Despite the wide consensus over the safety and efficacy of electroconvulsive therapy (ECT), it still faces unfavorable attitudes of patients and families. Little is known about how the experience with ECT affects the patients’ and their families’ attitude toward it. This study examined a sample of Iranian patients and their families regarding their experience with ECT and compared their knowledge and attitude toward ECT before and after this experience and their satisfaction with it. We surveyed 22 patients with major depressive disorder about to undergo ECT and 1 family member of each patient for their knowledge and attitude toward ECT and then surveyed them again after the trial of ECT to compare those variables while assessing their experience and satisfaction with ECT. Patients were rated using the Hamilton Depression Rating Scale and Mini-Mental Status Examination before and after the treatment. Before ECT, family members had a more favorable attitude toward ECT than patients, but after ECT, the patients’ attitude changed more positively. Both patients and their families had a poor knowledge of ECT before the ECT trial, but their total knowledge increased afterward, although not in the areas of indications and therapeutic effects. The majority of patients and their families found ECT to be beneficial and were satisfied with it. There was a high rate of perceived coercion to consent to ECT. Attention should be paid toward educating patients and their families about the ECT as well as informing them about their freedom of choice and right to refuse.

The purpose of this study is to estimate the predictors of working ability in depressed patients. Two hundred and twenty-six patients with depression consecutively admitted on outpatient basis from March 2003 to May 2006 were classified into working and non working groups. Severity of depression was measured by the Beck Depression Inventory and their occupational adjustment 2 months prior to the last episode was determined by Occupational Adjustment Scale, a subscale of Social Adjustment Scale. The groups were almost similar in terms of age, sex, education, and marital status. There were significant differences between them in terms of family history of depression, episodes of depression, history of suicide attempts, duration of illness and severity of depression (P < 0.01). The working depressed group differed significantly from the impaired depressed group in terms of work experience, job turnover, and overall occupational adjustment (P < 0.01). History of suicide attempt, family history of depression, time lost, severity of depression, pre-morbid occupational adjustment, age, and illness duration emerged as the most important predictors, explaining 64% of the patients' working ability. Our observations are on line with robust literature across the globe. Nature of illness condition as well as societal attitude can explain the impairment condition in depressed patients. Presence of a comprehensive integrated approach to their treatment and rehabilitation is imperative.

Introduction:Culture is defined as the sum total of the way people think, feel, and act as members of a social group. Culture is learnt. Cultures can overlap and individuals can belong to several cultures. cross-cultural psychopharmacological studies have mainly focused on differences in the pharmacokinetics and pharmaco-dynamics of psychotropic medications among various ethno-cultural groups and research on many socio-cultural non-biologic contextual factors in psycho-pharmacotherapy is sporadic and often not widely known. In this paper, the authors review the relevant literature in all these areas.Methods:Searching the recent thirty years studies on cultural issues in psycho-pharmacology in a wide area and then screening them systematically, fifteen relevant studies were selected and evaluated. Results were conceptually re-arranged and re-classified and are presented in the format of a narrative review.Results and Discussion:In a general aspect, cross-cultural factors affecting psycho pharmacotherapy can be divided in two groups i.e. primary variables which directly influence pharmaco-dynamics and pharmaco-kinetics and confounding variables which indirectly interact with drug treatment, selection, usage and response. In another point of view, trans-cultural psychopharmacological issues are classified in the domains of patient variables, doctor variables and environmental variables, each including many different factors and considerations which are elaborated and discussed in the full-text of this material.

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