Cognitive functioning in adults with autism spectrum disorder.

INTRODUCTION: Neuropsychological deficits in areas of Executive Functioning (EF), theory of mind, and central coherence have been well-documented among children and adolescents with autism spectrum disorder (ASD); however, there remains a significant gap in knowledge with regards to neuropsychological profile in adults with ASD. This study aims to investigate the intellectual functioning and neuropsychological profiles of a clinical population of adults with ASD. METHODS: This cross-sectional study included 40 available autistic individuals referred to an adult developmental disorders clinic at a hospital between 2021 and 2022. All participants were assessed using the Stanford-Binet Intelligence Scale (SBIS), Autism Spectrum Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and Social Responsiveness Scale (SRS). RESULTS: Individuals with ASD exhibited lower IQ scores across all domains of the Stanford-Binet Intelligence Scale, compared to the general population, although the mean IQ scores remained within the normal range. Significant differences were observed in Full Scale IQ, Verbal IQ, Non-Verbal IQ, Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual-Spatial Processing, and Working Memory compared to the general population. Additionally, autistic individuals' performance on verbal knowledge was higher compared to non-verbal knowledge. No significant correlations were found between the total and subscale scores of verbal and nonverbal IQ and AQ, RAADS-R, and SRS scores. CONCLUSION: Considering the significant impacts of cognitive and executive function on the social and occupational aspects of autistic adults, further investigations in this area are warranted.

Pattern of Compliance and Efficacy of Repetitive Transcranial Magnetic Stimulation Protocol for Treating Major Depressive Disorder Among Treatment Participants and Completers: A Report From Iran.

Introduction: Since the introduction of the Food and Drug Administration (FDA)-approved repetitive transcranial magnetic stimulation (rTMS) intervention in 2008, a breakthrough has been made in treating major depressive disorder (MDD). However, many sessions of treatment and its cost make it inconvenient for those who seek treatment, especially in large cities as well as in developing countries. Methods: A total of 22 patients (out of initial 24 referrals) who met diagnostic and statistical manual of mental disorders, 4th edition (DSM IV) criteria for MDD were enrolled in the study. All subjects had to fail at least one prior treatment for depression. The patients received the FDA-approved protocol of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. Results: Seventeen out of twenty-two cases showed significant improvements after two weeks of treatment. Only six patients continued their treatments for the next two to four weeks. Conclusion: We have replicated other studies showing that the use of rTMS is effective for many patients with MDD without major side effects and their improvements are measurable mostly after two weeks. Our data highlight the importance of the application of more convenient protocols that require fewer sessions on fewer days to help with compliance and outcome, particularly in large populated cities and countries, such as Iran going through economic hardship. Highlights: Repetitive transcranial magnetic stimulation (rTMS) is effective for treating major depresion.Improvemens are measurable after 2 weeks of treating with rTMS.Compliance is a major factorto for completing rTMS protocols. Plain Language Summary: Major depression is one of the most common psychiatric disorders leading to debilitating course causing significant burden for the society. Many cases with major depression are resistent to treatment as they try multiple interventions with no success. This condition is also called refractory depression. rTMS is a novel intervention introduced first almost two decades ago to treat refractory depression among some other psychiatric disorders. In this intervention pulses generated by magnetic stimulation over the brain leads to improvement is depression. As this treatment is safe with no pain and discomfort there have been much interest in the field to use it more frequently. rTMS is usually done over 15-30 sessions with its maximum effects appearing within the first two weeks of treatment. The number of sessions is a potential factor contributing to poor compliance in some cases especially those living in large metropolitan areas. In this paper we explored compliance and effect of treatment within the first two weeks among a group of patients in a private outpatient clinic of a large metropolitan area.

From neurodevelopmental to neurodegenerative disorders: Investigating symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in patients with dementia.

Dementia is characterized by a progressive cognitive decline that could be caused by several disorders. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two prevalent neurodevelopmental disorders that might overlap with dementia symptoms. Hence, this study aimed to evaluate the ASD and ADHD symptoms in dementia patients referred to a memory clinic in Iran. We recruited 65 dementia patients and instructed them to fill out the autism quotient (AQ) and the Conners' Adult ADHD Rating Scales (CAARS) questionnaires. Considering the cutoff points of AQ and CAARS questionnaires, 18.5% of participants were at higher risk of ASD, and 35.4% were at higher risk of ADHD. The results indicated that ADHD and ASD symptoms might be common comorbidities in patients with dementia which can increase the disease burden. Specialized ADHD and ASD screening tools in the elderly population with dementia are needed to prevent misdiagnoses due to symptom overlaps.

Camouflage and masking behavior in adult autism.

Introduction: Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts. Social camouflaging was first shown to be a characteristic of autistic persons, who actively try to disguise and compensate for their autism features in social contexts in an effort to socially blend in better. Recently, an increasing, though still insufficient, number of studies has been conducted on the concept of camouflage; however, different aspect of it, from psychopathology and etiology to its complications and consequences, are not clearly defined. We aimed to systematically review the existing literature on camouflage in autistic adults to describe the correlates of camouflage, motivations for exhibiting camouflage behavior, and the potential impacts of camouflage on the mental health of autistic individuals. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guidelines to conduct a systematic review. The databases of PubMed and Scopus, and PsycInfo were searched for eligible studies. Studies were published between January 1st, 1980, to April 1st, 2022. Results: We included 16 articles, of which four studies were qualitative and 11 were quantitative. One study used a mix method. The assessment tools used for camouflage, the correlates of camouflage including autism severity, gender, age, cognitive profile and neuroanatomical correlates, reasons for camouflage and the impacts of camouflaging behavior on mental health are discussed in this review. Discussion: In synthesizing the literature, we conclude that camouflage seems to be more common among females who report more autistic symptoms themselves. There may also be some differences between men and women in reasons of exhibiting it and its neuroanatomical correlates. Further research is needed as to why this phenomenon is more prevalent in females with implications for gender related cognitive and neuroanatomical differences. Effects of camouflage on mental health and daily life measures of individuals such as employment, university graduation, relationship, financial status, and quality of life should be studied with more details in future studies.

The Association Between Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Symptoms in Medical Students.

ABSTRACT: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are the two most prevalent neurodevelopmental disorders affecting communication and behavior. The co-occurrence of these conditions is probable and can contribute to several challenges in adaptive functioning and academic achievement.In this cross-sectional study, 168 Iranian medical students (107 female, 61 male) studying at Tehran University of Medical Sciences in 2021 were enrolled. We administered the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) and Adult ADHD Self-Report Scale (ASRS) questionnaires online to assess different symptoms of ASD and ADHD in our sample. In this study, the RAADS-R was translated into Persian and validated for the first time in Iran.The correlation tests demonstrated a significant association between the total score and different subscales' scores of the RAADS-R and the total score and the two subscales' scores of the ASRS questionnaire ( p < 0.001, 0.27 < Spearman correlation coefficient < 0.51). This study also illustrated a high prevalence of ASD and ADHD symptoms among the participants. Moreover, male respondents had a significantly higher prevalence of ASD symptoms (57.3% in males vs . 28.03% in females, p < 0.001).This study indicated that the distinct impairments in behavior and cognition attributed to ASD and ADHD could be common manifestations in medical students. Given that the co-occurrence of these disorders may lead to significant challenges in their professional life, the early diagnosis and subsequent support for medical students with co-occurring expressions of ASD and ADHD could be extremely helpful, as it could indirectly improve the medical services provided to patients by future physicians, leading to an improvement in public health.

Using a mobile application for psychiatry training in medical students: a quasi-experimental study.

OBJECTIVE: Microlearning and gamification through mobile technology can significantly enhance knowledge acquisition and satisfaction. Roozbehyar application, was designed using microlearning and gamification approaches for psychiatry clerkship training. METHOD: This quasi-experimental study was conducted in Roozbeh Hospital, in 2021. The intervention group was assigned to the Roozbehyar during a 4-week course. Knowledge and satisfaction were assessed after 4 weeks. RESULTS: We recruited 27 (F/M: 19/8) and 35 students (F/M: 22/13) in the intervention and control groups, respectively. Learning through Roozbehyar was associated with higher scores in the final written exam (p value: 0.031). No difference was seen in the final global assessment scores. The satisfaction scores of the students regarding the content and learners' aspect of the application were above average, yet scores in structural and support aspects were below average. CONCLUSIONS: We highlighted the effect of a microlearning mobile application in increasing knowledge and satisfaction in psychiatry training in medical students.

Roozbeh adult autism spectrum disorder clinic: lessons learned from first 34 cases.

Autism Spectrum Disorder (ASD) is a complex heterogeneous clinical entity with many overlaps and comorbidities with other psychiatric and developmental disorders. Adults with ASD lack adequate access to facilities and supports. This article describes the clinical profile of the first 34 patients admitted to Roozbeh adult ASD clinic during a 12-month period. Twenty-eight patients were male, all were single, 22 patients were unemployed and 26 were living with their families of origin. Obsession, inattention and sexual problems were the most common chief complaints. Multifaceted and gender-specific presentations results in misdiagnoses. Knowledge and training of the mental health professionals on adult ASD seem to be seriously inadequate. There is virtually no other specialized clinical and rehabilitation facilitates to help this vulnerable group of patients in Iran.

Persian Translation and Cultural Adaptation of Mini International Neuropsychiatric Interview and its Psychometric Properties.

BACKGROUND: The main objectives of this study were the translation, cultural adaptation, and assessment of the psychometric properties of the Persian version of Mini International Neuropsychiatric Interview (MINI). METHODS: All processes of linguistic methodology were conducted according to the published guidelines. A total of 180 patients with psychiatric problems were interviewed using MINI and Structured Clinical Interview for DSM-5(R) - Clinician Version (SCID-5-CV) by different interviewers. Another 30 patients were selected for examining the test-retest reliability. The study sample was recruited from a psychiatric hospital and a general hospital in Tehran, Iran. Face validity, feasibility, time of the interview, test-retest reliability, and concurrent validity were evaluated. RESULTS: Mean interview time was 19.76±10.30 minutes, indicating satisfactory feasibility. The test-retest reliability was very good (phi=2, Cramer's V=0.89, P<0.0001). The kappa values showed good or excellent agreement between MINI and SCID-5-CV for psychotic disorders (0.88), substance-related disorders (0.86), bipolar disorder (0.85), major depressive disorder (0.84), obsessive-compulsive disorder (0.74), and mental disorder due to other medical disorders (0.7). However, the kappa values were found to be lower for generalized anxiety disorder (0.44) and posttraumatic stress disorder (0.32) diagnoses. CONCLUSION: The Persian version of MINI is a feasible, reliable, and valid instrument for diagnosing some mental disorders. Further research is needed to evaluate the validity of this instrument in other categories of psychiatric diagnoses in the general population.

Relationship Between Psychological Impacts of COVID-19 and Loneliness in Patients With Dementia: A Cross-Sectional Study From Iran.

Objectives: Although the COVID-19 pandemic has affected people all around the world, the elderly is at a higher risk of suffering from its consequences. One of the serious concerns is developing loneliness and post-traumatic stress symptoms, which may contribute to cognitive decline at older ages. This study aimed to examine the psychological responses and loneliness in elderly patients diagnosed with dementia. Methods: Twenty-one patients diagnosed with dementia, with ages older than 40, and 19 caregivers were enrolled in the study. The patients have undergone a comprehensive neuropsychiatric interview and were assessed with De Jong Gierveld Scale for loneliness and Impact of Event Scale-Revised (IES-R). The severity of dementia was assessed by Functional Assessment Staging Tool (FAST Scale) and the Montreal Cognitive Assessment (MoCA). Results: No significant difference was seen in patients and caregivers in the IES-R and loneliness scales. A higher level of avoidance and social and total loneliness were seen in higher FAST levels (p-value: 0.046). There was a negatively significant correlation between MoCA score and avoidance. Hyperarousal was significantly correlated with emotional loneliness in patients. Conclusion: We found a direct relationship between cognitive decline and the psychological impacts of COVID-19. Our results highlight the need for more comprehensive studies to further investigate the influence of the pandemic on the worsening of cognitive impairment and loneliness in patients with dementia.

Distinct Aspects of Decision Making in Obsessive-Compulsive Disorder: Application of Unconscious Thought Theory.

Individuals with obsessive-compulsive disorder (OCD) rely on "explicit learning" strategies in decision making. It is suggested that periods of brief distraction (in healthy individuals) result in better decisions in complex situations. It can be hypothesized that periods of unconscious thought would not lead to better decisions due to impairment of implicit learning in OCD. A total of 121 OCD patients and 120 healthy participants were presented with a task in which they had to choose between four apartments with multiple attributes. Participants were randomly assigned to one of three conditions: making a decision immediately after being presented with options (immediate), after thinking carefully for 2 minutes (conscious thought [CT]), or after being distracted for 2 minutes (unconscious thought [UT]). Individuals with OCD performed worse than healthy controls in UT condition, although they did better in CT condition. Our study supports the idea of dysfunction in implicit processing and overreliance on explicit processes in OCD.

Emergency psychiatric services in Roozbeh Hospital: A qualitative study of the staff's experiences.

PURPOSE: This study aims to explore how psychiatric residents and nurses experience the conditions of psychiatric emergency services. DESIGN AND METHODS: This qualitative study was carried out using content analysis. Data were collected through unstructured interviews conducted during three focus groups. FINDINGS: The results of the focus groups were classified into the following five categories of issues influencing the staff's experiences: repetitive problems, long wait times, ambiguity, insecurity, and stability. PRACTICE IMPLICATIONS: Improving the staff's communication skills and educating them on how to manage violence, establishing a well-functional system of triage, and optimizing bed management and discharge planning are among several potential strategies that might be considered to improve the quality of care in psychiatric emergency services.

A Case of Congenital Insensitivity to Pain With Anhidrosis Comorbid With Attention Deficit Hyperactivity Disorder: Clinical Implications for Pathophysiology and Treatment.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive genetic disorder caused by a mutation in the neurotrophic tyrosine kinase receptor (NTRK1) gene. CIPA is accompanied by abnormal catecholamine metabolism and decreased blood concentration of dopamine and norepinephrine. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder of heterogeneous etiology and presentation, and recent reports have suggested a pathophysiological role of neurotrophins in ADHD. Furthermore, dopamine and norepinephrine are known to play major roles in the pathophysiology of ADHD, and the imbalance of monoaminergic and cholinergic systems as an underlying cause of ADHD has recently been studied. Here, we report the case of an 11-year-old boy with CIPA and comorbid ADHD. Our observations have important clinical implications for patients with CIPA. Because of deficiencies in self-control, proper management of these patients necessitates a highly structured and monitored environment, made dually important by possible comorbidity of ADHD.

Oxidized Low-Density Lipoprotein (ox-LDL) to LDL Ratio (ox-LDL/LDL) and ox-LDL to High-Density Lipoprotein Ratio (ox-LDL/HDL).

BACKGROUND: Oxidized low-density lipoprotein (ox-LDL) plays a principal role in diabetes complications, though ox-LDL concentrations and its functions are dependents of other oxidative and anti-oxidative particles. The oxLDL to low-density lipoprotein ratio (ox-LDL/LDL) and ox-LDL to high-density lipoprotein ratio (ox-LDL/HDL) as new lipid biomarkers may serve as a good estimation of oxidation and anti-oxidation in type 2 diabetes mellitus. The aim of this study was first to examine ox-LDL/LDL and ox-LDL/HDL levels in patients with type 2 diabetes mellitus compared to a control group and evaluate their diagnostic accuracies, and, second, to investigate the correlation of these two ratios with triglyceride and HDL levels. METHODS: This study was included 144 patients admitted to the diabetes clinic of a University general hospital and 41 healthy individuals as controls. Levels of LDL, HDL, triglyceride (TG) ox-LDL, and malondialdehyde (MDA) were measured for all patients. Levels of ox-LDL/LDL and ox-LDL/HDL were calculated. Diagnostic accuracies were determined by receiver-operating characteristic curve analysis by measuring the area under the curve. RESULTS: Ox-LDL, ox-LDL/LDL, and ox-LDL/HDL were significantly higher in patients compared to the control group after adjustment for age, gender, and BMI (p = 0.000). The area under the curve for diagnosing diabetes was 0.946 for ox-LDL/HDL, 0.918 for ox-LDL/LDL, and 0.832 for ox-LDL. Ox-LDL/HDL was positively correlated with MDA (r = 0.210, p = 0.011). Ox-LDL/LDL was negatively correlated with HDL (r = -0.2 p = 0.016) and positively correlated with TG (r = 0.45 p = 0.000). Ox-LDL/HDL and TG had significant positive correlation (r = 0.173 p = 0.037). The ox-LDL/LDL level was significantly higher in patients with coronary heart disease (CHD) or hypertension (HTN) compared to those without (p = 0.042). CONCLUSIONS: Our findings revealed that ox-LDL/LDL and ox-LDL/HDL are potent biomarkers of type 2 diabetes, which apparently reflect the association between lipids in the state of oxidative stress.