Stress differentially predicts multiple sclerosis relapses

Background and Objective: For decades, stress has been postulated as a risk factor for multiple sclerosis (MS) relapses. Because of conflicting results in previous studies we conducted a prospective study to investigate this relationship in a less studied, Middle Eastern population. Methods: In this prospective study, 57 Iranian MS patients were followed trimonthly for 12 months. Possible stressful events (measured with validated Persian version of Paykel’s questionnaire) and quality of life (measured with validated Persian version of the Multiple Sclerosis Impact Scale questionnaire) were assessed in successive visits in addition to other variables. Relapses were enquired and confirmed clinically by a Neurologist. Main analysis was done by use of Mixed Generalized Linear Model. Results: Mean age of the participants was 33.5±7.4 years, 81% were females, and all were receiving interferons. Number of stressors, not the stress severity measures, reached near significance in predicting relapses (p=0.054), and showed a trend towards significance in predicting severe relapses (p=0.082). Education and number of previous relapses were the only variables that had a near significance interaction with number of stressors in its association with MS relapse. This association was only significant among subjects with less than college education (P=0.008) and subjects with more than 2 relapses (p=0.038). Conclusion: Number of stressors, not their severity, was associated with MS relapses among Iranian patients. This association had interaction with education and history of previous relapses; it was significant only among lower educated patients or patients with more prior relapses.

[Comparison of the effectiveness of cognitive behavior therapy and mindfulness based therapy on the decrease in symptoms of patients who suffer from irritable bowel syndrome]

The current research is performed to compare the effectiveness of two methods of cognitive behavior therapy and mindfulness based therapy in decreasing symptoms of patients who suffer from irritable bowel syndrome. This was a quasi-experimental design study that consisted of an experimental group subdivided into two groups [pre- and final test] and a control group. Based on convenience sampling we randomly assigned 36 persons, 20 males and 16 females, n=12 per group, micro=32 years of age, to one of the three groups. Irritable bowel syndrome symptoms significantly decreased between the two treatment groups and the control group [p<0.05], which we attributed to the benefits of mindfulness based therapy. Therapists should consider modern psychotherapy techniques such as mindfulness based therapy as potential methods for decreasing the clinical symptoms of irritable bowel syndrome. Older techniques are not always perfect or effective.

Diagnosis, requests and timing of 503 psychiatric consultations in two general hospitals

The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists [two full-time and two part-time]. This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder [43.5%], adjustment disorder [10.9%] and cognitive disorder [7.6%]. In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days [range=1-90, SD=13]. Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction

Medical students' viewpoint regarding the integrated module of basal ganglia

Integration is an important educational strategy in medical education. Considering this idea, the goal of the present study was to design and implementation of longitudinal and vertical integrated education of anatomy, physiology, pharmacology, neurology and neuropsychiatry subjects of brain's basal ganglia by a multidisciplinary team. Kern's approach to curriculum development was used. Participants were 20 medical students at basic science level who contribute in a 10 stations of pre-test exam at Medical School's Skill Lab. After the implementation of the module by a multidisciplinary team, post-test were done. A structured questionnaire was designed to assess student opinions about adequacy, usefulness of the module using a Likert scale with 5 categories ranging from "completely agreement" to "completely disagreement". The result of pre and post-test were also compared. Twenty questionnaires were completed, giving a 77.63% satisfaction rate. Seventy-five percent of students found it useful and appropriate at basic science level. About fifty percent of students suggested the implementation of this module for other medical students. The score of post-test was significantly [14.52 +/- 0.47 vs 6.32 +/- 0.62, P<0.05] higher than pre-test results. The viewpoints of medical students were positive and they value the module highly. Since it is not easy to change the style we teach, these results suggest necessitate of supporting the faculty member's participation in these modules

Depression and anxiety in a cardiovascular outpatient clinic: a descriptive study

Cardiac diseases are psycho-somatic disorders, and psychological aspects play an essential role in their initiation and exacerbation. The aim of this study was to gain appropriate knowledge in the epidemiology of co-morbid depression and anxiety disorder in cardiovascular outpatients. This study is descriptive with a sample of patients attending a cardio-vascular clinic. 238 individuals were included in this study using a consecutive sampling method. The study instrument was Hospital Anxiety and Depression Scale [HADS] questionnaire, which is a clinical scale for assessing anxiety and depression. Of the 238 participants in this study, 93[38.7%] were male and 146 [61.3%] female. 28.5% of patients suffered from anxiety disorders, and 41.9% had depression. Regarding comorbid diseases such as diabetes mellitus, hyperlipidemia and hypertension, the severity of depression was just related to hypertension. There was a meaningful relationship between gender and symptoms of anxiety so that symptoms were more severe in women. Considering the high prevalence of depression and anxiety in patients suffering from cardio-vascular diseases, it is necessary to screen psychological disorders in patients with cardio-vascular diseases and improve their cardio-vascular health and quality of life as mush as possible

How to break bad news: physicians' and nurses' Attitude

Bad news disclosure is one of the most complex tasks of physicians. Recent evidences indicate that patients' and physicians' attitude toward breaking bad news has been changed since few years ago. The evidence of breaking bad news is different across cultures. The aim of this study is to evaluate the attitude of medical staff toward breaking bad news to provide a clinical guideline in Iran. A descriptive study was conducted during 2008-2009 on a sample of 100 medical staff [50 physicians and 50 nurses] at Cancer Institute of Imam Khomeini hospital. The subjects' demographic characteristics and their attitudes toward the manner of revealing the diagnosis were registered in a questionnaire. The majority of the physicians [86%, n=43] and nurses [74%, n=37], mostly the older and more experienced, tended to reveal the diagnosis to patients. Only a few physicians [8%, n=4] had been trained how to disclose bad news, which discloused diagnosis more than non trained ones. Physicians and nurses preferred to inform the patients about the diagnosis when either the patients were alone or in the presence of their spouse respectively. Only a few physicians [14%] and nurses [24%] agreed to explain life expectancy to patients. Compared to past, physicians and nurses are more willing to share cancer diagnosis with patients. However, lack of adequate communication skills in caregivers, and their concerns about managing patients' emotional reactions reduce their tendency to disclose bad news to the patients. Therefore, training physicians and nurses to expose bad news to the patients seems to be necessary

Psychological dimensions in patients admitted in Imam Khomeini general hospital in Tehran

The aim of this study was to assess the mental health of patients admitted in Internal medicine, Surgery and Gynecology wards of Imam Khomeini Hospital of Tehran in 2009. The symptom checklist-90-R [SCL-90-R] questionnaire was administered for 93 patients in internal, surgical and gynecological wards of Imam Khomeini hospital in 2009. In this study, the mean age was [32.89 +/- 12.69] with a range of 14 to 70 years old. 42 patients [44.7%] were male and 52 [59.6%] were female; 56 patients [59.6%] were married and 37 [40.4%] were single. There is a significant relationship between gender and marital status [P<0.04]. According to cut of point of Global Severity Index [GSI] which was reported in a study [0.7], 58.1 percent of the patients have different levels of psychiatric problems [GSI>0.7]. In psychiatric symptoms, somatization has the highest prevalence [90.5%], and depression [77.9%] and anxiety [71.6%] have a higher prevalence than other symptoms among patients who suffer from psychiatric problems. According to the result of the current study, there is a high prevalence of psychiatric problems among the admitted patients in Internal medicine, Surgery and Gynecology wards of a general hospital according to SCL-90-R questionnaire. This study advises that more attention be given to mental health in general hospitals