Pervasive refusal syndrome revisited: a conative disorder

The neurobiology of functional neurological disorders characterised by impaired awareness

We review the neurobiology of Functional Neurological Disorders (FND), i.e., neurological disorders not explained by currently identifiable histopathological processes, in order to focus on those characterised by impaired awareness (functionally impaired awareness disorders, FIAD), and especially, on the paradigmatic case of Resignation Syndrome (RS). We thus provide an improved more integrated theory of FIAD, able to guide both research priorities and the diagnostic formulation of FIAD. We systematically address the diverse spectrum of clinical presentations of FND with impaired awareness, and offer a new framework for understanding FIAD. We find that unraveling the historical development of neurobiological theory of FIAD is of paramount importance for its current understanding. Then, we integrate contemporary clinical material in order to contextualise the neurobiology of FIAD within social, cultural, and psychological perspectives. We thus review neuro-computational insights in FND in general, to arrive at a more coherent account of FIAD. FIAD may be based on maladaptive predictive coding, shaped by stress, attention, uncertainty, and, ultimately, neurally encoded beliefs and their updates. We also critically appraise arguments in support of and against such Bayesian models. Finally, we discuss implications of our theoretical account and provide pointers towards an improved clinical diagnostic formulation of FIAD. We suggest directions for future research towards a more unified theory on which future interventions and management strategies could be based, as effective treatments and clinical trial evidence remain limited.

Association of Social Determinants of Health and Vaccinations With Child Mental Health During the COVID-19 Pandemic in the US

IMPORTANCE

The COVID-19 pandemic disproportionately affected mental health in socioeconomically disadvantaged children in the US. However, little is known about the relationship of preexisting and time-varying social determinants of health (SDoH) at individual and structural levels, vaccination eligibility/rates, and the racial and ethnic differences to trajectories of child mental health during the COVID-19 pandemic.

OBJECTIVE

To estimate the association of trajectories of child mental health to multilevel SDoH and vaccination eligibility/rates.

DESIGN, SETTING, AND PARTICIPANTS

This prospective longitudinal cohort study, conducted from May 16, 2020, to March 2, 2021, integrated structural-level, pandemic-related data with the Adolescent Brain Cognitive Development (ABCD) cohort data (release 4.0). The ABCD study recruited 11 878 children (baseline) and conducted 6 COVID-19 rapid response surveys across 21 US sites (in 17 states) from May 16, 2020, to March 2, 2021.

EXPOSURES

Preexisting individual (eg, household income) and structural (area deprivation) SDoH and time-varying individual (eg, food insecurity, unemployment) and structural (eg, social distancing, vaccination eligibility/rates) SDoH.

MAIN OUTCOMES AND MEASURES

Perceived Stress Scale, the National Institutes of Health-Toolbox emotion measures, and COVID-19-related worry.

RESULTS

The longitudinal sample included 8493 children (mean [SD] age, 9.93 [0.63] years; 5011 girls [47.89%]; 245 Asian [2.34%], 1213 Black [11.59%], 2029 Hispanic [19.39%], 5851 White [55.93%], and 1124 children of other/multiracial ethnicity [10.74%]). Trajectories of stress, sadness, and COVID-19-related worry decreased after adult vaccination rollout. Compared with younger children, boys, White children, or those living with married parents, those who reported greater perceived stress included older children aged 12 to 15 years (β = 0.26; 95% CI, 0.12-0.41; P < .001); girls (β = 0.75; 95% CI, 0.61-0.89; P < .001); Hispanic children (β = 0.24; 95% CI, 0.01-0.47; P = .04); children living with separated parents (β = 0.50; 95% CI, 0.03-0.96; P = .04); children experiencing disrupted medical health care access (β = 0.19; 95% CI, 0.01-0.36; P = .04); children living in economically deprived neighborhoods (β = 0.28; 95% CI, 0.05-0.51; P = .02); children living in areas with more full-time working-class adults who were unable to social distance (β = 1.35; 95% CI, 0.13-2.67; P = .04); and children living in states with fewer fully vaccinated adults (β = 0.59; 95% CI, 0.16-1.02; P = .007). COVID-19 pandemic-related worry was higher among Asian children (β = 0.22; 95% CI, 0.08-0.37; P = .003), Black children (β = 0.33; 95% CI, 0.22-0.43; P < .001), children of other/multiracial ethnicity (β = 0.17; 95% CI, 0.09-0.25; P < .001), and children with disrupted medical health care (β = 0.15; 95% CI, 0.09-0.21) and disrupted mental health treatment (β = 0.11; 95% CI, 0.06-0.16). Inability to afford food was associated with increased sadness (β = 1.50; 95% CI, 0.06-2.93; P = .04). States with later vaccination eligibility dates for all adults were associated with greater COVID-19-related worry (β = 0.16; 95% CI, 0.01-0.31; P = .03) and decreased positive affect (β = -1.78; 95% CI, -3.39 to -0.18; P = .03) among children.

CONCLUSIONS AND RELEVANCE

Results of this study suggest a disproportionately adverse association of the COVID-19 pandemic with child mental health among racial and ethnic minority groups, which may be improved by addressing modifiable individual (food insecurity, unemployment, health services, parental supervision) and structural (area deprivation, job protection, vaccination) SDoH.

Early Adolescents' Experiences During the COVID-19 Pandemic and Changes in Their Well-Being

Background

Early adolescence is a time of psychological and social change that can coincide with declines in mental health and well-being. This study investigated the psychological and social impacts of the COVID-19 pandemic from the perspective of students who responded to a survey in Grades 7 and 8 (ages 12–14) in British Columbia (BC), Canada. The objectives of this study were (i) to provide an overview on early adolescents' experiences and social-emotional well-being during the pandemic; and (ii) to examine whether changes in social experiences as well as feeling safe from getting COVID-19 at school were associated with changes in well-being outcomes over the course of a year.

Methods

A sample of n = 1,755 students from a large public school district self-reported on their life satisfaction, optimism, and symptoms of sadness across two time points: First, in their Grade 7 year (pre-pandemic; January to March, 2020) and then 1 year later in their Grade 8 year (during the pandemic; January to March, 2021). In Grade 8, students also reported on pandemic-specific experiences, including changes in mental health, social relationships, and activities, as well as coping strategies and positive changes since the pandemic. Data were collected online using the Middle Years Development Instrument (MDI), a population-based self-report tool that assesses children's social-emotional development and well-being in the context of their home, school, and neighborhood. Multivariable linear regression analyses were used to examine associations between pandemic-related changes in relationships and perceived safety from getting COVID-19 at school with changes in well-being outcomes.

Results

Students reported a range of experiences, with a large proportion reporting moderate concerns and impacts of the pandemic, including worries about their mental health and missing school activities. Students reported significantly lower optimism, lower life satisfaction, and higher sadness compared to the previous year. Within the sample, improvements in relationships with parents and other adults at home was associated with higher well-being during the pandemic.

Implications

Results from this study can inform decision making of policy-makers, educators, and practitioners working with youth, by providing information on students' experiences during the pandemic and identifying factors that may be protective for students' mental health during and beyond the pandemic.

Comprehensive Analysis of the COVID-19: Based on the Social-Related Indexes From NUMBEO

Background

The COVID-19 has been spreading globally since 2019 and causes serious damage to the whole society. A macro perspective study to explore the changes of some social-related indexes of different countries is meaningful.

Methods

We collected nine social-related indexes and the score of COVID-safety-assessment. Data analysis is carried out using three time series models. In particular, a prediction-correction procedure was employed to explore the impact of the pandemic on the indexes of developed and developing countries.

Results

It shows that COVID-19 epidemic has an impact on the life of residents in various aspects, specifically in quality of life, purchasing power, and safety. Cluster analysis and bivariate statistical analysis further indicate that indexes affected by the pandemic in developed and developing countries are different.

Conclusion

This pandemic has altered the lives of residents in many ways. Our further research shows that the impacts of social-related indexes in developed and developing countries are different, which is bounded up with their epidemic severity and control measures. On the other hand, the climate is crucial for the control of COVID-19. Consequently, exploring the changes of social-related indexes is significative, and it is conducive to provide targeted governance strategies for various countries. Our article will contribute to countries with different levels of development pay more attention to social changes and take timely and effective measures to adjust social changes while trying to control this pandemic.

Phytotherapy for Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review and Meta-analysis

Attention deficit hyperactivity disorder (ADHD) is commonly a neurodevelopmental behavioural disorder in children and adolescents. Mainly characterized by symptoms like lack of attention, hyperactivity, and impulsiveness, it can impact the overall mental development of the one affected. Several factors, both genetic and non-genetic, can be responsible for this disorder. Although several traditional treatment methods involve medication and other counselling techniques, they also come with different side effects. Hence, the choice is now shifting to alternative treatment techniques. Herbal treatments are considered one of the most popular complementary and alternative medicine (CAM) administered. However, issues related to the safety and efficacy of herbal remedies for the treatment of ADHD need to be investigated further. This study aims to find out the recent advancement in evidence-based use of herbal remedies for ADHD by a comprehensive and systematic review that depicts the results of the published works on herbal therapy for the disorder. The electronic databases and the references retrieved from the included studies present related randomized controlled trials (RCTs) and open-label studies. Seven RCTs involving children and adolescents diagnosed with ADHD met the inclusion criteria. There is a fair indication of the efficacy and safety of Melissa officinalis L., Bacopa monnieri (L.) Wettst., Matricaria chamomilla L., and Valeriana officinalis L. from the studies evaluated in this systematic review for the treatment of various symptoms of ADHD. Limited evidence was found for Ginkgo biloba L. and pine bark extract. However, various other preparations from other plants did not show significant efficacy. There is inadequate proof to strongly support and recommend the administration of herbal medicines for ADHD, but more research is needed in the relevant field to popularize the alternative treatment approach.

Age-Related Differences in Psychological Distress during the COVID-19 Pandemic

While the negative impact of COVID-19 total lockdown on mental health in youth has been extensively studied, findings collected during subsequent waves of the pandemic, in which restrictive rules were more eased, are very sparse. Here, we explore perceived psychological distress during the partial lockdown of the third wave in Southern Italy in a large sample of students, focusing on age and gender differences. Also, we assessed whether attending the type of education could have a protective role on students' psychological well-being. An online survey was completed by 1064 southern Italian students (age range: 8-19 years; males = 368) from March to July 2021. The survey consists of a set of questions regarding general sociodemographic information as well as several aspects of students' psychological well-being. Psychological distress was higher in high school students compared to both elementary and middle ones. In addition, we found gender differences, but only in high school students, with females reporting higher psychological distress than males. Finally, our mediation analysis showed a mediated role of face-to-face schooling in the relationship between age and psychological distress. In conclusion, this study highlights age-related differences in psychological distress during the pandemic and the protective role of school in presence for mental health in Italian students.

Rates, perceptions and predictors of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents

Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14–18 years) took part in the ’in isolation instead of in school’ (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.

Quality of Life and Mental Health in Children and Adolescents after the First Year of the COVID-19 Pandemic: A Large Population-Based Survey in South Tyrol, Italy

BACKGROUND

Methodological heterogeneity of studies and geographical variation limit conclusions about the impact of the COVID-19 pandemic on the mental health of youth. This study aimed to explore the health-related quality of life and mental health of children and adolescents in the second year of the pandemic in South Tyrol, Italy.

METHODS

An online survey representative for the age and gender of the children and adolescents in South Tyrol was conducted among 5159 families with children and adolescents aged 7-19 years, between 28 May and 16 June 2021. The survey collecting parental ratings and self-rated questionnaires from children and adolescents aged 11-19 years included instruments to measure health-related quality of life (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). The results were compared with data from corresponding studies conducted in Germany.

RESULTS

Decreased health-related quality of life and increased conduct problems, peer-related mental health problems, anxiety, and depressive and psychosomatic symptoms in children and adolescents observed in the second year of the pandemic in Germany were confirmed in the second year in South Tyrol. Children and adolescents with low socioeconomic status, a migration background, and limited living space were significantly affected. Female sex and older age were associated with increased psychosocial problems and a positive family climate supported the mental health of children and adolescents during the pandemic.

CONCLUSIONS

Confirmation of findings of decreased health-related quality of life and increased emotional problems after the first year of the pandemic supports the ongoing call for low-threshold health promotion, prevention, and early intervention programs to support children and adolescents who have been severely affected by the pandemic.

Ability to Care for an Ill Loved One During the First COVID-19 Lockdown: Mediators of Informal Caregivers' Stress in Europe

Informal caregivers are overlooked, healthcare actors. They are at particular risk of distress and suffer from poor mental health. This study aimed to investigate the perceived stress and modulating factors during the first COVID-19 lockdown in Europe, regardless of the illness that care recipients suffer from. Sociodemographic data, coping resources, and perceived stress level using the Perceived Stress Scale (PSS-10) questionnaire were assessed using a web-based survey in Switzerland, France, and Belgium with 232 informal caregivers. Mediation analyses were used to identify the factors that modulate stress. Higher perceived stress among informal caregivers was associated with a younger age for the care recipient, family relationship with the care recipient, cohabitation, and female sex of the informal caregiver. These associations were partially mediated by the fear of getting ill (age, cohabitation), the conviction that lockdowns had a negative impact on health (age, kinship), and the perceived deterioration of the care recipient's health (gender). The fear of losing the ability to cope with caregiving tasks due to an illness (COVID-19 and/or other) and the negative impact of the lockdown on care recipients' health, particularly on the mental health of young care recipients, increased the stress of informal caregivers. Our results emphasize the importance of informal caregiving support to prevent heightened stress in lockdown conditions, regardless of care recipient illness or kinship.

A home-based exercise program during COVID-19 pandemic: Perceptions and acceptability of juvenile systemic lupus erythematosus and juvenile idiopathic arthritis adolescents

OBJECTIVES

To investigate the perceptions and acceptability of a home-based exercise intervention in systemic lupus erythematosus (JSLE) and juvenile idiopathic arthritis (JIA) adolescent patients during the COVID-19 pandemic, and to explore the effects of the intervention on health-related quality of life (HRQoL), sleep quality, and mental health conditions parameters.

METHODS

This was a randomized controlled trial of a 12-week, home-based exercise training program conducted between October and December 2020. During this period, social distancing measures were in place in Brazil to contain the spread of COVID-19. Adolescent patients diagnosed with JSLE and JIA participated in the study. Health-related qualitative and quantitative data were collected before and after the follow-up.

RESULTS

21 JSLE patients and 30 JIA patients were analyzed. Six themes emerged from patients' feedback: 1) Suitability of the home-based format; 2) Appropriate trainer supervision, 3) Motivators and facilitators for the program; 4) Barriers to the program; 5) Health benefits; 6) Patients' suggestions to improve the program. Overall, data indicated that the intervention showed good acceptability and elicited improvements in the perceived HRQoL and fatigue in JIA and JSLE patients during the pandemic. However, further quantitative analyses with validated HRQoL, sleep quality, and mental health conditions instruments did not capture these benefits (p>0.05).

CONCLUSION

Our main findings based on in-depth qualitative assessments suggest that a home-based exercise training program was suitable and well-accepted by adolescents with JSLE and JIA during the COVID-19 pandemic. Nonetheless, adherence was not high, particularly among JIA patients, suggesting that facilitators and barriers identified in the current study should be explored to improve the quality of new home-based exercise programs implementation, particularly in a future emerging crisis.

Pervasive Refusal Syndrome: Three Case Reports—Autism as a Predisposing Factor and Gentle Coercion to Shorten Duration of Disorder?

Background

Pervasive refusal syndrome (PRS) is a severe child psychiatric syndrome not yet included in the international classification and mostly affecting girls aged 7-15 years. Hospital admission and severe loss of function extend for many months and years but most recover. Autism has been suggested as a predisposing factor but largely lacks support for typical cases of PRS. Treatment is not evidence-based and described as requiring a lengthy inpatient stay with a very gradual and sensitive rehabilitation program. Case Presentations. Three cases of pervasive refusal syndrome (PRS) in girls aged 9–16 years are presented to report autism as a predisposing factor and to discuss gentle coercion as part of the management strategy to speed up the lengthy recovery. The cases, which met the proposed criteria and typical background characteristics, were noted with the addition of undiagnosed autism in two cases. The duration of inpatient admission was 8–14 months. Disease duration was 15-36 months. An adequate but negative lorazepam trial to rule out catatonia was carried out. Treatment was in one case successfully expedited with gentle coercion within a transparent management plan. Rehabilitation was slower in PRS with comorbid autism; additionally, accommodations to school and living support needed to be put in place.

Conclusions

PRS is a useful clinical entity and best perceived as a primitive reaction to overwhelming stress rather than as catatonia. Autism might be another predisposing factor and needs to be assessed. A psychoeducational approach and a clear management plan support rehabilitation. A gentle coercion might hasten recovery.

Children's perspectives on friendships and socialization during the COVID-19 pandemic: A qualitative approach

BACKGROUND

Good quality friendships and relationships are critical to the development of social competence and are associated with quality of life and mental health in childhood and adolescence. Through social distancing and isolation restrictions, the COVID-19 pandemic has had an impact on the way in which youth socialize and communicate with friends, peers, teachers and family on a daily basis. In order to understand children's social functioning during the pandemic, it is essential to gather information on their experiences and perceptions concerning the social changes unique to this period. The objective of this study was to document children and adolescents' perspectives regarding their social life and friendships during the COVID-19 pandemic, through qualitative interviews.

METHODS

Participants (N = 67, 5-14 years) were recruited in May and June 2020. Semi-structured interviews were conducted via a videoconferencing platform. A thematic qualitative analysis was conducted based on the transcribed and coded interviews (NVivo).

RESULTS

The upheavals related to the pandemic provoked reflection among the participants according to three main themes, each of which included sub-themes: (1) the irreplaceable nature of friendship, (2) the unsuspected benefits of school for socialization and (3) the limits and possibilities of virtual socialization.

CONCLUSIONS

The collection of rich, qualitative information on the perspectives of children and adolescents provides a deeper understanding of the consequences of the pandemic on their socialization and psychological health and contributes to our fundamental understanding of social competence in childhood.

Portuguese adolescents' cognitive well-being and basic psychological needs during the COVID-19 outbreak: A longitudinal study

Confinements and social distancing measures during COVID‐19 pandemic were particularly challenging to adolescents, impacting significantly their life and routines. Following a longitudinal design, this study sought to compare adolescents' cognitive well‐being—satisfaction with life, social support, and quality of life—before (T1) and during (T2) the COVID‐19 pandemic. Additionally, it aimed to clarify the predictive value of the three dimensions of the cognitive well‐being to the satisfaction of basic psychological needs of adolescents at school at T2. One thousand ninety‐nine Portuguese adolescents participated, showing generally increased scores in satisfaction with life, social support, and quality of life at T2. Even so, girls revealed lower changes in cognitive well‐being components compared with boys, between T1 and T2. In addition, satisfaction with life and quality of life were predictive of satisfaction of basic psychological needs at T2. This work highlights the relevance of cognitive well‐being as a dispositional dimension in determining the satisfaction of basic psychological needs in adolescence, during a worldwide catastrophic event.

Impact of COVID-19 Pandemic on Mental Health and Quality of Life. An Exploratory Study During the First Outbreak in Italy

The coronavirus pandemic has been sweeping the world for more than a year. As physical health begins to stabilize in the western world, an increasing concern is related to the impact of the virus and its containment measures on people's mental health. This work aimed to explore the effect of demographic factors (age, gender, level of education, and socioeconomic status) and variables such as fear of COVID-19 and social support in predicting the quality of life and mental health of adults during the first wave of the pandemic in Italy. Through an online survey with 1087 Italian adults (M = 39.7, SD = 16.39; 74.4% women), gender and socioeconomic status emerged as crucial factors in determining differences regarding people's responses and reactions to the pandemic. In addition, the results highlighted the importance of perceived social support and a moderate fear of COVID-19 in predicting people's quality of life and mental health. The study suggests important guidelines for the development of interventions to support the population's well-being and mental health.

Ontario COVID-19 and Kids Mental Health Study: a study protocol for the longitudinal prospective evaluation of the impact of emergency measures on child and adolescent mental health during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has impacted the mental health (MH) of children, adolescents and parents. Whereas youth with MH disorders and neurodevelopmental disorders (NDD) may be at higher risk for exacerbations in emotional and behavioural distress, children and adolescents without pre-existing MH disorders or NDD may also experience MH deterioration due to increases in stress, changes in health behaviours, loss of activities/school closures or loss of resources. Little is known about the impact of the COVID-19 emergency measures (EMs) on children's MH over the course of the pandemic.

METHODS AND ANALYSIS

Longitudinal study of four well-established, pre-existing cohorts in Ontario (two recruited in clinical settings, two recruited in community settings). Primary outcomes include the impact of EMs on six MH domains: depression, anxiety, irritability, inattention, hyperactivity and obsessive-compulsive behaviours. Risk and protective factors related to youth MH profiles and trajectories will be identified. In addition, the effects of school mitigation strategies, changes in MH services and family factors (ie, parental MH, economic deprivation and family functioning) on children's MH will be examined. Data will be collected via repeated online survey measures selected to ensure reliability and validity for the proposed populations and distributed through the pandemic periods.

ETHICS AND DISSEMINATION

The study was approved by institutional research ethics boards at participating research sites. Results will be disseminated through a robust knowledge translation partnership with key knowledge users. Materials to inform public awareness will be co-developed with educators, public health, and MH and health service providers. Connections with professional associations and MH advocacy groups will be leveraged to support youth MH policy in relation to EMs. Findings will further be shared through conference presentations, peer-reviewed journals and open-access publications.