Lack of awareness despite complex visual processing: Evidence from event-related potentials in a case of selective metamorphopsia.

Visual awareness is thought to result from integration of low- and high-level processing; instances of integration failure provide a crucial window into the cognitive and neural bases of awareness. We present neurophysiological evidence of complex cognitive processing in the absence of awareness, raising questions about the conditions necessary for visual awareness. We describe an individual with a neurodegenerative disease who exhibits impaired visual awareness for the digits 2 to 9, and stimuli presented in close proximity to these digits, due to perceptual distortion. We identified robust event-related potential responses indicating 1) face detection with the N170 component and 2) task-dependent target-word detection with the P3b component, despite no awareness of the presence of faces or target words. These data force us to reconsider the relationship between neural processing and visual awareness; even stimuli processed by a workspace-like cognitive system can remain inaccessible to awareness. We discuss how this finding challenges and constrains theories of visual awareness.

Properties of graphic motor plans in the writing system.

The present study explores the extent to which properties of abstract graphemic representations are maintained at the post-graphemic level of graphic motor plans, where the sequences of writing strokes for producing the letters in a word are represented. On the basis of results from a stroke patient (NGN) who has a deficit affecting the activation of graphic motor plans, we explore the post-graphemic representation of 1) consonant/vowel status of letters; 2) geminate (double) letters, such as the BB in RABBIT; and 3) digraphs, such as the SH in SHIP. Through analyses of NGN's letter substitution errors, we conclude that 1) consonant-vowel status is not represented at the level of graphic motor plans; 2) geminates have special representations at the motor-plan level, as at the graphemic level; and 3) digraphs are represented by two separate single-letter graphic motor plans, and not by unitary digraph motor plans.

Emotion regulation strategies among individuals with borderline personality disorder relative to other groups: A review.

Borderline personality disorder (BPD) is associated with difficulties in emotion regulation (ER) abilities. Investigations of ER strategies in BPD have been less robust. This systematic review identified 55 studies comparing ER strategy use between individuals diagnosed with BPD versus psychiatric and non-psychiatric comparison groups. Individuals with BPD reported more frequent maladaptive and less frequent adaptive ER strategy use than non-psychiatric controls. Results were less consistent relative to psychiatric comparison groups, though individuals with BPD reported greater self-criticism and avoidance. Groups responded comparably to instructed use of adaptive (but not maladaptive) ER strategies. This body of research would benefit from further examination of the roles of psychiatric comorbidity and problematic behaviours in the relationship between BPD and ER strategies.

Hyperoxaemia and hypoxaemia are associated with harm in patients with ARDS.

BACKGROUND: Oxygen therapy is routinely administered to mechanically ventilated patients. However, there remains uncertainty about the optimal oxygen titration target in patients with the acute respiratory distress syndrome (ARDS). METHODS: Prospectively identified adult patients meeting the Berlin definition of ARDS between 1st January 2014 and 13th December 2016 were analyzed. Oxygen exposure variables were collected at 6-hourly intervals. The primary exposure was the average time-weighted partial pressure of arterial oxygen (PaO2) calculated over a maximum of 7 days from meeting ARDS criteria. The primary outcome was ICU mortality. Univariable and multivariable logistic regression analyses were performed to assess the impact of exposure variables on clinical outcomes. Results are presented as odds ratio [95% confidence interval]. RESULTS: 202 patients were included in the final analysis. Overall ICU mortality was 31%. The average time-weighted PaO2 during the first 7 days of ARDS was similar between non-survivors and survivors (11.3 kPa [10.2, 12.5] (84.8 mmHg [76.5, 93.8]) vs. 11.9 kPa [10.9, 12.6] (89.3 mmHg [81.8, 94.5]); p = 0.08). In univariable and multivariable analysis, average time-weighted PaO2 demonstrated a U-shaped relationship with ICU mortality. There was a similar relationship identified with hospital mortality. CONCLUSIONS: In patients with ARDS, the predicted probability of both ICU and hospital mortality was lowest when the average time-weighted PaO2 was between 12.5 and 14 kPa (93.8-105.0 mmHg), suggesting this is a reasonable oxygenation target for clinicians to aim for.

Characterizing the choice to disclose nonsuicidal self-injury.

OBJECTIVE: Despite nonsuicidal self-injury (NSSI) being a prevalent and problematic behavior, only approximately half of those who engage in NSSI disclose their behavior. Yet, limited research has explored the choice to disclose. This study sought to identify if NSSI characteristics, emotional distress, and perceived interpersonal obstacles discriminated between NSSI disclosure status. Exploratory aims also investigated reasons for one's disclosure decision and disclosure contextual factors. METHOD: Participants included 977 undergraduate students (83% female) with a lifetime history of NSSI. RESULTS: Greater NSSI intrapersonal functions, suicide risk, and significant other support, and lower depression symptoms were associated with NSSI disclosure. Exploratory results highlight perceptions of one's NSSI severity and desire to receive support in disclosure choice; intrapersonal functions and peer support were associated with the timing of disclosure. CONCLUSIONS: Findings underscore the potential importance of individual attitudes toward NSSI, in addition to traditionally measured risk factors, as potential drivers in NSSI disclosure.

The role of therapeutic alliance in therapy for adults with problematic aggression and associated disorders.

The nature and quality of the relationship between therapist and client in psychotherapy, known as therapeutic alliance, have been proposed as one of the most important factors for successful treatment outcome, which has been has robustly supported across many types of treatment, populations, raters of alliance (i.e., client, therapist, or observer), and alliance measures. However, most research on alliance and treatment outcome has been conducted in children and adults with internalizing problems (e.g., mood and anxiety disorders) or children with externalizing problems (e.g., conduct disorder), despite the fact that alliance may be particularly important for adults with externalizing problems such as problematic aggression, who may have high levels of resistance, blaming, and interpersonal problems. Very limited research has examined the role of alliance in individuals who present to treatment due to high levels of aggressive behaviour specifically (e.g., those convicted of a violent offence). The current systematic review examined the extant research on the relationship between alliance and outcome in treatment of highly aggressive individuals, as well as those who are diagnosed with a disorder for which aggression is a primary symptom (i.e., post-traumatic stress disorder, antisocial personality disorder, and borderline personality disorder). Overall, it was shown that alliance has a positive impact on treatment outcome among those engaging in or at risk for problematic aggression. Additionally, the alliance-outcome relationship may be affected by therapy modality, alliance rater perspective, and potential mechanisms of alliance. Implications for future research, including utilizing more primarily aggressive samples, are discussed.

The interactive effects of peers and alcohol on functional brain connectivity in young adults.

Alcohol and peer influence are known to have independent effects on risky decision making. We investigated combined influences of peers and alcohol on functional brain connectivity and behavior. Young adults underwent fMRI while completing response inhibition (Go/No-Go) and risky driving (Stoplight) tasks. Intoxicated participants made more mistakes on Go/No-Go, and showed diminished connectivity between the anterior insular cortex (AIC) and regions implicated in executive function (e.g., dorsal anterior cingulate). During the Stoplight game, peer observation was associated with increased connectivity between the AIC and regions implicated in social cognition (e.g., ventromedial prefrontal cortex). Alcohol and peers also exerted interactive influences, such that some connectivity changes only occurred when participants were observed by peers and under the influence of alcohol. These findings suggest that brain systems underlying decision making function differently under the combined influence of alcohol and peers, and highlight mechanisms through which this combination of factors is particularly risky for youth.

Bimanual visually guided movements are more than the sum of their parts: Evidence from optic ataxia.

Many reaching actions involve both hands. An open question is whether two-handed reaching involves two simultaneous, independent unimanual reaches, or recruits additional or different processes than those mediating one-handed reaching. We tested optic ataxic patient MDK on a set of unimanual and bimanual reaching tasks. Although MDK was impaired in both types of reaching task, his bimanual reaching was considerably better than his unimanual reaching. These results imply that bimanual reaching involves different or additional processes relative to unimanual reaching. We suggest that bimanual reaching may involve monitoring of the distance between the two hands relative to the distance between the two targets.

Reconsidering important outcomes of the nonsuicidal self-injury disorder diagnostic criterion A.

OBJECTIVE: The nonsuicidal self-injury (NSSI) disorder diagnostic criteria have been the focus of empirical study. However, Criterion A (i.e., required frequency and timeframe) has received relatively limited attention. The current study aimed to examine the relationship between past 12-month NSSI frequency and eight NSSI behavior features among individuals with past 12-month and 1-month NSSI. METHOD: Participants were 723 undergraduate students reporting at least 1 past 12-month NSSI act and completed online questionnaires. Decision trees and structural equation model trees were utilized to examine the relationship between NSSI frequency and behavior features. RESULTS: Results highlight several potential subgroups: high (i.e., greater than 49 acts), moderate-to-high (i.e., 19-48 acts), low-to-moderate (i.e., 7-18 acts), and low (i.e., fewer than 6 acts) frequency subgroups. CONCLUSIONS: Findings suggest that increasing the NSSI disorder criterion A frequency cutoff or requiring at least one past month NSSI act may better demarcate individuals with more severe NSSI behavior.

A deficit in post-graphemic writing processes: Evidence for a graphomotor buffer.

Post-graphemic writing processes transform abstract letter representations into representations of writing movements. We describe an individual with an acquired post-graphemic writing deficit. NGN is normal in spelling words aloud, but impaired in writing words to dictation, with most errors involving letter substitutions (e.g., RUMOR written as BUMOR). NGN's deficit affects graphic motor plans, which specify the writing strokes for producing letters. Analyses of writing speed, fluency, and stroke patterns suggest that NGN's errors result from incomplete motor-plan activation. NGN's error rate is high for the first letter in a word, and declines across subsequent positions. On the basis of this serial position effect and other results, we propose that post-graphemic writing mechanisms include a graphomotor buffer, a writing-specific working memory that holds activated graphic motor plans bound to specific serial positions. We suggest that NGN's graphomotor buffer is damaged such that early serial positions are affected most severely. Finally, we present results speaking to the roles and capabilities of the graphomotor buffer, and the structure of graphic motor plans.

Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use.

Research has supported an association between suicidal thoughts/behaviors and risk taking, which may be particularly strong during adolescence when risk taking is known to increase. However, extant research has focused on individual risk-taking behaviors (e.g., alcohol use), limiting our ability to evaluate the unique association between different risk-taking behaviors and suicidal thoughts/behaviors. The current study aimed to fill this gap by examining the simultaneous influence of multiple risk-taking behaviors (i.e., risky sexual behavior, tobacco/alcohol use, illicit drug use, delinquent behavior, violent behavior) on adolescent suicidal thoughts/behaviors. Data from the National Longitudinal Study of Adolescent Health was utilized. The sample consisted of 4,834 adolescents who completed home interviews at two time points. At the first time point, participants' mean age was 15.15, with 48% (n = 2,315) identifying as male. Participants provided information about suicidal thoughts/behaviors and multiple risk-taking behaviors at an initial interview and at a second interview, approximately 11 months later. When independently examined, nearly all assessed risk-taking behaviors were independently associated with suicidal ideation concurrently and prospectively, and with suicide attempts concurrently. When all risk-taking behaviors were examined simultaneously, illicit drug use was the only significant concurrent and significant prospective, albeit negative, predictor of suicidal thoughts and only concurrent predictor of suicidal behavior. The current findings suggest that illicit drug use may have a stronger association with suicidal thoughts and behaviors than other risk-taking behavior. These findings have implications for prevention and intervention programs for adolescents.

Exploratory analysis of mediators of the relationship between childhood maltreatment and suicidal behavior.

INTRODUCTION: Suicide is a major public health concern. One consistently cited risk factor for suicide is childhood maltreatment, which also may play a role in the transition from suicidal ideation to suicidal behavior. METHOD: The current study aimed to examine the relationship between childhood maltreatment and suicide attempts during adolescence (N = 4834; 52.1% female; 67.5% Caucasian). Data from the U.S. National Longitudinal Study of Adolescent Health were utilized. Forty-six theoretically-relevant risk factors were explored as potential mediators of this relationship using an exploratory mediation data analytic method. RESULTS: Results demonstrated a significant childhood maltreatment - suicide attempt relationship only among females. After considering demographics and suicidal ideation, having received counseling in the previous 12 months was the most influential mediator, followed by having a friend attempt suicide in the previous 12 months. CONCLUSIONS: These findings highlight potential gender differences in the relationship between childhood maltreatment and later suicide attempts, and, moreover, the importance of assessing for recent exposure to peer suicidal behavior in suicide risk assessments.

The co-occurrence and correlates of anxiety disorders among adolescents with intermittent explosive disorder.

We examined the lifetime prevalence of anxiety disorders (ADs) among adolescents with lifetime intermittent explosive disorder (IED), as well as the impact of co-occurring ADs on anger attack frequency and persistence, additional comorbidity, impairment, and treatment utilization among adolescents with IED. IED was defined by the occurrence of at least three anger attacks that were disproportionate to the provocation within a single year. Data were drawn from the National Comorbidity Survey-Adolescent Supplement (N = 6,140), and diagnoses were based on structured lay-administered interviews. Over half (51.89%) of adolescents with IED had an AD, compared to only 22.88% of adolescents without IED. Compared to adolescents with IED alone, adolescents with IED and comorbid ADs: (a) were more likely to be female; (b) reported greater impairment in work/school, social, and overall functioning; (c) were more likely to receive an additional psychiatric diagnosis, a depressive or drug abuse diagnosis, or diagnoses of three or more additional disorders; and (d) had higher odds of receiving any mental/behavioral health treatment as well as treatment specifically focused on aggression. Adolescents with IED alone and those with comorbid ADs did not differ in the number of years experiencing anger attacks or the highest number of anger attacks in a given year. ADs frequently co-occur with IED and are associated with elevated comorbidity and greater impairment compared to IED alone. Gaining a better understanding of this comorbidity is essential for developing specialized and effective methods to screen and treat comorbid anxiety in adolescents with aggressive behavior problems.

Developmental dysgraphia: An overview and framework for research.

Developmental deficits in the acquisition of writing skills (developmental dysgraphias) are common and have significant consequences, yet these deficits have received relatively little attention from researchers. We offer a framework for studying developmental dysgraphias (including both spelling and handwriting deficits), arguing that research should be grounded in theories describing normal cognitive writing mechanisms and the acquisition of these mechanisms. We survey the current state of knowledge concerning developmental dysgraphia, discussing potential proximal and distal causes. One conclusion emerging from this discussion is that developmental writing deficits are diverse in their manifestations and causes. We suggest an agenda for research on developmental dysgraphia, and suggest that pursuing this agenda may contribute not only to a better understanding of developmental writing impairment, but also to a better understanding of normal writing mechanisms and their acquisition. Finally, we provide a brief introduction to the subsequent articles in this special issue on developmental dysgraphia.

The value of cognitive neuropsychology: The case of vision research.

Cognitive neuropsychological evidence is widely viewed as inherently flawed or weak, despite well-reasoned arguments to the contrary by many theorists. Rather than attempting yet another defence of cognitive neuropsychology on logical grounds, we point out through examples that in practice, cognitive neuropsychological evidence is widely accepted as valid and important, and has had a major impact on cognitive theory and research. Objections offered in the abstract rarely arise in the context of actual studies. We develop these points through examples from the domain of vision, discussing cerebral achromatopsia and akinetopsia, selective impairment and sparing of face recognition, perception-action dissociations, and blindsight.

Do reading and spelling share orthographic representations? Evidence from developmental dysgraphia.

Both spelling and reading depend on knowledge of the spellings of words. Despite this commonality, observed dissociations between spelling and reading in cases of acquired and developmental deficits suggest some degree of independence between the cognitive mechanisms involved in these skills. In this paper, we examine the relationship between spelling and reading in two children with developmental dysgraphia. For both children, we identified significant deficits in spelling that affected the processing of orthographic long-term memory representations of words. We then examined their reading skills for similar difficulties. Even with extensive testing, we found no evidence of a reading deficit for one of the children. We propose that there may be an underlying difficulty that specifically affects the learning of orthographic word representations for spelling. These results lead us to conclude that at least some components of lexical orthographic representation and processing develop with considerable independence in spelling and reading.

Cognitive processes in spatial mapping: Evidence from a developmental spatial deficit.

We report a case study of an adolescent girl (N.K.Y.) with a developmental deficit affecting spatial processing. In a simple spatial mapping task, N.K.Y. shows a striking dissociation: She succeeds in one variant of the experiment in which the stimuli are objects, but struggles in a structurally identical task with people as stimuli. We present evidence that this dissociation stems from a tendency to automatically adopt the spatial perspective of other people, but not objects-a phenomenon also observed in neurotypical individuals. When adopting another person's perspective, N.K.Y. imagines herself in the other's position, representing the other's left and right as if it were her own. N.K.Y.'s deficit in relating left-right information to her own body then disrupts her performance. Our results shed light on the nature of N.K.Y.'s deficit as well as the cognitive operations involved in spatial perspective taking.

Development of a screening questionnaire for DSM-5 intermittent explosive disorder (IED-SQ).

OBJECTIVE: This study was designed to develop and test a screening approach to identify individuals with DSM-5 Intermittent Explosive Disorder (IED), a disorder of recurrent, problematic, impulsive aggression. METHODS: A screening approach to diagnose DSM-5 IED (IED-SQ) was developed by combining items related to life history of aggression and items related to the DSM-5 diagnostic criteria for IED. In study 1, the IED-SQ was studied in 72 adult participants; 33 that met DSM-5 criteria for lifetime IED and 39 that did not. In study 2, the IED-SQ was given to 740 undergraduates at a US university. Measures of aggression and anger expression and anger control were assessed in both studies. RESULTS: In study 1, the IED-SQ demonstrated strong concordance with the best estimate diagnoses (Kappa =.80) for lifetime IED by DSM-5 criteria and good test-retest reliability (kappa =0.71). In study 2, the IED-SQ identified 4.3% of the undergraduate sample as meeting DSM-5 criteria for lifetime IED, a rate comparable to that in recent epidemiological studies. Participants identified as meeting DSM-5 criteria for lifetime IED, in both studies, had higher aggression scores, and higher anger expression, and lower anger control scores, compared to participants that did not meet DSM-5 criteria for lifetime IED. CONCLUSIONS: These data suggest that the IED-SQ is a useful screening tool that can quickly identify the presence of IED by DSM-5 criteria in adults.

Behavioral evidence of emotion dysregulation in binge eaters.

Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ2 = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (rpb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.

Neural representation of object orientation: A dissociation between MVPA and Repetition Suppression.

How is object orientation represented in the brain? Behavioral error patterns reveal systematic tendencies to confuse certain orientations with one another. Using fMRI, we asked whether more confusable orientations are represented more similarly in object selective cortex (LOC). We compared two widely-used measures of neural similarity: multi-voxel pattern similarity (MVP-similarity) and Repetition Suppression. In LO, we found that multi-voxel pattern similarity was predicted by the confusability of two orientations. By contrast, Repetition Suppression effects in LO were unrelated to the confusability of orientations. To account for these differences between MVP-similarity and Repetition Suppression, we propose that MVP-similarity reflects the topographical distribution of neural populations, whereas Repetition Suppression depends on repeated activation of particular groups of neurons. This hypothesis leads to a unified interpretation of our results and may explain other dissociations between MVPA and Repetition Suppression observed in the literature.