Attitude toward patients with mental disorders: what is going on amongst Iranian pharmacies?

INTRODUCTION: As the incidence of mental disorders continues to rise, and pharmacy staff can significantly affect the willingness of patients with mental disorders to seek help; we aimed to evaluate the stigmatizing attitude of the pharmacy staff toward these patients in Iran. METHODS: We conducted this cross-sectional study between April 2020 and December 2021 in Tehran, Iran, and included pharmacists, pharmacy technicians and pharmacy students, with the experience of working in a pharmacy for at least three months. The social distance scale (SDS) and dangerousness scale (DS) were used to measure the stigmatizing attitude of the participants. Higher scores indicated more stigmatizing attitudes. RESULTS: We included a total of 186 participants with a mean age of 32.97 ± 9.41 years, of which 101 (54.3%) were male, and 75 (40.3%) were pharmacists, 101 (54.3%) were pharmacy technicians, and 8 (4.3%) were pharmacy students. The mean SDS score was 14.2 ± 4.13, and the mean DS score was 33.85 ± 8.92. The greatest tendency for social distance was reported for a patient with a mental disorder, 'being the caretaker of their children for an hour or two' and 'marrying their children.' The most perceived dangerousness was reported for a patient with a mental disorder 'owning a gun.' Positive personal history of psychopharmacological treatment was statistically correlated with lower DS (P = 0.001) and SDS (P = 0.007) scores. Positive family history of psychiatric inpatient admission was significantly correlated with higher DS (P = 0.05) and SDS (P = 0.03) scores. Higher rates of 'received psychiatric prescriptions per month' was associated with lower DS scores (P = 0.04). CONCLUSION: Our participants did not have an overall positive attitude toward patients with mental disorders. Although, compared to previous studies, they held a more positive attitude. Positive personal history of psychopharmacological treatment predicted a more positive attitude and positive family history of psychiatric inpatient admission predicted a more negative attitude.

The attitude of contemporary Iranian directors and screenwriters toward patients with mental disorders in comparison with general population.

BACKGROUND: Mental disorders are accountable for 16% of global disability-adjusted life years (DALYs). Therefore, accessible, cost-effective interventions are needed to help provide preventive and therapeutic options. As directors and screenwriters can reach a great audience, they can use their platform to either promote stigma or educate the public with the correct definition and conception of mental disorders. Therefore, we aimed to measure the stigmatizing attitude of contemporary Iranian directors and screenwriters toward patients with mental disorders in comparison with a general population group. METHODS: In this comparative study, we included 72 directors and screenwriters between 18 and 65 years of age with a minimum involvement in at least one movie/television show, and 72 age and educationmatched controls. We collected the demographic data of the participants, and used the Persian version of the Level of Contact Report (LCR) to measure their familiarity with mental disorders, and used the Persian version of Social Distance Scale (SDS) and Dangerousness Scale (DS) to measure their attitude toward them. RESULTS: Compared to the general population group, directors and screenwriters had significantly lower SDS (12.51 ± 3.8 vs. 13.65 ± 3.73) and DS (12.51 ± 3.8 vs. 13.65 ± 3.73) scores (P < 0.001), indicating a more positive attitude toward patients with mental disorders. Familiarity with mental disorders was not significantly different between the groups. Female sex was associated with a more negative attitude among the directors and screenwriters group. Additionally, among the SDS items, 'How would you feel about someone with severe mental disorder marrying your children?' and 'How would you feel about someone with severe mental disorder taking care of your children for a couple of hours?' received the most negative feedback in both groups. And among the DS items, 'there should be a law forbidding a former mental patient the right to obtain a hunting license' received the most negative feedback in both groups. CONCLUSIONS: Iranian contemporary directors and screenwriters had a more positive attitude toward patients with mental disorders, compared to general population. Due to this relatively positive attitude, this group of artists can potentially contribute to anti-stigma initiatives by offering educational materials and resources, promoting mental health care, and improving access to mental health care.

The effect of drug holidays on sexual dysfunction in men treated with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine: an 8-week open-label randomized clinical trial.

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are widely used for the treatment of various mental disorders. Sexual dysfunction is one of the most common side effects of SSRIs, and often leads to poor adherence and treatment discontinuation. While several strategies have been employed to manage SSRI-induced sexual dysfunction, drug holidays has not been extensively studied for this purpose. This clinical trial aims to assess the effect of drug holidays on sexual dysfunction in married men under treatment with SSRIs other than fluoxetine (as its long half-life makes drug holidays ineffective). METHODS: This 8-week double-center, randomized, open-label, controlled trial was conducted in the outpatient clinics of Iran Psychiatric Hospital and Tehran Institute of Psychiatry, from January 2022 to March 2023. We included married men aged between18 and 50 years who had experienced sexual dysfunction during treatment with SSRIs, other than fluoxetine. The Male Sexual Health Questionnaire (MSHQ) and the 28-Question General Health Questionnaire (GHQ-28) were used for the assessment of sexual function and mental health status. The drug holidays group was instructed not to take their medications on the weekends. The control group was asked to continue their regular medication regimen without any changes. Both groups were assessed at baseline, and weeks 4 and 8. RESULTS: Sixty-three patients were included and randomly assigned to the drug holidays group (N = 32) or the control group (N = 31). Fifty patients (25 in each group) completed the trial. Drug holidays significantly improved erection, ejaculation, satisfaction, and the overall sexual health of the participants (P < 0.001). No significant change was observed in their mental health status. No major side effects were recorded. CONCLUSIONS: Drug holidays significantly improved the MSHQ scores in 'erection', 'ejaculation', 'satisfaction' and 'total' in married men with sexual dysfunction induced by SSRIs, other than fluoxetine, without causing any significant changes in their mental health status. Further research is needed to reach a certain conclusion. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials on 2021.10.25 ( www.irct.ir ; IRCT ID: IRCT20170123032145N6) before the trial.

Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive-compulsive disorder: a systematic review and meta-analysis of randomized clinical trials.

Obsessive-compulsive disorder (OCD) is the fourth most common mental disorder, and selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of its pharmacological treatment. About 40-60% of the cases are treatment-refractory, and this makes searching for second-line treatment necessary. 5-Hydroxytryptamine-3 (5-HT3) antagonists are among the many medications that have been used in augmentation with SSRIs. In this systematic review and meta-analysis, we assessed the efficacy and safety of 5-HT3 receptor antagonists in augmentation with SSRIs in treating moderate to severe OCD. We searched PubMed, Web of Science, Scopus, Cochrane library, and Google Scholar for relevant trials published up to December 2022. The effect size was the mean difference in Yale-Brown obsessive compulsive scale (Y-BOCS) scores before and after receiving 5-HT3 receptor antagonist drugs in augmentation with SSRIs in moderate to severe OCD patients. We included 6 randomized-controlled trails (RCTs) with 334 patients assessing the effect of the augmentation of SSRIs with ondansetron, granisetron, and tropisetron on treating moderate to severe OCD. Our results were in favor of the experimental group in total (Z = 8.37, P < 0.00001), in the compulsion subgroup (Z = 5.22, P < 0.00001), and in the obsession subgroup (Z = 8.33, P < 0.00001). They are well-tolerated, and have mild side effects and do not result in withdrawal. Augmentation of 5-HT3 antagonists with SSRIs can be beneficial in treating moderate to severe OCD. Further multi-center trials under adequate conditions in longer periods are needed to help come up with a comprehensive action plan.

Safety and Efficacy of Drug Holidays for Women with Sexual Dysfunction Induced by Selective Serotonin Reuptake Inhibitors (SSRIs) Other than Fluoxetine: An Open-Label Randomized Clinical Trial.

Selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of psychopharmacology. However, they cause side effects such as sexual dysfunction, leading to the discontinuation of treatment. We aimed to investigate the efficacy and safety of drug holidays for women experiencing sexual dysfunction Induced by SSRIs other than fluoxetine. This study was an 8-week randomized, open-label, controlled trial including married women aged between 18 and 50 years who had experienced sexual dysfunction while undergoing treatment with SSRIs. The intervention group implemented drug holidays by not taking medications on Thursdays and Fridays, while the control group continued regular medication use. The female sexual function index (FSFI) and the 28-question general health questionnaire (GHQ-28) were administered to assess sexual function and mental health, respectively. A total of 50 participants completed the trial. The drug holidays' group showed significant improvements in arousal (p < 0.001), desire (p = 0.001), orgasm (p < 0.001), satisfaction (p < 0.001), lubrication (p = 0.021), and overall sexual health (p < 0.001). The between-group difference of pain was significant (p < 0.001), despite no significant within-group change. Mental health improved in both groups, despite no significant between-group difference. No major adverse effects were reported. Drug holidays did not introduce immediate safety concerns or significant adverse effects during the timeframe of eight weeks, suggesting that it may be a safe and effective strategy for managing SSRI-induced sexual dysfunction in women, alongside improving mental health. Further research is needed to reach a definitive conclusion.

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial.

BACKGROUND: As 40-60% of the patients with obsessive-compulsive disorder (OCD) do not adequately respond to the first-line treatment, finding an effective second-line treatment is required. Our aim was to assess the efficacy and safety of agomelatine (a selective melatonin receptor agonist and a 5-hydroxytryptamine (HT)2 C antagonist) augmentation of sertraline in the treatment of patients with moderate to severe OCD. METHODS: In this 12-week randomized, double-blinded, placebo-controlled, parallel-group clinical trial, 65 patients with moderate to severe OCD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) criteria and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of over 21, were included. They were assigned with sertraline (100 mg/day for the first 4 weeks and 200 mg/day for the next 8 weeks) and either agomelatine (25 mg/day) or placebo. The primary outcome was OCD symptoms measured by the Y-BOCS. RESULTS: Fifty patients (24 in agomelatine group and 26 in placebo group) completed the trial. The Y-BOCS scores in total (MD (95% CI) = 12.25 (11.00, 13.49) (P < 0.001) vs. MD (95% CI) = 12.46 (6.65, 15.74) (P < 0.001)), the obsession subscale (MD (95% CI) = 5.04 (4.19, 5.88) (P < 0.001) vs. MD (95% CI) = 5.00 (3.84, 6.16) (P = 0.0001)), and compulsion subscale (MD (95% CI) = 7.21 (6.34, 8.07) (P < 0.001) vs. MD (95% CI) = 7.460 (6.50, 8.42) (P < 0.001)) significantly decreased in both groups. Although, at the end of the trial, no significant difference was observed between the scores of the two groups in total (MD (95% CI) = 0.480 (-1.23, 2.19) (P = 0.78)), the obsession subscale (MD (95% CI) = 1.020 (-0.15, 2.19) (P = 0.38)), and the compulsion subscale (MD (95% CI) = 0.540 (-0.34, 1.42) (P = 0.54)). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups. CONCLUSION: Agomelatine in augmentation with sertraline is safe and tolerable in patients with moderate to severe OCD. However, our study does not support its efficacy in improving OCD symptoms, compared to placebo. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials on 14/07/2020 ( www.irct.ir ; IRCT ID: IRCT20170123032145N5).

A new genetic variant, presenting as young onset rapidly progressive dementia and parkinsonism.

There are various neurodegenerative or hereditary causes of Parkinsonism. Therefore, clinicians should consider an increasing range of differential diagnoses when facing a patient with Parkinsonism, especially when associated with additional clinical features. Young-onset Parkinsonism, especially when accompanied by features uncommon in idiopathic Parkinson's disease raises the possibility of genetic etiology. Herein, we present a case of a 40-year-old man with genetic Parkinson's disease, presenting with rapidly progressive dementia. This round will describe our approach to this clinical presentation and the unveiling of a rare genetic condition.

Investigation of a group of Iranian theater artists' mental health and attitude toward patients with mental disorders.

Introduction: Stigmatizing attitude toward patients with severe mental disorders is one of the main obstacles of improving the mental health of societies. Media plays an important role in how the public views mental health issues. Thus, we have performed this study to investigate the Iranian theater artists' mental health status, and their view toward patients with severe mental disorders. Methods: This cross-sectional study was performed via an online anonymous survey including the Social Distance Scale and the Dangerousness Scale measuring the attitude of participants toward patients with severe mental disorders, and the 28-item General Health Questionnaire (GHQ-28). It was disseminated to artists who had the experience of working in theater in the past year in Iran. Results: Our survey was responded by 104 artists. Social Distance Scale scores' mean was 10.67 (scores can range from 0 to 21) and the Dangerousness Scale scores' mean was 28.87 (scores can range from 8 to 56); higher scores indicate worse discrimination. Our participants' strongest fears were to let someone with a severe mental disorder to take care of their children, and for these groups of patients to obtain a hunting license. Twenty-six (25%) participants were at risk of moderate to severe anxiety, and 18 (17.3%) participants were at risk of moderate to severe depression. Conclusion: By and large, our participants did not have a positive attitude toward patients with severe mental disorders. Providing the knowledge of mental health issues can help the general public to be more tolerant of the mentally ill and specifically, theater can be employed to fight stigmatizing mental health issues by educating its audience.

The Impact of the COVID-19 Pandemic on Iranian Psychiatric Trainees' and Early Career Psychiatrists' Well-being, Work Conditions, and Education.

OBJECTIVES: This study was conducted to investigate the impact of the COVID-19 pandemic on psychiatric trainees and early career psychiatrists in Iran. METHODS: In this cross-sectional survey, the authors used a 24-item questionnaire inquiring about the sociodemographic characteristics of the participants, their views on the impact of the COVID-19 pandemic on their professional careers, methods of education, workplace environment, well-being and mental health, and the use of telepsychiatry in Iran. RESULTS: A total of 159 responses were received. The majority (n=124, 78.0%) reported that "some but not all obligatory activities have been converted to online activities." Most of the participants (n=103, 64.8%) stated that the pandemic had not affected the duration of their training. Less than half (n=61, 38.4%) reported that their well-being had been affected rather negatively. Some (n=59, 37.1%) reported that their supervisors or coworkers had no significant impact on their well-being, whereas others (n=53, 33.3%) reported a rather positive impact. Almost half of the participants (n=78, 49.0%) did not have access to free psychological counseling. In addition, more than half (n=89, 56.0%) reported that there were no recommendations on how to proceed with telepsychiatry. CONCLUSIONS: This study calls for improvements in the education and well-being of psychiatric trainees and early career psychiatrists in Iran amid the COVID-19 pandemic. Additional research should be carried out to maximize learning, provide mental health care, and use telepsychiatry.

Attitude towards migration of psychiatric trainees and early career psychiatrists in Iran.

INTRODUCTION: Migration of medical professionals has been rapidly increasing in the past decades and it strongly affects origin and destination countries. OBJECTIVES: We aimed to explore the extent and the reasons of migration among psychiatric trainees and early career psychiatrists in Iran. METHODS: Our semi-structured 61-items questionnaire inquired participants' demographics, experiences of short-term mobility (from 3 months to 1 year), long-term migration (more than 1 year) and attitudes towards migration (current and future plans). RESULTS: A total of 184 responses were received. Most (73.4 %) participants were female, and within the age range of 25-65 (Mean: 34.9). Only 15.2 % had a short-term mobility experience, mostly due to academic reasons (35.7 %). Most (75 %) stated that this short-term mobility experience influenced them in favor of migration. The majority (83.7 %) had 'ever' considered leaving Iran, and more than half (57.3 %) stated they 'strongly agree' or 'agree' to leaving the country 'now' (at the time of the study). The main reason to migrate from Iran was first political, followed by work, financial, social, religious, academic, and cultural reasons, and the least ranked were personal reasons. In relation to their 5-year plans, 67.3 % saw themselves in the country they currently live in, Iran. The main features reported for an attractive job were 'pleasant work environment' (97.3 %), 'good welfare and social security' (96.7 %) and 'high salary '(96.2 %). CONCLUSIONS: This study calls for more support of psychiatric trainees and early career psychiatrists in Iran. Improvements in the political context, work conditions and finances might lower the rate of migratory intention and brain drain.

Psychotherapy training in Iran: A survey of Iranian early career psychiatrists and psychiatric trainees.

INTRODUCTION: Psychiatry's postgraduate training curriculum in Iran has been revised and one of the core revisions has been the incorporation of full-time 9-months of psychotherapy training. However, little is known about psychotherapy training in Iran. METHODS: An online anonymous survey was developed by the Early Career Psychiatrists (ECP) Section of the World Psychiatric Association (WPA). The survey included 16 questions about the: (a) quality of psychotherapy training (supervision, type of psychotherapy training available, barriers in accessing training); (b) organizational aspects of psychotherapy training (compulsoriness, payment, and assessment); (c) satisfaction with training in psychotherapy; (d) self-confidence in the use of psychotherapy. This survey was circulated to Iranian early career psychiatrists and psychiatric trainees. RESULTS: 112 early career psychiatrists and psychiatric trainees from across Iran responded to the survey; 98.2% of which stated that psychotherapy training is included in their psychiatry training, and cognitive behavioral therapy and psychodynamic psychotherapy were the most reported modalities integrated into their psychiatric training. Moreover, 43.3% of the participants reported that they were satisfied or very satisfied with their psychotherapy training during the training years. DISCUSSION: Psychotherapy is integrated into psychiatric training programs in most educational centers in Iran. The modalities and satisfaction of trainees are similar to that of high-income countries in other continents. Supervision and training in modalities like family therapy could be further implemented and adapted to the Iranian culture.