Continuous theta burst stimulation to dorsomedial prefrontal cortex in young adults with depression: Changes in resting frontostriatal functional connectivity relevant to positive mood.

Depression is associated with diminished positive affect (PA), postulated to reflect frontostriatal reward circuitry disruptions. Depression has consistently been associated with higher dorsomedial prefrontal cortex (dmPFC) activation, a region that regulates PA through ventral striatum (VS) connections. Low PA in depression may reflect dmPFC's aberrant functional connectivity (FC) with the VS. To test this, we applied theta burst stimulation (TBS) to dmPFC in 29 adults with depression (79% female, Mage = 21.4, SD = 2.04). Using a randomized, counterbalanced design, we administered 3 types of TBS at different sessions: intermittent (iTBS; potentiating), continuous (cTBS; depotentiating), and sham TBS (control). We used neuronavigation to target personalized dmPFC targets based on VS-dmPFC FC. PA and negative affect (NA), and resting-state fMRI were collected pre- and post-TBS. We found no changes in PA or NA with time (pre/post), condition (iTBS, cTBS, sham), or their interaction. Functional connectivity (FC) between the nucleus accumbens and dmPFC showed a significant condition (cTBS, iTBS, and sham) by time (pre-vs. post-TBS) interaction, and post-hoc testing showed decreased pre-to post-TBS for cTBS but not iTBS or sham. For cTBS only, reduced FC pre/post stimulation was associated with increased PA (but not NA). Our findings lend support to the proposed mechanistic model of aberrant FC between the dmPFC and VS in depression and suggest a way forward for treating depression in young adults. Future studies need to evaluate multi-session TBS to test clinical effects.

Effects of a brief online emotion word learning task on negative emotion differentiation, emotional self-efficacy, and prospective distress: Preliminary findings.

BACKGROUND: Disruptions in emotion processing are common across psychological disorders. Research suggests that emotion differentiation (ED; specificity in language used to characterize one's emotional experience) and emotional self-efficacy (ESE; perceived ability to understand and manage one's emotions) are important transdiagnostic factors associated with various psychological benefits. Whether ED and ESE can be improved in adults remains largely unclear. METHODS: Using a longitudinal prospective design, we tested a brief online training targeting emotion word knowledge (vs. a control condition) to see if it improved negative ED (NED) and ESE in a college sample. Moreover, we tested if changes in NED or ESE mediated the effects of the training on levels of psychological distress one week and two-months post-intervention. RESULTS: Findings provided partial support for our hypotheses. Individuals whose ESE increased post-intervention reported lower levels of distress two months later. Moreover, exploratory analyses revealed those who demonstrated greater training engagement experienced increases in NED that in turn predicted lower distress one-week post-intervention. However, there were no direct effects of intervention group on NED or ESE and distress. CONCLUSIONS: These findings highlight the potential of a remotely-administered emotion-language intervention to influence key dimensions of emotion processing and suggest avenues for further refinement. Both NED and ESE may be malleable for some, and that enhancements in ESE may produce long-term psychological benefits.

Emotional complexity under high stress: Do protective associations for risk behaviors persist even during a pandemic?

Risk behaviors like substance use and binge eating are often used to cope with negative emotions. Engagement in these behaviors has been exacerbated by the COVID-19 pandemic. Past research suggests that complex emotion conceptualizations captured as emotion differentiation (ability to discriminate between emotional states) and polarity (ability to integrate positive and negative features of emotional experience) may be protective. We examined associations of mean affect intensity, emotion differentiation, and emotion polarity with frequency of daily substance use and binge eating across 10 days in a demographically diverse sample of U.S. adults (N = 353) recruited between March 24 and April 9, 2020, when stay-at-home orders were initiated. Owing to the nested data structure and excessive zero values, analyses were conducted using multilevel zero-inflated negative binomial regression. Consistent with past research, negative affect was positively associated with frequency of substance use and binge eating. Importantly, results indicated that negative emotion differentiation was protective, predicting greater likelihood of not using substances and binge eating at all across the sampling period. These effects remained even after controlling for mean affect intensity, emotion polarity, and positive emotion differentiation. Neither positive emotion differentiation nor emotion polarity were significantly associated with either behavior. Our results suggest that greater complexity in conceptualization of negative emotions facilitates some protection against risk behaviors such as substance use and binge eating, even during periods of high environmental stress. These findings have important implications for optimizing interventions to reduce engagement in risk behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does past military experience impact fear reactivity in active-duty firefighters? Well, it is complicated.

OBJECTIVE: A significant proportion of military veterans successfully transition out of the military into civilian careers as first responders, such as firefighters. Like military service, being a firefighter is a high-risk profession involving exposure to aversive environments. Thus, it is possible that military experience might serve to buffer or exacerbate risk for negative psychological outcomes in firefighters. However, both occupations are associated with increased risk for psychopathology, such as PTSD, and little research has examined the effect of military service on processes that underlie stress in veterans serving as active-duty firefighters. The current study explores whether military service confers an adaptive advantage or an additional risk. METHOD: Using a case-control design, we examined differences in fear reactivity through electrodermal activity (EDA) and recording of fearful facial expressions, between 32 firefighters with and 32 firefighters without military veteran status (MVS; all men). Participants completed a semistructured, emotionally evocative interview with multiple contexts eliciting varying levels of emotion. RESULTS: MVS firefighters had relatively elevated EDA across contexts. However, lower baseline levels indicated calmer resting state in MVS firefighters. There was greater incidence of lifetime PTSD in MVS compared with non-MVS firefighters (40.6% vs. 15.6%). Overall, firefighters with past PTSD had less EDA reactivity. Finally, number of military deployments was associated with higher fear expressions throughout the interview. CONCLUSIONS: These findings highlight the need to consider interactions between military experience and psychiatric history in future investigations examining risk and resilience in first responders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Emotion differentiation and behavioral dysregulation in clinical and nonclinical samples: A meta-analysis.

Behavioral dysregulation that may manifest as the use of maladaptive behaviors aimed at regulating or avoiding distress, despite potential negative health consequences, is central to the development and maintenance of common psychological disorders. However, less is known about factors that may influence the engagement of these maladaptive behaviors. Recent research suggests that negative emotion differentiation (NED) may be important. The present investigation was a meta-analysis examining the relationship between NED and maladaptive behaviors ranging from binge drinking and nonsuicidal self-injury to treatment noncompliance, in clinical and nonclinical samples across 17 included studies obtained via electronic literature searches. Despite between-study methodological heterogeneity, our results indicated that NED was negatively associated with the enactment of maladaptive behaviors (r = -.15). Additionally, no significant differences in effect sizes were observed between clinical (n = 7; r = -.15) and nonclinical (n = 10; r = -.16) samples. Critically, the relationship between NED and maladaptive behaviors remained significant even after controlling for negative affect (NA; n = 11; r = -.09). This association also did not depend on levels of NA. Overall, our findings suggest that NED is generally associated with reduced engagement of maladaptive behaviors, regardless of diagnostic status and NA, and have important clinical implications for understanding and treating psychological disorders involving behavioral dysregulation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What Drives Preventive Health Behavior During a Global Pandemic? Emotion and Worry.

BACKGROUND & PURPOSE: Primary prevention of COVID-19 has focused on encouraging compliance with specific behaviors that restrict contagion. This investigation sought to characterize engagement in these behaviors in U.S. adults early during the pandemic and to build explanatory models of the psychological processes that drive them. METHODS: US adults were recruited through Qualtrics Research Panels (N = 324; 55% female; Mage = 50.91, SD = 15.98) and completed 10 days of online reports of emotion, COVID-19 perceived susceptibility and worry, and recommended behaviors (social distancing, hand washing, etc.). Factor analysis revealed behaviors loaded on two factors suggesting distinct motivational orientations: approach and avoidance. RESULTS: Changes in approach and avoidance behaviors over the 10 days indicated large individual differences consistent with three types of participants. Discrete emotions, including fear, guilt/shame, and happiness were associated with more recommended behaviors. Fear and COVID-19 worry indirectly influenced each other to facilitate more behavioral engagement. While emotions and worry strongly predicted individual differences in behavior across the 10 days, they did not predict as well why behaviors occurred on one day versus another. CONCLUSIONS: These findings suggest how daily affective processes motivate behavior, improving the understanding of compliance and efforts to target behaviors as primary prevention of disease.

Boosting positive mood in medical and emergency personnel during the COVID-19 pandemic: preliminary evidence of efficacy, feasibility and acceptability of a novel online ambulatory intervention.

OBJECTIVES: The aim of this project was to test the efficacy of a brief and novel online ambulatory intervention aimed at supporting psychological health and well-being for medical personnel and first responders during the COVID-19 pandemic. METHODS: Interested participants, n=28, actively employed as medical personnel, support staff and emergency responders, in the Midwestern USA in May-June of 2020, provided informed consent and were randomised to complete either low-dose or high-dose intervention, one time daily for 1 week via smartphone application. Each daily intervention included expressive writing, adaptive emotion regulation activity and (one vs two) positive emotion-generation activities, lasting 3-6 min a day. Ratings of negative and positive emotion were provided before and after each activity daily. Analyses tested compliance, acceptability, as well as efficacy at increasing positive emotion and decreasing negative emotion with each use and across time. RESULTS: The results indicated a 13% increase in positive emotion, t(25)=2.01, p=0.056; and decrease in negative emotion by 44%, t(25)=-4.00, p=0.001 across both doses. However, there was a clear advantage for individuals in the high-dose condition as daily boosts in positive emotion were significantly greater (an additional 9.4%) B=0.47, p=0.018. Overall, compliance was good. Acceptability ratings were good for those who completed the follow-up assessment. CONCLUSION: Front-line personnel, including medical staff and emergency responders, are experiencing unprecedented psychological stress during the COVID-19 pandemic. This investigation suggests both feasibility and efficacy for a brief, daily, ambulatory intervention which could provide essential psychological support to individuals at risk in the workplace.

Micro Versus Macro Processes: How specific stress exposure impacts sleep, affect, and risk-related behavior on the path to disease in high-risk adults.

BACKGROUND: The stress-to-disease association has been well-accepted for some time. However, the understanding of how stress exposure contributes to psychological disease progression remains unclear. OBJECTIVE: To test the real-time impact of variable stress exposure on risk-related clinical phenomena and affective disease progression in a high-risk sample of active-duty firefighters. METHODS: Participants completed weekly diaries reporting stressful event exposure, affect, sleep, and risk-related and healthy behaviors over six-months and were evaluated for lifetime and current psychiatric disease using clinical interviews before and after the sampling period. RESULTS: Stress exposure impacted clinical phenomena in differing ways. Major personal events and day-to-day hassles predicted health-impairing shifts in sleep and behavior that were associated with increases in symptoms and psychological distress over the 6-month period. In contrast, highly aversive incidents predicted greater adaptive behaviors that were uniquely predictive of symptom decreases over the six-month period. CONCLUSION: These findings shed new light on stress-to-disease processes, demonstrating how variable stress exposure influences critical shifts in behavior and sleep, contributing to psychological adjustment of firefighters over time. These data suggest practical ways to monitor risk in high-risk samples (e.g., monitoring sleep latency) and offer avenues for further explication of disease processes in real time.

Math matters: A novel, brief educational intervention decreases whole number bias when reasoning about COVID-19.

At the onset of the coronavirus disease (COVID-19) global pandemic, our interdisciplinary team hypothesized that a mathematical misconception-whole number bias (WNB)-contributed to beliefs that COVID-19 was less fatal than the flu. We created a brief online educational intervention for adults, leveraging evidence-based cognitive science research, to promote accurate understanding of rational numbers related to COVID-19. Participants from a Qualtrics panel (N = 1,297; 75% White) were randomly assigned to an intervention or control condition, solved health-related math problems, and subsequently completed 10 days of daily diaries in which health cognitions and affect were assessed. Participants who engaged with the intervention, relative to those in the control condition, were more accurate and less likely to explicitly mention WNB errors in their strategy reports as they solved COVID-19-related math problems. Math anxiety was positively associated with risk perceptions, worry, and negative affect immediately after the intervention and across the daily diaries. These results extend the benefits of worked examples in a practically relevant domain. Ameliorating WNB errors could not only help people think more accurately about COVID-19 statistics expressed as rational numbers, but also about novel future health crises, or any other context that involves information expressed as rational numbers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Feel to Heal: Negative Emotion Differentiation Promotes Medication Adherence in Multiple Sclerosis.

Multiple Sclerosis (MS) is a debilitating chronic autoimmune disease of the central nervous system that results in lower quality of life. Medication adherence is important for reducing relapse, disease progression, and MS-related symptoms, particularly during the early stages of MS. However, adherence may be impacted by negative emotional states. Therefore, it is important to identify protective factors. Past research suggests that the ability to discriminate between negative emotional states, also known as negative emotion differentiation (NED), may be protective against enactment of maladaptive risk-related behaviors. However, less is known as to how NED may promote adaptive health behaviors such as medication adherence. Utilizing weekly diaries, we investigated whether NED moderates the association between negative affect and medication adherence rates across 58 weeks among patients (n = 27) newly diagnosed with MS (following McDonald criteria). Results revealed that NED significantly moderated the relationship between negative affect and medication adherence. Specifically, greater negative affect was associated with lower adherence only for individuals reporting low NED. However, this link disappeared for those reporting moderate to high NED. Building upon past research, our findings suggest that NED may promote adaptive health behaviors and have important clinical implications for the treatment and management of chronic illness.

Emotion Differentiation as a Protective Factor Against the Behavioral Consequences of Rumination: A Conceptual Replication and Extension in the Context of Social Anxiety.

Rumination is thought to play a central role in affective disorders such as social anxiety disorder (SAD). Past research indicates that rumination tends to exacerbate negative emotions and increase the risk of engaging in maladaptive coping behaviors (e.g., avoiding social activities). However, little is known on how to effectively protect against the negative outcomes of rumination. Previously, Zaki, Coifman, Rafaeli, Berenson, and Downey (2013) found that negative emotion differentiation (NED) protected against rumination and nonsuicidal self-injury in borderline personality disorder. Nevertheless, it is unclear whether this protective effect would extend to other populations and behaviors. Therefore, the present investigation sought to replicate and extend Zaki et al.'s (2013) findings in the context of SAD. In two studies, we examined if NED would moderate the positive association between rumination and frequency of social avoidance. Study 1 involved 29 individuals who met criteria for SAD with or without co-occurring major depressive episode, while Study 2 involved a nonclinical sample of 190 college students. All participants completed a measure of rumination and an experience-sampling diary which provided indices of NED and social avoidance. The results from both studies were unanimous: NED significantly moderated the relationship between rumination and social avoidance such that the positive association between rumination and social avoidance was significant for low but not moderate to high NED. Overall, the findings provide a conceptual replication of Zaki et al. (2013) and further evidence for the protective effects of NED against the maladaptive behavioral consequences of rumination across populations.

A comparison of decentering across demographic groups and meditation experience: Support for the measurement invariance of the Experiences Questionnaire.

Theory and prior research suggests that decentering-an objective, distanced perspective on one's internal experiences-may vary based upon characteristics such as age, gender, race/ethnicity, and meditation experience. However, little is known about whether decentering measures are comparable in their meaning and interpretation when administered to individuals with different group membership (e.g., men or women; younger or older adults, etc.). The current study examined the measurement invariance of the Experiences Questionnaire (Fresco et al., 2007), a commonly used measure of decentering, evaluating age, gender, race/ethnicity, and meditation experience in three samples (students, community members, and clinical participants). Each sample was tested separately to assess the generalizability of results. The Experiences Questionnaire demonstrated full or partial measurement invariance in all cases, suggesting that scores are not biased based upon group membership and may be compared across individuals who vary in age, race/ethnicity, gender, and meditation experience. The current study also examined mean differences in decentering by groups, finding some evidence that decentering scores are higher for men, racial/ethnic minorities, older adults, and individuals with more meditation experiences. Implications are discussed for assessing decentering in diverse samples. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Synaptotagmin-7 as a positive regulator of glucose-induced glucagon-like peptide-1 secretion in mice.

AIMS/HYPOTHESIS: Glucagon-like peptide-1 (GLP-1), a hormone with potent antihyperglycaemic effects, is produced and secreted from highly specialised gut endocrine L-cells. It regulates glucose homeostasis by promoting glucose-dependent insulin secretion, suppressing glucagon secretion and enhancing insulin sensitivity. Similar to islet alpha and beta cells, L-cells are electrically excitable, and express calcium channels and ATP-sensitive potassium channels. GLP-1 is also stored in secretory granules, the exocytosis of which is triggered by increased intracellular calcium levels. Although the calcium dependence of GLP-1 granule exocytosis is well established, the identities of calcium-sensing proteins in GLP-1 secretion remain elusive. Here we tested whether synaptotagmin-7, a calcium sensor in pancreatic alpha and beta cells, regulates GLP-1 secretion. METHODS: We studied GLP-1 secretion using synaptotagmin-7 knockout (KO) mice and GLUTag cells with lentiviral-mediated synaptotagmin-7 silencing. RESULTS: We found that synaptotagmin-7 was co-localised with GLP-1 in intestinal L-cells. GLP-1 secretion was impaired in synaptotagmin-7 KO mice when they were challenged by glucose ingestion. Lentiviral knockdown (KD) of synaptotagmin-7 in GLUTag cells led to similar reductions in GLP-1 secretion, as determined by biochemical assays and by membrane capacitance measurements. Calcium response was not altered in synaptotagmin-7 KD cells. CONCLUSIONS/INTERPRETATION: These results demonstrate that synaptotagmin-7 functions as a positive regulator of GLP-1 secretion in intestinal L-cells and GLUTag cells, consistent with its proposed role as a calcium sensor in GLP-1 secretion.

Delayed onset of hyperglycaemia in a mouse model with impaired glucagon secretion demonstrates that dysregulated glucagon secretion promotes hyperglycaemia and type 2 diabetes.

AIMS/HYPOTHESIS: Type 2 diabetes is caused by relative deficiency of insulin secretion and is associated with dysregulation of glucagon secretion during the late stage of diabetes development. Like insulin secretion from beta cells, glucagon secretion is dependent on calcium signals and a calcium sensing protein, synaptotagmin-7. In this study, we tested the relative contribution of dysregulated glucagon secretion and reduced insulin release in the development of hyperglycaemia and type 2 diabetes by using synaptotagmin-7 knockout (KO) mice, which exhibit glucose intolerance, reduced insulin secretion and nearly abolished Ca(2+)-stimulated glucagon secretion. METHODS: We fed the synaptotagmin-7 KO and control mice with a high-fat diet (HFD) for 14 weeks, and compared their body weight, glucose levels, glucose and insulin tolerance, and insulin and glucagon secretion. RESULTS: On the HFD, synaptotagmin-7 KO mice showed progressive impairment of glucose tolerance and insulin secretion, along with continued maintenance of a low glucagon level. The control mice were less affected in terms of glucose intolerance, and showed enhanced insulin secretion with a concurrent increase in glucagon levels. Unexpectedly, after 14 weeks of HFD feeding, only the control mice displayed resting hyperglycaemia, whereas in synaptotagmin-7 KO mice defective insulin secretion and reduced insulin sensitivity were not sufficient to cause hyperglycaemia in the absence of enhanced glucagon secretion. CONCLUSIONS/INTERPRETATION: Our data uncover a previously overlooked role of dysregulated glucagon secretion in promoting hyperglycaemia and the ensuing diabetes, and strongly suggest maintenance of adequate regulation of glucagon secretion as an important therapeutic target in addition to the preservation of beta cell function and mass in the prevention and treatment of diabetes.

Seroprevalence of Toxoplasma gondii antibodies in pigs, goats, cattle, dogs and cats in peninsular Malaysia.

Antibodies to the protozoan parasite, Toxoplasma gondii were assayed in sera of 200 goats, 100 pigs, 126 cattle from various states of Malaysia, and 135 dogs and 55 cats around Ipoh region using an indirect fluorescence antibody test (IFAT, cut-off titer 1:200); antibodies were found in 35.5% of goats, 14.5% cats, 9.6% dogs, 7.9% local cattle and 4% yellow cattle but not in pigs. Results indicate that infection is most prevalent in goats.

Case report of a dermoid cyst at the floor of the mouth.

The growth of dermoid cysts at the floor of the mouth is considered a rare condition. Typically, intra-oral dermoid cysts present as non-tender, slow growing masses at the sublingual, submental and submandibular region. We report a case of a young adult male who presented at our hospital with a sublingual cyst superimposed with acute infection and failed antibiotic treatment. The cyst was excised and confirmed histopathologically as a dermoid cyst with overlying acute inflammation. Clinical progress was uneventful and postoperative recovery excellent with no recurrence.

A case of pseudohyperkalaemia and thrombocytosis.

An unusual cause of "hyperkalaemia" was observed in a neurosurgical patient admitted to our intensive care unit. The cause of the hyperkalaemia was not known initially and treatment with cation ion exchange resin was initiated to lower the elevated serum potassium level. The concurrent occurrence of thrombocytosis and hyperkalaemia raised the possibility of psuedohyperkalaemia associated with thrombocytosis. Simultaneous measurement of plasma and serum potassium with the Hitachi 917 Analyzer (indirect ion selective electrode, coefficient of variation = 1% to 2%) confirmed the diagnosis. Correlation between thrombocytosis and pseudohyperkalaemia was found to be highly significant (r = 0.54; P = 0.014). It is estimated that for for every 100 x 10(9)/L of platelets, an increase of 0.07 to 0.15 mmol/L of potassium is expected. In thrombocytosis, plasma rather than serum potassium should be measured.

Difficult pulmonary artery catheterization in a patient with persistent left superior vena cava.

A persistent left superior vena cava is an uncommon congenital abnormality. It arises when the left anterior cardinal vein fails to regress during the embryonic period. Although such patients are usually asymptomatic, they may have associated cardiovascular abnormalities. The anaesthetist may encounter difficulty in the insertion of pulmonary artery catheters. Other implications in the management of these patients in the operating theatre or intensive care unit are discussed.

Severe laryngospasm without intravenous access--a case report and literature review of the non-intravenous routes of administration of suxamethonium.

Severe laryngospasm may occur during inhalational induction of paediatric patients. Effective and rapid treatment of this complication is extremely important to prevent severe hypoxia. The treatment of choice is intravenous suxamethonium if muscle relaxation is desired. However, in the absence of intravenous access, alternate routes of administration have to be considered. The rapidity and the effectiveness in treating laryngospasm by these non-intravenous routes are important to the outcome of the patient. Though the intramuscular route may be relatively slower in onset time (time taken to reach maximum effect of paralysis) compared with the intravenous route, clinical experience so far indicates satisfactory result in the treatment of laryngospasm. Current evidences indicate that the intraosseous route is probably superior to the intramuscular route and comparable to the intravenous route in terms of onset time.