Psychological Aspects of Pregnancy and Lactation in Patients with Breast Cancer.

Young breast cancer patients face numerous challenges during the cancer trajectory. As in the last decade, women tend to delay pregnancies to a later time in life, and clinicians are often faced with young breast cancer patients who want to start a family or complete it. Becoming a mother is a delicate developmental process in which the woman redefines and restructures her identity as she gets prepared for her new role and responsibilities. When there is a history of cancer or cancer diagnosis is communicated during the pregnancy, fears, worries, and concerns emerge and specific support may be necessary. Follow-ups during the post-partum period are also recommended as lactation issues should not be overlooked. In this chapter, we analyze the psychological aspects of cancer survivors and women with pregnancy-associated breast cancer, and the management of these issues.

Psychometric Evaluation of the Persian Version of the Chronic Illness Anticipated Stigma Scale (CIASS).

PURPOSE: The present study aimed to evaluate the cross-cultural validation and psychometric properties of the Persian version of the Chronic Illness Anticipated Stigma Scale (CIASS) among the patients with chronic illness in Iran. METHOD: Following standard procedures, the questionnaire was administered to a total sample of 186 patients with chronic illness who were recruited from the referral hospital, including hospitalized and clinic outpatients plus several referral clinics. Test-retest reliability and internal consistency were analyzed through intraclass correlation coefficient and Cronbach's alpha tests, respectively. Validity was evaluated in the areas of content and face validity, convergent, and also structural validity. RESULTS: Cronbach's alpha coefficient for the reliability of the scale was 0.88.The results of explanatory factor analysis confirmed extraction of all dimensions in three factors, consisting of family and friends, work colleagues, and healthcare workers. Evaluating convergent validity using Spearman's correlations showed satisfactory results; the correlation between the domains of the CIASS demonstrated internal agreement of the measure determining additional evidence to suggest the validity of the Persian CIASS. CONCLUSION: The preliminary study of the Persian version of the CIASS indicates good reliability and validity of the measure in Iranian patients with chronic illnesses.

Association between dietary inflammatory index and mental disorders using multilevel modeling with GLIMMIX.

Introduction: The Dietary Inflammatory Index (DII) is a composite nutritional index that has gained significant attention in the past decade due to its association with physical and mental well-being. To accurately assess the precise effects of DII on health outcomes, the effects of nutrients and foods need to be adjusted. This study aimed to investigate the association between DII and mental disorders (depression, anxiety, and stress) using multilevel modeling to minimize the bias of the previous methods. Methods: This cross-sectional analytical study was conducted using data from the initial phase of the Tehran University of Medical Sciences Employees' Cohort Study (TEC). Nutritional information was obtained through a dish-based semi-quantitative food frequency questionnaire (DFQ), while psychological data were collected using the depression, anxiety and stress scale (DASS-42). The acquired data were analyzed using multilevel modeling in three levels (foods, nutrients, and DII, respectively) through GLIMMIX in the SAS software. Results: A total of 3,501 individuals participated in this study. The results of the multilevel model demonstrated a significant statistical association between DII and mental disorders after adjusting for baseline characteristics, nutrients and foods. For each unit increase in DII, the mean scores for stress, anxiety, and depression increased by 3.55, 4.26, and 3.02, respectively (p < 0.001). Conclusion: Based on the multilevel model's findings, it is recommended to minimize the use of pro-inflammatory nutrients and foods to increase the mental health. Multilevel data analysis has also been recommended in nutritional studies involving nested data to obtain more accurate and plausible estimates.

Senior medical students' attitudes toward psychiatry as a career choice before and after an undergraduate psychiatry internship in Iran.

OBJECTIVES: The study aimed to assess 1) the attitudes of medical students in the sixth and seventh years (known as interns in Iran) toward psychiatry as a career choice, and 2) the degree of attractiveness of psychiatry as a career choice, with regard to various defined aspects, before and after an undergraduate psychiatry internship (similar to the medical school psychiatry rotation in the United States, but mandatory in Iran) in three major medical schools in Tehran, the capital of Iran. METHOD: Sixth- and seventh-year medical students (locally called interns, N=347) at Tehran, Shahid Beheshti, and Iran Universities of Medical Sciences were consecutively invited to complete anonymous self-report questionnaires designed to assess their perceptions of careers in psychiatry before and after internship in psychiatry wards. Also, students evaluated psychiatry in terms of the factors that reflected the degree of attractiveness of this specialty. RESULTS: Positive responses toward choosing psychiatry as a career were seen in 18.8% before and 20.0% after psychiatry rotation. No significant differences were observed in the positive responses before and after psychiatry internship. The students' opinions changed to a more attractive degree in terms of only 3 out of the 13 defined aspects. There was also no significant difference in the total score on attractiveness of psychiatry before and after the psychiatry internship. CONCLUSIONS: The study indicated that undergraduate psychiatry internship might not induce more students to consider psychiatry as a possible career. The present pattern of psychiatry education in Iran seems not to positively affect most aspects of medical students' attitudes toward psychiatry.

Burnout among hospital staff during the COVID-19 pandemic: Longitudinal results from the international Cope-Corona survey study.

OBJECTIVE: Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS: Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS: A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION: Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions. REGISTRATION: Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond.

OBJECTIVE: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. METHODS: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. RESULTS: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. CONCLUSION: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

Persian Translation and Cultural Adaptation of Mini International Neuropsychiatric Interview and its Psychometric Properties.

BACKGROUND: The main objectives of this study were the translation, cultural adaptation, and assessment of the psychometric properties of the Persian version of Mini International Neuropsychiatric Interview (MINI). METHODS: All processes of linguistic methodology were conducted according to the published guidelines. A total of 180 patients with psychiatric problems were interviewed using MINI and Structured Clinical Interview for DSM-5(R) - Clinician Version (SCID-5-CV) by different interviewers. Another 30 patients were selected for examining the test-retest reliability. The study sample was recruited from a psychiatric hospital and a general hospital in Tehran, Iran. Face validity, feasibility, time of the interview, test-retest reliability, and concurrent validity were evaluated. RESULTS: Mean interview time was 19.76±10.30 minutes, indicating satisfactory feasibility. The test-retest reliability was very good (phi=2, Cramer's V=0.89, P<0.0001). The kappa values showed good or excellent agreement between MINI and SCID-5-CV for psychotic disorders (0.88), substance-related disorders (0.86), bipolar disorder (0.85), major depressive disorder (0.84), obsessive-compulsive disorder (0.74), and mental disorder due to other medical disorders (0.7). However, the kappa values were found to be lower for generalized anxiety disorder (0.44) and posttraumatic stress disorder (0.32) diagnoses. CONCLUSION: The Persian version of MINI is a feasible, reliable, and valid instrument for diagnosing some mental disorders. Further research is needed to evaluate the validity of this instrument in other categories of psychiatric diagnoses in the general population.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study.

BACKGROUND: The health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed. MATERIALS AND METHODS: The participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software. RESULTS: A wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals. CONCLUSION: Based on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

Effects on knowledge and attitudes of using stages of change to train general practitioners on management of depression: a randomized controlled study.

OBJECTIVE: To assess the impact on knowledge and attitudes of a tailored educational intervention on depression using a modified version of the Prochaska stages of change model, compared with standard continuing medical education, for general practitioners (GPs) in primary care in Iran. METHOD: Using a randomized controlled trial, a total of 192 GPs were evenly randomized to intervention or control arm. The topic for the educational intervention was depressive disorders. The participants were divided in to small and large groups, depending on their initial stage of change. The GPs' knowledge and skills regarding management of depressive disorders were assessed through a questionnaire with 7 multiple choice questions, 11 Likert statements, 3 case vignettes, and 1 essay question. Attitudes toward management of depressive disorders were also assessed. Both questionnaires were validated. RESULTS: There was a significant improvement in knowledge mean scores regarding multiple choice and Likert questions (intervention effect 6%; P = 0.002), as well as for the case vignettes and essay question (intervention effect 12%; P = 0.011) in the intervention arm, in comparison with the control arm. There were significant changes in mean attitude scores in both study arms, but no difference between them. CONCLUSIONS: A theoretical model of medical learning and behavioural change can be used to devise educational formats that suit different stages of learning. Such tailored educational formats can improve GPs' knowledge and skills regarding management of depressive disorders.

Over-expression of TGF-ß1 gene in medication free Schizophrenia.

BACKGROUND AND PURPOSE: Immunological pathways play a crucial role in developing and precipitating neuropsychiatric disorders. Although the exact pathogenesis of schizophrenia is unknown, the possible role of genetic and biomarker involvement of the immune system is gaining attention. Here we quantified the mRNA expression of cytokines as a key role player of the immune system from the peripheral blood mononuclear cells of patients with schizophrenia and healthy controls to identify the differentially expressed genes. METHODS: Sixteen medication-free schizophrenia patients and 16 healthy subjects were enrolled in the current study. To investigate the desired expression level of mRNAs including TGF-ß1, IL-1ß, IL-23, TNF-α, NF-κB, and BDNF, quantitative real-time PCR was performed using specific oligonucleotide primers and the Applied Bio systems StepOne™ real time PCR system. DNA methylation was also analyzed through methylation-specific polymerase chain reaction (MSP). RESULTS: TGF-ß1 was significantly up-regulated in peripheral blood mononuclear cells of patients vs. healthy individuals (P value = 0.03). In addition, we found a significant correlation between the positive symptom scale and TGF-ß1 gene overexpression (r = 0.536, P = 0.039). However, we did not observe any statistically significant differences for the methylation status of CpG Islands 1 and 2 between the patients and normal group. No statistical significance was found either for gene expression of IL-1ß (P = 0.32), IL-23 (P = 0.12), TNF-α (P = 0.87), NF-κB (P = 0.07), and BDNF (P = 0.33). CONCLUSIONS: Although the number of medication-free schizophrenia patients is extremely limited, our data highlighted the potential role of TGF-ß1 as a regulatory cytokine in complex inflammatory mechanism involved in medication-free schizophrenia. In addition, we observed that increased level of TGF-ß1 mRNA in this disease might not be under methylation as an epigenetic control element at the genomic level.

Efficacy of selegiline add on therapy to risperidone in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study.

OBJECTIVE: It has been reported that selegiline, a Selective Monoamine Oxidase Inhibitor B (MAOI-B), at low doses would be helpful for treating negative symptoms in schizophrenia. Nevertheless, the results are contradictory so far. This study was designed to investigate the effect of selegiline added to risperidone as augmentation therapy in patients with chronic schizophrenia and prominent negative symptoms in an 8 week, double blind and randomized clinical trial. METHODS: Eligible participants in this study were 40 patients with chronic schizophrenia. All patients were inpatients and were in the active phase of the illness, and met DSM-IV-TR criteria for schizophrenia. Patients were allocated in a random fashion, 20 to risperidone 6 mg/day plus selegiline 10 mg/day (5 mg bid) and 20 to risperidone 6 mg/day plus placebo. The principal measure of the outcome was Positive and Negative Syndrome Scale (PANSS). RESULTS: Although both protocols significantly decreased the score of the positive, negative, and general psychopathological symptoms over the trial period, the combination of risperidone and selegiline showed a significant superiority over risperidone alone in decreasing negative symptoms and PANSS total scores. CONCLUSION: The present study indicates selegiline as a potential adjunctive treatment strategy for the negative symptoms of schizophrenia. Nevertheless, results of larger controlled trials are needed before recommendation for a broad clinical application can be made.

Influence of citicoline on citalopram-induced antidepressant activity in depressive-like symptoms in male mice.

Depression is associated with significant functional disabilities. Application of new drugs which could enhance the effectiveness of antidepressants drug and reduce side effects of their long-term use seems necessary. Citicoline is used as an effective chemical agent for improving the symptoms of some neurodegenerative diseases. Therefore, in this survey, the application of citicoline as an adjuvant drug was evaluated in mice model of depression. A total of 180 adult NMRI male albino mice were used in this study. All groups were exposed to chronic unexpected mild stress (CUMS) followed by treatment with various doses of citalopram or/and citicoline or saline for 21 days. Sucrose preference (SP), open field (OF), and forced swimming test (FST) were applied to evaluate depression symptoms in the groups. The results indicated that only citicoline at the 5 mg/kg dose had shifted its status from being noneffective to become significantly effective in the co-administered group. The means of SP, OFT, and FST of the treatment groups were significantly different in favor of co-administered group compared with the other groups as well as the control group. Based on the results, it can be concluded that administration of citicoline, as an adjuvant drug, in combination with citalopram, enhanced the effectiveness of selective serotonin reuptake inhibitors (SSRI) drugs for depression treatment.

A Survey on Mental Health Status of Adult Population Aged 15 and above in the Province of Kermanshah, Iran.

INTRODUCTION: This research aims to determine the mental health status of population aged 15 and over in the province of Kermanshah in 2015. METHODS: The statistical population of this cross-sectional field survey consisted of residents of urban and rural areas of Kermanshah in Iran. An estimated sample size of 1200 people was chosen in three clusters: Kermanshah, Islamabad-e-Gharb, and Sonqor by using the systematic random sampling method. The General Health Questionnaire-28 (GHQ-28) was used as the screening tool for evaluation of status for mental disorders. The traditional method for scoring of GHQ-28 was used in this study. Data analysis was carried out using the SPSS-18 software. RESULTS: Response rate for the study was 97.83%. The results showed that 26.2% of individuals (29.4% of females and 23% of males) were suspected to suffer from mental disorder, in total. The prevalence of being suspected of mental disorders was 28.9% in urban and 19.7% in the rural areas. Somatization and anxiety symptoms were more prevalent than social dysfunction and depression symptoms and were more common in women than men. The results of this research also showed that the prevalence of being suspected of mental disorders increased with aging. Suspicion for these disorders was more common in females, those aged ≥65, people living in urban areas, divorced and widowed, illiterate, housewives and unemployed individuals compared with the other groups. CONCLUSION: This study showed that more than a quarter of the people in Kermanshah province were suspected to have mental disorders. These findings mandate further attention in the province health policy and program planning for prevention and promotion of mental health.

The Persian Version of Örebro Musculoskeletal Pain Screening Questionnaire: Translation and Evaluation of its Psychometric Properties.

BACKGROUND: Screening of psychosocial risk factors for chronic low back pain (LBP) is essential. The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) is one of the most recognized and widely used instruments for this purpose. This study aimed to translate the ÖMPSQ into Persian, to adapt it for Iranian culture, and to investigate its psychometric properties. METHODS: Using a linguistic methodology, the ÖMPSQ was translated into Persian according to the World Health Organization guideline. A total of 106 patients with LBP participated in the study. Internal consistency and test-retest reliability were evaluated. Concurrent validity was estimated with Pearson's correlation between the ÖMPSQ and short form health survey (SF-12), Hospital Anxiety and Depression Scale (HADS), and visual analog scale (VAS). Factor analysis was used to evaluate dimensionality. RESULTS: The content validity index was 0.80. The instrument had a good test-retest reliability (intraclass correlation coefficient = 0.82) and internal consistency (Cronbach's α =0.82). Factor analysis indicates that factorial structure of Persian version was similar to original questionnaire. There was a significant correlation (r = 0.252-0.639, P < 0.01) between VAS score and all the ÖMPSQ domains. Physical component summary of SF-12 was positively correlated with miscellaneous domain (r = 384, P < 0.05) and negatively correlated with psychology domain of ÖMPSQ (r = -0.364, P < 0.05). A significant correlation between total score and anxiety component of HADS and psychology domain of ÖMPSQ was found (r = 0.49, P < 0.01 and r = 0.442, P < 0.05, respectively). Correlations between the ÖMPSQ and SF-12 and HADS and VAS indicate acceptable concurrent validity. CONCLUSIONS: The Persian version of ÖMPSQ was as a valid and reliable instrument and also a good cross-cultural equivalent for original English version.

Correlation between testosterone, gonadotropins and prolactin and severity of negative symptoms in male patients with chronic schizophrenia.

The aim of this study was to evaluate the relationship between plasma levels of testosterone, FSH, LH and prolactin and the severity of negative symptoms in patients with chronic schizophrenia. Fifty-four male inpatients with chronic schizophrenia participated in this cross-sectional study. Twenty-five age-matched men without a history of psychiatric disorders or endocrine illnesses were used as controls. All patients were on risperidone 4 mg/day or haloperidol 10 mg/day and anticholinegic medication, biperidine 3 mg/day. The patients were assigned to groups with predominant negative and nonpredominant negative symptoms on the basis of their scores on the Positive and Negative Syndrome Scale (PANSS). Plasma levels of testosterone and free testosterone in the patients with predominant and nonpredominant negative symptoms were significantly lower than those in normal controls. Furthermore, plasma levels of FSH and LH, in the patients with predominant negative symptoms but not in the nonpredominant negative symptoms, were significantly lower than those in the normal controls. In contrast, plasma level of prolactin in the predominant negative symptoms group but not in the nonpredominant negative symptoms group was significantly higher than the aged matched normal males. Significant inverse correlation between negative subscale scores of PANSS and plasma levels of testosterone and free testosterone in the patients with predominant negative symptoms were detected. There was also a positive correlation between prolactin plasma levels and negative subscale scores. The present study indicates that assessment of sex hormones and function of hypothalamic-pituitary-gonadotropin axis could be an important biological marker for the severity of negative symptoms in schizophrenia and these findings may change the present pharmacotherapy for negative symptoms based on neuroendocrinology profiles of patients with schizophrenia.

Psychosocial Status of Liver Transplant Candidates in Iran and Its Correlation with Health-Related Quality of Life and Depression and Anxiety.

Objectives. The study was aimed at providing a psychosocial profile for Iranian liver transplant candidates referred to an established liver transplantation program. Material and Methods. Patients assessed for liver transplant candidacy in Imam Khomeini Hospital (Tehran, Iran) between March 2013 and September 2014 were included. The following battery of tests were administered: Psychosocial Assessment of Candidates for Transplant (PACT), the Short-Form health survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Results. Psychosocial assessment in 205 liver transplant candidates revealed significant impairments in several SF-36 domains; social functioning was the least and physical functioning was the most impaired domains. The prevalence of cases with probable anxiety and depressive disorders, according to HADS, was 13.8% and 5.6%, respectively. According to PACT, 24.3% of the assessed individuals were considered good or excellent candidates. In 11.2%, transplantation seemed poor candidate due to at least one major psychosocial or lifestyle risk factor. Poor candidate quality was associated with impaired health-related quality of life and higher scores on anxiety and depression scales (p < 0.05). Conclusions. Transplant programs could implement specific intervention programs based on normative databases to address the psychosocial issues in patients in order to improve patient care, quality of life, and transplant outcomes.

Adjunctive estrogen treatment in women with chronic schizophrenia: a double-blind, randomized, and placebo-controlled trial.

The estrogen hypothesis of schizophrenia postulates that estrogen exerts a protective effect against schizophrenia and that this partly explains the observed sex differences in premorbid adjustment, onset age, treatment response, and illness course. It has been suggested that estrogen supplementation can augment the treatment effects of antipsychotics. The purpose of the present investigation was to access the efficacy of ethinyl estradiol as an adjuvant agent in the treatment of premenopausal women with chronic schizophrenia in an 8-week, double-blind, and placebo-controlled trial. Eligible participants in the study were 32 women of childbearing age with schizophrenia. All patients were inpatients, in the active phase of illness, and met DSM-IV criteria for chronic schizophrenia. Patients were allocated in a random fashion, 16 to haloperidol 15 mg/day plus ethinyl estradiol 0.05 mg/day and 16 to haloperidol 15 mg/day plus placebo for an 8-week, double-blind, placebo-controlled study. Although both protocols significantly decreased the score of the positive, negative, and general psychopathological symptoms over the trial period, the combination of haloperidol and ethinyl estradiol showed a significant superiority over haloperidol alone in the treatment of positive and general psychopathology symptoms as well as Positive and Negative Syndrome Scale (PANSS) total scores. Although the means Extrapyramidal Symptoms Rating Scale (ESRS) for the placebo group were higher than ethinyl estradiol group, the differences were not significant over the trial. A significant difference was observed between the overall mean biperiden dosages in the two groups. The results of this study suggest that estrogen may be an effective adjuvant agent in the management of women of childbearing age with chronic schizophrenia. Nevertheless, results of larger controlled trials are needed before recommendation for a broad clinical application can be made.

Establishing a liver transplantation program at Tehran University of Medical Sciences, Iran: a report of ten years of experience.

In 2001, a Liver Transplantation (LT) program was commenced in Imam Khomeini Hospital Complex as the first one in the capital city of Tehran which is the second liver transplantation center in Iran. This study presents the results of our 10-year experience with LT.