Topiramate augmentation in refractory obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled trial

Background: This study aimed to assess the efficacy of topiramate, a glutamate-modulating agent, in patients with treatment-resistant obsessive-compulsive disorder (OCD) as an adjunct to serotonin reuptake inhibitors (SRIs). Materials and Methods: Thirty-eight patients with refractory OCD, were randomly assigned to receive topiramate or placebo. This study was designed as a 12 weeks, double-blind, placebo-controlled trial. Primary outcome measures were the change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score and the rate of treatment response in each group at the study end point. Treatment response was considered as 25% or more reduction in Y-BOCS score. Results: A total of 13 patients in the topiramate group and 14 ones in the placebo group completed the trial. Topiramate-assigned patients showed significantly improved mean Y-BOCS score over time (P < 0.001). Although differences between two groups were significant in the Y-BOCS score at the first 2 months (P = 0.01), this was not significant at the end of the study (P = 0.10). Changes of Clinical Global Impression (CGI)-Severity of Illness Scale score and CGI-Improvement Scale score were not significantly different between two groups (P > 0.05). Treatment response was almost significantly different in the topiramate group comparing placebo group (P = 0.054). Mean topiramate dosage was 137.5 mg/day (range, 100-200). Conclusion: This study didn’t show efficacy of topiramate as an agent to augment SRIs in treatment-resistant OCD patients

General Health Status in a Cohort of Iranian Patients with Intentional Self-poisoning: A Preventive Approach

Background: Prevention of suicide is one of the most important issues of community medicine in the world. Because of high accessibility of people to different drugs in our society, one of the easiest ways of suicide is intentional self-poisoning. In this study, demographic factors and health status of the patients with intentional self-poisoning were evaluated. Methods: A cross-sectional study was conducted in the poisoning referral center on 384 patients aged 15-40 years who committed intentional self-poisoning. Information was gathered using two questionnaires about demographic characteristics and the general health status of the patients. Results: 70.5% of the patients had easy accessibility to drugs. Most of the patients were women (62.5%) and single (51%). History of psychological disease was demonstrated in 82.5% of patients. In terms of general health status, the most common problems were social dysfunction (97.57%) and depression (88.9%). Conclusion: Easy accessibility to drugs and psychological problems may increase the risk of intentional self-poisoning. Being religious and the consequent hopefulness may have a positive protecting effect for the prevention of intentional self-poisoning