Attention-deficit hyperactivity symptoms and risk of alcohol use relapse.

AIM: Alcohol use disorder (AUD) is frequently accompanied by comorbid attention-deficit hyperactivity disorder (ADHD). Comorbid ADHD has been reported to increase the severity of AUD. We investigated whether ADHD severity also influences AUD relapse risk at baseline and after inpatient treatment. METHODS: In this study, 187 AUD patients admitted to Narimasu Kosei Hospital from October 2019 to March 2021 were included in the analysis. According to the Adult ADHD Self-Report Scale (ASRS), participants were divided into two groups: ASRS+ with ADHD characteristics (n = 43) and ASRS- with low/no ADHD characteristics (n = 144). Groups were compared for AUD relapse risk at the start of treatment (baseline) and before hospital discharge using the multidimensional Alcohol Relapse Risk Scale (ARRS). The change in relapse risk during hospitalization was also compared by assessment of the interaction between groups (ASRS+ vs. ASRS-) and time (at discharge vs. baseline). RESULTS: The total ARRS score and dimension subscores for stimulus-induced vulnerability and emotionality problems were significantly higher in the ASRS+ group at baseline and before discharge compared to the ASRS- group. There was a significant group × time interaction indicating less improvement of stimulus-induced vulnerability during inpatient treatment among the ASRS+ group compared to the ASRS- group. CONCLUSIONS: Our findings suggest that AUD patients with ADHD characteristics have a higher risk of relapse both at baseline and after inpatient treatment. Stimulus-induced vulnerability to relapse is less likely to improve with treatment in patients with ADHD characteristics.

Preoperative heart rate variability analysis is as a potential simple and easy measure for predicting perioperative delirium in esophageal surgery.

BACKGROUND: Delirium is one of the most common but severe perioperative complications. Autonomic activity evaluated by heart rate variability (HRV) has been recently reported as a useful tool for prediction and for early detection of delirium in acute care medicine, especially in postoperative intensive care unit (ICU) patients. We hypothesized that HRV, by 3-lead electrocardiogram (ECG), one day prior to surgery might correlate with the presence of postoperative delirium. MATERIALS AND METHODS: This study was cohort prospective pilot study. We measured preoperative HRV and postoperative delirium in patients who underwent surgery for elective esophageal cancer. ECG of the participants was performed for 10 min 6-12 h preceding surgery. Postoperatively, patients were admitted to the ICU or critical care unit and stayed for at least 3 days. Delirium was diagnosed by psychiatrist rounds twice a day. RESULTS: Delirium was assessed for 3 days after surgery and 30 patients performed the study. Seven patients developed delirium during their ICU stay, while the remaining twenty-three did not. After HRV analysis, the preoperative high frequency power in delirium patients was significantly lower than that in non-delirium patient. Other parameters of HRV, including lower frequency power, total power and the ratio showed no statistically significant difference between the groups. CONCLUSION: The results of current study demonstrated that preoperative measurement of HRV may be a useful predictor of delirium. Further investigation could pave the way to a non-invasive, minimally stressful method of predicting postoperative delirium.

Autoencoder-Based Extrasystole Detection and Modification of RRI Data for Precise Heart Rate Variability Analysis.

Heart rate variability, which is the fluctuation of the R-R interval (RRI) in electrocardiograms (ECG), has been widely adopted for autonomous evaluation. Since the HRV features that are extracted from RRI data easily fluctuate when arrhythmia occurs, RRI data with arrhythmia need to be modified appropriately before HRV analysis. In this study, we consider two types of extrasystoles-premature ventricular contraction (PVC) and premature atrial contraction (PAC)-which are types of extrasystoles that occur every day, even in healthy persons who have no cardiovascular diseases. A unified framework for ectopic RRI detection and a modification algorithm that utilizes an autoencoder (AE) type of neural network is proposed. The proposed framework consists of extrasystole occurrence detection from the RRI data and modification, whose targets are PVC and PAC. The RRI data are monitored by means of the AE in real time in the detection phase, and a denoising autoencoder (DAE) modifies the ectopic RRI caused by the detected extrasystole. These are referred to as AE-based extrasystole detection (AED) and DAE-based extrasystole modification (DAEM), respectively. The proposed framework was applied to real RRI data with PVC and PAC. The result showed that AED achieved a sensitivity of 93% and a false positive rate of 0.08 times per hour. The root mean squared error of the modified RRI decreased to 31% in PVC and 73% in PAC from the original RRI data by DAEM. In addition, the proposed framework was validated through application to a clinical epileptic seizure problem, which showed that it correctly suppressed the false positives caused by PVC. Thus, the proposed framework can contribute to realizing accurate HRV-based health monitoring and medical sensing systems.

Factors affecting mental illness and social stress in hospital workers treating COVID-19: Paradoxical distress during pandemic era.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has affected all countries in the world. Hospital workers are at high risk of mental illness, such as anxiety and depression. Furthermore, they also face many social stresses, such as deterioration of human relations and income reduction. Apart from mental illness, these social stresses can reduce motivation and lead to voluntary absenteeism, which contribute to a collapse of medical systems. Thus, for maintaining medical systems, it is crucial to clarify risk factors for both mental illness and increased social stress among hospital workers. However, little attention has been paid to factors affecting social stress, and thus, we aimed to address this gap. METHODS: In this cross-sectional survey of 588 hospital workers, the levels of anxiety, depression, and social stress were assessed using the 7-item Generalized Anxiety Disorder scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Multiple regression analyses were conducted to identify the demographic variables affecting these problems. RESULTS: Older age and female sex were common risk factors for anxiety, depression, and social stress. Moreover, occupational exposure to COVID-19 and hospital staff other than doctors/fewer non-work days were risk factors for increased anxiety and depression, respectively. Furthermore, living with families/others was a risk factor for increased social stress during this pandemic. CONCLUSION: Our findings could be useful for developing policies and practices to minimize the risk of mental illness and increased social stress among hospital workers, highlighting that attention should be paid to social factors, such as an individual's household situation.

Heart rate response to orthostatic challenge in patients with dementia with Lewy bodies and Alzheimer's disease.

BACKGROUND: To elucidate the differences in autonomic dysfunction between dementia with Lewy bodies (DLB) and Alzheimer's disease using a simple and convenient method, we investigated the heart rate response to orthostatic challenge. METHODS: Ninety-seven people participated in this cross-sectional study, and data from 26 DLB patients, 29 Alzheimer's disease patients, and 25 healthy elderly individuals were analysed. Participants underwent postural changes, including 5 min in a supine position, 1 min in a sitting position, and 3 min in an orthostatic position. Their heart rates were continuously recorded. Two heart rate variables were analysed as main outcomes: (i) the difference between heart rate in the sitting position and the peak heart rate within 15 s of orthostasis, defined as the 'early heart rate increase'; and (ii) the difference between the peak heart rate and the negative peak heart rate after this, defined as 'early heart rate recovery.' An early heart rate increase has been considered to reflect parasympathetic and sympathetic functions. Early heart rate recovery is considered to reflect parasympathetic function. We also investigated the frequency domains of resting heart rate variability. RESULTS: A significant difference was observed across the three groups in early heart rate increase, and that of the DLB group was lower than that of the healthy control group. Early heart rate recovery also differed significantly across the three groups, and that of the DLB group was less than that of the healthy control group. In addition, the power of the low-frequency component, which represents both sympathetic and parasympathetic activity, was significantly decreased in the DLB group compared to the Alzheimer's disease group. CONCLUSIONS: Impaired heart rate response to standing was detected in patients with DLB. Electrocardiogram is a convenient, non-invasive method that might be useful as a subsidiary marker for DLB diagnosis and differentiation from Alzheimer's disease.

Wearable Epileptic Seizure Prediction System with Machine-Learning-Based Anomaly Detection of Heart Rate Variability.

A warning prior to seizure onset can help improve the quality of life for epilepsy patients. The feasibility of a wearable system for predicting epileptic seizures using anomaly detection based on machine learning is evaluated. An original telemeter is developed for continuous measurement of R-R intervals derived from an electrocardiogram. A bespoke smartphone app calculates the indices of heart rate variability in real time from the R-R intervals, and the indices are monitored using multivariate statistical process control by the smartphone app. The proposed system was evaluated on seven epilepsy patients. The accuracy and reliability of the R-R interval measurement, which was examined in comparison with the reference electrocardiogram, showed sufficient performance for heart rate variability analysis. The results obtained using the proposed system were compared with those obtained using the existing video and electroencephalogram assessments; it was noted that the proposed method has a sensitivity of 85.7% in detecting heart rate variability change prior to seizures. The false positive rate of 0.62 times/h was not significantly different from the healthy controls. The prediction performance and practical advantages of portability and real-time operation are demonstrated in this study.

Predicting postictal suppression in electroconvulsive therapy using analysis of heart rate variability.

BACKGROUND: Postictal suppression on an electroencephalogram (EEG) represents electrical silence during electroconvulsive therapy (ECT) and has been considered as a key feature associated with the efficacy of treatment. The present study aimed to predict postictal suppression using heart rate variability (HRV). METHODS: Participants comprised 21 consecutive patients with depression who underwent bilateral pulse wave ECT. We analyzed the frequency domains of resting HRV before ECT. HRV indices such as the high-frequency component (HF) reflecting parasympathetic activity and the ratio of low-frequency component (LF)/HF reflecting sympathetic activity were natural log transformed for analysis. We evaluated ictal and peri-ictal EEG parameters and investigated their associations with HRV indices. RESULTS: Postictal suppression and regularity were positively associated with ln[HF]. Postictal suppression remained significantly associated with ln[HF] after adjusting for age in multiple regression analysis of patients with depression. LIMITATIONS: The present study could not examine the influence of diabetes mellitus, hypertension and polarity on HRV. In addition, the small sample size resulted in low statistical power. CONCLUSIONS: These results suggested that ln[HF] before ECT could be utilized as a predictor of postictal suppression on EEG during ECT.

Changes in cardiac autonomic nervous system activity during a course of electroconvulsive therapy.

AIM: Although electroencephalogram (EEG) seizure duration and seizure threshold change during a course of electroconvulsive therapy, the mechanisms by which these factors influence heart rate during subsequent electroconvulsive therapy sessions are currently unclear. In the current study, we investigated changes in heart rate during electroconvulsive therapy. METHODS: We recorded electroencephalography and electrocardiography during electroconvulsive therapy in 12 patients with major depressive disorder. Baseline heart rate was defined as the mean heart rate in the 30 seconds prior to stimulus onset. The TimeMax peak refers to the maximum heart rate after stimulus onset. Time1/2 points represent the time points at which the heart rate had decreased to a value midway between the baseline heart rate and the TimeMax peak. We examined the relationships between EEG seizure duration, TimeMax , and Time1/2 throughout the course of electroconvulsive therapy. RESULTS: Time1/2 decreased as the number of electroconvulsive sessions increased. Time1/2 was positively correlated with EEG seizure duration. CONCLUSION: The duration in which electroconvulsive therapy-induced sympathetic nervous system activation returned halfway to baseline levels gradually shortened during the course of electroconvulsive therapy.

Vowel-speech versus pure-tone processing in healthy subjects.

To investigate the characteristics of speech perception, we evaluated the differences in mismatch negativity (MMN) between vowel change and frequency change. Additionally, we examined the effects of gender, age, and educational length on MMN. Forty healthy adults (21 females), who were native Japanese speakers, participated in the study. A Japanese vowel-speech pair (standard/a/vs. deviant/o/) and a pure-tone pair (standard 1000 Hz vs. deviant 1050 Hz) were constructed. MMN elicited by vowel-speech sounds was larger and earlier compared with pure-tone sounds. Larger and earlier MMNs for vowel-speech sounds than for pure-tone sounds suggest different processing of linguistically relevant information at the early stage in the auditory cortex. In conclusion, the factors influencing on MMN are different between vowel-speech sounds and pure-tone sounds.

Is prolongation of corrected QT interval associated with seizures induced by electroconvulsive therapy reduced by atropine sulfate?

BACKGROUND: Electrocardiogram abnormalities have been reported during electroconvulsive therapy (ECT). A corrected QT interval (QTc) prolongation indicates delayed ventricular repolarization, which can trigger ventricular arrhythmias such as torsade de pointes (TdP). We examined the QTc changes during generalized tonic-clonic seizures induced by ECT, and the effects of atropine sulfate on these QTc changes. METHODS: We analyzed heart rate, QT interval, and QTc in 32 patients with depression who underwent ECT (25 women, 67.4 ± 8.7 years of age). The QTc from -30 to 0 seconds prestimulation was used as baseline, which was compared with QTc at 20-30 seconds and 140-150 seconds poststimulus onset. RESULTS: QTc was significantly prolonged at 20-30 seconds poststimulus, then significantly decreased at 140-150 seconds poststimulus, compared with baseline. QTc prolongation induced by ECT was significantly decreased by atropine sulfate. CONCLUSIONS: These data suggest that the risk of TdP may be enhanced by ECT. Further, the risk of cardiac ventricular arrhythmias, including TdP, may be reduced by administration of atropine sulfate.

Epileptic Seizure Prediction Based on Multivariate Statistical Process Control of Heart Rate Variability Features.

OBJECTIVE: The present study proposes a new epileptic seizure prediction method through integrating heart rate variability (HRV) analysis and an anomaly monitoring technique. METHODS: Because excessive neuronal activities in the preictal period of epilepsy affect the autonomic nervous systems and autonomic nervous function affects HRV, it is assumed that a seizure can be predicted through monitoring HRV. In the proposed method, eight HRV features are monitored for predicting seizures by using multivariate statistical process control, which is a well-known anomaly monitoring method. RESULTS: We applied the proposed method to the clinical data collected from 14 patients. In the collected data, 8 patients had a total of 11 awakening preictal episodes and the total length of interictal episodes was about 57 h. The application results of the proposed method demonstrated that seizures in ten out of eleven awakening preictal episodes could be predicted prior to the seizure onset, that is, its sensitivity was 91%, and its false positive rate was about 0.7 times per hour. CONCLUSION: This study proposed a new HRV-based epileptic seizure prediction method, and the possibility of realizing an HRV-based epileptic seizure prediction system was shown. SIGNIFICANCE: The proposed method can be used in daily life, because the heart rate can be measured easily by using a wearable sensor.

A Triphasic Change of Cardiac Autonomic Nervous System During Electroconvulsive Therapy.

OBJECTIVES: Dynamic autonomic activity changes have been repeatedly reported during electroconvulsive therapy (ECT). However, the specific timing of these changes remains unclear. To clarify whether sympathetic or parasympathetic nervous activity contributes separately to the second stage and the third stage during and after induced seizures by ECT, we examined heart rate (HR) and spectral analysis of variability (HRV) during ECT. METHODS: Seventeen patients with depression participated in the study and underwent ECT. The R-R intervals (RRI) were recorded and analyzed sequentially for the HRV indices high-frequency (HF) (an index of parasympathetic activity) and low-frequency (LF)/high-frequency (an index of sympathetic activity) for 4 minutes before and after stimulus onset by the maximum entropy method. Averaged HRs were compared between 3 heart beats prestimulus and poststimulus onset. The HRV power in the range of 30 to 80 and 80 to 130 seconds after a seizure was compared between the HF and LF/HF components. RESULTS: There was a significant reduction of the averaged HR over 3 HRs just after stimulus onset, suggesting parasympathetic dominance in the first phase. The LF/HF power significantly increased in the 30 to 80 s range after stimulus onset, whereas the HF power significantly increased in the 80 to 130 s range after stimulus onset, reflecting sympathetic activation in the second phase and parasympathetic activation in the third phase, respectively. CONCLUSIONS: The evaluation of HR and HRV revealed a triphasic change from parasympathetic to sympathetic to parasympathetic cardiac autonomic activity after ECT stimulus onset in depression patients.

Nonconvulsive status epilepticus in the elderly associated with newer antidepressants used at therapeutic doses: A report of three cases.

Classic antidepressants have been known to induce convulsive seizures and nonconvulsive status epilepticus (NCSE). On the other hand, many reports have emphasized the safety of novel antidepressants. However, we encountered three cases of NCSE in the elderly associated with the use of newer antidepressants at therapeutic doses. All three patients were male and were 73 years of age or older. One patient was recently diagnosed with temporal lobe epilepsy and treated with low-dose lamotrigine. In all patients, newer antidepressants were initiated because of depressive symptoms. After titrating to therapeutic doses (paroxetine 20 mg/day, sertraline 50 mg/day, and combination of sertraline 50 mg/day and mirtazapine 30 mg/day in one patient each), impaired consciousness appeared. Electroencephalography (EEG) showed generalized slow waves with intermittent spike-slow-wave complexes. Intravenous injection of antiepileptic drugs improved EEG findings and clinical symptoms. After discontinuance of the abovementioned antidepressants, NCSE did not recur in any of patients. These reports raise the question of whether the newer antidepressants, like classic antidepressants, might also induce NCSE in the elderly, even when used at therapeutic doses. Physicians should consider monitoring for possible NCSE when using newer antidepressants in patients who may have low drug tolerability. Active continuous video-EEG monitoring is essential when behavioral and psychological symptoms or change in consciousness level is suspected.

Changes in the duration and frequency of deviant stimuli engender different mismatch negativity patterns in temporal lobe epilepsy.

Mismatch negativity (MMN) is an event-related potential (ERP) component that reflects preattentive sensory memory functions. Previous research revealed that MMN is generated by distinct sources in the frontal and temporal lobes. Event-related potential abnormalities have been shown in the vicinity of seizure foci in epilepsy. Additionally, no published study has investigated the MMN in response to variations in both frequency and duration deviants in patients with temporal lobe epilepsy (TLE). The aims of this study were to compare MMN changes between the frontocentral sites and the mastoid sites and to compare MMNs related to deviant stimuli with different durations and frequencies in patients with TLE. We recorded MMNs elicited by duration and frequency changes of deviant stimuli from 15 patients with TLE and 15 healthy control subjects. We found that mean MMN amplitudes related to duration deviants were lower in patients with TLE at the mastoid sites relative to controls, whereas the MMN amplitudes at the frontocentral sites did not differ between the two groups. There were no MMN differences related to frequency deviants between TLE subjects and controls at the frontocentral sites or the mastoid sites. Mismatch negativity parameters related to duration deviants did not correlate with those related to deviant frequencies in the group with TLE. The present findings suggest selective impairments among multiple mismatch generators in TLE and suggest that processing of temporal information of auditory stimuli is selectively disturbed in TLE. Changes in MMN amplitudes related to duration deviants at the mastoid sites may represent deficits in time-dependent processing in TLE.

Distinct pre-attentive responses to non-scale notes: an auditory mismatch negativity (MMN) study.

OBJECTIVE: The aim of the present study was to examine patterns of neural activity in response to variations in scale notes and alterations from a scale note to a non-scale note. METHODS: Event-related potentials (ERPs) were recorded in response to scale and non-scale violin notes using an odd-ball mismatch negativity (MMN) paradigm. Standard stimuli were set to the scale note A4 (440 Hz). Deviant stimuli included two scale notes (scale-B, B4 = 494 Hz; scale-C, C5 = 523 Hz) and a non-scale note halfway between them (non-scale, B4+42¢ = 506 Hz). RESULTS: MMN amplitude elicited by the non-scale was significantly larger than that elicited by the scale-B and scale-C, which did not differ significantly from one another. CONCLUSION: The current results suggest that the human brain may possess pre-attentive mechanisms for extracting relational aspects among sounds of the musical scale. SIGNIFICANCE: The results indicate that non-scale notes may be processed in a different way even in the pre-attentive stage than scale notes.

Aroma helps to preserve information processing resources of the brain in healthy subjects but not in temporal lobe epilepsy.

PURPOSE: Inhalation of ylang-ylang aroma has been shown to reduce the auditory P300, an event-related potential thought to reflect higher-order processing. Because olfactory function is sometimes disturbed in temporal lobe epilepsy (TLE), the objective of the present study was to determine whether the effect of ylang-ylang aroma on the auditory P300 was impaired in patients with TLE. METHOD: Fourteen subjects with TLE and 14 healthy controls participated in this study. Electroencephalograms were recorded during an auditory oddball task, and ylang-ylang aroma or odorless air was delivered through a mask. RESULTS: We found that the ylang-ylang aroma prolonged the latencies of P300 in both groups. The ylang-ylang aroma significantly reduced the P300 amplitudes of healthy subjects as described previously. However, in TLE patients, the P300 was unaffected by the aroma. CONCLUSION: The current results show that exposure to the ylang-ylang aroma reduced information processing resources in healthy subjects but had limited effects in patients with TLE. We suggest that impaired higher-order olfactory processing in TLE patients may inhibit the effects of the ylang-ylang aroma on the P300.

Mismatch negativity for speech sounds in temporal lobe epilepsy.

The mismatch negativity (MMN) is an electrophysiological trace of change detection, measured by electroencephalography (EEG), and is a reliable marker for pre-attentive auditory sensory memory. We used a phonetic oddball paradigm in patients with temporal lobe epilepsy (TLE) to elicit the MMN response at fronto-central sites and the mismatch positivity (MMP) response at mastoid sites. The MMN in 26 patients was compared with that of 26 age- and gender-matched healthy control participants. Electroencephalography responses were recorded during the presentation of speech sounds: the vowels 'a' and 'o' in alternation. Average waveforms were obtained for standard and deviant trials. We found that the MMP response at bilateral mastoid sites was reduced, whereas the MMN response at fronto-central sites did not change significantly. These results support the view that the MMN is generated by separable sources in the frontal and temporal lobes and that these sources are differentially affected by TLE.

Abnormal mismatch negativity for pure-tone sounds in temporal lobe epilepsy.

Auditory processing abnormalities in temporal lobe epilepsy (TLE) were assessed by investigating mismatch negativity (MMN) in a group of 20 TLE patients and 20 healthy control subjects. MMN is an event-related potential (ERP) component that reflects pre-attentive sensory memory function. A passive oddball paradigm using frequency changes in sinusoidal tones was employed to evoke MMN. MMN at frontocentral sites was enhanced in TLE patients relative to controls, while mismatch signals at mastoid sites (i.e., mismatch positivity; MMP) did not differ between the two groups. In the MMP temporal range, greater positivity at mastoid sites in response to standard stimuli was observed in TLE patients than in controls. Both MMN and MMP were significantly delayed in the TLE group. These findings demonstrate that TLE patients have impaired pre-attentive processing of pure-tone sounds. Enhanced frontocentral MMN may reflect hyperexcitability of the frontal lobes in compensation for dysfunction of the temporal lobes. Larger positivity at the mastoids in response to standard stimuli may be attributed to poor neuronal adaptation in the temporal lobe. Taken together, results suggest that evaluation of MMN/P is a useful physiological tool for identifying pre-attentive auditory memory dysfunction in TLE.