Assessment of Neurocognitive Functions, Olfaction, Taste, Mental, and Psychosocial Health in COVID-19 in Adults: Recommendations for Harmonization of Research and Implications for Clinical Practice.

OBJECTIVE: To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition). METHODS: We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice. RESULTS: The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described. CONCLUSIONS: The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.

Social Perception in Mesial Temporal Lobe Epilepsy: Interpreting Social Information From Moving Shapes and Biological Motion.

Dysfunction in the understanding of social signals has been reported in persons with epilepsy, which may partially explain lower levels of life satisfaction in this patient population. Extensive assessment is necessary, particularly when the mesial temporal lobe, responsible for emotion processing, is affected. The authors examined multiple levels of social perception in patients with mesial temporal lobe epilepsy (MTLE), including judgments of point-light motion displays of human communicative interactions (Communicative Interactions Database-5 Alternative Forced Choice format) and theory-of-mind processes evaluated using geometric shapes (Frith-Happé animations [FHA]). This case-control study included MTLE patients with anterior temporal lobectomies (ATL+) (N=19), MTLE patients without lobectomies (ATL-) (N=21), and healthy controls (HCs) (N=20). Both groups of MTLE patients were less efficient in recognizing goal-directed and mentalizing interactions of FHA compared with HC subjects. The ATL+ group attributed emotions to FHA less accurately than HC subjects. Both the ATL- and ATL+ groups classified individual point-light animations more often as communicative than the HC group. ATL+ patients were also less efficient in interpreting point-light animations in terms of individual actions than the HC group. The number of years of epilepsy duration was inversely correlated with recognition of FHA interactions. The mean number of seizures was inversely correlated with the interaction identification in point-light stimuli. Patients with MTLE, irrespective of surgical treatment, present impaired social perception in domains assessed with abstract moving shapes or nonabstract biological motion. This impairment may be the basis of problems faced by patients reporting difficulties in understanding the intentions and feelings of other individuals.

Gaze matters! The effect of gaze direction on emotional enhancement of memory for faces in patients with mesial temporal lobe epilepsy.

PURPOSE: The aim of the study was to examine if gaze and emotional expression, both highly self-relevant social signals, affect the recollection accuracy of perceived faces in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Forty patients with MTLE (twenty-one without surgery and nineteen after anterior temporal lobectomy) as well as twenty healthy controls (HC) took part in the study. We used a set of 64 facial stimuli: 32 neutral and 32 emotional displays (16 fearful; 16 angry) from well-established affective stimuli databases. Half of the faces in each condition had eyes directed straight and half - away from the observer. Participants performed a gender identification task, and then, after a 45-minute delay were asked to identify the previously seen stimuli, presented among a new set of photos. RESULTS: Increased automatic learning of angry and fearful compared to neutral expressions was found in HC. There was no emotional enhancement of memory in MTLE but an increased learning for faces with averted than direct gaze. CONCLUSION: Our results expand on previous research by demonstrating that emotion expression and gaze direction can affect memory of faces. The study supports the hypothesis that healthy individuals and patients with temporal lobe abnormalities present different patterns of emotional gazes processing. The potential consequences of altered emotional gaze processing and social cognition impairments need to be further investigated to improve the quality of life of patients with MTLE.

Factors associated with prolonged COVID-related PTSD-like symptoms among adults diagnosed with mild COVID-19 in Poland.

COVID-19 has been considered a possible cause of post-traumatic stress disorder (PTSD) or similar conditions. However, what specific disease symptoms may contribute most to prolonged PTSD-like symptoms in COVID-19 survivors is unclear. The study aimed to present the factor structure of COVID-19 symptoms and identify which symptoms of COVID-19 best explain the subsequent presence of PTSD-like symptoms in mild COVID-19 survivors. COVID-positive adults (n = 341) completed online self-report scales at the baseline assessment (T1) and after approximately 4 months (T2), including The Patient Health Questionnaire Anxiety-Depression Scale; The Scale of Psychosocial Experience Related to COVID-19, The Primary Care PTSD Screen for DSM-5; and self-designed questionnaires evaluating the severity of COVID-related medical and neurocognitive symptoms and pre-pandemic variables. Exploratory factor analysis revealed five factors of COVID-19 symptoms: flu-like, respiratory, cold, neurological, and neurocognitive. Hierarchical logistic regression showed that besides selected control variables (anxiety and depression, presence of PTSD-like symptoms, COVID-related stigma in T1), neurocognitive symptoms of COVID-19 in T1 but not other symptoms of the disease were a significant predictor of the presence of PTSD-like symptom in T2. Findings suggest a need for a comprehensive neurocognitive assessment of people diagnosed with COVID-19 and prompt interventions targeting the prevention of potential risks for long-term PTSD-like states at the community level.

The Borderline Bias in Explicit Emotion Interpretation.

Atypical emotion interpretation has been widely reported in individuals with borderline personality disorder (iBPD); however, empirical studies reported mixed results so far. We suggest that discrepancies in observations of emotion interpretation by iBPD can be explained by biases related to their fear of rejection and abandonment, i.e., the three moral emotions of anger, disgust, and contempt. In this study, we hypothesized that iBPD would show a higher tendency to correctly interpret these three displays of social rejection and attribute more negative valence. A total of 28 inpatient iBPDs and 28 healthy controls were asked to judge static and dynamic facial expressions in terms of emotions, valence, and self-reported arousal evoked by the observed faces. Our results partially confirmed our expectations. The iBPD correctly interpreted the three unambiguous moral emotions. Contempt, a complex emotion with a difficulty in recognizing facial expressions, was recognized better by iBPD than by healthy controls. All negative emotions were judged more negatively by iBPD than by controls, but no difference was observed in the neutral or positive emotion. Alexithymia and anxiety trait and state levels were controlled in all analyses.

Risk of Developing Post-traumatic Stress Disorder in Severe COVID-19 Survivors, Their Families and Frontline Healthcare Workers: What Should Mental Health Specialists Prepare For?

Given the high mortality of the coronavirus disease 2019 (COVID-19), having severe COVID-19 may be a life-threatening event, especially for individuals at high risk of complications. Therefore, in the article we try to answer two questions that are relevant to public mental health: Can we define groups who are at higher risk of developing pandemic-related PTSD? How can health specialists prepare for it? Given the results of previous research on PTSD in epidemic (e.g., SARS) survivors, we suggest that mental health professionals in countries touched by the pandemic should prepare for an increase in the PTSD prevalence, specifically in: individuals who have had severe COVID-19; family members of these patients and of patients who have died; and frontline healthcare workers witnessing COVID-19 patients' sudden deaths, or numerous life-threatening situations. We postulate that these groups at risk should be routinely screened for PTSD in primary medical and pediatric care. Mental health services should prepare for providing therapeutic interventions for individuals with PTSD in the vulnerable groups, and support to their families, especially children.

Neuropsychological disorders after COVID-19. Urgent need for research and clinical practice.

Purpose: Numerous studies suggest that infection with coronavirus SARS-CoV-2, which causes acute respiratory distress syndrome and COVID-19 illness, can lead to changes in the central nervous system (CNS). Consequently, some individuals with SARS-CoV-2 infection may also present the symptoms of neuropsychological disorders. The goals of this literature review is the synthesis of various perspectives and up-to-date scientific knowledge as well as the formulation of initial recommendations for clinical practice. Views: According to current state of knowledge, numerous SARS-CoV-2 infection-specific and nonspecific risk factors exist for brain damage, which might lead to neuropsychological impairments in individuals who have recovered from COVID-19. The emerging evidence suggests significant behavioral and cognitive deficits in COVID-19 survivors, which are present in the early phase after recovery and persist for several months. Neuropsychological disturbances can potentially include a wide spectrum of disorders, yet deficits of attention, memory, executive functions, language and visuospatial orientation are among most commonly identified. The relationship between cognitive impairment, emotional disturbances and severity of COVID-19 symptoms needs to be submitted to further research. Conclusions: The scientific knowledge resulting from neuropsychological empirical studies during the COVID-19 pandemic allows for a postulate of an urgent evidence-based systematic neuropsychological research to be conducted among COVID-19 survivors. More than anything, the recovered individuals must be provided with adequate neuropsychological help in the form of neuropsychological diagnosis, monitoring and rehabilitation.

Cultural differences in food detection.

The ability to detect food plays an indispensable role in our survival and wellbeing. Previous psychological studies have revealed that food is detected more rapidly than non-food items. However, whether the detection of food could be modulated by cultural factors remains unknown. We investigated this issue in the present study using a visual search paradigm with Polish and Japanese participants. Photographs of international fast food, domestic Japanese food, or kitchen tools were presented alongside images of non-food distractors (cars). Participants were asked to judge whether the stimuli were all identical or not. The reaction time data showed that participants from both cultures detected food more rapidly than kitchen tools. Japanese participants detected fast food more rapidly than Japanese food, whereas Polish participants did not display such differences between food types. These results suggest that rapid detection of food is universal, but is modulated by cultural experiences.

Cultural Moderation of Unconscious Hedonic Responses to Food.

Previous psychological studies have shown that images of food elicit hedonic responses, either consciously or unconsciously, and that participants' cultural experiences moderate conscious hedonic ratings of food. However, whether cultural factors moderate unconscious hedonic responses to food remains unknown. We investigated this issue in Polish and Japanese participants using the subliminal affective priming paradigm. Images of international fast food and domestic Japanese food were presented subliminally as prime stimuli. Participants rated their preferences for the subsequently presented target ideographs. Participants also rated their preferences for supraliminally presented food images. In the subliminal rating task, Polish participants showed higher preference ratings for fast food primes than for Japanese food primes, whereas Japanese participants showed comparable preference ratings across these two conditions. In the supraliminal rating task, both Polish and Japanese participants reported comparable preferences for fast and Japanese food stimuli. These results suggest that cultural experiences moderate unconscious hedonic responses to food, which may not be detected based on explicit ratings.

Facial Expressions of Basic Emotions in Japanese Laypeople.

Facial expressions that show emotion play an important role in human social interactions. In previous theoretical studies, researchers have suggested that there are universal, prototypical facial expressions specific to basic emotions. However, the results of some empirical studies that tested the production of emotional facial expressions based on particular scenarios only partially supported the theoretical predictions. In addition, all of the previous studies were conducted in Western cultures. We investigated Japanese laypeople (n = 65) to provide further empirical evidence regarding the production of emotional facial expressions. The participants produced facial expressions for six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) in specific scenarios. Under the baseline condition, the participants imitated photographs of prototypical facial expressions. The produced facial expressions were automatically coded using FaceReader in terms of the intensities of emotions and facial action units. In contrast to the photograph condition, where all target emotions were shown clearly, the scenario condition elicited the target emotions clearly only for happy and surprised expressions. The photograph and scenario conditions yielded different profiles for the intensities of emotions and facial action units associated with all of the facial expressions tested. These results provide partial support for the theory of universal, prototypical facial expressions for basic emotions but suggest the possibility that the theory may need to be modified based on empirical evidence.

Naturalistic Emotion Decoding From Facial Action Sets.

Researchers have theoretically proposed that humans decode other individuals' emotions or elementary cognitive appraisals from particular sets of facial action units (AUs). However, only a few empirical studies have systematically tested the relationships between the decoding of emotions/appraisals and sets of AUs, and the results are mixed. Furthermore, the previous studies relied on facial expressions of actors and no study used spontaneous and dynamic facial expressions in naturalistic settings. We investigated this issue using video recordings of facial expressions filmed unobtrusively in a real-life emotional situation, specifically loss of luggage at an airport. The AUs observed in the videos were annotated using the Facial Action Coding System. Male participants (n = 98) were asked to decode emotions (e.g., anger) and appraisals (e.g., suddenness) from facial expressions. We explored the relationships between the emotion/appraisal decoding and AUs using stepwise multiple regression analyses. The results revealed that all the rated emotions and appraisals were associated with sets of AUs. The profiles of regression equations showed AUs both consistent and inconsistent with those in theoretical proposals. The results suggest that (1) the decoding of emotions and appraisals in facial expressions is implemented by the perception of set of AUs, and (2) the profiles of such AU sets could be different from previous theories.

Facial feedback affects valence judgments of dynamic and static emotional expressions.

The ability to judge others' emotions is required for the establishment and maintenance of smooth interactions in a community. Several lines of evidence suggest that the attribution of meaning to a face is influenced by the facial actions produced by an observer during the observation of a face. However, empirical studies testing causal relationships between observers' facial actions and emotion judgments have reported mixed findings. This issue was investigated by measuring emotion judgments in terms of valence and arousal dimensions while comparing dynamic vs. static presentations of facial expressions. We presented pictures and videos of facial expressions of anger and happiness. Participants (N = 36) were asked to differentiate between the gender of faces by activating the corrugator supercilii muscle (brow lowering) and zygomaticus major muscle (cheek raising). They were also asked to evaluate the internal states of the stimuli using the affect grid while maintaining the facial action until they finished responding. The cheek raising condition increased the attributed valence scores compared with the brow-lowering condition. This effect of facial actions was observed for static as well as for dynamic facial expressions. These data suggest that facial feedback mechanisms contribute to the judgment of the valence of emotional facial expressions.