Myoclonus as a single side effect of combination of selective serotonin reuptake inhibitors (SSRIS) and clomipramine: Three case reports

Selective Serotonin Reuptake Inhibitors (SSRIs) are the most popular psychiatric medications that are approved for several neuropsychiatric conditions such as depression and obsessive-compulsive disorder (OCD). On the other hand, clomipramine is a tricyclic anti-depressant which is the only approved medication, among this class, to treat OCD due to its substantial effects on serotonergic system. Combination of SSRIs and clomipramine is uncommon in routine psychiatric practice because it can increase the risk of serotonin syndrome which is characterized by myoclonus, headache, nausea, confusion, diarrhea, tremor, twitching muscles, and agitation. However, it could be useful in patients suffering from treatment-resistant OCD. Here, we describe three cases of OCD patients, treated by combination of SSRIs and clomipramine who showed only myoclonic movements in initial week without any other manifestations of the serotonin syndrome. In less than one week after initiation of medication, abnormal movements disappeared, and in six month follow-up evaluation, the patients were observed with considerable improvements. Indeed, myoclonic movements is not a predictor of full-blown serotonin syndrome when combination of SSRIs and clomipramine is used. Therefore, the combination could be a considerable approach in treatment of refractory OCD. © 2020, Mazandaran University of Medical Sciences. All rights reserved

Minocycline combination therapy with fluvoxamine in moderate-to-severe obsessive�compulsive disorder: A placebo-controlled, double-blind, randomized trial

Aim: Several lines of evidence implicate glutamatergic dysfunction in the pathophysiology of obsessive�compulsive disorder (OCD), presenting this neurotransmitter as a target for the development of novel pharmacotherapy. The objective of this study was to assess the efficacy of minocycline as an augmentative agent to fluvoxamine in the treatment of patients with OCD. Methods: One hundred and two patients with the diagnosis of moderate-to-severe OCD were recruited to this study. A randomized double-blind trial was designed and patients received either L-carnosine or placebo as adjuvant to fluvoxamine for 10 weeks. The patients randomly received either minocycline 100 mg twice per day or placebo for 10 weeks. All patients received fluvoxamine (100 mg/day) for the first 4 weeks, followed by 200 mg/day for the rest of the trial, regardless of their treatment groups. Participants were evaluated using the Yale�Brown Obsessive Compulsive Scale (Y-BOCS). The main outcome measure was to assess the efficacy of minocycline in improving the OCD symptoms. Results: General linear model repeated measures demonstrated significant effect for time � treatment interaction on the Y-BOCS total scores, F(1.49, 137.93) = 7.1, P = 0.003, and Y-BOCS Obsession subscale score, F(1.54, 141.94) = 9.72, P = 0.001, and near significant effect for the Y-BOCS Compulsion subscale score, F(1.27, 117.47) = 2.92, P = 0.08. A significantly greater rate of partial and complete response was observed in the minocycline group (P < 0.001). The frequency of side-effects was not significantly different between the treatment arms. Conclusion: The results of this study suggest that minocycline could be a tolerable and effective adjuvant in the management of patients with OCD. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurolog

Telepsychiatry During the COVID-19 Pandemic: Development of a Protocol for Telemental Health Care

Background: The rapid spread of the Coronavirus disease 2019 (COVID-19) has forced most countries to take drastic public health measures, including the closure of most mental health outpatient services and some inpatient units. This has suddenly created the need to adapt and expand telepsychiatry care across the world. However, not all health care services might be ready to cope with this public health demand. The present study was set to create a practical and clinically useful protocol for telemental health care to be applied in the context of the current COVID-19 pandemic. Methods: A panel of psychiatrists from 15 different countries covering all World Health Organization (WHO) regions was convened. The panel used a combination of reactive Delphi technique and consensus development conference strategies to develop a protocol for the provision of telemental health care during the COVID-19 pandemic. Results: The proposed protocol describes a semi-structured initial assessment and a series of potential interventions matching mild, moderate, or high-intensity needs of target populations. Conclusions: Telemedicine has become a pivotal tool in the task of ensuring the continuous provision of mental health care for the population, and the outlined protocol can assist with this task. The strength of this protocol lies in its practicality, clinical usefulness, and wide transferability, resulting from the diversity of the consensus group that developed it. Developed by psychiatrists from around the globe, the proposed protocol may prove helpful for many clinical and cultural contexts, assisting mental health care providers worldwide. © Copyright © 2020 Ramalho, Adiukwu, Gashi Bytyçi, El Hayek, Gonzalez-Diaz, Larnaout, Grandinetti, Nofal, Pereira-Sanchez, Pinto da Costa, Ransing, Teixeira, Shalbafan, Soler-Vidal, Syarif and Orsolini

Infectious disease outbreak related stigma and discrimination during the COVID-19 pandemic: Drivers, facilitators, manifestations, and outcomes across the world

Being part of a social minority (e.g. migrants, people of color or Asian descent in Western countries) is not itself a risk factor for contracting Coronavirus disease-2019 (COVID-19). However, certain groups of people across the world are being targeted by COVID-19 related stigma (COS) and discrimination, which constitutes a growing concern (Bagcchi, 2020). There is an urgent need to better understand it, as it may pose a barrier for accessing testing and health care and for maintaining treatment adherence (Stangl et al., 2019). It is very likely that COS is the consequence of multiple socio-ecological drivers (e.g., fear, misinformation) and facilitators (e.g., racism, poverty) (Logie, 2020). In this letter, we attempt to explore COS related factors based on the real-life experiences of a group of psychiatrists from thirteen countries using the health stigma and discrimination framework (HSDF) (Stangl et al., 2019). We categorized these experiences as per the process domains (such as drivers, facilitators); and these process domains along with examples/responses are depicted in Fig. (1)

COVID-19 mental health care toolkit: An international collaborative effort by Early Career Psychiatrists section

The collaborative effort of an international research team from the Early Career Psychiatrists section of the World Psychiatry Association has brought about an easy-to-use, quick and stepwise mental health care toolkit for the identification and appropriate referral of those in need of mental health care during the pandemic. This simple guide can be applied in the general outpatient setting and is catered for all healthcare professionals, regardless of their expertise within the mental health field with minimal training. It is our hope that by incorporating this toolkit into our daily clinical care during the pandemic for high-risk patients and patients with non-specific complaints, we will be able to bridge the mental health gap present in our society. © 2020 Author(s) (or their employer(s)) 2020

Validity and reliability of the Persian version of �drug-related knowledge and attitude questionnaire� among Iranian medical students

Background: Promoting drug-related knowledge and improving relevant attitudes among students are of crucial importance toward the prevention of drug misuse. Objective: This study aimed to assess the validity and reliability of the �drug-related knowledge and attitude questionnaire� among Iranian medical students. Methods: The participants of this cross-sectional study were students of Iran University of Medical Sciences. The �drug-related knowledge and attitude questionnaire� and a socio-demographic questionnaire were used to gather the data. Content validity was assessed by a panel of 11 experts, and face validity was evaluated by 10 participating students. Item-total correlation and Cronbach�s alpha coefficients were used as internal consistency estimates. Results: The face and content validity of the questionnaire were satisfactory. The overall content validity index was.82. Cronbach�s alpha was.679, indicating an acceptable degree of internal consistency and homogeneity between the items. Overall, most of the students had adequate knowledge about the harmful effects of addictive substances (48.11 ± 3.26). Conclusions: The �drug-related knowledge and attitude questionnaire� has favorable validity and reliability to assess the knowledge and attitude of Iranian students toward drug misuse and may be used in clinical and epidemiological studies. Besides, our findings can provide a suitable starting point for the implementation of effective psychoeducational interventions aimed at the improvement of the students� knowledge and attitudes toward drug misuse. © 2020, © 2020 Taylor & Francis Group, LLC

L-carnosine as an add-on to risperidone for treatment of negative symptoms in patients with stable schizophrenia: A double-blind, randomized placebo-controlled trial

Since l-carnosine has shown effectiveness in improvement of cognition in patients with schizophrenia, this 8-week, randomized, double-blind, placebo-controlled pilot study was conducted. Sixty-three patients with chronic schizophrenia, who were clinically stable on a stable dose of risperidone, entered the study. The patients were randomly assigned to l-carnosine (2 gr/day in two divided doses) or placebo for eight weeks. The patients were assessed using the positive and negative syndrome scale (PANSS), extrapyramidal symptom rating scale (ESRS), and Hamilton depression rating scale (HDRS) during the study course. Sixty patients completed the trial. L-carnosine resulted in greater improvement of negative scores as well as total PANSS scores but not positive subscale scores compared to placebo. HDRS scores and its changes did not differ between the two groups. Both groups demonstrated a constant ESRS score during the trial course. Frequency of other side effects was not significantly different between the two groups. In a multiple regression analysis model (controlled for positive, general psychopathology, depressive and extrapyramidal symptoms, as well as other variables), the treatment group significantly predicted changes in primary negative symptoms. In conclusion, l-carnosine add-on therapy can safely and effectively reduce the primary negative symptoms of patients with schizophrenia. © 201

L-carnosine as an add-on to risperidone for treatment of negative symptoms in patients with stable schizophrenia: A double-blind, randomized placebo-controlled trial

Since l-carnosine has shown effectiveness in improvement of cognition in patients with schizophrenia, this 8-week, randomized, double-blind, placebo-controlled pilot study was conducted. Sixty-three patients with chronic schizophrenia, who were clinically stable on a stable dose of risperidone, entered the study. The patients were randomly assigned to l-carnosine (2 gr/day in two divided doses) or placebo for eight weeks. The patients were assessed using the positive and negative syndrome scale (PANSS), extrapyramidal symptom rating scale (ESRS), and Hamilton depression rating scale (HDRS) during the study course. Sixty patients completed the trial. L-carnosine resulted in greater improvement of negative scores as well as total PANSS scores but not positive subscale scores compared to placebo. HDRS scores and its changes did not differ between the two groups. Both groups demonstrated a constant ESRS score during the trial course. Frequency of other side effects was not significantly different between the two groups. In a multiple regression analysis model (controlled for positive, general psychopathology, depressive and extrapyramidal symptoms, as well as other variables), the treatment group significantly predicted changes in primary negative symptoms. In conclusion, l-carnosine add-on therapy can safely and effectively reduce the primary negative symptoms of patients with schizophrenia. © 201

Palmitoylethanolamide as adjunctive therapy for autism: Efficacy and safety results from a randomized controlled trial

Inflammation as well as glutamate excitotoxicity have been proposed to participate in the propagation of autism. Palmitoylethanolamide (PEA) is an endocannabinoid proven to prevent glutamatergic toxicity and inhibit inflammatory responses simultaneously. The present randomized, parallel group, double-blind placebo-controlled trial is the first study depicted to probe the efficacy of co-treatment with risperidone and PEA over 10 weeks in children with autism. Seventy children (aged 4�12 years) with autism and moderate to severe symptoms of irritability were randomly assigned to two treatment regimens. The study outcomes were measured using the Aberrant Behavior Checklist-Community Edition (ABC-C). At trial endpoint (week 10), combination of PEA and risperidone had superior efficacy in ameliorating the ABC-irritability and hyperactivity/noncompliance symptoms (Cohen's d, 95 confidence interval (CI) = 0.94, 0.41 to 1.46, p = 0.001) compared with a risperidone plus placebo regimen. Interestingly, effect of combination treatment on hyperactivity symptoms was also observed at trial midpoint (week 5) but with a smaller effect size (d = 0.53, p = 0.04) than that at the endpoint (d = 0.94, p = 0.001). Meanwhile, there was a trend toward significance for superior effect of risperidone plus PEA over risperidone plus placebo on inappropriate speech at trial endpoint (d = 0.51, p = 0.051). No significant differences existed between the two treatment groups for the other two ABC-C subscales (lethargy/social withdrawal and stereotypic behavior). The findings suggest that PEA may augment therapeutic effects of risperidone on autism-related irritability and hyperactivity. Future studies are warranted to investigate whether PEA can serve as a stand-alone treatment for autism. © 2018 Elsevier Lt