ali pourramzani

Electroconvulsive therapy (ECT) is widely accepted as a safe and effective treatment in psychiatric patients. Although succinylcholine is the choice of muscle relaxant in this process, its adverse effects and contraindications must be considered.

This study investigated the efficacy of cisatracurium as an alternative in ECT patients. 

This single-blind clinical trial was performed in an academic hospital in Northern Iran from July 2023 to March 2024. A total of 62 eligible ECT patients were enrolled in the survey and randomly divided into succinylcholine (0.5 mg/kg) and cisatracurium (0.1 mg/kg) groups. Seizure duration, mean arterial pressure, heart rate, the time to return to spontaneous breathing, and recovery time were recorded and compared between the two groups.

No significant difference was observed between the two groups regarding seizure duration and hemodynamic parameters (P>0.05). However, the time to return to spontaneous breathing (P=0.0001) and recovery time (P=0.0001) were significantly longer in the cisatracurium group. None of the patients was affected by serious adverse effects.

Cisatracurium is a safe alternative to succinylcholine and can be administrated during ECT.

During the COVID-19 epidemic, the mental status of nurses and other healthcare workers was strongly influenced by environmental conditions. 

This study aimed to determine the association between social support and resilience with the mediating role of self-efficacy in nurses working in public hospitals.

In this cross-sectional study, 220 nurses working in the educational and medical centers of Rasht City, Iran, in 2021 were recruited by simple random sampling. The general self-efficacy scale, multidimensional scale of perceived social support questionnaire, and Connor and Davidson resilience scale were used to collect data. The Pearson correlation coefficient test was used to investigate the linear relationship of the variables. To evaluate the fit of the proposed model, the chi-square test, degrees of freedom, goodness of fit index, Tucker-Lewis index, comparative fit index, and root mean square error of approximation were calculated. Bootstrap test was used to investigate the role of self-efficacy in the middle of social support and resilience and to assess the direct effects of variables.  

The results showed that 201 women (91.4%) and 19 men (8.6%), with a mean age of 36±8.43 years, participated in this study. Moreover, 25.5% and 74.5% of participants worked in COVID-19 or non-COVID-19 wards, respectively. Data analysis using the Bootstrap test showed that self-efficacy mediated between social support and resilience (P=0.001). Also, the study findings have shown that the direct effects of social support on resilience are significant, with a path coefficient of 0.203 (P=0.004), so when social support increases, resilience increases, too. Also, in this research, the direct path of self-efficacy on resilience was significant with a path coefficient of 0.595 (P=0.001), so when self-efficacy increases, resilience increases, too.

Findings of this study have shown that nurses’ self-efficacy serves as a mediator in the relationship between social support and productivity. Empirical evidence suggests that individuals who receive greater social support exhibit heightened levels of self-efficacy.

Since the condition of the skin affects mental health, skin manifestations such as acne vulgaris might result in some psychosocial distress, including depression, anxiety, and social isolation. This study aimed to investigate feelings of loneliness and suicidal thoughts in patients with acne vulgaris. In this cross-sectional study, 147 patients with acne vulgaris, who were referred to the skin clinics affiliated with Guilan University of Medical Sciences (Rasht, Iran) in 2020, were requested to complete the UCLA feelings of loneliness and the Beck Scale for Suicidal Ideation (BSSI) questionnaires. The patients’ demographical data and dermatological characteristics were recorded, and all data were analyzed using SPSS 21. P ≤ 0.05 was considered statistically significant. The mean age of the participants was 26.75 ± 8.65 years, with females accounting for 83%. About 7.5% and 3.4% of patients had feelings of loneliness and suicidal thoughts, respectively. Being single was significantly associated with increased UCLA and BSSI scores (P < 0.05). Unemployment and using isotretinoin were correlated with higher BSSI scores (P < 0.05). The area under the ROC curve for predicting active or passive suicidal tendencies, based on the BSSI questionnaire and using the UCLA score, was 0.842, and the cut-off point of the UCLA score was 39.5, with sensitivity and specificity of 90% and 68.6%, respectively. A significant positive correlation was observed between the two questionnaires (r = 0.407, P < 0.001). A significant association between acne vulgaris and an increased risk of feelings of loneliness and suicidal thoughts demonstrated that dermatologists should consider the mental health status of these patients.

Evidence highlighted the high prevalence of some mental problems among individuals with psoriasis, including alexithymia and suicidal ideation. 

The present study aims to investigate the prevalence and comorbidity of alexithymia and suicidal ideation in individuals with psoriasis in Iran.

This cross-sectional study was conducted on 100 patients with psoriasis referred to Razi Dermatology Clinic and Beesat Clinic of hospitals affiliated to Guilan University of Medical Sciences, Rasht, Iran, in 2020. Psoriasis was diagnosed by a dermatologist, and the demographic and clinical characteristics of patients were recorded. The Toronto alexithymia scale (TAS-20) and the Beck scale for suicidal ideation (BSSI) were used to assess alexithymia and suicidal thoughts. 

The mean age of patients was 37.56±10.58 years, and 51% were female. Among patients, 52% had alexithymia, 23% were at high risk of suicide, and 6% were at very high risk of suicide. The moderate severity of psoriasis had a significant association with suicidal thoughts (P<0.05). The TAS-20 score had a significant association with the male gender and younger age, and the BSSI score had a significant association with the psoriasis area (P=0.003). The highest score of BSSI was seen in those with psoriasis in the face and limb/trunk (10±4.36 and 8.56±8.52, respectively).

Patients with psoriasis exhibit a significant prevalence of alexithymia and suicidal thoughts. Additionally, younger age and male gender were identified as factors associated with alexithymia in this population.

Electroshock therapy is an effective treatment method for patients who are resistant to drug treatment or need an emergence response.

The aim of this study was to investigate the mortality rate and complications caused by electroshock therapy in an academic hospital in Rasht.

In this retrospective descriptive study, the files of 23 patients who had complications from electroshock therapy in Rasht's Shafa Hospital between 2016 and 2021 were examined. Demographic information, cause of death and all complications that occurred from the time patient was admission to the time of discharge from the recovery ward were recorded. The collected data were analyzed using SPSS version 16 software and were analyzed using descriptive statistics of frequency, mean and standard deviation.

In this 5-year study, 24 patients had complications under electroshock therapy (0.15%) such as bradycardia, hypotension, and vomiting; also one case of mortality was recorded (0.006%). Of the complications, 19 cases (79.2%) were minor and 5 cases (20.8%) were major, and the highest rate of complications was in patients diagnosed with psychosis 8 cases (33.3%) and schizophrenia 5 cases (20.8%). There was no statistically significant relationship between gender, underlying disease and age with the occurrence of complications.

Considering the very low percentage of mortality and morbidity in this center, the interaction between the psychiatry and anesthesia group is appropriate and the care and monitoring of electroshock patients is acceptable. However, it is necessary to try to minimize these cases as much as possible

The risk of substance use is increasing among university students, especially medical students. This study aimed to investigate the frequency of smoking, alcohol consumption, and substance use and its relationship with general health indicators among the students of Guilan University of Medical Sciences (GUMS) in 2020. The differences in the frequency of substance use were also investigated from 2005.

This was a cross-sectional analytical study conducted on 406 students of GUMS, Iran, in 2020. The data were collected through three online questionnaires including a demographic questionnaire, the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the General Health Questionnaire (GHQ). The data were entered into SPSS software version 22 and analyzed using Chi-square, Fisher’s Exact tests, and logistic regression at a significance level of 0.05.

In this study, 53.9% of the participants were female, 46.1% were male, and 54.4% of them experienced using substances in their lifetime. The highest prevalence of use was in consumers of tobacco (46.8%), alcoholic beverages (34.7%), and cannabinoid compounds (19%). Besides, 48.5% of the participants were suspected of having some degree of psychiatric disorders, among which depression (11.6%) and anxiety (8.4%) were the most common. Moreover, substance use during students’ lifetime had a statistically significant association with anxiety, depression, and mental health.

The results of this study showed the prevalence of smoking, alcohol consumption, and substance use among the students of GUMS is worrying. The relationship between consumption and consumer’s health indicators highlights the necessity ofintervention and purposeful planning by policymakers in this field.

Based on research, acne vulgaris is associated with a high prevalence of attention deficit hyperactivity disorder (ADHD).

This study investigates the comorbidity of ADHD and acne vulgaris in individuals with acne vulgaris who were referred to the Razi Dermatology Specialist Clinic and Beesat Clinic of Guilan University of Medical Sciences, Rasht City, Iran, in 2021.

This case-control study includes 85 individuals with acne vulgaris and 85 without acne vulgaris. The Conners’ adult ADHD rating scales (CAARS) were used to evaluate ADHD symptoms. The study data were analyzed with SPSS software, version 24 at a significant level of <0.05.

The Mean±SD age of the study participants was 35.12±13.19 years, and 64.1% of them (n=109) were women. Of the total participants, 7.6% had ADHD, and the frequency of ADHD in individuals with acne vulgaris compared to controls was 8.2% vs 7.1%, and this difference was not significant (P=0.773). The frequency of ADHD and the mean score of ADHD in individuals with acne vulgaris were higher in those aged ≤30, women, and severe types of acne, but this difference between the two groups was not statistically significant (P>0.05).

Our findings showed no statistically significant difference between subjects with acne vulgaris and the control group in the score and frequency of ADHD. Also, we found no statistically significant difference in the score and the frequency of ADHD based on the severity of acne vulgaris.

 Breaking bad medical news is one of the most difficult tasks of physicians. In this regard, communication skills play a vital role.

 This study aimed to investigate patients’ preferences and attitudes toward receiving bad medical news in academic hospitals affiliated with Guilan University of Medical Sciences.

 This cross-sectional descriptive study was conducted on patients over 18 years of age from March 2021 to December 2021. A questionnaire taken from Alrukban’s study regarding patients’ demographic characteristics, preferences, and tendencies while receiving bad news was filled out through a face-to-face interview.

 In this study, 600 patients were interviewed, 96% of which preferred to know their disease diagnosis, 76.2% preferred to be the first person to receive bad news, and employed individuals with younger ages and higher levels of education significantly preferred to be the recipients of illness news. Furthermore, 40.7% of patients preferred not to be accompanied by anyone when receiving bad news, 82.3% preferred to be broken bad news by the head of the medical team, and 50.8%, particularly female, younger, and employed patients, preferred the physician to start the conversation containing some information about the disease. Also, younger female patients significantly preferred the physician to stay with them and provide additional information after presenting the diagnosis in a completely private space.

 Most patients preferred to know about their diagnosis. The impact of socio-demographical variables, including age, gender, level of education, and marital status, should be considered when breaking bad news.

Hoarding disorder (HD) has been classified as a mental disorder in the diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). This disorder might have some individual and social burden, and there has been limited data on the prevalence of HD in Iran.

The present study aimed to investigate the prevalence of HD and its relationship with the demographic characteristics in a nonclinical sample.

This was a descriptive cross-sectional study on people who accompanied patients visiting hospitals in Rasht City, Iran, from November 2021 to February 2022. The participants were evaluated with the demographic questionnaire and the saving inventory-revised (SI-R) for measuring hoarding-related experiences.

A total of 884 people with a Mean±SD of age 39.45±12.85 years participated in this study. About 3.2% of participants had HD. Their mean hoarding scores had a significant difference in terms of gender, level of education, and occupation (P<0.05). Still, the prevalence of HD had no statistically significant difference (P>0.05) in terms of age, gender, marital status, level of education, occupation, and place of residence.

Based on the present study, only 3.2% of participants suffered from HD. Although in terms of gender, level of education, and occupation, a significant difference was observed in hoarding scores, the prevalence of HD had no association with demographic characteristics.

Electroconvulsive therapy (ECT) is a vital treatment strategy for psychiatric patients, and cancellation of the procedure negatively impacts the recovery process. However, it may happen due to the lack of optimal conditions at admission.

This retrospective study occurred at Shafa Hospital, an academic center affiliated with the Guilan University of Medical Sciences (GUMS). The ECT anesthesia team developed an ECT patient preparation checklist, which was shared with psychiatrists. The rate and some related factors of case cancellation were compared between the two years before presenting the checklist, from May 2019 to May 2020, and the next year, from June 2020 to May 2021. The patients’ files were reviewed, and the required information was documented.

One hundred fifty-one cancellations were recorded during the two years of study, 82 cases in the first year and 69 in the second year. The most common reason for the cancellation was inadequate consultations followed by abnormal lab tests. In comparing the number of cancellations between the two years, before and after the checklist was provided, no significant difference was observed in terms of age (P = 0.288), gender (P = 0.24), psychiatric disorder (P = 0.399), and the number of ECT sessions (P = 0.36). However, the number of cancellations due to incomplete consultation significantly decreased after developing the checklist (P = 0.049), while unstable hemodynamics and changing patients’ conditions on an intended day also increased (P = 0.024). Residency visits did not significantly affect the number of cancellations over 2 years (P = 0.139).

This study concluded that preparing ECT patients according to the checklist led to better conditions and fewer cancellations. However, preventable causes still exist.

Breaking bad news is an unpleasant task for physicians, especially for patients with cancer. In this regard, the SPIKES protocol, which is prevalent in several countries, has not been discussed in Iran.

This study evaluated how the SPIKES protocol was followed by physicians. 

This descriptive cross-sectional study was conducted at Guilan academic hospitals from December 2021 to April 2022. Patients with cancer participated in the survey who were referred to the oncology academic centers for follow-ups or radiotherapy and chemotherapy. They were over 18 years old with the ability of proper communication. The SPIKES questionnaire consists of 12 questions with 6 subscales (settings, invitation, perception, knowledge, emotion, and strategy). It was filled out through a direct interview.

The data from 280 patients were analyzed. Everyone stated that at the time of receiving the diagnosis, the doctor was not in a hurry and made appropriate eye contact. About 61.1% believed they were emotionally supported, and 65.4% were satisfied with their final knowledge about the disease and treatment planning. Patients with older ages and lower levels of education were significantly more likely to state that physicians’ language was not comprehensive; physicians did not understand them, and the patients were not emotionally supported (P=0.0001).

This study showed that more attention should be paid to older patients with lower levels of education. They needed more time for conversation and simpler dialect. Some areas, such as “invitation” are required to be improved.

Resilience refers to a protective factor that reduces stress in people with multiple sclerosis (PwMS). Given the significance of this issue, the present research aimed to assess the validity and reliability of the Connor-Davidson Resilience Scale (CD-RISC) in PwMS.

The present cross-sectional study aimed to assess the psychometric properties of CD-RISC in the statistical population of Guilan MS Society (GMSS). In this study, 442 people with MS participated and responded to CD-RISC in an online survey. The data were analyzed in SPSS (version 23) and Amos (version 21) software packages.

The confirmatory factor analysis results of the first stage with five factors revealed that 25 CD-RISC items benefited from high factor load and good fit indices were reported (ꭕ2=605.55; df=265; P-Value=.0001; ꭕ2/df=2.28; GFI=.88; CFI=.93; TLI=.92; RMR=.06; RMSEA=.05); therefore, CD-RISC has good construct validity. Cronbach’s alpha coefficients for the whole scale and subscales were calculated at 0.94 and 0.71-0.89, respectively, indicating the optimal reliability of CD-RISC in PwMS.

The current study presented evidence for CD-RISC validity and reliability. Further studies are recommended to ensure the psychometric properties of this scale in other chronic patients.

Breaking Bad News (BBN) is a multidisciplinary and unpleasant task, and nurses play a vital role in this process as they are often exposed to such situations. It is a critical duty that has not been adequately addressed.

This study investigated the performance of nurses in academic hospitals affiliated with Guilan University of Medical Sciences (GUMS) regarding BBN.

During 2020, eligible nurses were interviewed, and a questionnaire containing 16 items about environmental and psychical support was filled out. The first 10 questions evaluated psychical support, and the next six assessed environmental support. Each question scored 10, "never," to 50, "always."

A total of 384 out of 410 nurses filled out the questionnaires, and a response rate of 93.65% was obtained. As shown, 346 (90.1%) responders were women, and 38 (9.9%) were men. Also, 289 (75.3%) had passed educational courses. A positive association was observed between psychical and environmental support and age (P = 0.007, P = 0.003) and years of experience (P = 0.013, P = 0.004). However, there was no significant difference respecting educational programs (P > 0.05).

This study revealed that the current educational programs are not practical and could not induce a significant difference in nurses’ answers. Effective interventions to improve nurses’ communication skills are strongly warranted.

 Perfectionism has positive and negative aspects that can have different academic or individual consequences for college students.

 This study aims to investigate the perfectionism in general medicine interns and the role of demographic factors.

 This cross-sectional study was conducted on 200 general medicine interns of Guilan University of Medical Sciences in 2021 who were selected using a convenience sampling method and completed a demographic form and the Frost Multidimensional Perfectionism Scale. Independent t-test and Mann-Whitney U test were used in SPSS v.19 software for data analysis.

 The participation rate was 84.5% (n=169). The maladaptive and adaptive perfectionism mean scores were 62.4±12.2 and 45.1±5.6, respectively. Students aged <25 years had higher scores in subscale of concern over mistakes (P=0.002). Male students had higher scores in parental expectations (P=0.002) and personal standards (P=0.044). Married students scored higher in parental expectations (P=0.031) and parental criticism (P=0.002) and lower scores in personal standards (P=0.002). Students with a history of physical illness had higher scores in personal standards (P=0.006) and lower scores in organization (P=0.045). In married students, more maladaptive perfectionism and less adaptive perfectionism were reported (P=0.018).

 Maladaptive perfectionism of general medicine interns is at moderate level while their adaptive perfectionism is at high level. Young age, gender and marital status affect their perfectionism.

This study aimed to determine prevalence of anxiety and depression and associated factors in the general population of Iran during the COVID-19 pandemic.

We conducted this web-based cross-sectional study on 5328 individuals in Iran between 17th and 29th of April 2020. Data were collected using the convenience sampling method through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected data on demographic variables, COVID-19-related variables, and symptoms of anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression.

The mean GAD-7 and PHQ-9 total scores were 7.17 (SD = 5.42) and 7.80 (SD = 6.68), respectively. Prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with female gender, being young and middle-aged, being unemployed or a housewife, having chronic diseases, spending considerable time thinking about COVID-19, having family members, friends, and/or relatives infected with COVID-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family.

Prevalence of anxiety and depression were considerably higher in the general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, the unemployed, and people with chronic disease.

 Adaptive narcissism is the presence of narcissistic personality traits in otherwise normal individuals. Considering the potential effects of narcissism on the medical profession.

 The aim of the present study was to investigate the prevalence of adaptive narcissism and its demographic correlations among a medical student population using self-assessment tools.

 Participants were selected through cluster sampling among students spending their internship in the Medical School of Guilan University of Medical Sciences in 2019 (N = 138). The 40-item Narcissistic Personality Inventory (NPI-40) was used to assess the prevalence of adaptive narcissism. Next, the demographic correlations of narcissism were studied.

 The prevalence of adaptive narcissism was 18.1%, with the NPI-40 mean score of 14.43. The self-sufficiency subscale of NPI-40 was correlated with the male gender (P = 0.01).

 Among medical interns, the whole constructs of adaptive narcissism are as high as found in a normal population and are not correlated with demographic characteristics of the given sample. The self-sufficiency subscale is positively correlated with the male gender.
 

The aim of this study was to examine the prevalence of restless legs syndrome amongst patients with inflammatory bowel disease.

Participants were 384 patients aged more than 18 years who had a history of admission with a diagnosis of inflammatory bowel disease (IBD) in the gastroenterology hospital in Guilan, Iran. The diagnosis of restless legs syndrome (RLS) was confirmed based on DSM-V, and its severity was identified using the International Restless Legs Scale (IRLS) questionnaire. The participants were assigned into two groups; patients with a history of IBD and RLS (n=61) and IBD without RLS (n=323). The prevalence of RLS, as well as demographic variables, have been analyzed between groups using the Chi-square test.

The prevalence of RLS was 15.9%. It was significantly higher in; women (P=0.042), primary/secondary, and high school graduates (p<0.0001), married (p =0.011), and retired (p =0.021) patients. The prevalence of RLS in patients affected with anemia was significantly more (p =0.043). Increasing age (OR=1.06) and the duration of IBD (OR=1.08) were associated with increased risk of RLS.

Our findings indicate RLS frequently happens in patients with IBD. As RLS can affect sleep quality, it should be considered as one of the causes of sleep disturbance in patients with IBD.

In Iran, inpatient group psychotherapy has been limited to transient practices for research purposes or fulfilling personal interest of therapists. The goal of this paper is to share and explain the experience of developing an inpatient group psychotherapy program in Roozbeh Psychiatric Hospital, Tehran, Iran. After theoretical delineation and preparation of a draft of the program guideline, two pilot sessions were held. Based on this initial experience a final treatment guideline was prepared. Afterwards, the program was continued for more than 1 year in a female ward at Roozbeh Psychiatric Hospital. The output of this exercise was a guideline that covers important topics in development of inpatient group psychotherapy. It is concluded that inpatient group psychotherapy has its unique challenges. Of the most important challenges that can be mentioned in this regard are the participation of patients with significant differences in levels of psychopathology and psychiatric signs and symptoms, and high comorbidity with specific personality traits or disorders. Other challenges relevant to the structure of the group include items such as very limited time for working through and inevitable out-of-group contacts.