Psychosocial Dysfunction Research Articles

Drug Resistance in Epilepsy: Clinical Impact, Potential Mechanisms, and New Innovative Treatment Options.

Epilepsy is a chronic neurologic disorder that affects over 70 million people worldwide. Despite the availability of over 20 antiseizure drugs (ASDs) for symptomatic treatment of epileptic seizures, about one-third of patients with epilepsy have seizures refractory to pharmacotherapy. Patients with such drug-resistant epilepsy (DRE) have increased risks of premature death, injuries, psychosocial dysfunction, and a reduced quality of life, so development of more effective therapies is an urgent clinical need. However, the various types of epilepsy and seizures and the complex temporal patterns of refractoriness complicate the issue. Furthermore, the underlying mechanisms of DRE are not fully understood, though recent work has begun to shape our understanding more clearly. Experimental models of DRE offer opportunities to discover, characterize, and challenge putative mechanisms of drug resistance. Furthermore, such preclinical models are important in developing therapies that may overcome drug resistance. Here, we will review the current understanding of the molecular, genetic, and structural mechanisms of ASD resistance and discuss how to overcome this problem. Encouragingly, better elucidation of the pathophysiological mechanisms underpinning epilepsies and drug resistance by concerted preclinical and clinical efforts have recently enabled a revised approach to the development of more promising therapies, including numerous potential etiology-specific drugs (“precision medicine”) for severe pediatric (monogenetic) epilepsies and novel multitargeted ASDs for acquired partial epilepsies, suggesting that the long hoped-for breakthrough in therapy for as-yet ASD-resistant patients is a feasible goal.Significance StatementDrug resistance provides a major challenge in epilepsy management. Here, we will review the current understanding of the molecular, genetic, and structural mechanisms of drug resistance in epilepsy and discuss how the problem might be overcome.

Modern Radiotherapy for Pediatric Brain Tumors.

Cancer is a leading cause of death in children with tumors of the central nervous system, the most commonly encountered solid malignancies in this population. Radiotherapy (RT) is an integral part of managing brain tumors, with excellent long-term survival overall. The tumor histology will dictate the volume of tissue requiring treatment and the dose. However, radiation in developing children can yield functional deficits and/or cosmetic defects and carries a risk of second tumors. In particular, children receiving RT are at risk for neurocognitive effects, neuroendocrine dysfunction, hearing loss, vascular anomalies and events, and psychosocial dysfunction. The risk of these late effects is directly correlated with the volume of tissue irradiated and dose delivered and is inversely correlated with age. To limit the risk of developing these late effects, improved conformity of radiation to the target volume has come from adopting a volumetric planning process. Radiation beam characteristics have also evolved to achieve this end, as exemplified through development of intensity modulated photons and the use of protons. Understanding dose limits of critical at-risk structures for different RT modalities is evolving. In this review, we discuss the physical basis of the most common RT modalities used to treat pediatric brain tumors (intensity modulated radiation therapy and proton therapy), the RT planning process, survival outcomes for several common pediatric malignant brain tumor histologies, RT-associated toxicities, and steps taken to mitigate the risk of acute and late effects from treatment.

Estrogen Formation and Inactivation Following TBI: What we Know and Where we Could go.

Traumatic brain injury (TBI) is responsible for various neuronal and cognitive deficits as well as psychosocial dysfunction. Characterized by damage inducing neuroinflammation, this response can cause an acute secondary injury that leads to widespread neurodegeneration and loss of neurological function. Estrogens decrease injury induced neuroinflammation and increase cell survival and neuroprotection and thus are a potential target for use following TBI. While much is known about the role of estrogens as a neuroprotective agent following TBI, less is known regarding their formation and inactivation following damage to the brain. Specifically, very little is known surrounding the majority of enzymes responsible for the production of estrogens. These estrogen metabolizing enzymes (EME) include aromatase, steroid sulfatase (STS), estrogen sulfotransferase (EST/SULT1E1), and some forms of 17β-hydroxysteroid dehydrogenase (HSD17B) and are involved in both the initial conversion and interconversion of estrogens from precursors. This article will review and offer new prospective and ideas on the expression of EMEs following TBI.

Quality of Life in Bell's Palsy: Correlation with Sunnybrook and House-Brackmann Over Time.

To compare patient-graded facial and social/well-being function with physician-graded facial function in Bell's palsy over time. A prospective follow-up study at two tertiary otorhinolaryngological centers. A total of 96 patients, 36 women and 60 men, aged 18-77 years, were included. Facial Clinimetric Evaluation (FaCE) scale and Facial Disability Index (FDI) scores were compared with Sunnybrook and House-Brackmann scores. Inclusion was on mean day 7 (96 patients) and follow-up on days 53 (81 patients) and 137 (32 patients). Initially, correlations between FaCE total score, FaCE domains, FDI physical function, FDI social/well-being function and Sunnybrook and House-Brackmann scores were low to fair, except for FaCE facial movement (r = 0.55). Correlations between FaCE total score and Sunnybrook score were very good to excellent at visits 2 (r = 0.83) and 3 (r = 0.81). Women scored FaCE social and FDI social/well-being function lower than men, despite similar Sunnybrook scores. In early stages of Bell's palsy, there were low to fair correlations between FaCE/FDI (except for facial movement) and Sunnybrook score. This implies that the design of the quality of life (QoL) instruments is less suited for the acute phase. The high correlations at follow-ups suggest that the questionnaires can be used for evaluation of QoL over time. Our results indicate that women experience more facial palsy-related psychosocial dysfunction. 4 Laryngoscope, 131:E612-E618, 2021.

A meta-analysis of psychodynamic treatments for borderline and cluster C personality disorders.

Personality disorders (PD) carry high psychosocial dysfunction and are associated with treatment resistance in nonspecialized care. Psychodynamic therapies (PDT) are often used to treat PDs, but there has never been a systematic meta-analysis of PDT trials for PD. To evaluate the evidence base for PDTs for PDs across multiple outcome domain, a systematic search for PDT for PD trials was conducted through PubMed and PsycINFO. Sixteen trials were identified, comprising 19 dynamic, 8 active, and 9 control groups predominantly reflecting treatment of borderline and mixed Cluster C PDs, and a random effects meta-analysis was undertaken. PDTs were superior to controls in improving core PD symptoms (g = -0.63; 95% confidence interval [CI; -0.87, -0.41]), suicidality (g = -0.79, p = .02; 95% CI [-1.38, -0.20]), general psychiatric symptoms (g = -0.47; 95% CI [-0.69, -0.25]), and functioning (g = -0.66; 95% CI [-1.01, -0.32]), but not for interpersonal problems due to heterogeneity (g = -1.25; 95% CI [-3.22, 0.71]). Outcomes for PDTs were not different from other active treatments in core PD (g = 0.05; 95% CI [-0.25, 0.35]) or other symptoms. This pattern continued into posttreatment follow-up (average 14 months). Study quality was generally rated as adequate and was unrelated to outcomes. Compared with other treatments, PDTs do not have different acute effects and are superior to controls, although only trials treating BPD employed active controls and non-BPD trials were of lower quality. Underresearched areas include narcissistic PD, specific Cluster C disorders, and personality pathology as a continuous construct. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Multiple risk factors affecting childhood psychosocial dysfunction in primary school Egyptian children

BackgroundChildhood psychosocial dysfunction (CPD) is an important cause of morbidity among children, and its frequency in primary care is growing. The information about its prevalence and risk factors is weak in many developing countries. The study aims to determine the prevalence of psychosocial problems among primary school children and identify the risk factors associated with childhood psychosocial dysfunction.ResultsA cross-sectional study was conducted on 368 primary school children aged 6–12 years. About (19.0%) of the studied sample had probable CPD according to Strengths and Difficulties Questionnaire (SDQ). CPD was statistically associated with older age group, male sex, and low social class.The association between biological and medical risk factors of the studied group and CPD showed statistical significant relations between CPD and low body weight (n = 35, 50.7%), maternal history of problems with pregnancy (n = 26, 66.47%), history of receiving medications during pregnancy (n = 13, 86.7%), abnormal general condition of baby at birth (n = 57, 16.2%), family history of mental disorders (n = 2, 100%), medical history of congenital diseases (n = 9, 90%), acute medical disorders (n = 29, 90.6%), chronic diseases, receiving medications (n = 22, 91.7%), and exposure to trauma (n = 27, 84.4%).Also, The association between psychosocial risk factors and CPD revealed high statistical significant relation between CPD among the studied children and presence of family problems (n = 33, 62.3%), living with single parent (n = 15, 71.4%), parent(s) death (n = 12, 63.2%), major changes in the family (n = 39, 79.6%), parent(s) smoking status (n = 22, 51.2%), and parent(s) addiction (n = 4, 100%).Moreover, there was statistical significant relation between CPD among the studied children and poor academic achievement (n = 19, 27.5%), problems with teachers (n = 25, 33.3%), problems with peers (n = 22, 51.2%), and exposure to violence (n = 56, 22.4%).ConclusionsPsychosocial dysfunction is common among Egyptian school children. It is associated with many risk factors. Hence, mental health services should be incorporated into primary health care facilities and school health program. Also, training of family physicians and primary health care providers is crucial.

Clonazepam add-on therapy for drug-resistant epilepsy.

This is an updated version of the original Cochrane Review published in 2018, Issue 5. Epilepsy affects over 70 million people worldwide, and nearly a quarter of patients with seizures have drug-resistant epilepsy. People with drug-resistant epilepsy have increased risks of premature death, injuries, psychosocial dysfunction, and a reduced quality of life. To assess the efficacy and tolerability of clonazepam when used as an add-on therapy for adults and children with drug-resistant focal onset or generalised onset epileptic seizures, when compared with placebo or another antiepileptic agent. For the latest update we searched the following databases on 4 June 2019: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid) 1946 to 3 June, 2019. The Cochrane Register of Studies (CRS Web) includes the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), and randomised or quasi-randomised, controlled trials from Embase, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP). Double-blind randomised controlled studies of add-on clonazepam in people with resistant focal or generalised onset seizures, with a minimum treatment period of eight weeks. The studies could be of parallel or cross-over design. Two review authors independently selected studies for inclusion, extracted relevant data, and assessed trial quality. We contacted study authors for additional information. We found no double-blind randomised controlled trials which met the inclusion criteria. There is no evidence from double-blind randomised controlled trials for or against the use of clonazepam as an add-on therapy for adults and children with drug-resistant focal or generalised onset epileptic seizures. Since the last version of this review no new studies have been found.

Assessment of Family Burden of Patients Suffering from Schizophrenia-Need of the Hour

Background: Schizophrenia is a debilitating, persistent disorder that requires continuous care and support. Families of Schizophrenic patient provide proper help, care and support to these people. Objectives: 1) To assess the burden on the families of patients suffering from schizophrenia. 2) To find out the relationship of family burden with social functioning, psychosocial dysfunction and the severity of illness. Material and Methods: It was a hospital based, cross-sectional study for the duration of 6 months. Purposive sampling was used to select 100 study participants. Out of the total, 50 study subjects were diagnosed cases of schizophrenia and 50 subjects were diabetic patients taken as controls. These patients had either spouse or other first degree relative as their caregivers. Two pre-tested, semi-structured questionnaire was used for data collection. The clinical symptomatology of the patients was assessed by Positive and Negative Syndrome Scale (PANSS). Dysfunction was assessed by Dysfunction Analysis Questionnaire (D.A.Q.). The Family Burden Interview schedule was used to assess the family burden. Quantitative data was expressed in the form of mean, standard deviation and using Student’s T-test. Qualitative variables were expressed as percentages and proportions and chi-square test. Statistically significant findings were considered when p value<0.05. Correlation was also seen between various socio-demographic variables. Result: All the caregivers of schizophrenic patients experienced moderate to severe burden in all the areas. Total burden among caregivers of schizophrenic patients was much higher as compared to diabetic patients which was statistically significant also. Conclusion-Families of schizophrenic patients carry a significant burden as compared to diabetes in terms of social, vocational, personal, familial and cognitive areas. Psychosocial intervention program should be instituted on the basis of proper assessment of key caregivers regarding their coping styles, communication skills and community resources. How to cite this article:Sunda LC, Kumari S, Sunda H. Assessment of Family Burden of Patients Suffering from Schizophrenia-Need of the Hour. J Adv Res Psychol Psychother 2019; 2(3&4): 11-22. DOI: https://doi.org/10.24321/2581.5822.201911

Between a rock and a hard place: Associations between Mentzos' "dilemma", self-reported interpersonal problems, and psychosocial functioning in individuals with non-affective psychoses.

Primary aim of this study was to determine the extent and type of self-reported interpersonal problems in patients with non-affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma", which describes an insufferable inner tension caused by an individual's struggle of being torn between "self-oriented" and "object-oriented" tendencies. In a cross-sectional study among 129 patients with non-affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' "dilemma" were obtained during a clinical research visit. Self-report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP-64D) and compared with a German representative standard sample. Second, IIP-64D scores were compared between groups with or without Mentzos' "dilemma". Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP-64D scores differed significantly from healthy controls, except for "self-centred" and "intrusive" interpersonal styles. Participants with a potential "psychotic dilemma" scored significantly higher on the subscales: "domineering", "self-centred", "cold", and "socially avoidant" than the group without a "psychotic dilemma". The total amount of interpersonal problems, and particularly high scores on the IIP-64D "socially avoidant" subscale, predicted psychosocial dysfunction, whereas a "cold" interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma".

Patient perceptions of misdiagnosis of endometriosis: results from an online national survey.

Background Endometriosis is an estrogen-dependent disease affecting 10% of females in which endometrial-like tissue grows outside the uterus, resulting in pain, infertility, and physical and psychosocial dysfunction. Prior research documenting diagnostic error reports a 6.7-year mean diagnostic delay. This study takes a patient-oriented approach and aims to complement prior research on diagnostic error by examining patient-reported experiences with misdiagnosis. Methods Data were part of a larger online survey comprising nonrandomly sampled patients with self-reported surgically confirmed endometriosis (n = 758). We examined patients' reports of misdiagnosis, to which healthcare professionals (HCPs) they attributed misdiagnosis, mean diagnostic delay, and endometriosis symptoms and physical sites predicting misdiagnosis reports. Results Mean reported diagnostic delay was 8.6 years. 75.2% of patients reported being misdiagnosed with another physical health (95.1%) and/or mental health problem (49.5%) and most frequently by gynecologists (53.2%) followed by general practitioners (34.4%). Higher odds of reporting a physical or mental health misdiagnosis was associated with reports of virtually all symptoms and endometriosis on the bladder, small bowel, pelvic sidewall, and rectum. Higher odds of reporting a physical health misdiagnosis was exclusively associated with reports of endometriosis on the appendix. Higher odds of reporting a mental health misdiagnosis was exclusively associated with reports of a younger symptom onset age; endometriosis on the diaphragm, large bowel, lung, and ureter; and comorbid adenomyosis diagnosis. Conclusions Endometriosis continues to present serious and complex diagnostic challenges. These findings corroborate previous objective investigations documenting endometriosis diagnostic error, establish the first patient-reported incidence, and further demonstrate value in including patients in diagnostic error research.

CARDIOVASCULAR AND HORMONAL DISORDERS AMONG WORKERS OCCUPATIONALLY-EXPOSED TO NOISE

Introduction: Noise exposure is a common risk factor for many health adverse effects like hearing impairment, cardiovascular diseases and psychosocial dysfunction. Hypercholesterolemia is suspected to be the main factor for the pathogenesis of prolonged noise-associated cardiovascular extra-auditory effects of occupationally-induced noise. Occupational stress and noise exposure were associated with lowering of total and free testosterone in active male workers which in turn was considered as a risk factor for cardiovascular disease, obesity and many other diseases causing overall mortality. Aim of work: To evaluate the environmental measurement of occupational noise intensity at different units of concrete pipes industry and to assess the effect of occupational noise exposure (either auditory or extra-auditory) on the exposed workers with emphasis on cardiovascular symptoms, serum cholesterol and testosterone levels. Materials and methods: A comparative cross sectional is conducted upon 105 male workers in a company for reinforced concrete pipes at Cairo, Egypt. The study group ages ranged from 24- 60 years. Duration of work ranged from 2- 40 years. The workers are classified into two groups: group (A): 52 workers who are exposed to high level noise ≥ 85dB, and group (B): 53 workers who are exposed to low level noise < 85dB.Both groups were interviewed using specially designed questionnaire with emphasis on occupational history ,cardiac history ,history of hearing impairment and sleep disturbances .Clinical (general and systemic) examination was done. Laboratory investigations were performed including serum total cholesterol level, total and free serum testosterone levels. Results: The prevalence of hearing impairment was significantly higher among workers exposed to noise level above 85dBA (61.5% ) as well as the prevalence of cardiac symptoms as palpitation , ischemic heart diseases and history of catheterization were significantly higher among workers from group (A) (53.8%, 40.4% and 15.4% respectively). The levels of total serum cholesterol were significantly higher among workers exposed to noise levels above 85dBA (odds Ratio = 17.6) while total and free testosterone were significantly lower among the same group. Conclusion: The current study revealed that exposure to chronic occupational noise above 85dBA was associated with hypercholesterolemia that leads in turn to cardiovascular disorders and also associated with low levels of serum testosterone hormone.

Assessment of disease-related knowledge among patients with chronic obstructive pulmonary disease: a cross-sectional study

Introduction. The main task of this study was to study the level of knowledge of the Ukrainian patient about chronic obstructive pulmonary disease (COPD), and the factors that cause and affect this indicator, with the help of a validated instrument. Methods. 41 patients were involved in the study. Socio-demographic data, information on the duration, course of the disease and cooperation with a physical therapist were collected. Anthropometric measurements, spirometry, pulse oximetry, tonometry were performed. Patients were surveyed with Modified Medical Research Council Dyspnea Scale, Hospital Anxiety and Depression Scale, Clinical COPD Questionnaire score, and Bristol COPD Knowledge Questionnaire (BCKQ). Bristol COPD Knowledge Questionnaire was translated, cross-culturally adapted and validated. Regression analysis was performed to determine relationships between the level of knowledge about the disease, socio-demographic data, indicators of respiratory system functional status, and survey data. Results. The average total score for BCKQ was 24.71±9.62 points. Patients gave the least number of correct answers to the question related to medical treatment. The level of knowledge depends on the factors such as age (β=-0.557; 95% CI: -1.041–0.086, p=0.086), duration of the disease (β=-0.114; 95% CI: -0.077–0.055, p=0.048), respiratory ratings, functional limitations, and own psychosocial dysfunction according to the CCQ scale (β =-0.506; 95% CI: -0.007–0.752, p=0.053), and the HADS depression score (β =-0.655; 95% CI: -4.257– -0.085, p=0.043). Conclusion. The level of knowledge of Ukrainian patients about COPD is low. More experience of the disease did not affect the increase in the level of knowledge. Older patients had a lower level of knowledge about their disease. Impact of body mass index, spirometry results, level of severity of shortness of breath, and symptoms of the disease on the level of knowledge was not revealed.

Prevalence and Presentation of Diabetes-Related Hypoglycemia Amongst Persons with Diabetes in a Tertiary Health Instition in Nigeria

Background: Hypoglycaemia is the most common acute complication of Diabetes Mellitus and often treatment-limiting, serious adverse effect of intensive diabetes therapy. Although it is preventable, hypoglycaemic episodes, especially if severe or recurrent may result in significant psychosocial dysfunction and lower quality of life. Aim: To determine the prevalence, frequency and timing of diabetes-related hypoglycaemia amongst persons with diabetes mellitus. Methods: This was a cross-sectional observational study involving patients attending the diabetes clinic and selected using systematic random sampling. An interviewer- administered questionnaire was used to obtain socio-demographic characteristics as well as experience of hypoglycaemia in the past 12months and severity graded. Data analysis was performed using SPSS 21.0, IBM SPSS Statistics, New York, USA Result: A total of 216 patients were recruited for the study. Eighty nine patients (41.2%) reported experiencing hypoglycaemia, out of which 46 (51.7%) occurred in the morning before breakfast and 16 (18.0%) experienced severe Hypoglycaemia. Skipped meal (58.4%) and overdose of GLA (31.5%) were the most common recognized causes of hypoglycaemia. Level 1 hypoglycaemia was the commonest grade of hypoglycaemia, while males and those on insulin alone had higher odds of having hypoglycaemia (P=0.059). Conclusion: The reported prevalence of hypoglycaemia amongst persons with diabetes mellitus within the last one year prior to the study was rather high which shows that hypoglycaemia is a common experience amongst type 2 diabetic undergoing management. Continuous patient education on the risks, causes, symptoms, and treatment of hypoglycaemia as well as self-monitoring of blood glucose is recommended for every person with diabetes at every health visits.

SCREENING ANALYSIS OF PSYCHOSOCIAL FUNCTIONING OF PRIMARY PUPILS AT SCHOOL

Currently, research on possible psychological and socio-psychological problems of children and adolescents during the period of their education is becoming increasingly important. Extensive use of short screening tests-questionnaires allows to identify possible deviations in the psychosocial functioning of ordinary children and adolescents, children with somatic diseases, victims of violence. The aim of the study was to increase the effectiveness of determining psychosocial dysfunction in children of primary school age by analyzing the results of a screening study. Using «Pediatric Symptom Checklist» methodology, including child (Y-PSC) and parent (PSC) versions in Ukrainian adaptation, 263 primary schoolchildren and 228 parents were examined by filling out a paper version or an online version. Statistical processing of the data was performed using t-test and one-way analysis of variance in a licensed SPSS Statistic v.20 software suite. With the help of adapted version of the methodology, it was determined that general average level of psychosocial functioning of primary pupils, according to Y-PSC, was exceeding the established norm, particularly during 2nd and 3rd study years; this fact can be the evidence of some stress in mechanisms of psychosocial adaptation during that period. According to the child version, critically high indicators were observed in 12.9% of cases – by attention subscale, in 33.1% – by internalization subscale, in 21.7% – by externalization subscale. According to parent version (PSC), critically high indicators were observed in 18.9% of cases – by attention subscale, in 7.9% – by internalization subscale, and in 32.9% – by externalization subscale. By one-way analysis of variance, it has been established that psychosocial state is affected by sex, grade and method of survey. For example, attention and externalization subscale indicators were higher in online data. In girls, there was a higher level of internalization, while in boys, veraciously – of externalization, according to both parent and child versions. Indicators by attention and externalization subscale have been significantly higher in first-graders, while the level of internalization – in students of 2nd and 3rd grade. Therefore, obtained results can be utilized as groundwork for further study of various age groups of schoolchildren and adolescents. Additionally, dynamic observation of risk group children while employing psychologists, primarily school psychologists, for support, psychological interventions, and psychoeducational programs, can produce certain reasonable activities for overcoming and deactualization of present deviations at a prenosological level.

Implications of Obstructive Sleep Apnea on the Cognitive Evolution of Alzheimer's Disease Patients

Background: Sleep-disordered breathing encompasses a group of diseases, of which obstructive sleep apnea (OSA) is most frequent. Alzheimer's disease (AD) is the most prevalent neurodegenerative disease; it is manifested as an initial deficit of episodic memory that evolves into global cognitive and psychosocial dysfunction, and its prevalence is increasing around the world. OSA has been described as a risk factor for AD, and its prevalence is higher in AD patients. However, little is known about the influence of OSA on cognition in the AD population.The aim of this study was to evaluate the impact of nontreated OSA on the cognitive evolution of patients with mild-moderate AD, to investigate whether the magnitude of the cognitive decline is associated with the severity of OSA and to evaluate the influence of OSA on several cognitive subdomains in AD patients. Methods: In this single-center study, patients with mild-moderate AD were recruited prospectively from a cognitive impairment unit and underwent overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) >15/h. AD severity was assessed using the Mini-Mental State Examination (MMSE). The primary outcome was to measure the change in cognitive score on the Alzheimer’s Disease Assessment Scale-cognitive scale (ADAS-cog) from baseline to 12 months in patients with mild AD with and without OSA. An extensive battery of neuropsychological tests, including the Epworth Sleepiness Scale (ESS), were performed and APOE status was measured. Findings: The cohort included 144 patients with a mean (SD) age of 75.19 (5.30) years; 72 (57.6%) were women, and the mean MMSE score was 23.5 (2.24) points at baseline. The mean (SD) change in the ADAS-cog score at 12 months was 3.19 (5.61) in the non-OSA group and 0.08 (5.62) in the OSA group, with a difference between the groups of -3.36 (95%CI 0.19 to 0.16; p=0.002). Regarding the changes in the ADAS-cog subitems at 12 months, ideational praxis, remembering test instructions and commands showed a significant difference between the groups (p<0.05). We did not observe significant differences in cognitive subdomains, such as memory or executive functioning, or for caregiver overload, on the extensive battery of neuropsychological assessments at 12 months. No significant differences were found according to OSA severity group by ADAS-cog or MMSE at 12 months neither at 36 months by MMSE.According to the MMSE score at 36 months, the mean change was similar between the groups, with a difference of 1.69 (95%CI -1.26 to 4.64; p = 0.445). Interpretation: In this large cohort of patients with AD, we demonstrated that that OSA did not worsen cognitive evolution after 1 year of follow-up, either in global cognition or in the different cognitive subdomains, or global cognition after 3 years of follow-up. Based on these findings, OSA does not modify the cognitive evolution of patients in mild or moderate stages of Alzheimer’s disease. Trial Registration: This study was registered with ClinicalTrials.gov (number NCT02814045). Funding Statement: This work was supported by “Fundacio La Marato TV3” (Gerard Pinol), the Spanish Respiratory Society (SEPAR), PERIS SLT008/18/00050, the Health Department of Generalitat de Catalunya and ALLER. This work was supported by the IRBLleida Biobank (B.0000682) and PLATAFORMA BIOBANCOS PT17/0015/0027/. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was conducted in accordance with the Declaration of Helsinki, and it was approved by the care ethics committee of Hospital Arnau de Vilanova de Lleida (CE-1218). All patients signed informed consent.

Stress Sensitivity and Signs of Anxiety or Depression among First Year Clinical Dental and Medical Students

Background: Negative stress symptoms are reported in the literature among clinical dental and medical students and can include signs of anxiety or depression. However, very little has been researched about existing psychological preconditions of these students that could make them more vulnerable to negative stress symptoms. Objective: The aims were to explore first year clinical dental and medical students’ experiences of stress intensity, stress sensitivity and signs of anxiety or depression. Gender was also explored as a possible predictor of these psychosocial phenomena. Methods: First year clinical students at Aarhus University dental (n = 49) and medical schools (n = 59) were recruited to fill out a 45-item questionnaire that comprised demographics and three scales: Cohens Perceived Personal Stress (PPS-10), Stress Sensitivity Inventory (SSI) and Depression Anxiety & Stress Scale (DASS-21). Groups and genders were compared by frequency and using association statistics, bivariate odds ratios, nominal logistic regression and ANOVA. Results: Stress intensity perceptions were moderate to high for many. Dental students scored higher than medical students on all mean test scores. In general, women showed higher levels of stress than men. Dental students scored significantly higher than medical students on Depression, Anxiety and Chronic Stress with ANOVA tests. However, when gender, age and medical or dental student status were added into a logistic regression analysis in which high stress sensitivity was the main dependent variable, only high scores in perceived stress intensity and signs of depression and anxiety showed significant main effects. Conclusion: Present study confirmed the literature that reports high degrees of stress among dental and medical students. But more importantly, Stress Sensitivity Inventory appeared to be a reliable and excellent predictor of high perceived stress and signs of depression and anxiety. It can be useful to detect and prevent student psychosocial dysfunction in clinical learning environments. An important challenge for medical and dental educational institutions is to provide specific student emotional support as early as needed as well as to consider appropriate stress prevention curriculum reforms.

The Relationship Between Social Risks and the Mental Health of School-Age Children in Primary Care.

The study's goal was to measure the association between social risks and the mental health of school-age children in primary care. We conducted a cross-sectional study in an urban safety-net hospital-based pediatric clinic using data collected from 2 standardized screening tools administered at well-child care visits for children age 6 to 11. Psychosocial dysfunction was measured with the Pediatric Symptom Checklist-17 (PSC-17), and 6 social risks (caregiver education, employment, child care, housing, food security, and household heat) were measured with the WE CARE screener. Multivariable linear and logistic regression analyses were conducted to measure the association between scores while controlling for sociodemographic characteristics. Among N=943 patients, cumulative social risks were significantly associated with a positive PSC-17 total score (adjusted odds ratio [aOR] 1.2; 95% confidence interval [CI] 1.1-1.5; P=.02), indicating psychosocial dysfunction. Children with ≥3 social risks were 2.4 times more likely to have a positive PSC-17 total score compared to children with <3 social risks (95% CI 1.5-3.9; P < .001). Of the individual social risks measured, only food insecurity significantly predicted a positive PSC-17 total score (aOR 1.9; 95% CI 1.1-3.2; P=.02) and attention score (aOR 1.9; 95% CI 1.1-3.4; P=.03). Number of risks on a social risk screener was associated with psychosocial dysfunction in school-age children. Food insecurity was the only individual risk associated with psychosocial dysfunction, in particular attention problems. Screening tools for social risks could be used to identify at-risk children whose mental health may be adversely impacted by their social conditions.

Depression Predicts Prolonged Length of Hospital Stay in Pediatric Inflammatory Bowel Disease.

Few studies report the impact of depression on inflammatory bowel disease (IBD)-related hospitalizations. We evaluated the association between depression and pediatric IBD-related hospitalizations. Our primary aim was to test the hypothesis that depression is associated with hospital length of stay (LOS); our secondary goal was to evaluate if patients with depression are at higher risk for undergoing additional imaging and procedures. Data were extracted from the 2012 Kids Inpatient Database (KID), the largest nationally representative publicly available all-payer pediatric inpatient cross-sectional database in the United States. Hospitalizations for patients less than 21 years with a primary diagnosis Crohn disease (CD) or ulcerative colitis (UC) by ICD-9 code were included. Multivariable logistic regression was used to predict long LOS controlling for patient- and hospital-level variables and for potential disease confounders. For primary IBD-related hospitalizations (N = 8222), depression was associated with prolonged LOS (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.19-1.90) and total parenteral nutrition use (OR 1.54; 95% CI 1.04-2.27). Depression was not associated with increased likelihood of surgery (OR 0.97; 95% CI 0.72-1.30), endoscopy (OR 0.91; 95% CI 0.74-1.14), blood transfusion (OR 0.85; 95% CI 0.58-1.23), or abdominal imaging (OR 1.15; 95% CI 0.53-2.53). Depression is associated with prolonged LOS in pediatric patients with IBD, even when controlling for gastrointestinal disease severity. Future research evaluating the efficacy of standardized depression screening and early intervention may be beneficial to improving inpatient outcomes in this population.

Cortical excitation-inhibition ratio mediates the effect of pre-attentive auditory processing deficits on interpersonal difficulties

Several lines of evidence identify aberrant excitatory-inhibitory neural processes across autism and schizophrenia spectrum disorders, particularly within the psychosocial domain. Such neural processes include increased excitatory glutamate and reduced inhibitory GABA concentrations, which may affect auditory pre-attentive processing as indexed by the mismatch negativity (MMN); thus, an excitation-inhibition imbalance might lead to aberrant MMN, which might in turn drive the relationship between the MMN and psychosocial difficulties. This research has the potential to enhance the neurochemical understanding of the relationship between electrophysiology (MMN) and behavioural/clinical measures (psychosocial difficulties).Thirty-eight adults (18 male, 18–40 years) completed the Schizotypal Personality Questionnaire (SPQ) and Autism-Spectrum Quotient (AQ). Glutamate and GABA concentrations in bilateral superior temporal cortex (STC) were quantified using proton magnetic resonance spectroscopy (1H-MRS) while auditory MMN to a duration deviant was measured with magnetoencephalography. Spearman correlations probed the relationships between STC glutamate/GABA ratios, MMN amplitude and latency, and AQ and SPQ dimensions. Mediation effects of glutamate/GABA ratios on the relationship between MMN and AQ-SPQ dimensions were probed using causal mediation analysis.Only SPQ-interpersonal and AQ-communication were significantly correlated with right hemisphere glutamate/GABA ratios and MMN latency (ps < 0.05), which were themselves correlated (p = .035). Two mediation models were investigated, with right MMN latency as predictor and SPQ-interpersonal and AQ-communication as outcome variables. Right STC glutamate/GABA ratios significantly mediated the relationship between MMN latency and SPQ-interpersonal scores, but only partially mediated the relationship between MMN latency and AQ-communication scores.These findings support the growing body of literature pointing toward an excitation-inhibition imbalance that is central to psychosocial functioning across multi-dimensional spectrum disorders, such as autism and schizophrenia, and provides neurochemical indicators of the processes that underlie psychosocial dysfunction.

Untreated PKU Patients without Intellectual Disability: What Do They Teach Us?

Phenylketonuria (PKU) management is aimed at preventing neurocognitive and psychosocial dysfunction by keeping plasma phenylalanine concentrations within the recommended target range. It can be questioned, however, whether universal plasma phenylalanine target levels would result in optimal neurocognitive outcomes for all patients, as similar plasma phenylalanine concentrations do not seem to have the same consequences to the brain for each PKU individual. To better understand the inter-individual differences in brain vulnerability to high plasma phenylalanine concentrations, we aimed to identify untreated and/or late-diagnosed PKU patients with near-normal outcome, despite high plasma phenylalanine concentrations, who are still alive. In total, we identified 16 such cases. While intellectual functioning in these patients was relatively unaffected, they often did present other neurological, psychological, and behavioral problems. Thereby, these “unusual” PKU patients show that the classical symptomatology of untreated or late-treated PKU may have to be rewritten. Moreover, these cases show that a lack of intellectual dysfunction despite high plasma phenylalanine concentrations does not necessarily imply that these high phenylalanine concentrations have not been toxic to the brain. Also, these cases may suggest that different mechanisms are involved in PKU pathophysiology, of which the relative importance seems to differ between patients and possibly also with increasing age. Further research should aim to better distinguish PKU patients with respect to their cerebral effects to high plasma phenylalanine concentrations.