Burden of Mental Health among Patients with Inflammatory Bowel Disease-A Cross-Sectional Study from a Tertiary IBD Center in Hungary.

Background: Inflammatory bowel diseases (IBDs) are chronic conditions that negatively affect the patient's quality of life. With the spread of the biopsychosocial model, the role of mental health in the activity and course of inflammatory bowel disease is becoming more and more recognized. Our study aimed to assess the prevalence of anxiety and depression in IBD patients in our tertiary referral center and determine the predictive factors of these mental conditions. Methods: A total of 117 patients were included consecutively between 1 December 2021 and 28 February 2022. We used a questionnaire to gather demographic information, disease course, and IBD-specific symptoms. We assessed anxiety symptoms using the GAD-7 and depressive complaints using the PHQ-9 questionnaire. We evaluated disease activity using CDAI and pMayo scores. Results: Of the 117 patients (male/female: 63/54), 88 suffered from Crohn's disease, and 29 were diagnosed with ulcerative colitis. Only 6 patients were taking medication for mood disorders, and 38 individuals sought mental support during their lifetime. A total of 15% of the population suffered from moderate-severe anxiety disorder, and 22% were affected by moderate-severe depression. The GAD-7 and PHQ9 values showed a significant correlation between the number of stools, bloody stools, abdominal pain, number of flare-ups, and CDAI scores. Conclusions: Our study confirmed that there is a high incidence of anxiety and depressive symptoms among IBD patients. Our results highlighted the symptoms that could be associated with mental disorders. It is important to assess the mental status of IBD patients to improve their quality of life.

[Verbal Episodic Memory Test]. / A Verbális Epizodikus Memória Teszt.

Background and purpose:

The decline of episodic memory is one of the earliest cognitive markers of mild cognitive impairment and various types of dementia. Until today, however, there is no standardized Hun­garian episodic memory test that takes into account the characteristics of the Hungarian language. The study presents the structure and standardized use of a new memory test (Verbal Episodic Memory Test, VEMT) as well as normative data in Hungary. 

The VEMT is suitable for the comprehensive examination of verbal learning abilities in a broader sense, and more specifically, for the neuropsychological measurement of verbal list learning abilities. In the present study, we constructed a normative database consisting of data from 385 participants.

We showed that the VEMT is sensitive to demographic factors (e.g., age) which are linked to differences in episodic memory performance. Open access to the test is provided, and the normative scores are presented as well. 

The indicators of the test are suitable for drawing a learning curve, for showing the interaction of new and previously learned information (interference effects), and for measuring differences between free recall and cued recall. Furthermore, the test scores are appropriate for distinguishing the effects of different types of memory encoding forms (phonological, semantic, and episodic), for measuring the ability to reconstruct the presentation of a sequence (memory order information), for detecting the rate of forgetting, for measuring recognition abilities, and for detecting hippocampus-related mnemonic pattern separation and completion functions. 

Litmus test of rich episodic representations: Context-induced false recognition.

Context-dependent episodic memory is typically investigated using tasks in which retrieval occurs either in the reinstated context of encoding or in a completely new context. A fundamental question of episodic memory models is the level of detail in episodic memory representations containing contextual information about the encoded event. The present study examined whether memory is affected when the contexts of encoding and retrieval are highly similar but not exactly the same. At encoding, participants saw unique object images presented on the background of unique context scene images. On a surprise recognition test, the objects were either old or visually similar to ones seen at encoding (lure stimuli). The objects were presented on either the old or a lure context image; the lure context image was visually similar to the corresponding object's encoding context. Context reinstatement increased the hit rate for the old objects, but also increased the false alarm for the lure objects. This latter finding indicates that the presence of the encoding context at test does not always aid recognition memory decisions. These results suggest that slight visual differences between the contexts of encoding and retrieval matter, as context reinstatement leads to a tendency to respond Old even in case of small differences in the old and lure contexts.

Irrelevant background context decreases mnemonic discrimination and increases false memory.

One of the greatest commonplaces in memory research is that context improves recall and enhances or leaves recognition intact. Here we present results which draw attention to the fact that the reappearance of irrelevant and unattended background contexts of encoding significantly impairs memory discrimination functions. This manuscript presents the results of two experiments in which participants made indoor/outdoor judgements for a large number of object images presented together with individual, irrelevant and presumably unattended background scenes. On a subsequent unexpected recognition test participants saw the incidentally encoded target objects, visually similar lures or new foil objects on the same or new background scenes. Our results showed that although the reappearance of the background scene raised the hit rate for target objects, it decreased mnemonic discrimination, a behavioral score for pattern separation, a hippocampal function that is affected in early dementia. Furthermore, the presence of the encoded background scene at the recognition test increased the false recognition of lure objects, even when participants were explicitly instructed to neglect the context scene. Altogether these results gave evidence that if context increases recognition hits for target memories, it does so at the cost of increasing false recognition and diminished discriminability for similar information.

Pupil size changes signal hippocampus-related memory functions.

A major task of episodic memory is to create unique, distinguishable representations of highly overlapping perceptual inputs. Several studies on this basic function have shown that it is based on the intact functioning of certain subregions of the hippocampus and is among the most sensitive behavioral indicators of mild cognitive impairment (MCI) and dementia. Here we assessed pupil dilation associated with performance in a widely used recognition paradigm that aims to uncover the intactness of fine-graded mnemonic discrimination. A sample of healthy undergraduate students was used. First, we showed that the correct discrimination between highly similar lure items and target items elicit larger pupil response than correct target identification. Second, we found that mnemonic discrimination is associated with larger pupil response in general as compared to target identification, regardless of whether the response was correct or not. These results suggest the pupil changes differentiate mnemonic discrimination and memory identification processes in recognition performance.

Retrieval practice decreases processing load of recall: Evidence revealed by pupillometry.

Retrieval practice is an effective long-term learning strategy. Items practiced through repeated retrieval are resistant to interference, stress, and secondary load, which attributes also characterize automatization in skill learning. In two experiments, we investigated whether retrieval practice is associated with decrease in processing load, which is a further attribute of automatization. Participants first learned paired associates, and then they practiced the items either by repeatedly studying or engaging in retrieval practice. Then their memory was assessed after either five minutes (Experiment 1) or one week (Experiment 2). Processing load was measured by assessing task-evoked pupil dilation during both retrieval practice and later recall. The pattern of results was similar in both experiments. During retrieval practice, processing load decreased during consecutive practice cycles. Moreover, during the final recall test, the retrieval of previously retrieval practiced items required less processing resources, as compared to the retrieval of previously restudied items. Our results suggest that repeated retrieval reduces processing load as well as attentional control involvement during practice and later recall.

How the size of the to-be-learned material influences the encoding and later retrieval of associative memories: A pupillometric assessment.

Pupillometry have recently added valuable insights about the cognitive and possible neurobiological processes underlying episodic memory. Most of the studies, however, investigated recognition memory, which only partially relies on cue-driven recollection, the hallmark feature of episodic memory. Here we measured pupil size during a paired associate learning task, where participants encoded word-pairs, and after a short delay they took part in a cued recall. Importantly, we manipulated the size of the learning set: participants either learnt two, four or eight word-pairs in a row. As expected, increasing set size resulted in larger forgetting, assumingly as a consequence of weaker memory strength for the word-pairs. Our results show an important difference between pupil size changes observed during encoding and retrieval. During retrieval, the pupil instantly begun to dilate, as a sign of increased processing load accompanying the retrieval of the target memory. Importantly, large set size was also associated with larger pupil dilation during retrieval. This supports the notion that pupil dilation can be regarded as a marker of memory strength. In contrast, during encoding, pupil dilation decreased with increasing amount of encoded information, which might be due to the overuse of attentional resources. Furthermore, we also found that serial position during encoding modulated subsequent memory effects: for the first three serial positions, successful recall was predicted by larger pupil dilation during encoding, whereas such subsequent memory effect was absent for later serial positions. These results suggest that the amount of information independently modulates pupil dilation during encoding and retrieval, and support the assumption that pupillometric investigation of paired associate learning could be an informative way to investigate the cognitive and neurobiological processes of episodic memory.

Physiological Measures of Dopaminergic and Noradrenergic Activity During Attentional Set Shifting and Reversal.

Dopamine (DA) and noradrenaline (NA) are important neurotransmitters, which are suggested to play a vital role in modulating the neural circuitry involved in the executive control of cognition. One way to investigate the functions of these neurotransmitter systems is to assess physiological indices of DA and NA transmission. Here we examined how variations of spontaneous eye-blink rate and pupil size, as indirect measures of DA and NA activity, respectively, are related to performance in a hallmark aspect of executive control: attentional set shifting. We used the Intra/Extradimensional Set Shifting Task, where participants have to choose between different compound stimuli while the stimulus-reward contingencies change periodically. During such rule shifts, participants have to refresh their attentional set while they reassess which stimulus-features are relevant. We found that both eye-blink rate (EBR) and pupil size increased after rule shifts, when explorative processes are required to establish stimulus-reward contingencies. Furthermore, baseline pupil size was related to performance during the most difficult, extradimensional set shifting stage, whereas baseline EBR was associated with task performance prior to this stage. Our results support a range of neurobiological models suggesting that the activity of DA and NA neurotransmitter systems determines individual differences in executive functions (EF), possibly by regulating neurotransmission in prefrontal circuits. We also suggest that assessing specific, easily accessible indirect physiological markers, such as pupil size and blink rate, contributes to the comprehension of the relationship between neurotransmitter systems and EF.

Acute stress affects prospective memory functions via associative memory processes.

Recent findings suggest that acute stress can improve the execution of delayed intentions (prospective memory, PM). However, it is unclear whether this improvement can be explained by altered executive control processes or by altered associative memory functioning. To investigate this issue, we used physical-psychosocial stressors to induce acute stress in laboratory settings. Then participants completed event- and time-based PM tasks requiring the different contribution of control processes and a control task (letter fluency) frequently used to measure executive functions. According to our results, acute stress had no impact on ongoing task performance, time-based PM, and verbal fluency, whereas it enhanced event-based PM as measured by response speed for the prospective cues. Our findings indicate that, here, acute stress did not affect executive control processes. We suggest that stress affected event-based PM via associative memory processes.

Tonic noradrenergic activity modulates explorative behavior and attentional set shifting: Evidence from pupillometry and gaze pattern analysis.

A constant task for every living organism is to decide whether to exploit rewards associated with current behavior or to explore the environment for more rewarding options. Current empirical evidence indicates that exploitation is related to phasic whereas exploration is related to tonic firing mode of noradrenergic neurons in the locus coeruleus. In humans, this exploration-exploitation trade-off is subserved by the ability to flexibly switch attention between task-related and task-irrelevant information. Here, we investigated whether this function, called attentional set shifting, is related to exploration and tonic noradrenergic discharge. We measured pretrial baseline pupil dilation, proved to be strongly correlated with the activity of the locus coeruleus, while human participants took part in well-known tasks of attentional set shifting. Study 1 used the Wisconsin Card Sorting Task, whereas in Study 2, the Intra/Extradimensional Set Shifting Task was used. Both tasks require participants to choose between different compound stimuli based on feedback provided for their previous decisions. During the task, stimulus-reward contingencies change periodically, thus participants are repeatedly required to reassess which stimulus features are relevant (i.e., they shift their attentional set). Our results showed that baseline pupil diameter steadily decreased when the stimulus-reward contingencies were stable, whereas they suddenly increased when these contingencies changed. Analysis of looking patterns also confirmed the presence of exploratory behavior during attentional set shifting. Thus, our results suggest that tonic firing mode of noradrenergic neurons in the locus coeruleus is implicated in attentional set shifting, as it regulates the amount of exploration.

The effect of deep brain stimulation of the subthalamic nucleus on executive functions: impaired verbal fluency and intact updating, planning and conflict resolution in Parkinson's disease.

Although the improvement of motor symptoms in Parkinson's disease (PD) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) is well documented, there are open questions regarding its impact on cognitive functions. The aim of this study was to assess the effect of bilateral DBS of the STN on executive functions in PD patients using a DBS wait-listed PD control group. Ten PD patients with DBS implantation (DBS group) and ten PD wait-listed patients (Clinical control group) participated in the study. Neuropsychological tasks were used to assess general mental ability and various executive functions. Each task was administered twice to each participant: before and after surgery (with the stimulators on) in the DBS group and with a matched delay between the two task administration points in the control group. There was no significant difference between the DBS and the control groups' performance in tasks measuring the updating of verbal, spatial or visual information (Digit span, Corsi and N-back tasks), planning and shifting (Trail Making B), and conflict resolution (Stroop task). However, the DBS group showed a significant decline on the semantic verbal fluency task after surgery compared to the control group, which is in line with findings of previous studies. Our results provide support for the relative cognitive safety of the STN DBS using a wait-listed PD control group. Differential effects of the STN DBS on frontostriatal networks are discussed.

The interplay of trait worry and trait anxiety in determining episodic retrieval: The role of cognitive control.

Worrying is a key concept in describing the complex relationship between anxiety and cognitive control. On the one hand, cognitive control processes might underlie the specific tendency to engage in worrying (i.e., trait worry), conceptualized as a future-oriented mental problem-solving activity. On the other hand, the general tendency to experience the signs and symptoms of anxiety (i.e., trait anxiety) is suggested to impair cognitive control because worrisome thoughts interfere with task-relevant processing. Based on these opposing tendencies, we predicted that the effect of the two related constructs, trait anxiety and trait worry, might cancel out one another. In statistics, such instances have been termed suppressor situations. In four experiments, we found evidence for such a suppressor situation: When their shared variance was controlled, trait worry was positively whereas trait anxiety was negatively related to performance in a memory task requiring strategic, effortful retrieval. We also showed that these opposing effects are related to temporal context reinstatement. Our results suggest that trait worry and trait anxiety possess unique sources of variance, which differently relate to performance in memory tasks requiring cognitive control.

Hypnosis Attenuates Executive Cost of Prospective Memory.

Prospective memory is the ability to formulate and carry out actions at the appropriate time or in the appropriate context. This study aimed to identify the effect of hypnosis on prospective memory performance and to analyze the involvement of executive control processes in intention realization in a hypnotically altered state of consciousness. In 1 experiment, manipulating hypnotic instruction in a within-subject fashion, the authors explored the event-based prospective memory performance of 23 volunteers in 3 conditions: baseline, expectation, and execution. The primary result was that executing prospective memory responses, at the same accuracy rate, produced a significantly lower cost of ongoing responses in terms of response latency in the hypnotic state than in wake condition.

Impaired executive functions in subjects with frequent nightmares as reflected by performance in different neuropsychological tasks.

Nightmare disorder is a prevalent parasomnia characterized by vivid and highly unpleasant dream experiences during night time sleep. The neural background of disturbed dreaming was proposed to be associated with impaired prefrontal and fronto-limbic functioning during REM sleep. We hypothesized that the impaired prefrontal and fronto-limbic functioning in subjects with frequent nightmares would be reflected at the behavioral level during waking tasks as well. 35-35 Subjects with frequent nightmares and matched controls participated in Study 1, involving an Emotional Go/NoGo, an Emotional Stroop task, and a Verbal Fluency task. Nightmare subjects exhibited longer reaction times in the Emotional Go/NoGo and Emotional Stroop tasks. Moreover, they committed more perseveration errors and showed less fluent word generation in the Verbal Fluency task. Nightmare subjects showed an overall slowing irrespective of the valence of the stimuli. While the effects of sleep quality and waking anxiety were associated to these deficits in some cases, these factors could not solely explain the difference between the two groups. In Study 2, 17 subjects with frequent nightmares and 18 controls were compared by a Color-word and an Emotional, block design Stroop task in order to avoid the slow effects of emotional interference potentially caused by previous items. Nightmare subjects were characterized by an overall slowing in the Emotional Stroop task, irrespective of the valence of the stimuli. In the Color-word Stroop task, nightmare subjects were not significantly slower in comparison with controls. Our results suggest that individuals with frequent nightmares are impaired in executive tasks involving the suppression of task-irrelevant semantic representations.

Mirroring intentional forgetting in a shared-goal learning situation.

BACKGROUND: Intentional forgetting refers to the surprising phenomenon that we can forget previously successfully encoded memories if we are instructed to do so. Here, we show that participants cannot only intentionally forget episodic memories but they can also mirror the "forgetting performance" of an observed model. METHODOLOGY/PRINCIPAL FINDINGS: In four experiments a participant observed a model who took part in a memory experiment. In Experiment 1 and 2 observers saw a movie about the experiment, whereas in Experiment 3 and 4 the observers and the models took part together in a real laboratory experiment. The observed memory experiment was a directed forgetting experiment where the models learned two lists of items and were instructed either to forget or to remember the first list. In Experiment 1 and 3 observers were instructed to simply observe the experiment ("simple observation" instruction). In Experiment 2 and 4, observers received instructions aimed to induce the same learning goal for the observers and the models ("observation with goal-sharing" instruction). A directed forgetting effect (the reliably lower recall of to-be-forgotten items) emerged only when models received the "observation with goal-sharing" instruction (P<.001 in Experiment 2, and P<.05 in Experiment 4), and it was absent when observers received the "simple observation" instruction (P>.1 in Experiment 1 and 3). CONCLUSION: If people observe another person with the same intention to learn, and see that this person is instructed to forget previously studied information, then they will produce the same intentional forgetting effect as the person they observed. This seems to be a an important aspect of human learning: if we can understand the goal of an observed person and this is in line with our behavioural goals then our learning performance will mirror the learning performance of the model.

[The role of cannabis use in psychosis]. / A kannabiszhasználat szerepe a pszichotikus állapotok kialakulásában.

The link between cannabis use and psychosis has been studied intensively and debated hotly for decades. The authors review the research that has been done on the topic, including the studies which produced evidence of a relationship between the two phenomena, and give a detailed analysis of the hypotheses about the nature of the link (the direction of causality). According to the reviewed literature an increased prevalence of cannabis use can be found in the schizophrenic population. The use of the drug is associated with a worse prognosis and an earlier onset of schizophrenia. However, findings about the possible effect of cannabis use on the specific symptoms of schizophrenia have been contradictory. An association has also been observed between cannabis use and schizotypal personality traits, but evidence for a specific, cannabis induced functional psychosis is still lacking. Based on the data of longitudinal studies, cannabis use should be recognized as a risk factor for later psychosis. The abuse of the drug increases the likelihood of later psychotic symptoms especially among individuals with vulnerability or when the use starts in early adolescence. At the same time, the role of self-medication or a common genetic background cannot be excluded either, and a circular causality is very possible.