Neuropsychiatric Symptoms of Alzheimer's Disease and Caregiver Burden

Introduction/Objectives

In addition to cognitive decline, one of the most important problems for caregivers of patients with Alzheimer's is neuropsychiatric symptoms (NPS). This study aimed to evaluate the NPS in patients with Alzheimer's disease (AD) and investigate its relationship with caregiver burden (CB).

Methods

In a cross-sectional study of 85 patients with AD referred to Shafa Hospital in Rasht and their caregivers in 2020, information was collected using a demographic questionnaire, Neuropsychiatric Inventory Questionnaire (NPI-Q), and the Caregiver Burden Inventory (CBI). Data were analyzed by Spearman correlation, t-test, and linear regression, with SPSS version 22.

Results

The mean age of the patients and their caregivers were 74.95 ± 8.87 years and 43.98 ± 11.38 years, respectively. The mean total score of NPS in patients with AD was 44.25 (0–144) and the mean CB score was 36.27 (0–96), which was a moderate level. According to the results, 91% of patients had apathy, while happiness/euphoria was reported as the most uncommon symptom. In addition, there was a significant relationship between the score of NPS and CB (r = 0.542, P < 0.0001), as well as all its sub-components, time-dependence burden with more correlation (r = 0.509, P < 0.0001), and social burden with less correlation (r = 0.352, P < 0.001). NPS, hallucination, aberrant motor behavior (AMB), delusion, and depression were most correlated with CB. Also, the mean score of CB was significantly higher in women than in men (P = 0.045). Living in a rural area had a significant relationship with NPS score (P = 0.026). Also, linear regression showed that with increasing 1 year of patients' age, the mean score of patient's NPS decreased by 0.374 (P = 0.048).

Conclusion

Neuropsychiatric symptoms, especially hallucination, aberrant motor behavior (AMB), delusion, and depression were associated with caregiver burden. Apathy was the most common symptom in patients with AD.

Psychometric Properties of 20-Item and 10-Item Persian Versions of Drug Abuse Screening Test

Introduction: Substance use disorder is one of the most critical social problems in Iran. For this disorder, weneed a proper assessment tool based on our indigenous culture. Objective: This study assesses the factor structure and psychometric properties of 10-item and 20-item Persian versions of Drug Abuse Screening Tests (DAST-10 and DAST-20). Materials and Methods: In this cross-sectional study, we randomly selected 200 participants referred to addiction treatment centers in Rasht City, Iran. After translation to Persian and back-translation to English, the face and content validity of DAST-10 and DAST-20 Persian versions were evaluated using the opinions of a panel of expertsand calculatingthe content validity ratio and content validity index. Then, the construct validity was evaluated by Confirmatory Factor Analysis(CFA), the Cronbach α coefficient was used for assessing internal consistency, and the Intraclass Correlation Coefficient (ICC) was used for assessing test-retest reliability. Results: The Mean±SD age of participants was 39.02±11.67 years. The majority (50%) were in the age range of 30-50 years. Based on the CFA fit indices, the two instruments had a good fit to the data, confirming the theoretical model Root Mean Square Error of Approximation (RMSEA) (RMSEA for DAST-20=0.080; RMSEA for DAST-10=0.055). The Cronbach α values ​​of DAST-20 and DAST-10 were 0.772 and 0.749, respectively, indicating their good and acceptable internal consistency. Their test-retest reliability was reported at 0.997 and 0.995 based on the results of ICC, respectively. There was a strong and significant positive correlation between the scores of Persian DAST-20 and DAST-10 (r=0.851, P=0.001). Conclusion: The DAST-20 and DAST-10 Persian versions which after correcting the model using confirmatory factor analysis, they were studies in DAST-8 and DAST-16 have good validity and reliability and can be used for screening the possible involvement of drugs in Iranian samples.

Comparison of Cognitive Function in Different Trimesters of Pregnancy

Background: Although pregnancy is a normal function in women, it is considered as a stressful experience which is associated with many psychological and physical changes in pregnant women. Objectives: This study aims to investigate and compare cognitive function in different trimesters of pregnancy. Materials & Methods: This was a longitudinal cohort study. Participants were 76 pregnantwomen with a mean age of 30.09±6.23 years referred to Al-Zahra Hospital in Rasht, Iran during 2019-2020. Participants were assessed in three trimesters of pregnancy using the Wechsler Memory Scale (WMS) and Mini-Mental State Exam (MMSE). The multilevel mixed-effects linear regression and repeated measures ANOVA were used for data analysis. All analyses were done in SPSS software v. 19 and Stata v. 14. Results: The mean score of WMS was significantly lower in the third trimester (84.95±12.07) than in the first and second trimesters (89.34±13.13 and 88.72±13.24, respectively) (P=0.001). The results of linear regression analysis showed no significant difference in MMSE score between different trimesters of pregnancy (P>0.05), while the WMS score was significantly different between different pregnancy trimesters; the change in WMS score was statistically significant only in the third trimester (P= 0.04). Conclusion: No impairment in general cognitive function occur during pregnancy, but memory impairment may occur. In the third trimester, pregnant women have the poorest memory function.

Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process.

Psychometric Properties of the Obsessive-compulsive Inventory: The Persian Child Version; a Preliminary Study

Background: The Obsessive-Compulsive Inventory-Child Version (OCI-CV) is an approved self-report assessment tool that includes various domains of Obsessive-Compulsive Disorder (OCD). Objectives: This study was done to evaluate the psychometric properties of the OCI-CV in a sample of youth with OCD. Materials & Methods: This was a descriptive-analytic study. The subjects were 107 children and adolescents, 7 to 17 years old admitted to the Shafa hospital and Gill psychiatric center in the north of Iran in 2017-2018. The subjects with the diagnosis of OCD based on a diagnostic interview by a youth psychiatrist based on the DSM-5 were included in the study. They were assessed by the OCI-CV, Revised Children’s Manifest Anxiety Scale (RCMAS), and children depression inventory (CDI). Data were analyzed by SPSS v. 22, using Cronbach alpha, Pearson correlation coefficient, and exploratory factor analysis. Results: Youth with the Mean±SD age 11.18±3.1 years participated in the study. Results showed that 51% of the samples were girls. The internal consistency assessed by the Cronbach alpha for the total scale was 0.75, indicating good reliability. The Pearson correlation coefficient between OCI-CV and RCMAS was 0.584 (P=0.01), and between OCI-CV and CDI was 0.232 (P=0.05), showing an excellent concurrent validity. Construct validity showed that all subscales had a high correlation with the total score of the questionnaire and the correlation coefficient was significant (P<0.05). Conclusion: The Persian version of the OCI-CV has good psychometric characteristics in the clinical sample of youth with OCD.

The Relationship Between Serum Dehydroepiandrosterone Concentration and Memory Function in the Elderly

Background: World population is rapidly aging, and the elderly are most at risk of cognitive impairment. Dehydroepiandrosterone (DHEA) and DHEA-Sulfate (DHEAS) have an essential effect on neuroprotection and might effectively improve cognition and memory. Objectives: This study aimed to investigate the relationship between the level of DHEA and memory function in the elderly. Materials & Methods: The present study was a cross-sectional analytical study, and the study population included the elderly (age 60 years and older) living in Rasht City, the north of Iran, in 2020. The participants completed a demographic questionnaire and Wechsler Memory Scale (WMS), and their serum DHEA levels were measured by the hormonal automation method. The data were analyzed by SPSS v. 23, using t-test, the one-way Analysis of Variance (ANOVA), Pearson and Spearman correlation coefficient. Results: The participants included 100 older people (57 females and 43 males) with a Mean±SD age of 67.38±5.39 years. There was no correlation between serum DHEA concentrations with a total score of the WMS (r=0.117, P=0.247). However, the correlation between the DHEA level and the scores of personal and current information and visual reproduction subscales were statistically significant (r=0.219, P=0.029; r=0.206, P=0.04). Conclusion: The study indicates that the total memory score was not associated with the level of serum DHEA.

Translation, Cultural Adaptation, and Psychometric Features of the Persian Version of the Copenhagen Multi-Centre Psychological Infertility-Fertility Problem Stress Scales (COMPI-FPSS)

Aims: This study was conducted for translation, cultural adaptation, and validation of the Persian version of the Copenhagen multi-centre psychological infertility-fertility problem stress scales (COMPI-FPSS). Study Design: This study was a methodological study. Place and Duration of Study: This research was done in an infertility clinic of an educational hospital in Rasht (north of Iran), from November 2019 to January 2020. Methodology: This study was performed in two phases including tool translation and psychometric testing. Totally, 200 infertile people selected through convenience sampling among subjects met inclusion criteria were included in the study. After obtaining permission from the original tool designer, the COMPI-FPSS (14 items) was translated into Persian using the forward-backward method. Face, content, and construct validity, as well as internal consistency (Cronbach's alpha coefficient and McDonald's coefficient omega) were evaluated, and test-retest was conducted. The data were analyzed using exploratory factor analysis (EFA) by SPSS software Ver. 16. Results: EFA led to retaining of 11 items with 3 factors of “personal domain”, “marital domain”, and “social domain”, which explained 54.42% of the total variance. Cronbach's alpha coefficient for the whole questionnaire was calculated as 0.89; also the overall McDonald's coefficient omega of the questionnaire was equal to 0.82. The correlation between the two test administrations with a 14-day interval was estimated as 0.93. Conclusion: The Persian version of the COMPI-FPSS with 11 items and 3 factors had the desired cultural adaptation, validity, and reliability and it is recommended to use it in the future studies and infertility treatment centers.

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta-Analysis

OBJECTIVE

We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data.

METHODS

The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis.

RESULTS

In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively.

CONCLUSIONS

This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021.

The Quality of Informed Consent Obtaining Before Electroconvulsive Therapy: A Report From a Referral, Academic Hospital

Background: In patients undergoing Electroconvulsive Therapy (ECT), obtaining written Informed Consent (IC) must be the standard measure before the procedure. The patient must be informed about the risks and benefits of the treatment and alternatives. Objectives: We aimed to investigate the quality of IC obtaining before the ECT course in an academic hospital in the North of Iran. Materials & Methods: This study was conducted at an academic center in the north of Iran during 2018-2019. Firstly the patients’ mental capacity was assessed, and if it was not adequate for giving informed consent, a patient’s relative was interviewed. The collected data were analyzed by SPSS V. 22. The Kolmogorov-Smirnov test was used to evaluate the normality assumption. To compare the mean scores in subgroups, we applied t-test. Results: A total of 259 people enrolled in the survey and were interviewed. Schizophrenia was the main cause of receiving ECT. The Mean±SD score of receiving information was 8.22±3.68 (0-16), understandability of IC 3.03±1.76 (0-6), patients’ voluntary acceptance of the treatment 1.38±0.68 (0-4) and physician-patient relationship 6.11±2.16 (0-12). The total Mean±SD score was 18.05±3.16 (0-38). Conclusion: IC process was not optimal in our center; however, great trust in the physicians was noticeable. The physician-patient relationship had the highest score while the intentional obtaining of informed consent achieved the lowest.

Memory Impairment in Patients With Schizophrenia and Bipolar Disorder With and Without Psychosis: A Comparative Study

Background: Cognitive impairment is a common symptom in both Schizophrenia (SZ) and Bipolar Disorder (BD), and studies have demonstrated memory impairment in patients with these disorders. Objectives: To compare memory impairment in patients with SZ, BD with psychosis, and BD without psychosis. Materials & Methods: This study was a cross-sectional study conducted on 42 patients referred to Shafa Hospital in Rasht, Iran. Patients were examined in 3 groups of 14 people each (SZ, BD with psychosis, and BD without psychosis). The study tools included a demographic information questionnaire, a Brief Psychiatric Rating Scale (BPRS), and Wechsler’s Memory Scale (WMS) for adults. The obtained data were analyzed by SPSS version 21 using the 1 way analysis of variance (ANOVA). Results: The mean BPRS scores in patients with SZ (47.28) was higher than that in BD with psychosis (43.93) and BD without psychosis (23.14). ANOVA results showed a significant difference between patients with SZ and BD without psychosis (P=0.001), as well as BD with psychosis and BD without psychosis (P=0.001). Also, there was a statistically significant difference in the mean WMS scores between patients with SZ (62.07) and BD with psychosis (76.57) (P=0.009) and between SZ and BD without psychosis (73.5) (P=0.047). BPRS and WMS scores in SZ and BD without psychosis patients had a negative correlation. Conclusion: The results showed that SZ is associated with weaker memory than BD, and a history of psychosis does not have a significant effect on memory function in patients with BD.

Comparing the prevalence of attention deficit hyperactivity disorder in hearing-impaired children with normal-hearing peers

OBJECTIVES

The most important aspect of hearing loss is its effect on the communication abilities of individuals. The aim of this study was to compare the prevalence of attention deficit hyperactivity disorder (ADHD) in hearing-impaired (HI) children with normal-hearing (NH) peers.

METHODS

A total of 130 children (65 children with severe-to-profound hearing loss and 65 NH peers) participated in this cross-sectional study from November 2013 to May 2014. ADHD Rating Scale IV questionnaires were given to children's parents to collect data. Descriptive and analytical analyses were used in order to achieve the objectives of the study.

RESULTS

The mean age of the HI children and NH peers was 14.1 and 13.3 years, respectively. In the case group, 52 children suffered from congenital hearing loss and 10 children had acquired hearing loss. In total, 19 cases (29.2%) and eight controls (12.3%) were diagnosed with ADHD. This difference was statistically significant (P=0.017). The prevalence of ADHD in children with hereditary or acquired hearing loss was 30.7% and 20.0%, respectively. However, this difference was not significant (P=0.71).

CONCLUSION

The prevalence of ADHD in school-aged children with hearing loss is higher than that in the general population of the same age. We could not find significant differences between the different subgroups due to the small sample size. Therefore, we recommend a further larger study to determine the interaction between hearing loss and ADHD.

Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls

OBJECTIVES

To investigate predictors of fear of falling (FOF) among older people with or without hip fracture.

METHODS

The FOF was assessed by the Visual Analogue Scale (VAS-FOF), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). The modified Berg Balance Scale (mBBS) to evaluate functional balance was used. All people were asked to complete the dizziness Handicap Inventory (DHI) and the 36-item Short Form Health Survey (SF-36) for evaluating quality of life.

RESULTS

Eighty-eight older adults (44 cases; 44 controls) took part in this study. The case group had received surgical intervention for femoral neck or trochanteric fracture resulting from a fall. The results showed significantly more intensity of FOF in hip fracture patients than controls (p < .001). The FOF was significantly correlated with anxiety, DHI, mBBS, and SF-36. The results of the multiple linear regression showed that four predictors explained about 44% of the variance of the FOF. It was found that mBBS and DHI significantly predicted FOF (p < .001 and < .001, respectively).

CONCLUSIONS

The hip fracture patients had a high degree of the fear of falling, low quality of life and low functional capacity. The mBBS and DHI were significant predictors of the FOF in older adults.

CLINICAL IMPLICATIONS

It may be useful to employ an inter-disciplinary approach to addressing fear of falling to best understand physiological and psychological contributions.

Clinical Performance of a Glass Hybrid Restorative in Extended Size Class II Cavities

Objective:

To evaluate the clinical performance of a glass hybrid restorative compared with a resin composite in the restoration of large and deep Class II cavities after 24 months.

Methods and Materials:

A total of 108 extended size, with the width of the proximal box not interfering with the peak of the cusps and the proximal box in occlusion, Class II lesions in 37 patients were either restored with a glass hybrid restorative or with a micro-hybrid composite resin in combination with selective etching by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at the six-, 12-, 18-, and 24-month recalls according to the modified US Public Health Service criteria. Negative replicas at each recall were observed under scanning electron microscopy (SEM) to examine surface characteristics. Data were analyzed statistically.

Results:

After 24 months, 90 restorations were evaluated in 32 patients (recall rate: 86.5%). Four glass hybrid restorations were missing; three were due to bulk and one was due to proximal fracture at 12 months. Only six restorations were scored as bravo at baseline and at the six-, 12-, 18-, and 24-month recalls for color (p&lt;0.05). No significant differences were observed between the two restorative materials for the other criteria evaluated (p&gt;0.05). SEM observations exhibited acceptable surface and marginal adaptation characteristics for both restorative materials at 24 months.

Conclusions:

Although glass hybrid restorations showed significant mismatch in color, both restorative materials exhibited successful performance for the restoration of large Class II cavities after 24 months.

Electroconvulsive Therapy-Related Anxiety: A Survey in an Academic Hospital in the North of Iran

Background

Electroconvulsive therapy (ECT) is a medical treatment most commonly used in the most severe psychiatric diseases; however due to unreal anxiety, it is not widely accepted by patients and their families.

Objectives

The present study aimed to investigate the main causes of ECT-related anxiety (ERA) in an academic hospital in the north of Iran.

Methods

In this study, the participants were hospitalized psychiatric patients with proper communication skills. A 12-item questionnaire encompassing four sections (namely ECT side-effects, procedure factors, medical team communication, and familial, social, and economic factors) were filled out by a responsible psychiatric resident through a face-to-face interview. The participants’ demographic information, including gender, age, psychiatry disorder, level of education, and history of ECT, were also recorded.

Results

In this study, 353 cases were analyzed, among whom 329 patients (93.2%) reported at least one item for ERA, and 143 patients (85.6 %) had the history of ECT. All the participants (100%) had no experience in this regard (P = 0.0001). The most common cause of ERA was ECT-related side effects (70.7%) such as memory impairment (60.4%), disablement (24.9%), and death (14.7%) followed by procedure factors (27.2%), general anesthesia (GA) (73.2 %), and electric current (26.8 %). A significant relationship was observed between gender and the history of ECT with the patients’ anxiety reasons (P = 0.0001); however, the other variables, including age (P = 0.72), type of disease (P = 0.144), and the level of education (P = 0.012) had no impact on the results.

Conclusions

In this paper, the main causes of ERA were general anesthesia, memory impairment, and electric current. Obviously, a multidisciplinary approach is required to help these patients to handle their fear and anxiety successfully.

Electroconvulsive Therapy Side Effects in Recovery Ward: A Report From the North of Iran

Background: Today, Electroconvulsive Therapy (ECT) is used to manage many psychiatric illnesses. Although this treatment is safe and effective, sometimes it may cause frequent, short-term complications. Objectives: We investigated ECT-related side effects in the recovery ward of an academic hospital in Iran. Materials & Methods: This cross-sectional study was conducted at Shafa Hospital on 235 patients. During the procedure, patients were monitored by electrocardiography, pulse oximetry, and noninvasive blood pressure measurements. General anesthesia induction was performed by propofol 1-1.5 mg/kg followed by succinylcholine 0.5 mg/kg as a muscle relaxant. Airway control was maintained by mask ventilation. After short hyperventilation, an electrical current was delivered to the brain through two electrodes placed bilaterally on the temporal region, resulting in a seizure that lasted between 20 to 60 seconds. A questionnaire, including demographic information and possible complications, was filled out in the recovery ward. Data were analyzed an reported by frequency reporting and t-test in SPSS software V. 20. Results: Among 235 cases, 160 (68.1%) had at least one complication. A total of 53 patients (22.6%) reported myalgia which was significantly higher in the male gender. Also, 89 patients (37.9%) reported headache, 15 (6.4%) nausea, 7 (3%) shivering, and 84 (35.5%) pain at the injection site. Male gender and younger people were more prone to myalgia. Conclusion: We found that headache, myalgia, and pain in the injection site were the main patients’ reported complaints after ECT.

Personality Profiles in Patients With Allergic Rhinitis

Background: Psychological factors can be associated with allergic disorders. However, no particular personality pattern associated with these disorders has yet been identified. Objectives: This study aimed at comparing the personality profiles of patients with perennial allergic rhinitis and normal controls. Materials & Methods: This cross-sectional study was done on 50 adult people with persistent allergic rhinitis for at least one year and 50 age- and sex-matched normal controls that completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A multivariate covariance analysis (MANCOVA) was carried out to discover possible personality differences between the two groups. The data were analyzed by SPSS v. 19 software. Results: The results of the MMPI showed no significant difference between the two groups in the validity scales (P=0.29). The most common modal validity presentation style in both groups was neutral self-presentation. The MANCOVA analysis showed significantly high scores on the hypochondriasis (F=18.13, P<0.005, partial η2 =0.16) and hysteria scales in allergic rhinitis subjects (F=8.68, P=0.04, partial η2 =0.08) compared with normal controls. The most common profiles with high scores in the allergic rhinitis subjects were schizophrenia (52%, P<0.01) and hypochondriasis (50%, P<0.01). These scales emphasized the feelings of isolation and discomfort in allergic people. The frequency of psychasthenia scale, which measures long lasting anxiety, was significantly different between the two groups (40% in allergic rhinitis subjects vs. 10% in normal controls, odds ratio=6 [95%CI 1.9-22.3], P<0.001). Conclusion: The score of psychological health is lower among allergic people than in normal contro

The Association Between Ginseng and Mania: A Case Report and Literature Review

Background: Ginseng has long been used as a tonic and panacea, a dietary supplement, or a therapeutic agent in different countries. Among many common side effects for this herbal, the affective disorder is one of the rare ones. Case presentation and Intervention: We present a case of mania with psychotic features. The patient was an 18-year-old male who consumed Asian red ginseng for five months to treat his overweight. His physical examination was normal except for mild mental retardation. Mental status examination revealed increased psychomotor activity, anxious mood, unstable affect, irritability, aggression, pressured speech, grandiosity, auditory hallucinations, and persecutory delusions. After the admission, he was ordered to stop ginseng taking and supportive care and treatment with risperidone, lorazepam, and valproate sodium started. After 15 days, all symptoms were treated. Conclusion: Despite the widespread use of herbal and dietary supplements, physicians and health care providers should be concerned about the side effects of these products, such as mania and psychosis.

Psychometric Properties of the Persian Version Post-Stroke Depression Scale: The Case of Neurology Outpatients in Rasht, North Iran

Background: Psychiatrists use different scales to evaluate post-stroke depression; however, some concerns have raised about their low specificity. Objectives: This study aimed to assess the validity and reliability of the Persian version of the Post-Stroke Depression Scale (PSDS) in Iran. Materials & Methods: In this analytical cross-sectional study, 155 patients with stroke who were referred to neurology clinics in Rasht City, Iran, were interviewed by a psychiatric assistant (Gold Standard DSM-5 interview was used to separate the depressed from the non-depressed). The participants were then assessed by the PSDS and the hospital anxiety and depression scale (HADS). Moreover, a Receiver Operating Characteristic (ROC) curve with the standard Gold DSM-5 interview was used to determine the ability of the scales and to categorize depression. Eventually, the data were analyzed in SPSS v. 19. Results: Data analysis indicates that the factor structure of HADS is one-dimensional, and exploratory and confirmatory analysis supported the fit for the one-factor model as the best fitting model. Bartlett test (The Chi-square=408.217, df=28, P<0.001) showed significant relationships between variables. The internal consistency of HADS was 0.638 for depression and 0.617 for anxiety. The test-retest reliability is equal to for 60 subjects were randomly re-evaluated within one to two weeks, reported that r=0.783, for anxiety and r=0.741 for depression. Finally, based on the ROC curve, the cut-off point of 9 was chosen, and the different severity of depression was distinguished by 9, 14, and 20. Conclusion: The Persian version of PSDS possesses appropriate psychometric properties among the Iranian population.

Psychometric Properties of the Persian Version of Dizziness Handicap Inventory

Introduction:

The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI with Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participants and implementation of a factor analysis.

Materials and Methods:

This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach’s alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire.

Results:

The Cronbach’s alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach’s alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI.

Conclusion:

As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.

Systematic Review and Meta-Analysis of the Effects of Soy on Glucose Metabolism in Patients with Type 2 Diabetes

OBJECTIVE

This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I2 statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests.

RESULTS

Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels.

CONCLUSIONS

Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.

Olfactory Identification among Various Subtypes of Parkinson Disease

Introduction: This study is aimed at investigating the olfactory function among different subtypes of Parkinson disease (PD) and the impact of sex on smell identification test. Methods: In this cross-sectional study, we used Iran-smell identification test (Iran-SIT). PD severity was determined using a Hoehn and Yahr (H&amp;Y) scale. We used analysis of covariance (ANCOVA) to compare the olfactory function among different PD subtypes. All analyses were performed using SPSS software version 16.0. Results: In total, 66 males and 38 females participated in this study. The most common PD subtype was postural instability and gait difficulty (38.5%). Severe hyposmia and anosmia were found in 44.6 and 19.6% of participants, respectively. Women had a higher score in olfactory function than men (p = 0.44). The score of subjects with stage 1 in the H&amp;Y scale was about 3 points higher than the score with stage 4. The ANCOVA showed a statistically significant effect of subtypes PD on Iran-SIT score after controlling for the effects of covariates (p = 0.03). There is a significant difference between tremor-dominant Parkinson disease (TDPD) and other subtypes of PD (p < 0.05). However, Iran-SIT scores failed to show a significant difference between men and women (p = 0.13). Discussion/Conclusion: Our results confirmed that PD is heterogeneous and there is significant variability in odor identification ability in these patients. We observed more olfactory impairment in TDPD, and subjects with higher H&amp;Y stage. We recommended future studies with repeated measurements of different aspects of smell function to characterize the temporal relationship of olfactory dysfunction with PD.

Add-on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial

OBJECTIVES

Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add-on probiotics on symptoms and QoL of patients.

METHODS

In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8-week washout. The primary outcome was the change of the Short Form 36-Item Health Survey (SF-36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test-22 (SNOT-22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires.

RESULTS

A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF-36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF-36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT-22 and CARAT.

CONCLUSION

This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended.

LEVEL OF EVIDENCE

1b Laryngoscope, 129:1744-1750, 2019.

An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province

Introduction: The escalating rate of old people with a functional impairment in Iran and the weakness of the family support due to the diminishing of family size have increased the demand for long-term care for the elderly with cognitive impairment (CI).

Objective: The purpose of this research is to explore the frequency of cognitive impairment in the elderly and its association with their daily functional impairment and disability.

Method: This is a cross-sectional and descriptive-analytic study conducted in 2016-2017. The study sample consisted of 393 elderly people who were 60 years old or older who live in of Guilan different counties. Samples were selected by using multi-stage cluster sampling. Subsequently, data were analyzed by using the Chi-square test and correlation and regression analysis conducted in SPSS 22.

Results: It was observed that 4.3, 28.6, and 37% of the subjects suffered from severe, moderate, and mild cognitive impairment, respectively. Cognitive impairment had a significant relationship with daily functioning and activities requiring special tools. Moreover, cognitive impairment in women, people with low education, and those over 70 years old was more common, and the difference between them was significant (p <0.001). Also, disability was significantly greater in the elderly with cognitive impairment.

Conclusion: Many old people need to be cared for after the appearance of cognitive impairment. Therefore, appropriate screening of cognitive impairments is conducive to early diagnosis and prevention of executive functioning problems.

Correction to: An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province

In the original publication, the corresponding author name has been incorrectly typeset as: Robabeh Soleimani. The correct corresponding author name is: Somayeh Shokrgozar. The original article is now corrected.

SLC6A3 polymorphism and response to methylphenidate in children with ADHD: A systematic review and meta-analysis

Methylphenidate (MPH) is the most commonly used treatment for attention-deficit hyperactivity disorder (ADHD) in children. However, the response to MPH is not similar in all patients. This meta-analysis investigated the potential role of SLC6A3 polymorphisms in response to MPH in children with ADHD. Clinical trials or naturalistic studies were selected from electronic databases. A meta-analysis was conducted using a random-effects model. Cohen's d effect size and 95% confidence intervals (CIs) were determined. Sensitivity analysis and meta-regression were performed. Q-statistic and Egger's tests were conducted to evaluate heterogeneity and publication bias, respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Sixteen studies with follow-up periods of 1-28 weeks were eligible. The mean treatment acceptability of MPH was 97.2%. In contrast to clinical trials, the meta-analysis of naturalistic studies indicated that children without 10/10 repeat carriers had better response to MPH (Cohen's d: -0.09 and 0.44, respectively). The 9/9 repeat polymorphism had no effect on the response rate (Cohen's d: -0.43). In the meta-regression, a significant association was observed between baseline severity of ADHD, MPH dosage, and combined type of ADHD in some genetic models. Sensitivity analysis indicated the robustness of our findings. No publication bias was observed in our meta-analysis. The GRADE evaluations revealed very low levels of confidence for each outcome of response to MPH. The results of clinical trials and naturalistic studies regarding the effect size between different polymorphisms of SLC6A3 were contradictory. Therefore, further research is recommended.

Correction to: An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province

[This corrects the article on p. 247 in vol. 11, PMID: 30364719.].

Protocol for a Systematic Review and Meta-Analysis of Lithium, Anticonvulsive or atypical antipsychotic Drugs for Treatment of Refractory Obsessive-Compulsive Disorder

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that causes significant distress to the afflicted individual. About half of OCD patients treated with an adequate trial of serotonin reuptake inhibitors fail to fully respond to treatment and continue to exhibit significant symptoms. Therefore, there is a need for other agents to alleviate the symptoms of these disorders. In spite of considerable research including numerous randomized controlled trials and systematic reviews, there exists uncertainty regarding what treatments are effective. In this systematic review, we evaluated the efficacy of mood stabilizers in treatment-refractory OCD.

MATERIALS AND METHODS

We conducted a meta-analysis of all randomized clinical trials evaluating lithium, anticonvulsive agents or atypical antipsychotic drugs for OCD to determine which therapies show more effective than a placebo, in reducing obsessive-compulsive symptoms. We acquired eligible studies through a systematic search of Cochrane Central Registry of Controlled Trials, MEDLINE, EMBASE, PsycINFO, Scopus, ProQuest and Google scholar. We conducted meta-analyses to establish the effect of lithium, anticonvulsive agents, or atypical antipsychotic drugs on patient-important outcomes when possible. To assess relative effects of treatments, we constructed a random effect model.

DISCUSSIONS

Our review was the first to evaluate all treatments for OCD, to provide the relative effectiveness of lithium, anticonvulsive agents, or atypical antipsychotic drugs, and prioritize patient-important outcomes with a focus on functional gains. Our review facilitated the evidence-based management of patients with resistant OCD, and identified the key areas for future research.

The Impact of Methylphenidate on Motor Performance in Children with both Attention Deficit Hyperactivity Disorder and Developmental Coordination Disorder: A Randomized Double-Blind Crossover Clinical Trial

BACKGROUND

Children with attention deficit hyperactivity disorder/developmental coordination disorder (ADHD/DCD) suffer from problems associated with gross and fine motor skills. There is no effective pharmacological therapy for such patients. We aimed to assess the impact of methylphenidate (MPH) on motor performance of children with ADHD/DCD.

METHODS

In this double-blind placebo-controlled, 17 children (12 boys) with ADHD/DCD with a mean age of 7 years 6 months were recruited in Shafa Hospital, Rasht, Iran. The response was defined as ≥25% reduction in the total score of ADHD rating scale-IV from the baseline. Sixteen boys entered phase 2 of the study in which the impact of MPH on motor function was determined through a crossover randomized clinical trial. Eligible individuals were scheduled for baseline and two assessment visits after a one-week period of intervention. We used the short form of Bruininks-Oseretsky test (BOT-2) to identify the disability of motor function. Children were randomly assigned to receive MPH or inert ingredients (placebo). In the second period, medication (MPH/placebo) was crossed over. The effects of MPH were analyzed using χ2 test for related samples to compare the performance during baseline, placebo, and MPH trials. The results were analyzed using the SPSS software version 16.0.

RESULTS

The mean minimal effective dose of MPH per day was 17.3 mg (0.85 mg/kg). Children with higher ADHD rating scale had a significantly lower standard score in BOT-2 (P=0.03). Following MPH intake, 26.6% of the children showed clinically significant improvement in motor function. However, the improvement was not statistically different between the MPH and placebo.

CONCLUSION

Although MPH improved ADHD symptoms, problems with motor performance still remained. Further work is required to determine the probable effects of MPH in a higher dosage or in different subtypes of ADHD.

TRIAL REGISTRATION NUMBER

IRCT201107071483N2.

Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies

OBJECTIVE

To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement.

DATA SOURCES

The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar.

REVIEW METHODS

A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I² statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated.

RESULTS

A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P < 0.001). Although there was no significant difference in the air-bone gap (ABG) closure of < 10 dB between the two groups, the subanalysis of prospective studies showed that patients in the TF group had less mean postoperative ABG (P = 0.02). Subgroup analysis of palisade grafts compared with that of TF graft revealed a significant difference in the graft integration rate favoring cartilage tympanoplasty (P = 0.01).

CONCLUSION

Cartilage grafting seemed to show a higher graft integration rate compared with TF grafting. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data.

LEVEL OF EVIDENCE

NA. Laryngoscope, 127:2139-2148, 2017.

Association of intimate partner violence with sociodemographic factors in married women: a population-based study in Iran

Intimate partner violence (IPV) is a neglected public health issue in Iran. This study was conducted among married women residing in urban Rasht (northern Iran), to estimate the prevalence and frequency of different forms of IPV from husband and their associations with socio-demographic factors. We carried out a population-based cross-sectional survey with cluster sampling design from February to October 2015. The samples consisted of married women aged ≥ 18 years with total household in Rasht city (north Iran) as the sample frame. We administered the Revised Conflict Tactics Scale (CTS-2) to estimate prevalence of past-year IPV. Of 2091 women, 57.1% had suffered psychological aggression, 27.6% physical abuse, 26.6% sexual abuse, and 6.9% injury. A significant association with IPV was found for women with, age ≤ 40 years, unemployed, low education, husband's addiction and rented-householders. Women who experienced physical abuse, had less age at marriage than women without violence. Also women with sexual coercion had less length of marriage than other non-abused women. On logistic regression, the strongest predictor of psychological, physical and sexual abuse was unemployment of spouse, whereas for injury it was low educational level (<12 years) of women. Our findings suggest that risk of IPV is high in our population. There is an obvious need of preventive and treatment activities. Our findings point at that various forms of abuse are different from each other in terms of differing characteristics of the perpetrators and it might be that also different strategies are needed to reduce and prevent these violence. Confirmation by further research is needed.

The Effect of Cognitive Behavior Therapy in Insomnia due to Methadone Maintenance Therapy: A Randomized Clinical Trial

BACKGROUND

Sleep disturbance is a common complaint of patients undergoing methadone maintenance therapy (MMT). There are limited studies about the effect of different treatments on insomnia due to MMT. In this study, we evaluated the effect of cognitive-behavioral treatment for insomnia (CBTI) on sleep disorders in patients undergoing MMT.

METHODS

Twenty-two patients with insomnia due to MMT (aged 18-60 years) participated in this randomized double-blind clinical trial. The intervention group received CBTI from a clinical psychologist for 8 weeks, whereas the control group received behavioral placebo therapy (BPT). The duration of individual sessions was 45 minutes, which was conducted once a week. The primary outcome was sleep disturbance assessed with Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS software version 19.

RESULTS

Eleven patients were assigned to each group. Two groups were matched according to demographic characteristics (age, marital status, education, and daily methadone doses). Although PSQI score was significantly reduced during weeks 5 and 8 after both interventions, there was a significant difference in intervention versus time interaction (P<0.02). The effects of CBTI versus placebo were significantly different (P<0.001). The time course was also significant (P<0.001).

CONCLUSION

This study showed that CBTI is more effective than BPT in overall sleep quality. We recommend further studies, with a larger sample, on CBTI in patients undergoing MMT.

Balance performance in older adults and its relationship with falling

BACKGROUND AND AIMS

A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population.

METHODS

A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: young-old (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests.

RESULTS

The fall rate (>2 in the last year) was 27.0 %. The cut-off point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cut-off point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test.

CONCLUSIONS

This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.

Melatonin for prevention of metabolic side-effects of olanzapine in patients with first-episode schizophrenia: randomized double-blind placebo-controlled study

We aimed to determine the efficacy of melatonin 3 mg/day in prevention of olanzapine-induced metabolic side-effects. In a randomized double-blind placebo-controlled study, 48 patients with first-episode schizophrenia who were eligible for olanzapine treatment, were randomly assigned to olanzapine plus either melatonin 3 mg/day or matched placebo for eight weeks. Anthropometric and metabolic parameters as well as psychiatric symptoms using The Positive and Negative Syndrome Scale (PANSS) were assessed at baseline, week 4, and 8. Primary outcome measure was the change from baseline in weight at week 8. Data were analyzed using t-test, Mann-Whitney U test, and mixed-effects model. Thirty-six patients had at least one post-baseline measurement. At week eight, melatonin was associated with significantly less weight gain [mean difference (MD) = 3.2 kg, P = 0.023], increase in waist circumference [MD = 2.83 cm, P = 0.041] and triglyceride concentration [MD = 62 mg/dl, P = 0.090 (nearly significant)] than the placebo. Changes in cholesterol, insulin, and blood sugar concentrations did not differ significantly between the two groups. Patients in the melatonin group experienced significantly more reduction in their PANSS scores [MD = 12.9 points, P = 0.014] than the placebo group. No serious adverse events were reported. To summarize, in patients treated with olanzapine, short-term melatonin treatment attenuates weight gain, abdominal obesity, and hypertriglyceridemia. It might also provide additional benefit for treatment of psychosis. The study was registered in the ClinicalTrials.gov (

REGISTRATION NUMBER

NCT01593774).

Xenotransplantation of cryopreserved human ovarian tissue into murine back muscle

BACKGROUND

Ovarian tissue (OT) cryopreservation and transplantation are options for fertility preservation in young female cancer patients.

METHODS

We investigated xenotransplantation of human OT into back muscle (B) of severe combined immunodeficiency mice. OT follicle content was evaluated by stereomicroscopy and pre-transplantation. Xenograft survival, follicular development (with/without FSH administration), apoptosis and vascularization were compared in B- versus K-site (under the kidney capsule) several times after grafting using histology, immunohistochemistry and magnetic resonance imaging. In vitro maturation (IVM) was also performed.

RESULTS

Anastomoses which developed from existing human and invading murine vessels were seen in OT at both sites, but angiogenesis was more prominent at the B- than K-site (P < 0.001). Vascularization and follicle size were correlated in the B-group (Spearman's coefficient 0.73; P < 0.001). FSH increased early (8 days) micro-vessel formation in B but not in K grafts (P < 0.0001, versus no FSH). B-site grafts showed a better histological morphology and survival (P = 0.0084), formation of larger antral follicles (P = 0.005), more metaphase-II (MII) oocytes, growing follicles (P = 0.028) and slightly fewer apoptotic follicles than K grafts. One MI oocyte from B underwent IVM and reached MII stage next day.

CONCLUSIONS

To our knowledge, this is the first report of MII and IVM-MII oocytes obtained from B xenografts. We report the largest oval-shaped antral follicles containing an MII oocyte obtained after OT xenotransplantation to date. Xenografting in the mouse B should be further explored as a method for human OT transplantation.

The effects of alprazolam on tinnitus: a cross-over randomized clinical trial

BACKGROUND

Tinnitus remains a phenomenon with an unknown pathophysiology and for which few therapeutic measures are available. To date there has been insufficient evidence to support the use of alprazolam in the treatment of tinnitus. We sought to evaluate the efficacy of alprazolam for relief of tinnitus.

MATERIAL/METHODS

Thirty-six tinnitus sufferers participated in this cross-over, randomized, triple-blind, placebo-controlled trial. Inclusion criteria included patients between ages 21 and 65, with a complaint of non-pulsatile tinnitus of more than 1 year duration. Patients with depressive or anxiety disorders were excluded, as were those using hearing aids. Participants received alprazolam 1.5 mg daily versus placebo in each period. Primary outcome variables included the Tinnitus Handicap Inventory (THI), a Visual Analog Scale (VAS), and tinnitus loudness.

RESULTS

Thirty patients completed the study. The average age of patients was 47.58+/-7.65 years. Alprazolam in comparison with placebo did not result in statistically significantly greater relief in THI score and tinnitus loudness. There was a significant improvement in VAS score in the alprazolam group compared with the placebo group (p<0.001).

CONCLUSIONS

These results suggest that although alprazolam did not improve the THI score or sensation level of loudness significantly, it has a desirable effect on VAS. Further work is needed to determine the beneficial effects of alprazolam in distressed or depressed patients.