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Background: Maternal parenting stress during childhood may have important influences on offspring internalizing and externalizing behaviors during adolescence in unmarried households, but it is unclear whether effects differ across different trajectory patterns of maternal parenting stress and for native-born vs. immigrant families., Methods: Using data from the Future of Families and Child Wellbeing Study, we identified trajectory patterns of maternal parenting stress from ages 1-9 years using semi-parametric group-based trajectory modeling. We used negative binomial regression models to estimate associations between maternal parenting stress trajectories and adolescent behavioral symptoms at age fifteen., Results: Five maternal parenting stress trajectory groups were identified among the 1982 unmarried families included in this study, representing consistently low (9.2 %), consistently mild (54.2 %), moderate and decreasing (14.4 %), moderate and increasing (16.0 %) and consistently high (6.2 %) levels of maternal parenting stress. For adolescent internalizing symptoms, all maternal parenting stress trajectory groups exhibited higher symptoms compared to the consistently low group: IRR for consistently mild: 1.21 (95 % CI: 0.98-1.56); IRR for moderate/decreasing: 1.34 (95 % CI: 1.04-1.74); IRR for moderate/increasing: 1.62 (95 % CI: 1.28-2.13); and IRR for consistently high: 1.74 (95 % CI = 1.29-2.41). Similar results were observed for adolescent externalizing symptoms. Stronger effects of maternal parenting stress trajectories on adolescent externalizing symptoms were observed among native-born vs. immigrant families., Limitations: Differential attrition and same-source bias may lead to under- or over-estimation of the associations of interest., Conclusions: Interventions targeting unmarried families with elevated maternal parenting stress during childhood may reduce behavioral symptoms in adolescence., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia from the early stages and can appear even in mild cognitive impairment (MCI). However, the prognostic impact of BPSD is unclear. This study examined the association between BPSD and mortality among people with cognitive impairment., Methods: This longitudinal study involved 1,065 males and 1,681 females (mean age: 77.1 years for males and 78.6 years for females) with MCI or dementia diagnosis from the National Center for Geriatrics and Gerontology-Life Stories of People with Dementia (NCGG-STORIES), a single-center memory clinic-based cohort study in Japan that registered first-time outpatients from 2010-2018. Information about death was collected through a mail survey returned by participants or their close relatives, with an up to 8-year follow-up. BPSD was assessed using the Dementia Behavior Disturbance Scale (DBD) at baseline., Results: During the follow-up period, 229 (28.1%) male and 254 (15.1%) female deaths occurred. Cox proportional hazards regression analysis showed that higher DBD scores were significantly associated with increased mortality risk among males, but not females (compared with the lowest quartile score group, hazard ratios for the highest quartile score group were 1.59; 95% confidence interval, [CI] 1.11-2.29 for males and 1.06; 95% CI, 0.66-1.70 for females). Among the DBD items, lack of interest in daily living, excessive daytime sleep, and refusal to receive care had a higher mortality risk., Conclusion: The findings suggest a potential association between BPSD and poor prognosis among males with cognitive impairment.

The purpose of this study is to assess the relationship between engagement in meaningful activities and behavioral and psychological symptoms of dementia (BPSD), including agitation, apathy, irritability, and depression among 71 assisted living (AL) residents with moderate to severe dementia. This secondary analysis used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) in five AL communities. The Engagement in Meaningful Activities Scale and the Neuropsychiatric Inventory Questionnaire were completed. Logistic regression was used to compare those with and without each BPSD symptom of interest on engagement in meaningful activities while controlling for age, sex, and cognitive impairment. On average, participants were 85 years old, white, females. Perceived engagement in meaningful activities was significantly associated with decreased odds of having agitation (OR=0.94, 95 % CI [.88-0.99]) but not with apathy, depression, or irritability. Engagement in meaningful activities may help reduce agitation among AL residents., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems)., Methods: The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers., Results: We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning., Limitations: Maternal and child measures were based on maternal reports only., Conclusions: The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare that are relevant to the content of this article., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Little is known about how clinical features prospectively influence peer relationships in autistic populations., Aims: This study investigated the clinical symptoms mediating the link between autism spectrum disorder (ASD) diagnosis and peer relationships at follow-up, i.e. the second time evaluation of this study., Methods: The sample consisted of 366 autistic youths and 134 non-autistic comparisons. The autistic traits and emotional/behavioral problems were measured at baseline by Social Responsiveness Scale (SRS) and Child Behavior Checklist (CBCL). The interactions and problems with peers were assessed by the Social Adjustment Inventory for Children and Adolescents (SAICA) at follow-up., Results: Each subscore of SRS and CBCL showed significant mediation effects. Multiple mediation analyses showed atypical social communication, social awareness problems, and delinquent behaviors mediated the link from ASD to less active peer interactions after controlling for sex, age, and IQ. Moreover, atypical social communication, social-emotional problems, and attention difficulties predicted problems with peers. After considering these mediation effects, the diagnosis of ASD still demonstrated a significantly direct effect on peer relationships at follow-up., Conclusions and Implications: Our findings support that social-related autistic features, attention problems, and delinquent behaviors mediated a link between ASD and peer relationships. These mediators are potential measures for improving interactions and decreasing difficulties with peers in the autistic population., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study examined daily occurrences of behavioral and psychological symptoms of dementia (BPSD) and whether caregivers' perceived distress towards BPSD varies throughout four phases of the day (i.e., morning, daytime, evening, and night). Family caregivers residing with relatives who were using adult day services (ADS) participated in an 8-day daily diary study (caregiver N = 173; caregiver-day N = 1,359). BPSD occurred most frequently in the evenings. ADS use, sleep disturbances, and dementia severity were significantly associated with BPSD occurrence for some phases of the day. Caregivers' distress towards BPSD occurrences increased throughout the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD at night on days when their relatives used ADS. Evidence of temporal patterns of BPSD in community-dwelling older adults and caregiver distress demonstrated the importance of ADS use for BPSD reactivity and identified potential target windows and associated contextual factors for individualized interventions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The seven tiered behavioural and psychological symptoms of dementia (BPSD) model of service delivery has been used by inpatient units. The classification of each tier is broadly defined and not always agreed upon by clinicians. The case study uses novel approach by combining the BPSD classification criteria with clinical presentation to identify the clinical characteristics of the case and match these characteristics against the BPSD classification. This process was enhanced by using case specific measures such as the Neuropsychiatric Inventory (NPI) and Cohen Mansfield Agitation Inventory (CMAI) scales and key clinical data., Case Presentation: A case study of 76 year old male diagnosed with mixed Alzheimer's and Vascular dementia. The clinical presentation of the symptomatology was deemed to be extreme, thus fitting into the seventh tier (Extreme) of the BPSD model of service delivery. The case is considered to fit into the Extreme BPSD category given the high levels of aggression, which were consistently reflected in high scores on NPI and CMAI, as well as long length of inpatient stay (over 3 years). The average number of Pro re nata (PRN) psychotropics medications per month was 56 and seclusion episodes of 6 times per month, with each episode lasting on average 132 min shows severity of behaviours. His level of aggression had resulted in environmental damage and staff injuries., Conclusion: We recommend patient clinical characteristics, relevant hospital data and specific measures should be used to develop consensus around defining and classifying cases into Extreme BPSD., (© 2024. Crown.)

With the increasing global aging population, dementia care has rapidly become a major social problem. Current diagnosis of Behavior and Psychological Symptoms of Dementia (BPSD) relies on clinical interviews, and behavioral rating scales based on a period of behavior observation, but these methods are not suitable for identification of occurrence of BPSD in the daily living, which is necessary for providing appropriate interventions for dementia, though, has been studied by few research groups in the literature. To address these issues, in this study developed a BPSD monitoring system consisting of a Psycho-Cognitive (PsyCo) BPSD model, a Behavior-Physio-Environment (BePhyEn) BPSD model, and an implementation platform. The PsyCo BPSD model provides BPSD assessment support to caregivers and care providers, while the BePhyEn BPSD model provides instantaneous alerts for BPSD enabled by a 24-hour home monitoring platform for early intervention, and thereby alleviation of burden to patients and caregivers. Data for acquiring the models were generated through extensive literature review and regularity determined. A mobile robot was utilized as the implementation platform for improving sensitivity of sensors for home monitoring, and elderly individual following algorithms were investigated. Experiments in a virtual home environment showed that, a virtual BPSD elderly individual can be followed safely by the robot, and BPSD occurrence could be identified accurately, demonstrating the possibility of modeling and identification of BPSD in home environment., (© 2024. The Author(s).)

Introduction: People caring for patients with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries, there is a lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia and to compare the effects of BPSD on caregiver burden across different types of dementia., Methods: A cross-sectional study was conducted on 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB), and vascular dementia (VD) and their caregivers who attended a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory. We used analysis of variance to compare the AD, bvFTD, DLB, and VD groups. Correlations between Zarit Burden Inventory and NPI subscale scores were assessed with Spearman's correlation., Results: DLB caregivers had significantly higher levels of burden than the other patient groups (p < 0.05) and higher total NPI scores than caregivers for other patient groups (p < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (p < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively., Conclusion: Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden., (© 2024 S. Karger AG, Basel.)

Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with Alzheimer's disease (AD), causing burdens on caregivers. Behavioral and psychological symptoms of dementia and subclinical epileptiform discharge (SED) increased with the disease course of AD. However, the interaction between them was still unknown. The present study aimed to evaluate the associations between SED and BPSD., Methods/design: Patients with AD from Kaohsiung Municipal Ta-tung Hospital were included in this study. International 10-20 system scalp electroencephalography (EEG) for 13 min was performed to detect SED. Behavioral and psychological symptoms of dementia was assessed by neuropsychiatric inventory (NPI) questionnaires. The occurrence of BPSD subsyndromes was compared between patients with and without SED., Results: Two hundred sixty-three adult patients qualified for the inclusion criteria and were enrolled in this study. The mean age of patients was 80.2 years, and approximately 62% were women. 17.1% of patients showed SED on EEG. Apathy was the most commonly reported BPSD subsyndrome in this cohort. There was no significant difference in the prevalence of BPSD between patients with and without SED. (75.6% vs. 67.4%, p = 0.2806). However, the NPI score of irritability subsyndrome was significantly higher in the SED (+) group (2.6 ± 3.7 vs. 1.2 ± 2.7, p = 0.0028). In addition, subclinical epileptiform discharge in the frontal lobe was associated with a considerably higher occurrence of hyperactivity subsyndrome, including irritability., Conclusions: SED may not be a direct cause of BPSD, but the presence of SED may affect the manifestation of BPSD., (© 2023 John Wiley & Sons Ltd.)

Objectives: The aims of this study were to: (1) describe the prevalence of behavioral and psychological symptoms of dementia in hospitalized older adults living with dementia and (2) examine the association of physical activity and behavioral and psychological symptoms of dementia among hospitalized older adults living with dementia, after controlling for covariates., Methods: Physical activity was measured using the Physical Activity Survey and behavioral and psychological symptoms of dementia were measured using the Neuropsychiatric Inventory. Descriptive analysis and multiple linear regressions were run using baseline data on 294 older adults with dementia hospitalized on general medical units from an ongoing study entitled Function Focused Care for Acute Care Using the Evidence Integration Triangle., Results: Participants performed an average of 7.92 (SD = 4.49) of 34 possible activities "in the last 24 h" prior to the Physical Activity Survey administration. A total of 132 participants (45.5%) had at least one behavioral and psychological symptom of dementia. We found that physical activity was not associated with behavioral and psychological symptoms of dementia (b = 0.01; p = 0.56), after controlling for covariates., Conclusions: Although this study found no evidence of an association between physical activity and behavioral and psychological symptoms of dementia, evidence of physical activity did not exacerbate these behaviors. Thus, given the benefits of physical activity, it is important to continue to encourage patients living with dementia to engage in activity., (© 2023 John Wiley & Sons Ltd.)

Most persons living with dementia (PLWD) exhibit behavioral or psychological symptoms of dementia (BPSD) over the course of the illness. The DICE Approach (DICE) is a framework that enables caregivers to identify, evaluate, and manage BPSD. This pilot pre-post test study examined the effects of DICE training on dementia care professionals' self-efficacy, knowledge, and attitudes regarding care of patients with BPSD. Participants underwent either in-person DICE training or, during the pandemic, online training. Case consultations were offered as additional learning opportunities in challenging situations. Of 134 participants in the trainings, 122 (91.0%) provided survey data for one or more instruments before and after training. Participants experienced significant improvement in knowledge and attitudes with respect to BPSD and improvement in self-efficacy with respect to helping caregivers respond to BPSD. Training dementia care professionals in DICE can improve their capacity to support caregivers in the management of BPSD., Competing Interests: Declaration of competing interest Dr. Walaszek declares the following interests: He receives royalties from American Psychiatric Association Publishing; he has received honoraria from Aurora Advocate Healthcare, University of Nebraska, University of Missouri-Kansas City, the Wisconsin Association of Medical Directors, and MercyHealth for presentations given. Dr. Endicott has received an honorarium from UnityPoint Health – Meriter and the Wisconsin Nurses Association APRN Forum for presentations given. Dr. Carlsson receives grant funding from NIH, NIH/Lilly, NIH/Eisai, and the Department of Veterans Affairs. Dr. Mahoney receives grant funding from NIH and royalties from Freiberg Press. The other authors do not have any interests to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The first-line management of behavioral and psychological symptoms of dementia (BPSD) is based on nonpharmacologic interventions such as the provision of guidance and medical support to caregivers. However, accessibility to specialized care and medical resources is often scarce. The ongoing COVID-19 pandemic has compromised the delivery of outpatient care (notably in order to minimize the risk of disease transmission), thus making it essential to provide other means of accessing care for these patient populations. The use of telemedicine (TM) may be a means of increasing access to specialist care for patients with disabilities and poor access to health services, such as those with BPSD. The aim of this study is to provide a review of the literature on the use of TM for treatment and follow-up of patients with BPSD and their caregivers. We searched the PUBMED, EMBASE and CINAHL for articles published between January 1st, 2000, and December 31st, 2020, on the applicability of TM support for people with BPSD and their caregivers. We included open-label studies, qualitative studies, and randomized controlled trials . We did not include studies on the use of TM during the COVID-19 pandemic. A total of 22 publications were included and reviewed. TM was found to 1) be acceptable and feasible for both patients and caregivers, 2) decrease the frequency and intensity of BPSD, and 3) improve the caregiver's perceived wellbeing and mental health. Videoconferencing was effective for patient-centered interventions in nursing homes. Telephone-based interventions were more relevant when they were targeted at caregivers. The published studies are lacking in scope and high-quality studies are now needed to confirm these findings and assess TM's cost-effectiveness and ability to improve the management of patients with BPSD. In view of the ongoing COVID-19 pandemic, remote solutions for assessing and monitoring individuals with BPSD are urgently needed - particularly those living in rural areas and so-called "medical deserts.", (Copyright © 2022 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: Clinical pathways are used to improve the quality of care, reduce variation and maximise health or treatment outcomes in selected populations. The aim of this study was to develop a draft clinical pathway based on the best practice evidence for use in the management of behavioural and psychological symptoms of dementia (BPSD) in residential aged care facilities (RACFs)., Methods: The pathway was developed using the best practice evidence from clinical practice guidelines, operational guides and a systematic literature review. A multidisciplinary team of health professionals and researchers worked in an iterative process to contextualise the proposed pathway to local needs and context, and improve its clarity and user-friendliness. The pathway was then re-assessed for accuracy and adherence to the evidence., Results: The draft pathway outlines processes for BPSD prevention, watchful waiting for mild-to-moderate BPSD, and specific interventions for severe BPSD. Ongoing risk assessment is required throughout, and non-pharmacological options are first-line interventions. Person-centred care was found to be an important care component across all three phases. An instruction guide with colour-coded flow charts was developed to assist staff with determining the best care and treatment for each person living with dementia. Feasibility testing is underway., Conclusions: A draft clinical pathway based on clinical practice guidelines was developed to enhance the translation of evidence into practice for the management of BPSD, by nursing and clinical leaders in RACFs., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc.)

Korsakoff Syndrome (KS) is commonly associated with behavioural symptoms such as agitation, apathy, and disinhibition. People with KS often reside in long-term care facilities, which reduces their exposure to natural light. Little is known regarding positive effects of light intervention in KS. Our objective was to evaluate the influence of a dawn simulation therapy on behavioural symptoms in KS. 38 patients residing in a 24-hour care facility were exposed for 6 weeks to a dawn simulation system in their bedrooms, which gradually increased from 0 lux to 290 lux. Behavioural symptoms were measured over 9 weeks. Weeks 1-3 consisted of the baseline phase and weeks 3-9 consisted of the light intervention phase. Our study showed that total severity of neuropsychiatric symptoms was less prominent during light intervention. More specifically, a decrease on the apathy, disinhibition, behaviour at night and appetite and eating behaviour subscales was found during the light intervention phase compared to the baseline phase. Additionally, a significant effect was found on decreasing emotional distress for caregivers. Results suggest that light intervention therapy has a positive effect on reducing behavioural symptoms in KS as well as the levels of stress experienced by the patients' caregivers.

Behavioral and psychological symptoms of dementia (BPSD) are symptoms of dementia that family caregivers find difficult to manage. Competence in managing BPSD differs according to individual family caregiver. The current study investigated the competence in managing BPSD, focusing on family caregivers who were recognized as managing them well. Twenty-four Korean family caregivers (83% female, mean age = 67 years) living with persons with dementia (PWD) were interviewed. Four themes were derived from the content analysis: Entering and Looking into the World of PWD , Keeping Daily Life in Harmony With BPSD , Becoming an Expert in BPSD , and Balancing Between Caregiving and Myself . Family caregivers minimized the impact of BPSD and maintained life balance. As a result, they were able to continue a harmonious life with PWD. [ Research in Gerontological Nursing, 15 (3), 141-150.].

Background: To conduct a comprehensive comparison of behavioural and psychological symptoms of dementia (BPSD) in Chinese people with early-onset Alzheimer's disease (EOAD) and late-onset Alzheimer's disease (LOAD) and analyse the factors of differences., Methods: A cross-sectional survey of 93 EOAD and100 LOAD and their caregivers in China from November 2018 to May 2019., Results: The total Neuropsychiatric Inventory score was significantly higher in LOAD. A higher level of agitation in EOAD was related to a lower quality of life of caregivers and the emotional expression of ignoring people with dementia. Higher euphoria scores in LOAD were associated with reduced negative coping by caregivers and reduced stability and predictability at home., Conclusion: The early identification and management of specific BPSD of EOAD and LOAD by family members and health professionals may improve the quality of care and life for people with dementia and that of caregivers., (© 2022 Japanese Psychogeriatric Society.)

Background: The Frontal Behavioral Inventory (FBI) is a questionnaire designed to quantify behavioral changes in frontotemporal dementia (FTD). Literature showed heterogeneous FBI profiles in FTD versus Alzheimer's disease (AD) with variable occurrence of positive and negative symptoms., Objective: In this study, we constructed a short FBI version (i.e., mini-FBI) with the aim to provide clinicians with a brief tool for the identification of early behavioral changes in behavioral variant of FTD (bvFTD), also facilitating the differential diagnosis with AD., Methods: 40 bvFTD and 33 AD patients were enrolled. FBI items were selected based on internal consistency and exploratory factor analysis. Convergent validity of mini-FBI was also assessed. A behavioral index (i.e., B-index) representing the balance between positive and negative mini-FBI symptoms was computed in order to analyze its distribution in bvFTD through a cluster analysis and to compare performance among patient groups., Results: The final version of the mini-FBI included 12 items, showing a significant convergent validity with the Neuropsychiatric Inventory scores (rp = 0.61, p < 0.001). Cluster analysis split patients in four clusters. bvFTD were included in three different clusters characterized by prevalent positive symptoms, both positive and negative symptoms, or prevalent negative behavioral alterations, similar to a subset of AD patients. A fourth cluster included only AD patients showing no positive symptoms., Conclusion: The mini-FBI is a valuable easily administrable questionnaire able to early identify symptoms effectively contributing to the bvFTD behavioral syndrome, aiding clinician in diagnosis and management.

Background: Behavioral and psychological symptoms of dementia (BPSD) have a large impact on the quality of life of patients with Alzheimer's disease (AD). Few studies have compared BPSD between early-onset (EOAD) and late-onset (LOAD) patients, finding conflicting results., Objective: The aims of this study were to: 1) characterize the presence, overall prevalence, and time of occurrence of BPSD in EOAD versus LOAD; 2) estimate the prevalence over time and severity of each BPSD in EOAD versus LOAD in three stages: pre-T0 (before the onset of the disease), T0 (from onset to 5 years), and T1 (from 5 years onwards); 3) track the manifestation of BPSD sub-syndromes (i.e., hyperactivity, psychosis, affective, and apathy) in EOAD versus LOAD at T0 and T1., Methods: The sample includes 1,538 LOAD and 387 EOAD diagnosed from 1996 to 2018. Comprehensive assessment batteries, including the Neuropsychiatric Inventory (NPI), were administered at the first medical assessment and at different follow-up period., Results: The overall prevalence for the most of BPSD was significantly higher in EOAD compared to LOAD whereas most BPSD appeared significantly later in EOAD patients. Between the two groups, from pre-T0 to T1 we recorded a different pattern of BPSD prevalence over time as well as for BPSD sub-syndromes at T0 and T1. Results on severity of BPSD did not show significant differences., Conclusion: EOAD and LOAD represent two different forms of a single entity not only from a neuropathological, cognitive, and functional level but also from a psychiatric point of view.

Behaviors and disorders related to self-regulation, such as substance use, antisocial behavior and attention-deficit/hyperactivity disorder, are collectively referred to as externalizing and have shared genetic liability. We applied a multivariate approach that leverages genetic correlations among externalizing traits for genome-wide association analyses. By pooling data from ~1.5 million people, our approach is statistically more powerful than single-trait analyses and identifies more than 500 genetic loci. The loci were enriched for genes expressed in the brain and related to nervous system development. A polygenic score constructed from our results predicts a range of behavioral and medical outcomes that were not part of genome-wide analyses, including traits that until now lacked well-performing polygenic scores, such as opioid use disorder, suicide, HIV infections, criminal convictions and unemployment. Our findings are consistent with the idea that persistent difficulties in self-regulation can be conceptualized as a neurodevelopmental trait with complex and far-reaching social and health correlates., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Depression and anxiety are highly prevalent and comorbid psychiatric traits that cause considerable burden worldwide. Here we use factor analysis and genomic structural equation modelling to investigate the genetic factor structure underlying 28 items assessing depression, anxiety and neuroticism, a closely related personality trait. Symptoms of depression and anxiety loaded on two distinct, although highly genetically correlated factors, and neuroticism items were partitioned between them. We used this factor structure to conduct genome-wide association analyses on latent factors of depressive symptoms (89 independent variants, 61 genomic loci) and anxiety symptoms (102 variants, 73 loci) in the UK Biobank. Of these associated variants, 72% and 78%, respectively, replicated in an independent cohort of approximately 1.9 million individuals with self-reported diagnosis of depression and anxiety. We use these results to characterize shared and trait-specific genetic associations. Our findings provide insight into the genetic architecture of depression and anxiety and comorbidity between them., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

The coronavirus disease 2019 (COVID-19) pandemic swept the nation by surprise, leaving a deep-seated impact on individuals' social, mental, and physical health. Despite there being disparities between Black and White/non-Hispanic individuals, minimal research has been conducted to explore the effects of the virus on marginalized groups. This study aimed to investigate Black adolescents' perceptions of their experiences with COVID-19, including the challenges they encountered, the coping strategies they employed, and their use of religious/spiritual and school-based support. Twelve Black youth between the ages of 12 and 18 years were interviewed during the early stages of the pandemic (June and July of 2020). Participants struggled with adjusting to the changes in their daily routines, navigating virtual learning, and emerging mental health difficulties (e.g., anxiety). To cope with these challenges, participants relied on emotion and problem-focused coping strategies, including strategies that were religious/spiritual in nature. Participants also relied on social support from family, school personnel, and their religious community, though they lamented about the varied support received from the latter two. Findings from this research support calls for mental health providers to employ culturally affirming mental health services and engage in interagency collaboration to support Black youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: To evaluate how sociodemographic characteristics and various aspects of parent well-being, family functioning, parent-child relationship, and child characteristics are related to psychological functioning in children aged 9 to 12 years during the COVID-19 lockdown., Method: Participants included 144 children aged 9 to 12 years and their parents who lived in the province of Quebec, Canada, during the COVID-19 mandatory lockdown. Parents and children were administered a phone-based survey in which various child, parent, parent-child, and family characteristics were assessed., Results: Results showed that higher internalizing problems in children were related to greater depressive symptoms in parents, lower attachment security to parents, and greater aversion to aloneness in children. Results on externalizing behavior problems showed that more problems were associated with more family dysfunction and chaos and lower attachment security to parents. Finally, results on children's anxiety toward COVID-19 showed that more anxiety was associated with greater parental anxiety toward COVID-19 and more child aversion to aloneness., Conclusion: Our findings showed that even during an unusual and stressful context such as a pandemic, proximal variables such as the attachment relationship that have been known to be closely associated with adaptation are significantly related to child psychological functioning. Such observations are important because they highlight factors that may accentuate child vulnerability in times of a pandemic and shed light on potential intervention targets., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Most studies investigating antipsychotic effectiveness report either total psychopathology or symptom cluster findings. Studies focusing on a separate symptom, such as hallucinations, a hallmark symptom in schizophrenia, are scarce.Therefore, the current study aims to compare the antihallucinatory effectiveness of 3 pharmacologically different antipsychotics: olanzapine, amisulpride, and aripiprazole., Methods: The present study is part of the Bergen-Stavanger-Innsbruck-Trondheim study, a 12-month prospective, randomized, pragmatic antipsychotic drug trial in active-phase schizophrenia spectrum disorders. The primary outcome of the present study was change of hallucinations as measured by item P3 (hallucinatory behavior) from the Positive and Negative Syndrome Scale in the subgroup with hallucinations at baseline. Primary analyses were intention to treat., Results: A total of 144 participants were included in the study, where 105 (72%) had a score of 3 or more on the Positive and Negative Syndrome Scale P3 item at baseline, indicating the presence of hallucinations (HALL subgroup).In the HALL subgroup, a significantly less reduction of hallucinations was revealed for participants using olanzapine in weeks 12, 26, 39, and 52 when compared with amisulpride and in weeks 26 and 52 when compared with aripiprazole. In subanalyses for participants never exposed to antipsychotic drugs (antipsychotic-naive) and those who had used antipsychotics before entering the study, antihallucinatory differences were revealed only in the latter group., Conclusions: A differential antihallucinatory effect of the 3 study drugs was present. The inferior effect of olanzapine seems to be driven by the subgroup of participants exposed to antipsychotic treatment before entering the study., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The present study examined the relationship between cultural identity conflict and psychological well-being, as well as the role of self-concept clarity and self-esteem in mediating this linkage. Elevated cultural identity conflict was hypothesized to be associated with lower psychological well-being via both (lower) self-concept clarity and (lower) self-esteem, with self-concept clarity preceding self-esteem. In a cross-sectional design, 473 bicultural young adults (age range, 18-35) completed an online questionnaire assessing cultural identity conflict, self-concept clarity, self-esteem, emotional distress, psychopathological symptoms, and satisfaction with life. Correlation analyses revealed that elevated cultural identity conflict was positively associated with emotional distress and psychopathological symptoms, and negatively associated with satisfaction with life. Mediation analyses indicated that these associations were mediated by lower self-concept clarity and lower self-esteem. The results support the importance of interventions that foster the development of skills in bicultural young adults to obtain more self-concept clarity and promote self-esteem and psychological well-being., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Clinicians may place more weight on vocal complaints of pain than the other pain behaviors when making decisions about pain management., Objectives: We examined the association between documented pain behaviors and pharmacological pain management among nursing home residents., Methods: We included 447,684 residents unable to self-report pain, with staff-documented pain behaviors (vocal, nonverbal, facial expressions, protective behaviors) and pharmacological pain management documented on the 2010-2016 Minimum Data Set 3.0. The outcome was no pharmacological pain medications, as needed only (pro re nata [PRN]), as scheduled only, or as scheduled with PRN medications. We estimated adjusted odds ratios and 95% confidence intervals from multinomial logistic models., Results: Relative to residents with vocal complaints only, those with one pain behavior documented (i.e., nonverbal, facial, or protective behavior) were more likely to lack pain medication versus scheduled and PRN medications. Residents with multiple pain behaviors documented were least likely to have no treatment relative to scheduled with PRN medications, PRN only, or scheduled only pain medication regimens., Discussion: The type and number of pain behaviors observed are associated with pharmacological pain management regimen. Improving staff recognition of pain among residents unable to self-report is warranted in nursing homes., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: When confronted with major threats, people often experience decline in well-being. The central purpose of this study was to identify mechanisms underlying change of well-being in times of threat, using the example of the COVID-19 pandemic, with a focus on appraisals of the pandemic and affective states, stress, as well as mindfulness in daily life., Method: We conducted a study across 3.5 weeks, including pretest, posttest, and a diary phase in-between. We worked with a sample of 460 adults, pre- and post-test information, as well as 7,189 observations from the diary phase., Results: Results showed that deterioration in mental health symptoms across the duration of the study was associated with (a) change towards less fortunate appraisals of the pandemic and (b), more negative affect and less mindfulness in daily life. Furthermore, appraisals of the pandemic at pretest predicted experiences in daily life, with more negative appraisals of the pandemic predicting more negative affect and stressor occurrence as well as less mindfulness., Conclusions: These findings speak to the dynamic nature of well-being and appraisals in times of threat, and highlight the role of experiences in daily life in changes in well-being., (© 2020 Wiley Periodicals LLC.)

Objective: The association between parental mental health difficulties and poor child outcomes is well documented. Few studies have investigated the intergenerational effects of trauma in immigrant populations. This study examined the relationships among parental trauma, parenting difficulty, duration of planned family separation, and child externalizing behavior in an archival dataset of West African voluntary and forced immigrants in New York City. We hypothesized that parenting difficulty would mediate the association between parental posttraumatic stress and child externalizing behavior and that this association would be stronger for parent-child dyads that had undergone lengthier separations during migration., Method: Ninety-one parents reported on their posttraumatic stress symptoms using the Harvard Trauma Questionnaire (HTQ) and on the behavioral health of one child between the ages of 5 and 12 years using the externalizing items of the Child Behavior Checklist (CBCL Externalizing). A 4-item self-report scale assessed difficulty parenting in the last month., Results: Linear regression analyses showed that parenting difficulty partially mediated the relationship between HTQ and CBCL scores. The relationship between HTQ and CBCL scores was not significant for parents separated from their children for one year or less but was significant for those never separated or separated for longer than 1 year. Higher HTQ scores were most strongly associated with higher CBCL Externalizing scores for those separated longer than one year., Conclusions: Findings suggest that children of immigrants recovering from trauma are at risk of exhibiting behavioral symptoms and highlight a potential intervention target for improving child outcomes in immigrant families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Students with preexisting mental health conditions or disabilities may fair worse due to virus mitigation strategies during the COVID-19 pandemic. This study was conducted to understand the experiences of students with preexisting mental health conditions or disabilities at a public university during COVID-19. We examined disruptions in the management of preexisting mental health conditions or disabilities and its impact on psychological well-being. Students were surveyed about their health care experiences during the COVID-19 pandemic between June and September 2020. Linear regressions and mediation analyses were conducted to examine the relationships between disruption to care, mental health self-efficacy, and four psychological well-being outcomes (stress, anxiety, depression, and overall distress). Of the total (N = 1,082) study participants, 258 (24%) reported having a preexisting mental health condition(s) or disabilities (81% female; Mage = 23.47). Of those, 155 (61%) reported that COVID-19 disrupted health care delivery and management of their conditions or disabilities. Of those who reported this disruption, 51% (n = 109) of participants reported a disruption in their ability to see a health care professional and 58% (n = 69) reported either that they lost care or that the quality of the new telemedicine care was not sufficient. A series of linear regressions revealed significant relationships between disruption to care and the four psychological outcomes. Mediation analyses revealed that depression, stress, anxiety, and overall distress were mediated by self-efficacy in managing mental health. University administrators and health care providers should evaluate the scope of mental health care and telemedicine services for students to help long-term psychological effects of COVID-19., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Traumatic brain injury (TBI) may alter the course of neuropsychiatric symptom (NPS) onset during dementia development. The connection among TBI, NPS, and dementia progression is of increasing interest to researchers and clinicians., Methods: Incidence of NPS was examined in participants with normal cognition who progressed to all-cause dementia based on whether TBI history was present (n = 130) or absent (n = 849). Survival analyses were used to examine NPS incidence across 7.6 ± 3.0 years of follow-up., Results: Participants with TBI history had increased prevalence and incidence of apathy (44.7% vs 29.9%, P = .0062; HR adj. = 1.708, P = .0018) and motor disturbances (17.2% vs 9.5%, P = .0458; HR adj. = 2.023, P = .0168), controlling for demographics and type of dementia diagnosis. Earlier anxiety onset was associated with TBI (692 days prior to dementia diagnosis vs 161 days, P = .0265)., Discussion: History of TBI is associated with increased risk for and earlier onset of NPS in the trajectory of dementia development., (© 2020 the Alzheimer's Association.)

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The current pandemic wave of COVID-19 has resulted in significant uncertainty for the general public. Mental health and examining factors that may influence distress have been outlined as key research priorities to inform interventions. This research sought to examine whether intolerance of uncertainty and coping responses influence the degree of distress experienced by the U.K. general public during the COVID-19 pandemic. Using a cross-sectional online questionnaire design, participants were recruited ( N = 842) using snowball sampling over a 10-day period in the early "lockdown" phase of the pandemic. Around a quarter of participants demonstrated significantly elevated anxiety and depression, with 14.8% reaching clinical cutoff for health anxiety. A one-way multivariate analysis of variance indicated those in "vulnerable" groups were significantly more anxious ( p < .001), and also more anxious in relation to their health ( p < .001). Mediation modeling demonstrated maladaptive coping responses partially mediated the predictive relationship between intolerance of uncertainty and psychological distress. Mental health difficulties have become significantly raised during the first wave of the COVID-19 pandemic in the United Kingdom, particularly for the vulnerable. Findings support emerging research suggesting the general public is struggling with uncertainty, more so than normal. Vulnerable groups are more anxious about their health, but not more intolerant of uncertainty than the nonvulnerable. Finally, this study indicated two modifiable factors that could act as treatment targets when adapting interventions for mental health during the COVID-19 global health crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Few studies have examined the longitudinal association between sluggish cognitive tempo (SCT) symptoms and internalizing symptoms, and no study has examined the potentially bidirectional associations between SCT and internalizing symptoms. The present study used a short-term longitudinal design to examine the directionality of the associations between SCT, depressive, and anxious symptoms in children. Teachers of 188 children in 1st to 6th grades (6-13 years of age; 47% boys) provided ratings of children's SCT, anxiety, and depressive symptoms in the fall school semester (T1) and again 6 months later (T2). Children in 3rd to 6th grades ( n = 133) provided ratings of anxiety and depressive symptoms at both time points. Cross-lagged panel models examining the longitudinal associations between SCT, anxiety, and depressive symptoms were conducted controlling for sex and grade, with separate models for teacher- and child-reported internalizing symptoms. SCT symptoms at Time 1 (T1) predicted increased depressive symptoms at T2, with findings consistent across teacher-rated depression and child-rated depression. Depression at T1 did not predict SCT at T2. SCT symptoms at T1 also predicted increased teacher-rated anxiety at T2 but not child-rated anxiety. Finally, child-rated anxiety at T1 predicted increased SCT at T2. Findings from this study provide the first evidence that SCT symptoms predict subsequent depressive symptoms and not the reverse. Associations between SCT and anxiety are more nuanced, with results differing based on the informant. Additional studies are needed to replicate and extend these findings across longer developmental periods with more time points and to examine mechanisms of the associations between SCT and internalizing symptoms in children.

Parental depressive symptoms are associated with greater variability and inconsistency in parenting behavior as well as children's emotional and behavioral dysregulation. The present study explored whether such relations extended to dyadic processes, examining whether maternal and paternal depressive symptoms at child age 3½ interacted with concurrent higher dyadic behavioral variability (DBV) in mother-child free play to heighten children's emotional and behavioral dysregulation at age 4 ( N = 100). Child dysregulation was measured as mother-reported emotional lability-negativity and externalizing problems, and DBV was measured as the number of transitions among dyadic behavioral states using state space grids. Parent behaviors included parent directives, positive reinforcement, and disengagement, and child behaviors included child compliance, persistence, and noncompliance, among others. Analyses also accounted for the degree of positive (compared to negative) behavioral content. Moderation analyses showed that DBV predicted greater child dysregulation only when maternal or paternal depressive symptoms were higher. Further, DBV was detrimental only when dyadic positive interaction content was low. Findings suggest DBV combined with low positive content in parent-child interactions is a particular risk factor for children's regulatory development. Fostering positive, predictable interaction patterns may be an important target for family interventions with a depressed parent. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using the ECLS-K, a dataset following a nationally representative cohort of children from kindergarten through 8th grade in the United States (N ≈ 9,250), this study fills the following knowledge gaps. We captured childhood economic experiences by incorporating multiple forms of exposures to income-based deprivation-poverty depth (i.e., the severity of deprivation), spells (i.e., length of time in poverty), and income volatility (i.e., fluctuations in family income)-with a latent class analysis. We also examined how different patterns of economic experiences shaped adolescents' socioemotional functioning through family stress (parental depressive symptoms and punitive parenting) and family investment (provision of stimulating materials and parental school involvement) pathways via structural equation modeling. Our analysis indicated 6 classes of deprivation, and these deprivation patterns had both direct and indirect significant associations with children's locus of control and internalizing behaviors. Our structural equation modeling results further indicated that deprivation was associated with parental depressive symptoms, which were, in turn, associated with parents providing less cognitively stimulating materials to children and engaging less in children's school activities. These disadvantages were associated with unfavorable socioemotional functioning in 8th grade. The findings highlight the importance of family practitioners and psychologists recognizing and acting on the interconnections among deprivation, inequity, and child well-being. Our results also suggest considering variations in economic experiences and mechanisms when developing informed policies and programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Guided by multiple theories illustrating the transactional nature of the relation between parents' and children's behaviors, the present meta-analysis provides synthesized evidence on the strength of child-driven effects in eliciting changes in parents' psychological stress and parenting practices. A meta-analysis of 45 independent samples with 640 effect sizes found significant positive associations between children's externalizing behaviors and parents' subsequent functioning (r = .087, 95% CI [.07, .10]). These associations were net of parents' functioning at baseline, and the strength of these associations was statistically comparable with the effects of parents on children's externalizing behaviors (r = .075, 95% CI [.06, .09]). In addition, the strength of the child-driven effects did not vary as a function of child gender, age, or the time interval between assessments. The implications of these findings with respect to research on the dynamic relation between parenting functioning and children's adjustment are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Although behavioral changes are common in nursing home residents with dementia and caffeine is known to influence behavior in healthy adults, the effects of caffeine on the behavior of persons with dementia has received little attention. In this study we assessed the relationship of caffeine and behavioral symptoms in older persons with dementia., Design: A multicenter sub-cohort study embedded in the Elderly Care Physicians (ECP) training program., Setting: Dutch nursing homes associated with the ECP training program., Participants: A total of 206 individuals with both diabetes and dementia resident in Dutch nursing homes., Measurements: Trainee ECPs collected data on caffeine consumption, cognition and behavioral symptoms using the NPI-NH, MDS-DRS and AES-C. Data on factors known to influence behavior in persons with dementia (e.g. marital status, kidney function, urinary tract infection and medication) were also collected., Results: Of the 206 participants, 70% showed behavioral symptoms. An increase in caffeine consumption was associated with a decrease in the presence of behavioral symptoms in the NPI-NH cluster affect and NPI-NH item agitation. Caffeine consumption groups also differed on the presence of disinhibition and depression. In addition, the severity of dementia influenced agitation, anxiety and the clusters affect and psychomotor., Conclusion: In a large group of older persons with dementia resident in nursing homes, a low daily consumption of caffeine was associated with greater behavioral symptoms., Competing Interests: All authors declare that they have no competing interests.

This study examines the association between behavioral health symptoms and use of behavioral health care (BHC; i.e., past year counseling and/or regular use of psychiatric medication) among a diverse group of mothers of toddlers. Data were from the Fragile Families and Child Wellbeing study (N = 4205 mothers). The association between symptom profiles (i.e., depressive, anxiety, and alcohol and drug dependence) and use of BHC was estimated with logistic regression models. Potential moderation by race/ethnicity was examined. Complex symptom profiles, older age, functional limitations, prior behavioral health symptoms, and having Medicaid were associated with increased BHC use. While BHC use varied by symptom profile (but not by race/ethnicity), BHC use was low across profiles. Pregnant women and women of color were most likely to have unmet needs, underscoring the need to improve screening and management systems for these populations.

Background: Advanced stages of dementia are characterized by severe cognitive and physical impairment. It has not yet been investigated whether persons with young onset dementia (YOD) and late onset dementia (LOD) differ in advanced disease stages., Objectives: To compare quality of life (QoL) between persons with advanced YOD and LOD; to explore the determinants of QoL; to investigate whether YOD and LOD differ with regard to symptoms and care., Methods: The study was performed in the context of EPYLOGE (IssuEs in Palliative care for persons in advanced and terminal stages of YOD and LOD in Germany). Persons with advanced dementia (PWAD) were assessed and caregivers were interviewed. QoL was measured with the proxy rating Quality of Life in Late Stage Dementia (QUALID) scale., Results: 93 persons with YOD and 98 with LOD were included. No significant differences in QoL were detected. Determinants of QoL were similar in YOD and LOD. Behavioral and psychological symptoms of dementia (BPSD), suffering and other distressing symptoms were associated with a lower QoL. In YOD but not in LOD antipsychotic treatment was associated with low QoL. The group of persons who were younger than 65 years at the time of the study visit experienced significantly more distressing symptoms than older PWAD., Conclusion: Overall, persons with advanced YOD do not appear to be disadvantaged compared to old and oldest PWAD. Special attention, however, must be paid to the group of the very young persons who seem to be particularly vulnerable.

Patients with systemic lupus erythematosus (SLE) experience chronic symptoms that negatively impact their quality of life (QoL). This study analyzed the variables that contributed to QoL in patients with SLE, including the mediating role of psychological morbidity and disease activity. This study used a transversal design and included 104 women with SLE. Participants answered several instruments assessing fatigue, psychological morbidity (depression and anxiety), body image, disease activity, and quality of life. The results showed that disease activity, fatigue severity, psychological morbidity and body image were associated with all domains of QoL. Additionally, psychological morbidity and disease activity mediated the relationship between body image and psychological morbidity. Also, disease activity mediated the relationship between body image and fatigue severity. According to the results, intervention in patients with SLE should focus on patients' psychological morbidity, particularly in the active phase of the disease. Body image, fatigue severity and psychological morbidity should be monitored in patients with SLE in order to promote QoL.

Constructs from positive psychology were employed to create an explicit model of caregiver resilience. Predictive and mediating relationships among resilience and related variables (personality, coping, self-efficacy, hope, social support) were then tested for their association with burden and psychological adjustment among family members caring for relatives with severe TBI. Family participants ( n  = 131) from six rehabilitation units from New South Wales and Queensland completed assessments which elicited explanatory (Eysenck Personality Questionnaire, Ways of Coping Questionnaire), mediating (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey), and caregiver outcome (Caregiver Burden Scale, Mental Health sub-Scale-SF36, General Health Questionnaire, and Positive and Negative Affect Scale) variables. Structural Equation Modeling (SEM) showed that resilience had a direct effect on positive affect in caregivers. Resilience also played a protective role in relation to two variables associated with caregiver vulnerability: an indirect association with caregiver burden mediated through social support; a direct effect on hope, which, in turn, was associated with positive mental health. Positive mental health then played a buffering role in relation to psychological distress and negative affect. Resilience, in combination with other psychological attributes, was associated with reduced morbidity among family caregivers after severe TBI.

Agitation is a common, treatable symptom that profoundly impacts quality of life and exacerbates caregiver fatigue in the hospice setting for patients with dementia. The objective of this study was to analyze the efficacy of tailored nonpharmacological interventions for mitigation of unwanted behaviors in the population of patients with behavioral and psychological symptoms in dementia while receiving hospice care. The 4-domain Pittsburgh Agitation Scale (PAS; Motor, Verbal, Aggressive, Resistance to Care) was used for multiple baseline and posttest measurements of agitation. Effectiveness of nonpharmacological interventions was evaluated using analysis of variance for repeated measures for the total PAS score. Motor agitation was the presenting problem with highest-rated severity compared with Verbal, Aggression, and Resistance to Care domains. Analysis of variance demonstrated no difference between baseline referral and pretest total PAS measures (P = .8), but a significant drop in total PAS agitation after intervention (P < .001). The best outcomes, however, were with patients receiving both nonpharmacological and standard pharmacological interventions as opposed to nonpharmacological interventions alone (P = .034). For patients with dementia presenting with behavioral and psychological symptoms, selected nonpharmacological interventions provide significant mitigation of agitation.

Many studies have identified some abnormalities in gastrointestinal (GI) physiology (e.g., increased intestinal permeability, overall microbiota alterations, and gut infection) in children with autism spectrum disorder (ASD). Furthermore, changes in the intestinal flora may be related to GI and ASD symptom severity. Thus, we decided to systematically review the effects of gut microbial-based interventions on gut microbiota, behavioral symptoms, and GI symptoms in children with ASD. We reviewed current evidence from the Cochrane Library, EBSCO PsycARTICLES, PubMed, Web of Science, and Scope databases up to July 12, 2020. Experimental studies that used gut microbial-based treatments among children with ASD were included. Independent data extraction and quality assessment of studies were conducted according to the PRISMA statement. Finally, we identified 16 articles and found that some interventions (i.e., prebiotic, probiotic, vitamin A supplementation, antibiotics, and fecal microbiota transplantation) could alter the gut microbiota and improve behavioral symptoms and GI symptoms among ASD patients. Our findings highlight that the gut microbiota could be a novel target for ASD patients in the future. However, we only provided suggestive but not conclusive evidence regarding the efficacy of interventions on GI and behavioral symptoms among ASD patients. Additional rigorous trials are needed to evaluate the effects of gut microbial-based treatments and explore potential mechanisms., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aim: To: (1) provide greater insight into the psychological and social impact of a range of demyelinating disorders, (2) explore differences between disorders, and (3) provide direction for future research., Method: Studies were identified by searching online databases. Studies that explored the psychological, emotional, or social impact of a range of demyelinating disorders in childhood, including acute disseminated encephalomyelitis (ADEM), optic neuritis, transverse myelitis, and multiple sclerosis, were included and screened independently by three authors. Data on the design, sample characteristics, psychosocial measures, key findings, and methodological strengths and limitations were extracted. Twenty-five studies were included in the narrative synthesis., Results: Demyelinating disorders are associated with lower quality of life, affecting young people's emotional, social, school, and behavioural functioning. There is a high prevalence of psychiatric disorders and fatigue, particularly in multiple sclerosis. Subtle differences exist in the psychological presentation between different demyelinating disorders, with clear gaps in the research for the long-term psychosocial impact of monophasic conditions., Interpretation: The difference between the impact of monophasic and relapsing demyelinating disorders on psychosocial functioning is unclear. Future research should aim to identify the psychosocial impact across disorders and over time, ensure that services are capturing those patients who may benefit from tailored interventions., What This Paper Adds: Prevalence of psychiatric diagnoses in paediatric demyelinating disorders is higher than controls. Depression and emotional concerns are elevated in paediatric demyelinating disorders. Demyelinating disorders impact children's quality of life across school, social, and physical functioning., (© 2020 Mac Keith Press.)