Publications by authors named "Leeba Rezaie"

32 Publications

Treatment of chronic insomnia with atypical antipsychotics: results from a follow-up study.

Sleep Sci 2021 Jan-Mar;14(1):27-32

Sleep disorders research center, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Objective: Second generation (atypical) antipsychotics are increasingly being used for treatment of insomnia, but there is little evidence to show long-term efficacy of these medication. This follow-up study was designed to assess patients with chronic insomnia who were treated with atypical antipsychotics.

Material And Methods: In this follow-up study, forty patients with chronic insomnia were evaluated between 2016 and 2018 following after one year of treatment with two atypical antipsychotic drugs of olanzapine and quetiapine in two groups in the sleep disorders research center of Kermanshah University of Medical Science in Iran. The Pittsburgh Sleep Quality Questionnaire (PSQI) and 5 consecutive nights of Actigraphy were utilized to evaluate both subjective and objective measures of sleep quality. Lastly, sleep quality before and after treatment and comparisons of sleep quality between the two groups were performed.

Results: Nine male participants comprised olanzapine group (n=22) and six male participants comprised the quetiapine group (n=18). The average age in the olanzapine group was 45.23±10.18 and the average age in the quetiapine group was 46.33±7.99. Results showed total PSQI score improved significantly in both groups (p<0.05), while the actigraphy results showed only significant improvement in sleep quality parameters in the quetiapine group (p<0.05).

Conclusion: Two atypical antipsychotics drugs of olanzapine and quetiapine have long-term efficacy in managing chronic insomnia. More improvements in objective sleep quality with quetiapine is promising for patients with chronic insomnia. Further research to evaluate long-term adverse effects of atypical antipsychotic drugs is recommended.
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http://dx.doi.org/10.5935/1984-0063.20190149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157779PMC
June 2021

Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores.

Life (Basel) 2021 Apr 21;11(5). Epub 2021 Apr 21.

Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran.

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model.

Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA.

Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores.

Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.
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http://dx.doi.org/10.3390/life11050368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143081PMC
April 2021

Personality profiles in paradoxical insomnia: a case-control study.

Sleep Sci 2020 Oct-Dec;13(4):242-248

Sleep disorders research center, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Introduction: Paradoxical insomnia (PARA-I) is a clinically challenging condition to diagnose and treat. Previous findings suggest that personality profiles of patients with PARA-I may be different from other subtypes of insomnia. Therefore, investigation of these profiles can be helpful in the clinical management of these patients.

Objective: The current study compares personality profiles of individuals with paradoxical insomnia (PARA-I), psycho-physiological insomnia (PSY-I), and normal sleepers (NS).

Material And Methods: A cross-sectional case-control study was conducted in the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, Kermanshah, Iran between 2015 and 2017. Patients with PARA-I (n=20), PSY-I (n=20), and NS (n=60) were matched for age, gender, education, and history of mental and/or physical illness and completed the Minnesota Multiphasic Personality Inventory (MMPI) short form. One-way analysis of variance (ANOVA) and the Kruskal-Wallis test were used to compare subscale means across groups.

Results: With the exception of the schizophrenia scale (P =.059), significant differences were found in all subscales of the insomnia groups compared to the NS group (P=.001). Compared to the NS group, patients with PARA-I showed significant differences in the hysteria and hypomania subscales (P<.05) and patients with PSY-I showed significant differences in the hysteria, hypochondriasis, and psychopathic subscales (P=.001). No significant differences were found between the PARA-I and PSY-I groups on any subscale.

Conclusion: This study demonstrates that significant differences in the personality profiles on the MMPI exist between PARA-I and PSY-I patients compared to NS. These findings should inform the diagnosis and future treatment approaches for insomnia.
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http://dx.doi.org/10.5935/1984-0063.20190148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856671PMC
February 2021

Personality profiles in paradoxical insomnia: a case-control study.

Sleep Sci 2020 Oct-Dec;13(4):242-248

Sleep disorders research center, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Introduction: Paradoxical insomnia (PARA-I) is a clinically challenging condition to diagnose and treat. Previous findings suggest that personality profiles of patients with PARA-I may be different from other subtypes of insomnia. Therefore, investigation of these profiles can be helpful in the clinical management of these patients.

Objective: The current study compares personality profiles of individuals with paradoxical insomnia (PARA-I), psycho-physiological insomnia (PSY-I), and normal sleepers (NS).

Material And Methods: A cross-sectional case-control study was conducted in the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, Kermanshah, Iran between 2015 and 2017. Patients with PARA-I (n=20), PSY-I (n=20), and NS (n=60) were matched for age, gender, education, and history of mental and/or physical illness and completed the Minnesota Multiphasic Personality Inventory (MMPI) short form. One-way analysis of variance (ANOVA) and the Kruskal-Wallis test were used to compare subscale means across groups.

Results: With the exception of the schizophrenia scale (P =.059), significant differences were found in all subscales of the insomnia groups compared to the NS group (P=.001). Compared to the NS group, patients with PARA-I showed significant differences in the hysteria and hypomania subscales (P<.05) and patients with PSY-I showed significant differences in the hysteria, hypochondriasis, and psychopathic subscales (P=.001). No significant differences were found between the PARA-I and PSY-I groups on any subscale.

Conclusion: This study demonstrates that significant differences in the personality profiles on the MMPI exist between PARA-I and PSY-I patients compared to NS. These findings should inform the diagnosis and future treatment approaches for insomnia.
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http://dx.doi.org/10.5935/1984-0063.20190148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856671PMC
February 2021

The Effectiveness of Occupational Therapy-Based Sleep Interventions on Quality of Life and Fatigue in Patients with Multiple Sclerosis: A Pilot Randomized Clinical Trial Study.

Neuropsychiatr Dis Treat 2020 29;16:1369-1379. Epub 2020 May 29.

Clinical Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA.

Purpose: Sleep difficulties are common in patients with multiple sclerosis (MS), which may increase feelings of fatigue, negatively interfere with daily activities, and consequently reduce their quality of life. Studies examining the effects of sleep-targeted interventions in MS are currently limited in the literature. Therefore, we aim to assess the effects of occupational therapy interventions on sleep quality, fatigue, and quality of life in patients with MS.

Patients And Methods: In a single-blind, randomized, controlled trial, which occurred between April 2018 and March 2019 in Tehran, Iran, 20 eligible patients with MS were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Short-Form Health Survey (SF-36). Patients were allocated randomly into the two following groups: patients receiving care-as-usual for MS (CAU) and patients receiving care-as-usual plus intervention (CAU + intervention). Both intervention groups underwent 2-3 sessions per week lasting 30-45 minutes for 8 weeks and received follow-up assessments. Data were analyzed using independent sample t-tests and Mann-Whitney U tests using SPSS (16 ver.) statistical software.

Results: In the intervention group, sleep quality improved significantly across all items (<0.001, effect size = 0.60) except for sleep efficiency and the use of sleep medications. FSS and FIS in the sleep intervention group were significantly reduced (<0.001, effect size = 0.76 and <0.001, effect size = 0.82, respectively). The quality of life in the intervention group improved significantly (<0.004, effect size = 0.51-0.76) with the exception of the social functioning subgroup.

Conclusion: Although this is the result of a pilot study and more patients should be added, this intervention program demonstrates improvement in sleep quality and quality of life while decreasing fatigue in patients with MS. Adjunction of this program, if results are similar with more patients, to routine occupational therapy (OT) interventions can help improve the rehabilitation program of MS patients.
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http://dx.doi.org/10.2147/NDT.S249277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269630PMC
May 2020

Letter to the editor concerning: "Drivers and consequences of self-immolation in parts of Iran, Iraq and Uzbekistan: A systematic review of qualitative evidence".

Burns 2020 Apr 16. Epub 2020 Apr 16.

Department of Psychology, University of Alabama at Birmingham, USA. Electronic address:

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http://dx.doi.org/10.1016/j.burns.2020.01.017DOI Listing
April 2020

Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study.

J Psychiatr Ment Health Nurs 2020 Dec 25;27(6):752-762. Epub 2020 May 25.

Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA.

WHAT IS KNOWN ON THE SUBJECT?: A search of common databases indicates the absence of any research focused on the needs of Iranian women diagnosed with severe mental illness post-discharge from an inpatient setting. Moreover, there is a lacuna of information about the unique experiences and needs of persons diagnosed with severe mental illness living in non-Western communities (esp. Middle Eastern communities). WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study examined interviews of women diagnosed with severe mental illness receiving treatment at an Iranian inpatient hospital. Three categories of post-discharge needs emerged: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings highlight the need for systemic changes to current care models. Broadly, families should be incorporated into care to improve outcomes and decrease stigma. Regarding mental health nursing, results highlighted the need for additional nursing and occupational therapy interventions to empower families and patients. Nursing practitioners can aid in preparing these patients for employment and public health initiatives to decrease stigma and improve access to care. ABSTRACT: Introduction Understanding the post-discharge needs of patients diagnosed with severe mental illness is critical for improving treatment outcomes. Aim The aim of the present study was to determine the unique post-discharge needs of Iranian women diagnosed with severe mental illness. Method Conventional content analysis was utilized to analyse data gathered via focus group interviews conducted within the psychiatric inpatient unit at Farabi hospital located in Kermanshah, Iran. Participants (N = 42; M age = 40; SD = 6.3 years) had been diagnosed with a severe mental illness, had a history of at least two psychiatric hospitalizations and were awaiting discharge following significant symptom improvement. Results Content analysis extracted three categories of post-discharge needs: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. Discussion/Implications for practice Analysis of interview data highlighted the general need for adopting a family-system approach to reduce stigma, increase knowledge and foster skill acquisition. Regarding mental health nursing, results highlighted the unique role of nurses and their capacity to pre-emptively address needs such as aiding in employment. Lastly, findings are contrasted against Western care models.
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http://dx.doi.org/10.1111/jpm.12634DOI Listing
December 2020

A Mixed-Method Modified Delphi Study toward Identifying Key Elements of Psychotherapy in Iran.

Int J Environ Res Public Health 2020 04 7;17(7). Epub 2020 Apr 7.

Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran.

Purpose: In Iran, psychotherapy is regarded as an effective treatment for psychiatric disorders. However, no previous research has identified the key elements of psychotherapy that may be specific to Iranian society. The current study was conducted in an attempt to identify these elements.

Methods: A mixed-method modified Delphi approach was used, taking place over several stages during 2017-2018. The first stage involved interviewing 12 experts in psychotherapy to identify key elements of psychotherapy in Iran by thematic analysis. Then, successive Delphi rounds were conducted to obtain consensus (75% agreement) from 70 psychotherapy experts on these key elements.

Results: Key elements of psychotherapy were grouped into the following themes: (1) systematic education/training; (2) psychotherapist competency; (3) psychotherapy reflective of Iranian societal needs; and (4) the substrate (scientific/ethical principles) of psychotherapy. Consensus was reached during two Delphi rounds. In Delphi round 1, 52.8% of the statements reached consensus, and all remaining statements reached consensus in round 2.

Conclusions: The key elements of psychotherapy in Iran are a set of conditions for the education and training of competent psychotherapists who can perform psychiatric interventions appropriate to Iranian society under supervised rules. These should serve as a framework for improving the current delivery of psychotherapy in Iran.
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http://dx.doi.org/10.3390/ijerph17072514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178105PMC
April 2020

Exploration of the Influential Factors on Adherence to Occupational Therapy in Parents of Children with Cerebral Palsy: A Qualitative Study.

Patient Prefer Adherence 2020 13;14:63-72. Epub 2020 Jan 13.

Division of Emergency Medicine, Children's National Health System, Washington DC, PA 20010, USA.

Background: Cerebral palsy (CP) is the leading cause of permanent disability in children. Occupational therapists serve a primary role in the rehabilitation of children with CP. Poor adherence to treatment is common. The aim of this study is to explore the viewpoint of occupational therapists on factors which impact adherence to occupational therapy (OT) interventions among parents of children with CP.

Material And Methods: A qualitative approach using semi-structured interviews were employed. Our participants were recruited by purposive sampling among occupational therapists who were working in Kermanshah province, western Iran. The interviews were taped and transcribed. Content analysis using constant comparison was performed.

Results: The mean age of our participants was 34.23±7.50. Four main categories with specific subcategories emerged as important in affecting adherence. The first category of child and family-related factors described factors such as the clinical status of the child and family composition. These factors had the potential for both improving and reducing adherence to treatment. The second category of therapist-related factors described the effect of appropriate professional skills of the therapist on improving adherence and included clinical competency, communication skills, and job satisfaction. The third category of environmental factors addressed factors such as cultural views of child disability and access to OT interventions. The category mostly emphasized environmental barriers to adherence to treatment. The fourth category of therapy-related factors described barriers such as the type of therapy, and the length of treatment.

Conclusion: Adherence to OT interventions in parents of children with CP can be influenced by several factors. These factors range from child and family-related factors to therapy-related factors and have the potential for both positively and negatively affecting adherence. Programs to improve adherence should address these factors together.
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http://dx.doi.org/10.2147/PPA.S229535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968817PMC
January 2020

Sleep quality as a target for improving quality of life in burn patients.

Burns 2020 03 31;46(2):496-497. Epub 2019 Dec 31.

Division of Emergency Medicine Children's National Health System, Washington, DC 20010, United States. Electronic address:

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http://dx.doi.org/10.1016/j.burns.2019.10.031DOI Listing
March 2020

Sleep quality as a target for improving quality of life in burn patients.

Burns 2020 03 31;46(2):496-497. Epub 2019 Dec 31.

Division of Emergency Medicine Children's National Health System, Washington, DC 20010, United States. Electronic address:

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http://dx.doi.org/10.1016/j.burns.2019.10.031DOI Listing
March 2020

Psychiatric needs for self-inflicted burn patients in developing countries: A call for action.

Burns 2019 11 25;45(7):1732-1733. Epub 2019 Aug 25.

Department of Psychology, University of Alabama at Birmingham, USA. Electronic address:

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http://dx.doi.org/10.1016/j.burns.2019.07.045DOI Listing
November 2019

The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah.

J Inj Violence Res 2019 Jul 2;11(2):225-232. Epub 2019 Jul 2.

Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: Earthquake is one of the most common natural disasters. A 7.3" Richter earthquake happened at 5km from the town of Ezgeleh in Kermanshah province in 2017, which caused several physical and mental injuries. The present study was conducted to investigate the sleep quality and mental health difficulties of those affected by earthquake and predict sleep quality according to severity of symptoms of depression, anxiety, and stress in the township of Sarpol-e Zahab, which suffered the most damage.

Methods: A total of 999 earthquake survivors living in temporary tents and camps were assessed in terms of sleep quality and pattern using Pittsburgh Sleep Quality Index, and severity of psychological symptoms using Depression, Anxiety, and Stress scale 10 days after the disaster.

Results: According to the results, poor sleep quality was experienced by 20.61% of survivors, severe stress by 60.5%, and severe depression by 41.5%, and moderate anxiety by 74%. The subjective quality, efficiency, daily dysfunction, use of hypnotics, and total sleep quality had a positive and significant relation with severity of experienced depression, anxiety, and stress. Sleep latency had a positive and significant relation only with stress, and sleep disturbance with depression and stress.

Conclusions: Severity of depression, anxiety, and stress can predict changes in total sleep quality of those affected by earthquake. Stress can be considered as the sole predictor of total sleep quality and the only factor that can explain components of sleep quality. The implications of the present study are debatable.
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http://dx.doi.org/10.5249/jivr.v11i2.1203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646827PMC
July 2019

Barriers to acceptance and adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea: a report from Kermanshah province, western Iran.

Patient Prefer Adherence 2018 20;12:1299-1304. Epub 2018 Jul 20.

Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,

Purpose: Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). CPAP acceptance and adherence are critical issues for optimal treatment outcome. Identifying barriers to acceptance and adherence can improve intervention development and outcomes. This study aimed to investigate the barriers to CPAP acceptance/adherence in patients with OSA in western Iran.

Patients And Methods: Patients with OSA, who had been prescribed CPAP by the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, were recruited. They were interviewed via telephone regarding acceptance (ie, CPAP use during the first 2 weeks) and adherence (ie, CPAP use 4 h/d for 70% of the nights per week). Barriers to acceptance and adherence were solicited.

Results: Out of a possible sample of 101, 97 patients (79 male) were reached and included in the study. They had a mean age of 48.76 years (SD =12.04) and mean apnea/hypopnea index score of 36.06 (SD =1.87). Patients were categorized into the following acceptance/adherence groups: nonacceptance (CPAP not purchased; 72.2%), poor adherence (5.2%), and adherent (22.7%). Inability to afford a CPAP device, perception of symptom reduction/no need for treatment, and dissatisfaction with treatment were among the most common reasons for nonacceptance and poor adherence.

Conclusion: CPAP acceptance and adherence in western Iran are low. Approximately 70% of the patients did not accept CPAP treatment (due to not obtaining the device) and 5% did not adhere. To improve acceptance/adherence, increased access (ie, reduced cost or increased insurance coverage) and enhanced education about the benefits of the treatment are recommended. Treatment monitoring via regular follow-ups may also prove beneficial.
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http://dx.doi.org/10.2147/PPA.S165905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056160PMC
July 2018

Paradoxical insomnia and subjective-objective sleep discrepancy: A review.

Sleep Med Rev 2018 08 6;40:196-202. Epub 2018 Jan 6.

Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Electronic address:

Paradoxical insomnia is characterized by discrepancy between subjective and objective assessments of sleep and is challenging to diagnosis and treat. Typically, polysomnographic (PSG) findings show significantly longer total sleep time than patients' report of sleep, and the difference between subjective and PSG sleep is greater than that seen in other insomnia subtypes. Subjective-objective sleep discrepancy may also present in different clinical pictures, as marked discrepancies between patients' perception of sleep and objective findings are common in a variety of medical, sleep and psychiatric disorders. However, there is a paucity of literature about the etiology and treatment of sleep discrepancy and paradoxical insomnia. Therefore, the underlying neurophysiological mechanisms of sleep discrepancy and paradoxical insomnia should be further investigated. Additionally, well-controlled clinical trials are needed to establish an evidence based intervention for treatment.
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http://dx.doi.org/10.1016/j.smrv.2018.01.002DOI Listing
August 2018

Exploration of the experience of living with chronic insomnia: A qualitative study.

Sleep Sci 2016 Jul-Sep;9(3):179-185. Epub 2016 Jul 19.

Oxford Brookes University, Faculty of Health and life Sciences, United Kingdom.

Background: Chronic insomnia is associated with consequential experience that may affect quality of life. Understanding such experience can be helpful in planning effective interventions for patients with chronic insomnia.

Objective: The study aimed to describe and illuminate the experience of living with chronic insomnia.

Method: The study was conducted using a descriptive phenomenology approach. Participants were selected purposefully from patients with chronic insomnia who had been referred to the sleep disorders research center at Kermanshah University of Medical Sciences in Iran in 2014. Data were gathered through in-depth unstructured interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology.

Results: Two main themes were found in this study, from which five sub themes were constructed: first, an upset mind, with the subthemes of insomnia as an unpleasant experience and insomnia as a worrying experience; and second, an unwanted new lifestyle with treatment seeking behavior, a boring new daily routine and being overshadowed by depressed mood as the subthemes.

Conclusion: The study identified the experience of living with chronic insomnia as a painful one with both mental and practical aspects. The experience also explains how mental engagement and practical outcomes of chronic insomnia may interfere with well-being and quality of life in sufferers. It is recommended that patients' experiences would be considered in assessment and treatment of chronic insomnia. Therefore, therapeutic interventions should pay attention to this area.
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http://dx.doi.org/10.1016/j.slsci.2016.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241582PMC
July 2016

Response to Letter to Editor "Some ethical challenges regarding self-immolation".

Burns 2016 08 17;42(5):1153-1154. Epub 2016 Apr 17.

Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA.

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http://dx.doi.org/10.1016/j.burns.2016.03.010DOI Listing
August 2016

Exploration of the reasons for dropping out of psychotherapy: A qualitative study.

Eval Program Plann 2016 06 15;56:23-30. Epub 2016 Mar 15.

Department of Psychology, Eastern Michigan University (EMU), USA. Electronic address:

Elucidating the reasons for dropping out of psychotherapy can lead to the development of interventions aimed at reducing patient drop out. The present study aimed to explore patients' reasons for dropping out of psychotherapy in Kermanshah, Iran. The present qualitative study was performed using conventional content analysis. The current sample included 15 participants consisting of 7 patients who dropped out of psychotherapy and 8 psychotherapists who have previously experienced patient dropout. A semi-structured interview was used for data collection. All interviews were audio recorded and subsequently transcribed. Content analysis using constant comparisons was performed for transcribed interviews. Four main categories emerged as reasons for dropping out of psychotherapy: dissatisfaction with the quality of psychotherapy, financial problems in psychotherapy, unprepared socio-cultural context of psychotherapy, and psychotherapy as a non-user friendly treatment. Additionally, specific subcategories within each main category were documented. The results revealed distinct reasons for psychotherapy drop out in the current Iranian-based sample. These identified reasons should be considered and addressed at the onset of treatment as well as in the development of formal interventions aimed at reducing dropout. Further research investigating the antecedents leading to patient drop out is recommended.
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http://dx.doi.org/10.1016/j.evalprogplan.2016.03.002DOI Listing
June 2016

Exploration of the reasons for dropping out of psychotherapy: A qualitative study.

Eval Program Plann 2016 06 15;56:23-30. Epub 2016 Mar 15.

Department of Psychology, Eastern Michigan University (EMU), USA. Electronic address:

Elucidating the reasons for dropping out of psychotherapy can lead to the development of interventions aimed at reducing patient drop out. The present study aimed to explore patients' reasons for dropping out of psychotherapy in Kermanshah, Iran. The present qualitative study was performed using conventional content analysis. The current sample included 15 participants consisting of 7 patients who dropped out of psychotherapy and 8 psychotherapists who have previously experienced patient dropout. A semi-structured interview was used for data collection. All interviews were audio recorded and subsequently transcribed. Content analysis using constant comparisons was performed for transcribed interviews. Four main categories emerged as reasons for dropping out of psychotherapy: dissatisfaction with the quality of psychotherapy, financial problems in psychotherapy, unprepared socio-cultural context of psychotherapy, and psychotherapy as a non-user friendly treatment. Additionally, specific subcategories within each main category were documented. The results revealed distinct reasons for psychotherapy drop out in the current Iranian-based sample. These identified reasons should be considered and addressed at the onset of treatment as well as in the development of formal interventions aimed at reducing dropout. Further research investigating the antecedents leading to patient drop out is recommended.
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http://dx.doi.org/10.1016/j.evalprogplan.2016.03.002DOI Listing
June 2016

Antidepressant-induced sexual dysfunction during treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial.

Gen Hosp Psychiatry 2015 Jan-Feb;37(1):40-5. Epub 2014 Oct 30.

Research Center for Environmental Determinants of Health (RCEDH), School of Population Health, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. Electronic address:

Background: Selective serotonin reuptake inhibitors (SSRIs) are common treatments for patients with major depressive disorder (MDD). However, adverse effects of SSRIs on sexual function are common in the treatment of patients with MDD. There is a discrepancy in the reported frequency of SSRI-induced sexual dysfunction. On the other hand, there is also less evidence about sexual dysfunction with serotonin receptor antagonists and reuptake inhibitors (SARIs). Therefore, we aimed to assess sexual dysfunction in MDD patients who received fluoxetine, sertraline and trazodone.

Method: In a single-blind, randomized, controlled trial in Kermanshah, Iran, during 2009-2010, 195 patients who met the DSMIV-IR criteria for MDD were enrolled. The patients completed the Hamilton Depression Rating Scale (HAM-D) and the sexual function questionnaire (SFQ). Eligible patients were allocated in three treatment groups (receiving fluoxetine, sertraline or trazodone) for 14 weeks randomly. Measurement of HAMD was repeated in 4-week interval. Analysis for comparing sexual dysfunction among three groups and men and women was performed.

Results: There were 102 men and 93 women in the three groups receiving fluoxetine (n=64), sertraline (n=67) and trazodone (n=64). There was no significant difference in the sexual dysfunction of the patients in the three groups at baseline (P>.05). After treatment, both men and women who had received fluoxetine had the most impairment in desire/drive items (43%-51% and 44%-50%, respectively), while patients receiving trazodone had the least impairment in these items (12%-18% and 23%-24%, respectively). Trazodone was also induced with a lower rate of impairment in arousal/orgasm items in men (9%-15%) compared with the other two drugs. Compared with fluoxetine and trazodone, sertraline was associated with intermediate impairment in sexual function (39%-42% in desire/drive items and 32%-39% in arousal/orgasm items) that was lower than that with fluoxetine and more than that with trazodone.

Conclusion: There were different rates of sexual dysfunction with different antidepressants drugs in under treated patients. Compared with fluoxetine, and sertraline, trazodone was associated with the fewest sexual dysfunction. Fluoxetine was also associated with more sexual dysfunction than sertraline. Further research to better identify the differences among antidepressant drugs is recommended.
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http://dx.doi.org/10.1016/j.genhosppsych.2014.10.010DOI Listing
September 2015

Antidepressant-induced sexual dysfunction during treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial.

Gen Hosp Psychiatry 2015 Jan-Feb;37(1):40-5. Epub 2014 Oct 30.

Research Center for Environmental Determinants of Health (RCEDH), School of Population Health, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. Electronic address:

Background: Selective serotonin reuptake inhibitors (SSRIs) are common treatments for patients with major depressive disorder (MDD). However, adverse effects of SSRIs on sexual function are common in the treatment of patients with MDD. There is a discrepancy in the reported frequency of SSRI-induced sexual dysfunction. On the other hand, there is also less evidence about sexual dysfunction with serotonin receptor antagonists and reuptake inhibitors (SARIs). Therefore, we aimed to assess sexual dysfunction in MDD patients who received fluoxetine, sertraline and trazodone.

Method: In a single-blind, randomized, controlled trial in Kermanshah, Iran, during 2009-2010, 195 patients who met the DSMIV-IR criteria for MDD were enrolled. The patients completed the Hamilton Depression Rating Scale (HAM-D) and the sexual function questionnaire (SFQ). Eligible patients were allocated in three treatment groups (receiving fluoxetine, sertraline or trazodone) for 14 weeks randomly. Measurement of HAMD was repeated in 4-week interval. Analysis for comparing sexual dysfunction among three groups and men and women was performed.

Results: There were 102 men and 93 women in the three groups receiving fluoxetine (n=64), sertraline (n=67) and trazodone (n=64). There was no significant difference in the sexual dysfunction of the patients in the three groups at baseline (P>.05). After treatment, both men and women who had received fluoxetine had the most impairment in desire/drive items (43%-51% and 44%-50%, respectively), while patients receiving trazodone had the least impairment in these items (12%-18% and 23%-24%, respectively). Trazodone was also induced with a lower rate of impairment in arousal/orgasm items in men (9%-15%) compared with the other two drugs. Compared with fluoxetine and trazodone, sertraline was associated with intermediate impairment in sexual function (39%-42% in desire/drive items and 32%-39% in arousal/orgasm items) that was lower than that with fluoxetine and more than that with trazodone.

Conclusion: There were different rates of sexual dysfunction with different antidepressants drugs in under treated patients. Compared with fluoxetine, and sertraline, trazodone was associated with the fewest sexual dysfunction. Fluoxetine was also associated with more sexual dysfunction than sertraline. Further research to better identify the differences among antidepressant drugs is recommended.
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http://dx.doi.org/10.1016/j.genhosppsych.2014.10.010DOI Listing
September 2015

Treatment of paradoxical insomnia with atypical antipsychotic drugs. A comparison of olanzapine and risperidone.

Neurosciences (Riyadh) 2013 Jan;18(1):64-9

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Objective: To compare the efficacy of 2 atypical anti-psychotic drugs, olanzapine and risperidone, in the treatment of paradoxical insomnia.

Methods: In this cross-sectional study over a 2-year period (September 2008 to September 2010), 29 patients with paradoxical insomnia, diagnosed in Kermanshah, Iran by both psychiatric interview and actigraphy, were randomly assigned to 2 groups. For 8 weeks, the first group (n=14) was treated with 10 mg olanzapine daily, and the second group (n=15) was treated with 4 mg risperidone daily. All participants completed the Pittsburgh Sleep Quality Inventory (PSQI) at baseline and at the end of the study.

Results: As expected, a baseline actigraphy analysis showed that total sleep time was not significantly different between the 2 treatment groups (p<0.3). In both groups, sleep quality was improved (p<0.001) with treatment. When comparing the 2 treatments directions, a significant difference emerged (9.21+/-2.35, 6.07+/-4.46) among the 2 treatment groups based on data from the PSQI. Patients who were treated with olanzapine showed greater improvement than patients who were treated by risperidone (p<0.04).

Conclusion: Atypical anti-psychotic drugs such as olanzapine and risperidone may be beneficial options for treatment of paradoxical insomnia. Larger clinical trials with longer periods of follow-up are needed for further investigation.
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January 2013

Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah, Iran.

Gen Hosp Psychiatry 2013 May-Jun;35(3):314-9. Epub 2012 Dec 21.

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah 6719851151, Iran.

Background: Outpatient psychiatric treatment provides both psychotherapy and pharmacotherapy for a large portion of psychiatric patients. Dropping out, or early termination of treatment, may be considered a common barrier to outpatient's psychiatric treatment. There are limited studies on this issue in Iran. The current study aimed to examine rates, predictors and reasons of dropping out of an outpatient psychiatric treatment.

Materials And Method: In this 6-month cohort study, 1500 outpatients who visited 10 psychiatrist's offices in the Iranian city of Kermanshah were recruited and followed for 2 years (2009-2011) for recommended treatments including admission to hospital, pharmacotherapy, psychotherapy and a combination of both psychotherapy and pharmacotherapy. Characteristics of patients who dropped out of the current study were collected, and reasons for dropping out were collected via phone or in person interview.

Results: Dropouts were prevalent in prescribed treatments. Pretreatment (primary) dropout rates in psychotherapy treatment were 4 times greater than dropout rates in pharmacotherapy treatment (80% and 20%, respectively). There were significance differences between dropouts and non-dropouts of pharmacotherapy with respect to patient characteristics; younger age, male gender, low level of education, unemployment, lack of insurance, new cases and divorce were more prevalent among dropouts (P<.001). With regard to diagnosis, dropping out was more prevalent among patients with substance-related disorders, schizophrenia and other psychotic disorders when compared to other diagnoses (P<.001). Commonly reported reasons for dropping out included overslept and too ill to attend treatment and fear of becoming addicted to prescribed psychotropic medication (30% and 18%, respectively). Lack of confidence in therapist ability and lack of confidence in the efficacy of the treatment were more prevalent in patients who dropped out of psychotherapy (P<.001).

Conclusion: Patient dropout is a common problem in outpatient psychiatric treatment, particularly in psychotherapy treatment. Further research on reasons for dropping out and strategies to reduce rates of dropouts is recommended.
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http://dx.doi.org/10.1016/j.genhosppsych.2012.10.008DOI Listing
December 2013

Evaluation of Dream Content among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses other than Schizophrenia, and Healthy Control.

Iran J Psychiatry 2012 ;7(1):26-30

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.

Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls.

Method: Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients.

Results: Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales.

Conclusion: Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395964PMC
October 2012

Evaluation of Dream Content among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses other than Schizophrenia, and Healthy Control.

Iran J Psychiatry 2012 ;7(1):26-30

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.

Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls.

Method: Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients.

Results: Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales.

Conclusion: Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395964PMC
October 2012

Evaluation of Dream Content among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses other than Schizophrenia, and Healthy Control.

Iran J Psychiatry 2012 ;7(1):26-30

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.

Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls.

Method: Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients.

Results: Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales.

Conclusion: Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395964PMC
October 2012

Evaluation of Dream Content among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses other than Schizophrenia, and Healthy Control.

Iran J Psychiatry 2012 ;7(1):26-30

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.

Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls.

Method: Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients.

Results: Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales.

Conclusion: Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395964PMC
October 2012

Prevalence of symptoms and risk of obstructive sleep apnea syndrome in the general population.

Arch Iran Med 2011 Sep;14(5):335-8

Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.

Background: Obstructive sleep apnea (OSA) syndrome is one of the most common sleep breathing disorders with significant consequences. The present study aims to determine prevalence of symptoms and risk of OSA in the general population of Kermanshah, Iran.

Methods: From 2007-2008 by random-cluster-sampling, 527 adult subjects were selected from the urban region of Kermanshah. The age range of the sample was from 20 to 87 years. Assessment was carried-out using the Berlin questionnaire, a valid scale that determined those at "high risk" and "low risk" for OSA symptoms. Common symptoms were later defined. 

Results: There were 144 (27.3%) out of the 527 subjects with a mean age of 48.6±16.6 years and a body mass index (BMI) of 25.1±3.3 at high risk for OSA (men 19%; women 8.3%); 261 (49.5%) suffered from snoring with a higher frequency among women (51.5%). From those who snored during sleep, 51 (10%) reported a breathing pause more than once per week. Subjects considered at high risk had a clinical history of diabetes (15.3%) and heart failure (16.7%).

Conclusion: Prevalence of symptoms, risk of OSA and associated factors in Kermanshah are noticeable. Considering the adverse effects of this condition on quality of life, further research in an effort for early diagnosis and treatment are recommended.
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http://dx.doi.org/009DOI Listing
September 2011

An innovative new method to diagnose enuresis objectively.

Neurosciences (Riyadh) 2011 Jul;16(3):287-9

Sleep Research Center, Department of Psychiatry, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.

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July 2011

An innovative new method to diagnose enuresis objectively.

Neurosciences (Riyadh) 2011 Jul;16(3):287-9

Sleep Research Center, Department of Psychiatry, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.

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July 2011