The Effect of Adding Mirtazapine to Quetiapine on Reducing Agitation in Patients with Alzheimer's Disease.

Background: Alzheimer's disease (AD) is one of the most debilitating diseases in old age, associated with cognitive decline and behavioral symptoms. Objective: This study aimed to investigate the effect of adding mirtazapine to quetiapine in reducing agitation among patients with AD. Methods: Thirty-seven elderly patients (18 cases and 19 controls) with AD, diagnosed according to National Institute on Aging and Alzheimer's Association (NIA-AA) criteria, were enrolled at Nezam-Mafi Clinic. Inclusion criteria comprised a minimum of two years post-diagnosis, a Cohen-Mansfield Agitation and Aggression Questionnaire (CMAI) score above 45, and treatment with 100-150 mg of quetiapine. Patients were randomly assigned to receive mirtazapine (15 mg at night, increased to 30 mg at night after two weeks) or a placebo. Cognitive changes were assessed at weeks 0 and 6 using the Mini-Mental State Examination instrument. Furthermore, symptoms of agitation and aggression were evaluated using the CMAI questionnaire at weeks 4 and 6. Results: In this study, the mean duration of AD in the control group was 4.68 years, and in the case group, it was 5.05 years. Although the total agitation score showed no significant change at the end of the study compared to the control group, the rate of physical non-aggressive behavior showed a significant decrease (p <  0.05). Conclusions: According to this study, adding mirtazapine to the antipsychotic drug regimen may not be an effective treatment for agitation in AD patients.

Stigma in people living with bipolar disorder and their families: a systematic review.

BACKGROUND: Stigma affects different life aspects in people living with bipolar disorder and their families. This study aimed to examining the experience of stigma and evaluating predictors, consequences and strategies to combat stigma in people with bipolar disorder and their families. METHODS: We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in 2022. We extensively reviewed six online databases (PubMed, Scopus, Medline, EMBASE, Web of Science and Google Scholar). Articles published in the English language about stigma in people living with bipolar disorders and their families were included. RESULTS: A total of 42,763 articles were retrieved, of which 40 articles from 14 countries were included in this study (n = 7417 participants). Of the 40 articles, 29 adopted quantitative methods (72.5%), two used mixed-methods (5%), eight used qualitative (20%) methods, and one was a case series (2.5%). The results of the studies were categorized into four themes: 1. Stigma experienced by people living with bipolar disorders and their families, 2. Predictors of stigma in people living with bipolar disorders and their families, 3. Consequences of stigma in people living with bipolar disorders and their families, 4. Effective interventions and strategies to reduce stigma in people living with bipolar disorders and their families. CONCLUSION: The results of this study might be useful to design psychiatric cognitive interventions to reduce stigma in people living with bipolar disorders and their families and designing community-based interventions to normalize bipolar disorder at the community level.

The bipolar patients' family experiences of the outcomes of encountering stigma in Tehran: A qualitative study.

INTRODUCTION: Nowadays, the most common psychological-social pressure to which bipolar patients' families are exposed is stigma. Therefore, the present study was conducted to delve into the bipolar patients' family experiences of the outcomes of encountering stigma. METHOD: The study was of qualitative type. Purposive sampling was used to select the participants from the persons suffering from bipolar disorder and their families. Twenty seven of the participants were interviewed. The main data collection instrument was semi-structured interview with open questions. Additionally, the collected data were analyzed via inductive content analysis method. The accuracy and validity of the study rooted in four factors: credibility, transferability, verifiability, and reliability. RESULTS: Data analysis led to 1,326 primary codes, which were further categorized into five main categories as the main outcomes of encountering stigma (social deprivation, emotional and sentimental excitement, objective and behavioral reflections, family solidarity threat, and separation from society) and 21 sub-categories. CONCLUSION: Given then irreparable outcomes of stigma for bipolar patients' family, it is necessary to take it into consideration. It is recommended to use media and also hygienic-treatment centers to educate different levels of society as to appropriate treatment with these patients and their families.

The effectiveness of psychoeducation in improving attitudes towards psychological disorders and internalized stigma in the family members of bipolar patients: A quasi-experimental study.

Family members of bipolar patients experience stigma following being labeled by others, which can disrupt their routine lives and result in social isolation. This study aims to evaluate the effectiveness of psychoeducation in improving the attitudes of bipolar patients' family members towards psychological disorders and internalized stigma. The present study is a quasi-experimental study with a pre- and post-test follow-up design, in which 74 individuals were selected by convenience sampling among families who had a member with a bipolar disorder who was referred to the largest psychiatric hospital in Iran in 2021. The participants were randomly divided into the experimental and control groups (n = 37 per group). The members of the experimental group then underwent eight 90-min sessions of psychoeducation. The control group also received psychoeducation at the end of the study. The results of analysis of covariance showed that psychoeducation reduced internalized stigma in the family members of bipolar patients and increased their positive attitudes towards psychological disorders compared with the control group (p < .01). On this basis, psychoeducation can be useful to reduce the internalized stigma of family members of bipolar patients and to increase their positive attitudes towards psychological disorders.

The process of stigma experience in the families of people living with bipolar disorder: a grounded theory study.

BACKGROUND: One of the most challenging issues faced by families of people living with bipolar disorder is stigma. This study was conducted to explain the process of stigma experience in the families of people living with bipolar disorder using the grounded theory method. METHODS: Data for this study were collected through semi-structured interviews with participants in Razi Psychiatric Hospital in Tehran, Iran, via purposive sampling and field notetaking. The dependability, conformability, and transferability measures were included to support the data accuracy and robustness, and MAXQDA 2020 software was used to facilitate data coding. The Strauss-Corbin method was used to analyse the data. RESULTS: A total of 20 family members of people living with bipolar disorder, four people living with bipolar disorder, and three mental health professionals participated in this study. The analysis of participants' experiences led to identifying 64 subcategories, 21 categories, and six main concepts, including social deprivation, being labelled, cultural deficiency and lack of awareness, economic challenges, forced acceptance of the existing situation, and social isolation. CONCLUSION: Families of people living with bipolar disorder experience social deprivation, social isolation, and social rejection, which have irreparable consequences for them. Overcoming stigma in these families should be a priority of policymakers and planners in the field of psychosocial health.

Recovery of struvite via coagulation and flocculation using natural compounds.

One of the major setbacks of struvite recovery processes is the difficulty in harvesting struvite crystals. This study evaluates the use of different coagulants to improve precipitation of struvite (MgNH4PO4.6H20) crystals. Chitosan and poly(diallyldimethyl ammonium chloride) (Poly-DADMAC) as a coagulant-flocculent and alginate and bentonite as a coagulant aid have been examined in jar tests. Also, a continuous three-phase process, i.e., struvite crystallization, coagulation/flocculation and precipitation process, was set up for real wastewater. Addition of chitosan as the coagulant and bentonite as the coagulant aid was significantly more efficient in forming struvite flocs in comparison to Poly-DADMAC alone or with coagulant aid, which did not show any positive effect. The calculated average settling velocity of struvite with chitosan-bentonite addition in synthetic and in real wastewater increased by approximately 5.3 and 2.8 folds, respectively, compared with that of no coagulant/flocculent addition. Phosphorus recovery of over 70% was achieved by the continuous process. Findings in this study clearly confirmed the possibility of using chitosan and bentonite as an efficient coagulant-flocculent to enhance the recovery of struvite crystals.

Struvite-based fertilizer and its physical and chemical properties.

This study describes a method to formulate struvite fine powder into pellets that are easy to spread on agricultural land. To evaluate the quality of produced pellets, some chemical and physical properties commonly measured for fertilizers were tested. The findings indicated that the salt index and heavy metal content ofstruvite pellets were significantly lower than those of commercial NPK fertilizers. In addition, the percentage of nutrient released from struvite pellets after 105 days was in the range of 9.6-23.2, 8.4-26.7 and 11.3-32.6% for nitrogen, phosphorous and magnesium, respectively, which is considerably lower than that of commercial NPK fertilizer. Among different formulations between struvite crystals and binders, starch and bentonite were the most efficient in agglomerating struvite powder, leading to an increase in the crush strength to over the recommended limit of >2.5 kgf for fertilizer hardness.

Evaluation of culture conditions for cellulase production by two Trichoderma reesei mutants under solid-state fermentation conditions.

Response surface methodology (RSM) was used to evaluate the effects of fermentation parameters for cellulase production by Trichoderma reesei QM9414 and T. reesei MCG77 in solid-state fermentation using rice bran as substrate. Initial pH, moisture content and temperature were optimized using filter paper activity (FPA) as response. Statistical analysis of the results for T. reesei QM9414 showed that only moisture content had significant effect on cellulase activity and had a linear effect on enzyme activity (maximum enzyme activities were obtained at 70% moisture content). The results for T. reesei MCG77 showed that temperature and moisture content were the most significant parameters for cellulase activity. The optimum cellulase production was in the temperature range of 25-30 degrees C and moisture content between 55% and 70%. After the optimization, the FPA in T. reesei MCG77 was increased by 2.5 folds compared to that of T. reesei QM9414.