Purpose: There are an increasing number of studies on the subjective experience of stigma amongst mentally ill persons but still few coming from low-and middle-income countries, and very few from Muslim countries. The objective of this study was to look into the experience of internalized stigma in mentally ill persons in Tehran, Iran. Methods:A total of 138 patients with an affective disorder or schizophrenia from three psychiatric institutions in Tehran responded to the Internalized Stigma of Mental Illness Scale. This is a 29-item self-report questionnaire with good psychometricproperties. An open-ended question about personal experiences of discrimination was included at the end of the questionnaire. Results:The experience of stigma because of mental illnesses was high in this Iranian sample. The level of stigma was similar to studies from Europe that used the same questionnaire. Conclusion:This is the first study of self-perceived stigma in mentally ill persons in Iran. Stigma is a reality even in an Islamic setting in spite of the teachings of the Koran and a rather well-developed mental health service. Implications:These results call for actions to reduce the experience of stigma in mentally ill persons in Iran.

Fatigue is a frequently reported symptom in major depressive disorder, occurring in over 90% of patients. Clinical presentations of fatigue within major depressive disorder encompass overlapping physical, cognitive and emotional aspects. While this review addresses the epidemiology, burden, functional impact and management of fatigue in major depressive disorder, the main focus is on available pharmacotherapy options and their comparative efficacies. Our review of the effects of pharmacological treatments on fatigue in major depressive disorder found that medications with dopaminergic and/or noradrenergic action such as modafinil, flupenthixol and atomoxetine were most effective in improving symptoms of fatigue and low energy. However, significant variation across studies in assessment tools and study inclusion/exclusion criteria may have contributed to inconsistent findings. The efficacy of non-pharmacological interventions is also discussed, including light therapy and exercise.

BackgroundEpilepsy is a prototypical, stigmatised disorder. Numerous studies have been conducted regarding the public perception of epilepsy, but they are primarily from high-income western countries; few studies have taken place in low- to middle-income countries with a traditional culture and a religious orientation.ObjectiveThe public knowledge and attitudes towards epilepsy in Tehran, Iran, is studied.DesignA survey of 800 subjects ranging from 18 to 85 years was randomly chosen from households in Tehran in 2009. The questionnaire used was based on the Caveness and Gallup's studies conducted in the United States in 1949 and it has been used in numerous similar studies all over the world. The mean age of the participants was 37.5 years and 46.7% were female. Pearson's Chi-squared test was used for subgroup analyses.ResultsThe majority of subjects cited brain disorders as a cause of epilepsy, while 17% indicated the will of God as the cause. Most individuals were willing to work with a person with epilepsy, allow their children to play with a child with epilepsy, and allow people with epilepsy to use public transportation (78–82%). However, only 28% were willing to accept the marriage of a family member to someone with epilepsy.ConclusionThe knowledge and attitudes towards epilepsy are similar to those in Europe, with the exception of a much lower acceptance regarding marriage to a person with epilepsy. However, the low acceptance for marrying someone with epilepsy reveals the remaining misconceptions about the nature of epilepsy in Iran, despite the high educational level in the studied population. Therefore, informational efforts must be employed to change the perception of epilepsy.

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Epilepsy is one of the most stigmatizing medical conditions worldwide. It could be argued that the problem of stigma and discrimination might be different in an Islamic culture. A cross-sectional study of 130 patients with epilepsy was performed using the Internalized Stigma of Mental Illness (ISMI) questionnaire that was adapted for epilepsy. The questionnaire contained 29 items on a 4-point scale in addition to an open-ended question about experience of discrimination. An average score above the midpoint (2.5) is suggested to indicate a high level of stigma. Approximately 23.7% of the patients reported a score above the midpoint. Unemployment and low education were significantly associated with a high level of internalized stigma. Although epilepsy can be effectively treated, patients in Tehran still experience much stigma. For this reason, strategies for reducing self-perception of stigma should be included in a treatment plan.