Lithium Plus Olanzapine: One of the Most Effective Combinations for Bipolar Disorder. A Case Report and a Concise Review of the Literature

Background: The recurrent nature of Bipolar Disorder (BD) is the main cause of disability associated with the illness. Despite the proliferation of drugs approved for the maintenance phase of BD, the relapse rate is still high. The combination of drugs, especially the potentiation of mood-stabilizers with second-generation antipsychotics, may reduce the risk of relapse and rehospitalization. However, studies on the efficacy of specific combinations are scarce. Case presentation: The clinical case of a 28-year-old woman involuntarily admitted to an Acute Psychiatric Unit is presented. She suffers a manic postpartum episode with mixed and psychotic features. During the hospitalization, she is successfully treated with a combination of lithium plus olanzapine. In the discussion, a concise narrative review of the scientific literature on the efficacy of such a combination in BD is made. Conclusion: The association of lithium plus olanzapine is one of the combinations with most evidence on its efficacy in BD, especially in mixed-featured episodes. Tolerability concerns should not be an obstacle to its use, although they must be considered

Effectiveness of Cognitive Behavioural Therapy for Suicide in Schizophrenia: A Systematic Review

Background: Suicide is probably one of the worst potential complications for people with schizophrenia. Even though the use of antipsychotic medication is essential in reducing suicidal behaviour, the use of psychological treatments seems to be in the same way necessary. Cognitive Behavioural Therapy (CBT) is an evidence-based form of psychotherapy that is constantly trying to synchronise with the latest recommendations from the research. The goal of the present work is to systematically review the scientific evidence from published studies testing the effectiveness of CBT designed to deal with suicide in patients with schizophrenia. Methods: We searched using multiple terms related to suicide prevention based on CBT in schizophrenia. Two databases (Medline and SCOPUS) were scrutinised for the electronic search and different reference lists from previous reviews were also hand checked. Results: We identified 5 randomised and controlled trials of CBT that included suicide-related cognitions or behaviours as a primary outcome measure. CBT focusing on suicidal cognitions and behaviours was found to be effective in reducing suicidal ideation. As the number of studies fulfilling the inclusion criteria is small and the assessment of outcomes is heterogeneous, we did not perform a meta-analysis and we present results in a narrative way. Conclusion: Research on CBT focused on suicide prevention in patients with schizophrenia is promising but current evidence is notoriously insufficient. Although those therapies seemed to be efficacious in the prevention of suicide, scarcity of randomised clinical trials specifically focusing on suicide is probably the most important issue to be faced. Given the current evidence, clinicians should be familiar with CBT techniques focusing on suicidal cognitions. However, suicide prevention and treatment in those with schizophrenia is complex, and many other factors such as possible earlier use of clozapine, optimizing adherence to medication, and other psychosocial aspects should be addressed. Combination of different strategies appears to be mandatory.

A Narrative Review on Dialectical Behavior Therapy for Patients with Depressive Difficulties

Background: Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy (CBT) that was earlier intended to treat only patients with borderline personality disorder (BPD), but researchers have found DBT to treat several psychological disorders, including depression. Aim: The article aims to review the clinical shreds of evidence regarding the use of DBT to treat depression. Methods: PubMed literature search was done by applying the year filter range, 2010 to 2021. Another filter applied was "Randomized controlled trial", so that the strength of evidence could be enhanced. The keywords used were "Dialectical Behavior Therapy" AND "Depression Results: 33 articles were found, out of which only 20 relevant articles were reviewed. DBT was found to alleviate depressive symptoms associated with different psychological disorders like bipolar disorder and BPD but the number of studies that validated the afore-mentioned were less than those studies which showed that DBT had no significant effect on the patients with depressive difficulties. The long-term effect of DBT for treating depression is under a suspect, as studies showed DBT got ineffective during the follow-ups Conclusion: DBT shows benefits in depression but further studies are still required to validate this concretely as DBT did not show a significant effect when compared to its control counterparts. There is much need for future studies which can evaluate the long-term efficacy of DBT in depression is another challenging area because follow-up data did not favor DBT.

Effect of Anger Management Education on Aggression in Bipolar Disorder Hospitalized Patients: A Pilot Study

Background: Aggression is one of the symptoms of bipolar disorder. This expression can be associated with negative personal and social effects Objective: This study aimed to determine the effect of anger management education on aggression in bipolar disorder. Method: This semi-experimental study with a repeated measures design was conducted in Hamadan, Iran, 2018. Fifty-two bipolar type-1 disorder patients were randomly selected from the Psychiatric Ward of Farshian Hospital through the convenience sampling method. The anger management education intervention included four sessions. Also, the State-Trait Anger Expression Inventory-2 (STAXI-2) was completed by the subjects before, immediately, and two weeks after the educational intervention. Data analysis was performed in SPSS16, using Mauchly’s sphericity test and the least significant difference. Results: The mean aggression score was 61.38±11.59 before the intervention, which reduced to 27.18±8.61 and 18.86±6.45 immediately and two weeks after the intervention, respectively. The repeated measures test showed that the decreasing trend of scores was statistically significant (P<0.001). Moreover, pairwise comparison of study stages demonstrated a significant difference between the first and second stages (P<0.001) and the second and third stages (P<0.001). Conclusion: Anger management education reduced the level of aggression in bipolar type-1 disorder. Therefore, it can be incorporated into nursing care programs

Internet Addiction, Depression and Relation with Academic Failure in Students of Allied Medical Sciences, Semnan, Iran

Background: Internet addiction, which is a result of increasing inevitable use of the Internet and smart phones, causes discomfort and serious social and occupational problems, consequently that can lead to some mental disorders such as depression. On the other hand, depression and Internet addiction are factors affecting students' academic performance. Objective: This study aimed to investigate Internet addiction, depression and their relation with academic failure in students of Semnan Allied Medical Sciences. Methods: In this cross-sectional study, all students who were in the 3rd and higher semesters were examined. Three questionnaires (demographic, Beck Depression Inventory, and the Internet Addiction Test by Young) were used. The academic failure was assessed using the student's grade point average in the previous 3 semesters. Collected data was analyzed through descriptive and inferential statistics methods at significance level of 0.05. Results: 170 students participated in this study. The correlation between depression and grade point average changes was negative (r=-0.19) and significant (p=0.01). Moreover, a positive (r=0.39) and significant (p=0.01) correlation was observed between depression and Internet addiction scores. Binary logistic regression analysis also indicated that students' depression score (P=0.04, OR1.04, CI 95%=1-1.08) and sex (P=0.008, OR=0.37, CI 95% = 0.17-0.77) can predict academic failure. Conclusion: Due to the observation of Internet addiction and depression in the students and effects of these disorders on their academic performance, it is necessary to educate students and families, identify risk factors and provide solutions to deal with it.

Evaluation of Childbirth Self-Efficacy in Pregnant Women with Variables: A Systematic Review and Meta-Analysis

Objective : The present study aims to examine childbirth self-efficacy levels with potential moderating variables. Methods: The systematic searches were conducted in nine databases in July 2019. The PRISMA checklist was used. The quality of studies was evaluated by two researchers. The random-effect model was used in the present meta-analysis. The heterogeneity tests and moderator analyses were performed. There were 18 eligible articles. Results: Results indicated that childbirth self-efficacy levels do not change based on parity (Q=0.784, p=0.376 for efficacy expectancy, Q=0.190, p=0.663 for outcome expectancy). The between-study variance was not significant for subdimensions of CBSEI (Qb = 1.531, p = .216), which means no significant difference between OE and EE levels was found. The between-study variance was not significant for OE levels (Qb = 0.333, p = .847), which means no significant difference was found between Outcome-AL, Outcome-SS, and OE-16. The moderator analysis, including Efficacy-AL, Efficacy-SS, and EE-16 presented a higher pooled mean score for EE-16 (111.56; 95% CI = 98.66 to 124.46). However, the between-study variance was not significant for EE levels (Qb = 4.240, p = .120). Despite the moderator analysis, the finding of high heterogeneity suggests the need for further studies which examine the concept of childbirth self-efficacy with additional variables. Conclusion: The study presents that childbirth self-efficacy levels do not change based on parity, stages of labor and subdimensions of CBSEI. Researchers need to examine the concept of childbirth self-efficacy with new variables for further clarify of concept.

Quality of Life in Family Caregivers of Patients with Schizophrenia: A Narrative Review

: Care for schizophrenia patients over the past few decades has shifted from inpatient treatment in mental institutions towards outpatient treatment options. While this has the potential to allow patients a more regular life with the ability to work and socialize, it has increased the burden on family caregivers. This state-of-the-art narrative review summarizes the most important factors, besides the clinical symptoms of schizophrenia, that impact the quality of life of caregivers negatively. These factors include the impact of the disease on household income and socioeconomic status, anxiety, stigma, negative changes in family dynamics as well as an overall reduction of social and family contacts.

The Experience of Depression Relapse among Adult Thai Patients with Depressive Disorder: A Qualitative Study

Background: Depressive disorder is a disease with widespread incidence and has shown an annual increase, while depression relapse is also rising continually due to multiple causes. In Thailand, although many studies have been conducted to prevent depression incidence and relapse, there is little known about the meaning of depression relapse in adult Thai patients. An exploration of the direct experiences of adult Thai patients seems a suitable way to gather data for a care system development. Objectives: The objective of this study is to describe the perceptions of adult Thai patients concerning their experience of depression relapse and its management among adult patients with depressive disorder in the Thai context. Methods: This research is a qualitative study using the directed content analysis approach. In-depth interviews with 20 adult Thai patients with depressive disorders that had direct experience with depression relapse were the data collection method used in this study. The interviews allowed the participants to talk about their experiences with depression relapse and how to manage depressive symptoms; the interviews lasted approximately 60 minutes. Results: Two themes emerged from the study. First, the experience of depression relapse is the feeling of something pulling away from happiness. Second, managing depression relapse. Conclusion: Depression relapse among adult Thai patients with depressive disorder is an experience causing patients to feel that they are losing their happiness again. Care and management of depression relapse by each patient differ, despite being in the same social contexts. Therefore, depression relapse risk assessment is important in the care of each patient in order to design more effective care.

Forensic Psychiatry and Psychopathology: An Amendment in Contemporary Period

: As stated by Jaspers, a delusion is a deviant assessment of reality that is irredeemably believed. Therefore, while the delusions are apprehended with the uncommon verdict and are not open to rationality, their irrationality or wrongness is obvious to other persons. While Norman Cameron’s pseudo-community, a supposed community of conspirators, was a historical description of conditions that promote the development of delusional disorders, modern technology and advancement of new communicative tools, like smartphone, hidden camera, satellite, internet, and stealthy or scheming tricks or setups, like double-crossing and masquerading scenarios, stressful circumstances, furtive or hectic arrangements, creating a scene to deceive, hack, or tampering, have brought about the possibility of a conspiracy by prejudiced or inimical people, which may amplify the conceivable diagnostic faults by the perplexity of circumstances. On the other hand, it is the duty of forensic and clinical psychiatrists to guess or discover any kind of deceptive entrapment or simulation. In the present article, the said eccentricities, which may have been accelerated by modern technology, have been discussed briefly, especially with respect to paranoia and paranoid ideation. Moreover, some clarifications for better demarcation of the discussed problem and modification of operational definitions in the realm of psychopathology have been suggested. Certainly, ample watchfulness by a clinical or forensic psychiatrist for neutralizing a thinkable intrigue is an apposite performance for improving civil rights and preventing preventable slips.

Association Between Structural Determinants of Health and Posttraumatic Stress Symptoms during the COVID-19 Pandemic

Background: Psychological problems, such as post-traumatic stress symptoms (PTSS), are among the most important complications associated with the COVID-19 pandemic in people. Studying the social determinants of health (SDH) and its impact on the populations during the crisis will help governments deal better with health emergencies so that every person can have an equal opportunity to stay healthy. Objective: To determine what factors affect PTSS, we conducted a study to investigate the association between structural determinants of health and PTSS during the COVID-19 pandemic. Methods: We conducted a cross-sectional study on 370 people referred to a selected laboratory between June and July 2020 in Karaj province, Iran. Post-traumatic stress disorder (PTSD) 8-item inventory was used to evaluate the PTSS and its subscales, including intrusion, avoidance, and hypervigilance in the participants. Results: Overall, 51.2% of participants were male, and 17.3% were positive for the IgM or IgG COVID-19 test. The most common symptoms in these patients were weakness, myalgia, cough, anosmia, and fever. The prevalence of total PTSS, intrusion, avoidance, and hypervigilance symptoms were 7.1%, 25.7%, 41.6%, and 16.2%, respectively. In univariable regression analysis, female gender (p-value=0.01, 95%CI (2.25-0.31)), un-employment (p-value=0.011, 95%CI (0.37-2.81)), having symptoms of COVID-19 disease (p-value=0.000, 95%CI (.82-2.75)), underlying chronic disease, were directly associated with PTSS. Conclusion: Results showed that sex and occupation as structural determinants of health could affect PTSS in the COVID-19 pandemic. However, in the multivariable model, having symptoms of the COVID-19 disease and underlying disease affected PTSS.