Treatment of bruxism with hydroxyzine.

OBJECTIVE: Bruxism or sleep jaw clenching and grinding of the teeth is an unresolved area in dentistry, psychiatry, and medicine. While many therapeutic approaches are introduced, nearly all of them are not effective or some of them are invasive approach. Three children with sleep bruxism treated with hydroxyzine are reported. STUDY DESIGN: The parents reported the severity of sleep bruxism in their children. All the children used to co-sleep with their parents. Hydroxyzine 10 to 25 mg per night was administered for all of the three patients. They were followed up for one to two months. None of them had any remarkable general medical condition or temporomandibular joint problem. RESULTS: The parents reported a significant reduction in the score of Visual Analog Scale (VAS) after taking hydroxyzine for one month. Drug adverse effect was not reported or found. CONCLUSIONS: These reports suggest that hydroxyzine may be effective for the treatment of bruxism in children. It is worthwhile conducting placebo-controlled studies investigating the possible role of hydroxyzine for the treatment of bruxism in children.  

A preliminary randomised double-blind placebo-controlled clinical trial of hydroxyzine for treating sleep bruxism in children.

This is a randomised placebo-controlled clinical trial investigating the efficacy of hydroxyzine for treating parent-reported sleep bruxism in children. Participants of this trial were 30 patients randomly allocated to one of the two groups in a ratio of 1:2. One group received hydroxyzine and the other group received placebo. The outcome measures were Visual Analogue Scale test and Clinical Global Severity scale. Assessments occurred at baseline and at the end of week 4. The side effects of drugs were assessed using a checklist. The number of children in the hydroxyzine and placebo groups was 21 and 9, respectively. The mean age of children in the hydroxyzine and placebo groups was 8·4(s.d. = 3·3) and 6·5(s.d. = 1·5) years, respectively. Hydroxyzine more than placebo decreased bruxism score (3·8 versus 2·2). No serious adverse effect was reported. Current evidence support that hydroxyzine is effective and well tolerated for treating bruxism in children.

Parents reported oral sensory sensitivity processing and food preference in ADHD.

Oral sensory processing in children with attention deficit hyperactivity disorder (ADHD) is an area with limited research. Oppositional defiant disorder (ODD) and separation anxiety disorder (SAD) symptoms usually co-occur with ADHD. This study investigates the association of oral sensory processing problems with ODD and SAD symptoms in children with ADHD. The parents of 189 children with ADHD completed Oral Over- and Underresponsivity Behaviors Inventory reporting oral overresponsivity (OR) and underresponsivity (UR) of their children. Only ODD score predicted OR scale score. None of ADHD severity, anxiety score, age and gender predicted OR score. UR scale score was only predicted by SAD and inattention scores. ODD score and hyperactivity/impulsivity score did not predict UR score. The ODD behaviour in children with ADHD needs to be evaluated and managed more extensively and it should include oral sensory occupational therapy. Future studies should extend this research to children with ADHD and obesity and food reward system.

Zinc for treating of children and adolescents with attention-deficit hyperactivity disorder: a systematic review of randomized controlled clinical trials.

This study systematically reviews the randomized clinical trials examining the effect of zinc on attention-deficit hyperactivity disorder (ADHD), searching the PubMed/Medline and Scholar Google databases. All randomized controlled trials that examined zinc as the intervention, and ADHD as the primary outcome were included. Only three randomized controlled trials, one which included a community sample and two that included clinical samples, met inclusion criteria. The only trial that was well controlled and randomized according to the baseline zinc level showed that using zinc, either alone or in combination with stimulants, did not improve ADHD. Considering the lack of clear evidence for the effect of zinc on ADHD and the possible effect of zinc on the nervous system, more clinical studies are needed to prove or disprove the effect of zinc as a monotherapy or adjuvant therapy.

Knowledge of and attitudes towards sexual and reproductive health in adults in Shiraz: a need for further education.

Sexual health influences general well-being and the overall quality of life of all men and women. This study in Shiraz, Islamic Republic of Iran, aimed to assess the level of knowledge of and attitudes towards sexual and reproductive health among adults. In a cross-sectional study in 2010, 276 men and 281 women were recruited at pre-marital counselling courses and completed a 33-item anonymous questionnaire in private. The overall level of knowledge of men and women was low. Both men and women had low scores on knowledge of genital anatomy, sexually transmitted infections and contraceptive use. The majority of participants had positive attitudes towards implementing educational programmes on sexual and reproductive health issues for young adults and prior to marriage. Efficient educational programmes providing up-to-date information about sexual and reproductive health are needed in the Islamic Republic of Iran.

Psychiatric problems and suicidal behaviour in incarcerated adolescents in the Islamic Republic of Iran.

Data are lacking about the prevalence of psychiatric disorders and suicidal behaviour in incarcerated adolescents in Asia. This cross-sectional study evaluated the prevalence of psychiatric disorders and the prediction of suicidal attempts in 100 incarcerated males aged 12-19 years in Shiraz. Data were collected in face-to-face interview using the Kiddie Schedule for Affective Disorders and Schizophrenia (Farsi version). The mean age was 16.8 (SD 1.3) years and mean age at first imprisonment was 16.0 (SD 1.5) years. Nearly 70% of the adolescents had at least one current psychiatric disorder, the commonest being: conduct disorder (55%), oppositional defiant disorder (48%) and attention deficit hyperactivity disorder (33%); 11% had major depressive disorder and 2% schizophrenia. In all, 20% had self-harmed without intent to kill themselves and 12% had attempted suicide, 50% of whom had tried more than once. In logistic regression analysis only self-harming behaviour and major depressive disorder were significant predictors of attempted suicide.

Glutathione-related factors and oxidative stress in autism, a review.

Autism spectrum disorders are complex neuro-developmental disorders whose neurobiology is proposed to be associated with oxidative stress which is induced by reactive oxygen species. The process of oxidative stress can be a target for therapeutic interventions. In this study, we aimed to review the role of oxidative stress, plasma glutathione (GSH), and related factors as the potential sources of damage to the brain as well as the possible related factors which reduce the oxidative stress. Methylation capacity, sulfates level, and the total glutathione level are decreased in autism. On the other hand, both oxidized glutathione and the ratio of oxidized to reduced glutathione are increased in autism. In addition, the activity of glutathione peroxidase, superoxide dismutase, and catalase, as a part of the antioxidative stress system are decreased. The current literature suggests an imbalance of oxidative and anti-oxidative stress systems in autism. Glutathione is involved in neuro-protection against oxidative stress and neuro-inflammation in autism by improving the anti-oxidative stress system. Decreasing the oxidative stress might be a potential treatment for autism.

Psychiatric problems and suicidal behaviour in incarcerated adolescents in the Islamic Republic of Iran

Data are lacking about the prevalence of psychiatric disorders and suicidal behaviour in incarcerated adolescents in Asia. This cross-sectional study evaluated the prevalence of psychiatric disorders and the prediction of suicidal attempts in 100 incarcerated males aged 12-19 years in Shiraz. Data were collected in face-to-face interview using the Kiddie Schedule for Affective Disorders and Schizophrenia [Farsi version]. The mean age was 16.8 [SD 1.3] years and mean age at first imprisonment was 16.0 [SD 1.5] years. Nearly 70% of the adolescents had at least one current psychiatric disorder, the commonest being: conduct disorder [55%], oppositional defiant disorder [48%] and attention deficit hyperactivity disorder [33%]; 11% had major depressive disorder and 2% schizophrenia. In all, 20% had self-harmed without intent to kill themselves and 12% had attempted suicide, 50% of whom had tried more than once. In logistic regression analysis only self-harming behaviour and major depressive disorder were significant predictors of attempted suicide

Are parent-reported repetitive and restricted behaviours associated with psychological problems in pre-school-aged children?

This study surveys the association of restricted and repetitive behaviours in pre-school children with their emotional and behavioural problems. Parents of 504 pre-school children selected by cluster sampling participated and filled in the questionnaires including repetitive and restricted behaviour (RRB) scale and the Strengths and Difficulties Questionnaire. The parents reported repetitive and restrictive behaviours are gender-related in pre-school-aged children. Hyperactivity and emotional problems are significantly in association with all the four types of repetitive and restrictive behaviours. Prosocial problems score is in association with 'reaction to change' subscale score. Children with higher scores of conduct problems have higher rates of 'sensorimotor stereotypies', 'reaction to change' and 'modulation insufficiency'. Pre-school children with a higher rate of RRBs are more hyperactive and have more emotional problems than those with lower rates of RRBs. Conduct problems are more common in children with 'sensorimotor stereotypies', 'reaction to change' and 'modulation insufficiency' problems. Repetitive and restricted behaviours are associated with mental health problems in pre-school-aged children.

Targeting Mitochondria by Olesoxime or Complement 1q Binding Protein as a Novel Management for Autism: A Hypothesis.

Excitotoxicity, oxidative stress, and mitochondrial dysfunction are associated with autism. Considering the preventive role of complement 1q binding protein or olesoxime for the opening of mitochondrial permeability transition pore mediated by oxidative stress, it is hypothesized that complement 1q binding protein or olesoxime may improve some symptoms of autism.

Predictors of different types of developmental coordination problems in ADHD: the effect of age, gender, ADHD symptom severity and comorbidities.

It is known that developmental coordination problems in children with ADHD are very common. However, it is not clear whether different subtypes of coordination problems are associated with ADHD comorbidities, inattentiveness severity, and impulsivity/hyperactivity severity. A clinical sample of 122 children and adolescents with ADHD and their parents were interviewed. The parents completed the validated and reliable Farsi version of DCD-Q regarding their children. The internal reliability of the DCD-Q was high for the full scale and the subscales. The confirmatory factor analysis indicated that the fit for the hypothesized factor structure of the DCD-Q was poor. Linear regression analysis indicated that the scores of validated DCD-Q in children with ADHD, except for the fine motor/hand writing score, were not predicted by the variables of gender, handedness, age, inattentiveness score, hyperactivity/impulsivity score, and oppositional defiant behavior score. The fit for the hypothesized factor structure of the DCD-Q is poor in children with ADHD. Fine motor/hand writing was predicted by inattention severity. The other subtypes of developmental coordination problems in children with ADHD cannot be attributed to the variables of gender, inattentiveness severity, hyperactivity/impulsivity severity, comorbidity with separation anxiety symptoms and oppositional defiant behavior score, and handedness.

Loss of taste and smell during treatment with topiramate.

Topiramate has already been suggested for treatment of olfactory hallucination. This is a report of a three and a half-year-old boy with idiopathic generalized tonic colonic epilepsy. He had lost his ability to detect and recognize taste and odor during treatment with topiramate. Those abilities improved after discontinuation of topiramate.

Major depressive disorder in children and adolescents after renal transplantation.

This cross-sectional study evaluated the prevalence of major depressive disorder and depressive symptoms in children and adolescents after renal transplantation. A total of 71 patients who had undergone renal transplantation were interviewed in person using the Farsi (Persian) version of the Kiddie Schedule for Affective Disorders and Schizophrenia and Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria. Major depressive disorder, depressive symptoms, and suicidal behaviors were assessed. The rate of major depressive disorder was 2.8%; two-thirds of the patients had irritability; and approximately 40% had recurrent thoughts of death and suicidal ideation. The rate of major depressive disorder was lower than in other chronic diseases such as thallasemia or hemophilia; however, the rate of suicidal behaviors was high.

Depression, anxiety and suicidal behaviour in children and adolescents with Haemophilia.

It was aimed to study the prevalence of major depressive disorder, separation anxiety disorder and suicidal behaviour in the children and adolescents with haemophilia. A total of 83 children and adolescents with haemophilia A or B aged 5-19 years old were randomly selected using systematic random sampling method. They were interviewed using the Farsi (Persian) version of Kiddie Schedule for Affective Disorders and Schizophrenia by face-to-face interview with the subjects and their primary caregivers, according to the DSM-IV diagnostic criteria. Major depressive disorder, separation anxiety disorder and suicidal behaviour were surveyed. The rate of major depressive disorder was 6.0%. Approximately 2.4% of the patients were suffering from at least five symptoms of major depression, and 4.8% were suffering from more than five symptoms of major depressive disorder. One-third of the children and adolescents were suffering from irritability. Approximately 36% of the subjects wished to die at least once during the last 6 months. Also, 6% of the subjects had thought about suicidal attempt. Approximately 4.8% of them met the criteria of separation anxiety disorder. The incidences of major depressive disorder and separation anxiety disorder were comparable to that prevalent in the thalassaemic patients. The proportion of patients with death wish was very high. The proportion of patients with suicidal thought and attempt was much lower than that in the children and adolescents with thalassaemia. Therefore, psychiatric consultation needs to be included in the management of these children.

Frequency of and barriers to utilization of mental health services in an Iranian population.

This study in 2005 compared the need for mental health services, actual use of services and barriers to use by 3 groups in Shiraz city in the Islamic Republic of Iran: a sample of the general population, parents of children with mental illness and primary-school teachers. Among the general population, 76.0% reported that they had wanted help in the previous 6 months and, of these, 50.0% actually sought it. The rates for parents of children with mental problems were 81.3% and 55.4% and for teachers were 60.0% and 35.0% respectively. The most common barriers to service use were logistic, especially the cost of and inconvenient access to services. Barriers related to perceptions of mental health services were also important, such as lack of trust and perceptions of friends/family.

Knowledge of pharmacists regarding ritalin and ADHD and their attitude towards the use of ritalin to treat ADHD.

OBJECTIVE: To survey the knowledge and attitude of pharmacists towards Attention Deficit Hyperactivity Disorder (ADHD) and the drug ritalin. METHOD: A self-reported questionnaire on knowledge and attitude towards ADHD and ritalin was completed by pharmacists. RESULTS: About 40% of respondents agreed that ADHD is due to biological and genetic vulnerabilities and causation. A total of 63% reported that the cause is a chaotic and dysfunctional family and 91% of the respondents believed that ADHD children misbehave primarily because they refuse to follow rules and complete assignments. About 85.5% reported that ritalin is used for enhancement of concentration and most of them (80%) recommended ritalin as the best medication. However, about 70% reported that they are not in favor of taking ritalin for ADHD and it should not be recommended for ADHD except in very severe cases. CONCLUSION: Although the subjects have a sound knowledge of ADHD, some gaps exist and there is not a favorable attitude toward treatment with ritalin. It seems that these pharmacists are not better informed than teachers in regard to some of ADHD characteristics. There is a gap between knowledge and attitude toward ritalin. Only a few respondents had the opportunity of learning about ADHD. The results could be used in the revision of university educational curricula for students of pharmacology and also for planning educational courses for continuous medical education programs. They should be provided with more up-to-date knowledge.