The Therapeutic Effectiveness of Risperidone on Negative Symptoms of Schizophrenia in Comparison with Haloperidol: A Randomized Clinical Trial

Introduction: A number of research studies have shown that the new generation of neuroleptic medications can more effectively contribute to treating negative symptoms of schizophrenia compared with the first generation by influence cognitive functioning. The present study examined the therapeutic effectiveness of manufactured Risperidone and Haloperidol in Iran on treating the negative symptoms of schizophrenia. Methods: This randomized clinical trial (RCT) study examined 100 hospitalized patients who met DSM-IV. TR criteria for schizophrenia were sampled at Razi psychiatric hospital in Tehran, Iran. After two weeks of stopping neuroleptic medications, the patients were randomly assigned into two groups, Risperidone and Haloperidol group. During 8 weeks of the study, baseline and weekly assessments were performed by completing brief psychiatric report scale (BPRS). Results: Both Risperidone and Haloperidol were effective in treating the negative symptoms of schizophrenia and improvements in both groups were initiated in the second week of treatment. The most prominent response rate was the second week in Haloperidol group and the eighth week in Risperidone group but this difference was not statistically significant. Discussion: Prescribing Risperidone or Haloperidol for treating negative symptoms of schizophrenia can be influenced by other criteria including side effects, previous treatment histories of patients and their families and a patient`s or physician` preference in prescribing a medication. Studies in other countries show that Haloperidol has better therapeutic effects in treating the negative symptoms of schizophrenia in comparison with Risperidone. Further studies on the therapeutic effectiveness of Risperidone and Haloperidol are suggested

Pattern of Antipsychotic Use and Its Determinants in Razi Psychiatric Hospital

Objectives: The aim of this study was to investigate the prevalence and its determinants of Antipsychotic Use in patients with psychiatric disorders. Materials and Methods: This study was on patients with psychiatric disorder that have discharged from the hospital. We have assessed all patients with psychiatric interview and evaluation of their psychiatric documentations. Results: 90.7% of all of patients had taken antipsychotic medications and antipsychotic polypharmacy was in 27.2% of these patients. The most prevalent component of antipsychotic polypharmacy was consisting of Chlorpromazine, Halopreidol and Chlorpromazine, Risperidone and then Chlorpromazine, Olanzapine respectively. There were significant relations between pattern of antipsychotic use and gender, occupation status, type of psychiatric ward, duration of hospitalization and cost of treatment but no relationship with age, educational status and duration of illness. Discussion: This study suggests that prevalence of antipsychotic polypharmacy is high in in-patient psychiatric patients

Obsessive-Compulsive Disorder in Hospitalized Patients with Schizophrenia

Introduction: Comorbid obsessive-compulsive disorder (OCD) has been reported among patients with schizophrenia in other countries. But, the literature is not well-documented on this issue in Iran (Persia). The present study aimed to investigate the prevalence and severity of OCD and some of its related factors in a group of patients with schizophrenia in Iran.  Methods: This is a cross-sectional study. A total of 150 hospitalized patients with schizophrenia were recruited at Razi Psychiatric Hospital in Tehran, Iran. Demographic and clinical checklists, as well as the Yale-Brown obsessive-compulsive scale (Y-BOCS), scale for assessment of negative symptoms (SANS), and scale for assessment of positive symptoms (SAPS) were administered to collect data. OCD was the dependent variable and independent variables included age, sex, severity of positive and negative symptoms, duration of schizophrenic disorder, the number of hospitalizations, and antipsychotic medications administered to them. Data were analyzed by analysis of variance (ANOVA), Chi-square, and T-test.  Results: Overall, 31.3% of patients had OCD with an average severity of 12.81(SD=10.27). The prevalence of OCD was not affected by the number of psychiatric hospitalizations for schizophrenia or the duration of schizophrenic disorder. The severity of OCD significantly reduced as the duration of schizophrenia and the severity of negative symptoms increased.  Conclusion: OCD was found among a considerable proportion of the study sample. OCD may be associated with exacerbating schizophrenic symptoms. Therefore, psychiatrists should consider the simultaneous treatment of OCD and schizophrenia. Further studies are suggested in this issue

Evaluation of Prevalence and Effective Factors on Changing the Diagnosis from Mood Disorders to Schizophrenia after Six Years

"n "nObjective: The purpose of this study was to assess the prevalence and possible variables on changing the diagnosis of mood disorder patients to schizophrenia. "n Method: "n "nThis study was a retrospective and comparative analytic research that was performed in 2006 in Razi psychiatric hospital. The sample consisted of all the 176 patients who were hospitalized in 2000 with the diagnosis of mood disorder. The patients were divided into two subgroups: the stable group with a persistent mood disorder diagnosis and the changed group with a changed mood disorder diagnosis to schizophrenia. Data were analyzed between these groups using chi-square and t student test. "nResults: Findings showed that 31.3% of all the patients shifted towards chizophrenia; 23.3% and 32.9% of the patients with major depressive disorder and bipolar disorders shifted towards schizophrenia respectively. No statistical difference was observed between the groups in demographic variables but there was a statistical difference in some of the clinical variables such as psychotic features (p<0.01), severe clinical features (p<0.05), and the gradual onset of disorder (p<0.05) with changing the diagnosis to schizophrenia. "nConclusion: Recognition of clinical variables associated with changing the diagnosis to schizophrenia such as psychotic features, severe clinical features and the gradual onset of disorder will help clinicians to manage these patients better than the past

Needle and syringe sharing among Iranian drug injectors

Abstract Objective The role of needle and syringe sharing behavior of injection drug users (IDUs) in spreading of blood-borne infections – specially HIV/AIDS – is well known. However, very little is known in this regard from Iran. The aim of our study was to determine the prevalence and associates of needle and syringe sharing among Iranian IDUs. Methods In a secondary analysis of a sample of drug dependents who were sampled from medical centers, prisons and streets of the capitals of 29 provinces in the Iran in 2007, 2091 male IDUs entered. Socio-demographic data, drug use data and high risk behaviors entered to a logistic regression to determine independent predictors of lifetime needle and syringe sharing. Results 749(35.8%) reported lifetime experience of needle and syringe sharing. The likelihood of lifetime needle and syringe sharing was increased by female gender, being jobless, having illegal income, drug use by family members, pleasure/enjoyment as causes of first injection, first injection in roofless and roofed public places, usual injection at groin, usual injection at scrotum, lifetime experience of nonfatal overdose, and history of arrest in past year and was decreased by being alone at most injections. Conclusion However this data has been extracted from cross-sectional design and we can not conclude causation, some of the introduced variables with association with needle and syringe sharing may be used in HIV prevention programs which target reducing syringe sharing among IDUs.</p

Attention Deficit Hyper Activity Disorder (ADHD) and Stress: A Mutual Relationship between Children and Mothers

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by high levels of inattention, hyperactivity and impulsivity which may result in mothers’ stress. The current study aims to compare stress among 45 mothers of ADHD children who had referred to “Rofeydeh psychiatric center” with 45 mothers of normal children. Methods: Brief demographic researcher-made questionnaire, Child Symptom Inventory-4 (CSI- 4), the Child Behavior Checklist (CBCL), and Parental Stress Index-Short Form (PSI/SF) were completed for each mother and child. Results: The results showed that except the component of acceptance, ADHD children had more problems in the field of attention compared with normal children. Mothers of ADHD children had also more stress compared with mothers of normal children. Discussion: ADHD can impair mothers’ mental health by inducing stress and this issue has important clinical and treatment implications. Specific treatment programs should be designed and implemented in Iran for the mothers of ADHD children to reduce stress among them and therefore, improve their mental health status

Pattern of Psychotropic Drug Prescription in the Elderly with Chronic Schizophrenia

Objectives: Psychotropic drug use in the elderly with chronic schizophrenia is an important issue in the field of psychiatry. The main goal of this study was to clarify the pattern of such drug use in these patients, in order to consider such therapy plan and focus on its cost attributing measures, for a more reasonable quality of care program. Methods: In this descriptive study, participants included 52 elderly patients at Tehran&rsquo;s Razi Mental Hospital who had chronic schizophrenia in the residual phase. Selected patients were taking at least two psychotropic drugs equivalent to 500mg Chlorpromazine. We prepared the list of the drugs used by completing the pre-designed questionnaire charts. Data were analyzed with SPSS 17. Results: In one case (1.92%) the entries were Risperidone, Chlorpromazine, Fluphenazine Decanoate, & Thiothixene). In 11 cases (21.2%) there were three entries and in 40 cases (76.8%) there were two. The Chlorpromazine equivalent dose in each group ranged from the lowest dose (750 mg) to the highest (5600 mg). The highest Chlorpromazine dose (5600 mg) equivalent per milligram belonged to the four entries of (Risperidone, Chlorpromazine, Fluphenazine Decanoate & Thiothixene). The lowest Chlorpromazine dose (750 mg) was seen in 3 entries of Risperidone, Chlorpromazine & Fluphenazine Decanoate. Discussion: There was a high prevalence of using more than two psychotropic medications from the first atypical antipsychotic category. Less frequently, the second and the third typical antipsychotics were used. We recommend further research into more feasible patterns of psychotropic prescriptions, lowering the amount of medication use and considering their cost-benefits in the elderly with chronic schizophrenia

Investigating the Attitude of Graduate Psychiatrists towards Objective Structured Clinical Examination (OSCE) and Conventional Clinical Interview Examination.

Objective: In the present study, we investigated the attitude of psychiatrists who graduated in 2002-2009 towards Objective Structured Clinical Examination (OSCE) and conventional clinical interview examination (Individual Patient Assessment). Method: We studied 134 psychiatrists graduated; half of whom were examined with conventional clinical interview and the others with OSCE. A questionnaire was prepared by a specialist workgroup to assess the participants’ attitude towards the exams. The questionnaire was initially examined in a pilot study. The findings of the questionnaire were used to assess the graduates’ attitude towards each examination, as well as to compare the examinations. Results: The OSCE group indicated a significantly more positive attitude compared to the conventional group (p = 0.03). Furthermore, the OSCE group believed the role of theoretical knowledge (p = 0.01) and pre-test practice (p = 0.03) to be significantly greater for success compared to the other group. The structure of OSCE wa  reported to be superior to conventional examination in terms of fairness and homogeneity (p = 0.004). First participation in exam (p = 0.04) and ultimate success in the exam (p = 0.009) were predictors of graduates’ attitude. Conclusion: Based on examinees ’attitudes, OSCE may be a more appropriate choice for graduation examinations of psychiatry compared to the conventional clinical interview examination