Brain Wave Patterns in Patients With Chronic Low Back Pain: A Case-control Study.

Introduction: Research evidence indicates that maladaptive reorganization of the brain plays a critical role in amplifying pain experiences and pain chronification; however, no clear evidence of change exists in brain wave activity among patients with chronic low back pain (CLBP). The objective of this study was to assess brain wave activity in patients with CLBP, compared to healthy controls. Methods: Twenty-five patients with CLBP and twenty-four healthy controls participated in the study. A quantitative electroencephalography device was used to assess brain wave activity in eyes-open and eyes-closed (EO and EC) conditions. The regional absolute and relative power of brain waves were compared between the groups. Results: Our results showed a significant increase in the absolute power of theta (F=5.905, P=0.019), alpha (F=5.404, P=0.024) waves in patients with CLBP compared to healthy subjects in both EC and EO conditions. Patients with CLBP showed a reduced delta absolute power in the frontal region (F=5.852, P=0.019) and augmented delta absolute power in the central region (F=5.597, P=0.022) in the EO condition. An increased delta absolute power was observed in the frontal (F=7.563 P=0.008), central (F=10.430, P=0.002), and parietal (F=4.596, P=0.037) regions in patients with CLBP compared to the healthy subjects in the EC condition. In the EC condition, significant increases in theta relative power (F=4.680, P=0.036) in the parietal region were also found in patients with CLBP. Conclusion: The increased absolute power of brain waves in people with CLBP may indicate cortical overactivity and changes in the pain processing mechanisms in these patients. Highlights: Chronic low back pain (CLBP) increases the alpha, theta, and delta power in the brain.CLBP is associated with increased brain wave activity in the frontal, central, and parietal regions.Our findings suggest altered central pain processing in CLBP. Plain Language Summary: Traditional diagnosis and treatment of CLBP are mainly focused on peripheral pathology. But, the modern neuroscience approach to pain highlights the role of cortical plasticity in chronic musculoskeletal pain. In this regard, several studies found structural and functional changes in the brain in patients with chronic pain. Detailed knowledge about cortical changes in CLBP can improve our understanding of mechanisms involved in CLBP, opening a new window to better treatment of LBP (Low back pain). This study investigated brain wave activity in patients with CLBP compared to healthy individuals. Our findings suggest increased brain activity in various parts of the brain in patients with chronic LBP. This finding indicates that CLBP treatment should focus on both peripheral and cortical factors rather than local tissue damage.

Predictive factors of anxiety and depression in COVID-19 survivors: A cross-sectional study.

Background: Depression and anxiety are among the most critically recognized psychological complication of the COVID-19 pandemic. Aim: This study aimed to examine the two predictors among COVID-19 survivors in Ahvaz, Iran, in 2022. Methodology: Using a descriptive-analytical design, 347 COVID-19 survivors referred to hospitals in Ahvaz were meticulously examined. The database of the COVID-19 registration system contained primary information about the samples. For data collection, questionnaires, including the Beck Anxiety and Depression Inventory and a demographic questionnaire, were utilized. Results: The results revealed a significant relationship between anxiety score and family size (p = 0.019), education level (p < 0.001), occupation (p = 0.015), household income status (p = 0.017), disease history (p = 0.017), ethnicity (p < 0.001), disease severity (p < 0.001), and quarantine period (p < 0.001). Furthermore, a significant correlation was observed between the average depression score and gender (p = 0.023), number of family households (p = 0.009), level of education (p < 0.001), occupation (p < 0.001), household income (p < 0.001), disease severity (p < 0.001), disease history (p < 0.001), and quarantine period (p < 0.001). Moreover, linear regression analysis indicated only a significant relationship between depression scores and the quarantine period variable (p < 0.001), among others. The simultaneous examination of all variables on depression disorder highlighted a meaningful relationship between depression score and disease history (p = 0.013), occupation (p = 0.002), household income status (p = 0.002), and family size (p = 0.039). Conclusions: This study revealed a significant relationship between certain demographic variables, such as quarantine period, disease history, employment status, household income status, and the number of family households, and an increase in the average depression and anxiety score.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

Objective: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. Methods: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. Results: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. Conclusions: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP).

OBJECTIVE: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. METHODS: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. RESULTS: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. CONCLUSIONS: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

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.

Toxoplasma gondii Exposure and the Risk of Attention Deficit Hyperactivity Disorder in Children and Adolescents.

BACKGROUND: Evidence suggests that Toxoplasma gondii, which causes toxoplasmosis, changes the metabolism of neurotransmitters, especially dopamine, resulting in both neurologic and psychiatric disorders. On the other hand, the dysregulation of catecholamines, especially of both norepinephrine and dopamine, has been proposed in the pathophysiology of attention deficit hyperactivity disorder (ADHD). The aim of the present study was to investigate anti-toxoplasma antibodies in children and adolescents with ADHD and compare it with a control group, to determine whether toxoplasmosis is a risk factor for ADHD. METHODS: A total of 200 children and adolescents (117 patients with ADHD and 83 individuals without ADHD) participated in the study. Participants were tested for the presence of anti-T. gondii antibodies by enzyme-linked immunosorbent assay. A Parent ADHD Rating Scale and Clinical Global Impression-severity Scale were also completed. Data were analyzed using a χ test and Fisher exact test. RESULTS: Anti-toxoplasma antibodies were detected in 18.1% of patients with ADHD disorder and 24% of individuals without ADHD. There was no significant difference in seropositivity between the 2 groups (P > 0.05). The number of patients with T. gondii infection in the 3 subgroups was 0, 9 and 12, respectively. The differences in infection rate among subgroups were not statistically significant (P > 0.05). CONCLUSION: Although not conclusive, the present study does not support the theory that T. gondii is a risk factor for ADHD.

Coenzyme Q10 supplementation reduces oxidative stress and decreases antioxidant enzyme activity in children with autism spectrum disorders.

Antioxidants and oxidative stress can participate in pathobiochemical mechanisms of autism spectrum disorders (ASDs). The aim was to identify the effects of early CoQ10 supplementation on oxidative stress in children with ASDs. Ninety children with ASDs were included in this study, based on DSM-IV criteria and using Childhood Autism Rating Scale (CARS) scores. Concentrations of CoQ10, MDA, total antioxidant status (TAS) assay, and antioxidant enzymes (superoxide dismutase or SOD and glutathione peroxidase or GPx) activity were determined in serum before and after 100 days of supportive therapy with CoQ10 at daily doses of 30 and 60 mg. Data on children's behavior were collected from parents and babysitters. CoQ10 supportive therapy was determined after three months with daily dose 2 ͯ 30 mg improved oxidative stress in the children with ASDs. A relation was seen between serum MDA (r2 = 0.668) and TAS (r2 = 0.007), and antioxidant enzymes (SOD [r2 = 0.01] and GPx [r2 = 0.001]) activity and CARS score. Based on the results, high doses of CoQ10 can improve gastrointestinal problems (P = 0.004) and sleep disorders (P = 0.005) in children with ASDs with an increase in the CoQ10 of the serum. We concluded that the serum concentration of CoQ10 and oxidative stress could be used as relevant biomarkers in helping the improvement of ASDs.

Effects of Folic Acid on Appetite in Children with Attention Deficit Hyperactivity Disorder (ADHD) Treated with Methylphenidate: A Randomized Double-Blind Clinical Trial.

BACKGROUND: The highly effective medications in treating attention deficit hyperactivity disorder (ADHD) symptoms are stimulants like methylphenidate. However, they have adverse effects like reduced appetite. We investigated the effects of folic acid on reduced appetite caused by the use of methylphenidate in children with ADHD. METHODS: This randomized double-blind clinical trial evaluated 70 outpatients, aged between 6 and 12 years, with a diagnosis of ADHD. The children were recruited from the Outpatient Child and Adolescent Psychiatric Clinic of Golestan Hospital (Ahwaz, Iran) between 2016 and 2017. The study subjects were randomly assigned to 2 groups: Group 1 received an average dose of methylphenidate (1 mg/kg) plus folic acid (5 mg/d) and Group 2 received an average dose of methylphenidate (1 mg/kg) plus a placebo (5 mg of sucrose) for 8 weeks. Assessments, comprising the Conners Parent Questionnaire, anthropometric measurements, and appetite questionnaire, were conducted by a psychiatrist at baseline and then at 2, 4, 6, and 8 weeks after the medication was started using repeated measure analysis. The data were analyzed with the Mann-Whitney U and ANOVA tests using the SPSS statistical software (v. 18.0). RESULTS: Age and gender were not associated with the groups. Weight, height, and the body mass index were not changed during the study in both groups. ADHD symptoms significantly decreased in both groups during the trial; however, no difference was observed between the groups. Moreover, appetite was significantly improved in Group 1. Both medications were well tolerated. CONCLUSION: It seems that folic acid improved the reduced appetite caused by the use of methylphenidate in our children with ADHD. Trial Registration Number: IRCT2016040927304N1.

Increased Serum Levels of Tumor Necrosis Factor-Alpha, Resistin, and Visfatin in the Children with Autism Spectrum Disorders: A Case-Control Study.

Background. Autism spectrum disorders (ASDs) are complex disorders where the pathogenesis is not fully understood. Several proinflammatory and immunoinflammatory disturbances have been observed in the etiology of ASD. There is, however, limited knowledge on variations of adipokines in ASD. The present study aimed to analyze the serum levels of resistin, visfatin, and tumor necrosis factor-alpha (TNF-α) in children with ASD in relation to body weight, gender, and ASD severity level. Method. In total, 30 children with ASD (mean age: 7.72 ± 2.65 y; range; 4-12 y) and 30 healthy children (mean age: 8.4 ± 2.66 y; range: 4-12 y), including males and females, were matched for age, gender, and body mass index (BMI). Serum samples were collected, and visfatin, resistin, and TNF-α serum levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Result. Serum visfatin, resistin, and TNF-α levels in children with ASD were significantly higher than that in the healthy patients (p < 0.05). Two significant correlations were found: a correlation between resistin and visfatin with TNF-α in children with ASD (R = 0.8 and R = 0.62, resp.) and a correlation between resistin and visfatin in children with ASD (R = 0.66). Conclusion. Higher TNF-α, resistin, and visfatin levels were found in children with ASD in comparison with controls, suggesting that elevated levels of serum proinflammatory agents may be implicated in the pathophysiology of ASD.

The Relationship between Body Mass Index and Depression among High School Girls in Ahvaz.

Objective. Today, obesity and depression are two major illnesses that are on the rise all over the world and threaten human health. This research was done to determine the relationship between Body Mass Index (BMI) and depression among Ahvaz high school female students. Method. In a descriptive-analytical study using stratified random sampling, 400 female high school students in academic year of 2013-2014 were picked and their height and weight were measured. BMI was classified based on World Health Organization classification. To assess the severity of depression, Beck depression questionnaire was used. In order to analyze the data, descriptive statistics and Pearson correlation test were used. Results. In terms of BMI 9% of students were slim, 77% were at an acceptable level, and 14% were overweight. Also, the prevalence of depression was 86.20% major depression and 13.79% moderate depression for obese persons, 10.41% major depression and 70.83% moderate depression for overweight persons, 8.78% major depression and 12.97% moderate depression for normal weight persons, and 9% moderate depression for slim persons. The relationship between BMI and depression among high school students is positive and significant (P < 0.001; r = 0.555). Conclusion. There is a positive and significant relationship between BMI and the severity of depression among Ahvaz high school female students.

Comparison between the efficacies of Risperidone with Haloperidol in the treatment of attention-deficit hyperactivity disorder (ADHD) among preschoolers: a randomized double-blind clinical trial.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disease with a worldwide pooled prevalence of 5.29%. OBJECTIVE: To compare the efficacy of Risperidone with Haloperidol in the treatment of attention-deficit hyperactivity disorder (ADHD) among 3- to 6-year-old children. METHODS: In a 6-week double-blind clinical trial, the efficacy of Risperidone 0.5-2 mg with a dose of maximum Haloperidol 0.075 mg/kg was assessed in 39 children aged 3-6 years. This study was conducted at the Golestan Psychiatric Clinic (Ahvaz, Iran). Measurement tools included the Conners' Parent Rating Scale (CPRS-48), Children's Global Assessment Scale (CGAS), and the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS). Data were analyzed using the Wilcoxon, Mann-Whitney, and Fisher's exact tests in the SPSS 19. RESULTS: During the 6 weeks, the decline in points was seen in Conner's rating scale and in ADHD-RS score in Risperidone and Haloperidol groups (p<0.001). On the CGAS scale, an increase of performance in both groups for six weeks was statistically significant (p<0.001). In the scales of ADHD-RS and CPRS-48, no statistically significant difference was observed between the two treatment groups; i.e., in terms of reducing the rate during weeks of two, four, and six (p>0.05). CONCLUSIONS: Haloperidol and Risperidone possibly can be an acceptable treatment choice in the ADHD treatment of 3- to 6-year-old children. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015082623766N1. FUNDING: This work was financially supported by grant (ref. no.: U-93130) from the vice chancellor for Research Affairs of Ahvaz Jundishapur University of Medical Sciences.

Comparison of Plasma Neurosteroid and Prolactin Levels in Patients with Schizophrenia and Healthy Individuals.

Background. The present study aimed to compare plasma levels of cortisol, testosterone, dehydroepiandrosterone (DHEA), and prolactin in patients with schizophrenia and healthy individuals. Method. A total of 100 patients with schizophrenia disorder (69 men and 31 women) and 190 healthy individuals (94 men and 96 women) participated in this cross-sectional study. They were tested for hormone levels and completed demographic questionnaires. Data were analyzed using multivariate analysis of variance (MANOVA) and one-way analysis of variance. Results. Serum testosterone level was significantly higher in men with schizophrenia than in healthy men. Women with schizophrenia had a significantly higher level of testosterone and lower level of prolactin compared to healthy women. There were no significant differences in hormone levels across various subtypes of schizophrenia. No significant differences also were observed in hormones levels in patients with first-episode schizophrenia disorder compared to those in patients with recurrent episodes. Conclusion. This study indicated that abnormal testosterone and prolactin levels might be associated with pathophysiology of schizophrenia disorder.

Effectiveness of reboxetine in treatment of outpatient children and adolescents with attention deficit-hyperactivity disorder with comorbid anxiety disorders.

OBJECTIVE: Some previous studies have reported that ADHD is often comorbid with anxiety disorders. The aim of the present study was to evaluate the effectiveness of reboxetine in treating outpatient children and adolescents with ADHD and comorbid anxiety disorders. METHOD: In this open-label study, 25 outpatient children and adolescents, aged 6-16 years were selected by convenient sampling and underwent treatment with 4mg reboxetine for four weeks. Data were collected at baseline, two weeks and four weeks after the start of the medication using Conners' Parent Questionnaire, Hamilton's Rating Scale for Anxiety, Clinical Global Assessment Scale, Clinical Global Impression-Severity Scale and Side Effects Form. Data were analyzed using repeated measure, analyses of variance (ANOVA), Tukey post hoc test and paired t-test. RESULTS: There were significant reduction in the total score of ADHD (F = 31.441; P <0.001) at the end of the treatment compared to baseline (Table 1). The differences between T0 and T2 in the subscales of attention deficit, hyperactivity and confrontation (F = 20.691; P <0.001, F = 28.810; P < 0.001, and F = 17.463; P <0.001, respectively) were also significant. Findings also indicated significant differences between T0 and T1 (P<0.01) and T1 and T2 (P<0.01) in all of the subscales except for confrontation. A significant improvement was observed in the severity of ADHD and anxiety disorders during different courses of the treatment (p<0.001). No significant changes were observed in systolic and diastolic blood pressure and pulse and weight of the patients during the study. The most common complications were headache and anorexia. CONCLUSIONS: The short-term treatment with reboxetine was effective in improving ADHD with comorbid anxiety disorders. Therefore, reboxetine could be used as a treatment option for ADHD in those children who experience comorbid anxiety disorders or in those who are non-responsive or intolerant to methylphenidate.

Comparison between the mental health of mothers of children with autism and control group.

OBJECTIVE: The aim of this study was to compare the mental health of mothers of children with autism and those of control group. METHODS: Sample of this study consists of 32 mothers of Children with Autistic disorder and 29 mothers of children without Autism; referring to hospitals of Ahvaz city using Convenience sampling. All subjects were asked to complete Demographic questionnaire and General HealthQuestionnaire (GHQ). Data were analyzed using Multivariate Analysis of variance (MANOVA). RESULTS: RESULTSindicated that significant differences exist in mental health (F=5.69, P=0.02) and anxiety/ insomnia (F=4.82, P=0.03), between mothers of children with Autismand control group. There were not any other significant differences in the other subscales. CONCLUSION: It is essential using some mental health improving interventions for mothers of children with Autistic disorder.

Efficacy of reboxetine in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled clinical trial.

OBJECTIVE: The main aim of this study is to evaluate the efficacy of reboxetine, a specific noradrenergic reuptake inhibitor, in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: In a double blind placebo-controlled clinical trial, the efficacy of 8 mg/day of reboxetine (twice daily) was compared with placebo in 40 adults diagnosed with ADHD during 6 weeks. The measures were Conners' Adult ADHD Rating Scale-Self-Report, Screening Version (CAARS-S, SV), Hamilton Anxiety and Depression Rating Scales, Clinical Global Impression - Severity Scale (CGI-S), and Global Assessment of Functioning Scale (GAF). RESULTS: There was a main effect of time and significant time X treatment (reboxetine vs. placebo) interaction on CAARS subscales and CGI scores which decreased along the study (p < 0.01). There was also a main effect of time and time X treatment interaction on GAF score which increased at the end point of the study (p < 0.01). In terms of Hamilton Anxiety and Depression Rating Scales there was just a main effect of time on Hamilton Depression Scale (p < 0.01). Irritability, anxiety, sleep disturbance, and dry mouth were the common side effects of reboxetine. CONCLUSION: Reboxetine could be used and tolerated as an effective treatment for adults with ADHD.