Background: Coronavirus disease 2019 (COVID-19) is a global public health emergency and may result in psychological problems such as anxiety and depression in general population. Therefore, this study aimed to determine the prevalence of anxiety and depression and their associated factors in general population of Iran during the COVID-19 pandemic.Methods: We conducted this web-based cross-sectional study on 5328 individuals in Iran, between 17 and 29 April 2020. Data were collected through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected information on demographic characteristics, COVID-19-related variables, and anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression.Results: The mean GAD-7 and PHQ-9 total scores were 7.17 (SD=5.42) and 7.80 (SD=6.68), respectively. The prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with being female, being young and middle-aged, being unemployed or housewife, having chronic diseases, long time thinking about COVID-19, having family members, friends, and/or relatives infected with COVI-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family. Conclusion: The prevalence of anxiety and depression were considerably high in general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, unemployed people, people with chronic disease. Thus, a holistic approach, including management policies, psychosocial interventions, training, support, and tele-mental health, is absolutely crucial to reduce mental health problems of the COVID-19 and any outbreaks of other infectious diseases.

In Iran, inpatient group psychotherapy has been limited to transient practices for research purposes or fulfilling personal interest of therapists. The goal of this paper is to share and explain the experience of developing an inpatient group psychotherapy program in Roozbeh Psychiatric Hospital, Tehran, Iran. After theoretical delineation and preparation of a draft of the program guideline, two pilot sessions were held. Based on this initial experience a final treatment guideline was prepared. Afterwards, the program was continued for more than 1 year in a female ward at Roozbeh Psychiatric Hospital. The output of this exercise was a guideline that covers important topics in development of inpatient group psychotherapy. It is concluded that inpatient group psychotherapy has its unique challenges. Of the most important challenges that can be mentioned in this regard are the participation of patients with significant differences in levels of psychopathology and psychiatric signs and symptoms, and high comorbidity with specific personality traits or disorders. Other challenges relevant to the structure of the group include items such as very limited time for working through and inevitable out-of-group contacts.

Background: Adaptive narcissism is the presence of narcissistic personality traits in otherwise normal individuals. Considering the potential effects of narcissism on the medical profession. Objectives: The aim of the present study was to investigate the prevalence of adaptive narcissism and its demographic correlations among a medical student population using self-assessment tools. Methods: Participants were selected through cluster sampling among students spending their internship in the Medical School of Guilan University of Medical Sciences in 2019 (N = 138). The 40-item Narcissistic Personality Inventory (NPI-40) was used to assess the prevalence of adaptive narcissism. Next, the demographic correlations of narcissism were studied. Results: The prevalence of adaptive narcissism was 18.1%, with the NPI-40 mean score of 14.43. The self-sufficiency subscale of NPI-40 was correlated with the male gender (P = 0.01). Conclusions: Among medical interns, the whole constructs of adaptive narcissism are as high as found in a normal population and are not correlated with demographic characteristics of the given sample. The self-sufficiency subscale is positively correlated with the male gender.

Background: Electroconvulsive therapy (ECT) is a vital treatment strategy for psychiatric patients, and cancellation of the procedure negatively impacts the recovery process. However, it may happen due to the lack of optimal conditions at admission. Methods: This retrospective study occurred at Shafa Hospital, an academic center affiliated with the Guilan University of Medical Sciences (GUMS). The ECT anesthesia team developed an ECT patient preparation checklist, which was shared with psychiatrists. The rate and some related factors of case cancellation were compared between the two years before presenting the checklist, from May 2019 to May 2020, and the next year, from June 2020 to May 2021. The patients’ files were reviewed, and the required information was documented. Results: One hundred fifty-one cancellations were recorded during the two years of study, 82 cases in the first year and 69 in the second year. The most common reason for the cancellation was inadequate consultations followed by abnormal lab tests. In comparing the number of cancellations between the two years, before and after the checklist was provided, no significant difference was observed in terms of age (P = 0.288), gender (P = 0.24), psychiatric disorder (P = 0.399), and the number of ECT sessions (P = 0.36). However, the number of cancellations due to incomplete consultation significantly decreased after developing the checklist (P = 0.049), while unstable hemodynamics and changing patients’ conditions on an intended day also increased (P = 0.024). Residency visits did not significantly affect the number of cancellations over 2 years (P = 0.139). Conclusions: This study concluded that preparing ECT patients according to the checklist led to better conditions and fewer cancellations. However, preventable causes still exist.

Background: Breaking bad news is an unpleasant task for physicians, especially for patients with cancer. In this regard, the SPIKES protocol, which is prevalent in several countries, has not been discussed in Iran. Objectives: This study evaluated how the SPIKES protocol was followed by physicians. Materials & Methods: This descriptive cross-sectional study was conducted at Guilan academic hospitals from December 2021 to April 2022. Patients with cancer participated in the survey who were referred to the oncology academic centers for follow-ups or radiotherapy and chemotherapy. They were over 18 years old with the ability of proper communication. The SPIKES questionnaire consists of 12 questions with 6 subscales (settings, invitation, perception, knowledge, emotion, and strategy). It was filled out through a direct interview. Results: The data from 280 patients were analyzed. Everyone stated that at the time of receiving the diagnosis, the doctor was not in a hurry and made appropriate eye contact. About 61.1% believed they were emotionally supported, and 65.4% were satisfied with their final knowledge about the disease and treatment planning. Patients with older ages and lower levels of education were significantly more likely to state that physicians’ language was not comprehensive; physicians did not understand them, and the patients were not emotionally supported (P=0.0001). Conclusion: This study showed that more attention should be paid to older patients with lower levels of education. They needed more time for conversation and simpler dialect. Some areas, such as “invitation” are required to be improved

Purpose: Paying attention to the factors affecting the psychological well-being of people with multiple sclerosis (PwMS) is of particular importance, hence the present study investigated the relationship between self-compassion and psychological well-being with the mediating role of resilience. Methods: This cross-sectional study was performed using an online survey in a sample of 410 PwMS registered with the Guilan MS Society (GMSS) of Iran. The study was conducted in 2021. A demographic questionnaire, Ryff 's Psychological Well-Being Scales (PWB), the Connor-Davidson Resilience Scale (CD-RISC), and the Self Compassion Scale Short Form (SCS-SF) were used to collect data. Data analysis was performed using structural equation modeling. Results:The model and data were sensibly in agreement. Moreover, bootstrap results showed that all direct path coefficients were significant (t ≥ 1.96). The direct effects of self-compassion and resilience on psychological well-being were significant, with standardized coefficients of 0.69 and 0.21. In addition resilience, with a coefficient of 0.73, was associated with psychological well-being. Furthermore, the indirect effect of self-compassion on psychological well-being with the mediating role of resilience was also confirmed (p ≤ 0.05). Conclusions:The administration of GCs may lead to changes in dopaminergic system activity (e.g. D 2 receptors activity), which significantly contribute to the predisposition to depression. Additionally, GCs therapy may cause changes in the activity of microRNAs (e.g. miR-124), which exacerbates symptoms of depression. Searching for specific changes in microRNA expression will provide clinically practical and easily applicable biomarkers of depression risk and new forms of pharmacotherapy in GC-induced depression.

Background: Breaking Bad News (BBN) is a multidisciplinary and unpleasant task, and nurses play a vital role in this process as they are often exposed to such situations. It is a critical duty that has not been adequately addressed. Objectives: This study investigated the performance of nurses in academic hospitals affiliated with Guilan University of Medical Sciences (GUMS) regarding BBN. Methods: During 2020, eligible nurses were interviewed, and a questionnaire containing 16 items about environmental and psychical support was filled out. The first 10 questions evaluated psychical support, and the next six assessed environmental support. Each question scored 10, "never," to 50, "always." Results: A total of 384 out of 410 nurses filled out the questionnaires, and a response rate of 93.65% was obtained. As shown, 346 (90.1%) responders were women, and 38 (9.9%) were men. Also, 289 (75.3%) had passed educational courses. A positive association was observed between psychical and environmental support and age (P = 0.007, P = 0.003) and years of experience (P = 0.013, P = 0.004). However, there was no significant difference respecting educational programs (P > 0.05). Conclusions: This study revealed that the current educational programs are not practical and could not induce a significant difference in nurses' answers. Effective interventions to improve nurses' communication skills are strongly warranted.