Iranian Journal of Psychiatry and Behavioral Sciences
Volume:10 Issue: 3, Sep 2016

Context: More than half of the bipolar disorder (BD) cases have an additional diagnosis; one of the most difficult to manage is obsessive-compulsive disorder (OCD). Although some authors recently investigated the co-occurrence of anxiety and BD, the topic remains insufficiently studied. The current study aimed to investigate differences in comorbid OCD between BD-I and BD-II.
Evidence Acquisition: A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-I/BD-II and OCD. Relevant papers published until June 30, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.
Fourteen articles met the inclusion criteria. The pooled prevalence of BD-I in OCD was 3.9% (95% confidence interval (CI), 2.4 to 6.4, I2 = 83%, Q = 56) while that of BD-II in OCD was 13.5% (95% CI, 9.3 to 19.3, I2 = 89%, Q = 91). The pooled prevalence of OCD in BD-I was 21.7 (95% CI, 4.8 to 60.3, I2 = 84%, Q = 95). With regard to OCD-BD predictors, mean age and rate of males did not predict the prevalence of BD-I (β = 0.0731, 95% CI, -0.1097 to 0.256, z = 0.78; β = 0.035, 95% CI, -0.2356 to 0.1656, z = 0.34) and BD-II (β = 0.0577, 95% CI, -0.1942 to 0.0788, z = 0.83; β = -0.0317, 95% CI, -0.1483 to 0.085, z = 0.53) in OCD. The mean age explained some of the observed heterogeneity (R2 = 0.13; R2 = 0.08).
This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-I/BD-II and OCD suggests that BD-OCD comorbidity is a common condition in psychiatry. However, the available evidence does not allow to assess whether BD-I or BD-II are more common in patients with OCD.

Context: There is no review of HIV responses in Arab states on the southern Persian Gulf border. This narrative review aimed to describe and synthesize HIV responses in Kuwait, Qatar, Bahrain and the United Arab Emirates (UAE).
Evidence Acquisition: A review of scientific databases and grey literature was conducted based on an international guide. Overall, 16 original studies and reports were found.
The review indicates that HIV has been found present in each Arab state based on sporadic case finding. The prevalence of HIV is the result of heterosexual relationship and/or drug injection. Mandatory testing of the nationals and expatriate workers is the main route of HIV detection. In general, HIV knowledge and education are poor. Only Bahrain has some non-governmental organizations that provide HIV education. Lack of identifying key populations and high risk behaviors has been reported in all of the states. HIV responses are mainly for Arab and Arabic-speaking nationals. Effective strategic plans for HIV have not been developed in all of the states. The provision of antiretroviral therapy for the nationals is the main HIV response. Only Qatar has paid for the treatment of Qatari and non-Qatari HIV-infected patients. As a HIV response, drug treatment is based on short-term inpatient rehabilitation. Only Qatar has voluntary HIV counseling and testing. Lack of needle and syringe programs has been reported for people who inject drugs with HIV problem in all of the states.
To conclude, HIV problem needs a comprehensive policy response in each state. Providing effective strategic plans for HIV and sero-surveillance data systems is required. Empowering human resources and infrastructural development are suggested.

Prazosin is significantly effective to reduce sleep disturbance and trauma nightmare in patients with post-traumatic stress disorder (PTSD); however, results of different studies were evaluated.
The current randomized clinical trial aimed to assess the effects of prazosin on sleep parameters and nightmares among veterans with chronic PTSD.
Thirty-two veterans with chronic war-induced PTSD and distressing nightmares were randomized into prazosin and placebo groups for eight weeks. The main symptoms were qualified using the recurrent distressing dreams item of the clinician administered PTSD scale (CAPS) and the daytime symptom severity was measured by PTSD checklist (PCL) and the objective sleep quality assessment by actigraphy.
Compared with placebo, prazosin had no significant effects on reduction of daytime symptoms (P = 0.69) and frequency and intensity of trauma-related nightmares. Also, there were no significant differences between pre- and post-treatment actigraphy measurements (P > 0.05).
The study findings showed that prazosin had no significant effect on reduction of PTSD symptoms as well as nightmares among veterans with chronic PTSD. Further clinical trials are needed to define the effect of prazosin on sleep physiology and whether such effects regarding the therapeutic response.

Different studies have suggested that antipsychotic medications of the first generation have better effectiveness for the treatment of psychotic symptoms compared with antipsychotic medications of the second generation.
The current study was the first pilot study in Iran that compared Haloperidol with Risperidone in the treatment of positive symptoms of psychosis among a group of methamphetamine-dependent patients.
This randomized clinical trial was designed and conducted in 2012. Overall, 44 patients who met the diagnostic and statistical manual of mental disorders, fourth edition-text revised (DSM.IV-TR) criteria for methamphetamine-associated psychosis (MAP) and were hospitalized at Razi psychiatric hospital in Tehran were selected. Patients (1: 1) were randomly divided to two groups. Overall, 22 subjects received Haloperidol (5 - 20 mg) and 22 subjects received Risperidone (2 - 8 mg). All subjects were assessed at baseline, during three consecutive weeks of treatment and one week after treatment (i.e., follow-up). Scale of assessment of positive symptoms (SAPS) was completed for each subject.
The study findings indicated that both Haloperidol ( Risperidone and Haloperidol are two effective antipsychotic medications for the treatment of positive symptoms of MAP but other aspects of these two neuroleptic medications such as the long-term treatment effects should be studied. Further studies with more samples and longer follow-ups are suggested.

Boswellia serrata and Melissa officinalis is traditionally used for its memory enhancing effects.
In this study, we evaluated the protective effects of combined form of these extracts on memory improvement of scopolamine treated rats by the Morris water maze method.
Two groups (group 1 and 2) of animals were pretreated with combined extracts of B. serrata and M. officinalis (200, 400 mg/Kg body weight) for four weeks and then, 30 minutes before starting the experiment scopolamine was injected (0.1 mg/kg body weight) intraperitoneally to pretreated animals. The control group was the animals that were injected by scopolamine and pre treated with distilled water (group 3). The normal group was treated with distilled water alone (group 4).
For time spent and distance, there was no substantial difference between groups 1, 2 and 4, while they had statistical difference with group 3 (P = 0.001). The spatial memory evaluation showed no significant difference between treated groups and normal group.
Therefore, the combination of the two extracts had the ability to improve memory as its traditional use.

To assess and compare demographic and diagnostic characteristics of inpatients with mood disorders in Iran.
We collected the demographic, clinical, and treatment characteristics of patients, who were hospitalized during five years from April 2006 to March 2010, in Iran hospital of psychiatry, a residency training center to evaluate the general clinical picture of the disorder.
Overall, 95.3% of subjects had a diagnosis of bipolar I disorder (BID), 2.5% were diagnosed as bipolar II disorder (BIID) and 1.3% and 0.9% met the criteria for major depressive disorder (MDD) and bipolar not otherwise specified (NOS), respectively. Compared to patients with MDD and BIID, the onset of BID was at an earlier age (32.2 ± 1, 34.8 ± 1.5 and 29.9 ± 1.9 years old, respectively, P Bipolar I disorder was the most common diagnosis for inpatients with mood disorders and a more severe course in BID may indicate more severe impairments that would result in more severe disabilities.

The aim of the present study was to test a structural model of hypothesized relationships between spiritual well-being, intervening variables of personal worth of self and others, commitment to relationship stability, commitment to relationship growth, positive interaction/appreciation, communication/conflict resolution, time spent together, and, the dependent variable, dyadic adjustment.
Two hundred and sixty eight (171 females and 97 males) married parent subjects were selected by convenience sampling from three universities in Mazandaran, Iran, to take part in this study. They were all volunteers and were not paid and their age range was 23 to 47 (31.07 ± 4.37 years). All participants were asked to complete the spiritual well-being scale (SWBS), family strengths scale (FSS) and revised dyadic adjustment scale (RDAS).
The results from structural equation modeling confirmed a hierarchy for the development of family strengths, and indicated that spiritual well-being and strength in most characteristics affected dyadic adjustment, positively (P Couples’ level of dyadic adjustment is increased when they have higher spiritual well-being, value each other, have commitment to each other, communicate well, enjoy being with each other, and spend time together.

Stigma of mental disorders causes a reduction in seeking help from the health care professionals and is evident across the world.
The current study aimed to compare medical students’ attitude towards mental illness after two different psychiatry clerkships in terms of the level of clinical exposure to patients with mental illness.
Patients and Through a quasi-experimental study, all of the 4th-year medical students were invited to enroll this study conducted in Tehran University of Medical Sciences (TUMS). They were non-randomly assigned into two different psychiatry clerkships from January 2009 to January 2010. One group was enrolled in the traditional lecture-based course (low-exposure) while the second group participated in a novel method with increased hours of patient exposure (high-exposure). Attitude towards mental illness (AMI) was measured by a 22-item questionnaire before and after the clerkship and data were compared between the two groups in terms of changing attitude towards mental illness in five different categories.
A total of 211 participants were enrolled in the study (115 female) of which 115 students (54.5%) were in low-exposure group and 96 students (45.5%) in the high-exposure group. Generally, AMI scores did not differ between the two groups and did not show any significant changes before and after the psychiatry clerkship. The only exceptions to this were AMI4 category (the concept of etiology of the mental illness), which significantly improved after the clerkship in the low-exposure (P = 0.011) and the high-exposure groups (P = 0.024), respectively.
Exposure of medical students to patients with mental illness did not improve attitude towards mental illness and psychiatric conditions.

Obesity is one of the most common chronic diseases with important medical effects, as well as mental and social health problems. Bariatric surgery is one of the most effective treatments of morbid obesity.
Because of the possible psychological changes, and its effects on weight loss after surgery, the current study aimed to compare marital satisfaction and self-confidence in patients with obesity before and after bariatric surgery in Rasoul-e-Akram hospital in 2013.
This prospective observational study was conducted on 69 candidates for bariatric surgery. Marital satisfaction and self-confidence were assessed before and six months after the surgery by Enrich marital satisfaction scale and Coopersmith self-esteem inventory. Descriptive statistics and T-tests were utilized to analyze data. Values of P ≤ 0.01 were considered statistically significant.
Despite the improvement of sexual relationship, marital satisfaction scores significantly decreased from141.26 ± 12.75 to 139.42 ± 12.52 six months after the surgery (P = 0.002). Satisfaction in scales of conflict resolution and communication showed a descending pattern (P Weight loss after bariatric surgery did not improve self-esteem and marital satisfaction six months post operatively; therefore, psychiatric assessment of patients before and after the surgery is crucial; since even if they are not associated with prognosis of the surgery, it is important to provide treatment for psychiatric problems. Prospective studies are recommended to assess post-operative changes of other psychological aspects.

The early relationships between infant and care takers are significant and the emotional interactions of these relationships play an important role in forming personality and adulthood relationships.
The current study aimed to investigate the relationship of attachment styles (AS) and emotional intelligence (EI) with marital satisfaction (MS).
In this cross-sectional research, 450 married people (226 male, 224 female) were selected using multistage sampling method in Mashhad, Iran, in 2011. Subjects completed the attachment styles questionnaire (ASQ), Bar-On emotional quotient inventory (EQ-i) and Enrich marital satisfaction questionnaire.
The results indicated that secure attachment style has positive significant relationship with marital satisfaction (r = 0.609, P 0.05).
According to the obtained results, attachment styles and emotional intelligence are the key factors in marital satisfaction that decrease marital disagreement and increase the positive interactions of the couples.

Increased prevalence of depression among patients with Rheumatoid arthritis (RA) has been described previously. However, the impact of depression among Iranian patients has not yet been investigated.
Here, the prevalence of depression was assessed and the effect of disease-related characteristics including pain, weakness and rheumatoid factor (RF) status on incidence of depression was evaluated.
Patients with RA, who were referred to rheumatology clinics of Kermanshah University of Medical Sciences and healthy subjects from the general population of Kermanshah participated in this investigation. Depression was assessed using Beck’s depression inventory II (BDI II). Pain and weakness were assessed subjectively by patients’ self-report. Data was collected during a year between 2012 and 2013. Chi-square test and independent t-test were used.
One hundred and seventy-one patients with RA and 198 healthy individuals participated in this investigation. In the RA group, depressive mood was detected in 45.7% of patients, which was significantly higher than healthy subjects (P = 0.008). Depression was more common in elderly patients (> 50 years old) in comparison with healthy subjects at a similar age (P = 0.03). Pain and weakness had no influence on depression incidence (P = 0.14 and 0.19, respectively) whereas patients with negative RF status were significantly more susceptible to severe depression (P: 0.001).
Depression is more common among Iranian patients with RA (45%) than healthy subjects regardless of gender. Depression has a significant association with older age. Negative RF status may predict future risk of depression.

Inadequate sleep hygiene may result in difficulties in daily functioning; therefore, reliable scales for measuring sleep hygiene are important.
The purpose of this study was to assess the psychometric properties of the Persian version of the Sleep Hygiene Index (SHI).
From April 2014 to May 2015, 1280 subjects, who were selected by cluster random sampling in Kermanshah province, filled out the SHI, Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and insomnia severity index (ISI). A subset of the participants (20%) repeated the SHI after a four to six-week interval to measure test–retest reliability. Then, we computed the Pearson product-moment correlation coefficients of SHI against PSQI, ESS and ISI, to demonstrate the construct validity of the SHI. The factor structure of the SHI was evaluated by explanatory factor analysis.
The interclass correlation coefficient was 0.89, and SHI was found to have good test–retest reliability (r = 0.89, P The Persian version of the SHI can be considered a reliable tool for evaluating sleep hygiene in the general population.

The current study aimed to investigate the relationship between cognitive distortions and attribution styles among divorce applicant couples and its impact on sexual satisfaction.
It was a cross-sectional study and its statistical samples were 55 divorce applicant couples (110 individuals) referred to Urmia courts, Urmia, Iran, from 2012 to 2013. The required data were gathered by interpersonal cognitive distortions, Larson sexual satisfaction and attribution style questionnaire.
The findings of the research indicated the existence of a significant relationship between attribution styles for pleasant events and cognitive distortions. The results showed that an increasing amount of pleasant events reduces cognitive distortions among the divorce applicant couples (P Normal and abnormal cognitive components are among the main factors affecting satisfaction or dissatisfaction in couples who are living together (sexual satisfaction is one of its main elements).

Preliminary evidence supports the role of neuroticism, experiential avoidance and emotion regulation in anxiety and depression; however, the mechanism of these relationships is not known well.
The present study mainly aimed to assess the mediating role of emotion regulation in the relationship between neuroticism and experiential avoidance and anxiety and depression symptoms.
By convenient sampling, 316 students from Tehran University of Medical Sciences, Iran University of Social Welfare and Rehabilitation Sciences and University of Tehran were selected and measures of experiential avoidance, neuroticism, emotion regulation, worry, anxiety and depression were administered among them, 2014-2015. Path analysis via regression according to Baron and Kenny evaluative criteria was used for data analysis.
Experiential avoidance and neuroticism predicted anxiety, and depression symptoms and the predictions were mediated by emotion regulation and worry.
Emotion regulation deficits have an outstanding role in the mechanism of anxiety and depression which are so comorbid and further studies are needed to evaluate emotion regulation with more advanced methods and along with other transdiagnostic components.

Injuries caused by sharp objects, which involve biological hazards are considered as one of the most important factors that lead to stress among the nursing staff. Contact with sharp objects is a major concern among healthcare workers, especially nurses.
This study was done to determine the amount of stress caused by exposure to sharp medical instruments among nurses.
This was a cross-sectional research on 527 nurses, working at different medical centers across Iran, with a cluster-sampling method. The relevant data was collected with a valid and reliable questionnaire. The Cronbach’s alpha coefficient of internal consistency of this instrument was 0.92 and interclass correlation coefficient was 0.94
The results showed that ward satisfaction, having master of science, age, and number of contacts were significantly able to predict variance in stress scores. The adjusted line regression model explained 36% of the overall variance in stress score (R2 = 0.60)
The results of this study showed that exposure to sharp objects may cause high stress in the nursing staff. Considering higher levels of stress in the area of contact care, the provisions on how to deal with patients and safe care can help reduce stress.

The present study aimed to recognize bullying behavior in the students in Iran and analyze the perception of school teachers and parents in this regard.
Several semi-structured interviews and observations were conducted with four teachers and eight parents of children involved in bully/victim problems and the analysis was interpreted through established comparative evaluation methods.
Iranian teachers and the parents perceived bullying mainly as physical and verbal attacks with little understanding of the psychological factors. They emphasized that the underlying influence of religious beliefs should also be considered in the context of bullying among Iranian society due to the strict conformance applied by parents upon their child.
Based on the outcomes of the study, it is recommended that the teachers participate in anti-bullying programs orientated to prevent bullying behaviors and develop strong supportive relationship with parents to reduce this behavior through personal contacts and interactive workshops.