Effect of Cuscuta epithymum Acquainted with Risperidone on the Improvement of Clinical Symptoms and Cognitive Impairment in Patients with Schizophrenia: A Triple-Blind Randomized Placebo-Controlled Trial.

BACKGROUND: Cuscuta epithymum (CE) is an established medicinal herb utilized for treating psychosis in Persian medicine. The aim of this study was to investigate the effect of CE combined with risperidone on the clinical symptoms and the cognitive impairment in patients diagnosed with schizophrenia. MATERIALS AND METHODS: In this triple-blind randomized placebo-controlled trial, the intervention group received a dose of 500 mg of CE in the form of a capsule to be taken twice a day accompanied by an appropriate dose of risperidone. The control group was presented with a placebo identical to that of the CE capsule plus the allocated dose of risperidone. The PANSS and SCoRS questionnaires were used to assess the status of subjects prior to the initiation of the intervention as well as being put to use at the end of the second, fourth, and eighth week post-intervention. Registering and recording intel concerning positive and negative symptoms felt by participants (PANNS), and a test to assess the cognitive impairment of the individuals. RESULTS: After eight weeks of treatment, all negative and positive symptoms besides hostility and somatic concern exhibited a significant improvement in the CE group (P <0.05). In contrast, the CE placebo group displayed no substantial improvement in the cases of the positive, negative and general symptoms (P>0.05) regarding cognitive impairment, after eight weeks of treatment, all symptoms were greatly improved in the CE group (P<0.05), while the effect of the placebo on the patients cognitive impairment remained mostly stationary (P>0.05). Consequently, after eight weeks after the intervention, we can determine that the CE treatment has been noticeably more effective at improving positive, negative and cognitive symptoms of patients with schizophrenia. CONCLUSION: The results of this study demonstrated that CE, possessing possible antioxidant and neuroprotective properties, safely improved the positive and negative symptoms, and cognitive impairment of patients with schizophrenia.

Injecting and Sexual Networks and Sociodemographic Factors and Dual HIV Risk among People Who Inject Drugs: A Cross-sectional Study in Kermanshah Province, Iran.

BACKGROUND: Few studies suggest that social network factors, including size of sexual network may associate with drug-related and sexual high-risk behaviors. The objective of this study is to investigate injecting and sexual networks and sociodemographic factors that might be associated with dual HIV risk (DHR) among people who inject drug (PWID). METHODS: The data from a cross-sectional study of 455 PWID that were recruited through peer-referral sampling were used in this study. The data were collected using a structured questionnaire consisted of modules on sociodemographic characteristics, sexual and injection-related risk behaviors during 12 months before the interview. DHR was defined as engaged in both using a syringe previously used by other PWIDs and unprotected sex during last 12 months. Data analysis was performed with descriptive and logistic regression. In final model, we considered variables with P < 0.500 as statistically significant. Finally, reported adjusted odds ratio (AOR) and confidence interval (95% CI) for variables that were significant in the final model. FINDINGS: A total of 455 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19-58) years. Overall, the prevalence of DHR In the last 12 months, 38% (95% CI: 18.3-51.2%). Multivariate model showed that regular visit to needle, syringe programs (NSPs) reduced odd of HDR to 50% when adjusted for other covariates, but still remained statistically significant (P < 0.050). The odds of reporting DHR was significantly higher in those ≥ 2 sex partners and injection partner (P < 0.010). Odds of DHR was higher (AOR: 2.3) among participants who had more than 2 injection per day but was not statistically significant (P > 0.050). CONCLUSION: DHR was common in PWID in Kermanshah, Iran. Having multiple injecting and sexual partners increased the odds of engaging in dual risk behaviors, but regular visit of NSPs can reduce the DHR among PWID.

Safety evaluation of saffron stigma (Crocus sativus L.) aqueous extract and crocin in patients with schizophrenia.

OBJECTIVES: Saffron is the stigma of Crocus sativus L., which has the potentials to play a role in the treatment of many diseases. Although many researches are now going on this precious spice, there are few data on saffron safety in human, especially in patients with chronic mental illnesses. This study aimed to evaluate the short-term safety and tolerability of both saffron and crocin (its major constituent) in adult patients with schizophrenia. MATERIALS AND METHODS: The capsules of saffron aqueous extract (SAE) and crocin were used to evaluate short-term safety and tolerability in patients with schizophrenia. A double-blind, placebo-controlled study was performed on patients with schizophrenia. The patients were all male and were divided into three 22-patient groups. While receiving their normal treatment, they also received a 12 week treatment with SAE (15 mg twice daily), crocin (15 mg twice daily) or placebo. RESULTS: A total of 61 patients completed the trial; none of them reported a serious side effect. WBC count increased significantly in patients receiving saffron aqua extract (SAE), but it was within the normal range and had no clinical significance. Other hematologic components, markers of thyroid, liver and kidney or inflammation markers had no statistically significant difference among the groups. CONCLUSION: This study showed that SAE and crocin in doses of 15 mg twice daily were safely tolerated in patients with schizophrenia.

The therapeutic effectiveness of risperidone on negative symptoms of schizophrenia in comparison with haloperidol: a randomized clinical trial.

INTRODUCTION: A number of research studies have shown that the new generation of neuroleptic medications can more effectively contribute to treating negative symptoms of schizophrenia compared with the first generation by influence cognitive functioning. The present study examined the therapeutic effectiveness of manufactured Risperidone and Haloperidol in Iran on treating the negative symptoms of schizophrenia. METHODS: This randomized clinical trial (RCT) study examined 100 hospitalized patients who met DSM-IV. TR criteria for schizophrenia were sampled at Razi psychiatric hospital in Tehran, Iran. After two weeks of stopping neuroleptic medications, the patients were randomly assigned into two groups, Risperidone and Haloperidol group. During 8 weeks of the study, baseline and weekly assessments were performed by completing brief psychiatric report scale (BPRS). RESULTS: Both Risperidone and Haloperidol were effective in treating the negative symptoms of schizophrenia and improvements in both groups were initiated in the second week of treatment. The most prominent response rate was the second week in Haloperidol group and the eighth week in Risperidone group but this difference was not statistically significant. DISCUSSION: Prescribing Risperidone or Haloperidol for treating negative symptoms of schizophrenia can be influenced by other criteria including side effects, previous treatment histories of patients and their families and a patient's or physician' preference in prescribing a medication. Studies in other countries show that Haloperidol has better therapeutic effects in treating the negative symptoms of schizophrenia in comparison with Risperidone. Further studies on the therapeutic effectiveness of Risperidone and Haloperidol are suggested.

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.

Anxiety and depression in a sample of Iranian patients with irritable bowel syndrome.

OBJECTIVE: Previous studies have shown that up to 50% to 70% of patients with irritable bowel syndrome (IBS) who seek treatment have psychiatric comorbidity. The aim of this study was to report the history of anxiety and depression in IBS patients. METHODS: The study, designed as a cross-sectional, was performed in a consecutive sample of individuals diagnosed with IBS in the Gastroenterology Clinic of Taleghani Hospital, Tehran province, Iran from October 2010 to October 2011. IBS was diagnosed according to the Rome III criteria. All participants were asked about perceived psychiatric symptoms such as depression and anxiety in the past six months. RESULTS: 153 treatment-seeking IBS patients were entered to the study. The mean age of IBS patients with history of psychiatric symptoms (33.9 years) was relatively lower than those without this history (39.3 years); p< 0.05. There was a significant difference regarding mean age of diarrhea-predominant IBS (IBS-D) patients with history of psychiatric symptoms (26.8 years) and without such history (37.9 years); p< 0.05. However, such a difference was not seen among other types of IBS. The most frequent psychiatric symptoms were reported by the constipation-predominant IBS (IBS-C) patients followed by mixed-IBS (IBS-M) and the least rate was seen in IBS-D. CONCLUSION: Approximately half of IBS patients reported anxiety and/or depression. IBS-C patients experienced higher proportions of anxiety and depression. DECLARATION OF INTEREST: None.

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.

Evaluation of psychological aspects among subtypes of irritable bowel syndrome.

CONTEXT: While some studies have found disparities between subtypes of irritable bowel syndrome (IBS), others did not found such differences. AIM: This study aimed to investigate whether there are differences in psychological features between the subtypes of IBS. SETTINGS AND DESIGN: A cross-sectional study was performed on all consecutive outpatients IBS diagnosed (from Oct. 2010 to Oct. 2011) in Taleghani Hospital gastroenterology clinic, Tehran, Iran. MATERIALS AND METHODS: A total of 153 consecutively diagnosed IBS patients (using Rome III criteria); including 80 constipation-predominant (IBS-C), 22 diarrhea-predominant (IBS-D), and 51 mixed IBS (IBS-M) were asked to complete the Symptom Checklist 90 Revised (SCL-90-R). STATISTICAL ANALYSIS: Pearson's chi-square test was used to compare nominal variables. One-way ANOVA was used to compare continuous variables. RESULTS: Although IBS-C patients were more suffered from psychiatric disorders, there were no statistical differences between mean score of IBS-C, IBS-D, and IBS-M patients regarding to all of SCL-90-R subscales and three global indices including Global Severity Index (GSI), Positive Symptom Distress Index (PSDI) and Positive Symptom Total (PST) (P<0.05). CONCLUSION: Our finding showed that there are no different symptomatic profiles between IBS subtypes.

Sensation seeking behavior among schizophrenics.

OBJECTIVE: To compare sensation seeking between schizophrenic patients (and clinical subtypes of schizophrenia) according to criteria of DSM-IV-TR; and a healthy control group. Two hypotheses were assumed: 1. Sensation seeking in the control group is higher than schizophrenic patients. 2. The levels of sensation seeking are different among clinical subtypes of schizophrenia. METHODS: The sample comprised a study group of 69 schizophrenic inpatients at Raazy Psychiatric Center, Tehran, Iran in 2005 (10 males and 10 females for each of paranoid, undifferentiated and residual subtypes, and 9 males from disorganized subtype), and 50 randomly selected healthy people, the control group. To measure sensation seeking, the Zuckermann Sensation Seeking Scale, a 41-item questionnaire form, was used after evaluating its validity and reliability. After obtaining a weak or negative correlation, we omitted 9 questions, so that finally a 32-item questionnaire with highest reliability (Cronbach`s alpha = 0.64), remained and was utilized. We used descriptive statistical methods and calculation of statistical indices, and Student t-test for independent groups to evaluate the research hypotheses. RESULTS: The first hypothesis was confirmed at a 99% significance level. The second hypothesis was rejected at a 95% significance level. CONCLUSION: We found a definite correlation between schizophrenia and a low level of sensation seeking. Accordingly, and since sensation seeking (as a part of temperament) has a strong genetic component, a low level of sensation seeking is probably an existing feature of schizophrenia. Assessing sensation seeking in high-risk populations (children or the siblings of schizophrenics) could be a practical attempt at prevention or immediate treatment of schizophrenia.

A point mutation at the calreticulin gene core promoter conserved sequence in a case of schizophrenia.

Exposure to atypical antipsychotic drugs such as valproate increases the expression of chaperones that assist in the folding of proteins in the endoplasmic reticulum (ER) including calreticulin, GRP78/BiP, GRP94, and PD1. This neuroprotective role may be involved in the pathophysiology of neuropsychiatric disorders such as schizophrenia and bipolar disorder. The 5'-flanking region of the human calreticulin gene was screened in 100 cases of schizophrenia by PCR/SSCA between -485 and +1 basepair (bp) relative to the transcription start site. A G > C point mutation was detected at -48 in a case of paranoid schizophrenia, which was not detected in 280 unrelated control subjects (560 chromosomes). This is the first report of mutation in relation with the calreticulin gene. The -48G > C mutation creates a CpG site at the core promoter region of the gene. The role of this mutation remains to be clarified in the pathophysiology of the disease.