Prevalence of mild behavioral impairment in patients with mild cognitive impairment.

Over the past years, increasing attention has been paid to the frequency of neuropsychiatric symptoms (NPS) in dementia, also known as the behavioral and psychological symptoms of dementia. This study's main goal was to determine the prevalence of Mild Behavioral Impairment (MBI) and its subdomains in patients with Mild Cognitive Impairment (MCI) in Iran. Participants included 96 patients with MCI who attended the memory clinic between July and December 2020. Global cognitive function was evaluated using the Persian version of the Montreal Cognitive Assessment (MoCA). To assess MBI, the Persian version of the MBI checklist (MBI-C) was completed by the patient or a close caregiver. The mean age of patients was 71.4 ± 9.3 years, and 56 patients (58.3%) were female. Regarding the cutoff point of 6.5, 48 patients (50%) had MBI. In both groups of MBI and non-MBI, 28 (58%) were female. There was no significant difference in MBI subdomains scores and total MBI scores between the two genders. In addition, we found no significant difference in total MBI in patients with different risk factors. There was no significant difference in MoCA score between MBI and non-MBI patients (24.1 ± 3.9 versus 23.7 ± 4.0) (p = 0.59). NPS are highly prevalent in MCI patients, with the most common ones being impulse dyscontrol, emotional dysregulation, and decreased motivation. Psychotic symptoms and social inappropriateness are rare. New-onset psychiatric symptoms and behavioral changes in older adults, even in a mild form (MBI), should increase the suspicion of subsequent cognitive impairment.

Wish to die and reasons for living among patients with amyotrophic lateral sclerosis.

OBJECTIVE: In Amyotrophic lateral sclerosis (ALS), disease severity, ineffective treatment, and increasing dependence on caregivers may give rise to hopelessness and suicidal ideation among patients. In clinical practice, the desire for death among patients with ALS often accompanies the desire to live and fear of death. Thus, we decided to study suicidal ideation among patients with ALS and examine protective factors and reasons for living. METHODS: We conducted a prospective, observational cohort study that recruited patients during routine visits to the outpatient multidisciplinary reference center for ALS. Depression was measured using the Beck Depression Inventory, suicidal ideation was assessed using the Columbia Suicide Severity Rating Scale, and reasons for living were assessed using the Reasons for Living inventory for adults. RESULTS: Among the 71 patients included, 39% expressed either passive (wish to die) or active suicidal ideation. Patients who expressed suicidal ideation were more likely to report depressive symptoms and have worse disability scores. A significant difference in the survival and coping beliefs subscore of the RFL inventory, which was negatively associated with suicidal ideation, had been found between those who did and did not have suicidal ideation. CONCLUSION: These findings have stressed the need for caregivers to recognize depression and other distressing expressions as well as provide adequate treatment. Therefore, close attention should be given to those suffering from depression while providing optimal care in terms of not only drug treatment but also psychological support.

Raloxifene adjunctive therapy for postmenopausal women suffering from chronic schizophrenia: a randomized double-blind and placebo controlled trial.

BACKGROUND: Cumulative evidence from epidemiological, preclinical and clinical studies suggests estrogens may have psychoprotective effects in schizophrenic patients. Selective Estrogen Receptor Modulators could have therapeutic benefits in schizophrenia for both sexes without being hazardous to gynecological tissues or having feminizing effects. Few studies have been conducted regarding the effects of raloxifene on postmenopausal women suffering from schizophrenia. We conducted this placebo-controlled trial to compare the add-on effect of raloxifene to risperidone versus risperidone with placebo. METHODS: This was an 8-week, parallel-group, placebo-controlled trial undertaken at two universities affiliated psychiatric Hospitals in Iran. Forty-six postmenopausal women with the definite diagnosis of schizophrenia were enrolled in the study. Patients received risperidone (6 mg/day in 3 divided doses) combined with either placebo (N = 23) or 120 mg/day of raloxifene (N = 23) for 8 weeks. Patients were assessed by a psychiatrist at baseline and at 2 and 8 weeks after the start of medical therapy. Efficacy was defined as the change from baseline to endpoint in score on Positive and Negative Syndrome Scale (PANSS). RESULTS: For PANSS scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 1.77, p = 0.18]. For positive subscale scores, there was marginal significant interaction between intervention type and time [F (2, 47) = 2.93, p = 0.06] and there was substantial main effect for time [F (2, 47) = 24.39, p = 0.001] within both groups showing reduction in positive subscale scores across the three time periods. In addition, the main effect comparing two types of intervention was significant [F (1, 48) = 3.78, p = 0.02]. On the other hand, for negative subscale scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 1.43, p = 0.23]. For general subscale scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 0.03, p = 0.86]. CONCLUSIONS: According to our findings, raloxifene as an adjunctive treatment to risperidone was only superior in improvement of positive symptoms and it was not effective in treating negative and general psychopathology symptoms. TRIAL REGISTRATION: The trial was registered at the Iranian registry of clinical trials: IRCT201205131556N42.