Objective: New coronavirus (COVID-19) pandemic socioeconomically affected the world. In this study, we measured the perceived stress in response to the COVID-19 pandemic among Iranians to determine the groups at both extremes of the spectrum followed by identifying the stressors and coping mechanisms. Methods: This study was a mixed-methods study. We distributed a web-based 10-item perceived stress scale (PSS-10), to measure perceived stress score (PSS), through social networks from March 12 to 23, 2020. Then, we interviewed 42 students, 31 homemakers, 27 healthcare providers, and 21 male participants to identify the sources of stress and coping mechanisms. Results: Finally, 13,454 participants completed the questionnaires. The median and interquartile range (IQR) of the participants’ PSS was 21 (15-25). Students, homemakers, and healthcare workers (HCWs) showed a higher median (IQR) of PSS compared to other groups (23 [18 to 27], 22 [16 to 26], and 19 [14 to 24], respectively). Male participants showed a lower median (IQR) PSS (17 [12 to 23]). Content analysis of 121 participants’ answers showed that the most common stressors were school-related issues mentioned by students, family-related issues mentioned by homemakers, and COVID-19-related issues mentioned by healthcare providers. Male participants’ coping mechanisms were mostly related to the perception of their abilities to cope with the current crisis. Conclusion: Our participants clinically showed a moderate level of PSS. The main stressors among students, homemakers, and HCWs were related to their principal role in this period, and male participants’ coping mechanisms were inspired by the self-image retrieved from the social perspectives.

Objectives: The Covid-19 has caused anxiety and stress in people all over the world. One of the most vulnerable groups during this epidemic are people with psychiatric disorders. In this study, we investigate the leading causes of concern among patients with psychiatric disorders and their families during and after hospitalization. The purpose of this study is to improve the care and service given to these patients and their caregivers regarding their concerns. Methods: In this study, 48 patients with psychiatric disorders hospitalized from late February to late April 2020 in the Iran Psychiatric Hospital were contacted by telephone. They completed a questionnaire related to the covid-19 pandemic and the problems caused by it during and after their hospitalization. Results: Inability to meet with family and the fear of infection to Covid-19 were among the main concerns of these patients at the time of admission. Their most worrying factors after discharge were the negative impact of quarantine on the recurrence of psychiatric illness. On the other hand, the most significant concern during the hospitalization of a patient with Covid-19 is the caregivers of these patients after discharge and the inaccessibility to a physician. Conclusion: The Covid-19 pandemic has caused challenges in treating psychiatric patients; thus, this study suggests some solutions such as providing a safe place for doctors to visit the patients, recommending the patients and the caregivers to observe self-hygiene protocols, and seeing patients virtually.

Background: As 40-60% of the patients with obsessive-compulsive disorder (OCD) do not adequately respond to the first-line treatment, finding an effective second-line treatment is required. Our aim was to assess the efficacy and safety of agomelatine (a selective melatonin receptor agonist and a 5-hydroxytryptamine (HT)2C antagonist) augmentation of sertraline in the treatment of patients with moderate to severe OCD. Methods: In this 12-week randomized, double-blinded, placebo-controlled, parallel-group clinical trial, 65 patients with moderate to severe OCD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM–5) criteria and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of over 21, were included. They were assigned with sertraline (100 mg/day for the first 4 weeks and 200 mg/day for the next 8 weeks) and either agomelatine (25 mg/day) or placebo. The primary outcome was OCD symptoms measured by the Y-BOCS. Results: Fifty patients (24 in agomelatine group and 26 in placebo group) completed the trial. The Y-BOCS scores in total (MD (95% CI) = 12.25 (11.00, 13.49) (p-value < 0.0001) vs. MD (95% CI) = 12.46 (6.65, 15.74) (p-value < 0.0001)), the obsession subscale (MD (95% CI) = 5.04 (4.19, 5.88) (p-value < 0.0001) vs. MD (95% CI) = 5.00 (3.84, 6.16) (p-value=0.0001)), and compulsion subscale (MD (95% CI) = 7.21 (6.34, 8.07) (p-value < 0.0001) vs. MD (95% CI) = 7.460 (6.50, 8.42) (p-value < 0.0001)) significantly decreased in both groups. Although, at the end of the trial, no significant difference was observed between the scores of the two groups in total (MD (95% CI) = 0.480 (-1.23, 2.19) (p-value= 0.78)), the obsession subscale (MD (95% CI) = 1.020 (-0.15, 2.19) (p-value=0.38)), and the compulsion subscale (MD (95% CI) = 0.540 (-0.34, 1.42) (p-value=0.54)). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups. Conclusion:Agomelatine in augmentation with sertraline is safe and tolerable in patients with moderate to severe OCD. However, our study does not support its efficacy in improving OCD symptoms, compared to placebo. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials on 14/07/2020 (www.irct.ir; IRCT ID: IRCT20170123032145N5). Funding: The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Iran University of Medical Sciences (Grant no: 98-4-75-16914).