Citalopram and group psychotherapy in breast cancer patients: A randomized clinical trial.

Background: Depression is a common psychiatric disorder in breast cancer patients. This study was designed to evaluate the clinical efficacy of group psychotherapy on breast cancer patients with depressive disorder who took citalopram. Methods: This clinical trial was conducted on 40 breast cancer patients with depressive disorder. The control group received citalopram 20-40 mg/ day for 12 weeks and the intervention group participated in 8 sessions of group psychotherapy in addition to the same dose of citalopram. At the baseline and 3, 6, and 12 weeks after treatment, patients were followed- up. Treatment outcomes and quality of life were compared between the 2 groups. Results: Overall, the depression score of Hospital Anxiety and Depression Scale (HADS) at baseline with the mean of 11.6±1.6 was signed in the range of clinical depression and after intervention it declined to 8.8±3.6 (in the 3rd week), 7.1±3.9 (6th week), and 5.9±4.5 (12th week). Furthermore, HADS anxiety score at baseline with the mean of 12.6±2.6 was signed in the range of clinical anxiety and after intervention it declined to 9.1±3.0, 7.3±4.1, and 6.0±4.0, respectively. This improvement was significantly more in the combined therapy intervention group (p<0.001). The mean score of quality of life based on WHO QOL-BREF questionnaire increased by 1.85 fold in the case group, improved from 44.09 to 81.70, while the slight change was observed in the control group (p<0.001). During the treatment, no significant adverse drug event was observed in the 2 groups (p>0.05). Conclusion: Group psychotherapy has a significant effect on improving depression, anxiety, and quality of life in breast cancer patients.

Efficacy of olanzapine in symptom relief and quality of life in gastric cancer patients receiving chemotherapy.

BACKGROUND: Considering the incidence and prevalence rates of gastric cancer in Mazandaran Province of Iran, this research was performed to evaluate the efficacy and safety of olanzapine in symptom relief and quality of life (QOL) improvement of gastric patients receiving chemotherapy. MATERIALS AND METHODS: This clinical trial was conducted on thirty new cases of gastric cancer patients whose treatment protocol was planned on chemotherapy and were allocated into two groups by simple random sampling. Intervention group (15 patients) received olanzapine tablets (2.5-10 mg/day) a day before the beginning of chemotherapy; in the 1st day of chemotherapy to 8 weeks after chemotherapy, besides the routine treatment regimens. The control group received only the routine treatment regimens. The patients were followed for 8 weeks after intervention. All of the patients were assessed with Hospital Anxiety and Depression Scale (HADS) and WHO-QOL-BREF questionnaires; further, Rhodes index was used to evaluate nausea and vomiting (N/V) status. RESULTS: All the recruited patients continued the allocated interventions (no lost to follow-up). N/V decreased in the case group, but the difference was not statistically significant (P = 0.438). The patients' appetite and body mass index increased (P = 0.006). Anxiety and depression subscales of HADS had significant differences between the two groups (P < 0.001) in the 4th and 8th week after treatment. Among the different subdomains of QOL, only physical health improved significantly after intervention (P < 0.05), but no significant difference was observed in other subdomains and also total QOL score (P > 0.05). No significant increase was observed in fasting and 2-h postprandial blood glucose and lipid profile (P > 0.05). CONCLUSION: Olanzapine can be considered as an effective drug to increase appetite and decrease anxiety and depression in patients with gastric cancer.

Comparison of self-esteem and quality of life in 8-12-year-old children with ADHD with and without learning disorders.

BACKGROUND: Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in school-aged children. Learning disorder (LD) is also one of the most important psychiatric disorders in children, which can often be associated with ADHD. In this study, we sought to compare self-esteem and quality of life in 8 to 12-year-old children with attention deficit/hyperactivity disorder with and without co-occurring learning disorders in order to emphasize the importance of attention and diagnosis in children with ADHD. METHOD: Among the 8- to 12-year-old outpatients referred to the child and adolescent psychiatry clinic of Omid Babol Clinic, 120 children aged 8 to 12 years with attention deficit/hyperactivity disorder whose disease was diagnosed by a child and adolescent psychiatry subspecialist. Among the tools used to collect information was the Colorado Learning Difficulties Questionnaire by Wilcott et al. (CLDQ), five-scale self-esteem test of Pepe et al. (1989) for children and quality-of-life questionnaire for 8-12-year-old children (PedsQL). RESULTS: This study investigated self-esteem and quality of life in children with ADHD (n = 120, 51.7% boys). Children with ADHD and learning disabilities reported significantly lower self-esteem and quality of life compared to those with ADHD alone. CONCLUSION: Considering the relatively high probability of co-occurrence of ADHD and learning disorders, if one of them is diagnosed in a child, it is possible to look for other disorders in the child in order to avoid the more severe negative effects that this co-occurrence can have on the child by diagnosing it as soon as possible.

Epidemiological trend of suicide in north of Iran from 2011 to 2018 with a focus on joinpoint regression.

Background: Deaths due to potential suicide are preventable and this phenomenon is costly for the health care system and contradicts the values and cultural standards of an Islamic country. Methods: This study is a retrospective study. The research population includes all cases of suicide during the years 2011-2018 who were referred to the emergency department of Babol hospitals. The results were analyzed using SPSS v.23 and Joinpoint Trend Analysis software 4.9.0.0 to identify significant changes in the temporal trends of the outbreak. Results: The highest percentage of suicides occurred in summer (27.8%), on Saturdays (13%) and at night (53%). A total of 1.9% of the cases were commit suicides (leading to death). The highest frequency of suicide was shown in 1397 (21.2%) and the lowest in 1392 (5.1%) and was more common in women (68.2% vs. 31.8%). Suicide-related deaths was higher in the second four years (63.5%), but suicide rate was significantly higher in the first four years (2011-2014) and the mortality rate due to suicide was higher in men than women. Conclusion: Suicide attempts were higher in women than men but the death rate was higher in men which means that men attempt suicide more seriously than women. The model also predicted that suicide rates would rise in the coming years. For this reason, this important issue, along with a detailed analysis of the roots of suicidal ideation and preventive measures, should be considered by health officials and social institutions.

Depression and quality of life in patients with type 2 diabetes mellitus.

Background: Depression as a frequent comorbidity in patients with diabetes requires serious attention, as failure to early detect and treat it can adversely affect the patients' complications. This study was performed to assess the prevalence of depression and quality of life in these patients. Methods: This cross-sectional study was carried-out on adult patients with type 2 diabetes mellitus referred to the endocrinology hospital clinics affiliated to Babol University of Medical Sciences, Babol, Iran, during 2018-2019. The presence and severity of depressive symptoms in patients have been assessed by Beck Depression Inventory-II; and the quality of life was measured by SF-36 questionnaire. Results: Totally, 400 patients with type 2 diabetes mellitus (300 females and 100 males) with mean age of 55.36±11.56 years were recruited. One hundred and thirty (32.5%) had depressive symptoms. Of the patients with depression, 115 (28.8%) had mild and 15 (3.8%) had moderate depression. After entering different variables in logistic regression analysis, gender (P=0.036) and ophthalmic complications (P=0.011) showed a significant association with depressive symptoms. The patients with depression had a worse quality of life compared to those who had not depressive symptoms. Quality of life score in patients with depression was significantly lower than patients without depression (p<0.0001). Conclusion: Nearly one third of the patients with type II diabetes mellitus might have depression. Diabetic patients with depression have a worse quality of life compared to those who have not depression symptoms.

Creutzfeldt-Jakob disease: A case report.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) as a life-threatening neurodegenerative disorder is not usually diagnosed in early stages of the disease because of a variety in its clinical manifestations. This study aimed to present a middle-aged woman with psychiatric symptoms who ultimately was diagnosed as a CJD case. CASE PRESENTATION: This 48-year-old woman had progressive symptoms of depressed mood, decreased sleep and appetite and mutism which started two months before the first visit. Gradually, slowness in movements, dysarthria and decreased performance were observed. Subsequently, when antidepressant and antipsychotic drugs were prescribed other symptoms such as ataxia and rigidity manifested in the patient. The problem list which led to final confirmation of the disease included non-specific neuropsychological presentations, hypersignality in caudate and putamen areas in brain MRI, generalized high frequency sharp waves in EEG, and protein 14-3-3 identification in cerebrospinal fluid. CONCLUSION: Although CJD is not a common disease, it should be considered in differential diagnoses whenever neuropsychological manifestations, especially progressive decline in cognition, along with symptoms such as visual hallucinations, myoclonus and ataxia are observed in the patient.

Association of Anxiety with Pain Perception following Periodontal Flap Surgery.

AIMS AND OBJECTIVES: Dental pain and anxiety are important factors that prevent patients from seeking dental care. The aim of this study was to assess the relationship between trait anxiety and state anxiety and also to determine the effects of age and sex on pain perception after periodontal flap surgery. MATERIALS AND METHODS: In this descriptive-analytical study, 50 patients who need periodontal flap surgery were assessed in a private periodontal specialty clinic in Babol city. The amount of anxiety was measured by the Spielberger State-Trait Anxiety Inventory test, and visual analog scale scores were used for postsurgical pain perceptions in 7 times (immediately after surgery and days 1-6 after surgery). Data were analyzed and evaluated by SPSS V22.0 software (IBM, United States). RESULTS: In the trait anxiety study, there was a significant difference in pain perception between different anxiety classes at times immediately after surgery, 1st day, and 2nd day after surgery (P < 0.05), and in the state anxiety study, there was a significant difference in pain perception between different anxiety classes at times immediately after surgery until the 5th day after surgery (P < 0.05). Furthermore, the results indicate that the pain perception in female was significantly higher than male, at times immediately after surgery, 3rd day, and 5th day after surgery (P < 0.05). However, there was no association between age and pain perception in different times (P > 0.05). CONCLUSIONS: Anxiety is associated with pain perception following periodontal flap surgery, and female experience more pain after surgery, whereas the amount of pain perception is not related to age.

Stimulant use in medical students and residents requires more careful attention.

BACKGROUND: Stimulant pharmaceuticals are abused among academic students to elevate mood, improve studying, intellectual capacity, memory and concentration, and increase wakefulness. This study was designed to evaluate the current situation of stimulant use among medical students and residents of Babol University of Medical Sciences. METHODS: This cross-sectional study was conducted among 560 medical students and clinical residents of Babol University of Medical Sciences during the academic year 2014-2015. A self-administered questionnaire was used for data collection. RESULTS: Four hundred and forty-four (79.3%) students filled out the questionnaires. 49 (11%) individuals reported amphetamine and methylphenidate (ritalin) use. The mean age of the stimulant drug users was 24.6±4.8 years. The main initiator factor was to improve concentration (29 persons; 59.2%). There were significant statistical correlations between stimulant drugs abuse and male gender, living in dormitor in residence and internship and past medical history of psychiatric disorders (depression, attention deficit hyperactivity disorder and substance abuse) (p<0.05).16 (32%) students started the drug use on their friends' advice; 15 (30%) due to self-medication and 12 (24%) persons with physician´s prescription. CONCLUSIONS: Because of significant prevalence of stimulant use, regulatory governmental policies and also planning to improve essential life skills, awareness about the side effects and complications of these drugs, screening of at-risk college students and early identification of the abusers are suggested.

Prevalence of depression and anxiety among cancer patients.

BACKGROUND: Depression and anxiety had negative effects on the quality of life of cancer patients, thus hospital anxiety and depression scale (HADS) is a useful instrument for screening these problems. This research was performed to assess the prevalence of their anxiety and depression. METHODS: From 2012-2013, one hundred fifty patients with recent diagnosis of different cancers in Babol, Iran were assessed. A presumptive diagnosis of anxiety and depression was based on a four point 14-item HADS. The score of 0-7 means without clinical symptoms of anxiety or depression, 8-10 mild and 11-21 symptomatic anxiety or depression. The data were collected and analyzed. RESULTS: Forty-four (29.3%) patients had mild anxiety, 25 (16.7%) symptomatic anxiety but mild and symptomatic depression were seen in 40 (26.7%) and 32 (21.3%) patients, respectively. There were significant relationships between anxiety, depression and the age group of the patients with higher frequency in older ages. There were significant relationships between anxiety and depression with the type of cancer and type of treatment. Breast and stomach cancer patients had the highest prevalence of anxiety and depression and the higher prevalence was observed in the patients who received chemotherapy as the single treatment. CONCLUSION: The results show that patients with breast and stomach cancer had the highest prevalence of anxiety and depression among all others cancer patients.

A Case Report of Prolonged Apnea during ECT in a Patient with Suicidal Attempt by Organophosphorus Poison.

Organophosphorus pesticides have been used in some cases for suicidal attempts. Such poison can affect plasma cholinesterase activity. The case was a 47-year-old man hospitalized due to suicide attempt with swallowing agricultural poison. The patient, diagnosed with major depressive disorder (MDD), underwent treatment with electroconvulsive therapy (ECT). At the first ECT session, the patient developed apnea for 45 minutes following receiving 20 mg succinylcholine. The patient was intubated; after restoration of respiration depth and rate, the patient was extubated. Collectively, in cases with history of suicide attempts, taking organophosphorus pesticides should be warn for pre-ECT anesthesia.