Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders.

BACKGROUND: Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. METHODS: Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. RESULTS: Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. CONCLUSIONS: Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery.

Selepressin in Septic Shock.

ABSTRACT: Sepsis and septic shock usually show a high mortality rate and frequently need of intensive care unit admissions. After fluid resuscitation, norepinephrine (NE) is the first-choice vasopressor in septic shock patients. However, high-NE doses are associated with increased rates of adverse effects and mortality. In this perspective, many authors have proposed the administration of non-adrenergic vasopressors (NAV). Selepressin is a selective vasopressin type 1A (V1A) receptor agonist and may be a valid option in this field, because it can decrease NE requirements and also limit the deleterious effects induced by high doses of catecholamines. Only few clinical data actually support selepressin administration in this setting. Here, we review the current literature on this topic analyzing some pathophysiological aspects, the rationale about the use of NAV, the possible use of selepressin differentiating animal, and human studies. Various issues remain unresolved and future trials should be focused on early interventions based on a multimodal activation of the vasopressive pathways using both alpha and V1A receptors pathways.

Assessing adherence to and usability of Experience Sampling Method (ESM) and actigraph in patients with Schizophrenia Spectrum Disorder: A mixed-method study.

The application of innovative technologies in psychiatry is promising, but the debate about its feasibility is not settled. Our aim was to investigate and compare adherence to and usability of 7-day monitoring with an Experience Sampling Method (ESM) and Actigraphy among a sample of individuals with a diagnosis of Schizophrenia Spectrum Disorders (SSD) and paired healthy controls. Twenty-two patients living in residential facilities (RFs), 20 outpatients and 26 controls were enrolled in this study as part of the DiAPAson project. Participants wore an actigraph and were evaluated for daily time use and mood with a smartphone-based ESM. Then, they completed questionnaires to assess the usability of the devices and were interviewed. Adherence was assessed as the percentage of time spent wearing actigraph and answering ESM notifications. Residential patients, compared to controls, showed significantly higher usability of the actigraph and lower adherence to both the actigraph and ESM. From the qualitative interviews, four high-order themes emerged: effects of monitoring, adherence and usability, emotions and mental states, and advice. Findings are promising for the application of these methodologies in such populations. The role of multidisciplinary staff in RFs is crucial for guaranteeing the realization of such projects.

DAily time use, Physical Activity, quality of care and interpersonal relationships in patients with Schizophrenia spectrum disorders (DiAPASon): an Italian multicentre study.

BACKGROUND: Schizophrenia spectrum disorders (SSD) are ranked among the leading causes of disabilities worldwide. Many people with SSD spend most of their daily time being inactive, and this is related to the severity of negative symptoms. Here, we present the 3-year DiAPAson project aimed at (1) evaluating the daily time use among patients with SSD living in Residential Facilities (RFs) compared to outpatients with SSD and to the general population (Study 1); (2) evaluating the quality of staff-patient relationships, its association with specific patient outcomes and the quality of care provided in RFs (Study 2); and (3) assessing daily activity patterns in residential patients, outpatients with SSD and healthy controls using real-time methodologies (Study 3). METHODS: Study 1 will include 300 patients with SSD living in RFs and 300 outpatients; data obtained in these clinical populations will be compared with normative data obtained by the National Institute of Statistics (ISTAT) in the national survey on daily time use. Time use assessments will consist of daily diaries asking participants to retrospectively report time spent in different activities. In Study 2, a series of questionnaires will be administered to 300 residential patients (recruited for Study 1) to evaluate the quality of care and staff-patient relationships, level of well-being and burnout of RFs' staff, and quality of RFs using a European standardized questionnaire (QuIRC-SA). In Study 3, the daily time use will be evaluated in a subgroup of 50 residential patients, 50 outpatients and 50 healthy controls using the Experience Sampling Method approach (participants will complete a brief questionnaire -about time use, mood and perceived energy- on a smartphone 8 times a day for 1 week) to compare retrospective and real-time reports. Moreover, their level of physical activity, sleep patterns, and energy expenditure will be monitored through a multi-sensor device. DISCUSSION: This project is highly innovative because it combines different types of assessments (i.e., retrospective and real-time reports; multi-sensor monitoring) to trace an accurate picture of daily time use and levels of physical activity that will help identify the best therapeutic options promoting daily activities and physical exercise in patients with SSD. TRIAL REGISTRATION: ISRCTN registry ID ISRCTN21141466.

The impact of psychostimulants on sustained attention over a 24-h period.

The off-label use of psychostimulants is a growing trend in healthy adults with many turning to these medications to increase alertness, attentional focus, and to help them study. However, the empirical literature on the efficacy of these medications for cognitive enhancement is controversial and the longer-term impact of these drugs on health and cognitive processing has not been thoroughly examined. Specifically, sleep supports daytime alertness, vigilance, and sustained attention, yet stimulants significantly disrupt sleep. Here, using a double-blind, placebo-controlled, crossover design, we tested the impact morning administration of psychostimulants (dextroamphetamine; DEX) had on: (1) tests of attention 75-min and 12-h after drug ingestion, (2) nighttime sleep and (3) post-sleep attention in healthy, young adults. First, we found that repeated testing led to significant decreases in performance from baseline in the placebo condition, and that DEX, compared to placebo, prevented deterioration at the 75-min test, and selectively for visual field at the 12 h and 24 h tests. We also found that stimulants, compared to placebo, benefitted attentional processing 75-min post-drug but this did not persist to the delayed test 12-h after drug administration. Additionally, morning stimulant administration resulted in robust nighttime sleep disruptions, yet post-sleep sustained attention was equivalent in the stimulant and placebo conditions, indicating that the initial boost to performance dissipated at 24 h, but the decrease was not significantly worse than placebo. Together, these results suggest that stimulant medications, commonly used off-label for cognitive enhancement may prevent deterioration of sustained attention brought on by repeated within-day testing. Additionally, these medications substantially disrupt nighttime sleep; which while coming at little cost to next-day attentional processing, may have steeper consequences for other cognitive domains.

Boosting Learning Efficacy with Noninvasive Brain Stimulation in Intact and Brain-Damaged Humans.

Numerous behavioral studies have shown that visual function can improve with training, although perceptual refinements generally require weeks to months of training to attain. This, along with questions about long-term retention of learning, limits practical and clinical applications of many such paradigms. Here, we show for the first time in female and male human participants that just 10 d of visual training coupled with transcranial random noise stimulation (tRNS) over visual areas causes dramatic improvements in visual motion perception. Relative to control conditions and anodal stimulation, tRNS-enhanced learning was at least twice as fast, and, crucially, it persisted for 6 months after the end of training and stimulation. Notably, tRNS also boosted learning in patients with chronic cortical blindness, leading to recovery of motion processing in the blind field after just 10 d of training, a period too short to elicit enhancements with training alone. In sum, our results reveal a remarkable enhancement of the capacity for long-lasting plastic and restorative changes when a neuromodulatory intervention is coupled with visual training.SIGNIFICANCE STATEMENT Our work demonstrates that visual training coupled with brain stimulation can dramatically reduce the training period from months to weeks, and lead to fast improvement in neurotypical subjects and chronic cortically blind patients, indicating the potential of our procedure to help restore damaged visual abilities for currently untreatable visual dysfunctions. Together, these results indicate the critical role of early visual areas in perceptual learning and reveal its capacity for long-lasting plastic changes promoted by neuromodulatory intervention.

Prolonged Neuromodulation of Cortical Networks Following Low-Frequency rTMS and Its Potential for Clinical Interventions.

Non-invasive brain stimulation safely induces persistent large-scale neural modulation in functionally connected brain circuits. Interruption models of repetitive transcranial magnetic stimulation (rTMS) capitalize on the acute impact of brain stimulation, which decays over minutes. However, rTMS also induces longer-lasting impact on cortical functions, evident by the use of multi-session rTMS in clinical population for therapeutic purposes. Defining the persistent cortical dynamics induced by rTMS is complicated by the complex balance of excitation and inhibition among functionally connected networks. Nonetheless, it is these neuronal dynamic responses that are essential for the development of new neuromodulatory protocols for translational applications. We will review evidence of prolonged changes of cortical response, tens of minutes following one session of low frequency rTMS over the cortex. We will focus on the different methods which resulted in prolonged behavioral and brain changes, such as the combination of brain stimulation techniques, and individually tailored stimulation protocols. We will also highlight studies which apply these methods in multi-session stimulation practices to extend stimulation impact into weeks and months. Our data and others' indicate that delayed cortical dynamics may persist much longer than previously thought and have potential as an extended temporal window during which cortical plasticity may be enhanced.

The Pivotal Role of the Right Parietal Lobe in Temporal Attention.

The visual system is extremely efficient at detecting events across time even at very fast presentation rates; however, discriminating the identity of those events is much slower and requires attention over time, a mechanism with a much coarser resolution [Cavanagh, P., Battelli, L., & Holcombe, A. O. Dynamic attention. In A. C. Nobre & S. Kastner (Eds.), The Oxford handbook of attention (pp. 652-675). Oxford: Oxford University Press, 2013]. Patients affected by right parietal lesion, including the TPJ, are severely impaired in discriminating events across time in both visual fields [Battelli, L., Cavanagh, P., & Thornton, I. M. Perception of biological motion in parietal patients. Neuropsychologia, 41, 1808-1816, 2003]. One way to test this ability is to use a simultaneity judgment task, whereby participants are asked to indicate whether two events occurred simultaneously or not. We psychophysically varied the frequency rate of four flickering disks, and on most of the trials, one disk (either in the left or right visual field) was flickering out-of-phase relative to the others. We asked participants to report whether two left-or-right-presented disks were simultaneous or not. We tested a total of 23 right and left parietal lesion patients in Experiment 1, and only right parietal patients showed impairment in both visual fields while their low-level visual functions were normal. Importantly, to causally link the right TPJ to the relative timing processing, we ran a TMS experiment on healthy participants. Participants underwent three stimulation sessions and performed the same simultaneity judgment task before and after 20 min of low-frequency inhibitory TMS over right TPJ, left TPJ, or early visual area as a control. rTMS over the right TPJ caused a bilateral impairment in the simultaneity judgment task, whereas rTMS over left TPJ or over early visual area did not affect performance. Altogether, our results directly link the right TPJ to the processing of relative time.

Angiotensin II in Refractory Septic Shock.

Refractory septic shock is defined as persistently low mean arterial blood pressure despite volume resuscitation and titrated vasopressors/inotropes in patients with a proven or suspected infection and concomitant organ dysfunction. Its management typically requires high doses of catecholamines, which can induce significant adverse effects such as ischemia and arrhythmias. Angiotensin II (Ang II), a key product of the renin-angiotensin-aldosterone system, is a vasopressor agent that could be used in conjunction with other vasopressors to stabilize critically ill patients during refractory septic shock, and reduce catecholamine requirements. However, very few clinical data are available to support Ang II administration in this setting. Here, we review the current literature on this topic to better understand the role of Ang II administration during refractory septic shock, differentiating experimental from clinical studies. We also consider the potential role of exogenous Ang II administration in specific organ dysfunction and possible pitfalls with Ang II in sepsis. Various issues remain unresolved and future studies should investigate important topics such as: the optimal dose and timing of Ang II administration, a comparison between Ang II and the other vasopressors (epinephrine; vasopressin), and Ang II effects on microcirculation.

Electrophysiological Correlates of the Autobiographical Implicit Association Test (aIAT): Response Conflict and Conflict Resolution.

The autobiographical IAT (aIAT) is an implicit behavioral instrument that can detect autobiographical memories encoded in an individual's mind by measuring how quickly this person can categorize and associate sentences related to a specific event with the logical dimensions true and false. Faster categorization when an event (e.g., I went to Paris) is associated with the dimension true than false indicates that that specific event is encoded as true in the individual's mind. The aim of this study is to investigate the electrophysiological correlates of the aIAT, used as a memory-detection technique (i.e., to identify which of two events is true). To this end, we recorded ERPs while participants performed an aIAT assessing which of two playing cards they had previously selected. We found an increased N200 and a decreased LPC (or P300) at the fronto-central sites when participants associated the selected playing card with the dimension false than true. Notably, both components have been previously and consistently reported in studies investigating deception. These results suggest that associating a true autobiographical event with the concept of false may involve the same cognitive processes associated with deception.

Human movements and abstract motion displays activate different processes in the observer's motor system.

Brain imaging studies have shown that observation of both bodily movements and abstract motion displays complying with human kinematics activate the observer's motor cortex. However, it is unknown whether the same processes are active in the two conditions. Here, we addressed this issue using transcranial magnetic stimulation (TMS) to directly compare cortico-spinal excitability during observation of actions and motion stimuli that complied with or violated normal human kinematics. We found that kinematics significantly modulated the motor-evoked potentials (MEPs) produced by TMS during observation of both human and abstract motion stimuli. However, only the temporal unfolding of cortico-spinal excitability during observation of human movements significantly correlated with instantaneous stimulus velocity. This correlation was present for normal movements and also for a subset of the movements having unnatural kinematics. Furthermore, bodily movements for which we found no correlation between MEPs and stimulus velocity produced significantly higher MEPs. Our novel results suggest a dissociation in how human movements and abstract motion displays engage the observer's motor system. Specifically, while both stimulus types significantly activate the observer's motor cortex, only bodily movements produce patterns of cortico-spinal excitability that closely follow the velocity profile of the observed movement. This internal "re-enactment" of observed bodily movements seems to be only partially attuned to normal human kinematics.

"I didn't want to do it!" The detection of past intentions.

In daily life and in courtrooms, people regularly analyze the minds of others to understand intentions. Specifically, the detection of intentions behind prior events is one of the main issues dealt with in courtrooms. To our knowledge, there are no experimental works focused on the use of memory detection techniques to detect past intentions. This study aims at investigating whether reaction times (RTs) could be used for this purpose, by evaluating the accuracy of the autobiographical Implicit Association Test (aIAT) in the detection of past intentions. Sixty healthy volunteers took part in the experiment (mean age: 36.5 y; range: 18-55; 30 males). Participants were asked to recall and report information about a meeting with a person that had occurred at least 1 month before. Half of the participants were required to report about an intentional meeting, whereas the other half reported on a chance meeting. Based on the conveyed information, participants performed a tailored aIAT in which they had to categorize real reported information contrasted with counterfeit information. Results demonstrated that RTs can be a useful measure for the detection of past intentions and that aIAT can detect real past intentions with an accuracy of 95%.

Functional connectivity of parietal cortex during temporal selective attention.

Perception of natural experiences requires allocation of attention towards features, objects, and events that are moving and changing over time. This allocation of attention is controlled by large-scale brain networks that, when damaged, cause widespread cognitive deficits. In particular, damage to ventral parietal cortex (right lateralized TPJ, STS, supramarginal and angular gyri) is associated with failures to selectively attend to and isolate features embedded within rapidly changing visual sequences (Battelli, Pascual-Leone, & Cavanagh, 2007; Husain, Shapiro, Martin, & Kennard, 1997). In this study, we used fMRI to investigate the neural activity and functional connectivity of intact parietal cortex while typical subjects judged the relative onsets and offsets of rapidly flickering tokens (a phase discrimination task in which right parietal patients are impaired). We found two regions in parietal cortex correlated with task performance: a bilateral posterior TPJ (pTPJ) and an anterior right-lateralized TPJ (R aTPJ). Both regions were deactivated when subjects engaged in the task but showed different patterns of functional connectivity. The bilateral pTPJ was strongly connected to nodes within the default mode network (DMN) and the R aTPJ was connected to the attention network. Accurate phase discriminations were associated with increased functional correlations between sensory cortex (hMT+) and the bilateral pTPJ, whereas accuracy on a control task was associated with yoked activity in the hMT+ and the R aTPJ. We conclude that temporal selective attention is particularly sensitive for revealing information pathways between sensory and core cognitive control networks that, when damaged, can lead to nonspatial attention impairments in right parietal stroke patients.

The origin of word-related motor activity.

Conceptual processing of verbs consistently recruits the left posterior middle temporal gyrus (lpMTG). The left precentral motor cortex also responds to verbs, with higher activity for action than nonaction verbs. The early timing of this effect has suggested that motor features of words' meaning are accessed directly, bypassing access to conceptual representations in lpMTG. An alternative hypothesis is that the retrieval of conceptual representations in lpMTG is necessary to drive more specific, motor-related representations in the precentral gyrus. To test these hypotheses, we first showed that repetitive transcranial magnetic stimulation (rTMS) applied to the verb-preferring lpMTG site selectively impoverished the semantic processing of verbs. In a second experiment, rTMS perturbation of lpMTG, relative to no stimulation (no-rTMS), eliminated the action-nonaction verb distinction in motor activity, as indexed by motor-evoked potentials induced in peripheral muscles with single-pulse TMS over the left primary motor cortex. rTMS pertubation of an occipital control site, relative to no-rTMS, did not affect the action-nonaction verb distinction in motor activity, but the verb contrast did not differ reliably from the lpMTG effect. The results show that lpMTG carries core semantic information necessary to drive the activation of specific (motor) features in the precentral gyrus.

Contralesional rTMS relieves visual extinction in chronic stroke.

Patients affected by right parietal lobe lesion can be severely impaired in sustained attention tasks, particularly in the left visual field. For example, patients with right parietal stroke are commonly limited in their ability to attentionally track multiple moving objects in their left visual field when competing stimuli are simultaneously presented in the right, ipsilesional visual field. This is a hallmark of visual extinction, a failure to respond to contralesional visual stimuli, when competing stimuli are presented in the good hemifield. It has been hypothesized that post-stroke hyperactivity of the undamaged left hemisphere leads to excessive cross-hemispheric inhibition of the damaged right hemisphere, thus exacerbating the attentional deficits. However, there has been no direct physiological demonstration of this hypothesis, as most of the studies are conducted using unilateral tasks, a condition not sufficient to drive inter-hemispheric competition. The inter-hemispheric inhibition hypothesis also raises the possibility that if hyperactivity of the healthy hemisphere were reduced, this could relieve inter-hemispheric inhibition, disinhibiting the damaged hemisphere and potentially restoring some function. To test this hypothesis, and to examine whether we could relieve deficits in sustained attention in right parietal patients, we used repetitive transcranial magnetic stimulation (rTMS) to reduce the activity of the left, healthy hemisphere. Six patients suffering from visual extinction underwent two counterbalanced sessions: low frequency rTMS over the left parietal lobe and sham control stimulation. The patients' performance in an attentional tracking task significantly improved in the contralesional visual field immediately after rTMS, but not after sham. Performance remained unaltered in the ipsilesional field. We hypothesize that rTMS temporarily releases the damaged right hemisphere from excessive cross-hemispheric inhibition by the hyperactive healthy hemisphere, leading to some cognitive recovery after cortical lesion.

Modulation of smoking and decision-making behaviors with transcranial direct current stimulation in tobacco smokers: a preliminary study.

BACKGROUND: Most tobacco smokers who wish to quit fail to reach their goal. One important, insufficiently emphasized aspect of addiction relates to the decision-making system, often characterized by dysfunctional cognitive control and a powerful drive for reward. Recent proof-of-principle studies indicate that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) can transiently modulate processes involved in decision-making, and reduce substance intake and craving for various addictions. We previously proposed that this beneficial effect of stimulation for reducing addictive behaviors is in part mediated by more reflective decision-making. The goal of this study was to test whether nicotine intake and decision-making behaviors are modulated by tDCS over the DLPFC in tobacco smokers who wished to quit smoking. METHODS: Subjects received two five-day tDCS regimens (active or sham). Stimulation was delivered over the right DLPFC at a 2 mA during 30 min. Nicotine cravings, cigarette consumption and decision-making were assessed before and after each session. RESULTS: Main findings include a significant decrease in the number of cigarettes smoked when participants received active as compared to sham stimulation. This effect lasted up to four days after the end of the stimulation regimen. In regards to decision-making, smokers rejected more often offers of cigarettes, but not offers of money, after they received active as compared to sham stimulation at the Ultimatum Game. No significant change was observed at the Risk Task with cigarettes or money as rewards. CONCLUSION: Overall, these findings suggest that tDCS over the DLPFC may be beneficial for smoking reduction and induce reward sensitive effects.

The autobiographical IAT: a review.

The autobiographical Implicit Association Test (aIAT; Sartori et al., 2008) is a variant of the Implicit Association Test (IAT; Greenwald et al., 1998) that is used to establish whether an autobiographical memory is encoded in the respondent's mind/brain. More specifically, with the aIAT, it is possible to evaluate which one of two autobiographical events is true. The method consists of a computerized categorization task. The aIAT includes stimuli belonging to four categories, two of them are logical categories and are represented by sentences that are always true (e.g., I am in front of a computer) or always false (e.g., I am climbing a mountain) for the respondent; two other categories are represented by alternative versions of an autobiographical event (e.g., I went to Paris for Christmas, or I went to New York for Christmas), only one of which is true. The true autobiographical event is identified because, in a combined block, it gives rise to faster reaction times when it shares the same motor response with true sentences. Here, we reviewed all the validation experiments and found more than 90% accuracy in detecting the true memory. We show that agreement in identifying the true autobiographical memory of the same aIAT repeated twice is, on average, more than 90%, and we report a technique for estimating accuracy associated with a single classification based on the D-IAT value, which may be used in single subject's investigations. We show that the aIAT might be used to identify also true intentions and reasons and conclude with a series of guidelines for building an effective aIAT.