Tehran University Medical Journal

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Background and Aim: With the introduction of long term subcutaneous administration of Deferoxamine there has been a decline in the morbidity and mortality of transfusion-dependent beta thalassemia patients. But parenteral iron chelation therapy is still a burden and a major reason for unsatisfactory compliance and places an additional psychological burden on the patients. There are some factors contributing to low compliance in these patients. To evaluate compliance to Deferoxamine and barriers of non adherence and assessment the prevalence of depression and it’s association with compliance.

Materials and Methods: 205 patients with major thalassemia in children medical center older than 6 years old were included. They were classified in 3 groups by compliance index (CI: No. of days of treatment per one month/No. of treatment days prescribed by physician). CI>75 % was considered good ,CI< 50-75%: moderate,CI<50%:weak and 3d group the patients without compliance. For assessment of depression: Beck Depression questionnaires were given to the patients older than 18 years old and Children Depression Inventories (CDI)“kovacs” were given to the rest

Results: Of 205 patients (110 females (54%) and 95 males (46%)), 13.3% were non compliant, 14% had poor compliance, 62.7% had good compliance. Females were more compliant than males (P=0.034). Compliance improved in older age groups meaningfully (P=0.037). There was negative association between compliance and serum ferritin level (P=0.02). 22% of children and 12% of Adults had severe depression according to the questionnaires. There was no association between compliance and depression. The most prevalent problem rgarding Desferal injection was local reactions in injection site (83%).

Conclusion: As oral chelation therapies are not used routinely, more investigations regarding the noncompliance must be considered and this method of chelation therapy must be encouraged. Compliance is a multifactorial problem, so the solution to which requires close interaction between the patient, the family and community.

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Background: Depressive disorders in children and adolescents are chronic and highly morbid. Few studies are carried out on antidepressant drugs for depressed youths, especially specific noradrenergic agents. Reboxetine is a selective norepinephrine reuptake inhibitor. This study was designed to evaluate the effect of reboxetine in childhood and adolescent depression.

Methods: Twenty patients of both genders, aged 7-17 years old, with major depressive or dysthymic disorders, as classified by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), participated in an 8-week clinical trial before-after study of reboxetine. Clinical semistructured interviews, based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), were carried out. Reboxtine was initiated at a dose of 1 mg/day and increased up to 6 mg/day. Patients were assessed for changes in: depressive symptoms using the Children's Depression Inventory (CDI) and global functioning by the Children's Global Assessment Scale (C-GAS). Side effect questionnaire was also administered.

Results: There was a significant decrease in the ineffectiveness subscale (C factor) of CDI (p=0.006). Although the CDI scores decreased by 32.69%, this change was not significant (p=0.39). No significant change in C-GAS (p=0.2) was observed. Adverse effects were relatively mild to moderate and transient. The most common adverse effects were decreased appetite and sedation.

Conclusions: Reboxetine is relatively well tolerated and improves feelings of ineffectiveness among depressed children and adolescents however it does not improve all depressive symptoms. Double-blind, placebo and active comparator controlled studies and larger sample sizes are indicated.

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Background: Considering the psycho-social model of diseases, the aim of this study was to evaluate the effect of psychiatric intervention on the pregnancy rate of infertile couples.

Methods: In a randomized clinical trial, 638 infertile patients referred to a university infertility clinic were evaluated. Among them, 140 couples with different levels of depression in at least one of the spouses were included in this substudy. These couples were divided randomly into two groups. The patients in the case group received 6-8 sessions of psychotherapy before starting infertility treatment and were given fluoxetine 20-60 mg per day during the same period. The control group did not receive any intervention. Three questionnaires including the Beck Depression Inventory (BDI), Holmes-Rahe stress scale and a socio-demographic questionnaire were applied for all patients. The clinical pregnancy rates of the two groups, based on sonographic detection of the gestational sac six weeks after LMP, were compared. The data were analyzed by paired-T test, T-test, χ² and the logistic regression method.

Results: The pregnancy rate was 47.1% in the case group and 7.1% in the control group. The pregnancy rate was significantly related to the duration and cause of infertility and the level of stress in both groups (p< 0.001). The pregnancy rate was shown to be higher in couples in which the male has a secondary level of education (p< 0.001).

Conclusions: Psychiatric interventions greatly improve pregnancy rates, and it is therefore crucial to mandate psychiatric counseling in all fertility centers in order to diagnose and treat infertile patients with psychiatric disorders and help couples deal with stress.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Iranian researchers and scientists in the fields of psychiatry and psychology undoubtedly need to spend more time and make considerable efforts to prepare and validate Persian versions of measurements. The present study was designed to validate HADS in Iranian clinically anxious and depressed patients compared to normal population.
Methods: 261 anxious and depressed patients referred to the inpatient clinic of Rouzbeh Psychiatric Hospital, Tehran, and 261 healthy volunteers (matched for their sex) were tested using HADS, and two additional clinical tools, ie., BDI & BAI. Then the patients were interviewed by a psychiatrist or a psychologist (using DSM IV checklist) and rated for their anxiety and depression severity levels based on a 10-point scale from 1 to 10. BDI and BAI were regarded as objective device providing other external criteria to examine validity further. Moreover, to assess reliability 10% of the patients (n= 27) were randomly selected and re-tested after three days.
Results: Findings showed that all measures and their subscales proved to be valid and reliable with good internal consistencies in Iranian depressed and anxious patients. This study provides clinicians and researchers with Iranian cut-off points for HADS, BDI and BAI, to be used in their settings, to categorize the patients with different levels of psychopathology.
Conclusion: The results support the use of all the measures and subscales examined in this study in clinical and research settings. The cut-off points obtained in this study are somehow different from those presented by original authors which will be discussed from cultural point of view in this report.

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Background: Postpartum depression is a mood disorder that has harmful effects on mothers, infants, family and relationships. Acute decrease of progesterone after delivery has been proposed as a cause for postpartum depression. This hormone can affect neurotransmitters' function. Zinc (Zn) and magnesium (Mg) as trace elements exert their antidepressant effects through neurotransmitter pathways. On the other hand, thiamin (Vit B1) deficiency leads to depression in animal models. The aim of this study was to evaluate effects of combination of zinc, magnesium and thiamine on postpartum depression and role of nitrergic system.

Methods: One hundred ten female mice in five groups were used. Postpartum depression was conducted using progesterone injections. Combinations of Zinc chloride, magnesium chloride and thiamine HCL were administered 30 minutes before open field and forced swimming test (FST). In order to investigate role of nitrergic system, L-arginine and LNAME were administered.

Results: All treatment groups spent less immobility time than the control group (p< 0.05). Combined administration of Zn+ Mg+ Vit B1 caused the most reduction in immobility time. Administration of L-NAME in Zn+ Mg+ Vit B1 group caused reduction in immobility time while administration of L-arginine caused increase in immobility time in the same group.

Conclusion: Zinc, magnesium and thiamine can improve depressive symptoms by nitrergic pathway. These elements as supplement compounds could be alternatives for antidepressants in postpartum period.

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Background: Cognitive problems in patients with post-traumatic stress disorder (PTSD) include poor concentration and impaired memory. Prevalence of PTSD in all aspects of life is 8% in USA. Regarding the importance of memory in functional levels, this study was performed to review memory status in these patients.

Methods: Fifty male war veterans with PTSD and major depression and 50 male non-veterans with depression participated in this study performed at psychiatric outpatient ward in Baqiyatallah hospital during 2008-2009. The patients met the DSM-IV diagnostic criteria. Depression severity, sex, age, educational level, and marital status were matched in both groups. A psychologist completed demographic and Mississippi questionnaires, PTSD checklist (PCL), beck depression Inventory and wechsler memory scale. The collected data were analyzed using SPSS software (version 11.0). A P-value smaller than 0.05 was considered significant.

Results: The mean age of the veterans and non-veterans was 43.9±4.7 and 42±9.4 years, respectively. Memory status did not differ between the two groups (P>0.05). There was no statistically significant correlation between duration and severity of PTSD with memory impairment (P>0.05). A negative correlation was found between personal and general information with re-experiencing in the veterans (P<0.05). Impaired memory was correlated with age greater than 45, educational level lower than high school diploma, severity of depression and longer participation in war.

Conclusion: Although both PTSD and major depression affected memory, but memory status did not differ between patients with PTSD and depression and patients with chronic depression.

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Background: Several studies that have evaluated psychological and counseling interventions suggest that a proactive approach may be effective in preparing patients for the experience of living with an implantable cardioverter-defibrillator (ICD). The purpose of this study was to develop and assess cognitive and behavioral interventions in reducing stress and anxiety and improving quality of life.

Methods: One hundred Patients with ICD in Shariati and Imam Khomeini Hospital in Tehran, Iran during 2009- 2010 were divided randomly into two groups to undergo cognitive and behavioral interventions (case group) or serve as the control group. The patients in the case group were received relaxation, cognitive and ICD alarm trainings three times during the study period. Routine care was the same in both groups after ICD implantation. We evaluated anxiety and depression by, respectively, Beck anxiety and Beck depression inventories in the two groups before and after ICD implantation. Quality of life was also evaluated by SF-36 instrument before and after the interventions. The results were later compared between the two groups.

Results: Beck scores for anxiety in the case and control groups before the interventions were 24.9±15.5 and 24.2±15.8 (P=0.590), respectively and after six months they were 13.5±8.3 and 17.9±10.1 (P=0.005), respectively. Beck scores for depression in the case and control groups before the interventions were 17.7±9.8 and 18.4±10.6 (P=0.590), respectively and after six months the scores, respectively, were 13.5±8.3 and 17.9±10.1 (P=0.005).

Conclusion: It seems that psychological interventions can reduce anxiety and depression after ICD implantation. Further studies with more sample sizes are necessary for the final judgment.

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Background: Postpartum depression (PPD) is a major depressive disorder and one of the most common complications of childbearing. PPD has a serious impact on the quality of life of all family members. Oxidative stress is one of the contributing factors in pathophysiology of major depression. Thus, drugs with potential antioxidant action could be an attractive target for treatment of depressive disorders. Matricaria Chamomilla and Selenium are natural sources of antioxidant. The aim of this study was to evaluate effects of oral administration of Matricaria Chamomilla aqueous extract and Selenium on experimental model of progesterone-induced postpartum depression and plasma oxidant-antioxidant system in mice. Methods: Seventy adult female mice in seven groups were used in this study. All animals received daily injections of progesterone 5 mg/kg intraperitoneally for five days after which progesterone was withdrawn for three days. After modelling postpartum depression with progesterone withdrawal, Matricaria Chamomilla 300 mg/kg and Selenium 0.1 mg/kg and their combination were administered via gavage and imipramine 15 mg/kg was administered intraperitoneally one hour before open field and forced swimming test (FST). In order to investigate the role of oxidant-antioxidant system, PAB and MDA were meatured. Results: All the treatment groups and the standard group spent less immobility time than the control group (P<0.05). Significant changes in the oxidative parameter (PAB and MDA) were not observed in all treatment groups and the standard group compared to the control group. Conclusion: Our study demonstrated the potential antidepressant activity of Matricaria chamomilla and Selenium in the experimental model of progesterone-induced postpartum depression in mice. These elements as supplement compounds could be alternatives for antidepressants in postpartum period. It seems that the antidepresent effects of this compounds do not induced by effects on oxidant-antioxidant system and may exert through any other pathway.

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Background: Nausea and vomiting is one of the most important complications in chemotherapy. Serotonin and dopamine are important neurotransmitters in nausea and vomiting. It seems that oxygen therapy and increase oxygen saturation can cause decrease these neurotransmitters. The aim of this study was to investigate the relationship between arterial oxygen saturation (SaO2) of patients and chemotherapy-induced nausea and vomiting. Methods: A descriptive-analytical study was performed in Koosar Hospital in Semnan, Iran, from 19 September 2013 to 25 April. At first, SaO2 of 30 patients in three periods (pre, during and post chemotherapy) were measured. Severity of nausea and vomiting in three days after chemotherapy was measured with an index of nausea, vomiting and retching (Rhodes Index). Also during chemotherapy, anxiety and depression of patients was measured with Hospital Anxiety and Depression Scale (HADS). Results: In this study thirty patients were evaluated. Most of them were women (66%) with mean age of 55.07±11.9 years old. The most common cancer in patients was breast cancer (46.7%). Mean of SaO2 was 92.1%±3.4 that was not significant difference during the chemotherapy. Mean of nausea and vomiting severity in first day of chemotherapy was (3.27±5.5), in second day was (4.5±6.2) and in third day was (7.2±8.7). The Pearson correlation coefficient did not show the relationship between oxygen saturation with severity of nausea and vomiting (P>0.05). Although severity of anxiety of patients was significant relationship with nausea and vomiting in third day (P=0.03). Conclusion: In this study there was no significant relationship between oxygen saturation and severity of nausea and vomiting, but anxiety of patients was related to nausea and vomiting in third day. Chemotherapy-induced nausea and vomiting was more common in third day and it seems that further research is needed for relationship between oxygen saturation and nausea and vomiting in third day of treatment.

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Background: Depression, as one of the most prevalent and disabling disorders in the world, has a complex and yet not well-known pathophysiology. Genetic, hormonal, neurotransmitter, inflammatory and neurodegenerative theories are all responsible. Studies show that depression leads to structural changes in the hippocampus, prefrontal cortex, amygdala, anterior cingulate, and basal bodies. Hippocampal volume loss is observed due to the death of nerve cells, neurons, and glial cells, and reduced neurogenesis. The hippocampus is a part of the limbic system. The limbic system is the area in the brain that is associated with memory, emotions, and motivation. The limbic system is located just above the brain stem and below the cortex. Despite the many studies related to the reduced hippocampal neurogenesis in depressed patients, no study has compared the amount of neurodegeneration between the left and right hippocampus. In this study, we compared neurodegeneration levels in the right and left hippocampus of the rats. Methods: Twenty male Sprague-Dawley rats that were purchased Razi Institute, Karaj, Iran, were evaluated in the study. This study was conducted in cellular and molecular center in Iran University of Medical Sciences, from June 2012 to June 2013. Half of them had unpredictable chronic mild stress (UCMS) for 21 days to develop depression. The forced-swimming test (FST) was used to measure the immobility time (IB), a symptom of depression. One week after the behavioral test, the rats were prepared for transcardial perfusion. Then, paraffin fixed brain was excised and the hippocampus was prepared for Nissl staining. All above-mentioned procedures were performed for the control group too except inducing UCMS. Results: Our results increased IB in the UCMS group, 68.8 second in stress group and 15.1 second in control group. Nissl staining showed prominent neural degeneration in the hippocampus of the rats in the UCMS group. Comparison of the left and right hippocampal cells revealed that the right hippocampus (mean= 49.166) was more vulnerable to stress than the left hippocampus (mean= 76.6). Conclusion: Our study showed different manifestations of depression after UCMS. It showed that UCMS could lead to mental depression. This study showed that the right hippocampus was more sensitive to stress than the left hippocampus. In fact, UCMS resulted in depression. The study showed that the right hippocampus was more sensitive to stress than the left hippocampus. Therefore, the main function of the right hemisphere, which is adaptation to the new environment, is disturbed more.

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Background: Approximately 50% to 80% of women experience varying degrees of postpartum depression. Oxidative stress is involved in many diseases, including depression. Common production of lipid peroxidation by oxidative stress is malondialdehyde (MDA). The endocannabinoid system is a nervous regulator and convoy the impression that the circulatory levels of endocannabinoid is significantly reduced in depressed women. The major purpose of this paper was to evaluate activity of the major antioxidant and endocannabinoid index in postpartum depression. Methods: A total of 130 women were entered in a case-control study in 12 Bahman Health Center from April 2011 to August 2011. In 4th to 6th week after delivery, women were equally divided into 2 groups based on Edinburg questionnaire (normal and postpartum depressive women). Serum MDA, total antioxidant capacity (TAC) and RBC catalase levels were determined to investigate the oxidative status. In addition, Mass spectrometry was applied for the analysis of serum anandamide (AEA) and 2-Arachidonoylglycerol (2-AG). Results: Based on Edinburg questionnaire, however, women age, husband age, husband marital number, gravidity, children number, salary and house size have no significant effect on postpartum depression, marital period was significantly increased postpartum depression (P< 0.05). In addition, women education, husband education, wanted or unwanted pregnancy from women, neonatal sex, satisfaction of neonatal sex from women and husbands, breast feeding and delivery have no significant effect on postpartum depression, and women Job (P< 0.001), husband job (P< 0.001), wanted or unwanted pregnancy from husbands (P< 0.05) were significantly changed postpartum depression. Serum MDA and RBC catalase levels were not significantly higher in depress compared with the normal group. TAC was significantly decreased in patients having postpartum depression (P< 0.05). Serum AEA and 2-AG levels were significantly lower in depress compared with the normal group (P< 0.01). Conclusion: Women’s Job, husband’s job, wanted or unwanted pregnancy from husbands and marital period are associated to postpartum depression. In postpartum depression, TAC, AEA and 2-AG are reduced. So it can be concluded that both antioxidant system and endocannabinoid concentration involved in the development of postpartum depression.

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Background: Cancer diagnosis is the biggest stress for the child and his family. Diagnosis and treatment of cancer in children can cause stress, which often has a negative effect on the health of parents. Psychological reactions such as anxiety, depression, denial and loss of confidence in parents observed that because of the fear of recurrence and future of children. This study aimed to determine the level of stress and anxiety and depression in parents of children with leukemia who were in the maintenance phase of treatment.

Methods: This cross-sectional study has been conducted on 48 parents have referred to the clinic of Dr. Sheikh Hospital of Mashhad City, Iran, whom selected using easy sampling method. DASS-21 questionnaire was used for data collection. Another questionnaire containing demographic information such as age, sex, income, educational level and duration of illness was filled under supervision of the psychologist and pediatric physician. Data with SPSS software, ver. 20 (IBM, Armonk, NY, USA), descriptive statistics and Pearson correlation analysis was performed. Results: The results showed that in this study, 37% had abnormal stress levels (33% and 2% of mild stress, moderate stress and severe stress 2%) and 79% had abnormal anxiety level (mild 19%, moderate 31% and severe 29%) and 67% had abnormal depression level (mild 33%, moderate depression 33%) tests, respectively. In our study, there was no relationship between age, sex and duration of illness with these variables.

Conclusion: According to this study, in addition to the classic treatment of patients, parent’s mental performance should be paid attention.

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Background: Body pain in multiple sclerosis (MS) is a common phenomenon that can create or exacerbate by different parameters of clinical, psychological and demographic. The aim of this study was to investigate the relationship between parameters of clinical (fatigue, clinical course, body mass index and duration), psychological (depression, anxiety and stress) and demographic (age, gender, marital status and education) characters with multiple sclerosis patient’s body pain. Methods: This cross-sectional study has been performed in the Multiple Sclerosis Society of Guilan Province and Imam Reza Specialized and Sub-specialized Clinic, Rasht City, Iran during June to February 2010. In this study 162 patients with MS were selected by consecutive sampling. We used the clinical and demographic variables inventory, body pain subscale of the health survey questionnaire, depression, anxiety and stress scale and fatigue severity scale along with identical analog-spring balance. The data were analyzed by Pearson correlation coefficient and point bi-serial, one-way analysis of variance, Gabriel test and stepwise multiple regression. Results: The findings showed that patients who scored 3 or higher in relapses experienced significantly more body pain than patients who scored 1-2 times of relapses (P= 0.031). In the meantime, significant differences were not found between the two groups of patients with a score of 3 or higher in relapses and non-relapse and between non-relapse patients and with a score 1-2 times of relapses in terms of body pain. Also, significant differences were not found in different groups of hospitalization in terms of body pain. However, anxiety and fatigue together could explain significantly 25% of the shared variance of body pain (F= 26.29, P≤ 0.0009). Conclusion: This study showed the effect of psychological and clinical factors on body pain exacerbation in MS patients. Therefore, it is necessary for clinicians to consider identifying these factors and the relationships of the factors with increasing pain in patients with MS.

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Results: We figured out that 15% of women and 13% of men had clinical depression. Severe anxiety was found in 30% of women and 6% of men. We found that there is a significant correlation between depression and duration of infertility in women but not in men. Whereas there is not any significant relationship between both of the disorders and level of education in the patients. Conclusion: This study showed that depression level among half of infertile women and one-third of infertile men were more than healthy men and women. One of the reasons could be family problems and pressure to get pregnant. The psychological burden of infertility can affect the whole life of the infertile couple. Fear of an ambiguous future after infertility treatment failure, expensive treatment and its outcomes can be so annoying for many men and women. Most of these problems are hidden from the eyes of the treatment team. Take a deep look at what infertile women and men say showed that they need the support of their spouses, friends and family, the medical team and insurance services.

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