Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels

Background: The behavioral variant of frontotemporal dementia (bvFTD), characterized by early behavioral abnormalities and late memory impairment, is a neurodegenerative disorder with a detrimental impact on patients and their caregivers. bvFTD is often difficult to distinguish from other neurodegenerative diseases, such as Alzheimer's disease (AD), using brief cognitive tests. Combining brief socio-cognitive and behavioral evaluations with standard cognitive testing could better discriminate bvFTD from AD patients. We sought to evaluate the diagnostic accuracy of brief socio-cognitive tests that may differentiate bvFTD and AD patients with low educational levels.Methods: A prospective study was performed on 51 individuals over the age of 50 with low educational levels, with bvFTD or AD diagnosed using published criteria, and who were receiving neurological care at a multidisciplinary neurology clinic in Lima, Peru, between July 2017 and December 2020. All patients had a comprehensive neurological evaluation, including a full neurocognitive battery and brief tests of cognition (Addenbrooke's Cognitive Examination version III, ACE-III), social cognition (Mini-social Cognition and Emotional Assessment, Mini-SEA), and behavioral assessments (Frontal Behavioral Inventory, FBI; Interpersonal Reactivity Index—Emphatic Concern, IRI-EC; IRI—Perspective Taking, IRI-PT; and Self-Monitoring Scale—revised version, r-SMS). Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was performed to compare the brief screening tests individually and combined to the gold standard of bvFTD and AD diagnoses.Results: The AD group was significantly older than the bvFTD group (p < 0.001). An analysis of the discriminatory ability of the ACE-III to distinguish between patients with AD and bvFTD (AUC = 0.85) and the INECO Frontal Screening (IFS; AUC = 0.78) shows that the former has greater discriminatory ability. Social and behavioral cognition tasks were able to appropriately discriminate bvFTD from AD. The Mini-SEA had high sensitivity and high moderate specificity (83%) for discriminating bvFTD from AD, which increased when combined with the brief screening tests ACE-III and IFS. The FBI was ideal with high sensitivity (83%), as well as the IRI-EC and IRI-PT that also were adequate for distinguishing bvFTD from AD.Conclusions: Our study supports the integration of socio-behavioral measures to the standard global cognitive and social cognition measures utilized for screening for bvFTD in a population with low levels of education.

Population Screening of Gambling Behavior: Playing to Escape From Problems May Be a Key Characteristic of At-Risk Players

The increase in gambling availability and the inclusion of gambling disorder as an addiction in DSM-5 highlight the importance of brief screening measures aiming to identify at-risk gamblers. The current study, using a brief telephone survey, assessed demographic characteristics and gambling behaviors in 2,118 adults. Questions were developed based on DSM-5 criteria for Gambling Disorder and common assessment tools. A 7% prevalence of as at-risk gamblers was identified. Male gender, low monthly income, high frequency of gambling behavior, large amounts of money spent, and gambling to escape from everyday problems or for amusement, specifically for men, were found to be the characteristics that can help in the early identification of at-risk gamblers. Gambling for financial gain and as a way to socialize, age, and employment status were not significant predictors of gambling severity. This study shows that the above characteristics can be assessed easily through phone screening of large populations, aiding in prevention practices to reduce the problematic use of gambling activities.

Neurodevelopmental disorders in youth justice: a systematic review of screening, assessment and interventions

Objectives This study aims to systematically review screening and assessment approaches and therapeutic interventions for young people with neurodevelopmental disorders (NDDs) in the youth justice system (YJS). Method Five databases were searched (PubMed, Embase, CINAHL, Web of Science and PsycINFO) for studies evaluating effectiveness of screening, assessment or interventions, targeting people aged 10–18 years in youth justice with a NDD. Results Eighteen peer-reviewed articles (9 screening/assessment; 9 intervention studies) were eligible. More comprehensive assessment appeared to be superior to brief screening for identifying NDDs. Interventions addressed social and emotional wellbeing, educational, employment, language and communication and behavioural outcomes, community engagement, quality of life factors and recidivism. Limited consideration was given to cultural diversity in evaluations of screening, assessment or interventions. Conclusions The limited amount of evidence retrieved suggests further research is urgently needed in the provision of culturally competent and holistic screening, assessment and treatment for young people with NDDs in the YJS.

Validation of a Brief Screening Instrument for Chemical Intolerance in a large U.S. National Sample

Keywords: Chemical Intolerance, Drug Intolerance, Food Intolerance, QEESI, BREESI, Multiple Chemical Sensitivity, Toxicant-induced Loss of Tolerance, Prevalence

Co-morbid gambling disorder in a local drug and alcohol service: an audit to determine prevalence

AimsNational surveys show that over 56% of adults in England gamble annually, and of those surveyed, 0.5% were problem gamblers, equating to 300,000 problem gamblers at any point. The prevalence of problem gambling in patients with a substance misuse disorder ranges from 20.5% to 55%.The audit aims to improve the care of patients with comorbid substance misuse and gambling disorder by assessing the extent to which the service currently enquires about and records problem gambling in its patient cohort.It is hypothesised that as no formal recording process is in place locally, this information will not be recorded systematically and in a way that is easily retrievable by the service.The audit will allow the service to assess whether changes need to be made to the initial assessment pathways into treatment for substance-related disorders to adequately record this information so that further assessment and onward referral can take place.MethodAll active patients (n = 2824) within the service had both their electronic initial assessments and their entire electronic notes screened for terms such as ‘betting’ and ‘gambling’ and this was recorded using an Excel spreadsheet. Prevalence rates across the teams (opiates, non-opiates and alcohol) were then calculated.ResultThe results showed that 0% of patients had any entries in their initial screening noting any gambling activity. Further scrutiny of the records revealed that only 3.5% (n-99) had ever discussed gambling with a worker in any of the services.ConclusionThe majority (n = 52) of patients who had discussed gambling only had one positive search result, suggesting this was not followed-up in a systematic fashion. Recommendations are to revise the common assessment pro-forma to include a validated brief screening tool (lie/bet), where one positive answer triggers a further assessment with an appropriate clinician for consideration of referral to the local NHS gambling service.

Screening for family functioning and mental health in adolescents with non-cardiac chest pain: A comparison study for a frequently encountered problem

Chest pain is highly prevalent in adolescence, represents a considerable burden for health services, and rarely associated with cardiac disease. Since psychosocial factors are related to chest pain there is a need for exploring the accompanying family functioning and mental health problems in adolescents with non-cardiac chest pain. Here, we assessed these determinants in 68 adolescents with non-cardiac chest pain and 68 age and-sex matched control participants using the 4-item Patient Health Questionnaire-4 for a brief screening for anxiety and depression and the Family APGAR Scale to assess the perception of family functioning. Adolescents with non-cardiac chest pain reported more depression, anxiety and experienced impaired family functioning (p=0.003, p<0.001, p<0.001). The results indicated that non-cardiac chest pain is a warning sign of an underlying mental health problem with accompanying family issues and it deserves further psychosocial investigation including anxiety, depression, and impaired satisfaction of the adolescents’ family’s responsiveness.