A wide divide exists between punitive versus treatment perspectives regarding the treatment of sex offenses, notably paraphilias, within Western societies with the United States leading the punitive perspective and Europe the clinical treatment focus of this continuum. Indeed, despite new inroads in treatment protocols, convicted sex offenders in the U.S. are given a life-sentence of social/legal stigma, a fate not even assigned to convicted murderers.

To review the legal actions of various governments against the current state-of-the-art diagnostic and treatment protocols for treating paraphilia - based on the Depo-Lupron, Triptorelin model.

Analyze the U.S., Canadian, and European systems relevant to the Exclusion-Inclusion Spectrum regarding sex offenders where EU nations focus on treatment and inclusion back into society while the USA demonizes and excluded paraphilias.

In the USA, the action of conservative groups has resulted in compulsory sex offender registration, community notification, and civil commitment beyond the completion of criminal sentences, regardless of the effectiveness of clinical treatment. In 2007, Human Rights Watch called for an end to the registration of juveniles, residency restrictions, and the availability of online registration list that is the foundation of the USA model. In contrast, Canada sex offenses are handled at the federal level. In December 2004, Canada passed its Sex Offender Information Registration Act where their registry is accessible only to Canadian law enforcement and is maintained by the Royal Canadian Mounted Police. It is unlawful for citizens to access the sex offender database or to distribute this data.

Few prospective cohort studies describe the risk of type 2 diabetes mellitus associated with depression or anxiety. We aimed to determine the 2-year diabetes incidence and pattern of explanatory factors associated with depressive and/or anxiety disorders.

A prospective cohort of 2,981 participants (aged 18–65 years, 66% women) recruited in the NESDA from community, primary care and outpatient psychiatric clinics were followed-up for two years. Complete data were analyzed from 2,460 participants without baseline diabetes. Lifetime or current (past 6-month) depressive and/or anxiety disorders at baseline were assessed using the CIDI and classified by the DSM-IV. Diabetes was classified by either self-report, medications, or fasting plasma glucose ≥7.0mmol/L. Baseline covariates included age, gender, lifestyle factors, and medical conditions. Odds ratios (OR[95% confidence intervals]) for diabetes were determined using exact logistic regression.

The unadjusted 2-year diabetes incidence was 0.2% (1/571), 1.1% (6/548), and 1.8% (24/1,340) for no, remitted, and current depressive and/or anxiety disorders, respectively. In comparison to controls, current depressive and/or anxiety disorders was associated with diabetes incidence in unadjusted (OR 10.4[1.7,429.0]) and age-adjusted (OR 11.9[1.9,423.0]) analyses. The strength of this association (β) was slightly changed after further adjustments for impaired fasting glucose (11.4%), high triglycerides (−7.8%), and lifestyle cumulative risk score (−5.0%), in contrast to other covariates when assessed in separate models.

The relative odds of developing diabetes within two years was increased for persons with current depressive and/or anxiety disorders, which was partially explained by, but remained independent of, lifestyle cumulative risk factors.

Whether the prevalence of type 1 or 2 diabetes is rising among people with psychopathology is uncertain. This study investigates changes in the prevalence of type 1 and type 2 diabetes associated with psychopathology in the adult Australian population from 2001 to 2008.

Data analysed were from 48,359 participants aged ≥25 years from the 2001, 2004-05 or 2007-08 National Health Surveys. Lifetime diagnosis of type 1 and type 2 diabetes was determined by self-report. Psychopathology status was determined with the 10-item Kessler Psychological Distress Scale (using scores ≥30), and contemporaneous use of antidepressants or anti-anxiety medications.

Overall, the prevalence of type 1 diabetes remained stable whereas the prevalence of type 2 diabetes increased by 36% between 2001 and 2008. On average, odds ratios with 95% confidence intervals (95% CI) for type 1 and type 2 diabetes ranged from 1.43 (0.98,2.10) to 2.44 (1.63,3.64) and 1.32 (1.13,1.53) to 1.67 (1.39,2.02) for people with compared to those without psychopathology by any definition independent of socio-demographic covariates, consistently over the 8-year period. After further adjustments for lifestyle covariates, the strength of these estimates were attenuated and ranged from 1.32 (0.90,1.95) to 2.24 (1.49,3.36) and 1.16 (0.99,1.36) to 1.51 (1.24,1.83) for type 1 and type 2 diabetes.

The prevalence of both type 1 and type 2 diabetes was consistently higher for people with psychopathology from 2001-2008. Clinicians should consider routinely screening patients with diabetes for psychopathology and vice versa, as well as lifestyle risk factors, to inform practice.

Anxiety-related disorders have frequently been considered as potential risk factors for developing and/or worsening cardiovascular diseases. The prevalence of panic attack and depression as anxiety-related disorders are reported to be 10% and 15% respectively among cardiovascular patients.

To evaluate anxiety among cardiovascular patients.

This study was aimed to assess the prevalence of anxiety and its associated factors among cardiovascular patients.

It was a descriptive cross-sectional study in which anxiety-related disorders were investigated among 60 cardiovascular patients hospitalized at the Shaheed Mostafa Hospital in Ilam in 2009. The General Health Questionnaire (GHQ-28) was used for data gathering. Collected data were analyzed using SPSS-17 software.

Mean age±standard deviation was 62.6 ± 3.1years. The prevalence of anxiety was estimated to be 20%. Majority of the patients were female (63.3%) and more than three quarters (77%) were illiterate. Almost two-thirds (67%) reported unemployment without any source of income. One in every four samples was smoker and half of them reported having a family problem at home. History of heart attack, hypertension, hyperlipidemia and hospital admission were 33.7%, 56.7%, 40.0% and 63.3% respectively. There was a significant association between anxiety-raised of suffering from a mental crisis due to loss or sickness of family members/ close friends and increased rate of cardiovascular disorders (p< 0.05).

The rate of anxiety-related disorders in Ilam was significantly higher compared to the national reports across the country which needs more attention by health workers. Psychological consultations, behavioral-conceptual therapies and regular exercises are recommended.

Researchers on Gender Identity Disorder from different countries have reported an increase in the prevalence of GID during the last few decades, as well as changes in the sex ratio of male to female (MTF) and female to male (FTM) GIDs. The aim of this article is to estimate the prevalence and sex ratio of GID in Iran during 2002 to 2009.

All psychiatric records of subjects referred to the Tehran Psychiatric Institute from April 2002 to March 2009 with a diagnosis of GID by two independent reviewers, were assessed. Prevalence of GID was calculated based on the ratio of the total number of identified subjects to the total population aged between 15 and 44 years old.

281 GID subjects with mean age 24.74 at first visit, were studied. The prevalence of MTF and FTM GID was calculated as 1:145,000 and 1:136,000, respectively, and the sex ratio of MTF to FTM GID was 0.96:1. The majority of subjects (229 cases, 81.5%) reported first obvious signs of GID in their childhood and 27 (9.6%) at 14–18 years old. FTM GID subjects showed less obvious childhood signs of GID than MTF GID.

The sex ratio of GID near 1:1 in Iran may indicate that fewer MTF GID subjects seek help in Iran than other countries. We assume that the exact prevalence would be much higher and active prevalence in future reports would be much higher.

Domestic violence against women (DV) in one of health problems that have 9–15% of burden of diseases in middle aged women and would lead to another health problems such as psychiatric disorders and could increase health services utilization and costs.

To estimate prevalence of DV in married women in Tehran and its relation to health services utilization.

A household survey of 615 married women in 22 city districts of Tehran in 2011 with a cluster sampling method was done. Demographic, knowledge, attitude and experience of DV in last 12 months and during marital life, health services utilization in last 1 and 12 months were collected. Analysis were done by STATA, SPSS and ArcGIS softwares.

We interviewed 615 married women, mean±SE age 42.6±1.1 years and duration of marriage 21.5±0.7 years. Physical and non-physical DV during marital life were 35.1% and 7.2%; respectively and during last 12 months were 18.9% and 35.6%; respectively. Health service utilization during last 1 and 12 months were 2.6 and 7.15 time per person; respectively. Women with non-physical DV utilized more mental health and non-prescribed medicine use (P< 0.05). Women with physical DV had less physician (GP, Specialist) services use (1.8±0.6 vs. 2.3±0.1, respectively, P = 0.045) but similar rate of all services utilization with women without physical DV.

DV victims had higher rates of anxiety and depression that would lead to higher health services utilization among them and may produce at least 250 billion Rials annual cost to health system.

Suicide is an important public health problem worldwide. The aim of this study was to describe the epidemiology of suicide and attempted suicide in Iran.

A retrospective study from March 2001 to March 2008 examined some characteristics of cases of suicide and attempted suicide in the Islamic Republic of Iran based on the health system database of 41 medical universities.

A total of 53 100 cases of suicide and attempted suicide were analysed. Just over half were among women (55.0%). The most favoured method of attempted suicide among both males and females was drug overdose. Self-burning was more frequent in females (5.8%) while hanging (4.5%), cutting (2.8%) and firearms (0.5%) were more common in males. There were 3883 (7.3%) completed (fatal) suicides. Hanging had the highest case fatality rate (76.5%) and drug overdose the lowest (2.3%). Older people had a higher mortality rate.

Suicide and attempted suicides increased from 8.3 per 100 000 population in 2001 to 19.4 in 2005, then declined to 16.3 in 2008.

The pilot study aimed to evaluate the effectiveness of a collaborative education program in term of feedbacks from community suicidal precaution nurses (CSPN) and caregivers.

A convenience sample of eight caregivers of patients who presented with suicidal idea or attempted suicide before current admission, and were diagnosed with depression in a study ward were recruited. Knowledge and theory about elderly suicide and caring skill were taught by the psycho-geriatric ward nurse during patient hospitalization. When patient was discharged, the CSPN were liaised. They would help caregivers transforming the theory into practice at their home, and then reinforce their suicidal precaution skills. The effectiveness of the collaborative education program was evaluated by feedbacks from CSPN and caregivers.

The CSPN agreed that the collaborative program was useful and practical, which bridged caregivers’ knowledge gap. The program provided a continuous support to caregivers before and after patients’ discharge. The caregivers expressed that the program was satisfactory and met their needs.

The collaborative program was effective in providing continuous support on practicing the suicidal precaution skill among the caregivers.

There are disparities in mental health services (MHS) utilization within and between populations and several factors are studied as its potential correlates. Identifying those correlates would help health policy makers to adjust service provision with characteristics of their community.

To evaluate demographic, socioeconomic and system correlates of MHS utilization among married women from Tehran, Iran.

A household survey of 615 married women residents of 22 municipal districts of Tehran selected via a cluster sampling method. All subjects were asked about health services utilization during last one and 12 months as well as need and access for MHS, demographic and socioeconomic factors. Independent correlates of MHS use were determined with logistic regression analysis.

Total 615 women, mean±SE age and duration of marital life of 42.6±0.9 and 22±0.8 years, respectively were selected, rate of MHS utilization during last one and 12 months were 5.2% and 10.1% respectively. 23.6% of women reported having mental illness and 19.3% and 17.9% had need for MHS and access to outpatient health services, respectively. Logistic regression models showed that need for MHS (OR:5.25, 95%CI:2.7–10.1), access to outpatient services (OR:2.17, 95%CI:1.04–4.52), smoking (OR:3.4, 95%CI:1.16–10.2) and crowding index (OR:0.69, 95%CI:0.48–0.99).

Rate of MHS utilization in women are low considering the near to estimated rate of perceived illness. Bridging the gap between perceived illness and need for services, then providing better access to services in areas with higher crowding index and higher rates of smoking in residents should considered in any mental health promotion programs.

There are in the literature a few case reports about the development of a manic-psychotic features after the use of antibiotics.This side effect is compared to the frequent and widespread use not very common.

Awareness about the potential neuropsychiatric side effects of antibiotics.

A 53 year old man was seen with since two days manifest agitation, religious utterances, confusion, sleep disturbance and sexual disinheriting. He started ten days before admission a course with Amoxicillin / Clavulanic-acid 500/125 mg t.i.d. for erysipelas to the right leg. He seems to be manic psychotic. During the hospitalization he refused to take the prescribed risperidon. He took only the lorazepam. On the third hospital day the psychiatric symptoms were fully remitted. He had two years ago the same psychiatric symptoms after a seven-day treatment with cotrimoxazole. His condition is completely disappeared within 24 hours after cotrimoxazol discontinuation and without any intake of psychotropic drugs. Pathophysiology: Unclear. Possibly interact antibiotics with different neurotransmitters: for example penicillin inhibits GABA- A and benzodiazepine receptors. This leads to a stimulation of the central nervous system resulting in neurotoxicity and reduction of the seizure threshold. The inhibition of the hepatic P450 enzyme system which results in increased serum levels of antibiotics and subsequently to neurotoxicity. Prostaglandins and cortisol may also play a role.

Manic-psychosis as a side-effect of antibiotics is rare and the symptoms usually disappear within a few days after stopping the antibiotic and a treatment with psychotropic drugs is usually not necessary.

War trauma has long been associated with Post-traumatic Stress Disorder (PTSD), a term coined in 1980 in the DSM-III to explain the post-war impact on U.S. and coalition veterans who served in Vietnam. New dimensions of war trauma have emerged with the 1991 Gulf War and the wars in Iraq and Afghanistan. These challenges to the traditional diagnosis are seen as being consequences of the new dynamics associated with these conflicts, notably the heavy reliance on reserve troops and the National Guard; a high proportion of female service personnel; and multiple deployment as well as the introduction of suicide bombers and the use of IEDs (Improvised Explosive Devices).

To articulate the new dimensions of war trauma including the pervasive atmosphere of hyper-vigilance; sexual tension within the military ranks; and the high prevalence of closed head injuries.

A through analysis of the latest research on war trauma including the proposed DSM-V diagnostic criteria.

MRI and other medical research indicates certain neurophysiological mechanisms associated particularly with PTSD distinguishing it from other forms of war trauma (adjustment disorders; panic disorders; depression, personality disorders...). Pre-morbid health and social factors are also seen as playing a role in the resilience to, or proneness toward, PTSD. Regarding treatment protocols, the immediate administration of opiates or new grade anti-psychotics seem to have the effect of keeping the trauma in the “acute stress” mode instead of the more difficult to treat, PTSD. Cultural differences are also addressed.

Several studies have suggested that vitamin D and testosterone levels may be physiologically and pathologically interlinked. However this relsationship has not been studied in schizophrenia.

To demonstrate an association between vitamin D and testosterone levles in schizophrenia.

To establish that hypovitaminosis D is associated with hypotestosteronrmia.

Laboratory data of all male patients with schizophrenia seen for annual physicals in our office was reviewed. Vitamin D was measured as 25-hydroxyvitamin D and classified as follows: more than 30 ng/ml: normal; 21 to 30 ng/ml: mild deficiency; 11 to 20 ng/mL: moderate deficiency; 10 ng/ml or less: severe deficiency. Testosterone levels were tested by L/MSMS methodology (normal: 348.0–1197 ng/dL).

47 male patients had both vitamin d and testosterone measured: Of these 47, 36 (77%) had hypovitaminosis D and 20 (43%) had LTL. Of the 11 with normal vitamin d levels, 2 (18%) had LTL and 8 (82%) had NTL. Of the 36 with low vitamin D, 18 (50%) had LTL and 18 had NTL (50%). Of the 6 with severe deficiency, 4 (66%) had low and 2 had normal testosterone levels (NTL); of the 15 with moderate deficiency, 7 (47%) had LTL and 9 had NTL and of the 15 with mild deficiency, 7 (47%) had LTL and 8 had NTL.

Vitamin D deficiency appears to be closely related to low testosterone levels in a male schizophrenic population. Supplementation with both vitamin D and testosterone may be needed in these patients.

Obsessive Compulsive Disorder (OCD) is an anxiety disorder which is usually characterized by two types of symptoms, namely.obsessions and compulsions.

Psychosomatic disorders include psycho-cutaneous disease, obsessive-compulsive disorde r(OCD) might be expressed as dermatological lesion and are known as dermo-OCD.

The aim of this study were to determine the prevalence and severity of OCD and its relationship with dermatological disease in sari, Iran, 2011.

The sample consisted of 265 consecutively presenting dermatological patients who agreed to participate in the study, the subjects were assessed with structured clinical interview (SCID-I) by psychiatrist resident and also completed the yalebrown obsessive compulsive scale(Y-BOCS). T-test and chi-square were used to analyze of data.

Of the 265 dermatological patients, 24(9.1%) met DSM-IV criteria for OCD. Only 9(37.5%) of them had previousely been diagnosed as OCD. The most common obsession were washing 13(54.1) and pathological doubt 7 (25%), contamination7 (25%), checking 7(25%).

There is a high prevalence of OCD in dermatological patients and with considerating of importance of OCD with comorbitiy of skin disease, dermatologist must be aware about relationship between two disorders and referring OCD patients to psychiatrist.

Anorexia Nervosa is a serious mental illness and is frequently seen in young females in childhood and adolescence. The most common ages of onset of anorexia nervosa are the mid teens.

To our knowledge this is singular report of a case of delusional disorder in which Anorexia Nervosa preceded the onset of psychotic symptoms. Age and sex of our case are unusual in Anorexia nervosa.

In this report a rare case of Anorexia nervosa is presented in which the patient is a 32 year old male with poor socioeconomic background from a developing country who subsequently experienced a distinct onset of delusional disorder. After four weeks, delusional disorder and Anorexia Nervosa resolved due to treatment by atypical antipsychotics (Risperidone).

The association between anorexia Nervosa and Delusional Disorder is important. In the case which is reported here delusional thoughts started six month after anorexia nervosa when the patient became extremely thin and cachectic.

In fact the theory of occurrence of psychotic disorder as a result of severe malnutrition is intensified.

The efficacy, acceptability and/or tolerability of available antidepressants are not yet satisfactory.

This meta-analysis aimed to summarize the efficacy, acceptability and tolerability of quetiapine treatment for MDD.

MEDLINE, EMBASE, CINHL, PsycINFO and Cochrane Controlled Trials Register were searched in February 2012. Efficacy outcomes were pooled mean changed scores of the standard depressive rating scales. The overall discontinuation rate and discontinuation rate due to adverse events were considered as the measure of acceptability and tolerability, respectively.

A total of 1497 participants in three published RCTs were included. The pooled mean changed score of the Montgomery-Asberg Depression Rating Scale and Hamilton Depression Rating Scale of the quetiapine-treated group were higher than those of the placebo-treated group with WMDs (95%CI) of 3.37 (-3.95, -2.79) and -2.46 (-3.47, -1.45), respectively. The overall response and remission rates were greater in the quetiapine-treated group with RRs (95%CIs) of 1.44 (1.26, 1.64) and 1.37 (1.12, 1.68), respectively. The pooled overall discontinuation rate was not different between groups with an RR (95%CI) of 1.16 (0.97, 1.39). The pooled discontinuation rate due to adverse event was greater in the quetiapine group with an RR (95%CI) of 2.90 (1.87, 4.48). The pooled mean change Pittsburgh Sleep Quality Index scores was also higher in the quetiapine-treated group [WMD (95%CI) of -1.21 (-1.81, -0.61)].

Quetiapine XR is effective for the treatment of MDD. These patients may not accept and tolerate this agent well. Its advantage on sleep improvement may be of benefit for patients with MDD.

Absconding from a psychiatric ward (leaving without permission) is a costly event in many ways.

Some risks of absconding include missed treatment which results in longer rehabilitation time or lack of treatment altogether.

To investigate the motivation and characteristics of patients absconding from a psychiatric ward in Iran.

A prospective study was conducted for patients who absconded from psychiatric ward in the period between July 2010 and July 2011. The variables were patients’ age, gender, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. All patients were interviewed to assess their motivation for absconding.

Over a one-year period of data collection 56 absconding events were recorded, with the incidence rate of 4.24%. The mean age of absconders was 31+8.4 years, 47 (83.9%) absconders were males, 28 (50.9%) absconds happened through the park fence.

Bipolar mood disorder or schizophrenia was the diagnosis of 23 (41%) absconders. The mean number of days of hospitalization in patients who left the wards was 11 days. The main motivation to abscond was boredom from the ward environment and missing the family.

The risk of absconding is highest in the early days of admission especially in male, young patients with diagnosis of bipolar mood disorder or schizophrenia.

Patient satisfaction is an important indicator of quality of care and health facilities. It is a predictor of patient willingness to follow treatment regimen.

Patient perception of nurse caring has been associated with positive patient outcomes, better postoperative functional status and less symptom distress

To determine efficacy of transactional analysis training on inpatient‘s satisfaction of nurses.

This study was performed as a double blind, experimental design with participants assigned to either an intervention or a control group. The participants were the nurses who worked in the morning shift of a general hospital in Iran.

The intervention group received a brief training of transactional analysis by psychiatrist. Self-administered Satisfaction Questionnaire was used for assessing Patients’ satisfaction one week and one month and three months after training. Chi squares and t-test were used for Data analysis.

The study was conducted on 25 nurses in two groups of intervention and controls. twenty nurses (91.7%) were female and two nurses (8.3%) were male. Range of work experience was from 3 years to 20 years. There was a significant difference between patients’ satisfaction with intervention and control groups one week after TA education (P< 0.05).

Application of the education intervention program provided a desirable effect by improving inpatients’ satisfaction.

It is widely accepted that obesity is a major public health problem in the world. The rapid rise in prevalence suggests environmental factors are responsible. Increased use of information and communication technology is also reported to be associated with increased rates of obesity.

Although many studies have analyzed the impact of televison viewing on obesity, the association of excessive Internet use with body mass index (BMI) has heretofore been evaluated only in relatively few studies.

The purpose of this study was to investigate Internet use patterns and Internet addiction among adolescents and to examine the correlation between problematic Internet use and BMI.

The study was conducted among 1938 students, aged between 14 and 18 years. Internet Addiction Test (IAT), Eating Attitudes Test, and a sociodemographic query form were used in the collection of data.

According to the IAT, 10.5% of the study sample was a ‘problematic Internet user’ or an ‘Internet addict’. A significant positive correlation between BMI and IAT (r = 0.307; p < 0.01) and weekly Internet use (r = 0.215; p < 0.01) was found. Linear regression analysis revealed a significant independent association of IAT with BMI (r = 0.235; p < 0.001). Web surfing, watching online videos, chat rooms and Internet messaging, and playing online games were significantly associated with increased BMI (p< 0.05).

These results indicate an association between the Internet addiction and BMI. Further studies are needed to describe the causality of this association.