Acid folic supplementation in major depressive disorder treatment: A double-blind randomized clinical trial

Background: Augmentation therapy involves the addition of a second drug, such as mood stabilizers, antipsychotics, and nutritional supplements, to a primary antidepressant treatment. Studies on adding folic acid to a preexisting antidepressive regimen as a form of augmentation therapy have had different and even controversial results. Objectives: This study aimed to determine the effects that adding folic acid to a pharmaceutical diet with citalopram has on the treatment of depression. Methods: This double-blind randomized clinical trial was conducted in Kashan, Iran on 90 patients who suffered from depression. Patients were allocated to study groups using random permuted blocks. One group (n=45) received a dosage of 20 mg citalopram in combination with 2.5mgfolic acid on a daily basis, and the other group (n=45) received the same daily dose of citalopram with a placebo for eight weeks. To measure the severity of each patient’s depression, the Beck depression inventory II (BDI-II) questionnaire was used prior to starting the antidepressant therapy and was repeated four, six, and eight weeks after beginning the treatment. A reduction from the original BDI-II scores that was greater than 50% was considered to be a response to treatment. Results: The average depression scores before treatment were 30.11±10.41 in the intervention group and 31.24±10.26 in the control group (P=0.6). At the end of the study, the depression scores in the intervention and the control groups were 13.31±6.57 and 19.11±8.59, respectively (P<0.001). A reduction in the average depression scores of the intervention group was statistically significant after six and eight weeks (P=0.01 and P=0.001, respectively). At the end of the study, the frequency of response to treatment was 73.3% in the intervention group and 40.0% in the control group (P<0.001). Conclusions: Folic acid, when used as a complementary therapy, can improve a patient’s response to antidepressants used for the treatment of major depression

Therapeutic effect of adjunctive N-acetyl cysteine (NAC) on symptoms of chronic schizophrenia: A double-blind, randomized clinical trial

Abstract Background Schizophrenia is one of the most disabling psychiatric syndromes with the prevalence of 1% in the general population. Despite availability of various antipsychotics, negative symptoms and cognitive impairment are difficult to treat. In addition antipsychotic monotherapy is not effective in most of these patients. Current evidence indicates the roles of glutamatergic system in this disorder. N-acetyl cysteine (NAC) also increases extracellular glutamate. This study was conducted to evaluate the clinical effects of oral NAC as an add-on to maintenance medication for the treatment of chronic schizophrenia. Materials and methods This 12-week, double-blind, randomized, placebo-controlled, clinical trial was performed to determine the effectiveness of 1200 mg N-acetyl cysteine as an adjunctive treatment with conventional antipsychotic medications in 84 patients with chronic schizophrenia. The subjects were evaluated with the Positive and Negative Syndrome Scale (PANSS), Mini-Mental State Examination (MMSE), and a standard neuropsychological screening test. Data were analyzed with SPSS-16 software. Results NAC-treated patients showed significantly improvement in the positive (F = 5.47, P = 0.02) and negative (F = 0.20, df = 1) PANSS subscale. Also the general and total PANSS score of NAC group declined over times whilst it was increased for placebo group. Regarding cognitive functions, improvement was observed in some explored areas, such as attention, short-term and working memory, executive functioning and speed of processing. There was no significant difference between the 2 groups in the frequency of adverse effects. Conclusion The present study detected improvement in positive, negative, general and total psychopathology symptoms as well as cognitive performance with NAC treatment. It is also well-tolerated, safe and easy-to-use agent as an effective therapeutic strategy to improve outcome in schizophrenia treatment. Keywords N-acetyl cysteine Schizophrenia Cognitive impairment Positive and negative symptoms scale (PANSS) Glutamatergic syste

Evaluation of essential depression in patients with physical complaints hospitalized in Akhavan Hospital in 1999

History and Objectives: Considering the incidence of essential depression in patients with physical complaints and lack of precise information in this field, this study was conducted in Akhavan hospital in 1999. Materials and Methods: The descriptive strategy of this study was carried out on 300 male and female patients. All of the hospitalized patients were randomly divided into control (n=150) and case (n=150) groups and their personal characteristics were recorded. Then, Beck test was applied and for those patients with marks higher than 11, a psychiatric interview was arranged according to DSM-IV diagnostic criteria. The statistical X² test was used for analysis. Results: Case group consists of 35 male and 115 female patients and control groups comprised of 83 male and 67 female patients. The highest frequency was that from women with an approximate age of 40 years. The incidence of essential depression was 80% and 27.3% in case and control groups respectively. The most common complaints were those from head and neck (35.5%), musculoskeletal (33.7%), gastrointestinal (18.4%) and cardiovascular and respiratory (12.4%) systems. In addition, there was a relationship between essential depression and physical complaints (P<0.0001). Conclusion and Recommendations: With regard to the high incidence of essential depression, it is recommended to conduct more studies in this field

Comorbidity and pattern of substance use in hospitalized psychiatric patients

Background: Substance use in patients with psychiatric disorder is an every-day seen. Detection of this comorbidity can significantly affect the treatment of these disorders, as well as substance use. Objectives: This study has been conducted to determine the prevalence and pattern of substance use in hospitalized psychiatric patients. Patients and Methods: In this cross-sectional study, 210 hospitalized psychiatric patients were selected by simple randomization from all records of hospitalized patients. The instrument of gathering data was a demographic checklist including age, gender, marital status, education, type of disorder and substance abuse and duration of psychiatric disorder. Data were analyzed by SPSS version 16 using Fisher exact and Chi square tests. Results: The mean age of patients was 37.9 years. Most of the patients were male, married and unemployed. The Prevalence of substance use was 36.7. The most prevalent pattern of substance use was opium, opioid, methamphetamines and other substances (poly substance). The prevalence of substance use in patients with mood disorders was more than the other disorders and the most prevalent substance use in these patients was opium and opioid. Poly substance use was the most prevalent pattern of use (80 ) in psychotic and mood disorders due to substance. Significant difference was seen between genders, marital status, occupation, duration of illness and frequency of substance use (P < 0.05), however no significant difference was seen between educational levels, age and substance use. Conclusions: The patients with mood disorders had the highest comorbidity with substance use and concurrent use of poly substance was the most prevalent pattern of use in these patients. Therefore, successful treatment of psychiatric disorders and substance use needs multimodal and more serious interventions. Regarding to the pattern of poly substance use in these patients, careful screening should be performed at admission. © 2014, Iranian Red Crescent Medical Journal

Prevalence of Burnout in Senior Medical Students of Kashan University of Medical Sciences in 2008

Background and Objectives: Burnout is caused by high-stress jobs and could induce somatic, psychological disorders and negative attitude to professional actives so that this condition causes poor relationship with the patient. This study aimed at investigating burnout in senior medical students of Kashan University of Medical Sciences.Methods: This research was a cross sectional study carried out on all senior medical students (N=56) in 2008. Data were obtained by two questionnaires including demographic questionnaire and Maslach burnout Inventory. They were then analyzed using SPSS software and Chi square Test. Results: The findings showed that the majority of medical students (91.1%) had burnout and only 8.9% of them had not burnout. Severe burnout was in 16% of students. There was not any significant relationship between burnout and sex, age, smoking, duration of education, interest in medical course and marital status P<0.05.Conclusion: The results of the study showed that burnout is common problem in senior medical students and need special consideration. Therefore medical students should be encouraged to seek help and adequate facilities by holding workshops of life-skill training and coping with stress. However, burnout should be paid special attention in medical students by counseling centers of University for prevention of consequences

Prevalence of psychiatric disorders and related factors in male prisoners

Background: Prisoners are at risk of mental disorders. Therefore attention to mental health of prisoners is important. Objectives: This study aimed determine to the prevalence of mental disorders among Kashan prisoners. Patients and Methods: This cross sectional study was carried out in Kashan prison (Iran). 180 Subjects were selected by using stratified random sampling and evaluated with Symptoms Check List-90-Revised (SCL-90-R) questionnaire and clinical interview based on Diagnostic Statistical Manual of Disease-IV (DSM-IV) check list by two psychiatrists. Data were analyzed by SPSS-16 software and Chi square, Kolmogrov Smirnov, Mann-whiteny and Leven tests. Results: The mean age of prisoners was 31.9 ± 8.96.The prevalence of psychiatric disorders in prisoners were 43.4. The most frequent disorders were major depressive disorders (27.9), Post traumatic Stress Disorder (17.4) and substance use disorders (17.4).28.3 of prisoners had personality disorders, that the most prevalent were antisocial personality and borderline personality. The comorbidity of psychiatric disorders was (36) in axis I. Suicidal thoughts there were in 44.6 of prisoners. History of head trauma in Prisoners with psychiatric disorders was (52.2). There was significant difference between head trauma and psychiatric disorders (P = 0.05). Significant difference was between marital status and duration of imprisonment with psychiatric disorders P < 0.05.There was not significant difference between type of crime and educational level with psychiatric disorders. Conclusions: About half of all prisoners suffered from psychiatric disorders; therefore treatment psychiatric disorder in this group is essential for prevention of crime.Prisoners are at risk of mental disorders. Therefore attention to mental health of prisoners is important. © 2013, Iranian Red Crescent Medical Journal; Published by Kowsar Corp

The effect of aversion therapy in a case with conversion disorder associated with mood and obsessive-compulsive disorders

Background: Conversion disorder is a type of motor or sensory dysfunction that does not conform to the concepts of anatomy and physiology of the central or peripheral nervous systems. This disorder, more prevalent among the young women, may appear after the stress, creating several non-prevalent clinical signs usually associated with mood and anxiety disorders. Therefore, this study aimed to examine the effect of aversion therapy on a patient with conversion disorder associated with mood and obsessive-compulsive disorders. Case Report: The case is a 49-year-old woman with conversion disorder associated with mood and obsessive-compulsive disorders and a recent history of twitching in three fingers of her left hand. Finally, the disorder was improved as a result of the aversion therapy.Conclusion: In conversion disorder, considering the co-morbid mental disorders is very important for an effective treatment and aversion therapy can also be considered as a method of treatment

Comparing the effects of fluoxetine and fluvoxamine in the treatment of children and adolescents with depression

Background: Major depressive disorder (MDD) is a severe disorder that has a significant impact on the psychological and social functioning of children and adolescents. Considering the current limitations in the treatment of this disorder the present study aimed to examine the effect of fluoxetine and fluvoxamine on the treatment of child and adolescent depression. Materials and Methods: In this double-blind clinical trial study, 40 children and adolescents with MDD referred to child psychiatric clinic of Kashan University of Medical Sciences (during 2013-2014) were randomly divided into the fluvoxamine and fluoxetine groups. Data were collected using the children's depression inventory, children's global assessment scale, and drug side effect questionnaire. The participants were evaluated at the beginning and 2, 4, and 8 weeks after the beginning of the treatment. Results: The mean age of children and adolescents was 12.40±2.63 years. The mean scores of CDI in the flouxetine and fluvoxamine groups were significantly decreased from 25.65±10.49 to 11.55±3.23 and from 28.45±7.61 to 8.05±4.87, respectively. Moreover, the mean scores of CDI in the flovaxamine group demonstrated a significant decrease at weeks 4 and 8 compared to the fluoxetine group (P=0.03 and P=0.005, respectively). In the 8th week the response rates to treatment were 85 and 55 in the fluvoxamine and fluoxetine groups, respectively. No serious side effect was observed in the participants and no suicidal attempts were reported during the study. Conclusion: Considering that there is a significant reduction in the depression score in the fluvoxamine group compared to the fluoxetine one, fluvoxamine can be used as an effective and safe drug in the treatment of MDD in children and adolescents

Prevalence of psychiatric disorders in the general population of Kashan, Iran

Background: Mental health is one of the most important public health issues because of its major contribution in decreasing the global burden of disease and its important role in assurance, dynamism, and efficacy. The present study evaluates the prevalence of mental disorders in the over 18-year-old population in Kashan, Iran during 2008-2009. Methods: This was a descriptive, cross-sectional study. Subjects were selected via stratified random sampling. The study was conducted in two stages. In the first stage, subjects were evaluated using the General Health Questionnaire. In stage two, two psychiatrists used a DSM-IV checklist to conduct clinical interviews. The collected data were analyzed by SPSS version 16, OR, CI, Chi-square, and Mantel-Heanszel tests. Results: The prevalence of mental disorders in Kashan was 29.2. In women it was 35.5, and in men, 21.2. The most prevalent disorders were mood (9.3) and anxiety disorders (4.7). Among the 505 subjects with mental disorders based on clinical interviews, 162 (32.1) suffered from mood disorders, 129 (25.6) anxiety disorders, 21 (4.2) psychotic disorders, 16 (3.4) neurologic disorders, 17 (3.4) dissociative disorders, and 120 (23.7) had other disorders. In this study, 7.8 of the subjects had more than one mental disorder. In the case of mood disorders, major depression (8.2) was the most common; as for anxiety disorders, generalized anxiety disorder (7.2) was the most prevalent. The prevalence was higher in people aged 56-65 (35.8), widows (35.8), the illiterate (42.8), and the unemployed (38.8). Mental disorder was significantly affected by gender, education, occupation, and marital status. Conclusions: The results show that psychiatric disorders in Kashan are higher than at the time of the previous research in this region (1999). Therefore, prevention programs and treatment of psychiatric disorders in this city are of great priority