Electroencephalogram utilization and psychiatric comorbidities among children and adolescents with epilepsy in rural Southwestern Uganda

Objective This study aimed at describing routine electroencephalogram (EEG) findings among children and adolescents with a clinical diagnosis of epilepsy and determines how interictal EEG abnormalities vary with the psychiatric comorbidities. Methods We conducted a cross-sectional study among children and adolescents with epilepsy aged 5–18 years receiving care from a regional referral hospital in Southwestern Uganda. Psychiatric comorbidities were assessed using an adapted parent version of Child and Adolescent Symptom Inventory-5. Thirty-minute EEG samples were taken from routine EEG recordings that were locally performed and remotely interpreted for all participants. Results Of the 140 participants, 71 (50.7%) had normal EEG findings and 51 (36.4%) had epileptiform abnormalities while 18 (12.9%) had non-epileptiform. Of those who had epileptiform abnormalities on EEG, 23 (45.1%) were focal, 26 (51.0%) were generalized, and 2 (3.9%) were focal with bilateral spread. There was no significant association between the different psychiatric comorbidities and the interictal EEG abnormalities. Conclusions Among children and adolescents with a clinical diagnosis of epilepsy in Southwestern Uganda, only 36% showed epileptiform abnormalities on their EEG recordings. There was no association between the interictal EEG abnormalities and psychiatric comorbidities.

Prevalence Rates and Evolution of Psychiatric Disorders Among Incarcerated Youths in Comparison With Non-incarcerated Youths

Background: Our main objective was to provide estimates of the prevalence rates of psychiatric disorders and comorbidities among youths in a juvenile detention center in Geneva, Switzerland. We also aimed to investigate potential positive effects of intensive psychotherapeutic and educational services this center provides. Finally, we examined psychiatric care prior to and after custody as well as the evolution of the youths' mental health during detention.Methods: We conducted a longitudinal study including a group of incarcerated (n = 86) and a group of non-incarcerated (n = 169) youths (12–18 years old). Measures included diagnoses of psychiatric disorders, cognitive functions, trauma, psychopathic traits and the Youth Self-Report (aggressive behavior, attentional disorders, criminal behavior, social withdrawal, anxiety, depression and somatic complaints) collected at baseline and at discharge for the incarcerated group. Data were analyzed using mixed-effect models.Results: Psychiatric disorders were prevalent in the incarcerated group (82.6, 95% CI: 71.6–90.7%), but young people also often suffered from several disorders simultaneously. Two-thirds of the incarcerated participants had a diagnosis of two or more psychiatric disorders. Regarding health care, most incarcerated participants (79.1%) had psychiatric care prior to detention. The planned care after detention was associated with psychiatric comorbidities, care being more likely planned for those with comorbidities (p = 0.030). Compared to the non-incarcerated group, the incarcerated group had lower scores on cognitive functioning (p < 0.001) and higher scores on trauma (p < 0.021) and psychopathic traits (p < 0.034). The youths' stay in the detention center was associated with a positive change of mental health, with externalized problems being significantly reduced at the end of their stay (p = 0.017).Conclusion: Our findings showed that youths in conflict with the law are characterized by (1) their internal vulnerabilities: a high prevalence of psychiatric disorders and psychiatric comorbidities, lower cognitive functions, externalized problems and psychopathic traits; (2) environmental factors: victims of violence and sexual abuse; and (3) their psychiatric history. Besides, the evolution of the most prevalent issues was favorable over time, which puts into question the usual perspective about the deleterious effect of detention.

Psychiatric Comorbidities and Dehydration are More Common in Children Admitted to the Emergency Department for Eating Disorders in the COVID-19 Era.

Purpose Since the beginning of COVID-19 pandemic, social distancing and home-confinement had a significant impact on children, especially on those with eating disorders (ED). The primary objective of this retrospective study was to describe and analyze the demographic and clinical profiles of children presenting with ED during the COVID-19 pandemic.Methods We conducted a retrospective review of clinical charts of patients with ED younger than 18 years who accessed the emergency department of the Bambino Gesù Children's Hospital, Rome, between March 2019 and March 2021. Of these, we reported and compared the demographic, clinical and laboratory data before and after the COVID-19 pandemic and looked for predictors of ED severity.Results A total of 211 admissions for ED were recorded. The patients, mostly females (86.3%) were on average 14.1 years old. The mean weight loss on admission was 11 kg. Bradycardia was observed in 31.3% of the study sample. 16.6% of patients had an associate psychiatric disorder and 60.2% required psychotropic drugs. 68.7% of the patients required hospitalization. Respectively, 96 and 115 patients were admitted before and during the COVID-19 pandemic. The latter were hospitalized more (78.3 vs 57.3%; p=0.001), yet for less time (19 vs 26 days; p=0.004), had a higher mean serum creatinine (0.68 vs 0.47; p<0.001) and were more frequently diagnosed with an associated psychiatric disorder (23.5 vs 8.3%; p=0.003).Conclusion Our study shows a significant increase of hospitalizations of children with ED during the COVID-19 pandemic, along with a shorter length of stay, more psychiatric comorbidities, and some distinctive features at the laboratory workup, such as an increase of serum creatinine and/or a reduction of serum albumin.Level of evidence III, evidence obtained from well-designed cohort or case-control analytic studies

Psychiatric Comorbidities and Liver Injury Are Associated With Unbalanced Plasma Bile Acid Profile During Methamphetamine Withdrawal

BackgroundThe pathogenesis of methamphetamine usedisorders (MUDs) remains largely unknown; however, bile acids may play arole as potential mediators of liver injury and psychiatric comorbidities.The aim of this study was to characterize bile acid (BA) profiles in plasmaof patients with MUDs undergoing withdrawal.MethodsLiver functions and psychiatric symptoms wereevaluated in a retrospective cohort (30 MUDs versus 30 control subjects) andan exploratory cohort (30 MUDs including 10 subjects each at the 7-day,3-month, and 12-month withdrawal stages versus 10 control subjects). BAcompositions in plasma samples from MUD patients in the exploratory cohortwere determined by gas-liquid chromatography.ResultsBoth psychiatric comorbidities andmethamphetamine-induced liver injury were observed in patients in both MUDcohorts. The plasma concentrations of the total BA, cholic acid (CA), andchenodeoxycholic acid (CDCA) were lower in MUD patients relative tocontrols. The maximum decline was observed at the 3-month stage, withgradual recovery at the 12-month stage. Notably, the ratios of deoxycholicacid (DCA)/CA and lithocholic acid (LCA)/CDCA were statistically significantat the 3-month stage comparing with controls. Significant correlations werefound between the LCA/CDCA and taurolithocholic acid (TLCA)/CDCA ratios andthe levels of alanine transaminase and aspartate aminotransferase, andbetween the LCA/CDCA ratio and the HAM-A score.ConclusionBA profile during METH withdrawal weremarkedly altered, with these unbalanced BAs being associated with liverinjury. The associations between BA profiles and psychiatric symptomssuggest an association between specific BAs and disease progression,possibly through the liver-brain axis.

A System-wide Retrospective Cohort Analysis of Psychiatric Diagnoses and Persistent Symptoms Following Concussion

ObjectiveTo evaluate the epidemiologic features of psychiatric comorbidities following mild traumatic brain injury (MTBI, or concussion) in a state-wide hospital system cohort over a 10-year period.BackgroundThe epidemiology of neuropsychiatric symptoms and diagnoses following concussion are poorly understood. Despite the rebirth of post-concussion syndrome (PCS) as persistent post-concussion symptoms (PPCS), entailing diverse and complex somatic, cognitive, and emotional components with significant potential overlap or confounding of psychiatric comorbidities, there is scarce characterization of the incidence of such comorbidities following concussion. The study of demographic factors as they relate to psychiatric diagnoses following concussion remains in infancy.Design/MethodsWe conducted an observational retrospective cohort study of all patients who received a diagnosis of concussion within Ochsner Health (OH) over a 10-year period. System-wide electronic medical records were evaluated using ICD-10 codes to collect data on patients with a diagnosis of MTBI or concussion, as compared to patients with no diagnosis of concussion over the same period. Data on subpopulations corresponding to psychiatric diagnostic outcomes following diagnosis of concussion were collected and evaluated to determine timeline-related incidences of outcomes, as well as on demographic and morbid features corresponding to each outcome. These included age, sex, race, ethnicity, household income, neurologic and psychiatric history, cause of concussion, and presence of loss of consciousness.ResultsWe report incidence, demographic, and morbid factor data on patients with a diagnosis of concussion, and as related to outcomes following diagnosis of concussion, including: (1) new diagnosis of PCS, (2) meeting PPCS Berlin Sport Concussion Consensus criteria, (3) new unclassified neuropsychiatric symptoms, (4) any new psychiatric diagnosis, (5) new psychiatric diagnosis excluding PCS, (6) new anxiety, dissociative, stress-related, or somatoform disorder diagnosis, (7) new reaction to severe stress or adjustment disorder diagnosis, and (8) new PTSD diagnosis.ConclusionsWe call for multidisciplinary awareness, screening, and longitudinal research of patients with concussion.

Outcomes of Endolymphatic Sac Surgery for Meniere’s Disease with and without Comorbid Migraine

Purpose. To explore outcomes of endolymphatic sac surgery for patients with Meniere’s disease with and without the comorbid condition of migraine. Materials and Methods. A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. Results. Patients with Meniere’s disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, p = 0.01 ), shorter duration of vertigo episodes (143 vs. 393 min, p = 0.02 ), and younger age (36.6 vs. 50.8 yr, p = 0.005 ) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 ( p < 0.001 ). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference ( p = 0.59 ). Of the patients who required secondary treatment (10.42%), none had migraine. Conclusions. Endolymphatic sac surgery is an effective surgical intervention for Meniere’s disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities.

Linking gene expression patterns and brain morphometry to trauma and symptom severity in patients with functional seizures

ObjectiveAdverse life experiences (ALEs) increase the susceptibility to functional (somatoform/dissociative) symptoms, likely through neurodevelopmental effects. This analysis aimed to illuminate potential genetic influences in neuroanatomical variation related to functional symptoms and ALEs in patients with functional seizures.MethodsQuestionnaires, structural brain MRIs and Allen Human Brain Atlas gene expression information were used to probe the intersection of functional symptom severity (Somatoform Dissociation Questionnaire, SDQ-20), ALE burden, and gray matter volumes in 20 patients with functional seizures.ResultsFunctional symptom severity positively correlated with the extent of sexual trauma, emotional neglect, and threat to life experiences. In voxel-based morphometry analyses, increased SDQ-20 scores related to decreased bilateral insula, left orbitofrontal, right amygdala, and perigenual and posterior cingulate gray matter volumes. Left insula findings held adjusted for psychiatric comorbidities. Increased sexual trauma burden correlated with decreased right posterior insula and putamen volumes; increased emotional neglect related to decreased bilateral insula and right amygdala volumes. The sexual trauma–right insula/putamen and emotional neglect– right amygdala relationships held adjusting for individual differences in psychiatric comorbidities. When probing the intersection of symptom severity and sexual trauma volumetric findings, genes overrepresented in adrenergic, serotonergic, oxytocin, opioid, and GABA receptor signaling pathways were spatially correlated. This set of genes was over-expressed in cortical and amygdala development.ConclusionALEs and functional symptom severity were associated with gray matter alterations in cingulo-insular and amygdala areas. Transcriptomic analysis of this anatomical variation revealed a potential involvement of several receptor signaling pathways.