Cognitive impacts of circadian misalignment and sleep disruption - shift working and new parenthood

Laboratory studies of prolonged sleep deprivation have revealed several negative cognitive impacts. It is uncertain however, how applicable insights derived from these studies are to the various sleep disturbances found in real-world settings. Individuals regularly experiencing forms of sleep disturbance are shift workers (SWs) and new parents (NPs). Shift work is increasingly common in contemporary society and these individuals often experience circadian misalignment. New parenthood is strongly associated with unpredictable sleep disturbance, though not the prolonged wakefulness applied in laboratory studies. Improved understanding of cognitive deficits in these groups is of considerable importance, given that SWs, despite potential cognitive compromise, are expected to work as effectively and productively as non-SWs. Similarly, NPs are expected to care for a newborn whilst operating safely in the surrounding world. Therefore, direct cognitive assessment in these groups, as opposed to laboratory-based studies mimicking the patterns of sleep disruption experienced, is valuable. Here, using online cognitive assessments, four domains that are vital in an occupational and parenting context (attention, response inhibition, working memory and visuomotor control) were evaluated in occupationally heterogeneous and homogenous SW cohorts, to determine the impact of job role, and in a NP cohort including both sexes, to evaluate any sex differences. All cohorts were assessed in conditions of minimal fatigue to dissociate potential contributions of acute daily fatigue from more chronic lifestyle effects. A frontal EEG analysis of SWs was conducted, using EEG headbands, to screen for physiological correlates. This study revealed little to no impairment in all four cognitive domains in SWs and NPs, suggesting that the cognitive impairments often reported in these groups are primarily driven by acute fatigue that can be alleviated with sleep. EEG analysis of SWs suggested the presence of some physiological changes, which could indicate compensatory mechanisms engaged to maintain the consistent cognitive performance observed

Augmentation of clozapine with ECT: a retrospective case analysis

Objective:We sought to assess the effectiveness of clozapine augmentation with ECT (C+ECT) in patients with clozapine-resistant schizophrenia. Methods:We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT. Results:Forty-two patients were treated with C+ECT over a ten year period. The mean age of the patients at initiation of ECT was 46.3 (SD=8.2) years (range 27-62 years). The mean number of ECTs given was 10.6(SD = 5.3)(Range 3-25) with the majority receiving twice weekly ECT. Seventy six percent of patients (n=32) showed a Clinical Global Impression improvement score (CGI-I) of≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Sixty four percent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness, or duration of clozapine treatment.Seventy five percent of responders remained out of hospital over the course of one-year follow up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised. Conclusion:This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended

The effect of the COVID-19 pandemic on disgust sensitivity in a sample of UK adults

The COVID-19 pandemic led to the introduction of a range of infection prevention and control (IPC) measures that resulted in dramatic changes in people’s lives however these IPC measures are not practiced consistently across the population. One predictor of an individual’s responses to the pandemic is disgust sensitivity. Understanding how disgust sensitivity varies within the population could help to inform design of public health messages to promote more uniform behavioral change during future pandemics. To understand the effect of the current COVID-19 pandemic on an individual’s pathogen disgust sensitivity we have compared pathogen disgust sensitivity during the current COVID-19 pandemic to baseline pathogen disgust sensitivity, determined prior to the COVID-19 pandemic, in the same sample of UK adults. We find that the COVID-19 pandemic did not alter overall pathogen disgust sensitivity suggesting that disgust sensitivity is stable despite IPC measures, public health messaging, media coverage and other factors associated with the COVID-19 pandemic

Can air purification improve sleep quality? A 2-week randomised controlled crossover pilot study in healthy adults

Insufficient quantity and quality of sleep is a public health concern which can be addressed by interventions for improving sleep outcomes. Environmental factors such as poor air quality are a potential target for intervention, particularly in light of associations between air pollution and worse sleep. The aim of this pilot study was to investigate the effects of using an air purifier on sleep outcomes and mood in 30 healthy adults. There were two conditions (i) air purifier with a High Efficiency Particulate Air (HEPA) filter (ii) air purifier with a placebo filter. Participants undertook both conditions, each over two weeks with a two-week washout, following a counterbalanced, double-blind design. Daily sleep outcomes were measured with actigraphy watches and sleep diaries, whilst daily mood was assessed with the Positive and Negative Affect Schedule. The Insomnia Severity Index, the Pittsburgh Sleep Quality Index, and symptoms of anxiety and depression were measured pre and post. The purifier filter was associated with increased total sleep time for an average of 12 minutes per night and increased total time in bed for an average of 19 minutes per night relative to the placebo. There were several sleep and mood outcomes for which no changes were observed, and time awake after sleep onset was higher for the purifier filter. Air quality was better during the HEPA filter condition. These findings offer positive indications that environmental interventions which improve air quality can have benefits for sleep outcomes in healthy populations who are not exhibiting clinical sleep disturbances

The CRF-1 Receptor Antagonist, CP-154,526, Attenuates Stress-Induced Increases in Ethanol Consumption by BALB/cJ Mice

Corticotropin-releasing factor (CRF) signaling modulates neurobiological responses to stress and ethanol, and may modulate observed increases in ethanol consumption following exposure to stressful events. The current experiment was conducted to further characterize the role of CRF1 receptor (CRF1R) signaling in stress-induced increases in ethanol consumption in BALB/cJ and C57BL/6N mice

A novel group parenting intervention to reduce emotional and behavioural difficulties in young autistic children:protocol for the Autism Spectrum Treatment and Resilience pilot randomised controlled trial

INTRODUCTION: The majority of young autistic children display impairing emotional and behavioural difficulties that contribute to family stress. There is some evidence that behavioural parenting interventions are effective for reducing behavioural difficulties in autistic children, with less evidence assessing change in emotional difficulties. Previous trials have tended to use unblinded parent-report measures as primary outcomes and many do not employ an active control, limiting the conclusions that can be drawn. METHODS AND ANALYSIS: The Autism Spectrum Treatment and Resilience study is a pilot randomised controlled trial (RCT) testing the specific effect of a 12-week group parenting intervention (Predictive Parenting) on primary and secondary outcomes, in comparison to an attention control condition consisting of psychoeducation parent groups. Following a feasibility study to test research procedures and the interventions, the pilot RCT participants include 60 parents of autistic children aged 4-8 years who are randomised to Predictive Parenting versus the attention control. Measures are administered at baseline and post intervention to assess group differences in child and parent outcomes, costs and service use and adverse events. The primary outcome is an objective measure of child behaviours that challenge during interactions with their parent and a researcher. The trial aims to provide data on recruitment, retention, completion of measures and acceptability of the intervention and research protocol, in addition to providing a preliminary indication of potential efficacy and establishing an effect size that could be used to power a larger-scale efficacy trial. We will also provide preliminary estimates of the cost-effectiveness of the interventions. ETHICS AND DISSEMINATION: Ethical approval was granted from NHS Camden and Kings Cross Research Ethics Committee (ref: 16/LO/1769) along with NHS R&D approval from South London and Maudsley, Guy's and St Thomas', and Croydon Health Services NHS Trusts. The findings will be disseminated through publication in peer-reviewed journals and presentations at conferences. TRIAL REGISTRATION NUMBER: ISRCTN91411078

Augmentation of clozapine with ECT: a retrospective case analysis

Objective:We sought to assess the effectiveness of clozapine augmentation with ECT (C+ECT) in patients with clozapine-resistant schizophrenia. Methods:We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT. Results:Forty-two patients were treated with C+ECT over a ten year period. The mean age of the patients at initiation of ECT was 46.3 (SD=8.2) years (range 27-62 years). The mean number of ECTs given was 10.6(SD = 5.3)(Range 3-25) with the majority receiving twice weekly ECT. Seventy six percent of patients (n=32) showed a Clinical Global Impression improvement score (CGI-I) of≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Sixty four percent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness, or duration of clozapine treatment.Seventy five percent of responders remained out of hospital over the course of one-year follow up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised. Conclusion:This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended

A background of bias: Subtle changes in line up backgrounds increase the own race bias

In police photo lineups there can sometimes be small variations in shades and hues of the background images due to the faces being filmed under different lighting and cameras. Own race bias refers to a situation where people are better at remembering the faces of those who are the same race as them and find it more difficult to recognise faces from a different race. In this paper we investigated the influence of small colour variations in backgrounds for the recognition of Black and White faces. Across 3 experiments we found when small changes were introduced into the backgrounds of the images this increased false identifications for previously unseen Black faces, but not White faces. This finding suggests that the police need to ensure that the backgrounds of the photo lineups they use are all uniform to reduce mistaken identifications of innocent suspects

A background of bias: Subtle changes in line up backgrounds increase the own race bias

In police photo lineups there can sometimes be small variations in shades and hues of the background images due to the faces being filmed under different lighting and cameras. Own race bias refers to a situation where people are better at remembering the faces of those who are the same race as them and find it more difficult to recognise faces from a different race. In this paper we investigated the influence of small colour variations in backgrounds for the recognition of Black and White faces. Across 3 experiments we found when small changes were introduced into the backgrounds of the images this increased false identifications for previously unseen Black faces, but not White faces. This finding suggests that the police need to ensure that the backgrounds of the photo lineups they use are all uniform to reduce mistaken identifications of innocent suspects