Acetaminophen as Adjuvant to Risperidone in Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Objective: Although the pathogenesis of schizophrenia is still uncertain, a variety of predisposing mechanisms have been implicated including inflammatory cascades. The present study was conducted to investigate the effectiveness of acetaminophen as a cyclooxygenase inhibitor in treating patients with schizophrenia. Method: A double-blind clinical trial was performed on 52 patients with chronic schizophrenia. Patients received risperidone (up to 6 mg/day) plus either acetaminophen (975mg/day) or placebo. Psychotic symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS) at the onset of the trial, and at 2, 4, 6, and 8 weeks post therapy. Results: Compared to the placebo group, the acetaminophen group showed no significant difference in any subtypes of PANSS. Moreover, the side effect profiles of the 2treatment regimens were not significantly different. Conclusion: Acetaminophen adjuvant to risperidone showed no significant effect in ameliorating symptoms of schizophrenia. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (registration number: IRCT201410251556N67).

Minocycline as Adjunctive Treatment to Risperidone in Children with Autistic Disorder: A Randomized, Double-Blind Placebo-Controlled Trial.

OBJECTIVE: This is an investigation of minocycline efficacy and safety as an adjuvant to risperidone in management of children with autism. METHODS: Forty-six children with diagnosis of autistic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) criteria and a score of ≥12 on the Aberrant Behavior Checklist-Community (ABC-C) irritability subscale, who were already drug-free for at least 6 months participated in a randomized controlled trial and underwent 10 weeks of treatment with either minocycline (50 mg twice per day) or placebo in addition to risperidone titrated up to 2 mg/day (based on bodyweight). Patients were evaluated using ABC-C at baseline and at weeks 5 and 10. RESULTS: General linear model repeated measures showed significant effect for time × treatment interaction on the irritability [F(2, 88) = 3.94, p = 0.02] and hyperactivity/noncompliance [F(1.50, 66.05) = 7.92, p = 0.002], but not for lethargy/social withdrawal [F(1.61, 71.02) = 0.98, p = 0.36], stereotypic behavior [F(1.34, 58.80) = 1.55, p = 0.22], and inappropriate speech subscale scores [F(1.52, 66.88) = 1.15, p = 0.31]. By week 10, 21 (91.3%) patients in the minocycline group and 15 (65.5%) patients in the placebo group achieved at least partial response (p = 0.03). Frequencies of adverse events were not significantly different between groups. CONCLUSIONS: Minocycline seems to be a safe and effective adjuvant in management of patients with autistic disorder. Future studies with larger sample sizes, longer follow-ups, and inflammatory cytokine measurements are warranted to confirm these findings and provide insight into minocycline mechanism of action in autistic disorder.

Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial.

Olanzapine is the frequently prescribed drug in children and adolescents with bipolar disorder, but unfortunately it has metabolic side-effects. On the other hand, in a number of melatonin studies on sleep cycle, regulation of metabolic abnormalities has been reported. Therefore, we aimed to study effects of melatonin in reducing metabolic side-effects of olanzapine in 11-17 year-old patients with bipolar disorder. Seventy-seven 11-17 year-old outpatients entered into the study after their initial diagnosis of bipolar mood disorder by a psychiatrist. After assessing inclusion and exclusion criteria, 48 patients consented to participate in the study. Of this number, 24 patients were allocated to olanzapine, lithium carbonate, and melatonin and 24 patients were allocated to olanzapine, lithium carbonate, and placebo. Young mania rating scale was performed at baseline. Before treatment initiation and at sixth and twelfth weeks after treatment, Lipid profile, Fasting Blood Sugar (FBS), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were measured. ANOVA with repeated measure and independent sample t-test were used for data analysis. Nineteen patients in each group completed the study and yielded data for analysis.  ANOVA with repeated measure showed that FBS and Triglyceride (TG) (especially in boys) demonstrated greater increase in the placebo group compared to the melatonin group but the differences were not statistically significant. Melatonin significantly inhibited the rise in Total Cholesterol levels compared to placebo (P=0.032). Mean SBP rose more slowly in the melatonin group (1.05mmHg) compared to placebo (6.36 mmHg) (P=0.023). The trends in DBP did not show any significant pattern. Administration of melatonin along with olanzapine and lithium carbonate could significantly inhibit the rise in cholesterol level and SBP compared to placebo. The effect of melatonin on TG was more obvious in boys. Melatonin was more effective in prevention of SBP rise.

Bupropion in adults with Attention-Deficit/Hyperactivity Disorder: a randomized, double-blind study.

Attention-Deficit/Hyperactivity Disorder is one of the most common mental disorders in childhood, and it continues to adulthood without proper treatment. Stimulants have been used in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) for many years, and the efficacy of methylphenidate in the treatment of adults with ADHD has been proven to be acceptable according to meta-analysis studies. However, there are some concerns about stimulants. Finding other effective medications for the treatment of adult ADHD seems necessary. We hypothesized bupropion could be effective in the treatment of adult ADHD because some theoretical and experimental evidence exists to support efficacy of this medication. Forty-two patients with a diagnosis of ADHD, according to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, were randomized to receive 150 mg/day bupropion or placebo for a 6-week double-blind, placebo-controlled clinical trial. Each patient filled the Conners' Adult ADHD Rating Scales-Self-Report-Screening version (CAARS) before starting to take medication and in weeks 3 and 6 of the study. The mean score of the two groups receiving bupropion or placebo decreased over the 6 weeks. There was a significant difference between the two groups in CAARS score after 6 weeks. Bupropion is more effective than placebo in the treatment of adults with ADHD. Bupropion can be an alternative medication for the treatment of Adults with ADHD as its clinical efficacy was proven by other studies.