ADHD is one of the most common neuro-psychiatric disorders in children Methyl Phenidate is the most frequent medication prescribed for this disorder. Bupropion is suggested as an alternative medication for treatment.

This research aims to compare the efficacy and safety of Bupropion and Methyl Phenidate(Ritaline) in children with ADHD.

This research was a double blind clinical trial and was approved by the Ethics Committee of Mashhad University of Medical SciencesForty children with ADHD, aged 6 to 12, from consecutive referrals to child psychiatric clinic of Ebn-e-Sina hospital were selected and randomly divided into two categories,treatment with Methyl Phenidate and Bupropion. Evaluations were carried out based on ADHD Rating Scale (by teacher and parent) and Clinical Global Scale (by clinician) at the beginning of the study, 4 and 8 weeks through the study. Adverse effects were checked at 4 and 8 weeks time as well. Data were analyzed by SPSS11.5.

Methyl-phenidate and Bupropion were both significantly effective in reduction of ADHD symptoms of children based on parents and teachers ratings in 8 weeks treatment (P< 0.001). The therapeutic response, in parents’ views, was better in Methyl -phenidate group than Bupropion (p=0.014).

Results showed that Bupropion was an effective in ADHD treatment but its effect based on the parent's report was less than Methyl-phenidate.

Many researchers have emphasized the importance of teaching stress management and self-care skills to medical students as they are vulnerable to develop psychological health problems.

To explore potential effects of a 4-hour stress management intervention on medical students’ psychological health.

To determine changes of psychological distress symptoms between the intervention and control groups.

A randomized controlled trial study was conducted in a medical school. Out of 500 medical students who were randomly invited to participate in this study, 171 medical students consented. They were randomly assigned into the study groups. Their psychological distress symptoms were measured by the DASS-21 at five different intervals. The Repeated Measure ANCOVA was performed to determine the effects of intervention.

A total of 153 medical students (intervention = 73 and control = 80) completed this study. There was a significant reduction of the symptoms among the intervention group at different intervals (p = 0.007). The intervention group experienced significantly lower psychological distress symptoms than the control group (p = 0.011). The effect size was -0.43, indicating the symptoms were significantly improved by 43% of a standard deviation as a result of the intervention. The effects were sustained for duration of 32 weeks post intervention.

The results support the effectiveness of the brief intervention to improve psychological health of medical students. It is a promising intervention to be adopted by medical schools as it consumes minimal amount of time, money and man power as well as simple to be implemented.

Pathologic changes in neuronal plasticity and apoptosis are important factors influencing alterations in synaptic transmission and impaired cognitive function, characteristic features of schizophrenia. Brain derived neurotrophic factor (BDNF), complexin-2, and annexin A-5 are known as members of regulatory pathways responsible for maintenance of neuronal plasticity and apoptosis.

The study was focused on assessment of possible association of functional single nucleotide polymorphisms (SNPs) and expression levels of BDNF, complexin-2, and annexin A-5 with schizophrenia.

For this purpose we investigated functional polymorphisms and plasma levels of these proteins in schizophreniaaffected neuroleptic-treated and neuroleptic-free patients and healthy controls.

DNA samples were genotyped by polymerase chain reaction with sequence-specific primers. Plasma levels of BDNF, complexin-2, and annexin A-5 were measured with an enzyme-linked immunosorbent assay. The significance of differences between allele and phenotype frequencies in study groups was determined using Pearson's χ2 test. For evaluation of intergroup differences in the levels of BDNF, complexin-2, and annexin A-5, both parametric and non-parametric statistics were used. The assessment of correlation between the measured parameters within each group was also performed. P-values less than 0.05 were considered significant.

In patients with schizophrenia, as compared to controls, the carriers of mutant alleles of the functional polymorphisms of BDNF, complexin-2, and annexin A-5 genes were overrepresented, and the blood levels of these proteins were altered.

Functional polymorphisms of genes encoding BDNF, complexin-2, and annexin A-5 proteins are associated with schizophrenia resulting in altered expression levels of these proteins upon this disorder.

Family functioning is one of the most important factors in psychiatric treatment. The purpose of this study was to compare the family functioning between patients with psychotic and non psychotic disorders in Shahrekord, Iran.

This analytical discriptive study was performed on family members of 200 patients with schizophrenia(psychotic), mood and anxiety disorders(nonpsychotic). The data was collected through interview by using the family assessment device (FAD). Quantative analysis of data was undertaken by using T students.

The mean of the total score of FAD in family members of psychotic and nonpsychotic patients was 2.55 ± .31 and 2.34 ± .25 respectively, and FAD in non psychotic patients was significantly better than psychotic patients in all dimensions of FAD.

The present study highlights that the family functioning among caregivers of patients with Psychotic and non psychotic disorders were unhealthy in all of the domains of the family functioning.

Aggressive behavior is a critical issue for psychiatric services, because of the adverse impact on patients and staff, and management of this behavior is difficult. This study was done by aim of determination of nurses’ problem in management of aggressive behavior in psychiatric wards.

This descriptive analytic study was done in 41 nurses who worked in Hajar and Sina Psychiatric ward in 2011. Sampling method was census. Data was gathered by self-making questionnaire include two parts: nurses’ demographic data and aggression management problem in three domains: personal, physical, and organizational factors. Data was analyzed by SPSS software 18, and means and frequency and analytical statistic exams such as Mann-Whitney and chi square were used.

The average of aggression episode was 4.44±3.3 time and in 51.25% occurred in all work shifts. 82.9% of aggression episode was mix verbal and physical aggression. The most aggressive patients suffer from schizophrenia and they had 30 till 40 years old. The most frequent problem in management of aggressive patients was related to personal problem specially fear about physical conflict with patients and physical restriction side effects. There was no significant relationship between age, sex, work shift and ward with aggression frequency (P>0.05),but there was significant difference between two hospital in physical environment (P= 0.003) and personal problems (P=0.011).

Results of this study revealed that nurses who work in psychiatry ward have some problem in management of aggressive patient's especially in personal and physical environment domain, and attention of managers is necessary.

Psychiatric morbidity and concomittant alcohol use are associated with poor outcomes among substance dependent individuals.

To investigate the prevalence of psychiatric morbidity and alcohol use among the inmates and their psychosocial correlates.

Cross-sectional study involving 201 inmates age 18 years and above with written consent who currently seeking treatment on volunteer basis under the government run rehabilitation centre in sunagi Besi, Kuala Lumpur. The study was conducted in December 2011 with approval from the Ethic committee board from the university hospital. The psychiatric morbidity measured by MINI Neuropsychiatric Inventory (MINI ver 5.0) and alcohol use measured by AUDIT.

The current prevalence of anxiety and depression are 27.9% and 39.8% respectively. The lifetime prevalence for depression is 21.9%. We also found that lifetime and current prevalence of alcohol use are 77% and 37% respectively. Univariate analysis showed significant association between psychiatric morbidity and alcohol use among this group of inmates (Odd ratio=1.9, P< 0.05) and educational status(Odd ratio =, p< 0.05). However, no significance association found between alcohol use with age, gender, ethnicity, marital status, religion and methadone treatment status. 73.1% of inmates also receiving methadone maintenance therapy during the study take place. Mean dose of methadone is 52.2mg daily (minimum 25mg daily, maximum 119mg daily).

There is high prevalence of psychiatric morbidity and alcohol use among the inmates seeking treatment in government run rehabilitation centre on top of receiving methadone treatment. Therefore, this centre need specialised care to cater the dual diagnosis group clients.

The objective of this study was to assess the nonpsychotic psychiatric disorders of stoma patients in Iran.

The only study that evaluated stoma patients in Iran indicated that postoperative problems, especially psychosocial ones, have a rather high frequency in comparison with other reports, but since no standardized questionnaire was applied for the evaluation of psychosocial problems and their severity, further studies were needed.

In this cross-sectional study, patients referred to the Iranian Ostomy Association from 2005 to 2006 filled the 28-item General Health Questionnaire (GHQ) in Farsi as a screening instrument to identify cases of nonpsychotic psychiatric morbidity.

A total of 155 patients participated in the study, of whom 79 (51%) were female and 76 (49%) were male. Fifty-five percent of the patients (n=86) had psychiatric problems. The females’ mean GHQ score was significantly higher than that of males (P=.001). Psychiatric disorder was significantly more frequent among patients with the following specifications: educational level of high school or lower (P=.001), mucosal hemorrhage of the ostomy (P=.03), stomal stenosis (P=.012), and history of psychiatric drug consumption (P=.000). GHQ score decreased as stoma age increased (P=.032; r=−.177).

Similar to other complications, psychiatric problems are prevalent in Iranian stoma patients. Our findings highlight the need for special support.

To investigate the association between catechol-O-methyl transferase (COMT) gene polymorphism and Gilles de la Tourette’s syndrome (GTS).

Using Amplification Refractory Mutation System(ARMS) PCR genotyping assay method, a polymorphism (val158met) of COMT gene was genotyped in 112 of all GTS patients including 54 GTS-alone patients, 48 GTS+ADHD patients among of them and 71 healthy controls. The correlation between positive association of polymorphism (val158met) of COMT gene in GTS and the age of onset in patients with GTS was also analyzed.

When compared with healthy controls, genotype of val158met did not differ in total GTS patients or alone- GTS patients (x2=0.56, P = 0.756; x2= 1.05, P = 0.600 respectively). There is also no significant difference (P>0.05) in allele distribution of val158met in total GTS patients or alone- GTS patients when respectively compared with controls (x2= 0.18, P = 0.669; x2= 0.29, P = 0.593 respectively). However, Genotype distribution of val158met was significantly different between GTS+ADHD patients and controls (x2=6.35, P = 0.041). The frequency of the val allele of this locus was significantly higher in GTS+ADHD patients than those in controls (x2= 5.49, P = 0.019).The age of onset in children with GTS having the val/val genotype of COMT gene val158met polymorphism were significantly earlier than no val/val genotype (P = 0.016).

Polymorphism (val158met) of COMT gene may be associated with GTS children with comorbid ADHD, which may play an important role to make the age of onset in children with GTS become earlier.

To explore the relationship between resilience and social support, coping style of children in two middle schools for providing an evidence for improving childrens’resilience.

Six hundred childrens were surveyed with the Connor-Davidson resilience questionnaire(CD-RISC), perceived social support scale(PSSS)and coping style questionnaire (CSQ).

Resilience had significant difference between male and female children.

The resilience was positively correlated with social support and two factors of coping style: seeking help and solving problem, but negatively correlated with the other factors in coping style questionnaire.

Children with high score in Connor-Davidson resilience questionnaire are more tend to the positive coping style.

Social support is an important factor of resilience in children.

Epidemiological studies have convinced that prenatal stress (PS) might cause offspring depression.

Our pervious research work certified that PS can increases the glutamate level of hippocampus of rat offspring, which inspired us to explore the pathogenesis of depression by focusing on glutamatergic system.

Pregnant rats were randomly assigned to control group (CON), mid prenatal stress group (MPS) and late prenatal stress group (LPS). The pregnant rats of MPS and LPS were exposed to restraint stress on days 7–13, 14–20 of pregnancy three times for 45 min respectively. Tail suspension test (TST) was performed to examine the depression like behavior and Western-blot were used to test phosphorylated GluR1(pGluR1) of AMPAR expression in the hippocampus, striatum and frontal cortex of one month rat offspring.

For both male and female offspring, the time of immobility of TST in LPS (156±11, 155±12) and MPS (173±15, 155±12) was significantly longer (P< 0.05) than CON(118±8,113±12), the latency in MPS (18±3, 24±3) was significantly shorter (P< 0.05) than CON (30±5, 58±11). The pGluR1 expression in hippocampus and frontal cortex in LPS (1.77±0.45, 1.00±0.09) and MPS (1.65±0.51, 1.05±0.18) were significantly lower (P< 0.05) than CON (3.72±0.86, 2.05±0.34) in male rat offspring.

It is suggested that the PS may induce depression like behavior in rat offspring, and glutamate receptors subunit pGluR1 might be involved in the etiology of depression.

(The research is supported by National Natural Science Foundation of China, No: 30970952, 18110059).

Research has shown that Mirtazapine has been effective in stimulating appetite in the elderly. We present a case series of three patients with Moderate Intellectual Disability, each presenting with intractable refusal to eat over several months. They did not have overt symptoms of depression according to carers and family. Two patients were being considered for Percutaneous Endoscopic Gastrostomy (PEG) feeding in view of their significant weight loss and deteriorating physical health.

Mirtazapine was introduced as an appetite stimulant, despite the apparent lack of depressive symptoms. All three patients experienced an improvement in their appetite within days of initiation of Mirtazapine, increasing their calorie and fluid intake and obviating the need for PEG feeding. During the following 3 months, the patients also developed an increased interest in activities, improved sleeping pattern and improved concentration.

These patients had very limited communication skills and there was little suggestion of depression at the time of assessment. The families and carers also did not feel that their relative was significantly depressed. Despite this, Mirtazapine had the two fold benefit of early appetite stimulation and, over the subsequent weeks, treating what in hindsight had been an underlying depressive episode. A lesson to be learnt is that primary refusal to eat, even in the absence of overt depressive symptoms may indicate an occult depressive episode in this patient group. We have shown that Mirtazapine can be an effective treatment in such cases and can prevent distressing medical intervention from having to be used.

Quality and clarity of correspondence with other professionals and especially GPs have been always important. Nowadays when patients would receive a copy of our letters automatically, this has become even more sensitive and paramount.

A guideline and template were designed based on the best recommendations taken from available NHS policies, review of literature and interviewing six experienced psychiatry consultants in Oxford deanery.

• – Decide about sending a copy of your letter to each patient individually. It is a clinical decision. Do not send a copy if this would mean compromising the information you need to give to GP. Situations like third party information, safeguarding issue, risk to therapeutic relationship and lastly, patient’s refusal to have a copy of letter

• – Send a separate letter to the patient if your are directly asked in one of situations outlined above. This letter should be short and simple containing clear treatment plan.

• – Letter to GP should be short (200-300 words) with simple language.

• – Use a standard template for writing to GP. Template should have headings for “Reason for referral”, “Impression/diagnosis”, “Summary of findings”, “Prognosis”, “Risks”, “Information given to the patient”, “Detailed treatment plan”, “Name of care coordinator” and finally “Follow up details”.

Writing short, simple and clear letters would facilitate communication between psychiatrist and GP. This eventually will improve the quality of patient care. Using of a standard template, attending report writing courses and thoughtful deciding about sending a copy to each patient are greatly recommended.

Elderly psychiatric patients are at constant risk of having a fall due to numerous reasons e.g. frailty, gait problem, vision problem, cognitive and judgment impairment, psychotropic medications.

Consequences of a fall for an elderly patient could be potentially life threatening, protracted, painful and detrimental. Also the cost of falls for NHS is enormous.

To improve the quality of fall reviews undertaken by junior doctors in Oxford Health Foundation Trust.

The quality of a random sample of 23 fall reviews by junior doctors was assessed against the national guideline (NICE guideline No.: CG21).

Proper actions taken to raise the awareness of junior doctors i.e. circulating an email and short talk about national standards.

The second cycle (Sample size: 17) in 6 months time showed substantial improvement in most areas but not all of them.

In the next stage a “Fall intervention proforma” designed for the wards. Also reminding posters were mounted in clinical rooms and junior doctors’ offices.

The third cycle (Sample size: 10) in 6 months time conducted to assess the sustainability of improvements in our compliance.

Our compliance improved from less than 50% in most essential components of a high quality fall review (Musculoskeletal examination, Neurological examination, History taking, Cardiovascular examination, Medication review) to around 100% in 3rd cycle.

• – routine use of “Fall intervention proforma” as standard check list on the wards

• – mounting of reminding posters in clinical rooms

• – a short talk about fall reviews in induction programme for new junior doctors

Despite the availability of an ever-expanding range of typical and atypical antipsychotics, a substantial proportion of patients with schizophrenia show a partial or total lack of response to antipsychotic mono therapy. This study was done to evaluate the effect of purslane on psychologic symptoms of schizophrenic patients.

This randomized clinical trial study was carried out on 60 chronic schizophrenic patients in Sina hospital Shahrekord, Iran during 2011-12. Subjects were randomly divided into intervention and control groups. The control group received Risperidone up to 6mg/day and Biperiden 4mg/day for 8 weeks. The Patients in interventional group received 1gr extract of purslane daily with the same regimen for 8 weeks. The scales for assessment of positive symptoms (SAPS) and assessment of negative symptoms (SANS) were recorded in prior and 8th weeks. In addition, CRP and MDA level of patients were assessed in two stage of study.

At the end of study, the mean score of positive symptoms were 47.93±18.56 and 57.1±14.83 in intervention and control groups, respectively (P< 0.05), and the mean score of negative symptoms were 40.83±11.03 and 46.13± 9.34 (P< 0.05).The CRP levels of patients in intervention and control groups were .53±.55 and 1.72±.73 at 8 week respectively (P< .05) and the MDA levels were 3.25±1.25 and 5.43± 1.76 respectively (P< .05).

According to findings of this study, the use of purslane as an adjunct to Respridone can improve psychological condition of chronic schizophrenic patients and decrease MDA and CRP levels of them.

This case-control study aimed to assess the intervention effects of six-session interpersonal psychotherapy (IPT-A) on reducing the severity of anxiety and depression in adolescent victims.

A total of 30 adolescents who had clinical significant level after experiencing bullied experiences were allocated to a six-session course of IPT-A (N = 15) or to treatment as usual (TAU) (N = 15). T test was performed to examine the effect of IPT-A on reducing the severity of anxiety and depression related to the bullied events.

Pre-intervention age, sex, anxiety and depression showed no significant difference between two groups. As the preintervention severity of two groups were no significant different, results showed the IPT-A group to have significantly lower post-intervention severity levels of anxiety and depression (p< .05) than the TAU group. Effective size showed moderate to high level between IPT-A and TAU.

The results of this study support the effectiveness of the IPT-A in improving anxiety symptoms and depression in adolescents experiencing traumatic bullied experiences.

Understanding the mechanism of withdrawing in drug addicted patients is a key factor in controlling addiction problem. Social characteristics and history of addiction including attempts to withdraw were measured in 362 drug addicted males referred to treatment centres or were accessed via some other addicted persons in Yasouj, Iran.

More than 70% of participants reported at least one attempt for withdraw during their addiction period. The main method of withdrawal was methadone replacement (39%). The main reason to quite is reported as tiredness from addiction (37%) and family pressure (25%). The average duration of withdraw at first attempt is 132 days (vary from 1 to 2580 days).

Most drug addicted individuals tried to quite (once at least) using a private method. The reason for using private methods is possibly to prevent being known and marked as addicted in their community. It seams that a maturation level (tiredness) or pressure from family is needed before attempting to quite. However, efforts predominantly fail as most patients return to drug shortly.