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{"project":"2_test","denotations":[{"id":"25657768-17476553-54197796","span":{"begin":2260,"end":2262},"obj":"17476553"},{"id":"25657768-9204677-54197797","span":{"begin":2263,"end":2265},"obj":"9204677"},{"id":"25657768-8750075-54197798","span":{"begin":4528,"end":4530},"obj":"8750075"},{"id":"25657768-8750076-54197798","span":{"begin":4528,"end":4530},"obj":"8750076"},{"id":"25657768-21641182-54197798","span":{"begin":4528,"end":4530},"obj":"21641182"},{"id":"T32928","span":{"begin":2260,"end":2262},"obj":"17476553"},{"id":"T78680","span":{"begin":2263,"end":2265},"obj":"9204677"},{"id":"T61057","span":{"begin":4528,"end":4530},"obj":"8750075"},{"id":"T35913","span":{"begin":4528,"end":4530},"obj":"8750076"},{"id":"T48210","span":{"begin":4528,"end":4530},"obj":"21641182"}],"text":"Materials\u0026 Methods\nIn this study, 42 patients aged 2–6 years with PKU (serum phenylalanine level \u003e 6 mg/dl at the time of diagnosis, normal serum tyrosine) underwent initial assessment in the PKU specialized clinic of Besat Hospital of Hamadan, which is a provincial referral center for PKU patients. Then, cases with behavioral disorders (from the view of the parent and physical examination) were selected and referred to the Pediatric Psychiatry Clinic. \nA pediatric psychiatrist made the psychiatric diagnosis through a clinical interview based on DSM-IV-TR criteria for children \u003c6 years and a semi-structured diagnostic interview (KSADS) for children \u003e 6 years, and determined the need to receive drug treatment for each child according to the type of diagnosis, severity of symptoms, effect of behavior problems on children’s performance, and non-responsiveness to behavior interventions.\nThe Kiddie-schedule for affective disorders and schizophrenia-present and lifetime (KSADS) is a semistructured diagnostic interview that can be performed by a trained specialist for children aged 6–18 years. The interview consists of a screening interview, which evaluates symptoms of mood disorders, psychosis, anxiety disorders, elimination disorders (enuresis and encopresis), attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder, tick, and alcohol substance abuse. It also has five supplementary appendices in domains, including mood, anxiety, behavioral disorders, psychotic disorders, and substance abuse. The appendices will be completed if problematic domains are found during the screening interview. Hence, the interview provides the possibility of diagnosis of DSM-IV diagnoses in a wide range of psychiatric disorders. Interrater agreement in scoring screens and diagnoses was reported high (93–100%). \nTest-retest reliability kappa coefficient were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (0.77–1.00) and in the good range concerning present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (0.63–0.67). The existing data support the validity of KSADS diagnoses (23,24). Intelligence status of the patient was assessed according to parental reports of childhood developmental history and patient current cognitive performance, and by the Wechsler Intelligence Test at ages over 5 years, and intellectual disability was being diagnosed according to DSM-IV criteria. After a written consent was obtained from the parents, the patients were randomly divided into 2 groups: the first group underwent treatment with a risperidone tablet in a dose range from 0.75 mg/d to 1.5 mg/d, based on patient’s weight. Therefore, for children weighing less than 50 kg, risperidone was started at a dose of 0.25 mg/d and gradually increased to the final dose of 0.75 mg/d over a period of one week. Whereas, for children more than 50 kg, the starting dose of risperidone was 0.5 mg/d and the final dose was 1.5 mg/d. In the second group, for children less than 50 kg, buspirone was started at a dose of 2.5 mg/d, and was raised to 15 mg/d over two weeks, and in children more than 50 kg, the initial dose was 5 mg/d and the final dose was 15 mg/d. The treatment was continued for 8 weeks in both groups. After completing the 8 week treatment period, the dosage of the first drug was reduced and discontinued and then, patients in the first and second groups were given, respectively, buspirone and risperidone with the mentioned conditions. The second treatment period was continued for 8 weeks. Some patients were already under treatment with risperidone, the dose was only adjusted if needed, and they were placed in the buspirone group after 8 weeks.\nConsidering that all patients were in the intellectual disability range upon the initial assessment, they were evaluated in terms of changes in the severity of behavioral disorders in three stages of before treatment, after treatment with risperidone, and after treatment with buspirone by the NCBRF, which was completed by parents.\nNCBRF has been designed specifically for the assessment of behavioral problems in children with intellectual disability. It consists of 10 items on social competence and 66 items on behavioral problems that comprise 6 subscales, including conduct problems, insecure/anxious, hyperactive, self-injury/stereotypic self-isolated/ritualistic, and overly sensitive (25-27). \nOverall improvement was measured by the 7-point CGI after the end of the 8-week treatment period through asking question from parents and assessment of children by the therapist (28,29). This scale has been used to assess disease severity and overall improvement, and is scored on a 1–7 scale; the lower scores indicate the decrease of psychopathology and more therapeutic effects. The phenylalanine level of patients was measured at least one time during treatment with each drug. The exclusion criteria were an increase of behavioral disorders, adverse effects from the drugs, existence of a severe chronic diseases, and phenylalanine more than 10 mg/dl during the treatment period. The data obtained from NCBRF and CGI together with other PKU related data were collected from the dossiers of patients and were recorded on data collection forms. The data were analyzed using SPSS software (ver. 16)."}

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PMC:4307366 / 4641-10079 JSON TXT