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Background and purpose : There has been some controversies about the etiological relationship between celiac and psychosis. Ït is even considered that the difference in prevalence of schizophrenia in different countries is due to differences in cereal and wheat consumption. There are reports that psychotic symptoms of schizophrenic patients have been reduced after consumption of gluten free diet. Some reports indicated that history of celiac disease is a risk factor for schizophrenia. The aim of this study was to investigate the association between psychotic symptoms and celiac disease.
Materials and methods : Ïn a retrospective cohort study, 13 celiac patients and 26 controls were recruited and matched for age, sex, perceived stress and thyroid function. Â semi structured psychiatric interview based on DSM-ÏV, family history of psychosis, neurological examination for neurological soft signs and determination of serological levels of ÏL-2 receptors were done for each groups.
Results : Non of the individuals in the case and control groups had psychotic symptoms. Neurological soft sign scores and serological levels of ÏL-2 receptors in each group were not significantly different. Two of the celiac patients had a positive family history of psychotic disease, but no one in control group had such a history. Serological levels of ÏL-2 receptors in celiac patients who had gluten free diet were higher than non-gluten free diet celiac patients (P=0.05).
Çonclusion : Ïn this study psychosis was not higher in celiac group than control, and non-significant difference between ÏL-2 receptor levels in celiac and control group was unexpected. More investigation with larger sample size or bootstrap re-sampling after several years is recommended.

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Background and purpose: In spite of discovering new antipsychotics in the past years, many patients of schizophrenia don’t response to none of them and are resistance to treatment. In this case, clozapine, ECT or some combination of drug mostly be used, but there are many patients of schizophrenia who are resistance to them. In recent years, of combination of ECT and clozapine has been suggested for these patients with promising results in primary studies. The purpose of this study was to evaluate the effects of a combination of ECT clozapine in treatment of resistance schizophrenia in comparison with clozapine and ECT administered reparately and double blind.
Materials and methods : Eighteen resistance schizophrenia patients were selected and divided into three groups. The first group took clozapine, the second group took ECT, and third group took a combination of ECT and clozapine. The responses to treatment evaluated with PANSS and analysed with ANOVA and t-test.
Results : The rate of decrease of PANSS scale in three groups of clozapine, ECT and combination both of them were 46%, 40%, 71% respectively, with significant difference (p<0.05). Combination of ECT and clozapine showed faster response than ECT and clozapine alone.
Conclusion : Combination of ECT and clozapine was effective and safe in treatment of resistance schizophrenia.

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Background and purpose:Çlozapine is an antipsychotic with the least extrapyramidal side effects and more agranulositosis than typical antipsychotics. Çlozapine has the unique effects on the treatment-resistant schizophrenia but with threatening side effects on the patients. Thus we did this prospective study in order to identufy the side effects of clozapine in Ïranian treatment-resistant schizopherenic patients at Razi psychiatric center, Ïran.
Materials and methods : We selected 80 treatment-resistant schizopherenic patients on the basis of DSM-ÏV. Âfter 2 weeks drug free period, The aptients received haloperidol for 6 weeks and then 40 patients were selected with BPRS score above 45. These patients took clozapine with the similar way which increased to 900 mg/day. They were assessed by internal side effects, ËPS questionnaires and laboratory examination weekly followed for 20 weeks.
Results :The results showed that 8 patients were excluded from study due to severe side effects. The most prevalent internal side effects were fatigue, sedation and siallorrhea the most prevalent extrapyramidal symptom. The difference between the mean of WBÇ, RBÇ and hemoglobin and the score of ËPS in the early and late stages of treatment were not significant statistically, but significant for platelet.
Çonclusion: Çareful clinical monitoring of the physical status and specially hematological status during treatment with clozapine and education to the patients and their care givers carers can prevent fatality by early recognition of severe side effects.

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Background and Purpose: Different studies have shown that caregivers of patients suffering from chronic physical or mental disorder endure a considerable burden. Authors decided to evaluate such burden on two groups of caregivers, (schizophrenic and ESRD patients), since few studies have been carried out regarding this subject in Iran.
Materials and Methods:In an experimental, cross sectional, comparative, two-tier cohort study, 60 caregivers (30 of Schizophrenic and 30 of those suffering from End Stage Renal Disease), were selected as convenient groups. Demographic questionnaires and FBIS were completed for both groups and results were reviewed by SPSS software based on t test.
Results:Caregivers of Schizophrenic patients endured a heavier burden in comparison with those suffering from ESRD by a meaningful difference, (0.05%). The results achieved from subgroups also showed that caregivers of both groups bear almost similar economic burden. In subgroup of objective burden, the caregivers of schizophrenic patients endured more burdens in comparison with patients suffering from ESRD, with once again a meaningful difference. Moreover, in subgroup of subjective burden, the caregivers of Schizophrenic patients endured more burdens comparing to patients suffering from ESRD, however the difference was not meaningful.
Conclusion:This study revealed that the caregivers of Schizophrenic patients experience more burdens, both objective and subjective, in comparison with patients suffering from ESRD.

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Background and Purpose: In recent years, review of opioid system and its changes in the psychopathology of schizophrenia through thear probable role our on neuronal synopses and cell body of dopaminergic neurons and also decrease dopamine secretion from acumbans nuclei and effects of opium agonists in treatment of those patients has been adventajes for clinicians.
Materials and methods: In a prospective double blind evaluation, 60 chronic schizophrenic inpatients on a stable regimen of neuroleptic medication with positive and negative symptom scale (PANSS) score of higher than 80 and were randomly assigned to either antipsychotic plus naltrexone or antipsychotic plus placebo. Thirty patients (30) received 100 mg/day of naltrexone plus antipsychotic drug while 30 received placebo plus antipsychotic drug for 6 weeks. PANSS scores were evaluated on the base of the study, biweekly through out the study and two weeks after the trial. The treatment effect was calculated by repeated measurement ANOVA.
Results: Difference between four types of symptoms (positive symptom, negative symptom, general psychopathological symptom, total score of PANSS) in the case and control groups was not significant (P < 0.05). In supplement two (S2) scores, a statistically non significant difference was seen in two groups (P < 0.07).
Conclusion: Additional treatment with 100 mg/day naltrexone in a 6 week trial had no significant therapeutic effect on typical or atypical antipsychotic drugs with regards to schizophrenia psychopathology.

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Background and purpose: Dermatoglyphic patterns and nervous system share a common stem and genetic basis. Âccordingly the aim of this study was to investigate the relationship between schizophrenia and bipolar disorder, and dermatoglyphic patterns.
Materials and methods: The fingerprint patterns of 100 patients with bipolar Ï disorder (BÏD), 100 patients with schizophrenia (SÇH) and 100 healthy controls (Çontrol Group: ÇG) were analyzed and compared in this case-control study blindly.
Results: The frequency of whorl pattern was higher in BÏD group than in ÇG group (P<0.03). The frequency of arches in SÇH group was less prevalent than that in ÇG (P<0.002). Dermatoglyphic analysis showed only significant differences in the 2nd and 3rd finger of the left hand between BÏD and ÇG (P<0.02 and P<01 respectively). The difference was also significant in the 1st and 4th finger of the right hand as well as in the 4th finger of the left hand between SÇH and ÇG (P<0.04, P<04, and P<02 respectively). Dermatoglyphic pattern of the BÏD and SÇH patients was not significantly different.
Çonclusion: Higher whorl pattern in the 2nd and 3rd finger of the left hand and lower arches in the 1st and 4thfinger of the right hand as well as in the 4th finger of the left hand may be associated with BÏD and SÇH respectively. There is no significant difference between dermatoglyphic pattern of BÏD and SÇH for clinical use.

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Schizophrenia in children at or younger than 5 years of age is remarkably rare. Psychotic symptoms usually emerge insidiously but are often severe and long lasting. These children have high rate of significant premorbid abnormalities and is more common in boys. The reported case is a 5 years old girl developed auditory and visual hallucination out of blue and grossly disorganized behavior over time, without premorbid abnormalities. The child was diagnosed with very early onset schizophrenia (VËÔS) based on multilinated surveys. The patient responded well to risperidone. Âcute onset VËÔS especially without premorbid abnormalities is extremely rare, complete clinical and paraclinical surveys should be done to exclude other similar disorders.

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Abstract Background and purpose: Schizophrenic patients have many problems related to cognitive domain, particularly social cognition. Recent research assesses the ability to recognize negative facial expressions in schizophrenic patients (paranoid/non-paranoid) in comparison with their siblings and healthy people. Materials and methods: In this descriptive-correlation research, 15 paranoid schizophrenic patients and 15 non-paranoid schizophrenic patients, and 30 siblings, and 30 healthy people were selected while available. This test is a software which displays 14 pictures for less than 1 second. The results of research were analyzed through multi variance method (MANOVA). Results: The findings showed that non-paranoid schizophrenic patients were less able to diagnose the negative facial expressions in comparison with their siblings (P<0.001), while no significant differences were found between paranoid schizophrenics’ performance and their siblings. There was significant difference between the ability of the siblings of non-paranoid schizophrenics in comparison with that of the healthy people. Conclusion: It can be inferred that inability in the recognition of facial expressions is a cognitive deficit that intensifies the negative symptoms of schizophrenia disorder. Key words: Negative facial expressions, paranoid schizophrenia, non-paranoid schizophrenia, siblings

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Background and purpose: Despite the availability of typical and atypical antipsychotic drugs, a large number of patients with schizophrenia do not show a good response to monotherapy with these drugs. This study was done to evaluate the effect of purslane on psychological symptoms of schizophrenic patients. Materials and methods: This randomized clinical trial was carried out in 60 chronic schizophrenic patients treated with risperidone in Sina hospital Joneghan, Iran during 2011-2012. The patients were randomly divided into intervention and control groups. The control group received risperidone 6mg/day and Biperiden 4mg/day for eight weeks. The Patients in the interventional group received 1gr extract of purslane daily with the same regimen for eight weeks. The scales for assessment of positive symptoms (SAPS), assessment of negative symptoms (SANS) and CRP level were recorded prior to and 8th week after the study. The data was then analyzed using SPSS V. 16. Results: At the end of study, the mean score of positive symptoms were 47.93 ± 18.56 and 57.1 ± 14.83 in intervention and control groups, respectively (P<0.05), and the mean score of negative symptoms were 40.83 ± 11.03 and 46.13 ± 9.34, respectively (P<0.05). The CRP levels of patients in intervention and control groups were 0.53 ± 0.55 and 1.72 ± 0.73, respectively (P<0.05). Conclusion: According to findings using purslane as an adjunct to respridone can improve psychological condition of chronic schizophrenic patients and decrease their CRP levels. (Clinical Trials Registry Number: IRCT201203112085N7)

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Background and purpose: EEG is used as a diagnostic tool in the diagnosis and prognosis of disease spread. Among the psychiatric illnesses that can utilize EEG to measure response to treatment, schizophrenia can be noted. Many investigations on the application of data EEG as a predictor of treatment response in patients with schizophrenia refractory to clozapine has been done in order to resolve contradictions and the limitations of previous studies. We studied the response to treatment with clozapine, with the PANSS greater number of samples making them prior studies have examined. Material & methods: In a cross-sectional study, 70 patients with schizophrenia resistant to treatment with candidates receiving clozapine were selected from those EEG and PANSS baseline was patient during twelve weeks of treatment with clozapine were again patients PANSS was used and EEG raw patients with a good response to treatment and disease with poor response to treatment were compared with each other. After data collection, descriptive statistics software SPSS17 square test was used for the analysis of EEG data from a linear regression to examine the relationship between the indicators of response to clozapine treatment. Results: The results showed that there is coherence of EEG and the treatment response to clozapine significant correlation was (P= 0.00). The results showed that there is presence of asymmetry in EEG and the treatment response to clozapine significant correlation was (P= 0.8). Conclusion: The EEG abnormalities include coherence of EEG in predicting response to treatment in patients with treatment-resistant schizophrenia to clozapine which is effective.

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Background and purpose: Together with drug treatment can be benefited of Cognitive-behavioral therapy improvement in people with schizophrenia. This study investigates the impact of cognitive-behavioral therapy on patients with positive symptoms of schizophrenia. Materials and methods: The study population includes all women and men who have schizophrenia in the Farabi Hospital in Kermanshah. They were randomly chosen including 31 persons, they were divided into two equal groups. (Control groups n=51 experimental, n=51). Both groups were tested by the test case SAPS. Then, the test group for 51 sessions According to the treatment protocol was the cognitive-behavioral therapyAfter the intervention, the incoming data using analysis of covariance (ANCOVA) was analyzed. Results: After two sessions, the experience group showed positive signs less than the controlling group meaningfully (P<0.001). Conclusion: It means that the behavioral-knowing treatments are known as the influencing treatment to decrease the positive signs of schizophrenia

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Background and purpose: Borna disease virus (BDV) is a unique RNA virus with wide range of hosts. There are many similarities in behavioral disorders caused by BDV in animals and certain mental disorders in human which suggests possible etiology of these disorders. The purpose of this study was to investigate the relationship between BDV and etiopathogenesis of psychiatric disorders, particularly schizophrenia and its prevalence in this group of patients. Material and methods: RNA was extracted from blood cell of 30 patients with schizophrenia and 15 healthy volunteers. It was screened for a 391-nucleotide, highly conserved region of the p24 and 447-nucleotideregion of the p40 of BDV, using specific primers and nested RT-PCR. Results: The mean age of the patients and controls were 36.03 ± 11.28 and 31.86 ± 10.61 years, respectively. BDV RNA was detected in eight patients with schizophrenia, while none of the healthy subjects was found infected with BDV. The prevalence of BDV virus was significantly higher in people with schizophrenia (26.66%) compared to that of the control group (P< 0.05). Conclusion: This study supports previous findings regarding the relationship between BDV and psychiatric disorders, especially schizophrenia. Therefore, this virus could be considered as an environmental factor that can increase the risk of mental illnesses in adults.

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Background and purpose: Memantine is a medication used to treat moderate to severe Alzheimer^’s disease. Memantine targeting the glutamatergic system specifically N-Methyl-D-Aspartate offer a novel approach in treatment of psychiatric disorders such as schizophrenia and schizoaffective disorder. The purpose of this study was to evaluate the efficacy and safety of memantine in combination with antipsychotics in patients with schizophrenia and schizoaffective disorder.
Materials and methods: A double-blind, placebo-controlled trial was performed in patients aged 18-65 years old with confirmed diagnosis of schizophrenia and schizoaffective disorder. Those who were pregnant, allergic to memantine, and not willing to participate in the study were excluded. Participants were assigned to receive either memantine (5-20 mg/day) (n= 29) or placebo (n= 29), in addition to antipsychotic for 90 days. The Positive and Negative Syndrome Scale (PANSS) was completed at baseline and day 30 and 90.
Results: The study showed no significant difference in reduction of PANSS scores for positive sign between the treatment group (6.32±7.17) and controls (4.17±6.25) (P=0.07).
Conclusion: Memantine was found to have no effect on positive sign of schizophrenia and schizoaffective disorder.
 
(Clinical Trials Registry Number: IRCT: 201310083210N5)
 
 

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 Background and purpose: Stigma and burden of care in caregivers of patients with schizophrenia have negative effects on the patient and their families. This research aimed to determine the effect of self-care training based on Acceptance and Commitment Therapy (ACT) on perceived stigma and caregiver burden of schizophrenic patients.
Materials and methods: This randomized clinical trial included 80 caregivers of schizophrenia patients in Sari Zare Hospital. Participants in intervention group received self-care training based on ACT in 8 sessions twice a week, while the control group received only routine care. The scores for stigma and care burden were measured in both groups before and after the intervention using Shamsaei stigma questionnaire and Zarit Burden Interview (ZBI, 22-item). T-test and paired t-test and descriptive statistical methods were used to analyze the data.
Results: The mean changes of the total score for perceived stigma before and after the intervention were found to be significantly different between the intervention group (65.45±6.79) and the control group (80.25±10.34)(P<0.05). Also, intergroup comparison showed a significant difference in mean changes of the total scores for burden of care before and after the intervention between the intervention group (44.35 ± 6.37) and the control group (55.05 ±10.29) (P <0.05).
Conclusion: According to current study, self-care training based on Acceptance and Commitment Therapy will improve perceived stigma and reduce burden of care in caregivers of patients with schizophrenia and such non-invasive interventions are recommended.

(Clinical Trials Registry Number: IRCT20171203037723N6)