Is there a survival processing effect in metacognition?

Memory systems serve an adaptive function for the fitness of organisms. A good example of this is the Survival Processing Effect (SPE) which points to increased retention of information when it is processed in a survival context compared to other contexts. Survival processing may also affect metacognitive processes, by increasing confidence judgments as well as increasing metacognitive sensitivity. No previous study, however, has directly examined whether processing information for survival also has an effect on metacognitive processes. Here we ask whether SPE extends to the metacognitive system in terms of both metacognitive sensitivity and confidence bias. In Experiment 1 participants were asked to rate a list of words in terms of relevance in a survival scenario or a moving scenario. In a surprise old/new recognition test, they were given one word at a time and asked to indicate if they have rated the presented word before and state how confident they are in that choice. Surprisingly, the results did not reveal a SPE, which may have been due to high overall performance in the recognition task. In Experiment 2 we increased the level of difficulty of the memory task, which resulted in a robust SPE, but could not find this effect in metacognitive monitoring. Together, these results suggest that survival processing may not affect metacognitive processes in a reliable fashion.

The roots of paternal depression: Experienced and nonexperienced trauma or Folie a Deux?

The transition to fatherhood may be challenged with anxiety and trepidation. A high prevalence has been found for paternal depression and it is reactive to maternal depression. This review aims to address potential sources of paternal depression, which may have adverse consequences on child development. We describe through three hypotheses how fathers may be at risk of depression during the transition to fatherhood: (1) psychological (interacting with ecological systems); (2) brain functional∖structural changes; and (3) (epi)genomic. We propose that paternal stressful experiences during the transition to fatherhood may be the source for paternal depression through direct stressful paternal experiences or via (potential, currently debated) nonexperienced (by the father) epigenomic transgenerational transmission. On the other hand, we suggest that resilient fathers may undergo a transient dysphoric period affected by identifying with the newborn's vulnerability as well as with the mother's postpartum vulnerability resulting in "paternity blues." In accordance with recent views on paternal "heightened sensitivity" toward the infant, we propose that the identification of both parents with the vulnerability of the newborn creates a sensitive period of Folie a Deux (shared madness) which may be a healthy transient, albeit a quasi-pathological period, recruited by the orienting response of the newborn for survival.

An interview with retired Commander (CDR) Everett Alvarez.

Mr. Everett Alvarez is a prior Navy pilot and officer who served during the Vietnam War as a Lieutenant Junior Grade (LTJG, O-2). Mr. Alvarez was the first pilot shot down, captured, and held as a prisoner of war (POW) at the Hoa Lò Prison, also known as the "Hanoi Hilton." He was held as a POW for 8.5 years, the second longest period of time a United States service member has been held captive. After his release and return to the United States, Mr. Alvarez continued his Naval service with a successful career. He went on to receive his Master of Science degree in Operations Research and Systems Analysis and retired at the rank of Commander (CDR, O-5). Retired CDR Alvarez has continued his service to the United States by holding positions such as the Deputy Director of the Peace Corps, Deputy Administrator of the Department of Veterans Affairs (VA), and Chairman and board member of the Board of Regents for the Uniformed Services University of the Health Sciences (USU). Interviewers were doctoral candidates in the USU Department of Medical and Clinical Psychology and Graduate School of Nursing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Gone with the Wind.

OBJECTIVE: If the narrative of "coronavirus" has an underlying theme, it may perhaps for some be one of survival, whilst for others, the theme might be suffering. The recurring motif of survival has continued throughout history, yet for the first time the sum of all fears has amounted to a run on the bare essentials. This paper seeks to offer an alternative formulation of "panic buying," with references to literature, philosophy, and contemporary neurobiology. CONCLUSION: The bare essentials disappeared perhaps as part of some self-fulfilling prophecy: the supermarkets became bare because others inadvertently lead us to believe they would become bare. The contagion model of emotional propagation provides a psychological model of how "panic buying" by an individual might lead to the replication of panic in an observer. The Polyvagal Theory further informs us of how the threat posed by the pandemic primes our limbic system to perceive danger, and explains how witnessing others engaging in fight-flight responses might evoke a fearful affect in an observer. In the end, it is perhaps through Nietzsche's study of classical tragedy that we may find some meaning to the pandemic, allowing our collective lived experience to serve as a template for growth.

Associations of Coffee and Tea Consumption With Survival to Age 90 Years Among Older Women.

BACKGROUND: Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age. OBJECTIVE: To examine associations of coffee and tea consumption with survival to age 90 years. DESIGN: Prospective cohort study among participants from the Women's Health Initiative, recruited during 1993 to 1998 and followed up until March 31, 2018. SETTING: The setting included 40 US clinical centers. PARTICIPANTS: A racially and ethnically diverse cohort of 27,480 older women, aged 65 to 81 years at baseline. MEASUREMENTS: Women were classified as having either survived to age 90 years or died before this age. Consumption of caffeinated and decaffeinated coffee and caffeinated tea was assessed at baseline and categorized as 0, 1, 2 to 3, or 4 or more cups/day. Associations of coffee and tea consumption with survival to age 90 years were examined using logistic regression models adjusted for sociodemographic characteristics, lifestyle behaviors, dietary quality, and chronic disease history. RESULTS: A total of 14,659 (53.3%) women survived to age 90 years during follow-up. Caffeinated coffee, decaffeinated coffee, or caffeinated tea consumption was not significantly associated with survival to age 90 years after adjusting for confounders. Findings did not significantly vary by smoking, body mass index, or race/ethnicity. CONCLUSION: No amount of coffee or tea consumption was associated with late-age survival among older women. These findings may be reassuring to older women who consume coffee and tea as part of their daily diets but do not support drinking these beverages to achieve longevity.

Risk and protective factors for repeated overdose after opioid overdose survival.

BACKGROUND: Nonfatal opioid overdose (OD) is an opportunity to identify patients who may benefit from interventions to reduce repeated overdose (rOD). In this study, we sought to determine risk and protective factors associated with rOD. METHODS: In this retrospective cohort study of 4,155 patients aged 18-64 who presented to one of 16 emergency departments in a single Western Pennsylvania health system between July 2015 and January 2018 for index opioid overdose (iOD) and survived to discharge, we identified demographic and clinical factors association with rOD within one-year. Relative risk of repeated opioid overdose was estimated using adjusted Cox proportional hazard ratios (aHRs). RESULTS: 14.9 % of patients (95 % CI 13.9-16.1) had a rOD, with 29 % occurring within 30 days from iOD. The adjusted hazard of opioid overdose was increased for male patients (aHR = 1.19; 95 % CI 1.01, 1.41), those with pre-iOD diagnoses of anxiety (aHR = 1.41; 95 % CI1.13, 1.77), depression (aHR = 1.44; 95 % CI 1.17, 1.78), substance use disorders (aHR = 1.30; 95 % CI 1.09, 1.55), and alcohol use disorder (aHR = 1.52; 95 % CI 1.02, 2.25). The hazard was lower for individuals prescribed an opioid in the 90 days prior to iOD (aHR = 0.59; 95 % CI 0.37, 0.97) and those admitted to the hospital for iOD (aHR = 0.56; 95 % CI 0.37, 0.86). CONCLUSION: We found that, among ED patients who survive an initial OD, mental health and substance use diagnoses are associated with a higher hazard of repeated overdoses whereas opioids prescriptions and admission are associated with lower hazards.

Threat, its impacts over survival systems, and related behavioral disorders

Defensive and appetitive motivation systems have evolved to propitiate more sophisticated interactions with environment threats and needs, such as nutrients, water, reproduction, and temperature regulation. In contact with survival-relevant environmental stimuli, organisms change as a whole to maximize fitness to that occasion. In this paper, an overview on defensive systems is described, as well as some relevant aspects of defensive states, including their impacts over appetitive functions. A parallel between these characteristics and what is called threat-related disorders in the present paper is drawn and, finally, these similarities are used as basis for a theoretical proposition that at least part of these disorders can be seen as persistent states of defense.

Funções de sobrevivência e sistemas orgânicos relacionados evoluíram para propiciar interações mais sofisticadas com ameaças ambientais e necessidades individuais, tais como nutrientes, água, reprodução e regulação da temperatura. Apesar de o termo "sistema" sugerir ações independentes de circuitos em face de tais estímulos, evidências sugerem que os organismos se alteram como um todo em situações relevantes para a sobrevivência, maximizando sua adequação à ocasião. No presente artigo, é apresentada uma visão global de tais alterações organísmicas em face de ameaças, bem como o impaco dessas alterações sobre funções apetitivas. Traça-se, também, um paralelo entre essas características e os transtornos relativos a ameaças. Por fim, as similaridades apontadas servirão como base para uma proposição teórica segundo a qual ao menos parte desses transtornos pode ser entendida como estados permanentes de defesa.

Pre-treatment quality of life as a predictor of distant metastasis-free survival and overall survival in patients with head and neck cancer who underwent free flap reconstruction.

PURPOSE: This study examined the prognostic associations of pre-treatment quality of life (QoL) with overall survival (OS) and distant metastasis-free survival (DFMS) among patients with head and neck cancer (HNC) who underwent free flap reconstruction. METHODS: A cohort of 127 HNC patients who received free flap reconstruction between November 2010 and June 2014 at a hospital were recruited. Pre-treatment QoL was measured by the University of Washington Quality of Life Questionnaire, which contains six physical domains, including speech, swallowing, appearance, saliva, taste and chewing, as well as the six social-emotional domains of pain, activity, recreation, shoulder, mood, and anxiety. Cox regression analyses were performed. RESULTS: Results showed that pre-treatment QoL was predictive of OS and DMFS. Of the domains, swallowing, chewing, speech, taste, saliva, pain and shoulder were demonstrated to be significant predictors of OS. Additionally, swallowing, chewing, speech, pain and activity were demonstrated making significant contributions to DMFS. CONCLUSION: Our data supported that physical domains of pre-treatment QoL were predictors for OS and DFMS in HNC patients with free-flap reconstruction. Longitudinal studies are warranted to clarify the prognostic abilities of social-emotional domains. Information on pre-treatment QoL should be taken into account to individualize care plan for these patients, and hence prolong their survival.

The entrepreneurship of survival among urban adults experiencing homelessness and mental illness.

AIMS: Using an entrepreneurship lens, this study examined the narratives of urban adults experiencing homelessness and living with mental illness, to explore strategies used for day-to-day survival. METHODS: Semi-structured qualitative interviews were conducted with 14 females, 30 males, and one individual identifying as "other," living in a mid-sized Canadian city. The average age was 39 years. Data were transcribed verbatim and analyzed using thematic analysis informed by grounded theory. FINDINGS: Participants described creative and intentional strategies for managing life on the street without permanent shelter, including recognition of opportunities, mobilization of their own or acquired resources, and use of social connections and communication skills, and strategies that demonstrated entrepreneurial processes. CONCLUSIONS: Findings suggest that participants used survival entrepreneurship strategies and processes to navigate daily life while experiencing homelessness. Recognition and validation of the propensity for enterprise and self-sufficiency are central for both individual recovery and ending homelessness within similar populations.

Viviendo con "Él" en la casa: experiencia del cáncer de mama hereditario / Living with "it" at home: the experience on hereditary breast cancer

El cáncer de mama hereditario es un fenómeno que afecta de manera particular a mujeres jóvenes. Sus experiencias están fuertemente influenciadas por la convivencia con mujeres de sus familias que lo han padecido. Por esto vivir en sus hogares con "él", el cáncer de mama, da cuenta de la cercanía de este padecimiento en la cotidianidad de la vida. Este relato biográfico nos acerca a la experiencia de una mujer joven que padece cáncer de mama, quien ha convivido con "él" y las consecuencias de su tratamiento en la figura de su madre, una sobreviviente de la enfermedad. así, ante el diagnóstico, este hecho tuvo gran influencia en su firme decisión de sobrevivir con un cuerpo lo más parecido al anterior de la irrupción de la enfermedad. De esta manera la reconstrucción de sus senos se convirtió no solo en su fin último, sino también en la forma de sentir que venció la batalla contra el cáncer

Hereditary breast cancer is a phenomenon afflicting mainly young women. their experiences are strongly influenced by living altogether with female relatives who suffered it. Therefore, to live at home with "it", that breast cancer, reflects how close is the disease in their daily lives. This biographical correlate brings us a young woman's experience who suffers breast cancer, who lives with "it" and its treatment consequences looking into the mirror of her mother, a cancer survivor. So, in this way, given the diagnosis, this fact exerted great influence in her stubbornness to survive with a body resembling that one before disease. Hence, her breasts reconstruction became not only her ultimate end, but also a way to feel she won her battle against cancer

The contagion of optimism: The relationship between patient optimism and palliative care clinician overestimation of survival among hospitalized patients with advanced cancer.

OBJECTIVE: Clinicians frequently overestimate survival time among seriously ill patients, and this can result in medical treatment at end of life that does not reflect the patient's preferences. Little is known, however, about the sources of clinicians' optimistic bias in survival estimation. Related work in social networks and experimental psychology demonstrates that psychological states-such as optimism-can transfer from one person to another. METHODS: We directly observed and audio recorded 189 initial inpatient palliative care consultations among hospitalized patients with advanced cancer. Patients self-reported their level of trait optimism and expectations for survival prognosis prior to the palliative care consultation, and the palliative care clinicians rated their expectations for the patient's survival time following the initial conversation with the patient. We followed patient mortality for 6 months. RESULTS: Patient optimism was associated with clinician overestimation of their survival in a dose-response relationship. Clinicians were approximately three times as likely to overestimate the survival of patients endorsing both high trait optimism and optimistic ratings of their survival time compared with neither (OR: 2.95; 95% CI: 1.24-7.02). This association was not attenuated by adjustment for age, gender, race, ethnicity, education, income, cancer type, functional status, quality of life, or white blood cell count (ORadj : 3.45; 95% CI: 1.24-9.66). CONCLUSION: Patients' optimism may have some influence over their clinicians' prognostic judgments.

Long-Term Effects of Chemical Warfare on Post-traumatic Stress Disorder, Depression, and Chronic Medical Conditions in Veterans.

We investigated the association between exposure to chemical warfare and chronic mental/physical conditions. This was a secondary analysis of data from a case-control study on Iranian male veterans. Participants with neuropsychiatric disorders other than depressive/anxiety disorders, anatomical defects, or malignancies were excluded. Compared to non-exposed veterans, exposed veterans demonstrated significantly higher odds of PTSD [OR (95% CI) = 5.23 (1.98-13.85)], hypertension [OR (95% CI) = 5.57 (1.68-18.48)], coronary heart disease [OR (95% CI) = 6.8 (1.62-28.49)], and diabetes [OR (95% CI) = 3.88 (1.35-11.16)], and marginally higher odds of moderate to severe depressive symptoms [OR (95% CI) = 2.21 (0.93-5.28)]. This study provides preliminary evidence on association of exposure to chemical warfare with long-term mental disorders as well as chronic medical conditions.

Unconfirmed death as a predictor of psychological morbidity in family members of disappeared persons.

BACKGROUND: The 2004 tsunami, the civil conflict until 2009 and the youth insurrection in the late 1980s in Sri Lanka resulted in many persons being classified as 'missing' as they disappeared and were unaccounted for. Our aim was to compare the prevalence of major depressive disorder (MDD) and prolonged grief disorder (PGD) in families of disappeared individuals, who eventually received the mortal remains and those who did not. METHOD: An ethically approved cross sectional study was conducted in a purposively selected sample after informed consent. Information on the circumstances of the family member going missing was gathered. Culturally adapted versions of the General Health Questionnaire and the Beck Depression Scale were administered. Those who screened positive were assessed by a psychiatrist on Diagnostic and Statistical Manual of Mental Disorders-5 criteria to arrive at a diagnosis. RESULTS: Of 391 cases of disappearances studied, MDD (17.5% v. 6%) and PGD (22% v. 7%) were significantly higher in those who did not eventually receive the mortal remains of the disappeared person. Among those who did not receive the mortal remains, being unsure whether the disappeared person was dead or alive was highly predictive of MDD and PGD. Mothers and wives, older family members and those with a family history of mental illness were more vulnerable. CONCLUSIONS: Family members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.

Reasons for living and dying in suicide attempters: a two-year prospective study.

BACKGROUND: The internal suicide debate hypothesis assumes that in a suicidal crisis, individuals are involved in an internal struggle over whether to live or die. Reasons for living (RFL) and Reasons for dying (RFD) are important individual reasons for staying alive (e.g. family) or wanting to die (e.g. hopelessness) and reflect this internal motivational conflict of the suicidal mind. The aim of this study was to explore the association between RFL and RFD of suicide attempters and current and future suicide ideation and behavior. METHOD: The sample consisted of 60 patients who were admitted at a psychiatric emergency unit in Switzerland following an attempted suicide. They received treatment as usual, participated in an assessment interview and completed self-report questionnaires. Additionally, they were instructed to write down up to five individual RFL and RFD. The number of RFL and RFD responses, depressive symptoms, and suicide ideation were assessed at baseline and 6, 12, and 24 months follow-up. Outcome measures were suicide ideation and repeated suicide attempts. Multiple imputations were used in order to address missing data. RESULTS: The number of RFD responses was the strongest predictor for increased suicide ideation at baseline. The number of RFL responses was not associated with suicide ideation and reattempts. RFD, depressive symptoms, and baseline suicide ideation predicted subsequent suicide reattempt up to 12 months later in simple regression analyses. Mediation analyses suggested that RFD mediated the effect of depressive symptoms at baseline on suicide ideation at 12-months follow-up. CONCLUSION: RFL were unrelated to the mental health of study participants and did not function as protective factor against suicide risk. RFD may be an important motivational driver in the suicidal process. Clinical interventions should focus more on the reduction of RFD than on RFL in suicidal individuals.

Adaptive Memory: Survival Processing and Social Isolation.

Social isolation was examined to assess its potential influence on the survival processing effect, which shows that individuals are more likely to remember something when it is processed with regard to their survival. Participants imagined being stranded in the grasslands, going on a space mission, or moving to a foreign land while alone or with a group of friends and rated a list of words for their relevance to the assigned scenario. An incidental memory test showed the typical survival processing effect on recall memory, with a significant interaction showing that the effect occurred in the isolated condition but not in the group condition. A second experiment examined rates of recognition for an isolated and group condition for the grasslands and moving scenarios and found a marginally significant effect of isolation in addition to the typical survival processing effect. Further, in both experiments, the perceived isolation of the isolated and group survival grasslands scenarios was significantly higher than the other conditions. The results are discussed with regard to the self-reference effect and the object-function account of the survival processing effect.

Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use.

BACKGROUND: Patients with advanced cancer often face distressing decisions about chemotherapy. There are conflicting data on the relationships among perceived prognosis, psychological characteristics, and chemotherapy use, which impair the refinement of decision support interventions. OBJECTIVE: Clarify the relationships among patient and oncologist estimates of life expectancy for 6 and 12 months, chemotherapy use, and patient psychological characteristics. DESIGN: Secondary analysis of data from two cross-sectional studies. SETTING/SUBJECTS: One hundred sixty-six patients with advanced stage cancer recruited from ambulatory cancer clinics. MEASUREMENTS: All data were obtained at study enrollment. Patients completed the Adult Hope Scale, Hospital Anxiety and Depression Scale, and Life Orientation Test-Revised. Patients and their oncologists provided estimates of surviving beyond 6 and 12 months. Chemotherapy use was determined by chart review. RESULTS: There were no significant associations between life-expectancy estimates and chemotherapy use nor patient anxiety, depression, hope, or optimism and chemotherapy use. Patients' life expectancy estimates for 12 months and oncologists' for 6 months were associated with higher patient anxiety and depression. Finally, both oncologist and patient estimates of life expectancy for 6 and 12 months were associated with increased levels of trait hope. CONCLUSION: Advanced cancer patients who provide less optimistic estimates of life expectancy have increased anxiety and depression, but do not use chemotherapy more often. Increased patient trait hope is associated with more favorable oncologist estimates. These findings highlight the need for interventions to support both patients and oncologists as they clarify prognostic expectations and patients cope with the psychological distress of a limited life expectancy.

Changes in mood, fatigue, sleep, cognitive performance and stress hormones among instructors conducting stressful military captivity survival training.

Numerous studies have examined the effects of captivity survival training on psychological and physiological function in trainees. In the present study we shifted the focus to instructors, and measured the effects that the delivery of training exerts on their levels of stress and performance. Because instructors are called upon to perform difficult duties (e.g., mock interrogations) under extreme conditions, we hypothesized that significant increases in psychological and physiological indices of stress would occur due to training. In addition, as part of their job tasking, the instructors conducted courses in consecutive weeks. This offered a unique and ecologically valid opportunity to assess carryover of stress from one week to the next. We hypothesized stress levels would be higher in the second than the first week of training. Our first hypothesis was supported: Delivering training was associated with impairments in mood, fatigue, and sleep, as well as a reduction in the ratio of testosterone/cortisol level in blood. Our second hypothesis was largely not supported as a 3-day break separating consecutive courses appeared sufficient for restoring psychological and physiological function. Our results demonstrate that although the delivery of training exerts negative effects on instructors' levels of stress, the 3-day recovery period separating consecutive courses is sufficient to return psychological and physiological function to baseline levels.

Survival, Signaling, and Security: Foster Carers' and Residential Carers' Accounts of Self-Harming Practices Among Children and Young People in Care.

Research on clinicians' interpretations of self-harming practices has shown that they can often be negative. To date there has been limited consideration of other professionals' narratives, notably those working in social care. This article presents focus group and interview data generated with foster carers ( n = 15) and residential carers ( n = 15) to explore the symbolic meanings ascribed to self-harm among the children and young people they care for. Three repertoires of interpretation are presented: survival, which conceives self-harm as a mechanism for redefining the identity of "looked-after"; signaling, which understands self-harm as a communicative tool for the expression of emotion; and security, which sees self-harming practices as testing the authenticity and safety of the caring relationship. Through their focus on sociocultural narratives, carers position themselves as experts on self-harm due to their intimacy with young people's social worlds. This construction potentially creates distance from health professionals, which is problematic given the current privileging of interprofessional working.

'Why didn't you write a not-for-cardiopulmonary resuscitation order?' Unexpected death or failure of process?

Objective The aim of the present study was to understand the reasons for the delivery of non-beneficial cardiopulmonary resuscitation (CPR) attempts in a tertiary private hospital over 12 months. We determined doctors' expectations of survival after CPR for their patient, whether they had considered a not-for-resuscitation (NFR) order and the barriers to completion of NFR orders. Methods Anonymous questionnaires were sent to the doctors primarily responsible for a given patient's care in the hospital within 2 weeks of the unsuccessful CPR attempt. The data were analysed quantitatively where appropriate and qualitatively for themes for open-text responses Results Most doctors surveyed in the present study understood the poor outcome after CPR in the older person. Most doctors had an expectation that their own patient had a poor prognosis and a poor likely predicted outcome after CPR. This implied that the patient's death was neither unexpected nor likely to be reversible. Some doctors considered NFR orders, but multiple barriers to completion were cited, including the family's wishes, being time poor and diffusion or deferral of responsibility. Conclusions It is likely that futile CPR is provided contrary to policy and legal documents relating to end-of-life care, with the potential for harms relating to both patient and family, and members of resuscitation teams. The failure appears to relate to process rather than recognition of poor patient outcome. What is known about the topic? Mandatory CPR has been established in Australian hospitals on the premise that it will save lives. The outcome from in-hospital cardiac arrest has not improved despite significant training and resources. The outcome for those acutely hospitalised patients aged over 80 years has been repeatedly demonstrated to be poor with significant morbidity in the survivors. There is emerging literature on the extent of the delivery of non-beneficial treatments at the end of life, including futile CPR, the recognition of harms incurred by patients, families and members of the resuscitation teams and on the opportunity cost of the inappropriate use of resources. What does this paper add? This is the first study, to our knowledge, that has demonstrated that doctors understood the outcomes for CPR, particularly in those aged 80 years and older, and that failure to recognise poor outcome and prognosis in their own patients is not a barrier to writing NFR orders. What are the implications for practitioners? Recognition of the poor outcomes from CPR for the elderly patient for whom the doctor has a duty of care should result in a discussion with the patients, allowing an exploration of values and expectations of treatment. This would promote shared decision making, which includes the use of CPR. Facilitation of these discussions should be the focus of health service review.