The Effects of Alcohol Hangover on Mood and Performance Assessed at Home.

The current study evaluated the next day consequences of a social night of drinking compared to a no alcohol night, with standardised mood and portable screen-based performance measures assessed in the morning at participants' homes, and a breathalyser screen for zero alcohol. A mixed sex group (n = 20) took part in the study. Participants reported consuming on average 16.9 units (135 g) alcohol, resulting in a hangover rating of 60 (out of 100) compared to 0.3 following the no alcohol night. Statistical significance comparisons contrasting the hangover with the no alcohol condition revealed an increase in negative mood and irritability during hangover and an (unexpected) increase in risk and thrill seeking. Performance scores showed an overall slowing of responses across measures, but with less impact on errors. The results support the description of hangover as a general state of cognitive impairment, reflected in slower responses and reduced accuracy across a variety of measures of cognitive function. This suggests a general level of impairment due to hangover, as well as increased negative mood. The use of a naturalistic design enabled the impact of more typical levels of alcohol associated with real life social consumption to be assessed, revealing wide ranging neurocognitive impairment with these higher doses. This study has successfully demonstrated the sensitivity of home-based assessment of the impact of alcohol hangover on a range of subjective and objective measures. The observed impairments, which may significantly impair daily activities such as driving a car or job performance, should be further investigated and taken into account by policy makers.

Attentional and working memory performance following alcohol and energy drink: A randomised, double-blind, placebo-controlled, factorial design laboratory study.

Alcohol mixed with energy drinks (AMED) studies have typically not shown antagonism of acute alcohol effects by energy drink (ED), particularly over relatively short time frames. This study investigated the effects of alcohol, ED, and AMED on attentional and working memory processes over a 3 h period. Twenty-four young adults took part in a randomised, double-blind, placebo-controlled, factorial, 4-arm study. They were administered 0.6g/kg alcohol and 250 ml ED (containing 80 mg caffeine), and matching placebos alone and in combination. A battery of attentional and working memory measures was completed at baseline then 45, 90 and 180 min post-treatment. Alcohol produced a characteristic shift in speed/accuracy trade-off, having little effect on reaction times while increasing errors on all attentional measures (4-choice Reaction Time, Number Pairs and Visual Search), as well as a composite Attentional error score and one working memory task (Serial Sevens). ED alone improved two working memory measures (Memory Scanning accuracy and Digit-Symbol reaction times) and improved speed of responding on a composite Working Memory score. There was no consistent pattern of AMED vs. alcohol effects; AMED produced more errors than alcohol alone on one attentional measure (Visual Search errors) at 45 min only whereas AMED resulted in fewer errors on the Serial Sevens task at 90 min and better Digit-Symbol accuracy and reaction time at 45 min. Alcohol consumption increases error rate across several attentional and working memory processes. Mutual antagonism between alcohol and ED showed no consistent pattern and likely reflects a complex interaction between caffeine and alcohol levels, phase of the blood alcohol limb, task domain and cognitive load.

Do daily fluctuations in inhibitory control predict alcohol consumption? An ecological momentary assessment study.

RATIONALE: Deficient inhibitory control is predictive of increased alcohol consumption in the laboratory; however, little is known about this relationship in naturalistic, real-world settings. OBJECTIVES: In the present study, we implemented ecological momentary assessment methods to investigate the relationship between inhibitory control and alcohol consumption in the real world. METHODS: Heavy drinkers who were motivated to reduce their alcohol consumption (N = 100) were loaned a smartphone which administered a stop signal task twice per day at random intervals between 10 a.m. and 6 p.m. for 2 weeks. Each day, participants also recorded their planned and actual alcohol consumption and their subjective craving and mood. We hypothesised that day-to-day fluctuations in inhibitory control (stop signal reaction time) would predict alcohol consumption, over and above planned consumption and craving. RESULTS: Multilevel modelling demonstrated that daily alcohol consumption was predicted by planned consumption (ß = .816; 95% CI .762-.870) and craving (ß = .022; 95% CI .013-.031), but inhibitory control did not predict any additional variance in alcohol consumption. However, secondary analyses demonstrated that the magnitude of deterioration in inhibitory control across the day was a significant predictor of increased alcohol consumption on that day (ß = .007; 95% CI .004-.011), after controlling for planned consumption and craving. CONCLUSIONS: These findings demonstrate that short-term fluctuations in inhibitory control predict alcohol consumption, which suggests that transient fluctuations in inhibition may be a risk factor for heavy drinking episodes.

Interactive Voice Response and Text-based Self-report Versions of the Electronic Columbia-Suicide Severity Rating Scale Are Equivalent.

Objectives: Our study objective was to compare the equivalence of a new version of the electronic Columbia-Suicide Severity Rating Scale that was administered on a tablet device with the existing interactive voice response version in order to support the prospective monitoring of suicidal ideation and behavior in clinical trials and clinical practice. Design: This was a randomized, crossover-equivalence study with no treatment intervention. Setting: The study setting was a psychiatric hospital. Participants: Fifty-eight recently admitted psychiatric inpatients and 28 employees of the hospital site were included in the study. Mean age was 41.0 years (standard deviation=12.5), and 59 percent were female. Measurements: Participants completed both tablet and interactive voice response versions in randomized order, with a 25-minute break between administrations. Finally, participants completed a second administration of the first administered version. Intraclass correlation coefficients (ICCs) and Kappa coefficients were used to evaluate agreement across modalities. Results: High levels of agreement were observed for most severe lifetime (ICC=0.88) and recent (ICC=0.79) ideation, occurrence of actual lifetime (Kappa=0.81) and recent (Kappa=0.73) suicide attempts, and occurrence of lifetime interrupted attempts (Kappa=0.78), aborted attempts (Kappa=0.54), and preparatory behaviors (Kappa=0.77), as well as non-suicidal self-injurious behavior (Kappa=0.73). Scores from both modes significantly differentiated psychiatric patients and hospital employee controls, and the test-retest reliability of both modes was excellent. Conclusions: These results support the validity and reliability of the new tablet-based electronic Columbia-Suicide Severity Rating Scale. This will allow the inclusion of the electronic Columbia-Suicide Severity Rating Scale in a wider range of clinical studies, particularly where a tablet is also being used to collect other study data.

The Effect of Breakfast Prior to Morning Exercise on Cognitive Performance, Mood and Appetite Later in the Day in Habitually Active Women.

Pre-exercise nutritional practices for active females exercising for mood, cognitive and appetite benefits are not well established. Results from an initial field pilot study showed that higher energy intake at breakfast was associated with lower fatigue and higher overall mood and alertness post-exercise (all p < 0.05). In a follow-up, randomised, controlled trial, 24 active women completed three trials in a balanced, cross-over design. At 0815 h participants completed baseline cognitive tasks, mood and appetite visual analogue scales (VAS) and were administered a cereal breakfast (providing 118 or 236 kcal) or no breakfast. After 45 min, they completed a 30 min run at 65% heart rate reserve (HRR). Parameters were re-assessed immediately after exercise, then hourly until lunch (~1240 h), immediately post-lunch and at 1500 and 1900 h via a mobile phone. Breakfast enhanced feelings of relaxation before lunch (p < 0.05, d > 0.40), though breakfast was detrimental for working memory mid-afternoon (p = 0.019, d = 0.37) and mental fatigue and tension later in the day (all p < 0.05, d > 0.038). Breakfast was also beneficial for appetite control before lunch irrespective of size (all p < 0.05, d > 0.43). These data provide information on pre-exercise nutritional practices for active females and suggest that a small breakfast eaten prior to exercise can benefit post-exercise mood and subjective appetite ratings.

Symptoms and impact of COPD assessed by an electronic diary in patients with moderate-to-severe COPD: psychometric results from the SHINE study.

BACKGROUND: Symptoms, particularly dyspnea, and activity limitation, have an impact on the health status and the ability to function normally in patients with chronic obstructive pulmonary disease (COPD). METHODS: To develop an electronic patient diary (eDiary), qualitative patient interviews were conducted from 2009 to 2010 to identify relevant symptoms and degree of bother due to symptoms. The eDiary was completed by a subset of 209 patients with moderate-to-severe COPD in the 26-week QVA149 SHINE study. Two morning assessments (since awakening and since the last assessment) and one evening assessment were made each day. Assessments covered five symptoms ("shortness of breath," "phlegm/mucus," "chest tightness," "wheezing," and "coughing") and two impact items ("bothered by COPD" and "difficulty with activities") and were scored on a 10-point numeric scale. RESULTS: Patient compliance with the eDiary was 90.4% at baseline and 81.3% at week 26. Correlations between shortness of breath and impact items were >0.95. Regression analysis showed that shortness of breath was a highly significant (P<0.0001) predictor of impact items. Exploratory factor analysis gave a single factor comprising all eDiary items, including both symptoms and impact items. Shortness of breath, the total score (including five symptoms and two impact items), and the five-item symptom score from the eDiary performed well, with good consistency and reliability. The eDiary showed good sensitivity to change, with a 0.6 points reduction in the symptoms scores (on a 0-10 point scale) representing a meaningful change. CONCLUSION: The eDiary was found to be valid, reliable, and responsive. The high correlations obtained between "shortness of breath" and the ratings of "bother" and "difficulty with activities" confirmed the relevance of this symptom in patients with COPD. Future studies will be required to explore further psychometric properties and their ability to differentiate between COPD treatments.

Naturalistic Effects of Five Days of Bedtime Caffeine Use on Sleep, Next-Day Cognitive Performance, and Mood.

Background: Disruptive effects of caffeine on sleep have previously been reported, although measures of next-day mood and performance have rarely been included. The present study aims to evaluate the effects of caffeine on sleep and associated next-day effects in a naturalistic field setting. Methods: Nineteen participants (daily caffeine intake 0-141 mg), assessed as good sleepers, took part in a randomized, placebo-controlled, double-blind, 2-week crossover study to assess the effects of bedtime caffeine use (250 mg) on sleep and next-day cognitive performance and mood, which were assessed on a mobile phone in the morning and afternoon. Sleep was assessed objectively (actiwatch) and subjectively (sleep diary). Results: Caffeine's effects on sleep were largely restricted to the first day of administration, with actigraphically measured reduced sleep efficiency, increased activity score and fragmentation index, decreased self-rated sleep quality, and an increased occurrence of participants waking early; only decreased sleep efficiency remained over the week. Effects on next-day performance and mood were evident over the whole week, although despite disrupting sleep, accuracy on a working memory task was higher after caffeine than placebo administration. Conclusions: Caffeine disrupted sleep, although when assessing next-day performance, which may have been affected by the presence of residual caffeine, performance appeared better after caffeine compared to placebo, although this was most likely due to prevention of the effects of overnight withdrawal from caffeine rather than representing a net benefit. Furthermore, partial tolerance developed to the effects of caffeine on sleep.

Vitamins and psychological functioning: a mobile phone assessment of the effects of a B vitamin complex, vitamin C and minerals on cognitive performance and subjective mood and energy.

OBJECTIVES: Despite being widely consumed, the effects of multi-vitamin supplements on psychological functioning have received little research attention. METHODS: Using a mobile phone testing paradigm, 198 males (30-55 years) in full-time employment took part in this randomised, placebo-controlled, double-blind, parallel-groups trial assessing the effects of a multi-vitamin/mineral on cognitive performance and psychological state/mood. Participants completed two cognitive tasks and a number of visual analogue scales (VAS) before and after a full day's work, on the day before, and 7, 14, 21 and 28 days after, commencing their treatment. RESULTS: Participants in the vitamin/mineral group rated themselves as having greater 'physical stamina' across assessments and weeks. They also rated themselves as having had greater 'concentration' and 'mental stamina' during the working day at the assessment carried out after a day's work, but not at the time of the assessment completed prior to work. Participants in this group also reported greater subjective 'alertness' on Bond-Lader mood scales during the post-work assessment on day 14 and both the pre and post-work assessments on day 28. CONCLUSIONS: These findings complement the results from the laboratory-based, randomised-controlled trial in the same cohort and suggest that healthy members of the general population may benefit from augmented levels of vitamins/minerals via direct dietary supplementation.

Cognitive effects of creatine ethyl ester supplementation.

Supplementation with creatine-based substances as a means of enhancing athletic performance has become widespread. Until recently, however, the effects of creatine supplementation on cognitive performance has been given little attention. This study used a new form of creatine--creatine ethyl ester--to investigate whether supplementation would improve performance in five cognitive tasks, using a double-blind, placebo-controlled study. Creatine dosing led to an improvement over the placebo condition on several measures. Although creatine seems to facilitate cognition on some tasks, these results require replication using objective measures of compliance. The improvement is discussed in the context of research examining the influence of brain energy capacity on cognitive performance.

Alcohol and cognitive function: assessment in everyday life and laboratory settings using mobile phones.

BACKGROUND: Mobile phone (cellphone) technology makes it practicable to assess cognitive function in a natural setting. We assessed this method and compared impairment of performance due to alcohol in everyday life with measurements made in the laboratory. METHODS: Thirty-eight volunteers (20 male, aged 18-54 years) took part in the everyday study, completing assessments twice a day for 14 days following requests sent by text messages to the mobile phone. Twenty-six of them (12 male, aged 19-54) took part in a subsequent two-period crossover lab study comparing alcohol with no alcohol (placebo). RESULTS: Everyday entries with 5 or more units of alcohol consumed in the past 6 hours (inferred mean blood alcohol concentration 95 ml/100 ml) showed higher scores for errors in tests of attention and working memory compared with entries with no alcohol consumed that day. Response times were impaired for only 1 test, sustained attention to response. The laboratory comparison of alcohol (mean blood alcohol concentration 124 mg/100 ml) with placebo showed impairment to both reaction time and error scores for all tests. A similar degree of subjective drunkenness was reported in both settings. CONCLUSIONS: We found that mobile phones allowed practical research on cognitive performance in an everyday life setting. Alcohol impaired function in both laboratory and everyday life settings at relevant doses of alcohol.

Evaluation of a roadside impairment test device using alcohol.

The main objective of this study was to compare the performance of a portable impairment test device known as roadside impairment testing apparatus (RITA) with the field impairment tests (FIT) that are used at the roadside by UK police. One hundred and twenty two healthy volunteers aged 18-70 years took part in this two-period crossover evaluation. The volunteers received a dose of alcohol and placebo, in the form of a drink, on separate days. Doses were calculated to produce blood alcohol concentrations of 90 mg/100ml and RITA and FIT testing was carried out between 30 and 75 min post-drink. FIT was found to have a diagnostic accuracy of 62.7%. However, there was a substantial age effect for FIT scores, with volunteers aged over 40 showing failure rates on placebo similar to the failure rates on alcohol of younger volunteers. The accuracy of RITA was between 66 and 70%, not significantly higher than that of FIT. However, RITA did not show a marked age effect. Advantageously, this could result in fewer false positives being recorded if RITA were deployed at the roadside. Horizontal gaze nystagmus (HGN) was also investigated and posted an accuracy of 74%. The inclusion of HGN as one component of a UK roadside impairment test battery warrants further exploration with other drugs.

Cognitive and mood effects of 8 weeks' supplementation with 400 mg or 1000 mg of the omega-3 essential fatty acid docosahexaenoic acid (DHA) in healthy children aged 10-12 years.

INTRODUCTION: Despite media and public expectation of efficacy, no study to date has investigated the cognitive and mood effects of omega 3 supplementation in healthy children. SUBJECTS AND METHODS: This randomised, double-blind, placebo-controlled, parallel groups pilot study assessed the cognitive and mood effects of either 400 mg or 1000 mg of docosahexaenoic acid (DHA) in 90 healthy children aged 10-12 years. Cognitive performance and mood was assessed prior to, and 8 weeks following, commencement of treatment. RESULTS: There was a significant treatment effect on one cognitive measure (speed of word recognition), with the lower dose speeding, and the higher dose slowing, performance. Overall, the pattern of results strongly suggests that this effect was due to chance fluctuations in performance and that the treatments had no consistent or interpretable effect on performance. CONCLUSIONS: The results here do not suggest that supplementation with these doses of DHA for 8 weeks has any beneficial effect on brain function in cognitively intact children.

Cognitive and mood effects in healthy children during 12 weeks' supplementation with multi-vitamin/minerals.

Adequate levels of vitamins and minerals are essential for optimal neural functioning. A high proportion of individuals, including children, suffer from deficiencies in one or more vitamins or minerals. This study investigated whether daily supplementation with vitamins/minerals could modulate cognitive performance and mood in healthy children. In this randomised, double-blind, placebo-controlled, parallel groups investigation, eighty-one healthy children aged from 8 to 14 years underwent laboratory assessments of their cognitive performance and mood pre-dose and at 1 and 3 h post-dose on the first and last days of 12 weeks' supplementation with a commercially available vitamins/mineral product (Pharmaton Kiddi). Interim assessments were also completed at home after 4 and 8 weeks at 3 h post-dose. Each assessment comprised completion of a cognitive battery, delivered over the Internet, which included tasks assessing mood and the speed and accuracy of attention and aspects of memory (secondary, semantic and spatial working memory). The vitamin/mineral group performed more accurately on two attention tasks: 'Arrows' choice reaction time task at 4 and 8 weeks; 'Arrow Flankers' choice reaction time task at 4, 8 and 12 weeks. A single task outcome (Picture Recognition errors) evinced significant decrements at 12 weeks. Mood was not modulated in any interpretable manner. Whilst it is possible that the significant improvements following treatment were due to non-significant numerical differences in performance at baseline, these results would seem to suggest that vitamin/mineral supplementation has the potential to improve brain function in healthy children. This proposition requires further investigation.

Effects of ethanol and promethazine on awareness of errors and judgements of performance.

Ethanol may affect detection and processing of errors in performance tasks, and thus influence the speed accuracy trade-off. In this double-blind study, 11 volunteers, (seven female, four male) took part in four sessions in which they received ethanol (Eth; mean blood alcohol concentration at 60 min: 87.3, SD: 18.4), placebo (Pla), promethazine 20mg (P20) and 30 mg (P30) in randomized order. A computerized four choice reaction time test (FCRT), other performance measures and visual analogue scales (VAS) were administered before dosing and at intervals up to 2.5h after. During the FCRT volunteers reported errors verbally. These reports were recorded together with error signals from the computer. The overall pattern of effects was as expected for Eth, with increases in errors for most tasks, and subjective drowsiness. P30 affected only the FCRT, and both P30 and P20 caused drowsiness. The number of errors made by the volunteers in the FCRT was significantly increased for both Eth (N 5.20, p 0.01) and P30 (N 3.81, p 0.01) compared to Pla (1.84) with no significant change in response speed. The proportion of errors detected was slightly but not significantly reduced (Pla 68%, Eth 63%, P30 57%). These results show that error processing is not significantly impaired by ethanol, and a reduction in awareness of errors cannot account for the increased errors which occur when performance is impaired by ethanol.

Effects of ethanol on kinaesthetic perception.

In normal subjects, alcohol increases handwriting size, but the mechanism is not understood. Here we show that the alcohol effect on handwriting can be explained by a selective impairment of kinaesthetic perception. Thirty volunteers (15 male, aged 18-29 years) took part in an open study. They were tested before and after a drink containing vodka intended to produce a blood alcohol concentration of about 80mg/100ml. Tests included kinaesthetic distance estimation, in which volunteers worked with preferred hand and arm behind a screen which hid their movements; visual distance estimation; and measures of handwriting and drawing. Blood alcohol concentration at 55min, based on breathalyser measurements, was 76.7mg/100ml (SD 9.8). When asked to move the hand and mark a distance of 10cm from a starting point, distances estimates increased by 7-10% (p 0.01). Similar increases were seen for writing words and drawing characters. Signatures were increased in height but not in length. Distances estimated visually were increased much less, by 3-4% (p 0.05). Tests of psychomotor performance indicated the expected effects of ethanol. These results suggest that ethanol affects writing size by reducing kinaesthetically perceived distances.

Selective effects of clonidine and temazepam on attention and memory.

The present study compared the effects of clonidine and temazepam on performance on a range of tasks aiming to assess the role of central noradrenergic mechanisms in cognitive function. Fifteen healthy volunteers (seven male, eight female), aged 18-25 years, took part in a five-period crossover study in which they received placebo, temazepam (15 and 30 mg) and clonidine (150 and 300 microg) by mouth in counterbalanced order in sessions at least 4 days apart. A test battery was administered before treatment and at 45, 90 and 135 min after the dose. Performance on most tests was significantly impaired in a dose-related fashion, and subjective sedation was recorded for both drugs. The greatest impairments with clonidine were on attention in the presence of distractors. Clonidine did not affect the formation of new long-term memories, in contrast to temazepam, but did impair measures of working memory. Subjective effects, especially feelings of drunkenness and abnormality, were particularly marked with clonidine. These results support the suggestion that central noradrenergic function may be involved in preventing distraction, but do not confirm other reports suggesting that some aspects of performance are improved with clonidine.

Electronic diaries and questionnaires: designing user interfaces that are easy for all patients to use.

We propose a set of requirements for designing handheld computer systems for electronic collection of patient diary and questionnaire data in clinical trials: (1) the system should be suitable for use by all types of patient to be included in the clinical trial programme; (2) patients must be capable of using the system and be comfortable with it after a short period of training; (3) responses should always result from an action by the user--defaults should not be taken as data; (4) all information necessary to a given question should be simultaneously available on the screen. This applies to both the questions and the response options. We present guidelines as to how these requirements may be met in practice, so that bias may be avoided both in patient selection and in the responses made; so that electronic data collection may be as effective as possible, and so that study procedures are convenient and unobtrusive for the patients.

Effect of ethanol on judgments of performance.

Ethanol impairs cognitive and psychomotor performance, although the precise reasons for this remain unclear. We investigated the effect of ethanol on individuals' judgment of their performance. Eighteen healthy volunteers (19-22 years) received a high dose of ethanol (0.8 g/kg for males and 0.7 g/kg, for females), a medium dose (75% of the high dose) and a placebo in counterbalanced order on three study days. A general knowledge (GK) test was administered on a pen computer 75 min after the drink. An adaptive algorithm adjusted the difficulty of questions so that scores were similar on all three study days. Volunteers then rated how well they believed they had performed the GK task using a visual analogue scale. A battery of other performance tests and mood ratings was also completed both before and after the GK test. These showed the expected effects of ethanol. There were no significant differences in scores on the GK test between treatment sessions. There was a highly significant dose-dependent increase with ethanol on volunteers' ratings of their performance on this test. These findings suggest that ethanol leads to an overoptimistic assessment of ability which may contribute to ethanol's impairment of performance.