Depression and Anxiety Among COVID-19 Patients Admitted to a "Red Zone" Intensive Care Unit: Do the Factors of Self-Awareness of Somatic Health, Anxiety, and Depression Contribute to the Course of Sars-Cov-2 Infection?

BACKGROUND: The prevalence of depressive disorders in the general population increased significantly during the COVID-19 pandemic. The aim of this study is to examine the relationship between history of anxiety and depressive disorders and COVID-19 outcome, hospitalization and severity of anxiety and depression, and whether such relationships are explicable by direct impact of the disease. SUBJECTS AND METHODS: We conducted a questionnaire survey among 98 inpatients in the Department of Infectious Diseases of the Clinics of Samara State Medical University. The self-report questionnaire consisted of 120 items, including socio-demographic characteristics of participants, State-Trait Anxiety Inventory, and the Center for Epidemiologic Studies Depression Scale, with items reflecting subjective feelings about the COVID-19 pandemic. We used one-factor analysis of variance to compare between groups for those indicators that conformed to a normal distribution, and the chi-square test (χ2) or Fisher's exact test to analyze group differences in the distribution of categorical variables was used. RESULTS: The mean (SD) total score on the STAI anxiety scale among hospitalized patients (51 (10.1)) significantly exceeded that of the COMET-G control group (44.9 (11.7) (H=22.8, p<0.001). There was a similar difference in the severity of depression as measured by the CES-D scale (23.4 (12.6) versus 18.0 (11.8), H=15.2 and p<0.001). In contrast to the general population, there were no statistically significant differences in anxiety and depression severity in the matched samples 52 subjects fulfilling the criteria of age, gender, and general perception of health condition. CONCLUSIONS: Anxiety and depression scores among ICU (red zone) inpatients significantly exceeded the scores observed in the COMET-G general population group. Our study did not confirm expected relationship between symptoms of anxiety and depression (based on questionnaire response) and the risk of severe course of COVID-19 (e.g. hospitalization) in matched samples, but proved that the factor of self-awareness of health state may be related to the COVID-19 course severity. Future research would benefit from clinical interview of inpatients and follow-up monitoring of affective disorders to specify whether anxiety and particular type of depression (e.g., anxious) are selectively related to the severity of COVID-19 course and risks of affective disorders persistence after somatic recovery. The accumulation of mental disorders with age, and the bidirectional association of mood disorders and infectious diseases should be considered when assessing the risk factors.

Cleaner fish with mirror self-recognition capacity precisely realize their body size based on their mental image.

Animals exhibiting mirror self-recognition (MSR) are considered self-aware; however, studies on their level of self-awareness remain inconclusive. Recent research has indicated the potential for cleaner fish (Labroides dimidiatus) to possess a sophisticated level of private self-awareness. However, as this study revealed only an aspect of private self-awareness, further investigation into other elements is essential to substantiate this hypothesis. Here, we show that cleaner fish, having attained MSR, construct a mental image of their bodies by investigating their ability to recall body size. A size-based hierarchy governs the outcomes of their confrontations. The mirror-naïve fish behaved aggressively when presented with photographs of two unfamiliar conspecifics that were 10% larger and 10% smaller than their body sizes. After passing the MSR test, they refrained from aggression toward the larger photographs but still behaved aggressively toward the smaller ones without re-examining their mirror images. These findings suggest that cleaner fish accurately recognize their body size based on mental images of their bodies formed through MSR. Additionally, mirror-experienced fish frequently revisited the mirror when presented with an intimidating larger photograph, implying the potential use of mirrors for assessing body size. Our study established cleaner fish as the first non-human animal to be demonstrated to possess private self-awareness.

Reflexive neural circuits and the origin of language and music codes.

Conscious activity is grounded in the reflexive self-awareness in sense perception, through which the codes signifying sensual perceptive events operate and constrain human behavior. These codes grow via the creative generation of hypertextual statements. We apply the model of Vladimir Lefebvre (Lefebvre, V.A., 1987, J. Soc. Biol. Struct. 10, 129-175) to reveal the underlying structures on which the perception and creative development of language and music codes are based. According to this model, the reflexive structure of conscious subject is grounded in three thermodynamic cycles united by the control of the basic functional cycle by the second one, and resulting in the internal action that it turn is perceived by the third cycle evaluating this action. In this arrangement, the generative language structures are formed and the frequencies of sounds that form musical phrases and patterns are selected. We discuss the participation of certain neural brain structures and the establishment of reflexive neural circuits in the ad hoc transformation of perceptive signals, and show the similarities between the processes of perception and of biological self-maintenance and morphogenesis. We trace the peculiarities of the temporal encoding of emotions in music and musical creativity, as well as the principles of sharing musical information between the performing and the perceiving individuals.

Characterizing post-traumatic growth in individuals with traumatic brain injury according to social participation, self-awareness, and self-identity.

PURPOSE: After traumatic brain injury (TBI), individuals may face challenges in their social participation, self-awareness, and self-identity. However, positive life changes can also be experienced (i.e., post-traumatic growth). This study aimed to characterize the social participation, self-awareness, and self-identity of individuals with TBI displaying post-traumatic growth. MATERIALS AND METHODS: Fifteen participants (male = 10, mean age = 49.7 years) with moderate to severe TBI (average years post-injury = 15.2) were included in this mixed-methods study. Self-report questionnaires were used to assess social participation, self-awareness, and self-identity. Qualitative data, collected using semi-structured interviews, were used to categorize participants into two groups: higher (n = 8) and lower (n = 7) post-traumatic growth. Descriptive statistics were used to characterize participants in each group in terms of their social participation, self-awareness, and self-identity. RESULTS: Participants with higher post-traumatic growth had increased social participation, higher self-awareness, and fewer negative discrepancies between their pre- and post-injury self-identities, compared to participants with lower post-traumatic growth. CONCLUSION: This study contributes to a more comprehensive understanding of post-traumatic growth through the use of both qualitative and quantitative data. These findings can inform future research and development of programs to promote post-traumatic growth post-TBI.

Individuals may experience post-traumatic growth after sustaining a traumatic brain injury (TBI)Social participation, self-awareness, and self-identity could influence post-traumatic growth after TBIIn rehabilitation, post-traumatic growth may be facilitated for individuals with (TBI) through higher engagement in activities, better recognition of limitations, and positive changes to self-identity.

Survey of Moral Distress and Self-Awareness among Health Care Professionals.

Health care professionals experience moral distress due to challenging ethical decision-making during patient care. Self-awareness can be associated with moral distress. This study determined the levels of and relationship between moral distress and self-awareness of health care professionals. A convenience sample of physicians and nurses was recruited. Data were collected using the Moral Distress and Self-Awareness Scales. In total, 168 physicians and 201 nurses participated with a mean age of 30.54 ± 7.87 and clinical experience of 6.40 ± 6.22 years. Moderate levels of moral distress (127.07 ± 71.90) and high levels of self-awareness (70.20 ± 11.37) were found. A weak positive correlation was found between self-awareness and moral distress (r = 0.21, p < 0.001) and weak negative correlation between moral distress (r = - 0.115, p = 0.03) and age. Nurses were more self-aware, but no differences were observed in moral distress based on sex and clinical settings. A weak correlation between self-awareness and moral distress may suggest that self-awareness can increase intrapersonal tensions, contributing to distress. Further research is needed to support any conclusive relationship between moral distress and self-awareness.

Non-technical skills for neurosurgeons: An international survey.

Introduction: Neurosurgery is considered a technically demanding specialty; nonetheless, it also requires non-technical skills (NTSs) to reach mastery. Research question: This study seeks to understand how important NTSs are perceived by neurosurgeons across diverse roles and socio-economic backgrounds. The objective is to identify key NTSs and explore their role in surgical precision, teamwork, and collaboration. Material and method: An international survey involving 372 neurosurgeons from various socio-economic and cultural contexts was conducted. The extensive sample and inclusive methodology provide a comprehensive perspective on the perceived importance of NTSs in neurosurgery. Results: The survey results highlight the universal significance of NTSs among neurosurgeons. Attention to detail, humility, and self-awareness are considered essential for surgical precision, effective teamwork, and collaboration. The findings underscore the necessity for integrated training programs that combine NTSs with technical skills. Discussion and conclusion: The study emphasizes the importance of effective training methods such as simulations, mentorship, and role-playing in equipping neurosurgeons to navigate the complexities of their profession. Future research should focus on optimizing teaching methods for NTSs, comparing traditional courses, online modules, and hybrid training programs. Addressing the global disparity in neurosurgical care, particularly in low- and middle-income countries, is crucial for improving patient outcomes worldwide.

Exploring Pharmacy Students' Leadership Styles Using the 5 Voices Assessment.

OBJECTIVE: Leadership development assessments are a critical component of student pharmacists' understanding and development of effective team strategies. METHODS: The 5 Voices tool, developed by GiANT Worldwide, was incorporated into the leadership curriculum across 2 colleges of pharmacies for second-year Doctor of Pharmacy (PharmD) students. One public land-grant institution administers the assessment in the fall semester during a 2-h class session as part of a leadership elective leadership course and a private liberal arts institution distributes the 5 Voices assessment to all students during a 1-h spring semester required course. RESULTS: Responses from 456 PharmD students were included in the analysis, with 159 (34.9%) and 297 (65.1%) coming from the University of Minnesota and Drake University, respectively. Overall, 49.1% of PharmD students had nurturer as their foundational (first) voice. No differences were found in the distribution of first voices between institutions. The PharmD data are higher than the nurturer population-level average (43%). CONCLUSION: Introducing students to the 5 Voices assessment provides an opportunity for them to gain a better understanding of what they can contribute to a team. In addition, because nurturer is a dominant voice, this understanding can help provide appreciation for other voices necessary for team development.

Interoception, network physiology and the emergence of bodily self-awareness.

The interplay between the brain and interoceptive signals is key in maintaining internal balance and orchestrating neural dynamics, encompassing influences on perceptual and self-awareness. Central to this interplay is the differentiation between the external world, others and the self, a cornerstone in the construction of bodily self-awareness. This review synthesizes physiological and behavioral evidence illustrating how interoceptive signals can mediate or influence bodily self-awareness, by encompassing interactions with various sensory modalities. To deepen our understanding of the basis of bodily self-awareness, we propose a network physiology perspective. This approach explores complex neural computations across multiple nodes, shifting the focus from localized areas to large-scale neural networks. It examines how these networks operate in parallel with and adapt to changes in visceral activities. Within this framework, we propose to investigate physiological factors that disrupt bodily self-awareness, emphasizing the impact of interoceptive pathway disruptions, offering insights across several clinical contexts. This integrative perspective not only can enhance the accuracy of mental health assessments but also paves the way for targeted interventions.

Reduced awareness of cognitive deficits in idiopathic normal pressure hydrocephalus and its change following lumbar puncture.

OBJECTIVE: Awareness of cognitive deficits is related to executive functions and may, therefore, be sensitive to the effects of lumbar puncture (LP) in idiopathic normal pressure hydrocephalus (iNPH). Although a reduction in awareness of cognitive deficits (RACD) has been previously described in iNPH, there is a lack of systematic, psychometrically validated reports. In this study, we investigated RACD and its LP-related changes in iNPH patients and compared them with those in clinical and healthy control groups. METHODS: RACD was assessed before and after lumbar puncture (LP) in 24 patients (14 iNPH, 10 other age-associated cognitive syndromes; AACS) and compared with 23 healthy controls (HC), employing two RACD measures alongside cognitive examination. Local metacognition was measured using a visual percentile-based rating system and operationalized as the t-scaled distance between the participants' task-specific performance estimations and their objective test performance (ΔTSPE). Global metacognition, targeting broader estimates of cognitive functioning (ECF), was quantified by subtracting self- from informant-obtained sum scores on a questionnaire evaluating participants' dysexecutive problems (DEX-DS). Within-group and between-group differences in ΔTSPE and DEX-DS scores were compared non-parametrically, focusing on post-LP changes. RESULTS: Averaged ΔTSPE was higher in the patient groups and mirrored the groups' lower objective test performance, while averaged DEX-DS showed no group difference. Following LP, group comparisons revealed iNPH-specific decrease in both RACD measures. CONCLUSION: Our study revealed LP-related RACD changes in iNPH patients compared to those in AACS and HC participants. The results suggest a mitigation of impaired metacognitive abilities in iNPH, possibly resulting from LP-induced improvements in (local) metacognitive performance, facilitating ECF adjustment alongside a metacognitively stimulating testing procedure.

Prospective memory functions in traumatic brain injury: The role of neuropsychological deficits, metamemory and impaired self-awareness.

A large body of evidence suggests that individuals with traumatic brain injury (TBI) have significant difficulties with prospective memory (PM), the memory for future intentions. However, the processes underlying this cognitive deficit remain unclear. This study aimed to gather further evidence regarding PM functions in TBI and clarify the role of neuropsychological deficits, metamemory, and mood disorders. We used a laboratory-based clinical measure, the Virtual Week, to examine PM function in 18 patients with TBI and 18 healthy control subjects. Measures of attention, processing speed, executive functions, episodic memory, and self-report questionnaires were also administered. In line with prior literature, our findings indicate that individuals with TBI had a consistent deficit compared to controls across all PM tasks. In previous studies, TBI patients had more severe impairment on time-based tasks; nevertheless, our results show that across all participants event-based tasks were easier to perform compared to time-based only when the retrospective memory demand was high. The patients were not only impaired on the prospective component of PM but also failed to recognise the content of their task (the retrospective component). Interestingly, the TBI group did not report higher levels of everyday memory problems, anxiety and depression compared to the control group. These measures also failed to correlate with PM and recognition memory performance. This study found that besides the neuropsychological deficits, a global impairment in PM functioning is present in individuals with TBI across various task types, tasks low and high in retrospective demands, and event versus time-based.

Identifying conflict monitoring as a specific executive component that contributes to impaired self-awareness in patients with acquired brain injury.

OBJECTIVE: Impaired self-awareness (SA) after acquired brain injury (ABI) has traditionally been linked to deficits in executive functions. However, conflicting findings about this relationship have been reported in the literature. This inconsistency is probably due to the multicomponent nature of both constructs, as not all aspects of executive functions may be equally relevant to all components of self-awareness. This study explored whether offline SA (i.e. metacognitive knowledge) and online SA (i.e. error detection) relate to a less studied executive component, conflict monitoring/resolution. METHOD: Twenty-six patients with ABI performed the Three-Conflict Cognitive Control Task (3CCT), an experimental task that allowed to measure the ability to monitor and solve three different types of conflicts (Distractors-filtering, Spatial Stroop and Simon). Measures of SA were collected: offline SA was based on self-informant discrepancy about patient's everyday functional difficulties, and online SA was based on error detection abilities during a performance-based naturalistic task (The Breakfast Conflict Task). RESULTS: After controlling for global cognition, the conflict monitoring measure of 3CCT demonstarted incremental validity in predicting offline and online SA measured in naturalistic tasks. CONCLUSIONS: Conflict monitoring/resolution seems to be an important component of SA. This finding contributes to further understand the relationship between executive functions and SA. In addition, conflict monitoring/resolution is an executive component that should be considered when designing assessment and intervention strategies to deal with ISA.

Level of Self-Objectification among Adolescent Girls from Co-educational Schools and All-Girls Schools: A Comparative Study.

Background: Indian females have been objectified since time immemorial. The ancient Indian texts and architecture have numerous instances of sexual objectification of females. In the present time, self-objectification in girls is evident from the increasing popularity of apps like Photoshop, the rise in the makeup industry, plastic and cosmetic surgeries, and so on. This is especially relevant for females across the globe and leads to huge negative effects on women's identities. Purpose: The aim of the present study is to assess and compare the levels of body surveillance (self-objectification), body shaming, and control beliefs in adolescent girls from co-educational schools and all-girls schools. Methods: Four hundred adolescent girls from Convent schools in different cities in Uttar Pradesh were included in the study using purposive (homogeneous) sampling based on the inclusion criteria. The Objectified Body Consciousness Scale (OBCS) was used to assess body surveillance (self-objectification), body shaming, and control beliefs. Results: The results of the study revealed that the level of body surveillance (self-objectification) was significantly high among Indian adolescent girls. It was found that all-girls schools had a higher level of body surveillance (self-objectification), body shaming, and control beliefs as compared to adolescent girls from co-educational schools. Conclusion: It can be concluded that the phenomenon of self-objectification has numerous implications for the physical and mental well-being of girls, particularly during their formative years. Healthy behaviors and positive thoughts are the best ways to respect and honor one's body. The research suggests the need for meditation, awareness workshops, and school-level counseling for adolescent girls, especially in all-girls schools.

A systematic literature review of the impact of impaired self-awareness on the process of rehabilitation in acquired brain injury.

BACKGROUND: Impaired self-awareness (ISA) is common in individuals with an acquired brain injury (ABI) and can lead to reduced awareness of one's difficulties. Previous reviews have found that ISA impacts on functional outcomes in rehabilitation. However, to date there has not been a systematic literature review which examines how ISA impacts on the process of rehabilitation in ABI populations. METHOD: A literature search was conducted using several databases in May 2024, including Academic Search Premier, CINAHL, MEDLINE, APA PsycARTICLES and APA PsycINFO. Seventeen articles were selected for the review and were analyzed using Narrative Synthesis. RESULTS: Four themes arose from the findings, including goal setting, treatment adherence, engagement and willingness to change and time spent in hospital. ISA was found to impact on the value adult ABI participants placed in rehabilitation, which decreased treatment compliance, motivation, and engagement. ISA also impacted on goal setting and behavior and resulted in a longer length of time spent in hospital. CONCLUSION: This review emphasizes the impact of ISA on various aspects/processes of rehabilitation in ABI and provides considerations of how clinicians might adapt interventions to manage these difficulties.

Validation of the Self Awareness Outcome Questionnaire (SAOQ) in the Italian framework.

Background: Self-awareness is the process of understanding yourself and is an essential concept for personal growth and individual advancement. It refers to the ability to recognize and comprehend one's thoughts, emotions, behaviors, and personality traits. Being self-aware allows improvement in the management of emotions, interpersonal relationships, and making conscious decisions that reflect on values and objectives. However, measuring self-awareness can be a challenge. Finding a reliable and valid method to assess this complex aspect of self can be crucial for quantifying the level and monitoring its progress over time. Methods: The Self Awareness Outcome Questionnaire (SAOQ) has been identified as a suitable tool for this purpose. This study aims to ensure that the scale, initially developed in English, maintains its accuracy and sensitivity even after being translated into Italian. Differences between test and re-test were assessed. The significance of Cronbach's alpha was estimated. Results: The results show no significant differences between groups. Conclusions: The Italian version of the SAOQ gives us the possibility to further analyze research on self-awareness.

The blushing brain: neural substrates of cheek temperature increase in response to self-observation.

Darwin proposed that blushing-the reddening of the face owing to heightened self-awareness-is 'the most human of all expressions'. Yet, relatively little is known about the underlying mechanisms of blushing. Theories diverge on whether it is a rapid, spontaneous emotional response that does not involve reflection upon the self or whether it results from higher-order socio-cognitive processes. Investigating the neural substrates of blushing can shed light on the mental processes underlying blushing and the mechanisms involved in self-awareness. To reveal neural activity associated with blushing, 16-20 year-old participants (n = 40) watched pre-recorded videos of themselves (versus other people as a control condition) singing karaoke in a magnetic resonance imaging scanner. We measured participants' cheek temperature increase-an indicator of blushing-and their brain activity. The results showed that blushing is higher when watching oneself versus others sing. Those who blushed more while watching themselves sing had, on average, higher activation in the cerebellum (lobule V) and the left paracentral lobe and exhibited more time-locked processing of the videos in early visual cortices. These findings show that blushing is associated with the activation of brain areas involved in emotional arousal, suggesting that it may occur independently of higher-order socio-cognitive processes. Our results provide new avenues for future research on self-awareness in infants and non-human animals.

Erratum: Forgetting ourselves in flow: an active inference account of flow states and how we experience ourselves within them.

[This corrects the article DOI: 10.3389/fpsyg.2024.1354719.].

Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis.

BACKGROUND: A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. OBJECTIVE: The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. METHODS: This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant's goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, "What were your top 1 or 2 takeaways from your recent Health Coaching session?" and "Is there anything you would change about our Health Coaching sessions?" A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). RESULTS: The following four themes emerged from participants' feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. CONCLUSIONS: Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31841.

Forgetting ourselves in flow: an active inference account of flow states and how we experience ourselves within them.

Flow has been described as a state of optimal performance, experienced universally across a broad range of domains: from art to athletics, gaming to writing. However, its phenomenal characteristics can, at first glance, be puzzling. Firstly, individuals in flow supposedly report a loss of self-awareness, even though they perform in a manner which seems to evince their agency and skill. Secondly, flow states are felt to be effortless, despite the prerequisite complexity of the tasks that engender them. In this paper, we unpick these features of flow, as well as others, through the active inference framework, which posits that action and perception are forms of active Bayesian inference directed at sustained self-organisation; i.e., the minimisation of variational free energy. We propose that the phenomenology of flow is rooted in the deployment of high precision weight over (i) the expected sensory consequences of action and (ii) beliefs about how action will sequentially unfold. This computational mechanism thus draws the embodied cognitive system to minimise the ensuing (i.e., expected) free energy through the exploitation of the pragmatic affordances at hand. Furthermore, given the challenging dynamics the flow-inducing situation presents, attention must be wholly focussed on the unfolding task whilst counterfactual planning is restricted, leading to the attested loss of the sense of self-as-object. This involves the inhibition of both the sense of self as a temporally extended object and higher-order, meta-cognitive forms of self-conceptualisation. Nevertheless, we stress that self-awareness is not entirely lost in flow. Rather, it is pre-reflective and bodily. Our approach to bodily-action-centred phenomenology can be applied to similar facets of seemingly agentive experience beyond canonical flow states, providing insights into the mechanisms of so-called selfless experiences, embodied expertise and wellbeing.

Early social-cognitive development as a dynamic developmental system-a lifeworld approach.

Based on developmental systems and dynamic systems theories, we propose the lifeworld approach-a conceptual framework for research and a hypothesis concerning early social-cognitive development. As a framework, the lifeworld approach recognizes the social embeddedness of development and shifts the focus away from individual developmental outcomes toward the reciprocal interplay of processes within and between individuals that co-constitutes early social-cognitive development. As a hypothesis, the lifeworld approach proposes that the changing developmental system-spanning the different individuals as their subsystems-strives toward attractor states through regulation at the behavioral level, which results in both the emergence and further differentiation of developmental attainments. The lifeworld approach-as a framework and a hypothesis, including key methodological approaches to test it-is exemplified by research on infants' self-awareness, prosocial behavior and social learning. Equipped with, first, a conceptual framework grounded in a modern view on development and, second, a growing suite of methodological approaches, developmental science can advance by analyzing the mutually influential relations between intra-individual and interactional processes in order to identify key mechanisms underlying early social-cognitive development.

What I think she thinks about my paralysed body: Social inferences about disability-related content in anosognosia for hemiplegia.

The neuropsychological disorder of anosognosia for hemiplegia (AHP) can offer unique insights into the neurocognitive processes of body consciousness and representation. Previous studies have found associations between selective social cognition deficits and anosognosia. In this study, we examined how such social cognition deficits may directly interact with representations of one's body as disabled in AHP. We used a modified set of previously validated Theory of Mind (ToM) stories to create disability-related content that was related to post-stroke paralysis and to investigate differences between right hemisphere damage patients with (n = 19) and without (n = 19) AHP. We expected AHP patients to perform worse than controls when trying to infer paralysis-related mental states in the paralysis-related ToM stories and explored whether such differences depended on the inference patients were asked to perform (e.g. self or other referent perspective-taking). Using an advanced structural neuroimaging technique, we expected selective social cognitive deficits to be associated with posterior parietal cortex lesions and deficits in self-referent perspective-taking in paralysis-related mentalising to be associated with frontoparietal disconnections. Group- and individual-level results revealed that AHP patients performed worse than HP controls when trying to infer paralysis-related mental states. Exploratory lesion analysis results revealed some of the hypothesised lesions, but also unexpected white matter disconnections in the posterior body and splenium of the corpus collosum associated with a self-referent perspective-taking in paralysis-related ToM stories. The study has implications for the multi-layered nature of body awareness, including abstract, social perspectives and beliefs about the body.