Background and Aims: Internet gaming disorder (IGD) is a relevant psychiatric disorder during adolescence. Excessive digital gaming has been associated with youth mental health problems. Prospective studies combining psychological and biological outcomes in childhood and adolescence are rare.Methods: A sample of n = 178 children was studied at primary school age (M = 7.7 years, t1) and during adolescence (M = 13.3 years, t2). Data was collected in mother‐ (t1, t2) and self‐reports (t2) on screen time, gaming behavior, emotional/behavioral symptoms and biological/psychological stress. Adolescent gamers and nongamers were compared using sex‐controlled (co)variance analyses and correlations with the gaming scores were carried out.Results: At t1, there were no differences between adolescent gamers versus nongamers. At t2, self‐reports indicated elevated psychological stress (p = 0.01) and an increase in behavioral symptoms (p = 0.01) in both sexes. Furthermore, gaming girls exhibited a higher prevalence of self‐reported emotional symptoms (p = 0.05); no differences were observed in mother‐reports or hair cortisol concentrations. In the gaming group, more DSM‐5 internet gaming disorder (IGD) symptoms at t2 were associated with higher mother‐rated total symptoms and digital gaming screen time at t1 in boys (p = 0.03/0.04), higher self‐rated psychological stress and more emotional/behavioral/total symptoms in boys (p = 0.002–0.02) and lower hair cortisol concentrations in girls (p = 0.003) at t2.Conclusion: The phenomenon of online gaming in adolescence had no precursors in childhood, while it was associated with current mental health and stress parameters. The extent of gaming, as defined by the DSM‐5 IGD symptoms, was found to be associated with screen time and mental health issues in childhood and adolescence. Consequently, it can be hypothesized that adolescent online gaming is a symptom of earlier as well as a risk factor for current mental health problems during adolescence, with specific consequences for boys and girls.

Obstructive sleep apnea (OSA) is prevalent among psychiatric patients and can exacerbate psychiatric conditions. Screening for OSA in this population is challenging due to overlapping symptoms and adherence issues. This study evaluated the diagnostic accuracy of the STOP-Bang, BOAH, GOAL, NoSAS, and No-Apnea screening questionnaires in psychiatric patients. In this observational cohort study, consecutive psychiatric patients admitted to a single tertiary care center between June 1, 2016 and December 31, 2022 were screened using the STOP-Bang questionnaire and additional data on parameters of the other questionnaires were collected. Polygraphy was performed using the Somnocheck micro CARDIO® system to record the Apnea-Hypopnea Index (AHI). Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve, sensitivity, and specificity analysis. Among 128 patients (median age 61.5 [IQR, 52.3-73.0] years; 77 [60.2 %] men), the No-Apnea questionnaire achieved the highest sensitivity for any OSA (AHI ≤5) at 96.00 % (95 % CI, 89.35 %-98.58 %; AUC, 0.68), followed by GOAL at 92.00 % (95 % CI, 83.78 %-96.27 %; AUC, 0.59) and STOP-Bang at 90.67 % (95 % CI, 81.85 %-95.26 %; AUC, 0.66). The specificities of all questionnaires were low, ranging from 15.09 % (STOP-Bang; 95 % CI, 8.35 %-25.90 %) to 50.94 % (BOAH; 95 % CI, 38.65 %-63.13 %). The STOP-Bang, GOAL, and No-Apnea questionnaires effectively identify psychiatric patients at risk for OSA, though their low specificity underscores the necessity for confirmatory diagnostics, such as polygraphy. The No-Apnea score, which relies only on objective variables, may offer particular benefits in psychiatric settings.

Background: Symptoms of obstructive sleep apnoea (OSA) overlap significantly with those of psychiatric disorders, making accurate diagnosis of OSA challenging within psychiatric settings. Diagnosing OSA in psychiatric patients is crucial because untreated OSA can exacerbate psychiatric symptoms, reduce treatment efficacy, and impair overall quality of life. This study aimed to determine the diagnostic accuracy of a readily accessible procedure for psychiatric patients in a real-world clinical setting by comparing the Somnocheck micro CARDIO^® (SCm) portable cardiorespiratory polygraphy device with the gold standard polysomnography (PSG). Methods: This observational cohort study included consecutive psychiatric patients at intermediate to high risk for OSA based on screening with the STOP-Bang questionnaire, admitted to a single tertiary care centre between June 1, 2016 and December 31, 2022. The Apnoea-Hypopnoea-Index (AHI), Apnoea-Index (AI), Oxygen-Desaturation-Index (ODI), and minimum oxygen saturation were measured sequentially by SCm and PSG. Results: A total of 57 patients were analysed (median age 62.0 [Interquartile Range (IQR), 51.5–72.5] years; 34 [59.6%] men). Regarding AHI, no significant differences (AHI measured by PSG, median, 16.6 [IQR, 6.2–26.7] vs. AHI measured by SCm, median, 14.9 [IQR, 10.0-22.8]; p = 0.812; r = 0.71) were found between SCm and PSG. AI, ODI and minimum oxygen saturation differed significantly between SCm and PSG. Using optimised cut-off values (any OSA: AHI_SCm ≥ 9.25), SCm showed high sensitivity (0.894) and high specificity (0.800) for the diagnosis of OSA, with an area under the receiver operating characteristic curve of 0.877. Conclusions: This study found that the SCm portable device was accurate in identifying psychiatric patients with OSA. AHI measurement by SCm provided reliable diagnostic performance in comparison with the gold standard polysomnography. These findings support the integration of polygraphic measurements into the routine sleep assessment of psychiatric patients. Early and accurate diagnosis of OSA in this population can significantly improve the management of both sleep disorders and psychiatric conditions, potentially enhancing overall treatment outcomes and quality of life for these patients.

Objectives: We aimed to determine temporal patterns of blood–brain barrier (BBB) dysfunction, edema formation and functional recovery in acute stroke. Materials and Methods: Patients of two observational studies on ischemic and hemorrhagic stroke between 2006 and 2019 were analyzed. Blood–brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio. Edema formation was measured on all available imaging scans during hospital stay. Relative edema was defined as the ratio of edema volume to stroke volume. Multivariable regression models were applied to analyze associations and calculate predicted probabilities. Results: Overall, 138 stroke patients, 103 (74.6%) with ischemic stroke and 35 (25.4%) with hemorrhagic stroke, were analyzed. The predicted probability of substantial BBB dysfunction was approximately 46 (37–55) % among patients analyzed on 1 day after symptom onset and declined with increasing time, thereafter reaching 10 (3–29) % on day 30. The maximal extent of edema was lower in ischemic versus hemorrhagic stroke (relative edema: 1.5 [1.2–1.8] vs. 2.6 [1.9–4.5], p = 0.003) and occurred earlier after stroke onset (5.9 [4.6–8.5] days vs. 12.3 [9.7–16.4] days, p = 0.009). BBB dysfunction was associated with increased edema formation (adjusted relative edema: 4.0 [2.8–4.5] vs. 2.3 [1.8–3.0], p = 0.037) and lower chances of functional recovery (20/48 [41.7%] vs. 51/90 [56.7%], adjusted Odds Ratio: 0.37 [0.16–0.88], p = 0.025) in both ischemic and hemorrhagic stroke patients. Conclusions: BBB dysfunction frequently occurred in acute ischemic and hemorrhagic stroke and was associated with secondary injury and worse clinical outcomes. Future studies should evaluate BBB dysfunction as a potential therapeutic target using advanced imaging techniques early after stroke onset. Edema formation was aggravated and prolonged in hemorrhagic versus ischemic stroke.

Background: Prenatal alcohol exposure (PAE) is a major preventable cause of neurodevelopmental impairment. Little is known about its impact on real-life child/adolescent academic outcomes, which are key functional indicators of long-term social participation. Methods: PAE was assessed in a sample of 156 participants via (1) meconium ethyl glucuronide (EtG) concentration (≥10 ng/g; EtG-positive, n = 36) and (2) third-trimester maternal self-report (SR-positive, n = 40). At primary school (6–10 years, t1) and secondary school ages (12–14 years, t2), exposed and non-exposed children were compared regarding primary school grades (t1) and secondary track placement (t2). Results: At t1, EtG-positive children exhibited lower school report grades by trend (n = 15, p = 0.068–0.085) with a moderate effect size (r = 0.36–0.39). SR-positive children demonstrated significantly lower school report grades (n = 15, p = 0.016) with strong effect (r = 0.56). At t2, both exposure groups had increased trend-significant odds of attending lower educational tracks (EtG-positive/-negative: n = 153, OR = 1.84, p = 0.059; SR-positive/-negative: n = 153, OR = 1.78, p = 0.066). Conclusions: PAE is associated with reduced real-life academic outcomes across development. School performance represents a sensitive functional outcome of neurodevelopmental vulnerability following PAE. Meconium EtG may contribute to postnatal identification of affected children.

Background: Insomnia is common among medical students and is linked to impaired mental health and academic functioning. Medical students are exposed to persistent psychosocial stress, yet the extent to which state factors (e.g., stress, mood) versus trait factors (e.g., chronotype, sleep beliefs) contribute to insomnia severity is unclear. While dysfunctional sleep beliefs are relatively stable cognitive traits, they remain amenable to targeted interventions. Methods: We conducted a cross-sectional survey at a German medical school during a fourth year exam period. Students completed the Insomnia Severity Index (ISI; primary outcome), selected items of the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-2 (GAD-2), a visual analogue scale (VAS) for stress, the Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS-16), and reduced the Morningness–Eveningness Questionnaire (rMEQ); academic performance was recorded. Group differences were tested with t tests and chi-square tests. A multivariable linear regression modeled insomnia severity (ISI) as a function of state and trait variables; a secondary model examined DBAS-16 subscales. Results: Of 124 students, 46.0% (57/124) screened positive for clinically relevant insomnia symptoms (ISI > 10). Students with clinically relevant inomnias symptoms had shorter total sleep time (391.0 ± 76.5 vs. 438.2 ± 58.3 min; P < 0.001), longer sleep onset latency (51.1 ± 37.1 vs. 21.6 ± 18.0 min; P < 0.001), and lower sleep efficiency (82.2% ± 12.2% vs. 90.1% ± 7.2%; P < 0.001). In adjusted analyses (R² = 0.572; adjusted R² = 0.523), higher PHQ-9 (β = 0.30; P = 0.01) and DBAS-16 (β = 0.28; P < 0.001) were independently associated with higher ISI, whereas higher sleep efficiency (β = −0.30; P < 0.001) and academic performance (β = −0.15; P = 0.037) were inversely associated; perceived stress, anxiety, and chronotype were not independent correlates. In the DBAS-16 subscale model (R² = 0.332; adjusted R² = 0.307), Worry/Helplessness and Perceived Consequences were significantly associated with higher ISI. Conclusions: Clinically relevant insomnia symptoms were frequent among medical students. Depressive symptoms and dysfunctional sleep beliefs were key correlates of insomnia severity, and academic performance was inversely related. These findings suggest that sleep health and mental well-being deserve attention in medical education and student health services.