Iranian Journal of Psychiatry

Artificial Intelligence-Powered Cognitive Behavioral Therapy Chatbots, a Systematic Review

Maryam Farzan — 2024-12-29

Objective: This review identifies the characteristic features of artificial intelligence (AI) chatbots and their therapeutic effect; assesses their efficacy in treatment of depression, anxiety, and other mental health disorders; and establishes levels of user engagement and satisfaction.

Method: Searches were conducted on the PubMed, Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, and Google Scholar databases using a set of keywords such as, not limited to, AI cognitive behavioral therapy (AI CBT), Youper, Wysa, Woebot, and other related terms. We included studies that were empirical, peer-reviewed, conducted between January 2017 and June 2024, and primarily focused on efficacy regarding the interventions and therapeutic outcomes. Data were then extracted and analyzed using both qualitative and quantitative methods concerning the mental health outcome.

Results: Our review identified large improvements across the three chatbots in symptoms of mental health, as supported by the 10 included studies: five on Woebot, four on Wysa, and one on Youper. Woebot showed remarkable reductions in depression and anxiety with high user engagement; Wysa demonstrated similar improvements, especially in users with chronic pain or maternal mental health challenges; Youper also presented a significant symptom reduction, including a 48% decrease in depression and a 43% decrease in anxiety. Common benefits of all chatbots were the therapeutic alliance and a high rate of satisfaction among users. We have also discussed the included studies’ limitations; that is, study design shortcomings and lack of sample diversity.

Conclusion: AI CBT chatbots, including but not limited to Woebot, Wysa, and Youper, are highly promising because of their availability and effectiveness in mental health support. They provide a useful complement to standard therapy when professional help is unavailable, and offer constant engagement with tailored interventions. However, it is necessary that further studies investigate their potential impact as long-term intervention models and explore how they may be integrated into holistic mental health care systems.

Effects of B Vitamins on Symptoms and Cognitive Functions in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Somayeh Agmashe — 2024-12-29

Objective: Schizophrenia which is a chronic disabling burdensome psychotic disorder has been treated with different antipsychotic medications. Some studies have reported a possible correlation between deficiency in minerals, nutrients and vitamins — mainly group B vitamins — and the development of schizophrenia. In the present study, we aimed to examine the effect of the B vitamin group as an adjuvant treatment to antipsychotics in individuals with chronic schizophrenia.

Method: In a randomized, double-blind clinical trial study, involving two groups of 25 patients with chronic schizophrenia, we compared the effects of a 12-week adjuvant treatment with a combination of B vitamins — B1 (15mg), B2 (15mg), B6 (10mg), B12 (10µg) and nicotinamide (50 mg) — with a placebo. The impact on negative, positive and cognitive symptoms of schizophrenia was assessed for both groups before the intervention (T0) and at 4, 8 and 12 weeks after the intervention (T1, T2, and T3, respectively).

Results: Following the treatment, negative symptoms scores decreased in the treatment group at 12 weeks following the beginning of the treatment (F (4, 45) = 464.7, P < 0.0001). Although a trend toward improvement in positive symptoms and cognitive scores was seen, these changes were not significant.

Conclusion: Our results suggest that selecting the group B vitamins as an adjuvant treatment to the antipsychotics may have beneficial effects on improving negative symptoms of patients with chronic schizophrenia.

Investigating the Relationship between Automatic Negative Thoughts and Experiential Avoidance with Psychological Distress and the Mediating Role of Cognitive Emotion Regulation in Patients with a History of Suicide Attempt

Ahmad Alipour — 2024-12-29

Objective: Automatic negative thoughts have an important role in development of a persistent negative cognitive bias, which may ultimately result in suicidal ideation. The primary objective of the present study was to examine the relationship between automatic negative thoughts and experiential avoidance in relation to psychological distress.

Method: The study sample comprised 441 individuals who had attempted suicide. Participants underwent interviews utilizing standardized questionnaires including Automatic Thoughts Questionnaire, Kessler Psychological Distress Scale, Acceptance and Action Questionnaire–II, and Cognitive Emotion Regulation Questionnaire along with its nine subscales. After internal relationships assessment among the research variables, outlier detection was done using the boxplot analysis and standard deviation distance metrics. To analyze the direct and indirect associations between the input and output variables, Structural Equation Modeling (SEM) was employed. In addition, SPSS-28 and Amos 29 software were used to analyzed the data.

Results: The final model showed that automatic negative thoughts were significantly inversely associated with adaptive cognitive emotion regulation (β = -0.42, P ≤ 0.01) and significantly positively related to both maladaptive cognitive emotion regulation (β = 0.49, P ≤ 0.01) and psychological distress (β = 0.53, P < 0.01). Additionally, experiential avoidance showed a significant positive relationship with maladaptive cognitive emotion regulation (β = 0.22, P < 0.01).

Conclusion: This research demonstrated that automatic negative thoughts could worsen psychological distress through the regulation of cognitive emotion in those who had a history of suicide. By the clinical management of automatic negative thoughts and shifting individuals’ cognitive emotion regulation toward adaptive strategies, there is potential for a substantial reduction in suicidal ideation and attempts which can be evaluated in future clinical trials.

The Association of Serum Lactoferrin Level with Psychological Symptoms, Cognition, and Executive Function in Schizophrenia Patients

Niloufar Mahdavi Hezaveh — 2024-12-29

Objective: Lactoferrin, a glycoprotein, has known neuroprotective effects, yet its role in the pathophysiology of neuropsychiatric disorders, particularly schizophrenia, remains unclear. This study aims to assess changes in lactoferrin levels during different phases of schizophrenia and explore its relationship with cognitive symptoms and performance.

Method: This before/after interventional study involved 30 patients diagnosed with schizophrenia. Participants were evaluated at two time points: upon hospital admission and after the resolution of acute symptoms. The Positive and Negative Syndrome Scale (PANSS) was utilized to measure symptom severity, while the Brief Assessment of Cognition in Schizophrenia (BACS) assessed the neurocognitive function. Serum lactoferrin levels were quantified using the Enzyme-Linked Immunosorbent Assay (ELISA) method.

Results: Serum lactoferrin levels significantly decreased from 130.63 ± 52.49 ng/mL at admission to 85.42 ± 29.03 ng/mL at discharge (P < 0.001). No significant correlation was found between lactoferrin levels and PANSS scores (r = 0.011, P = 0.975). However, an inverse correlation was observed between changes in lactoferrin levels and the executive function subscale of the BACS (r = -0.360, P = 0.050). Cognitive assessments indicated significant improvements in verbal memory (P = 0.033), working memory (P = 0.002), and executive function (P = 0.039) post-treatment.

Conclusion: The study demonstrates a significant reduction in serum lactoferrin levels during the acute phase of schizophrenia, suggesting its potential role in modulating cognitive functions, particularly the executive function, rather than influencing positive or negative symptoms.

A Serial Mediation Model of Perceived Social Class and Cyberbullying: The Role of Subjective Vitality in Friendship Relations and Psychological Distress

Hadi Samadieh — 2024-12-29

Objective: The link between individuals' perceptions of social class (PSC) and various forms of bullying, including cyberbullying, has not been extensively studied. Additionally, the mechanisms through which PSC impact aggressive behaviors like cyberbullying remain unclear. Therefore, this study aimed to explore the influence of perceived social class on cyberbullying, considering subjective vitality and psychological distress as serial mediators.

Method: Utilizing a cross-sectional design, the research involved 584 Iranian students (Mage = 20.59, SD = 1.99) from several universities who completed questionnaires assessing Subjective Social Class (SSC), Subjective Vitality Scale (SVS), Psychological Distress Scale (K6), and Cyberbullying Involvement Scale (CIS). Hayes' PROCESS macro (Model 6) in SPSS was employed to analyze the chain mediation effects.

Results: The Results demonstrated that the direct impact of PSC on cyberbullying was significant (Effect = -0.229, 95% CI: -0.294 to -0.164). Subjective vitality and psychological distress serially mediated the link between PSC and cyberbullying (Effect = -0.022, 95% CI: -0.035 to -0.012). In addition, both subjective vitality (Effect = -0.046, 95% CI: -0.080 to -0.017), and psychological distress (Effect = -0.09, 95% CI: -0.123 to -0.059), independently mediated the association between PSC and cyberbullying.

Conclusion: This research not only broadens the theoretical understanding of how individuals' perceptions of their social rank influence cyberbullying behaviors, but also provides actionable strategies for officials and experts to deploy effective interventions in higher education to mitigate cyberbullying.

Role of Melatonin as an Adjunctive Treatment for Depression and Cognitive Impairment in Hemodialysis Patients: A Randomized, Double-Blind Clinical Trial

Shima Hatamkhani — 2024-12-29

Objective: Chronic kidney disease (CKD) is a pervasive health issue associated with various complications, including cognitive impairment and depression among patients undergoing hemodialysis. This study aimed to assess the impact of melatonin on depression and cognitive function in hemodialysis patients.

Method: A randomized, double-blinded, placebo-controlled clinical trial was conducted in 50 hemodialysis patients, with half of the patients receiving 3 mg daily melatonin and the other half receiving a placebo for two months. Depression and cognitive function were evaluated using the Beck Depression Inventory (BDI) and Mini-Mental State Examination (MMSE) questionnaire, respectively. Quantitative variables were analyzed using a t-test. The Chi-square test also evaluated qualitative variables. Quantitative data were analyzed by covariance analysis before and after the intervention.

Results: Hypertension was the most prevalent underlying condition among study participants, affecting 40% of the intervention group. The intervention group exhibited baseline depressive symptoms (mean BDI score: 16.12 ± 7.12), which significantly improved post-intervention (13.6 ± 6.6). Notably, both the intervention and control groups demonstrated significant reductions in depressive symptoms, as assessed by paired t-tests (P = 0.033 and P = 0.02, respectively). Cognitive function, as measured by the MMSE, improved in both groups (1.28 ± 0.81 for melatonin, 1.52 ± 0.1 for placebo), with significant within-group differences (P = 0.048 and P = 0.002, respectively). ANCOVA analysis revealed no significant between-group differences in BDI scores (F(1,47) = 0.196, P = 0.66, partial eta-squared = 0.004). and in MMSE scores (F(1,47) = 0.003, P = 0.954, partial eta-squared = 0.00) post-intervention.

Conclusion: While this study did not demonstrate significant effects of melatonin on depression and cognitive impairment in hemodialysis patients, positive changes were observed, warranting further research to optimize treatment regimens and explore the potential therapeutic benefits of melatonin in this patient population.

Investigating the Relationships between Internet Addiction and Suicidal Ideation in Adolescent Girls

Zeynab Akbari — 2024-12-29

Objective: Suicidal ideation (SI) signifies a psychiatric crisis, and individuals with SI are at a significantly higher risk of suicide attempts compared to those without. According to previous research, three factors that affect SI in adolescent girls are externalization problems, alexithymia, and perceived social support (PSS). As a result, the present research aimed to examine whether internet addiction (IA) is associated with SI through the mediating roles of PSS, externalizing problems, and alexithymia among adolescent girls in Tehran, Iran.

Method: The current correlational study employed a structural equation modeling approach. Model fit indices such as the Chi-square to degrees of freedom ratio (CMIN/DF), normed fit index (NFI), root mean square error of approximation (RMSEA), Tucker-Lewis index (TLI), and goodness-of-fit index (CFI) were reported to assess the model’s adequacy.

A total of 441 adolescent girls were selected from high school and between the ages of 11 and 19 using a convenience sampling method. Participants completed the Multidimensional Scale of Perceived Social Support (MSPSS), the Beck Scale for Suicidal Ideation (BSSI), the Cell-Phone Over-Use Scale (COS), the Youth Self-Report (YSR), and the Toronto Alexithymia Scale-20 (TAS-20) in a written manner. Data analysis was done using SPSS 25 and AMOS 22.

Results: Results revealed a significant positive correlation between IA and SI (P < 0.001). The study's most significant findings indicate that PSS, externalizing problems, and alexithymia significantly mediate the relationship between SI and IA. The coefficient of determination for the SI variable was 0.33, which means that predictor variables can explain 33% of the variance in SI (IA, PSS, alexithymia, and externalizing problems).

Conclusion: IA showed direct and indirect effects on SI. Using these findings, we can elucidate the mechanism of how IA affects individual SI, providing critical information for the development and implementation of targeted strategies and interventions to reduce SI among Iranian adolescent girls. Psychological interventions that address the role of externalizing behaviors, alexithymia, and PSS in adolescents with IA may help reduce SI.

Validity and Reliability Assessment of the Arabic Version of the Social and Emotional Competencies Questionnaire in a Moroccan Nursing Student Population

Jamal Ksiksou — 2024-12-29

Objective: The Social and Emotional Competencies Questionnaire (SEC-Q) represents one of the existing tests for assessing these competences in students. The purpose of the present research was to examine the psychometric properties of the SEC-Q in Moroccan nursing students.

Method: A sample of 320 Moroccan nursing students, including 190 women and 130 men, was selected using a stratified convenience sampling method. Methodology consisted of forward and backward translations, linguistic adaptation, and pilot revision. Structural validity was investigated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed through test-retest analysis using Pearson's correlation.

Results: Factor analyses produced a four-factor version of 16 items with a range of factor loadings from 0.72 to 0.89. Cronbach's alpha values were 0.92 for the self-awareness factor, 0.91 for the self-management factor, 0.90 for the social awareness factor, and 0.92 for the decision-making factor. These high values indicate excellent reliability. The test-retest coefficient for a 20-day interval between two assessments gave an rtt value of 0.92, demonstrating excellent response reliability. A strong correlation between the SECQ-AV, WLEIS and PSS-CP was found, demonstrating satisfactory convergent and divergent validity (P < 0.05).

Conclusion: The Arabic version of SECQ demonstrated its validity and reliability for assessing social and emotional competencies in Moroccan nursing students. However, the sample selected was drawn from a single nursing training institute, which limits the representativeness of the entire student population, and makes it difficult to generalize the results. A cross-sectional study will therefore produce much more varied results, by including a very large sample from different regions and different nursing training institutes in Morocco.

Arabic Version of the Leahy Emotional Schemas Scale-II

Magda Ghassan Fathy — 2024-12-29

Objective: This study aimed to translate the Leahy Emotional Schemas Scale-II (LESS-II) into Arabic and validate its psychometric properties among Iraqi university students. The hypothesis was that the Arabic version would retain the original factor structure and demonstrate robustness and validity.

Method: The process involved translation, cultural adaptation, backward translation, and the bilingual method to ensure linguistic and cultural relevance. The sample consisted of 280 Iraqi university students (64% female, 36% male). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted to assess the factor structure. Reliability was tested using Cronbach’s alpha and test-retest methods.

Results: EFA identified a 14-factor structure aligned with Leahy’s model, accounting for 91.83% of the total variance. CFA confirmed a good model fit (RMSEA = 0.08, CFI = 0.93, TLI = 0.90). The total scale’s reliability (Cronbach’s alpha) was 0.82, with test-retest reliability at 0.87. Pearson correlations indicated significant relationships between LESS-II factors, anxiety, and depression, supporting construct validity.

Conclusion: The Arabic LESS-II was established as a valid and reliable tool for assessing emotional schemas. However, the study's reliance on a nonclinical sample limits generalizability. Future research should validate the scale in diverse and clinical populations, highlighting its potential utility in Arabic-speaking contexts for both research and clinical practice.

Applications of Behavioral Economics and Neuroeconomics in Mental Health

Barno Sayfutdinovna Abdullaeva — 2024-12-29

Objective: The integration of behavioral economics and neuroeconomics into mental health offers innovative perspectives on understanding and addressing psychological disorders. This overview aims to synthesize current knowledge and explore the implications of these interdisciplinary approaches in the context of mental health.

Method: In this narrative review, we summarized the current evidence regarding the applications of behavioral economics and neuroeconomics approaches in the field of mental health.

Results: Behavioral economics and neuroeconomics provide valuable insights into the cognitive and emotional processes underlying mental health disorders, such as irrational decision-making, impulsivity, and self-control issues. Concepts such as loss aversion, temporal discounting, and framing effects inform the development of innovative interventions and policy initiatives. Behavioral economic interventions, including nudges, incentives, and commitment devices, show promise in promoting treatment adherence, reducing risky behaviors, and enhancing mental well-being. Neuroeconomics contributes by identifying neural markers predictive of treatment response and relapse risk, paving the way for personalized treatment approaches.

Conclusion: The integration of behavioral economics and neuroeconomics into mental health research and practice holds significant potential for improving the understanding of psychological disorders and developing more effective, personalized interventions. Further research is needed to elucidate the mechanisms of action, optimize intervention strategies, and address ethical considerations associated with these approaches in mental health settings.

Neurocognitive Deficits in Individuals at Ultra-High-Risk for Psychosis: An Overview of Systematic Reviews

Farnaz Asadiof — 2024-12-29

Objective: Identifying individuals at ultra-high risk for psychosis (UHRP) is crucial for early intervention and prevention strategies. Neurocognitive deficits have been increasingly recognized as potential predictors of psychosis onset. This overview aims to consolidate current evidence and elucidate the role of neurocognitive predictors in identifying UHRP individuals.

Method: we systematically searched three scientific databases, i.e., PubMed, Scopus, and Google Scholar using predefined keywords related to predictive neurocognitive markers and ultra-high risk psychosis. By following the PRISMA procedure, we included all relevant systematic-reviews and meta-analyses in our data-synthesis.

Results: Neurocognitive deficits, including impairments in working memory, attentional control, verbal learning, and executive functions, have been consistently identified as predictors of psychosis conversion in individuals at UHRP. Structural and functional neuroimaging studies have further revealed aberrant brain connectivity, reduced gray matter volume, and altered neural activation patterns in key brain regions to be involved in psychosis. Moreover, the combination of neurocognitive and clinical risk factors has been shown to enhance the accuracy of predicting psychosis onset and inform personalized intervention strategies.

Conclusion: Neurocognitive deficits serve as valuable predictors of the risk of psychosis in individuals with UHRP, offering insights into the underlying neurobiological mechanisms and potential targets for early intervention. Future research should focus on refining predictive models, elucidating the neurodevelopmental trajectories, and evaluating the efficacy of targeted interventions in mitigating the psychosis risk.

A Meta-Analysis of the Structural Validity of Original and Brief Versions of the Personality Inventory for DSM-5 in Iran

Saeid Komasi — 2024-12-29

Objective: The Personality Inventory for DSM-5 (PID-5) is a widely used scale to evaluate the dimensional constructs of two trait models proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11). The present meta-analysis first aimed to examine the factor structure, reliability, and congruence coefficients of the Persian version of the PID-5 to assess both trait models. The second aim was to evaluate the factor structure and reliability of the Persian version of the Personality Inventory for DSM-5-Brief Form (PID-5-BF).

Method: A systematic search was conducted in PubMed, Magiran, and SID to find records in English and Farsi from January 2013 to December 2023. According to the PRISMA, data from nine medium- to high-quality reports including 7,608 participants were analyzed using the random-effects method. Quality of studies, heterogeneity, and publication bias were reported.

Results: The five-factor structure of the PID-5 to measure both trait models was supported by the pooled estimates of factor loadings. The alpha coefficient median for the DSM-5 model was 0.83 (range: 0.82-0.90), and the congruence coefficient median was .91 (range: 0.80-0.97). The ICD-11 alpha median was .78 (range: 0.68-0.91), and congruency median was 0.90 (range: 0.71-0.96). The factor loadings for negative affectivity, detachment, antagonism, disinhibition, and psychoticism on the PID-5-BF were 0.44-0.69, 0.38-0.67, 0.46-0.72, 0.42-0.70, and 0.44-0.76, respectively, and the alpha median was 0.73 (range: 0.65-0.76).

Conclusion: Since both the original and brief versions of the PID-5 are valid and strongly similar to international structures, the clinical and research applications of these questionnaires are recommended to mental health professionals in Iran.

Potential Antidepressant Effects of Omeprazole Introduced through Network Analysis and Systems Biology Should Be Interpreted with Caution in the Clinical Environment

Seyed-Ali Mostafavi — 2024-12-29

The Article Abstract is not available.