اشرف کربلایی نوری

Background and Aims Sleep problems such as insomnia are common in individuals with severe mental disorders. The sleep-enhancing interventions provided by occupational therapists can be used for primary prevention and health promotion. This study aims to explore the existing evidence on occupation-based sleep interventions for individuals with severe mental disorders.Methods This is a scoping review, conducted based on Arksey and O’Malley’ five-step method. A search was first conducted in eight online databases (MagIran, SID, IranDoc, Google Scholar, PubMed, Cochrane Library, Scopus, Web of Science , OT seeker, Psych INFO) to find articles that addressed sleep interventions for individuals with severe mental disorders Two raters reviewed all articles independently. Articles were categorized according to the type of sleep interventions.Results  Thirty-two studies were reviewed. Four categories of occupation-based sleep interventions were extracted, including cognitive behavioral therapy (n=12), physical activity (n=7), multicomponent interventions (n=5), and other interventions (n=8).Conclusion The occupation-based sleep interventions can improve sleep quality and health in people with severe mental disorders.  Occupational therapists and clinicians need to conduct more studies to provide evidence for occupation-based sleep interventions.

The importance of participatory health governance has been acknowledged by the World Health Organization. Studies have shown the positive effects of participation in occupation-based intervention in patients with severe mental disorders, including schizophrenia, in outpatient and inpatient wards. The purpose of this article is to review the studies on occupation-based interventions in patients with severe mental disorders.

This is a narrative review study. A search for related articles was conducted in PubMed, Google Scholar, Cochrane, ScienceDirect, Scopus, OTseeker, PsycInfo databases using the keywords “severe mental disorder”, “serious mental illness”, “schizophrenia”, “Major depression disorder”, “Bipolar disorder”, “Occupational therapy”, Occupation”, and “Occupation-based intervention” without the time limitation. Titles and abstracts of 480 yielded articles were examined.

Twelve articles were reviewed; Two were related to occupation-based interventions in psychiatric inpatients, five were related to occupation-based interventions in outpatients, and five were related to occupation-based interventions in both inpatients and outpatients. Among these articles, one studied the challenges of using occupation-based interventions.

It seems that occupation-based interventions in inpatients and outpatients with mental illness have been used more to reduce symptoms, and less attention has been paid to the effectiveness of these interventions in maintaining and or improving occupational performance in these patients. The Canadian model of occupational performance and the recovery framework have been used in the design of these interventions. To achieve better results in psychosocial rehabilitation where occupation-based interventions lead to an increase in quality of life, the challenges in this area should be solved.

 This study aimed to translate the Assessment of Interpersonal Problem-Solving Skills (AIPSS) into Persian and to evaluate the validity and reliability of the Persian version of AIPSS to use for adults with schizophrenia.

In this methodological study, the translation process was performed according to the International Quality of Life Assessment (IQOLA) protocol. The face validity of the translated AIPSS was determined based on the opinions of experts and The Content Validity Index (CVI) and Content Validity Ratio (CVR) were also calculated for each item. The Persian version of the test was performed on 52 patients with schizophrenia disorders at Tehran’s Razi Mental Hospital; they were selected using a convenience sampling method. Cronbach’s alpha coefficient was used to evaluate internal consistency. Inter-rater reliability was determined by the Intraclass Correlation Coefficient (ICC). A retest was complete on 15 patients with 2 weeks interval and ICC was used to determine the test-retest reliability.

 Face validity was confirmed by the experts’ opinions. The Content Validity Ratio (CVR) and the Content Validity Index (CVI) were equal to one for all scenes. Cronbachchr('39')s alpha coefficient for all scales was ranged between 0.511 and 0.821. The ICC in all scales were more than 0.98 for inter-rater reliability. In calculating test-retest reliability, the ICC for all scales ranged 0.733-0.893.

 Results show that the Persian version of AIPSS has acceptable face validity, content validity, internal consistency, inter-rater reliability test-retest reliability. Therefore, this instrument can be used in clinical fields and research studies to assess the social skills of Iranian patients with schizophrenia.

Severe psychiatric disorders, such as mood disorders and schizophrenia, are caused due to impairment of physiological, psychosocial, and genetic functions. These disorders affect the functional performance of these people. Functional performance is called the ability of individuals to carry out daily activities and to have efficiency in their fields of work, leisure, and self-care, as well as having the satisfaction of doing these activities. The existence of functional performance contributes to the participation, well-being, and independence of these individuals. Therefore, evaluating functional performance and familiarity with the most widely used tools and appropriate psychometric properties in this field is essential for the provision of services.

In the current study, functional performance was first defined and described in severe psychiatric patients. After examining existing books in the field of occupational therapy of mental health, and google scholar, OT seeker, PubMed, and ProQuest databases, in the first step, identifying the most commonly used tests, in the second step, we examined the psychometric properties of the tests on the database and the test manual.

Our investigation resulted in identifying 316 tests. According to entry and exit criteria, including functional performance measurement, the use of standardized methods and training, adult psychiatric disorder, clinical application, showing treatment efficacy, measurements individual profile, and appropriate psychometric properties, six tests, namely OPHI, COPM, ACLS, KELS, BaFPE, and AMPS were studied.

According to the results, considering the importance of functional performance in their ability to participate, well-being, and independence, familiarity with the functional performance evaluation tools identified in this study can be an important step in screening, providing health care, and demonstrating the effectiveness of treatment for these individuals. Also, in order to use these tests in our country, it is recommended that the tests which have not been standardized be investigated.

 Parkinson Disease (PD) is a progressive neurodegenerative disorder affecting motor and cognitive functions. Cognitive impairments are related to different causes such as health indicators.   This study aimed to examine the relationship between cognitive impairment and health indicators of patients with PD.  This study was a cross-sectional and descriptive study. By convenience sampling method, a total of 30 PD patients 60-70 years old, diagnosed by a neurologist, were recruited. Cognitive Montreal Test was administrated to measure their global cognitive function. Rey visual test was used to determine their visual memory and the Wechsler test (adult memory) was used to assess their verbal memory. Their sleep quality was assessed by the Pittsburgh Sleep Quality Index. Demographic information and health indicators such as blood pressure were collected via interview. The obtained data were analyzed in SPSS 22.  The results showed significant relationship between some indicators such as blood pressure with verbal memory (r=-0.514, P=0.004), and sleep disorder (r=-0.421, P=0.031), and visual memory (r=0.368, P=0.045).  This research revealed that blood pressure and sleep disturbances can affect memory function. Therefore, the cognitive problems in people with PD can be postponed by screening these factors and controlling them with early medical interventions.

The Bay Area Functional Performance Evaluation-Task Oriented Assessment (BaFPE-TOA) is a standard test developed by Williams and Bloomer in 1977-1978 in order to evaluate functional performance. This test consists of five tasks (sorting shells, money and marketing, home drawing, block design, kinetic person design), twelve parameters (memory for written and verbal instructions, organization, attention span, evidence of disorder, ability to abstract, completion, errors, efficiency, motivation and compliance, frustration tolerance, self-confidence, general affective impression) and three components (cognitive, affective, and performance components). The purpose of this study was to translate the BaFPE-TOA in Persian and to evaluate the face and content validity, and internal consistency in patients with severe psychiatric disorders.
A non-experimental and methodological study was carried out in Tehran in 2017; the study population included adult patients diagnosed with severe psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this study, demographic questionnaire and BaFPE test were used. Convenience Sampling was done on patients who were admitted to Razi Psychiatric Hospital. In order to prepare the Persian version, the translation of the BaFPE-TOA test was carried out in accordance with the International Quality of Life Assessment (IQOLA) project, which included: 1. Translation of the original version into Persian; 2. Review by translators and professors; 3. Translation quality; 4. Translation of the Persian version into English; and 5. Comparison of the English version with the original version. The Persian version was assigned to five experts to evaluate the content validity in terms of simplicity, relevance, clarity, and necessity. The face validity of the test was performed on three patients and two healthy individuals in order to find difficulties in the understanding of words and phrases, the appropriateness of the items, the likelihood of ambiguity and inadequate perceptions of expressions or the lack of meaning in words. After confirmation, a Persian version of the test was performed on 55 patients with severe psychiatric disorders who qualified the inclusion criteria. Inclusion criteria for this study included: 1. People with psychiatric disorders based on DSM-5 and are listed in the medical records by a psychiatrist; 2. Over 18 years old; 3. Complete consent to enter the study; 4. Aability to write and read; 5. Lack of comorbidity (mental retardation, drug abuse); 6. Lack of physical constraints affecting the performance of specified tasks; 7 Lack of visual impairment or severe hearing loss. Cronbach’s alpha coefficient was used to evaluate the internal consistency with respect to the four options of the test. Data analysis was performed using SPSS v.16 software.
Experts’ opinions about the quality of translation and replacement of words in the translation process were according to the IQOLA method. The face validity of the test according to the experts’ opinion and its association with healthy subjects and patients showed that the clarity and implementation of common language were of good quality. The content validity of the test was performed according to the opinion of the five experts in mental health; the Content Validity Ratio (CVR) and the Content Validity Index (CVI), were equal to one for all domains. The minimum acceptable value for content validity based on CVI and CVR indices was 0.80 and 0.99, respectively, which indicated validity of the content and the lack of impact of culture on the parameters, tasks, and components of the BaFPE-TOA test. The results of the Cronbach’s alpha coefficient for all fields was related to the twelve functional parameters, the three components, and the five tasks; the efficiency parameter was above 0.7 (the minimum acceptable value), indicative of the good internal reliability of this test.
According to the experts’ opinion, the Persian version of the BaFPE-TOA test has a proper translation, with acceptable face and content validity and internal consistency. Therefore, this test can be recommended for the evaluation of functional performance in patients with severe psychiatric disorders.

Occupational therapists working at mental health areas face more issues as compared to their colleagues working in other fields. The present study is aimed at exploring the experiences of the occupational therapists who envisage ethical issues in psycho-social rehabilitation. The present study is a 'qualitative study' in which 'content analysi's has been conducted. A 'purposive sample' consisting of twenty volunteer occupational therapists who work at mental health centers were selected. The participant’s ages ranged from 24 to 45(with average 34) years. The shortest and longest work’s experiences of the participants were one year and twenty years respectively. The participants discussed the major problems they had experienced in dealing with mentally ill people through focus group discussion (five sessions). Having the objective of the study in mind, the ethical issues were then extracted. The most important ethical issue in dealing with mentally ill patient, as stated by the participants, was the therapist's insufficient knowledge of communicating and of employing the therapeutic services. The codes extracted from this study were grouped into four main categories, namely 'compatibility of therapy with the patient's characteristics', well-being of the patients and quality of services', 'compatibility of plans with the patient's condition' and finally 'the procedure of referring the patients for occupational therapy'. The findings of the study suggest that the occupational therapists working in the field of mental health care are encountered by many ethical issues and it is imperative for the occupational therapists to upgrade their knowledge and awareness in various fields in order to settle and overcome the foregoing ethical issues. Exposing these issues and sharing them with other professionals in an attempt to explore successful and safe approaches towards improving the rehabilitation of the mentally ill people is essential as well.

The aim of the present study was to determine the effect of «Community Re-entry Program» (CRM) on psychological condition in the patients with schizophrenia.

In this quasi experimental design study that sampling was performed available and none randomized. 24 patients with schizophrenia who had the inclusion criteria selected and were placed into two intervention (n=12) and control groups (n=12). Data were collected using the Positive and Negative Symptoms Scales (PANSS) questionnaires and interviews. Then intervention group were instructed Community Re-entry Program (CRM). The program was contained 16 sessions، which was administered every other day، 3 times a week، during run program were used only routine treatment of patients in psychiatric hospitals (medication therapy and occupational therapy). The data from this study were analyzed through the t-test for independent groups.

The findings indicated that the negative symptoms of schizophrenia patients in the intervention group، compared with the control group showed no significant change after the implementation of community re-entry program (P<0. 05). Although it was evident that the change in the total average and other aspects but changes to the dimensions of (positive symptoms، general psychopathology and total score) were not significant (P>0. 05).

According the research findings community re-entry program could reduce negative symptoms in schizophrenia patients، this significant improvement can be attributed to the effect of the intervention، and the difference was not observed in the control group.

Although motor difficulties are not considered as a diagnostic criterion in Diagnostic and Statistical Manual of Mental Disorders: However its association with Attention Deficit Hyperactivity Disorder (ADHD) is commonly reported. CO-OP is a problem-solving approach developed to help children with Developmental Coordination Disorder and addresses their motor-based problems. In this approach, therapist supports the children to use their cognitive strategies in a process of guided discovery to solve occupational performance problems. The objectives of CO-OP are to improve the motor performance of children with ADHD by helping them to discover various procedures to remove barriers and enhance supports by facilitating activities and participation. This study was designed to examine the influence of CO-OP on motor-based occupational performance of children with ADHD.

A single case experimental design (multiple baseline) was used to examine the influence of a 12 weeks intervention of CO-OP (twice a week) on Six children with ADHD. Each child selected three different goals to practice during intervention. Outcome measures included the Canadian Occupational Performance Measure (COPM), and the Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP). At first and prior to the intervention, the COPM was administered to the children and parents separately to obtain a rating of performance and satisfaction of the child in selective goals. The CO-OP intervention protocol was based on Polatajko and colleague's work in 2001. During intervention, children were taught the global problem solving strategies helping them to discover and perform domain-specific strategies. Therapist and family also supported children to achieve the performance of selected goals.

The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results support the use of the CO-OP with children with ADHD.

Further research into the application of CO-OP with children with ADHD is warranted based on preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.

The purpose of this study is to investigate the effect of group social skill training on drug abuse treatment prognosis.

To achieve this goal, 20 available subjects residing at Tehran Clinic were selected. These subjects were randomly assigned into two experimental and control groups. The experimental group participated in ten 2-hour sessions and were trained social skills, and the control group was in the waiting list. Measurement tools consisted of ACIS Questionnaire and laboratory test; Both experimental and control groups were subjected to pre and post tests. Data were analyzed using paired t test, independent t test, Mann-Whitney u test.

Results indicated that, the communication and interaction skills in experimental group had improved significantly in comparison with control group, also in the control group of a person suffering from lapse, but none of those two groups relapsed after 1- month follow up.

According to our results it can be concluded that social skills training can be used as a suitable tool to increase communication and interaction skills.

Cognition, a quite complicated skill, is the base of all goal- directed functions of human beings. The impact of cognitive disorders on the functioning of neurologic and psychiatric patients could not be more emphasized. Thus, careful assessment of cognitive capacity to predict how well these kinds of patient will function seems to be necessary. Allen cognitive level screen (ACL) provides a quick estimate of current capacity to learn and remained abilities of patients with cognitive impairments. In this analytical- descriptive study, cognitive levels of 30 inpatients and 30 outpatients with schizophrenia as well as 30 normal subjects were evaluated and subsequently were compared using ACLS. The impact of demographic variables on cognitive level was also determined. Results were statistically analyzed through Pearson correlation and one-way ANOVA. Statically significant difference was found between ACL scores of normal people and patient groups (P < 0.001). There was also a difference between ACL scores of outpatients and inpatients with schizophrenia (P < 0.001). Cognitive level was shown to have a positive correlation with education(r = 0.545), illness-onset age (r = 594) and a negative correlation with length of illness (r = -0.574), period of institutionalization (r = -0.454). There was no significant correlation between cognitive level and demographic variables in normal group. The results of this study indicate that normal group’s cognition level was higher than schizophrenic patients and that the cognitive level of outpatients was better than inpatients. Illness onset age, period of institutionalized, length of illness and education all can influence cognitive level of schizophrenic patients.

Considering schizophrenic patients’ problems with living skills, it seems necessary to evaluate these skills in this group of patients. In the present study, The Kohlman Evaluation of Living Skills (KELS), developed by Linda Thomson Kohlman at Seattle, Washington (1978), was first translated into Persian and then its reliability and validity was determined. To evaluate test- retest reliability, interrater reliability, and concurrent validity and construct validity of the Persian version of KELS, this cross- sectional analytical-descriptive study was conducted. The subjects who were assessed by the Persian version included 105 outpatients with schizophrenia, 35 inpatients with schizophrenia and 35 nonpsychiatric participants. The comparison of two sets of scores, gathered by two separate evaluators from 30 outpatients (r=0.997), as well as the results of test retest reliability in 24 outpatients (r=0.967) showed an acceptable reliability of the Persian version of KELS. The concurrent validity was determined by comparing the scores of 35 inpatients obtained via KELS and those obtained through Global Assessment Scale (r=0.886). The Persian version of KELS was found to be able to differentiate between living skills of nonpsychiatric participants and schizophrenic patients supporting construct validity. This study demonstrated that the Kohlman evaluation of living skills has an appropriate reliability and validity for being used with the population of schizophrenic patients.

Sociocultural emphasis and increased interest in physical attractiveness and current attitudes body structure have increased body image dissatisfaction among women. The prevalence of body image dissatisfaction is linked with various psychological disorders and disturbances such as low self-esteem, depression and other disorders. The present study investigated the short program aerobic exercise effects on body image among women. In this interventional and quasi experimental study, 82 females among 150 women (18-45 years old) referred to Enghelab and Gol sports clubs in Tehran were selected by convenient and simple sampling based on inclusive and exclusive criteria and randomly divided into two intervention and control groups. They did not participate in any exercise in last 3 months and also they did not have any physical disease and meet criteria for deficit of body image attitudes. Data collection was done by using demographic and Multidimensional Body Self-Relation Questionnaire. The intervention group participated in aerobic exercise program. These sessions lasted 3 hours per week for 4 weeks. Data were analyzed by Chi–Square, Paired T and Independent T tests. There were significant differences between two groups after intervention in sub items of body image including: self-appearance evaluation (P<0.001), self-appearance orientation (P<0.001), health orientation (P=0.003), illness orientation (P=0.002), but their fitness evaluation (P=0.141), self-fitness orientation (P=0.888), health evaluation (P=0.072), self-body satisfaction (P=0.082), overweight preoccupations (P=0.167) and self-assesed weight (P=0.156) did not change clearly. Short periods of aerobic exercise can effectively promote body image attitudes among women, and exercise can be used as a method of treatment in occupational therapy of the disorder.

Quality of life has recently been recognized as an important goal of health care in psychiatry. In this study quality of life of chronic psychiatric patients was evaluated after psychosocial occupational therapy interventions. This study is interventional and quasi experimental. Twoenty four chronic mental patients who had refered to SINA Daily Center as intervention group and fifty chronic mental patients as control group were selected by simle and convenient sampling. The instrument was Wisconsin Quality of Life Client Questionnaire that included 8 subscales. Occupational therapy services consisting group therapy, activity therapy and art therapy, according to center’ plane, were performed during 3 months (2 times in week, 90 minutes in each session) for intervention group. Independent T test & Paired T test were used for data analysis. There was no significant difference between two groups in parts of QOL before intervention, but after intervention, significant differences were observed in mean scores of satisfaction level, occupational activities, psychological well–being, physical health and total quality o life (P<0.001), also social relation (P=0.005) and economic situation (P=0.003).There was no significant difference between two group in symptoms (P=0.277) and activity of daily living (P=0.020) after intervention. Psychosocial occupational therapy services are effective on satisfaction level and quality of life of chronic psychiatric patients.

Schizophrenia generally has cognitive impairments. So, cognitive impairments can affect whole life's aspects, cognitive assessment helps develop treatment planning and obtain independency in Occupational performance areas. The goal of this study is supporting construct validity of the Iranian version of Lowenstein Occupational Therapy cognitive assessment (LOTCA) through comparison of cognition among schizophrenic patients and general population. This is a validity testing study that was performed on 737 person (237- patient & 500- general population `) in 20-60 age by comparative method. Samples were selected randomly accordance to research criteria. The tool was Lotca that asses six cognitive areas. Data gathered through demographic questionnaire and Lotca's scoring sheet and analyzed by Spearman correlation coefficient, Leven and Independent T-tests. There was significant different in cognitive performance between schizophrenic patients and normal population in all subtests of LOTCA (P>0.001). Comparison of cognitive performance of inpatients and outpatients showed significant difference in orientation, visual perception, visu-motor organization, thinking operations attention and concentration (P>0.001). In females thinking operations (P=0.033) and attention and concentration (P=0.007) was higher than males. The mean scores of subscales in employed person significantly were higher than unemployed persons (P>0.001). Subscales scores has reduced with increasing of age. Married persons showed higher orientation (P=0.033). Also there was significant difference between level of education and desirability of seven subscales (P>0.001). Results supports and confirms the construct validity of Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) for cognitive status evaluation of schizophrenic patients.

Depression is one of the most common mental disorders affects 20 million adults every year. Antidepressant medication and psychotherapy are commonly used for these patients. It seems necessary to promote alternative methods in regards of tardiness and side effects of these therapies. This study investigated the aerobic exercise effects on depression among adult women. In this quasi experimental study, 82 participants met criteria for depression based on a Beck Depression Inventory. 41 women participated in aerobic exercise program. These sessions lasted 3 hours a week for 4 weeks. Control group (n = 41) did not participate in any exercise activity. The results revealed significant improvement in depression (P < 0.05) compared with the witness group and before exercises so as to regarding Beck Depression Inventory (II), it was changed from mediocre to mild in control group and steady in witness group. Four weeks aerobic exercises can effectively reduce depression in women, and be used as a method of treatment in occupational therapy

The purpose of the present study was to depict the condition of chronic schizophrenic patients and their carers after discharge regarding functions and quality of life of patients as well as carers burden. To this end a series of questionairs including family experiences interview scale (FEIS), Morningside rehabilitation status scale (MRSS) and Wisconsin quality of life (WQL) were administered on 260 schizophrenic palients and 261 carers. Finding revealed that tensions (70%) and negative emotions (94%) were prevalent in the majority of the carers. The function of caring for the ill member of the family had intrupted the routine life of most carers, more than half of the patients were moderately dependent on others, they were redundent/jobless and had limited social interactions. As for avocation 72% of patients, listened to radio or audio cassettes and did walking. Over half of the patients experienced difficulties for conducting their different functions. This group have perceived their mental health status at undesirable level. However, the patients were content with their quality of life except for inadequate recreation and feeling lonely. These findings imply the necessity for the provision of psycho-social services for patients and their carers. An emphasized component of such programme should include teaching the nature of illness as well as life skills to both groups.