Intentional interruptions during compression only CPR: A scoping review.

Introduction: Out of hospital cardiac arrest (OHCA) remains one of the main causes of death among industrialized countries. The initiation of cardiopulmonary resuscitation (CPR) by laypeople before the arrival of emergency medical services improves survival. Mouth-to-mouth ventilation may constitute a hindering factor to start bystander CPR, while during continuous chest compressions (CCC) CPR quality decreases rapidly. The aim of this scoping review is to examine the existing literature on strategies that investigate the inclusion of intentional pauses during compression-only resuscitation (CO-CPR) to improve the performance in the context of single lay rescuer OHCA. Methods: The protocol of this Scoping review was prospectively registered in Open Science Framework (https://osf.io/rvn8j). A systematic search of PubMed, Scopus, EMBASE, CINAHL was performed. Results: Six articles were included. All studies were carried out on simulation manikins and involved a total of 1214 subjects. One study had a multicenter design. Three studies were randomized controlled simulation trials, the rest were prospective randomized crossover studies. The tested protocols were heterogeneous and compared CCC to CO-CPR with intentional interruptions of various length. The most common primary outcome was compressions depth. Compression rate, rescuers' perceived exertion and composite outcomes were also evaluated. Compressions depth and perceived exertion improved in most study groups while compression rate and chest compression fraction remained within guidelines indications. Conclusions: In simulation studies, the inclusion of intentional interruptions during CO-CPR within the specific scenario of single rescuer bystander CPR during OHCA may improve the rate of compressions with correct depth and lower rate of perceived exertion. Further high-quality research and feasibility and safety of protocols incorporating intentional interruptions during CO-CPR may be justified.

Understanding the Pathophysiology of Mental Diseases and Early Diagnosis Thanks to Electrophysiological Tools: Some Insights and Empirical Facts.

Objective. Neurophysiological tools remain indispensable instruments in the assessment of psychiatric disorders. These techniques are widely available, inexpensive and well tolerated, providing access to the assessment of brain functional alterations. In the clinical psychiatric context, electrophysiological techniques are required to provide important information on brain function. While there is an immediate benefit in the clinical application of these techniques in the daily routine (emergency assessments, exclusion of organic brain alterations), these tools are also useful in monitoring the progress of psychiatric disorders or the effects of therapy. There is increasing evidence and convincing literature to confirm that electroencephalography and related techniques can contribute to the diagnostic workup, to the identification of subgroups of disease categories, to the assessment of long-term causes and to facilitate response predictions. Methods and Results. In this report we focus on 3 different novel developments of the use of neurophysiological techniques in 3 highly prevalent psychiatric disorders: (1) the value of EEG recordings and machine learning analyses (deep learning) in order to improve the diagnosis of dementia subtypes; (2) the use of mismatch negativity in the early diagnosis of schizophrenia; and (3) the monitoring of addiction and the prevention of relapse using cognitive event-related potentials. Empirical evidence was presented. Conclusion. Such information emphasized the important role of neurophysiological tools in the identification of useful biological markers leading to a more efficient care management. The potential of the implementation of machine learning approaches together with the conduction of large cross-sectional and longitudinal studies was also discussed.

Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial.

BACKGROUND: A significant number of individuals with alcohol use disorder remain unresponsive to currently available treatments, which calls for the development of new alternatives. In parallel, psilocybin-assisted therapy for alcohol use disorder has recently yielded promising preliminary results. Building on extant findings, the proposed study is set to evaluate the feasibility and preliminary clinical efficacy of psilocybin-assisted therapy when incorporated as an auxiliary intervention during inpatient rehabilitation for severe alcohol use disorder. Moreover, it intends to pinpoint the modifications in the two core neurocognitive systems underscored by dual-process models of addiction. METHODS: In this double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial, 62 participants aged 21-64 years will be enrolled to undergo psilocybin-assisted therapy as part of a 4-week inpatient rehabilitation for severe alcohol use disorder. The experimental group will receive a high dose of psilocybin (30 mg), whereas the control group will receive an active placebo dose of psilocybin (5 mg), both within the context of a brief standardized psychotherapeutic intervention drawing from key elements of acceptance and commitment therapy. The primary clinical outcome is the between-group difference regarding the change in percentage of heavy drinking days from baseline to four weeks posthospital discharge, while safety and feasibility metrics will also be reported as primary outcomes. Key secondary assessments include between-group differences in terms of changes in (1) drinking behavior parameters up to six months posthospital discharge, (2) symptoms of depression, anxiety, trauma, and global functioning, (3) neuroplasticity and key neurocognitive mechanisms associated with addiction, and (4) psychological processes and alcohol-related parameters. DISCUSSION: The discussion outlines issues that might arise from our design. TRIAL REGISTRATION: EudraCT 2022-002369-14 and NCT06160232.

Rhabdomyolysis as cause, consequence, or mimicker of myocardial infarction: A case report.

Key Clinical Message: A timely diagnosis is essential to start appropriate therapy and to reduce risks of life-threatening complications of rhabdomyolysis. Some cases can undergo differential diagnosis with other clinical conditions, e.g., myocardial infarction. Abstract: We present the case of a 65-years-old male who was admitted to the emergency department with a clinical presentation related to myocardial infarction. The patient underwent coronary angioplasty and was then admitted to ICU due to hemodynamical instability, elevated potassium levels, and anuria. Further investigations revealed rhabdomyolysis. The patient received vasopressors, oxygenation support and renal replacement therapy. Outcomes at ICU discharge were favorable. The temporal association between rhabdomyolysis and myocardial infarction, together with an unclear pathophysiological relationship, made differential diagnosis difficult. We discuss this uncertainty in light of published literature.

A Comparative Event-Related Potentials Study between Alcohol Use Disorder, Gambling Disorder and Healthy Control Subjects through a Contextual Go/NoGo Task.

(1) Background: Inhibitory and rewarding processes that mediate attentional biases to addiction-related cues may slightly differ between patients suffering from alcohol use (AUD) or gambling (GD) disorder. (2) Methods: 23 AUD inpatients, 19 GD patients, and 22 healthy controls performed four separate Go/NoGo tasks, in, respectively, an alcohol, gambling, food, and neutral long-lasting cueing context during the recording of event-related potentials (ERPs). (3) Results: AUD patients showed a poorer inhibitory performance than controls (slower response latencies, lower N2d, and delayed P3d components). In addition, AUD patients showed a preserved inhibitory performance in the alcohol-related context (but a more disrupted one in the food-related context), while GD patients showed a specific inhibitory deficit in the game-related context, both indexed by N2d amplitude modulations. (4) Conclusions: Despite sharing common addiction-related mechanisms, AUD and GD patients showed different patterns of response to (non-)rewarding cues that should be taken into account in the therapeutic context.

Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study.

AIMS: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. MEASUREMENTS: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. FINDINGS: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. CONCLUSIONS: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Proactive and Reactive Inhibitory Control Strategies: Exploring the Impact of Interindividual Variables on an ERP Continuous Performance Task (AX-CPT).

According to the Dual Mechanisms of Control (DMC) framework, cognitive control can be divided into two strategies: proactive cognitive control, which relies mainly on the active maintenance of contextual information relevant to the ongoing task; and reactive cognitive control, which is a form of transient control triggered by an external cue. Although cognitive control has been studied extensively, little is known about the specificities of inhibition within the framework of the DMC model and the influence of interindividual variables on inhibitory control.Thanks to an inhibitory version of the continuous performance task (CPT), we studied behavioral performances and Event-Related Potentials (ERPs) related to proactive and reactive inhibition, and their links to psychological profile and cognitive performances. One hundred and five young adults underwent the task, along with a short clinical and cognitive evaluation.We were able to observe ERPs related to proactive (cue-N1, cue-N2, cue-P3, and the contingent negative variation) and reactive inhibitory control (target-N2 and target-P3). Our results showed that proactive strategies appeared to be linked with impulsivity, working memory abilities, dominant response inhibition, gender, and the consumption pattern of nicotine. Reactive strategies appeared to be linked with attentional and working memories abilities.Overall, the inhibitory AX-CPT allowed a specific investigation of cognitive control within the framework of the DMC based on behavioral and ERP variables. This provided us an opportunity to investigate the principal ERP components related to proactive and reactive inhibitory control strategies as well as to link them with specific clinical and cognitive variables.

Comparison of Neural Correlates of Reactive Inhibition in Cocaine, Heroin, and Polydrug Users through a Contextual Go/No-Go Task Using Event-Related Potentials.

Recent global data indicates a worldwide increase in polydrug use associated with a shift from recreational to productive habits of consumption. Such non-responsible abuse of substances (alcohol, cocaine, heroin, etc.) is likely to lead to addictive disorders that are characterized by various neuropsychopharmacological effects. A main cognitive function involved in the onset and long-term maintenance of addiction is reactive inhibition, i.e., the ability to withhold a prepotent motor dominant response. In the present study, 63 (poly)drug user patients who were undergoing a detoxification program, in addition to 19 healthy controls matched for gender, age, and education, were subjected to a "contextual Go/No-Go task" with concomitant electroencephalography. Stimuli were superimposed on three contextual backgrounds: control (black screen), drug-unrelated (neutral pictures), or drug-related (pictures related to drug consumption). Of these patients, 23 were cocaine users (CU), 21 were heroin users (HU), and 19 were polydrug users (PDU). The main results showed that (1) at the behavioral level, more commission errors occurred with the PDU patients compared to the healthy controls; (2) at the neurophysiological level, specific alterations were found on classical event-related potentials that index reactive inhibition. Indeed, the higher rate of errors in the PDU group was subtended by both reduced amplitude and latency on the ∆N2 component and increased ∆P3 latency compared to controls. These data clearly suggest a more deleterious impact of polydrug use on inhibitory functions. In addition, our results provide evidence of reduced ERN amplitude in cocaine users, suggesting that impaired performance monitoring and error-processing may support impaired awareness, thereby preventing these patients from changing their behaviors.

The Role of the Posterior Cerebellum in Dysfunctional Social Sequencing.

Recent advances in social neuroscience have highlighted the critical role of the cerebellum in social cognition, and especially the posterior cerebellum. Studies have supported the view that the posterior cerebellum builds internal action models of our social interactions to predict how other people's actions will be executed and what our most likely responses are to these actions. This mechanism allows to better anticipate action sequences during social interactions in an automatic and intuitive way and to fine-tune these anticipations, making it easier to understand other's social behaviors and mental states (e.g., beliefs, intentions, traits). In this paper, we argue that the central role of the posterior cerebellum in identifying and automatizing social action sequencing provides a fruitful starting point for investigating social dysfunctions in a variety of clinical pathologies, such as autism, obsessive-compulsive and bipolar disorder, depression, and addiction. Our key hypothesis is that dysfunctions of the posterior cerebellum lead to under- or overuse of inflexible social routines and lack of plasticity for learning new, more adaptive, social automatisms. We briefly review past research supporting this view and propose a program of research to test our hypothesis. This approach might alleviate a variety of mental problems of individuals who suffer from inflexible automatizations that stand in the way of adjustable and intuitive social behavior, by increasing posterior cerebellar plasticity using noninvasive neurostimulation or neuro-guided training programs.

Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial.

BACKGROUND: Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. OBJECTIVE: To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence. METHODS: A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year). RESULTS: Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT. CONCLUSIONS: AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054.

Use of cognitive event-related potentials in the management of psychiatric disorders: Towards an individual follow-up and multi-component clinical approach.

Relapse prevention remains a major challenge in psychiatry, thus indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. In recent years, several intervention strategies have been devised that are aimed at improving psychiatric treatment by providing a complementary set of add-on tools that can be used by clinicians to improve current patient assessment. Among these, cognitive event-related potentials (ERPs) have been indexed as valuable biomarkers of the pathophysiological mechanisms of various mental illnesses. However, despite decades of research, their clinical utility is still controversial and a matter of debate. In this opinion review, I present the main arguments supporting the use of cognitive ERPs in the management of psychiatric disorders, stressing why it is currently still not the case despite the vast number of ERP studies to date. I also propose a clinically-oriented suitable way in which this technique could - in my opinion - be effectively incorporated into individual patient care by promotion of the use of individual ERP test-retest sessions and the use of a multi-component approach.

Distinct Whole-Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder.

BACKGROUND: Spontaneous motor responses of approach and avoidance toward stimuli are important in characterizing psychopathological conditions, including alcohol use disorder (AUD). However, divergent results have been reported, possibly due to confounded parameters (e.g., using a symbolic vs. a sensorimotor task, implementation of approach-avoidance as a measure vs. a manipulation). METHODS: We studied whole-body/posturometric changes by using a sensorimotor measure relying on embodied cognition principles to assess forward (approach) and backward (avoidance) spontaneous leaning movements. Over a 12-second period, 51 male patients with AUD and 29 male control participants were instructed to stand still in response to both alcohol and sexual visual content. Patients with AUD were then divided into "abstainers" and "relapsers," depending on their continuous abstinence at 2 weeks postdischarge (obtained via a telephone follow-up interview). The effects of the group, the stimulus type, the experimental period, and their interactions on the posturometric changes were tested using mixed Analyses of variance (ANOVAs), with a significance threshold set at 0.05. RESULTS: Contrary to our expectations, patients and controls did not show significant difference in their forward/backward micromovements while passively viewing alcohol or sexual content (p > 0.1). However, in line with our hypothesis, patients who relapsed several weeks following discharge from the rehabilitation program were significantly more reactive and more likely to lean back during the first seconds of viewing alcohol cues (p = 0.002). Further, "relapsers" were more likely to lean forward during exposure to sexual content than participants who remained abstinent (p < 0.001). CONCLUSIONS: Among individuals with AUD, there are distinct pattern of spontaneous movements that differentiate "abstainers" and "relapsers," findings that can be understood in light of existing data and theories on action tendencies.

Transcranial Direct Current Stimulation Combined With Cognitive Training Induces Response Inhibition Facilitation Through Distinct Neural Responses According to the Stimulation Site: A Follow-up Event-Related Potentials Study.

OBJECTIVE: We investigated whether the mid-term impact (1 week posttraining) of a "combined cognitive rehabilitation (CRP)/transcranial direct current stimulation (tDCS) program" on the performance of a Go/No-go task was enhanced compared with isolated CRP and whether it varied according to the stimulation site (right inferior frontal gyrus [rIFG] vs right dorsolateral prefrontal cortex [rDLPFC]). METHODS: A total of 150 healthy participants were assigned to (1) an Inhibition Training (IT) group, (2) a group receiving active tDCS over the rIFG in combination with IT (IT + IF), (3) a group receiving active tDCS over the rDLPFC in combination with IT (IT + DL), (4) a group receiving IT with sham tDCS (ITsham), and (5) a No-Training (NT) group to control for test-retest effects. Each group undertook 3 sessions of a Go/No-go task concomitant with the recording of event-related potentials (T0, before training; T1, at the end of a 4-day training session [20 minutes each day]; T2, 1 week after T1). RESULTS: With the exception of the NT participants, all the groups exhibited improved performances at T2. The IT + DL group exhibited the best improvement profile, indexed by faster response times (RTs) (T0 > T1 = T2), with a reduced rate of errors at the posttraining sessions compared with both T0 and T1. This "inhibitory learning effect" was neurophysiologically indexed by shorter No-go N2d latencies and enhanced No-go P3d amplitudes. CONCLUSION: CRP combined with active tDCS over the rDLPFC appears to be optimal for boosting long-term (one week) inhibitory skills as it induced specific and robust neural changes.

Special Report on the Impact of the COVID-19 Pandemic on Clinical EEG and Research and Consensus Recommendations for the Safe Use of EEG.

INTRODUCTION: The global COVID-19 pandemic has affected the economy, daily life, and mental/physical health. The latter includes the use of electroencephalography (EEG) in clinical practice and research. We report a survey of the impact of COVID-19 on the use of clinical EEG in practice and research in several countries, and the recommendations of an international panel of experts for the safe application of EEG during and after this pandemic. METHODS: Fifteen clinicians from 8 different countries and 25 researchers from 13 different countries reported the impact of COVID-19 on their EEG activities, the procedures implemented in response to the COVID-19 pandemic, and precautions planned or already implemented during the reopening of EEG activities. RESULTS: Of the 15 clinical centers responding, 11 reported a total stoppage of all EEG activities, while 4 reduced the number of tests per day. In research settings, all 25 laboratories reported a complete stoppage of activity, with 7 laboratories reopening to some extent since initial closure. In both settings, recommended precautions for restarting or continuing EEG recording included strict hygienic rules, social distance, and assessment for infection symptoms among staff and patients/participants. CONCLUSIONS: The COVID-19 pandemic interfered with the use of EEG recordings in clinical practice and even more in clinical research. We suggest updated best practices to allow safe EEG recordings in both research and clinical settings. The continued use of EEG is important in those with psychiatric diseases, particularly in times of social alarm such as the COVID-19 pandemic.

Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.

Preventing relapse in alcohol disorder with EEG-neurofeedback as a neuromodulation technique: A review and new insights regarding its application.

Alcohol Use Disorder (AUD) has a disconcertingly high relapse rate (70-80% within a year following withdrawal). Preventing relapse or minimizing its extent is hence a challenging goal for long-term successful management of AUD. New perspectives that rely on diverse neuromodulation tools have been developed in this regard as care supports. This paper focuses on electroencephalogram-neurofeedback (EEG-NF), which is a tool that has experienced renewed interest in both clinical and research areas. We review the literature on EEG-based neurofeedback studies investigating the efficacy in AUD and including at least 10 neurofeedback training sessions. As neurofeedback is a form of biofeedback in which a measure of brain activity is provided as feedback in real-time to a subject, the high degree of temporal resolution of the EEG interface supports optimal learning. By offering a wide range of brain oscillation targets (alpha, beta, theta, delta, gamma, and SMR) the EEG-NF procedure increases the scope of possible investigations through a multitude of experimental protocols that can be considered to reinforce or inhibit specific forms of EEG activity associated with AUD-related cognitive impairments. The present review provides an overview of the EEG-NF protocols that have been used in AUD and it highlights the current paucity of robust evidence. Within this framework, this review presents the arguments in favor of the application of EEG-NF as an add-on tool in the management of alcohol disorders to enhance the cognitive abilities required to maintain abstinence more specifically, with a focus on inhibition and attentional skills.