Iranian Traditional Medicine for Treatment of Attention Deficit Disorder with Hyperactivity in Children: A Systematic Review of Randomized Controlled Trials.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a complex etiology. Stimulants as a first-line treatment are not effective in some cases. In this study, we conducted a systematic review to evaluate the efficacy of traditional Persian Iranian medicine (TIM) for children and adolescents with ADHD. Methods: Data were collected mainly from PubMed, Google Scholar, Web of Science, ProQuest, and Scopus databases until Dec 2022. The keywords related to ADHD, traditional Persian medicine (TPM), and (TIM) were searched. Two reviewers independently screened 714 abstracts and eventually, eight trials were included in the systematic reviews. Changes in the severity of ADHD symptoms were considered based on the validated cutoff on recognized rating scales as the result of the effect of TIM on ADHD. Results: Interventions included herbal extracts of Passiflora incarnate, whey protein, Ginkgo biloba, Crocus sativus L, sweet almond syrup, and horse milk. In all studies, except G. biloba, there was evidence of a reduction in the severity of ADHD. Low evidence could be found for G. biloba. Conclusion: Herbal and traditional remedies are an efficient and safe solution to alleviate the symptoms of ADHD. In future studies, TIM as a complementary therapy may be useful to alleviate ADHD symptoms, especially in children who are resistant to stimulant medications.

A randomized controlled trial of Vitamin D supplementation in Iranian patients with schizophrenia: Effects on serum levels of glycogen synthase kinase-3ß and symptom severity.

BACKGROUND: Growing evidence has shown that hypovitaminosis D is a risk factor for developing schizophrenia and comorbid conditions. Therefore, this study aimed to examine the effect of vitamin D supplementation on serum levels of vitamin D, metabolic factors related to insulin resistance (IR) and the severity of the disorder in patients with schizophrenia. METHODS: Forty-eight chronic male patients with schizophrenia with vitamin D deficiency (≤20 ng/mL= (≤50 nmol/l) were selected and randomly assigned to vitamin D treatment and placebo groups. Subjects were supplemented for 8 weeks with vitamin D (2000 IU/day) or placebo. RESULTS: Within-group comparison revealed that the vitamin D group had a significant reduction in waist circumference, Positive and Negative Syndrome Scale - total score (PANSS-TS), and glycogen synthase kinase 3 beta (GSK-3ß) levels (P = .022, P = <.001 and P = .013, respectively). On the other hand, the placebo group showed a significant increase in the level of fasting serum insulin and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (P = .003 and P = .003). The between-group comparison showed a significant difference in terms of PANSS-TS, GSK-3ß, fasting serum insulin (FSI), and HOMA-IR (P = .022, P = .048, P = .013 and P = .014 respectively). CONCLUSIONS: Among vitamin D deficient patients with schizophrenia, vitamin D supplementation may affect GSK-3 ß, an important biomarker in schizophrenia and insulin resistance. In addition, vitamin D supplementation in such patients may reduce the disorder's symptom severity.

The Therapeutic Effect of Electroconvulsive Therapy in Patients With Obsessive-compulsive Disorder: A Quasi-experimental Study.

Introduction: Electroconvulsive therapy (ECT) is an effective treatment for some psychiatric disorders. It is postulated that ECT should primarily be considered for patients with treatment-resistant obsessive-compulsive disorder (OCD) in the context of major depression. Therefore, we aimed to evaluate the efficacy of ECT in OCD patients without comorbid psychiatric disorders. Methods: This quasi-experimental study was conducted on 12 adult patients with severe OCD (Yale-Brown test score above 25) and no comorbid psychiatric disorders referred to a tertiary care hospital for psychiatric disorders. Treatment was administered three times a week for up to three to four weeks (a minimum of 8 sessions and a maximum of 12 sessions). We completed the Yale-Brown test for all patients before ECT, on the day after applying ECT, and two months after the final ECT session to evaluate the effect of therapy. Results: Yale-Brown patients' Mean±SD significantly decreased after the ECT sessions from 28.08±2.50 to 17.17±3.78 (P=0.043). After treatment, the severity of OCD decreased in all patients and turned to mild and moderate levels in 4 patients (33.3%) and 8 (66.7%), respectively. After two months, the Mean±SD Yale-Brown score slightly increased to 18.08±1.62 (P=0.125), and the severity of OCD in all 12 patients (100%) became moderate. Nevertheless, in none of them, the Yale-Brown score increased and returned to the baseline value in this period. None of the patients developed significant side effects during or after ECT sessions. Conclusion: ECT was a safe and effective therapeutic strategy for patients with treatment-resistant OCD with no comorbid psychiatric disorders. However, further randomized controlled trials are required to validate the efficacy of ECT for OCD treatment before implementing it in the routine clinical practice.

Determination of strain around distal implants as abutments for partial and fixed implant-supported prostheses with posterior cantilever.

This study aimed to compare strain around implants used as abutments for removable partial dentures with wrought wires and fixed partial dentures with ball attachments and fixed dentures with posterior cantilever. An edentulous mandibular model was constructed using epoxy resin with four parallel implants in the area between the two mental foramina. Four strain gauges were attached to the buccal, lingual, mesial, and distal aspects of each implant. One fixed prosthesis with cantilever and two removable partial dentures were considered as prosthetic treatments. A vertical 500-N force was applied with 10-N intervals. The maximum strain in the fixed prosthesis was higher than that of the partial removable denture; in the removable denture with a wrought wire arm, it was higher than that in the denture with a ball attachment (P < 0.001). The lowest rate of strain was recorded on the mesial aspect (P < 0.05). However, the highest rate of strain was recorded on the lingual and distal aspects of the removable denture with a wrought wire in the buccal aspect and the removable prosthesis with the ball attachment on the buccal and lingual aspects (P < 0.05). Finally, despite minor differences in the maximum strain rate in each implant position, the differences were not statistically significant (P > 0.05). Partial removable denture with a ball attachment decreased strain more than that by the removable portal denture with a wrought wire arm. The worst type of prosthesis in terms of the overall strain rate was the fixed prosthesis with cantilever.

An Observational Cohort of First Episode Psychosis in Iran: The Azeri Recent Onset Acute Phase Psychosis Survey (ARAS Cohort) Study Protocol.

Background: Most of our knowledge about the etiology, course, treatment, and outcome of schizophrenia spectrum and other psychotic disorders stems from Western countries. Data from populations living in other geographical areas and low- and middle-income countries, with different genomes (ethnicity) and exposomes (e.g., culture and social support, drugs of abuse, religion), will add to our knowledge of this complex disorder. Methods: The Azeri Acute phase/Recent onset psychosis Survey (ARAS) has been initiated to study the course of the disorder in patients with recent-onset psychosis using validated diagnostic tools and a comprehensive outcome monitoring system, aiming to reveal indicators for understanding the risk and resilience factors and for choosing the best-personalized treatment strategy. All participants will be evaluated for clinical signs and symptoms as well as risk and resilience factors and will be followed up for 1, 3, and 5 years for outcomes in several domains. A hierarchical cluster method will be applied to identify the number of clusters for each outcome. Defined models will be applied to assess the predictive value of cognition on symptomatic and functional outcomes at follow-up. Discussion: The ARAS cohort will yield significant academic- (research and education) and care-related achievements. ARAS data and experience will have value both in being a useful model for other parts of this region and in an expansion of the currently available knowledge.

Reliability and validity of Azeri Turkish version of geriatric depression scale.

Background: In older adults, depression symptoms may be masked by physical complaints and be even attributed to the natural aging process, which may be resulted in improper diagnosis. Native-language scales can be highly effective in the detection of depressive disorders. In this study we attempted to assess the reliability and validity of the Azeri Turkish version of the geriatric depression scale (GDS). Methods: In this psychometric study, the GDS and the Structured Clinical Interview for DSM IV(SCID) questionnaires were administered to a sample of 387 older adults (60 years and older)from the member households of Tabriz health centers. The English version of GDS was translated into Azeri Turkish. Translation-back translation process was conducted. The receiver operating characteristics (ROC) curve, as well as sensitivity and specificity, were used to determine the validity of the questionnaire, and the test-retest method was used to calculate reliability. Results: The mean age of participants was 69.30. The area under the ROC curve for the scores higher than five was 0.832 and for the scores equal to ten and above was 0.871. The sensitivity and specificity for the scores higher than five were 90.9% and 73.4%, respectively. The reliability of this scale was confirmed based on intraclass coefficient (ICC) = 0.79. Conclusion : The Azeri Turkish version of GDS was found with appropriate levels of validity and reliability.

Comparison of Auditory Brain Stem Responses and Otoacoustic Emission of Autism with Healthy Children.

BACKGROUND: Autism is a neurodevelopment disorder, including difficulty in establishing relationships and social interaction, difficulty in communication, performing restricted, and repetitive behaviors. The impaired reception and integration of sensory information especially auditory data are one of the main characteristics of children with autism. According to various studies, the brain stem plays a key role in the reception and integration of auditory and sensory data. Hence, this study aims to comparison auditory brain stem responses (ABR) and otoacoustic emission (OAE) of autism patients with healthy children. MATERIALS AND METHODS: This case-control study was performed on 20 autism children (4-8 years old) as case group who referred to psychiatry clinics affiliated with Tabriz University of Medical Sciences and 20 healthy age-matched as the control group. The severity of autism was evaluated by the Gilliam Autism Rating Scale (GARS). Also, ABR and OAE were recorded, and all data compared with the healthy children. RESULTS: The latencies between the waves III-V and I-V bilaterally, and wave V bilaterally and wave I in the left ear showed a significant increase in children with autism compared to the healthy group. CONCLUSION: This study shows that there was a reduced nerve conduction velocity in the auditory pathway of the brain stem in children with autism compared to healthy children.

The first evidence of an association between a polymorphism in the endocannabinoid-degrading enzyme FAAH (FAAH rs2295633) with attention deficit hyperactivity disorder.

Several single nucleotide polymorphisms (SNPs) of the fatty acid amide hydrolase (FAAH), the degrading enzyme of the endocannabinoids, have been shown to be associated with many neuropsychiatric disorders. Here, FAAH rs2295633 was studied in ADHD and case-control healthy children. There was a significant difference in the allele frequency (P = .04) and genotype distribution (P = .04) of the FAAH rs2295633 between ADHD cases and controls. The ADHD children appeared to have less of TT genotype (OR 0.396, 95% CI 0.178-0.884, p = .024) and T allele (OR 0.658, 95% CI 0.440-0.982, p = .04). To our best knowledge, this is the first statistical significant association between FAAH rs2295633 genotype and ADHD disorder. Larger sample sizes and functional studies are warranted to explore the clinical utility of FAAH genotyping as a possible marker for increased ADHD risk in children.

Evaluation of strain in mandibular denture-supporting area in three different occlusal schemes during jaw movements.

Background. Various occlusal schemes have been introduced over the years to enhance the stability, comfort, beauty and function of complete denture, of which lingualized, bilateral balanced and monoplane occlusions are the most recommended. The aim of this study was to compare the strain in mandibular denture-supporting structures in three different occlusal schemes. Methods. Two mandibular and maxillary models were simulated using epoxy resin, and strain gauges were embedded on each side of the mandible in mental foramen, buccal shelf and distolingual area. Strain values were measured in three occlusal schemes at centric occlusion protrusive and lateral movements. Data were analyzed with one-way and three-way ANOVA, followed by post-hoc Tukey tests. The significant level was set at 0.05. Results. The mean strain in denture-supporting area was lower in monoplane occlusion than the two other occlusal schemes, and the mean of values in the buccal shelf was higher than that of mental foramen and distolingual area. In all the three occlusal schemes, the mean strain values on the working side were higher than those on the non-working side during eccentric movements. Conclusion. Monoplane occlusal scheme imposed lower strain on denture-supporting area, with the buccal shelf being the primary strain-bearing area to tolerate more pressure than the rest of the denture-supporting areas. In terms of strain distribu-tion scheme, in all the three occlusal schemes, the working side received more strain than the non-working side during eccen-tric movements.

DRD4 Gene Polymorphisms as a Risk Factor for Children with Attention Deficit Hyperactivity Disorder in Iranian Population.

BACKGROUND AND OBJECTIVE: Dopamine dysfunction is known to be associated with attention deficit hyperactivity disorder (ADHD). Dopamine D4 receptor gene (DRD4) is one of the important genes in this pathway. This study intended to investigate the variable number of tandem repeats (VNTR) in exon 3 of the DRD4 gene in Iranian children and adolescents. MATERIALS AND METHODS: In this study, 130 children with ADHD, aged 6-14 years, and 130 healthy children, within the same age range, were enrolled. All children were selected from northwest of Iran which have Caucasian ethnic background and are of a Turkic ethnic group. VNTR polymorphisms of the DRD4 gene were evaluated by PCR using exon 3-specific primers followed by agarose gel electrophoresis. FINDINGS: The Hardy-Weinberg principle and Chi-square test showed a significant difference in 4-repetition (4R) alleles between the ADHD (76.2%) and control (53.8%) groups (p = 0.004; X2 = 17.39; df = 5). The least percentage of repetition alleles in both groups was 2R. CONCLUSION: There is a significant correlation between the 4R alleles of DRD4 and ADHD in the northwest of Iran.

A Randomized Trial of Comparing the Efficacy of Two Neurofeedback Protocols for Treatment of Clinical and Cognitive Symptoms of ADHD: Theta Suppression/Beta Enhancement and Theta Suppression/Alpha Enhancement.

Introduction. Neurofeedback (NF) is an adjuvant or alternative therapy for children with Attention Deficit Hyperactivity Disorder (ADHD). This study intended to compare the efficacy of two different NF protocols on clinical and cognitive symptoms of ADHD. Materials and Methods. In this clinical trial, sixty children with ADHD aged 7 to 10 years old were randomly grouped to receive two different NF treatments (theta suppression/beta enhancement protocol and theta suppression/alpha enhancement protocol). Clinical and cognitive assessments were conducted prior to and following the treatment and also after an eight-week follow-up. Results. Both protocols alleviated the symptoms of ADHD in general (p < 0.001), hyperactivity (p < 0.001), inattention (p < 0.001), and omission errors (p < 0.001); however, they did not affect the oppositional and impulsive scales nor commission errors. These effects were maintained after an eight-week intervention-free period. The only significant difference between the two NF protocols was that high-frequency alpha enhancement protocol performed better in suppressing omission errors (p < 0.001). Conclusion. The two NF protocols with theta suppression/beta enhancement and theta suppression/alpha enhancement have considerable and comparable effect on clinical symptoms of ADHD. Alpha enhancement protocol was more effective in suppressing omission errors.

Knowledge and Attitude of Parents of Children With Attention Deficit Hyperactivity Disorder Towards the Illness.

BACKGROUND: The knowledge and attitude of parents about attention deficit hyperactivity disorder (ADHD) is a public health issue in which management and rehabilitation approaches may be influenced. OBJECTIVES: The current study aimed to evaluate the knowledge and attitude of the parents of children with ADHD towards this disorder in Tabriz, Iran. MATERIALS AND METHODS: The current cross-sectional study evaluated 295 parents of children and adolescents with ADHD referred to psychiatric clinics of Tabriz University of Medical Sciences. The subjects were diagnosed based on Kiddie schedule for affective disorders and schizophrenia for school-aged children (K-SADS) and recruited according to a convenience sampling method in the first five months of 2014. The parents' knowledge and attitude towards ADHD was studied by a researcher-made questionnaire. RESULTS: The overall knowledge of parents was 66% in which 76.72% were aware of related signs and symptoms and 43.38% were able to identify the aberrations. Meanwhile, 44.62% of the parents knew the etiology and 54.75% had information about treatment strategies. In addition, 33.55%, 37.91%, 25.52% were aware of ADHD consequences, diagnosis and prevalence dimensions, respectively. Moreover, 82.72% of the parents had a positive attitude towards ADHD. A positive correlation was found between parents' attitude towards ADHD and their overall knowledge (identification, etiology, treatment, consequences and prevalence dimensions), ranging from 0.12 to 0.36 (P < 0.50). Age, gender, and place of residence did not have a correlation with parents' knowledge and attitude towards ADHD. Parent's education level only had a positive correlation with the knowledge of symptoms, with a value of 0.19 (P < 0.01). Parents with a higher overall knowledge, knowledge of ADHD symptoms, and prevalence rates accepted combination therapy (P < 0.05). CONCLUSIONS: While the overall knowledge of parents regarding ADHD was favorable, they were mostly unable to identify the aberrations in children with ADHD. These results may help practitioners address pitfalls in parent management training programs.

Elevated Brain-Derived Neurotrophic Factor Correlates Negatively with Severity and Duration of Major Depressive Episodes.

BACKGROUND AND OBJECTIVE: Major depressive disorder is a neuropsychiatric condition associated with neurochemical changes that alter levels of neurotrophins. We aimed to measure serum levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in patients experiencing their first episode of major depression and to examine those levels in relation to the severity and duration of the depressive episode. METHODS: We recruited 85 participants: 44 drug-free patients with major depression (35 women, 9 men) and 41 healthy controls (32 women, 9 men). We used the Hamilton Rating Scale for Depression to assess the severity of the patients' depression. We assessed the controls' mental health according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria. To assess all participants' stress levels, we used the Holmes and Rahe stress scale. We measured all participants' serum BDNF and NGF levels via enzyme-linked immunosorbent assay. RESULTS: The mean stress score was significantly higher in the patients than the controls (P=0.03). The patients had higher serum BDNF than the controls (P=0.001), but similar NGF levels. BDNF levels correlated negatively with symptom severity (r=-0.33, P=0.03) and duration (r=-0.2, P=0.06). NGF levels did not correlate with stress or with severity or duration of depressive episode. CONCLUSIONS: These findings suggest that an elevated serum BDNF level may contribute to the pathophysiology of major depressive disorder. The findings also indicate a possible role for BDNF in altering the clinical course of the condition.

Prevalence of Head and Neck Tumors in Children under 12 Years of Age Referred to the Pathology Department of Children's Hospital in Tabriz during a 10-year Period.

Background and aims. Head and neck tumors are the most common complaints of people referring to different medical sections, especially in children. The aim of this study was to evaluate the prevalence of these tumors in children less than 12 years of age to provide a better perspective for future studies. Materials and methods. All the files in Department of Pathology at Tabriz Pediatric Hospital from 2001 to 2011 were screened for head and neck tumors in children under 12 years of age. Data including age and gender as well as the type, the location, and benign/malignant characteristic of the tumor were recorded. Data were analyzed by SPSS 15 statistical software, using descriptive statistics and chi-square test. Results. A total of 160 cases were identified. Most of the tumors were benign (68%) and most of the tumors occurred in the neck region (41%). The most frequent benign and malignant tumors were lymphangioma and non-Hodgkin lymphoma, respectively. The majority of benign tumors were found in children younger than 2 years old (P=0.007), but there was no age predilection for malignant tumors. Conclusion. According to our results, benign tumors were more prevalent than malignant ones. Although a low rate of benign tumors in males shows that more attention should be paid to the early diagnosis of head and neck tumors.

Serum 25-Hydroxyvitamin D in Patients with Major Depressive Disorder.

BACKGROUND: We investigated the association between serum 25(OH) D levels and depressive symptoms in patients with major depressive disorder (MDD). METHODS: Eighty-five adults, 44 drug free patients with MDD and 41 apparently healthy controls, participated in the study. The Hamilton Depression Rating Scale was used to assess severity of major depression. Mental health of the controls was assessed according to DSM-IV criteria. Stress level of the participants was assessed by the Holmes and Rahe stress scale. Serum 25(OH) D levels was measured by immunochemiluminescence assay. Vitamin D deficiency was defined as a serum 25(OH) D concentration of lower than 20 ng/ml. RESULTS: Depressed patients had the higher levels of stress. There was a positive correlation between stress level and disease severity (r= 0.32, P= 0.03). In total participants, mean percentage of vitamin D deficiency was 77.6% with 75% in patients and 80.5% in the healthy subjects. There were no differences between the two groups in serum 25(OH) D levels and percentage of subjects with the vitamin deficiency. A negative correlation was observed between disease severity and serum 25(OH) D level of patients with depression episodes < 2 y (r= -0.38, P = 0.08) and winter samples (samples collected and measured from December to march, r= -0.62, P = 0.004). CONCLUSION: Serum 25(OH) D levels were not associated with depression. However, the inverse relationship between levels of vitamin D and depressive symptoms in current depression episodes and in sun-deprived season warrants further investigation.