-
Translational Psychiatry Jul 2023The anterior cingulate cortex (ACC) has been implicated in attention deficit hyperactivity disorder (ADHD). More specifically, an appropriate balance of excitatory and...
The anterior cingulate cortex (ACC) has been implicated in attention deficit hyperactivity disorder (ADHD). More specifically, an appropriate balance of excitatory and inhibitory activity in the ACC may be critical for the control of impulsivity, hyperactivity, and sustained attention which are centrally affected in ADHD. Hence, pharmacological augmentation of parvalbumin- (PV) or somatostatin-positive (Sst) inhibitory ACC interneurons could be a potential treatment strategy. We, therefore, tested whether stimulation of G-protein-coupled receptors (GPCRs) in these interneurons could improve attention or impulsivity assessed with the 5-choice-serial reaction-time task in male mice. When challenging impulse control behaviourally or pharmacologically, activation of the chemogenetic GPCR hM3Dq in ACC PV-cells caused a selective decrease of active erroneous-i.e. incorrect and premature-responses, indicating improved attentional and impulse control. When challenging attention, in contrast, omissions were increased, albeit without extension of reward latencies or decreases of attentional accuracy. These effects largely resembled those of the ADHD medication atomoxetine. Additionally, they were mostly independent of each other within individual animals. GPCR activation in ACC PV-cells also reduced hyperactivity. In contrast, if hM3Dq was activated in Sst-interneurons, no improvement of impulse control was observed, and a reduction of incorrect responses was only induced at high agonist levels and accompanied by reduced motivational drive. These results suggest that the activation of GPCRs expressed specifically in PV-cells of the ACC may be a viable strategy to improve certain aspects of sustained attention, impulsivity and hyperactivity in ADHD.
Topics: Male; Mice; Animals; Gyrus Cinguli; Parvalbumins; Attention Deficit Disorder with Hyperactivity; Psychomotor Agitation; Impulsive Behavior; Interneurons
PubMed: 37407615
DOI: 10.1038/s41398-023-02541-z -
African Journal of Emergency Medicine :... Sep 2023Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS)... (Review)
Review
BACKGROUND
Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS) operate. This scoping review aimed to examine the available literature on physical restraint of patients within the prehospital setting and to identify guidelines and their effectiveness, safety to patients and health care practitioners and strategies relating to physical restraint when used by EMS.
METHODS
We performed our scoping review using the methodological framework described by Arksey and O'Malley augmented by that of Sucharew and Macaluso. Several steps guided the review process: identification of the research question, eligibility criteria, information sources (CINAHL, Medline, Cochrane and Scopus), search, selection and data collection, ethical approval, collation, summarizing and reporting on the results.
RESULTS
The population of interest, in this scoping review was prehospital physically restrained patients, however, there was a reduced research focus on this population in comparison to the larger emergency department.
CONCLUSION
The limitation of informed consent from incapacitated patients may relate to the lack of prospective real-world research from previous and future studies. Future research should focus on patient management, adverse events, practitioner risk, policy, and education within the prehospital setting.
PubMed: 37334175
DOI: 10.1016/j.afjem.2023.03.006 -
Korean Journal of Anesthesiology Oct 2023Early postoperative neurocognitive disorders (ePND), include both emergence delirium, which is defined as very early onset postoperative delirium, and emergence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Early postoperative neurocognitive disorders (ePND), include both emergence delirium, which is defined as very early onset postoperative delirium, and emergence agitation, defined as motor arousal. Although research on anesthesia emergence is limited, ePND are likely associated with unfavorable outcomes. This meta-analysis assessed the effect of ePND on clinically relevant outcomes.
METHODS
A systematic search of studies published between 2002 and 2022 on MEDLINE, PubMed, Google Scholar, and the Cochrane Library was performed. Studies that included adults with emergence agitation and/or delirium and reported at least one of the following outcomes: mortality, postoperative delirium, length of post-anesthesia care unit stay, or length of hospital stay were included. The internal validity, risk of bias, and certainty of the evidence were assessed.
RESULTS
A total of 16,028 patients from 21 prospective observational studies and one case-control retrospective study were included in this meta-analysis. The occurrence rate of ePND was 13% (data excluding the case-control study). The mortality rate was 2.4% in patients with ePND vs. 1.2% in the normal emergence group (risk ratio [RR]: 2.6, P = 0.01, very low quality of evidence). Postoperative delirium occurred in 29% of patients with ePND and 4.5% of patients with normal emergence (RR: 9.5, P < 0.001, I2 = 93%). Patients with ePND had a prolonged length of post-anesthesia care unit stay (P = 0.004) and length of hospital stay (P < 0.001).
CONCLUSIONS
This meta-analysis suggests that ePND are associated with twice the risk of mortality and a 9-fold increased risk of postoperative delirium.
Topics: Adult; Humans; Emergence Delirium; Retrospective Studies; Case-Control Studies; Anesthesia; Prospective Studies; Observational Studies as Topic
PubMed: 37232073
DOI: 10.4097/kja.23126 -
Journal of Affective Disorders Sep 2023Several studies have reported the association of psychotic-like experiences (PLEs) with non-suicidal self-injury (NSSI). It has been hypothesized that both constructs...
BACKGROUND
Several studies have reported the association of psychotic-like experiences (PLEs) with non-suicidal self-injury (NSSI). It has been hypothesized that both constructs might share overlapping backgrounds. This study aimed to investigate the relationships between childhood trauma, depression, PLEs and lifetime characteristics of NSSI.
METHODS
Participants included individuals aged 18-35 years who had a negative history of psychiatric treatment. They were surveyed through the computer-assisted web interview. A network analysis was performed.
RESULTS
A total of 4203 non-clinical adults (63.8 % females) were enrolled. The characteristics of NSSI and a history of childhood sexual abuse were the most central nodes in the network. A history of childhood sexual abuse was the only category of childhood trauma that was directly connected to the characteristics of NSSI (i.e., longer lifetime duration of NSSI). The shortest pathways from other categories of childhood trauma (emotional abuse, emotional neglect and bullying) were connected to the lifetime characteristics through the effects of sexual abuse. However, other pathways were also possible and converged on nodes representing persecutory thoughts, déjàvu experiences, psychomotor retardation/agitation and suicidal ideation. These psychopathological symptoms were the only nodes directly connected to the characteristics of NSSI (i.e., lifetime duration and a history of severe NSSI).
LIMITATIONS
The main limitations include the use of a non-clinical sample and cross-sectional design.
CONCLUSIONS
Our findings do not support the hypothesis that PLEs and NSSI might be associated due to shared correlates. In other words, the associations of childhood trauma and PLEs with NSSI might be independent.
Topics: Adult; Female; Humans; Male; Depression; Adverse Childhood Experiences; Cross-Sectional Studies; Mental Disorders; Self-Injurious Behavior; Suicidal Ideation; Risk Factors
PubMed: 37230261
DOI: 10.1016/j.jad.2023.05.044 -
Journal of Affective Disorders Aug 2023Shortly after the first outbreak of COVID-19 in Wuhan, the disease spread rapidly around the world. Previous findings reported an increase in mental health problems...
BACKGROUND
Shortly after the first outbreak of COVID-19 in Wuhan, the disease spread rapidly around the world. Previous findings reported an increase in mental health problems among Chinese medical staff, but there was a lack of research following changes in COVID-19 prevention and control policies.
METHODS
Medical staff were recruited separately in China from 15 to 16 December 2022 (N = 765, wave 1) and from 5 to 8 January 2023 (N = 690, wave 2). All participants completed the assessments of Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Euthymia Scale. Network analysis was used to explore the relationships between symptoms both within and across depression, anxiety and euthymia.
RESULTS
Medical staff showed worse anxiety, depression and euthymia at wave 2 than at wave 1. Depression, motor, restlessness and uncontrollable worrying showed high centrality (i.e., strength, expected influence, closeness) at wave 1, but higher at peak. Meanwhile, motor symptoms and restlessness showed the strongest connection between different mental disorders at both wave 1 and wave 2. The network structure was stable over time after the relaxation of the infection policy.
LIMITATIONS
Our participants were not a random sample and the assessments were based on self-reports.
CONCLUSIONS
This study indicated the changes in central and bridging symptoms in medical staff at different stages after lifting of restrictions and the withdrawal of testing requirements, which provided management suggestions for the Chinese government and hospitals, as well as clinical guidance for psychological interventions.
Topics: Humans; COVID-19; Mental Health; SARS-CoV-2; Psychomotor Agitation; Anxiety; Medical Staff; China; Depression
PubMed: 37172655
DOI: 10.1016/j.jad.2023.05.013 -
Psychological Medicine Aug 2023This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness.
BACKGROUND
This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness.
METHODS
Participants were formerly depressed patients ( = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item 'I feel restless', for each individual separately.
RESULTS
An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases.
CONCLUSIONS
Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.
Topics: Humans; Depression; Psychomotor Agitation; Cross-Sectional Studies; Emotions; Antidepressive Agents
PubMed: 35833374
DOI: 10.1017/S0033291722002069