Current Status of Health and Social Services for Children with Autism in Iran: Parents’ Perspectives

Objective: The present study is a part of a larger study that aimed at developing a comprehensive model of service delivery for individuals with autism in Iran based on the local needs and characteristics. In this study, the status of the services provided to those with autism in Iran was investigated based on the perspectives of parents of children with autism. Method: A semi-structured interview was used to qualitatively investigate the status of the services with regards to autism in Iran based on the perspectives of parents of children with autism. Results: This study revealed several barriers, including shortness of eligible professionals, difficulty in access to care for families, high costs, and lack of formal and informal supports, in providing services to those with autism in Iran. Early detection and diagnosis are of prime importance. We also need to train our specialists to diagnose autism based on the standard protocols and tests. Conclusion: In sum, we need a comprehensive program that involves different sectors in charge of health and education in Iran

A multicenter randomized controlled trial of aftercare services for severe mental illness: study protocol

BACKGROUND: Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country’s urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services. METHOD/DESIGN: This is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services. DISCUSSION: This paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran. TRIAL REGISTRATION: IRCT201009052557N

Province-level Prevalence of Psychiatric Disorders: Application of Small-Area Methodology to the Iranian Mental Health Survey (IranMHS)

Objective: National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. Method: In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). Results: A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. Conclusion: The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions

Barriers to Family Caregivers’ Coping With Patients With Severe Mental Illness in Iran

The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers’ experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers’ ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient’s isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.The study was supported by Grant TBZMED·REC.5825 from the deputy of research in Tabriz University of Medical Sciences

Quality of Life in Bipolar Type I Disorder in a One-Year Followup

Objectives. The aims of this study were (i) to compare Quality of Life (QOL) of patients with bipolar disorder (BD) type I to those with schizophrenia during a one-year period after hospitalization and (ii) to assess the association of different domains of QOL with severity of clinical symptoms and level of functioning in bipolar patients group. Method. A hundred and two participants were consecutively recruited before discharge from an acute hospitalization. To measure QOL as the main outcome variable, the Farsi (Persian) version of the World Health Organization's QOL Instrument Short Version (WHOQOL BREF) was used. Affective symptoms, overall functioning, and severity of mental illness were assessed as well. The assessment procedure was repeated four, eight, and 12 months after discharge. Results. No significant differences were found between patients with BD and schizophrenia on four domains of WHOQOL BREF at the baseline and the four, eight, and 12 month assessments. Within the subjects with bipolar I disorder, the most stable finding was negative association of depression severity with WHOQOL-BREF on the all four domains during repeated assessments. Conclusion. The findings suggest that persistent depressive symptoms might be the primary determinant of impaired QOL in patients with bipolar I disorder

Cognitive Behavior Therapy for Trichotillomania: Report of a Case Resistant to Pharmacological Treatment

Objective: To report a case of trichotillomania that was resistant to pharmacological treatment but responded well to a behavioral therapy program based on habit reversal. Method: The patient was a 47-year-old lady. Her problem had started at the age of seventeen. She had experienced several treatments including full doses of antidepressants, mood stabilizers, antipsychotic, and benzodiazepines as single treatments or in combination. The mentioned medication did not affect her condition. In addition, she was drowsy during the daytime and her function was seriously impaired. At the time CBT was started for the patient, she was receiving fluoxetine 40 mg daily, which she had received during the treatment period. Initial assessments included a detailed behavioral interview, daily chart of activities, record of hair pulling behavior with a description of patient’s emotional and situational status during the action. The treatment procedures included self monitoring, pulled hair saving and competing response. The patient was followed for 18 months. Results: Only 2 bouts of hair pulling were reported, both of which occurred in the fist 6 months of the treatment. The patient’s hair became thicker, and she was very satisfied with the therapy. Her social relations and function improved markedly, and her anxiety and sadness left her. Conclusion: This case showed that certain components of habit reversal such as awareness, self-monitoring, pulled hair saving, and competing response were effective in our patient

Development of day center in Roozbeh hospital: A teamwork experience

Introduction: Team working is an important part of psychiatry but psychiatry delivery services with teamwork approach were limited in our country. Providing rehabilitation services in a coordinated and comprehensive manner requires a professional team consists of psychiatrist, psychologist, occupational therapist, social worker and their collaborative approach. The aim of this study is to present a team work experience in development of a rehabilitation service and team service providing. Materials and Methods: We explained the experiences of 4 academic members who were involved in set up or development of day center. Furthermore, a group discussion session with staff held and their experiences in team working especially in day center were discussed. Results: The results of these interviews emphasize on the important role of social structures, responsibility, time commitment, the need to be patient in team work, the need to create and strengthen a sense of trust between group members, the need to maintain members’ motivations and to find solutions to resolve the interpersonal conflicts. Conclusion: Finding some solutions for enhancement of responsibility, building sense of trust and dissolve interpersonal conflict is very important in team working

Exploratory Factor Analysis of SCL90-R Symptoms Relevant to Psychosis

"nObjective: Inconsistent results have been reported regarding the symptom dimensions relevant to psychosis in symptoms check list revised (SCL90-R), i.e., "psychoticism" and "paranoid ideation". Therefore, some studies have suggested different factor structures for questions of these two dimensions, and proposed two newly defined dimensions of "schizotypal signs" and "schizophrenia nuclear symptoms". We conducted an exploratory factor analysis on the items of these two dimensions in a general population sample in Iran. "nMethod: A total of 2158 subjects residing in Southern Tehran (capital of Iran) were interviewed using the psychoticism and paranoid ideation questions in SCL90-R to assess severity of these symptom dimensions. Factor analysis was done through SAS 9.1.3 PROC FACTOR using Promax rotation (power=3) on the matrix of "polychoric correlations among variables" as the input data. "nResults: Two factors were retained by the proportion criterion. Considering loadings >= 0.5 as minimum criteria for factor loadings, 7 out of 10 questions  from psychoticism ,and 3 out of 6 questions from paranoid ideation were retained, and others were eliminated. The factor labels proposed by the questionnaire suited the extracted factors and were retained. Internal consistency for each of the dimensions was acceptable (Cronbach's alpha 0.7 and 0.74 for paranoid ideation and psychoticism respectively). Composite scores showed a half-normal distribution for both dimensions which is predictable for instruments that detect psychotic symptoms. "nConclusion: Results were in contrast with similar studies, and questioned them by suggesting a different factor structure obtained from a statistically large population. The population in a developing nation (Iran) in this study and the socio-cultural differences in developed settings are the potential sources for discrepancies between this analysis and previous reports

The effect of neighborhood deprivation on mental health in low- and middle-income countries: A scoping review protocol

Background: Most environmental research on mental health originates from high-income countries, and information about the rest of the world is very limited. The impact of the environment on mental health can vary depending on socio-cultural contexts. Still, very few studies have explored the association between neighborhood deprivation and mental health in Low and Middle-Income Countries (LMICs). We intend to conduct our exploration of such an association by using a scoping review approach. Objectives: We will address the following broad questions: 1) what does published research in LMIC countries tell us about the evidence regarding the association between neighborhood-level deprivation and indicators of mental health and illness? 2) What are the proposed mechanisms explaining any observed association in LMICs? 3) What are the gaps in research in the LMIC settings that should be approached in future research? Methods: The following stages will be completed: First, we will systematically search for relevant primary studies in electronic databases (Ovid Medline, Scopus, Socindex, Policy Commons, and PsycINFO), citations in the reference lists, and by contacting existing networks and researchers. Then, a two-stage screening procedure will be employed to select the relevant studies. First, we will screen the titles and abstracts and then review the selected full text by two independent researchers. After charting the data from the selected study reports, we will collate, summarize, report, and discuss the results

Factors influencing treatment dropout among patients in Community Mental Health Centers (CMHC) of Tehran city, Iran

Introduction: The current research aims at investigating the effect of demographic features such as educational level, gender, type of disorder, and physician's empathy and emotional intelligence on Community Mental Health Centers (CMHC) patients’ treatment dropout. Materials and Methods: A sample of 4101 patients and 26 physicians were selected. Patients’ information was collected through CMHC registration software (information was already saved on the software since the centers have been established). Information related to physicians was also collected via two questionnaires, namely Bar-On EQ Inventory, and Jefferson Scale of Physician Empathy (JSPE), merely after consent forms were filled out. Based on the type of data, the collected information was transferred into nominal data, and later analyzed through Chi-square test via SPSS software. Results: The results of the current research suggested that the more empathetic a physician is, the less likely patients’ treatment dropout would be. Moreover, there was no significant relationship between the EI average score and treatment dropout. There was only a significant relationship between treatment dropout and adaptability, an EI competency. The findings of the current research indicated that none of the patients’ demographic variables (gender, educational level, and type of disorder) had a significant relationship with treatment dropout. Conclusion: Based on the findings of this study, physicians’ communication skills, empathy, and adaptability did not significantly contribute to their patients’ treatment dropout