Purpose Accumulating evidence highlights the importance of microbiota-directed intervention in neuropsychiatric disorders. This study aims to investigate the effects of probiotic supplements as an adjunct therapy in combination with Ritalin in children with attention-deficit hyperactivity disorder (ADHD). Design/methodology/approach Children with ADHD, aged 6–12 years, who had an intelligent quotient of ≥70 were enrolled in the study. Participants were randomly assigned to either the group that received probiotics or the group that received the placebo in addition to the weight-adjusted dose of Ritalin. Parents were asked to complete the revised Conners Parent Rating Scale–short version (CPRS–RS), and the psychiatrist completed the seven-point Clinical Global Impression–Severity (CGI–S) scale. Two study groups were compared in three time points, including T1 (before intervention), T2 (at the end of fourth week) and T3 (at the end of the eighth week). Findings A total of 38 participants completed the study. After eight weeks of intervention, the probiotic group had a significant improvement regarding CPRS–RS scores in T2 (9.4 unit, p = 0.014) and T3 (18.6 unit, p < 0.001), compared to placebo. In addition, children in the probiotic group had 0.7 unit lower CGI in T3 (p = 0.018) than the placebo group. A significant reduction of CGI scores was observed in each interval (T2 vs T1, T3 vs T2 and T3 vs T1; p < 0.05). This significant change in CGI score between intervals was also detected in the placebo group in T2 vs T1 (p = 0.002) and T3 vs T1 (p < 0.001). Mean CPRS scores of the groups were different in T2 and T3 (p = 0.011 and p < 0.001, respectively) and mean CGI scores of the two study groups were different in T3 (p = 0.018). Originality/value Eight weeks of supplementation with probiotics had a favorable effect on symptoms and severity of ADHD. Therefore, probiotics as an adjuvant treatment might have a promising efficacy regarding the management of ADHD.

Background: In many developing countries, most patients referred for hospitalization for high suicide risk are deprived of adequate care, mainly because of limited psychiatric facilities. Objectives: We aimed to investigate the short-term outcomes of an outpatient psychiatric crisis intervention (PCI) service enhanced with case management for patients with suicide risk where hospital admission was impossible because of the bed shortage. Methods: We developed a service model provided by a team of psychiatry residents, psychologists, and social workers supervised by a faculty psychiatrist. We piloted it in Roozbeh Psychiatry Hospital for patients when hospitalization was indicated for suicidality, but admission was not possible due to the bed shortage. This study followed an action research design and methodology. The sample was selected from individuals referred to Roozbeh Hospital. All subjects who fulfilled the inclusion criteria were included in the study. Convenience sampling was used for the satisfaction assessments. Results: The PCI provided the service to 173 patients. The suicide risk was resolved in 48 (27.7%) patients. The remaining consisted of individuals finally hospitalized when beds were available (73 patients, 42.2%) or dropped out of the service (52 patients, 30.1%). Most patients (86%) were satisfied with the service. Only one non-lethal suicide attempt was reported in the two-month follow-up. Conclusions: An outpatient crisis service for suicidality enhanced with case management may reduce the need for hospitalization. However, randomized controlled studies are needed to establish its effectiveness.