Iranian Journal of Psychiatry
Volume:1 Issue: 1, Winter 2006

This review will indicate the quality of the evidence supporting the clinical effects of a number of commonly used types of herbal medicines for psychiatric and neurological disorders. We conducted a review of literature to understand the biochemical and evidential bases for the use of herbs in psychiatric and neurological disorders as follow: 1) Alzheimer’s disease, 2) Depression, 3) Anxiety, 4) Insomnia, 5) Substance use disorders, 6) Attention deficit/hyperactivity disorder (ADHD), 7) Migraine. Evidences support use of Ginkgo biloba, Huperzine A, Galantamine, Melissa officinalis,and Salvia officinalis for Alzheimer’s disease; St. John’s wort, Lavender, and Saffron for depression; Passionflower, and Kava, for anxiety disorders; Valerian, and English Lavender for sleep disorders; Hypericum for substance related disorders; Ginkgo biloba, and Passionflower for ADHD; and feverfew, and Butterbur root for migraine. The highest level of confidence derives from well-designed, randomized, double blind controlled studies. Herbs may have beneficial effects in variety of psychiatric and neurological disorder; however we must consider their potential side effects and drug-drug interactions.

This study was designed to estimate prevalence rates of psychological problems in immigrant Iranian children in the UK and to evaluate the associated characteristics. A group of 244 children and adolescents, 111 boys and 133 girls between the ages 6 to 15 was selected. The children were categorised into groups with different psychological problems by their teachers on the Teacher’s Report Form (TRF). Also, the parents and The children completed the Child Behaviour Checklist (CBCL) and the Youth Self-Report (YSR) for the ages 11 to 15 years, respectively. Two-way ANOVAs using gender and age groups as factors showed that there were significant effects of gender in these subscales. Attention problems (p<0.001), delinquent behaviour (p<0.001), aggressive behaviour (p<0.01), externalising (p<0.001) and total problems (p<0.02). Two-way ANOVAs using age-group and gender as factors showed that there were no significant effects of age in the eight subscales of the CBCL; although a trend toward significance was observed for the withdrawn subscale. The interactions between gender and age for all subscales were not significant. The results show that the level of psychological problems in this group is as high as their counterparts in Iran and Achenbach''s US normative samples, if not higher. This might result from immigration stressors and the pressure of bilingual education.

This study aimed to examine the effects of haloperidol and amphetamine on human startle response modulated by emotionallytoned film clips. Sixty participants, in two groups (one receiving haloperidol and the other receiving amphetamine) were tested using electromyography (EMG) to measure eye-blink muscle (orbicular oculi) while different emotions were induced by six 2-minute film clips. An affective rating shows the negative and positive effects of the two drugs on emotional reactivity, neither amphetamine nor haloperidol had any impact on the modulation of the startle response. The methodological and theoretical aspects of the study and findings will be discussed.

This study was conducted to identify the characteristics of patients with psychosis who had escaped from hospital or were discharged prematurely and against medical advice. We carried out this retrospective study on 72 patients with psychosis who were discharged prematurely over a 38-month period and compared them to 76 patients with psychosis who were discharged according to the physician’s order, as the control group. In addition to the demographic factors, we assessed the following: the patient’s and their care giver’s level of education, in hospital stay, suicidal idea and attempt, smoking, substance abuse, psychiatric diagnosis, arrest record, imprisonment, positive history of psychiatric disorder in the first degree family members, first episode of psychosis, admission with police assistance, unemployment, and escape history (from hospital, school, military service, home, work and prison). The two groups of patients were comparable in regard to two factors: the in hospital stay, and a positive history of escape. The latter was defined as leaving home, quitting work, escaping from school and military service, and a positive history of escape from hospital. Irregular discharge of patients with psychosis seems to be predictable by their positive escape history, and therefore preventable. Irregular discharge is more likely in the first few days of hospital admission. There is also a great tendency towards irregular discharge when in hospital stay gets long.

To describe a home care service developed in Roozbeh Hospital for patients with bipolar disorder and schizophrenia and report baseline and 6-month follow-up data. Roozbeh Home Care Program consists of home visits by multidisciplinary home care teams, including general practitioners, nurses, and social workers who are supervised by psychiatrists. Home visits are scheduled as biweekly for the first three months following discharge and then on a monthly basis and the care includes biopsychosocial assessments and interventions. Baseline and 6-month data were extracted using a chart review. After 10 months of the Program development, 53 patients were enrolled and a total of 349 home visits were made. Of these, 29 were followed for at least 6 months. More than 86% of the patients remained in the community throughout the follow-up period, most in full remission and a small minority (4 patients) with a mild to moderate relapse that was overcome with interventions made by the home care teams. A home care service is a feasible mode of community-based aftercare for patients discharged from the hospital. Its effectiveness should be assessed by a randomized controlled trial.

Depression is a major health problem, which is not only underrecognized and undertreated, but is also associated with significant morbidity and mortality. It has been suggested that combination therapy rapidly reduces depressive symptoms in patients with moderate to severe depression and is more effective than monotherapy; but this suggestion remains controversial. Serotonergic and noradrenergic enhancement may be synergistic and more effective than serotonergic enhancement alone in the management of depression. The objective of this double blind, placebo-controlled study was to investigate the efficacy and tolerability of the combination of citalopram and nortriptyline for the treatment of moderate to severe major depression. 45 patients, who met the DSM-IV criteria for major depressive disorder based on the clinical interview, were included in the study. Patients had a baseline Hamilton Depression Rating Scale score of at least 20. In this trial, patients were randomly assigned to receive nortriptyline 50 mg/day plus citalopram 40 mg/day (group1) or placebo plus citalopram 40 mg/day (group2), for an 8 week, double-blind, placebo-controlled trial. Both protocols significantly decreased the score of Hamilton Depression Rating Scale over the trial period, but the combination of nortriptyline and citalopram showed a significant superiority over citalopram alone in the treatment of moderate to severe major depressive disorder (t = 3.34, d.f. = 36, P = 0.001). The difference between the two groups in the frequency of side effects was not significant. The results of this study suggest that combination of nortriptyline and citalopram is more effective than citalopram alone in the treatment of depression. This advantage is probably the result of reuptake inhibition of both serotonin and norepinephrine

This study was conducted to compare the effects of clomipramine and fluoxetine on fasting blood glucose (FBS) in children with obsessive-compulsive disorder (OCD). Thirty nondiabetic children with OCD entered this randomized trial. Subjects were between 7 to 17 years of age and had not received any medication that could affect blood glucose level for at least 2 weeks prior to the initiation of the study. Patients were assigned to receive 20 to 60 mg/d of fluoxetine or 75 to 200 mg/d of clomipramine for 8 weeks. The exclusion criteria were pregnancy and lactation, history of diabetes mellitus, any liver and thyroid disorder, epilepsy and major heart disease. Additionally, none of the patients should have received electroconvulsive therapy within 6 months prior to the initiation of the study. FBS levels were measured at baseline, 4 and 8 weeks after the initiation of the trial. In the fluoxetine group, FBS level was decreased from 82.93 mg/dL (baseline) to 79.73 mg/dL at week 4 (P<0.001) and to 72.53 mg/dL at week 8 (P<0.001). On the other hand, in the clomipramine group, FBS level was increased from 84.93 mg/dL (baseline) to 87.00 mg/dL at week 4 (P<0.05) and to 95.33 mg/dL at week 8 (P<0.001). This 8-week study demonstrated that FBS levels may decrease in children with OCD who received flouxetine, and may increase in those treated with clomipramine. Therefore, it is suggested that FBS levels should be monitored and taken into consideration when choosing between fluoxetine and clomipramine in the treatment of OCD.

To report a case of trichotillomania that was resistant to pharmacological treatment but responded well to a behavioral therapy program based on habit reversal. The patient was a 47-year-old lady. Her problem had started at the age of seventeen. She had experienced several treatments including full doses of antidepressants, mood stabilizers, antipsychotic, and benzodiazepines as single treatments or in combination. The mentioned medication did not affect her condition. In addition, she was drowsy during the daytime and her function was seriously impaired. At the time CBT was started for the patient, she was receiving fluoxetine 40 mg daily, which she had received during the treatment period. Initial assessments included a detailed behavioral interview, daily chart of activities, record of hair pulling behavior with a description of patient’s emotional and situational status during the action. The treatment procedures included self monitoring, pulled hair saving and competing response. The patient was followed for 18 months. Only 2 bouts of hair pulling were reported, both of which occurred in the fist 6 months of the treatment. The patient’s hair became thicker, and she was very satisfied with the therapy. Her social relations and function improved markedly, and her anxiety and sadness left her. This case showed that certain components of habit reversal such as awareness, self-monitoring, pulled hair saving, and competing response were effective in our patient.