Neuropsychological Problems Research Articles

Autonomous Estimation of Patients’ Neuropsychological State Using Convolutional Neural Networks

The number of patients with neuropsychological problems is increasing rapidly in the world. Autonomous methods are replacing the traditional diagnosis methods in detection and classification of many mental and neurological problems. Machine learning algorithms and especially deep neural networks are able to diagnose various neurological and psychological complications automatically. In this paper, a machine learning based framework is used for autonomous estimation of patients’ neuropsychological state. The proposed framework can automatically diagnose neuropsychological state of the patients and present a personalized solution for their problems. A convolutional neural networks is used for automatic profiling of patients and to classify their mental state according to their EEG signals. The proposed framework can be used to help patients to have better life experience.

Neuropsychological manifestations of long COVID in hospitalized and non-hospitalized Brazilian Patients.

There has been a significant increase in number of patients seeking neuropsychological rehabilitation months after the acute phase of COVID-19 infection. Identify the cognitive and psychiatric disorders in patients with long COVID or Post-Acute Sequelae of COVID (PASC) and explore the association between disease severity during the acute phase and persistent neuropsychological manifestations. 614 adults were assessed an average of eight months post-infection. Participants were, on average, 47.6 y.o., who sought rehabilitation for neuropsychological problems. Patients were evaluated using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing tests (NEUPSILIN) for executive functions, and the Hospital Anxiety and Depression Scale (HADS). The BNIS score was significantly below reference values in all subscales, especially affect and memory. Verbal Fluency and Clock Drawing subtest results were also lower. Patients with PASC tested high for anxiety/depression, but there was no statistically significant relationship between HADS and BNIS scores. Neuropsychological evaluations showed no differences in cognitive or psychiatric profiles between hospitalized and non-hospitalized patients. Neuropsychological results suggest executive function problems and high incidence of anxiety/depression, irrespective of acute-phase severity, underscoring a need for neurorehabilitation programs while providing data for public policy initiatives.

Creatine and Alpha-Lipoic Acid Antidepressant-Like Effect Following Cyclosporine A Administration

Cyclosporine A (CYA), is an immunosuppressant drug used to prevent graft rejection, but it may initiate neuropsychological problems such as depression. The aim was to evaluate the antidepressant-like effects of creatine (Crt), a mediator of oxidative phosphorylation, and alpha-lipoic acid (ALA), a cofactor for the mitochondrial respiratory chain following CYA administration. Female mice (27 ± 2 g) were used, immobility time during the forced swimming test (FST) was measured, and hippocampal brain-derived neurotrophic factor (BDNF) level was evaluated. CYA 20 mg/kg, ALA 40 mg/kg, fluoxetine 20 mg/kg, and Crt 10 mg/kg (oral) were administered for 6 consecutive days, and the tests were performed on day 7. ALA, but not Crt, treatment alone decreased immobility in the FST (i.e., decreases depression-like behavior). CYA administration increased immobility in the FST (175.1 ± 13.16 s, vs. vehicle 130.9 ± 13.5 s, p= 0.0364), and this depression-like behavior was prevented by co-administrating, ALA (100 ± 15.9 s, p= 0.020) or Crt (93.5 ± 16.6, p= 0.009) and the positive control, fluoxetine. Notably, there was a synergistic effect of Crt-ALA co-administration since CYA-induced immobility was lower in this group than in the groups pretreated with Crt or ALA. These behavioral changes were observed without treatment effects on locomotor activity in an open field. CYA treatment increased hippocampal BDNF protein levels prevented by co-administration of ALA (with or without Crt) or fluoxetine. CYA-induced depression-like behavior might be related to hippocampal mitochondrial dysfunction as ALA and Crt prevented the development of this behavioral phenotype. ALA, similar to fluoxetine, prevented BDNF alteration and its possible neurological changes.

Allergic rhinitis in BALB/c mice is associated with behavioral and hippocampus changes and neuroinflammation via the TLR4/ NF-κB signaling pathway

BackgroundAllergic rhinitis is a systemic disease with high prevalence, which some of its neuropsychological problems have been reported. The primary pathophysiology and mechanism of the neuropsychological dysfunction of AR patients have not been described yet, so here we subjected an animal model of AR to identify any behavioral or seizure threshold changes and to assess the pathophysiology of the disease. MethodsEighty male BALB/C mice were randomly divided into the allergic rhinitis group and controls. Allergic rhinitis was induced in the first group by administering OVA and aluminum hydroxide intraperitoneally and then nasal injection of OVA for 14 consecutive days. Both groups were subjected to different tests for assessing depressive-like behavior, anxiety, spatial and contextual memory, and learning and seizure threshold. Hippocampus and plasma samples of mice were subjected for analyzing cytokines and immune modulators and for pathology and immunohistochemistry evaluation. ResultsThe depressive and anxiety-like behavior were increased in AR, and the spatial learning and memory were disturbed in the AR group. Also, AR mice had lower seizure thresholds compared to controls. Lab data suggested that TLR4, NF-κB, IL-1β, and TNFα expressions were increased in the AR hippocampus as well as their plasma proinflammatory cytokines. Likewise, demyelination, cell death, and M1 macrophage aggregation were increased in the AR hippocampus. ConclusionBehavioral and cognitive problems should be taken seriously in patients with AR or other atopic diseases, and more investigating is required to clear the pathophysiology behind it and its treatment.

Anxiety as neuropsychological symptom of aphasia

Aphasia causes a significant limitation on the person who suffers it since communication is essential for the human being. Among the behavioural changes observed in people with aphasia, we can highlight impulsive responses, rejection and states of intense anxiety [21]. People with aphasia face daily challenges from impaired communication skills. This can be a source of stress and anxiety, as well as other neuropsychological problems (depression, behavioural changes, aggressiveness / apathy, among others).

Long-term neuropsychological and behavioral outcome of mild and moderate hypoxic ischemic encephalopathy

BackgroundOutcomes for infants who survive mild-moderate hypoxic ischemic encephalopathy (HIE) into adolescence is relatively uncharted. AimsWe examined neuropsychological and behavioral outcomes in adolescents with mild and moderate HIE, using both parent and self - informants, and including healthy peers and nearest age siblings as controls. Participants23 adolescents with a history of mild-moderate HIE (M age = 14.45 years, SD = 1.03; 14 boys and 9 girls) were recruited from an original cohort of 53. A group of their nearest – age siblings (n = 13), and healthy peers (n = 14) were recruited as controls. Outcome measuresA number of neuropsychological sub-tests, taken from the WISC-V.UK, Children's Memory Scale, NEPSY, WIAT-III.UK, Rey Complex Figure Copy Test and British Picture Vocabulary Scale were administered. Behavioral adjustment was assessed using the Strengths and Difficulties Questionnaire and the competence subscales of the Child Behavior Checklist. ResultsNo differences in neuropsychological and behavioral outcomes were observed between mild and moderate HIE cohorts. Together they had significantly lower scores on tests of attention/executive functioning, verbal reasoning and sensory-motor ability compared to healthy peers, with moderate to large effect sizes. Remedial provision at school was greater in the HIE group. Parents reported elevated levels of peer problems in the HIE group compared to both siblings and healthy peers. Reduced competencies were also observed. ConclusionsWe found evidence that both mild and moderate survivors of HIE experience neuropsychological, school and peer relationship problems in adolescence.

Research protocol - Assessing Post-Stroke Psychology Longitudinal Evaluation (APPLE) study: A prospective cohort study in stroke.

Cognitive and mood problems have been highlighted as priorities in stroke research and guidelines recommend early screening. However, there is limited detail on the preferred approach.We aimed to (1) determine the optimal methods for evaluating psychological problems that pre-date stroke; (2) assess the test accuracy, feasibility and acceptability of brief cognitive and mood tests used at various time-points following stroke; (3) describe temporal changes in cognition and mood following stroke and explore predictors of change. We established a multi-centre, prospective, observational cohort with acute stroke as the inception point - Assessing Post-stroke Psychology Longitudinal Evaluation (APPLE). We approached patients admitted with stroke or transient ischaemic attack (TIA) from 11 different hospital sites across the United Kingdom. Baseline demographics, clinical, functional, cognitive, and mood data were collected. Consenting stroke survivors were followed up with more extensive evaluations of cognition and mood at 1, 6, 12 and 18 months. Continuous recruitment was from February 2017 to February 2019. With 357 consented to full follow-up. Eighteen-month assessments were completed in September 2020 with permissions in-place for longer term in-person or electronic follow-up. A qualitative study has been completed, and a participant sample biobank and individual participant database are both available. The APPLE study will provide guidance on optimal tool selection for cognitive and mood assessment both before and after stroke, as well as information on prognosis and natural history of neuropsychological problems in stroke. The study data, neuroimaging and tissue biobank are all available as a resource for future research.

School considerations for children with heart disease during the COVID-19 pandemic.

This article presents data on Coronavirus disease (COVID-19)-related learning, health, and mental health concerns of 134 families of children with heart disease (HD), the most common birth defect, who are followed by a unique hospital-based Educational Achievement Partnership Program (EAPP) designed to serve as a liaison across the family, the child's medical team, and school. At-school, remote, and hybrid learning alternatives prompted by the COVID-19 pandemic presented families with an especially complex decision to make for children with HD due to competing complications in this population: Increased susceptibility to illness, greater risk of neuropsychological problems, and higher level of individualized education services that are not readily transferable to a home learning platform. Parents of school-aged children with HD completed a survey about COVID-19-related school support needs as part of a quality improvement project. Survey results revealed 51% of children would learn from home during the 2020-2021 school year due to concerns about the child's underlying health condition, indicating a marked change in schooling modality compared to prior years (4% in 2019). Nearly 75% of families requested medical guidance for COVID-19-related school health and education plan addendums. Seventy-three percent of families had mental health concerns about their child; severity of HD was related to families' reports about mental health concerns. Findings suggest follow-up is needed by school psychologists and medical consultative collaborative partners to support the transition back to in-person schooling after the COVID-19 pandemic concludes and to identify long-term educational consequences of disrupted learning during this period. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neuropsychological Sequelae, Quality of Life and Adaptive Behavior in Children and Adolescents with Anti-NMDAR Encephalitis: A Narrative Review.

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune illness characterized by a constellation of often severe, but treatable, psychiatric and neurological symptoms. Whereas symptoms such as psychosis and bizarre and abnormal motor behavior are common in adults, pediatric patients typically present with behavioral changes, irritability and sleep dysfunction. The recovery phase is usually slow and may be associated with longstanding adaptive, behavioral and neuropsychological problems. Very few studies explored the cognitive and adaptive sequelae in children with anti-NMDAR encephalitis. The present review article suggests that, although most children and adolescents return to their daily life and previous activities, they may have a low quality of life and show neuropsychological sequelae involving language, memory, especially verbal memory, and attentional resources, even after several months from the hospital discharge. In particular, the available results reveal difficulties in cognitive skills involving executive functions. This impairment is considered the “core” of the cognitive profile of young patients with anti-NMDAR encephalitis. On the other hand, some cognitive skills, such as general intelligence, show good overall recovery over time. Additional neuropsychological research evaluating larger samples, more homogenous methods and longitudinal studies is required.

Neuropsychological sympt chological symptoms related t elated to the CO o the COVID-19 pandemic VID-19 pandemic experienced by the general population and particularly by the healthcare personnel

Undoubtedly, the outbreak of COVID-19 still represents an overanxious event for both society and population. The fear of getting infected is ubiquitous in the time of the pandemic. The population presented worrying thoughts related to the fact that the health care system was not able to provide enough services during the COVID-19 pandemic. The number of the hospital beds and ventilators was insufficient in order to ensure enough care, considering the increased number of COVID-19 cases that were admitted to the hospitals. Furthermore, people were fearful about the possibility of the global economy becoming decimated. The fright and also the feelings of anxiety related to the COVID-19 pandemic can become overpowering and create negative psychological states. In addition, mental health can be affected and influenced during outbreaks of infectious diseases and can be related to the misconception of symptoms, for example perception related phenomenon and corporal modifications. The population that could experiment these feelings, could instantly relate them to the coronavirus infection and express furthermore unpleasant sensations, in connection to more expressed anxiety and fear. Particularly affected were the healthcare workers of the medical system, who were the main combatants in this pandemic. The neuropsychological problems were difficult to avoid by the general population and this became even more difficult to be dealt with by the medical personnel.

Study protocol: DexaDays-2, hydrocortisone for treatment of dexamethasone-induced neurobehavioral side effects in pediatric leukemia patients: a double-blind placebo controlled randomized intervention study with cross-over design

BackgroundDexamethasone, a highly effective drug in treating pediatric acute lymphoblastic leukemia (ALL), can induce serious neurobehavioral side effects. These side effects are experienced by patients and parents as detrimental with respect to health related quality of life (HRQoL). Based on previous studies, it has been suggested that neurobehavioral side effects are associated to cortisol depletion of the mineralocorticoid receptor in the brain. Our previously reported randomized controlled trial, the Dexadagen study (NTR3280), suggests that physiological hydrocortisone addition during dexamethasone treatment may overcome clinically relevant neurobehavioral problems in patients who experience these problems during dexamethasone treatment. With our current study, we aim to replicate these results in a targeted larger sample before further implementing this intervention into standard of care.MethodsIn a national center setting, pediatric ALL patients between 3 and 18 years are enrolled in an Identification study, which identifies patients with clinically relevant dexamethasone-induced neurobehavioral side effects using the Strengths and Difficulties Questionnaire (SDQ). Contributing factors, such as genetic susceptibility, dexamethasone pharmacokinetics as well as psychosocial and family factors are studied to determine their influence in the inter-patient variability for developing dexamethasone-induced neurobehavioral side effects.Patients with clinically relevant problems (i.e. a rise of ≥ 5 points on the SDQ Total Difficulties Score after 5 days of dexamethasone) are subsequently included in a randomized double-blind placebo-controlled trial with a cross-over design. They receive two courses placebo followed by two courses hydrocortisone during dexamethasone treatment, or vice versa, each time at least 16 days without study medication in between. The primary endpoint is change in SDQ score. The secondary endpoints are sleep (measured with actigraphy and the Sleep Disturbance Scale for Children) and HRQoL (Pediatric Quality of Life Questionnaire).DiscussionThe results of our current study may contribute to the management of future ALL patients who experience dexamethasone-induced neuropsychological problems as it may improve HRQoL for patients who suffer most from dexamethasone-induced neurobehavioral side effects. Furthermore, by investigating multiple risk factors that could be related to inter-patient variability in developing these side effects, we might be able to identify and treat patients who are at risk earlier during treatment.Trial registrationMedical Ethical Committee approval number: NL62388.078.17. Affiliation: Erasmus Medical Centre. Netherlands Trial Register: NL6507 (NTR6695). Registered 5 September 2017

A Commentary on “The Rorschach and Violent Crime” (de Ruiter, 2021)

A Commentary on “The Rorschach and Violent Crime” (de Ruiter, 2021)

Reduced risk aversion and impaired short-term memory in juvenile rats with malformation of cortical development

Malformation of cortical developments (MCDs) is currently an incurable disease and is associated with significant neuropsychological problems, such as intellectual disability, epilepsy, and anxiety disorders from a young age. Development of a suitable animal model and pathophysiological study is therefore necessary to better understand and treat MCDs from being an incurable disease. The Y-maze, open field, and fear conditioning studies were performed at postnatal days 40–44 to validate the behavioral phenotypes of the existing rat model of MCD with prenatal methylazoxymethanol exposure at their developmental period. The study results show that juvenile rats with MCD spent significantly less time inside the novel arms in Y-maze and less time in the peripheral zones of the open field. Additionally, the rats with MCDs showed attenuated freezing behavior to sound and light cues as well as to context after fear conditioning. This comprehensive behavioral analysis of rats with MCDs at the juvenile period indicate a lack of spatial memory, decreased anxiety, and learning disability in these rats, which is compatible with the human behavioral phenotype of MCDs and can be used as the behavioral biomarkers for future translational research.

Small molecule 1a reduces FMRpolyG-mediated toxicity in in vitro and in vivo models for FMR1 premutation.

Fragile X-associated tremor and ataxia syndrome (FXTAS) is a late-onset, progressive neurodegenerative disorder characterized by tremors, ataxia and neuropsychological problems. This disease is quite common in the general population with approximately 20 million carriers worldwide. The risk of developing FXTAS increases dramatically with age, with about 45% of male carriers over the age of 50 being affected. FXTAS is caused by a CGG-repeat expansion (CGGexp) in the fragile X mental retardation 1 (FMR1) gene. CGGexp RNA is translated into the FMRpolyG protein by a mechanism called RAN translation. Although both gene and pathogenic trigger are known, no therapeutic interventions are available at this moment. Here, we present, for the first time, primary hippocampal neurons derived from the ubiquitous inducible mouse model which is used as a screening tool for targeted interventions. A promising candidate is the repeat binding, RAN translation blocking, small molecule 1a. Small molecule 1a shields the disease-causing CGGexp from being translated into the toxic FMRpolyG protein. Primary hippocampal neurons formed FMRpolyG-positive inclusions, and upon treatment with 1a, the numbers of FMRpolyG-positive inclusions are reduced. We also describe for the first time the formation of FMRpolyG-positive inclusions in the liver of this mouse model. Treatment with 1a reduced the insoluble FMRpolyG protein fraction in the liver but not the number of inclusions. Moreover, 1a treatment had a reducing effect on the number of Rad23b-positive inclusions and insoluble Rad23b protein levels. These data suggest that targeted small molecule therapy is effective in an FXTAS mouse model and has the potential to treat CGGexp-mediated diseases, including FXTAS.

Neuropsychological and behavioural profiles of students with intellectual development disorder on parents and teachers' perceptions.

Children with intellectual development disorder (IDD) have high rates of comorbid neuropsychological and behavioural problems. However, there are not many studies on this population in middle-income and low-income countries. Therefore, we aimed to investigate the prevalence of neuropsychological and behavioural problems in students with and without IDD and to assess the correlation between the responses from informants (parents and teachers) and the clinical diagnoses in Brazil. After clinical diagnosis, 78 male and female students (7-15years old) were divided into two groups: children with IDD (n=39) and children without IDD (n=39). The Child Behaviour Checklist (CBCL) and Teacher's Report Form (TRF) scales were used to track neuropsychological and behavioural problems. Calculations of prevalence ratios were performed using Poisson regression with Wald tests. The CBCL and TRF results were compared between groups with Mann-Whitney U-tests and receiver operating characteristic (ROC) analyses. The agreement between scales was assessed using the Spearman correlation test. Neuropsychological and behavioural problems were significantly more prevalent in students with IDD. The average amount of CBCL problems was significantly higher than that of TRF in the dimensions of thought, attention, somatic, attention deficit/hyperactivity, opposition defiant and total problems. Low-to-moderate correlations between CBCL and TRF dimensions in the IDD group were observed. ROC analyses revealed that the dimensions of internalising problems and total scores reflecting CBCL and TRF problems were the most important factors for identifying neuropsychological and behavioural problems in the IDD group. Students with IDD require early identification of behavioural and emotional symptoms to avoid the underdiagnoses of various mental health problems, especially those with internalising characteristics. The CBCL and TRF may assist in the early screening of these comorbidities.

Schizophrenia: The Dark Side of Toxoplasmosis

Toxoplasma gondii is an intracellular parasite that has been associated with several mental disorders. It usually causes an inapparent primary infection. Found worldwide, T. gondii is capable of infecting virtually all warm-blooded animals.1-3Schizophrenia is a neurological disorder characterized with long-term and devastating neuropsychological problems, usually presenting in adolescents or young adults. The disease affects almost 1.1% of the global population including all races and ethnic groups with an equal prevalence in both sexes.1 T. gondii seroprevalence is strongly associated with 12-month generalized anxiety disorder but not with other anxiety, depressive, or alcohol-related disorders. Because of the intracellular nature of some parasites, their treatment and development of new drugs is a major challenge for scientists.4 Recently, the use of nanoparticles and nano-scaffolds has suggested for the treatment of parasitic diseases, although limited research has been done in this regard.5-7

Neuropsychologische problemen na focale laesies in het cerebellum: de kleine hersenen worden groot

Neuropsychological problems after focal lesions in the cerebellum: the little brain grows big Initially researchers believed that the cerebellum was only involved in motor and speech functions. During the last few years however, increasing knowledge was gained regarding the neuropsychological functions of the cerebellum. These functions are not exclusively considered as being regulated by cortical brain structures, but rather as functions regulated by a closed cerebro-cerebellar circuit. Studies focused on evaluating neuropsychological functioning in patients with focal lesions in the cerebellum have discovered that cognitive problems with regard to working memory, anterograde memory, visuospatial functions, language and executive functions are frequently documented. Besides cognitive deficits, these patients can also show emotional and/or behavioral changes. Several authors assume that the research findings concerning memory, visuospatial functions and more particularly language can be explained by the concept of crossed cerebellar-cerebral diaschisis.

Integrated analysis of differentially expressed genes and construction of a competing endogenous RNA network in human Huntington neural progenitor cells

BackgroundHuntington's disease (HD) is one of the most common polyglutamine disorders, leading to progressive dyskinesia, cognitive impairment, and neuropsychological problems. Besides the dysregulation of many protein-coding genes in HD, previous studies have revealed a variety of non-coding RNAs that are also dysregulated in HD, including several long non-coding RNAs (lncRNAs). However, an integrated analysis of differentially expressed (DE) genes based on a competing endogenous RNA (ceRNA) network is still currently lacking.MethodsIn this study, we have systematically analyzed the gene expression profile data of neural progenitor cells (NPCs) derived from patients with HD and controls (healthy controls and the isogenic controls of HD patient cell lines corrected using a CRISPR-Cas9 approach at the HTT locus) to screen out DE mRNAs and DE lncRNAs and create a ceRNA network. To learn more about the possible functions of lncRNAs in the ceRNA regulatory network in HD, we conducted a functional analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) and established a protein–protein interaction (PPI) network for mRNAs interacting with these lncRNAs.ResultsWe identified 490 DE mRNAs and 94 DE lncRNAs, respectively. Of these, 189 mRNAs and 20 lncRNAs were applied to create a ceRNA network. The results showed that the function of DE lncRNAs mainly correlated with transcriptional regulation as demonstrated by GO analysis. Also, KEGG enrichment analysis showed these lncRNAs were involved in tumor necrosis factor, calcium, Wnt, and NF-kappa B signaling pathways. Interestingly, the PPI network revealed that a variety of transcription factors in the ceRNA network interacted with each other, suggesting such lncRNAs may regulate transcription in HD by controlling the expression of such protein-coding genes, especially transcription factors.ConclusionsOur research provides new clues for uncovering the mechanisms of lncRNAs in HD and can be used as the focus for further investigation.

Tyrosine supplementation for phenylketonuria.

Phenylketonuria is an inherited disease for which the main treatment is the dietary restriction of the amino acid phenylalanine. The diet has to be initiated in the neonatal period to prevent or reduce mental handicap. However, the diet is very restrictive and unpalatable and can be difficult to follow. A deficiency of the amino acid tyrosine has been suggested as a cause of some of the neuropsychological problems exhibited in phenylketonuria. Therefore, this review aims to assess the efficacy of tyrosine supplementation for phenylketonuria. This is an update of previously published versions of this review. To assess the effects of tyrosine supplementation alongside or instead of a phenylalanine-restricted diet for people with phenylketonuria, who commenced on diet at diagnosis and either continued on the diet or relaxed the diet later in life. To assess the evidence that tyrosine supplementation alongside, or instead of a phenylalanine-restricted diet improves intelligence, neuropsychological performance, growth and nutritional status, mortality rate and quality of life. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register which is comprised of references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Additional studies were identified from handsearches of the Journal of Inherited Metabolic Disease (from inception in 1978 to 1998). The manufacturers of prescribable dietary products used in the treatment of phenylketonuria were also contacted for further references. Date of the most recent search of the Group's Inborn Errors of Metabolism Trials Register: 07 December 2020. All randomised or quasi-randomised trials investigating the use of tyrosine supplementation versus placebo in people with phenylketonuria in addition to, or instead of, a phenylalanine-restricted diet. People treated for maternal phenylketonuria were excluded. Two authors independently assessed the trial eligibility, methodological quality and extracted the data. Six trials were found, of which three trials reporting the results of a total of 56 participants, were suitable for inclusion in the review. The blood tyrosine concentrations were significantly higher in the participants receiving tyrosine supplements than those in the placebo group, mean difference 23.46 (95% confidence interval 12.87 to 34.05). No significant differences were found between any of the other outcomes measured. The trials were assessed as having a low to moderate risk of bias across several domains. From the available evidence no recommendations can be made about whether tyrosine supplementation should be introduced into routine clinical practice. Further randomised controlled studies are required to provide more evidence. However, given this is not an active area of research, we have no plans to update this review in the future.

Effect of Psychodrama on Post-traumatic Stress Disorder Symptoms in Primary School Students Living in Earthquake-stricken Areas

Objectives: This study aims to determine the effectiveness of psychodrama in reducing the symptoms of Post-Traumatic Stress Disorder (PTSD) in primary school students living in earthquake-stricken areas. Methods: This is a quasi-experimental study with pre-test/post-test design using a control group. The study population consists of all male primary school students diagnosed with PTSD living in Salas-e Babajani County, Kermanshah, Iran. Of these, 40 were selected using a purposive sampling method and based on the PTSD criteria, and were then divided into two groups of intervention (n=20) and control (n=20). Research instruments were a diagnostic interview based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria and the PTSD Checklist for DSM5 (PCL-5) questionnaire. Data were analyzed using one-way and multivariate analysis of covariance. Results: Psychodrama reduced the symptoms of PTSD in children with an effect size of 0.51 (P<0.001). Conclusion: Psychodrama is an effective method for reducing the PTSD symptoms and neuropsychological problems. For the generalization of its results, further studies are recommended.