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Background and objectives The etiology of schizophrenia (SCZ) is not yet known, but the genetic factor has an essential role. Its heritability is estimated up to 85 percent. This study aimed to determine whether the selected brain-derived neurotropic factor (BDNF) gene variant (rs6265) is associated with SCZ, its psychopathology and intelligence quotient (IQ). Methods Rs6265 was genotyped in 159 participants, including 71 unrelated patients with SCZ (males = 40 [56%]) and 88 healthy controls (males = 35 [40%]). Psychopathology assessment was done by using positive and negative symptoms scale (PANSS), and IQ was measured by Wechsler adult intelligence scale (WAIS). COCAPHASE and CLUMP22 softwares were used to compare allele and genotype frequencies respectively. Two-way multivariate ANOVA was done using SPSS22 to evaluate the effects of the group (patients and healthy control) and the genotype on the test scores, including PANSS and WAIS scores, considering sex and smoking status as covariates. Results The study showed that the BDNF rs6265 C allele and CC genotypes, psychopathology, including PANSS scores, and also IQ were significantly different in all, male and female patients compared to healthy participants. For rs6265, we found significantly higher frequencies of the C allele (P = 0.04) in all participants with SCZ. The findings also revealed that BDNF polymorphism (rs6265) increased significantly the risk of SCZ in different genetic models. Conclusion The results showed that the BDNF rs6265 may be associated with the risk of SCZ development in an Iranian group of patients with SCZ. These results may be helpful in better understanding the role of the BDNF gene in the pathogenesis of the disorder.

This study aimed to explore the spiritual pain concept in the Iranian-Islamic context using a hybrid research model during 2020-2021. During the first phase, international and Iranian-Islamic literature was systematically searched and reviewed. During the second phase, the researchers referred to oncology wards, palliative care centers, and intensive care units and conducted unstructured interviews with 19 dying patients. In the third phase, attributes, and final analysis of spiritual pain was extracted from the first phase, and following the second phase, the definition of spiritual pain was finalized. The results showed that spiritual pain is a type of unique transcendental pain in the context of a continuum, rooted in human nature. At the one end of the continuum, there is the pain of deprivation from worldly pleasures (oneself, the family, and others). At the other end, there is the pain of breaking away from and striving to return to one's origin (God). Exploring spiritual pain in the Iranian-Islamic context can help develop tools and clinical guidelines and plan for the presence of specialists at the bedside to relieve this pain.

Introduction: Recent studies have shown that Polyunsaturated Fatty Acids (PUFAs), including Eicosapentaenoic Acid (EPA), and Arachidonic Acid (AA), are associated with cognitive functions in patients with Coronary Artery Disease (CAD). Nevertheless, controversial results have been reported, too. The current study aimed to clarify the association of serum EPA and AA levels with cognitive decline in an Iranian sample with CAD. Methods: We evaluated cognitive function with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), in relation to serum levels of EPA and AA, in 179 CAD patients. The associations between the MMSE and MoCA scores and the other demographic parameters were evaluated. Results: Patients with CAD generally had mild cognitive impairment. But we could not find any significant correlation between PUFAs and cognitive function. However, BMI was associated with EPA/MoCA; age was associated with MMSE/MoCA and BMI. Finally, the correlation between sex and MMSE/MoCA was significant. Conclusion: Subjects generally had mild cognitive impairment, but we could not find any significant correlation between serum EPA and AA levels with cognitive function.

Background Obsessive-compulsive disorder (OCD) is an anxiety disorder that causes impairment in daily activities. This study aimed to assess the safety and efficacy of transcranial direct current stimulation (tDCS) as adjunctive therapy with fluoxetine in individuals diagnosed with moderate to severe OCD. Methods This is a randomized, double-blind sham-controlled trial. Individuals with OCD who had baseline Yale-Brown obsessive-compulsive scale (Y-BOCS) of > 15 were enrolled. Eligible cases were randomly assigned in 1:1 ratio to receive either 20-min-period of stimulation with tDCS and fluoxetine (experimental arm) or fluoxetine only (sham control arm). The anodal electrode of tDCS was placed over the left dorsolateral prefrontal cortex (Fp3) and the cathodal electrode was placed over the right orbitofrontal cortex (F8). Two mA electrical stimulation with the tDCS was used for 20 min in individuals of experimental group. In the control group, electrodes were placed and stimulation was administered for 30 s to induce the same skin sensation as in experimental group. This procedure was performed three times per week for 8 weeks. Y-BOCS test was assessed at baseline, week 4 (after 12th stimulation), week 8 (after 24th stimulation), and 1 month after the last stimulation. The primary endpoints were the mean changes in Y-BOCS total score from baseline to the last visit. The secondary endpoints were the mean changes in obsession and compulsion sub-scores from baseline to the last visit. Adverse events were also assessed. Mixed design repeated measures analysis of variance assessed the endpoints. Results Sixty individuals (30 in each group) were participated. All individuals in control group and 28 cases in experimental arm completed the trial. The mean Y-BOCS (F(1.85) = 30.83; P (2.23) = 25.01; P (2.06) = 10.81; P P > 0.05). The tDCS was well tolerated and no major adverse events were reported. Conclusion This study showed that among individuals with moderate to severe OCD, there was no significant difference regarding OC symptoms between cases used tDCS as adjunctive therapy with fluoxetine and individuals used fluoxetine only. Trial registration IRCT2017030632904N1. Registered 14 July 2017, http://irct.ir/user/trial/44193/view

Background and Objectives: The decreased level of self-esteem and life satisfaction is prevalent among patients with coronary artery disease (CAD). The present study aimed to investigate the effectiveness of an Islamic approach to hope therapy on the promotion of self-esteem and life satisfaction in comparison with its conventional approach in patients with CAD. Methods: The study was conducted in a quasi-experimental control group pretest-posttest design. The participants were 60 patients with CAD selected by convenience sampling method from one of Qom hospitals. Data collection tools included the Self-Esteem Scale, Satisfaction with Life Scale, and Hope State Scale. After collecting pre-test data, participants were divided into three peer groups, and the intervention was performed in eight sessions each lasting for 90-minute. An experimental group was exposed to Islamic hope therapy and the other received conventional hope therapy, while the control group received a stress management package. Finally, all the groups undertook the same posttests and the data obtained were analyzed in SPSS22 software using the Covariance test. Results: Both Islamic and conventional hope therapy increased hope (7, 10.5), life satisfaction )9, 12.8), and self-esteem (7.5, 13.9) of the patients with CAD significantly. Moreover, it was found that Islamic hope therapy was more effective in the enhancement of self-esteem and life satisfaction, compared to conventional hope therapy. Conclusion: Islamic hope therapy outperformed the conventional hope therapy in terms of increasing the self-esteem and life satisfaction of patients with CAD. Therefore, it is recommended to use Islamic hope therapy for patients with CAD and other similar chronic diseases.

Education and creativity are interrelated, and motivation is regarded as a factor influencing creativity. On the other hand, it seems to be a connection between creative achievements and one’s perc...

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An overview of spiritual care studies can help reveal the dimensions of spiritual care and summarize the findings of available studies. Thus, we designed the present study based on existing studies to explain the dimensions of spiritual care.In this thematic analysis, we gathered the related articles published in Persian and English in the last 8 years (2013-2021) with the help of the keywords of Care, Support, Spirituality, Religion, Treatment, Hospice, and Palliative, and searching in electronic databases, including PubMed, Scopus, Web Of Sciences, Magiran, Islamic Science Citation (ISC), and Scientific Information Database (SID). We accurately studied 79 articles that met the inclusion criteria, and then the spiritual care components were extracted and coded, and finally, the codes were categorized as themes and sub-theme.Thematic analysis of available studies revealed that the dimensions (theme) of spiritual care include: spiritual and religious assessment, developing a structure for providing spiritual care, establishing effective and supportive communication with the patient, training the patient, answering his questions, encouraging, maintaining, and improving social communications, encouraging the patient to live happily, helping the patient to achieve peace and calmness, supporting for spiritual rituals and activities, supporting and training the patient's family, and supporting the dying patient.Spiritual care includes various and numerous dimensions. Considering the widespread dimensions of spiritual care, it seems necessary to design and plan appropriate studies to reveal other spiritual care dimensions from the perspective of patients and care providers in different cultures.

Background and objectives This study aimed to determine whether the selected neuregulin1 (NRG1) gene variants (rs2439272 and rs6988339) are associated with schizophrenia, and Cognitive Impairments Associated with Schizophrenia (CIAS). Methods Participants with schizophrenia (N = 276) and healthy controls (N = 193) were enrolled. Cognitive assessment using the Wisconsin card sorting test (WCST) and Wechsler adult intelligence scale and genotyping for selected variants of NRG1 were performed. Results For both the rs2439272 and rs6988339, compared to healthy controls, we found significant higher frequencies of the G allele and the GG genotype in all and male participants with schizophrenia, and with all Wechsler adult intelligence score (WAIS) and Wisconsin card sorting test (WCST) scores (except for non-perseverative score) in all, male and female participants. Conclusions There was an association between rs2439272, rs6988339 of NRG1 variants and schizophrenia and CIAS (intelligence and executive functions).

Background In line with the significance of organizational commitment, the question arises "Do spiritual health and psychological well-being optimize teachers' organizational commitment?" The purpose of this study was to determine the relationship between spiritual health, psychological well-being and the organizational commitment of high school teachers. Methods This was a cross-sectional study in which, 346 teachers in Tehran high schools participated through multi-stage sampling. The data were collected using Ryff Psychological Well-being Questionnaire (1989), Spiritual Health Questionnaire in Iranian Society (2014) and Organizational Commitment scale of Allen and Meyer (1990), and their relationships were assessed. Results Psychological well-being and spiritual health had positive and significant relationship with teachers' organizational commitment. Furthermore, approximately 50% of variations in organizational commitment subscales could be explained by the variables of spiritual health and psychological well-being. Conclusion Psychological well-being and spiritual health can predict organizational commitment as the dependent variable among high school teachers.

Objective Based on the few population-based studies that have been conducted in the Middle East, we determined the incidence of stroke in Qom, one of the central provinces of Iran. Methods The Qom province includes an estimated at-risk population of about 1 million. During a 12-month period (November 2018–November 2019), all first-ever strokes occurring in the target population were registered. Hospitalized cases were ascertained by discharge codes. Out-of-hospital cases were ascertained by a prospective screening of emergency medical services, emergency departments, ambulances records, primary care clinics, rural and urban public health centers, primary care physician offices, and neurologists’ offices. Crude and age-adjusted incidence rates (per 100,000 person-years) were calculated. Results During the study period, 1462 first-ever strokes occurred with a mean age of 68.1 (17–103) years; of these 45.2% were females (661 cases). The crude annual incidence rate per 100,000 at-risk populations was 145.4 (95% confidence interval, 138.1–153.0) for all types of stroke (156.5 for males and 134.3 for females), 26.4 (95% confidence interval, 23.5–29.8) for hemorrhagic stroke, and 114 (95% confidence interval, 105–121) for ischemic stroke. The incidence rate adjusted to the world population was 201.4 (95% confidence interval, 193–210) per 100,000 at-risk populations (adj incidence, 218.5 for males vs 187.4 for females). The total fatality rate during the first 28 days was 19.6%. Conclusion This study states that in this region there is a high incidence of stroke, which occurs at a younger age than the global average. There was a high prevalence of underlying stroke risk factors.

Background Spirituality is recognized as an important issue in health care, and every individual has spiritual needs. Despite increased knowledge about spiritual care and its necessity, there is no unique agreed-upon framework for spiritual care among the practitioners. This study aimed to explore the concept from the viewpoint of both health-care providers and patients within the Iranian social, cultural and overall contexts and present a charter for providing spiritual care. Methods The first phase of the study was a systematic literature review. The next phase consisted of two qualitative studies on the components of spiritual care from the perspective of healthcare providers and its dimensions as perceived by patients. The findings were then integrated to make up a charter draft that was accredited through expert opinion. Results The review of literatures led to the identification of two main themes and 10 themes. Perspectives of health-care providers were categorized into four main themes and 10 themes, and patients’ opinions were classified into three main themes and 11 themes. The themes and their subthemes were integrated to build the concepts and form the proposed charter with 30 statements. Conclusion The charter of spiritual care for patients is intended to present an agreed-upon framework for spiritual care delivery and resolve some of the problems in this path. This can improve health-care delivery system.

Background and Objective:Hope therapy is an efficient and positive psychology intervention used to treat chronic diseases. The purpose of this study was to investigate the effect of hope therapy on anxiety and depression using an Islamic approach and compare this approach with conventional hope therapy in coronary heart disease (CAD) patients. Materials and Methods:The study was conducted in the form of a randomized trial with pre- post-test, and control groups. A total of 45 patients with CAD were sampled through convenience sampling from a hospital in Qom city, Iran. Data were collected using Snyder’s hope questionnaire, and the Hospital Anxiety and Depression Scale (HADS). After collecting pre-test data, the participants were randomly divided into three groups of peers, and the intervention sessions were performed in eight sessions of 90 minutes each. One experimental group received Islamic hope therapy, and the other experimental group was exposed to conventional hope therapy, while the control group received a stress relief package. All three groups undertook a post-test, the data from which were analyzed by SPSS 22, using Levin, Kolmogorov-Smirnov, and covariance tests. Results:Islamic and conventional hope therapy both significantly outperformed the stress relief package in terms of increasing hope and decreasing depression. Also, Islamic hope therapy had an especially significant effect on reducing anxiety. Conclusion:Islamic hope therapy seems similar to conventional hope therapy in its ability to increase hope and reduce depression and is more effective in reducing anxiety. Therefore, it could be helpful in treatment of patients with CAD and other chronic diseases that cause patients a high level of anxiety.

Background and Objectives: Philosophy of medicine as a field of study mainly concentrates on issues, such as ontology, epistemology, axiology, and logic. Although axiology has attracted more attention due to its position in medical ethics, especially in relation to modern medical ethical challenges, other topics of philosophy of medicine should be also considered important and necessary. Developing training courses at prestigious universities, publication of journals and books, holding conference meetings, are indicative of special attention to this relatively new field of knowledge. Some stipulated goals of Iran medical education system, such as critical thinking and problem solving skills, have also made these issues important and necessary to be paid attention to. Addressing philosophy of medicine in medical education program, can lead to contemplation on critical thinking, nature of rational thinking, its governing rules, and its role in health care system, and this is while, medical education system has taken distance from combination of wisdom and medicine, which is the main feature of former and influential Iranian physicians. Graduates of medical education system and provider of health services need to know the principles of health anthropology and the nature of health and disease in order to consider humans to be more than a body and to possess special dignity, and apply their professional practices and behaviors according to this approach. It seems that presenting the mentioned issues as a course entitled "Introduction to Medical Philosophy" to the medical students, may changes the attitude of health care providers. &nbsp

This article is a Letter to the Editor and does not include an Abstract.

Background & Objective: Mild cognitive impairment (MCI) is a transient state between normal condition and dementia. Available data indicates that coronary artery diseases (CAD) may increase the risk of MCI. Hence, the early detection of MCI can prevent the progression of cognitive decline. Materials & Methods: A sample of 65 subjects with degrees of CAD was enrolled to the study. For cognitive assessment, Mini Mental State Examination and Montreal Cognitive Assessment were used. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of MoCA were assessed in the cut-off points of 26 and 25. The SPSS 22 was used for data analysis. The statistical significance was set at P-value. Results: The prevalence of cognitive impairment was calculated 41.5% and between 47.7% and 60% by MMSE and MoCA, respectively. At the cut-off point of 25 for MoCA test, the sensitivity and specificity were 92.6% and 84.2%, and PPV and NPV were 80.6% and 94.1%, respectively, and the efficacy of MoCA test for the detection of MCI was 87.69%. At the cut-off point of 26 for MoCA test, the sensitivity and specificity were 96.3% and 65.8%, and PPV and NPV were 66.7% and 96.2%, respectively, and the efficacy of MoCA test was 78.46%. Conclusion: The prevalence of MCI in patients with CAD was higher than what was previously reported. The MoCA was more sensitive for recognizing the MCI in these patients. We suggested the cut-off point of 25 for the higher accuracy of the MoCA in detecting MCI in CAD patients.

Background: Chronic abuse of methamphetamine and morphine may result in cognitive impairment with negative consequences for patients’ treatment and rehabilitation. Objectives: We applied Conner’s CPT II (continuous performance test) to determine the effect of methamphetamine and morphine use on patient performance in terms of type of substance use. Methods: The research was performed at the Tehran University of Medical Sciences, Iran, during the autumn and winter of 2014. Twenty-two male patients previously dependent on morphine, twenty-one former methamphetamine abusers, and nineteen healthy controls were assessed by Conner’s CPT II. The patients groups were pure consumers of their drug of choice in the last six months before treatment, and were in their abstinence period without intoxication or withdrawal symptoms. Initially, the potential depression and anxiety levels of volunteers were evaluated with the Hamilton questionnaire, and then a computerized CPT test was performed. Results: Omission errors (P = 0.008) and variability (P = 0.02) in the methamphetamine group and variability in ex-morphine users were significantly higher in comparison with healthy controls (P = 0.004). Conclusions: Significant differences in CPT performance were observed between the methamphetamine group and the healthy control group.

Stroke is the third leading cause of death. The role of genetics in the etiology and development of this disease is undeniable. As a result of inadequate previous research, more and more studies in the field of genetics are necessary to identify pathways involved in the pathogenesis of stroke, which in turn, may lead to new therapeutic approaches. However, due to the multifactorial nature of stroke and the few studies conducted in this field, genetic diversity is able to predict only a small fraction of the risk of disease. On the other hand, studies have shown genetically different architecture for different types of stroke, and finally pharmacogenomics as an important part of personalized medicine approach, is influenced by genetic studies, all of which confirm the need of addressing the topic by researchers.

Background: During the last two decades, much effort is put to better understand the etiology of schizophrenia. Studying negative symptoms such as endophenotypes is a plausible approach to elucidate the genetic basis of schizophrenia. Neuregulin-1 (NRG1) is a key candidate gene to develop schizophrenia and its negative symptoms. The NRG1 variant rs6988339 was previously characterized as a schizophrenia susceptibility locus in different Scottish populations. Objectives: The current study aimed to examine the association of rs6988339 with schizophrenia and its negative symptoms in an Iranian population. Methods: The current case-controlled study enrolled 469 subjects (276 unrelated schizophrenia patients and 193 healthy controls). The study investigated the association of rs6988339 with schizophrenia and its negative symptoms (assessed with the positive and negative syndrome scale; PANSS) in an Iranian population. Results: The obtained results showed that rs6988339 was a schizophrenia susceptibility locus in the Iranian population, the minor allele G was the risk allele and A the protective allele (P = 0.0007). Of the four subscales of the PANSS test, the negative score showed the strongest association with this variant (P = 0.001). Conclusions: The results further supported the implication of NRG1 in the pathogenesis of negative symptoms in schizophrenia.