Iranian Journal of Psychiatry and Behavioral Sciences
Volume:15 Issue: 3, Sep 2021

 Attention-deficit/hyperactivity disorder (ADHD) is characterized by behavioral and neurodevelopmental problems. It is estimated that 3 - 7% of children and adolescents suffer from this problem. Apart from synthetic drugs, other effective types of medication like herbal medicines are of great importance.

 This study aimed to evaluate the effectiveness of methylphenidate (MPH) and its combination with Crocus sativus (saffron) in the treatment of children suffering from ADHD.

 The sample included 70 children aged between 6 and 16 years who had been diagnosed with ADHD. The patients were randomly assigned into two equal groups (n = 35 in each group). While both groups received 20 or 30 mg/d of MPH (20 and 30 mg/d for < 30 and > 30, respectively), one of them also received 20 or 30 mg/d of saffron in a capsule based on BMI (20 and 30 mg/d for < 30 and > 30, respectively). To collect data, parents and teachers completed Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV). Also, for analyzing the data, the repeated measures analysis of variance (RMANOVA) was used.

 The results of general linear model (GLM) repeated measures indicated that in both groups, the patients had less symptoms after eight weeks of treatment. However, after four weeks, the average score assigned by the parents and teachers in the MPH with saffron group was lower than the average total score in the MPH group (P < 0.05).

 Using MPH combined with saffron proved to be more effective in the treatment of patients suffering from ADHD compared to separate treatments. It seems that the duration of therapy can be reduced and the effectiveness be improved by prescribing proposed combined treatment.

 Awareness of people’s motivations for committing high-risk behaviors helps to explain the underlying causes and provides a framework for their use in preventive and therapeutic interventions.

 This study aimed to evaluate the predictive model of high-risk behaviors in adolescents based on their motivations.

 The present research has a correlational design and uses structural equation modeling. The sample included 450 male students selected through a convenience sampling method to complete the Iranian Adolescents’ Risk-taking and Motives for Risk-taking scale. Data were analyzed using structural equation modeling.

 The results showed that thrill-seeking, calculation, audience control, irresponsibility, and hedonistic motivation had significant relationships with high-risk behaviors. Also, except for attention-seeking, other motivations could significantly contribute to the prediction of high-risk behaviors. Also, the motivations had the strongest impact on alcohol consumption and the minimum impact on smoking. Finally, motivations generally explained 44% of the high-risk behaviors variance.

 Considering the role of motivations in doing high-risk behaviors, more attention should be given to these factors in preventive and therapeutic interventions.

 The COVID-19 pandemic as a stressor can harm the community's mental health. Iran is one of the first countries to be severely affected by COVID-19 since February 2020.

 This study aimed to assess the rates of COVID-19-related Posttraumatic Stress Symptoms (PTSS) and the general mental health burden among the Iranian population during the pandemic and to explore the potential influencing factors.

 Through a web-based cross-sectional survey, based on social media, data were collected from self-selected volunteers using a demographic information form, General Health Questionnaire-28 (GHQ-28), and Impact of Event Scale-Revised (IES-R).

 Among 1,910 analyzed respondents, the overall prevalence of COVID-19-related PTSS and general mental health burden was 62.4 and 43.6%, respectively. Regarding mental health, the burden was greater in the social and anxiety dimensions than in the physical and depression dimensions. The prevalence of PTSS was higher in women, younger age groups, divorced/widowed individuals, people with a history of psychiatric disorders, and those who had experienced other stressful events in the last year (P-values < 0.05). Multivariable logistic regression showed that a positive history of other stressful events and the GHQ-28 score were the potential influencing factors associated with PTSS (AOR = 2.468 and 6.007, respectively; P-values < 0.001).

 The study identified a significant mental health burden and PTSS among Iranians during the COVID-19 pandemic. Continuous assessment and monitoring of the psychological consequences of pandemics should be considered in Iran and other countries.

 The birth and hospitalization of a premature infant in the neonatal intensive care unit (NICU) can cause mood swings in mothers. Improving these mothers’ moods and reducing their stress is a care priority, which can be achieved by applying some innovative = strategies like using positive touch.

 The purpose of the present study was to investigate the effect of positive touch on mood states of mothers of premature infants hospitalized in the NICU.

 The present randomized clinical trial was conducted on 80 mothers whose premature infants were hospitalized in the NICU of two hospitals in northern Iran in 2018. The participants were divided into two equal groups (n = 40) of experimental and control. All participants received a Profile of Mood States (POMS) questionnaire both at the time of admission and discharge. The experimental group received positive touch from the beginning of admission to the NICU until the time of discharge, while the control group only received the routine care.

 The mean and standard deviation of mothers’ mood scores before the intervention (74.35 ± 36.27) were significantly higher compared to after the intervention (48.63 ± 16.02) (P = 0.001). Moreover, the mean and standard deviation for the sub-components were as follows: (1) tension before intervention (13.6 ± 7.49) vs. after intervention (7.45 ± 4.107) (P < 0.001); (2) depression before intervention (15.73 ± 13.11) vs. after intervention (7.5 ± 8.85) (P < 0.001); (3) fatigue before intervention (7.5 ± 6.47) vs. after intervention (3.95 ± 2.88) (P < 0.001); (4) confusion before intervention (9.63 ± 4.65) vs. after intervention (6.73 ± 2.42) (P < 0.001); (5) anger before intervention (12.97 ± 9.58) vs. after intervention (6.07 ± 4.42) (P < 0.001); and (6) vigor before intervention (14.93 ± 4.59) vs. after intervention (16.93 ± 3.21) (P = 0.001). As the figures show, there were significant differences in all of the sub-components before and after the intervention.

 It is recommended that mothers be given more opportunities in the NICU to employ positive touch and establish a closer interaction with their infants.

 Obsessive-compulsive disorder (OCD) is one of the common psychiatric disorders among children and adolescents that can be created by both genetic and environmental factors.

 The present study aimed to evaluate the frequency of OCD and its patterns in families with OCD children.

 In this cross-sectional study, 95 children and adolescents with OCD who were referred to the Psychology Clinic of Rafsanjan, Iran, in 2016 were enrolled by a convenience sampling method. The research tool was an obsessive-compulsive questionnaire (children form), and interviews were also carried out with the patients to find the deterioration of the symptoms in them and/or their families. Data were presented and analyzed by mean ± SD, frequency, and Chi-square test. The level of significance was 0.05.

 The highest frequency of OCD patterns was washing, Checking, and doubt. 36.7% of fathers and 56.1% of mothers had one of obsessive-compulsive disorder patterns. Meanwhile, the most common pattern observed in the parents was cleaning. In total, 79.6% of the paternal families and 87.7% of the maternal families of the patients had OCD. Moreover, a significant relationship was observed in the levels of OCD between children and mothers (P = 0.027), whereas no significant association was detected between the OCD of children and that of their parents.

 Family history (especially maternal family) plays a significant role in OCD development, which is indicative of the transmission pattern of multifactorial traits, while the heritability of OCD is still not determined.
 

 Teachers are regarded to have a key role in the diagnosis, referral, implementation, and follow-up interventions and treatment of children with attention-deficit/hyperactivity disorder (ADHD).

 The current study aimed to investigate the teachers’ knowledge, attitude, and function related to ADHD and evaluate the effectiveness of a training program in this regard.

 This quasi-experimental study was conducted on teachers in the elementary schools of Gorgan, Iran, in 2014. A total of six one-day workshops were held. In each workshop, 24 teachers were trained about ADHD for 4 h. Teachers’ knowledge, attitude, and function were assessed before, immediately after the workshops, and 2 weeks later. The data were analyzed using the analysis of variance (ANOVA), repeated-measures ANOVA, and Bonferroni post-hoc test.

 The results revealed that older (P < 0.05) and more experienced teachers (P < 0.05), those working at public schools (P < 0.001), and teachers without higher education (P < 0.05) had significantly lower levels of knowledge and less positive attitude toward children with ADHD. In addition, differences between the mean scores before and after the intervention for knowledge (P < 0.001) and attitude (P < 0.001) were statistically significant.

 Training teachers could improve the teachers’ knowledge and attitude toward ADHD. Workshop education appears to be an effective and efficient training method that can decrease the awareness gap between teachers with different experiences and education levels.

 Improvement of the quality of life of people with developmental disorders and their full integration within society requires comprehensive mental, intellectual, and physical rehabilitation. To achieve a favorable outcome, rehabilitation should be delivered in a continuous manner and with small attrition. Research in this area is scarce.

 The current study aimed to determine the incidence of dropout from rehabilitation and its associated factors in children with developmental disorders.

 In this prospective study, we recruited 225 children with developmental disorders and their parent (s) seeking rehabilitation services for the first time. They attended different centers in all regions of Tehran during 2016 - 2017. We completed a checklist using semi-structured interviews. The follow-up was performed every three months for at least six months to record the dropout from rehabilitation and the associated factors. Data analysis included the chi-square test and logistic regression.

 The dropout rate was found to be 10.9% within three months and reached a total of 19.3% in six months. It was significantly associated with the following factors after eliminating confounding effects: (1) poor family satisfaction with the centers in three-month analysis (OR = 10.76; CI: 2.764 - 41.906, P = 0.001) and after six months (OR = 4.51; CI: 1.30 - 15.67, P < 0.02); (2) the type of service sectors (public and charity vs. private) (OR = 7.12; CI: 2.12 - 23.93, P = 0.002); (3) moderate severity of the developmental disorder in three-month analysis (OR = 4.55; CI: 1.24 - 16.78, P < 0.03); (4) child's perceived “lack of cooperation” in attending rehabilitation sessions in six months (OR = 6.79; CI: 1.42 - 32.53, P < 0.02); and (5) the type of developmental disability (specific learning disorder vs. others) in six months (OR = 6.68; CI: 2.85 - 15.65, P < 0.001). In the open questions, the high cost of services was stated as the most important reason for dropout.

 Our findings indicate that dropout was associated with family dissatisfaction with the low quality of services, mainly in the public and charity centers. Children with disabilities of moderate severity were most likely to drop out from rehabilitation. Specific learning disorders seem to be the most challenging type of disability that leads to the highest dropout rates. The findings provide opportunities for further research in this area and to gain more information to render rehabilitation services more efficiently.

 Individual factors that can lead to psychological disorders, including early maladaptive schemas, sexual self-esteem, and anxiety, and their impact on the female orgasmic disorder (FOD), has not yet been thoroughly examined.

 The purpose of this study was to compare these factors in women with FOD to those without the condition.

 This descriptive research was causal-comparative or ex post facto study, and the statistical population was two groups of married women aged 18 to 40 years. Out of 152 women who participated, 66 cases had FOD, and 86 cases had no FOD according to the cut-off scores of the Female Sexual Function Index questionnaire and based on the DSM5 criteria. The Young Early Maladaptive Schema questionnaire (YEMSQ) (1995), Zeanah and Schwarz’s Sexual Self-esteem Inventory for Women (SSEI-W) (1996), and the Beck Anxiety inventory (BAI) (1988) were filled out by all the participants. An independent t-test at a significance level of P < 0.05 was applied to analyze the data using SPSS 24.

 The results indicated that the mean scores of women with FOD were significantly higher in all schema areas than the mean scores of women without FOD (P < 0.001), and the mean scores of women without FOD were significantly higher on the sexual self-esteem scale and all its sub-scales than those with FOD (P < 0.001). Also, the mean anxiety scores of women with FOD were significantly higher than the mean scores of women without FOD (P < 0.001).

 These results support the differences in individual psychological factors among women with FOD and those without and can be used for education, prevention, evaluation, and treatment of orgasmic disorders.

 While organ transplantation is a common surgical procedure worldwide, it is yet well-examined how the recipients of newly-transplanted organs adapt and accept a new organ from another body. Adaptation and acceptance of a vital organ from another person is a complex phenomenon, and medical staff needs to delve into this issue to provide appropriate care.

 The present study aimed to explore the transplant recipients' experiences of adaptation to the transplanted organ.

 A qualitative research design with a hermeneutic phenomenological approach was adopted in this study. In-depth unstructured interviews were conducted by one of the authors (Z. S.) in different locations across Iran. The purposive sampling method was used to select 20 transplant recipients (n = 4 kidney transplantation; n = 10 heart transplantation; n = 4 liver transplantations; and n= 2 blood transfusion).

 The constitutive pattern emerged from the data was ‘Psychological adaptation to transplanted organ’, with three themes (namely ‘Alien organ,’ ‘Ensure of being the patch of togetherness,’ and ‘Durability of new organ in body’) and several sub-themes.

 According to the organ recipients' experiences, it takes time for the recipients to accept another person's organ as their own. The transplant team members need to openly and proactively discuss the many psychological and spiritual issues to which the newly-transplanted organ recipients are exposed to facilitate the adaptation and acceptance of the new organs.

 With the outbreak of the Coronavirus, many restrictions are imposed on the processes of a funeral procession, funeral ablution, burial, mass mourning, and the memorial gathering of the family, relatives, friends, and neighbors.

 Given the lack of research on the mourning experiences of families of the dead infected with coronavirus, the present study was to fill this gap in the literature.

 In this qualitative study, some semi-structured individual interviews were carried out in the Bu Ali Sina Medical Educational Center, Sari, Iran, with 16 individuals of the families of the dead with coronavirus, who were selected using the purposive sampling method. The interviews were recorded, transcribed, encoded, and categorized, and the data analysis was performed using Graneheim and Lundman’s qualitative approach. Guba and Lincoln’s criteria were also adopted to ensure the data reliability and validity.

 Four main themes (namely psychological, behavioral, and physical reactions, virtual mourning, regretful mourning, and feelings of rejection and fear) and twelve subthemes were extracted from the collected data.

 According to the research results, COVID-19 changed the personal and social lives of the families with dead infected with Coronavirus from different perspectives. In this regard, providing support to families during the mourning period would help them better adjust with such changes causing the loss of a family member.
 

 Electroconvulsive therapy (ECT) is an effective strategy in the treatment of mood disorders; however, it is associated with some cognitive complications.

 This study aimed to evaluate the efficacy of donepezil as an acetylcholinesterase inhibitor in improving cognitive impairment induced by ECT in mood disorder patients.

 Ninety-six mood disorder patients were randomly assigned to the donepezil (5mg/day) or placebo groups. The Persian versions of the Mini-Mental Status examination (MMSE) and Addenbrooke’s Cognitive Examination Revised (ACE-R) were used to evaluate cognitive performance before the first ECT session, after the fourth ECT session, and four weeks after the last ECT session.

 The mean scores of MMSE and ACE-R revealed significant improvement in the donepezil group over time (P < 0.001). All ACE-R subscales increased significantly following the intervention implementation in the donepezil group (P < 0.001). Furthermore, the donepezil group reported no remarkable complications and completed the study.

 Donepezil co-administration with ECT may improve the ECT-induced cognitive disturbances.

 University students' attitude and desire to use stimulants and hallucinogens are mainly aroused as a result of their ignorance or lack of knowledge.

 The present study was to evaluate the knowledge, attitude, and performance of medical students in Ilam regarding the use of stimulants.

 This cross-sectional study encompassed 451 students from the Ilam University of Medical Sciences in 2019. The demographic information questionnaire, Addiction Susceptibility Questionnaire (ASQ), and Questionnaire of Knowledge, Attitude, and Behavior were used to collect the required data. Moreover, there were reports of mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. Chi-square, ANOVA, and independent-samples t-tests were used to examine the relationship among the research variables.

 A majority of students were undergraduates (> 60%), and about 33% of the participants were medical students. About 8% of the participants reported the lifetime use of stimulants. Moreover, 40% of students had insufficient knowledge, and the participants’ mean score of attitude was 16. There was a significant relationship between students' knowledge with their age, marital status, faculty, and level of education. Moreover, there was a significant relationship between the participants’ performance with age, level of education, and faculty. A significant relationship was also detected between the students’ attitude with their faculty and level of education.

 The medical students’ knowledge level was not satisfactory. Accordingly, training sessions and counseling programs are recommended to increase their knowledge and improve their attitudes.
 

 Social-cognitive theorists suggest that cognitive-emotional factors play essential roles in academic outputs like academic engagement.

 The purpose of the present study was to investigate the relationship between social achievement goals and academic engagement by mediating role of academic and social positive emotions.

 The method of present study was descriptive cross-sectional study based on correlational research. Using cluster multi-stage sampling method, this study included 566 undergraduate students (278 male and 288 female) in the first semester of 2018. The research instruments were Social Achievement Goals scale, Academic Hope scale, Admiration scale, and Academic Engagement inventory. Data were analyzed using correlation matrix and structural equation modeling.

 Results of analyzing data showed that social development goal had a positive indirect effect (β = 0.41, P = 0.01) on academic engagement through academic hope and admiration. Also, social demonstration-approach goal had an indirect and negative effect (β = -0.08, P = 0.01) on academic engagement by the mediating role of admiration. Finally, the research model was able to explain 31% of the variance of academic engagement with two latent variables of social achievement goals and academic and social positive emotions.

 In general, social achievement goals and positive emotions significantly explained the variance of academic engagement. The findings provide supportive evidence for how motivations and emotions can affect academic engagement.
 

 High-risk behaviors of adolescents and failure to correct their insights and attitudes can have many negative consequences.

 The purpose of this study was to determine the effect of life skills training on adolescents’ tendency to engage in high-risk behaviors.

 The present study was a randomized controlled clinical trial, in which 100 high school students from both sexes were selected via the multistage cluster random sampling method and divided into the intervention (n = 50) and control (n = 50) groups using the block randomization method with a block size of 4. Eight life skills training group discussion sessions of 45 minutes weekly were held for the intervention groups for two months, and a one-hour follow-up session was held 20 days after the end of the eight sessions. The study instruments included a demographic questionnaire and the Iranian adolescents’ risk-taking scale. After confirming the validity and reliability of the instruments and obtaining written informed consent of the participants, they were asked to fill out the questionnaires. Using SPSS 18, the data were analyzed by standard deviations for quantitative variables and percentages for qualitative data, as well as chi-squared test, the independent t-test, and repeated-measures analysis of variance, the results being reported at a significance level of 0.05.

 The results showed that life skills training led to significant decreases in the mean scores of high-risk behaviors, including drug abuse, alcohol consumption, smoking, and violence, at different times in the intervention group in both sexes (P < 0.05), while no significant changes were observed in the control group.

 The results showed that life skills training can reduce adolescents’ tendency to engage in high-risk behaviors.
 

 The obesity crisis is one of the major public health issues in the 21st century, and depression, anxiety, and stress are the psychological factors that mediate obesity.

 This research was conducted to evaluate the effectiveness of Internet-based cognitive-behavioral therapy (ICBT) in reducing body mass index (BMI), stress, anxiety, and depression in overweight women via a virtual group.

 This randomized controlled trial study was conducted on three groups of the experiment, the waiting list, and the treatment-as-usual. It was done as single-phase, single-center, and double-blinded. The statistical population included all women with BMI ≥ 25 in Neyshabur city in 2019 - 2020. The research sample included 90 subjects randomly assigned to the groups. The therapeutic intervention was applied in the form of 42 ICBT sessions using a virtual WhatsApp group. The participants completed the Depression Anxiety Stress Scale (DASS), and their BMI was also calculated before and after the sessions.

 The analysis of covariance indicated the significant effect of ICBT on the reduction of BMI compared to the usual treatment group and waiting list group [F (72, 2) = 15.54, P < 0.0005; Partialη2 = 0.30]. However, it was not significant on the reduction of stress [F (72, 2) = 0.47, P = 0.63; Partialη2 = 0.01], anxiety [F (72, 2) = 0.49, P = 0.61; Partialη2 = 0.01], and depression [F (72, 2) = 0.06, P = 0.93; Partialη2 = 0.002].

 The present study showed the direct effect of ICBT on the reduction of BMI like the treatment-as-usual for obesity. However, these sessions could not reduce the participants’ stress, anxiety, and depression.

 Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder worldwide. Inadequate response of OCD patients to a usual agent makes this disorder a great challenge, and recent studies have recommended augmentation therapy as a new choice.

 As traces of noradrenergic dysfunction have been noted in OCD pathophysiology, the current study aimed to assess the efficacy of clonidine augmentation therapy for treating OCD.

 This was a randomized clinical trial conducted on 57 OCD patients divided into the two groups of 1-mg clonidine augmentation therapy (n = 28) and placebo group (n = 29). The medication was administered for 12 weeks. Patients’ primary treatment, including SSRIs or clomipramine, continued by receiving the same dose used before participation in this study. The Yale-Brown Obsessive-Compulsive scale (Y-BOCS) and Clinical Global Impression-Severity scale (CGI-S) were used to assess the patients at the start of the study and then at four-week intervals. Drug-related adverse effects and global improvement were assessed and compared between the two groups.

 The initial CGI scores were 3.89 ± 1.57 and 4.10 ± 1.61 at the baseline and 2.29 ± 1.18 and 3.07 ± 1.51 at the end of the study in the intervention and control groups, respectively. Both groups revealed a significant improvement (P-value = 0.001) with no significant difference between them (P-value = 0.22). The primary Y-BOCS score in the clonidine-treated group was 27.61 ± 8.08 versus 28.69 ± 7.44 in the control group at the baseline, which declined to 20.25 ± 6.08 versus 25.45 ± 7.35 at the end of the study, respectively. Both groups revealed a significant improvement (P-value = 0.001), but there was no statistically significant difference between them (P-value = 0.06). Drug-related complications were not statistically different between the two groups (P-value > 0.05); however, the clonidine-treated patients presented more adverse effects than control subjects.

 Although the use of clonidine posed no remarkable drug-related adverse effects, it was not superior to placebo considering symptom relief.

 The prevalence of diabetes is on the rise, and the lack of regular self-care activities can exacerbate this disease. Therefore, finding effective and short-term treatments is needed for these patients.

 The purpose of this study was to investigate the effectiveness of acceptance-based emotion regulation group therapy in controlling diabetes in patients with type 2 diabetes.

 This experimental study included the three stages of pre-test, post-test, and six-month after follow-up, as well as a control group. The statistical sample consisted of 33 patients with type 2 diabetes referred to the Iranian Diabetes Association, of whom 16 patients were allocated to the intervention group and 17 to the control group. The study was conducted in Tehran in 2019 - 2020. Acceptance-based emotion regulation group therapy lasted 14 weeks, during which some aspects of acceptance and commitment therapy, dialectical therapy, and emotion-focused treatment were combined and provided to the patients. The questionnaires used were the Summary of Diabetes Self-care activities (SDSCA) and Diabetes Dependent Quality of Life scale. Also, a structured DSM-V clinical interview was performed, and glycosylated hemoglobin (HbA1c) was measured. To analyze the data, mixed design ANOVA was run in SPSS version 21.

 The findings revealed that the mean difference between pre-test and post-test in the experimental group was significant for the variables of HbA1c, quality of life, and self-care while the mean difference between the post-test and follow-up was not significant for HbA1c (P = 0.17) and quality of life (P = 0.27), indicating the stability of the therapeutic effect after six months of the intervention. Based on the present findings, acceptance-based emotion regulation group therapy led to a decrease in HbA1c and an increase in self-care and quality of life in patients with type 2 diabetes.

 Our results showed that acceptance-based emotion regulation group therapy improved self-care, quality of life, and HbA1c in type 2 diabetic patients, so it can be used as a complementary intervention along with medical treatments.
 

 Research indicates the increasing prevalence of high-risk behaviors among adolescents, which may have many causes.

 The present study aimed to investigate the relationship between spiritual well-being and other dimensions of well-being and the tendency for high-risk behaviors in adolescents, with an emphasis on the mediating role of personality traits.

 This is a descriptive and correlational study. The statistical population of the study consisted of all high school students in the second semester of the academic year 2018 - 2019 in the city of Tehran. Data collection tools were Spiritual, Psychological, Social, and Physical Well-being questionnaires, Iranian Adolescent Risk questionnaire, and PID-5 Personality Characteristics questionnaire-short version. SPSS V.22, R programming V.3.6, and AMOS V.24 were used to analyze the data.

 The results showed that there is a significant relationship between spiritual well-being and other aspects of well-being, i.e., physical health (r = 0.28), social well-being (r = 0.39), psychological well-being (r = 0.44), with P < 0.01 for all. There was also a significant negative relationship between spiritual well-being and components of high-risk behavior (r = 0.48, P < 0.01). In addition, personality traits were found to play a significant role as a mediating variable in the relationship between spiritual well-being and high-risk behaviors.

 Spiritual well-being is a factor affecting other aspects of well-being and reducing risky behaviors, and personality traits play an important role in mediating the relationship between spiritual well-being and other dimensions of well-being and high-risk behaviors.

According to the existing evidence, physical health in patients with mental disorders is poorer than in the general population. After a comprehensive literature review, we developed and implemented the first structured sports and exercise unit in a psychiatric hospital in Iran. After running workshops and supervision sessions for nurses and personal trainers, we provided a nutrition education program (NEP) alongside a combination of aerobic and resistance exercise three times a week. After unit development, we made several efforts to introduce the services to psychiatrists and residents by sending emails, holding a symposium, and notifications in hospital virtual channel. In about five months, 69 patients were introduced to sports and exercise specialists, 67 were included in exercise therapy, and three high-risk patients were excluded. The age range of participants was 19 - 50 years, and the mean age was 33.54 years. The total number of provided exercise therapy service was 533, and the mean of sessions was eight. The average duration of participation in the program was 24 days. Exercise therapy and lifestyle modification package for patients with mental illness should be integrated into a comprehensive treatment program. Starting this intervention during patients’ admission may lead to more engagement after discharge.

 Hyperhomocysteinemia is a risk factor for atherosclerosis and vascular disease, which is correlated with cerebral problems and various neurological disorders.

 We report a 20-year-old lady with a history of hyperhomocysteinemia affected with stroke, seizure, and mood disorder. By initiating medication for these illnesses, different complications appeared. During the hospital stay, drugs for treating a disease deteriorated the other. We encountered a complex patient and numerous ambiguities in her management.

 For patients with elevated serum homocysteine and psychiatry disorders, it is important to consider MTHFR gene mutation. A challenge in these patients is to select the medication that does not deteriorate hyperhomocysteinemia. In this complex case, we used carbamazepine that was accompanied by clinical improvement.