Domestic violence against women (DV) in one of health problems that have 9–15% of burden of diseases in middle aged women and would lead to another health problems such as psychiatric disorders and could increase health services utilization and costs.

To estimate prevalence of DV in married women in Tehran and its relation to health services utilization.

A household survey of 615 married women in 22 city districts of Tehran in 2011 with a cluster sampling method was done. Demographic, knowledge, attitude and experience of DV in last 12 months and during marital life, health services utilization in last 1 and 12 months were collected. Analysis were done by STATA, SPSS and ArcGIS softwares.

We interviewed 615 married women, mean±SE age 42.6±1.1 years and duration of marriage 21.5±0.7 years. Physical and non-physical DV during marital life were 35.1% and 7.2%; respectively and during last 12 months were 18.9% and 35.6%; respectively. Health service utilization during last 1 and 12 months were 2.6 and 7.15 time per person; respectively. Women with non-physical DV utilized more mental health and non-prescribed medicine use (P< 0.05). Women with physical DV had less physician (GP, Specialist) services use (1.8±0.6 vs. 2.3±0.1, respectively, P = 0.045) but similar rate of all services utilization with women without physical DV.

DV victims had higher rates of anxiety and depression that would lead to higher health services utilization among them and may produce at least 250 billion Rials annual cost to health system.

L’étude des facteurs de vulnérabilité à la schizophrénie est un enjeu majeur de la psychiatrie actuelle [3]. Nous avons donc réalisé une étude dans l’objectif d’expliciter les liens existant entre traumatismes subis dans l’enfance et anomalies anatomiques observées dans la schizophrénie.

Au total 26 sujets schizophrènes stabilisés par rispéridone ou aripiprazole depuis au moins 6 semaines et 31 volontaires sains appariés ont été inclus. La sévérité des traumatismes infantiles a été évaluée avec la Childhood Trauma Questionnaire (CTQ). L’analyse en Voxel-Based Morphometry (VBM) a été réalisée à partir d’IRM anatomiques haute résolution en veillant à la qualité du prétraitement [1] et après correction pour les comparaisons multiples.

En cohérence avec notre hypothèse principale, il a été retrouvé une corrélation négative entre la négligence émotionnelle dans l’enfance et le volume total de matière grise chez les schizophrènes (Δ = −0,50 ; p = 0,003 après ajustement sur l’âge, le sexe et le niveau éducatif). La même tendance est retrouvée non significative chez les volontaires sains. Outre cet effet global, il existe une corrélation négative entre la négligence émotionnelle et la densité de matière grise des schizophrènes dans le cortex cingulaire antérieur dorsal gauche (Z-score = 3,9 ; pFWE = 0,046) et le cortex préfrontal dorsolatéral droit (Z-score = 4,19 ; pFWE = 0,002). La comparaison de la densité de matière grise entre sujets schizophrènes et volontaires sains révèle des diminutions de densités centrées sur la partie antérieure des insula et le gyrus temporal supérieur gauche.

Ce résultat original démontre l’impact des interactions précoces, auxquelles les schizophrènes semblent particulièrement sensibles, sur la morphologie cérébrale. Les régions retrouvées, cortex cingulaire antérieur dorsal et cortex préfrontal dorsolatéral, sont particulièrement impliquées dans les troubles cognitifs et la dimension de désorganisation de la schizophrénie [2].

Suicide is an important public health problem worldwide. The aim of this study was to describe the epidemiology of suicide and attempted suicide in Iran.

A retrospective study from March 2001 to March 2008 examined some characteristics of cases of suicide and attempted suicide in the Islamic Republic of Iran based on the health system database of 41 medical universities.

A total of 53 100 cases of suicide and attempted suicide were analysed. Just over half were among women (55.0%). The most favoured method of attempted suicide among both males and females was drug overdose. Self-burning was more frequent in females (5.8%) while hanging (4.5%), cutting (2.8%) and firearms (0.5%) were more common in males. There were 3883 (7.3%) completed (fatal) suicides. Hanging had the highest case fatality rate (76.5%) and drug overdose the lowest (2.3%). Older people had a higher mortality rate.

Suicide and attempted suicides increased from 8.3 per 100 000 population in 2001 to 19.4 in 2005, then declined to 16.3 in 2008.

The pilot study aimed to evaluate the effectiveness of a collaborative education program in term of feedbacks from community suicidal precaution nurses (CSPN) and caregivers.

A convenience sample of eight caregivers of patients who presented with suicidal idea or attempted suicide before current admission, and were diagnosed with depression in a study ward were recruited. Knowledge and theory about elderly suicide and caring skill were taught by the psycho-geriatric ward nurse during patient hospitalization. When patient was discharged, the CSPN were liaised. They would help caregivers transforming the theory into practice at their home, and then reinforce their suicidal precaution skills. The effectiveness of the collaborative education program was evaluated by feedbacks from CSPN and caregivers.

The CSPN agreed that the collaborative program was useful and practical, which bridged caregivers’ knowledge gap. The program provided a continuous support to caregivers before and after patients’ discharge. The caregivers expressed that the program was satisfactory and met their needs.

The collaborative program was effective in providing continuous support on practicing the suicidal precaution skill among the caregivers.

Une forte corpulence dans l’enfance ou l’adolescence pourrait influencer le risque de dépression chez l’adulte indépendamment de l’indice de masse corporelle à l’âge adulte [1,2]. Notre objectif était d’identifier chez des femmes françaises post-ménopausées l’association entre la corpulence à la naissance, dans l’enfance et au cours des premières années de vie adulte et le risque de dépression.

Au sein de la cohorte E3N, 41 144 femmes ont renseigné leur poids et taille de naissance ainsi que la silhouette de Sørensen [3] qui correspondait le mieux à leur silhouette à 8 ans, à la puberté, à 20–25 ans et 35–40 ans. Des trajectoires représentant l’évolution de la silhouette au cours du temps ont été estimées grâce à un modèle à classes latentes (Fig. 1). Des modèles logistiques multinomiaux multi-ajustés ont ensuite permis d’estimer les associations entre ces facteurs et la dépression définie par l’échelle CES-D (CES-D ≥ 23), classée en dépression récurrente ou primo-incidente selon l’existence ou non d’un antécédent de trouble psychologique traité.

Fig. 1

Trajectoires de corpulence au cours de la vie, étude E3N (n = 41 144).

Le risque de dépression primo-incidente était plus élevé chez les femmes dont le poids de naissance était élevé, comparées à celles ayant un poids de naissance moyen (OR = 1,16 ; 95 % IC 1,01–1,34), mais aussi chez celles dont la corpulence était élevée tout au long de la vie, comparées à celles dont la corpulence restait faible (OR = 1,49 ; 95 % IC 1,22–1,80). Inversement, la dépression récurrente était associée à un poids de naissance faible (OR = 1,22 ; 95 % IC 1,05–1,41) et à la trajectoire correspondant à une augmentation de la corpulence entre 8 ans et la puberté puis à sa stabilisation (OR = 1,27 ; 95 % IC 1,03–1,56).

Le risque de dépression à l’âge adulte était associé à la corpulence à la naissance et à l’évolution de la corpulence au cours de la vie mais différait selon le caractère primo-incident ou récurrent de la dépression.

There are disparities in mental health services (MHS) utilization within and between populations and several factors are studied as its potential correlates. Identifying those correlates would help health policy makers to adjust service provision with characteristics of their community.

To evaluate demographic, socioeconomic and system correlates of MHS utilization among married women from Tehran, Iran.

A household survey of 615 married women residents of 22 municipal districts of Tehran selected via a cluster sampling method. All subjects were asked about health services utilization during last one and 12 months as well as need and access for MHS, demographic and socioeconomic factors. Independent correlates of MHS use were determined with logistic regression analysis.

Total 615 women, mean±SE age and duration of marital life of 42.6±0.9 and 22±0.8 years, respectively were selected, rate of MHS utilization during last one and 12 months were 5.2% and 10.1% respectively. 23.6% of women reported having mental illness and 19.3% and 17.9% had need for MHS and access to outpatient health services, respectively. Logistic regression models showed that need for MHS (OR:5.25, 95%CI:2.7–10.1), access to outpatient services (OR:2.17, 95%CI:1.04–4.52), smoking (OR:3.4, 95%CI:1.16–10.2) and crowding index (OR:0.69, 95%CI:0.48–0.99).

Rate of MHS utilization in women are low considering the near to estimated rate of perceived illness. Bridging the gap between perceived illness and need for services, then providing better access to services in areas with higher crowding index and higher rates of smoking in residents should considered in any mental health promotion programs.

Les études précédentes ont suggéré une association positive entre la dépression et le surpoids et/ou l’obésité notamment au sein de populations nord-américaines [2]. Notre objectif était d’identifier les associations transversales entre la dépression primo-incidente ou récurrente et différentes mesures anthropométriques au sein d’une population de femmes françaises post-ménopausées.

Chez 38 974 femmes de la cohorte E3N en 2005, la dépression a été définie selon l’échelle CES-D (CESD ≥ 23) puis classée en dépression récurrente ou primo-incidente, selon l’existence ou non d’un antécédent autodéclaré de traitement pour trouble psychologique. Les associations entre les mesures anthropométriques, découpées en quartiles, et le risque de dépression ont ensuite été estimés grâce à des modèles logistiques multinomiaux.

Un faible poids (< 55 kg) et un faible indice de masse corporel (IMC < 20 kg/m2) étaient associés au risque de dépression primo-incidente (respectivement OR = 1,14 ; 95 % IC 1,01–1,29 et OR = 1,20 ; 95 % IC 1,05–1,36) et récurrente (OR = 1,26, 95 % IC 1,12–1,40 et OR = 1,33, 95 % IC 1,18–1,50). L’augmentation de risque associé à un faible tour de hanche (TH < 93 cm) disparaissait après ajustement sur l’IMC. Les catégories les plus élevées de poids, d’IMC ou de TH étaient associées à un risque plus élevé de dépression récurrente. Une augmentation du tour de taille (TT) ou du ratio taille/hanche était significativement associée à une augmentation du risque des deux types de dépression (p-trend < 0,001), indépendamment de l’IMC.

Les femmes les plus minces [1] ainsi que chez celles ayant un TT ou un ratio taille/hanche élevé [3] pourraient avoir un risque plus élevé de dépression, et notamment de dépression primo-incidente. De nouvelles études longitudinales sont cependant nécessaires afin de préciser la temporalité des associations entre ces mesures anthropométriques et la dépression et appuyer ces hypothèses.

There are in the literature a few case reports about the development of a manic-psychotic features after the use of antibiotics.This side effect is compared to the frequent and widespread use not very common.

Awareness about the potential neuropsychiatric side effects of antibiotics.

A 53 year old man was seen with since two days manifest agitation, religious utterances, confusion, sleep disturbance and sexual disinheriting. He started ten days before admission a course with Amoxicillin / Clavulanic-acid 500/125 mg t.i.d. for erysipelas to the right leg. He seems to be manic psychotic. During the hospitalization he refused to take the prescribed risperidon. He took only the lorazepam. On the third hospital day the psychiatric symptoms were fully remitted. He had two years ago the same psychiatric symptoms after a seven-day treatment with cotrimoxazole. His condition is completely disappeared within 24 hours after cotrimoxazol discontinuation and without any intake of psychotropic drugs. Pathophysiology: Unclear. Possibly interact antibiotics with different neurotransmitters: for example penicillin inhibits GABA- A and benzodiazepine receptors. This leads to a stimulation of the central nervous system resulting in neurotoxicity and reduction of the seizure threshold. The inhibition of the hepatic P450 enzyme system which results in increased serum levels of antibiotics and subsequently to neurotoxicity. Prostaglandins and cortisol may also play a role.

Manic-psychosis as a side-effect of antibiotics is rare and the symptoms usually disappear within a few days after stopping the antibiotic and a treatment with psychotropic drugs is usually not necessary.

Les femmes en attente de don d’ovocytes sont confrontées à diverses difficultés peu explorées dans la littérature : vécu subjectif douloureux, échecs des FIV précédentes, long délai d’attente d’un don, dissociation de la filiation génétique et gestationnelle… L’objectif principal est de déterminer si l’« attente d’un don d’ovocytes » est anxio-dépressiogène, et si le locus de contrôle externe constitue un facteur protecteur.

Les 3 groupes de femmes inclus sont en attente d’un don d’ovocytes (n = 10), en cours d’une première FIV (FIV1 ; n = 34) ou d’une deuxième FIV ou plus (FIV2+ ; n = 39). Elles ont été évaluées sur l’anxiété (State-Trait Anxiety Inventory), la dépression (Beck Depression Inventory), les locus de contrôle, la réaction à l’infertilité.

Les femmes receveuses étaient significativement plus âgées. Elles étaient significativement plus anxieuses mais pas plus dépressives que les groupes FIV. Leur anxiété actuelle était en partie expliquée par une internalité plus marquée. Pourtant, chez les femmes infertiles en général, c’est l’externalité de type « Autre toutpuissant » qui expliquait en partie la diminution de l’anxiété et la diminution du vécu négatif émotionnel de l’infertilité.

Ces résultats sur le locus de contrôle des femmes infertiles éclairent la réflexion sur le mode relationnel médecin malade, chez des patientes anxieuses sans maîtrise de leur fécondité et devant faire confiance aux équipes soignantes.

War trauma has long been associated with Post-traumatic Stress Disorder (PTSD), a term coined in 1980 in the DSM-III to explain the post-war impact on U.S. and coalition veterans who served in Vietnam. New dimensions of war trauma have emerged with the 1991 Gulf War and the wars in Iraq and Afghanistan. These challenges to the traditional diagnosis are seen as being consequences of the new dynamics associated with these conflicts, notably the heavy reliance on reserve troops and the National Guard; a high proportion of female service personnel; and multiple deployment as well as the introduction of suicide bombers and the use of IEDs (Improvised Explosive Devices).

To articulate the new dimensions of war trauma including the pervasive atmosphere of hyper-vigilance; sexual tension within the military ranks; and the high prevalence of closed head injuries.

A through analysis of the latest research on war trauma including the proposed DSM-V diagnostic criteria.

MRI and other medical research indicates certain neurophysiological mechanisms associated particularly with PTSD distinguishing it from other forms of war trauma (adjustment disorders; panic disorders; depression, personality disorders...). Pre-morbid health and social factors are also seen as playing a role in the resilience to, or proneness toward, PTSD. Regarding treatment protocols, the immediate administration of opiates or new grade anti-psychotics seem to have the effect of keeping the trauma in the “acute stress” mode instead of the more difficult to treat, PTSD. Cultural differences are also addressed.

Le projet PSYCHE (Personalised monitoring Systems for care in mental Health) vise à évaluer la capacité d’un système de monitoring à détecter et à prédire les changements d’humeur chez des patients cyclothymiques ou présentant un trouble bipolaire à cycles rapides. Ce système permet l’enregistrement de données physiologiques telles que le rythme cardiaque, respiratoire, l’actimétrie, la voix et de données issues d’autoévaluations de l’humeur et du sommeil. Nous présentons ici l’intégration dans la vie quotidienne du concept PSYCHE.

Une évaluation de la faisabilité et de l’acceptabilité de ce système a été menée sur 4 sujets cyclothymiques lors de la visite d’inclusion, après 7 jours d’utilisation du système et en fin d’étude. Celle-ci, d’une durée totale de 14 semaines, consiste en des enregistrements bi-hebdomadaires : (i) via un t-shirt porté la nuit muni de capteurs raccordés à un boîtier électronique (SEW), de l’actimétrie, des rythmes cardiaque et respiratoire, (ii) via un smartphone, de la voix et de l’humeur (questionnaire ISS de Bauer). Par ailleurs, un agenda de l’humeur est rempli quotidiennement sur smartphone.

L’impression initiale, à 7 jours et à 14 semaines sur le concept PSYCHE, est hautement favorable. Les patients se montrent à la fois enthousiastes et rapportent d’un grand niveau d’aisance avec le matériel, malgré des problèmes de connexion entre le smartphone et le boîtier SEW rencontrés par 2 sujets au début de l’étude.

Le système PSYCHE réclame un bon niveau d’adaptation technologique et un investissement important pour la réalisation de l’ensemble des activités de suivis, mais bénéficie d’une bonne acceptabilité. Des optimisations techniques restent nécessaires pour que le système PSYCHE soit applicable dans un contexte clinique.

Several studies have suggested that vitamin D and testosterone levels may be physiologically and pathologically interlinked. However this relsationship has not been studied in schizophrenia.

To demonstrate an association between vitamin D and testosterone levles in schizophrenia.

To establish that hypovitaminosis D is associated with hypotestosteronrmia.

Laboratory data of all male patients with schizophrenia seen for annual physicals in our office was reviewed. Vitamin D was measured as 25-hydroxyvitamin D and classified as follows: more than 30 ng/ml: normal; 21 to 30 ng/ml: mild deficiency; 11 to 20 ng/mL: moderate deficiency; 10 ng/ml or less: severe deficiency. Testosterone levels were tested by L/MSMS methodology (normal: 348.0–1197 ng/dL).

47 male patients had both vitamin d and testosterone measured: Of these 47, 36 (77%) had hypovitaminosis D and 20 (43%) had LTL. Of the 11 with normal vitamin d levels, 2 (18%) had LTL and 8 (82%) had NTL. Of the 36 with low vitamin D, 18 (50%) had LTL and 18 had NTL (50%). Of the 6 with severe deficiency, 4 (66%) had low and 2 had normal testosterone levels (NTL); of the 15 with moderate deficiency, 7 (47%) had LTL and 9 had NTL and of the 15 with mild deficiency, 7 (47%) had LTL and 8 had NTL.

Vitamin D deficiency appears to be closely related to low testosterone levels in a male schizophrenic population. Supplementation with both vitamin D and testosterone may be needed in these patients.

Obsessive Compulsive Disorder (OCD) is an anxiety disorder which is usually characterized by two types of symptoms, namely.obsessions and compulsions.

Psychosomatic disorders include psycho-cutaneous disease, obsessive-compulsive disorde r(OCD) might be expressed as dermatological lesion and are known as dermo-OCD.

The aim of this study were to determine the prevalence and severity of OCD and its relationship with dermatological disease in sari, Iran, 2011.

The sample consisted of 265 consecutively presenting dermatological patients who agreed to participate in the study, the subjects were assessed with structured clinical interview (SCID-I) by psychiatrist resident and also completed the yalebrown obsessive compulsive scale(Y-BOCS). T-test and chi-square were used to analyze of data.

Of the 265 dermatological patients, 24(9.1%) met DSM-IV criteria for OCD. Only 9(37.5%) of them had previousely been diagnosed as OCD. The most common obsession were washing 13(54.1) and pathological doubt 7 (25%), contamination7 (25%), checking 7(25%).

There is a high prevalence of OCD in dermatological patients and with considerating of importance of OCD with comorbitiy of skin disease, dermatologist must be aware about relationship between two disorders and referring OCD patients to psychiatrist.

Anorexia Nervosa is a serious mental illness and is frequently seen in young females in childhood and adolescence. The most common ages of onset of anorexia nervosa are the mid teens.

To our knowledge this is singular report of a case of delusional disorder in which Anorexia Nervosa preceded the onset of psychotic symptoms. Age and sex of our case are unusual in Anorexia nervosa.

In this report a rare case of Anorexia nervosa is presented in which the patient is a 32 year old male with poor socioeconomic background from a developing country who subsequently experienced a distinct onset of delusional disorder. After four weeks, delusional disorder and Anorexia Nervosa resolved due to treatment by atypical antipsychotics (Risperidone).

The association between anorexia Nervosa and Delusional Disorder is important. In the case which is reported here delusional thoughts started six month after anorexia nervosa when the patient became extremely thin and cachectic.

In fact the theory of occurrence of psychotic disorder as a result of severe malnutrition is intensified.

Mr H.K., âgé de 23 ans, célibataire, scolarisé jusqu’au baccalauréat, benjamin d’une fratrie de 5, hospitalisé pour une schizophrénie avec une symptomatologie faite d’un délire de grandeur, un délire mystique, un délire de filiation et un syndrome dissociatif. Les entretiens du patient et de la famille ont révélé plusieurs discordances indiquant l’existence probable de secret de famille et de non-dits.

Mr K.M., âgé de 32 ans, célibataire, scolarisé jusqu’en 5e année secondaire, enfant adoptif, son père adoptif est décédé, il est suivi pour une schizophrénie paranoïde avec comme symptomatologie un délire de grandeur, de filiation et de persécution. La mère adoptive a toujours nié l’adoption. Dans les familles de patients psychotiques, on retrouve souvent des fantômes, tels qu’Abraham et Torok les ont décrits, c’est-à-dire des deuils pathologiques et des secrets inavoués. Le fantôme familial se transmet de génération en génération, par un non-dit, des béances, un silence, en sinistre héritage.

The efficacy, acceptability and/or tolerability of available antidepressants are not yet satisfactory.

This meta-analysis aimed to summarize the efficacy, acceptability and tolerability of quetiapine treatment for MDD.

MEDLINE, EMBASE, CINHL, PsycINFO and Cochrane Controlled Trials Register were searched in February 2012. Efficacy outcomes were pooled mean changed scores of the standard depressive rating scales. The overall discontinuation rate and discontinuation rate due to adverse events were considered as the measure of acceptability and tolerability, respectively.

A total of 1497 participants in three published RCTs were included. The pooled mean changed score of the Montgomery-Asberg Depression Rating Scale and Hamilton Depression Rating Scale of the quetiapine-treated group were higher than those of the placebo-treated group with WMDs (95%CI) of 3.37 (-3.95, -2.79) and -2.46 (-3.47, -1.45), respectively. The overall response and remission rates were greater in the quetiapine-treated group with RRs (95%CIs) of 1.44 (1.26, 1.64) and 1.37 (1.12, 1.68), respectively. The pooled overall discontinuation rate was not different between groups with an RR (95%CI) of 1.16 (0.97, 1.39). The pooled discontinuation rate due to adverse event was greater in the quetiapine group with an RR (95%CI) of 2.90 (1.87, 4.48). The pooled mean change Pittsburgh Sleep Quality Index scores was also higher in the quetiapine-treated group [WMD (95%CI) of -1.21 (-1.81, -0.61)].

Quetiapine XR is effective for the treatment of MDD. These patients may not accept and tolerate this agent well. Its advantage on sleep improvement may be of benefit for patients with MDD.

Absconding from a psychiatric ward (leaving without permission) is a costly event in many ways.

Some risks of absconding include missed treatment which results in longer rehabilitation time or lack of treatment altogether.

To investigate the motivation and characteristics of patients absconding from a psychiatric ward in Iran.

A prospective study was conducted for patients who absconded from psychiatric ward in the period between July 2010 and July 2011. The variables were patients’ age, gender, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. All patients were interviewed to assess their motivation for absconding.

Over a one-year period of data collection 56 absconding events were recorded, with the incidence rate of 4.24%. The mean age of absconders was 31+8.4 years, 47 (83.9%) absconders were males, 28 (50.9%) absconds happened through the park fence.

Bipolar mood disorder or schizophrenia was the diagnosis of 23 (41%) absconders. The mean number of days of hospitalization in patients who left the wards was 11 days. The main motivation to abscond was boredom from the ward environment and missing the family.

The risk of absconding is highest in the early days of admission especially in male, young patients with diagnosis of bipolar mood disorder or schizophrenia.