Prevalence, Incidence and Health Impacts of Sleep Disorders on Coronary Artery Disease Risk Factors: Results of a Community-Based Cohort Study (KERCADRS).

Objective: Sleep disorders are associated with many health problems including anxiety, depression and coronary artery disease (CAD). This study investigated the prevalence, predictors and health impacts of insomnia and hypersomnia in southeastern Iran as well as the five-year incidence rate (IR) of these sleep disorders. Method : The present study was a cross-sectional, single-stage, cluster sampling study examining nine CAD risk factors (KERCADR study phase two), including sleep disorders, carried out in Kerman on 9997 participants, 15 to 80 years old. Medical examination along with demographic, sleep status, Physical activity level (GPAQ), anxiety and depression status (Beck Inventories) were assessed and fasting blood sample was taken for blood glucose and lipids analysis. STATA v15 software was used for data analysis using survey data analysis package and a univariable survey logistic regression model. Results: From 9997 participants, 59.4% were female. 45.3% of the participants were suffering from insomnia and hypersomnia, which was 15% more than the phase 1 prevalence (P < 0.001). Participants with insomnia had higher chance of being anxious, but participants with hypersomnia had higher chance of being depressed, be a cigarette smoker, opium user, and sedentary (P < 0.001). In regards to marital status, prevalence of hypersomnia was as follows in ascending order of prevalence: singles > married > widowed > divorced. While the IR of insomnia was higher in females, males had higher IR of hypersomnia. In addition, the IR of both sleep disorders was higher in participants with Low Physical Activity (LPA). Conclusion: The results showed high current prevalence and increasing trends of sleep disorders in the past five years. If left unaddressed, burden of CVDs in the community will demonstrate a significant increase in the future as a result of sleep disorders and other associated risk factors.

Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients.

BACKGROUND: Psychological disorders, such as depression and anxiety, are common among individuals who have experienced coronavirus disease 2019 (COVID-19); however, diagnosis may be challenging and subjected to invalidity. This study aimed to examine agreement between online self-assessment and psychiatric telephone interview among COVID-19 survivors. MATERIALS AND METHODS: This cross-sectional descriptive study was carried out from March to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID-19 were contacted within the first week after discharge and were asked to fill the Hospital Anxiety and Depression scale (HADS) and socio-demography questionnaire. They were later interviewed using Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Agreement between the data extracted from self-report and telephone interview was analyzed using Cohen's kappa coefficient, sensitivity, and specificity. RESULTS: Out of 200 post-COVID patients, 60 participants completed all assessments. Prevalence of depression was observed to be 88% via telephone interview and 45% via self-assessment. Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview, in comparison to 31% diagnosed with anxiety using self-report questionnaire. The agreement between online self-assessment and telephone interview for depression and anxiety was not significant (κ = 0.08 and κ = 0.1, respectively). CONCLUSION: The discordance between online self-report and clinician's assessment via phone contact interview indicates that using self-report evaluations is not sufficient as the single assessment tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis of psychiatric problems in pandemics.

Trends in the prevalence and incidence of anxiety and depressive symptoms in Iran: findings from KERCADRS.

OBJECTIVES: Anxiety and depression (A&D) are common mental disorders with high economical and health burdens. This study aimed to investigate the prevalence and the incidence rate of A&D symptoms and their relationship with sociodemographic and other risk factors and comorbidities in adults living in southeastern Iran. DESIGN: A population-based cohort study with random cluster household survey sampling method. SETTING: Second round of Kerman Coronary Artery Disease Risk Factors Study (KERCADRS) (2014-2018) performed in Southeastern, Iran. PARTICIPANTS: We recruited 9997 participants (15-80 years) in the second round of the study, from whom 2820 persons were the people who also participated in the first round of KERCADRS in 2009-2012. The age-standardised A&D prevalence was measured among all participants, and the 5-year A&D incidence rate was measured in those who were free from A&D in the first round in 2009-2012 and were at risk of A&D in the follow-up. The relationship between A&D and demographic characteristics, smoking, opium use, obesity and physical activity was assessed by logistic regression models. RESULTS: Overall, the prevalence of anxiety (48.1% to 16.4%, p<0.001) and depression (5.9% to 1.3%, p<0.001) decreased between the two rounds. The highest prevalence of anxiety was among widowed (31.4%), unemployed (21.3%), obese (19.4%), and opium users (17.4%). Young adults, women, those divorced or widowed, and those with obesity and low physical activity had a higher chance of developing anxiety. The 5-year incidence rate (person/1000 person-years) was 15.0 for anxiety and 3.9 for depression. CONCLUSION: Despite the overall decrease in the prevalence of A&D symptoms in last 5 years in the area, young adults, women, unemployed, opium users, people with low physical activity and those with obesity had a higher chance of developing anxiety and are in need of more targeted interventions.

The Efficacy of Probiotics for Treatment of Bipolar Disorder-Type 1: A Randomized, Double-Blind, Placebo Controlled Trial.

Objective: Bipolar disorders are among the most common chronic mental disorders. Despite the recent improvement in controlling psychiatric disorders, treatment of bipolar disorders remains a challenge. The aim of this study was to determine the effect of consuming probiotics in patients with bipolar disorder-type 1 compared to the placebo group. Method : This was a permuted blocked randomized clinical trial conducted in Shahid Beheshti mental hospital in Kerman, Iran, from October 2017 to October 2018. Two psychiatrists diagnosed and hospitalized all 38 patients with type 1 bipolar disorder based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Using blind randomized blocking method size 4, patients were divided into 2 groups of placebo and probiotic. Young Mania Rating Scale (YMRS) and Hamilton's Depression Rating Scale (HDRS) were completed at the beginning, week 4, and week 8 of the study by a psychiatry resident. Independent t test, Mann-Whitney and repeated measures ANOVA tests were used. Data were analyzed using SPSS software version 20. Results: There was no significant difference between the 2 groups in age, sex, and severity of mania and depression. Consumption of probiotics reduced the scores of YMRS and HDRS over time in the probiotic group more than the placebo group, but it was not significant. Conclusion: Consumption of probiotics had non-significant effects on improvement and treatment of bipolar type 1 patients. It is suggested that future studies be conducted with different probiotic microbial strains and longer period of treatment.

A double blind randomized clinical trial of buprenorphine augmentation for treatment of psychotic symptoms in opioid addicted bipolar patients.

OBJECTIVE: To assess the efficacy of buprenorphine augmentation in treatment of psychotic symptoms in bipolar disorder type I. DESIGN: Bipolar type I patients with manic or depressive episodes and psychotic feature and with opioid dependency comorbidity were randomly included and allocated. Both groups of buprenorphine (4 or 6 mg/d) and placebo were also treated with enough dosages of sodium valproate and risperidone. Psychosis as primary outcome and depressive and manic symptoms as secondary outcome were assessed at baseline and after 1 and 2 weeks. Data were analyzed through t test and repeated measure ANOVA. RESULTS: Twenty-four patients remained in each group. Both groups displayed significant reduction in psychotic, depressive, and manic symptoms during the 2 weeks of study, although there was not any significant difference between them. CONCLUSIONS: Buprenorphine did not add any efficacy to usual treatment of psychotic episodes of bipolar, although did not aggravate psychiatric symptoms.

When Thoughts Are in a Race: Area 10 and Bipolar Disorders.

Racing thought, when patients incessantly shift from one word or sentence to another while pending previous ones unfinished, is a symptom of (hypo)mania in bipolar disorders received less attention hitherto. Here, based on few evidence, we aim to unfold our hypothetical viewpoint that the frontopolar cortex that is believed to play a part in multitasking and management of competing goals might be dysfunctional in bipolar patients and may contribute in induction of flight of ideas. We then address new avenues for future research and try to encourage researchers to design more comprehensive studies to either accept or decline this proposed conjecture.

The Relationship between Extrinsic and Intrinsic Religious Orientation with Perceived Stress and Cigarette Addiction among University Students.

BACKGROUND: Psychological stress is associated with unhealthy lifestyles, including smoking. Moreover, religious beliefs can play a significant role in relieving mental disorders such as anxiety and stress. Due to the frequent exposure of medical students to stressful situations, this study was conducted with the aim to investigate the relationship of internal and external religious orientation with perceived stress and nicotine dependence. METHODS: This correlational study was carried out on medical students of Kerman University of Medical Sciences, Kerman, Iran, in 2015. The sample size was determined to be 224 individuals using the Morgan table. The participants were selected using stratified random ýsampling. The data collection tools consisted of a demographic information form, the Religious Orientation Scale (ROS) (Allport and Ross), the Perceived Stress Scale (PSS-14), and the Fagerstrom Test for Nicotine Dependence (FTND). Data were analyzed using multiple regression analysis, analysis of variance (ANOVA), Pearson correlation coefficient, and t-test in SPSS software. FINDINGS: The findings of the study showed that internal religious orientation had a significant negative relationship with perceived stress and nicotine dependence; however, no significant relationship was observed between external religious orientation and these variables. CONCLUSION: Based on the results of the study, it can be concluded that the religious beliefs of individuals have a preventive role in perceived stress and nicotine dependence.

Bipolar disorder and the endocannabinoid system.

OBJECTIVE: Bipolar disorder (BD) is a debilitating, lifelong neuropsychiatric illness characterised by unsteady mood states which vacillate from (hypo)mania to depression. Despite the availability of pharmaceutical agents which can be effective in ameliorating the acute affective symptoms and prevent episodic relapse, BD is inadequately treated in a subset of patients. The endocannabinoid system (ECS) is known to exert neuromodulatory effects on other neurotransmitter systems critical in governing emotions. Several studies ranging from clinical to molecular, as well as anecdotal evidence, have placed a spotlight on the potential role of the ECS in the pathophysiology of BD. In this perspective, we present advantages and disadvantages of cannabis use in the management of illness course of BD and provide mechanistic insights into how this system might contribute to the pathophysiology of BD. RESULTS: We highlight the putative role of selective cannabinoid receptor 2 (CB2) agonists in BD and briefly discuss findings which provide a rationale for targeting the ECS to assuage the symptoms of BD. Further, data encourage basic and clinical studies to determine how cannabis and cannabinoids (CBs) can affect mood and to investigate emerging CB-based options as probable treatment approaches. CONCLUSION: The probable role of the ECS has been almost neglected in BD; however, from data available which suggest a role of ECS in mood control, it is justified to support conducting comprehensive studies to determine whether ECS manipulation could positively affect BD. Based on the limited available data, we suggest that activation of CB2 may stabilise mood in this disorder.

Prevalence of anxiety and depression symptoms and their relationship with other coronary artery disease risk factors: A population-based study on 5900 residents in Southeast Iran.

INTRODUCTION: Anxiety and depression are reported as the most prevalent psychiatric disorders worldwide. Here, we studied the prevalence of such disorders with co-morbidities of coronary artery disease (CAD) risk factors in an urban population in Iran. METHODS: 5900 people were selected from 15 to 75-years-olds through single-stage cluster sampling. In addition to examining them for CAD risk factors, Beck anxiety and depression inventories were used to measure anxiety and depression symptoms. The standardized population prevalence of such disorders is reported and the predictors of having anxiety or depression were assessed using Poisson regression model. RESULTS: Overall 25.4% had moderate and 22.7% had severe anxiety. Severe anxiety significantly and constantly increased by age groups (p=0.01). The risk for anxiety was higher among females (Adjusted Risk Ratio, ARR 1.2), and those who were student/soldier (ARR 1.07). Those with high level of physical activity were at lower risk for anxiety (ARR 0.92). The risk of depression (any level) was higher among females (ARR 1.3), those holding high-school level of education (ARR 1.41), and those who used opium either occasionally (ARR 1.17) or frequently (ARR 1.3). Both anxiety and depression were significantly associated with two main CAD risk factors, low physical activity and opium use. CONCLUSION: We found that the majority of residents in Kerman, particularly women, are suffering from mild to server depression and anxiety symptoms. Public health interventions to increase public awareness on such symptoms, screening and delivery of prevention and treatment services are required to prevent from the growing burden of such disorders and cardiovascular diseases.

Assessment of Cognitive Functions in Methadone Maintenance Patients.

BACKGROUND: Methadone maintenance has received little scientific attention regarding neurocognitive effects. This study is aimed to assess the neuropsychological performance of methadone maintenance patients (MMP) compared to those healthy controls. METHODS: Thirty-five MMP and 35 healthy controls, matched for age, gender, education and employment status, examined on a battery of tests aimed at assessing verbal fluency, executive functions, verbal memory, and working memory, using controlled oral word association test (COWAT), trial making test (TMT) Part A and B, Rey auditory verbal learning test (RAVLT), and backward digit span. FINDINGS: MMP performed significantly poorly than controls in cognitive domains of verbal fluency, executive function, and verbal memory. MMP did not exhibit impairment in working memory, and TMT Part A compared to controls. CONCLUSION: These results suggest that methadone consumption induces significant cognitive impairment that could compromise drug-treatment outcomes in MMP.

Patterns of psychotropic medication prescriptions by psychiatrists for private clinic outpatients in kerman province, iran.

OBJECTIVES: The aim of this study was to assess the pattern and utilisation of psychotropic drug prescriptions by psychiatrists in Kerman Province, Iran. METHODS: The prescriptions of 27 psychiatrists were randomly selected from two Iranian public insurance organisations and were analysed for the mean number of drugs/prescriptions, drug category and the most frequently prescribed drug in each category as well as overall. RESULTS: A total of 6,414 prescriptions were analysed. The mean number of drugs per prescription was 2.9. Antidepressants (61.0%) were the most frequently prescribed category of psychotropic medications, followed by antipsychotics (29.5%), sedative/hypnotics or anti-anxiety drugs (27.5%) and mood stabilisers (18.5%). The combination of antidepressants with antipsychotics was the most commonly prescribed combination (18.8%). Fluoxetine (16.5%) and trifluoperazine (13.5%) were among the most frequently prescribed antidepressants and antipsychotics, respectively. Clonazepam (10.5%) was the most commonly prescribed benzodiazepine agent, followed by alprazolam (8.5%). In terms of total drug utilisation, sertraline (12.4%) was the most commonly used psychotropic medication followed by fluoxetine (9.7%), trifluoperazine (6.6%), propranolol (4.5%) and clonazepam (3.7%). CONCLUSION: A high proportion of psychotropic prescriptions in Kerman Province were for antidepressants, followed by antipsychotics and the benzodiazepines. Further research is needed to determine the underlying correlation between prescription practice and the diagnosis and patient characteristics, as well as to investigate the use of different psychotropic medications.

Diagnostic stability of psychiatric disorders in re-admitted psychiatric patients in Kerman, Iran.

BACKGROUND: Several studies have evaluated the stability of psychiatric diagnosis follow in readmission of patients in psychiatric hospitals. However, there is little data concerning this matter from Iran. This study is designed to evaluate this diagnostic stability of the commonest psychiatric disorders in Iran. OBJECTIVES: The objective of this study was to determine the long-term diagnostic stability of the most prevalent psychiatric disorders among re-admitted patients at the Shahid Beheshti teaching hospital in Kerman, Iran. PATIENTS &METHODS: This study was based on 485 adult patients re-admitted at the Shahid Beheshti hospital between July and November 2012.All of the diagnoses were made according to DSM IV TR.Prospective and retrospective consistency and the ratio of patients who were obtained a diagnosis in at least 75%, 100% of the admissions were calculated. RESULTS: The most frequent diagnoses at the first admission were bipolar disorder (48.5%) and Major depressive disorder (18.8%). The most stable diagnosis was bipolar disorder (71% prospective consistency, 69.4% retrospective consistency). Schizoaffective disorder had the greatest diagnostic instability (28.5% prospective consistency, 16.6% retrospective consistency). CONCLUSIONS: Among the cases evaluated, bipolar disorder had the most stability in diagnosis and the stability of schizoaffective disorder was poor.