Video game addiction is associated with early stage of inhibitory control problems: An event-related potential study using cued Go/NoGo task

Video game addiction (VGA) is associated with cognitive problems, particularly deficits in inhibitory control. The present study aimed to investigate behavioural responses and event-related potential associated with specific response inhibition using the cued Go/NoGo task to examine the effects of VGA on brain activity related to response inhibition. Twenty-five individuals addicted to video games (action video games) and 25 matched healthy controls participated in the study. The results showed that the VGA group had significantly more commission error in the NoGo trials and faster reaction time in the Go trials compared with the control group. The event-related potential analyses revealed significant reductions in amplitudes of N2 cue and N2 NoGo in the VGA group. While there was no significant difference between the N2 amplitudes of the Go and NoGo trials in the VGA group, the control group had a larger N2 amplitude in the NoGo trials. These results indicate that VGA subjects have difficulties in the early stages of response inhibition, as well as some level of impairment in proactive cognitive control.

EEG-biomarker theta/beta ratio and attentional quotients in adults who stutter: An electrophysiological and behavioral study

INTRODUCTION

There is increasing evidence that connects developmental stuttering to attention. However, findings have represented contradiction. Therefore, this study was conducted to investigate the possible relationship between stuttering and attention in resting and undertask conditions.

METHODS

In a cross-sectional study, 26 right-handed AWS (adults who stutter) and 25 matched fluent speakers were enrolled. Demographic data were collected, and the Beck anxiety inventory (BAI) was filled out for all participants. Then, QEEG was conducted, followed by IVA2. CPT test for all subjects. Finally, data were analyzed using SPSS software version 16.

RESULTS

AWS indicated significantly weaker auditory focus attention in the task (p = .02) than the control group, while a similar resting-state EEG marker of attention was found between groups (p > .05). Moreover, attention was not correlated between the two conditions (p > .05).

CONCLUSION

The EEG marker of attention did not necessarily designate the attentional performance of AWS under the task. Furthermore, attentional skills could be considered in the assessment and therapeutic programs of at least some groups of AWS.

Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients

BACKGROUND

Psychological disorders, such as depression and anxiety, are common among individuals who have experienced coronavirus disease 2019 (COVID-19); however, diagnosis may be challenging and subjected to invalidity. This study aimed to examine agreement between online self-assessment and psychiatric telephone interview among COVID-19 survivors.

MATERIALS AND METHODS

This cross-sectional descriptive study was carried out from March to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID-19 were contacted within the first week after discharge and were asked to fill the Hospital Anxiety and Depression scale (HADS) and socio-demography questionnaire. They were later interviewed using Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Agreement between the data extracted from self-report and telephone interview was analyzed using Cohen's kappa coefficient, sensitivity, and specificity.

RESULTS

Out of 200 post-COVID patients, 60 participants completed all assessments. Prevalence of depression was observed to be 88% via telephone interview and 45% via self-assessment. Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview, in comparison to 31% diagnosed with anxiety using self-report questionnaire. The agreement between online self-assessment and telephone interview for depression and anxiety was not significant (κ = 0.08 and κ = 0.1, respectively).

CONCLUSION

The discordance between online self-report and clinician's assessment via phone contact interview indicates that using self-report evaluations is not sufficient as the single assessment tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis of psychiatric problems in pandemics.

Validation of the Persian version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women

BACKGROUND

Anxiety disorder is more common in women than men. To some extent, it can be attributed to childbirth and factors related to pregnancy in women. Therefore, it is necessary for mothers to use valid and reliable scale to assess perinatal anxiety, such as the perinatal anxiety screening scale (PASS). The purpose of this study was to investigate the validity and reliability of the PASS in Persian language.

METHODS

The PASS was translated into Persian (PASS-IR). Generally, 224 women antenatal and 125 postnatal answered the questions of PASS, EPDS-10, BAI and DASS-21 questionnaires. The data was collected in the health centers of Kerman by random sampling method. Finally, content validity, factor analysis, internal consistency and test-retest reliability were evaluated.

RESULTS

The mean age of the participants was 32.89 years (range between 18 and 45 and SD = 6.23). More than half of the participating were at risk of severe anxiety (53.5%). Content Validity Index (CVI) and Content Validity Ratio (CVR) were 0.80 and 0.87. PASS-IR subscales include social anxiety and specific fears, general anxiety and adjustment, acute anxiety and trauma, and perfectionism and control. PASS-IR was significantly correlated with EPDS-10 (rho = 0.42), BAI (rho = 0.53), DASS-21 with three concepts of depression, anxiety and stress (rho = 0.51, rho = 0.49 and rho = 0.49), and adverse life events (rho = 0.30).

CONCLUSION

The results of this study show that PASS-IR has good validity and reliability. Therefore, it can be used to screen for anxiety disorder among Iranian women in the perinatal stage.

Comparing Cognitive Functions in Patients with Schizophrenia and Methamphetamine-Induced Psychosis with Healthy Controls

BACKGROUND

There are similar findings about the similarities and differences of cognitive dysfunctions in patients with schizophrenia and methamphetamine-induced psychosis (MIP). This study aimed to compare cognitive functioning in schizophrenia and MIP patients, using a performance-based cognitive assessment battery and an interview-based assessment of cognition.

METHODS

Three groups participated in this study including, (a) 30 patients with MIP, (b) 30 patients with schizophrenia, and (c) 30 healthy individuals. All participants received the Brief Assessment of Cognition in Schizophrenia (BACS), a standardized performance-based cognitive battery, the Schizophrenia Cognition Rating Scale (SCoRS), and the interview-based assessment of cognition.

FINDINGS

Both groups of patients with schizophrenia and MIP performed poorly on all the BACS cognitive domains compared with the healthy controls. The two patient groups were significantly different on the three BACS subscales including verbal fluency, verbal memory, and speed of information processing. Schizophrenia patients performed worse than the MIP group concerning these three subscales. However, the two patient groups were similar in executive function, working memory, and motor speed. Moreover, the SCoRS-informant, SCoRS-global, and PANSS-negative significantly differed between schizophrenia and MIP patients.

CONCLUSION

Although cognitive dysfunctions are mostly similar in patients with MIP and schizophrenia, there are some differences especially in the functions related to prefrontal and temporal lobes.

Neurocognitive Functions Related to Parietal Lobe in Patients with Schizophrenia and Methamphetamine Induced Psychotic Disorder and Healthy Individuals: A Comparative Study

BACKGROUND

There are some inconsistent findings about neurocognitive functions in schizophrenia and methamphetamine induced psychosis (MIP). This study aimed to compare these two disorders in terms of neurocognitive functions related to parietal lobe.

METHODS

This was a cross-sectional study in which 30 patients with schizophrenia, 30 patients with MIP, and 32 healthy individuals were compared. The two groups of patients were selected through convenience sampling from among patients hospitalized in Shahid Beheshti hospital in Kerman, Iran and healthy individuals were selected via convenience sampling from among the employees of Kerman University of Medical Sciences. The three groups were administered clock-drawing test (CDT), Rey-Osterrieth complex figure (ROCF) copying test, and interlocking finger test (IFT) and their demographic and clinical data were collected. The one-way analysis of variance (ANOVA) was used to investigate the differences between the groups. Multivariate analysis of covariance was also used to examine the effects of confounding factors. Besides, follow-up pairwise comparisons were performed after adjustment for multiple testing.

FINDINGS

The group with schizophrenia had significantly more impairment than the group with MIP with reference to the results of IFT and the ROCF test. However, the scores of patients with MIP on these two tests were not different from those of the normal controls. With regard to the CDT, the only significant difference was observed between the group with schizophrenia and controls.

CONCLUSION

On the condition that the results are replicated in other studies, some parietal lobe neurocognitive tests might be used when it is difficult to differentially diagnose schizophrenia and MIP.

Designing the minimum data set of bipolar disorder: A basis for introducing the effective factors in managing, controlling, and monitoring the bipolar disorder

BACKGROUND AND AIM

Bipolar disorder (BD) is one of the most challenging psychiatric disorders in the management area that can lead to functional, occupational, and cognitive disorders. Without proper care, this complication can lead to profound psychological challenges and even death. The aim of this study is to design a minimum data set (MDS) for BD.

MATERIALS AND METHODS

This descriptive cross-sectional study was conducted in two steps. In the first step, a survey was conducted in PubMed, Web of Science, and SCOPUS databases to identify the demographic, managerial, and clinical data elements. Then, the required data elements were extracted from the studies by the data extraction form and used in a questionnaire. In the second step, to confirm the data element set, the designed questionnaire was distributed and collected among 20 psychiatrists and subspecialists during a two-stage Delphi technique. Descriptive statistics (frequency and mean) were conducted to analyze the data.

RESULTS

Totally, 112 managerial and clinical data elements in 14 categories were extracted from the studies. Based on the experts' opinion and their consensus, 88 necessary data elements were considered to bipolar MDS. "Medication nonadherence," "history of suicide," and "substance abuse and addiction" were the most important data elements.

CONCLUSION

In this study, an MDS was designed for BD. Providing this MDS, in addition to improving the clinical processes, it is possible to help electronic system designers and health data managers to know what information should be included in the health systems or any kind of self-care or self-management software to meet the information needs of these patients.

Proactive and reactive inhibitory control are differently affected by video game addiction: An event-related potential study

INTRODUCTION

Video game addiction (VGA) is associated with physical and mental disorders, one of which is problem in executive function, particularly inhibitory control. The present study aimed to investigate reactive and proactive inhibitory controls by event-related potential (ERP).

METHODS

Thirty video game (action video games)-addicted subjects and 30 matched healthy controls participated in the study, who were tested by the selective stop-signal task.

RESULTS

The main results revealed that the VGA group had significantly more problems in preparatory processes and proactive stop trials, showing that VGA has a negative effect on proactive inhibition.

CONCLUSION

Finding the problem in proactive inhibitory control might be helpful in developing new treatments and rehabilitation methods in these fields.

Validity and reliability of a Persian version of the self- evaluation of negative symptoms (SNS)

AIM

The Self-evaluation of Negative Symptoms (SNS) has been developed to allow schizophrenia patients to evaluate themselves in five dimensions of negative symptoms. The present study aimed to examine psychometric properties of the Persian version of SNS.

METHODS

A group of 50 patients with schizophrenia and a group of 50 healthy controls received the Persian-SNS. Severity of negative symptoms were evaluated by the Scale for Assessment of Negative symptoms (SANS) and the Brief Psychiatric Rating Scale (BPRS).

RESULTS

The results showed that the Cronbach's alpha for the Persian SNS was 0.95. The Persian-SNS and its subscales showed significant positive correlations with the total SANS score and SANS subscales as well as BPRS negative subscale, thus confirming the validity of the scale. Finally, the Persian-SNS showed the ability to discriminate patients with schizophrenia from healthy controls.

CONCLUSION

The acceptable properties of the Persian version of SNS demonstrated that it is a practical tool for screening negative symptoms in Persian-speaking schizophrenia patients.

Nanocurcumin as an Add-on to Antipsychotic Drugs for Treatment of Negative Symptoms in Patients With Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE/BACKGROUND

It is well documented that one of the pathophysiological mechanisms of negative symptoms in patients with schizophrenia is hypofunction of N-methyl-d-aspartate receptors. This double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of nanocurcumin as an adjuvant agent on psychotic symptoms, especially negative symptoms, in patients with chronic schizophrenia.

METHODS/PROCEDURES

Fifty-six inpatients with stable chronic schizophrenia and predominant negative symptoms were randomized in a 1:1 ratio to nanocurcumin soft gel capsule (160 mg/d) and control groups, along with their antipsychotic regimen for 16 weeks. The efficacy of treatment was assessed by Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Clinical Global Impressions-Severity, and Clinical Global Impressions-Improvement scales. Extrapyramidal symptoms were evaluated by Simpson-Angus Scale and Barnes Akathisia Rating Scale. Patients were assessed at baseline and weeks 4, 8, 12, and 16 after the medication started.

FINDINGS/RESULTS

No significant differences were observed in demographic or clinical variables between both groups at baseline. The nanocurcumin group showed significantly greater improvement on the negative subscale (P = 0.05), the general psychopathology subscale (P < 0.001), the positive subscale (P = 0.004), total Positive and Negative Syndrome Scale (P < 0.001), Clinical Global Impressions-Severity (P < 0.001), and Clinical Global Impressions-Improvement scores (P < 0.001) in comparison with the control group at the endpoint. Extrapyramidal symptom rating scales and Calgary Depression Scale for Schizophrenia and frequency of other adverse effects were comparable between 2 groups.

IMPLICATIONS/CONCLUSIONS

The present study indicates nanocurcumin as a safe and potential adjunctive treatment strategy for treatment of primary negative symptoms of schizophrenia.

Auditory processing in schizophrenia: Behavioural evidence of abnormal spatial awareness

Spatial processing deficits are the reason for many daily life problems of schizophrenia (SCZ) patients. In this study, we aimed to examine the possibility of abnormal bias to one hemifield, in form of hemispatial neglect and extinction, in auditory modality in SCZ. Twenty-five SCZ patients and 25 healthy individuals were compared on speech tasks to study the auditory neglect and extinction, as well as an auditory localization task for studying neglect. In the speech tasks, participants reproduced some nonsense syllables, played from one or two speakers on the right and/or left sides. On the localization task, examinees discriminated the subjective location of the noise stimuli presented randomly from five speakers. On the speech task, patients had significantly lower hit rates for the right ear compared with controls (p = 0.01). While healthy controls showed right ear advantage, SCZs showed a left ear priority. In the localization task, although both groups had a left-side bias, this bias was much more prominent for the patients (all p < 0.05). SCZ could potentially alter the auditory spatial function, which may appear in the form of auditory neglect and extinction on the right side, depending on the characteristics of patient population.

Comparing Copper Serum Level and Cognitive Functioning in Patients With Schizophrenia and Healthy Controls

Introduction:

The altered serum profiles of several trace elements have been reported in Schizophrenia (SCZ). This study was designed to elucidate whether the serum levels of Copper (Cu) and Magnesium (Mg), the two essential trace elements which contribute to neurotransmitter transmission, are altered in patients with SCZ. We also investigated whether there is an interrelation between cognitive functioning and the serum levels of Cu and Mg.

Methods:

Sixty patients with SCZ and 30 healthy controls participated in this study. The patient group was divided into the following: i) early patients (n=35, ≤5 years of illness initiation), and ii) chronic patients (n=25, ≥5 years of illness duration). The serum levels of Cu and Mg were measured by atomic absorption spectroscopy and ion-selective electrode potentiometry, respectively. To assess cognitive abilities, a Persian adaptation of the Brief Assessment of Cognition in Schizophrenia (BACS) was administered.

Results:

The present research results revealed significantly higher Cu serum levels in both patient groups [early patients (M=94.6), chronic patients (M=97.5)], compared to the controls (M=71.0) (P<0.001); however, no significant difference was observed among the study groups for Mg [patients with the recent onset (M=2.0), chronic patients (M=2.0), and controls (M=1.9)] P=0.1. While the serum Cu profile of healthy individuals revealed a negative correlation with working memory (r=−0.42, P=0.02), and executive functioning (r=−0.40, P=0.03), no significant correlation was observed between Cu serum levels of patients and BACS cognitive domains.

Conclusion:

findings suggested that the high Cu serum concentration might impact the cognitive decline in healthy individuals; however, no significant correlation was observed in the Patients; i.e. most likely because cognition is severely impaired in SCZ. Additional studies examining trace elements in drug-naïve patients with SCZ are required.

Looking into a Deluded Brain through a Neuroimaging Lens

Delusions are irrational, tenacious, and incorrigible false beliefs that are the most common symptom of a range of brain disorders including schizophrenia, Alzheimer's, and Parkinson's disease. In the case of schizophrenia and other primary delusional disorders, their appearance is often how the disorder is first detected and can be sufficient for diagnosis. At this time, not much is known about the brain dysfunctions leading to delusions, and hindering our understanding is that the complexity of the nature of delusions, and their very unique relevance to the human experience has hampered elucidation of their underlying neurobiology using either patients or animal models. Advances in neuroimaging along with improved psychiatric and cognitive modeling offers us a new opportunity to look with more investigative power into the deluded brain. In this article, based on data obtained from neuroimaging studies, we have attempted to draw a picture of the neural networks involved when delusion is present and evaluate whether different manifestations of delusions engage different regions of the brain.

Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial

OBJECTIVE

The objective of this study was to examine the effect of mobile phone applications (App) based cognitive behavioral therapy (CBT) on postpartum depression.

METHOD

A non-blinded parallel-group randomized controlled trial was conducted. The study population consisted of women attended to three health care centers in Kerman, Iran. Participants were recruited between September and November 2018, and randomized 1:1 to either the intervention group (mobile application access) or control group (no mobile application access). All participants completed the Edinburgh Postnatal Depression Scale (EPDS) at the baseline and 2 months after baseline. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression.

RESULTS

A total of 75 women with an average age of 27 years participated in this study. Before the intervention, there was no statistically significant difference between the EPDS score between the two groups (p > 0.001). However, in the intervention group, the average EPDS score after intervention was 8.18 and in the control group was 15.05, which was statistically significant (p < 0.001).

CONCLUSION

These findings provide proof that providing a CBT program using a mobile application can lead to clinically important improvements in outcomes for mothers who suffer from postpartum depression.

Symmetrical electrophysiological brain responses to unilateral and bilateral auditory stimuli suggest disrupted spatial processing in schizophrenia

Research has found auditory spatial processing deficits in patients with schizophrenia (SCZ), but no study has examined SCZ patients' auditory spatial processing at both pre-attentional and attentional stages. To address this gap, we investigated schizophrenics' brain responses to sounds originating from different locations (right, left, and bilateral sources). The event-related potentials (ERPs) of 25 chronic schizophrenic patients and 25 healthy subjects were compared. Mismatch negativity (MMN) in response to frequency and duration deviants was assessed. Two P3 components (P3a and P3b) were elicited via a frequency discrimination task, and MMN and P3 were recorded through separate monaural and dichotic stimulation paradigms. Our results corroborated the previously published finding that MMN, P3a, and P3b amplitudes are reduced in SCZ patients, but they showed no significant effect of stimulus location on either MMN or P3. These results indicated similarity between the SCZ patients and healthy individuals as regards patterns of ERP responses to stimuli that come from different directions. No evidence of auditory hemispatial bias in the SCZ patients was found, supporting the existence of non-lateralized spatial processing deficits in such patients and suggesting compensatory changes in the hemispheric laterality of patients' brains.

Comparison of Buprenorphine and Buprenorphine/naloxone in Detoxification of Opioid-dependent Men

Background

Buprenorphine sublingual tablets are now available in Iran for opioid detoxification in clinics. Aim of the present study was to compare the efficiency of buprenorphine with buprenorphine/naloxone in short-term detoxification in a group of Iranian male opioid-dependent patients.

Methods

A double-blind trial was carried out on a group of male opioid dependent patients in a psychiatric hospital in Kerman, Iran, during year 2017. A group of 100 men who met the diagnostic criteria for opiate dependence were included in the study from individuals who had referred for detoxification. They were allocated to the two groups receiving either buprenorphine (n = 51) or buprenorphine/naloxone (n = 49). Severity of withdrawal symptoms and signs were evaluated by Clinical Opiate Withdrawal Scale (COWS) and Adjective Rating Scale for Withdrawal (ARSW).

Findings

The mean scores of COWS and ARSW in the two groups treated with buprenorphine and buprenorphine/naloxone significantly reduced from the first day to the fifth day of detoxification (P < 0.050). Moreover, there was no significant difference between the two groups in terms of objective and subjective symptom reduction (P > 0.050).

Conclusion

Buprenorphine/naloxone is as effective as buprenorphine in controlling opiate withdrawal symptoms.

Evaluating the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A Preliminary Study

Objective: Despite accumulated evidence that demonstrates clinical outcome of telepsychiatry is comparable with conventional method; little research has been done on telepsychiatry in developing countries. This study aimed to evaluate the diagnostic agreement between telepsychiatry assessment and face-to-face assessment. Moreover, patient and doctor satisfaction was assessed by self-report questionnaire. Method : This study was conducted in an inpatient department of a university-affiliated hospital in Kerman University of Medical Sciences, Iran. The study sample consisted of 40 inpatients aged over 18 years who were selected from October 2016 to February 2017. All patients were visited onc e by face-to-face conventional method and once by interactive video teleconsultation by 2 psychiatric consultants. Results: Results of this study revealed that the diagnostic agreement between the 2 interviewers was 75%. Moreover, about 85% of the patients preferred telepsychiatry for follow-up visits. Also, more than 82% of the patients would recommend telepsychiatry to others although 95% of them perceived contact via telepsychiatry as uncomfortable to some extent. Conclusion: Telepsychiatry service can be used for psychiatric evaluation in Iran, and it has a desirable effect on patient and doctor satisfaction. The results of this study showed the capacity of moving towards using telepsychiatry.

Anodal transcranial direct current stimulation enhances positive changes in movement functions, visual attention and depression of patients with chronic ischemic stroke: A clinical trial

Introduction: Stroke is one of the most serious and debilitating diseases in our society. Stroke survivors can suffer several neurological impairments. They typically show pathological changes in neural functions of brain areas. Transcranial direct current stimulation (tDCS) can be applied to modify cerebral excitability and has been recently applied in the treatment of neuropsychological and neurological disorders. The aim of the study herein was to evaluate changes in movement and cognitive functions of chronic ischemic stroke patients using anodic and cathodic tDCS. Method: In this clinical trial, 100 patients with chronic ischemic stroke were divided in 4 groups (control, sham, anodic tDCS, and cathodic tDCS; n=25 per group). The patients underwent routine treatment and received the same tDCS protocol (3 times per week of 30-min sessions during one month). Movement and cognitive functions were evaluated using the NIHSS Scale & Trail Making Test and the Beck Test, before and after 1 and 3 months of tDCS sessions. All data were analyzed by 2-way repeated measures ANOVA using SPSS program (version 18). Results: The results showed that there were significant increases (P<0.001) in NIHSS score and Barthel index between anodic group versus control, sham, or cathodic group, at various timepoints (before vs. 1 month after tDCS, 1 month vs. 3 months after tDCS, and before vs. 3 months after tDCS). Furthermore, there were significant decreases (P<0.001) between anodic group versus control, sham, or cathodic group, at the various timepoints (before vs. 1 month after tDCS, 1 month vs. 3 months after tDCS, and before vs. 3 months after tDCS). Conclusion: Anodic tDCS has advantageous effects on movement and cognitive rehabilitation in stroke patients, but future studies are needed to further discern the differences and develop precise treatment protocols.  

Validation of the Persian version of the Schizophrenia Cognition Rating Scale (SCoRS) in patients with schizophrenia

The Schizophrenia Cognition Rating Scale (SCoRS) is an interview-based assessment of cognition that involves interviews with patients and informants. The SCoRS has shown good reliability, validity, and sensitivity to cognitive impairment in schizophrenia, with the advantage of brief administration and scoring time. The present study aimed to test the concurrent validity of the Persian version of the SCoRS. A group of 35 patients with schizophrenia and a group of 35 healthy controls received the Persian-SCoRS in the first session, and a standardized performance-based cognitive battery, the Brief Assessment of Cognition in Schizophrenia (BACS), in the second session.Our results indicated that the Persian version of the SCoRS was sensitive to cognitive impairment in the patients. The Persian SCoRS global rating was significantly associated with the composite score generated from the Persian version of the BACS and predicted functional outcomes as measured by Global Assessment of Functioning (GAF) and World Health Organization Quality of Life (WHO QOL). A Persian version of the SCoRS, an interview based measure of cognition that included informants, is related to cognitive performance and global functioning.

Chlorpromazine versus clotiapine for schizophrenia

BACKGROUND

Schizophrenia is a chronic, disabling and severe mental disorder, characterised by disturbance in perception, thought, language, affect and motor behaviour. Chlorpromazine and clotiapine are among antipsychotic drugs used for the treatment of people with schizophrenia.

OBJECTIVES

To determine the clinical effects, safety and cost-effectiveness of chlorpromazine compared with clotiapine for adults with schizophrenia.

SEARCH METHODS

We searched Cochrane Schizophrenia's Trials Register (last update search 16/01/2016), which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the Register.

SELECTION CRITERIA

All randomised clinical trials focusing on chlorpromazine versus clotiapine for schizophrenia. We included trials meeting our selection criteria and reporting useable data.

DATA COLLECTION AND ANALYSIS

We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE.

MAIN RESULTS

We have included four studies, published between 1974 and 2003, randomising 276 people with schizophrenia to receive either chlorpromazine or clotiapine. The studies were poor at concealing allocation of treatment and blinding of outcome assessment. Our main outcomes of interest were clinically important change in global and mental state, specific change in negative symptoms, incidence of movement disorder (dyskinesia), leaving the study early for any reason, and costs. All reported data were short-term (under six months' follow-up).The trials did not report data for the important outcomes of clinically important change in global or mental state, or cost of care. Improvement in mental state was reported using the Positive and Negative Syndrome Scale (PANSS). When chlorpromazine was compared with clotiapine the average improvement scores for mental state using the PANSS total was higher in the clotiapine group (1 RCT, N = 31, MD 11.50 95% CI 9.42 to 13.58, very low-quality evidence). The average change scores on the PANSS negative sub-scale were similar between treatment groups (1 RCT, N = 21, MD -0.97 95% CI -2.76 to 0.82, very low-quality evidence). There was no clear difference in incidence of dyskinesia (1 RCT, N = 68, RR 3.00 95% CI 0.13 to 71.15, very low-quality evidence). Similar numbers of participants left the study early from each treatment group (3 RCTs, N = 158, RR 0.68 95% CI 0.24 to 1.88, very low-quality evidence).

AUTHORS' CONCLUSIONS

Clinically important changes in global and mental state were not reported. Only one trial reported the average change in overall mental state; results favour clotiapine but these limited data are very difficult to trust due to methodological limitations of the study. The comparative effectiveness of chlorpromazine compared to clotiapine on change in global state remains unanswered. Results in this review suggest chlorpromazine and clotiapine cause similar adverse effects, although again, the quality of evidence for this is poor, making firm conclusions difficult.

Numerical distance effect in patients with schizophrenia

There is growing evidence showing that mental representation of numbers is impaired in patients with schizophrenia. Yet, no study has examined the distance effect in the patients. We assessed the distance effect using two number size comparison tasks, with different number references (5 and 7) in 23 patients and 28 healthy individuals. Response times and error rates significantly increased when the distances between the centered references and the targets decreased in both groups. However, patients responded significantly slower and had more error rates compared to controls. Our finding indicates distance effect in patients is similar to the controls, indicating an automatic numerical processing is preserved in patients with schizophrenia.

Neural evidence for compromised mental imagery in individuals with chronic schizophrenia

Mental imagery impairment has been reported in schizophrenia. The present study aimed to investigate the neural evidence for mental imagery impairment in patients with schizophrenia. The study participants included 20 patients with chronic schizophrenia and 18 healthy control subjects. Event-related potentials were recorded during a mental hand rotation task, in which participants were instructed to judge the laterality of hands displayed in different orientations. The performances of patients were significantly less accurate and slower than control subjects on hand rotation task. Moreover, the patients showed significantly reduced rotation-related negativity amplitude for mental rotation effect. The results demonstrate mental imagery impairment in patients with schizophrenia at both the behavioral and neural levels.

Evaluation of the Prevalence of Drug Abuse and Smoking in Parents of Children with Attention Deficit Hyperactivity Disorder

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) affects 5% of children. In addition to pharmacotherapy, non-drug treatments such as appropriate parenting are also very important in the treatment of these children. Diagnosis and treatment of parents with psychiatric disorders and substance abuse and evaluation of the frequency of these disorders in parents is critical.

METHODS

In this case-control study, 200 parents were studied. The target population included parents of 7 to 12 year-old children who referred to child and adolescent psychiatric clinics. The control group included parents of children who referred to child non-psychiatric clinics. The parents were evaluated via a demographic information form, and structured interviews based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) for nicotine and drug addiction. Then, the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) was used to assess their anxiety and depression.

FINDINGS

Among the studied parents, the comparison of drug abuse, smoking, and stress showed significant differences between the two groups. In terms of depression and ADHD, the difference between the case and control groups was not statistically significant.

CONCLUSION

The higher prevalence of these disorders in parents of children with ADHD may indicate the possible role of this disorder in the etiology.

Sex-specific restoration of MK-801-induced sensorimotor gating deficit by environmental enrichment

Despite ample evidence of N-methyl-D-aspartate (NMDA) receptor dysfunction in schizophrenia, no study has addressed the effects of enriched environment (EE) on sensorimotor gating deficits induced by postnatal NMDA receptor blockade. We evaluated the effect of EE on sensorimotor gating (measured by prepulse inhibition, PPI), or on sensorimotor gating deficit induced by the NMDA receptor antagonist (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801) in both sexes of Wistar rats. Rats were injected with MK-801 (1 mg/kg) on postnatal days (P) 6-10. EE was provided from birth up to the time of experiments on P28-30 or P58-60. PPI data were collected at three prepulse intensities and then averaged to yield global PPI. MK-801 treatment reduced PPI significantly in both sexes. While EE per se had no significant effect on PPI, it restored MK-801-induced PPI deficit only in male rats. An extended period of EE did not influence PPI deficit in female rats. Our results indicate that postnatal exposure to MK-801 may exert long-lasting effects on neuronal circuits underlying sensorimotor gating. Sex-specific modulation of such effects by EE suggests sexually dimorphic mechanisms are involved.

Assessment of Cognitive Functions in Methadone Maintenance Patients

BACKGROUND

Methadone maintenance has received little scientific attention regarding neurocognitive effects. This study is aimed to assess the neuropsychological performance of methadone maintenance patients (MMP) compared to those healthy controls.

METHODS

Thirty-five MMP and 35 healthy controls, matched for age, gender, education and employment status, examined on a battery of tests aimed at assessing verbal fluency, executive functions, verbal memory, and working memory, using controlled oral word association test (COWAT), trial making test (TMT) Part A and B, Rey auditory verbal learning test (RAVLT), and backward digit span.

FINDINGS

MMP performed significantly poorly than controls in cognitive domains of verbal fluency, executive function, and verbal memory. MMP did not exhibit impairment in working memory, and TMT Part A compared to controls.

CONCLUSION

These results suggest that methadone consumption induces significant cognitive impairment that could compromise drug-treatment outcomes in MMP.

A Study of the Sexual Function, Sleep, and Weight Status of Patients after 6 Months of Methadone Maintenance Treatment

BACKGROUND

Methadone is a synthetic opioid and receptor agonist morphine; thus, its consumption has the effects and side effects of opioid. Methadone maintenance treatment (MMT) is used as an alternative treatment for people who are suffering from substance abuse and do not have the ability to withdraw. Despite its benefits, this drug also has side effects. The purpose of this study was to investigate the effects of methadone treatment on sexual function, sleep, and weight after 6 months.

METHODS

The study subjects consisted of 200 patients who had referred to the Methadone Clinic of Shahid Beheshti Training Hospital, Kerman, Iran, during a 6-month period and were treated using MMT. Data collection tools consisted of the demographic questionnaire, Pittsburgh sleep quality index (PSQI), and Arizona sexual experience scale (ASEX). The questionnaires were completed by the participants before and 6 months after the treatment.

FINDINGS

The results of this study showed that methadone consumption has significant effects on sexual dysfunction, sleep disorders, and weight gain.

CONCLUSION

The consideration of the side effects of MMT can result in consumers' commitment to the treatment.

A Study of the Prevalence of Psychiatric Disorders in Patients with Methamphetamine-Induced Psychosis

BACKGROUND

The abuse of narcotic drugs and psychotropic substances such as amphetamines and ecstasy has had a growing trend. Tachycardia, increased blood pressure, hallucinations, panic attacks, and psychosis are the negative effects of methamphetamine abuse. The present study aimed to assess psychiatric disorders associated with methamphetamine-induced psychotic disorder.

METHODS

This cross-sectional study was performed from October 2013 to March 2014 on 165 patients hospitalized at Shahid Beheshti Hospital in Kerman, Iran, and diagnosed with psychosis induced by methamphetamine abuse within the previous 6 months. Study subjects were selected via census method. Based on the exclusion criteria and due to the lack of cooperation of some patients, 121 patients were enrolled in the study. Research data were gathered using clinical interviews, the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton anxiety scale (HAM-A) and Hamilton rating scale for depression (HRSD), Young mania rating scale (YMRS), substance dependence severity scale (SDSS), positive and negative syndrome scale (PANSS), and clinical global impression (CGI) scale. The data analysis was performed using SPSS software, descriptive statistics, and ANOVA.

FINDINGS

Among the 121 patients of the sample group, 4 patients (3.3%) had anxiety, 58 patients (47.9%) depression, 30 patients (24.8%) obsessive-compulsive disorder (OCD), 20 patients (16.5%) bipolar mood disorder (BMD), 8 patients (6.6%) persistent psychotic symptoms, 85 patients (70.2%) personality disorder, and 36 patients (29.8%) had no personality disorders. The highest prevalence was related to borderline personality disorder (35.5%). However, 45 patients (37.2%) had no impairment associated with methamphetamine-induced psychosis.

CONCLUSION

It seems that there is comorbidity between psychiatric disorders, including mood disorders, especially depressive disorder, childhood history of attention deficit hyperactivity disorder (ADHD), bipolar disorder, and personality disorders such as borderline personality disorder, and antisocial personality disorders, and methamphetamine abuse.

Frequency of Psychiatric Disorders in Children of Opioid or Methamphetamine-Dependent Patients

BACKGROUND

Addiction is one of the main problems of human societies, which is more common in developing countries. In addition, it causes to personal and social problems and family problem. The aim of this study was to examine the prevalence of psychiatric disorders in children 5-15 years old of opioid or methamphetamine dependence patients.

METHODS

For this study, three groups including: (1) children of parents addicted to opium, (2) children of parents addicted to methamphetamine, and (3) control group were examined. Child symptom inventory-4 (CSI-4) questionnaires completed by non-hospitalized guardian and control group; then make interviews with the children by the Kiddie-schedule for affective disorders and schizophrenia (K-SADS). Data were analyzed by chi-square test and ANOVA.

FINDINGS

Survey showed that the frequency of attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder, obsessive-compulsive disorder, specific phobia (SP), and separation anxiety disorder in children of addicted parents were more than a non-addicted parent. However, there was no significant difference between the two groups in the frequency of conduct disorder, social phobia, and oppositional defiant disorders (ODDs).

CONCLUSION

Parental addiction can lead to an increase in some psychiatric disorders in the children. Therefore follow-up, early diagnosis, treatment, and prevention of these disorders in children of the drug-dependent parent are necessary to reduce health costs and improve the health system.

Prior regular exercise reverses the decreased effects of sleep deprivation on brain-derived neurotrophic factor levels in the hippocampus of ovariectomized female rats

Previous studies indicated that brain-derived neurotrophic factor (BDNF) is the main candidate to mediate the beneficial effects of exercise on cognitive function in sleep deprived male rats. In addition, our previous findings demonstrate that female rats are more vulnerable to the deleterious effects of sleep deprivation on cognitive performance and synaptic plasticity. Therefore, the current study was designed to investigate the effects of treadmill exercise and/or sleep deprivation (SD) on the levels of BDNF mRNA and protein in the hippocampus of female rats. Intact and ovariectomized (OVX) female Wistar rats were used in the present experiment. The exercise protocol was four weeks treadmill running and sleep deprivation was accomplished using the multiple platform method. Quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and immunoblot analysis were used to evaluate the level of BDNF mRNA and protein in the rat hippocampus respectively. Our results showed that protein and mRNA expression of BDNF was significantly (p<0.05) decreased after 72 h SD in OVX rats in compared with other groups. Furthermore, sleep deprived OVX rats under exercise conditions had a significant (p<0.05) up-regulation of the BDNF protein and mRNA in the hippocampus. These findings suggest that regular exercise can exert a protective effect against hippocampus-related functions and impairments induced by sleep deprivation probably by inducing BDNF expression.

Abnormalities of mental rotation of hands associated with speed of information processing and executive function in chronic schizophrenic patients

AIM

Deficits in mental imagery ability have been reported in patients with schizophrenia. However, there is scarce evidence about the correlation between impairment in mental rotation and other cognitive deficits in the patients. The aim of this study was to assess mental rotation ability, along with other measures of cognitive function in patients with schizophrenia.

METHODS

The performance of 29 patients with schizophrenia was compared with 29 healthy controls. Mental rotation was measured with the Hand Rotation Task, and cognitive functions were measured with the Brief Assessment of Cognition in Schizophrenia (BACS).

RESULTS

On Hand Rotation Task, the patients were significantly slower and less accurate compared to controls. Moreover, mental rotation accuracy was significantly correlated with all the BACS domains except verbal memory. In multiple regression analysis, the two BACS subscales, Tower of London and Symbol Coding tasks, were significant predictors and accounted for 41% of the variance in accuracy in the patients.

CONCLUSION

These results support previous findings showing dysfunction of the posterior parietal cortex in schizophrenia, which is involved in general mental rotation, as well as other cognitive processes.

Validation of the Persian version of the brief assessment of cognition in schizophrenia in patients with schizophrenia and healthy controls

AIMS

The Brief Assessment of Cognition in Schizophrenia (BACS) is designed for assessment of cognitive function in patients with schizophrenia. Versions of the BACS in English and other languages have been shown to be as sensitive to cognitive dysfunction as a standard test battery, with the advantage of brief administration and scoring time. The present study aimed to test the concurrent validity of the Persian version of the BACS (Persian-BACS).

METHODS

A group of 50 patients with schizophrenia-spectrum disorders and a group of 50 healthy controls received the Persian-BACS in a first session, and in a second session a standard neurocognitive battery.

RESULTS

Cronbach's alpha for the Persian-BACS was 0.74. All the Persian-BACS subscales were significantly correlated with the corresponding standard neurocognitive subscales and the Pearson correlation of the composite scores from the two instruments was 0.71. Moreover, a one-factor solution was found that accounted for 67.9% of the variance. Finally, the Persian-BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls.

CONCLUSION

Good psychometric properties of the Persian-BACS suggest that it is a useful tool for assessing cognition in schizophrenic patients with Persian as their primary language.

The reliability and validity study of the Kinesthetic and Visual Imagery Questionnaire in individuals with multiple sclerosis

Objective

Motor imagery (MI) has been recently considered as an adjunct to physical rehabilitation in patients with multiple sclerosis (MS). It is necessary to assess MI abilities and benefits in patients with MS by using a reliable tool. The Kinesthetic and Visual Imagery Questionnaire (KVIQ) was recently developed to assess MI ability in patients with stroke and other disabilities. Considering the different underlying pathologies, the present study aimed to examine the validity and reliability of the KVIQ in MS patients.

Method

Fifteen MS patients were assessed using the KVIQ in 2 sessions (5-14days apart) by the same examiner. In the second session, the participants also completed a revised MI questionnaire (MIQ-R) as the gold standard. Intra-class correlation coefficients (ICCs) were measured to determine test-retest reliability. Spearman's correlation analysis was performed to assess concurrent validity with the MIQ-R. Furthermore, the internal consistency (Cronbach's alpha) and factorial structure of the KVIQ were studied.

Results

The test-retest reliability for the KVIQ was good (ICCs: total KVIQ=0.89, visual KVIQ=0.85, and kinesthetic KVIQ=0.93), and the concurrent validity between the KVIQ and MIQ-R was good (r=0.79). The KVIQ had good internal consistency, with high Cronbach's alpha (alpha=0.84). Factorial analysis showed the bi-factorial structure of the KVIQ, which was explained by visual=57.6% and kinesthetic=32.4%.

Conclusions

The results of the present study revealed that the KVIQ is a valid and reliable tool for assessing MI in MS patients.

Compromised motor imagery ability in individuals with multiple sclerosis and mild physical disability: an ERP study

BACKGROUND

Motor imagery (MI) impairment has been reported in individuals with multiple sclerosis (MS). The present study was designed to investigate neural evidence for MI impairment and its relationship to working memory in MS patients.

METHODS

The study participants included 24 early stage MS patients (age: 22-40/mean=32.7 years; M/F=4/20; years since duration: 1-10/mean=5.8) and 24 age-, gender-, and education-matched controls (age: 21-40/mean=31.8 years; M/F=5/19). Event-related potentials were recorded during a mental hand rotation task, in which participants were instructed to judge the laterality of hands displayed in different orientations. Furthermore, the Paced Auditory Serial Addition Test (PASAT) was used for assessment of working memory.

RESULTS

At the behavioral level, MS patients were significantly less accurate and much slower (accuracy: 83.80 ± 7.72%; reaction time: 1665.95 ± 269.82 ms) than controls (accuracy: 88.35 ± 7.68%; reaction time: 1505.16 ± 225.11 ms). At the neural level, MS patients showed a significantly reduced amplitude (MS: 0.99 ± 0.89 μv, controls: 1.46 ± 1.00 μv) and delayed peak latency (MS: 458.45 ± 67.60 ms, controls: 417.91 ± 62.47 ms) at P3 for mental rotation effect. Moreover, there were significant correlations between individuals' PASAT scores and performance of the hand rotation task.

CONCLUSION

The results of the present study demonstrate MI impairment in patients with MS at both the behavioral and neural level. Neuronal activity dysfunction (decreased and delayed activity) in patients with MS provides new insights into MI impairment. Furthermore, our findings suggest the contribution of working memory dysfunction to compromised MI ability in patients with MS.

The prevalence of problematic internet use and the related factors in medical students, kerman, iran

BACKGROUND

Although problematic Internet use (PIU) is a growing problem among adolescents, few studies have examined its prevalence among university students in Iran. This study was designed to investigate the prevalence of PIU and its potential risk factors among students at Kerman University of Medical Sciences, Kerman, Iran.

METHODS

In a cross-sectional study, data was collected from 976 university students. PIU was assessed by the 18-item Problematic Internet Use Questionnaire. In addition, information on demographics and Internet usage pattern was also collected.

FINDINGS

A total of 920 students completed the survey (response rate = 94.8%). Of them, 98% were Internet users. Overall, 21% of the students were identified as problematic Internet users. Logistic regression analysis showed that spending more time online, having a history of psychiatric disorders, and using the Internet for chatting and playing games were risk factors for PIU.

CONCLUSION

PIU is a common problem among university students. These results suggest the need for preventive and interventional strategies for this vulnerable group.

The Correlation between Methadone Dosage and Comorbid Psychiatric Disorders in Patients on Methadone Maintenance Treatment

BACKGROUND

Methadone Maintenance Treatment is a useful method for opioid dependents, which results in harm reduction and increased quality of life in opioid dependents. The prevalence of psychiatric disorders in addicts is higher than in the general population which can interfere with the course and treatment of substance dependents and decrease the efficacy of treatment.

METHODS

This descriptive, cross-sectional study was aimed to determine the correlation between psychiatric disorders and methadone dosage. It was performed on 154 patients of Kerman Shahid Beheshti Hospital's Methadone Clinic during a six month period from Dec 2010 to Jul 2011. The study population was chosen by convenience sampling. The searching tools were Socio-Demographic Questionnaire, psychiatric structured interview based on DSM-IV-TR, Beck Depression Inventory, Young Mania Rating Scales, and Anxiety and Depression Rating Scales.

FINDINGS

Significant correlations were observed between increased methadone dosage and antisocial personality disorder. In addition, significant positive correlations were observed between increased methadone dosage and Hamilton anxiety scores, Hamilton depression scores and Young Mania scores.

CONCLUSION

High methadone dosage may be a marker of coexisting psychiatric disorders in patients on methadone maintenance treatment which indicates the necessity of devoting further attention to this group. Psychiatric services should be open and accessible to the patients, especially those who seek treatment voluntarily. Early diagnosis and treatment of patients with coexisting psychiatric disorders may increase the efficacy of methadone maintenance treatment.

Evidence of abnormalities in mid-latency auditory evoked responses (MLAER) in cognitive subtypes of patients with schizophrenia

Abnormalities in measures of mid-latency auditory evoked responses (MLAER) have frequently been reported in schizophrenia, while few studies have examined whether these measures could distinguish cognitive subtypes of schizophrenia. The aim of this study was to investigate whether patterns of performance on MLAER measures could differentiate a cognitive subtype of patients characterized by pervasive cognitive deficits (CD) from patients with only mild cognitive deficits (CS) and controls. An auditory paired-click conditioning test was administered to 55 schizophrenia patients (26 CD, 29 CS) and 49 healthy controls. Amplitudes, latencies and sensory gating indices of the P50, N100, and P200 MLAER were analysed. The results showed that CD patients exhibited smaller S1 amplitudes of N100 and P200 than controls, while CS patients were comparable to controls. Binary logistic regression identified the P200 S1 amplitude as a significant predictor of patients' membership in the CD subtype. However, none of the other MLAER measures could differentiate the two subtypes of schizophrenia. These findings suggest that the abnormal pathophysiologic mechanisms underlying the electrophysiological brain responses to auditory stimulation are associated with the pervasive cognitive deficits, which characterize the CD subtype of schizophrenia. This finding might provide additional electrophysiological endophenotypes for future genetic research of schizophrenia.

Estimating the relapse risk of Plasmodium vivax in Iran under national chemotherapy scheme using a novel method

OBJECTIVES

This study aimed to estimate the relapse risk of Plasmodium vivax under national chemotherapy scheme using a novel method, and assessed its pattern in Kahnooj, a malaria endemic area in Iran.

METHODS

The authors traced repeated episodes of malaria attack between 1994 and 2001 and then, estimated the risks of secondary attack of P. vivax, classified by the species in their primary attack. It is suggested that the difference between the secondary attack rate in those who were infected by P falciparum and P. vivax in their primary attack may estimate the P. vivax relapse rate indirectly.

RESULTS

This method showed that the relapse risk of P. vivax with in one and two years after the primary attack were 16.8 and 24.5% respectively. The risks of relapse before three or after 18 months were very low.

INTERPRETATION & CONCLUSION

The relapse pattern of P. vivax was compatible with the dominant pattern in most of the temperate areas. In addition, the relapse risk was very close to the estimated relapse risks in clinical trials on anti-relapse drugs. Therefore, we concluded that the anti-relapse therapy in the study area was effective; also, this method may estimate the relapse risk of P. vivax accurately.

Comparing the results of light microscopy with the results of PCR method in the diagnosis of Plasmodium vivax

BACKGROUND AND OBJECTIVES

Although polymerase chain reaction (PCR) is a new technique in the diagnosis of malaria with very high accuracy; light microscopy is still conventional diagnostic method in Iran. In this study we checked the accuracy of light microscopy using the results of PCR as gold standard in Iran.

METHODS

The blood samples were collected from 124 febrile cases in Kahnooj district. The blood slides were read by microscopists, and double checked by experts in provincial referral laboratory. DNA samples were processed by PCR to amplify species-specific sequences of 18s subunit ribosomal ribonucleic acid (18ssrRNA) genes of Plasmodium vivax and P. falciparum.

RESULTS

The sensitivity and specificity of microscopy in the detection of Plasmodium spp infection were 77% (95% CI: 46-94%) and 100% (95% CI: 95-100%), correspondingly. Also, the estimated positive and negative predictive values were 100% (95% CI: 66-100%) and 97% (95% CI: 91-99%), respectively.

INTERPRETATION AND CONCLUSION

According to these results, we believe that the accuracy of light microscopy in the diagnosis of malaria in Kahnooj was acceptable. Expert micorscopists in endemic areas of Iran such as Kahnooj and available equipments in one hand and expensive PCR test on the other hand may convince that in current situation we do not have to change the diagnostic method.