RESUMEN
OBJECTIVE: Serotonin reuptake inhibitors are frequently used in first-line treatments for patients with obsessive-compulsive disorder. Nevertheless, many of these patients do not respond well to initial therapy. The hypothesis of glutamatergic dysfunction in specific brain regions has been proposed in the pathophysiology of obsessive-compulsive disorder. This study was designed to evaluate the possible efficacy of lamotrigine, a glutamatergic agent in Serotonin reuptake inhibitors-resistant patients with obsessive-compulsive disorder. METHOD: This study was a 12-week, double blind, randomized, placebo-controlled trial of adjunctive fixed-doses of lamotrigine (100 mg) to Serotonin reuptake inhibitors therapy in obsessive-compulsive disorder. Eligible subjects who had a total Y-BOCS of 21 or above were randomly assigned to receive adjunctive treatment with either lamotrigine (n = 26), or placebo (n = 27). Response to lamotrigine was defined as clinical improvement (>25% decrease in the total Y-BOCS score), which was administered at weeks 0, 8 and 12. RESULTS: At the endpoint (week 12), significant differences were observed in obsession, compulsion, and total Y-BOCS scores comparing lamotrigine to placebo (P = 0.01, 0.005 and 0.007 respectively). The mean reduction in obsession, compulsion and total scores in lamotrigine group was about 4.15, 4.50 and 8.73, respectively. Similarly, the mean reductions in the placebo group were 2.52, 2.56 and 5.07. Effect sizes for efficacy measureswerecalculatedbyCohen'sd, and it was calculated as 0.54 for the total YBOCS. CONCLUSION: Our findings provide evidence that this augmentation is well tolerated and may be an effective strategy for patients with refractory obsessive-compulsive disorder.
RESUMEN
BACKGROUND: The pattern of relapses in patients with ulcerative colitis (UC) has a significant role in taking decisions about the therapy and the follow up of patients. This study is designed to find out the pattern, time and severity of relapses in Iranian patients with UC. METHOD: From 1991 to 2003, a period of 13 years, the pattern of relapses in 163 patients with UC who had been admitted to a private referral gastroenterology clinic in Iran were evaluated. RESULTS: 163 patients (58.3% female, 41.7% male) were included, aged from 17 to 74 years with mean age of 38.9 ± 12.3 years. Mean follow up time was 52.7 ± 41.4 months (ranges 12 and 155 months). Mean relapse chance was 0.028 ± 0.036 for each patient in every month (ranges 0-0.21). The mean time from the initial attack to the first relapse was 23.8 ± 22.5 months, which was not the same in patients with different primary disease severity (p = 0.03). CONCLUSION: The time and severity of the relapses relate to the severity of UC. Iranian patients have a milder course of the disease.