[Clinical characteristics and diagnostic stability of bipolar disorder in children and adolescents]

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 wasAttention 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.

[ efficacy of an integrated treatment in comparison with treatment as usual in a group of children and adolescents with first-episode psychosis during a two -year follow-up]

This study aimed to compare the efficacy of an integrated treatment [IT] versus treatment as usual [TAU] in a group of inpatient children and adolescents with first episode psychosis [FEP] during a two year follow up. In a randomized controlled trial, 40 children and adolescents with FEP based on DSM-IV criteria were recruited from referrals to Robe Hospital [Tehran, Iran]. They were divided into a TAU group [N=20], and an IT group [N=20] who received a low dose of atypical antipsychotic medications and family psycho-education program, and were followed up by telephone contacts. All participants were evaluated at admission and discharge as well as in 6, 12, 18 and 24 month intervals using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Persian Version [K-SADS-PLPV], Positive and Negative Syndrome Scale [PANSS], Young Mania Rating Scale [YMRS], Children's Depression Inventory [CDI], Hamilton Depression Rating Scale [HAM-D], Global Assessment of Functioning Scale [GAF], and Children Global Assessment Scale [CGAS]. Statistical methods consisted of analysis of independent t and x[2] for qualitative variables, and random effect regression model for quantitative variables. The two groups showed significant improvement in all outcome measures at different time-points. The rate and duration of recurrences were lower in the IT group compared to the TAU group. All of the other outcome measures were comparable in the two groups and there was no difference between them in different follow-up periods. Integrated treatment may decrease the rate and duration of recurrences in children and adolescents with FEP

[Short-time outcome predictors of bipolar disorder type I in children and adolescents]

This study aimed to evaluate the three and six month clinical and demographic outcome predictors [recurrence rate, the rate of hospitalization, severity of illness and recovery rates] in a group of children and adolescents with type I bipolar disorders. The participants of this longitudinal and prospective study were 80 children and adolescents admitted in Roozbeh Hospital, Tehran, Iran with a diagnosis of type I bipolar disorder. Consecutive referrals were included in a prospective cohort. The participants were evaluated at admission, discharge, and follow-up at 3 and 6 months, using demographic questionnaire, Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Persian Version [K-SADS-PL-PV], Young Mania Rating Scale [Y-MRS], Children Depression Inventory [CDI], Beck Depression Inventory [BDI], and Clinical Global Impression [CGI]. The Pearson correlation coefficient and multivariate regressions were used for data analysis. The 6-month follow-up showed that there was a positive correlation between the severity of mania with male gender [p=0.01] and the severity of mania at admission [p=0.04]. The rate of recurrence at the 6-month follow-up was correlated [p=0.05, r=0.22] with psychosis at admission. The duration of untreated disorder [p=0.03] had a positive correlation with the severity of global impairment at the 6 month follow-up. This study confirms the role of some demographic and clinical features in predicting the course of disease and response to treatment

Normative data and psychometric properties of the child behavior checklist and teacher rating form in an Iranian community sample

The objective of this study was to determine the normative data and psychometric properties of the parent and teacher rating form of the child behavior checklist [CBCL] in an Iranian community sample. A sample of 6-12 year old students was randomly selected from ten elementary schools in Tehran, Iran. The parent's and teacher's versions of CBCL were accomplished. Clinical interview and the kiddie schedule for affective disorders and schizophrenia - present and lifetime version, Persian version [K-SADS-PL-PV] were used to evaluate the validity and the cut-off point of CBCL and the teacher rating form [TRF]. Among 600 recruited students with mean age of 9.11 years [SD=1.45], 54.16% were girls [n=325]. Girls had significantly lower scores in Attention Problems, Delinquent Behavior, Aggressive Behavior, Externalizing and Total Problems than boys [P<0.01]. The relation was significant between the CBCL Internalizing and students' ages [beta =0.124, P=0.002]. The Internal consistency, the correlation among the CBCL and TRF scales, and the inter-rater correlations for CBCL/TRF scales were good to high for most indices and subscales. Based on the receiver operating characteristics [ROC] analysis the best convergences were between the CBCL Attention Problems subscale and attention deficit hyperactivity disorder [ADHD] diagnosis, the CBCL Total Problems and any disorders, the CBCL Externalizing and ADHD+ODD diagnosis. The sensitivities and specificities of the CBCL subscales were higher than the TRF except for Externalizing/ADHD+ oppositional defiant disorder [ODD] which was reverse. These results support the multicultural CBCL/TRF findings. CBCL is a useful instrument to consider ADHD and any disorders in community samples

[Is early sex reassignment in ambiguous genitalia reasonable?]

Ambiguous genitalia is a medical emergency in newborns and effort is made to perform sex reassignment and reconstructive surgery as soon as possible. However, conflict between the assigned sex and later gender identity are still present in many cases. This discrepancy between sexual and gender identities leads to several complications that are the focus of the present study. The literature review was performed by searching some knowledge-based databases such as Medline/PubMed [from the National Library of Medicine], Scopus, PsyClic and the Iranian Scientific Information Database [SID] on the internet and all the available articles in relevant journals published up to August 2009. A significant number of intersex individuals suffer from incoherence between the sex reassigned to them by the medical team, and their gender identity revealed to them in teen ages or adulthood. As an adult, a large number of these individuals do not live according to their early reassigned sex and some may seek further sex reassignment congruent to their gender identity. A number of these cases have spoken out against the treatments performed during their childhood. They believe that the current treatment strategies for intersex individuals are paternalistic and incompatible with codes of medical ethics and human rights. The current knowledge about the complexities of sexual identity development, gender identity, gender role and sexual orientation is sparse and incomprehensive. The current approach for the management of infants with ambiguous genitalia seems to need major reevaluation. It seems better to defer any sex reassignment and reconstructive surgery until their gender is revealed and they are legally eligible to decide about these issues by themselves

[Effect of the positive parenting program on parents of children with attention deficit hyperactivity disorder]

The efficacy of the positive parenting program for parents of children with behavior problems was confirmed in several studies. Yet, such studies have not been conducted for children with attention deficit hyperactivity disorder [ADHD] in Iran, so we decided to evaluate it because of high frequency of the problem. In this clinical trial study, sixty mothers [30 in each control and intervention groups] who had at least one child with clinically diagnosed ADHD and aged between 6 to 12 years old were recruited from the consecutive referrals to the child and adolescent psychiatric clinic of Ruzbeh hospital, Tehran, Iran. The mothers in two groups were matched in some demographic variables. Mothers in both groups completed the battery of self-report questionnaires of study at the beginning and after the 8[th] session. The discrepancies of pre and post intervention were compared between two groups by SPSS software using repeated measure ANOVA statistical method. Intervention group was associated with significantly lower levels of child behavior problems in Conners' scale and ADHD rating scale [P<0.001]; here, parents reported lower levels of dysfunctional parenting than the control group [P<0.001]. The parents in intervention group had significant improvement on measures of depression, anxiety and stress in comparison with the control group [P<0.001]. They also showed significant improvement in all items in strengths and difficulties questionnaire [SDQ] scale except conduct problems in comparison with the control group [P<0.001]. According to the findings of this study, implication of positive parenting program for parents of children with ADHD is recommended to reduce the problem behavior of kids and to improve their abilities

[Compare the efficacy of lithium carbonate and sodium valproate in treatment of bipolar children and adolescents in acute phase [mixed and mania] treatment at Roozbeh hospital]

To compar the efficacy of lithium carbonate and sodium valproate in treatment of bipolar children and adolescents in acute phase [mixed and mania] in 6 week treatment at Roozbeh hospital. A double-blind and randomized controlled clinical trial in 30 patient [8-18 years] for a 6 week trial patients were diagnosed based on DSM-IV criteria through clinical interview and K-SADS. MRS and CGAS were used to measure the severity of symptoms and the level of functional impairment patients categorized into 2 groups randomly. In both groups means of MRS decreased [at the end of 3[rd] and 6[th] weeks] and there was no significant difference between two groups. Means of CGAS had significant difference between two groups at 3[rd] week [p<0.05]. patient who received sodium valproate had more improvement in function, but it was not at end of 6[th] week. The study demonstrated the same amount of decrease in sign and severity of symptoms and the same improvement in global functioning in tow groups. It seems that the efficacy of lithium carbonate and sodium valproate in acute phase of bipolar disorder is the same greater improvement of functioning at the end of the 3[rd] week in valproate group comparing to the lithium group suggests that sodium valproate may act faster than lithium carbonate. This replicate in future research

[Reliability of the Persian translation of the composite international diagnostic interview [CIDI] for diagnosing schizophrenia and bipolar disorder]

This study aimed to assess the reliability of the Persian version of the Composite International Diagnostic Interview [CIDI] for a lifetime diagnosis of schizophrenia and bipolar disorder according to DSM-IV and lCD-10. This project was conducted at three stages of translation of the instrument, reliability assessment and validation, and feasibility and diagnostic reliability assessments for bipolar disorder and schizophrenia using a test-retest methodology. Trained interviewers administered the instrument twice [at 3-7 days' interval] to 100 clients at four university centers [complete CIDI on 65 persons and psychosis/mania module on 35 persons]. Test-retest reliability of CIDI for bipolar disorder was moderate in DSM-IV diagnostic system and poor in ICD-10. Test-retest reliability of CIDI for schizophrenia was poor in both diagnostic systems. The results showed that the diagnostic reliability was good only for bipolar disorder in DSM-IV, otherwise it was not acceptable. However, since the samples were selected from the clinical population, the results cannot be generalized to the normal population. According to the results, adaptation of the key questions to the Persian culture must be considered

[Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV [SCID]]

In this study the Structured Diagnostic Interview for DSM-IV axis I disorders [SCIDI] was translated into Persian using a cross-cultural methodology, and its reliability and feasibility was tested in a multi-center study. The study had two phases: a] translation of the instrument and assessing the cross-cultural equivalence, including forward and backward translation, and face validity of the translated version in regard with cross-cultural characteristics; b] reliability and feasibility assessment of the Persian translation on an Iranian clinical population. This is part of a larger study on validation of the SCID on 299 subjects admitted to outpatient and inpatient services of thee psychiatric centers [Roozbeh Hospital, Imam Hossein Hospital and Iran Hospital] in Tehran, Iran. For test-retest reliability assessment, two SCID interviews [3 to 7 days apart] were administered to 104 subjects and the level of diagnostic agreement was assessd. Feasibility for interviewees [n=299] and interviewers was tested by questionnaires considering the length of interview, its being boring/tiring, comprehensibility and acceptance of the questions, and difficulty of administration. Diagnostic agreement of SCID test and retest were fair to good for most diagnostic categories [kappas over 0.6]. Overall weighted kappa equaled 0.52 for current diagnoses and 0.55 for lifetime diagnoses. Most interviewees and interviewers reported the administration of the Persian SCID as feasible. Acceptable reliability of diagnoses made by the Persian translation of SCID, and its feasibility suggest it as a useful diagnostic instrument in clinical, research, and educational settings

[Anger management group therapy with cognitive behavior approach in institution adolescents]

This study aimed to assess the effectiveness of group therapy with cognitive behavior approach for anger management on institution adolescents. The study was a controlled clinical trial on orphan children who lived at institutions of the Welfare Organization. The subjects were assessed prior to the intervention as well as one week after the eighth session of therapy using the Adolescents Anger Rating Scale [AARS]. Of 40 subjects, 16 were placed in the case group and 24 were the controls. Cases and controls matched in regard with age, gender, education, and pre- intervention AARS scores. In the case group, anger management group therapy was associated with lower reactive anger [with borderline significance] and insignificant lower overall anger score and instrumental anger. The overall, instrumental, and reactive anger and anger management scores did not differ in cases and controls. In the case group, reactive anger was reduced significantly in girls as compared to boys. Most of the study variables showed improvement, although not statistically significant probably due to the small sample size. Since this study was the first of the kind, the researchers recommend that the results can be used for future studies