Prevalence and determinants of post-traumatic stress disorder five months after the 2019 huge flooding in Iran.

BACKGROUND: Despite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019. METHODS: An analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants. RESULTS: Out of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7-28.8%) and was significantly higher in Lorestan province (39.7%, P < 0.001). Determinants of PTSD, were unemployment (adjusted odds ratio [AOR] = 3.53, CI 95%: 1.38-9.00), primary (AOR = 2.44, CI 95%: 1.10-5.41) or high school (AOR = 2.35, CI 95%: 1.25-4.40) education (vs. university), a history of mental disorders (AOR = 2.36, CI 95%: 1.22-4.58), high damage to assets (AOR = 2.29, CI 95%: 1.40-3.75), limited access to health care services after the flood (AOR = 1.95, CI 95%: 1.20-3.19), not receiving compensation for flood damage (AOR = 1.94, CI 95%: 1.01-3.83), high wealth index (AOR = 1.90, CI 95%: 1.23-2.93), and flooded house with a height of more than one meter (AOR = 1.66, CI 95%: 1.02-2.76). CONCLUSION: Results show a notable prevalence of PTSD, especially in Lorestan province, among adults affected by floods. Determinants of PTSD include unemployment, lower education, psychiatric history, extensive property damage, limited post-flood healthcare access, lack of compensation, and increased flood exposure. We recommend adopting an inclusive screening approach for high-risk groups and developing appropriate therapeutic and supportive interventions.

The Effect of Combined Intervention on Improvement of Early Lexical Development in Minimally Verbal Children with Autism Spectrum Disorder.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by severe communication deficits and limited and repetitive behavioral tendencies. There are several treatment approaches and methods for minimally verbal children with ASD; nonetheless, there is inconclusive evidence about how early lexical development could be improved. The present study aimed to investigate the effect of combined intervention derived from the principles of different theories-including contemporary behaviorism, schemas, sociocultural, and event representation theories-to improve early lexical development in minimally verbal children with ASD. Methods: In this single-group pretest-posttest study, 10 children with ASD (mean age, 47.9 ± 8.3 months), including 7 boys and 3 girls, participated. Participants received 16 intervention sessions in 8 weeks. The combined intervention consisted of various methods derived from contemporary behaviorism, schemas, sociocultural, and event representation approaches. The MacArthur-Bates Communicative Development Inventory 1 (Infant form) assessed early lexical development before and after intervention and after a 2-month follow-up. The Friedman test was used to analyze the data, and pairwise comparisons were performed with the Will-Coxon test. Cohen's d was used to investigate the effect sizes. Results: Significant increases in expressive vocabulary (P < 0.001) and receptive language (P < 0.001) were seen after the end of the intervention and at the follow-up (P = 0.005). Large effect sizes were found for expressive vocabulary (d = 3.7) and receptive vocabulary (d = 2.17). Conclusion: This study suggests that the combination of intervention based contemporary behaviorism, schemas, sociocultural, and event representation approaches improved receptive and expressive vocabulary in minimally verbal children with ASD.

Evaluation of DNA repair capacity in parents of pediatric patients diagnosed with autism spectrum disorder using the comet assay procedure.

Background: Autism Spectrum Disorder (ASD) is characterized by impairments in social communication, limited repetitive behaviors, impaired language development, and interest or activity patterns, which include a group complex neurodevelopmental syndrome with diverse phenotypes that reveal considerable etiological and clinical heterogeneity and are also considered one of the most heritable disorders (over 90%). Genetic, epigenetic, and environmental factors play a role in the development of ASD. Aim: This study was designed to investigate the extent of DNA damage in parents of autistic children by treating peripheral blood mononuclear cells (PBMCs) with bleomycin and hydrogen peroxide (H2O2). Methods: Peripheral blood mononuclear cells (PBMCs) were isolated by the Ficoll method and treated with a specific concentration of bleomycin and H2O2 for 30 min and 5 min, respectively. Then, the degree of DNA damage was analyzed by the alkaline comet assay or single cell gel electrophoresis (SCGE), an effective way to measure DNA fragmentation in eukaryotic cells. Results: Our findings revealed that there is a significant difference in the increase of DNA damage in parents with affected children compared to the control group, which can indicate the inability of the DNA molecule repair system. Furthermore, our study showed a significant association between fathers' occupational difficulties (exposed to the influence of environmental factors), as well as family marriage, and suffering from ASD in offspring. Conclusion: Our results suggested that the influence of environmental factors on parents of autistic children may affect the development of autistic disorder in their offspring. Subsequently, based on our results, investigating the effect of environmental factors on the amount of DNA damage in parents with affected children requires more studies.

Psychological impact of the Spring 2019 flood among adult population of Iran.

BACKGROUND: From March to April 2019, a flood occurred in several regions of Iran. The most affected provinces were Golestan, Lorestan, and Khuzestan. AIMS: The present study aimed to determine the prevalence and determinants of psychological distress and depression among the affected adult population 6 months after the event. METHODS: A cross-sectional household survey with face-to-face interview was carried out on a random sample of 1,671 adults aged above 15 years living in the flood-affected areas from August to September 2019. We applied GHQ-28 and PHQ-9 for the assessment of psychological distress and depression, respectively. RESULTS: The prevalence of psychological distress and depression were 33.6% (95% CI [29.5, 37.7]) and 23.0% (95% CI [19.4, 26.7]), respectively. Determinants of psychological distress were a history of mental disorders (Adjusted odds ratio [AOR] = 4.7), primary (AOR = 2.9) or high school (AOR = 2.4) education (vs. university), no compensation received (AOR = 2.1), high damage to assets (AOR = 1.8), the house flooded more than 1 m (AOR = 1.8), female gender (AOR = 1.8), and limited access to health care services (AOR = 1.8). Determinants of depression were unemployment (AOR = 5.3) or being a housewife (AOR = 2.7), a history of mental disorders (AOR = 4.1), high damage to assets (AOR = 2.5), no compensation received (AOR = 2.0), the house flooded more than 1 m (AOR = 1.8), limited access to health care services (AOR = 1.8), and high wealth index (AOR = 1.7). CONCLUSION: The results of this study revealed a high prevalence of psychological distress and depression in the flood-affected adult population. The high-risk group, particularly flood victims who had a history of mental disorders, and those exposed to severe damages of flood, should be prioritized for screening, and mental health services.

C1q/TNF-related protein-1: Potential biomarker for early diagnosis of autism spectrum disorder.

INTRODUCTION: Autism spectrum disorders (ASDs) are neurodevelopmental diseases characterized by communication inabilities, social interaction impairment, repetitive behavior, as well as learning problems. Although the exact mechanism underlying this disease is still obscure, researchers believe that several factors play a significant role in its development and pathogenesis. Some authors have reported an association between adipokines family and autism. C1q/TNF-related protein-1 (CTRP1) is a member of the adipokines family, and we hypothesized that this adipokine might have an influential role in the pathogenesis of ASDs. Since there is no specific marker for screening the disease, we evaluated CTRP1 as a potential marker for achieving this purpose. METHODS: Blood samples were collected from 82 (41 ASDs boys, 41 healthy boys as controls) children aged 5-7 years old. CTRP1 gene expression and CTRP1 serum level were measured by quantitative realtime-PCR and enzyme-linked immunosorbent assay methods, respectively. RESULTS: It was found that CTRP1 is significantly elevated in autistic children in comparison to healthy controls, both at the gene expression level, as well as at the serum level; demonstrating a good diagnostic value with a good range of sensitivity and specificity for detecting ASDs. CONCLUSION: CTRP1 expression is elevated in ASDs boys aged 5-7 years old, suggesting a role for this adipokine in ASDs pathophysiology. Also, receiver operating characteristic curve analyses revealed that this adipokine could be utilized as a diagnostic biomarker for differentiating ASDs patients from healthy individuals along with other recently proposed biomarkers.

Parent training intervention for autism symptoms, functional emotional development, and parental stress in children with autism disorder: A randomized clinical trial.

OBJECTIVE: Today, early interventions to treat autistic children through parent training interventions is of outmost importance. Interventions are focused on developmental or behavioral approaches and are mostly individual or group ones. In the present study, both proposed approaches in the form of structured individual and group parent training sessions among Iranian families are investigated. METHOD: This study was a randomized clinical trial which was performed in 2019-2020 in Tehran. Forty four 3-5 year-old children with autism participated in the study and were assigned to experimental (n = 22) and control (n = 22) groups through block randomization method. To evaluate the effectiveness of therapy on autism symptoms, Gilliam Autism Rating and Functional Emotional Assessment Scales were used. Also, Parenting Stress Index and Quality of Life Questionnaire were implemented to investigate the secondary effects of the therapy. After 12 therapy sessions, both groups took the posttest and 3 months later, follow up evaluations were performed. RESULTS: The treatment group manifested significant improvement regarding autism symptoms in both the posttest and follow up (ŋ2 = .77, P < .05) as well as Functional Emotional Development (ŋ2 = .62, P < .05). Comparing the means indicates that the experimental group mean score is significantly higher in quality of life and lower in parenting stress than the control group's. CONCLUSION: Parent training is effective on autism symptoms and functional emotional development. Regarding the fact that the follow-up phase coincided with Covid-19 pandemic and quarantine, it can be concluded that the therapy has been successful in maintaining the attained capabilities.

Psychometric Properties of the Persian Version of the Teasing Questionnaire 23.

The current study was a cross-sectional research and aimed to investigate the factor structure, internal consistency, and validities of the Persian version of the Teasing Questionnaire-Revised (TQ-R). Forward and backward translations of the TQ-R were performed; face and content validities were determined based on comments by a sample of psychology students and specialists. Using the cluster sampling method, 290 participants were recruited, and 201 valid data (M age = 23.53, SD = 3.53, 64.2% men) were analyzed. The factor structure was assessed by confirmatory and exploratory factor analysis (EFA). The result of the confirmatory factor analysis(es) did not confirm the proposed three, four, and five-factor models. EFA revealed four factors with 23 items, explaining 52.03% of the total variance. The internal consistency of the Persian version of Teasing Questionnaire 23 was in the excellent range (α = 0.92), and its expected associations with external correlates (e.g., depression and anxiety) supported the measure's convergent validity. The findings indicated that the Persian version of the TQ-R has sound psychometric properties and can be used as a valid and reliable tool in research and clinical outcomes.

The prevalence of attention deficit hyperactivity disorder in Iran: An updated systematic review.

Background: Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children and adolescents. There is a controversy over the true prevalence of ADHD in Iran, the knowledge of which is crucial for allocating health care resources and identifying research priorities. This is an updated systematic review of the prevalence of ADHD in Iranian children and adolescents. Methods: For this systematic review, PubMed/Medline, Web of Science, Scopus, PsycINFO, IranPsych, IranMedex, Irandoc, Google Scholar, and grey literature were reached for publications between January 1990 and December 2018 that reported prevalence estimates of ADHD in Iran. Parallel independent assessments were conducted. The Quality Assessment Checklist for Prevalence Studies was used to assess the overall quality of studies. Results: A total of 34 original studies covering 33 621 Iranian children, adolescents, and adults were included. The included studies were mostly conducted on the population of preschool, elementary, middle, and high school-aged children as well as adolescents. Also, 6 studies addressed university students. Prevalence estimates of ADHD reported varied substantially across the studies and offered a range of heterogeneous data. Conclusion: Overall, making exact comparisons among studies was not easy because the assessment method and the type of sampling could impact prevalence estimates. These factors need to be considered when comparing data from different studies.

Assessment of Peripheral Blood Lymphocytes in Parents of Autistic Children by Cytokinesis Block Micronucleus Assay.

Autism spectrum disorders are neurodevelopmental complex diseases with causative de-novo and inherited genetic factors. They include a range of cognitive and behavioral conditions such as pervasive developmental disorder, Asperger's syndrome, and autism. Cytokinesis-block micronucleus assay, as a cytogenetic study has been considered as one of the indicators of chromosomal damage in peripheral blood. This study aimed to investigate the frequency of micronucleus (MN) in peripheral blood lymphocytes of parents with autistic children. The study was case-control and the cases were parents of autistic children referring to the psychiatric department of the Ali-Asghar Hospital of Tehran. The total number of samples was 60 cases and 30 controls. The results showed that autistic children's parents had a significant increase in MN frequency in binucleated lymphocytes. Further researches are suggested to analyze the environmental and genetic reasons for MN increase in autistic children parents.

Impact of Coping Skills Training on the Quality of Life Among the Daughters of Mothers with Breast Cancer.

BACKGROUND: Cancer affects the quality of life (QoL) of patients and their families. The purpose of this study was to determine the effect of coping skills training on the QoL among daughters of mothers with breast cancer. METHODS: In this quasi-experimental pre-test/post-test design, data were collected from 70 participants (35 in each of the control and education groups) from January 2016 to July 2017 in Imam Khomeini and Rasole-e-Akram Hospitals in Tehran. The education group participated in a workshop and group discussion (groups of 5 to 8 participants) with the presence of a pediatric psychiatrist and two pediatric nurses, and then a follow up program was performed. The Pediatric Quality of Life Inventory version 4.0 was used in this study in two stages of pre-test (before education) and post-test (four weeks later). Data were analyzed through SPSS, version 21 using independent t-test and paired t-test for comparison of the mean scores of the two groups, with the significance level of 0.05. RESULTS: After the education, there were significantly improved scores of the QoL in the dimensions of physical functioning (P<0.001), emotional functioning (P<0.001), and school functioning (P<0.001) in the study group compared to the control group. The social functioning did not show a significant change (P<0.083). CONCLUSION: The findings of the study confirm that coping skills training can lead to the improvement of QoL in adolescent daughters of mothers with breast cancer. Healthcare professionals must provide the mothers and daughters with information about breast cancer and instruments to handle their situation to promote the daughters' QoL.

The causative variants of amyloidosis in the autism.

PURPOSE: Autism spectrum disorders (ASD) consist of a group of neurodevelopmental disorders that include autistic behavior, Asperger's syndrome and pervasive developmental disabilities. According to the increasing observations that patients with mitochondrial disorders have symptoms associated with ASD, we have aimed to analyze the role of mitochondrial DNA (mtDNA) variation in autistic patients. MATERIAL AND METHODS: We selected children with autistic behaviors (15-60 CARS Score). The mitochondrial DNA extraction process was done by GeNet Bio DNA extraction kit. The regions of interest were amplified using independent PCR runs. After purification of PCR products, both strands were sequenced by Big Dye Termination system in a directly determined automated sequencing on an ABI 3700 capillary sequencer machine using both primers. All sequencing results were analyzed using bioinformatics' tools sequencher software 5. RESULTS: In this study, 31 samples were examined, which 15 unique variants were detected in genes related to COXI-III. The most frequent variant (30.76%) were related to COX1 with amino acid change A â†’ A. The only significant pathogenic variant was C8264G, except for C8264G, all variants seemed to be homoplasmic substitution. CONCLUSION: In our study, among the variations we found, one variant what probably had an interesting association with possible amyloidosis, had been reported in patient with autism previously. It is hoped that with finding more definable genetic and biological markers, the autistic children diagnosis and treatment will be more effective.

Internalizing and Externalizing Problems, Empathy Quotient, and Systemizing Quotient in 4 to 11 Years-Old Siblings of Children with Autistic Spectrum Disorder Compared to Control Group.

Objective: This study was conducted to recognize the problems of living with a sibling with Autistic Spectrum Disorder (ASD) to improve their quality of life. Method : A total of 30 participants were selected among the 4-to11- year-old siblings of children who had referred to Tehran Psychiatric Institute due to autism spectrum disorder. For the control group, 30 children aged 4 to11years old who were the siblings of patients with chronic diseases referring to Pediatric Clinic of Rasoul-e Akram (PBUH) hospital were selected. Gilliam Autism Rating Scale-Second Edition (GARS-2) was filled out for patients and siblings participating in the study and Child Behavior Checklist was completed by their parents. Results: The mean age of the patients in this study was 4.46 ± 9.66 years (range: 1.5-22 years), and the mean age in the healthy children was 2.54 ± 8.18 years (range: 4-11 years). The mean scores of anxiety/depression, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, and rule-breaking behavior subscale of CBCL (Child Behavior Checklist) were not significantly different between groups. Aggressive behavior was the only subscale that showed such difference (p = 0.008). Externalizing problems in children who had siblings with ASD was higher than children who had siblings with physical illness. In a group in which a sibling had ASD, sisters were more anxious/ depressed than brothers. Conclusion: Due to various psychological and social problems that siblings of children with ASD experience throughout their life, studying their psychological problems to improve their quality of life seems to be of paramount importance.

Suicide Probability in Adolescents With a History of Childhood Maltreatment: The Role of Non-Suicidal Self-Injury, Emotion Regulation Difficulties, and Forms of Self-Criticism.

BACKGROUND: Suicidal attempt and non-suicidal self-injury are very common in adolescents with a history of childhood maltreatment. By identifying correlates of these kinds of high-risk behaviors, it is possible to prevent and decrease completed suicide. OBJECTIVES: The aims of this study were: 1) to compare adolescents with a history of childhood maltreatment with non-suicidal self injury (NSSI) or past suicidal attempt in terms of suicide probability, and 2) to investigate the association between NSSI, forms of self-criticism, emotion regulation difficulties, and suicide probability. PATIENTS AND METHODS: Participants were 169 adolescents living in Iranian social welfare centers who had a history of childhood maltreatment. The Suicide Probability Scale, Difficulties in Emotion Regulation Scale, Forms of Self-criticism, and the Non-Suicidal Self injury (NSSI) checklist were used for assessment. RESULTS: Adolescents with NSSI and suicidal attempts had higher rates of suicide ideation than adolescents with NSSI-only (P < 0.05). Feelings of inadequacy, self-hatred, difficulty with impulse control, and frequency of NSSI can predict 50% variance of suicide probability (P < 0.001). CONCLUSIONS: Adolescents with histories of suicidal attempts and NSSI, compared with adolescents with NSSI-only, were more prone to suicide. Self-criticism, poor impulse control, and the frequency of NSSI were the main risk factors associated with suicide probability in adolescents with a history of childhood maltreatment.

Factors Associated With Suicidal Attempts in Iran: A Systematic Review.

CONTEXT: Suicide prevention is a health service priority. Some surveys have assessed suicidal behaviors and potential risk factors. OBJECTIVES: The current paper aimed to gather information about etiology of suicide attempts in Iran. DATA SOURCES: Pubmed, ISI web of science, PsychInfo, IranPsych, IranMedex, IranDoc as well as gray literature were searched. STUDY SELECTION: By electronic and gray literature search, 128 articles were enrolled in this paper. Pubmed, ISI web of science, PsychInfo, IranPsych, IranMedex, IranDoc were searched for electronic search. After reading the abstracts, 84 studies were excluded and full texts of 44 articles were reviewed critically. DATA EXTRACTION: Pubmed, ISI web of science, PsychInfo, IranPsych, IranMedex, IranDoc as well as gray literature were searched to find any study about etiologic factors of suicide attempt in Iran. RESULTS: Depressive disorder was the most common diagnosis in suicide attempters that is 45% of the evaluated cases had depression. One study that had used Minnesota multiphasic personality inventory (MMPI) found that Histrionics in females and Schizophrenia and Paranoia in males were significantly influential. Family conflicts with 50.7% and conflict with parents with 44% were two effective psychosocial factors in suicidal attempts. In around one fourth (28.7%) of the cases, conflict with spouse was the main etiologic factor. CONCLUSIONS: According to the methodological limitations, outcomes should be generalized cautiously. Further studies will help to plan preventive strategies for suicidal attempts; therefore, continued researches should be conducted to fill the data gaps.

Integrating a suicide prevention program into the primary health care network: a field trial study in Iran.

OBJECTIVE: To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. METHODOLOGY: This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. RESULTS: We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P < 0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. CONCLUSION: Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.

Familial characteristics of street children in tehran, iran.

OBJECTIVE: The phenomenon of street children is one of the most important concerns facing global community. Identifying risk factors in such children could lead to crucial investigations to find their essential needs by intervention programs. The present study examined the family profile of street children in Tehran, Iran. METHODS: The sample consisted of 576 street children who were evaluated by 15 examiners. Using multi-stage sampling, twenty-seven different areas of Tehran were divided into 5 clusters and the children were selected randomly from each cluster. The two questionnaires applied included a demographic questionnaire and a questionnaire about high-risk behaviors such as substance use, alcohol consumption, cigarette smoking, etc. RESULTS: There was a statistical significant association between the length of work time and two variables: sex and economic status of family (p < 0.05). Incarceration history of street children who had lost both their parents and their parents had been divorced was significantly higher than others (p < 0.05). CONCLUSION: The street children's lifestyle is a risk factor for affecting them to variety types of socio-mental problems. Statistical significant association between parental divorces or the loss of both parents with a history of conviction mentions the important role of parents in transmitting moral and social values to children.

Therapeutic intervention and parenting style of abusive parents.

BACKGROUND: Victims of abuse comprise a significant proportion of all child psychiatric admissions, with an estimated 30% incidence of lifetime of physical and sexual abuse among child and adolescent outpatients, and as high as 55% among psychiatric inpatients. OBJECTIVES: The present study was conducted to examine the effects of therapeutic intervention and parent management training on parenting skill of abusive parents. PATIENTS AND METHODS: The study population consisted of all children who were referred to Child Psychiatric and Pediatric Departments of Imam Hossein Hospital, Tehran, IR Iran diagnosed with child abuse. Children and their families were visited by a psychiatrist for psychiatric problems. Later, the necessary interventions were taken for the children. To study the effect of intervention, parents completed 'Being a Parent and Parenting Scale' before intervention, and then again, in the third and sixth months following the intervention. The interventions included 8 weekly parent management training sessions for all of the involved parents and additional pharmacologic and psychological interventions according to the subjects' needs. RESULTS: Participants included 73 children with the mean age of 6.9 ± 4.3 year, while the mean age of parents was 31.76 ± 6.52 year for the mothers and 38.07 ± 8.45 year for the fathers. General anxiety disorder (30.1%) and depression (27.4%) were the most common psychiatric disorders among mothers. In parenting scale, there were significant differences between the zero and third month in all subscales (P = 0.008), but there was no significant difference in verbosity and overreactivity after 6 months. Laxness showed significant changes over the period (P = 0.03). In viewing the 'Being a Parent Scale', there was no significant difference in satisfaction and competency subscales before and after the intervention. CONCLUSIONS: Therapeutic intervention and parent management training improves parenting skill of abusive parents, and this might lead to fewer incidents of abuse or neglect.

A review on genetics of sleep disorders.

One-third of population deal with sleep disorders which might be due to social, economic or medical problems. Studies on twins have indicated the role of genetic factors in these disorders. Monozygotic twins have a very similar hypnogram. A higher prevalence of some sleep disorders is reported in relatives of the patients with these disorders. Genes also affect sleep disorders as well as some other disorders at the same time. Sleep disorders can also influence the level of the personal and social functioning. Recent genetic advances have clarified the role of different genes in sleep disorders. The purpose of this article is to present a brief review about the role of genetic factors in some of the sleep disorders.

Idiopathic Thrombocytopenia and Neurologic Manifestations in A Young Female Leading to the Diagnosis of Wilson's Disease.

We present a 19-year-old patient with hematologic and neurologic manifestations associated with Wilson's disease. Idiopathic thrombocytopenia was diagnosed in October 2009. Bone marrow aspiration was normal. Gradually her neurologic and psychiatric symptoms emerged, dysarthria, writing apraxia, learning difficulties, emotionalism and eventually dystonia of hands. The serum ceruloplasmin was low, and the Kayser Fleischer's ring was positive. MRI of the brain showed abnormality in the bilateral basal ganglia, brain stem and superior cerebellar peduncles without post-contrast enhancement.

Early onset bipolar disorder in a 5.5 years- old child.

Bipolar disorder is a mental disease that can be presented as irritable mood with affective storms, mixed symptoms of depression and mania, rapid cycles, emotional labiality and irritability during all episodes. A confirmed positive familial history of the disease is the single most robust risk factor for developing the illness. This report presents 5.5 years-old girl with the symptoms of bipolar disorder and with the purpose to draw attention to the diversity of possible symptoms of mood disorders in childhood.