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1.
Article En | MEDLINE | ID: mdl-32908795

Background: The importance of vitamin D deficiency in Parkinson's disease, its negative influence on bone health, and even disease pathogenesis has been studied intensively. However, despite its possible severe impact on health and quality of life, there is not a sufficient understanding of its role in other movement disorders. This systematic review aims at providing an overview of the prevalence of vitamin D deficiency, bone metabolism alterations, and fractures in each of the most common hyperkinetic movement disorders (HKMDs). Methods: The study search was conducted through PubMed with keywords or Medical Related Subjects (MeSH) of common HKMDs linked with the terms of vitamin D, osteoporosis, injuries, and fractures. Results: Out of 1585 studies screened 40 were included in our review. They show that there is evidence that several HKMDs, including Huntington disease, Restless Legs Syndrome, and tremor, are associated with low vitamin D serum levels in up to 83% and 89% of patients. Reduced bone mineral density associated with vitamin D insufficiency was described in Huntington disease. Discussion: Our survey suggests that vitamin D deficiency, bone structure changes, and fractures are important but yet under-investigated issues in HKMDs. HKMDs-patients, particularly with a history of previous falls, should have their vitamin D-levels tested and supplemented where appropriate. Highlights: Contrary to Parkinson's disease, vitamin D deficiency, and bone abnormalities are under-investigated in hyperkinetic movement disorders (HKMDs). Several HKMDs, including essential tremor, RLS, and Huntington disease, are associated with vitamin D deficiency in up to 89%, the latter also with reduced bone mineral density. Testing and where appropriate supplementation is recommended.


Bone Diseases, Metabolic/epidemiology , Fractures, Bone/epidemiology , Hyperkinesis/epidemiology , Movement Disorders/epidemiology , Vitamin D Deficiency/epidemiology , Bone Diseases, Metabolic/etiology , Comorbidity , Fractures, Bone/etiology , Humans , Hyperkinesis/etiology , Movement Disorders/etiology , Vitamin D Deficiency/complications
2.
Pediatr Int ; 62(7): 840-847, 2020 Jul.
Article En | MEDLINE | ID: mdl-32034991

BACKGROUND: The most common respiratory disturbance in sleeping children is obstructive sleep apnea syndrome (OSAS). Passive smoking is one of factors predisposing to OSAS. The aim of this study was to determine the correlations between exposure to tobacco smoke (passive smoking) and development of respiratory disorders in children during sleep. METHODS: One hundred and sixty school-aged children (6-18 years) were included in the study. The inclusion criterion was exposure to tobacco smoke at home (n = 90). The control group were school-aged children who had had no contact with tobacco smoke at home (n = 70). Exclusion criteria were obesity and children with impaired patency of the nose. Each child had a polygraphic examination performed at home. The children and their parents completed a questionnaire to assess the level of child's exposure to tobacco smoke. The study ran from December 15, 2012 to February 26, 2016. RESULTS: OSAS was observed in 12% of children with an apnea-hypopnea index >1.5 (<13 years of age) and an apnea-hypopnea index >5 (for children >13 years), and with diurnal and nocturnal symptoms. Children exposed to tobacco smoke presented more apnea-hypopnea events (n = 17) than the control group (n = 3; P < 0.001). In the group exposed to tobacco smoke the following issues were noted: concentration problems (38.9%), tiredness/lethargy (46.7%), and irritability/hyperactivity (36.7%). No statistically significant differences were found in waking up, snoring, or sleep apnea. CONCLUSIONS: OSAS occurs more often in children exposed to tobacco smoke and these children demonstrate concentration problems, tiredness, and irritability/hyperactivity to a greater extent than control group.


Sleep Apnea, Obstructive/epidemiology , Tobacco Smoke Pollution/adverse effects , Adolescent , Child , Female , Humans , Hyperkinesis/epidemiology , Irritable Mood , Lethargy/epidemiology , Male , Obesity/epidemiology , Polysomnography/methods , Risk Factors , Sleep , Sleep Apnea Syndromes/epidemiology , Sleep Apnea, Obstructive/etiology , Snoring/epidemiology , Surveys and Questionnaires
3.
Aust N Z J Psychiatry ; 54(3): 259-271, 2020 03.
Article En | MEDLINE | ID: mdl-31561712

OBJECTIVE: This study examined the secondary mental health outcomes of two contrasting alcohol prevention approaches, whereby one intervention targets common underlying personality risk for alcohol use and mental health problems (Preventure) and the other targets alcohol- and drug-related behaviours and cognitions (Climate Schools). METHODS: A 2 × 2 cluster randomised controlled factorial design trial was conducted in 26 Australian schools randomised to the following 4 conditions: Climate Schools (n = 6), Preventure (n = 7), combined Climate Schools and Preventure (CAP; n = 6) or treatment as usual (TAU; n = 7). Participants completed questionnaires at baseline, 6, 12, 24 and 36 months post-baseline including the Brief Symptom Inventory anxiety and depression scales and hyperactivity and conduct scales of the Strengths and Difficulties Questionnaire. Analyses focused on students who were at high-risk based on personality traits (n = 947; Mage = 13.3). The effectiveness of each approach in reducing symptoms of internalising and externalising problems was assessed using multi-level mixed effects analysis. RESULTS: Main effects for each intervention relative to not receiving that intervention revealed significant main effects of Preventure in reducing anxiety symptoms (d = -0.27, 95% confidence interval [CI] = [-0.53, -0.01], p < 0.05) and a marginal effect in reducing depressive symptoms (d = -0.24, 95% CI = [-0.49, 0.01], p = 0.06) over 3 years. Interaction effects revealed that when delivered alone, Preventure significantly reduced conduct problems (d = -0.45, 95% CI = [-0.78, -0.11], p < 0.05) and hyperactivity symptoms (d = -0.38, 95% CI = [-0.70,-0.07], p < 0.05) compared to TAU. CONCLUSION: This study is the first to report the effectiveness of personality-targeted alcohol prevention in reducing internalising and externalising symptoms relative to an active control, providing evidence in favour of its specificity in preventing concurrent substance use and mental health problems among high-risk youth.


Alcohol Drinking/prevention & control , Anxiety/prevention & control , Depression/prevention & control , Health Education/methods , Hyperkinesis/prevention & control , School Health Services , Adolescent , Anxiety/epidemiology , Australia/epidemiology , Child , Depression/epidemiology , Female , Humans , Hyperkinesis/epidemiology , Male , Personality , Program Evaluation , Schools , Self Report , Students/psychology
4.
Sci Rep ; 9(1): 1705, 2019 02 08.
Article En | MEDLINE | ID: mdl-30737414

Flunarizine (fz) causes side effects such as movement disorders (MDs). We investigated risk factors associated with fz-related MDs. Participants were recruited from the longitudinal health insurance databases and included patients who took fz for more than 1 month. Patients with one of the underlying diseases, or with concomitant drug use (antipsychotics, metoclopramide or reserpine), and those diagnosed with MDs before fz use were excluded. Fz-related MD was defined as a new diagnosis of parkinsonism or hyperkinetic syndrome including dyskinesia or secondary dystonia during fz use or within 3 months after drug discontinuation. After exposure, 288 individuals had fz-related MDs (parkinsonism, n = 240; hyperkinesia, n = 48). Risk factors associated with these disorders were higher-dose exposure (cumulative defined daily dose [cDDD] ≥87.75, odds ratio [OR]: 3.80; 95% CI: 2.61-5.52), older age (OR: 1.07; 95% CI: 1.06-1.09), history of essential tremor (OR: 6.39; 95% CI: 2.29-17.78) and cardiovascular disease (CVD) (OR: 1.47; 95% CI: 1.14-1.9). The optimal value of cDDD to predict MDs was 58.5 (sensitivity: 0.67, specificity: 0.60), indicating an overall exposure of 585 mg. Higher exposure dose and duration, older age, history of essential tremor, and CVD were associated with fz-associated MDs. Clinicians ought to watch for extrapyramidal side effects when prescribing fz.


Flunarizine/adverse effects , Hyperkinesis/epidemiology , Parkinson Disease, Secondary/epidemiology , Aged , Case-Control Studies , Databases, Factual , Female , Humans , Hyperkinesis/chemically induced , Insurance, Health , Male , Middle Aged , Parkinson Disease, Secondary/chemically induced , Risk Factors
5.
Eur Child Adolesc Psychiatry ; 28(4): 557-570, 2019 Apr.
Article En | MEDLINE | ID: mdl-30232561

Diagnostic guidelines differ between DSM attention-deficit/hyperactivity disorder (ADHD) and ICD hyperkinetic disorder (HKD). Only 145 of 579 children age 7-9 in the Multimodal Treatment Study of ADHD (the MTA) with combined-type DSM-IV ADHD met criteria for ICD-10 HKD, because major internalizing comorbidities and more stringent symptom count/pervasiveness requirements excluded most. The 145 HKD had significantly better 14-month medication response than the rest. We explored whether HKD had greater adult symptom persistence and/or impairment than other ADHD. Multi-informant assessments were done for 16 years. We used the 12/14/16-year assessments, in young adulthood. The post-attrition 109 with baseline HKD had no greater adult persistence of ADHD symptoms/impairment than 367 without HKD, but had more cumulative stimulant use, more job losses, lower emotional lability, and fewer car crashes. However, those excluded for internalizing comorbidity but otherwise meeting HKD criteria had significantly more persistence. Only 6 of the 109 (5.5%) with baseline HKD met ICD-10 criteria for HKD in adulthood, compared to 25 of 367 (6.8%) without a childhood HKD diagnosis. Despite greater initial symptom severity, HKD had no worse 16-year young adult outcome than others, except for job losses, balanced by less emotional lability and fewer crashes. Comorbid internalizing disorder seems to have worse prognosis than initial severity/pervasiveness of ADHD symptoms.


Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Hyperkinesis/diagnosis , Hyperkinesis/therapy , International Classification of Diseases , Adolescent , Adult , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Combined Modality Therapy/methods , Combined Modality Therapy/psychology , Combined Modality Therapy/trends , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Female , Follow-Up Studies , Humans , Hyperkinesis/epidemiology , International Classification of Diseases/trends , Male , Predictive Value of Tests , Treatment Outcome , Young Adult
6.
Atten Defic Hyperact Disord ; 11(2): 183-189, 2019 Jun.
Article En | MEDLINE | ID: mdl-30171588

Identify correlates of nicotine dependence [lifetime (l) and ongoing (o)] in adults with attention-deficit/hyperactivity disorder (ADHD) in childhood. We conducted a 33-year prospective follow-up of boys (mean age 8) with combined type ADHD (n = 135/207, 65% original sample). Correlates of nicotine dependence in adulthood were selected from characteristics obtained in childhood and adolescence. Among selected childhood features, only immature behavior was significantly related to nicotine dependence (OR(o) = 0.29, p = 0.02), indexing decreased risk. In contrast, several adolescent variables significantly correlated (p < 0.01) with nicotine dependence at mean age 41, including alcohol substance use disorder (SUD, OR(l) = 4.97), non-alcohol SUD (OR(o) = 4.33/OR(l) = 10.93), parental antisocial personality disorder (OR(l) = 4.42), parental SUD (OR(l) = 3.58), dropped out of school (OR(l) = 2.29), impulsivity (OR(o) = 1.53/OR(l) = 1.59), hyperactivity (OR(o) = 1.38), and number of antisocial behaviors (OR(o) = 1.10/OR(l) = 1.14). Results highlight the role of adolescent psychopathology in the development of nicotine dependence, motivating prospective longitudinal efforts to better define the developmental trajectories of risk and protection.


Antisocial Personality Disorder/epidemiology , Attention Deficit Disorder with Hyperactivity/epidemiology , Child of Impaired Parents/psychology , Hyperkinesis/epidemiology , Substance-Related Disorders/epidemiology , Tobacco Use Disorder/epidemiology , Adult , Comorbidity/trends , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , United States/epidemiology
7.
Tidsskr Nor Laegeforen ; 138(20)2018 12 11.
Article En, Nor | MEDLINE | ID: mdl-30539620

BACKGROUND: Hyperkinetic disorder is one of the most frequently used psychiatric diagnoses among children and adolescents in Norway. It has previously been shown that use of the diagnosis varies widely by county. MATERIAL AND METHOD: We estimated the proportion of children with hyperkinetic disorder using patient data from the Norwegian Patient Registry and population data from the Norwegian Population Registry. The estimations were made for both Norway as a whole and by county. Assessment and documentation of the diagnosis were surveyed by linking the Norwegian Patient Registry and the Norwegian Mother and Child Cohort Study. We reviewed medical records from specialist mental health services for children and adolescents and assessed whether the diagnoses met the research criteria for hyperkinetic disorder. RESULTS: At 12 years of age, 5.4 % of Norwegian boys and 2.1 % of Norwegian girls had been diagnosed with hyperkinetic disorder by specialist health services. The proportion of children varied between 1.4 % and 5.5 % among the counties. A review of medical records for 549 children showed that 49 % of the diagnoses were reliably documented in the records. The main reasons that the diagnosis was not documented were a discrepancy between the information in the medical record and diagnostic criteria (38 %) and inadequate differential diagnostic assessment (46 %). INTERPRETATION: There was considerable geographic variation in the proportions of children and adolescents with hyperkinetic disorder. A large percentage of the diagnoses were not reliably documented in medical records. The guideline for evaluation, diagnostics and medical recordkeeping should be reviewed.


Attention Deficit Disorder with Hyperactivity , Hyperkinesis , Adolescent , Age Distribution , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Documentation/standards , Female , Humans , Hyperkinesis/diagnosis , Hyperkinesis/epidemiology , Male , Medical Records , Norway/epidemiology , Registries , Sex Distribution
8.
BMC Psychiatry ; 18(1): 368, 2018 11 20.
Article En | MEDLINE | ID: mdl-30458756

BACKGROUND: Longitudinal studies have consistently reported that prenatal exposure to acetaminophen can to lead to an increased risk of attention deficit-hyperactivity disorder during childhood. This study aimed to investigate the association between intrauterine exposure to acetaminophen and the presence of emotional and behavioral problems at the ages of 6 and 11 years in a low-middle income country. METHODS: We performed a prospective longitudinal population-based study using data from the 2004 Pelotas birth cohort. From the 4231 initial cohort participants, 3722 and 3566 children were assessed at 6 and 11 years of age, respectively. The outcomes were assessed using the parent version of Strengths and Difficulties Questionnaire (SDQ). The cut-off points established for the Brazilian population were used to categorize the outcomes. Crude and adjusted odds ratio were obtained through logistic regression. RESULTS: Acetaminophen was used by 27.5% (95% confidence interval [CI]: 26.1-28.9) of the mothers at least once during pregnancy. The prevalence of emotional problems at 6 and 11 years was 13.6 and 19.9%, respectively. For hyperactivity problems, prevalence was 13.9 and 16.1%, respectively. Intrauterine exposure to acetaminophen increased the odds of having emotional (odds ratio [OR] = 1.47; 95% CI: 1.07-2.02) and hyperactivity/inattention (OR = 1.42; 95% CI: 1.06-1.92) problems in 6-year-old boys. At the age of 11, a small decrease in the effect was observed for both outcomes after adjustment: OR = 1.31 (95% CI: 0.99-1.73) for emotional problems and OR = 1.25 (95% CI: 0.95-1.65) for hyperactivity/inattention in boys. No association for any phenotypes at both ages was observed for girls. CONCLUSION: The effect of intrauterine exposure to acetaminophen in emotional and hyperactivity symptoms was dependent on sex in a Brazilian cohort. While it seemed to be important for boys, mainly at 6 years of age, for girls, no association was observed.


Acetaminophen/adverse effects , Affective Symptoms/epidemiology , Hyperkinesis/epidemiology , Prenatal Exposure Delayed Effects/epidemiology , Adult , Age Factors , Brazil/epidemiology , Child , Cohort Studies , Female , Humans , Income , Male , Odds Ratio , Pregnancy , Prevalence , Sex Factors , Surveys and Questionnaires , Young Adult
9.
Arch Dis Child ; 103(8): 790-794, 2018 08.
Article En | MEDLINE | ID: mdl-29519947

INTRODUCTION: Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED). METHODS: We retrospectively analysed a case series of 256 children (aged 2 months to 17 years) presenting with AHMD to the pEDs of six Italian tertiary care hospitals over a 2-year period (January 2012 to December 2013). RESULTS: The most common type of AHMD was tics (44.5%), followed by tremors (21.1%), chorea (13.7%), dystonia (10.2%), myoclonus (6.3%) and stereotypies (4.3%). Neuropsychiatric disorders (including tic disorders, psychogenic movement disorders and idiopathic stereotypies) were the most represented cause (51.2%). Inflammatory conditions (infectious and immune-mediated neurological disorders) accounted for 17.6% of the cases whereas non-inflammatory disorders (including drug-induced AHMDs, genetic/metabolic diseases, paroxysmal non-epileptic movements and idiopathic AHMDs) accounted for 31.2%. Neuropsychiatric disorders prevailed among preschoolers and schoolers (51.9% and 25.2%, respectively), non-inflammatory disorders were more frequent in infants and toddlers (63.8%), whereas inflammatory conditions were more often encountered among schoolers (73.3%). In 5 out of 36 Sydenham's chorea (SC) cases, tics were the presentation symptom on admission to emergency department (ED), highlighting the difficulties in early diagnosis of SC. Inflammatory disorders were associated with a longer hospital stay and a greater need of neuroimaging test compared with other disorders. CONCLUSIONS: This study provides the first large sample of paediatric patients presenting to the ED for AHMDs, helping to elucidate the epidemiology, aetiology and clinical presentation of these disorders.


Hyperkinesis/epidemiology , Movement Disorders/epidemiology , Acute Disease , Adolescent , Age Distribution , Child , Child, Preschool , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Hyperkinesis/diagnosis , Hyperkinesis/drug therapy , Infant , Italy/epidemiology , Length of Stay/statistics & numerical data , Male , Movement Disorders/diagnosis , Movement Disorders/drug therapy , Retrospective Studies , Tertiary Care Centers/statistics & numerical data
10.
Neurotoxicology ; 69: 253-259, 2018 12.
Article En | MEDLINE | ID: mdl-29432852

Manganese (Mn) is an essential element, however high levels of Mn have been associated with lower neuropsychological performance and behavioral problems in children. We investigated the associations between hair Mn concentrations and neuropsychological and behavioral performances among children with long-term exposure to airborne Mn aged between 7 and 12 years. Neuropsychological performance included tests of: verbal memory, inhibitory control, cognitive flexibility, verbal fluency, and motor function. We used the Conners Abbreviated Rating Scale for teachers to assess students' behaviors of hyperactivity. Hair manganese (MnH) concentrations in children and exposure to airborne manganese from a ferro-manganese alloy plant were analyzed and correlated with tests scores. Multivariable linear models adjusting for potential confounders showed that elevated levels of MnH were associated with lower performance in verbal memory, as measured by the free recall after interference (ß = - 1.8; 95% CI: - 3.4, - 0.2), which indicates susceptibility to interference, and Delayed Effect (ß = -2.0; 95% CI: -3.7, - 0.2), representing a loss of information over time. Additionally, we found patterns of effect modification by sex in three subtests measuring verbal memory: the free recall after interference score, Interference Effect, and Delayed Effect (all at p < 0.10). Overall, the results suggest that long-term airborne Mn exposure may be associated with lower performance in verbal memory, and hyperactivity behaviors.


Executive Function/drug effects , Hyperkinesis/chemically induced , Hyperkinesis/epidemiology , Manganese/adverse effects , Memory/drug effects , Verbal Learning/drug effects , Brazil/epidemiology , Child , Cross-Sectional Studies , Environmental Exposure , Executive Function/physiology , Female , Humans , Hyperkinesis/diagnosis , Male , Memory/physiology , Verbal Learning/physiology
11.
Blood Cells Mol Dis ; 68: 86-92, 2018 02.
Article En | MEDLINE | ID: mdl-27789132

BACKGROUND: Neuronopathic Gaucher disease type 3 (GD3) is frequent in northern Sweden, whereas GD1 is found throughout the country. In a nation-wide study, we examined neurological manifestations and clinical course in 12 patients with GD3 and 13 patients with GD1. METHODS: The patients were evaluated by standardized neurological assessments. Every sixth month, the GD3 patients were rated with the modified Severity Scoring Tool. At baseline and at the 3years follow-up, patients underwent University of Pennsylvania Smell Identification Test, Montreal Cognitive Assessment and Hospital Anxiety and Depression Scale. When clinical signs were present, additional examinations were undertaken. RESULTS: Marked clinical heterogeneity was evident in both GD3 and GD1 groups. Several GD3 patients had a hitherto unreported rapid and repetitive dystonia-like hyperkinetic movement disorder. Most patients with GD3 have abnormalities of horizontal gaze, ataxia and focal epilepsy, some also had cognitive impairment, anxiety and hyposmia. Six GD3 patients, all homoallelic for L444P GBA1 mutations, have lived beyond 40years of age; and none has developed Parkinsonism. Two of the GD1 patients suffer from Parkinsonism; mild to complete hyposmia was present in six GD3 and five GD1 patients. Neither the group of GD3 nor GD1 patients had detectable progression of their neurological manifestations. CONCLUSIONS: These middle-aged and older Swedish GD3 or GD1 patients are clinically stable over time. However, we have identified unusual clinical features, discordant phenotypes and a hyperkinetic dystonia-like movement disorder which appears unique to this Swedish disease variant and expands the phenotype for GD.


Dystonia/complications , Gaucher Disease/complications , Hyperkinesis/complications , Adult , Aged , Aged, 80 and over , Anxiety/complications , Anxiety/epidemiology , Cognitive Dysfunction/complications , Cognitive Dysfunction/epidemiology , Depression/complications , Depression/epidemiology , Disease Progression , Dystonia/epidemiology , Female , Follow-Up Studies , Gaucher Disease/epidemiology , Humans , Hyperkinesis/epidemiology , Longitudinal Studies , Male , Middle Aged , Sweden/epidemiology , Young Adult
12.
Environ Res ; 158: 358-365, 2017 10.
Article En | MEDLINE | ID: mdl-28686950

OBJECTIVES: Our objective was to examine the relationship between residential proximity to agricultural fumigant use and neurodevelopment in 7-year old children. METHODS: Participants were living in the agricultural Salinas Valley, California and enrolled in the Center for the Health Assessment of Mothers and Children Of Salinas (CHAMACOS) study. We administered the Wechsler Intelligence Scale for Children (4th Edition) to assess cognition and the Behavioral Assessment System for Children (2nd Edition) to assess behavior. We estimated agricultural fumigant use within 3, 5 and 8km of residences during pregnancy and from birth to age 7 using California's Pesticide Use Report data. We evaluated the association between prenatal (n = 285) and postnatal (n = 255) residential proximity to agricultural use of methyl bromide, chloropicrin, metam sodium and 1,3-dichloropropene with neurodevelopment. RESULTS: We observed decreases of 2.6 points (95% Confidence Interval (CI): -5.2, 0.0) and 2.4 points (95% CI: -4.7, -0.2) in Full-Scale intelligence quotient for each ten-fold increase in methyl bromide and chloropicrin use within 8km of the child's residences from birth to 7-years of age, respectively. There were no associations between residential proximity to use of other fumigants and cognition or proximity to use of any fumigant and hyperactivity or attention problems. These findings should be explored in larger studies.


Attention/drug effects , Hyperkinesis/epidemiology , Intelligence Tests , Pesticides/toxicity , Prenatal Exposure Delayed Effects/epidemiology , California/epidemiology , Child , Female , Fumigation , Humans , Hyperkinesis/chemically induced , Longitudinal Studies , Pregnancy
13.
Am J Geriatr Psychiatry ; 25(10): 1064-1071, 2017 Oct.
Article En | MEDLINE | ID: mdl-28579352

OBJECTIVE: To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. METHODS: This is a point prevalence study nested in the "Delirium Day 2015", which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. RESULTS: Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). CONCLUSIONS: The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.


Delirium/classification , Delirium/diagnosis , Dementia , Hyperkinesis/diagnosis , Hypokinesia/diagnosis , Severity of Illness Index , Aged , Aged, 80 and over , Comorbidity , Delirium/complications , Delirium/epidemiology , Dementia/epidemiology , Female , Humans , Hyperkinesis/epidemiology , Hyperkinesis/etiology , Hypokinesia/epidemiology , Hypokinesia/etiology , Italy/epidemiology , Male
14.
Zebrafish ; 14(3): 216-222, 2017 06.
Article En | MEDLINE | ID: mdl-28266909

The use of electronic cigarettes (e-cigarettes) is increasing as an alternative to tobacco burning cigarettes; however, their safety remains to be fully determined. The long-term effects of e-cigarettes are unknown, including the effects of maternal e-cigarette use on pre- and postnatal development. Additional research on the safety of e-cigarettes is needed. Especially useful would be information from high- and moderate-throughput economic model systems. This study investigates the effects of 1,2-propanediol, which was identified as the main component of e-cigarette liquid, on early development of zebrafish (an in vivo high-throughput model system that was recently proposed for the study of tobacco cigarette and e-cigarette toxicity). Zebrafish embryos were exposed to 1.25% or 2.5% 1,2-propanediol from 6 to 72 h post-fertilization (hpf). We show that exposure to 1,2-propanediol did not significantly affect mortality. Hatching success was significantly lower in 2.5% 1,2-propanediol-exposed embryos at 48 hpf, but at 72 hpf no significant differences were noted. Moreover, exposure to 1,2-propanediol reduced growth and increased the incidence of string heart, pericardial edema, and yolk sac edema. Most importantly, developmental exposure to 1.25% 1,2-propanediol caused hyperactive swimming behavior in larvae. This study demonstrates that 1,2-propanediol has adverse impacts on early development in zebrafish.


Behavior, Animal/drug effects , Embryo, Nonmammalian/drug effects , Hyperkinesis/epidemiology , Propylene Glycol/toxicity , Zebrafish/growth & development , Animals , Disease Models, Animal , Edema/chemically induced , Edema/epidemiology , Heart Diseases/chemically induced , Heart Diseases/epidemiology , Hyperkinesis/chemically induced , Larva/drug effects , Larva/growth & development , Pharmaceutical Vehicles , Swimming/physiology , Teratogens/toxicity , Yolk Sac/drug effects , Zebrafish/embryology
15.
J Head Trauma Rehabil ; 32(5): E50-E54, 2017.
Article En | MEDLINE | ID: mdl-28060200

OBJECTIVE: Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH. SETTING/PARTICIPANTS/DESIGN: We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH. PSH was defined as a paroxysm of 3 or more of the following characteristics: (1) tachycardia, (2) tachypnea, (3) hypertension, (4) fever, (5) dystonia (rigidity or decerebrate posturing), and (6) diaphoresis, with no other obvious causation (ie, alcohol withdrawal, sepsis). MAIN MEASURES: The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization. RESULTS: Nineteen (11%) of the 167 patients met criteria for PSH. Patients with PSH had a higher 5-day cumulative mCFSS score than those without PSH (median [interquartile range] = 36 [29-42] vs 29 [22-35], P = .01). Of the 4 components of the mCFSS, elevated temperature appeared to be most predictive of the development of PSH, especially during the first 24 hours (odds ratio = 1.95; 95% confidence interval, 1.12-3.40). CONCLUSION: Early fever after TBI may signal impending autonomic dysfunction.


Autonomic Nervous System Diseases/epidemiology , Brain Injuries, Traumatic/diagnosis , Brain Injuries, Traumatic/epidemiology , Fever/epidemiology , Hyperkinesis/epidemiology , Adult , Autonomic Nervous System Diseases/diagnosis , Brain Injuries, Traumatic/therapy , Cohort Studies , Comorbidity , Female , Fever/diagnosis , Glasgow Coma Scale , Humans , Hyperkinesis/diagnosis , Injury Severity Score , Male , Middle Aged , Monitoring, Physiologic/methods , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment , Statistics, Nonparametric , Survival Rate
16.
J Atten Disord ; 21(11): 904-912, 2017 Sep.
Article En | MEDLINE | ID: mdl-25001369

OBJECTIVE: To examine different risk factors between disruptive behavior disorders (DBD) and ADHD or combined DBD and ADHD. METHOD: The study population was derived from the Northern Finland Birth Cohort 1986. Psychiatric diagnoses were defined from the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview. The study sample was divided into four groups-people with DBD ( n = 44), with ADHD ( n = 91), with both ( n = 72), and without either ( n = 250)-to evaluate the different risk factors behind these disorders. RESULTS: After adjusting with possible confounding factors, female gender and paternal admittance to inpatient psychiatric care increased the odds that an adolescent was having DBD. Childhood hyperactivity symptoms increased the odds of having ADHD and childhood hyperactivity symptoms and scholastic impairment increased the odds of having both disorders. CONCLUSION: Our study indicates DBD and ADHD have clearly different risk factors, and the impact of the paternal factors on DBD should be noted more than has been before.


Attention Deficit and Disruptive Behavior Disorders/epidemiology , Problem Behavior/psychology , Adolescent , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit and Disruptive Behavior Disorders/psychology , Child , Female , Finland/epidemiology , Humans , Hyperkinesis/epidemiology , Hyperkinesis/psychology , Male , Prospective Studies , Risk Factors
17.
J Atten Disord ; 21(12): 986-996, 2017 Oct.
Article En | MEDLINE | ID: mdl-25416465

OBJECTIVES: To examine the performance on the Deese-Roediger-McDermott task of adults divided into ADHD subtypes and compares their performance to that of healthy controls to examine whether adults with ADHD are more susceptible to the production of false memories under experimental conditions. METHOD: A total of 128 adults with ADHD (50% females), classified into three Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV-TR) subtypes, were compared with 48 controls. RESULTS: The results indicated that the ADHD participants recalled and recognized fewer studied words than the controls, the ADHD groups produced more false memories than the control group, no differences in either the false positives or the false negatives. The ADHD-combined (ADHD-CT) group recognized significantly more critical words than the control, ADHD-predominantly inattentive (ADHD-IA), and ADHD-predominantly hyperactive-impulsive (ADHD-HI) groups. The ADHD groups recalled and recognized more false positives, were more confident in their false responses, and displayed more knowledge corruption than the controls. The ADHD-CT group recalled and recognized more false positives than the other ADHD groups. CONCLUSION: The adults with ADHD have more false memories than the controls and that false memory formation varied with the ADHD subtypes.


Attention Deficit Disorder with Hyperactivity/diagnosis , Hyperkinesis/diagnosis , Memory Disorders/etiology , Memory/physiology , Mental Recall , Adult , Attention Deficit Disorder with Hyperactivity/epidemiology , Case-Control Studies , Delusions , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Hyperkinesis/epidemiology , Impulsive Behavior , International Classification of Diseases , Male , Mental Recall/physiology , Neuropsychological Tests , Recognition, Psychology/physiology , Young Adult
18.
PLoS One ; 11(7): e0158786, 2016.
Article En | MEDLINE | ID: mdl-27414399

BACKGROUND: Enuresis (9% at age 9.5) negatively affects children's psychosocial status. Clinically-diagnosed enuresis (2% at the age) is associated with hyperactivity-inattention, and common neural bases have been postulated to underlie this association. It is, however, unclear whether this association is applicable to enuresis overall among the general population of early adolescents when considered comorbid behavioral problems. We aimed to examine whether enuresis correlates with hyperactivity-inattention after controlling for the effects of other behavioral problems. METHODS: Participants were 4,478 children (mean age 10.2 ± 0.3 years old) and their parents from the Tokyo Early Adolescence Survey (T-EAS), a population-representative cross-sectional study conducted in Tokyo, Japan conducted from 2012 to 2015. Children's enuresis and behavioral problems, including hyperactivity-inattention (as measured by the Strength and Difficulties Questionnaire), were examined using parent-reporting questionnaires. Multivariate linear regression was used to explore whether enuresis predicts hyperactivity-inattention. RESULTS: The hyperactivity-inattention score was significantly higher in the enuretic group than the non-enuretic group (enuretic: M (SD) = 3.8 (2.3), non-enuretic: M (SD) = 3.0 (2.1), Hedge's g = 0.39, p < .001). This association remained significant even after controlling for other behavioral problems and including sex, age, intelligence quotient (IQ), low birth weight and parents' education (ß = .054 [95% CI: .028-.080], p < .001). CONCLUSIONS: Enuresis was independently associated with hyperactivity-inattention in early adolescents among general population even when other behavioral problems were considered. These results suggest that, as with clinically-diagnosed cases, enuresis may predict need for screening and psychosocial support for hyperactivity-inattention.


Attention Deficit Disorder with Hyperactivity/epidemiology , Hyperkinesis/epidemiology , Nocturnal Enuresis/epidemiology , Age Factors , Attention Deficit Disorder with Hyperactivity/psychology , Child , Comorbidity , Cross-Sectional Studies , Female , Humans , Hyperkinesis/psychology , Male , Nocturnal Enuresis/psychology , Prevalence , Problem Behavior/psychology , Severity of Illness Index , Sex Factors , Tokyo
19.
Drug Alcohol Depend ; 163: 251-5, 2016 Jun 01.
Article En | MEDLINE | ID: mdl-27114206

BACKGROUND: Cannabis is the most commonly used illegal substance among adolescents and young adults. Problematic cannabis use is often associated with comorbid psychopathological problems. The purpose of the current study was to elucidate the underlying developmental processes connecting externalizing and internalizing psychopathology in childhood and adolescence with problematic cannabis use in young adulthood. METHODS: Data were drawn from the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study from birth to adulthood. For n=307 participants, symptom scores of conduct/oppositional defiant disorder, attention problems, hyperactivity/impulsivity, and internalizing disorders were available for the periods of childhood (4.5-11 years) and adolescence (15 years). At age 25 years, problematic cannabis use was assessed via clinical interview and a self-rating questionnaire. RESULTS: At age 25 years, problematic cannabis use was identified in n=28 participants (9.1%). Childhood conduct/oppositional behavior problems were predictive of problematic cannabis use during young adulthood when comorbid symptoms were controlled for. No such effect was found for childhood attention, hyperactivity/impulsivity or internalizing problems. With respect to psychopathological symptoms during adolescence, only attention problems were significantly related to later problematic cannabis use when controlling for comorbidity. CONCLUSIONS: The current study highlights the role of conduct/oppositional behavior problems during childhood and attention problems during adolescence in later problematic cannabis use. It sheds more light on the developmental sequence of childhood and adolescence psychopathology and young adult cannabis use, which is a prerequisite for effective prevention approaches.


Child Behavior Disorders/epidemiology , Child Behavior Disorders/psychology , Marijuana Smoking/epidemiology , Marijuana Smoking/psychology , Adolescent , Adolescent Behavior/psychology , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit and Disruptive Behavior Disorders/psychology , Cannabis , Child , Child Behavior/psychology , Child Behavior Disorders/diagnosis , Child, Preschool , Female , Humans , Hyperkinesis/diagnosis , Hyperkinesis/epidemiology , Hyperkinesis/psychology , Longitudinal Studies , Male , Predictive Value of Tests , Prospective Studies , Psychopathology , Surveys and Questionnaires , Young Adult
20.
Eur Child Adolesc Psychiatry ; 25(6): 639-48, 2016 Jun.
Article En | MEDLINE | ID: mdl-26459316

Problematic substance use and mental health problems often co-occur in adolescents. Effective school-based interventions that are brief and target multiple problems are promising in the field of health promotion. Preventure is a brief, school-based, selective preventive intervention, tailored to four personality profiles. Preventure has already proved effective on alcohol outcomes. Previous trials also reveal effects on several mental health outcomes, yet the evidence for these outcomes is limited. This study presents the results of the Dutch Preventure Trial, on a range of mental health outcomes. In a cluster RCT, including 699 high risk students (mean age 14 years), the intervention effects on mental health problems at 2, 6, and 12 months post intervention were tested in the total high risk population and in four specific personality groups. No significant intervention effects were found on 22 from the 24 tests. A positive intervention effect on anxiety was found in the anxiety sensitivity personality group at 12-month follow-up, and a negative intervention effect on depression was found at 12-month follow-up in the negative thinking group. In post hoc growth curve analyses these effects were not found. This study found no convincing evidence for the effectiveness of Preventure in The Netherlands on mental health problems. This finding is not in line with the results of an earlier effectiveness study in the UK. This highlights the need for more research into the knowledge transfer model of interventions, to ensure that interventions are effective in a variety of circumstances.


Anxiety/psychology , Depression/psychology , Early Medical Intervention/methods , Hyperkinesis/psychology , Juvenile Delinquency/psychology , School Health Services , Adolescent , Anxiety/epidemiology , Anxiety/prevention & control , Cluster Analysis , Depression/epidemiology , Depression/prevention & control , Female , Follow-Up Studies , Humans , Hyperkinesis/epidemiology , Hyperkinesis/prevention & control , Male , Netherlands/epidemiology , Schools , Surveys and Questionnaires , Treatment Outcome
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