Out-of-pocket cost of drug abuse consequences: results from Iranian National Mental Health Survey

Drug abuse has significant cost to the individual, the family and the society. This study aimed to assess out of-pocket costs of consequences of drug use disorder. Data were drawn from the Iranian Mental Health Survey [IranMHS] through face-to-face interviews with 7841 respondents aged 15-64 years. We used a bottom-up cost-of-illness method for economic analysis. Out-of-pocket costs for treatment of mental and drug problems, treatment of medical illnesses, as well as costs of crimes were assessed. The average of total annual expense was US dollar 2120.6 for those with drug use disorder, which was 23.5% of annual income of an average Iranian family in the year 2011. The average of total out-of-pocket cost was US$ 674.6 for those with other mental disorder and US dollar 421.9 for those with no mental disorder. Catastrophic payment was reported in 47.6% of the patients with drug use disorder and 14.4% of those with other mental disorder. Thus, considerable amount of family resources are spent on the consequences of drug use

Assessing measurement error in surveys using latent class analysis: application to self-reported illicit drug use in data from the Iranian Mental Health Survey / 한국역학회지

Latent class analysis (LCA) is a method of assessing and correcting measurement error in surveys. The local independence assumption in LCA assumes that indicators are independent from each other condition on the latent variable. Violation of this assumption leads to unreliable results. We explored this issue by using LCA to estimate the prevalence of illicit drug use in the Iranian Mental Health Survey. The following three indicators were included in the LCA models: five or more instances of using any illicit drug in the past 12 months (indicator A), any use of any illicit drug in the past 12 months (indicator B), and the self-perceived need of treatment services or having received treatment for a substance use disorder in the past 12 months (indicator C). Gender was also used in all LCA models as a grouping variable. One LCA model using indicators A and B, as well as 10 different LCA models using indicators A, B, and C, were fitted to the data. The three models that had the best fit to the data included the following correlations between indicators: (AC and AB), (AC), and (AC, BC, and AB). The estimated prevalence of illicit drug use based on these three models was 28.9%, 6.2% and 42.2%, respectively. None of these models completely controlled for violation of the local independence assumption. In order to perform unbiased estimations using the LCA approach, the factors violating the local independence assumption (behaviorally correlated error, bivocality, and latent heterogeneity) should be completely taken into account in all models using well-known methods.

[Clinical characteristics and diagnostic stability of bipolar disorder in children and adolescents]

The aim of this study was to evaluate the clinical characteristics and diagnostic stability of children and adolescents with bipolar disorder. In this prospective study, 257 subjects with bipolar disorder who were consecutively admitted to Roozbeh Hospital [Tehran, Iran] were enrolled. Demographic characteristics, diagnosis, treatment, comorbid disorders and mood and psychotic symptoms were extracted from the patients' admission files and the information questionnaire, which had been filled in the admission time by the patients. In the further assessment, diagnostic evaluation was done using the Schedule for Affective Disorders and Schizophrenia for School-aged children present and lifetime version [K-SADS-PL], for the patients under 18, and the Schedule for Affective Disorders and Schizophrenia [SADS] for the patients older than 18. Severity of the symptoms in the acute phase of mood disorder was evaluated by the Young Mania Rating Scale [Y-MRS] in manic phase and Beck Depression Inventory [BDI] for patients older than 16 or Children Depression Inventory [CDI] for the patients under 16 in depressive phase. Also, current and past levels of functioning were evaluated by the Global Assessment of Functioning [GAF] scale for patients older than 18 and the Child Global Assessment Scale [CGAS] for the patients under 18. The most common symptom, irritability, was accompanied by elated mood in most cases. 73.2% of the patients had at least one comorbid disorder and the most common comorbid disorder wasAttention Deficit Hyperactivity Disorder [44.2%]. Diagnostic stability in all periods of illness was higher than 80%. This study supports the high diagnostic stability of bipolar disorder in both children and adolescents.

[Quality of studies on the prevalence of psychiatric disorders in Iran]

The aim of this research was to investigate the quality of studies on the prevalence of psychiatric disorders in Iran. All studies on the prevalence of psychiatric disorders among Iraniangeneral population as well as school children over 15 were identified through searching several databases including PubMed, ISI WOS, PsychINFO, CINAHL, Irandoc, EMBASE, IranPsych, IranMedex, and Scientific Information Database as well as reference lists of the accessed documents, unpublished reports, conference proceedings and dissertations. The original studies, which contained an estimation of the prevalence of "any psychiatric disorder" [overall prevalence] among a sample of general population or high school students in the country were selected. A quality assessment checklist was developed based on the following criteria: accurate description of research questions, random sampling, representativeness of the study sample for a defined target population, using the same method of data collection for the entire sample, using valid and reliable tools, and proper analysis of the results. The assessment was performed on those studies on the prevalence of any psychiatric disorder in the country that had used random sampling [43 studies]. It showed that in only about 40% of the studies the sample was representative of the target population. In more than 25% of the studies, validity and reliability of the Persian translation of the instruments were not assessed or were not reported. In total, nearly a third of studies had acceptable quality [random sampling, application of valid and reliable tools, and sample representing the target population]. Although this research - as part of a systematic review-was based only on a group of prevalence studies in psychiatric disorders, its findings indicated that a significant proportion of these studies are non-compliant with key quality measures. Instead of mere emphasis on increasing the number and quantity of studies, policy makers should employ strategies to improve research quality

Emotional intelligence in a group of patients with first-episode psychosis in Iran

This study was aimed to evaluate the Emotional Intelligence [EI] of a group of patients with first episode psychosis in Iran as compared with a healthy control group. A case-control design was used. EI was assessed using Persian version of Bar-On Emotional Quotient inventory [EQ-i] administered on 25 patients with history of a single psychotic episode in the last two years, as well as 64 healthy participants. The mean [+/- SD] of EI scores of patients' and healthy controls' group was 319.8 [+/- 40.9] and 328.8 [+/- 33.3], respectively. Two-independent sample t-test revealed no significant difference in the EI scores of two groups [P=0.29]. In contrast with chronic schizophrenia, the patients with first-episode psychosis were not different from the healthy subjects in terms of emotional intelligence score. It might be implied that the low emotional intelligence of the patients with chronic psychotic disorders is an accumulative result of the underlying disease over time

Exploratory factor analysis of scl90-R symptoms relevant to psychosis

Inconsistent results have been reported regarding the symptom dimensions relevant to psychosis in symptoms check list revised [SCL90-R], i.e., [psychoticism] and [paranoid ideation]. Therefore, some studies have suggested different factor structures for questions of these two dimensions, and proposed two newly defined dimensions of [schizotypal signs] and [schizophrenia nuclear symptoms]. We conducted an exploratory factor analysis on the items of these two dimensions in a general population sample in Iran. A total of 2158 subjects residing in Southern Tehran [capital of Iran] were interviewed using the psychoticism and paranoid ideation questions in SCL90-R to assess severity of these symptom dimensions. Factor analysis was done through SAS 9.1.3 PROC FACTOR using Promax rotation [power=3] on the matrix of [polychoric correlations among variables] as the input data. Two factors were retained by the proportion criterion. Considering loadings >= 0.5 as minimum criteria for factor loadings, 7 out of 10 questions from psychoticism, and 3 out of 6 questions from paranoid ideation were retained, and others were eliminated. The factor labels proposed by the questionnaire suited the extracted factors and were retained. Internal consistency for each of the dimensions was acceptable [Cronbach's alpha 0.7 and 0.74 for paranoid ideation and psychoticism respectively]. Composite scores showed a half-normal distribution for both dimensions which is predictable for instruments that detect psychotic symptoms. Results were in contrast with similar studies, and questioned them by suggesting a different factor structure obtained from a statistically large population. The population in a developing nation [Iran] in this study and the socio-cultural differences in developed settings are the potential sources for discrepancies between this analysis and previous reports

[Cultural adaptation, validity and reliability of Persian version of experience of caregiving inventory in families of patients with severe mental disorders]

This study aims to evaluate the cultural adaptation, validity and reliability of the Persian version of Experience of Caregiving Inventory [ECI] in families of patients with severe mental disorders. After the translation and cultural adaptation of ECI, 225 family members of patients with severe mental disorders completed the ECI, the General Health Questionnaire [GHQ-28] and a demographic questionnaire. The Split half test was used to assess reliability. To determine internal consistency, Cronbach's alpha test and the concurrent validity was calculated by Pearson's correlation between the GHQ-28 and the ECI total negative score. Reliability of the Inventory as assessed by the Spearman-Brown correlation coefficient was 0.80. The range of the Cronbach's alpha for each subscale, total negative score and total positive score was 0.51 to 0.90. Pearson's correlation between the GHQ-28 score and the total negative score was 0.37 [p<0.01]. The Persian version of the ECI has good reliability and validity for family members of patients with severe mental disorders

[Community psychiatry residency training programs across the globe: a review]

Following the approval of the standards for the four-year psychiatry residency curriculum in Iran, training in community psychiatry is now considered as an obligatory 3-month course. Gathering information about the community psychiatry residency programs in other countries could help us in planning and development of an Iranian program. The aim of the current study was to review the programs in different countries. A comprehensive search was performed in various databases using specific keywords such as "residency", "community", and "psychiatry". Moreover, the published training programs of the universities in different countries were obtained. Training varies considerably across different university departments; both in the content and methods of the training and duration of the courses. This variation may be due to different needs and/or available community settings. However, some common features emerge; for example, didactic teachings are integrated in most programs, residents actively participate in delivering community-based services [such as those in community mental health centers and outreach services], and learning how to work in team-based services is a main objective

Psychiatric problems in general outpatient clinics: prevalence and reasons for help seeking

The aims of the present study are to examine the prevalence of psychiatric problems and the reasons for seeking care in urban health centers in district 17 of Tehran [capital of Iran], and to study the sensitivity and predictive value of the presence of psychiatric symptoms as chief complaint and self-report of a psychiatric history for correct recognition of a psychiatric problem. The present research was a cross-sectional and descriptive study. Two urban health centers located in district 17 in Tehran were randomly selected from a total of 7 health centers. Patients referring to outpatient clinics of the centers were consecutively asked to fill in General Health Questionnaire-28 and a pathways-to-care questionnaire. In total, 126 subjects [54% female] were included. Forty-two patients [33.3%] had psychiatric problem based on GHQ. Only 11 [8.7%] had psychiatric symptoms as chief complaints [reasons for referral] and 60 [47.6%] considered themselves having a psychiatric illnesses. Of all GHQ cases, 27 [64.2%] had never consulted for a psychiatric illness. The sensitivity of self-report of psychiatric complaint or illness was less than 70% with positive predictive values of less than 55%. In line with previous research, psychiatric disorders were commonly observed in outpatient clinics in Tehran. However, most of those with a problem had not sought care. In addition, sole reliance on patients' self-report of psychiatric complaint or illness might not lead to proper recognition of patients in primary care

Trifluoperazine-induced cholestatic jaundice

Liver injury occurs with many drugs; therefore, a thorough work up is important for establishing the diagnosis. We report a case of trifluoperazine-induced cholestatic jaundice. A 44-year old male with schizoaffective disorder developed an increase in liver enzymes and jaundice after starting treatment with trifluoperazine .Workup for other potential etiologies was negative

Training health professionals to conduct family education for families of patients with first-episode psychosis: adherence to protocol

The implementation of family psychoeducation at the service delivery level is not without difficulty. Few mental health professionals receive special training to work with families especially in Iran. The aim of the present study was to evaluate the effectiveness of training health professionals in terms of their adherence to protocol. Eight professionals [general practitioners, nurses and social workers] participated in a training program for health professionals as part of the Roozbeh First-Episode Psychosis Program [RooF] to conduct family psychoeducation. Training included a 3-day- workshop and 12 supervision sessions during the course of the implementation of the psychoeducation program. The family psychoeducation sessions [multiple-family group or single-family home-based] were tape-recorded. Transcripts of the audiotaped sessions were analyzed based on the content of the manual and were scored accordingly. Twenty-four recorded sessions were analyzed in terms of the adherence to protocol, the number of questions and the time for each session. The overall rating showed a 72% adherence to the protocol. Multiple-family group sessions had a higher rate compared to the singlefamily home-based family psychoeducation sessions [79% to 69%] as well as the time spent and questions asked. The rate of adherence to the protocol of conducting the family psychoeducation sessions had not changed over time. Considering the amount of time taken for training and supervision, the level of adherence to the protocol was satisfactory. Tape recording sessions and regular supervision would be beneficial following specialized training. Further research is needed to tailor the amount of training and supervision required for professionals to conduct family psychoeducation programs in different settings

Association of premorbid adjustment with symptom profile and quality of life in first episode psychosis in a tertiary hospital in Tehran, Iran

Poor premorbid adjustment has been reported to be a predictor of more severe psychotic symptoms and poor quality of life in such psychotic disorders as schizophrenia. However, most studies were performed on chronic schizophrenic patients, and proposed the likelihood of recall biases and the effect of chronicity. The aim of this study was to investigate these factors in a sample of first episode psychotic patients, as a part of Roozbeh first episode psychosis project [RooF]. Premorbid adjustment was assessed using Premorbid Adjustment Scale [PAS] in 48 patients with the first psychotic episode who were admitted to Roozbeh Psychiatric Hospital. The severity of symptoms was measured using Positive and Negative Scale [PANSS] in three subgroups of positive, negative and general subscales. Quality of life was measured using WHO QOL, and Global Assessment of Functioning [GAF] was also measured. The mean age was 24 years. Poor Premorbid adjustment in late adolescence was significantly associated with more severe symptoms according to PANSS negative symptoms [p=0.019, r=0.44]. Furthermore, sociability and peer relationship domains had a positive correlation with PANSS negative subscale scores [r=0.531, p=0.002 and r=0.385, p=0.03, respectively]. There were no significant differences between males and females in premorbid adjustment. Furthermore, this study failed to show any differences between affective and non-affective psychosis in premorbid functioning. Our study confirms poor premorbid adjustment association with more severe negative symptoms and poor quality of life in a sample of Iranian first episode psychotic patients

Roozbeh home care program for severe mental disorders: a preliminary report

To describe a home care service developed in Roozbeh Hospital for patients with bipolar disorder and schizophrenia and report baseline and 6-month follow-up data. Roozbeh Home Care Program consists of home visits by multidisciplinary home care teams, including general practitioners, nurses, and social workers who are supervised by psychiatrists. Home visits are scheduled as biweekly for the first three months following discharge and then on a monthly basis and the care includes biopsychosocial assessments and interventions. Baseline and 6-month data were extracted using a chart review. After 10 months of the Program development. 53 patients were enrolled and a total of 349 home visits were made. Of these, 29 were followed for at least 6 months. More than 86% of the patients remained in the community throughout the follow-up period, most in full remission and a small minority [4 patients] with a mild to moderate relapse that was overcome with interventions made by the home care teams. A home care service is a feasible mode of community-based aftercare for patients discharged from the hospital. Its effectiveness should be assessed by a randomized controlled trial

Cognitive behavior therapy for trichotillomania: report of a case resistant to pharmacological treatment

To report a case of trichotillomania that was resistant to pharmacological treatment but responded well to a behavioral therapy program based on habit reversal. The patient was a 47-year-old lady. Her problem had started at the age of seventeen. She had experienced several treatments including full doses of antidepressants, mood stabilizers, antipsychotic, and benzodiazepines as single treatments or in combination. The mentioned medication did not affect her condition. In addition, she was drowsy during the daytime and her function was seriously impaired. At the time CBT was started for the patient, she was receiving fluoxetine 40 mg daily, which she had received during the treatment period. Initial assessments included a detailed behavioral interview, daily chart of activities, record of hair pulling behavior with a description of patient's emotional and situational status during the action. The treatment procedures included self monitoring, pulled hair saving and competing response. The patient was followed for 18 months. Only 2 bouts of hair pulling were reported, both of which occurred in the first 6 months of the treatment. The patient's hair became thicker, and she was very satisfied with the therapy. Her social relations and function improved markedly, and her anxiety and sadness left her. This case showed that certain components of habit reversal such as awareness, self-monitoring, pulled hair saving, and competing response were effective in our patient

[Reliability of the Persian translation of the composite international diagnostic interview [CIDI] for diagnosing schizophrenia and bipolar disorder]

This study aimed to assess the reliability of the Persian version of the Composite International Diagnostic Interview [CIDI] for a lifetime diagnosis of schizophrenia and bipolar disorder according to DSM-IV and lCD-10. This project was conducted at three stages of translation of the instrument, reliability assessment and validation, and feasibility and diagnostic reliability assessments for bipolar disorder and schizophrenia using a test-retest methodology. Trained interviewers administered the instrument twice [at 3-7 days' interval] to 100 clients at four university centers [complete CIDI on 65 persons and psychosis/mania module on 35 persons]. Test-retest reliability of CIDI for bipolar disorder was moderate in DSM-IV diagnostic system and poor in ICD-10. Test-retest reliability of CIDI for schizophrenia was poor in both diagnostic systems. The results showed that the diagnostic reliability was good only for bipolar disorder in DSM-IV, otherwise it was not acceptable. However, since the samples were selected from the clinical population, the results cannot be generalized to the normal population. According to the results, adaptation of the key questions to the Persian culture must be considered

[Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV [SCID]]

In this study the Structured Diagnostic Interview for DSM-IV axis I disorders [SCIDI] was translated into Persian using a cross-cultural methodology, and its reliability and feasibility was tested in a multi-center study. The study had two phases: a] translation of the instrument and assessing the cross-cultural equivalence, including forward and backward translation, and face validity of the translated version in regard with cross-cultural characteristics; b] reliability and feasibility assessment of the Persian translation on an Iranian clinical population. This is part of a larger study on validation of the SCID on 299 subjects admitted to outpatient and inpatient services of thee psychiatric centers [Roozbeh Hospital, Imam Hossein Hospital and Iran Hospital] in Tehran, Iran. For test-retest reliability assessment, two SCID interviews [3 to 7 days apart] were administered to 104 subjects and the level of diagnostic agreement was assessd. Feasibility for interviewees [n=299] and interviewers was tested by questionnaires considering the length of interview, its being boring/tiring, comprehensibility and acceptance of the questions, and difficulty of administration. Diagnostic agreement of SCID test and retest were fair to good for most diagnostic categories [kappas over 0.6]. Overall weighted kappa equaled 0.52 for current diagnoses and 0.55 for lifetime diagnoses. Most interviewees and interviewers reported the administration of the Persian SCID as feasible. Acceptable reliability of diagnoses made by the Persian translation of SCID, and its feasibility suggest it as a useful diagnostic instrument in clinical, research, and educational settings

[Analysis of Iran's mental health research over 3 decades: a scientometric study]

Objective: To describe the characteristics of Iran’s mental health research articles that are published over a 30-year period

Method: The articles include those concerned with psychiatry, psychology, and neuroscience that were published in the national as well as international scientific journals. These articles were drawn from a national database of published research in psychiatry, psychology as well as neuroscience [IranPsych]. For this study, articles were limited to those published in a 30-year period of 1973-2002 [1352-1381 in Persian calendar]

Results: Of a total of 3031 articles published in the 30-year period, 19.8% were published in the international journals. The publication trends showed a marked increase in number over item, especially in the last 5 years. Among research areas, psychology, clinical sciences, and the neurosciences constituted the largest proportions [52.8%, 31.6%, and 13.5%, respectively]. The trend of research areas revealed an upward trajectory for the proportion of neuroscience research and a decline in the proportion of mental health service research. The topic of 38.6% of all articles was in the category of mental disorders, with pharmacotherapy and psychotherapy researches constituting 14.5% and 5.7% of the articles, respectively. Among mental disorders, the largest proportions of the published research were about mood disorders, substance use related disorders, and anxiety disorders. The most commonly used research method was cross-sectional, with experimental designs comprising 15.9% and prospective research accounting for 1%. The preferred places for data collection included hospitals, schools and universities. In more than 90% of the articles there were no references to the funding sources and only 2.1% of the articles were carried out with international collaboration of the authors

Conclusion: The rising trend of mental health research publications shows the significant contribution of nation’s mental health researchers. The results of this study could provide an empirical basis for policy making and strategic planning in mental health research