Elder abuse among Spanish and Iranian people: new methodological approach to the same old story.

Elder abuse continues to be a taboo, mostly underestimated, ignored by societies across the world. Recent systematic reviews and meta-analyses have revealed significant variations in the prevalence of elder abuse, with large geographic variations. This is the first study that compares the prevalence of elder abuse and risk factors between a European and Asian countries and using the same method. Cross-sectional surveys were conducted in Spain and Iran. Eight hundred forty subjects, aged 65 and over, were chosen randomly from patients in primary care health centres. Prevalence of abuse and subtypes and risk factors were obtained using structured interviews. To minimize the potential effects of selection bias, a propensity score matching was performed. Multiple correspondence analysis was used to evaluate the possible relationships among all the variables and to identify specific profiles. Five hundred thirty-two older people remained for the analysis after matching. The prevalence of abuse was 39.1% in Spain and 80.5% in Iran. Elder abuse and its subtypes are significantly more probable in Iran than in Spain. Out of every five elderly people questioned, two in Spain and four in Iran responded affirmatively to a question concerning elder abuse. Multiple correspondence analysis allows the differences between patterns of elder abuse between both populations to be visualized. Elder abuse is a prevalent problem in Spain and Iran. While some characteristics are shared in the pattern of abuse there are different profiles between the two countries. Detecting elder abuse should be a priority objective in clinical and forensic setting. Key points • This is the first study that compares the prevalence of elder abuse between a European and Asian country, using the same methodology. • Multiple correspondence analysis allows specific elder abuse profiles to be identified. • Elder abuse is significantly more likely to occur in Iran than in Spain. • Out of every five elderly people questioned, two in Spain and four in Iran responded affirmatively to a question concerning elder abuse.

Patients with OCD report lower quality of life after controlling for expert-rated symptoms of depression and anxiety.

BACKGROUND: One to three percent of the adult population suffers from obsessive-compulsive disorders (OCD). Previous studies have also shown that, compared to controls, patients with OCD report a lower QoL. The latter is associated with self-rated symptoms of depression and anxiety. The aim of the present study was to compare the quality of life of OCD patients with that of healthy controls, while introducing expert-rated symptoms of depression and anxiety as covariates. Gender was also taken into account as an additional associated factor. METHOD: A total of 100 patients diagnosed with OCD (mean age: 32 years; 64% females) and healthy 100 controls (mean age: 31 years; 59% females; no discernible psychiatric disorder) took part in the present cross-sectional study. All participants completed questionnaires covering socio-demographic characteristics and dimensions of QoL. Experts rated participants' symptoms of OCD (Yale-Brown Obsessive-Compulsive Scale), anxiety (Hamilton Anxiety Rating Scale) and depression (Hamilton Depression Rating Scale). RESULTS: Compared to healthy controls, patients with OCD reported a lower QoL, and had higher symptoms of depression and anxiety. This pattern was particularly pronounced among female patients with OCD. QoL was lower in patients with OCD, even when controlling for depression and anxiety. Results from binary logistic regressions showed that female gender, low QoL and higher symptoms of OCD, depression and anxiety together predicted status as patient with OCD. CONCLUSIONS: Compared to healthy controls, patients with OCD have a poorer quality of life and this is independent of depression or anxiety, and is particularly pronounced among female patients. Thus, treatment of OCD might take into account patients' comorbidities and gender.

Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression.

Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

"I love you forever (more or less)" - stability and change in adolescents' romantic love status and associations with mood states

Objective: Experiencing romantic love is an important part of individual development. Here, we investigated stability and change in romantic love and psychological correlates, including mood states, anxiety, and sleep, among Iranian adolescents over a period of 8 months. Method: Two hundred and one adolescents who had taken part in a previous study were contacted; 157 responded. Participants completed a questionnaire covering sociodemographic data, current state of love, and mood, including symptoms of depression, anxiety (state and trait), and hypomania. They also completed a sleep and activity log. Results: Of 64 participants formerly in love, 45 were still in love; of 86 participants not in love at baseline, 69 were still not in love (overall stability, 76%); 17 had fallen in love recently while 19 were no longer in love. Significant and important changes in mood and anxiety were observed in that experiencing romantic love was associated with higher anxiety scores. Hypomania scores increased in those newly in love, and decreased in those in a longer-lasting romantic relationship. Sleep and sleep-related variables were not associated with romantic love status. Conclusion: These findings suggest that, among Iranian adolescents, the state of love is fairly stable, and that love status seems to be associated with specific states of mood and anxiety.

Detached mindfulness reduced both depression and anxiety in elderly women with major depressive disorders.

We investigated the influence of detached mindfulness (DM) in treating symptoms of depression and anxiety among elderly women. Thirty-four elderly females (mean age: 69.23 years) suffering from moderate major depressive disorders (MDD) and treated with a standard medication (citalopram) at therapeutic doses were randomly assigned either to an intervention condition (DM; group treatment, twice weekly) or to a control condition (with leisure activities, twice weekly). At baseline (BL), four weeks later at study completion (SC), and four weeks after that at follow-up (FU), participants completed ratings for symptoms of depression and anxiety; experts blind to patients' group assignments rated patients' symptoms of depression. Symptoms of depression (self and experts' ratings) and anxiety declined significantly over time in the DM, but not in the control condition. Effects remained stable at FU. The pattern of results suggests that, compared to a control condition, a specific psychotherapeutic intervention such as DM can have a beneficial effect in elderly female patients with MDD.

"I love you forever (more or less)" - stability and change in adolescents' romantic love status and associations with mood states.

OBJECTIVE: Experiencing romantic love is an important part of individual development. Here, we investigated stability and change in romantic love and psychological correlates, including mood states, anxiety, and sleep, among Iranian adolescents over a period of 8 months. METHOD: Two hundred and one adolescents who had taken part in a previous study were contacted; 157 responded. Participants completed a questionnaire covering sociodemographic data, current state of love, and mood, including symptoms of depression, anxiety (state and trait), and hypomania. They also completed a sleep and activity log. RESULTS: Of 64 participants formerly in love, 45 were still in love; of 86 participants not in love at baseline, 69 were still not in love (overall stability, 76%); 17 had fallen in love recently while 19 were no longer in love. Significant and important changes in mood and anxiety were observed in that experiencing romantic love was associated with higher anxiety scores. Hypomania scores increased in those newly in love, and decreased in those in a longer-lasting romantic relationship. Sleep and sleep-related variables were not associated with romantic love status. CONCLUSION: These findings suggest that, among Iranian adolescents, the state of love is fairly stable, and that love status seems to be associated with specific states of mood and anxiety.

Children with ADHD and symptoms of oppositional defiant disorder improved in behavior when treated with methylphenidate and adjuvant risperidone, though weight gain was also observed - Results from a randomized, double-blind, placebo-controlled clinical trial.

Children with ADHD often show symptoms of oppositional defiant disorders (ODD). We investigated the impact of adjuvant risperidone (RISP) to a standard treatment with methylphenidate (MPH) in children with ADHD and symptoms of ODD. Eighty-four children with ADHD and ODD (age: M=8.55; range: 7.28-9.95 years; 73.8% males) took part in a double-blind, randomized, placebo-controlled, clinical trial lasting eight weeks. Participants were randomly assigned either to the MPH+RISP (1mg/kg/d+0.5mg/d) or to the MPH+PLCO (1mg/kg/d+placebo) condition. Symptoms of ADHD, weight, height, and blood pressure were assessed at baseline, and at weeks 2, 4, 6 and 8. Symptoms of ADHD decreased over time, but more so in the MPH+RISP than in the MPH only condition. In the MPH+RISP condition weight, waist circumference and prolactine levels increased over time. Data suggest that adjuvant RISP improved symptoms in children with ADHD and ODD, but weight gain and higher prolactine levels were also observed, which are two alarming side effects. This may become an issue, once children become adolescents, a period of life in which body shape and body self-image are closely linked to self-confidence and peer acceptance. Health care professionals should carefully balance the short-term and long-term costs and benefits of administration of RISP.

In patients suffering from major depressive disorders, quantitative EEG showed favorable changes in left and right prefrontal cortex.

BACKGROUND: Patients suffering from major depressive disorders (MDD) report anhedonia, low concentration and lack of goal-oriented behavior. Data from imaging and quantitative EEG (QEEG) studies show an asymmetry in the prefrontal cortex (PFC), with lower left as compared to right PFC-activity, associated with specific depression-related behavior. Cordance is a QEEG measurement, which combines absolute and relative power of EEG-spectra with strong correlations with regional perfusion. The aim of the present study was to investigate to what extent a four weeks lasting treatment with a standard SSRI had an influence on neuronal activation and MDD-related symptoms. METHOD: Twenty patients suffering from severe MDD were treated with citalopram (40mg) for four consecutive weeks. At baseline and at the end of the treatment, patients underwent QEEG. Experts rated the degree of depression with the Hamilton Depression Rating Scale (HDRS). RESULTS: Over time, theta cordance increased over right ventromedial and left dorsolateral PFC, whereas alpha cordance decreased over dorsolateral PFC. Improvement in MDD-related symptoms was higher in patients showing decreased EEG theta cordance over right dorsal PFC and increased EEG alpha cordance over left dorsolateral PFC. CONCLUSIONS: In patients suffering from MDD, treatment response was associated with favorable changes in neuronal activity.

Psychiatric Disorders and Personality Profiles of Middle-Aged Suicide Attempters with No Evidence of Specific Psychopathological Profiles Referred to an Emergency Department.

Objective: The present study aimed at assessing the sociodemographic and psychiatric characteristics of 40 to 65 year- old suicide attempters, who were referred to an emergency department within 4 hours of the attempt. Method: A total of 93 suicide attempters (Mean age=46.59 years) who were referred to an emergency department, were assessed in this study. Patients completed questionnaires covering sociodemographic data, personality traits, mood, and impulsivity. Psychiatric status of the patients was rated by experts. Results: Experts rated 85 (92.4%) of the suicide attempters as having a psychiatric disorder. Based on self-ratings and compared to normative data, 42 (46.6%) patients were psychopathologically ill. It was found that suicide attempts were not related to impulsive personality traits, mood disorders, sociodemographic patterns, or gender (gender-ratio: 1:1.58; f: m). Conclusion: The pattern of results suggests that further unknown factors were involved in pushing people to attempt suicide.

"Always Look on the Bright Side of Life!" - Higher Hypomania Scores Are Associated with Higher Mental Toughness, Increased Physical Activity, and Lower Symptoms of Depression and Lower Sleep Complaints.

Background: In the present study, we explored the associations between hypomania, symptoms of depression, sleep complaints, physical activity and mental toughness. The latter construct has gained interest for its association with a broad variety of favorable behavior in both clinical and non-clinical samples. Subjects and Methods: The non-clinical sample consisted of 206 young adults (M = 21.3 years; age range: 18-24 years; 57.3% males). They completed questionnaires covering hypomania, mental toughness, symptoms of depression, physical activity, and sleep quality. Results: Higher hypomania scores were associated with higher mental toughness, increased physical activity, lower symptoms of depression and lower sleep complaints. No gender differences were observed. Higher hypomania scores were predicted by higher scores of mental toughness subscales of control and challenge, and physical activity. Conclusion: The pattern of results suggests that among a non-clinical sample of young adults, self-rated hypomania scores were associated with higher scores on mental toughness and physical activity, along with lower depression and sleep complaints. The pattern of results further suggests that hypomania traits are associated with a broad range of favorable psychological, behavioral and sleep-related traits, at least among a non-clinical sample of young adults.

Levels of mania and cognitive performance two years after ECT in patients with bipolar I disorder - results from a follow-up study.

BACKGROUND: There is limited evidence on the long-term outcomes for patients with bipolar I disorder (BP-I-D) and treated with ECT. Therefore, we asked whether mania scores and cognitive performance at the end of ECT treatment (baseline/BL) predicted mania scores, cognitive performance, recurrence, treatment adherence, and mood (depression; hypomania) two years later (follow-up/FU). METHOD: 38 patients with BP-I-D undergoing ECT at baseline were followed up two years later. A brief psychiatric and cognitive assessment (Mini Mental State Examination; short-term verbal memory test) was performed; patients completed questionnaires covering recurrence, treatment adherence, and mood (depression; hypomania). RESULTS: High cognitive performance at BL predicted high cognitive performance at FU; low mania scores at BL predicted low mania scores at FU. By FU, cognitive performance had increased and mania scores decreased. Mania scores and cognitive performance at BL did not predict recurrence, or adherence to medication, or mood (depression; hypomania). CONCLUSIONS: The pattern of results suggests that after two years of successful treatment of acute mania with ECT, cognitive impairment, measured by MMSE and a short-term verbal memory test, is not impaired and mood symptom recurrence seems to be improved. Mania scores and cognitive performance at the end of ECT treatment predicted neither mood (depression; hypomania), nor recurrence, or adherence to medication two years later.

Repetitive Transcranial Magnetic Stimulation Improved Symptoms of Obsessive-Compulsive Disorder, but Also Cognitive Performance: Results from a Randomized Clinical Trial with a Cross-Over Design and Sham Condition.

OBJECTIVE: There is some evidence that repetitive transcranial magnetic stimulation (rTMS) is an effective method of treating patients suffering from obsessive-compulsive disorder (OCD). Here, we tested the hypothesis that rTMS has a positive impact both on symptom severity and cognitive performance in such patients. Specifically, short-term verbal processing speed and flexibility were assessed. METHOD: Ten patients suffering from refractory OCD and treated with standard medication were randomly assigned either to a treatment-first or to a sham-first condition. At baseline and after 2 and 4 weeks, symptom severity (experts' ratings) and cognitive performance (auditory perception, visual perception, short-term memory, and processing speed) were assessed. After 2 weeks, the treatment condition switched to the sham condition, and the sham condition switched to the treatment condition. RESULTS: Under treatment but not under sham conditions, symptom severity reduced. Moreover, cognitive performance improved in parallel. CONCLUSIONS: rTMS is a safe and efficient treatment for patients suffering from refractory OCD; symptoms and cognitive performance improved in parallel.

Demographic and mental history-related data predicted occurrence of psychosis in metamphetamine users.

Methamphetamine use is increasing worldwide, and the occurrence of psychosis further complicates treatment. This holds also true for Iran. The aim of the present study was to investigate possible predictors of metamphetamine-induced psychosis. 237 methamphetamine users (70.9% with psychosis; mean age: M=33.41 years) took part in the study. A psychiatric interview was performed covering socio-demographic and illness-related information. Male gender, low education, unemployment, being single, a history of mental disorders, and a higher number of previous hospitalizations predicted the occurrence of psychosis, while age and duration of metamphetamine use were excluded from the equation. Socio-demographic and mental illness-related dimension seemed suitable to predict occurrence of psychosis among metamphetamine abusers.

Validity and test-retest reliability of the Persian version of the Montgomery-Asberg Depression Rating Scale.

BACKGROUND AND AIMS: The Montgomery-Asberg Depression Rating Scale (MADRS) is an expert's rating tool to assess the severity and symptoms of depression. The aim of the present two studies was to validate the Persian version of the MADRS and determine its test-retest reliability in patients diagnosed with major depressive disorders (MDD). METHODS: In study 1, the translated MADRS and the Hamilton Depression Rating Scale (HDRS) were applied to 210 patients diagnosed with MDD and 100 healthy adults. In study 2, 200 patients diagnosed with MDD were assessed with the MADRS in face-to-face interviews. Thereafter, 100 patients were assessed 3-14 days later, again via face-to-face-interviews, while the other 100 patients were assessed 3-14 days later via a telephone interview. RESULTS: Study 1: The MADRS and HDRS scores between patients with MDD and healthy controls differed significantly. Agreement between scoring of the MADRS and HDRS was high (r=0.95). Study 2: The intraclass correlation coefficient (test-retest reliability) was r=0.944 for the face-to-face interviews, and r=0.959 for the telephone interviews. CONCLUSION: The present data suggest that the Persian MADRS has high validity and excellent test-retest reliability over a time interval of 3-14 days, irrespective of whether the second assessment was carried out face-to-face or via a telephone interview.

Adjuvant thiamine improved standard treatment in patients with major depressive disorder: results from a randomized, double-blind, and placebo-controlled clinical trial.

Given that antidepressants (ADs) work slowly, there is interest in means to accelerate their therapeutic effect and to reduce side effects. In this regard, thiamine (vitamin B1) is attracting growing interest. Thiamine is an essential nutrient, while thiamine deficiency leads to a broad variety of disorders including irritability and symptoms of depression. Here, we tested the hypothesis that adjuvant thiamine would reduce depression, compared to placebo. A total of 51 inpatients (mean age: 35.2 years; 53 % females) with MDD (Hamilton Depression Rating Scale score (HDRS) at baseline: >24) took part in the study. A standardized treatment with SSRI was introduced and kept at therapeutic levels throughout the study. Patients were randomly assigned either to the thiamine or the placebo condition. Experts rated (HDRS) symptoms of depression at baseline, and after 3, 6, and 12 weeks (end of the study). Between baseline and the end of the study, depression had reduced in both groups. Compared to placebo, adjuvant thiamine improved symptoms of depression after 6 week of treatment, and improvements remained fairly stable until the end of the study, though mean differences at week 12 were not statistically significant anymore. No adverse side effects were reported in either group. Results suggest that among younger patients with MDD adjuvant thiamine alleviated symptoms of depression faster compared to placebo. Importantly, improvements were observed within 6 weeks of initiation of treatment. Thus, thiamine might have the potential to counteract the time lag in the antidepressant effects of ADs.

Higher emotional intelligence is related to lower test anxiety among students.

BACKGROUND: For students attending university courses, experiencing test anxiety (TA) dramatically impairs cognitive performance and success at exams. Whereas TA is a specific case of social phobia, emotional intelligence (EI) is an umbrella term covering interpersonal and intrapersonal skills, along with positive stress management, adaptability, and mood. In the present study, we tested the hypothesis that higher EI and lower TA are associated. Further, sex differences were explored. METHOD: During an exam week, a total of 200 university students completed questionnaires covering sociodemographic information, TA, and EI. RESULTS: Higher scores on EI traits were associated with lower TA scores. Relative to male participants, female participants reported higher TA scores, but not EI scores. Intrapersonal and interpersonal skills and mood predicted low TA, while sex, stress management, and adaptability were excluded from the equation. CONCLUSION: The pattern of results suggests that efforts to improve intrapersonal and interpersonal skills, and mood might benefit students with high TA. Specifically, social commitment might counteract TA.

Electroconvulsive therapy (ECT) and aerobic exercise training (AET) increased plasma BDNF and ameliorated depressive symptoms in patients suffering from major depressive disorder.

BACKGROUND: To treat patients suffering from major depressive disorder (MDD), research has focused on electroconvulsive therapy (ECT) and aerobic exercise training (AET). Brain derived neurotrophic factor (BDNF) seems to be key in MDD. The aims of the present study were therefore two-fold, to investigate in a three-arm interventional study the differential effects of ECT, ECT plus AET, and AET alone in patients suffering from TR-MDD on 1. depressive symptoms and 2. plasma BDNF (pBDNF). METHODS: 60 patients with MDD (mean age: 31 years; 31.6% female patients) were randomly assigned either to the ECT, ECT + AET, or AET condition. The AET condition consisted of treadmill exercise for 45 min, three times a week. Both depression severity and pBDNF levels were assessed at baseline and 4 weeks later. All patients were further treated with an SSRI standard medication. RESULTS: pBDNF levels increased over time in all three study conditions, though, highest increase was observed in the ECT + EAT condition, and lowest increase was observed in the AET condition. Depressive symptoms decreased in all three conditions over time, though, strongest decrease was observed in the ECT + AET condition. The combination of ECT + AET led to significantly greater remission rates than in either the ECT or AET alone conditions. BDNF levels were not associated with symptoms of depression. CONCLUSIONS: The pattern of results suggests that ECT, AET and particularly their combination are promising directions for the treatment of patients suffering from MDD, and that it remains unclear to what extent pBDNF is key and a reliable biomarker for MDD.

The prevalence and clinical features of amphetamine-induced obsessive compulsive disorder.

BACKGROUND: Amphetamine abuse is increasing worldwide, and the occurrence of amphetamine-induced (AI) psychiatric issues further complicates treatment. In response, the DSM 5 has introduced the classification of amphetamine-induced obsessive-compulsive disorders (AI-OCD), though little has been published on either its prevalence rates or its clinical features. The aim of the present study was therefore to investigate the prevalence of AI-OCD, to describe patients' clinical features, and to compare the prevalence rate among such patients with those for OCD in the general population in Western countries and Iran. METHODS: A total of 547 patients with amphetamine abuse or dependency and with a positive urine test (mean age: 31.64 years; 75.5% males) took part in the study. A psychiatric interview was carried out, covering both socio-demographic and illness-related information. RESULTS: 18 (3.3%) patients suffered from OCD prior to amphetamine abuse, 491 (89.8%) had no OCD, and 38 (6.9%) suffered from AI-OCD. Neither socio-demographic nor illness-related dimensions predicted patients with diagnosed AI-OCD. The prevalence of AI-OCD was significantly higher than that for OCD in the general population (2.3% in Western countries, 1.8% in Iran). CONCLUSIONS: Data suggest that prevalence rate of AI-OCD is about 7%. Neither socio-demographic nor illness-related dimensions predicted the occurrence of AI-OCD. Thus, it remains unclear why some amphetamine abusers develop AI-OCD while others do not.

The relation between anxiety and BMI - is it all in our curves?

The relation between anxiety and excessive weight is unclear. The aims of the present study were three-fold: First, we examined the association between anxiety and Body Mass Index (BMI). Second, we examined this association separately for female and male participants. Next, we examined both linear and non-linear associations between anxiety and BMI. The BMI was assessed of 92 patients (mean age: M=27.52; 57% females) suffering from anxiety disorders. Patients completed the Beck Anxiety Inventory. Both linear and non-linear correlations were computed for the sample as a whole and separately by gender. No gender differences were observed in anxiety scores or BMI. No linear correlation between anxiety scores and BMI was observed. In contrast, a non-linear correlation showed an inverted U-shaped association, with lower anxiety scores both for lower and very high BMI indices, and higher anxiety scores for medium to high BMI indices. Separate computations revealed no differences between males and females. The pattern of results suggests that the association between BMI and anxiety is complex and more accurately captured with non-linear correlations.

Repetitive Transcranial Magnetic Stimulation Improved Symptoms of Obsessive-Compulsive Disorders but Not Executive Functions: Results from a Randomized Clinical Trial with Crossover Design and Sham Condition.

OBJECTIVE: Whereas there is growing evidence that repetitive transcranial magnetic stimulation (rTMS) favorably impacts on symptoms of obsessive-compulsive disorders (OCD), less is known regarding the influence of rTMS on cognitive performance of patients with OCD. Here, we tested the hypothesis that rTMS has a positive impact both on symptom severity and executive functions in such patients. METHODS: We assessed 10 patients diagnosed with OCD (mean age: 33.5 years) and treated with a standard medication; they were randomly assigned either to a treatment-first or to a sham-first condition. Symptom severity (experts' ratings) and executive functions (Wisconsin Card Sorting Test) were assessed by independent raters unaware of the patients' group assignments at baseline, after 2 and 4 weeks. After 2 weeks, treatment switched to sham condition, and sham condition switched to treatment condition. RESULTS: Under treatment but not under sham conditions, symptom severity decreased. Performance on the executive function test increased continuously with every new assessment and was unrelated to rTMS treatment. CONCLUSION: Whereas the present study confirmed previous research suggesting that rTMS improved symptoms of OCD, rTMS did not improve executive functions to a greater degree than sham treatment. More research is needed to investigate the effect of rTMS on executive functions in patients with OCD.