Experience of individuals with unconsummated marriage in Iran: A qualitative content analysis.

Background: Sex is one of the important aspects of marriage and a way of expressing intimacy. Unconsummated marriage is a common problem whose prevalence is about 1.5% in Iran and can significantly influence marital life. Objective: This study aimed to assess the unconsummated marriage in a qualitative mode to offer new and beneficial solutions resulting from a better understanding. Materials and Methods: In this qualitative study, conventional content analysis was used. Data collection and analysis were done from April 2013 to April 2014 with 11 women and 5 men participating, who were referred to the sexual disorders clinic of Tehran Psychiatric Institute and Rasool Akram hospital of Tehran, Iran. The researchers examined the files of people referred to these clinics with the diagnosis of unconsummated marriage. Our tool for data collection was a semi-structured interview. 2 experienced faculty psychiatrists recorded all the information based on standards for reporting qualitative research guidelines. Data were analyzed using qualitative technique and coding. Guba and Lincoln criteria was used for data validity. Results: The codes of the participants' experiences were classified into 6 main categories, which include self-concept, intrapersonal factors, partner's problem, preparedness for sex, emotional relationship between couples, and the effects of unconsummated marriage on the participant's life. Conclusion: Significant experiences among women included excessive anxiety toward the society and their spouses, and among men were weakness and guilt. Being unable to have sex negatively affected their view of life and caused great harm to their self-perception. Participants personality traits and their self-concept, and attitude toward their partners were important issues.

Granisetron-mediated augmentation of sertraline therapeutic effect in obsessive-compulsive disorder: a double-blind placebo-controlled, randomized clinical trial.

BACKGROUND: Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually relieve the severity of symptoms by as much as 20-30%, and satisfactory treatment is obtained in 40-60% of patients with OCD. Nevertheless, the remaining symptoms continue to impair the patients' function. Therefore, it is necessary to investigate possible strategies to improve the mitigation of symptoms. In this study, the main objective was to examine and investigate the effectiveness of granisetron, which is a serotonin 5-hydroxytryptamine receptor type 3 (5-HT3) antagonist, as an adjunct therapy to selective serotonin reuptake inhibitors, for the purpose of ameliorating OCD symptoms. METHODS: fifty-eight patients diagnosed with OCD, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, who had a Yale-Brown obsessive-compulsive scale (Y-BOCS) score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either granisetron (1 mg twice daily) and sertraline (100 mg daily initially followed by 200 mg daily after week 4) or placebo and sertraline. The primary outcome was OCD symptoms measured by the Y-BOCS. RESULTS: Y-BOCS total score significantly dropped in both groups (28.9 to 17.7 for granisetron plus sertraline and 27.5 to 19.3 for placebo plus sertraline group with a slightly greater drop for granisetron plus sertraline group), while the granisetron plus sertraline group experienced a significantly greater reduction in obsession scores (Greenhouse-Geisser F(2.32,97.57) = 4.52,p-value = 0.01). Moreover, in comparison with the placebo plus sertraline group, the proportion of the patients showing complete response was considerably higher among the granisetron plus sertraline group (P-value < 0.01). No major adverse effects were observed in any of the groups. CONCLUSION: The results suggest that granisetron augmentation of sertraline may increase the rate of response in patients with moderate to severe non-refractory OCD. Further studies are suggested in this regard.

War, immigration and COVID-19: The experience of Afghan immigrants to Iran Amid the pandemic.

Introduction: Afghanistan's domestic upheaval following the Taliban's invasion leads to massive displacement of its population. The number of Afghan refugees in Iran has dramatically increased since the Taliban's takeover of Afghanistan in August 2021. Multiple pre-and post-migratory traumatic experiences affect immigrants' physical, psychological, social, and economic wellbeing. The coronavirus outbreak, considered a traumatic experience in human life in the 21st century, added to their problems in Iran and exposed them to new challenges. This qualitative study aimed to investigate their experiences early before, during, and after immigration and the pandemic's challenges to their lives in Iran. Methods: In the present qualitative study, ten Afghan residents living in Iran who immigrated to Iran legally or illegally since the summer of 2021 and the last year after the second Taliban invasion were selected via purposive sampling. A semi-structured interview was applied to gather the data, and the data were analyzed through Braun and Clarke's thematic analysis method. Results: Ten male participants with a mean age of 26 y/o were interviewed. Their residence in Iran was between 20 days and 8 months. Four main themes were extracted. The first theme, the Tsunami of suffering, represents a disruption of the normal flow of life. Six subthemes, including loss, being near death, insecurity, sudden hopelessness, leaving the country involuntarily, and reluctance to explore underlying emotions, are included in this category. The second one, Lost in space, describes the participant's attempt to leave Afghanistan following the extensive losses and violent death threats. Their experiences are categorized into four subthemes: the miserable trip, encountering death, life-threatening experiences, and being physically and verbally abused. The third theme, with its five subthemes, try to demonstrate the participants' experiences after getting to their destination in Iran. The last one, Challenges of the COVID-19 explained the experience of Taliban return, war trauma, running away, and living as a refugee or immigrant coincided with the COVID pandemic. Discussion: Our interviewees explained multiple and successive traumatic experiences of war, migration, and the pandemic. The central clinical features of survivors are fears of losing control, being overwhelmed, and inability to cope. They felt abandoned because not only lost their family support in their homeland but could not also receive support in Iran due to the pandemic-related social distancing and isolation. They were dissociated and emotionally numb when describing their experience, which is a hallmark of experiencing severe, unprocessed traumas. Conclusion: Gaining a better understanding of Afghan refugees lived experiences may help provide them with better social and health care support. Proper mental and physical healthcare support and de-stigmatization programs may reduce the impact of multiple traumas on their wellbeing.

The Impact of the COVID-19 Pandemic on Iranian Psychiatric Trainees' and Early Career Psychiatrists' Well-being, Work Conditions, and Education.

OBJECTIVES: This study was conducted to investigate the impact of the COVID-19 pandemic on psychiatric trainees and early career psychiatrists in Iran. METHODS: In this cross-sectional survey, the authors used a 24-item questionnaire inquiring about the sociodemographic characteristics of the participants, their views on the impact of the COVID-19 pandemic on their professional careers, methods of education, workplace environment, well-being and mental health, and the use of telepsychiatry in Iran. RESULTS: A total of 159 responses were received. The majority (n=124, 78.0%) reported that "some but not all obligatory activities have been converted to online activities." Most of the participants (n=103, 64.8%) stated that the pandemic had not affected the duration of their training. Less than half (n=61, 38.4%) reported that their well-being had been affected rather negatively. Some (n=59, 37.1%) reported that their supervisors or coworkers had no significant impact on their well-being, whereas others (n=53, 33.3%) reported a rather positive impact. Almost half of the participants (n=78, 49.0%) did not have access to free psychological counseling. In addition, more than half (n=89, 56.0%) reported that there were no recommendations on how to proceed with telepsychiatry. CONCLUSIONS: This study calls for improvements in the education and well-being of psychiatric trainees and early career psychiatrists in Iran amid the COVID-19 pandemic. Additional research should be carried out to maximize learning, provide mental health care, and use telepsychiatry.

C1q/TNF-related protein-1: Potential biomarker for early diagnosis of autism spectrum disorder.

INTRODUCTION: Autism spectrum disorders (ASDs) are neurodevelopmental diseases characterized by communication inabilities, social interaction impairment, repetitive behavior, as well as learning problems. Although the exact mechanism underlying this disease is still obscure, researchers believe that several factors play a significant role in its development and pathogenesis. Some authors have reported an association between adipokines family and autism. C1q/TNF-related protein-1 (CTRP1) is a member of the adipokines family, and we hypothesized that this adipokine might have an influential role in the pathogenesis of ASDs. Since there is no specific marker for screening the disease, we evaluated CTRP1 as a potential marker for achieving this purpose. METHODS: Blood samples were collected from 82 (41 ASDs boys, 41 healthy boys as controls) children aged 5-7 years old. CTRP1 gene expression and CTRP1 serum level were measured by quantitative realtime-PCR and enzyme-linked immunosorbent assay methods, respectively. RESULTS: It was found that CTRP1 is significantly elevated in autistic children in comparison to healthy controls, both at the gene expression level, as well as at the serum level; demonstrating a good diagnostic value with a good range of sensitivity and specificity for detecting ASDs. CONCLUSION: CTRP1 expression is elevated in ASDs boys aged 5-7 years old, suggesting a role for this adipokine in ASDs pathophysiology. Also, receiver operating characteristic curve analyses revealed that this adipokine could be utilized as a diagnostic biomarker for differentiating ASDs patients from healthy individuals along with other recently proposed biomarkers.

HIV prevalence among men who have sex with men in Iran: A systematic review and meta-analysis.

Background: The need for informed policymaking highlights the importance of data on human immunodeficiency virus (HIV) prevalence on key populations. In this systematic review and meta-analysis, we aimed to provide an overview of HIV prevalence in men who have sex with men (MSM) in Iran. Methods: We searched literature published between January 2008 and December 2019 to identify studies reporting the prevalence of HIV infection or acquired immunodeficiency syndrome (AIDS) in a population of adult Iranian men with history of sexual contact with other men. We employed Metaprop command in Stata to pool proportions from different studies. Results: Among the 16 studies retrieved, 2 were performed on MSM population directly, 7 among people who inject drugs, 4 among prisoners, 2 among the homeless, and 1 among methamphetamine users. HIV prevalence was 7% (95% CI, 5%-10%) based on the meta-analysis, although noticeable heterogeneity existed because of target population, study year, and study location, which imposed limitations to provide a robust summary measure for the prevalence of HIV. Conclusion: There is a potential risk of observing a high prevalence of HIV in MSM that could hamper the results of various preventive strategies and their achievements in other subpopulations.

Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The COVID-19 pandemic has had a far-reaching negative impact on healthcare systems worldwide and has placed healthcare providers under immense physiological and psychological pressures. OBJECTIVE: The aim of current study was to undertake an in-depth exploration of the experiences of health-care staff working during the COVID-19 crisis. METHODS: Using a thematic analysis approach, a qualitative study was conducted using semi-structured interviews with 97 health care professionals. Participants were health care professionals including pre-hospital emergency services (EMS), physicians, nurses, pharmacists, laboratory personnel, radiology technicians, hospital managers and managers in the ministry of health who work directly or indirectly with COVID-19 cases. RESULTS: Data analysis highlighted four main themes, namely: 'Working in the pandemic era', 'Changes in personal life and enhanced negative affect', 'Gaining experience, normalization and adaptation to the pandemic' and 'Mental Health Considerations' which indicated that mental ill deteriorations unfolded through a stage-wise process as the pandemic unfolded. CONCLUSIONS: Participants experienced a wide range of emotions and development during the unfolding of the pandemic. Providing mental health aid should thus be an essential part of services for healthcare providers during the pandemic. Based on our results the aid should be focused on the various stages and should be individual-centred. Such interventions are crucial to sustain workers in their ability to cope throughout the duration of the pandemic.

Psychotherapy training in Iran: A survey of Iranian early career psychiatrists and psychiatric trainees.

INTRODUCTION: Psychiatry's postgraduate training curriculum in Iran has been revised and one of the core revisions has been the incorporation of full-time 9-months of psychotherapy training. However, little is known about psychotherapy training in Iran. METHODS: An online anonymous survey was developed by the Early Career Psychiatrists (ECP) Section of the World Psychiatric Association (WPA). The survey included 16 questions about the: (a) quality of psychotherapy training (supervision, type of psychotherapy training available, barriers in accessing training); (b) organizational aspects of psychotherapy training (compulsoriness, payment, and assessment); (c) satisfaction with training in psychotherapy; (d) self-confidence in the use of psychotherapy. This survey was circulated to Iranian early career psychiatrists and psychiatric trainees. RESULTS: 112 early career psychiatrists and psychiatric trainees from across Iran responded to the survey; 98.2% of which stated that psychotherapy training is included in their psychiatry training, and cognitive behavioral therapy and psychodynamic psychotherapy were the most reported modalities integrated into their psychiatric training. Moreover, 43.3% of the participants reported that they were satisfied or very satisfied with their psychotherapy training during the training years. DISCUSSION: Psychotherapy is integrated into psychiatric training programs in most educational centers in Iran. The modalities and satisfaction of trainees are similar to that of high-income countries in other continents. Supervision and training in modalities like family therapy could be further implemented and adapted to the Iranian culture.

Gender role conflict: Is it a predictor of marital dissatisfaction? A cross sectional study in Tehran.

Background: Gender role, sex-oriented attitudes, behaviors, cognitions, and emotions play an essential role in interpersonal relationships. Along with other factors, marital relationships and satisfaction can also be affected by a person's gender role. The increased rate of divorce is related to a decrease in marital satisfaction. The aim of this study was to evaluate the predictor power of gender role conflict on marital satisfaction considering the role of demographic variables (age, income, number of children, and number of family members), marriage-related factors (duration of the marriage, family functioning), and mental health disorder. Methods: This was a cross sectional study. Participants were selected from couples who were attending West of Tehran health center. A total of 123 married couples aged 18 to 60 years who did not have mental or other medical disorders were recruited. Data gathering tools were McMaster Family Assessment Device (FAD), ENRICH Marital Satisfaction Scale, Bem Sex-Role Inventory (BSRI), a sociodemographic questionnaire, and Brief Symptom Inventory (BSI). Pearson correlation, chi-square, t test, ANOVA, Scheffe post hoc, and linear regression tests were used to analyze the data. Data were analyzed using SPSS 16, and in all statistical tests, significance level was set at p<0.05. Results: No significant correlations were observed between marital satisfaction and age, number of family members, duration of the marriage, number of children, and income (p>0.05). The presence of gender role conflict was correlated with lower marital satisfaction. Family functioning, gender role conflict, and presence of psychotic problems were predictors of marital satisfaction (p<0.001, R2=0.419). Conclusion: Screening couples who applied for divorce due to psychiatric problems and gender role conflict and evaluating their family functioning may have a positive effect on reduction of divorce rate.

Quality of life in people with transsexuality after surgery: a systematic review and meta-analysis.

BACKGROUND: Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a systematic review and meta-analysis about the quality of life (QoL) of individuals during the post transsexual surgery period. METHODS: We searched major biomedical electronic databases, including Scopus, Google Scholar, Psychological Information Database (PsycInfo), Web of Science, PubMed, Excerpta Medica dataBASE (EMBASE), and ProQuest, for all relevant literature published in English up to December 2019. The included papers required to be cross sectional studies that reported quality of life in people with transsexuality post surgery. After selecting eligible studies, 2 authors extracted data of each study independently and resolved any inconsistency by consensus with the third reviewer. The risk of bias was assessed by 2 independent research experts by the Newcastle-Ottawa Scale (NOS). RESULTS: In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis. The pooled mean of quality of life in transsexual individuals was obtained to be 70.45 (95%CI 55.87-85.03) and 59.17 (95%CI 48.59-69.74), based on World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36), respectively. Also, the results of the subgroup analysis for the weighted mean quality of life in male to female and female to male showed that the mean quality of life in female to male was 57.54 (95%CI 42.24-72.84) and it was 62.47 (95%CI 45.94-79.00) in male to female, based on SF36 questionnaire. Moreover, the weighted mean quality of life in female to male was 69.99 (95%CI 43.76, 96.23) and it was 70.65 (95%CI 53.11, 88.19) in male to female, based on WHOQoL-BREF questionnaire. CONCLUSION: The results of this systematic review may support the approaches to transsexuality that facilitates sex reassignment. In this review, the means of quality of life after surgery were not compared to the means of quality of life before surgery or even before hormonal therapy which was due to inadequate number of primary studies.

Fluvoxamine combination therapy with tropisetron for obsessive-compulsive disorder patients: A placebo-controlled, randomized clinical trial.

BACKGROUND: About 50% of obsessive-compulsive disorder patients still suffer significant symptoms even after the recommended first-line therapy. This demonstrates the necessity to investigate strategies to improve alleviation of symptoms. OBJECTIVE: The main objective of this study was to investigate the efficacy of a 5-hydroxytryptophan 3 receptor antagonist, tropisetron, as an adjuvant therapy to selective serotonin reuptake inhibitors, in ameliorating obsessive-compulsive disorder symptoms. METHODS: Men and women between the ages of 18-60 years diagnosed with obsessive-compulsive disorder, based on DSM5, who had a Yale-Brown obsessive compulsive scale score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either tropisetron (5 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 4) or placebo and fluvoxamine. The primary outcome of interest in this study was the Yale-Brown obsessive compulsive scale total score decrease from baseline. RESULTS: One hundred and eight participants were equally randomized into two groups; 48 participants in each group finished the trial. The Yale-Brown obsessive compulsive total score significantly dropped in both groups while the tropisetron group participants experienced a significantly higher decrease in their scores (Greenhouse-Geisser F(1.53-65.87)=3.516, p-value=0.04). No major adverse effect was observed in any of the groups. CONCLUSION: This trial showed a significant efficacy for tropisetron over placebo in treatment of obsessive-compulsive disorder symptoms when added to fluvoxamine.

HIV Prevalence and Sexual Behaviors Among Transgender Women in Tehran, Iran.

To date, no study has looked at the prevalence of HIV and the high-risk behaviors among transgender women in Iran. Between May 2013 and February 2014, 104 transgender women were recruited for participation in this study. Inclusion criteria consisted of having an official letter from the Tehran Psychiatric Institute, or a well-known psychiatrist, that showed a diagnosis of gender dysphoria and/or completed Gender-Affirming Surgery at least 6 months prior to this study. Of the 104 participants, 2 were diagnosed with HIV, which translates to a HIV prevalence of 1.9%. Condom use with a non-paying partner, casual partner, and paying partner was respectively 39.7%, 34.6%, and 53.3%. A high percentage of transgender women in Tehran engage in high-risk sexual behaviors including condomless receptive anal sex, which is of particular concern given the low rates of HIV testing. Targeted public intervention programs and research are desperately needed for this high-risk group.

Validity and reliability of Persian translation of the Borderline Evaluation of Severity over Time (BEST) questionnaire.

Background: Borderline Evaluation of Severity over Time (BEST) is one of the self-reported tools for evaluation of the severity and track the response of treatment of borderline personality disorder. The present study evaluated the validity and reliability of Persian Translation of the Borderline Evaluation of Severity over Time (BEST) Questionnaire and to compare it with a semi-structured clinical interview for DSM-IV axis II (SCID-II). Methods: The questionnaire was translated into Persian and then, the content and face validities of the questionnaire were determined. The translated BEST questionnaire and SCID-II were conducted on 33 outpatients and 32 hospitalized patients with diagnosis of borderline personality disorder and 30 patients' companions. Forty-five patients completed the questionnaire again in an interval between 7 to 45 days. The data were analyzed using exploratory factor analysis, paired sample t-test, and the Pearson correlation coefficient and Cronbach's α coefficient. Results: This study evaluates the content validity, face validity, and criterion validity and reliability of the Persian version of the BEST Questionnaire. The mean scores of the BEST questionnaire were 45.6, 39.2, and 24.3 in in-patients, outpatients, and controls, respectively (p=0.001). The mean scores of the BEST questionnaire were 43.7 in the first evaluation, and 41.4 in the second one (r=0.619, p<0.001). Cronbach's α coefficient was 0.761, and it reached to 0.898 after omitting items 13 to 15. The questionnaire had a two-factor structure, including internal turmoil and the disturbance in interpersonal relationships. Conclusion: The Persian version of the BEST Questionnaire has a high face and content validity, high criterion validity, moderate to high reliability, and an acceptable two-factor structure.

Religious Coping and Quality of Life in Women with Breast Cancer.

BACKGROUND: The aim of this study was to assess the predictive role of religious coping in quality of life of breast cancer patients. MATERIALS AND METHODS: This multi-center cross-sectional study was conducted in Tehran, Iran, from October 2014 to May 2015. A total of 224 women with breast cancer completed measures of socio-demographic information, religious coping (brief RCOPE), and quality of life (FACT-B). Data were analyzed using descriptive statistics and the t-test, ANOVA, and linear regression analysis. RESULTS: The mean age was 47.1 (SD=9.07) years and the majority were married (81.3%). The mean score for positive religious coping was 22.98 (SD=4.09) while it was 10.13 (SD=3.90) for negative religious coping. Multiple linear regression showed positive and negative religious coping as predictor variables explained a significant amount of variance in overall QOL score (R(2)=.22, P=.001) after controlling for socio-demographic, and clinical variables. Positive religious coping was associated with improved QOL (ß=0.29; p=0.001). In contrast, negative religious coping was significantly associated with worse QOL (ß=-0.26; p=0.005). CONCLUSIONS: The results indicated the used types of religious coping strategies are related to better or poorer QOL and highlight the importance of religious support in breast cancer care.

Sexual orientation, theory of mind and empathy: a comparison of male homosexual and male and female heterosexuals.

BACKGROUND: Researchers have been investigating similarities of and differences between homosexuals and heterosexuals for past few decades. Several studies have shown that in the particular domain (e.g., spatial ability), male homosexuals would resemble female heterosexuals better than male heterosexuals. Executive function, however, has received more attention than social cognition in this line of research. METHODS: This study focuses on theory of mind and empathy as two important components of social cognition in male homosexuals (N=14), male heterosexuals (N=15) and female heterosexuals (N=14). RESULTS: Applying Reading the Mind in the Eyes test and the Empathy Quotient, no significant difference between groups was identified. CONCLUSION: This study suggests that similarities of male homosexuals and female heterosexuals may be confined to executive function and not extended to some social cognition abilities like theory of mind or empathy.