Comparing the Impact of Atropine Drops and Amitriptyline Tablets in Treatment of Clozapine-Induced Sialorrhea: A Randomized Double-Blind Placebo Controlled Clinical Trial

Clozapine is an atypical antipsychotic employed to treat patients with psychotic disorders. It is associated with sialorrhea as a problematic adverse effect in 30-80% of cases. Various medications such as atropine and amitriptyline have been suggested for its treatment. We aimed to compare the effects of atropine drops and amitriptyline tablets in the treatment of clozapine-induced sialorrhea. The present double-blind, randomized clinical trial aimed to evaluate the effect of atropine drops and amitriptyline tablets in reducing clozapine-induced sialorrhea in patients with psychotic disorders. Forty-six patients were treated for 4 weeks in two groups: group “A”(atropine drops and placebo tablets) and group “B” (amitriptyline tablets and placebo drops). Toronto Nocturnal Hypersalivation Scale (TNHS) and Clinical Global Impression (CGI) rating scale were used for measurement of the severity and frequency of sialorrhea and global symptom severity and treatment response, respectively. Kolmogorov–Smirnov, Chi-square and Fisher's exact tests were used for statistical analyses. Demographic information of the two groups had no significant difference (P>0.05). There was no patient with adverse effects that interfered with the study. Mean TNHS and Meier scores in groups “A” and “B” were 3.48±0.21 vs.3.24±0.18, and 1.9±0.07 vs.1.86±0.07, respectively, and the difference was not statistically significant (P=0.35 vs. P=0.67). In patients with clozapine-induced sialorrhea, 1% atropine drops (1.7 mg sublingual drops daily) can be just as effective as amitriptyline tablets (29.08 mg daily, oral) in controlling sialorrhea

Psychological Experience and Needs of Front-line Nurses during COVID-19 Outbreak in Iran: A Qualitative Study

Background and purpose: At the beginning of 2020, Covid-19 disease spread rapidly in most parts of the world. Meanwhile, medical staff experienced a lot of stress due to the high disease transmission rate and considerable rate of morbidity and mortality. The aim of this study was to explain the psychological experience and psychological needs of nurses working at frontline of treatment of patients with Covid-19. Materials and methods: We performed a phenomenological qualitative research in Sari, Iran May and June 2020. The participants included 9 nurses selected via convenience sampling. Data were collected using in-depth and semi-structured interviews by a psychiatrist. Finally, Data were coded and analyzed using MAXQDA-2020 software. Results: According to findings, three main themes were extracted, each theme was formed from categories and each category included some codes. Emotional experiences, expectations from superiors, and the need for psychological interventions were the main themes. Conclusion: In this study, nurses reported different emotions such as satisfaction, anger, and worries about being at risk of infection and transmitting the disease to their family. The needs of nurses included psychological and financial supports and appreciation and empathy from the authorities, workplace security, and in-person psychological interventions

A triple-blinded, randomized, placebo-controlled trial to examine the efficacy of buspirone added to typical antipsychotic drugs in patients with chronic schizophrenia

Background: The purpose of this study was to test the hypothesis that the addition of buspirone, a partial agonist of 5HT1A receptor, to ongoing treatment with typical antipsychotics would improve the positive and negative symptoms in patients with chronic schizophrenia. Materials and Methods: In this study, 50 patients including 40 male and 10 female were recruited with chronic schizophrenia who were inpatients at psychiatric teaching hospital or asylums, aged between 18 and 65 years (mean age = 47 ± 10.02). All patients were on the stable dose of typical antipsychotics for at least 1-month, and their acute symptoms were controlled. Patients were allocated in a random fashion: 25 patients to buspirone at 30 mg/day plus typical antipsychotic and 25 patients to placebo plus typical antipsychotic. The positive and negative syndrome scale (PANSS), Simpson-Angus extrapyramidal rating scale (SAS) and mini mental state examination (MMSE), were administered at baseline, and 2, 4, and 6 weeks after the addition of buspirone. Results: The 30 mg/day buspirone was well-tolerated, and no clinically important adverse effects were seen. There was no statistically significant difference between the two groups in MMSE and SAS scales. There was a significant reduction in subscales of negative, general, positive, and total of PANSS over the 6-week trial in buspirone group. There was a statistically significant difference between the two groups negative subscale (mean ± standard deviation [SD] = 14.08 ± 1.4 in buspirone group) P = 0.0219, general subscale (mean ± SD = 27.42 ± 2.1 in buspirone group) P = 0.0004, and total subscale (mean ± SD = 55.63 ± 3.9 in buspirone group) P = 0.0298, of PANSS in the 6-week of trial. Conclusion: The results suggest that adjunctive treatment with 5HT1A agonist such as buspirone may improve the negative symptoms of schizophrenia. Further studies are indicated to determine the efficacy of 5HT1A agonist treatment in chronic schizophrenia

Prevalence and Severity of Obsessive-Compulsive Disorder and Their Relationships with Dermatological Diseases

Most obsessive-compulsive disorder (OCD) patients meet psychiatrists 5 to 10 years after onset of OCD .Its relatively high prevalence ratio and the delay in seeking help suggest that patients with OCD may seek help at non-psychiatric clinics. The present study was undertaken to provide some epidemiological data on the prevalence and severity of OCD in dermatological patients. The participants included 265 consecutive patients with primary dermatologic chief complaint. They were visited by a dermatologist and diagnosis of dermatological lesion was done according to ICD-10. All patients were visited by a psychiatry resident and were screened for OCD using the structured clinical interview for DSM-IV-TR (SCID-I). If the diagnosis of OCD has been made, the Yale-Brown obsessive compulsive scale(Y-BOCS) was used to evaluate the severity of OCD. To analyze the data student t-test for quantitative variables and X2 tests for categorical variables. From the total of 265 patients, 24 (9.1%) met the DSM-IV-TR criteria for OCD and 9 (37.5%) with OCD had previously been diagnosed with OCD, however, only three were treated pharmacologically. The most symptoms were pathological doubt (29.1%), fear of contamination (29.1%) and washing (54.16%).  Severity of OCD according to Y-BOCS was evaluated among patients with OCD. Six (25%) were found with subclinical OCD, 11(45.8%) had mild OCD, six (25%) had moderate OCD, and one (4.2%) was detected with severe OCD. prevalence of OCD in dermatology clinic was higher compared with general population