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Objectives: There are a few instruments available to assess sexual issues in Persian according to indigenous culture. This study aims to translate three instruments of Sexual Addiction Screening Test – Revised (SAST-R), Sexual Risk Survey (SRS) and sexual behavior subscale of the Youth Risk Behavior Surveillance System (YRBSS), and evaluate their psychometric parameters. Methods: After translating the selected instruments into Persian, a group of psychiatrists evaluated its content validity. The final versions were distributed among 92 participants (45 men and 47 women) selected from among the companions of patients referred to the clinics of Iran Psychiatric Hospital. Then, the factor structure and internal consistency of them were assessed. Results: The Cronbach’s alpha coefficient for Persian versions of SAST-R, SRS and sexual behavior subscale of YRBSS was obtained 0.878, 0.869 and 0.511, respectively. The factor analysis extracted 12 factors for the SAST-R explaining 71.4% of the variances, 5 factors for the SRS explaining 76.2%b of the variances, and 2 factors for the sexual behavior subscale explaining 56.7% of the variances. Conclusion: Persian version of the SAST-R has high internal consistency with a complex factor structure. The Persian version of SRS has high internal consistency with a well-defined factor structure, while the sexual behavior subscale of YRBSS has a good factor structure with a moderate internal consistency. These instruments can be used on Iranian population. Further studies are recommended to evaluate their construct validity and reliability.

Background: The negative experience of hospitalization in psychiatric wards is a common issue that can have destructive effects on treatment outcomes. Considering the significance of improving inpatient psychiatric care, this qualitative study was implemented to elucidate the patients’ experience of hospitalization in a psychiatric hospital from September 2017 to February 2018. Methods: The information was gathered using two approaches: focus groups, and in-depth individual interviews with hospitalized patients. Twenty-two patients, including 16 women and 6 men, participated in this research. Content analysis method was used for analyzing the data. Results: Participants’ negative experiences were categorized into three main categories: imprisonment, loneliness, and untrustworthy atmosphere. According to our study, the numerous restrictions and inflexible regulations of the ward, insufficient interaction with the psychiatrist and nurses, coercion, and insufficient physical facilities caused negative experiences. Conclusion: It seems to be critical that the extent of care for each patient be individualized and free of humiliation.

BackgroundBorderline personality disorder is a major mental illness characterized by sustained relationship instability, impulsive behavior, and intense affects. Adherence is a complex behavior, from minor refusals of treatment to abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and psychotherapy adherence, patients’ attitude towards medication, and assessing medication and treatment adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran.MethodsThe study was a retrospective cohort study. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. In the next step, we contacted the patients and asked them to fill out the questionnaires. Data were collected using the Drug Attitude Inventory-10 (DAI-10) questionnaire and a researcher-made questionnaire to determine the attitude of patients toward pharmacological and psychotherapy treatment as well as therapeutic adherence. After collecting data, patients’ therapeutic adherence was divided into three groups: poor, partial, and good compliance. The data were analyzed by SPSS software version-22.Results Ninety-four patients were involved in the study, and fifty-four were women. In psychotherapy adherence, patients with higher education and hospital admission history have better compliance. Findings of DAI showed that 54 (57.4%) participants had negative attitudes toward medication, while 38 (40.4%) participants showed a negative attitude toward psychotherapy treatment. Additionally, the percentage of patients who had good psychotherapy adherence (44.7%) was higher than that of patients with good medication adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%), and then fear of medication dependence (40%). Patients with higher education level and positive history of hospitalization in a psychiatric ward had better psychotherapy adherence (PConclusionsResults of the current study show that attitude toward psychotherapy is more favorable than pharmacotherapy among patients with BPD. The rationale may be medications are mainly prescribed for comorbid conditions, and do not have substantial effects on the BPD symptoms, resulting in low medication adherence.

Borderline personality disorder (BPD) is characterized by impairments in impulse control, social functioning along with a deficit in emotional awareness and empathy. In this study, nine BPD patiens filled out the demography, Interpersonal Reactive Index(IRI), Toronto Alexithymia Scale 20 (TAS 20), The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Borderline Evaluation Severity over Time (BEST) questionnaire. Default mode network (DMN) connectivity was measured using resting-state fMRI before psychodynamic psychotherapy and then every four months for a year after initiating psychotherapy. BPD patients present with aberrant DMN connectivity compared to healthy controls. Over a year of psychotherapy, the BPD patients showed both neuroimaging changes (decreasing nodal degree connection in the dorsal anterior cingulate cortex and increasing in other cingulate cortex regions) and behavioral improvement in their symptoms and substance use. There was also a significant positive association between the decreased nodal degree in regions of the cingulate gyrus and a decrease in the score of the TAS-20 indicating difficulty in identifying feelings after psychotherapy. In BPD, there is altered connectivity within the DMN and disruption in self-processing and emotion regulation. Psychotherapy may modify the DMN connectivity and that modification is associated with positive changes in BPD behavioral symptoms.

Background: Borderline personality disorder is a major mental illness characterized by a sustained relationship instability, impulsive behavior and intense affects. Adherence is a complex behavior, from minor refusals of treatment to inappropriate use of health services or even abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and non-pharmacological adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran.Methods: The study was a retrospective cohort. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. In the next step, we contacted the patients and asked them to fill out the questionnaires. Data were collected using the Drug Attitude Inventory (DAI) questionnaire and a researcher made questionnaire to determine the attitude of patients toward pharmacological and non-pharmacological treatment and therapeutic adherence. After collecting data, patients’ therapeutic acceptance was divided into three groups: poor, partial, good compliance. The data were analyzed by SPSS software version-22.Results: Ninety-four patients were involved in the study and fifty four of them were women. In terms of psychotherapy adherence, patients with higher education and hospital admission history have better compliance. Medication attitudes were negative in 54 patients (57.4%), while 40.4% of them stated that psychotherapy or counselling did not help their condition and showed a negative attitude toward non-pharmacological treatment. Additionally, psychotherapy good adherence of the patients (44.7%) was higher than medication good adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%) and then fear of medication dependence (40%). The results showed no relationship between other demographic factors and treatment adherence.Conclusions: Results of the current study show that attitude toward psychotherapy is more positive than pharmacotherapy. In addition, according to the results, working on changeable factors such as patients’ fear of dependence to medication, dissatisfaction with the therapist, and medication side effects may improve patients' treatment adherence.

Background While advances in the field of functional magnetic resonance imaging (fMRI) provide new opportunities to study brain networks underlying the experience of hallucinations in psychosis, there are methodological challenges unique to symptom-capture studies. Study Design We extracted brain networks activated during hallucination-capture for schizophrenia patients when fMRI data collected from two sites was merged (combined N = 27). A multidimensional analysis technique was applied, which would allow separation of brain networks involved in the hallucinatory experience itself from those involved in the motor response of indicating the beginning and end of the perceived hallucinatory experience. To avoid reverse inference when attributing a function (e.g., a hallucination) to anatomical regions, it was required that longer hallucinatory experiences produce extended brain responses relative to shorter. Study Results For radio-speech sound files, an auditory perception brain network emerged, and displayed speech-duration-dependent hemodynamic responses (HDRs). However, in the hallucination-capture blocks, no network showed hallucination-duration-dependent HDRs, but a retrieved network that was anatomically classified as motor response emerged. Conclusions During symptom capture of hallucinations during fMRI, no HDR showed duration dependence, but a brain network anatomically matching the motor response network was retrieved. Previous reports on brain networks detected by fMRI during hallucination capture are reviewed in this context; namely, that the brain networks interpreted as involved in hallucinations may in fact be involved only in the motor response indicating the onset of the hallucination.

SummaryAn analysis of an internationally shared functional magnetic resonance imaging (fMRI) data involving healthy participants and schizophrenia patients extracted brain networks involved in listening to radio speech and capture hallucination experiences. A multidimensional analysis technique demonstrated that for radio-speech sound files, a brain network matching known auditory perception networks emerged, and importantly, displayed speech-duration-dependent hemodynamic responses (HDRs), confirming fMRI detection of these speech events. In the hallucination-capture data, although a sensorimotor (response) network emerged, it did not show hallucination-duration-dependent HDRs. We conclude that although fMRI retrieved the brain network involved in generating the motor responses indicating the start and end of an experienced hallucination, the hallucination event itself was not detected. Previous reports on brain networks detected by fMRI during hallucination capture is reviewed in this context.

Introduction: Anti-N-methyl-d-aspartic acid receptor (NMDAR) autoimmune encephalitis is one of the most challenging disorders with both psychiatric and neurologic presentations. Approximately three-fourth of patients with anti-NMDA receptor encephalitis (anti-NMDARE) first referred to psychiatrists. Case Presentation: A 15-year-old female adolescent was admitted to a psychiatric hospital. She presented a history of behavior changes, including aggression, the symptoms mimicking depression, and suicidal ideation, for one year. Then she showed more severe disinhibited behaviors, stupor, and generalized tonic-colonic seizure, so she was hospitalized in a general hospital. After neurological assessments, she was referred to a psychiatric hospital due to her uncontrollable aggressive behaviors in addition to sleep disturbance, rapid mood swings, restlessness, stereotypic behaviors, fluctuating attention and concentration, misidentification delusion, and perceptual changes. All lab tests and brain images were normal. Electroencephalograms showed generalized sharp and slow waves. The autoimmune panel tests were requested. When anti-glutamate receptor antibody was finally reported in her CSF, anti-NMDARE was finally diagnosed. Her symptoms improved by receiving five corticosteroid pulses. Conclusions: In patients with first and acute psychotic symptoms, especially in young individuals with seizures, the possibility of autoimmune disorders should be kept in mind, and complementary tests must be done for autoantibody detection.

Background: Discharge from the hospital against the doctor’s advice and refusal of receiving treatment is one of the significant issues at the time of hospitalization, which is especially crucial in relation to psychiatric patients. It can exacerbate the disorder and the subsequent complications and increase further hospital admissions. The present study was designed to evaluate the causes of discharge from the hospital and the refusal of receiving treatment against medical advice in hospitalized patients in Iran Psychiatric Hospital. Methods: The present study was a descriptive cross-sectional study. One hundred patients hospitalized in Iran Psychiatric Hospital discharged with personal consent against medical advice from July to December 2018 were studied. Two methods were used for assessment; the fulfillment of a routine ministry-approved checklist by the dischargers themselves and the face-to-face interview with both the patient and discharger based on a researcher-made checklist. Cohen’s Kappa coefficient was used to assess the agreement of the answers of patients to both routine ministry-approved and researcher-made checklists by SPSS software version 16.0 with an overall accuracy of 95%. Results: Based on the results extracted from the researcher-made checklist, 43 (43%) of the discharges were generally based on patient-related factors. The personal insistence to discharge by the patient was cited as the main reason for discharge. Cohen’s Kappa coefficient showed no significant agreement between the patient’s answers to the interview and what they have previously filled in the routine ministry-approved checklist. More specifically, the measure of agreement for answers of patients to questions in the standard checklist and the questions asked by the interviewer was 0.078 (p=0.167). Conclusion: From the results of this study, it can be concluded that the face-to-face interview based on the researcher-made checklist can more effectively determine the reasons for discharge of patients due to the accuracy of the interview.

The objective of the cross-sectional study reported here was to compare the quality of life of patients with an appropriate stoma site and with that of patients with an inappropriate stoma site. Two groups of patients with permanent intestinal stomas were assessed, 174 patients with appropriate stoma sites and 174 patients with inappropriate stoma sites. We used the EORTC QLQ-C30 and the EORTC QLQ-CR38, which evaluate 26 quality of life (QoL) scales. Data analysis was performed with SPSS software. From a total of 9 functional scales, 3 scales in patients with an appropriate stoma site were significantly higher than in patients with an inappropriate stoma site: sexual enjoyment (71.2% vs. 63.2%; p = 0.02), physical functioning (74.3% vs. 68.2%; p = 0.005), and role functioning (74.3% vs. 64.4%; p

Introduction The objective of this study was to assess the nonpsychotic psychiatric disorders of stoma patients in Iran. Method In this cross-sectional study, patients referred to the Iranian Ostomy Association from 2005 to 2006 filled the 28-item General Health Questionnaire (GHQ) in Farsi as a screening instrument to identify cases of nonpsychotic psychiatric morbidity. Results A total of 155 patients participated in the study, of whom 79 (51%) were female and 76 (49%) were male. Fifty-five percent of the patients ( n =86) had psychiatric problems. The females' mean GHQ score was significantly higher than that of males ( P =.001). Psychiatric disorder was significantly more frequent among patients with the following specifications: educational level of high school or lower ( P =.001), mucosal hemorrhage of the ostomy ( P =.03), stomal stenosis ( P =.012), and history of psychiatric drug consumption ( P =.000). GHQ score decreased as stoma age increased ( P =.032; r =−.177). Discussion Similar to other complications, psychiatric problems are prevalent in Iranian stoma patients. Our findings highlight the need for special support.

Domestic violence (DV) especially intimate partner violence is a global health problem responsible for significant part of burden of diseases in women. Mental health problems such as depression and anxiety are possibly results and resulted in IPV. To investigate correlation between IPV and depression and anxiety among married women, in a household survey of married women in Tehran, Iran, at summer 2011, we recruited 615 samples with cluster sampling method and they are directly asked about experience of 23 different types of physical and non-physical IPV during marital life and last 12 months. Depression and anxiety were assessed by Beck depression inventory II (BDI) and Beck Anxiety inventory (BAI). Multinominal regression model was used to assess the independent relationship of factor on IPV. Mean (±SE) age and duration of marriage were 42.6 ± 0.9 and 22 ± 0.8, respectively. Non-physical violence and physical violence during marital life reported in 77.2 and 35.1 %. Clinically significant depression and anxiety was reported in 15.3 and 32.7 % of women, respectively. The odds ratio (95 % CI) of clinically significant depression and anxiety in DV victims were 5.8 (2.3-14.6) and 2.6 (1.6-4.3). DV as a social factor is significantly correlated factor with depression and anxiety. Comprehensive view and collaborative work to detect and address social determinants of mental illness like DV is a crucial point in mental health promotion programs.

The aim of this study was to determine the age of appearance of secondary sexual characteristics in Iranian girls living in Tehran. A cross-sectional study was conducted between 2003 and 2004 on 1420 6-17-year-old females in different parts of Tehran. Data were collected on the basis of a multistage probability sampling. Secondary sexual characteristics were evaluated by inspection and palpation, and were recorded according to Tanner staging. The subjects were asked about the occurrence of menarche and the age of its onset. Generalized additive logistic modelling was used for the analysis of data. The median age (percentile 10-percentile 90) of Tanner 2 of breast development (B2) and Tanner 2 of pubic hair growth (P2) among 1136 girls was 9.74 years (8.23-11.94) and 10.49 years (8.86-12.17), respectively. The ages of the 2.5 percentile for B2 and P2 were 7.42 and 7.03 years, respectively, so the onset of puberty at < 7 years and 5 months is considered precocious in this population. The median age of menarche in 399 girls was 12.68 years (11.27-15.96).