Epilepsy and Behavior

Although epilepsy is defined by the occurrence of spontaneous epileptic seizures, a large body of evidence indicates that epilepsy is linked to a spectrum of behavioral, psychiatric, and cognitive disorders as well as to sudden death. Explanations for these associations include the following: (1) The effects of structural lesions that may impair the functions subserved by the regions of the brain involved in the lesion. (2) The effects of seizure activity that may begin well before a clinical seizure occurs and may persist long after it is over, raising questions about what truly constitutes "interictal." In addition, encephalopathic effects of epilepsy in infancy during critical periods in development may be particularly severe and potentially irreversible. (3) Shared mechanisms underlying seizures as well as these other disorders in the absence of structural lesions or separate diseases of the central nervous system (CNS). Epidemiologic and clinical studies demonstrate the elevated risk of cognitive, psychiatric, and behavioral disorders not just during but also prior to the onset of epilepsy (seizures) itself. These may outlast the active phase of epilepsy as well. The mounting evidence argues strongly for the recognition of epilepsy as part of a spectrum of disorders and against the notion that even uncomplicated epilepsy can a priori be considered benign.

Significance. The increasing intensity of social processes contributes to the increase in the incidence of mental disorders and behavioral disorders among citizens. A history of mental and behavioral disorders creates conditions for social isolation of the patient. A questionnaire survey was conducted with the purpose of identifying factors associated with the attitude of citizens towards patients with mental and behavioral disorders. Material and methods. To collect data, a validated author's questionnaire was used, the answers to the questions and judgments of which were presented in the form of a five-level scale of the total Likert ratings. Simple and multiple binary logistic regression analysis, and simple ordinal logistic regression analysis were used to select factors that affect the respondents' choice of options for questions-judgments reflecting their attitude towards patients with mental disorders and behavioral disorders. Results. Respondents with a history of dealing with patients with mental disorders and behavioral disorders are more likely to agree with the statement that the latter should be isolated from society. Older respondents are more likely to agree with the statement that patients with mental and behavioral disorders may be restricted in rights. Middle-aged respondents (compared with the elderly) who have secondary vocational education (compared with those with higher education) are more likely to agree with the statement that patients with mental disorders and behavioral disorders pose a danger. Non-religious respondents are less likely to agree with the statement that patients with mental disorders and behavioral disorders pose a danger. Conclusion. The attitude of residents of Cherepovets towards people with mental disorders and behavioral disorders is mediated by the characteristics of their demographic status, previous history of dealing with such patients and self-rated religious commitment. Scope of application. The study results can be used to develop social programs aimed at preventing interpersonal conflicts and formation of negative social stereotypes resulting in social isolation of people with mental and behavioral disorders.

To examine longitudinal reciprocal relationships between marijuana use and psychiatric disorders, and identify the role of HIV in a sample (N = 340) of youth perinatally infected with HIV (PHIV+) and youth perinatally exposed but uninfected with HIV (PHIV-) (60.6% PHIV+; 9-16 years at baseline; 51% female). Cross-lagged structural equation modeling was used to examine longitudinal associations between changes in marijuana use and changes in any behavioral, mood, and anxiety disorders at three time points across adolescence. Marijuana use predicted behavioral and mood disorders in youth, regardless of HIV status. Behavioral and mood disorders predicted marijuana use for PHIV- youth; behavioral disorders predicted marijuana use for PHIV+ youth. Anxiety disorders and marijuana use were not associated for either group. For PHIV+ and PHIV- youth, interventions that target early marijuana use may reduce later psychiatric disorders. Similarly, treatment for early behavioral disorders may prevent subsequent marijuana use.

Objective: High prevalence of behavioral and psychological disorders in children with thalassemia can be associated with a decrease in the self-esteem of patients and can completely alter the person's self-concept. The aim of this study was to determine the prevalence of behavioral problems and its relationship with self-esteem and self-concept in patients with thalassemia major aged 6 to 18 years. Method : In a cross-sectional study, 30 patients with thalassemia major at the age of 6 to 18 years were enrolled. behavioral problems, self-esteem, and self-concept were evaluated by the child's behavioral check list at the ages of 6 to 18 years (CBCL 6-18), the Coopersmith's Self-Esteem Inventory, and the Piers-Harris Children's Self-Concept Scale. Results: A total of 10.0% of patients had behavioral disorders, 3 (10.0%) desirable self-esteem, 15 (50.0%) moderate self-esteem, and 12 (40.0%) poor self-esteem. There was a strong but adverse correlation between behavioral disorder score and both self-esteem score (correlation coefficient equal to -0.886, p value = 0.001) and self-concept score (correlation coefficient equal to -0.498, p value = 0.001), and thus those patients with behavioral disorder had less appropriate self-esteem and self-concept. Conclusion: The incidence of behavioral disorders is associated with decreased self-esteem and poor self-concept in these patients. Therefore, improvement in behavioral disorders can be expected by improving self-esteem and self-concept in such patients.

The positron emission tomography (PET) imaging technique, which is utilized in human behavior and psychiatric disorder research, was performed on the brains of clinically normal mixed breed dogs, 3 hound-type (long floppy ears) mixed breed dogs and 3 non-hound retriever-type mixed breed dogs. Glucose metabolism was obtained with F-18 fluorodeoxyglucose (FDG), and quantitative analysis was performed by standardized uptake value (SUV) measurement. Magnetic resonance (MR) images were obtained in each dog, and these images were superimposed on PET images to identify anatomical locations. The glucose metabolism in each region of interest was compared between the three hound-type dogs and 3 non-hound-type dogs. The two anatomically different types of dog were compared to assess whether breed-typical behavioral tendencies (e.g., sniffing behavior in hound-type dogs, staring and retrieving in Labrador-type dogs) are reflected in baseline brain metabolic activity. There were no significant differences between the hound-type dogs and non-hound-type dogs in cerebral SUV values. These data might serve as normal canine cerebral metabolism data for FDG PET studies in dogs and form the basis for investigations into behavioral disorders in dogs such as compulsive disorder, anxiety disorders and cognitive dysfunction.

PurposeAlthough benign rolandic epilepsy (BRE) is a benign condition, it may be associated with a spectrum of behavioral, psychiatric, and cognitive disorders. This study aimed to assess the cognitive and other neuropsychological profiles of children with BRE.MethodsIn total, 23 children with BRE were consecutively recruited. All children underwent sleep electroencephalography (EEG) and were assessed on a battery of comprehensive neuropsychological tests including the Korean versions of the Wechsler intelligence scale for children III, frontal executive neuropsychological test, rey complex figure test, Wisconsin card sorting test, attention deficit diagnostic scale, and child behavior checklist scale.ResultsThe study subjects included 13 boys and 10 girls aged 9.0±1.6 years. Our subjects showed an average monthly seizure frequency of 0.9±0.7, and a majority of them had focal seizures (70%). The spike index (frequency/min) was 4.1±5.3 (right) and 13.1±15.9 (left). Of the 23 subjects, 9 showed frequent spikes (>10/min) on the EEG. The subjects had normal cognitive and frontal executive functions, memory, and other neuropsychological sub-domain scores, even though 8 children (35%) showed some evidence of learning difficulties, attention deficits, and aggressive behavior.ConclusionOur data have limited predictive value; however, these data demonstrate that although BRE appears to be benign at the onset, children with BRE might develop cognitive, behavioral, and other psychiatric disorders during the active phase of epilepsy, and these problems may even outlast the BRE. Therefore, we recommend scrupulous follow-up for children with BRE.

22.4 Screening and Diagnosis of Conduct Disorder in Boys and Girls

Genetically determined neurodevelopmental syndromes are frequently associated with a particular developmental trajectory, and with a cognitive profile and increased propensity to specific mental and behavioural disorders that are particular to, but not necessarily unique to the syndrome. How should these mental and behavioural disorders best be conceptualised given that similar symptoms are included in the definition of different mental disorders as listed in DSM-5 and ICD-10? In addition, a different conceptual framework, that of applied behavioural analysis, has been used to inform interventions for what are termed ‘challenging behaviours’ in contrast to types of interventions for those conditions meeting diagnostic criteria for a ‘mental disorder’. These syndrome-specific developmental profiles and associated co-morbidities must be a direct or indirect consequence of the genetic abnormality associated with that syndrome, but the genetic loci associated with the syndrome may not be involved in the aetiology of similar symptoms in the general population. This being so, should we expect underlying brain mechanisms and treatments for specific psychopathology in one group to be effective in the other? Using Prader-Willi syndrome as an example, we propose that the conceptual thinking that informed the development of the Research Domain Criteria provides a model for taxonomy of psychiatric and behavioural disorders in genetically determined neurodevelopmental syndromes. This model brings together diagnostic, psychological and developmental approaches with the aim of matching specific behaviours to identifiable neural mechanisms.

The transition to ICD-11 was recommended by the WHO beginning from January 1, 2022. This classification went into effect on February 11, 2022. All sexual disorders, apart from paraphilias that in ICD-11are termed as paraphilic disorders and included into the Chapter “Mental, behavioural or neurodevelopmental disorders”, were removed from this class. But it should be noted that paraphilic disorders were also simultaneously included into the new ICD-11 rubric “Conditions related to sexual health”. All other sexual disorders have also been included in this chapter. The following fact served as one of impulses for separation of the above chapter. LGBT activists and organizations applied to the ICD-11 project demanding to exclude this pathology from the list of mental disorders, because its presence in the above list, in their opinion, broke human rights. That application was not ignored. In ICD-11 the block F64 “Gender identity disorders” from ICD-10 was replaced with “Gender incongruence”. Also, gender incongruence (transgenderism) in ICD-11 was transferred from “Mental and behavioural disorders” ICD-10 to “Conditions related to sexual health”. In this way mental pathology “was turned” into the norm by means of a “depathologizing” effect of social factors. But leaders of organizations of transgenders do not like even the terminology, which reflects in the ICD-11. What do they think, the term “gender incongruence” is stigmatizing too, because it contains the word “incongruence” as one of its components. The problems, which compose the group “Conditions related to sexual health”, are present in Chapter 17 of ICD-11. These include (1) sexual dysfunctions; (2) sexual pain disorders; (3) gender incongruence; (4) changes in female genital anatomy; (5) changes in male genital anatomy; (6) paraphilic disorders; (7) adrenogenital disorders; (8) predominantly sexually transmitted infections; (9) contact with health services for contraceptive management. The article discusses aspects associated with sexual dysfunctions: the required duration of their existence for making a proper diagnosis; the obligation of presence of the diagnostic criterion, according to which a sexual problem must cause clinically significant distress; the exclusion of sexual aversion from this category; the transfer of excessive sexual drive to the Chapter “Compulsive sexual behaviour disorder”; the discussion of the problem of a normal duration of a sexual intercourse, and others. The article contains the author’s table of comparisons of sexual dysfunctions as well as sexual pain disorders in ICD-10 and ICD-11. The author informs that Chapter F66 “Psychological and behavioural disorders associated with sexual development and orientation”, which also contained egodystonic sexual orientation, was completely excluded from ICD-11. The discussion also involves partial depathologizing of paraphilias, which is based on the absence of a diagnostic criterion of the presence of distress caused by them, which is reflected in ICD-11. According to this approach, if such distress is absent and a person fully accepts the direction of his sexual drive, then we are talking about a mentally healthy person who has paraphilia, and if paraphilia is not accepted and causes distress, then this is a paraphilic disorder, which refers to mental pathology. The above is fully applied to paedophilia too. What calls attention to itself is absence of masochism among the paraphilic disorders listed above. The author believes that, from a medical point of view, the partial depathologization of paraphilias, which is reflected in ICD-11, is scientifically unfounded, a consequence of the action of exclusively social factors. Therefore, when diagnosing these disorders, it is advisable to use the traditional approach to their diagnosis.

BackgroundMany studies have highlighted the high prevalence of executive disorders in stroke. However, major uncertainties remain due to use of variable and non-validated methods. The objectives of this study were: 1) to characterize the executive disorder profile in stroke using a standardized battery, validated diagnosis criteria of executive disorders and validated framework for the interpretation of neuropsychological data and 2) examine the sensitivity of the harmonization standards protocol proposed by the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network (NINDS-CSN) for the diagnosis of Vascular Cognitive Impairment.Methods237 patients (infarct: 57; cerebral hemorrhage: 54; ruptured aneurysm of the anterior communicating artery (ACoA): 80; cerebral venous thrombosis (CVT): 46) were examined by using the GREFEX battery. The patients’ test results were interpreted with a validated framework derived from normative data from 780 controls.ResultsDysexecutive syndrome was observed in 88 (55.7%; 95%CI: 48–63.4) out of the 156 patients with full cognitive and behavioral data: 40 (45.5%) had combined behavioral and cognitive syndromes, 29 (33%) had a behavioral disorder alone and 19 (21.6%) had a cognitive syndrome alone. The dysexecutive profile was characterized by prominent impairments of initiation and generation in the cognitive domain and by hypoactivity with disinterest and anticipation loss in the behavioral domain. Cognitive impairment was more frequent (p = 0.014) in hemorrhage and behavioral disorders were more frequent (p = 0.004) in infarct and hemorrhage. The harmonization standards protocol underestimated (p = 0.007) executive disorders in CVT or ACoA.ConclusionsThis profile of executive disorders implies that the assessment should include both cognitive tests and a validated inventory for behavioral dysexecutive syndrome. Initial assessment may be performed with a short cognitive battery, such as the harmonization standards protocol. However, administration of a full cognitive battery is required in selected patients.

Background: In New York State (NYS), extreme heat events in the warm months (May – September) are expected to increase over the next 60 years. Additionally, NYS experiences extremely low temperatures in the colder months (October – April). Extreme temperature events are linked to increased emergency department visits, hospitalizations, and mortality for individuals with mental and behavioral disorders. This research aims to characterize individual and regional risk factors for mental and behavioral disorder hospitalizations with concurrent temperature-related illness in NYS. Methods: Using data from the NYS Statewide and Planning Research and Cooperative System between 2005 – 2019, multivariate log binomial regression models were used to estimate risk ratios (RR) of risk factors for hospitalization with a diagnosis of mental or behavioral disorders and concurrent cold-related illness or heat-related illness. Results: Dementia (RR 1.65; 95% CI:1.49, 1.83) and schizophrenia (RR 1.38; 95% CI:1.19, 1.60) were associated with an increased risk for heat-related illness among hospitalizations for mental and behavioral disorders; while alcohol dependence (RR 2.10; 95% CI:1.99, 2.22), dementia (RR 1.52; 95% CI:1.44, 1.60), schizophrenia (RR 1.41; 95% CI:1.31, 1.52), and non-dependent drug/alcohol use (RR 1.20; 95% CI:1.15, 1.26) were associated with an increased risk of cold-related illness among hospitalizations for mental and behavioral disorders. Risk factors for hospitalizations for mental and behavioral disorders and concurrent heat-related illness include increasing age, male gender, non-Hispanic black race, and medium hospital size. Risk factors for hospitalizations for mental and behavioral disorders and concurrent cold-related illness include increasing age, male gender, non-Hispanic black race, being on Medicare, Medicaid, or uninsured status, the presence of respiratory disease, and rural hospital location. Conclusion: These results agree with prior risk factor findings for mental and behavioral disorder hospitalizations with a concurrent heat-related illness. This research adds to the literature by identifying dementia, schizophrenia, substance related addictive disorders including alcohol dependence and non-dependent substance use, increasing age, male gender, non-Hispanic black and other race, Medicare coverage, Medicaid coverage, uninsured status, respiratory disease, and rural location as risk factors for mental and behavioral disorder hospitalizations with a concurrent cold-related illness.

Mental and behavioral disorders are an important public health problem and constitute a priority for the WHO, whose recommendations include the surveillance of their risk factors. On the other hand, drought episodes have been increasing in frequency and severity in Europe since 1980. Therefore, to review the present knowledge about the impact of drought on mental and behavioral disorders, in the present climate change context, and to underline potential research gaps, could be of major interest. Thus, we performed a narrative review using online academic databases with the aim of identifying relevant literature about the impact of drought on mental and behavioral disorders. To the best of our knowledge, no study in Europe quantifies the potential association between drought and mental disorders. A limited number of studies have found significant associations between droughts (with different temporal ranges) and various measures of mental health. However, according to our review, only three of them quantified the association between drought and objective mental health outcomes, such as number of emergencies due to clinically diagnosed mental disorders or suicides. Additionally, few studies used specific indices as a measure of drought; and finally, as far as authors are aware, none of them has analyzed this relationship adjusting for various other potential environmental confounders. Moreover, the eventual association could vary between different geographical areas within the same country. Therefore, national and regional studies would be especially necessary. Thus, there is a need for specific national and regional studies, in Europe and globally, that assess the impact of specific indices of drought (with different temporal ranges) on objective mental health outcomes controlling for potential environmental confounders. Moreover, the quantification of its cost would be necessary for health prioritization, evidence-based policies and strategic health planning.

This chapter focuses on students with emotional and behavioral disorders and how to keep them from incarceration through special education and mental health collaboration. It explains how children and youth with emotional disturbance (ED) encounter difficulties that often surface in school, particularly in connection with zero tolerance policies. These policies, it argues, have had a disproportionately negative effect on youth with ED because they behave in ways that violate those policies. Moreover, mental health services for youth in public schools are often ad hoc, fragmented, and suffer from inadequate funding. As a result, the juvenile justice system is utilized as a de facto approach to treatment of youth behavioral and mental disorders. The chapter proposes a tiered, comprehensive approach to prevention, based on universal programs aimed at all youth, selective interventions aimed at identified at-risk youth, and intensive interventions aimed at youth with the most severe issues or those who have already experienced the juvenile justice system.

Introduction: there are many distinct mental disorders, with different presentations. They are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behavior, and relationships with others. Mental disorders include depression, bipolar disorder, schizophrenia, alcoholism, substance abuse disorders, psychosis in general, dementia, and developmental disorders, including autism. Even so, it is one of the areas that receives the least attention and funding from public health. Around 1 billion people live with a mental disorder, 3 million people lose their lives every year due to harmful alcohol use, and one person dies every 40 seconds by suicide. Objective: to analyze mortality due to mental and behavioral disorders in Brazil from 2009 to 2019. Method: this is a cross-sectional, observational, ecological epidemiological study using official data from the Mortality Information System (MSS) and the Hospital Information System. Data were collected by place of occurrence and place of residence among patients in Brazil from 2009 to 2019. Hospital Admission Authorization Forms and Admission Notification Forms were included. The data source was the Death Certificate. Results: analyzing mortality due to mental and behavioral disorders between the sexes, it was noted that only male patients showed a reduction in the rate in all Brazilian regions, highlighting the Northeast ( β = -0.27, p = 0.001), Southeast ( β = -0.20, p = 0.003) and South ( β = -0.19, p = 0.023) regions, which showed significant reductions. When making a comparison in the studied series, both sexes showed a reduction, but only the male sex had a significant decline (male: β = -0.20, p = 0.001; female: β = -0.03, p = 0.146). Conclusion: mortality from mental and behavioral disorders revealed higher rates in 2011 (7,376), corresponding to a greater proportion of males (11.25), especially single individuals, in all regions of the Brazilian federation unit. Regarding the total analysis of deaths in the study series, there was an increase in mortality among females, with prevalence in the Northeast Region and in widowed marital status.

Cognitive and psychological disorders are among the most frequently observed sequelae in brain tumor survivors. The goal of this work was to verify the presence of these disorders in a group of children and adolescents diagnosed with brain tumor before age 18 years, differentiate these disorders according to age of assessment, identify correlations between the two types of impairments and define possible associations between these impairments and clinical variables. The study involved 76 patients diagnosed with brain tumor before age 18 years. Three age groups were formed, and all the patients received a standardized battery of age-matched cognitive and psychological tests. According to our findings, all three groups present with cognitive and psychological-behavioral disorders. Their frequency varies according to age of onset and is strongly associated to time since diagnosis. The performance intelligence quotient (PIQ) was more impaired than the verbal intelligence quotient (VIQ). Internalizing problems, withdrawal and social problems were the most frequent psychological disorders. Correlations were found between cognitive impairment and the onset of the main psychological and behavioral disorders. These findings are relevant as they point out the long-term outcome of brain tumor survivors. Hence, the recommendation to diversify psychological interventions and rehabilitation plans according to the patients' age.