Structural and functional brain correlates of theory of mind impairment post-stroke.

The ability to understand the mental states of others - also known as Theory of Mind (ToM) - is critical for normal social interactions. We combine behavioural probes with structural and functional brain imaging to provide the first comprehensive analysis of ToM deficits following stroke using the Reading the Mind in the Eyes Test (RMET). First, fMRI was used to identify the functional brain network involved in a non-clinical cohort. Results indicated that, relative to a control task, the RMET increased activity in a widespread functional bilateral network comprising frontal and temporo-parietal areas. To investigate how damage to grey and white matter components of this network can lead to ToM impairment, parcel-based lesion-symptom mapping (PLSM), white-matter tract-wise statistical analysis (TSA) and disconnectome symptom mapping (DSM) were performed using structural images from 64 stroke patients. PLSM results revealed that low scores on the RMET were associated with damage centered around the right posterior frontal gyrus and insula. TSA and DSM results further revealed that low RMET scores were associated with damage to white-matter tracts connecting frontal and temporo-parietal components of the RMET functional network. Together, these findings suggest that making judgements about the mental states of others imposes demands on a large functional network that can easily be disrupted, both by damage to grey matter areas that form part of the network directly, or the white-matter pathways that connect them.

Factors influencing early withdrawal from a drug and alcohol treatment program and client perceptions of successful recovery and employment: a qualitative study.

BACKGROUND: Substance use disorders are a major contributor to the economic and healthcare burden in Australia. Therapeutic communities (TCs) are utilised treatment methods globally, though low program completion rates continue to represent a major obstacle in effective and sustainable drug and alcohol treatment. The aim of this study was to explore reasons for early withdrawal from TC programs and perceptions of successful recovery. This study also aimed to explore how employment and volunteering related to early exit and perceptions of successful recovery. METHODS: Semi-structured qualitative interviews were conducted with 13 ex-residents from a long-term TC program at a community-based rehab organisation in regional Australia. RESULTS: Thematic analysis revealed a complex interplay of factors contributing to early TC withdrawal, and perceptions of successful recovery from a lived experience perspective and how this was shaped by employment and volunteering. Eleven themes were identified. Three relating to reasons for joining the program, which connected with ultimate withdrawal from the program: Pre-program existing relationships, pre-program employment situation and needing a 'circuit breaker' in their life. Three relating to reasons for early withdrawal: TC program characteristics, relationships during the program and planning future employment. Five relating to perceptions of successful recovery: Improved understanding of their addiction, reduced substance use, improved physical and psychological health, relationship success and employment success. CONCLUSIONS: Reasons for leaving treatment early are multi-faceted and revolve around relationships, planning future employment and program characteristics. The influence that each plays on their decision to leave early is varied and determined by the value they assign it. Perceived success extends far beyond achieving and maintaining abstinence to encompass improved relationships, psychological and physical wellbeing, understanding of addiction and employment, studying or volunteering. Self-worth and feeling able to contribute to society through employment, study and volunteering were perceived to be essential elements of successful recovery. Clinicians, policy makers and program developers should use the extended definition of successful recovery from the ex-clients perspective when determining the clinical and economic effectiveness of TC programs.