Investigation of Neurocognitive Deficits, Quality of Life, and Functional Performance in Ultra-High-Risk Individuals Compared to Familial High-Risk Individuals for Schizophrenia.

Objective: This study aimed to investigate neurocognitive functioning, quality of life, and global functional performance in Ultra-High Risk (UHR) individuals compared to Familial High-Risk (FHR) individuals for developing schizophrenia. Method : An observational cross-sectional study was conducted using a convenient sampling method at Roozbeh Hospital in Tehran, Iran, from June 2017 to January 2020. The study included 40 UHR individuals based on the Structured Interview for Psychosis Syndrome (SIPS) interview, as well as 34 FHR individuals due to genetic risk. Neurocognitive functioning, quality of life, and global functional performance were assessed by using the Cambridge Automated Neuropsychological Test Battery (CANTAB) and Controlled Oral Word Association Test (COWAT), Quality of Life Scale (QLS), and Global Assessment of Functioning (GAF). Results: UHR individuals for schizophrenia demonstrated significant lower scores in phonemic and semantic verbal fluency (t = 6.218, P < 0.001; t = 4.184, P < 0.001, respectively), more total errors for spatial working memory (t = -5.874, P < 0.001), and fewer problems solved in minimum moves in Stocking of Cambridge (SOC) (t = -2.706, P < 0.01) compared to FHR individuals. Intra-Extra Dimension (IED) did not differ significantly between the two groups. Moreover, the study indicated significant GAF decline (F = 79.257, P < 0.001) and lower total score on the QLS (t = -10.655, P < 0.001) in UHR compared to FHR individuals. Conclusion: It is possible to differentiate UHR individuals from FHR individuals through neurocognitive, quality of life, and global functioning assessment.

The Consequences of Discontinuing a Home Care Service for Patients with Severe Mental Illness After the COVID-19 Pandemic.

Continuity of care has been considered, as a key component of the treatment process, especially after discharge from the hospital. Establishing treatment continuity is critical to achieving successful treatment outcomes. Roozbeh Home Care Program was developed to ensure the continuity of care in patients with severe mental illness. This study aims to investigate the consequences of discontinuing a home care service including; relapse, readmission, service satisfaction, severity and disability, in patients with severe mental illness in Iran. Forty-three patients who received home care service for more than 6 months were included. They were assessed 3 and 6 months after receiving the service; and 12 months after the program discontinuation. There was a significant difference between the hospitalization rate during (0.42 ± 0.64) and 1 year after the program's discontinuation (0.65 ± 1.46). The majority of the caregivers (70%) were highly satisfied with the home care services. Among the patients who received the homecare services, 40.4% were highly satisfied; and 21.2% were moderately satisfied. There was no significant difference between disability (as measured by World Health Organization Disability Assessment Schedule), clinical improvement (as measured by Clinical Global Impression-Improvement Scale), or severity of illness (as measured by Clinical Global Impression Severity of the Illness Scale) during and 1 year after program's discontinuation. During the time of receiving the service, hospitalization rate was reduced. Patients and caregivers were satisfied with the service. Providing psychiatric services at home should be considered as a solution to maintain the continuity of care.

What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students.

INTRODUCTION: Differences in the viewpoints of clinical faculty members and medical students about prioritizing professional norms accepted by the professional community and lack of alignment of these views can lead to distortion of understanding, problems in learning and assessment of professionalism, and failure in students' professional identity formation. This study aimed to identify the differences in viewpoints of clinical faculty members and medical students about prioritizing the importance and prevalence of professional and unprofessional behaviors among undergraduate medical students. METHODS: A multi-stage qualitative study was conducted at Tehran University of Medical Sciences during 2020-2021. At first, a systematic search was conducted to identify professional and unprofessional behaviors using the directional content analysis method. A panel of experts was formed to check the codes obtained from reviewing the literature and to evaluate its compliance with the context. Then, the modified nominal group technique sessions were held with clinical faculty members and medical students to strengthen the codes extracted from the studies and systematically integrate their views to achieve a comprehensive list of professional and unprofessional behaviors in accordance with the context. Finally, a consensus was made among them about prioritizing the importance and prevalence of these behaviors in undergraduate medical students. RESULTS: A total of 490 codes of professional behaviors and 595 unprofessional behavior codes were identified in the literature review. In the following sessions of the modified nominal group, 13 clinical faculty members listed 105 codes of professional and unprofessional behaviors, and 51 medical students also listed 313 codes. The results of the modified nominal group technique showed that the faculty members reported the importance of unprofessional behaviors higher than professional ones. At the same time, students rated the importance of professional behaviors higher than unprofessional ones. Both faculty members and students rate the prevalence of professional behaviors as high and the prevalence of unprofessional behaviors as low. CONCLUSION: The results showed a difference of views between clinical faculty members and medical students about prioritizing professional and unprofessional behaviors. It is essential to align their viewpoints to understand, learn and value professionalism to develop a professional identity.

Association of suicide with short-term exposure to air pollution at different lag times: A systematic review and meta-analysis.

BACKGROUND: Suicide is a major public health problem, with some environmental risk factors. OBJECTIVES: This meta-analysis study explored the association between short-term exposure to air pollution and suicide mortality, with an emphasis on different lag times. METHODS: A systematic search was used to find relevant studies in databases including Scopus, Web of Knowledge, Pubmed, and Embase published up to 19 May 2020. The inclusion criteria included case-crossover or time-series studies assessing the association of criteria air pollutants with suicide mortality at different Lag Days of 0-7 (LD0 to LD7) and Cumulative Lags of 1-7 days (CL1 to CL7). Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS: Of 1436 retrieved articles, 11 were eligible for data extraction, representing data on 283,550 suicides published between 2010 and 2019. The odds of suicide death increase with each 10 µg/m3 increase in the mean concentrations of NO2 at CL1 (1.013: 1.006-1.021), CL2 (1.028: 1.003-1.053), CL3 (1.035: 1.001-1.070), and LD2 (1.011: 1.001-1.022), SO2 at CL1 (1.024: 1.014-1.034), CL2 (1.030: 1.012-1.048), CL3 (1.029: 1.009-1.049), and CL4 (1.027: 1.005-1.049), O3 at CL6 (1.008: 1.000-1.016), PM10 at CL1 (1.004: 1.000-1.008), and PM2.5 at CL1 (1.017: 1.003-1.031). Besides, the odds of suicide death increases with each 0.5 mg/m3 increase in the mean concentration of CO at LD6 (1.005: 1.000-1.011). However, it decreased with increased O3 exposure at LD3 (0.997: 0.994-1.000). CONCLUSION: The study supports a positive association between air pollution and suicide mortality. No immediate risk was elucidated but the possible effects seem to be exerted cumulatively.

Developing and validating an instrument to measure: the medical professionalism climate in clinical settings.

This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of "personal behavior", "collegiality" and "respect for patient autonomy" in a 25-item questionnaire for service providers and a single factor of "professional behavior" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.

Personal factors affecting medical professionalism: a qualitative study in Iran.

Professional behavior with patients and interactions with colleagues, the institution and professional bodies are influenced by many factors. The purpose of this manuscript is to clarify those personal factors affecting medical professionalism in clinical settings affiliated with Tehran University of Medical Sciences. For this purpose, a qualitative study was carried out. One hundred and eighty-two participants were recruited through purposive sampling of clinical staff, physicians, and medical students in Tehran. Data were collected through 22 focus group discussions, and conventional content analysis was used to analyze the data. The results were reported in five categories to present the participants' views. Categories were extracted from 103 codes and consisted of 1) people's belief in professionalism, 2) personality traits, 3) problems in family, 4) mental or physical health status, and 5) communication skills. The results showed that despite the facilitator roles of some personal factors, others act as barriers to professional behaviors. In order to control their impact, it is crucial to pay attention to them at the time of student/staff selection. Strengthening support systems in the organization is also essential for decreasing the effect of family problems or physical and mental health problems.

A framework for participatory selection of the school dean: Report of an experience.

INTRODUCTION: Selection of the managers and leaders is a major concern of leading organizations. Recruitment of the qualified individuals in an educational organization depends on effective selection techniques. The present study reports the experience of Tehran University of Medical Sciences (TUMS) in designing a framework for selection of school dean. MATERIALS AND METHODS: First, a literature review was conducted to identify the common frameworks for the selection of deans in academic environment. Then, the perceptions of key stakeholders were collected via focus group discussions. Thematic analysis was used to categorize participants' comments. Following, an institutional guideline for selection of school dean was developed based on the derived themes and subthemes by a task force and approved by the board of directors. RESULTS: Three themes and nine subthemes were extracted, resulting in the selection framework for the school dean at TUMS with three phases of preparation, selection, and appointment. The preparation phase includes organizational needs analysis, designing the selection strategy and determining the eligibility of nominee. In the selection phases, various methods such as personal resume, interview, and consultation with beneficiaries were recommended, and the appointment phase includes formal appointment of the selected nominee by the university chancellor. CONCLUSIONS: We developed a framework for selection of school dean at TUMS. It recognizes the process that top managers would look out when selecting school deans. The framework may result to choose the proper individuals who have suitable plans and stronger Curriculum Vitae, while involving key stakeholders and collecting wisdom.

Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis.

BACKGROUND: Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium concentration in drinking water and suicide mortality in the general population. METHODS: A systematic search was conducted in Web of Knowledge, PubMed, ScienceDirect, and Scopus to find papers reporting the crude relationship between drinking water lithium and suicide incidence in the general population until June 2019. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model. RESULTS: We retrieved 308 English original articles, of which 13 ecologic studies with a total sample size of 939 regions and one cohort study with a sample size of 3,740,113 people were eligible for the meta-analysis. A significant relationship was found between the lithium concentration in drinking water and reduced suicide mortality (OR= 0.42; 95% CI: 0.27-0.67; p-value <0.01). Ten studies reported gender-specific responses to lithium, with the pooled estimates as follows: OR= 0.54; 95% CI: 0.35-0.84; p-value <0.01 for men, OR= 0.70; 95% CI: 0.48-1.01; p-value =0.057 for women, and OR= 0.63; 95% CI: 0.47-0.83; p-value <0.01 for total. LIMITATIONS: The study was limited to the assessment of the crude relationship between lithium exposure and suicide rate without considering the role of confounders. CONCLUSIONS: Lithium in drinking water is dose-dependently associated with reduced suicide mortality at least in ecological studies. However, we need well-designed clinical trials to confirm the protective effect of drinking water lithium intake against suicide.

Educational system defects and observing professional behavior: A qualitative study.

BACKGROUND: Observing professional behavior in clinical settings encounters many obstacles. In this research, the effect of defects of the educational system in observing professional behavior in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated. MATERIALS AND METHODS: This qualitative content analysis study was conducted using focused group discussions in TUMS. Twenty-two focused group discussions with 182 faculty members, medical students, and clinical staff were conducted. Conventional content analysis was used to analyze the data. RESULTS: One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70 codes from the viewpoint of faculty members and medical students) were extracted. The codes are categorized into 4 categories and 17 subcategories. The categories include "educators' imperfections," "inadequate initial training," "lack of attention to continuous professional education," and "lack of passion for professionalism education." CONCLUSION: Greater efforts to empower educators, planning for the effectiveness of initial education, and motivating employees might play a role in promoting the observance of professional behavior in clinical settings. Professional behavior training should be considered at the entrance into the system. This education should be strengthened by continuing theoretical and practical training and addressed by proper supervision. It is also important to focus on attracting the attention of teachers to their own model role in observing professional behavior by others.

Health State Utilities for Patient's Current Health from Bipolar Type I Disorder.

BACKGROUND: Bipolar Type I Disorder (BID) is a disabling mental disorder among young adults that places enormous psychological, social, and economic burdens on patients, their families, and health care systems and decreases quality of life (QOL). Few studies have investigated the quality-adjusted life-years (QALY), health state preferences, and utilities in patients with BID. AIM OF STUDY: The aim of this study was to elicit health state utilities for current health among a sample of individuals with BID irrespective of their clinical conditions at the time of evaluation. METHODS: One hundred individuals with BID were consecutively enrolled in this cross-sectional study. Preferences were elicited from patients with visual analogous scale (VAS) and time trade-off (TTO). To assess quality of life, the Farsi version of the World Health Organization's QOL Instrument-Short Version (WHOQOL-BREF) was used. In addition, health state was assessed with the Short Form-36 (SF-36) health survey, and then a specially- derived reduced version of the SF-36 (the `SF-6D') was calculated as an alternative to existing preference-based measures of health for conducting economic evaluation of various interventions. Moreover, several clinical measures were administered to participants. RESULTS: The mean (S.D.) VAS, TTO, and SF-6D utility scores were 0.59 (0.21), 0.44 (0.33), and 0.61 (0.11), respectively. There were significant associations of most selected clinical characteristics with VAS and TTO scores. Additionally, there were strong correlations between all domains of WHOQOL-BREF and VAS scores as well as moderate to strong correlations with TTO scores. Furthermore, there were strong correlations between all scales of SF-36 scores and VAS scores as well as moderate to strong correlations between the scales of SF-36 scores and TTO scores. DISCUSSION: The current study showed that even unstable patients could evaluate their own health states. Furthermore, the present study showed substantial decrements in health-related life preferences among persons with BID. Additionally, the patients with most recent depressive or mixed episodes reported lower VAS scores than those with most recent manic episodes. LIMITATIONS: This study was performed on a group of patients with BID in a referral psychiatric center. This sample can potentially make a selection bias. Furthermore, this study was cross-sectional. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Generally, clinical features could explain more than half of the variances in VAS utility scores. Among all clinical features, severity of symptoms and duration of disease were among the main factors significantly associated with the utility decreases. IMPLICATION FOR HEALTH POLICIES: The present study data provide health state preferences useful for cost-utility and outcome-modeling studies as well as health policy and decision-making. Also, the evaluations were partially affected by severity of symptoms. Therefore, utilities obtained in this study can be utilized to develop QALY and provide utility values that can be used in economic models for cost-utility studies. IMPLICATIONS FOR FURTHER RESEARCH: The comparison of the utility in a group of patients in different mood episodes and in their controlled periods and calculating the proportion of each episode to total duration of disease and to the patient's life span in future investigations may add crucial information to the present knowledge. The evaluation of biological and non-biological therapies by measuring utility and health value as health output indicators is strongly suggested.

Twelve-month course and outcome of methamphetamine-induced psychosis compared with first episode primary psychotic disorders.

BACKGROUND: To assess the clinical course and outcome of patients with methamphetamine-induced psychosis in comparison with patients with primary psychotic disorders. METHODS: This prospective study was conducted on patients with methamphetamine-induced psychosis, and 2 groups of primary psychotic disorders: affective psychosis and non-affective psychosis admitted to 2 psychiatric hospitals in Tehran, Iran, with a first episode of a psychotic illness. A total of 165 subjects (55 in each group) were selected using convenience sampling. They were assessed at the time of admission, discharge and 6 and 12 months after discharge using the Positive and Negative Syndrome Scale, the Young Mania Rating Scale and the Global Assessment of Functioning Scale. The frequency of readmissions and suicide attempts were also assessed. RESULTS: Significant differences were found in the trend of changes of symptoms and functioning among the 3 groups. At all-time points, the severity of negative psychotic symptoms and dysfunction in the non-affective psychosis group were greater than those in affective or methamphetamine-induced psychosis groups, with latter 2 having similar profiles. However, the course of positive symptoms in methamphetamine-induced psychosis was more similar to non-affective psychosis. Number of suicide attempts and readmissions were non-significantly higher in methamphetamine-induced psychosis than in the other groups. CONCLUSION: Methamphetamine-induced psychosis does not have a satisfactory course and in some cases symptoms may remain even after many months of follow-up. Rate of certain outcomes such as re-hospitalization is also considerably high. It is a challenge for the health-care system that requires evidence-based interventions.

Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.

BACKGROUND: There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery. AIMS OF THE STUDY: The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran. METHODS: This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period. RESULTS: There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year. DISCUSSION AND LIMITATIONS: Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted. IMPLICATIONS FOR HEALTH CARE PROVISION, USE AND POLICIES: Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population. IMPLICATIONS FOR FURTHER RESEARCH: Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercare service program compared with routine conventional care.

The Effect of Clinical Exposure to Patients on Medical Students' Attitude Towards Mental Illness.

BACKGROUND: Stigma of mental disorders causes a reduction in seeking help from the health care professionals and is evident across the world. OBJECTIVES: The current study aimed to compare medical students' attitude towards mental illness after two different psychiatry clerkships in terms of the level of clinical exposure to patients with mental illness. PATIENTS AND METHODS: Through a quasi-experimental study, all of the 4th-year medical students were invited to enroll this study conducted in Tehran University of Medical Sciences (TUMS). They were non-randomly assigned into two different psychiatry clerkships from January 2009 to January 2010. One group was enrolled in the traditional lecture-based course (low-exposure) while the second group participated in a novel method with increased hours of patient exposure (high-exposure). Attitude towards mental illness (AMI) was measured by a 22-item questionnaire before and after the clerkship and data were compared between the two groups in terms of changing attitude towards mental illness in five different categories. RESULTS: A total of 211 participants were enrolled in the study (115 female) of which 115 students (54.5%) were in low-exposure group and 96 students (45.5%) in the high-exposure group. Generally, AMI scores did not differ between the two groups and did not show any significant changes before and after the psychiatry clerkship. The only exceptions to this were AMI4 category (the concept of etiology of the mental illness), which significantly improved after the clerkship in the low-exposure (P = 0.011) and the high-exposure groups (P = 0.024), respectively. CONCLUSIONS: Exposure of medical students to patients with mental illness did not improve attitude towards mental illness and psychiatric conditions.

Transition to Psychosis: Evaluation of the First-Degree Relatives of Patients with Schizophrenia .

OBJECTIVE: Schizophrenia and other psychoses have devastating personal and social impacts and many efforts have been devoted to study prodromal syndromes for psychosis in order to achieve earlier detection and interventions. However, only few studies have been performed in developing countries on this subject, and there is a dearth of evidence in the Iranian population. In this study, we focused on conversion rate to psychosis and changes in prodromal symptoms in a group of first-degree relatives of patients with schizophrenia and to compare the conversion rate in those with and without prodromal symptoms as assessed by the Structured Interview for Prodromal Syndromes (SIPS) and Scale of Prodromal Symptoms (SOPS). METHOD: Participants were the first-degree relatives of hospitalized patients with schizophrenia at Roozbeh Hospital, Tehran, Iran. At baseline, a trained psychiatrist interviewed the participants using the SIPS and the SOPS and assigned them to high- or low-risk groups either based on the presence of prodromal criteria or seeking mental health services. After 12 months, the same examiner re-evaluated the participants in order to determine the changes in their symptoms and identify the probable transitions to psychosis. RESULTS: One hundred participants, 50 participants within each of high- or low-risk groups, were recruited at baseline. Eight participants dropped out of the study. At the follow-up, the rate of transition to full psychosis among high-risk group was 13% (95% CI [0.029, 0.23]), whereas none of the low-risk participants developed psychosis. None of the high-risk participants demonstrated attenuation in their prodromal states after a one-year follow-up. In contrast, of the 50 low-risk participants, three experienced prodromal symptoms for psychosis during this period. High-risk participant's illustrated higher severity in almost all of the SOPS items compared to the low-risk participants at both baseline and follow-up evaluations. CONCLUSION: Prodromal syndrome for psychosis based on the SIPS and the SOPS was a predictive factor for transition to psychosis after a 12- month period in a group of first-degree relatives of patients with schizophrenia admitted to a psychiatric hospital in Iran. Conducting further studies on this at-risk population is highly recommended in order to provide practical methods for early screening and therapeutic interventions. .

Evaluation of the performance of general practitioners in a collaborative care program by employing simulated patients.

OBJECTIVE: To compare the performance of the general practitioners (GPs) in a collaborative care (CC) program in Iran with a control group of GPs in the usual care by employing simulated patients. METHODS: Six trained simulated patients (SPs) made unannounced visits to 26 GP offices participating in the CC program and to 26 age and sex matched controls. The SPs role played five clinical scenarios of mental disorders and filled out checklists to evaluate the GPs' performance regarding interviewing, taking history, establishing rapport, showing empathy, and giving advice to patients. Additionally, the GPs' plan of care and prescriptions were evaluated later by a psychiatrist based on the documents provided by the SPs. RESULTS: There was a significant difference between collaborative care and control group physicians in their global performance; CC physicians built up better patient-physician relationship. They performed better in evaluating a psychotic patient, although not better in their management. CC physicians were marginally better in approach to patients with generalized anxiety disorder (GAD) and mild major depressive disorder. CONCLUSION: The overall performance of physicians in CC was better than the GPs in the control group in making an effective patient-physician relationship, and evaluating a psychotic patient. The main weakness of the GPs was in proper treatment of the minor and more common psychiatric disorders and in evaluation of patients with suicidal ideations who were in need for emergent referral. Evaluating performance of the practitioners is feasible employing SPs and the findings can be translated into improvements in the available services.

Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period.

BACKGROUND: Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder. OBJECTIVES: This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms. PATIENTS AND METHODS: In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests. RESULTS: We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group. CONCLUSION: In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder.

Correlation of neurological soft signs and neurocognitive performance in first episode psychosis.

Neurological soft signs and neurocognitive impairments are commonly observed in first episode psychosis but the correlation of these factors remains controversial. Here, we evaluated 30 patients with remitted first episode psychosis and 30 healthy controls for the presence and severity of neurological soft signs (using the Neurological Evaluation Scale--NES) and for neurocognitive impairments (using seven subtests of the Cambridge Neuropsychological Test Automated Battery--CANTAB). NES score was higher in patients compared to controls. Neurocognitive impairment was evident in patients in the following domains: working memory, spatial recognition memory, attention set shifting, planning and inhibition. The NES revealed significant correlations with spatial working memory performance and Intra-Extra Dimensional Set Shifting (as a component of executive function). These correlations were observed both in patients and in controls. Planning and inhibition showed correlation with the total NES score and the sequencing of complex motor acts in both groups. In addition, spatial span and spatial recognition memory showed significant correlation with total NES score and the sequencing of complex motor acts in controls. The correlation between sequencing of complex motor acts and specific domains of neurocognitive tasks suggests that similar neuroanatomical substrates might be implicated in these processes.

Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder.

Accumulating evidence suggests that N-methyl-d-aspartate receptor (NMDAR) antagonists (e.g. ketamine) may exert rapid antidepressant effects in MDD patients. In the present study, we evaluated the rapid antidepressant effects of ketamine compared with the electroconvulsive therapy (ECT) in hospitalized patients with MDD. In this blind, randomized study, 18 patients with DSM-IV MDD were divided into two groups which received either three intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min) or ECT on 3 test days (every 48 h). The primary outcome measure was the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS), which was used to rate overall depressive symptoms at baseline, 24 h after each treatment, 72 h and one week after the last (third) ketamine or ECT. Within 24 h, depressive symptoms significantly improved in subjects receiving the first dose of ketamine compared with ECT group. Compared to baseline level, this improvement remained significant throughout the study. Depressive symptoms after the second dose ketamine was also lower than the second ECT. This study showed that ketamine is as effective as ECT in improving depressive symptoms in MDD patients and have more rapid antidepressant effects compared with the ECT.

Evaluation of the Persian version of modified fatigue impact scale in Iranian patients with multiple sclerosis.

BACKGROUND: Fatigue, a major cause of disability in individuals with multiple sclerosis (MS), is associated with reduced quality of life. The aim of this study was to evaluate the reliability and reproducibility of the Persian version of Modified Fatigue Impact Scale (MFIS) in Iranian patients with MS. METHODS: This study included 15 subjects with clinically definite MS, 15 hospitalized patients with MS, and 15 hospitalized patients with other chronic illnesses (as controls). They filled in the Persian version of the MFIS twice with a three-day interval. MFIS items were analyzed and the correlation coefficient was calculated. RESULTS: THERE WAS A GOOD CORRELATION BETWEEN THE SCORES OF THE TWO MEASUREMENTS (CORRELATION COEFFICIENT: 0.984, P < 0.001) especially in physical and cognitive subgroups. The reproducibility of psychosocial subscale was lower than physical and cognitive subscales. CONCLUSION: According to our findings, the Persian version of the MFIS has a good reliability and reproducibility for assessment of fatigue in patients with MS.