Being an Infant in a Pandemic: Influences of the COVID-19 Pandemic on Infants, Toddlers and Their Mothers in a Clinical Population.

The COVID-19 pandemic and the ongoing lockdowns might have had a strong impact on mental health of mothers and their infants/toddlers. For example, families had to deal with health issues and social isolation, which might have affected mental health and parent-child interactions. The aim of this study is to evaluate differences in (1) infantile regulatory disorders, (2) maternal mental health, (3) the impact of maternal mental health on infantile regulatory disorders, and (4) alterations in the mother-child interaction for participants recruited before versus after the onset of the first German lockdown. For this reason, mother-child dyads have been divided into two groups and were compared by analyzing clinical interviews on psychopathology of mother and child (M.I.N.I. & DC:05) and mother-child-interactions (Emotional Availability Scales). Results showed that (1) differences in infantile sleeping disorders emerged (phi = 0.243; p = 0.016) compared to the pre-lockdown group, while (2) the occurrence of maternal panic and anxiety increased in the post-lockdown group (phi = 0.229; p = 0.022). Moreover, there was (3) an association for maternal panic and child's sleep disorder, and (4) specific associations with maternal non-hostility in the mother-child-interaction. In conclusion, the present study highlights the differences of maternal mental health occurrences and infants' regulatory problems, as well as the possible effects of the COVID-19 pandemic for infants. In the pre-lockdown group, maternal non-hostility might have acted as a promotive factor against regulatory disorders, while this mechanism was mitigated in the post-lockdown group.

Past attachment experiences, the potential link of mentalization and the transmission of behavior to the child by mothers with mental health problems: cross-sectional analysis of a clinical sample.

Maternal capacity to mentalize (= reflective functioning, RF), secure attachment and emotionally available parenting has an impact on the child's development. The transmission of mothers' past attachment experiences gained with both her caregivers in her own childhood and the impact on current mother-child interaction is part of the 'transmission gap.' This study explores the transgenerational transmission mechanisms and the potential moderating effect of RF in a clinical sample of 113 mother-child dyads suffering from mental health problems. In a cross-sectional study, the associations between maternal attachment experiences, RF (coded based on Adult Attachment Interviews) and current mother-child interaction (Emotional Availability Scales) were examined with univariate correlation, moderator analyses, and structural equation models. We found relationships between attachment experiences and mother-child interaction, but RF had no moderating effect. Past loving experiences and perceived neglection, particularly with the own father in childhood, were predictors for the present mother-child interaction. There seems to be an intergenerational transmission of attachment experiences to the ongoing generation. Particularly past adverse childhood experiences with the own father seem to explain currently disruptive interactions with the child.Trial registration: DRKS00017008 and DRKS00016353.

[Inpatient Psychodynamic Therapy for Children and Adolescents with Complex ADHD: Results of a Naturalistic Clinical Trial]. / Stationäre psychodynamische Therapie bei Kindern und Jugendlichen mit komplexer ADHS: Ergebnisse einer naturalistischen klinischen Studie.

The Attention deficit/hyperactivity disorder (ADHD) is a common mental disorder in childhood and adolescence. However, it is a very heterogeneous disorder with subgroups of patients with mild symptoms and others with severe and complex impairments. Patients suffering from complex ADHD are usually characterized by multiple developmental disorders and impaired personality development. Due to the multimodal origin of the disorder, multimodal treatment approaches aimed at reducing the various deficits are usually indicated. The current study evaluated a multimodal inpatient psychodynamic treatment (PDT) for children and adolescents suffering from ADHD. 47 patients (age 9-17 years) were included in the study. Next to complex impairments (comorbid mental disorders, deficits regarding psychic structure, learning disorders and sensorimotor integration disorders), a high number of adverse childhood experiences (M = 11.71) was particularly remarkable in the sample. The PDT led to significant improvements regarding ADHD symptoms and general level of functioning. However, first symptom improvements were already evident at the end of the waiting period. For ten patients who participated in the follow-up assessment effects remained stable six months after treatment. Due to the high drop-out rate, however, the study results have to be regarded as preliminary.

Efficacy of parent-infant psychotherapy compared to care as usual in children with regulatory disorders in clinical and outpatient settings: study protocol of a randomised controlled trial as part of the SKKIPPI project.

BACKGROUND: The first years of life are a significant period for child development, when children are particularly sensitive and prone to crises. This early phase lays the foundation for healthy growth. Clinical assessment of psychological symptoms in early infancy and adequate treatment are both important in improving the diagnostic outcome and preventing later long-term developmental consequences. The most common psychological problems in the first 3 years of life are regulatory disorders. The aim of this trial is to investigate the efficacy of Parent-Infant Psychotherapy (PIP) for infants and young children (aged 0-36 months, diagnosed with at least one regulatory disorder) and their mothers, compared to care as usual (CAU). METHODS: In this open multicentre randomised controlled trial, 160 mother-infant dyads are randomised to receive PIP or CAU for 6 weeks of intervention in clinical or outpatient (including home treatment) settings. The primary outcome is the maternal sensitivity (sensitivity scale of the Emotional Availability Scales (EAS)) after 6 weeks. Secondary outcomes include assessment of interaction, mental health problems, attachment, development, psychological factors, treatment adherence, health care system utilisation, and costs, after 6 weeks and 12 months. DISCUSSION: This study will evaluate whether a manualised focus-based short-term psychodynamic psychotherapeutic intervention in mother-child dyads improves the care situation for families of children diagnosed with regulatory disorders, and helps prevent long-term psychopathologies. Assessment of the intervention in different settings will support the development of more tailored interventions for affected infants and their mothers. TRIAL REGISTRATION: German Clinical Trial Register, ID: DRKS00017008 . Registered 03/20/2019.

Language Models Explain Word Reading Times Better Than Empirical Predictability.

Though there is a strong consensus that word length and frequency are the most important single-word features determining visual-orthographic access to the mental lexicon, there is less agreement as how to best capture syntactic and semantic factors. The traditional approach in cognitive reading research assumes that word predictability from sentence context is best captured by cloze completion probability (CCP) derived from human performance data. We review recent research suggesting that probabilistic language models provide deeper explanations for syntactic and semantic effects than CCP. Then we compare CCP with three probabilistic language models for predicting word viewing times in an English and a German eye tracking sample: (1) Symbolic n-gram models consolidate syntactic and semantic short-range relations by computing the probability of a word to occur, given two preceding words. (2) Topic models rely on subsymbolic representations to capture long-range semantic similarity by word co-occurrence counts in documents. (3) In recurrent neural networks (RNNs), the subsymbolic units are trained to predict the next word, given all preceding words in the sentences. To examine lexical retrieval, these models were used to predict single fixation durations and gaze durations to capture rapidly successful and standard lexical access, and total viewing time to capture late semantic integration. The linear item-level analyses showed greater correlations of all language models with all eye-movement measures than CCP. Then we examined non-linear relations between the different types of predictability and the reading times using generalized additive models. N-gram and RNN probabilities of the present word more consistently predicted reading performance compared with topic models or CCP. For the effects of last-word probability on current-word viewing times, we obtained the best results with n-gram models. Such count-based models seem to best capture short-range access that is still underway when the eyes move on to the subsequent word. The prediction-trained RNN models, in contrast, better predicted early preprocessing of the next word. In sum, our results demonstrate that the different language models account for differential cognitive processes during reading. We discuss these algorithmically concrete blueprints of lexical consolidation as theoretically deep explanations for human reading.

Neurocognitive Effects of Self-Determined Choice and Emotional Arousal on Time Estimation.

Even though effects of emotion and motivation on cognition are well documented, the interaction of all three factors is rarely investigated. Here, we used electroencephalography (EEG) to examine the effects of self-determined choice-as an experimental manipulation of intrinsic motivation - and emotional stimulus content on task preparation and engagement in a temporal production task. Behavioral results indicated a modulation of time processing depending on choice and emotional content. Underlying EEG signals revealed differential modulations by choice on the contingent negative variation (CNV) during task and response preparation and by emotional content on the late positive potential (LPP) in response to the onset of an emotional picture during temporal production. Also, we obtained preliminary evidence for interaction effects of choice and emotional content on the LPP. The feedback-related negativity (FRN) in response to information regarding temporal production success was also affected by interactions of choice and emotional content. These findings indicate that besides separate effects of motivation and emotion, there may be time windows during task engagement in which both factors jointly affect cognitive processing. These results are interpreted as dynamic modulations of attentional resource allocation.

[Postpartum mental health problems: healthcare service situation and effectiveness of parent-infant psychotherapy. Presentation of the SKKIPPI project funded by the German Innovationsfonds]. / Postpartale psychische Erkrankungen: Versorgungslage und Wirksamkeit der Eltern-Säugling-Kleinkind-Psychotherapie. Vorstellung des Innovationsfondprojektes SKKIPPI.

After the birth of a child, parents may experience episodes of stress and psychological strain. Some infants show psychological or somatic stress in the form of early regulatory disorders. While the close connection between parental psychological stress, early regulatory disorders, and the development of the parent-child relationship is well documented, current data on effective treatment options are lacking. Previous care services mostly operate on a preventive basis; evidence-based psychotherapeutic services with a special focus on the parent-child relationship are rare.SKKIPPI is a multicenter research project (Berlin, Flensburg, Hamburg, Leipzig) and consists of several study parts with a mixed methods approach: an epidemiological cohort study, two randomized controlled intervention studies (RCTs), and a qualitative study. A population-based cohort study records the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use of health and social services by parents and their children within the first two years of life, using online questionnaires and telephone interviews. The aim of the two RCTs is to evaluate the efficacy of a focused, dyadic parent-infant psychotherapy (Eltern-Säugling-Kleinkind-Psychotherapie, ESKP) compared to routine treatment in inpatient and outpatient settings. The focus of these RCTs is on the improvement of maternal sensitivity and on mother-child attachment, as well as child development and the reduction of mother-child psychopathological symptoms. The qualitative study intends to reconstruct the perspectives of parents on the assistance system and to explore reasons for underuse. The results are expected to help develop preventive as well as therapeutic strategies in the German health system.

Effects of visual map complexity on the attentional processing of landmarks.

In the era of smartphones, route-planning and navigation is supported by freely and globally available web mapping services, such as OpenStreetMap or Google Maps. These services provide digital maps, as well as route planning functions that visually highlight the suggested route in the map. Additionally, such digital maps contain landmark pictograms, i.e. representations of salient objects in the environment. These landmark representations are, amongst other reference points, relevant for orientation, route memory, and the formation of a cognitive map of the environment. The amount of visible landmarks in maps used for navigation and route planning depends on the width of the displayed margin areas around the route. The amount of further reference points is based on the visual complexity of the map. This raises the question how factors like the distance of landmark representations to the route and visual map complexity determine the relevance of specific landmarks for memorizing a route. In order to answer this question, two experiments that investigated the relation between eye fixation patterns on landmark representations, landmark positions, route memory and visual map complexity were carried out. The results indicate that the attentional processing of landmark representations gradually decreases with an increasing distance to the route, decision points and potential decision points. Furthermore, this relation was found to be affected by the visual complexity of the map. In maps with low visual complexity, landmark representations further away from the route are fixated. However, route memory was not found to be affected by visual complexity of the map. We argue that map users might require a certain amount of reference points to form spatial relations as a foundation for a mental representation of space. As maps with low visual complexity offer less reference points, people need to scan a wider area. Therefore, visual complexity of the area displayed in a map should be considered in navigation-oriented map design by increasing displayed margins around the route in maps with a low visual complexity. In order to verify our assumption that the amount of reference points not only affects visual attention processes, but also the formation of a mental representation of space, additional research is required.

Moral decision making under modafinil: a randomized placebo-controlled double-blind crossover fMRI study.

RATIONALE: Modafinil is increasingly used by healthy humans as a neuroenhancer in order to improve cognitive functioning. Research on the effects of modafinil on cognition yielded most consistent findings for complex tasks relying on the prefrontal cortex (PFC). OBJECTIVES: The present randomized placebo-controlled double-blind crossover study aimed to investigate the effect of a single dose of modafinil (200 mg) on everyday moral decision making and its neural correlates, which have been linked to the ventro- and dorsomedial PFC. METHODS: Healthy male study participants were presented with short stories describing everyday moral or neutral dilemmas. Each moral dilemma required a decision between a personal desire and a moral standard, while the neutral dilemmas required decisions between two personal desires. The participants underwent this task twice, once under the influence of modafinil and once under placebo. Brain activity associated with the processing of the dilemmas was assessed by means of functional magnetic resonance imaging. RESULTS: For the processing of moral vs. neutral dilemmas, activations were found in a network of brain regions linked to social cognitive processes including, among others, the bilateral medial PFC, the insula, and the precuneus. Modafinil was found to increase the number of moral decisions and had no effect on brain activity associated with dilemma processing. Exploratory analyses revealed reduced response-locked activity in the dorsomedial PFC for moral compared to neutral dilemmas under modafinil, but not under placebo. CONCLUSIONS: The results are discussed in terms of altered predictions of others' emotional states under modafinil, possibly due to higher processing efficiency.

Individual differences in emotion processing: how similar are diffusion model parameters across tasks?

The goal of this study was to replicate findings of diffusion model parameters capturing emotion effects in a lexical decision task and investigating whether these findings extend to other tasks of implicit emotion processing. Additionally, we were interested in the stability of diffusion model parameters across emotional stimuli and tasks for individual subjects. Responses to words in a lexical decision task were compared with responses to faces in a gender categorization task for stimuli of the emotion categories: happy, neutral and fear. Main effects of emotion as well as stability of emerging response style patterns as evident in diffusion model parameters across these tasks were analyzed. Based on earlier findings, drift rates were assumed to be more similar in response to stimuli of the same emotion category compared to stimuli of a different emotion category. Results showed that emotion effects of the tasks differed with a processing advantage for happy followed by neutral and fear-related words in the lexical decision task and a processing advantage for neutral followed by happy and fearful faces in the gender categorization task. Both emotion effects were captured in estimated drift rate parameters-and in case of the lexical decision task also in the non-decision time parameters. A principal component analysis showed that contrary to our hypothesis drift rates were more similar within a specific task context than within a specific emotion category. Individual response patterns of subjects across tasks were evident in significant correlations regarding diffusion model parameters including response styles, non-decision times and information accumulation.

Meaningfulness of landmark pictograms reduces visual salience and recognition performance.

Landmarks, objects in the environment used for orientation, navigation and the formation of cognitive maps are often represented in maps as pictograms. In order to support these tasks effectively and efficiently, landmark pictograms also need to be salient, as the map user needs to identify and process them quickly and easily. Two additional relevant characteristics for the usability of landmark pictograms are their meaningfulness and recognition performance. Meaningfulness is required to understand which categories of objects are represented by the pictograms. Ease of recognition prevents the necessity to consult a map repetitively and may support the formation of a cognitive map of the environment. In the present study, we investigated the relation between salience, meaningfulness and recognition performance of OpenStreetMap (OSM) pictograms and the potential effects of the visual complexity of pictograms on these usability characteristics. Salience was measured via eye fixations on specific pictograms, meaningfulness with an explicit continuous scale and recognition performance with a yes/no recognition memory paradigm. Statistical analyses showed that pictograms drew more visual attention if they were visually complex or if their meaning was inapprehensible or ambiguous. Less apprehensible pictograms were also recognized more often. Interestingly, the data indicated that longer fixations could lead to worse recognition performance. Long fixations on a pictogram may increase the likelihood of false recognition in subsequent situations where the pictogram is no longer valid or relevant. Based on the findings, we suggest balancing the meaningfulness and visual complexity of contiguous pictograms to enhance their recognition and to provide an optimal level of salience of single objects.

Hippocampal-Temporopolar Connectivity Contributes to Episodic Simulation During Social Cognition.

People are better able to empathize with others when they are given information concerning the context driving that person's experiences. This suggests that people draw on prior memories when empathizing, but the mechanisms underlying this connection remain largely unexplored. The present study investigates how variations in episodic information shape the emotional response towards a movie character. Episodic information is either absent or provided by a written context preceding empathic film clips. It was shown that sad context information increases empathic concern for a movie character. This was tracked by neural activity in the temporal pole (TP) and anterior hippocampus (aHP). Dynamic causal modeling with Bayesian Model Selection has shown that context changes the effective connectivity from left aHP to the right TP. The same crossed-hemispheric coupling was found during rest, when people are left to their own thoughts. We conclude that (i) that the integration of episodic memory also supports the specific case of integrating context into empathic judgments, (ii) the right TP supports emotion processing by integrating episodic memory into empathic inferences, and (iii) lateral integration is a key process for episodic simulation during rest and during task. We propose that a disruption of the mechanism may underlie empathy deficits in clinical conditions, such as autism spectrum disorder.

Lexical olfaction recruits olfactory orbitofrontal cortex in metaphorical and literal contexts.

The investigation of specific lexical categories has substantially contributed to advancing our knowledge on how meaning is neurally represented. One sensory domain that has received particularly little attention is olfaction. This study aims to investigate the neural representation of lexical olfaction. In an fMRI experiment, participants read olfactory metaphors, their literal paraphrases, and literal olfactory sentences. Regions of interest were defined by a functional localizer run of odor processing. We observed activation in secondary olfactory areas during metaphorical and literal olfactory processing, thus extending previous findings to the novel source domain of olfaction. Previously reported enhanced activation in emotion-related areas due to metaphoricity could not be replicated. Finally, no primary olfactory cortex was found active during lexical olfaction processing. We suggest that this absence is due to olfactory hedonicity being crucial to understand the meaning of the current olfactory expressions. Consequently, the processing of olfactory hedonicity recruits secondary olfactory areas.

Audiovisual communication of object-names improves the spatial accuracy of recalled object-locations in topographic maps.

Knowing the correct location of a specific object learned from a (topographic) map is fundamental for orientation and navigation tasks. Spatial reference systems, such as coordinates or cardinal directions, are helpful tools for any geometric localization of positions that aims to be as exact as possible. Considering modern visualization techniques of multimedia cartography, map elements transferred through the auditory channel can be added easily. Audiovisual approaches have been discussed in the cartographic community for many years. However, the effectiveness of audiovisual map elements for map use has hardly been explored so far. Within an interdisciplinary (cartography-cognitive psychology) research project, it is examined whether map users remember object-locations better if they do not just read the corresponding place names, but also listen to them as voice recordings. This approach is based on the idea that learning object-identities influences learning object-locations, which is crucial for map-reading tasks. The results of an empirical study show that the additional auditory communication of object names not only improves memory for the names (object-identities), but also for the spatial accuracy of their corresponding object-locations. The audiovisual communication of semantic attribute information of a spatial object seems to improve the binding of object-identity and object-location, which enhances the spatial accuracy of object-location memory.

Electrophysiological correlates of the drift diffusion model in visual word recognition.

This study was designed to explore the electrophysiological correlates of the diffusion models drift rate parameter in cognitive decision making. Eighty-two participants completed a lexical decision task while their stimulus-dependent event-related potentials (ERP) and theta frequency band power were measured. A mass univariate approach was applied to examine the timeline at which correlations were evident. Individual differences in drift rate parameter and condition-wise within-subject differences in drift rates for word emotionality and item repetition were found to be related to amplitude differences in the late positive complex (LPC). No relations to theta frequency band power changes were obtained. The drift rate parameter captures information accumulation of noisy evidence, while LPC amplitudes are discussed to reflect the strength of a memory trace. While these results point to a common underlying cognitive mechanism to explain drift rates and LPC modulation, they also provide a new angle on the timeline of visual word processing following word identification. Further confirmations of the results are needed to approve the LPC as neurophysiological marker of information accumulation. Hum Brain Mapp 38:5616-5627, 2017. © 2017 Wiley Periodicals, Inc.

Preprocessing of emotional visual information in the human piriform cortex.

This study examines the processing of visual information by the olfactory system in humans. Recent data point to the processing of visual stimuli by the piriform cortex, a region mainly known as part of the primary olfactory cortex. Moreover, the piriform cortex generates predictive templates of olfactory stimuli to facilitate olfactory processing. This study fills the gap relating to the question whether this region is also capable of preprocessing emotional visual information. To gain insight into the preprocessing and transfer of emotional visual information into olfactory processing, we recorded hemodynamic responses during affective priming using functional magnetic resonance imaging (fMRI). Odors of different valence (pleasant, neutral and unpleasant) were primed by images of emotional facial expressions (happy, neutral and disgust). Our findings are the first to demonstrate that the piriform cortex preprocesses emotional visual information prior to any olfactory stimulation and that the emotional connotation of this preprocessing is subsequently transferred and integrated into an extended olfactory network for olfactory processing.

What our eyes tell us about feelings: Tracking pupillary responses during emotion regulation processes.

Emotion regulation is essential for adaptive behavior and mental health. Strategies applied to alter emotions are known to differ in their impact on psychological and physiological aspects of the emotional response. However, emotion regulation outcome has primarily been assessed via self-report, and studies comparing regulation strategies with regard to their peripheral physiological mechanisms are limited in number. In the present study, we therefore aimed to investigate the effects of different emotion regulation strategies on pupil dilation, skin conductance responses, and subjective emotional responses. Thirty healthy females were presented with negative and neutral pictures and asked to maintain or up- and downregulate their upcoming emotional responses through reappraisal or distraction. Pupil dilation and skin conductance responses were significantly enhanced when viewing negative relative to neutral pictures. For the pupil, this emotional arousal effect manifested specifically late during the pupillary response. In accordance with subjective ratings, increasing negative emotions through reappraisal led to the most prominent pupil size enlargements, whereas no consistent effect for downregulation was found. In contrast, early peak dilations were enhanced in all emotion regulation conditions independent of strategy. Skin conductance responses were not further modulated by emotion regulation. These results indicate that pupil diameter is modulated by emotional arousal, but is initially related to the extent of mental effort required to regulate automatic emotional responses. Our data thus provide first evidence that the pupillary response might comprise two distinct temporal components reflecting cognitive emotion regulation effort on the one hand and emotion regulation success on the other hand.

The Temporal Pole Top-Down Modulates the Ventral Visual Stream During Social Cognition.

The temporal pole (TP) has been associated with diverse functions of social cognition and emotion processing. Although the underlying mechanism remains elusive, one possibility is that TP acts as domain-general hub integrating socioemotional information. To test this, 26 participants were presented with 60 empathy-evoking film clips during fMRI scanning. The film clips were preceded by a linguistic sad or neutral context and half of the clips were accompanied by sad music. In line with its hypothesized role, TP was involved in the processing of sad context and furthermore tracked participants' empathic concern. To examine the neuromodulatory impact of TP, we applied nonlinear dynamic causal modeling to a multisensory integration network from previous work consisting of superior temporal gyrus (STG), fusiform gyrus (FG), and amygdala, which was extended by an additional node in the TP. Bayesian model comparison revealed a gating of STG and TP on fusiform-amygdalar coupling and an increase of TP to FG connectivity during the integration of contextual information. Moreover, these backward projections were strengthened by emotional music. The findings indicate that during social cognition, TP integrates information from different modalities and top-down modulates lower-level perceptual areas in the ventral visual stream as a function of integration demands.

Differences in the dynamics of affective and cognitive processing - An ERP study.

A controversy in emotion research concerns the question of whether affective or cognitive primacy are evident in processing affective stimuli and the factors contributing to each alternative. Using electrophysiological recordings in an adapted visual oddball paradigm allowed tracking the dynamics of affective and cognitive effects. Stimuli consisted of face pictures displaying affective expressions with rare oddballs differing from frequent stimuli in either affective expression, structure (while frequent stimuli were shown frontally these deviants were turned sideways) or they differed on both dimensions, i.e. in affective expression and structure. Results revealed a defined sequence of differences in ERP amplitudes: For stimuli deviating in their affective expression only, P1 modulations ~100ms were evident, while affective differences of structure deviants were not evident before the N170 time window. All three types of deviants differed in P300 amplitudes, indicating integration of affective and structural information. These results encompass evidence for both, cognitive and affective primacy depending on stimulus properties. Specifically affective primacy is only visible when the respective facial features can be extracted with ease. When structural differences make face processing harder, however, cognitive primacy is brought forward.

Modafinil alters decision making based on feedback history - a randomized placebo-controlled double blind study in humans.

Modafinil is becoming increasingly popular as a cognitive enhancer. Research on the effects of modafinil on cognitive function have yielded mixed results, with negative findings for simple memory and attention tasks and enhancing effects for more complex tasks. In the present study we examined whether modafinil, due to its known effect on the dopamine level in the striatum, alters feedback-related choice behaviour. We applied a task that separately tests the choice of previously rewarded behaviours (approach) and avoidance of previously punished behaviours. 18 participants received a single dose of 200 mg modafinil. Their performance was compared to a group of 22 participants who received placebo in a double-blind design. Modafinil but not placebo induced a significant bias towards approach behaviour as compared to the frequency of avoidance behaviour. General attention, overall feedback-based acquisition of choice behaviour and reaction times in high vs low conflict choices were not significantly affected by modafinil. This finding suggests that modafinil has a specific effect on dopamine-mediated choice behaviour based on the history of feedback, while a contribution of noradrenaline is also conceivable. The described change in decision making cannot be considered as cognitive enhancement, but might rather have detrimental effects on decisions in everyday life.