consider sexual desire as a biological phenomenon, while others stress its psychological aspect. The question is why people experience different levels of sexual desire in different societies. This question can be answered from a sociological perspective.
    Objectives
    This study aimed at exploring Iranian couples’ perceptions of the role of sexual socialization in their sexual desire.
    Methods
    This research had a qualitative thematic analysis method. Data collection was performed through 14 individual semi-structured interviews with seven couples, selected through purposive sampling. Thematic analysis was performed concurrently with data collection.
    Results
    Analyzing participants’ perceptions led to the extraction of 333 codes, five sub-sub-themes and two sub-themes “dual role of the parents” and “dual role of the community” in sexual development. The participants’ dual role of parents, included parents’ ability for sexual training of children and adolescents and the affectionate relationship between parents in the presence of children. Dual role of the community included sources of sexual information and sexual health education, beliefs and sociocultural taboos in sexual issues, and perception of couples from religious teachings about sexual issues. The main theme shared between sub-themes was “dual role of sexual socialization”.
    Conclusions
    Sexual desire was stronger in those whose sexual development had occurred in an active social context. In most cases, however, the couple’s sexual desire had weakened because their sexual development had occurred in a passive social context. Educating sexual health experts, who can provide the sexual training needed at the individual, family, and community levels and act as reliable educational resources in line with the religious, cultural and social structure of the Iranian society seems necessary.
    Keywords: Sexual Desire, Sociocultural Context, Thematic Analysis, Iranian Couples
  • Masoumeh Dejman , Zohreh Mahmoodi , Monir Baradaran Eftekhari , Ameneh Setareh Forouzan , Katayoun Falahat , Mohsen Shati , Arash Mirabzadeh , Judy Bass Page 23
    Background and Objectives
    Depression is one of the most important mental disorders affecting 350 million people in the world. The aim of this study was to explore the similarities and differences in the symptoms and experiences of depression in cities representing the Fars, Turk, and Kurd ethnic groups of Iran.
    Methods
    A qualitative study was implemented in three ethnic groups in Iran between April 2016 and March 2017 using individual interviews with 44 depressed patients, 20 people of their relatives, and three key informants in Tehran (Fars), Tabriz (Turk), and Sanandaj (Kurd) cities. The data were analyzed using directed content analysis.
    Results
    The analysis of the data led to the extraction of four main themes, including cognitive, behavioral, physical, and emotional/motivational symptoms.
    Conclusions
    The study findings would help to explore various expressions of depression and provide a multidimensional construct to develop the culturally specific measurement of depression in three different ethnic groups.
    Keywords: Depression, Ethnic Groups, Symptoms, Iran
  • Robabe Khalili , Masoud Sirati Nir , * , Masoud Fallahi Khoshknab , Hosein Mahmoudi , Abbas Ebadi Page 24
    Background
    The lack of self-care in patients with post-traumatic stress disorder can cause physical health problems, which consequently result in a poor quality of life.
    Objectives
    This study aimed at identifying and exploring the factors facilitating self-care in veterans with chronic post-traumatic disorder.
    Methods
    This qualitative research was conducted by conventional content analysis. 12 veterans with the chronic post-traumatic stress disorder and 13 caregivers were selected using purposive sampling to participate in the study. Data collection was carried out during 18 individual interviews and two group interviews, which were profound and semi-structured.
    Results
    Five main categories including spirituality, personal knowledge, family support, social support, and institutional facilities were extracted as factors facilitating self-care in physical, psychological, emotional, and spiritual domains. A total of 14 sub-categories emerged.
    Conclusions
    Planning and intervention on the factors facilitating self-care in different domains can help to achieve independence in caring for veterans with post-traumatic stress disorder.
    Keywords: Caregivers, Chronic Post-Traumatic Stress Disorder, Self-Care, Qualitative Research, Veterans
  • Maryam Shirmohammadi , Mohsen Shahriari , Ehsan Shamsi Gooshki , Shahnaz Kohan Page 25
    Background
    Assessment of ethical issues in sexual health research around the world shows that published studies are scattered and limited and cannot be used as reliable sources for other studies.
    Objectives
    This qualitative study aimed to explore the challenging experiences of sexual health researchers in Iran.
    Methods
    This study was conducted using a conventional qualitative content analysis method. Data were collected through in-depth individual interviews. The interviews were written and coded through conventional content analysis to form the initial categories.
    Results
    Based on the data analysis, three main categories, seven subcategories, and 14 second subcategories were extracted. The main categories included: 1- challenges related to biomedical research ethics committees, 2- challenges of sexual health researchers, and 3- challenges related to sexual health topics.
    Conclusions
    This study was carried out to provide a better understanding of the challenges of sexual health researchers in their studies. The importance of detecting these challenges empowered researchers to cope with the challenges during their study.
    Keywords: Challenge, Health, Qualitative, Research, Sex
  • Imaneh Abasi , Gregory Feldman , Shirin Farazmand , Abbas Pourshahbaz , Mohammad Ebrahim Sarichloo Page 26
    Background
    Despite the existence of the large body of studies demonstrating cognitive responses to negative mood, cognitive responses to positive mood have received relatively less attention.
    Objectives
    The aim of the present study was to investigate the psychometric properties of the Responses to Positive Affect (RPA) questionnaire in Iranian population.
    Methods
    Using purposive sampling and a cross-sectional design, 499 participants of a community sample of Tehran, Iran during 2016 - 2017 responded to RPA, Ruminative Response Scale, Beck Depression Inventory, Social Interaction Anxiety Scale, and Generalized Anxiety Disorder 7-item scale. Data was analyzed using SPSS 23 and AMOS 23.
    Results
    Exploratory factor analysis yielded 2 factors (positive rumination and dampening) which accounted for 47.84% of the total variance. Confirmatory factor analysis results showed a very good fit to the data as χ2 = 135.51, df = 82, χ2/df = 1.65, P < 0.001, CFI = 0.98, GFI = 0.97, RMSEA = 0.03. Results of convergent validity showed that there are significant negative correlations between positive rumination and reflection, depression and generalized anxiety symptoms and significant positive correlations between dampening and brooding, reflection, depression, social phobia and generalized anxiety symptoms. Results of incremental validity analyses revealed that RPA subscales accounted for significant variance in depressive symptoms above and beyond brooding and reflection. Test retest reliability of positive rumination and dampening were 0.81 and 0.83, respectively.
    Conclusions
    Responses to Positive Affect questionnaire demonstrates acceptable validity and reliability in Iranian population. Further research is needed to assess RPA in various clinical samples.
    Keywords: Affect, Anxiety, Depression, Emotion Regulation
  • Ehda Zoljanahi , Mahdi Mohammadi, Nezhad , Bahram Sadeghpour Gilde , Hamid Reza Taheri Page 27
    Background
    Causal attribution has a significant role in developing and improving athletes᾿ ability. Sport attributional style scale (SASS) measures six attributional dimensions in sports. Hanrahan et al. stated that SASS has an acceptable reliability and validity in sports. However, psychometric characteristics of this scale have not yet been studied on Iranian athletes’ population.
    Objectives
    To determine the psychometric characteristics of SASS with 16 items (long form) in elite Iranian athletes’ population.
    Methods
    This research is a descriptive-exploratory study. The English version of SASS was translated into Persian and extra comparison of the original and backward translated versions was done. The statistical population consisted of 2,853 elite team athletes and 1,456 elite individual athletes. From that population, 192 elite team athletes and 144 elite individual athletes were randomly selected as the sample from different sport clubs in Tehran in year of 2014.
    Results
    The content validity of the backward translation of the original version was confirmed. Coefficients of Cronbach’s alpha of SASS in team and individual sports was 0.95 and 0.98, respectively. Construct validity of four factors of SASS in team sports after failure and in individual sports after success, five factors of SASS in individual sports after failure, and six factors of SASS in team sports after success, and some items of SASS components were approved. Internal consistency, convergent validity, divergent validity, and construct reliability of new scale were approved.
    Conclusions
    The present study showed that SASS has suitable reliability and overall, four factors and some items in this scale were detected to have acceptable validity in elite Iranian athletes’ population.
    Keywords: Sport Attributional Style Scale (SASS), Reliability, Validity, Elite Athletes
  • Hassan Rafiey , Fardin Alipour , Richard LeBeau , Yahya Salimi , Shokoufeh Ahmadi Page 28
    Background
    There is great need across the globe for self-report scales of depression that are brief to administer, comprehensive in content, and psychometrically valid. As most of the widely used and well-validated scales originate in English, it is essential to carefully translate them, following the psychometric validation of the adapted scales.
    Objectives
    The current study aimed at investigating the translation and validation of the Persian version of one of the most widely utilized self-report depression scales in the world, the patient health questionnaire (PHQ).
    Methods
    The current study evaluated the validity and reliability of the PHQ in a population-based sample of 600 adult survivors of an earthquake in Iran in 2015. Researchers used the forward-backward method to translate the PHQ-9 into the Persian language. Data were analyzed using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).
    Results
    Consistent with the results of validation studies on the original English-language versions of the scales, the current study found strong evidence of internal consistency (Cronbach’s alpha = 0.86). CFA suggested that the 1-factor structure fit reasonably well. Convergent validity was confirmed by the significant and positive correlation between the scores of national stressful events survey for posttraumatic stress disorder-short scale (NSESSS-PTSD) and the PHQ-9 (r = 0.29, P < 0.001). Approximately one-third of the sample reported some depression symptoms, with less than 10% indicating moderately severe to severe symptoms.
    Conclusions
    Although replication studies are needed, the current study results suggested that the Persian version of the PHQ-9 was a valid and reliable tool to efficiently, comprehensively, and accurately assess depression symptoms in the Iranian subjects.
    Keywords: Assessment, Depression, Patient Health Questionnaire, Psychometrics, Self-Report
  • Malihe Farid , Mahnaz Akbari Kamrani , Sedigheh Jafarian Page 29
    Background
    Coping strategies are one of the key elements of mental health and have a significant relationship with mental health. Cash developed the body image coping strategies inventory (BICSI) to evaluate how individuals cope with threats or challenges about their body image.
    Objectives
    The purpose of this study was to examine the factor structure of the BICSI among Iranian female adolescents.
    Methods
    Participants were 537 high school students from Karaj, Iran, who volunteered for participating in this study. In order to achieve the aim of the study (factorial validity), the study population (n = 537 participants) was split into two subsamples randomly. The subsamples were processed by the randomization function on SPSS (V. 22). AMOS Graphic (V. 20) software was used in order to examine the factorial validity of three BICSI factors.
    Results
    The Persian version of BICSI met all the requirements for confirming the quality of measurement. In addition, the factorability of constructs in the scale was confirmed as the results of confirmatory factor analysis showed good model fit indices (P ≤ 0.05). Cronbach’s alpha as an internal consistency indicator was above 0.8 for all three subscales.
    Conclusions
    Based on the results of this study, the Persian version of BICSI was validated among Iranian adolescents.
    Keywords: Body Image, Psychometrics, Translation, Iran
  • Masoumeh Sadeghipour Roudsari , Ahmad Ali Akbari Kamrani , Mahshid Foroughan , Farahnaz Mohammadi Shahboulaghi , Masoud Karimlou Page 30
    Background
    The population of old people in Iran is increasing, as well as the prevalence of dementia. For early detection and intervention, proper dementia screening tools are needed. The clock drawing test (CDT) is a quick, inexpensive and well accepted test for the screening of cognitive problems.
    Objectives
    The aim of this study was to evaluate psychometric properties of CDT among aged people in Iran.
    Methods
    The clock drawing test, using Shulman’s modified scoring method, was performed on 74 aged members of Iran’s Alzheimer Association services in Tehran from May to September 2012 convenient sampling method was used. The participants with the following characteristics were selected: age 60 years or more, able to communicate and with 4 years of formal education. Using the diagnostic criteria for dementia of the diagnostic and statistical manual of mental disorder, 4th edition, (DSM-IV) as a gold standard, the difference between CDT mean scores of dementia and non-dementia patients were evaluated. The receiver operating characteristics (ROC) curve was used to determine the optimal cut off points for CDT using the 20th version of SPSS.
    Results
    The mean age of participants was 72 ± 7.95 years. There was a significant difference between the scores of participants with and without dementia (P < 0.001). The best cut off point was 3/4 with 90% sensitivity and 73% specificity. The area under the ROC curve was 0.896 (P < 0.001), which indicates proper accuracy of the test.
    Conclusions
    The clock drawing test has acceptable psychometric properties among the aged people of Iran. The Persian version of CDT can be applied for the screening and monitoring cognitive problems in this population. Further studies are required to assess the impact of literacy level and different scoring systems on the accuracy of the results obtained by the CDT.
    Keywords: Aged, Cognition, Psychometrics, Screening
  • Azam Naghavi , Samaneh Salimi Page 31
    Background
    Mental health professionals including rehabilitation counselors are often exposed to vicarious trauma, while they work with traumatized clients.
    Objectives
    The current study aimed at explaining the experiences of exposure to vicarious trauma and its consequences for rehabilitation counselors as well as the experience of vicarious growth.
    Methods
    The current study employed a collaborative autoetnographic approach to describe the experiences of working with traumatized clients. Collaborative autoethnography is a type of qualitative research method that allows two or more researchers to utilize ethnography and autobiography collaboratively to explain similar experiences. In this method, researchers collect data from their own life stories and analyze the data using various types of qualitative analyses. To analyze the current study data, a thematic analysis approach was employed.
    Results
    It was found that lack of experience in working with difficult cases, lack of access to supervision, and a lack of vicarious trauma-related knowledge were major contributors to the experience of vicarious trauma. On the other hand, journal writing, visiting a counselor, peer support, and gaining knowledge were useful to overcome this stress. The next findings showed that although visiting traumatized clients may lead to experiencing vicarious trauma, it can also lead to experiencing vicarious growth. Vicarious trauma helped to be more mindful about life and death, cherish the family and friends, and experience growth.
    Conclusions
    Rehabilitation counselors might experience both vicarious trauma and vicarious posttraumatic growth. The experience of vicarious trauma has a negative effect on counselors and they should employ self-care strategy to mitigate the negative results of exposure to traumatic experiences of others and if they wish to experience vicarious growth.
    Keywords: Mental Health Rehabilitation, Psychological Trauma, Qualitative Research, Rehabilitation Counselor, Stress Disorder
  • Saeed Ariapooran , Mehdi Khezeli Page 32
    Objectives
    Divorce is one of the main life stressors imposing a negative effect on suicidal ideation. In addition, social support and psychological resilience can have a special impact on divorce. This study aimed to determine the relationship of social support and resilience with suicidal ideation in divorced women.
    Methods
    The study participants consisted of 124 divorced women who were covered by the Imam Khomeini Relief Foundation of Kermanshah city (the west of Iran). Data collection tools included the multidimensional scale of perceived social support, Connor-Davidson resilience scale, and Beck scale for suicidal ideation.
    Results
    According to the score of Beck suicidal ideation, 16.1% of the divorced women had no suicidal ideation, 49.2% had a low risk of suicidal ideation, and 34.7% had a high risk of suicidal ideation. Social support and resilience were the most powerful variables in predicting the symptoms of suicidal ideation in divorced women, in sequence (∆R2 = 0.24, F (2, 121) = 20.44, P < 0.001).
    Conclusions
    The results confirm the role of social support and resilience in predicting the symptoms of suicidal ideation. Therefore, we suggest considering these variables in future studies to predict the symptoms of suicidal ideation in divorcees.
    Keywords: Divorce, Psychological Resilience, Social Support, Suicidal Ideation
  • Farnoush Sina , Samaneh Najarpourian , S. Abdolvahab Samavi Page 33
    Background
    Generally, people tend to create stories relevant to their romantic beliefs based on their personalities and personal experiences.
    Objectives
    The current study aimed at investigating and determining the role of attachment styles and the Sternberg love story to predict marital satisfaction.
    Methods
    The current descriptive-correlational study was conducted on a population including all couples in Qeshm Island, Iran. The 400 participants (200 couples) were selected through stratified sampling method. To collect the needed data, three different instruments were employed namely couples satisfaction index (CSI), the Sternberg love story index, and experiences in close relationships questionnaire. The collected data were analyzed through correlation and multiple regression analyses.
    Results
    The results of the study revealed that the male dominant love story, male and female social receptivity, and male entertainment significantly and positively predicted the marital satisfaction. On the other hand, female and male anxious and avoidance attachment, female dominant, female and male submission, and female self-pleasure negatively and significantly predicted marital satisfaction. It is noteworthy that the relationship between entertainment love story in females and pleasure love story in males was not significant. Totally, 49% of marital satisfaction variance in males and 77% of marital satisfaction variance in females were accounted by predictor variables.
    Conclusions
    Variety of male and female love story and attachment styles can affect marital satisfaction.
    Keywords: Attachment Styles, Love Story, Marital Satisfaction
  • Mohammad Hassan Novin , Hassan Eftekhar, Ardebili , Azizollah Batebi , Zahra Mohtasham Amiri , Nahid Bazarganian Langeroodi Page 34
    Background
    Substance use disorder is a multidimensional phenomenon, which is becoming increasingly prevalent and important. It is the result of psychological, biological, social, and familial factors, and it seems that psychological factors play a very important role in its process.
    Objectives
    The purpose of this study was to determine the prevalence of depression among patients visiting substance abuse treatment centers and to evaluate influential factors.
    Methods
    A descriptive analytic research was conducted on 241 patients, who were selected randomly from visitors of the maintenance methadone therapy centers in Guilan province, Iran (January to May 2013). Based on population, Guilan was divided to three regions, east, west, and center. In each region, three or four substance abuse treatment centers were chosen randomly. To collect the data, two questionnaires were used, including demographic characteristics and abused substance characteristics, and Beck’s depression inventory. The data were analyzed using the SPSS software.
    Results
    According to this study, the mean age of visitors was 38.29 years old. Prevalence of depression among patients was 48.96%. There was a significant negative relationship between the degree of depression and age (Pearson coefficient -0.17, P value 0.01). Logistic regression indicated that the factors affecting depression included type of abused drugs, income, duration of treatment, and place of residence. There was no significant relationship between depression and education level, physical diseases, and duration of drug use.
    Conclusions
    Concerning the abovementioned points, it seems that depression is one of the common problems of substance use disorder. Considering the mental problems of substance abusers, appropriate therapies have an essential role in their treatment.
    Keywords: Substance Abuse, Depression, Maintenance, Methadone
  • Asghar Arfaie , Ali Reza Shafiee, Kandjani , Aydin Arfaie , Salman Safikhanlou , Hossein Dadashzadeh , Kowsar Tarvirdizade Page 35
    Background
    Personality characteristics, health status, clinical course and prognosis of patients with panic disorder affect pharmacological and psychological treatment of these patients. The purpose of this study was to study personality patterns of patients with panic disorder (PD) by grouping them according to an important condition, that is, agoraphobia.
    Objectives
    As little data exists in the filed of personality profiles and it's potential impact on the course of panic disorder, we conducted the study in an Iranian population in Tabriz city during 2015 - 2016.
    Methods
    A total of 120 patients with panic disorder were selected and evaluated using psychiatric interviews, as well as NEO Five-Factor Inventory and Millon Clinical Multiaxial Inventory-III (MCMI).
    Results
    From 96 patients who completed the study, 10.42% were diagnosed to have panic disorder with agoraphobia. The mean age of the patients was 35.12 ± 9.50 years old. The most common comorbid psychiatric condition was major depressive disorder in both groups of with and without agoraphobia. None of the patients exceeded from the cutoff point described for MCMI. Patients with agoraphobia scored higher in borderline personality, anxiety, and post-traumatic stress scales. Patients without agoraphobia had higher scores for narcissistic personality. There was no significant difference in scores of NEO-FFI with regard to the presence of agoraphobia, and all the patients scored high in agreeableness and conscientiousness.
    Conclusions
    Despite comparable scores of NEO between PD patients with and without agoraphobia, they scored significantly different in MCMI for borderline and narcissistic personalities, anxiety, and post-traumatic stress disorder.
    Keywords: Panic Disorder, Agoraphobia, Personality Profiles, Comorbidity
  • Abdolhamid Parsa , Seyyed Ali Tabaeian , Sadra Einizadeh , Mohammad Babaeian Page 36
    Introduction
    The Z-drug zolpidem is an imidazopyridine hypnotic that is prescribed widely for short-term treatment of sleeping problems. However, there have been various cases affected by the side effects of this medication.
    Case Presentation
    Further to the extant reports of zolpidem adverse reactions, in the current manuscript, two cases of zolpidem toxicity in 2016 in Tehran are presented. They had both taken 20 mg of zolpidem and as a result, they began to develop an altered level of mentality.
    Conclusions
    Zolpidem use may affect the mental status and results in performing unconscious behaviors.
    Keywords: Altered Mental Status, Case Report, Insomnia, Somnambulism, Zolpidem