Prevalence of depressive disorders in Rasht, Iran: A community based study.

INTRODUCTION: Depression is a well known health problem worldwide. Prevalence of depressive disorders varies in different societies. AIM: to determine the prevalence of depressive disorders and some associated factors in Rasht City (Northern part of Iran). MATERIALS AND METHODS: 4020 subjects were selected among 394925 residents of Rasht aged between 18-70 during 2003 - 2004. In the first phase, subjects were screened by Beck's Depression Inventory. In the second phase, those who scored more than 15 were assessed through semi-structured psychiatric interview (DSMIV-TR). Socio-demographic characteristics including age, gender, marital status, educational level, and socio-economic class were recorded as well. RESULTS: 9.5% of samples (63% female and 37% male) were diagnosed by depressive disorders. The prevalence of minor depressive disorder, dysthymia and major depressive disorder was 5%, 2/5%, and 1% respectively. Socio-economic class was significantly associated with both depressive symptoms based on BDI score (p < 0.001) and depressive disorders based on clinical interview (p < 0.001). CONCLUSION: Comparing to other studies, this study revealed that prevalence of dysthymic and minor depressive disorder were more than major depressive disorder, and low socio-economic class was the most significant risk factor associated with depression. Regarding our study limitations, researchers and policy makers should not consider our findings as conclusive results. Findings of this study could be applied by researchers using analytical methodology to assess relationship between depressive disorders and associated factors.

Evaluation of partial epilepsy in Iran: role of video-EEG, EEG, and MRI with epilepsy protocol.

BACKGROUND: We evaluated the diagnostic value of Electroencephalography (EEG), video-EEG monitoring (VEM) and Magnetic resonance imaging (MRI) of the brain with epilepsy protocol in patients with complex partial epilepsy. METHODS: Forty-two consecutive patients underwent complete neurological examination, EEG, and MRI with a modified epilepsy protocol. A subset of these patients (n = 29) also underwent VEM. Data were presented using descriptive statistics and were analyzed using Chi square and McNemar tests. RESULTS: Twenty-four women and eighteen men entered the study. The mean (±SD) age for patients, was 25.2(±10.1) and mean (±SD) age at onset was 10.9(±8.1). All patients had abnormal ictal or interictal EEG. Fifteen patients had normal MRI. Temporal lobe involvement was the most common involvement in both EEG (27 patients) and MRI (14 patients). Interictal EEG was abnormal in 81% of patients which showed epileptiform discharges in about half of the cases. In half of patients who had lateralized finding on MRI, site of the lesion was congruent between MRI and interictal EEG. Thirty-six patients had symptoms suggesting a specific lobe, of which interictal EEG was able to show the concordant lobe in 22 (61%) patients. McNemar test showed superiority of EEG over MRI in correct diagnosis of the involved lobe based on the clinical manifestations (P < 0.01). CONCLUSION: In our setting, both ictal and interictal EEG perform better than MRI in evaluating complex partial epilepsy. In addition, combination of these tools may increase the yield of showing abnormality to near 100% in patients with complex partial epilepsy.

Sildenafil adjunctive therapy to risperidone in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled trial.

RATIONAL: It has been suggested that phosphodiesterase 5 inhibitors such as sildenafil may be effective in the treatment of negative symptoms of schizophrenia. OBJECTIVE: This study was designed to investigate the effect of sildenafil added to risperidone as augmentation therapy in patients with chronic schizophrenia and prominent negative symptoms in a double-blind and randomized clinical trial. METHODS: Eligible participants in the study were 40 patients with chronic schizophrenia with ages ranging from 18 to 45 years. All patients were inpatients and were in the active phase of the illness and met DSM-IV-TR criteria for schizophrenia. Patients were allocated in a random fashion: 20 to risperidone (6 mg/day) plus sildenafil (75 mg/day) and 20 to risperidone (6 mg/day) plus placebo. The principal measure of outcome was Positive and Negative Syndrome Scale (PANSS). RESULTS: Although both protocols significantly decreased the score of the positive, negative, and general psychopathological symptoms over the trial period, the combination of risperidone and sildenafil showed a significant superiority over risperidone alone in decreasing negative symptoms and PANSS total scores over the 8-week trial (between-subjects factor; F = 4.77, df = 1; P = 0.03; F = 5.91, df = 1, P = 0.02 respectively). CONCLUSION: Therapy with 75 mg/day of sildenafil was well tolerated, and no clinically important side effects were observed. The present study indicates sildenafil as a potential adjunctive treatment strategy for treatment of negative symptoms of schizophrenia. This trial is registered with the Iranian Clinical Trials Registry (IRCT1138901151556N11).

Double-blind, randomized, placebo-controlled 6-week study on the efficacy and safety of the tamoxifen adjunctive to lithium in acute bipolar mania.

BACKGROUND: Considerable amount of biochemical data supports the potential involvement of protein kinase C in the pathophysiology and treatment of bipolar disorder. The aim of this double-blind, placebo-controlled study was to investigate the efficacy and tolerability of tamoxifen as an adjunct to lithium for the treatment of acute mania in hospitalized bipolar patients. METHODS: Eligible participants were 40 inpatients, between the ages of 19 and 49 years with current manic episode. Patients were randomly allocated to lithium (1-1.2 mEq/L) + tamoxifen 80 mg/day (group A) or lithium (1-1.2 mEq/L) + placebo (group B) for a 6-week, double-blind, placebo-controlled study. The principal measure of outcome was the Young Mania Rating Scale. The raters used standardized instructions for Young Mania Rating Scale. RESULTS: Young Mania Rating Scale scores improved with tamoxifen. The difference between the two protocols was significant as indicated by the effect of the group, the between-subjects factor (F=5.41, df=1, p=0.02). A significant difference was observed on the Positive and Negative Syndrome Scale total score at week 6 in the two groups. The difference between the two groups in the frequency of side effects was not significant except for fatigue that occurred more often in the tamoxifen group. LIMITATIONS: Tamoxifen is an antagonist of estrogen receptor as well. CONCLUSION: The results demonstrate that the combination of tamoxifen with lithium was superior to lithium alone for the rapid reduction of manic symptoms. The combined use of tamoxifen with lithium was well tolerated in these acutely manic patients.