Self-assessment of residents in breaking bad news; skills and barriers.

INTRODUCTION: Breaking bad news (BBN) is inevitable in medicine and is one of the most important and difficult professional tasks of physicians. The main aims of this study are to evaluate residents' practice of BBN and identify perceived barriers to its implementation. METHODS: In this cross-sectional study in 2021, 240 residents from medical, surgical, and emergency medicine departments completed the demographic questionnaire, the Persian SPIKES questionnaire (P-SPIKES), and the researchers-made questionnaire of Barriers to Breaking Bad News (BBBN). In addition, they were asked about their previous experience, previous training, and their perceived level of competence in BBN. RESULTS: 46.5% and 36.84% of residents rated their perceived competence in BBN and managing the patient's emotions during BBN as good or very good, respectively. The most difficult aspects of BBN for residents were expressing upsetting information (78.1%) and not disappointing the patient while being honest (58.3%). The mean and standard deviation of the score of the P- SPIKES was 55.92 ± 6.84. The most common SPIKES item was not giving bad news by phone (98.9%). The SPIKES total score was only related to age (positive relationship). The most commonly reported barriers to BBN were concerns about controlling the patient's emotions (61%) and the aggressiveness of the patient or companions (52.6%). A significant proportion of participants identified lack of training (28%) and insufficient skills (21.9%) as significant barriers to BBN. CONCLUSIONS: The skill of residents in BBN is insufficient in some aspects and points to the need for BBN training courses during residency. BBN is difficult for residents in some aspects and residents may perceive barriers. To overcome the existing barriers and increase residents' confidence in BBN, strategies such as incorporating BBN training into residency educational curricula and communication skills are recommended.

Prevalence and Correlates of Food Addiction in Bariatric Surgery Candidates and Its Effect on Bariatric Surgery Outcome: A Prospective Observational Study.

PURPOSE: Studies have shown a high prevalence of food addiction (FA) in bariatric surgery candidates. This study examines prevalence of FA prior to and one year after bariatric surgery and the determinants of preoperative FA. Additionally, this study investigates how preoperative variables affect excess weight loss (EWL) one year after bariatric surgery. MATERIALS AND METHODS: This prospective observational study included 102 patients at an obesity surgery clinic. Self-report measures, including demographic characteristics, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the Depression Anxiety Stress Scale (DASS-21), and the Dutch Eating Behavior Questionnaire (DEBQ) were used two weeks before and one year after surgery. RESULTS: The FA prevalence among bariatric surgery candidates decreased from 43.6% before surgery to 9.7% one year after surgery. Among independent variables, female gender and anxiety symptoms were associated with FA (OR = 4.20, 95% CI: 1.35-24.16, p = 0.028 and OR = 5.29, 95% CI: 1.49-18.81, p = 0.010, respectively). Only gender had a significant association with %EWL after surgery (p = 0.022); females had a higher mean %EWL than males. CONCLUSION: FA is common among candidates for bariatric surgery, especially in women and participants with anxiety symptoms. The prevalence of FA, emotional eating, and external eating decreased after bariatric surgery.

Repetitive Transcranial Magnetic Stimulation in Delirium: A Double-blind, Randomized, Sham-controlled, Pilot Study.

Introduction: Delirium is a fatal but potentially reversible disorder of the central nervous system that imposes high costs on health systems. This study aims to evaluate the effect of intermittent theta-burst stimulation on the severity and course of delirium disorder. Methods: This is a double-blind, randomized, sham-controlled pilot study. The study participants were randomly allocated into the active (active intermittent theta-burst stimulation) and sham groups. The severity of delirium was assessed 15 minutes before the intervention and 15 minutes after that by the Neelon and Champagne (NEECHAM) confusion scale. Results: In the active group, total and subscale scores of NEECHAM significantly decreased after intervention (P<0.05). Although no statistical difference was found in the control group regarding the subscale scores of NEECHAM, the difference in the total scores before and after the sham intervention was statistically significant. Conclusion: Carrying one session of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex can reduce the delirium severity in a short period, although it will not decrease the number of delirium cases three days after the intervention. Highlights: Delirium is a CNS disorder;Delirium treatment is based on pharmacological and non-pharmacological;rTMS is quasi-modern treatment of neurocognitive disorders. Plain Language Summary: Delirium is fatal but reversible disorder. regarding the restrictions of routine treatments of delirium and by considering the cognition disturbances as the core symptom of delirium, and the positive effect of rTMS on cognition functions. we hypothesized that rTMS could be effective in the treatment of delirium.

Investigation the Effectiveness of Duloxetine in Quality of Life and Symptoms of Patients with Irritable Bowel Syndrome.

BACKGROUND: Selective norepinephrine-serotonin receptor inhibitors (SNRIs) such as duloxetine have already shown beneficial effects on symptoms in irritable bowel syndrome (IBS) patients. The purpose of the present investigation was to assess the efficacy of duloxetine in the symptom and quality of life improvement in diarrhea predominant-IBS (IBS-D) patients. MATERIALS AND METHODS: IN a randomized, double-blind and placebo-controlled study, sixty patients diagnosed with IBS-D (ROM-IV criteria), referred to the gastrointestinal clinic of Rasoul-e-Akram Hospital of Iran university of medical sciences, randomly assigned in the treatment groups, group A: patients who received 135 mg mebeverine tablet twice a day combined with 30 mg duloxetine capsule per day and group B, who received the same regimen, except for placebo capsule once per day instead of duloxetine for twelve weeks. The assessment was performed using the IBS severity index, and IBS quality of life questionnaire (IBS-QOF) at baseline, and weeks 4, 8, and 12 after beginning the treatment. Drug adverse effects and compliance to treatment were evaluated every 2 weeks after starting the treatment. RESULTS: Sixty patients completed the trial. The duloxetine group showed significantly greater improvement on the IBS symptoms (P < 0.001), and the IBS-QOF (P < 0.001) in comparison to the placebo group at the endpoint. CONCLUSIONS: This study showed that adding duloxetine to mebeverine is safe with good efficacy on symptoms and QOL improvement in IBS-D patients. Besides, this study showed that 12 weeks' treatment duration is significantly more effective than 4 weeks' treatment, and drug adverse effects are more prominently seen in the first 2 weeks of treatment.

What Happens to Patients with Bipolar Disorder after Bariatric Surgery? A Review.

Bipolar disorder (BD) patients are at high risk of obesity, which affects their quality of life (QOL). Since there is a high comorbidity between BD and obesity, most BD patients seek surgical intervention for obesity. Nowadays, bariatric surgery (BS) is considered appropriate for carefully selected patients with BD. Evaluations before performing BS and careful follow-up of patients with the bipolar spectrum are highly recommended. This study reviews the effects of BS on the course of BD and, at the same time, assesses the effect of BD on the consequences of the surgery. Our results showed that the number of studies approving the promising impact of surgery on BD was more than those disapproving it. However, more accurate results require more than 3-year follow-ups.

Relationship of personality characteristics and eating attitude with the success of bariatric surgery.

Background: Obesity is a chronic disease that causes several medical and psychiatric complications. There are plenty of pharmacological and non-pharmacological therapies for obesity treatment. Bariatric surgery is one of the most efficient nonpharmacological treatment for morbid obesity; however, several psychological factors affect the success of bariatric surgery. This study aims to evaluate personality characteristics and eating attitude relationship with the success of bariatric surgery. Methods: This study was carried out on 75 patients with obesity who were candidates of bariatric surgery in the obesity clinic of Rasoul-e-Akram Hospital in Tehran. The patients were asked to fill the TCI and EAT-26 questionnaires before and after the surgery. Statistical analyses were performed using the SPSS-23 applying T-test, Mann-Whitney tests and Pearson and Spearman's correlation coefficient. The significance level was set at 0.05. Results: Seventy-five patients, including 13 men and 62 women, were assessed through this study. The mean of the BMI of the participants was 44.7 prior to the surgery and 30 after the operation. Personality characteristics and eating attitudes had no significant relationship with the success of bariatric surgery. Conclusion: Although the eating attitude and personal characteristics of the bariatric surgery candidates before the surgery was not related to the outcome of the surgery, they should be considered in post-operational psychological assessments.

High Frequency of Bipolar Disorder Comorbidity in Medical Inpatients.

Objective: Bipolar disorder is a severe, disabling, and recurring disorder. Some studies have shown that the frequency of bipolar disorder in patients with medical diseases is higher than healthy controls. The aim of this study was to investigate the frequency of bipolar disorders in medically ill patients hospitalized in Iranian general hospitals. Method : In this cross sectional study, 697 inpatients (342 men, 49.1%) from different wards of 3 general hospitals, with the mean age of 39.3+-10, were enrolled in the study using nonprobability sampling. Demographic questionnaire, Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) were used. Inclusion criteria were as follow: informed consent, age 18-65 years, ability to speak Persian, and having at least middle school education. Results: The frequency of bipolar disorder was 12.1% and 20.8% based on BSDS and MDQ, respectively. The results of both tests were positive in 7.9% of hospitalized patients. The frequency of bipolar mood disorder was significantly higher in single patients and in those with comorbidity of alcohol and substance use disorders. Conclusion: Considering the high frequency of bipolar mood disorders in hospitalized medically ill patients and its probable effects on compliance and prognosis, early screening, diagnosis, and treatment of bipolar mood disorders is important in these patients.

Efficacy of Botox versus Placebo for Treatment of Patients with Major Depression.

BACKGROUND: Treatment of major depression is crucial to decrease the burden of disease. Hence, in this study, the efficacy of Botox was compared with placebo for treatment of patients with major depression. METHODS: In this randomized clinical trial, 28 consecutive patients with major depression were enrolled. The patients were randomly assigned to receive either Botox or placebo and the scores of Beck Depression Inventory were determined and compared at baseline and after two and six weeks in the groups and between the groups. In addition, the drug adverse effects were compared between groups. This study had been registered in TCTR with TCTR20170409001 code. RESULTS: There was a statistically significant difference two group for 6th week Beck Score (P=0.004), but at baseline and after two weeks, there was no significant difference (P>0.05). None of the patients experienced side effects. CONCLUSION: Finally, Botox is effective for treatment of patients with major depression and it has a high safety.

Demographic and Diagnostic Features of 3147 Inpatients With Mood Disorders in Iran.

OBJECTIVES: To assess and compare demographic and diagnostic characteristics of inpatients with mood disorders in Iran. MATERIALS AND METHODS: We collected the demographic, clinical, and treatment characteristics of patients, who were hospitalized during five years from April 2006 to March 2010, in Iran hospital of psychiatry, a residency training center to evaluate the general clinical picture of the disorder. RESULTS: Overall, 95.3% of subjects had a diagnosis of bipolar I disorder (BID), 2.5% were diagnosed as bipolar II disorder (BIID) and 1.3% and 0.9% met the criteria for major depressive disorder (MDD) and bipolar not otherwise specified (NOS), respectively. Compared to patients with MDD and BIID, the onset of BID was at an earlier age (32.2 ± 1, 34.8 ± 1.5 and 29.9 ± 1.9 years old, respectively, P < 0.001). In addition, a number of admissions, mean duration of each admission and number of treatments with electro-convulsive therapy (ECT) were significantly higher in patients with BID. CONCLUSIONS: Bipolar I disorder was the most common diagnosis for inpatients with mood disorders and a more severe course in BID may indicate more severe impairments that would result in more severe disabilities.

Comparison Between Marital Satisfaction and Self-Esteem Before and After Bariatric Surgery in Patients With Obesity.

BACKGROUND: Obesity is one of the most common chronic diseases with important medical effects, as well as mental and social health problems. Bariatric surgery is one of the most effective treatments of morbid obesity. OBJECTIVES: Because of the possible psychological changes, and its effects on weight loss after surgery, the current study aimed to compare marital satisfaction and self-confidence in patients with obesity before and after bariatric surgery in Rasoul-e-Akram hospital in 2013. MATERIALS AND METHODS: This prospective observational study was conducted on 69 candidates for bariatric surgery. Marital satisfaction and self-confidence were assessed before and six months after the surgery by Enrich marital satisfaction scale and Coopersmith self-esteem inventory. Descriptive statistics and T-tests were utilized to analyze data. Values of P ≤ 0.01 were considered statistically significant. RESULTS: Despite the improvement of sexual relationship, marital satisfaction scores significantly decreased from141.26 ± 12.75 to 139.42 ± 12.52 six months after the surgery (P = 0.002). Satisfaction in scales of conflict resolution and communication showed a descending pattern (P < 0.001). No significant difference was found between self-esteem before and after the surgery (P = 0.321). CONCLUSIONS: Weight loss after bariatric surgery did not improve self-esteem and marital satisfaction six months post operatively; therefore, psychiatric assessment of patients before and after the surgery is crucial; since even if they are not associated with prognosis of the surgery, it is important to provide treatment for psychiatric problems. Prospective studies are recommended to assess post-operative changes of other psychological aspects.

Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis.

BACKGROUND: Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients' survival rates. OBJECTIVES: This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. PATIENTS AND METHODS: In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5%) with the mean age of 55.7 ± 17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chi-square test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. RESULTS: The prevalence rates of depression and anxiety (HADS score ≥ 8) were 31.5% and 41.7%, respectively. The prevalence of both conditions was significantly higher in women than in men (P < 0.05). The mean values of Kt/V and URR were not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. CONCLUSIONS: Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy.

Comparing the Excessive Daytime Sleepiness of Obese and Non-obese Patients.

BACKGROUND: Obesity, particularly morbid obesity, has various physical and mental complications. Excessive daytime somnolence (EDS) is a sleep disorder that reduces individuals' performance capability and the accuracy of their short-term memory and causes learning problems. This retrospective study aimed to document the presence of EDS in a sample of obese patients in comparison to patients with a normal weight. OBJECTIVES: This article compares the excessive daytime sleepiness of obese and non-obese patients in the minimally invasive surgery research center in Tehran, Iran. PATIENTS AND METHODS: In this case-control study, we compared excessive daytime sleepiness in 55 obese patients who were candidates for laparoscopic surgery, with a body mass index (BMI) of equal to or greater than 30 kg/ m2, with 55 controls with a normal BMI (19.5 - 24.9 kg/ m2). The process of selecting the control group in our case-control study is matching in group levels, so that the controls are similar to the case group with regard to certain key characteristics, such as age, sex, and race. The sleep assessment was based on the Epworth sleepiness scale (ESS) questionnaire. Analysis of variance (ANOVA) was used to compare the means of quantitative data, such as the ESS score of groups. RESULTS: Sleepiness was not affected by gender in cases or controls. The sleepiness prevalence was 29 (52.7%) in the cases group and 17 (30.9%) in the control group (OR = 2.493 (95% CI 1.144 -5.435)). The mean ESS scores in cases and controls were 7.82 ± 3.86 and 10.54 ± 6.15, respectively (P = 0.007). Moreover, the prevalence of sleepiness and the mean ESS scores in class III of obesity differed significantly from the controls (16 (57.1%) vs. 17 (30.9%)) (OR = 2.980 (95% CI 1.162 - 7.645)) and (11.04 ± 5.93 vs. 7.82 ± 3.86) (P = 0.013), respectively. CONCLUSIONS: Our findings suggest a strong relationship between EDS and obesity, particularly morbid obesity. Therefore, physicians must be familiar with EDS as a mixed clinical entity indicating careful assessment and specific treatment planning.

Repetitive Transcranial Magnetic Stimulation in Resistant Visual Hallucinations in a Woman With Schizophrenia: A Case Report.

A 29-year-old woman with schizophrenia introduced for application of repetitive transcranial magnetic stimulation for refractory visual hallucinations. Following inhibitory rTMS on visual cortex she reported significant reduction in severity and simplification of complexity of hallucinations, which lasted for three months. rTMS can be considered as a possibly potent treatment for visual hallucinations.

Comparison of Demographic and Diagnostic Characteristics of Iranian Inpatients With Bipolar I Disorder to Western Counterparts.

BACKGROUND: Patients' characteristics influence the disorders outcome, so it is valuable to compare mood disorders and inpatients' attributes in different large samples. OBJECTIVES: This study was designed to assess demographic and diagnostic characteristics of 3000 Iranian inpatient with bipolar disorders. PATIENTS AND METHODS: We collected the information of demographic, clinical, and therapeutic characteristics of the patients who were hospitalized in Iran Hospital of Psychiatry, a university affiliated hospital in Tehran, during the 5 years from 2006 to 2011. RESULTS: About 66.1% of the subjects were males and 33.9% were females. Iranian patients are characterized by a higher rate of unemployment, being more single, having health insurance and lower rate of divorce and education compared to the other clinical samples. In the majority of the patients, the disorder had begun with manic phase. CONCLUSIONS: Clinical and therapeutic features of Iranian patients are different from patients in western countries.

Quality of sleep for hospitalized patients in Rasoul-Akram hospital.

BACKGROUND: Sleep disturbances have negative effects on medical conditions, mental health and cognitive performance. It was shown that about 60% of inpatients suffer from sleep problems. The aim of this study was to assess the correlation between sleep quality and other factors in the inpatients of Rasoul-e-Akram hospital. METHODS: In this cross-sectional study, all the hospitalized patients in twelve wards of Rasoul-e-Akram hospital during September 2012, were examined. Sleeping habits of 209 inpatients of different wards were assessed through the Persian version of Pittsburgh Sleep Questionnaire (PSQI). A self-designed 18- question questionnaire was conducted for all patients in order to assess their attitude to interior and atmosphere of wards. Content validity and test retest reliability were evaluated. The pain level was also measured by the visual analog scale (VAS) and scores analyzed by the statistical methods of frequency, percentage, chi-square and logistic regression. RESULTS: The mean of the total scores in PSQI was 8.8±4.8 and 70.8% of the patients were 'poor sleepers' (global PSQI> 5). Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication and attitude toward the overall atmosphere and interior of wards have caused deviation in scores. CONCLUSION: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.

Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria.

Objectives. Cooccurring psychiatric disorders influence the outcome and prognosis of gender dysphoria. The aim of this study is to assess psychiatric comorbidities in a group of patients. Methods. Eighty-three patients requesting sex reassignment surgery (SRS) were recruited and assessed through the Persian Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Results. Fifty-seven (62.7%) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%) were the three most prevalent disorders. Conclusion. Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity.

The Relationship between Major Depressive Disorder and Personality Traits.

OBJECTIVE: The aim of this study was to compare the clinical temperaments and characters of Iranian patients with Major Depressive Disorder (MDD) with healthy controls. METHOD: The study participants included 47 outpatients with Major Depressive Disorder (MDD) and 120 normal controls with no psychiatric disorders. Sampling method was convenience. The MDD patients were diagnosed as MDD by a psychiatrist using the Persian structured clinical interview for axis I disorders (SCID-I), and they completed at least 8 weeks of antidepressant treatment. All the patients filled out the Persian version of the Temperament and Character Inventory (TCI). Data were analyzed using SPSS version 17, Chi square, T test and Multiple Regression. The level of significance was set at 5%. RESULTS: The present study demonstrates a link between depression and lower persistence (p≤0.001), self-directedness (p≤0.001) and cooperativeness (p≤0.001) scores. A negative correlation between age and Harm Avoidance (p≤0.001) was observed in both groups. CONCLUSION: Lower scores of persistence (P), self-directedness (SD) and cooperativeness (CO) were observed in patients with depression more than controls even in the remission phase which could indicate a relationship between these traits and depression.

The comparison of severity and prevalence of major depressive disorder, general anxiety disorder and eating disorders before and after bariatric surgery.

BACKGROUND: Severe obesity is highly co-morbid with psychiatric disorders and may have effect on the quality of life. This study aimed to compare severity and prevalence rate of depression, anxiety and eating disorders and quality of life in severe obese patients before and 6 months after the gastric bypass surgery. METHODS: This was a prospective observational study which conducted at Hazarat Rasool-Akram Hospital in Tehran, 2012. Questionnaires included demographic questions, eating disorder Inventory (EDI), The Short Form Health Survey (SF-36) for quality of life, Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) and Hamilton Rating Scale for Depression (HRSD) and anxiety (HRSA). Participants were interviewed two times, before surgery and six months after, to determine changes of the disorders. Patients with the history of bariatric surgery, individuals younger than 18 year old and those who disagreed to join the study were excluded. RESULTS: In assessing the eating disorder inventory-3rd version (EDI-3), Significant reduction in drive for thinness (DT) (p= 0.010), bulimia (B) (p< 0.0001) and body dissatisfaction mean (BD) (0.038) was observed at the 6-month follow-up. At this period, the mean for physical component summary of SF36, significantly decreased (p< 0.0001), however mental component summary did not significantly differ (p= 0.368); Also differences in severity of anxiety (p= 0.852), and depression in HRSD (p= 0.311), prevalence of depression (p= 0.189) and prevalence of general anxiety disorder according to SCID (p=0.167) did not differ significantly, at this period. CONCLUSION: Although weight loss after bariatric surgery improved the physical component of quality of life, this improvement did not affect the mental aspect of life, depression and anxiety and it seems that these psychopathologies need attention and treatment in addition to weight loss treatments in patients with obesity.

Comparison of Temperament and Character in Major Depressive Disorder Versus Bipolar II Disorder.

OBJECTIVE: The aim was to determine how personality of major depressive disorder (MDD) patients is different from that of bipolar II disorder (BIID) patients. METHODS: In this cross-sectional study, two groups of patients with MDD (47 patients) and BIID (45 patients) between 18 and 55 years old were included and compared. The research instrument that subjects answered to was Temperament and Characteristic Inventory-125-R. RESULTS: Among temperament dimensions, novelty seeking, and reward-dependently in contrast with other traits such as harm avoidance and persistence showed a significant difference between the two studied groups. Among characteristic dimensions, self-direction and self-transcendence demonstrated a significant difference between the two groups (p < 0.005). CONCLUSION: Patients suffering from BIID are sensation seeker and are motivated by stimulates more often than MDD patients are. They feel euphoria more and, find the world more stimulating.

The Relationship between Attention/Vigilance and Symptom Severity in Schizophrenic Patients.

OBJECTIVE: In schizophrenia, neurocognitive functions are one to two standard deviations below the normal controls and these deficits have a significant relationship with overall functioning and poor outcome. According to this fact, it is important to investigate the factors that effect neurocognition in schizophrenic patients. This study was carried out to demonstrate the relationship between attention/vigilance and some demographic and clinical variables in Iranian schizophrenic patients. METHODS: This was a cross-sectional study; the participants were 60 Iranian schizophrenic patients. They were assessed using the Positive and Negative Syndrome Scale, and the Continuous Performance Test. RESULTS: No significant relationship was found between gender, age, education, Positive and Negative Syndrome Scale scores and CPS scores. CONCLUSIONS: Our findings suggest that contrary to some domains of cognitive functions, in schizophrenia, attention/vigilance is not influenced by severity of symptoms.