Barriers, Facilitators, and Preferences for Mental Health Services Among Patients With Systemic Lupus Erythematosus: A Qualitative Study.

OBJECTIVE: Although patients with systemic lupus erythematosus (SLE) experience high levels of depression and anxiety disorders, evidence concerning patient perceptions of facilitators and barriers to effective uptake of mental health services (eg, referral to therapists and psychiatrists, psychoeducational interventions, or support groups) is limited. METHODS: We conducted semistructured qualitative interviews with 15 adults with SLE to explore patient experiences and perceptions of mental health services to identify facilitators and barriers to accessing mental health care among patients with SLE. Qualitative interviews were conducted via telephone and audio recorded for transcription and directed content analysis using NVivo software by two coders. RESULTS: The median age of the 15 participants was 48 years, 87% were female, 33% identified as Black or African American, and 33% identified as Hispanic or Latino. Qualitative themes were organized into three domains: barriers, facilitators, and preferences for mental health services. Barriers to the use of mental health services include mental health stigma, sociodemographic factors, lack of autonomy, and time commitment. Facilitators to the use of mental health services included strong relationships with their rheumatologists and mental health care clinician experience with patients with SLE. Preferences for mental health services included education-based formats, mental health providers who work with patients with SLE, peer group formats, demographically and disease-matched psychological resources, and an emphasis on non-disease-related activities. CONCLUSION: In the setting of persistent unmet psychosocial needs of patients living with SLE, data from this qualitative study will inform the development and refinement of mental health interventions that bolster psychological wellbeing in the SLE population.

Subclinical eating disorder traits are correlated with cortical thickness in regions associated with food reward and perception.

Behavioral traits associated with various forms of psychopathology are conceptualized as dimensional, varying from those present in a frank disorder to subclinical expression. Demonstrating links between these behavioral traits and neurobiological indicators, such as brain structure, provides one form of validation for this view. However, unlike behavioral dimensions associated with other forms of psychopathology (e.g., autism spectrum disorder, attention deficit hyperactivity disorder, antisocial disorders), eating disorder traits have not been investigated in this manner in spite of the potential that such an approach has to elucidate etiological mechanisms. Therefore, we examined for the first time neural endophenotypes of Anorexia Nervosa and Bulimia via dimensional traits (measured using the Eating Disorders Inventory-3) in a large subclinical sample of young adults (n = 456 and n = 247, respectively; ages = 18-22 years) who each provided a structural magnetic resonance imaging scan. Cortical thickness was quantified at 81,924 vertices across the cortical surface. We found: 1) increasing eating disorder traits correlated with thinner cortex in the insula and orbitofrontal cortex, among other regions, and 2) using these regions as seeds, increasing eating disorder trait scores negatively modulated structural covariance between these seed regions and other cortical regions linked to regulatory and sensorimotor functions (e.g., frontal and temporal cortices). These findings parallel those found in the clinical literature (i.e., thinner cortex in these food-related regions in individuals with eating disorders) and therefore provide evidence supporting the dimensional view of behavioral traits associated with eating disorders. Extending this approach to genetic and neuroimaging genetics studies holds promise to inform etiology.

Music Intervention as a Tool in Improving Patient Experience in Palliative Care.

BACKGROUND:: The pain, anxiety, and stress associated with end-of-life care are paramount issues to address for both patients and their families. Reduction in these factors could translate to improved quality of life. OBJECTIVE:: We studied the effect of adding music to standard care for patients receiving a hospice or palliative care consult at 2 hospitals in the Care New England health-care system. In this mixed quantitative and qualitative study, we implemented live music intervention sessions. DESIGN/MEASUREMENTS:: Outcomes include symptom burden pre- and post-intervention using the Edmonton Symptom Assessment Scale, opioid use in equivalent time periods before and after the music intervention, and qualitative personal narratives of patients' and families' experiences with the music. RESULTS:: There were significant decreases in pain, anxiety, nausea, shortness of breath, and feelings of depression along with significant increase in feelings of well-being. Opioid use in time periods after the music intervention trended toward decreased usage when compared to the equivalent time period before. Finally, compiled personal narratives of patients' and families' experiences of the music intervention demonstrated common themes of spirituality, comfort, relaxation, escape, and reflection. CONCLUSIONS:: This project demonstrated the beneficial effects of music in a patient population that struggles with symptom management when only pharmacologic management is used. These data elucidate biological and psychosocial factors that are positively impacted by the intervention. With additional evidence in music as well as other artistic modalities, it is promising that arts-based programs in inpatient hospice and palliative care settings will continue to expand and flourish.

Interfering With Inner Speech Selectively Disrupts Problem Solving and Is Linked With Real-World Executive Functioning.

Purpose: According to Vygotskian theory, verbal thinking serves to guide our behavior and underpins critical self-regulatory functions. Indeed, numerous studies now link inner speech usage with performance on tests of executive function (EF). However, the selectivity of inner speech contributions to multifactorial executive planning performance and links with real-world functioning are limited. Therefore, the present study seeks to fill this gap in our knowledge. Method: Fifty-one adults completed the Tower of London under 2 conditions, (a) articulatory suppression and (b) foot tapping, and provided self-ratings of real-world executive functioning (utilizing the Behavior Rating Inventory of Executive Function-Adult Version; Roth, Isquith, & Gioia, 2006). Results: Interfering with inner speech selectively disrupted Tower of London performance over and above a simultaneous motor task (i.e., foot tapping). Furthermore, this selectivity in performance was linked with real-world self-monitoring. Conclusion: These results provide further evidence for specific links between verbal thinking and EF (particularly using multifactorial tasks of planning) and suggest that inner speech might serve as a key intervention target in clinical disorders where EF deficits are prominent.

Privileged Functional Connectivity between the Visual Word Form Area and the Language System.

The visual word form area (VWFA) is a region in the left occipitotemporal sulcus of literate individuals that is purportedly specialized for visual word recognition. However, there is considerable controversy about its functional specificity and connectivity, with some arguing that it serves as a domain-general, rather than word-specific, visual processor. The VWFA is a critical region for testing hypotheses about the nature of cortical organization, because it is known to develop only through experience (i.e., reading acquisition), and widespread literacy is too recent to have influenced genetic determinants of brain organization. Using a combination of advanced fMRI analysis techniques, including individual functional localization, multivoxel pattern analysis, and high-resolution resting-state functional connectivity (RSFC) analyses, with data from 33 healthy adult human participants, we demonstrate that (1) the VWFA can discriminate words from nonword letter strings (pseudowords); (2) the VWFA has preferential RSFC with Wernicke's area and other core regions of the language system; and (3) the strength of the RSFC between the VWFA and Wernicke's area predicts performance on a semantic classification task with words but not other categories of visual stimuli. Our results are consistent with the hypothesis that the VWFA is specialized for lexical processing of real words because of its functional connectivity with Wernicke's area.SIGNIFICANCE STATEMENT The visual word form area (VWFA) is critical for determining the nature of category-related organization of the ventral visual system. However, its functional specificity and connectivity are fiercely debated. Recent work concluded that the VWFA is a domain-general, rather than word-specific, visual processor with no preferential functional connectivity with the language system. Using more advanced techniques, our results stand in stark contrast to these earlier findings. We demonstrate that the VWFA is highly specialized for lexical processing of real words, and that a fundamental factor driving this specialization is its preferential intrinsic functional connectivity with core regions of the language system. Our results support the hypothesis that intrinsic functional connectivity contributes to category-related specialization within the human ventral visual system.

Functional connectivity constrains the category-related organization of human ventral occipitotemporal cortex.

One of the most robust and oft-replicated findings in cognitive neuroscience is that several spatially distinct, functionally dissociable ventral occipitotemporal cortex (VOTC) regions respond preferentially to different categories of concrete entities. However, the determinants of this category-related organization remain to be fully determined. One recent proposal is that privileged connectivity of these VOTC regions with other regions that store and/or process category-relevant properties may be a major contributing factor. To test this hypothesis, we used a multicategory functional magnetic resonance imaging (MRI) localizer to individually define category-related brain regions of interest (ROIs) in a large group of subjects (n = 33). We then used these ROIs in resting-state functional connectivity MRI analyses to explore spontaneous functional connectivity among these regions. We demonstrate that during rest, distinct category-preferential VOTC regions show differentially stronger functional connectivity with other regions that have congruent category-preference, as defined by the functional localizer. Importantly, a "tool"-preferential region in the left medial fusiform gyrus showed differentially stronger functional connectivity with other left lateralized cortical regions associated with perceiving and knowing about common tools-posterior middle temporal gyrus (involved in perception of nonbiological motion), lateral parietal cortex (critical for reaching, grasping, manipulating), and ventral premotor cortex (involved in storing/executing motor programs)-relative to other category-related regions in VOTC of both the right and left hemisphere. Our findings support the claim that privileged connectivity with other cortical regions that store and/or process category-relevant properties constrains the category-related organization of VOTC.

Real-world scene representations in high-level visual cortex: it's the spaces more than the places.

Real-world scenes are incredibly complex and heterogeneous, yet we are able to identify and categorize them effortlessly. In humans, the ventral temporal parahippocampal place area (PPA) has been implicated in scene processing, but scene information is contained in many visual areas, leaving their specific contributions unclear. Although early theories of PPA emphasized its role in spatial processing, more recent reports of its function have emphasized semantic or contextual processing. Here, using functional imaging, we reconstructed the organization of scene representations across human ventral visual cortex by analyzing the distributed response to 96 diverse real-world scenes. We found that, although individual scenes could be decoded in both PPA and early visual cortex (EVC), the structure of representations in these regions was vastly different. In both regions, spatial rather than semantic factors defined the structure of representations. However, in PPA, representations were defined primarily by the spatial factor of expanse (open, closed) and in EVC primarily by distance (near, far). Furthermore, independent behavioral ratings of expanse and distance correlated strongly with representations in PPA and peripheral EVC, respectively. In neither region was content (manmade, natural) a major contributor to the overall organization. Furthermore, the response of PPA could not be used to decode the high-level semantic category of scenes even when spatial factors were held constant, nor could category be decoded across different distances. These findings demonstrate, contrary to recent reports, that the response PPA primarily reflects spatial, not categorical or contextual, aspects of real-world scenes.