Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents.

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p= 5.4, 95% CI = 5.1-5.7) and encopresis (p= 0.13, 95% CI = 0.09-0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95% CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95% CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders.

The prevalence of depression, anxiety, stress, and related factors among COVID-19 patients in Kurdistan Province, Iran (2020).

The emergence of mental health problems during a pandemic is a major concern of healthcare systems. This cross-sectional, analytical study was performed on 1072 patients with COVID-19 disease without pre-existing mental disorders in Kurdistan Province in 2020 to obtain the frequency of depression, anxiety, and stress using a valid, standard electronic depression, anxiety, and stress scale-21 questionnaire. Data analyses were conducted in SPSS Version 23 using logistic regression modeling. The mean age of the participants was 31.91 ± 10.28 years and 543 subjects (50.7%) were female. The prevalence of stress, anxiety, and depression was 51.7% (95% confidence interval [CI]: 48.7-54.7), 64.3% (95% CI: 61.3-67.1), 61.4% (95% CI: 58.4-64.2), respectively. The prevalence of depression, anxiety, and stress was higher in the employees and retirees compared to the unemployed and homemakers (P < 0.05). Furthermore, the frequency of stress (odds ratio [OR]: 1.36, P = 0.01) and depression (OR: 1.3, P = 0.04) in patients who undertook severe protection measures was significantly higher than those who used lower. The patients with COVID-19 experienced high levels of depression, anxiety, and stress. Therefore, it is essential to provide psychological and psychiatric services to these patients electronically or face to face at health centers.

Prevalence, comorbidity and predictors of anxiety disorders among children and adolescents.

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

Prevalence, comorbidities, and sociodemographic predictors of conduct disorder: the national epidemiology of Iranian children and adolescents psychiatric disorders (IRCAP).

The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6-18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). In this study, 54 children aged 6-9 years (0.58%, CI 0.47-0.77), 64 adolescents aged 10-14 years (0.57%, CI 0.47-0.77), and 117 adolescents aged 15-18 years (1.22%, CI 0.96-1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50-61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68-38.56), tobacco use (20.43%, CI 15.77-26.04), and depressive disorders (18.30%, CI 13.88-23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population.

Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents.

OBJECTIVE: This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents. METHOD: We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia-present and lifetime version (K-SADS-PL) semi-structured face-to-face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data. RESULTS: Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81-1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge-eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive-compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders. DISCUSSION: Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge-eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors.

Prevalence of Autism and its Comorbidities and the Relationship with Maternal Psychopathology: A National Population-Based Study.

BACKGROUND: There is no clear picture regarding the prevalence rates of autism and its comorbidities among Iranian children and adolescents. The present study aimed to estimate these rates as part of a large national population-based study on epidemiology of psychiatric disorders in Iranian children and adolescents. METHODS: The total sample consisted of 31000 children and adolescents between 6 to 18 years of age. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Present and Life time version (K-SADS-PL) was used as the diagnostic tool. RESULTS: The prevalence of autism in the total sample is equal to 0.1% (10 per 10000), with a 2:1 male-to-female ratio. In total, 86% of people with autism had at least one comorbid condition. Intellectual disability, epilepsy, enuresis and attention deficit and hyperactivity disorder (ADHD) with prevalence rates of 70.3%, 29.7%, 27% and 21.62%, respectively, were the most prevalent comorbid conditions in people with autism. Maternal personality disorders were also shown to be associated with increasing risk of autism. CONCLUSION: The present study shows high prevalence rates for autism and its comorbid conditions among Iranian children and adolescents. It also reveals that there is a relationship between some maternal psychiatric disorders and the risk of autism.

Gender Determines the Pattern of Correlation between Body Mass Index and Major Depressive Disorder among Children and Adolescents: Results from Iranian Children and Adolescents' Psychiatric Disorders Study.

Background: We aimed to determine the correlation of BMI with depression and to determine the role of gender in this association, in a large study sample. Methods: We used the data of participants in the Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) Study, conducted in 2017. This study was a national community-based, cross-sectional study in which the urban and rural areas of all provinces of Iran were covered. Overall 30,532 children and adolescents, ages 6-18, were randomly selected with the stratified cluster sampling method. Results: Of a total of 30,532 participants, 25,321, whose BMI had been measured and who had been interviewed with Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), entered the study (12,455 boys and 12,866 girls). We categorized the participants according to the national cutoff points for BMI classification. After controlling for age, father's and mother's job and education, and place of residence, the odds ratio (OR) of depression in underweight, healthy weight, and overweight boys compared with obese boys was 2.19 [95% confidence interval (95% CI): 1.00-4.81], 1.06 (95% CI: 0.73-1.55), and 0.80 (95% CI: 0.49-1.32), respectively. In the girls' subgroup, after controlling for the aforementioned covariates, the OR of depression in healthy weight, overweight, and obese participants compared with underweight subjects was 1.29 (95% CI: 0.52-3.19), 1.54 (95% CI: 0.59-3.98), and 1.79 (95% CI: 0.68-4.69), respectively. Conclusions: Underweight boys were more likely diagnosed with depression than normal weight and overweight boys. While in girls, the probability of depression increased by increased BMI.

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents.

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method : A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

Effect of omega-3 plus methylphenidate as an alternative therapy to reduce attention deficit-hyperactivity disorder in children.

BACKGROUND: Attention deficit-hyperactivity disorder (ADHD) is one of the most common chronic behavioral disorders in school-aged children. PURPOSE: This study aimed to evaluate the effect of omega-3 supplementation as an alternative therapy for ADHD, which can be caused by vitamin and mineral deficiencies. METHODS: This was a double-blinded clinical trial study. Sixty-six children with ADHD (aged 6-12 years) referred to our child and adolescent psychiatric educational and therapeutic clinic were selected based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Instruments including the Parent ADHD Rating Scale were used to assess ADHD at 0, 2, 4, and 8 weeks during the study. RESULTS: The results showed no statistically significant difference between the methylphenidate with omega-3 group and methylphenidate with placebo group based on the Parents ADHD Rating Scale between week 0 (P≥0.96) and week 8 (P≥0.75). There were no significant intergroup differences between the Inattention (P≥0.48) and hyperactivity/impulsivity (P≥0.80) subscale scores on the Parents ADHD Rating Scale. The most common drug complications in the methylphenidate with placebo and methylphenidate with omega-3 groups were anorexia (27 [54%] vs. 41 [60.29%], respectively) and diarrhea (10 [20%] vs. 8 [11.76%], respectively), but the differences were not statistically significant (P> 0.05). CONCLUSION: Our results demonstrate that a specific dose of omega-3 for 8 weeks had no effect on ADHD.

The effect of memantine in adult patients with attention deficit hyperactivity disorder.

BACKGROUND: Hyperactivity disorder and attention deficit are common neurological disorders in children and adolescents. The symptoms of hyperactivity are decreased in adults, and attention deficit is more noticeable. This study was carried out to evaluate the effect of memantine on adult patients with attention deficit hyperactivity disorder (ADHD). MATERIALS AND METHODS: In a double-blind clinical trial study, 40 patients aged 18 to 45 years with ADHD were selected on the basis on the Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, and randomly assigned memantine or placebo. Before starting the treatment, Conners' screening questionnaire was completed for each patient, and the subjects were entered the study after acquiring minimum acceptable score in the questionnaire. RESULTS: The mean age of patients who were receiving memantine and placebo was about 34.7 ± 4.48 and 31.5 ± 7.4 years, respectively. The results have shown a significant difference in the behavior and attention deficit between the two groups treated with memantine and placebo during 6 weeks (p < 0.001). Also, there was a significant difference in the third and sixth weeks between treatment groups in hyperactivity and attention deficit index (p = 0.001). CONCLUSION: The results of this study indicated that memantine was effective in reducing symptoms of Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability.

The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression.

BACKGROUND: Depressive disorders are a major public health problem in developed and developing countries. Recently, several risk factors have been described for depressive disorders in children and adolescents. The aim of the present study was to identify the main risk factors that can affect the incidence of depression in Iranian children and adolescents. METHODS: A total of 30,546 children and adolescents (between 6 and 18 years of age) participated in a cross-sectional study to identify the predictors of depressive disorders. Depressive disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). In addition, a demographic characteristics questionnaire was completed by parents of the participants. The data was analyzed using the SPSS22 software via performing the descriptive analysis and the multiple logistic regression analysis methods. P-values less than 0.05 were considered statistically significant. RESULTS: Results showed that a higher age (15-18), being female, and the father's unemployment were associated with an increased odds ratio for depressive disorders. The age of 10-14 (OR = 2.1; 95% CI, 1.57-2.81), the age of 15-18 (OR = 4.44; 95% CI, 3.38-5.83), female gender (OR = 1.44; 95% CI, 1.2-1.73) and the father's unemployment (OR = 1.59; 95% CI, 1.01-2.5) were significant positive predictors, whereas, the mother's job (as a housewife) (OR = 0.66; 95% CI, 0.45-0.96) and a history of psychiatric hospitalization of the father and mother (OR = 0.34; 95% CI, 0.15-0.78 and OR = 0.34; 95% CI, 0.14-0.84) were negative predictors for depressive symptoms. CONCLUSION: Depressive symptoms are common in children and adolescents and are correlated with age and gender. The assessment of the prevalence of psychiatric disorders, especially the depressive disorders and their comorbidities, may help to prevent mood disorders in children and adolescents.

Memantine versus Methylphenidate in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Double-Blind, Randomized Clinical Trial.

OBJECTIVES: The aim of this randomized clinical trial was to assess the efficacy of memantine versus methylphenidate in the treatment of children with attention deficit hyperactivity disorder. METHOD: Forty participants (34 boys and 6 girls) aged 6-11 who were diagnosed with attention deficit hyperactivity disorder based on (DSM-IV-TR) criteria were selected for this study. The participants were randomly assigned to two groups: group one (n = 22) received memantine and the other group (n = 18) received methylphenidate for six weeks. Treatment outcomes were assessed using the Attention Deficit Hyperactivity Rating Scale and Clinical Global Impression- Severity Scale administered at baseline and at weeks 3 and 6 following the treatment. Also, a two-way repeated measures analysis of variance (time- treatment interaction) was used. RESULTS: At 6 weeks, methylphenidate produced a significantly better outcome on the Parent Rating Scale scores and Clinical Global Impression- Severity than memantine. Side effects were observed more often in the memantine group. However, with respect to the frequency of side effects, the difference between the memantine and methylphenidate groups was not significant. The most common side effects associated with memantine are appetite suppression, headache, vomiting, nausea and fatigue. CONCLUSION: The results of this study revealed that although memantine was less effective than methylphenidate in the treatment of attention deficit hyperactivity disorder, it may be considered as an alternative treatment.

Double-blind controlled trial of venlafaxine for treatment of adults with attention deficit/hyperactivity disorder.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders beginning in childhood that may continue to adulthood. The purpose of this study was to evaluate the possible therapeutic effect of venlafaxine in adults with ADHD. METHODS: In a double-blind setting, drug-naïve adults with a diagnosis of ADHD based on DSM-IV-TR criteria were randomly selected to receive either venlafaxine (up to 225 mg/day) or a placebo for 6 weeks. The Conners Adult ADHD Rating Scale self-report screening version was administered before and during the treatment at 2-week intervals to measure the therapeutic effects. RESULTS: The mean age (SD) of patients was 30.5 (8.1) years. Eleven out of 20 patients receiving venlafaxine and 13 out of 21 patients receiving the placebo were male. The two groups were not significantly different in terms of age, educational level, weight, or blood pressure. Significant decrease was observed in both subscales (inattentive, hyperactive/impulsive), total ADHD symptoms score, and ADHD index in both the venlafaxine and the placebo groups. Seventy-five percent of treatment group versus 20% of placebo group met treatment response criteria when defined as a 25% drop in total ADHD score (p = 0.001). No serious adverse effects were reported during the trial. CONCLUSIONS: In this double-blind trial, the symptoms of adult ADHD decreased after a 6-week trial of either venlafaxine or a placebo with no significant difference. However, a significant treatment response defined as a 25% drop in ADHD index (measured by a self-report scale) was achieved by venlafaxine. The interpretation of these results is limited by the short duration of follow-up in this study.