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BACKGROUND: Knowledge and skill about sedation of aggressive patients is necessary for each psychiatrist. The purpose of this study was comparing the velocity and durability of sedation induced by the haloperidol, trifluoperazine, promethazine, and chlorpromazine in aggressive patients. MATERIALS AND METHODS: This randomized clinical trial was done on 76 aggressive patients referred to Psychiatry Emergency Service of Noor Hospital of Isfahan University of Medical Sciences that were randomly divided into four groups of haloperidol, promethazine, chlorpromazine, and trifluoperazine. Patients were evaluated at 30 min intervals for aggressive symptoms, and if they did not respond to intervention after the first 30 min or if they showed aggression again, a same dose of the injected drug was prescribed. The length of sedation time was recorded for each patient. RESULTS: Seventy-six patients with the mean age of 31.89 ± 8.73 years were participated and 63.2% of them were male. Response to intervention after the first injection was seen in 40.8% and 59.2% needed the second injection. The mean time needed for obtaining sedation was 17.38 ± 8.23 and 19.66 ± 4.64 min after the first and second injection, respectively. The mean times of sedation induction were not significantly related to age, gender, type of substance used, type of aggression, and type of psychiatric disorder. Considering the type of drugs, there was no significant difference between velocity and durability effect of sedation after the first and second injection. CONCLUSION: Comparing the velocity and durability of sedative effect of the four studied drugs on acute aggressive patients, did not show any significant difference between them.

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BACKGROUND: Suicide is a major problem, and its prevention is a global priority. In many cases, suicide attempter attempts to do it again after the rescue. In current study we aimed to compare active visit and treatment of patients in a periodic manner with treatment as usual, in the prevention of recurrent suicidal attempts. MATERIALS AND METHODS: This study was a randomized controlled clinical trial which was conducted in Isfahan Noor Hospital's Emergency Center on 60 patients in 2013-2014. The samples were selected using simple random sampling and they were assigned into two groups: The conventional treatment group (treatment as usual) (30 patients), and visit and active treatment (30 patients). In the intervention group, there were ten follow-ups by a face-to-face visit over 12 months, and six follow-ups by phone call in control group. Through the completion of the initial and follow-up questionnaire evaluation was performed. The data were analyzed using Cochran test, and repeated measure (ANOVA). RESULTS: During the 12-month follow-up visit and active treatment, significant difference in reducing suicidal thoughts (P = 0.003) was observed and an increase in the life expectancy (P = 0.001), interest and motivation in life (P = 0.001) was found in the intervention group, and also nonsignificant reduction was found in the rate of suicidal attempts. CONCLUSION: Visit and active treatment is useful in suicide attempters and it can helps in preventing recurrent suicide attempt as a preventive program by increasing hope and reducing suicidal thoughts.

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BACKGROUND: To evaluate the efficacy of different ways of communications on prevention of suicidal reattempt, we compared the efficacy of phone call versus face-to-face follow-up in patients with previous attempt. MATERIALS AND METHODS: In a randomized controlled clinical trial, 55 suicide reattempters who were admitted to the poisoning emergency were divided into phone call (29 patients) and face-to-face (26 patients) groups randomly. They were followed at 8 occasions: 2nd and 4th weeks, and the 2nd, 3rd, 4th, 5th, 6th, and 8th months. The suicidal reattempt, suicidal thought, hope, and interest of the patients were assessed on each occasion, and the patients were guided to visit by a therapist, if needed. The findings were analyzed by Mann-Whitney, Chi-square, Cochran, Friedman, and independent t-tests using SPSS 20. RESULTS: The status of "hope" and "interest" improved in both groups, but it showed more significant difference in the face-to-face group. Suicidal thoughts in both groups decreased over time, and this was more significant in the face-to-face group. However, we did not found any significant difference in the frequency of the suicidal reattempts between two groups. CONCLUSION: Face-to-face versus phone call follow-up of suicide attempters can significantly alleviate suicidal thoughts and improve hopes and interests.

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OBJECTIVE: Preclinical studies and early pilot clinical investigations have suggested that N-acetylcysteine (NAC) may be useful in treatment of methamphetamine (METH) dependence. The present study evaluated whether NAC would suppress craving to the METH. METHODS: In a double-blind, controlled crossover clinical trial, 32 METH-dependent volunteers were chosen to receive either NAC (1200 mg/day) or placebo, randomly. They were intervened in two four-week sessions. During first session they received either 1200 mg/day of NAC (group A) or placebo (group B). After three days of washout period, next session started with the crossover intervention of the previous regimen. During these eight weeks, all participants received standardized, and Matrix Model of treatment. Craving was assessed using the Cocaine Craving Questionnaire-Brief (CCQ-Brief). The data were analyzed using SPSS version 20.0 (SPSS Inc. Chicago, Illinois, USA). RESULTS: In 23 subjects who completed the study, the mean score of CCQ-Brief reduced in four consecutive weeks with NAC treatment. The mean (SD) scores of carving in group A and B were 3.38 (1.16) and 5.96 (1.03), at the end of first session; and 4.57 (1.88) and 3.2 (0.86), at the end of the second session, respectively. Our findings indicate that the main effect was significant for NAC (P < 0.001). Across placebo and NAC conditions, only mild side effects were noted, and the number of subjects who reported side effects did not differ. CONCLUSION: The NAC showed good efficacy in suppressing METH craving, and may be a useful pharmacological treatment for METH dependency.

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BACKGROUND: prevention of suicide is one of priority world health. Suicide is one of the preventable causes of death. The aim of this study is evaluation of telephone follow up on suicide reattempt. MATERIALS AND METHODS: This randomized controlled clinical trial is a prospective study which has been done in Noor Hospital of Isfahan-Iran, at 2010. 139 patients who have suicide attempt history divided in one of two groups, randomly, 70 patients in" treatment as usual (TAU)" and 69 patients in "brief interventional control (BIC). Seven telephone contact with BIC group patients have been done "during six months" and two questionnaires have been filled in each session. The data has been analyzed by descriptive and Chi-square test, under SPSS. RESULTS: No significant differences of suicide reattempt has been found between two groups (P = 0.18), but significant reduction in frequency of suicidal thoughts (P = 0.007) and increase in hope at life (P = 0.001) was shown in intervention group. CONCLUSION: Telephones follow up in patients with suicide history decrease suicidal thought frequency" and increase hope in life, significantly.

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BACKGROUND: Because of more frequency of suicidal attempts in females, we need to study about its relationship with the female hormones. The aim of this study was to evaluate the serum estrogen and progesterone concentration and their relationship with suicidal attempt ranking in the attempted females. MATERIALS AND METHODS: The studied cases chose from patients who had referred to clinical toxicology emergency of Noor Hospital (Isfahan, Iran), during 2012, because of suicidal attempt. The estrogen and progesterone serum level of the 111 females were measured during 24 hours after suicidal attempt. The rank of their suicide, the demographic properties, and the menstrual cycle phase of them were also registered, as the patient's statement. The results were analyzed by ANCOVA and Kruscal-Wallis under SPSS16. RESULTS: Mean serum concentration of the estrogen was 76.8 pg/mL, and the mean serum concentration of progesterone was 2.99 ng/mL. Of them, 62.2% were in the luteal phase, and 37.8% were in the follicular phase, as they said. The serum progesterone concentration of the patients with more than two times suicidal attempts was significantly higher than the others. CONCLUSION: The suicidal attempt ranks significantly related to the serum progesterone concentration and the luteal phase.

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Head trauma and brain injuries are common causes of emergency admission and usually predispose multiple psychiatric complications. In turn, the traumas often occur after some psychiatric disorders. Therefore, the complicated interaction of these factors often causes difficulties in diagnosis and management of the patients. The side-effects of surgical and medical treatments may also complicate these processes more, as well. In this study, we present a case of a young patient with these complex factors and discuss the diagnosis and management.

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BACKGROUND: Due to the controversy over efficacy of cognitive-behavioral therapy for chronic depression, recently, there has been an increasingly tendency toward therapeutic methods based on the cultural and spiritual approaches. The aim of this research was to compare efficacy of spiritual integrated psychotherapy (SIPT) and cognitive-behavioral therapy (CBT) on the intensity of depression symptoms and dysfunctional attitudes of patients with dysthymic disorder. MATERIALS AND METHODS: This study had a mixed qualitative and quantitative design. In the first phase, SIPT model was prepared and, in the second phase, a double-blind random clinical trial was performed. Sixty-two patients with dysthymic disorder were selected from several centers include Nour and Alzahra Medical Center, Counseling Centers of Isfahan University of Medical Sciences and Goldis in Isfahan. The participants were randomly assigned to three experimental groups and one control group. The first group received 8 sessions treatment of SIPT, second groups also had 8 sessions of cognitive-behavioral therapy, which was specific to dysthymic disorder and third group were under antidepressant treatment. Beck depression inventory and dysfunctional attitudes scale were used to evaluate all the participants in four measurement stages. The data were analyzed using MANCOVA repeated measure method. RESULTS: The results revealed that SIPT had more efficacy than medication based on both scales (P < 0.01); however, it was not different from CBT. SIPT was more effective on the modification of dysfunctional attitudes compared with CBT and medication (P < 0.05). CONCLUSION: These findings supported the efficacy of psychotherapy enriched with cultural capacities and religious teachings.

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OBJECTIVE: Antipsychotic medications are the frontline treatment for the most psychotic disorders. The aim of this study is to compare the onset of action of the first and second generation antipsychotics and the rate of their side-effects in the treatment of acute psychosis. METHODS: In a double-blind, controlled clinical trial, 40 acute psychotic patients were randomly allocated in four groups and treated with each of the four antipsychotics: olanzapine, risperidone, haloperidol or thiothixene. The onset of action of each drug was assessed by the Positive and Negative Symptoms Scale. The data were analyzed by Wilcoxon (Gehan) survival and Log Rank analysis, using SPSS version 20.0. FINDINGS: Initial response was observed in 97.5% (N = 39) of subjects during 2 weeks of intervention. The mean time to the first response was 6.15 ± 2.9 days and this was significantly shorter for risperidone than others. The most common side-effects were sedation and drug induced Parkinsonism. CONCLUSION: Risperidone represented shorter onset of action for the treatment of acute psychotic symptoms compared with olanzapine, haloperidol and thiothixene.

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BACKGROUND: According to Beck theory, dysfunctional attitude has a central role in emergence of depression. The aim of this study was to determine contributions of dysfunctional attitude and general health index to depression. METHODS: In this case-control study, two groups of subjects participated. The first group consisted of 65 patients with major depression and dysthymic disorder, who were recruited from Noor and Navab Safavi Psychiatry Clinics in Isfahan. The control group was consisted of 65 non-patient individuals who were accompanied or relatives of the patients and was matched with them based on age, sex and education. Both groups completed 26-item Dysfunctional Attitude Scale (DAS-26) and 28-item General Health Questionnaire (GHQ-28). Logistic regression and correlation methods were applied for statistical analysis. RESULTS: Logistic regression analysis showed that by an increase of one level in categorized DAS-26 scores and one score in the physical symptoms, anxiety, social dysfunction and depression subscales of GHQ-28 the risk of depression increase by 6.8, 1.6, 1.9, 3.7, 4.78 times, respectively. CONCLUSIONS: Capability of dysfunctional attitude and general health subscales to predict depression supports the Beck's cognitive diathesis stress theory of depression that dysfunctional attitude may be a predisposing risk factor for depression.

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BACKGROUND: Electroconvulsive therapy (ECT) is one of the most efficacious treatment for major depressive disorder (MDD), it is also used as a rapid and efficacious treatment for other psychiatric disorders, especially treatment resistant ones. The cognitive impairment is one of the most important side effects of ECT. This study examined the Memoral herbal efficacy in prevention of ECT-induced memory impairment. METHODS: In a randomized clinical trial, 70 patients with mood disorders who were candidates for ECT enrolled in either Memoral or Control group, and received either Memoral or placebo. The memory was assessed by Addenbrook Cognitive Examination (ACE), and the findings were analyzed by ANOVA under SPSS18. RESULTS: The Memoral group patients showed significantly higher total ACE scores than placebo group (P < 0.001). The scores of attention and orientation, verbal fluency and memory subscales not only never decreased during the study in Memoral group, but also increased. There was no significant difference between these scores of Memoral and placebo groups for the subscales of language and visuospacial ability. CONCLUSION: The Memoral herbal is an efficacious and safe choice in prevention of ECT- induced cognitive impairment.

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OBJECTIVE: University students' mental health affects not only their educational achievements, but also their professional future. The authors assessed the prevalence of suicidal ideation, depression, and aggression among students of three major universities in Isfahan, Iran. METHODS: In 2008, 470 students were entered into the study using a convenience sampling method. The three measurement tools applied were Aggression Questionnaire (AGQ), Beck Depression Inventor (BDI), and Beck Scale for Suicide Ideation (BSSI). RESULTS: Suicidal ideation was present in 7.58% of the students, depression in 28.04%, and aggression in 30.11% of them. The ratio of depression to suicidal ideation was approximately 4:1. No significant difference in the mean scores of aggression, depression, and suicidal ideation was observed between the three universities. No significant relationships were found between mean scores of aggression, depression, and suicidal ideation with age and gender. There was no meaningful relationship between the mean scores of aggression and marriage status, but the mean scores of depression (P = 0.01) and suicidal ideation (P = 0.0001) were significantly lower in the married students compared to the single ones. Aggression was significantly associated with depression and suicidal ideation (P = 0.0001). CONCLUSION: The frequency of suicidal ideation, aggression, and depression was less in our studied college students than in previous non-Iranian studies. The decreasing trend in reported frequency of mild depression during previous years is a noticeable finding. Yet, the findings seek more preventing programs among college students.