Midwife-led psycho-education intervention to reduce childbirth fear: a quasi-experimental study.

This quasi-experimental study aimed to assess the impact of a midwife-led psycho-education intervention on reducing fear of childbirth (FOC) and perceived stress (PS) in pregnant women. The present study involved 96 pregnant women. The intervention group received three 30-45 min telephone sessions using 'BELIEF' (Birth Emotion-Looking to Improve Expectant Fear) psycho-education approach. The outcomes were assessed using questionnaires on childbirth attitudes and PS. Data analysis was performed using Stata version 17. In the intervention group, the mean score for FOC decreased from 39.41 ± 7.02 to 29.91 ± 5.60 (9.5; 24.1%). The mean difference (MD) of 28.22% was statistically significant (adjusted MD: -10.51, 95% CI: -11.60, -9.41, P < 0.001). In the intervention group, mean scores for PS decreased from 22.77 ± 6.94 to 18.23 ± 5.69 (4.54; 19.93%). In the control group, scores increased from 22.68 ± 6.76 to 24.82 ± 6.58 (2.14; 9.43%). The 29.36% MD was statistically significant (aMD: -6.95, 95% CI: -8.73, -5.18, P < 0.001). The findings of this study indicate that the midwife-led psycho-education intervention, utilizing the 'BELIEF' protocol over the telephone, has a significant effect on reducing FOC and PS, as well as increasing the preference for vaginal birth.

Association among general health, personality traits, and headache severity in patients with migraine.

Background: Because migraine is a common headache, finding ways to approach it better would be useful. So, studying the relation of dimensions of general health and personality types and pain severity in patients with migraine will be useful for fulfilling this aim. Methods: In this cross-sectional study, the number of patients with migraine headache studied in this study was 170. The checklists used in this study were migraine disability assessment (MIDAS), visual analog scale (VAS), Neuroticism-Extraversion-Openness (NEO FFI), and General Health Questionnaire (GHQ-28). Results: The average scores of general health dimensions in migraine sufferers with aura were higher than in migraine patients without aura. But this difference was significant only in the index of physical symptoms (P=0.02). There was a negative correlation between pain intensity and general health dimensions but it was not statistically significan. A positive correlation was observed between headache intensity and extroversion, which was significant (r=0.18 and P=0.01). The score of physical symptoms increases significantly with the increase of disability severity (P=0.007). Conclusion: According to the results, the severity of migraine disability, general health dimensions, and personality types in patients with and without Aura was not different. Also, general health dimensions and personality types were not associated with pain intensity and the severity of migraine disability.

Psychological distress in pregnancy and postpartum: a cross-sectional study of Babol pregnancy mental health registry.

BACKGROUND: Psychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum. METHODS: A cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions. RESULTS: The prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (ß = 1.776, P < 0.001), as well as its three subscales: somatization (ß = 1.355, P = 0.019), anxiety symptoms (ß = 2.249, P < 0.001), and depressive symptoms (ß = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (ß = 1.344, P = 0.038) and the somatization subscale (ß = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (ß = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (ß = 1.998, P = 0.012) and depressive symptoms (ß = 1.949, P = 0.020). CONCLUSION: The high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits.

Comparison of Aripiprazole and Risperidone effectiveness in treating obsessive-compulsive disorder in patients with bipolar disorder: Double-blind, randomized clinical trial.

Background: Obsessive-compulsive disorder (OCD) is a mental illness with a chronic coarse and waxing and waning of symptoms. Treatment of OCD in patients with bipolar disorder (BD) remains challenging. Objectives: The present study aims to compare the safety and effectiveness of Risperidone and Aripiprazole as adjunctive therapy with valproate sodium, in treating mania, depression, and OCD in patients with comorbidity of OCD-BD. Methods: This research is 3 phase, double-blind, randomized clinical trial, with a total number of 64 patients. The diagnostic psychiatrist clinical interview was based on diagnostic and statistical manual of mental disorders, 5th edition (DSM-5) criteria. For assessing severity of OCD, mania, and depression, Yale-Brown obsessive-compulsive scale (Y-BOCS), young mania rating scale (YMRS), and Hamilton depression rating scale (HAM-D) scores were used. Patients were randomly assigned to the two parallel groups. All patients in both group were received valproate sodium, one group was treated with Aripiprazole and the other group was treated with Risperidon as adjective therapy with valproate sodium.The SPSS software (version 22), χ 2 test, t-test, and analysis of variance with repeated measures were used to analyze the data. Results: The dosage and time of both drugs were statistically significant in reducing the mean score of all three mentioned scales, but the effect of group was not statistically significant in HAM-D and YMRS scores, only in terms of OCD, the mean of the Y-BOCS score was significantly lower in the Aripiprazole group (p < 0.001). In relation to side effects, Risperidone induced statistically significant weight gain (p < 0.001) and Aripiprazole induced statistically significant sleep disturbance (p < 0.05). Conclusions: Both Aripiprazole and Risperidone can be used effectively as adjunctive therapy with valproate sodium in treating OCD in patients with BD without any serious and life threatening adverse effect. Aripiprazole is more effective than Risperidone in treating OCD in BD.

Prevalence of Psychological Distress and Posttraumatic Stress Symptoms and Associated Factors in Hospitalized Iranian COVID-19 Patients.

Objectives: To investigate the prevalence of psychiatric symptoms/distress and posttraumatic stress (PTS) and associated factors among inpatients with COVID-19 before discharge from the hospital. Methods: This cross-sectional study was conducted in two teaching referral hospitals in Babol, Iran from July to November 2020. The subjects were inpatients diagnosed with COVID-19 who were clinically stable. Before their discharge from the hospital, the patients completed three questionnaires: demographic data, Brief Symptom Inventory, and Primary Care Post Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual-5. Results: The subjects were 477 inpatients diagnosed with COVID-19 including 40 (8.4%) admitted to intensive care units. Their average age was 60.5±17.9 years; 53.9% were female. Most had symptoms of significant psychological distress (96.0%) and PTS (8.1%) prior to discharge. A higher level of education (-0.18; standard error (SE) = 0.05; p < 0.001) was a negative predictor of psychiatric distress. The admission to intensive care units (0.86; SE = 0.08; p< 0.001) was a positive predictor of psychiatric distress. Conclusions: Most COVID-19 inpatients suffered significant psychiatric distress and PTS symptoms before discharge. Appropriate mental health crisis interventions are recommended for COVID-19 patients during hospitalization.

Screening of psychiatric disorders in women with high-risk pregnancy: Accuracy of three psychological tools.

PURPOSE: This study investigated the optimal cutoff points of three psychological tools for screening psychiatric disorders in women with high-risk pregnancy. DESIGN AND METHODS: In this cross-sectional study (N = 155), sensitivity/specificity of the Edinburgh Postnatal Depression Scale (EPDS), the Brief Symptom Inventory 53-items (BSI-53), and the BSI-18 were computed with respect to having a psychiatric diagnosis based on the clinical interview. RESULTS: The usual cutoffs (≥13 for EPDS, T-score of 63 for BSI-53) demonstrated poor diagnostic accuracy. The optimal thresholds were computed for EPDS cutoff of 6.5, GSI = 0.47 for BSI-53, and GSI = 0.5 for BSI-18. PRACTICE IMPLICATIONS: The use of psychological tools among pregnant women with high-risk pregnancy may need to be modified in order to accurately identify psychiatric disorders.

Evaluation of the cognitive impairments and depressive symptoms in patients with Parkinson's disease: A case-control study from Iran.

BACKGROUND: Parkinson's disease is a progressive neurodegenerative disease and the second most common neurological disease in the world, which usually affects people mainly in later years of life. Cognitive impairments and depressive symptoms are important symptoms in these patients that are associated with a poor prognosis. The study will focus on the original data regarding the cognitive impairments and depressive symptoms in patients with Parkinson's disease and control group. METHODS: In a case-control study, a total of 100 Parkinson's patients who were hospitalized in Rouhani Hospital and 200 non-Parkinson's people (control group) from Amirkola Health and aging project (AHAP) Marras et al., Babol, Iran were enrolled between September 2019 to February 2020. Data were collected by simple random sampling. Data were collected using a four-part questionnaire, including demographic characteristics, Unified Parkinson Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging Scale (MHYSS), Mini-M ental State Examination (MMSE) and Geriatric Depression Scale (GDS). P-value less than 0.05 was considered as significant RESULTS: A total of 300 persons were enrolled in the study. The mean age of Parkinson's patients and non-Parkinson's people was 70.34 ± 7.76 and 70.87 ± 7.59 years, respectively. The mean MMSE score in Parkinson's and non-Parkinson's people was 24.80 ± 4.53 and 25.40 ± 3.1, respectively (p = 0.182). The mean GDS score in Parkinson's and non-Parkinson's people was 7.06 ± 4.06 and 4.31 ± 3.47, respectively (p = 0.001). There was a statistically significant relationship between depressive symptoms and cognitive impairments with disease severity (p = 0.022 and p = 0.012, respectively). In addition, variables, such as age and the education level were associated with cognitive impairments (p = 0.001 and p = 0.021, respectively), but these variables were not significantly associated with depressive symptoms (p = 0.843 and p = 0.411, respectively). There was a significant relationship between depressive symptoms and cognitive impairment in Parkinson's patients and the control group (p = 0.001 and p = 0.003, respectively). CONCLUSIONS: Cognitive impairments and depressive symptoms were significantly associated with an increase in the severity of Parkinson's disease, and also, depressive symptoms in Parkinson's patients was associated with an increase in cognitive impairments.

Depressive symptoms and psychological distress from antenatal to postnatal period in women with high-risk pregnancy: A prospective study during the COVID-19 pandemic.

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental disorders in postnatal period remains unknown. AIM: The study aimed to determine the extent to which the COVID-19 pandemic may aggravate depressive symptoms and psychological distress of women with high-risk pregnancy in postnatal period. METHODS: This prospective cross-sectional study was conducted on women with complicated pregnancies from antenatal to postnatal period. In the first phase, from December 2019 to January 2020 (before the beginning of the COVID-19 pandemic), 122 pregnant women filled in the Edinburgh Postnatal Depression Scale (EPDS) and Brief Symptom Inventory 53-items (BSI-53). In the second phase, with the start of the COVID-19 pandemic from February to June, 30% of the participants (41/122) completed three questionnaires: EPDS, BSI-53, and the posttraumatic stress disorder (PTSD) scale in postpartum period. RESULTS: During the COVID-19 pandemic, from antenatal to postnatal period, the depression score of EPDS, total scores, all the subscales of BSI-53, and global severity index-53 increased in women with high-risk pregnancy. Furthermore, the persistence of antenatal depression occurred in 85.7% of the participants, and the onset of postnatal depression occurred in 80% of them. About 12% of the women also experienced PTSD symptoms during the postnatal period. CONCLUSION: The COVID-19 pandemic may aggravate the prevalence and persistence of postnatal depression in women with high-risk pregnancy. The study calls for clinical implementation to identify and help women with mental disorders in postnatal period, especially women experiencing complicated pregnancies.

Predictors of Physician's Empathy: The Role of Spiritual Well-being, Dispositional Perspectives, and Psychological Well-being.

OBJECTIVES: Empathy is a core component of an efficient physician-patient relationship. Although students' preexisting medical views may influence responses to physician-patient relationship, there is little knowledge about the psychological predictive factors of empathic perspective for physician-patient relationship. We aimed to examine whether psychological well-being, dispositional perspective, and spiritual well-being could predict the empathic perspective of medical students regarding the physician-patient relationship. METHODS: In a cross-sectional study, 350 medical students of Babol University of Medical Sciences were recruited at four levels of education including basic sciences, preclinical medicine, clerkship, and internship. The students completed four questionnaires including Jefferson Scale of Empathy - student version, Brief Ryff psychological well-being, Individual Disposition, and Spiritual Well-Being. RESULTS: The score of medical student's perspective to clinical empathy was high (106.1±29.8, range: 20-140), but diminished with further years of education. Female students had higher empathy scores than their male counterparts. Pearson's correlation coefficient revealed a strong positive significant relationship between student's perspective to clinical empathy and spiritual well-being (r = 0.56), cognitive empathy (r = 0.51), and psychological well-being (r = 0.43), and tendency to egalitarianism (r = 0.37). The results of stepwise multivariate analysis regression revealed that cognitive empathy (ß = 0.300), self-esteem (ß = 0.133), and spiritual well-being (ß = 0.388) positively predicted student's perspective to clinical empathy regarding the physician-patient relationship. CONCLUSIONS: The results suggested that promoting empathic care in curricula of medical schools may be more effective if students' preexisting perspectives, cognitive empathy, self-esteem, spiritual well-being, and tendency to egalitarianism are taken into account.

Prevalence and factors related to psychiatric symptoms in low risk pregnancy.

BACKGROUND: Psychiatric disorders are associated with poor pregnancy outcomes both for mother and child. This study aimed to determine the prevalence and related demographic risk factors of psychiatric symptoms among the pregnant women in Babol City. METHODS: This cross-sectional study was conducted in five private and public obstetrics clinics of Babol city. During routine appointments of prenatal care, 176 pregnant women filled in three questionnaires including; sociodemographic questionnaire, Edinburg Prenatal Depression Scale (EPDS), and Symptom Checklist-25 (SCL-25). Wilcoxon test, Spearman correlation, and multivariate logistic regression tests were used to interpret the data. RESULTS: The prevalence of depressive disorders was 15.4%% for Edinburg scores ≥13. The overall rate of maternal psychiatric symptoms (global severity index or GSI scores ≥ 1.75) was 48.5%. The prevalence of psychiatric symptoms was high; for 25% somatization, 258% anxiety, obsession-compulsion disorders or OCD 6.4%, 8.8% interpersonal sensitivity, 5.3% phobia, 7.6% paranoid ideation, and 1.2% psychoticism. Multivariate logistic regression revealed that pregnant women with history of abortion in previous pregnancy were at risk of depressive symptoms more (ß=3.18, CI 1.28-7.93, p=0.01) than those without history of abortion. Also, the only demographic factor related to psychiatric symptoms was the age of pregnant women; younger age was associated with higher symptom levels for GSI ((r=-0.17). CONCLUSION: The high prevalence of psychiatric symptoms, especially depressive symptoms, in pregnant women highlights the need for continued research on screening, identifying the risk factors, and developing effective treatments for mental disorders in pregnant women.

Improvement in Cognitive Status and Depressive Symptoms Three Months after Cataract Surgery.

BACKGROUND: Cataract induced vision impairment can lead to loss of older people's independence and self-esteem and limit their daily activities. Moreover it has comorbid cognitive impairment and depression. Cataract surgery may be one way to attenuate these comorbidities. The aim of this study was to compare pre-operative and postoperative depressive symptoms and cognitive impairments of patients who underwent cataract surgery. METHODS: This study was a before - after clinical trial. Participants completed the following validated surveys one day before and again three months after surgery. Dependent variables were preoperative to postoperative within-patient difference in Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE) scores. Independent variable was improvement of visual acuity. RESULTS: Mean age was 71.77±8.08, 54% were females. Mean postoperative visual acuity improvement was 0.7720±0.1758, mean GDS score difference was -1.49±1.72 and mean MMSE score difference was 0.28±0.88. Postoperative improvement of visual acuity, GDS and MMSE scores were statistically significant (p=0.001). The mean visual acuity improvement in the participants with age over 80 years was lower than the younger subjects; while improvement in MMSE scores in this age group was significantly higher than them. There were no significant relationship between visual acuity, GDS and MMSE scores before and after surgery based on BMI and educational level. CONCLUSIONS: It was concluded that cataract surgery is effective for relieving depressive symptoms in the elderly. Improved visual acuity at older ages has far more effects on reducing cognitive impairment.

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

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

Psychological Reactions among Patients with Chronic Hepatitis B: a Qualitative Study.

INTRODUCTION: Hepatitis B is the most prevalent type of viral hepatitis. Psychological reactions among patients with hepatitis B infection is considerably different and affects their decision about treating and following up the disease. The present study aims at explaining the psychological demonstrations experienced by these patients. METHODS: In this qualitative study, a total of 18 patients with hepatitis B (8 women and 10 men) were selected by purposive sampling method. Data were collected by unstructured in-depth interviews during 2014-2015 in the medical centers of three cities in Iran. All interviews were recorded, typed and analyzed by the conventional content analysis approach. RESULTS: By analyzing the data, the main theme including psychological instability, with three sub-themes were emerged: grief reaction (stupor, denial, anger and aggression), emotional challenges (worry and apprehension, contradiction with beliefs, fear of deprivation, fear of stigma, waiting for death and prognosis ambiguity) and inferiority complex (social withdrawal, sense of humiliation and embarrassment and sense of guilt and blame) were acquired. CONCLUSION: The findings indicate that patients with hepatitis B experience various psychological reactions that need to be controlled and managed by themselves or healthcare providers. Thus, implementation of health interventions with emphasis on psychological care to prevent problems and execution of educational and consultation programs about hepatitis especially by medical centers and mass media is seems necessary.