Recurrent cannabis-induced catatonia: a case report and comprehensive systematic literature review.

Background: Catatonia presents itself as a complex neuropsychiatric syndrome, giving rise to various motor, speech, and behavioral challenges. It is noteworthy that approximately 10% of psychiatric hospital admissions can be attributed to this condition. It is imperative to note that cannabis-induced catatonia, while infrequent, has been linked to the use of marijuana. This connection has the potential to disrupt neurotransmitter systems, necessitating further research for a comprehensive understanding and effective treatment, particularly given the evolving trends in cannabis use. In this context, we shall delve into a unique case of recurrent cannabis-induced catatonia. Case presentation: A 23-year-old gentleman, who has previously struggled with substance use disorder, experienced the emergence of mutism, social isolation, and a fixed gaze subsequent to his use of cannabis. Remarkably, despite the absence of hallucinations, he exhibited recurrent episodes of catatonia. These episodes were effectively addressed through a combination of electroconvulsive therapy (ECT) and lorazepam administration. Notably, when the lorazepam dosage was gradually reduced to below 2 mg per day, the catatonic symptoms resurfaced; however, they promptly abated upon reinstating the medication. The diagnosis of cannabis-induced catatonia was established, and its management primarily involved a therapeutic approach encompassing ECT and lorazepam. It is pertinent to underscore that this catatonic condition can be directly linked to the individual's cannabis usage. Conclusion: The connection between cannabis and catatonia is intricate and not entirely comprehended. Although cannabis possesses therapeutic advantages, it can paradoxically trigger catatonia in certain individuals. Multiple factors, such as genetics, cannabinoids, and neurotransmitter systems, contribute to this intricacy, underscoring the necessity for additional research.

Comparison of ketamine with buprenorphine as adjunctive therapy in the treatment of comorbid major depressive disorder and opium use disorders: A randomized controlled trial.

BACKGROUND: Comorbid major depressive disorder (MDD) and opium use disorder (OUD) are known to increase the risk of suicide. The purpose of this study was to compare the efficacy and safety of adjunctive therapy with either ketamine or buprenorphine as a fast-acting treatment in patients with comorbid MDD and OUD. METHODS: This was a randomized double-blind controlled trial in adults admitted to a hospital in Iran. Sixty-six participants were enrolled and received ketamine or buprenorphine, along with current antidepressant therapy. The primary outcome was change in depressive symptoms assessed using Beck Depression Inventory (BDI) after 2 hours, 24 hours, and 7 days. Secondary outcomes included changes in suicidal ideation, evaluated by the Beck Scale for Suicidal Ideation (BSSI). RESULTS: Both groups experienced a significant decrease in the severity of depression compared to before the study (P < .05). However, there was no significant difference in the between-group comparison (P > .05). Both groups also exhibited a significant reduction in suicidal ideation compared to before the study, with the severity of this decrease being over 85% in both groups (P < .05). CONCLUSION: Both ketamine and buprenorphine appear to be equally effective in reducing symptoms of depression and suicidal ideation among individuals with MDD and OUD.

Early onset frontotemporal dementia following cannabis abuse: a case report.

BACKGROUND: Frontotemporal disorders (FTD) are the consequence of impairment to neurons in the frontal and temporal lobes of the brain. Also, no definitive treatment has been found for FTD. Cannabinoid products can be used to manage treatment-resistant behavioral variants of Frontotemporal dementia (bvFTD). CASE PRESENTATION: We describe the case of 34 years old male with two years of marijuana abuse. At first, he presented with symptoms of apathy and bizarre behavior, which became more severe, and led to disinhibition. The clinical symptoms and imaging findings made FTD probable for him, which was very interesting to report. CONCLUSIONS: While cannabis has demonstrated potential in managing behavioral and mental symptoms of dementia, the presented case highlights the profound impact of cannabis consumption on brain structure and chemistry, including the potential for neurodegenerative disorders like FTD.

Anxiety treatment of methamphetamine-dependent patients with buprenorphine: A randomized, double-blind, clinical trial.

Objectives: In this double-blind, randomized clinical trial, the effectiveness of buprenorphine (BUPRE) in the reduction of anxiety symptoms among the methamphetamine (MA) dependents was evaluated. Materials and Methods: The 60 MA-dependent patients were randomly assigned to three groups (0.1 mg, 1 mg, and 8 mg of BUPRE), The Hamilton Anxiety Rating Scale was administrated to assess the anxiety symptoms daily at baseline and second to the 5th day after intervention. The inclusion criteria were the MA dependence, age of over 18 years, and absence of any chronic physical illnesses; exclusion criteria were the presence of other drug dependence in combination with MA. The mixed-design analysis of variance was performed for data analysis. Results: A significant main effect of time (F = 51.456, P < 0.001) and group (F = 4.572, P = 0.014) and group-by-time interaction (F = 8.475, P < 0.001) were detected. Conclusions: This finding supports the efficacy of BUPRE to decrease anxiety. High doses of the drug (1 and 8 mg) were more effective than 0.1 mg. Here was not a significant difference between anxiety score when patients received 1 mg of BUPRE instead of 8 mg.

Investigating the sequential patterns of methamphetamine use initiation in Iran.

BACKGROUND: Methamphetamine (MA) remains one of the most commonly used amphetamine-type stimulants, accounting for the second most widely-used substance after marijuana. Due to increased use of MA, a wide variety of research has focused on the patterns of MA use initiation among adolescents. Nevertheless, there are few data available for people who use MA. The present study set out to assess the sequential patterns of substance use initiation in patients with MA use disorders in Iran. MATERIALS AND METHODS: This cross-sectional study described substance initiation patterns for 302 patients who used MA admitted to hospitals and psychiatric centers of Shiraz University of Medical Sciences. The study was conducted between April 2015 and June 2016. After obtaining informed consents, participants were interviewed by trained interviewers using face-to-face, semi-structured interviews. The collecting data were analyzed using the chi square tests and one-way analysis of variance (ANOVA) tests to compare the relationship between qualitative and quantitative variables, respectively. RESULTS: Out of 302 participants enrolled in the study, 16 (5.3%) and 286 (94.7%) were female and male, respectively. The mean age of participants in the study was 37.29 years. The mean age of onset of MA use was found to be 15.9 years. 46.1% of the patients started MA use before 15 years. 77.2% of the patients who used MA had family members with a history of substance use. 93.71% of the patients who used MA started substance use with tobacco, alcohol, or opium, as the most frequent substances. Tobacco, as the first substance or starting substance, exhibited the most widely-used substance (69.53% of the cases). Tobacco-alcohol-cannabis-opium-heroin-MA sequencing was significantly related to the early onset of the substance use. Early-onset substance use was significantly higher in those with lower income, primary education, and family history of substance use. No significant relationship was found between employment status with the age of onset of substance use, and different substance use with marital status. CONCLUSION: Tobacco, alcohol and opium can be considered as the main sequencing substances for initiation to MA use. Standardized measures to decrease and control access to main starting and sequencing substances, including tobacco, alcohol, and opium, can greatly help decrease the early onset of the MA use, develop suitable prevention, and establish early intervention strategies.

Rapid effect of a single-dose buprenorphine on reduction of opioid craving and suicidal ideation: A randomized, double blind, placebo-controlled study.

OBJECTIVE: Opioid use disorder is a prevalent addiction problem that can be treated with buprenorphine, but dependence, diversion, and abuse of buprenorphine occur. Although including naloxone reduces these problems, the combination formulation is not available worldwide. The administration of the medication under supervision may also be useful in decreasing unintended uses of the medication. The objective is to assess the influence of a single, physician-administered dose of buprenorphine on withdrawal craving and suicidal ideation in opioid-dependent patients over a period of 4 days of abstinence from opioids. MATERIALS AND METHODS: Sixty-one men who used heroin, opium, or prescription opioids and met Diagnostic and Statistical Manual of Mental Disorders Five Edition criteria for opioid use disorder were randomized to receive a single, sublingual dose of buprenorphine (16 mg, 32 mg, or placebo; n's = 20, 20, and 21 per group). The study was carried out in an inpatient psychiatric ward, with appropriate precautions and monitoring of cardiovascular and respiratory measures. Buprenorphine was administered when the patients were in moderate opioid withdrawal, exhibiting four to five symptoms. Self-reports of craving (The Opioid Craving Scale) and suicidal ideation (Beck Scale for Suicidal Ideation) were taken at baseline and on each of the 4 days after treatment. RESULTS: The group did not differ significantly on demographic features, and all of the patients completed the 4-day study. Craving was reduced from baseline during the observation period in each of the three groups, demonstrating a significant effect of treatment (P < 0.0005), and the dose-by-time interaction (P < 0.0005). Both 32 mg and 16 mg groups differed significantly from the placebo group. No significant differences were observed between the 32 and 16 mg groups, suggesting that the maximal effect on craving reduction was achieved with the 16-mg dose. Suicidal ideation was decreased from baseline during the observation period in each of the three groups, demonstrating a significant effect of treatment (P < 0.0005), and the dose-by-time interaction (P < 0.017).The 32 mg group differed significantly from the placebo group. No significant differences were observed between the 16 and placebo groups, suggesting that the maximal effect on suicidal ideation reduction was achieved with the 32 mg dose. CONCLUSIONS: A single high dose of 16 mg or 32 mg buprenorphine reduces opioid craving, but a single high dose of only 32 mg buprenorphine reduces suicidal ideation.

Prevalence of Substance Abuse (Tobacco, Alcohol, Narcotics and Psychotropic Drugs) and Its Relationship to Family Factors in Pre-university Male Students in Shiraz 2017-2018.

Teenagers are valuable resources in communities and they are faced with multiple risk factors. Factors such as family attachment, devotion to family, parent's educational level, and parental support are the protective factors against high-risk behaviors. The purpose of this study was to determine the prevalence of drug use among pre-university students and its relationship with familial factors. 1000 Fourth grade high-school male students were randomly selected during 6 months in four districts of Shiraz City during 2017-2018. 14% of the participants were current smokers, 13.5% had a history of alcohol consumption, and 1% used psychotropic drugs, respectively. Moreover 59% of the participants who had consumed alcohol were cigarette smokers as well. 4.5% of them used all the three substances such as alcohol, tobacco and psychotropic drugs. Children whose parents do not set clear regulations or do not control their children are at higher risk of drug abuse.

A randomized clinical trial on the effects of bupropion and buprenorphine on the reduction of methamphetamine craving.

BACKGROUND: The purpose of this study was to compare the effect of 300 mg of bupropion and 8 mg of buprenorphine per day on the treatment of methamphetamine withdrawal cravings over a 2-week treatment interval. METHOD: Sixty-five methamphetamine-dependent men who met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision) criteria for methamphetamine dependence and withdrawal were randomly divided into two groups. Subjects randomly received 300 mg of bupropion or 8 mg of buprenorphine per day in a psychiatric ward. Of the 65 subjects, 35 (53.8%) received buprenorphine and 30 (46.2%) received bupropion. The subjects were assessed by using methamphetamine craving score, interview, and negative urine drug test. FINDINGS: There were no statistically significant differences between the two groups in regard to age, education, duration of methamphetamine dependency, marital status, employment, and income. The mean ages were 32.8 years (standard deviation (SD) = 7.26, range = 22 to 59) for the buprenorphine group and 32.21 years (SD = 8.45, range = 17 to 51) for the bupropion group. All 65 patients completed the 2-week study. Both medications were effective in the reduction of methamphetamine cravings. Reduction of craving in the buprenorphine group was significantly more than the bupropion group (P = 0.011). Overall, a significant main effect of day (P <0.001) and group (P = 0.011) and a non-significant group-by-day interaction (P >0.05) were detected. CONCLUSIONS: The results support the safety and effectiveness of buprenorphine and bupropion in the treatment of methamphetamine withdrawal craving. Administration of 8 mg of buprenorphine per day can be recommended for the treatment of methamphetamine withdrawal cravings. We should note that it is to be expected that craving decreases over time without any medication. So the conclusion may not be that bupropion and buprenorphine both lower the craving. As the buprenorphine is superior to bupropion, only buprenorphine does so for sure. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) registration number: IRCT2015010320540N1 . Date registered: April 10, 2015.

Single high-dose buprenorphine for opioid craving during withdrawal.

BACKGROUND: Opioid use disorder is one of the most prevalent addiction problems worldwide. Buprenorphine is used as a medication to treat this disorder, but in countries where buprenorphine is unavailable in combination with naloxone, diversion can be a problem if the medication is given outside a hospital setting. OBJECTIVE: The objective of this research is to evaluate the effect of a single, high dose of buprenorphine on craving in opioid-dependent patients over 5 days of abstinence from use of other opioids. The primary goal was to determine the safety and efficacy of buprenorphine during withdrawal in a hospital setting. METHODS: Ninety men who used opium, heroin, or prescribed opioids and met DSM-5 criteria for opioid use disorder (severe form) were randomized to three groups (n = 30 per group) to receive a single, sublingual dose of buprenorphine (32, 64, or 96 mg). The study was conducted in an inpatient psychiatric ward, with appropriate precautions and monitoring of respiratory and cardiovascular measures. Buprenorphine was administered when the patients were in moderate opiate withdrawal, as indicated by the presence of four to five symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed at baseline. Self-reports of craving were obtained at baseline and on each of the 5 days after buprenorphine administration. FINDINGS: Craving decreased from baseline in each of the three groups (p < 0.0001), with a significant interaction between group and time (p < 0.038), indicating that groups with higher doses of buprenorphine had greater reduction. CONCLUSIONS: A single, high dose of buprenorphine can reduce craving during opioid withdrawal; additional studies with follow-up are warranted to evaluate safety.

The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: a randomized, double-blind, clinical trial.

BACKGROUND: Buprenorphine is usually administered to treat opioid use disorder and pain syndromes. This research presents the first study regarding the effectiveness of different singly administered high doses of buprenorphine (a partial opioid agonist (of µ-opioid receptors), a potent opioid antagonist (of κ-receptors) and a partial agonist of nociception receptors) in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence. It follows small studies that suggest that ultra-low-dose buprenorphine may be useful in reducing suicidal ideation. The goal of this study was to describe the outcome of different doses of buprenorphine on suicidal opioid-dependent patients over a 3-day interval, by conducting a randomized clinical trial. METHODS: Fifty-one suicidal male inpatients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for both opioid dependence and major depressive disorder were randomized to three groups (n = 17 per group) to receive a single, sublingual dose of buprenorphine (32 mg, 64 mg, or 96 mg). Out of 51 participants, there were 47 patients; 16 (34.04%) received 32 mg, 17 (36.17%) received 64 mg, and 14 (29.78%) received 96 mg of sublingual buprenorphine. They were evaluated by using psychometric assessment of the Beck Scale for Suicidal Ideation (BSSI) and interviews based on DSM-5 criteria. A placebo group was not included because of the high probability of severe withdrawal without active pharmacological treatment. The study was conducted with appropriate precautions and monitoring of respiratory and cardiovascular measures. The medication was administered while the patients were in moderate opiate withdrawal, as indicated by the presence of four to five withdrawal symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed. RESULTS: Patients completed the 3-day trial course. The outcomes illustrated a significant reduction in BSSI scores within each of the three groups, p < 0.01., but no difference in results between the groups, p = 0.408. CONCLUSIONS: The results suggest that a single high dose of buprenorphine could rapidly treat suicidal ideations. A single high dose of buprenorphine may be a main-mechanism medication that gives a rapid treatment for suicidal opioid-dependent patients. Placebo-controlled trials are required to measure the safety and the physiological and psychological effects of this medication.

Ultrarapid Influence of Buprenorphine on Major Depression in Opioid-Dependent Patients: A Double Blind, Randomized Clinical Trial.

OBJECTIVE: To examine the impact of different doses of buprenorphine on depression symptoms in opioid dependent inpatient over a three-day interval, using a randomized clinical trial design (RCT). DESIGN: Patients were randomized and assigned to three groups. PARTICIPANTS: Forty males who were admitted to an inpatient psychiatric unit and who fulfilled the DSM-5 criteria for both opioid dependence and major depressive disorder. INTERVENTION: Patients randomly received 32 mg, 64 mg, or 96 mg of buprenorphine as a single high dose. Out of 40 patients, 11 (27.5%) received 32 mg, 14 (35%) received 64 mg and 15 (37.5%) received 96 mg of buprenorphine. We conducted medical precautional measures, including cardiovascular and respiratory monitoring. MEASUREMENTS: Depression was measured by the Beck Depression Inventory (BDI). All patients completed the three-day treatment duration. The results showed a significant reduction in depression symptoms within each of the three groups (p = 0.00), although there was no significant difference in depression outcome across the groups (p = 0.90). CONCLUSIONS: The results suggest that a single high dose of buprenorphine could provide a safe, simple and speedy means of depression improvement. A single high dose of buprenorphine can be used as medication that supplies a fast and maintained treatment for major depressive disorder in patients who are opioid dependent. Placebo-controlled trials of longer periods and larger sample sizes are needed to test ability and safety, as well as the physiological and psychological impact of extended exposure to this drug.

Suicide of Australians during the Vietnam War.

OBJECTIVES: National suicide rates fall during times of war. This fits with the notion of the population coming together against a common foe. But, what happens in the case of a war which is not fully supported, which draws the population and families apart? We consider this question by examining the Australian suicide rates during the divisive Vietnam War. METHODS: We graphed and examined the Australian suicide figures for 1921-2010. RESULTS: We found clear evidence of a decrease in the suicide rate for World War II (consistent with other studies), but a marked elevation of suicide during the Vietnam War. CONCLUSIONS: The elevation of the Australian suicide rate during the Vietnam War is consistent with Durkheim's social integration model - when social integration is lessened, either by individual characteristics or societal characteristics, the risk of suicide rises.

Anxiety Treatment of Opioid Dependent Patients with Buprenorphine: A Randomized, Double-blind, Clinical Trial.

OBJECTIVE: The objective of this study is to examine the impact of vary doses of buprenorphine on anxiety symptoms in opioid-dependent inpatients over a 7 days period, using a randomized controlled trial design. DESIGN: Patients were randomized to three groups. PATIENTS AND METHODS: Fourteen men who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for both opioid use disorder and generalized anxiety disorder and were seeking for treatment. INTERVENTION: Patients obtain dosages of 32 mg or 64 mg or 96 mg of buprenorphine as a single dose only and were treated in a psychiatric inpatient unit. Of 14 subjects; 5 (35.7%) obtained 32 mg, 4 (28.6%) obtained 64 mg, and 5 (35.7%) obtained 96 mg of buprenorphine. MEASUREMENTS: Administering daily Hamilton Anxiety Rating Scale and interview. RESULTS: All the patients ended the 7-day treatment time. The results showed a significant reduction in anxiety symptoms within each of the three groups (P = 0.00), but no difference in outcome between the groups (P = 0.605). CONCLUSIONS: The outcome suggests a single high dose of buprenorphine can supply a speedy, safe, simple, and suitable means of anxiety treatment. The single high dose of buprenorphine could be a novel mechanism medication that provides a rapid and sustained improvement for generalized anxiety disorder in opioid dependent patients. Placebo-controlled trials of longer duration are needed to evaluate ability, safety, and psychological and physiological influence of extended exposure to this medication.

Comparing the effect of buprenorphine and methadone in the reduction of methamphetamine craving: a randomized clinical trial.

BACKGROUND: We sought to test the effectiveness of methadone and buprenorphine in the treatment of methamphetamine withdrawal craving over a 17-day treatment period. METHODS: Patients were randomized into one of two groups. The study sample comprised 40 male subjects dependent on methamphetamine who met criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for methamphetamine dependence and withdrawal and were seeking treatment. Furthermore, they should have a history of daily methamphetamine use for at least 6 months and should have discontinued their use just before starting the protocol. Patients received 40 mg of methadone or 8 mg of buprenorphine per day and were treated in an inpatient psychiatric hospital. We used methamphetamine craving score, negative urine drug screening test (thin-layer chromatography) during the study, and retention in treatment. RESULTS: All 40 patients completed the study. Both drugs were effective in decreasing methamphetamine craving during methamphetamine withdrawal. Reduction of craving in the buprenorphine group was significantly more than in the methadone group (P < 0.05). CONCLUSIONS: The results favor the efficacy and safety of buprenorphine as a short-term treatment for methamphetamine withdrawal craving. We should mention that it is to be expected that craving declines over time without any medication. Therefore, the conclusion may not be that methadone and buprenorphine both reduce the craving. Because buprenorphine is superior to methadone, only buprenorphine surely reduces craving. TRIAL REGISTRATION: Iranian Registry of Clinical Trials identifier: IRCT2015112125160N1 . Registered on 4 June 2016.

Suicide Triggers Described by Herodotus.

OBJECTIVE: The aim of this study was to better understand the triggers of suicide, particularly among the ancient Greek and Persian soldiers and commanders. METHOD: 'Herodotus:TheHistories' is a history of the rulers and soldiery who participated in the Greco-Persian wars (492-449 BCE). A new translation (2013) of this manuscript was studied. Accounts of suicide were collected and collated, with descriptions of circumstances, methods, and probable triggers. RESULTS: Nine accounts of suicide were identified. Eight of these were named individuals (4 Greeks and 4 Persians); of whom, seven were male. Only one (not the female) appeared to act in response to a mental disorder. Other triggers of suicide included guilt, avoidance of dishonour/punishment and altruism. Cutting/ stabbing was the most common method; others included hanging, jumping, poison, and burning (the single female). CONCLUSION: While soldiers at a time of war do not reflect the general community, they are nevertheless members of their society. Thus, this evidence demonstrates that suicide triggered by burdensome circumstances (in addition to mental disorder) was known to the Greek and Persian people more than two millennia ago.

Female Sexual Dysfunction Among the Wives of Opioid-Dependent Males in Iran.

BACKGROUND: Opiate abuse in males has significant effects on their sexual functions. In contrast, sexuality in females is a multidimensional issue that can strongly be affected by several factors in their partners. However, only a limited number of studies have assessed the role of males' opioid dependency in their female partners' sexual function. OBJECTIVES: The present study aimed to evaluate the effect of males' opioid dependency on their wives' sexual function compared to the sexual function of the females whose husbands were not opioid dependent. PATIENTS AND METHODS: This study included 340 women who were selected through convenience sampling and divided into a control (females whose husbands were not opioid dependent) and a case group (women whose husbands were opioid dependent). The data were collected through an interview according to the DSM-IV-R criteria for female sexual dysfunctions by a senior female medical student who was one of the researchers. Finally, the data were entered into the SPSS statistical software (v. 15) and analyzed using the t-test and chi-square test. RESULTS: According to the results, the frequency of hypoactive sexual desire disorder and sexual aversion disorder in the control group was significantly higher than that of the case group (P < 0.05). CONCLUSIONS: The results showed that having an addicted husband could strongly affect some sexual domains in women. It could change the pattern of desire and motivation for sexual contact in females and alter their attitude toward the sexual relationship, thereby causing disturbances in the females' normal sexual function.

Double-Blind Phase III Randomized Trial of the Antiprogestin Agent Mifepristone in the Treatment of Unresectable Meningioma: SWOG S9005.

PURPOSE: Progesterone receptors are expressed in approximately 70% of meningiomas. Mifepristone is an oral antiprogestational agent reported to have modest activity in a phase II study. This multicenter, prospective, randomized, placebo-controlled phase III trial conducted by SWOG was planned to define the role of mifepristone in the treatment of unresectable meningioma. PATIENTS AND METHODS: Eligible patients were randomly assigned to receive either mifepristone or placebo for 2 years unless disease progressed. Patients who were stable or responding to protocol therapy after 2 years had the option to continue with the same blinded therapy. Serial follow-up allowed assessment of efficacy and toxicity. Time to treatment failure and overall survival were ascertained for all randomly assigned patients. On progression, patients receiving placebo could cross over and receive active drug. RESULTS: Among 164 eligible patients, 80 were randomly assigned to mifepristone and 84 to placebo. Twenty-four patients (30%) were able to complete 2 years of mifepristone without disease progression, adverse effects, or other reasons for discontinuation. Twenty-eight patients (33%) in the placebo arm completed the 2-year study. There was no statistical difference between the arms in terms of failure-free or overall survival. CONCLUSION: Long-term administration of mifepristone was well tolerated but had no impact on patients with unresectable meningioma.

Sleep Quality among Patients with Mild Traumatic Brain Injury: A Cross-Sectional Study.

OBJECTIVE: To evaluate and describe the sleep quality in seven subscales among the patients with mild traumatic brain injury (TBI) and compare it with normal patterns. METHODS: This cross-sectional study was conducted within a 6-month period from February to August 2014 in Shahid Rajaei trauma center of Shiraz. Participants were selected randomly from all adult (18-60 years of age) patients admitted during the study period with impression of mild TBI (GCS of more than 13). The patients' sleep quality and demographic characteristics were evaluated by Pittsburgh sleep quality index (PSQI) and self- report questionnaire, respectively. Results were compared with normal data, which extracted from the normative data of PSQI manual. RESULTS: Overall we included 60 patients with mild TBI with mean age of 36.2±13.4 years. All the patients had sleep disturbance. Among them there were 46 (76.7%) men and 14 (23.3%) women. The subjective sleep quality ( p=0.01), sleep latency ( p=0.01), habitual sleep efficiency ( p=0.01), sleep disturbance ( p=0.01), use of sleep medication ( p=0.01) and day time dysfunction ( p=0.01) were significantly impaired in patients with mild TBI when compared to normal values. There were no difference between men and women regarding the sleep quality. The sleep duration was comparable between the subjects and the normal values. CONCLUSION: Patients with mild TBI have poor sleep quality which should be considered as one of the main factors in interventions after the injury and it might lead to better quality of life.

Remission of Methamphetamine-Induced Withdrawal Delirium and Craving After Electroconvulsive Therapy.

INTRODUCTION: The aim of this study is to describe the use of electroconvulsive therapy (ECT) in the treatment of methamphetamine-induced withdrawal delirium and craving in a single case. CASE PRESENTATION: A 44-year-old male presented to the hospital in Fars province, Iran, with Methamphetamine-Induced Withdrawal Delirium who responded to ECT. CONCLUSIONS: The electroconvulsive therapy can be a suitable option for the treatment of methamphetamine withdrawal delirium and craving. Also, it can be usefully employed in these very serious conditions which may represent a risk to life.