Dissociation as a causal pathway from sexual abuse to positive symptoms in the spectrum of psychotic disorders.

BACKGROUND: Although numerous studies have supported the role of childhood maltreatment in the etiology of psychosis, underlying mechanisms have not been well understood yet. The present study aimed to investigate the mediating role of particular forms of dissociation in the relationship between five major types of childhood abuse and psychotic symptoms among patients with schizophrenia spectrum and other psychotic disorders. METHODS: In this cross-sectional correlation study, 70 first-episode psychotic patients and 70 chronic psychotic patients were selected by systematic random sampling (with the sampling interval of 3) from among inpatients and outpatients referring to Baharan Psychiatric hospital, Zahedan, Iran, and were matched based on age, gender, and education level. Moreover, 70 age-, gender-, and education level-matched community controls were recruited from hospital staff and their relatives and friends. All of the participants completed a research interview and questionnaires. Data on experiences of childhood maltreatment, psychosis, dissociation, and demographics were collected and analyzed by SPSS V25 software. RESULTS: The obtained results revealed that the mean scores of sexual abuse, emotional abuse, and physical abuse were higher in psychotic patients than community controls (without any significant difference between first-episode psychotic patients and chronic psychotic patients). Furthermore, the highest mean scores of dissociative experiences belonged to chronic psychotic patients. Multiple-mediation also indicated that absorption and dissociative amnesia played a mediating role in the relationship between sexual abuse and positive symptoms. Moreover, this study demonstrated the role of physical abuse in predicting psychotic symptoms even in the absence of sexual abuse. CONCLUSIONS: This study illustrated specific associations among childhood maltreatment, dissociative experiences, and psychotic symptoms in the clinical population. Thus, to provide appropriate interventions, patients with schizophrenia spectrum and other psychotic disorders were asked about a wide range of possible adverse childhood experiences and dissociative experiences. Nevertheless, further studies using prospective or longitudinal designs need to be carried out to realize the differential contribution of various forms of childhood maltreatment and their potential interactions, more precisely.

Opium Effect in Pregnancy on the Dynamics of Maternal Behavior: Testing a Neurochemical Model.

BACKGROUND: Investigations into neurochemical mechanisms of opioid addiction are difficult due to the complexity of behavior and multiplicity of involved neurotransmitter and hormonal systems. The aim of this study was to examine the benefits of structured analysis of these mechanisms using the framework of the neurochemical model Functional Ensemble of Temperament (FET) and the example of maternal behavior under the condition of opium consumption in pregnancy. The FET differentiates between (a) endurance, (b) speed of integration, and (c) emotionality aspects of behavior suggesting that these systems are differentially regulated by (a) serotonin-neuropeptides-brain-derived neurotrophic factor (BDNF), (b) dopamine-GABA, and (c) opioid receptor systems, correspondingly. The FET also suggests that mu-opioid receptors (MORs) binding the endorphines (including opium's ingredient morphine) have a stronger association with regulation endurance, whereas delta-OR have a stronger association with integration of behavior and kappa-OR - with the perceptual mobilization seen in anxiety. To test the predictions of this model, we compared the impact of massive MOR dysregulation on 3 behavioral aspects of behavior and on serotonin, BDNF, and corticosterone levels. METHODS: The study used 24 female white Wistar rats which were randomly divided into (1) control group: pregnant rats without any intervention; (2) opium-exposed group: animals that were exposed to opium during pregnancy and after the delivery until the end of the study. At the end of the study, the levels of BDNF, serotonin (5-HT) in the hippocampus of the mother's brain, and serum corticosterone, as well as 12 aspects of the maternal behavior were evaluated. The differences between control and experimental groups were assessed using the t test for independent samples. RESULTS: The BDNF and serotonin concentrations in the hippocampus of the mother rats which were exposed to opium were lower than in the control group; the mean corticosterone in exposed mothers was higher than in the control group. Behaviorally, opium-consuming mothers showed lower endurance in 4 distinct behavioral categories (nesting, feeding, grooming, and retrieval) than the mothers in the control group. Ease of integration of behavior was affected to a lesser degree, showing a significant effect only in 1 out of 5 applied measures. Self-grooming, seen as an emotionality-related aspect of behavior, was not affected. CONCLUSION: Opium exposure during pregnancy in our experiment primarily reduced the endurance of rat's maternal behavior, but the speed of integration of behavioral acts was less affected. This negative impact of opium on endurance was associated with a decrease of BDNF and serotonin levels in the hippocampus and an increase in corticosterone level in opium-consuming mothers. There is no effect of opium exposure on self-grooming behavior. This pattern supports the FET hypothesis about the role of 5-HT and BDNF in endurance, differential regulation of endurance, integrative and emotionality aspects of behavior, and differential association of the MOR system with endurance aspects, in comparison with kappa- and delta opioid receptors.

National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

BACKGROUND: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. METHODS: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). RESULTS: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. CONCLUSION: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

Effectiveness of school-based mental health programs on mental health among adolescents.

AIM: This study aimed to investigate the effect of school-based interventions on mental health among adolescents in the southeast of Iran. METHODS: This interventional quasi-experimental study included a total of 420 adolescent girls studying 10th grade in the public schools of Zahedan, Iran. Data were collected using general health questionnaire-28 questionnaire. After pretest, multidimensional interventions (individual education, group education, individual consultations, modern education, and parents' educational packages) were given to the intervention group from October 2015 to June 2016. After a 3-month interval, the posttest was conducted in October 2016. Data were analyzed by covariance analysis. RESULTS: There was a significant statistical difference between the changes in the mental health scores after the intervention among the two study groups (P < 0.05). Furthermore, after the intervention, moderate-to-severe mental health problems decreased considerably among the students in the intervention group compared to controls. The greatest impact was on individual psychological counseling. CONCLUSIONS: The results of the study showed that by applying group training and individual counseling in the schools improves mental health. Therefore, identifying student problems and parent-teacher cooperation as well as consulting with specialist counselors can be effective in providing practical and effective solutions in this regard. Therefore, findings suggest that prioritizing mental health and taking action on the field are of utmost importance.

Combination Therapy and Opioids: Effectiveness of Transcranial Direct-Current Stimulation (tDCS) and Emotion Regulation Training in Reducing Current Drug Craving.

Background and objectives: Craving is the main symptom of addiction that is accompanied by dependence and relapse. The present study was aimed to compare the effectiveness of combined Transcranial Direct-Current Stimulation (tDCS) and emotion regulation training with that of separate tDCS and emotion regulation training in reducing current drug craving and thoughts and fantasies about drug use. Materials and methodology: This was a quasi-experimental study with a pretest-posttest design and three intervention groups. The statistical population included all patients dependent on opioids in medium-term residential drug rehabilitation centers in Zahedan, Iran, in 2018-2019. From eight randomly selected centers, a total of 54 patients were selected based on inclusion and exclusion criteria, and randomly divided into three intervention groups. Data were gathered using the Personal Drug Use Questionnaire, Desires for Drug Questionnaire (DDQ), and Drug Use Thoughts, Fantasies, and Temptations Questionnaire. All analyses were performed using SPSS-16. Results: The Kruskal-Wallis test indicated significant differences between the three intervention groups in current drug craving and thoughts and fantasies about drug use (P ..001). In addition, examination of the mean rank showed that t significant decrease was higher for the combined tDCS and emotion regulation training group. Conclusion: Addiction is very similar to other chronic disorders. Therefore, combined (integrated) therapies can have a very important role in treating addiction, especially in relapse prevention.

The Effect of Stress Management Training through PRECEDE-PROCEED Model on Occupational Stress among Nurses and Midwives at Iran Hospital, Iranshahr.

INTRODUCTION: Occupational stress is a major factor in hindering the performance of nurses and midwives and developing physical and mental complications in them. Given that these two groups are in direct contact with patients more than other medical staff and stress management training can be effective in the reduction of occupational stress among the nurses and midwives. AIM: This study was set out to compare the effect of a PRECEDE-PROCEED based stress management training program on the occupational stress of the nurses and midwives. MATERIALS AND METHODS: This quasi-experimental study was conducted on the aforementioned nurses and midwives. Data collection instruments included the Nursing Stress Scale (NSS). The training program was held in two 4-hour-long sessions for three months from 1st January to 31st March 2013. RESULTS: The results showed a significant increase in the PRECEDE scores of both groups by the end of the program, as compared to the baseline. A significant decrease was also observed in the stress scores of both groups. There was no difference between groups in these regards. CONCLUSION: The PRECEDE-based stress management training is effective in the reduction of occupational stress among the nurses and midwives.

The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients With Chronic Headache.

The aim of this study was to determine the effectiveness of Mindfulness-Based Stress reduction (MBSR) on perceived pain intensity and quality of life in patients with chronic headache. Thus, forty patients based on the diagnosis of a neurologist and diagnostic criteria of the International Headache Society (IHS) for migraine and chronic tension-type headache were selected and randomly assigned to the intervention group and control group, respectively. The participants completed the Pain and quality of life (SF-36) questionnaire. The intervention group enrolled in an eight-week MBSR program that incorporated meditation and daily home practice, per week, session of 90-minutes. Results of covariance analysis with the elimination of the pre-test showed significantly improvement of pain and quality of life in the intervention group compared with the control group. The findings from this study revealed that MBSR can be used non-pharmacological intervention for improvement the quality of life and development of strategies to cope with pain in patients with chronic headache. And can be used in combination with other therapies such as pharmacotherapy.

Evaluation of the efficacy of low-level laser in improving the symptoms of burning mouth syndrome.

BACKGROUND: Burning mouth syndrome (BMS) is common conditions that affects menopause women, patients suffer from sever burning sensation. Up to now there is no definitive treatment for this disease. Present study was undertaken to evaluate the efficacy of low-level laser (LLL) in improving the symptoms of burning mouth syndrome. MATERIAL AND METHODS: Twenty patients with BMS were enrolled in this study; they were divided in two groups randomly. In the laser group, in each patient, 10 areas on the oral mucosa were selected and underwent LLL irradiation at a wavelength of 630 nm, and a power of 30 mW for 10 seconds twice a week for 4 weeks. In the placebo group, silent/off laser therapy was carried out during the same period in the same areas. Burning sensation and quality of life were evaluated. RESULTS: Burning sensation severity and quality of life in the two groups after intervention were different significant statistically, (p= 0.004, p= 0.01 respectively) .Patients in laser group had better results. CONCLUSIONS: It can be concluded that low level laser might decrease the intensity of burning mouth syndrome. KEY WORDS: Pain, low-level laser, burning mouth syndrome, oral mucosa.

The Effectiveness of Mindfulness-Based Cognitive Group Therapy on Marital Satisfaction and General Health in Woman With Infertility.

Infertility affects around 80 million people around the world and it has been estimated that psychological problems in infertile couples is within the range of 25-60%. The purpose of this study was to determine the effectiveness of Mindfulness-based cognitive group therapy on consciousness regarding marital satisfaction and general health in woman with infertility. Recent work is a clinical trial with a pre/posttest plan for control group. Covering 60 women who were selected by in access method and arranged randomly in interference (30) and control (30) groups. Before and after implementation of independent variable, all subjects were measured in both groups using Enrich questionnaire and marital satisfaction questionnaire. Results of covariance analysis of posttest, after controlling the scores of pretest illustrated the meaningful difference of marital satisfaction and mental health scores in interference and control groups after treatment and the fact that MBCT treatment in infertile women revealed that this method has an appropriate contribution to improvement of marital satisfaction and mental health. Necessary trainings for infertile people through consultation services can improve their mental health and marital satisfaction and significantly help reducing infertile couples' problems.

The relationship between personality styles of sociotropy and autonomy and suicidal tendency in medical students.

The research aim was investigating the relationship between personality styles of autonomy and sociotropy, and suicidal behavior at Zahedan University of medical sciences' medical students. This was a descriptive correlational study. The population consisted of all medical students at Zahedan University of Medical Sciences internship period 2002-2003. The number of samples was 102 patients, including 47 males and 55 females. To collect information, the personal style inventory (PSI) with 48 items. Twenty four items to assess sociotropy, 24 items to assess autonomy, and to measure suicide the suicidal subscale (MMPI) with 21 items were used. The two scales had the content validity and for the reliability used Cronbach a. So the reliability of the personality styles is 0.84 and the reliability of the suicidal subscales is 0.83. Data were analyzed using Pearson's correlation methods. The results showed that there is an inverse and significant relation between autonomic style and trends of suicide in men (P = 0.02, r = -0.43), but no association between sociotropy and suicidal tendencies were observed in men. There was no significant relationship between autonomy and sociotropy personality styles and tendency towards suicide in women.

High-risk behaviors related to intentional and unintentional harm in adolescents of zahedan, iran.

BACKGROUND: Adolescence and youth are life-threatening stages of development when a range of unsafe behaviors can harmfully affect a person's health and their social and educational performance. OBJECTIVES: The present study aimed to determine the incidence and prevalence of high-risk behaviors related to intentional and unintentional harm in adolescents of Zahedan (Iran). PATIENTS AND METHODS: This cross-sectional study included 1000 randomly selected male and female high school students of Zahedan, Iran. The Persian version of High Risk Behavior Questionnaire and Goldberg's 28-item General Health Questionnaire were used to collect data. Descriptive statistics (frequency and percentage) was used to analyze data. RESULTS: The most prevalent behaviors were not wearing seat belt (48%), riding a motorcycle without a helmet (42.3%) and involvement in physical conflicts (38.7%). Both the incidence and prevalence of the studied behaviors were higher in boys than girls. Moreover, greater prevalence of behaviors related to intentional and unintentional harm was observed in subjects with a drug abusing friend or family member. CONCLUSIONS: The incidence and prevalence of high-risk behaviors in the studied population were slightly lower compared to several other parts of the country and some other countries. Nevertheless, since the rates and trend are alarming, sectoral and intersectoral cooperation is indispensable to the implementation of preventive interventions at different levels of society. Such efforts would obviously require the help of experts in various fields and necessitate the assessment of sociocultural features of the population.

Effectiveness of Combined Copying Skills Training and Pharmacological Therapy for Patients with Migraine.

Headache is one of the most common complaints in neurological clinics. The current study carried out to determine the benefits of combined Coping Skills Training (CST) and Pharmacotherapy (Ph) for patients with migraine. Forty patients with migraine recruited from the outpatient clinics of Zahedan University of Medical Sciences( Iran) and randomly assigned to one of two treatment groups: the first group received combined coping skills training (CST) and pharmacotherapy(Ph); and the second group received the pharmacotherapy alone(Ph). Five patients due to lack of regular presence or filling out the questionnaires excluded from the study. Finally, the results of 35 subjects were analyzed. Data collection was done using the World Health Organization Quality of Life Questionnaire, General Self-Efficacy Scale-Sherer, Ways of Coping Questionnaire and Migraine Headache Index. The results of ANCOVA on post-test, after controlling the pre-test scores, suggested a significant difference in self-efficacy scores between CST+Ph and Ph groups. Moreover, results of ANCOVA did not show significant differences between the two groups in the scores of pain severity, quality of life, and the use of coping strategies. Findings of the present study indicated that coping-skills training, as a psychological intervention, improved self-efficacy. Further longitudinal studies are needed to confirm this conclusion.

Epidemiology of Suicide and its Associated Socio-demographic Factors in Patients Admitted to Emergency Department of Zahedan Khatam-Al-Anbia Hospital.

BACKGROUND: Suicide is a growing public health problem all over the world. Understanding the prevalence of suicide and its correlates is of great importance in planning programs to reduce the risk in different societies. OBJECTIVES: The present study was conducted to assess the epidemiology of suicide and its associated risk factors in Sistan and Balouchestan Province, southeast of Iran. PATIENTS AND METHODS: We investigated a total of 369 suicide cases admitted to the emergency department of Zahedan Khatam- Al- Anbia hospital between March 2010 and February 2012. Data was collected from the hospital information system (HIS) using a semi-structured questionnaire. Descriptive statistics and chi-square tests were used to identify the factors associated with suicidal behaviors. RESULTS: A greater proportion of the study subjects (65%) were female. They were more likely to be young (43.5% in the age group of 16 to 25 years) and illiterate or have a primary school education (20.9% and 48.8%, respectively). Housewives and self-employed individuals and those with a low or medium income dominated the suicide cases. The most common method of suicide was burning (53.4%) followed by drug ingestion (23.8%). One third of the suicide cases occurred during spring. The case fatality rate was 49.6% and it was significantly associated with low income, summer time suicides, burning as a method of suicide. CONCLUSIONS: This study highlights the burden of suicide and itspotential socio-demographic risk factors in Sistan and Blouchestan Province. This information has an implication for planning the preventive measures, policy making and future research.

Frequency of structural brain abnormalities among adult diagnosed with Attention - Deficit/Hyperactivity Disorder.

Although ADHD is known as a childhood disorder, it is prevalent among adults as well. Several studies have been conducted on the etiology of this disorder and its neurobiological and neuroanatomical manifestations in children, but the knowledge of adult ADHD is not enough. The present research was aimed at studying the structural brain abnormalities in adult ADHD cases. Fifteen adult patients diagnosed with ADHD, developed during their childhood, were selected for this study. In addition to clinical interview and Magnetic Resonance Imaging (MRI), all the participants were asked to fill the (ASRS-VI.I). The results indicated that about 40 % of adults with ADHD suffer from structural brain abnormalities. The results of MRI showed that 100% of the individuals with inattentive and combined types of ADHD were structurally damaged but MRI results did not reveal any structural brain abnormalities in hyperactive participants. The results of the present study are somewhat consistent with the results of previous studies. In general, any brain injury in the region related to cognitive processes (such as attention, memorization, and prevention) and brain circuits related to motor functions and motivation can contribute a role to the induction of ADHD symptoms. It is recommended to conduct more researches in the future with larger samples using other methods that are capable of assessing brain performance and the level and mechanism of the functions of neurotransmitters and neuronal modulators.

Djinnati syndrome: symptoms and prevalence in rural population of Baluchistan (southeast of Iran).

OBJECTIVE: The present study describes "Djinnati," a culture-bound syndrome and examines its prevalence and demographic attributes such as age, gender and education level in the rural population of Baluchistan in southeast Iran. METHOD: In this cross-sectional study, the participants (n=4129) were recruited from people living in rural areas of Baluchistan (southeast Iran) by multistage sampling. The data were collected through interviews with local healers, health care personnel, family health records, interview patients suspected with the disorder and their relatives. We administered the dissociative experiences scale. RESULTS: Prevalence of Djinnati syndrome was about 0.5% in the studied population and 1.03% in women. All patients who experienced episodic symptoms of Djinnati were female. The most common reported symptoms were altered consciousness and memory, muteness, laughing, crying, incomprehensible speech and hallucination that have been attributed to a foreign entity called "Djinn." In addition loss of speech or change in speech rhythm and tone of voice was observed in a subgroup. In one case, speaking in a different language during the attack was reported. There was partial and rarely complete amnesia during the attack. Attacks usually lasted from 30 min to 2h. DISCUSSION: It is suggested that future studies explore prevalence of Djinnati syndrome in women and explore predisposing, precipitating, and maintaining factors. It is further suggested that a comprehensive pathology model should integrate the data related to socio-cultural context in order to prevent and treat this syndrome.

A comparative study of self-regulation in substance dependent and non-dependent individuals.

BACKGROUND: Several factors influence the beginning and maintenance of substance use. The purpose of this study was to examine as well as to compare 'self-regulation' in both substance dependent and non-substance dependent individuals. METHOD: In a cross-sectional study 228 (118 substance dependent and 110 with no history of using substance) participants aged 16-55 were recruited. All of the participants were asked to complete the Self-Regulation Inventory (SRI-25) and a demographic characteristics data checklist. Data was analyzed using descriptive statistics (frequency, mean and standard deviation) and the t-test. RESULTS: The results showed significant differences between substance dependent and non- substance dependent groups in all the scales of the self-regulation inventory including positive actions, controllability, expression of feelings and needs, assertiveness, and well-being seeking (p<0.01). CONCLUSION: Self-regulation and self-control skills in drug dependent individuals are lower than those without substance dependence individuals. It is concluded that substance use may related to a deficiency in self-control and regulation of feelings. Therefore, for prevention and treatment of substance dependence disorder, it is necessary to work out and exploit strategies that include the improvement of self-regulation.

Premenstrual syndrome symptomatology among married women of fertile age based on methods of contraception (hormonal versus non-hormonal methods of contraception).

INTRODUCTION: Premenstrual syndrome (PMS) refers to the cyclic occurrence of a set of disturbing physical, emotional or behavioral alterations that are of sufficient severity to interfere with interpersonal relations and routine life. Normal variations in gonadal estrogen and progesterone lead to biochemical reactions in the brain, resulting in PMS symptoms. This study aims to investigate the prevalence of PMS and PMDD signs among married women of fertile age (MWFA) based on the methods of birth control. METHOD AND MATERIALS: In a descriptive study, a number of 400 married women referring to 20 family healthcare clinics that use contraceptive methods were recruited and PMS questionnaire were administered to them. RESULTS: From 400 subjects, 205 took oral contraceptive pills (hormonal methods of contraception) and 195 used other birth control methods (non-hormonal method). A number of 345 subjects (86.25%) at least experienced one PMS symptom and 55 subjects (13.75%) did not report any symptoms. Of those who use hormonal contraceptives (HCs), 182 (88.8%) reported PMS symptoms and 23(11.2) lacked any symptoms. CONCLUSION: About 86% of the subjects showed moderate to severe of PMS symptoms. Although using hormonal contraceptive method can theoretically reduce PMS symptoms, such effect was not observed in this study. The results of this research should be generalized with caution. Future studies are suggested.