The Effects of Demographic Characteristics, Memory Deficits, and Executive Functioning Impairments in Failure to Respond to Fluvoxamine among Patients with Obsessive-Compulsive Disorder in Iran.

Background: Identifying treatment-response predictors could help improve treatment protocols as well as appropriately tailoring them to each subject, leading to a more desirable and accelerated recovery in patients. Thus, the present study aimed to investigate the role of demographic characteristics, memory deficits, and executive functioning impairments in failure to respond to fluvoxamine among patients with obsessive-compulsive disorder (OCD). Methods: This 2-group design (treatment-responsive and treatment-resistant) experimental study explored 76 participants who had received fluvoxamine monotherapy for OCD for ≥6 months. The study participants were from Iran. Four data collection tools were used in this study (ie, Demographic Data Form, WMS-III, WCST, and Y-BOCS). The achieved data were analyzed in SPSS-16 by descriptive statistics, such as mean and standard deviation and frequency and percentages, as well as an independent samples t-test, a chi-square test, and a Fisher exact test at P <0.05. Results: The present study findings indicated that 56 (81.2%) out of 76 patients with OCD responded to fluvoxamine treatment. A significant difference between the study groups highlighted age as an influential factor in providing a positive therapeutic response to fluvoxamine (P=0.048). However, the groups did not significantly differ in terms of gender (P=0.272), marital status (P=0.753), educational level (P=0.332), disease duration (P=0.276), and occupational status (P=0.473). While there was no significant difference between the groups (P=0.639) in terms of memory deficits (P=0.639), the response rate to fluvoxamine treatment was significantly higher in those with a healthy executive functioning, compared with patients with impairments in this respect (P=0.043). Conclusion: The obtained data suggested that fluvoxamine has a favorable efficacy in the treatment of OCD, and especially in young patients with healthy executive functioning.

DNA Banking to Assess Genetic Influences on Schizophrenia.

Background: Schizophrenia is among the most prevalent psychiatric disorders globally, with a lifetime prevalence rate of 0.3% to 0.7%, characterized by the heterogeneous presence of positive, negative, and cognitive symptoms that affect all aspects of mental activity. We aimed to describe the genetics of schizophrenia to widening our understanding of the inheritance of this illness. Methods: This quasi-experimental study was conducted in Razi psychiatric hospital in Tehran province, Iran. Recruitment of the study samples was conducted in Tehran, Iran, among patients with schizophrenia and their families. For this purpose, individuals with schizophrenia in 40 families with at least 1 to 2 affected members were identified and selected based on a clinical interview conducted by a psychiatrist and according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The clinical and paraclinical data, drug and substance usage, and medical treatments were collected through a standardized clinical questionnaire. Besides, the Global Assessment Scale and the Positive and Negative Syndrome Scale were completed for all study participants. Results: A total of 22 families had a negative family history, and 1 affected member and the rest of the studied families had a positive family history and at least 2 affected members. In addition, genealogical data (family tree) and lymphoblastic cell categories were developed to examine genes, and subsequent research results will be reported in the future. Conclusion: As the research continues, the approach to sampling must be modified to ensure that the deoxyribonucleic acid bank is as extensively representative as possible of all schizophrenia cases.

Serum Vitamin D, Mania and Depression-Related Scores: A Comparison among Mixed Bipolar, Mania, and Healthy Subjects.

Objective: Manic and mixed episodes of bipolar disorder are important episodes of this disorder. The aim of the current study was to assess serum vitamin D (SVD) levels in patients with mania and mixed bipolar disorder, compared to healthy subjects. Method : The current cross-sectional study was conducted on 75 subjects, including healthy subjects (n = 25), patients with acute-phase mania (n = 25), and patients with mixed bipolar disorder (n = 25). The SVD levels were measured in all of the enrolled subjects. The Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), and Clinical Global Impression- Severity (CGI-S) were used to assess disease activity in patient groups. Data analysis was performed using SPSS version 18. For statistical analysis, analysis of variance (ANOVA), independent-sample t test, Pearson correlation, and Chi-square tests were utilized. P-values < 0.05 were considered statistically significant. Results: The results showed that the mean of SVD was significantly lower in mania and mixed bipolar patients compared to healthy subjects (P < 0.05). In addition, the number of subjects with SVD ≥ 20 ng/ml was higher in the healthy group compared to the patient groups (P < 0.05). Also, SVD was negatively correlated with the CGI-S (r = -0.311; P = 0.028), YMRS (r = -0.464; P = 0.001), and HDRS (r = -0.393; P = 0.005) in the total patient subjects. Conclusion: Prevalence of low SVD was considerably high in mania and mixed bipolar patients compared to healthy subjects. Additionally, meaningful negative correlations were found between SVD and disease activity-related variables including the HDRS, YMRS, and CGI-S.

A Network Analysis Study to Evaluate Obsessive-Compulsive Beliefs/Dimensions and Personality Beliefs in Patients with Obsessive-Compulsive Disorder (OCD): A Cross-Sectional Study in Two Common OCD Subtypes.

Objective: Obsessive-Compulsive Disorder (OCD) has been considered a heterogeneous psychiatric disorder. Identifying this heterogeneity can lead to better diagnosis and treatment. The two most common OCD subtypes include contamination/cleaning and danger/checking. This study aimed to identify the network structure of OCD symptoms, personality, and obsessive beliefs in these OCD subtypes. Method : 333 patients with OCD were included in the study (156 patients with the danger/check subtype and 177 patients with the contamination/cleaning subtype). In addition, 276 healthy individuals participated in this study. We used a network analysis approach to determine the OCD central symptoms [nodes]. The Personality Beliefs Questionnaire-Short Form [PBQ-SF], Obsessive-Compulsive Inventory-Revised [OCI-R], and Obsessional Beliefs Questionnaire-44 [OBQ-44] were used for network estimation. Results: The results indicated that the network structure in healthy individuals was different from the network structure in patients with obsessive-compulsive disorder [PwOCD]. In healthy individuals, "obsessive" personality belief and "danger" obsessive belief were the most strength nodes and formed the core of the central communication between symptoms in these subjects. Regarding the contamination/cleaning subtype, the most central symptoms include "washing" obsessive symptom, "danger" obsessive belief, and "wash" obsessive symptom. However, "perfect" obsessive beliefs, "check" obsessive symptoms, and "avoidant" personality beliefs were the most central symptoms in the danger/check subtype. These results demonstrated that each of the studied groups had a unique network structure, which is consistent with the heterogeneous nature of OCD. Conclusion: Different OCD subtypes have different cognitive-behavioral network structures. According to the results of this study, these symptoms should be given priority in OCD theoretical models and treatment strategies.

Co-administration of probiotic and vitamin D significantly improves cognitive function in schizophrenic patients: A double-blinded randomized controlled trial.

AIM: Manipulation of the intestinal microbiome and supplying vitamin D can attenuate psychiatric symptoms in schizophrenic patients. The current study tried to evaluate the effects of probiotic/vitamin D supplementation on the cognitive function and disease severity of schizophrenic patients. METHODS: In the present study, 70 patients (aged 18-65) with schizophrenia were recruited. Participants were randomly allocated to the placebo (n = 35) and intervention (probiotic supplements+400 IU vitamin D, n = 35) groups. Severity of disease and cognitive function (primary outcomes) were evaluated by Positive and Negative Syndrome Scale (PANSS) and Montreal Cognitive Assessment (MoCA) tests, respectively. Moreover, lipid profile, body mass index (BMI), gastrointestinal (GI) problems, serum C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were evaluated as secondary outcomes. RESULTS: A total of 69 patients completed the study. The MoCA score was increased by 1.96 units in the probiotic-containing supplement group compared to the placebo (p = 0.004). Also, the percentage of subjects with MoCA score ≥ 26 rose significantly in the intervention group (p = 0.031). Moreover, TC (p = 0.011), FBS (p = 0.009), and CRP (p < 0.001) significantly decreased in the supplement group compared to the placebo. Although the probiotic supplement reduced PANSS score by 2.82 units, the difference between the study groups was not statistically significant (p = 0.247). CONCLUSION: Co-administration of probiotics and vitamin D has beneficial effects on the improvement of cognitive function in schizophrenic patients.

Factors associated with suicidal ideation among medical residents in Tehran during the COVID-19 pandemic: A multicentric cross-sectional survey.

BACKGROUND: The mental health of medical residents, challenged by their intensive training, is of utmost concern. In light of reported suicides among Iranian medical residents in 2021, this study investigates the factors behind suicidal ideation among medical residents during the COVID-19 pandemic in Tehran. METHODS: This study conducted a cross-sectional online survey among medical residents in various specialties in Tehran, Iran, amidst the COVID-19 pandemic. Suicidal ideation was assessed using the Beck Scale for Suicidal Ideation (BSSI), while depression, anxiety, and stress were measured using the DASS-21. It also collected demographic and clinical data from the participants. The data were analyzed using descriptive statistics, the Chi-square test, and multiple linear regression to examine the prevalence and determinants of suicidal ideation among medical residents. RESULTS: The study enrolled 353 medical residents and found that 34.3% of them had suicidal ideation, with 10.2% indicating a high risk. The study also found high levels of depression, anxiety, and stress among the participants. The variables that significantly predicted suicidal ideation were depression, history of alcohol/substance use, personal history of suicide attempts, history of self-mutilation, family history of suicide attempts, number of shifts in a month, death of close persons because of COVID-19, and income. Depression was the strongest predictor of suicidal ideation. CONCLUSION: These findings underscore the urgent need for effective interventions and support systems to address the mental health needs of medical residents in Iran. The strategies should prioritize destigmatizing mental health, promoting access to mental health services, fostering a supportive training environment, and enhancing income opportunities.

Comparison of Caregivers' Burden among Family Members of Patients with Severe Mental Disorders and Patients with Substance Use Disorder.

Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder. Method : First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers. Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers' burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013). Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.

Social and demographical determinants of quality of life in people who live with HIV/AIDS infection: evidence from a meta-analysis.

The aim of this meta-analysis is to summarize the available evidence on the social and demographic determinants of health-related quality of life (QoL) for HIV-infected populations in order to provide a direction to policy makers, planners, and program developers on how best to use their resources to improve the QoL of HIV-infected people.PubMed, Science Direct, Web of Science, and Cochrane electronic databases were searched (up to February 2017) to identify the relevant studies. A meta-analysis was conducted with procreate polled odds ratios (ORs and ß) and the confidence intervals of 95% on determining factors of QoL in social and demographic terms. Random effect model was applied to calculate pooled estimation, due to varied sampling methods of researches.In total, 5607 papers were identified from 4 databases and additional search in reference lists. Of these, 2107 articles were selected for full-text review. We included 19 studies that met the eligibility criteria. The pooled effect size shows a relative positive impact of social support for QoL among HIV/AIDS patients and its lower boundary is about 0.61 and the higher about 1.49. The pooled effect size has a considerable negative impact stigma on people who live with HIV/AIDS (PWLHs') QoL ranges from -0.34 to -0.32. Low socioeconomic status (poverty situation) was found to have a degenerative impact with PWLHs' QoL. Our finding indicates an association between younger 35 and QoL is negative with a relatively wide range, the minimum level of education has a weak association with PWLHs' QoL (ES: 0.14-0.2).There are several sociodemographic determinants of QoL among PWLHs and in this study, we found that stigma, low level of socioeconomic status, and being younger than 35 years old have a negative association with QoL, while the social support showed a positive association and a minimum level of education did not show a rigorous negative or positive association.

Investigating the Attitude of Graduate Psychiatrists towards Objective Structured Clinical Examination (OSCE) and Conventional Clinical Interview Examination.

OBJECTIVE: In the present study, we investigated the attitude of psychiatrists who graduated in 2002-2009 towards Objective Structured Clinical Examination (OSCE) and conventional clinical interview examination (Individual Patient Assessment). METHOD: We studied 134 psychiatrists graduated; half of whom were examined with conventional clinical interview and the others with OSCE. A questionnaire was prepared by a specialist workgroup to assess the participants' attitude towards the exams. The questionnaire was initially examined in a pilot study. The findings of the questionnaire were used to assess the graduates' attitude towards each examination, as well as to compare the examinations. RESULTS: The OSCE group indicated a significantly more positive attitude compared to the conventional group (p = 0.03). Furthermore, the OSCE group believed the role of theoretical knowledge (p = 0.01) and pre-test practice (p = 0.03) to be significantly greater for success compared to the other group. The structure of OSCE was reported to be superior to conventional examination in terms of fairness and homogeneity (p = 0.004). First participation in exam (p = 0.04) and ultimate success in the exam (p = 0.009) were predictors of graduates' attitude. CONCLUSION: Based on examinees 'attitudes, OSCE may be a more appropriate choice for graduation examinations of psychiatry compared to the conventional clinical interview examination.

Topiramate Add-on Lithium Carbonate for Treatment of Acute Mania.

OBJECTIVE: The purpose of this study was to evaluate the effect of adjunctive topiramate in treating acute mania. METHODS: In this study which was a double-blinded randomized clinical trial, 46 bipolar patients in manic episode, were treated with lithium carbonate and topiramate versus lithium carbonate and placebo and treatment responses were assessed by Young Mania Rating Scale (YMRS) weekly. RESULTS: In both intervention and control groups, YMRS score had significant decline after 8 weeks(p < 0.001), but there was no statistically significant difference between the two groups (p = 0.419). The highest score decline was after two weeks. YMRS score at baseline did not have statistically significant difference between the intervention and control groups (p = 0.709). CONCLUSIONS: This study failed to show antimanic efficacy of adjunctive topiramate in the treatment of those with acute manic. DECLARATION OF INTEREST: None. CLINICAL TRIAL REGISTRATION: URL: http://www.irct.ir.IRCT201110317960N1.