Behavioral Complaints Research Articles

The unmet mental health needs of adolescents with HIV in eastern Tanzania: Experiences of healthcare providers, adolescents, and caregivers.

Adolescents with Human Immunodeficiency Virus (HIV) are at greater risk for mental health problems than their HIV-negative counterparts. However, there is a dearth of evidence on the need for mental health services, including interventions for depression in adolescents with HIV (AWHIV), in most low- and middle-income countries (LMICs). This study's objective was to explore the unmet mental health needs of AWHIV to inform the development and implementation of a psychological intervention for depression in AWHIV in Dar es Salaam, Tanzania. A descriptive phenomenological qualitative study design was used. Consultative meetings with providers and 45 in-depth interviews were conducted with AWHIV, caregivers, and healthcare providers (HCPs) to explore their experiences and unmet mental health needs for AWHIV. Data from the consultative meetings were triangulated to validate the obtained information with those from interviews. Data were organized and managed with the aid of NVIvo-11. The thematic analysis framework guided data analysis. Five major themes emerged: Experience of complex symptoms, unmet need for services, impact of the unmet needs, ways utilized in managing symptoms, and preferred intervention. Complex depressive symptoms expressed as physical, behavioral, or somatic complaints adversely affected ART adherence and academic performance, led to substance use, and compromised overall quality of life in AWHIV. HIV-Care and Treatment Centers (HIV-CTCs) did not conduct formal mental health screenings. Instead, caregivers and HCPs addressed the symptoms of mental health problems with death threats and corporal punishments. No evidence-based depression interventions existed in HIV-CTCs for observed symptoms. This study reports on unmet mental health needs with a clear impact on the lives of AWHIV, which may have significant implications for treatment adherence. There is an urgent need to develop and implement effective and scalable interventions to address these mental health needs.

Clinical Profile and Echocardiographic Evaluation of COPD Patients Admitted in a Tertiary Care Hospital

Introduction: Chronic obstructive pulmonary disease (COPD) ranks as the fourth leading cause of global mortality, with anticipated increases in prevalence and mortality in the future. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) highlights the importance of considering COPD diagnosis in patients with relevant symptoms or risk factors, confirmed through spirometry. While COPD is preventable and treatable, it often presents with significant extra-pulmonary effects, particularly cardiac manifestations. Echocardiography offers a rapid, noninvasive method to assess these cardiac complications. Objective: This study aimed to investigate the clinical profiles and echocardiographic changes in COPD patients and their correlation with disease severity. Method: Conducted as an observational cross-sectional study, the research took place in the indoor departments of Medicine and Respiratory Medicine at Sir Salimullah Medical College & Mitford Hospital, Dhaka, between May 25th, 2017, and November 24th, 2017; enrolling 105 diagnosed COPD patients aged e”18 years. Data collection involved a structured questionnaire covering socio-demographic details, risk behavior, and respiratory complaints. Physical examinations, spirometry, and echocardiography were conducted for diagnosis, severity grading, and cardiac evaluation, respectively. Statistical analysis employed SPSS software (version-22), presenting results through frequency, percentage, tables, graphs, and figures. Result: The study population was predominantly male (88.6%) with a mean age of 64.1 years. Most patients (94.2%) were smokers with a mean pack-year history of 22.03. All patients presented with cough and shortness of breath, and 88.5% had wheezing. Spirometry revealed moderate COPD in 40% of patients, with a distribution across all severity grades. Echocardiography showed abnormalities in 52.4% of patients, with tricuspid regurgitation, pulmonary hypertension, and right ventricular dilatation being the most frequent findings. A significant correlation was observed between C OPD severity and the presence of these echocardiographic abnormalities. Conclusion: Clinical examination unveiled common respiratory findings, while echocardiography demonstrated diverse cardiac manifestations in COPD patients. A significant proportion of patients exhibited normal findings on X-ray and echocardiography. The study highlights the prevalence of moderate COPD severity and the association between very severe COPD and specific cardiac complications, emphasizing the importance of comprehensive assessment and management strategies for COPD patients. J MEDICINE 2024; 25: 115-120

Direct Current Stimulation of Prefrontal Cortex Is Not Effective in Progressive Supranuclear Palsy: A Randomized Trial.

Progressive supranuclear palsy (PSP) is a rare 4R-tauopathy. Transcranial direct current stimulation (tDCS) may improve specific symptoms. This randomized, double-blinded, sham-controlled trial aimed at verifying the short-, mid-, and long-term effect of multiple sessions of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) cortex in PSP. Twenty-five patients were randomly assigned to active or sham stimulation (2 mA for 20 minute) for 5 days/week for 2 weeks. Participants underwent assessments at baseline, after the 2-week stimulation protocol, then after 45 days and 3 months from baseline. Primary outcomes were verbal and semantic fluency. The efficacy was verified with analysis of covariance. We failed to detect a significant effect of active stimulation on primary outcomes. Stimulation was associated to worsening of specific behavioral complaints. A 2-week protocol of anodal left DLPFC tDCS is not effective in PSP. Specific challenges in running symptomatic clinical trials with classic design are highlighted. © 2024 International Parkinson and Movement Disorder Society.

Measuring Anxiety Symptoms – Psychometric Properties of the Dutch Version of the Lehrer–Woolfolk Anxiety Scale Questionnaire

Abstract: Introduction: The Lehrer–Woolfolk Anxiety Symptom Questionnaire (LWASQ) is a self-report questionnaire based on the tripartite model of Lang (1971) for measuring treatment progress. However, so far little is known about its psychometric qualities. Two studies were conducted to get more clarity on the factor structure and reliability of the LWASQ. Method: Factor structure and internal consistency of the LWASQ were assessed using a sample of 2,117 patients with anxiety disorders. Test–retest reliability was measured with a three-week interval, using a sample of 49 people in a general population. We aimed to measure construct validity with a third sample of patients with anxiety disorders, but were not able to due to a small sample size. Results: Factor analysis confirmed the three known factors of the LWASQ, i.e., somatic complaints, cognitive problems, and behavioral complaints. Both internal consistency for all three subscales ( r = .852–.927) and test–retest reliability were found to be good ( r = .88). Conclusion: Psychometric properties of the LWASQ are promising, but further validation is needed to draw more definitive conclusions regarding its usefulness in a clinical population.

Central auditory processing and self-perception questionnaire after acoustically controlled auditory training in individuals with mild traumatic brain injury.

To correlate behavioral assessment results of central auditory processing and the self-perception questionnaire after acoustically controlled auditory training. The study assessed 10 individuals with a mean age of 44.5 years who had suffered mild traumatic brain injury. They underwent behavioral assessment of central auditory processing and answered the Formal Auditory Training self-perception questionnaire after the therapeutic intervention - whose questions address auditory perception, understanding orders, request to repeat statements, occurrence of misunderstandings, attention span, auditory performance in noisy environments, telephone communication, and self-esteem. Patients were asked to indicate the frequency with which the listed behaviors occurred. Figure-ground, sequential memory for sounds, and temporal processing correlated with improvement in following instructions, fewer requests to repeat statements, increased attention span, improved communication, and understanding on the phone and when watching TV. Auditory closure, figure-ground, and temporal processing had improved in the assessment after the acoustically controlled auditory training, and there were fewer auditory behavior complaints.

Sleep, Behavioral, and Cognitive Complaints in Children with Neurofibromatosis Type 1: A Public Health Challenge

Abstract Background: Neurofibromatosis type I (NF1) is a genetic and neurodevelopmental condition impacting the peripheral nervous system. Predominant clinical features include "café au lait" spots, neurofibromas, and cognitive challenges. While some clinical reports suggest a link between NF1 and alterations in sleep, there is a lack of studies exploring this connection specifically in children. This becomes crucial, given that sleep significantly influences a child's neurobehavioral, neurocognitive, and psychosocial development. Objective: To describe sleep, cognitive, and behavioral complaints in Brazilian children diagnosed with Neurofibromatosis type 1. Methods: Parents of children within the age range from 1 to 12 years old answered an online questionnaire composed of 24 questions related to sleep habits, sleep patterns, and cognitive and behavioral complaints. Results: Data was collected from 41 children, who were categorized between preschoolers (32%) and school-aged (68%). 63% of the entire sample reported sleep complaints. 66% of the children slept less than 10 hours a day, 26% of them being preschoolers and 74% school-aged. 85% of the children used electronics devices at night, and more than half (54%) of the sample had more than 2 hours of daily screen time. 66% of the children had a late bedtime. Easy crying (31%) was the most reported behavioral complaint in preschoolers, and anxiety (32%) was more prevalent in school-aged children. Alterations in attention and focus (44%) was the most frequent cognitive issue in the entire sample. Conclusion: This is the first study carried out in Brazil that assesses sleep, behavioral and cognitive complaints, and sleep patterns in children with NF1. It was reported that children with NF1 have significant sleep complaints and insufficient sleep duration. Additionally, behavioral, and cognitive complaints were widely reported. We reinforce the relevance of sleep assessment during routine clinical examination of patients with NF1. Keywords: Neurofibromatosis 1, Child, Sleep, Cognition, Behavior.

Increasing Chlamydia and Gonorrhea Testing for Adolescents in the Pediatric Emergency Department.

Adolescents who use the emergency department are more likely to engage in high-risk sexual activity and are at an increased risk of sexually transmitted infections. We aimed to increase testing for Chlamydia and gonorrhea from 12% to 50% among adolescents presenting to our pediatric emergency department with at-risk chief complaints over 12 months. Plan-Do-Study-Act cycles were initiated in July 2020. A multidisciplinary team reviewed preexisting data and developed interventions to increase Chlamydia and gonorrhea testing in teens with at-risk complaints, including genitourinary and behavioral health complaints, and females with abdominal pain. Two categories of interventions were implemented: education and electronic medical record optimization. Process measures were the proportion of patients with a documented sexual history and the proportion of patients tested with a documented confidential phone number. Secondary outcome measures included the weekly number of positive test results and the proportion of patients testing positive who were contacted to arrange treatment. Statistical process control charts were used to examine changes in measures over time. Within 14 months of project initiation, the proportion of at-risk patients tested increased from 12% to 59%. Teen phone number documentation remained unchanged from 23%. Sexual history documentation remained unchanged from 46%. The number of positive test results increased from 1.8 to 3.4 per month, and the proportion of patients testing positive who were contacted to arrange treatment remained unchanged at 83%. We surpassed our goal and increased the proportion of at-risk patients tested for Chlamydia and gonorrhea to 59%, sustained for 4 months from the last intervention.

Cross-lagged Relations of Children’s Somatoform Complaints: Embedment within Learning Theory and Secondary Gain Concept

The current state of research on the emergence and maintenance of somatoform symptoms in childhood identifies the influence of both child and parental factors. The aim of the present study is to examine reciprocal relations and stability between somatoform complaints, children’s adaptive emotion regulation (ER) strategies, withdrawal behavior, and overprotective parenting. In total, 97 children (female n = 46, (47%); M age T1 = 9.7 years (SD) = 0.54) and their parents completed questionnaires at two time points. A cross-lagged panel design was used to analyze reciprocal associations and stability effects between the included variables over one year (Kearney, 2017; Selig & Little, 2012). Results show significant autoregressive effects of both the individual child and parental variables. Parental overprotection predicted child emotion regulation, withdrawal behavior, and somatoform complaints over time; with no reciprocal effects. Similarly, only unilateral effects were shown between adaptive ER strategies, and withdrawal behaviors, and somatoform symptoms. The results are discussed in the framework of learning theory and secondary gain.

Psychiatric presentation in undiagnosed intracranial space-occupying lesions: A case series

Intracranial space-occupying lesions (SOLs) account for about 5–10 deaths per 100,000 in India. They present with physical symptoms such as headache, nausea, vomiting, and weakness; neurological symptoms such as seizures, and focal neurological deficit; and behavioral changes manifesting as depression (15–20%), anxiety (30–50%), psychosis (<5%), and personality changes (16–76%). Therefore, it is necessary to do an appropriate general, neurological, and behavioral examination for proper diagnosis and management. A series of four cases who reported to psychiatric outpatient with behavioural complaints and no focal neurological deficits were reported. The most common presentation of SOLs is seizure, headache, vomiting, and loss of consciousness. Along with this complaint, some patients may present with abnormal behavior. However, it is very rare for a SOL to present solely with psychiatric or behavioral complaints. Therefore, it becomes imperative to keep a close watch on the symptoms and send for timely investigations.

“Your son needs help … and we're gonna help him”: A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department

Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.

Alternative care sites and resident exposure in pediatric emergency medicine: Who, what, and where.

Emergency medicine (EM) physicians and pediatricians who provide acute pediatric care depend on clinical exposure during residency to learn pediatric EM. Increasing volumes of pediatric patients, especially with behavioral health complaints, have stressed pediatric emergency departments (ED) and prompted clinical operations innovations including alternative care sites outside the main ED. We investigated the impact of these recent trends and resulting alternative care sites on the exposure of residents to core pediatric conditions. This retrospective study reviewed patient encounters between July 1, 2018, and December 31, 2022, at a pediatric ED that hosts one pediatric and three EM residencies. During the study, the hospital employed alternative care sites in response to increased and shifting patient populations. Median patients per resident per academic year were compared before and after the opening of alternative care sites, overall and stratified by patient factors (age, sex, Emergency Severity Index [ESI], and diagnostic category). The study also compared the percentage of residents who saw no patients with a given diagnosis between the two periods. Of 231,101 patient encounters, 199,947 were seen in the main ED and 31,154 in alternative care sites. The median number of patients seen by a single resident in a single academic year ranged from 82 to 136 for pediatric residents and from 128 to 183 for EM residents. The median number of patients per resident per year did not decrease for any age group, sex, ESI level, or diagnosis across the two periods. Residents saw a median of 19 more patients with psychiatric diagnoses (95% CI 15.4-22.7) in the more recent period. Seven diagnoses were not seen by at least 20% of residents during both periods. Current pediatric ED capacity challenges can be addressed with alternative care sites without decreasing volume or variety of patients seen by residents.

Neurological and cognitive impairment in COVID‐19: clinical characterization andepidemiological

AbstractBackgroundCOVID‐19 neurological manifestations were demonstrated during the pandemic, including cognitive impairment. Objectives: To determine the prevalence of cognitive and behavioral complaints (such as dementia, MCI or SCD) in a outpatient sample with recent SARS‐COV2 infection. Specific: Evaluate the association of cognitive impairment with the presence of the polymorphism found in the APOE gene and with respiratory diseaseMethodObservational, longitudinal, prospective clinical study. Inclusion criteria: patients with confirmed Covid‐19. Patients are evaluated in an outpatient clinic. They are evaluated through a standardized attendance record, with somatic and cognitive neurological assessment. Cognitive assessment involves the application of cognitive (ACER, MMSE and CDR), functional (Pfeffer) and psychiatric (GDS or Beck) screening instruments, in addition to subsequent extensive neuropsychological assessment. In addition, APOE polymorphism is analysed.ResultsTo date, 200 patients were evaluated. The average age is 46.5 years, with 65.4% female, 79.16% with 8 or more years of schooling, in addition to 57.5% of the sample with cognitive complaints.ConclusionsThe results so far in our study demonstrate that cognitive complaints are frequent in patients even in the chronic phase of the disease.

Mental Health and Physical Complaints of German Children and Adolescents before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Study.

The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (β = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.

Theta power and functional connectivity as neurophysiological markers of executive functions in individuals with cognitive complaints in daily life

Impairments in executive functions (EFs) are common across psychological disorders. Research into the neural oscillations underlying EFs has the potential to help understand these impairments and contribute to the development of interventions. The aim of this study is to assess theta power and functional theta connectivity in the sensor space of the regions of the superordinate network for the core EFs: conflict monitoring, response inhibition, set-shifting, and working memory updating. We recruited adults with self-reported everyday EFs complaints and formed two groups: one with attention deficit hyperactivity disorder (ADHD) (n=27) and another without any diagnosis (n=22), and compared them to controls (n=21) on the Stroop, Stop-signal, Switching, and N-back task using EEG. Power and functional connectivity analyses were conducted for four regions of interest: frontal-midline, frontolateral left and right, and parietal region. For all four EFs, the groups showed a dynamical increase in theta power over time in the four regions of interest, as well as in functional theta connectivity between these regions. Group differences were found especially for conflict monitoring, with differences in theta power in the frontal-midline and frontolateral right region. These neural markers are also associated with behavioural performance and complaints in daily life. For set-shifting, group differences were less pronounced and for response inhibition and working memory updating no group differences were observed.

Prehospital Use of Ketamine versus Benzodiazepines for Sedation among Pediatric Patients with Behavioral Emergencies

Introduction Ketamine is an emerging alternative sedation agent for prehospital management of agitation, yet research is limited regarding its use for children. Our objective was to compare the effectiveness and safety of ketamine and benzodiazepines when used for emergent prehospital sedation of pediatric patients with behavioral emergencies. Methods We performed a retrospective review of 9-1-1 EMS records from the 2019-2020 ESO Data Collaborative research datasets. We included patients ≤18 years of age who received ketamine or benzodiazepines for EMS primary and secondary impressions indicating behavioral conditions. We excluded patients with first Glasgow Coma Scale (GCS) scores ≤8, those receiving ketamine or benzodiazepines prior to EMS arrival, those receiving both ketamine and benzodiazepines, and interfacility transfers. Effectiveness outcomes included general clinician assessment of improvement, decrease in GCS, and administration of a subsequent sedative. Safety outcomes included mortality; advanced airway placement; ventilatory assistance without advanced airway placement; or marked sedation (GCS ≤8). Chi-square and t-tests were used to compare the ketamine and benzodiazepines groups. Results Of 57,970 pediatric patients with behavioral complaints and GCS scores >8, 1,539 received ketamine (13.3%, n = 205) or a benzodiazepine (86.7%, n = 1,334). Most patients were ≥12 years old (89.2%, n = 1,372), predominantly Caucasian (48.3%, n = 744), and were equally distributed by sex (49.7% male, n = 765). First treatment with ketamine was associated with a greater likelihood of improvement (88.8% vs 70.5%, p < 0.001) and a greater average GCS reduction compared to treatment with benzodiazepines (-2.5 [SD:4.0] vs −0.3 [SD:1.7], p < 0.001). Fewer patients who received ketamine received subsequent medication compared to those who received benzodiazepines (12.2% vs 27.0%, p < 0.001). Marked sedation was more frequent with ketamine than benzodiazepines (28.8% vs 2.9%, p < 0.001). Provision of ventilatory support (1.5% vs 0.5%, p = 0.14) and advanced airway placement (1.0% vs 0.2%, p = 0.09) were similar between ketamine and benzodiazepine groups. No prehospital deaths were reported. Conclusion In this pediatric cohort, prehospital sedation with ketamine was associated with greater patient improvement, less subsequent sedative administration, and greater sedation compared to benzodiazepines. Though we identified low rates of adverse events in both groups, ketamine was associated with more instances of marked sedation, which bears further study.

Dementia : current guidelines for clinical management

Dementia is an umbrella term used to describe a group of symptoms associated with a decline in cognitive abilities that are severe enough to interfere with daily functioning and independence. While Alzheimer's disease (AD) is the most frequent cause, dementia in old aged persons represents rather a syndrome caused by various underlying conditions and diseases. Successful treatment allows for the individual clinical picture, and should be aimed at helping the patient regarding his cognitive deficits, behavioral and psychiatric complaints, sleep disorders, as well as management of daily life. Recently published promising study results on the use of monoclonal antibody therapies in AD give reason to believe that treatments will be available soon that can modulate disease progression at the neurobiological level.

Cat-human bond: Satisfaction and behavioural complaints among Italian respondents

The present is a study of the data collected through an online survey which investigated satisfaction of Italian cat-caretakers with their pet, considering health and behavioural complaints. The survey was advertised using social media and a virtual snowball sampling method was applied. The questionnaire collected information about caretaker’s demographics, their cat’s origin, health problems and behavioural complaints, and their satisfaction with the cat. 6096 respondents completed the questionnaire. Logistic regression was applied and some cats’ and caretakers’ demographics predicted both the presence of behavioural problems and the assignment of maximum score in satisfaction. House soiling was the most frequently reported behavioural complaint (4.7%) and it was predicted by both management factors (i.e., number of cats in the household, p < 0.05), and cat-related ones (e.g., cat’s age, anxiety level, and health problems, all p < 0.001). House soiling, aggression (both intra and inter-species), fear, hyperactivity and eating disorders decreased caretakers’ satisfaction (all p < 0.001), whereas the presence of what respondents identified as health problems did not. Moreover, some cat features as “being affectionate” increased the caretaker’s satisfaction (p < 0.001). The results of this study highlighted the impact of behavioural complaints on the cat caretaker’s satisfaction with their pet, supporting the need of prevention and/or treatment of behavioural problems or inappropriate behaviours to avoid unsatisfactory relationship between cats and their caretaker and to improve cat welfare.

CBT WITH YOUTH: THE ESSENTIAL CHANGEMAKERS FOR THE NEXT NORMAL

Waves and surges continue to characterize the COVID-19 pandemic, fueling heightened uncertainty, anxiety, frustration, depression, and other behavioral health complaints. Mounting numbers of distressed young patients and their families are seeking mental health care. Therefore, child and adolescent psychiatrists need to be equipped to deliver as well as train others to implement effective CBT procedures. These goals are the precise foci of this practitioner-friendly Workshop.

Sleep in Paralympic athletes and its relationship with injuries and illnesses

ObjectivesTo evaluate sleep characteristics and investigate the relationship of sleep with injuries and illnesses in Paralympic athletes. DesignCross-sectional. SettingSports Training Center. Participants20 Paralympic athletes of athletics, swimming, and powerlifting. OutcomesInjury and illnesses were recorded during the sports season through the Oslo Sports Trauma Research Center questionnaire (OSTRC-BR). Sleep-wake pattern was monitored for 2 weeks using actigraphy. Chronotype, sleep quality, sleep behavior, and sleep complaints were cross-sectionally collected. ResultsPoor sleep quality and poor sleep behavior were highly prevalent. The mean total sleep time was 6.57 ± 49.91. Duration of naps (r= −0.46; p=0.04) was associated with occurrence of health problems; frequency of insomnia (r= 0.51; p= 0.02), Pittsburgh Sleep Quality Index score (r= 0.45; p=0.04), and frequency of awakenings at night (r= 0.58; p= 0.01) were associated with severity of health problems; frequency of movements during sleep was associated with OSTRC-BR cumulative score (r= 0.58; p=0.00); and frequency of nightmares was associated with OSTRC mean score. ConclusionsParalympic athletes tend to report poor sleep quality, have poor sleep behavior and sleep less than the recommended. Insomnia symptoms, awakenings at night, movements during sleep and poor sleep quality were associated with the occurrence and/or severity of health problems.

When Attention-Deficit/Hyperactivity Disorder reaches adulthood

IntroductionAttention-Deficit/Hyperactivity Disorder (ADHD) was classically considered a childhood-onset neurodevelopmental condition. Over the past 40 years, it became evident that it can persist during adulthood.ObjectivesThe purpose of the authors is to describe the characteristics of ADHD in adults and the specific comorbidities, proposing an approach to these patients.MethodsA brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.ResultsOnly 40-50% of children and adolescents with ADHD will have symptoms that persist into adulthood (estimated adult prevalence of 2.8% across 20 countries; 25% in prisons). A more subtle presentation in adults and the difficulty to access past medical history, lead to diagnosis and treatment rates of lower than 20% (versus 50% in children). Well-characterized core symptoms in children evolve into a predominance of inattention symptoms. They became adults with marked disorganization, difficulties in completing tasks and managing time. Emotional dysregulation is a very prevalent symptom in this population. The comorbidities rate increase over time (reaching 75% of patients).ConclusionsAdults (or even older subjects) with cognitive and/or behavioural complaints should be submitted to systematic screening for ADHD. Non-treated ADHD symptoms in adulthood are associated with severe impairment, therefore adjustments in the health care system to support the transition from child to adult services are needed.DisclosureNo significant relationships.