Absconding from a Psychiatric Hospital in a Developing Country, Related Factors, and the Consequences.

Background: This study aimed to investigate the factors related to absconding and consequences of absconding in a psychiatric hospital in a developing country within 3 years. Methods: This was a retrograde descriptive cross-sectional study from a psychiatry hospital in a developing country, Iran. The registered data of absconding between March 2018 and February 2021 were extracted. Furthermore, a retrograde follow-up by telephone on what happened after the absconding and the remembered motives was done. The obtained data were analyzed using SPSS statistical software for Windows Version 23 by descriptive statistics. The chi-square test, Fisher exact test, Student t test, or Mann-Whitney U tests were used for data analysis. P ˂ .05 was considered statistically significant. Results: Out of 7069 admitted patients during a 36-month period, 51 (39 men and 12 women) had absconded. The total absconding rate was 0.72%. The mean ± (SD) age of the patients was 29.7 ± (10.46) years, with a range of 10 to 54 years. No statistical difference between men and women emerged in terms of age (P = 0.89). Most of the absconders were men (76%), young (mean age, 29.7 years), single (70.6%), and involuntarily hospitalized (78.4%) in an urban area (90.2%), and absconded in the evening shift (58.8%) via the route of the main gate (58.8%) in the early days of admission (5 days). In terms of psychiatric diagnosis, the highest rank belonged to bipolar disorder (33.33%) and substance-related disorders (33.33%). About one-third of absconders had a current substance-related problem and most of them had experienced withdrawal symptoms or cravings days before absconding (75%). Absconders mentioned that "no need for admission" (45.1%), "economic problems" (23.5%), and "substance craving" (13.7%) were the most common reasons for leaving the hospital. Most of the absconders were hospitalized later (70.5%). The risk for self-harm (21%) or harm to others (2%) after absconding was low. Conclusion: The general profile of absconders was concordant with previous studies. It was highlighted that economic problems in recent years had an evident impact on patients and it could be postulated that consideration of substance withdrawal may decrease absconding. It is advised to adhere to the policies that support community-based psychiatry and place an emphasis on early discharge and continuity of outpatient care.

Evaluating family knowledge about sexual health in patients with severe mental illness: a qualitative study in Iran.

INTRODUCTION: Although paying more attention to sex education in patients with severe mental illness is recommended in the literature, the role of families has not been specifically clarified. AIM: This study aims to explore family knowledge about sexual health in patients with severe mental illness in Iran. METHODS: We conducted a total number of 21 interviews with 4 patients, 5 families, 7 psychiatrists, 1 general practitioner, 2 nurses, and 2 psychologists through purposive sampling. The text was analyzed using conventional qualitative content analysis. RESULTS: The family knowledge about patients' sexual health is described in three subcategories: 'informal sources for knowledge acquisition', 'common myths, and 'inappropriate reaction to the patients' needs". CONCLUSIONS: Family sex education should be integrated into a comprehensive rehabilitation program to promote sexual health in patients with severe mental illness. Family members should be aware of the necessity of accurate information about patients' sexual concerns.

Exploring the hidden curriculum of professionalism and medical ethics in a psychiatry emergency department.

PURPOSE: To investigate the hidden curriculum of professionalism in the emergency department. DESIGN AND METHODS: This is a qualitative study that consisted of six in-depth semi-structured interviews and a focus group with psychiatry residents of a teaching hospital program about their perception of professionalism in emergency department. A simple content analysis method has been conducted for the extraction of findings. FINDINGS: Common themes that were detected in the hidden curriculum were "Disregarding the priority of the patients"; "Overriding patient autonomy"; "Non-empathetic care"; "Breaching Confidentiality"; "Injustice in providing care"; and "Dishonesty" PRACTICE IMPLICATIONS: Professional behaviors are mostly learned through the hidden curriculum. The hidden and formal curricula of professionalism are different in several domains. Paying attention to organizational culture and social environment is critical for promoting professionalism.

Psychiatric residents' experience about Balint groups: A qualitative study using phenomenological approach in Iran.

INTRODUCTION: Previous research has shown that Balint group is effective in the professional and personal development of residents. The aim of this study was to investigate the experience of psychiatric residents about Balint groups. METHODS: This is a qualitative study using a phenomenological approach. Seven sessions of the Balint groups were held with a number of psychiatric residents at Mazandaran University of Medical Sciences. Two of the leaders were psychoanalytic psychotherapist. Finally, eight in-depth semi-structured interviews and focused group interview were conducted. Data were collected by tape recorded interviews. Data were analyzed using MAXQDA-10 software. RESULTS: Three main themes were obtained from the interviews that included "Early experiences", "Touching the Balint group" and "Relationship with Balint group". The category of "Early experiences" included three categories of "defenseless", "fire under the ashes" and "deep feeling". Touching the Balint group theme included categories such as "Empathetic", "I am not the only one ...", "Releasing", "Reading story", "This patient", and "Getting closer". The relationship with Balint group theme included three categories of "first of all", "attachment" and "courage and time". CONCLUSION: Based on the findings of this study, while some aspects of Balint group are stressful but ultimately improve the emotions and better understanding of the patient. This research shows incorporating Balint group into the educational program and curriculum of psychiatric residents in Iran might be helpful, but more qualitative and quantitative research is necessary.

Association between spiritual intelligence and stress, anxiety, and depression coping styles in patients with cancer receiving chemotherapy in university hospitals of Tehran University of medical science.

BACKGROUND: Holistic care addresses the physical, psychological, social, and spiritual dimensions of the patient in which spiritual dimension plays a pivotal role in patient care. OBJECTIVE: The objective of this study is to investigate the association between spiritual intelligence with stress, anxiety, and depression coping styles in patients with cancer. METHODS: This analytic descriptive study was carried out on 276 patients with cancer receiving chemotherapy in university hospitals of Tehran University of Medical Sciences during 2013-2014. The participants were selected using cluster sampling. Data collection tools included patients' medical history, demographic questionnaire developed by researcher, spiritual intelligence self-report inventory questionnaire, ways of coping questionnaire, and depression, anxiety, and stress scales-42. Pearson correlation and multiple regression analyses were conducted to analyze the data using SPSS 20. Differences were considered significant at the P < 0.05 level. RESULTS: There was inverse significant relationship between spiritual intelligence and stress (r = -0.268 and P < 0.001) and between spiritual intelligence and anxiety (r = -0.200 and P = 0.001) and between spiritual intelligence and depression (r = -0.317 and P = 0.000). There was a significant relationship between spiritual intelligence and coping styles (P < 0.01). The highest association was observed between spiritual intelligence and problem-focused strategy or positive reevaluation strategy (P = 0.000 and r = 0.668 and P = 0.000 and r = 0.667, respectively). CONCLUSIONS: Spirituality and religion are an important source of strength for adjusting of patients to cancer and help patients to achieve the sense of meaning and purpose in the course of disease. IMPLICATIONS FOR PRACTICE: Establishment of settings in hospitals focusing on using spiritual intelligence to improve treatment outcomes in patients with cancer.

Emergency psychiatric services in Roozbeh Hospital: A qualitative study of the staff's experiences.

PURPOSE: This study aims to explore how psychiatric residents and nurses experience the conditions of psychiatric emergency services. DESIGN AND METHODS: This qualitative study was carried out using content analysis. Data were collected through unstructured interviews conducted during three focus groups. FINDINGS: The results of the focus groups were classified into the following five categories of issues influencing the staff's experiences: repetitive problems, long wait times, ambiguity, insecurity, and stability. PRACTICE IMPLICATIONS: Improving the staff's communication skills and educating them on how to manage violence, establishing a well-functional system of triage, and optimizing bed management and discharge planning are among several potential strategies that might be considered to improve the quality of care in psychiatric emergency services.

Developing an Inpatient Group Psychotherapy Program: Challenges and Lessons Learnt.

In Iran, inpatient group psychotherapy has been limited to transient practices for research purposes or fulfilling personal interest of therapists. The goal of this paper is to share and explain the experience of developing an inpatient group psychotherapy program in Roozbeh Psychiatric Hospital, Tehran, Iran. After theoretical delineation and preparation of a draft of the program guideline, two pilot sessions were held. Based on this initial experience a final treatment guideline was prepared. Afterwards, the program was continued for more than 1 year in a female ward at Roozbeh Psychiatric Hospital. The output of this exercise was a guideline that covers important topics in development of inpatient group psychotherapy. It is concluded that inpatient group psychotherapy has its unique challenges. Of the most important challenges that can be mentioned in this regard are the participation of patients with significant differences in levels of psychopathology and psychiatric signs and symptoms, and high comorbidity with specific personality traits or disorders. Other challenges relevant to the structure of the group include items such as very limited time for working through and inevitable out-of-group contacts.

Psychiatrists and Their Role in an Integrative Approach to Sexual Problems.

Sexuality is a unit part of humans that has been evaluated as several fragmented particles for years. Although many biomedical and psychosocial approaches have been developed in the field of sex, these approaches usually have not been led to the complete satisfaction of the patients. It seems that for a comprehensive evaluation and management of the sexual problems, the unity of sex should be respected and the biopsychosocial multilayer aspects of the sex should be apprehended. Psychiatry is a unique point that both biomedical and psychosocial sciences reach each other. Therefore, psychiatrists should play a critical role as a modulator in the multidisciplinary team for management of the sexual problems. In this regard, comprehensive training of psychiatrists is highly recommended. One of the primary steps could be developing the psychosexual fellowship.

Relationship of cortisol, norepinephrine, and epinephrine levels with war-induced posttraumatic stress disorder in fathers and their offspring.

OBJECTIVE: To compare afternoon serum/plasma levels of hormones in four groups: (A) veterans with posttraumatic stress disorder (PTSD), (B) offspring of PTSD veterans, (C) veterans without PTSD, and (D) offspring of non-PTSD veterans. METHODS: Evaluation consisted of a semi-structured interview for axis I and II diagnoses, followed by measurement of afternoon serum cortisol and plasma epinephrine and norepinephrine by ELISA (Diametra) and LND (LDN Labor Diagnostika Nord GmbH & Co. KG) respectively. Data were analyzed using descriptive statistics and the Student t, Kolmogorov-Smirnov, and nonparametric Mann-Whitney tests. RESULTS: One hundred and sixty-eight volunteers were investigated across the four groups. The groups were similar in terms of demographic characteristics, war experience and traumatization, and psychiatric and medical conditions other than PTSD (group A was similar to group C and group B was similar to group D). Between-groups comparisons did not yield statistically significant differences. Post-hoc analyses revealed significant differences in afternoon cortisol level between the offspring of veterans with current/past history of PTSD and the offspring of veterans without a history of PTSD. CONCLUSION: We only found decreased cortisol levels in offspring of veterans after rearranging the groups to reflect previous history of PTSD. Further studies are required to investigate the relationship between cortisol levels and the transgenerational effects of trauma and parental PTSD.

Relationship of cortisol, norepinephrine, and epinephrine levels with war-induced posttraumatic stress disorder in fathers and their offspring

Objective: To compare afternoon serum/plasma levels of hormones in four groups: (A) veterans with posttraumatic stress disorder (PTSD), (B) offspring of PTSD veterans, (C) veterans without PTSD, and (D) offspring of non-PTSD veterans. Methods: Evaluation consisted of a semi-structured interview for axis I and II diagnoses, followed by measurement of afternoon serum cortisol and plasma epinephrine and norepinephrine by ELISA (Diametra) and LND (LDN Labor Diagnostika Nord GmbH & Co. KG) respectively. Data were analyzed using descriptive statistics and the Student t, Kolmogorov-Smirnov, and nonparametric Mann-Whitney tests. Results: One hundred and sixty-eight volunteers were investigated across the four groups. The groups were similar in terms of demographic characteristics, war experience and traumatization, and psychiatric and medical conditions other than PTSD (group A was similar to group C and group B was similar to group D). Between-groups comparisons did not yield statistically significant differences. Post-hoc analyses revealed significant differences in afternoon cortisol level between the offspring of veterans with current/past history of PTSD and the offspring of veterans without a history of PTSD. Conclusion: We only found decreased cortisol levels in offspring of veterans after rearranging the groups to reflect previous history of PTSD. Further studies are required to investigate the relationship between cortisol levels and the transgenerational effects of trauma and parental PTSD. .

A review on the evidence of transgenerational transmission of posttraumatic stress disorder vulnerability

Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. .

A review on the evidence of transgenerational transmission of posttraumatic stress disorder vulnerability.

OBJECTIVE: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. METHODS: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. RESULTS: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. CONCLUSIONS: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability.

Comparison of the analgesic effect of ibuprofen with mesalamine after discectomy surgery in patients with lumbar disc herniation: a double-blind randomized controlled trial.

BACKGROUND: Pain management is an important component in the postoperative period following discectomy. AIMS: We hypothesized that mesalamine considering its better safety profile, is likely to be a better choice, if it would be as effective as ibuprofen in controlling post-discectomy pain. SETTINGS AND DESIGN: A double-blind randomized controlled trial was performed on patients who underwent lumbar discectomy surgery. MATERIALS AND METHODS: Of the 58 patients who had lumbar discectomy, 27 patients were randomized to oral ibuprofen 500 mg and 31 patients to mesalamine 400 mg, three times a day for nine days following surgery. There was no placebo group. Severity of pain was assessed by using 10- cm visual analogue scale (VAS), once before operation and for nine days after. STATISTICAL ANALYSIS: Mean +/- SD pain scores were compared between groups and the statistical difference was estimated by Student's test using SPSS (Version 13). We also calculated the power of each t-test. Repeated measure ANOVA was performed for measuring the effect of time. RESULTS: The age range of the patients was 35 to 60 years (mean: 42.2 years). Mean +/- SD preoperative pain scores for ibuprofen or mesalamine-treated groups were 7.852 +/- 2.441 and 7.806 +/- 2.892, respectively. At the end of day 9, mean +/- SD of pain score was 2.704 +/- 2.284 and 2.717 +/- 2.273 for ibuprofen and mesalamine-treated groups respectively. Both drugs significantly reduced postoperative pain and there was no statistically significant difference between the two groups. CONCLUSIONS: Since both drugs showed almost equal analgesic effect, considering its safety profile mesalamine, seems to be the preferred choice to alleviate post-discectomy surgery pain.

Gamma knife radiosurgery in patients with trigeminal neuralgia: quality of life, outcomes, and complications.

OBJECTIVE: to assess the outcomes, complications, and alteration in quality of life (QOL) in patients with trigeminal neuralgia who were treated with gamma knife radiosurgery (GKRS) in a prospective observational study. METHODS AND MATERIALS: between June 2006 and May 2007, 30 patients of medically refractory trigeminal neuralgia were included in our study and treated with GKRS at Iran Gamma Knife Centre (IGKC), Tehran, Iran. A median maximum prescription dose of 90Gy (range: 85-95) was delivered to the trigeminal nerve root entry zone. All involved patients completed QOL questionnaire SF-36 before GKRS and 9-12 months after it. All data from questionnaires and the basic characteristics of the radiosurgery and patients were analyzed using descriptive statistics, paired T-test, Fisher's exact test, bivariate correlation, and independent sample T-test. RESULTS: In all SF-36 domains significant changes before and after GKRS were noticed except physical function (PF) and role limitation due to physical problem (RP). Bodily pain after GKRS was 100 (excellent result) in 12 (40%) of study participants, 90-99 (good result) in 3 (10%), 50-89 (fair result) in 10 (33%) and less than 50 (poor result) in five (17%). Four cases (13%) faced to facial numbness. No other complications were noticed. CONCLUSIONS: GKRS positively changes the several aspect of QOL especially those related to pain relief and mental health component of QOL. The rate of diminishing pain in our study is comparable with other series. The GKRS complication is limited in both variety and number.

Pituitary apoplexy presenting as acute painful isolated unilateral third cranial nerve palsy.

A 40-year-old man presented with a sudden severe headache and complete right-sided ptosis. Neuro-ophthalmic examination revealed a right oculomotor nerve palsy. Computed tomography of the brain showed a round isodense intrasellar mass. Magnetic resonance imaging demonstrated a pituitary tumor with some areas of infarction and invasion into the right cavernous sinus, which was diagnosed as pituitary apoplexy. The patient received intravenous steroid for 10 days with no recovery of the oculomotor nerve palsy. He underwent trans-sphenoid tumor resection followed by complete recovery of the oculomotor nerve and no sign of tumor in postoperative MRI, two weeks after the surgery.

Left somatosensory cortex tumor presented with radicular hand pain and paresthesia.

Concurrent lesions in the brain and spinal cord, which can produce similar symptoms are truly confusing situations. Herein, we report on a 56-year-old woman who suffered from an intermittent radicular pain and paresthesia in her right upper limb and mild headache. Imaging showed a cervical vertebral disc herniation and a small round tumor of the somatosensory cortex with clear border, considered as a little meningioma, which could be followed. To deal with these two concurrent lesions, we faced a challenging condition.

Near-infrared laser spectroscopy as a screening tool for detecting hematoma in patients with head trauma.

INTRODUCTION: Among imaging techniques, computed tomography (CT) is a reliable method for detecting intracranial hematomas in patients with head trauma, but it is not generally available in special circumstances like prehospital situations and harsh conditions such as those following an earthquake. OBJECTIVE: The objective of this study is to determine if near-infrared spectroscopy (NIRS) is useful for performing CT scans on patients with closed head trauma that present to medical centers that do not have the ability to perform a CT scan or in prehospital or harsh situations. Near-infrared spectroscopy and CT scan were compared according to sensitivity and specificity. METHODS: This was an observational, prospective study. One hundred forty-eight patients admitted to Rasool Akram General Hospital in Tehran, Iran with head injuries during a one-month period were studied using NIRS and CT. The observational, prospective study was conducted and sensitivity, specificity, positive and negative predictive values of NIRS were calculated. Chi-square and Kappa analysis was performed, and a p-value <0.05 was considered significant. RESULTS: According to the CT scan findings, 54 (36.5%) of the patients developed intracranial hematoma. The NIRS examination showed that 69 patients (46.6%) might have intracranial hematoma. The number of true negatives was 73 and the number of false negatives was six patients. The sensitivity and specificity of NIRS examination was 88.9% and 77.7%, respectively. CONCLUSIONS: This study speculates that NIRS may be a useful screening tool to detect intracranial hematoma. This capability could be useful in special situations like in a deprived area, medical centers without CT scan capabilities, prehospital situations, and in harsh conditions like those after an earthquake or other disasters that causes increased numbers of victims with closed head trauma.