Pregnancy-Related Maternal Risk Factors of Attention-Deficit Hyperactivity Disorder: A Case-Control Study

Background. The etiology of attention-deficit hyperactivity disorder (ADHD) is complex.This study was conducted to evaluate the pregnancy-related maternal risk factors of ADHD. Methods. 164 ADHD children attending to Child and Adolescent Psychiatric Clinics compared with 166 normal children selected in a random-cluster method from primary schools. ADHD rating scale and clinical interview based on Schedule for Affective disorders and Schizophrenia for School-Aged Children (K-SADS) were used to diagnose ADHD cases and to select the control group. Results. The mean maternal age at pregnancy, duration of pregnancy, and the mean paternal age were alike in two groups. The ADHD children's mothers compared with those of control group had higher frequencies of somatic diseases, psychiatric disorders, and alcohol and cigarette exposure during the pregnancies (P < 0.01). Also birth by cesarean section was more common among mothers of ADHD children (P < 0.001). These factors plus trauma to the abdomen during pregnancy were significantly predictors of ADHD in children. Conclusions. Some pregnancy-related maternal factors may be considered as environmental risk factors for ADHD. Each of these factors considered in our study as a risk factor needs to be tested and confirmed through next methodologically appropriate researches in this field

Psychometric Properties of the Preschool Age Psychiatric Assessment (PAPA) in Farsi: Based on DSM-5

ObjectivesThe first onset of many psychiatric disorders usually occurs inchildhood or adolescence. The structured interview of Preschool Age Psychiatric Assessment (PAPA) was developed in response to the need for a standardized and reliable method to assess psychiatric disorders in preschool-age children. This study aimed to translate DSM-5-based PAPA into Farsi and evaluate its face and content validity and reliability.Materials &amp; MethodsThe procedure was a forward translation of PAPA to Farsi, evaluation for face and content validity, finalization of items within the 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 the validity of the changes for localization and cultural considerations. The interviews based on the final Farsi version were performed on thirty parents of children from two to five years old (chosen from Tabriz health centers) to determine the reliability and were repeated at an interval of two weeks. ResultsThe mean of CVI=0.91 and Modified Kappa=0.90 were obtained, and reliability with Cronbach’s alpha was 0.89.ConclusionThe Farsi version of the DSM-5-based PAPA diagnostic interview has good face and content validity and reliability

Assessment of neuropsychiatric indicators in children and adolescents with primary brain tumors and other brain space occupying lesions before and after surgery

&nbsp; Objective Cognitive abilities may be impaired due to brain lesions in children and adolescents. This study aimed to investigate neuropsychiatric indicators in children and adolescents with primary brain tumor and other brain space occupying lesions (SOL) before and after surgical procedure. Methods &amp; materials the current study is a pre and post study which was conducted on 81 patients with brain space occupying lesions aged less than 18. Patients with metastatic brain tumors were excluded. The study was performed between 20 December 2016 to 20 December 2017 on patients hospitalized in neurosurgery ward of Imam Reza university hospital, Tabriz, Iran. Before and after surgical procedure, Digit span forward and backward Task (to assess working memory), Stroop task and Trail Making Task A &amp; B (to assess attention) and Rey Osterrieth Complex Figure Test (to assess Visual Spatial Memory) were done. Then, scores of tests were compared with normal values as well as the post-surgery scores. Results the most prevalent type of space occupying brain lesion was medulloblastoma and the most common region of involvement was posterior fossa tumor. Scores of all tests after surgery comparing to before surgery were significantly improved (P&lt;0.05). In assessment of Digit span forward and backward Task with standard scores, there was no significant difference among scores of patients before surgery with the standard value (P&gt;0.05). Regarding scores of various stages of Rey Osterrieth Complex Figure Test, the&nbsp; scores of immediate recall stage was significantly low (P&lt;0.05). Among Trail Making Task A &amp; B and stroop task, before surgery, just the Trail Making Task A &amp; B was significantly increased (P&lt;0.05). Scores of Trail Making Task A was significantly higher in patients with medulloblastoma and anatomically in left temporal tumors which indicate greater damage of attention field (P&lt;0.05). In addition, in cerebellar tumor, scores of immediate recall stage of Rey Osterrieth Complex Figure Test was significantly lower (P&lt;0.05). Conclusions Visuo-Spatial Memory and attention in pre-surgery assessments was significantly impaired comparing to general population (P&lt;0.05). Working memory, Visuo-Spatial Memory and attention showed improvement comparing to pre-surgery. Deficits in attention domain was greater in medulloblastoma

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

Screening of attention deficit hyperactivity disorder in children aged 3 to 6 years and 11 month olds

BackgroundADHD (Attention deficit hyperactivity disorder) is a multifactorial disorder, defined by hyperactivity, impulsivity and attention deficits. Symptoms of ADHD begins during early childhood and negatively affects functionality at various levels.AimsThis descriptive and cross-sectional study was conducted in 2016 to screen for Attention Deficit Hyperactivity Disorder in children aged 3 to 6 years, 11 months olds of Tabriz in Iran.MethodsA total of 737 children aged 36 months to 6 years, 11 months in Tabriz were randomly selected from kindergarten and preschool centres. Both the Conners Early Childhood-Parent and -Teacher forms were used to estimate the prevalence of ADHD.ResultsThe results indicated that the prevalence of ADHD was 337 (45.7 per cent) based on Conners EC-Parent, 416 (56.4 per cent) according to Conners EC-Teacher, and 225 (30.5 per cent) based on the both Conners EC-Teacher & Parent scales. The results of Fischer's exact test showed that the prevalence of ADHD in boys (n=117, 35.3 per cent) was significantly higher than that of the girls (n=108, 26.6 per cent) (p=0.01, X2=6.57). The results of Chi-square test indicated that there was no difference among different age groups in terms of the prevalence of ADHD (X2=2.86, p=0.41).ConclusionADHD screening based on the Conners EC-Teacher & Parent forms was estimated to be 30.5 per cent. The regional prevalence of ADHD appears to be greater among children under the age of 7, although the use of the new Conners EC tool in this study could have possibly affected the ADHD prevalence estimates

Inflammation-Driven Reprogramming of CD4+Foxp3+ Regulatory T Cells into Pathogenic Th1/Th17 T Effectors Is Abrogated by mTOR Inhibition in vivo

While natural CD4+Foxp3+ regulatory T (nTREG) cells have long been viewed as a stable and distinct lineage that is committed to suppressive functions in vivo, recent evidence supporting this notion remains highly controversial. We sought to determine whether Foxp3 expression and the nTREG cell phenotype are stable in vivo and modulated by the inflammatory microenvironment. Here, we show that Foxp3+ nTREG cells from thymic or peripheral lymphoid organs reveal extensive functional plasticity in vivo. We show that nTREG cells readily lose Foxp3 expression, destabilizing their phenotype, in turn, enabling them to reprogram into Th1 and Th17 effector cells. nTREG cell reprogramming is a characteristic of the entire Foxp3+ nTREG population and the stable Foxp3NEG TREG cell phenotype is associated with a methylated foxp3 promoter. The extent of nTREG cell reprogramming is modulated by the presence of effector T cell-mediated signals, and occurs independently of variation in IL-2 production in vivo. Moreover, the gut microenvironment or parasitic infection favours the reprogramming of Foxp3+ TREG cells into effector T cells and promotes host immunity. IL-17 is predominantly produced by reprogrammed Foxp3+ nTREG cells, and precedes Foxp3 down-regulation, a process accentuated in mesenteric sites. Lastly, mTOR inhibition with the immunosuppressive drug, rapamycin, stabilizes Foxp3 expression in TREG cells and strongly inhibits IL-17 but not RORγt expression in reprogrammed Foxp3− TREG cells. Overall, inflammatory signals modulate mTOR signalling and influence the stability of the Foxp3+ nTREG cell phenotype

Previous medical history of diseases in children with attention deficit hyperactivity disorder and their parents

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

Correlation of Obesity and Overweight with Emotional-Behavioral Problems in Primary School Age Girls in Tabriz, Iran

Objective: Obesity and overweight have shown an increasing trend in most developing countries. Childhood obesity would impose numerous health-related problems. This study was conducted to determine the correlation of obesity and overweight with emotional-behavioral problems in primary school age girls. Methods: In a cross-sectional study, 300 primary school girls (aged 7-11 years) were selected using a multistaged sampling method, including randomized cluster and stratified method. For all students body mass index was measured and then based on BMI for age and sex, from each grade (1-5), 20 students were selected for each group of normal weight, overweight and obese. The emotional-behavioral problems were evaluated using child behavior checklist that consists of 113 items for childhood behavioral problems. Findings: Total behavioral problems were seen in 17%, 27%, and 2% in obese, overweight, and normal weight children, respectively. Internalizing problems (including Anxious/Depressed, Withdrawn, and Somatic Complaints) were seen in 11%, 15%, and 2% and externalizing problems (including Aggressive and Delinquent Behaviors) were observed in 8%, 17%, and 2% in obese, overweight, and normal weight children, respectively. The mean scores in all scales were higher in obese and overweight children in comparison with normal weight children and the emotional-behavioral problems had significant positive correlation with obesity and overweight (P<0.01). Conclusion: Despite the cultural differences between east and west, yet there are similarities in the most of the emotional-behavioral problems related to overweight and obesity. Also, it seems that the risk of behavioral-emotional problems in overweight girls is more than in obese girls. Overweight and Obesity prevention may be a primary preventive step for these problems in children

Designing and standardization of Persian version of verbal fluency test among Iranian bilingual (Turkish-Persian) adolescents

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 performanc