Neurocognitive Functions Related to Parietal Lobe in Patients with Schizophrenia and Methamphetamine Induced Psychotic Disorder and Healthy Individuals: A Comparative Study.

Background: There are some inconsistent findings about neurocognitive functions in schizophrenia and methamphetamine induced psychosis (MIP). This study aimed to compare these two disorders in terms of neurocognitive functions related to parietal lobe. Methods: This was a cross-sectional study in which 30 patients with schizophrenia, 30 patients with MIP, and 32 healthy individuals were compared. The two groups of patients were selected through convenience sampling from among patients hospitalized in Shahid Beheshti hospital in Kerman, Iran and healthy individuals were selected via convenience sampling from among the employees of Kerman University of Medical Sciences. The three groups were administered clock-drawing test (CDT), Rey-Osterrieth complex figure (ROCF) copying test, and interlocking finger test (IFT) and their demographic and clinical data were collected. The one-way analysis of variance (ANOVA) was used to investigate the differences between the groups. Multivariate analysis of covariance was also used to examine the effects of confounding factors. Besides, follow-up pairwise comparisons were performed after adjustment for multiple testing. Findings: The group with schizophrenia had significantly more impairment than the group with MIP with reference to the results of IFT and the ROCF test. However, the scores of patients with MIP on these two tests were not different from those of the normal controls. With regard to the CDT, the only significant difference was observed between the group with schizophrenia and controls. Conclusion: On the condition that the results are replicated in other studies, some parietal lobe neurocognitive tests might be used when it is difficult to differentially diagnose schizophrenia and MIP.

A double blind randomized clinical trial of buprenorphine augmentation for treatment of psychotic symptoms in opioid addicted bipolar patients.

OBJECTIVE: To assess the efficacy of buprenorphine augmentation in treatment of psychotic symptoms in bipolar disorder type I. DESIGN: Bipolar type I patients with manic or depressive episodes and psychotic feature and with opioid dependency comorbidity were randomly included and allocated. Both groups of buprenorphine (4 or 6 mg/d) and placebo were also treated with enough dosages of sodium valproate and risperidone. Psychosis as primary outcome and depressive and manic symptoms as secondary outcome were assessed at baseline and after 1 and 2 weeks. Data were analyzed through t test and repeated measure ANOVA. RESULTS: Twenty-four patients remained in each group. Both groups displayed significant reduction in psychotic, depressive, and manic symptoms during the 2 weeks of study, although there was not any significant difference between them. CONCLUSIONS: Buprenorphine did not add any efficacy to usual treatment of psychotic episodes of bipolar, although did not aggravate psychiatric symptoms.

Chlorpromazine versus penfluridol for schizophrenia.

BACKGROUND: The efficacy of chlorpromazine, a benchmark antipsychotic, has not been fully assessed in direct comparison with different individual antipsychotics. Penfluridol is another old antipsychotic with a long half-life so one oral dose may last up to one week. This could confer advantage. OBJECTIVES: To assess the clinical effects of chlorpromazine compared with penfluridol for adults with schizophrenia. SEARCH METHODS: On 31 March 2017, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: We included all randomised clinical trials focusing on chlorpromazine versus penfluridol for adults with schizophrenia or related disorders. Outcomes of interest were death, service utilisation, global state, mental state, adverse effects and leaving the study early. We included trials meeting our selection criteria and reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we planned to estimate the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS: The review includes three studies with a total of 130 participants. Short-term results for hospital admissions showed no clear difference between chlorpromazine and penfluridol (1 RCT, n = 29, RR 0.19, 95% CI 0.01 to 3.60, low-quality evidence). No clear difference in the incidence of akathisia was found at medium term (2 RCTs, n = 85, RR 0.19, 95% CI 0.04 to 1.06, low-quality evidence), and similar numbers of participants - nearly half - from each treatment group left the study early (3 RCTs, n = 130, RR 1.21, 95% CI 0.83 to 1.77, low-quality evidence). The risk of needing additional antiparkinsonian medication was less in the chlorpromazine group (2 RCTs, n = 74, RR 0.70, 95% CI 0.51 to 0.95). No useable data reported clinically important change in global or mental state. No data were reported for relapse. No deaths were reported by the trials. AUTHORS' CONCLUSIONS: Only three small studies provided data and the quality of reporting and evidence is low. Limited data indicate the efficacy and adverse effects profiles of chlorpromazine and penfluridol are generally similar. Penfluridol, however, may confer advantage by needing to be given only once per week. Firm conclusions are not possible without good-quality trials, and where these treatments are used, such trials are justified.

Opioid withdrawal-induced hypomania: a case series.

The aim of this study was to report hypomanic symptoms after opioid withdrawal. In this case series, nine opioid-dependent patients with hypomanic profile on opioid withdrawal were selected from outpatients in a private psychiatric clinic. Opium dependency was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Substance history, clinical features, temperament, and family history were retrospectively probed. Patients displayed pure or mixed hypomanic symptoms on opioid withdrawal. In nearly all subjects, the symptoms continued until individuals started taking the opioid again. Features of hyperthymic temperament and family history of bipolarity were traced in most of the individuals.

Effects of methadone on liver enzymes in patients undergoing methadone maintenance treatment.

BACKGROUND: Methadone is currently the most frequently used substance in the treatment of short-term and particularly long-term opiate dependence. Patients' beliefs about the adverse effects of methadone on function of organs, especially liver, have widely affected the use of this substance. This study aimed to determine the effects of methadone on liver enzyme levels in patients on methadone maintenance treatment. METHODS: In a retrospective study, a total of 94 patients undergoing methadone maintenance therapy were recruited from Shahid Beheshti Hospital (Kerman, Iran). Liver enzyme levels in all patients were tested every six months from the onset of treatment until 24 months. The relations between test results and age, gender, and methadone dose were then evaluated. Data was analyzed using logistic regression with random data plan. FINDINGS: At the 24th month, alanine aminotransferase (ALT) levels in 4 patients (4.3%) and aspartate aminotransferase (AST) levels in 3 patients (3.2%) were above normal. Among 46 patients (50%) who had normal alkaline phosphatase (ALP) levels after 24 months, 26 subjects were younger than 40 and 20 subjects were over 40 years of age. The mean age of subjects with abnormal ALP levels and the mean methadone dose were 39.9 years and 19.55 cc, respectively. CONCLUSION: The results of this study indicated the significant effect of methadone on ALP levels. These effects can account for cholestatic pattern liver injury (obstruction). Further prospective studies including greater samples of patients with heart and liver complications and encompassing other drugs are required to confirm our findings.