[Attitude of patients with multiple sclerosis towards the impacts of the disease on their social and sexual activities]

MULTIPLE SCLEROSIS [MS] is a chronic disease with relapsing and remitting periods. As it can make disabilities in patients' physical activities, MS can affect patients' psycho-social status to various degrees. The aim of this study was to evaluate attitudes of patients with MS towards the impacts of the disease on their social and sexual activities. One hundred patients with a diagnosis of MS hospitalized in Az'zahra Hospital in 2006-2007 were selected through a simple randomized sampling. Data was collected using Beck Depression Inventory [BDI] as well as two other researcher-made questionnaires to assess patients' attitudes. Data was analyzed by SPSS-12 software using t-test and ANOVA. The mean score of patients' attitude toward the adverse impacts of MS on their social and sexual activities were 23.64 and 14.23 respectively [the mean scores of the tests are 24 for impacts on social activities and 12 for impacts on sexual activities]. According to the results, patients with MS believed that the disease has had a moderate impact on their social activities but a relatively high adverse impact on their sexual ones. Patients with MS viewed the disease as moderately disturbing for their social activities and highly interfering with their sexual life. There were significant differences in this regard according to sex and depression co-morbidity

[Sodium valproate as an adjunctive to risperidone in treatment of schizophrenia]

Although sodium valproate came to the market as an anticonvulsant drug, nowadays it is wildly used in the management of psychiatric disorders. It is used as a mood stabilizer and as an adjunctive agent in treatment of depression and psychosis. There are controversies regarding sodium valproate efficacy in psychosis. Although some studies have reported that it is effective in the management of positive symptoms and aggression in acute psychosis, others have not found such an association. This study aimed to investigate the effects of adjunctive sodium valproate in the pharmacological management of patients with schizophrenia. In a double blind clinical trial, in 2 mental health hospitals [Noor and Farabi] in Isfahan during the spring and summer of 2006, 32 schizophrenic patients [aged 18-65 years], who were in immediate need of admission, were randomly allocated into two groups. The first group was treated by combination of sodium valproate and risperidone and the other by combination of placebo and risperidone. A diagnosis of schizophrenia was established based on DSM-IV-TR criteria. All patients were assessed by PANSS on the 1[st], 14[th] and 28[th] days of the admission. The collected data were analyzed by T Student and Paired T tests and repeated measure of ANOVA through SPSS. Comparison of PANSS mean scores in two groups, before and after the trial, showed statistically significant differences. The reduction in PANSS score was significantly higher in the group treated with sodium valproate than in placebo group [p=0.006]. Although, there was a statistically significant reduction in positive symptoms in both groups after 2 weeks of treatment [p=0.048], the difference was not significant in the fourth week. Our study shows that if used as an adjunct to antipsychotic in the management of acute psychosis, sodium valproate will speed up the recovery of positive sysmptoms

[ 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 different doses of maprotiline on the treatment of Iranian patients suffering from moderate MDD]

Treatment effect of maprotiline at different doses [50-150 mg/d] as a tetracyclic antidepressant, with major effects on NEP and less anticholinergic side effects compared to some other tricyclic medications, has been compared with other medications. Given ethical and cultural differences as well as pharmacokinetic characteristics between Iranian populations, the current study was carried out to determine the effect of different doses of maprotiline in treatment of moderate MDD, its therapeutic ratio and related side effects in each dose, and also to define the effective dose of maprotiline. This quasi-experimental study was performed on the patients with moderate MDD who referred to psychiatry clinics. Thirty cases were selected from the patient with age between 25- 50 years, with 20

[Efficacy of lamotrigin in treatment of avoidance / numbing in post-traumatic stress disorders]

Post-traumatic stress disorder [PTSD] is a chronic illness which is difficult to treat; yet, it is a common disorder which is associated with significant morbidity and mortality. The hypothesis that exposure to traumatic events may sensitize or kindle limbic nuclei has led to efforts to treat PTSD with anticonvulsants based on the kindling hypothesis. This double-blind clinical trial assesses clinical response to lamotrigine as a potential treatment. Thirty patients with PTSD were randomly assigned in a double-blind design. They were treated for 3 months with lamotrigine [N=1 5, 150-500 mg/day] as odd-on or placebo [N=15]. The patients were measured in the first visit and at the end of 3 months by clinician administration. PTSD scales [CAPS] paired t-test, and Friedman and Will Coxon were used for data analysis. The mean score of frequency of PTSD criteria in Lamotrigine group in the first visit was 10.1 +/- 2.2 and in placebo group was 12.75 +/- 2.24. The mean score of these criteria in lamotrigin group after treatment period was 9 +/- 2.5 and for placebo group was 12.45 +/- 2.7. The analysis of these sores showed a significant difference in Lamotrigine group and a non significant difference in placebo group. The mean score of Intensity of PTSD criteria in Lamotrigine group in first visit was 9.4 +/- 1 .2 and in placebo group was 9.1 +/- 1-9. The mean score of these criteria in Lamotrigine group after treatment group was 8.4 +/- 2 and for placebo group was 9.1 +/- 2. The analysis of these scores showed a significant difference in lamotrigine group and a non-significant difference in placebo group. In placebo group, the analysis of mean sores of all intensity and frequency of criteria before and after taking placebo showed a non-significant difference. In Lamotrigine group, the analysis of mean scores of intensity and frequency of criteria such as avoidance of thoughts or feelings, avoidances of activities, place, people, inability to recall important aspect of trauma and diminished interest in activities before and after taking lamotrigine showed a significant difference and in other criteria showed a non-significant difference. Comparison of mean of decline in CAPS scores before and after treatment in placebo and lamotrigine group showed a significant difference in the four symptoms in lamotrigine group. Results of the study suggest that lamotrigine is a safe, well tolerated and significant effective treatment for avoidance numbing of PTSD

[Comparison of the efficacy of two combinations; sodium valproate with lithium and sodium valproate with olanzapine treatment of acute mania]

Acute mania is a psychiatric emergency state that often requires rapid management. There are many different therapeutic protocols for this emergent situation. One of them is combination of moodstabilizers and antipsychotics. Olanzapine which is now available in our country can be used for this purpose. In this study, we compared the effectiveness, rapidity of response and side effects of sodium valproate plus olanzapine [group I] with sodium valproate plus lithium [group II] in acutely manic or mixed bipolar patients. In this randomized, double blind, parallel group study, 44 acutely manic or mixed patients according to DSM IV-TR criteria were randomly assigned to receive combinations of sodium valproate [20mg/kg per day] with either olanzapine [5-15mg/day] or lithium [900mg/day] during a ten-day course. Efficacy was measured with Young Mania Rating Scale [YMRS]. Effectiveness measures included YMRS response [YMRS reduction >/= 50%] and YMRS remission [YMRS<=12]. Data was entered in SPSS11 software program and analyzed by Mann-Whitney, Fisher exact test and Wilcoxon tests [P-values < 0.05 were significant]. Total number of patients were 44 [mean age 27.18 +/- 7.34], 21 in group I and 23 in group II. Response rate was 85.7% [18 patients] and 73.9% [17 patients] in group I and II, respectively; with no significant differences between the two groups[P=0.33]. Remission rate was 42.9%[9 patients] and 43.5% [10 patients] in group I and II, respectively; with no significant differences between two groups[P=0.97]. The reduction in total scores in YMRS on the 2nd, 7th and 10th days of study were significant in both groups [P<0.05], but the rapidity of response was similar. The rates of adverse effects between two groups were not statistically significant. Both combinations of drugs were effective in acutely manic or mixed patients. Both treatments were safe and well tolerated

comparison of topiramate and placebo in the treatment of posttraumatic stress disorder: a randomized, double- blind study

Background: posttraumatic stress disorder [PTSD] is a chronic illness and a difficult - to - treat condition. The Hypothesis that exposure to Traumatic events may sensitize or kindle limbic nuclei has led to efforts to treat PTSD with anticonvulsants. Based on the kindling hypothesis of PTSD, this clinical trial was designed to assess the clinical response to topiramate [a new anticonvulsant] as a potential Treatment for PTSD

Methods: sixty seven combat veterans with PTSD [range 30-50 years old; SD: 39.5 +/- 4.19] randomly assigned in a double - blind design. They were Treated for 12 weeks with topiramat [N=34, 50-500 mg/day] as add - on therapy or placebo [N=33]. Patients were monthly assessed for three consecutive months using Clinician - Administered PTSD Scale [CAPS]

Results: two patients were withdrawn from the study because of topiramate side effects.In reminders, the mean Score of topiramate group, in the first visit was 50.70 +/- 7.7 and the mean score of placebo group was 48.9 +/- 9.13. After finishing the treatment period, the mean score of the topiramate group was 32.75 +/- 8.2 and of the placebo group was 46.62 +/- 8.8. The analysis of these scores showed a significant difference between the two groups [P=0.00]. Frequency and intensity of re-experience criteria [intrusive memory, night mare, and flash back], sleep problem, irritability, anger, frequency of difficulty to recall, and intensity of startle reaction in topiramate group was significantly less than placebo group [P < 0.05]

Conclusion: the results of this study suggest that topiramate is a safe, well - tolerated, and significantly effective Treatment for PTSD