Current Psychiatry Research and Reviews - Volume 16, Issue 3, 2020

Background: In 2013, Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the DSM-5 in part to curb the rapid rise in the rates of bipolar diagnosis among children and adolescents during the decade before the DSM-5 publication. DMDD proved to be a controversial diagnosis for many reasons. Objective: This brief review aims to provide an overview of the DMDD diagnosis and its origins and summarize available data on the impact of the introduction of the DMDD diagnosis on the rates of bipolar disorder among children and adolescents. Methods: Multiple scientific databases were searched using the related terms “DMDD”, “Disruptive Mood Dysregulation”, and “pediatric bipolar disorder” in combination with the terms “diagnosis” and “impact”. The retrieved articles were reviewed carefully. Results: The DMDD diagnosis rates have steadily increased since its introduction. Furthermore, available data show a decrease in the rates of bipolar disorder diagnosis among children and adolescents over the past few years. Conclusion: The very limited available data since 2013 show a decline in the diagnosis of bipolar disorder among children and adolescents. More time and further research are needed to more accurately determine the impact of the DMDD diagnosis on the rates of bipolar disorder in this population.

Background: The novel coronavirus disease outbreak of 2019 was declared as a public health emergency by the World Health Organization. At present, the virus has spread throughout the world, leading to millions of cases and is further increasing. Objective: The main objective of this study is to review the impact of Corona Virus Disease 2019 (COVID-19) on the mental health of frontline workers, isolated and quarantined people and the general population. Methods: The relevant articles were extracted from PubMed, Web of Science and ScienceDirect database by using the keywords “Mental health”, “COVID-19”, “Impact of COVID-19”, “Frontline workers”, “Quarantine”, “Isolation”, “Immunity” and “Economy”. The retrieved articles were included in the study based on inclusion criteria to perform the review. All the selected scientific articles were critically reviewed and the information is summarized in this narrative review. Results: The majority of the studies stated that frontline health workers were at an increased risk of depression. The infected, suspects and quarantined people were reported with high stress, posttraumatic stress disorder, and suicidal thoughts. The pandemic has devastated the world’s economy, which has severely impacted global mental health. Conclusion: Mental health should be taken into account, and necessary interventional initiatives need to be considered both by the health authorities and the government to minimize the adversity of the consequences. The pandemic may disappear with the discovery of new vaccines or medications, but its negative impact on mental health may persist, particularly among vulnerable populations. Thus, mental health must be a matter of concern in the present scenario.

Background: Panic disorder (PD) is a kind of anxiety disorder that impacts the life quality and functional perspectives in patients. However, the pathophysiological study of PD seems still inadequate and many unresolved issues need to be clarified. Objectives: In this review article of biomarkers in PD, the investigator will focus on the findings of magnetic resonance imaging (MRI) of the brain in the pathophysiology study. The MRI biomarkers would be divided into several categories, on the basis of structural and functional perspectives. Methods: The structural category would include the gray matter and white matter tract studies. The functional category would consist of functional MRI (fMRI), resting-state fMRI (Rs-fMRI), and magnetic resonance spectroscopy (MRS). The PD biomarkers revealed by the above methodologies would be discussed in this article. Results: For the gray matter perspectives, the PD patients would have alterations in the volumes of fear network structures, such as the amygdala, parahippocampal gyrus, thalamus, anterior cingulate cortex, insula, and frontal regions. For the white matter tract studies, the PD patients seemed to have alterations in the fasciculus linking the fear network regions, such as the anterior thalamic radiation, uncinate fasciculus, fronto-occipital fasciculus, and superior longitudinal fasciculus. For the fMRI studies in PD, the significant results also focused on the fear network regions, such as the amygdala, hippocampus, thalamus, insula, and frontal regions. For the Rs-fMRI studies, PD patients seemed to have alterations in the regions of the default mode network and fear network model. At last, the MRS results showed alterations in neuron metabolites of the hippocampus, amygdala, occipital cortex, and frontal regions. Conclusion: The MRI biomarkers in PD might be compatible with the extended fear network model hypothesis in PD, which included the amygdala, hippocampus, thalamus, insula, frontal regions, and sensory-related cortex.

Background: Depression is a heavily prevalent mental disorder. Symptoms of depression extend beyond mood, cognition, and behavior to include a spectrum of somatic manifestations in all organic systems. Changes in sleep and neuroendocrine rhythms are especially prominent, and disruptions of circadian rhythms have been closely related to the neurobiology of depression. With the advent of increased research in chronobiology, various pathophysiologic mechanisms have been proposed, including anomalies of sleep architecture, the effects of clock gene polymorphisms in monoamine metabolism, and the deleterious impact of social zeitgebers. The identification of these chronodisruptions has propelled the emergence of several chronotherapeutic strategies, both pharmacological and non-pharmacological, with varying degrees of clinical evidence. Methods: The fundamental objective of this review is to integrate current knowledge about the role of chronobiology and depression and to summarize the interventions developed to resynchronize biorhythms both within an individual and with geophysical time. Results: We have found that among the non-pharmacological alternatives, triple chronotherapywhich encompasses bright light therapy, sleep deprivation therapy, and consecutive sleep phase advance therapy-has garnered the most considerable scientific interest. On the other hand, agomelatine appears to be the most promising pharmacological option, given its unique melatonergic pharmacodynamics. Conclusion: Research in chronotherapy as a treatment for depression is currently booming. Novel interventions could play a significant role in adopting new options for the treatment of depression, with Tripe Cronotherapy standing out as the most promising treatment.

Background: Since warfarin has a very narrow therapeutic index, the interaction between warfarin and antidepressants is very critical and has potentially severe consequences. It is unclear whether clinicians have sufficient knowledge about the risk of bleeding when warfarin and antidepressants are used concomitantly. Objective: In this systematic review, we discuss the main considerations when using warfarin with antidepressants. Methods: The information about warfarin-antidepressant interactions was obtained from Google Scholar^®, PubMed/MEDLINE^® and a hand search of the published literature. The following research terms which were systematically combined with each other to find articles: warfarin, anticoagulant, interactions, antidepressant (and each antidepressant name individually), SSRI, SNRI, TCA, MAOI. Results: Several possible mechanisms that can cause bleeding when antidepressants and warfarin are used concomitantly, have been discussed. According to the available data, sertraline and citalopram/ escitalopram are safer antidepressants to use with warfarin, whereas fluoxetine and fluvoxamine have a higher interaction potential with warfarin. The remaining antidepressants appear to lie somewhere in between and have little empirical data to guide the clinicians. Conclusion: It is recommended that when an antidepressant is prescribed to a patient using warfarin, patient’s international normalized ratio (INR) level should be checked regularly. In this review, the interaction between warfarin and antidepressants, including new ones, were evaluated inclusively and in detail.

Background: Burnout is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. It was initially investigated among employees and restricted to those who work in human services and educational institutions. However, this study aimed to evaluate the prevalence and associated risk factors of burnout among Egyptian medical students in Damietta Faculty of Medicine, Al-Azhar University. Methods: This cross-sectional study was conducted between December 2017 and March 2018, involved first to sixth-year medical students. The questioner consisted of four sections: 1) Sociodemographics and personal characteristics of participants such as age, gender, and academic year; 2) Burnout measurement: Burnout was measured by MBI-SS, a modified form of MBI-GS; 3) Related risk factors; 4) association between burnout and performance. Results: Out of 322 students, 222 students completed the questionnaire with a 67% response rate. The mean age was 21.1 ± 1.9, and 197 (88.7%) students were males. Our analysis demonstrated that the prevalence of burnout was 51.8%. In terms of subscales, 198 participants have high emotional exhaustion, 201 showed a high degree of depersonalization, and 110 participants have personal accomplishment. There was a significant difference between both groups in terms of gender (p=0.01) and marital status (p=0.005). Regression analysis demonstrated that high-risk factors related to studying burden, social burden, and future burden are associated with a higher risk of burnout with odd ratio (OR= 1.10, 95% CI (1.05-1.155), p<0.05), (OR= 1.05, 95% CI (1.01-1.09), p<0.05), and (OR= 1.15, 95% CI (1.05-1.26), p<0.05), respectively. Conclusion: This study found that the burnout prevalence was 52± with quite a high percentage of emotional exhaustion (EE) and depersonalization (DP), and a low level of personal accomplishment. Moreover, a significant association between gender, grade of medical school, marital status, and risk factors related to the study burden, future burden, and social burden.

Background: Multiple sclerosis (MS) is a chronic disease that affects the central nervous system. Depression, anxiety and stress are the most common psychiatric comorbidities in MS, which can have adverse consequences. The aim of this study was to determine the effect of relaxation (Jacobson and Benson) technique on depression, anxiety and stress in MS patients. Methods: This clinical trial was conducted since December 2016 to March 2017 in the Multiple Sclerosis Association and the Neurology Clinic of Farshchian Hospital (Sina) in Hamadan. Sixty patients with multiple sclerosis were randomly assigned to two experimental (n=30) and control (n=30) groups. The control group received routine care and experimental group received the relaxation technique (Jacobson and Benson) in 8 sessions of 60-minute twice a week for 4 weeks in addition to receiving routine care. The DASS-21 scale was completed by samples before and after the intervention. Results: Results of the study showed that in the intervention group, the scores of depression, anxiety and stress after using relaxation (Jacobson and Benson) was decreased significantly (P<0.05), while in the control group no significant decrease was observed (P<0.05). Conclusion: The results of this study showed that relaxation (Jacobson and Benson) is effective in reducing depression, anxiety and stress in patients with multiple sclerosis. Therefore, in addition to prescribing medication, it is suggested that complementary therapies be performed for these patients.

Background: Infertility can result in many problems for couples. In most cases, the stress and anxiety of treating infertility can reduce fertility and affect marital disputes. The provision of counseling and informing can reduce stress and improve couples’ relationships and positively influence infertility treatment in many cases. The present study, therefore, was conducted to evaluate the effect of counseling on the stress of infertile women admitted to an infertility center in Hamadan City, Iran. Methods: The present study was performed as a two-group randomized clinical trial with two pretest and posttest stages on 104 eligible women admitted to Fatemieh Hospital in Hamadan during 2017-18. Members of the intervention group received group counseling with a cognitive-behavioral approach to stress reduction in four 1-h sessions during the 4 weeks. Data were obtained using demographic characteristics and Harry’s Stress Assessment questionnaires. Data were analyzed using SPSS 21 software, paired and independent t-test, and analysis of covariance at a significance level of < 0.05. Results: Mean stress scores were 181.82 ± 15.9 and 189.11 ± 2.1 in the pre-intervention stage, and 174.6 ± 29.6 and in the test group 78.10 ± 1.3 in the post-intervention phase in the test and control groups, respectively. High-stress levels were observed in both groups before the intervention. Independent t-test revealed that mean stress scores were significantly different in the two groups at both pre- and post-intervention stages (P < 0.05). The paired t-test indicated a significantly reduced stress score in the intervention group (P < 0.05). Conclusion: Stress management counseling in infertile women can play a positive and effective role in stress mitigation and promotion of their mental health. Therefore, the effect of this counseling can be more reliably emphasized on improving the effectiveness of infertility treatment.