Search

Background: The objective of this review is to evaluate the associations between short-term exposure to radiofrequency electromagnetic fields (RF-EMF) and cognitive performance in human experimental studies. Methods: Online databases (PubMed, Embase, Scopus, Web of Science and EMF-Portal) were searched for studies that evaluated effects of exposure to RF-EMF on seven domains of cognitive performance in human experimental studies. The assessment of study quality was based on the Risk of Bias (RoB) tool developed by the Office of Health Assessment and Translation (OHAT). Random effects meta-analyses of Hedges’s g were conducted separately for accuracy- and speed-related performance measures of various cognitive domains, for which data from at least two studies were available. Finally, the certainty of evidence for each identified outcome was assessed according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: 57,543 records were identified and 76 studies (80 reports) met the inclusion criteria. The included 76 studies with 3846 participants, consisting of humans of different age, sex and health status from 19 countries, were conducted between 1989 and 2021. Quantitative data from 50 studies (52 reports) with 2433 participants were included into the meta-analyses. These studies were performed in 15 countries between 2001 and 2021. The majority of the included studies used head exposure with GSM 900 uplink.None of the meta-analyses observed a statistically significant effect of RF-EMF exposure compared to sham on cognitive performance as measured by the confidence interval surrounding the Hedges’s g or the significance of the z-statistic.For the domain Orientation and Attention, subclass Attention – Attentional Capacity RF-EMF exposure results in little to no difference in accuracy (Hedges’s g 0.024, 95 % CI [−0.10; 0.15], I2 = 28 %, 473 participants).For the domain Orientation and Attention, subclass Attention – Concentration / Focused Attention RF-EMF exposure results in little to no difference in speed (Hedges’s g 0.005, 95 % CI [−0.17; 0.18], I2 = 7 %, 132 participants) and probably results in little to no difference in accuracy; it does not reduce accuracy (Hedges’s g 0.097, 95 % CI [−0.05; 0.24], I2 = 0 %, 217 participants).For the domain Orientation and Attention, subclass Attention – Vigilance RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges’s g 0.118, 95 % CI [−0.04; 0.28], I2 = 41 %, 247 participants) and results in little to no difference in accuracy (Hedges’s g 0.042, 95 % CI, [−0.09; 0.18], I2 = 0 %, 199 participants).For the domain Orientation and Attention, subclass Attention – Selective Attention RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges’s g 0.080, 95 % CI [−0.09; 0.25], I2 = 63 %, 452 participants); it may result in little to no difference in accuracy, but it probably does not reduce accuracy (Hedges’s g 0.178, 95 % CI [−0.02; 0.38], I2 = 68 %, 480 participants).For the domain Orientation and Attention, subclass Attention – Divided Attention RF-EMF exposure results in little to no difference in speed (Hedges’s g −0.010, 95 % CI [−0.14; 0.12], I2 = 5 %, 307 participants) and may result in little to no difference in accuracy (Hedges’s g −0.089, 95 % CI [−0.35; 0.18], I2 = 53 %, 167 participants).For the domain Orientation and Attention, subclass Processing Speed − Simple Reaction Time Task RF-EMF exposure results in little to no difference in speed (Hedges’s g 0.069, 95 % CI [−0.02; +0.16], I2 = 29 %, 820 participants).For the domain Orientation and Attention, subclass Processing Speed – 2-Choice Reaction Time Task RF-EMF exposure results in little to no difference in speed (Hedges’s g −0.023, 95 % CI [−0.13; 0.08], I2 = 0 %, 401 participants), and may result in little to no difference in accuracy (Hedges’s g −0.063, 95 % CI [−0.38; 0.25], I2 = 63 %, 117 participants).For the domain Orientation and Attention, subclass Processing Speed – >2-Choice Reaction Time Task RF-EMF exposure results in little to no difference in speed (Hedges’s g −0.054, 95 % CI [−0.14; 0.03], I2 = 0 %, 544 participants) and probably results in little to no difference in accuracy (Hedges’s g −0.129, 95 % CI [−0.30; 0.04], I2 = 0 %, 131 participants).For the domain Orientation and Attention, subclass Processing Speed – Other Tasks RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges’s g 0.067, 95 % CI [−0.12; 0.26], I2 = 38 %, 249 participants); it results in little to no difference in accuracy (Hedges’s g 0.036, 95 % CI [−0.08; 0.15], I2 = 0 %, 354 participants).For the domain Orientation and Attention, subclass Working Memory – n-back Task (0–3-back) we found Hedges’s g ranging from −0.090, 95 % CI [−0.18; 0.01] to 0.060, 95 % CI [−0.06; 0.18], all I2 = 0 %, 237 to 474 participants, and conclude that RF-EMF exposure results in little to no difference in both speed and accuracy.For the domain Orientation and Attention, subclass Working Memory – Mental Tracking RF-EMF exposure results in little to no difference in accuracy (Hedges’s g −0.047, 95 % [CI −0.15; 0.05], I2 = 0 %, 438 participants).For the domain Perception, subclass Visual and Auditory Perception RF-EMF exposure may result in little to no difference in speed (Hedges’s g −0.015, 95 % CI [−0.23; 0.195], I2 = 0 %, 84 participants) and probably results in little to no difference in accuracy (Hedges’s g 0.035, 95 % CI [−0.13; 0.199], I2 = 0 %, 137 participants).For the domain Memory, subclass Verbal and Visual Memory RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges’s g 0.042, 95 % CI [−0.15; 0.23], I2 = 0 %, 102 participants); it may result in little to no difference in accuracy (Hedges’s g −0.087, 95 % CI [−0.38; 0.20], I2 = 85 %, 625 participants).For the domain Verbal Functions and Language Skills, subclass Verbal Expression, a meta-analysis was not possible because one of the two included studies did not provide numerical values. Results of both studies did not indicate statistically significant effects of RF-EMF exposure on both speed and accuracy.For the domain Construction and Motor Performance, subclass Motor Skills RF-EMF exposure may reduce speed, but the evidence is very uncertain (Hedges’s g −0.919, 95 % CI [−3.09; 1.26], I2 = 96 %, 42 participants); it probably results in little to no difference in accuracy and does not reduce accuracy (Hedges’s g 0.228, 95 % CI [−0.01; 0.46], I2 = 0 %, 109 participants).For the domain Concept Formation and Reasoning, subclass Reasoning RF-EMF exposure results in little to no difference in speed (Hedges’s g 0.010, 95 % CI [−0.11; 0.13], I2 = 0 %, 263 participants) and probably results in little to no difference in accuracy and does not reduce accuracy (Hedges’s g 0.051, 95 % CI [−0.14; 0.25], I2 = 0 %, 100 participants).For the domain Concept Formation and Reasoning, subclass Mathematical Procedures RF-EMF exposure results in little to no difference in speed (Hedges’s g 0.033, 95 % CI [−0.12; 0.18], I2 = 0 %, 168 participants) and may result in little to no difference in accuracy but probably does not reduce accuracy (Hedges’s g 0.232, 95 % CI [−0.12; +0.59], I2 = 86 %, 253 participants).For the domain Executive Functions there were no studies. Discussion: Overall, the results from all domains and subclasses across their speed- and accuracy-related outcome measures according to GRADE provide high to low certainty of evidence that short-term RF-EMF exposure does not reduce cognitive performance in human experimental studies. For 16 out of 35 subdomains some uncertainty remains, because of limitations in the study quality, inconsistency in the results or imprecision of the combined effect size estimate. Future research should focus on construction and motor performance, elderly, and consideration of both sexes. Other: This review was partially funded by the WHO radioprotection programme.The protocol for this review was registered in Prospero reg. no. CRD42021236168 and published in Environment International (Pophof et al. 2021).

Abstract Background GHB (gammahydroxybutyrate) and its precursors are popular recreational drugs due to their sedative, anxiolytic and sexually stimulating effects. Their use has been steadily increasing in recent years. The detoxification process is complex and prone to high rates of complications while little is known about the pathophysiology. This study aims to elucidate the characteristics of GHB-addicted patients and to evaluate the risks and complications of GHB withdrawal treatment. Methods This observational study describes prospectively the socioeconomic status, clinical history and course of inpatient detoxification treatment of a group of 39 patients suffering from GHB substance use disorder. Detoxification treatment took place in a highly specialized psychiatric inpatient unit for substance use disorders. Results GHB patients were characterised by being young, well-educated and by living alone. More than 50% of the patients had no regular income. The patients were male and female in equal numbers. Detoxification treatment was complicated, with high rates of delirium (30.8%) and high need for intensive care (20.5%). Conclusions In our sample, GHB users were young, well-educated people and male and female in equal number. Detoxification proved to be dangerous for GHB-addicted patients. The presence of delirium and the need for transfer to an intensive care unit during detoxification treatment was extraordinarily high, even with appropriate clinical treatment. The reasons for this remain unknown. Therefore an intensive care unit should be available for GHB detoxification treatment. Further studies are needed to evaluate the options for prophylactic treatment of delirium during detoxification.

BackgroundThere are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland.MethodsThis is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS.ResultsThe prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS.ConclusionsClinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients.

Background: The World Health Organization (WHO) is currently assessing the potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMFs) in the general and working population. Related to one such health effect, there is a concern that RF-EMFs may affect cognitive performance in humans. The systematic review (SR) aims to identify, summarize and synthesize the evidence base related to this question. Here, we present the protocol for the planned SR. Objectives: The main objective is to present a protocol for a SR which will evaluate the associations between short-term exposure to RF-EMFs and cognitive performance in human experimental studies. Data sources: We will search the following databases: PubMed, Embase, Web of Science, Scopus, and the EMF-Portal. The reference lists of included studies and retrieved review articles will be manually searched. Study eligibility and criteria: We will include randomized human experimental studies that assess the effects of RF-EMFs on cognitive performance compared to no exposure or lower exposure. We will include peer-reviewed articles of any publication date in any language that report primary data. Data extraction and analysis: Data will be extracted according to a pre-defined set of forms developed and piloted by the review author team. To assess the risk of bias, we will apply the Rating Tool for Human and Animal Studies developed by NTP/OHAT, supplemented with additional questions relevant for cross-over studies. Where sufficiently similar studies are identified (e.g. the heterogeneity concerning population, exposure and outcome is low and the studies can be combined), we will conduct random-effects meta-analysis; otherwise, we will conduct a narrative synthesis. Assessment of certainty of evidence: The certainty of evidence for each identified outcome will be assessed according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Performing the review according to this protocol will allow the identification of possible effects of RF-EMFs on cognitive performance in humans.The protocol has been registered in PROSPERO, an open-source protocol registration system, to foster transparency.

Increasing evidence supports a close link between REM sleep and the consolidation of emotionally toned memories such as traumatic experiences. In order to investigate the role of sleep for the development of symptoms related to traumatic experiences, beyond experimental models in the laboratory, sleep of acutely traumatised individuals may be examined on the first night after trauma. This might allow us to identify EEG variables predicting the development of posttraumatic stress disorder (PTSD) symptoms, and guide the way to novel sleep interventions to prevent PTSD. Based on our experience, patients’ acceptance of polysomnography in the first hours after treatment in an emergency room poses obstacles to such a strategy. Wearable, self-applicable sleep recorders might be an option for the investigation of sleep in the aftermath of trauma. They would considerably decrease the perceived burden for patients and thus increase the likelihood of successful patient recruitment. As one potential sleep intervention, sleep deprivation directly after trauma has been suggested to reduce the consolidation of traumatic memories and hence act as a secondary preventive measure. However, experimental data from sleep deprivation studies in healthy volunteers with the trauma film paradigm have been inconclusive regarding the beneficial or detrimental effects of sleep on traumatic memory processing. Depending on further insights into the role of sleep in traumatic memory consolidation through observational and experimental studies, several options for therapeutic sleep interventions are conceivable: besides behavioural sleep deprivation, selective REM sleep suppression or enhancement by a pharmacological intervention into the serotonergic, noradrenergic or cholinergic systems might provide novel therapeutic options. While REM-modulating drugs have been used with some success for the prevention of PTSD after trauma, they have never been tried before the first night of sleep. In conclusion, more experimental and observational research is needed before sleep interventions are performed in actual trauma victims.

Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls.Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of “periodicity,” i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires.Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients.Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

Background: Sleep disturbance is a common characteristic of patients with post-traumatic stress disorder (PTSD). Besides the clinical descriptions of nightmares and insomnia, periodic limb movements (PLMs) are reported to co-occur in PTSD. Although the causal relationship between sleep disturbance and PTSD is not fully understood, sleep disturbance is an independent risk factor for the development and reactivation of PTSD. In contrast, the link between PTSD and REM sleep behaviour disorder (RBD) is less clear. Method: A case report is presented to illustrate differential diagnosis and time course of sleep disturbance in the context of PTSD. Result: A 63-year-old man who had been successfully treated for PTSD but who suffered the re-occurrence of disturbed sleep due to RBD and PLM, which was misdiagnosed as reactivation of PTSD. Conclusions: RBD can mimic PTSD-related nightmares. Accurate diagnosis of sleep disturbance in PTSD is relevant for treatment and prognostic evaluation.

No previous studies have evaluated the influence of significant international sports events on qualified detoxification treatment outcome. This prospective study examines the impact of the 2012 UEFA European Football Championship on inpatient treatment outcome of alcohol dependent patients. Hospital admission and premature drop-out rates of consecutively admitted alcohol dependent patients were determined before, during and immediately after the UEFA Championship in the year 2012. The admission rate of male patients increased significantly after the European Football Championship had ended whereas for female patients, no change in admission rate was found. Daily average discharge rate was calculated. No statistically relevant differences between the treatment days before, during and after the UEFA Championship was found for the discharges. During the tournament, exclusively male patients dropped out. Our results are consistent with an interpretation of an association between European Football Championship and detoxification treatment outcome. Further research to replicate and extend our findings is necessary.

Disrupted sleep is prevalent in both mood and thyroid disorders. Given the emerging use of thyroid hormones in the treatment of mood disorders, we investigated the effects of supraphysiological doses of levothyroxine (L-T4) on sleep. In an open-label design, 13 healthy subjects received up to 500 μg/day for an eight-week period. A baseline night was polysomnographically recorded (PSG) followed by PSG under the maximum tolerated dose of L-T4. All subjects developed hyperthyroxinemia. The heart rate and respiration rate increased significantly with treatment; a significant increase in body temperature was observed in men but not in women. Surprisingly, treatment with supraphysiological doses of L-T4 did not cause significant effects on sleep architecture. However, the increase in body movements and REM density was close to reaching statistical significance. Here, we report on the sleep data, thyroid hormone levels, and physiological parameters during sleep. We conclude that experimentally induced hyperthyroidism does not profoundly change the sleep structure in healthy individuals underlining the good tolerability of treatment with supraphysiological doses of L-T4 in patients with mood disorders.

Rationale/statement of the problem: Although tricyclic antidepressants (TCAs) are not recommended as first line therapy for depression in patients with coronary heart disease (CHD), they are still occasionally prescribed. Rationales may include resistance to other classes of antidepressants, previous response to TCAs, or treatment continuation after onset of a CHD. Despite their antidepressive effectiveness, TCAs may worsen cardiovascular prognosis because of autonomic side effects. Here, we examined potential adverse effects of TCAs on autonomic function as marked by heart rate variability (HRV) and norepinephrine (NE) levels. Methods: A total of 956 outpatients with stable CHD, 44 used TCAs. All patients were prospectively followed for 7.2±2.6 years. Standard deviation of all normal RR intervals (SDNN) as a measure of HRV was calculated from 24 h-electrocardiographic recordings. NE levels were measured in plasma and 24 h-urinary samples. We also calculated hazard ratios for all-cause mortality. Results: Users of TCAs had an increased risk of mortality compared to non-users (p=0.02 in an unadjusted model, p=0.01 in a model adjusted for age, sex, smoking, diabetes, congestive heart failure and depressive symptoms). When additionally adjusted for HRV and plasma NE, there was no significant association of TCA use and mortality. TCA users had an increased risk of being in the lowest tertile of HRV (p