ABSTRACT
Background: Addiction leads to numerous physical and mental problems for the addicted person and consequently major problems for the relatives
Objectives: The current study aimed at investigating the psychodynamic characteristics of females with addicted husbands in Kerman, Iran
Methods: In the current cross sectional study, 60 volunteer females with addicted husbands were compared with 60 wives of non-addict males. The thematic apperception [TAT] projective test along with the Ruben scoring system was used to evaluate the sample units. Data were collected from September 2015 to February 2016 and analyzed using t test and the Pearson chi-square test with SPSS software version 20
Results: The mean age of the case group was 32.6 +/- 2.4 years with more children, compared with the control group [P < 0.05]. The current study results showed a significant relationship between the groups regarding main conflict [P < 0.001], defence mechanism [immature defence P < 0.003 and neurotic defence P < 0.001], adequacy of superego [P < 0.001], feelings such as anger [P < 0.001] and guilt-frustration [P < 0.048], and unfavorable outcomes [P < 0.001]
Conclusions: Understanding and perception of the nature of addiction, how to deal with it, and cope with the addict bring a deep challenge to the personality characteristics of the addict's spouse. In consequence, such scenarios lead to conflicting communications among them and they turn to the frequent use of immature and neurotic defence mechanisms such as identification and cope with the problem in the interpersonal relationships. Identification of the characteristics of such females helps to employ better strategies to improve their quality of life
ABSTRACT
Drug non adherence is one of the major problems in treatment of psychiatric patients which could increase the risk of relapse and re-hospitalization. The aim of this study is to determine factors associated with drug non adherence by patients with mood disorders after their discharge from hospital and assessment of relation between drug attitude and drug adherence. In this cohort, prospective, and descriptive study, 150 patients with mood disorders [major depressive disorder, bipolar mood disorder] at the time of discharge were assessed. For each patient, demographic information form and Drug Attitude Inventory [DAI-10] [persian translation] was completed at the time of discharge. Then all of the patients were monitored monthly until 6 months through telephone. In every follow up DAI-10 and drug use inventory [which consists of causes of drug non adherence] were completed. Finally relation between different variables and patient drug attitude with drug adherence were assessed. From all studied variables such as demographic factors, diagnosis, treatment factors, and drug attitude, only drug attitude had a significant relation with drug adherence. Patients' attitude toward drugs has a major role in drug adherence
ABSTRACT
Cardiovascular operations are associated with an inherent bleeding tendency that sometimes leads to severe bleeding and transfusion requirement. Pharmacological intervention to minimize post-bypass bleeding and blood product transfusions has received increasing attention from both medical and economic viewpoints. This double-blind, randomized, placebo-controlled clinical trial recruited three groups of patients [each group consisting of 50patients] undergoing on-pump coronary artery bypass graft surgery [CABG] and blindly randomized them to receive either low aprotinin, tranexamic acid, or placebo. The results were, subsequently, evaluated and compared between the groups. All the patients were operated on by one surgeon and the same surgery team. The following variables were similar between the groups, and there was no statistically significant difference between the groups in terms of these variables: age [p value = 0.308], sex [p value = 0.973], hyperlipidemia [p value = 0.720], hypertension [p value = 0.786], smoking [p value = 0.72], and diabetes [p value = 0.960]. The amounts of drainage from chest tubes were less in the aprotinin and tranexamic acid groups than the amount in the placebo group; the difference was statistically important [p value < 0.001]. There was no statistically significant difference with respect to need for reoperation for bleeding between the three groups [p value = 0.998]. Complications following surgery in the three groups were statistically the same and not significantly different. All the complications [myocardial infarction, pericardial effusion, neurological complication and renal complication] had a good course, and all the patients were discharged from the hospital uneventfully. There was no mortality in any group. Low-dose aprotinin and tranexamic acid can significantly reduce blood loss and transfusion requirement in CABG without importantly increasing mortality and morbidity
ABSTRACT
Cardiovascular operations are associated with an inherent bleeding tendency that sometime leads to severe bleeding and transfusion requirement. Pharmacologic intervention to minimize post-bypass bleeding and blood product transfusions has received increasing attention for both medical and economic perspectives. In this double-blind, randomized, placebo-controlled clinical trial, three groups of patients, each comprising 50 patients undergoing on-pump coronary artery bypass grafting surgery [CABG] were blindly randomized to receive either low aprotinin, tranexamic acid, or placebo; the results were subsequently evaluated and compared between the groups. The following variables were similar in the groups, and there were no statistically significant differences in these variables: age [p value=0.308], sex [p valuco.973], hyperlipidemia [p value=0.720], hypertension [p value=0.786], smoking [p value=0.72], and diabetes [p value=0.960]. The amounts of drainage from chest tubes were less in the aprotinin and tranexamic acid groups compared to the placebo group, and this was statistically significant [p value<0.001]. There was no statistically significant difference in need for reoperation for bleeding between the three groups [p value=0.998]. Complications following surgery in the three groups were statistically the same and not significantly different [Table below]. All the complications had a good course, and all the patients were discharged from hospital uneventftilly. There was no mortality in any group. Low-dose aprotinin and tranexamic acid can significantly reduce blood loss and transfttsion requirement in CABG without importantly increasing mortality and morbidity
ABSTRACT
Long-segment reconstruction of the diffusely diseased left anterior descending artery [LAD] with left internal thoracic artery [LITA] is one of the methods offered in order to deal with complicated, multiple, and long-segment lesions in the LAD. In this prospective study, we analyzed the results obtained with this technique. Between Feb. 2007 and Feb. 2009, 56 patients underwent surgery via this technique. The LITA was used as a patch along the opened narrow segment of the LAD from 2 to 8 cm. Data on all the patients were collected, and all the patients were worked up for postoperative complications such as postoperative myocardial infarction, ECG changes, NIHA class, enzymatic changes, and postoperative bleeding. CT-Angiography was performed between 6 to 1 8 months after surgery in some cases. Fifty-six cases, comprising 42 [75%] men and 14 [25%] women between 43 and 78 years of age [mean age= 59.8 +/- 9.3 years] with multiple and long-segment lesions in the LAD were included in this study. Preoperative risk factors were hypertension [66.1%], diabetes [57.1%], hyperlipidemia [50%], cigarette smoking [50%], renal failure [1.8%], and positive family history [7.1%]. Twenty-three [41.1%] patients had remote and 9 [16.1%] had recent myocardial infarction. Significant left main lesions were found in 7 [12.5%] patients, peripheral vascular disease in 3 [5.3%], and preoperative arrhythmias in 2 [3.6%]. The mean number of grafts was 2.85 +/- 1.5. Postoperative complications were arrhythmias in 10 [1 7.8%] patients, postoperative myocardial infarction in 1 [1.8%], surgical bleeding in 7 [12.5%], infections in 3 [5.3%], plural effusion in 3 [5.3%], tamponade in 2 [3.6%], and pericardial effusion in 1 [1.8%]; there was no mortality amongst the patients. CT-angiography, performed in 6 patients between the six and eighteenth postoperative months, revealed patent anastomoses in all the patients. Long segment and multiple lesions in the LAD pose a challenge for cardiac surgeons. The results of long-segment LAD reconstruction using the LITA are very encouraging
ABSTRACT
Surgical revascularization for coronary artery lesions secondary to Kawasaki disease [KD] has been rarely reported in adolescent patients. We report a young adult with no coronary risk factors but with a giant solitary coronary aneurysm with obstructive thrombosis inside, presumably secondary to KD, who underwent coronary artery bypass grafting [CABG] with left internal thoracic artery [LITA] and SVG. Because coronary artery sequelae of KD can be a cause of ischemic heart disease even in young adults, heightened awareness of this entity is required for young adults with coronary lesions but without coronary risk factors
Subject(s)
Humans , Male , Mucocutaneous Lymph Node Syndrome , Coronary Vessels/surgery , Coronary Artery Bypass , Coronary Thrombosis , Mammary Arteries , Myocardial Revascularization , Coronary Angiography , AdolescentABSTRACT
Obesity is a common risk factor for morbidity and mortality after cardiac surgery. However, the relationship between obesity and postoperative risk has not been fully defined. A prospective study of 1015 consecutive patients undergoing isolated coronary artery bypass grafting [CABG] was carried out. Body mass index [BMI] was used as the measure of obesity and was categorized as normal weight [BMI=20-25] and obese [BMI > 25 and < 35]. The preoperative, operative, and postoperative risk factors as well as the complication and in-hospital death rates were compared between the two groups. Of the 1015 patients, 40% had a normal weight and 49% were obese. Compared with the normal-weight group, the obese group had a significantly higher incidence of diabetes mellitus [P=0.007] and lower arterial partial pressure of oxygen [PaO2] [P=0.03]. The normal-weight patients had a higher New York Heart Association [NYHA] Functional Class [P=0.03] and were at a higher risk for emergent surgery [P=0.003] or reoperation [P=0.002]. Among the postoperative complications, respiratory complications [P=0.027] were more frequent in the obese patients. The duration of mechanical ventilation [P=0.001], the incidence of arrhythmia [P=0.011], low cardiac output syndrome [P=0.001], reintubation [P=0.001], and neurological complications [P=0.003] were significantly higher in the normal-weight patients. Obesity was associated with a lower risk of reoperation for bleeding [P=0.032]. There were no significant differences in infective complications, length of intensive care unit [ICU] stay, total length of stay in hospital, and operative mortality between the groups. In the patients undergoing isolated CABG procedures, obesity did not increase the risk of operative mortality and morbidity with the exception of respiratory complications. The normal body weight patients were at a higher risk for complications than were the obese patients. Therefore, obese patients may safely undergo CABG without previous weight reduction if due attention is paid to minimize respiratory complications
Subject(s)
Humans , Male , Female , Coronary Artery Bypass/mortality , Hospital Mortality , Morbidity , Prospective Studies , Obesity , Postoperative ComplicationsABSTRACT
Capgras syndrome is one of the misidentification syndromes. In this phenomenon the patient has a delusional belief that familiar persons have been replaced by imposters. We report a middle aged schizophrenic female who believed that the lower half of her body has been replaced by that of another person, known as prostitute by the patient. She also reported hallucination of sexual intercourse. Rare variants of Capgras syndromes have been reported so far, but there is no report of delusion of half of body replacement. The mentioned case can be considered as incomplete Capgras syndrome that is another variant of this syndrome
Subject(s)
Humans , Female , Schizophrenia , DelusionsABSTRACT
Delusion of parasitosis is a rare condition in which the patient has a strong conviction that he or she is infested by small organisms. The condition may exist as an isolated phenomenon, or may occur in association with other psychiatric syndromes. We report a single case of a rare form of this phenomenon. A middle-aged woman who met forth edition of diagnostic and statistical manual of mental disorders criteria for major depressive disorder with psychotic features is described. She had delusions of oral parasitosis. She felt lizards and small organisms in her mouth. To the best of our knowledge, there has been only one previous report of delusions of oral parasitosis to date. We discuss the interesting aspects of this case
Subject(s)
Humans , Female , Parasitic Diseases , Depressive Disorder, Major , MouthABSTRACT
This project was conducted to appraise the role of naltrexone drug and its relation with the demographics and psychological factors in relapse prevention of opium addicts post the detoxification phase. In this cross-sectional study, 107 male opium dependents who had received detoxification treatment at the dual diagnosis ward of Shahid Beheshti Hospital of Kerman were educated about naltrexone maintenance treatment. The continuum of naltrexone consumption by the subjects was followed up via telephone contacts one month and once again in three months after hospital discharge. Subjects demographic factors were evaluated by way of a demographic questionnaire and their psychological features were assessed by SCL-90-R questionnaire before the appearance of withdrawal symptoms. The mean age of subjects was 33.75 +/- 7.86 years. There was a positive correlation between patients' level of education and the length of time subjects remained on naltrexone drug. 27.1% of subjects consumed the drug for less than a month; 59.8% took it for one month, and 13.1% used it for three months. The first group scored significantly higher across all scales of SCL-90-R than the other two groups. Prescription of naltrexone is more beneficial for educated patients. Pharmacotherapy coupled with non-medicinal treatment may lengthen naltrexone maintenance treatment
Subject(s)
Humans , Male , Narcotic Antagonists , Cross-Sectional Studies , Psychotherapy , Opioid-Related Disorders/rehabilitation , DemographyABSTRACT
Self-mutilation is defined as intentional damaging of the body without intention to die. Patients with borderline personality disorder frequently mutilate themselves by means of cutting, burning and abrading their skin. In this case report, a patient with borderline personality disorder is described who has cut his skin and suck his blood several times. He had also the history of killing pigeons and sucking their blood. One time he had sucked his wife's blood. Blood sucking is the main theme of Bram Stocker's novel in which the character of the novel, Dracula, sucked the blood of human beings. Here we present blood sucking as a real symptom and not an imaginary one. This symptom associated with self- cutting is well understood in borderline personality disorder
ABSTRACT
Self-mutilation is defined as intentional damaging of the body without intention to die. Patients with borderline personality disorder frequently mutilate themselves by means of cutting, burning and abrading their skin. In this case report, a patient with borderline personality disorder is described who has cut his skin and suck his blood Several times. He had also the history of killing pigeons and sucking their blood. One time he had sucked his wife's blood. Blood sucking is the main theme of Bram Stocker's novel in which the character of the novel, Dracula, sucked the blood of human beings. Here we present blood sucking as a real symptom and not an imaginary one. This symptom associated with self cutting is well understood in borderline personality disorder
Subject(s)
Humans , Male , Self Mutilation , Signs and SymptomsABSTRACT
Many psychiatric patients have nicotine and other substance dependence. To determine the prevalence of nicotine and opium dependence among psychiatric in-patients in Kerman, a city in southwestern Iran. Three groups of psychiatric inpatients, chronic medical patients and a sample from local population, each including 400 subjects were selected. Nicotine dependence was evaluated by Fagerstrom test for nicotine dependence. Scores >7 were considered positive for nicotine dependence. Opium dependence was evaluated by a semi-structured interview based on DSM IV. 115 [28.75%] out of 400 psychiatric patients had nicotine dependence which was significantly higher than that of the two other groups [p<0.0001]. 140 [35%] of psychiatric patients had opium dependence that did not differ from chronic medical patient but was higher than the control group [p<0.0001]. Frequencies of nicotine and opium dependence were higher among males in all three groups. The highest frequencies of nicotine and opium dependence were observed among patients with post-traumatic stress disorder. Psychiatric patients are predisposed to substance dependence. One plausible reason for opium dependence in our patients is cultural factors. Substance dependence associated with other psychiatric disorders should be considered whenever treatment plan is made