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Background. This study assessed the potential efficacy of donepezil in treating autism spectrum disorder (ASD), a neurodevelopmental condition characterized by social communication difficulties and repetitive behaviors. Donepezil, primarily used to treat Alzheimer’s disease as an acetylcholinesterase inhibitor, has gained attention as a potential treatment for ASD symptoms. Methods. Following PRISMA guidelines, a systematic review was conducted to investigate the effects of donepezil on individuals with ASD. Outcome measures assessed various aspects of ASD, including language skills, executive function, behavior, and core symptoms. Nine studies were identified, including four randomized controlled trials (RCTs), three retrospective studies, one open-label trial, and one case report. Results. One RCT reported significant improvements in expressive and receptive language skills, especially in younger children. Another study combining donepezil with choline supplementation showed enhanced receptive language skills, particularly in younger participants. An open-label trial indicated improved rapid eye movement sleep patterns in autistic children treated with donepezil. Several retrospective studies reported improvements in behavioral symptoms, such as aggression and hyperactivity. However, other RCTs did not find statistically significant improvements in executive functioning. Conclusion. In general, donepezil use in ASD demonstrates promise in specific areas, notably language development and behavioral symptom management. However, the results are contradictory, requiring further research to clarify its role, optimal dosing, long-term effects, and potential side effects in individuals with ASD. Practical Implications. Donepezil can be used to improve the clinical global impression and language skills of people with ASD.

Background: Conduct disorder is a prevalent difficulty among children and adolescents, encompassing a range of mental and behavioral problems. The present study aimed to determine the association of developmental family functioning and conduct disorder signs with the mediating effect of cognitive emotion regulation in adolescents.Methods: The present descriptive-correlational study was conducted on 362 students aged 15-18 (16.70±0.92) in Tabriz, Iran in 2023. The study participants were chosen through multi-stage cluster sampling technique. Data collection was done using Cognitive Emotion Regulation Questionnaire (CERQ), Youth Self Report Questionnaire (YSRQ) and Developmental Family Functioning Assessment Scale Questionnaire (DFFAQ) and interviews. Data analysis was done through descriptive statistical methods and path analysis with SPSS version 23 and LISREL version 8.80.Results: Mean±SD of the studied variables were as follows: Attention and regulation (2.35±0.54), Logical thinking (1.96±0.49), Discipline (1.95±0.45), Catastrophizing (2.63±1.16), and Acceptance (2.75±1.24). The data analysis showed that the developmental family functioning had a significant association with negative (r=-0.21, P=0.0001) and positive strategies (r=0.32, P=0.0001) of cognitive emotion regulation. Also, negative (r=0.31, P=0.0001) and positive strategies (r=-0.44, P=0.0001) of cognitive emotion regulation had a statistically significant correlation with conduct disorder symptoms.Conclusion: Based on the results of the present study, developmental family functioning has a significant association with the symptoms of conduct disorder in adolescents due to the association between negative and positive strategies of cognitive emotion regulation.

Background. Attention deficient-hyperactivity disorder (ADHD) is the most prevalent psychiatric diagnosis in preschool children. The present study aimed to translate and determine the validity and reliability of the Persian version of Conners Early Childhood Attention Deficit-Hyperactivity Disorder Questionnaire–Parents’ Form in Iranian children aged 3-6 years. Methods. We included 1,013 pediatrics aged

Background. Considering the importance of self-esteem as an influential variable in the mental health of children with Attention Deficit Hyperactivity Disorder (ADHD) and also the inconsistent findings in the related literature, this study intended to compare the level of self-esteem in public, social, academic, and family contexts in students with and without ADHD. Methods. The research design was based on the causal-comparative study. The intended first population of this study consisted of students with ADHD who had visited the child and adolescent psychiatry clinic of Razi Hospital in Tabriz during 2021 (1400 in the solar calendar); the second population was made up of healthy counterparts of this clinical group (i.e., students without ADHD). Based on the purposive sampling method, 48 students who were diagnosed with ADHD without co-occurring psychiatric disorder by a child psychiatry specialist were selected as the study group. Also, 48 healthy students from Tabriz schools were selected as the group without ADHD. Results. Given the obtained results, a statistically significant difference was found between the ADHD group and the non-ADHD group in light of the composite scores of the self-esteem sub-components. The findings showed a statistically significant difference between the two groups in terms of the public and the family subscales, that is, the public self-esteem of the group with ADHD was higher than the mean of the general self-esteem of the non-ADHD group, and the mean of the family self-esteem of the non-ADHD group was higher than that of the ADHD group. However, there was no significant difference between the two groups in terms of the social and academic subscales. Conclusion. Based on the findings, it was concluded that the self-esteem of students with ADHD in their inner world is different from other individuals’ inferences about the self-esteem of these children. In other words, these children had acceptable self-esteem in their psychological world according to their psychological conditions. In addition, considering the low family self-esteem of the participants with ADHD, the behavioral quality of these children’s parents and relatives may have affected how they define family relationships and consequently, lowered their value. Practical Implications. Considering the obtained results, it was suggested to pay attention to these children’s self-esteem in their interventions and use the potential of this variable in controlling individual and family behaviors.

Background: Methylphenidate is an important drug treatment for attention-deficit/hyperactivity disorder (ADHD). Parents’ knowledge of the drug predicts their adherence to this treatment and active participation in the therapeutic interventions. The present study aimed to evaluate the knowledge and attitude of the parents of children with ADHD, who referred to the child and adolescent psychiatry clinic of Tabriz University of Medical Sciences, regarding methylphenidate (Ritalin).Methods: This descriptive, cross-sectional study was performed on 300 parents during 2019-2020. The subjects were selected through convenience sampling. Data were collected using the socioeconomic status questionnaire and a researchermade questionnaire, which encompassed the two sections of demographic information and parents’ attitudes, knowledge and performance. The validity and reliability of the tool were confirmed. Data analysis was performed in SPSS version 16 using descriptive statistics, Chi-square, and t-test.Results: The mothers played a more significant role in the care of children with ADHD compared to the fathers. Significant correlations were observed between the parents’ knowledge, attitude, and performance with Ritalin consumption, and the knowledge score of the parents was low (46.6%), confirming their need for education in this regard. Meanwhile, 52.86% of the parents had a moderate knowledge level, and only 1% had excellent knowledge regarding the drug. Overall, the parents considered methylphenidate a more effective drug for ADHD compared to other medications. However, 84% of the parents were concerned about their children’s Ritalin addiction. According to the results, mothers played a more significant role in the treatment of children with ADHD compared to the fathers.Conclusion: According to the results, parents’ participation in the treatment of children and adolescents with ADHD as a supporter and provider of methylphenidate had a positive effect in this regard. Therefore, supporting and improving the knowledge and attitude of parents could improve their perception of methylphenidate consumption by their ADHD children, thereby enhancing the prognosis of the patients.

Abstract Background The prevalence of psychiatric disorders by demographic characteristics in elderly people is poorly understood, at least in the northwest of Iran. We aimed to estimate the prevalence of various psychiatric disorders in the elderly population in East Azerbaijan Province, Tabriz. A total of 1000 aging people were randomly selected from the general population. Data were collected using valid structured instruments and face-to-face interviews by trained psychologists. The Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Abbreviated Mental Test Questionnaire were used. Chi-square (χ 2) test was used for categorized variables, and an independent T-test was carried out for quantitative variables. Results Overall, 38.5% of the elderly had at least one mental disorder (47.2% women, 27.3% men). The prevalence of major depressive disorder (MDD) and any anxiety disorders was 16.6% (22.4% female and 9.3% male) and 16.7% (23.1% female and 8.6% male), respectively. Likewise, the overall prevalence of any depressive symptoms, post-traumatic stress disorder (PTSD), general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and panic disorders were 21.6%, 7%, 5.3%, and 5.9%, respectively. The prevalence of any mental disorder in the first, second, and third quartiles of the socio-economic level was 54.3%, 37%, and 17.8%, respectively. The prevalence of any mental disorders among the marginalized and the non-marginalized population is 55.3 and 31.5%, respectively. Conclusions We found 38.5% (47.2% women, 27.3% men) of the elderly people had any mental disorders, and 21.6% of them had any depressive disorders. The prevalence of mental disorders in elders was almost like adults and middle-aged people in this study. However, the prevalence of mental disorders was higher than in marginalized population and low socio-economic status.

Background. Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders starting at an early age with symptoms of attention deficit hyperactivity disorder and impulsivity. This study aimed to investigate the molecular alterations of the DRD4 gene, which have been linked to ADHD in previous studies with respect to the dose of methylphenidate. Methods. The study population included all ADHD patients needing drug therapy aged 5-18 years referred to Bozorgmehr psychiatric clinic in Tabriz in 2017 for one year. After diagnosis, symptoms severity was assessed using the Conners Scale for ADHD Assessment. Then, 4 ml of blood was collected from each individual and DNA was extracted using salting out method. After performing polymerase chain reaction (PCR), the products were separated using specific restriction enzymes and then polymorphisms of Ex3 VNTR and rs3758653 of DRD4 gene were analyzed in 2% agarose gel. The last dose to achieve the therapeutic response was recorded in mg/kg. Then, we investigated the relationship between the doses of drug used to achieve the therapeutic response and the existence of the mentioned polymorphisms. Results. There was no significant relationship between treatment response and type of polymorphism. Also, there was no significant relationship between the average dose of drug and the polymorphisms of three replicates, four replicates, six replicates, and more than six replicates in EX3VNTR in DRD4 gene. In addition, we witnessed no statistically significant relationship between the mean drug dose and CC, TC, and TT genotypes in DRD4rs3758653. Conclusion. There was no significant relationship between treatment response and type of polymorphism. There was no significant relationship between the average dose of drug and the polymorphisms of three replicate, four replicates, six replicates and more than six replicates in EX3VNTR in DRD4 gene. Between mean drug dose and CC, TC and TT genotypes in DRD4rs3758653, there was no statistically significant relationship. Practical Implications. Determining the reduction of ADHD symptoms by taking methylphenidate and evaluating the relationship between presence or absence of DRD4 polymorphisms and the dosage of drug to achieve a better response to treatment can collect enough evidence to determine the dose of methylphenidate according to the molecular analysis of DRD4 gene in patients with ADHD. This can reduce doctor visits, save time, and decrease the drug side effects.

Background. Psychiatric studies are influenced by geographical conditions and research methods. Among them, the use of diagnostic tools may cause controversy over the results of studies on psychiatric disorders as such ADHD. The aim of this study was to investigate comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder. Methods. In this study, 400 children and adolescents with ADHD were selected from the clients of Razi and Sharif Hospital Psychiatric Clinic. For sample selection, a demographic questionnaire and semi-structured diagnostic interview (K-SADS-PL) were utilized to evaluate the presence of psychiatric disorders. The duration of the project was 4 months. Results. The mean age of the patients was 9.16±2.46 years and the highest frequency was in the age group of 6 to 9 years (63%). Of the 400 patients studied, 73.3% were boys. The highest frequency of education was related to preschool (61.5%). A history of ADHD was positive in 10.8% in the father, 2.3% in the mother and 3.8% in both parents. Also, 9.5% of patients had a history of ADHD in their brother and 4% had a positive history of ADHD in their sister. The most common psychiatric disorder in the present study was oppositional defiant disorder (92%). One comorbid disorder was identifiable in more than 54% of participants. Conclusion. The most common psychiatric disorder in children with ADHD includes oppositional defiant disorder, which is more common in boys, although no significant differences was founded in terms of sex and age. Practical Implications. Findings of this study suggest that the clinicians, child psychologists and psychiatrists ought to take into consideration the probability of comorbid disorders with ADHD, since failing to consider them might directly influence the quality and quantity of treatments utilized.

Background. One of the most common childhood disorders is attention-deficit/hyperactivity disorder (ADHD). This study aimed to determine the prevalence of ADHD in children aged 6-11 years in Piranshahr city (Iran). Methods. This descriptive-analytical study involved six hundred primary school students (300 girls and 300 boys) in Piranshahr city who were enrolled in the study using stratified random sampling. The frequency of ADHD was assessed using the short form of the Conners Teacher and Parent Rating Scale. Results. The frequency of inattention and hyperactivity indices in girls were respectively 13% and 15%, per Conners Parents Rating Scale, and 14.6% and 16.6% per Conners Teacher Rating Scale, while the frequency of ADHD index was 6.33% and 8.66%, respectively. The frequency of inattention and hyperactivity indexes in boys were respectively 11% and 17% per Conners Teacher Rating Scale, and 20.6% and 24.6%, respectively, per Conners Parents Rating scale, whereas the frequency of ADHD index was based on parents and teacher was 5.6% and 18.3%, respectively. Conclusion. This study showed that the prevalence of children prone to ADHD in the Piranshahr region is relatively high in comparison with other regions of the country. Therefore, it is necessary to study this disorder in the identity card of children at the entrance to kindergartens and schools to identify the patients, so through timely and appropriate intervention, its important complications in adolescence and adulthood can be prevented.

Introduction: Parents problems can not only lead to the occurrence or aggravation of their childrens disorders, but also affect their childrens psychological problems. Aim: The purpose of this study was to compare personality disorder symptom in parents of children with autism disorders, attention deficit hyperactivity disorder (ADHD) and normal control. Method: This is a cross-sectional study. The population of this study included all parents of children with autism and ADHD from Tabriz City in year 2020. 130 parents of children with autism, 170 parents of children with ADHD were selected available sampling method and were mached with 273 parents of normal control. All the clinical assessment of autism, ADHD and comorbidities were conducted by child and adolescent psychiatrists. The severity of personality disorder symptom were assessed by Millon Clinical Multiaxial Inventory (MCMI-III). Kruskal-Wallis test using SPSS version 26 software was used for data analysis. Results: According to results of Kruskal-Wallis test, the mean ranking of personality disorders in the three groups respectively were parents of children with autism> parents of children with ADHD> control parents were (p

Objectives: The prevalence of attention deficit hyperactivity disorder (ADHD) in children has been rising more rapidly in recent years. Studies have shown that attention to the nutritional deficiencies in these children can be effective in controlling symptoms. Therefore, we decided to examine the magnesium supplementation in children with ADHD under treatment with methylphenidate. Materials and Methods: The study was conducted on 40 children with ADHD. The children were randomly assigned to 2 groups. The intervention group (n = 20) received magnesium tablets (10 mg/d) with methylphenidate (0.5 to 1 mg/kg/d) for eight weeks and the control group (n = 20) received placebo with methylphenidate (0.5 to 1 mg/d). Both groups were assessed before and after the intervention using the Conner’s parent rating scale. Results: At baseline, the mean total score was 74.4 ± 10.4 in the intervention group and 76.8 ± 6.6 in the control group (P=0.79). At the end of the study, the total score of Conner’s Parent Rating Scale was 61.9 ± 11.1 in the intervention group and 68.8 ± 7.3 in the control group (P=0.02). There was also a significant difference between the groups in the scores of the inattention subscale at the end of the study (P=0.001). Conclusions: The findings of the present study suggest that magnesium supplementation with methylphenidate can be effective in reducing ADHD symptoms.

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.

Background: Literature indicates high levels of burden in primary caregivers of children with attention-deficit hyperactivity disorder (ADHD). Identifying the related factors might help in planning the interventions to reduce it. Objective: This study aimed to identify the caregiver burden and its related factors in Iranian mothers with children suffering from ADHD. Methods: In this correlational study, 246 mothers with children and adolescents suffering from ADHD referred to psychiatric clinics of Tabriz University of Medical Sciences were included through a convenient sampling method. Data were collected using a demographic information form, Zarit Burden Interview, Swanson Nolan and Pelham Parent Rating Scale-IV, and the Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version. Data were analyzed using descriptive statistics, t-test, Pearson's correlation coefficient, analysis of variance, and multiple linear regression analysis. Results: A majority of children (66%) were in the combined subtype. The mean of the disorder severity was 1.91 ± 0.79, 1.76 ± 0.70, and 1.81 ± 0.61 in impulsive, inattentive, and combined subtypes, respectively. The mean of mothers' caregiver burden was 40.43 ± 1.38. A significant relationship was found between the mean severity of the disorder subtypes and caregiver burden. The correlation coefficient was 0.36, 0.29, and 0.29 for the impulsive, inattentive, and combined subtypes, respectively. The mother's age, existence of ADHD in the child's brother, family member's cooperation in caregiving, and the child's birth rank could significantly predict the caregiver burden. Conclusion: Given the role of family-related factors in the burden of care in mothers of children with ADHD, family-centered care and home visits are recommended to assist mothers of these children.

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

Introduction: This study was conducted in order to compare the attachment styles of the patients suffering from major depression disorder (MDD), obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) with those of the healthy people. Methods: In this case-control study, a total number of 60 male/female patients with MDD and OCD were categorized into three 20-subject groups, then 20 healthy people were included in one control group. The study instruments were Hazan and Shaver's Attachment Style Questionnaire (version 1993), Beck Depression Inventory (BDI-II), Maudsley Obsessive-Compulsive Inventory (MOCI), Penn State Worry Questionnaire (PSWQ), and Beck Anxiety Inventory (BAI). The data were analyzed using chi-square test. Results: There was a significant difference between the attachment styles of the healthy people and the patients suffering from MDD (P < 0.001), OCD (P = 0.013) and GAD (P = 0.013). Moreover, a significant difference was observed between the attachment styles of patients with MDD, OCD (P = 0.012) and GAD (P = 0.010). These findings indicated that patients with MDD were more insecurely attached in comparison to patients with OCD and GAD. However, there was no significant difference between the attachment styles of patients with OCD and GAD (P = 0.089). Conclusion: This study indicated that there was a significant difference between the attachment styles of patients with MDD, OCD, and GAD, and the healthy people. This finding indicates that in the etiology of mental disorders, the effects of attachment styles should not be disregarded.

Introduction: Epilepsy is a common disorder worldwide, commonly starting during childhood. Despite the high impact of psychiatric comorbidities in these patients, little is known about Iranian children with epilepsy. Methods: This cross sectional study was carried out in the tertiary clinics of the Tabriz University of Medical Sciences, Tabriz, Iran. All of the children (aged between 6 and 18) with a diagnosis of epilepsy were enrolled in this study. A semi-structured psychiatric interview was carried out using the Farsi (Persian) version of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). Results: From a total of 298 participants, 270 (90.6%) completed the process, including 120 (44.4%) girls and 150 (55.6%) boys. At least one psychiatric diagnosis was made in 222 (82.2%) patients. The most prevalent psychiatric disorders in children and adolescents with epilepsy were attention deficit/hyperactivity disorder (34.4%), major depressive disorder (MDD) (29.6%), social phobia (14.8%) and oppositional defiant disorder (ODD) (14.8%). Agoraphobia and anorexia nervosa were significantly more prevalent among girls. The following disorders were more prevalent in children aged between 13 and 18: MDD (47.5%), psychotic disorder (2.5%), social phobia (23.7%), generalized anxiety disorder (GAD) (15.3%), conduct disorder (13.6%), chronic motor tic disorder (13.6%) and substance related disorders (4.8%). Separation anxiety (15.1%) and enuresis (1.5%), on the other hand, were more prevalent among younger children. A logistic regression model showed that psychiatric disorders in parents or siblings could independently predict at least one psychiatric comorbidity in children with epilepsy.Conclusion: Iranian children with epilepsy face a high burden of psychiatric and behavioral comorbidities compared to same aged general population that should be considered for comprehensive care.

Introduction: Prenatal diagnosis is testing for detection of diseases or conditions in a fetus or embryo before it is born. Most of prenatal diagnostic (PD) techniques are invasive and done in late stages of pregnancy. Using fetal DNA in maternal blood for fetal sex determination in early pregnancy might help in management of X-linked genetic diseases. This study aimed to investigate the accuracy of sex determination using fetal DNA in maternal blood at 8-12 weeks of gestation. Methods: In this cross-sectional study, 30 pregnant women at 8-12 weeks of gestation were enrolled. The sex-determining region Y (SRY) gene expression with the internal control (IC) glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was investigated with quantitative real-time polymerase chain reaction (PCR) using specific primers and probes. Results: Accuracy of sex determination with SRY gene expression in 8-12 weeks of pregnancy were 85%, 85%, 90% and 100% respectively. Conclusion: It seems that fetal sex determining using fetal DNA in maternal blood is a reliable method for early stage of pregnancy.

Introduction: The aim of this study was to determine the effectiveness of mindfulness-based cognitive therapy (MBCT) on positive reappraisal in patients suffering from obsessive compulsive disorder (OCD). Methods: The research design was quasi-experimental of pre-test and post-test type with control group. The statistical population of present study involved all patients referring to psychiatry clinics of Tabriz University of Medical Sciences who received obsessive-compulsive disorders diagnosis. Thirty available patients were selected that filled cognitive emotion regulation questionnaire (CERQ) after being randomly assigned to experimental and control groups. The experimental group attended 8 sessions of MBCT. The cognitive emotional regulation questioner was administered after completion of the sessions and data of both states (before and after sessions) were collected and analyzed using covariance analysis test. Results: The MBCT was effective in increasing positive strategies (positive reappraisal, positive refocusing, planning, putting into perspective) and decreasing negative strategies (self-blame, blaming others, catastrophizing, rumination, and acceptance) in patients with obsessive-compulsive disorder (P

Introduction: This study aimed to examine the role of prenatal stressful events in mothers of children and adolescents with autistic disorder (AD). Methods: This case-control study was conducted in 2014. A total number of 115 children and adolescents with AD were selected by convenience method from the autism rehabilitation centers in Tabriz, Iran. Moreover, 112 typically developing (TD) children and adolescents were selected from public schools using a random clustering method. Two groups were matched in terms of mother's and child's age and mother's educational level. The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) semi-structured diagnostic interview was used to evaluate the presence of psychiatric disorders. The diagnosis of AD was made based on the DSM-IV criteria during separate diagnostic interviews by two child and adolescent psychiatrists. The life stressful events’ inventory was used to assess the presence of stressful events during pregnancy. Results: According to Fisher's exact test, the frequency of stressful life events including failure to achieve life goals, high debt, frequent marital conflict, conflict with spouse's family, changes in sleeping habits, and sexual difficulties in the mothers of AD children during pregnancy was significantly higher than the mothers of TD children. Also, mothers of AD children reported significantly higher frequency for the positive stressful life events including the major job progress, starting or finishing education, change of education, location, and summer vacation during pregnancy. Conclusion: Some stressful life events in mothers during pregnancy may be considered as risk factors for developing AD in their children. Further researches are needed to establish the results of this study.

Introduction: Childhood is the time of onset for many psychiatric disorders. Preschool Age Psychiatric Assessment (PAPA) is developed in response to the need for a standard and reliable tool for assessment of psychiatric disorders in preschool age. The aim of this study was to translate this tool to Farsi and evaluate the face and content validity of this precious and comprehensive tool. Methods: The process was forward translation to Farsi, evaluation for face and content validity, finalization of items within expert panel, backward translation to English, matching the original PAPA with randomly selected items from the backward translation version and revision as needed and finally evaluation for validity of the changes for localization and cultural considerations. Results: The research team translated original PAPA to Farsi. In the next step, evaluation for face and content validity was performed by expert panel, a mean of 30-35 items from 100 pages were revised and 7 items which were not compatible with social and cultural conditions in our country got localized. Two percent of pages from this forward translation (14 pages) were randomly selected as a sample from the whole questionnaire in order to be back translated to Farsi and expert panel were asked to evaluate. This version was revised based on their comments. The localized items were evaluated based on certainty, necessity and appropriateness and revised if needed. Conclusion: Farsi version of PAPA diagnostic interview for preschool age is available and has face and content validity.

Abstract Background Burn injuries are considered one of the most preventable public health issue among children; however, are a cause of significant morbidity and mortality in Iran. The aim of this study was to assess individual-level predictors of severe burn injuries among children leading to hospitalization, in East Azerbaijan Province, in North-West of Iran. Methods The study was conducted through a hospital based case–control design involving 281 burn victims and 273 hospital-based controls who were frequency matched on age, gender and urbanity. Both bivariate and multivariate methods were used to analyze the data. Results Mean age of the participants was 40.5 months (95 % CI: 37–44) with the majority of burns occurring at ages between 2 months-13.9 years. It was demonstrated that with increase in the caregiver’s age there was a decrease in the odds of burn injuries (OR = 0.94, 95 % CI: 0.92-0.97). According to the multivariate logistic regression there were independent factors associated with burn injuries including childhood ADHD (OR = 2.82, 95 % CI: 1.68 - 4.76), child’s age (OR = 0.73, 95%CI: 0.67 - 0.80), flammability of clothing (OR = 1.60, 95 % CI: 1.12 - 2.28), daily length of watching television (OR = 1.31, 95 % CI: 1.06 - 1.61), playing outdoors (OR = 1.32, 95 % CI: 1.16 - 1.50) and increment in the economic status (OR = 1.37, 95 % CI: 1.18 - 1.60). Conclusion Major risk predictors of burn injuries among the Iranian population included childhood ADHD, child’s age, watching television, playing outdoors, high economic status and flammable clothing.

Introduction: Comparison of the demographic characteristics of patients provides useful information to their identification. This study aimed to determine the demographic characteristics of children and adolescents with autistic disorder (AD). Methods: In this cross-sectional case-control study, 115 children and adolescents with AD were selected from Autism Society Rehabilitation Center in Tabriz, Iran, and 112 normal children and adolescents from the public schools, in 2014. The participants in both groups were matched regarding age and gender. Diagnosis of AD was performed using diagnostic and statistical manual of mental disorders-4th edition (DSM-IV) criteria and clinical diagnostic interviews by two child and adolescent psychiatrists. The demographic information of children and adolescents and their parents were collected from the medical records of children and interviews with their mothers. Results: Most of the children with autism had second or higher birth order and had families with more than three members. Mothers of children with autism had significantly lower levels of education and were mostly housewives. Fathers of autistic children mostly had high school diploma and fewer had university education, and most of them were employed. However, there was no statistically significant difference between the AD group and the control group regarding the average height and weight of children and the residence (urban or rural) and age of parents at childbirth.Conclusion: The demographic characteristics of the two groups of children and adolescents with AD and normal controls were different from each other regarding family size, birth order, parent occupation, and parent education variables.

BACKGROUND AND OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in children. Nutritional deficiency may play a role in the etiology of this disorder. The purpose of this study was to determine and compare the nutritional status (dietary intake and anthropometric indices) of boys with and without ADHD. METHODS: This case-control study was conducted on 36 boys with ADHD (case group) and 37 normal children (control group), aged 6-12 years. The case subjects were assesssed by an expert psychiatrist via clinical evaluations and psychiatric questionnaires. Height, weight, and body mass index (BMI) of the subjects were measured. Dietary intake was recorded, using a three-day food record (three non-consecutive days including one holiday and two weekdays) and analyzed using Nutritionist IV software. FINDINGS: The mean weight, height, and BMI values were higher in children with ADHD, compared to the control group (p

Introduction: The etiology of Attention deficit hyperactivity disorder (ADHD) is complex and most likely includes genetic and environmental factors. This study was conducted to evaluatethe role of previous medical history of diseases in ADHD children and their parents during theearlier years of the ADHD children's lives. Methods: In this case-control study, 164 ADHD children attending to Child and AdolescentPsychiatric Clinics of Tabriz University of Medical Sciences, Iran, compared with 166 normal children selected in a random-cluster method from primary and guidance schools. ADHDrating scale (Parents version) and clinical interview based on schedule for Schedule forAffective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version(K-SADS) were used to diagnose ADHD cases and to select the control group. Two groupswere compared for the existence of previous medical history of diseases in children andparents. Fisher's exact test and logistic regression model were used for data analysis. Results: The frequency of maternal history of medical disorders (28.7% vs. 12.0%; P = 0.001)was significantly higher in children with ADHD compared with the control group. The frequency of jaundice, dysentery, epilepsy, asthma, allergy, and head trauma in the medicalhistory of children were not significantly differed between the two groups. Conclusion: According to this preliminary study, it may be concluded that the maternal historyof medical disorders is one of contributing risk factors for ADHD.

BACKGROUND: The present study aims to design and standardize the verbal fluency test (VFT) among bilingual (Turkish-Persian) adolescents in Tabriz, Iran. METHODS: In the designing stage, 190 adolescents who were already selected randomly from among the guidance and high school students in Tabriz were classified into three age groups (11-12, 13-15, 16-18). The screening test including 33 Persian letters and three ‘animal’, ‘fruit’, and ‘supermarket stuff’ categories, and SDQ was administered to them. The results were the three letters ‘M’, ‘D’, and ‘B’ for phonological fluency, and two ‘animal’ and ‘supermarket stuff’ categories for semantic fluency in the Persian language. In the standardization stage, the letters and categories specified in the designing stage were administered in the same order to 302 adolescents. Moreover, 28 adolescents diagnosed with ADHD were selected to estimate the discriminant validity of VFT. RESULTS: Pearson correlation coefficient between test-retest of the three letters ‘M’, ‘D’, and ‘B’ for phonological fluency were estimated at 0.67, 0.66, and 0.75, respectively. Furthermore, for the two categories of ‘animal’ and ‘supermarket stuff’ it was estimated to be 0.80 and 0.65, respectively. All these amounts were significant (P < 0.01). The discriminant validity, which was estimated through comparison between the scores of normal and ADHD adolescents, showed that the obtained t value for all indices except for the letter ‘B’ was meaningful. The results of MANOVA between two gender groups were significant at P < 0.05 for three ‘M’, ‘D’, and ‘B’ variables of verbal fluency and ‘animal’ semantic fluency. In both verbal and semantic fluency the mean of subjects’ performance scores showed that females outperformed males. CONCLUSIONS: The findings of the current study indicated that VFT is reliable in the studied sample group, and has a valid psychometric property in discrimination between ADHD adolescents and normal adolescents. Furthermore, ageand sex could affect VFT performance

Background. The Barkley Adult Attention Deficit/Hyperactivity Disorder (ADHD) Rating Scale-IV (BAARS-IV) was developed, and it demonstrated good psychometric properties. The BAARS-IV includes 27 questions on the symptoms of adult ADHD. The purpose of the present study is to investigate the psychometric testing of the Persian version of BAARS-IV among the elderlies in Tabriz City. Method. This cross-sectional study was conducted in Tabriz City—in the west of Iran—in 2015 via enrolling of 121 old-aged people. We did the process of translation and adaptation of BAARS-IV and examined its concurrent validity, internal consistency, and test-retest reliability. Result. The BAARS-IV demonstrated good internal consistency and test-retest reliability. Correlations between the BAARS-IV and the CAARS-S: SV were high and evidence supporting concurrent validity was revealed. Cronbach’s alpha for the overall scale and subscales stood at 0.89, 0.81, 0.66, 0.56, and 0.82, respectively. Conclusion. The Persian BAARS-IV showed acceptable reliability and validity. BAARS-IV was determined to be composed of internally consistent and psychometrically sound items.

Objective: Major depressive disorder (MDD) is one of the most common psychiatric disorders which affects married couples frequently.The present study aims to explain the role of family processes, social support and demographic factors in marital satisfaction of women with Major Depressive Disorder (MDD).Method: In this cross-sectional study, 188 women with MDD were randomly selected among the patients who visited Bozorgmehr Clinic of Tabriz University of Medical Sciences. The sample selection was carried out through structured psychiatric interviews based on DSM-TV-TR criteria. Data were collected using Index of Marital Satisfaction (IMS), Family Process Scale (FPS) and Norbeck Social Support Questionnaire (NSSQ).The Mann Whitney U, Multivariate and ANOVA tests were used to analyze the data.Results: No relationship was observed between age, educational level, age difference of couples and number of children with family processes and marital satisfaction (p≥0.05). The patients with low educational level reported less social support (p≥0.05).Marital satisfaction and family coherence were lower when the husband had a psychiatric disorder (P≤0.01). The family processes (family coherence, problem-solving skills, communication skills and religious beliefs) and social support positively predicted marital satisfaction, while the husband's psychiatric disorders negatively predicted marital satisfaction.Conclusion: The findings highlight the significance of family processes, social support and husband's psychiatric disorders in marital satisfaction of women with MDD.

"nObjective: Nowadays, it is well known that the attention-deficit/hyperactivity disorder (ADHD) is not confined to children and adolescents. Recent data showed that a considerable portion of the general adult population may be affected by ADHD. On the other hand, the impact of ADHD on driving performance, a major area of adult life, has gained enthusiasm. More recent studies revealed an association between adult ADHD and undesirable driving problems. This study was performed to determine the association between presence of adult ADHD and traffic injuries. "nMethods: In this case-control study, in a 13 month period, 140 subjects (70 drivers/riders injured in traffic accidents ,and 70 age- and sex-matched non traumatic controls) were selected to participate in the study and were placed in two groups . Subjects with psychiatric comorbidities were excluded. The Conners' Adult ADHD Rating Scale (CAARS) self-report (screening version) was used for screening adult ADHD in both groups. Finally, the occurrence of this condition was compared between the case and control groups. "nResults: Sixty- nine males and one female were recruited in each group with a mean age of 29.31±9.32 (18-61) years in the case and 29.03±9.07 (range: 18-60) years in the control groups (P > 0.05). Previous history of traffic accident was significantly higher in the case group (15.7% vs. 4.3%, P=0.024). The mean driving time in a day was also significantly higher in the case group. In the case group, the scores of CAARS (the ADHD index, ADHD symptoms total, inattentive subscale and hyperactive/impulsive subscale) were positive (higher than 70) in 4.3, 10, 7.1 and 10 percent of patients respectively. Among the controls, the corresponding proportions were 4.3, 14.3, 8.6 and 8.6 percent respectively. The two groups were comparable for the mentioned rates. "nConclusion: The results of this study revealed no significant association between ADHD and traffic injuries in Tabriz- Iran

"n Objective: Patients with bipolar mood disorder constitute a relatively large number of individuals hospitalized in psychiatric hospitals. This disorder is highly co-morbid with other psychiatric disorders and may effect their clinical course. The goal of this study was to determine the co-occurrence rate of anxiety disorders and substance abuse with bipolar mood disorders and their impact on clinical course. "n Methods: 153 bipolar patients (type I) were selected among the hospitalized patients at Razi Psychiatric Hospital in Tabriz, Iran, from September 2007 to October 2008 through convenience sampling method. The participants were evaluated by a structured clinical interview based on DSM-IV criteria (SCID), Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating Scale (YMRS). Results: Co-morbidity of anxiety disorders was 43% . Occurrence of anxiety disorders was 26% for obsessive-compulsive disorder, 24.8% for generalized anxiety disorder, 3.9% for phobia and 2% for panic disorder. Co-morbidity of substance abuse was 7.2% and the highest occurrence of substance abuse was 5.2% for alcoholism and 3.9% for opium. No significant difference was observed between the severity of disease and duration of hospitalization in bipolar patients with or without anxiety disorder. The severity of disease and duration of hospitalization in bipolar patients with substance abuse was higher compared to bipolar patients without substance abuse (P

"nObjective: The current study was conducted to compare the efficacy and side effects of bifrontal electrode placement with standard bitemporal electrode placement in the treatment of patients with major depression. "nMethod: Eighty nine patients with major depression were treated with a course of bifrontal or bitemporal ECT. All patients received 8 sessions of ECT treatment; and the Hamilton Rating scale for Depression and the standardized Mini-Mental state were administered 24 hours prior to the first session and 24 hours after the last session. This study was a Double Blind Randomized Clinical Trial. "nResults: 68 of the 89 patients completed the study in the two groups of bifrontal (31 patients) and bitemporal (37 patients). The mean decrease in the Hamilton Rating scale for Depression score after ECT was the same in the both groups and was about 20 (SD± 3/2),showing a significant difference between the 2 groups. Nevertheless, the mean decrease in Mini-Mental state Examination score was different in the 2 groups and was 0/67 for the bifrontal ECT group (SD± 0/65) and 2/35 for the bitemporal ECT group (SD±0/94),, indicating a statistically significant difference(P

Objective. Emotional intelligence might play an important role in the onset and persistence of different psychopathologies. This study investigated the relationship between emotional intelligence and alcohol dependence. Methods. In this case-control study, participants included alcohol dependent individuals and mentally healthy inpatients. Each group consisted of 40 individuals (male/female: 1). The diagnosis was based on the criteria of the DSM-IV-TR using the Structured Clinical Interview for DSM-IV (SCID-IV). All the participants completed Bar-On emotional intelligence test. Results. 20 males and 20 females were included in each group. Mean age of alcohol dependent participants and controls was 31.28 ± 7.82 and 34.93 ± 9.83 years in that order. The analyses showed that the alcohol dependent individuals had a significant difference compared with the control group and received lower scores in empathy, responsibility, impulse control, self-esteem, optimism, emotional consciousness, stress tolerance, autonomy, problem-solving, and total score of emotional intelligence components. Conclusion. Patients with alcohol dependence have deficits in components of emotional intelligence. Identifying and targeted training of the individuals with lower scores in components of emotional intelligence may be effective in prevention of alcohol dependence.

There are few reports of severe self-injury to eyes in patients with schizophrenia. We report on a 41-year-old woman, primarily visiting for symptoms of endophthalmitis resulting from self-inflicted needles. Further evaluations established the diagnosis of schizophrenia because of arguing and commenting on auditory hallucinations and negative symptoms including social isolation, decreased self-care, blunt affect, and a monotone voice. The patient had been suffering from auditory hallucinations for several years and found relief in bodily pain caused by needles. The patient received 6 mg of risperidone. Hallucinations were resolved and self-injury behaviour was not repeated.

Objective: Withdrawal symptoms are a main reason of continuous use of opioid. This study compares the efficacy of augmentation of amantadine with clonidine in decreasing opioid withdrawal symptoms. Methods: This double-blind randomized clinical trial was carried out in the detoxification and rehabilitation inpatient ward at Razi Hospital, Tabriz, Iran during 2012. The patients were randomly assigned to receive clonidine or clonidine plus amantadine; and withdrawal symptoms were evaluated in the admission day and 24, 48, and 72 hours later. Data were analyzed using SPSS by the 2*2 repeated analyses of variances (ANOVA). Results: From the total of 69 participants, 30 patients completed the trial in each group. The severity of symptoms, however, had an increasing trend in both groups. Analysis of variance of the symptom severity score (by The Clinical Opiate Withdrawal Scale) revealed a significant group-time interaction, and the patients who were receiving amantadine experienced milder symptoms . Conclusions: Treatment of opioid withdrawal symptoms with amantadine and clonidine would result in a better outcome compared with clonidine alone.

Objective: Attention deficit hyperactivity disorder in adults (adult ADHD) is gaining more attention nowadays. Nevertheless, very few studies have addressed this issue in Iran. The present study was conducted to determine the prevalence of adult ADHD in Tabriz, North-West of Iran. Methods: Four hundred urban inhabitants of Tabriz- with a n age range of 18 to 45 years were selected through the probability proportional to size cluster sampling in 2009. The screening was performed by Conner's Adult ADHD Rating Scale, and the definite diagnosis of Adult ADHD was performed via clinical interview according to DSM-IV-TR andWender Utah criteria. Results: The prevalence of adult ADHD was estimated to be 3.8%. Men when compared with women were more likely to have ADHD (5.5 % in men versus 2 % in women). Marital status, birth order, educational level and occupational status showed no significant association with adult ADHD. History of psychiatric treatment, alcohol drinking and smoking had similar relative frequency in subjects with and without adult ADHD. Conclusion: The prevalence of adult ADHD in this region of Iran seems to be substantially higher than expected or treated. This would require more attention to be drawn by health sector managers in order to improve the knowledge of the general population and the knowledge of the health care professionals about the disorder.

Background. Evaluation of family system is an important area in the context of child and adolescent mental health. This study aimed to estimate psychiatric disorders in parents of children and adolescents with bipolar I disorder (BID). Methods and Materials. In this cross-sectional study, during 2012-2013, all of the children and adolescents diagnosed with BID based on Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version were included. All of the parents (both mother and father) were evaluated by Structured Clinical Interview for DSM-IV-TR. Statistical Analysis. Prevalence rates are reported and independent-sample t-test and chi-square test were used when appropriate. Results. A total of 108 families were interviewed. 25% of mothers and 33% of fathers met the criteria for at least one psychiatric disorder, with major depressive disorder, BMD, and cluster B personality disorder being more prevalent. Fathers were more likely to receive a dual psychiatric diagnosis. Cluster B personality disorder and substance dependence were more prevalent among fathers while major depressive disorder was more prevalent among mothers. Conclusion. This study confirmed a higher prevalence of psychiatric disorders in parents of children with BID and emphasizes parental evolution.

Objectives. The present study was carried out aiming to identify the personality profile of parents of children with Attention Deficit Hyperactivity Disorder (ADHD). Methods. This study is of a descriptive, analytic, cross-sectional type in which parents of 6–12-year-old children with ADHD who were referred to the Bozorgmehr Psychiatric Clinic, affiliated with Tabriz University of Medical Sciences, were enrolled. ADHD was diagnosed according to the criteria of DSM-IV-TR and a quasi-structured diagnostic interview (K-SADS-PL). The personality profile of the parents was assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Results. According to the findings of this study, the most common personality problems based on the assessment scales in the MCMI-III belonged to the clinical patterns of depressive personality in 43 persons (25.3%), histrionic personality in 34 persons (20%), and compulsive personality in 29 persons (17.1%). According to discriminant analysis, four scales of somatoform, sadistic, dependence, and though disorder were direct and antisocial scale was reverse significant predictors of membership in the women group. Conclusion. According to the findings of this pilot study, personality disorders are prevalent in parents of ADHD children and mothers suffer from personality disorders more than fathers.

Background. Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children. The aim of this study was to evaluate risk factors for ADHD in children. Method. In this case-control study, 404 children between 4 and 11 years old were selected by cluster sampling method from preschool children (208 patients as cases and 196 controls). All the participants were interviewed by a child and adolescent psychiatrist to survey risk factors of ADHD. Results. Among cases, 59.3% of children were boys and 38.4% were girls, which is different to that in control group with 40.7% boys and 61.6% girls. The chi-square showed statistically significance (P value < 0.0001). The other significant factors by chi-square were fathers' somatic or psychiatric disease (P value < 0.0001), history of trauma and accident during pregnancy (P value = 0.039), abortion proceeds (P value < 0.0001), unintended pregnancy (P value < 0.0001), and history of head trauma (P value < 0.0001). Conclusions. Findings of our study suggest that maternal and paternal adverse events were associated with ADHD symptoms, but breast feeding is a protective factor.

Objective: Nowadays, it is well known that the attentiondeficit/ hyperactivity disorder (ADHD) is not confined to children and adolescents. Recent data showed that a considerable portion of the general adult population may be affected by ADHD. On the other hand, the impact of ADHD on driving performance, a major area of adult life, has gained enthusiasm. More recent studies revealed an association between adult ADHD and undesirable driving problems. This study was performed to determine the association between presence of adult ADHD and traffic injuries. Methods: In this case-control study, in a 13 month period, 140 subjects (70 drivers/riders injured in traffic accidents ,and 70 age- and sexmatched non traumatic controls) were selected to participate in the study and were placed in two groups . Subjects with psychiatric comorbidities were excluded. The Conners’ Adult ADHD Rating Scale (CAARS) selfreport (screening version) was used for screening adult ADHD in both groups. Finally, the occurrence of this cond tion was compared between the case and control groups . Results: Sixty- nine males and one female were recruited in each group with a mean age of 29.31±9.32 (18-61) years in the case and 29.03±9.07 (range: 18-60) years in the control groups (P > 0.05). Previous history of traffic accident was significantly higher in the case group (15.7% vs. 4.3%, P=0.024). The mean driving time in a day was also significantly higher in the case group. In the case group, the scores of CAARS (the ADHD index, ADHD symptoms total, inattentive subscale and hyperactive/impulsive subscale) were positive (higher than 70) in 4.3, 10, 7.1 and 10 percent of patients respectively. Among the controls, the corresponding proportions were 4.3, 14.3, 8.6 and 8.6 percent respectively. The two groups were comparable for the mentioned rates. Conclusion: The results of this study revealed no significant association between ADHD and traffic injuries in Tabriz- Iran.

The long story of The Snake and The Man (1976-1978) is a work by Simin Daneshvar that is derived from religious narratives, sacred texts, and mythical narratives. Laurent Genie's theoretical definition of the concept of intertextuality in the article “Strategy of Forms” serves as the theoretical foundation for this paper’s examination of the intertextual contribution of the narrations mentioned in the construction and payment of that literary work. In this article, Genie proposes that the intertextuality should be referenced when elements beyond the lexical unit of the prototext can be retrieved in the new text, a distinction between his conception of intertextuality, known as soft intertextuality, and Julia Kristeva’s intertextuality, known as hard intertextuality. In other words, the relationship between the texts is not limited to lexical and formal relationships; the intertextual relationship of two texts is not determined by the vague and mysterious sum of the effects of one on the other, but rather by the degree of interconnection between the two texts and how one influences the other. This underscores the two types of intertextuality: strong and weak. In his opinion, “weak intertextuality” is established when two texts communicate in at least two formal and thematic aspects, and “strong intertextuality” is established when texts cease to communicate on one of these two levels. The present study isqualitative in nature.