Moderate similarity leads to empathic concern, but high similarity can also induce personal distress towards others' pain

Empathic concern and personal distress are common vicarious emotional responses that arise when witnessing someone else's pain. However, the influence of perceived similarity on these responses remains unclear. In this study, we examined how perceived similarity with an injured target impacts vicarious emotional responses. A total of 87 participants watched a video of an athlete in pain preceded by a clip describing the athlete's trajectory, which indicated either high, moderate, or low similarity to the participants. Emotional self-reports, facial expressions, gaze behavior, and pupil diameter were measured as indicators of the participants' emotional responses. Participants in the moderate- and high-similarity groups exhibited greater empathic concern, as evidenced by their display of more sadness compared with those in the low-similarity group. Furthermore, those in the moderate-similarity group exhibited less avoidance by displaying reduced disgust, indicating lower personal distress compared with those in the low-similarity condition. Nevertheless, the high-similarity group displayed just as much disgust as the low-similarity group. These findings suggest that perceived similarity enhances empathic concern to others' suffering, but that high similarity can also lead to personal distress. Future studies on empathy should explore distinct vicarious states using multimodal measurements to further advance our understanding of these processes.

Domain specificity of error monitoring: An ERP study in young and older adults

Metacognition refers to the ability to monitor and control one's cognitive processes, which plays an important role in decision-making throughout the lifespan. It is still debated whether metacognitive abilities decline with age. Neuroimaging evidence suggests that metacognition is served by domain-specific mechanisms. These domains may differentially decline with increasing age. The current investigates whether the error-related negativity (ERN) and the error positivity (Pe) which reflect error detection and error awareness, respectively, differ across perceptual and memory domains in young and older adults. In total, 38 young adults and 37 older adults completed a classic Flanker Task (perceptual) and an adapted memory-based version. No difference in ERN amplitude was found between young and older adults and across domains. Perceptual ERN peaked earlier than Memory ERN. Memory ΔERN was larger than Perceptual ΔERN. Pe was smaller in older adults and ΔPe was larger for perceptual than memory flanker. Memory Pe peaked earlier in young as compared to older adults. Multivariate analyses of whole scalp data supported cross-domain differences. During the task, ERN decreased in young but not in older adults. Memory Pe decreased in young adults but increased in older adults while no significant change in perceptual Pe was found. The study's findings suggest that neural correlates of error monitoring differ across cognitive domains. Moreover, it was shown that error awareness declines in old age but its within-task dynamics vary across cognitive domains. Possible mechanisms underlying metacognition impairments in aging are discussed.

The cognitive neuroscience of self-awareness: Current framework, clinical implications, and future research directions

Self-awareness, the ability to take oneself as the object of awareness, has been an enigma for our species, with different answers to this question being provided by religion, philosophy, and, more recently, science. The current review aims to discuss the neurocognitive mechanisms underlying self-awareness. The multidimensional nature of self-awareness will be explored, suggesting how it can be thought of as an emergent property observed in different cognitive complexity levels, within a predictive coding approach. A presentation of alterations of self-awareness in neuropsychiatric conditions will ground a discussion on alternative frameworks to understand this phenomenon, in health and psychopathology, with future research directions being indicated to fill current gaps in the literature. This article is categorized under: Philosophy > Consciousness Psychology > Brain Function and Dysfunction Neuroscience > Cognition.

Experiences of cognitive stimulation therapy (CST) in Brazil: a qualitative study of people with dementia and their caregivers

OBJECTIVES

There is a lack of investment in psychosocial treatments for people with dementia in Brazil. Cognitive Stimulation Therapy (CST) is a group-based intervention that has shown to have benefits on activities of daily living and mood for people with dementia in Brazil. This study aims to explore the experiences and perceived changes following CST groups.

METHODS

Individual interviews were conducted with the participants of the group (n = 12) and their caregivers (n = 11). Framework analysis was used to inspect the data.

RESULTS

Two main themes have emerged: 'Personal benefits of being part of the group', containing two subthemes: 'Benefits for caregivers' and 'Benefits for person with dementia' and 'Day-to-day changes', containing seven subthemes; 'Memory', Sociability', 'Language', 'Mood', 'Orientation', 'Everyday activities' and 'Behavioural and psychological symptoms'.

CONCLUSION

Results suggest that CST groups led to perceived personal benefits for the people with dementia and caregivers and that there are perceived changes for the participants of the groups.

A quantitative textual analysis of the subjective effects of ayahuasca in naïve users with and without depression

Ayahuasca is a brew with psychoactive properties that has been used as an entheogen for centuries, with more recent studies suggesting it is a promising treatment for some clinical disorders. Although there is an emerging scientific literature on its effects, to the best of our knowledge no study has explored the self-reported experiences of first-time ayahuasca users with quantitative textual analysis tools. Accordingly, the current study aimed to analyze the subjective experience of naive individuals with depression and healthy controls after consuming ayahuasca. For this purpose, responses from a subsample of participants from a previous clinical trial to open-ended questions regarding their experience with ayahuasca underwent textual analysis. Data from nine patients with treatment-resistant depression and 20 healthy individuals were included, and quantitative textual analysis was performed using IRaMuTeQ 0.7 alpha 2 and R 3.1.2. The analysis identified five clusters: alterations in the state of consciousness, cognitive changes, somatic alterations, auditory experiences, and visual perceptual content. Additionally, findings suggest specific features of the experience of people with depression with ayahuasca, such as increased aversive bodily reactions. The results are consistent with previous findings indicating central axes of the psychedelic experience, and may inform therapeutic approaches using ayahuasca.

The Association of Classic Serotonergic Psychedelic Use and Intention of Future Use with Nature Relatedness

This study sought to investigate the effects of different substances on nature relatedness (NR) in the general population. An online cross-sectional survey done in Brazil investigated use of ayahuasca/DMT, psilocybe mushrooms, LSD, MDMA/ecstasy, cocaine, cannabis, and alcohol. NR was assessed using the short-form version of the nature related scale (NR-6). One-way analysis of variance (ANOVA) was used to assess group differences between substance naïve-individuals, past users, and current users of each substance. Regression models were used including all the substances and subsequently, sociodemographic variables. ANOVAs with substances which showed significantly higher NR-6 scores in the regression model were used in order to assess the effect of intention of future use on NR. ANOVAs indicated higher NR in users of classic serotonergic psychedelics (ayahuasca/DMT, psilocybe mushrooms, LSD), cannabis, and MDMA/ecstasy. Regression models showed that current use of ayahuasca/DMT and psilocybe mushrooms, and past use of LSD had a positive association with NR. When sociodemographic variables were added, only ayahuasca/DMT past and current use were positively associated with NR. Intention of future use was only significantly associated with NR in individuals who reported intention of future use of psilocybe mushrooms.

Therapeutic Protocols Using Ketamine and Esketamine for Depressive Disorders: A Systematic Review

Depression is one of the most prevalent mental health disorders globally, causing severe emotional suffering, reducing life expectancy and increasing the risk of suicide. Recently, the use of dissociative psychedelic substances such as ketamine and esketamine for depressive disorders has expanded treatment options. We sought to analyze, through a systematic review, the existing protocols for the treatment of depression with ketamine and esketamine. The search adopted PRISMA criteria and was performed using PubMed and Web of Science databases. Procedures in each study were compared, focusing on the sample recruited, therapeutic approaches, including the clinical team and professionals engaged in treatment, medical procedures, description of the setting (including music) and factors such as specific medication (ketamine or esketamine), route of administration and dosage employed. Results indicated the predominance of a medical approach, with a limited number of studies on ketamine assisted psychotherapy (KAP) and other modalities of psychedelic assisted therapy. Additionally, there is limited information on psychosocial elements such as preparation, psychological support during session and integration of experience. Altogether these findings suggest that treatment of depression with ketamine or esketamine diverges in relation to the practices employed with psychedelic substances. This is discussed considering future research directions in the field.

Nondeclarative associative learning in Alzheimer's disease: An overview of eyeblink, fear, and other emotion-based conditioning

Alzheimer's disease is a neurodegenerative disorder that is characterized by progressive cognitive decline, particularly in declarative memory, and the presence of β-amyloid plaques, neurofibrillary tangles, and cortical atrophy (especially in the temporal lobe). Unlike the relationship between the temporal cortex and declarative memory, nondeclarative memories (e.g., motor, fear, and other emotion-based memories) involve distinct neural structures. The present review investigates nondeclarative associative learning ability in Alzheimer's disease. We discuss eyeblink conditioning, fear conditioning, and other emotion-based learning and present the functions and brain areas that are involved in each type of learning. Evidence suggests that nondeclarative learning is also affected by Alzheimer's disease, although some forms of learning may be relatively preserved. Details about each nondeclarative associative learning process and the implications of these findings are presented.

The self and self-knowledge after frontal lobe neurosurgical lesions

BACKGROUND

Evidence suggests that damage to the frontal lobes can be associated with changes in cognitive and behavioral functioning and reduced awareness that such changes have occurred. In the current study, the Cognitive Awareness Model was used as a theoretical framework to explore knowledge of the self in people with acquired frontal lesions.

METHODS

Fifteen individuals with focal frontal lobe lesions (FFL) and their nominated informants were compared with fifteen healthy matched control-informant dyads on questionnaire measures designed to assess awareness of difficulties. Questionnaires were adapted to ensure all enabled pre- and post-injury perspectives to be gained from both patient and informant, and to allow novel exploration of awareness of deficits from a third person perspective.

RESULTS

Individuals with frontal lobe lesions showed adequate awareness of their post-surgery changes, which was substantiated by their informant report. Compared to the control group, the patient group was found to acknowledge more difficulties in current functioning. Perspective-taking ability was limited with both patients and controls being comparatively unreliable in assessing how they were perceived by others.

CONCLUSION

These results demonstrate that FLL patients are engaging in more atypical behaviors compared to healthy controls, but suggest that they are aware of and acknowledge these difficulties. The importance of obtaining multiple viewpoints when examining an individual's level of awareness and the clinical implications of this are discussed.

Effects of DBT-based interventions on alexithymia: a systematic review

While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial

OBJECTIVES

Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial.

METHODS

47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention.

RESULTS

Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability.

CONCLUSIONS

These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects.

CLINICAL IMPLICATIONS

Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers.

Behavioral restriction, lorazepam, and escitalopram uniquely influence the expression of naturalistic stereotypy in deer mice: perspectives on anxiety- and compulsive-like behavior

Introduction: Stereotypical expression in laboratory-housed rodents can be explained by different motivational, coping, and motor dysfunction theories. Here, we aimed to explore the neurocognitive underpinnings of high stereotypical (HS) expression in deer mice (Peromyscus maniculatus bairdii), previously proposed as a model system of compulsive-like behavioral persistence. Specifically, we aimed to establish whether HS behavior is related to an underlying escape-related trigger. Methods: One-hundred and sixteen deer mice were classified as either non-stereotypical (NS) or HS. Mice of each cohort were further subdivided and exposed to either sub-acute (3-day) or chronic (25-day) behavioral restriction (R), and high-dose escitalopram (ESC), lorazepam (LOR), alone and in combination with R (ESC+R and LOR+R, respectively). Mice were reassessed for stereotypical behavior at both time points. Results: Our results indicate that HS behavior is likely not temporally and functionally related to an anxiogenic trigger, i.e., R, but rather that HS is associated with parallel changes in anxiogenic feedback processing. We also show that chronic R alone significantly decreased the time spent in expressing HS behavior in animals of the HS, but not NS phenotype. Discussion: This points to the possibility that HS-expressing mice represent a subgroup of P. maniculatus bairdii in which unique interactions between neurobiology and processes of gradual behavioral organization, may contribute to the expression of the typical behaviors observed in this cohort. Collectively, our findings highlight the value of the deer mouse model system to investigate the potential neurocognitive mechanisms that may underlie the development of persistent phenotypes that can likely not be explained entirely by current theories.

Adaptation and latent structure of the Brazilian version of the Ego Dissolution Inventory (EDI-BR): An exploratory study

INTRODUCTION

Existing scales that seek to measure alterations in self-experience were based on studies conducted in developed countries. Therefore, the aim of this study was to evaluate the psychometric properties of the Ego-Dissolution Inventory (EDI), translate and adapt it to the Brazilian context.

METHODS

Translation of the measure was made by two translators fluent in both English and Portuguese, with back-translation into English to ensure there was no loss of meaning. The scale was included in an online survey exploring substance use. A total of 528 participants answered the full scale. We calculated the Kaiser-Meyer-Olkin (KMO) measure to evaluate sampling adequacy, then ran Exploratory Analysis Factor (EFAs) to investigate the factor structure of the EDI.

RESULTS

The scale showed acceptable psychometric properties, with excellent internal consistency and sampling adequacy for a factor analysis. Kaiser-Gutman's criteria and Hull's method pointed to a three-factor solution, while Parallel Analysis suggested a two-factor solution. All items showed salient loadings, with two items exhibiting cross-loading. Positive but weak correlations were found between EDI factors 1 and 2 and nature-relatedness.

CONCLUSIONS

The validated scale showed solid psychometric properties, with potential differences in factor structure in relation to the English version. Considering validation as ongoing process, it is recommended to conduct studies comparing the scores of ego dissolution across distinct substances and different regions of the country.

Self- and Other-Evaluation in Alzheimer’s Disease

Background: Impaired awareness of ability is common in dementia and has important clinical implications. Evidence from different clinical groups has shown that awareness can vary according to whether evaluation refers to self or other performance. Objective: The present study aimed to investigate awareness for self- and other-performance in Alzheimer’s disease (AD) patients, exploring if results vary according to cognitive domain of the tasks. It was hypothesized that, particularly for memory tasks, AD patients would be inaccurate in relation to self-but not other-performance. Methods: Twenty-two mild to moderate AD patients and twenty-two healthy older adults participated. Two tasks, with reaction time (RT) and working memory tasks, were carried out, and each had a success and a failure condition. Participants were asked to estimate their own performance, as well as the performance of another person they observed. Awareness of performance was measured comparing participant estimations of performance with actual performance. Results: For both the RT and working memory tasks, results indicate that participants from both groups overestimated the performance in the failure condition and underestimated the performance in the success condition. They tended to overestimate more the performance of the other person compared to themselves. Additionally, for the working memory task, AD patients tended to overestimate more performances compared to controls. Conclusion: Findings suggest that the AD and control groups present the same pattern, with attribution of better performance to another person. For the AD group, the pattern of response was different for memory tasks, which may suggest domain-specific limited awareness.

Suicidal Ideation in Bipolar Disorder: The Relation with Clinical and Sociodemographic Variables

INTRODUCTION

Bipolar disorder (BD) has the highest risk of suicide among all mental disorders. Thus, identifying factors related to suicidal ideation is essential for a better assessment of the risk of suicide in BD.

OBJECTIVE

To analyze the relationship between suicidal ideation and clinical and sociodemographic characteristics in BD patients.

METHOD

This is a cross-sectional study that included eighty individuals with BD. Information regarding sociodemographic data and history of attempted suicide were collected, and the Hamilton Depression Scale, Young Mania Rating Scale, Positive And Negative Syndrome Scale/positive symptom subscale, Clinical Global Impressions Scale for use in bipolar illness, Insight Scale for Affective Disorders, and Barratt Impulsiveness Scale were administered. The presence and severity of suicidal ideation were assessed using the Beck Scale for Suicidal Ideation.

RESULTS

All regression models significantly predicted suicidal ideation. In the model that had the lowest AIC score and the highest cross-validity, the severity of depressive and of manic symptoms (standardized β = 0.49, p < 0.001; standardized β = 0.42, p = 0.007), the insight level (standardized β = - 0.38, p = 0.012) and previous suicide attempt (standardized β = 0.20, p = 0.036) acted as predictors of suicidal ideation, while degree of impulsivity (β standardized = 0.13, p = 0.229) and educational level (standardized β = - 0.16, p = 0.108) did not give a significant contribution.

CONCLUSION

According to our results, more severe depression and mania symptoms, higher level of insight and a history of suicide attempt indicate the occurrence of suicidal ideation in BD.

Delivering Cognitive Stimulation Therapy (CST) Virtually: Developing and Field-Testing a New Framework

Purpose

This feasibility and pilot study aimed to develop and field-test a 14-session virtual Cognitive Stimulation Therapy (vCST) programme for people living with dementia, developed as a result of services moving online during the COVID-19 pandemic.

Methods

The vCST protocol was developed using the existing group CST manual, through stakeholder consultation with people living with dementia, caregivers, CST group facilitators and dementia service managers. This protocol was then field-tested with 10 groups of people living with dementia in the Brazil, China (Hong Kong), India, Ireland and the UK, and feedback on the protocol was gathered from 14 facilitators.

Results

Field testing in five countries indicated acceptability to group facilitators and participants. Feedback from these groups was used to refine the developed protocol. The final vCST protocol is proposed, including session materials for delivery of CST over videoconferencing and a framework for offering CST virtually in global settings.

Conclusion

vCST is a feasible online intervention for many people living with dementia. We recommend that it is offered to those unable to access traditional in-person CST for health reasons, lack of transport or COVID-19 restrictions. Further research is needed to explore if participant outcomes are comparable to in-person CST groups.

Awareness for People With Alzheimer’s Disease: Profiles and Weekly Trajectories

Objective: To understand awareness and fluctuations of awareness in Alzheimer’s disease (AD), it is fruitful to consider the objects of awareness, e.g., cognitive functioning or recognition of the disease, as well as the mechanisms and modes of expression underlying awareness. With a holistic and discourse-centered approach, we aimed to identify different awareness profiles and test whether these profiles were stable or whether transitions from one profile to another occurred over short time intervals.

Methods: Twenty-eight residents of nursing homes with a diagnosis of AD participated in four semistructured interviews at biweekly intervals. These interviews were cluster analyzed to determine profiles of awareness. A Markov chain was applied to model their fluctuation.

Results: Five awareness profiles were observed that differed in terms of objects and underlying processes. Awareness proved to be quite stable for four of the five profiles. Interindividual variability in awareness was also observed through numerous different trajectories that were identified.

Discussion: Self-awareness and disease awareness are characterized by profiles that vary subtly between individuals. Fluctuations in awareness underscore the need to employ assessment intervals that closely reflect daily life in institutions.

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country

OBJECTIVE

To investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.

METHODS

Dementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben's advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.

RESULTS

PwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.

CONCLUSION

Results reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

Development and acceptability of a brief, evidence-based Dementia Awareness for Caregivers course in low- and middle-income countries

Background

Knowledge of and attitudes towards dementia vary across countries, and for caregivers in low- and middle-income countries (LMICs), access to information can be challenging. There is an urgent need for brief, easily accessible and culturally appropriate educational courses for caregivers of persons with dementia, providing much needed information whilst addressing important psychological concepts such as stigma.

Methods

An international and multidisciplinary team developed Dementia Awareness for Caregivers (DAC) courses in four stages: (1) scoping review and module agreement, (2) development of an International template (DAC-International) containing a standardised process for adding information, (3) development of local DACs using a standardised format and (4) acceptability of courses in Brazil, India and Tanzania.

Findings

The DAC-International was developed, comprising three modules: ‘What is dementia?’; ‘Positive engagement’ and ‘Caring for someone with dementia’. Three local versions were developed from this (DAC-Brazil, DAC-India and DAC-Tanzania), where additions of country-specific information included prevalent stereotypes and the addition of culturally relevant case studies. An initial field test was conducted in each country (n = 85), which indicated acceptability to participants.

Conclusions

The methods used here resulted in culturally valid and acceptable educational courses for carers of people with dementia. Future work will consist of large-scale, formal evaluations and the development of additional local courses.

An evolutionary view of self-awareness

The capacity to be self-aware is regarded as a fundamental difference between humans and other species. However, growing evidence challenges this notion, indicating that many animals show complex signs and behaviors that are consonant with self-awareness. In this review, we suggest that many animals are indeed self-aware, but that the complexity of this process differs among species. We discuss this topic by addressing several different questions regarding self-awareness: what is self-awareness, how has self-awareness been studied experimentally, which species may be self-aware, what are its potential adaptive advantages. We conclude by proposing alternative models for the emergence of self-awareness in relation to species evolutionary paths, indicating future research questions to advance this field further.

Modeling Quality of Life in Alzheimer Disease: The Impact of Cognitive, Functional, and Mood Variables in Self and Carers' Perceptions

Quality of life (QoL) includes complex interactions between objective and subjective factors. Through structural equation modeling, we analyzed people with Alzheimer disease (PwAD) and carers' ratings to identify the factors associated with PwAD QoL. We included 264 PwAD and their carers. Model 1, carers' ratings of PwAD QoL, showed a bidirectional association with worse depressive symptoms, lower functionality, and impairment on awareness being linked. These variables were associated with burden and all of them directly affecting carers' ratings of PwAD QoL. Model 2, PwAD self-reported QoL, had the same bidirectional associations among the same variables with all of them influencing PwAD self-reported QoL. However, the interpretations of these similar associations should be different. The path analysis increased the understanding of the relationship between QoL and cognition, functionality, mood, awareness, and burden. Our findings bring together a number of consistent predictors and confirm their different effects in PwAD and carers' point of view about QoL.

New insights into neural networks of error monitoring and clinical implications: a systematic review of ERP studies in neurological diseases

Error monitoring allows for the efficient performance of goal-directed behaviors and successful learning. Furthermore, error monitoring as a metacognitive ability may play a crucial role for neuropsychological interventions, such as rehabilitation. In the past decades, research has suggested two electrophysiological markers for error monitoring: the error-related negativity (ERN) and the error positivity (Pe), thought to reflect, respectively, error detection and error awareness. Studies on several neurological diseases have investigated the alteration of the ERN and the Pe, but these findings have not been summarized. Accordingly, a systematic review was conducted to understand what neurological conditions present alterations of error monitoring event-related potentials and their relation with clinical measures. Overall, ERN tended to be reduced in most neurological conditions while results related to Pe integrity are less clear. ERN and Pe were found to be associated with several measures of clinical severity. Additionally, we explored the contribution of different brain structures to neural networks underlying error monitoring, further elaborating on the domain-specificity of error processing and clinical implications of findings. In conclusion, electrophysiological signatures of error monitoring could be reliable measures of neurological dysfunction and a robust tool in neuropsychological rehabilitation.

Stereotypy and spontaneous alternation in deer mice and its response to anti-adenosinergic intervention

Repetitive behavioral phenotypes are a trait of several neuropsychiatric disorders, including obsessive-compulsive disorder (OCD). Such behaviors are typified by complex interactions between cognitive and neurobiological processes which most likely contribute to the suboptimal treatment responses often observed. To this end, exploration of the adenosinergic system may be useful, since adenosine-receptor modulation has previously shown promise to restore control over voluntary behavior and improve cognition in patients presenting with motor repetition. Here, we employed the deer mouse (Peromyscus maniculatus bairdii) model of compulsive-like behavioral persistence, seeking to investigate possible associations between stereotypic motor behavior and cognitive flexibility as measured in the T-maze continuous alternation task (T-CAT). The effect of istradefylline, a selective adenosine A_2A receptor antagonist at two doses (10 and 20 mg kg^-1  day^-1 ) on the expression of stereotypy and T-CAT performance in high (H) and non-(N) stereotypical animals, was investigated in comparison to a control intervention (six groups; n = 8 or 9 per group). No correlation between H behavior and T-CAT performance was found. However, H but not N animals presented with istradefylline-sensitive spontaneous alternation and stereotypy, in that istradefylline at both doses significantly improved the spontaneous alternation scores and attenuated the stereotypical expression of H animals. Thus, evidence is presented that anti-adenosinergic drug action improves repetitive behavior and spontaneous alternation in stereotypical deer mice, putatively pointing to a shared psychobiological construct underlying naturalistic stereotypy and alterations in cognitive flexibility in deer mice.

The Seven Selves of Dementia

The self is a complex and multifaceted phenomenon, encompassing a variety of cognitive processes and psychosocial influences. Considering this, there is a multiplicity of "selves," the current review suggesting that seven fundamental self-processes can be identified that further our understanding of the experience of dementia. These include (1) an embodied self, manifest as corporeal awareness; (2) an agentic self, related to being an agent and influencing life circumstances; (3) an implicit self, linked to non-conscious self-processing; (4) a critical self, which defines the core of self-identity; (5) a surrogate self, based on third-person perspective information; (6) an extended self, including external objects or existences that are incorporated into the self; and, finally, (7) an emergent self, a property of the self-processes that give rise to the sense of a unified self. These are discussed in relation to self-awareness and their use in making sense of the experience of dementia.

Structural Gray and White Matter Correlates of Awareness in Alzheimer's Disease

BACKGROUND

Unawareness of disease is a common feature of Alzheimer's disease (AD), but few studies explored its neural correlates. Additionally, neural correlates according to the object of awareness are unexplored.

OBJECTIVE

To investigate structural brain correlates in relation to different objects of awareness.

METHODS

27 people with AD underwent MRI scanning on a 3T Siemens Prisma. T1-MPRAGE was used to investigate cortical thickness and white matter microstructure was defined by DTI as fractional anisotropy, mean, axial, and radial diffusivity. Preprocessing used FreeSurfer6.0, ExploreDTI, and FSL-TBSS. Awareness of disease, cognitive deficits, emotional state, relationships, and functional capacity were assessed with the short version of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia. Voxel-wise correlations between brain structure and awareness were determined by FSL-PALM. Analyses were corrected for multiple comparisons using Threshold Free Cluster Enhancement and FWE.

RESULTS

Lower left hemisphere cortical thickness was related to poorer disease awareness uncorrected and corrected for age, sex, and MMSE. In the uncorrected model, mainly right-sided, but also left temporal lower cortical thickness was related to decreased awareness of cognitive deficits. Correcting for age, sex, and MMSE eliminated correlations for the right hemisphere, but extensive correlations in the left hemisphere remained. For white matter integrity, higher right hemisphere MD was related to lower cognitive awareness deficits, and lower FA was related to lower functional capacity awareness.

CONCLUSION

Findings suggest that extensive regions of the brain are linked to self-awareness, with particular frontal and temporal alterations leading to unawareness, in agreement with theoretical models indicating executive and mnemonic forms of anosognosia in AD.

The Child Emotion Facial Expression Set: A Database for Emotion Recognition in Children

Background: This study developed a photo and video database of 4-to-6-year-olds expressing the seven induced and posed universal emotions and a neutral expression. Children participated in photo and video sessions designed to elicit the emotions, and the resulting images were further assessed by independent judges in two rounds.

Methods: In the first round, two independent judges (1 and 2), experts in the Facial Action Coding System, firstly analysed 3,668 emotions facial expressions stimuli from 132 children. Both judges reached 100% agreement regarding 1,985 stimuli (124 children), which were then selected for a second round of analysis between judges 3 and 4.

Results: The result was 1,985 stimuli (51% of the photographs) were produced from 124 participants (55% girls). A Kappa index of 0.70 and an accuracy of 73% between experts were observed. Lower accuracy was found for emotional expression by 4-year-olds than 6-year-olds. Happiness, disgust and contempt had the highest agreement. After a sub-analysis evaluation of all four judges, 100% agreement was reached for 1,381 stimuli which compound the ChildEFES database with 124 participants (59% girls) and 51% induced photographs. The number of stimuli of each emotion were: 87 for neutrality, 363 for happiness, 170 for disgust, 104 for surprise, 152 for fear, 144 for sadness, 157 for anger 157, and 183 for contempt.

Conclusions: The findings show that this photo and video database can facilitate research on the mechanisms involved in early childhood recognition of facial emotions in children, contributing to the understanding of facial emotion recognition deficits which characterise several neurodevelopmental and psychiatric disorders.

Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial

OBJECTIVE

The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit.

METHODS

A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured.

RESULTS

PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden.

CONCLUSIONS

CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.

Cerebral effects of glucagon-like peptide-1 receptor blockade before and after Roux-en-Y gastric bypass surgery in obese women: A proof-of-concept resting-state functional MRI study

AIM

To assess the effects of Roux-en-Y gastric bypass surgery (RYGB)-related changes in glucagon-like peptide-1 (GLP-1) on cerebral resting-state functioning in obese women.

MATERIALS AND METHODS

In nine obese females aged 40-54 years in the fasted state, we studied the effects of RYGB and GLP-1 on five a priori selected networks implicated in food- and reward-related processes as well as environment monitoring (default mode, right frontoparietal, basal ganglia, insula/anterior cingulate and anterior cingulate/orbitofrontal networks).

RESULTS

Before surgery, GLP-1 receptor blockade (using exendin9-39) was associated with increased right caudate nucleus (basal ganglia network) and decreased right middle frontal (right frontoparietal network) connectivity compared with placebo. RYGB resulted in decreased right orbitofrontal (insula/anterior cingulate network) connectivity. In the default mode network, after surgery, GLP-1 receptor blockade had a larger effect on connectivity in this region than GLP-1 receptor blockade before RYGB (all P_FWE  < .05). Results remained similar after correction for changes in body weight. Default mode and right frontoparietal network connectivity changes were related to changes in body mass index and food scores after RYGB.

CONCLUSIONS

These findings suggest GLP-1 involvement in resting-state networks related to food and reward processes and monitoring of the internal and external environment, pointing to a potential role for GLP-1-induced changes in resting-state connectivity in RYGB-mediated weight loss and appetite control.

Autobiographical Memory and Episodic Specificity Across Different Affective States in Bipolar Disorder

Autobiographical memory is essential to ground a sense of self-identity, contributing to social functioning and the development of future plans, and being an essential source for the psychiatric interview. Previous studies have suggested loss of autobiographical episodic specificity in unipolar depression, but relatively fewer investigations have been conducted in bipolar disorder (BD) patients, particularly across different mood states. Similarly, there is a scarcity of systematic investigations about mood-congruent and mood-dependent memory in relation to autobiographical memory in BD. Considering this, a total of 74 patients with BD (24 in euthymia, 26 in mania, and 24 in depression) responded with autobiographical memories to cue words belonging to four categories: mania, depression, BD, and neutral. Episodic specificity was scored according to the Autobiographical Interview, with high intra- and inter-rater reliability. Results indicated that patients in mania generally re-experience more episodic details than those in depression. Depressed bipolar patients reported fewer details of perception and less time integration of memories than those in euthymia or mania. Words linked to depression and BD induced greater episodic re-experiencing than neutral words, just as words about BD provided greater episodic re-experiencing and more details of emotion/thoughts than words about mania. Words linked to depression provoked more time details about the recalled episodes than words on BD or neutral themes. No mood-congruent or mood-dependent effects were observed. Current findings may improve the ability of clinicians to conduct psychiatric interviews and the diagnosis of BD, with special attention to how memory details are generated across different mood states of the condition. Additionally, interventions to foster autobiographical recollection in BD may be developed, similar to what has already been done in the context of schizophrenia.

Understanding Alzheimer's disease as a disorder of consciousness

People with Alzheimer's disease (AD) demonstrate a range of alterations in consciousness. Changes in awareness of cognitive deficit, self-awareness, and introspection are seen early in AD, and dysfunction of awareness and arousal progresses with increasing disease severity. However, heterogeneity of deficits between individuals and a lack of empirical studies in people with severe dementia highlight the importance of identifying and applying biomarkers of awareness in AD. Impairments of awareness in AD are associated with neuropathology in regions that overlap with proposed neural correlates of consciousness. Recent developments in consciousness science provide theoretical frameworks and experimental approaches to help further understand the conscious experience of people with AD. Recognition of AD as a disorder of consciousness is overdue, and important to both understand the lived experience of people with AD and to improve care.

Awareness of deficit following traumatic brain injury: A systematic review of current methods of assessment

Background: Awareness of deficit plays an important role in adjustment following a brain injury and has been noted to impact on engagement with and outcome of rehabilitation. However, there are challenges associated with the assessment of awareness. Aim: To systematically review all instruments used to assess intellectual awareness of deficits following Traumatic Brain Injury (TBI) in adults, and evaluate instrument characteristics (e.g., the format and focus of measures of awareness) and assessment methods adopted. Results: Thirty-four studies, all rated as fair to good quality, were identified and within these twenty-three different assessment tools were adopted. The most common method of assessment was patient-proxy discrepancy, with three frequently used instruments employed in a total of 22 of the 34 studies. Across studies, variability was noted regarding the type of assessment method dependent on various sample demographics (e.g., age of sample) and injury characteristics (e.g., time post injury). Conclusions: There is no consensus on the preferred instrument to assess intellectual awareness of deficits after TBI. Continued instrument development should attempt to incorporate multiple perspectives and assessment should take into account demographic and injury-related factors. An insightful avenue for future research would be to determine which factors are likely to impact awareness measurement.

A New Approach for Developing "Implementation Plans" for Cognitive Stimulation Therapy (CST) in Low and Middle-Income Countries: Results From the CST-International Study

Background: Even with a strong evidence base, many healthcare interventions fail to be translated to clinical practice due to the absence of robust implementation strategies. For disorders such as Alzheimer's disease and other dementias, access to evidence-based interventions beyond research settings is of great importance. Cognitive Stimulation Therapy (CST) is a brief, group-based intervention, with consistent evidence of effectiveness. Methods: An implementation focused, three-phase methodology was developed using extensive stakeholder engagement. The methods resulted in a standardized Implementation Plan for the successful translation of CST from research to practice. The methodology was developed using the Consolidated Framework for Implementation Research (CFIR) and refined in three countries that vary in levels of economic development and healthcare systems (Brazil, India and Tanzania). Results: Five Implemention Plans for CST were produced. Each plan contained implementation strategies and action plans devised in conjunction with policy professionals, healthcare professionals, people with dementia and family carers, and an international team of researchers and clinicians. Conclusion: This novel methodology can act as a template for implementation studies in diverse healthcare systems across the world. It is an effective means of devising socio-culturally informed Implementation Plans that account for economic realities, health equity and healthcare access.

Theoretical, and epistemological challenges in scientific investigations of complex emotional states in animals

This review brings to light critical epistemological and theoretical considerations when studying complex emotional states in animals. We discuss anthropomorphic and Umwelt perspectives of nonhuman animals and the ways in which distinct theories of consciousness and neural processing may restrict the potential for the development of knowledge on the topic. Within the same line of argumentation, we consider influences of the debate between monism and dualism and psychology's behaviorism and cognitive theories. Finally, we contrast the affective consciousness, higher-order emotional consciousness, and constructed emotion theories to further our understanding of complex emotional states in animals.

Comparison of mortality rate in older adults with and without functional awareness: the Neurological Disorders in Central Spain (NEDICES) population-based study

OBJECTIVES

The main aim of the study was to compare the rates of mortality in older adults with and without functional unawareness (FU). We also tested a possible interaction effect between levels of awareness and education, as a single cognitive reserve proxy, on mortality.

STUDY DESIGN

The study design is a longitudinal population-based cohort study.

METHODS

The Neurological Disorders in Central Spain is epidemiological study to detect main age-associated conditions in people aged 65 years and older. Participants were collected from updated population-based registers of residents in three areas of central Spain. Awareness of functional limitations was established in accordance with the discrepancy between two sources of information on functional impairments: reliable informants versus the participants themselves. Three mutually exclusive groups were formed, namely, Functional Limitation Complaints (FCs), FU, and Functional Awareness (FA). Cox's regression models, adjusted by different covariates, were used to calculate the risk of mortality for each group at 5-year follow-up (vs. reference group without limitations).

RESULTS

Of 1818 selected individuals, 229 (12.5%) showed FA, 254 (13.9%) showed FC, and 96 (5%) were classified as FU. All these groups showed an increased risk of mortality at 5-year follow-up [adjusted hazard ratio (HR) for FC < FU < FA]. However, the association of FU with mortality remained significant only for highly educated individuals.

CONCLUSIONS

Functional impairment was associated with increased mortality rates, regardless of the presence of unawareness. This study extends the role of education in modulating the symptoms and prognosis of individuals at very mild or preclinical dementia stages.

The Petrified Self 10 Years After: Current Evidence for Mnemonic anosognosia

Lack of awareness about disease, its symptoms and consequences, also termed anosognosia, is a common feature of Alzheimer's disease (AD). It has been hypothesized that memory disorder may be a key contributing factor to anosognosia, with people with AD not being able to update their personal information about performance and relying on older consolidated material about ability. This potentially outdated sense of self has been named, as a metaphor, the petrified self. In the current review, evidence from the past 10 years in relation to this concept is critically appraised. In particular, focus is given to empirical evidence produced on anterograde memory deficits about performance, the profile of autobiographical retrograde memory loss and the role of frontal lobes in anosognosia in AD. Finally, wider consequences of this metaphor for the understanding of selfhood in dementia are discussed.

Self-reported negative outcomes of psilocybin users: A quantitative textual analysis

Psilocybin, a substance mainly found in mushrooms of the genus psilocybe, has been historically used for ritualistic, recreational and, more recently, medicinal purposes. The scientific literature suggests low toxicity, low risk of addiction, overdose, or other causes of injury commonly caused by substances of abuse, with growing interest in the use of this substance for conditions such as treatment-resistant depression. However, the presence of negative outcomes linked to psilocybin use is not clear yet. The objective of this study is to investigate the negative effects of psilocybin consumption, according to the users' own perception through self-reports extracted from an online platform. 346 reports were analyzed with the assistance of the IRAMUTEQ textual analysis software, adopting the procedures of Descending Hierarchical Classification, Correspondence Factor Analysis and Specificities Analysis. The text segments were grouped in 4 main clusters, describing thinking distortions, emergencies, perceptual alterations and the administration of the substance. Bad trips were more frequent in female users, being associated with thinking distortions. The use of multiple doses of psilocybin in the same session or its combination with other substances was linked to the occurrence of long-term negative outcomes, while the use of mushrooms in single high doses was linked to medical emergencies. These results can be useful for a better understanding of the effects of psilocybin use, guiding harm-reduction initiatives.

Cognitive stimulation therapy for brazilian people with dementia: examination of implementation' issues and cultural adaptation

Objectives: The prevalence of dementia has been increasing particularly in developing countries. However, people with dementia (PwD) in Brazil are currently offered no psychosocial treatment upon diagnosis. Cognitive stimulation therapy (CST) that originated in the UK has proven benefits on cognition and quality of life in PwD. We investigate the possible issues for the implementation of CST for the Brazilian population and its cultural appropriateness. Method: Individual interviews and focus groups were conducted with PwD, their caregivers and health professionals (n = 37). Data were recorded and transcribed, before being analyzed using Framework Analysis. Results: Regarding the issues for implementation of CST in the Brazilian population, two main themes emerged, 'Barriers' and 'Facilitators', along with nine subthemes. Overall, the activities and materials were seen as being appropriate for use with the Brazilian population, some minor changes were suggested. Conclusions: The results indicate that CST is appropriate for use in the Brazilian population, only some cultural adaptations are necessary. In the stakeholders' opinions, CTS intervention is needed in Brazil, due to the lack of treatment options for PwD in developing countries.

Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International)

INTRODUCTION

In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income).

METHODS AND ANALYSIS

Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation.

ETHICS AND DISSEMINATION

Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer's Disease International, and via ongoing engagement with key policymakers.

Clinical and Cognitive Correlates of Insight in Bipolar Disorder

Insight is greatly impaired in Bipolar Disorder (BD), especially during mania. Cognitive impairment is also present in BD. Despite that, few studies have investigated a possible association between these two aspects. The main goal of the current study is to compare BD affective states regarding performance in cognitive testing and investigate clinical and cognitive predictors for insight loss in BD. The study investigated a sample of 65 patients who were evaluated in one of the BD phases (mania, euthymia or depression). All the subjects underwent neuropsychological evaluation and completed the Insight Scale for Affective Disorders (ISAD). The relationship between level of insight and clinical/cognitive variables was analyzed through multiple regression models. No significant differences were found among BD phases regarding performance on cognitive testing. Insight was more impaired in mania then in depression or euthymia. Predictors for loss of insight were: severity of manic symptoms and impairments in selective attention (Symbol search test), divided attention (Trail making test) and inhibition (Stroop test). The sample size is a potential limitation of the current study. Nevertheless, the results suggest this had limited impact, with group differences being detected for a number of variables. The results found have important clinical importance, suggesting, for example, that rehabilitation of specific cognitive skills may improve insight in BD.

Perfil financeiro dos psicólogos brasileiros: análise estatística relacionada ao ano de 2015

La psicología brasileña ha revelado una tendencia creciente en su crecimiento. En 2013, una investigación llevada a cabo por el Consejo Federal mostró que Brasil tiene más de 250 000 profesionales con licencia, revelando 1.24 psicólogos por cada 1 000 habitantes. Sin embargo, faltan datos en la literatura sobre la información sobre el perfil financiero del psicólogo brasileño, que es el objetivo de este estudio. Dicho esto, esta investigación es un estudio exploratorio no probabilístico, tipo encuesta, realizado en 2015, en el que participaron 437 psicólogos de todo Brasil. El estudio concluyó que los psicólogos económicamente activos son en su mayoría mujeres jóvenes, que tienen un ingreso mensual de R$ 2 000 en promedio y trabajan principalmente en la clínica. Esta investigación proporciona nuevos datos sobre el perfil profesional del psicólogo brasileño.

The relationship between insight and affective temperament in bipolar disorder: an exploratory study

INTRODUCTION

In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far.

OBJECTIVE

To evaluate the relationship between affective temperament and insight in bipolar disorder.

METHOD

A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales.

RESULTS

In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder.

CONCLUSION

In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.

Accelerated executive functions decline and gray matter structural changes in middle-aged type 1 diabetes mellitus patients with proliferative retinopathy

BACKGROUND

The aim of the present study was to determine trajectories of cognitive and cortical changes over time in middle-aged patients with type 1 diabetes mellitus (T1DM) and proliferative retinopathy.

METHODS

Twenty-five patients and 25 controls underwent neuropsychological assessment and neuroimaging twice in a mean (±SD) of 3.56 ± 0.65 and 3.94 ± 0.91 years, respectively (P = 0.098). Cognitive assessment included the domains of general cognitive ability, memory, information processing speed, executive functions, attention, and motor and psychomotor speed. Symmetrized percentage change in local cortical thickness, surface area, and volume was determined using the FreeSurfer 6 vertex-wise general linear model method. Analyses were performed uncorrected and corrected for baseline systolic blood pressure and depressive symptoms.

RESULTS

In patients versus controls, accelerated executive function decline was accompanied by, but not related to, lower left frontal and temporal surface area, left parietal and right frontal thickness, and bilateral frontal and right posterior cingulate volume (family-wise error [FWE]-corrected P < 0.05 for all). In patients, lower executive performance was related to loss of right precuneus surface area (P_FWE  = 0.005). Higher HbA1c during follow-up was related to executive function decline (r = -0.509, P = 0.016) and loss of left hemisphere surface area (r_{corrected analysis}  = -0.555, P = 0.007).

CONCLUSIONS

After 3.5 years of follow-up, middle-aged T1DM patients with proliferative retinopathy, mild focal changes in executive functions, and cortical structure were found, which may indicate accelerated aging.

PTSD in mental health outpatient settings: highly prevalent and under-recognized

OBJECTIVES

To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training.

METHODS

We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records.

RESULTS

Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals.

CONCLUSIONS

These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.

Cross-cultural adaptation and validation of the Brazilian version of the Beliefs about Emotions Scale

Introduction Beliefs about the unacceptability of expression and experience of emotion are present in the general population but seem to be more prevalent in patients with a number of health conditions. Such beliefs, which may be viewed as a form of perfectionism about emotions, may have a deleterious effect on symptomatology as well as on treatment adherence and outcome. Nevertheless, few questionnaires have been developed to measure such beliefs about emotions, and no instrument has been validated in a developing country. The current study adapted and validated the Beliefs about Emotions Scale in a Brazilian sample. Methods The adaptation procedure included translation, back-translation and analysis of the content, with the final Brazilian Portuguese version of the scale being tested online in a sample of 645 participants. Internal consistency of the scale was very high and results of a principal axis factoring analysis indicated a two-factor solution. Results Respondents with high fatigue levels showed more perfectionist beliefs, and the scale correlated positively with questionnaires measuring anxiety, depression and fear of negative evaluation, confirming cross-cultural associations reported before. Finally, men, non-Caucasians and participants with lower educational achievement gave greater endorsement to such beliefs than women, Caucasian individuals and participants with higher educational level. Conclusions The study confirms previous clinical findings reported in the literature, but indicates novel associations with demographic variables. The latter may reflect cultural differences related to beliefs about emotions in Brazil.

Cortical thickness and metacognition in cognitively diverse older adults

OBJECTIVE

Metacognition, or the ability to accurately identify, appraise, and monitor one's deficits, is commonly impaired in Alzheimer's disease (AD). Poor metacognition prevents correct appraisal of a range of physical, cognitive, and emotional symptoms and facilitates anosognosia, which has important clinical implications for individuals (e.g., diminished treatment adherence, increased engagement in high-risk situations) and caregivers (e.g., higher burden). However, the neural correlates of metacognitive disturbance are still debated in the literature, partly because of the subjective nature of traditional awareness measures.

METHOD

An objective Feeling of Knowing (FOK) task was used to measure metamemory capacity in a group of cognitively diverse older adults, including 14 with mild to moderate AD and 20 cognitively healthy older adults. The association between three different objective metamemory measures of the FOK task and regional cortical thickness (12 bilateral regions of interest [ROIs] hypothesized to support self-awareness) was analyzed using partial correlations.

RESULTS

Less accurate metamemory at the local and global levels was associated with reduced right posterior cingulate cortical thickness, r = -0.42, p = .02 and reduced right medial prefrontal, r = -0.39, p = .029, respectively.

CONCLUSIONS

To our knowledge, this was the first study to examine metacognition in relation to cortical thickness. Both global and local metamemory functions appear to rely on the integrity of right sided midline regions, known to be important for processing self-referential information. Findings are conceptualized with regard to the Default Mode Network, and also considered in relation to recent findings pointing to the right insula as a region critical for self-awareness. (PsycINFO Database Record