Impaired Social Functioning Research Articles

Metacognitive Training for Subjects with Bipolar Disorder: A Randomized Controlled Trial

Introduction: Impairments in social cognition in bipolar disorder (BD) have been extensively described in the last decade but few treatment strategies have been studied to address this issue. This study presents findings from a randomized controlled trial (RCT) investigating the efficacy of metacognitive training for bipolar disorder (MCT-BD) compared to Treatment as Usual (TAU) among individuals with BD in remission. The aim was to determine whether MCT-BD could improve social cognition and overall functioning in this population. Methods: Participants (N = 56) were recruited via social media and an internal database at the University of São Paulo Medical School. Inclusion criteria included a confirmed BD diagnosis, current state of remission, and the presence of social functioning impairments. Exclusion criteria included any impairments that could hinder neuropsychological testing. Patients were randomly assigned to either MCT-BD or TAU, with assessments conducted at baseline and follow-up. The MCT-BD program consisted of nine sessions. Results: The overall attendance rate across all MCT-BD intervention sessions was 96.6%. The MCT-BD program demonstrated added value in improving social cognition, specifically in emotion recognition reaction time. However, no significant changes were found in theory of mind, psychosocial functioning, or quality of life. Conclusion: This RCT provides preliminary evidence for the efficacy of MCT-BD in improving emotion recognition latency, emphasizing the importance of targeted interventions in social cognition outcomes for individuals with BD. The study’s strengths include high completion rates and comprehensive cognitive assessments. Future studies should explore long-term effects and personalized treatment approaches aiming to improve social-cognitive deficits in this population.

Alterations of subcortical structural volume in pediatric bipolar disorder patients with and without psychotic symptoms.

Pediatric bipolar disorder (PBD) with psychotic symptoms may predict more severe impairment in social functioning, but the underlying biological mechanisms remain unclear. The aim of this study was to investigate alterations in subcortical structural volume in PBD with and without psychotic symptoms. We recruited 24 psychotic PBD (P-PBD) patients, 24 non-psychotic PBD (NP-PBD) patients, and 18 healthy controls (HCs). All participants underwent scanning with a 3.0 T Siemens Trio scanner. The FreeSurfer 7.4.0 software was employed to calculate the volume of each subcortical structure. An analysis of covariance (ANCOVA) was performed to identify brain regions with significant volume differences among the three groups, and then the inter-group comparisons were calculated. Partial correlation analyses were conducted to identify relationships between subcortical structural volumes and clinical features. Finally, receiver operating characteristic curve (ROC) analysis was employed to verify the capacity to distinguish between P-PBD and NP-PBD, P-PBD and HCs, and NP-PBD and HCs. ANCOVA revealed significant differences in the volumes of bilateral lateral ventricles, third ventricle, left thalamus, and right pallidum among three groups. Compared with HC, the third ventricle volume was increased in both groups of PBD patients, whereas the left thalamus and right pallidum volumes were decreased, and the bilateral lateral ventricles were enlarged in P-PBD patients. In contrast, only the third ventricle showed further enlargement in the group of P-PBD patients compared with NP-PBD patients. Partial correlation analyses revealed that episode times were associated with the third ventricle volume in P-PBD patients. Furthermore, ROC analyses indicated that volume in the left lateral ventricle exhibited the greatest capacity to distinguish between the P-PBD and NP-PBD, and the third ventricle performed best in distinguishing both the P-PBD group from HCs and the NP-PBD group from HCs. The combined metrics demonstrated greater diagnostic value in two-by-two comparisons. Current research suggests that PBD with psychotic symptoms may have more extensive lateral and third ventricular volume enlargement. Bilateral lateral ventricles may serve as potential neurobiomarkers to distinguish P- PBD patients from NP-PBD patients.

Dutch Validation of the Self-Evaluation of Negative Symptoms Scale (SNS)

Background/objectives: Negative symptoms in schizophrenia spectrum disorders are related to impaired social functioning and lower quality of life, making accurate assessment important. To date, most tools for assessing negative symptoms are observational, which can be influenced by the raters’ experience and opinion. Self-rating scales, like the Self-Evaluation of Negative Symptoms (SNS), could complement observer ratings by adding information from the patient’s perspective. Here, we aim to evaluate the psychometric properties of the Dutch translation of the SNS and the relationship between the SNS and functional outcomes. Methods: The SNS was added to the Pharmacotherapy Monitoring Outcome Survey (PHAMOUS)-protocol for adults with a DSM-5 classification of a disorder in the psychosis spectrum. Internal consistency was assessed by Cronbach’s alpha. Confirmatory factor analysis (CFA) was used to evaluate the construct validity of the five subscales of the SNS. Correlational analyses were performed between the SNS and the Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), the Global Assessment of Functioning (GAF), Functional Remission tool (FR) and the Manchester Short Assessment of Quality of Life (ManSA). Results: A total of 247 patients participated in this study. Internal consistency was good (α = 0.87). CFA confirmed the five-factor structure of the SNS. The SNS was significantly correlated (all p < 0.001) with the PANSS positive (r = 0.31), PANSS negative (r = 0.33), HoNOS (r = 0.37), FR (r = 0.27) and the ManSA (r = −0.40). Conclusions: The Dutch SNS shows good psychometric properties and is related to functional outcomes and quality of life. The SNS can be valuable in complementing current observational-based instruments, and future research may investigate whether the SNS can be used as a standalone measurement tool for the assessment of negative symptoms.

A prognostic model for predicting functional impairment in youth mental health services.

Functional impairment is a major concern among those presenting to youth mental health services and can have a profound impact on long-term outcomes. Early recognition and prevention for those at risk of functional impairment is essential to guide effective youth mental health care. Yet, identifying those at risk is challenging and impacts the appropriate allocation of indicated prevention and early intervention strategies. We developed a prognostic model to predict a young person's social and occupational functional impairment trajectory over 3 months. The sample included 718 young people (12-25years) engaged in youth mental health care. A Bayesian random effects model was designed using demographic and clinical factors and model performance was evaluated on held-out test data via 5-fold cross-validation. Eight factors were identified as the optimal set for prediction: employment, education, or training status; self-harm; psychotic-like experiences; physical health comorbidity; childhood-onset syndrome; illness type; clinical stage; and circadian disturbances. The model had an acceptable area under the curve (AUC) of 0.70 (95% CI, 0.56-0.81) overall, indicating its utility for predicting functional impairment over 3 months. For those with good baseline functioning, it showed excellent performance (AUC=0.80, 0.67-0.79) for identifying individuals at risk of deterioration. We developed and validated a prognostic model for youth mental health services to predict functional impairment trajectories over a 3-month period. This model serves as a foundation for further tool development and demonstrates its potential to guide indicated prevention and early intervention for enhancing functional outcomes or preventing functional decline.

Intra-familial rape – characteristics of the phenomenon = Zgwałcenie w rodzinie – charakterystyka zjawiska

The main aim of the study was an attempt to develop and present characteristics of rapes that occurred in the family, with consideration of the modus operandi of the perpetrators according to the degree of kinship, their motivational background, the circumstances under which the acts were committed, and the psychosocial profile of the perpetrator and the victim. Moreover, an attempt was made to isolate the risk factors for intra-familial rapes, with the possibility of using them in preventive measures. The study was conducted based on empirical material from court cases in which the perpetrators of rapes were related to the victims. The research material consisted of files of criminal cases completed with a final judgment in 2015-2020. At the request of the researcher, criminal cases meeting the accepted criteria, where the male or female perpetrator of rape was a person related to the victim or a partner, were made available from the criminal departments of the courts. In the study presented here, a total of 46 intra-familial rape cases were analysed, of which 38 involve incestuous rape and 8 involve partner rape. Regardless of the type of abuse and kinship, the perpetrators were characterized by a fairly low psychosocial status (low level of education, low occupational status), addiction or alcohol abuse, personality disorders, problems with higher emotionality. Most of the acts against minors were of a substitutionary nature, the perpetrators did not show sexual preference disorders in the form of paedophilia. Alcohol abuse and personality disorders are risk factors irrespective of the cases. Impulse and emotional control deficits, deficits in understanding emotions and feelings, low self-esteem and lack of established normal male role models. A risk factor is the perpetrators’ limited intellect and associated impaired social functioning: reduced critical thinking, lack of internalised social norms, elevated levels of sexual drive and limitations in the areas of impulse control and deferring gratification.

The Brief Observation of Symptoms of Autism: Validation study in a Latin American sample.

Autism spectrum disorder is a complex condition associated with significant impairments in social communication and behavioral functioning. Diagnosis is dependent on clinician expertise, gathering of developmental history, and observation of specific behaviors. The suggested protocols include tools rendered invalid during the pandemic, which created significant barriers for diagnostic assessments. Furthermore, there are additional barriers in low-income countries in access to screening tools and standardized diagnostic tests for autism spectrum disorders that were only exacerbated during COVID-19. The Brief Observation of Symptoms of Autism instrument was developed to improve access to diagnostic assessment via telehealth during this time. The current study sought to validate the use of the Brief Observation of Symptoms of Autism within two Latin American countries. A sample of 313 children and adults from Argentina and Chile were examined. Results showed valid sensitivity and specificity scores with good fit across modules using two factors (i.e. Social Affect and Restricted, Repetitive Behaviors). Preliminary results of the current study demonstrated that the Brief Observation of Symptoms of Autism is a valid instrument for Latin American population and shows promise to be used beyond the pandemic to ease the diagnostic process. This is a collaborative work with BRINCAR Parent Association, who defined the need in our country to run the validation of Brief Observation of Symptoms of Autism and gave us support as the stakeholders at Lancet Commission.

Real-Life Functioning in 22q11.2 Deletion Syndrome in Relation to Neurocognitive Abilities and Psychotic Symptoms: A Comparison With Idiopathic Schizophrenia.

The 22q11.2 deletion syndrome (22q11.2DS) entails intellectual disabilities and higher risk of psychotic disorders. Neurocognitive deficits predict real-life functioning of schizophrenic patients. We investigated real-life functioning in 22q11.2DS, aiming at defining how neurocognitive profile and psychopathological variables impact on psychotic patients' social functioning. We recruited 63 patients with schizophrenia (SCZ, N = 63), 44 with 22q11.2DS (DEL, N = 44) and 19 with 22q11.2DS and psychosis (DEL-SCZ, N = 19), all matched for age, sex and neurocognitive profile; we administered the Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS), the Specific Levels of Functioning (SLoF) scale and the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). We implemented descriptive analyses, MANCOVA and linear regression statistics. The DEL-SCZ and the SCZ groups showed similar levels in Interpersonal Relationships (p = 0.093) and Social Acceptability subscales (p = 0.283). The DEL group scored higher on the Interpersonal Relationships subscale compared with the SCZ group (p = 0.001). The groups scored similarly on the other SLoF subscales. Both BNSS total score (beta = -0.343; p = 0.004) and BNSS asociality (beta = -0.487; p = 0.038) significantly predicted the Interpersonal Relationships variable in the groups with psychosis (SCZ and DEL-SCZ). Individuals with 22q11.2DS display a similar real-life functioning to patients with chronic schizophrenia. Social functioning impairments are typical of psychosis regardless of the genetic condition and highly predicted by negative symptoms like asociality. The 22q11.2DS represents a reliable biological model to study vulnerability to psychosis and its consequences on patients' real-life and social functioning.

From active escapism to virtual withdrawal: Validation of the Compensatory-Dissociative Online Gaming scales (C-DOGs).

In the Compensatory-Dissociative Online Gaming (C-DOG; Giardina etal., 2024) model, we proposed a continuum from compensatory to dissociative gaming involvement. This continuum represents different degrees of integration between physical and virtual environments with three core processes - Active Escapism, Escape, and Dissociation - and two peripheral processes - Gaming-Related Relaxation and Body-Mind Detachment. Here, we developed and tested a multidimensional measure based on this model. We capitalized on existing items for measuring escapism and dissociation and we generated new items consistent with the hypothesized model dimensions. A total of 54 items were administered to 1,176 online gamers playing different game genres, together with measures of problematic gaming, passion for gaming, and other psychological distress indicators. Exploratory and confirmatory factor analyses yielded a six-factor, 36-item structure, with multiple hierarchical regression analyses highlighting unique associations with other psychological constructs assessed. The following factors were identified: (1) Emotional Displacement - redirection of negative emotion into the game with associated relaxation; (2) Absorption - detachment of the player from time and space while gaming; (3) Active Escapism - simulative use of the game to compensate for lack of self-confidence in reaching physical life objectives; (4) Virtual Withdrawal - maladaptive gaming to balance impaired social functioning, predicted by traumatic experiences and pervasive depression; (5) Dissociative Regulation - dysfunctional level of engagement associated with excessive anxiety; (6) Failure Escape - problematic avoidance via gaming related to fear of future failures. The C-DOG factors identify critical psychological processes associated with problematic gaming, with relevant research and clinical implications.

Impact of play restriction during the COVID-19 pandemic on mental well-being in children with a chronic condition

This study is to investigate the effects of social restrictions, induced by the COVID-19 pandemic, on play behavior, and the associations with mental well-being in children with a chronic physical condition. Additionally, we explored potential moderating effects of environmental factors. Data from the PROactive cohort study including children with a chronic physical condition was used. Play behavior was measured with a self-developed questionnaire distributed during the pandemic with questions concerning behavior before and during the pandemic (with whom they most often played, where, and how many days/week (face-to-face and online)). Mental well-being, including life satisfaction, quality of life, and internalizing symptoms were assessed during the pandemic. Analyses were performed separately for the ages 8–12 years and 13–18 years. Differences in play behavior were analyzed with McNemar’s and Wilcoxon signed-rank tests. Linear regression analyses were used to analyse associations between play behavior and mental well-being. P-values were adjusted for false discovery rate. Interaction terms were added with several environmental factors, to explore potential moderating effects. In total, 756 participants (8–12 years: n = 261; 13–18 years: n = 495) were included in this study. Differences in play behavior between pre-pandemic and during the pandemic were observed. With whom they mostly played (friends/family members), compared to playing alone, was related to mental well-being in both age groups. Moreover, for children between 13 and 18 years playing outside was positively associated with life satisfaction and negatively related to internalizing symptoms. Experiencing a negative influence of the pandemic on leisure time, social support, and distress of the child are potential moderators.Conclusions: The COVID-19 pandemic induced changes in play behavior. During the pandemic, mainly not playing alone, but with friends or family members, and for older children playing outside, was related to better mental well-being in children with a chronic physical condition.What is known:• Children with a chronic physical condition are at risk for developing social and emotional problems, that include depressive symptoms, anxiety, aggression, physical impairment and problems in academic and social functioning. These problems may be related to limitations in play activities these children are thought to experience. However, there is limited empirical data to relate limitations in play and mental well-being in these children.What is new:• The COVID-19 pandemic presented an opportunity to investigate alterations in play behavior in relation with mental well-being among children with a chronic physical condition. Based on data from the PROactive cohort, including data for children with a chronic condition, we determined the impact of the pandemic on play in these children and related it to their mental well-being. Our data emphasize the importance of play, and particular playing with others, for mental-well-being and may facilitate prevention strategies for children growing up with a chronic condition.

Social isolation, loneliness, and functional disability in Chinese older women and men: a longitudinal cross-lag analysis

BackgroundIn this study, we explored the relationship between social isolation, loneliness, and functional impairment in 50-year-old participants, by sex.MethodsUsing longitudinal data from the China Health and Retirement Longitudinal Study (2018 and 2020), 6,524 participants meeting the inclusion criteria were analyzed. A cross-lag model was established to explore the associations between social isolation, loneliness, activities of daily living (ADL), and instrumental ADL (IADL) disability over time, with results stratified by sex.ResultsSocial isolation was not significantly associated with ADL and IADL disability, but loneliness was. Autoregressive associations indicated that social isolation, loneliness, and functional disability in 2018 predicted their exacerbations in 2020 (p < 0.001). Cross-lag analysis showed that the time-lagged effect of loneliness on ADL disability was greater in women (β = 0.27) than in men (β = 0.06); the time-lagged effect of ADL disability on loneliness was greater in men (β = 0.16) than in women (β = 0.05). The bidirectional time-lagged effects of loneliness and IADL disability showed opposite patterns between the sexes.ConclusionFunctional disability in China was significantly associated with loneliness but not with social isolation. Sex differences were observed in the time-lagged effect of loneliness on functional disability. These findings extend our understanding of the association between social relationships and functional disability in non-Western populations.

Polygenic Risk Assessment for Schizophrenia in Patients with Nonpsychotic Disorders and Attenuated Symptoms of Psychosis: A Pilot Study

Background: significant contribution of genetic factors in the development of schizophrenia is a generally recognized fact. Polygenic risk index for schizophrenia turned out to be an effective tool allowing to draw a dividing line between schizophrenia and mentally healthy control in terms of genetics. Objective: to assess the predictive ability of the polygenic risk score for schizophrenia (SZ-PRS) in adolescent patients with a first depressive episode and attenuated psychotic symptoms (APS). Patients and Methods: sixty adolescent inpatient with a first depressive episode were examined. Based on the presence of APS at admission, patients were divided into two groups: a group with APS and a group without APS. Subgroups of patients in the first group were identified through follow-up observations: those with psychosis manifestation and/or low social functioning and those without manifestation and with high social functioning. Whole-genome genotyping was performed for all participants, and SZ-PRS were calculated. For comparison, a group of patients diagnosed with schizophrenia (n = 879) and a group of mentally healthy individuals (n = 759), who had previously undergone whole-genome genotyping and had their SZ-PRS calculated, were used. Results: SZ-PRS of the APS group occupy an intermediate position between the healthy control and schizophrenia patients, significantly differing from each of them. The group without APS did not differ from the control group, but compared to the group of schizophrenia patients, the SZ-PRS in this group was significantly lower. Comparing subgroups of patients showed that the SZ-PRS in the APS group without psychosis manifestation and social functioning impairment was significantly lower than in the group with schizophrenia manifestation. The APS subgroups with psychosis manifestation and with functioning impairment did not differ significantly from each other or from the schizophrenia group. Conclusion: the results obtained for the first time for the russian population showed that SZ-PRS can be considered as a tool for assessing the risk of developing psychosis or reduced social functioning in patients with APS.

Subjective and objective effects of anxiety and fatigue on social function in patients with enterostomy and their family caregivers.

Many patients with enterostomy and their family caregivers experience severe anxiety and fatigue, which affects their participation in normal social activities and family life, resulting in impaired social function. The purpose of this study was to understand the status of social function of patients with enterostomy and their family caregivers;at the same time to analyze the subjective and objective effects of anxiety and fatigue on their social functions. The self-made general information questionnaire, WHO Social Disability rating Scale, Miao Yu's Multidimensional Fatigue Scale-20 and Zung et al. 's Self-rating Anxiety Scale were used to investigate the general situation, social function, fatigue and anxiety of enterostomy patients and their family caregivers who came to the hospital for treatment from March 28, 2023 to November 30, 2023. SPSS27.0 was used to complete the statistical analysis of the data, and AMOS26.0 was used to establish the structural equation model to complete the subject and object effect analysis. A total of 260 pairs of enterostomy patients and their family caregivers were included in this study. The social function scores of enterostomy patients and their family caregivers were (8.80±3.44) and (6.44±3.60). The anxiety scores were (37.81±7.60) and (34.73±7.50). The fatigue scores were (63.35±12.80) and (51.21±12.38).The results of the subject-object effect analysis reported the subject effect: the anxiety of patients with enterostomy had a significant positive impact on the degree of social dysfunction (β = 0.154, P = 0.015); The fatigue of patients with enterostomy had a significant positive effect on the degree of social dysfunction (β = 0.132, P = 0.034). The anxiety of family caregivers had a significant positive effect on the degree of social dysfunction (β = 0.161, P = 0.023). The fatigue of family caregivers had a significant positive effect on the degree of social dysfunction (β = 0.201, P = 0.005). In terms of object effects: only the fatigue of family caregivers had a significant positive impact on the degree of social dysfunction of enterostomy patients (β = 0.224, P < 0.001), and other ways had no object effects. Patients with enterostomy and their family caregivers have serious social function defects. Clinical medical staff should take care of them as a whole in order to better return to family and society after surgery.

Introduction and preliminary psychometric evaluation of the assessment of functional capacity interview for older adults

Measures of complex functional decision-making capacity can greatly aid in assessing mild cognitive impairment (MCI) and facilitating early intervention in dementia care. We examined the ability of the Assessment of Functional Capacity Interview (AFCI) to detect functional differences among older adults who were cognitively unimpaired (CU), or who presented with subjective cognitive decline (SCD) or MCI. A sample of 97 older adults (CU; n = 30, Mage = 74.64 ± 7.42 years; SCD; n = 34, Mage = 72.56 ± 6.43 years; MCI; n = 33, Mage = 78.28 ± 7.55 years) underwent neuropsychological testing and responded to the Financial Capacity Instrument (FCI-SF). Informants completed the Assessment of Functional Capacity (AFCI), an instrument of functional decision-making capacity, and responded to the Social Vulnerability Scale (SVS15) and Amsterdam Instrumental Activity of Daily Living (A-IADL-Q-SV), a measure of functional status, for comparison. According to informant-reported responses, the CU group had significantly lower AFCI total (and domain) scores, H(2) = 27.59, p<.001, relative to MCI. Additionally, the CU group had significantly lower AFCI scores in the Home and Personal Safety domain relative to the SCD group, H(2) = 14.06, p<.05. In the overall sample, AFCI total scores were associated with FCI-SF, SVS15, and A-IADL-Q-SV scores and cognitive measures. Our results demonstrate that the AFCI is sensitive to impairment in safety, social, financial, and medical functioning in MCI and is associated with measures of cognitive functioning and social vulnerability in older adults. Incorporating this instrument as a supplement to cognitive screening instruments may aid in the prevention of hazardous decision-making in older adults.

Behavioural profiling following acute stress uncovers associations with future stress sensitivity and past childhood abuse.

Background: Individuals greatly differ in their responses to acute stress, ranging from resilience to vulnerability that may yield stress-related psychopathology. Stress-related psychopathologies involve, by definition, substantial modifications across multiple behavioural domains, including impaired cognitive, affective and social functioning. Nevertheless, and despite extensive investigation of individual variability in stress responsivity, no study to date simultaneously assessed the impact of acute stress across multiple behavioural domains within a given individual.Objective: To address this critical gap, 84 healthy female participants (mean age 24.45 ± 3.02, range 19-35) underwent an established acute stress induction procedure and completed three behavioural tasks, probing the functional domains of positive, cognitive and social processing, both before and after the acute stress procedure.Method: A novel behavioural profiling algorithm was implemented to identify individuals whose performance was substantially impacted by stress across all three functional domains.Results: Approximately 30% of participants exhibited substantial deviation in their performance from before to after stress in all three tasks, hereon defined as stress-affected. Stress-affected participants did not differ in their psychological and physiological responses to the acute stress procedure from the other stress-unaffected 70% of the sample. However, follow-up assessments in 66 of these participants revealed higher levels of stress six months following the procedure among the stress-affected compared to the stress-unaffected group. Stress-affected individuals also reported more aversive childhood experiences, such that the odds of participants who were sexually abused at an early age to be affected behaviourally by acute stress later in life increased by more than five-fold.Conclusions: Taken together, these findings suggest that being affected by acute stress across multiple functional domains is associated with future stress sensitivity and past childhood sexual abuse. Probing individual differences in the impact of acute stress across domains of functionality may better align with the multi-dimensional nature of stress responsivity, uncovering latent vulnerability.

Long COVID and recovery from Long COVID: quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection

BackgroundRecovery from SARS CoV-2 infection is expected within 3 months. Long COVID occurs after SARS-CoV-2 when symptoms are present for more than 3 months that are continuous, relapsing and remitting, or progressive. Better understanding of Long COVID illness trajectories could strengthen patient care and support.MethodsWe characterized functional impairments, quality of life (QoL), and cognition among patients who recovered from SARS-CoV-2 infection within 3 months (without Long COVID), after 3 months (Recovered Long COVID), or remained symptomatic (Long COVID). Among 7305 patients identified with previous SARS-CoV-2 infection between March 2020 and December 2021, confirmed in the medical record with laboratory test or physician diagnosis, 435 (6%) completed a single self-administered survey between March 2022 and September 2022. Multi-domain QoL and cognitive concerns were evaluated using PROMIS-29 and the Cognitive Change Index-12.ResultsNearly half the participants (47.7%) were surveyed more than 2 years from initial infection (median = 23.3 months; IQR = 18.6, 26.7) and 86.7% were surveyed more than 1 year from infection. A significantly greater proportion of the Long COVID (n = 215) group, (Current and Recovered combined), had moderate-to-severe impairment in all health domains assessed compared to those Without Long COVID (n = 220; all p < 0.05). The Recovered Long COVID group (n = 34) had significantly lower prevalence of fatigue, pain, depression, and physical and social function impairment compared to those with Current Long COVID (n = 181; all p < 0.05). However, compared to patients Without Long COVID, the Recovered Long COVID group had greater prevalences of fatigue, pain (p ≤ 0.06) and subjective cognitive decline (61.8% vs 29.1%; p < 0.01). Multivariate relative risk (RR) regression indicated Long COVID risk was greater for older age groups (RR range 1.46–1.52; all p ≤ 0.05), those without a bachelor’s degree (RR = 1.33; 95% CI = 1.03–1.71; p = 0.03), and those with 3 or more comorbidities prior to SARS-CoV-2 infection (RR = 1.45; 95% CI = 1.11–1.90; p < 0.01).ConclusionsLong COVID is associated with long-term subjective cognitive decline and diminished quality of life. Clinically significant cognitive complaints, fatigue, and pain were present even in those who reported they had recovered from Long COVID. These findings have implications for the sustainability of participation in work, education, and social activities.

Assessing suicidality in adult ADHD patients: prevalence and related factors

BackgroundThe association between Attention-deficit hyperactivity disorder (ADHD) and suicidality has been subject of growing interest for research in the latest years. Suicidality was generally assessed categorically and without the use of validated instruments, leading to heterogeneous or even conflicting evidence. The prevalence of both suicidal ideation and attempts varies considerably, and the associated risk factors remain unclear. Our study investigated suicidality in ADHD using a dimensional approach and a validated and internationally recognized instrument. Our primary aim was to evaluate the prevalence of suicidal ideation (SI), severe suicidal ideation (SSI), suicidal behavior (SB) and non suicidal self-injury behavior (NSSIB) in a sample of adult patients with ADHD. The second objective was to identify sociodemographic and clinical features associated with increased risk of suicidality in these patients.MethodsThe sample included 74 adult patients with clinical diagnosis of ADHD. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic regressions were used to examine predictors of SI, SSI, SB and NSSIB.ResultsThe lifetime prevalence of SI and SSI were 59.5% and 16.2%, respectively. The 9.5% of patients showed lifetime SB, while NSSIB was found in 10.8% of the subjects. Lifetime SI was associated with severity of inattentive symptoms during adulthood, low self-esteem and impairment in social functioning. Lifetime SSI appeared related to severity of inattentive symptoms during childhood, attentional impulsiveness and number of hospitalizations, while physical activity appeared to be protective. The prevalence of lifetime SB and NSSIB did not appear significantly related to any socio-demographic or clinical feature.ConclusionsAdults with ADHD should be considered at risk of suicide and it is important to determine which patients are at higher risk, in order to guide preventive interventions. The association between ADHD and suicidal ideation did not appear to be influenced by psychiatric comorbidities, but rather by inattention itself, which represents the core symptom of ADHD.

Neonatal Seizures and Associated Neurobehavioral Profiles in Preschool Age Children

BackgroundNeonatal seizures are common with acute brain injury. Up to 25% of survivors develop post-neonatal epilepsy. We hypothesized post-neonatal epilepsy diagnosed by age 24-months would increase risk for early markers of neurobehavioral disorders than acute provoked neonatal seizures alone. MethodsNeonates with acute provoked seizures born 7/2015-3/2018 enrolled at 9 Neonatal Seizure Registry sites. Composite scores from parent-completed standardized ratings assessed Adaptive, Social, Externalizing, Internalizing, Self-Regulation, and Sensory Seeking domains. Linear regression demonstrated relationships between composite scores for children who developed post-neonatal epilepsy compared with those who did not. Results were adjusted for seizure etiology, sex, gestational age, and cerebral palsy (CP) severity. Results151 children (n=20, 13% with post-neonatal epilepsy), 4.1 years median age participated. Children with epilepsy had impaired adaptive (Cohen’s d = 1.62, p<.0001), social (Cohen’s d = 0.86, p=0.004), and executive functioning (Cohen’s d = 0.56, p=0.06) compared to children without epilepsy. Mean neurobehavioral scores for children without epilepsy were within normative average range. Risk for impairment among children with epilepsy persisted after adjusting for neonatal seizure etiology, sex, and gestational age, but not when adjusting for CP severity. ConclusionsIn this cohort of survivors of provoked neonatal seizures, there was higher incidence of adverse neurobehavioral outcomes among preschool children diagnosed with post-neonatal epilepsy compared with those without epilepsy. CP severity was associated with greater impairment, results also suggest that epilepsy is an independent predictor of adaptive functioning. Children with post-neonatal epilepsy should be screened for neurobehavioral problems to facilitate early identification and developmental support.

Health-Related Quality of Life and Financial Burden in Ethiopian Patients With Chronic Myeloid Leukemia Receiving Tyrosine Kinase Inhibitors: A Cross-Sectional Study.

Health-related quality of life (HRQoL) is now an important goal of therapy for patients with chronic myeloid leukemia (CML). However, there is paucity of data for patients living in low-income countries (LICs) and on factors associated with their HRQoL profile. The primary objective was to compare the HRQoL of patients with CML living in an LIC (Ethiopia) with that of patients living in a high-income country (HIC). Adult patients with CML treated with tyrosine kinase inhibitors in Ethiopia were considered eligible for this study. To assess their HRQoL and symptom burden, eligible patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the EORTC Quality of Life Questionnaire Chronic Myeloid Leukemia 24 (QLQ-CML24). A matched case-control analysis was applied to compare the HRQoL profile of the herein-recruited Ethiopian cohort with a sample of patients with CML from an HIC (Italy). Overall, 395 Ethiopian patients were enrolled between February 2021 and June 2021. Except for dyspnea and satisfaction with care, the Ethiopian patients reported lower HRQoL and functioning and higher symptom burden compared with patients with CML living in an HIC. A remarkable proportion of Ethiopian patients (n = 353, 89.4%) reported financial toxicity (FT). Compared with patients without FT, those with FT reported a higher prevalence of clinically important problems and symptoms across all the QLQ-C30 scales. For example, the prevalence of clinically important impairment of social functioning was almost sixfold higher for patients with FT compared with those without FT (41.8%, 7.1%, respectively). Our results indicate that the HRQoL profile of patients with CML living in Ethiopia may be worse across several important functional and symptom domains than that of their peers living in an HIC. In addition, FT is highly prevalent among these patients and it is associated with poorer HRQoL outcomes.

Empowering Social Growth Through Virtual Reality-Based Intervention for Children With Attention-Deficit/Hyperactivity Disorder: 3-Arm Randomized Controlled Trial.

Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation. This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training. A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention. The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P<.001) and on parent-rated self-control (F2,85=18.77; P<.001), initiative (F2,85=11.93; P<.001), and emotional control (F2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05). The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits. ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526. RR2-10.2196/48208.

Severity of Depression among Incarcerated Men in Meru, Main Prison

Purpose: Depression is one of the most prevalent mental disorders globally and it is known to cause impairment in cognitive, social, emotional and occupational functioning. In Kenya, a moderate to high prevalence of depression has been established among incarcerated men in several prisons, Meru main prison included. This study, therefore sought to assess the severity of depression among incarcerated men in Meru, Main Prison. Methodology: The study employed a quasi-experimental research design. The study was conducted in Meru, Main Prison. A sample size of 148 inmates was selected using a simple random sampling technique. Quantitative data was obtained from the social demographic questionnaire and the BDI-II. Results: The study found that the severity of depression among incarcerated men in Meru main prison was higher at 46.3% as opposed to moderate depression at 27.9%, and mild depression at 18%. This implied that prisoners going through severe depression are more than those other levels of depression. Conclusion: The study concluded that severity of depression was higher among the participants aged 20 to 30 years compared to other age categories and among the first time in prison. The proportion of clinical depression was higher among young adults aged 20-30 years in prison compared to the middle adults and adults 30-50 years. Therefore, it is recommended that the government of Kenya may engage young adults with job opportunities, and social engagement. This might limit the proportion of young adults languishing in prison instead of utilizing their youthful strength productively in society.