Comparison of Caregivers' Burden among Family Members of Patients with Severe Mental Disorders and Patients with Substance Use Disorder

Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder. Method : First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers. Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers' burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013). Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.

A Narrative Review of Stigma Related to Infectious Disease Outbreaks: What Can Be Learned in the Face of the Covid-19 Pandemic?

Infectious disease pandemics are associated with social consequences and stigma that are noticeably similar in various health conditions, health systems, and cultures. Stigma impacts health-related outcomes, not only as a barrier to receiving the timely diagnosis and appropriate treatment but also as an important variable that increases mental health issues such as anxiety and depression. The COVID-19 outbreak has been associated with stigma too. Studying similarities as well as differences in the features of stigma observed in each outbreak can provide us with the knowledge and deeper understanding of the situation, which is necessary for approaching the issue comprehensively. The stigma needs to be addressed rigorously by professionals and health care providers as well as authorities. Here, we narratively review stigma due to some well-known infectious diseases and how it parallels to the current COVID-19 situation. After discussing its effects on both individuals and societies, we provide solutions to manage this important issue.

Attention-Deficit Hyperactivity Disorder in Adults Using Methamphetamine: Does It Affect Comorbidity, Quality of Life, and Global Functioning?

Objective: Attention-deficit hyperactivity disorder (ADHD) is common in adulthood, and it is associated with different high- risk behaviors, particularly substance use. Evidence suggests a high prevalence of ADHD in adults who take methamphetamine (METH). This study aimed at comparing functional level, quality of life, and psychiatric comorbidities in METH users with and without adult ADHD (A-ADHD). Method: In this cross-sectional study, 134 patients who had a history of METH use (at least once in lifetime) were selected from among inpatient and outpatient referrals to a psychiatric hospital. DIVA was performed for those who were positive on the Conners' Adult ADHD Rating Scales-Self-Report-Screening Version (CAARS-SR-SV). The Global Assessment of Functioning (GAF) and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF) were used to assess the participants' level of functioning and quality of life, respectively. Psychiatric comorbidities including substance use disorders were evaluated using the Structured Clinical Interview for DSM-IV-Axis I (SCID-I). Results: Among the METH users, 10.4% were diagnosed as having A-ADHD. A-ADHD was more prevalent among female METH users than males. The hyperactive-impulsive and combined types were more common than the inattentive type. Opiates and cannabis were the most commonly abused drugs by the 2 groups, while sedative-hypnotic use was significantly higher in the individuals with A-ADHD. Substance-induced mood disorder was the most prevalent comorbidity in the 2 groups and was higher in those with A-ADHD. quality of life and the GAF scores were significantly lower in those with A-ADHD and duration of METH use was higher Compared to the METH users without A-ADHD, (p>0.05). Conclusion: This study provided some preliminary findings supporting the prevalence of Adult ADHD among METH users and its negative impacts on their global functioning and quality of life. To provide more effective intervention for METH users, detection and treatment of those with A-ADHD can be of clinical value.

Latent and active tuberculosis: evaluation of injecting drug users

Background

There is a high risk of tuberculosis (TB) infection among injecting drug users (IDUs).

Objectives

This study aimed to determine the frequency of latent and active TB infection among IDUs.

Materials and Methods

In a cross-sectional study between 2008 and 2009, IDUs referred to the methadone maintenance treatment (MMT) centers in Hamedan-Iran, undergone tuberculin skin test (PPD; purified protein derivative) were recruited. The participants with positive results for PPD test (> 5 mm and > 10 mm in HIV positive and negative cases), undergone other complementary procedures such as chest-X-ray and sputum smear test.

Results

Overall, 268 IDUs between 18 and 70 (mean: 34.5 [8.2]) years were included in the study. PPD test had positive findings in 49 cases (18.3%). There was no significant difference of PPD positivity between HIV positive and negative participants (17.7% vs. 18.5%). An active TB was found among IDUs.

Conclusions

The high prevalence of latent and active TB among IDUs indicates the need for TB screening tests among this population.

Acne vulgaris: therapy directed at pathophysiologic defects

An effective therapeutic regimen for the treatment of acne vulgaris is presented. The emphasis is based upon correcting a defect in keratinization of the sebaceous follicles with a combination of vitamins A and E. This prevents the formation of milia and comedones, thus depriving the Propionibacterium acnes of a culture medium. Vitamin E also prevents irritating lipid peroxidation of sebum, damaged by bacterial growth, which may be responsible for the inflammatory aspects of acne. No antibiotics were employed in the series of 98 consecutive cases examined herein.

Facial dermatitis following friction treatment of acne

A case report is presented herein of a twenty year old woman in whom an acute dermatitis of the face developed, which may have been caused by the use of a skin machine, possibly in combination with the use of a topical medication.

Synergism of vitamins A and E with dermatologic applications

A synergism between vitamins A and E has been demonstrated by a number of investigators, notably Stanley R. Ames, who showed that in rats on a vitamin E deficient diet, the serum vitamin A level remained low, no matter how much vitamin A was given by mouth, or even by injection, but that adding vitamin E to the diet restored the vitamin A serum level to normal. We have utilized these observations with a high degree of success where vitamin A alone had failed to control three dermatologic conditions involving a defect in keratinization, namely, keratosis follicularis (Darier's disease), pityriasis rubra pilaris, and acne vulgaris. It is possible that a number of additional dermatoses characterized by dyskeratosis or hyperkeratosis might also be benefited by this combination.

Lupus erythematosus and vitamin E: an effective and nontoxic therapy

Despite conflicting opinions, our personal experience and a number of reviewed clinical reports indicate that vitamin E, properly administered in adequate doses, is a safe and effective treatment for chronic discoid lupus erythematosus, and may be of value in treating other types of the disease. A possible mechanism leading to the development of autoimmune diseases, including lupus erythematosus, is discussed, together with a rational approach aimed at the cellular level, rather than at attacking the body's immune defenses, which could lead to increased susceptibility to malignant and infectious diseases.

Porphyria cutanea tarda: response to vitamin E. A review and two case reports

Porphyria cutanea tarda is a disease characterized by a triad of cutaneous manifestations: "fragile" skin, usually involving the dorsal aspects of the hands, forearms, legs, or feet; mild hyperpigmentation; and hypertrichosis, especially of the face. The condition is due to a metabolic defect of liver function involving heme synthesis, resulting in the formation of abnormal amounts of uroporphyrin, and sometimes, coproporphyrin or both, which can be measured quantitatively in the urine. Present methods of treatment, including repeated phlebotomy, alkalinization, or chloroquine leave much to be desired. Based on recent experimental and clinical reports and on our personal experience with two patients, we suggest a more logical therapeutic approach in the form of large doses of vitamin E, which apparently corrects the metabolic defect causing the disease.

Is vitamin E involved in the autoimmune mechanism?

Autoimmune diseases are characterized by an alteration of the body's defense mechanism, designed for protection against infections and toxic injuries, which for unknown reasons attacks and destroys normal tissue. Some evidence strongly suggests that such diseases are the result of hydrolytic enzymes that escape from lysosomes whose membranes have been damaged by lipid peroxidation or other causes and that combine with and denature normal tissue proteins--in effect converting them into foreign proteins--to which the body then reacts by producing antibodies. During the past ten years, in a private dermatologic practice, we have conducted clinical investigations on the possible therapeutic value of vitamin E in the management of a number of disabling skin diseases of unknown etiology as well as several muscular disorders. Among the diseases that were successfully controlled were a number in the autoimmune category, including scleroderma, discoid lupus erythematosus, porphyria cutanea tarda, several types of vasculitis, and polymyositis. Since vitamin E is a physiologic stabilizer of cellular and lysosomal membranes, and since some autoimmune diseases respond to vitamin E, we suggest that a relative deficiency of vitamin E damages lysosomal membranes, thus initiating the autoimmune process.

Polymyositis: response to vitamin E

A 70-year-old woman with polymyositis was treated with three different immunosuppressive drugs. Her condition deteriorated over a three-month period until she became totally helpness. She then made a dramatic improvement when large doses of vitamin E (d, alpha-tocopheryl acetate) were administered. Current knowledge regarding the nature of polymyositis and the rationale for using vitamin E to treat it are discussed.

Leg cramps (systremma0 and "restless legs" syndrome. Response to vitamin E (tocopherol)

A clinical investigation into the therapeutic value of vitamin E (tocopherol) in certain dermatological conditions of obscure etiology led to the incidental observation that this compound produced beneficial effects in some of the patients who were suffering from frequent and severe nocturnal leg cramps. Nearly all of the patients with leg cramps received prompt and gratifying relief from their symptoms while taking vitamin E in the form of d, alpha-tocopheryl acetate, 100 I.U. three times a day before meals. The group included 24 private patients with leg cramps and two with the "restless legs" syndrome, probably a related condition. One of the patients with leg and foot cramps also had severe nocturnal rectal cramps which were also relieved. Nocturnal leg cramps constitute a relatively common complaint in the general practice of medicine and may be very distressing to the patient. Not only is the cause obscure and the treatment relatively unsatisfactory, but even its proper medical name, systremma (anything twisted up together), is unknown to most physicians.

Stretch garment dermatitis

A disease of the skin, not hitherto described, is caused by pressure or tension on the skin from the wearing of tight-fitting stretch garments such as "stretch bras," "stretch girdles" and "stretch socks." The condition is not due to chemical sensitization of fabrics, dyes or other additives but is of mechanical origin. The eruption may assume various clinical forms and may be characterized by a nondescript erythematous and eczematous appearance or may consist of an exaggeration, in the areas covered by the stretch garment, of already existing dermatosis such as lichen planus, psoriasis, acne vulgaris, discoid lupus erythematosus or atopic dermatitis.