Introduction Migration of medical professionals has been rapidly increasing in the past decades and it strongly affects origin and destination countries. Objectives We aimed to explore the extent and the reasons of migration among psychiatric trainees and early career psychiatrists in Iran. Methods Our semi-structured 61-items questionnaire inquired participants’ demographics, experiences of short-term mobility (from 3 months to 1 year), long-term migration (more than 1 year) and attitudes towards migration (current and future plans). Results A total of 184 responses were received. Most (73.4 %) participants were female, and within the age range of 25–65 (Mean: 34.9). Only 15.2 % had a short-term mobility experience, mostly due to academic reasons (35.7 %). Most (75 %) stated that this short-term mobility experience influenced them in favor of migration. The majority (83.7 %) had ‘ever’ considered leaving Iran, and more than half (57.3 %) stated they ‘strongly agree’ or ‘agree’ to leaving the country ‘now’ (at the time of the study). The main reason to migrate from Iran was first political, followed by work, financial, social, religious, academic, and cultural reasons, and the least ranked were personal reasons. In relation to their 5-year plans, 67.3 % saw themselves in the country they currently live in, Iran. The main features reported for an attractive job were ‘pleasant work environment’ (97.3 %), ‘good welfare and social security’ (96.7 %) and ‘high salary ‘(96.2 %). Conclusions This study calls for more support of psychiatric trainees and early career psychiatrists in Iran. Improvements in the political context, work conditions and finances might lower the rate of migratory intention and brain drain.

Introduction Psychiatry's postgraduate training curriculum in Iran has been revised and one of the core revisions has been the incorporation of full‐time 9‐months of psychotherapy training. However, little is known about psychotherapy training in Iran. Methods An online anonymous survey was developed by the Early Career Psychiatrists (ECP) Section of the World Psychiatric Association (WPA). The survey included 16 questions about the: (a) quality of psychotherapy training (supervision, type of psychotherapy training available, barriers in accessing training); (b) organizational aspects of psychotherapy training (compulsoriness, payment, and assessment); (c) satisfaction with training in psychotherapy; (d) self‐confidence in the use of psychotherapy. This survey was circulated to Iranian early career psychiatrists and psychiatric trainees. Results 112 early career psychiatrists and psychiatric trainees from across Iran responded to the survey; 98.2% of which stated that psychotherapy training is included in their psychiatry training, and cognitive behavioral therapy and psychodynamic psychotherapy were the most reported modalities integrated into their psychiatric training. Moreover, 43.3% of the participants reported that they were satisfied or very satisfied with their psychotherapy training during the training years. Discussion Psychotherapy is integrated into psychiatric training programs in most educational centers in Iran. The modalities and satisfaction of trainees are similar to that of high‐income countries in other continents. Supervision and training in modalities like family therapy could be further implemented and adapted to the Iranian culture.

IntroductionStigmatizing attitude toward patients with severe mental disorders is one of the main obstacles of improving the mental health of societies. Media plays an important role in how the public views mental health issues. Thus, we have performed this study to investigate the Iranian theater artists' mental health status, and their view toward patients with severe mental disorders.MethodsThis cross-sectional study was performed via an online anonymous survey including the Social Distance Scale and the Dangerousness Scale measuring the attitude of participants toward patients with severe mental disorders, and the 28-item General Health Questionnaire (GHQ-28). It was disseminated to artists who had the experience of working in theater in the past year in Iran.ResultsOur survey was responded by 104 artists. Social Distance Scale scores' mean was 10.67 (scores can range from 0 to 21) and the Dangerousness Scale scores' mean was 28.87 (scores can range from 8 to 56); higher scores indicate worse discrimination. Our participants' strongest fears were to let someone with a severe mental disorder to take care of their children, and for these groups of patients to obtain a hunting license. Twenty-six (25%) participants were at risk of moderate to severe anxiety, and 18 (17.3%) participants were at risk of moderate to severe depression.ConclusionBy and large, our participants did not have a positive attitude toward patients with severe mental disorders. Providing the knowledge of mental health issues can help the general public to be more tolerant of the mentally ill and specifically, theater can be employed to fight stigmatizing mental health issues by educating its audience.

Objectives This study was conducted to investigate the impact of the COVID-19 pandemic on psychiatric trainees and early career psychiatrists in Iran. Methods In this cross-sectional survey, the authors used a 24-item questionnaire inquiring about the sociodemographic characteristics of the participants, their views on the impact of the COVID-19 pandemic on their professional careers, methods of education, workplace environment, well-being and mental health, and the use of telepsychiatry in Iran. Results A total of 159 responses were received. The majority ( n =124, 78.0%) reported that “some but not all obligatory activities have been converted to online activities.” Most of the participants ( n =103, 64.8%) stated that the pandemic had not affected the duration of their training. Less than half ( n =61, 38.4%) reported that their well-being had been affected rather negatively. Some ( n =59, 37.1%) reported that their supervisors or coworkers had no significant impact on their well-being, whereas others ( n =53, 33.3%) reported a rather positive impact. Almost half of the participants ( n =78, 49.0%) did not have access to free psychological counseling. In addition, more than half ( n =89, 56.0%) reported that there were no recommendations on how to proceed with telepsychiatry. Conclusions This study calls for improvements in the education and well-being of psychiatric trainees and early career psychiatrists in Iran amid the COVID-19 pandemic. Additional research should be carried out to maximize learning, provide mental health care, and use telepsychiatry.

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Background: As 40-60% of the patients with obsessive-compulsive disorder (OCD) do not adequately respond to the first-line treatment, finding an effective second-line treatment is required. Our aim was to assess the efficacy and safety of agomelatine (a selective melatonin receptor agonist and a 5-hydroxytryptamine (HT)2C antagonist) augmentation of sertraline in the treatment of patients with moderate to severe OCD. Methods: In this 12-week randomized, double-blinded, placebo-controlled, parallel-group clinical trial, 65 patients with moderate to severe OCD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM–5) criteria and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of over 21, were included. They were assigned with sertraline (100 mg/day for the first 4 weeks and 200 mg/day for the next 8 weeks) and either agomelatine (25 mg/day) or placebo. The primary outcome was OCD symptoms measured by the Y-BOCS. Results: Fifty patients (24 in agomelatine group and 26 in placebo group) completed the trial. The Y-BOCS scores in total (MD (95% CI) = 12.25 (11.00, 13.49) (p-value < 0.0001) vs. MD (95% CI) = 12.46 (6.65, 15.74) (p-value < 0.0001)), the obsession subscale (MD (95% CI) = 5.04 (4.19, 5.88) (p-value < 0.0001) vs. MD (95% CI) = 5.00 (3.84, 6.16) (p-value=0.0001)), and compulsion subscale (MD (95% CI) = 7.21 (6.34, 8.07) (p-value < 0.0001) vs. MD (95% CI) = 7.460 (6.50, 8.42) (p-value < 0.0001)) significantly decreased in both groups. Although, at the end of the trial, no significant difference was observed between the scores of the two groups in total (MD (95% CI) = 0.480 (-1.23, 2.19) (p-value= 0.78)), the obsession subscale (MD (95% CI) = 1.020 (-0.15, 2.19) (p-value=0.38)), and the compulsion subscale (MD (95% CI) = 0.540 (-0.34, 1.42) (p-value=0.54)). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups. Conclusion:Agomelatine in augmentation with sertraline is safe and tolerable in patients with moderate to severe OCD. However, our study does not support its efficacy in improving OCD symptoms, compared to placebo. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials on 14/07/2020 (www.irct.ir; IRCT ID: IRCT20170123032145N5). Funding: The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Iran University of Medical Sciences (Grant no: 98-4-75-16914).

Background: obsessive–compulsive disorder (OCD) is the fourth most common mental disorder, and selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of its pharmacological treatment. About 40-60% of the cases are treatment-refractory, and this makes searching for second-line treatment necessary. 5-hydroxytryptamine-3 (5-HT3) antagonists are among the many medications that have been used in augmentation with SSRIs. Objectives: In this systematic review and meta-analysis, we assessed the efficacy of 5-HT3 receptor antagonists in augmentation with SSRIs in treating moderate to severe OCD. Methods: We searched PubMed, Web of Science, Scopus, Cochrane library, and Google Scholar for relevant trials published up to December 2022. The effect size was the mean difference in Yale-Brown obsessive compulsive scale (Y-BOCS) scores before and after receiving 5-HT3 receptor antagonist drugs in augmentation with SSRIs in moderate to severe OCD patients. Results: We included 6 randomized-controlled trails (RCTs) with 334 patients assessing the effect of the augmentation of SSRIs with ondansetron, granisetron, and tropisetron on treating moderate to severe OCD. Our results were in favor of the experimental group in total (Z=8.37, P<0.00001), in the compulsion subgroup (Z=5.22, P<0.00001), and in the obsession subgroup (Z=8.33, P<0.00001). They are well-tolerated, and have mild side effects and do not result in withdrawal. Conclusion: Augmentation of 5HT-3 antagonists with SSRIs can be beneficial in treating moderate to severe OCD. Further multi-center trials under adequate conditions in longer periods are needed to help come up with a comprehensive action plan.