Publications by authors named "Nazila Shahmansouri"

18 Publications

  • Page 1 of 1

Depression and Anxiety among Iranian Medical Students during COVID-19 Pandemic.

Iran J Psychiatry 2020 Jul;15(3):228-235

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

COVID-19 has spread throughout the world and has become a global pandemic. This situation can cause psychological distress among people, especially health care workers. This study aimed to determine depression and anxiety levels among Iranian medical students during the COVID-19 pandemic. In this cross sectional study, we designed an online survey of Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) questionnaires. The survey link was sent to 500 medical clerks and interns studying at Tehran University of Medical Sciences (TUMS). A total of 64.6% of the students completed the survey. The prevalence of mild to severe anxiety and depression among them was 38.1% and 27.6%, respectively. Anxiety and changes in sleep patterns were the most common symptoms. Higher levels of anxiety were related to female gender, lower grade point average (GPA), and experience of COVID-19 symptoms. Students with lower GPA and prior experience of COVID-19 symptoms were more likely to feel depressed. Depression and anxiety did not significantly differ among Iranian medical students before and after the COVID-19 outbreak. Somatic symptoms of depression are more common during this pandemic and need particular attention in future similar situations. A higher GPA is related to lower anxiety and depression among medical students.
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http://dx.doi.org/10.18502/ijps.v15i3.3815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603582PMC
July 2020

Association between Illness Perception and Emotional Status in Iranian Patients after Heart Transplantation.

J Tehran Heart Cent 2020 Jan;15(1):12-17

Psychosomatic Medicine Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Heart transplantation is a major procedure which imposes high emotional stress on patients. Illness perception (IP) is a psychological issue which affects psychological adjustment after transplantation. This study aimed to investigate the association between IP and emotional status in Iranian post-heart transplantation patients. The present cross-sectional study, conducted between 2018 and 2019 in Imam Khomeini Hospital, Tehran, Iran, recruited 121 post-heart transplantation patients. IP was measured using the Brief Illness Perception Questionnaire (B-IPQ), and emotional status was measured using the Hospital Anxiety and Depression Scale. The association between IP and depression/anxiety was assessed. Men comprised 80.2% of the study population. The mean age of the participants was 43.9±12.95 years. Definite caseness for depression and anxiety was reported in 11.6% and 18.2% of the participants, respectively. The median score of IP was 55. The association between anxiety and IP in total IP and the 3 dimensions of IP was statically significant (P=0.015, P=0.018, P=0.002, and P=0.023 for the cognition, emotion, and understanding dimensions and the total IPQ, respectively). Additionally, the association between depression and IP was significant (P=0.001, P=0.029, and P=0.002 for the cognition and emotion dimensions and the total IPQ, correspondingly, except for the understanding dimension). Furthermore, lower levels of anxiety in the patients showed a greater impact on IP than did depression. There was a significant association between IP and depression and anxiety in our study population. Therefore, the diagnosis and management of anxiety and depression in heart transplantation patients may improve IP. The cross-sectional design of the present study precluded an investigation of the causality between IP and emotional status.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360865PMC
January 2020

Assessment and detection of depression in patients with coronary artery disease: validation of the Persian version of the PHQ-9.

Contemp Nurse 2019 Apr - Jun;55(2-3):185-194. Epub 2019 Jul 12.

d School of Nursing, The Johns Hopkins University , Baltimore , MD , USA.

Depression is a common comorbidity in patients with coronary artery disease (CAD), which often remains undetected and untreated. This study aimed to examine the psychometric properties of the Depression Module of the Patient Health Questionnaire (PHQ-9) on a sample of cardiac patients in Iran. Method: The Persian version of the PHQ-9 was developed and administered to 150 patients with CAD, admitted to a tertiary hospital in Tehran, Iran. The major depression module of the International Neuropsychiatric Interview (MINI) was used as the gold standard for the diagnosis of depression. The Persian PHQ-9 demonstrated acceptable internal consistency, with Cronbach's alpha coefficient of 0.80. The optimal cut-off score of ≥7 showed a sensitivity of 76, specificity of 78, and the area under curve of 0.82. The Persian PHQ-9 has acceptable psychometric properties to screen for and detect a current depressive episode in patients with CAD, with recommended cut-off score of ≥7.
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http://dx.doi.org/10.1080/10376178.2019.1641119DOI Listing
February 2020

Association between illness perception and health-related quality of life in patients with preexisting premature coronary artery disease.

J Psychosom Res 2019 05 2;120:118-123. Epub 2019 Mar 2.

Research Department, Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Illness perception in younger age differs from that in older age. We aimed to examine the association between illness perception and health-related quality of life (HRQoL) in patients with premature coronary artery disease (CAD).

Methods: In a cross-sectional design, between November 2016 and September 2017, a total of 779 adults (52.5% female) with premature CAD (diagnosed in men aged ≤ 45 y and women aged ≤ 55 y) completed the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Brief Illness Perception, and the Short-Form Health Survey 36 questionnaires in an outpatient clinic 8 years after the diagnosis.

Results: The patients were treated with coronary artery bypass graft surgery (24.6%), percutaneous coronary intervention (39.5%), and medical treatment (35.8%). The cognitive, emotional, and comprehension aspects of illness perception had significant associations with both physical and mental health in univariable analysis (all Ps < 0.001). After adjustments for potential confounding factors, higher cognitive perception was independently associated with greater physical health [OR = 4.13, Confidence interval (CI): 3.53-4.72] and mental health (OR = 3.17, CI: 2.57-3.77). Additionally, emotional perception was also directly associated with higher physical (OR = 1.62, CI: 1.17-2.06) and mental (OR = 1.52, CI: 1.07-1.96) health; all Ps < 0.001.

Conclusions: Of the 3 different aspects of illness perception, cognitive perception appeared to have the greatest influence on HRQoL, either physical or mental health. Further studies are needed to investigate whether cognitive interventions can improve HRQoL in premature CAD patients and, thus, their outcome.
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http://dx.doi.org/10.1016/j.jpsychores.2019.03.001DOI Listing
May 2019

Saffron () versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial.

Avicenna J Phytomed 2018 Nov-Dec;8(6):513-523

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Saffron was found efficient and safe in treatment of neuropsychiatric disorders, in particular depression. We compared the efficacy of saffron with duloxetine in treatment of patients with fibromyalgia.

Materials And Methods: In this double-blind parallel-group clinical trial, outpatients with fibromyalgia were randomized to receive either saffron 15 mg or duloxetine 30 mg starting with 1 capsule per day in the first week followed by 2 capsules per day from week 2 until the end of week 8. Participants were men and women aged 18-60 years diagnosed with fibromyalgia based on the American College of Rheumatology 2010 criteria who also had a pain score≥40 based on visual analogue scale. Participants were excluded in case they had rheumatologic diseases, inflammatory/infectious/autoimmune arthritis, comorbid neuropsychiatric disorders except depressive disorders, pain due to traumatic injuries, drug history of duloxetine or saffron use, current use of psychoactive medications, recent use of muscle relaxants, steroids, opioid analgesics, benzodiazepines, anti-epileptics, or injective analgesics. Primary outcomes included differences in mean score changes from baseline to endpoint between the treatment arms for Hamilton Rating Scale for Depression, Fibromyalgia Impact Questionnaire, and Brief Pain Inventory.

Results: Socio-demographic characteristics and baseline scores were similarly distributed between the two treatment arms (2n=46). No significant difference was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms (Mean score changes: -4.26 to 2.37; p-values: 0.182-0.900) nor in terms of timetreatment interactions (p-values: 0.209-0.964).

Conclusions: Saffron and duloxetine demonstrated comparable efficacy in treatment of fibromyalgia symptoms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235666PMC
November 2018

Illness Perceptions in Patients with Premature Coronary Artery Disease: A Sex-Based Analysis 8 Years After the Diagnosis.

J Clin Psychol Med Settings 2019 06;26(2):158-165

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

To assess illness perceptions in patients with premature atherosclerotic coronary artery disease (CAD), 717 adults with premature CAD (diagnosis of CAD in men age < 45 years and women age < 55 years) completed sociodemographic indices, the Beck's Depression Inventory-II, Beck Anxiety Inventory and the Brief Illness Perceptions 8 years after the diagnosis. Mean age was 49.59 ± 3.57 years for men and 57.72 ± 4.90 years for women at the time of study. Both sexes were treated through coronary artery bypass graft surgery, percutaneous coronary intervention, or medical treatment. Depressive and anxiety symptoms were significantly more prevalent among women. Generally, the patients believed that their disease was chronic and well controlled and that it had no considerable negative impact on their routine life. Overall, patients had a low concern about their illness. Women had a more negative perception of their disease than did men which may indicate their need for higher psychological support.
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http://dx.doi.org/10.1007/s10880-018-9575-6DOI Listing
June 2019

Does oral administration of ketamine accelerate response to treatment in major depressive disorder? Results of a double-blind controlled trial.

J Affect Disord 2018 08 22;235:236-241. Epub 2018 Feb 22.

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical sciences, Tehran, Iran. Electronic address:

Background: Major depressive disorder (MDD) exerts a high health and financial burden on society. The conventional pharmacotherapies for MDD are partially effective and the response to medication often starts with some delay. There are recent reports of antidepressant effects for oral ketamine.

Methods: We employed a double-blind controlled trial to examine the time course of the therapeutic effect of ketamine when combined with the conventional administration of sertraline. A total of 81 patients participated in the study and were scored with the Hamilton Depression Rating Scale (HDRS) at baseline and at 2, 4 and 6 weeks after the start of the trial RESULTS: General linear model repeated measures demonstrated significant effect for time × treatment interaction on the HDRS scores, with significant difference at all time points post treatment. Early improvement was significantly greater in the ketamine group (85.4%) compared to the placebo group (42.5%). We did not observe any side effects for ketamine administration.

Limitations: Our follow up was limited to 6 weeks post initiation of treatment and cannot reveal the potential long-term adverse effects of oral ketamine and the sustainability of its benefit.

Conclusion: Altogether, our results suggest that oral ketamine may be considered as suitable adjuvant to sertraline in relieving depressive symptoms.
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http://dx.doi.org/10.1016/j.jad.2018.02.056DOI Listing
August 2018

A Survey on Mental Health Status of Adult Population Aged 15 and above in the Province of Chaharmahal and Bakhtiari, Iran.

Arch Iran Med 2017 Nov 1;20(11 Suppl. 1):S19-S22. Epub 2017 Nov 1.

Mental Health Expertise of Charmahal and Bakhtiari Provincial Health Center, Chaharmahal and Bakhtiari University of Medical Sciences, Shahre Kord, Iran.

Introduction: This research aims to determine the mental health status of population aged 15 and over in the province of Chaharmahal and Bakhtiari in 2015.

Methods: The statistical population of this cross-sectional field survey consisted of residents of urban and rural areas of Chaharmahal and Bakhtiari in Iran. An estimated sample size of 1200 people was chosen using systematic random cluster sampling. The access was provided by the contribution of Geographical Post Office of Shahre Kord, Farsan and Farrokhshar cities. The General Health Questionnaire-28 (GHQ-28) was used as the screening tool for mental disorders. The analysis of data in the current study was carried out using the SPSS-18 software.

Results: Using GHQ traditional scoring method, the results showed that 24.9% of the subjects were at risk of mental disorders (26.8% of females and 23% of males). Urban areas (27.1%) were more at risk of mental disorders compared with rural residents (19.1%). Anxiety and somatization symptoms were more frequent than depression and social dysfunction among respondents. The obtained data revealed that the prevalence of mental disorders increased with age. The results also indicated that mental disorders were more common in certain subgroups, in particular females, people aged 65 years and above, the divorced and widowed, illiterate and unemployed adults.

Conclusion: Our findings suggest that one fourth of the participants are at risk of developing mental disorders. Although the prevalence of these disorders has decreased from 39.1% to 24.9% between 1999 and 2015, it is still of great importance to further promote mental health policies and advocate psychological welfare of those suffering from mental disorders along with their re-empowerment.
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November 2017

Effects of Saffron on Cognition, Anxiety, and Depression in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Double-Blind Placebo-Controlled Trial.

J Altern Complement Med 2018 Apr 29;24(4):361-368. Epub 2017 Nov 29.

1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences , Tehran, Iran .

Objectives: Cognitive decline, depression, and anxiety are among the major concerns in patients undergoing coronary artery bypass grafting (CABG). Crocus sativus L. (saffron) seems to be a promising candidate for treatment of these conditions.

Design: In this 12-week, randomized, double-blind, placebo-controlled clinical trial, men and women with on-pump CABG, who had Wechsler Memory Scale (WMS) score >70 and age <70 years, received either saffron capsules (15 mg/twice daily) or placebo. Patients were excluded if they had history of treatment with saffron or acetylcholinesterase inhibitors, comorbid neuropsychiatric disorders, serious medical conditions other than cardiovascular diseases, and hypersensitivity to herbal compounds. The primary outcome was defined as the difference in mean total score changes for WMS-Revised from the baseline to week 12 between the saffron and placebo groups. Secondary outcomes included difference in mean score changes from baseline to endpoint between the two treatment groups for Mini Mental Status Examination and subscales of Hospital Anxiety and Depression Scale ( www.irct.ir ; IRCT201408071556N63).

Results: No significant difference was detected in primary or secondary outcomes between the saffron and placebo groups. Also, no significant time × treatment interaction effect was found for any of the scales.

Conclusions: The results of this trial do not support the hypothesis of potential benefits of saffron in treatment of CABG-related neuropsychiatric conditions.
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http://dx.doi.org/10.1089/acm.2017.0173DOI Listing
April 2018

Psychological Features of Takotsubo Cardiomyopathy: Report of Four Cases.

J Tehran Heart Cent 2017 Apr;12(2):95-98

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Takotsubo or stress-induced cardiomyopathy is a cardiomyopathy in which the patient has a sudden onset, reversible left ventricular systolic dysfunction without any significant coronary artery disease. Four women, who were at a mean age of 64 years and suffered from chest pain exacerbated by emotional stress, were admitted as cases of acute coronary syndrome and were completely evaluated through precise history taking, physical examination, and ECG. Coronary angiography or coronary multidetector computed tomography was used to exclude significant coronary artery disease. In these patients with confirmed Takotsubo cardiomyopathy, in addition to the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) criteria, a 71-item form of the Minnesota Multiphasic Personality Inventory (MMPI)-Mini-Mult-was employed for psychological assessment. The main common elevated scale was hypochondriasis. Individuals with high scores on this scale are obsessed with themselves, especially in regard to their body, and often use their disease symptoms in order to manipulate others. They are mainly passive aggressive, critical, and demanding, which stems from their lack of effective verbal abilities as a means of communication, specifically when it comes to anger or hostility expression. To the best of our knowledge, there is no available study evaluating patients with Takotsubo cardiomyopathy using the Mini-Mult questionnaire for psychological assessment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558063PMC
April 2017

Factors Associated with Depressive Symptoms in Young Adults with Coronary Artery Disease: Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) Study.

Iran J Psychiatry 2016 Oct;11(4):214-223

Department of Clinical Epidemiology and Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands.

Depressed coronary artery disease (CAD) patients may experience a poorer prognosis than non-depressed patients. The aim of this study was to find the associated factors for depressive symptoms in young adults with CAD. This was a cross-sectional study within Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Young adult CAD patients (men ≤ 45 year-old and women ≤ 55 year-old) were visited from March 2013 to February 2014. Demographic, clinical and laboratory data were collected and all patients were asked to fill in the Beck Depression Inventory II. Informed consent was obtained from all participants. A logistic regression model was used to find multiple associated factors of depressive symptoms. Seven hundred seventy patients (mean ±SD age: 45.34 ±5.75 y, men: 47.7%) were visited. The point prevalence of depressive symptoms was 46.9% in women and 30.2% in men (p < 0.001). Logistic regressions model revealed that the most important associated factors for depressive symptoms in the male premature CAD patients were opium usage (OR: 2.4, 95% CI: 1.33-4.43), major adverse cardiac events (MACE) (OR: 2.2, 95% CI: 1.17-3.93), initial coronary artery bypass grafting (CABG) treatment (OR: 2.1, 95% CI: 1.07-4.06), positive family history for CAD (OR: 1.8, 95% CI: 1.11-3.01) and cigarette smoking (OR: 1.7, 95% CI: 0.97-2.98). Hypertension showed a protective role in this group of patients (OR = 0.5, CI = 0.29-0.92). In the female patients, hypertension (OR = 1.5, CI = 0.96-2.22) and body mass index (BMI) (OR = 1.1, CI = 1.02-1.10) were associated with depressive symptoms. : In premature CAD male patients, opium usage, MACE, initial CABG treatment, positive family history for CAD and cigarette smoking were associated with depressive symptoms; and hypertension and BMI were associated with depressive symptoms in women.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206323PMC
October 2016

Factors Associated with Anxiety in Premature Coronary Artery Disease Patients: THC-PAC Study.

Acta Med Iran 2016 Apr;54(4):261-9

Department of Clinical Epidemiology and Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands.

Anxiety may negatively affect the course of coronary artery disease (CAD). The aim of this study was to assess which factors are associated with anxiety in young adults with CAD. A cohort of individuals with premature coronary artery disease was formed between 2004-2011, as the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Patients (men≤45-year-old, and women≤55-year-old) were visited between March 2013 and February 2014. All participants were examined, and their demographic, clinical, and laboratory data were collected. Then, all participants filled in the Beck Anxiety Inventory. Logistic regression models were used to identifying factors related to anxiety in both sexes. During the study, 708 patients (mean [SD] age: 45.3 [5.8] y, men:48.2%) were visited. Anxiety was present in 53.0% of participants (66.0% of women and 39.0% of men). The logistic regressions model showed that the associated factors for anxiety in men were opium usage (OR=1.89, 95% CI: 1.09-3.27), positive family history (OR=1.49, 95% CI:0.94-2.35), and creatinine serum level (OR=1.17, 95% CI:1.05-1.303); and in women were major adverse cardiac events (MACE) during follow-up (OR=2.30, 95% CI:1.25-4.23), hypertension (OR=1.71, 95% CI:1.07-2.73) and the duration of CAD (OR=0.99, 95% CI:0.98-1.00). In premature CAD patients, the determinants of anxiety seem to be different in each sex. Opium usage, positive family history of CAD, and creatinine serum levels in men, and MACE, hypertension, and duration of CAD in women appear the relevant factors in this regard.
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April 2016

Evaluating the Potential Effect of Melatonin on the post-Cardiac Surgery Sleep Disorder.

J Tehran Heart Cent 2015 Jul;10(3):122-8

Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG.

Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant.

Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant.

Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685367PMC
July 2015

Introducing the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort: THC-PAC Study.

J Tehran Heart Cent 2015 8;10(1):34-42. Epub 2015 Jan 8.

Department of Clinical Epidemiology and Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands.

Background: Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center's Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first study of its kind in the Middle East to assess major adverse cardiac events (MACE) in young CAD patients.

Methods: The cohort consists of CAD patients, males ≤ 45 years old and females ≤ 55 years old. The participants are residents of Tehran or its suburbs and underwent coronary angiography between June 2004 and July 2011. A 10-year follow-up, via either clinical visits or telephone calls at least once a year, was commenced in August 2012. The end point is considered MACE, encompassing death, myocardial infarction, stroke, new coronary involvement, percutaneous coronary intervention, and coronary artery bypass grafting.

Results: The cohort comprises 1232 eligible patients (613 [49.8%] males) at a mean age of 45.1 years (SD = 5.8). High frequencies of conventional risk factors, including hyperlipidemia (884 [71.8%]), hypertension (575 [46.7%]), positive family history (539 [43.8%]), cigarette smoking (479 [38.8%]), and diabetes mellitus (390 [31.7%]), were seen in the participants. The mean body mass index (BMI) of the enrolled patients was high (29.2 ± 4.8 kg/m(2)), and 532 (43.3%) and 440 (35.8%) of them were overweight and obese, respectively. The females' BMI was higher (30.4 ± 5.3 vs. 28.0 ± 3.9 kg/m2; P < 0.001) and they had a greater mean abdominal circumference (99.9 ± 13.5 vs. 98.1 ± 9.3 cm; P = 0.035). Between August 2012 and August 2013, follow-up was successful in 1173 (95.2%) patients (median follow-up duration = 55.3 months, 95%CI: 53.5-57.0 months).

Conclusion: Our younger patients with CAD had a high frequency of risk factors compared to the same-age general population and all-age CAD patients, which may predispose them to higher incidence of recurrent MACE.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494517PMC
July 2015

Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients.

J Tehran Heart Cent 2015 Apr;10(2):85-92

Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient's life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery.

Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change.

Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change.

Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients' basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477092PMC
April 2015

Simvastatin versus atorvastatin for improving mild to moderate depression in post-coronary artery bypass graft patients: A double-blind, placebo-controlled, randomized trial.

J Affect Disord 2015 Sep 7;183:149-55. Epub 2015 May 7.

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: A decreased risk of developing depression has been reported among statin users. Aside from their lipid-lowering effects, statins are considered immunomodulatory agents and have protective effects against oxidative stress and inflammation which are well known for their association with depression. The aim of the present study was to compare the probable antidepressant effects of simvastatin and atorvastatin among post-coronary artery bypass graft (CABG) surgery patients with high and low potentials for blood-brain-barrier penetration, respectively.

Method: Forty-six outpatients who had undergone CABG in the last 6 months and suffered from mild to moderate depression participated in a parallel, double-blind, placebo-controlled trial, and were randomized to undergo 6 weeks of treatment with either simvastatin (20mg/day) or atorvastatin (20mg/day). Participants were evaluated using Hamilton depression rating scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to evaluate the efficacy of simvastatin in improving the depressive symptoms.

Result: General linear model repeated measures demonstrated significant effect for time×treatment interaction on the HDRS scores [F (1.62, 71.06)=3.41, P=0.048]. There was no significant difference between the treatment groups regarding the adverse events. No one experienced serious adverse event.

Limitation: The limitations of the present study were its small sample size and the short-term follow-up period.

Conclusion: Treatment with simvastatin seems to be well tolerated with superior antidepressant effects compared to atorvastatin in post-CABG patients. Long-term outcomes of this practice and its probable influence on other psychological aspects are yet to be investigated in future studies.

Trial Registration: Iranian registry of clinical trials (http://www.irct.ir): IRCT201410271556N68.
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http://dx.doi.org/10.1016/j.jad.2015.04.049DOI Listing
September 2015

Simvastatin versus atorvastatin for improving mild to moderate depression in post-coronary artery bypass graft patients: A double-blind, placebo-controlled, randomized trial.

J Affect Disord 2015 Sep 7;183:149-55. Epub 2015 May 7.

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: A decreased risk of developing depression has been reported among statin users. Aside from their lipid-lowering effects, statins are considered immunomodulatory agents and have protective effects against oxidative stress and inflammation which are well known for their association with depression. The aim of the present study was to compare the probable antidepressant effects of simvastatin and atorvastatin among post-coronary artery bypass graft (CABG) surgery patients with high and low potentials for blood-brain-barrier penetration, respectively.

Method: Forty-six outpatients who had undergone CABG in the last 6 months and suffered from mild to moderate depression participated in a parallel, double-blind, placebo-controlled trial, and were randomized to undergo 6 weeks of treatment with either simvastatin (20mg/day) or atorvastatin (20mg/day). Participants were evaluated using Hamilton depression rating scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to evaluate the efficacy of simvastatin in improving the depressive symptoms.

Result: General linear model repeated measures demonstrated significant effect for time×treatment interaction on the HDRS scores [F (1.62, 71.06)=3.41, P=0.048]. There was no significant difference between the treatment groups regarding the adverse events. No one experienced serious adverse event.

Limitation: The limitations of the present study were its small sample size and the short-term follow-up period.

Conclusion: Treatment with simvastatin seems to be well tolerated with superior antidepressant effects compared to atorvastatin in post-CABG patients. Long-term outcomes of this practice and its probable influence on other psychological aspects are yet to be investigated in future studies.

Trial Registration: Iranian registry of clinical trials (http://www.irct.ir): IRCT201410271556N68.
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http://dx.doi.org/10.1016/j.jad.2015.04.049DOI Listing
September 2015

A randomized, double-blind, clinical trial comparing the efficacy and safety of Crocus sativus L. with fluoxetine for improving mild to moderate depression in post percutaneous coronary intervention patients.

J Affect Disord 2014 Feb 16;155:216-22. Epub 2013 Nov 16.

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: A significant correlation exists between coronary artery diseases and depression. The aim of this trial was to compare the efficacy and safety of saffron versus fluoxetine in improving depressive symptoms of patients who were suffering from depression after performing percutaneous coronary intervention (PCI).

Methods: In this randomized double-blind parallel-group study, 40 patients with a diagnosis of mild to moderate depression who had undergone PCI in the last six months were randomized to receive either fluoexetine (40mg/day) or saffron (30mg/day) capsule for six weeks. Participants were evaluated by Hamilton depression rating scale (HDRS) at weeks 3 and 6 and the adverse events were systemically recorded.

Results: By the study endpoint, no significant difference was detected between two groups in reduction of HDRS scores (P=0.62). Remission and response rates were not significantly different as well (P=1.00 and P=0.67; respectively). There was no significant difference between two groups in the frequency of adverse events during this trial.

Limitations: Relatively small sample size and short observational period were the major limitations of this study.

Conclusion: Short-term therapy with saffron capsules showed the same antidepressant efficacy compared with fluoxetine in patients with a prior history of PCI who were suffering from depression.
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http://dx.doi.org/10.1016/j.jad.2013.11.003DOI Listing
February 2014