Iranian Journal of Psychiatry
Volume:7 Issue: 1, Winter 2012

To compare the effects of topiramate versus valproate sodium as an add-on therapy to a combination of lithium and risperidone (Li+Ris) on body weight and serum lipid profile in children and adolescents with bipolar disorder. In a single-blind randomized clinical trial, thirty children and adolescents with bipolar disorder type I in the manic or mixed phase, treated with the combination of Li+Ris at therapeutic doses for at least 4 weeks who had the indication of add-on therapy due to a recurrent episode; a partial response or non response in the current episode or relapse were included. Participants were randomly assigned to receive either topiramate or sodium valproate as the third drug add-on therapy for a total of 6 weeks. Weight, height and serum lipid profiles were determined at baseline and at the end of week 6. Differences in the mean levels of lipid profiles at baseline and after week 6 evaluation were not significant in both treatment groups. BMI z-score increased in both treatment groups, being significant only in the Li+Ris/Valproate group, increasing from (mean ±SD) 0.38 ±0.55 to 0.72 ±1.23 (p<0.05). Between group changes in BMI z-score was not significant.Among the BMI percentile categories, participants in the normal weight subgroup showed a significant increase in BMI z-score during the 6 week trial, compared to overweight/obese subgroup, in both Li+Ris/Valproate and Li+Ris/Topiramate treatment groups. Elevated mean serum level of triglyceride and a high proportion of participants with elevated total cholesterol (≥ 170 mg/dl), triglyceride (≥ 110 mg/dl), and BMI percentile 85-<95 at baseline (before randomization) and at the end of 6 week study were noted. When topiramate and valproate sodium are used for six weeks as adjunctive treatment to a combination of Li+Ris, they act alike on lipid milieu of children and adolescents with bipolar disorder. Both Li+Ris/Valproate and Li+Ris/Topiramate therapies can lead to an increase in BMI z-score. This increase is statistically significant with Li+Ris/Valproate therapy. This suggests that topiramate could attenuate the ongoing weight gain from lithium and risperidone. In this study, the majority of participants who gained weight were those with BMI less than 85th percentile. This suggests that normal weight patients may have greater weight gain potential than overweight/obese patients.High proportion of metabolic abnormalities among the patients at baseline, which remained elevated throughout the trial, warrants cardiometabolic monitoring in this population.

The present study aimed to examine the efficacy of metacognitive therapy in treatment of patients with pure obsession. Six patients suffering from pure obsession were selected using purposeful sampling method and were included after meeting the inclusion criteria of the study. Patients were assessed using the structured clinical interview for DSM- IV Axis I disorder - patient edition (SCID- I/P). The patient's main obsessions were present including sexual, aggressive and blasphemous thoughts. In response to these obsessions, all patients used covert rituals and compulsive behaviors. In this study, multiple baseline, a major type of single- subject empirical design, was employed. During the baseline (3-7 weeks) and treatment (14 weekly sessions) and follow-up (3 months) patients filled out the Obsessive Compulsive Inventory (Revised form) (OCI-R), Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), Metacognitive Questionnaire (MCQ), Thought Fusion Inventory (TFI) and Beck Depression Inventory- II (BDIII). To implement metacognitive therapy, Well's theraputicimstruction for OCD was used. The results indicated that Metacognitive Therapy (MCT) is effective in reducing obsessive - compulsive symptoms and in modifying metacognitive beliefs and thought-fusion beliefs. Metacognitive therapy is effective in treatment of pure obsession.

In schizophrenia, neurocognitive functions are one to two standard deviations below the normal controls and these deficits have a significant relationship with overall functioning and poor outcome. According to this fact, it is important to investigate the factors that effect neurocognition in schizophrenic patients. This study was carried out to demonstrate the relationship between attention/vigilance and some demographic and clinical variables in Iranian schizophrenic patients. This was a cross-sectional study; the participants were 60 Iranian schizophrenic patients. They were assessed using the Positive and Negative Syndrome Scale, and the Continuous Performance Test. No significant relationship was found between gender, age, education, Positive and Negative Syndrome Scale scores and CPS scores. Our findings suggest that contrary to some domains of cognitive functions, in schizophrenia, attention/vigilance is not influenced by severity of symptoms.

Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls. Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients. Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales. Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.

The aim of this study was to compare defense styles and mechanisms in adult patients suffering from obsessive-compulsive disorder (OCD), and panic disorder (PD) with normal subjects in Iran. Defensive patterns of 22 patients with OCD, 28 patients with PD and those of 116 normal individuals (as a control group) were assessed using the Farsi version of Defense Style Questionnaire-40 (DSQ-40). The content validity of this questionnaire was done prior to the initiation of the present study. Both groups of patients with OCD or PD used more immature and less mature styles compared to the control group. No significant difference was observed in the use of neurotic style between the two groups. It is suggested that immature defenses may have an important role in the pathogenesis of OCD and PD.

Premenstrual syndrome is a common disorder experienced by up to 50% of women during reproductive age. The prevalence of severe form of PMS (PMDD) is 3 % to 8%. Psychiatric disorders in PMS patients have resulted in significant morbidity and in some cases caused resistance to the treatment process 390 participants (264 with PMS/PMDD, and 126 healthy students of University of Guilan) who completed the demographic questionnaire, daily symptom rating (DSR) and the checklist 90-revised (SCL-90-R) took part in this study. This study was conducted using a cross sectional method. According to repeated measure variance, the mean scores of psychiatric symptoms (Depression, Anxiety, Aggression, Interpersonal sensitivity) in the PMS group were significantly higher than the healthy group (p< 0/05), and increase in severity of PMS from mild to severe was accompanied by increase in mean score of these subscales. There was a significant difference in mean score of depression, anxiety, aggression and interpersonal sensitivity between the 3rd and the 13th day of the cycle. Significant effect of the DSR grouping (PMS and Healthy group) and time interaction emerged in interpersonal sensitivity and aggression, significant effect on the DSR grouping (Mild, Moderate, Severer) and time interaction demonstrated in interpersonal sensitivity. Patients with prospective confirmed PMDD seemed to suffer from psychiatric symptoms. Therefore, recognizing co-morbid psychiatric symptoms in patients with PMDD is of prime importance. All healthcare providers should be sensitive to mental status of women with PMS.

Childhood autism is a neurodevelopmental disorder characterized by impairments in social interactions, verbal and non-verbal communication and by a pattern of stereotypical behaviors and interests. The aim of this study was to estimate the dysmorphic facial features of children with autism and children with Asperger syndrome. The examination was conducted on 60 children (30 with childhood autism and 30 with Asperger syndrome). The photo anthropometric method used in this study followed the protocol established by Stengel-Rutkowski et al. The performed statistical analysis showed that in patients with childhood autism, the anteriorly rotated ears and the long back of the nose appeared more often. In the group of children with autism, there was a connection between the amount of dysmorphies and the presence of some somatic diseases in the first-degree relatives. There was also a connection between the motor coordination and the age the child began to walk. In patients with childhood autism, there were certain dysmorphies (like the anterior rotated ears and the long back of the nose) which appeared more often. Although the connection was not statistically significant, it seemed to concur with data from the literature. Formulation of the other conclusions would require broader studies e.g. dealing with a familial analysis of dysmorphic features.

Beta-thalassemia major (β-TM) is a chronic, genetic and hematological disorder. Children and teenagers with chronic physical illnesses exemplified by thalassemia are vulnerable to emotional and behavioral problems. The aim of this study was to evaluate mental health and its related factors among young patients with beta-thalassemia major. In this cross-sectional observational descriptive-analytic study, we studied 164 patients suffering from Beta-thalassemia major with age range of 15-24 years who referred for treatment to Ali Ebn-e Abitaleb (AS) University Hospital in Zahedan, a city in South East of Iran, during 2009- 2010. The demographic data and pattern of mental health were collected by standard general health questionnaire (GHQ-28).Data was analyzed using statistical software SPSS (version 17.0); Student t test and Chi-square (χ2) were used. In this study, 96 (58.5%) patients were male; the mean age of all patients was 18.78 ±2.28. Based on data analysis, 83 patients (50.8%) suspected to have psychiatric disorders (58.8% of girls, 44.8% of boys). In addition, frequency of somatic symptoms, depression disorder, anxiety disorder and social dysfunction in all patients were 7.3%, 11.6%, 8.5% and 4.3% respectively. In illiterate patients, 70.4% suspected to have psychiatric disorder. Except for somatic disorder, other mental disorders were more frequent in girls. No significant association was found between mental state and gender, marital and literacy status and occupation. In this study, due to high prevalence of psychological disorders in young patients with Beta-thalassemia major, especially in girls, we suggest implementing further educational psychological programs to decrease the frequency of disorders. Moreover, conducting more quantitative and comprehensive researches is suggested to evaluate specific effective factors in psycho-social health.