Depression and Anxiety in Iranian Mothers of Children with Epilepsy

How to Cite this Article: Soltanifar A, Ashrafzadeh F, Mohareri F, Mokhber N. Depression and Anxiety in Iranian Mothers ofChildren with Epilepsy. Iranian Journal of Child Neurology 2012;6(1):29-34. ObjectiveEpilepsy is a common neurological disorder in children. Parents with epileptic children have many psychosocial care needs. So the main goal of this study was to evaluate depression and anxiety in Iranian mothers with epileptic children.Materials & MethodsWe identified 30 mothers of children with epilepsy and 30 mothers of children without epilepsy with children aged between 8 and 12 years who met the study criteria. In all children with epilepsy, the mothers were the main caregivers and all these children lived in two-parent families. Children in the control group were in the same age. Ninety-eight percent of children in the control group lived in two-parent families with the mother as the main caregiver. All mothers fulfilled the Beck Depression Inventory (BDI) and Spielberger State-Trait Anxiety Inventory.ResultsAccording to these data, BDI scores were significantly higher in the mothers of epileptic children (mean of Beck score=16.5) compared to the control group (mean of Beck score=9.8). The total, Spielberger State-Trait Anxiety Inventory scores for mothers of children with epilepsy were 100.3, 51.7 and 48.6. However, these scores in the control group were 86.9, 45.1 and 41.8. These differences were statistically significant.In a second analysis, using the demographic data, we did not find any statistically significant relation between anxiety or depression and the mothers’ job, children’s medication and other demographic variables.ConclusionNeurologists and psychiatrists need to develop better programs for adequate management of psychiatric disorders in mothers with epileptic children. References 1. Cowan LD. The epidemiology of the epilepsies inchildren. 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J Neurosci Nurs 2009Oct;41(5):244-50.8. Pianta RC, Lothman DJ. Predicting behavior problemsin children with epilepsy: child factors, disease factors,family stress, and child-mother interaction. Child Dev1994 Oct;65(5):1415-28.9. Dunn DW, Austin JK, Huster GA. Symptoms ofdepression in adolescents with epilepsy. J Am Acad ChildAdolesc Psychiatr 1999;38:1133-8.10. Shore CP, Austin JK, Huster GA, Dunn DW. Identifyingrisk factors for maternal depression in families ofadolescents with epilepsy. J Specialists Pediatr Nurs2002;7:71-80.11. Yongli, Cheng-Ye ji, Jiong Qin, Zhi-Xiang Zhang.Parental anxiety and quality of Life of epileptic children.Biomed Environ Sci 2008 Jun;21(3):228-32.12. Williams J, Steel C, Sharp GB, DelosReyes E, PhillipsT, Bates S, et al. Parental anxiety and quality of life inchildren with epilepsy. Epilepsy Behav 2003;4:483-6.13. Lv R, Wu L, Jin L, Lu Q, Wang M, Qu Y, Liu H. Depression,anxiety and quality of life in parents of children withepilepsy. Acta Neurol Scand 2009 Nov;120(5):335-41.14. Baki O, Erdogan A, Kantarci O, Akisik G, KayaalpL, Yalcinkaya C. Anxiety and depression in childrenwith epilepsy and their mothers. Epilepsy Behav 2004Dec;5(6):958-64.15. Yam WK, Ronen GM, Cherk SW, Rosenbaum P, ChanKY, Streiner DL, et al. Health-related quality of lifeof children with epilepsy in Hong Kong: how does itcompare with that of youth with epilepsy in Canada?Epilepsy Behav 2008 Apr;12(3):419-26.16. Ghassemzadeh H, Mojtabai R, Karamghadiri N,Ebrahimkhani N. Psychometric properties of a Persianlanguageversion of the Beck Depression Inventory Second edition: BDI-II-PERSIAN. Depress Anxiety2005;21(4):185-92.17. Hojat M, Shapurian R, Mehryar AH. Psychometricproperties of a Persian version of the short form of theBeck Depression Inventory for Iranian college students.Psychol Rep 1986 Aug;59(1):331-8.18. Kalkhoran MA, Karimollahi M. Religiousness andpreoperative anxiety: a correlational study. Ann GenPsychiatry 2007;6:17.19. Mu PF, Kuo HC, Chang KP. Boundary ambiguity, copingpatterns and depression in mothers caring for children withepilepsy in Taiwan. Int J Nurs Stud 2005 Mar;42(3):273-82.20. Lv R, Wu L, Jin L, Lu Q, Wang M, Qu Y, et al. Depression,anxiety and quality of life in parents of children withepilepsy. Acta Neurol Scand 2009 Nov;120(5):335-41.21. (Wood LJ, Sherman E, Hamiwka LD, Blackman M,Wirrell E. Depression, anxiety, and quality of life insiblings of children with intractable epilepsy. EpilepsyBehav 2008 Jul;13(1):144-8.22. Tosun A, Gokcen S, Ozbaran B, Serdaroglu G, Polat M,Tekgul H, et al. The effect of depression on academicachievement in children with epilepsy. Epilepsy Behav2008 Oct;13(3):494-8.23. Rodenburg R, Meijer AM, Dekovic M, Aldenkamp AP. Family factors and psychopathology in childrenwith epilepsy: a literature review. Epilepsy Behav 2005Jun;6(4):488-503.24. Wirrell EC, Wood L, Hamiwka LD, Sherman EM. Parenting stress in mothers of children with intractableepilepsy. Epilepsy Behav 2008 Jul;13(1):169-73

The Relationship of Gender Role Attitude and Division of Household labor with Couples' Perceived justice

Background & aim: Given the advancements in science, technology, and cultural globalization, Iranian families has changed in several aspects affecting individual’s perception of justice in division of household labor. Therefore, we sought to evaluate the correlation of gender role attitude and household labor division with perceived justice in couples. Methods: The present correlational study was conducted in 180 couples visiting healthcare centers of Mashhad, Iran, in 2014. The participants were selected through the three-stage cluster sampling method. Data collection tools included questionnaires of gender role attitude, participation in household labor, and perceived justice. Spearman rho and Pearson correlation coefficient were run in SPSS, version 16. Results: A significant correlation was seen between women’s gender role attitude with their involvement in household labor and perceived justice (P=0.04, P=0.03, respectively). But there was no correlation between their involvement in household labor and perceived justice (P=0.83). There was no correlation between men’s gender role attitude and their involvement in household labor (P=0.61), whereas their gender role attitude was correlated with perception of justice (P=0.01, r=-0.13). There was also a direct correlation between male involvement in household labor and perceived justice (P=0.00, r=0.19). Conclusion: Most employed women despite having modern gender role attitudes, had still more involvement in household labor. Almost half of men who had traditional gender role attitudes, reported appropriate involvement in household labor. Men with more involvement in household labor had a higher perception of justice

Anxiety, Depression, and Spirituality Among Caregivers of Patients With Alzheimer Disease

Introduction: The nature of the Alzheimer’s disease gradually makes patients dependent to persistent care. This may have a large negative effect on the caregivers’ quality of life and predisposes them to psychological distress. Spirituality, however, may act as a buffer and enhance their adaptability with stressful conditions. This study aimed to evaluate the association between spirituality and symptoms of anxiety and depression in a sample of caregivers of patients with Alzheimer’s disease. Methods: In this cross-sectional study, 209 outpatients with moderate Alzheimer’s disease (using DSM-IV criteria and MMSE test) and their caregivers were selected. Patients’ and caregivers’ demographic data were recorded. The Spiritual Intelligence Questionnaire and Hospital Anxiety-Depression Scale were completed by caregivers. Results: Spirituality was negatively correlated with depressive symptoms. Spirituality, however, had a positive but non-significant correlation with anxiety symptoms. Conclusion: Although symptoms of anxiety and depression are highly prevalent in Alzheimer caregivers, only depressive symptoms are directly linked to spirituality. Spiritually-based approach may be a component of therapeutic interventions, in order to enhance caregivers’ adaptability

Anticonvulsant treatments of dysphoric mania: a trial of gabapentin, lamotrigine and carbamazepine in Iran

The treatment of dysphoric mania is challenging given the need to treat symptoms of both depression and mania simultaneously without provoking any clinical exacerbation. The newer antiepileptic drugs such as gabapentin, lamotrogine, and carbamazepine are often used as adjuncts to either lithium or valproic acid in the treatment of bipolar disorder. We decided to undertake a monotherapy trial because previous evidence suggested mixed states may be more responsive to anticonvulsants than more traditional antimanic agents. 51 patients with a DSM IV diagnosis of dysphoric mania were randomized to three groups comprising gapbapentin, lamotrogine or carbamazepine and followed for 8 weeks. Psychiatric diagnosis was verified by the structural clinical interview for the DSM-IV (SCID). The MMPI-2 in full was used to assess symptoms at baseline and 8 weeks. All three groups showed significant changes in MMPI-2 scores for depression and mania subscales. Gabapentin showed the greatest change in depression symptom improvement relative to lamotrogine and carbamazepine, respectively. Although manic symptoms improved overall, here were no differences between groups in the degree of manic symptom improvement

Original Article Efficacy of Addition of Folic Acid to Sodium Valproate in Treatment of Acute Mania, a Double Blind Clinical Trial Study

Abstract Introduction: Treatment resistance is common in acute mania, so the role of augmented therapies, including nutritional factors and vitamins have always been considered. This study aimed to assess the effect of addition of folic acid to sodium valproate in treatment of acute mania. Methods: This double blind randomized clinical trial study was done in Mashhad Avicenna psychiatric hospital, in 2011 and was registered with IRCT201112188106N1 code in Iranian registry clinical trials site. Twenty nine manic patients, divided into two groups randomly. They received sodium-valproate+folic acid or sodium-valproate+placebo. The severity of mania, by Jung Mania Rating Scale (YMRS), and cognitional improvement, by Mini-Mental State Examination (MMSE), were determined at baseline, after 3 and 6 weeks. Data analyzed by SPSS-16, к 2 and t-student tests. Result: The mean scores of YMRS at baseline, after 3 and 6 weeks, in the folice acid group were 22±2.44, 8.26±4.86 and 3.13±1.64 respectively, and in placebo group were 21.14±1.95, 14.14±4.31 and 13±5.21 respectively. The mean scores of YMRS significantly decreased in the folic acid group compared to the placebo group after 3,6 weeks (p=0.005, p<0.001 respectively). The mean scores of MMSE showed no significant difference in same intervals (p=0.068, p=0.068). Conclusion: Our study showed that adjuvant treatment by folic acid in addition to standard treatment with sodium-valproate during manic phase in patients with BMD-I after 6 weeks of treatment was effective

The Incidence and Characteristics of Stroke in Urban-Dwelling Iranian Women

Background: Population-based data regarding stroke among women are scarce in developing countries. This study was designed to determine whether sex differences exist in stroke incidence, mortality, and recurrence. Methods: The Mashhad Stroke Incidence Study is a population-based cohort study in Iran. For a period of 1 year, all patients with stroke in 3 geographical regions in Mashhad were recruited and then followed up for 5 years. Age- and sex-specific crude incidence rates were standardized to the World Health Organization New World Population. Male-to-female incidence rate ratios were assessed for all age groups and all subtypes of first-ever stroke (FES). Results: The annual crude incidence rate of FES (per 100,000 population) was similar in men (144; 95% confidence interval [CI]: 129-160) and women (133; 95% CI: 119-149). Standardized FES annual incidence rates were 239 (95% CI: 213-267) for men and 225 (95% CI 200-253) for women, both greater than in most western countries. There were no significant differences in stroke recurrence or case-fatality between women and men during early and long-term follow-up. Conclusion: The similar incidence of stroke between men and women highlights the importance of equally prioritizing adequate preventive strategies for both sexes. The greater relative incidence of stroke in women in Mashhad compared with other countries warrants improvement of primary and secondary stroke prevention

Comparing post-traumatic stress disorder (PTSD) in primiparous and multiparous women with preeclampsia

Background and Aim: Post-Traumatic Stress Disorder is one of the anxiety disorders which occur in postpartum period. The prevalence of PTSD – induced by preeclampsia has been already reported as 28%, however no study was found to compare PTSD in primiparous and multiparous women. This study was therefore conducted to compare PTSD in primiparous and multiparous women. Methods: This comparative descriptive study was performed on 100 pregnant women with preeclampsia including 56 primiparous and 44 multiparous women who selected conveniently from labor wards of university hospitals in Mashhad, Iran in 2012. PTSD was diagnosed by psychiatrist interview and Perinatal Post-traumatic stress Questionnaire (PPQ) in 6th week postpartum. Social support was measured using Hopkins questionnaire in 2nd and 6th week postpartum. Data analyzed with SPSS Version 16 using Spearman correlation coefficient and Mann-Whitney test. Results: The rate of PTSD was 24% in primiparous and 37.8% in multiparous women. There was no significant difference in relation to mean score of PTSD in primiparous and multiparous women. Mean score of social support in 2nd and 6th week postpartum was significantly higher in primiparous women (P=0.000). 34% of multiparous vs. 5.4% of primiparous women had unwanted pregnancy (P=0.000). There was also a direct relationship between postpartum social support in 2nd (P=0.005) and 6th week  postpartum (P=0.002) and the rate of PTSD. Conclusion: The rate and mean score of PTSD in multiparous has been higher than primiparous women. Thus, it seems that multiparous women are at higher risk for PTSD due to lower postpartum social support and higher rate of unwanted pregnancy

Homicide attempt due to medication induced mania

Bipolar disorders are a group of mental disorders characterized by fluctuations in mood, with depressive symptoms generally dominating the course of disorder. Research on the efficacy of serotonergic antidepressants in bipolar depression is controversial and as a result, treatment of depressive symptoms in bipolar disorder is difficult. A particularly difficult situation arises when bipolar disorder is unrecognized and the depressive state is treated as major depressive disorder with the use of serotonergic antidepressants, which can result in the phenomenon of antidepressant induced mania (AIM). In this report, we present a case of antidepressant induced mania (AIM) with homicidal ideation after initiation of serotonergic antidepressants. Here, we discuss the importance of monitoring for bipolar disorder after prescribing serotonergic antidepressant therapy as well as medico-legal considerations

Seroepidemiological Study of Toxoplasma gondii Infection among Psychiatric Patients in Mashhad, Northeast of Iran

Background: Psychiatric patients have an increased risk of some infections like toxoplasmosis. Investigations on Toxoplasma gondii infection among psychiatric patients have been limited in Mashhad, Northeast of Iran. In this case-control study, prevalence of T. gondii was investigated by serological method. Methods: This case-control study was performed among psychiatric patients admitted to Avicenna Hospital in Mashhad, Northeast of Iran. Three hundred and fifty inpatients and 350 controls were examined in 2012-2013 for detection of IgG and IgM antibodies against T. gondii in their blood sera by ELISA. Socio-demographic and clinical manifestations of the patients were obtained. Results: Anti-T. gondii IgG antibodies was found in 164 (46.85%) of 350 psychiatric inpatients and 120 (34.28%) of 350 controls. Seventeen (4.85%) of psychiatric individuals and 3 (0.85%) of control group were IgM+/IgG- indicating acute form of toxoplasmosis. There were no statistically significant differences between the case and control groups. In patient group, schizophrenic patients had the highest positive rate (46.28%) and bipolar mood disorder had the second most prevalent rate (20%). Of 162 schizophrenia patients, 65 (40.1%) had latent infection which was higher than that observed in controls. Conclusion: The prevalence of T. gondii infection among psychiatric patients suffering from schizophrenia was more in Mashhad, compared with control group