Behavioral Disinhibition Research Articles

Adverse childhood experiences do not moderate the association between aggressive antisocial behavior and general disinhibition in a forensic psychiatric inpatient sample.

Adverse childhood experiences (ACE) and high levels of disinhibition have been associated with a variety of negative outcomes such as aggressive antisocial behavior (AAB). However, forensic psychiatric populations remain an understudied group in this field of research. This study aimed to fill that gap by investigating associations between ACE, AAB, and disinhibition in a forensic psychiatric sample. Furthermore, we aimed to explore such findings by investigating whether ACE might have a moderating effect on the association between disinhibition and AAB. A sample of forensic psychiatric patients (n = 89) was recruited from a high-security forensic psychiatric facility in Sweden. All study variables were moderately to strongly related to each other, although we found no moderating effect of ACE. Post hoc analysis indicated that our ACE items had differential effects on AAB scores, with placement outside the family home, absent parents, and parental drug abuse producing the largest effect on AAB levels. Our findings are in line with previous research demonstrating a significant and robust relationship between ACE, AAB, and disinhibition. Forensic psychiatric populations are exposed to high levels of both self-reported and documented ACE. This calls for trauma-informed care and highlights the importance of considering ACE in risk assessment, preventive work, and policy making.

A Predictive Biomarker Model Using Quantitative Electroencephalography in Adolescent Major Depressive Disorder.

Background: With evolving understanding of psychiatric diagnosis and treatment, demand for biomarkers for psychiatric disorders in children and adolescents has grown dramatically. This study utilized quantitative electroencephalography (qEEG) to develop a predictive model for adolescent major depressive disorder (MDD). We hypothesized that youth with MDD compared to healthy controls (HCs) could be differentiated using a singular logistic regression model that utilized qEEG data alone. Methods: qEEG data and psychometric measures were obtained in adolescents aged 14-17 years with MDD (n = 35) and age- and gender-matched HCs (n = 14). qEEG in four frequency bands (alpha, beta, theta, and delta) was collected and coherence, cross-correlation, and power data streams obtained. A two-stage analytical framework was then used to develop the final logistic regression model, which was then evaluated using a receiver-operating characteristic curve (ROC) analysis. Results: Within the initial analysis, six qEEG dyads (all coherence) had significant predictive values. Within the final biomarkers, just four predictors, including F3-C3 (R frontal) alpha coherence, P3-O1 (R parietal) theta coherence, CZ-PZ (central) beta coherence, and P8-O2 (L parietal occipital) theta power were used in the final model, which yielded an ROC area of 0.8226. Conclusions: We replicated our previous findings of qEEG differences between adolescents and HCs and successfully developed a single-value predictive model with a robust ROC area. Furthermore, the brain areas involved in behavioral disinhibition and resting state/default mode networks were again shown to be involved in the observed differences. Thus, qEEG appears to be a potential low-cost and effective intermediate biomarker for MDD in youth.

Social isolation & toxic behavior of students in e-learning: evidence during the time of the COVID-19 pandemic

ABSTRACT The global COVID-19 pandemic has led educational institutions to shut down and adopt e-learning practices through computer-mediated communication. An unanticipated switch of online classes from face-to-face classes isolates students from social groups and teachers, causing online disinhibition. Therefore, this paper investigates factors influencing university students’ toxic disinhibition behavior in online classrooms, WhatsApp groups, and Telegram groups. Also, social isolation has been used as a moderating variable to identify whether social isolation strengthens or weakens the proposed association. The research holds the basis of “Social Cognitive Theory” and “Theory of Planned Behavior.” The data from 506 university students have been collected for analysis. The proposed framework and research hypotheses have been assessed via PLS-SEM using Smart PLS software. Findings from the study show that toxic behavior victimization, attitude, subjective norms, and behavioral control are factors that positively & significantly affect toxic disinhibition online. Furthermore, motives and self-efficacy showed an insignificant influence on toxic disinhibition. Additionally, toxic disinhibition significantly & positively affects toxic behavior. At last, social isolation is likely to have a moderation effect on the variables. Hence, the research yields guidance on reducing toxic disinhibition online. Further, implications and recommendations are discussed at the end of the study.

Online Disinhibition and Online Trolling Among Chinese College Students: The Mediation of the Dark Triad and the Moderation of Gender.

The Dark Triad (Machiavellianism, psychopathy, narcissism) is associated with online disinhibition and antisocial online behaviors. However, the mediating role between online disinhibition and online trolling has never previously been investigated. We examined direct and indirect associations between online disinhibition and online trolling via the Dark Triad among 1,303 participants. The results showed that online disinhibition is positively correlated with online trolling, and their link is partly mediated by Machiavellianism and psychopathy. Furthermore, men exhibited higher levels of Dark Triad traits and were more likely to engage in online trolling than women. Moderated mediation analyses indicated that gender moderated the relationship between psychopathy and online trolling. The study provided a promising perspective for the intervention of online trolling, namely netizens should be taught to reduce impulsivity and improve empathy and self-control, especially for men.

“Neurotic people tend to eat less when disinhibited”: The mediating role of food-related cognitive flexibility in restrained eaters

ObjectivesThis study aims to reveal the individual differences in Neuroticism and cognitive flexibility among successful restrained eaters (SREs), unsuccessful restrained eaters (UREs), and non-restrained eaters (NREs). Moreover, this study is dedicated to investigating whether certain personality traits and cognitive flexibility could concurrently influence disinhibited eating behaviors among restrained eaters and reveal the pathways through which they interact. MethodsFemale participants aged 17 and 24 years (NREs = 23; SREs = 24; UREs = 23) were assessed with body mass index (BMI) and appetite state measurement, the Dutch Eating Behavior Questionnaire (DEBQ), the NEO Five-Factor Inventory (NEO-FFI), and the Positive and Negative Affect Schedule. To measure behavioral and neural responses related to cognitive flexibility, participants were required to complete a food-related switching task, and their brain activities were recorded through the technique of electroencephalography (EEG). Here we analyzed two widely investigated components—the N2 and P3 components that separately relate to conflict monitoring and response inhibition. ResultsThe behavioral performance of food-related task switching did not show significant between-group differences. However, in comparison to NREs and SREs, UREs elicited larger N2 and lower P3 amplitudes during task switching. In addition, UREs exhibited a lower level of Neuroticism than SREs and NREs. Furthermore, food-related task switching induced N2 amplitude fully mediated the association between Neuroticism and disinhibited eating behavior in restrained eaters controlled for BMI and negative affect. Importantly, when a parallel mediation model with N2 and P3 was built concurrently, N2 was still able to fully mediate the association. ConclusionAccording to behavioral and neural evidence, increased N2 amplitude induced by food-related task switching totally mediated the negative association between Neuroticism and disinhibited eating in restrained eaters.

Toward precision nutrition: A cross‐sectional study on the genetic risks of nutrients deficiencies and eating behaviors among the Orang Asli and Malays

AbstractThis cross‐sectional study aimed to profile 15 genetic markers associated with the risks of nutrient deficiencies and eating disinhibition behaviors that could lead to obesity among the Orang Asli (OA) and the Malays. The whole‐genome sequences of 98 OA and 96 Malay individuals were mined for these 15 genetic variants. The distributions of risk allele frequencies were then compared with other world populations to determine the impact of these genetic variations on the wellness of the two cohorts. The risk alleles include rs2025804 G, rs1800497 T, rs4680 G, rs602662 G, rs174547 C, and rs4654748 C, were commonly found among the OA and Malays and are likely to be pathogenic genetics variants for obesity. The risk allele frequencies differed significantly between the studied and the other five populations (p < .05). We believe that this is the first reported study on the genetic variants associated with nutrient deficiencies and eating disinhibition behaviors that are likely to increase risks of obesity among the OA and Malays.

Persistent Deficits in Self-Regulation as a Mediator between Childhood Attention-Deficit/Hyperactivity Disorder Symptoms and Substance Use Disorders

Background: The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. Objective(s): The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. Methods: The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)—behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)—and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). Results: The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. Conclusions: These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.

A-259 Interpersonal Dominance Predicts Treatment Resistance in Adolescents Without, But Not With, Attention-Deficit/Hyperactivity Disorder

Abstract Objective: Attention-deficit/hyperactivity disorder (ADHD) has been associated with interpersonal challenges in adolescents. Greater interpersonal dominance has been found to predict poorer therapeutic alliance in adolescents, but previous work has not examined a potential moderating impact of ADHD. The goal of the present study was to examine the relationship between dominance and treatment resistance as measured by the Personality Assessment Inventory-Adolescent (PAI-A) in a mixed clinical sample. Method: Data were collected from 144 adolescents referred for neuropsychological evaluation (M=15.27 years, Range=12-19, 41.0% female, 47.9% diagnosed with ADHD). ADHD diagnosis was determined through neuropsychological clinical evaluation of behavior, mood, and cognitive functioning across settings. Exploratory moderation analysis was conducted to examine if interpersonal dominance predicts treatment rejection and to see if the relationship is moderated by ADHD status. Results: Controlling for ADHD status, the main effect of dominance was significant, such that higher interpersonal dominance was associated with greater treatment rejection (t=2.38, p=.019). No main effect for the relationship between ADHD status and treatment rejection when controlling for dominance was observed. In participants without ADHD, dominance significantly predicted treatment rejection (t=2.38, p=.019), but the effect was no longer significant in adolescents with ADHD. Conclusion: Based on self-report of personality, interpersonal dominance is related to treatment rejection in adolescents without ADHD, but not adolescents with ADHD. Symptoms of ADHD such as impulsivity and behavioral disinhibition may impact responses related to interpersonal functioning and thus ratings for adolescents with ADHD may not reflect the same constructs important for treatment considerations.

A-274 A Case Study of Progressive Supranuclear Palsy in a 68-year-old with Pronounced Frontal-Executive Deficits Complicated by Cerebrovascular Disease

Abstract Objective: Individuals with Progressive Supranuclear Palsy (PSP) often experience cognitive decline, repeated falls, restricted gaze, bradykinesia, and depression/behavioral changes. Despite having certain distinguishing features neuroanatomically and neurologically, PSP continues to be difficult to classify and distinguish from some other more well-known neurodegenerative and movement-related disorders. Method: A 68-year-old white male presented for a neuropsychological evaluation (2022) initially after his neurologist became suspicious of him having cerebellar degeneration or multisystem atrophy. He reported a progressive one-year decline in memory, motor abilities, and executive functions, along with having personality changes and a loss of independence in his activities of daily living (ADLs). To complicate the differential diagnosis, an MRI of his brain from six months prior simply concluded “age-related changes”. Upon revisiting this MRI and closer visual inspection, focal atrophy of the midbrain became apparent on a sagittal section, in addition to bilateral ischemic changes in the white matter. He was later diagnosed with PSP. Results: Despite demonstrating adequate performance on simple cognitive screening measures, he displayed marked behavioral disinhibition, executive/attention problems, visuospatial concerns, decreased motor abilities, and variable memory functioning that were found to impact his ability to carry out instrumental and even some basic ADLs. Conclusions: Cases such as this one requiring diagnostic clarification lend support to the “hummingbird sign” (midbrain atrophy) being a useful imaging marker in distinguishing PSP from other clinical disorders. Additionally, in contrast to other neurodegenerative disorders, frontal-executive deficits (e.g., disinhibition) were a particularly pronounced feature in his PSP neurocognitive profile, followed by milder difficulties in memory, language, and visuospatial functions.

Low-grade inflammation as mediator between diet and behavioral disinhibition: A UK Biobank study

BackgroundDietary patterns have been associated with variations in behavior. However, evidence has been limited and mixed, and the underlying mechanism remains unclear. ObjectiveExtend a previous study reporting significant associations between food patterns and behavioral disinhibition and explore whether low-grade inflammation is linked to behaviors and mediates the association between diet and behavioral disinhibition. DesignAmong participants of the UK Biobank (UKB) we extracted a single behavioral disinhibition principal component using the UKB touchscreen questionnaire, Mental Health Questionnaire (MHQ), and registered diagnoses. We identified four dietary patterns (prudent diet, elimination of wheat/dairy/eggs, meat-based diet, full-cream dairy consumption) by using the Food Frequency Questionnaire (FFQ). Immune biomarkers and an aggregated inflammation score (INFLA-score) were used to characterize low-grade inflammation. Associations between dietary patterns and immune biomarkers, between immune biomarkers and disinhibition were assessed, with adjustment for demographics, lifestyle factors, and somatic health conditions. Next, mediation analyses were run to examine whether the association between dietary patterns and disinhibition was partially explained by inflammatory levels. We also conducted subgroup analyses to explore whether associations and the mediation effect differed by sex, age, ethnicity/race, body-mass-index (BMI), and socioeconomic status (SES). ResultsThe prudent diet was negatively, and the meat-based diet was positively associated with several pro-inflammatory biomarkers. Most immune biomarkers were positively associated with disinhibition (numbers of lymphocytes (βstandardized = 0.082, p < 0.001), monocytes (βstandardized = 0.043, p < 0.001), neutrophils (βstandardized = 0.071, p < 0.001), platelets (βstandardized = 0.022, p < 0.001), leukocytes (βstandardized = 0.093, p < 0.001), C-reactive protein (βstandardized = 0.051, p < 0.001), and for INFLA-score (βstandardized = 0.074, p < 0.001). In the mediation model, the INFLA-score mediated the association between prudent diet and meat-based diet and disinhibition score, with a significant indirect effect of low-grade inflammation for the prudent diet-disinhibition association (βstandardized = -0.007, p < 0.001) and for meat-disinhibition association (βstandardized = 0.001, p < 0.001)). Although all effects were small, covariates and interaction term adjustments did not attenuate the effects, and neither did most subgroup-only analyses. ConclusionsThe prudent diet was associated with a lower disinhibition score and this effect was partially mediated by the lower inflammation. Reversely, the meat-based diet was linked to more inflammation, which was associated with more disinhibition. Our findings suggest mediating effects of immune function in the relationship between diet and behavioral disinhibition. However further alternative designs such as interventional trials are needed to establish causal effects.

Cascades From Early Adolescent Impulsivity to Late Adolescent Antisocial Personality Disorder and Alcohol Use Disorder

PurposeThe behavioral disinhibition model (BDM) posits that a liability toward impulsivity evident by early adolescence underlies the coemergence of antisocial behavior and alcohol use (i.e., problem behaviors) in early-adolescence to mid-adolescence, but that the subsequent development of these problem behaviors (rather than impulsivity itself) predicts the emergence of antisocial personality disorder (APD) and alcohol use disorder (AUD) in late adolescence. The present study was designed to test these predictions of the BDM from early to late adolescence. MethodsWe used five-year longitudinal self-report data from the Philadelphia Trajectory Study that was collected from 2006–2012. Mediational analyses were performed using the Random Intercept Cross-lagged Panel Model, which enables the detection of within-person predictions of changes in problem behaviors during adolescence. The sample was ethnically and socioeconomically diverse, including 364 urban US community youth (at baseline: Mage = 13.51(.95); 49.1% female). ResultsConsistent with the BDM, mediational analyses revealed that changes in early adolescent impulsivity predicted late adolescent APD and AUD criteria, mediated by changes in mid-adolescent alcohol use and conduct problems. DiscussionInterventions targeting impulsivity in early adolescence could potentially halt the cascading chain of events leading to both late adolescent APD and AUD by decelerating growth in antisocial behavior and alcohol use during early-adolescence to mid-adolescence. From mid-adolescence to late-adolescence, the consequences of early impulsivity, especially involvement in antisocial behaviors, become a more relevant predictor of both APD and AUD rather than impulsivity itself.

The Syndemic of Substance Use, High-Risk Sexual Behavior, and Violence: A Qualitative Exploration of the Intersections and Implications for HIV/STI Prevention Among Key Populations in Lagos, Nigeria

BackgroundKey populations (KP) are defined groups with an increased risk of HIV due to specific higher risk behaviours. KP who use substances engage in risky behaviors that may play a co-active role in HIV transmission and acquisition in Nigeria. This qualitative study explored the 'syndemics' of substance use, sexual risk behavior, violence and HIV infection among KP who use substances.MethodsNineteen sexually active men who have sex with men [MSM] and 18 female sex workers [FSW] aged 16 years and older who use substances were purposively selected to participate in sixteen in-depth interviews and two focus groups. We utilized a syndemic framework to explore the interaction of socio-economic factors, substance use and high-risk sexual practices. The interviews were audio-recorded, transcribed, organized in NVIVO 11 and analyzed using thematic analysis.ResultsMajority (95%) were non-injection substance users (primarily alcohol and marijuana); a few KP also used cocaine and heroin. Sixty percent of participants were between 16-24 years. Substance use utilities and trajectories were heavily influenced by KP social networks. They used substances as a coping strategy for both physical and emotional issues as well as to enhance sex work and sexual activities. Key HIV/STI risk drivers in the settings of substance use during sexual intercourse that emerged from this study include multiple sexual partnerships, condom-less sex, transactional sex, intergenerational sex, double penetration, rimming, and sexual violence. Poverty and adverse socio-economic conditions were identified as drivers of high-risk sexual practices as higher sexual risks attracted higher financial rewards.Conclusions and RecommendationsFindings indicate that KP were more inclined to engage in high-risk sexual practices after the use of substances, potentially increasing HIV risk. The syndemic of substance use, high-risk sexual behavior, adverse socio-economic situations, and violence intersect to limit HIV prevention efforts among KP. The behavioural disinhibition effects of substances as well as social and structural drivers should be considered in the design of targeted KP HIV prevention programs. HIV intervention programs in Nigeria may yield better outcomes if they address the nexus of sexual risk behavior and substance use as well as knowledge and appropriate use of HIV prophylaxis.

Control Yourself: Broad Implications of Narrowed Attention

Attention represents a key element of self-control, and multiple theoretical accounts have highlighted the role played by abundant attentional capacity in effecting successful self-regulation. What, then, are the consequences of living in today’s world, in which attention can become so easily divided by a multitude of stimuli? In this article, we consider the implications of divided attention for self-control and show that although the end result is typically disinhibited behavior, under specified conditions, attentional limitation, or what we term attentional myopia, can be associated with enhanced restraint.

Exploring the Posting of Nude Photographs on Reddit in Relation to Self-Esteem, Perceived Attractiveness, Narcissism, and Sensation Seeking

While many scholars have explored the sharing of nude photographs one-to-one (i.e., sexting), few have examined the sharing of nudity in a one-to-many context. The current study examined the sharing of nude photographs on Reddit, framing the practice as an act of disinhibited online behavior. A survey (n = 628) was conducted to assess whether Redditors levels of sensation seeking, self-esteem, perceived attractiveness, and narcissism would be related to whether or not they posted nude photographs on the site. Results indicated that posting nudity on Reddit was significantly associated with higher perceived attractiveness and narcissism, but not sensation seeking or self-esteem. The role of gender and sexual orientation in the posting of nudity online was also assessed, and an overrepresentation of nude content produced by females and bisexual persons, as well as an underrepresentation of nude content produced by males and heterosexuals, was found. Findings are discussed in relation to self-concept, sexual health, and the online disinhibition effect.

Biological basis and psychiatric symptoms in frontotemporal dementia.

Frontotemporal dementia is a neurodegenerative disease characterized by focal degeneration of the frontal and temporal lobes, clinically presenting with disinhibited behavior, personality changes, progressive non-fluent aphasia and/or impaired semantic memory. Research progress has been made in re-organizing the clinical concept of frontotemporal dementia and neuropathological classification based on multiple accumulating proteins. Alongside this progress a list of genetic mutations or variants that are causative or increase the risk of frontotemporal dementia have been identified and some of these gene products are extensively studied. However, there are still a lot of points that need to be overcome, including lack of specific diagnostic biomarker which enable antemortem diagnosis of underlying neurodegenerative process, and lack of disease modifying therapy which could prevent disease progression. Early and precise diagnosis of frontotemporal dementia is urgently required. In this context, how to define prodromal frontotemporal dementia and early differential diagnosis from primary psychiatric disorders are also important issues. In this review we will summarize and discuss current understanding of biological basis and psychiatric symptoms in frontotemporal dementia.

Dark Triad Psychopathy Outperforms Self-Control in Predicting Antisocial Outcomes: A Structural Equation Modeling Approach.

Dark Triad traits and self-control are considered viable causal precursors to antisocial and criminal outcomes in youth. The purpose of the present study is to concurrently compare how Dark Triad traits and self-control differ in terms of predicting self-reported juvenile delinquency, CD symptoms, proactive overt aggression, and crime seriousness. The sample consisted of 567 (M = 15.91 years, SD = 0.99 years, age range = 14–18 years) Southern European youth from Portugal. Structural-equation-modelling procedures revealed that the psychopathy factor of Dark Triad traits presented the strongest significant hypothetical causal associations with the antisocial/criminal outcomes, followed by self-control. Machiavellianism and narcissism presented the lowest causal associations. Our findings indicate that psychopathy, as operationalized in the Dark Triad, concurrently surpasses self-control and the remaining factors of the Dark Triad in terms of predicting antisocial/criminal outcomes in youth. This suggests that behavioral disinhibition, or a core incapacity to regulate one’s conduct, is central for understanding delinquency and externalizing psychopathology. Comparatively, the interpersonal component of dark personality features, such as Machiavellianism and narcissism, are secondary for understanding crime.

Asymptomatic COVID-19 Infection Induced First Episode Psychosis: A Case Series

Aims: We presented 3 similar cases of 1st episode psychosis that occurred after Corona Virus Disease -2019 (COVID-19) infection which we treated at our institute’s on going post-COVID-19 mental health clinic, to provide more evidence to the existing literature and to describe whether an asymptomatic COVID-19 infection can also induce psychosis in previously healthy individuals and tried to elaborate the probable etiology and nature of the psychotic symptoms.&#x0D; Presentation of the Cases: All the 3 cases had COVID-19 infection, few days before their psychotic symptoms started for the 1st time. They didn’t have any history of regular substance or medication use that are known to induce psychosis or any previous history of psychiatric disease or family history of psychiatric disease, without any abnormality in physical examinations and laboratory investigations. All the cases had history of stress which were not overwhelming (except the 3rd case) and were mostly related to COVID-19 infection and pandemic associated social and financial stress. 1st case (54 years, married male) developed delusion of persecution, delusion of reference, 2nd and 3rd person auditory hallucinations, 2nd case (61 years, widower male) developed delusion of persecution, 2nd person auditory hallucination (commanding type), disinhibited behaviour (disrobing in public) and the 3rd case (32 years, unmarried male) developed delusion of persecution and delusional misidentification (Intermetamorphosis). All of them responded well to commonly used antipsychotics within 4 weeks that prompted a diagnosis of Acute and Transient Psychotic disorder according to ICD-10 criteria.&#x0D; Discussion: This study points out that even an asymptomatic COVID-19 can induce psychosis for the first time in life, where the etiology most probably is the direct effect of the virus itself on brain or the COVID-19 and pandemic related stress which is supported by the fact that factors like family history of psychiatric disease, substance use or medication use or any comorbidity that can induce psychosis were also absent. The psychopathological findings were persecutory delusion and auditory hallucinations with one case having Intermetamorphosis phenomenon which is a rare finding and perhaps a novel finding in post-COVID-19 Psychosis.&#x0D; Conclusion: All COVID-19 infected individuals should be screened early for appearance of any symptom that raises the suspicion of psychosis. Large studies are needed to ascertain the etiology of post-COVID-19 psychosis.

0664 Temporal Patterns of Suicidal Ideation in the Emergency Department

Abstract Introduction Nocturnal wakefulness may be dangerous for vulnerable populations: the incident risk for suicide is highest at night after adjusting for population wakefulness, and nocturnal wakefulness is associated with suicidal ideation. These observations support the hypothesis that sleep- and circadian-dependent changes in mood, reward processing, and executive function increase the risk for disinhibited behavior at night (during periods of nocturnal wakefulness). The present study evaluated this hypothesis by using the timing of emergency department encounters for suicidal ideation. Methods An archival analysis of data from two emergency departments (EDs) in Tucson, Arizona from 2018 and 2019 yielded 51,370 encounters for any reason across 29,359 individuals with usable data, and the time of initial contact was extracted for each case. Of these, 571 individuals (1.94%) sought care for 763 (1.49%) instances of suicidal ideation (determined by ICD-10 code R45.861). Encounters were characterized by date/time, age, sex, race/ethnicity, blood alcohol level (if tested), homelessness, and prior diagnosis of a psychotic disorder, bipolar disorder, or depressive disorder. Suicidal ideation encounters were analyzed as raw counts and as a proportion of all encounters by clock hour and time-of-day categories (night: 12AM-5:59AM; morning: 6AM-11:59AM; afternoon:12PM-5:59PM; evening: 6PM-11:59PM) using robust Poisson models. Results Although most ED encounters occurred between 6PM and midnight (mean: 9:42PM), the greatest number of suicidal ideation encounters occurred between 12AM and 3AM (mean: 12:18AM). After adjusting for the per-hour proportion of ED visits, the incident risk for a suicidal ideation encounter increased between 8AM and 11AM, peaked at 10AM (IRR: 1.95 [1.10-3.44]) and was lowest at 4PM (IRR: 0.54 [0.32-0.91]). Compared to the evening, the incident risk of suicidal ideation was 64% greater in the morning (IRR: 1.64 [1.31-2.06]), 25% greater at night (IRR: 1.25 [1.00-1.56]), but not different for afternoon encounters. Conclusion After adjusting for overall encounter rates, ED encounters for suicidal ideation are more likely to occur in the morning. Although the morning peak in incident risk is later than the reported nocturnal risk for incident suicide, this may reflect a delay between when an individual develops suicidal ideation and when they seek or receive treatment. Support (If Any)

Detection of Parent-of-Origin Effects for the Variants Associated With Behavioral Disinhibition in the MCTFR Data.

Behavioral disinhibition is one of the important characteristics of many mental diseases. It has been reported in literature that serious behavioral disinhibition will affect people’s health and greatly reduce people’s quality of life. Meanwhile, behavioral disinhibition can easily lead to illegal drug abuse and violent crimes, etc., which will bring great harm to the society. At present, large-scale genome-wide association analysis has identified many loci associated with behavioral disinhibition. However, these studies have not incorporated the parent-of-origin effects (POE) into analysis, which may ignore or underestimate the genetic effects of loci on behavioral disinhibition. Therefore, in this article, we analyzed the five phenotypes related to behavioral disinhibition in the Minnesota Center for Twin and Family Research data (nicotine, alcohol consumption, alcohol dependence, illicit drugs, and non-substance use related behavioral disinhibition), to further explore the POE of variants on behavioral disinhibition. We applied a linear mixed model to test for the POE at a genome-wide scale on five transformed phenotypes, and found nine SNPs with statistically significant POE at the significance level of 5 × 10−8. Among them, SNPs rs4141854, rs9394515, and rs4711553 have been reported to be associated with two neurological disorders (restless legs syndrome and Tourette’s syndrome) which are related to behavioral disinhibition; SNPs rs12960235 and rs715351 have been found to be associated with head and neck squamous cell carcinoma, skin cancer and type I diabetes, while both SNPs have not been identified to be related to behavioral disinhibition in literature; SNPs rs704833, rs6837925, rs1863548, and rs11067062 are novel loci identified in this article, and their function annotations have not been reported in literature. Follow-up study in molecular genetics is needed to verify whether they are surely related to behavioral disinhibition.

Pharmacological and nonpharmacological approaches to reduce disinhibited behaviors in dementia: a systematic review.

Disinhibited behaviors in dementia are associated with multiple negative outcomes. However, effective interventions are under-researched. This systematic review aims to provide an overview of intervention studies that report outcome measures of disinhibited behaviors in dementia. Systematic searches of the databases MEDLINE, EMBASE, and PsychINFO, Social Work Abstracts and Cochrane Central Register of Controlled Trial databases were conducted for publications published between 2002 and March 2020. We included hand-searched reviews,original articles, case reports, cohort studies, and randomized controlled trials (RCTs). All studies were rated for research quality. Statistical and clinical significance were considered for individual studies. Effect sizes were included where provided or calculated where possible. Mean effect sizes were calculated for RCTs only. The systematic review included studies involving people living with dementia. The Neuropsychiatric Inventory disinhibition subscale was used most often. Nine pharmacological and 21 nonpharmacological intervention studies utilized different theoretical/clinical approaches. These included pain management, antidepressants, models of care, education and/or training, music-based approaches, and physical activity. The quality of research in RCTs was strong with a greater effect size in nonpharmacological compared to pharmacological approaches (mean Cohen's d = 0.49 and 0.27, respectively). Disinhibition was a secondary outcome in all studies. Pharmacological (including pain management and antidepressants) and, more so, nonpharmacological (models of care, education/training, physical activity, and music) approaches were effective in reducing disinhibition.