Clinical and course indicators of bipolar disorder type I with and without opioid dependence

BACKGROUND: The existing evidence about the clinical situations of the bipolar patients with opioid dependence is scarce. The present study was carried out to compare the clinical features and course of the bipolar disorder type I regarding the two subgroups of opioid dependent and non-dependent. METHODS: There were 178 adult patients with bipolar disorder type I consecutively referred to the Iran Hospital of Psychiatry, Tehran, Iran, from January 2008 to January 2009 who enrolled in the study. The Persian Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), HDRS-17, and Y-MRS were administered for all patients. Other clinical information was gathered through the face-to-face interviews with the probands and the hospital records. The T test, Chi square test and logistic regression were used to analyze the data. RESULTS: The mean age of probands were 33.6 (± 11.1) years old and they were mostly male. Among the evaluated indices, the factors gender, anxiety disorders comorbidity, non-adherence, and positive family history were different significantly and independently from the other studied factors between opioid dependent and non-dependent bipolar patients. CONCLUSIONS: Despite some differences, the opioid dependent and non-dependent bipolar patients did not have any significant difference regarding most of the examined clinical and course indices

Association between anxiety and depression with dialysis adequacy in patients on maintenance hemodialysis

Background: Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients' survival rates. Objectives: This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. PatientsandMethods: In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5) with themeanage of 55.7-17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chisquare test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. Results: The prevalence rates of depression and anxiety (HADS score �8) were 31.5 and 41.7, respectively. The prevalence of both conditions was significantly higher inwomenthan inmen(P < 0.05). Themeanvalues of Kt/V andURRwere not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. Conclusions: Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy. © 2016, Mazandaran University of Medical Sciences

High frequency of bipolar disorder comorbidity in medical inpatients

Objective: Bipolar disorder is a severe, disabling, and recurring disorder. Some studies have shown that the frequency of bipolar disorder in patients with medical diseases is higher than healthy controls. The aim of this study was to investigate the frequency of bipolar disorders in medically ill patients hospitalized in Iranian general hospitals. Method: In this cross sectional study, 697 inpatients (342 men, 49.1) from different wards of 3 general hospitals, with the mean age of 39.3+-10, were enrolled in the study using nonprobability sampling. Demographic questionnaire, Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) were used. Inclusion criteria were as follow: informed consent, age 18-65 years, ability to speak Persian, and having at least middle school education. Results: The frequency of bipolar disorder was 12.1 and 20.8 based on BSDS and MDQ, respectively. The results of both tests were positive in 7.9 of hospitalized patients. The frequency of bipolar mood disorder was significantly higher in single patients and in those with comorbidity of alcohol and substance use disorders. Conclusion: Considering the high frequency of bipolar mood disorders in hospitalized medically ill patients and its probable effects on compliance and prognosis, early screening, diagnosis, and treatment of bipolar mood disorders is important in these patients. © 2019 Tehran University of Medical Sciences. All rights reserved

Spiritual care for cancer patients in Iran

Background: Studies have shown that a return to spirituality is a major coping response in cancer patients so that therapists can adopt a holistic approach by addressing spirituality in their patient care. The present study was conducted to develop a guideline in the spiritual field for healthcare providers who serve cancer patients in Iran. Materials and Methods: Relevant statements were extracted from scientific documents that through study questions were reviewed and modified by a consensus panel. Results: The statements were arranged in six areas, including spiritual needs assessment, spiritual care candidates, the main components of spiritual care, spiritual care providers, the settings of spiritual care and the resources and facilities for spiritual care. Conclusions: In addition to the development and preparation of these guidelines, health policy-makers should also seek to motivate and train health service providers to offer these services and facilitate their provision and help with widespread implementation

Demographic and diagnostic features of 3147 inpatients with mood disorders in Iran

Objectives: To assess and compare demographic and diagnostic characteristics of inpatients with mood disorders in Iran. Materials and Methods: We collected the demographic, clinical, and treatment characteristics of patients, who were hospitalized during five years from April 2006 to March 2010, in Iran hospital of psychiatry, a residency training center to evaluate the general clinical picture of the disorder. Results: Overall, 95.3 of subjects had a diagnosis of bipolar I disorder (BID), 2.5 were diagnosed as bipolar II disorder (BIID) and 1.3 and 0.9 met the criteria for major depressive disorder (MDD) and bipolar not otherwise specified (NOS), respectively. Compared to patients withMDDand BIID, the onset of BID was at an earlier age (32.2 ± 1, 34.8 ± 1.5 and 29.9 ± 1.9 years old, respectively, P < 0.001). In addition, a number of admissions, mean duration of each admission and number of treatments with electro-convulsive therapy (ECT) were significantly higher in patients with BID. Conclusions: Bipolar I disorder was the most common diagnosis for inpatients with mood disorders and a more severe course in BID may indicate more severe impairments that would result in more severe disabilities. © 2016, Mazandaran University of Medical Sciences

The relationship between maternal awareness, socioeconomic situation of families and metabolic control in children with type 1 diabetes miletus in an Iranian population

Background: Type 1 diabetes mellitus (T1DM) is one of the most common chronic pediatric conditions, with potentially life-threatening sequels. However, good metabolic control can protect the patients against sequels. Objectives: The aim of this study was to examine the relationship between awareness of the mothers about this disease on improving diabetic children metabolic control and also, to examine the relationship between socioeconomic situations of families and control of diabetes in this group of patients. Patients and Methods: This is a cross-sectional descriptive analytic study on 80 diabetic children and their mothers, who were registered in the diabetes association of Iran, for outpatient control of disease. Diabetes knowledge was measured by Michigan diabetes knowledge test and glycemic control was assessed by glycosylated hemoglobin (HbA1c). To assess the socio-economic status of a diabetic child's family, educational level, occupational and marital status of parents were asked and the socioeconomic status (SES) was evaluated with Hollingshed four-factor index of SES. Results: Mothers' mean knowledge score was 17.72, children's mean HbA1c was 7.77 and mean of SES was 27.89. There was no significant correlation between children's HbA1c and mother's SES. Also, there was an inverse linear relationship between mothers' knowledge score and children's HbA1c and there was a direct linear relationship between the mothers' knowledge score and SES. Conclusions: Finally, based on the results obtained in this study, it can be concluded that the awareness of mothers of T1DM children has a good impact on blood sugar control, whereas the SES of families has no direct effect on blood sugar control. Additionally, SES can indirectly impact on the consciousness of mothers and lead to the reduction of HbA1c. © 2015, Iranian Society of Pediatrics

Comparison between marital satisfaction and self-esteem before and after bariatric surgery in patients with obesity

Background: Obesity is one of the most common chronic diseases with important medical effects, as well as mental and social health problems. Bariatric surgery is one of the most effective treatments of morbid obesity. Objectives: Because of the possible psychological changes, and its effects on weight loss after surgery, the current study aimed to compare marital satisfaction and self-confidence in patients with obesity before and after bariatric surgery in Rasoul-e-Akram hospital in 2013. Materials and Methods: This prospective observational study was conducted on 69 candidates for bariatric surgery. Marital satisfaction and self-confidence were assessed before and six months after the surgery by Enrich marital satisfaction scale and Coopersmith self-esteem inventory. Descriptive statistics and T-tests were utilized to analyze data. Values of P � 0.01 were considered statistically significant. Results: Despite the improvement of sexual relationship, marital satisfaction scores significantly decreased from 141.26 ± 12.75 to 139.42 ± 12.52 six months after the surgery (P = 0.002). Satisfaction in scales of conflict resolution and communication showed a descending pattern (P < 0.001). No significant difference was found between self-esteem before and after the surgery (P = 0.321). Conclusions: Weight loss after bariatric surgery did not improve self-esteem and marital satisfaction six months post operatively; therefore, psychiatric assessment of patients before and after the surgery is crucial; since even if they are not associated with prognosis of the surgery, it is important to provide treatment for psychiatric problems. Prospective studies are recommended to assess post-operative changes of other psychological aspects. © 2016, Mazandaran University of Medical Sciences

Comparing the excessive daytime sleepiness of obese and non-obese patients

Background: Obesity, particularly morbid obesity, has various physical and mental complications. Excessive daytime somnolence (EDS) is a sleep disorder that reduces individuals� performance capability and the accuracy of their short-term memory and causes learning problems. This retrospective study aimed to document the presence of EDS in a sample of obese patients in comparison to patients with a normal weight. Objectives: This article compares the excessive daytime sleepiness of obese and non-obese patients in the minimally invasive surgery research center in Tehran, Iran. Patients and Methods: In this case-control study, we compared excessive daytime sleepiness in 55 obese patients who were candidates for laparoscopic surgery, with a body mass index (BMI) of equal to or greater than 30 kg/m2, with 55 controls with a normal BMI (19.5-24.9 kg/m2). The process of selecting the control group in our case-control study is matching in group levels, so that the controls are similar to the case group with regard to certain key characteristics, such as age, sex, and race. The sleep assessment was based on the Epworth sleepiness scale (ESS) questionnaire. Analysis of variance (ANOVA) was used to compare the means of quantitative data, such as the ESS score of groups. Results: Sleepiness was not affected by gender in cases or controls. The sleepiness prevalence was 29 (52.7) in the cases group and 17 (30.9) in the control group (OR = 2.493 (95 CI 1.144-5.435)). The mean ESS scores in cases and controls were 7.82 ± 3.86 and 10.54±6.15, respectively (P = 0.007). Moreover, the prevalence of sleepiness and the mean ESS scores in class III of obesity differed significantly from the controls (16 (57.1) vs. 17 (30.9)) (OR = 2.980 (95 CI 1.162-7.645)) and (11.04±5.93 vs. 7.82±3.86) (P = 0.013), respectively. Conclusions: Our findings suggest a strong relationship between EDS and obesity, particularly morbid obesity. Therefore, physicians must be familiar with EDS as a mixed clinical entity indicating careful assessment and specific treatment planning. © 2016, Iranian Red Crescent Medical Journal

The impact of depression, personality, and mental health on outcomes of total knee arthroplasty

Background: Precise assessment of preoperative mental health and psychological determinants may be useful in identifying patients at risk for poor postoperative outcomes of total knee arthroplasty (TKA). The aim of this study was to investigate the influence of psychological status and physical and mental health on the outcome of patients undergoing TKA. Methods: Fifty-two patients undergoing unilateral TKA were assessed preoperatively with Oxford Happiness Inventory, Eysenck Personality Inventory, 12-item short form health survey (SF-12), and Knee Injury and Osteoarthritis Outcome Score (KOOS) for evaluating depression, personality traits, physical and mental health, and function, respectively. At 1 year after surgery, health-related quality of life (HRQL) and function were assessed using the SF-12 and KOOS. Results: HRQL and function of all personality traits increased significantly after TKA, without significant difference among them. Extroversion and neuroticism did not have significant correlation with subjective well-being, HRQL, and function before and after surgery. Subjective well-being and the baseline physical and mental health scores were correlated strongly and directly with postoperative physical component summary, mental component summary, and KOOS scores and their improvement. Among many factors that significantly affected the outcomes of TKA, the only independent predictor of physical, mental, and functional outcome was depression. Conclusions: Outcomes of surgery were not significantly different among diverse personality traits. Patients with less depressive symptoms and higher baseline mental and physical scores had significantly greater improvement in HRQL after surgery. The only independent factor affecting the physical, mental, and functional outcome was depression. © 2020 by The Korean Orthopaedic Association

Comparison of demographic and diagnostic characteristics of Iranian inpatients with bipolar I disorder to western counterparts

Background: Patients' characteristics influence the disorders outcome, so it is valuable to compare mood disorders and inpatients' attributes in different large samples. Objectives: This study was designed to assess demographic and diagnostic characteristics of 3000 Iranian inpatient with bipolar disorders. Patients and Methods: We collected the information of demographic, clinical, and therapeutic characteristics of the patients who were hospitalized in Iran Hospital of Psychiatry, a university affiliated hospital in Tehran, during the 5 years from 2006 to 2011. Results: About 66.1 of the subjects were males and 33.9 were females. Iranian patients are characterized by a higher rate of unemployment, being more single, having health insurance and lower rate of divorce and education compared to the other clinical samples. In the majority of the patients, the disorder had begun with manic phase. Conclusions: Clinical and therapeutic features of Iranian patients are different from patients in western countries. © 2015, Mazandaran University of Medical Sciences