Search

Background Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs. Method Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable. Results Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p’s $$\le$$ ≤ .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d = .68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System). Discussion These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims. Conclusion Mentalization-based treatment may be an effective treatment for patients with a broad range of PDs. Trial registration The study design was approved by the Leiden University Ethical Committee.

Abstract Aim There is limited evidence regarding predictors of changes in suicidal ideation (SI) in patients with major depressive disorder (MDD). The objective of this study was to describe changes in SI over a 6‐month period and identify their predictors from naturalistic observations of MDD patients. Methods In the cross‐sectional analysis, we examined 257 patients with MDD at the first‐visit assessment. Among the patients, 119 who completed the 6‐month assessment (completers) were included in the longitudinal analysis. For the evaluation of depressive symptoms, including SI, the Quick Inventory of Depressive Symptomatology‐Japanese version was administered at both the first‐visit and follow‐up assessments. At baseline, we also administered the Japanese version of the Ten Item Personality Inventory to assess personality traits and the PRIME Screen‐Revised to assess psychotic symptoms. Results In the cross‐sectional analysis of first‐visit patients, 36.2% (93/257) exhibited SI. Among completers, 14.3% (17/119) had prolonged SI. Among the completers with SI at the first‐visit assessment, 38.6% (17/44) had SI at the follow‐up assessment (prolonged SI). In linear regression models including all completers, prolonged SI was positively associated with endorsement of suspiciousness/persecutory ideas and negatively associated with higher age. Conclusion More than one‐third of completers who had SI at the first‐visit assessment experienced prolonged SI (SI at follow‐up). Our findings can help clinicians predict the course of MDD by identifying associated demographic and clinical characteristics.

Background: A prolonged repetitive transcranial magnetic stimulation (rTMS) treatment course could be beneficial for some patients experiencing major depressive episodes (MDE). We identified trajectories of rTMS response in depressive patients who received an extended rTMS treatment course and sought to determine which trajectories achieved the greatest benefit with a prolonged treatment course. Method: We applied group-based trajectory modeling to a naturalistic dataset of depressive patients receiving a prolonged course of sequential bilateral rTMS (up to 51 treatment sessions) to the dorsolateral prefrontal cortex. Trajectories of the PHQ-9 with extended treatment courses were characterized, and we explored the association between baseline clinical characteristics and group membership using multinomial logistic regression. Results: Among the 324 study participants, four trajectories were identified: “linear response, extended course” (N = 73; 22.5 %); “nonresponse” (N = 23; 7.1 %); “slowed response” (N = 159; 49.1 %); “rapid response, standard treatment length” (N = 69; 21.3 %). Only the “linear response, extended course” group showed considerable clinical improvement after receiving additional rTMS treatments. Greater baseline depressive symptoms were associated with linear response and non-response. Conclusion: Our results confirmed the distinctive response trajectories in depressive patients receiving rTMS and further highlighted that prolonged rTMS treatment courses may be beneficial for a subset of patients with higher initial symptom levels and linear early treatment response.

Background: Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs. Method: Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable. Results: Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p's ≤ .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d =.68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System). Discussion: These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims. Conclusion: Mentalization-based treatment may be an effective treatment for patients with a broad range of PDs. Trial registration: The study design was approved by the Leiden University Ethical Committee. [ABSTRACT FROM AUTHOR]

Aim: There is limited evidence regarding predictors of changes in suicidal ideation (SI) in patients with major depressive disorder (MDD). The objective of this study was to describe changes in SI over a 6‐month period and identify their predictors from naturalistic observations of MDD patients. Methods: In the cross‐sectional analysis, we examined 257 patients with MDD at the first‐visit assessment. Among the patients, 119 who completed the 6‐month assessment (completers) were included in the longitudinal analysis. For the evaluation of depressive symptoms, including SI, the Quick Inventory of Depressive Symptomatology‐Japanese version was administered at both the first‐visit and follow‐up assessments. At baseline, we also administered the Japanese version of the Ten Item Personality Inventory to assess personality traits and the PRIME Screen‐Revised to assess psychotic symptoms. Results: In the cross‐sectional analysis of first‐visit patients, 36.2% (93/257) exhibited SI. Among completers, 14.3% (17/119) had prolonged SI. Among the completers with SI at the first‐visit assessment, 38.6% (17/44) had SI at the follow‐up assessment (prolonged SI). In linear regression models including all completers, prolonged SI was positively associated with endorsement of suspiciousness/persecutory ideas and negatively associated with higher age. Conclusion: More than one‐third of completers who had SI at the first‐visit assessment experienced prolonged SI (SI at follow‐up). Our findings can help clinicians predict the course of MDD by identifying associated demographic and clinical characteristics. [ABSTRACT FROM AUTHOR]

Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps < 0.01). However, individual patients reported some negative effects of therapy. The results underline the value of thorough investigations of novel therapeutic interventions in naturalistic settings. [ABSTRACT FROM AUTHOR]

A prolonged repetitive transcranial magnetic stimulation (rTMS) treatment course could be beneficial for some patients experiencing major depressive episodes (MDE). We identified trajectories of rTMS response in depressive patients who received an extended rTMS treatment course and sought to determine which trajectories achieved the greatest benefit with a prolonged treatment course. We applied group-based trajectory modeling to a naturalistic dataset of depressive patients receiving a prolonged course of sequential bilateral rTMS (up to 51 treatment sessions) to the dorsolateral prefrontal cortex. Trajectories of the PHQ-9 with extended treatment courses were characterized, and we explored the association between baseline clinical characteristics and group membership using multinomial logistic regression. Among the 324 study participants, four trajectories were identified: "linear response, extended course" (N = 73; 22.5 %); "nonresponse" (N = 23; 7.1 %); "slowed response" (N = 159; 49.1 %); "rapid response, standard treatment length" (N = 69; 21.3 %). Only the "linear response, extended course" group showed considerable clinical improvement after receiving additional rTMS treatments. Greater baseline depressive symptoms were associated with linear response and non-response. Our results confirmed the distinctive response trajectories in depressive patients receiving rTMS and further highlighted that prolonged rTMS treatment courses may be beneficial for a subset of patients with higher initial symptom levels and linear early treatment response. • A moderate proportion of patients could benefit from the prolonged treatment course. • The baseline symptom severity predicts the membership of this subgroup. • We identified four trajectories of response, replicating our previous findings. [ABSTRACT FROM AUTHOR]

Objective: (1) To assess mental workloads of intensive care unit (ICU) nurses in 12-hour working shifts (days and nights) using eye movement data; (2) to explore the impact of stress on the ocular metrics of nurses performing patient care in the ICU. Background: Prior studies have employed workload scoring systems or accelerometer data to assess ICU nurses' workload. This is the first naturalistic attempt to explore nurses' mental workload using eye movement data. Methods: Tobii Pro Glasses 2 eye-tracking and Empatica E4 devices were used to collect eye movement and physiological data from 15 nurses during 12-hour shifts (252 observation hours). We used mixed-effect models and an ordinal regression model with a random effect to analyze the changes in eye movement metrics during high stress episodes. Results: While the cadence and characteristics of nurse workload can vary between day shift and night shift, no significant difference in eye movement values was detected. However, eye movement metrics showed that the initial handoff period of nursing shifts has a higher mental workload compared with other times. Analysis of ocular metrics showed that stress is positively associated with an increase in number of eye fixations and gaze entropy, but negatively correlated with the duration of saccades and pupil diameter. Conclusion: Eye-tracking technology can be used to assess the temporal variation of stress and associated changes with mental workload in the ICU environment. A real-time system could be developed for monitoring stress and workload for intervention development. [ABSTRACT FROM AUTHOR]

This study assessed the accuracy of a smartphone telematics algorithm that classifies car trips as driver or non-driver. Participants’ trips were measured for 4 weeks by Way to Drive, a research telematics application that uses the same data algorithms as leading auto-insurance companies. At the end of each week, participants completed a survey prompting them to review trips within the app and report time and nature of any misclassified trips. Overall accuracy of driver vs. non-driver classification was high (96.5 %, SD = 5.1 %). Sensitivity, the percentage of actual driver trips classified as such, was also high (97.5 %, SD = 4.6 %). Specificity, the percentage of non-driver trips classified as such, was slightly lower and more variable (91.2 %, SD = 14.8 %). The algorithm’s accuracy was generally robust to a variety of phone characteristics, vehicle features, and driving habits.

Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps

Physiological linkage refers to the degree to which two individuals' central/peripheral physiological activities change in coordinated ways. Previous research has focused primarily on linkage in the autonomic nervous system in laboratory settings, particularly examining how linkage is associated with social behavior and relationship quality. In this study, we examined how linkage in couples' daily somatic activity (e.g., synchronized movement measured from wrist sensors)-another important aspect of peripheral physiology-was associated with relationship quality and mental health. We focused on persons with neurodegenerative diseases (PWNDs) and their spousal caregivers, whose linkage might have direct implications for the PWND-caregiver relationship and caregiver's health. Twenty-two PWNDs and their caregivers wore wristwatch actigraphy devices that provided continuous measurement of activity over 7 days at home. PWND-caregiver activity linkage was quantified by the degree to which activity was "in-phase" or "anti-phase" linked (i.e., coordinated changes in the same or opposite direction) during waking hours, computed by correlating minute-by-minute activity levels averaged using a 10-min rolling window. Caregivers completed well-validated surveys that assessed their mental health (including anxiety and depression) and relationship quality with the PWND. We found that lower in-phase activity linkage, but not anti-phase linkage, was associated with higher caregiver anxiety. These dyad-level effects were robust, remaining significant after adjusting for somatic activity at the individual level. No effects were found for caregiver depression or relationship quality. These findings suggest activity linkage and wearables may be useful for day-by-day monitoring of vulnerable populations such as family caregivers. We offered several possible explanations for our findings.

• The study did not find any statistical difference in the driving outcomes examined; however the treatment effects for personalized feedback were consistently in the expected positive direction. • Young drivers in regional WA improved their speeding scores and overall driving performance scores compared to young drivers in the metropolitan area. • Females, significantly improved their harsh deceleration scores compared to males, regardless of group allocation. • This research highlight the use of smartphone telematics as an opportunity to not only enhance the safety of provisional young drivers but also provide data-informed decision making and policy development. Introduction : The role of real-time data capture (via telematics technology) is gathering prominence as a strategy to provide feedback to young drivers about important road safety issues. Method : A naturalistic driving study was undertaken to determine whether providing personalized feedback (via a smartphone app) to young provisional drivers aged 17–20 years living in metropolitan and regional Western Australia (WA) reduced their risky driving behavior compared to a control group who did not receive feedback. Speeding over the posted speed limit, harsh decelerations (braking), harsh accelerations and overall driving performance, were recorded continuously using the smartphone app during the 11-week study. Four separate Generalised Estimating Equations (GEE) linear regression models were undertaken after accounting for relevant confounders including driving exposure to determine the difference between the intervention and control group for the 4 driving outcomes obtained from the smartphone app. Results : The study found that there was no significant change in overall driving scores between the intervention and control groups (p = 0.35). However, the overall driving score significantly improved by 0.19 points for young provisional drivers who lived in regional areas compared to those in the metropolitan area (p = 0.05) after adjusting for potential confounders. There was also no significant change in harsh braking scores (p = 0.46) and harsh acceleration scores between the intervention and control groups (p = 0.26) However, harsh acceleration scores improved by 0.37 points for females compared to males (p = 0.04). Lastly, there was no significant change in speed scores between the control and intervention groups (p = 0.72). However, the speed scores of participants who lived in regional WA improved by 0.22 points compared to those in the metropolitan area (p = 0.02). Furthermore, for every 1,000 km travelled, speed scores worsened by −0.08 points (p < 0.01) regardless of group. Conclusions : The study did not find any statistical difference in the driving outcomes examined; however the treatment effects for feedback were consistently in the expected positive direction. Young drivers in regional WA also improved their speeding scores and overall driving performance scores compared to young drivers in the metropolitan area. Females, also significantly improved their harsh deceleration scores compared to males, regardless of group allocation. These results highlight the use of smartphone telematics as an opportunity to not only enhance the safety of provisional young drivers but also provide data-informed decision making and policy development. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term treatment course. Identifying brain-based biomarkers of early rTMS therapeutic response remains an important unanswered question. In this pilot study, we examined the effects of rTMS on individuals with pharmacoresistant depression using a graph-based method, called Functional Cortical Networks (FCN), and serial electroencephalography (EEG). We hypothesized that changes in brain activity would occur early in treatment course. Methods: A total of 15 patients with pharmacoresistant depression underwent five rTMS sessions (5Hz over the left dorsolateral prefrontal cortex, 120%MT, up to 4,000 pulses/session). Five participants received additional rTMS treatment, up to 40 sessions. Resting EEG activity was measured at baseline and following every five sessions, using 64-channel EEG, for 10 minutes with eyes closed. An FCN model was constructed using time-varying graphs and motif synchronization. The primary outcome was acute changes in weighted-node degree. Secondary outcomes included serial FFT-based power spectral analysis and changes in depressive symptoms measured by the 9-Item Patient Health Questionnaire (PHQ-9) and the 30-itemInventory of Depressive Symptoms-Self Report (IDS-SR). Results: We found a significant acute effect over the left posterior area after five sessions, as evidenced by an increase in weighted-node degree of 37,824.59 (95% CI, 468.20 to 75,180.98) and a marginal enhancement in the left frontal region (t (14) = 2.0820, p = 0.056). One-way repeated measures ANOVA indicated a significant decrease in absolute beta power over the left prefrontal cortex (F (7, 28) = 2.37, p = 0.048) following ten rTMS sessions. Furthermore, a significant clinical improvement was observed following five rTMS sessions on both PHQ-9 (t (14) = 2.7093, p = 0.017) and IDS-SR (t (14) = 2.5278, p = 0.024) and progressed along the treatment course. Discussion: Our findings suggest that FCN models and serial EEG may contribute to a deeper understanding of mechanisms underlying rTMS treatment. Additional research is required to investigate the acute and serial effects of rTMS in pharmacoresistant depression and assess whether early EEG changes could serve as predictors of therapeutic rTMS response. [ABSTRACT FROM AUTHOR]

In 2008, the U.S. FDA approved rTMS as a treatment against medication-resistant depression. However, real-world rTMS outcomes remain understudied. This study investigates how rTMS for depression is delivered in routine clinical practice in France, and measures its effectiveness as well as its moderators. Five centers provided retrospective data on patients who were treated with rTMS for treatment-resistant depression from January 2015 to December 2020. Patients were assessed twice using a hetero-questionnaire, with baseline and immediate post-treatment assessments. We conducted univariate analyses to study which factors were significantly associated with rTMS effectiveness. We then included age, gender, and significant factors in a multivariate model. We collected data from 435 patients with a mean age of 51.27 (14.91): 66 % were female, and 26 % suffered from bipolar depression. Stimulation was delivered using four different stimulation parameters: 1 Hz (7 % of the individuals), 10 Hz (43 %), 20 Hz (12 %), and 50 Hz (intermittent Theta Burst Stimulation, iTBS) (38 %). The mean improvement of depressive symptoms was 33 % (p < 0.001, effect-size: 0.79). Response and remission rates were of 31 % and 22.8 %, respectively. In the multivariate analysis, improvement in depressive symptoms was associated with higher baseline symptoms. This is one of the largest studies that investigates, with careful clinician-rated scales by trained psychiatrists, the effect of rTMS in naturalistic settings. Repetitive TMS appears to be effective in routine clinical practice, although its efficacy could be improved by analyzing predictors of response, as well as personalized targeting of specific brain areas. • This is the largest study to evaluate the efficacy of rTMS on the dorsolateral prefrontal cortex (DLPFC) in patients with treatment-resistant depression (TRD) in real-world practice, using a standardized clinical hetero-assessment. • Data were analyzed from 435 patients with treatment-resistant depression, 26% of whom had bipolar depression. • The mean improvement was 33% (SD = 31%), the mean (SD) decrease in depression severity assessed by MADRS was 9.47 (8.73), response and remission rates were 31% and 23%, respectively. • Multivariate analyses showed a significant effect of baseline MADRS score on depression score reduction, and an association with remission with a low baseline MADRS score. • No serious adverse events or potentially predictive events (eg, seizures or maniac switching) were reported. [ABSTRACT FROM AUTHOR]

Background: Intensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses' workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients. Method: A prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods. Results: Participants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < 0.001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts (p = 0.58) at the COVID unit. The cohorts expressed similar contributors to stress, based in communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers. Conclusion: Nurses in COVID units, irrespective of whether they care for a COVID patient, experience occupational stress and burnout. [ABSTRACT FROM AUTHOR]

BackgroundIntensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses’ workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients.MethodA prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods.ResultsParticipants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p

Previous studies have shown, although not consistently, that first generation antipsychotics (FGA) are associated with a prevalence of extrapyramidal symptoms (EPS) higher than second generation antipsychotics (SGA). We assessed the prevalence and the incidence of antipsychotic-induced EPS in a large sample of community-dwelling Italian persons with schizophrenia before and after a 4-year naturalistic treatment, to shed light on their natural evolution and to identify possible predicting factors. EPS and psychopathology were assessed in 571 subjects with schizophrenia before (baseline) and after 4-year follow-up. Patients underwent treatment with SGA and/or FGA according to the referring clinicians' judgment. Relationships between EPS and psychopathology were assessed by network analysis, while a linear multiple regression investigated factors correlated to the presence of EPS at follow-up. EPS were significantly more frequent in the FGA- than in the SGA-treated group, and patients with EPS presented a more severe psychopathology. Parkinsonism was directly and positively connected with poor emotional expression at baseline and with poor emotional expression and disorganization at follow-up. Over the 4-year follow-up, emergent EPS were more frequent in FGA-treated patients, while relieved EPS occurred more frequently in SGA-treated persons. The presence of EPS at follow-up was significantly associated with EPS at baseline, illness duration, antipsychotic generation and the daily dose of antipsychotic medications. After a 4-year naturalistic treatment, EPS disappeared more frequently in SGA-treated patients, while they emerged more frequently in FGA-treated individuals. Therefore, although SGA did not eliminate the risk of EPS, these drugs seem to be associated to a more favorable EPS natural evolution. [ABSTRACT FROM AUTHOR]

While naturalistic stimuli, such as movies, better represent the complexity of the real world and are perhaps crucial to understanding the dynamics of emotion processing, there is limited research on emotions with naturalistic stimuli. There is a need to understand the temporal dynamics of emotion processing and their relationship to different dimensions of emotion experience. In addition, there is a need to understand the dynamics of functional connectivity underlying different emotional experiences that occur during or prior to such experiences. To address these questions, we recorded the EEG of participants and asked them to mark the temporal location of their emotional experience as they watched a video. We also obtained self-assessment ratings for emotional multimedia stimuli. We calculated dynamic functional the connectivity (DFC) patterns in all the frequency bands, including information about hubs in the network. The change in functional networks was quantified in terms of temporal variability, which was then used in regression analysis to evaluate whether temporal variability in DFC (tvDFC) could predict different dimensions of emotional experience. We observed that the connectivity patterns in the upper beta band could differentiate emotion categories better during or prior to the reported emotional experience. The temporal variability in functional connectivity dynamics is primarily related to emotional arousal followed by dominance. The hubs in the functional networks were found across the right frontal and bilateral parietal lobes, which have been reported to facilitate affect, interoception, action, and memory-related processing. Since our study was performed with naturalistic real-life resembling emotional videos, the study contributes significantly to understanding the dynamics of emotion processing. The results support constructivist theories of emotional experience and show that changes in dynamic functional connectivity can predict aspects of our emotional experience. [ABSTRACT FROM AUTHOR]

Long-term neurological and neurodevelopmental sequelae are a concerning issue for people with Enterovirus A71 (EV-A71) central nervous system (CNS) infection. Unfortunately, no longitudinal prospective clinical study has systematically investigated the consequences of EV-A71 CNS infection during early life on the later development of other psychiatric disorders. In this naturalistic longitudinal follow-up design, we followed forty-three youth, who got EV-A71 CNS involvement 6–18 years ago and were enrolled in other EV-A71 clinical studies then. Their psychiatric presentation, emotional/behavioral problems, and cognitive issues were examined using a psychiatrist-conducted diagnostic interview, parent- and self-rated questionnaires, and neuropsychological tests, respectively. We compared the prevalence of psychiatric disorders in youth with EV-A71 CNS involvement to a nationally representative cohort. Emotion/behavior and cognition in EV-A71-CNS-infected youth were compared to those in a matched community-based sample of healthy controls and youth with attention-deficit/hyperactivity disorder (ADHD). Compared to a national sample (absolute ADHD prevalence 10.1%), youth with EV-A71 CNS involvement had three times the odds of receiving an ADHD diagnosis (standardized prevalence ratio, 95% CI = 1.8, 4.2; absolute ADHD prevalence 34.9%). No other psychiatric diagnoses were more common in EV-A71-CNS-infected youth. Compared to community-based ADHD youth, EV-A71-CNS-infected youth with psychiatric disorders showed comparable core ADHD symptoms, opposition/defiance, autistic features, and suboptimal sustained attention performance (based on the Conners’ Continuous Performance Test), all of which were more severe than healthy controls. EV-A71-CNS-infected youth without psychiatric disorders showed comparable autistic features to EV-A71-CNS-infected youth with psychiatric disorders and ADHD youth. EV-A71 CNS involvement may cause long-term, adverse psychiatric outcomes that develop into an ADHD diagnosis alongside social/communication/emotion problems and autistic features. We recommend earlier identification and intervention of these problems among these children.

Background: Treatment resistant depression is common in older adults and treatment is often complicated by medical comorbidities and polypharmacy. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for this group due to its favorable profile. However, early influential studies suggested that rTMS is less effective in older adults. This evidence remains controversial. Methods: Here, we evaluated the rTMS treatment outcomes in a large international multicenter naturalistic cohort of >500 patients comparing older vs. younger adults. Results: We show that older adults, while having similar antidepressant response to younger adults, respond more slowly, which may help to explain differences from earlier studies when the duration of a treatment course was shorter. Conclusions: Such evidence helps to resolve a long-standing controversy in treating older depressed patients with rTMS. Moreover, these findings provide an important data point in the call to revise policy decisions frommajor insurance providers that have unfairly excluded older adults. [ABSTRACT FROM AUTHOR]

There is limited evidence regarding predictors of long-term clinical outcomes in patients with bipolar disorder (BD). The objective of this study was to describe 3-year clinical outcomes and identify their predictors from participants in the multicenter treatment survey for BD in psychiatric outpatient clinics (MUSUBI). The MUSUBI was a naturalistic study investigating patients with BD in real-world clinical practice. Our study extracted data regarding 1647 outpatients with BD from 2016, 2017, and 2019 as baseline, 1-year, and 3-year assessments. As clinical outcomes, we assessed the presence of time ill (depressive and manic) during the 1 year prior to the 3-year assessment and durable remission (53 weeks or more) prior to the 3-year assessment. Participants with durable remission prior to the 3-year assessment had significant associations with diagnosis of a personality disorder and duration of continuous remission at baseline. Regarding the presence of depressive symptoms during the 1 year prior to the 3-year assessment, work status, Global Assessment of Functioning (GAF) scores, suicidal ideation, and duration of continuous remission at baseline had significant associations with this outcome. At the 3-year assessment, 19.3% of participants (318/1647) achieved durable remission, while 47.5% of them (782/1647) were not remitted. Our findings can help clinicians predict the illness course of BD by understanding demographic and clinical characteristics. [ABSTRACT FROM AUTHOR]

The study adopts a naturalistic perspective, looking at the relationship between socio-economic status (SES), activities and variation sets in child-directed speech (CDS) to Spanish-speaking Argentinian toddlers. It aims to determine the effect of SES and type of activity on the proportion of words and utterances in variation sets and on the pragmatic function they serve in interaction. Thirty two children (mean: 14.3 months) and their families were audio-recorded for four hours and the middle two hours were analyzed using CLAN. We developed an automatic algorithm for variation sets extraction that compares noun, verb and adjective lexemes in successive utterances. Mixed-effects beta regression showed SES and activity type effects on the proportion of variation sets and on the pragmatic function served by variation sets. Findings revealed that the contextual variables considered impact on how interlocutors organize the information to young children at the local level of natural at home interactions. [ABSTRACT FROM AUTHOR]

Digital streaming services, such as Netflix, provide viewers with unprecedented access to foreign language TV and film content. The two most prevalent translation methods are subtitling and dubbing, and today's Netflix viewer often has the opportunity to select a specific translation method. While previous research on subtitling/dubbing has investigated a wide range of outcome variables, the impact on viewer enjoyment has received virtually no attention. This research is, to our knowledge, the first investigation that has allowed participants to (a) view content in the natural setting, and (b) make a direct comparison of both translation methods by using a repeated measures design. Specifically, participants (N = 45) watched back-to-back episodes of a Netflix original foreign language series at a time and place that they choose to replicate the typical viewing experience. In between episodes, participants changed the translation method, allowing for a direct comparison of subtitling/dubbing on viewer enjoyment. Results indicated that the subtitling condition not only increased enjoyment of individual episodes, but a strong majority indicated they would select subtitling over dubbing to enjoy future foreign language viewing. Limitations of the generalizability of the results and ideas for future research using the naturalistic repeated measures design outlined in this paper are discussed. [ABSTRACT FROM AUTHOR]

Cognitive–behavioral therapy is a well-established treatment for obsessive–compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y–BOCS (Yale–Brown obsessive–compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y–BOCS in terms of the interference, severity, and impairment of obsessive–compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes. [ABSTRACT FROM AUTHOR]

Objective: The effectiveness of ECT under naturalistic conditions has not been well-studied. The current study aimed to 1) characterize a naturalistic sample of ECT patients; and 2) examine the long-term outcomes of ECT on depressive symptoms (Beck Depression Inventory-II; BDI-II) and functional disability symptoms (WHO Disability Assessment Schedule 2.0) in this sample. Methods: Participants were adults who received ECT for a major depressive episode at an ambulatory ECT clinic between September 2010 and November 2020. Clinical and cognitive assessments were completed at baseline (n = 100), mid-ECT (n = 94), 2–4 weeks post-ECT (n = 64), 6-months post-ECT (n = 34), and 12-months post-ECT (n = 19). Results: At baseline, participants had severe levels of depressive symptoms (BDI-II: M = 41.0, SD = 9.4), and 62.9% screened positive for multiple psychiatric diagnoses on the MINI International Neuropsychiatric Interview. Depressive symptoms (F (4,49.1) = 49.92, P < 0.001) and disability symptoms (F (3,40.72) = 12.30, P < 0.001) improved significantly following ECT, and this was maintained at 12-months follow-up. Improvement in depressive symptoms trended towards significantly predicting reduction in disability symptoms from baseline to post-ECT, (F (1,56) = 3.67, P = 0.061). Although our clinical remission rate of 27% (BDI-II score ≤ 13 and ≥ 50% improvement) and overall response rate of 41.3% (≥ 50% improvement in BDI-II score) were lower than the rates reported in the extant RCT and community ECT literature, 36% of those treated with ECT were lost to follow-up and did not complete post-ECT rating scales. At baseline, remitters had significantly fewer psychiatric comorbidities, lower BDI-II scores, and lower disability symptoms than non-responders (P < 0.05). Conclusions: Participants were severely symptomatic and clinically complex. ECT was effective at reducing depressive symptoms and functional disability in this heterogeneous sample. Although a large amount of missing data may have distorted our calculated response/remission rates, it is also likely that clinical heterogeneity and severity contribute to lower-than-expected remission and response rates to ECT. [ABSTRACT FROM AUTHOR]

BackgroundTreatment resistant depression is common in older adults and treatment is often complicated by medical comorbidities and polypharmacy. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for this group due to its favorable profile. However, early influential studies suggested that rTMS is less effective in older adults. This evidence remains controversial.MethodsHere, we evaluated the rTMS treatment outcomes in a large international multicenter naturalistic cohort of >500 patients comparing older vs. younger adults.ResultsWe show that older adults, while having similar antidepressant response to younger adults, respond more slowly, which may help to explain differences from earlier studies when the duration of a treatment course was shorter.ConclusionsSuch evidence helps to resolve a long-standing controversy in treating older depressed patients with rTMS. Moreover, these findings provide an important data point in the call to revise policy decisions from major insurance providers that have unfairly excluded older adults.

Objective: To identify physiological correlates to stress in intensive care unit nurses. Background: Most research on stress correlates are done in laboratory environments; naturalistic investigation of stress remains a general gap. Method: Electrodermal activity, heart rate, and skin temperatures were recorded continuously for 12-hr nursing shifts (23 participants) using a wrist-worn wearable technology (Empatica E4). Results: Positive correlations included stress and heart rate (ρ =.35, p <.001), stress and skin temperature (ρ =.49, p <.05), and heart rate and skin temperatures (ρ =.54, p =.0008). Discussion: The presence and direction of some correlations found in this study differ from those anticipated from prior literature, illustrating the importance of complementing laboratory research with naturalistic studies. Further work is warranted to recognize nursing activities associated with a high level of stress and the underlying reasons associated with changes in physiological responses. Application: Heart rate and skin temperature may be used for real-time detection of stress, but more work is needed to validate such surrogate measures. [ABSTRACT FROM AUTHOR]

While naturalistic stimuli, such as movies, better represent the complexity of the real world and are perhaps crucial to understanding the dynamics of emotion processing, there is limited research on emotions with naturalistic stimuli. There is a need to understand the temporal dynamics of emotion processing and their relationship to different dimensions of emotion experience. In addition, there is a need to understand the dynamics of functional connectivity underlying different emotional experiences that occur during or prior to such experiences. To address these questions, we recorded the EEG of participants and asked them to mark the temporal location of their emotional experience as they watched a video. We also obtained self-assessment ratings for emotional multimedia stimuli. We calculated dynamic functional the connectivity (DFC) patterns in all the frequency bands, including information about hubs in the network. The change in functional networks was quantified in terms of temporal variability, which was then used in regression analysis to evaluate whether temporal variability in DFC (tvDFC) could predict different dimensions of emotional experience. We observed that the connectivity patterns in the upper beta band could differentiate emotion categories better during or prior to the reported emotional experience. The temporal variability in functional connectivity dynamics is primarily related to emotional arousal followed by dominance. The hubs in the functional networks were found across the right frontal and bilateral parietal lobes, which have been reported to facilitate affect, interoception, action, and memory-related processing. Since our study was performed with naturalistic real-life resembling emotional videos, the study contributes significantly to understanding the dynamics of emotion processing. The results support constructivist theories of emotional experience and show that changes in dynamic functional connectivity can predict aspects of our emotional experience.

• Evaluated accelerated TMS for TRD treatment in real-world Quebec center setting. • Review of 247 TRD patients; 36.1 % achieved remission with accelerated TMS. • Key predictors: depression severity, patient age, prior antidepressant trials. • Patients not completing TMS had more severe symptoms, greater resistance. • Study confirms TMS efficacy in real-world TRD populations beyond clinical trials. To assess the effectiveness of accelerated transcranial magnetic stimulation (TMS) for treatment-resistant depression (TRD) in a tertiary referral center in Quebec, Canada, focusing on a real-world clinical setting. We reviewed the data of 247 TRD patients treated between January 2012 and May 2022 who received accelerated TMS. Participants were adults diagnosed with unipolar or bipolar depression, resistant to at least two antidepressant trials, and assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Significant symptom reduction was found in the completer sample (N = 147), with 46.3 % of patients meeting post-treatment response criteria and 36.1 % achieving remission. Baseline severity of depression, age, and the number of antidepressant trials were key predictors of treatment outcomes. Patients who did not complete treatment had generally more severe depressive and anxious symptoms and greater treatment resistance. No significant differences in response rates were observed across different TMS coils. The study demonstrated the effectiveness and tolerability of accelerated TMS for TRD in a real-world clinical setting. [ABSTRACT FROM AUTHOR]

BackgroundThe aim of this study was to investigate the effectiveness of psychotherapeutic interventions for clinically referred adolescents, as well as to examine whether sociodemographic, clinical, or treatment-related variables and patients’ role expectations predict treatment outcome or are possible predictors of treatment dropout.MethodThe study comprised 58 adolescents (mean age 14.2, 65.5% female) suffering from diverse psychiatric disorders referred to psychotherapeutic interventions conducted in outpatient care. The outcome measures, The Beck Depression Inventory, and the Clinical Outcomes in Routine Evaluation – Outcome Measure were filled in at baseline and at 3-, 6-, and 12-month follow-ups. Possible predictors were assessed at baseline.ResultsThe results indicate that the mean level of symptoms and psychological distress decreased during the treatment, most reduction occurring in the first 6 months. The frequency of treatment sessions was the strongest predictor of good outcome. Adolescents with a higher level of externalizing problems or lower level of expectations for their own active role in treatment seem to have a higher risk of dropping out.ConclusionOffering intensive treatment for a shorter period might be the most efficient way to gain symptom reduction and decrease psychological distress in psychotherapeutic interventions with adolescents. Being aware of externalizing behavior and increasing the adolescents’ own agency during the assessment could strengthen commitment and result in the adolescent benefiting more from treatment.

Background: The aim of this study was to investigate the effectiveness of psychotherapeutic interventions for clinically referred adolescents, as well as to examine whether sociodemographic, clinical, or treatment-related variables and patients' role expectations predict treatment outcome or are possible predictors of treatment dropout. Method: The study comprised 58 adolescents (mean age 14.2, 65.5% female) suffering from diverse psychiatric disorders referred to psychotherapeutic interventions conducted in outpatient care. The outcome measures, The Beck Depression Inventory, and the Clinical Outcomes in Routine Evaluation – Outcome Measure were filled in at baseline and at 3-, 6-, and 12-month follow-ups. Possible predictors were assessed at baseline. Results: The results indicate that the mean level of symptoms and psychological distress decreased during the treatment, most reduction occurring in the first 6 months. The frequency of treatment sessions was the strongest predictor of good outcome. Adolescents with a higher level of externalizing problems or lower level of expectations for their own active role in treatment seem to have a higher risk of dropping out. Conclusion: Offering intensive treatment for a shorter period might be the most efficient way to gain symptom reduction and decrease psychological distress in psychotherapeutic interventions with adolescents. Being aware of externalizing behavior and increasing the adolescents' own agency during the assessment could strengthen commitment and result in the adolescent benefiting more from treatment. [ABSTRACT FROM AUTHOR]

This paper proposes a non-parametric Bayesian approach to detect the change-points of intensity rates in the recurrent-event context and cluster subjects by the change-points. Recurrent events are commonly observed in medical and engineering research. The event counts are assumed to follow a non-homogeneous Poisson process with piecewise-constant intensity functions. We propose a Dirichlet process mixture model to accommodate heterogeneity in subject-specific change-points. The proposed approach provides an objective way of clustering subjects based on the change-points without the need of pre-specified number of latent clusters or model selection procedure. A simulation study shows that the proposed model outperforms the existing Bayesian finite mixture model in detecting the number of latent classes. The simulation study also suggests that the proposed method is robust to the violation of model assumptions. We apply the proposed methodology to the Naturalistic Teenage Driving Study data to assess the change in driving risk and detect subgroups of drivers. [ABSTRACT FROM AUTHOR]

• This study collected video data from cameras attached to bicycles of group riders. • The most common unsafe event involved a motor vehicle attempting to pass the group. • Motorists were at fault for 83% of unsafe events but few involved reckless behaviour. • Motorist education and infrastructure modifications may reduce unsafe events. Little is known about the safety issues affecting non-professional group riders. This study aimed to identify the most common unsafe events involving a motor vehicle that occurred while group riding, describe their characteristics and suggest potential preventative measures. A naturalistic study collected video footage from cameras attached to the bicycles of group riders who rode on-road for training, fitness or recreation in Perth, Western Australia. Fifty-two riders from 40 different riding groups, recorded footage of 126 group riding trips, resulting in 135 h of video. A total of 108 unsafe events ('near-crashes/ crash relevant events' and ' close passing only events') involving the group riders and a motor vehicle were observed. The most common type of unsafe event involved a motor vehicle attempting to pass/ overtake the group (65.7%). For 39.4% of the passing events, the presence of road infrastructure ahead (e.g. roundabout, traffic island) prevented safe passing and led to an unsafe event. Motorists were at fault for 83.3% of all unsafe events and reckless behaviour by the motorist was observed for 13.3% of these at-fault events. Aggressive communication on the part of the motorist or rider/s was observed for 15% of all unsafe events. This study highlighted that motorists were at fault for the majority of unsafe events involving group riders but only a small proportion involved reckless behaviour. Further research should examine the effectiveness of motorist education as well as infrastructure modifications on popular group riding routes, for reducing unsafe events involving group riders. [ABSTRACT FROM AUTHOR]

Objective: Speeding behavior is recognized as one of the three main causes of risk on the roads and the most frequent ordinary violation among truck drivers. The study reported in this article focused on the driving anger personality trait and its role in predicting the observed speeding behavior in a sample of truck drivers.Methods: A longitudinal study design was implemented, where 93 Serbian truck drivers filled in an adapted form of the Driving Anger Scale designed to assess the amount of driving anger evoked by specific traffic situations. The drivers' second-by-second speeding behavior data were captured using GPS tracking and recording devices installed in the vehicles over a period of six months. Hierarchical multiple linear regression was used to examine the predictive performance of driving anger.Results: The results showed that more than three fourths of the exceeded speed ranged from 1 to 9 km/h and the highest percentage of speed events occurred in urban areas. The findings suggest that truck drivers experienced the highest level of anger in driving because of the discourteous and illegal behavior of other drivers. Younger truck drivers are more likely to drive fast compared to older drivers. Truck drivers who perform driving tasks more often and spend less time driving are more likely to participate in speed events. The results revealed that the subscales of anger, hostile gestures and traffic obstructions have a positive effect, while slow driving has a negative effect on the observed speeding behavior of truck drivers.Conclusions: This study confirms the predictive performance of driving anger facets. The results of the research can help us improve our understanding of the mechanisms of speeding behavior of truck drivers. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to describe the quality of naturalistic communication between patients with advanced cancer and their spouse caregivers using observational methods. We also assessed the association between patient and caregiver communication behaviors and psychological and physical health using the actor-partner interdependence model.Methods: Data on 81 dyads were gathered as part of a prospective observational study. Patients with advanced cancer and their spouse caregivers completed demographic, physical health, and emotional well-being questionnaires. Cancer and relationship communication captured in "day-in-the-life" audio recordings were coded using Gottman's Turning System to assess the quality of bids for attention and responses.Results: Bids for attention were most often informational (Low Bids) and responses were mostly positive and effortful (Turn Towards); patients and caregivers did not significantly differ in communication behavior. More effortful bids for attention (High Bids) were associated with more positive and effortful responses. Patient communication behaviors were significantly associated with caregiver emotional well-being, whereas caregiver communication behaviors were significantly associated with their own emotional well-being and patient physical health.Conclusions: While patients may benefit from caregivers' more positive and engaged communication at home, the emotional labor of focusing on and engaging the patient may take a toll on caregivers' own well-being. This work contributes to the understanding of what everyday communication looks like for patients with advanced cancer and their spouse caregivers and how this communication may impact physical and psychological health. Our findings provide a foundation to develop guidelines for psychosocial couple-based interventions. [ABSTRACT FROM AUTHOR]

A naturalistic field observation study is presented, exploring the experienced riders' eye fixations on specific traffic objects and their relative semantic content during lane-splitting manoeuvre in urban settings. Six experienced motorcyclists rode their own motorcycles equipped with an eye-tracking system. Data were extracted using manual video annotation and stimulated retrospective think-aloud methods. In total, 54 cases of lane-splitting (i.e., passing between a consecutive set of three moving cars) were analysed in terms of traffic objects and car-body parts fixated upon. Eye-fixation results on traffic objects show that all six riders tended to fixate less on the nearest target cars, allocating more fixations in monitoring the farthest target car and traffic ahead. In addition, all six riders fixated consistently on specific car-body parts of the target cars, namely, on the front body parts of the nearest target car (i.e. wing mirror, front side window, and front wing/tyre) and on the rear body parts of the farthest target car (i.e., rear light, rear quarter pillar, and rear wing/tyre). Riders' commentaries revealed that the aforementioned fixations were intentionally made in search of (1) assessing the level of drivers' attentiveness of the neighboring car(s), and (2) anticipating the possible path deviations of the neighboring car(s), for monitoring the upcoming contingencies in the traffic ahead rather than simply monitoring the actual movements of the target cars. Implications for developing specifications of riders' and drivers' assistance systems are discussed. [ABSTRACT FROM AUTHOR]

Background: Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction.Methods: Participants were treatment-seeking patients (N = 247) at an outpatient anxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses.Results: Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081).Limitations: This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group.Conclusions: These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples. [ABSTRACT FROM AUTHOR]

Depression has a chronic and recurrent course often with early onset and is the leading cause of disability worldwide. In contrast to diagnoses for other conditions which rely on precise medical tests, the diagnosis of depression still focuses exclusively on symptom reports. As a result, heterogeneous patient groups are included under broad categories. Furthermore, in the absence of companion diagnostic tests, choosing specific treatments for patients remains imprecise with only one-third of patients entering remission with initial treatment, with others requiring multiple intervention steps to achieve remission. In addition to improving treatment outcomes, disease prevention is essential to reduce overall disease burden. Adolescence is a critical window where complex emotional, social, familial, and biological shifts may predispose to lifelong depression. Thus, personalized medicine, integrating individual variability in genes, brain function, and clinical phenotypes, can offer a comprehensive approach to provide precise diagnosis, novel drug development, optimal treatment assignment, and prevention of illness and its associated burden. Texas Resilience Against Depression study (T-RAD) encompasses two natural history, longitudinal (10 + years), prospective studies (D2K and RAD), each enrolling 2500 participants. The D2K study follows participants (ages 10 years and older) who have a current or past diagnosis of depression or bipolar disorder. The RAD study follows participants aged 10–24 years who are at risk for depression but not yet suffering from the disease. The T-RAD study will help to uncover the socio-demographic, lifestyle, clinical, psychological, and neurobiological factors that contribute to mood disorder onset, recurrence, progression, and differential treatment response. [ABSTRACT FROM AUTHOR]

Objectives: Mindfulness-based cognitive therapy (MBCT), an intervention that integrates mindfulness with cognitive-behavioral therapy, is an 8-week program originally developed to prevent relapses in patients with depression. Previous studies have demonstrated the efficacy of MBCT for preventing relapse, but few studies have evaluated MBCT in naturalistic conditions with real-world samples. Therefore, we sought to explore the characteristics and experiences of individuals receiving MBCT in primary care. Methods: Mixed-methods approach combining descriptive and qualitative data. Quantitative data were obtained from 269 individuals from different socioeconomic backgrounds who participated in an MBCT program in our healthcare area during the years 2017 and 2018. Qualitative data were obtained from a subsample of participants who agree to participate in semi-structured individual interviews. An interpretative phenomenological analysis (IPA) approach was used to analyze the qualitative data. Results: In the whole sample (n = 269), the most commonly diagnosed disorders were adjustment (41.6%), mood (22.7%), and anxiety (14.1%). Most participants (60%) were taking psychotropic medications (mainly antidepressants). Overall, mindfulness training improved depressive and anxiety symptoms, regardless of the specific diagnosis. A subsample of 14 individuals participated in the qualitative study. Four overarching themes emerged from the IPA analysis in this subsample: (1) effects of mindfulness practice, (2) learning process, (3) group experience, and (4) mindfulness in the healthcare system. Conclusions: The findings of this naturalistic, mixed-methods study suggest that MBCT could be an effective approach to treating the symptoms of common mental disorders in the primary care setting. [ABSTRACT FROM AUTHOR]

The One-to-One program aims to reduce criminal recidivism among prisoners shortly awaiting release, and among probationers. Of 1,484 program participants in Sweden, 776 contained adequate data for analysis. Pre- and post-program scores were available for the Alternative Thinking Test, Levenson's Locus of Control Scale, Skill Survey, Citizen Scale, and Problem Checklist, all areas addressed in the program. This study examined predictive properties of test scores and background characteristics regarding recidivism, as well as differences between sub-groups. All post-tests indicated pro-social changes. Older participants were more likely to complete the program. The most potent predictor for non-recidivism was program completion, with non-completers 64% more likely to re-offend. Significant associations occurred between recidivism and the tests measuring skill improvement over time, chance locus of control pre- and post-program, and attitudes and values (Citizen Scale), partly supporting the theory behind the program. [ABSTRACT FROM AUTHOR]

Copyright of Praxis der Kinderpsychologie und Kinderpsychiatrie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out. [ABSTRACT FROM AUTHOR]

The number of older adults is increasing, especially among low- and middle-income countries. This raises specific issues related to healthcare since, as people are living longer, it is much more likely they will be living with complex co-morbidities, both physical and mental. In a naturalistic study from a private healthcare clinic from an industrial town in North India, details of 52 patients (mean age 72.4 years) were collected. Two thirds were male, and a vast majority attended the clinic accompanied by a family member. Those with different types of dementias were much more likely to present with sleep disturbances. A significant number of patients were illiterate or poorly educated, and a large number dropped out of healthcare. Reasons for this are discussed and detailed presentations regarding symptoms are described. Healthcare policies must take into account rural urban factors and ensure that policies take into account healthcare needs of older adults across geographical areas and complex co-morbidities. [ABSTRACT FROM AUTHOR]

Time perception is an important psychological concept and many studies have established a link between time perception and wellbeing outcomes. Prior research and accounts of human experiences have shown that the onset of COVID-19 and related lockdowns led to distortions in time perception especially in the early months. This exploratory study was conducted longitudinally across three survey time points during the COVID-19 pandemic, Dec 2020 (N = 452), March 2021 (N = 302), and March 2022 (N = 228), focusing on remote workers in the US. This is one of the first studies looking to surface relationships between shifts in time perception in relation to shifts in nature exposure (both indoor and outdoor) during the pandemic. In this study we focus on four measures of time perception: overall perceived speed of time passage, day-to-day perceived speed of time passage, blurring of boundaries between time markers, and time perspectives. As hypothesized, our results show that during the pandemic, as time passed, people experienced a shift towards faster perceived speed of time passage, both overall and day-to-day, as well as a decrease in blurring of boundaries. We also found indoor nature exposure to be significantly associated with faster overall and day-to-day perceived speed of time passage, while outdoor exposure was marginally significantly associated with faster day-to-day perceived speed of time passage. This study is an initial step to understand how nature exposure might be a valuable way of mitigating temporal distortions, even in circumstances as adverse as a global pandemic. • Longitudinal study conducted across three survey time points during COVID-19 pandemic. • Naturalistic study examining the impact of nature exposure on time perception. • Indoor and outdoor nature exposure were studied. • Four different measures of time perception were measured. • Nature exposure was associated with faster perceived speed of time passage. [ABSTRACT FROM AUTHOR]