Classification of drug-naive children with attention-deficit/hyperactivity disorder from typical development controls using resting-state fMRI and graph theoretical approach.

Background and objectives: The study of brain functional connectivity alterations in children with Attention-Deficit/Hyperactivity Disorder (ADHD) has been the subject of considerable investigation, but the biological mechanisms underlying these changes remain poorly understood. Here, we aim to investigate the brain alterations in patients with ADHD and Typical Development (TD) children and accurately classify ADHD children from TD controls using the graph-theoretical measures obtained from resting-state fMRI (rs-fMRI). Materials and methods: We investigated the performances of rs-fMRI data for classifying drug-naive children with ADHD from TD controls. Fifty six drug-naive ADHD children (average age 11.86 ± 2.21 years; 49 male) and 56 age matched TD controls (average age 11.51 ± 1.77 years, 44 male) were included in this study. The graph measures extracted from rs-fMRI functional connectivity were used as features. Extracted network-based features were fed to the RFE feature selection algorithm to select the most discriminating subset of features. We trained and tested Support Vector Machine (SVM), Random Forest (RF), and Gradient Boosting (GB) using Peking center data from ADHD-200 database to classify ADHD and TD children using discriminative features. In addition to the machine learning approach, the statistical analysis was conducted on graph measures to discover the differences in the brain network of patients with ADHD. Results: An accuracy of 78.2% was achieved for classifying drug-naive children with ADHD from TD controls employing the optimal features and the GB classifier. We also performed a hub node analysis and found that the number of hubs in TD controls and ADHD children were 8 and 5, respectively, indicating that children with ADHD have disturbance of critical communication regions in their brain network. The findings of this study provide insight into the neurophysiological mechanisms underlying ADHD. Conclusion: Pattern recognition and graph measures of the brain networks, based on the rs-fMRI data, can efficiently assist in the classification of ADHD children from TD controls.

Can levetiracetam improve clinical symptoms in schizophrenic patients? A randomized placebo-controlled clinical trial.

INTRODUCTION: Schizophrenia is associated with persistent cognitive deficits, which worsen treatment outcomes despite increasing antipsychotic doses. This study aimed to assess the effect of levetiracetam on the severity of schizophrenia symptoms and cognitive deficits in these patients. MATERIALS AND METHODS: In this randomized, controlled, three-blind randomized clinical trial approved by Mashhad University of Medical Sciences, Iran (IRCT20101130005280N31), forty chronic schizophrenic patients aged 18-60 years were randomly divided into two groups of levetiracetam and placebo. The levetiracetam group received levetiracetam for 8 weeks. The symptoms were evaluated by Positive and Negative Symptoms Scale (PANSS), Stroop test, Digit Span test and Wisconsin Test at baseline, 4th week, and 8th week. Data were analyzed through SPSS V. 23 software, descriptive tests and inferential statistics. RESULTS: At the end of the study, all subscales of the PANSS questionnaire reduced significantly (P < 0.05). Also, all subscales of the cognitive tests had significant changes. The trends of digit span tests, correct number of consonants and inconsonant were increasing. While the trends related to consonant errors, inconsistent errors, consistent reaction time and nonconsistent reaction time were decreasing. The changes in the number of classes were increased while changes in preservation error were decreased. CONCLUSION: The results showed that levetiracetam has significant effects on clinical symptoms, especially negative symptoms. Also, it impacts significantly on cognitive functions. It is recommended that it be added to the pharmacological regimen of these patients to improve their clinical symptoms, quality of life and treatment outcomes.

Assessment of the efficacy of omega-3 fatty acids on metabolic and inflammatory parameters in patients with schizophrenia taking clozapine and sodium valproate.

Omega-3 fatty acid (FA) supplementation has been reported to improve several cardio-metabolic risk factors. We aimed to assess the efficacy of omega-3 fatty acids on metabolic and inflammatory indices in patients with schizophrenia who were taking clozapine and sodium valproate. All patients were on a stable dose of 300-400mg of clozapine for 3 months. Subjects were randomized to treatment with either omega-3 fatty acid (4gr/day) or a placebo for 8 weeks. Height, weight, abdominal circumference, serum lipid profile, fasting blood glucose (FBG), and serum high sensitivity-C-reactive protein (hs-CRP) were determined at baseline and after 8 weeks of treatment. Fifty six subjects were recruited into the study. Patients with schizophrenia who were in the group receiving omega-3 FA capsules had an improvement in some anthropometric indices including weight, BMI, wrist and waist circumference, compared to the placebo group. Only changes in waist circumferences remained significantly different after adjustment for serum fasted TG. Our results showed omega-3 FA supplementation can improve some anthropometric indices in patients with schizophrenia who are taking clozapine pharmacotherapy.

Psychological status in children with ear and nose foreign body insertion.

OBJECTIVE: Children with psychological disorders are prone to various unintentional injuries, one of the most common of which is foreign body inserting. In spite of the high incidence, the association is not studied yet. METHODS: This is a case control study in otorhinolaryngology and psychology departments, at a tertiary referral teaching hospital. One hundred five children (2-12 years old) who were referred for removal of foreign bodies in their ear or nose over a period of one year were selected for the study. Also, 155 children were selected and matched from the same community as the controls. Parents were given the standard strengths and difficulty questionnaire (SDQ) for psychological evaluation of their child. The total score and also the subscales for emotional symptoms, hyperactivity disorders, conduct problems, peer-relationship problemsand prosocialbehaviors were recorded and statistical analysis was performed. RESULTS: In the case group, 34 cases (%32.4) were suffering from foreign bodies in their ear, 70 cases (%66.7) in their nose, and just one case (%1) in both. Age and sex distributionin the two groups were comparable. There were significant differences of SDQ scores between the two groups in total score (p < 0.001), emotional symptoms (p < 0.001), hyperactivity disorders (p < 0.001), conduct problems (p < 0.001), and prosocial behaviors (p < 0.001). However peer-relationship problems showed no significant difference between the two groups (p = 0.161). CONCLUSION: Psychological problems are more common in children with foreign bodies than the controls. Thus physicians are recommended to consider referring these patients to the pediatric psychologist.

Psychiatric Disorders in Iranian Children and Adolescents.

OBJECTIVE: The aim of the present study was to investigate the epidemiology of psychiatric disorders in children and adolescents in five provinces of Iran: Tehran, Shiraz, Isfahan, Tabriz and Mashhad. METHOD: In the present study, we selected 9,636 children and adolescents aged 6-18 years through multistage cluster random sampling method from Tehran, Shiraz, Isfahan, Tabriz and Mashhad. We instructed the clinical psychologists to complete the Strengths and Difficulties Questionnaire (SDQ) for the participants, andthose who received a high score on SDQ, completed the Persian version of Kiddie-SADS-Present and Lifetime Version (K-SADS-PL). We used descriptive analysis and 95% confidence interval to investigate the relationship between scores of the K-SADS questionnaire and demographic factors. We used one-way ANOVA to test the significant differences among the disorders according to sex, age and province of residence. RESULTS: Based on the results, oppositional defiant disorder (ODD) (4.45%) had the highest prevalence of psychiatric disorders in the five provinces and substance abuse and alcohol abuse (0%) had the lowest prevalence. In addition, attention deficit hyperactivity disorder (ADHD) had the most prevalence in boys (5.03%) and ODD had the most prevalence in girls (4.05%). Among the three age groups, 6 to 9 year olds had the highest rates of ADHD (5.69%); 10 to 14 and 15 to 18 year olds had the highest rates of ODD (4.32% and 4.37% respectively). Among the five provinces, Tehran and Mashhad allocated the highest rates of ODD; Isfahan and Shiraz had the highest rates of ADHD; and Tabriz had the highest rates of social phobia. CONCLUSION: The current study revealed that the overall frequency of psychiatric disorders based on Kiddie-SADS-Present and Lifetime Version (K-SADS-PL) was higher than a similar study. Moreover, in this study, among the five provinces, Tehran and Mashhad allocated the highest rates of ODD; Isfahan and Shiraz had the highest rates of ADHD; and Tabriz had the highest rates of social phobia. Therefore, these percentage of psychiatric disorders in Iran lead us toward a greater use of consultation and mental health services.

Psychological Aspects in Children and Adolescents With Major Thalassemia: A Case-Control Study.

BACKGROUND: Thalassemia is an inherited blood disease. It is a serious public health problem throughout the Mediterranean region, the Middle East and the Indian subcontinent, as well as in Southeast Asia. OBJECTIVES: Thalassemia is an inherited blood disease. It is a serious public health problem. In this study we assessed psychological aspects in Iranian children and adolescents with thalassemia major. PATIENTS AND METHODS: In this case-control study sixty healthy subjects aged 7-18 years and Sixty Patients with confirmed diagnosis of major thalassemia were enrolled. After obtaining informed consent from parents of all participating thalassemia patients and healthycontrols, we assessed psychological aspects and quality of life by Pediatric Quality of LifeTM (PedsQL™), Strengths and Difficulties Questionnaires (SDQ), State and Trait Anxiety, Children's Depression Inventory (CDI). RESULTS: The results of this study indicate that there are significant changes in depression, anxiety, QOL and behavioral screening between children with thalassemia major compared with healthy subjects by means of both parents and children reports. According to the results, children with thalassemia major have more psychological problems than healthy ones. Patients with thalassemia have a lower QOL than their peers (P = 0.001), the rate of depression is higher in this group (P = 0.015), Also behavioral problems in these children are more than healthy subjects (P = 0.009). CONCLUSIONS: We recommend appropriate treatment and counseling procedures in addition to specific treatment of thalassemia. According to the results we suggest to establish pediatric psychiatric clinics beside thalassemic clinics to cure psychological aspects of the disease.

Double-blind, randomized, clinical trial of metformin as add-on treatment with clozapine in treatment of schizophrenia disorder.

BACKGROUND: One of the major causes of death in schizophrenia is a metabolic syndrome. The clozapine has the highest rate of weight gain among antipsychotics. It has been shown that metformin can promote weight loss. We aimed to investigate the effect of metformin as an adjunctive therapy with clozapine to prevent metabolic syndrome in patients with schizophrenia. MATERIALS AND METHODS: A total of 37 patients consisting metformin group (19 cases) and a group of placebo consisting of 18 cases were evaluated. A brief psychiatric rating scale score (BPRS) and metabolic profiles was determined for all patients. All of the variables were also determined at 2, 8, 16, and 20 weeks after the onset of the study. RESULTS: The mean age of the group of metformin was 47.2 ± 10.4 compared with 45.8 ± 10.2 for the group of placebo. The difference in mean waist circumference and serum level of triglyceride at baseline compared with the end of study showed a statistically significant difference between two groups (P = 0. 000). A statistically significant difference was also observed in a comparison of mean difference of weight and body mass index at baseline compared with end of study (P = 0. 000). There was a statistically significant difference of fasting blood sugar (P = 0.011) and serum high-density lipoprotein (P = 0.000) between two groups but this difference was not significant for mean BPRS scores, mean systolic and diastolic blood pressure, serum level of triiodothyronine, thyroxin and thyroid stimulating hormone, serum low-density lipoprotein and serum cholesterol. CONCLUSION: Metformin could be considered an adjunctive therapy with clozapine to prevent metabolic syndrome in schizophrenic patients.

Comparison the effectiveness of aripiprazole and risperidone for the treatment of acute bipolar mania.

BACKGROUND: Second-generation antipsychotics, approved for the treatment of mania, are associated with adverse effects such as weight gain and metabolic disorders. Aripiprazole, a recently introduced second-generation antipsychotic, are thought to account for its low propensity for weight gain, metabolic disturbances and sedation. The purpose of this study was to investigate the effect of risperidone versus aripiprazole in the treatment of acute mania. MATERIALS AND METHODS: Fifty patients with acute episodes of mania were enrolled in this study, and they were randomly assigned into a risperidone group of 24 cases and an aripiprazole group of 26 cases. In group A, aripiprazole with a dose of 5-30 mg/day and in group B, risperidone with a dose of 2-8 mg/day was given to patients. The average dose of aripiprazole was 27 mg/day, and the average dose of risperidone was 6 mg/day. The effects of each drug for the treatment of acute mania were assessed on the 1(st) day of admission and on days 2, 4, 6, 8 and at weeks 2, 4 and 6 after therapy using the young mania rating scale (YMRS) and at the baseline and on weeks 3 and 6 after admission using the clinical global impression (CGI) scale. RESULTS: The mean age of the group of risperidone was 34 ± 8.6 years and in a group of aripiprazole it was 34 ± 9.1 years (P = 0.83). Comparison of YMRS scores over the period of 6 weeks revealed a statistically significant difference in both groups (P < 0.0001). There was also a statistically significant difference in YMRS scores between risperidone and aripiprazole at day 8 (P = 0.026) and weeks 2 (P = 0.035) and 4 (P = 0.042). There was also a statistically significant difference in CGI-Severity scale score at weeks 3 (P = 0.003) and 6 (P = 0.000) and in CGI-Improvement scale score at weeks 3 (P = 0.005) and 6 (P = 0.002). The most common side-effect observed in both groups was headache (0%15/4 in aripiprazole vs. %16/7 in risperidone). CONCLUSION: Aripiprazole that is readily available in our market, could be considered more effective than risperidone in the treatment of acute mania.

Psychological problems of Iranian children and adolescents: parent report form of Strengths and Difficulties Questionnaire.

OBJECTIVE: The aim of this study was to evaluate the degree of psychological problems Iranian children and adolescents have, using parent report form of the Strengths and Difficulties Questionnaire (SDQ). METHODS: In a community-based study, 9636 children and adolescents aged 6-17 years were selected using the multistage cluster random sampling method from five provinces of Iran: Tehran, Isfahan, Fars, Razavi Khorasan and East Azerbaijan. The parents completed the SDQ, which consisted of five subscales including emotional problems, conduct problems, hyperactivity, peer problems and prosocial behaviors. RESULT: The results revealed 21.4% of emotional problems, 32.9% of conduct problems, 20% of hyperactivity, 25.6% of peer problems, 7.6% of problems in prosocial behaviors and 16.7% of total difficulties among Iranian children and adolescents. We found that emotional problems were more prevalent among girls, while conduct problems, hyperactivity, total difficulties and problems in prosocial behaviors were more prevalent among boys. High educational level of parents was a protective factor against some psychological problems. CONCLUSION: Considering the proportion of psychological problems in Iranian children and adolescents, we need to develop and implement special policies and programs to provide appropriate mental health services.

Baclofen add-on to citalopram in treatment of posttraumatic stress disorder.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a chronic disabling illness, resulting from exposure to extreme traumatic event. Although different pharmacologic agents are suggested for treatment of PTSD, none have been completely effective in eliminating symptoms. The purpose of this study was to assess the use of baclofen as an add-on to citalopram in treatment of PTSD. METHODS: In this double-blind clinical trial, 40 Iranian combat veterans with PTSD were randomly assigned to 2 groups. The first group received a combination treatment of 20 to 60 mg/d citalopram and 40 mg/d baclofen, and the second group received 20 to 60 mg/d citalopram plus placebo. Symptom severity was assessed by Clinician-Administered PTSD Scale at the beginning of the study and after 2, 4, 6, and 8 weeks. Global Assessment of Functioning and Hamilton Rating Scale for Anxiety and Depression were also used at the same periods. Data were analyzed with independent t test and paired t test using SPSS software version 13 (IBM, Armonk, NY). RESULTS: Twenty-three male patients (baclofen group, 13 patients; placebo group, 10 patients) completed the study. Dropout from the treatment was not caused by adverse effects of the new medications in any of the subjects. Baclofen group showed significantly larger improvement in Clinician-Administered PTSD Scale total (P = 0.040), hyperarousal (P = 0.020), and avoidance (0.020) scores, Global Assessment of Functioning score (0.001), depression (P = 0.000), and anxiety (P = 0.000) after 8 weeks of treatment. No intergroup difference was found in improvement of reexperience symptoms (P = 0.740). CONCLUSIONS: Baclofen showed to be an effective add-on to selective serotonin reuptake inhibitors in treatment of PTSD for better symptom recovery and functional improvement.

Qulaity of life in cystic fibrosis children.

OBJECTIVE: Cystic fibrosis (CF) is a chronic, multisystem genetic disease with a wide variability in clinical severity. The measurement of quality of life in CF provides additional information about the impact of this disease. This article tries to assess quality of life (QoL) in children and adolescents with CF and to compare it with control group. METHODS: Patients 2-18 years old with admission diagnosis of cystic fibrosis entered the study. QoL was observed in CF patients and compared with control group. FINDINGS: Based on children's reports, significant differences between the CF patients and control group were noted for emotional, physical, social, school performance, and total scores (P<0.05). Based on parents' reports, quality of life score in CF patients from the physical point of view as well as social and total scores were decreased (P<0.05). CONCLUSION: QoL in CF patients seems to be low, and therapy programs should take into account the suggestive perceived quality of life.

Psychological problems in Iranian adolescents: application of the self report form of strengths and difficulties questionnaire.

OBJECTIVE: The aim of the present study was to investigate the epidemiology of psychological problems in adolescents in five provinces of Tehran, Khorasan Razavi, Isfahan, East Azerbaijan and Fars in Iran. METHODS: In the present cross-sectional and descriptive - analytical study, 5171 adolescents aged 12 to 17 years were selected through multistage cluster sampling method from Tehran, Isfahan, Fars, Khorasan Razavi and East Azarbaijan provinces. The self-report form of Strengths and Difficulties Questionnaire (SDQ) was used to obtain the demographic data of each adolescent. Descriptive analysis and 95% confidence interval were used to investigate the relationship between scores of the SDQ questionnaire and demographic factors. RESULT: Based on the results, the highest prevalence of psychological problems in the five provinces was related to conduct problems (24%), and the lowest prevalence was related to social problems (5.76%). Also, comparison of 95% confidence interval of prevalence of psychological problems between the two genders suggested a significant difference only in emotional problems of the self-report version of the SDQ between the two genders. The result revealed no significant difference in the psychological problems of the self-report version of the SDQ between the two age's groups and between the middle and high school graduates (p≤0.05). Among the 5 provinces, Fars allocated the highest rates of conduct problems (28.4), hyperactivity problems (21.5%) and overall criterion problems (17.3%); Esfahan had the highest rates of emotional problems (9.1%) and problems with peers (8.1%); and Khorasan Razavi had the highest rates of social problems (7.6%). CONCLUSION: In this study, the highest prevalence of psychological problems in the five provinces was related to conduct problems, and the lowest prevalence was related to social problems. It was determined that girls have more emotional problems than boys. Also, no significant difference was found in the psychological problems of 12 to 14 and 15 to 17 year old adolescents or between middle and high school graduates. In the current study, the prevalence of psychological problems in adolescents in the urban population in Fars province was higher than expected.

Does omega-3 supplement enhance the therapeutic results of methylphenidate in attention deficit hyperactivity disorder patients?

BACKGROUND: Although most of the ADHD (Attention Deficit Hyperactivity Disorder) patients respond to stimulant drugs very well, alternative drugs are required for non respondents. It has been revealed that subgroups of patients with ADHD have omega-3 fatty acid deficiency. So, the present study was planned to illustrate the effect of omega-3 supplementation, as an add-on to methylphenidate, on ADHD patients. MATERIALS AND METHODS: In this double-blind RCT, ADHD children without any co morbidity, who had been diagnosed by a child and adolescent psychiatrist in child and adolescent university clinic, participated and were randomly divided into 2 groups. The experimental group methylphenidate plus omega-3 capsule (2000mg/d), while control group took methylphenidate plus placebo. Severity of ADHD symptoms were assessed by ADHD rating scale at the baseline and after 2, 4 and 8 weeks of treatment. RESULTS: 69 patients (experimental = 36, control = 33) aged 7 to 15 participated. A significant reduction of both parent's and teacher's ADHD rating scale scores in both groups was observed. Bu t it couldn't show any difference between two groups. Difference score of parent's at baseline was 1.86+- (5/40), Pv 0.262, after 2 weeks -.70+- (4/30), Pv 0.668,4 weeks. 19+- (5/60), Pv 0.902 and 8 weeks. 30+- (4/42), Pv 0.845. Difference score of Teacher's at baseline was -1.56+- (3/45), Pv 0.541, after 2 weeks -.46+- (6/24), Pv 0.888, 4 weeks. 45+- (5/41), 0.868 and 8 weeks. 73+- (4/18), Pv 0.748. CONCLUSION: Omega-3 did not enhance the therapeutic results of methylphenidate in ADHD patients.

Effects of probiotics on quality of life in children with cystic fibrosis; a randomized controlled trial.

OBJECTIVE: Patients with cystic fibrosis (CF) usually have abnormal intestinal microbiota and dysregulated immune mediators due to massive exposure to antibiotics. Probiotics as immunomodulatory and anti-inflammatory substances are considered to improve both clinical and biochemical intestinal and pulmonary function in CF patients. We decided to investigate the effects of probiotics on quality of life and pulmonary exacerbations in children with cystic fibrosis. METHODS: In a prospective, randomized, controlled clinical trial, 37 CF patients (2-12 years old) were randomly divided into two groups. 20 patients of probiotic group took probiotics (2×10(9)CFU/d) for one month while 17 patients of control group took placebo capsules. Quality of life was determined using PedsQL™4.0 questionnaire at the beginning, then three and six months after completing the treatment period. Rate of pulmonary exacerbation in probiotic group patients was also evaluated during three months after intervention and compared to the same three months of the previous year. Results were analyzed using SPSS (11.5). P<0.05 was considered statistically significant. FINDINGS: Significant improvement was observed in the mean total score of parent reported quality of life among probiotic group patients in comparison with placebo group at 3(rd) month (P=0.01), but this was not significant at 6(th) month of probiotic treatment. Rate of pulmonary exacerbation was significantly reduced among probiotic group (P<0.01). CONCLUSION: Probiotics are considered as useful nutritional supplements on reducing number of pulmonary exacerbations and improving quality of life in patients with cystic fibrosis. Effects of probiotics seem to be temporary and probably continuous ingestion might have more stable improving effects on quality of life.

Frequency of obsessive-compulsive disorder in patients with multiple sclerosis: A cross-sectional study.

BACKGROUND: Obsessive compulsive disorder has been reported in patients with multiple sclerosis (MS). Obsessive compulsive disorder (OCD) is a kind of anxiety disorder characterized by a combination of repetitive thoughts and repetitive behaviors for reducing anxiety. We aimed to investigate the frequency of OCD in patients with MS. MATERIALS AND METHODS: 112 patients with multiple sclerosis participated in this study. Demographic data were obtained through using patients' medical records. MS clinical subtypes, the duration of disease and neurological signs were determined. The Kurtzke Expanded Disability Status Scale (EDSS) was used to quantify disability in MS, which was confirmed by psychiatrist through using DSM-IV criteria for OCD. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to rate the severity of OCD. Data analysis was performed by SPSS for Windows software (version 15.0) and Chi-square test and Exact test were used for analyzing data. RESULTS: The frequency of OCD in patients with MS was 16.1%. The OCD was significantly correlated with a higher EDSS score (X(2) = 86.515, P = 0.0001). OCD was also significantly correlated with the duration of disease, phenotypic subgroup, cranial nerve involvement, cerebellar, autonomic, sensory and motor nerve involvement. CONCLUSIONS: OCD might be considered in quantifying disability of patients with MS. It might be suggested that all the patients with MS to be screened for OCD.

Effect of topiramate augmentation in chronic schizophrenia: a placebo-controlled trial.

BACKGROUND: The limitations of antipsychotics for treatment of schizophrenia have led to investigation of the usefulness of pharmacological augmentation strategies. Clinical studies have provided evidence for glutamate abnormalities in schizophrenia. Topiramate is an anticonvulsant drug with alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor antagonist properties; therefore, the objective of the present study was to explore the therapeutic efficacy of topiramate as an adjunctive medication in schizophrenia. METHODS: A 17 week, double-blind, placebo-controlled clinical trial was performed on 80 patients (25 - 65 years) from 2005 - 2007. All were hospitalized in Mashhad psychiatric hospitals with chronic DSM-IV-TR-diagnosed schizophrenia. All participants received up to 300 mg/day of clozapine. In addition, participants randomly received either topiramate (200 - 300 mg/day) or placebo gradually added to their ongoing treatment. Efficacy of medication was measured by administering Positive and Negative Syndrome Scale at baseline and weeks 4, 8, 12, and 17. RESULTS: During the study, 5 patients from the placebo group and 12 participants from topiramate group were excluded. Clozapine and topiramate group showed significant decreases in all three subscales of PANSS values from baseline, with the maximum efficacy in week 12. However, after tapering topiramate, the general psychopathology sign was the only subscale that showed a significant difference. The clozapine and placebo group showed a significant decrease in all three subscales of PANSS values compared to baseline. The significant efficacy for all subscales was obtained at the end point. No significant differences in PANSS scores from baseline to end point were noted between case and control groups. CONCLUSION: Augmentation of clozapine and topiramate did not significantly decline patterns in any of the three subscales of PANSS compared to the clozapine and placebo group. Irct ID: IRCT138904014236N1

Reboxetine versus methylphenidate in treatment of children and adolescents with attention deficit-hyperactivity disorder.

BACKGROUND AND PURPOSE: Attention deficit-hyperactivity disorder (ADHD) is a common psychiatric diagnosis among children and adolescents. This study has been conducted to evaluate the efficacy and tolerability of reboxetine in comparison with methylphenidate in treatment of children and adolescents with ADHD. METHODS: Thirty three children, 7-16 years of age, diagnosed with ADHD, participated in a 6-week, double-blind clinical trial with reboxetine (4-6 mg/d) and methylphenidate (20-50 mg/d) in two divided doses. The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist at baseline, 14, 28, and 42 days after the start of medication. RESULTS: No significant differences were observed between the two protocols on the Parent (P = 0.26) and Teacher (P = 0.97) ADHD Rating Scale scores and in treatment dropouts. A significant improvement in ADHD symptoms was observed over the 6 weeks of treatment for Parent ADHD Rating Scale (P < 0.001) and Teacher ADHD Rating Scale score in both groups (P < 0.001). The most common adverse effects reported with reboxetine were drowsiness and anorexia with mild to moderate severity. CONCLUSIONS: The study revealed that reboxetine may be beneficial in treatment of ADHD. Further studies are required to clarify the potential therapeutic effects on comorbid depression and anxiety and adverse effect profile.

The prevalence of attention deficit hyperactivity disorder in preschool-age children in Mashhad, north-East of Iran.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood-onset psychiatric disorders. Although the onset of ADHD is frequently prior to the age of seven years, there is a paucity of data on the prevalence of the disorder in preschool-age children. This study was performed to determine the prevalence rate of ADHD in preschool-age children in kindergartens of Mashhad, North-East of Iran. METHODS: One thousand eighty-three (553 males and 530 females) children aged between five and six years, were selected at random from 155 kindergartens in ten districts of Mashhad. The ten-item Conner's Index questionnaire was completed for each child by teachers and parents. Parents of children whose scores were positive for ADHD (>15) were interviewed by a psychiatrist and the ADHD was diagnosed based on DSM-IV diagnostic criteria and the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version. RESULTS: One hundred thirty-three (12.3%; CI 95%: 10.3 -14.2%) children were diagnosed to have ADHD. CONCLUSION: The prevalence of ADHD in preschool-age children in North-East of Iran is consistent with previous studies in other countries. This study recommends the need for diagnosis and treatment of ADHD in preschool-age children.