Iranian Journal of Psychiatry

An Increased Need to Identify Protective Factors for Sexual Assault

Mohammad Reza Mohammadi — 2024-06-22

The Article Abstract is not available.

A Comparison of Effectiveness of Attention Process Training (APT) with Parenting Management Training (PMT) in Reducing Symptoms of Attention Deficit Hyperactivity Disorder

Mehriar Nadermohammadi Moghadam — 2024-06-22

Objective: Child-oriented psychotherapies, such as Attention Process Training (APT), target ADHD symptoms directly, whereas family-oriented interventions, like Parent Management Training (PMT), address its functional impairments. The aim of this study was to compare the effectiveness of APT and PMT in treating ADHD symptoms.

Method: This research was a randomized controlled trial in which 45 children (26 females and 19 males, with a mean age of 8.47 ± 1.66 years) with ADHD were selected conveniently and assigned randomly to one of three groups (PMT = 15, APT = 15, and CTRL = 15). The groups had no significant differences in ADHD severity. The PMT children were managed with parenting techniques. Children in the APT group practiced attention techniques, while children in the control group did not receive any intervention. Ritalin was prescribed to all the children in the three groups. The score on the Conners Parenting Rating Scale-Revised: Short form was the outcome variable.

Results: Both interventions decreased ADHD symptoms severity more than the control group. Howver, the reduction in the APT group was more than in the PMT group (P-value < 0.001). The scores of 40% of the APT group and 80% of the PMT group did not fall below the cut-off point. In the APT group after the intervention, the inattention subscale was significantly lower than the hyperactivity subscale, while in the PMT group, the hyperactivity subscale was lower. The effect sizes of APT and PMT were 2.18 and 2.09, respectively.

Conclusion: For ADHD, psychological interventions are crucial in addition to medication. According to the results of this study, APT is more effective for inattention symptoms, while PMT is more effective for hyperactivity symptoms. When selecting psychotherapy, the subtype of ADHD should be taken into account. Treatment sessions must also be completed according to intervention protocols.

Serum Vitamin D, Mania and Depression-Related Scores: A Comparison among Mixed Bipolar, Mania, and Healthy Subjects

Ali Nazeri Astaneh — 2024-06-22

Objective: Manic and mixed episodes of bipolar disorder are important episodes of this disorder. The aim of the current study was to assess serum vitamin D (SVD) levels in patients with mania and mixed bipolar disorder, compared to healthy subjects.

Method: The current cross-sectional study was conducted on 75 subjects, including healthy subjects (n = 25), patients with acute-phase mania (n = 25), and patients with mixed bipolar disorder (n = 25). The SVD levels were measured in all of the enrolled subjects. The Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), and Clinical Global Impression- Severity (CGI-S) were used to assess disease activity in patient groups. Data analysis was performed using SPSS version 18. For statistical analysis, analysis of variance (ANOVA), independent-sample t test, Pearson correlation, and Chi-square tests were utilized. P-values < 0.05 were considered statistically significant.

Results: The results showed that the mean of SVD was significantly lower in mania and mixed bipolar patients compared to healthy subjects (P < 0.05). In addition, the number of subjects with SVD ≥ 20 ng/ml was higher in the healthy group compared to the patient groups (P < 0.05). Also, SVD was negatively correlated with the CGI-S (r = -0.311; P = 0.028), YMRS (r = -0.464; P = 0.001), and HDRS (r = -0.393; P = 0.005) in the total patient subjects.

Conclusion: Prevalence of low SVD was considerably high in mania and mixed bipolar patients compared to healthy subjects. Additionally, meaningful negative correlations were found between SVD and disease activity-related variables including the HDRS, YMRS, and CGI-S.

The Relationship between Game Addiction and Aggression among Adolescents with Mediating Role of Narcissism and Self-Control

Yifei Pan — 2024-06-22

Objective: With the increase of game addiction, the problem of aggression as one of the most serious issues confronting today’s society is affecting the mental health of the young generation. While available research has clarified the relationship between game addiction and aggression, this research contributes to future literature through examining the mediating role of narcissism and self-control in this relationship.

Method: This study is a quantitative, cross-sectional, correlational research conducted in 2023 on Malaysian adolescents aged 12 to 18 years. Volunteer adolescents completed self-report questionnaires including the Buss and Perry Aggression Questionnaire, Gaming Addiction Scale, Childhood Narcissism Scale, and Brief Self-Control Scale. All questionnaires were prepared through a Sojump link posted on social media platforms. Descriptive statistics, Pearson correlation analysis, and path analysis were used for statistical analysis.

Results: N = 595 adolescents were participated in this survey. According to correlation analysis, there were significant positive correlations between game addiction and aggression (r = 0.777, P < 0.001), game addiction and narcissism (r = 0.785, P < 0.001) as well as a significant negative correlation between game addiction and self-control (r = -0.668, P < 0.001). Besides, narcissism and self-control could significantly partially mediate the relationship between game addiction and aggression. The mediation model discovered a significant path from game addiction to narcissism (β = 0.785, CI = [0.7692, 1.0293], P < 0.001) and from narcissism to aggression (β = 0.442, CI [0.7731, 1.7244], P < 0.001). The total effect of game addiction on aggression was found to be statistically significant (β = 0.777, P < 0.001).

Conclusion: The findings of this research reveal a captivating profile, indicating that specific psychological attributes such as aggression, self-control, and narcissistic tendencies might make certain individuals more susceptible to developing an addiction to online games.

The Profile of Self-Harm and Suicide in Iran Considering Gender Differences: A Multicenter Study Affiliated with the National Trauma Registry of Iran

Zahra Ramezani — 2024-06-22

Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI).

Method: This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death.

Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15.

Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome.

Validation of the Indonesian Version of the Inventory of Statements About Self-Injury (ISAS) Questionnaire

Rini Gusya Liza — 2024-06-22

Objective: This current study aimed to validate the Indonesian version of the Inventory of Statements About Self-Injury (ISAS) questionnaire, which provides a better understanding of Non-Suicidal Self-Injury (NSSI) disorders.

Method: The study used a cross-sectional design and involved 314 adolescents and young adults in high school or university. A stratified sampling method was used. All participants filled out the ISAS questionnaire. Data were analyzed for content validity, construct validity, item discrimination value, and internal consistency (Croncbach’s α). The translation process was carried out using forward and back-translation methods.

Results: The ISAS questionnaire consists of section I, the behavioral scale, and section II, the functional scale. For content validity, Aiken's V coefficient obtained for both scale sections I and II is in the range of 0.917 – 1. This result shows that all items on the scale have very good validity. Confirmatory Factor Analyses were carried out using Lisrel 8.80 software on section II, resulting in several goodness of fit values that were not good enough (χ² = 457.68; P < 0.000; df = 64; χ² / df = 7.151, RMSEA = 0.130) and several other values that are quite acceptable (CFI = 0.95; SRMS = 0.057; NFI = 0.95; GFI = 0.83). The factor loading from section II ranges from 0.43 - 0.91. The item discrimination value using the corrected item-total correlation of section I is in the range of 0.031 - 0.837 and section II ranges from 0.290 – 0.854. The reliability analysis values in section I and II of the ISAS are α = 0.527 and α = 0.966, respectively.

Conclusion: This is the first study to have validated the Indonesian version of the ISAS questionnaire. The Indonesian version of the ISAS questionnaire is considered a valid and reliable instrument to assess NSSI disorders.

Validity and Reliability Assessment of the Complete Persian Version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-Questionnaire in an Iranian Population

Seyed Saeed Sadr — 2024-06-22

Objective: The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego – Auto-questionnaire (TEMPS-A) assesses five affective temperaments and has been translated into 32 languages. A 35-item short version is available in Persian, but the complete version is not yet translated. This study aimed to assess the validity and reliability of the complete Persian version of the TEMPS-A in an Iranian population.

Method: This descriptive study translated the TEMPS-A questionnaire from English to Persian using a standard forward-backward method. The translation was evaluated for face and content validity by 10 psychiatry specialists, with quantitative content validity assessed through content validity ratio (CVR) and content validity index (CVI) calculations. The Persian TEMPS-A was completed twice, with a two-week interval, by 30 individuals out of the 319 medical staff of Imam Hossein Hospital in Tehran, Iran, who participated in the study, and its reliability was evaluated using Cronbach's alpha. The questionnaire was then distributed to the entire sample (n = 319) for the analysis of temperament frequencies and statistical indices by a statistician.

Results: The Persian version of the TEMPS-A, consisting of 110 items across five factors (depressive, cyclothymic, hyperthymic, irritable, and anxious), demonstrated excellent reliability with Cronbach’s alpha values of 0.910, 0.909, 0.911, 0.910, and 0.909, respectively. The questions related to cyclothymic and hyperthymic temperaments exhibited the highest and lowest correlation coefficients with the general scale, respectively. Most subscales in the Persian TEMPS-A version showed correlation coefficients ranging from 0.28 to 0.68. An ANOVA with Cochrane's test revealed a significant difference in the mean scores of the questionnaire items (P < 0.001), with a grand mean score of 1.73 across all questions.

Conclusion: The Persian version of the TEMPS-A, consisting of 110 items, showed good internal consistency and a strong correlation with the original version. This suggests that it is suitable for use in temperament studies among the Iranian population.

Investigating Cortical Complexity in Mixed Dementia through Nonlinear Dynamic Analyses: A Resting-State EEG Study

Harikumar Pallathadka — 2024-06-22

Objective: Dementia is a broad term referring to a decline in problem-solving abilities, language skills, memory, and other cognitive functions to a degree that it significantly disrupts everyday activities. The underlying cause of dementia is the impairment or loss of nerve cells and their connections within the brain. The particular symptoms experienced are contingent upon specific regions of the brain affected by this damage. In this research, we aimed to investigate the nonlinear dynamics of the mixed demented brain compared to healthy subjects using electroencephalogram (EEG) analysis.

Method: For this purpose, EEG was recorded from 66 patients with mixed dementia and 65 healthy subjects during rest. After signal preprocessing, sample entropy and Katz fractal dimension analyses were applied to the preprocessed EEG data. Analysis of variance with repeated measures was utilized to compare the nonlinear dynamics of brain activity between dementia and healthy states and partial correlation analysis was employed to explore the relationship between EEG complexity measures and cognitive and neuropsychiatric symptoms of patients.

Results: Based on repeated measures ANOVA, there was a significant main effect between groups for both Katz fractal dimension (F = 4.10, P = 0.01) and sample entropy (F = 4.81, P = 0.009) measures. Post hoc comparisons revealed that EEG complexity was significantly reduced in dementia mainly in the occipitoparietal and temporal areas (P < 0.05). MMSE scores were positively correlated with EEG complexity measures, while NPI scores were negatively correlated with EEG complexity measures, mainly in the occipitoparietal and temporal areas (P < 0.05). Moreover, using a KNN classifier, all significant complexity measures yielded the best classification performance with an accuracy of 98.05%, sensitivity of 97.03% and specificity of 99.16% in detecting dementia.

Conclusion: This study demonstrated a unique dynamic system within the brain impacted by dementia that results in more predictable patterns of cortical activity mainly in the occipitoparietal and temporal areas. These abnormal patterns were associated with patients' cognitive capacity and neuropsychiatric symptoms.

Application of Acceptance and Commitment Therapy (ACT) in Children and Adolescents Psychotherapy: An Umbrella Review

Gooya Tayyebi — 2024-06-22

Objective: Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention that has gained increasing attention in recent years. While extensively studied for its effectiveness in adult populations, there has been growing interest in exploring the application of ACT in children and adolescents psychotherapy. This umbrella review aims to provide an overview of the current literature on the use and efficacy of ACT in children and adolescents, as well as to highlight potential considerations and future directions for research.

Method: A comprehensive search was done in scientific databases, including Scopus, PubMed, and Web of Sciences, using keywords related to ACT, children, adolescents, and psychotherapy. Relevant articles were included, with a focus on systematic reviews and meta-analysis.

Results: Our findings indicate consistent effectiveness for ACT and related interventions across various delivery formats, including in-person, group, and internet-based approaches, in reducing symptoms of internalizing and externalizing problems, as well as improving overall quality of life among children and adolescents. However, two articles comparing ACT with traditional cognitive behavioral therapy did not demonstrate superiority. Additionally, when comparing internet-based and in-person delivery modes, the included studies did not show significant differences between the two types.

Conclusion: ACT shows promise as an effective therapeutic approach in children and adolescents psychotherapy. However, more research is warranted to establish its specific techniques and adaptations for different age groups and presenting problems. Additionally, future research should explore the feasibility and effectiveness of delivering ACT in varied settings.

Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers

Amirhossein Jafari — 2024-06-23

Objective: Suicide is an important health issue nearly all over the world. The Columbia Suicide Severity Rating Scale (CSSRS) is a well-known instrument for suicide risk assessment. Our purpose in this study is to provide a Persian version of the C-SSRS and evaluate its psychometric properties in the Iranian military population, particularly suicide risk leveling characteristic of the C-SSRS.

Method: For linguistic adaptation, we gathered opinions of an expert panel consisting of 23 professionals in mental health sciences. Furthermore, this version was administered to two groups of soldiers, one representing a sample of normal population (N = 338), while the other group comprised a sample of clinical population from a referral psychiatric hospital (N = 348) in Tehran, capital of Iran, from July 2021 until one year later. Besides the C-SSRS, the Beck Scale for Suicidal Ideation (BSSI), Beck Hopelessness Scale (BSS), and General Health Questionnaire 28 (GHQ28) were obtained from the participants. Correlation coefficients, internal consistency, and factor analysis were evaluated using the Statistical Package for the Social Sciences (version 23) software.

Results: All items of the Persian version of the C-SSRS had acceptable content validity and face validity. This tool demonstrated high correlation coefficients with the BSSI (r = 0.73, P < 0.001) and BHS (r = 0.64, P < 0.001), but a low correlation coefficient with the GHQ28 (r = 0.22, P < 0.001). Specifically, the suicide risk level based on the C-SSRS had a high correlation with both the BSSI and BHS. Also, its internal consistency was satisfactory (Cronbach's alpha = 0.89). Furthermore, factor analysis revealed two factors that is consistent with suicidal ideation and suicidal behavior factors.

Conclusion: Our results indicated acceptable validity and reliability for the Persian version of the C-SSRS, demonstrating its capability to classify suicide risk. It can be concluded that the ordinal suicide risk level (as red, orange, yellow and green) is a valid index for the application of the C-SSRS.