Depression and Anxiety in Iranian Mothers of Children with Epilepsy

How to Cite this Article: Soltanifar A, Ashrafzadeh F, Mohareri F, Mokhber N. Depression and Anxiety in Iranian Mothers ofChildren with Epilepsy. Iranian Journal of Child Neurology 2012;6(1):29-34. ObjectiveEpilepsy is a common neurological disorder in children. Parents with epileptic children have many psychosocial care needs. So the main goal of this study was to evaluate depression and anxiety in Iranian mothers with epileptic children.Materials & MethodsWe identified 30 mothers of children with epilepsy and 30 mothers of children without epilepsy with children aged between 8 and 12 years who met the study criteria. In all children with epilepsy, the mothers were the main caregivers and all these children lived in two-parent families. Children in the control group were in the same age. Ninety-eight percent of children in the control group lived in two-parent families with the mother as the main caregiver. All mothers fulfilled the Beck Depression Inventory (BDI) and Spielberger State-Trait Anxiety Inventory.ResultsAccording to these data, BDI scores were significantly higher in the mothers of epileptic children (mean of Beck score=16.5) compared to the control group (mean of Beck score=9.8). The total, Spielberger State-Trait Anxiety Inventory scores for mothers of children with epilepsy were 100.3, 51.7 and 48.6. However, these scores in the control group were 86.9, 45.1 and 41.8. These differences were statistically significant.In a second analysis, using the demographic data, we did not find any statistically significant relation between anxiety or depression and the mothers’ job, children’s medication and other demographic variables.ConclusionNeurologists and psychiatrists need to develop better programs for adequate management of psychiatric disorders in mothers with epileptic children. References 1. Cowan LD. The epidemiology of the epilepsies inchildren. 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J Neurosci Nurs 2009Oct;41(5):244-50.8. Pianta RC, Lothman DJ. Predicting behavior problemsin children with epilepsy: child factors, disease factors,family stress, and child-mother interaction. Child Dev1994 Oct;65(5):1415-28.9. Dunn DW, Austin JK, Huster GA. Symptoms ofdepression in adolescents with epilepsy. J Am Acad ChildAdolesc Psychiatr 1999;38:1133-8.10. Shore CP, Austin JK, Huster GA, Dunn DW. Identifyingrisk factors for maternal depression in families ofadolescents with epilepsy. J Specialists Pediatr Nurs2002;7:71-80.11. Yongli, Cheng-Ye ji, Jiong Qin, Zhi-Xiang Zhang.Parental anxiety and quality of Life of epileptic children.Biomed Environ Sci 2008 Jun;21(3):228-32.12. Williams J, Steel C, Sharp GB, DelosReyes E, PhillipsT, Bates S, et al. Parental anxiety and quality of life inchildren with epilepsy. Epilepsy Behav 2003;4:483-6.13. Lv R, Wu L, Jin L, Lu Q, Wang M, Qu Y, Liu H. Depression,anxiety and quality of life in parents of children withepilepsy. 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Mu PF, Kuo HC, Chang KP. Boundary ambiguity, copingpatterns and depression in mothers caring for children withepilepsy in Taiwan. Int J Nurs Stud 2005 Mar;42(3):273-82.20. Lv R, Wu L, Jin L, Lu Q, Wang M, Qu Y, et al. Depression,anxiety and quality of life in parents of children withepilepsy. Acta Neurol Scand 2009 Nov;120(5):335-41.21. (Wood LJ, Sherman E, Hamiwka LD, Blackman M,Wirrell E. Depression, anxiety, and quality of life insiblings of children with intractable epilepsy. EpilepsyBehav 2008 Jul;13(1):144-8.22. Tosun A, Gokcen S, Ozbaran B, Serdaroglu G, Polat M,Tekgul H, et al. The effect of depression on academicachievement in children with epilepsy. Epilepsy Behav2008 Oct;13(3):494-8.23. Rodenburg R, Meijer AM, Dekovic M, Aldenkamp AP. Family factors and psychopathology in childrenwith epilepsy: a literature review. Epilepsy Behav 2005Jun;6(4):488-503.24. Wirrell EC, Wood L, Hamiwka LD, Sherman EM. Parenting stress in mothers of children with intractableepilepsy. Epilepsy Behav 2008 Jul;13(1):169-73

Knowledge and Attitude of Pediatricians and Pediatric Residents Regarding Child Abuse and Neglect

Introduction:Child abuse and neglect is a public health challenge with lifelong consequences for survivors. Physicians’ knowledge regarding child abuse and neglect is essential for diagnosis, treatment, and timely referral to legal authorities. This study aimed to determine pediatric residents’ and pediatricians’ knowledge and attitude regarding child abuse and neglect.Methods: In this cross-sectional study, pediatric residents› and pediatricians› knowledge and attitude regarding child abuse and neglect were measured using a standard questionnaire with confirmed validity and reliability. In this questionnaire, knowledge score ranged from 0 to 17, and attitude score ranged from 10 to 50. After collecting the questionnaires and calculating the scores, the information was entered into the SPSS software (version 22), and statistical analysis was performed.Results: A total of 80 participants, including 38 pediatric residents and 42 pediatricians, participated in this research. Among them, 71.3% were female, and 28.8% were male. The mean score of knowledge and attitude in all participants was 14.05 ± 1.88 out of 17 and 41.39 ± 4.36 out of 50, respectively. The mean score in the pediatric residents and pediatricians was 13.42 ± 2.02.  and 14.62 ± 1.57 for knowledge and 40.66 ± 4.32 and 42.05 ± 4.35 for attitude, respectively. Regarding knowledge, 19 participants (23.8%) had a good score, 35 (43.8%) had a moderate score, and 26 (32.5%) had a poor score (p=0.24). There was a significant difference in terms of knowledge score among four academic groups (first-year resident, second-year resident, third-year resident, and pediatrician) (p=0.031), as the score wassignificantly higher in pediatricians than in residents (p=0.004). However, no significant difference was observed for attitude score (p=0.056). In general, and regarding all participants, no significant relationship was observed between attitude score and knowledge score (p=0.059).Conclusion: Most pediatric residents and pediatricians participating in the present study had moderate knowledge and attitude toward child abuse and neglect, and less than a quarter of the participants had good knowledge in this regard. Also, the pediatricians had significantly higher knowledge scores than the pediatric residents. These results emphasize the importance of more education for pediatric residents regarding child abuse and neglect and continuing education programs for pediatricians

Short-Term Family-Focused Psycho-Educational Program for Bipolar Mood Disorder in Mashhad

Background: Bipolar mood disorder type 1 is one of the mostserious psychiatric disorders. We aimed to assess the efficacyof a short-term family–focused treatment for patients with bipolarmood disorder type 1 in a one-year follow-up period.Methods: Sixty patients with bipolar mood disorder and acutemania episodes who referred to Ibn-e-Sina Psychiatric Hospitalin Mashhad were recruited. Half of them were randomly assignedto the psycho-education group. Their available adultfamily members received a psycho-educational training sessionbefore the patients' discharge from the hospital. All patients receivedconcurrent appropriate pharmacotherapy and psychotherapy.All the patients were evaluated by a blind home-visit teamevery 3 months for a period of one year. The evaluation includedthe number of psychiatric visits, patients' adherence, relapsestatus, number of re-hospitalizations, and time to relapse.Results: Fifty-seven patients completed the trial. In the experimentalgroup, there were four patients with relapse(13.79%) and in the control group nine patients (31.58%) hadrelapse of the disorder (P=0.006). The mean time of takingmedications in the education group was 11.41 months. Thistime was 9.14 months in the control group (P<0.001). Therewas also a significant difference between the two groups interms of frequency of psychiatric visits (P<0.001).Conclusion: Short–term family-focused psycho-education isan effective adjunct to pharmacotherapy for bipolar mood disorder.Further studies are needed to evaluate the efficacy andcost-effectiveness of long-term family-focused psychoeducationaltreatment for patients with bipolar mood disorder

Prevalence of Sleep Disturbance and Potential Associated Factors among Medical Students from Mashhad, Iran

Study Objectives. A very limited number of studies have evaluated the prevalence of sleep problems, and related factors, in Iranian medical students. The aim of this study was to determine the prevalence of sleep disturbance and potential associated factors among medical students of Mashhad University of Medical Sciences, Mashhad, Iran. Methods. In this cross-sectional study, 315 medical students chosen by stratified random sampling participated in the academic year 2018-2019. The Pittsburgh Instrument and DASS-21 questionnaire were used to evaluate sleep quality and anxiety, depression, and stress, respectively. Also, demographic, educational, and socioeconomic information was collected. SPSS 16 software was used for data analysis. Results. Out of 300 students who completed the questionnaires, 165 (55%) were male, with a mean age of 21.94±2.28 years old. The prevalence of poor sleep quality was 51.3%. We did not find significant associations among age, sex, and poor sleep quality. Concurrent psychological symptoms such as stress, depression, and anxiety were significantly associated with sleep disorders. After adjusting variables in the multivariable regression model, depression (OR=2.81, 95% CI: 1.35-5.87; p=0.006) and the number of hours spent on using smartphones in 24 hours (OR=1.13, 95% CI: 1.02-1.25; p=0.01) were significantly associated with poor sleep quality among medical students. Conclusion. The prevalence of poor sleep quality among medical students was high, and we found that increased use of smartphones during the day and depression were associated with sleep disorders

Barkley's Parent Training Program, Working Memory Training and their Combination for Children with ADHD: Attention Deficit Hyperactivity Disorder.

Objective: The aim of the current study was to examine the effectiveness of Barkley's parent training program, working memory training and the combination of these two interventions for children with Attention deficit hyperactivity disorder (ADHD). Methods: In this study, 36 participants with ADHD (aged 6 to 12 years) were selected by convenience sampling. Revision of the Swanson, Nolan and Pelham (SNAP) questionnaire (SNAP–IV), Child Behavior Checklist (CBCL) and clinical interviews were employed to diagnose ADHD. Wechsler Intelligence Scale for Children-Fourth Edition was also implemented. The participants were randomly assigned to the three intervention groups of Barkley's parent training program, working memory training and the combined group. SNAP-IV and CBCL were used as pre-tests and post-tests across all three groups. Data were analyzed using MANCOVA (SPSS version18). Results: There was a significant difference (p< 0.05) in the decline of attention deficit and hyperactivity /impulsivity symptoms betwe  n the combined treatment group and working memory training group and also between the combined treatment group and the parent training group in SNAP. In terms of attention problems (experience-based subscales) of CBCL, there was a significant difference (p< 0.001) between the combined treatment group and working memory training group. Furthermore, compared to the working memory training and parent training groups, the combined group demonstrated a significant decline (p< 0.01) in clinical symptoms of ADHD (based on DSM). Conclusion: It was revealed that combined treatment in comparison with the other two methods suppressed the clinical symptoms of ADHD more significantly

Efficacy of adding acupuncture to Methylphenidate in children and adolescents with attention deficit hyperactivity disorder: A randomized clinical trial

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most prevalent finding in children with behavioral issues. It has been shown that acupuncture, as a complementary medicine, may have some beneficial effects in ADHD treatment; however, the available evidence of its effectiveness are inadequate. This study aimed to investigate the effectiveness of acupuncture treatment in patients with ADHD. Methods: This double blind randomized sham controlled trial was conducted on patients with confirmed ADHD referred to Ibn-e-Sina Psychiatric Hospital, Mashhad, Iran between January 2017 and June 2017. Patients were randomly allocated into either an acupuncture (experimental group) or a sham acupuncture (control group). All patients received a standard treatment of 0.3–1 mg/kg of Methylphenidate (Ritalin) in 2 or 3 divided doses. Within 4 weeks the intervention group received acupuncture treatment 3 times a week. Sham acupuncture was used for the control group within the same duration as acupuncture group. The treatment outcomes were measured using home version of ADHD-rating scale (RS) and the Continuous Performance Test after 3 weeks. Independent-samples t-test, Pearson Chi-square test, and Paired-samples t-test were used for data analysis with SPSS version 16.0. Results: This study was conducted on 59 patients (52 males) with a mean age of 10.64 ± 2.46 years in two groups of experiment (n = 31) and control (n = 28). ADHD-RS total score was significantly more decreased in acupuncture group after 3 weeks (-6.29 ± 7.1 vs. -1.96 ± 6.7; p = 0.007). Also, the hyperactivity and impulsivity was significantly more decreased in the acupuncture group compared to the sham control group (-3.29 ± 3.7 vs. -0.45 ± 4.1; p = 0.005). Furthermore, acupuncture did not considerably change Omission error, Commission error, Reaction Time and Correct hit (p > 0.05). Conclusion: Our study showed that acupuncture can significantly improve the parent-report ADHD-RS. Nevertheless, it did not improve the attention deficit. We recommend further investigations with larger sample sizes and longer follow-up. The adverse effects of acupuncture on ADHD patients were not assessed in this study, but should be measured in future studies

The Evaluation of Food Allergy on Behavior in Autistic Children

Background: Despite many efforts, the etiology of autism remains unknown. Food allergy has been suggested as a pathogenic factor in Autism Spectrum Disorder (ASD). Our aim in this study was to determine whether food allergy could be considered as a risk factor for autistic children. Methods: Thirty-nine autistic children were examined by the skin prick test (SPT), and total serum IgE was evaluated by ELISA. SPTs were performed for egg whites, oranges, peanuts, tomatoes, tuna fish, walnuts, aubergines, melons, grapes, and cow milk. Parents and teachers were then asked to exclude these items from the childrens’ diets for six months. After the treatment period, the autistic children who tested positive for food allergies were re-assessed by a standard questionnaire to obtain further information about their medical histories. Results: Three of the study’s 39 autistic children (7.7%) tested positive on the SPT. Total serum IgE levels were elevated in 56.4% of the subjects (mean=164±24.5, cut-off >155 IU/ml). The results showed a decreased mean in the childrens’ autistic behaviors on the Children Autism Rating Scale (CARS) after both eight weeks and six months; however, this decrease was not statistically significant. Conclusion: Food allergy may play a role in the pathophysiology of autism. We conclude that avoidance of certain foods benefits the behavior of autistic children