[ 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

Training health professionals to conduct family education for families of patients with first-episode psychosis: adherence to protocol

The implementation of family psychoeducation at the service delivery level is not without difficulty. Few mental health professionals receive special training to work with families especially in Iran. The aim of the present study was to evaluate the effectiveness of training health professionals in terms of their adherence to protocol. Eight professionals [general practitioners, nurses and social workers] participated in a training program for health professionals as part of the Roozbeh First-Episode Psychosis Program [RooF] to conduct family psychoeducation. Training included a 3-day- workshop and 12 supervision sessions during the course of the implementation of the psychoeducation program. The family psychoeducation sessions [multiple-family group or single-family home-based] were tape-recorded. Transcripts of the audiotaped sessions were analyzed based on the content of the manual and were scored accordingly. Twenty-four recorded sessions were analyzed in terms of the adherence to protocol, the number of questions and the time for each session. The overall rating showed a 72% adherence to the protocol. Multiple-family group sessions had a higher rate compared to the singlefamily home-based family psychoeducation sessions [79% to 69%] as well as the time spent and questions asked. The rate of adherence to the protocol of conducting the family psychoeducation sessions had not changed over time. Considering the amount of time taken for training and supervision, the level of adherence to the protocol was satisfactory. Tape recording sessions and regular supervision would be beneficial following specialized training. Further research is needed to tailor the amount of training and supervision required for professionals to conduct family psychoeducation programs in different settings

Anxiety disorders in multiple sclerosis: significance of obsessive-compulsive disorder comorbidity

Considering reports on the associations of symptoms of anxiety disorders with multiple sclerosis [MS], this study aimed to 1] further evaluate various anxiety disorders systematically presenting in patients with MS and 2] compare the results with a control group. To assess anxiety disorders in patients with MS in a case-control study, 85 registered patients in the Iranian Multiple Sclerosis Society [IMSS] were randomly selected according to the inclusion criteria. A group of healthy individuals whose age and gender were matched with the case group were also selected. Both groups underwent a clinical interview based on DSM-IV diagnostic criteria. Frequency of diagnosis of all anxiety disorders in the two groups was 22.4% and 7.1%, respectively, indicating a statistically significant difference. Frequency of obsessive-compulsive disorder [OCD] was significantly higher in the case group [P < 0.05]. Relation of university education with the diagnosis of generalized anxiety disorder was significant too [P < 0.05]. OCD in patients with MS was more frequently observed than in the control group

[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