Mindfulness plus physical activity reduces emotion dysregulation and insomnia severity among people with major depression.

BACKGROUND: As the disorder progresses, patients with depression suffer from decreased emotional stability, cognitive control and motivation. In the present study, we examined the effectiveness of three interventions on emotion dysregulation and insomnia severity: 1) mindfulness; 2) physical activity, and 3) mindfulness plus physical activity. METHOD: A total of 50 participants (mean age 33.21 ± 5.72 SD, 59% females) with major depression were randomly assigned to one of the three study conditions. Emotional dysregulation and insomnia severity were assessed at baseline, eight weeks later at study completion, and 4 weeks after that at follow-up. RESULTS: Emotion regulation and sleep quality improved over time from baseline to study completion and to follow-up. Compared to the mindfulness and physical activity alone conditions, the mindfulness plus physical activity condition led to higher emotion regulation and sleep quality. CONCLUSION: The combination of physical activity and mindfulness seems to have a beneficial effect on sleep quality and emotion regulation in those with major depression disorder and could be a valuable treatment strategy.

Better sleep quality and higher physical activity levels predict lower emotion dysregulation among persons with major depression disorder.

BACKGROUND: People with Major Depression Disorders (MDD) often complain about sleep problems and experience emotion dysregulation. Prior research suggests physical activity can improve both sleep quality and emotional control. However, there is limited research on emotion regulation and the impact of physical activity and sleep in this population. OBJECTIVES: The present study examined the relationships between sleep quality, emotion regulation, and physical activity levels among patients with MDD. METHODS: The sample consisted of 118 patients with MDD (mean age: 31.85 years) who completed questionnaires on sleep quality, physical activity, emotion regulation, and depression. RESULTS: Results showed that more sleep problems were associated with worse emotion dysregulation, and more physical activity was associated with fewer sleep problems and less emotion dysregulation. Furthermore, physical activity and sleep quality significantly predicted emotion dysregulation, with physical activity being the stronger predictor. CONCLUSIONS: Results from this study suggest that individuals with MDD who are able to engage in physical activity and get better sleep could experience emotional regulation benefits.

Exploration of the Barriers to Clozapine Prescribing in Patients with Treatment-Resistant Schizophrenia: A Qualitative Study.

Treatment-resistance schizophrenia (TRS) is one of the psychiatric challenges. While clozapine is an effective treatment for patients with TRS, there are some barriers to clozapine prescribing in these patients. The study aims to explore the barriers from Iranian psychiatrists' points of view. The study was conducted by a qualitative approach using content analysis. The Participants included 12 psychiatrists who were selected purposefully. Data were collected using a semi-structured interview from May to December 2020. All interviews were recorded and transcribed and analyzed qualitatively using constant comparisons. Three main categories emerged concerning barriers to the use of clozapine: drug-related barriers, psychiatrist and health system-related barriers, and patient and family-related barriers. Additionally, specific subcategories within each main category were documented. The present study showed that there are three main groups of barriers to the use of clozapine in patients with TRS. Psychiatrist and health system-related barriers may influence the other two groups of barriers. Further research to investigate the effective strategies to overcome the barriers is recommended.

Efficacy and Side Effects of Aripiprazole and Olanzapine in Patients with Psychotic Disorders: A Randomized Controlled Trial.

Objectives: In clinical experience, selecting atypical antipsychotics optimally balancing their benefits and potential side effects is seen to improve treatment adherence in patients. This study aimed to compare the effectiveness and side effect profiles of aripiprazole and olanzapine in patients with psychotic disorders. Methods: In this double-blind clinical trial, the subjects were patients with psychotic disorders treated with aripiprazole and olanzapine. The subjects were randomly divided into two equally sized groups. One group was treated with olanzapine and the other group with aripiprazole. All participants were assessed using the positive and negative syndrome scale and side effects were monitored over a two-month follow-up period. Results: The participants comprised N = 76 patients (65 male; 11 female). Treatments with both aripiprazole (n = 38) and olanzapine (n = 38) were associated with a significant decrease in the severity of psychotic symptoms over the two-month treatment period. This decrease was achieved faster in the olanzapine group. There were no significant differences in the changes in body mass index, waist circumference, blood sugar, triglyceride, or cholesterol between the two groups. A qualitative difference between the groups was found in their total sleep duration. Conclusions: Olanzapine was more effective than aripiprazole in reducing psychotic symptoms. There were no significant differences between the overall side effect profiles of the two drugs.

Iranian psychiatrists' attitude towards clozapine use for patients with treatment-resistant schizophrenia: a nationwide survey.

BACKGROUND: Clozapine has the greatest efficacy for treatment-resistant schizophrenia (TRS), even though its underutilization is not uncommon across different countries. This study aimed to investigate the knowledge and attitude of Iranian psychiatrists toward clozapine use. METHOD: In this cross-sectional study, a questionnaire was distributed among psychiatrists registered with the Iranian Psychiatrists Association (including its provincial branches) to assess their knowledge and attitude towards clozapine use. A total of 282 psychiatrists completed the questionnaire. Descriptive analysis was used to describe demographic information, and Chi-square tests were conducted to determine if there is an association between academic position and work experience. All statistical analyses were performed using SPSS® version 25.0 for Windows, and a significance level of 0.05 was used. RESULTS: Most respondents (93%) acknowledged that they prescribed clozapine for their patients, and 74% believed that clozapine was more effective than other antipsychotic drugs. However, 43.3% of the respondents said they did not believe in the safety of clozapine. Difficulty initiating and having no firsthand experience in the superiority of clozapine were reported by 81.2 and 80% of the respondents, respectively. Our results also showed an association between having an academic position and access to appropriate facilities for the control and management of patients treated with clozapine and believing in the safety of clozapine (p < 0.05). Longer work experience (more than 15 years) was associated with a higher prescription of clozapine, belief in greater effectiveness of clozapine, and its safety (p < 0.0001). CONCLUSION: Iranian psychiatrists had a good self-perception of knowledge about the efficacy of clozapine for patients with TRS, but concerns about serious side effects are common. Psychiatrists with longer work experience and academic positions were more optimistic towards clozapine use than the younger ones with no academic position. Considering the results in planning the strategies to decrease concerns about clozapine use is recommended.

Treatment of chronic insomnia with atypical antipsychotics: results from a follow-up study.

OBJECTIVE: Second generation (atypical) antipsychotics are increasingly being used for treatment of insomnia, but there is little evidence to show long-term efficacy of these medication. This follow-up study was designed to assess patients with chronic insomnia who were treated with atypical antipsychotics. MATERIAL AND METHODS: In this follow-up study, forty patients with chronic insomnia were evaluated between 2016 and 2018 following after one year of treatment with two atypical antipsychotic drugs of olanzapine and quetiapine in two groups in the sleep disorders research center of Kermanshah University of Medical Science in Iran. The Pittsburgh Sleep Quality Questionnaire (PSQI) and 5 consecutive nights of Actigraphy were utilized to evaluate both subjective and objective measures of sleep quality. Lastly, sleep quality before and after treatment and comparisons of sleep quality between the two groups were performed. RESULTS: Nine male participants comprised olanzapine group (n=22) and six male participants comprised the quetiapine group (n=18). The average age in the olanzapine group was 45.23±10.18 and the average age in the quetiapine group was 46.33±7.99. Results showed total PSQI score improved significantly in both groups (p<0.05), while the actigraphy results showed only significant improvement in sleep quality parameters in the quetiapine group (p<0.05). CONCLUSION: Two atypical antipsychotics drugs of olanzapine and quetiapine have long-term efficacy in managing chronic insomnia. More improvements in objective sleep quality with quetiapine is promising for patients with chronic insomnia. Further research to evaluate long-term adverse effects of atypical antipsychotic drugs is recommended.

Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores.

OBJECTIVE: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. METHODS: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X2-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. RESULTS: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. CONCLUSION: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

The Effectiveness of Occupational Therapy-Based Sleep Interventions on Quality of Life and Fatigue in Patients with Multiple Sclerosis: A Pilot Randomized Clinical Trial Study.

PURPOSE: Sleep difficulties are common in patients with multiple sclerosis (MS), which may increase feelings of fatigue, negatively interfere with daily activities, and consequently reduce their quality of life. Studies examining the effects of sleep-targeted interventions in MS are currently limited in the literature. Therefore, we aim to assess the effects of occupational therapy interventions on sleep quality, fatigue, and quality of life in patients with MS. PATIENTS AND METHODS: In a single-blind, randomized, controlled trial, which occurred between April 2018 and March 2019 in Tehran, Iran, 20 eligible patients with MS were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Short-Form Health Survey (SF-36). Patients were allocated randomly into the two following groups: patients receiving care-as-usual for MS (CAU) and patients receiving care-as-usual plus intervention (CAU + intervention). Both intervention groups underwent 2-3 sessions per week lasting 30-45 minutes for 8 weeks and received follow-up assessments. Data were analyzed using independent sample t-tests and Mann-Whitney U tests using SPSS (16 ver.) statistical software. RESULTS: In the intervention group, sleep quality improved significantly across all items (p<0.001, effect size = 0.60) except for sleep efficiency and the use of sleep medications. FSS and FIS in the sleep intervention group were significantly reduced (p<0.001, effect size = 0.76 and p<0.001, effect size = 0.82, respectively). The quality of life in the intervention group improved significantly (p<0.004, effect size = 0.51-0.76) with the exception of the social functioning subgroup. CONCLUSION: Although this is the result of a pilot study and more patients should be added, this intervention program demonstrates improvement in sleep quality and quality of life while decreasing fatigue in patients with MS. Adjunction of this program, if results are similar with more patients, to routine occupational therapy (OT) interventions can help improve the rehabilitation program of MS patients.

A Mixed-Method Modified Delphi Study toward Identifying Key Elements of Psychotherapy in Iran.

PURPOSE: In Iran, psychotherapy is regarded as an effective treatment for psychiatric disorders. However, no previous research has identified the key elements of psychotherapy that may be specific to Iranian society. The current study was conducted in an attempt to identify these elements. METHODS: A mixed-method modified Delphi approach was used, taking place over several stages during 2017-2018. The first stage involved interviewing 12 experts in psychotherapy to identify key elements of psychotherapy in Iran by thematic analysis. Then, successive Delphi rounds were conducted to obtain consensus (75% agreement) from 70 psychotherapy experts on these key elements. RESULTS: Key elements of psychotherapy were grouped into the following themes: (1) systematic education/training; (2) psychotherapist competency; (3) psychotherapy reflective of Iranian societal needs; and (4) the substrate (scientific/ethical principles) of psychotherapy. Consensus was reached during two Delphi rounds. In Delphi round 1, 52.8% of the statements reached consensus, and all remaining statements reached consensus in round 2. CONCLUSIONS: The key elements of psychotherapy in Iran are a set of conditions for the education and training of competent psychotherapists who can perform psychiatric interventions appropriate to Iranian society under supervised rules. These should serve as a framework for improving the current delivery of psychotherapy in Iran.

Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: A search of common databases indicates the absence of any research focused on the needs of Iranian women diagnosed with severe mental illness post-discharge from an inpatient setting. Moreover, there is a lacuna of information about the unique experiences and needs of persons diagnosed with severe mental illness living in non-Western communities (esp. Middle Eastern communities). WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study examined interviews of women diagnosed with severe mental illness receiving treatment at an Iranian inpatient hospital. Three categories of post-discharge needs emerged: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings highlight the need for systemic changes to current care models. Broadly, families should be incorporated into care to improve outcomes and decrease stigma. Regarding mental health nursing, results highlighted the need for additional nursing and occupational therapy interventions to empower families and patients. Nursing practitioners can aid in preparing these patients for employment and public health initiatives to decrease stigma and improve access to care. ABSTRACT: Introduction Understanding the post-discharge needs of patients diagnosed with severe mental illness is critical for improving treatment outcomes. Aim The aim of the present study was to determine the unique post-discharge needs of Iranian women diagnosed with severe mental illness. Method Conventional content analysis was utilized to analyse data gathered via focus group interviews conducted within the psychiatric inpatient unit at Farabi hospital located in Kermanshah, Iran. Participants (N = 42; M age = 40; SD = 6.3 years) had been diagnosed with a severe mental illness, had a history of at least two psychiatric hospitalizations and were awaiting discharge following significant symptom improvement. Results Content analysis extracted three categories of post-discharge needs: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. Discussion/Implications for practice Analysis of interview data highlighted the general need for adopting a family-system approach to reduce stigma, increase knowledge and foster skill acquisition. Regarding mental health nursing, results highlighted the unique role of nurses and their capacity to pre-emptively address needs such as aiding in employment. Lastly, findings are contrasted against Western care models.

Exploration of the Influential Factors on Adherence to Occupational Therapy in Parents of Children with Cerebral Palsy: A Qualitative Study.

BACKGROUND: Cerebral palsy (CP) is the leading cause of permanent disability in children. Occupational therapists serve a primary role in the rehabilitation of children with CP. Poor adherence to treatment is common. The aim of this study is to explore the viewpoint of occupational therapists on factors which impact adherence to occupational therapy (OT) interventions among parents of children with CP. MATERIAL AND METHODS: A qualitative approach using semi-structured interviews were employed. Our participants were recruited by purposive sampling among occupational therapists who were working in Kermanshah province, western Iran. The interviews were taped and transcribed. Content analysis using constant comparison was performed. RESULTS: The mean age of our participants was 34.23±7.50. Four main categories with specific subcategories emerged as important in affecting adherence. The first category of child and family-related factors described factors such as the clinical status of the child and family composition. These factors had the potential for both improving and reducing adherence to treatment. The second category of therapist-related factors described the effect of appropriate professional skills of the therapist on improving adherence and included clinical competency, communication skills, and job satisfaction. The third category of environmental factors addressed factors such as cultural views of child disability and access to OT interventions. The category mostly emphasized environmental barriers to adherence to treatment. The fourth category of therapy-related factors described barriers such as the type of therapy, and the length of treatment. CONCLUSION: Adherence to OT interventions in parents of children with CP can be influenced by several factors. These factors range from child and family-related factors to therapy-related factors and have the potential for both positively and negatively affecting adherence. Programs to improve adherence should address these factors together.

Personality profiles in paradoxical insomnia: a case-control study.

INTRODUCTION: Paradoxical insomnia (PARA-I) is a clinically challenging condition to diagnose and treat. Previous findings suggest that personality profiles of patients with PARA-I may be different from other subtypes of insomnia. Therefore, investigation of these profiles can be helpful in the clinical management of these patients. OBJECTIVE: The current study compares personality profiles of individuals with paradoxical insomnia (PARA-I), psycho-physiological insomnia (PSY-I), and normal sleepers (NS). MATERIAL AND METHODS: A cross-sectional case-control study was conducted in the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, Kermanshah, Iran between 2015 and 2017. Patients with PARA-I (n=20), PSY-I (n=20), and NS (n=60) were matched for age, gender, education, and history of mental and/or physical illness and completed the Minnesota Multiphasic Personality Inventory (MMPI) short form. One-way analysis of variance (ANOVA) and the Kruskal-Wallis test were used to compare subscale means across groups. RESULTS: With the exception of the schizophrenia scale (P =.059), significant differences were found in all subscales of the insomnia groups compared to the NS group (P=.001). Compared to the NS group, patients with PARA-I showed significant differences in the hysteria and hypomania subscales (P<.05) and patients with PSY-I showed significant differences in the hysteria, hypochondriasis, and psychopathic subscales (P=.001). No significant differences were found between the PARA-I and PSY-I groups on any subscale. CONCLUSION: This study demonstrates that significant differences in the personality profiles on the MMPI exist between PARA-I and PSY-I patients compared to NS. These findings should inform the diagnosis and future treatment approaches for insomnia.

The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah.

BACKGROUND: Earthquake is one of the most common natural disasters. A 7.3" Richter earthquake happened at 5km from the town of Ezgeleh in Kermanshah province in 2017, which caused several physical and mental injuries. The present study was conducted to investigate the sleep quality and mental health difficulties of those affected by earthquake and predict sleep quality according to severity of symptoms of depression, anxiety, and stress in the township of Sarpol-e Zahab, which suffered the most damage. METHODS: A total of 999 earthquake survivors living in temporary tents and camps were assessed in terms of sleep quality and pattern using Pittsburgh Sleep Quality Index, and severity of psychological symptoms using Depression, Anxiety, and Stress scale 10 days after the disaster. RESULTS: According to the results, poor sleep quality was experienced by 20.61% of survivors, severe stress by 60.5%, and severe depression by 41.5%, and moderate anxiety by 74%. The subjective quality, efficiency, daily dysfunction, use of hypnotics, and total sleep quality had a positive and significant relation with severity of experienced depression, anxiety, and stress. Sleep latency had a positive and significant relation only with stress, and sleep disturbance with depression and stress. CONCLUSIONS: Severity of depression, anxiety, and stress can predict changes in total sleep quality of those affected by earthquake. Stress can be considered as the sole predictor of total sleep quality and the only factor that can explain components of sleep quality. The implications of the present study are debatable.

Barriers to acceptance and adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea: a report from Kermanshah province, western Iran.

PURPOSE: Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). CPAP acceptance and adherence are critical issues for optimal treatment outcome. Identifying barriers to acceptance and adherence can improve intervention development and outcomes. This study aimed to investigate the barriers to CPAP acceptance/adherence in patients with OSA in western Iran. PATIENTS AND METHODS: Patients with OSA, who had been prescribed CPAP by the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, were recruited. They were interviewed via telephone regarding acceptance (ie, CPAP use during the first 2 weeks) and adherence (ie, CPAP use 4 h/d for 70% of the nights per week). Barriers to acceptance and adherence were solicited. RESULTS: Out of a possible sample of 101, 97 patients (79 male) were reached and included in the study. They had a mean age of 48.76 years (SD =12.04) and mean apnea/hypopnea index score of 36.06 (SD =1.87). Patients were categorized into the following acceptance/adherence groups: nonacceptance (CPAP not purchased; 72.2%), poor adherence (5.2%), and adherent (22.7%). Inability to afford a CPAP device, perception of symptom reduction/no need for treatment, and dissatisfaction with treatment were among the most common reasons for nonacceptance and poor adherence. CONCLUSION: CPAP acceptance and adherence in western Iran are low. Approximately 70% of the patients did not accept CPAP treatment (due to not obtaining the device) and 5% did not adhere. To improve acceptance/adherence, increased access (ie, reduced cost or increased insurance coverage) and enhanced education about the benefits of the treatment are recommended. Treatment monitoring via regular follow-ups may also prove beneficial.

Paradoxical insomnia and subjective-objective sleep discrepancy: A review.

Paradoxical insomnia is characterized by discrepancy between subjective and objective assessments of sleep and is challenging to diagnosis and treat. Typically, polysomnographic (PSG) findings show significantly longer total sleep time than patients' report of sleep, and the difference between subjective and PSG sleep is greater than that seen in other insomnia subtypes. Subjective-objective sleep discrepancy may also present in different clinical pictures, as marked discrepancies between patients' perception of sleep and objective findings are common in a variety of medical, sleep and psychiatric disorders. However, there is a paucity of literature about the etiology and treatment of sleep discrepancy and paradoxical insomnia. Therefore, the underlying neurophysiological mechanisms of sleep discrepancy and paradoxical insomnia should be further investigated. Additionally, well-controlled clinical trials are needed to establish an evidence based intervention for treatment.