BackgroundOver the past few years, methamphetamine-induced psychosis (MIP) has increased in Iran, accounting for a significant percentage of psychiatry hospital admissions. The present study was conducted with an aim to investigate clinical symptoms, and course and treatment methods of MIP inpatients in Shafa Psychiatry Hospital in northern Iran.MethodsParticipants were 152 MIP inpatients. Brief Psychiatric Rating Scale (BPRS) subscales of suspiciousness, unusual thought content; hallucinations and hostility were used to measure psychiatric symptoms. Data regarding suicide and homicide and violence were also obtained through interviews with the inpatients and their family. Based on their lengths of recovery time, the inpatients were categorized into 3 clinical groups. These inpatients received their usual treatments and were monitored for their psychiatric symptoms and clinical course of illness. The data were analyzed by descriptive statistics.ResultsThe most frequent psychiatric symptoms were violence (75.6 %), intimate partner violence (61.2 %), delusions of persecution (85.5 %), delusions of reference (38.5 %), delusions of grandiosity (32.9 %), delusions of infidelity (30.2 %), auditory hallucinations (51.3 %), visual hallucinations (18.4 %), suicidal thoughts (14.5 %), homicidal thoughts (3.9 %), suicide attempts (10.5 %) and homicide attempts (0.7 %). Recovery from psychotic symptoms in 31.6 % of the inpatients took more than one month. 46.1% of the inpatients were treated with Risperidone and 37.5 % with Olanzapine. Persecutory delusion and auditory hallucination were the most frequent persistent psychotic symptoms. 20.8 % of the inpatients with duration of psychosis more than one month were treated with electroconvulsive therapy (ECT) along with antipsychotics.ConclusionAll forms of violence are highly frequent in MIP inpatients. Our finding agrees with many other studies suggesting that recovery from MIP can take more than a month. Initial promising findings were found regarding the efficacy of Electroconvulsive therapy in MIP patients.

Background:During the past years, significant efforts have been made to explain the biological backgrounds of obsessive-compulsive disorder (OCD). Cortical-subcortical and neurotransmitter models are used for explaining the symptoms of OCD, so our hypothesis is that brain's transcranial direct current stimulation (TDCS) can regulate the brain activities of the OCD patients. Thus, based on the mentioned issues, this research seeks to investigate the efficacy of TDCS in treatment-resistant patients who suffer from severe OCD.Materials and Methods:The present study is a clinical trial research which was based on the available sampling method, 42 treatment-resistant patients who suffer from severe OCD were selected as research's samples (2015–2016). Medical intervention protocol in this study is TDCS cathode type that was done in 15 sessions for 3 consecutive weeks (each session was conducted for 30 min daily). Yale–Brown Obsessive-Compulsive Scale was used for evaluating the efficacy of TDCS method during the 1st, 5th, 10th, and 15th sessions and it was also used for checking the 1st and 3rd monthly follow-up phases.Results:Variance within-group analysis (repeated measure) showed that the mean differences in the different stages of evaluation are significant (seven stages of evaluation).Conclusion:TDCS can be introduced as an appropriate, strong tool for regulating the brain - behavioral systems and it can also be introduced as a suitable alternative treatment for treatment-resistant patients who suffer from severe OCD.

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Background. Topiramate (TPM) is a psychotropic drug, which is used mainly as an antiepileptic drug and now over the years is used for a wider range of indications, including migraine prophylaxis and binge eating disorders. Although ocular side effects of Topiramate have been frequently reported, neuroophthalmologic manifestations such as myokymia are rarely reported. Case Presentation. This case report presents a case of a 47-year-old woman who had begun TPM for binge eating problem. She developed unilateral long standing lower eyelid twitching, which progressed to upper eyelid and eyebrow at the same side. The patient was not a smoker or excessive alcohol or caffeine abuser. Increasing the resting time and changing life style made no significant changes in her eyelid twitching. There was no definite evidence by neuroimaging and clinical or laboratory evaluations causing eyelid myokymia. The symptoms resolved with discontinuation of TPM. Conclusion. Although eyelid myokymia is a benign and self-limited condition, it sometimes becomes a source of distress in chronic long standing cases. Physicians should be aware of the neuroophthalmologic side effects of this drug.

Background: There are many controversies about the frequency and burden of suicidality in patients with Obsessive-Compulsive Disorder (OCD). Objectives: This study was done to determine the prevalence and risk factors of current suicidal ideations in patients with OCD. Materials & Methods: In this cross-sectional study, 258 outpatients with OCD (Yale-Brawn Obsessive Compulsive Scale, Y-BOCS ≥16) referring to two psychiatry clinics in Guilan, Iran, from March 2018 to September 2019 were evaluated. Suicidality score of the Brief Psychiatric Rating Scale (BPRS) ≥4 was considered for current suicidal ideation at the first visit. Beck Scale for Suicidal Ideation (BSSI) was used to evaluate the intensity of suicidal ideations a week before evaluation. Simple linear and binary logistic regression analyses were used to analyze data by SPSS v. 20. Results: Current suicidal ideation was found in 22.1% of patients. The previous history of suicide attempt (BPRS, P<0.0001 and BSSI, P<0.0001), a history of OCD in first-degree relatives (BPRS: P=0.004 and BSSI: P=0.010), a history of suicide attempts in first-degree relatives (BPRS: P=0.013 and BSSI: P<0.0001), comorbid diagnosis of depressive or body dysmorphic disorder (BPRS, P<0.0001 and BSSI, P<0.0001), and higher Y-BOCS score (BPRS: P=0.043 and BSSI: P<0.0001) were associated with a higher risk of having suicidal ideation. Conclusion: Suicidal thoughts are high in Iranian patients with OCD at their first visit to psychiatry clinics. The previous suicide history, positive history of OCD and suicide attempts in their first-degree relatives, the severity of OCD, and some comorbid psychological disorders are associated with a higher risk of suicidal ideation among OCD patients.

Background:Methamphetamine-induced psychotic disorder (MIP) cannot be easily differentiated from other psychotic disorders. Some studies have reported that patients with MIP and schizophrenia have differences in their cognitive functioning. We hypothesized that their performance would be different on neuropsychological tests which assess executive functions and visual memory.Materials and Methods:In a cross-sectional study, 30 patients with MIP, 31 patients with schizophrenia, and 31 healthy controls were assessed by Rey–Osterrieth complex figure (ROCF) test and visual search and attention test (VSAT). One-way analysis of variance was performed to compare the mean scores of tests. Tukey's HSD test was used for post hoc analysis.Results:Three groups had significant differences according to ROCF test (F = 15.76, P < 0.0001), VSAT (F = 39.78, P < 0.0001), left VSAT (F = 37.96, P < 0.0001), right VSAT (F = 40.40, P < 0.0001), and the time of the test administration (F = 3.26, P = 0.04). The post hoc analysis showed that the mean score of ROCF test and VSAT (total, right, and left) was significantly higher in the control group than in the other two groups. The time of administering the test in the control group was significantly shorter than in the MIP group (P < 0.03) and nonsignificantly shorter than in the schizophrenia group (P = 0.54). The mean score of right side VSAT was significantly higher in the MIP group than in the schizophrenia group.Conclusion:ROCF could not differentiate MIP from schizophrenia. The better performance of patients with MIP on right side VSAT that is reported in this and in the previous study needs to be reevaluated in more controlled studies.

Objective: One of the difficult comorbidity of Obsessive-Compulsive disorder (OCD) to manage is bipolar disorder (BD). Results of previous studies on OCD-BD comorbidity may have been affected by different clinical definitions of OCD-BD, small or different sample sizes, different thresholds for including BD patients and different accuracies in OCD diagnosing. We tried to reduce limitations of previous studies and hypothesized that the OCD-BD group is a unique category and can be associated with greater levels of severity, episodic course of illness, more hostility and suicidal behaviors and different dimensions of OC symptoms. Method: We compared 44 OCD-BD patients with 94 OCD patients who had completed at least a 24-month follow-up period. Clinical interviews and rating scales, and obtaining information from clinical charts were used to assess the patients. Life chartings of OCD and BD course were made for each patient and were categorized into four groups based on the clinical course of OCD. Results: OCD-BD was characterized by a more continuous course, higher dysfunction, suicide and hostility scores. OC aggressive symptoms, having first-degree relatives with OCD and comorbidity of any anxiety disorders were associated with a reduction in odds of belonging to the OCD-BD group. Conclusion: OCD-BD can be considered a unique category with greater morbidity and a more episodic course of OCD. Further research is recommended for exploring potential biological, social and psychological factors along with OCD-BD comorbidity.