Neurobehavioral Condition Research Articles

Improving delirium assessments in acute senior health: A quality improvement project for care of the older person

BackgroundDelirium is a common and reversible neurobehavioral condition with significant morbidity and mortality ramifications for older patients. Consequentially, clear guidelines exist pertaining to its swift identification and management. However, studies suggest that adherence to these guidelines are poor. This audit aimed to evaluate compliance to the National Institute for Health and Care Excellence’s (NICE) delirium guidelines in an Acute Senior Health Unit (ASHU) and to present a single centre experience of a low-cost ward-based intervention for improving delirium guideline adherence.MethodsA retrospective observational audit was conducted on patients admitted to ASHU between 01/07/2023 and 30/07/2023. Data on delirium assessments, diagnoses and causes of delirium were obtained through retrospective database searches. Posters and education based multidisciplinary team (MDT) interventions were designed and initiated following grounded thematic literature analysis and ward discussion. A methodically equivalent audit was then conducted between 01/09/2023 and 30/09/23. Data was anonymised and blinded and analysis was performed on SPSS V12.0.ResultsA total of 128 patients were included in the study. Initial audit revealed suboptimal compliance with NICE recommendations. Chi-square test of independence found that patients were statistically more likely to receive a full delirium assessment (1.9% vs. 56.6%, p = 0.001) and formal diagnosis (5.8% vs. 27.6%, p = 0.002) after the ward-based intervention.ConclusionThis study provides limited evidence in favour of low-cost MDT based interventions for improving adherence to NICE delirium guidelines and provides a 5-step framework for future studies. This study also explores the potential patient implications of these interventions. A repeat audit should be conducted to ensure lasting and sustainable change is achieved.Trial registration/clinical trial numberAUDI003614.

JNK Signaling Positively Regulates Acute Ethanol Tolerance in C. elegans.

Alcohol use disorder (AUD) is a chronic neurobehavioral condition characterized by a cycle of tolerance development, increased consumption, and reinstated craving and seeking behaviors during withdrawal. Understanding the intricate mechanisms of AUD necessitates reliable animal models reflecting its key features. Caenorhabditis elegans (C. elegans), with its conserved nervous system and genetic tractability, has emerged as a valuable model organism to study AUD. Here, we employ an ethanol vapor exposure model in Caenorhabditis elegans, recapitulating AUD features while maintaining high-throughput scalability. We demonstrate that ethanol vapor exposure induces intoxication-like behaviors, acute tolerance, and ethanol preference, akin to mammalian AUD traits. Leveraging this model, we elucidate the conserved role of c-jun N-terminal kinase (JNK) signaling in mediating acute ethanol tolerance. Mutants lacking JNK signaling components exhibit impaired tolerance development, highlighting JNK's positive regulation. Furthermore, we detect ethanol-induced JNK activation in C. elegans. Our findings underscore the utility of C. elegans with ethanol vapor exposure for studying AUD and offer novel insights into the molecular mechanisms underlying acute ethanol tolerance through JNK signaling.

Epigenetic underpinnings of the autistic mind: Histone modifications and prefrontal excitation/inhibition imbalance.

Autism spectrum disorder (ASD) is complex neurobehavioral condition influenced by several cellular and molecular mechanisms that are often concerned with synaptogenesis and synaptic activity. Based on the excitation/inhibition (E/I) imbalance theory, ASD could be the result of disruption in excitatory and inhibitory synaptic transmission across the brain. The prefrontal cortex (PFC) is the chief regulator of executive function and can be affected by altered neuronal excitation and inhibition in the course of ASD. The molecular mechanisms involved in E/I imbalance are subject to epigenetic regulation. In ASD, altered enrichment and spreading of histone H3 and H4 modifications such as the activation-linked H3K4me2/3, H3K9ac, and H3K27ac, and repression-linked H3K9me2, H3K27me3, and H4K20me2 in the PFC result in dysregulation of molecules mediating synaptic excitation (ARC, EGR1, mGluR2, mGluR3, GluN2A, and GluN2B) and synaptic inhibition (BSN, EphA7, SLC6A1). Histone modifications are a dynamic component of the epigenetic regulatory elements with a pronounced effect on patterns of gene expression with regards to any biological process. The excitation/inhibition imbalance associated with ASD is based on the excitatory and inhibitory synaptic activity in different regions of the brain, including the PFC, the ultimate outcome of which is highly influenced by transcriptional activity of relevant genes.

Neurobehavioral perspectives on autistic spectrum disorder

Understanding genetics and environmental influences in autism has been explored in greater depth in recent decades. However, the mechanism by which they converge that leads to autism still needs to be explored further. An autism diagnosis in DSM-5 results from a neurodevelopmental disorder hurting normal brain function, affecting communication and social interaction combined with restricted or repetitive patterns of behavior and interests. This paper reviews current work investigating how the underlying mechanism of the brain structure and function relates to the complex and aberrant behavioral manifestations of autism. Mapping this connection can provide us with a better understanding of autism signs and symptoms, making the process of accurate diagnosis more straightforward. As a complex neurobehavioral condition, autistic individuals process the environment and their interactions with others differently from those without autism. So, they make different perceptions and connections between themselves and the environment. Consequently, they will have difficulty communicating, forming relationships, and responding appropriately to their environment. It is this lifelong neurobehavioral dysfunction that prevents autistic individuals from adequately understanding what they perceive and the emotional expression of others. There will be differences in their mental states, how their brains work, and how their thinking processes will be affected by a neurodevelopmental disability.

Neurobehavioral Changes Associated with Rheumatic Fever and Rheumatic Heart Disease: A Narrative Review

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions triggered by Group A Streptococcus skin or throat infections. If ARF/RHD is undetected, misdiagnosed or antibiotic treatment is not provided early, patients may develop cardiac failure, leading to premature death. Although it is an easily preventable disease, ARF/RHD remains the most significant cause of heart disease-associated deaths in people under 25 years old, both in low- and middle-income countries and among First Nations in high-income countries. Up to 30% of the patients with ARF/RHD present with a neurobehavioral condition – Sydenham’s chorea (SC). The clinical course of SC is mostly self-limiting and is characterized by the onset of involuntary choreiform movements and neuropsychiatric features such as obsessive-compulsive disorder, tics, depression and anxiety, psychosis, and attention-deficit hyperactivity disorder. While the precise mechanism as to why only a proportion of patients with ARF/RHD develop SC remains unknown, an impaired blood–brain barrier is considered to play a central role in its development. The most well-characterized neurobehavioral outcome is stroke which may occur in isolation or as part of systemic thromboembolism. Both infective endocarditis and mitral valve disease with or without aortic valve disease increase the embolic and ischemic stroke risk. ARF/RHD is known to significantly impact the quality of life with neuropsychiatric consequences. Another neurobehavioral syndrome which occurs in the absence of ARF/RHD is “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections” (PANDAS). PANDAS has been categorized as a subset of pediatric acute-onset neuropsychiatric syndromes. However, establishing a diagnosis of PANDAS has been challenging. In this review, we discuss the current status of our understanding regarding the different manifestations of poststreptococcal neurobehavioral changes. Particular attention is given to ARF/RHD-associated SC, and we highlight the areas for further research to understand the association between poststreptococcal sequelae and neurobehavioral abnormalities.

Minimally conscious state plus versus minus: Likelihood of emergence and long-term functional independence.

Severe brain injuries can result in disorders of consciousness, such as the Minimally Conscious State (MCS), where individuals display intermittent yet discernible signs of conscious awareness. The varied levels of responsiveness and awareness observed in this state have spurred the progressive delineation of two subgroups within MCS, termed "plus" (MCS+) and "minus" (MCS-). However, the clinical validity of these classifications remains uncertain. This study aimed to investigate and compare the likelihood of emergence from MCS, as well as the functional independence after emergence, in individuals categorized as in MCS+ and MCS-. Demographic and behavioral data of 80 participants, admitted as either in MCS+ (n = 30) or MCS- (n = 50) to a long-term neurorehabilitation unit, were retrospectively analyzed. The neurobehavioral condition of each participant was evaluated weekly until discharge, demise, or emergence from MCS. The functional independence of those participants who emerged from MCS was assessed 6 months after emergence. While only about half of the individuals classified as in MCS- (n = 24) emerged from the MCS, all those admitted as in MCS+ did, and in a shorter postinjury period. Despite these differences, all individuals who emerged from the MCS demonstrated similar high disability and low functional independence 6 months after emergence, regardless of their state at admission. Individuals classified as MCS+ exhibited a higher likelihood of emergence and a shorter time to emergence compared to those in MCS-. However, the level of functional independence 6 months after emergence was found to be unrelated to the initial state at admission.

Which information derived from the Coma Recovery Scale-Revised provides the most reliable prediction of clinical diagnosis and recovery of consciousness? A comparative study using machine learning techniques.

The Coma Recovery Scale-Revised (CRS-R) is the most recommended clinical tool to examine the neurobehavioral condition of individuals with disorders of consciousness (DOCs). Different studies have investigated the prognostic value of the information provided by the conventional administration of the scale, while other measures derived from the scale have been proposed to improve the prognosis of DOCs. However, the heterogeneity of the data used in the different studies prevents a reliable comparison of the identified predictors and measures. This study investigates which information derived from the CRS-R provides the most reliable prediction of both the clinical diagnosis and recovery of consciousness at the discharge of a long-term neurorehabilitation program. Retrospective observational multisite study. The enrollment was performed in three neurorehabilitation facilities of the same hospital network. A total of 171 individuals with DOCs admitted to an inpatient neurorehabilitation program for a minimum of 3 months were enrolled. Machine learning classifiers were trained to predict the clinical diagnosis and recovery of consciousness at discharge using clinical confounders and different metrics extracted from the CRS-R scale. Results showed that the neurobehavioral state at discharge was predicted with acceptable and comparable predictive value with all the indices and measures derived from the CRS-R, but for the clinical diagnosis and the Consciousness Domain Index, and the recovery of consciousness was predicted with higher accuracy and similarly by all the investigated measures, with the exception of initial clinical diagnosis. Interestingly, the total score in the CRS-R and, especially, the total score in its subscales provided the best overall results, in contrast to the clinical diagnosis, which could indicate that a comprehensive measure of the clinical diagnosis rather than the condition of the individuals could provide a more reliable prediction of the neurobehavioral progress of individuals with prolonged DOC. The results of this work have important implications in clinical practice, offering a more accurate prognosis of patients and thus giving the possibility to personalize and optimize the rehabilitation plan of patients with DoC using low-cost and easily collectable information.

Obsessive-Compulsive Disorder in Children and Adolescents.

Obsessive-compulsive disorder (OCD) in children and adolescents is a neurobehavioral condition that can lead to functional impairment in multiple domains and decreased quality of life. We review the clinical presentation, diagnostic considerations, and common comorbidities of pediatric OCD. An overview of the biological and psychological models of OCD is provided along with a discussion of developmental considerations in youth. We also describe evidence-based treatments for OCD in childhood and adolescence, including cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) and pharmacotherapy. Finally, research evaluating the delivery of CBT in different formats and modalities is discussed, and we conclude with suggestions for future research directions.

Development of an electronic medical record provider evaluation template for children with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral condition in children. Current guidelines recommend that Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) criteria be met before diagnosing ADHD. However, 14-49% of providers are not documenting the use of DSM-V criteria in screening and diagnosis. The use of a standardized electronic health record (EHR) ADHD template is a potential option to assist providers with documenting the DSM-V criteria. The aim for this project was to provide a 1-hour educational in-service on the use of the DSM-V criteria, Vanderbilt rating scale, and a revised EHR ADHD template, and to assess provider use pre and post intervention. Results showed that few providers (n = 1; 2%) document using DSM-V criteria preintervention and post intervention with only a modest increase in template use (n = 3; 5%). However, there were statistical differences between provider type with advanced practice registered nurses and physician assistants screening more frequently using the EHR DSM-V ADHD template compared with physicians (p = .009). Future studies are needed to evaluate barriers to use, including practice preference, openness to change, and other factors that may affect provider workflow.

Diagnosis-Based Hybridization of Multimedical Tests and Sociodemographic Characteristics of Autism Spectrum Disorder Using Artificial Intelligence and Machine Learning Techniques: A Systematic Review.

Autism spectrum disorder (ASD) is a complex neurobehavioral condition that begins in childhood and continues throughout life, affecting communication and verbal and behavioral skills. It is challenging to discover autism in the early stages of life, which prompted researchers to intensify efforts to reach the best solutions to treat this challenge by introducing artificial intelligence (AI) techniques and machine learning (ML) algorithms, which played an essential role in greatly assisting the medical and healthcare staff and trying to obtain the highest predictive results for autism spectrum disorder. This study is aimed at systematically reviewing the literature related to the criteria, including multimedical tests and sociodemographic characteristics in AI techniques and ML contributions. Accordingly, this study checked the Web of Science (WoS), Science Direct (SD), IEEE Xplore digital library, and Scopus databases. A set of 944 articles from 2017 to 2021 is collected to reveal a clear picture and better understand all the academic literature through a definitive collection of 40 articles based on our inclusion and exclusion criteria. The selected articles were divided based on similarity, objective, and aim evidence across studies. They are divided into two main categories: the first category is “diagnosis of ASD based on questionnaires and sociodemographic features” (n = 39). This category contains a subsection that consists of three categories: (a) early diagnosis of ASD towards analysis, (b) diagnosis of ASD towards prediction, and (c) diagnosis of ASD based on resampling techniques. The second category consists of “diagnosis ASD based on medical and family characteristic features” (n = 1). This multidisciplinary systematic review revealed the taxonomy, motivations, recommendations, and challenges of diagnosis ASD research in utilizing AI techniques and ML algorithms that need synergistic attention. Thus, this systematic review performs a comprehensive science mapping analysis and identifies the open issues that help accomplish the recommended solution of diagnosis ASD research. Finally, this study critically reviews the literature and attempts to address the diagnosis ASD research gaps in knowledge and highlights the available ASD datasets, AI techniques and ML algorithms, and the feature selection methods that have been collected from the final set of articles.

The Effects of Drugs used for the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) on Pregnancy Outcome and Breast-feeding: A Critical Review.

Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral condition found in 5-10% of school-age children and in 2-5% of adults. Stimulants affecting the dopaminergic, noradrenergic and/or serotonergic systems are commonly used for treatment in children and adults, including women of childbearing age. The data on the effects of stimulants (methylphenidate and amphetamines) in pregnancy are generally reassuring, but methylphenidate might slightly increase the rate of cardiac malformations and of spontaneous abortions, while amphetamines might slightly increase the risk for premature birth, low birth weight and other pregnancy complications. Bupropion, a dopamine and norepinephrine reuptake inhibitor, when used as an antidepressant, appears to be safe in pregnancy. The data on the use of atomoxetine, guanfacine and clonidine in pregnancy are scarce. Importantly, there are practically no data on the long-term neurodevelopmental effects of most of these drugs. The published data on the development of children born to methamphetamine-abusing women may be misleading since these women generally use other drugs, including alcohol, and the home environment where the child is raised may not be optimal. The treating physician should judge the need for treatment during pregnancy in relation to the severity of the clinical symptoms. If needed, methylphenidate is preferred over amphetamines because breast feeding is possible. If one uses non-stimulant medications, bupropion seems to be the preferred drug.

When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress.

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for.

Impact of nutrition education program on caregivers influencing the dietary practices of autistic children

Autism is a complex neurobehavioral condition that includes disability in social connection, formative language, and relational abilities joined with inflexible behaviors. Children with autism experience difficulty in communication.

Practical guide and some recommendations for the diagnosis and management of Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is described as the most common neurobehavioral condition of childhood. Symptoms include difficulty concentrating, hyperactivity and poorly controlled impulsivity. ADHD always manifests in childhood, children with the syndrome rush around the room, switch their attention from one to the other, cannot calm down and take lessons or reading. ADHD may persist into adulthood causing disruptions to both professional and personal life. The pharmacotherapy of ADHD is cost-effective, but treatment should be individual. Main outlines of clinical practice guide on management of ADHD of Academy of Medicine and Ministry of Health of Singapore are discussed in this article. Some focus on diagnostic process and associated with ADHD problems is emphasized. It can be invaluable example for the specialists engaged in the treatment of the children with this psychiatric disorder.

Getting the Lay of the Land: Human and Animal Evidence on Environmental Chemicals and Autism.

Getting the Lay of the Land: Human and Animal Evidence on Environmental Chemicals and Autism.

Morphological features of the ventral tegmental area: a brainstem structure related to attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is the most common behavioral disorder of the childhood and more interest is raised by clinical investigators nowadays. In spite of being the most studied neurobehavioral condition in child psychiatry, the pathophysiology of ADHD remains elusive. The ventral tegmental area (VTA) has been implicated in the etiology of ADHD. This part of the midbrain needs to be investigated further due to its complex cytoarchitecture and connectivity in order to gain insight into the neurobiology of ADHD. In this review, we will first briefly explain the history of the VTA researches and then summarize the anatomical features and connectivity of this region.

Effects of Narrative Therapy and Computer-Assisted Cognitive Rehabilitation on the Reduction of ADHD Symptoms in Children

BACKGROUND AND OBJECTIVE: Attention deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral condition in children, which adversely affects the psychological function of children in educational, social, and emotional areas. Use of non-pharmacological treatment methods, such as narrative therapy and computerassisted cognitive rehabilitation, is necessary for ADHD patients due to lack of side effects and concerns regarding medication therapy. This study aimed to evaluate the effects of narrative therapy and computer-assisted cognitive rehabilitation on the symptoms of ADHD in children. METHODS: This quasi-experimental study was conducted in Sari, Iran during June-February 2015 using the pretestposttest approach with a control group. In total, 30 children aged 7-12 years diagnosed with ADHD were selected and divided into three groups. Children of the first group received eight sessions of narrative therapy, while the second group received 10 sessions of computer-assisted cognitive rehabilitation, and the third group received no training. Data were collected using the Raven’s colored matrices, Conners' Parent Rating Scale (CPRS-48), and CogniPlus software. FINDINGS: Mean post-test scores of ADHD symptoms were 20.1±5.21 and 20±3.55 in the narrative therapy and computer-assisted cognitive rehabilitation groups, respectively; however, no significant difference was observed between the groups in this regard. Moreover, these scores were 37.4±9.84 and 38.95±9.06 in the control group, which showed a significant difference compared to the experimental groups (p<0.05). CONCLUSION: According to the results of this study, narrative therapy and computer-assisted cognitive rehabilitation could remarkably reduce ADHD symptoms in children.

An integrative neurocircuit perspective on psychogenic nonepileptic seizures and functional movement disorders: neural functional unawareness.

Functional neurological disorder (conversion disorder) is a neurobehavioral condition frequently encountered by neurologists. Psychogenic nonepileptic seizure (PNES) and functional movement disorder (FMD) patients present to epileptologists and movement disorder specialists respectively, yet neurologists lack a neurobiological perspective through which to understand these enigmatic groups. Observational research studies suggest that PNES and FMD may represent variants of similar (or the same) conditions given that both groups exhibit a female predominance, have increased prevalence of mood-anxiety disorders, frequently endorse prior abuse, and share phenotypic characteristics. In this perspective article, neuroimaging studies in PNES and FMD are reviewed, and discussed using studies of emotional dysregulation, dissociation and psychological trauma in the context of motor control. Convergent neuroimaging findings implicate alterations in brain circuits mediating emotional expression, regulation and awareness (anterior cingulate and ventromedial prefrontal cortices, insula, amygdala, vermis), cognitive control and motor inhibition (dorsal anterior cingulate, dorsolateral prefrontal, inferior frontal cortices), self-referential processing and perceptual awareness (posterior parietal cortex, temporoparietal junction), and motor planning and coordination (supplementary motor area, cerebellum). Striatal-thalamic components of prefrontal-parietal networks may also play a role in pathophysiology. Aberrant medial prefrontal and amygdalar neuroplastic changes mediated by chronic stress may facilitate the development of functional neurological symptoms in a subset of patients. Improved biological understanding of PNES and FMD will likely reduce stigma and aid the identification of neuroimaging biomarkers guiding treatment development, selection, and prognosis. Additional research should investigate neurocircuit abnormalities within and across functional neurological disorder subtypes, as well as compare PNES and FMD with mood-anxiety-dissociative disorders.

Parent Training and Behavior Therapy on Behaviors of Children With Attention Deficit-Hyperactivity Disorder

Background: Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral condition characterized by poor attention, hyperactivity and misbehavior. Parent training and behavioral therapy are psychosocial techniques aimed at training parents to manage and change their children’s behavior. Objectives: This study examined the impact of parent training and behavioral therapy to control ADHD children. Patients and Methods: This research was a pretest-posttest study, conducted on 61 ADHD children selected randomly among referrals to psychological clinic (Hamdelan) Zahedan, Iran in 2010. Eight sessions of parent training based on the Barkley method and eight sessions of behavioral therapy were held for children's parents. The measurement tool was a researcher made questionnaires, consisting of diagnostic symptoms and features of ADHD based on DSM IV (diagnostic and statistical manual of mental disorders). Data were analyzed using t-test and SPSS software version 17. Results: Nine girls (14.8%) and 52 boys (85%), 6 - 14 years old, participated in the study. Mean scores showed that the symptoms reduced after intervention significantly (P < 0.01). The results indicated that parent training and behavioral therapy were effective in controlling ADHD children's behaviors. Conclusions: The results of the present study can greatly benefit ADHD children since behavioral training may have a greater impact, than just the medication therapy on their social life.

Prevalence of Attention Deficit Hyperactivity Disorder among children in selected schools at Nellore.

Attention Deficit Hyperactivity Disorder is a neurobehavioral condition characterized by excessive restlessness, inattention, distraction and impulsivity. It is usually identified when children are school aged, although it also can be diagnosed in people of all age groups.ADHD tends to improve with age but can cause significant interference in a child’s academics and interpersonal relations in the initial years.the aim of the study is to determine the prevalence of attention deficit hyper activity disorder among children in selected schools.A quantitative approach is adopted for this study. Descriptive research design was used. The setting selected for this study is Kuruganti Nagi Reddy Government high school B.V Nagar in Nellore. The target population of the study is children studying in primary schools. Samples consist of children between 5-12 years of age. The sample size of the study is of 100 children between 5-12 years of age.Non probability purposive sampling technique is adopted for this study.Study concluded that prevalence of ADHD symptoms among 100children 35children had ADHD symptoms and 6(17.2%) had oppositional defiant symptoms.