Does physical activity moderate the association between screen time and psychosocial development in early childhood? Analysis of a longitudinal infant cohort study in Ireland.

The objective of this study was to explore the extent to which the association between screen time and psychosocial development in preschool children differed between the sexes and according to their frequency of engagement in physical activity. Data are based on a prospective cohort of Irish children, collected between 2010 and 2013 when children were ages 3 (n=9786) and 5 years (n=9001). Children's screen time (h/day), psychosocial development (Strengths and Difficulties Questionnaire), and physical activity (bouts/week) were assessed via caregiver report. The magnitude of the association between screen time and changes in behavioural difficulties differed significantly between the sexes. For boys, the association between increased screen time and the onset of behavioural problems coincided directly with a reduction in their frequency of engagement in physical activity. The association between screen time and changes in behavioural difficulties was not moderated by girls' engagement in physical activity, however; and there was no difference in the association between screen time and prosocial behaviours at different frequencies of engagement in physical activity for either boys or girls.Conclusions: Results support recommendations to establish greater balance between physical activity and sedentary behaviours in token economy systems to minimise the negative effects of excessive screen time. What is Known: • Provision of screen time has become normalised as a behavioural reinforcer for use with young children. • Screen viewing above recommended guidelines is associated with behavioural problems that reflect poor self-regulation. What is New: • Boys' levels of engagement in physical activity moderated the relationship between screen time and changes in behavioural difficulties between the ages of 3 and 5 years. • Neither screen time nor physical activity was significantly associated with changes in prosocial behaviours between the ages of 3 and 5 years for either boys or girls.

Risks and Benefits of Rapid Clozapine Titration.

Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

The treatment of behavioral disturbances and psychosis associated with dementia. / Terapia zaburzen behawioralnych i psychoz towarzyszacych otepieniu.

Behavioral disturbances and psychosis associated with dementia are becoming an increasingly common cause of morbidity in patients with dementia. Approximately 70% of individuals with dementia will experience agitation, and 75% will experience symptoms of psychosis such as delusions or hallucinations. The goal of this article is to review the pharmacologic treatment options for behavioral disturbances and psychosis associated with dementia. A literature review was conducted on PubMed/Medline using key words of "dementia" and "interventions." The results were filtered for meta-analysis, clinical trials, and systematic reviews. The results were then reviewed. At this time, the most evidence exists for the use of a second generation antipsychotics (SGAs), but consideration should be given to their collective boxed warning of morbidity/mortality. The evidence for second line treatments are limited. There is limited evidence to support the use of first generation antipsychotics (FGAs), antidepressants, anticonvulsants, cognitive enhancers, and analgesics. Additional randomized control trials are needed to guide clinical decision making regarding the behavioral disturbances and psychosis associated with dementia.