The effect of cognitive behavioral counseling on anxiety and worry level of women with intermediate risk during first trimester screening for down syndrome: a randomized controlled trial: a randomized controlled trial.

BACKGROUND: Anxiety related to prenatal screening programs negatively affects maternal and child health. OBJECTIVE: The study aimed to determine the effect of Cognitive Behavioral Counseling on the anxiety and worry levels of women with intermediate risk during first-trimester screening for Down Syndrome. METHODS: The study was a randomized controlled trial conducted on 52 pregnant women with intermediate risk (1: 51 - 1:1500) during first-trimester screening for Down Syndrome and without additional structural anomalies that referred to three cities of Zanjan province in 2021. The eligible women were randomly assigned to intervention and control groups, with a block size of four. The intervention group received CBC in four sessions of 120 min two times a week by phone. Data were collected using Vandenberg Anxiety Questionnaire, and Cambridge Worry Questionnaire in three phases baseline, after the intervention, and 6 weeks follow-ups. Data were analyzed using independent t-test, chi-square, and repeated measures ANOVA at a 95% confidence level. (P < 0.05). RESULTS: In the counselling group, the mean (SD) of a total score of anxiety before the intervention was 67.11 (20.68) which decreased to 32.50 (13.58) in six weeks after the intervention. Furthermore, the mean (SD) of a total score of worry before the intervention was 56.19 (16.76) which decreased to 32.96 (8.89) six weeks after the intervention. Based on the repeated measures ANOVA test, the mean total score of anxiety and worry were statistically significant 6 weeks after the intervention compared with the control group(p < 0.001). CONCLUSION: Based on the study results, CBC can reduce the anxiety and worry levels of women with intermediate risk during first trimester screening for Down Syndrome. TRIAL REGISTRATION: The study was registered at the Iranian Registry of Clinical Trials website under the code IRCT20160608028352N8, ( https://en.irct.ir/trial/49998 ). The first trial registration date was (29/08/2020).

Comparing the effectiveness of CBT and low-frequency rTMS in reducing symptom severity and depression and improving working memory in adults with OCD: a clinical trial.

OBJECTIVE: This study aims to compare the effectiveness of cognitive-behavioral therapy (CBT) and low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) in reducing symptom severity and depression and improving working memory in adults with obsessive-compulsive disorder (OCD). METHODS: This is a randomized clinical trial conducted on 24 adults with OCD, randomly assigned into two groups of CBT (n = 12, received CBT with exposure and response prevention (ERP) individually at 20 sessions) and rTMS (n = 12, received LF (1-Hz) rTMS over the right dorsolateral prefrontal cortex (DLPFC) at 10 sessions). They completed the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Rating Scale, and two N-Back tasks before, immediately, and 1 month after interventions. RESULTS: Results showed a significant difference between the two methods in reducing the severity of OCD symptoms (p < 0.05) and depression (p = 0.002) immediately after interventions where the CBT with ERP was more effective, but no significant difference was found in terms of working memory (p > 0.05). No significant difference was found between groups in any study variables 1 month after interventions. CONCLUSION: Individual CBT with ERP is superior to LF rTMS for reducing the severity of symptoms and depression in OCD patients. However, there is no difference between them in improving working memory.

Study rationale and design of a study of EMPAgliflozin's effects in patients with type 2 diabetes mellitus and Coronary ARtery disease: the EMPA-CARD randomized controlled trial.

BACKGROUND: Recent trials have revealed that sodium-glucose co-transporter 2 inhibitors (SGLT2-i) are effective against hyperglycemia and also reduce micro- and macro-vascular complications in patients with type 2 diabetes mellitus (T2DM). Most of the beneficial cardiovascular effects have been investigated in patients with heart failure and coronary artery disease (CAD). Yet, few human studies have been conducted to investigate the molecular mechanisms underlying these clinically beneficial effects in patients with CAD. Accordingly, the EMPA-CARD trial was designed to focus on the molecular effects of empagliflozin in patients with T2DM and CAD. METHODS: In this multicenter, triple-blind randomized controlled trial, patients with documented known T2DM and CAD will be recruited. They will be randomized on a 1:1 ratio and assigned into two groups of empagliflozin 10 mg/daily and placebo. The primary endpoint is the effect of empagliflozin on changes of plasma interleukin 6 (IL-6) after 26 weeks of treatment. The secondary endpoints will consist of changes in other inflammatory biomarkers (Interleukin 1-beta and high-sensitive C-reactive protein), markers of oxidative stress, platelet function, and glycemic status. DISCUSSION: The EMPA-CARD trial mainly tests the hypothesis that SGLT2 inhibition by empagliflozin may improve inflammatory status measured as reduction in inflammatory biomarkers in patients with T2DM and CAD. The results will provide information about the underlying mechanisms of SGLT2 inhibition that mediate the beneficial effects of this medication on clinical outcomes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials. www.IRCT.ir , Identifier: IRCT20190412043247N2. Registration Date: 6/13/2020. Registration timing: prospective.

Effect of medication therapy combined with transcranial direct current stimulation on depression and response inhibition of patients with bipolar disorder type I: a clinical trial.

OBJECTIVE: Bipolar Disorder (BD) is one of the most common mental disorders associated with depressive symptoms and impairment in executive functions such as response inhibition. This study aimed to investigate the effectiveness of medication therapy combined with Transcranial Direct Current Stimulation (tDCS) on depression and response inhibition of patients with BD. METHOD: This is a double-blinded randomized clinical trial with pretest, posttest, and follow-up design. Participants were 30 patients with BD randomly assigned to two groups of Medication+tDCS (n = 15, receiving medications plus tDCS with 2 mA intensity over dorsolateral prefrontal cortex for 10 days, two sessions per day each for 20 min) and Medication (n = 15, receiving mood stabilizers including 2-5 tables of 300 mg (mg) lithium, 200 mg sodium valproate, and 200 mg carbamazepine two times per day). Pretest, posttest and 3-month follow-up assessments were the 21-item Hamilton Depression Rating Scale (HDRS) and a Go/No-Go test. Collected data were analyzed in SPSS v.20 software. RESULTS: The mean HDRS score in both groups was reduced after both interventional techniques, where the group received combined therapy showed more reduction (P < 0.01), although their effects were not maintained after 3 months. In examining response inhibition variable, only the combined therapy could reduce the commission error of patients under a go/no-go task (p < 0.05), but its effect was not maintained after 3 months. There was no significant difference in the group received medication therapy alone. CONCLUSION: Medication in combination with tDCS can reduce the depressive symptoms and improve the response inhibition ability of people with BD. TRIAL REGISTRATION: This study was registred by Iranian Registry of Clinical Trials (Parallel, ID: IRCT20191229045931N1 , Registration date: 24/08/2020).

The effect of solution-focused counseling on violence rate and quality of life of pregnant women at risk of domestic violence: a randomized controlled trial.

BACKGROUND: Domestic violence during pregnancy as one of the most common social problems and major challenges of health systems can affect the health of the mother and fetus. The study aimed to compare the two groups of intervention based on solution-focused counseling and control in terms of violence and quality of life amounts in women who had experienced domestic violence. METHODS: A randomized controlled trial on 90 pregnant women was blocked into two intervention groups (n = 45) and a control (n = 45). The intervention group received six counseling sessions with a solution-focused approach. Study tool included conflict tactics scale (CTS- 2) and short form health survey (SF-36). The tools were completed once before the intervention and again 6 weeks after the end of the counseling sessions by the participants of both groups. The P-value less than 0.05 was considered statistically significant. RESULTS: A total of 82/90 pregnant women were analyzed. The results showed that median and interquartile range (IQR) of physical, psychological and sexual violence significantly decreased in the intervention group than the control group (Ps = 0.001). Moreover, quality of life scores significantly improved in the intervention group compared to the control group (P = 0.001). CONCLUSION: Solution-focused counseling could be an effective approach to reduce the amount of violence and increase the quality of life in women exposed to domestic violence. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2017040628352N4 . Date of registration: August 20th 2017.

Empagliflozin improves left ventricular ejection fraction and end systolic volume in patients with type 2 diabetes mellitus and coronary artery disease: a post-hoc analysis of EMPA-CARD trial.

Background: Sodium glucose co-transporter2 (SGLT2) inhibitors have exhibited cardioprotective properties in diabetes patients. The aim of this study was to investigate the effect of Empagliflozin on changes in echocardiographic parameters. Methods: This was a post hoc analysis of the EMPA-CARD trial which was a multicenter, triple-blind randomized controlled trial. Type 2 diabetes mellitus patients with concomitant history of coronary artery disease were randomized on a 1:1 ratio into two groups receiving either 10 mg/day Empagliflozin or placebo. Patients with a history of heart failure (NYHA class 3-4) and ejection fraction (EF) < 40% were excluded. Trans-thoracic echocardiography was performed at baseline and at 26 weeks of intervention. Results: A total of 69 (Empagliflozin = 39 and placebo = 30) patients underwent echocardiography. Significant changes were observed for left ventricular ejection fraction [standard error (SE) = 0.76; beta (95% correlation interval (CrI)] = -5.558 (-7.25; -4.18) and left ventricular end-systolic volume (SE = 1.38; beta (95% CrI) = 3.915 (1.2; 0.66). Other echocardiographic parameters relating to right ventricular or atrial function did not change significantly. Conclusion: Empagliflozin can have cardioprotective benefits in subjects without HF. Further studies are required to determine the effect of Empagliflozin in non-HF patients. Trial registration: The original EMPA-CARD study has been registered in Iranian Registry of Clinical Trials. www.IRCT.ir, Identifier: IRCT20190412043247N2. Registration Date: 6/13/2020. Registration timing: prospective.

Disrupted resting-state functional connectivity of frontal network in opium use disorder.

Opioid use disorder (OUD) as a chronic relapsing disorder is initially driven by dysfunction of brain reward networks and associated with several psychiatric disorders. Resting-state EEG was recorded in 24 healthy participants as well as 31 patients with OUD. Healthy participants do not meet OUD criteria. After pre-processing of the raw EEG, functional connectivity in the frontal network using eLORETA and all networks using graph analysis method were calculated. Patients with OUD had higher electrical neuronal activity compared to healthy participants in higher frequency bands. The statistical analysis revealed that patients with OUD had significantly decreased phase synchronization in ß1 and ß2 frequency bands compared with the healthy group in the frontal network. Regarding global network topology, we found a significant decrease in the characteristic path length and an increase in global efficiency, clustering coefficient, and transitivity in patients compared with the healthy group. These changes indicated that local specialization and global integration of the brain were disrupted in OUD and it suggests a tendency toward random network configuration of functional brain networks in patients with OUD. Disturbances in EEG-based brain network indices might reflect an altered cortical functional network in OUD. These findings might provide useful biomarkers to understand cortical brain pathology in opium use disorder.

A Randomized Clinical Trial to Assess the Effect of Medication Therapy Plus tDCS on Problem-solving and Emotion Regulation of Patients with Bipolar Disorder Type I.

Objective: This study aims to evaluate the effectiveness of medication therapy combined with transcranial Direct Current Stimulation (tDCS) in improving problem-solving and emotion regulation abilities of patients with bipolar disorder (BD) type I. Methods: This is a randomized clinical trial conducted on 30 patients with BD I, randomly assigned into two groups of Medication (n = 15, receiving mood stabilizers including 2-5 tablets of lithium 300 mg, sodium valproate 200 mg, and carbamazepine 200 mg) and Medication + tDCS (n = 15, receiving mood stabilizers plus tDCS with 2 mA intensity over the right dorsolateral prefrontal cortex for 10 days, two sessions per day each for 20 minutes). The Tower of London (TOL) test and Emotion Regulation Questionnaire (ERQ) were used for assessments before, immediately, and 3 months after interventions. Results: There was a significant difference between groups in total ERQ (p = 0.001) and its cognitive reappraisal domain (p = 0.000) which were increased, but the difference was not significant in its expressive suppression domain (p > 0.05). After 3 months, their level decreased. In examining problem-solving variable, the combined therapy could significantly reduce only the total number of errors under TOL test (p = 0.00), but it remained unchanged after 3 months. Conclusion: Medication therapy plus tDCS is effective in improving problem-solving and emotional regulation (cognitive reappraisal) skills of patients with BD I.

Empagliflozin improves high-sensitive cardiac troponin-I and high-density lipoprotein cholesterol in patients with type 2 diabetes mellitus and coronary artery disease: a post-hoc analysis of EMPA-CARD Trial.

Background: Empagliflozin is a sodium glucose cotransporter-2 (SGLT2) inhibitor that has been suggested to improve cardiac function and vascular recovery. The risk of coronary artery diseases is much higher in diabetic patients and is associated with greater morbidity and mortality. High-sensitivity cardiac troponin-I (hs-cTnI) is an important prognostic biomarker in cardiac diseases. Therefore, this study aimed to investigate the effect of empagliflozin compared to placebo on changes in hs-cTnI and lipid profile after 26 weeks of treatment. Methods: This was an ancillary study in a randomized trial of patients with concomitant type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) (The EMPA-CARD study). Patients who were already on standard anti-diabetic/anti-ischemic medications were randomized to receive either placebo or empagliflozin 10 mg/daily. Serum hs-cTnI and lipid profile were measured at baseline and after 26 weeks. Results: Of the 95 randomized patients, hs-cTnI and lipid profile were measured for a total of 77 patients. No significant difference was observed regarding the baseline characteristics between the two arms. Compared to placebo, empagliflozin significantly reduced hs-cTnI after 26 weeks (mean difference (MD) of -13.242, 95%CI: -14.151 to -12.333, p < 0.001). In the empagliflozin group, non-significant reductions in total cholesterol, LDL-C, and triglyceride have resulted; however, there was an increase in HDL-C level (MD = 2.40,95%CI:0.16-4.60, p < 0.04). Conclusion: Empagliflozin compared to placebo was superior in reducing circulating hs-cTnI that may indicate improvements in cardiomyocytes function in patients with T2DM and CAD. Moreover, empagliflozin had a modest impact on the serum lipid profile biomarkers. Trial registration: The original EMPA-CARD study has been registered in Iranian Registry of Clinical Trials. www.IRCT.ir, Identifier: IRCT20190412043247N2. Registration Date: 6/13/2020. Registration timing: prospective.

Personality disorders, depression and anxiety in mothers of children with ADHD and anxiety disorders in Iran.

BACKGROUND/AIM: This study aims to assess and compare personality disorders and psychiatric disorders (depression and anxiety) in mothers of children with ADHD and anxiety disorders aged 2-16 years living in Iran. MATERIAL AND METHODS: This is a descriptive cross-sectional study. Participants were 168 mothers (100 with children having ADHD and 68 with children having anxiety disorders). The Millon Clinical Multiaxial Inventory-III, the Depression Anxiety Stress Scale (DASS-21) and the Symptom Checklist-90-Revised (SCL-90-R) were used for assessing personality disorders, depression and anxiety in mothers. Collected data were analysed in SPSS software. RESULTS: Of 168 mothers, only 100 completed the questionnaires completely (68 having children with ADHD and 32 with anxious children). Of 100 mothers, 61 had personality disorders, where 21 had children with anxiety disorders and 40 had children with ADHD. The most common personality disorder was depressive personality disorder (n = 27) followed by compulsive personality disorder (n = 15). No antisocial, borderline and paranoid personality disorders were observed in mothers. Based on DASS-21, 72 mothers had depression, and 84 had anxiety. Based on the SCL-90-R, 86 had depression, and 81 had anxiety. We found no statistically significant difference between the two groups of mothers in terms of personality disorders, depression and anxiety. CONCLUSION: Prevalence of depression, anxiety and personality disorders in mothers of children with anxiety disorders and ADHD in Iran is high, and there is no difference between them. It is recommended that psychiatric and psychological counseling be provided for these mothers.

Comparing LORETA Z Score Neurofeedback and Cognitive Rehabilitation Regarding Their Effectiveness in Reducing Craving in Opioid Addicts.

Introduction: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have numerous psychological benefits for patients with substance use disorders. However, the effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z Score Neurofeedback (LZNFB) and cognitive rehabilitation therapy in reducing opioid craving has not been investigated. Thus, the present study aimed to compare the effectiveness of LZNFB and cognitive rehabilitation therapy with Methadone Maintenance Treatment (MMT) in reducing craving in patients with opioid use disorder. Methods: Thirty patients with opioid use disorder undergoing MMT were randomly assigned into three groups: LZNFB with MMT, cognitive rehabilitation with MMT (as experimental groups), and MMT alone control group. The LZNFB and cognitive rehabilitation groups received 20 and 15 sessions of treatment, respectively. The three groups were assessed using several questionnaires and dot-probe task at pretest, posttest, and one-month follow-up. Results: The results showed that both experimental groups accomplished a significantly greater reduction in opioid craving than MMT alone group at posttest and follow-up (P<0.05). The LZNFB plus MMT group showed a greater decrease in opioid craving than the cognitive rehabilitation plus MMT group. In addition, the cognitive rehabilitation plus MMT group experienced greater improvement in attentional bias towards craving cues than the LZNFB with MMT group at posttest and follow-up. Finally, the LZNFB plus MMT group and cognitive rehabilitation plus MMT group got higher scores on the recovery assessment scale than MMT alone group at posttest and follow-up. According to study results, LZNFB training is more effective than cognitive rehabilitation in decreasing cravings and improving the quality of life in addiction to opioids. Conclusion: The current study's findings provided preliminary support for the effectiveness of LZNFB and cognitive rehabilitation in reducing opioid craving, improving attentional bias towards craving cues, and the quality of life among Iranian opioid use patients. Highlights: LZNFB training showed higher decrease in opioid craving than the Cognitive rehabilitation in opioid addicts.Cognitive rehabilitation group experienced greater improvement on attentional bias towards craving cues than LZNFB.LZNFB and Cognitive rehabilitation with MMT group got higher scores on the recovery assessment scale than MMT alone group.LZNFB training is more effective than Cognitive Rehabilitation in decreasing of craving in addiction. opioids. Plain Language Summary: Addiction is a chronic relapsing disease that makes many problems for human society. Routine medical treatments are not completely effective and they have relapse. New forms of non-medical treatments such as neurofeedback and cognitive rehabilitation are effective and safe without impressive side effects . This article shows the efficacy of above mentioned interventions for decrease craving and control of this problem.

Using Bilateral tDCS to Modulate EEG Amplitude and Coherence of Men With Opioid Use Disorder Under Methadone Therapy: A Sham-controlled Clinical Trial.

Objective. This study aimed to investigate the effect of bilateral transcranial direct current stimulation (tDCS) on the electroencephalography (EEG) amplitude and coherence in male patients with opioid use disorder (OUD), who were under methadone therapy. It compares the effects of active versus sham tDCS. Methods. This is a double-blind sham-controlled clinical trial. Participants were 30 male patients with OUD; they were divided into 3 groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. Their brainwave activity was measured by quantitative EEG before study and then active groups underwent tDCS (2 mA, 20 min) applied over their right/left dorsolateral prefrontal cortex (DLPFC) for 10 consecutive days. After stimulation, they were re-assessed. The collected data were analyzed in SPSS, MATLAB, and NeuroGuide v.2 applications. Results. After active tDCS, a significant decrease in amplitude of slow brain waves (delta, theta, and alpha) in prefrontal, frontal, occipital, and parietal areas, and an increase in the coherence of beta, delta, and theta frequency bands in the parietal, central, and temporal regions of addicts were reported. In the sham group, there was a significant decrease in the amplitude of the alpha wave and in the coherence of delta and theta waves. Conclusion. The active tDCS over the right/left DLPFC, as a noninvasive and complementary treatment, can modulate the amplitude and coherence of brainwaves in patients with OUD.

The effect of EMPAgliflozin on markers of inflammation in patients with concomitant type 2 diabetes mellitus and Coronary ARtery Disease: the EMPA-CARD randomized controlled trial.

Systemic inflammation and oxidative burden in patients with type 2 diabetes mellitus (T2DM) causes deleterious cardiovascular outcomes. We sought to investigate the clinical antioxidative and anti-inflammatory effects of empagliflozin. Platelet function, oxidant and antioxidant biomarkers and pro-inflammatory agents at baseline and at 26 weeks were measured. A total of 95 patients (41.05% male, mean age 62.85 ± 7.91 years, mean HbA1c 7.89 ± 0.96%) with concomitant T2DM and coronary artery disease (CAD) were randomized (1:1) to receive empagliflozin (10 mg/daily) or placebo. Patients treated with empagliflozin had lower levels of interleukin 6 (IL-6) (adjusted difference (adiff): - 1.06 pg/mL, 95% CI - 1.80; - 0.32, P = 0.006), interleukin 1ß (IL-1ß) and high-sensitive C-reactive protein (Hs-CRP) (adiff: - 4.58 pg/mL and - 2.86 mg/L; P = 0.32 and 0.003, respectively) compared to placebo. There were elevations in super oxidase dismutase (SOD) activity, glutathione (GSHr), and total antioxidant capacity (TAC) with empagliflozin (adiff: 3.7 U/mL, 0.57 muM, and 124.08 mmol/L, 95% CI 1.36; 6.05, 0.19; 0.95, and 47.98; 200.18, P = 0.002, 0.004, and 0.002, respectively). While reactive oxygen species (ROS) improved significantly (adiff: - 342.51, 95% CI - 474.23; - 210.79, P < 0.001), the changes in catalase activity (CAT), malondialdehyde (MDA), or protein carbonyl groups (PCG) were not significant. Moreover, the P-selectin antigen expression on platelet surface was significantly reduced (adiff: - 8.81, 95% CI - 14.87; - 2.75, P = 0.005). Markers of glycemic status (fasting blood glucose, HbA1c, and HOMA-IR (homeostatic model assessment for insulin resistance) significantly improved (P < 0.001). Among patients with T2DM and CAD, 6-month treatment with empagliflozin can mitigate inflammation, platelet activity and oxidative stress and is associated with clinical cardiovascular benefits.Trial Registration Iranian Registry of Clinical Trials. www.IRCT.ir , Identifier: IRCT20190412043247N2. Registration Date: 6/13/2020. Registration timing: prospective.

The Effect of Problem-Solving-Approach-Based Counselling on Maternal Role Adaptation in Women with Late Preterm Infant: A Randomized Controlled Trial.

Introduction: Mothers with preterm infants experience numerous stressful problems which can have negative effects on maternal role adaptation. This study aimed to investigate the effectiveness of consultation using a problem-solving approach on adaptation to the maternal role in women with late preterm infants. Methods: This randomized controlled trial (RCT) was carried out on 80 women with spontaneous late preterm infants recruited at Ayatollah Mousavi Hospital of Zanjan. Using convenience sampling method, the participants were assigned into two groups of intervention and control according to block design. Taking a problem-solving approach, counselling was carried out individually in four sessions. The control group received only routine care. The data were collected using adaptation to maternal role questionnaire including 33 items based on a five-point Likert scale ranging in seven areas, in two steps (before counselling and one month after the last counselling session). Data analysis was performed using the SPSS ver. 16.0 software (SPSS, Inc., Chicago, IL). Results: The total score of adaptations to maternal role and its areas was significantly higher in the intervention group after the follow-up period. Conclusion: A comprehensive counselling including various dimensions of maternity adaptation had a positive effect on improving the adaptation to maternal role in mothers with late preterm infants.

The Effect of Quantitative Electroencephalography-Based Neurofeedback Therapy on Anxiety, Depression, and Emotion Regulation in People with Generalized Anxiety Disorder.

INTRODUCTION: Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders that has significant adverse effects on social functioning, occupational/academic performance, and daily living. This study aimed to evaluate the effect of Quantitative Electroencephalography (QEEG)-based Neurofeedback (NFB) therapy on anxiety, depression, and emotion regulation of people with GAD. METHODS: This research is a quasi-experimental study with a pre-test/post-test/follow-up design and a control group. The study participants were 29 college students with GAD living in Zanjan City, Iran, who were selected using a convenience sampling method. Then, they were randomly divided into two groups of intervention (n=15) and control (n=14). The protocol of NFB therapy was designed based on the QEEG method. The intervention group received QEEG-based NFB therapy for 8 weeks (20 sessions, 2 sessions per week, each session for 45 min), while the control group received no intervention. The samples were surveyed and measured by using a 7-item GAD scale, Emotion Regulation Questionnaire (ERQ), 21-item Depression, Anxiety, and Stress Scale (DASS), and Structured Clinical Interview for DSM (SCID) before and after the intervention and then at a 3-month follow-up. The collected data were analyzed in SPSS software V. 22 using univariate ANCOVA and repeated measures ANOVA. RESULTS: The within-subjects effect of time (pre-test, post-test, and follow-up) was statistically significant (P=0.031). The intervention group showed significant changes in the post-test and follow-up phases in comparison with the control group. The anxiety and depression levels of patients reduced significantly (P=0.001), and their emotion regulation improved (P=0.001) after the intervention, and they remained unchanged in the follow-up period. CONCLUSION: QEEG-based NFB therapy can reduce anxiety and depression and improve emotion regulation in patients with GAD.

The Relationship between Depression and Anxiety with Temporomandibular Disorder Symptoms in Dental Students.

Objectives:It can be said that approximately 60-70% of the general population would probably experience at least one symptom of temporomandibular disorder (TMD) in their lives, but only about 5% of these people seek treatment. On the other hand, depression and anxiety are now recognized as a serious public health problem among adults. Anxiety disorder is a chronic, high-risk disease that may lead to dysfunction and reduce quality of life. The aim of this study was to assess the association between depression and anxiety with TMD in dentistry students of Zanjan Dental School in 2020-2021. Methods:The population of this study consisted of students with TMD, and the control population was selected from students of the same faculty. To collect the data, volunteers first answered questions about the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Then the Depression, Anxiety and Stress Scale (DASS-21) questionnaire was completed by students in both groups. The collected data were then entered into stata software version 14. Results:According to the results of univariate analysis of logistic regression, gender, tuition, residential status, stress, anxiety and depression have a significant effect on TMD (P <0.2). After examining the gisimultaneous effect of variables and eliminating possible confounding variables with multiple logistic regression models, stress was identified as the most effective factor in TMD (significance level in this model is less than 0.05). Conclusion:Based on findings, while there was a significant relationship between stress, depression and anxiety with symptoms of TMD, stress alone was identified as the most effective factor in developing TMD.

A sham-controlled clinical trial to examine the effect of bilateral tDCS on craving, TNF-α and IL-6 expression levels, and impulsivity of males with opioid use disorder.

BACKGROUND: Opioid use disorder (OUD) is one of the problems and concerns of all countries in the world. On the other hand, transcranial direct current stimulation (tDCS) has been used as a new therapeutic intervention in various psychiatric disorders. OBJECTIVE: This study aimed to investigate the effect of bilateral tDCS on the expression levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), craving and impulsive behaviors of male patients with OUD. METHODS: This is a double-blind sham-controlled clinical trial. Participants were 31 male patients with OUD divided into three groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. They received active tDCS (2 mA, 20 min), applied over their dorsolateral prefrontal cortex (DLPFC) for 10 consecutive days. Expression levels of IL-6 and TNF-α cytokines were measured using ELISA method, and the Desires for Drug Questionnaire and the Barratt Impulsiveness Scale version 11 were used to assess the craving and impulsivity of subjects, respectively. RESULTS: Both active and sham tDCS could significantly reduce drug craving in subjects (p < 0.05). Active tDCS over the right/left DLPFC significantly reduced impulsivity and its dimensions (overall, attentional, motor, and nonplanning) compared to the sham tDCS (p < 0.05). It could also reduce the expression levels of IL-6 and TNF-α, but the difference was not statistically significant. CONCLUSIONS: The active tDCS over the right/left DLPFC, as a noninvasive and complementary treatment, can be used along with other common methods for the treatment of patients with OUD. It can improve their cognitive functions by reducing impulsivity.

Cognitive-Behavioral Therapy Versus Transcranial Direct Current Stimulation for Augmenting Selective Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder Patients.

INTRODUCTION: Obsessive-Compulsive Disorder (OCD) belongs to the categories of psychiatric disorders with the potential to turn into a chronic condition without receiving the necessary treatments. The main feature of OCD is the frequent or intense obsession and compulsion that might induce great pain and suffering in patients. Moreover, as one of the most prevalent abnormalities, depression usually follows OCD. The present study aimed to compare the effects of Exposure and Response Prevention (ERP) and Transcranial Direct Current Stimulation (tDCS) treatments adjunct to pharmacotherapy on decreasing the severity of obsession-depression symptoms and improving the quality of life in OCD patients. METHODS: This was a quasi-experimental study with a pre-test, post-test design and a follow-up stage. The statistical population comprised all the patients diagnosed with OCD in Zanjan Province, Iran. Besides, 26 OCD patients referring to Shahid Beheshti Medical Center in Zanjan were selected using a purposive sampling method. Then, they were randomly assigned to two treatment groups. The study subjects completed the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI 2), and the Quality of Life Questionnaire at the pre-treatment, post-treatment, and follow-up stages (1 month and 2 months after the treatment). Analysis of Covariance (ANCOVA) and Reliable Change Index (RCI) methods were used to measure statistical and clinical significances, respectively. The collected data were analyzed using SPSS. RESULTS: The obtained data suggested no significant difference between the ERP and tDCS groups concerning the symptoms of OCD and depression at the post-test stage (P>0.05). Conversely, in terms of life quality, there was a significant difference between the ERP and tDCS groups at the post-test phase (P<0.05). CONCLUSION: Although the present findings revealed no statistically significant difference between the ERP and tDCS groups (except for the quality of life variable), the pharmacotherapy-ERP combination proved to be more effective than pharmaco therapy-tDCS in treating OCD patients.

Stress, Anxiety, and Depression Levels Among Healthcare Staff During the COVID-19 Epidemic.

INTRODUCTION: In the Coronavirus Disease 2019 (COVID-19) pandemic, medical staff Are in direct contact with the patients and experience high work pressure. Direct contact with the patients could create some psychological problems in this group. Thus, the prevalence of such problems must be investigated in them. The present study aimed to determine the level of stress, anxiety, and depression among the healthcare staff in Zanjan City, Iran, during the COVID-19 epidemic. METHODS: This descriptive study has a cross-sectional design. The Sample of the study population consisted of 535 Staff healthcare members of Vali-e-Asr Hospital in Zanjan City, Iran. A sample of 200 of medical staff was randomly selected to participate in the present study. The required data were collected using the electronic version of Depression, Anxiety, Stress Scale (DASS) tool. Descriptive statistics, as well as the inferential statistics (the Pearson correlation coefficient, Spearman correlation coefficient, Phi, and Cramer's correlation tests), were used to analyze the obtained data in SPSS. RESULTS: The mean age of the study participants was 40.60 years. The mean values of depression, anxiety, and stress in study samples were 6.27, 5.38, and 8.41, respectively. There was a significant relation between gender and variables of depression, anxiety, and stress. There was also an inverse relationship between stress and variables of educational level and age (P<0/05). CONCLUSION: We found that our sample reported a normal degree of Depression, anxiety, and stress. The extent of stress induced by direct contact with patients was higher in female employees. Furthermore, with the increase in the education and age of the employees, their stress level decreased.

Comparing the Effectiveness of Neurofeedback and Transcranial Direct Current Stimulation on Sleep Quality of Patients With Migraine.

INTRODUCTION: Migraine is considered one of the most common primary headache disorders. Migraine attacks may occur due to a lack of sleep. Furthermore, sleep is regarded as one of the smoothing factors of migraine pain. Patients with sleep disorders often suffer from headaches when they wake up compared with healthy individuals. METHODS: This research was a quasi-experimental study with a pre-test-post-test design and a 2-month follow-up. The samples included 20 migraine patients within the age range of 15 to 55 years who were selected as volunteers for treatment by the neurologists and psychiatrists during 2017. The initial evaluation was then conducted based on the inclusion and exclusion criteria and using the Ahvaz migraine questionnaire, and Pittsburgh sleep quality index. The patients were randomly assigned to two neurofeedback (n=10) and transcranial Direct Current Stimulation (tDCS) (n=10) groups and evaluated three times. The obtained data were analyzed by the repeated measures ANCOVA and Chi-square test in SPSS. RESULTS: Based on the scores of both groups, no significant difference was observed between neurofeedback and tDCS groups. However, based on the results, neurofeedback decreased sleep latency, whereas tDCS increased sleep efficiency. Overall, these two treatments were effective in improving subjective sleep quality and sleep quality. CONCLUSION: Both neurofeedback and tDCS treatments could significantly enhance sleep quality of the patients in the post-test and 2-month follow-up. Given the effectiveness of both treatments, neurofeedback and tDCS are recommended to be used for improving the sleep status of patients with migraine.