Neuroimmune Mechanisms Transforming Acute Injury to Long-Term Brain Dysfunction After Sepsis.

Factors associated with long-term brain dysfunction (LTBD) in survivors of chronic critical illness (CCI) have not been explored but may be important for clinical practice and planning by patients, families, and providers. To identify risk factors for LTBD after treatment for CCI and to explore the association between acute delirium and coma during hospital treatment and LTBD. A prospective cohort study of adults admitted to a respiratory care unit for treatment of CCI. Using the Confusion Assessment Method for ICU and the Richmond Agitation and Sedation Scale, we evaluated patients for delirium and coma during their hospital treatment for CCI. We collected data on other potential risk factors for LTBD by prospectively reviewing the patients' medical records and interviewing surrogates. We contacted survivors by telephone at 6 months after discharge to assess brain function using the telephone Confusion Assessment Method. Among 385 patients treated for CCI, 213 (56.1%) were dead at 6 months, and 108 of 167 (64.7%) of survivors were impaired. We used multinomial logistic regression in which the outcomes were (1) death, (2) brain dysfunction, and (3) survival without LTBD. Older patients, patients with higher Acute Physiology Score, and those with multiple complications during treatment for CCI were more likely to have LTBD. Acute brain dysfunction during hospital treatment was also associated with an increased risk of LTBD (odds ratio, 2.14; 95% confidence interval, 1.02-4.52). LTBD after treatment for CCI is associated with brain dysfunction during such treatment as well as with older age and higher severity of illness of the patients.

Objectives The primary objectives of the study were to (i) establish the 12-month incidence and comorbidity of symptoms of mental health disorders (distress, anxiety/depression, sleep disturbance, alcohol misuse, disordered eating) among Dutch former elite athletes and (ii) explore the potential relationship with the stressors involuntary retirement, recent life events, career dissatisfaction. The secondary objective was to investigate whether the incidence of symptoms of mental health disorders and their potential relationship with stressors are related to duration since retirement. Methods An observational prospective cohort study with a 12-month follow-up was conducted among Dutch former elite athletes. Symptoms of mental health disorders and potential stressors were assessed using validated questionnaires. Results A total of 282 participants were included at baseline and 193 completed follow-up. The incidence ranged from 7% for alcohol misuse to 28% for anxiety/depression. Comorbidity of two or three symptoms of mental health disorders was reported in 7% and 4%, respectively. Adverse life events were significantly related to disordered eating (RR = 1.30, 95%CI = 1.05–1.61), while career dissatisfaction also showed a significant relationship with disordered eating (RR = 3.98, 95%CI = 1.32–11.99) and sleep disturbance (RR = 3.23, 95%CI = 1.10–9.51). The stressor involuntary retirement did not have a significant relationship with any symptoms of mental health disorders. The effect of duration since retirement seemed to be most present in the first 15 years since athletic career retirement in the plotted graphs. Conclusions The 12-month incidence of symptoms of mental health disorders ranged from 7% to 28% and comorbidity of symptoms of mental health disorders was present in 12%. Adverse life events and career dissatisfaction only increased the risk of certain symptoms of mental health disorders. Duration since retirement might affect the incidence of symptoms of mental health disorders and its relationship with stressors in the first 15 years.

BackgroundRates of mental health disorders are significantly greater in children with physical illnesses than in physically well children. Children with neurological conditions, such as epilepsy, are known to have particularly high rates of mental health disorders. Despite this, mental health problems in children with neurological conditions have remained under-recognised and under-treated in clinical settings. Evidence-based guided self-help interventions are efficacious in reducing symptoms of mental health disorders in children, but their efficacy in reducing symptoms of common mental health disorders in children with neurological conditions has not been investigated. We aim to pilot a guided self-help intervention for the treatment of mental health disorders in children with neurological conditions.Methods/designA pilot randomised controlled trial with 18 patients with neurological conditions and mental health disorders will be conducted. Participants attending specialist neurology clinics at a National UK Children’s Hospital will be randomised to receive guided self-help for common mental health disorders or to a 12-week waiting list control. Participants in the treatment group will receive 10 sessions of guided self-help delivered over the telephone. The waiting list control group will receive the intervention after a waiting period of 12 weeks. The primary outcome measure is reduction in symptoms of mental health disorders. Exclusion criteria are limited to those at significant risk of harm to self or others, the presence of primary mental health disorder other than anxiety, depression or disruptive behaviour (e.g. psychosis, eating disorder, obsessive-compulsive disorder) or intellectual disability at a level meaning potential participants would be unable to access the intervention. The study has ethical approval from the Camden and Islington NHS Research Ethics Committee, registration number 14.LO.1353. Results will be disseminated to patients, the wider public, clinicians and researchers through publication in journals and presentation at conferences.DiscussionThis is the first study to investigate guided self-help interventions for mental health problems in children with neurological conditions, a group which is currently under-represented in mental health research. The intervention is modular and adapted from an empirically supported cognitive behavioural treatment. The generalisability and broad inclusion criteria are strengths but may also lead to some weaknesses.Trial registrationCurrent Controlled Trials: ISRCTN21184717. Registered on 25 September 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1663-z) contains supplementary material, which is available to authorized users.

ObjectiveRoyal Canadian Mounted Police report experiencing extremely frequent potentially psychologically traumatic events (PPTE). In a recent study, approximately half of participating RCMP screened positive for one or more mental disorders, which is approximately five times the diagnostic proportion for the general Canadian population. Increased reporting of mental health symptoms been linked to PPTE exposures. Programs promoting physical activity may be useful interventions to supplement or pair with mental health interventions, providing anxiolytic, antidepressant, and stress-buffering effects. The current study was designed to assess the relationship between physical activity behaviors and reported mental health disorder symptoms of cadets during the Royal Mounted Canadian Police (RCMP) Cadet Training Program (CTP). The current study also examined the relationship between exercise and mental health disorder symptoms of cadets during the CTP.MethodsThe study included data from 394 cadets (76.1% male). An analysis of variance (ANOVA) and a series of t-tests were used to assess several differences across sociodemographic groups. Bivariate Spearman’s Rank correlations were performed between the average number of active calories burned per day, as recorded by Apple Watches, and changes in self-reported mental health disorder symptoms (i.e., Generalized Anxiety Disorder [GAD], Major Depressive Disorder [MDD], Posttraumatic Stress Disorder [PTSD], Social Anxiety Disorder [SAD]. Alcohol Use Disorders [AUD], Panic Disorder [PD]) from pre-training (starting the CTP) to pre-deployment (completing the CTP) 26 weeks later.ResultsThere were statistically significant correlations between physical activity and self-reported mental health disorder symptom scores during CTP. Cadets who performed more physical activity from pre-training to pre-deployment had statistically significantly greater decreases in symptoms of GAD (ρ = −0.472, p < 0.001), MDD (ρ = −0.307, p < 0.001), PTSD (ρ = −0.343, p < 0.001), and AUD (ρ = −0.085, p < 0.05). There was no statistically significant relationship between physical activity and changes in PD symptoms (ρ = −0.037, p > 0.05). There were also no statistically significant relationships between pre-CTP mental health disorder symptom scores and the volume of physical activity performed during CTP.ConclusionThere was evidence of a significant relationship between reductions in mental health disorder symptom scores and physical activity during the 26-week CTP. The results highlight the role that exercise can play as an important tool for reducing mental health disorder symptoms, considering there was no relationship between pre-CTP baseline mental health scores and physical activity performed during CTP. Further research is needed to understand differences in physical activity behaviours among cadets and serving RCMP.

Dysregulated host response to infection, which cause life-threatening organ dysfunction, was defined as sepsis. Sepsis can cause acute and long-term brain dysfunction, namely, sepsis-associated encephalopathy (SAE) and cognitive impairment. SAE refers to changes in consciousness without direct evidence of central nervous system infection. It is highly prevalent and may cause poor outcomes in sepsis patients. Cognitive impairment seriously affects the life quality of sepsis patients and increases the medical burden. The pathogenesis of sepsis-induced brain dysfunction is mainly characterized by the interaction of systemic inflammation, blood-brain barrier (BBB) dysfunction, neuroinflammation, microcirculation dysfunction, and brain dysfunction. Currently, the diagnosis of sepsis-induced brain dysfunction is based on clinical manifestation of altered consciousness along with neuropathological examination, and the treatment is mainly involves controlling sepsis. Although treatments for sepsis-induced brain dysfunction have been tested in animals, clinical treat sepsis-induced brain dysfunction is still difficult. Therefore, we review the underlying mechanisms of sepsis-induced brain injury, which mainly focus on the influence of systemic inflammation on BBB, neuroinflammation, brain microcirculation, and the brain function, which want to bring new mechanism-based directions for future basic and clinical research aimed at preventing or ameliorating brain dysfunction.

BackgroundMental illness is a worldwide public health concern. In the UK, there is a high prevalence of mental illness and poor mental wellbeing among young people. The aim of this study was to investigate whether physical activity is associated with better mental wellbeing and reduced symptoms of mental health disorder in adolescents.MethodsA cohort of 928 12–13 year olds (Year 8) from six secondary schools in England, who had participated in the AHEAD trial, ‘Activity and Healthy Eating in Adolescence’, were followed up three years later (when 15–16 years old, Year 11). At baseline, physical activity was measured using accelerometers. At follow-up, mental wellbeing was measured using the ‘Warwick Edinburgh Mental Wellbeing Scale’ (WEMWBS) and symptoms of mental health disorder using the ‘Strengths and Difficulties Questionnaire’ (SDQ). Multivariable linear regression analyses were used to investigate associations between physical activity and both mental wellbeing and symptoms of mental health disorder.Results794 (86%) of the eligible 928 young people provided valid accelerometer data at baseline. 668 (72%) provided complete mental wellbeing data and 673 (73%) provided complete symptoms of mental health disorder data at follow-up. The multivariable analyses showed no evidence of an association between physical activity volume (counts per minute (cpm)) or intensity (Moderate to Vigorous Physical Activity (MVPA)) and mental wellbeing (WEMWBS overall score) or overall symptoms of mental health disorder (SDQ Total Difficulties Score). However, higher levels of physical activity volume at age 12–13 years were associated with lower scores on the emotional problems subscale of the SDQ at age 15–16 years.ConclusionsThis cohort study found no strong evidence that physical activity is associated with better mental wellbeing or reduced symptoms of mental health disorder in adolescents. However, a protective association between physical activity and the emotional problems subscale of the SDQ was found. This suggests that physical activity has the potential to reduce symptoms of depression and anxiety in adolescents. Future cohort study designs should allow for repeated measures to fully explore the temporal nature of any relationship.

BACKGROUND Refugees and asylum seekers are susceptible to developing common mental disorders due to their exposure to stressful experiences before, during and after their flight. The Syrian Civil War, which started in 2011, has led to a massive number of Syrians seeking refuge and asylum in European countries, including Switzerland. Currently, Syrians are the second-largest refugee and asylum-seeking population in Switzerland. However, very little is known about the problems faced by this new population in Switzerland and their needs relating to mental health services. Identifying the problems faced by this community is crucial to providing adapted and tailored mental health services to Syrian refugees in Switzerland. AIM OF THE STUDY The current study aimed to identify problems that Syrian refugees and asylum seekers face daily while living in Switzerland in order to inform the adaptation of a brief psychological intervention. METHODS We used a cross-sectional, qualitative design and collected data according to The Manual for Design, Implementation, Monitoring and Evaluation of Mental Health and Psychosocial Assistance Programs for Trauma Survivors in order to identify problems perceived by the target population. Free-listing, open-ended interviews were conducted with 30 adult Syrian refugees and asylum seekers and analyzed using thematic analysis. RESULTS The results show that besides physical health problems, Syrians experience primarily two types of problems: practical and psychological (emotional) problems. These two types of problems are closely interrelated. The most common practical problems (problems with government and authorities, problems related to residence permits, problems with integration, cultural differences, language problems, problems related to education, problems related to employment, and problems with housing) were reported by almost half of all participants. Symptoms of mental disorders and feelings of uncertainty, frustration and injustice were the most common psychological problems and were mentioned by more than one third of the participants. The finding that almost half of the participants reported typical symptoms of mental health disorders suggests that a considerable number of Syrian refugees and asylum seekers might need mental healthcare. CONCLUSIONS Authorities, practitioners and researchers should recognize that Syrian refugees and asylum seekers are strongly affected by a broad range of problems. Besides practical problems, they suffer a multitude of psychological problems, and a significant number of them report, among other issues, symptoms of mental health disorders. Officials working with this population should be aware of this vulnerability and be prepared to refer clients in need of mental healthcare to mental healthcare providers. Moreover, the significant variety and number of problems experienced by this population should be taken into consideration when developing solutions tailored to their needs.

IntroductionRoyal Canadian Mounted Police (RCMP) officers self-report high levels of mental health disorder symptoms, such as alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder. Participation in regular mental health monitoring has been associated with improved mental health disorder symptom reporting and may provide an accessible tool to support RCMP mental health. The current study assessed relationships between self-reported mental health disorder symptoms and the completion of daily surveys (i.e., daily mental health disorder symptom monitoring) by RCMP cadets during the Cadet Training Program (CTP).MethodsParticipants were RCMP cadets (n = 394; 76.1% men) in the Standard Training Program who completed the 26-week CTP and daily self-monitoring surveys, as well as full mental health assessments at pre-training (i.e., starting the CTP) and pre-deployment (i.e., ~2 weeks prior to deployment to the field). Symptoms of alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder were assessed. Changes in mental health disorder symptom reporting from pre-training to pre-deployment were calculated. Spearman’s rank correlations were estimated for number of daily surveys completed and change in mental health disorder symptom scores between pre-training and pre-deployment.ResultsThere were statistically significant inverse relationships between number of daily surveys completed and number of mental health disorder symptoms reported; specifically, cadets who completed more daily surveys during CTP reported fewer symptoms of alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder.ConclusionAn inverse correlation between number of daily surveys completed and mental health disorder symptom scores indicated that participation in daily mental health monitoring was associated with improvements in self-reported mental health disorder symptoms between pre-training and pre-deployment. Regular self-monitoring of mental health disorder symptoms may help to mitigate mental health challenges among RCMP cadets and officers.

Prevalence of symptoms of common mental disorders among elite Canadian athletes

Critically ill patients frequently experience acute brain dysfunction in the form of coma or delirium, both of which are common during acute and chronic critical illness (CCI). These manifestations of brain dysfunction are associated with numerous adverse outcomes during acute critical illness, including prolonged hospitalization, increased healthcare costs, and increased mortality. The prognosis of CCI patients with coma or delirium has not yet been thoroughly studied, but preliminary studies suggest this population is at high risk for detrimental outcomes associated with acute brain dysfunction. Additionally, a high percentage of patients who survive acute or CCI suffer from long-term brain dysfunction, which manifests primarily as memory deficits and executive dysfunction and is predicted by brain dysfunction in the ICU. Interventions directed at reducing the burden of brain dysfunction during critical illness have shown promise in studies of patients with acute critical illness, but these therapies have yet to be studied during CCI. Thus, multicenter randomized trials are needed to determine which interventions are most effective for such patients. Until these data are available, management strategies that have been proven beneficial during acute critical illness-such as reduction of sedative exposure, especially to benzodiazepines, and early use of physical and occupational therapy-should be employed during the treatment of patients with CCI.

Juvenile offenders often suffer from concurrent mental health disorders, yet there is a dearth of effective prevention programs targeted for these youths. Extant evidence suggests that programs incorporating art instruction may be effective in reducing symptoms of mental health disorders and offending behaviors. This study examined the Prodigy Cultural Arts Program, which utilizes cultural arts classes infused with a skills curriculum, for effects on symptoms of mental health disorders in at-risk and adjudicated youths. Results suggest that youths participating in the Prodigy Cultural Arts Program experience a significant decrease in overall symptoms of mental health disorders. Furthermore, gender appears to be an important factor both for symptoms of mental health disorders at pretest and for overall change in these symptoms.

The research aimed to study the impact of living in displacement camps on mental health and Quality of life among Syrians in Northwest Syria. A descriptive and analytical approach was utilized, where two scales of mental health (SCL – 90 - R) and Quality of life (WHOQOL – BREF) were applied, with (306) participants. Results show that symptoms of mental health disorders appear at different levels, where the most common disorder is Depression, and the least common is Psychoticism. Quality of life results show that the most common issue was General Health, and the least common was environmental health. Differences between educational status and gender were statistically significant when studying the presence of mental health disorders, where it was lower in males than in females. Quality of life results showed significant differences between all demographic characteristics except the duration of stay in the camp. It was higher in females than in males. It was higher among the employed than the unemployed, and the age (under 18 years) had the highest Quality of life .Regarding marital status, it was highest in the (single and widowed). The Quality of life was highest among the university degree holders. There was a moderate and inverse correlation between Symptoms of mental health disorders and Quality of life, where the correlation coefficient was (-0.382), and this indicates a lower level of mental health with increasing deterioration in Quality of life. The results showed that Quality of life contributes to interpreting the variance in Symptoms of mental health disorders. The beta value (β = - 0.391) means that whenever Quality of life improved by one unit, Symptoms of mental health disorders decreased by (0.391) unit . To conclude, quality of life statistically significantly contributes to explaining mental health disorders among Syrians in displaced camps.

Neuroanatomy and Physiology of Brain Dysfunction in Sepsis

Summary: Introduction: Mental health disorders around the world, as well as in our country, present a serious social and medical problem. Aim: To demonstrate and study the prevalence of mental disorders, to determine its relation to age and sex distribution of patients treated at the General Practice Department of the Health Care Centre Doljevac. Method: A survey was conducted on the basis of medical records and the electronic database of health-insured patients of Doljevac aging 18 and older who came to see their doctor during 2013. The data were collected, analyzed and presented graphically. Results: Of the total number of insured patients of Doljevac aging over 18 (19,030) during 2013, 4,378 patients (23%) came to see their general practitioners for some symptoms of mental health disorder. Most patients with symptoms of mental health disorder accounted for females 69.30%, while males accounted for 30.70%. 55.85% of the total number patients were diagnosed with F41 (anxiety disorder), 17.10% with F32 (depressive disorder), and 12.29%with F43 (a reaction to severe stress and adjustment disorders). Most commonly mental disorders were present in patients aging 35-65, (49.27%) and in patients over 65 years of age (41.09%), while in patients aging 18-35 the presence was 9.64%. Conclusion: The study of patients treated at the Health Care Centre Doljevac showed a high prevalence of mental disorders in patients. It is alarming that a quarter of the population from the territory of the municipality of Doljevac have symptoms of some mental health disorder. All age groups suffer from these and the incidence in working population is caused by social and economic circumstances.

Although much emphasis has been placed on the impact of ambiguity on cognitive processes, the impact of mental health disorder symptoms and racial/ethnic disparities in cancer perception of fatalism and ambiguity remains less explored. This study explored the association between mental health disorder symptoms and negative cancer perceptions. Also, we assessed differences in these outcomes within mental health disorder symptoms and racial/ethnic subgroups to investigate the association between cancer perceptions and the other covariates within the aforementioned subgroups. We used the 2019-2020 Health Information National Trends Survey data (N = 9,303) to assess the perception of cancer fatalism and cancer communication ambiguity and employed weighted multivariable logistic regression to determine the effects of mental health disorder symptoms using the Patient Health Questionnaire-4 (PHQ-4) scale on these negative cancer perceptions among United States adults. People with moderate [Adjusted Odds Ratio (AOR) = 1.58, 95% Confidence Interval (CI) = 1.09, 2.31] and severe anxiety/depression (AOR = 1.88, 95% CI = 1.12, 3.14) symptoms were more likely to have cancer fatalism perceptions than people with no anxiety/depression symptoms. People with mild (AOR = 1.33, 95% CI = 1.06, 1.69) or severe (AOR = 1.80, 95% CI = 1.03, 3.16) anxiety/depression symptoms were more likely to perceive cancer communication as ambiguous compared to people who had no anxiety/depression symptoms. The study showed that mental health status was associated with both cancer fatalism and perceived cancer communication ambiguity. This suggests that interventions aimed at reducing mental health disorder symptoms may potentially reduce these negative perceptions, thereby improving participation in cancer prevention programs.