Impaired Social Functioning Research Articles

Insight into impaired social functioning in dementia

Background:People with dementia commonly have impaired social functioning and may not recognise this. This lack of insight may result in worse outcomes for the person and their family carers. We aimed to characterise insight into social functioning in dementia, and describe its association with dementia severity.Methods:Observational cross-sectional study of people aged >65 years with clinically diagnosed dementia and their family informants recruited from three sites in Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia scale (SF-DEM), which assesses three domains: “spending time with other people” (domain 1), “communicating with other people” (domain 2), and “sensitivity to other people” (domain 3). We calculated lack of insight into social functioning as the discrepancy between the ratings of the participants with dementia and their informant. We described this discrepancy and the proportion of people with dementia whose rating was overestimated, congruent or underestimated compared to their family informant. We calculated the association between SF-DEM discrepancy score and total mini-mental status examination (MMSE) score and recall and attention/concentration subdomains.Results:In 108 participants with dementia (50.9% women), mean age = 78.9 (standard deviation, SD 6.5) years, and mean MMSE score = 22.7 (SD 3.7). Ratings of patients and informants for domain 1 did not differ, but patient-rating was higher than carer-rating for domain 2 (patient-rated score 11.2 (2.5), carer-rated score 10.1 (3.4); p = 0.003) and domain 3 (patient-rated score 9.7 (2.4), carer-rated score 8.1 (2.8); p < 0.001). Sixty (55.6%) people with dementia overestimated their overall social functioning, 30 (27.8%) underestimated, and 18 (16.7%) gave ratings congruent with their family informant. Performance on the MMSE, and its sub-domains was not associated with SF-DEM discrepancy score.Conclusions:We found that insight varies according to subdomains of social functioning, with people with dementia rating their communication and sensitivity differently, and usually higher than their carers. Researchers and clinicians should consider insight into social functioning in dementia as a multidimensional, rather than a unified, concept. Clinicians should help family members understand and adapt by explaining their relative with dementia’s lack of insight about aspects of their social functioning.

S2: Social functioning in people with dementia and its cognitive and psychiatric consequences

Symposium OverviewSocial functioning is fundamental to human experience. The profound social functioning impairments affecting people with dementia are distressing to them and their families and account for significant individual, family and societal burden. There are no effective treatments that improve this major aspect of dementia, so there is urgent need to characterise social functioning decline in dementia and its consequences to inform future therapeutic approaches. In this symposium, an international panel will present perspectives on social functioning in dementia from across the disease course.

A rare case of capgras syndrome: The impersonation delusion

Capgras syndrome is a rare psychiatric disorder characterized by the delusional belief that a person or people close to the affected individual have been replaced by identical impostors. This case report presents the unique clinical presentation and management of a 52-year-old male patient who exhibited classic symptoms of capgras syndrome. The patient’s delusion emerged following a traumatic brain injury, leading to significant distress and impaired social functioning. The assessment, diagnosis, and treatment approach are discussed, highlighting the interdisciplinary collaboration between psychiatry, neurology, and neuropsychology. This case report sheds light on the challenges associated with the management of capgras syndrome and emphasizes the importance of a comprehensive and individualized treatment plan.

Impaired Cognitive Function in Immune-TTP Is Better Predicted By Serum Thrombomodulin Than ADAMTS13 Activity: Results of a Longitudinal Multicenter Pilot Study

Background: High rates of mood disorders and cognitive dysfunction in immune-mediated thrombotic thrombocytopenic purpura (iTTP) survivors have been observed. However, there are no long-term prospective studies to precisely define the proportion of affected patients, rate of progression, and underlying mechanisms. We hypothesized that a large-scale multicenter study is essential to determine the natural history of these complications. Thus, we conducted a multicenter pilot study of iTTP patients in remission to assess feasibility, study design, and explore novel biomarkers. Given ADAMTS13 deficiency during remission is a risk factor for stroke, we also hypothesized that low ADAMTS13 activity predisposes patients to cognitive impairment. Methods: We aimed to enroll 50 participants from 3 USTMA Consortium sites, prospectively including adult iTTP patients (age ≥ 18 years) in clinical remission (ADAMTS13 remission was not required) for at least 90 days. Diagnosis of iTTP relied on ADAMTS13 activity <10% during an acute TMA episode. Over 2 years, participants underwent comprehensive assessments of mental and physical health, cognition, ADAMTS13 activity, and biomarker sample collection every 3 months. Study assessments included: Beck Anxiety Index (BAI), Beck Depression Index-II (BDI), Headache Impact Test (HIT-6), SF-36v2 (health-related quality of life), and CPT-3 (computer-based assessment of reaction-time, attention, and processing speed). Cognition was assessed annually (entry, year 1 and close) using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with the Montreal Cognitive Assessment (MoCA) substituted the other visits. Results: Between September 2019 and July 2022, we enrolled 38 of 50 planned participants. Of the 38 enrolled, 16 completed the study (42.1%) 11 were lost to follow up because they did not complete the close-out visit (29%), and 11 have not yet completed the study (29%). After excluding lost subjects, we found that 131 of 221 visits were completed (59%). Demographics and burden of mental and physical health impairments are shown (Figure A). At enrollment, 45% (15/33) had at least moderate anxiety on BAI, and 45 % (15/33) had at least moderate depression on BDI. HIT-6 revealed69.7 % (23/33) had clinically significant headaches warranting referral to a specialist (median score 57, IQR 47-63). SF-36 found increased fatigue (median fatigue score of 30, population mean 52.15) and pain (median 57.5, population mean 78.77), as well as impairments in social functioning (median 50, population mean 78.77) and general health (median 35, population mean 56.99). The The CPT-3 test (see table) was highly unacceptable to some participants at all sites. RBANS scores at enrollment detected overall cognitive impairment (median score 18 th %ile) with marked deficiencies in immediate memory (median score 11 th %ile), visuospatial construction (median score 10 th %ile), and milder impairments in language and delayed memory with no evidence of attention deficits. We collected several novel biomarkers and observed a correlation between serum CD141 (thrombomodulin) and overall RBANS scores (Figure B) when compared between participants above and below the median baseline CD141. This association was not seen with ADAMTS13, or the other biomarkers collected (Syndecan-1, Vascular adhesion protein-1, E-selectin). Conclusions: In this pilot study, we found a high attrition rate, likely due to the frequency of study visits and the COVID-19 pandemic. We conclude a larger study is feasible but should account for high attrition, employ less frequent study visits, and avoid unacceptable study assessments to reduce lost subjects. Enrollment findings confirmed previous single-center reports of high prevalence of mental health disorders, reduced physical health, and subtle but measurable cognitive deficits. The CPT-3 test should be excluded from future studies due to poor acceptance. Surprisingly, we found no association between lower ADAMTS13 activity and cognitive impairment but observed a significant link between serum CD141 and cognitive impairment. These findings suggest CD141 is potentially a sensitive biomarker for risk of cognitive impairment during remission and may suggest a novel mechanism. A longer-term study with more subjects will be essential to fully explore the clinical and therapeutic implications of these findings.

Sexual Health in Young Adult Patients after Chimeric Antigen Receptor T-Cell Therapy

Background: Chimeric antigen receptor T-cell therapy (CAR T) has shown significant promise for treating relapsed/refractory hematologic malignancies. Although there is growing literature on immune mediated toxicities, studies examining late effects and survivorship concerns are limited. Sexual health is an important survivorship issue with implications for overall health-related quality of life (HRQOL) and is particularly relevant for young adults (YAs) aged 18-39 years. For YAs, cancer co-occurs with a critical period of physical and psychosocial development during which romantic relationships are formed and physical, psychosocial, and sexual milestones are achieved. No studies have evaluated sexual health among YAs treated with CAR T. To address this knowledge gap, we conducted a mixed methods study to examine sexual health and HRQOL after CAR T among YAs and explore communication about sexual health between YA CAR T recipients and their healthcare providers. Methods: This was a cross-sectional, single center study conducted at Moffitt Cancer Center. Participants were adults aged 18-39 years treated with CAR T. Participants were asked to complete a one-time survey and an individual semi-structured interview. The survey included short form measures from the Patient-Reported Outcomes Measurement Information System (PROMIS) assessing sexual health (desire/interest in sexual activity, sexual function, sexual satisfaction) and HRQOL (depression, anxiety, fatigue, sleep disturbance, pain interference, global pain, physical function, social function, cognitive function, emotional impact). PROMIS scores were calculated as T-scores with a normative M=50, SD=10, and a minimally important difference (MID) of 5 points. The survey also included study-specific items assessing patient-provider communication about sexual health. For qualitative data collection, a semi-structured interview guide was used to assess the impact of cancer and CAR T on participants' sexual health and HRQOL, as well as patients' experiences with communicating about sexual health with providers, partners, and their broader support system during and after treatment. Preliminary analysis included descriptive statistics for quantitative data in relation to evidence-based thresholds, and a preliminary thematic analysis of qualitative data. Results: In total, n=13 YA CAR T recipients completed the study survey, and n=10 agreed to participate in individual semi-structured interviews. Participant characteristics are depicted in Table 1. Median age of participants was 35 years (range: 21-39), 61.5% identified as male, and the majority (92.3%) identified as heterosexual. Median time since CAR T infusion was 30 months (range: 1-50). Quantitative data overall and by biological sex are summarized in Table 2. Average interest in sexual activity was low among females (M=35.1, SD=10.0) but not males (M=48.7, SD=10.3). All other average scores were within normal ranges. Several differences in average scores between males and females exceeded the 5-point MID, with female participants reporting less interest in sexual activity, worse fatigue, more impaired social function, and worse emotional impact. Most YAs had not discussed (46.2%) or did not remember discussing (38.5%) sexual health with a healthcare provider before CAR T. Most (76.9%) had not discussed sexual health with a healthcare provider since receiving CAR T. Three major themes emerged from the qualitative data: 1) YAs perceive a lack of awareness of YA sexual health priorities among their healthcare team, 2) There is a lack of communication and information about potential sexual health side effects after CAR T, and 3) Parents as caregivers are a barrier to YAs communicating with their healthcare team about sexual health. Conclusion: This was the first study to explore sexual health outcomes among YA cancer survivors treated with CAR T. Findings highlight a need for improved patient-provider communication regarding sexual health and more publicly available educational resources. Providers may prioritize one-on-one discussions with patients and limit parent involvement when discussing sexual health needs. As the population of CAR T survivors continues to grow, it is imperative to examine patient reported outcomes and late effects to improve survivorship outcomes. Author Note: AB & VIG share first authorship. LO & RF share senior authorship.

Sex and age differences in social and cognitive function in offspring exposed to late gestational hypoxia

BackgroundGestational sleep apnea is a hypoxic sleep disorder that affects 8–26% of pregnancies and increases the risk for central nervous system dysfunction in offspring. Specifically, there are sex differences in the sensitivity of the fetal hippocampus to hypoxic insults, and hippocampal impairments are associated with social dysfunction, repetitive behaviors, anxiety, and cognitive impairment. Yet, it is unclear whether gestational sleep apnea impacts these hippocampal-associated functions and if sex and age modify these effects. To examine the relationship between gestational sleep apnea and hippocampal-associated behaviors, we used chronic intermittent hypoxia (CIH) to model late gestational sleep apnea in pregnant rats. We hypothesized that late gestational CIH would produce sex- and age-specific social, anxiety-like, repetitive, and cognitive impairments in offspring.MethodsTimed pregnant Long-Evans rats were exposed to CIH or room air normoxia from GD 15–19. Behavioral testing of offspring occurred during either puberty or young adulthood. To examine gestational hypoxia-induced behavioral phenotypes, we quantified hippocampal-associated behaviors (social function, repetitive behaviors, anxiety-like behaviors, and spatial memory and learning), hippocampal neuronal activity (glutamatergic NMDA receptors, dopamine transporter, monoamine oxidase-A, early growth response protein 1, and doublecortin), and circulating hormones in offspring.ResultsLate gestational CIH induced sex- and age-specific differences in social, repetitive, and memory functions in offspring. In female pubertal offspring, CIH impaired social function, increased repetitive behaviors, and elevated circulating corticosterone levels but did not impact memory. In contrast, CIH transiently induced spatial memory dysfunction in pubertal male offspring but did not impact social or repetitive functions. Long-term effects of gestational CIH on social behaviors were only observed in female offspring, wherein CIH induced social disengagement and suppression of circulating corticosterone levels in young adulthood. No effects of gestational CIH were observed in anxiety-like behaviors, hippocampal neuronal activity, or circulating testosterone and estradiol levels, regardless of sex or age of offspring.ConclusionsOur results indicate that hypoxia-associated pregnancy complications during late gestation can increase the risk for behavioral and physiological outcomes in offspring, such as social dysfunction, repetitive behaviors, and cognitive impairment, that are dependent on sex and age.

Ayurvedic Management of Comorbid State of Autism with Attention Deficit Hyperactivity Disorder w.s.r Unmada

Unmada a term used in Ayurveda, refers to a condition characterized by mental instability, restlessness and abnormal behaviors. It similar to modern day autism spectrum disorder (ASD) and attention deficit hyperactive disorder (ADHD). ASD and ADHD are neuro developmental and neuropsychiatric disorder. These disorders have shared genetic heritability and are both associated with shared impairment in social functioning and executive functioning. However, in the phenotypic presentation of the impairment which characterized ASD and ADHD. The fundamental principles of Ayuvedic management are to restore the balance of the Doshas. In the case of Unmada, particularly when comorbid with autism and ADHD, the focus on pacifying the aggravated Vata dosha. This can be achieved through a combination of dietary modification, lifestyle changed, Balpanchkarma and Marma therapies and Medhya Dravya. Aim and Objective: A case study of Ayurvedic management of comorbid state of Autism and Attention Deficit Hyperactivity Disorder w.s.r Unmaad. Material and Method: A 5-year-old female patient was come to the OPD of Kaumarbhritya Department, Rishikul Campus, UAU, Haridwar. With complain of difficulty in speaking as per development age, poor eye contact, hyperactive in nature with addiction of mobile in the last three year. This condition can be understood as Unmada. Treatment including with some Balpanchkarma and Marma therapies, and Ayurvedic formulations for 2-3 months. Result: There significant improvement in the condition of the patient. Ayurvedic intervention in this case reveals the true potential and efficacy of our Ayurvedic science.

Порушення соціального функціонування у хворих з депресиівними розладами в умовах стресу війни

Abstract The psychotraumatic factors that occurred during the war of 2022-2023 significantly affect the exacerbation / onset and manifestations of depressive syndrome (DS) in schizophrenia spectrum disorders (SSD) and neurotic depressive disorders (NDD), as well as worsen the level of social functioning (SF) of patients. Objective. To study the SF impairment in patients with DS in patients with SSD and NDD, and the relationship between the stress factors and the exacerbation of psychopathological symptoms and their severity in these patients. Methods and materials. There was conducted psychopathological examination of 92 patients with SSD (schizophrenia, Sch and schizoaffective disorder, SchAD) and neurotic DR (recurrent depression, RD and depressive reaction as adjustment disorders, AD) who experienced severe stress during the war. Results. In the research the largest number of patients were women (60.9% of cases). Among patients aged 18 - 25 years, majority of cases was the patients with AD (46.2%), in the group of 26 - 35 years - with SSD (50,0% with Sch and with SchAD). The vast majority of RD cases were presented among patients aged 36-50 years. Depressive syndrome significantly prevailed in patients with RD, and depressive-phobic syndrome in patients with AD. Whereas, depressive-delusional syndrome was most often diagnosed in patients with SSD. Among all examined patient’s reactive exacerbation of the main disease (in case of SSD and RD), as well as the development of RA occurred as a result of a significant impact of stress factors of different content, but related to the war in all cases.The most frequent of these were the feeling of "war fatigue", uncertainty and/or hopelessness about the future (in general 82% of patients with RD and RA); difficulties during evacuation, caused a strong increase in family conflicts, especially in patients with SSD (57.9% of cases in general) and RA; significant reduction of money for life. The impairment of SF in patients with various mental disorders and DS as a result of war-related stressors was mainly manifested in significant difficulty in daily professional and household duties (91.3% of all patients); the feeling of social support lacks and loneliness; frequent and/or prolonged interpersonal conflicts; as well as a strong financial problem. Other psychopathological features associated with DS that develop under the war stress influence and worsened the level of patients' SF were sleep disturbances (97.8% of cases) with a significant direct correlation with a significant difficulty in daily activities; self-disbelief and hopelessness, as well as the emergence or strong increasing of suicidal thoughts were noted by more than 80% of the examined patients (36.0% of patients with NDDs had suicide attempts or self-injurirs - most often in AD); constant fatigue (80.0% of patients with NDDs). Conclusion. Understanding the impact of war-related stressors on the manifestations of DS, and the features and level of SF impairment need the use of treatment and rehabilitation complex for patients with DS (with SSD and NDD) who have experienced a severe psychotraumatic situation. It will allow timely and effective treatment of reactive states (relapses of psychotic episodes), take to account into the severity and characteristics of DS, and the content and severity of stressful effects in order to achieve remission, restore social adaptation of patients, and reduce the risk of self-destructive or aggressive behavior of them.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder.

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.

Families Taking Care of Individuals with Schizophrenia: A Mixed Method Resilience Study

Background: Schizophrenia, a debilitating disease, causes affected individuals to have personal and social function impairment. As a consequence, affected individuals rely on family caregivers most of the time. Access to mental health care is still limited in Lubuk Pakam, with only one district hospital providing psychiatric care. Therefore, the family must play a great role in providing care for schizophrenic individuals. The aim of our study was to investigate resilience and assess the efficacy of the family empowerment module among families taking care of individuals with schizophrenia. Methods: We conducted two sequential studies, both quantitative and qualitative studies (mixed method), to investigate the family resilience profile. The family empowerment module was asserted and efficacy was measured using a dependent t-test. Multivariate analysis with linear regression was used to assess the relationship between independent variables (burden, stigma, social, and health care support) and the dependent variable (family resilience). Result: The family burden has shown a negative coefficient regression score of 0.130, which means that family burden has an impact of 13%, leading towards the decline of family resilience. A considerable increase in family resilience was noted after the implementation of the family empowerment module (p = 0.001). Conclusion: Implementation of the family empowerment module has helped in increasing family resilience. We suggest that this implementation can also be carried out, especially in other county hospitals with similar relatable situations.

Modulation of PI3K/Akt/GSK3β signaling cascade through G protein-coupled receptor 55 (GPR55) activation: Prenatal lysophosphatidylinositol attenuates valproic acid-induced synaptic abnormalities and mitochondrial dysfunction

AimsDysregulation of PI3K/Akt/GSK3β signaling has been implicated in various neurological disorders, including autism spectrum disorder (ASD). G protein-coupled receptor 55 (GPR55) has recently emerged as a potential regulator of this signaling cascade. This study explores the intricate modulation of the PI3K/Akt/GSK3β signaling cascade via GPR55 activation and its potential therapeutic implications in the context of autism-associated neuronal impairments. Main methodsValproic acid (VPA) was administered on embryonic day 12 (E12) to induce ASD, and lysophosphatidylinositol (LPI), a GPR55 agonist, was used prenatally to modulate the receptor activity. Golgi-cox staining was performed to observe neuronal morphology, and Hematoxylin and eosin (H and E) staining was carried out to quantify damaged neurons. Enzyme-linked immunosorbent assay (ELISA) was implemented to identify molecular mediators involved in neuroprotection. Key findingsPrenatal VPA exposure resulted in significant abnormalities in synaptic development, which were further evidenced by impairments in social interaction and cognitive function. When LPI was administered, most of the synaptic abnormalities were alleviated, as reflected by higher neuron and dendritic spine count. LPI treatment also reduced cytoplasmic cytochrome c concentration and related neuronal cell death. Mechanistically, GPR55 activation by LPI increases the expression of phospho-Akt and phospho-GSK3β, leading to the activation of this signaling in the process of rescuing synaptic abnormalities and mitochondria-mediated neuronal apoptosis. SignificanceThe observed therapeutic effects of GPR55 activation shed light on its significance as a prospective target for ameliorating mitochondrial dysfunction and dendritic spine loss, offering novel prospects for developing targeted interventions to alleviate the neuropathological causes of ASD.

Impact of social-functioning and sleep on quality of life in chronic inflammatory demyelinating polyneuropathy

Introduction/AimsThe impact of impairment of social functioning and sleep on health-related quality of life (HR-QoL), is unknown in chronic inflammatory demyelinating polyneuropathy (CIDP). The value of the Chronic Acquired Polyneuropathy Patient-Reported Index (CAP-PRI) to identify potential social functioning and sleep issues is equally unknown. MethodsWe performed a cross-sectional evaluation of social functioning and sleep using the “Scales for Outcomes in Parkinson’s Disease” (SCOPA) in 40 subjects with clinically-stable CIDP through a structured questionnaire. We assessed HR-QoL through the CAP-PRI. Disability was evaluated through the Overall Neuropathy Limitation Score (ONLS). ResultsSCOPA social functioning scores were impaired at least “a little” per averaged item in > 50 % of subjects, and at least “quite a bit” per averaged item in > 20 %. Most affected items were (i) difficulty with work/household/other chores (ii) difficulties with hobbies/sport/leisure activities. SCOPA sleep sub-scores indicated at least “a little concern” for night-time sleep in nearly 50 % of subjects. Abnormal sleep timing was rare. Associations were found between both SCOPA social-functioning and SCOPA sleep scores and the CAP-PRI. Linear regression demonstrated the SCOPA social-functioning score was independently associated with the CAP-PRI. The CAP-PRI showed high association with disability scores, good internal consistency, absence of ceiling effect, absence of significant floor-effect, and good criteria-related as well as construct-related validity. DiscussionSocial functioning and night-time sleep are frequently affected in CIDP and impact on HR-QoL. In contrast to traditional disability scales, the CAP-PRI additionally allows adequately capturing these impairments and may represent an adequate holistic outcome measure.

Alerting network, cognitive flexibility in children with attention deficit hyperactivity disorder and the moderating effect of neuroticism.

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, and cognitive flexibility is a sub-component of executive functioning. Studies have shown impairments in cognitive flexibility in ADHD, which is affected by attentional processes. Personality, as a long-standing trait, has a profound effect on ADHD. However, previous studies have not assessed the relationship between attentional function, personality traits, and cognitive flexibility in children with ADHD. This study explored the association between attention networks, personality, and cognitive flexibility in ADHD, filling a gap in the related field. We expect our findings will provide insights into and clues for the prevention and interventional treatment of ADHD. This study primarily aimed to analyze differences in cognitive flexibility between individuals with ADHD and those without and further examine associations between attention networks, personality, and cognitive flexibility in children with ADHD. Overall, 55 children aged 7 to 11 years diagnosed with ADHD and 40 children without ADHD participated in this study. Cognitive flexibility, personality traits, and attentional networks were assessed using the Wisconsin Card Sorting Test, Eysenck Personality Questionnaire, and Attention Network Test, respectively. Additionally, the association between personality traits and strong attentional functioning and cognitive flexibility was investigated using multiple regression analysis. Children with ADHD had significant deficits in cognitive flexibility. A multiple regression analysis revealed that the alerting effect was highly associated with cognitive flexibility at high levels of neuroticism. This association was not salient in individuals with low levels of neuroticism. This study demonstrated that the ADHD group experienced lower cognitive flexibility than the control group. In addition, we showed the effect of neuroticism and alerting networks on cognitive flexibility. These findings may help psychiatrists provide intervention strategies to mitigate the impairment of social functioning in ADHD with cognitive spirituality deficits.

The Quality of Life of Caregivers of People with Type 2 Diabetes Estimated Using the WHOQOL-BREF Questionnaire

Type 2 diabetes (T2D) poses a growing global health challenge, impacting patients’ and their caregivers’ well-being. This study investigates the influence of T2D complications on caregivers’ quality of life (QoL) using the WHOQOL-BREF questionnaire, accounting for factors like age, disease duration, and control. The research involved 382 T2D patients and 300 caregivers from Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases. The WHOQOL-BREF questionnaire assessed caregivers’ QoL across physical, psychological, social, and environmental domains. Complications, including retinopathy, neuropathy, and kidney disease, were examined for their effects on QoL. Patients’ age impact, gender differences, and disease duration were analyzed. T2D complications had varying impacts on different QoL domains. Caregivers of patients with multiple complications showed significant social functioning impairment. Those without complications reported lower psychological health. Age correlated with poorer physical health scores. Female caregivers rated higher in psychological and environmental health. Disease duration and T2D control had no significant impact on caregiver QoL. Caregivers’ concerns included medication adherence and worry about their partner’s health. This study illustrates the delicate interplay between T2D patients and caregivers, highlighting the multifaceted effects of chronic illness. Comprehensive healthcare techniques that address emotional and social components in addition to medical care are critical for improving the well-being of both patients and their caregivers. The findings contribute to a broader understanding of T2D care dynamics, advocating for empathetic and all-encompassing healthcare practices.

Is brain perfusion correlated to switching mood states and cognitive impairment in bipolar disorder type I? A longitudinal study using perfusion imaging approach.

Type I Bipolar disorder (BD-I) is a neuropsychiatric disorder characterized by manic or mixed-featured episodes, impaired cognitive functioning, and persistent work and social functioning impairment. This study aimed to investigate within-subject; (i) differences in brain perfusion using Single-photon emission computed tomography (SPECT) between manic and euthymic states in BD-I patients; (ii) explore potential associations between altered brain perfusion and cognitive status; and (iii) examine the relationship between cerebral perfusion and mania symptom ratings. Seventeen adult patients diagnosed with BD-I in a manic episode were recruited, and clinical assessments, cognitive tests, and brain perfusion studies were conducted at baseline (mania state) and a follow-up visit 6 months later. The results showed cognitive impairment during the manic episode, which persisted during the euthymic state at follow-up. However, no significant changes in brain perfusion were observed between the manic and euthymic states. During mania, trends toward decreased perfusion in the left cerebellum and right superior parietal lobule were noted. Additionally, trends indicated a higher perfusion imbalance in the left superior and middle frontal gyrus during mania and the right superior and middle frontal gyrus during euthymia. No significant correlations existed between brain perfusion, mania symptom ratings, and cognitive performance, indicating that symptomatology might represent more than neural hemodynamics. These findings suggest that cognitive impairment may persist in BD-I patients and highlight the need for therapeutic interventions targeting cognitive deficits. More extensive studies with extended follow-up periods are warranted further to investigate brain perfusion and cognitive functioning in BD-I patients.

Internet Addiction and its Impact on Medical Education in India

Background: In the recent past, Internet addiction has become a topic of concern, with studies reporting its association with various negative consequences, such as decreased academic performance, compromised mental health, impaired social functioning and reduced quality of life. Despite the growing concern about the impact of internet addiction on medical education in India, the existing literature on this topic is limited and lacks a comprehensive synthesis of evidence. Aims and Objectives: This meta-analysis aims to offer a significant understanding regarding the correlation between internet addiction and medical education. Materials and Methods: The present meta-analysis followed the guidelines by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for conducting as well as, reporting the meta-analyses. Studies conducted in various regions of India were included and were published between 2010 and 2022. Results and Analysis: The pooled effect size for academic performance, as measured by exam scores was SMD -0.36 (95% CI: -0.52 to -0.21), indicated to have a significant detrimental effect of internet addiction on academic performance. For mental health indicators, the pooled effect size was found to be having a SMD 0.45 (95% CI: 0.22 to 0.69, P<0.001), indicating a significant positive association. Conclusion: Internet addiction is associated with various negative consequences, such as decreased academic performance, increased risk of mental health disorders, and impaired interpersonal relationships. The results also highlight the need for awareness, prevention, and intervention programs targeted at addressing internet addiction among the students in medical education.

General practitioner assessment and management of insomnia in adults.

Sleep disturbance is among the most prevalent presentations in Australian general practice. Insomnia, the most common sleep disorder, is associated with impaired daytime, social and occupational function, reduced quality of life and substantially increased risk of future depression. Guidelines from Australian and international general practice, sleep and medical societies strongly recommend cognitive behavioural therapy for insomnia (CBT-i) as the first-line treatment for chronic insomnia. This is because CBT-i targets the underlying causes of insomnia, results in sustained improvements and commonly improves comorbid conditions such as depression and pain. This article aims to provide an overview of evidence-based assessment, management and referral options for insomnia in Australian general practice. Access to brief insomnia assessment andevidenced-based treatments are becoming increasingly available to Australian general practitioners. CBT-i can be delivered through self-guided online programs or by suitably trained general practitioners and psychologists.

Social pleasure in daily life: A meta-analysis of experience sampling studies in schizophrenia.

Social anhedonia is considered a key feature of schizophrenia that leads to impaired social functioning. Although traditional laboratory measures assess non-current social pleasure, researchers have begun using experience sampling methods (ESM) to measure current, or consummatory, experiences of social pleasure in daily life. A recent meta-analysis examined deficits in consummatory social pleasure in schizophrenia and found vast heterogeneity in effect sizes across ESM studies. Thus, this meta-analysis aimed to extend those results by testing moderators of this effect. Meta-analysis of 14 ESM studies suggests those with psychotic disorders exhibit a moderate deficit in consummatory social pleasure compared to healthy controls. Yet, this effect was significantly moderated by the type of measure used to assess social pleasure. Measures that directly assessed positive emotional experience during socialization yielded small effects that failed to reach significance; indirect measures of other social factors related to pleasure yielded large, significant effects. This suggests daily social anhedonia observed in psychotic disorders is not due to reduced experience of positive emotion. Instead, social anhedonia may be driven by other elements of social functioning. Most clinical variables did not influence effects, but there was a trend such that patient groups with lower cognitive functioning exhibited greater pleasure deficits. Inconsistent reporting across studies limited our ability to examine other real-world variables that may contribute to deficits in social pleasure. Yet, results show different ESM items used to measure social pleasure do not assess the same construct. Future research is needed to validate ESM measures and standardize protocols across studies.

Criminal law protection on juvenile crimes with bipolar disorders

BackgroundBipolar disorder refers to a type of mood disorder that includes both manic or mild manic episodes and depressive episodes in clinical practice. Compared with a single disease, comorbidities typically have characteristics such as severe symptoms, long course of disease, severe social function impairment, high risk of suicide, and poor prognosis. Minors are prone to engage in criminal behavior under the influence of bipolar disorder. This study will use group psychological counseling combined with criminal law protection education to intervene and treat underage patients.Subjects and Methods80 underage bipolar disorder patients were selected and divided into two groups according to a random number table method: the control group received group psychological counseling for intervention, while the research group received group psychological counseling combined with communication training and nursing. The improvement of the condition, self-care ability, depression, mania, quality of life, medication compliance, and social adaptability scores of the two groups of patients were compared.ResultsThe results showed that before the intervention, there was no statistically significant difference in the improvement of the condition, self-care ability, depression, mania, quality of life, medication compliance, and social adaptation scores between the two groups. After 12 weeks of intervention, the improvement score of the study group’s condition and self-care ability score were higher than that of the control group.ConclusionsThe combination of group psychological counseling and criminal law protection education can enhance the treatment effect of underage bipolar disorder patients, improve their quality of life, alleviate negative emotions, and achieve better nursing outcomes.

Deficits in Key Brain Network for Social Interaction in Individuals with Schizophrenia.

Individuals with schizophrenia (SZ) show impairment in social functioning. The reward network and the emotional salience network are considered to play important roles in social interaction. The current study investigated alterations in the resting-state (rs-) amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo) and functional connectivity (fc) in the reward network and the emotional salience network in SZ patients. MRI scans were collected from 60 subjects, including 30 SZ patients and 30 matched healthy controls. SZ symptoms were measured using the Positive and Negative Syndrome Scale (PANSS). We analyzed the ALFF, fALFF and ReHo in key brain regions in the reward network and emotional salience network as well as rs-fc among the bilateral amygdala, lateral orbitofrontal cortex (OFC), medial OFC and insula between groups. The SZ patients demonstrated increased ALFF in the right caudate and right putamen, increased fALFF and ReHo in the bilateral caudate, putamen and pallidum, along with decreased fALFF in the bilateral insula. Additionally, reduced rs-fc was found between the right lateral OFC and the left amygdala, which simultaneously belong to the reward network and the emotional salience network. These findings highlight the association between impaired social functioning in SZ patients and aberrant resting-state ALFF, fALFF, ReHo and fc. Future studies are needed to conduct network-based statistical analysis and task-state fMRI, reflecting live social interaction to advance our understanding of the mechanism of social interaction deficits in SZ.