Iranian Journal of Psychiatry and Behavioral Sciences
Volume:15 Issue: 2, Jun 2021

 Patients with spinal cord injuries suffer from some psychological problems, such as inadequate emotional regulation and flexibility for adapting to the post-injury condition. In this regard, acceptance and commitment therapy (ACT) can improve psychological flexibility and emotional regulation.

 The main goal of this study was to analyze the effectiveness of ACT in improving psychological flexibility and emotional regulation in patients with spinal cord injuries.

 This quasi-experimental design study was based on a pretest-posttest method with a control group. The study population consisted of all patients with spinal cord injury referred to Jalaeipour Rehabilitation Center in Tehran. The study sample included 30 patients with spinal cord injury selected by the purposive sampling method. The inclusion criteria were patients aged 20 to 55 years, residing in Tehran, and with at least a high school diploma. The injury duration varied between one and five years, and the injuries were thoracic and lumbar injuries and an intermediate score of psychological flexibility and emotion regulation. The exclusion criteria were patients with cervical spinal cord injuries, as well as patients who were simultaneously receiving another psychological treatment together with the subjects who suffered from brain damage. Patients were randomly assigned to the experimental and control groups based on random numbers. There were 15 patients in each group. The intervention group received ACT during eight sessions (1.5-hour group therapy) held once a week at Jalaeipour Rehabilitation Center in Tehran (2018), while the control group received routine care. Dennis and Vander Wal’s cognitive flexibility inventory (CFI) and Gross and John’s emotion regulation questionnaire (ERQ) were completed before and one week after the intervention. The data were analyzed using multivariate analysis of covariance (MANCOVA).

 There was a significant difference in demographic indicators between the two groups. Based on MANCOVA with the baseline score, the mean scores of psychological flexibility and emotion regulation had a significant difference regarding the results of ACT between the experimental and control groups (P < 0.05).

 According to the findings, ACT can improve psychological flexibility and emotional regulation in patients with spinal cord injuries.

Context: 

Cancer diagnosis and its therapeutic methods can lead to considerable psychological problems and decrease the levels of hope in patients. Due to the considerably important multidimensional effects of hope on the life of patients with cancer, this study aimed to assess the effect of psycho-socio-spiritual strategies on the hope level of patients with cancer.

Evidence Acquisition:

 In this narrative review, electronic databases were searched including Google Scholar, Scientific Information Database, Magiran, PubMed, ScienceDirect, Web of Science (ISI), Ovid, and Scopus. Those articles published between 1978 and 2020 were retrieved and assessed through the abstract and full-text appraisal. Finally, 74 articles were included in this study.

 Psycho-socio-spiritual strategies for affecting the hope level of patients with cancer were classified as follows: (1) psychological interventions (psychotherapy, counseling, coping skills training, stress management training, crisis management, individual or group supporting therapy, hope therapy, and psychoeducational interventions); (2) social interventions (social and family support intervention); and (3) spiritual interventions (logotherapy, religion therapy, and praying).

 Due to the chronic nature of cancer disease, in addition to the important role of pharmacological treatment such as chemotherapy and radiotherapy, considering non-pharmacological approaches such as hope-fostering interventions for these patients is essential and can lead to a better quality of life.
 

 Today, the prevalence of psychological problems such as stress, anxiety, and depression in hemodialysis patients has increased and affected their quality of life.

 Given the relationship between resilience interventions and psychological problems, this study aimed to investigate the effect of resilience training on stress, anxiety, depression, and quality of life in hemodialysis patients.

 This was a controlled clinical trial study on 57 hemodialysis patients referred to Fasa city hemodialysis centers from October to December 2019. Patients were selected using a simple sampling method and divided into two groups of intervention (n = 29) and control (n = 28) using the block randomization method. In 12 sessions of a 90-minute workshop, the intervention group was taught resilience skills by a clinical psychologist. Before and after the intervention, stress, anxiety, depression, and quality of life were measured using the Depression anxiety stress scale (DASS) 21 and SF-36 questionnaires. Data were analyzed with Statistical Package for the Social Sciences (SPSS) software version 20 using t-test, Kolmogorov-Smirnov, and chi-Square tests.

 According to the paired t-test, the patients’ mean score of stress, anxiety, and quality of life significantly decreased in the intervention group (P < 0.001), whereas depression score did not significantly change after the intervention (P = 0.689). The difference in the mean scores of stress, anxiety, depression, and quality of patients' life was not significant in the intervention group before the intervention and in the control group before and after the intervention (P > 0.05).

 Resilience training reduced stress and anxiety in hemodialysis patients and improved their quality of life. Thus the use of resilience intervention programs along with other methods for hemodialysis patients' care and treatment programs is recommended as a non-invasive, non-pharmacological, inexpensive, and cost-effective method without complications.

 Sibling relationships are very significant relationships, and their termination due to death will have profound long-term effects on the life of the surviving children.

 The purpose of the current study was to determine the effectiveness of theraplay on internalizing and externalizing problems in bereaved siblings.

 This study was carried out using a single-subject multiple baseline design with follow-up. The statistical population included siblings and mothers of children aged 6 - 10 years who were on treatment at Mahak Pediatric Cancer Hospital and died one or two years ago. From this population, four mother-child pairs were selected as the study sample by convenience sampling. Each mother-child pair participated in 15 theraplay sessions once a week (45-min sessions). The assessments were carried out using the Child Behavior Checklist (CBCL) at baseline and in the intervention sessions and follow-up. Visual analysis of graphic displays of level, Reliable Change Index (RCI), and clinical significance were used to analyze the data. Data analysis and drawing the graphs were performed in Microsoft Excel 2016.

 The results of the visual and quantitative data analysis showed a significant reduction in the four participants' internalizing problems during therapy. The reduction in the scores of this subscale in participants 1, 2, and 3 continued into the follow-up period and was noticeable. The results also showed that theraplay reduced the externalizing problems of most participants. A large proportion of these results persisted into the follow-up period.

 Theraplay appears to effectively reduce the internalizing and externalizing problems of bereaved siblings.

 The COVID-19 pandemic has had adverse psychological, social, and economic consequences around the world. Nurses and physicians have been more negatively affected by this pandemic as compared to other occupational groups.

 The present survey aimed to investigate the job burnout and mental health of nurses during the COVID-19 pandemic and to explore the mediating role of resilience in the relationship between mental health and job burnout.

 This cross-sectional study was carried out in two public hospitals of Kashan, Iran from March 2020 until the end of June 2020. A total of 108 nurses participated in this study. The assessment tools included the General Health Questionnaire-28 (GHQ-28), nurses’ job Burnout Questionnaire, and Resilience Scale. Hierarchical linear regression models were used to evaluate the mediating role of resilience in the relationship between job burnout and mental health.

 The results showed that 61.1% of the participants had mild to severe mental health problems, while 13% reported no job burnout. In terms of resilience, most participants (88.9%) reported moderate resilience. Based on the results, resilience partially mediated the effect of mental health problems on job burnout. The present findings highlighted the mediating role of resilience in the relationship between job burnout and mental health problems among nurses.

 The present findings suggested that evaluation of resilience resources and traits might be helpful in predicting individuals at risk of psychological problems and job burnout.

 There is ample evidence indicating that the parents of children with cerebral palsy report the experience of hope, despite all problems to which they are exposed.

 This study aimed to explain the factors facilitating hope regarding the experiences of parents having children suffering from cerebral palsy.

 This qualitative study was carried out using the content analysis method. The experiments of 17 parents (11 females and 6 males) having children with cerebral palsy were collected in in-depth unstructured interviews in 2019, and then content analysis was performed using Strauss and Corbin’s approach. The purposive sampling method was used as long as data saturation was reached. After that, the collected data were analyzed using the content analysis method.

 In this study, several factors were extracted as facilitators of hope in parents of children with cerebral palsy. These effective facilitating factors were classified into four main categories: promising treatment, positive beliefs, motivational drivers, and support networks.

 Various factors can be effective in promoting hope in parents of children with cerebral palsy, the detection of which would help developing educational and counseling programs and providing support for such parents.
 

 The outbreak of coronavirus disease 2019 (COVID-19) pandemic has led to public panic and psychological problems. In this regard, few studies have reported the post-discharge mental health status of COVID-19 survivors.

 This study aimed to evaluate the mental health status of COVID-19 survivors and determine the risk factors of adverse psychological outcomes.

 This cross-sectional study consisted of 188 COVID-19 survivors discharged from hospital. Data were recorded using social media applications. To evaluate the mental health status, Hospital Anxiety and Depression Scale (HADS) and Depressive Anxiety and Stress Scale 42 (DASS-42) were used. Ordinal regression with a logit link was used to assess the simultaneous effect of variables.

 The mean age of participants was 56.4 ± 9.6 years, and the majority of patients were male (62.2%). According to HADS, 81 (43.1%) and 24 (12.8%) patients suffered from anxiety and depression, respectively. Using DASS-42, we reported at least a mild degree of depression [23 (12.2%)], anxiety [20 (10.6%)], and stress [74 (39.4%)] among the discharged patients. Depression, anxiety, and stress were significantly associated with length of hospital stay (P < 0.05). In addition, there was a direct association between stress and patients’ number of children (β = 0.38, P = 0.02).

 Depression, anxiety, and stress are relatively high among COVID-19 survivors. Length of hospital stay and number of children were identified as the predisposing factors for adverse psychological outcomes.

 Autism is one of the prevalent disorders in childhood. Children with autism have difficulties in different life skills and their daily activities. Pretend plays are essential in improving these skills, but the patterns of playing are impaired in this group.

 The present study was designed to compare pretend plays between high-functioning autistic children and typical peers.

 The research is the result of a cross-sectional study. Two groups of children with high-functioning autism and typical peers in the age range of 5 - 7 years were studied. Each group consisted of 87 participants who were selected by convenience sampling. Each participant was assessed by the Child-Initiated Pretend Play assessment (ChIPPA) test. The results were analyzed using descriptive statistics and an independent t-test.

 Data analysis and comparison of scores between the two groups of children showed a significant difference in the mean scores. The average percentage score of the number of object substitutions (NOS) and the elaborate pretend play actions (PEPA) in children with autism were lower than typical peers (P < 0.001). In other words, children with autism were less able to organize play and pretend. But the number of imitated actions (NIA) scores in children with autism was higher than their counterparts (P < 0.001). That is, children with autism relied more on examiner-playing patterns.

 The significant difference in scores between children with autism and typical peers showed significantly lower pretend skills in children with autism. According to pretend play basics on academic skills, language, and having a flexible mind, and with the attention to the same problems in children with autism, pretend play can be in greater attention to be improved among these groups.

 Preschool is one of the most important ages in learning and developing social skills in children. One of the most important issues in the education of healthcare providers is to improve their knowledge about children's social skills because healthcare providers, as an important part of a health team, are at the forefront of communication with families.

 This study was done to investigate the effect of education to health care providers with the gamification method on the social skills of preschool children.

 In the present quasi-experimental study, 71 female healthcare providers working in selected collective health centers in Shiraz, Iran, were included in the study. The educational content of this study was an educational software as question games based on gamification, which was provided to healthcare providers. Data collection tools were two questionnaires, including a demographic information questionnaire and a researcher-made questionnaire on social skills in preschool children. To analyze data, the effectiveness of the intervention was measured using Wilks' lambda multivariate test. The relationship between knowledge score and participants' demographic variables was assessed by the linear regression analysis. Data were analyzed using SPSS software (version 22).

 There was an increase in the knowledge of healthcare providers at three-time points, including before, immediately after, and one month after the educational intervention. Significant relationships were also observed between mean knowledge scores of the participants in all components of the questionnaire before, immediately after, and one month after the intervention (P < 0.001), with significant increases in mean post-intervention scores. The knowledge scores at three-time points, before, immediately after, and one month after the intervention, had significant associations with the educational level of participants (P < 0.001).

 Increasing the awareness of health care providers through the gamification method showed that this method has an important role in implementing social skills training for children.
 

Anti-N-methyl-d-aspartic acid receptor (NMDAR) autoimmune encephalitis is one of the most challenging disorders with both psychiatric and neurologic presentations. Approximately three-fourth of patients with anti-NMDA receptor encephalitis (anti-NMDARE) first referred to psychiatrists.

A 15-year-old female adolescent was admitted to a psychiatric hospital. She presented a history of behavior changes, including aggression, the symptoms mimicking depression, and suicidal ideation, for one year. Then she showed more severe disinhibited behaviors, stupor, and generalized tonic-colonic seizure, so she was hospitalized in a general hospital. After neurological assessments, she was referred to a psychiatric hospital due to her uncontrollable aggressive behaviors in addition to sleep disturbance, rapid mood swings, restlessness, stereotypic behaviors, fluctuating attention and concentration, misidentification delusion, and perceptual changes. All lab tests and brain images were normal. Electroencephalograms showed generalized sharp and slow waves. The autoimmune panel tests were requested. When anti-glutamate receptor antibody was finally reported in her CSF, anti-NMDARE was finally diagnosed. Her symptoms improved by receiving five corticosteroid pulses.

In patients with first and acute psychotic symptoms, especially in young individuals with seizures, the possibility of autoimmune disorders should be kept in mind, and complementary tests must be done for autoantibody detection.

Marital satisfaction is one of the main factors affecting the quality of life in marital relationships. It refers to individuals’ positive attitudes toward their marital relationship, and marital dissatisfaction is a negative and displeased attitude toward various aspects of marital relationship.

The present study aimed to explore the causal relationship between attachment styles and marital satisfaction regarding the mediating role of Gottman’s marital communication model.

The statistical population encompassed all university students in Ahvaz in the academic year 2019 - 2020. The multi-stage random sampling method was used, and 230 persons were selected as the study samples. Hudson’s Index of Marital Satisfaction (IMS), Coolins and Reed’s Revised Adult Attachment Scale (RAAS), and Gottman’s Communication Skills Scale (FHS) were also used to collect the data. Data analysis was performed using SPSS software version 26 and AMOS software version 24.

The results indicated that the study model well-fitted the study population, and all direct paths were statistically significant. Moreover, there was a significant relationship between secure attachment, anxiety-insecure attachment, and avoidanceinsecure attachment with marital satisfaction mediated by Gottman’s communication skills (P ≤ 0.001).

Given the effect of Gottman’s couple attachment styles and four communication skills on marital satisfaction, their effectiveness in marital satisfaction is proved. Accordingly, therapists are recommended to implement educational and treatment programs containing cognitive and preventive attachment styles and Gottman’s communication skills to promote couples’ marital satisfaction.

Facial emotion recognition (FER) is an important social skill. Some studies have determined the capability of FER in substance abusers, but their results are contradictory.

This study aimed to investigate FER ability in opioid antecedent subjects and mixed opioid-methamphetamine antecedent subjects under methadone maintenance therapy compared to a control group.

Following a retrospective cohort design, 71 methadone-maintained subjects (MMS) (40 individuals with a history of only opioid use disorder and 31 patients with a history of both opioid and methamphetamine use disorder) and 40 healthy participants filled the Persian version of Ackman and Friesen facial emotion experiment, which were matched based on age, education, and gender. Demographic and substance use characteristics were evaluated. Both groups were similar concerning the duration of the opioid use disorder, methadone maintenance treatment, and currently prescribed methadone dose. Data were analyzed using the chi-square, independent t-test, one-way ANOVA, and Welch test. Statistical significance was considered when P-value < 0.05.

Total FER scores were significantly lower in MMS compared to the control group. Concerning the subgroups, recognition of sadness was impaired in patients with a history of opioid use disorder (with and without a history of methamphetamine use disorder), while in recognition of anger and wonder, patients with both opioid and methamphetamine use disorder history had a significantly lower performance. There was no other significant difference between the groups.

The findings suggest that social cognition deficit should be considered in strategies related to the addiction (both treatment and rehabilitation).

School violence as a health issue is a global concern. One of the problems that affect the health and well-being of children at school is bullying.

In this study, we aimed to examine the association of depression and anxiety with bullying among 6 - 19-year-old students in Iran.

This study was conducted in Tehran, Iran, in 2020. A multistage cluster sampling method was used, and 54,550 students aged six to 19 years of both sexes, from urban and rural areas, were selected. Standard questionnaires, according to the WHO recommendations, were used for data collection. Involvement in bullying in the past 12 months and anxiety and depression status in both bully and bullied students were investigated by standard questionnaires. To compare the psychiatric problems and violent behavior, the Wald chi-square test was applied. The multilevel fixed-effect model and logistic multivariate regression were used to adjust the multilevel effects and estimate the odds of anxiety and depression in both bully and bullied students. All statistical analyses were performed at a 95% significance level.

Of the total students, 50.9% were males, 29.45% were in the 6 - 10 age group, and 70.55% in the 11 - 19 age group. There was a significant difference in depression and anxiety between boys and girls in both age groups (P < 0.001). Amongst males, 11.7% of the students aged 6 - 10 and 11% of the students aged 11 - 19 and in females, 7.7% aged 6 - 10 and 10.4% aged 11 - 19 had at least four experiences of bullying to others in the last year. The odds ratios for depression in male bullies were 1.3 and 1.5 in 6 - 10 and 11 - 19 age groups, respectively. The odds ratios for depression in bullied males and females were 4.2 and 3.9 in 6 - 10 and 2.9 and 4.3 in 11 - 19 age groups, respectively. Bulling others increased the odds of anxiety to 1.7 and 1.9 in males and 2.1 and 1.9 in females in 6 - 10 and 11 - 19 age groups, respectively. In bullied students, the odds of anxiety were estimated at 2.9 and 2.2 in males and 3.4 and 2.2 in female students respectively, in 6 - 10 and 11 - 19 age groups.

There was a significant positive association between psychological disorders (anxiety and depression) and bullying among 6 - 19-year-old students. Victims of bullying were more at risk of depression and anxiety. This health-threatening phenomenon should not be ignored.

Acute mania causes many problems for the patient and others. Therefore, it is very important to eliminate the symptoms quickly.

The present study made the individual comparison of the therapeutic effects of sodium valproate combined with quetiapine or haloperidol as an add-on among patients with bipolar I disorder experiencing an episode of mania or mixed feature admitted to a Psychiatric Center in Tehran.

The present study was a double-blind clinical randomized trial conducted on 36 patients. All patients were investigated by the Young Mania Rating Scale (YMRS). The study lasted six weeks in total (after raising drug dosage to the maximum level). We prescribed sodium valproate 15 mg/kg plus quetiapine 500 mg daily in one group and sodium valproate 15 mg/kg plus haloperidol 10 mg daily in the other group. In addition, an equivalent dosage of quetiapine and haloperidol was prescribed. This study used different data analysis methods such as Paired t test, ANOVA, and chi-square test.

The YMRS scores did not show any statistically significant difference between quetiapine and haloperidol receiving groups (P > 0.05).

This paper argued that a combination of sodium valproate with either quetiapine or haloperidol could be effective in the management of acute mania or mixed bipolar I disorder to reduce the severity and duration of symptoms, although there was no statistically significant difference between the efficacy of these two pharmacological therapies.

Aging is considered as a natural process and part of the stages of human life. In this regard, well-being can be achieved through learning certain skills and provision of appropriate care. Death of a spouse in this period is rather inevitable. Hence, old people consider this period as a loneliness period. Despite many advantages that elderly remarriage brings and consequently influences their life quality, marriage in this period is a taboo among people of the society, especially in Iran.

This study aimed to explore the experiences of the elderly regarding remarriage.

This conventional content analysis study was conducted in Iran during 2018. Semi-structured interviews with 20 elderlies living in Tehran were conducted to collect data. For data analysis, Graneheim and Lundman’s approach was adopted. The interviews were continued until reaching data saturation.

After data analysis, four main categories and 14 subcategories appeared. The main categories included “there is no fool like an old fool”, “spring in autumn”, “gift of old age”, and “realistic choice.”

Remarriage prevents many future problems for elderlies, such as the feeling of rejection, loneliness, isolation, depression, and low self-esteem. Therefore, serious efforts and planning are required to promote the knowledge level of the society regarding this issue.

During coronavirus (COVID-19) pandemic, frontline medical staff were exposed to numerous psychological problems due to unpredictable conditions. A psychological intervention for medical staff is the provision of a group where emotions and feelings are shared.

The purpose of this study was to evaluate the experiences of front-line medical staff about virtual Balint group.

Eight sessions of virtual Balint group were held through Skype. Participants were the frontline medical staff involved in the treatment of COVID-19 patients. The group leader was a psychiatrist and an analytical psychotherapist. The group had two coleaders, a clinical psychologist and a psychiatrist. They were both experienced conductors who had a background of participation in Balint groups. Finally, eight in-depth semi-structured interviews were performed. Interpretative phenomenological analysis (IPA) was carried out to analyze the obtained data.

Three themes were extracted, including the effects of Balint group, Balint group structure, and virtuality of Balint group. Each theme included several categories, and each category had some codes.

Leaders in the Balint group were active and had a supportive role. Some participants did not share their faces, and this made others feel insecure. Body language is an important issue in empathy and understanding of others that is overlooked in virtual Balint groups.

Diagnostic questionnaires play a great role in accelerating the diagnosis of mental disorders.

This study aimed to provide a cross-cultural adaption form of Self-report oppositional defiant behavior inventory (SRODBI) in Persian and assess the validity and reliability of this Persian form.

The present study was done on two research samples, including a sample of 294 students who were selected in the school year of 2019 - 2020 (girls and boys) from high schools of Dezful city by multi-stage random sampling method and a sample of 320 parents. The validity of the oppositional defiant behavior inventory was assessed by two methods of confirmatory factor analysis and convergent validity, and the reliability of the inventory was assessed using Cronbach’s alpha and split-half methods.

Cronbach’s alpha was obtained at 0.73 (0.87) for the whole self-report scale (parent version), 0.72 (0.74) for the subscale of irritability, and 0.81 (0.80) for the subscale of stubborn and resentful behavior. The correlation between SR-ODBI and Achenbach Youth Mental Health Test was 0.56 (P < 0.01). The results of confirmatory factor analysis (RMSEA = 0.06 and 0.08) also indicated a relatively good fit of structures of the oppositional defiant behavior inventory.

The results of the research indicated that the Persian version of the Oppositional Defiant Behavior Inventory in Iran has good reliability and validity

With the growing use of social networks, a large number of studies have investigated their psychological effects. Previous research has demonstrated that virtual networks, especially Instagram, negatively affect users’ mental health and make them vulnerable to mental disorders. However, the studies have been descriptive and provide descriptive statements; hence, they do not contribute to in-depth understanding of such vulnerability. Accordingly, qualitative studies should be conducted to delve into this phenomenon.

This article aimed to understand the key personality traits of popular Iranian Instagram users, assuming that the networks make individuals psychoanalytically vulnerable to clinical outcomes.

Regarding the research method, the deductive content analysis was adopted for the data extracted from semi-structured in-depth interviews with users having > 10,000 followers. Psychodynamic diagnostic manual, PDM-2 second edition, and the structured analysis matrix were considered to make sense of the collected data.

The results demonstrated that the dominant key personality traits in popular Instagram users were narcissism with three subcategories (namely narcissistic central tension, pathogenic belief about oneself, and pathogenic belief about others) and depression with two subcategories (namely depressive pathogenic belief about oneself and pathogenic belief about others).

According to the findings, the structures and categories underpinning our experiences by Instagram are inherently narcissistic. Rather than changing individuals’ dynamics, Instagram promotes this intellectual and communicative style inversely by normalizing it and reinforcing the narcissistic personality disorder established by the family and cultural structure of society.

Stimulants are highly effective in controlling symptoms of Attention-deficit/hyperactivity disorder (ADHD), but 30% of individuals with ADHD do not respond to them or cannot tolerate their side effects; thus, alternative treatment approaches need to be considered.

To evaluate the effect and safety of piracetam as an adjuvant therapy plus methylphenidate (MPH) in children with ADHD.

Thirty-six children with ADHD (6-16 years old), admitted to three academic outpatient child psychiatric clinics in the second half of 2015, were randomly assigned to the “methylphenidate plus piracetam group” and the “methylphenidate plus placebo” group, in a double-blind, placebo-controlled study, for 6 weeks. The “Conner’s Parents’ Rating Scale-Revised (CPRS-R), Children Symptom Inventory-4 (CSI-4), Clinical Global Impression-Improvement scale (CGI-I), and Children’ Global Assessment Scale (CGAS) were completed at baseline and at the ends of the third and the sixth week, and the New York State Psychiatric Institute side effect forms were completed weekly, as outcome measures.

The level of improvement in CPRS-R, CSI-4, and CGI-I scales were significantly higher in the “methylphenidate plus piracetam” group compared with the “methylphenidate plus placebo” group. Side effects were not remarkable in any group.

Piracetam as a short-term adjuvant treatment to methylphenidate can have considerable therapeutic effect and safety profile in children with ADHD and deserves further exploration to assess its potentialities in ADHD treatment.