Evaluating the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A Preliminary Study.

Objective: Despite accumulated evidence that demonstrates clinical outcome of telepsychiatry is comparable with conventional method; little research has been done on telepsychiatry in developing countries. This study aimed to evaluate the diagnostic agreement between telepsychiatry assessment and face-to-face assessment. Moreover, patient and doctor satisfaction was assessed by self-report questionnaire. Method : This study was conducted in an inpatient department of a university-affiliated hospital in Kerman University of Medical Sciences, Iran. The study sample consisted of 40 inpatients aged over 18 years who were selected from October 2016 to February 2017. All patients were visited onc e by face-to-face conventional method and once by interactive video teleconsultation by 2 psychiatric consultants. Results: Results of this study revealed that the diagnostic agreement between the 2 interviewers was 75%. Moreover, about 85% of the patients preferred telepsychiatry for follow-up visits. Also, more than 82% of the patients would recommend telepsychiatry to others although 95% of them perceived contact via telepsychiatry as uncomfortable to some extent. Conclusion: Telepsychiatry service can be used for psychiatric evaluation in Iran, and it has a desirable effect on patient and doctor satisfaction. The results of this study showed the capacity of moving towards using telepsychiatry.

Effectiveness of Electroconvulsive Therapy in Persistent Methamphetamine Psychosis: A Pilot Study.

BACKGROUND: Persistent methamphetamine (METH) psychosis is a psychotic state beyond 1-month after abstinence, for which there is no effective treatment. This study aimed to evaluate the effectiveness of electroconvulsive therapy (ECT) in persistent METH psychosis patients hospitalized at Shahid Beheshti Hospital, Kerman, Iran, from 6 September 2012 until 6 September 2013, who were not remitted after treatment with olanzapine. METHODS: This research was a pilot study on hospitalized patients. After 4 weeks of treatment with olanzapine, 10 out of 71 studied patients did not show complete remission of psychotic symptoms despite their response to the treatment. The mentioned 10 patients were divided into 2 groups by random digit numbers. 5 patients had continued olanzapine and other 5 received 6 sessions of bilateral ECT every other day in addition to olanzapine. FINDINGS: Remission rate of patients in the initial 4 weeks was 78.7%. Reduction in total brief psychiatric rating scale (BPRS) scale at the end of 1-week compared with the next week demonstrated improvement in the symptoms until the end of the study. There was no significant difference in BPRS scores between weeks 4 and 6 in the two groups. CONCLUSION: This research demonstrated that few sessions of ECT in persistent METH psychosis will not lead to remission in all patients.

A study of the phenomenology of psychosis induced by methamphetamine: a preliminary research.

BACKGROUND: Psychotic disorder due to industrial drug, such as methamphetamine addiction, is one of the important causes for referral to psychiatric hospital. Psychotic symptoms in these patients are varied. A group of researchers believe that methamphetamine-induced psychosis is completely similar to schizophrenia. Others believe that at least some cases of permanent psychotic clinical manifestation due to methamphetamine abuse are different from schizophrenia. In the present study, the existence of differences between psychotic symptoms caused by methamphetamine addiction and schizophrenia is investigated. METHODS: This study was a qualitative study. Patients with psychosis due to methamphetamine addiction were selected from among patients who were hospitalized in hospitals of the Kerman University of Medical Sciences, Iran. All patients were interviewed using unstructured interview based on self- reporting. Interviews were recorded and reviewed later. FINDINGS: Based on clinical observations, some of the patients with psychotic disorder due to methamphetamine showed rare symptoms that had been mostly reported in psychosis due to organic disorders and some of them showed symptoms that had not been reported before. CONCLUSION: This study showed that in a group of patients with methamphetamine-induced psychosis, clinical manifestation is different from schizophrenia.

Effect of Cultural Themes on Forming Cotard's Syndrome: Reporting a Case of Cotard's Syndrome with Depersonalization and Out of Body Experience Symptoms.

OBJECTIVE: Cotard's syndrome is a rare psychiatric syndrome. Its core symptom is nihilistic ideation or delusion. CASE REPORT: A female patient with Cotard's syndrome symptoms associated with out of body experience and depersonalization, and complicated grief was referred for evaluation. She believed that she was killed by a creature named "Aal" in the Persian folklore Conclusions: Cultural and superstitious beliefs could affect the forming of the complex constellation of the patient's symptoms including Cotard's syndrome symptoms. The resolution of symptoms might be achieved step by step. DECLARATION OF INTEREST: None.

Suicide in narcotic drugs dependents.

BACKGROUND: The problem of addiction is one of the four global crises. These patients are more vulnerable to mental disorders. This study aimed to examine the risk of suicide in drug dependent patients. METHODS: In this cross-sectional study, patients who referred for addiction treatment were selected and the control group was chosen among their companions who did not have narcotic drugs dependence. Suicide risk was assessed through California Suicide Risk Assessment Questionnaire. Beck's Depression Inventory questionnaire was used to assess the depression level. FINDINGS: The comparison of average education (P < 0.01) and the unemployment rate (P = 0.03) and previous attempted suicide (P = 0.01) between the narcotic drug dependent group and control group showed a statistically significant difference. Suicide risk score (P < 0.01) and depression score (P < 0.01) differences were statistically significant. The average scores of depression score in addicts was significantly associated with their previous attempted suicide (P = 0.01). In the control group, there was a significant association in suicide score and depression score with their previous attempted suicide (P < 0.01). Suicide score were compared based on the depression degree in both groups and statistically significant differences were found (P < 0.01). CONCLUSION: The suicide risk and depression in drug addicts are more than general population and they are closely related to each other.

The Risk of Suicide according to Drug Abuse and Nicotine Dependence in Patients with War Injuries and Chronic Traumatic Stress Disorder.

BACKGROUND: The incidence of suicide is higher in individuals with post-traumatic stress disorder (PTSD) than the general population. This prevalence rate is related to many factors including drug dependence. This study was conducted in people wounded during the Iran-Iraq war with PTSD, in order to compare the risk of suicide in those with and without drug and nicotine dependence. METHODS: This cross-sectional study, conducted in 2007-2008, comprised 104 male individuals who had participated in the Iran-Iraq war and had a current diagnosis of PTSD. They had been referred to a psychiatry hospital and the psychiatrists' offices in Kerman, Iran. Three questionnaires were used including Davidson Trauma Scale, California Risk Estimator for Suicide and the Fagerstrom Test for Nicotine Dependence to assess the severity of PTSD, the risk of suicide, and nicotine dependence, respectively. Data were analyzed by descriptive and analytical statistics using chi-square, regression, analysis of variance (ANOVA), student-t and correlation tests. FINDINGS: The severity of PTSD was significantly different in individuals with low to moderate dependence on cigarette smoking than in those with heavy dependence on smoking (P = 0.002). However, the corresponding figures were not significantly different in individuals with and without substance abuse. Although the risk of suicide had no significant difference among individuals with low to moderate dependence on cigarettes compared to those with high nicotine dependence, it was higher in subjects with substance abuse than in those without it (P = 0.0001). CONCLUSION: Our findings suggest that dependence on cigarettes may not play a role in increasing the risk of suicide, whereas the dependence on opium and its derivatives may increase this risk. Therefore, prevention and treatment of drug abuse may be effective on the incidence of suicide in patients with war injuries and PTSD.

Identity disturbance and substance-dependence in patients with borderline personality disorder.

BACKGROUND: Identity disturbance is one of the DSM-IV criteria for borderline personality disorder, but there has been little attention to its nature. Four subsets of identity disturbance (role absorption, painful incoherence, inconsistency and lack of commitment) have been assessed. This study aimed to assess the role of these subsets in patients with borderline personality disorder and to examine the relationship between identity disturbances and substance-dependence. METHODS: This case-control study was conducted on 40 patients with borderline personality disorder who were referred to Shahid Beheshti Hospital in Kerman from 2004 to 2005 and 40 healthy people who were matched with the case group in term of gender and educational level. Data gathering was carried out with three questionnaires including a demographic-related questionnaire, disturbance questionnaire (including 35 items) and a questionnaire related to substance-dependence and its related factors. Statistical analysis was performed using SPSS 11 for Windows, t test and ANOVA. FINDINGS: The mean score of 33 items of the identity disturbance questionnaire were greater with significant difference in the case group (P<0.05). The means differences in the two groups in all subsets were statistically significant, except for role absorption (P<0.05). The means differences in all subsets in substance-dependent and substance-independent subjects in both groups were not significant statistically. The most common substance-dependence in both groups was related to cigarette smoking and cannabis. Opium and cannabis dependence was significantly greater in patients with borderline personality disorder. CONCLUSION: Identity disturbance is one of the major criteria for borderline personality disorder, but in different societies the role of its subsets are different. On the other hand, assessing subsets of identity disturbance has no value in assessing substance-dependence in patients with borderline personality disorder.

Comparative Evaluation of Psychiatric Disorders in Opium and Heroin Dependent Patients†This article has been published in the Journal of Rafsanjan University of Medical Sciences in Persian language.

BACKGROUND: Opium dependency is an important health problem in Iran. Several studies show that most opium dependent patients have concomitant psychiatric disorders. The aim of this study was evaluation of psychiatric disorders in opium dependency in comparison with heroin dependency. METHODS: This is a descriptive study on 192 male opium dependent patients who were admitted in dual- diagnosis ward of Beheshti Hospital in Kerman for detoxification. After evaluation of their demographic data, they were assessed by means of SCL-90-R test. FINDINGS: The mean age of subjects was 33.92±7.67 years. All scales of SCL-90-R were evaluated as borderline or sick. The scores of obsession-compulsion, anxiety, phobia, psychosis, PST, and GSI were significantly higher in heroin dependents compared to opium dependent patients (P < 0.05). CONCLUSION: It is recommended that all patients with opium dependency should be evaluated for co-morbid psychiatric disorders. This may improve the outcome and management of their dependency.

The prevalence of complicated grief among Bam earthquake survivors in Iran.

Earthquake is a natural disaster, which causes many psychological problems in survivors. Complicated grief is one of these sequelae. A devastating earthquake with a magnitude of 6.3 on the Richter scale destroyed the city of Bam in Kerman Province, Iran. Twenty-six thousand people were killed. Many of the survivors should have developed psychological problems in the aftermath of the disaster. In this study, we examined the prevalence of complicated grief and its correlation with the demographic factors and some suggested contributing variables. In this cross-sectional study, 400 persons were selected by stratified multistage area sampling. The survivors were interviewed in their temporary residential camp. After evaluating their demographic data, they were evaluated with the inventory of complicated grief. The cut-off point was set to 25. The mean+/-SD age of the participants was 37.8+/-12.7 years. Complicated grief was detected in 304 (76%) of the respondents. Score of complicated grief was higher among women and in those with lower educational levels. Presence in the city during the earthquake, observing burial of corpses, destruction of residential homes during the earthquake, residential problem after the catastrophe, and loss of at least one of the first relatives during previous earthquakes were variables which were correlated with complicated grief. Existence of complicated grief in more than two-thirds of respondents requires more attention of mental health services. Rebuilding of homes and solving the residential problems of survivors are the factors, which could help survivors to find their mental health within a shorter period.

Self-mutilation of the nose in a schizophrenic patient with Cotard syndrome.

Cotard syndrome is a rare condition, which its main symptom is nihilistic delusion. Self-mutilation of the nose is also a rare condition, which has not been seen in schizophrenic patients with Cotard syndrome. A single case is presented here. A 32-year-old woman who was diagnosed as having schizophrenia and believed that she was dead, cut the tip of her nose. She had no guilt feeling and described her act as a cosmetic surgery. We try to explain how various symptoms that seem to be very far from each other could exist side by side. Misinterpretation of her face is suggested to be the starting point in her complex symptoms.

Delusion of oral parasitosis in a patient with major depressive disorder.

Delusion of parasitosis is a rare condition in which the patient has a strong conviction that he or she is infested by small organisms. The condition may exist as an isolated phenomenon, or may occur in association with other psychiatric syndromes. We report a single case of a rare form of this phenomenon. A middle-aged woman who met forth edition of diagnostic and statistical manual of mental disorders criteria for major depressive disorder with psychotic features is described. She had delusions of oral parasitosis. She felt lizards and small organisms in her mouth. To the best of our knowledge, there has been only one previous report of delusions of oral parasitosis to date. We discuss the interesting aspects of this case.