Objective: The retina is a protrusion of the brain, so researchers have recently proposed retinal changes as a new marker for studying central nervous system diseases. To investigate optic nerve head neurovascular structure assessed by optical coherence tomography angiography (OCTA) in schizophrenia compared to healthy subjects. Methods: The study was conducted from 2019 to 2021 at the Ibn Sina Psychiatric Hospital in Mashhad, Iran. We enrolled 22 hospitalized known cases of schizophrenia, treated with risperidone as an antipsychotic drug, and 22 healthy subjects. The two groups were matched in age and gender. In the schizophrenic group, the positive and negative syndrome scale test was used to assess the illness severity. All subjects underwent complete ophthalmic evaluations and OCTA imaging. Results: We found that the cup/disc area ratio, vertical cup/disc ratio, and horizontal cup/disc ratio are significantly higher in patients with schizophrenia than in healthy subjects (with p-values of 0.019, 0.015, and 0.022, respectively). No statistically significant difference in the peripapillary retinal nerve fiber layer and vascular parameters of the optic nerve head was observed between schizophrenia and healthy groups. Conclusion: We found evidence regarding the difference in the optic nerve head tomographic properties in schizophrenia compared to healthy subjects. However, ONH vascular parameters showed no significant difference. More studies are needed for a definite conclusion.
Inflammatory processes in the brain play a role in acute mania etiopathogenesis. There is little evidence indicating the efficacy of celecoxib adjuvant therapy in treatmenting of manic episodes of bipolar disorder. Therefore, this clinical trial aimed to assess the celecoxib effect on treating acute mania. In a double-blind, placebo-controlled trial, 58 patients meeting the criteria for acute mania were enrolled. After considering eligibility, 45 patients were included in the study and randomly divided into two groups. The first group (23 patients) received sodium valproate 400 mg/day along with celecoxib 400 mg/day, and the second group (22 patients) received sodium valproate 400 mg/day and a placebo. The subjects were evaluated by the Young Mania Rating Scale (YMRS) at the beginning of the study and 9, 18, and 28 days following the initiation of the medication. Evaluation of baseline factors indicated a significant difference in age ( P = 0.01) and psychiatric history ( P = 0.02) between the two groups. However, other factors were similar between groups ( P ≥ 0.05). Comparing the YMRS score between celecoxib and placebo groups revealed no significant difference on days 0, 9, 18, and 28. However, the YMRS score at the end of the study decreased by 16.05 ± 7.65 in the intervention group ( P < 0.001) and 12.50 ± 5.98 in controls ( P < 0.001) compared to the baseline, the trend of change was not significant between the two groups during the time of the study ( F = 0.38; P = 0.84). Although celecoxib adjuvant therapy indicated no considerable side effects, a longer treatment duration may be needed to detect its beneficial effects for treating acute mania in bipolar patients. Trial registration: Iran clinical trial register: IRCT20200306046708N1.
Antipsychotic Agents , Bipolar Disorder , Humans , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Valproic Acid/therapeutic use , Celecoxib/adverse effects , Mania/chemically induced , Iran , Treatment Outcome , Double-Blind Method , Psychiatric Status Rating Scales , Antipsychotic Agents/therapeutic use
BACKGROUND: Physical changes in high-risk pregnancy (HRP) can lead to changes in mood and social relationships and negative effects on women's well-being. Individuals in different sociocultural contexts have different perceptions of well-being. Yet, there is limited information about perceptions of well-being in HRP. This study aimed to explore the Iranian women's experiences of well-being in HRP. MATERIALS AND METHODS: This qualitative study was conducted in 2019-2020 through directed content analysis based on the conceptual framework of well-being in HRP. Participants were 26 women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran. Face-to-face semistructured interviews were held for data collection until data saturation. Data were analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed using the MAXQDA (v. 10) program. RESULTS: Well-being in HRP had seven attributes in the five main dimensions of physical, mental-emotional, social, marital, and spiritual well-being. The seven attributes of well-being in HRP were controlled physical conditions, controlled mood, emotions, and affections, perceived threat, self-efficacy, and competence for multiple role performance, maintained social relationships, meaning seeking and relationship with the Creator, and positive marital relationships. CONCLUSION: The present study provide an in-depth understanding about well-being in the Iranian women with HRP. It is a complex and multidimensional concept with physical, mental-emotional, social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to promote well-being among women with HRP and designed the guidelines to provide woman-centered care.
BACKGROUND: Assessment of well-being in high-risk pregnancy (HRP) is the key to achieve positive maternal and fetal outcomes. Although there are a wide range of instruments for well-being assessment, none of them is comprehensive for well-being assessment in HRP. The present study aimed at the development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index (HRPWBI). METHODS: This methodological study was conducted using the Waltz's four-step method. The dimensions of well-being in HRP were determined based on a conceptual model and the blueprint and the item pool of HRPWBI were developed. Then, the face and the content validity were assessed and item analysis was performed. Construct validity was also assessed through exploratory factor analysis with principal component analysis on the data obtained from 376 women with HRP in Mashhad, Iran. Finally, internal consistency, test-retest stability, sensitivity, and interpretability of HRPWBI were assessed. RESULTS: The scale- content validity index (SCVI) of HRPWBI was 0.91. In factor analysis, 33 items were loaded on seven factors which explained 53.77% of the total variance. Internal consistency, relative stability, absolute stability, sensitivity, and interpretability of HRPWBI were confirmed with a Cronbach's alpha of 0.84, a test-retest intraclass correlation coefficient of 0.97, a standard error of measurement of 0.92, a minimal detectable change of 8.09, and a minimal important change of 2.92, respectively. CONCLUSION: HRPWBI is a valid and reliable instrument for well-being assessment among women with HRP. It can be used to assess well-being and the effects of well-being improvement interventions on well-being among women with HRP.
High-risk pregnancy (HRP) is one of the world's most serious reproductive health issues. Assessing well-being in high-risk pregnancies is the key to achieving positive maternal and fetal outcomes. This study aims to develop, psychometrically test and validate the High-Risk Pregnancy Well-Being Index (HRPWBI). This study demonstrated that the (HRPWBI) is a valid and reliable tool for assessing the well-being of HRP women. It can evaluate the state of well-being in women with high-risk pregnancies, investigate the factors influencing the well-being of mothers with high-risk pregnancies, and examine the effects of interventions on improving well-being in women with HRP. To ensure that Policy maker, researchers and Clinicians in management of women with High-Risk Pregnancy incorporates measures to improve the well-being of this vulnerable group of women with high-risk pregnancies into its planning and policies.
Family , Pregnancy, High-Risk , Pregnancy , Female , Humans , Psychometrics , Factor Analysis, Statistical , Fetus
Background: Maternal near-miss (MNM) is defined as "a woman who almost died but survived a serious maternal complication during pregnancy, childbirth, or within 42 days of completion of pregnancy". Despite the long-term physical and psychological burden of this event on the mother's life, the meaning of MNM is not clear. In addition, the mother's role complicates the understanding of this phenomenon. Therefore, this study aimed to understand lived experience of Iranian "near-miss" mothers in the postpartum period. Methods: In this Heideggerian phenomenological study, we used Souza and colleagues' theoretical framework to understand the meaning of the lived experience of near-miss mothers in-depth. The participants had experienced MNM at least one year ago by World Health Organization (WHO)approach in multicenter, academic, tertiary care hospitals in Mashhad, Iran. Taking into account reflexivity and after obtaining ethical approval, participants were purposively sampled using semi-structured interviews, and data analysis was conducted by Diekelmann and colleagues up to data saturation. Data collection and analysis has been argued by Lincoln and Guba. Discussion: Our findings resulted in updating the existing knowledge about the meaning of MNM and its implication. Given the different needs and challenges of near-miss mothers, it is necessary to design a supportive program of primary care for them. Policymakers and managers should consider the lived experience of these mothers when planning and taking decisions.
INTRODUCTION: Inflammatory processes in the brain play an important role in the etiopathogenesis of Obsessive-Compulsive Disorder (OCD). Cyclooxygenase inhibitors, such as celecoxib reduce the production of proinflammatory cytokines. This double-blind study aimed to investigate the effects of adding celecoxib to Selective Serotonin Reuptake Inhibitors (SSRIs)on treating OCD. METHODS: Sixty patients who met the diagnosis criteria for OCD based on the Diagnostic and Statistical Manual of Mental Disorders -Fourth Edition- Text Revision (DSM-IV-TR) were recruited in the present study. Two psychiatrists independently confirmed the diagnosis by performing structured interviews. The study participants included 23 patients who received SSRIs and celecoxib (400 mg twice daily) and 22 patients in the control group that received SSRIs and placebo. Moreover, at baseline, in weeks 4, 8, and 12, the explored patients were assessed by a psychiatrist using the Yale-Brown Obsessive-Compulsive Scale (Y-BCOS). RESULTS: A significant difference was observed in the change of scores on the Y-BOCS in week 12, compared with the onset of the study between the study groups (t= -8.976, df=38, P=0.001). There was a significant difference between the study groups in obsession (F= 49.19, df= 1, P≤0.001), compulsion (F= 13.78, df= 1, P= 0.001), and OCD (F= 57.25, df= 1, P≤0.001), i.e., higher in the celecoxib group. CONCLUSION: This study showed that adjuvant treatment with celecoxib can further improve the symptoms of OCD in individuals receiving SSRIs.
BACKGROUND: High-risk pregnancy is associated with many problems which can affect marital well-being as well as maternal and fetal health. Yet, there is limited information about the conditions which affect marital well-being in high-risk pregnancy. This study aimed to explore the pregnant women's experiences of the conditions affecting marital well-being in high-risk pregnancy. METHODS: This qualitative study was conducted from October 2018 to December 2019. Participants were 24 women with high-risk pregnancy who were purposively selected from three public and two private hospitals as well as a primary healthcare center in Mashhad, Iran. Face-to-face semi-structured interviews were conducted for data collection. Data were analyzed concurrently with data collection through Graneheim and Lundman's content analysis (2004). The MAXQDA program (v. 10) was used for data management. RESULTS: Conditions affecting marital well-being in high-risk pregnancy were categorized into eleven subcategories and three main categories, namely emotional spousal intimacy in the midst of danger, husband's commitment to manage the difficult conditions of pregnancy and sexual relationship during high-risk pregnancy. CONCLUSION: Several conditions can affect marital well-being in high-risk pregnancy. Healthcare providers can develop and use strategies for the effective management of these conditions, thereby improving marital well-being among women with high-risk pregnancy.
BACKGROUND: A prerequisite to the interventions for well-being improvement in high-risk pregnancy (HRP) is to make the concept clear, objective, and measurable. Despite the wealth of studies into the concept of well-being in HRP, there is no clear definition for it. This study aimed to explore the concept of well-being in HRP. METHODS: This integrative review was conducted using the Whittemore and Knafl's approach. A literature search was done without any data limitation in dictionaries, thesauruses, encyclopedias, well-being-related textbooks, midwifery, psychology, and mental health journals, and Iranian and international databases. The most primary inclusion criterion was relevance to well-being in HRP. The full-texts of all these articles were assessed using the checklists of the Joanna Briggs Institute. Data were analyzed through the constant comparison method and were managed using the MAXQDA 10 software. Meaning units were identified and coded. The codes were grouped into subcategories and categories according to the attributes, antecedents, and consequences of well-being in HRP. RESULTS: Thirty articles were included in the review, from which 540 codes were extracted. The codes were grouped into seven main attributes, eight main antecedents, and five main consequences of well-being in HRP. The four unique dimensions of well-being in HRP are physical, mental-emotional, social, and spiritual well-being. These dimensions differentiate well-being in HRP from well-being in low-risk pregnancy and in non-pregnancy conditions. CONCLUSION: As a complex and multidimensional concept, well-being in HRP refers to the pregnant woman's evaluation of her life during HRP. It includes physical, hedonic, and eudaimonic components. The assessment of well-being in HRP should include all these components.
Health Status , Pregnancy, High-Risk , Quality of Life , Female , Humans , Pregnancy
BACKGROUND: Maternal Near Miss (MNM) event is associated with emotional, psychological, and social effects on women. Determining the needs of women with these experiences is the key to programming for providing high-quality care and reducing its burden. Hence, this study was conducted to determine the needs of women who have experienced MNM. MATERIALS AND METHODS: In this literature systematic review, to achieve the intended information, articles published in Web of Science and PubMed databases were systematically searched. The search strategy focused on three keywords or phrases: "maternal morbidity" OR "maternal near miss" AND "needs." Publication date was all relevant articles before 2019, and publication language was restricted to English. Article search was conducted by two independent reviewers. After the primary search, 2140 articles were found. Eventually, 77 articles, including 20 qualitative studies and 57 quantitative studies, were enrolled for final evaluation. RESULTS: According to the results, the needs of these women could be categorized into six groups of "Management and care needs of health system," "Educational needs of health system," "Follow up and continuity of care at the primary care level," "Need to develop a physical, psychological and social of care packages," "Social support," and "Psychosocial support and counseling." CONCLUSIONS: The near-miss events change the mothers' living conditions, and therefore, they need to receive special support, given the difficult conditions they are undergoing. It is necessary that a supportive program be designed to follow-up MNM after the discharge to be run by the primary care team.
BACKGROUND: Bipolar disorder (BD) is one of the most important psychiatric disorders in the world. There is evidence suggesting the role of inflammatory mediators such as chemokines in the etiology of BD. The objective of the current study was to evaluate the gene expression of CCL2, CCL3, and CXCL8 in patients with BD and compare them to healthy controls. MATERIALS AND METHODS: A total of 48 patients with confirmed BD and 48 healthy controls enrolled in this study. All patients were recruited from April to August 2016 at Ibn-Sina Psychiatric Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. RNA was extracted from the whole blood samples and then cDNA was synthesized. Gene expression of CCL2, CCL3, and CXCL8 was measured using SYBR® Green real-time polymerase chain reaction. The difference of delta-CT values between patients and healthy controls was compared with the independent samples t-tests. RESULTS: CCL2 and CXCL8 genes expressed at higher levels in patients with BD as compared to healthy controls, but not significant. On the contrary, we found lower expression levels for CCL3 gene in our patients compared to healthy controls, but the difference was not statistically significant. CONCLUSION: Our findings do not show an association between the gene expression of CCL2, CCL3 and CXCL8 and BD. Increasing the sample size and evaluation on the gene expression of other chemokines in depression and mania phases of BD might be helpful to get a better conclusion.
Background: Neuropsychiatric dysfunction is one of the most common complications after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to evaluate cognitive function, depression, and quality of life (QOL) in patients with aSAH. Methods: In this study, we prospectively enrolled patients with SAH due to rupture of anterior circulation aneurysms who referred to Ghaem hospital, Mashhad, Iran, and who had good function outcome [modified Rankin scale (mRS) > 2]. They underwent microsurgery or endovascular treatment. Cognitive function, depression, and QOL were evaluated 6 months after surgery with standard psychiatric examinations, including Mini-Mental State Examination (MMSE) for cognitive function, Hospital Anxiety and Depression Scale (HADS) for depression, and 36-Item Short Form Health Survey (SF-36) for QOL. Risk factors for cognitive dysfunction were assessed. Results: Fifty-three patients were entered the study. The mean of age was 50.9 ± 13.6 years. QOL and its components were affected in most patients. Fifty-five percent of patients suffered from depression. Cognitive impairment was found in 57% of patients. Older patients experienced more cognitive impairment (P < 0.001). Conclusion: Neuropsychological sequels are common in patients with aSAH, even if they classified as good functional outcome (mRS > 2). These complications could be found with appropriate neuropsychological evaluation of these patients to be managed as soon as possible.
Objective: Bipolar disorder (BD) is a disabling psychiatric disorder with frequent recurrences. Besides pharmacotherapy, psychoeducation could be helpful in reducing symptoms as well as recurrence of this disorder, leading to improvement of patients' quality of life. This study aimed at investigating the effectiveness of a culturally adjusted structured program for training Iranian BD patients. Method: In a 6-month course (spring and summer 2014), 24 BD patients, visiting the outpatient clinic of Ibn-Sina Hospital in Mashhad and experiencing euthymic phase, were allocated in to 2 groups of intervention and control. The intervention group received 8 sessions of psychoeducation in four weeks. Patients in the control group received the usual treatment. The patients were evaluated with Hamilton Depression Rating Scale, Young Mania Rating Scale, and Short Form 36 before the intervention and 4 weeks later, and the results were compared using independent t test. The patients were reexamined after 6 months for recurrence, hospitalization, treatment adherence, and visiting a psychiatrist, and were compared with patients in the control groups. Results: There was a significant difference in the intervention group in improvement in quality of life before and after treatment (p<0.003). In addition, the difference was significant between the 2 groups in the number of recurrence (p<0.001) and hospitalization (p<0.000) in 6 months. Conclusion: In addition to pharmacotherapy, psychoeducation of patients with BD can improve their quality of life and decrease the risk of disorder recurrence.
INTRODUCTION: Journal club is a valuable educational tool in the medical field. This method follows different goals. This study aims to investigate the effect on psychiatry residents of changing journal clubs from the traditional method to the evidence-based method. METHOD: This study was conducted using a before-after design. First- and second-year residents of psychiatry were included in the study. First, the status quo was evaluated by standardized questionnaire regarding the effect of journal club. Then, ten sessions were held to familiarize the residents with the concept of journal club. After that, evidence-based journal club sessions were held. The questionnaire was given to the residents again after the final session. Data were analyzed through descriptive statistics (frequency and percentage frequency, mean and standard deviation), and analytic statistics (paired t-test) using SPSS 22. RESULTS: Of a total of 20 first- and second-year residents of psychiatry, the data of 18 residents were finally analyzed. Most of the subjects (17 [93.7%]) were females. The mean overall score before and after the intervention was 1.83±0.45 and 2.85±0.57, respectively, which showed a significant increase (P<0.001). CONCLUSION: Moving toward evidence-based journal clubs seems like an appropriate measure to reach the goals set by this educational tool.
INTRODUCTION: The aim of this study was to explore the probable prophylactic effects and evaluate different doses of topiramate on body weight in patients treated with olanzapine. MATERIALS AND METHODS: This was a 12 week, double-blind, placebo-controlled clinical trial (Iranian Clinical Trial Registration Code: 201402085280N15) to assess the preventative effects and estimate the optimal dosage of topiramate in drug-induced weight gain. Sixty eight patients aged 18 to 60 that were hospitalized and treated with olanzapine between 2009-2011due to the onset of an acute episode of schizophrenia or a manic episode of bipolar I disorder were selected in Mashhad, the second largest city in the northeast of Iran. Patients were randomly assigned to 4 groups, including 1- placebo; 2- 50 mg/day; 3- 100 mg/day; and 4- 200 mg/day topiramate. Two psychiatrists assigned participants to an intervention group and followed up the treatment process. Raters weighed patients at baseline and also at weeks 1, 2, 4, 6, 8, and 12, respectively. Waist and wrist circumferences were measured at baseline and weeks 4, 8, and 12. Body weight, BMI, wrist, and waist circumference changes were outcome measures of the study. Collected data were analyzed by ANOVA, post hoc Tukey test, Kruskal-Wallis, Mann-Whitney U, and Cohen's d with SPSS version 14. A p-value of less than 0.05 was considered significant. RESULTS: All outcome measures were significantly less than the placebo group compared to the topiramate groups at the end of the fourth week and continued to twelfth week. Nevertheless, there was no statistically significant difference in the measures of any of the topiramate groups with each other at any interval. CONCLUSION: All doses of 50, 100, and 200mg were shown effective in preventing olanzapine-related obesity in schizophrenic and/or bipolar patients.
Anticonvulsants/administration & dosage , Bipolar Disorder/drug therapy , Fructose/analogs & derivatives , Schizophrenia/drug therapy , Weight Gain , Adolescent , Adult , Anticonvulsants/adverse effects , Bipolar Disorder/complications , Dose-Response Relationship, Drug , Double-Blind Method , Female , Fructose/administration & dosage , Fructose/adverse effects , Humans , Male , Middle Aged , Psychometrics , Schizophrenia/complications , Topiramate , Treatment Outcome , Young Adult
BACKGROUND: Substance dependency is a major problem for the general health of a society. Different approaches have investigated the substance dependency in order to explain it. Gray's reinforcement sensitivity theory (RST) is an advanced and important neuropsychological theory in this area. OBJECTIVES: The aim of this study was to compare three systems of the revised reinforcement sensitivity theory the behavioral activation system (r-BAS), the revised behavioral inhibition system (r-BIS), and the revised fight/flight/freezing system (r-FFFS) between patients dependent on methamphetamine and opiates, and a group of controls. PATIENTS AND METHODS: This research was a causal-comparative study that was conducted in the first six months of 2012. The population of the study was males of Mashhad city, who were dependent on methamphetamine or opiates, and ruling out psychotic disorders and prominent Axis II. Twenty-five people were selected by the convenient sampling method. Also, 25 non-dependent people from the patients' relatives were selected and matched for the variables of age, gender, and education to participate in this study. Participants were evaluated using a structured clinical interview (SCID) for DSM-IV, demographic questionnaire information, and a Jackson-5 questionnaire (2009). Data were analyzed by Chi-square, K-S, and independent t-test. RESULTS: The methamphetamine dependent group had a higher sensitivity in the r-BAS, r-BIS, and the r-Fight and r-Freezing systems compared to the control group (P < 0.05). However, there was no significant difference in r-Flight between the two groups (P > 0.05). "The scores of r-BIS were also significantly higher in the methamphetamine-dependent group than the opioid-dependent and control groups. For the r-Fight variable, the methamphetamine-dependent group was higher than the opioid-dependent group". CONCLUSIONS: The personality patterns of patients dependent on methamphetamines were different from the controls. These people have a high sensitivity to punishment cues, such as being compared in social conditions and a tendency for reinforcement and reward, because of their higher sensitivity in the behavioral inhibition and activation systems.
OBJECTIVE: The aim of this study was to conduct a systematic review of literature to retrieve all randomized controlled trials that evaluated the efficacy of tamoxifen on manic mood episodes and meta-analyze their quantitative results. METHODS: Four electronic databases were systematically searched from their inception to March 2014: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials), Scopus, and PsychINFO. Pooled difference in means of changes in mania scores and pooled odds ratio of treatment response (for tamoxifen monotherapy) were calculated as the main effect size. A random effects model was used to pool the data across studies. Quantitative syntheses were expressed by forest plots. RESULTS: Five randomized controlled trials (3 adjunct trials and 2 monotherapy trials) were included. Regarding adjunct tamoxifen, the standardized difference in mean of mania score changes in tamoxifen arm as compared with control arm was 0.669 (95% confidence interval [CI], 0.15-1.189; P = 0.012). Regarding monotherapy, the pooled difference in means of mania score changes in the tamoxifen arm as compared with the placebo arm was 22.09 (95% CI, 20.98-23.192; P < 0.000000001). Pooled odds ratio of response to treatment was 15.36 (95% CI, 2.99-78.73; P = 0.001) in the tamoxifen group as compared with the placebo group. CONCLUSIONS: Tamoxifen can be considered an effective treatment for manic bipolar patients. Making a conclusion regarding the efficacy and safety for longer periods warrants further studies with a larger sample size and longer follow-up duration.
Bipolar Disorder/drug therapy , Protein Kinase C/antagonists & inhibitors , Protein Kinase Inhibitors/therapeutic use , Randomized Controlled Trials as Topic/methods , Tamoxifen/therapeutic use , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , Humans , Protein Kinase Inhibitors/pharmacology , Tamoxifen/pharmacology
The pathogenesis of Bipolar I Disorder (BP-I) involves immune-mediated mechanisms, especially an imbalance in pro-inflammatory/anti-inflammatory cytokines in plasma or cerebrospinal fluid. Interleukin-1 (IL-1) gene cluster, coding some of these pro-inflammatory cytokines, might play a role in various neuropathologies related to neuron inflammation. The aim of the present study was to investigate the possible role of IL-1 gene cluster polymorphisms in determining the susceptibility to BP-I in Iranian population. 48 patients with BP-I in Mashhad (in north-eastern Iran), diagnosed by two psychiatrists using SCID (structured clinical interview for DSM disorders) were selected through convenient sampling and were compared with 47 healthy controls, voluntarily enrolled in the study. Patients with non-Persian ethnicity, history of immunoallergic disorders, endocrinopathies, neurologic disorders, and substance-induced mood disorders were excluded from both case and control groups. Genotyping of IL-1 gene cluster polymorphisms, including IL-1a-889, IL-1b +3954, IL-1b-511, and IL-1RN (VNTR) were carried out using Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and compared by SPSS using Fisher's exact and chi-square tests. The frequency of IL-1b-511 CC genotype and C/T allelic frequency were significantly different between BMD patients and healthy controls (p=0.04 and p=0.02, respectively). Among patients, -511 T allele was significantly more frequent in those with a positive history of major depression. Moreover, +3954 T allele was significantly more frequent in early onset BMD patients. The results suggest a positive association between IL-1 gene cluster variation and BP-I. This polymorphism may contribute to genetic vulnerability through its possible role in neuron inflammation.
Bipolar Disorder/genetics , Interleukin 1 Receptor Antagonist Protein/genetics , Interleukin-1alpha/genetics , Interleukin-1beta/genetics , Adolescent , Adult , Case-Control Studies , Female , Genetic Predisposition to Disease , Humans , Iran , Male , Middle Aged , Minisatellite Repeats , Polymerase Chain Reaction , Polymorphism, Genetic , Polymorphism, Restriction Fragment Length , Polymorphism, Single Nucleotide , Young Adult
STUDY DESIGN: Case report. INTRODUCTION: Pisa syndrome (pleurothotonus) is a rare neurologic syndrome, often considered as a consequence of long-term treatment with neuroleptic drugs, defined as more than 10 degrees tonic lateral flexion in upright spine without any significant associated vertebral rotation resembled the leaning tower of Pisa. Unfamiliarity of many neuro- and orthopedic surgeons with this syndrome can lead to unnecessary diagnostic and therapeutic interventions. CASE REPORT: A 33-year-old woman, who has been treated as a schizophrenic patient for 16 years, was referred to our spine clinic with signs of trunk shift. She was consuming valproic acid 500 mg twice a day and clozapine 100 mg three times daily, as an unchanged regimen for the past 2 years. Few months after treatment with clozapine, her parents noticed that the patient progressively leaned to one side. Physical and imaging examinations revealed a severe left truncal shift associated with right cervical tilt. Drug regimen was changed and clozapine dosage reduced to 200 mg daily, and bipyridine 2 mg daily was added to the therapeutic regimen. By 1 month, the deformity gradually disappeared and normal body posture was restored. At the last follow-up visit, 28 months later, normal body posture was observed to be maintained, and no evidence of spinal deformity was noted. CONCLUSIONS: Spine deformity surgeons visiting patients with abnormal postures of the trunk need to ask the patient about medications they are receiving and should be aware of their neuropsychiatric complications. Even drugs with the minimum risk of dystonia, such as clozapine, may cause dystonic disorders like Pisa syndrome.
BACKGROUND: There are important differences regarding cancer disclosure in various geographical populations (Europeans, Western Asia, Eastern Asia), depending on multiple sociocultural factors, and therefore, there is no standard protocol on this issue, especially in Iran. OBJECTIVES: To evaluate the amount of information that Iranian patients have and their preference for the disclosure of the cancer diagnosis. PATIENTS AND METHODS: In this cross sectional descriptive research, patients admitted in the oncology departments of 3 referral medical centers, Imam Hussein, Shohada-e-Tajrish and Modarres, in Tehran, from March 2007 to April 2008, were questioned about their awareness and knowledge regarding their diagnosis. Two different structured questionnaires were designed for the people who know and who didn't know their diagnosis. For the former, the survey concerned their psychological reactions to their situations, whether they would prefer to know about their diagnosis and by whom they are preferred to be informed .For the latter, the questionnaire included their preference whether to know the diagnosis and their current emotional state. Descriptive statistics and chi square test was applied to analyze gathering Data, using SPSS version 14. RESULTS: 60.3% of the patients knew their diagnosis. Among the subjects who did not know their diagnosis, 88% preferred to be more informed about their diagnosis and 68% had some psychological reaction to their situations. Among the subjects who knew their diagnosis, 92.1 % preferred to know their diagnosis, 73.6% preferred to be informed directly by their physicians. Following the diagnostic disclosure, 81.5% reported that they had felt nervous, anxious and worried. CONCLUSIONS: The majority of Iranian patients with malignancy want to know the truth and they prefer to be informed directly by their doctors.
