Psychiatric Symptoms in Women with High-risk Pregnancy in the Postpartum Period: A Case-control Study

Abstract Objective: Psychiatric symptoms are common mental issues in pregnancy and the postpartum period. There is limited information regarding the psychiatric symptoms of women with high-risk pregnancy in the postpartum period. This study aimed to compare the severity of psychiatric symptoms and psychological distress in women with high-risk and low-risk pregnancies in the postpartum period. Methods: This case-control study examined 250 women in the postpartum period in two groups with low-risk (n = 112) and high-risk (n = 138) pregnancies. Women completed the Brief Symptom Inventory-53 (BSI-53) and the Risk Postnatal Psychosocial Depression Risk Questionnaire (PPDRQ). Results: The mean severity of psychiatric symptoms in women with high-risk pregnancies was significantly higher than that in women with low-risk pregnancies (39.34 ± 17.51 vs. 30.26 ± 17.08). Additionally, the frequency of psychological distress in women with high-risk pregnancies was approximately twice higher than that in women with low-risk pregnancies (30.3% vs. 15.2%). Furthermore, the risk factors for depression in women with high-risk pregnancies were almost 1.5 times (59.8% vs. 39.8%) higher than the factors in women with low-risk pregnancies. The results of the logistic analysis indicated that high-risk pregnancies could be twice the odds ratio of developing postpartum psychological distress (ß = 2.14, 95% CI 1.4-6.3, p= 0.036). Conclusion: Psychiatric symptoms and the psychological distress index are higher in postpartum women with high-risk pregnancies than in postpartum women with low-risk pregnancies. The study suggests that obstetricians and pregnant women's health care providers should strongly consider screening of psychiatric symptoms in women with high-risk pregnancies both during pregnancy and after delivery as the women's routine care priorities.

The association between the salivary cortisol level of mothers, children's temperament, and early childhood caries

Background: Multiple factors can affect early childhood caries (ECC). Maternal stress and child's temperament, as predictors of child behavior, are among factors that may be associated with ECC. Objectives: The aim of this study was to evaluate the association between the salivary cortisol level of mothers as an indicator of maternal stress, child's temperament, and ECC. Methods: Ninety preschool children, who were divided into three groups of ECC, severe ECC (S-ECC), and caries-free (CF), were included in this study, as well as their mothers with no history of anxiety disorders. The salivary cortisol levels of mothers were analyzed using ELISA assay. Children were examined for the evidence of caries, using the decayed-missing-filled teeth index, based on the World Health Organization standard criteria. Child temperament was also assessed, using Cloninger's Preschool Temperament and Character Inventory, consisting of seven significant factors (cooperativeness, harm avoidance, novelty seeking, reward dependence, persistence, self-directing, and self-transcendence). Results: The association between the salivary cortisol level of mothers and temperament of children with S-ECC was positive although it was not statistically significant (P > 0.05). Of seven temperament factors, only harm avoidance was significantly different between the CF and S-ECC groups (P = 0.016). Conclusion: Maternal stress and child's temperament were not associated with ECC. Based on the present findings, children with less harm avoidance may be more prone to S-ECC.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders / O papel da psicoterapia psicodinâmica de longo prazo na melhora de padrões de apego, estilos de defesa e alexitimia em pacientes com transtornos depressivos e de ansiedade

Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.

A Negative Association between Social Support and Depression in the Elderly Population of Amirkola City.

Introduction: Depression is one of the most common psychiatric disorders in old age. The aim of the study was to investigate the relationship between social support and depression in elderly population of Amirkola city, northern Iran. Also, a few studies have been conducted to determine whether there is any association between social support and depression in different cultural settings, e.g. in western countries. Methodology: This cross sectional study came from the Amirkola Health and Ageing Project (AHAP), that was undertaken among 1612 older people aged 60 years and over (881 males and 731 females) in Amirkola. The sampling method was done using the census records. Depression was assessed via the shortened 15 item version of Geriatric Depression Scale (GDS) and social support measured by the shortened 11 item version of the Duke Social Support Index (DSSI). Results: The prevalence of depressive symptoms was 43.4%. The mean social support score in the subjects without depressive symptoms was 28.32±2.79 which has been significantly higher than those with depressive symptoms 25.86±3.44. Linear regression analysis displays the variables in the final model like social support, age, gender, education, living status; social support was negatively the most associated variable with depression (β for social satisfaction= -0.245, P<0.001 and for social interaction 0 -0.199 P<0.001). Thus for the males, those who are younger, those who are more educated, those who are married and those who are employed, their social support scores were higher. Conclusions: Lack of social support is negatively associated with depression in the elderly people in Iran.

Evaluation to the Female Sexual Dysfunction in a Simple of Iranian Infertile Women.

Introduction: Female sexual dysfunction (FSD) is recognized as a widespread health problem. Infertility may result in increased sexual dysfunction. The aim of this study was to evaluate the prevalence of FSD and some demographic characteristic with female sexual function; detect predictors factors of female sexual domains on sexual dysfunction asample of Iranian infertile women. Methodology: The cross-sectional study was carried out between August 2013 and January 2014 on 208 women referring to Fatemeh Zahra Infertility & Reproductive Center, Babol, Iran. Each survey contains demographic information and one validated questionnaire, the Female Sexual Function Index (FSFI). A score≤ 26.55 is considered ‘‘at risk’’ for sexual dysfunction. Statistical analyses were performed using Independent sample t test, linear and logistic regression with P<.05 indicating statistical significance. All statistical analyses were performed using SPSS software (Version 17). Results: The percentage of sexual dysfunction was 46.6. The mean score of total sexual function was 26.18±4.14. The lowest mean of FSFI domains was related to desire and then arousal in infertile women. There was a significant association between all of the domains of sexual function with sexual function. All of the female sexual domains had the positive significant predictors of sexual function in infertile women. Standardized beta values showed that orgasm contributed to the greatest amount of unique variance to the model for infertile women sexual function, and followed by sexual satisfaction, sexual arousal, lubricant, sexual desire, and sexual pain (P<.001). There was a significant correlation between the domains of sexual function except pain and desire. The strongest correlation value was between the domains of sexual satisfaction and orgasm, and then arousal with orgasm. There was a significant association between sexual dysfunction and educational level, husband’s educational level, and infertility cause. Conclusions: With considering to the high prevalence of sexual dysfunction in selected infertile women, therefore, early screening is needed for detecting predictor's factors o sexual dysfunction.

The role of psychiatric symptoms, alexithymia, and maladaptive defenses in patients with functional dyspepsia.

Background: Functional dyspepsia (FD) is a condition commonly seen in gastroenterological practice. The pathophysiology of FD is likely to be multi-factorial and remains incompletely understood. Although evidence for a psychological etiology is growing, few researches have investigated the role of psychological factors in FD disease. The aim of the study was to assess the role of alexithymia, psychiatric symptoms, and defense mechanism in patients with FD. Materials and Methods: In a case-control study, 60 consecutive with established FD referred to gastroenterology and 60 healthy people matched regarding demographic variables were selected. The subjects filled out three questionnaires; Symptom Checklist-90-Revised 40-item Defense Style and 20-item Toronto Alexithymia Scale. Statistical Analysis: Student's t-test and multivariate analysis variance model were used to compare the two groups. Results: Significantly higher scores were found in patients with dyspepsia when compared with controls for most psychiatric symptoms (depression P < 0.001, anxiety P < 0.001, obsessive-compulsion P < 0.001, interpersonal sensitivity P < 0.001, psychoticism P < 0.001, hostility P < 0.001, and total score of psychiatric symptoms P < 0.001). Alexithymia symptoms (both (difficulty in identifying feelings and difficulty in describing feelings) was higher in FD patients than healthy individuals ( P < 0.001). Also, the use of maladaptive defense mechanisms (both neurotic and immature) in FD patients significantly was higher than healthy individuals ( P < 0.001). Conclusion: Psychiatric symptoms, alexithymia, and maladaptive defense play significant role in the emergence of FD symptoms. This study proposes that FD patients should be evaluated and treated by departments of gastroenterology and psychiatry.