The P3-model of perioperative psychological preparation: Pre-surgical and pre-medical procedural psychological preparation and psychophysiological interventions.

Applied psychophysiological and psychological interventions can support successful post-surgical outcomes among patients who undergo surgical or medical procedures. However, more translational research is needed to extend the current understandings and practices of evidence-based and evidence-informed behavioral interventions to improve the outcomes of surgical and medical procedures. As healthcare becomes increasingly integrative, biopsychosocial oriented practitioners (e.g., health psychologists, neuropsychologists, pain psychologists, psychiatrists, nurses) will play an integral role with surgical and interventional professionals (e.g., neurosurgeons, bariatric surgeons, anesthesiologist, transplant surgeons, interventionalist, radiologist). These roles include pre-surgical evaluations, identifying pre-emptive concerns and implementing behavioral interventions, which ultimately act to improve the outcome of the surgery or medical procedure. In this paper, the authors 1) review the status of the broader practice of perioperative behavioral interventions; 2) review the pre-surgical and pre-procedural behavioral risk factors and translate psychophysiological and behavioral interventions to optimize post-surgical and post-procedural outcomes; and 3) provide a general framework (P3-Model) that can be used in a perioperative practice to carry out pre-surgical and pre-procedural behavioral interventions. Specifically, the role of behavioral and biofeedback interventions in the preparation of patients who are undergoing surgeries and medical procedures will be detailed. Psychological preparation that addresses pre-surgical and pre-medical procedure behavioral risk factors help perioperative healthcare providers and patients to have maximal post-operative success.

Clarification the optimal cut-off values for Persian-language versions of depression screening tools in Iranian patients with type 2 diabetes.

INTRODUCTION: Depression is the most common psychiatric disorder in patients with type 2 diabetes. There are many questionnaires to measure depression symptoms. These tools are generally used with the same cut-off points in different medical diseases. The present study investigates the optimal cut-off points of these tools in patients with type 2 diabetes in the Iranian diabetic population. The original version of this tool is prepared in Persian. METHOD: Two-hundred and forty four patients with a diagnosis of diabetes were selected to participate in the study. The gold standard for diagnosing depression was the Structured Mini-International Neuropsychiatric Interview. We applied the cut-off points of the Persian versions of the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Depression in Diabetes Self-Rating Scale (DDS-RS), Problematic Areas in Diabetes Survey (PAID), Hamilton Depression Rating Scale (HDRS) and Depression in Diabetes Self-Rating Scale (DDS-RS). RESULTS: 23.8% of patients were diagnosed with depression. Depressed patients had higher levels of HbA1c and physical complaints than non-depressed patients. In all tools, the sum of Sensitivity and Specificity of our proposed cut-off points was better than the conventional cut-off points. In HADS, the results showed that this questionnaire performed better and more efficiently than other tools. CONCLUSION: In patients with type 2 diabetes, it is better to use the proposed cut-off point's specific to this disorder in the Iranian population. These cut-off points have a higher ability to identify depressed and non-depressed cases.

Childhood disintegrative disorder with seasonal total mutism: A rare clinical presentation.

Childhood disintegrative disorder (CDD) is a rare autistic-like clinical condition with unknown etiology, in that previously acquired age-appropriate language, social and adaptive abilities deteriorate significantly in 2-10-year-old healthy children, although physical and neurological evaluations display no observable abnormality. Our case is a 22-year-old female born of a consanguineous marriage, with the appearance of CDD symptoms in her fifth year of age following normal mental and physical development during her initial four years of life. Without any precipitating factor, she gradually lost her language abilities, social relational skills, affectionate behavior, adaptive capacities, peer play and meaningful interest in her surrounding, friends and family members over a period of 4 years, reaching a plateau in her ninth year of age. The unique special clinical symptom in this case is a seasonal total mutism, which after the beginning of her CDD symptoms is revealing every year covering the spring. As no additional physical or psychological change accompanies her total seasonal speech loss, it cannot be attributed to any mental condition known as having a seasonal pattern. Because in the literature CDD is presented mostly as case reports with lacking of advanced research data, describing any new case is recommended to improve the knowledge about this rare condition, especially if it displays some new unusual signs, not reported till now.