Efficacy of intramuscular haloperidol versus haloperidol plus promethazine in controlling aggressive behavior of psychiatric patients admitted to emergency rooms

Introduction: The aim of this study was to compare the therapeutic and adverse effects of haloperidol to the combination of haloperidol and promethazine (antipsychotic + antihistamine) for controlling patients with aggressive or violent behavior referred to psychiatric emergency rooms. Methods: Using a double-blind randomized controlled trial, 100 psychiatric patients admitted to emergency room of Taleghani hospital, Tehran/Iran, randomly received intramuscular haloperidol or haloperidol plus promethazine. The patients were observed at 20, 40, 60, 120 minute intervals and then at 6, 12 and 24 hourly intervals to determine if they were tranquil or asleep, need for further injection, serious adverse effects, acute dystonia, akathisia, need for other medications, and need for admission to hospital based on clinical judgment. Results: The mean age of patients was 36.25 years and 69% were male. Patients receiving promethazine plus haloperidol were more tranquil after 2, 6 and 12 hours and sustained sleep after hours 2 and 6. Adding promethazine to haloperidol decreased the need for repeated involvement of the psychiatrist on duty, using additional medications and hospital admission. Patients taking the combination of haloperidol and promethazine did not experience more adverse effects than those taking only haloperidol. Conclusion: The combination of haloperidol plus promethazine can be safely used in emergency rooms for controlling patient with agitation and aggressive behavior resulting in a sustained tranquilization or asleep and lower need for further intervention

Molecular evaluation of Ex3 VNTR polymorphism of the DRD4 gene in patients with autism spectrum disorder

Abstract Objective Autism Spectrum Disorders (ASDs) are a group of neurodevelopmental disorders that affect social and communication skills. They are characterized by severe communication and social skills disabilities and limited and repetitive activities and their prevalence appear to be steadily increasing. Genes involved in the dopamine pathway may play an important role in the development of autism and this study we evaluated the possible association between Ex3 VNTR polymorphism of the DRD4 gene and autism spectrum disorder in the Iranian population. Materials & Methods In this case-control study,97 children with autism and 103 healthy individuals were selected from the northwestern area of Iran as the case group and the control group, respectively. After genomic extraction from peripheral blood samples by the proteinase K method, the polymerase chain reaction (PCR) technique was used to determine the genotypes of polymorphism. The data then were coded and analyzed using SPSS22 software. Result The results of the study showed that the allele frequencies were different in the two groups and some of these differences were statistically significant. The most common allele in both the ASD and the control group was the 700 bp allele and its frequency was significantly different in the two groups, being more common in the ASD group. (p-value=0.0018). The other allele with a statistically different frequency was the 800 bp allele which was less frequent in the ASD group (p-value=0.0017). Conclusion These results suggest a potential association between Ex3 VNTR polymorphism of the DRD4 gene and autism spectrum disorder in the Iranian population and necessitate further studies evaluating the DRD4 gene

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

  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 & 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 & 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<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>0.05). Regarding scores of various stages of Rey Osterrieth Complex Figure Test, the  scores of immediate recall stage was significantly low (P<0.05). Among Trail Making Task A & B and stroop task, before surgery, just the Trail Making Task A & B was significantly increased (P<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<0.05). In addition, in cerebellar tumor, scores of immediate recall stage of Rey Osterrieth Complex Figure Test was significantly lower (P<0.05). Conclusions Visuo-Spatial Memory and attention in pre-surgery assessments was significantly impaired comparing to general population (P<0.05). Working memory, Visuo-Spatial Memory and attention showed improvement comparing to pre-surgery. Deficits in attention domain was greater in medulloblastoma

The relationship between attention-deficit/ hyperactivity disorder and trauma in adolescents

Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity. Methods: In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22. Results: There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P < 0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. Conclusion: Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society

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

Functional Consequences of Road Traffic Injuries: Preliminary Results from PERSIAN Traffic Cohort (PTC)

Introduction: Traffic injuries are one of the main causes of death worldwide. After decreasing mortality rates and improving the recovery of injured patients, long-term functional consequences need to be addressed. The purpose of this study was to assess the functional outcomes of road traffic injuries and their predictors six months after hospital discharge, based on the preliminary results from PTC.Methods: A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled-in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients were hospitalized after road accidents at two referral trauma centers, (from 23 September 2018 to 20 March 2019).Results: The majority of participants were men (82.7%), (Mean age =38.8). The mean score of WHODAS 2.0 was 17.8) SD=9.1). The highest score was estimated for the self-care dimension 3.3 (SD=1.8), and the lowest score for getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05).Conclusion: The current study identified some functional disabilities among patients sustaining road traffic injuries. It is evident from the results that a proportion of patients do not recover six months after the injury and suffer a disability, especially in self-care, mobility, and life activities, which potentially prevent them from returning to normalcy. In addition, age, gender, physiotherapy, injury localization was related to WHODAS 2.0 score

A meta-analysis of systematic reviews and meta-analyses to evaluate the psychological consequences of COVID-19

Abstract Background Several meta-analysis studies have been reported in the literature on the incidence of psychopathological conditions resulting from the COVID-19 pandemic. This investigation aims to compile and analyze the findings of previously published meta-analysis research, as shown by the present meta-analysis of previous meta-analysis studies. Methods The PubMed and Scopus databases were searched from 1 January 2019 to 30 May 2022. The procedure was carried out according to the PRISMA flow chart and the qualities of the identified studies were analyzed using AMSTAR 2. Heterogeneities and risk of bias were assessed using the Meta-MUMS tool. The corresponding results, forest and funnel plots of the psychological consequences of COVID-19 were synthesized. Results Eleven meta-analysis studies were included. Random-effects meta-analysis of anxiety and depression showed (ER = 0.318 p-value < 0.001, ER = 0.295 p-value < 0.001) high heterogeneities (I2 = 99.70%, I2 = 99.75) between studies. Random-effects meta-analyses of sleep difficulties and insomnia were shown (ER = 0.347 p-value < 0.001, ER = 0.265, p-value < 0.001) along with heterogeneities (I2 = 99.89, I2 = 99.64). According to the random meta-analysis of post-traumatic stress syndrome (PTSS) and post-traumatic stress disorder (PTSD) (ER = 0.246, p-value = 0.001, ER = 0.223 p-value < 0.001) with heterogeneities (I2 = 99.75, I2 = 99.17). Random-effects meta-analyses of somatic and fear symptoms have been shown (ER = 0.16 p-value < 0.001, ER = 0.41, p-value = 0.089) with high heterogeneities (I2 = 99.62, I2 = 98.63). Random-effects meta-analysis of obsessive–compulsive symptoms and distress (ER = 0.297 p-value = 0.103; ER = 0.428, p-value = 0.013) with high heterogeneity, as I2 = 99.38%. Subgroup analysis of all symptoms and Egger's tests for detecting publication bias were also assessed. Conclusion The data from the current meta-analysis showed different psychological disorders of COVID-19 during the pandemic. Clinicians should be aware of the prevalence with which COVID-19-infected patients experience emotional distress, anxiety, fatigue, and PTSD. About half of the included systematic reviews (SRs)/meta-analyses (MAs) suffered from poorer methodological quality and increased risk of bias, reducing confidence in the findings. There must be more SRs/MAs and high-quality clinical trials conducted to confirm these findings

Risky driving behaviors: Scoping review

Background. Risky driving behaviors increase the risk of injury and death due to crash. Vast strata of behaviors are considered as risky behavior in the literature. The aim of this scoping review was to extract and determine various behaviors tagged as risky driving behavior. Methods. Based on Arkesy and OMalley framework, a scoping review study was conducted. Literature search was done through PubMed, Embase, Scopus and Web of Science databases. Snowballing of references and hand search of related journals were also used. Time limitation for search was defined from 1st January 2000 to 30th December 2019. Screening process was done independently by two researchers. Data was systematically extracted from the included articles using a predetermined extraction table. Results. Literature review resulted in 3761 articles. After the screening process, 45 articles were included in the study. Majority of included articles were from United States (n=13), followed by Iran (n=5), Australia (n=4) and China (n=4). Speeding (reported in 70% of included studies), drunk driving (52%), aggressive driving (44%), tailgating (41%) and not-using seat belt (37%) were the most frequent behaviors tagged as risky driving behaviors in the included studies. Conclusion. Regarding the discrepancies in understanding, definition, and categories of risky driving behaviors, it is of great importance to develop a unified standard definition and categorize risky behaviors which would facilitate global movements to reduce risky driving behaviors through effective interventions. Practical Implications. The results will guide the policymakers to clearly develop suitable policies in national, regional or local levels to prevent and reduce the negative results of risky driving behaviours

Assessment of Behavioral Approach and Behavioral Inhibition Systems in Mood Disorders

Introduction: Psychiatric disorders could be evaluated in terms of behavioral activation and inhibition systems. Dysregulation of these systems may lead to development of manic or depressive episodes in patients with mood disorders. This study aimed to identify Behavioral Approach System (BAS) and Behavioral Inhibition System (BIS) hypersensitivity as the functional brain system behaviors in patients with major depressive disorder and bipolar mood disorder I, compared to healthy individuals. Methods: This case-control study was conducted in Razi Psychiatric Hospital, a mental health referral center in Northwest of Iran. The study consisted of two groups of patients, one with major depressive and the other with bipolar mood disorders and one healthy group. Each group had 40 patients (20 men and 20 women). The study data were collected through BIS and BAS questionnaire, Beck Depression Inventory (BDI-II), Young Mania Rating Scale (YMRS). The obtained data were analyzed by SPSS version 18. Results: The findings showed a significant negative correlation between BIS, BAS and BAS subscales with the severity of depression and positive correlation with mania symptoms (P<0.05). Conclusion: BAS and BIS dysregulations may predispose people to mood disorder symptoms. BAS is hyperactive during manic phase and may predict the symptom severity of bipolar mood disorder

Does Severity of Attention Deficit /Hyperactivity Disorder impact Trauma in Children?

Introduction: Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with high heritability. It is the most common childhood mental disorder. The key aspects of ADHD may put the affected children at risk for different traumatic experiences. Therefore, this study was conducted to investigate the relationship between the severity of trauma and ADHD symptoms in children. Methods: In this descriptive-correlational study, the target population included 90 children aged 6-12 years old, visiting Imam Reza, Children, Sina, and Shohada Hospitals in Tabriz, Iran. The severity of trauma was assessed, using placebo transdermal system (PTS), and the ADHD symptoms were evaluated, using Conners' Parent Rating Scale. To rule out other psychiatric disorders, the Child Symptoms Inventory-4 (CSI-4) was employed. Results: Results showed a significant positive correlation between the severity of trauma and ADHD, hyperactivity, oppositional/impulsivity, and attention-deficit scores (P < 0.01). In addition, results from the independent t-test suggested a significance difference between the ADHD and non-ADHD children in terms of the severity of trauma. Conclusion: There was a significant relationship between the symptoms of ADHD and the severity of trauma in children, in a way that the scores of the aforementioned variables improved with increasing the severity of trauma. Regarding the profound effects of trauma on human and financial resources, required measures should be taken for making house and school settings safe for such children