فهرست مطالب maryam tabatabaee

 In many developing countries, most patients referred for hospitalization for high suicide risk are deprived of adequate care, mainly because of limited psychiatric facilities.

 We aimed to investigate the short-term outcomes of an outpatient psychiatric crisis intervention (PCI) service enhanced with case management for patients with suicide risk where hospital admission was impossible because of the bed shortage.

 We developed a service model provided by a team of psychiatry residents, psychologists, and social workers supervised by a faculty psychiatrist. We piloted it in Roozbeh Psychiatry Hospital for patients when hospitalization was indicated for suicidality, but admission was not possible due to the bed shortage. This study followed an action research design and methodology. The sample was selected from individuals referred to Roozbeh Hospital. All subjects who fulfilled the inclusion criteria were included in the study. Convenience sampling was used for the satisfaction assessments.

 The PCI provided the service to 173 patients. The suicide risk was resolved in 48 (27.7%) patients. The remaining consisted of individuals finally hospitalized when beds were available (73 patients, 42.2%) or dropped out of the service (52 patients, 30.1%). Most patients (86%) were satisfied with the service. Only one non-lethal suicide attempt was reported in the two-month follow-up.

 An outpatient crisis service for suicidality enhanced with case management may reduce the need for hospitalization. However, randomized controlled studies are needed to establish its effectiveness.

Despite effective treatments are available for depressive disorders, less than half of patients utilize them and the treatment gap is large.

This study aimed to investigate factors associated with adherence to follow-up in patients diagnosed with a depressive disorder in the collaborative care program in Tehran between May 2017 to October 2017.

A retrospective cross-sectional study was performed in three community mental health centers (CMHCs) in Tehran.

A total of 435 cases were recruited, and their adherence to follow-up rate was 41.6%. According to multivariate regression, being visited in a particular center, having a high school or higher level of education, having a positive family history with effective treatment, taking selective serotonin reuptake inhibitors (SSRIs), experiencing a lower level of perceived mental health before the first visit, and referral to a psychiatrist could predict adherence to follow-up. Patients who had a chief complaint of typical depressive symptoms and those who were employed were less likely to be adherent to follow-up.

More population-based studies in various settings and cultures are needed to enhance our knowledge regarding interventions necessary to deliver quality care to depressed patients.

Follicular fluid (FF) plays a key role in preparing a microenvironment for the development and fertilization of oocytes. Moreover, biochemical and hormonal changes in the FF surrounding the oocyte can affect its quality and successful fertilization. The present study was conducted to investigate the relationship of beta human chorionic gonadotropin (beta-HCG) and anti-mullerian hormone (AMH) levels of FF with oocyte maturation in in-vitro fertilization (IVF) cycles.

FF was monitored in 30 women under a controlled ovarian stimulation cycle. Oocyte maturation was examined by an embryologist. Beta-HCG and AMH levels were then investigated in the FF containing metaphase I (MI), metaphase II (MII) and germinal vesicle (GV) oocytes using ELISA. To evaluate clinical pregnancy, serum levels of beta-HCG were measured 14 days after transfering the embryo. Identifying fetal heart rate (FHR) was considered clinical pregnancy.

No significant differences were observed in the mean betal-HCG levels between the mature (53.73±21.081 IU/ml) and immature oocytes (52.90±21.000 IU/ml) (P=0.8). Beta-HCG levels of the FF containing the MII oocytes (64.73±14.49 IU/ml) were significantly related to clinical pregnancy (P=0.04). Oocyte maturation and clinical pregnancy were also found not to be significantly related to AMH levels of FF.

The present study found oocyte maturation not to be significantly associated with the beta-HCG and AMH levels of FF. Beta-HCG levels of FF were also found to be associated with clinical pregnancy. The other constituents of FF along with AMH and beta-HCG might have therefore affected the oocyte quality and maturation.

There are evidence-based practices in the field of family and patient psychoeducation for patients suffering from severe mental disorders. However, given the variation in resources and cultural contexts, implementation of these services, especially in low- and middle-income countries is faced with challenges. This study aimed to review articles on family and patient psychoeducation of severe mental disorders in Iran and to find the characteristics of the main components necessary for the implementation of such practices in clinical settings. All published studies on family and patient psychoeducation for severe mental disorders (schizophrenia, schizoaffective, and bipolar disorder) conducted in Iran were searched up to May 2018; and key features and findings of each study were extracted and presented. Forty-eight studies were included in this review, of which 27 were randomized controlled trials, and 20 were quasi-experimental. One study was an implementation and service development report. The main findings of these studies were a significant decrease in relapse rate and/or rehospitalization rate and a significant decrease of burden and distress of families. Despite a wide diversity in approaches, this review showed that different psychosocial interventions in which psychoeducation is one of their core and main components have promising results, demonstrating the significance of this intervention in Iranian mental health research. In our opinion, based on evidence, even with limited resources, it is no longer acceptable to deprioritize some forms of psychoeducation for patients and their families in clinical settings.

Cognitive impairment is a chronic and disabling manifestation of schizophrenia.
This before-after study was conducted to examine the effect of a short course computer-assisted cognitive remediation on improving cognitive functions of patients with schizophrenia.
Twenty patients with schizophrenia were enrolled into the study. The intervention consisted of 10 one-hour sessions held 2-3 times a week, using the Cogpack software that includes tasks to improve attention, memory, and executive function. The patients’ cognitive functioning was assessed before and after the remediation, using tests in the CANTAB battery, including stop signal task (SST) and choice reaction time (CRT) to assess attention levels, pattern recognition memory (PRM) and Paired associate learning (PAL) to examine memory, and stocking of Cambridge (SOC) and intra-extra dimensional task (IED) to evaluate executive function.
IED and SOC revealed a statistically significant improvement in executive function after the intervention. PAL revealed a significant improvement in memory functioning in most aspects after the intervention, while PRM did not. CRT showed a significant improvement in some aspects of attention and concentration after the intervention, while SST did not.
This before-after study revealed that a relatively short course of a computer-assisted cognitive remediation can be applied to improve several aspects of cognitive functioning in patients with schizophrenia. A randomized controlled trial is required to establish the effectiveness of the intervention.

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.

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.

The aim of this study was to evaluate the efficacy of a new psychiatry clerkship curriculum which was designed to improve the knowledge and skills of medical students of Tehran University of Medical Sciences (TUMS), Iran. This quasi-experimental study was conducted in two consecutive semesters from February 2009 to January 2010. In total, 167 medical students participated in the study. In the first semester, as the control group, the clerks’ training was based on the traditional curriculum. In the next semester, we constructed and applied a new curriculum based on the SPICES model (student-centered, problem-based, integrated, community-based, elective and systematic).At the end of the clerkship, the students were given two exams: Multiple Choice Questions (MCQ) to assess their knowledge, and Objective Structured Clinical Examination (OSCE) to assess their skills. Baseline data and test performance for each student were analyzed. Compared to the control group, students in the intervention group showed significantly higher OSCE scores (P= 0.01). With respect to MCQ score, no significant difference was found between the two groups. The results suggest that the revised curriculum is more effective than the traditional one in improving the required clinical skills in medical students during their psychiatry clerkship.

The aim of this study was to evaluate the clinical characteristics and diagnostic stability of children and adolescents with bipolar disorder.

In this prospective study, 257 subjects with bipolar disorder who were consecutively admitted to Roozbeh Hospital (Tehran, Iran) were enrolled. Demographic characteristics, diagnosis, treatment, comorbid disorders and mood and psychotic symptoms were extracted from the patients’ admission files and the information questionnaire, which had been filled in the admission time by the patients. In the further assessment, diagnostic evaluation was done using the Schedule for Affective Disorders and Schizophrenia for School-aged children present and lifetime version (K-SADS-PL), for the patients under 18, and the Schedule for Affective Disorders and Schizophrenia (SADS) for the patients older than 18. Severity of the symptoms in the acute phase of mood disorder was evaluated by the Young Mania Rating Scale (Y-MRS) in manic phase and Beck Depression Inventory (BDI) for patients older than 16 or Children Depression Inventory (CDI) for the patients under 16 in depressive phase. Also, current and past levels of functioning were evaluated by the Global Assessment of Functioning (GAF) scale for patients older than 18 and the Child Global Assessment Scale (CGAS) for the patients under 18.

The most common symptom, irritability, was accompanied by elated mood in most cases. 73.2% of the patients had at least one comorbid disorder and the most common comorbid disorder was Attention Deficit Hyperactivity Disorder (44.2%). Diagnostic stability in all periods of illness was higher than 80%.

This study supports the high diagnostic stability of bipolar disorder in both children and adolescents.

The lithium concentration in the plasma is assumed to give someindication as to the concentration of this ion in different organ cells especially incentral nervous system. While the practical value of intracellular lithium measurement is controversial however, erythrocytes have proved to be useful for studying lithium concentration and its transport across the membrane. There are some reports suggesting that neuroleptic drugs are able to affect the erythrocyte lithium concentration (ELCs), although these studies have yielded inconsistent results. In the present study the effect of risperidone and olanzapine as atypical antipsychotic and haloperidol as standard typical antipsychotic on lithium ratio in 46 acute manic patients was studied. ELCs were measured using atomic absorption spectrophotometer. Clinical response was evaluated by using Young mania rating scale (YMRS). No significant difference was found between LRs and dose or type of antipsychotics. Also there were no significant differences between LRs and clinical response or remission. The concurrent use of an atypical antipsychotics and lithium may not significantly alter the lithium transport in the erythrocyte and presumably in the nerve cells. A more comprehensive study is warranted to confirm the results of this study