The role of feared possible selves in the relationship between inferential confusion and obsessive-compulsive symptoms: A replication and extension in a clinical sample.

OBJECTIVES: The feared possible self refers to an imagined version of self that one is afraid of being or becoming. Previous evidence has shown that dysfunctional reasoning (i.e., inferential confusion) is associated with obsessive-compulsive disorder (OCD) symptoms, which is partially mediated by a feared self. However, the evidence is reliant on non-clinical samples and a general measure of the feared self. METHODS: Using a cross-sectional design, the current study attempted to replicate and extend this literature in a sample clinically diagnosed with OCD (n = 350) to assess the pathway from inferential confusion to OCD symptoms when feared self is accounted for as a mediator, particularly the individual dimensions of feared self (i.e., corrupted, culpable, and malformed feared selves). Participants completed a structured clinical interview for DSM-5, as well as measures of inferential confusion (Dysfunctional Reasoning Processes Task), obsessive beliefs, feared self, OCD symptoms, and psychological distress. RESULTS: Inferential confusion directly, and indirectly through the feared corrupted self, affected OCD symptoms, even after adjusting for obsessive beliefs, psychological distress, and comorbidity. However, the feared culpable and malformed selves did not play a role in this pathway. CONCLUSIONS: The study underscores that the feared corrupted self links inferential confusion to OCD symptoms, translating to the need to consider both dysfunctional reasoning processes and this specific feared self in clinical settings when treating OCD. Furthermore, the study provides more support for the inference-based approach (IBA) to OCD.

Managing the Dual Diagnosis Dilemma of Bipolar Disorder and Substance Abuse in Clinical Settings.

OBJECTIVE: Drug addiction is a chronic mental disorder that significantly impacts all aspects of an individual's life, and substance use disorder in patients with bipolar disorder. The objective of this study is to assess the frequency of substance abuse among patients with bipolar spectrum disorder. METHOD: This cross-sectional study evaluated the frequency of bipolar spectrum disorder in patients taking methadone through various screening measures, including Mini Mental State Examination (MMSE), DSM IV criteria, Mood Disorders Questionnaire (MDQ), Goodwin and Ghaemi's criteria, and Akiskal classification for bipolar disorders. RESULTS: Out of the total 197 participants in the study, 77 were identified as individuals engaging in poly-substance abuse. The investigation assessed the frequency of bipolar spectrum disorder based on various diagnostic criteria: 24% according to DSM-IV criteria, 29.9% using MDQ, 29.9% based on Ghaemi and Goodwin's criteria, and the highest rate at 48.2% when applying Akiskal's classification. CONCLUSIONS: This study highlights the high frequency of bipolar disorder among individuals with substance use disorder, especially those with concomitant depression. Therefore, it is crucial to pay special attention to individuals with substance use disorder with co-existing bipolar disorder.

The Independent Contribution of Positive and Negative Metacognitions About Smoking to Urge to Smoke, Withdrawal Symptoms and Dependence in Smoking-Dependent Men.

Previous research has indicated that various factors, such as psychological distress, distress intolerance, anhedonia, impulsivity and smoking metacognitions, have been individually linked to the urge to smoke, withdrawal symptoms and dependence. However, these factors have not been collectively examined to determine whether smoking metacognitions independently and significantly contribute to these outcomes. Therefore, the aim of this study was to investigate the impact of distress intolerance, anhedonia, impulsivity and smoking metacognitions on the urge to smoke, withdrawal symptoms and dependency in men who are dependent on smoking. A total of 300 smoking-dependent men completed psychological scales and smoking-related measures. The findings of the study indicated that positive metacognitions about emotion regulation significantly predicted the urge to smoke, even when accounting for other significant predictors such as the number of daily cigarettes smoked, psychological distress, anhedonia and impulsivity. Furthermore, positive metacognitions about cognitive regulation were found to be a significant predictor of withdrawal symptoms, independent of other significant predictors such as psychological distress and the urge to smoke. Smoking dependence was predicted by negative metacognitions about uncontrollability beyond other significant predictors, including the number of daily cigarettes smoked and distress intolerance. These results highlight the role of metacognitions about smoking in both short- and long-term clinical outcomes related to smoking. Consequently, addressing such beliefs during treatment for smoking dependence should be an important therapeutic goal.

The Connections Between Alexithymia, Childhood Maltreatment, Impulsivity and Extreme Sensory Processing Patterns in Relation to Bipolar Symptoms in Inpatients With Bipolar Disorder.

Childhood maltreatment, alexithymia and impulsivity are related to bipolar disorder (BD), but the role of potential underlying mechanisms of this link, such as extreme sensory processing, in BD are unclear. This study compared sensory processing patterns between individuals with BD-I or BD-II and between those with and without alexithymia and childhood maltreatment. Additionally, the study aimed to examine the role of extreme sensory processing in the relationship between childhood trauma, alexithymia and impulsivity with both depression and mania in a sample of hospitalized individuals with BD (n = 300). Participants completed self-report and clinician-rated scales. Patients with BD-II exceeded those with BD-I in low registration, sensory sensitivity and sensation avoidance, whereas patients with BD-I exhibited a more heightened sensation-seeking pattern. Patients with BD who had alexithymia and a history of childhood maltreatment exhibited more heightened sensory processing patterns, apart from sensory seeking, compared to those without alexithymia and childhood maltreatment. Additionally, the same pattern was more pronounced in individuals with BD who had both alexithymia and childhood maltreatment compared to those with either condition or neither of these conditions. The pathways from childhood maltreatment and alexithymia to depressive symptoms were mediated by low registration and sensation avoidance. Sensory seeking indirectly affected the link between alexithymia and manic symptoms. Childhood maltreatment and challenges in effectively processing emotional information, along with their related hypo- and hypersensitivity, may characterize BD individuals and its manifestation of depressive and manic symptoms.

Cross-sectional direct and indirect relationships between the corrupted feared self and obsessive-compulsive symptoms in a clinical sample: The role of mental contamination.

OBJECTIVES: There is a significant relationship between a general feared self and contact contamination concerns in obsessive-compulsive disorder (OCD), especially when the influence of mental contamination is considered a part of this relationship. However, these associations have not been explored in a clinical OCD sample when using each dimension of the multidimensional conceptualization of the feared self as the predictor (i.e., the corrupted, culpable, and malformed feared selves). METHODS: We tested these associations using a cross-sectional design. Specifically, a sample of patients diagnosed with OCD (N = 417) completed a series of self-report measures of OCD symptoms and its related constructs. We also explored these associations with unacceptable thoughts as the outcome, rather than contamination concerns, due to unacceptable thoughts having evidenced strong associations with the feared self and mental contamination. RESULTS: After controlling for relevant cognitive (i.e., obsessive beliefs) and affective (i.e., depressive symptoms) constructs and comorbidity, the corrupted feared self was found to have a direct link, along with an indirect link through mental contamination, with symptoms of contact contamination and unacceptable thoughts. CONCLUSIONS: The fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns. The corrupted feared self and mental contamination should therefore be targeted in treatments for repugnant obsessions and contamination-related OCD.

Further validation of the Multidimensional Version of the Fear-of-Self Questionnaire in a Persian non-clinical and clinical obsessive-compulsive disorder sample.

Previous research has shown that vulnerable self-themes and feared self-perceptions may play an important role in the development and maintenance of obsessive-compulsive disorder (OCD). In particular, the recently validated Multidimensional Version of the Fear-of-Self Questionnaire (FSQ-MV) has shown strong relationships with OCD symptoms independent of cognitive constructs and negative mood in non-clinical samples. The current study aimed to further evaluate the validity and reliability of a Persian version of the FSQ-MV in OCD patients (N = 300), as well as non-clinical individuals (N = 300). Participants completed a set of scales evaluating feared self-perceptions and OCD-related symptoms/conditions. The results showed that the Persian version of the FSQ-MV replicated the three-factor structure of the original scale in non-clinical and OCD patients. The FSQ-MV and its subscales had excellent reliability. Additionally, the FSQ-MV was significantly associated with related cognitive constructs, as well as OCD symptoms and their severity, in both samples. The feared self, especially the corrupted feared self, was a significant unique predictor of OC symptomology, especially for repugnant obsessions, and OCD severity. The study confirmed the validity and reliability of the Persian version of the FSQ-MV. Moreover, cognitive conceptualizations may benefit from a consideration of the feared self in OCD, which may play an important role in its development, maintenance and severity.

Desire thinking as an underlying mechanism in alcohol use disorder and nicotine dependence.

Desire thinking is an emerging construct in the addictive behaviours literature. No research, to date, has investigated its contribution to problematic alcohol use and nicotine dependence in patient samples when accounting for established predictors of addictive behaviours. The present study sought to clarify, in patient samples, the relative contribution of desire thinking in the associations between negative affect, impulsivity and thought suppression on the one hand and craving, problematic alcohol use and nicotine dependence on the other. To achieve this goal, two groups of individuals with alcohol use disorder (AUD) (n = 370; age range = 15-67 years) and nicotine dependence (n = 365; age range = 17-75 years) were selected, and measures of negative affect, impulsivity, thought suppression, craving, desire thinking, problematic alcohol use and nicotine dependence were completed by both groups. Results showed that in both groups, negative affect and thought suppression indirectly affected alcohol and nicotine craving, problematic alcohol use and nicotine dependence through the mediating role of desire thinking. The present study shows the independent role of desire thinking in predicting problematic alcohol use and nicotine dependence in patient samples, indicating its potential relevance for treatment.

Confirmatory evaluation of the bipolar depression rating scale (BDRS) in a large sample of female patients with bipolar depression.

OBJECTIVE: The Bipolar Depression Rating Scale (BDRS) is a structured rating scale designed to assess depressive and mixed symptoms in bipolar disorder (BD). Previous studies evaluating the scale have been performed on small samples or on patients in a depressive phase, but not on patients in a mixed or manic phase. This study evaluated the Persian version of the BDRS regarding its factor structure, reliability, and validity in a large sample of Iranian women with BD in a depressive or mixed/manic phase. METHODS: Three-hundred and one female BD inpatients completed the BDRS, the Beck Depression Inventory-II (BDI-II), the Hamilton Depression Rating Scale (HDRS), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). RESULTS: The BDRS demonstrated a three-factor structure with good reliability. The BDRS and its psychological and somatic symptom clusters had stronger correlations with other measures of depressive symptoms than a measure of mania. The BDRS mixed symptom cluster also had a stronger correlation with a measure of mania than other measures of depression, supporting the scales' convergent and discriminant validity. CONCLUSIONS: The BDRS demonstrated psychometric validity in assessing depressive and mixed symptoms in Iranian women with BD in a depressive or mixed/manic phase.KEY POINTSThe Bipolar Depression Rating Scale (BDRS) was validated in Iranian women with BD.The BDRS showed a three-factor structure, similar to the original validation.The BDRS had good reliability based on Omega and test-retest coefficients.The findings provided evidence for the convergent and discriminant validity of the BDRS.

The independent contribution of desire thinking to problematic social media use.

In the present study, we investigated the role of desire thinking in problematic social media use (PSMU) whilst accounting for negative affect, impulsivity, and thought suppression. A sample of individuals with PSMU (n = 350) who used social media at least 8 h daily was recruited. Participants completed measures of negative affect, impulsivity, thought suppression, craving, desire thinking, and PSMU. Results indicated that negative affect, impulsivity, and thought suppression had significant indirect effects on craving and PSMU through the significant mediating role of desire thinking. The present study shows that desire thinking is an underlying mechanism linking established variables associated with PSMU (negative affect, impulsivity, and thought suppression) to craving and PSMU. Focusing efforts on the interruption of desire thinking may be beneficial to support individuals in disengaging from PSMU.

The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: The role of specific stress responses to COVID-19.

Suicidal ideation is prevalent in patients with obsessive-compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive-compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.

The effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms and suicidal ideation in females with bipolar disorder: emotion dysregulation as a mediator.

OBJECTIVES: The relations of childhood emotional maltreatment and alexithymia to the clinical course of bipolar disorder (BD) have been widely recognised. Difficulties in regulating emotions may explain these relationships. The current study evaluated the effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms as well as suicidal ideation in female patients with BD. Emotion dysregulation was evaluated as a mediating factor. METHODS: Three hundred hospitalised female patients with a diagnosis of BD provided information regarding their history of childhood emotional maltreatment, alexithymia, difficulties in emotion regulation, depressive and manic symptoms, and suicidal ideation. A series of structural equation models (SEMs) were calculated to assess the associations between these variables. RESULTS: Childhood emotional abuse and difficulty in identifying feelings were indirectly associated with depressive and manic symptoms as well as suicidal ideation. This association was mediated by emotion dysregulation. This association remained significant after depressive and manic symptoms were controlled in the model. CONCLUSIONS: This study indicates that patients with BD who experienced emotional abuse during childhood and have difficulties identifying emotions report greater emotion dysregulation. These individuals, in turn, are more likely to experience more severe depressive and manic symptoms as well as suicidal ideation.Key pointsChildhood emotional maltreatment and emotional and clinical factors in bipolar disorder were assessed.Childhood emotional abuse indirectly affected clinical factors via emotion dysregulation.Difficulty in identifying feelings was linked to clinical factors via emotional dysregulation.Emotional dysregulation affected the links of childhood emotional maltreatment and difficulty in identifying feelings on suicidal ideation after controlling for clinical symptoms.Emotional dysregulation dimensions of impulse, strategies, and goals emerge in relation to suicidal ideation.

Alexithymia, empathy, negative affect and physical symptoms in patients with asthma.

Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale-20 (TAS-20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales-21 (DASS-21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS-20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS-20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS-20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.

Validity and Reliability Assessment of the Complete Persian Version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-Questionnaire in an Iranian Population.

Objective: The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Auto-questionnaire (TEMPS-A) assesses five affective temperaments and has been translated into 32 languages. A 35-item short version is available in Persian, but the complete version is not yet translated. This study aimed to assess the validity and reliability of the complete Persian version of the TEMPS-A in an Iranian population. Method : This descriptive study translated the TEMPS-A questionnaire from English to Persian using a standard forward-backward method. The translation was evaluated for face and content validity by 10 psychiatry specialists, with quantitative content validity assessed through content validity ratio (CVR) and content validity index (CVI) calculations. The Persian TEMPS-A was completed twice, with a two-week interval, by 30 individuals out of the 319 medical staff of Imam Hossein Hospital in Tehran, Iran, who participated in the study, and its reliability was evaluated using Cronbach's alpha. The questionnaire was then distributed to the entire sample (n = 319) for the analysis of temperament frequencies and statistical indices by a statistician. Results: The Persian version of the TEMPS-A, consisting of 110 items across five factors (depressive, cyclothymic, hyperthymic, irritable, and anxious), demonstrated excellent reliability with Cronbach's alpha values of 0.910, 0.909, 0.911, 0.910, and 0.909, respectively. The questions related to cyclothymic and hyperthymic temperaments exhibited the highest and lowest correlation coefficients with the general scale, respectively. Most subscales in the Persian TEMPS-A version showed correlation coefficients ranging from 0.28 to 0.68. An ANOVA with Cochrane's test revealed a significant difference in the mean scores of the questionnaire items (P < 0.001), with a grand mean score of 1.73 across all questions. Conclusion: The Persian version of the TEMPS-A, consisting of 110 items, showed good internal consistency and a strong correlation with the original version. This suggests that it is suitable for use in temperament studies among the Iranian population.

The contribution of alexithymia, childhood maltreatment, impulsivity, C-reactive protein, lipid profile, and thyroid hormones to aggression and psychological distress (depression and anxiety) in schizophrenia.

There are individual effects of alexithymia, childhood maltreatment, impulsivity, and some biological markers on aggression and psychological distress in schizophrenia. However, the combined effects of these psychological and biological markers have not yet been fully studied. This study therefore aimed to investigate the influence of these psychological and biological markers on aggression and psychological distress (e.g., depression and anxiety) in inpatients with schizophrenia (n = 355). Participants completed self-report and clinician-rated scales, and blood samples were collected. There were no significant differences between patients with and without alexithymia regarding biological markers. Patients with childhood maltreatment exhibited higher levels of free triiodothyronine (FT3) and C-reactive protein (CRP), as well as lower total cholesterol (TC) levels, compared to non-traumatized individuals. Aggression was positively predicted by psychological distress, alexithymia, childhood maltreatment, impulsivity, CRP, and FT3, and negatively by TC and low-density lipoprotein cholesterol. Negative symptoms, childhood maltreatment, alexithymia, aggression, and CRP positively, and high-density lipoprotein cholesterol negatively emerged as predictors of psychological distress. The study highlights the connections between childhood maltreatment, alexithymia, impulsivity, and potentially related biological dysregulation in explaining aggression and negative mood states as a bio-psychological model of aggression and mood in schizophrenia.

Iran Quality of Care in Medicine Program (IQCAMP): Design and Outcomes.

BACKGROUND: Assessment of quality and cost of medical care has become a core health policy concern. We conducted a nationwide survey to assess these measures in Iran as a developing country. To present the protocol for the Iran Quality of Care in Medicine Program (IQCAMP) study, which estimates the quality, cost, and utilization of health services for seven diseases in Iran. METHODS: We selected eight provinces for this nationally representative short longitudinal survey. Interviewers from each province were trained comprehensively. The standard definition of seven high-burden conditions (acute myocardial infarction [MI], heart failure [HF], diabetes mellitus [DM], stroke, chronic obstructive pulmonary (COPD) disease, major depression, and end-stage renal disease [ESRD]) helped customize a protocol for disease identification. With a 3-month follow-up window, the participants answered pre-specified questions four times. The expert panels developed a questionnaire in four modules (demographics, health status, utilization, cost, and quality). The expert panel chose an inclusive set of quality indicators from the current literature for each condition. The design team specified the necessary elements in the survey to calculate the cost of care for each condition. The utilization assessment included various services, including hospital admissions, outpatient visits, and medication. RESULTS: Totally, 156 specialists and 78 trained nurses assisted with patient identification, recruitment, and interviewing. A total of 1666 patients participated in the study, and 1291 patients completed all four visits. CONCLUSION: The IQCAMP study was the first healthcare utilization, cost, and quality survey in Iran with a longitudinal data collection to represent the pattern, quantity, and quality of medical care provided for high-burden conditions.

The Persian Version of the COVID-19 Phobia Scale (Persian-C19P-S) and the Differences in COVID-19-Related Phobic Reactions in Patients with Anxiety Disorders.

Coronavirus disease 2019 (COVID-19) is a pandemic outbreak increasing several psychological distress, such as anxiety and phobia, and may affect patients with anxiety disorders. A scale has been recently designed to assess COVID-19-related phobic reactions named the COVID-19 Phobia Scale (C19P-S). The present study aimed to evaluate factor structure, reliability, and validity of the Persian version of the C19P-S (Persian-C19P-S) in patients with anxiety disorders and to compare COVID-19-related phobia among these patients. Three hundred patients with anxiety disorders completed the Persian-C19P-S and other scales assessing anxiety traits (e.g., the Short Health Anxiety Inventory (SHAI), the Health Concerns Questionnaire-54 (HCQ-54), and the Patient Health Questionnaire-4 (PHQ-4)) and COVID-19-related distress (e.g., the COVID Stress Scales (CSS) and the Fear of COVID-19 Scale (FCV-19)). The results showed that the Persian-C19P-S replicated the four-factor structure of the original C19P-S. Internal consistency and test-retest reliability coefficients evidenced the reliability of the scale. The validity of the scale (convergent and discriminant validity) was confirmed. Patients who had generalized anxiety and panic disorders showed higher phobic reactions related to COVID-19 than those with social anxiety disorder and specific phobia. This study indicates that the Persian version of the C19P-S is a valid scale to be used in Iranian patients with anxiety disorders to evaluate COVID-19-related phobia. Moreover, COVID-19-related phobic reactions are higher in some specific types of anxiety disorders.

The desire thinking questionnaire-Persian version (DTQ-P) and its association with addictive behaviors in individuals with alcohol use disorder, nicotine dependence, and problematic social media use.

Desire thinking is an emerging construct which has been shown to play a role in addictive behaviors. The present study sought to validate a translated Persian version of the Desire Thinking Questionnaire (DTQ) in three groups of individuals with Alcohol Use Disorder (AUD; n = 300), nicotine dependence (n = 300), and problematic social media use (n = 300). All three groups completed the translated Persian version of the DTQ, the Barratt Impulsiveness Scale-15 (BIS-15), the White Bear Suppression Inventory (WBSI), and the Depression Anxiety and Stress Scale-21 (DASS-21). Measures of alcohol use, nicotine dependence and problematic social media use were also collected. The results confirmed a two-factor structure of the Persian version of the DTQ with good reliability and validity in all three groups. Furthermore, both the verbal perseveration and imaginal prefiguration components of the Persian version of the DTQ were found to predict addictive behaviors beyond demographic and clinical characteristics, negative affect, impulsiveness, and thought suppression. The study confirms the psychometric properties of the Persian version of the DTQ and the role of desire thinking as an independent predictor of AUD, nicotine dependence, and the problematic use of social media.

Major Depressive Disorder in Iran: Epidemiology, Health Care Provision, Utilization, and Challenges.

One in eight adults in Iran is estimated to have major depressive disorder (MDD) - a leading cause of disability in the country. Many remain undiagnosed, and some receive only partial treatment. An estimated 60% of those with MDD were reported to have received no treatment during the past year. In this paper, we have critically reviewed the current health-care structure in the country along with prevailing patterns of health-care service utilization. We have addressed the role of psychiatrists, general practitioners (GPs), psychologists, and other health-care personnel in the treatment and care of patients with MDD, with an emphasis on the quality of service provision. In addition, the strengths and weaknesses of primary healthcare (PHC), the health insurance system, and inpatient care have been discussed. We have paid attention to the contextual issues such as mental health literacy, stigma, and healthcare inequity where relevant. Finally, practical recommendations have been provided to improve the quality of care for patients with MDD in Iran.