Self-understanding: An analytic End-result of Self-absorption

Freud made many significant and important contributions to the understanding of the functioning of the human mind, but among the most enduring and influential is the concept of the dynamic unconscious. Despite controversies regarding the theoretical underpinnings of the unconscious, the substantial discovery of a level of unconscious functioning of the mind has remained as valid and unscathed as ever. While insight, as a main therapeutic goal, is similar to a passage between conscious awareness and unconscious motivations, self-understanding in the psychiatric evaluation, refers to the patient's understanding of how he or she is feeling, presenting, and functioning as well as the potential causes of his or her psychiatric presentation. Interpretation of dreams and free association are extremely important techniques that psychoanalysts make use of in order to get to the lowermost of a patient's conflicts. But it seems that there may also be an alternate  process that can result in a similar, though restricted, result, without any analyst, coach, session, contract, therapeutic alliance and so on, in a liable person who wants to analysis his/her inner psychological events. The succeeding case is a brilliant example in this regard who acknowledged part of his unconscious sphere by his own, based on a sequential occurrence of emotional interactions.</p

Antidepressant Controlled Trial For Negative Symptoms In Schizophrenia (ACTIONS): a double-blind, placebo-controlled, randomised clinical trial

Background Negative symptoms of schizophrenia represent deficiencies in emotional responsiveness, motivation, socialisation, speech and movement. When persistent, they are held to account for much of the poor functional outcomes associated with schizophrenia. There are currently no approved pharmacological treatments. While the available evidence suggests that a combination of antipsychotic and antidepressant medication may be effective in treating negative symptoms, it is too limited to allow any firm conclusions. Objective To establish the clinical effectiveness and cost-effectiveness of augmentation of antipsychotic medication with the antidepressant citalopram for the management of negative symptoms in schizophrenia. Design A multicentre, double-blind, individually randomised, placebo-controlled trial with 12-month follow-up Setting Adult psychiatric services, treating people with schizophrenia. Participants Inpatients or outpatients with schizophrenia, on continuing, stable antipsychotic medication, with persistent negative symptoms at a criterion level of severity. Interventions Eligible participants were randomised 1 : 1 to treatment with either placebo (one capsule) or 20 mg of citalopram per day for 48 weeks, with the clinical option at 4 weeks to increase the daily dosage to 40 mg of citalopram or two placebo capsules for the remainder of the study. Main Outcome Measures The primary outcomes were quality of life measured at 12 and 48 weeks assessed using the Heinrich’s Quality of Life Scale, and negative symptoms at 12 weeks measured on the negative symptom subscale of the Positive and Negative Syndrome Scale. Results No therapeutic benefit in terms of improvement in quality of life or negative symptoms was detected for citalopram over 12 weeks or at 48 weeks, but secondary analysis suggested modest improvement in the negative symptom domain, avolition/amotivation, at 12 weeks (mean difference –1.3, 95% confidence interval–2.5 to–0.09). There were no statistically significant differences between the two treatment arms over 48-week follow-up in either the health economics outcomes or costs, and no differences in the frequency or severity of adverse effects, including corrected QT interval prolongation. Limitations The trial under-recruited, partly because cardiac safety concerns about citalopram were raised, with the 62 participants recruited falling well short of the target recruitment of 358. Although this was the largest sample randomised to citalopram in a randomised controlled trial of antidepressant augmentation for negative symptoms of schizophrenia and had the longest follow-up, the power of statistical analysis to detect significant differences between the active and placebo groups was limited. Conclusion Although adjunctive citalopram did not improve negative symptoms overall, there was evidence of some positive effect on avolition/amotivation, recognised as a critical barrier to psychosocial rehabilitation and achieving better social and community functional outcomes. Comprehensive assessment of side-effect burden did not identify any serious safety or tolerability issues. The addition of citalopram as a long-term prescribing strategy for the treatment of negative symptoms may merit further investigation in larger studies. Future Work Further studies of the viability of adjunctive antidepressant treatment for negative symptoms in schizophrenia should include appropriate safety monitoring and use rating scales that allow for evaluation of avolition/amotivation as a discrete negative symptom domain. Overcoming the barriers to recruiting an adequate sample size will remain a challenge.</p

Rehabilitation of Schizophrenia: Adjunctive Therapy of Negative Symptoms

Negative symptoms in schizophrenia are among the important barriers against psychosocial rehabilitation of such patients. Adjunctive drugs can be used for reducing the severity of these symptoms. In this research we studied the efficacy of Clomipramine, Alprazolam, Citalopram, Bromocriptine, Fluoxetine, Nortriptyline, Maprotiline and Fluvoxamine, in this regard. After a primary prevalence survey regarding Negative symptoms, 170 schizophrenic patients were divided into three different groups, and then the aforesaid adjuvant drugs were examined in three double-blind clinical controlled trials. Estimation of negative symptoms by &quot;SANS&quot; were done at the beginning of each trial for the first time and then three weeks later, after prescription of drugs in lower dosage and finally at the end of sixth week, means three weeks after doubling the dosages. The data were analyzed by z and chi-square (X2test) formula. Clomipramine, Alprazolam, Citalopram, Nortriptyline and Maprotiline could reduce the severity of negative symptoms. Their effectiveness in comparing with placebo was statistically remarkable. No important side effect or worsening of positive symptoms was seen in our samples during aforesaid trials. Conservative usage of adjuvant drugs can be an advantageous means for making rehabilitative programs more efficacious than before

Effeciveness of Citalopram, Alprazolam and Clomipramine in Amelioration of Negative Sympotoms in Schizphrenia

Objective: Negative symptoms of schizophrenia are among the major barriers against rehabilitation of such patients and hinder their appropriate communication with others. Using of adjunctive drugs in addition to current treatments may reduce these symptoms. In this research we have discussed the efficacy of Citalopram, Clomipramine and Alprazolam in reducing such symptoms. Materials & Methods: Forty male, randomly chosen, schizophrenic patients who have been and are hospitalized for life long residential care in Razi psychiatric hospital, had been chosen for a Double-Blind study (CCT) and divided into four groups and treated with 20 mg Citalopram, 0.75 mg Alprazolam, 25 mg Clomipramine and placebo, respectively, in addition to current treatments (typical antipsychosis). After two weeks, there was doubling of foresaid doses, which continued for another two weeks, and then tapered and terminated. Existence and severity of negative symptoms had been measured with the scale of SANS in the beginning and before applying of adjunctive drugs, and then at the end of second week of therapy, and finally at the end of fourth week during these research no side effect had led to distress for patients. Data has been surveyed according to Z and chi-square (X2-test) formula for comparing of variables. Results: Citalopram, Alprazolam, and Clomipramine have decreased the severity of negative symptoms, respectively, in 80%, 50% and 50% of patients. In the majority of these patients these decrease has been restricted to 20% from baseline. Only Clomipramine could decrease up to 40% in two cases. Mean while, Clomipramine but, generally these drugs were more efficacious on mild to moderate symptoms (grade 1,2 and 3). Decreasing of symptoms were independent of each other and with variable patterns. There was no statistically important difference between aged and non aged patients. No patient in control group had any benefit from placebo. Conclusion: Treatment with Citalopram, Alprazolam and Clomipramine can result in benefit and decrease of negative. symptoms in schizophrenic patients. In this regard, overally, the lower side effects and pharmacokinetic interactions of Citalopram in comparing with Clomipramine and Alprazolam deserve attention

Augmentation of aripiprazole by flupenthixol decanoate in poorly responsive schizophrenia: a randomized clinical study

OBJECTIVE: According to some studies, while first-generation antipsychotics were associated with slightly better outcomes and lower costs in comparison with second-generation antipsychotics, atypical antipsychotics have become the most commonly used class of antipsychotic drugs in clinical practice. The objective of this study was to examine whether there could be any positive outcome if flupenthixol decanoate was added, as an adjuvant, to aripiprazole in poorly responsive cases of schizophrenia. METHODS: Twenty-four male inpatients with diagnosis of schizophrenia, according to the DSM-5 diagnostic criteria, who had shown poor response to aripiprazole, were entered into an eight-week, parallel group, single-blind study for random assignment to either aripiprazole plus augmentative flupenthixol decanoate or current antipsychotic treatment in a 1:1 ratio. Primary outcome measures of the study were changes in the mean total scores of the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). The secondary measures were the Schedule for Assessment of Insight (SAI), the Clinical Global Impressions-Severity Scale (CGI-S), and the Simpson-Angus Scale (SAS). RESULTS: According to the findings, the mean total scores of SAPS, SAI, and CGI-S in the augmented group decreased significantly in comparison with the aripiprazole group (p  .05). Also, the mean total score of SAS was significantly increased in the augmented group (p < .01). The effect-size analysis showed a large improvement with flupenthixol augmentation in terms of SAPS, SAI, and CGI-S scores. CONCLUSIONS: While emergence of extra-pyramidal side effects should not be overlooked by clinicians, adding flupenthixol decanoate to aripiprazole may be beneficial for some cases of poorly responsive schizophrenia

An Introduction to Razi Psychiatry Hospital

Razi Psychiatry Hospital is one of the most important clinical and educational fields with respect to mental health in Iran. It has a long record of service in this regard since the last century. This piece of writing aims to make a concise acquaintance with its different goals, committees, departments, activities and investigational efforts

Adjunctive quetiapine may help fluvoxamine-resistant obsessive-compulsive disorder among female in-patients: A randomized-controlled study

INTRODUCTION: while around half of the patients with obsessive-compulsive disorder do not respond efficiently to current serotonin-reuptake inhibitors, the objective of the present study was to compare the effectiveness and safety of quetiapine versus aripiprazole in patients with obsessive-compulsive disorder, who had not responded effectively to fluvoxamine. METHOD: Forty-four patients with obsessive-compulsive disorder, who had not responded effectively to fluvoxamine at maximum dose (300 milligram per day) and duration (twelve weeks), were allocated randomly, in a double-blind trial, to receive quetiapine (n = 22) or aripiprazole (n = 22), in addition to their serotonin-reuptake inhibitor, for twelve weeks. While treatment response was evaluated by the Yale-Brown Obsessive-Compulsive Scale (YBOCS), as primary outcome scale, Clinical Global Impressions-Severity Scale (CGI-S), as well, had been used as an ancillary measure. RESULTS: 54.54% of patients in the quetiapione group (n = 12) and 27.27% of cases in the aripiprazole group (n = 6) responded partially to the abovementioned augmentation. According to the findings, the mean +/− SD baseline YBOCS’ score, dropped from 31.18+/−4.93 to 27.97+/−3.71 (p < 0.01), and 33.27 +/− 3.90 to 30.72+/−4.67 (p < 0.06), by quetiapine and aripiprazole, respectively. In this regard, no significant alteration with respect to CGI-S was evident in either of the aforementioned groups. CONCLUSION: This study indicated that patients with treatment-resistant obsessive-compulsive disorder could benefit more from adding quetiapine, in comparison with aripiprazole, to their ongoing serotonergic medication

Extended-release carbamazepine versus lithium in management of acute mania in male inpatients with bipolar I disorder

INTRODUCTION: Since extended-release formulations of CBZ have been developed to decrease daily fluctuations in serum CBZ concentrations and improve dosing convenience, several large clinical trials have recently been conducted to assess the efficacy and tolerability of this form of CBZ in bipolar disorder. In the present assessment, extended-release carbamazepine has been compared with lithium, in a head-to-head evaluation, to assess its efficacy and safety in a group of non-Western patient population with diagnosis of acute mania. METHOD: Fifty male inpatients with diagnosis of bipolar I disorder, according to Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5), entered into a 3-week study, for random assignment to extended-release carbamazepine or lithium carbonate. The assessment had been accomplished as a double-blind design, while the patients, staff, prescribers, and assessor were unaware of the prescribed drugs that were packed into identical capsules. Primary outcome measure in the present assessment was Manic State Rating Scale (MSRS), which had been scored at baseline and weekly intervals up to the third week. Also, insight and overall illness severity and improvement had been rated by the Schedule for Assessment of Insight (SAI), Clinical Global Impressions-Global Improvement Scale (CGI-I), and Clinical Global Impressions-Severity Scale (CGI-S), respectively. Treatment effectiveness had been analysed by t-test and repeated measures analysis of variance (ANOVA). Statistical significance had been defined as p-value ≤.05. RESULTS: While mean total score of MSRS improved significantly by both lithium and extended-release carbamazepine at the end of the third week, between-group analysis displayed significant advantage of lithium, regarding both frequency and intensity, at the end of trial. Mean total score of SAI showed significant improvement by both of them. However, again, the CGI-I demonstrated significant improvement by extended-release carbamazepine and lithium, CGI-S revealed significant progress only by lithium. Moreover, the effect size (ES) analysis showed large improvement of MSRS with lithium and medium improvement by extended-release carbamazepine. Post hoc power analysis showed an intermediate power of 0.42 on behalf of the present assessment. CONCLUSION: Although both extended-release carbamazepine and lithium were helpful for improvement of manic symptoms, treatment with lithium seems to be more advantageous