Attention Disorders Research Articles

Measuring subjective cognitive complaints with covid-19 brain fog using the subjective scale to investigate cognition (SSTICS)

The term “brain fog” has emerged from the observations of neuropsychiatric conditions present in post-COVID-19 infections. This is characterized by concentration and memory problems, selective attention disorders and difficulties in executive functions, yet it is unclear how long these deficits may persist and which cognitive functions are most vulnerable. Therefore, there is a need to properly evaluate these cognitive complaints using an assessment tool that specifies their intensity and nature. Our primary objective was to explore subjective perceptions of cognitive functioning in COVID-19-associated with brain fog using a tool that was previously validated for assessing subjective cognitive complaints. A total of 68 participants were recruited and the Subjective Scale to Investigate Cognition (SSTICS) was used to assess cognitive complaints. This was the first time that the SSTICS was used for this purpose in subjects with COVID-19. In addition, participants were administered a questionnaire assessing for the presence of various symptoms, as well as COVID-19 clinical parameters. The neuropsychological basis for the construct of the SSTICS was related to the cognitive complaints expressed by participants. A reliability analysis of our sample indicated a high degree of internal consistency (Cronbach’s alpha= 0.951). Associations between various SSTICS scores and COVID-related symptomatology and the differences between group of participants who reported cognitive complaints (“complainers”) and those who did not were assessed. We performed an exploratory factorial analysis based on Principal Component Analysis (PCA). Based on their distribution, participants were grouped into: “good functioning” - scores 0-9 (35.3%); “medium functioning” - scores 14-23 (25%); and “poor functioning” - scores 26-71 (39.7%). The mean SSTICS score was 20.59 (SD 16.61) and correlated with the quarantine duration and loss of smell. Complainers differed significantly from non-complainers in the total number of symptoms, the quarantine duration and the presence/absence of specific symptoms, such as loss of smell, tiredness and aches/pains. Our study showed that >10% of patients reported subjective cognitive complaints following COVID-19, with most reporting mild or serious cognitive complaints, mostly within the domains of memory, attention, language, executive functioning or praxis.

Prevalence of Brugada ECG pattern in psychiatric patients: a longitudinal prospective cohort of 550 patients

Abstract Background Brugada syndrome (BrS) is an inherited disorder with autosomal dominant transmission, which occurs predominantly in males in the third to fourth decade of life with resting syncope, nocturnal agonic breathing, major ventricular arrhythmias and sudden death. Arrhythmic complications can occur spontaneously or following exposure to triggers such as fever, or certain categories of medications, including psychiatric drugs. Aim of the study To evaluate the prevalence of Brugada ECG pattern in psychiatric patients. Methods from January 2023 to Decembre 2023, 550 consecutive patients who were admitted to the psychiatric department of our university hospital were enrolled. For each patient, electrocardiographic and anamnestic data including psychiatric diagnosis, current drug therapy and family history were collected. Results Twenty-one out of five-hundred and fifty patients (3.8%) presented with a Brugada ECG pattern. Mean age was 42±6 years and seventeen out of twenty-one patients (81%) were male. Two patients exhibited a Spontaneous type 1 Brugada ECG pattern meanwhile nineteen patients had a Brugada type 2 or 3 ECG pattern. When compared to the general population, those with Brugada ECG had longer P wave duration (110±7 vs 103±13 msec p<0.01) and longer QRS duration (97±14 vs 89±12 msec p=0.04). Evaluating psychiatric disorders, patients with Brugada ECG had high prevalence of mood disorders (10 out of 21, 47%). Other disorders were schizophrenia (3 out of 21, 14%), cognitive retardation (5 out of 21, 23%), and attention disorder (1 out of 21, 5%). Moreover 4 patients were drug addicted. Only 5 out of 21 (24%) patients had a family history of psychiatric and neurological disorders. Conclusions Brugada ECG pattern has a prevalence of 3.8% in a large cohort of psychiatric patients. Mood disorders was the most common diagnosis in this cohort. Large prospective registries are needed to evaluate the clinical feature and potential clinical implication of this findings.

A cross-sectional study on distinctive factors associated with conduct behaviors among children presenting with inattention-hyperactivity disorders in Indian context

Abstract Introduction: Conduct behaviors are frequently associated with disorders of inattention and hyperactivity. Many studies have been done in the Western population on predictors of those conduct behaviors among these children with inattention-hyperactivity. However, such studies are lacking in the Indian context. Thus, the current study examined the distinctive factors associated with conduct behaviors among children presenting with inattention-hyperactivity Disorders in the Indian setting. Materials and Methods: A cross-sectional study was done in a Medical College of Kolkata with two groups of children and adolescents each having 50 samples diagnosed as hyperkinetic conduct disorder (HKCD) and hyperkinetic disorder of attention and activity (HKD-AA) as per International Classification of Diseases-10th version. Comparison between the two groups was made with the abbreviated (10-item) Conners’ rating scale for parents (CPRS-HI) and a semi-structured socio-demographic pro forma to find out the distinctive factors associated with HKCD. Results: On comparison between the two groups, significant differences (P < 0.05) were found in items such as male sex, birth complications, inadequate social-skill development, paternal alcohol use disorders (AUD), and disturbed family ambience, which were significantly higher in HKCD. Among CPRS-HI items, impulsivity was the distinguishing feature of HKCD. However, the total severity scores of CPRS-HI were similar in both the groups. In our population, maternal substance abuse was not found, and mood and alcohol use disorders were more common than childhood externalizing disorders in the family history. Conclusion: Similar to the Western population, in our study male sex, birth complications, paternal-AUD, and disturbed family ambience are distinctively higher in conduct behaviors, but contrary to them, there is no maternal substance abuse, and severity of inattention-hyperactivity scores are similar in children with or without conduct behaviors.

Sociomedical assessment: basics of assessment in general and specifically in the case of fatigue and burnout

The sociomedical report is an essential basis for making decisions about benefits from social insurance providers. As an instrument of medical information, the sociomedical assessment can be based on very different questions, such as the question of ability to work, earning capacity, participation in professional or social life, or the need for medical treatment. It is important to obtain acomprehensive picture of the individual situation in order to create the basis for decisions about benefit entitlements and support measures. The various issues in the respective sociolegal context may require not only the sociomedical report but also other expertise. The international classification of functioning, disability, and health (ICF) and the World Health Organization (WHO) bio-psycho-social model on which it is based enable health problems and their effects to be considered in the context of life and work. The components of functional ability and disability are assessed in their interaction from asociomedical perspective. What is important is not the diagnosis but rather the person and the individual impact of the health disorders on their activities and participation.In the case of fatigue and burnout, amedical symptom complex with (psychophysical) exhaustion and the resulting attention and concentration disorders are in the focus of the sociomedical assessment. It can be difficult to objectify symptoms and complaints in these diseases, which can lead to particular challenges during assessment, especially when validating complaints.

Traits of Developmental Disorders in Adults With Listening Difficulties Without Diagnosis of Autism Spectrum Disorder And/or Attention-Deficit/Hyperactivity Disorder.

Background: Some individuals have a normal audiogram but have listening difficulties (LiD). As many studies have investigated the relationship between listening and developmental disorders, the traits of developmental disorders might explain the symptoms of LiD. In this study, we examined the traits of developmental disorders of adults with LiD to help clarify the cause of LiD symptoms. Methods: In total, 60 adults with LiD and 57 adults without LiD were included. Participants completed a questionnaire for the autism spectrum quotient (AQ) test, the Adult Attention-Deficit Hyperactivity Disorder Self-Rating Scale (A-ADHD), the Adolescent/Adult Sensory Profile (SP), and the severity of subjective LiD in daily life. Results: Before analysis, we excluded participants with LiD who were already diagnosed or met the criteria for autism spectrum disorder (ASD) or ADHD, and the results of the remaining 30 participants (50.0%) with LiD were analyzed. Adults with LiD showed higher scores than those without LiD in the AQ. Attention switching in the AQ and attention ability in the A-ADHD scale were correlated with the severity of LiD symptoms in everyday life. The AQ scores were also significantly correlated with subscales of the SP. Conclusions: Adults with LiD showed greater autistic traits than those without LiD; therefore, LiD symptoms are possibly related to autistic symptoms. Furthermore, adults with LiD might have attention disorder traits of both ASD and ADHD and sensory processing problems. These findings suggest that the attention problems in adults with LiD noted in previous studies might be related to these traits of developmental disorders.

Factors and prediction model associated with resumption of social outings in stroke survivors 6 months after onset: a multicenter prospective study

ABSTRACT Objectives To identify factors associated with the resumption of social outings 6 months after stroke onset and develop a simple clinically practical prediction model. Materials and methods Participants were recruited from first-ever stroke survivors admitted to three rehabilitation wards, and resumption of social outings 6 months after stroke onset was assessed using the Japanese version of the Frenchay Activities Index. The association of physical and cognitive functions with activities of daily living at admission to the rehabilitation ward and resumption of social outings 6 months after stroke onset was examined using logistic regression and decision trees. Results Notably, 63.2% of the 57 stroke survivors who participated in this study had lower Frenchay Activities Index scores for social outings 6 months after stroke onset than before. Logistic regression analysis revealed that attention deficit and grooming on the Functional Independence Measure (FIMTM) were significantly associated with decreased social outing scores 6 months after stroke onset. A decision tree model was created to predict the resumption of social outings using the presence or absence of attention disorders and FIMTM grooming score (>2 or ≤ 2). Conclusions The results of this study suggest that attention deficit and beyond a certain level of independence in grooming (FIMTM >2) at admission to the rehabilitation ward are associated with recovery to the pre-stroke level of social outings 6 months after stroke onset. The decision tree created in this study holds promise as a simple model to predict the resumption of social outings among stroke survivors.

Study of etiology, clinical profile, and outcome of altered sensorium patients admitted in a tertiary care hospital

Background: Altered sensorium is one of the most common presentations in patients coming to the emergency room. It includes decreased level of consciousness, attention disorder, arousal disorder, and cognitive disorder. The causes of altered sensorium can be varied, some of which are cerebrovascular diseases, alcoholism, cerebral trauma, hypoglycemia, epilepsy, drug intoxication, and neuroinfection. 4–10% of the patients presenting to the emergency department may have altered mental status. The outcome is dependent on early identification and effective treatment using investigations and imaging technologies, and it might range from full recovery to permanent damage to death. Aims and Objectives: (1) To study clinical profile and etiology in altered sensorium patients. (2) To assess outcomes in altered sensorium patients. Materials and Methods: In this prospective cross-sectional study, clinical examination and investigations are done and data are collected using pro forma for patients fulfilling the inclusion criteria. In this study, all altered sensorium patients were evaluated by detailed history, clinical examination, Glasgow Coma Scale (GCS), laboratory investigations, computed tomography brain, and other investigations. All patients were followed up till discharge or death of the patient in the hospital. Results: There were 270 patients who presented with encephalopathy, 184 (68%) were males. The majority of these patients 60 (22.2%) were in the age group of 51–60 years old. The most common cause is neurological in 109 (40.3%) patients, metabolic in 64 (24%) patients, and sepsis in 50 (19%) patients. Ischemic stroke 83 (76%) is the most common neurological cause. Hepatic encephalopathy was the most common cause of metabolic encephalopathy present in 21 (32%) patients. Pneumonia was the most common infection. There were 114 (42.2%) deaths. Septic encephalopathy is the most common cause of mortality. Early presentation to the hospital, higher GCS, and conscious level at presentation were good prognostic markers of outcome in patients, while septic encephalopathy was found to have the worst prognosis. Conclusion: The common etiologies of encephalopathy are neurological followed by metabolic and sepsis. Early presentation to the emergency room within 6 h of symptom onset, higher GCS, neurological and metabolic causes are associated with a good prognosis. The mortality rate was 42.2%. Septic encephalopathy is the most common cause of death with pneumonia being the most common source of infection.

Impact of pre-stroke cognitive decline on rehabilitation effectiveness and cognitive-functional status of patients in the acute period of ischemic stroke

Summary. The aim was to assess the influence of premorbid cognitive deficit on the effectiveness of rehabilitation using VR technologies and cognitive-functional status of patients in the acute period of ischemic stroke based on statistical methodology. Materials and methods: 120 patients diagnosed with ischemic stroke were examined. The IQCODE questionnaire was used to identify the patient’s cognitive decline before and the Pandas and SciPy libraries. Results: all patients had a multifunctional type of cognitive impairment with a predominant decline in the areas of executive function, memory, speech and perception. Patients of the 2nd group had a more pronounced deficit in the areas of constructive praxis, episodic memory, semantic information processing and perception. Assessment of the dynamics of cognitive impairment during therapy revealed a significant improvement in memory loss (p=0, 0034), executive dysfunction (p<0.0001) and attention impairment (p=0.0001) in patients of 1st group and regression cognitive deficit in almost all cognitive areas in patients of 2nd group. Factors impeding rehabilitation in 1st group of patients were attention (r = -0,325) and perceptual disorders (r = -0,425); in 2nd group: semantic aphasia (r = -0,425), constructive apraxia (r = -0,325), speech impairment (r = — 0,375), object agnosia (r = -0,323) and IQCODE (r = -0,395). Conclusion: pre-stroke cognitive impairments are predictors of the development and progression of post-stroke cognitive deficits and reduce the possibilities of rehabilitation and cognitive recovery. The introduction of IQCODE in the diagnosis of cognitive dysfunction in the acute period of ischemic stroke is a useful tool in predicting the course and development of cognitive deficit and studying the prospects of rehabilitation programmes using VR technologies in patients with pre-stroke cognitive impairment.

Cognitive impairments in autoimmune encephalitis: the role of autoimmune antibodies and oligoclonal bands.

The presence of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) is a pivotal diagnostic marker for multiple sclerosis (MS). These bands play a crucial role in the diagnosis and understanding of a wide array of immune diseases. In this study, we explore the relationship between the cognitive profile of autoimmune encephalitis (AIE) and the presence of OCBs in CSF, with a particular emphasis on NMDA receptor antibodies. We studied a cohort of 21 patients across five tertiary centers, segregated into two distinct categories. One group comprised individuals who tested positive only for autoimmune encephalitis antibodies indicative of encephalitis, while the other group included patients whose CSF was positive for both autoimmune encephalitis antibodies and OCBs. Our investigation focused primarily on cognitive functions and behavioral alterations, supplemented by auxiliary diagnostic assessments such as CSF cell count, magnetic resonance imaging (MRI), and electroencephalogram (EEG) results, evaluated for the two patient groups. To validate our findings, we employed statistical analyses such as Fisher's exact test with Benjamini-Hochberg correction. Our study included 21 patients, comprising 14 who were presented with only autoimmune encephalitis antibodies, and 7 who were dual-positive. Among these patients, we focused on those with NMDA receptor antibodies. Of these, five were dual positive, and nine were positive only for NMDA receptor antibodies. The dual-positive NMDA group, with an average age of 27 ± 16.47 years, exhibited significantly higher CSF cell counts (p=0.0487) and more pronounced language and attention deficits (p= 0.0264). MRI and EEG results did not differ significantly between the groups. Our results point to OCBs as an additional marker of disease severity in AIE, especially in NMDA receptor-antibody positive patients, possibly indicating a broader inflammatory process, as reflected in elevated CSF lymphocytes. Regular testing for OCBs in cases of suspected AIE may aid in disease prognosis and identification of patients more prone to language and attention disorders, improving diagnosis and targeting treatment for these cognitive aspects.

Consequences of bullying on the life and health of the person being bullied

One of the most serious pathologies in the work environment is bullying. Victims of mobbing experience emotional, psychological and sometimes even physical violence, which causes consequences on an individual, organizational, social level. Due to the serious consequences of bullying, it becomes necessary to continuously monitor this phenomenon in the context of formulating possible ways to prevent and rehabilitate those who have experienced it. The purpose of the research undertaken was to learn about the consequences of bullying on the personal lives and health of victims of bullying. 13 respondents took part in the study. In selecting the sample, the assumption was made that those taking part in the study must have a court case held, during which the occurrence of mobbing in the employment relationship was found. A qualitative strategy using a narrative interview was used to obtain and analyze data. The presentation of the results of the study was divided into two areas: the consequences of bullying on personal life and the consequences of bullying on the victim's health. The most common symptoms of somatic disorders in the subjects related to the experience of bullying were headaches, dizziness, abdominal pain, nausea, pain in the heart area, sleep disturbances, and general weakness. In the area of mental disorders associated with experienced bullying, those surveyed most often mentioned: concentration and attention disorders, mood disorders, depression, addiction to psychoactive substances, and even suicidal thoughts. All the mental disorders mentioned are inextricably linked to exposure to chronic stress. It is the substrate of physiological, emotional and behavioral reactions, as well as intellectual reactions. All the listed consequences of bullying on the health of the victim, affect personal life. The experience of bullying affects a person's creative activity, which is passion. The consequence of bullying situations is the abandonment of activity, and the return to previous passions causes frustration, stress, and attacks of aggression in the subjects. Those affected by bullying transfer their problems to their private lives, so the effects of bullying also affect the immediate family. The prolongation of the bullying situation and the behavior of the victim of bullying often leads in the family sphere to: quarrels, frustration, deterioration of ties and relations, aggression and family breakdown. In order to design intervention and prevention measures, it is necessary to increase public awareness of the phenomenon of mobbing and its consequences for the individual, the organization and society.

A - 59 An Exploration of a Passive Decision Making Style within the Cognitive Disengagement Syndrome Population and its Contribution to Social Isolation

Abstract Objective Recent research has shown that Cognitive Disengagement Syndrome (CDS) may reduce decision-making independence. In this way, CDS may include a prognosis of social disengagement due to symptoms of the disorder such as apathy, low motivation, passivity, and low energy. This poster investigates the relationship between CDS symptoms and social disengagement and explores possible treatment focuses that could increase individuals’ connection to others and the world around them. Data Selection Information regarding this poster was obtained through a review of the literature including peer-reviewed articles from 2019–2024. Articles were gathered from the Journal of Clinical Child and Adolescent Psychology, Journal of Attention Disorders, Journal of Pediatric Psychology, Child Neuropsychology, and Research in Developmental Disabilities. Informal analyses were used to determine themes including keywords such as sluggish cognitive tempo, cognitive disengagement syndrome, decision-making, social isolation, and apathy. Data Synthesis CDS is associated with lower levels of assertiveness and higher levels of passivity than in the Attention Deficit Hyperactivity Disorder Inattentive Type (ADHD-IN) population. Current research suggests CDS is associated with social isolation influenced by difficulty initiating conversations and being more likely to engage in anxious rumination during conversations. Treatment interventions for CDS should target shyness, task-unrelated thought patterns, behavioral inhibition, hyperreactivity to social stressors, socially isolating behavioral addictions, verbal inhibition, and difficulty with divided attention. Conclusions Based on conclusions drawn in this poster, future studies should examine the impact of loneliness on social initiation frequency within the CDS population. The development of a questionnaire that aims to differentiate ADHD-IN from CDS may also be useful.

Transtorno de Déficit de Atenção/Hiperatividade

Although the terms “learning difficulty” and “learning disorder” are not the subject of recent investigations, there are still some misunderstandings regarding these terms, including among professionals in the field of Education. In this sense, this study aimed to analyze the conceptions of Attention Deficit Hyperactivity Disorder (ADHD) of pedagogy students. To this end, a questionnaire was developed with questions that covered not only the scientific theme, but also the relationship with learning difficulties, notions of identification, the data collection instrument also allows the participant to mention how prepared they feel to work with a student with the disorder. 33 students participated in the study, being first- and fourth-year students, regularly enrolled in the Pedagogy course at a Public Higher Education Institution. The results demonstrate that students have difficulty in conceptualizing both what Attention Disorder (ADD) and what Hyperactivity is. The participants' responses were redundant, always bringing the aspect of difficulty in concentration and/or focus, nor a relational deficit in ADHD. as a Learning Disorder. Furthermore, 86% of these students did not yet feel prepared to work with this audience and had difficulty presenting possible strategies. Such data reinforce the importance not only of more studies in this area, but especially that the theme be included in Teacher Training, in order to alleviate such difficulties in conceptualization, as well as in planning actions with future students.

Analysis of the causes, psychological mechanisms, and coping strategies of short video addiction in China.

Short video addiction refers to the uncontrollable desire of users to watch short videos, leading to significant behavioral loss of control or attention disorders, which in turn result in difficulties in social interaction, learning, and work adaptation. With the "invasion" of short videos into people's daily lives and their spread among underage groups, the issue of short video addiction has attracted widespread social attention. Firstly, based on the causes of short video addiction, this study analyzes it from four levels: algorithm design, content services, platform control, and user experience. Secondly, combining relevant scientific theories, the psychological mechanisms of short video addiction are explained from four levels: cognition, emotion, motivation, and social factors. Finally, in terms of coping strategies, on the theoretical level, further research on the occurrence mechanism of short video addiction should be deepened, and attention should be paid to the influence of recommendation algorithms on short video addiction. On the practical level, the obligations and responsibilities of relevant stakeholders such as short video producers, platforms, and regulators in preventing short video addiction should be clarified, aiming to promote prevention and management of short video addiction.

Changing patterns of hospitalization for sedative misuse among youth aged 10–24 years in Quebec, Canada

PurposeTo assess trends in hospitalization for sedative misuse among youth. MethodsUsing a serial cross-sectional design, we computed hospitalization rates for sedative-related suicide attempts, sedative use disorders, and other sedative poisonings within individuals aged 5–24 years in Quebec, Canada. We computed sedative-related hospitalization rates in 2006–2011, 2012–2017, and 2018–2023, and examined differences according to age, sex, polysubstance use, mental health comorbidity, and social vulnerability using rate ratios (RR) and 95 % confidence intervals (CI) comparing the last time period relative to the first. ResultsSedative-related hospitalization rates more than doubled during the study. Suicide attempts using sedatives increased from 50.5 per 100,000 youth in 2006–2011, to 82.2 in 2012–2017 and 114.4 in 2018–2023 (RR 2.26, 95 % CI 1.63–3.15), while sedative use disorders increased from 13.1 to 21.8 and 60.5 per 100,000 in these same time periods (RR 4.62, 95 % CI 2.54–8.40). Rates increased for 10–24 year-olds and in both sexes, particularly among youth with polysubstance use, anxiety and attention disorders, and social vulnerability. DiscussionSedative misuse requiring hospitalization appears to be a growing issue among youth.

The Pathobiology of Behavioral Changes in Multiple System Atrophy: An Update.

While cognitive impairment, which was previously considered a red flag against the clinical diagnosis of multiple system atrophy (MSA), is a common symptom of this rare neurodegenerative disorder, behavioral disorders are reported in 30 to 70% of MSA patients. They include anxiety, apathy, impaired attention, compulsive and REM sleep behavior disorders (RBD), and these conditions, like depression, are early and pervasive features in MSA, which may contribute to disease progression. Despite changing concepts of behavioral changes in this synucleinopathy, the underlying pathophysiological and biochemical mechanisms are poorly understood. While specific neuropathological data are unavailable, neuroimaging studies related anxiety disorders to changes in the cortico-limbic system, apathy (and depression) to dysfunction of prefrontal-subcortical circuits, and compulsive behaviors to impairment of basal ganglia networks and involvement of orbito-frontal circuits. Anxiety has also been related to α-synuclein (αSyn) pathology in the amygdala, RBD to striatal monoaminergic deficit, and compulsive behavior in response to dopamine agonist therapy in MSA, while the basic mechanisms of the other behavioral disorders and their relations to other non-motor dysfunctions in MSA are unknown. In view of the scarcity of functional and biochemical findings in MSA with behavioral symptoms, further neuroimaging and biochemical studies are warranted in order to obtain better insight into their pathogenesis as a basis for the development of diagnostic biomarkers and future adequate treatment modalities of these debilitating comorbidities.

The engagement of temporal attention in left spatial neglect

Previous literature showed how left spatial neglect arises from an asymmetrical distribution of spatial attention. However, it was also suggested that left spatial neglect might be partially caused or at least worsened by non-spatial attention disorders of the right-lateralized stimulus-driven attentional fronto-parietal network. Here, we psychophysically tested the efficiency of temporal attentional engagement of foveal perception through meta-contrast (Experiment 1) and “attentional” masking (Experiment 2) tasks in patients with right-hemisphere stroke with left neglect (N+), without left neglect (N-) and matched healthy controls (C). In both experiments, N+ patients showed higher thresholds, not only than Cs, but also than N- patients. Temporal engagement was clinically impaired in all N+ patients and highly correlated with their typical inability to direct spatial attention towards stimuli on the left side. Our findings suggest that a temporal impairment of attentional engagement is a relevant deficit of left spatial neglect.

Exemple d’une équipe territoriale de niveau 3 (« recours ») dans le TDAH : l’Équipe de Coordination Lyonnaise des troubles de l’Attention et de l’Hyperactivité (ECLAH)

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) affects 6% of children and 3% of adults, representing approximately 481,600 youths and 240,800 adults in the Auvergne-Rhône-Alpes region. Despite its prevalence, the French national strategy for neurodevelopmental disorders (2023–2027) highlights the lack of dedicated healthcare pathways for ADHD and the challenges in accessing diagnosis, treatment, and psychosocial rehabilitation. In Auvergne-Rhône-Alpes, the discordance between the significant public health issue posed by ADHD and the local healthcare resources has often led to misdirection and congestion of specialized hospital teams. This situation persists despite the well-documented medical and societal complications of untreated ADHD. At the Vinatier Hospital in Lyon, several specialized teams offer expertise in ADHD for children and adults, but there was no specific team dedicated to ADHD until recently. The Lyon ADHD Coordination Team (ECLAH)Formed in November 2023 at the initiative of professionals from the Vinatier Hospital, ECLAH is a multidisciplinary team comprising psychologists, neuropsychologists, psychiatrists, child psychiatrists, addiction specialists, pharmacists, project managers, and clinical research associates. ECLAH aims to meet the national strategy's requirements for ADHD in the Auvergne-Rhône-Alpes region by coordinating care networks, providing information, training, care, and conducting research in the field of ADHD. ECLAH functions as a resource team, complementing existing structures without replacing them, and focuses on specialization and expertise in ADHD to enhance ongoing efforts. Training MissionThe team contributes to the “Inter-University Diploma in ADHD across all ages” (DIU). The training “ADHD: From Screening to Support” equips healthcare professionals with the knowledge and tools necessary for ADHD diagnosis and treatment. The “DIVA Adult 5.0: Diagnostic Goal!” training focuses on diagnostic reasoning and interviewing techniques for ADHD evaluation. These programs adhere to current scientific data and ADHD guidelines from recognized scientific societies, with a Qualiopi® certification pending for continuous medical education validation. Following training, professionals receive implementation support through multidisciplinary guidance meetings. Coordination and Information MissionECLAH is organizing a care network for ADHD in Auvergne-Rhône-Alpes, collaborating with general practitioners, health and educational institutions, medico-social establishments, penitentiary care, expert centers, and patient associations. The team provides information and guidance to institutions and professionals seeking ADHD-related resources either directly or through its developing website. The team maintains adherence to scientific data and best practice recommendations (RBPP) in the region, fostering expertise through awareness, training, tele-expertise, and multidisciplinary concertation meetings. ECLAH also coordinates with national ADHD organizations, contributing to the harmonization of practices and the development of ADHD guidelines. Care MissionECLAH offers third-line or “recourse” consultations for children and adults with complex cases requiring diagnostic or therapeutic support. These consultations, often involving differential diagnoses and comorbidity assessments, are conducted in partnership with specialized units such as the Center for the Evaluation of Language, Learning, and Attention Disorders (CETESLA) for child psychiatry and the University Addiction Service of Lyon (SUAL) for adults. ECLAH also provides psychoeducation and therapeutic education groups for individuals with complex ADHD or contraindications to medication. A support group for caregivers is planned, leveraging the “BREF” psychoeducation program. Research MissionECLAH engages in medical research, focusing on ADHD characteristics in women by hormonal status, the cessation of methylphenidate treatment in adolescents, links between asthma and ADHD, and screening for ADHD in high-level young athletes. ConclusionECLAH is a third-level territorial team supporting professionals and their ADHD patients in Auvergne-Rhône-Alpes. By coordinating the regional care network, ECLAH enhances the existing care structures, ensuring access to reliable ADHD information and treatment pathways. The team plans to introduce a psychoeducation group for families and prioritize ADHD detection in penitentiary settings for both adults and youths.

The accuracy of bedside attention tests for delirium detection in older outpatients with cognitive impairment

BackgroundTo determine the test accuracy of four observations, three explorations and four short tests commonly used in psychiatric examinations to detect attention disorders related to delirium in older outpatients. MethodWe performed a test accuracy study among 86 older patients referred for cognitive screening to an outpatient clinic of a psychiatric institution. Eleven index tests were applied without knowledge of the reference standard. A geriatrician or psychiatrist blinded to the results of the index tests determined the reference diagnosis with DSM-IV-TR criteria. Observations were lack of adequate/ regular eye-contact, dozing off during conversation, dozing off when not stimulated, and losing the point of story. Explored was lack of concentration during activities, difficulty following conversation, and being easily distracted. Serial 7s, WORLD spelled backward, months of the year backward (MOTYB) and counting back from 20 to 0 were applied. Test accuracy was calculated for the single tests and combinations. ResultsDozing off during conversation scored high specificity (97.9 %) as did dozing off when not stimulated (97.9 %), but both had low sensitivity (< 27.9 %). Test accuracy of the exploration questions was low. Serial 7s and WORLD spelled backwards had high sensitivity (92.7 %, respectively 80.5 %) but low specificity (< 51.1 % %). The best combination was MOTYB with WORLD spelled backward (sensitivity of 63.4 %, specificity of 77.8 %). ConclusionsNo single observation, exploration or short test of attention was found to have both high sensitivity and specificity. Probably, attention deficits in delirium are best detected with a combination of observations and short tests as part of a comprehensive psychiatric examination.

Predictors of clinical insight in first-episode psychosis: Different patterns in men and women

BackgroundWe aimed to explore gender-related differences in the associations of insight impairment with clinical symptoms, metacognition, and social cognition in psychosis. MethodsRegression analysis of several clinical insight dimensions was conducted on the data from 116 men and 56 women with first-episode psychosis. Various clinical symptoms and measures of metacognition and social cognition were entered as predictors. ResultsIn both men and women, delusions emerged as a strong predictor of all insight dimensions, and verbal hallucinations as a strong predictor of symptom relabelling. In men, certain negative symptoms as well as self-certainty, lack of self-reflectiveness, impaired theory of mind, attributional biases, and a jumping-to-conclusions bias were additional predictors of poor insight, while good insight was associated with depression, anxiety, avolition, blunted affect, and impaired emotional recognition. In women, poor insight was associated with a self-serving/externalising bias, impaired emotional recognition, and attention disorders. ConclusionsPoor insight in first-episode psychosis is strongly linked to deficits in metacognition and social cognition, with marked differences between men and women with respect to the specific skills involved in the impairment. Meanwhile, good insight is linked to a variety of affective manifestations in men. These findings suggest new avenues for more targeted cognitive interventions to improve clinical insight in psychosis.

Multidisciplinary assessment and interventions for childhood auditory processing disorder (APD) and listening difficulties (LiD).

Auditory processing disorder (APD) has been studied in both research and clinic settings, but the relation between the two has not been addressed. In a longitudinal research study (SICLiD), we found that children with clinically normal audiometry who had caregiver-reported listening difficulties (LiD), with or without clinically assessed APD, performed poorly on both listening and cognitive tests. Specific questions asked here were, for the children with LiD, what other neurodevelopmental clinical conditions were identified, what interventions were used by different clinical providers, and how clinical practice was predicted by research results. Study setting was a large, research-led, tertiary pediatric hospital. Electronic medical records of 74 children aged 6-13 years, recruited into SICLiD and assigned to an LiD group based on a validated and reliable caregiver report (ECLiPS), were independently reviewed. Focus was on clinical assessments and interventions following appointments provided in the Hospital Divisions of Audiology, Occupational Therapy, Psychology (Developmental and Behavioral Pediatrics), and Speech-Language Pathology (SLP), prior to participation in SICLiD. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on SICLiD assessments of listening and cognitive function. SICLiD z-scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses. Most (86%) of the children with LiD had been evaluated by at least one clinical service. Overall, 24 assessment categories related to LiD, including APD, were identified. Most common conditions were attention (32%), language (28%), hearing (18%), anxiety (16%), and autism spectrum (6%) disorders. Performance on SICLiD measures varied significantly between providers, conditions, and interventions. Significant relationships between SICLiD and clinical conditions were mostly caregiver-reported items from the ECLiPS or the Children's Communication Checklist (CCC-2). Other significant correlations were scarce, but included the SCAN composite score, which predicted clinical language and attention, but not other auditory abilities or APD. SICLiD data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. The variety of disciplines, assessments, conditions and interventions revealed here supports previous studies showing that LiD and APD are multifaceted problems of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a diagnostic path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.