Cognitive rehabilitation in bipolar spectrum disorder: A systematic review.

Background and objectives: Neurocognitive deficits in bipolar disorder (BD) have a negative impact on the quality of life, even during the euthymic phase. And many studies conducted to improve cognitive deficits in bipolar disorder. This systematic review aims to summarize studies on cognitive rehabilitation (CR) conducted in bipolar patients and evaluate its impact on neurocognitive deficits. The primary objective is to explore how CR interventions can enhance cognitive functioning, treatment outcomes, and overall quality of life in this population. Methods: A comprehensive search was conducted on PubMed, Google Scholar, Scopus, Embase, and PsycINFO databases from 1950 to 2023, following the 2015 PRISMA-P guidelines, using search terms related to BD and CR. Results: The initial search yielded 371 titles across the five databases. After applying inclusion and exclusion criteria through screening, a total of 23 articles were included in the study. The selected articles evaluated verbal memory, attention, executive functions, and social cognition. Conclusion: The findings suggest that CR can be an effective treatment approach for bipolar patients, aimed at enhancing their cognitive abilities, treatment outcomes, and overall quality of life. The primary finding of this study indicates that cognitive-behavioral therapy (CBT) protocols, skill training, and homework exercises, which offer a daily structure, social support, and opportunities for exchanging coping strategies, are more effective in enhancing cognitive functions. However, it is important to acknowledge the notable limitations of this review. Firstly, we did not assess the methodological rigor of the included studies. Additionally, there was a lack of detailed analysis regarding specific cognitive rehabilitation approaches that adhere to core CR principles, resulting in increased heterogeneity within the reviewed studies.

Assessing the effect of Alpinia galanga extract on the treatment of SSRI-induced erectile dysfunction: A randomized triple-blind clinical trial.

Objective: SSRIs are considered the first line in the medical treatment of depression and anxiety disorders. One of their most common side effects, sexual dysfunction, has led many patients to discontinuing their medication and treatment course. Alpinia galanga, a plant from the ginger family, has been shown to enhance androgenic activity and sexual function. This study aimed to assess whether the addition of Alpinia galanga extract to the treatment regimen of adult males consuming SSRIs can improve SSRI-induced erectile dysfunction. Materials and methods: This triple-blind randomized clinical trial was conducted on 60 adult males who were being treated with SSRIs at the time of the study. The participants were divided into two groups, a group of 30 people receiving 500 mg of Alpinia galanga extract and a group of 30 subjects receiving placebo. The population were re-assessed on week 2 and week 4 of the study using the international index of erectile function (IIEF), the Beck Depression Inventory, and the Beck Anxiety Inventory. In all the tests, a p-value of 0.05 was considered as the cut-off for significance. Results: At the beginning of the study, the IIEF scores of the placebo group and the intervention group were 10.6 ± 3.8 and 11.2 ± 4.8, respectively, which were not significantly different (p-value = 0.577). By week 4 of the study, the IIEF scores of the control group and the Alpinia galanga group had increased to 13.7 ± 4.3 and 17.4 ± 3.7 respectively, which demonstrates a remarkably larger increase in the group receiving Alpinia galanga extract in comparison to the placebo group (p-value < 0.001). Conclusion: In this study, the effect of the addition of Alpinia galanga extract to the treatment regimen of male patients using SSRIs on the sexual dysfunction experienced by this group has been promising. Similar results, if proven, can aid both patients and clinicians in making and following better treatment plans with more pleasant outcomes. Clinical trial registration: [https://clinicaltrials.gov/], identifier [IRCT20101130005280N41].

Citalopram-induced sleep bruxism in a breastfed infant: A case report.

Bruxism associated with antidepressant use is an under-recognized phenomenon. The use of citalopram has gained wide acceptance in the treatment of depression and anxiety disorders; however, the consumption of this medication during lactation and pregnancy has not been carefully characterized. There are limited studies about its side effects in the breastfeeding period. Here, we report a rare case of citalopram-induced sleep bruxism in a 9-month-old female breastfed infant whose mother used SSRI agent citaloporm for her anxiety disorder. Within 2 weeks of initiating her citalopram treatment, with a starting dose of 10 mg/day, the patient reported sleep bruxism in her infant. Thorough examinations of the infant were performed and no abnormal finding was reported. After ruling out other possible causes, the new-onset bruxism symptoms were attributed to the mother's recent use of citalopram, which was discontinued thereafter. The infant's symptoms of bruxism disappeared following the discontinuation of the medication by her mother. These findings and similar reports could draw more attention to bruxism or other possible symptoms in breastfed infants of mothers consuming psychotropic medications.

The effect of adding curcumin to sodium valproate in treatment of patients with bipolar disorder in the acute phase of mania: A randomized double-blind clinical trial.

Background: Inflammatory processes play a role in the etiopathogenesis of bipolar disorder type 1. Full therapeutic responses are seldom seen and the ongoing inflammatory processes in the brain could lead to neuronal loss. Curcumin, a relatively safe herbal compound, has been shown to have anti-inflammatory effects. The present randomized double-blind clinical trial study aimed to investigate the effect of adding curcumin to the treatment regimen of BID. Materials and methods: This randomized double-blind clinical trial was conducted on 78 patients diagnosed with BID according to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) criteria. The sample were divided into two groups. Patients in both groups received sodium valproate starting at a dose of 600 milligrams per day and administered up to 20 milligrams per kilogram per day or the highest dosage of the patient's tolerance. Patients in the intervention group also received curcumin as nanomicelle in soft gelatin capsules 40 milligrams per day. The control group received placebo tablets with the same characteristics as the curcumin tablets. They were assessed by a psychiatrist using the Young Mania Rating Scale (YMRS), Mini-Mental State Examination (MMSE), Clinical Global Impression (CGI), and a medication side effect questionnaire at the beginning of the study, as well as in the first, second, and fourth weeks of the study. Results: Among the 78 patients chosen to participate in the project, 54 people completed the trial. No specific side effect was observed in the two groups. Both groups showed an increase in their MMSE scores compared to the beginning of the study (value of p < 0.001). Although this increase was not statistically different between the two groups (value of p = 0.68). The YMRS score of both groups decreased significantly by the end of the study (value of p < 0.001); however, this decrease was not significantly different between the two groups (value of p = 0.64). In addition, the two groups experienced a significant increase in their CGI scores throughout the study (value of p < 0.001), this increase however was not statistically different between the two groups (value of p = 0.88). Conclusion: The present study suggested that curcumin may not be a useful adjuvant agent in the management of patients with BID receiving sodium valproate as treatment.Clinical trial registration: Iranian Registry of Clinical Trials (IRCT), identifier IRCT2016102530504N1.

Addition of intramuscular to vaginal progesterone for luteal phase support in fresh embryo transfer cycles: A cross-sectional study.

Background: Luteal phase deficiency is common in assisted reproductive technology and is characterized by inadequate progesterone production. Various studies have shown that administration of progesterone in fresh embryo transfer cycles increases the rate of clinical pregnancy and live birth rate. Progesterone administration has variable types: oral, vaginal, oil-based intramuscular, and subcutaneous. Objective: This study aims to compare the effect of adding intramuscular progesterone to the vaginal progesterone for luteal phase support in the fresh embryo transfer cycle. Materials and Methods: This study reviewed the information related to 355 women who had a fresh embryo transfer between March 2020 and February 2021 at the Yazd Reproductive Sciences Institute, Yazd, Iran. The participants population were divided into 2 groups based on the type of luteal phase support regime: group I (n = 173) received 400 mg vaginal progesterone alone twice a day from the day of ovum pick up; and group II (n = 182) received 50 mg IM of progesterone in addition to vaginal progesterone 400 mg twice a day from the day of ovum pick up. Chemical and clinical pregnancy rates were compared between groups. Results: The basic characteristics of groups were statistically similar. The rates of chemical and clinical pregnancy were higher in the vaginal plus IM progesterone group than in the vaginal progesterone group. Moreover, chemical pregnancy showed a significant difference between the groups (p = 0.011). Conclusion: Our findings demonstrated that the addition of IM progesterone to the vaginal progesterone improves the chemical pregnancy rate in fresh embryo transfer.

Implementation of Educational-Interactive-Psychiatric Management Software for Patients with Bipolar Disorder.

Background: Bipolar disorder is considered a psychiatric disease without any effective screening questionnaire to monitor and manage Iranian patients. This study aims to implement a researcher-made questionnaire in the form of educational interactive software for better management of patients with bipolar disorder and prevent further complications. Methods: The present cross-sectional study evaluated the efficacy of psychoeducational-interactive-therapeutic software for patients with bipolar disorder, which is a network-based software providing a researcher-made questionnaire in a planned manner. This software can predict the occurrence of future bipolar episodes for each patient by using artificial intelligence algorithms after the occurrence of two mood episodes as the training phase. The patients with bipolar disorder were asked to use the software for a year and their mood episodes were compared before and after using the software. We evaluate the reliability of the questionnaires in the software with internal consistency using alpha Cronbach test and test-retest analysis. Face validity and content validity were also evaluated. Results: The content validity index of the instrument was 93%, and the Cronbach's alpha coefficient of the whole questionnaire was 0.955. Also, the ICC coefficient for this questionnaire is above 0.70, and the correlation coefficient of the answers in all constructs of the questionnaire is more than 0.8. Thirty male patients with bipolar disorder who experienced four episodes of mood swings per year experienced an average of 2 mood episodes per year following the use of this software. Conclusion: Our Psychoeducational-interactive-therapeutic software is the first Persian language software based on artificial intelligence to monitor clinical symptoms in patients with bipolar disorder, which uses a standard questionnaire to predict the incidence of episodes of depression and mania in these patients.

Personality profile and therapeutic response to lithium carbonate and sodium valproate in mania with psychotic features.

Bipolar disorder is one of the major psychiatric disorders. Therefore, determining the factors that predict mood stabilizer response is important. This study aimed to investigate the relationship between personality profile and the response to lithium carbonate and sodium valproate in patients with psychotic mania. In this study, 50 patients with bipolar I disorder (manic episode with psychotic features) were randomly assigned to receive lithium carbonate (up to a serum level of 0.8-1.5 mEq/L) or sodium valproate (20 mg/kg). After stabilization of acute manic phase, Temperament and Character Inventory was completed by the patients themselves. Fifty subjects completed this study. The mean age ± SD of participants in the sodium valproate group and lithium carbonate group was 32.99 ± 9.94 and 30.73±7.94 years, respectively. The responders to sodium valproate had significantly higher scores in novelty seeking, harm avoidance (P = 0.003 and 0.004, respectively) and lower scores in persistence (P = 0.006) than the non-responders, but the responders to lithium carbonate did not have significantly different personality profiles. The results of the present study revealed that the personality profiles in the inpatients with psychotic mania are related to the responses to sodium valproate, but are irrelevant to the responses to lithium carbonate.

Efficacy of repetitive transcranial magnetic stimulation in patients with obsessive-compulsive disorder: a pilot study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a common disabling psychiatric disorder. Considering the lack of an acceptable treatment response in many patients, several efforts have been made to increase the efficacy of therapy. We aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the supplementary motor area in the treatment of patients with drug-resistant OCD and examine changes in brain function. METHODS: This quasi-experimental study was performed on 12 patients who were referred to outpatient clinics of Ibn-e-Sina psychiatric hospital and were diagnosed with OCD according to the clinical and diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). All patients received 20 rTMS sessions in their right supplementary motor region. Main outcomes were assessed using quantitative electroencephalography (qEEG) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after the intervention. In addition, Y­BOCS was completed after 10 rTMS sessions and after the 6­week follow-up. Data were analyzed with SPSS. RESULTS: Ten of 12 patients completed this study, of whom 7 (70%) were female. The mean age was 36.66 ± 10.28 years. Y­BOCS overall score significantly decreased over time during the course of study compared to baseline (P < 0.05). A significant decrease in beta wave activity of the parietal and occipital regions was seen in posttreatment qEEG, compared with baseline (P < 0.05). CONCLUSIONS: rTMS over the supplementary motor area at 20 sessions could effectively improve Y­BOCS score and decrease beta wave activity in parietal and occipital regions. Further studies are needed to approve these findings in a controlled design.

Self-perceived acute psychological stress and risk of mortality, recurrence and disability after stroke: Mashhad Stroke Incidence Study.

This longitudinal study was designed to evaluate the association between acute pre-stroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first-ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe pre-stroke stress in the 2 weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute pre-stroke stress and study outcomes. Among 624 patients with FES, 169 reported acute pre-stroke stress. Patients with acute pre-stroke stress were younger than those without stress (60.7 ± 14.4 vs. 66.2 ± 14.7; p < 0.001). The frequency of traditional vascular risk factors was not different in patients with and without acute pre-stroke stress. We did not find any association between acute pre-stroke stress and stroke outcomes. Although acute stress was common in our cohort, our results did not support an association between acute pre-stroke stress and the severity of stroke at admission and long-term stroke outcomes.

Comparison of parental stress among mothers and fathers of children with autistic spectrum disorder in Iran.

BACKGROUND: Most of the studies about parenting stress among parents of children with autistic spectrum disorder (ASD) have been conducted in western societies. The objective of this research, conducted in Iran, is to evaluate the parenting stress among fathers and mothers of children with ASD and find the correlation between severity of the disorder in children and the level of parental stress. MATERIALS AND METHODS: Participants included 42 couples having children aged between 2 and 12 diagnosed with ASD based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The diagnosis was made by two child and adolescent psychiatrists. Demographic information of the participants was collected using a questionnaire. The severity of pervasive developmental disorder in children was determined based on Childhood Autism Rating Scale (CARS); stress of parents was measured using Parenting Stress Index (PSI). Collected information was analyzed by the SPSS (version 16) software. RESULTS: Evaluation of subscales in participants' data showed a positive correlation coefficient between the PSI-parent domain and Childhood Autism Rating Scale-Parent form CARS-P rating (r = 0.339, P =0 0.028) and also between the total stress index and CARS-P rating (r = 0.333, P = 0.031) for fathers. It is thus suggested that fathers of children with more severe developmental disorders experience more stress. The results showed significant differences between fathers and mothers in the three PSI subscales including PSI-child domain score (P < 0.005), PSI-parent domain score (P < 0.005), and the total stress index (P < 0.005). Mothers had significantly more stress than fathers. CONCLUSIONS: These findings show that parents with ASD children have many emotional needs which should be considered in planning the effective treatment strategies for their children.

Coping mechanisms, depression and suicidal risk among patients suffering from idiopathic epilepsy.

BACKGROUND: Depression disorder is the most prevalent neuropsychiatric disorder associated with epilepsy, and a correlation has been detected between depression and suicide. There is a relationship between suicidal behavior and coping mechanisms; therefore, it is important to undertake psychoanalytic psychotherapy to reduce depressive symptoms. OBJECTIVES: To evaluate the Coping Mechanisms, Depression and Suicidal Risk among Patients Suffering from Idiopathic Epilepsy. MATERIALS AND METHODS: The present study is a cross-sectional pilot study in which 93 Iranian patients with idiopathic epilepsy were selected from Qaem hospital and neurological clinics. They answered three questionnaires: BDI, SSI, and a questionnaire of coping mechanisms. Patients were then interviewed and divided into two groups: patients with depression and suicidal ideation, and patients without depression and suicidal ideation. The two groups were compared in terms of coping mechanisms. RESULTS: Among the patients who filled the questionnaires, only 74 were selected for the interview. 58.9% of the patients did not have depression or suicidal ideation and 23.3% of them had either depression or suicidal ideation. Findings of the study showed that the two groups had a significant difference in terms of repressive coping method efficiency (P = 0.022). However, there was no significant difference between the two groups in terms of problem-focused coping method (P = 0.25) and the emotion-focused coping method efficacy (P = 0.31). CONCLUSIONS: Iranian patients with idiopathic epilepsy and with either depression or suicidal ideation, make significant improvement using repressive coping method in comparison to patients with idiopathic epilepsy who did not suffer from depression or suicidal ideation. The effect of other coping mechanisms was not significantly different between the two groups.