Predictors of physical restraint in a psychiatric emergency setting

Background: Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible. Methods: This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group. Results: Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained. Conclusion: Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients

Development of a pre-hospital emergencies protocol for the management of suicidal patients in Iran

Background: Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation. Method: We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks. Results: The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered. Conclusion: A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians. © 2021, The Author(s)

Determining test-retest reliability and internal consistency of the persian version of personality inventory for diagnostic and statistical manual of mental disorders-5th edition (PID-5) among medical students and patients with psychiatric disorders

Background: Given the need for access to reliable diagnostic instruments of mental disorders in Persian language, the present study was designed to translate and determine the reliability and internal consistency of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders-5th Edition (PID-5) instrument. Methods: Research sample was selected based on non-random (convenience) method for medical students (healthy population) and patients with personality disorder. After translating PID-5 via forward and backward translation method, test-retest reliability (10-20 days period) and internal consistency of the instrument were determined. This study was conducted in Hazrat-Rasoul Hospital, Iran Psychiatry Hospital and Tehran Psychiatric Institute, Tehran, Iran, during the year 2015. Questionnaires were self-reported and interviews were done by well-trained psychiatry residents. Findings: Totally, 217 individuals were assessed (114 healthy volunteers and 103 patients with personality disorders). Of 25 surveyed facets, eccentricity had the highest Cronbach�s alpha coefficient. The lowest alpha was seen for suspiciousness. Overall, in 22 facets from all 25 facets, alpha coefficients were higher than 0.700. To assess test-retest reliability, 28 persons of the medical students group completed the questionnaire for the second time. The correlation coefficient between the two measures in three facets (irresponsibility, perceptual dysregulation and rigid perfectionism) was between 0.800 and 0.900. In other aspects, the correlation coefficient between the two measures was higher than 0.900. Conclusion: The Persian version of PID-5 instrument had good test-retest reliability (r = 0.829 to 0.944) in a short time (about two weeks) and its internal consistency was desirable (Cronbach�s alpha = 0.697 to 0.944). � 2016, Isfahan University of Medical Sciences(IUMS). All rights reserved

The frequency of sexual abuse and depression in a sample of street children of one of deprived districts of Tehran

The purpose of this study was to determine the frequency of sexual abuse and depression among street children who live in a deprived district of Tehran. The researchers used the K-SADS questionnaire and a clinical interview were used to evaluate depression and sexual abuse in 87 street children in Tehran. Eighteen (20.9) of the children had been sexually abused. Depressed children were 3.2 times more likely to be sexually abused than non-depressed children. Furthermore, 26 girls (86.7) and 27 boys (48.2) suffered from depression. The frequency of depression demonstrated a significant association with the father's or breadwinner's history of imprisonment or unemployment. Interventional programs providing education and support should be implemented for street children. Copyright © by The Haworth Press, Inc. All rights reserved

Neurological soft signs in mentally disordered offenders

The study used the Neurological Evaluation Scale to assess neurological soft signs in 351 offenders and 80 healthy comparison subjects. Offenders were also interviewed using the Structured Clinical Interview for DSM-IV and the Hare Psychopathy Checklist. Neurological signs were significantly increased in offenders compared with healthy subjects. Offenders with repeated misdemeanors had higher rates of neurological signs than those with a single felony. Neurological scores were significantly predicted by lifetime diagnoses of psychotic, anxiety, and substance use disorders. Each diagnostic category was associated with a distinct pattern of neurological abnormalities. Copyright © 2007 American Psychiatric Publishing, Inc

How gender, majors, religion and mental health affect the justified death attitude?

Background: Death penalty and euthanasia are disputed practices in the world. However, they are considered "justified" by their proponents. We newly developed a scale for assessment of the attitude toward justified death, which determines "hot cognition" using a number of scenarios. Objectives: This study aimed at assessing the effects of the major demographic items including gender, major, religion, and mental health on the justified death attitude. Methods: A total of 481 participants including 419 university students and 62 seminarians participated in the study in Tehran, Iran. The Persian versions of the justified death attitude scale and the general health questionnaire-12 were used for data collection. Data were analyzed using the multivariate analysis of variance. Results: Capital punishment was suggested more frequently for rape and drug trafficking and less frequently for murder, and infrequently for adultery. Men and religious subjects showed a more positive attitude toward execution. Furthermore, most of the subjects did not agree with euthanasia; surprisingly, active euthanasia was more acceptable than passive euthanasia. Finally, death penalty and euthanasia did not show an association with mental health. Conclusions: Individual characteristics like gender, major, and religiosity could significantly affect the attitude of people toward justified death. Further studies including neuropsychological methods are suggested. © 2017, Iranian Journal of Psychiatry and Behavioral Sciences

First line in psychiatric emergency: Pre-hospital emergency protocol for mental disorders in Iran

Introduction: This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands. Methods: The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems. Results: Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center). Discussion: This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different. © 2020 The Author(s)

Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories

Several studies have reported clinical manifestations of the new coronavirus disease. However, few studies have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed the medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) that were treated in a large referral center in Tehran, Iran from March 2019 to May 2020. We used clustering approach to categorize clinical symptoms. One hundred and fifty-one patients showed at least one neuropsychiatric symptom. Limb force reductions, headache followed by anosmia, hypogeusia were among the most common neuropsychiatric symptoms in COVID-19 patients. Hierarchical clustering analysis showed that neuropsychiatric symptoms group together in three distinct groups: anosmia and hypogeusia; dizziness, headache, and limb force reduction; photophobia, mental state change, hallucination, vision and speech problem, seizure, stroke, and balance disturbance. Three non-neuropsychiatric cluster of symptoms included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are very prevalent and heterogeneous in patients with coronavirus 2 infection and these heterogeneous presentations may be originating from different underlying mechanisms. Anosmia and hypogeusia seem to be distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be a constitutional or a neuropsychiatric symptom. © 2020, The Author(s)

Iranian and American Moral Judgments for Everyday Dilemmas Are Mostly Similar

Moral judgment is a complex cognitive process that partly depends upon social and individual cultural values. There have been various efforts to categorize different aspects of moral judgment, but most studies depend upon rare dilemmas. We recruited 25 subjects from Tehran, Iran, to rate 150 everyday moral scenarios developed by Knutson et al. Using exploratory factor analysis (EFA), we observed that the same moral dimensions (except socialness dimension) were driven by the same moral cognitive factors (norm violation, intention, and social affect) in Iranian vs. American studies. However, there were minor differences in the factor loadings between the two cultures. Furthermore, based on the EFA results, we developed a short form of the questionnaire by removing eleven of the fifteen scenarios from each of the ten categories. These results could be used in further studies to better understand the similarities and differences in moral judgment in everyday interactions across different cultures. © Copyright © 2021 Yazdanpanah, Soltani, Mirfazeli, Shariat, Jahanbakhshi, GhaffariHosseini, Alavi, Hosseinpour, Javadnia and Grafman

Iranian College Students� Attitudes Toward Premarital Sex, Marriage, and Family Before and After the Islamic Revolution

Objectives: The purpose of this study was to examine Iranian college students� attitudes toward premarital sex and marriage before and after the Islamic Revolution. Methods: Responses to a survey from 526 students at University of Shiraz in 2011 were compared to those from another study of 392 students from the same university who completed the same survey in 1977 (2 years before the Islamic Revolution). Results: No substantial changes were observed to indicate that college students adopted theocratic views on premarital sex and marriage after the Islamic Revolution. Conclusions: The Islamic regime's efforts to cultivate conservative attitudes toward sexuality and marriage have not achieved their goals. © 2015, Copyright © Taylor & Francis Group, LLC