Have the sleep habits in children of health workers been more affected during the COVID-19 pandemic?

BackgroundChanges have occurred in children's sleep habits during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to compare the sleep patterns during the COVID-19 pandemic of school age children of health worker parents (Group 1) and non-health worker parents (Group 2).MethodOne hundred twenty-two participants were included in Group 1 and 250 in Group 2. The families' sociodemographic characteristics (education levels and occupations of mothers and fathers, parental shift-working status, monthly family income, number of children in the family, and place of residence), general information for the children taking part (diagnosis of COVID-19 or COVID-19 related isolation, distance education, participation in sporting activities, time spent watching TV, time devoted to reading, time spent on telephones/tablets/computers, and time spent on indoor activities), and the responses given to the Children's Sleep Habits Questionnaire (CSQH)-abbreviated form were all examined.ResultsGroup 1 consisted of 122 individuals, 66 (54.1%) female and 56 (45.9%) male, and Group 2 of 250 individuals, 129 (51.6%) female and 121 (48.4%) male. Statistically significant differences were determined between the groups in terms of parental education levels and occupations, family monthly income, number of children in the family, place of residence, parental shift-working status, and length of time spent on indoor activities. Total CSHQ scores were 41.57 ± 7.57 (20–60) in Group 1 and 39.6 ± 8.47 (17–68) in Group 2 (p:0.03).ConclusionGreater impairment of sleep habits of school age children of health workers compared to those of non-health workers in the COVID-19 pandemic is proved for the first time in this study. Further assessment of the effects of the COVID-19 pandemic on children's sleep habits is now required, and appropriate measures must be taken in the light of the results obtained.     

What has caused the fall in stroke admissions during the COVID-19 pandemic?

Journal of Neurology -     

Autonomic function test during the COVID-19 pandemic: is it safe and sound?

Clinical Autonomic Research -     

Facing new fears during the COVID-19 pandemic: The State of America’s mental health

ObjectiveCOVID-19 is rearranging our society with fear and worry about the novel coronavirus impacting the mental health of Americans. The current study examines the intersection of COVID-19 fear, worries and perceived threat with social vulnerabilities and mental health consequences, namely anxiety and depressive symptomatology.MethodsUsing an online platform, a national sample (n = 10, 368) of U.S. adults was surveyed during the week of March 23, 2020. The sample was post-strata weighted to ensure adequate representation of the U.S. population based on population estimates for gender, race/ethnicity, income, age, and geography.ResultsFear and worry are not distributed equally across the country; rather they are concentrated in places where the largest number of confirmed COVID-19 cases is found. Additionally, data highlight significant differences in the subjective perception of distress across groups with varying social vulnerabilities. Women, Hispanics, Asians, families with children under 18, and foreign-born respondents reported higher levels of subjective fear and worry compared to their counterparts. Finally, even after controlling for social vulnerability, subjective assessments of distress were positive, and significantly related to anxiety and depressive symptomatology; prior mental health research from China and Europe confirm what others have begun to document in the United States.ConclusionsThis preliminary work provides practitioners with a glimpse of what lies ahead, which individuals and communities may be the most vulnerable, and what types of strategic interventions might help to address a wide range of mental health consequences for Americans in the months and years ahead.     

Self-harm: a transdiagnostic marker of psychopathology and suicide risk during the COVID-19 pandemic?

There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive–behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive–behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.

     

Assessment of COVID-19 trauma responses. Who has been more traumatized during the pandemic?

Background and ObjectiveTo evaluate the effect of cognitive and sociodemographic characteristics of healthcare and non-healthcare workers on their traumatic responses to the COVID-19 pandemic.MethodsData were collected using an online survey between August-September 2020. The survey included the following scales: Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), and Impact of Event Scale-Revised (IES-R). Traumatic responses were categorized into three types: avoidance (IES-R_A), intrusion (IES-R_I), and hyperarousal (IES-R_H).ResultsThe study included a total of 672 participants, comprised of 399 (59.4%) men, and 273 (40.6%) women with a mean age of 39.25 ± 933 years. The results indicated that women had higher IES-R_I (r = .5.78, p < 0.001), IES-R_A (r = 4.47, p < 0.001), and IES-R_H (r = .5.20, p < 0.001) scores compared to men. Patients with a history of psychiatric diseases had significantly higher IES-R_I (r = ?3.82, p < 0.001), IES-R_A (r = ?2.00, p < 0.05), and IES-R_H (r = ?4.06, p < 0.001) scores compared to patients with no history of psychiatric diseases. Non-healthcare workers had significantly higher IES-R_A (r = ?2.69, p < 0.01) scores compared to healthcare workers.ConclusionFemale gender and a positive history of psychiatric diseases were found to lead to an increase in the frequency of all three traumatic responses to COVID-19. Contrary to expectation, being a healthcare worker was not found as a factor facilitating trauma response formation in our study.     

How is the COVID-19 pandemic affecting individuals with obsessive-compulsive disorder (OCD) symptoms?

The novel coronavirus disease (COVID-19) pandemic has caused substantial public health burden and widespread anxiety. The adverse mental health effects caused by COVID-19 may be particularly acute for individuals with obsessive-compulsive disorder (OCD). For the present study, we developed an online survey to investigate how COVID-19 has affected the OCD community. The survey included both quantitative and qualitative questions to assess multiple facets of how the pandemic has affected individuals with OCD symptoms. Responses were collected from adults with self-identified OCD recruited from OCD-specific forums and websites (n = 252). The majority (76.2 %) of respondents reported that their OCD symptoms had worsened since the outbreak, though there was substantial variability in individual responses. Negative effects of COVID-19 were more strongly linked to contamination and responsibility for harm symptoms than for other symptom dimensions. The self-identified OCD group also reported heightened concerns about COVID-19 compared to a community control sample recruited through Amazon’s Mechanical Turk (MTurk). Lastly, many participants reported that the pandemic had interfered with their OCD treatment, yet they remained mostly satisfied with how their treatment providers had handled the crisis. These results highlight the importance of considering how COVID-19 has affected the OCD community, with possible implications for treatment providers.     

Status epilepticus admissions during the COVID-19 pandemic in Salzburg—A population-based study

Several emergencies were admitted less frequently to the hospital during the coronavirus disease 2019 (COVID-19) pandemic. To investigate whether this also occurred with status epilepticus (SE) we compared admissions due to first SE from March to April 2020 (“Time of COVID,” TOC) with January to February 2020 (“pre-COVID,” preCOV). We also compared admission numbers in TOC and preCOV with the respective 2-month periods in 2018 and 2019 in a retrospective cohort analysis. Two investigators independently searched the hospital patient database for various forms of SE. There was no significant change in the 2-month incidences of first SE in the city of Salzburg from preCOV of 6.1 (95% confidence interval [CI] 2.9-12.3) to TOC of 6.9/100 000 adults (95% CI 3.4-13.3). Admission numbers did not differ significantly from previous years. Estimated adjusted incidence was in line with a recent 5-year epidemiological study in Salzburg. However, a trend toward less-frequent nonconvulsive SE (NCSE) and loss of female predominance were indirect hints of underdiagnosing SE. In contrast to other medical conditions, SE most often presents clinically with impaired consciousness, which may promote admission to emergency departments even in times of lock-down. Further research of medical support of women and patients with NCSE during pandemic-related restrictions is warranted.     

How have the selective serotonin reuptake inhibitor antidepressants affected suicide mortality?

OBJECTIVE: We review evidence on two claims that have been made about the effects of selective serotonin reuptake inhibitor (SSRI) antidepressants; that they have: (i) decreased suicide rates in the population; and (ii) increased suicide rates in some individuals early in treatment. METHOD: We critically review evidence in the English-speaking peer-reviewed medical literature on: (i) meta-analyses of randomized controlled trials (RCTs) of SSRIs; (ii) observational studies of suicide risk in patients prescribed SSRIs and other antidepressants; and (iii) ecological studies of correlations between population use of SSRI use and population suicide rates. RESULTS: The largest and most recent meta-analyses of RCTs of SSRIs have found suggestive evidence that SSRIs increase suicidal ideation early in treatment compared with placebo. Observational studies have found an increased risk of self-harm within 9 days of an antidepressant drug being prescribed but the risk has been similar for the older tricyclic antidepressants and the SSRIs. Ecological studies in developed countries have found either that suicide rates have declined as SSRI use has increased, or have found no relationship between suicide rates and increased SSRI use. CONCLUSIONS: Meta-analyses of RCTs suggest that SSRIs increase suicide ideation compared with placebo but the observational studies suggest that SSRIs do not increase suicide risk more than older antidepressants. If SSRIs increase suicide risk in some patients, the number of additional deaths is very small because ecological studies have generally found that suicide mortality has declined (or at least not increased) as SSRI use has increased.     

What factors explain anger and mental health during the COVID-19 pandemic? The case of Israeli society

BACKGROUNDWhat factors affected the levels of anger and emotional distress experienced during the coronavirus disease 2019 (COVID-19) pandemic? We hypothesized that (1) sociodemographic factors and resiliency factors would partially explain psychological distress and anger, with stronger resiliency associated with lower levels of distress and anger; (2) women would report more trust in national leadership, as well as more psychological problems; (3) individuals of low socioeconomic status would report less resiliency, less trust in national leadership, and greater distress than individuals of higher socioeconomic status; and (4) hope would mediate the relationships between the other resiliency factors and both anger and distress.AIMTo explore whether community resilience, hope, and trust in leaders were associated with lower levels of anger and emotional distress during the COVID-19 pandemic.METHODSFor this observational study, data were gathered in Israel during the second wave of the COVID-19 pandemic, just before the Jewish New Year (mid-September 2020), as a second lockdown was announced. Data were gathered from 636 Israeli adults, who were recruited by the Midgam research panel. The participants filled out self-reported questionnaires including one on state anger, the Brief Symptom Inventory as a measure of mental-health problems (i.e., somatization, depression, and anxiety), and questionnaires about trust in the state’s leaders, community resilience (CCRAM), and hope as measures of coping resources and resiliency. t-tests were used to explore differences between men and women and between those of lower and higher socioeconomic status. A hierarchical multiple regression analysis was then used to examine whether and how the sociodemographic and resiliency variables explained state anger and psychological distress. A Sobel test was used to evaluate the possible effects of hope on community resilience and trust in leadership in the context of both distress and anger.RESULTSOur results revealed differences between women and men in terms of anger and mental-health problems, but not in terms of coping resources. Women reported higher levels of both anger and mental-health problems. Participants of lower socioeconomic status reported more mental-health problems, more anger, and greater trust in the state’s leaders; whereas those of higher socioeconomic status reported greater hope. Furthermore, hierarchical multiple regression analyses revealed that the sociodemographic factors of gender, age, and socioeconomic status, as well as community resilience, trust in the state’s leaders, and hope explained mental health with a total of 19% of the variance and anger with a total of 33% of the variance. The Sobel tests showed that hope mediated the relationships between community resilience and mental health (z = 3.46, P < 0.001), community resilience and anger (z = 2.90, P < 0.01), and trust in leaders and anger (z = 3.26, P < 0.01), but did not affect the relationship between trust in leaders and mental health (z = 1.53, P > 0.05).CONCLUSIONPersonal and communal factors affect psychological distress. Personal resilience is an important factor that should be strengthened throughout life. Trust in leadership is important for citizens’ mental health.     

Did the role of the neurologist in the emergency department change during the COVID-19 pandemic? Evidence from an Italian nationwide survey

Neurological Sciences - This study aims to assess whether the role of neurologists in the emergency department changed during the coronavirus (COVID)-19 pandemic. Data from an Italian national...     

How does the ‘environment’ come to the person? The ‘ecology of the person’ and addiction

Currently, psychiatry lacks a field that can be called “theoretical psychiatry”, which uses theoretical concepts and explanatory models: The main stream of research is to collect data of all kinds in the hope that the computational Big Data approach will shed a bright light on the black box of mental disorders. Accordingly, the biology-based Research Domain Criteria of the National Institute of Mental Health have been established. However, as philosophical analyses of concepts and methods have shown, several epistemological gaps stand in the way of a consistent multilevel understanding of mental disorders. Also, the implicit ontological problems in the biological reduction of the psychosocial level and in the integration of so-called hard and soft disciplines are mostly left out. As a consequence, a non-reductive psychological theory of mental disorders is sought that also integrates correlating biological and sociological issues. In this context, one example of promising nonreductive psychiatric research is the option of systems/network psychopathology. The possibilities for integrating different psychological perspectives are highlighted for the field of addiction research and treatment, where pragmatic behaviorist approaches dominate over the theory-based practice of psychoanalysis. In comparing the theoretical constructs of these two approaches, the relevance of the concept of “(social) environment” as the wealth of influential sociocultural factors is discussed at levels superior to the interpersonal micro-level, namely the organizational meso- and societal macro level, which is not sufficiently considered in current biopsychiatry. On this basis of argumentation, the usefulness of grounding and framing psychiatry through the field of ecological sciences, especially human ecology, is demonstrated. Finally, to this end, an outline of an ecological model of mental health and illness is presented.     

How important are the team dynamics in the battle against COVID-19?

Journal of Neurology -     

Editorial: How in the world are we handling COVID-19?

These are not normal times. As an editorial team, we felt that there was an urgency to reflect on our global experiences of the COVID-19 pandemic with our international colleagues. Instead of our planned debate series, we therefore commissioned a series of reflections on the impact of the pandemic on child and adolescent mental health throughout the world. We hope that you will find these reflections informative, thought-provoking, and in some cases, inspirational.     

How do young children with DCD participate and enjoy daily activities?

Developmental problems may decrease participation of children. The objective of this study was to evaluate multidimensional aspects of participation amongst preschool children with and without DCD. Participants included 63 children with mean age of 4.96 years (SD = 0.62; range = 4.02-6.35 years). Twenty one children were diagnosed with DCD, 21 children without DCD who were referred to OT due to mild developmental problems, and 21 children from mainstream public kindergartens whom did not require any developmental intervention. All three groups were matched for age, gender, and socioeconomic status. Children were administered the M-ABC2 and their parents completed the PSQ questionnaire. Results indicate significant differences in level of independence and subjective measures of participation (enjoyment and parents’ satisfaction) between the DCD group and the two other groups. The results indicate that from a young age, and in comparison to their peers, the participation of children with DCD is compromised. The integration of the DSM diagnostic criteria and the ICF perception of health enables us to capture the full scope of DCD and its complexity.     

Video-based screening for children with suspected autism spectrum disorder – experience during the COVID-19 pandemic in India

BackgroundAssessments for children with autism spectrum disorder (ASD) must adapt to the current COVID-19 pandemic through innovation in screening and assessment strategies using technology. To our knowledge there are no such studies reported from India. We aimed to study the predictive ability of video-based screening tool with definitive diagnosis in children with ASD.MethodThirty-nine children were screened independently by two examiners with a video-based screening tool to start intervention followed by an in-person evaluation by clinical DSM-5 diagnosis three months later.ResultSimilar to studies from developed countries, videos assessments showed a 94.87% correlation with the final diagnosis. Interobserver video agreement had a kappa correlation of 0.803, which was classified as substantial agreement.ConclusionVideo-based evaluations may be used as an interim assessment to initiate early intervention in children with ASD in resource-limited setups in the current pandemic situation. Large, well-designed prospective studies are required to confirm our results.     

How to capture activities of daily living in myotonic dystrophy type 2?

Myotonic dystrophy type 2 (DM2) lacks validated patients´ reported outcomes (PROs). This represents a limit for monitoring disease progression and perceived efficacy of symptomatic treatments. Our aim was to investigate whether PROs for activities of daily living designed for other neuromuscular diseases could be used in DM2. Sixty-six DM2 patients completed the following PROs: DM1-Activ-c, Rasch-built Pompe-specific activity (R-PAct) scale, McGill-pain questionnaire, fatigue and daytime sleepiness scale and Beck depression inventory (BDI-II). Clinical data and motor outcome measures (6-minutes walking test - 6MWT, manual muscle testing, quick motor function test and myotonia behavior scale) were collected as well. Patients underwent one visit at baseline and one after 10 months. Ceiling/flooring effects, criterion validity and discriminant validity were calculated. DM1-activ-c and R-PAct showed acceptable ceiling effects despite being built for myotonic dystrophy type 1 and Pompe disease, respectively. The difficulty hierarchy of the single items was better preserved in R-PAct than in DM1-Activ-c. Both tests showed excellent criterion validity highly correlating with 6MWT, quick motor function test, myalgia and disease duration. They could partially discriminate patients with different disability grades. These results suggest that DM1-Activ-c, slightly better than R-PAct, might be adopted for monitoring activities of daily living also in DM2, at least until disease-specific PROs will be available.