We have identified several risk factors for injection sites infections among PWID, including frequency of injection per day, reuse of their own syringes, not using NSP services, HIV status, socioeconomic status with skin infections in PWID. Prevention strategies to reduce skin infections should focus on high-risk injection behaviors and improving access to NSP services.
Introduction: By increasing the number of effective treatments, mania is still remains a challenging problem for health systems. The aim of this study was to compare the efficacy of risperidone and aripiprazole in combination with sodium valproate in bipolar patients with acute manic or mixed episodes who were hospitalized in Razi Psychiatric Hospital in Tehran. Methods: This study was conducted as a double-blind randomized clinical trial in two groups of bipolar disorder patients with manic or mixed episodes (age rage, 18-65 years). The patients were randomly categorized into two groups who received valproate with aripiprazole or risperidone. The clinical response was assessed by the Young mania rating scale and weight gain within 3 and 6 weeks. Data were analyzed using the Chi-square test, paired t-test and analysis of covariance and repeated measures. Results: The study participants had no significant difference in demographic characteristics. Evaluation of the treatment response after 3 and 6 weeks (50% reduction in the Young's scale) in both groups showed no significant difference between the two therapeutic combinations. The combination of sodium valproate and risperidone showed higher weight gain in comparison with the combination of valproate and aripiprazole at the end of the week 6 (P < 0.001). Conclusions: The mentioned therapeutic combinations in the bipolar I disorder with a manic or mixed episode have a similar therapeutic effect. Also, there was no significant difference in their efficacy and both treatments can be used. However, due to the less weight gain, the combination of valproate and aripiprazole is recommended as a safer and more effective therapy in patients who were prone to weight gain.
The effect of metformin on weight changes and some metabolic parameters in patients with schizophrenia and schizoaffective disorder was investigated in this study. Methods: As a randomized double-blind controlled clinical trial, this study was performed from 2018 to 2019. A total of 66 obese patients (BMI≥27) with schizophrenia and schizoaffective disorder, hospitalized in the departments of Razi Psychiatric Hospital, entered the study; then, they were randomly divided into intervention and control groups after completing the informed consent form. The patients received metformin or placebo for 12 weeks. The dose of metformin was gradually increased and in case of a patient's tolerance, was prescribed up to 500 mg twice daily. During the study, all patients received their previous therapies. The variables included BMI, weight, waist circumference, lipid profile, and fasting blood glucose, which were studied at the beginning of the study and at weeks 4, 8, and, 12. The data were analyzed, using a post hoc test by SPSS software. Results: The results showed a significant decrease in weight (3.5 kg) and BMI (1.30) at the end of the week 12, and there was a significant reduction in waist circumference (5.9 cm) at the end of the week 8 compared to the placebo group (P<0.05). Moreover, metformin had no significant effect on fasting blood glucose and lipid profile in comparison with the placebo group. Discussion: Based on the findings of this study, by reducing the weight, waist circumference, and BMI, metformin can have a significant role in decreasing the complications of obesity and metabolic disorders in patients with schizophrenia and schizoaffective disorder. Therefore, given that the complications of metformin are low and transient, it can be recommended as a safe and tolerable drug in obese patients with schizophrenia and schizoaffective disorder.
Schizophrenia is a chronic psychiatric disorder, which reduces the patient's quality of life. Although a minimum dose of medications has been recommended for treating this disorder, antipsychotic polypharmacy has been used experimentally leading to an increase in drug interactions. Aripiprazole is associated with a lower risk of metabolic side effects and is recommended as a first-line treatment for schizophrenia. Biomarkers can serve as predictive of treatment response in patients with schizophrenia. The aim of this study was to compare the efficacy of antipsychotic medication polypharmacy with Aripiprazole monotherapy in patients with long-term schizophrenia, using blood biomarkers. Methods: Nineteen patients with long-term schizophrenia, who had received at least 2 types of antipsychotics with daily doses of more than 500 mg of Chlorpromazine, were included in the study. The response rates to the treatment based on the Brief Psychiatric Rating Scale (BPRS) score and the blood level of Interleukin 2 (IL-2), Interleukin 6 (IL-6), Interleukin-1 Receptor Antagonist (IL-1RA), and Brain-derived Neurotrophic Factor (BDNF) biomarkers were compared in antipsychotic polypharmacy and 6 months after monotherapy with Aripiprazole. Results: The mean concentrations of IL-6, IL-1RA, and IL-2 significantly decreased after the intervention. The mean changes in the BPRS scores and also the relationship between changes in blood biomarkers and BPRS scores after intervention were not significant. Discussion: The conversion of the antipsychotic polypharmacy state to monotherapy with Aripiprazole has been accompanied by a significant decrease in the serum levels of IL-2, IL-6, and IL-1RA. These biomarkers can be used for evaluating the response rate of schizophrenia treatments in the future.
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