/
3898
: *
29
! "# " $ %&'
.
:) * +,-
) (
ACT! " # $
%
& ' (
1*
2
! 2
2
1 -
2 -
! / #
$ # %&'(
/ !
1 /
! *(
98 -& & / 79
: 1 / 10 / 97 :
13 / 11 / 97
:# $
%& .(%) * %+ ,% - % . -/ 0 + 1 * + 2 !3 4 ) ) 567 7 # 8 9 : ) * 1 8
) <=3 1 > ? ,! - @ . =3 A B C&1D # #,E 1 - F G (ACT
( . ,I / .
>1 1 : &
- I #) . + * I,) - J & # K L # M 0 F N3 3 O P A B #=Q R #,%E 1 %
# ( ,I / .
%9 3 #!B %9 S% P * #= - ,) <+ . , T 3 J 1 U 73 ,E J< * # # #!B %9 1
, ) Q
# >1 # 1 #,V , %) Q % #!B %9 % C&1D% F %& J . %+ U , V & F K
) #%,V (SCID
KD 1 # ) ( = F &
, +
2%731 1 7%) K , * & & $ C / F %I
%V F % ACT
: ) ) W3 X + F Y ) 3 >1 # * / () # Z , . + * I,) * 8 9
%!< F %!< %[ \ % V (RCI
.(V K ) 3 C ) 1 = Q
#,V : &
* - * / () # F &
F % / ] Q - \ ,B C&
(P<0/05)
%
% = 3 % C %) 1 Q
.()
# , 1 ^ F K
:
) <=3 1 > ? ,! - . # #,E 1 - F G (ACT
( . ,I / .() @
_ 1
* F F &
:
F G <=3 1 > ? ,! - (
. ,I / .
/
3998
# $
3,) 4 /,! 5 , *
$ ! 6
/70 8 * / 0 9,/* : ," ;
.
< .$> ! ?7 4,! @ ;! A
B 3 C ;! 0 )
1 D E FG + A .(
A C ! ; ,"
$ H D ;! ( I
J,7K .$ >
B 4, I L . ?1>
L B 4, I
A < ; 4,8$ . ?1> ;! L $
A $ 9 : " .$
L 8 >
B*
M N 2 : " $
AO8 ! . . ,7!
> P 8 + 7 ! ; 4,Q B
4, I L 5
; B * R +L L
2
$,G HF . ,S )
2 + C + $2 > .(
$ T F :$ U N A ; 0 B 4, I L 2
$ : ,,6 7,
M K J
$ 2 0 ;! 4, ) * 2 4 V L
M K J 7,
8 > 2 * $ 2
2 G + &, ; $ 72 , ' ) W ! 8 > C
$ , ) 3
* ;! ( M Y
:$ U N A B
4, I L
! 4,Q 32
$ , 4, ) 2 )
4 MO 8 ( .
3,) ,) ) 5 MO 8 \* ! ;] $. $ ! / (
B8 > ;^C W : ,2 2
! ? * 4 ; >
_G
` C ?, JS ;! * ' 6G A B ) 6 .(
; 0 + 1 * B , * J% 2
+ b) ;
'O N A _c. + + ! $ + ! 2
\F! + * .$
$ $) 4 , \W ! ;c! 2
? * + 1 4, ]/2 2 @) , , * B , * D T ;! C , T ;! $,
) 7 e & & .(
;Q * $ $) + 2 ; B $>
M M N % L , IH : ,,6 $> M /* 2
T C B71> 5 * ;! $ ! * .B KH e & ; * b, $>
:$
» ; >( JG ,S M /* ;! B + ! $ L C *
+ $ I ;! C ; B h,S
$ .«
* , ; C M /& N ;!
$ >
; ' 1C ,,6 + 2 : ,2 2
$ G /*
>
) 8 L ;! , * + , ,) .(
,> + ; k ^ 2
;! '+ L (5, / 7, ) $
; I ; C %! /,!
! 9 N 4 + >
$
; % L > B + ! $ 2 $ 2 2
$ M ) 9 .(
:Om& + 1 A * B + ! $ $) ;] .B A < V C HR
;2 n ;! , * * + , ,) 1970
! .
M 4 N
$* 2 2 2 P ;!
, ,)
;.O*
$ $> $ )
10 ^ ;! .(
$ B + ! ;
?1G A < $ ) , * 2 C p q 7 ;! ; 7! C ( + ! /.
.B W $
20 80 M M 5 A r & + $R
* V , *
$ >
) 11 :U .(
) 12 (
M / W
; , > 8 ;! B + ! ?1> 4
50
3,) $R ,!
M / W 4 L ^ ;! s$
90
t .B ,6 , $R )
13 4,/ , ( $ +
80
J ; & + $R B ) B,KC ! +
; > ( A ;! / M 5 :$ A r $
$ % $ L
20 8 %! % L + $R
J + b) ; +
.$ 2
$ $) , * ;1 ;! ;0 ! ;! B H * $ V
: R 4 $ V 7 ! ? %! ^ , ) 14 , * HR ;G K .(
.B M
2 ;! 3 ,8 2
5 * ;! B ; C 3 C 4 0 H,/1
/
4098
* ;! H N ;! . FG * C ;! , * . + ,7! /W
.B 3 C
% L ;! ; k P 2 J2 ' () 2
; I
;8 > >
+
8 $ $0 2
.$> ! ;,u C 4 ! k P 2
?,G 4 ;! :O1 ; $ $ L $ >
/ C ; ,2 $ 2 8
1C : 7W 2
?,G 4,/2 ;! .$ ;! $! 2 $ > 8 4 + " 4 1V . $ > 8 t
$,) L A N ! & K N 2 ;! $
$ ) 15 .(
$%& ' () ! ?R W ; ACT
k P + ,2 , n B
1/2 ) 16 $> ; 8 > v c (
,! 8 4 2 32 ; 7
/
4 .$> ! $,I & T c8 2 C 32 & $ ! C ' () >
qO! K ; C 3 C (: 7W 1C ) 2w t
$! 32 "x M M /*
) 15 ! .(
5, 1 + I ?,G ;! $%& ' () eH 2
;! 8) 2 L 42w ' () $ /,2 I ;! ;0 8 > 3H7 ;^FG $ + (; , + *
'+
A c& \* ! ; ; $%& ?/* 2 ()
8 >
>
; 32 4/u $
$ ,) J O*
_c. 2 ! " A
* ' 6G + , H0
! U ! /,!
) 17 .(
M ;! $%& ' () ! HR 2$ L C ;! ; 7! /,! ;H/0 + eH C ;! ; B L ; V $ ! 1C + ! + B ; V + ,!
D c : ,2 ; V $ H7 ! JW 1C +
! $ ?/F ,!
; ! $ A
4, ) * ' 6G , L M ;! ;H! K
$ ,!
) 17 .(
! $%& ' () ! ! "
7 e,N B,&u +
B $> k H& ,G ! 2
) 15
! .(
2 ; $ 2
! 2
MO 8 k P
<
+ , ,) A
4 C 32 * ' 6G M / W J,/& t cu MO 8 7C t cu MO 8 ; C
;! u y + b) MO 8
"x 2
$ > !
) 18
; , ,) .(
2 @)
; ; $2
_G W ! % ; & A ;1H! * ' 6G M /
@ ! 4,,& 2 M N , * :$> $
:$
L
T 9C 2
? *
! n L
$
$ V A <
) 20 19 /,K 7 ` , (
,"z % L + ; >
]/2 . () ?,HF C p 4,
1/2 G )
21 ; ( ' () !
A :UO 8 ! 3 !$, ;H8 $ 5 $%&
! 2 @) + 8 ! .B * + , ,) @ ;!
BH* ;! ' 4 , ;! ; $ ! 4 k , 1 2 L 3 C ' () ?Y L ; K% 2
;^FG mW ; , + * ;! 8 ; $%& ?/*
$2 M W
: m. $!
C C ! h, + 2 8 >
" 3 C h0 $ + , ,) !
A * )
22 ( 1/2 {,2 . )
23 (
" 32 @) 5 /,! ; ! 4 !
;! ; 7!
%! p .$ . 3
* + , ,) A _G 32 t cu 7C
;! t 0 H v c ; ) n8 ;! B 7
1/2 S ! . )
24
* BF 2 @) (
! 2 B8 > ! "
^ 1I ; )
42w) ( 2 L M &C
N + v & 2
/
4198
, 4 ;! ,C A * + , ,) B ;
8 > ' ; $ C -
B8 > C
!
^ 1I
* , 32 3 C
A 32 $ . ! :$ B* N
%! t cu /70 JQO* ,C 7 G + C ! B & ,"z 3 C * / 0
78 .$ "x )
25
* ! 2 @) (
! $%& ' () ! 2 ! "
$ C B ; , 4 ;! & * ; 1 M ; * ; 1 M 32 ACT
&
+ .B ! 3 ! "
) 26
;G K (
C ! $, ! C k P * BF ' ' () ! C k P 2
' 4 ! " 4, ]/2 $ v c .$ 7 " ,C * + , H0
;! ;0 ! 4 ! ! ;1 ;! ^ $> v c \W
;Q ;! ; 7! /,! * + , ,) 2 12
B 4, I L 8 ! R 8 B,/2 +
: u $> !
v c ;,u C 4 $> y 7W u W ;&G c k ) $%& ' () ! ; >
(ACT
; 7! /,! * + , ,) ;!
B 4, I L "x
.B
>1 1
&
; $ V ; ) n8 v N D + 32 @) 4 v N +L ! 1H) /2 3 : I 2
? > u W 32 @) L ; / . ! ; ,) 3
+ I
;! ; 7! /,!
B 4, I L ' 9 N + ; !
; /
! + $ /C$2 , & 9,KF L ;& 0 4,
;&0 7 %! , * T ;! $
M t 1 %>
1396
< B%0) A
+ b) ( 8 : $8 BC
; W
; W k 9KF n , ; / .$> t ; C 8 ,G !
b) 32 @)
TO & 32 @) n > + W + 4 P 8 2
: * 2 ,& .$ $> ;&G c $ L C 9,KF ;! 7! MO 8 ;! C <O ! :+ $ ! B
4, I L
BC k$*
4,W ,S 2
1 ?. $W + H . ;K! 32 @) 0 4 *
30
40 : 7H0 B > B%0 , 4 > M P 8 2 ,& .JH| + :O, F ?. $W @ ;! :UO 8 ;! O ! :+ $ ! : *
BC + 1 + ,S ;! 2
ACT
4, ) 4 * ;K! 4 > $ 32 @) 0 + + 30 + U ! 40 : 7H0 ; B%0 , k$*
. 8 1>L c8
:+ $ * 3 2 !
8 ,G ! ; W ) ; C
; W 4 :(SCID
! TO y L , / 2 2
:UO 8
;! 7! ! B
4, I L $, z !
> B " }, .BC k /,! $ ) $
B,/
) 27 ) h u ( 60
h u * ;! $R
t + 4,! )
! 2 ' SCID
.$
1/2 I > ! )
28
! , 9C (
}, Y
! t 8 n H ~ 8 2
+ U ! ) ) 60
.($R ? ) ) H 9C
}, H&C 2 52
}, ? ! $R 2
/* M N 55
;! ($R B
. ! t 8 , $ L
; )
@ 8 > B,&/0 2 4 :
: *ON L ^ ;! 9KF n ; ) B,&/0 B,7 0 4 :;H/0 + L ; / 8 >
B,&u :O, F •c C D M 6 >
;K!
.BC . I ... T
3 +L )
B,
; ,>
:(
;!
^ },
7!
;!
B 4, I L +
B,
; ,>
I
$>
.
/
4298
y ,K 4 : 1 , * * $ 2 $ 2 y ,K 37 M € 5
;
^ ;! ; B B "
+ $ ;! ; 7! C B,&u ,
. I + ; 2 ,
0 4 / (
/ ?. $W L ; >
0 ; 4 / $ 2
L Y $W ! ;! 7! ; , 148
.B ;! 7! ; 4 ,! ,! ; /
y ,K 4 ' ! 85
T N & ;V 2 .$> !
* / 0 /70 eH ? * ," BF ,!
J O* > $, ;! q $ ; C . :U € ; 0 . $2 8 + ! 8 + ,!
; ;! J O* ; ) %
;! /,! ; B N
! ) ;! M , " $ ! ,C N + H B ) 29 .(
$& n +L ) h u )
30 ! (
• IGL ' + I 84
/ 0 .B $> '
1/2 k 1, 32 @) )
31
! + ?R W p (
IGL h u ; ; ) )
! •
! ! y ,K 4 84
/ 0 h u ; F ! $> !
n F ^ + ;1 ! O* y ,K + B ; C . ,G ! : m. ,G !
4,! ,) 7 /2 h u 9 N 4 2
! y ,K ;&G c & ) ;! ` ! 2
h u BC . )
727 / 0 ; $ ; F (r-
+ $ y ,K 4 U ! * BIR ,
L F R .B , * * & ;&G c $> $, ,G ! 4, + 4 ; n
B . F I 2731 : ) V F ACT
8 9
* ?1 ) 4 4 ! I, 7H n
) 32 .B $> 4 $ ,2 , : ^ BF (
$& ;! /,! 32 @) 4 12
4 y ! ;7H0 BF ?1 )
. $%& ' () !
1/2 6R n ?1 ) 4 .BC $ 2 8 ) 32 .B $> ;/0 (
>1 /,!
B >
4,&0 4,! + 32 @) 4 $
T ;!
t 1 %> 7 %! , *
B ^ ;! .$ $> t $ ! A$2 4 ;! !
BC : R 5> | n , ; W ,G ! ; W ,* ! + , $, ! b|
n I ; C 8
.$> k 9KF
$/2 ! HR ;,G }, ;1 + $&!
TO B> /2 $> B * P 8 2
+ b) $ $> ; C ^ L ; / &! /,!
B u 32 @) A $2 • L + ;
.$> (8 2
TO y ! /,! ;1 L + $&!
8 2
P
;! $ $> t $ $> ; ) n8 ;HW /2 N
;!
;HR C ! 5 ;! 5 h, ^ + C N _0 ; F 4 $! .$ $> v N ;7H0 5 + & ; ) n8 ;HW 3 ;7H0 + b) M _0 L + $&! $> M ;7H0 k ; I2
k M ;7H0 M _0 k ;7H0 k ;7H0 k _0 k ;7H0 , k _0
.$> v N M ;7H0 M _0 ! 5 ;&G c v N M R 9 N ! $
/2 ; $ V ; ) n8 12
B! ; ;7H0
k , ,) ; I2 3> N , ,) /,! .$>
+ I ! : .O 2 ;H8 $ ;HW ; N y ,K 32 @) 2 !
! + 8 2
2 @) n ;H8 $ ?W / .$ C . .BC k u W ;&G c
/
4398
\1 1 F <=3 1 > ? ,! - 5 E , ).
: ) 8 9 K
-
: 7H0 8 : 7H0 F
M ;7H0
& ) D > ! $> L 4 / 2
2 ? > 2
.(ƒO ! 4 C ,G U ? T )
k ;7H0
; 2 ;! B 7 2 L ?/F A M ;! C ; 2
& ) >
4 / 2
! : R 2 ? T )
.(ƒO ! 4 C ,G + U
k ;7H0
& ) ƒO8 $, :J 7, ! ;%0 M 7 2
.(... { R
k %V ;7H0
& ) HR ;G 7 &! N C : ,2 M 7 2
k 1> ,) p „ M .( $> 9> *
J ) ;7H0
& ) ,2 ? / : !L T bI : * … $
.(... > C
J > ;7H0
& ) ; ! + C / 4 / 2
$ 2
.(p c> ;FIR L ? ! ; &0 ,|
J I2 ;7H0
& ) ,2 ' () _ / 2
4 U ,2 $ 2
M C 72 B O* $C y c) y ! ! .(... O 2 . $ $ !
J 2 ;7H0
& ) C ,,6 B/ ;! ,2 ' () + B W 2
.(... 9H8 p T k $
J% ;7H0 '+
& ) A $2 2 H1 + ; K 2
3 e,
'+
.(... 2
J2 ;7H0
& ) ,,6 ! B,G €7 ' ()
B $ ) 2
.( H/* 4 / ; 4 !
J2 + ;7H0 $%& ) $%& : &. $ + ;! ,2 ? / ' 7
.(... k / k / L ;! $ ) C
J2 + ;7H0
! _/0 . H ! + $
F / J Q /
v N Y $ /2 5 2
' 4, 7
J, $ ' + I ;HR W p ?,HF ,,6 }8 > ' + 4, ]/2 . ! / V $
) ) (RCI ) A 7 G C 7! 1,0 33
! (
vOR M C + $ 47 7 $>
; F !
! ! .$> I : / & L ,,6 BC ,) 3 & ,G ! ,,6 %!
! O* 0 L 2 ,6 ,,6 &0
^
;cK 4 C , %! $R ' + 2 ! ' !
+ ! " , ! B%0 .$ I }8 >
2 3>
( ,H/* 3 ) ! " ;
) : 1 b 2 k 34
$> I , ( .
#,V
&
M $0 2
@ +L 8 > B,&/0 2 2
.B $> ;Q
\1 2 KD 1. ( = F &
/ , + C&1D F &
B >
$ 4 B,&u
?2 , :O, F B,&u
M 6 >
: $.
H . :$
7!
;K!
T
/,!
M 39
?2 JH|
5 M
!
/,!
k 30
?2 JH| + 1,!
3 M 5
!
/,!
k 36
?2 JH|
$ T †/
, * 3 M 5
!
M $0 3 ) ,,6 }8 > %! $R
/,!
$ 2 y ,K , * * $ 2
.B $>
\1 3 . - F W3 X + 1 F !< [
, * & & $
$ C M /,!
k /,!
k /,!
M ; ) n8 124
115
136
M ;7H0 126
113
133
J2 + ;7H0
73 61
78
) ,,6 }8 >
) (RCI 25
/ 6 - 62
/ 6 - 11
/ 7 -
%! $R 41٪
46٪
42٪
H %! $R
43٪
k B! , ,)
78 69
84
) ,,6 }8 >
) (RCI 64
/ 5 - 64
/ 5 - 38
/ 6 -
%! $R 37٪
40٪
38٪
H %! $R
33 / 38٪
) I B O*
- ( : / 2 ,,6 $ 2 .$> !
; c /2 M $0 2
3 /,! $2
y ,K U ! : / ; ) n8 ;HW M ;! 8L ;7H0 ; ; > , * * $ 2 $ 2
%!
41 ٪ ;! , ,) k ;HW + $&!
37 $, ٪
4 $ L B $! ) ,,6 }8 > ;! ;0 ! .B
/
4498
) + b) ;HW /,!
25 / 6 - RCI=
8L (
) , ,) ;HW 64
/ 5 - RCI=
L & ( 2
) •c p<0.05
%! ,,6 ! & + W (
$ 2 J O* :$> $ $ L 0 ! + * $ 2
'+ + ) ,,6 }8 > $K ) B L ^ Z
&
96 / 1 4 C ^ ! 4, ]/2 .(B ,!
& ' ! ;cK + ;! /,! : / 32 85
$R
k / ;HW $ L B $! %!
) 41 (
, ,) ) 37 ^ + ,,6 M . ?! . & (
,G ! .$> !
: ,,6 $ ; ) n8 ;HW J2 k /,!
$ M /,! $ ;! . ! " $W : ,,6
$> ?W / N + b) B Y
%! $R 46
,,6 }8 > .B $ L B $! ٪
+ b) ;HW ;! ; ) n8 ;HW + $ L B $! ) , * * $ 2 $ 2 y ,K : /
) 1 62 / 6 - RCI=
, ,) k B! + b) (
) 64 / 5 - RCI=
HW ;! B 7 ( + W ; ) n8 ;
$ 2 $ 2 J O* :$> $ ,,6 ! &
: / 32 ! 4, ]/2 .B L ^ + /,! * ) ' ! ;cK + ;! /,!
85 ( ) %! $R 46٪
(
) , ,) ;HW k / ;HW 8L ;7H0 40٪
(
+ ;H8 $ ' 4 & ,"
,G ! ^
.$> !
%! $R , k /,!
42 ;HW + b) ٪
, ,) $2 6
; I2 ,
4, ) / /,! 4 p $ $2
%! $R ;! $ L 38
;! ;0 ! .B $, ٪
32 L ^ + , /,! 4 $ L B $! p n8 ;HW ;! B 7 8L ;7H0 &
) & •c ; ) p<0.05
) ,,6 }8 > ! (
) 11 / 7 - RCI=
8 + ( : / 32 .$2
& ' ! ;cK + ;! /,!
85
%! $R ?! .
) + b) ;HW ;^WO 42٪
, ,) + $&! (
) 38٪
$ 2 J O* :$> ,,6 & ! H,G ( .B ,G ! E FG + /,! * $ 2
;! H %! $R ƒ C ;! ;0 ! 4 ! ! ) + b) ;HW $ L B 43٪
;HW (
) , ,) 33
/ 38٪ ,u C ( $, 32 @) ; ; , >
) $%& ' () ! ; J , (ACT
;! ; 7! /,! * + , ,) B
4, I L "x
.B
0 20 40 60 80 100 120 140 160
ﻝﻭﺍ ﻪﻳﺎﭘ ﻁﺧ ﻡﻭﺩ ﻪﻳﺎﭘ ﻁﺧ ﻡﻭﺳ ﻪﻳﺎﭘ ﻁﺧ ﻡﺭﺎﻬﭼ ﻪﻳﺎﭘ ﻁﺧ ﻝﻭﺍ ﻪﺳﻠﺟ ﻡﻭﺳ ﻪﺳﻠﺟ ﻡﺷﺷ ﻪﺳﻠﺟ ﻡﻬﻧ ﻪﺳﻠﺟ ﻡﻫﺩﺯﺍﻭﺩ ﻪﺳﻠﺟ ﻝﻭﺍ یﺭﻳﮕﻳﭘ ﻡﻭﺩ یﺭﻳﮕﻳﭘ ﻡﻭﺳ یﺭﻳﮕﻳﭘ
1 .
& $ - 5 W3 1
1 - # M 2B , * &
F G
/ ; c /2 1
n8 ;HW $2
$ 2 $ 2 y ,K : / •c /,! ; 2 ; ) , / ;HW ;! ! B U ! , * * ; ;HW 4 8L $ 4,/2 $,) G
%! $R 32 / ! , ,) ;HW . / $2 + : ,,6 p $ ) + W >
J O* 32 ; ) n8 ;HW ! ;7 K : I $ V 2 0 , * $ 2 $ 2 2
$2 /,! 4,!
. >
}8 > ! 4, ]/2 3> 2
! " ;
+ ( ,H/* 3 )
b 2 k $
: 1
) 34 ( :$ L B $! + p
/
4598
1 - P L 32 $KV) ,,6 + $ HR 2
(‡B C ƒ I :
; C 4 + W 32 @) 2
32 $%& ' () ! ; B ;! ; 7! /,! * M / W B
4, I L B "
%! $R ;! /,! ; V H
43 + $&! $R
;H8 $ 33
/ 38
; C B , ,) + $&! $R $
;HW + $&! + $&! ;HW % L : / •c ; > 32 ; ) n8 ;HW ! ;7 K , ,)
$2 % L ,,6 . >
2 - ,,6 /,! + $R $ V) ,,6 B,H $
$ V 1 ,,6 $R (‡$
:
; C 2 ; $2
$ L C ; ) n8 ;HW ;! B 7 /,! ; 2
; > P L 7F : ,,6 L + b) $
E FG + J2 L E FG + J2 $ L 0 ;! : ,,6 & ,G !
$> ! .
3 - + W ) ,,6 B, /*
$ $ + 2
• ,,6 $KV 8 * / 0 H6> 1H/*
) 1H/* H ! + y ,K :(‡B W (GAF
$ L C + $&! /,! ; 2 ; B 4 + * / 0 H6> 1H/* 3 C , ,)
+ $ 8 / BC ,)
5 2 : / .$
+ ) 1H/* H ! + y ,K /,!
;! (GAF
M $0 v >
4 .$> !
\1 4 .
7 $ - 5
) - = 1 2! (GAF ACT
+L + ? .
+ $&!
M /,!
45 75
k /,!
40 70
k /,!
45 80
M $0 p ;! ;0 ! 4
; BI
) $%& ' () ! + W ! (ACT
2
8 * / 0 H6> 1H/* ;H/0 + $ + .B ; > ( Y ,"
4 - $ L C + $ ;V C ) ' () ,
$ ) ;! L ; > B ;&G c :(‡$
u W ; W k ; 2 e,I $
A c& > , $> ; C ^ U ! ()
$ > mW 8L %! , ! /,! ; 2 8 ! $ ?6> ?,G ;! k /,! ;V
D > ,8 ! : 7H0 + .$>
5 - B O " L) / /70
p :(‡B ; C 3 C /,!
B O $2
; C , 32 $ L C /,! /70 P L Y B ! /,! ; 2 2
%! : ,,6 $ : 8 ! 4 C ^ $2 K /,! : / B,&u >
y ,
) 1H/* H ! + 1H/* %! (GAF
+ W * 4 ! ?,G $ + 2 .$> !
6 - ; > k $KV 2 ) : "
W u W ;&G c , ,) ; I2 3> p :(‡B P L hHS ; B 4 + 2
2
; > k .B
1 ^
# , F K
4,,& A$2 ! u W ;&G c ! "
) $%& ' () ! * + , ,) (ACT
;! ; 7! /,!
B 4, I L
; C .$> k 2
+ , ,) $%& ' () ! ; ;! ; 7! /,! * B
4, I L "
.B
}8 > ! 4, ]/2 3> 2
! " ;
( ,H/* 3 ) : 1 b 2 k $ +
) 34 (
, ,,6 B, /* ,,6 B,H ,,6 + $ ;H/0 + ! " + W p : " / ' ()
* + , ,) $%& ' () ! /,!
; 7!
;!
B 4, I L ! $ L B ;! p .B
; C 32 @) 2 1/2 {,2
) 23 1 s(
:U )
18 s(
/2 G 1 ) 21 s(
T + 4,H7 !
/
4698
4 5 )
22 78 ( )
25 ( /2
.
; C ! ` L 4,, 32 @) 4
; BI + $ $0 M$ $%& ' () y
5/ C ;! M$ 4 .B L B8 >
$
$ + ; ,7 :O1 ;! B 7 3 8 $ L + ,7! .$ ,,6 0 L 2
5/ ;! 2
%! y 7W $
' () G .$ > ! ; >
$ + ! q W R $%&
A R / %!
y 7W ! %! $ + ;1 + ^
$> $> ! /2 %!
) 17 ' () ! .(
&0 ! mC '+ L 9 N + $%&
BW : N 8 : 7W 1C ;! B Y >
$ ; , + $
$ ,% * ; ;
3> 2 $%& ' () ! 1 .$ L 0 ! 8 > 3H7 ' () & 4 , ! $ L C ; , + * ;! 8 ; $%& ?/* + ! `
h, J2 ! %>+
A c& $ >
()
$ L $ $) 8 >
) 17 (
! " ;
* + , ,) ACT
.$> ! " $
4 ; B 4 $%& ' () ! A$2
;/2 ; $ L C 3>
L c& 2 A ()
B /W 8 >
BK,KW .$ / B K $
;8 V q $ $> C ; + t 0
!
& V $ , 8 > , L A c
()
B $> 8 >
) 15 A c& .(
2w ()
; $ L 1C k + C $ $ 2 ! 2
; , + ; A ;! 3 A * ' 6G +
V 2 2 '+ L h, 4 $! .B 42w 2 L 1C $ ! + C 4 $
$ L
; ;! 7! C q . & $ 2 ! 2
y ! ;%0 $ ! + :O1 ; + 2
; U K& %!
; ! ;! ! 3 ' 6G 2
.$ L A
; C 4,,
@)
! " ~ 8 32
* + , ,) ACT
; BI
J2 k %I $%& ' () ! , L
," , 8 > 3H7 OY ) 1C 5 ; $> !
BC ! ;! ; 7! C s C (A ;! ?, 4,! ,) 1C ;! ; 7! C 2
J , L
. 8 > 3H7 ' 1C ! C . $ ,
J2 / , L B,&. + ' 8 2w : m. $
8 +
$2 ,/ B,&.
) 15 4 ; , .(
42w '+ L ! ," M W + ?/* 2 L
B, 7W A + > ,2 1 ˆ G ,C 2
: ,! 4 ! C ;c! ;c ;! 1>L C ? $&
A ;! 4 4 ! ! . >
$
'+ L 8 : ,! $ ! ; >
, /2 ;! $ ?/F $ (|!
+ ?K 7 $
.$ ?/* : ,! 4
* ;1 ;! ;0 ! A ;! $ B + !
@ +
?1 2 A :UO 8 _ > +
;Q ;! ‰ ! + , 5 B A ! 2
y 7W ;! .$ ŠIW + M N p ; >
^ KG ! " $%& ' () ! ; $
‰ ! ,)
+ $&! ;! B 7 ,
; ^ ! ; B + )
' () !
; B 7/2 $%&
A c& 3 C L ()
,,6 ; ;! B 41/ + $&! 8 >
. > + M N $> B Y C
B $F + u W ;&G c 2
;!
8
32 @) ! 2 ,6 ! >
, ,) !
6
; I2
! ,7 0 5
+L 2 ; > ( ) J,/& B7 !
/
4798
; C % ,) . ` , W L ;& 0 ;! 2
U N , ,) + L : K,KF >
+
C b 0 2
! " > I ,
+ ;! ; 7! /,! ! ' 4 . ! + ,C ;! ; 7! /,! ;H/0
. ,
1 7 3
;G + ; C ! u W ;G K 4 $! .$> ! k F 4,G €7 + ;H,
! 4 , * T , t 1 %> 7 %
2 @) L ; / t ; %>
B > 32 @) $ L C M N ; /,! + , $ ?/&! 1 $K $ >
; B w > .$ L
/ ‹ & $ 7 _C ! ;&G c 4 p .$> !
/
4898
References
1. Tarabar AF, Nelson LS. The resurgent and abuse of heroin by children in the United States. Current Opinion in Psychiatry. 2003;
15(3): 210-215.
2. Barlow D, Durand M. Abnormal psychology. Translated by Raza Abdi et al.
Tehran: Avicenna Publishing House. 2017;
220-235. (In Persian)
3. Haddad S, Khosravi M, Najafi M, Sabahi P.
Comparison of Attention Function in Meth- Amphetamines. Journal of Clinical Psychology. 2014; 6 (2): 85-95. (In Persian).
4. Aram PW, Bailey GJR, Lavin A, See R.
Methamphetamine Self-Administration Produces Attentional Set-Shifting Deficits and Alters Prefrontal Cortical Neurophysiology in Rats. Biological Psychiatry. 2011; 69(3): 253–259.
5. Bolla KI, Ernst M, Kiehl KA, Mouratidis M, Eldreth DA. Prefrontal cortical dysfunction in abstinent cocaine abusers.
Neuropsychology Clinical. 2004; 16, 456–
464.
6. Hester R, Garavan H. Executive dysfunction in cocaine addiction: evidence for discordant frontal, cingulate, and cerebellar activity.
Journal of Neuroscience. 2004; 24: 1017–
1022.
7. Brower KJ, Perron BE. Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances.
Journal of Medical Hypotheses. 2010; 74:
928–933.
8. Ibrahim F, Kumar N. The Influence of community on Relapse Addiction to Drug use: evidence from Malaysia. European
Journal of social Sciences. 2009; (11) 3: 89- 100.
9. Marlatt GA, Barrett k. Relapse Prevention:
In H.P kleber (Ed) the text book of substance abuse. Washing ton D.C. American psychiatric press Inc. 1994; 121-143.
10. Bahari F. Addiction to counseling and treatment (Guide to the behavioral change in addicts). Tehran: Nashredanjeh, Second Edition. 2013; 115-170. (In Persian).
11. Verdejo Garcia A, Lawrence AJ, Clark L.
Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high risk research, problem gamblers and genetic association studies.
Neuroscience and Biobehavioral Reviews.
2008; 32: 777–810.
12. Marlatt G, Gordon J (Eds). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York:
Guilford. 1985; 208-250.
13. Karimian N. Effectiveness of cognitive- behavioral stress management on the prevention of recurrence of dependent men.
Quarterly Journal of Addiction Research.
2011; 5 (20), 86-73. (In Persian).
14. Porzour C, Alizadeh GJ, Yagooty ZH, Basharpour S. Effectiveness of quality of life-based positive-quality psychotherapy on improving the quality of life of opiate addicts. Quarterly Journal of Addiction Research. 2015; 9 (35), 48-137. (In Persian).
15. Hayes SC, Sterosal K. Practical Guide to Acceptance and Commitment-Based Treatment, translation by Alizadeh Mousavi and Pir Javid. Tehran: Faraangizesh. 2015;
95-135 (In Persian).
/
4998
16. Hayes SC, Luoma JB, Bond F, Masuda A, Lillis J. Acceptance and Commitment Therapy: Model, Processes and Outcomes.
Behavior Research and Therapy. 2006; 4: 1- 25.
17. Hayes SC, Lillis C. Acceptance and Commitment Therapy (Theory Psychotherapy). American Psychological Assn. 2012; 109-141.
18. Witkiewitz K, Marlatt A, Walker D. Mind- fullness-based relapse prevention for alcohol and substance use disorders: The meditation tortoise wins the race. Journal of Cognitive Psychotherapy. 2005; 19, 221-229.
19. Ilhan IO, Demirbas H, Dogan YB.
Validation study of the Turkish version of the Yale-Brown Obsessive Compulsive Scale for heavy drinking in a group of male patients. Drug and Alcohol Review. 2006;
25: 357-360.
20. Walton-Moss B, McCaul ME. Factors associated with lifetime history of drug treatment among substance dependent women. Addictive Behaviors. 2006; 31: 246- 53.
21. Li CS, Milivojevic V, Kemp K, Hong K, Sinha R. Performance monitoring and stop signal inhibition in abstinent patients with cocaine dependence. Drug Alcohol Dependence. 2006; 85: 205–212.
22. Breslin FC, Zack M, McMain S. An information processing analysis of mind fullness: Implication for relapse prevention in the treatment of substance abuse. Clinical Psychology, Science and Practice. 2002; 9:
275-299.
23. Twohig MP, Shoenberger D, Hayes SC. A preliminary investigation of Acceptance and Commitment Therapy as a treatment for marijuana dependence in adults. Journal of Applied Behavior Analysis. 2007; 40: 619- 632.
24. Dabbaghi P, Asgharnejad A, Atef VM, Bolhari J. Effectiveness of Group Cognitive Therapy Based on Thinking (Mindfulness) and Activating Spiritual Schemes in Preventing the Recurrence of Opiate Use.
Iranian Journal of Psychiatry and Clinical Psychology. 2007; 13 (4): 366-375. (In Persian).
25. Tamoradi A, Khosravi P. The effectiveness of group therapy based on admission and commitment on controlling impulse and relapse in addicts. Tehran: Third International Conference on Recent Innovations in Psychology. Counseling and Behavioral Sciences. 2016; 12: 25-42. (In Persian)
26. Zargar F, Mohammadi A, Omidi A, Bagherian R. Third wave of behavioral therapy with an emphasis on acceptance behavioral therapy. Journal of Behavioral Sciences Research. 2012; 10 (5): 383-390.
(In Persian)
27. Tran GQ, Smith GP. Behavioral Assessment in the Measurement of Treatment Outcome, In. SN. Haynes, & EM. Heiby (Eds), Comprehensive Handbook of Psychological Assessment. New York: Wiley. 2004; 269- 290.
28. Sharifi V, Asadi SM, Amini H, Kaviani H, Semnani Y, Sha'bani A. The Proofreading Diagnostic Interview for DSM-IV. New
/
5098
cognitive science. 2004; 21 (2). 10-22. (In Persian).
29. Gorski TT. Passages through Recovery.
Center City, MN: Hazelden Press. 1989;
47-63.
30. Asadi A. The study of the effect of the company in the groups of anonymous addicts on the rate of addiction recurrence in their addicts. The Center for the Treatment of Addictive Behzisti of Isfahan, a master's thesis. Khorazgan Azad University. 2003;
60-79. (In Persian).
31. Niknam M, Madahi M, Shafiabadi AS.
Comparison of the Effectiveness of Marlat and Meaningful Cognitive-Behavioral Model on Reducing Craving and Preventing the Return of Women Dependent on Materials. Quarterly Journal of Psychological Applications Research. 2017;
8 (2):15-1. (In Persian).
32. Wilson KG, Gifford E, Beten S. Individual Acceptance and Commitment therapy Protocol for drug addicts. Translation by Farhad Asghari et al. Tehran: Pejhwak honar
& Andisheh Publications. 2014; 39-65. (In Persian).
33. Jacobson NS, Follette WC, Revenstorf D.
Psychotherapy outcome research: Methods or reporting variability andevaluating clinical significance. Behavior Therapy. 1984; 15:
336-352.
34. Ingram RE, Hayes A, Scott W. empirically supported treatments: A critical analysis. In Snyder CR, Ingram RE (Eds.). Handbook of psychological change: Psychotherapy processes and practices for the 21st century.
New York: Wiley; 2000; 41-60.
/
5198
Effectiveness of Acceptance and Commitment Therapy (ACT) in Relapse Prevention in Methamphetamine Addict Patients
Arjmand Ghujur K1*, Mahmoud Aliloo M2, Khanjani Z2, Bakhshipour A2
1. Faculty of psychology, Ph.D. student, Tabriz University, Tabriz, Iran [email protected]
2. Professor, Department of Psychology, Tabriz University, Tabriz, Iran
Received: 22 Des 2018 Accepted: 2 Feb 2019
Abstract
Background: Drug abuse has become one of the major problems in society and has become more prevalent among young people. The aim of this study was to evaluate the effectiveness of acceptance and commitment therapy (ACT) in relapse prevention in methamphetamine-dependent patients.
Materials and Methods: In this study, a single-case experimental design with a linear asynchronous base line was used. Three male methamphetamine addicted patients were chosen, who had come to the Welfare Organization, and to the Addiction Withdrawal Center in Takab Township. Patients underwent a diagnostic interview, and a structured clinical interview with a purposeful sampling method. The study tools used were Structured Clinical interview (SCID), demographic characteristic questionnaire, urine test, Gorski Relapse Prediction Scale (1989) and Individual Therapy Protocol (ACT). The results were determined using methods of visual inspection, reliable change index (RCI), improvement percentage formula, clinical significance change and operational measurement.
Results: The data showed that there was a significant reduction in the probability of recurrence in patients (P <0.05), based on clinical and operational measurements.
Conclusion: Acceptance and commitment (ACT) therapy is effective in preventing relapse in methamphetamine-dependent patients.
Keywords:acceptance and commitment therapy, relapse prevention, methamphetamine
*Citation: Arjmand Ghujur K, Mahmoud Aliloo M, Khanjani Z, Bakhshipour A. Effectiveness of Acceptance and Commitment Therapy (ACT) in Relapse Prevention in Methamphetamine Addict Patients. Yafte. 2019; 21(1):38-51.
