Implementation of Intrahospital Transfer Strategy During COVID-19 and Identify Success Factors Based on DEMATEL Technique.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID. METHODS: Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors' success. RESULTS: The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria. CONCLUSION: The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies.

Prevalence and determinants of post-traumatic stress disorder five months after the 2019 huge flooding in Iran.

BACKGROUND: Despite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019. METHODS: An analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants. RESULTS: Out of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7-28.8%) and was significantly higher in Lorestan province (39.7%, P < 0.001). Determinants of PTSD, were unemployment (adjusted odds ratio [AOR] = 3.53, CI 95%: 1.38-9.00), primary (AOR = 2.44, CI 95%: 1.10-5.41) or high school (AOR = 2.35, CI 95%: 1.25-4.40) education (vs. university), a history of mental disorders (AOR = 2.36, CI 95%: 1.22-4.58), high damage to assets (AOR = 2.29, CI 95%: 1.40-3.75), limited access to health care services after the flood (AOR = 1.95, CI 95%: 1.20-3.19), not receiving compensation for flood damage (AOR = 1.94, CI 95%: 1.01-3.83), high wealth index (AOR = 1.90, CI 95%: 1.23-2.93), and flooded house with a height of more than one meter (AOR = 1.66, CI 95%: 1.02-2.76). CONCLUSION: Results show a notable prevalence of PTSD, especially in Lorestan province, among adults affected by floods. Determinants of PTSD include unemployment, lower education, psychiatric history, extensive property damage, limited post-flood healthcare access, lack of compensation, and increased flood exposure. We recommend adopting an inclusive screening approach for high-risk groups and developing appropriate therapeutic and supportive interventions.

Psychological impact of the Spring 2019 flood among adult population of Iran.

BACKGROUND: From March to April 2019, a flood occurred in several regions of Iran. The most affected provinces were Golestan, Lorestan, and Khuzestan. AIMS: The present study aimed to determine the prevalence and determinants of psychological distress and depression among the affected adult population 6 months after the event. METHODS: A cross-sectional household survey with face-to-face interview was carried out on a random sample of 1,671 adults aged above 15 years living in the flood-affected areas from August to September 2019. We applied GHQ-28 and PHQ-9 for the assessment of psychological distress and depression, respectively. RESULTS: The prevalence of psychological distress and depression were 33.6% (95% CI [29.5, 37.7]) and 23.0% (95% CI [19.4, 26.7]), respectively. Determinants of psychological distress were a history of mental disorders (Adjusted odds ratio [AOR] = 4.7), primary (AOR = 2.9) or high school (AOR = 2.4) education (vs. university), no compensation received (AOR = 2.1), high damage to assets (AOR = 1.8), the house flooded more than 1 m (AOR = 1.8), female gender (AOR = 1.8), and limited access to health care services (AOR = 1.8). Determinants of depression were unemployment (AOR = 5.3) or being a housewife (AOR = 2.7), a history of mental disorders (AOR = 4.1), high damage to assets (AOR = 2.5), no compensation received (AOR = 2.0), the house flooded more than 1 m (AOR = 1.8), limited access to health care services (AOR = 1.8), and high wealth index (AOR = 1.7). CONCLUSION: The results of this study revealed a high prevalence of psychological distress and depression in the flood-affected adult population. The high-risk group, particularly flood victims who had a history of mental disorders, and those exposed to severe damages of flood, should be prioritized for screening, and mental health services.

Comorbidities of Major Depressive Disorder and Bipolar Disorders in Patients with Substance Use Disorder in Iran Psychiatric Hospital: A Cross-sectional Study.

Background: Mood disorders are the most common psychiatric comorbidities in substance users. Mood disorders and substance use disorders are 2 intertwined processes in which treating one aid in treating the other. Depression and substance use disorder are now regarded as major mental health issues due to their widespread incidence. The study was designed to investigate the prevalence of major depressive disorder (MDD) and bipolar I and II disorders in patients with substance use disorder. Methods: The participants of this cross-sectional study were 320 patients with substance use disorder based on the DSM-5 (diagnostic and statistical manual of mental disorders 5th edition) criteria in Iran Psychiatric Hospital in 2020, who were assessed using the SCID-5-CV (Structured Clinical Interview for DSM-5 disorders-clinician version), and the demographic and clinical variables questionnaire considering familial and substance use history. The chi-square, Fisher, independent t test, and logistic regression were used to analyze the data. Results: Of the patients, 32.8% (n = 105) had mood disorders. The most common mood disorder was MDD (16.9%, n = 54), followed by bipolar I (12.5%, n = 40) and bipolar II (2.8%, n = 9) disorders. Methamphetamine was the most commonly used substance (47.5%, n = 152). Also, 62.5% (n = 200) of participants consumed 2 or more substances simultaneously. The chance of having a mood disorder in married and divorced patients was 2.12 and 2.04 times more than in single patients, respectively. Conclusion: The lifetime prevalence of bipolar I disorder in patients with substance use disorders is several times more than the general population, thus psychiatrists should pay more attention to mood comorbidities diagnosis and treatment in substance users.

Traumatic Events Exposure and Post Traumatic Stress Disorder in Caregivers of Patients with Bipolar Disorder, Bipolar Disorder and Comorbid Post Traumatic Stress Disorder and Multiple Sclerosis.

Background: Chronic diseases affect the lives of the patient and caregiver. Caring for a patient with a chronic psychiatric illness, such as bipolar disorder, is a stressful and challenging activity. Caregivers of severe psychiatric patients are the primary victims of violence by patients. Caring for these patients can be very stressful for the caregiver to the extent of experiencing post-traumatic stress symptoms. This study compares the frequency of trauma exposure and PTSD in the caregivers of patients with bipolar disorder type 1(BD-1), bipolar disorder type 1, comorbid post-traumatic stress disorder (BD-1+PTSD), and multiple sclerosis (MS).The MS group served as the control group. Methods: This cross-sectional study with convenient sampling was conducted at three hospitals in Tehran, Iran, from April 2020 to January 2022. One hundred eighty caregivers answered a clinical demographic questionnaire. We then used the Trauma History Questionnaire (THQ) to assess the frequency of exposure to different types of trauma. Then, the Persian version of the SCID-5, a valid and reliable instrument for psychiatric diagnoses, was used to diagnose PTSD. Chi-square was used for analyzing data. Results: Exposure to trauma has a significant difference between the groups. BD-1 + PTSD patients' caregivers were exposed to more physical assaults than others (P < 0.0001) There was a significant difference between sexual harassment in the MS group (P = 0.010). There was a significant difference between the three groups in the development of PTSD (P = 0.003). PTSD prevalence in the BD-1 + PTSD caregiver group is more than in other groups. In the caregivers of BD-1+PTSD, the caregiving experience caused traumatic exposure and the development of PTSD in all caregivers. Conclusion: This study shows that the prevalence of exposure to traumatic events and PTSD is higher in the caregivers of BD-1 patients, especially if the patient has comorbid PTSD. Detecting these symptoms early and using intervention can make the caregiving burden more tolerable.

First-episode mania after COVID-19: A case series in Iran.

Background: Increasing reports of manic episodes in patients during acute infection with COVID-19 have been documented since the pandemic began, including individuals without a previous personal or family history of bipolar disorder. As infections and autoimmunity have putative roles in bipolar disorder, we aimed to document the clinical presentations, associated stressors, family aggregation patterns, and brain imaging and electroencephalographic correlates with a series of patients with episodes of mania that emerged shortly after COVID-19 infections. Methods: We obtained all relevant clinical information from 12 patients whose first manic episode started within a month of COVID-19 infection and were treated at Rasool-e-Akram hospital and Iran psychiatric hospital, two tertiary medical centers in Tehran, Iran, in 2021. Results: Patients had a mean age of 44. The interval between the onset of symptoms of COVID and mania ranged between 0 and 28 days (mean: 16.25, median: 14 days); it was observed to be shorter in patients with a family history of mood disorders but not in those receiving corticosteroids. Alongside a descriptive overview of our sample, we provide detailed narrative descriptions of two of the cases for illustrative purposes and discuss our observations in the context of other cases reported elsewhere and the state-of-the-art regarding infectious diseases, COVID-19, and bipolar disorder as reported in previous literature. Conclusion: Our case series documents observational and naturalistic evidence from a dozen of cases of mania in the context of acute COVID-19, which, while limited, calls for analytical research of the phenomenon, and points at a family history of bipolar disorder and the use of corticosteroids as factors for particular focus.

Implementation of Clean Hospital Strategy and Prioritizing Covid-19 Prevention Factors Using Best-Worst Method.

Many nations have suffered the catastrophe of COVID-19, and one of the first countries affected by the pandemic was Iran; all industries and individuals have been adversely affected by the pandemic. Health care systems and patients' conditions, in particular, were disrupted due to canceling elective surgery. To put it more sharply, a delay in performing elective surgery may potentially impact patients' survival and the quality of their lives. To cope with the new situation, in the first stage, the Clean Hospital strategy was proposed in order to minimize the effects of this pandemic on elective surgical services. The mentioned strategy is a try to provide a solution and resume elective surgeries in the pandemic period. In the second stage, panel discussion, Delphi method, and the best-worst method (BWM) were employed to prioritize the factors that inhibit Coronavirus transmission. The proposed strategy and the results of this study could be used by policymakers and health departments to resume elective surgeries and control the infection to maintain a hospital or a section of it clear. The overall result of the study showed that the most important Covid-19 prevention factors in Clean Hospitals were personal protection (w = 0.212), screening checklist (w = 0.182), and check body temperature (w = 0.126), respectively (C1 > C2 > C3). According to the financial, time, and human resource limitations, first, resources were allocated to higher priority criteria, and in order of priority, all items (C1, C2, …., C9) were used in the Clean hospital strategy.

Identifying Recent Manic Symptoms by Newly Discharged Patients with Bipolar Disorder.

Background: Bipolar disorder type I is a chronic and recurrent disease and is considered as the ninth nonfatal disease. Identifying the symptoms of the manic episode, which are more likely detected by patients, increases the ability of psychiatrists in diagnosing this disorder. Methods: In this cross-sectional study, a total of 96 patients with bipolar disorder were enrolled from 2 academic psychiatric centers. Then, using the patients' medical records, demographic data were collected. Further, both the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview and the Young mania rating scale (Y-MRS) scale were also performed. Then, about 27 to 33 days after discharge, the patients were contacted by phone and the SCID-I interview was conducted again. Meanwhile, to make the patients focus on the period from which they have recently improved, the phrase "the recent period of hospitalization" was added to the interview questions and the symptoms were checked. Results: At the beginning of the hospitalization, the most common symptom in the total population was irritable mood (89.5%): in the male population decreased need for sleep (98.2%), and in the female population irritable mood (97.5%). In addition, in the evaluation, about 1 month later, irritable mood (69.7%) and decreased need for sleep (67.7%) were the most common symptoms detected by the patients. In terms of the predictive value of each symptom to the diagnosis of that symptom by the psychiatrist, the highest positive predictive value was related to the symptoms of irritable mood (95.5%), decreased need for sleep (95.4%), and talkativeness (95.2%). However, the highest negative predictive value was related to the symptom of elevated mood (87.5%). Conclusion: The patients who have passed manic episodes are more able to detect some symptoms of this episode. Despite some limitations, it seems that using these statistical findings in practice may promote clinical assessment and diagnosis of bipolar disorder type I by psychiatrists.

Measuring the customer satisfaction of public transportation in Tehran during the COVID-19 pandemic using MCDM techniques.

The expeditiously spreading of coronavirus disease 2019 (COVID-19) has affected every facet of human lives, including transportation. Due to some characteristics of COVID-19, like high infectivity, people prefer to use their private cars more than before. On the one hand, this circumstance caused public transportation to face an unprecedented decrease in demand and, consequently, revenue. On the other hand, it could intensify traffic congestion during rush hours. This study provides a computational framework to assess public transportation's customer satisfaction in Tehran during the COVID-19 pandemic. To this end, a combined multi-criteria decision-making (MCDM) approach based on the best-worst method (BWM) and fuzzy technique for order performance by similarity to ideal solution (fuzzy TOPSIS) is introduced, which benefits from all the advantages of BWM and fuzzy TOPSIS procedure and consequently provides consistent and reliable outcomes. Outcomes of the implemented model provide precious insight for improving service quality during and after the pandemic; for example, it reveals the performance of each transport mode about each criterion which can help policymakers and transit agencies to allocate resources more intelligently. Final results indicate that during the pandemic, taxis had a better performance compared to other transportation modes.

Clinical manifestations, treatment options, and comorbidities in COVID-19 relapse patients: A systematic review.

INTRODUCTION: Interest revolving around coronavirus disease 2019 (COVID-19) reinfection is escalating rapidly. By definition, reinfection denotes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), PCR redetection, and COVID-19 recurrence within three months of the initial symptoms. The main aim of the current systematic review was to evaluate the features of COVID-19 relapse patients. MATERIALS AND METHODS: For this study, we used a string of terms developed by a skilled librarian and through a systematical search in PubMed, Web of Science, and Embase for eligible studies. Clinical surveys of any type were included from January 2019 to March 2021. Eligible studies consisted of two positive assessments separated by a negative result via RT-PCR. RESULTS: Fifty-four studies included 207 cases of COVID-19 reinfection. Children were less likely to have COVID-19 relapse. However, the most patients were in the age group of 20-40 years. Asthenia (66.6%), headache (66.6%), and cough (54.7%) were prevalent symptoms in the first SARS-CoV-2 infection. Asthenia (62.9%), myalgia (62.9%), and headache (61.1%) were most frequent in the second one. The most common treatment options used in first COVID-19 infection were lopinavir/ritonavir (80%), oxygen support (69.2%), and oseltamivir (66.6). However, for the treatment of second infection, mostly antibiotics (100%), dexamethasone (100%), and remdesivir (80%) were used. In addition, obesity (32.5%), kidney failure (30.7%), and hypertension (30.1%) were the most common comorbidities. Unfortunately, approximately 4.5% of patients died. CONCLUSION: We found the potency of COVID-19 recurrence as an outstanding issue. This feature should be regarded in the COVID-19 management. Furthermore, the first and second COVID-19 are similar in clinical features. For clinically practical comparison of the symptoms severity between two epochs of infection, uniform data of both are required. We suggest that future studies undertake a homogenous approach to establish the clinical patterns of the reinfection phenomena.

Evaluation of the effect of sofosbuvir and daclatasvir in hospitalized COVID-19 patients: a randomized double-blind clinical trial (DISCOVER).

BACKGROUND: The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19. METHODS: This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O2 saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1. RESULTS: Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95-1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77-1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality. CONCLUSIONS: We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients.

Psychometric properties of Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV).

OBJECTIVES: The purpose of this study was to evaluate the psychometric properties of Structured Clinical Interview Version for DSM-5 (R) Clinical Version (SCID-5-CV) in a population of patients with psychiatric disorders in Tehran. METHOD: The study population included all outpatients and inpatients referred to three psychiatric centers in Tehran, namely Iran Psychiatric Hospital, Rasoul Akram Hospital, and Clinic of Behavioral Sciences and Mental Health (Tehran Psychiatric Institute). Inclusion criteria included age between 16 and 70 years, informed consent to study, ability to understand and speak Persian, and no specific physical problems that interfere with the conduct of the interview. Also, exclusion criteria included inability to communicate, mental retardation or dementia, severe symptoms of acute psychosis, and severe restlessness. In addition to demographic questionnaire, Persian version of SCID-5-CV was used in this study. Finally, diagnostic validity, test-retest reliability, and inter-rater reliability were used to evaluate the information. RESULTS: In terms of the kappa criterion, for all diagnoses except for anxiety disorders, kappa was above 0.4 as a result of agreement above average, but in anxiety disorders with kappa 0.34 there was a moderate agreement between psychiatrist and SCID interviewer reports. Also, according to the psychiatrist's diagnosis as the gold standard, in most diagnoses, except for anxiety disorders, kappa was higher than 0.80, indicating the desirable characteristic of this tool in the diagnosis of disorders. Sensitivity of all diagnoses was higher than 0.80. CONCLUSION: According to the findings of the present study, SCID-5-CV can be used for diagnostic purposes in psychiatric clinics and hospitals and to evaluate the treatment process of patients. In general, this version is suitable especially the schizophrenia spectrum and other psychiatric disorders; however, using SCID-5-CV for anxiety-related disorders should be done with caution.

Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence.

BACKGROUND: Bipolar disorder is a common psychiatric disorder with a massive psychological and social burden. Research indicates that treatment adherence is not good in these patients. The families' knowledge about the disorder is fundamental for managing their patients' disorder. The purpose of the present study was to investigate the knowledge of the family members of a sample of Iranian patients with bipolar I disorder (BD-I) and to explore the potential reasons for treatment non-adherence. METHODS: This study was conducted by qualitative content analysis. In-depth interviews were held and open-coding inductive analysis was performed. A thematic content analysis was used for the qualitative data analysis. RESULTS: The viewpoints of the family members of the patients were categorized in five themes, including knowledge about the disorder, information about the medications, information about the treatment and the respective role of the family, reasons for pharmacological treatment non-adherence, and strategies applied by families to enhance treatment adherence in the patients. The research findings showed that the family members did not have enough information about the nature of BD-I, which they attributed to their lack of training on the disorder. The families did not know what caused the recurrence of the disorder and did not have sufficient knowledge about its prescribed medications and treatments. Also, most families did not know about the etiology of the disorder. CONCLUSION: The lack of knowledge among the family members of patients with BD-I can have a significant impact on relapse and treatment non-adherence. These issues need to be further emphasized in the training of patients' families. The present findings can be used to re-design the guidelines and protocols in a way to improve treatment adherence and avoid the relapse of BD-I symptoms.

Comparison of the Efficacy and Safety of Atazanavir/Ritonavir Plus Hydroxychloroquine with Lopinavir/Ritonavir Plus Hydroxychloroquine in Patients with Moderate COVID-19, A Randomized, Double-blind Clinical Trial.

This was a randomized, double-blind clinical trial to compare the efficacy and safety of Atazanavir/Ritonavir (ATZ/RTV) with Lopinavir/Ritonavir (LPV/RTV) in moderate Coronavirus disease 2019 (COVID-19). Participants were randomly assigned to receive a single dose of hydroxychloroquine (HCQ) plus ATZ/RTV or LPV/RTV for a minimum of 5 to a maximum of 10 days. The primary outcomes were the reduced length of hospital stay and clinical recovery within 10 days from starting the intervention. The rate of intensive care unit (ICU) admission, intubation, and mortality, the lengths of ICU stay and being intubated, recovery within 14 days, and the frequency of adverse reactions were considered as secondary outcomes. Among 132 enrolled patients, 62 cases in each arm were analyzed at the end of the intervention. Fifty-one (82.3%) cases in the ATZ/RTV arm versus 41 (66.1%) in the LPV/RTV arm were discharged within 10 days (P = 0.06). The median number of the intervention days was 6 (IQR: 5-8) in ATZ/RTV arm versus 7 (IQR: 6-9) in LPV/RTV arm (P = 0.01). The rate and length of ICU admission and intubation (P ≥ 0.99), rate of mortality (P = 0.49), and recovery within 14 days (P = 0.09) were not statistically different between groups. The most reported adverse reactions were nausea and vomiting that all cases were in the LPV/RTV arm (P = 0.006). ATZ/RTV is better tolerated in comparison with LPV/RTV; however, it did not show more efficacy than LPV/RTV in clinical outcomes of COVID-19 in this study.

Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: a single-centre, randomized controlled trial.

BACKGROUND: New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19. METHODS: This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1. RESULTS: Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray's P = 0.033). CONCLUSIONS: This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further.

The experience of patients with bipolar disorder from diagnosis disclosure: A qualitative study.

Background: Disclosure of the diagnosis is an essential part of the treatment process and an important part of patient rights. However, it can be a very stressful experience, especially in mental health disorders. Patients with bipolar disorder have a unique experience of receiving and managing their diagnosis. The objective of the current study was to explore the experience of patients with bipolar disorder of diagnosis disclosure. Methods: This was a qualitative study. Participants were recruited from patients who knew their disorder's name using purposive sampling method. The inclusion criteria were being diagnosed by a psychiatrist as having bipolar disorder and the disclosure was conducted by a psychiatrist. Sixteen semi-structured, in-depth interviews were conducted with twelve patients. Data were analyzed using thematic content analysis. Results: Patients received their diagnosis name in three steps including Wandering in Unknowns, Limited Brightness and Reaching to a Relative Insight. Patients believed that disclosure of the diagnosis was not accompanied by enough information. Conclusion: The disclosure of diagnosis in patients with bipolar disorder without providing enough information is stressful and is not helpful in empowering these patients. Based on our results, disclosure of diagnosis to patients with bipolar disorder was not conducted with enough information and patients had problems for understanding their symptoms and treatments.

Screening bipolar disorders in a general hospital: Psychometric findings for the Persian version of mood disorder questionnaire and bipolar spectrum diagnostic scale.

Background: Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) are used to screen patients with bipolar disorders and have been examined in some psychiatric settings. The present study aimed to assess the validity and reliability of these 2 tools on inpatients in a general hospital. Methods: In a cross-sectional study in 2011, a total of 207 inpatients admitted to different wards of Rasoul Akram hospital, Tehran, were selected by systematic random sampling. Demographic questionnaire, MDQ, and BSDS were completed. Also, Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) was performed for all participants within 72 hours. The SCID-I was used as the gold standard of psychiatric diagnoses to identify the predictive validity of the 2 screening tests. Sensitivity and specificity indices were identified using Roc curve. The 2 screening tools were recompleted by 20% of the patients (n=43) after 3-7 days to measure test-retest reliability using paired t test and correlation between measures in 2 separate occasions. Results: In this study, 101 female and 106 male (m=36.9±15.5 yrs.) patients were entered the study, of them 56 (32 males) had bipolar disorder according to SCID-I. The most common bipolar disorder was bipolar disorder type II (9.7%). Pearson's test showed a high test-retest reliability for both MDQ (r=0.72, p<0.001) and BSDS (r=0.77, p<0.001). For MDQ, the scores 5 (sensitivity=0.60; specificity=0.73) and 6 (sensitivity=0.56; specificity=0.77) were the best cutoff points. Positive and negative predictive values for the mentioned cutoff points were 0.45 and 0.83 (for the score 5) and 0.48 and 0.82 (for the score 6), respectively. The best cutoff point for BSDS was 11 with the sensitivity, specificity, and positive and negative predictive values of 0.74, 0.69, 0.47, and 0.87. Conclusion: The Persian versions of MDQ and BSDS have acceptable validity and reliability to screen Persian patients with bipolar spectrum disorders in a general hospital.

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.

Studying the predictive factors of suicide attempts in patients with type 1 bipolar disorder.

Bipolar disorder has the highest suicide attempt rate among psychiatric disorders. Many factors are associated with the risk of suicide attempt in patients with type 1 bipolar disorder, but the relation between them has still not been explicitly stated. This study aimed to examine the predictability of suicide attempt risk in BID patients based on quality of life, stressful life events, comorbidity of axis I disorders and medication compliance. We selected 140 inpatients with type 1 bipolar disorder by convenient sampling. Then they completed the WHOQOL-BREF questionnaire, Paykel's stressful life events scale and the medication adherence report scale (MARS). Logistic regression analysis showed that bipolar patients with axis I comorbidity are 40 times more likely to attempt suicide than those without axis I comorbidity. The higher the patients' quality of life, the lower the chance of attempt of suicide. Higher medication compliance reduces the likelihood of suicidal attempt in these patients. And, the increase of stressful life events would raise the risk of suicide attempts, but the relationship wasn't significant. So it can be concluded that quality of life, stressful life events and axis I comorbidity can predict the risk of suicide attempts in patients with type 1 bipolar disorder.