Follow-up after PICU discharge for patients with acquired brain injury: the role of an abbreviated neuropsychological evaluation and a return-to-school program.

Objective: To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among pediatric intensive care unit (PICU) survivors with acquired brain injury in our post-discharge follow-up programs, and describe our process for facilitating this population's return to academic life. Design: Retrospective cohort study. Setting: Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs. Patients: Children age > 4 years enrolled in the neurocritical care follow-up programs (n=289) at these institutions who underwent neurocognitive and psychological testing between 2017-2021. Interventions: None. Measurements and Main Results: One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%) and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder (PTSD) or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation. Conclusions: Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully re-integrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors, and establish a rationale for early academic support upon the child's return to school.

Childhood abuse and vulnerability to depression: cognitive scars in otherwise healthy young adults.

Models of depression vulnerability posit that negative early experiences, such as exposure to childhood abuse (CA), increase vulnerability to depression later in life. Though most victims of CA do not go on to develop depression, the question remains as to whether these individuals retain cognitive 'scars' that may contribute to depression vulnerability. The present study examined the relationship between self-reported, retrospective CA and cognitive vulnerability to depression in a carefully selected sample of young adults without current or past psychopathology. We measured cognitive vulnerability with both a self-report questionnaire, the Dysfunctional Attitudes Scale (DAS), and a measure of information processing bias, the Scrambled Sentences Test (SST). Self-reported severity of CA was associated with increased cognitive vulnerability to depression on both the DAS and SST. Vulnerability to depression as measured by the SST, but not by the DAS, prospectively predicted increases in depressive symptoms over a 6-month period. Scores on the SST also interacted with CA to predict increases in depressive symptoms. These findings demonstrate the pernicious effects of CA even in those without current or past psychopathology.

The role of controlled attention on recall in major depression.

Information processing biases are hallmark features of major depressive disorder (MDD). Depressed individuals display biased memory and attention for negative material. Given that memory is highly dependent on attention for initial encoding, understanding the interplay of these processes may provide important insight into mechanisms that produce memory biases in depression. In particular, attentional control-the ability to selectively attend to task-relevant information by both inhibiting the processing of irrelevant information and disengaging attention from irrelevant material-may be one area of impairment in MDD. In the current study, clinically depressed (MDD: n = 15) and never depressed (non-MDD: n = 22) participants' line of visual gaze was assessed while participants viewed positive and negative word pairs. For each word pair, participants were instructed to attend to one word (target) and ignore one word (distracter). Free recall of study stimuli was then assessed. Depressed individuals displayed greater recall of negatively valenced target words following the task. Although there were no group differences in attentional control in the context of negative words, attention to negative targets mediated the relationship between depression status and recall of negative words. Results suggest a stronger link between attention and memory for negative material in MDD.

The development of a novel scale to assess intra- and interpersonal emotion regulation strategies: The Emotion Regulation Strategy Scale (ERSS).

Existing emotion regulation research focuses on how individuals use different strategies to manage their own emotions-also called intra-personal emotion regulation. However, people often leverage connections with others to regulate their own emotions-interpersonal emotion regulation. The goal of the present studies was to develop a comprehensive and efficient scale-the Emotion Regulation Strategies Scale (ERSS)-to assess nine specific emotion regulation strategies that individuals use both intra-personally and interpersonally. These emotion regulation strategies were cognitive reappraisal, distraction, situation selection, problem solving, acceptance, calming, savoring, rumination, and expressive suppression. Data were collected between 2020 and 2022. Study 1 adopted a qualitative approach to establish original scale items. Results of the confirmatory factor analysis in Study 2 confirmed a nine-factor solution for both the intra- and the interpersonal scales and finalized scale items. A second confirmatory factor analysis in Study 3 found the ERSS for both the intra-personal and interpersonal scale models to possess good model fit. Correlations from Study 3 showed the ERSS subscales to be related in expected ways to existing emotion regulation scales, yet not redundant with these scales. The degree to which individuals used the range of intra- and interpersonal emotion regulation strategies assessed on the ERSS also related to the levels of clinical symptoms. The ERSS represents a comprehensive novel scale that can flexibly assess a range of specific emotion regulation strategies used both intra- and interpersonally. Future work should be conducted using the ERSS cross culturally and in clinical samples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Seeing red: Distraction influences visual attention for anger but not for other negative emotions.

Emotion regulation is a vital skill that improves psychological well-being and overall functioning. Distraction (the purposeful internal disengagement from an emotional stimulus) and cognitive reappraisal (the process of changing one's thoughts about an emotional event/stimulus) are two well-established regulation strategies that can effectively decrease negative affect. Less understood, however, are the attention allocation strategies that occur when engaging in these emotion regulation strategies-specifically, do people visually scan emotional information differently when distracting vs. reappraising? In the current study, community participants were randomly assigned to either distract, reappraise, or view naturally while watching four emotional film clips that each elicited a different negative emotional state: anger, fear, sadness, and disgust. Eye tracking was used to record total time spent gazing ("dwell time") at faces within the emotion-eliciting film clips. An effect of condition was found for anger-eliciting material only: participants in the distraction condition exhibited shorter dwell times compared with reappraisal and natural viewing. Importantly, this effect was moderated by state anxiety, such that it was found at low but not high levels of state anxiety. These results show that emotion regulation strategies differentially affect attention to emotion-eliciting stimuli and points to the role of current affective states in impacting how distraction is used. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Positive emotion in daily life: Emotion regulation and depression.

Depression is associated with the infrequent use of emotion regulation strategies that increase positive emotion and the frequent use of strategies that decrease positive emotion. However, prior research mostly relies on global, retrospective assessments that fail to capture dynamic relations between positive emotion and emotion regulation in ecologically valid settings. This study used an ecological momentary assessment (EMA) design to test whether depression is related to positive emotion regulation in daily life. We recruited 108 individuals to complete a 14-day EMA study, tracking strategy use and positive emotion over time. Higher momentary positive emotion was associated with greater subsequent use of positive rumination and less use of dampening. Elevated depressive symptoms, however, were associated with lower average use of positive rumination and higher average use of dampening. Depressive symptom levels did not modulate relations between positive emotion and emotion regulation strategy use. Less use of positive rumination and more use of dampening were related to lower levels of momentary positive emotion. Taken together, depression was associated with a pattern of strategy use that is associated with low positive emotion. Emotion regulation may help to explain positive emotion deficits in depression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury.

Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population's academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients.

INTRODUCTION: Use of virtual reality (VR) in healthcare has expanded in recent years. The challenges faced by patients with prolonged COVID-19-related hospitalizations - social isolation, disability, neurologic sequelae, adjustment-related anxiety, depression, and stress - may be mitigated by the novel use of VR as one modality of a comprehensive rehabilitation plan. This descriptive study aimed to understand patient satisfaction and perceived benefit of virtual reality on a COVID-19 recovery unit, as well as the logistical and operational feasibility of providing VR content for patients and staff. MATERIALS AND METHODS: During the COVID-19 surge in New York City in 2020, the COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and staff to participate in VR sessions with three categories of experience: (1) Guided meditation, (2) Exploration of natural environments, (3) Cognitive stimulation games. Patients and staff were surveyed about satisfaction and perceived benefit. RESULTS: 13 patients and 11 staff were surveyed, with median patient satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," and median staff satisfaction scores of 10. 13/13 patients answered "yes" to recommending the therapy to others, and 12/13 answered "yes" to perceived enhancement of their treatment. 11/11 staff answered "yes" to recommending the therapy to others, and 11/11 answered "yes" to perceived enhancement of their wellbeing. DISCUSSION: A VR program implemented on a COVID-19 rehabilitation unit for patients and healthcare providers was rated as highly satisfactory with perceived benefit by survey respondents. Participants commented that the use of VR was useful in coping with isolation and loneliness, and could be implemented within the context of clinical care for COVID-19 patients as part of a comprehensive rehabilitation model. The use of VR was also logistically and operationally feasible on the CRU. Future work to compare benefits of VR to standard neuropsychological rehabilitation is needed.

Emotion and Emotion Preferences in Daily Life: The Role of Anxiety.

People vary in their emotion preferences (i.e., desired emotional states). No study, however, has examined the nature of emotion preferences in anxiety. The current study utilized a 14-day ecological momentary assessment (EMA) paradigm to investigate the daily dynamics of emotion preferences and state emotion as they relate to individual differences in trait anxiety and anxiety symptom severity. Individuals with higher levels of trait anxiety and with more severe anxiety symptoms report greater preferences for state anxiety compared to their low anxiety counterparts. Relations between anxiety preferences and subsequent anxiety vary as a function of trait anxiety and symptom severity, and different associations are observed between the two measures of anxiety. The current findings suggest that aberrant emotion preferences may contribute to emotion dysfunction in anxiety, and highlight emotion preferences as a novel treatment target for interventions that aim to improve emotion functioning among people with elevated levels of anxiety.

Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19.

Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation.  Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.

Understanding positive emotion deficits in depression: From emotion preferences to emotion regulation.

Depression is characterized by increased levels of negative affect and decreased levels of positive affect. Prior research shows that individual differences in emotion regulation play an important role in understanding sustained negative affect within the disorder; yet, much less is known about the regulation of positive emotion in depression. The current paper utilizes emotion regulation models that synthesizes multiple emotion processes, including what people want to feel (emotion preferences) and the ways in which people typically respond to emotion (habitual use of emotion regulation strategies), to increase our understanding of positive emotion in depression. In doing so, we propose that depression is associated with relative reductions in the preference for positive emotion; these reductions may therefore increase the habitual use of emotion regulation strategies that serve to down-regulate positive emotion and decrease the use of strategies that serve to up-regulate positive emotion. Dysfunction in habitual emotion regulation strategy use may, in turn, contribute to the relatively low levels of positive emotion within the disorder. The paper also discusses important empirical gaps in the extant literature on emotion preferences and emotion regulation in depression and highlights novel treatment targets (e.g., emotion preferences) for interventions aimed at improving emotion dysfunction in depression.

Sleep and sadness: exploring the relation among sleep, cognitive control, and depressive symptoms in young adults.

BACKGROUND: Sleep disturbance is a common feature of depression. However, recent work has found that individuals who are vulnerable to depression report poorer sleep quality compared to their low-risk counterparts, suggesting that sleep disturbance may precede depression. In addition, both sleep disturbance and depression are related to deficits in cognitive control processes. Thus we examined if poor sleep quality predicts subsequent increases in depressive symptoms and if levels of cognitive control mediated this relation. METHODS: Thirty-five undergraduate students participated in two experimental sessions separated by 3 weeks. Participants wore an actigraph watch between sessions, which provided an objective measure of sleep patterns. We assessed self-reported sleep quality and depressive symptoms at both sessions. Last, individuals completed an exogenous cuing task, which measured ability to disengage attention from neutral and negative stimuli during the second session. RESULTS: Using path analyses, we found that both greater self-reported sleep difficulty and more objective sleep stability measures significantly predicted greater difficulty disengaging attention (i.e., less cognitive control) from negative stimuli. Less cognitive control over negative stimuli in turn predicted increased depression symptoms at the second session. Exploratory associations among the circadian locomotor output cycles kaput gene, CLOCK, single nucleotide polymorphism (SNP), rs11932595, as well as sleep assessments and depressive symptoms also are presented. CONCLUSIONS: These preliminary results suggest that sleep disruptions may contribute to increases in depressive symptoms via their impact on cognitive control. Further, variation in the CLOCK gene may be associated with sleep quality.