The prevalence of psychiatric disorders among 5–10 year olds in rural, urban and slum areas in Bangladesh

BACKGROUND: No previous epidemiological studies of child mental health have been conducted in Bangladesh, partly due to lack of suitable measures. METHODS: A Bangla translation of a standardised child psychiatric interview, the Development and Well-Being Assessment (DAWBA), was validated against routine clinical diagnoses on a consecutive series of 100 referrals to a child mental health service. A two-phase study of prevalence was applied to random samples of 5- to 10-year-olds (N=922) drawn from three contrasting areas: a rural area, a moderately prosperous urban area, and an urban slum. RESULTS: There was substantial agreement between the DAWBA and the independent clinic diagnosis (kappa=0.63-0.94). The estimated prevalence of any ICD-10 diagnosis was 15% (95% CI 11-21%). The rate of obsessive-compulsive disorder was higher than in previous studies. Children from the slum area were significantly more likely to have serious behavioural problems, and marginally more likely to have post-traumatic stress disorder. CONCLUSION: A conservative extrapolation is that around 5 million Bangladeshi children and adolescents have psychiatric disorders. In a country with very few child mental health professionals, there is a vast gap between need and provision that must be addressed.     

Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson’s disease

The objective of this study is to assess how the non-motor symptoms of Parkinson’s disease (PD), such as depression, cognitive deterioration, neuropsychiatric and sleep disorders, affect the quality of life, and to compare them with the motor symptoms in order to determine their real impact. A cross-sectional study was designed including 99 patients (mean age 68.5 ± 9.9 years, duration of disease 8.7 ± 6.2 years). Demographic data, onset of PD, years on treatment with levodopa (LD), class of dopaminergic drug prescribed, and dosages were obtained. The following scales were used: quality of life (PDQ-39), Unified Parkinson’s Disease Rating Scale (UPDRS I–IV), Parkinson Disease Sleep Scale (PDSS) and daytime sleepiness (Epworth), Mini-Mental State Examination, depression (HAM-D), and the neuropsychiatric inventory (NPI-10). The PDQ-39 summary index (PDQ-39 SI) was 24.7 ± 13.2. A linear regression model including all variables showed that four independent variables accounted for 67.2% of the variance in the PDQ-39 SI (F = 33,277; p < 0.001): NPI, PDSS, UPDRS IV, and UPDRS I. When sub-items of the NPI, PDSS and UPDRS IV scales are analyzed, significant correlations (p < 0.001) are found between the PDQ-39 SI and depression, agitation, apathy, anxiety, hallucinations, delusions, incontinence of urine, morning painful posturing, restlessness in bed, morning fatigue, duration of off periods, unpredictable and predictable off periods, early morning dystonia, and sudden off periods. Neuropsychiatric symptoms, especially depression, nighttime sleep disorders such as urinary incontinence, nighttime restlessness, morning fatigue and somnolence, off-period dystonia and motor fluctuations are the variables that most affect the quality of life of patients with PD.     

The population prevalence of child psychiatric disorders in Danish 8– to 9–year–old children

The overall prevalence rates of general and specific child psychiatric disorders in Danish children are unknown. In this study, which aimed to estimate prevalence rates, a multi–method strategy using a two–step design was employed. The first step involved assessment with the Child Behaviour Checklist (CBCL). The second step consisted of assessment using the Schedule for Affective Disorders and Schizophrenia for School–Aged Children; Present and Lifetime version (K–SADS–PL), The Children’s Global Assessment Scale (C–GAS), The Wechsler Intelligence Scale for Children (WISCIII), The Autism Spectrum Disorder Screening Questionnaire (ASSQ), and a checklist containing the diagnostic criteria for Pervasive Developmental Disorders (PDD). Non–respondents were assessed through teachers using a modified brief version of the K–SADS–PL. A total of 751 children were targeted. The overall estimated prevalence rate of child psychopathology was 11.8 % [95% confidence interval (CI): 8.8, 14.8]. Attention Deficit/ Hyperactivity Disorder (ADHD) was found to be the most common specific child psychiatric disorder. There was no difference in prevalence rates between respondents and non–respondents. The estimated prevalence rates were broadly comparable to prevalence rates found in other epidemiological studies. The teacher–based interview proved to be a valid instrument for the assessment of non–respondents.     

The prevalence of DSM-IV psychiatric disorders among 7–10 year old Yemeni schoolchildren

BACKGROUND: The planning of child mental health services should be based on recent high-quality data on the prevalence and type of mental health disorders, and yet such data are not available in Yemen and many other Arab countries. METHODS: Representative samples of Yemeni 7-10 year olds (n = 1,210) were assessed using a two-phase design in an urban area and a one-phase design in a rural area. Psychopathology was assessed using the Strengths and Difficulties Questionnaire for screening purposes and the Development and Well-being Assessment to generate psychiatric diagnoses. RESULTS: The overall prevalence of DSM-IV disorders was 15.7% in Yemen (95% CI 11.7-20.2%). Anxiety disorders were the commonest diagnostic grouping in Yemen (9.3%, 95% CI = 5.8-12.8%), followed by behavioural disorders (7.1%, 95% CI = 4.4-9.9%) and attention-deficit/hyperactivity disorder (ADHD; 1.3%, 95% CI = 0.1-2.5%). There were no significant urban-rural differences. CONCLUSIONS: Roughly a sixth of Yemeni schoolchildren have at least one DSM-IV psychiatric disorder, involving a level of distress or social impairment likely to warrant treatment.     

Swedish clinical guidelines—Prevention and management of metabolic risk in patients with severe psychiatric disorders

Individuals with severe psychiatric disorders are more likely than the population at large to develop metabolic derangements such as overweight and diabetes. Cardiovascular disease is also more frequently seen in this group. Contributing factors may include inappropriate diet or lack of physical activity, but antipsychotic medication may also play a role. Seven Swedish specialist medical societies have collaborated in formulating a set of concise clinically applicable guidelines—reproduced here in modified form—for the prevention and management of metabolic risk in this patient group. The importance of implementation is emphasized.     

The impact of sleep and mood disorders on quality of life in Parkinson’s disease patients

Sleep disturbances are common and often severe in patients with Parkinson’s disease (PD) and their symptoms can be present at any time of day. The purpose of our study was to examine how excessive daytime sleepiness or poor nocturnal sleep quality and mood disorders influence the quality of life (QoL) in PD patients. Ninety-three PD patients from eastern Slovakia were recruited (49.5% males, mean age 68.0 ± 9.5 years, mean disease duration 6.1 ± 5.9 years). Sleep disturbances were measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI); QoL with the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39); depression and anxiety with the Hospital Anxiety and Depression Scale (HADS) and disease severity with the Unified Parkinson’s Disease Rating Scale (UPDRS). χ ² test, bivariate correlations and multiple linear regressions were performed. PSQI and ESS had significant correlations with worse QoL (p < 0.01, p < 0.05, respectively). HADS-D (p < 0.01), HADS-A (p < 0.01), UPDRS (p < 0.01) and disease duration (p < 0.05) were also significantly related to worse QoL. In the linear regression analysis, however, only PSQI (p < 0.01), anxiety (p < 0.001) and UPDRS (p < 0.001) remained significant. The model with PSQI explained 74% of the variance, and the model with ESS explained 63% of the variance in PDQ-39 when analyses were performed separately. In an overall model, however, only PSQI remained significant, accounting for 82% of the variance in PDQ-39. Nighttime poor sleep and anxiety are important contributors leading to a worse QoL. As these are treatable conditions, they should be recognized by clinicians and managed properly.     

The study of sleep disorder factors in patients with Guillain–Barré syndrome

In this study, we explore the sleep disorders and its associated factors in patients with Guillain–Barré syndrome (GBS), so as to work out appropriate interventions to promote early recovery of the patients. This study subjects included 49 patients with GBS who had been admitted to the Department of Neurology at The Affiliated Hospital of Hebei University, fulfilling National Institute of Neurological and Communicative Diseases and Stroke (NINCDS) criteria for GBS; 37 cases were male and 12 female (age: 27–68 years). Patients were evaluated once daily for two consecutive weeks. By using Wong and Baker Face Scale (WBFS) to evaluate the numbness and pain in patients, 0 points representing completely no pain and 10 points represents the most severity of the pain reactions; the same applies for numbness. The GBS Disability Scale (GBS DS) is used to evaluate the severity of GBS. The Hospital Anxiety and Depression Scale (HADS) is used to evaluate the anxiety and depression the patient is experiencing. All patients take routine EMG and sleep EEG. The sleep quality of the subjects was evaluated by the Pittsburgh Sleep Quality Index Scale (PSQI) and Richard Campbell Sleep Rating Scale. This study found that the application of ventilators, numbness, anxiety and severe limb movement disorders are the main factors causing sleep disorders. Cerebrospinal fluid (CSF) protein concentration is also associated with sleep disorders. But, no obvious abnormalities were found in sleep EEG. The application of the ventilator, numbness, anxiety and severe limb movement disorder are main factors causing sleep disorders. CSF protein concentration is also associated with sleep disorders.     

Low self-esteem and psychiatric patients: Part II – The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients

Background  

The objective of the present study was to identify the effects and relative importance of demographic factors and psychosocial stressors on self-esteem of psychiatric patients.     

An age-period-cohort analysis for prevalence of common psychiatric disorders in Japan, 1999–2017

Purpose

This study aimed to analyze the prevalence of common psychiatric disorders in Japan via an age-period-cohort (APC) analysis.

Methods

Data were used on the prevalence of schizophrenia, schizotypal, and delusional disorders; mood [affective] disorders (mood disorders, hereafter); and neurotic, stress-related, and somatoform disorders from the 1999–2017 Patient Survey in Japan. The age group was defined as 20–89 years with 5-year increments; the cohort was assigned for each age group of each year with a 1-year shift. A Bayesian APC analysis was used to decompose changes in prevalence into three effects: age, period, and cohort.

Results

The APC analysis revealed that the peaks of age effect varied among sexes and diseases. The period effects for all the diseases showed increasing trends over the analyzed years. Although the cohort effect for the prevalence of schizophrenia, schizotypal, and delusional disorders increased until the 1960s, it decreased afterwards. On the other hand, the cohort effects for the prevalence of mood disorders and neurotic, stress-related, and somatoform disorders increased from around the 1950s, and it indicates the prevalence increased particularly in young ages over the years. Also, the trends of each effect were relatively similar between mood disorders and neurotic, stress-related, and somatoform disorders.

Conclusion

Increase in public awareness and psychological stress associated with a change in a social environment is thought to affect the period and cohort effects on the prevalence of mood disorders and neurotic, stress-related, and somatoform disorders.

     

Meta-analysis of cognitive functioning in patients with psychotic disorders and obsessive–compulsive symptoms

European Archives of Psychiatry and Clinical Neuroscience - Obsessive–compulsive symptoms (OCS) in psychotic disorders are associated with unfavorable outcomes, whether this extends to...     

Differences in hypothalamic–pituitary–adrenal axis functioning among children with ADHD predominantly inattentive and combined types

Some evidence suggests that the HPA axis may be dysfunctional in children with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate whether a different pattern of HPA axis activity is found between the inattentive (I) and combined (C) subtypes of ADHD, in comparison with healthy control children. A total of 100 prepubertal subjects [52 children with ADHD combined type (ADHD-C), 23 children with ADHD predominantly inattentive type (ADHD-I), and 25 healthy control subjects] were studied. The effects of stress were studied by comparing cortisol responses to a psychosocial stressor, consisting of a public speaking task. Children with ADHD-I showed an elevated cortisol response to the psychosocial stressor, in contrast to children with ADHD-C who showed a blunted cortisol response to the psychosocial stressor. When a distinction was made between responders and non-responders (a subject was classified as a responder when there was an increase in cortisol reactivity), hyperactivity symptoms were clearly related to a lower cortisol reactivity to stress. The results indicate that a low-cortisol responsivity to stress may be a neurobiological marker for children with ADHD-C, but not for those with ADHD-I. Directions for future research and clinical implications are discussed.     

The interaction of Urocortin II and Urocortin III with amygdalar and hypothalamic cotricotropin-releasing factor (CRF) – Reflections on the regulation of the hypothalamic–pituitary–adrenal (HPA) axis

Urocortin II (Ucn II) and Urocortin III (Ucn III) are selective agonists of the CRF receptor type 2 (CRFR2). The aim of the present experiments was to investigate the effects of Ucn II and Ucn III on the central CRF and peripheral glucocorticoids in rats. Increasing doses (0.5–1–2–5 μg/2 μl) of Ucn II or Ucn III were administered intracerebroventricularly, then CRF concentration was determined by immunoassays in two different brain regions, the amygdala and the hypothalamus, and in two different time paradigms, 5 and 30 min after the administration of peptides. In parallel with the second determination, plasma corticosterone concentration was measured by chemofluorescent assay. The amygdalar CRF amount was increased significantly by 0.5 and 5 μg of UCN II and 2 and 5 μg of UCN III in the 5 min experiments and by 5 μg of UCN II and 0.5 and 5 μg of UCN III in the 30 min experiments. The hypothalamic CRF content was not affected considerably in the 5 min paradigm, but it was influenced significantly in the 30 min paradigm, with 0.5 and 1 μg of UCN II and 0.5–2 μg of UCN III decreasing, and 2 and 5 μg of UCN II and 5 μg of UCN III increasing the hormone concentration, respectively. The plasma corticosterone concentration was decreased by 1 and 2 μg of UCN II and UCN III and increased by 0.5 and 5 μg of UCN III. The present results demonstrate that central administration of Ucn II and Ucn III modulate time-dependently and dose-dependently the amygdalar and the hypothalamic CRF concentration, and, directly or indirectly, the plasma corticosterone concentration. The present experiments suggest that the role of CRFR2 in the regulation of the HPA axis can be inhibitory or stimulatory, depending on the actual concentration of their agonists.     

Association between sleep disorders and cognitive dysfunctions in non-demented patients with advanced Parkinson’s disease

Journal of Neurology - Parkinson’s disease (PD) is increasingly recognized as a multidimensional disorder, characterized by several non-motor symptoms, including disturbances of sleep and...     

The association of neural axis and craniovertebral junction anomalies with scoliosis in Rubinstein–Taybi syndrome

Object

Rubinstein–Taybi syndrome (RSTS) is a rare condition with characteristic genetic and clinical features. The presence of variable vertebral and neural axis abnormalities has been reported in the literature. We describe the possible association of multiple different spinal anomalies in these patients.

Results

The radiological exams of two RSTS patients (a female and male of 11 and 13 years) have been reviewed. Both patients presented the simultaneous association of craniovertebral junction bony abnormalities (occipito-C1 condyle subluxation and posterior C2–C3 arches fusion), Chiari I malformation, spinal cord syrinx, low-lying conus medullaris, and scoliosis.

Conclusion

An association of different spinal cord anomalies is possible in RSTS patients and has to be investigated with a comprehensive neuroimaging study in order to address the proper treatment and prevent the development of neurologic deficits.