The Effects of Demographic Characteristics, Memory Deficits, and Executive Functioning Impairments in Failure to Respond to Fluvoxamine among Patients with Obsessive-Compulsive Disorder in Iran.

Background: Identifying treatment-response predictors could help improve treatment protocols as well as appropriately tailoring them to each subject, leading to a more desirable and accelerated recovery in patients. Thus, the present study aimed to investigate the role of demographic characteristics, memory deficits, and executive functioning impairments in failure to respond to fluvoxamine among patients with obsessive-compulsive disorder (OCD). Methods: This 2-group design (treatment-responsive and treatment-resistant) experimental study explored 76 participants who had received fluvoxamine monotherapy for OCD for ≥6 months. The study participants were from Iran. Four data collection tools were used in this study (ie, Demographic Data Form, WMS-III, WCST, and Y-BOCS). The achieved data were analyzed in SPSS-16 by descriptive statistics, such as mean and standard deviation and frequency and percentages, as well as an independent samples t-test, a chi-square test, and a Fisher exact test at P <0.05. Results: The present study findings indicated that 56 (81.2%) out of 76 patients with OCD responded to fluvoxamine treatment. A significant difference between the study groups highlighted age as an influential factor in providing a positive therapeutic response to fluvoxamine (P=0.048). However, the groups did not significantly differ in terms of gender (P=0.272), marital status (P=0.753), educational level (P=0.332), disease duration (P=0.276), and occupational status (P=0.473). While there was no significant difference between the groups (P=0.639) in terms of memory deficits (P=0.639), the response rate to fluvoxamine treatment was significantly higher in those with a healthy executive functioning, compared with patients with impairments in this respect (P=0.043). Conclusion: The obtained data suggested that fluvoxamine has a favorable efficacy in the treatment of OCD, and especially in young patients with healthy executive functioning.

Comparing Injecting Risk Behaviors of Long-Term Injectors with New Injectors in Tehran, Iran.

BACKGROUND: Global estimates suggest there are 15.6 million people who inject drugs (PWID) of whom 17.8% are living with HIV.Few studies have characterized newly-onset injectors with long-term injectors and its association with injecting risk behaviors. OBJECTIVES: We examined the relationship between length of injection and risk behaviors among people who inject drugs (PWID) in Tehran, Iran. METHODS: A cross-sectional study was conducted among PWID, from March to August 2016 in Tehran, Iran. PWID were recruited by convenience and snowball sampling from five Drop-in Centers (DIC) located in the south of Tehran. Our primary independent variable was length of injecting career, defined as the number of months since injecting initiation. Those defined as new injectors (were injecting for less than 18 months), and long-term injectors (as injecting drugs for more than 18 months). We reported the adjusted odds ratio (aOR) point estimate and 95% confidence interval (CI95%) as the effect measure. The level of significance used in multiple logistic regression model was 0.05. We used STATA v. 11 for all analyzes. RESULTS: The analytical sample comprised of 500 participants (100% male). Mean (±SD) age of PWID with a length of injection history was 31.2 ± 7.2 years. Overall, 270 (54%) (CI95%: 49.6%, 58.4%) of participants were long-term injectors. The average age of drug use initiation among long-term injectors group was lower as compared to new injectors group (31.2 vs. 29.4, p < 0.001). The odds of distributive syringe sharing among new injectors were two times higher than long-term injectors (AOR = 2.1, 95% CI 1.4-4.7). The odds of receptive syringe sharing were lower among new injectors group (AOR = 0.7, CI95% 0.2-0.87), compared to long-term injectors. New injectors had higher odds of reusing their own syringes (OR = 2.8, 95% CI: 1.4-5.7; p = 0.01). CONCLUSIONS: Improvements in harm reduction service provision can occur through taregted risk reduction education for new injectors focusing on reducing distributive syringe sharing among them.

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 was 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.

Topiramate Add-on Lithium Carbonate for Treatment of Acute Mania.

OBJECTIVE: The purpose of this study was to evaluate the effect of adjunctive topiramate in treating acute mania. METHODS: In this study which was a double-blinded randomized clinical trial, 46 bipolar patients in manic episode, were treated with lithium carbonate and topiramate versus lithium carbonate and placebo and treatment responses were assessed by Young Mania Rating Scale (YMRS) weekly. RESULTS: In both intervention and control groups, YMRS score had significant decline after 8 weeks(p < 0.001), but there was no statistically significant difference between the two groups (p = 0.419). The highest score decline was after two weeks. YMRS score at baseline did not have statistically significant difference between the intervention and control groups (p = 0.709). CONCLUSIONS: This study failed to show antimanic efficacy of adjunctive topiramate in the treatment of those with acute manic. DECLARATION OF INTEREST: None. CLINICAL TRIAL REGISTRATION: URL: http://www.irct.ir.IRCT201110317960N1.