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"Ginkgo biloba" has been reported to affect the neurotransmitter system and to have antioxidant properties that could impact the pathogenesis of Autism Spectrum Disorder. Based on these studies, we decided to assess the effectiveness of "Ginkgo biloba" extract (Ginko T.D., Tolidaru, Iran) as an adjunctive agent to risperidone in the treatment of autism. Forty-seven outpatients with a DSM-IV-TR diagnosis of autism ages between 4 and 12 years were assigned to this double blinded clinical trial and were randomly divided into two groups. One group received risperidone plus Ginko T.D and the other received risperidone plus placebo. The dose of risperidone was 1-3 mg/day and the dose of Ginko T.D. was 80 mg/day for patients under 30 kg and 120 mg/day for patients above 30 kg. Patients were assessed using Aberrant Behavior Checklist-Community (ABC-C) rating scale and the side effect check list every 2 weeks until the endpoint. None of the 5 subscales of ABC-C rating scale showed significant differences between the two groups. Incidents of side effects were not significantly different between the two groups. Adding "Ginkgo biloba" to risperidone did not affect the treatment outcome of ADs. Nevertheless, further observations are needed to confirm this result.

Objective: To study the psychiatric comorbidity of a clinical sample of children with ADHD and the psychiatric disorders in their parents. Method: Structured psychiatric interviews assessing lifetime psychiatric disorders by "DSM-IV" criteria, using the Farsi version of the Schedule for Affective Disorders and Schizophrenia. Results: The mean age of the children was 8.7, mothers, 40.1, and fathers, 34.6 years. Only 7.6% of the boys and 21.7% of the girls manifested ADHD without any other psychiatric comorbidity. The most common comorbid disorders were disruptive behavior disorders and anxiety disorders. The prevalence of lifetime ADHD in the parents was 45.8% and 17.7%, respectively. The rate for major depressive disorder in mothers and fathers was 48.1% and 43.0%, respectively. Discussion: The clinical sample of ADHD children typically had at least one other psychiatric disorder, usually oppositional defiant disorder in boys and anxiety disorders in girls. The most common psychiatric disorder in the parents was mood disorder. (Contains 2 tables.)

Abstract Background Some studies have shown that neurological and mental disorders in children with celiac disease are higher than in the general population. The aim of this study is to find frequency of ADHD in celiac patients. Result The findings of the study showed that the frequency of ADHD in males was 6 cases (22.2%) and 6 cases (18.2%) in females, and although the ADHD score was higher in males, there was no significant difference in sex (P = 0.697). The frequency of ADHD in terms of age group also showed that there were no hyperactive children in the age group under 5 years of age; in the age group of 5–9 years old, 8 cases (28.6%); in the age group of 10 to 14 years old, 4 cases (19%); and in the age group of 15 and older, no one was diagnosed with ADHD. The chi-square test showed that the frequency of ADHD in terms of age group was not significantly different (P = 0.26). It should be noted that according to Pearson correlation test, there was a reverse correlation between the age and ADHD, but it was not statistically significant (P = 0.33). Conclusions The frequency of ADHD among boys and girls with celiac disease was 22.2% and 18.2%, respectively.

Abstract Introduction Internet addiction disorder has reportedly become an important cause of health and social problems. The aim of this study was to investigate the effectiveness of cognitive-behavioral group therapy for internet addiction symptoms, quality of life, and mental health of students with internet addiction. Methods This was a quasi-experimental study with pretest-posttest measures and a control group. The statistical population of the study consisted of all students at Tehran universities in the academic year of 2018-19. The target group was selected through an internet addiction test and a clinical interview using a targeted sampling method and was divided into experimental and control groups by randomization. The experimental group participated in fifteen 90-minute cognitive-behavioral group therapy sessions. Before, immediately after, and 3 months after the treatment, the internet addiction symptoms of both groups were evaluated to assess mental health with the IAT, quality of life (QOL), and SCL-90-R questionnaires. Data were analyzed with ANCOVA analysis using SPSS Statistics 20 software. Results After treatment, cognitive-behavioral therapy groups showed reductions in internet addiction scores (p < 0.05). Results showed that the cognitive-behavioral group therapy was effective for improving quality of life (p < 0.05) and mental illnesses (p < 0.05) in students with internet addiction. Conclusions Cognitive-behavioral group therapy can enhance awareness and mental health of students with internet addiction. Therefore, this intervention can be used as a beneficial treatment to reduce internet addiction symptoms and improve the condition of people with behavioral addictions such as internet dependency.

Objective: Smartphone is an important technology device in our lifestyle. It has an important part of our daily lives, but it also has a negative effect, such as cell phone dependency. This research aimed to evaluate the psychometric properties of mobile phone abuse (MPA) in the Iranian population. Method: In this study, data were chosen from 1100 participants who were studying in Tehran universities. The principal version of the scale was translated into Persian using the back translation method. All attendees completed Demographic Questionnaire, MPA Questionnaire, and Mobile Phone Problematic Use Scale (MPPUS). Eventually, a clinical interview (based on the fifth version of DSM) was done for all the participants. For data analysis, internal and external consistency, factor analysis, construct validity and confirmatory factor analysis (CFA) were used. Statistically, less than 0.05 were considered to be ‎ significant.‎ Results: According to expert judgments, content validity index was satisfactory. Furthermore, the reliability of the questionnaire was confirmed with Cronbach’s α of 0.90 and test-retest reliability of 0.56 after 3 weeks. The best cutoff point for this questionnaire (MPA) was 46. Also, 4 factors were extracted by principal components method and varimax rotation: “excessive use of cell phone,” “addictive use of social networks,” “mood modification,” and “preoccupation” for both male and female students. Conclusion: MPA could be used in studies on the evaluation of mobile phone addiction. This can be a stepping stone towards the identification of problems and improvement of students’ mobile phone abuse.

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.

Objective: Despite the awareness of smartphone addiction, low findings and lack of validated standards have led to insufficient information in this area. This study aimed to examine the relationship between mobile phone dependency and mental disorders in students in Iran, while controlling for the impact of gender, age, educational levels, and marital status. Method: In this cross-sectional study, a sample of 1400 university students (445 males and 955 females) aged 18-35 years were selected from 3 cities of Tehran, Isfahan and Karaj. The participants filled out a set of questionnaires: Cell Phone Dependency Questionnaire (CPDQ), Millon Multiaxial Clinical Inventory, and participated in interviews. Data were analyzed using multiple logistic regression method via SPSS-22 software. Results: In terms of controlling the demographic variables, the results revealed that bipolar disorder, depression, anxiety, somatization, dependent personality disorder, and compulsive personality disorder could increase the possibility of mobile phone addiction by 4.2, 4.2, 1.2, 2.8, 3.1, and 3.2 folds, respectively (P < 0.05). However, other disorders and demographic characteristics did not have any significant effects on the equation. Conclusion: The results can help better understand the relationship between psychological syndromes and smartphone addiction and can also facilitate further studies in this field. In addition, those students with smartphone addiction should be provided with different preventative strategies. Moreover, a growing range of stimulating applications may trigger the risk of addiction.

Objective: Smart phones have rapidly become an integral, and for some, an essential communication device worldwide. The issue of identity has always been a subject of interest among psychologists. The present study was conducted to compare personal and national identity and their subscales between cell phone addicts and non-addicts. Method: In this cross-sectional study, 500 student cell phone users from various universities in Tehran were recruited using stratified sampling. Participants completed cell phone addiction questionnaires including Mobile Phone Problematic Use Scale (MPPUS), Cell Phone Dependency Questionnaire (CPDQ), Personal Identity Development Questionnaire, Extended Objective Measure of Ego Identity Status (EOMEIS) and National Identity Questionnaire. Then, the subscales of these instruments were analyzed using SPSS Version 20. Results: Results of this study revealed significant differences between cell phone addicts and non-addicts in the scores of national identity, personal identity, and most subscales, except for some subscales (P

Objective: Glutamate is considered a target for treating obsessive-compulsive disorder (OCD). The efficacy and safety of the nutritional supplement of N-Acetylcysteine (NAC) as an adjuvant to serotonin reuptake inhibitor (SSRI) for treating children and adolescents with OCD has never been examined. Methods: This was a 10-week randomized double-blind placebo-controlled clinical trial with 34 OCD outpatients. The patients received citalopram plus NAC or placebo. Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Pediatric Quality of Life Inventory (PedsQL™) were used. Adverse effects were monitored. Results: YBOCS score was not different between the two groups at baseline, but the score was different between the two groups at the end of this trial (P

Objective: Driving is a complex behavior and is affected by several factors. This cohort study aimed at representing the main determinants such as personality features, driving behavior, and mental illnesses on driving violation based on logistic regression. Method: In this cohort study, 800 heavy truck and lorry drivers were recruited. Participants were selected from those individuals who referred to Imam Sajjad hospital in Tehran, Iran during fall 2013 to summer 2015. Manchester Driving Behavior Questionnaire (MDBQ), Big Five Personality Test (NEO Personality Inventory), and SADS (Semi-Structural Interview) were used in this study. After 2 years, we checked all traffic violations caused by human factors involving the drivers. SPSS Version 18 was used for data analysis; t test and logistic regression (OR) was also used. Results: The findings of the present study revealed significant differences between the 2 groups of drivers (those who were and were not involved in driving offenses) with respect to controlling the effective and demographic variables. Moreover, it was found that depression and anxiety could increase the chance of accidents (2.4 and 2.7 accidents odds, respectively) (P = 0.04, P = 0.004). Furthermore, just neuroticism could increase 1.1 odds of traffic offences (P = 0.009), but other personality traits did not have an effect on the equation. Conclusion: Consistent with previous examinations, some mental disorders may affect traffic violations. Considering the magnitude and sensitivity of driving behavior, it is essential to evaluate multiple psychological factors in drivers before and after receiving or renewing their driver’s licenses.

bjective: This clinical trial examines the effect of augmentation of methylphenidate (MPH) with folic acid to improve quality of life, and to treat aggression and ADHD symptoms .Method:Participants of this eight week randomized double blind placebo controlled clinical trial were 49 children with ADHD. They were randomly assigned into one of the two groups: the first group receiving methylphenidate (10 to 20mg/day) plus folic (5mg/day), and the second group receiving methylphenidate plus placebo. Parent-reported ADHD symptoms and Overt Aggression Scale score were the outcome measures. Quality of life was assessed as well. Assessments were performed at pre-intervention, and at one month and two months after starting the interventions using repeated measure analysis Results:The mean age of children was 9.6(2.7) years. Age and gender were not associated with the groups. ADHD symptoms significantly decreased in both groups during the trial. However, no difference was observed between the groups. Moreover, aggression non-significantly decreased in both groups. Meanwhile, there was no difference between the two groups in efficacy for treating different types of aggressive behaviors including: verbal aggression, physical aggression against people, physical aggression against properties or objects, and aggression against self (self-injurious behavior). While methylphenidate improved quality of life of children with ADHD, folic acid did not improve it more than placebo. Both medications were well tolerated.Conclusion:considering the marked limitations of this trial, this primarily report suggests that methylphenidate may improve ADHD symptoms and the quality of life of children with ADHD. Current evidence does not support that folic acid as an adjuvant is effective for treating ADHD symptoms or aggression, or the improving quality of life of children with ADHD.

Objective:This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature .Method:Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n=30), OMT (n=30), and wait-list or control group (n=31). The mean length of nail was considered as the main outcome .Results:The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P

Objective: The aim of the present study was to investigate the epidemiology of psychiatric disorders in ‎children and adolescents in five provinces of Iran: Tehran, Shiraz, Isfahan, Tabriz and Mashhad.‎ Method: In the present study, we selected 9,636 children and adolescents aged 6-18 years through ‎multistage cluster random sampling method from Tehran, Shiraz, Isfahan, Tabriz and Mashhad. ‎We instructed the clinical psychologists to complete the Strengths and Difficulties Questionnaire ‎‎(SDQ) for the participants, and those who received a high score on SDQ, completed the Persian ‎version of Kiddie-SADS-Present and Lifetime Version (K-SADS-PL). We used descriptive ‎analysis and 95% confidence interval to investigate the relationship between scores of the K-‎SADS questionnaire and demographic factors‏. ‏We used one-way ANOVA to test the significant ‎differences among the disorders according to sex, age and province of residence.‎‎ Results: Based on the results, oppositional defiant disorder (ODD) (4.45%) had the highest prevalence of psychiatric ‎disorders in the five provinces and substance abuse and alcohol abuse (0%) had the lowest ‎prevalence. In addition, attention deficit hyperactivity disorder (ADHD) had the most ‎prevalence in boys (5.03%) and ODD had the most prevalence in ‎girls (4.05%). Among the three age groups, 6 to 9 year olds had the highest rates of ADHD ‎‎(5.69%); 10 to 14 and 15 to 18 year olds had the highest rates of ODD (4.32% and 4.37% ‎respectively). Among the five provinces, Tehran and Mashhad allocated the highest rates of ODD; Isfahan and Shiraz had the highest rates of ADHD; and Tabriz had the highest rates of social phobia.‎ Conclusion: The current study revealed that the overall frequency of psychiatric disorders based on Kiddie-‎SADS-Present and Lifetime Version (K-SADS-PL) was higher than a similar study. Moreover, in ‎this study, among the five provinces, Tehran and Mashhad allocated the highest rates of ODD; Isfahan and Shiraz had the highest rates of ADHD; and Tabriz had the highest rates of social phobia. Therefore, these percentage ‎of psychiatric disorders in Iran lead us toward a greater use of consultation and mental health ‎services‏.

Objective: Violence imposed on wives by their inpatient psychiatric husbands has not been studied yet. The current study surveyed the rates and predictors of violence committed by inpatient psychiatric husbands towards their wives. Methods: A convenient sample of wives of 209 married male psychiatric inpatients completed a self-reported questionnaire. They were asked about physical, emotional, social and economic abuse. Results: More than 80% of the husbands socially abused their wives; 73.0% of the wives had been regularly beaten by their husbands; the rate for humiliation was 77.2%; and only 14.1% of the wives reported that their sexual relationship with their husbands is with desire. Conclusion: There is a dramatic high rate of different types of abuse toward wives by their inpatient psychiatric husbands. They are commonly victimized by their husbands. Moreover, different types of violence always co-occur. Future studies should consider this important issue which is unfortunately an ignored research area.

Objective: It is not clear whether sibling’s gender ratio is associated with attention deficit hyperactivity disorder (ADHD). This study examines whether inattentiveness severity and hyperactivity/impulsivity severity are associated with birth order of children with ADHD.Method: Participants are a clinical sample of 173 children and adolescents with ADHD and 43 ones without ADHD. Diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders forth edition-Text Revision (DSM-IV-TR), diagnostic criteria according to face-to-face interview with the children and their parents. ADHD DSM-IV checklist was used to measure inattentiveness and hyperactivity/impulsivity scores.Results: The association of birth order and diagnosis of ADHD was not statistically significant after adjusting for covariate factors. The gender ratio of siblings is not associated with ADHD.Conclusion: Birth order and siblings gender ratio are independent of ADHD diagnosis. The results of this study support the fact that genetic factors rather than environmental factor of birth order is associated with ADHD. Moreover, contrary to autism, the current results do not suggest the androgen theory for ADHD.

"n Objective: "n "nThis study surveys children and their parents' perceptions, and their treatment preference of significant/bothersome symptoms in children with Tourette syndrome. "nMethods: "nThirty five children and adolescents who referred to an out-patient clinic of a Child Psychiatry Clinic were selected as subjects for this study. The children and their parents were interviewed about their perception of significant/bothersome symptoms of motor tics, vocal tics, learning difficulties, attention deficit disorder, hyperactivity, obsessions, compulsions, and rage attacks. "nResults: "nAbout two thirds of the subjects had symptom of rage. Inattentiveness and hyperactivity were observed in more than half of the children. There was a statistically significant difference between parents and their children in frequency of motor tics and rage attacks . Children reported the necessity for controlling and management of these symptoms less than their parents. "nDiscussion: "nThe rates of motor, vocal tics and rage attacks in the Iranian sample are similar to other studies. Rage attack is one of the most common significant/bothersome symptoms reported that should be treated. While motor tics were not rated among the most common features that should be treated in a study in Canada, it was the most common significant/bothersome symptom in Iran. Parents perceive motor tics and rage attacks as more significant/bothersome symptoms compared to children.

"n Objective: "n "nThe aim of this report was to study the gender role on autismsymptoms distribution and severity in a clinical sample from Iran. Then, the results were compared with the published study from the same community population sample, Iran. "nMethod: The subjects of this retrospective study were a convenient clinical sample of the referrals of children with pervasive developmental disorders. The diagnosis was made according to DSM-IV diagnostic criteria. "nResults: "nMost of the subjects were boys. Boys were referred for evaluation more frequently than girls. The sample included 61 children and adolescents aged 2.1 to 15 years; of whom, 49 had autism. The mean age of children with autism was 7.2(SD=3.2) years. The mean of age, the diagnosis and severity of the symptoms were not related to gender . "n "n "nConclusion: Usually, those with severe cases of autism refer to clinics for treatment. Therefore, the clinical sample of children with autism is just the tip of the iceberg and they may not be the actual representative of community sample of children with autism. Preventive programs should be more focused on the screening and referring of inflected girls for service utilization .

"n Objective: "n To study the validity and reliability of the Persian version of the Strengths and Difficulties Questionnaire (SDQ). "nMethod: The data for this study was collected from the psychiatric clinic of Hafez hospital and 16 regular schools in four regions of Shiraz using stratified random sampling .The 25 items of the SDQ were completed for 379 boys and 377 girls. The 756 participants aged 3-18 were divided to 3 groups according to age classification.The SDQ was completed by parents, teachers and adolescents according to their age. Clinical interview was performed for 155 children and adolescents who referred to the psychiatric clinic. "nResults: The mean age of the children was 10.3 years (SD=3.6, range 3-18 years). Children were divided to 3 groups: 1) among the participants 17 (2.3%) were aged 3-4 years,; 2) 409 (54%) were aged 4-11 years, and 3) 330 (43.7%) were aged 11-16 years. Good internal consistencies were found for the self report SDQ scales (mean ل for subscales 0.628). For the teacher SDQ scales, the internal consistencies were lower than the self-report scales (mean ل for subscales 0.454). The lowest internal consistencies were found for the parents SDQ scales. There was sufficient convergent and discriminant validity. "nConclusions: The Persian translation of the self reported SDQ has acceptable psychometric properties. Internal consistency of the self-report SDQ was good.The mean inter-informant correlations of the SDQ scales were satisfactory.

Objective:To study the prevalence and demographic characteristics of mood disorders among Iranian adults. Method: In this cross-sectional population-based epidemiological study (age > 18) in Iran, 25180 individuals were selected through a randomized cluster sampling method for a diagnosis using the Schedule for Affective Disorders and Schizophrenia (SADS). They were then interviewed at home by 250 trained clinical psychologists. Results: The estimated lifetime prevalence of Major Depressive Disorder (MDD) and Minor Depressive Disorder (mDD) were 3.1% and 0.3% respectively. Also, the estimated lifetime prevalence of Bipolar Mood disorder (BMD) type I and type II were 0.1% and 0.7% respectively. The current prevalence of MDD, mDD, BMD-I, and BMD-II were 1.8%, 0.2%, 0.04%, and 0.3% respectively. Mood disorders were associated with female gender, lower education, being married, being middle-aged, living in cities, and not being a homemaker. Conclusion: The prevalence of mood disorders was lower among Iranian adults than reported in Western studies, and a number of demographic associations differed from those reported in Western studies. Important cultural differences in the nature or manifestation of depression are implied by these results.

Attention deficit hyperactivity disorder (ADHD) is the most common behavioral problem during childhood and in school-aged children. Various projection drawings have been designed for assessing children's personality and psychological disorders including the tests of draw a person (DAP) and draw a family (DAF). We aimed to compare the differences between typically developing children and children with ADHD using these tests.In this case-control study, all the 9-10 year-old boy students studying at the third and fourth grades were enrolled from schools in the 2nd educational district of Shiraz, south of Iran. Eighty students were then selected and enrolled into the ADHD group and the control group. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition- text Revised (DSM-IV-TR), and the Child Symptoms Inventory were used to diagnose the children with ADHD. We evaluated and analyzed impulsiveness, non-impulsiveness, emotional problems and incompatibility indices in the DAP and DAF tests in each group.A significant difference was found in the indices of incompatibility and emotional problems, impulsiveness, non-impulsiveness and DAF between typically developing children and those with ADHD. The mean (±SD) total scores of the above mentioned indices in the ADHD group were 19.79(±2.94), 12.31(±1.84), 5.26(±2.29) and 5.89(±2.13), respectively (P

Objectives. Many patients with bipolar disorder suffer from metabolic disorder. Lovastatin is effective for treating major depression. This double-blind randomized placebo controlled clinical trial investigates whether lovastatin is a useful adjuvant to lithium for treating mania. Methods. Fifty-four patients with bipolar disorder-manic phase were randomly allocated into lovastatin or placebo group. The clinical symptoms were assessed at baseline, week 2, and week 4 using Young Mania Rating Scale. Adverse effects were checked. Results. Forty-six out of 54 patients completed this trial. The mania score in the lovastatin group decreased from 40.6 (11.1) at baseline to 12.9 (8.7) and 4.1 (5.4) at weeks 2 and 4, respectively. The score in the placebo group decreased from 41.0 (11.2) at baseline to 12.8 (8.07) and 5.8 (4.6) at weeks 2 and 4, respectively. However, there was no significant difference between groups at week 2 and week 4. The adverse effects rates were comparable between the two groups. No serious adverse effect was found. Tremor and nausea were the most common adverse effects. Conclusions. Lovastatin neither exacerbated nor decreased the symptoms of mania in patients with bipolar disorder. Current results support that the combination of lovastatin with lithium is tolerated well in bipolar disorder. The trial was registered with the Iranian Clinical Trials Registry (IRCT201302203930N18).

Objective: The aim of the present study was to investigate the epidemiology of psychological problems in adolescents in five provinces of Tehran, Khorasan Razavi, Isfahan, East Azerbaijan and Fars in Iran. Methods: In the present cross-sectional and descriptive – analytical study, 5171 adolescents aged 12 to 17 years were selected through multistage cluster sampling method from Tehran, Isfahan, Fars, Khorasan Razavi and East Azarbaijan provinces. The self-report form of Strengths and Difficulties Questionnaire (SDQ) was used to obtain the demographic data of each adolescent. Descriptive analysis and 95% confidence interval were used to investigate the relationship between scores of the SDQ questionnaire and demographic factors. Result: Based on the results, the highest prevalence of psychological problems in the five provinces was related to conduct problems (24%), and the lowest prevalence was related to social problems (5.76%). Also, comparison of 95% confidence interval of prevalence of psychological probl ms between the two genders suggested a significant difference only in emotional problems of the self-report version of the SDQ between the two genders. The result revealed no significant difference in the psychological problems of the self-report version of the SDQ between the two age’s groups and between the middle and high school graduates (p≤0.05). Among the 5 provinces, Fars allocated the highest rates of conduct problems (28.4), hyperactivity problems (21.5%) and overall criterion problems (17.3%); Esfahan had the highest rates of emotional problems (9.1%) and problems with peers (8.1%); and Khorasan Razavi had the highest rates of social problems (7.6%). Conclusion: In this study, the highest prevalence of psychological problems in the five provinces was related to conduct problems, and the lowest prevalence was related to social problems. It was determined that girls have more emotional problems than boys. Also, no significant difference was found in the psychological problems of 12 to 14 and 15 to 17 ear old adolescents or between middle and high school graduates. In the current study, the prevalence of psychological problems in adolescents in the urban population in Fars province was higher than expected.

Objective: This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature . Method: Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n=30), OMT (n=30), and wait-list or control group (n=31). The mean length of nail was considered as the main outcome Results: The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P

Objective: This study surveys children and their parent's perceptions, and their treatment preference of significant/bothersome symptoms in children with Tourette syndrome. Methods: Thirty five children and adolescents who referred to an out-patient clinic of a Child Psychiatry Clinic were selected as subjects for this study. The children and their parents were interviewed about their perception of significant/bothersome symptoms of motor tics, vocal tics, learning difficulties, attention deficit disorder, hyperactivity, obsessions, compulsions, and rage attacks. Results: About two thirds of the subjects had symptom of rage. Inattentiveness and hyperactivity were observed in more than half of the children. There was a statistically significant difference between parents and their children in frequency of motor tics and rage attacks. Children reported the necessity for controlling and management of these symptoms less than their parents. Discussion: The rates of motor, vocal tics and rage attacks in the Iranian sample are similar to other studies. Rage attack is one of the most common significant/bothersome symptoms reported that should be treated. While motor tics were not rated among the most common features that should be treated in a study in Canada, it was the most common significant/bothersome symptom in Iran. Parents perceive motor tics and rage attacks as more significant/bothersome symptoms compared to children.

Abstract Background Following the agreements on the reformulating and revising of ADHD diagnostic criteria, recently, the proposed revision for ADHD added 4 new symptoms to the hyperactivity and Impulsivity aspect in DSM-V. This study investigates the psychometric properties of the proposed ADHD diagnostic criteria. Method ADHD diagnosis was made according to DSM-IV. The parents completed the screening test of ADHD checklist of Child Symptom Inventory-4 and the 4 items describing the new proposed symptoms in DSM-V. Results The confirmatory factor analysis of the ADHD DSM-V derived items supports the loading of two factors including inattentiveness and hyperactivity/impulsivity. There is a sufficient reliability for the items. However, confirmatory factor analysis showed that the three-factor model is better fitted than the two-factor one. Moreover, the results of the exploratory analysis raised some concerns about the factor loading of the four new items. Conclusions The current results support the two-factor model of the DSM-V ADHD diagnostic criteria including inattentiveness and hyperactivity/impulsivity. However, the four new items can be considered as a third factor.

Abstract Background Anger is an ignored research area in children and young adolescents with Attention deficit hyperactivity disorder (ADHD) in the school setting. This study compares school anger dimensions in children and young adolescents with ADHD and a control group. Methods The subjects were a clinical sample of 67 children and young adolescents with ADHD and their parents, with a sample of 91 children from the community of similar age and gender as control group. Anger was measured by the Farsi version of the Multidimensional School Anger Inventory (MSAI). Results The scores of the two components of "Hostile Outlook" and "Positive Coping" were different between the groups. The mean scores for the Anger components did not statistically differ between the children with ADHD and ODD and ADHD without ODD, boys and girls, or different types of ADHD. Conclusion Children with ADHD do not report higher rates of experience of anger and they do not apply destructive strategies more than the control group. However, children with ADHD appear to have a more hostile outlook toward school and their coping strategy is weaker than that of the control group.

Abstract Background Nail biting (NB) is a very common unwanted behavior. The majority of children are motivated to stop NB and have already tried to stop it, but are generally unsuccessful in doing so. It is a difficult behavior to modify or treat. The objective of this study was to investigate the prevalence of co-morbid psychiatric disorders in a clinical sample of children with NB who present at a child and adolescent mental healthcare outpatient clinic and the prevalence of psychiatric disorders in their parents. Method A consecutive sample of 450 referred children was examined for NB and 63 (14%) were found to have NB. The children and adolescents with nail biting and their parents were interviewed according to DSM-IV diagnostic criteria. They were also asked about lip biting, head banging, skin biting, and hair pulling behaviors. Results Nail biting is common amongst children and adolescents referred to a child and adolescent mental health clinic. The most common co-morbid psychiatric disorders in these children were attention deficit hyperactivity disorder (74.6%), oppositional defiant disorder (36%), separation anxiety disorder (20.6%), enuresis (15.6%), tic disorder (12.7%) and obsessive compulsive disorder (11.1%). The rates of major depressive disorder, mental retardation, and pervasive developmental disorder were 6.7%, 9.5%, 3.2%, respectively. There was no association between the age of onset of nail biting and the co-morbid psychiatric disorder. Severity and frequency of NB were not associated with any co-morbid psychiatric disorder. About 56.8% of the mothers and 45.9% of the fathers were suffering from at least one psychiatric disorder. The most common psychiatric disorder found in these parents was major depression. Conclusion Nail biting presents in a significant proportion of referrals to a mental healthcare clinic setting. Nail biting should be routinely looked for and asked for in the child and adolescent mental healthcare setting because it is common in a clinical population, easily visible in consultation and relatively unintrusive to ask about. If present, its detection can then be followed by looking for other more subtle stereotypic or self-mutilating behaviors.

Abstract Background Sleep patterns and habits in high school students in Iran have not been well studied to date. This paper aims to re-address this balance and analyse sleep patterns and habits in Iranian children of high school age. Methods The subjects were 1,420 high school students randomly selected by stratified cluster sampling. This was a self-report study using a questionnaire which included items about usual sleep/wake behaviours over the previous month, such as sleep schedule, falling asleep in class, difficulty falling asleep, tiredness or sleepiness during the day, difficulty getting up in the morning, nightmares, and taking sleeping pills. Results The mean duration of night sleep was 7.7 h, with no difference between girls, boys, and school year (grade). The mean time of waking in the morning was not different between genders. About 9.9% of the girls and 4.6% of the boys perceived their quality of sleep as being bad, and 58% of them reported sleepiness during the day. About 4.2% of the subjects had used medication to enhance sleep. The time of going to bed was associated with grade level and gender. Sleep latency was not associated with gender and grade leve, l and 1.4% experienced bruxism more than four times a week. Conclusion Our results are in contrast with that of previous studies that concluded sleep duration is shorter in Asia than in Europe, that boys woke-up significantly later than girls, and that the frequency of sleep latency category was associated with gender and grade level. The magnitude of the daytime sleepiness, daytime sleepiness during classes, sleep latency, and incidences of waking up at night represent major public health concerns for Iran.

Abstract Background Semi-structural clinical interviews are very important in the area of mental health research and services. There were no studies of the reliability and validity of the Farsi (Persian) version of Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) in Iran. This study compares the results of face-to-face, semi-structural interview and clinical interview by a child and adolescent psychiatrist. Method Subjects were 109 children and adolescents recruited to the child and adolescent psychiatry outpatient clinic of Hafez Hospital. Order of interview (in-psychiatrist or the semi-structural interview) was determined using random assignment within a counterbalanced framework. After, translation and back translation of K-SADS-PL, the Farsi version of K-SADS-PL was provided and used in the study. The interviewer was unaware of the child and adolescent psychiatrist diagnosis at the time of making the interview. Consensual validity, test-retest and inter-rater reliability, sensitivity, specifity, positive and negative predictive validity for the disorders were studied. Results Consensual validity of all of the psychiatric disorders was good to excellent. It was highest for panic disorder, conduct disorder, and simple phobia. Consensual validity of anorexia nervosa was 0.49. There was sufficient validity and test-retest and inter-rater reliability and good to excellent sensitivity and specifity and positive and negative predictive validity for nearly all of the disorders. Test-retest reliabilities of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and tic disorder were 0.81, 0.67, and 0.56; respectively. Inter-rater reliabilities of ADHD, and ODD were 0.69 and 0.69. Tic disorder, post traumatic disorder, panic disorder, and ADHD had the highest positive predictive validities. Conclusion The Farsi version of K-SADS-PL is a valid and reliable interview instrument for use in assessing and diagnosising child and adolescent psychiatric disorders.

Abstract Background Estimates of the annual prevalence for Obsessive Compulsive Disorder (OCD) were consistent across the international sites range, 1.9% – 2.5%. The nine population surveys, which used Diagnostic Interview Schedule, estimated a six-month prevalence of OCD ranging from 0.7% to 2.1%. This study performed in order to determine the prevalence of OCD in a population-based study among Iranian adults aged 18 and older and to study the association of them with factors such as sex, marital status, education, type of occupation and residential area. Methods A cross-sectional nationwide epidemiological study of the Iranian population aged 18 and older was designed to estimate the prevalence of psychiatric disorders and their association with the above mentioned factors. 25180 individuals were selected and interviewed through a randomized systematic and cluster sampling method from all Iranian households. Schedule for Affective Disorders and Schizophrenia (SADS) and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used in diagnosis of OCD. 250 clinical psychologists interviewed the selected subjects face to face at their homes. Results The prevalence of OCD in Iran is 1.8% (0.7% and 2.8% in males and females; respectively). 50.3% of the survey sample were men, 49.9% women, 29.1% single, 67.45% married, 0.4% separated or divorced, 2.5% widow/widower and 4% undetermined. All of the above-mentioned factors were examined in the univariate and multivariate logistic regression models. Although the data did not fit the models well, but in univariate models, sex, the category "single" of marital status, age, the categories "business" and "housewife" and residential areas showed significant effect adjusting for the factors, but the models didn't fit the data properly. Conclusion The study suggests that the prevalence of OCD is not rare in the community of Iran and is within the range of other countries. Similar to prior studies in other communities, OCD is more common in females than males.