Resting state functional connectivity correlates of rumination and worry in internalizing psychopathologies.

BACKGROUND: Rumination and worry are repetitive negative thinking (RNT) tendencies that contribute to the development and maintenance of internalizing psychopathologies. Accruing data suggest rumination and worry represent overlapping and unique transdiagnostic cognitive processes. Yet, prior neuroimaging research has mostly focused on rumination in depression, which points to involvement of resting-state brain activity in default mode, executive, salience, and/or affective networks. METHODS: The current study examined relations between brain activity during rest and RNT in a transdiagnostic sample. Resting-state fMRI data was analyzed in 80 unmedicated patients with internalizing conditions. Regression analysis, controlling for anxiety and depression symptoms, was performed with seed regions implicated in default mode, executive, salience, and affective networks. Rumination and worry were assessed with standard self-report measures. RESULTS: Whole-brain regression results showed more rumination and worry jointly corresponded with greater positive resting-state functional connectivity (rsFC) between the amygdala and prefrontal regions (i.e., middle frontal gyrus, inferior frontal gyrus). Conversely, more worry (controlling for rumination) corresponded with greater negative rsFC between amygdala and precuneus. No significant results were observed for rumination alone (controlling for worry). CONCLUSIONS: Findings indicate the affective network plays a role in RNT, and distinct patterns of connectivity between amygdala and regions implicated in the executive and default mode networks were observed across patients with internalizing conditions. Results suggest different mechanisms contribute to RNT as a unitary construct and worry as a unique construct.

Crime Risk and Depression Differentially Relate to Aspects of Sleep in Patients with Major Depression or Social Anxiety.

Individuals with internalizing conditions such as depression or anxiety are at risk of sleep difficulties. Social-ecological models of sleep health propose factors at the individual (e.g., mental health) and neighborhood (e.g., crime risk) levels that contribute to sleep difficulties. However, these relationships have been under-researched in terms of internalizing conditions. Therefore, the current study comprised participants diagnosed with major depression (n = 24) or social anxiety (n = 35). Sleep measures included actigraphic variables (i.e., total sleep time, waking after sleep onset, sleep onset latency) and subjective sleep quality. Geocoding was used to assess nationally-normed crime risk exposure at the person level (e.g., murder, assault) and property level (e.g., robbery, burglary). Analyses consisted of independent t-tests to evaluate potential differences between diagnostic groups. To examine relationships, multiple regressions were used with internalizing symptoms, crime risk, and age as independent variables and sleep measures as the dependent variable. The t-test results revealed that groups differed in symptoms and age but not sleep or neighborhood crime. Regression results revealed crime risk positively corresponded with sleep onset latency but no other sleep measures. Also, only depression positively corresponded with total sleep time. Preliminary findings suggest exposure to crime and depression relate differentially to facets of sleep in individuals with internalizing conditions.

Comparing embedded performance validity indicators within the WAIS-IV Letter-Number sequencing subtest to Reliable Digit Span among adults referred for evaluation of attention-deficit/hyperactivity disorder.

Objectives: This study investigated the Wechsler Adult Intelligence Scale-Fourth Edition Letter-Number Sequencing (LNS) subtest as an embedded performance validity indicator among adults undergoing an attention-deficit/hyperactivity disorder (ADHD) evaluation, and its potential incremental value over Reliable Digit Span (RDS). Method: This cross-sectional study comprised 543 adults who underwent neuropsychological evaluation for ADHD. Patients were divided into valid (n = 480) and invalid (n = 63) groups based on multiple criterion performance validity tests. Results: LNS total raw scores, age-corrected scaled scores, and age- and education-corrected T-scores demonstrated excellent classification accuracy (area under the curve of .84, .83, and .82, respectively). The optimal cutoff for LNS raw score (≤16), age-corrected scaled score (≤7), and age- and education-corrected T-score (≤36) yielded .51 sensitivity and .94 specificity. Slightly lower sensitivity (.40) and higher specificity (.98) was associated with a more conservative T-score cutoff of ≤33. Multivariate models incorporating both LNS and RDS improved classification accuracy (area under the curve of .86), and LNS scores explained a significant but modest proportion of variance in validity status above and beyond RDS. Chaining LNS T-score of ≤33 with RDS cutoff of ≤7 increased sensitivity to .69 while maintaining ≥.90 specificity. Conclusions: Findings provide preliminary evidence for the criterion and construct validity of LNS as an embedded validity indicator in ADHD evaluations. Practitioners are encouraged to use LNS T-score cutoff of ≤33 or ≤36 to assess the validity of obtained test data. Employing either of these LNS cutoffs with RDS may enhance the detection of invalid performance.

Effect of processing speed and memory performance on classification accuracy of the dot counting test in a mixed neuropsychiatric sample.

OBJECTIVE: This study examined the impact of impairment in two specific cognitive abilities, processing speed and memory, on Dot Counting Test (DCT) classification accuracy by evaluating performance validity classification accuracy across cognitively unimpaired, single-domain impairment, and multidomain impairment subgroups within a mixed clinical sample. METHOD: Cross-sectional data were analyzed from 348 adult outpatients classified as valid (n = 284) or invalid (n = 64) based on four independent criterion performance validity tests (PVTs). Unimpaired (n = 164), single-domain processing speed impairment (n = 24), single-domain memory impairment (n = 53), and multidomain processing speed and memory impairment (n = 43) clinical subgroups were established among the valid group. Both the traditional DCT E-score and unrounded E-score were examined. RESULTS: Overall, the DCT demonstrated acceptable to excellent classification accuracy across the unimpaired (area under the curve [AUC] traditional E-score=.855; unrounded E-score=.855) and single-domain impairment groups (traditional E-score AUCs = .690-.754; unrounded E-score AUCs = .692-747). However, it did not reliably discriminate the multidomain processing speed and memory impairment group from the invalid performers (traditional and unrounded E-scores AUC = .557). CONCLUSIONS: Findings support the DCT as a non-memory-based freestanding PVT for use with single-domain cognitive impairment, with traditional E-score ≥17 (unrounded E-score ≥16.95) recommended for those with memory impairment and traditional E-score ≥19 (unrounded ≥18.08) with processing speed impairment. Moreover, results replicated previously established optimal cutoffs for unimpaired groups using both the traditional (≥14) and unrounded (≥13.84) E-scores. However, the DCT did not reliably discriminate between invalid performance and multidomain cognitive impairment, indicating caution is warranted when using the DCT with patients suspected of greater cognitive impairment.

Social Determinants of Health: Associations Between Dichotomous Versus Dimensional Scores, Neuropsychological Test Performance, and Psychiatric Symptoms.

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation (Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients' risk of poor cognitive or psychiatric outcomes based on SDOH.

Objective and Subjective Sleep Measures Are Related to Suicidal Ideation and Are Transdiagnostic Features of Major Depressive Disorder and Social Anxiety Disorder.

Suicide is a major public health problem and previous studies in major depression and anxiety show problematic sleep is a risk factor for suicidal ideation (SI). However, less is known about sleep and SI in social anxiety disorder (SAD), despite the pervasiveness of SAD. Therefore, the current study comprised participants with major depressive disorder (MDD) (without comorbid SAD) (n = 26) and participants with SAD (without comorbid MDD) (n = 41). Wrist actigraphy was used to estimate sleep duration, wake after sleep onset, and sleep efficiency; sleep quality was evaluated with self-report. Self-report was also used to examine SI. These measures were submitted to independent t-tests and multiple regression analysis. t-test results revealed sleep and SI did not differ between MDD and SAD groups. Multiple regression results showed shorter sleep duration and worse sleep quality related to greater SI when taking symptom severity and age into account. Post-hoc partial correlational analysis showed these sleep-SI relationships remained significant after controlling for symptom severity and age. Preliminary findings indicate sleep and SI may be transdiagnostic features of MDD and SAD. Evidence of distinct sleep-SI relationships are consistent with previous reports showing that sleep difficulties contribute to SI. Altogether, improving sleep duration and sleep quality may reduce the risk of SI.

Actigraphic Wake after Sleep Onset and Symptom Severity Correspond with Rumination in Trauma-Exposed Individuals.

Rumination and worry are forms of repetitive negative thinking (RNT) commonly associated with internalizing psychopathologies, although less is known about RNT in trauma-exposed individuals with internalizing psychopathologies. Separate lines of research show RNT also plays a role in problematic sleep, which is frequently experienced after trauma exposure. To address gaps in the literature, the current study examines the impact of sleep and symptoms on RNT in trauma-exposed participants. A transdiagnostic sample of 46 unmedicated treatment-seeking trauma-exposed participants completed standard measures of rumination and worry, as well as clinical measures that assessed posttraumatic stress, depression, and anxiety severity. Actigraphic sleep variables were sleep duration, wake after sleep onset (WASO), and sleep efficiency. Sleep and clinical measures were submitted to multiple regression analyses with rumination and worry as dependent variables. The regression results showed that rumination was significantly explained by WASO and posttraumatic stress symptom (PTSS) severity, and the omnibus test was significant. Depression, anxiety, and other estimates of sleep were not significant. No significant results emerged for worry. Preliminary findings suggest that PTSS and WASO, an index of fragmented sleep, may contribute to rumination, but not worry, in trauma-exposed individuals. Longitudinal studies are needed to determine potential causal relationships.

Assessment of learning and memory impairments in adults with predominately inattentive versus combined presentation attention-deficit/hyperactivity disorder.

This cross-sectional study compared adults diagnosed with Attention-Deficit/Hyperactivity Disorder-Inattentive (ADHD-I) and ADHD-Combined (ADHD-C) presentations with a non-ADHD group on verbal and visual learning and delayed recall using the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test-Revised (BVMT-R), respectively. Data from 380 predominately college student adult outpatients were used, with 155 who met criteria for ADHD-I, 165 who met criteria for ADHD-C, and 60 who did not meet criteria for ADHD but were diagnosed with a primary depressive or anxiety disorder or received no diagnosis. Each patient was administered the RAVLT and BVMT-R as part of a comprehensive neuropsychological evaluation. Significant main effects of study group were found, such that patients with ADHD-C demonstrated worse learning and delayed recall of both verbal and visual information than patients with ADHD-I and the non-ADHD group. Patients with ADHD-I performed comparably to the non-ADHD group, apart from visual learning and delayed recall. Notably, more patients in the ADHD groups had possible or probable learning and memory impairment compared to the non-ADHD group. Findings were consistent with previous research indicating that those with ADHD exhibit poorer verbal and visual learning and delayed recall than those without ADHD.

Using the Grooved Pegboard Test as an Embedded Validity Indicator in a Mixed Neuropsychiatric Sample with Varying Cognitive Impairment: Cross-Validation Problems.

Embedded validity indicators (EVIs) derived from motor tests have received less empirical attention than those derived from tests of other neuropsychological abilities, particularly memory. Preliminary evidence suggests that the Grooved Pegboard Test (GPB) may function as an EVI, but existing studies were largely conducted using simulators and population samples without cognitive impairment. In this study we aimed to evaluate the GPB's classification accuracy as an EVI among a mixed clinical neuropsychiatric sample with and without cognitive impairment. This cross-sectional study comprised 223 patients clinically referred for neuropsychological testing. GPB raw and T-scores for both dominant and nondominant hands were examined as EVIs. A known-groups design, based on ≤1 failure on a battery of validated, independent criterion PVTs, showed that GPB performance differed significantly by validity group. Within the valid group, receiver operating characteristic curve analyses revealed that only the dominant hand raw score displayed acceptable classification accuracy for detecting invalid performance (area under curve [AUC] = .72), with an optimal cut-score of ≥106 seconds (33% sensitivity/88% specificity). All other scores had marginally lower classification accuracy (AUCs = .65-.68) for differentiating valid from invalid performers. Therefore, the GPB demonstrated limited utility as an EVI in a clinical sample containing patients with bona fide cognitive impairment.

Cognitive Performance and Psychiatric Self-Reports Across Adult Cognitive Disengagement Syndrome and ADHD Diagnostic Groups.

OBJECTIVE: Cognitive disengagement syndrome (CDS) is characterized by inattention, under-arousal, and fatigue and frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD). Although CDS is associated with cognitive complaints, its association with objective cognitive performance is less well understood. METHOD: This study investigated neuropsychological correlates of CDS symptoms among 169 adults (Mage = 29.4) referred for outpatient neuropsychological evaluation following inattention complaints. We evaluated cognitive and self-report differences across four high/low CDS and positive/negative ADHD groups, and cognitive and self-report correlates of CDS symptomology. RESULTS: There were no differences in cognitive performance, significant differences in self-reported psychiatric symptoms (greater CDS symptomatology, impulsivity among the high CDS groups; greater inattention among the positive ADHD/high CDS groups; greater hyperactivity among the positive ADHD groups), significant intercorrelations within cognitive and self-report measures, nonsignificant correlations between cognitive measures and self-report measures. CONCLUSION: Findings support prior work demonstrating weak to null associations between ADHD and CDS symptoms and cognitive performance among adults.

Sleep quality and emotion recognition in individuals with and without internalizing psychopathologies.

BACKGROUND AND OBJECTIVES: Separate lines of research indicate sleep quality may impact recognition of facial expressions in anxious or depressed individuals. This study examined facial emotion recognition ability in the context of self-perceived sleep quality and anxiety and depression symptom levels in individuals with and without internalizing psychopathologies. METHODS: Seventy anxious and/or depressed patients and 24 demographically matched healthy controls completed the Pittsburgh Sleep Quality Index (PSQI), standard measures of anxiety and depression, and an Emotion Recognition Task comprising negative and positive facial expressions. RESULTS: Analyses of variance results revealed patients reported worse sleep quality than controls. Linear mixed-effects models indicated that all participants demonstrated better emotion recognition abilities in identifying positive versus negative emotions. For reaction time, but not accuracy, regression results revealed significant individual differences, with worse sleep quality predicting slower reaction times for positive faces, specifically for happiness. LIMITATIONS: The use of a subjective measure of sleep quality and a specific behavioral paradigm for emotion recognition may impact the generalizability of the findings. CONCLUSIONS: Associations between task performance and emotional valence of facial expression implies that poor sleep quality, beyond internalizing symptom severity, may disrupt emotion processing.

Individual differences in striatal and amygdala response to emotional faces are related to symptom severity in social anxiety disorder.

Social anxiety disorder (SAD) is a common heterogeneous disorder characterized by excessive fear and deficient positive experiences. Case-control emotion processing studies indicate that altered amygdala and striatum function may underlie SAD; however, links between these regions and symptomatology have yet to be established. Therefore, in the current study, 80 individuals diagnosed with SAD completed a validated emotion processing task during functional magnetic resonance imaging. Anatomy-based regions of interest were amygdala, caudate, putamen, and nucleus accumbens. Neural activity in response to angry > happy faces and fearful > happy faces in these regions were submitted to multiple linear regression analysis with bootstrapping. Additionally, multiple linear regression analysis was performed to explore clinical features of SAD. Results showed greater putamen activity and less amygdala activity in response to angry > happy faces were related to greater social anxiety severity. In the model consisting of caudate and amygdala activity in response to angry > happy faces, results were marginally related to social anxiety severity and the pattern of activity was similar to the regression model comprising putamen and amygdala. Nucleus accumbens activity was not related to social anxiety severity. There was no correspondence between brain activity in response to fearful > happy faces and social anxiety severity. Clinical variables revealed greater levels of anhedonia and general anxiety were related to social anxiety severity, however, neural activity was not related to these features of SAD. Neuroimaging findings suggest that variance in dorsal striatal and amygdala activity in response to certain social signals of threat contrasted with an approach/rewarding social signal may contribute to individual differences in SAD. Clinical findings indicate variance in anhedonia and general anxiety symptoms may contribute to individual differences in social anxiety severity.

Neural mechanisms and predictors of SSRI and CBT treatment of anxiety: A randomized trial focused on emotion and cognitive processing.

Anxiety disorders (ADs) are common and difficult to treat. While research suggests ADs are characterized by an imbalance between bottom-up and top-down attention processes and that effective treatments work by correcting this dysfunction, there is insufficient data to explain how and for whom treatments work. The late positive potential (LPP), an event-related potential reflecting elaborative processing of motivationally salient stimuli, is sensitive to both bottom-up and top-down processes. The present study examines the LPP in healthy controls (HC) and patients with ADs under low and high working memory (WM) load to assess its utility as a predictor and index of symptom reduction in patients who underwent cognitive behavioral therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) treatment. The LPP when viewing negative and neutral distractor images and WM performance were assessed in 96 participants (40 HC, 32 CBT, 24 SSRI) during a letter recall task at Week 0 and in a subset of the study sample (23 CBT, 16 SSRI) at Week 12. Patients were randomly assigned to twelve weeks of CBT or SSRI treatment. Participants completed self-reported symptom measures at each time point. Greater Week 0 LPP to negative images under low WM load predicted greater symptom reduction in the SSRI, but not the CBT, group. Regression analyses examining the LPP to negative images as an index of symptom reduction revealed a smaller decrease in the LPP to negative images under low WM load was associated with less anxiety reduction across treatment modalities. Findings suggest the LPP during low WM load may serve as a cost-effective predictor and index of treatment outcome in ADs. Clinical Trials Registration: ClinicalTrials.gov (Identifier: NCT01903447).

Threat Conditioning and Trait-Based Vulnerability to Personality Disorder.

Some personality disorders (PDs) are accompanied by heightened threat sensitivity to benign events, whereas others are associated with minimal reactivity to danger or punishment. Such aberrant patterns of defensive responding may be due to abnormal threat learning processes, analogous to those observed in other fear- and fearlessness-based disorders. We investigated threat learning deficits with a Pavlovian differential conditioning procedure in an undergraduate sample (n = 117) overselected for negative affectivity. Contrary to predictions, maladaptive personality traits, as assessed via the Personality Inventory for DSM-5, were largely unrelated to defensive responding (i.e., subjective and electrodermal reactions to danger and safety cues) during threat conditioning. We discuss the possible boundary conditions of threat learning abnormalities in PD and suggest research designs that could more effectively reveal such deficits, if they exist.