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Research on the cerebellum and its functional organization has significantly expanded over the last decades, expanding our comprehension of its role far beyond motor control, including critical contributions to cognition and affective processing. Notably, the cerebellar lateralization mirrors contralateral brain lateralization, a complex phenomenon that remains unexplored, especially across different stages of life. The present work aims to bridge this gap by providing a comprehensive scoping review of the lateralization of motor, cognitive, and affective functioning within the cerebellum across the lifespan. A methodical search in electronic databases (i.e., PubMed, Embase, and PsycINFO) was conducted up to October 2024, focusing on neuroimaging studies with healthy participants of all ages performing motor, cognitive, or affective tasks. Our selection process, which involved multiple independent reviewers, identified 128 studies reporting cerebellar asymmetries in individuals from early childhood to older age, with a significant portion of studies regarding young-middle adults (19-45 years old). The majority of the findings confirmed established lateralization patterns in motor and language processing, such as ipsilateral motor control and right-lateralized language functions. However, less attention has been paid to other cognitive functions and affective processing where more heterogeneous and less consistent asymmetries have been observed. To the best of our knowledge, this scoping review is the first to comprehensively investigate the motor, cognitive, and affective functional lateralization of the cerebellum across lifespan, highlighting previously overlooked dimensions of cerebellar contributions., Competing Interests: Declarations. Conflict of interests: The authors do not have any conflict of interest to declare., (© 2025. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Current information on treatment and clinical characteristics of U.S. adults with schizophrenia spectrum disorders (i.e., schizophrenia, schizoaffective, and schizophreniform disorders) may help inform public health policy and service development for this population., Methods: Data were from the U.S. Mental and Substance Use Disorders Prevalence Study, conducted from October 2020 to October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 for past-year psychiatric and substance use disorder diagnoses among adults ages 18-65 years. Using sampling weights, the authors examined clinical and treatment characteristics among those with schizophrenia spectrum disorders and compared sociodemographic characteristics and comorbid behavioral health conditions of individuals with or without such disorders (N=4,764)., Results: Among 114 adults with schizophrenia spectrum disorders, the most common comorbid conditions were major depressive episode (52%, 95% CI=34%-69%) and alcohol use (23%, CI=3%-43%), cannabis use (20%, 95% CI=1%-39%), and posttraumatic stress (17%, 95% CI=5%-30%) disorders. Global Assessment of Functioning scores were lower among people with than among those without schizophrenia spectrum disorders (mean±SE=44.8±2.0 vs. 77.2±0.5, p<0.01, respectively), indicating worse functioning. In the past year, 71% (95% CI=55%-87%) of adults with schizophrenia spectrum disorders received at least some mental health treatment, and 26% (95% CI=13%-38%) received minimally adequate treatment., Conclusions: Individuals with schizophrenia spectrum disorders face substantial challenges in the United States, including high rates of comorbid mental health conditions and substance use; few received adequate treatment. A strong social safety net and active clinical interventions are required to address the socioeconomic challenges and unmet mental health service needs of this population., Competing Interests: The authors report no financial relationships with commercial interests. Dr. Dixon is Editor of Psychiatric Services. Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript.

Learning Health Systems (LHSs) strive to continuously integrate innovations and evidence-based practices in healthcare settings, thereby enhancing programmatic and patient outcomes. Duration of untreated psychosis (DUP) is a variable worthy of empirical attention, as the construct has been identified as a leading predictor of psychotic spectrum disorder prognosis and, despite the proliferation of early intervention for psychosis (EIP) teams across the U.S., remains longer than the recommended maximum established by the World Health Organization. Pathways to care are causally implicated as a DUP reduction rate-limiting factor. This paper illustrates a balanced care model, wherein resource-intensive community and clinical services are centralized to support a more efficient, standardized, and direct pathway to EIP care; identification of psychosis and psychotic risk states is made by highly-trained diagnosticians; and measurement-based care across the Learning Health System (LHS) is supported by a central assessment team. The Central Assessment of Psychosis Service (CAPS) streamlines core front-end EIP functions across the LHS, thereby alleviating the burden on EIP teams while enhancing access, equity, efficiency, and quality of the initial psychodiagnostic assessment. CAPS represents an innovative application of the balanced care model that preserves the core functions of the EIP team while task sharing or task shifting resource-intensive activities to an academic medical center partner. We review the five core functions of a centralized referral, screening, and assessment service. Given the potential for centralization to reduce DUP and enhance equity and access across the LHS, this paper will include concrete recommendations for policymakers considering centralizing core functions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, (Copyright © 2024 University of Washington School of Medicine. Published by Elsevier B.V. All rights reserved.)

Background: Knowledge of clinical, treatment and life circumstances of individuals with bipolar I disorder (BP-I) in US households is informed by decades old epidemiological surveys., Methods: The Mental and Substance Use Disorders Prevalence Study was conducted October 2020-October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 diagnosing 12-month prevalence of BP-I and other mental health disorders (MHD) among 4764 adults aged 18-65 years and collected sociodemographic information. We examined clinical characteristics, differences by sex and age among adults with BP-I, and compared adults with BP-I versus no MHD regarding sociodemographic characteristics, functioning, and substance use disorders (SUDs)., Results: Prevalence of BP-I in the MDPS was 1.5 %. Among those with BP-I, 73.4 % had comorbid psychiatric disorders, and 43.4 % had comorbid SUDs. Alcohol use disorder was higher in those with BP-I versus no MHD (33.0 % vs. 6.3 %). Mean Global Assessment of Functioning scores were lower among those with BP-I versus no MHD (53.2 vs. 77.0). Of individuals with BP-I, 64.9 % had past-year outpatient, 5.4 % inpatient, and 18.7 % minimally adequate treatment (≥1 antimanic agent and ≥ 4 outpatient visits). Individuals with BP-I were less likely to be employed (37.3 % vs. 63.0 %) and have a family income ≥$20,000 (48.2 % vs. 81.9 %) versus no MDPS MHD., Limitations: The survey response rate was low., Conclusions: In this sample, many individuals with BP-I had psychiatric and SUD comorbidities, lived in poverty and had functional impairment. Few received adequate treatment; women and younger individuals were particularly disadvantaged. Early detection and treatment represent substantial opportunities to improve outcomes., Competing Interests: Declaration of competing interest Dr. Kessler: In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. All other authors have no declarations to report., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Sexuality is a fundamental part of human existence and it encompasses thoughts, desires, behaviors, relationships, as well as neuropsychological and physiological components. However, sexuality in older adults is under-researched from the neuropsychological and psychophysiological perspectives and is often neglected by healthcare providers in the clinical practice. This article aims to explore the state of the art on the neuropsychology and psychophysiology of older adults' sexuality, proposing future research directions and emphasizing its significance. By summarizing current knowledge on the sexuality of younger individuals, it was possible to lay the groundwork for formulating research questions about older adults' sexuality. The implications proposed in this article will potentially impact both the scientific and also the clinical field. In fact, gaining insights on the neuropsychological and psychophysiological aspects of sexuality in healthy older adults can also shed light into those with neurocognitive disorders., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Trazodone, an antidepressant drug is also largely used in several medical contexts. Insomnia, behavioral disorders, and anxiety may be underlying symptoms for prescribing trazodone. This cross-sectional study aims to identify reasons for trazodone prescription, assess the efficacy, as well as identify any related side effects in older persons living in long term care facilities (LTCFs)., Methods: Older adults aged ≥ 60 years, at risk of or affected with Covid-19 and enrolled in the GeroCovid Observational study from LTCFs, and using trazodone were included. A structured questionnaire was administered to treating physicians regarding reasons for trazodone prescription, discontinuation, possible adverse events and benefits., Results: Thirty-seven out 74 LTCFs participating in both the GeroCovid and GeroCovid Vax studies completed the questionnaire regarding trazodone use. Of the 427 participants included in this study analysis, we found that 43% had diagnoses of dementia and depression, 33% had dementia, no behavioral and psychological symptoms of dementia (BPSD) and no depression, 14% had dementia with BPSD and no depression, and < 11% had only depression. The main reasons for trazodone prescription included agitation, insomnia, depression and anxiety. Trazodone use was reported as partially or totally effective in more than 90% of participants using the drug. Falls were the most frequent adverse event (30% of participants)., Conclusions: Our data suggest that trazodone behaves as an eclectic antidepressant that, in the clinical practice, may also be used for BPSD and insomnia, especially in older people with dementia., (© 2024 John Wiley & Sons Ltd.)

Intermediary-purveyor organizations (IPOs) are a type of dissemination support system that are intended to enhance the adoption and sustainment of empirically supported treatments (ESTs) by deploying empirically supported strategies to remediate implementation challenges. Despite the recent proliferation of government-funded IPOs for other psychiatric populations, IPOs that can redress the substantial science-to-practice gap among clients who experience psychotic disorders are not well documented. This article provides an overview of an IPO in an R1 academic medical center whose mission is to enhance access to evidence-based interventions for individuals who have or are at risk for a psychotic disorder. The article spotlights the functions of an IPO and illustrates these functions with a use case, cognitive behavioral therapy for psychosis. We highlight IPO-led activities related to cognitive behavioral therapy for psychosis purveyance, professional development, quality improvement, public awareness education and training, research and evaluation, as well as program and policy development. Finally, we address the advantages and disadvantages of establishing IPOs of this nature in academic medical centers, the importance of academic-community partnerships in advancing EST implementation, and present considerations for replication. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The present study aims to investigate the relationship between cerebellar volumes and cognitive reserve in individuals with Mild Cognitive Impairment (MCI). A description of proxies of cerebellar cognitive reserve in terms of different volumes across lobules is also provided. 36 individuals with MCI underwent neuropsychological (MoCA, MMSE, Clock test, CRIq) assessment and neuroimaging acquisition with magnetic resonance imaging at 3 T. Simple linear correlations were applied between cerebellar volumes and cognitive measures. Multiple linear regression models were then used to estimate standardized regression coefficients and 95% confidence intervals. Simple linear correlations between cerebellar lobules volumes and cognitive features highlighted a significant association between CRIq&#95;Working activity and specific motor cerebellar volumes: Left&#95;V (ρ = 0.40, p = 0.02), Right&#95;V (r = 0.42, p = 0.002), Vermis&#95;VIIIb (ρ = 0.47, p = 0.003), Left&#95;X (ρ = -0.46, p = 0.002) and Vermis&#95;X (r = 0.35, p = 0.03). Furthermore, CRIq&#95;Working activity scores correlated with certain cerebellar lobules implicated in cognition: Left&#95;Crus&#95;II, Vermis VIIb, Left&#95;IX. MMSE was associated only with the Right&#95;VIIB volume (r = 0.35, p = 0.02), while Clock Drawing Test scores correlated with both Left&#95;Crus&#95;I and Right&#95;Crus&#95;I (r = -0.42 and r = 0.42, p = 0.02, respectively). This study suggests that a higher cognitive reserve is associated with specific cerebellar lobule volumes and that Working activity may play a predominant role in this association. These findings contribute to the understanding of the relationship between cerebellar volumes and cognitive reserve, highlighting the potential modulatory role of Working activity on cerebellum response to cognitive decline., (© 2024. The Author(s).)

The literature on COVID-19 continues to increase daily. Cognitive sequelae associated with COVID-19 infection still draw the attention of the scientific community given the lack of consensus about their existence, etiology, characterization and reversibility. The aim of this study is to provide a neuropsychological identikit for younger (<65 years) and older (≥65 years) individuals diagnosed with COVID-19 infection, at baseline and after 3 and 6 months. In total, 226 individuals took part in a retrospective observational study and their cognitive performance was compared across groups (younger adults vs. older adults) and time (T0, T1, T2). The results highlighted differences between younger and older adults in the Montreal Cognitive Assessment (MoCA) global score, as expected in consideration of the different physiological conditions of the two populations. However, memory performance highlighted the two groups as characterized by a difference in patterns of recall that may move beyond a physiological explanation and provide information about COVID-19 cognitive sequelae. This study suggests that cognitive deficits observed in COVID-19 survivors may reflect a difficulty in attention and concentration that interferes mainly with retrieval processes. This result fits well with the concept of "brain fog" typical of post-COVID-19 syndrome and may also reflect the stress experienced while facing the pandemic.

Background: Malnutrition and sarcopenia significantly increase the risk of intra-hospital delirium, particularly among older adults. Given the potential correlation between calf circumference (CC) and these conditions, CC emerges as a promising predisposing factor for delirium. This study aims to investigate the independent association between delirium and anthropometric parameters, focusing on evaluating CC's predictive capacity for intra-hospital delirium risk. Additionally, it aims to compare CC's predictive performance with the widely used Mini Nutritional Assessment (MNA), while also considering potential gender disparities., Methods: This is a retrospective study which enrolled patients aged ≥ 65 years from September 2021 to March 2022 at the Padova Hospital (Italy). Physical characteristics, intra-hospital delirium incidence, and body composition were assessed. Sarcopenia was diagnosed using the 2019 European Consensus criteria., Results: Among 207 subjects, delirium affected 19% of patients. CC showed a significant association with intra-hospital delirium among the analyzed anthropometric parameters. ROC curves indicated that CC's predictive capacity for delirium onset was comparable to MNA (p = 0.98), particularly in women. In a multivariable logistic regression model, female gender and higher cognitive and CC scores emerged as protective factors against delirium onset, with each unit increase in CC associated with a 24% reduction in the odds of delirium. Conversely, sarcopenia did not significantly influence delirium onset., Conclusions: CC shows promise as a predisposing factor for intra-hospital delirium, similar to MNA, albeit with significant gender differences. CC could serve as a valuable tool for assessing delirium risk among female patients. Further validation of these findings is necessary through larger-scale studies., (© 2024. The Author(s).)

Background and Objectives: Anorexia of aging (AoA) is a prevalent geriatric syndrome characterized by a multifactorial decline in appetite and reduced food intake associated with the aging process. This systematic review aims to investigate the use and outcomes of cannabinoids in addressing AoA, with the goal of providing a comprehensive understanding and discussing their potential integration into daily clinical practice., Methods: A thorough search of databases (Embase Ovid, Scopus, PubMed, Cochrane Library, and Web of Science) identified 6100 studies. After eliminating duplicates and screening titles and abstracts, 25 studies underwent full appraisal. Two reviewers assessed inclusion suitability, and study methodologies were evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies and the modified Jadad Scoring Scale for randomized controlled trials. Ultimately, six studies published between 2002 and 2019, involving 869 participants, were included in the review., Results: Out of the 6 fin. l papers selected, 5 were randomized trials, and 1 was a prospective study. Megestrol acetate (800 mg/d) proved to be more effective than dronabinol 2.5 mg twice a day in increasing appetite. Nabilone (at a dosage of 0.5 mg per day) did not show superiority over placebo in alleviating symptoms such as pain, nausea, loss of appetite, and weight. However, with a double dosage followed by 1.0 mg/6 weeks, after eight weeks of treatment, patients recorded a significant increase in calorie intake and carbohydrate consumption compared to the placebo group, with some patients also experiencing substantial weight gain. Regarding delta-9-tetrahydrocannabinol (THC), a weight increase of ≥10% was observed in 17.6% of patients with doses of 5 mg or 10 mg capsules daily, without significant side effects. Additionally, patients treated with THC 2.5 mg reported improved chemosensory perception and increased appetite before meals compared to placebo. No significant side effects were reported in older adults taking cannabinoids., Conclusions: Cannabinoids offer promise in enhancing the quality of life for older individuals with active neoplastic disease. However, to establish comprehensive guidelines, further research with larger sample sizes is essential. Only through this approach can we fully grasp the potential and application of cannabinoids in addressing the nutritional concerns associated with neoplastic diseases., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Rathke's cleft cyst (RCC) is a benign cystic lesion that is commonly discovered incidentally and remains asymptomatic in most cases. However, its association with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion leading to hyponatremia (HN) is rare and has only been sporadically reported in the medical literature. In this article, we present a unique case of RCC manifesting with HN and discuss the diagnostic and management challenges encountered in a neurosurgical context. Additionally, we provide a comprehensive review of existing literature on RCC presenting with HN to enhance our understanding of this rare presentation. A 56-year-old woman with acute-onset blurry vision, headaches, and low fluid intake was diagnosed with euvolemic HN secondary to SIADH. Further evaluation revealed an intrasellar cystic lesion consistent with RCC, which was successfully resected through endoscopic transnasal transsphenoidal surgery, resulting in a complete recovery without the need for hormone replacement. The most likely explanation for the HN due to SIADH in this case is the release of accumulated antidiuretic hormone (ADH) due to compression by the cyst and the irritating effect of inflammation at this location. Accurate evaluation and classification of HN are essential for proper diagnosis and management, considering the rarity of RCC presenting with HN. A multidisciplinary approach to treatment can lead to favorable functional outcomes; however, further research is necessary to better comprehend this unique clinical entity and optimize neurosurgical approaches., Competing Interests: Conflict of Interest None declared., (Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: This report uses data from Mental Disorders Prevalence Study (MDPS), a large epidemiologic study that provided national prevalence estimates of seven mental disorders based on the Structured Clinical Interview for DSM-5 (SCID), to assess the odds of treatment disruption during COVID for SMI and non-SMI groups., Methods: This cross-sectional study conducted from 2020 to 2022 included 2,810 household participants with any lifetime mental health treatment. Weighted logistic regressions estimated the odds of reporting disruptions in access to mental health care or psychotropic prescriptions due to COVID. SMI was broadly defined as having an MDP diagnosis and serious functional impairment (GAF ≤50, a validated and widely used cutoff). Non-SMI groups were a mental diagnosis without serious impairment (MDPS diagnosis, GAF >50) and any lifetime treatment and no serious impairment (no MDPS diagnosis, GAF >50)., Results: The SMI and mental disorder without serious impairment groups had approximately 6.4- and 2.4-greater odds, respectively, of reporting inability to access mental health care and 4- and 3- greater odds, respectively, of having prescriptions delayed, relative to the group with any lifetime treatment. Among those with serious mental illness, having Medicare insurance increased the odds of reporting inability to access mental health care., Conclusions: Individuals with SMI were much more likely to experience treatment disruptions throughout the pandemic than non-SMI groups., Competing Interests: Additional Declarations: No competing interests reported.

Introduction: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. This randomized controlled trial aims to evaluate the effectiveness of an integrated approach in improving older individuals' adherence to medical recommendations after hospital discharge., Methods: Data from an expected sample of 360 older inpatients (and their caregivers) will be collected. Medical recommendations' understanding will be tested before and after the routine explanation received by in-charge physicians. Participants will be randomized in the control (usual care) and intervention group. The intervention consists of educational training by a multidisciplinary team (occupational therapist, dietician, and physician, in consultation with a pharmacologist) at hospital discharge and, after hospital discharge, receiving a phone recall checking for therapy adherence and having the possibility to contact the study team for potential related concerns. After 7 days, medication adherence will be assessed through structured phone interviews comparing ongoing and prescribed medications and by administering the 4-item validated Morisky, Green, Levine scale and the Medication adherence report scale (MARS-5). At 30 and 90 days from discharge, data on medication adherence, falls, rehospitalizations, and vital status will be collected through phone interviews and hospital records., Trial Registration: Registration: NCT05719870 (clinicaltrial.gov). https://classic.clinicaltrials.gov/ct2/show/NCT05719870., Competing Interests: The authors do not declare any conflict of interest., (Copyright: © 2024 Zanforlini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The hypothesis implicit in the rating scale design is that the categories reflect increasing levels of the latent variable. Rasch models for ordered polytomous items include parameters, called thresholds, that allow for empirically testing this hypothesis. Failure of the thresholds to advance monotonically with the categories (a condition that is referred to as "threshold disordering") provides evidence that the rating scale is not functioning as intended. This work focuses on scales consisting of rather large numbers of categories, whose use is often recommended in the literature. Threshold disordering is observed in both an extended 8-point scale specially developed for the Patient Health Questionnaire-9 and the original 10-point scale of the Behavioral Religiosity Scale. The results of this work prompt practitioners not to take the functioning of the rating scale for granted, but to verify it empirically., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: This study evaluates whether social interaction level modifies the association between frailty and cognitive decline in older adults., Methods: A total of 2701 adults aged ≥65 years enrolled in the Progetto Veneto Anziani (Pro.V.A.), participated in the study. At baseline, participants were classified as having low, moderate, or high social interactions based on: cohabiting status, frequency of contacts with relatives/friends or involvement in childcare activities, and frequency of participation in social or community activities. Baseline frailty was defined as the presence of ≥3 criteria among: weight loss, weakness, slowness, low physical activity, and exhaustion. Cognitive function was assessed through the Mini-Mental State Examination (MMSE) at baseline and after 4.4 and 7 years. The association between frailty and MMSE changes over time was evaluated through linear mixed models. Interaction and subgroup analyses explored the modifying effect of social interaction level on the above association., Results: The mean age of participants was 76.1 years, and 59.1% were women. Frail individuals had a steeper annual MMSE decline than their non-frail counterparts (ß=-0.40, 95%CI: -0.59, -0.20). When stratifying participants by social interaction level, we found that the association between frailty and MMSE changes over time was stronger in those with low social interactions (ß=-0.74, 95%CI: -1.33, -0.15) while attenuated in those with moderate (ß=-0.42, 95%CI: -0.74, -0.11) or high social interaction level (ß=-0.29, 95%CI: -0.58, 0.01)., Conclusion: Maintaining frequent social interactions might mitigate the negative impact of frailty on older people's cognitive functions.

Background: Coronavirus Disease-2019 (COVID-19), driven by the SARS-CoV-2 virus, has disproportionately affected the elderly, with comorbidities like sarcopenia worsening prognosis. Considering the significant impact of RNA vaccines on survival rates in this population, our objective is to investigate the impact of vaccination on the survival of hospitalized elderly patients with COVID-19, considering the presence or absence of sarcopenia., Methods: Prospective study conducted on 159 patients aged>65 years from September 2021 to March 2022. Data about clinical and body composition, and mortality at 12-months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria., Results: At the twelfth month post-discharge, vaccinated sarcopenic individuals exhibited a mortality risk similar to vaccinated non-sarcopenic individuals, and lower than unvaccinated non-sarcopenic patients. Cox regression analysis, adjusted for age, gender, comorbidity, functional and vaccinal status, showed that the presence of sarcopenia did not significantly impact the risk of death within 12-months post-discharge., Discussion: Vaccination emerges as a protective measure for sarcopenic patients, countering the potential adverse effects of sarcopenia on COVID-19 outcomes, underscoring the importance of immunization in the frail elderly with a call for meticulous monitoring of its benefits., Conclusions: Our study represents the first attempt to analyze the vaccine's effect on survival in sarcopenic hospitalized older adults with COVID-19. The administration of vaccination to sarcopenic patients proves pivotal, as its omission could lead to notably unfavorable outcomes within this specific population., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. x All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version. x This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue. x The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript. x The following authors have affiliations with organizations with direct or indirect financial interest in the subject matter discussed in the manuscript., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Rationale: Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care hospitals have implemented systems aimed at detecting and responding to such patients., Objectives: To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients., Panel Design: The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines., Methods: We generated actionable questions using the Population, Intervention, Control, and Outcomes (PICO) format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation Approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs)., Results: The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among unselected patients. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system., Conclusions: The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU., Competing Interests: Funding for these guidelines was provided solely by the Society of Critical Care Medicine. Panel members disclosed all potential financial and intellectual conflicts of interest according to the American College of Critical Care Medicine/Society of Critical Care Medicine Standard Operating Procedures. Refer to Supplemental Digital Contents 1 and 2 (http://links.lww.com/CCM/H434) for details. Dr. Penoyer received funding from Ivenix, Inc, Avanos, ICU Medical, and BD. Dr. Davis disclosed he is a consultant for Zoll and Healthstream and is Chief Executive Officer of Medical X Technologies. Dr. Edelson disclosed that she is president and co-founder of AgileMD and received equity interest, she is an employee of the National Institutes of Health, and received a research grant from BARDA (ARCD.P0535US). Dr. Rowley received funding from Draeger, STIMIT, and Vyaire. Dr. DeVita disclosed that he is a consultant for Hill Rom. Dr. Welch disclosed that he is an advisor in a one-off Becton, Dickinson and Co. Adult and Specialist Critical Care Advisory Board. Dr. Kellett disclosed that he is the founder and major shareholder of Tapa Healthcare DAC. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Rationale: Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients., Objectives: To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients., Panel Design: The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines., Methods: We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs)., Results: The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS)., Conclusions: The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU., Competing Interests: Panel members disclosed all potential financial and intellectual conflicts of interest according to the American College of Critical Care Medicine/Society of Critical Care Medicine Standard Operating Procedures. For details, please refer to Supplemental Digital Contents 1 and 2 (http://links.lww.com/CCM/H433). Dr. Penoyer received funding from Ivenix, Avanos, ICU Medical, and BD. Dr. Davis disclosed he is a consultant for Zoll and Healthstream and is Chief Executive Officer of Medical X Technologies. Dr. Edelson disclosed that she is president and co-founder of AgileMD and received equity interest, she is an employee of the National Institutes of Health, and she received a research grant from BARDA (ARCD.P0535US). Dr. Rowley received funding from Draeger, STIMIT, and Vyaire. Dr. DeVita disclosed that he is a consultant for Hill Rom. Dr. Welch disclosed that he is an advisor in a one-off Becton, Dickinson and Co. Adult and Specialist Critical Care Advisory Board. Dr. Kellett disclosed that he is the founder and major shareholder of Tapa Healthcare DAC. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), have provided valuable insights into the role of the cerebellum in cognitive processes. However, replicating findings from studies involving cerebellar stimulation poses challenges. This meta-analysis investigates the impact of NIBS on cognitive processes associated with the cerebellum. We conducted a systematic search and analyzed 66 studies and 91 experiments involving healthy adults who underwent either TMS or transcranial direct current stimulation (tDCS) targeting the cerebellum. The results indicate that anodal tDCS applied to the medial cerebellum enhances cognitive performance. In contrast, high-frequency TMS disrupts cognitive performance when targeting the lateral cerebellar hemispheres or when employed in online protocols. Similarly, low-frequency TMS and continuous theta burst stimulation (cTBS) diminish performance in offline protocols. Moreover, high-frequency TMS impairs accuracy. By identifying consistent effects and moderators of modulation, this meta-analysis contributes to improving the replicability of studies using NIBS on the cerebellum and provides guidance for future research aimed at developing effective NIBS interventions targeting the cerebellum., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: How to detect the clinical impact of anticholinergic (AC) burden in people with HIV (PWH) remains poorly investigated. We cross-sectionally described the prevalence and type of AC signs/symptoms and the screening accuracy of three AC scales in detecting their presence in a modern cohort of PWH., Methods: We calculated AC Burden Scale (ABS), AC Risk Score (ARS) and AC Drug Score (ADS) in 721 adult PWH and recorded the presence of AC signs/symptoms over the previous 3 months. High AC risk was defined by ABS score ≥2, and ARS or ADS score ≥3. Comparisons among the scale were based on Cohen's inter-rater agreement, and their screening accuracy was assessed by receiver operating characteristics (ROC) curves and performance measures., Results: We enrolled 721 PWH, of whom 72.0% of participants were male; the median age was 53 years, and 164 participants (22.7%) were on at least one AC drug. Among these, 28.6% experienced at least one AC sign/symptom. Agreement in AC risk classification was substantial only between ARS and ADS (k = 0.6). Lower and higher risk of AC signs/symptoms was associated with dual regimens [adjusted OR (aOR) = 0.12 versus three-drug regimens, P = 0.002] and increasing number of AC drugs (aOR = 12.91, P < 0.001). Depression and COPD were also associated with higher risk of AC signs/symptoms in analysis unadjusted for number of AC drugs. ABS and ADS showed the best area under the ROC curve (AUROC) of 0.85 (0.78-0.92) and 0.84 (0.75-0.92; P < 0.001 for both). However, at the cut-off used for the general population, the sensitivity of all three scales was very low (34.0%, 46.8% and 46.8%)., Conclusions: Up to one-fourth of participants in our cohort were exposed to at least one AC drug, and among them AC signs/symptoms affected more than one-fourth. Both polypharmacy (as number of antiretrovirals and of co-medications with AC properties) and to a lesser extent specific comorbidities shaped the risk of developing AC signs/symptoms. Sensitive screenings for AC risk in PWH should prefer ABS or ADS based on lower cut-offs than those suggested for the general population., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aims: Considering the impact of sarcopenia on mortality, and the difficulty to assessment of body composition, the hypothesis of the study is that calf circumference (CC) is closely related to mortality in older patients. The aim of the study was to analyze the potential role of CC to predict mortality in old individuals at 3, 6 and 12 months after discharge from hospital., Methods: Patients aged >65 years were recruited for this retrospective study from September 2021 to March 2022. Their physical and body composition characteristics (including Body Mass Index-BMI and Mini Nutritional Assessment-MNA) were measured; data on mortality at 3 (T3), 6 (T6) and 12 (T12) months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria., Results: Participants were 192 older adults (92 women), with a mean age of 82.8±7.0 years. Sarcopenic people were 41. The mortality rate was higher in sarcopenic people only at T3 and T6. CC had comparable validity in predicting mortality to that of MNA and ASMMI (Appendicular Skeletal Muscle Mass), and was better than BMI and serum albumin at each time point. Youden's index showed that the best cut-off for CC for predicting mortality was 30.6 cm both at T3 (sensitivity: 74%; specificity: 75%) and T6 (sensitivity: 75%; specificity: 67%). At the Cox regression model for mortality, high values of CC (HR 0.73, CI95% 0.60-0.89/p<0.001) and ADL scores (HR 0.72, CI95% 0.54-0.96/p=0.04) were protective factors at T6 and T12 respectively; at T12 high comorbidity rate was a risk factor (HR 1.28, IC95% 1.02-1.62/p=0.04)., Conclusions: CC has a validity comparable to MNA and ASMMI in predicting mortality at 3, 6 and 12 months after hospital discharge. Moreover, it can be considered an independent predictor of medium-term mortality in the hospitalized older population. CC can be an effective method for the prognostic stratification of these patients, due to its simplicity and immediacy., Competing Interests: The authors have no relevant financial or non-financial interests to disclose.

This research aimed at investigating how the experience of trauma can influence the psychological correlates of long-COVID over time in a clinical sample of patients hospitalized because of COVID-19. Through a longitudinal research design, 70 post-acute patients with COVID-19 were followed-up after hospital discharge in 3-time points up to 6 months and completed the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Symptoms Checklist-90-Revised (SCL-90 R). Repeated measures mixed models with random intercept were used to evaluate the effect of trauma (yes/no) over time (T1, T2, T3) on the SCL-90-R scales. Results showed that patients with trauma display significantly worse psychological outcomes in all the SCL-90-R dimensions [all p adj < .05 for the principal effects of trauma(y)], especially in symptoms of depression [time 2 vs time 1*trauma(y): b = -3.86, 95%CI (-7.18, -0.53), p adj  = .035; time 3 vs time 1*trauma(y): b = -4.77, 95%CI (-8.10, -1.45), p adj  = .011], anxiety [time 3 vs time 1*trauma(y): b = -4.54, 95%CI (-7.72, -1.37), p adj  = .011], and obsessive-compulsive difficulties [time 3 vs time 1*trauma(y): b = -4.03, 95%CI (-7.20, -0.86), p adj  = .027]. These findings shed light on the long-term psychological consequences of COVID-19 among hospitalized patients and highlight the key role of trauma, suggesting its assessment to tailor psychological interventions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population., Objective: The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers., Methods: We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication., Results: In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52)., Conclusions: To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis., (©Benjamin Buck, Mary Wingerson, Erica Whiting, Jaime Snyder, Maria Monroe-DeVita, Dror Ben-Zeev. Originally published in JMIR Mental Health (https://mental.jmir.org), 30.11.2023.)

Coordinated specialty care (CSC) improves mental health and functional outcomes among individuals with first-episode psychosis but lacks a standardized approach to addressing chronic disease risk. The authors used community-based participatory intervention mapping with nine CSC teams to implement a nurse care manager role for the team in order to identify and address chronic disease risk factors. The role was piloted at one CSC site to explore its feasibility and acceptability. The nurse care manager role was highly acceptable to clients, team members, and leadership. More than one-quarter of the nurse's time was spent on nonbillable activities, and lack of a clear plan for financial sustainability was the primary barrier to implementation., Competing Interests: The authors report no financial relationships with commercial interests.

Background: The containment measures linked to the COVID-19 pandemic negatively affected the phyco-physical well-being of the population, especially older adults with neurocognitive disorders (NCDs). This study aims to evaluate whether the frailty of NCD patients was associated with different changes in multiple health domains, in particular in relation to loneliness and social isolation, pre- and post-lockdown., Materials and Methods: Patients were recruited from 10 Italian Centers for Cognitive Disorders and Dementia. Data were collected in the pre-pandemic period (T0), during the pandemic lockdown (T1), and 6-9 months post-lockdown (T2). The UCLA Loneliness Scale-3, Activities of Daily Living (ADL), Instrumental ADL (IADL), Mini-Mental State Examination, and Neuropsychiatric Inventory (NPI) were administered. Caregivers' burden was also tested. Patients were categorized as non-frail, pre-frail, and frail according to the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale., Results: The sample included 165 subjects (61.9% women, mean age 79.5 ± 4.9 years). In the whole sample, the ADL, IADL, and NPI scores significantly declined between T0 and T2. There were no significative variations in functional and cognitive domains between the frail groups. During lockdown we recorded higher Depression Anxiety Stress Scales and Perceived Stress Scale scores in frail people. In multivariable logistic regression, frailty was associated with an increase in social isolation, and a loss of IADL., Conclusions: We observed a global deterioration in functional and neuro-psychiatric domains irrespective of the degree of frailty. Frailty was associated with the worsening of social isolation during lockdown. Frail patients and their caregivers seemed to experience more anxiety and stress disorders during SARS-CoV-2 pandemic., (© 2023 The Authors. Psychogeriatrics published by John Wiley & Sons Australia, Ltd on behalf of Japanese Psychogeriatric Society.)

Young adults with first episode psychosis use cannabis at high rates. In light of progressively tolerant attitudes toward cannabis, decreased perceptions of risk, and limited implementation of substance use modules within coordinated specialty care (CSC) programs, this study sought to describe factors contributing to CSC providers' intentions to implement motivational enhancement therapy (MET) for cannabis reduction. Two focus groups were conducted with CSC providers (n = 14), with questions guided by theory of planned behavior. Content and thematic analyses were conducted to identify salient themes associated with the theory. Participants generally indicated intentions to implement MET; limiting factors included concerns about clients' willingness to discuss cannabis use, perception of support for abstinence-only goals, and concerns about intervention mechanics such as computerized assessments. To reduce barriers limiting provider intention to implement MET, authors recommend training on assessment protocols, the merits of harm-reduction, and strategies for lower-risk cannabis use.Please confirm if the author names are presented accurately and in the correct sequence. Author 1 Given name: [Ryan] Last name [Petros]. Author 2 Given name: [Denise D.] Last name [Walker]. Author 3 Given name: [Adam] Last name [Davis]. Author 4 Given name: [Maria] Last name [Monroe-DeVita]. Also, kindly confirm the details in the metadata are correct.Confirmed!, (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: The most recent guidelines recommend that selection of liver transplant recipient patients be guided by a multidimensional approach that includes frailty assessment. Different scales have been developed to identify frail patients and determine their prognosis, but the data on older adult candidates are still inconclusive. The aim of this study was to compare the accuracy of the Liver Frailty Index (LFI) and the Multidimensional Prognostic Index (MPI) as predictors of mortality in a cohort of older people patients being evaluated for liver transplantation., Methods: This retrospective study was conducted on 68 patients > 70 years being followed at the University Hospital of Padua in 2018. Clinical information on each patient, Model For End-Stage Liver Disease (MELD), Body Mass Index (BMI), Activities of Daily Living (ADL), Mini Nutritional Assessment (MNA), LFI, MPI, and date-of-death, were recorded. The observational period was 3 years., Results: We studied 68 individuals (25 women), with a mean age 72.21 ± 1.64 years. Twenty-five (36.2%) patients died during the observational period. ROC curve analysis showed both MPI and LFI to be good predictors of mortality (AUC 0.7, p = 0.007, and AUC 0.689, p = 0.015, respectively). MELD (HR 1.99, p = 0.001), BMI (HR 2.34, p = 0.001), and poor ADL (HR 3.34, p = 0.04) were risk factors for mortality in these patients, while male sex (HR 0.1, p = 0.01) and high MNA scores (HR 0.57, p = 0.01) were protective factors., Conclusion: Our study confirmed the prognostic value of MPI in older adult patients awaiting liver transplantation. In this cohort, good nutritional status and male sex were protective factors, while high MELD and BMI scores and poor functional status were risk factors., (© 2023. The Author(s).)

Objective: There has been growing interest in the past few years on the relationship between impairment of motor functions and cognitive decline, so that the first can be considered a marker of dementia. In MCI patients, the deficit in processing visual information interferes with postural control, causing oscillations and instability. Postural control is usually evaluated through the Short Physical Performance Battery (SPPB) test or Tinetti scale, but, to our knowledge, there are no many studies that considered the Biodex Balance System (BBS) in the evaluation of postural controls in MCI patients. The aim of this study was first to confirm the bi- directional relationship between cognitive and motor performance, and then to compare traditional evaluation scales (SPPB and Tinetti) with a biomechanical tool, the BBS., Materials and Methods: Observational retrospective study. In 45 elderly patients with cognitive impairment we evaluated cognition, assessed with the MMSE and MoCA, malnutrition with the MNA, and sarcopenia with DEXA (ASMMI). Motor performance was assessed with SPPB, Tinetti, and BBS., Results: MMSE correlated more with BBS than with the traditional scales, while MoCA was also correlated with SPPB and Tinetti scores., Conclusions: BBS had a stronger correlation with cognitive performance compared with the traditional scales. The relationship between MoCA executive items and the BBS tests suggests the usefulness of targeted interventions involving cognitive stimulation to improve motor performance, and motor training to slow the progression of cognitive decline, particularly in MCI., Competing Interests: Declaration of Competing Interest There are no known conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome. The manuscript has been read and approved by all named authors, and there are no other persons who satisfy the criteria for authorship that are not listed. The order of authors listed in the manuscript has been approved by all of the authors. The Corresponding Author is the sole contact for the Editorial process. She is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective : No evidence-based intervention effectively reduces cannabis use in young adults with psychosis (YAP). To generate hypotheses about why, a scoping review was conducted to synthesize evidence about motivations for cannabis use and reduction/cessation for YAP and the psychosocial interventions trialed to identify possible gaps between motivations and interventive strategies. Methods : A systematic literature search was conducted in December, 2022. Reviews of titles and abstracts ( N  = 3,216) and full-texts ( n  = 136) resulted in 46 articles. Results : YAP use cannabis for pleasure, to reduce dysphoria, and for social and recreational reasons; motivations for cessation include insight about cannabis-psychosis interactions, incompatibility with goals and social roles, and support from social networks. Interventions with at least minimal evidence of efficacy include motivational interviewing, cognitive-behavioral strategies, and family skills training. Conclusions : Authors recommend additional research on mechanisms of change and motivational enhancement therapy, behavioral activation, and family-based skills interventions matched to YAP motivations for use/cessation.

Cognitive Reserve (CR) plays a protective role in neurological and acute/chronic diseases. Its effect on mood, however, is still unclear, although it may be relevant in a hospital setting. We aimed to explore the relationship between CR and depressive mood in older inpatients, evaluating possible gender- and age-related differences. This study involved 86 inpatients aged ≥65 years with an MMSE ≥15. Participants underwent a multidimensional evaluation that included the assessment of CR with the Cognitive Reserve Index questionnaire, divided into three sections (Education, Working Activity, and Leisure Time). Depressive mood was assessed with the 15-item Geriatric Depression Scale (GDS). The relationship between CR and GDS was evaluated by multivariable linear regressions. Significant inverse associations between CR and GDS scores emerged in the total sample (β = -0.03 [SD = 0.02], p = .047), especially in men (β = -0.05 [SD = 0.02], p = .005) and in individuals aged <85 years (β = -0.07 [SD = 0.03], p = .01). Among the single CRI sections, CRI-Leisure Time was significantly associated with GDS in the total sample, in men, and participants <85 years. CR seems to be inversely associated with depressive mood in older inpatients. This relationship is particularly marked for CR related to Leisure Time, which may be modifiable even in older age through social support and interaction.

Objective: Psychomotor slowdown was observed in individuals with Obstructive Sleep Apnea Syndrome (OSAS). Previous studies evaluated separately cognitive and motor reaction times, finding that OSAS individuals show a specific impairment in the latter. The present study investigates whether eye-to-hand coordination (EHC), a specific psychomotor ability, is compromised in OSAS., Method: The EHC was measured in 30 OSAS individuals who were matched with 30 healthy controls by the Two-Hand Coordination Test analyzing the speed, accuracy, and coordination; the role of these variables was investigated in predicting the group they belonged to., Results: The OSAS participants showed poorer performance in the execution accuracy (t(55) = -3.36, d'Cohen = -0.89, p ≤ .001), which was also found to be the only predictor of the belonging to group (β = 0.43 (0.18), p < .05)., Conclusions: The OSAS individuals show impairments in EHC and in correcting their error (executive slowdown). This is the first investigation exploring EHC coordination in this population and contributes in understanding the psychomotor slowness characterizing OSAS., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Objectives: One of the pathogenetic hypotheses of delirium is the "neuroinflammatory theory" with consequent neurotoxicity of brain connectivity networks. Micronutrients may play a significant role in the prevention of neuroinflammation. This systematic review addresses the role of micronutrients in the development of delirium in older populations., Methods: The EBSCO, Cochrane, PubMed, and Web of Science databases were searched for articles on delirium and micronutrients. The methodological quality of the studies included in the review was evaluated with the Newcastle-Ottawa Scales for observational studies and for case-control studies., Results: 1326 papers were identified from the searches, 7 of which met the inclusion criteria (see section 2.3). All the papers included were written in English. Delirium was predominantly secondary to post-operative dysfunction or acute medical conditions. By altering the production of neurotransmitters resulting in an imbalance, and by reducing their immunomodulatory role with a consequent increase in inflammatory oxidative stress, micronutrient deficiency seems to be associated with an increased incidence of delirium., Conclusions: This review supports the existence of an association between micronutrient deficiency (i.e. cobalamin, thiamine, and vitamin D) and an increased incidence of delirium, with a greater prevalence in hospitalized patients., Competing Interests: All authors declare they have no competing interests.

Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible "pocket" guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Devita et al.)

Objective: Young adults experiencing a first episode of psychosis (FEP) have high rates of cannabis use and cannabis use disorder (CUD). No evidence-based practice effectively treats CUD for people with FEP, and little is known about factors that influence intentions to reduce or stop using. A critical inquiry was conducted to identify salient factors contributing to intentions of young adults with FEP to reduce or discontinue cannabis use, guided by theory of planned behavior (TPB)., Method: Online focus groups ( n = 3) and individual interviews ( n = 3) were conducted with 16 young adults with FEP (mean age of 23.7) and historical cannabis use (averaging 11.8 days of use in the previous 30). A content analysis was conducted to sort data into TPB constructs, and a thematic analysis was subsequently performed to identify the breadth of themes., Results: Participants identified benefits of cannabis reduction and cessation for pursuing life goals, but most maintained regular use. Participants perceived cannabis as a facilitator of social interactions, enjoyable activities, and improved mental health (and reduced dysthymia). Many were concerned about reducing or discontinuing cannabis without replacement strategies to compensate for its benefits., Conclusions and Implications for Practice: In spite of life goals incompatible with cannabis use, cessation was not favored given the perceived benefits of cannabis and participants' lack of replacement strategies to facilitate social interactions, enjoyable activities, and euthymia. Interventions may be improved by addressing motivations for use and by teaching skills to build positive social support, schedule enjoyable activities, and ameliorate dysthymia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Recent studies reported the development of psychological distress symptoms in patients who recovered from COVID-19. However, evidence is still scarce and new data are needed to define the exact risk and protective factors that can explain the variability in symptoms manifestation. In this study, we enrolled 257 patients who recovered from COVID-19 and we evaluated the levels of psychological distress through the Symptoms Checklist-90-R scale. Data concerning illness-related variables were collected from medical records, while the presence of subjective cognitive difficulties, both before and after the illness, as well as the level of the cognitive reserve (CR), were assessed over a clinical interview. Results revealed that being female and reporting the presence of subjective cognitive difficulties after COVID-19 were associated with higher levels of psychological distress. At the same time, being admitted to the hospital and having a high CR were protective factors. Adding new information to this emerging research field, our results highlight the importance of a complete psychological and cognitive assessment in patients with COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Devita, Di Rosa, Iannizzi, Bianconi, Contin, Tiriolo, Ghisi, Schiavo, Bernardinello, Cocconcelli, Balestro, Cattelan, Leoni, Volpe and Mapelli.)

Objective: The authors of this systematic review (SR) sought to provide evidence for effects of commonly used psychosocial interventions on several outcomes among adults with schizophrenia., Methods: MEDLINE, the Cochrane Library, and PsycINFO databases were searched through July 2020. Eligible studies were SRs and trials of at least 12 weeks duration and with ≥50 participants that compared psychosocial interventions with treatment as usual among adults with schizophrenia. Study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source were extracted, along with quality criteria. The evidence was evaluated on quality and strength of evidence stratified by intervention area and outcome, according to the Evidence-Based Practice Centers Methods Guide of the Agency for Healthcare Research and Quality., Results: Nine SRs and 30 trials (N=23,921 patients) in 11 intervention areas were included. Trials were mostly of fair quality and had low-to-moderate strength of evidence. Compared with treatment as usual, most psychosocial interventions were more effective in improving intervention-targeted outcomes, including core illness symptoms. Compared with treatment as usual, assertive community treatment, cognitive-behavioral therapy (CBT), family interventions, psychoeducation, social skills training, supported employment, and early interventions for first-episode psychosis (FEP) improved various functional outcomes. CBT and early interventions for FEP improved quality of life. Family interventions, psychoeducation, illness self-management, and early interventions for FEP reduced relapse., Conclusions: Compared with treatment as usual, most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse frequency among adults with schizophrenia.

Duration of untreated psychosis (DUP) is a reliable predictor of longitudinal psychosis trajectory. The limited availability of specialized assessment needed for early identification contributes to a lengthy average DUP in the United States. This column outlines the development of the Central Assessment of Psychosis Service (CAPS), a novel tele-evaluation service that extends specialized expertise in screening and assessment of psychosis and psychosis risk to publicly funded early psychosis clinics. Preliminary implementation outcomes among the first five CAPS sites suggest that CAPS is acceptable, appropriate, and feasible to implement. Programmatic data collection is underway and will be reported at a future date.

Objective: Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a training for families of individuals with psychosis that consists of recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training informed by cognitive-behavioral therapy for psychosis (CBTp). The authors assessed the effects of a 1-day and a 4-day training on the natural supports (i.e., family and other caregivers) of individuals with psychotic disorders., Methods: Attendees of a 1-day (N=168) and a 4-day (N=29) Psychosis REACH training were surveyed at three timepoints: pretraining, posttraining, and 4-month follow-up. Longitudinal changes across the full sample were evaluated by paired-sample t tests or a one-way repeated-measures analysis of variance (ANOVA). Two-way mixed ANOVAs were conducted with training condition, time, and the training condition × time interactions entered into the model., Results: Reductions were noted in self-perceived depression, anxiety, negative aspects of the caregiving experience, and expressed emotion. Trainees also showed more prosocial attitudes toward psychosis immediately and at 4 months after the training., Conclusions: This evaluation of the launch of Psychosis REACH in the United States suggests that the training can improve the mental health, attitudinal, and relational outcomes of family and caregivers of individuals with psychosis. Given the dearth of CBTp and family interventions for psychosis in mental health services in the United States, short-term, intensive training that supplements clinical services has intuitive appeal as a means of surmounting the barriers that have plagued family interventions.

Backgrounds: Acetylcholinesterase inhibitors (AChEI) and cognitive stimulation (CS) are the standard pharmacological and non-pharmacological treatments for Alzheimer's disease (AD)., Aims: The aim of this study was to investigate the effects of these treatments, alone or combined, on the neuropsychological profiles of patients with AD., Methods: Forty participants were assigned to three groups receiving either only AChEI (n = 14), AChEI + CS (n = 15), or only CS (n = 11). Cognition was evaluated at baseline and after three months. Linear mixed-effects models were used to investigate differences among the treatments in terms of changes in the patients' neuropsychological profiles., Results: Results, although preliminary because of the small sample size, suggest that a general improvement was found in patients who received AChEI + CS and those who received only CS compared with those who received only AChEI. Interestingly, individuals who received only CS showed a significant improvement in immediate memory recall than those who received only AChEI. Furthermore, the group receiving AChEI + CS showed an improvement in delayed recall than the other two groups., Discussion: The combination of AChEI and CS seems to have the greatest benefit for patients with mild AD. More interestingly, CS alone is more effective than AChEI alone, even in improving memory, considered to be the "lost" cognitive domain in AD., (© 2021. The Author(s).)

Objectives: Studies have shown that religiosity (R) and spirituality (S) can positively impact older adults' life. Nevertheless, no validated tools for measuring these constructs in the older Italian population are currently available. This study investigates the psychometric properties of two of the most common measures of R and S in the literature: the Francis Scale of Attitude toward Christianity short form (FSACsf) and the Behavioral Religiosity Scale (BRS)., Method: 313 older Italians completed the questionnaires anonymously. The functioning of the items and the response scales, the factor structure, age invariance and internal consistency of both scales were investigated., Results: Each scale defines a substantively unidimensional variable. Moreover, items seem, on the whole, to be well formulated. The values of the Rasch-Andrich thresholds suggest that the response scale of the FSACsf was adequate for measuring spirituality. However, this was not the case for BRS, where the response categories needed to be collapsed to measure behavioral religiosity properly. Age invariance was confirmed for each scale. Cronbach's α, composite reliability and person separation reliability revealed both scales to be internally consistent., Discussion: The results suggest that the scales have solid psychometric properties, and can therefore be considered valid, reliable tools for investigating religiosity and spirituality in older people.

Aim: Many studies have been carried out with the aim of understanding the manifold effects of the novel coronavirus (Covid-19) on individuals' clinical and psychological states. This paper deals with perceived stress (PS) and cognitive efficiency (CE) in older adults with dementia during the first wave of the pandemic. The study also investigated the potential effects of PS and CE on participants' cognitive functioning. The modulating effect of cognitive reserve (CR) on these variables was also considered, given its well-known role in the onset and evolution of neurodegenerative diseases., Method: Thirty-eight older adults with mild/moderate dementia (mean age: 81.47 ± 5.05; mean MMSE pre-lockdown: 24.03 ± 3.14) were recruited for this study from March to May [4]. Two questionnaires, the Perceived Stress Scale (PSS) and the FLEI Mental Ability Questionnaire (FLEI), were administered to all participants by telephone every two weeks during lockdown (T1: early April, T2: mid-April, T3: early May). After lockdown, their neuropsychological and psychological profiles were assessed. Linear mixed-effects models were used to investigate changes over time., Results: The level of PS increased at both Time 2 and Time 3 (f 2  = 0.10). Cognitive functioning worsened during lockdown, resulting in lower scores at the post-lockdown evaluation (f 2 s = 0.09 and 0.06 for MMSE and ENB-2, respectively). The decrease in these scores was not associated with either PS or CE. Although the size of these effects was rather small, their clinical relevance is not negligible., Conclusion: Individuals with dementia seem to have experienced stress (S) during the first-wave of lockdown related to Covid-19. Cognition worsened during the pandemic, in accordance with the neurodegenerative nature of the disease, but it was unrelated to PS and CE., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: The spread of COVID-19 has undeniably unsettled the social, psychological and emotional life of the entire world population. Particular attention should be paid to older adults with dementia, given their vulnerability to emotional stressors. The aim of this retrospective study is to evaluate the impact of the first wave quarantine related to Covid-19 on psychological and affective well-being of older adults with mild/major neurocognitive disorders and of their caregivers. Methods: Data on participants' assessment before the quarantine (PREQ) were retrospectively collected. Patients with Mild Cognitive Impairment (MCI) or dementia were recruited from different Centers for Cognitive Decline and Dementia in Italy. During the quarantine, psychological and affective well-being were evaluated by phone through the administrations of scales measuring anxiety and depression (DASS), perceived stress (PSS), coping strategies (COPE) and the caregivers' burden (CBI). The scales' results were compared across participants' PREQ cognitive level (Mini Mental State Examination, MMSE ≥25, 23-24, and ≤ 22) with multiple linear regression models. Results: The sample included 168 patients (64% women) with a mean age of 79 ± 7 years. After adjusting for potential confounders, more severe cognitive impairment was independently associated with higher DASS and PSS score, and poorer coping strategies ( p < 0.05). Cognitive functioning was also inversely associated with CBI. Conclusions: The impact of the quarantine on the psycho-affective well-being of individuals with MCI and dementia and on caregivers' burden varies according to the PREQ cognitive functioning with more severely impaired patients having worse outcomes., Competing Interests: SS is shareholder and GZ is shareholder and employee of Bluecompanion Ltd (London, UK). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Coin, Devita, Trevisan, Biasin, Terziotti, Signore, Fumagalli, Gareri, Malara, Mossello, Volpato, Monzani, Bellelli, Zia, Ranhoff and Antonelli Incalzi.)

Literature about the novel Coronavirus (COVID-19) is currently focusing on the potential cognitive and neuropsychiatric sequelae observed in individuals receiving intensive care unit (ICU) treatments. The aim of the present study is to evaluate the differences in cognitive and psychological sequelae of COVID-19 between younger and older adults, regardless of being admitted to the ICU or not. The study involved 299 recovered individuals (from 18 to 90 years old), who underwent a comprehensive cognitive and psychological assessment. Linear regression models were conducted separately for Montreal Cognitive Assessment (MoCA) test and Post-traumatic Stress Disorder Checklist (PCL) scores to investigate the effect of socio-demographic and clinical characteristics on them. Separate linear regression models were then applied sorting participants by age: younger adults (<65 years) and older adults (≥65 years). In the whole sample, PCL scores were predicted by the intensity of care received, by being intubated, and by the persistence of cough after 1 month after hospitalization. Only age had instead an effect on cognition. In younger adults, PCL scores were predicted by the presence of neurological symptoms, by the intensity of care received, and by being intubated; MoCA scores were only predicted by the intensity of care received. No significant associations were found in older adults. Psychological negative effects of the COVID-19 pandemic particularly affect individuals under 65 years old, who also subjectively report cognitive sequelae associated with the infection. Individuals over 65 years old, instead, seem to be free from psychological and cognitive difficulties due to COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Devita, Di Rosa, Iannizzi, Bianconi, Contin, Tiriolo, Bernardinello, Cocconcelli, Balestro, Cattelan, Leoni, Mapelli and Volpe.)

The role of the cerebellum in neurodegenerative disorders that target cognitive functions has been a subject of increasing interest over the past years. However, a review focused on making clinicians more aware of the role of the cerebellum in dementia is still missing. This narrative review explores the possible factors explaining the involvement of the cerebellum in different kinds of dementia by providing more insights on how this structure can be relevant in clinical practice. It emerged that, despite overlapping in specific areas, structural cerebellar alterations in dementia show a certain degree of disease-specificity. Furthermore, the relevance of cerebellar changes in dementia is corroborated by correlations observed between their topography and cognitive symptomatology, as well as by its previously ignored involvement of the cerebellum in early stages of dementia. Despite needing further investigations, these findings could become a useful diagnostic aid for clinicians that should not be overlooked, in particular for those individuals who do not show distinct and manifest brain or neuropsychological alterations, but that still make clinicians suspect the presence of a neurocognitive disease., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Clinician burnout in healthcare is extensive and of growing concern. In mental health and rehabilitation settings, research on interventions to improve burnout and work engagement is limited and rarely addresses organizational drivers of burnout. This study sought to elaborate on the organizational influence of burnout and work engagement in mental health. Methods: We randomly selected 40 mental health clinicians and managers who were participating in a burnout intervention and conducted semi-structured interviews to understand their views of organizational conditions impacting burnout and work engagement. Data were analyzed using a thematic analytical approach. Results: Analyses yielded three major themes where organizational contexts might reduce burnout and increase work engagement: (a) a work culture that prioritizes person-centered care over productivity and other performance metrics, (b) robust management skills and practices to overcome bureaucracy, and (c) opportunities for employee professional development and self-care. Participants also referenced three levels of the organizational context that they believed influenced burnout and work engagement: front-line supervisors and program managers, organizational executive leadership, and the larger health system. Conclusions and Implications for Practice: Findings point to several possible targets of intervention at various organizational levels that could guide the field toward more effective ways to reduce burnout and improve work engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).