Randomized controlled trial of aripiprazole versus risperidone for the treatment of amphetamine-induced psychosis.

BACKGROUND: Lifetime prevalence of amphetamine-induced psychotic disorder is reported as being up to 23% for methamphetamine (MA) abusers. Approximately 25% of those with a baseline DSM-IV diagnosis of substance-induced psychosis are diagnosed with primary psychosis at one-year follow-up. Evidence on the treatment of amphetamine psychosis is very limited. OBJECTIVES: To investigate the efficacy of risperidone versus aripiprazole in treatment of amphetamine-induced psychotic symptoms. METHODS: In a double-blind study, 45 participants were randomly allocated to either aripiprazole 15 mg or risperidone 4 mg daily over a six-week trial. Positive and negative symptoms of psychosis were assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) at baseline and completion of the trial. RESULTS: SANS and SAPS scores decreased significantly in both groups. Mean SAPS score reduction in risperidone and aripiprazole group was 16.20 and 10.80, respectively, after trial course (p < 0.001). Mean SANS score reduction in risperidone and aripiprazole group was 9.35 and 11.25, respectively (p = 0.08). CONCLUSIONS: Both aripiprazole and risperidone were effective for patients diagnosed with amphetamine-induced psychotic disorder. However, risperidone had the greater effect on positive psychotic symptoms while patients with negative symptoms may respond better to aripiprazole. There is a case for further studies evaluating the efficacy of atypical antipsychotics in this disorder.

Comparison of ultra-long gonadotropin releasing hormone agonist versus standard downregulation in women with adenomyosis undergoing frozen-thawed embryo transfer: a randomized clinical trial.

BACKGROUND: Adenomyosis can lead to infertility and failure of in vitro fertilization. Limited evidence suggests that the use of long-term treatment with gonadotropin-releasing hormone (GnRH) agonists followed by frozen-thawed embryo transfer (FET) may be the preferred approach for women with adenomyosis. OBJECTIVE: The aim of this randomized controlled trial is to compare the efficacy of an ultra-long GnRH agonist with standard downregulation in women with adenomyosis undergoing FET. MATERIALS AND METHODS: This randomized controlled trial enrolled 72 women with adenomyosis diagnosed by sonographic criteria who underwent FET cycles at the Avicenna Infertility Center. These women were randomly assigned to two equal groups: one received GnRH agonist treatment for three months before the FET cycle and the other served as the standard downregulation group. Results were reported as chemical and clinical pregnancy rates. RESULTS: The two groups were similar in age, body mass index, anti-Müllerian hormone levels, number of previous pregnancies and miscarriages, presence of uterine myomas, and endometriosis. However, the total dose of estradiol used until embryo transfer was significantly higher in the ultra-long GnRH agonist group than in the standard group (96.14 mg vs. 80.52 mg, p-value = 0.004). Nevertheless, chemical and clinical pregnancy rates did not differ significantly between the two groups. CONCLUSIONS: Ultra-long GnRH agonist downregulation did not improve the chemical and clinical pregnancy rate in the FET cycle in women with adenomyosis compared with standard GnRH agonist downregulation in the other words, ultra-long GnRH agonist downregulation is not superior to standard protocol. In women with adenomyosis (without history of endometriosis), downregulation of standard GnRH agonists prior to frozen-thawed embryo transfer may be the preferred embryo transfer protocol to gain higher clinical/chemical pregnancy rate. TRIAL REGISTRATION: Clinical trial registry: IRCT20160717028967N9, available at: https://irct.behdasht.gov.ir/trial/36103 .

Comparison of Vitex agnus-castus Extracts with Placebo in Reducing Menopausal Symptoms: A Randomized Double-Blind Study.

BACKGROUND: Menopausal symptoms have remarkable negative effects on women's quality of life, justifying the need to assess various therapeutic options. This research aimed to determine the effectiveness of Vitex agnus-castus extracts in alleviating menopausal symptoms in comparison with that of placebo. METHODS: This study was a randomized controlled double-blind clinical trial with a study group of 52 women referred to a clinic in Kermanshah in 2017. The participants were randomly divided into two groups: Vitex group (26 subjects) and placebo group (26 subjects). Menopausal symptoms were assessed using the Greene Scale before and 8 weeks after the intervention. RESULTS: After the intervention, the mean scores for total menopausal disorder, anxiety, and vasomotor dysfunction were significantly lower in the Vitex group than in the placebo group (P<0.05). The mean scores of the variables of somatic complications, depression, and sexual dysfunction did not show significant differences between the Vitex and placebo groups (P>0.05). CONCLUSION: Administration of Vitex agnus-castus extracts as a phytoestrogenic medicine can alleviate menopausal symptoms in women.

Rosa Damascena oil improved methadone-related sexual dysfunction in females with opioid use disorder under methadone maintenance therapy - results from a double-blind, randomized, and placebo-controlled trial.

BACKGROUND: Methadone maintenance therapy (MMT) is provided to patients with opioid use disorder (OUD). However, as with all opioids, methadone impacts negatively on sexual function. To counter this, Rosa Damascena oil (RDO) has been used successfully for opioid-dependent male patients under MMT and with methadone-related sexual dysfunction (MRSD). In the present study, we tested the possible influence of RDO on sexual function and sex hormones of opioid-dependent female patients undergoing MMT and with MRSD. METHODS: Fifty female patients (mean age: 38.8 years) diagnosed with OUD, undergoing MMT and with MRSD were randomly assigned either to the RDO or the placebo condition. At baseline, patients completed questionnaires covering socio-demographic and OUD-related information. At baseline, and four and eight weeks later they additionally completed questionnaires on sexual function and happiness. Blood samples to assess thyroid hormones, prolactin, progesterone, and estradiol levels were taken at baseline and eight weeks later (end of the study). RESULTS: Over time sexual function and happiness increased, but more so in the RDO condition than in the placebo condition. Over time, prolactin decreased, and progesterone, and estradiol increased, but again more so in the RDO condition. Sex hormone levels and sexual function were statistically unrelated. CONCLUSIONS: Results from this double-blind, randomized, and placebo-controlled clinical trial showed that opioid-dependent females undergoing MMT and with MRDS did benefit from RDO administration, as sexual function and happiness increased, and female sexual hormone levels changed in positive directions.

Effect of maternal anxiety on maternal serum and fetal cord blood cortisol.

INTRODUCTION: Prenatal exposure to maternal anxiety and inappropriate levels of glucocorticoids may influence intrauterine growth and affect later health outcomes. We examined the relationship between maternal anxiety, maternal serum, and fetal cord blood cortisol. METHODS: Eighty-four pregnant women with gestational age above 37 weeks admitted for elective caesarian section were studied. The Spielberger State-Trait Anxiety Inventory was used to assess maternal anxiety. Maternal blood was sampled immediately before caesarean section. Cord blood sample was taken immediately after birth. Multiple regression analysis was performed. RESULTS: Maternal trait anxiety score, maternal serum cortisol, and neonatal weight were associated with the fetal cord blood cortisol (r = 0.21, P = 0.04). Bivariate correlation analysis revealed a positive correlation between maternal trait anxiety and fetal cord blood cortisol (r = 0.21, P = 0.03). CONCLUSIONS: These data suggested that high maternal trait anxiety increases fetus cord blood cortisol and may regulate fetal growth.

Post partum depression and thyroid function.

OBJECTIVE: Risk of depression is particularly high for women during the prenatal period. Various investigators have attempted to establish a link between thyroid function and post partum depression. This study aimed to investigate whether thyroid function differs in women with postpartum depression compared to a control group. METHODS: In this case-control study, subjects were selected from Obstetrics & Gynecology and Psychiatric clinics of Kermanshah University of Medical Sciences. Forty eight patients suffering from postpartum depression according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition totally revised (DSM-IV-TR), and 65 normal controls underwent diagnostic evaluation by one trained psychiatrist using Structured Clinical Interview for DSM-IV-TR. Then, the demographic questionnaire and the Persian version of Edinburgh Postnatal Depression Scale (EPDS) were completed by the participants. Finally, their thyroid functions were assessed. Data analyses were done using the SPSS program 13. RESULTS: No statistically significant differences were observed between thyroid function tests and postpartum depression. According to multiple regression analysis with stepwise method, subjects with lower serum TSH, T3RU, T3 levels, younger age and longer period after delivery tended to have higher EPDS scores (P-value=0.008). CONCLUSION: The present study reports that those women with postpartum depression had a no greater prevalence of thyroid dysfunction than the control subjects. It seems that thyroid dysfunction should be considered in women with postpartum depression individually, but the role of thyroid as an important cause of this condition is not yet established. This suggests that future studies should concentrate on this concept in postpartum depression.