Effect of postpartum depression on women's mental and physical health four years after childbirth

Background: Postpartum depression has been shown to affect women's health in the long term but no studies have assessed this in the Islamic Republic of Iran.

Aims: This study determined the prevalence of current depression and illness in women who had experienced postpartum depression four years after childbirth, and evaluated the factors associated with current depression.

Methods: In a cohort study in 2009, 1801 pregnant women without depression at 32–42 weeks of pregnancy attending Mazandaran primary healthcare centres were examined for postpartum depression using the Edinburgh Postnatal Depression Scale [EPDS]. After four years, 204 women of the original cohort with postpartum depression and 467 without postpartum depression were again evaluated using the EPDS, and other questionnaires to determine the prevalence of current depression and other health problems. Multivariable logistic regression analysis was used to evaluate the factors associated with current depression and other health problems.

Results: The mean age of the women was 30.13 [SD 5.21] years. Women with postpartum depression were two times more likely to experience depression four years after childbirth [OR = 2.16, 95% CI: 1.38–3.36]. They were also significantly more likely to experience chronic diseases [OR = 2.49, 95% CI: 1.38–4.50] and score higher on the General Health Questionnaire [OR = 2.50, 95% CI: 1.38–4.50].

Conclusions: Postpartum depression predisposes women to later depression and other mental and physical health problems. Women with postpartum depression need to be identified and provided with support and appropriate interventions to avoid later health problems

Evaluation of the personality traits of asthmatic patients

The effect of mental status on physical conditions has been well established and it has been proven that psychosocial factors play an important role in physical diseases. There are numerous factors that may be involved in development of asthma. Emotional stress and anxiety attacks are of the factors responsible for initiation of asthmatic attacks. For evaluation of the personality traits of asthmatic patients, the Minnesota Multiphasic Personality Inventory [MMPI] test was used which had 8 clinical and 3 validity scales. It is one of the most frequently used personality tests in mental health. This study was performed on 300 asthmatic patients including 197 females and 103 males. Along with personality traits, we also evaluated demographic characteristics of patients including age, sex, level of education, marital status, and number of children. Level of education, age and marital status were significantly correlated with the severity of disease [P=0.001, P=0.007 and P=0.011, respectively]. Our study results showed that people with low educational level, middle-aged and married individuals were at higher risk of developing severe asthma. Correlation coefficients between clinical scales of D [depression], Hs [hypochondriasis], Hy [hysteria], Pt [psychasthenia], Pa [paranoia] and Sc [schizophrenia] and severity of asthma were rD=0.301, rHs=0.306, rHy=0.159, rPt=0.161, rPa=0.1431 and rSc=0.136, respectively. All correlations were statistically significant indicating the presence of depression, excitability and anxiety symptoms in these patients. Signs and symptoms of mental disorders are usually disregarded and therefore, they often remain undiagnosed. However, such conditions are potential risk factors for psychosomatic diseases like asthma

[Attitude and practice of pediatrics and gynecology physicians in the cities of Sari and Babol regarding non-initiation and discontinuation of resuscitation in cases of gravely Ill newborns]

There are some debates with decision making for withdrawal/ withholding of life sustaining treatment in infants with adverse prognoses and incurable conditions. This study is conducted to review attitudes and practice of pediatrics and gynecology physicians in this field. This survey was conducted during 2009 in Sari and Babol. A total of 140 pediatricians, gynecologists and residents/fellows in these fields were recruited by census; 106 doctors completed an anonymous questionnaire [response rate 75.7%]. More than 70 percent of respondents disagreed and less than a quarter of them agreed with euthanasia. Thus far, none of the doctors prescribed drugs to expedite neonatal death. Withdrawal of life sustaining treatment in infants with adverse prognoses and incurable conditions was uncommon, and reported by one fifth of physicians in their diagnosis of infants with multiple congenital anomalies. Influential factors in their decision to withdraw life sustaining treatment in these infants were: the number of children, the insistence of hospital staff, the request from parents, the infant's sex, lack of hospital facilities, parental history of infertility and family income, respectively. Religious beliefs were effective for withdrawal/withholding of life sustaining treatment in the decision making process and was led to an agreement more with the approval of the law in the majority of cases. This study revealed that attitude and sanctity of life, overcomes the attitude regarding to quality of life from most of the physicians. Law approval in this field is necessary

Spouse abuse in Sari-Iran

Spouse abuse is a major worldwide health concern and includes a wide range of emotional, physical and sexual maltreatments. The objective of present study was to determine the prevalence and risk factors of spouse abuse among women who were registered with health centers in the city of Sari. We distributed two specifically designed questionnaires among one thousand women whose name was in the list of health centers register in Sari. The subjects had been randomly selected from a list of 49330 registered women. Demographic data and data on spouse abuse were then analyzed by using Student's unpaired t-test and Chi- square test. Including mild forms of abuse, 73.5%, 92.2% and 49.6% of women reported that they were subjected to physical, emotional and sexual abuse respectively at least once during their lives. This figure was 3%, 10.4% and 5.8% for moderate forms, and 0.5%, 1% and 2.2% for severe forms of abuse. Younger age, un- employment, low level of education, substance misuse, presence of a physical or a psychological problem and having more children were risk factors for domestic violence. The study revealed a high prevalence, especially mild forms of domestic maltreatment in the sample population. The type and risk factors of domestic violence seems to be similar throughout the world irrespective of differences in cultural and religious backgrounds. Authors believe that addressing unemployment, substance misuse problems and early treatment of mental illness in young couples in Iran will reduce the risk of domestic violence

How to run psychiatry OSCE in three days

Objectivity, reliability and validity of examinations in psychiatry have always been one of the major concerns of experts in this discipline. Recently, objective structured clinical examination [OSCE] for its unique approach and by providing the requirements of psychiatric examinations has been a topic of interest. In Iran, an OSCE has been replaced the individual patient assessment [IPA] for examination of the National Board of Psychiatry. Although it is better to provide psychiatry OSCE in an extended time frame, in some cases this examination should be executed in a short period of time. For executing OSCE in psychiatry, especially if it should be performed in a short time, it requires addressing various points. In this article, based upon the previous experiences, we offer a standard format for establishing a practical, reliable and measurable OSCE in psychiatry in three days

[Evaluation of naltrexone augmentation to the antipsychotic drugs on positive and negative symptoms of schizophrenia]

In recent years, review of opioid system and its changes in the psychopathology of schizophrenia through thear probable role our on neuronal synopses and cell body of dopaminergic neurons and also decrease dopamine secretion from acumbans nuclei and effects of opium agonists in treatment of those patients has been adventajes for clinicians. In a prospective double blind evaluation, 60 chronic schizophrenic inpatients on a stable regimen of neuroleptic medication with positive and negative symptom scale [PANSS] score of higher than 80 and were randomly assigned to either antipsychotic plus naltrexone or antipsychotic plus placebo. Thirty patients [30] received 100 mg/day of naltrexone plus antipsychotic drug while 30 received placebo plus antipsychotic drug for 6 weeks. PANSS scores were evaluated on the base of the study, biweekly throughout the study and two weeks after the trial. The treatment effect was calculated by repeated measurement ANOVA. Difference between four types of symptoms [positive symptom, negative symptom, general psychopathological symptom, total score of PANSS] in the case and control groups was not significant [P < 0.05]. In supplement two [S2] scores, a statistically non significant difference was seen in two groups [P < 0.07]. Additional treatment with 100 mg/day naltrexone in a 6 week trial had no significant therapeutic effect on typical or atypical antipsychotic drugs with regards to schizophrenia psychopathology

[Study on the simultaneity of the substance abuse with psychiatric disorder in referred outpatients to psychiatry clinic of zare hospital for period of one year]

One of the important problems in diagnosis and treatment of psychiatric disorders is its accompaniment with substance abuse. In addition to substance abuse symptoms which are present in all addicts, in psychiatric patients it cause special problems in main diagnosis, slow reaction to therapy and even non effectiveness of the therapy and also poor prognosis. Considering its different prevalence in studies and also considering the point that a similar work has never been done in Iran, this study is designed to find out the abundancy of disorders and pattern and type of substances used by the referred patients to psychiatric clinic of zare hospital. In this descriptive research study, 782 referrals to psychiatric clinic of zare hospital in a period of one year were evaluated D.S.M. IV interview. The self made Questionnaire which is filed by a psychologist and then referred to a psychiatric for the diagnosis of the disease, includes the time of Commencement, amount and type of substance used. The results obtained, showed that 79.1% were men, 20.9% were women, 54.4% were urban and 45.5% were from rural areas. 4.8% were referred for substance - withdrawal and 95.2% for psychiatry problems. And also the 28% were smokers, 68.4% never smoked and 3.8% were smokers in the past. 12.7% were substance abuse at persent 3.3% had a history if substance abuse in the past and 84% had no history of substance abuse ever. Substance dependency and nondependency were 8.6% and 91.4% respectively. The percentages for the first consumed substance were as follow: 60.8 opium, 6.4 alcohal, 26.4 hashish, 4 heroin and 2.4 other substances. From psychiatry diagnostic point of view 28.7% suffered from schizophrenia, 41% had mood disorders, 14% had personality disorders and 4% suffered from anxiety. There has been a statistically significant relationship between the variables such as sex, residential areas, occupation, education, marital status, history of cigarette smoking and age of commence ment of smoking with substance dependency [p<0.05]. Considering the high prevalence of Substance usage by the patients referred to psychiatric clinics, the Concurrency of substance usage and psychiatry problems are important in history taking and treatment of the patients. On the other hand to have a high success Coefficient, a simultaneous psychiatric diagnosis for the patients referred for withdrawal, should be kept in mind