The Effectiveness of Telephone-based Psychological Services to COVID-19.

Background: The COVID-19 pandemic has disrupted the delivery of mental health services, leading to the development of telepsychiatry. Aim: The present study investigates the effectiveness of telephone-delivered treatment for psychological disorders of COVID-19 survivors in Tehran, the capital of Iran. Methods: In this non-randomized controlled trial, 91 COVID-19 survivors, primarily residents were enrolled. Participants completed a baseline questionnaire and a psychological screening questionnaire. The intervention included the telephone-based psychological services provided by trained psychiatric residents. The Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) was administered to assess the presence of PTSD symptoms. Symptoms of anxiety and depression were measured by the Patient Health Questionnaire. Results: The General Health Questionnaire (GHQ) adjusted mean difference was significantly lower in the intervention group than in the control group. There was a significant negative correlation between the Spost-GHQ score and history of going to the clinic and history of psychiatric disorders, but no relationship with the history of hospitalization. All participants completed the satisfaction form, with almost half of them being "satisfied" or "very satisfied" with the telehealth calls. Conclusion: Telephonic delivery of psychological services showed an effective way of providing evidence-based psychological support during the pandemic. This telehealth program can offer much-needed assistance to individuals with COVID-19 improving their psychological wellbeing.

Caring Behaviors Inventory-24: translation, cross-cultural adaptation, and psychometric testing for using in nurses and patients.

BACKGROUND: To measure caring behaviors, it is necessary to have an instrument adapted based on the contextual culture. This study aimed to translate Caring Behaviors Inventory-24 (CBI-24) into Persian and determine its psychometric properties. METHODS: This is a methodological study conducted to translate and then psychometrically test The CBI-24. The forward-backward translation was conducted using the World Health Organization (WHO) model and Wild et al. (2005) approach. The face, content, and construct validity of the inventory were assessed using cognitive interviews (10 nurses and 10 patients), expert panel deliberations (10 experts), and the exploratory and confirmatory factor analyses (300 nurses and 300 patients), respectively. The reliability was determined using the internal consistency (300 nurses and 300 patients) and test-retest method (30 nurses and 30 patients). RESULTS: After translating the CBI-24 and combining its items, the forward translation was initially conducted and the final backward translation was then sent to the developer for confirmation. The final version of the inventory was prepared after the completion of cognitive interviews. The content validity index of all items was reported to be more than 0.8 and good. The Cohen's kappa coefficient of all items was also shown to be higher than 0.74 and excellent. The factor loading of all items except item 19 was above 0.3. Item 19 was removed since it caused the alpha value of the respectfulness dimension to be 0.32. The Cronbach's alpha and the correlation coefficient of the whole inventory were calculated to be 0.95 and 0.88, respectively. CONCLUSION: The Persian version of CBI-24 can be a suitable tool for measuring caring behaviors among patients and nurses.

Theory of mind in adolescents with Attention-Deficit Hyperactivity Disorder: A cross-sectional study.

Objective: Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that may be associated with impaired Theory of Mind (ToM) and social cognition. ToM is a domain in social cognition, referring to one's ability to attribute beliefs, intents, perspectives, and understandings to oneself or others and to understand others' mental states. Materials & Methods: The present study enrolled 52 ADHD of adolescents and 41 healthy age-matched controls in this study. This study applied The Reading the Mind in The Eyes Task (RMET) and Theory of Mind Assessment Scale (Th.o.m.a.s.) for all participants. The results of these tasks were compared between the two study groups. Results: No significant differences were found between these two study groups regarding ToM abilities using mean scores in the Th.o.m.a.s. inventory and the RMET. Furthermore, no association was found between the mean score in the ToM (in both study groups) and this study's parameters of gender, mean age, birth rank, family structure, and income. Conclusion: This study did not support the hypothesis that adolescents with ADHD perform worse on ToM tasks.

Paradoxical perception of humanistic care in the intensive care unit: A qualitative study.

AIM: The aim of this study was to explore the perceptions of nurses, patients and attendants of humanistic care in the intensive care unit. DESIGN: The present study was a qualitative conventional content analysis conducted in the intensive care unit in a hospital in Iran, in 2019. METHODS: Data were collected using semi-structured interviews and field notes through purposive sampling with 17 nurses who worked in an adult ICU in a teaching hospital, 4 attendants and 4 alert patients, and then analysed using the Elo-Kyngäs method in 2008. RESULTS: Analysis of the data led to the extraction of Four main themes as follows: (1) Insufficient understanding of nurses and patients' families of each other's roles, needs and expectations; (2) The use of personal and situational reasoning rather than ethical principles; (3) Caring stagnation; and (4) Satisfaction with care.

Effect of General Practitioner Training in a Collaborative Child Mental Health Care Program on Children's Mental Health Outcomes in a Low-Resource Setting: A Cluster Randomized Trial.

Importance: Integrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care. Objectives: To explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care. Design, Setting, and Participants: This cluster randomized trial was conducted within an adult collaborative care program in Tehran, Iran. General practitioners (GPs), their 5- to 15-year-old patients, and patients' parents were included. Children and youths coming for routine medical visits who scored greater than the cutoff on the Strengths and Difficulties Questionnaire (SDQ) were followed up for 6 months. The study was conducted from May 2018 to October 2019, and analysis was conducted from March 2020 to August 2021. Interventions: GPs were randomized to either a 2.5-day training on managing common child mental health problems (intervention) or refresher training on identification and referral (control). Main Outcomes and Measures: Primary outcome was change in SDQ total problems score; secondary outcomes included discussion of psychosocial issues by the GPs and receipt of mental health care during the follow-up period. Results: Overall, 49 GPs cared for 389 children who scored greater than the cutoff on the SDQ (216 children in intervention group, 173 in control group). Patients' mean (SD) age was 8.9 (2.9) years (range, 5 to 15 years), and 182 (47%) were female patients. At 6 months, children in the intervention group had greater odds of receiving mental health care during the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% Cl, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to say they had provided counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, there was no greater improvement in SDQ scores among children seen by intervention vs control GPs. Adjusted for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables associated with change in SDQ scores over time, there was not a significant time-treatment interaction at either the 3- or 6-month follow-up points (linear combination of coefficients for intervention, 0.57 [95% CI, -1.07 to 2.22] and -0.08 [95%CI, -1.76 to 1.56], respectively). In a subgroup of GPs with practices composed of 50% or more children, children seen by intervention GPs improved to a significantly greater extent (-3.6 points; 95% CI, -6.7 to -0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) compared with those seen by control GPs. Conclusions and Relevance: In this cluster randomized trial, GP training on managing common child mental health problems did not demonstrate greater improvement in child SDQ scores. Child mental health training for GPs in collaborative care can improve children's access to mental health care, but prior experience working with children and their families may be required for GPs to use a brief training in a way that improves child outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT03144739.

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.

Humanistic Care in Nursing: Concept Analysis Using Rodgers' Evolutionary Approach.

Background: Despite the importance and prominent role as a clinical, theoretical, and research approach in nursing practice, humanistic care nature and boundaries are not explicit and challenging for nurses to understand. This study was conducted to clarify the concept of humanistic care in nursing. Materials and Methods: Based on Rogers's evolutionary concept analysis, keywords such as "humanistic car *," "caring behave *," "humanistic nurs *," "humanistic model of care," were searched in PubMed, SCOPUS, Science Direct, Web of Science, WILEY, Springer, SAGE, ProQuest, SID, Iranmedex without time limit until November 2018. Sixty-five documents in nursing and ten documents in the medical discipline were finalized for thematic analysis. Results: Nine attributes of the humanistic care, including "excellence in clinical literacy," "creating a healing environment," "a comprehensive and unique viewpoint," "contribution to clients' adaptation and flourishing of their talents," "unrequited love and affection," "preservation of human dignity," "real presence," "constructive dynamic interaction," and "nurse's self-care," were recognized. Assessing the historical and evolutionary course of the concept's semantic tendency revealed three periods: The focus in first, second, and third was on the nurse-patient relationship, quantitative tendency/measurement, and metaphysics/spiritual humanism, respectively. The comparison of interdisciplinary differences indicated greater semantic comprehensiveness and depth in the nursing discipline. Conclusions: Clear and practical definition and identification of humanistic care in nursing can be helpful in the further development of existing knowledge, instrumentation, designing guidelines, clinical interventions, knowledge translation, and correction of concept misuse. The identified antecedents and consequences can be in various aspects of clinical management.

The influential factors in humanistic critical care nursing.

BACKGROUND: One of the main concerns in critical care units is the development of humanistic approaches. In this regard, recognizing the factors affecting humanistic nursing can contribute to humanizing nursing care in these units. OBJECTIVE: The objective was to recognize the influential factors of humanistic nursing in critical care units. RESEARCH DESIGN: This qualitative study was carried out using a phenomenology method. Thirty-nine in-depth unstructured interviews were performed. The data were analyzed using the phenomenological nursology approach. To guarantee trustworthiness, prolonged engagement, member check, triangulation of resources, and maximum variation sampling were used. PARTICIPANTS AND RESEARCH CONTEXT: Purposeful sampling was employed to select 10 nurses, 8 patients, and 4 patient's relatives from the intensive care unit and critical care unit departments. ETHICAL CONSIDERATION: This study was approved by the ethics committee of Lorestan University of Medical Sciences with the code of LUMS.REC.1395.121. FINDING: The participants' experiences were reflected in the following three main concepts: (a) moral, educational, and existential nature of the two humans involved in the interaction; (b) maintenance of the nurses' dignity; and (c) interactions in the cultural and social context. DISCUSSION: The nurse and patient, organizational environment, and society give rise to a set of intertwined characteristics which influence the realization of humanistic nursing. By affecting the nurses' educational background and maintaining their dignity, the atmosphere of the hospital and cultural readiness of the society pave the way for delivering the humanistic care.

A case-control study on the severity postpartum depression among COVID19 positive mother.

BACKGROUND: COVID19 pandemic has caused a variety of psychological problems including panic disorder, anxiety and depression. It is also associated with adverse psychological outcomes in pregnant women. The aim of this study was to compare the severity of postpartum depression in pregnant women with and without COVID-19 during the coronavirus epidemic. METHODS: This case-control study was performed on 102 pregnant women referred to the hospitals of (XXX). Using questionnaire, consisting of demographic and maternal data (age, number of pregnancies, type of delivery, history of any disease, history of drug use, breastfeeding experience, separation of mother from infant due to coronavirus) and score from Edinburgh postnatal depression scale (EPDS) score data from all the participants obtained and analyzed statistically using SPSSv23. RESULTS: The results showed that the mean EPDS score in COVID-positive mothers was 26.64 and in COVID-negative mothers was 24.76, which was statistically significant, p < 0.001. The score did not vary among the two group with respect to age group and type of delivery method. The score was significantly higher among the women with 3-4 pregnancies. CONCLUSION: COVID-positive status is associated with increased postnatal depression among women. Perinatal and postnatal psychological consultancy is required in such patients along with monitoring of maternal and neonate physical and mental health.

Development and psychometric properties of health care workers' concerns in infectious outbreaks scale.

Introduction: Healthcare workers are a crucial workforce; from a moral perspective, understanding their concerns and how to support them is crucial and makes it possible for health services to keep functioning. This study aimed to develop and validate Health Care Workers' Concerns in Infectious Outbreaks Scale (HCWCIOS). Methods: This exploratory sequential mix-method study was employed to design and validate the HCWCIOS. The initial tool was designed after searching similar studies and performing a qualitative phase under the semi-structured approach. Both qualitative and quantitative methods were used to evaluate the face and content validity. The content validity ratio, content validity index, and item-level content validity index were also calculated. Exploratory factor analysis was employed to evaluate the construct validity. Using a convenient sampling method, 354 Iranian healthcare workers participated in the study. Computing Cronbach's alpha coefficient estimated the internal consistency for HCWCIOS and its subscales. Furthermore assessed was test-retest reliability. Results: The preliminary scale was designed with 57 items. By eliminating nine items in the content validity phase and 12 items during factor analysis, the final 36-item scale was developed on six factors: inadequate preparedness, lack of knowledge, risk perception, affected social relations, work pressure, and absenteeism. These six factors accounted for 46.507% of the total variance. The whole scale's Cronbach's alpha coefficient was 0.912, and the intra-class correlation coefficient was 0.88. Conclusion: A 36-item HCWCIOS has good psychometric properties and is suitable for measuring healthcare workers' concerns during a pandemic.

Prevalence of Mental Health Problems and Its Associated Factors Among Recovered COVID-19 Patients During the Pandemic: A Single-Center Study.

Introduction: The coronavirus disease 2019 (COVID-19), is profoundly affecting the mental health status. Although the burden of mental health problems has been reported in the general population and health care workers, little is known about the prevalence of mental health disorders among recovered COVID-19 patients and their associated factors. Methods: A cross-sectional telephonic-study of recovered COVID-19 patients with and without a history of hospitalization was conducted from April 20 to June 20, 2020, in Tehran, Iran. We assessed the anxiety symptoms, depression, and post-traumatic stress disorder (PTSD) among participants, using the Patient Health Questionnaire (PHQ-4) and PTSD checklist for DSM-5 (PCL-5). Logistic regression analyses were used to explore the risk factors associated with mental health problems. Results: A total of 602 individuals with a mean age of 53.2 years (SD: 14.7), completed the study. The rates of mental health symptoms among the respondents were 5.8% (95% CI: 4.2-7.8%) for anxiety, 5.0% (95% CI: 3.5-7.0%) for depression, and 3.8% (95% CI: 2.3-5.3%) for PTSD disorders. Moreover, being younger than 50 years and female gender was significantly associated with a higher probability of reporting anxiety (p < 0.01), and depression (p < 0.001 for being younger than 50 years, p < 0.02 for female gender). Conclusions: The current study indicated that patients with COVID-19 presented features of anxiety, depression, and PTSD. These results may help implement appropriate mental health intervention policies for those at risk and minimize the mental health consequences of the COVID-19.

Children and adolescents' mental health in Iran's primary care: Perspectives of general practitioners, school staff and help seekers.

BACKGROUND: Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners' capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a training program for general practitioners (GPs) to extend this collaboration to include services for children and adolescents. In the formative phase of this project, we conducted a qualitative study to obtain information relevant to the design of the training program. METHODS: We conducted semi-structured individual interviews with 28 stakeholders; including 15 GPs working in a collaborative care network, 6 parents and 4 adolescents who had received child mental health care from a GP, and 3 policymakers. We also held a focus group discussion with 8 school teachers and counselors. All interviews were transcribed during the interviews' sessions and then were thematically analyzed. RESULTS: GPs reported seeing a range of child emotional and behavioral problems but felt the need for additional training in diagnosis and management, especially in skills for interviewing and communicating with children. GPs also expressed the need to understand legal issues involved in treating children, including cases of possible child abuse. School staff agreed that GPs could help with children's educational and emotional problems but also believed GPs would need extra training. Parents indicated a preference for GPs over psychiatrists (as did adolescents) as a source of mental health care, and for psychological over pharmacological interventions. Adolescents expressed a preference not to speak about private issues in the presence of their parents, and expressed concern that the GPs did not respect their preference. They also desired a more active role during visits. CONCLUSIONS: Before expanding the scope of practice of Iranian GPs to provide management of common emotional and behavioral problems in children and adolescents, the concerns and specific needs of these practitioners need to be addressed. Parents and youth in the study expressed a preference for mental health care from a GP rather than a specialist. However, they also commented on the need for restructuring the current GP visits to facilitate youth participation. These findings provide directions for expanding the scope of practice of adult collaborative care networks to meet the mental health care needs of children and adolescents more expeditiously and effectively.

The effect of knowledge brokering on nurses' empathy with patients receiving cardiac care: a study protocol.

BACKGROUND: Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses' empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses' empathy with patients receiving cardiac care. METHODS: This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins' knowledge translation framework 2009. Monica's Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant. DISCUSSION: To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships.

An investigation into the frequency of addiction to video games in children with attention-deficit hyperactivity disorder.

BACKGROUND AND OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is known as the most common neurological disorder in childhood. Failure to timely diagnose ADHD can lead to harmful effects for the individual and the family. The relationship between this disorder and the addiction to video games has been reported in children. Therefore, this study aimed to investigate the degree of addiction to video games in Iranian children with ADHD, compared with normal children. MATERIALS AND METHODS: In this applied research, 99 children with ADHD referring to Imam Hossein Hospital and 99 normal children in elementary schools of Tehran (control group) were recruited. Data were collected using Conner's Scale and Young's Internet Addiction Test (video games). The data were analyzed using SPSS (version 22). RESULTS: In this study, 11% of the children with ADHD and 4% of the normal children had addiction to video games. This difference was significant between the two groups (P < 0.05). Moreover, 58% of the children with ADHD and 27% of the normal children were exposed to video games. This difference was also significant between the two groups (P < 0.05). CONCLUSION: The results showed that the frequency and prevalence of addiction to video games were higher in children with ADHD than in normal children. Therefore, it can be concluded that timely diagnosis of this disorder leads to better treatment.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders.

INTRODUCTION: Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. OBJECTIVE: To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. METHODS: In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. RESULTS: The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. CONCLUSION: Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Explaining Postdischarge Care Needs of Cancer Patients: A Qualitative Study.

AIM: This study aimed to explain the postdischarge care needs of cancer patients. MATERIALS AND METHODS: In this qualitative content analysis, nine cancer patients presenting to the department of chemotherapy or an oncologist's office, four of patients' accompaniments, four nurses, and two oncologists were selected purposefully until data saturation. They underwent deep individual interviews. Data were collected from October 2016 to June 2017. Data were analyzed using Zhang's method with an inductive approach to extract the themes. RESULTS: Data analysis led to the formation of two main categories of healing and relaxation needs (with subcategories of "respect and friendship," "trust and confidence," "relief," "patience and tolerance," "empowerment," and "protection from tension and excessive pressure") and monitoring and balancing conditions (with subcategories of "care monitoring" and "protection"). CONCLUSIONS: Postdischarge needs are a set of needs for primary exposure to diagnosis, outpatient attendance at the hospital and treatment centers, access to the treatment team, family readiness, and care systems and community needs for acceptance and care of these patients. The discharge plan should be designed in accordance with the needs set out above, so that the patients can meet the needs of the acute and disease encounter phase and also can manage the emerging postdischarge needs, such as empowerment.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders / O papel da psicoterapia psicodinâmica de longo prazo na melhora de padrões de apego, estilos de defesa e alexitimia em pacientes com transtornos depressivos e de ansiedade

Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.