Risk and protective factors for psychological distress during COVID-19 in Israel.

The purpose of the present study was to identify the protective and risk factors related to psychological distress during COVID-19 in an Israeli sample. An online survey was administered from April 19 to May 2, 2020, while a strict lockdown was in place. Participants were recruited by snowball sampling. Psychological distress was evaluated using the Generalized Anxiety Disorder questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Risk and protective factors for psychological distress were assessed on the Multi-dimensional Perceived Social Support (MSPSS), the coping strategies (COPE), the Life Orientation Test (LOT), and the Gratitude questionnaire. Out of the 655 valid questionnaires collected (from participants ranging in age from 18 to 86, 246 males, 409 females), 138 (21.3%) were positive for moderate to very severe depression and 87 (13.2%) for moderate to extremely severe anxiety. Participants who were screened for depression and anxiety were more likely to be women and young adults (18-24). After adjusting statistically for gender, age, and socioeconomic status, depression and anxiety remained significantly associated with both emotion-focused (PHQ-ß =.437, p < .001, GAD-ß=.441, p < .001) and problem-focused (PHQ-ß =-.219, p < .001, GAD-ß=-.143, p < .001) coping strategies, as well as on the social support (PHQ-ß =-.167, p < .001, GAD-ß=-.155, p < .001), life orientation (GAD-ß=-.09, p < .001), and gratitude scales (PHQ-ß =-.07, p < .001). Levels of anxiety and depression were generally associated with gender (women), age (younger population), socioeconomic status (low), and an emotion-focused strategy as risk factors. A problem-focused strategy, social support, life orientation, and gratitude served as protective factors above and beyond personal background.

Risk Factors and Multidimensional Assessment of Long Coronavirus Disease Fatigue: A Nested Case-Control Study.

BACKGROUND: Fatigue is the most prevalent and debilitating long-COVID (coronavirus disease) symptom; however, risk factors and pathophysiology of this condition remain unknown. We assessed risk factors for long-COVID fatigue and explored its possible pathophysiology. METHODS: This was a nested case-control study in a COVID recovery clinic. Individuals with (cases) and without (controls) significant fatigue were included. We performed a multidimensional assessment evaluating various parameters, including pulmonary function tests and cardiopulmonary exercise testing, and implemented multivariable logistic regression to assess risk factors for significant long-COVID fatigue. RESULTS: A total of 141 individuals were included. The mean age was 47 (SD: 13) years; 115 (82%) were recovering from mild coronavirus disease 2019 (COVID-19). Mean time for evaluation was 8 months following COVID-19. Sixty-six (47%) individuals were classified with significant long-COVID fatigue. They had a significantly higher number of children, lower proportion of hypothyroidism, higher proportion of sore throat during acute illness, higher proportions of long-COVID symptoms, and of physical limitation in daily activities. Individuals with long-COVID fatigue also had poorer sleep quality and higher degree of depression. They had significantly lower heart rate [153.52 (22.64) vs 163.52 (18.53); P = .038] and oxygen consumption per kilogram [27.69 (7.52) vs 30.71 (7.52); P = .036] at peak exercise. The 2 independent risk factors for fatigue identified in multivariable analysis were peak exercise heart rate (OR: .79 per 10 beats/minute; 95% CI: .65-.96; P = .019) and long-COVID memory impairment (OR: 3.76; 95% CI: 1.57-9.01; P = .003). CONCLUSIONS: Long-COVID fatigue may be related to autonomic dysfunction, impaired cognition, and decreased mood. This may suggest a limbic-vagal pathophysiology. CLINICAL TRIALS REGISTRATION: NCT04851561.

The Montreal Cognitive Assessment Test (MoCA) as a screening tool for cognitive dysfunction in fibromyalgia.

OBJECTIVES: Cognitive dysfunction is one of the criteria for the diagnosis of fibromyalgia (FM) and is typically based on self-report questionnaires such as the Symptom Severity Scale. However, recent studies have shown that there is no correlation between these subjective measures of cognitive dysfunction and more lengthy objective measures of cognitive functioning. This points to the need for a briefer valid evaluation tool for cognitive dysfunction in FM. The aim of this study is to examine whether the Montreal Cognitive Assessment (MoCA) test is a valid measure of cognitive assessment in FM patients, by comparing it to a comprehensive computerised cognitive assessment battery. METHODS: Sixty-two FM patients (55 women, 7 men, mean age = 46.17 years, sd=12.56) were administered the MoCA and a computerised cognitive assessment battery. FM symptoms were assessed on the Fibromyalgia Impact Questionnaire (FIQ), the Widespread Pain Index (WPI), the Symptom Severity Scale (SSS), and the Beck Depression Inventory (BDI-2). Patient effort was controlled on the TOMM (Test of Memory Malingering). RESULTS: Moderate positive correlations were found between the MoCA and the computerised cognitive scores as follows: Global Cognitive Score (r=0.493**, p=0.00), Memory Index Score (r= 0.384**, p=0.002), Executive Function Index Score (r=0.461**, p=0.00), Attention Index Score (r=0.310*, p=0.016), Information Processing Speed Index Score (r=0.435**, p=0.001), and Motor Skills (r=0.406**, p=0.002). CONCLUSIONS: The MoCA is an acceptable cognitive screening test for the cognitive evaluation of FM patients.

Quantitative Meta-Analyses: Lateralization of Memory Functions Before and After Surgery in Children with Temporal Lobe Epilepsy.

RATIONALE: Memory deficits in children with epilepsy have been reported in some but not all studies assessing the effects of side of seizures and resection from the temporal lobe on cognitive performance. This meta-analysis provides a quantitative systematic review of previous studies on this issue. METHOD: A critical review and meta-analysis of the literature on memory performance in children with Temporal Lobe Epilepsy (TLE) was conducted. Search identified 25 studies, 13 of which compared children with TLE to healthy age-matched controls and 12 of which compared children with TLE before and after surgery. RESULTS: Heterogeneity of the comparisons of children with TLE to healthy controls impeded drawing definitive conclusions. However, in 55% of the studies, verbal memory in children with left TLE (LTLE) was impaired as compared to healthy controls. Verbal memory performance slightly declines after pediatric LTLE surgery, but nonverbal memory tasks are not affected. By contrast, verbal memory performance is not affected by pediatric right TLE (RTLE) surgery. CONCLUSIONS: The findings suggest that side of the epileptogenic zone and resection from the temporal lobe affect verbal memory in children with LTLE. Right resection seems to be safe with respect to verbal memory performance.

Physical and mental impact of COVID-19 outbreak on fibromyalgia patients.

OBJECTIVES: Acute or chronic stress may trigger or aggravate symptoms of fibromyalgia (FM). We aimed to evaluate the physical and mental health of fibromyalgia patients during the COVID 19 outbreak and identify protective/risk factors. METHODS: An online survey was published in May 2020, following two months of lockdown due to the COVID 19 outbreak, including questionnaires regarding demographic characteristics, access to medical services, anxiety, depression, life approach, coping strategies, perception of social support, widespread pain index (WPI) and symptoms severity scale (SSS), insomnia severity index (ISI) and patient global assessment. RESULTS: Of the 233 patients included in the study, 98% were forced to discontinue complementary or alternative treatments during lockdown. Up to 30% of responders who had been treated with medical cannabis had to stop due to logistic difficulties and this was associated with significantly higher scores of WPI/SSS (p=0.024). Higher levels of anxiety and depression were significantly correlated with higher levels of pain, sleep disorders and subjective perception of deterioration (p=0.00). Higher scores of social support and positive life approach were correlated with less anxiety and depression (p<0.01), lower levels of pain (p<0.05) and less sleep disturbances (p<0.01). Avoidant coping style was strongly associated to higher levels of pain, sleep disturbances, anxiety, depression, and subjective perception of worsening (p<0.01). CONCLUSIONS: Fibromyalgia patients reported adverse mental and physical outcomes during the COVID-19 outbreak. Factors such as stopping current treatments may play a central role. Social support and a positive life approach appear to be protective.

Good pain, bad pain: illness perception and physician attitudes towards rheumatoid arthritis and fibromyalgia patients.

OBJECTIVES: Rheumatoid arthritis (RA) and fibromyalgia syndrome (FM) are common diagnoses encountered in rheumatology practice, but do not enjoy the same status. We aimed to examine physician's illness perceptions regarding these two rheumatologic disorders and to evaluate how they correlate with their relationship with these patients. METHODS: Forty-five rheumatologists were enrolled in the study. Demographic data were registered. Measures collected included the Brief Illness Perception Questionnaire (BIPQ) and the Difficult Doctor- Patient Relation Questionnaire (DDPRQ-10). Both were recorded twice, related to FM and RA. Empathy and burnout were also assessed. RESULTS: Of 45 physicians included in the study, only 53% were willing to accept FM patients. FM was considered a more severe disease than RA (FM-BIPQ mean score 54, SD 5.5 versus RA-BIPQ mean 45.6 SD 6.5, p<0.00) in terms of treatment control, understanding and emotional response generated by the disease. Doctor-patient relationship was perceived more difficult with FM patients compared to RA patients (FM-DDPRQ mean score 35.1, SD 9.2 versus RA-DDPRQ mean 19.6, SD 7.1, p<0.00), and was significantly correlated to the patient's concern about the illness (p<0.034) and patient's emotional response (p<0.036). Resistance to accept FM patients was largely influenced by difficult doctor-patient relationship. Higher levels of empathy were found in physicians experiencing less difficulty with FM patients. CONCLUSIONS: FM patients were perceived as more difficult than RA patients, with a high level of concern and emotional response. A high proportion of physicians were reluctant to accept them because they feel emotional/psychological difficulties meeting and coping with these patients.

A modified version of the 2016 ACR fibromyalgia criteria cognitive items results in stronger correlations between subjective and objective measures of cognitive impairment.

OBJECTIVES: In a previous study, we showed that the subjective item assessing cognitive impairment (SSS-Cog) for fibromyalgia (FM) did not correlate with the objective cognitive measures. In the current study, we describe two modifications designed to enhance this correlation: extending the SSS-cog scale from 0-3 to 1-5, and administration of a new questionnaire that specifically targets the cognitive impairments associated with FM. METHODS: Sixty-two FM patients underwent a computerised cognitive assessment battery. FM symptoms were assessed on the Fibromyalgia Impact Questionnaire (FIQ); the Widespread Pain Index (WPI); the Symptom Severity Scale (SSS), the new SSS-Cog scale ranging from 1 to 5, the Beck Depression Inventory (BDI) and the new cognitive questionnaire developed by the authors. RESULTS: Significant correlations were found between the new SSS-Cog, the global cognitive score and all indices [Global Score r=-0.532, p=0.00; Indices: Memory r=-0.305, p=.01; Executive function r=-0.514, p=0.00; Attention r=-0.471, p=0.00; Processing Speed r=-0.468, p=0.00; Motor Skills r=-0.495, p=.00]. Significant correlations were found between the new questionnaire and the global cognitive score and all indices except the memory index [Global Score r=-0.522, p=0.00; Indices: Memory r=-0.163, p=0.212; Executive function r=-0.477, p=0.00; Attention r=-0.439, p=0.00; Processing Speed r=-0.496, p=0.00; Motor Skills r=-0.532, p=0.00]. CONCLUSIONS: Given the simplicity involved in extending the scale, we suggest incorporating this modification into the FM diagnostic criteria of the American College of Rheumatology (ACR).

Physical fitness mediates the association between age and cognition in healthy adults.

BACKGROUND: Physical fitness is an important contributor to healthy aging that improves cognition. Older adults who engage in cardiorespiratory fitness activities show less cognitive decline. AIMS: To examine whether physical fitness acts as a potential protective mechanism shielding against the negative associations between age and cognition. Specifically, we examined whether physical fitness mediates the relationship between age and processing speed. METHODS: 114 (M = 63.80, SD = 10.63) senior executives completed a computerized cognitive battery composed of four processing speed tasks. Level of physical fitness was assessed on a treadmill stress test and reported in metabolic equivalents (METs). RESULTS: Older age was associated with slower processing speed (r = 0.25, p = 0.007), whereas greater physical fitness was associated with faster processing speed (r = -0.30, p = 0.001). Path analysis indicated that the association between age and processing speed was fully mediated by the level of physical fitness (Indirect effect: ß = 0.10, p = 0.008; Direct effect: ß = 0.16, p = 0.20). CONCLUSIONS AND DISCUSSION: The findings indicate that physical fitness is a strong mediator of the relationship between age and processing speed and imply that physical fitness makes a major contribution to cognitive reserve during the aging process. The results may suggest that the decrease in physical fitness during aging may partially account for slower cognitive processing.

Can the RAVLT predict deterioration from MCI to dementia? Data from long term follow up.

OBJECTIVE: To assess whether the Rey Auditory Verbal Learning Test (RAVLT) could differentiate deterioration from Mild Cognitive Impairment (MCI) to dementia. METHODS: Twenty-six participants who were diagnosed with MCI performed the RAVLT and the Mini Mental State Examination (MMSE) at baseline and after nearly a decade (M = 8.8 years, SD = 3.16), in order to evaluate whether they progressed to dementia. RESULTS: Twelve participants [5 males, 7 females; age M = 63.7 (7.7)] kept their diagnoses of MCI; 14 participants [11 males, 3 females; age M = 75.0 (6.5)] converted to dementia. Both groups had similar MMSE scores at baseline [26.6 (0.6); and 26.6 (0.7) respectively]. Significant differences between dementia and MCI groups were found on most measures of the RAVLT at baseline: Immediate memory [p = .04], delayed recall [p = .003], total learning [p = .01], learning rate [p = .002], retrieval efficiency [p = .004], and false alarms [p = .004]. Thus, the RAVLT results were significantly worse at baseline in those who later converted. The results remain the same when controlling for age. CONCLUSION: The results extend previous findings with follow-up of nearly a decade demonstrating that most of the RAVLT measures are sensitive to differentiate conversion from MCI to dementia.

Attachment Anxiety Moderates the Association Between ADHD and Psychological Distress.

This study aims at examining the possible moderating role of attachment style in the association between ADHD and psychological distress, namely, anxiety and depression symptoms. Study included ninty nine participants: Sixty adults with ADHD diagnosis and thirty nine adults without ADHD or other neurological and/or psychiatric disorders. All participants completed the Patient Health Questionnaire (PHQ-9), State-Trait Anxiety (STAI) questionnaires, Emotion in Close Relationships (ECR-R) questionnaire and Adult ADHD Self-Report Scale-Version 1.1 (ASRS-v1.1). Adults with ADHD had greater symptoms of depression (p < .001) and anxiety (p < .001) than adults without ADHD. Process analysis yielded that attachment anxiety moderated the association between ADHD, anxiety and depression, therefore only adults with ADHD that had moderate to high attachment anxiety exhibited higher levels of depression (p < .01) and anxiety (p < .001). No moderating effect was observed for attachment avoidance. Moreover, we did not find correlations between ADHD, anxiety and depression when secure attachment was the moderator; indicating that secure attachment could serve as a "protective factor" against psychological distress among ADHD individuals. Among anxiously attached adults, ADHD was associated with higher levels psychological distress. These findings highlight the important role of attachment style in mental health of adults with ADHD.

Is the Cutoff of the MoCA too High? Longitudinal Data From Highly Educated Older Adults.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is widely used to evaluate cognitive decline in older individuals. Although, age and education-related norms have been published, the vast majority of diagnostic clinicians use the MoCA cutoff score to identify patients with cognitive impairment. AIM: To identify whether the MoCA cutoff is too stringent for cognitively normal older adults. METHODS: Twenty-seven participants aged 68 to 83 (mean = 75.07, standard deviation [SD] = 4.62), with high education level (mean = 17.14 years, SD = 3.21) underwent cognitive assessment once a year for 5 consecutive years. The cognitive assessment included MoCA; Rey Auditory Verbal Learning Test; Rey Osterrieth Complex Figure test; Wechsler Adult Intelligence Scale Information and Digit Span Subtest; Trail Making Test; Verbal Fluency Test; and Beck Depression Inventory questionnaire. Repeated measures analysis of variance (ANOVA) was used to analyze all standardized scores as well as MoCA standardized and raw scores across all years. RESULTS: Repeated-measures ANOVA for MoCA raw scores yielded significant decline across the years (P < .05). From the second year and forward, the average MoCA total score was below the cutoff of 26/30. However, in substantial contrast, all other neuropsychological scores and the MoCA standardized scores were within the normal range and even above in all years. CONCLUSION: Our study demonstrates that the currently used MoCA cutoff is too high even for highly educated, cognitively normal older adults. Therefore, it is crucial to use the age- and education-related norms for the MoCA in order to avoid misdiagnosis of cognitive decline.

The associations between executive functions and different aspects of perceived pain, beyond the influence of depression, in rehabilitation setting.

We investigated the relations between several aspects of Perceived Pain (PP) and different measurements of Executive Functions (EFs), above the influence of depression, in the context of medical rehabilitation. Eighty-one neurologically intact patients participated in this study in their sub-acute stage of recovery. Different aspects of EFs were assessed using the Wisconsin Card Sorting Test (WCST), the Stop-Signal Test (SST) and the Digit Span Backward subtest of the WAIS-III (Span-B). Different aspects of PP were measured: Pain Disability Index (PDI), The Short-Form McGill Questionnaire (SF-MPQ) and the Pain Catastrophizing Scale (PCS). Depression symptoms were assessed using the Patient Health Questionnaire. The results indicate that irrespective of the presence of depression, mental flexibility is correlated with pain disability and pain severity (WSCT - PDI partial correlation: r = -.23; p=.047, WSCT - SF-MPQ partial correlation: r = -.31; p = .006). Response inhibition is correlated with pain disability (SST - PDI partial correlation: r = .37; p = .001). Updating was not correlated with any of the PP aspects. These results remain much the same after removing the chronic pain patients from the analyses. The present study emphasizes the multidimensional nature of the term "perceived pain", as well as the term "executive functions", and the relations between them.

Pain Catastrophizing Mediates the Association Between Mindfulness and Psychological Distress in Chronic Pain Syndrome.

AIM: Trait mindfulness has been found to be inversely associated with emotional distress such as depression and anxiety among patients suffering from pain. The current study investigated the putative mechanisms underlying these associations by examining whether pain catastrophizing mediates the association between mindfulness and psychological distress and whether this model differs in patients suffering from chronic pain compared to patients experiencing nonchronic pain in a medical rehabilitation setting. METHODS: Forty-eight patients in their subacute stage of recovery participated in the study. Seventeen participants had a diagnosis of chronic pain. Trait mindfulness was assessed using the Mindful Attention Awareness Scale, pain catastrophizing was assessed using the Pain Catastrophizing Scale, depression symptoms were assessed using the Patient Health Questionnaire, and anxiety was assessed using the Generalized Anxiety Disorder scale. Two mediation models were used, with pain catastrophizing mediating the association between mindfulness and depression and anxiety. RESULTS: Catastrophizing significantly mediated the association between trait mindfulness and depression (P < 0.05, confidence interval [CI] = -0.35, -0.05). Catastrophizing also mediated the relationship between trait mindfulness and anxiety (P < 0.05, CI = -0.34, -0.04). Two moderated mediation models were tested, in which pain catastrophizing fully mediated the relationship between trait mindfulness and depression and anxiety, but only in patients with chronic pain. CONCLUSIONS: The negative association between trait mindfulness and psychological distress may thus be partly attributed to pain catastrophizing: individuals high in trait mindfulness engage in less catastrophic thinking and therefore experience less distress. Importantly, this was only observed in the patients with chronic pain. These results further underscore the need to cope with pain catastrophizing and encourage mindfulness among patients with chronic pain.

Does the cognitive index of the symptom severity scale evaluate cognition? Data from subjective and objective cognitive measures in fibromyalgia.

OBJECTIVES: The current provisional diagnostic criteria for the fibromyalgia syndrome (FM) include a cognitive index score (SSS-Cog), which constitutes a part of the Symptom Severity Scale (SSS). The current study aimed at assessing the validity of the cognitive index score, by comparing this subjective measure of cognitive impairment with an objective measure of cognitive functioning, collected through comprehensive computerised cognitive testing and assessment. METHODS: 50 FM patients underwent a computerised cognitive assessment battery, including testing in domains of memory, executive function, attention and information processing speed (NeuroTraxCorp.). Age and education standardised scores were computed. FM symptoms were assessed by the Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI) and Symptom Severity Scale (SSS), a Visual Analog Scale (VAS) of clinical pain and the Beck Depression inventory (BDI-II). RESULTS: The index score for subjective assessment of cognitive decline (SSS-Cog) was not correlated with any of the objective cognitive measures. However, a positive correlation was found between the SSS-Cog and the FIQ, the WPI and the VAS measures, all reflecting subjective overall functional ability. CONCLUSIONS: No significant relationship was found between FM patients' subjective appraisal of cognitive deficit and objective cognitive scores on all computerised subtests. However, subjective appraisal of cognitive impairment was found to be strongly and significantly related to patients' functional ability. Therefore, we suggest reconsidering the definition of this index score (SSS-Cog) and propose developing novel and more accurately defined tools in order to measure cognitive impairment in FM patients, for both diagnostic and epidemiological purposes.

The association of total cholesterol with processing speed is moderated by age in mid- to late-age healthy adults.

OBJECTIVES: To investigate the nature of the association of normal levels of total cholesterol with cognitive function and the contribution of age to this association. METHODS: A sample of 61 senior executives, who were summoned for an annual medical examination with approximately four measurements of total cholesterol during 4 years, were examined with a computerized cognitive battery assessing mental processing speed as a sensitive measure of cognitive decline. We examined the association of total cholesterol with processing speed and the moderating effect of age on this association. RESULTS: A multiple regression analysis yielded a significant interaction between cholesterol and age for processing speed (p = .045). In order to examine the source of the interaction, simple slope analysis was performed. A significant negative high correlation was found for young subjects (p = .021), while no significant correlation was observed at middle (p = .286) or older (p = .584) age. The difference in slopes was robust to adjustment for potential confounding factors, including body mass index, and fasting glucose. CONCLUSIONS: Within the normal range, higher total cholesterol levels were associated with better processing speed in younger ages and this association diminished with increasing age. Our findings highlight the important role of brain cholesterol in good cognitive functioning.

Downwards Vertical Attention Bias in Conversion Disorder vs Controls: A Pilot Study.

BACKGROUND: Conversion disorder (CD) is a largely enigmatic disorder, one that requires a thorough ruling-out process. Prior research suggests that metaphors and conceptualization are rooted in physical experience, and that we interpret our affective world through metaphors. Spatial metaphors (interaction of affect and vertical space) are a prominent example of the grounding of metaphors. This is a relatively unpaved direction of research of CD. OBJECTIVES: The present pilot study sought to explore this view by investigating the "healthy is up, sick is down" spatial metaphors (e.g., "fell ill" and "top shape") in patients with CD, examining the correlation between the processing of bodily-related words, CD, and vertical space. We hypothesized that patients with CD, who experience their bodies as ill, will demonstrate a downwards bias when processing bodily-related words; corresponding to the "healthy is up, sick is down" spatial metaphor. METHODS: A total of 8 female patients (ages M-38.13 SD-10.44) and 42 female controls (ages M-36.4 SD-14.57) performed a visual attention task. Participants were asked to identify a spatial probe at the top or the bottom of a screen, following either a bodily related (e.g., arm) or non-bodily related (e.g., clock) prime word. RESULTS: As predicted, when processing bodily-related words, patients with CD demonstrated a downwards attention bias. Moreover, the higher the patient's level of somatization, the faster the patient detected lower (vs upper) spatial targets. CONCLUSIONS: This study suggests that the changed health paradigm of patients with CD is grounded in sensorimotor perception. Further research could propose new diagnostic and treatment options for CD.

Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire.

OBJECTIVES: Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ. METHODS: We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity. RESULTS: We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity. DISCUSSION: Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.

Long COVID-19 Enigma: Unmasking the Role of Distinctive Personality Profiles as Risk Factors.

Background: The COVID-19 (Coronavirus disease 2019) pandemic has prompted extensive research into lingering effects, especially in 'Long COVID' patients. Despite exploration, contributing factors remain elusive; Objective: This study explores the potential link between distinctive personality profiles, particularly type D personality, and an increased risk of Long COVID; Methods: A retrospective cross-sectional study at Tel-Aviv Sourasky Medical Center's Post-COVID clinic analyzed data from 373 Long COVID patients through comprehensive questionnaires covering Long COVID syndrome, Fibromyalgia criteria, personality assessments, social support, and subjective evaluations of cognitive decline, health and life quality. In total, 116 out of 373 patients completed the questionnaire, yielding a 31% participation rate; Results: Cluster analysis revealed two groups, with Cluster 1 (N = 58) exhibiting Type D personality traits while Cluster 2 (N = 56) not meeting criteria for Type D personality. In comparison to Cluster 2, Cluster 1 patients reported heightened anxiety, depression, reduced social support, increased pain symptoms, manifestations of fibromyalgia, cognitive decline, and poor sleep quality, contributing to a diminished quality-of-life perception; Conclusions: findings highlight diverse personality profiles among Long COVID patients, emphasizing the need for tailored care. This approach shows potential for improving Long COVID patient care, aligning with the evolving personalized medicine paradigm.

The ventrolateral prefrontal cortex is part of the modular working memory system: A functional neuroanatomical perspective.

For many years, the functional role of the ventrolateral Pre-Frontal Cortex (PFC) was associated with executive functions, specifically in the context of non-affective cognitive processes. However, recent research has suggested that the ventrolateral PFC is also involved in the attention system. The Ben Shalom model of the functional organization of the prefrontal cortex (2019) posits that the ventrolateral PFC selects perceptual stimuli after integration by the adjacent ventromedial PFC. This article reviews the state-of-the-art findings to better understand the role of the ventrolateral PFC in the selection of perceptual information as grounded in the Ben Shalom model. Numerous studies have reported converging evidence for the selective role of this area. However, most argue that this perceptual selection takes place through the active updating of information values linked to goal-oriented actions. These studies thus view the ventrolateral PFC as part of a system that actively manipulates and changes processed information such as the working memory function, rather than being part of the attention system. In agreement with this view, this review suggests that this area is part of a complex and modular working memory system and illustrates with reference to Diamond's work on ADD. This working memory system is functionally and anatomically dispersed and includes the dorsolateral PFC, the ACC, the parietal cortex, the basal ganglia, and the cerebellum. Hence, future research should continue to explore the specific neurofunctional roles of these areas in working memory systems, and the connections between the different subareas in this complex array.

Adaptation and initial validation of the Arabic version of the Word Memory Test (WMTARB).

BACKGROUND: The feigning of cognitive impairment is common in neuropsychological assessments, especially in a medicolegal setting. The Word Memory Test (WMT) is a forced-choice recognition memory performance validity test (PVT) which is widely used to detect noncredible performance. Though translated to several languages, this was not done for one of the most common languages, Arabic. The aim of the current study was to evaluate the convergent validity of the Arabic adaptation of the WMT (WMTARB) among Israeli Arabic speakers. METHODS: We adapted the WMT to Arabic using the back-translation method and in accordance with relevant guidelines. We then randomly assigned healthy Arabic speaking adults (N = 63) to either a simulation or honest control condition. The participants then performed neuropsychological tests which included the WMTARB and the Test of Memory Malingering (TOMM), a well-validated nonverbal PVT. RESULTS: The WMTARB had high split-half reliability and its measures were significantly correlated with that of the TOMM (p < .001). High concordance was found in classification of participants using the WMTARB and TOMM (specificity = 94.29% and sensitivity = 100% using the conventional TOMM trial 2 cutoff as gold standard). As expected, simulators' accuracy on the WMTARB was significantly lower than that of honest controls. None of the demographic variables significantly correlated with WMTARB measures. CONCLUSION: The WMTARB shows initial evidence of reliability and validity, emphasizing its potential use in the large population of Arabic speakers and universality in detecting noncredible performance. The findings, however, are preliminary and mandate validation in clinical settings.