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Gillis K, van Diermen L, Lips D, Lahaye H, De Witte M, Van Wiele L, Roelant E, Hockley J, Van Bogaert P. The impact of need-based care on formal caregivers' wellbeing in nursing homes: A cluster randomized controlled trial. Int J Nurs Stud 2024; 150:104654. [PMID: 38101268 DOI: 10.1016/j.ijnurstu.2023.104654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Need-based care is a structured and standardized model that supports formal caregivers in nursing homes in delivering person-centered care by responding with tailored non-pharmacological interventions on residents' unmet needs as well as having positive effects on behavioral and psychological symptoms on residents with dementia. However, limited resources as well as the shortage of caregivers in nursing homes make the implementation of need-based care challenging, especially when it comes to finding ways to spend more time with residents. The aim of this study is to evaluate the impact of the implementation of need-based care in nursing homes on formal caregivers' wellbeing. METHODS A three-arm cluster randomized controlled trial was set up in 24 Belgian nursing homes: formal caregivers in the 'need-based care' group (intervention; n = 195) spent time twice a week with residents who had behavioral and psychological symptoms according to the principles of need-based care while formal caregivers in the 'time' group (n = 257) filled in the way they spent time twice a week; a third group delivered standard care (n = 299). An implementation strategy was built upon the Implementation Quality Framework and used in the 'need-based care group'. A total of 741 formal caregivers completed the digital questionnaire at one or more of the five time points (every nine weeks) between November 2021 and July 2022; they rated their sense of competence in dementia care, level of burnout, and, level of engagement. Moments of time were registered in a printed registration book. RESULTS Only formal caregivers from the 'need-based care' group experienced a higher sense of competence in dementia care at time points three (p = 0.010) and four (p = 0.001) compared with baseline with an increase of respectively 1.5 (95 % confidence interval [0.25, 2.84]) and 2.4 (95 % confidence interval [0.77, 4.04]) points. No differences in scores on burnout and engagement were found. CONCLUSION Despite challenging workforce circumstances in nursing homes, caregivers in the need-based care group as well as in the time group were able to spend time twice a week with residents with behavioral and psychological symptoms. No negative effects were found on formal caregivers' wellbeing after the implementation of need-based care in nursing homes. However, it requires strong leadership and the use of well-considered implementation strategies including reflective practice. TRIAL REGISTRY Trial registration number ISRCTN56768265 (10/08/2023).
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Affiliation(s)
- Katrin Gillis
- Research group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium; Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600 Wilrijk, Belgium.
| | - Linda van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium; Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium.
| | - Dirk Lips
- Curando vzw, Pensionaatstraat 58A, Ruiselede, Belgium.
| | - Hilde Lahaye
- Research group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium.
| | - Marianne De Witte
- Research group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium; Curando vzw, Pensionaatstraat 58A, Ruiselede, Belgium.
| | - Leen Van Wiele
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600 Wilrijk, Belgium.
| | - Ella Roelant
- StatUa, Center for Statistics, University of Antwerp, Prinsstraat 13, Antwerp, Belgium; Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium.
| | - Jo Hockley
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh EH8 9AG, Scotland, UK
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600 Wilrijk, Belgium.
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Gillis K, van Diermen L, Lahaye H, De Witte M, De Wit Y, Roelant E, Lips D, Zhiri A, Hockley J, Van Bogaert P. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers' distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 2023; 14:1083-1096. [PMID: 37405630 DOI: 10.1007/s41999-023-00825-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD. METHODS A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8 weeks. In the time group, formal caregivers spent 'extra time'. In the standard care group, it was 'care as usual'. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers' distress. RESULTS Need-based interventions had a significant effect on residents' levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never). CONCLUSION Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers' distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia. TRIAL REGISTRY Trial registration number B300201942084 (18/11/2019).
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Affiliation(s)
- Katrin Gillis
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium.
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium.
| | - Linda van Diermen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Psychiatric Centre Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Hilde Lahaye
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
| | - Marianne De Witte
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Yentl De Wit
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Ella Roelant
- Center for Statistics, StatUa, University of Antwerp, Prinsstraat 13, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium
| | - Dirk Lips
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Abdesselam Zhiri
- R&D Department, Pranarôm International S.A. 37, Avenue des Artisans, 7822, Ghislenghien, Belgium
- Plant Biotechnology Research Unit, Université Libre de Bruxelles (ULB), Plant Biotechnology Research Unit, CP 300, Rue Prof. Jeener & Brachet 12, 6041, Gosselies, Belgium
| | - Jo Hockley
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium
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Heniquez A, Lahaye H, Boissel L, Guilé JM, Benarous X. [Interoceptive difficulties in children and adolescents with severe form of somatic symptom disorder: A pilot study with nineteen participants]. Encephale 2023; 49:510-515. [PMID: 36244837 DOI: 10.1016/j.encep.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Despite the high rate of somatic symptom disorder (TSS) in the pediatric population, etiological mechanisms remain poorly understood. Previous studies conducted in youths with anxiety, eating disorder, or autistic disorder support a relation between difficulties in the perception of sensory signals (i.e., interoception) and difficulties in identifying emotions. METHOD A cross-sectional study was carried out at the University Hospital of Amiens-Picardie in 19 young people aged 9 to 17 hospitalized in the pediatric ward for TSS. A mental heartbeat tracking task was used to assess interoceptive accuracy, awareness and sensibility. The Porges Body Perception Questionnaire (PBPQ) was used to assess interoceptive attention. Other questionnaires were used to assess associated clinical dimensions such as depression, anxiety, emotional dysregulation and alexithymia. RESULTS The mean interoceptive accuracy score was lower in TSS subjects compared to expected scores in the general population (33% error vs. 20%). A statistically significant correlation was found between, on the one hand, interoceptive sensibility and the "avoidance" subscore of the ECAP (r=0.51) and, on the other hand, between interoceptive awareness and the total score of the Child Depression Inventory (r=0.51). A significant relationship was found between the PBPQ scale total score and the Children-Toronto Alexithymia Scale total score (r=0.42), in particular with the "difficulty expressing emotions" subscore (r=0.62). CONCLUSION This study confirms that interoceptive difficulties occur in young patients with severe TSS. Our finding adds empirical evidence supporting the relations between interoceptive difficulties, alexithymia and somatic symptoms in children and adolescents.
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Affiliation(s)
- A Heniquez
- Unité de périnatalité, service de psychopathologie de l'enfant et de l'adolescent, CHU Amiens-Picardie, Amiens, France
| | - H Lahaye
- Unité de périnatalité, service de psychopathologie de l'enfant et de l'adolescent, CHU Amiens-Picardie, Amiens, France; Inserm, Unit U1105, GRAMFC, université Picardie Jules-Verne, Amiens, France
| | - L Boissel
- Unité de périnatalité, service de psychopathologie de l'enfant et de l'adolescent, CHU Amiens-Picardie, Amiens, France; Inserm, Unit U1105, GRAMFC, université Picardie Jules-Verne, Amiens, France
| | - J-M Guilé
- Unité de périnatalité, service de psychopathologie de l'enfant et de l'adolescent, CHU Amiens-Picardie, Amiens, France; Inserm, Unit U1105, GRAMFC, université Picardie Jules-Verne, Amiens, France
| | - X Benarous
- Unité de périnatalité, service de psychopathologie de l'enfant et de l'adolescent, CHU Amiens-Picardie, Amiens, France; Inserm, Unit U1105, GRAMFC, université Picardie Jules-Verne, Amiens, France.
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Benarous X, Brocheton C, Bonnay C, Boissel L, Crovetto C, Lahaye H, Guilé JM, Theret P, Gondry J, Foulon A. Postpartum maternal anxiety and depression during COVID-19 pandemic: Rates, risk factors and relations with maternal bonding. Neuropsychiatr Enfance Adolesc 2023; 71:44-51. [PMID: 36540656 PMCID: PMC9755008 DOI: 10.1016/j.neurenf.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives This study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding. Patients and methods During the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2-3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS). Results The rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26). Discussion The observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.
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Affiliation(s)
- X. Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Corresponding author
| | - C. Brocheton
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - C. Bonnay
- Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
| | - L. Boissel
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - C. Crovetto
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France
| | - H. Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - J.-M. Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Child and Adolescent Psychiatrie Department, Établissement Publique de Santé Mentale de la Somme, France
| | - P. Theret
- Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
| | - J. Gondry
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
| | - A. Foulon
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
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Gillis K, Stifkens K, Lahaye H, Van Bogaert P. Developing an effective strategy to implement non-pharmaceutical interventions amongst residents with dementia in residential care facilities: Caregivers' perspectives. Alzheimers Dement 2022. [PMID: 34971294 DOI: 10.1002/alz.053127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Non-pharmaceutical interventions based on unfulfilled needs amongst residents with dementia reduce symptoms of agitation, aggression and depression. However, to implement these interventions in daily practice in residential care facilities, caregivers need to (a) analyse resident's behaviour, (b) recognize unfulfilled needs and (c) apply an individualized non-pharmaceutical intervention. OBJECTIVES To develop an effective strategy for the implementation of such complex approach, insights in caregivers' perception of barriers and facilitating factors are needed. METHODS A total of thirteen focus group interviews with fifty-six caregivers from twelve residential care facilities was conducted between October 2019 and February 2020. RESULTS Despite a person-centred vision and culture in residential care facilities, caregivers recognize that dealing with altered behaviour amongst residents with dementia is challenging and that non-pharmaceutical interventions are seldom used. However caregivers are willing to invest in a team-based person-centred approach, different perspectives on priorities in care processes seem to influence the implementation. Participants refer to the importance of an open team culture where safety is guaranteed. An open culture stimulates an attitude of reflection, which is necessary to attune person-centred care to different perspectives. Therefore the presence of clinical and facilitating leadership is crucial to ensure motivation, a sense of competency, communication, problem-solving competences, practical organization of non-pharmaceutical interventions and continuity in care processes. Ward managers and clinical leaders prefer to be supported by an implementation coach who provides education and training to the team members and who facilitates from a neutral perspective moments of intervision on a regular base. CONCLUSIONS Caregivers recognize the presence of a person-centred vision and culture, team willingness and different perspectives on priorities in care processes as influencing factors for the implementation of non-pharmaceutical interventions. Strong clinical and facilitating leadership and the availability of an implementation coach may support caregivers in dealing with different perspectives on priorities in care. IMPLICATIONS FOR CLINICAL PRACTICE An educational package, intervision sessions and a leadership trajectory are recommended elements of strategy to implement non-pharmaceutical interventions based on unfulfilled needs amongst residents with dementia.
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Affiliation(s)
| | | | - Hilde Lahaye
- Odisee University College, Sint-Niklaas, Belgium
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Gillis K, Lahaye H, Dom S, Lips D, Arnouts H, Van Bogaert P. A person-centred team approach targeting agitated and aggressive behaviour amongst nursing home residents with dementia using the Senses Framework. Int J Older People Nurs 2019; 14:e12269. [PMID: 31469240 DOI: 10.1111/opn.12269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/25/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The increase in agitated or aggressive behaviour amongst nursing home residents with dementia is a challenging problem. Such behaviour causes stress for both resident and caregiver. Many non-pharmacological interventions have been studied, but these interventions disregard the resident's unfulfilled needs and are executed by a single, designated caregiver. This study tests a non-pharmacological intervention, applied by the entire team and based on the resident's underlying needs. DESIGN A pretest and post-test interventional study design was used, in which 65 residents with dementia who expressed agitated or aggressive behaviour. Data were collected from December 2016 until March 2017. METHODS The ABC method and the Senses Framework were used to assign residents to either therapeutic touch, group music sessions or a meaningful individual activity. All staff members applied the interventions. Data were collected by use of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI). RESULTS The frequency of aggression, loss of decorum, depression and the severity of aggression decreased for all three interventions. However, the overall severity of fear also increased. The overall prevalence of agitated of residents decreased for the therapeutic touch, group music sessions and individual activities. CONCLUSIONS This study shows the possibilities of designing individualised interventions on the Senses Framework and the ABC method for addressing agitated and aggressive behaviour amongst nursing home residents with dementia. The framework presented in this study should be further explored. IMPLICATIONS FOR PRACTICE A team-based approach is effective to reduce agitated or aggressive behaviour amongst nursing home residents.
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Affiliation(s)
- Katrin Gillis
- Odisee University College, Sint-Niklaas, Belgium.,Curando VZW, Ruiselede, Belgium
| | - Hilde Lahaye
- Odisee University College, Sint-Niklaas, Belgium.,VZW Woonzorg Samen Ouder, Sint-Niklaas, Belgium
| | - Stijn Dom
- Faculty of Medicine and Healthcare, Antwerp University, Antwerp, Belgium
| | | | - Heidi Arnouts
- Odisee University College, Sint-Niklaas, Belgium.,Department of Engineering Management, Antwerp University, Antwerp, Belgium
| | - Peter Van Bogaert
- Faculty of Medicine and Healthcare, Antwerp University, Antwerp, Belgium
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Delaplace R, Garny de La Rivière S, Bon Saint Come M, Lahaye H, Popov I, Rey N, Visticot A, Guilé JM. Sleep and disruptive mood dysregulation disorder: A pilot actigraphy study. Arch Pediatr 2018; 25:S0929-693X(18)30109-X. [PMID: 29909941 DOI: 10.1016/j.arcped.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 05/01/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To explore the clinical characteristics and motor activity profile during sleep periods of children and adolescents presenting with disruptive mood dysregulation disorder (DMDD). METHOD Twenty-one youths (mean age±standard deviation, 11.7±3 years) wore a wrist actigraph for 9 consecutive days (including both school days and non-school days), to measure sleep parameters: sleep latency, sleep efficiency and the number and duration of periods of wakefulness after sleep onset (WASO). We divided the night-time actigraphy recording sessions into three sections and compared the first and last thirds of the night. RESULTS All the study participants had a psychiatric comorbidity (primarily attention deficit hyperactivity disorder, depressive disorder or anxiety disorder). On non-school days, bedrest onset and activity onset were shifted later by about 1h. There was no significant difference between school days and non-school days with regard to the total sleep time. Sleep efficiency was significantly greater on non-school days. Sleep was fragmented on both school days and non-school days. The mean number of episodes of WASO was 24.9 for school days and 30.9 for non-school days. Relative to the first third of the night, we observed a significantly greater number of episodes of WASO during the last third of the night, a period associated with a larger proportion of rapid eye movement (REM) sleep. DISCUSSION Sleep appeared to be fragmented in the study population of youths with DMDD. The greater frequency of WASO in the last third of the night points to a possible impairment of the motor inhibition normally associated with REM sleep.
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Affiliation(s)
- R Delaplace
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France
| | - S Garny de La Rivière
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France; Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - M Bon Saint Come
- Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - H Lahaye
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France; Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - I Popov
- CRC pédiatrique, CHU d'Amiens, 80480 Amiens, France
| | - N Rey
- Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - A Visticot
- Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France; Centre hospitalier, boulevard Georges-Besnier, 62000 Arras, France
| | - J-M Guilé
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France; Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France.
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