An Adolescent Presenting With Mania and Catatonia Associated With Coronavirus Disease-2019 Encephalitis.

There is growing evidence that coronavirus disease-2019 (COVID-19) infection may have various neuropsychiatric manifestations and long-term outcomes. In this article, the authors report a rare case of a 16-year-old male with no previous history of psychiatric illness who presented with an acute manic episode, including laughing for no evident reason, talking to himself, isolation, irritability, sleeplessness, decreased appetite, prolonged staring episodes, having delusions about being harmed or controlled, and aggression. Despite initiating outpatient treatment with a mood stabilizer and antipsychotic for presumed bipolar disorder with psychotic features, his symptoms worsened, and he became catatonic with a decreased level of consciousness, leading to his hospitalization on day 10. Although he had not shown typical evidence of infection with COVID-19 in the days leading up to or during his hospitalization and his initial COVID-19 test was negative, his COVID-19 test was positive on day 14, and his chest X-ray showed infiltrations. His acute manic symptoms and catatonia were identified to be associated with COVID-19 encephalitis after excluding other causes. He responded well to treatment with lorazepam for catatonia and a course of intravenous immunoglobulin, methylprednisolone, and remdesivir for COVID-19 encephalitis. This case demonstrates the workup and treatment of a rare neuropsychiatric manifestation of COVID-19 encephalitis in an adolescent, which started with no past psychiatric history and no typical symptoms of COVID-19 infection.

The Effect of Adding Sour Cherry Concentrate to The Usual Treatment of Attention Deficit Hyperactivity Disorder In 6 To 12 Years Old Children.

INTRODUCTION: This study aimed to evaluate the efficacy of sour cherry concentrate in symptoms of Attention Deficit Hyperactivity Disorder (ADHD). METHODS: In a randomized clinical trial, 70 children with ADHD referred to the psychiatric clinic of Ibn-e-Sina Hospital, Mashhad, Iran, in 2021 were selected. Patients were randomly divided into two groups. The intervention group received 75 ml of sour cherry concentrate twice daily in addition to the routine treatment for 2 weeks. The patients were evaluated using The Conner's Parent Rating Scale (CPRS) before and after the study by a psychiatry resident. RESULTS: Based on the findings, no significant differences were observed between the groups in change percent of Cognitive impairments (p = .317), Hyperactivity/impulsivity (p = .525), Oppositional (p = .986), and ADHD index (p = .451). Moreover, 28.6% and 31.4% of children with ADHD consuming the concentrate presented abdominal pain, and asthenia, respectively. CONCLUSION: The present study did not indicate a beneficial effect of sour cherry concentrate on symptoms of ADHD.

A survey of Psychiatric Disorders and Their Comorbidities in Children and Adolescents.

BACKGROUND: This community-based study aimed to investigate the psychiatric disorders and their comorbidities according to the kind of psychiatric disorders. Frequency of demographic factors and the prevalence of total psychiatric disorders in term of demographic charactheristics were obtained too. MATERIALS AND METHODS: The present study focused on 1028 children and adolescent aged 6 to 18 years old across the Razavi Khorasan province by random sampling. The subjects included 496 boys and 532 girls from three age groups (6-9 years, 10-14 years and 15-18 years). Eight clinical psychologists trained to complete the Persian version of K-SADS-PL (Kiddie-SADS present and life time version). This scale measures five diagnostic appendixes of psychiatric disorders. Demographic data of participants were collected too. The data were recorded into the SPSS version 16. The relationship between psychiatric disorders and demographic factors deliberate by descriptive analysis and 95% confidence interval. RESULTS: The total rate of psychiatric disorders among children and adolescent was estimated as 20.5%, elimination disorders with a rate of 12.9% was the most prevalent disorder in the subjects. The lowest prevalence belongs to psychotic disorder and bulimia nervosa (0.1%). Of participants with mood disorders about 71.4% have behavioral disorders too. Anxiety disorders also commonly occurred in person with mood disorders. The comparison of ORs and their 95% confidence interval revealed that there is a significant difference for total psychiatric disorder among boys and girls (OR=0.6 for girls; 95% CI: 0.44-0.82). The rate of total psychiatric disorders in rural and urban areas was 14.9% and 21.1% respectively. CONCLUSION: With attention to the high prevalence of psychiatric disorders among children and adolescents, it's necessary that healthcare officials pay more attention to reinforcement of mental health care.

Preventive effect of cyproheptadine on sleep and appetite disorders induced by methylphenidate: an exploratory randomised, double-blinded, placebo-controlled clinical trial.

OBJECTIVES: Insomnia and loss of appetite are the most common side effects of methylphenidate in patients with attention deficit/hyperactivity disorder (ADHD). The adverse effects may limit optimal dosing and patients' compliance with treatment leading to the discontinuation of treatment. This research evaluates the preventive effects of cyproheptadine on sleeping and appetite disorders induced by methylphenidate in ADHD children. METHODS: During this exploratory, randomised, double-blinded, placebo-controlled clinical trial, forty patients with ADHD diagnosis who had received methylphenidate randomly were assigned to participate in the cyproheptadine or the placebo group. Patients' weight and Pittsburgh Sleep Quality Index (PSQI) score were recorded at baseline, after four, six and eight weeks of treatment. The ADHD Parent Rating Scale-V score was also defined at the beginning and the end of study for each patient. RESULTS: There was no significant difference between the cyproheptadine and the placebo groups regarding their weight, rate of growth and PSQI score in the monthly assessment. In addition, there was no significant difference in response to the therapy between the two groups. CONCLUSIONS: Based on our findings, cyproheptadine does not have any considerable preventive effect on sleeping and appetite disorders induced by methylphenidate in ADHD children.

Adherence to a Dash-style diet in relation to depression and aggression in adolescent girls.

The aim of this study was to assess adherence to the Dietary Approach to Stop Hypertension (DASH) dietary pattern in relation to depression and aggression in adolescent girls. The study was carried out among 580 girls aged between 12 and 18 years of age. DASH scores were determined according to the method of Fung et al. A Persian version of the Beck Depression Inventory and Buss-Perry questionnaire were used for the assessment of depression and aggression. We analysed our data using crude and adjusted models. Adjustments were made for age, energy intake, mother's job status, passive smoking, start of menstruation, parental death, parental divorce, physical activity level and body mass index, using three different models. A high adherence to a Dash-style diet (for individuals in the upper quartile) was associated with a lower odds of depression compared with subjects with lower adherence (those in the lowest quartile) (OR 0.47; 95% CI 0.26-0.84, P-value = 0.009); these associations remained significant after adjustments. However, we did not obtain any significant relationship between a DASH-style diet and aggression. We observed a significant inverse relationship between greater adherence to a DASH diet and lower odds of depression. Further prospective studies are needed to confirm these findings.

Evaluation of the Effectiveness of the Friends for Life Program on Children's Anxiety and Depression.

Objective: Anxiety disorders and depression during childhood and adolescence are among highly prevalent serious mental health problems, which lead to reduced performance in children and can also negatively affect children's emotional and social long-term development. This study, which was conducted in Mashhad in 2015, aimed at evaluating the effectiveness of the Friends for Life cognitive-behavioral program in reducing the symptoms of anxiety and depression in children. Method: In this controlled clinical trial, 248 male students aged 10 were screened for mild to moderate symptoms of anxiety and depression using the Revised Children's Manifest Anxiety (RCMA) and the Children's Depression Inventory (CDI). Of the participants, 40 students met the inclusion criteria. The demographic questionnaire, the Strengths and Difficulties Questionnaire (SDQ), and the Depression-Anxiety-Stress Scale (DASS) were filled out by parents. The children in the experimental group received the Friends for Life cognitive-behavioral training program for eight 1-hour weekly sessions. RCMA, CDI, SDQ, and DASS were filled out again by both groups at the end of the sessions and 3 months later. To evaluate comparability between the 2 groups, Mann-Whitney test was used for qualitative variables and paired t test and repeated measure for quantitative variables with normal distribution. Statistical analysis was performed using SPSS-16. All statistical references were made at □=0.05. Results: Children's depression and manifest anxiety scores were not significantly different in the 2 groups before the intervention; however, their changes immediately after intervention and at the 3- month follow-up were significant (p<0.001). Moreover, hyperactivity (p = 0.039), peer problems (p = 0.011), and parental depression (p = 0.015) scores significantly changed in both groups over time. Conclusion: Implementation of Friends for Life program is effective in prevention and treatment of the symptoms of anxiety and depression in children.

Evaluation of anxiety and depression in mothers of children with asthma.

BACKGROUND: Asthma is the most common chronic disease in childhood. Parents have an important role in managing asthma in children. Studies have shown a higher degree of depression and anxiety and lower family performance in mothers of asthmatic children in comparison with the control group. OBJECTIVE: The aim of this study was to evaluate the parenting styles and also depression, anxiety and stress parameters in mothers of children with asthma. METHODS: This case-control study was performed on 45 mothers of 3 to 15 years old asthmatic children in the allergy clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during the years of 2014 to 2016. The control group was 45 mothers of non-asthmatic children who were matched for the age of their children with the case group in the same population. The parenting styles, as well as depression and anxiety of mothers were evaluated using parenting scales, and the depression-anxiety-stress scales (DASS). The mothers were also asked to fill a strengths and difficulties questionnaire (SDQ) for their children. Furthermore, parenting styles in the case group were compared to mothers of children without asthma as the control group. The data were then analyzed by SPSS 11.5, using Chi-square, ANOVA, and independent-samples t-test. RESULTS: The results of this study showed that 21 mothers (74.6%) were normal, but 12 mothers (26.7%) had a mild -, 9 (20%) a moderate - and 3 (6.7%) a severe degree of abnormality according to DASS. Independent-samples t-test showed a significant difference between the case and control groups regarding depression in mothers and laxness (p<0.001), over reactivity (p<0.013) and verbosity (p<0.031) in children with asthma. CONCLUSION: The results of this study demonstrated that anxiety and depression are partially frequent in mothers of children with asthma, and parenting styles are less affective in these families.

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.

Causes of Incivility in Iranian Nursing Students: A Qualitative Study.

BACKGROUND: Incivility among nursing students is a common academic problem. Knowing the causes of students' incivility will enable the faculty members and academic institutions to select correct strategies to deal with this problem. This study was conducted to explore the causes of incivility among nursing students from both educators' and students' points of view. METHODS: gThis qualitative content analysis study was applied in order to explore experiences and insights of 17 nursing lecturers and 9 nursing students who were selected through purposeful sampling and interviewed on the causes of incivility. Participants were selected among students and lecturers of nursing schools in Khorasan Razavi. The inclusion criteria for the students were having passed one educational term and for the lecturers having one year experience of teaching respectively. Data gathering was done using deep semi-structured interviews starting from March 2014 to March 2015. RESULTS: Three main categories extracted from the data were student related factors, teacher related factors, and organizational factors. Non-educational engagement, attracting attentions, lack of motivation, students' personality, and lack of experience were the subcategories of student related factors. Subcategories of teacher related factors included lack of skills, teachers' personal qualities, lack of experience, and incivility of teachers. Finally, the subcategories of organizational factors included no evaluation system for teachers and lack of understanding the organizational rules and regulations. CONCLUSION: The results of this study indicated that factors related to students, teachers, and organization may lead to nursing students' incivility and clarified its dimensions. In order to develop a civil environment in nursing college, managers and educators' awareness should be promoted via various ways such as workshops.

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.

Comparison of parental stress among mothers and fathers of children with autistic spectrum disorder in Iran.

BACKGROUND: Most of the studies about parenting stress among parents of children with autistic spectrum disorder (ASD) have been conducted in western societies. The objective of this research, conducted in Iran, is to evaluate the parenting stress among fathers and mothers of children with ASD and find the correlation between severity of the disorder in children and the level of parental stress. MATERIALS AND METHODS: Participants included 42 couples having children aged between 2 and 12 diagnosed with ASD based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The diagnosis was made by two child and adolescent psychiatrists. Demographic information of the participants was collected using a questionnaire. The severity of pervasive developmental disorder in children was determined based on Childhood Autism Rating Scale (CARS); stress of parents was measured using Parenting Stress Index (PSI). Collected information was analyzed by the SPSS (version 16) software. RESULTS: Evaluation of subscales in participants' data showed a positive correlation coefficient between the PSI-parent domain and Childhood Autism Rating Scale-Parent form CARS-P rating (r = 0.339, P =0 0.028) and also between the total stress index and CARS-P rating (r = 0.333, P = 0.031) for fathers. It is thus suggested that fathers of children with more severe developmental disorders experience more stress. The results showed significant differences between fathers and mothers in the three PSI subscales including PSI-child domain score (P < 0.005), PSI-parent domain score (P < 0.005), and the total stress index (P < 0.005). Mothers had significantly more stress than fathers. CONCLUSIONS: These findings show that parents with ASD children have many emotional needs which should be considered in planning the effective treatment strategies for their children.

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.

Barkley's Parent Training Program, Working Memory Training and their Combination for Children with ADHD: Attention Deficit Hyperactivity Disorder.

OBJECTIVE: The aim of the current study was to examine the effectiveness of Barkley's parent training program, working memory training and the combination of these two interventions for children with Attention deficit hyperactivity disorder (ADHD). METHODS: In this study, 36 participants with ADHD (aged 6 to 12 years) were selected by convenience sampling. Revision of the Swanson, Nolan and Pelham (SNAP) questionnaire (SNAP-IV), Child Behavior Checklist (CBCL) and clinical interviews were employed to diagnose ADHD. Wechsler Intelligence Scale for Children-Fourth Edition was also implemented. The participants were randomly assigned to the three intervention groups of Barkley's parent training program, working memory training and the combined group. SNAP-IV and CBCL were used as pre-tests and post-tests across all three groups. Data were analyzed using MANCOVA (SPSS version18). RESULTS: There was a significant difference (p< 0.05) in the decline of attention deficit and hyperactivity /impulsivity symptoms between the combined treatment group and working memory training group and also between the combined treatment group and the parent training group in SNAP. In terms of attention problems (experience-based subscales) of CBCL, there was a significant difference (p< 0.001) between the combined treatment group and working memory training group. Furthermore, compared to the working memory training and parent training groups, the combined group demonstrated a significant decline (p< 0.01) in clinical symptoms of ADHD (based on DSM). CONCLUSION: It was revealed that combined treatment in comparison with the other two methods suppressed the clinical symptoms of ADHD more significantly.

A study of incivility in the Iranian nursing training system based on educators and students' experiences: a quantitative content analysis.

BACKGROUND: It is absolutely essential to know the negative impacts incivility in students and educators may have on the creation of a suitable teaching-learning environment. Better education of to-be nurses would improve their service to patients and society in the future. There has been no research in Iran so far on this particular case. This study examines the experiences of uncivil or disrespectful behavior from the standpoint of educators and students. METHODOLOGY & METHODS: A quantitative content analysis was carried out to study manuscripts presented in the form of open questionnaires. To this end, data produced from detailed answers from 640 students and educators were inputted into the computer and line-by-line and sentence-by-sentence coding was done. After that, implied codes were added, the categories were revealed, and finally counting frequency of code in categories was carried out. RESULTS: The most important categories that students considered uncivil behavior were waste of class time, distraction, incompetence in managing the class, discrimination, bad assessment, insult and threat on behalf of the educators. In contrast to their view, what the educators thought of as disrespectful included class disorder, humiliation of other students, irregular attendance of classes, bad sitting postures, non-observance of Islamic standards, and coming unprepared to the class by students. CONCLUSION: From the viewpoint of students and educators, incivility is present towards one another in the academic environment. This study determines the most important forms of the same from their stand point. Since disrespectful and threatening behavior has a significant impact on learning environment, we highly recommend a thorough examination to be carried out in future studies on the origin and the managing strategies of such behaviors.

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.