nastaran habibi

Disruptive and conduct behaviors are the most common conditions used to help adolescent patients refer to mental health clinics for counseling. The prevalence of this disorder is increasing and it is necessary to concentrate on this topic. The comorbidity of conduct disorder (CD) with other emotional and behavioral problems is common. One of the comorbidity disorders for which contradictory results are reported is attention deficit hyperactivity disorder (ADHD). Several studies have demonstrated the comorbidity of these two disorders in patients with a younger age of onset, more severe symptoms, and more stable disease. Hence, this study determines the prognostic value of the Minnesota multiphasic personality inventory adolescent-restructured form (MMPI-A-RF) for CDs and investigates the effect of comorbidities, such as ADHD.

The sample of the present comparative casual study consisted of 295 adolescents who were selected by purposeful sampling, based on the current and the Kiddie schedule for affective disorder and schizophrenia-present and lifetime for school-age children (6-18 years old) and the final version of the MMPI-A-RF questionnaire. The Mean±SD of all the MMPI-A-RF scores were compared among three groups of patients with CD (n=40), patients with a comorbid diagnosis of conduct disorder and ADHD (n=68 people), and patients with other psychiatric disorders (mood and anxiety disorders). Analysis of variance was used to determine the significance of differences among the three groups. If the deviations were significant, the Games–Howell post hoc test was used to inspect differences between the groups.

The comparison of CD and CD+ADHD patients with other disorders revealed meaningful differences in almost all the indicators related to externalizing problems. The CD+ADHD group had markedly greater scores on the scales of antisocial behaviors (P<0.001), aggressive-revised personality (P<0.001), and conduct problems (P<0.001) compared to the CD group and other psychiatric disorders group.

The results are consistent with the background and revealed more severe symptoms and more functional degradation in the CD+ADHD group compared to the CD and other psychiatric disorders group. This subgroup can have different risk symptoms, clinical courses, and drug responses. MMPI-A-RF can supply valuable information about the comorbidity of psychiatric disorders.

In order to have more effective programs and social interventions controlling the burden of diseases, it is necessary for policy makers to have valid evidence about the role of socioeconomic determinants. The present study aimed to provide empirical evidence about the relationship of socioeconomic inequalities and the availability of resources with the burden of diseases among the provinces of the country in 2019.

This descriptive and analytical research was carried out using the provincial data of 2019. The required provincial data were extracted from the Statistical Yearbook Report and the Household Income Expenditure Report of the Statistics Center and the data related to adjusted years with disability and early death (DALI) from the 2019 disease burden estimates. DALY's inequality was investigated by estimating the concentration index and extracting the concentration curve at a 95% confidence interval. The analyses were carried out in the Stata software (version 15).

In 2019, the average per capita DALY was 18.33±3.98. The average socio-economic index and resource availability index for 31 provinces were obtained at 0.37±0.21 and 0.64±0.20, respectively. Considering the difference in the available resources (covariate), there was a statistically significant difference between the socio-economic quartiles in terms of the distribution of per capita DALY (P<0.01). Therefore, the effect size of belonging to the socio-economic quartile was 0.758 (P<0.01). Nonetheless, the effect size of the difference in resource availability was not statistically significant.

Health policymakers at national and provincial levels should try to reduce inequality by promoting programs to encourage healthy lifestyles, developing universal access to early screening services, and preventing the causes of death.

The aim of this study was to investigate the effectiveness of organizational training skills program on homework management efficiency of children with attention deficit hyperactivity disorder (ADHD).

This study was quasi-experimental with pre-test, post-test and a control group. The sample consisted of 40 boys with ADHD, in age range of 7 to 13 years old and their parents, in academic year of 2020-2021 in Tehran province. The sample size was calculated using the estimation formula (Richard, 1988), the probability of the first type error was 0.05, the probability of the second type error was 0.20, the test power was 0.80 and the effect size (d = 0.49) was 40 persons. The sample was randomly selected from one of those clinics which were admitting and treating ADHD children. Children were chosen by the entering and exiting criteria and randomly put in two groups: experiment and control (each group consisted of 20 boys). Based on behavioral and individual perspective of each boy the instruction and training had been applied in 20 sessions (including organizational skills, organizational behaviors in home, family conflict, the problems of not doing homework and etc.) (Abikoff, Gallagher,2008). Three instruments were used in this study: Coolidge (2002), Brief executive function (2000), and Barkley executive function (2012) questionnaires The data were analyzed by Multivariate Covariance Analysis (MANCOVA) and the statistical analysis was performed by SPSS software version 23.

The results showed that the level of organizational problems of ADHD students of experimental group had been lessoned significantly by training homework management skills in compared with control group. Scores of the three tests indicated a significant difference between pre-tests and post- tests; (F(1,32)=20.97, P< 0/001) , (F(1,32)=14.78, P= 0/001), (F(1,32)=20.16 ، P< 0/001) .

The findings of this study indicated that the organizational training skills program could reduce the efficiency problems of homework organization and management of students with ADHD.

Millions of children are left to survive on the streets around the world. Investigations on drug use disorders among street children reveal that they not only abuse all types of drugs higher than their peers who live at home or in shelters, but also they abuse more harmful drugs such as injection drugs or methamphetamines. This guideline provides a comprehensive approach to the treatment and management of substance use disorders among children of 3 to 18 years of age for the staff of substance use disorder clinics. It highlights examples of how to perceive and approach the management and issues of substance abuse among street children at an early stage of development through various medical, psycho-social, and other interventions. It also defines the characteristics of the street children with a focus on prevention. These provisions consist of addressing the applicability matters in this area and necessity of a decision model in our country.

In the treatment of bipolar disorder in youths, often more than one medication should be prescribed. In the current study, we compared the efficacy and tolerability of the combination of lithium and quetiapine with lithium and risperidone in the treatment of manic or mixed episodes in children and adolescents.
Thirty patients (aged 10-18 years) who were hospitalized for a manic or mixed episode were recruited from consecutive inpatient admissions to the Child and Adolescent Psychiatric Unit at Razi Psychiatric Hospital (University of Social Welfare and Rehabilitation Sciences, Tehran, Iran) from June 2012 to September. They were randomly treated with lithium (with the usual dose to achieve blood levels 0.8-1) and quetiapine (400-600 mg per day) or risperidone (0.5-6 mg per day). The primary outcome measure with respect to efficacy was the mean decrease in Young Mania Rating Scale (YMRS) score. Side effects were also assessed. The independent t test and two-factor repeated measure analysis of variance (ANOVA) was used for data analysis. P-value of less than 0.05 was considered statistically significant.
The reduction in YMRS scores was similar in both groups. The remission rate (YMRS Both protocols were effective. Quetiapine in combination with lithium in manic or mixed episodes of bipolar I disorder in children and adolescents was not superior to lithium and risperidone, but was associated with fewer complications.

Knowledge and attitude of parents about attention deficit/hyperactivity disorder (ADHD) is an important factor in management of the disorder in children. This study investigates the parents’ knowledge and attitude towards ADHD, its symptoms, diagnosis, treatment and prognosis.
In this cross-sectional descriptive study, the subjects were 150 parents (120 mother and 30 father) of ADHD children who were referred to a child psychiatry clinic affiliated in university of social welfare and rehabilitation sciences in Tehran. The diagnosis was made by a child psychiatrist according to DSM-IV TR criteria. The parents completed a 40 items questionnaire that was prepared by the authors and assessed their knowledge and attitude towards ADHD and source of their information.
The most common source of parent’s information about ADHD was TV. The parent’s knowledge about the symptoms of the disorder was relatively good. But in regard to diagnosis, treatment and prognosis of the disorder, they have very low knowledge and even incorrect beliefs. The parent’s knowledge significantly correlated with their educational level (p=0.01).
In general, knowledge of the parents was low and it can lead to misdiagnosis or mismanagement of this common and important disorder and need to further consideration in terms of educating parents about the disorder in media specially TV.

Attention-deficit/hyperactivity disorder (ADHD) is a common and mostly chronic mental health condition that affects children, adolescents, and adults. Stimulants and atomoxetine are first-line agents for the treatment of ADHD. Despite the impressive track record of stimulants in the treatment of ADHD, they fail in 25% of patients due to lack of efficacy or the emergence of unwanted side effects. Accordingly, this study carried out to compare efficacy and safety of duloxetine (a serotonin and norepinephrine reuptake inhibitor) and methylphenidate (a short acting stimulant) in the treatment of children with attention-deficit/hyperactivity disorder.
Twenty-four children diagnosed with ADHD participated in this 6 weeks open clinical trial. Patients were between 6 to 11 years old that had been referred to psychiatry clinic at Akhavan and Rofide Medical and Rehabilitation Center in Tehran from September 2012 to July 2014. Diagnosis was made by two child psychiatrist according to DSM-IV TR criteria. Thirteen patients received duloxetine and others received methylphenidate. Conner’ parent rating scale-revised-short form (CPRS-RS) and ADHD-rating scale (ADHD-RS) were used at the beginning and then each two weeks to assess efficacy of treatment. Routine laboratory tests and electrocardiogram (ECG) was carried out in the beginning and end of the trial.
Twenty children with ADHD completed the study (Ten in methylphenidate and ten in duloxetine group). In both groups, scales of CPRS-RS and ADHD-RS were reduced from baseline to endpoint, but this reduction in methylphenidate group was significantly greater than duloxetine group (P= 0.000). The most common side effect was gastrointestinal problems in duloxetine group and anorexia in methylphenidate group. No serious side effects and no changes in laboratory and ECG indexes were seen in both groups.
Duloxetine is not efficacious as well as methylphenidate in treatment of children with ADHD. Although more research are needed to achieve more accurate results.

Stimulants are first-line agents for the treatment of attention-deficit/hyperactivity disorder (ADHD). Despite the impressive track record of stimulants in the treatment of ADHD, they fail in 25% of patients due to lack of efficacy or the emergence of unwanted side effects.. In this study, we investigated the efficacy and safety of duloxetine, a serotonin and norepinephrine reuptake inhibitor, in the treatment of children with attention-deficit hyperactivity disorder (ADHD)..Patients and In an open label clinical trial, 13 children aged 6 – 11 years diagnosed with ADHD were prescribed 30 mg/day duloxetine once daily by oral administration for six weeks. Conners Parent Rating Scale-Revised-Short form (CPRS-R-S) and the ADHD Rating Scale were used to assess the efficacy of the treatment.. Ten children with a mean age of 8.40 ± 1.67 years terminated the trial. A significant reduction in CPRS-R and its subscales was evident from week four of the study. In terms of side effects, duloxetine was generally safe and well tolerated.. This preliminary assessment suggests that duloxetine may be a medication of interest in the treatment of children with ADHD. Further controlled studies with larger samples are required to evaluate the efficacy of duloxetine in treatment of children with ADHD..

The aim of this study was to evaluate the clinical characteristics and diagnostic stability of children and adolescents with bipolar disorder.

In this prospective study, 257 subjects with bipolar disorder who were consecutively admitted to Roozbeh Hospital (Tehran, Iran) were enrolled. Demographic characteristics, diagnosis, treatment, comorbid disorders and mood and psychotic symptoms were extracted from the patients’ admission files and the information questionnaire, which had been filled in the admission time by the patients. In the further assessment, diagnostic evaluation was done using the Schedule for Affective Disorders and Schizophrenia for School-aged children present and lifetime version (K-SADS-PL), for the patients under 18, and the Schedule for Affective Disorders and Schizophrenia (SADS) for the patients older than 18. Severity of the symptoms in the acute phase of mood disorder was evaluated by the Young Mania Rating Scale (Y-MRS) in manic phase and Beck Depression Inventory (BDI) for patients older than 16 or Children Depression Inventory (CDI) for the patients under 16 in depressive phase. Also, current and past levels of functioning were evaluated by the Global Assessment of Functioning (GAF) scale for patients older than 18 and the Child Global Assessment Scale (CGAS) for the patients under 18.

The most common symptom, irritability, was accompanied by elated mood in most cases. 73.2% of the patients had at least one comorbid disorder and the most common comorbid disorder was Attention Deficit Hyperactivity Disorder (44.2%). Diagnostic stability in all periods of illness was higher than 80%.

This study supports the high diagnostic stability of bipolar disorder in both children and adolescents.

Depression is a major health problem, which is not only underrecognized and undertreated, but is also associated with significant morbidity and mortality. It has been suggested that combination therapy rapidly reduces depressive symptoms in patients with moderate to severe depression and is more effective than monotherapy; but this suggestion remains controversial. Serotonergic and noradrenergic enhancement may be synergistic and more effective than serotonergic enhancement alone in the management of depression. The objective of this double blind, placebo-controlled study was to investigate the efficacy and tolerability of the combination of citalopram and nortriptyline for the treatment of moderate to severe major depression. 45 patients, who met the DSM-IV criteria for major depressive disorder based on the clinical interview, were included in the study. Patients had a baseline Hamilton Depression Rating Scale score of at least 20. In this trial, patients were randomly assigned to receive nortriptyline 50 mg/day plus citalopram 40 mg/day (group1) or placebo plus citalopram 40 mg/day (group2), for an 8 week, double-blind, placebo-controlled trial. Both protocols significantly decreased the score of Hamilton Depression Rating Scale over the trial period, but the combination of nortriptyline and citalopram showed a significant superiority over citalopram alone in the treatment of moderate to severe major depressive disorder (t = 3.34, d.f. = 36, P = 0.001). The difference between the two groups in the frequency of side effects was not significant. The results of this study suggest that combination of nortriptyline and citalopram is more effective than citalopram alone in the treatment of depression. This advantage is probably the result of reuptake inhibition of both serotonin and norepinephrine