Psychopharmacology of Attention-Deficit Hyperactivity Disorder: Effects and Side Effects.

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children which manifests with hyperactivity, impulsivity, and/or inattention. Several drugs are used in treatment of ADHD. Stimulants, atomoxetine, anti-depressants, and bupropion are common medications used in the treatment of ADHD. Stimulants are widely used as the first line treatment in children with ADHD. Their mechanism of action is the release of dopamine and norepinephrine in central nervous system. Methylphenidate is the most common stimulant used for the treatment of ADHD. Methylphenidate significantly reduces ADHD symptoms in children both at home and school and improves their social skills. Methylphenidate is safe in healthy children and has shown to have no cardiac side effects in these patients. Other medications include: Atomoxetine, Amphetamines, Clonidine, Melatonin, and anti-depressants. Effects, side effects, and mechanism of action these drugs have been discussed in this paper.

Seizure Duration and Hemodynamic State During Electroconvulsive Therapy: Sodium Thiopental Versus Propofol.

INTRODUCTION: General anesthesia is required for Electroconvulsive Therapy (ECT) and it is usually provided by a hypnotic agent. The seizure duration is important for the treatment, and it is usually accompanied by severe hemodynamic changes. The aim of this study was to compare the effects of sodium thiopental versus Propofol on seizure duration and hemodynamic variables during ECT. METHODS: A number of 100 patient-sessions of ECT were included in this randomized clinical trial. The initial hemodynamic state of each patient was recorded. Anesthesia was induced by Sodium thiopental in the 1st group and with Propofol in 2nd group. All the patients received the muscle relaxant succinylcholine. The hemodynamic variables after seizure and seizure duration were recorded. The data were analyzed through SPSS 20 and independent t-test. P<0.05 was considered significant. RESULTS: The mean duration of seizure in the sodium thiopental group was significantly longer than the Propofol group (40.3±16.6 sec versus 32±11.3 sec) (P=0.001). There was no statistically significant difference between the mean energy level applied in the two groups (20.5±3.81 joules in the sodium thiopental versus 20.2±3.49 joules in the Propofol group). The mean systolic and diastolic blood pressure at all times after seizure and mean heart rate at 3 and 5 minutes after seizure were significantly lower in Propofol than sodium thiopental groups. DISCUSSION AND CONCLUSION: Propofol provides a more stable hemodynamic state for the ECT procedures, and its use is highly preferred over sodium thiopental in patients with cardiovascular disease.

Humanin: a possible linkage between Alzheimer's disease and type 2 diabetes.

The prevalence of Alzheimer's disease (AD) is higher among type 2 diabetes mellitus (T2DM) patients. In T2DM patients, the progression of AD is more rapid. Furthermore, several pathophysiological pathways are common to AD and T2DM. Humanin is a recently introduced, mitochondrial-derived peptide with neuroprotective effects. Humanin can alter the mechanisms involved in AD and T2DM pathogenesis. Insulin resistance as well as oxidative stress has been shown to be associated with increased amyloid deposition in brain neurons and islet beta cells. Moreover, advanced glycation end products and lipid metabolism disorders are common pathways of oxidative stress and low-grade systemic inflammation in AD and T2DM. These common pathways may explain AD and T2DM pathogenesis and suggest common treatments for both diseases. Treatments for T2DM and AD attempt to slow cognitive decline, and recent investigations have focused on agents that may alter pathways common to AD and T2DM pathogenesis. Non-steroidal antiinflammatory drugs, such as interleukin-1 antagonists and statins, are possible drug candidates for both AD and T2DM.

Prevalence of Adult Attention Deficit Hyperactivity Disorder (Adult ADHD): Tabriz.

OBJECTIVE: Attention deficit hyperactivity disorder in adults (adult ADHD) is gaining more attention nowadays. Nevertheless, very few studies have addressed this issue in Iran. The present study was conducted to determine the prevalence of adult ADHD in Tabriz, North-West of Iran. METHODS: Four hundred urban inhabitants of Tabriz- with an age range of 18 to 45 years were selected through the probability proportional to size cluster sampling in 2009. The screening was performed by Conner's Adult ADHD Rating Scale, and the definite diagnosis of Adult ADHD was performed via clinical interview according to DSM-IV-TR and Wender Utah criteria. RESULTS: The prevalence of adult ADHD was estimated to be 3.8%. Men when compared with women were more likely to have ADHD (5.5 % in men versus 2 % in women). Marital status, birth order, educational level and occupational status showed no significant association with adult ADHD. History of psychiatric treatment, alcohol drinking and smoking had similar relative frequency in subjects with and without adult ADHD. CONCLUSION: The prevalence of adult ADHD in this region of Iran seems to be substantially higher than expected or treated. This would require more attention to be drawn by health sector managers in order to improve the knowledge of the general population and the knowledge of the health care professionals about the disorder.

Evaluation of attention-deficit hyperactivity disorder risk factors.

Background. Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children. The aim of this study was to evaluate risk factors for ADHD in children. Method. In this case-control study, 404 children between 4 and 11 years old were selected by cluster sampling method from preschool children (208 patients as cases and 196 controls). All the participants were interviewed by a child and adolescent psychiatrist to survey risk factors of ADHD. Results. Among cases, 59.3% of children were boys and 38.4% were girls, which is different to that in control group with 40.7% boys and 61.6% girls. The chi-square showed statistically significance (P value < 0.0001). The other significant factors by chi-square were fathers' somatic or psychiatric disease (P value < 0.0001), history of trauma and accident during pregnancy (P value = 0.039), abortion proceeds (P value < 0.0001), unintended pregnancy (P value < 0.0001), and history of head trauma (P value < 0.0001). Conclusions. Findings of our study suggest that maternal and paternal adverse events were associated with ADHD symptoms, but breast feeding is a protective factor.

Psychiatric comorbidities in ADHD children: an Iranian study among primary school students.

BACKGROUND: This study was performed to determine the lifetime prevalence of psychiatric disorders concomitant with attention deficit/hyperactivity disorder (ADHD) among primary school students. METHODS: One thousand six hundred fifty-eight primary school students (781 females and 877 males) were selected in a cluster random manner in 2010. The first screening was performed by the Conner's teacher rating scale revised and Teacher ADHD rating scale-IV and then the students, in whom the ADHD was diagnosed by a child and adolescent psychiatrist according to DSM-IV-TR, were evaluated by K-SADS-PL semi-structured interview to detect the psychiatric comorbidities. RESULTS: The prevalence of psychiatric comorbidities in ADHD subjects was 62.5%. Oppositional defiant disorder (29.4%), specific phobia (21.9%), and enuresis (17.5%) were the most common comorbidities. The most common comorbidities in ADHD-IA (inattentive type) (n = 29) were specific phobia (34.5%), oppositional defiant disorder (20.7%), chronic motor tic disorder (17.2%), and enuresis (17.2%). The most common comorbidities in ADHD-HI (hyperactive/impulsive type) (n = 15) were chronic motor tic disorder (33.3%), oppositional defiant disorder (26.7%), and specific phobia (26.7%). The most common comorbidities in ADHD-C (combined type) (n = 116) were oppositional defiant (31.9%), enuresis (19%), and specific phobia (18.1%). The frequency of chronic vocal tic disorder was higher in ADHD-HI compared with ADHD-C (P = 0.01). CONCLUSION: The results of this study indicated that the frequency of other psychiatric comorbidities in primary school students with ADHD is high that may affect disease course and treatment. Hence, evaluation for other comorbidities in ADHD patients should be considered. 

Tourette's syndrome, chronic tics, and comorbid attention deficit/hyperactivity disorder in elementary students.

BACKGROUND: This study estimated the true prevalence of chronic motor and vocal tic disorders, and Tourette's syndrome in students as well as its comorbidity with attention deficit/hyperactivity disorder (ADHD). METHODS: A random clustered sample of elementary students was selected from schools in Tabriz, Iran. Students were screened by Conner's teacher rating scale for ADHD and a detailed history from parents and teachers for the presence of any type of tic was obtained. Next, a clinical interview based on the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), and an interview with parents lead to the definitive diagnosis. RESULTS: A total of 1658 children were evaluated. Vocal tic was observed in 3.2% (±SD = 0.02) students, and was more prevalent in boys. ADHD was diagnosed in 45.5% of these students. Motor tic was observed in 7.3% (±SD = 0.02) of students. Almost half (48.1%) of these students had ADHD. Tourette's syndrome was observed in 1.3% (±SD = 0.01), with a male/female ratio of 3.5:1. CONCLUSION: This is the first study to provide the prevalence of chronic tics in elementary school students in Iran. ADHD is more common among students with chronic tics and Tourette's syndrome.

The evaluation of relationship between group A streptococcal infection with tic disorders in children.

OBJECTIVE: To evaluate the relationship between group A beta hemolytic streptococcus infection (GABHS) and tic disorders in children. METHODS: This is a case-control study that was conducted in Child and Adolescent Psychiatric Clinic, Isfahan, Iran, between May 2008 and February 2009. Thirty-six children (aged 5-15) with tic and 36 children without tic and obsessive-compulsive disorder (OCD) were investigated for clinical and laboratory signs of GABHS. The tools utilized in this research were clinical interview according to the DSM IV-TR and laboratory tests (throat culture, rapid antigen detection test [RADT], anti streptolysin O [ASO] and yale global tics severity scale [YGTSS]). The control group was of the same gender and age as the tic group who had come to the clinic for other illnesses and was in need of blood test. None of the subjects in the case and control groups had a clinical history of GABHS infection. RESULTS: The relationship between tic disorder and GABHS infection (if any of these laboratory tests takes place: throat culture, RADT, ASO > or = 250) in the tic group was 16 (44.4%) and in the control group was 9 (25%), there were significant differences (p<0.05). No significant correlation was found between ASO titer and YGTSS scores. The specificity of RADT was 100%. CONCLUSION: The result showed correlation between GABHS infection and tic disorder, but it does not mean that GABHS infection caused tic disorder.