Loperamide Dependence: A Case Report

Background: Loperamide is used as an antidiarrheal drug and is available over-the-counter. It cannot pass the blood-brain barrier and it does not have a considerable abuse potential. It can lead to dangerous cardiac arrhythmia.Case Report: Herein, we report a 35-year-old man with a 13-year history of abusing opioids who had undergone detoxification for four times during this period. He underwent detoxification for using 200 mg loperamide daily with anticholinergic agents, clonidine, non-steroidal analgesics, and diazepam. No evidence of arrhythmia was seen in the patient.Conclusion: Tolerating high doses of loperamide could be dangerous and increases the risk of fatal cardiac arrhythmias

Stability of depressive symptoms over 3 months post-partum

Aim: Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. Methods: From a longitudinal cohortof 2279 women who attended Mazandaran’s primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. Results: The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. Conclusion: Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health

Perspective of postpartum depression theories: a narrative literature review

Postpartum depression is the most prevalent emotional problem during a women's lifespan. Untreated postpartum depression may lead to several consequences such as child, infant, fetal, and maternal effects. The main purpose of this article is to briefly describe different theoretical perspectives of postpartum depression. A literature search was conducted in Psych Info, PubMed, and Science Direct between 1950 and 2015. Additional articles and book chapters were referenced from these sources. Different theories were suggested for developing postpartum depression. Three theories, namely, biological, psychosocial, and evolutionary were discussed. One theory or combinations of psychosocial, biological, and evolutionary theories were considered for postpartum depression. The most important factor that makes clinicians' choice of intervention is their theoretical perspectives. Healthcare providers and physicians should help women to make informed choices regarding their treatment based on related theories

An Overview of the Research Reports on Addiction in Iranian Journals from 2010 to 2015

Background: The articles and research reports presented in the scientific journals are selected without a proper critical appraisal in many cases. This is a major problem, as it leads to the opinions of the experts being neglected in many of these scientific journals. A descriptive study was done in fall and winter of 2016.Methods: Journals were identified searching the electronic databases, including PubMed, Medline, Scopus, Google Scholar, and national Persian databases of SID and Magiran. All the articles on addiction published in the time span of 2010-2015 in 8 psychiatry, psychology, and addiction journals were included in this study. The journals included Journal of Behavioral Sciences, Iranian Journal of Psychiatry and Clinical Psychology, Journal of Fundamentals of Mental Health, and Journal of Research on Addiction in Persian, and Health and Addiction Journal, International Journal of Psychiatry and Behavioral Sciences, Journal of Research in Behavioral Sciences, and International Journal of Psychological Studies in English. These journals were evaluated according to their research design and methodology, scientific writing style, and the validity of the references. For all of the 264 articles, the research design and references were thoroughly evaluated.Findings: The most frequent problems were seen in the introduction section, the sampling method of study, the exclusive criteria, analysis, and the limitations of the study.Conclusion: Major deficiencies in the articles on addiction in Iranian journals were seen. It can be prevented by including important items in the checklists published by some of the journals for reviewers

Efficacy of Smoking Cessation on Stress, Anxiety, and Depression in Smokers with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Clinical Trial

Background: Stress, anxiety, and depression have been reported as very common comorbidities in smokers with chronic obstructive pulmonary disease (COPD). This study was aimed to investigate the effectiveness of smoking cessation on stress, anxiety, and depression in smokers with COPD. Methods: Three block-randomized controlled trial groups with a block size of 6 and 9 including guided self-change (GSC) (n = 19), nicotine replacement therapy (NRT) (n = 19), and combined GSC-NRT (n = 19) with a follow-up of 29 weeks were considered in this research. Participants included elderly adult smokers with COPD. The patients carried out 5 weekly GSC counseling sessions and NRT for smoking cessation. Transtheoretical Model (TTM) questionnaire, Fagerstrom Test for Nicotine Dependence (FTND), Depression Anxiety Stress Scale (DASS), the Beck Depression Inventory-II (BDI-II), and Hospital Anxiety and Depression Scale (HADS) as well as the exhaled carbon monoxide (CO) were evaluated over the baseline and 12 and 29 weeks following treatments. Findings: COPD participants with mean of 23 daily cigarette smoking completed the current study. The odds ratio (OR) of smoking cessation in GSC and GSC-NRT groups decreased more than NRT group. In addition, DASS, FTND, and the exhaled CO in GSC and GSC-NRT groups showed a better performance compared with the NRT group. Conclusion: The results showed that GSC and combined GSC-NRT therapy were significantly more effective than NRT alone. Also, the findings showed that GSC, NRT, and combined GSC-NRT were effective on stress, depression, and anxiety decreasing in smoking cessation. It seems that reducing smoking is associated with recovery in stress, anxiety, and depression in smokers with COPD

Study of Methamphetamine Use in Patients Referred to Emergency Ward of a General Hospital at North of Iran in 2017

Background: Acute use of methamphetamine affects the sympathetic system and causes symptoms like tachycardia, hypertension (HTN), tachypnea, peripheral blood vessels constriction, hyperthermia, and mydriasis that can lead to many medical complications. Thus, this study aimed to evaluate the use of methamphetamine, clinical symptoms, and admission causes in patients referred to emergency ward of Imam Khomeini General Hospital in Sari, Iran. Methods:In this cross-sectional study, 3263 patients were enrolled in the census. The population was patients referred to emergency ward of Imam Khomeini Hospital in Sari, in 2017. Clinical signs and symptoms, test results, primary and definite diagnosis, and patients' status during discharge or referral were extracted from medical records. Statistical analysis was performed using SPSS software. Findings: A total of 3263 people were enrolled in the study. The prevalence of positive methamphetamine test in patients referred to the emergency department was 1.2%, which was significantly higher in men (P = 0.017). The mean age was 39.9 ± 17.2 years. Methamphetamine users were more likely to be traumatized than the general population. There was a statistically significant difference in seizure (P = 0.003), chest pain (P < 0.001), tachycardia (P < 0.001), palpitation (P < 0.001), HTN (P = 0.002), tachypnea (P = 0.001), visual hallucinations (P = 0.001), auditory hallucinations (P = 0.001), paranoia (P = 0.001), grandiosity (P = 0.035), talkativeness (P = 0.001), suicidal ideation (P < 0.001), homicidal ideation (P = 0.001), violence (P < 0.001), and disorientation (P < 0.001) in positive methamphetamine test group. Conclusion: Methamphetamine use is more frequent in young men in the second and third decades of life. The most common clinical symptoms in these patients were HTN, chest pain, palpitations, tachycardia, seizure, aggression, anxiety, delusions, and hallucination

Drug-related Death low Registration in Iran: A Mixed Method Approach for Causes, Recommendations to Solve This Problem and Geographical Evaluation of an Intervention

Background: The death registration is conducted by different systems in Iran. The drug-related death registration is exclusively conducted by Ministry of Health and Medical Education (MOHME) and Legal Medicine Organization (LMO). This study investigates the causes of undercounting drug-related deaths (DRDs) in Iran, provides recommendations for addressing this issue, and provides a geographical evaluation of the integrity and quality of drug-related mortality registration (2014–2017).Methods: This is a mix-method study. In part1, individual targeted interviews were conducted with 12 experts in death registration in MOHME and LMO to collect data on the causes of low registration in Iran and provide recommendations for resolving the issue. Part2 of the study involved an intervention in the form of a memorandum of understanding on reduction of low-registrations. This memorandum was signed to transfer information about the corpses between the MOHME and LMO. First, the number of DRDs (2014-2017) was examined using capture-recapture method and, then, we calculated and compared the rate of pre intervention (2014-2016) and post-intervention (2017) under-registration to assess whether this memorandum of understanding had been effective in reduction of under-registrations.Findings: In part1, according to the participants, the causes of undercounting DRDs in LMO and MOHME were arranged and categorized into 4 categories: weak administration system, physician and personnel training problems, system constraints, and client-related problems. Also, some suggestions were presented to help resolving the problem of undercounting; these suggestions concern the administrative system, technology, and educational domains. In part 2, about half of the provinces in Iran had a positive performance in reducing the undercount.Conclusion: At the macro level, the memorandum of understanding between the two organizations responsible for registering deaths was effective. However, increasing the quality of data registrations requires monitoring at the micro and organizational levels to lead to a positive performance in reducing death under-registration in all provinces

Cognitive-Behavioral Therapy and Hypnosis Intervention on Anxiety, Depression, and Quality of Life in Patients with Breast Cancer Undergoing Chemotherapy: A Clinical Trial

Background: Women with breast cancer undergo painful and distressing treatment procedures. Hypnotherapy and cognitive-behavioral therapy (CBT) could be considered as an effective therapy. Method: In this clinical trial, 50 women aged 25 to 65 were assigned to three groups (CBT, hypnosis, and control groups). Eight one-hour treatment sessions were run for each of the hypnosis and CBT groups. We utilized The European Organization for Research and Treatment of Breast Cancer-specific Quality of Life (QoL), The European Organization for Research and Treatment of Cancer QoL questionnaires, and The Hospital Anxiety and Depression Scale for the evaluation of the QoL, anxiety, and depression at the beginning and end of the treatment, as well as six months post-treatment. Results: The improvements in the stress, depression, and qoL amongst the three groups were significant, although these improvements in CBT group were more than those in hypnosis group, and in hypnosis and CBT groups were not significant. Physical functioning, body image, sexual functioning, arm symptoms, breast symptoms, future perspective, pain, digestive problems, and functional scale significantly changed in CBT and hypnosis groups (p <0.05). Memory and social functioning; however, did not change in the groups and across the three groups. In addition, sleeping disorders and emotional malfunctioning were recovered only in the hypnosis group, which was statistically significant. Conclusion: We found hypnosis exclusively effective on reducing certain problems of breast cancer patients, such as sleeping disorders and emotional malfunctioning; therefore, it is suggested as an efficient solution for these patients’ problems

Willingness to Receive Treatment for Hepatitis C among Injecting Drug ‎Users on Methadone Program: Implications for Education and Treatment

Background: Hepatitis C virus (HCV) is common among people who inject drugs (PWID) on methadone program in Iran (Persia). However, a few PWID on methadone program report willingness to receive HCV treatment. This study aimed to assess the factors which were associated with willingness to receive HCV treatment in a group of PWID on methadone program in Iran.Methods: We surveyed 187 PWID at seven drops in centers in Tehran, Iran. Details of demographic characteristics, drug use, injection, HCV, and drug treatment history were collected a using 25-item questionnaire. Participants were serologically tested for the current status of HCV.Findings: The study found that 28.3% of the participants were HCV seropositive. In total, 49.1% of the participants reported unwillingness to receive HCV treatment. Awareness of current HCV status [odds ratio (OR) = 3.43; 95% confidence interval (CI): 1.33-7.26; P < 0.050]; adequate knowledge of HCV treatment centers in the community (OR = 3.9; 95% CI: 1.24-5.38; P < 0.050); participation in an educational program on HCV (OR = 2.9; 95% CI: 2.33-8.56; P < 0.001) and recent participation in the meetings of self-help groups (OR = 4.6; 95% CI: 3.43-9.33; P < 0.001) were significantly associated with current willingness to receive HCV treatment. Conclusion:The study results indicate that awareness of HCV status and the provision of adequate HCV education via different information centers can be associated with an increased willingness for HCV treatment among PWID on methadone program. Conducting more research is suggested to assess the efficacy of educational programs and self-help groups in facilitating HCV treatment among PWID on methadone program