Abstract
In the January issue of the International Journal of Psychiatry in Medicine (IJPM) we include articles that examine psychological symptoms in patients with medical disorders (hemophilia, multiple sclerosis), mental conditions (schizophrenia, eating disorder, premenstrual dysphoric disorder, post-earthquake PTSD), dental problems, and nonpathological states (PMS, mothers with premature infants), particularly conditions relevant to practitioners seeing such patients in primary care settings. As usual, articles on a range of subjects from different countries throughout the world are included here.
First is a study examining the association between antihypertensive medications and the severity of depressive symptoms among 431 patients seen in internal medicine outpatient clinics at Prince Hamza Hospital in Amman, Jordan. Despite previous research showing a positive correlation between antidepressant medication and depressive symptoms, this study surprisingly found no such association in this patient group. Instead, severe depressive symptoms were more often associated with younger age, a diagnosis of diabetes, and not surprisingly, anxiety and insomnia.
The second article examines the prevalence of depression and anxiety among 90 patients with hemophilia A (84%) or hemophilia B (16%) seen at an adult hemophilia clinic in Turkey. Patients were screened for depressive and anxiety symptoms using the Beck Depression Inventory and the State-Trait Anxiety Inventory. Researchers found that 24% met criteria for significant depressive symptoms and 74% did so for significant anxiety symptoms. Patients with hemophilia B had higher anxiety scores than did those with hemophilia A. The only significant correlate of depressive symptoms in these hemophilia patients was education level, where those with only a high school education had greater depressive symptoms compared to those with a university education.
The third article examines the association between emotional symptoms and the perception of dental pain among 328 patients (average age 32 years) referred to dental clinics in Kermanshah, Iran. Established scales were used to assess pain perception, pain anxiety, dental anxiety, and mental pain. Dental pain perception (assessed by the Revised McGill Pain Questionnaire) was positively related to dental anxiety, pain anxiety, and mental pain, causing researchers to conclude that given the importance of dental care to overall health, psychological interventions may be needed to reduce perceptions of dental pain in high risk patients seen by dentists in Iran.
Next is an article examining the prevalence of depression, anxiety, insomnia and dysmenorrhea among 129 stressed fingolimod-treated women with multiple sclerosis being cared for at Al-Bashir Hospital in Amman, Jordan. The prevalence of severe depression was 56%, severe anxiety 62%, severe insomnia 36%, and severe dysmenorrhea 23%. Correlates of each of these conditions from multivariate models were identified. The high level of emotional disorder found here among stressed women receiving fingolimod for multiple sclerosis underscores the need for primary care clinicians to be alert for psychological conditions in such women. The significant correlates determined in this study may help clinicians identify those at high risk.
Next is an article that examines the prevalence of PTSD among 103 patients with schizophrenia compared to 103 healthy control subjects two years after surviving a 6.8 magnitude earthquake in Elazığ, Turkey, in the year 2020. In this natural disaster, 41 persons died and 1466 were seriously injured. Researchers found that 12% of those with schizophrenia and 25% of healthy controls (p = .01) experienced earthquake-related PTSD diagnoses (using the CAPS-5). Higher levels of religious coping (perhaps motivated by high stress), greater degrees of self-blaming, less emotional support, and having to go to a safer place on the night of the earthquake (perhaps indicating proximity to the event) were associated with PTSD in patients with schizophrenia, whereas history of traumatic events, self-blaming, and less social support from family were associated with PTSD symptoms in healthy control subjects. Given the persistence of significant PTSD symptoms as long as 2 years following this traumatic event, researchers suggest that clinicians focus on specific characteristics that increase risk of PTSD in patients with schizophrenia and those in healthy persons without schizophrenia, since risk factors may differ in each group. The reason for the significantly lower risk of PTSD in those with schizophrenia requires further study.
The next article examines an eating disorder – orthorexia nervosa – which has received little attention thus far in the Western world. Orthorexia nervosa involves an obsession with eating foods that one considers healthy. A community sample of 350 participants were surveyed in Gaziantep, Turkey, using the Teruel Orthorexia Scale (capable of identifying persons with orthorexia nervosa and differentiating them from those with healthy orthorexia). Also administered was the Beck Depression Inventory, Beck Anxiety Inventory, and a 10-item Big 5 personality inventory. The prevalence of healthy orthorexia was found to be 32%, while the prevalence of orthorexia nervosa was 10%. Regression analyses demonstrated that healthy orthorexia was associated with significantly fewer depressive symptoms and a greater likelihood of having agreeableness as a personality trait. However, no specific emotional symptoms or personality traits were associated with orthorexia nervosa. Researchers concluded that sociocultural factors may be important for understanding this disorder in Turkey.
The seventh article in this issue examines the prevalence and correlates of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) among 1125 female college students aged 18-25 in Turkey between December 2022 and May 2023. Investigators found a prevalence of 49% for PMS and 48% for PMDD among these students. Women with blood group types B, AB, and O were significantly more likely to have PMS than those with blood group type A. Women with PMS were also less likely to be physically active based on metabolic equivalent task score. Those with PMDD had significantly longer menstrual cycle duration, greater caffeine intake, and were more likely to have major depressive disorder. Researchers concluded that PMS and PMDD are common among young women in Turkey, and are each associated with distinct characteristics that primary care physicians should be alert for.
Finally, researchers in Iran conducted a randomized controlled trial comparing the effects of transdiagnostic therapy (TT) with those of progressive muscle relaxation (PMR) on emotional regulation, self-compassion, maternal role adaption, and social/work adjustment in 27 mothers of premature infants. Mothers were randomized to either TT (n = 13) or PMR (n = 14), with each group receiving eight 45–60 minute weekly sessions. In the between-group comparison conducted immediately post-intervention and at follow-up, those in the TT group scored significantly better on emotional regulation, self-compassion, maternal role adaptation, and social/work adjustment, compared to those in the PMR group. Researchers tentatively concluded that transdiagnostic therapy (a form of CBT) is significantly more effective than PMR in improving the emotional health of mothers with premature infants in Iran.
As can be seen by this brief overview, each of the articles in this issue provide findings that may help primary care professionals provide better care to patients in the Middle East and throughout the world.
Call for Papers
Several special theme-based issues of IJPM are planned for the future. Readers are encouraged to submit original research and state-of-the-art systematic or meta-analytic reviews on depression in the medically ill, moral injury, and chronic pain. Each of these topics has enormous relevance to the practices of psychiatrists, primary care physicians, and medical specialists. Submissions in these areas will be given priority.