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مقایسه خودآسیب‌رسانی و اقدام به خودکشی در نوجوانان: مرور نظام‌مند Comparison of Self-harm and Suicide Attempt in Adolescents: A Systematic Review 1 1   هدف : هدف این مقاله مرور نظام‌مند پژوهش­های اخیر با موضوع خودآسیب‌رسانی و اقدام به خودکشی در نوجوانا­ن بود. روش : کلیدواژه‌های «اقدام به خودکشی»، «خودجرحی بدون خودکشی»، «خودجرحی» و «خودآسیب‌رسانی عمدی» در پایگاه‌های Pubmed و PsycINFO جست‌وجو شد. از بانک‌های اطلاعاتی SID و شبکه تحقیقات سلامت روان ( MHRN ) نیز برای یافتن منابع داخلی استفاده شد. از میان 120 مطالعه انگلیسی‌زبان گردآوری‌شده، پس از حذف مقاله‌های نامرتبط، 30 مقاله بر اساس طرح مطالعه، گروه نمونه و اهداف انتخاب شدند. مقاله‌های فارسی یافت‌شده جداگانه بررسی شدند. یافته­ها : اقدام خودکشی را می‌توان بر اساس شدت خودآسیب‌رسانی پیش‌بینی کرد. عوامل خطر مشترک زیادی در مورد دو رفتار خودآسیب‌رسانی و اقدام به خودکشی وجود دارد. شدت نشانه­های افسردگی، فراوانی تشخیص­های اختلال استرس پس از سانحه ( PTSD ) و اختلال شخصیت مرزی در نوجوانان دارای سابقه اقدام به خودکشی بیشتر از نوجوانان خودآسیب‌رسان است. نقایص تنظیم هیجانی و کاهش ترس از مرگ بر اثر تکرار خودآسیب‌رسانی دو عامل تبیین کننده ارتباط خودآسیب‌رسانی و اقدام به خودکشی هستند. نتیجه­گیری : تفاوت خودآسیب‌رسانی و اقدام به خودکشی یک تفاوت کمی است، اما انگیزه‌های خود‌آسیب‌رسانی با اقدام به خودکشی تفاوت دارد. 2   Objectives : The purpose of this paper was to systematically review current researches about self-harm and suicide attempt in adolescents. Method: Keywords of “suicide attempt”, “nonsuicidal self-injury” (NSSI), “self-harm”, and “deliberate self-harm” (DSH) were searched through PsycINFO and PubMed. The SID and Mental Health Research Network (MHRN) databases were also searched for domestic resources. Of 120 collected English articles, and after eliminating the irrelevants, 30 articles were selected based on the study design, the sampling methods, and the goals of the study. The Persian articles were studied separately. Results: Suicide attempt could be predicted by severity of self-harm. There exists many common risk factors for self-harm and suicide attempt. Symptoms of depression, the frequency of posttraumatic stress disorder and borderline personality disorder in adolescents with history of suicide attempt are greater than that of adolescents with history of self-harm. Difficulties in regulating emotions and red uction of fear of death which are gained through repetition of self-harm were two factors explained relationship between self-harm and suicide attempt. Conclusion: It seems that the difference between self-harm and suicide attempt is quantitative, but reasons for self-harm was differ from suicide attempt . 3 13 2014/08/13 1393/5/22 2014/08/13 1393/5/22 میترا حکیم شوشتری Mitra Hakim Shooshtari دانشگاه علوم پزشکی ایران، مرکز تحقیقات بهداشت روان، دانشکده علوم رفتاری و سلامت روان - انستیتو روانپزشکی تهران ایران حمید خانی پور Hamid Khanipour تهران، بزرگراه همت غرب، دهکده المپیک، دانشکده روانشناسی و علوم تربیتی علامه طباطبایی. دورنگار: 22180045-021 ایران E-mail: khanipur.hamid@gmail.com self-harm suicide attempt adolescents systematic review خودآسیب‌رسانی؛ اقدام به خودکشی؛ نوجوانان؛ مرور نظام‌مند 1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS). [Internet]. New York: Center for Disease Control and Prevention; 2008. [Undated; 2013 June 5]. Available from: http://www.cdc.gov/injury/wisqars/index.html. ##2. Panaghi L, Ahmadabadi Z, Peiravi H, Abolmasoomi F. Suicide trend in university students during, 2003 to 2008. Iran J Psychiatry Clin Psychol. 2010; 16(2):87-98. [Persian]##3. Shaffer D, Jacobson C. Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. (NSSI) as a DSM–V disorder. [Internet]. Washington, DC: American Psychiatric Association; 2009. [Undated; 2013 June 5]. Available from: http://www.dsm5.org/ Pages/Default.aspx. ##4. Walsh BW. Treating self-injury: A practical guide. New York: Guilford Press; 2006. ##5. Ross S, Heath N. A study of the frequency of self mutilation in a community sample of adolescents. J Youth Adolesc. 2002; 31(1):67-77.##6. Madge N, Hewitt A, Hawton K, DeWilde EJ, Corcoran P, Fekete S, et al. Deliberate self-harm within an international community sample of young people: Comparative findings from the child & adolescent self-harm in Europe (CASE) study. J Child Psychol Psychiatry. 2008; 49(6):667-77.##7. Jacobson CM, Gould M. The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Arch Suicide Res. 2007; 11(2):129-47. ##8. Simeon E, Hollander E. Self-injurious behaviors, assessment and treatment. Washington, DC: American Psychiatric Publishing; 2001.##8. Favazza A. Bodies under siege: Self-mutilation and body modification in culture and psychiatry. Baltimore, MD: Johns Hopkins University Press; 1996.##9. Muehlenkamp J. Self-injurious behavior as a separate clinical syndrome. Am J Orthopsychiatry. 2005; 75(2): 324-33.##10. Baetens I, Claes L,Onghena P, Muehlenkamp J, Grietens H, Onghena P. Non-suicidal and suicidal self-injurious behavior among Flemish adolescents: A web-survey. Arch Suicide Res. 2011; 15(1):56-67.##11. Tang J, Yu Y, Wu Y, Ma Y, Zhu H, Zhang P, et al. Association between non-suicidal self-injuries and suicide attempts in Chinese adolescents and college students: A cross-section study. PLoS One, 2011; 6(4): 1790-9.##12. Muehlenkamp J, Gutierrez PM. Risk for suicide attempts among adolescents who engage in non suicidal self-injury. Arch Suicide Res. 2007; 11(1):69-82.##13. Horesh N, Nachshoni T, Wolmer L, Toren P. A comparison of life events in suicidal and non-suicidal adolescents and young adults with major depression and borderline personality disorder. Compr Psychiatry. 2009; 50(6):496-502.##14. Portzkyc G, DeWilde EJ, Van Heeringen C. Deliberate self-harm in young people: Differences in prevalence and risk factors between the Netherlands and Belgium. Eur Child Adolesc Psychiatry. 2008; 17(3):179-86.##15. Edgardh K, Ormstad K. Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen- year-old boys and girls. Acta Paediatr. 2000; 89(3): 310-9.##16. Hollander M. Helping teen who cut. New York: Guilford press; 2008.##16. Fergusson DM, Woodward LJ, Horwood LJ. Risk factors and life processes associated with the onset of suicidal behavior during adolescence and early adulthood. Psychol Med. 2000; 30(1):23-39.##17. Fleischmann A, Bertolote JM, Belfer M, Beautrais A. Completed suicide and psychiatric diagnoses in young people: A critical examination of the evidence. Am J Orthopsychiatry. 2005; 75(4):676-83.##18. Marttunen MJ, Henriksson MM, Isometsa ET, Heikkinen ME, Aro HM, Lonnqvist JK. Completed suicide among adolescents with no diagnosable psychiatric disorder. J Adolesc. 1998; 33(131):669-81.##19. Asarnow JR, Porta G, Spirito A, Emslie G, Clarke G, Wagner KD, et al. Suicide attempts and non suicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. J Am Academy Child psychiatry. 2011; 50(8):772-81##20. Prinstein MJ, Nock MK, Simon V, Aikin JW, Cheah CSL, Spirito A. Longitudinal trajectories and predictors of suicidal ideation and attempts following inpatient hospitalization. J Consult Clin Psychol. 2008; 76(1): 92-103.##21. Wilkinson P, Kelvin R, Roberts C, Dubicka B, & Goodyear I. Clinical and Psychosocial predictors of suicide attempts and nonsuicidal self-injury in the adolescent depression antidepressants and psychotherapy trial. Am J Psychiatry, 2011; 168(5): 495-501. ##22. Tuisku M, Pelkonen O, Kiviruusu L, Karlsson L, Strandholm T, Marttunen M. Factors associated with deliberate self-harm behavior among depressed adolescent outpatients. J Adolesc. 2009; 32(5):1125-36.##23. Brausch AM, Gutierrez PM. Differences in non-suicidal self-injury and suicide attempts in adolescents. J Youth Adolesc. 2010; 39(3):233-42.##24. Nock MK, Joiner TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006; 144(1):65-72.##25. Nock MK, Prinstein MJ. Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. J Abnorm Psychol. 2009; 118(4): 816-27.##26. Jacobson CM, Muehlenkamp J, Miller AL, Turner JB. Psychiatric Impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychiatry. 2008; 37(2):363-75.##27. Muehlenkamp J, Ertelt T, Miller AL, Claes L. Borderline personality symptoms differentiate non suicidal and suicidal self-injury in ethnically diverse adolescent outpatients. J Child Psychol Psychiatry. 2011; 52(2): 148-55. ##28. Klonsky ED. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev.2007; 27(2): 226-39. ##29. Khanipour H, Borjali A, Golzari M, Falsafinejad M, Hakim-Shushtari M. Self-harm in adolescents with delinquency and history of mood disorder: A qualitative research. J Qual Res Health Sci. 2013; 2(3):195-207. [Persian]##30. Rissanen ML, Kylma J, Laukkanen E. Descriptions of self-mutilation among finish adolescents: A qualitative descriptive inquiry. Issues Ment Health Nurs. 2008; 29(2):145-63.##31. Nock MK, Prinstein MJ. A functional approach to the assessment of self mutilation behavior. J Consult Clin Psychol. 2004; 72(5):885-90. ##32. Glenn RC, Klonsky D. Social context during non-suicidal self-injury indicates suicide risk. Pers Individ Dif. 2009; 46(1):25-9.##33. Howe-Martin LS, Murrell AR, Guarnaccia CA. Repetitive non suicidal self-injury as experiential avoidance among a community sample of adolescents. J Clin Psychol. 2012; 68(7):809-28. ##34. Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberates self-harm: The experiential avoidance model. Behav Res Ther. 2006; 44(3):371-94.##35. Williams JK. Suicide and attempted suicide and self-harm. London: Penguin book; 1997. ##36. Rodham K, Hawton K, Evans E. Reasons for deliberate self-harm: Comparison of Self-poisoners and self cutters in a community sample of adolescents. J Am Acad Child Adolesc Psychiatry. 2004; 43(1):80-7.##37. Maclaughlin C. Suicide-related behavior: Understanding, caring and therapeutic responses. New York: John Wiley & Sons; 2008. ##38. Peyvastegar M, Prevalence of deliberate self harm and correlation with loneliness and attachment style in girl’s students. Psychol Stud. 2013; 9(3):30-51. [Persian]##39. Hemmati N, Daneshamooz B, Panaghi L. Frequency of suicide thoughts in high school student in Ilam Province. New Cogn Sci. 2003; 6(1):79-86. [Persian]##40. Mohammadkhani P. Epidemiology of suicidal thought and suicide attempt in girls in high risk region of Iran. Sci J Soc Welfare. 2003; 4(14):157-73. [Persian]##41. Mehrabi H, Sheikh Darani H. The role of effective factors on suicidal tendency in female high school students. Knowl Res Appl Psychol. 2013; 14(3):91-100. [Persian]##42. Najafi F, Ahmadi-Jooybari T, Moradinazar M, Izadi N. Causes and factors related to deliberate poisoning in 15 to 20 years youth: one case center study with 321 patients. Sci J Forensic Med. 2012; 18(1):33-8. [Persian]##43. Joiner T. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005.##44. Nock MK. Why do people hurt themselves? New insight in to the nature and functions of self-injury. Curr Dir Psychol Sci. 2009; 18(2):78-83.## ##

تحریک‌پذیری‌های شدید و دائمی در کودکان: چالش‌های تشخیصی و نقش DSM Severe and Nonepisodic Irritabilities in Children: Diagnostic Debates and DSM Role 1 1 هدف: تحریک‌پذیری‌های شدید و دائمی (غیردوره‌ای) در 3/3 درصد کودکان دیده می‌شود و به مراقبت‌های جدی بالینی نیاز دارد. چهارمین ویراست راهنمای آماری و تشخیصی اختلال‌های روانی (DSM-IV) دستورالعملی برای تشخیص‌گذاری روی این کودکان ندارد و این موضوع سبب اختلاف نظر بالینگران در تشخیص و درمان شده است. تدوینگران DSM-5 تلاش کرده‌اند تا گامی برای رفع این کاستی بردارند. روش: داده‌ها در یک بررسی مروری که تا زمستان 1391 ادامه داشت، با جست‌وجو در پایگاه‌های معتبر انگلیسی و فارسی گردآوری شد. از میان یافته‌های جست‌وجو، 66 مقاله، دربرگیرنده مقاله‌های مروری، فراتحلیل، پژوهش‌های بالینی شاهددار، مقاله‌های اصیل و گزارش‌های موردی، جدا شد. در 46 مورد اصل مقاله مطالعه شد، اما در 20 مورد ناچار به چکیده بسنده شد. کیفیت مقاله‌ها از سوی نگارندگان به‌طور جداگانه بررسی شد و مقاله‌هایی که روی کیفیت آنها اتفاق ‌نظر وجود داشت، بررسی و تحلیل شدند. یافته‌ها: صاحب‌نظران همواره در مورد ارزش تحریک‌پذیری در تشخیص اختلال‌های کودکان مناقشه داشته‌اند. در دهه گذشته، دیدگاه بالینی حاکم، تحریک‌پذیری‌های شدید و دائمی را نماد اختلال دوقطبی در کودکان می‌دانست. به‌نظر می‌رسد ارزش تشخیصی تحریک‌پذیری با میزان شدت و دائمی/دوره‌ای بودن آن ارتباط دارد. به بیان دیگر، تحریک‌پذیری تنها در صورتی که شدید و دوره‌ای باشد، برای اختلال دوقطبی ارزش تشخیصی یا پیش‌بینی‌کننده دارد. در DSM-5، نام اختلال بدسامانی خلق ایذایی (DMDD) روی این نشانه‌ها نهاده و معیارهای آن تنظیم شده است. نتیجه‌گیری: مهم است کودکان مبتلا به تحریک‌پذیری‌های شدید و دائمی (غیردوره‌ای) جایگاه مشخصی در DSM-5 داشته باشند تا ضمن رفع سردرگمی بالینگران، اجرای پژوهش‌های دقیق برای دسته‌بندی صحیح تشخیصی و درمانی آنان تسهیل شود. 2 Objectives: Severe and nonepisodic irritabilities are prevalent in 3.3% of children and needs intensive clinical care. Diagnostic and Statistical Manual of Mental Disorders (DSM) lacks any guidance on their diagnosis and this has led to controversies among clinicians in their diagnosis and treatment. Workgroups of DSM-5 have tried to remove this paucity. Method: Data were collected through review of the literature appeared until the end of 2012 by searching in relevant English and Persian databases. Of retrieved materials, 66 studies including systematic reviews, meta-analyses, original articles and case reports were extracted. Full-texts of 46 studies and inevitably 20 abstracts were reviewed. The quality of studies were checked separately and qualified ones were reviewed. Results: There has been controversies among professionals about significance of irritability in diagnosing psychiatric disorders in children and adolescents. The dominant clinical school in past decade, formulated severe and nonepisodic irritabilities as being characteristic of bipolar disorder in children. Studies suggest that the diagnostic value of irritability depends on its severity and being episodic or nonepisodic. It seems that irritability can have diagnostic and predictive value for bipolar disorder, only if being severe and episodic. In DSM-5, this condition is called Disruptive Mood Dysregulation Disorder (DMDD) and its criteria is established. Conclusion: It is important that children suffering severe nonepisodic irritabilities have a home in DSM-5 to eliminate clinicians’ confusion, while facilitating precise research for classifying them accurately according to diagnosis and treatment. 14 28 2014/08/132014/08/10 1393/5/19 2014/08/132014/08/10 1393/5/19 الهام شیرازی Elham Shirazi تهران، خیابان ستارخان، خیابان نیایش، خیابان شهید منصوری، دانشکده علوم رفتاری و سلامت روان - انستیتو روانپزشکی تهران. دورنگار: 66506853- 021 ایران E-mail: shirazi.e@iums.ac.ir امیر شعبانی Amir Shabani تهران، خیابان ستارخان، خیابان نیایش، خیابان شهید منصوری، دانشکده علوم رفتاری و سلامت روان - انستیتو روانپزشکی تهران. دورنگار: 66506853- 021 ایران جواد علاقبندراد Javad Alaghband-Rad دانشگاه علوم پزشکی تهران، بیمارستان روزبه ایران bipolar disorder irritable mood child DSM-5 اختلال دوقطبی؛ خلق تحریک‌پذیر؛ کودک؛ DSM-5 1. Brotman MA, Schmajuk M, Rich BA, Dickstein DP, Guyer AE, Costello EJ, et al. Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry. 2006; 60(9): 991-7.##2. Carlson GA, Potegal M, Potegal M, Margulies D, Gutkovich Z, Basile J. Rages-What are they and who has them? J Child Adolesc Psychopharmacol. 2009; 19(3):281-8.##3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4thed. Washington, DC: American Psychiatric Association; 1994.##4. Shirazi E, Shahrivar Z. Diagnostic debates of childhood bipolar disorder: From the formal diagnostic criteria to the severe mood dysregulation. Iran J Psychiatry Clin Psychol. 2009; 15(2):128-46. [Persian]##5. Shirazi E, Shahrivar Z. Diagnostic debates of childhood bipolar disorder: From the formal diagnostic criteria to the severe mood dysregulation. In: Boutros N, editor. Yearbook of international psychiatry and behavioral neurosciences. New York: Nova Science Publishers; 2009. p. 309-330.##6. Biederman J, Faraone SV, Wozniak J, Mick E, Kwon A, Aleardi M. Further evidence of unique developmental phenotypic correlates of pediatric bipolar disorder: Findings from a large sample of clinically referred preadolescent children assessed over the last 7 years. J Affect Disord. 2004; 82(Suppl 1):s45-58.##7. Mick E, Spencer T, Wozniak J, Biederman J. Heterogeneity of irritability in attention-deficit/hyperactivity disorder subjects with and without mood disorders. Biol Psychiatry. 2005; 58(7):376-582.##8. Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, OLfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in yooth. Arch Gen Psychiatry. 2007; 64(9):1032-9.##9. Blader JC, Carlson GA. Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004. Biol Psychiatry. 2007; 62(2):107-14.##10. American Psychiatric Association. Taskforce DV. Issues pertinent to developmental approach to bipolar disorder in DSM-5 [Internet]. Washington, DC: American Psychiatric Association; 2010 [undated; cited 2010 March 25]. Available from: http://www. dsm5.org/ProposedRevisions/ Pages/ proposedrevision. aspx?rid= 397.## 11. American Psychiatric Association. Taskforce DV. Justification for temper dysregulation disorder with dysphoria [Internet]. Washington, DC: American Psychiatric Association; 2010 [undated; cited 2010 March 25]. Available from: http://www.dsm5.org/ProposedRevisions/ Pages/proposedrevision.aspx?rid= 397.##12. Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS. Defining clinical phenotypes of juvenile mania.Am J Psychiatry 2003; 160(3): 430-437.##13. American Psychiatric Association. DSM-5 Development: Proposed Revisions [Internet]. Washington, DC: American Psychiatric Association; 2012 [undated; cited 2012 April]. Available from: http://www.dsm5.org/Proposed Revisions/ pages/proposedrevision. aspx? rid= 397.##14. Parens E, Johnston J. Controversies concerning the diagnosis and treatment of bipolar disorder in children. Child Adolesc Psychiatry Ment Health [Internet]. [undated; cited 2010 Mar 10]. Available from: http:// www.creativecommons.org/ Licenses/ by/ 2.O##15. Geller B, Sun K, Zimmerman B, Luby J, Frazier J, Williams M. Complex and rapid- cycling in bipolar children and adolescents: A preliminary study. J Affect Disord. 1995; 34(4):254-68.##16. Wozniak J, Biederman J, Kiely K, Ablon JS, Faraone SV, Mundy E, et al. Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. J Am Acad Child Adolesc Psychiatry. 1995; 34(7):867-76.##17. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. Am J Psychiatry. 1970; 126(7): 83-7.##18. Stringaris A. Irritability in children and adolescents: A challenge for DSM-5. Eur Child Adolesc Psychiatry. 2011; 20(2):61-6.##19. Hunt J, Birmaher B, Leonard H, Strober M, Axelson D, Ryan N, et al. Irritability without elation in a large bipolar youth sample: Frequency and clinical description. J Am Acad Child Adolesc Psychiatry. 2009; 48(7):730-9.##20. Geller B, Craney J, Bolhofner K, Nickelsburg M, Williams M, Zimmerman B. Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar phenotype. Am J Psychiatry. 2002; 159(6):927-33.##21. Biederman J. Mania is mistaken for ADHD in prepubertal children (Debate Forum: Affirmative). J Am Acad Child Adolesc Psychiatry. 1998; 37(10):1091-3.##22. Kowatch R, Youngstrom E, Danielyan A, Findling R. Review and meta- analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord. 2005; 7(6):483-96.##23. Jairam R, Prabhuswamy M, Dullur P. Do we really know how to treat a child with bipolar disorder or one with severe mood dysregulation? Is there a magic bullet? Depress Res Treat. 2012;2012:967302. ##24. Mick E, Spencer T, Wozniak J, Biederman J. Heterogeneity of irritability in attention-deficit/ hyperactivity disorder subjects with and without mood disorders. Biol Psychiatry. 2005; 58(7):576-82.##25. Stringaris A, Cohen P, Pine DS, Leibenluft E. Adult outcomes of youth irritability: A 20-year prospective community-based study. Am J Psychiatry. 2009; 166(9): 1048-54.##26. Stringaris A, Baroni A, Haimm C, Brotman M, Lowe CH, Myers F, et al. Pediatric bipolar disorder versus severe mood dysregulation: Risk for mania episodes on follow-up. J Am Acad Child Adolesc Psychiatry. 2010; 49(4):397-405.##27. Geller B, Tillman R, Craney JL, Bolhofner BS. Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry. 2004; 61(5):459-67.##28. Wozniak J, Biederman J, Kwon A, Mick E, Faraone S, Orlovsky K, et al. How cardinal are cardinal symptoms in pediatric bipolar disorder? An examination of clinical correlates. Biol Psychiatry. 2005; 58(7):583-8.##29. Davari-Ashtiani R, Alaghband-Rad J, Sharifi V, Amini H, Kaviani H, Shabani A, et al. Reliability of the Persian translation of the composite international diagnostic interview (CIDI) for diagnosing schizophrenia and bipolar disorder. Adv Cogn Sci. 2004; 6(1,2):1-9. [Persian]##30. Amini H, Alaghband-Rad J, Sharifi V, Davari-Ashtiani R, Kaviani H, Shahrivar Z, et al. Validity of a Farsi translation of the composite international diagnostic interview (CIDI) to diagnose schizophrenia and bipolar disorder. Tehran U Med J. 2006; 64(8):31-42. [Persian]##31. Shabani A. Strategies for decreasing false negative and positive diagnoses of bipolar disorder. Iran J Psychiatry Clin Psychol. 2009; 15(2):99-127. [Persian]##32. Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youth. Am J Psychiatry. 2011; 168(2):129-42.##33. Tillman R, Geller B. Definitions of rapid, ultrarapid, and ultradian cycling and of episode duration in pediatric and adult bipolar disorders: A proposal to distinguish episodes from cycles. J Child Adolesc Psychopharmacology. 2003; 13(3):267-71.##34. Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, et al. Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry. 2006; 63(2):175-83.##35. Shahrivar Z, Alaghband-Rad J, Shirazi E. Does attention deficit/hyperactivity disorder affect clinical characteristics of mania in children and adolescents? Iran J Psychiatry Clin Psychology. 2006; 12(3):197-203. [Persian]##36. Bhangoo RK, Dell ML, Towbin K, Myers FS, Lowe CH, Pine DS, et al. Clinical correlates of episodicity in juvenile mania. J Child Adolesc Psychopharmacology. 2003; 13(4):507-14.##37. Leibenluft E, Cohen P, Gorrindo T, Brook JS, Pine DS. Chronic versus episodic irritability in youth: A community-based, longitudinal study of clinical and diagnostic associations. J Child Adolesc Psychophar-macology. 2006; 16(4):456-66.##38. Masi G, Perugi G, Millepiedi S, Mucci M, Pari C, Pfanner C, et al. Clinical implications of DSM-IV subtyping of bipolar disorders in in referred children and adolescents. J Am Acad Child Adolesc Psychiatry. 2007; 46(10):1299-306.##39. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, DSM-5. Washington, DC: American Psychiatric Publishing; 2013.##40. Axelson DA, Birmaher B, Findling RL, Fristad MA, Kowatch RA, Youngstorm EA, et al. Commentary: Concerns regarding the inclusion of temper dysregulation disorder with dysphoria in the diagnostic and statistical manual of mental disorder, fifth edition. J Clin Psychiatry. 2011; 72(9):1257-62.##41. American Psychiatric Association. DSM-5 proposed revisions include new diagnostic category of Temper Dysregulation with Dysphoria (TDD) [Internet]. ashington, DC: American Psychiatric Association; 2010 [updated 2010 February 10; cited 2010 February 10th]. Available from: http://www.dsm5.org/Proposed Revisions/Pages/proposedrevision.aspx? rid= 397.##42. Copeland WE, Shanahan L, Costello EJ, Angold A. Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Arch Gen Psychiatry. 2009; 66(7):764-72.##43. Stringaris A, Goodman R. Three dimensions of oppositionality in youth. J Child Psychol Psychiatry. 2009; 50(3):216-23.##44. Stringaris A, Goodman R. Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. J Am Acad Child Adolesc Psychiatry. 2009; 48(4):404-12.## ##

اثربخشی ریواستیگمین در کاهش نشانه‌های حرکت‌پریشی دیررس در بیماران مبتلا به اسکیزوفرنیا The Effectiveness of Rivastigmine in Reducing Tardive Dyskinesia Symptoms in Patients with Schizophrenia 1 1   هدف : هدف پژوهش حاضر بررسی اثربخشی داروی ریواستیگمین بر کاهش نشانه‌های حرکت‌پریشی دیررس (دیسکینزی تاردیو) در بیماران مبتلا به اسکیزوفرنیای دریافت‌کننده داروهای ضدروان‌پریشی بود. روش : 40 بیمار مرد مبتلا به اسکیزوفرنیا با نشانه‌های حرکت‌پریشی دیررس (بر اساس ملاک‌های DSM-IV-TR ) که در مرکز روانپزشکی رازی بستری شده بودند و در یک ماه پیش از مطالعه از نظر روانی در شرایط پایداری به‌سر می‌بردند، با نمونه‌گیری در دسترس انتخاب شدند. آزمودنی‌ها به‌طور تصادفی به دو گروه 20 نفری تقسیم شدند و یک گروه دارونما و گروه دیگر ریواستیگمین دریافت کردند. در آغاز بررسی و همچنین پس از سپری شدن هشت هفته، نشانه‌های حرکتی بیماران با مقیاس حرکات غیرارادی نابهنجار ( AIMS ) بررسی شد. تحلیل داده‌ها با روش تحلیل کوواریانس صورت گرفت. یافته‌ها : یافته‌ها نشان داد میان نمره‌های پس‌آزمون دو گروه آزمایش و گواه تفاوت معنی‌داری وجود داشت (05/0 p< ). نتیجه‌گیری : ریواستیگمین بر کاهش نشانه‌های حرکت‌پریشی دیررس در بیماران مبتلا به اختلال اسکیزوفرنیا مؤثر است. 2   Objectives : The aim of this study was to examine the effectiveness of rivastigmine on reducing tardive dyskinesia (TD) symptoms in patients with schizophrenia receiving antipsychotic treatment. Method: Forty male patients with schizophrenia and tardive dyskinesia symptoms [based on the Diagnostic and Statistical Manual of Mental Disorders, 4th. ed., Text Revision (DSM- IV-TR) criteria] hospitalized in Razi Psychiatric Hospital with a stable mental status within a month prior to the study were selected using convenience sampling. The subjects were randomly divided into two groups each with 20 individuals one group received placebo and the other rivastigmine. At the beginning of the study and after eight weeks, severity of symptoms of TD was assessed by Abnormal Involuntary Movement Scale (AIMS). Data analysis was done by analysis of covariance. Results: There were significant difference between posttest mean scores of the two groups (p<0.05). Conclusions: Rivastigmine is effective in reducing TD symptoms in patients with schizophrenia . 29 34 2014/08/132014/08/102014/07/27 1393/5/5 2014/08/132014/08/102014/07/27 1393/5/5 امیرعباس جهانیان Amir Abbas Jahanian دانشگاه علوم بهزیستی و توانبخشی ایران امید رضایی Omid Rezaei دانشگاه علوم بهزیستی و توانبخشی. تهران، اوین، بلوار دانشجو، خیابان کودکیار، دانشگاه علوم بهزیستی و توانبخشی، گروه روانپزشکی. دورنگار: 22180140-021 ایران E-mail:dr.rezaei@uswr.ac.ir فربد فدایی Farbod Fadai دانشگاه علوم بهزیستی و توانبخشی ایران آزاده یراقچی Azadeh Yaraghchi دانشگاه آزاد اسلامی، واحد علوم و تحقیقات ایران tardive dyskinesia rivastigmine schizophrenia Abnormal Involuntary Movement Scale حرکت‌پریشی دیررس؛ ریواستیگمین؛ اسکیزوفرنیا؛ مقیاس حرکات غیرارادی نابهنجار 1. Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock’s comprehensive text book of psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.##2. Sadock BJ, Sadock VA. Kaplan & Sadock’s synopsis of psychiatry. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.##3.Kane JM, Smith JM. Tardive dyskinesia prevalence and risk factors. Arch Gen Psychiatry. 1982; 39(4): 473-81.##4. Wolf ME, Mosnaim AD. Tardive dyskinesia: Biological mechanisms and clinical aspects. 1st ed. Washington, DC: American Psychiatric Press; 1988.##5.Jeste DV, Doongaji DR, Linnoila M. Elevated cerebrospinal fluid noradrenaline in tardive dyskinesia. Brit J Psychiatry. 1984; 144:177-80.##6.Brainin M, Reisner TH, Zeitlhofer J. Tardive dyskinesia, clinical correlation with computed tomography in patients aged less than 60 years. J Neurosurg Psychiatry. 1983; 46(11):1037-40.##7.Margolese HC, Choinrad G, Kolivakis TT, Beauclair L, Miller R. Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 1: Pathophysiology and mechanisms of induction. Can J Psychiatry. 2005; 50(9):541-7.##8.Miller R, Choinrad G. Loss of striatal cholinergic neurons as a basis for tardive and L-dopa-induced dyskinesias, neuroleptic induced super sensitivity psychosis and refractory schizophrenia. Biol Psychiatry. 1993; 34(10):713-38.##9.Cummings JL. Cholinesterase inhibitors: A new class of psychotropic compounds. Am J Psychiatry. 2000; 157(1):4-15.##10.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.##11.Egan MF, Hyde TM. Treatment of tardive dyskinesia with Vitamin E. Am J Psychiatry. 1992; 149(6):773-7.##12. Kim JH, Jung HY, Kang UG, Jeong SH, Ahn YM, Byun HJ, et al. Metric characteristics of the drug-induced extra pyramidal symptoms scale (DIEPSS): A practical combined rating scale for drug-induced movement disorders. Mov Disord. 2002; 17(6):1354-9.##13.Yoshimi A, Togo T, Sugiyama K, Uehara K, Otsuko T. Treatment of refractory tardive dyskinesia with donepezil in an elderly patient with depression. Psychogeriatrics. 2008; 8(4):196-8.##14. Caroff SN, Campbell EC, Havey J, Sullivan KA, Mann SC, Gallop R. Treatment of tardive dyskinesia with donepezil: A pilot study. J Clin Psychiatry. 2001; 62(10):772-6.##15. Caroff SN, Walker P, Campbell C, Lorry A, Petro C, Lynch K, et al. Treatment of tardive dyskinesia with Galantamine: A randomized controlled cross-over trial. J Clin Psychiatry. 2007; 68(3):410-5.##16.Tarsy D, Baldessarini RJ. Epidemiology of tardive dyskinesia: Is risk declining with modern antipsychotics? Mov Disord. 2006; 21(5):589-98.##17.Bradley WG, Daroff RB, Fenichel GM. Neurology in clinical practice: Principles of diagnosis and management. 3rd ed. Oxford: Butterworth-Heinemann; 1999.## ##

سیر اختلال‌های پسیکوتیک: پیگیری سه‌ساله بیماران مبتلا به پسیکوز بار اول Course of Psychotic Disorders: A 3-Year Follow-up Study of Patients with First Episode Psychosis 1 1   هدف : هدف این مطالعه آینده‌نگر سه‌ساله بررسی ویژگی‌ها، سیر و پیامدهای بالینی بیماران مبتلا به پسیکوز بار اول بود که در فاصله سال‌های 1385 تا 1387، به بیمارستان روزبه مراجعه کرده بودند. روش : بیماران مراجعه‌کننده به بیمارستان روزبه (برای بستری)، در صورت وجود هرگونه نشانه پسیکوتیک و در صورتی که مشکل اخیر نخستین رویداد بیماری‌شان بود، وارد مطالعه شدند. در بدو بستری، بیمار از نظر شدت نشانه‌ها، میزان عملکرد کلی و کیفیت زندگی ارزیابی شد. برای گردآوری داده‌ها مقیاس نشانه‌های مثبت و منفی ( PANSS )، مقیاس سنجش کلی عملکرد ( GAF ) و مقیاس کوتاه کیفیت زندگی سازمان جهانی بهداشت ( WHOQoL-BREF ) به‌کار رفت. این ارزیابی‌ها در زمان ترخیص از بیمارستان، 6، 12 و 24 ماه و 4-3 سال پس از ترخیص تکرار شد. میزان بستری مجدد نیز طی دوره پیگیری اندازه­گیری شد. داده‌ها به روش تحلیل واریانس با اندازه‌گیری مکرر و آزمون t جفتی تحلیل شدند. یافته­ها : از 104 بیماری که وارد طرح شده بودند، 59 نفر مرد و 45 نفر زن بودند. میانگین (±انحراف معیار) سنی آنان 6/30 سال (7/9±) بود. بر اساس تشخیص­های زمان ترخیص، 48 نفر به اختلال دوقطبی (رویدادهای خلقی با ویژگی‌های پسیکوتیک)، 22 نفر به اسکیزوفرنیا، 7 نفر به اختلال افسردگی اساسی (با ویژگی‌های پسیکوتیک) و باقی (27 نفر) به سایر اختلال‌های پسیکوتیک مبتلا بودند. یافته‌ها نشان داد عملکرد کلی، نشانه‌های مثبت، منفی و عمومی پسیکوز بیماران در طول زمان، به‌شکل قابل توجهی بهبود یافته بود، ولی تحلیل‌های دیگر نشان داد بهبود تنها در زمان ترخیص بارز بود و هیچ‌یک از این شاخص‌ها، پس از ترخیص و در فواصل پیگیری تغییری نداشت. کیفیت زندگی بیماران نیز در طول زمان در هیچ یک از فواصل تغییری نداشت. در میان افرادی که به آنها دسترسی حاصل شد، میزان عود منجر به بستری در سه سال اول پس از ترخیص 1/41 درصد بود. نتیجه­گیری : درصد قابل توجهی از بیماران ظرف 3 سال از بستری، دچار عود منجر به بستری دوباره شدند. این یافته در کنار عدم تغییر قابل توجه عملکرد و کیفیت زندگی بیماران در طول پیگیری، اهمیت به کار بستن مداخلات مؤثر برای پیشگیری از عود و توانبخشی را نمایان می­سازد. 2 Objectives: The goal of the current 3-year follow-up study was to investigate characteristics, course and clinical outcomes of a group of patients with first episode psychosis admitted to Roozbeh Hospital during 2007-2009. Method: Patients admitted to Roozbeh Hospital with a first presentation of any psychotic symptoms were included. At admission, the patients were assessed with regard to severity of symptoms, global functioning and quality of life. For data collection, the Positive and Negative Symptoms Scale (PANSS), Global Assessment of Functioning (GAF), and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF) were used. These assessments were repeated at the time of discharge, and on six, 12, and 24 months as well as three to four years after discharge. Readmissions in the follow-up period were also recorded. The data were analyzed using repeated measure analysis of variance and paired t-test. Results: Of 104 recruited patients, 59 (56.7%) were male. Their mean age (±SD) was 30.6 years (±9.7). Based on discharge diagnoses, 48 individuals had bipolar I disorder (with psychotic features), 22 patients had schizophrenia, seven cases had major depressive disorder (with psychotic features), and the remaining 27 were diagnosed with other psychotic disorders. Patients’ global functioning, and positive, negative and general psychotic symptoms were improved noticeably during follow-up. Nonetheless, the improvement was apparent at solely the time of discharge and none of these measures changed between discharge and follow-up intervals. The patients’ quality of life showed no changes during any of these intervals. Of those with available data, the rate of readmission was 41.1%. Conclusion: A significant proportion of the patients experienced relapse leading to rehopitalization during the first three years after the index hospitalization. This finding along with the lack of improvement of functioning and quality of life during the follow-up period underlines the importance of providing effective interventions for relapse prevention and rehabilitation 35 42 2014/08/132014/08/102014/07/272014/08/10 1393/5/19 2014/08/132014/08/102014/07/272014/08/10 1393/5/19 ونداد شریفی Vandad Sharifi گروه روانپزشکی و مرکز تحقیقات روانپزشکی و روانشناسی. تهران، خیابان کارگر، پایین‌تر از چهارراه لشگر، بیمارستان روزبه. دورنگار: 55419113-021 ایران E-mail:vsharifi@tums.ac.ir همایون امینی Homayoun Amini دانشگاه علوم ‌پزشکی تهران ایران زهرا شهریور Zahra Shahrivar فوق تخصص روانپزشکی کودک و نوجوان، دانشیار دانشگاه علوم‌پزشکی تهران ایران یاسمن متقی پور Yasaman Mottaghipour دانشگاه علوم ‌پزشکی شهید بهشتی، بیمارستان طالقانی ایران جواد محمودی قرائی Javad Mahmoudi Gharaee دانشگاه علوم ‌پزشکی تهران ایران جواد علاقبند راد Javad Alaghband-Rad دانشگاه علوم‌ پزشکی تهران ایران psychotic disorders outcome assessment relapse recurrence اختلال‌های پسیکوتیک؛ ارزیابی پیامد؛ عود 1.Hegarty JD, Baldessarini MD, Tohen M, Waternaux C, Oepen G. One hundred years of schizophrenia: a meta-analysis of the outcome literature. Am J Psychiatry. 1994; 151(110):1409-15.##2.Vazquez Barquero JL, Cuesta MJ, Herrera Castanedo S, Lastra I, Herran A, Dunn G. Cantabria first-episode schizophrenia study: Three-year follow-up. Br J Psychiatry. 1999; 174(2):141-9.##3.Wiersma D, Niehuis F, Slooff C, Giel R. Natural course of schizophrenic disorders: A 15-year follow-up of a Dutch incidence cohort. Schizophr Bull. 1998; 24(1):75-85.##4.McGlashan TH. A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophr Bull. 1988; 14(4):515-42. ##5.Falloon IRH, Coverdale JH, Brooker C. Psychosocial interventions in schizophrenia: A review. Int J Ment Health. 1996; 25(1):3-23.##6.Häfner H, Hambrecht M, Löffler W, Munk-Jorgensen P, Riecher-Rossler A. Is schizophrenia a disorder of all ages? A comparison of first episode and early course across the life-cycle. Psychol Med. 1998; 28(2):351-65.##7.Wyatt RJ. Neuroleptics and the natural course of schizophrenia. Schizophr Bull. 1991; 17(2):325-51.##8.Norman RM, Malla AK. Duration of untreated psychosis: A critical examination of the concept and its importance. Psychol Med. 2001; 31(3):381-400.##9.Correll CU, Mendelwitz AJ. First psychotic episode: A window of opportunity. Curr Psychiatr. 2003; 2(4):51-67.##10. Larsen TK, McGlashan TH, Moe LC. First-episode schizophrenia I. Early course parameters. Schiz Bull. 1996; 22(2):241-56.##11.Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999; 56(3):241-7. ##12.Young LT, Bakish D, Beaulieu S. The neurobiology of treatment response to antidepressants and mood stabilizing medications. J Psychiatry Neurosci. 2002; 27(4):260-5.##13.Birchwood M, Todd P, Jackson C. Early intervention in psychosis: The critical period hypothesis. Br J Psychiatry Suppl. 1998; 172(33):53-9.##14.Falloon IR, Coverdale JH, Laidlaw TM, Merry S, Kydd RR, Morosini P. Early intervention for schizophrenic disorders: Implementing optimal strategies in routine clinical services. Br J Psychiatry. 1998; 172(Suppl):33-8. ##15.Edwards J, McGorry PD, Pennell K. Models of early intervention in psychosis: An analysis of service approaches. In: Birchwood M, Fowler D, Jackson S. editors. Early intervention in psychosis: A guide to concepts evidence and intervention. Chichester: John Wiley & Sons; 2000. ##16.Alaghband-Rad J, Boroumand M, Amini H, Sharifi V, Omid A, Davari-Ashtiani R, et al. Non-affective acute remitting psychosis: A preliminary report from Iran. Acta Psychiatr Scand. 2006; 113(2):96-101.##17.Amini H, Alaghband-Rad J, Omid A, Sharifi V, Davari-Ashtiani R, Momeni F, et al. Diagnostic stability in patients with first-episode psychosis. Australas Psychiatry. 2005; 13(4):388-92. ##18.Alaghbandrad J, Amini H, Sharifi V, Dashti b. A 2 year followup study on patients with first episode psychosis admitted to Roozbeh Hospital: Demographic and clinical characteristics and comparison of a specialized program and treatment as usual. Final Report. Tehran: Tehran University of Medical Sciences; 2010.##19.Kay S, Fiszbein A, Opler l. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13(32):261-76.##20.Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean? Schizophr Res. 2005; 79(2-3):231-8. ##21.American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.##22. Izutsu T, Tsutsumi A, Islam A, Matsuo Y, Yamada HS, Kurita H, Wakai S. Validity and reliability of the Bangla version of WHOQOL-BREF on an adolescent population in Bangladesh, Qual Life Res. 2005; 14(7):1783-9. ##23.Nejat S, Montazeri A, Holakouie Naieni K, Mohammad K, Majdzadeh SR. The world health organization quality of life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. J School pub Health Inst Pub Health Res. 2006; 4(1):1-12. [Persian]##24.Gleeson JFM, Alvarez-Jimenez M, Cotton SM, Parker AG, Hetrick S. A systematic review of relapse measure- ment in randomized controlled trials of relapse prevention in first-episode psychosis. Schizophr Res. 2010; 119(1-3):79-88.##25.Açok A, Polat A, Akır S, Genç A. One year outcome in first episode schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2006; 256(1):37-43.##26. Menezes NM, Arenovich T, Zipursky RB. Systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med. 2006; 36(10):1349-62.##27.Shahrivar Z, Alaghband-rad J, Mahmoudi Gharaee J, Seddigh A, Salesian N, Jalali Roudsari M, et al. The efficacy of an integrated treatment in comparison with treatment as usual in a group of children and adolescents with first-episode psychosis during a two year follow-up. Iran J Psychiatry Clin Psychol. 2012; 18(2):115-27. [Persian]##28.Pencer A, Addington J, Addington D. Outcome of a first episode of psychosis in adolescence: A 2-year follow-up. Psychiatry Res. 2005; 133(1):35-43.##29.Cougnard A, Parrot M, Grolleau S, Kalmi E, Desage A, Misdrahi D, et al. Pattern of health service utilization and predictors of readmission after a first admission for psychosis: A 2-year follow-up study. Acta Psychiatr Scand. 2006; 113(4):340-9.##30.Amini H, Sharifi V, Nejatisafa A, Arbabi M, Tabatabaee M, Alimadadi Z, et al. One year follow-up of patients with bipolar disorder admitted to Roozbeh Hospital. Iran J Psychiatry Clin Psychol. 2009; 15(2):168-74. [Persian]##31.Amini H. First-episode psychosis: An overview of research in Iran. Iran J Psychiatry Behav Sci. 2011; 5(1):6-16.##32.Sharifi V, Tehranidoost M, Yunesian M, Amini H, Mohammadi M, Jalali Roudsari M. Effectiveness of a low-intensity home-based aftercare for patients with severe mental disorders: A 12-month randomized controlled study. Community Ment Health J. 2012; 48(6):766-70.## ##

گرایش جنسی در افراد مبتلا به اختلال هویت جنسی Sexual Orientation in Patients with Gender Identity Disorder 1 1 هدف : پژوهش حاضر به‌عنوان بخشی از یک مطالعه وسیع‌تر روی نقش‌های جنسیتی افراد مبتلا به اختلال هویت جنسی ش جنسی در مبتلایان و مقایسه آنان با افراد سالم بود. روش : در بررسی مقطعی حاضر، 12 مرد و 27 زن مبتلا به اختلال هویت جنسی با 81 مرد و 89 زن شاهد مقایسه شدند. گرایش جنسی افراد و انگاره فرد از هویت جنسی با دو پرسش بررسی شد. داده‌ها با استفاده از آزمون T ، تحلیل واریانس، آزمون مجذور خی و آماره کاپا تحلیل شدند. یافته‌ها : در گروه مردان مبتلا به GID ، یک نفر به زنان گرایش جنسی داشت و بقیه (7/91 درصد) به مردان گرایش داشتند. در گروه زنان مبتلا به GID ، فراوانی گرایش جنسی به زنان و مردان، به‌ترتیب، 3/96 و 7/3 درصد بود. فراوانی دگرجنس‌گرایی در مردان و زنان شاهد، به‌ترتیب 8/93 و 7/69 درصد برآورد شد. فراوانی افراد مبتلا به GID متمایل به جنسیت زیستی خود میان مردان و زنان تفاوتی نشان نداد (05/0< p ) و هم‌خوانی بالایی میان جنسیت زیستی و گرایش جنسی این افراد دیده شد (653/0= κ ، 164/0= SE ، 001/0> p ). نتیجه‌گیری : در بیماران ایرانی دچار اختلال هویت جنسی ( GID ) هم‌خوانی بالایی میان جنسیت ترجیحی و گرایش جنسی افراد دیده شد. 2   Objectives : The present study was conducted as a part of a broader study on gender roles in patients with gender identity disorder (GID), and its goal was to determine patients’ sexual orientation comparing to healthy controls. Method: In current cross-sectional study, 12 males and 27 females with GID were compared with 81 male and 89 female controls. The participants’ gender orientation and gender self-identity were investigated via asking two questions. Data analysis was carried out using t-test, analysis of variance, chi-square, and kappa statistic. Results: In the male-to-female GID patients, one participant was sexually attracted to females and the rest (91.7 percent) to males. In the female-to-male GID patients, the frequency of sexual orientation to females and males were 96.3 percent and 3.7 percent, respectively. The frequency of heterosexuality in male and female controls was 93.8 percent and 69.7 percent, respectively. The frequency of individuals with GID who sexually attracted to the same-sex showed no statistically significant difference between males and females (p>0.05), though a substantial concordance was observed between these patients’ biological sex and sexual orientations (κ=0.653, SE=0.164, p<0.001). Conclusion : In Iranian patients with GID, a substantial concordance was observed between biological sex and sexual orientation . 43 49 2014/08/132014/08/102014/07/272014/08/102014/07/23 1393/5/1 2014/08/132014/08/102014/07/272014/08/102014/07/23 1393/5/1 کاوه علوی Kaveh Alavi دانشگاه علوم پزشکی و خدمات بهداشتی- درمانی ایران. مرکز تحقیقات بهداشت روان، دانشکده علوم رفتاری و سلامت روان - انستیتو روانپزشکی تهران. ایران امیرحسین جلالی ندوشن Amir Hossein Jalali دانشگاه علوم پزشکی و خدمات بهداشتی- درمانی ایران. مرکز تحقیقات بهداشت روان، دانشکده علوم رفتاری و سلامت روان - انستیتو روانپزشکی تهران. ایران مهرداد افتخار Mehrdad Eftekhar دانشگاه علوم پزشکی و خدمات بهداشتی- درمانی ایران. مرکز تحقیقات بهداشت روان. تهران، خیابان ستارخان، خیابان نیایش، خیابان شهید منصوری، دانشکده علوم رفتاری و سلامت روان - انستیتو روانپزشکی تهران. دورنگار: 66506862-021 ایران E-mail: mehrdad.eftekhar@gmail.com : gender identity disorder gender dysphoria sexual orientation homosexuality اختلال هویت جنسی؛ ملال جنسیتی؛ گرایش جنسی؛ هم‌جنس‌گرایی 1.American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revised (DSM-IV-TR). Washington DC: American Psychiatry Association; 2000.##2.Benjamin H. The Transsexual phenomenon. New York: The Julian Press; 1966.##3.Bentler PM. Atypology of transsexualism: Gender identity theory and data. Arch Sex Behav. 1976; 5(6):567-84.##4.Blanchard R. Typology of male-to-female transsexualism. Arch Sex Behav. 1985; 14(3):247-61. ##5.Blanchard R, Clemmensen LH, Steiner BW. Heterosexual and homosexual gender dysphoria. Arch Sex Behav. 1987; 16(2):139-52. ##6.Blanchard R. Nonhomosexual gender dysphoria. J Sex Res. 1988; 24(1):188-93. ##7.Blanchard R. The concept of autogynecophilia and the typology of male gender dysphoria. J Nerv Ment Dis. 1989; 177(10):616-23. ##8.Blanchard R. The classification and labeling of nonhomosexual gender dysphorias. Arch Sex Behav. 1989; 18(4):315-34.##9.American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition (DSM-III). Washington DC: American Psychiatry Association; 1980.##10.American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition, Revised (DSM-III-R). Washington DC: American Psychiatry Association; 1987.##11.Green R. Gender identity disorders. In: Sadock JS, Sadock VA, Ruiz P. editors. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Baltimore MD: Lippincott Williams & Wilkins; 2009. ##12.De Cuypere G, Janes C, Rubens R. Psychosocial functioning of transsexuals in Belgium. Acta Psychiatr Scand. 1995; 91(3):180-4.##13.Lawrence AA. Sexuality before and after male-to-female sex reassignment surgery. Arch Sex Behav. 2005; 34(2):147-66.##14.Schroder M, Carroll R. Sexological outcomes of gender reassignment surgery. J Sex Educ Ther. 1999; 24(3): 137-46. ##15.Mehrabi F. Study of some of characteristics of Iranian patients with transsexualism. Iran J Psychiatry Clin Psychol. 1996; 2(3):6-12. [Persian]##16.Ahmadzad-Asl M, Jalali AH, Alavi K, Naserbakht M, Taban M, Mohseninia-Omrani K, et al. The epidemiology of transsexualism in Iran. J Gay Lesbian Ment Health. 2010; 15(1):83-93.##17.Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2008 national survey of family growth. Natl Health Stat Report. 2011; 36:1-36. ##18.Drescher J, Byne W. Homosexuality, gay and lesbian identity and homosexual behavior. In: Sadock JS, Sadock VA, Ruiz P. editors. Kaplan & Sadock’s comprehensive textbook of psychiatry. 9th ed. Baltimore MD: Lippincott Williams & Wilkins; 2009. ##19.Docter RF, Fleming JS. Measures of transgender behavior. Arch Sex Behav. 2001; 30(3):255-71.##1. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revised (DSM-IV-TR). Washington DC: American Psychiatry Association; 2000.##2. Benjamin H. The Transsexual phenomenon. New York: The Julian Press; 1966.##3. Bentler PM. Atypology of transsexualism: Gender identity theory and data. Arch Sex Behav. 1976; 5(6):567-84.##4. Blanchard R. Typology of male-to-female transsexualism. Arch Sex Behav. 1985; 14(3):247-61. ## ##5. Blanchard R, Clemmensen LH, Steiner BW. Heterosexual and homosexual gender dysphoria. Arch Sex Behav. 1987; 16(2):139-52. ##6. Blanchard R. Nonhomosexual gender dysphoria. J Sex Res. 1988; 24(1):188-93. ##7. Blanchard R. The concept of autogynecophilia and the typology of male gender dysphoria. J Nerv Ment Dis. 1989; 177(10):616-23. ##8. Blanchard R. The classification and labeling of nonhomosexual gender dysphorias. Arch Sex Behav. 1989; 18(4):315-34.##9. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition (DSM-III). Washington DC: American Psychiatry Association; 1980.##10. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition, Revised (DSM-III-R). Washington DC: American Psychiatry Association; 1987.##11. Green R. Gender identity disorders. In: Sadock JS, Sadock VA, Ruiz P. editors. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Baltimore MD: Lippincott Williams & Wilkins; 2009. ##12. De Cuypere G, Janes C, Rubens R. Psychosocial functioning of transsexuals in Belgium. Acta Psychiatr Scand. 1995; 91(3):180-4.##13. Lawrence AA. Sexuality before and after male-to-female sex reassignment surgery. Arch Sex Behav. 2005; 34(2):147-66.##14. Schroder M, Carroll R. Sexological outcomes of gender reassignment surgery. J Sex Educ Ther. 1999; 24(3): 137-46. ##15. Mehrabi F. Study of some of characteristics of Iranian patients with transsexualism. Iran J Psychiatry Clin Psychol. 1996; 2(3):6-12. [Persian]##16. Ahmadzad-Asl M, Jalali AH, Alavi K, Naserbakht M, Taban M, Mohseninia-Omrani K, et al. The epidemiology of transsexualism in Iran. J Gay Lesbian Ment Health. 2010; 15(1):83-93.##17. Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2008 national survey of family growth. Natl Health Stat Report. 2011; 36:1-36. ##18. Drescher J, Byne W. Homosexuality, gay and lesbian identity and homosexual behavior. In: Sadock JS, Sadock VA, Ruiz P. editors. Kaplan & Sadock’s comprehensive textbook of psychiatry. 9th ed. Baltimore MD: Lippincott Williams & Wilkins; 2009. ##19. Docter RF, Fleming JS. Measures of transgender behavior. Arch Sex Behav. 2001; 30(3):255-71.## ## ##

اجرای پایلوت دستورالعمل مراقبت و رفتار با کودک و نوجوان در مرکز روانپزشکی اطفال بیمارستان امام حسین (ع) Pilot Implementation of the Code of Conduct for Children and Adolescents in Child Psychiatric Department of Imam Hossein Hospital 1 1  هدف : هدف پژوهش حاضر اجرای آزمایشی دستورالعمل مراقبت و رفتار با کودک و نوجوان در یک مرکز درمانی روانپزشکی کودک و نوجوان بود. روش : پژوهش نیمه‌آزمایشی و آینده‌نگر حاضر در بخش و درمانگاه روانپزشکی کودک و نوجوان بیمارستان امام حسین (ع) تهران در دو فاز شش ماهه انجام شد. فاز اول شامل راهبرد‌های اجرایی- آموزشی و پژوهشی بود و در فاز دوم دستورالعمل مراقبت و رفتار با کودک و نوجوان در بخش و درمانگاه روانپزشکی اجرا شد. آزمودنی‌ها، والدین کودکان مراجعه‌کننده به بخش و درمانگاه روانپزشکی کودک بودند. پرسشنامه مورد استفاده از دستورالعمل مراقبت و رفتار با کودک/ نوجوان استخراج و توسط والدین تکمیل شد. در فاز نخست و پیش از انجام هر گونه مداخله، پرسشنامه‌های پیش‌آزمون و پس از اجرای آزمایشی دستورالعمل، پرسشنامه‌های پس‌آزمون تکمیل شدند. تعداد نمونه‌های پیش‌آزمون (و پس‌آزمون) بخش و درمانگاه به‌ترتیب 33 (24) و 60 (56) نفر بود. داده‌ها با مجذور خی و آزمون t مستقل و وابسته تحلیل شدند. یافته‌ها : آزمودنی‌های مراجعه‌کننده به بخش روانپزشکی در دو مرحله پیش‌آزمون و پس‌آزمون در دریافت کتابچه‌های آموزشی و اطلاع‌رسانی تفاوت معنی‌دار داشتند (001/0 p< ) ولی میزان رضایت از وضعیت رفاهی و امکانات بخش تغییری نداشت. در درمانگاه، میزان رضایت مراجعان از نحوه ارتباط کارکنان (01/0 p= ) و نیز رضایت از وضعیت رفاهی و امکانات درمانگاه (001/0 p< ) در مرحله پس‌آزمون نسبت به مرحله پیش‌آزمون افزایش داشت. نتیجه‌گیری : تغییرات ساده‌ای مانند بهبود شرایط فیزیکی و امکانات رفاهی و اطلاع‌رسانی به مراجعان می‌تواند باعث افزایش رضایت مراجعان شود. اما مواردی مانند تغییر رفتار و شیوه برخورد و ارتباط کارکنان با مراجعان نیاز به زمان طولانی‌تر، آموزش، تمرین و ممارست بیشتری دارد. 2   Objectives : The aim of this study was to pilot implementation of the code of conduct for the children and adolescents in a child and adolescent psychiatric center. Method: The present quasi-experimental and prospective study was carried out in child psychiatric ward and clinic of Imam Hossien Hospital, Tehran, Iran, in two six-month phases. The first phase included the research executive-educational strategy and during the second phase the code of conduct for the children and adolescents was implemented in the psychiatric ward and clinic. The subjects were parents of children referred to child psychiatry clinic and ward. The used questionnaire was extracted from the code of conduct for the children/ adolescents and completed by the parents. Pretest questionnaires were filled out in the first phase and prior to any intervention, and posttest questionnaires after pilot implementation of the guideline. The number of pretest (and posttest) subjects in the ward and clinic were 33 (24) and 60 (56), respectively. The data was analyzed using Chi-square and dependent and independent t-tests. Results: There was significant difference between pretest and posttest scores of the subjects referred to psychiatric ward in receiving instructive and informative booklets (p<0.001), but there was no change in the level of satisfaction for the physical conditions and facilities of the ward. In the clinic, the level of satisfaction of clients with the staffs communication behavior (p<0.01), and with the clinic conditions and facilities (p<0.001) increased in the posttest compared to the pretest. Conclusion: Some simple changes such as improving the physical conditions and facilities, and information services could increase the clients’ satisfaction. Nonetheless, changes like modifying the staff behavior, and their interaction and communication with the clients require more time, training, practice, and rehearsal . 50 62 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/26 1393/5/4 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/26 1393/5/4 فریبا عربگل Fariba Arabgol دانشگاه علوم پزشکی شهید بهشتی، گروه روانپزشکی، مرکز تحقیقات علوم رفتاری. تهران، خیابان شهید مدنی، بیمارستان امام حسین (ع)، مجموعه روانپزشکی، دورنگار: 77551023-021 ایران E-mail:farabgol@sbmu.ac.ir مژگان خادمی Mojgan Khademi دانشگاه علوم پزشکی شهید بهشتی، مرکز تحقیقات علوم رفتاری ایران سید سعید صدر Saeed Sadr دانشگاه علوم پزشکی شهید بهشتی، مرکز تحقیقات علوم رفتاری ایران نجمه خسروان مهر Najmeh Khosravan mehr دانشگاه علوم پزشکی شهید بهشتی ایران هما مذهب دار Homa Mazhabdar دانشگاه علوم پزشکی شهید بهشتی ایران احمد حاجبی Ahmad Hajebi دانشگاه علوم پزشکی ایران، مرکز تحقیقات بهداشت روان، دانشکده علوم رفتاری و سلامت روان- انستیتو روانپزشکی تهران. ایران code of conduct code of ethics children and adolescents psychiatric ward دستورالعمل رفتاری؛ دستورالعمل اخلاقی؛ کودک و نوجوان؛ بخش روانپزشکی 1. LaDou J, Tennenhouse DJ, Feitshans IL. Codes of ethics (conduct). Occup Med. 2002; 17(4):559-85.##2. Foà V. The ICOH international code of ethics for occupational health professionals. G Ital Med Lav Ergon. 2010; 32(4 Suppl):68-70.##3. Stievano A, De Marinis MG, Kelly D, Filkins J, Meyenburg-Altwarg I, Petrangeli M, et al. A proto-code of ethics and conduct for European nurse directors. Nurs Ethics. 2012; 19(2):279-88. ##4. Lagan C, Wehbe-Janek H, Waldo K, Fox A, Jo C, Rahm M. Evaluation of an interprofessional clinician-patient communication workshop utilizing standardized patient methodology. J Surg Educ. 2013; 70(1):95-103.##5. American Psychological Association. Ethical principles of psychologists and code of conduct. Adopted 2002 with Amendment 2010. Available from: http://www.apa.org/ethics/code/principles.pdf. Accessed Feb 9, 2013.##6. Southall DP, Burr S, Smith RD, Bull DN, Radford A, Williams A, Nicholson S. The Child friendly healthcare initiative (CFHI): Healthcare provision in accordance with the UN convention on the right of the child and adolescent health and development of the world health organization (WHO). Royal College of Nursing (UK). Royal College of Paediatrics and Child Health (UK). United Nations Children\'s Fund (UNICEF). Pediatrics. 2000; 106(5):1054-64.##7. The Lucile Packard children’s hospital and Stanford hospital and clinics code of conduct. 2011. Available from:http://stanfordhospital.org/overview/assets/SOM-Code-of-Conduct%2026July11.pdf. Accessed Feb 9, 2013.##8. The code of conduct, children’s hospital Boston. 2011. Available from: http://www.childrenshospital.org/about/ Site1394/Documents/code_of_conduct.pdf.Accessed Feb 9, 2013.##9. Code of conduct 2012 eddition, university hospitals. 2012. available from: http://www.uhhospitals.org/about/ mission-and-vision/code-of-conduct. Accessed Feb 7, 2013.##10. The children’s hospital of Philadelphia: Compliance standards of conduct. 2012. available from: http:// www.chop.edu/export/download/pdfs/articles/setting_standard_for_chop.pdf. Accessed Feb 7, 2013. ##11. Code of ethics for child welfare professionals. 2010. Available from: http://www.state.il.us/DCFS/docs/Code- Ethics.pdf. Accessed Feb 7, 2013.##12. Children’s hospital Colorado code of conduct january 2013. Available from: http://www.childrenscolorado. org/pdf/Code%20of%20Conduct_January%202013.pdf. Accessed Feb 5, 2013.##13. Arabgol F. Code of conduct guideline for children and adolescents in child medical centers. Mental and social health administration of the ministry of health & medical education (MoHME) and UNICEF. Tehran: ministry of health & medical education; 2008. [In Persian]##14. Biering P. Child and adolescent experience of and satisfaction with psychiatric care: A critical review of the research literature. J Psychiatr Ment Health Nurs. 2010; 17(1):65-72.##15. Puri N, Gupta A, Aggarwal AK, Kaushal V. Outpatient satisfaction and quality of health care in North Indian medical institute. Int J Health Care Qual Assur. 2012; 25(8):682-97.##16. Kaplan S, Busner J, Chibnall J, Kang G. Consumer satisfaction at a child and adolescent state psychiatric hospital. Psychiatr Serv. 2001; 52(2):202-6.##17. Sherman-Bien SA, Malcarne VL, Roesch S, Varni JW, Katz ER. Quantifying the relationship among hospital ##design, satisfaction, and psychosocial functioning in a pediatric hematology-oncology inpatient unit. HERD. 2011; 4(4):34-59.##18. Kotzer AM, Zacharakis SK, Raynolds M, Buenning F. Evaluation of the built environment: Staff and family satisfaction pre- and post-occupancy of the children\'s hospital. HERD. 2011; 4(4):60-78.##19. Marriage K, Petrie J, Worling D. Consumer satisfaction with an adolescent inpatient psychiatric unit. Can J Psychiatry. 2001; 46(10):969-75.##20. Magaret ND, Clark TA, Warden CR, Magnusson AR, Hedges JR. Patient satisfaction in the emergency department. A survey of pediatric patients and their parents. Acad Emerg Med. 2002; 9(12):1379-88.##21. Bhargava A, Thakur A, Mishra B, Taneja J, Dogra V, Loomba P. Patient satisfaction survey of microbiological tests done in G.B. Pant Hospital. Int J Health Care Qual Assur. 2012; 25(7):555-64.##22. Martin D, Lange K, Sima A, Kownatka D, Skovlund S, Danne T, et al. Recommendations for age-appropriate education of children and adolescents with diabetes and their parents in the European Union. Pediatr Diabetes. 2012; 13(Suppl 16):20-8. ##23. Lambert V, Coad J, Hicks P, Glacken M. Social spaces for young children in hospital. Child Care Health Dev [Internet]. 2013 Jan 7: DOI: 10.1111/cch.12016. Available from:http://onlinelibrary.wiley.com/doi/10.1111/cch.12016/full## ##

عوامل خطر و محافظت‌کننده در استعداد اعتیاد دانشجویان استان آذربایجان غربی Risk and Protective Factors in West Azerbaijan Province Students Addiction Susceptibility 1 1 هدف : بررسی عوامل خطر و محافظت‌کننده در استعداد اعتیاد دانشجویان هدف پژوهش حاضر بود. روش : ‌ از میان جامعه هدف (دانشجویان دختر و پسر دوره کاردانی و کارشناسی دانشگاه‌های آزاد اسلامی استان آذربایجان غربی با دامنه سنی 41-18 سال)، 592 نفر به روش نمونه‌گیری تصادفی خوشه‌ای از دانشگاه‌های‌ آزاد اسلامی ارومیه، خوی، ماکو، مهاباد و بوکان برحسب جنسیت، رشته و سال تحصیلی انتخاب شدند. داده‌ها به‌وسیله پرسشنامه استعداد اعتیاد، نسخه دانشجویان ( ASQ-SV ) گردآوری و به روش تحلیل واریانس یک طرفه و تحلیل مسیر تجزیه و تحلیل شدند. یافته‌ها : استعداد اعتیاد در دانشجویان پسر بیشتر از دختر، مجرد بیشتر از متأهل، سال‌های‌ تحصیلی بالاتر بیشتر از سال‌های پایین‌تر و مصرف‌کنندگان دایمی و گاه‌گدار سیگار بیشتر از غیرسیگاری‌ها و در گروه­های مختلف آموزشی یکسان بود. اشتغال مادر به‌طور غیرمستقیم با افزایش پیشرفت تحصیلی دانشجویان موجب کاهش استعداد اعتیاد آنان شده، اما به‌طور مستقیم در افزایش و کاهش وضعیت تحصیلی و استعداد اعتیاد تأثیری نداشت. تعداد دوستان در افزایش و کاهش پیشرفت تحصیلی تأثیری نداشت، اما به‌طور مستقیم و غیرمستقیم با افزایش وضعیت نامطلوب تحصیلی، افزایش استعداد اعتیاد را در پی داشت. نتیجه‌گیری : پیشرفت تحصیلی، وضعیت مطلوب تحصیلی، تعداد اندک دوستان، عدم مصرف سیگار و اشتغال مادر عوامل محفاظت‌کننده و مرد بودن، تجرد، افت تحصیلی، وضعیت نامطلوب تحصیلی، تعدد دوستان و مصرف دایمی یا گاه‌گدار سیگار از عوامل خطر برای استعداد اعتیاد محسوب می‌شود. 2 Objectives: The purpose of this study was to investigate the risk and protective factors of youth addiction susceptibility. Method: From target population-associate’s degree and undergraduate male and female students from Islamic Azad University branches in West Azerbaijan province aged 18 to 41 years- 592 students were chosen using cluster random sampling method from Islamic Azad University branches in Uremia, Khoy, Mako, Mahabad and Bokan based on sex, course of study, and academic grade. Data was gathered through Addiction Susceptibility Questionnaire-Student Version (ASQ-SV) and analyzed using one way analysis of variance and path analysis. Results: The addiction susceptibility in male students was more than the females’, single more than the married, higher academic grades more than the lower grades, regular and sporadic users more than non-users of cigarettes, and the same in different educational groups. Mother employment with increasing the students' academic achievement indirectly decreased their addiction susceptibility, but directly was ineffective to the increase and decrease of student academic status and addiction susceptibility. The number of friends did not affect the increase and decrease of academic achievement, but directly and indirectly increased their addiction susceptibility with increasing the unfavorable academic status. Conclusion: The academic achievement, favorable academic status, few friends, nonsmoking and employed mothers were considered as protective factors and being male, single, academic drop, unfavorable academic status, the number of friends, and regular or sporadic smoking as the risk factors for addiction susceptibility. 63 73 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/262014/07/23 1393/5/1 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/262014/07/23 1393/5/1 علی زینالی Ali Zeinali دانشگاه آزاد اسلامی خوی. خوی، بلوار ولایت فقیه، دانشگاه آزاد اسلامی واحد خوی. دورنگار: 2550026-0461 ایران E-mail: zeinali@iaukhoy.ac.ir addiction susceptibility risk factors protective factors students استعداد اعتیاد؛ عوامل خطر؛ عوامل محافظت‌کننده؛ جوانان 1. Palmer RHC, Young SE, Hopfer CJ, Corley RP, Stallings MC, Crowley TJ, et al. Developmental epidemiology of drug use and abuse in adolescence and young adulthood: Evidence of generalized risk. Drug Alcohol Depend. 2009; 102(1-3):78–87.##2. Young SE, Corley RP, Stallings MC, Rhee SH, Crowley TJ, Hewitt JK. Substance use, abuse and dependence in adolescence: prevalence, symptom profiles and correlates. Drug Alcohol Depend. 2002; 68(3): 309–22.##3. Agatsuma S, Hiroi N. Genetic basis of drug dependence and comorbid behavioral traits. Nihon Shinkei SeishinYakurigaku Zasshi. 2004; 24(3):137-45. ##4. Hiroi N, Agatsuma S. Genetic susceptibility to substance dependence. J Mol Psychol. 2005; 10(4):336-44.##5. Gendreau P, Gendreau LP. The addiction-prone personality: A study of Canadian heroin addicts. Can J Behav Sci. 1970; 2(1):18-25.##6. Lettieri DJ, Sayers M, Pearson HW. Theories on drug abuse, selected contemporary perspectives. U.S, Washington, D.C: NIDA Research Monograph; 1980.##7. Barnes GE, Murray RP, Patton D, Bentler PM, Anderson RE. The addiction-prone personality. In: Kaplan HB, Gottfried AE, Gottfried AW, editors. Longitudinal research in the social and behavioural sciences. New York: Kluwer Academic/Plenum Publishers; 2000. p. 1-320. ##8. Franke P, Neef D, Weiffenbach O, Gansicke M, Hautzinger M, Maier W. Psychiatric comorbidity in risk groups of opioid addiction: A comparison between opioid dependent and non-opioid dependent prisoners (in jail due to the German narcotics law). Fortschr Neurol Psychiatr. 2003; 71(1):37-44.##9. Zeinali A, Wahdat R, Eisavi M. Pre-addiction susceptibility backgrounds in recovered drug users. Iran J Psychiatry Clin Psychol. 2008; 14(1): 71-9. [Persian]##10. Zeinali A, Sharif, H, Enayati M, Asgari P, Pasha G. The mediational pathway among parenting styles, attachment styles and self-regulation with addiction susceptibility of adolescents. J Res Med Sci. 2011; 16(9):1105-21. ##11. Vahdat R, Zeinali A. Epidemiology of addiction susceptibility in Iran high school adolescent. Final Report of research. Tehran: University of Social Welfare and Rehabilitation; 2005. [Persian]##12. Zeinali A. Etiological study of personal backgrounds in Recovered drug users. Final report of research. Tehran: University of Social Welfare and Rehabilitation; 2005. [Persian]##13. Weinstein ND. Testing four competing theories of ##health-protective behavior. Health Psychol. 1993, 12(4): 324-333.##14. Krumm-Merabet C, Meyer TD. Leisure activities, alcohol, and nicotine consumption in people with a hypomanic/ hyperthymic temperament. Pers Indiv Differ. 2005; 38: 701-712.##15. Chen K, Sheth AJ, Elliott DK, Yeager A. Prevalence and correlates of past-year substance use, abuse, and dependence in a suburban community sample of high-school students. Addict Behav. 2004; 29: 413-423.##16. Farjad M, Behravesh H, Vajdi N. Addiction, understanding the causes, symptoms and Non-pharmacologic treatments of addiction. Tehran: Badr Publication; 1995. [Persian]##17. Harrison PA, Fulkerson JA, Beebe TJ. DSM-IV substance use disorder criteria for adolescents: A critical examination based on a statewide school survey. Am J Psychiatry. 1998; 155(4):486–92.##18. Simons-Morton B, Haynie DL, Crump A, Eitel P, Saylor KE. Peer and parent influences on smoking and drinking among early adolescents. Health Educ Behav. 2001, 28(1):95-107.##19. Cho H, Hallfors DD, Iritani BJ. Early initiation of substance use and subsequent risk factors related to suicide among urban high school students. Addict Behav. 2007; 32(8):1628–39.##20. Rohde P, Lewinsohn PM, Brown RA, Gau JM, Kahler CW. Psychiatric disorders, familial factors and cigarette smoking: Associations with smoking initiation. Nicotine Tob Res. 2003; 5(1):85−98.##21. Botvin GJ, Griffin KW. Life skills training as a primary prevention approach for adolescent drug abuse and other problem behaviors. Int J Emerg Ment Health. 2002; 4(1):41-7.##22. Mohammadpoorasl A, Fakhari A, Rostami F, Vahidi R. Predicting the initiation of substance abuse in Iranian adolescents. Addict Behav. 2007; 32(12):3153-9. ##23. Vahdat R. Study of addiction potential in Urmia high school students based on APS scale. [dissertation]. [Rodehen]: Islamic Azad University, Rodehen Branch; 2005. [Persian]##24. Berk LE. Development through the lifespan. 5th ed. Boston, MA: Pearson/Allyn and Bacon; 2009. ##25. Emmelkamp PM, Heeres H. Drug addiction and parental rearing style. J Int Addict. 1988; 23(2):207-16.##26. Sharifi HP, Sharifi N. Research methods in the behavioral sciences. Tehran: Sokhan Publication; 2004. [Persian]##27. Zeinali, A; & Vahdat, R. The Construction and Validation of Addiction Susceptibility Questionnaire (ASQ). Procedia-Social and Behavioral Sciences, 2011, 30: 1742-1747.##28. Zeinali A. Development and validation of addiction susceptibility questionnaire- student version (ASQ-SV). J New Find Psychol. 2013; 25(7):85-99. [Persian]##29. Conrod PJ, Pihl RO, Stewart SH, Dongier M. Validation of a system of classifying female substance abusers on the basis of personality and motivational risk factors for substance abuse. Psychol Addict Behav. 2000; 14(3):243-56.##30. Ismail A, Seneviratne R, Newcombe P, Wanigaratne S. A Model of substance abuse risk adapting to the Sri Lankan context. Evaluation Rev. 2009; 33(1):83-97.##31. Woicik PB, Conrod PJ, Stewart SH, Pihl RO. The substance use risk profile scale: A scale measuring traits linked to reinforcement-specific substance use profiles. Addict Behav. 2009; 34(12):1042−55.##32. Krank M, Stewart SH, O\'Connor RM, Conrod PJ, Woicik PB, Wall AM. Structural, concurrent, and predictive validity of the substance use risk profile scale in early adolescence. Addict Behav. 2011; 36(1-2):37-46.##33. Zeinali A. Epidemiology of addiction susceptibility in students of West Azarbaijan Islamic Azad Universities. Final report of research [dissertation]. [Khoy]: Islamic Azad University, Khoy Branch; 2012. [Persian]##34. Williams FP, Mcshane MD. Criminological theory. London: Pritice-Hall; 1999.##35. Akbari Zardkhaneh S, Sohrabi F, Taraghijah S, Poorsharifi H, Taramian F, Peirovi H. Substance abuse among State university students in Iran. J Educ Psychol Stud. 2011; 7(12):1-22. [Persian]##36. Rosenhan D, Seligman M. Abnormal psychology. 3rd ed. New York: Norton; 1995.##37. Minooee M, Salehi M. Assessment of the scientific validity, reliability and normalization of APS, AAS and MAC-R tests for spotting vulnerable individuals exposed to drug abuse among the male high school students in the city of Tehran. Res Addict. 2003; 1(3):77-107. [Persian]##38. Kordmirza E, Azad H, Eskandari H. Normalization of addiction potential scale for spotting individuals exposed to drug abuse among students of Tehran universities. Res Addict. 2003; 1(2):47-80. [Persian]## ##

ویژگی‌های روانسنجی مقیاس سنجش جهانی دمانس رولاند (RUDAS) در نمونه‌ای از سالمندان ایرانی Psychometric Characteristics of the Rowland Universal Dementia Assessment Scale (RUDAS) in a Sample of Iranian Elderly 1 1 هدف: هدف پژوهش حاضر تعیین ویژگی‌های روانسنجی مقیاس سنجش جهانی دمانس رولاند (RUDAS) در نمونه‌ای از سالمندان ایرانی بود. روش: ابتدا با نمونه‌گیری در دسترس، 500 سالمند از دو مرکز، آسایشگاه سالمندان کهریزک (305 نفر) و کانون جهان‌دیدگان (195 نفر)، مورد بررسی قرار گرفتند. سپس 61 نفر دیگر نیز برای محاسبه پایایی بازآزمایی بررسی شدند. برای گردآوری داده‌ها افزون بر مقیاس سنجش جهانی دمانس رولاند (RUDAS)، معاینه مختصر وضعیت روانی (MMSE)، پرسشنامه آگاهی‌دهنده کاهش شناختی در پیری (IQCDE)، مقیاس افسردگی سالمندان (GDS) و پرسشنامه اروپایی پنج بعدی کیفیت زندگی (EuroQol-5D) به‌کار رفت. تجزیه و تحلیل داده‌ها به روش همبستگی پیرسون و تحلیل عامل اکتشافی و تأییدی انجام شد. یافته‌ها: یافته‌ها نشانگر همبستگی RUDAS با سایر ابزارها (001/0 p) و بنابراین برخورداری از روایی همگرا و افتراقی مناسب بود. پایایی بازآزمایی دوهفته‌ای و آلفای کرونباخ RUDAS به‌ترتیب 88/0 و 77/0 به‌دست آمد. نقطه برش، ویژگی و حساسیت این آزمون به‌ترتیب20، 79/0 و 86/0 بود. از سوی دیگر تحلیل عاملی RUDAS بیانگر اشباع آن از یک عامل بود. نتیجه‌گیری: RUDAS از ویژگی‌های روانسنجی مناسب برای کاربرد در جمعیت سالمندان ایرانی برخوردار است 2 Objectives: The purpose of this research was to investigate the psychometric characteristics of the Rowland Universal Dementia Assessment Scale (RUDAS) in a sample of Iranian elderly population. Method: Using convenience sampling, 500 elderly individuals were selected from two senior centers including Kahrizak Geriatric Nursing Home (n=305) and Jahan-Didegan Elderly Charity Foundation (n=195). Then, 61 other individuals were investigated for test–retest reliability evaluation. In addition to the RUDAS, data were collected through Mini Mental State Examination (MMSE), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Generic Depressed Scale (GDS), and European Quality of Life 5 Dimensions (EuroQul-5D). Data were analyzed was by Pearson correlation and exploratory and confirmatory factor analysis methods. Results: The findings indicates a signification correlation between the RUDAS and other scales (p0.001), and thus its appropriate convergent and discriminate validity. The 2-week test-retest reliability and Cronbach’s alpha for RUDAS were 0.88 and 0.77, respectively. The cut-off point, specificity and sensitivity were 20, 0.79, and 0.86, respectively. On the other hand, RUDAS factor analysis depicted its saturation for one factor. Conclusion: The RUDAS possess suitable psychometric characteristics to be used among Iranian elderly population. 74 84 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/262014/07/232014/08/12 1393/5/21 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/262014/07/232014/08/12 1393/5/21 سوسن سالاری Sousan Salari کاشمر، دانشگاه آزاد اسلامی، واحد کاشمر، باشگاه دانش‌پژوهان جوان. دورنگار: 55045-053282 ایران E-mail:salary.susan@yahoo.com محمدرضا شعیری Mohammad Reza Shaeiri دانشگاه شاهد ایران محمدعلی اصغری مقدم Mohammad Ali Asghari- Moghaddam دانشگاه شاهد ایران Rowland Universal Dementia Assessment scale (RUDAS) validity reliability elderly factor analysis مقیاس سنجش جهانی دمانس رولاند(RUDAS)؛ روایی؛ پایایی؛ سالمند؛ تحلیل عاملی 1. Foroughan M, Jafari Z, Shirinbayan PF, Barahani ZR, Rahgozar M. Standardization mini mental status examination (MMSE) in elderly in Tehran. J New Cogn Sci. 2009; 10(2):29-37. [Persian]##2. Statistical center of Iran. Excerpts census of population and housing census. Tehran: Statistical center of Iran Pub; 2006. [Persian]##3. Zanjani H.Opening speech In: Proceedings of aging. Tehran: Ketab Ashna Pub; 1999. [Persian]##4. Craik IM, Salthouse ST. The Handbook of aging and cognition, 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.##5. Dixon R, Backman L, Nilsson LG. New frontiers in cognitive aging. England: Oxford University Press; 2004.##6. Chop WC, Robnett HR. Gerontology for the health care from fissional. Philadelphia: FA Davis Company; 1999.##7. Kaplan H, Sadocks V. Handbook of Psychiatry Behavioral and Sciences-Clinical Psychiatry 3th ed.Tehran: Shahre ab pub; 2005 [Persian].##8. Walash D. Dementia care training manual for staff in nursing and residential settings. London: Jessica Kingsley Publishers; 2006.##9. Folstein MF, Folstin SE, MeHuge PR. Mini-mental: A practical method for grading the cognitive state of patient for the clinicians. J Psychiatry Res.1975; 12(3):189-98.##10. Escobar JI, Burnam A, Karno M, Forsythe A, Landsverk J, Golding JM. Use of the mini-mental state examination (MMSE) in a community population of mixed ethnicity. Cultural and linguistic artifacts. J Nerv Ment Dis. 1986; 174(10):607-14.##11. Fuld PA, Muramoto O, Blau A, Westbrook L, Katzman R. Cross-cultural and multi-ethnic dementia evaluation by mental status and memory testing. J Psychiatry Res. 1988; 24(4):511-9.##12. Copeland JR, Kelleher MJ, Kellett JM, Gourlay AJ, Gurland BJ, Fleiss JL, Sharpe L. A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: The geriatric mental state schedule-I. Development and reliability. J Psychol Med. 1976; 6(3):439-49.##13. Graves AB, Mortimer JA, Larson EB, Wenzlow A, Bowen JD, McCormick WC. Head circumference as a measure of cognitive reserve. Association with severity of impairment in Alzheimer\'s disease. Br J Psychiatry. 1996; 169(1):86-92.##14. Glosser G, Wolfe N, Albert ML, Lavine L, Steele JC, Calne DB, Schoenberg BS. Cross-cultural cognitive examination: Validation of a dementia screening instrument for neuro-epidemiological research. J Am Geriatr Soc. 1993; 41(9):931-9.##15. Hall KS, Gao S, Emsley CL, Ogunniyi AO, Morgan O, Hendrie HC. Community screening interview for dementia (CSI \'D\'); Performance in five disparate study sites. Int J Geriatr Psychiatry. 2000; 15(6):521-31.##16. Teng EL, Chui HC. The modified mini-mental state (3MS) examination. J Clin Psychiatry. 1987; 48(8): 314-8.##17. Teng EL, Hasegawa K, Homma A, Imai Y, Larson E, Graves A, et al. The cognitive abilities screening instrument (CASI): A practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr. 1994; 6(1):45-58.##18. Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999; 14(11):936-40.##19. Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke\'s cognitive examination revised (ACE-R): A brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry. 2006; 21(11):1078-85.##20. Burns A, Lawlor C. Assessment scales in old age psychiatry. 2nd ed. London: Inform a Healthcare; 2004.##21. Fratiglioni L, von Strauss E, QiuC X. Epidemiology of the dementia of old age. In: Jacoby R, Oppenheimer C, Dening T, Thomas A, editors. Oxford textbook of old age psychiatry. Oxford: Oxford University Press; 2008. P.391-406.##22. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968; 114(512):797-811.##23. Storey JE, Jeffrey TJ, Rowland DA, Conforti G, Hugh G, Dickson R. The Rowland universal dementia ##assessment scale (RUDAS): A multicultural cognitive assessment scale. Int Psychogeriatr. 2004; 16(1):13-31.##24. Iype T, Ajitha B K, Antony P, Ajeeth NB, Job S, Shaji KS. Usefulness of the Rowland universal dementia assessment scale in South India. J Neurol Neurosurg Psychiatry. 2006; 77(4):513-4. ##25. Rowland JT, Basic D, Storey JE, Conforti DA. The Rowland universal dementia assessment scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. Int Psychogeriatr. 2006; 18(1):111-20.##26. Jacova C, Kertesz A, Blair M, Fisk JD, Feldman HH. Neuropsychological testing and assessment for dementia. Alzheimers Dement. 2007; 3(4):299-317.##27. Basic D, Khoo A, Conforti D, Rowland J, Vrantsidis F, Logiudice D, et al. Rowland universal dementia assessment scale, mini-mental state examination and general practitioner assessment of cognition in a multicultural cohort of community-dwelling older persons with early dementia. Aust Psychol. 2009; 44(1):40-53.##28. Pang J, Yu H, Pearson K, Lynch P, Fong C. Comparison of the MMSE and RUDAS cognitive screening tools in an elderly inpatient population in everyday clinical use. Intern Med J. 2009; 39(6):411-4.##29. Ismail Z, Rajji TK, Shulman KI. Brief cognitive screening instruments: An update. Int J Geriatr Psychiatry. 2010; 25(2):111-20.##30. Wong L, Martin-Khan M, Rowland J, Varghese P, Gray LC. The Rowland universal dementia assessment scale (RUDAS) as a reliable screening tool for dementia when administered via videoconferencing in elderly post-acute hospital patients. J Telemed Telecare. 2012; 18(3):176-9.##31. Beers MH, Berkow R. Aging and mental health. In: The Merck manual of geriatrics.3th ed. USA: Merk; 2000. P.307-10.##32. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiatr Res. 1982-1983; 17(1):37-49.##33. Malakouti K, Fathollah C, Mirabzadeh A, Salavati M, Khany SH. Standardization of geriatric depression scale (GDS); Form of 15 questions in Iranian. Int J Geriatr Psychiatry. 2006; 21(6):588-93.##34. Kral VA. The relationship between senile dementia##(Alzheimer type) and depression. Can J Psychiatry. 1983; 28(4):304-6.##35. Emery V. Pseudo dementia: A theoretical and empirical discussion. Cleveland OH: Case Western Reserve Geriatric Education Center; 1988.##36. Jorm AF, Jacomb PA. The informant questionnaire on cognitive decline in the elderly (IQCDE): Socio-demographic correlates, reliability, validity and some norms. Psychol Med. 1989; 19(4):1015-22.##37. Allain TJ, Wilson AO, Gomo ZA, Adamchak DJ, Matenga JA. Abbreviated mental test (AMT) in the elderly: Shortcoming of an adapted AMT in Zimbabwe. Cent Afr J Med. 1996; 42(4):98-101.##38. Safarzadeh A. preparation and preliminary application of the mini-scale dimension five quality of life (EuroQol). [dissertation]. [Tehran]: Shahed University; 2009. 210p. [Persian]##39. Ghorbani A. Nurse-surgical, geriatric health care. Tehran: Tabligh Bashari Pub; 1996. [Persian]##40. McClane KS. Screening instruments for use in a complete geriatric assessment. Clin Nurse Spec. 2006; 20(4):201-7.##41. Ruby C, Castilla P, Miguel E, Habeych S. Subtypes of depression among patients with Alzheimer\'s disease and other dementias. J Alzheimer’s Dementia. 2010; 12(6):63-9.##42. Hirono N, Kitagaki H, Kazui H, Hashimoto M, Mori E. Impact of white matter changes on clinical manifestation of Alzheimer\'s disease: Quantitative study. J Stroke. 2000; 31(21):2182-8.##43. Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Latoussakis V, Kanellopoulos D, Klimstra S, et al. Micro structural white matter abnormalities and remission of geriatric depression. Am J Psychiatry. 2008; 165(2):238-44.##44. Chen R, Hu Z, Wei L, Qin X, McCracken C, Copeland JR. Severity of depression and risk for subsequent dementia: Cohort studies in China and the UK. Br J Psychiatry. 2008; 193(5):373-7.##45. Korczyn AD, Halperin I. Depression and dementia. J Neural Sci. 2009; 283(1-2):139-42.##46. Gilley DW, Wilson RS, Bienias JL, Bennett DA, Evans DA. Predictors of depressive symptoms in persons with AD. J Gerontology. 2004; 59(4):75-83.## ##

تاریخچه روانپزشکی در تبریز History of psychiatry in Tabriz 1 1 در این مقاله سرگذشت بیماران روانی در تبریز و پیشینه روانپزشکی در این شهر مرور شده است و نگاهی به تاریخچه روانپزشکی قدیم و نوین در تبریز  و سیر تکاملی آن دارد. در تاریخچه قدیم طب و روانپزشکی  در تبریز، نام دانشگاه ربع رشیدی و بیمارستان­ها و خدمات پزشکی آن قابل ذکر است. بزرگ­ترین بیمارستان در ایران در قرن هشتم هجری یا سیزدهم میلادی که مقارن با قرون وسطی در غرب بود، توسط خواجه رشید­الدین فضل­اله همدانی در شهر تبریز، پایتخت آن زمان امپراتوری بزرگ ایران در دانشگاه ربع رشیدی بنا نهاده شد و در آن مداوای بیماران از جمله بیماران روانی به طرز اخلاقی و با علم روز انجام می­شد؛ با این حال، متأسفانه فقط بیست سال دوام داشت و پس از قتل خواجه با خاک یکسان شد. بعد از آن تا زمان تأسیس دانشگاه تبریز در سال 1329 شمسی و دانشکده پزشکی و بخش روانپزشکی در سال 1331، وضع روانپزشکی و مراقبت بیماران دورانی بسیار نابسامان و آشفته را گذرانده است. 2 History of Psychiatry and Psychology 85 91 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/262014/07/232014/08/122014/07/26 1393/5/4 2014/08/132014/08/102014/07/272014/08/102014/07/232014/07/262014/07/232014/08/122014/07/26 1393/5/4 سید محمد علی قریشی‌زاده Seied Mohammad Ali Goreishizadeh دانشگاه علوم پزشکی تبریز. دورنگار: 3803351-0411 ایران E-mail:goreishm@tbzmed.ac.ir History psychiatry Tabriz تاریخچه روانپزشکی تبریز 1. Tabriz university publications. Forty-year history of Tabriz University: 1947 to 1987. Tabriz: Tabriz University Publications; 1987. [Persian]##2. Irantoorism. akairan. Iranshenasi-Irangardi. Azarbaijan-e-Sharghi. [Internet]. Tehran: AkaIran; 2013[updated 2013, March 31th, cited 2014 February 17th]. Available from: www. Irantoorism.akairan.com. [Persian]## ##3. Zaka Y. Tabriz earthquakes. Tehran: Kavian; 1980. [Persian]##4. Sardarinia S, Baghcheban J. The most famous people of Azarbaijan. 2nded. Tabriz: Shaieste Publication; 2000. [Persian]##5. Omrani B, Esmaeily Sangary H. Historical area of Tabriz. Tabriz: Miras Book; 2006. [Persian]##6. Tabriz University. About university. Introduction & history [Internet]. Tabriz: Tabriz University. [updated 2010 June 19th, cited 2014 February 17th]. Available from: www.tabrizu.ac.ir. [Persian]##7. Raeisnia R. Azarbaijan through the history of Iran. Tabriz: Nima Publications; 1991. [Persian]##8. Khanloo M. Ancient Tabriz: Very old days up to now. Tabriz: Talash Tabriz; 1987. [Persian]##9. Encyclopaedia Islamica Foundation. Hospital. [Internet]. Tehran: Encyclopaedia Islamica Foundation; 2011. [updated 2011 September 28th, cited 2014 February 19th]. Available from: Encyclopaedia Islamica.com. index.php. [Persian]##10. Tabriz University of Medical Sciences. Health Care. Hospital & Clinics. Razi Hospital. Introduction & history. [Internet]. Tabriz: Tabriz University of Medical Sciences; 2011 [Updated 2011 October 7th, cited 2014 February 17th]. Available from: www:portal-en.tbzmed.ac.ir /#Hospitals & Clinics. [Persian] ## ##