Tic disorder in allergic rhinitis children and adolescents: a case-control study.

BACKGROUND: Allergic rhinitis is the most common allergic disease. It can accompany psychological disorders such as tic disorders due to the prolonged course of the symptoms of allergic rhinitis. This pioneer case-control study aims to investigate tic disorders in children and adolescents under 18 years of age diagnosed with allergic rhinitis. METHOD: The case group in this study consisted of patients who had both allergic rhinitis and tic disorders. Patients with allergic rhinitis without tic disorders were also enrolled as the control group with matched gender and age. Demographic characteristics, tic classifications, and contributing factors for allergic rhinitis and tic disorders were studied among the cases. Tic disorders were evaluated using DSM-5 criteria for the classification of tic disorders. RESULTS: 47 patients in the case group and 47 patients in the control group were included in this study. 53.2% and 46.8% were males and females in the case group, respectively. The mean age of the patients was 10.46 ± 3.97 years old. Sound tics were more common among the patients compared to motor tics. Patients with concomitant AR and tic disorders had more days per week with AR symptoms (P-value ≤ 0.001; OR (every day vs. three days a week = 11.02(2.98, 40.76))). Most patients with sound tick were women (p: 0.026), and most patients with motion tic were in the Provisional tic disorder group (p: 0.001). The history of infantile eczema was seen more in patients without sound tic (p: 0.025), and otitis media was significantly less common among patients with sound tics (p: 0.026). Provisional tic disorder was the most common class among the patients. In the case group (coexistence between allergic rhinitis and tic) compared to the control group, patients had significantly more days with AR symptoms per week. CONCLUSION: This preliminary study indicates that Provisional tic disorder was the most common classification of tic among patients with allergic rhinitis, especially in patients with motor tics. Asthma in motor tics, a history of food allergy in infancy, and a history of infantile eczema were also common among patients with vocal tics. Also, patients with allergic rhinitis and tic had more severe disease (more symptoms per week) than those with rhinitis alone. These findings emphasize the association of tic disorders with immunological pathways.

A survey of physicians' opinions about functional seizures (psychogenic nonepileptic seizures).

OBJECTIVES: Opinions of healthcare professionals may shape their attitudes towards any given condition and patient population. The aim of the current study was to gather the views of healthcare providers on some of the issues on symptomatology and terminology of functional seizures (FS). METHODS: This was a questionnaire study that was sent to all neurologists and psychiatrists practicing in Fars province, Iran. The survey included six questions: one question about professional qualifications, one question on the participants' personal experience with the topic of interest (i.e., FS), and four questions probing their opinions about the matter of interest. RESULTS: Of the 81 physicians approached, 69 responded (response rate: 85%; 32 psychiatrists and 37 neurologists). Physicians held varying opinions on some of the key issues (e.g., terminology, semiology, and driving permission) in this patient population. Participants were almost evenly split on how to make an advice on driving permission in these patients. Most physicians endorsed "psychogenic nonepileptic seizures" to label this condition. CONCLUSION: This study highlights some of the challenging issues surrounding FS. Investigators should explore the pathophysiology and nature of FS and whether these patients have any difficulties with driving and other important issues in their daily lives.

Disability benefits in patients with psychogenic nonepileptic seizures: a survey of physicians' opinions.

OBJECTIVES: The aim of the current study was to gather the views of healthcare providers practicing in the field of psychogenic nonepileptic seizures (PNES) on the issue of "disability benefits eligibility and PNES". METHODS: This was a questionnaire study that was sent to all neurologists and psychiatrists practicing in Fars province, Iran. The survey included seven questions: one question about professional qualifications, one question on the participants' personal experience with the topic of interest (i.e., PNES), and five questions probing their opinions about the matter of interest (i.e., the issue of disability benefits eligibility in PNES). RESULTS: The response rate was 72%. Respondents included 32 psychiatrists and 31 neurologists. In response to the question "Do you think that patients with PNES should be counseled to avoid performing all jobs or professions as long as they have active PNES?", 47 (75%) physicians answered "no" (22 neurologists and 25 psychiatrists; P = .5). In response to the question "Do you think that patients with PNES should be qualified for disability benefits?", 47 (75%) physicians answered "Patients with specific jobs or professions should be qualified for disability benefits" (23 neurologists and 24 psychiatrists; P = 1); while, nobody believed that "All of them should be qualified for disability benefits". CONCLUSION: While collection of the opinions of physicians is valuable, this is just one piece of the puzzle; future studies should investigate the opinions of other stakeholders. More importantly, investigators should explore whether patients with PNES have any job-related difficulties.

Job consultation in patients with psychogenic nonepileptic seizures: Systematic review and survey of physicians' opinion.

OBJECTIVES: The objectives of this study were 1) to review the literature about "job/employment and psychogenic nonepileptic seizures (PNES)" and 2) to gather the views of neurologists and psychiatrists on the issue of job consultation in patients with PNES. METHODS: Phase one involved a systematic literature review; phase two involved the collection of the views of neurologists and psychiatrists, practicing in Fars province, Iran, on the issue of job consultation in patients with PNES. A questionnaire was designed for the purpose of this study. RESULTS: No studies were identified by the systematic review process on the issue of job consultation in patients with PNES. Of the 87 health-care professionals approached, 63 responded to the survey (response rate: 72%). Respondents included 31 neurologists and 32 psychiatrists. In response to the question "Should all patients with PNES be counseled to pursue any job or profession they would like?", 17 (55%) neurologists and 19 (59%) psychiatrists answered "no" (p = 0.8). CONCLUSION: While it is possible that some patients with PNES are more likely than other people in the general public to be involved in job-related difficulties (performing duties related to any job, accidents, etc.), there is currently no evidence supporting or refuting this proposition. However, in this study, the majority of the health-care professionals, who often deal with these patients, believed that not all patients with PNES should be counseled to pursue any job or profession they would like (i.e., there should be some restrictions).

Fluvoxamine combination therapy with tropisetron for obsessive-compulsive disorder patients: A placebo-controlled, randomized clinical trial.

BACKGROUND: About 50% of obsessive-compulsive disorder patients still suffer significant symptoms even after the recommended first-line therapy. This demonstrates the necessity to investigate strategies to improve alleviation of symptoms. OBJECTIVE: The main objective of this study was to investigate the efficacy of a 5-hydroxytryptophan 3 receptor antagonist, tropisetron, as an adjuvant therapy to selective serotonin reuptake inhibitors, in ameliorating obsessive-compulsive disorder symptoms. METHODS: Men and women between the ages of 18-60 years diagnosed with obsessive-compulsive disorder, based on DSM5, who had a Yale-Brown obsessive compulsive scale score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either tropisetron (5 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 4) or placebo and fluvoxamine. The primary outcome of interest in this study was the Yale-Brown obsessive compulsive scale total score decrease from baseline. RESULTS: One hundred and eight participants were equally randomized into two groups; 48 participants in each group finished the trial. The Yale-Brown obsessive compulsive total score significantly dropped in both groups while the tropisetron group participants experienced a significantly higher decrease in their scores (Greenhouse-Geisser F(1.53-65.87)=3.516, p-value=0.04). No major adverse effect was observed in any of the groups. CONCLUSION: This trial showed a significant efficacy for tropisetron over placebo in treatment of obsessive-compulsive disorder symptoms when added to fluvoxamine.

Comparing escitaloipram with sertraline for obsessive and compulsive symptoms in patients with obsessive compulsive disorder: A comparative double blind clinical trial.

BACKGROUND: Escitalopram has some unique features among selective serotonin reuptake inhibitors. The aim of this survey is to compare the efficacy of escitalopram with sertraline on obsessive and compulsive symptoms in patients with Obsessive Compulsive Disorder (OCD). METHODS: In this 12-week double blind controlled randomized clinical trial, 57 patients with OCD were randomly allocated to receive escitalopram or sertraline. Yale Brown obsessive compulsive behavior scale (YBOCS) was used to assess the outcomes. Adverse effects were also recorded. RESULTS: 41 patients (20 in the escitalopram group and 21 in the sertraline group) completed the trial. In the escitalopram group 15 (70%) patients and in the sertraline group 16 (76.19%) patients showed more than 34% decrease in mean YBOCS score at the end of the trial (P=0.531). The two groups revealed significant decrease in YBOCS scores without significant difference (P=0.861) at week 12. No serious adverse effects were reported. CONCLUSIONS: Our results demonstrated that escitalopram is as effective as sertraline in treatment of obsessions and compulsions in patients with OCD. However, it needs to be noted that our study is preliminary and larger double blind controlled studies are needed to confirm the results.

Efficacy of Nepeta Menthoides Boiss and Buhse Freeze-Dried Aqueous Extract on Anxiety of Patients with Depression: A Double-Blind Randomized Controlled Clinical Trial.

BACKGROUND: The efficacy and safety of Nepeta menthoides freeze-dried aqueous extract were assessed on the anxiety of patients suffering from depression. METHOD: Patients received either N. menthoides formulation (400 mg/BID) or Sertraline (50 mg/BID) for 4 weeks. The Beck Anxiety Inventory (BAI) scales were used to assess the anxiety in two-week intervals (2nd, 4th, and 6th weeks). Folin-Ciocalteu and Dowd methods were used to determine the formulation of total phenol and flavonoid contents. RESULTS: Compared with Sertraline, N. menthoides showed a higher reduction in BAI scores in the 2nd (16.52±8.07 vs. 21.38±10.98, P<0.05) and 4th week (11.55±6.74 vs. 20.47±11.53, P<0.05) along with a reduction in the recurrence rate and side effects. Total phenolic and flavonoid contents revealed in the presence of 127.09±0.43 mg GAE/g and 16.93±0.09 mg Q/g of extract. CONCLUSION: N. menthoides could be effective in the control and introducing a delay in recurrence of anxiety in patients with depression.

Duloxetine Augmentation in Resistant Obsessive-Compulsive Disorder: A Double-Blind Controlled Clinical Trial.

INTRODUCTION: The aim of this study is to evaluate the efficacy of duloxetine augmentation in treatment of resistant obsessive-compulsive disorder (OCD). METHODS: This augmentation trial was designed as an 8-week randomized controlled, double-blind study. Forty-six patients experiencing OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram, or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti-OCD treatment. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Treatment response was defined as 25% or more decrease in scores of Y-BOCS. The mean dosage of duloxetine was 44.4 mg/d (range, 20-60 mg/d), and the mean dosage of sertraline was 123.8 mg/d (range, 50-200 mg/d). RESULTS: Forty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement during the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 & P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score, and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS. DISCUSSION: Our double-blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in patients with resistant OCD. However, it needs to be noted that our study is preliminary, and larger double-blind placebo-controlled studies are necessary to confirm the results.

Nepeta menthoides Boiss. & Buhse freeze-dried aqueous extract versus sertraline in the treatment of major depression: A double blind randomized controlled trial.

BACKGROUND: Depression is the most common psychiatric disorder in the world. The conventional medications for depression, however, often have significant side effects. These adverse effects of conventional therapies, have motivated researchers to study alternative options including complementary and traditional treatments for solving the problem. OBJECTIVE: To compare the efficacy of Nepeta menthoides Boiss. & Buhse freeze-dried aqueous extract with sertraline in the treatment of major depression. DESIGN AND SETTING: From April to September of 2015, 72 patients from two psychiatry clinics of Shiraz University of Medical Sciences who met the criteria for major depression based on the structured clinical interview as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, participated in a two-armed double-blind randomized controlled trial. INTERVENTION: Subjects were randomly assigned to receive Nepeta menthoides or sertraline for four weeks. OUTCOME MEASURES: Patients were evaluated in terms of the Beck Depression Inventory-II (BDI-II) total score and common side effects of medications at the base line, the second and fourth weeks, and two weeks following the intervention (i.e. in the sixth week). RESULTS: The mean changes in the Beck Depression Inventory scores in Nepeta menthoides group were significantly higher in terms of the BDI-II scores diminution as compared to that of the control (p≤0.001). Two weeks follow up after intervention showed a lower recurrence rate in the Nepeta menthoides group (p≤0.001). CONCLUSION: Nepeta menthoides may have potential benefits in the control of mood in patients suffering from major depression. Sustention of antidepressant effect and delay in the recurrence of depression could be considered worthwhile using this herb.

Comparing the Effects of Sertraline with Duloxetine for Depression Severity and Symptoms: A Double-Blind, Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Selecting the most effective treatment for major depressive disorder (MDD) is a challenge for clinicians. The aim of this study was to compare the effects of sertraline with duloxetine on major depression signs and symptoms. METHODS: The trial was a 6-week, randomized, controlled, double-blind study. Sixty-three patients with diagnosis of MDD according to DSM-IV-TR criteria were randomly assigned to receive either duloxetine (31 patients) or sertraline (32 patients). The mean dosage of duloxetine was 55 mg/day (range 40-60 mg/day) and the mean dosage of sertraline was 146 mg/day (range 50-200 mg/day). Subjects were assessed at baseline, and at the end of week 6. Depression severity and symptoms were assessed by 21-item Hamilton Depression Rating Scale (HAM-D). RESULTS: Of 63 patients who were randomized to treatment, 54 patients including 28 in the sertraline group and 26 in the duloxetine group completed the trial. The HAM-D total score for both groups was significantly reduced at the end of the trial period without significant difference from each other (p = 0.463). Of the symptoms studied, psychomotor retardation, general somatic symptoms and sexual problems improved more in the duloxetine group. On the other hand, agitation, anxiety symptoms and hypochondriasis ameliorated better in the sertraline group. There was no difference between the two groups regarding the other symptoms. CONCLUSIONS: Our study shows that the antidepressant mechanism of action has influence on its effects on different signs and symptoms. Clinician awareness of an antidepressant's special effects can help in selecting appropriate medicine.

Comparing Gabapentin with Clonazepam for Residual Sleeping Problems following Antidepressant Therapy in Patients with Major Depressive Disorder: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVE: Residual sleeping disturbances after improvement of depression in major depressed patients are associated with more functional problems, increased relapses and more risk of becoming resistant to treatment. The aim of this study was to compare the efficacy of gabapentin with clonazepam for treating residual sleeping disturbances. METHODS: This comparative trial was designed as a randomized, controlled, double-blind study. Sixty-three patients with a DSM-IV diagnosis of major depressive disorder (MDD) who had been treated with one of the selective serotonin reuptake inhibitors (SSRIs; fluoxetine, citalopram or sertraline) were included in the study. The patients' depression had improved [Hamilton Depression Rating Scale (HDRS) <10] but they were complaining of sleeping problems [Pittsburgh Sleep Quality Index (PSQI) >5; Insomnia Severity Index (ISI) >8]. Patients were randomized to receive a flexible dose of gabapentin (100-600 mg/day) or clonazepam (0.5-2 mg/day) beside their current antidepressant medication for a period of 4 weeks. Outcome measures were PSQI, ISI and Clinical Global Impression (CGI). RESULTS: Our results demonstrated that similar to the clonazepam group, sleeping problems improved significantly in the gabapentin group at the end of the trial (PSQI: P = 0.001, Z = 3.549; ISI: P = 0.001, Z = 3.347). The two groups did not show a significant difference in treating residual sleep disturbances (PSQI: P = 0.234, Z = 1.432; ISI: P = 0.456, Z = 1.347). CONCLUSION: This study revealed that gabapentin is comparable to clonazepam for treating sleeping problems associated with major depression.

Sleep Quality among Patients with Mild Traumatic Brain Injury: A Cross-Sectional Study.

OBJECTIVE: To evaluate and describe the sleep quality in seven subscales among the patients with mild traumatic brain injury (TBI) and compare it with normal patterns. METHODS: This cross-sectional study was conducted within a 6-month period from February to August 2014 in Shahid Rajaei trauma center of Shiraz. Participants were selected randomly from all adult (18-60 years of age) patients admitted during the study period with impression of mild TBI (GCS of more than 13). The patients' sleep quality and demographic characteristics were evaluated by Pittsburgh sleep quality index (PSQI) and self- report questionnaire, respectively. Results were compared with normal data, which extracted from the normative data of PSQI manual. RESULTS: Overall we included 60 patients with mild TBI with mean age of 36.2±13.4 years. All the patients had sleep disturbance. Among them there were 46 (76.7%) men and 14 (23.3%) women. The subjective sleep quality ( p=0.01), sleep latency ( p=0.01), habitual sleep efficiency ( p=0.01), sleep disturbance ( p=0.01), use of sleep medication ( p=0.01) and day time dysfunction ( p=0.01) were significantly impaired in patients with mild TBI when compared to normal values. There were no difference between men and women regarding the sleep quality. The sleep duration was comparable between the subjects and the normal values. CONCLUSION: Patients with mild TBI have poor sleep quality which should be considered as one of the main factors in interventions after the injury and it might lead to better quality of life.