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Day-to-day we have to make choices. Even simple decisions involve complex cognitive processes that are still not clearly understood. When it comes to critical decisions which may lead to impactful and irreversible consequences, the understanding of the decision-making process is highly relevant. Dysfunctional coping responses may lead to stress and ultimately to trauma. In the present project, we aim to understand decision-making in the context of firefighting and to study how neurocognitive control and stress management strategies affect decision-making. We present here a functional brain imaging paradigm coupled with biosensors while firefighters play a decision-making task. In this computerized task, the firefighter faces the dilemma of entering or not in a burning house, with variable risk of house collapsing, variable number of victims in danger and variable probability of the victims saving themselves. We present here the preliminary results from a cohort of 13 firefighters, of which none presented clinically significant symptoms of post-traumatic stress disorder. We found brain regions, including the ventromedial and dorsolateral prefrontal cortices and angular gyrus, showing a parametric pattern of activation during the decision phase, i.e. the lower the risk of collapsing, the higher the neural activity in these areas. This suggests that these regions are processing that risk information and signalling the chances of being successful in the rescue phase. We also found that the power in high frequencies of the pulse rate variability of this cohort of firefighters is higher when they decide to enter for the rescue. It is suggestive that deciding not to enter for rescue causes an increase in arousal, which may be related to the expectation about the victims’ outcome (whether they survived or not). Concerning coping strategies, we found that active coping used in personal context was significantly correlated with the age and the years of experience in our sample of firefighters. We aim to understand if this pattern of brain activity reflects the coping strategies and if, in turn, it is reflected in the physiological signals we measure. Concurrently, we are recruiting firefighters with post-traumatic stress disorder and non-firefighters to perform the same task. We will investigate whether the decision processes in firefighters are different from non-firefighters, and we will address if post-traumatic stress disorder impairs decision-making in this context. Biosignals will also be used in a second phase of the project to inform training systems about the physiological state of the firefighter during virtual reality simulation. This may help developing optimal neurocognitive control and better coping strategies to deal with stress.

Schizophrenia is a severe mental disorder and one of the leading causes of disease burden worldwide. It represents a source of significant suffering and disability to the affected individuals, and is associated with substantial societal and economical costs. The diagnosis of schizophrenia still depends exclusively on the detection of symptoms that are also present in other mental disorders. This situation causes overlapping of the boundaries of the diagnostic categories and constitutes a source of diagnostic errors. Moreover, current treatment algorithms do not take into account the substantial interindividual variability in response to antipsychotic drugs. As a result, around one-third of patients are treatment-resistant to first line antipsychotic drugs. This deleterious consequence is associated with poor individual outcomes and elevated healthcare costs. Neuroimaging research in schizophrenia has shed some light in a vast array of structural and functional connectivity abnormalities and neurochemical (dopamine and glutamate) imbalances, which may constitute ‘organic surrogates’ of this disorder. However, the neuroimaging field, so far, has not been able to identify biomarkers that could facilitate early detection and allow individualised treatment management. This paper reviews neuroimaging studies from different modalities that may provide relevant biomarkers for schizophrenia. We discuss how the current application of novel Machine Learning methods to the analyses of imaging data is allowing the translation of such findings into potential biomarkers enabling the prediction of clinical outcomes at the individual level, towards the development of innovative and personalised treatment strategies. info:eu-repo/semantics/publishedVersion

Background: Delayed diagnosis of bipolar disorder (BD) is common in adolescents and young adults and the search for biomarkers to help in early diagnosis in BD at-risk populations is an important goal of neuroimaging research. Functional connectivity studies in BD patients suggests that anomalous connectivity between prefrontal and limbic regions could be risk biomarkers for BD. The aim of this review is to provide an overview of the neuroimaging literature that employed functional connectivity techniques in adolescents and young adults at-risk for BD. Methods: A literature search was conducted using PubMed and EMBASE databases, to identify fMRI studies that em- ployed a measure of functional or e ective connectivity or network based statistics and included individuals at-risk for BD who were in the age range of early-mid adolescence (13–18 years old) and/or young adulthood (19–25 years old). Results: Ten studies focusing on 4 functional imaging domains were identi ed, namely emotion processing, a ective cognition, reward processing and resting-state. Altered functional connectivity between amygdala and ventrolateral prefrontal cortex (PFC); amygdala and anterior cingulate cortex and between anterior cingulate cortex, ventrolateral PFC and dorsolateral PFC emerged as putative risk biomarkers. Heterogeneity in BD at-risk samples, tasks and connectivity analysis methods has been identi ed. Conclusions: Youth at-risk for BD have altered functional connectivity in prefrontal-limbic networks supporting emo- tion regulation that might underlie emotion lability and mood dysregulation predisposing to BD. Future longitudinal studies in adolescents and young adults with Bipolar At-Risk criteria are important to establish functional connectivity measures as risk biomarkers.

Background:Cognitive interventions (either restorative or compensatory) developed for mild Alzheimer's Disease (AD) have been tested widely with cognitive measures, but less is known about how the effects of such interventions are generalizable to daily functioning. In the present study, we looked at affective state and perceived functionality and quality of life indicators, for three different cognitive rehabilitation programs.Methods:Fifty-one AD patients in the mild stage of the disease were selected for the study and were randomly assigned to one of three cognitive training groups: (1) Memo+ (a paper and pencil memory training program); (2) SenseCam (wearable camera used as a passive external memory aid); (3) Written diary (a personal journal, used as control condition). All patients attended 11 sessions, twice a week, of 1-hour length. The three outcome indicators were examined with standardized instruments applied before the intervention, one week after and at six months follow-up.Results:After treatment, the SenseCam and Memo+ groups had significantly reduced depressive symptoms compared to the Diary control condition. The same was found for measures of perceived functional capacity. No intervention effects were found for quality of life measures. The immediate effects of the interventions were not maintained at follow-up.Conclusions:Our results suggest that two types of memory rehabilitation can improve depressive symptomology and instrumental activities of daily living, suggesting that these interventions can stimulate not only cognition but also well-being, at least in the short term.

Although functional recovery could be advocated as an achievable treatment goal, many effective interventions for the treatment of psychotic symptoms, such as antipsychotic drugs, may not improve functioning. The last two decades of cognitive and clinical research on schizophrenia were a turning point for the firm acknowledgment of how relevant social cognitive deficits and negative symptoms could be in predicting psychosocial functioning. The relevance of so cial cognition dysfunction in schizophrenia patients’ daily living is now unabated. In fact, social cognition deficits could be the most significant predictor of functionality in patients with schizophrenia, non-redundantly with neurocogni tion. Emerging evidence suggests that negative symptoms appear to play an indirect role, mediating the relationship between neurocognition and social cognition with functional outcomes. Further explorations of this mediating role of negative symptoms have revealed that motivational deficits appear to be particularly important in explaining the relationship between both neurocognitive and social cognitive dysfunction and functional outcomes in schizophrenia. In this paper we will address the relative contribution of two key constructs—social cognitive deficits and negative symptoms, namely how intertwined they could be in daily life functioning of patients with schizophrenia.

Background Violence by intimate partners (IPV) can be prevented and its impact reduced. This calls for to deal with violence from a public health perspective, according the ecological model, associated to a multidisciplinary and multisectoral networking approach. In Coimbra various sectors are working together from 2000, in tackling the problem of IPV. Health sector is an active and valuable ally in the global response to violence and brings a variety of advantages and assets to this work, from primary to terciary prevention, including programs for victims and perpetrators. Description of the problem IPV is a serious problem that occurs in all countries, among heterosexual or same-sex couples. The consequences are profound, extending beyond the health and happiness of individuals to affect the well-being of entire communities. Results Our strategies are addressed to prevention (al all levels). We deal with violence taking steps to understand the range of factors that put people at risk for violence and protect them from experiencing or perpetrating violence. Our fundamental goal is to stop IPV before it begins. Networks “Violence´s Group: Information, Research, Intervention” (2002), “School Against Violence” (2007), along with the training of 480 professionals (health, other sectors) in our region (2009–2012), in the area of prevention of IPV, are examples of our networking strategy. The Family Violence Unit, UVF (2004) - CHUC, integrates both networks; of the 1400 cases (2/3 women, 1/3 men) at UVF, we did not record any murder to date. Our strategy is recognised at regional and national levels. Conclusions We believe that prevent efforts associated to investigation and a networking strategy (from micro to macrosystem, throughout the life cycle), at individual, family, community, and political levels, are one of the keys to prevent IPV.