Medication adherence and its relationship with self-esteem among patients with epilepsy in Isfahan, Iran

Medication adherence is of utmost importance in achieving the desired therapeutic outcome and effectively managing seizures in patients with epilepsy (PWE). It is imperative to recognize self-esteem as a psychological determinant that potentially influences the optimal compliance with anti-seizure medications (ASMs) among PWE. The objective of this study was to explore medication adherence and its relationship with self-esteem among individuals diagnosed with epilepsy in Isfahan, Iran.

METHODS

This descriptive-analytical study was conducted in the year 2021, encompassing a cohort of 250 PWE who were referred to designated medical facilities in Isfahan, Iran, and were selected by the consecutive sampling technique. A 3-part instrument including demographic components, the Rosenberg Self-Esteem Scale, and the Morissky Drug Adherence Questionnaire employed for data collection.

RESULTS

The mean and standard deviation of adherence to the medicinal regimen in the participants were 6.9 ± 2.02, and 46.4 % had a low level of adherence to the medication regimen (total score 0-6). At the same time, the mean and standard deviation of self-esteem in these patients was 5.11 ± 2.11. There was a statistically significant and direct correlation between adherence to the prescribed drug regimen and self-esteem (rs = 0.464, p = 0.00).

CONCLUSION

Based on the findings of the study that showed a statistically significant and positive correlation between self-esteem and adherence to the medication regimen, it is advisable to enhance and advocate for these factors in PWE.

How can healthcare providers involve with families in the care of patients with chronic mental illness? A mixed methods protocol study to adapt the clinical practice guideline

BACKGROUND

Chronic mental illnesses have long periods, are recurring, and require continuous care as well as an integrated and collaborative approach to organize the care. The purpose of this article is to summarize the most important steps necessary for adapting a clinical practice guideline for family-centered collaborative care of patients with chronic mental illnesses referring to the medical centers.

MATERIALS AND METHODS

As the study will be an exploratory mixed methods study, the design will be carried out as a sequential qualitative-quantitative study (QUAL quan), consisting of 3 phases, 9 modules, and 24 sequential steps, which is based on the Guidelines International Network to adapt the guideline manual. In the first phase, the prerequisites for adaptation of the clinical guideline were established. In the second phase, to collect evidence, a qualitative study (semi-structured interview) will be conducted to explore the dimensions and components of the care needs of patients with chronic mental disorders and their families from the perspectives of patients, caregivers, and healthcare providers. Additionally, a literature review to extract relevant clinical guidelines and articles will be done. A panel of experts will screen and evaluate potential clinical guidelines, and a draft guideline will be developed.

DISCUSSION

It is expected that these findings will meet the needs of patients with mental illness and their caregivers by providing integrated care and improving collaborative care within the sociocultural context of Iran.

Family-centered collaborative care for patients with chronic mental illness: A systematic review

Background

Chronic mental illnesses (CMI) are long lasting and reoccurring and require continuous care as well as an integrated and collaborative approach to organize the care. This study sought to examine whether family centered collaborative care is an acceptable treatment option for individuals with CMI.

Materials and Methods

From the years 2000 to 2021, ten electronic databases relating to family centered collaborative care for mental illness were searched adopting Preferred Reporting Items for Systematic Reviews and Meta Analysis checklist. Twenty seven relevant articles and a thesis from among 6956 studies retrieved, were assessed their quality appraisal through four standardized tools. The studies were rated as good, moderate, or poor. Studies were calibrated, different opinions were discussed, and extracted data were done.

Results

Evidence included 11 randomized controlled trials (from 19 articles), one randomized control trial, three mixed methods studies (from 3 articles and 1 thesis), and a qualitative study (from 4 articles). The quality of seven studies was good, 15 were moderate quality, and seven were poor quality. According to moderate to high quality qualitative research, family centered collaborative care was considered an acceptable intervention; though a few studies supported it.

Conclusion

The findings demonstrated that family involvement in the care of patients with CMI affects no recurrence of the disease, and no re hospitalization of patients with this disorder. As a result, engaging family members in the care process can have a positive impact on the health and well being of these patients.

The relationship between spiritual intelligence and resilience in family caregivers of patients with chronic mental disorders

PURPOSE

The aim of this study is to investigate the relationship between spiritual intelligence and resilience in family caregivers of patients with chronic mental disorders referred to psychiatric clinics in Isfahan (Iran).

DESIGN AND METHODS

This cross-sectional study was conducted on 188 family caregivers. Data were collected using demographic characteristics checklist, spiritual intelligence self-report inventory, and Connor-Davidson resilience scale.

FINDINGS

There was a significant and positive relationship between resilience and spiritual intelligence, including all its components, among the family caregivers (p < 0.05) PRACTICE IMPLICATIONS: Healthcare managers are recommended to consider the components of spiritual intelligence and resilience in designing preventive, educational, and personal promotion interventions for patients with mental disorders.

The Effect of a Spirituality-Based Program on Stress, Anxiety, and Depression of Caregivers of Patients with Mental Disorders in Iran

One of the important issues regarding caring for patients with mental disorders is the high prevalence of stress, anxiety, and depression in their caregivers. This study aimed to investigate the effect of a spirituality-based program on stress, anxiety, and depression of caregivers of patients with mental disorders. This clinical-trial study involved 60 family caregivers of patients with mental disorders who were referred to the clinic of Shahid Ayatollah Modarres Psychiatric Hospital in Isfahan, Iran, during 2019-2020. Accordingly, the samples were selected using convenient sampling method and then divided into two groups of experimental and control by simple random allocation. Next, the spirituality-based intervention was performed for the intervention group, and the needed data were collected in both intervention and control groups before, immediately after, and one month after the intervention. The data collection tool used in this study was DASS-21 questionnaire. No significant differences were observed between the two groups in terms of the mean scores of stress, anxiety, and depression (p > 0.05) before the intervention. However, some significant differences were found in terms of the stress, anxiety, and depression scores between the two groups immediately (p < 0.001) and one month after the intervention (p < 0.001). The spirituality-based program seemed to affect stress, anxiety, and depression of caregivers of patients with mental disorders positively. So, it is suggested to perform this intervention as an inexpensive and available supportive method for family caregivers of patients with mental disorders.

Barriers to family involvement in the care of patients with chronic mental illnesses: A qualitative study

INTRODUCTION

Caregivers are patients' family members or intimate friends who take care of individuals suffering from chronic mental illnesses without being paid. Evidence has supported the role of family-centered collaborative care in the treatment of patients with chronic mental illnesses. It has also been emphasized by national policies. However, carrying out this type of care is accompanied by challenges in Iran. Considering the importance of family participation in taking care of these patients as well as the necessity to determine its effective factors, the present study aimed to assess the barriers to family involvement in the care of patients with chronic mental illnesses.

METHOD

A conventional content analysis was used to conduct this qualitative study. Thirty four health care providers, patients, and caregivers were interviewed unstructured in-depth face-to-face using purposive sampling. Until saturation of data, sampling and data analysis were conducted simultaneously. Graneheim and Lundman's method was used to record, transcribe, and analyze the interviews.

RESULT

The results showed that there were many barriers to the collaboration of family in the care of patients with chronic mental illnesses. Accordingly, four main categories and twelve subcategories were extracted from the data as follows: "family-related barriers", "treatment-related factors", "disease nature threatening care", and "mental disease-associated stigma in the society".

CONCLUSION

The findings presented the barriers to family centers' collaborative care in patients with chronic mental illnesses and the necessary components of family involvement in the care to be used by healthcare managers and policymakers. The reported barriers emphasize the need for the development of structured approaches whose implementation is easy for health care providers, does not require a lot of time and resources, and can improve patient and family outcomes.

A quality assessment of clinical practice guidelines with recommendations for family involvement in the care of individuals diagnosed with schizophrenia, bipolar mood disorder, and major depressive disorder: Critical appraisal utilizing AGREE II

INTRODUCTION

Evidence suggests that family-center collaborative care is useful for individuals identified with chronic mental illness. Clinical practice guidelines offer specific recommendations primarily based on to be had studies and are beneficial in informing evidence-based practice and guiding destiny studies.

OBJECTIVE

Identify current scientific practice guidelines including family-center collaborative care suggestions for individuals with Bipolar Mood Disorder, Schizophrenia, and Major Depressive Disorder and analyze the selection of guidelines for their methodological quality.

METHODS

A systematic search was conducted on seven electronic databases (G-I-N), (NICE), (MOH), (SIGN), (WHO), (NIH) and (APA) and additional sources. Three referees independently reviewed articles and selected guidelines for inclusion criteria. Subsequently, 18 trained appraisers independently assessed all 15 guidelines using AGREE II.

RESULTS

The mean scores for domains and overall quality were computed. For the overall assessment of the guidelines, 60% reached the quality threshold with domain scores of 60%. The overall average quality rating for these guidelines was 58/29%.

CONCLUSION

The applicability of the guidelines needs to be improved in order to improve their relevance and clinical utilization. As individuals with chronic mental illnesses progress through their disease course, families and health care providers play a crucial role in helping them. The analysis of research knowledge on effective rehabilitation techniques, including the involvement of families in treatment, can be enhanced by using well-developed and appropriate methods.

Psycho-social experience of oocyte recipient women: a qualitative study

Background

Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The identification of these challenges during the treatment process is crucial to improve recipient mental health. Thus, the aim of this study was to gain an understanding of the experiences of oocyte recipient women.

Methods

This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation.

Results

Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial.

Conclusion

The results indicated that the process of treatment with donated oocyte is followed by the experiences of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women.

Plain English summary

Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The aim of this study was to gain an understanding of the experiences of oocyte recipient women. This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation. Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial. The results indicated that the process of treatment with donated oocyte is followed by experience of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women.

The effectiveness of bright light exposure in shift-worker nurses: A systematic review and meta-analysis

Bright light exposure is as one of the non-pharmacological measures to sleep management in shift-worker. This study was conducted to determine the effectiveness of bright light exposure in shift-worker nurses. We performed a systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and using existing literature in the following databases: Cochrane Library, Embase, PubMed, Scopus, Web of Science, to examine any eligible and relevant interventional (randomized controlled trial, experimental and quasi-experimental studies) which were published by December 31, 2018. The obtained documents were analyzed using Stata 14.1 and Cochrane Collaboration's RevMan 5.3. Five studies met eligibility criteria. Results from fixed-effect meta-analysis of the included studies revealed that the exposure could decrease the sleepiness levels, complaints related to shift-work, insomnia and increased the psychomotor error (95% confidence interval (CI): -0.87,-0.43, p=0.000, I²=98.6%), alertness and daytime sleep duration following night shifts (95% CI: 0.08,0.99, p=0.000, I²=92.7%). However, in the random effects model, none of them were statistically significant. Although the results of fixed-effect are in favor of beneficial effects of bright light exposure in shift-worker nurses, the random effects could not approve these findings. Maybe because of either large heterogeneity or insufficiency of the number of studies. Besides, because of the low number of studies, it was impossible to deal with high amount of heterogeneity using subgroup analysis or meta-regression. So the controversy on this topic continues to persist, which highlights the need for more well-designed randomized control trials with larger sample sizes in the future.

Psychological and Personality Characteristics of Applicants for Facial Cosmetic Surgery

OBJECTIVE

The aim of this study was to investigate the psychological and personality characteristics of the applicants for facial cosmetic surgery.

METHODS

This descriptive-analytical study was conducted on 385 facial cosmetic surgery applicants who referred to medical centers in Ahvaz (south Iran). The data collection tool included three questionnaires: (1) demographic questions, (2) the General Health Questionnaire (GHQ), and (3) the NEO Five-Factor Inventory (NEO-FFI).

RESULTS

The results showed that 45.2% of the participants had abnormal health status. The mean score of the participants on the openness subscale was insignificantly lower than that of the general population (p > 0.05). On the other hand, the mean scores of the participants on the conscientiousness and agreeableness subscales were significantly lower (p < 0.001). Finally, the mean score of the samples on the extroversion subscale was significantly higher than that of the general population (p < 0.001).

CONCLUSION

Given the results of the study, it is strongly recommended to address the personality and psychological characteristics of the applicants for cosmetic surgery before operating on them.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The effect of an emotional intelligence component program on happiness in patients with epilepsy

Emotional intelligence is a psychological component that may affect happiness level in patients with epilepsy. Given the high prevalence of depression in patients with epilepsy, as well as the limitations of studies in this regard in Iran, the aim of this study was to investigate the effect of an emotional intelligence component program on happiness in patients with epilepsy.

METHODS

This randomized clinical trial study conducted on 70 patients with epilepsy who were randomly divided into two experimental and control groups of 35 patients. Emotional Intelligence Training Based on Bar-On Combined Model was provided in eight 90-minute sessions for eight weeks. Data were collected using a two-part questionnaire: demographic data and the Oxford Happiness Questionnaire (OHQ).

RESULTS

The mean age of the subjects was 33.3 ± 10.4 years in the intervention group and 34.4 ± 9.3 years in the control group. The independent t-test results showed no significant difference between the two groups before the intervention (p = 0.195). The Mann-Whitney test results showed a significant difference between the two groups after emotional intelligence training (p < 0.001).

CONCLUSION

Overall, the findings of this study showed that emotional intelligence training led to improvement of happiness in patients with epilepsy. According to the results of the study, it is suggested that training based on emotional intelligence components be used as an approach to improve happiness level in patients with epilepsy.

A mental health program for infertile couples undergoing oocyte donation: protocol for a mixed methods study

Background

The psychological consequences of infertility in couples undergoing oocyte donation differ culturally, racially, religiously, and legally from other infertile couples undergoing assisted reproductive treatments. Therefore, the inclusion of a mental health program in assisted reproductive services is essential for these couples. As such, the aim of this study is to develop a program for improving the mental health of these couples.

Methods

This study is designed using an exploratory mixed method and the program based on Talbot and Verrinder model. Different steps of this research include determination of a specific topic for planning (needs assessment), initial design of the program, finalization of the program (using the views of experts in this area), implementation of the program, monitoring of the implementation of the program and evaluation of the program. To perform the first step of Talbot’s program, the first phase of the study will be conducted. At first, through a qualitative study, the items of the questionnaire are designed and then its psychometric steps will be performed by a cross-sectional study. In the second and third steps, the classic Delphi technique will be used in four-round for initiation and finalization of the program, and the second phase will be completed. The fourth, fifth and sixth steps of the program including implementation, monitoring of the implementation and evaluation of the program in the future will be performed.

Discussion

Designing an appropriate program based on the documentations of the qualitative study and evidence can improve the mental health and quality of life of the couples undergoing oocyte donation. The program, based on the measurement of needs, will be implemented using a tool designed specifically for the target population and can be useful in the processes of treatment, education, policymaking and legislation as well as research.

Stressors in open-heart surgery patients: A qualitative study

BACKGROUND

Open-heart surgery is a stressful experience for the patients and their families. From the moment that patients are told they must undergo surgery until discharge, they experience different degrees of worry and nervousness. This study was conducted with the aim of identifying stress factors in heart surgery patients.

METHODS

This study was performed using a qualitative method on 21 participants (14 patients and 7 caregivers). The research environment was open-heart surgery wards of two educational hospitals in Ahwaz (south of Iran) in 2017. The participants were selected through purposive sampling. The data were collected through semi-structured interviews, and then, analyzed using the qualitative approach of content analysis proposed by Graneheim and Lundmnan (2004).

RESULTS

The 5 themes of “physical stressors”, “self-care stressors”, “psychological stressors”, “religious stressors”, and “hospital stressors” were obtained. These themes were the result of the patients’ experiences and dimensions of patients’ perceptions regarding stressors in open-heart surgery.

CONCLUSION

Stress in patients undergoing open-heart surgery is a contextual and relative concept and a subjective experience, which is experienced as a sense of worry. Identifying and clarifying stressors in open-heart surgery patients for nurses is vital, like a key for improving care quality. Nursing managers in clinical practice can also benefit from these findings regarding heart surgery in improving the care quality and professional performance of nurses.

Correction to: Relationship Between Care Burden and Religious Beliefs Among Family Caregivers of Mentally Ill Patients

The original version of this article unfortunately contained a mistake in the author name. The co-author name should be Reza Masoudi instead of Reza Masoodi.

Relationship Between Care Burden and Religious Beliefs Among Family Caregivers of Mentally Ill Patients

Families are considered as primary sources of care for individuals suffering from mental disorders. However, one of the major stresses in families is the infliction of a family member with mental illnesses causing dysfunction in health dimensions or generally their quality of life. Currently, most experts believe that religion can affect physical health and other aspects of human life. So, the aim of this study was to investigate "the relationship between care burden and religious beliefs among family caregivers of mentally ill patients." This cross-sectional study was carried out in Iran on 152 families with mentally ill patients who were hospitalized in psychiatric wards. The sampling method was nonprobability and consecutive sampling method. The data collection instruments included a demographic characteristic questionnaire, Religious Beliefs, and Zarit Care Burden Questionnaires. The mean score for care burden was 30.99 (SD = 16.45). 5.9% of the participants reported a low level, and 39.5% experienced a moderate level of care burden. Moreover, the mean score for religious beliefs was 115.5 (SD = 13.49), and majority of the participants (70.4%) were endowed with strong religious beliefs. There were no significant associations between care burden and intensity of religious beliefs among the study samples (P = 0.483). Considering the results of this study indicating experience of moderate-to-high levels of care burden in families with mentally ill patients, it is recommended to consider such families and their religious beliefs as contributing factors in coping with challenges of mental disorders.

Coping strategies and their relationship with emotional intelligence in patients with epilepsy referred to Isfahan Epilepsy Society in 2017

INTRODUCTION

Epilepsy is a common neurological disorder, and the patients with epilepsy are heavily influenced by the psychological and social aspects of the illness. Therefore, patients try to use coping strategies to control their stress and tension in this situation. Given the importance of the issue of adaptation and coping with stress in patients with epilepsy, as well as the different factors affecting coping strategies in these patients, the present study aimed to investigate the relationship between coping strategies and emotional intelligence in patients with epilepsy.

METHODS

This descriptive-analytic study conducted on 134 male and female patients with epilepsy referred to the Epilepsy Society of Isfahan, Iran. The consecutive sampling method was applied in this study. The data collection tool included a three-section questionnaire: the Demographic information, the Coping Inventory for Stressful Situations (CISS), and the Bar-On Emotional Quotient Inventory (EQ-i).

RESULTS

The emotion-focused coping strategy was mostly used by 53.7% of the samples. The mean and standard deviation of the total score of emotional intelligence was 285.6 ± 39.5. Moreover, Pearson correlation test showed a significant difference between emotional intelligence variables and coping strategies (p < 0.001).

CONCLUSION

According to the relationship between emotional intelligence and coping strategies, it is suggested to consider ways to improve the emotional intelligence of patients with epilepsy in order to use more adaptive coping strategies.

Investigating the effect of multisensory stimulation on depression and anxiety of the elderly nursing home residents: A randomized controlled trial

PURPOSE

The aim was to determine the effect of multisensory stimulation (MSS) on the depression and anxiety status among nursing home-dwelling elderly people in Ahvaz, Iran.

DESIGN AND METHODS

This clinical trial study conducted on 28 old people living in nursing homes in Ahvaz, who were divided into two groups of intervention and control. The interventions included sensory stimulations of touch, sound, and sight for 4 weeks and 3 sessions weekly and 25 min per each session.

FINDINGS

The mean depression and anxiety scores of the intervention group before and after the intervention were 14.5 ± 5.5 and 10.1 ± 5.3 and, 9.6 ± 8.1 and 6.1 ± 6.2, respectively.

PRACTICE IMPLICATIONS

MSS could improve the condition of depression and anxiety in the elderly nursing home residents.

Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran

BACKGROUND

The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards.

DESIGN

A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data.

RESULTS

Four themes were developed based on the analysed data: "experiencing psycho-social challenges," "experiencing psychological challenges," "encountering catalysts causing challenges," and "employing various strategies for coping with challenges."

CONCLUSIONS

Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.

Commitment to care: the most important coping strategies among family caregivers of patients undergoing haemodialysis

BACKGROUND

Caregivers of patients undergoing haemodialysis often experience an intensive burden of care; therefore, it is important to understand the type of strategies that are used by caregivers to adapt and to commit themselves to caring for another individual.

AIM

The aim of this study was to explore the specific coping strategies used by family caregivers of patients undergoing haemodialysis.

METHODS

In this qualitative study, 16 family caregivers of patients undergoing haemodialysis were selected through purposive sampling in four dialysis centres in south of Iran. Semi-structured interviews were used to collect data. A content analysis of the interviews was performed to determine relevant themes.

RESULTS

Data analysis resulted in the emergence of four categories including 'cultural and religious constructs', 'sense of responsibility', 'self-restraint' and 'satisfactory caring', as whole of these categories are included in the main theme of 'commitment to care' which is experienced by the family caregivers during the care of patients undergoing haemodialysis.

CONCLUSIONS

This study demonstrates that coping strategies stemming from the cultural beliefs of caregivers are very salient in their commitment to care; thus, the health-care team, especially nurses, should encourage family caregivers to use these strategies to maintain their physical and psychological health and to provide quality care for patients.

Adherence to Medication Regimen in Patients with Severe and Chronic Psychiatric Disorders: A Qualitative Study

Nonadherence to treatment is common in patients with chronic psychiatric disorders. Few studies have been conducted in Iran on lack of adherence to medication regimen in patients with severe psychiatric disorders. The present study was carried out with the purpose of gaining insight into the experiences of patients, their family members, and nurses on the medication adherence in patients with severe and chronic psychiatric disorders in selected hospitals in Ahvaz, Iran. A qualitative content analysis study was used in the study and the participants included 7 nurses, 5 patients, and 4 family members. The patients were being treated in psychiatric wards of the hospitals of Ahvaz, in southern Iran. The results of data analysis revealed three main themes: 1) Intentional abandonment of medications; 2) Catalysts of medication discontinuation (including side effects, asymptomatic periods, lack of knowledge of family members, and cultural shame of medication use); and 3) Consequences of medication discontinuation. According to the findings of the study, cultural attitudes play an important role in adherence to treatment regimen among the patients with chronic psychiatric disorders. It is recommended to arrange different programs to improve the situation with an emphasis on improving the general attitude of society towards mental illnesses and the need for regular use of the medications.