The effect of donepezil hydrochloride on post-COVID memory impairment: A randomized controlled trial.

BACKGROUND: Post-Coronavirus Disease (COVID-19) condition, known as "post-COVID syndrome," is associated with a range of complications persisting even after recovery. Among these complications, cognitive dysfunction, including memory impairment, has been relatively common observed, impacting executive function and quality of life. To date, no approved treatment exists for this specific complication. Therefore, the present clinical trial aimed to investigate the impact of Donepezil Hydrochloride on post-COVID memory impairment. METHODS: A randomized, controlled trial (Approval ID: IRCT20210816052203N1) was conducted, enrolling 25 patients with post-COVID memory impairment. Participants with a history of hospitalization were randomly assigned to either the drug group (n = 10) or the control group (n = 15). Memory indices were assessed at baseline, one month, and three months later using the Wechsler Memory Scale-Revised test. SPSS software and appropriate statistical tests were employed for data analysis. RESULTS: The statistical analysis revealed no significant difference in WMS-R subtest and index scores between the drug and control groups at the 4-week and 12-week follow-up periods. However, within the drug group, there was a notable increase in the visual reproduction I and verbal paired associates II subtests during the specified time intervals. CONCLUSION: While donepezil 5 mg did not exhibit a significant overall increase in memory scales compared to the control group over time, our findings suggest that this medication may exert a positive effect on specific memory subtests. Further research and exploration are warranted to better understand the potential benefits of donepezil in managing post-COVID-related memory impairment. TRIAL REGISTRATION: The study was approved by the Research Ethics Committee of Aja University of Medical Sciences (Approval ID: IR.AJAUMS.REC.1400.125) and registered in the Iranian Registry of Clinical Trials (IRCT) (Approval ID: IRCT20210816052203N1).

Assessing the impact of stigma reduction interventions in Iran: A qualitative study from the perspective of mental health stakeholders.

Introduction: The fear and embarrassment associated with stigmas discourage patients from help seeking behavior, which may explain why even the patients' loved ones advise them to discontinue treatment to avoid being labeled. In addition, stigmas can lead to personal and family issues, causing patients to disregard their illness. As such, their disease may develop into a chronic condition. This being said, the present study aims to investigate the challenges, solutions, and successes associated with stigmatization in Iran from the perspective of mental health stakeholders. Method: A qualitative study was conducted in the summer of 2022. Purposive sampling was utilized to recruit participants. The primary data collection method involved a focus group interview that lasted 110 min. The project manager monitored the interviews, and all research team members attended the meetings, took notes, and made the necessary preparations. After explaining the study's purpose and ensuring the data's confidentiality, the interviewer led a focus group discussion. The interviews were recorded with the participants' consent. A focus group was used to conduct interviews with 13 individuals until data saturation was reached. Findings: Ten psychologists, psychiatrists, and managers responsible for mental health, two patients, and one patient's family member participated in the current study as eligible participants. Repeated readings led to the emergence of three main classes under the headings of challenges, solutions, and successes of stigma management in Iran, each containing subclasses. Conclusion: The majority of the proposed solutions in this study centered on raising awareness and training diverse individuals and groups to lessen stigmas. The most crucial de-stigmatization measure is to offer training that will cause the current stereotypes to change. This must be taken by patients and their families as well as therapists, leaders, policymakers, the general public, and the media. Ideally, younger members of the target groups should be considered for these pieces of training, which must be based on research and derived from cultural and localized needs.

Teaching Media Literacy to Psychiatry Residents in Iran.

Background: Negative public perceptions of mental diseases and even therapists are among the most important obstacles to patients' therapeutic progress. Such attitudes are constructed by cultural and social structures. Through continuous reproducing and representing these attitudes, the media can strengthen the negative attitudes toward mental patients. On the other hand, the critical representation of social and cultural clichés in the media can reduce mental illness stigma. Psychiatrists should interact with the media regarding their concerns about mental illness stigma to achieve this goal; as a result, they must learn how to communicate with the media. Methods: A 5-day workshop was designed and implemented with the participation of 11 facilitators and 16 psychiatry residents from five universities in Iran. Then, a focus group session was held. Results: According to the results of the quantitative data analysis, the trainees prefer online media over traditional media, implying that they prefer interactive media platforms. Before the workshop, the trainees had believed that media coverage of psychiatry is biased and erroneous and that they should oversee the entire process of health content development by journalists. Besides, they were also interested in communicating with society. After the workshop, the focus group interview showed that the participating psychiatry residents felt that this activity improved their media literacy, enhanced their skills at interacting with the media, and encouraged them to interact more with the media in the future on health-related issues. Conclusion: Residents in psychiatry have a higher tendency for communicating with the media in the field of mental health in general. They stated that they needed to engage in the creation of popular mental health content.

Clergy's Viewpoint Change Toward Mental Health and Stigma on Mental Illness: A Short Course Training.

Background: As stigma is one of the main barriers in promoting the mental health, the present study was designed with the purpose of reviewing clergy's viewpoint regarding the effect of mental health workshops on these barriers. Methods: For this study, by order of Iran's Health Ministry, a questionnaire was designed to examine the clergy's viewpoint related to mental illnesses and the consequent stigma. Ten faculty members and psychiatrists confirmed the questionnaire's validity after some modifications. In this research, 30 members of the clergy from the main religious city in Iran's "Qom" Seminary attended the training workshops for 2 days. The data obtained from the clergy's responses were analyzed using the SPSS software (ver.16) and descriptive and analytical tests. Also, the significance level was considered p < 0.05 in all tests. The results exhibited that the mean and standard deviation (Mean ± SD) of the clergy's attitude domain and awareness before the workshop was 1.90 ± 26.30 and 8.31 ± 1.64, respectively. Also, average and standard deviation (Mean ± SD) of their attitude domain and awareness after the workshop was 1.95 ± 29.73 and 1.18 ± 10.70, respectively. Discussion: The present study, which was designed to examine the clergy's viewpoint toward mental illnesses and the consequent stigma in the most considerable religious base in the country, illustrated that one strategy for reducing mental illness stigma in religious communities can be by holding training sessions to promote the clergy's awareness of and attitude toward mental health. Conclusion: There was a significant statistical difference between their awareness and attitude scores before and after the workshop (p < 0.01). In the present research, the awareness and attitude of clergy toward mental health and stigma due to mental illness was relatively good and significantly increased by holding the workshop.

Donepezil Beyond Alzheimer's Disease? A Narrative Review of Therapeutic Potentials of Donepezil in Different Diseases.

Donepezil hydrochloride is an acetylcholine esterase inhibitor studied and approved to treat Alzheimer's disease (AD). However, this drug can have positive therapeutic potential in treating different conditions, including various neurodegenerative disorders such as other types of dementia, multiple sclerosis, Parkinson's disease, psychiatric and mood disorders, and even infectious diseases. Hence, this study reviewed the therapeutic potential of this drug in treating Alzheimer's and other diseases by reviewing the articles from databases including Web of Science, Scopus, PubMed, Cochrane, and Science Direct. It was shown that donepezil could affect the pathophysiology of these diseases via mechanisms such as increasing the concentration of acetylcholine, modulating local and systemic inflammatory processes, affecting acetylcholine receptors like nicotinic and muscarinic receptors, and activating various cellular signaling via receptors like sigma-1 receptors. Despite many therapeutic potentials, this drug has not yet been approved for treating non-Alzheimer's diseases, and more comprehensive studies are needed.

The prevalence of depression among iran-iraq war veterans, combatants and former prisoners of war: A systematic review and meta-analysis.

By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran-Iraq war (1980-1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full-text review. Eventually, 19 studies were included in our systematic review and meta-analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval = 15.0-32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs.

Screening borderline personality disorder: The psychometric properties of the Persian version of the McLean screening instrument for borderline personality disorder.

BACKGROUND: Screening for personality disorders through reliable instruments is of high importance for clinical and preventive purposes. Examining the psychometric properties of measures in societies with diverse cultures can improve their external validity. This research is specifically aimed to studying psychometric properties of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) in a sample of Iranian men serving military service. MATERIALS AND METHODS: The Persian version of the MSI-BPD was prepared through forwarding translation, reconciliation, and back-translation. A sample of 254 soldiers was selected through the convenience sampling method in Tehran and completed a set of questionnaires, including the MSI-BPD, The Deliberate Self-harm Inventory (DSHI), Borderline Personality Scale (STB), Cognitive Flexibility Inventory (CFI), and Self-Compassion Scale (SCS) Short-Form. The construct validity of the MSI-BPD was assessed using confirmatory factor analysis and divergent and convergent validity. Internal Consistency and test-retest reliability (2 weeks'interval) were used to evaluate the reliability. Data analysis was conducted using LISREL (version 8.8) and SSPS (version 22) software. RESULTS: MSI-BPD and its subscales were found to be valid and reliable measures, with good internal consistency and good test-retest reliability among soldiers. In terms of convergent validity, MSI-BPD and subscales showed a significant positive correlation with self-report measures of DSHI and STB. MSI-BPD and subscales showed negative correlation with SCS Short-Form and CFI, thus demonstrated a good divergent validity. The results of this study also provide support for both one-factor and two-factor models of the MSI-BPD. CONCLUSION: The MSI-BPD showed good validity and reliability, making it a useful measure to Screening borderline personality disorder in the Iranian population. Screening offers a means of identifying persons for more detailed evaluation for early intervention and for research. The MSI-BPD is an efficient instrument suitable for screening purposes among soldiers.

Transcranial Direct Current Stimulation for Treatment-Resistant Major Depression: A Double-Blind Randomized Sham-Controlled Trial.

In the current study, we tried to evaluate the effect of transcranial direct current stimulation (tDCS) on treatment-resistant major depression. We carried out a double-blind randomized sham-controlled trial was conducted in University Hospitals. Individuals with less than 50% decrease in the intensity of depression after 8 weeks of treatment with selective serotonin reuptake inhibitors were recruited. Thirty patients (16 women) with a mean (SD) age of 47.2 (12.0) years were randomly allocated to 2 groups. For the active group we administered 2-mA stimulation 20 minutes for each session, with 30 seconds ramp-up from 0 and 30 seconds ramp-down. For the sham group we administered 30 seconds ramp-up to 2 mA, 10 seconds stimulation, 30 seconds ramp-down, and 20 minutes no current. The anode was fixed on the center of F3, and the cathode on F4, over the dorsolateral prefrontal cortex. We assessed the Hamilton Depression Rating Scale at the baseline (mean difference = 1.0, P = .630), at the last session of tDCS, and at 1-month postintervention. There were statistically significant differences in the mean Hamilton scores after the intervention, and 1 month later in favor of active group; P < .001, and P = .003, respectively. Mixed analysis of variance showed a significant difference in the mean scores for active group P = .010 and pattern of change during the study P < .001 in favor of active intervention. We concluded that tDCS is an efficient therapy for patients with resistant major depression, and the benefits would remain at least for 1 month.

Stigma Barriers of Mental Health in Iran: A Qualitative Study by Stakeholders of Mental Health.

Objective: Many people who access mental health services usually do not seek treatment to avoid the consequences of stigma and label of mental illness. Thus, determining each aspect related to stigma reduction barriers seems necessary. This qualitative study was conducted to investigate stigma reduction barriers towards mental disorders in Iran. Method: In this study that was conducted from 2013 to 2015, content analysis was used and all stakeholders were selected by purposive sampling technique. All data were obtained through 16 individual interviews, 2 focus groups, and 6 written narratives. The data were collected, coded, and analyzed accordingly. Results: The major themes were as follow: The universality of stigma, beliefs, attitudes and lack of awareness, mental health providers and other specialists, cultural barriers, structures and policymakers, and insufficient financial resources. Conclusion: It is necessarily to identify the barriers of stigma reduction programs in Iran to increase the quality of life of patients with mental disorders. In the present study, due to the presence of mental health stakeholders, the main barriers were obtained.

Strategies to reduce the stigma toward people with mental disorders in Iran: stakeholders' perspectives.

BACKGROUND: Stigma affects all aspects of mental disorders, and is the most important risk factor for promoting mental health. The aim of this study was to explore strategies effective in reducing the stigma toward people with mental disorders in Iran. METHODS: This qualitative study was conducted from 2013 to 2016. All participants were recruited by purposive sampling method. The majority of them were stakeholders of mental health in Iran. Data were collected through eight individual interviews, two focus groups, and six written narratives. The data were collected, coded and analyzed simultaneously. Content analysis was employed to analyze the qualitative interview data. RESULTS: The major themes that emerged were: "Emphasis on education and changing attitudes", "Changing the culture", "Promoting supportive services", "Role of various organizations and institutions", "Integrated reform of structures and policies to improve the performance of custodians", and "Evidence-based actions". CONCLUSIONS: This study did not investigate the extent of stigma or its origins, rather it examines strategies appropriate for implementation in Iran. Additional studies are needed to evaluate the effectiveness of strategies for reducing the stigma attached to patients with mental disorders.

Omega-3 Fatty Acids and Cholesterol Have a Main Role in Antidepression Diet of Iranian Traditional Medicine.

Depression is one of the major health problems of our world. Recent studies have revealed the relationship between diet and depression. In Iranian traditional medicine, there is a therapeutic diet that is recommended in melancholic diseases like depression. One of the main components of this diet is meat. Meats are divided into 2 groups: recommended and abstinent. The aim of this study was to clarify the logic of this diet through comparing nutritional elements of the 2 groups with each other. For this purpose, prominent books on Iranian traditional medicine were searched for abstinent and recommended meats traditionally prescribed for depressed patients. The results of each group were compared with the other by using Mann-Whitney Test (SPSS version 16). The results showed that recommended meats contain higher amounts of polyunsaturated fatty acids ( P = .01) especially omega-3 ( P = .03). Both groups contain high amounts of cholesterol. Iranian traditional medicine recommends consumption of meats that contains cholesterol with omega-3 fatty acids in depression.

Mental health among Iranian combat veterans with ankle-foot neuromusculoskeletal injuries.

BACKGROUND: Veterans with purely physical disorders, such as ankle-foot neuromusculoskeletal disorders, are often neglected in psychological assessments because mental health evaluations are usually focused on those with a psychological disturbance or with a high percentage of injury. The purpose of this study was to evaluate the psychological condition of veterans with ankle-foot neuromusculoskeletal disorders. METHODS: A cross-sectional study was performed between 2014 and 2016 on veterans with war-related ankle-foot injuries living in two provinces of Iran. An information form for demographic data and injury-related factors was used. Additionally, the previously validated Persian version of the Symptom Checklist-90-Revision (SCL-90-R) questionnaire was used for data collection. RESULTS: The respondents were 215 male veterans with a mean age of 51.7 ± 7.5 years. The most common mental health problems were observed for the somatization (24.7%), obsessions-compulsions (14.4%), and anxiety (12.6%). Based on the Global Severity Index (GSI), 48.6% of individuals had a possible psychiatric/psychological illness. According to the multivariate regression analysis, GSI scores were significantly higher among veterans who were older than 27 years at the time of injury (P = 0.005), had an associated injury (P = 0.002), and had a history of hospitalization within the past 12 months for reasons other than their injury (P = 0.035). CONCLUSIONS: Approximately half of the combat veterans with ankle-foot neuromusculoskeletal disorders likely had psychological problems. The evaluation of the patterns and predicting factors of psychological conditions may inform strategic planning efforts and decision-making, which, in turn, may provide a better quality of life for veterans. Further studies that utilize longitudinal designs are needed to evaluate and compare the psychological status of different groups of veterans and other groups in the general population.

Association of the T-786C, G894T and 4a/4b polymorphisms of the endothelial nitric oxide synthase gene with vasculogenic erectile dysfunction in Iranian subjects.

OBJECTIVE: • To investigate the association of the T-786C, G894T and variable number of tandem repeats (VNTRs) in intron 4 (a/b) polymorphisms of the eNOS gene in Iranian subjects with vasculogenic erectile dysfunction (ED). PATIENTS AND METHODS: • A total of 322 consecutive patients with vasculogenic ED were recruited. Patients with concomitant risk factors for ED were excluded. • Patients with ED were identified based on history-taking, detailed physical examination, serum biochemistry, sex hormone measurements, application of the International Index of Erectile Function (IIEF) questionnaire, and penile duplex Doppler ultrasonography after intracavernosal injection of 20 µg prostaglandin E(1) . The control group comprised 318 age-matched healthy male volunteers. • Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism and the T-786C, G894T and VNTR intron 4 polymorphisms of the eNOS gene were determined. RESULTS: • After multivariate regression analysis, significant differences were seen in the frequencies of genotypes and alleles of the two T-786C and G894T polymorphisms when patients with ED and normal controls were compared. • In a multiple logistic regression analysis, the odds ratio (OR) of increased ED was strongly associated with the -786C allele [adjusted OR = 3.12, 95% confidence interval (CI) = 2.28-4.25; P= 0.001] and the 894T allele (adjusted OR = 3.87, 95% CI = 2.53-4.87; P= 0.001). • The data showed a higher prevalence of the T-786C CC genotype (adjusted OR = 2.72, 95% CI = 1.88-3.65; P= 0.006), and the G894T GT (adjusted OR = 1.72, 95% CI 1.24-2.83; P= 0.037) and G894T TT genotypes (adjusted OR = 3.42, 95% CI 2.42-4.26; P= 0.001) in patients with ED than in the controls. CONCLUSIONS: • The findings of the present study suggest that the eNOS T-786C and G894T polymorphisms are strong predictors of the predisposition to ED in addition to traditional risk factors, signifying a genetic influence for this multifactorial disease. • Further studies in different ethnic populations are needed to better elucidate the role of eNOS gene polymorphism in the pathogenesis of ED.

A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women.

OBJECTIVE: To compare the efficacy of sustained-release (SR) bupropion to placebo in treating hypoactive sexual desire disorder (HSDD) in ovulating women. PATIENTS AND METHODS: After a 1-week, placebo lead-in phase, 232 treatment-seeking women with regular menstrual cycles were randomly assigned to bupropion SR 150 mg/daily (116) or placebo (116) for 12 weeks under double-blind conditions. Efficacy was assessed with the Brief Index of Sexual Functioning for Women (BISF-W), the Personal Distress Scale (PDS), the global efficacy question (GEQ; 'Did the treatment you received during the 12-week improve meaningful your sexual desire?') and overall patient satisfaction question ('Are you satisfied with the efficacy of your treatment?'). RESULTS: The mean (sd) composite score on the BISF-W, increased from 15.8 (2.6) and 15.5 (2.2) at baseline to 33.9 (4.2) and 16.9 (2.6) in the bupropion and placebo groups, respectively (P= 0.001). The odds ratio (95% confidence interval) for response in the bupropion group relative to placebo was 3.2 (2.1-6.3). The thoughts/desire score more than doubled in patients treated with bupropion (P= 0.001). At the 12-week evaluation the reduction in the PDS scale was 29.4% in bupropion and 4.7% in the placebo group (P= 0.01). In response to the GEQ, of patients in the bupropion and placebo groups, 65.3%, and 4.3%, respectively, responded 'Definitely yes' (P= 0.001). Of patients in the bupropion and placebo groups, 71.8%, and 3.7%, respectively, were definitely satisfied with the efficacy of their treatment, (P= 0.001). After 12 weeks of treatment, 82 women (78.1%) in the bupropion and five (4.9%) in the placebo group were willing to continue therapy (P= 0.001). CONCLUSIONS: The results from this study indicate that bupropion SR is an effective and well-tolerated treatment for HSDD in ovulating women. Further controlled trials are warranted.

High-altitude sleep disturbance: results of the Groningen Sleep Quality Questionnaire survey.

OBJECTIVE: To assess the Groningen Sleep Quality Scale (GSQS) for evaluation of high-altitude sleep (HAS) disturbance and employ GSQ questionnaire to describe HAS. METHODS: After the first night's stay at the altitude of 3500 m, quality of sleep for 100 participants (age: 29.13+/-11.01 years; 36 females/64 males) was assessed using the self-administered 15-item GSQS translated into Farsi. RESULTS: Mean GSQS score was 5.36+/-4.32; 38 (38%) participants had a score equal to or less than 2, and 46 (46%) participants had a score equal to or more than 6. A Cronbach's alpha of 0.90 was calculated for internal consistency. Waking up several times during the night was the most prevalent complaint during the first night of sleep, and absolute inability to sleep was the most uncommon problem. CONCLUSIONS: HAS disturbance, which involved many of newcomers to a high altitude, had various harmful effects. For HAS research, GSQS was confirmed to be valid and reliable.

How do examiners and examinees think about role-playing of standardized patients in an OSCE setting?

OBJECTIVE: The use of standardized patients in Objective Structured Clinical Examinations in the assessment of psychiatric residents has increased in recent years. The aim of this study is to investigate the experience of psychiatry residents and examiners with standardized patients in Iran. METHOD: Final-year residents in psychiatry participated in this study. Experienced examiners were asked to complete a questionnaire concerning the ability of standardized patients to realistically portray psychiatric patients. RESULTS: Standardized patients can convincingly portray psychiatric disorders and act according to the requested complex scenarios. CONCLUSIONS: According to these findings, the authors recommend the use of standardized patients in OSCEs for psychiatric board certification exams.