Seyed Kazem Malakouti

Tehran University of Medical Sciences, Teheran, Tehrān, Iran

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Publications (19)20.11 Total impact

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    ABSTRACT: Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country's urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services.Method/DesignThis is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services. This paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran.Trial registrationIRCT201009052557N2.
    BMC Psychiatry 07/2013; 13(1):178. · 2.23 Impact Factor
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    ABSTRACT: Premenstrual syndrome (PMS) refers to a cyclic appearance of somatic and psychiatric symptoms that affect some women. Finding an effective and safe method for the treatment of PMS has always been a serious concern, because approximately 40% of women report PMS, and in 2-10% of cases it is severe enough to affect their life style and job. The purpose of the present study is to evaluate the effect of omega-3 fatty acids on the treatment of PMS. A randomized double blind controlled trial was performed on 184 eligible women. The eligible women were randomly assigned into two groups. The number of women who have finalized the study with us was 124. In the case group (omega-3 group=group A, n=70), omega-3 in an amount of 2g was prescribed for a one per day basis on a single dosage (two 1g pearls), and in the control group (placebo group=group B, n=69) 2 placebo soft gel, which were completely similar to omega-3 soft gels, were prescribed. The severity and duration of each of the symptoms were compared in both groups 1.5 and 3months after the beginning of treatment. There were no significant differences between the two groups according to age, BMI, level of education, and the severity and duration of primary symptoms. After 45days from starting omega-3, the mean severity of depression (P=0.03), anxiety (P=0.02), lack of concentration (P=0.03) and bloating (P=0.02) in the case group, were all significantly lower than in the control group. The duration of depression (P=0.04) and bloating (P=0.031) in the case group were less than in the control group. After 90days from starting the treatment, the mean severity of depression (P=0.007), anxiety (P=0.004), lack of concentration (P=0.009), bloating (P=0.004), nervousness (P=0.01) and the duration of depression (P=0.01), nervousness (P=0.02), anxiety (P=0.03), lack of concentration (P=0.02), bloating (P=0.004), headache (P=0.04) and breast tenderness (P=0.02) were all lower in the case group. It appears that omega-3 fatty acids may reduce the psychiatric symptoms of PMS including depression, nervousness, anxiety, and lack of concentration and may also reduce the somatic symptoms of PMS including bloating, headache and breast tenderness. These effects increased by longer duration of treatment.
    Complementary therapies in medicine 06/2013; 21(3):141-6. · 1.95 Impact Factor
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    ABSTRACT: The aim of this study is to determine the frequency of various methods of suicide in Eastern Mediterranean Region by a systematic review and meta-analysis. All published articles in international database were systematically searched before September 2011. In order to analyze the data we used STATA, ver.10 software. We reported proportions with standard errors (SE) for single studies and pooled estimates for proportions of different suicidal methods based on random model meta-analysis. We included 19 articles in the final analysis. The pooled proportion of hanging, self-immolation, and poisoning were 39.7% (95% CI: 26.8%-52.7%), 17.4% (95% CI: 10%-24.8%), and 20.3% (95% CI: 14%-26.5%) respectively. Self-immolation and poisoning were gender dependent and hanging was country dependent in the meta-regression method. We found out that the 3 most common methods of suicide in EMR are hanging, poisoning, and self-immolation. These methods are estimated to account for 77.4% of all methods of suicide in EMR.
    Archives of suicide research: official journal of the International Academy for Suicide Research 01/2013; 17(4):335-44.
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    ABSTRACT: Comorbidity of chronic tinnitus and mental disorders may result in more disability. This research provides an evaluation about the effects of medically treated comorbid mental disorder on chronic tinnitus. Fifty-five patients diagnosed with chronic tinnitus and mental disorders were randomly requited by producing a before-after design. They underwent three months of drug therapy for comorbid mental disorders by psychiatrists. Study instruments are Tinnitus Handicap Inventory, Tinnitus Questionnaire, Loudness Match Tinnitus, Hamilton Depression Rating Scale, Beck Anxiety Inventory, The Structured Clinical Interview and Symptom Check List -90. Three months medical treatment puts forward the argument that among mental disorders, anxiety and major depressive disorder demonstrate a significant reduction. Pearson Correlation coefficient ostensibly reveals that there is no significant relationship between mental disorders and tinnitus severity. The statistics lend support to profound effect of major depressive disorder as a key factor on tinnitus disability exacerbation. Medical treatment also touches on issue such as tinnitus severity, its disabling effects and TQ subscales that statistics shows significant trends in their reduction. Findings lay emphasis on tinnitus severity reduction and connection might be established between alleviated mental disorders comorbidity and the improvement of quality of life.
    The international tinnitus journal 12/2012; 17(2):163-168.
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    ABSTRACT: This study aims to demonstrate the sexual functioning of elderly Iranian retirees who reside in Tehran, Iran. The participants' sexual interests are also reviewed in association with their physical and mental health status. The authors recruited 390 elders (199 men, 191 women) by convenient sampling from 4 retirement organizations in Tehran from April 2007 to October 2008. Tools for evaluation included use of a demographic questionnaire, modified Brief Index of Sexual Functioning for Women, Brief Sexual Function Inventory for Men, and the General Health Questionnaire. Sexual activity was "important/very important" in 56.6% and 17.0% of men and women, respectively (p < .005), but their satisfaction from sexual life was similar. Sexual desire and activities were more common among men than among women (p < .05). Impotency and ejaculatory problems were 40% and 33%, respectively, among the male study participants. This study indicated that having a sexual partner was the most important variable for sexual activities. This study provides a profile of sexual behaviors among elderly people in Iran and shows that although sexual decline and dysfunction are seen in both genders, both groups express satisfaction with their sexual affairs when they have a partner available.
    Journal of Sex and Marital Therapy 07/2012; 38(4):365-77. · 1.27 Impact Factor
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    ABSTRACT: This study aimed to validate the Farsi version of Neuropsychiatric Inventory (F-NPI), with the aim of promoting clinical assessment and local research on evaluation of neuropsychiatric symptom profiles of individuals with dementia in Iran. In this cross-sectional, psychometric study, 100 patients with dementia in the age range of 60–90 years participated. Two trained psychiatrists interviewed the study subjects. Positive and Negative Symptoms Scale (PANSS) and Geriatric Depression Scale (GDS) were used to determine the concurrent validity. Testretest,inter-rater reliability and internal consistency were calculated. Discrimination validity was determined,using a matched control group consisting of 49 participants without dementia. Cronbach’s α and Pearson’ scorrelation coefficients were used to analyze the data. The internal consistency (Cronbach’s α = 0.9) was excellent. The inter-rater reliability varied between 0.6 and 0.98 for frequency, severity and total scale of the F-NPI, and test-retest reliability was between 0.4 and 0.96. Concurrent validity varied between 0.3 and 0.9 (P < 0.05). The most prevalent symptom was “apathy” and the least prevalent was “euphoria”. The Farsi version of NPI has satisfactory psychometric indexes and is applicable for clinical and study works in Iranian community.
    International Psychogeriatrics 02/2012; 24(2):223-30. · 2.19 Impact Factor
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    ABSTRACT: Objective: Complaining of psychiatric symptoms is more common among individuals suffering from tinnitus. The aim of this study is to determine the psychiatric diagnosis and symptoms of patients with chronic tinnitus. Materials and Methods: Four hundred patients with chronic tinnitus from the registry of Otorhinolaryngology Research Center of Rasoul General Hospital, Tehran, Iran were enrolled. The study instruments were Structured Clinical Interview for DSM-III-R, axis I psychiatric disorders, Tinnitus Handicap Index (THI) and Symptom Check List-90-Revised. Results: The lifetime and current psychiatric disorders among patients with chronic tinnitus were 60% and 55% respectively. Depressive and anxiety disorders were the most common type. Females with severe THI were 75.6% versus 63.9% in men. Discussion: The comorbidity of chronic tinnitus with depressive and anxiety disorders is more common. This may have treatment implication to alleviate the stress and dysfunction resulted from chronic tinnitus.
    The international tinnitus journal 01/2011; 1616(16):118-22.
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    ABSTRACT: Objective: Complaining of psychiatric symptoms is more common among individuals suffering from tinnitus. The aim of this study is to determine the psychiatric diagnosis and symptoms of patients with chronic tinnitus. Materials and Methods: Four hundred patients with chronic tinnitus from the registry of Otorhinolaryngology Research Center of Rasoul General Hospital, Tehran, Iran were enrolled. The study instruments were Structured Clinical Interview for DSM-III-R, axis I psychiatric disorders, Tinnitus Handicap Index (THI) and Symptom Check List-90-Revised. Results: The lifetime and current psychiatric disorders among patients with chronic tinnitus were 60% and 55% respectively. Depressive and anxiety disorders were the most common type. Females with severe THI were 75.6% versus 63.9% in men. Discussion: The comorbidity of chronic tinnitus with depressive and anxiety disorders is more common. This may have treatment implication to alleviate the stress and dysfunction resulted from chronic tinnitus.
    The international tinnitus journal 01/2011; 1616(16):118-22.
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    Seyed Kazem Malakouti, Marzieh Nojomi, Maryam Salehi, Bita Bijari
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    ABSTRACT: In the last 30 years, ever since the PHC network in Iran has been established, the job duties of Behvarzes (Mental Health Workers in rural areas) have been constantly increasing. The aim of this study was to determine the burnout level, mental health status and the severity of occupational stress among Behvarzes. All Behvarzes (227) working in areas covered by Iran University of Medical Sciences were considered for participation in the study. Maslach Burnout Inventory, GHQ-12, and Stainmentz questionnaires were used. The completed questionnaires were returned by 93% of the subjects. The mean score of job stress was in the first percentile (42.8 ± 27.16). 17.6% of the study subjects had moderate to severe level of burnout; 12.3%, 5.3% and 43% of the subjects had abnormal scores on emotional exhaustion, depersonalization and personal subscales respectively; and 28.3% of the cases were suspected to have mental disorders by GHQ. In spite of increasing assigned jobs to Behvarzes, job stress and burnout are not seriously distressful. Providing more desirable personal accomplishment for Behvarzes by reducing job ambiguity/ conflict, participating in planning new programs, and improving interaction with health authorities may help them to overcome their job related pressure and increasing workload.
    Iranian journal of psychiatry. 01/2011; 6(2):70-4.
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    ABSTRACT: Complaining of psychiatric symptoms is more common among individuals suffering from tinnitus. The aim of this study is to determine the psychiatric diagnosis and symptoms of patients with chronic tinnitus. Four hundred patients with chronic tinnitus from the registry of Otorhinolaryngology Research Center of Rasoul General Hospital, Tehran, Iran were enrolled. The study instruments were Structured Clinical Interview for DSM-III-R, axis I psychiatric disorders, Tinnitus Handicap Index (THI) and Symptom Check List-90-Revised. The lifetime and current psychiatric disorders among patients with chronic tinnitus were 60% and 55% respectively. Depressive and anxiety disorders were the most common type. Females with severe THI were 75.6% versus 63.9% in men. The comorbidity of chronic tinnitus with depressive and anxiety disorders is more common. This may have treatment implication to alleviate the stress and dysfunction resulted from chronic tinnitus.
    The international tinnitus journal 01/2010; 16(2):118-22.
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    ABSTRACT: The objective of this study was to evaluate the effectiveness of case-management services and the feasibility of considering the Consumers' Family Members (CFM) as service providers in Iran as a developing country. Three trained case-managers were allocated into each group (Mental Health Worker-MHW and CFM), providing 12 months of home-visit services for 129 individuals with schizophrenia. Burden, knowledge, quality of life and the general health condition of the caregivers, as well as positive/negative symptoms and social skills of the consumers were evaluated. Most clinical variables were improved without significant differences between groups. The hospitalization rate was reduced by 67%.
    Community Mental Health Journal 06/2009; 45(6):447-52. · 1.03 Impact Factor
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    ABSTRACT: Complaints of sleep disturbance increase with age and many studies have reported on the relationship of sleep problems to the greater use of health services, physical and mental morbidity, functional decline, and all causes of mortality. This study aimed to examine sleep patterns and sleep disturbances in Iranian elders and correlate their sleep quality to their health status. Four hundred men and women, aged 60 years or older, were interviewed by trained interviewers regarding their physical and mental health status. The Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale (ESS), and a General Health Questionnaire (GHQ) were then administered to each participant. The data gathered were analyzed using chi(2)-test, t-test, and one-way analysis of variance and logistic regression. The results indicated that the majority of participants (82.6%) suffered from poor sleep quality and approximately one-third (29.2%) experienced sleepiness during the daytime. Difficulty falling asleep (p < or = 0.001) and maintaining sleep (p < or = 0.01) and the feeling of being too hot at night (p < or = 0.005) were significantly more prevalent in women, but men suffered more from leg twitching (p < or = 0.01). Being female (OR = 2.52), and having GHQ scores of more than 11 (OR = 4.14) increased the risk of poor sleep quality considerably. Promoting sleep hygiene education of elders in primary health care services are recommended.
    International Journal of Geriatric Psychiatry 04/2009; 24(11):1201-8. · 2.98 Impact Factor
  • S. K. Malakouti, M. Foroughan, M. Nojomi, M. Ghalebandi
    European Psychiatry - EUR PSYCHIAT. 01/2009; 24.
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    ABSTRACT: Aim of this study was to evaluate the prevalence of suicide ideation and behavior in a community sample of an Iranian city, Karaj. Study sample consisted of 2,300 subjects, chosen randomly from the community. The WHO/SUPRE-MISS survey questionnaire, used in this study. Lifetime prevalence for suicide thoughts, plans and attempts were 12.7, 6.2 and 3.3%, respectively and for the previous year they were 5.7, 2.9 and 1%, respectively. Although it is not possible to generalize the results to the country, but in some area of Iran, the prevalence of suicide ideation, plan and attempt appeared to be similar to that of many developed countries.
    Community Mental Health Journal 01/2009; 45(1):37-41. · 1.03 Impact Factor
  • European Psychiatry - EUR PSYCHIAT. 01/2009; 24.
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    ABSTRACT: This cross-sectional study was conducted as a part of the Multisite Intervention Study on Suicidal Behaviors, a WHO multinational project, and aimed at determining demographic and clinical characteristics of suicide attempters seen at emergency care departments (EDs) in Karaj, Iran. The population under study comprised all suicide attempters seen at EDs of hospitals in Karaj from 2002 to 2003. In total, 632 suicide attempters agreed to participate in the study. Information about demographic and clinical variables; the method, time and place of the suicide attempt; earlier attempts; the use of health services, etc was collected by examining hospital records and by interviewing patients. Data were analyzed with SPSS software. Most of the suicide attempters were women (62.5%), single (53.6%), and had a high-school education (52.8%). The mean age was 24.5 (+/-9) years. Many of the male suicide attempters were unemployed (29.8%) and the majority of female attempters were housewives (67.5%). A positive history of suicide among relatives was observed in 15.4% of the attempters. A total of 28% of the participants had previously attempted suicide. A total of 23.7% reported poor physical health in the 3 months before the attempt. The suicide attempters seen at the EDs typically were unemployed men, high-school students, women, and housewives.
    European Journal of Emergency Medicine 09/2008; 15(4):221-3. · 0.73 Impact Factor
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    ABSTRACT: The present study is part of the WHO/SUPRE-MISS conducted in Iran. The aim of the study was to determine the lifetime prevalence of suicide behaviors in a community sample of Iranian adults. Five hundred and four families were selected randomly according to electricity bills in Karaj, 45 km from the capital city, represented the catchment area for this investigation. The SUPRE-MISS questionnaires used in this study compromised a variety of aspects of suicidal behaviors. Lifetime prevalence rates for suicidal ideation, planning and attempts were 14%, 6.6%, and 4.1% respectively. Tobacco users and long-term mental and physical disabilities were significantly higher among subjects with a history of suicidal attempts. Younger ages, tobacco abuse, and long-term mental or physical disabilities could be considered risk factors for attempting suicide.
    Archives of Suicide Research 02/2008; 12(2):141-7. · 1.53 Impact Factor
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    ABSTRACT: The object of this study was to develop an Iranian version of the General Health Questionnaire-28 (GHQ-28) for use with elderly subjects. The GHQ-28 Farsi version was evaluated for face validity among 204 elderly subjects aged 59 years or older, chosen randomly from residents of Tehran. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of mental disorders. The GHQ-28 was an internally consistent measure. Cronbach's alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Four factors were extracted using factor analysis: "depression," "psychosocial activity," "anxiety," and "somatic." Using receiver operating curve (ROC) analysis, the optimum cutoff score for the GHQ-28 in this group was 19/20 (sensitivity 0.83, specificity 0.76). Using a loading of 0.6 or greater, a short form of the instrument (GHQ-15) (alpha=0.9) was derived and correlated well with the longer form of the scale (r=0.97). Using ROC analysis, the optimum cutoff score was 10/11 (sensitivity 0.83, specificity 0.69). The short and long forms of the GHQ-28 are suitable screening instruments for elderly Iranian residents, particularly those living in urban areas.
    International Psychogeriatrics 09/2007; 19(4):623-34. · 2.19 Impact Factor
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    ABSTRACT: Depressive disorders are a public health problem even in developing countries. Access to valid and reliable screening instruments is needed for conducting community surveys. The main objective of this study is to provide the Iranian version of the Geriatric Depression Scale-15 (GDS). The GDS-15 Farsi version was developed by translation and back translation. Two hundred and four subjects aged 59 years or older, who were chosen randomly from residents of the Ekbatan district of Tehran, the capital city of Iran, completed the GDS-15. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of major depressive disorders. The GDS was found to be an internally consistent measure. Alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Two factors were extracted by using factor analysis and the principle component analysis (varimax rotation): 'depression' and 'psychosocial activity'. The Depression factor (omitting items 2, 9, 10, 13), which could be considered as a short form of the scale (alpha = 0.92), has significant correlation with the main scale (r = 0.58). Using receiver operating curve (ROC) analysis, the optimum cutoff score for GDS-15 is 7/8, yielding a sensitivity of 0.9 and a specificity of 0.84. The optimum cutoff score for GDS-11 is 6, yielding a sensitivity of 0.9 and a specificity of 0.83. The long and short forms of the GDS have excellent properties as screening instruments for major depression in older dwellers in Iran, particularly in urban areas, as presented in our findings.
    International Journal of Geriatric Psychiatry 07/2006; 21(6):588-93. · 2.98 Impact Factor