Attitude of Iranian medical specialty trainees toward providing health care services to patients with mental disorders

IntroductionThe stigma of mental illness has a negative impact on the diagnosis and treatment of these disorders. Considering the high prevalence of mental illness, the attitude of medical specialists toward mental disorders, who are front liners in diagnosing and treating these patients, is critical. Therefore, we examined the attitude of Iranian medical specialty trainees toward providing health care services for patients with mental illness.MethodsWe included 143 residents in the fields that have the most interactions with patients with mental disorders, including internal medicine, surgery, neurology, cardiovascular diseases, and psychiatry. A demographic checklist, as well as the opening minds scale for health care providers stigma assessment questionnaire, was provided, which measures five dimensions of improvement, social responsibility, social distance, exposure, and other (such as risk) in health care providers toward delivering the healthcare services to patients with mental disorders.ResultsThe mean score of stigma for mental illness in medical specialty trainees was 61.36 ± 4.83 out of 100. Psychiatric residents have the least stigmatizing attitude (58.38 ± 3.54), and internal medicine and cardiology residents have the highest score, respectively, (62.96 ± 6.05, 62.45 ± 3.80). As for comparing subscales between specialties, only the social responsibility subscale showed a significant difference, with psychiatry having less stigma toward social responsibility (12.93 ± 2.01) than cardiology (15.09 ± 1.50) trainees.ConclusionThe attitude of medical specialty trainees toward providing health care services for patients with mental illness is not uniform; internal medicine and cardiology residents have more stigmatizing attitude, while psychiatric residents have less stigmatizing attitude. It seems that not every contact could be useful in making a better attitude toward mental illness, but it needs preconditions, like a structured contact that leads to positive outcomes. Anti-stigma interventions are needed to improve the attitude of medical specialty trainees toward providing health care services to patients with mental illness

Does watching a movie improve empathy? A cluster randomized controlled trial

Background: We studied if watching a movie about the patient physician encounter alone or in combination with a communication skills training workshop could improve empathy score of medical students. Methods: One hundred and thirty three medical students participated in one of the following four groups of the study. Group A: a three hour workshop (42 students); group B: watching the movie “The Doctor” (23 students); group C: watching the movie “The Doctor”, then, participating in a three hour workshop the next day (22 students); group D: control group with no intervention (46 students). Participants completed Jefferson Scale of Empathy (JSE), Student Version to assess empathy score before and after the intervention, and one month later. A linear mixed effect model analyzed the effect of intervention across groups considering the effects of other significant variables. Results: All of the three interventions had an immediate improving effect on empathy scores compared to control group. However, the improvement effect remained significant only in groups A (p=.015) and C (p=.001) one month later. Conclusions: Watching selected movies has a significant but transient effect on empathy of students. Combining two methods of watching the movie and communication skills workshop, seems to add the beneficial effects

Clinical Features of Patients Newly Admitted to the Emergency Department of a Psychiatric Hospital with an Emphasis on Physical Examination

Introduction: Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. Objective: We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. Methods: We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. Results: Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. Conclusions: Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting

Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex enhances working memory

Neuroimaging and electrophysiological studies have unequivocally identified the dorsolateral prefrontal cortex (DLPFC) as a crucial structure for top-down control of working memory (WM) processes. By modulating the excitability of neurons in a targeted cortical area, transcranial magnetic stimulation (TMS) offers a unique way to modulate DLPFC function, opening the possibility of WM facilitation. Even though TMS neuromodulation effects over the left DLPFC have successfully improved WM performance in patients with depression and schizophrenia in a multitude of studies, raising the potential of TMS as a safe efficacious treatment for WM deficits, TMS interventions in healthy individuals have produced mixed and inconclusive results. Here, we stimulated the left DLPFC of healthy individuals using a high-frequency repetitive TMS protocol and evaluated behavioral performance in a battery of cognitive tasks. We found that TMS treatment enhanced WM performance in a verbal digit span and a visuospatial 2-back task

The change in attitude and knowledge of health care personnel and general population following trainings provided during integration of mental health in Primary Health Care in Iran: a systematic review

<p>Abstract</p> <p>Background</p> <p>Mental health has been integrated in the primary health care program in small cities and villages of Iran in a national level since the late 1980s. We performed a systematic review of literature to investigate the effect of education on change in attitude and knowledge of mental health care providers and the population covered in the program during the recent two decades in Iran.</p> <p>Methods</p> <p>Electronic bibliographic databases including Pubmed, PsycINFO and EMBase as well as the main Iranian databases (Scientific Information Database, IranMedex, IranPsych, and IranDoc) were searched. Additionally, hand searching, personal contacts and tracking of reference lists were performed. All of the studies which compared the attitude and knowledge of the related population before and after an educational intervention were recruited.</p> <p>Results</p> <p>Six articles met the inclusion criteria and entered the review. All of these studies showed an improvement in the attitude and knowledge of the studied population. Although the studies were different in many respects, a meta-analysis on the two more similar studies showed a significant effect of training on long term improvement of the knowledge and attitude of the population.</p> <p>Conclusion</p> <p>A short term training improved knowledge and attitude of the population and health personnel immediately after the intervention. There is also evidence for a long term change in the attitude and knowledge of general population after short term training.</p

Short-term and long-term mate preference in men and women in an Iranian population.

Mate preference in short-term relationships and long-term ones may depend on many physical, psychological, and socio-cultural factors. In this study, 178 students (81 females) in sports and 153 engineering students (64 females) answered the systemizing quotient (SQ) and empathizing quotient (EQ) questionnaires and had their digit ratio measured. They rated their preferred mate on 12 black-line drawing body figures varying in body mass index (BMI) and waist to hip ratio (WHR) for short-term and long-term relationships. Men relative to women preferred lower WHR and BMI for mate selection for both short-term and long-term relationships. BMI and WHR preference in men is independent of each other, but has a negative correlation in women. For men, digit ratio was inversely associated with BMI (p = 0.039, B = - 0.154) preference in a short-term relationship, and EQ was inversely associated with WHR preference in a long-term relationship (p = 0.045, B = - 0.164). Furthermore, men and women in sports, compared to engineering students, preferred higher (p = 0.009, B = 0.201) and lower BMI (p = 0.034, B = - 0.182) for short-term relationships, respectively. Women were more consistent in their preferences for short-term and long-term relationships relative to men. Both biological factors and social/experiential factors contribute to mate preferences in men while in women, mostly social/experiential factors contribute to them

Non-recurrence of carbamazepine induced vitiligo after rechallenge with carbamazepine.

Objective: Vitiligo is a rare side effect of carbamazepine whose exact mechanism is unknown. The aim of this report is to describe a single case of vitiligo induced by carbamazepine . Methods: The case was a patient with Bipolar I disorder whose medications were changed from valproate to carbamazepine and who developed vitiligo after a short while. We followed the case for about four years when he was rechallenged with carbamazepine. Results: When depigmentation occurred, we immediately discontinued carbamazepine after which the depigmented areas improved gradually. About three years later, he received carbamazepine again, but depigmentation did not recur. Conclusion: Carbamazepine-induced vitiligo is not an absolute contraindication for the prescription of carbamazepine if other choices fail to respond or are not tolerated. The case has implications for the mechanism of medication induced vitiligo

Repetitive Transcranial Magnetic Stimulation in Delirium: A Double-blind, Randomized, Sham-controlled, Pilot Study

Introduction: Delirium is a fatal but potentially reversible disorder of the central nervous system that imposes high costs on health systems. This study aims to evaluate the effect of intermittent theta-burst stimulation on the severity and course of delirium disorder. Methods: This is a double-blind, randomized, sham-controlled pilot study. The study participants were randomly allocated into the active (active intermittent theta-burst stimulation) and sham groups. The severity of delirium was assessed 15 minutes before the intervention and 15 minutes after that by the Neelon and Champagne (NEECHAM) confusion scale. Results: In the active group, total and subscale scores of NEECHAM significantly decreased after intervention (P<0.05). Although no statistical difference was found in the control group regarding the subscale scores of NEECHAM, the difference in the total scores before and after the sham intervention was statistically significant. Conclusion: Carrying one session of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex can reduce the delirium severity in a short period, although it will not decrease the number of delirium cases three days after the intervention