Functional Neuroimaging of Adult-to-Adult Romantic Attachment Separation, Rejection, and Loss: A Systematic Review.

Romantic attachment rejection (RAR) is a highly prevalent phenomenon among young adults. Rejection by a romantic attachment figure can be a painful and incapacitating experience with lasting negative mental health sequelae, yet the underlying neurobiology of RAR is not well characterized. We systematically reviewed functional neuroimaging studies of adult RAR. Four functional magnetic resonance imaging (fMRI) studies that measured participants' responses to real or imagined RAR and met inclusion criteria were evaluated. These included studies were published between 2004 and 2018. Brain activity in adult participants with an RAR appears to be influenced by the stimulus used to elicit a reaction as well as by attachment styles. Brain regions that show a significant change in activation following a rejection stimulus include cortical regions (cingulate, insular, orbitofrontal, and prefrontal), and subcortical regions (angular gyrus, hippocampus, striatum, tegmental area, and temporal pole) and correspond to (i) pain, distress, and memory retrieval; (ii) reward, romantic love, and dopaminergic circuits; and (iii) emotion regulation and behavioural adaptation. Further neuroimaging studies of adult RAR, as moderated by stimulus and attachment style, are needed to better understand the underlying neurobiology of RAR.

The relationship between potentially traumatic or stressful events, HIV infection and neurocognitive impairment (NCI): a systematic review of observational epidemiological studies.

BACKGROUND: HIV/AIDS and potentially traumatic events (PTEs) or stressful life events (SLEs) and/or PTSD are independently associated with neurocognitive impairment (NCI). Literature suggests that HIV and PTE/SLE exposure independently and consistently affect various domains of cognition including language ability, working memory and psychomotor speed. There are limited data on the interaction between HIV infection and PTEs and their combined effect on NCI. OBJECTIVE: In this systematic review, we synthesise evidence for the combined effect of HIV infection and PTEs and SLEs and/or post-traumatic stress disorder (PTSD) on NCI of people living with HIV/AIDS (PLWHA) from high-, middle- and low- income countries. METHOD: Our inclusion criteria were observational epidemiological studies (case-control, cohort and cross-sectional designs) that investigated the interaction of HIV infection, PTEs and SLEs and/or PTSD and specifically their combined effect on NCI in adults. We searched a number of electronic databases including Pubmed/Medline, PsycINFO, Scopus and Global Health using the search terms: cognition, HIV/AIDS, observational studies, trauma and permutations thereof. RESULTS: Fifteen studies were included in the review, of which the majority were conducted in high-income countries. Ten of the fifteen studies were conducted in the United States of America (USA) and five in South Africa. Seven of these focused on early life stress/childhood trauma. The remaining studies assessed adult-onset PTEs and SLEs only. Eight studies included women only. Overall, the studies suggest that PTE and SLE exposure and/or PTSD are a significant risk factor for NCI in adults living with HIV, with impairments in memory and executive functions being the most likely consequence of PTE and SLE exposure. CONCLUSION: These findings highlight the need for trauma screening and for the integration of trauma-focused interventions in HIV care to improve outcomes.

Antecedentes: El VIH/SIDA y los eventos potencialmente traumáticos (PTEs) o los eventos estresantes de la vida (SLEs) y/o TEPT se asocian independientemente con el deterioro neurocognitivo (NCI). La literatura sugiere que la exposición al VIH, PTE y SLE afecta de manera independiente y consistente varios dominios de la cognición, incluida la capacidad del lenguaje, la memoria de trabajo y la velocidad psicomotora. Hay datos limitados sobre la interacción entre la infección por VIH y los PTE, y su efecto combinado sobre el NCI.Objetivo: En esta revisión sistemática sintetizamos evidencia del efecto combinado de la infección por VIH, PTEs y SLEs, y/o TEPT en el NCI de personas que viven con VIH/SIDA (PLWHA) en países de ingresos altos, medios y bajos.Método: Nuestros criterios de inclusión fueron estudios epidemiológicos observacionales (diseño de caso-control, cohortes y diseños transversales) que investigaron la interacción de la infección por VIH, PTEs y SLEs y/o TEPT, y específicamente su efecto combinado sobre el NCI en adultos. Se realizaron búsquedas en varias bases de datos electrónicas, que incluyeron a Pubmed/Medline, PsycINFO, Scopus y Global Health, utilizando los términos de búsqueda: cognición, VIH/SIDA, estudios de observación, trauma y permutaciones de los mismos.Resultados: Quince estudios se incluyeron en la revisión, de los cuales la mayoría se realizaron en países de altos ingresos. Diez de los quince estudios fueron realizados en los Estados Unidos de América (EE.UU.) y cinco en Sudáfrica. Siete de éstos se centraron en el estrés de la vida temprana/trauma infantil. Los estudios restantes evaluaron PTEs y SLEs cuya aparición fue en la vida adulta solamente. Ocho estudios incluyeron sólo mujeres. En general, los estudios sugieren que la exposición a PTE y SLE y/o TEPT es un factor de riesgo significativo para NCI en adultos que viven con VIH, con el deterioro en la memoria y las funciones ejecutivas como la consecuencia más probable de la exposición a PTE y SLE.Conclusión: Estos hallazgos resaltan la necesidad de la detección de traumas y la integración de intervenciones centradas en el trauma en la atención del VIH para mejorar sus resultados.

The relationship between cognitive change and physical health and behavioural outcomes in a Ugandan cohort of adults living with HIV - a longitudinal study.

We investigated changes in cognitive function and physical health and behavioural outcomes (HIV disease progression, health-seeking behaviour, adherence to HIV medications and risky sexual behaviour) at baseline and 12 months later among 1126 Ugandan adults living with HIV. Overall, cognitive function improved from baseline to follow-up, except for gait speed, which was slower at follow-up compared to baseline. There were improvements in physical health and behavioural outcomes by follow-up, with greater improvements among individuals on ART compared to those not on ART. Change in gait speed over time significantly predicted risky sexual behaviours at follow-up. This is the first study to investigate the longitudinal relationships between cognitive function and health outcomes among Ugandan adults living with HIV and provide insights into the possible links between cognitive function and negative clinical and behavioural health outcomes in people living with HIV.

Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender.

BACKGROUND: Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth. METHODS: The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors. RESULTS: Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group. CONCLUSIONS: There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.

Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma.

Background: Prior research on adaptation after early trauma among black South African women typically assessed resilience in ways that lacked contextual specificity. In addition, the neurocognitive correlates of social and occupational resilience have not been investigated. Objective: The primary aim of this exploratory study was to identify domains of neurocognitive functioning associated with social and occupational resilience, defined as functioning at a level beyond what would be expected given exposure to childhood trauma. Methods: A sample of black South African women, N = 314, completed a neuropsychological battery, a questionnaire assessing exposure to childhood trauma, and self-report measures of functional status. We generated indices of social and occupational resilience by regressing childhood trauma exposure on social and occupational functioning, saving the residuals as indices of social and occupational functioning beyond what would be expected given exposure to childhood trauma. Results: Women with lower non-verbal memory evidenced greater social and occupational resilience above and beyond the effects attributable to age, education, HIV status, and depressive and posttraumatic stress symptoms. In addition, women with greater occupational resilience exhibited lower semantic language fluency and processing speed. Conclusion: Results are somewhat consistent with prior studies implicating memory effects in impairment following trauma, though our findings suggest that reduced abilities in these domains may be associated with greater resilience. Studies that use prospective designs and objective assessment of functional status are needed to determine whether non-verbal memory, semantic fluency, and processing speed are implicated in the neural circuitry of post-traumatic exposure resilience.

Planteamiento: Las investigaciones previas sobre la adaptación después del trauma temprano entre las mujeres negras de Sudáfrica generalmente evaluaban la resiliencia de maneras que carecían de especificidad contextual. Además, no se han investigados los correlatos neurocognitivos de la resiliencia social y ocupacional. Objetivo: El objetivo principal de este estudio exploratorio fue identificar los dominios del funcionamiento neurocognitivo asociados con la resiliencia social y ocupacional, que se define como el funcionamiento en un nivel mayor de lo que se esperaría dada la exposición al trauma infantil. Métodos: Una muestra de mujeres negras sudafricanas, N = 314, completó una batería neuropsicológica, un cuestionario que evaluaba la exposición al trauma infantil y medidas de auto informe de su funcionamiento. Generamos índices de resiliencia social y ocupacional mediante la regresión de la exposición al trauma infantil en el funcionamiento social y laboral, conservando los residuos como índices de funcionamiento social y laboral más allá de lo esperado dada la exposición al trauma infantil. Resultados: Las mujeres con menor memoria no verbal mostraron una mayor resiliencia social y ocupacional por encima y más allá de los efectos atribuibles a la edad, la educación, el estado del VIH y los síntomas de depresión y estrés postraumático. Además, las mujeres con mayor resiliencia ocupacional mostraron menor fluidez del lenguaje semántico y de velocidad de procesamiento. Conclusión: Los resultados son algo consistentes con los estudios previos que implican los efectos de la memoria en el deterioro después del trauma, aunque nuestros hallazgos sugieren que las habilidades reducidas en estos dominios pueden asociarse a una mayor resiliencia. Se necesitan estudios que usen diseños prospectivos y una evaluación objetiva del estado funcional para determinar si la memoria no verbal, la fluidez semántica y la velocidad de procesamiento están implicadas en los circuitos neuronales de la resiliencia a la exposición postraumática.

Cognitive-behavioural interventions for mood and anxiety disorders in HIV: a systematic review.

BACKGROUND: Mood and anxiety disorders are highly prevalent and comorbid with HIV/AIDS. However, there is a paucity of research on the effectiveness of cognitive-behavioural interventions (CBI) for common mental disorders in HIV-infected adults. The present study sought to review the existing literature on the use of CBI for depression and anxiety in HIV-positive adults and to assess the effect size of these interventions. METHODS: We did duplicate searches of databases (from inception to 17-22 May 2012). The following online databases were searched: PubMed, The Cochrane Central Register of Controlled Trials and PsychArticles. RESULTS: We identified 20 studies suitable for inclusion. A total of 2886 participants were enroled in these studies, of which 2173 participants completed treatment. The present review of the literature suggests that CBI may be effective in the treatment of depression and anxiety in individuals living with HIV/AIDS. Significant reductions in depression and anxiety were reported in intervention studies that directly and indirectly targeted depression and/or anxiety. Effect sizes ranged from 0.02 to 1.02 for depression and 0.04 to 0.70 for anxiety. LIMITATIONS: Some trials included an immediate postintervention assessment but no follow-up assessments of outcome. This omission makes it difficult to determine whether the intervention effects are sustainable over time. CONCLUSION: The present review of the literature suggests that CBI may have a positive impact on the treatment of depression and anxiety in adults living with HIV/AIDS.

Neurocognitive deficits in HIV-infected women and victims of childhood trauma.

The study investigated the behavioral and brain effects of childhood trauma and human immunodeficiency virus (HIV) infection, both separately and in combination, and assessed potential interactions in women who were dually affected. Eighty-three HIV-positive and 47 matched HIV-negative South African women underwent neuromedical, neuropsychiatric, and neurocognitive assessments. Univariate tests of significance assessed if either HIV infection or childhood trauma, or the combination, had a significant effect on neurocognitive performance. The majority of women were Black (96%) and had an average age of 30 years. An analysis of covariance revealed significant HIV effects for the Hopkins Verbal Learning Test (HVLT) learning and delay trials (p < 0.01) and the Halstead Category Test (HCT) (p < 0.05). A significant trauma effect was seen on the HVLT delay trial (p < 0.05). The results provide evidence for neurocognitive dysfunction in memory and executive functions in HIV-infected women and memory disturbances in trauma exposed women.

Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals.

It has been suggested that an HIV diagnosis may increase the likelihood of mental disorders among infected individuals and that the progression of HIV may be hastened by mental disorders like anxiety and depression. Therefore, a brief screening measure, with good sensitivity/specificity for psychiatric diagnoses that could be given to HIV-infected individuals would be useful. We assessed the validity of the K-10, using the MINI International Neuropsychiatric Interview as the gold standard, in a sample of 429 HIV-infected adults enrolled in HIV care and treatment services near Cape Town, South Africa. There was significant agreement between the K-10 and the MINI-defined depressive and anxiety disorders. A receiver operating characteristic (ROC) curve analysis indicated that the K-10 showed agreeable sensitivity and specificity in detecting depression (area under the ROC curve, 0.77), generalized anxiety disorder (0.78), and posttraumatic stress disorder (PTSD) (0.77). The K-10 may be a useful screening measure for detecting mood and anxiety disorders, including PTSD, in patients with HIV/AIDS.

Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women.

It has been suggested that women experience depression most commonly in the childbearing years and that reproductive events such as pregnancy and child birth may coincide with the onset of mood and anxiety disorders in women. Therefore, a brief screening tool, with good sensitivity/specificity for psychiatric diagnoses that could be administered to pregnant women would be a valuable and useful proxy measure. We assessed the validity of the K-10, using the SCID as the gold standard, in a sample of 129 healthy pregnant women who presented for care at midwife obstetric units in Cape Town, South Africa. A receiver-operating characteristic curve (ROC) analysis indicated that the K-10 showed agreeable sensitivity and specificity in detecting depression (area under the receiver-operating characteristic curve, 0.66), posttraumatic stress disorder (0.69), panic disorder (0.71), and social phobia (0.76). The K-10 may be a useful screening measure for mood and anxiety disorders in pregnant women.

Monitoring acrylic fiber workers for liver toxicity and exposure to dimethylacetamide. 1. Assessing exposure to dimethylacetamide by air and biological monitoring.

Worker exposure to N,N-dimethylacetamide (DMAC) in an acrylic fiber manufacturing facility was measured, over a 1-year study period, by full-shift (12 hours) personal air monitoring for DMAC and by biological monitoring for levels of DMAC, N-methylacetamide (MMAC), and acetamide in spot urine samples. Ninety-three of 127 male workers in seven job classifications in the solution preparation and spinning departments of the plant were monitored on the second consecutive workday after at least 3 days off for the first 10 months of the study and on both the first and second days during the study's final 2 months. Postshift urinary MMAC levels were significantly correlated (P < .0001, r2 = .54) with DMAC in air levels. An air level of 6.7 ppm 12-hour time-weighted average (TWA) corresponded to a urine MMAC level of 62 mg/g creatinine in a postshift spot urine sample obtained after the second consecutive workday. To minimize exposure misclassification due to variability in the regression relationship, a level of 35 mg MMAC/g creatinine in a postshift spot urine sample was recommended as a biomonitoring index. Postshift urine MMAC levels did not appear to plateau at higher air levels, nor did it appear that the DMAC demethylation metabolic mechanisms became saturated at threshold limit value (TLV)-level air-exposure levels. Urine MMAC levels in postshift samples obtained the second workday appeared to be greater than levels in postshift first-day samples, but the number of days until this postshift level would plateau could not be determined from this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring acrylic fiber workers for liver toxicity and exposure to dimethylacetamide. 2. Serum clinical chemistry results of dimethylacetamide-exposed workers.

Worker exposure to N,N-dimethylacetamide (DMAC) in an acrylic fiber manufacturing facility was measured, over a 1-year study period, by full-shift (12 hours) personal air monitoring for DMAC and biological monitoring for levels of DMAC, N-methylacetamide (MMAC) and acetamide in post-shift spot urine samples. Evidence of liver toxicity was assessed by serum clinical chemistry tests (serum levels of total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptase) at least once during the study period for all 127 male workers in the two study departments and for 217 male in-plant controls with no previous or current exposure to DMAC. If a worker's biomonitoring results exceeded one of two "trigger" values established for the study (60 mg MMAC/g creatinine or 136 mg DMAC equivalent/g creatinine), additional serum clinical chemistry tests were conducted at weekly intervals for 3 weeks. DMAC-exposed workers were classified as either high exposure, if one or more biomonitoring result exceeded one of the trigger values, or unspecified exposure if none of them did. Control-group employees were classified as no-exposure. Mean DMAC in air levels for the high- and unspecified-exposure groups appeared to differ (geometric mean DMAC in air levels of 1.9 and 1.3 ppm 12-hour time-weighted average, respectively). No significant DMAC exposure-related trends in hepatic serum clinical chemistry results were detected. Neither transient increases in serum analyte levels after a "high" biomonitoring result (one that exceeded a trigger value) nor an elevated mean level over the study period when compared with in-plant controls were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary structure of the putative human oncogene, pim-1.

A full-length (6.1-kb) human genomic pim-1 gene, together with its immediate 5'-upstream promoter sequence (Ppim) was isolated and sequenced. The human pim-1 gene shares an overall nucleotide (nt) sequence identity of 53% with the previously reported murine pim-1 gene. It consists of six exons and five introns and contains a protein-coding region that is identical in nt sequence to a full-length human pim-1 cDNA. The gene codes for a predicted Pim-1 protein of 313 amino acids (aa) with an Mr of 35,690 and a pI of 5.7. The deduced aa sequence of the human Pim-1 has 94% identity with the murine Pim-1 whereas the nt sequences of the two genes are 88% identical. All of the conserved aa residues of the mouse pim-1 gene, which are homologous to known protein kinases are conserved in the predicted human protein. The human Ppim region is very G + C-rich (69%) and shares greater than 80% identity with the murine Ppim. The Ppim has no TATA- or CAAT-box sequences but does contain a number of nt sequences similar to the putative binding sites of several presumptive transcription factors.

[Controlled study on the treatment of hypertension with verapamil in retard form]. / Kontrollierte Studie zur Behandlung der Hypertonie mit Verapamil in Retardform.

The antihypertensive effect of an oral slow release (retard) formulation of verapamil was evaluated in a negative (placebo) and positive (nifedipine) controlled study. After a run-in period of one week without antihypertensive therapy, 54 patients were classified as having mild to moderate hypertension (diastolic blood pressure 95-115 mm Hg) and assigned randomly to one of three groups (n = 18 each). These received one of the following treatments over 2 weeks: either placebo b.i.d., or a nifedipine retard preparation 20 mg b.i.d., or a verapamil retard preparation 240 mg b.i.d. Assessments of blood pressure were made at rest and during a standardized bicycle stress test. Data were recorded at baseline and at the end of each week. After one week of treatment, 1 patient receiving nifedipine and 14 patients receiving placebo dropped out of the study because their diastolic pressures were equal to or above the values before treatment. After two weeks of treatment, 13 of 18 patients on verapamil and 9 of 18 patients on nifedipine had resting diastolic pressures less than or equal to 90 mm Hg. Also systolic pressure and blood pressures during exercise were significantly lowered by both active drugs. Verapamil caused a fall in heart rate during rest and under maximal exercise. Undesired side effects from verapamil were constipation (6 of 18) and headache (1 of 18); those from nifedipine were flush or headache (5 each of 18); ankle edema, dizziness, or tachycardia were each reported by one patient. In comparison with placebo values, verapamil lengthened the atrioventricular conduction time (PQ-interval) significantly, however, PQ-interval did not exceed 0.24 s.(ABSTRACT TRUNCATED AT 250 WORDS)