Screening of psoriatic arthritis by dermatologists - a German nationwide survey.

BACKGROUND AND OBJECTIVES: Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO. PATIENTS AND METHODS: This non-interventional, prospective, epidemiological, cross-sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types. RESULTS: One hundred ninety-five patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (< 45%). Especially, ultrasounds (≤ 5%) and MRIs (< 6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences. CONCLUSIONS: Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening.

The association of dispositional anxiety with the NoGo N2 under relaxation instruction vs. speed/accuracy instruction.

Prior research suggests that cognitive control, indicated by NoGo N2 amplitudes in Go/NoGo tasks, is associated with dispositional anxiety. This negative association tends to be reduced in anxiety-enhancing experimental conditions. However, anxiety-reducing conditions have not yet been investigated systematically. Thus, the present study compares the effect of a relaxation instruction with the conventional speed/accuracy instruction in a Go/NoGo task on the correlation of the NoGo N2 with two subconstructs of dispositional anxiety, namely anxious apprehension and anxious arousal. As the test of differences between correlations needs considerable statistical power, the present study was included into the multi-lab CoScience Project. The hypotheses, manipulation checks, and the main path of pre-processing and statistical analysis were preregistered. Complete data sets of 777 participants were available for data analysis. Preregistered general linear models revealed that the different instructions of the task (speed/accuracy vs. relaxation) had no effect on the association between dispositional anxiety and the NoGo N2 amplitude in general. This result was supported by Cooperative-Forking-Path analysis. In contrast, a preregistered latent growth model with categorical variables revealed that anxious arousal was a negative predictor of the NoGo N2 intercept and a positive predictor of the NoGo N2 slope. Non-preregistered growth models, allowing for correlations of anxious apprehension with anxious arousal, revealed that higher anxious apprehension scores were associated with more negative NoGo N2 amplitudes with increased relaxation. Results are discussed in the context of the compensatory error monitoring hypothesis and the revised Reinforcement Sensitivity Theory.

Motor inhibition errors and interference suppression errors differ systematically on neural and behavioural features of response monitoring.

Action inhibition and error commission are prominent in everyday life. Inhibition comprises at least two facets: motor inhibition and interference suppression. When motor inhibition fails, a strong response impulse cannot be inhibited. When interference suppression fails, we become distracted by irrelevant stimuli. We investigated the neural and behavioural similarities and differences between motor inhibition errors and interference suppression errors systematically from stimulus-onset to post-response adaptation. To enable a direct comparison between both error types, we developed a complex speeded choice task where we assessed the error types in two perceptually similar conditions. Comparing the error types along the processing stream showed that the P2, an early component in the event-related potential associated with sensory gating, is the first marker for differences between the two error types. Further error-specific variations were found for the parietal P3 (associated with context updating and attentional resource allocation), for the lateralized readiness potential (LRP, associated with primary motor cortex activity), and for the Pe (associated with error evidence accumulation). For motor inhibition errors, the P2, P3 and Pe tended to be enhanced compared to successful inhibition. The LRP for motor inhibition errors was marked by multiple small response impulses. For interference suppression errors, all components were more similar to those of successful inhibition. Together, these findings suggest that motor inhibition errors arise from a deficient early inhibitory process at the perceptual and motor level, and become more apparent than interference suppression errors, that arise from an impeded response selection process.

Neural correlates of confidence during decision formation in a perceptual judgment task.

When we make a decision, we also estimate the probability that our choice is correct or accurate. This probability estimate is termed our degree of decision confidence. Recent work has reported event-related potential (ERP) correlates of confidence both during decision formation (the centro-parietal positivity component; CPP) and after a decision has been made (the error positivity component; Pe). However, there are several measurement confounds that complicate the interpretation of these findings. More recent studies that overcome these issues have so far produced conflicting results. To better characterise the ERP correlates of confidence we presented participants with a comparative brightness judgment task while recording electroencephalography. Participants judged which of two flickering squares (varying in luminance over time) was brighter on average. Participants then gave confidence ratings ranging from "surely incorrect" to "surely correct". To elicit a range of confidence ratings we manipulated both the mean luminance difference between the brighter and darker squares (relative evidence) and the overall luminance of both squares (absolute evidence). We found larger CPP amplitudes in trials with higher confidence ratings. This association was not simply a by-product of differences in relative evidence (which covaries with confidence) across trials. We did not identify postdecisional ERP correlates of confidence, except when they were artificially produced by pre-response ERP baselines. These results provide further evidence for neural correlates of processes that inform confidence judgments during decision formation.

Management of psoriatic arthritis by dermatologists - a German nationwide survey.

BACKGROUND AND OBJECTIVES: Psoriatic arthritis (PsA) warrants early diagnosis and treatment for optimal results. This study aimed to elucidate routine monitoring activities for PsA with concurrent psoriasis (PsO) by dermatologists to gather data on how conditions for optimal treatment are ensured. PATIENTS AND METHODS: This non-interventional, prospective, epidemiological, cross-sectional study (2016-2019) included patients with confirmed PsA from dermatologists. Descriptive statistics were conducted for center and patient characteristics as well as for data of PsA monitoring and treatment stratified by different center types. RESULTS: 212 patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. The majority of the PsA patients were diagnosed by a rheumatologist (> 55% in each center type) at an early or intermediate stage (> 59%). Treatment was initiated most frequently by a dermatologist (office-based physicians: 69.6%, hospitals: 60.9%, university hospitals: 82.9%). Patients were treated with biologics more frequently in university hospitals (single therapy: 43.9%, in combination with systemic therapy: 26.8%) compared to private practices (single: 44.6%, combination: 13.5%) and non-university hospitals (single: 34.8%, combination: 8.7%). CONCLUSIONS: As PsA diagnosis was performed most frequently by rheumatologists whereas treatment was primarily initiated by dermatologists, an optimal collaboration between these specialists is crucial.

Perfectionism-related variations in error processing in a task with increased response selection complexity.

Perfectionists strive for a flawless performance because they are intrinsically motivated to set and achieve high goals (personal standards perfectionism; PSP) and/or because they are afraid to be negatively evaluated by others (evaluative concern perfectionism; ECP). We investigated the differential relationships of these perfectionism dimensions with performance, post-response adaptation, error processing (reflected by two components of the event-related potential: error/correct negativity - Ne/c; error/correct positivity - Pe/c) and error detection. In contrast to previous studies, we employed a task with increased response selection complexity providing more room for perfectionistic dispositions to manifest themselves. Although ECP was related to indicators of increased preoccupation with errors, high-EC perfectionists made more errors than low-EC perfectionists. This observation may be explained by insufficient early error processing as indicated by a reduced Ne/c effect and a lack of post-response adaptation. PSP had a moderating effect on the relationship between ECP and early error processing. Our results provide evidence that pure-EC perfectionists may spend many of their cognitive resources on error-related contents and worrying, leaving less capacity for cognitive control and thus producing a structural lack of error processing.

Larger error negativity peak amplitudes for accuracy versus speed instructions may reflect more neuro-cognitive alignment, not more intense error processing.

Understanding human error processing is a highly relevant interdisciplinary goal. More than 30 years of research in this field have established the error negativity (Ne) as a fundamental electrophysiological marker of various types of erroneous decisions (e.g. perceptual, economic) and related clinically relevant variations. A common finding is that the Ne is more pronounced when participants are instructed to focus on response accuracy rather than response speed, an observation that has been interpreted as reflecting more thorough error processing. We challenge this wide-spread interpretation by demonstrating that when controlling for the level of non-event-related noise in the participant-average waveform and for single-trial peak latency variability, the significant speed-accuracy difference in the participant-average waveform vanishes. This suggests that the previously reported Ne differences may be mostly attributable to a more precise alignment of neuro-cognitive processes and not (only) to more intense error processing under accuracy instructions, opening up novel perspectives on previous findings.

Narcissism and the perception of failure - evidence from the error-related negativity and the error positivity.

The literature on narcissism suggests two contradictory ways how highly narcissistic individuals deal with their failures: They might avoid consciously recognising their failures to protect their ego or they might vigilantly turn towards their failures to process cues that are important for maintaining their grandiosity. We tried to dissolve these contradictory positions by studying event-related potential components of error processing and their variations with narcissism. With a speeded go/no-go task, we examined how the error-related negativity (Ne; reflecting an early, automatic processing stage) and the error positivity (Pe; associated with conscious error detection) vary with Admiration and Rivalry, two narcissism dimensions, under ego-threatening conditions. Using multilevel models, we showed that participants with high Rivalry displayed higher Ne amplitudes suggesting a heightened trait of defensive reactivity. We did not find variations of either narcissism dimension with the Pe, which would have pointed to weaker error awareness. Thus, our results only supported the second position: a heightened vigilance to errors in narcissism at early, rather automatic processing stages.

The influence of error detection and error significance on neural and behavioral correlates of error processing in a complex choice task.

Error detection and error significance form essential mechanisms that influence error processing and action adaptation. Error detection often is assessed by an immediate self-evaluation of accuracy. Our study used cognitive neuroscience methods to elucidate whether self-evaluation itself influences error processing by increasing error significance in the context of a complex response selection process. In a novel eight-alternative response task, our participants responded to eight symbol stimuli with eight different response keys and a specific stimulus-response assignment. In the first part of the experiment, the participants merely performed the task. In the second part, they also evaluated their response accuracy on each trial. We replicated variations in early and later stages of error processing and action adaptation as a function of error detection. The additional self-evaluation enhanced error processing on later stages, probably reflecting error evidence accumulation, whereas earlier error monitoring processes were not amplified. Implementing multivariate pattern analysis revealed that self-evaluation influenced brain activity patterns preceding and following the response onset, independent of response accuracy. The classifier successfully differentiated between responses from the self- and the no-self-evaluation condition several hundred milliseconds before response onset. Subsequent exploratory analyses indicated that both self-evaluation and the time on task contributed to these differences in brain activity patterns. This suggests that in addition to its effect on error processing, self-evaluation in a complex choice task seems to have an influence on early and general processing mechanisms (e.g., the quality of attention and stimulus encoding), which is amplified by the time on task.

Divergent effects of absolute evidence magnitude on decision accuracy and confidence in perceptual judgements.

Whether people change their mind after making a perceptual judgement may depend on how confident they are in their decision. Recently, it was shown that, when making perceptual judgements about stimuli containing high levels of 'absolute evidence' (i.e., the overall magnitude of sensory evidence across choice options), people make less accurate decisions and are also slower to change their mind and correct their mistakes. Here we report two studies that investigated whether high levels of absolute evidence also lead to increased decision confidence. We used a luminance judgment task in which participants decided which of two dynamic, flickering stimuli was brighter. After making a decision, participants rated their confidence. We manipulated relative evidence (i.e., the mean luminance difference between the two stimuli) and absolute evidence (i.e., the summed luminance of the two stimuli). In the first experiment, we found that higher absolute evidence was associated with decreased decision accuracy but increased decision confidence. In the second experiment, we additionally manipulated the degree of luminance variability to assess whether the observed effects were due to differences in perceived evidence variability. We replicated the results of the first experiment but did not find substantial effects of luminance variability on confidence ratings. Our findings support the view that decisions and confidence judgements are based on partly dissociable sources of information, and suggest that decisions initially made with higher confidence may be more resistant to subsequent changes of mind.

Social anxiety disorder with comorbid major depression - why fearful attachment style is relevant.

Individuals with social anxiety disorder (SAD) often suffer from comorbid major depressive disorder (MDD), which goes along with increased clinical and functional impairment. There has been little research on underlying differences regarding childhood adversities and attachment styles between individuals with SAD with and without comorbid MDD. In the present study, the consecutive sample comprised 612 SCID-diagnosed participants. Of these, n = 472 (62.3% women, 40.7 ± 13.8 years) showed SAD and comorbid MDD (SAD-MDD group) and n = 140 (47.9% women, 43.7 ± 14.7 years) showed just SAD (SAD group). The two groups were compared regarding SAD symptom severity (Social Phobia Inventory; SPIN), childhood adversities (Adverse Childhood Experience Questionnaire; ACE) and attachment styles (Attachment Style Questionnaire, ASQ). The SAD-MDD group reported significantly more severe SAD symptoms (p = .002, d = 0.30), more childhood adversities (p < .001, d = 0.35) and a higher level of fearful attachment style (p < .001, d = 0.30). Group significantly moderated the association between fearful attachment style and SAD symptom severity (ß = .292, p < .05) but not between preoccupied attachment style and SAD symptom severity (ß = -.184, p = .124; R2adj = .168, p < .05). Fearful attachment style mediated the association between childhood adversities and SAD symptom severity in the SAD-MDD group. Our study could identify a specific significance of fearful attachment style for the association between negative childhood experiences and social anxiety symptoms in SAD-MDD. Findings have specific implications for the therapeutic relationship.

Linking neurophysiological processes of action monitoring to post-response speed-accuracy adjustments in a neuro-cognitive diffusion model.

The cognitive system needs to continuously monitor actions and initiate adaptive measures aimed at increasing task performance and avoiding future errors. To investigate the link between the contributing cognitive processes, we introduce the neuro-cognitive diffusion model, a statistical approach that allows a combination of computational modelling of behavioural and electrophysiological data on a single-trial level. This unique combination of methods allowed us to demonstrate across three experimental datasets that early response monitoring (error negativity; Ne/c) was related to more response caution and increased attention on task-relevant features on the subsequent trial, thereby preventing future errors, whereas later response monitoring (error positivity, Pe/c) maintained the ability of responding fast under speed pressure. Our results suggest that Pe/c-related processes might keep Ne/c-related processes in check regarding their impact on post-response adaptation to reconcile the conflicting criteria of fast and accurate responding.

The relationship between response dynamics and the formation of confidence varies across the lifespan.

Accurate metacognitive judgments, such as forming a confidence judgment, are crucial for goal-directed behavior but decline with older age. Besides changes in the sensory processing of stimulus features, there might also be changes in the motoric aspects of giving responses that account for age-related changes in confidence. In order to assess the association between confidence and response parameters across the adult lifespan, we measured response times and peak forces in a four-choice flanker task with subsequent confidence judgments. In 65 healthy adults from 20 to 76 years of age, we showed divergent associations of each measure with confidence, depending on decision accuracy. Participants indicated higher confidence after faster responses in correct but not incorrect trials. They also indicated higher confidence after less forceful responses in errors but not in correct trials. Notably, these associations were age-dependent as the relationship between confidence and response time was more pronounced in older participants, while the relationship between confidence and response force decayed with age. Our results add to the notion that confidence is related to response parameters and demonstrate noteworthy changes in the observed associations across the adult lifespan. These changes potentially constitute an expression of general age-related deficits in performance monitoring or, alternatively, index a failing mechanism in the computation of confidence in older adults.

Neural correlates of metacognition across the adult lifespan.

Metacognitive accuracy describes the degree of overlap between the subjective perception of one's decision accuracy (i.e. confidence) and objectively observed performance. With older age, the need for accurate metacognitive evaluation increases; however, error detection rates typically decrease. We investigated the effect of ageing on metacognitive accuracy using event-related potentials (ERPs) reflecting error detection and confidence: the error/correct negativity (Ne/c) and the error/correct positivity (Pe/c). Sixty-five healthy adults (20 to 76 years) completed a complex Flanker task and provided confidence ratings. We found that metacognitive accuracy declined with age beyond the expected decline in task performance, while the adaptive adjustment of behaviour was well preserved. Pe amplitudes following errors varied by confidence rating, but they did not mirror the reduction in metacognitive accuracy. Ne amplitudes decreased with age for low confidence errors. The results suggest that age-related difficulties in metacognitive evaluation could be related to an impaired integration of decision accuracy and confidence information processing. Ultimately, training the metacognitive evaluation of fundamental decisions in older adults might constitute a promising endeavour.

Predicting participants' attitudes from patterns of event-related potentials during the reading of morally relevant statements - An MVPA investigation.

Morality and language are hardly separable, given that morality-related aspects such as knowledge, emotions, or experiences are connected with language on different levels. One question that arises is: How rapidly do neural processes set in when processing statements that reflect moral value containing information? In the current study, participants read sentences about morally relevant statements (e.g., 'Wars are acceptable') and expressed their (dis)agreement with the statements while their electroencephalogram (EEG) was recorded. Multivariate pattern classification (MVPA) was used during language processing to predict the individual's response. Our results show that (1) the response ('yes' vs. 'no') could be predicted from 180 ms following the decision-relevant word (here acceptable), and (2) the attitude (pro vs. contra the topic) could be predicted from 170 ms following the topic word (here wars). We suggest that the successful MVPA classification is due to different brain activity patterns evoked by differences in activated mental representations (e.g. valence, arousal, etc.) depending on whether the attitude towards the topic is positive or negative and whether it is in accordance with the presented decisive word or not.

Neural correlates of error detection during complex response selection: Introduction of a novel eight-alternative response task.

Error processing in complex decision tasks should be more difficult compared to a simple and commonly used two-choice task. We developed an eight-alternative response task (8ART), which allowed us to investigate different aspects of error detection. We analysed event-related potentials (ERP; N = 30). Interestingly, the response time moderated several findings. For example, only for fast responses, we observed the well-known effect of larger error negativity (Ne) in signalled and non-signalled errors compared to correct responses, but not for slow responses. We identified at least two different error sources due to post-experimental reports and certainty ratings: impulsive (fast) errors and (slow) memory errors. Interestingly, the participants were able to perform the task and to identify both, impulsive and memory errors successfully. Preliminary evidence indicated that early (Ne-related) error processing was not sensitive to memory errors but to impulsive errors, whereas the error positivity seemed to be sensitive to both error types.

Face Perception and Narcissism: Variations of Event-Related Potential Components (P1 & N170) with Admiration and Rivalry.

Previous studies have demonstrated that highly narcissistic individuals perceive themselves as grandiose and devaluate and sometimes overvalue others. These results are mainly based on behavioural data, but we still know little about the neural correlates underlying, such as perceptional processes. To this end, we investigated event-related potential components (ERP) of visual face processing (P1 and N170) and their variations with narcissism. Participants (N = 59) completed the Narcissistic Admiration and Rivalry Questionnaire and were shown pictures of their own face, a celebrity's face, and a stranger's face. Variations of P1 and N170 with Admiration and Rivalry were analysed using multilevel models. Results revealed moderating effects of both narcissism dimensions on the ERP components of interest. Participants with either high Admiration or low Rivalry scores showed a lower P1 amplitude when viewing their own face compared with when viewing a celebrity's face. Moreover, the Self-Stranger difference in the N170 component (higher N170 amplitude in the Self condition) was larger for higher Rivalry scores. The findings showed, for the first time, variations of both narcissism dimensions with ERPs of early face processing. We related these effects to processes of attentional selection, an expectancy-driven perception, and the mobilisation of defensive systems. The results demonstrated that by linking self-report instruments to P1 and N170, and possibly to other ERP components, we might better understand self- and other-perception in narcissism.

Preserved performance monitoring and error detection in left hemisphere stroke.

Depending on the lesion site, a stroke typically affects various aspects of cognitive control. While executing a task, the performance monitoring system constantly compares an intended action plan with the executed action and thereby registers inaccurate actions in case of any mismatch. When errors occur, the performance monitoring system signals the need for more cognitive control, which is most efficient when the subject notices errors rather than processing them subconsciously. The current study aimed to investigate performance monitoring and error detection in a large sample of patients with left hemisphere (LH) stroke. In addition to clinical and neuropsychological tests, 24 LH stroke patients and 32 healthy age-matched controls performed a Go/Nogo task with simultaneous electroencephalography (EEG) measurements. This set-up enabled us to compare performance monitoring at the behavioral and the neural level. EEG data were analyzed using event-related potentials [ERPs; e.g., the error-related negativity (Ne/ERN) and error positivity (Pe)] and additionally more sensitive whole-brain multivariate pattern classification analyses (MVPA). We hypothesized that LH stroke patients would show behavioural deficits in error detection when compared to healthy controls, mirrored by differences in neural signals, in particular reflected in the Pe component. Interestingly, despite clinically relevant cognitive deficits (e.g., aphasia and apraxia) including executive dysfunction (trail making test), we did not observe any behavioral impairments related to performance monitoring and error processing in the current LH stroke patients. Patients also showed similar results for Ne/ERN and Pe components, compared to the control group, and a highly similar prediction of errors from multivariate signals. ERP abnormalities during stimulus processing (i.e., N2 and P3) demonstrated the specificity of these findings in the current LH stroke patients. In contrast to previous studies, by employing a relatively large patient sample, a well-controlled experimental paradigm with a standardized error signaling procedure, and advanced data analysis, we were able to show that performance monitoring (of simple actions) is a preserved cognitive control function in LH stroke patients that might constitute a useful resource in rehabilitative therapies for re-learning impeded functions.

The gamma model analysis (GMA): Introducing a novel scoring method for the shape of components of the event-related potential.

BACKGROUND: Research using the event-related potential (ERP) method to investigate cognitive processes has usually focused on the analysis of either individual peaks or the area under the curve as components of interest. These approaches, however, do not analyse or describe the substantial variation in size and shape across the entire individual waveforms. NEW METHOD: Here we show that the precision of ERP analyses can be improved by fitting gamma functions to components of interest. Gamma model analyses provide time-dependent and shape-related information about the component, such as the component's rise and decline. We demonstrated the advantages of the gamma model analysis in a simulation study and in a two-choice response task, as well as a force production task. RESULTS: The gamma model parameters were sensitive to experimental variations, as well as variations in behavioural parameters. COMPARISON WITH EXISTING METHODS: Gamma model analyses provide researchers with additional reliable indicators about the shape of an ERP component's waveform, which previous analytical techniques could not. CONCLUSION: This approach, therefore, provides a novel toolset to better understand the exact relationship between ERP components, behaviour and cognition.