Abstract Introduction Rapid-eye movement (REM) sleep (~20% of total sleep time in adults aged ≥65) plays an important role in memory consolidation. Patients with Mild Cognitive Impairment (MCI) have reduced REM sleep and increased REM latency. Although major depressive disorder (MDD) is also associated with MCI, few studies explore interactions between affective disorders, REM-sleep disorders, and neurocognitive deficits (NCDs). This study addresses said literature gap by sampling from adults ≥65 populations to characterize interactions between NCDs, depressive disorders (Dep), obstructive sleep apnea (OSA), and weight. Methods In a retrospective chart review, patients with OSA who received polysomnography (PSG) were identified using ICD-10 codes. Inclusion criteria were ≥65, alive, and without history of cerebrovascular events. Primary outcome was NCD presence. Results N=70; NCD+=35. Female=41. No REM sleep=15. Mean age=75.0. Mean Weight=87.9 kg. Dep+=16. Taking psychotropic medications (PsyMeds+)=33. On univariable logistic regression, Dep+ shows strongest association with NCDs (OR 6.30 [1.78-29.90], p=0.0083), and weight is inversely associated with NCDs (OR per kg=0.97 [0.95-0.99], p=0.0144). Age at first PSG (OR per year=1.07 [1.00-1.16], Wilcoxon p=0.051) and REM% (OR=0.96 [0.91-1.01], Wilcoxon p=0.106) both approach significance. Age at Dep diagnosis and PsyMed+ are not significantly associated with NCDs. In multivariable models, depression remained the dominant NCD predictor, increasing probabilities from ~30–60% to ~75–90% across age and REM% strata; age and REM% exerted modest effects. After adjustments of REM% and depressive disorders, lower weight continued to trend toward higher NCD odds (OR per kg=0.97 [0.94–1.00], p=0.054). Conclusion Depression in general ≥65 populations has reported ORs between 1.2-2.5 for NCDs. While more data are necessary to narrow 95% CIs, our higher OR for depression in older patients with OSA suggests complex interactions between depression and REM% for NCD risks. Weight loss, a recognized depressive symptom, has also been linked to NCDs. Our results suggest lower weight could be predictive of NCDs independently of depression in patients with OSA. Earlier OSA diagnosis and CPAP treatment could potentially reduce risks for NCDs. Prospective studies are needed. Finally, even with OSA (potentially memory-impairing), our data do not support concerns that antidepressants independently contribute to memory loss. Support (if any)

Abstract Introduction In Obstructive Sleep Apnea (OSA) patients, treatment with continuous positive airway pressure (CPAP) increases rapid eye movement (REM) sleep, highlighting the potential for sleep restoration. Fibromyalgia (FM) is a chronic pain condition often co-occurring with OSA and associated with sleep disturbances. REM sleep plays a key role in pain modulation, and REM deprivation has been linked to increased pain sensitivity, a core symptom of FM. In healthy adults, REM comprises ~25% of total sleep time, and reduced REM may alter pain perception. We hypothesize that patients with comorbid OSA and FM will exhibit reduced REM sleep compared to OSA alone, suggesting a mechanism by which FM may exacerbate pain and sleep-related symptoms in this population. Methods This IRB-approved retrospective chart review identified patients with FM and OSA through EPIC using diagnostic codes (ICD 10: M79.7, G47.33; ICD-9: 729.1, 327.23). FM+OSA patients were collected from 2012–2018 and OSA-only patients from 2019–2024. Polysomnography reports were reviewed for REM latency, REM duration, and REM percentage of total sleep time (TST) using supercomputer analysis. weight and BMI were collected from EPIC demographics. Results A total of 433 patients with FM+OSA and 250 patients with OSA only were included. The FM+OSA group was predominantly female (379/433). Average REM duration was 39.3 minutes in the FM+OSA group versus 45.5 minutes in the OSA-only group, a 6.2-minute difference (p < 0.01). REM percentage of TST was 12.6% in FM+OSA versus 14.4% in the OSA only group, reaching marginal statistical significance (Fisher exact test statistic= 0.0969, p < 0.10). Conclusion Both OSA and FM+OSA patients exhibited reduced REM sleep compared to population norms, with FM contributing an additional reduction in REM sleep, both in absolute minutes and as a percentage of total sleep time. This greater REM loss in FM+OSA supports the hypothesis that altered REM sleep may explain the heightened pain burden in FM. Prospective studies are needed to determine whether reduced REM directly influences pain perception in FM and whether interventions that restore REM sleep can mitigate pain. Support (if any)

Abstract Introduction Obstructive Sleep Apnea (OSA) is associated with elevated rates of depression and metabolic syndrome, likely mediated by intermittent hypoxia and sleep fragmentation. Whether these outcomes differ based on respiratory events occurring during REM versus non-REM sleep remains uncertain. This study examines the relationship between REM-related oxygen saturation (SaO₂), AHI severity, depression, and metabolic abnormalities in adults with OSA. Methods A retrospective chart review was conducted on adults with OSA who underwent baseline polysomnography without CPAP therapy. Extracted variables included mean REM SaO₂, total AHI, depression diagnosis, and metabolic syndrome components (hypertension, type 2 diabetes, and hyperlipidemia). Patients who did not enter REM sleep were excluded from REM SaO₂ analyses but retained for descriptive comparison. Linear regression assessed the association between mean REM SaO₂ and total AHI. Independent t-tests compared mean REM SaO₂ across diagnoses of depression, hypertension, type 2 diabetes, and hyperlipidemia. Results Of 250 patients reviewed, 35 (14%) did not reach REM sleep. Among the 215 patients who achieved REM sleep, lower mean REM SaO₂ significantly predicted higher total AHI (β = –3.18; p < 0.001). Mean REM SaO₂ did not differ by depression (p = 0.35) or hyperlipidemia (p = 0.19) but was significantly lower in patients with type 2 diabetes (p < 0.01) and hypertension (p < 0.001). Compared with REM-capable patients, those who failed to reach REM exhibited more severe OSA (mean AHI 40 vs 23) and higher rates of depression (40% vs 33%), hyperlipidemia (77% vs 40%), type 2 diabetes (37% vs 20%), and hypertension (71% vs 46%). Conclusion Mean REM SaO₂ is strongly associated with AHI severity in patients with OSA. While REM SaO₂ was not associated with depression or hyperlipidemia, its significant relationship with hypertension and type 2 diabetes highlights possible links between REM-related desaturation and cardiometabolic burden. Individuals who failed to reach REM sleep had more severe OSA and a greater prevalence of all comorbidities. Prospective studies including larger proportions of patients with severe OSA are needed to further define these associations. Support (if any)

Catatonia is a psychomotor syndrome that can present secondary to mood and psychotic disorders, other medical conditions, antipsychotic use, and alcohol withdrawal (Rasmussen et al., World Journal of Psychiatry, 6:391-398, 2016). In addition, acute and chronic trauma are increasingly recognized as a substrate for catatonia (Dhossche et al., Acta Psychiatrica Scandinavica, 125:25-32, 2012). Catatonia is a clinical diagnosis that relies on standardized examination of the patient. The Pediatric Catatonia Rating Scale (PCRS) was modified from the Bush Francis Catatonia Rating Scale and validated in children and adolescents (Benarous et al., Schizophrenia Research, 176:378-386, 2016). Changes included the addition of urinary incontinence, schizophasia and acrocyanosis; and withdrawal was separated into refusal to eat or drink and social withdrawal (Benarous et al., Schizophrenia Research, 176:378-386, 2016). In both pediatric and adult patients, catatonia must be differentiated from other movement disorder emergencies such as serotonin syndrome and neuroleptic malignant syndrome, which can also present with altered mental status and autonomic dysfunction (Rajan et al., Seminars in Neurology, 39:125-136, 2019). In pediatric patients, catatonia may be the genuine diagnosis in cases of Resignation Syndrome and Pervasive Refusal Syndrome (Sallin et al., Frontiers in Behavioral Neuroscience, 10(7), 2016; Ngo and Hodes, Clinical Child Psychology and Psychiatry, 25:227-241, 2019). The literature on pediatric catatonia is scarce but nevertheless expanding. Herein, we contribute to the literature by reporting four complex cases of pediatric catatonia that appear to have been triggered by a traumatic event and further reviewing the role of acute and chronic trauma in the presentation of pediatric catatonia.

Background: Fibromyalgia (FM) is a chronic pain disorder and is associated with disability, and high levels of pain and suffering. FM is known to co-occur with obesity and obstructive sleep apnea (OSA). Individuals with FM often experience symptoms of pain, depression and anxiety, sleep disturbances, and fatigue. These symptoms may be exacerbated by OSA and contribute to the symptoms’ severity in FM. Obesity is a common comorbidity in OSA patients, and as FM and OSA are related in some patients, obesity also may contribute to FM symptom severity. For healthcare providers to effectively manage FM patients, a better understanding of the co-occurrence between these FM comorbidities and psychological factors is needed. Methods: This study was approved by IRB and conducted using a retrospective EPIC chart review. To identify FM, the following ICD-9 codes were used: (729.1) and ICD-10 (M79.7) codes. To identify patients with OSA, the following ICD-9 codes were used: (327.23) and ICD-10 (G47.33). Body Mass Index (BMI), the total number of medical diagnoses, and psychiatric conditions were documented for each patient. The prevalence of psychiatric conditions including depression and anxiety was compared between patients with and without obesity (BMI > 30), and patients with fewer than 25 medical diagnoses and those with 25 or more diagnoses. A chart review was conducted to identify patients with fibromyalgia with prior serum cortisol testing within the last ten years. Cortisol levels were compared and patients were divided into six groups: 1. FM without identified psychiatric conditions; 2. FM with psychiatric diagnosis of adjustment disorders and insomnia; 3. FM with psychiatric diagnosis of depressive disorders; 4. FM with psychiatric diagnosis of bipolar disorders; 5. FM with psychiatric diagnosis of mixed anxiety and depression; 6. FM with psychiatric diagnosis of anxiety disorders. Available C-reactive protein (CRP) values were gathered. Results: The total FM and OSA population was N = 331. The mean age of the patient population was 63.49 years old, with 297 being female. The diagnoses mean was 31.79 ± 17.25 and the mean total psychiatric diagnoses was 2.80 ± 1.66. The mean BMI was 36.69 ± 8.86, with obesity present in 77.95% of the patients. A total of 66.99% of patients had comorbid anxiety and depression with 25 or more medical problems vs. 33.01% of patients who had fewer than 25 medical problems (odds ratio = 1.50). Patients with a BMI < 30 (N = 71) had rates of anxiety and depression at 64.79% and a mean total of 2.79 ± 1.66 psychiatric diagnoses, whereas patients with a BMI > 30 (N = 258) had rates of anxiety and depression at 61.63% (odds ratio = 1.28) and a mean total of 2.80 ± 1.66 psychiatric diagnoses. The most common other psychiatric conditions among FM/OSA patients included hypersomnia and substance use disorders. Cortisol data: Available cortisol results: FM n = 64, female: 59, male: 5, mean age: 63, average BMI: 38.8. The averages for serum cortisol alone for groups 1–6, respectively, are 9.06, 5.49, 13.00, 14.17, 12.25, and 16.03 μg/dL. These results indicate a relatively upward cortisol serum value by the addition of several psychiatric conditions, with the most notable being anxiety for patients with FM. CRP values were available for 53 patients with an average CRP of 4.14. Discussion: Higher rates of anxiety and depression were present in FM patients with 25 or more diagnoses. The odds ratios indicate that a patient with 25 or more medical problems was 1.5 times more likely to have anxiety and depression than those with fewer diagnoses. Additionally, those with a BMI > 30 were 1.3 times more likely to have anxiety and depression than those with a normal BMI. Conclusion: addressing psychological factors in FM and OSA is important as high healthcare utilization is common in patients with FM and OSA.

Studies have shown that decrease in time intubated is associated with better prognosis. Delirium is associated with increased duration of mechanical ventilation and Intensive Care Unit (ICU) length of stay. However, there is limited report on delirium in intubated seizure patients. As per report, low Glasgow Coma Scale (GCS) increased the risk of delirium and thus increasing ICU length of stay. Information on delirium and outcome in intubated seizure patients receiving lacosamide versus phenytoin is limited. Our retrospective pilot study aimed to assess the GCS scores and impact of delirium in intubated seizure patients who were treated with phenytoin and lacosamide. In this retrospective pilot study, review was conducted via chart review of hospitalized, intubated seizure patients on Phenytoin or Lacosamide at Loyola University Medical Center Neurology ICU from 2018 to 2020. Endotracheal intubation was identified by ICD 10, ICD-10-PCS 0BH17EZ, (Z99.11), and Delirium diagnosis was identified using delirium ICD codes 10 F05, R41. 82 R41.0, ICD 9: 293, 780.97, and 298.2. Hospital and ICU patient admit and discharge dates and Glasgow Coma Scale scores were extracted. This pilot study investigated qualitative variables. The patient age at admission was an average of 65 years. A total of 20 charts were included in the final analysis. 50% of phenytoin group experienced delirium (4/8), 50% of the lacosamide group also experienced delirium (6/12). Number of Days Intubated in Delirium: 2.0 days, no delirium: 1.5 days, number of Days in ICU in Delirium: 5.6 days, no delirium: 3.3 days, number of days in hospital in delirium: 13.7 days, no delirium: 8.5 day. Patients with delirium had longer ICU stays (5.6 days vs. 3.3) and hospital stays (13.7 days vs. 8.5). Patients with GCS less than 10 were much more likely to experience delirium, with 8 out of 11 (73%) patients experiencing delirium versus 2 out of 9 (22%) for patients with GCS greater than 10. Low GCS score at ICU admission could predict emerging delirium in intubated seizure patients. Studies are required to see if early treatment of delirium can decrease the ICU length of stay. Our pilot study highlighted that GCS scores are a key component of assessment of functioning over hospital admission. Prospective and larger studies are required to determine the impact of delirium and relationship between GCS scores and delirium in intubated seizure patients. KeywordsStatus epilepticus; intubation; seizure; delirium; anticonvulsants; Glasgow Coma Scale score

Background: This pilot study measures pain perception, somatosensory amplification and its relationship to health anxiety in patients with fibromyalgia (FM) and patients with FM and obstructive sleep apnea (OSA); this study also examines the effects of OSA on pain perception in patients with FM. Methods: In this pilot study, patients diagnosed with FM or FM and OSA, completed three self-reported questionnaires: Short-Form study results were analyzed. Scores were summarized using medians and interquartile ranges and are compared using Wilcoxon rank sum tests. Results: Overall FM (n = 25), female n=23 male n=3 mean age, 57.48 years. OSA n=17 (68%) and 8 (32%) were not. The SF-MPQ Sensory sub-scale scores and the SF-MPQ overall scores differed significantly between patients with and without OSA. The SF-MPQ Sensory sub-scale scores were significantly lower for patients with OSA (p=0.03), as were SF-MPQ overall scores (p=0.04). SSAS overall scores and IBQ overall scores did not differ significantly by OSA diagnosis. Correlations of the different dimensions of IBQ with SSAS and mean number of diagnoses in FM and FM+OSA, mean number of diagnoses in problem list of SSAS <= 30 was 29.5, mean number of diagnoses in SSAS >= 30 was 34.9. Discussion: Developing a better understanding of the effects of OSA on pain perception in patients with FM is needed for improved health status. More research is needed to see if higher pain perception and SSAS score lead to increased health care utilization and to evaluate the relationship between untreated disordered sleeping and pain perception in patients with FM. Conclusion: Our findings highlight the need for more research to evaluate the relationship between treated and untreated disordered sleeping, pain perception, somatization and illness behavior in the health status of individuals with FM.

The Coronavirus Disease (COVID-19) pandemic has contributed to a co-occurring psychiatric epidemic. Children and adolescents have been particularly impacted, with disruptions in continuity of learning and healthcare. Psychological stressors such as fear of infection, boredom, decreased socialization, supply shortages, and incomplete information have contributed to low mood, irritability, insomnia, and emotional exhaustion. Our study contributes to this research by quantifying the devastating psychiatric toll that the COVID isolation period and virtual schooling had on the mental health of children. The Loyola University Medical Center (LUMC) Consultation-Liaison Psychiatry Service (CLP) (Maywood, IL) designed a study to identify and analyze data regarding the total number of CLP consult requests, patient presentations to the emergency department (ED), and admissions to the Pediatrics floor and Pediatric Intensive Care Unit (PICU) during the COVID pandemic. IRB approval was obtained for this retrospective chart review study. ED visits and Pediatric floor/PICU admissions of all pediatric patients (6-18 years old), specifically those related to mental health, were identified using ICD-9 diagnostic coding for the dates of March 2019 through February 2022. The total number of admissions and encounter diagnoses were analyzed and compared between 3 pandemic periods: Pre-pandemic phase (March 2019-February 2020), acute pandemic phase: isolation/virtual schooling (March 2020-February 2021), and chronic pandemic phase: post-isolation/virtual schooling (March 2021-February 2022). During the chronic pandemic phase, ED visits and Pediatric floor/PICU admissions of all pediatric patients were identified via manual chart review of existing CLP patient lists. The total number of admissions, along with diagnoses during encounters, were compared between the 3 periods and psychiatric admissions were further subcategorized into intentional drug overdoses. In the pre-pandemic phase, there were 39,304 total encounters for children (6-18 years), with 11,189 ED-only visits, and 3,043 inpatient admissions. In the acute pandemic phase, total encounters fell to 15,779, with 4,631 ED-only visits, and 2,578 inpatient admissions. Pre-pandemic, 0.55% of all pediatric encounters required psychiatry consults compared to 1.32% after the onset of the pandemic. During the pre-pandemic phase, there were 27 PICU admissions for psychiatric-related conditions (i.e. intentional ingestion) or 4.52% of all PICU admissions. During the acute pandemic period, there were 57 PICU admissions for psychiatric-related conditions or 11.19% of all PICU admissions. Specifically, there was a rise in intentional ingestion cases from 25 prior to the pandemic to 44 after the onset of the pandemic. During the chronic pandemic period, there were 43 PICU admissions for psychiatric-related conditions. Of those 43 admissions, 33 were intentional drug overdoses. Total encounters during this phase were comparable to the pre-pandemic phase (39,304 encounters pre-pandemic vs. 32,544 encounters in chronic pandemic phase).At this large academic medical center, the pandemic has had a clear impact on total pediatric encounters, with a rise in the number of PICU admissions for psychiatric-related conditions. Findings from this study can be used to inform public policy and develop guidelines in preparation for future pandemics. Safeguards should be put in place to address the significant effects that social isolation and virtual schooling have on the mental health of children, including but not limited to widespread therapy sessions incorporated into the virtual school day and socially distanced in-person activities when safe.