[Investigation of antipsychotic induced parkinsonism in patients with schizophrenia]

Antipsychotic drugs have an important role in psychiatric treatment. Their side effects such as drug induced Parkinsonism, which has been a historical challenge for patients and physicians, account a major cause of treatment rejection by the patients. Drug induced Parkinsonism is the second cause of Parkinson syndrome. The aim of this study was to evaluate antipsychotic induced Parkinsonism in patients with schizophrenia. This cross sectional descriptive study was done in the year 1999 in Noor and Shariaty Hospitals of Isfahan. 200 patients with schizophrenia, affected with Parkinsonism complication, were investigated. Variables were sex, age, dosage and group of drug, duration of treatment, Parkinsonism criteria and simultaneous anti cholinergic prescription. Data was gathered in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. 122 men and 78 women were studied. 26.5% of patients had drug induced Parkinsonism, which was mostly seen in women [32% versus 22.9% in men], higher age [10-19 years: 0%, 50 years and higher: 33%], and when anticholinergic was not used simultaneously [35.7% versus 25% in anticholinergic users group]. Prevalence of Parkinsonism, in high, medium, and low drug potentials was 28.7%, 29.4% and 19.2%, respectively. Differences in all of the above groups were not significant. Prevalence increased in dosage of less than 100mg [chlorpromazine equivalent dosage] versus 101-300mg [p>0.05], and in 3-6 months after onset of treatment [p<0.05]. The most prevalence criterion was rigidity [84.9%]. Parkinsonism was diagnosed in 11.76% of patients using atypical drug [clozapin]. Anti psychotic induced Parkinsonism increased in higher ages, women and when anticholinergic was not used simultaneously. This side effect was found in all groups even with clozapin. It had a greater prevalence in the beginning of treatment but decreased with treatment continuation and anticholinergic prescription. Future studies particularly on the atypical groups are suggested

[ survey on frequency of drug-induced akathisia in psychiatric wards using two methods: clinical diagnosis and Barnes rating scale]

Akathisia syndrome is one of the medication induced movement disorders that is found is patients who take neuroleptic drug. In this disorder the patients has an inner sense of restlessness and there are some restless movement in patients' limbs. Akathisia can cause drug noncompliance. To make a proper decision for treating the patients and using the best kinds of drugs, a proper rating scale for diagnosing akathisia should be determined. This cross sectional study was performed in descriptive - analytic style. Samples were 156 hospitalized patients who were on psychiatric drugs. For each patient two data collection forms were prepared. The first form involved questions about diagnosis and akathisia management by physicians. The second form involved Barnes rating scale for Akathisia [BARS]. The data analysis was performed using SPSS, tests were t-student and statistical significance was assessed at the 5% alpha level. This study was performed in Noor, Farabi and Modares hospitals in the spring and summer of 1383 [2004] in Isfahan [Iran]. Among 156 patients, akathisia was diagnosed in 15.4% by BARS scale and in 9.6% by physicians. There was significant difference between the diagnosis of Akathisia by BARS and the diagnosis by physicians. Among patients who had akathisia [in BARS], 29.2% had mild akathisia, 50% had moderate akathisia, 20.8% had marked akathisia Pseudoakathisia was diagnosed in 2.6% of 156 samples. All of the patients, who had akathisia, were taking Antipsychotic drug [83.3% Typical and 16.7% atypical antipsychotic]. For treatment, the physicians reduced the dosage of antipsychotic drugs in 80% of the akathisia patients, and added a new drug for 60% of the patients and changed the antipsychotic drug for 20% of them. In our study, akathisia was diagnosed for 24 patients by BARS. But the physicians did not diagnose akathisia in some of these patients. This might have negative effects on treatment of the patients. Therefore, it's necessary to introduce the Barns akathisia rating scale [BARS] to all physicians and encourage them to apply in all wards to suspicious cases

Effect of cyproheptadine on combat related posttraumatic stress disorder nightmares

Recent studies have shown the role of serotonergic system in posttraumatic stress disorder [PTSD]. Terazodone and nefazodone [5HT[2] receptor antagonists] ameliorated PTSD nightmares but the reports are mixed. This study prompted an open trial of cyproheptadine for Iran versus Iraq combat PTSD patient nightmares. 25 patients studied in an eight-week, before-after trial of cyproheptadine. The participants were male and chronic PTSD patients with combat related nightmare. The exclusion criteria included current substance abuse or dependence, psychotic disorders and any medical condition that contraindicated the use of cyproheptadine. Five patients were excluded from the study because of side effects including dizziness and somnolence. Twenty patients completed the study. Average of nightmare severity decreased from 6.85 to 5.05, which was statistically significant [P<0.01] The data suggest that cyproheptadine, as a 5HT[2] antagonist, may be effective in treament of PTSD nightmare