OBJECTIVES: Functional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents. METHODS: In this double-blind, randomized, placebo-controlled trial, 140 patients aged 4-16 years eligible for the study were randomized into two groups, receiving either 0.25-0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured. RESULTS: 136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 ± 2.4 years and 8.0 ± 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001). CONCLUSION: Risperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.
Antipsychotic Agents , Fecal Incontinence , Adolescent , Child , Child, Preschool , Humans , Antipsychotic Agents/therapeutic use , Comorbidity , Fecal Incontinence/drug therapy , Fecal Incontinence/chemically induced , Fecal Incontinence/epidemiology , Risperidone/therapeutic use , Male , Female
This study aimed to evaluate the efficacy of Duloxetine on electrodiagnostic findings of Paclitaxel-induced peripheral neuropathy in patients with breast cancer. This randomized, double-blind clinical trial was conducted on 40 patients with breast cancer who received Paclitaxel as their first chemotherapy session. All the patients were randomly allocated into two groups, intervention (20 subjects) and placebo (20 subjects). The intervention group received 30 mg duloxetine/day in the first week, followed by 60 mg (twice daily) until 8 weeks. The patient neurotoxicity questionnaire (PNQ) was used to evaluate the severity of neuropathy. Nerve conduction study was also performed. The evaluations were performed at the baseline and 8 weeks after the treatment. Out of 20 subjects in the placebo group, 10 (50%) patients had neurotoxicity (two milds, three moderate, four severe, and one incapacitated), according to PNQ. However, in the duloxetine group, two patients had mild neurotoxicity ( P = 0.03). Significant differences between groups related to the mean of Median Sensory Latency ( P <0.001), Median Motor Latency ( P < 0.001), and Median Motor velocity ( P = 0.001) were reported. However, the relative risk of polyneuropathy between the two groups (relative risk: 1) was not significant. Regarding the results, duloxetine could be an effective treatment for preventing paclitaxel-induced peripheral neuropathy in patients with breast cancer, and an electrodiagnostic study confirmed this effect.
Breast Neoplasms , Neurotoxicity Syndromes , Peripheral Nervous System Diseases , Humans , Female , Paclitaxel/therapeutic use , Duloxetine Hydrochloride/adverse effects , Peripheral Nervous System Diseases/chemically induced , Breast Neoplasms/drug therapy
Objective: Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that may be associated with impaired Theory of Mind (ToM) and social cognition. ToM is a domain in social cognition, referring to one's ability to attribute beliefs, intents, perspectives, and understandings to oneself or others and to understand others' mental states. Materials & Methods: The present study enrolled 52 ADHD of adolescents and 41 healthy age-matched controls in this study. This study applied The Reading the Mind in The Eyes Task (RMET) and Theory of Mind Assessment Scale (Th.o.m.a.s.) for all participants. The results of these tasks were compared between the two study groups. Results: No significant differences were found between these two study groups regarding ToM abilities using mean scores in the Th.o.m.a.s. inventory and the RMET. Furthermore, no association was found between the mean score in the ToM (in both study groups) and this study's parameters of gender, mean age, birth rank, family structure, and income. Conclusion: This study did not support the hypothesis that adolescents with ADHD perform worse on ToM tasks.
Objective: To determine the clinical and MRI characteristics of multiple sclerosis (MS) in the children and adolescents. Material & Methods: In this cross-sectional study, information of 95 MS patients was obtained from the Iranian MS registry. Disease characteristics and imaging data were collected using medical records. Results: Ninety-five patients including 64 female and 31 male subjects with mean age of 13.97±2.4 years (range, 8-18) years were enrolled. The most frequent signs and symptoms were ophthalmic symptoms (n=61, 64.2%), brainstem signs (n=44, 46.3%), cerebellar signs (n=32, 33.6%) and pyramidal signs (n=26, 27.3%). Blurred vision (n=21, 34.4%) was the most common ophthalmic symptom and ataxia (n=24, 75%) the most prevalent cerebellar sign. The most common brainstem signs/symptoms were motor symptoms and vertigo (each n=14, 31.8%) and the most common pyramidal sign/symptom was right upper monoparesis (n=14, 23.3%). Active demyelinating lesions were reported in brain MRI of all patients, mostly appeared as periventricular (n=91, 95.8%) and pericallosal (n=55, 57.9%) lesions. Acute demyelinating spinal lesions were presented in 38 patients (51.3%) with a prominent involvement of the cervical spine (n=33, 86.8%). Conclusion: In our study, the most frequent signs and symptoms were eye symptoms, brainstem signs, cerebellar signs and pyramidal signs, respectively. Moreover, our results showed that MRI plays a critical role in the diagnostic evaluation of MS in children with presence of brain lesions in all patients and spinal lesion in a considerable portion of patients.
Objectives: Stuttering is a common problem at all ages that is required to be treated since childhood. Atomoxetine is currently used for the treatment of attention deficit hyperactivity disorder (ADHD). It can be effective for the treatment of stuttering due to its selective inhibition of norepinephrine reuptake and dopaminergic properties. Therefore, this randomized controlled trial aimed to evaluate the effect of atomoxetine on children's stuttering. Materials & Methods: The children aged 4-12 years and diagnosed with stuttering, referred to Pediatric Neurology and Psychology clinics , were randomly divided into experimental (n=50) and control (n=50) groups. One group received atomoxetine plus speech therapy, and the other group received only speech therapy. Both groups completed the Stuttering Severity Instrument-Fourth Edition at the baseline (on the first visit) and 3 months after the intervention. The results were compared between the two groups using SPSS software (version 21). Results: Most of the children (67%) were male. Moreover, 24%, 46%, and 30% of the subjects were within the age ranges of < 60, 60-95, and > 95 months, respectively. Nearly half of the patients (52%) had a positive family history of stuttering. Stuttering severity was the highest within the age range of 60-95 months, in left-handed children, in those who used formula, and in those who felt insecure in the family; however, there was no difference in stuttering severity based on child's gender, concomitant ADHD, multilingualism, facial or movement tics, sleeping hours, and using teats. The mean stuttering severity reduced in both groups (P<0.001), with a greater decrease in the experimental group, compared to that of the control group (P=0.011). Conclusion: Atomoxetine plus speech therapy is effective for the treatment of children's stuttering and can be used as a complementary treatment strategy in such patients.
Objectives: Given the importance of having a continuous performance for the academic and social life of children with attention-deficit/hyperactivity disorder (ADHD), in this study, a Continuous Performance Test (CPT) was used to compare the effect of long-acting methylphenidate and modafinil on attention and impulsivity of these children. Materials & Methods: A randomized clinical trial was conducted on 50 children with ADHD aged 6 to 12 years in the child and adolescent psychiatric departments of Imam Hossein and Mofid hospitals, Tehran, Iran. The children were selected by availability sampling and randomly assigned into two equal groups (n=25 in each). While the first group was treated with long-acting methylphenidate, the second was treated with modafinil for 14 days. The CPT was carried out before and after the treatment. The obtained data were analyzed by F and t tests. Results: Long-acting methylphenidate and modafinil were both effective in improving attention and impulsivity in children with ADHD. There was no significant difference between the two drugs in terms of effectiveness on attention and impulsivity. Conclusion: The findings of this study showed that long-acting methylphenidate and modafinil are equally effective in improving attention and impulsivity in children with ADHD aged 6 to 12 years.
OBJECTIVE: The aim of the present study was to screen the toddlers who are suspected to be autistic in their well-child visits at age 18 to 24 months via the Quantitative-Checklist for Autism in Toddlers (Q-CHAT). MATERIALS & METHODS: After the screening, the screen-positive cases were clinically assessed by a child psychiatrist and a child developmental psychologist. The total sample included 2467 toddlers; the mean total score of Q-CHAT was 30.64 (SD: 9.133). RESULT: According to the clinical examinations, 6 cases met the criteria for autism (equal to 5.8% of screen-positive cases and 0.25% of the total sample), and 18 cases had a high probability of autism or other neurodevelopmental disorders. CONCLUSION: This study showed that the toddlers who were at risk of autism could be screened in PHC. Also, Q-CHAT could be used as a screening tool in Iran.
BACKGROUND: Concerning the high prevalence of anxiety disorders and joint hypermobility in children and the lack of related studies in this age group, we aimed to assess the association of hypermobility with anxiety disorders in children. METHODS: In this case-control study, 93 children ages 8-15 years with anxiety disorders referring to the Child and Adolescent Psychiatry Clinic of Mofid Children's Hospital, Tehran, Iran, during 2018, were enrolled. The control group consisted of 100 age and sex-matched children without anxiety disorders. Anxiety was evaluated using the Spence Children Anxiety Scale (SCAS). The diagnosis of generalized joint hypermobility was done based on Beighton and Shiari-Javadi criteria. RESULTS: Based on Beighton's diagnostic criteria 52.7% of the children in the case group and 16% of the children in the control group had generalized joint hypermobility. Moreover, based on Shiari-Javadi criteria, 49.5 and 13% of the children in the case and control groups had generalized joint hypermobility, respectively. Moreover, the internal correlation between the two criteria was 0.91 showing almost complete compatibility between the two (P < 0.001). Age was a risk factor that could predict hypermobility in these children. Other variables such as sex, severity, and type of anxiety disorders, and ADHD, were not predictors of hypermobility syndrome. CONCLUSION: The prevalence of hypermobility was three times higher in children with anxiety disorders and only age was a predictor for the possibility to suffer from generalized joint hypermobility in these children.
Anxiety Disorders/epidemiology , Joint Instability/diagnosis , Joint Instability/epidemiology , Adolescent , Case-Control Studies , Child , Female , Humans , Iran/epidemiology , Logistic Models , Male , Prevalence , Risk Factors , Severity of Illness Index
OBJECTIVES: Childhood malignancies raise a range of medical, psychological and social concerns. Identifying psychiatric disorders along with providing mental health services to prevent the emergence and aggravation of mental health problems in children seems necessary in pediatric hospitals. We aimed to find out the frequency of probable emotional and behavioral disorders among children and adolescents with malignancy. MATERIALS & METHODS: This was a cross-sectional study conducted at the Hematology-Oncology Ward of Mofid Hospital, Tehran, Iran, during 2017-2018. Emotional and behavioral disorders were assessed in 399 pediatric cancer patients aged 5 to 12 years using the Parent Checklist of CSI-4. RESULTS: Overall, 89.2% of the samples met the diagnostic criteria for at least one disorder. The most prevalent psychiatric disorders were specific phobia (57%), enuresis (41.9%), obsessive-compulsive disorder (45.6%) and separation anxiety disorder (30.3%). Our results did not show any significant relationship between gender or disease type and the prevalence of psychiatric disorders. CONCLUSION: The prevalence of emotional and behavioral disorders in pediatric cancer patients admitted to children's hospitals is common. These disorders affect the treatment and quality of life of these patients. Therefore, our findings may guide parents, nurses and clinicians to become more cognizant of the identification and management of these disorders.
BACKGROUND: Childhood cancer is an overwhelming life event that can completely change the lives of the sufferers and their parents. Todays, advances of medical science have shifted the fetal nature of childhood cancer to chronic one exposing children and their family to behavioral and psychosocial problems. The aim of this study was to investigate the effect of filial therapy on children's depressive symptoms and their mother's stress, anxiety, and depression. MATERIALS AND METHODS: In this randomized controlled trial, 32 mothers with their children who suffered from cancer were recruited (16 in each group). During a 10-week training sessions, filial therapy group underwent child-parent relation therapy (CPRT). Training sessions were held once a week. Control group received no training and only individual counseling sessions were held for them we needed. Both groups were assessed before and after the intervention using depression, anxiety, and stress questionnaire-21 (DASS-21), children depression inventory (CDI), and Wong-Baker faces pain rating scale (WBFPRS). Sample randomization and data analysis were conducted by using SPSS (version 20) and running independent t-test and chi-square test. P value< 0.05 was set as the significant level. RESULTS: Mothers in the filial therapy group experienced significant decrease in their level of depression, anxiety, and stress in the posttest (p < 0.001). In contrast to filial therapy group, mothers in the control group did not show an improvement in their level of depression, anxiety, and stress. Moreover, the results of the current investigative showed that depression of children in the filial therapy group significantly reduced at post-test (p < 0.001). On the other hand, the mean of children's depression in the control group remained steady. CONCLUSION: The findings of the present study revealed that using filial therapy could reduce the depression of children with cancer and their parent's depression, anxiety, and stress. Accordingly, we suggest filial therapy programs as a routine for addressing psychosocial problems of children with cancer and their families.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Anxiety Disorders/therapy , Depression/therapy , Family Therapy/methods , Mothers/psychology , Neoplasms/drug therapy , Stress, Psychological/therapy , Adult , Anxiety Disorders/etiology , Anxiety Disorders/psychology , Case-Control Studies , Child , Depression/etiology , Depression/psychology , Female , Follow-Up Studies , Humans , Male , Neoplasms/pathology , Neoplasms/psychology , Parent-Child Relations , Prognosis , Psychotherapy/methods , Single-Blind Method , Stress, Psychological/etiology , Stress, Psychological/psychology , Surveys and Questionnaires
OBJECTIVE: As there were a few studies on the mental disorders resulting from diabetes in children, this study aimed at investigating the prevalence of psychological disorders among children. MATERIALS & METHODS: We enrolled 323 children with diabetes type 1 aged 5-12 yr old referring to Endocrinology Clinic of Mofid Hospital, Tehran, Iran in 2014-2015. In addition, 317 healthy children were considered as control group. The materials used for data analysis were information form and questionnaire CSI-4 filled out by their parents. The filled questionnaires were rated in that day and then analyzed and diagnosed by the Pediatric Psychiatrist in order to determine the type and intensity of psychological disorder. Results were analyzed using SPSS 20. T tests, Scheffe post hoc test and Pearson's correlation test were used for analysis of data. The amounts were significantly different at P<0.05. RESULTS: In terms of Neuro-Evolutionary disorders, Attention-deficit (ADD), hyperactivity (HD) and Attention-deficit hyperactivity disorders (ADHD) in children with diabetes were significantly higher than those in healthy children (P=0.001). Severe fundamental depressive disorders were higher in diabetic children (P=0.001). In terms of anxiety disorder, a specific phobia and panic was significantly higher in diabetic children (P=0.005). Regarding aggressive behaviors, diabetic children were more disobedient and stubborn than the others. CONCLUSION: The prevalence of psychological disorders among diabetic children was higher than that of the others. As psychological disorders will effect on the life quality of children, improvement of life quality of diabetic children and adolescents, on-time diagnosis and treatment of psychological disorders in these patients seems essential.
OBJECTIVE: Premenstrual syndrome (PMS) is a cluster of physical and emotional changes that typically begins several days before the menstrual period that disappears quickly after menstruation. It seems that co-occurrence of depression increases the risk and severity of this syndrome. In this cross-sectional research, we evaluated an association between PMS and depression in medical students. METHODS: A hundred female medical students of Shahid Beheshti University of Medical Sciences that were available assigned for research. They were divided into two groups after administration of demographic questionnaire and PMS questionnaire made by researchers based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Technical Revision; group with or without PMS diagnosis. Then, they completed Beck's Depression Inventory. RESULTS: From 100 participants, 55% (n = 55) met the PMS criteria and 45% had no PMS. In the PMS group 30% (n = 17) had no depression; 38% (n = 21) had mild depression; 23% (n = 13) had moderate depression; and 7% (n = 4) had severe depression. In the group with no PMS 60% (n = 27) had no depression; 20% (n = 9) had mild depression; 17% (n = 8) had moderate depression; 2% (n = 1) had severe depression. The rate of depression was significantly higher in PMS group (p = 0.04). CONCLUSION: In this research, PMS had an elevated frequency in medical students. In students with PMS, rate of depression was higher than students without PMS.
