Over-Reporting of Somatic and Psychiatric PTSD Symptoms Among People Who Experienced Motor Vehicle Accidents and Did Not Seek Psychiatric Help in a Primary Care Setting.

Background: Over-reporting of posttraumatic stress disorder (PTSD) symptoms has been observed in some cases, following a motor vehicle accident (MVA). It has been suggested, however, that these are cases of underdiagnoses in primary care settings. The current study focused on people with PTSD in primary care settings who experienced an MVA and do not seek psychiatric help. Methods: In the over 3000 patient registry of a primary care clinic, 174 people who experienced an MVA (PE-MVA) were identified. The final sample included 45 PE-MVA, who were administered the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS-2), and completed the Injury Severity Scale (ISS) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) content scales. Results: PE-MVA with PTSD reported more psychopathology on both MMPI-2 and CAPS-2 than those without PTSD. Severity of injury, measured by the ISS, did not differ significantly between the two PE-MVA groups. The significant differences between the PE-MVA with PTSD and those without PTSD disappeared after adjusting for the covariates of bias scales [Infrequency (F) and Fake Bad (FBS)] in MMPI-2, but not in CAPS-2. Conclusion: The results suggest that in primary care settings, PE-MVA with PTSD who do not seek psychiatric help, over-report psychiatric and somatic symptoms. In a personal injury setting the F scale of the MMPI-2 showed less sensitivity to exaggerated somatic symptoms than the FBS scale. Bias scales of PE-MVA with PTSD are major contributors to the elevation of the MMPI-2 scores but not the CAPS-2 score.

Relationship between smoking, narcissism, and impulsiveness among young women.

Although the connection between smoking and individual differences has been recently recognized, the relationship between narcissistic personality traits and cigarette smoking has received less attention. The notion that personality traits can be associated with addictive behavior is influential in clinical practice. However, questions remain about specific interactions between smoking and personality characteristics that need empirical support to substantiate this hypothesis. This study thus identifies narcissistic and impulsive personality traits as precursors of smoking in a sample of tattooed individuals. In a cross-sectional study (N = 120), personality traits were assessed in young women (aged 18-35 years) using the narcissistic personality inventory and the Barratt Impulsivity Scale (BIS-11). The current study, using the regression analysis, has clearly demonstrated that young women who smoke have different personality characteristics as compared with women who do not smoke.

The Influence of Substance Abuse on Inhibition Capacities and Risky Decision in a Group of Outpatient Schizophrenia Patients.

OBJECTIVE: Substance abuse is common among patients with schizophrenia, is related to worse course and outcome of illness. Unfortunately, little is known about how substance abuse affects the cognitive function of schizophrenia patients, whose cognitive function is often already comprised. Neurocognitive functioning includes inhibition control and decision-making, and both schizophrenia and substance use disorder are related to impairments of inhibition control. However, the influence of substance abuse on inhibition capacities among schizophrenia patients is unclear. Methods: This study measured the influence of substance use disorder on inhibition capacities and risky decision-making in a group of 39 schizophrenia patients that were evaluated using a socio-demographic questionnaire and clinical assessment using the Positive and Negative Syndromes Scale for Schizophrenia. To assess inhibition control we utilized the Matching Familiar Figure Test (MFFT) and the Stroop task, and to evaluate decision-making we used the Iowa Gambling Task (IGT) and self-report questionnaire, the Barratt Impulsiveness Scale. Results: Univariate analysis found significant differences between the groups with regard to criminal history (χ2 = 5.97, p=.015), smoking status (χ2 = 12.30, p<.001), and total BIS score (t= -2.69, df = 37, p=.01). Our model did not find a significant effect of substance abuse on the first response time and number of errors on the MFFT or in the total interference index of Stroop performance and net score on risky decision-making in the IGT. The two groups did not differ significantly either in first response time or in number of errors on the MFFT (F = 0.54, p=.47, d = 0.24, 95% CI [-0.4, 0.88]; F = 0.28, p=.60, d = 0.61, 95% CI [0, 1.26], respectively), nor did they differ in the total interference index of the Stroop task (F(1)=0.49, p=.49, d = 0.25, 95% CI [-0.38, 0.88]). Conclusion: The analyses did not detect any statistically significant effect of substance abuse on inhibition control or risky decision-making processes in outpatients diagnosed with schizophrenia, despite increased impulsivity, criminal history and smoking status. These results neither support nor disprove previous findings.

The role of inhibition capacities in the Iowa gambling test performance in young tattooed women.

BACKGROUND: Using the Iowa Gambling Test (IGT), we demonstrated previously impaired decision- making process in young tattooed women. The purpose of the present study was to explore the associations among the three facets of impaired inhibition (response inhibition, reflection inhibition and interference inhibition) and decision-making processes in this population. METHODS: To this end, the participants of the previous study (60 tattooed women and 60 non-tattooed women) were assessed in the Go/NoGo task, a measure of response inhibition, the Matched Familiar Figure Test (MFFT), a measure of reflection inhibition and the Stroop task a measure of interference inhibition. RESULTS: Tattooed women were significantly slower than non-tattooed women in the Go/NoGo performance; however, no differences were detected in the MFFT and the Stroop task. A hierarchical regression analysis did not reveal any significant main effects of these inhibition measures on the IGT performance. CONCLUSIONS: These findings do not support the hypothesis that risky decision in young tattooed women is due to impaired inhibitory control. Further studies are needed to identify the cognitive mechanisms involved in the tendency to risky decisions in young tattooed women.

Do young women with tattoos have lower self-esteem and body image than their peers without tattoos? A non-verbal repertory grid technique approach.

Available evidence regarding the reasons for people to acquire body markers such as tattoos is contradictory. The present study was designed to investigate the relationship between self-esteem and body image in young women with tattoos. To this end, the repertory grid technique (RGT) was adapted and used to assess differences between women with and without tattoos in terms of self-esteem and body image. Sixty young women with tattoos and sixty young women without (all aged 18-35 years), performed the Color RGT in order to evaluate the relationship between self-esteem and body image. Compared to women without tattoos, women with tattoos showed significantly lower self-esteem and displayed stronger relationships between three constructs: ideal body, ideal self and tattooed woman status. No significant differences in body image were detected between the two groups. Women with tattoos were characterized by an association between body image and self-esteem, while women without tattoos did not display such a correlation. Thus, it appears that links between self-esteem, ideal body, ideal self and constructs of "woman with tattoos" may play a role in tattooing behavior in young women.

Distinct Response Inhibition Patterns in Obsessive Compulsive Disorder Patients and Pathological Gamblers.

Background: Obsessive-compulsive disorder (OCD) and pathological gambling (PG) are common disorders. The cognitive models of OCD and PG focus on abnormalities in response inhibition. Although, these functions have been studied in different PG and OCD samples, no study has compared the response inhibition in both. Methods: Medication-naïve OCD (n = 61) and PG subjects (n = 109) and healthy controls (n = 131) performed CPT and Go/NoGo tasks. Results: Compared to healthy controls (HC), PG and OCD groups underperformed on speed and exhibited larger time variability on the CPT and Go/NoGo task. Only in OCD patients, a positive correlation between omission errors and response time (RT) was observed in the CPT. At the Go/NoGo task, a negative correlation between false alarms and RT (a fast-errors trade-off) was significant only in the PG group. The HC group had greater sensitivity values (d') than the OCD and PG groups in the Go/NoGo task. The PG group displayed lower d' values and more conservative response criterion in the CPT. In addition, only the OCD group expressed a high switching cost compared to both the PG and HC groups in terms of the RT and d' values. Conclusions: Both the PG and OCD groups demonstrated impaired response inhibition compared to the HC group. On several measures, the OCD and PG groups showed comparable impairments, and in others these were distinct. Thus, it appears that distinct neurocognitive patterns are involved in performance of the CPT and the Go/NoGo tasks among OCD and PG subjects whose cognitive status is currently under intensive investigation.

The role of gender in association between inhibition capacities and risky decision making.

BACKGROUND: Research on the association between decision making and inhibition abilities has exhibited fundamental controversies. Some authors claim that inhibition abilities are an integral part of the decision-making process, whereas others suggest that the decision-making process does not operate in close association with inhibition abilities. Can gender explain variations in risky decisions via inhibition influences? PURPOSE: The purpose of the present study was to explore the associations between response inhibition, reflection inhibition, interference inhibition, and decision-making processes in men and women. METHODS: To this end, 46 women and 46 men were assessed by the Go/NoGo task, a measure of response inhibition, by the Matching Familiar Figure Test, a measure of reflection inhibition; and by the Stroop task, a measure of interference inhibition. RESULTS: No differences were detected in these measures between groups. The net score of the performance on the last section of the Iowa Gambling Task choices did not correlate with the inhibition measures in the two groups. We did not discover any significant main effects of gender on the association between these measures. CONCLUSION: These findings do not support the hypothesis that risky decisions are due to impaired inhibitory control. Further studies are needed to identify the cognitive mechanisms involved in the tendency to make risky decisions.

Ability to use the wait-and-see strategy in pathological gamblers.

Pathological gamblers (PGs) perform differently on neurocognitive tests than do healthy controls (HC). The aim of this study was to assess "waiting ability" - a major components of inhibition control-using a modified Stop Signal Task (SST) in a population of male PGs (N=55), and HCs (N=53). Results indicated no differences between PGs and HCs in reaction times, intra-individual response variability, or number of false alarms and misses. In conclusion, PGs were not impaired in their ability to manipulate their on-line response strategy during the experimental task and were instead able to change their strategy to decrease the number of false alarms. However, much more empirical and theoretical work needs to be carried out in order to understand the key neural basis of impulsivity among PGs.

Intrusive trauma recollections is associated with impairment of interference inhibition and psychomotor speed in PTSD.

BACKGROUND: Intrusive cognitions that enter consciousness involuntarily are prominent symptoms of posttraumatic stress disorder (PTSD). The present study aimed to identify neuropsychological mechanisms involved. METHOD: Fifty PTSD outpatients and 50 healthy controls were tested using Finger Tapping, Simple and Choice Reaction Times and Stroop Tasks, to measure motor, psychomotor speed, response selection, and interference inhibition ability respectively. RESULTS: PTSD patients performed poorly in all tests, presumably owing to their generalized slowness of information processing and motor reaction. Psychomotor speed was a predictor of slowness and high error rate during the Stroop. Impaired inhibition, as measured by the interference index of the Stroop task, explained 9.7% of the predicated variance in frequency of re-experiencing PTSD symptoms and 23.5% of the predicated variance in augmentation of the interference response time. CONCLUSION: Impaired interference control may be related to internal (re-experiencing) and external (sensory) stimuli that leads to cognitive deficits in PTSD patients.

Response inhibition and sustained and attention in Heavy smokers versus non-smokers.

BACKGROUND: Repeated nicotine administration induces neuro-adaptations associated with abnormal dopaminergic activity. These neuronal changes may contribute to impaired inhibitory control and attention deficit. However, it remains unclear whether smokers perform worse than non-smokers on tests that involve attention and control of impulsivity. The present study examined response inhibition and sustained attention capacities in a large sample of smokers and non-smokers. METHODS: Continuous Performance Test (CPT) and Go/ NoGo computerized tasks were used as a measure of response-inhibition ability and sustained attention. Threeway repeated measures analysis of covariance was used with response time, variability of response time, number of commission errors (inappropriate responses to stimuli) and number of omission errors (missed stimuli) as dependent measures. Main effects were: group (smokers and controls), condition (CPT and Go/NoGo), and block (in each condition); gender, education, and age were used as covariates. RESULTS AND CONCLUSIONS: Smokers, as compared to the control group, made more errors of commission in the Go/ NoGo task, reflecting impaired inhibition ability. However, we found no significant differences between the groups in our measure of sustained attention. Impaired response inhibition was found to co-occur with heavy smoking and therefore may be a potential target for the development of more effective cessation programs.

Interactions between risky decisions, impulsiveness and smoking in young tattooed women.

BACKGROUND: According to previous studies, one of the common problems of everyday life of persons with tattoos is risky behavior. However, direct examination of the decision making process, as well as factors which determine women's risk-taking decisions to get tattoos, have not been conducted. This study investigates whether risk taking decision-making is associated with the self-assessment impulsiveness in tattooed women. METHODS: Young women (aged 18-35 years) with (N = 60) and without (N = 60) tattoos, performed the Iowa Gambling Task (IGT), as a measure of decision-making processes, as well as completing the Barratt Impulsivity Scale (BIS-11). RESULTS: Tattooed women showed significantly higher scores in the BIS-11 and preference for disadvantageous decks on the IGT compared to non-tattooed women. There was no significant correlation between risky decision-making in the IGT and BIS-11 impulsivity measures. A significantly higher rate of smoking was observed in the tattooed women. However, the analysis did not reveal a group effect after adjustment for smoking in the IGT and the BIS-11 measures. CONCLUSIONS: The present study was specifically designed to resolve questions regarding associations between impulsiveness and risky decision-making in tattooed women. It shows that in tattooed women, risky decisions are not a direct result of their self-reported impulsiveness. Smoking does not explain the psychometric differences between tattooed women and controls.

Can Minnesota Multiphasic Personality Inventory-2 predict response to selective serotonin reuptake inhibitors in depressed outpatients?

There is growing evidence that individual differences among patients with major depressive disorder (MDD) on psychological and demographic measures may predict the therapeutic response to selective serotonin reuptake inhibitors (SSRIs). In this retrospective chart review, 108 outpatients with current major depressive episodes were treated with citalopram, paroxetine, or fluvoxamine. The Hamilton Depression Rating Scale and the Minnesota Multiphasic Personality Inventory-2 were administered before and after 8 weeks of SSRIs treatment. Clinical response was defined as a 50% or greater decrease in the 17-item Hamilton Depression Rating Scale total score (final visit minus baseline). This naturalistic short-term follow-up outcome study demonstrates that among depressive outpatients who responded to an 8-week trial, 57.4% achieved a good response to SSRIs. Statistical analysis showed that SSRI treatment may be 3.03 times more advantageous for MDD outpatients who are younger than 39 years. The patients with an elevated score of above 66T on the Social Introversion Minnesota Multiphasic Personality Inventory-2 scale are approximately 0.37 times as likely to be SSRI responders as are patients with a Social Introversion score less than 66T. Thus, it seems that in MDD outpatient age is the strongest predictor of response to SSRIs.

Risk-taking decisions in pathological gamblers is not a result of their impaired inhibition ability.

This work investigates whether inhibition impairments influence the decision making process in pathological gamblers (PGs). The PG (N=51) subjects performed the Iowa Gambling Task (IGT as the measure of the decision making process) and two tests of inhibition: the Stroop (interference inhibition), and the Go/NoGo (response inhibition), and were compared with demographically matched healthy subjects (N=57). Performance in the IGT block 1 and block 2 did not differ between the groups, but the differences between the PGs and healthy controls began to be significant in block 3, block 4 and block 5. PGs learned the IGT task more slowly than the healthy controls and had non-optimal outcomes (more disadvantageous choices). Impaired IGT performance in PGs was not related to an inhibition ability measured by the Stroop (interference response time) and the Go/NoGo (number of commission errors) parameters. Further controlled studies with neuroimaging techniques may help to clarify the particular brain mechanisms underlying the impaired decision making process in PGs.

Pathological gambling: an impulse control disorder? Measurement of impulsivity using neurocognitive tests.

Pathological gambling is classified in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) and in the ICD-10 (International Classification of Disease) as an impulse control disorder. The association between impulsivity and pathological gambling remains a matter of debate: some researchers find high levels of impulsivity within pathological gamblers, others report no difference compared to controls, and yet others even suggest that it is lower. In this review we examine the relationship between pathological gambling and impulsivity assessed by various neurocognitive tests. These tests--the Stroop task, the Stop Signal Task, the Matching Familiar Figures Task, the Iowa Gambling Task, the Wisconsin Card Sorting Test, the Tower of London test, and the Continuous Performance Test--demonstrated less impulsivity in gambling behavior. The differences in performance between pathological gamblers and healthy controls on the neurocognitive tasks could be due to addictive behavior features rather than impulsive behavior.

Speed-accuracy tradeoff in decision-making performance among pathological gamblers.

BACKGROUND: Pathological gambling is classified as an impulse control disorder in the DSM-IV-TR; however, few studies have investigated the relationship between gambling behavior and impulsive decision-making in time-non-limited situations. METHODS: The subjects performed the Matching Familiar Figures Test (MFFT). The MFFT investigated the reflection-impulsivity dimension in pathological gamblers (n = 82) and demographically matched healthy subjects (n = 82). RESULTS: Our study demonstrated that pathological gamblers had a significantly higher rate of errors than healthy controls (p = 0.01) but were not different in terms of response time (p = 0.49). We found a similar power of correlation between the number of errors and response time in both pathological gamblers and controls. We may conclude that impaired performance of our pathological gamblers as compared to controls in a situation without time limit pressure cannot be explained by a trade-off of greater speed at the cost of less accuracy. CONCLUSIONS: The results of our study showed that pathological gamblers tend to make more errors but do not exhibit quicker responses as compared to the control group. Diminished MFFT performance in pathological gamblers as compared to controls supports findings of previous studies which show that pathological gamblers have impaired decision-making. Further controlled studies with a larger sample size which examine MFFT performance in pathological gamblers are necessary to confirm our results.

Stroop performance in major depression: selective attention impairment or psychomotor slowness?

BACKGROUND: Numerous neuropsychological studies reported impaired Stroop performance in major depressive disorder (MDD) patients. METHODS: The present study attempted to identify possible neuropsychological mechanisms involved in this impairment in untreated MDD outpatients (n=75) as compared to healthy subjects (n=83). Inspection Time, Finger Tapping, Simple and Choice Reaction Time were considered as measures of perceptual, motor, psychomotor speed, and response selection, respectively. RESULTS: MDD patients performed significantly slower than healthy controls in the neutral and the congruent conditions, but not in the incongruent ones. In order to identify predictors of Stroop performance, linear hierarchical regressions analyses were performed. Age, motor and psychomotor speed were predictors of response time and accuracy on Stroop performance. Significant correlations between response time and the number of errors in all three Stroop conditions were found in MDD patients, while such a correlation was obtained in the healthy controls only in the incongruent condition. LIMITATIONS: Although education was included as a covariate in our analyses, suggesting that the observed effects could not be ascribed to education differences, further testing with education-matched samples is warranted. CONCLUSIONS: Our study shows that the Stroop task performance is affected by both aging and MDD. Impairment in the Stroop performance can be predicted by psychomotor slowness and by vigilance level in MDD outpatients, but not by impairment of selective attention per se.

Neuropsychological mechanisms of Digit Symbol Substitution Test impairment in Asperger Disorder.

Our aim was to investigate the neurocognitive mechanisms recruited by adolescents with Asperger Disorder (AD), in comparison to controls, and to detect the underlying mechanisms during the complex information processing required for the performance of the Digit Symbol Substitution Test (DSST). Male adolescents (n=23; mean age 15.1+/-3.6 years) with a DSM-IV diagnosis of AD were compared with a normal male control group with similar demographic characteristics (n=43; mean age: 15.1+/-3.6 years). A computerized neurocognitive battery was administered and included: Inspection Time (IT), Finger Tapping Test (FTT), Simple Reaction Time (SRT), Choice Reaction Time (CRT), Digit Running task (DRT), Stroop test and Digit Symbol Substitution Test (DSST). Adolescents with AD performed significantly worse than controls on the DSST. This impaired DSST performance was related to cognitive mechanisms different from those employed by normal controls. Motor slowness and inability to deal with increased amounts of information affected the performance of the AD group, while shifting of attention was the limiting factor in the controls. Both groups were similarly dependent on response selection. This study demonstrated differences in performance in complex cognitive tasks between adolescents with AD and normal controls that may be related to differences in neurocognitive mechanisms underlying information processing. Future neuroimaging studies are needed to clarify the neural network involved in the differences in cognitive performance between AD subjects and normal controls.

Antipsychotic treatment in schizophrenia: the role of computerized neuropsychological assessment.

The present study analyzes the role of neurocognitive assessment instruments in the detection of the contribution of antipsychotic treatment to cognitive functioning. Recently, a panel of experts suggested six main domains (working memory; attention/vigilance; verbal/visual learning and memory; reasoning and problem solving; speed of processing) implicated in schizophrenia-related cognitive deficits, which serve as a theoretical base for creation of real-time computerized neurocognitive batteries. The high sensitivity of computerized neuropsychological testing is based on their ability to adopt the reaction time (RT) paradigm for the assessment of brain function in a real-time regime. This testing is highly relevant for the monitoring of the cognitive effects of antipsychotics. Computerized assessment assists in the identification of state- and trait-related cognitive impairments. The optimal real-time computerized neurocognitive battery should composite balance between broad and narrow coverage of cognitive domains relevant to the beneficial effects of antipsychotics and will enable better planning of treatment and rehabilitation programs.

Go-no-go performance in pathological gamblers.

Previous neuropsychological studies demonstrated various deficits of impulse control in pathological gamblers (PGs). However, there are limited data available on response-inhibition impairment among PGs. The present study attempted to assess response inhibition in untreated PGs (N=83), in comparison with normal subjects (N=84). Go/no-go and target-detection conditions of a computerized task were used as a measure of response-inhibition ability. A repeated measures analysis of covariance (ANCOVA-RM) was used with response time, variability of response time, and number of false alarms and misses as dependent measures; group (PG and controls) as the between-subjects measure; condition (target detection or go/no-go) and time slice (first and second in each condition) as repeated measures within-subject factors; and educational level as a covariate. Our results showed that PGs were significantly more impaired in both target detection and go/no-go task performance than controls. The PGs had significantly more false alarms and misses than controls, and they were slower and less consistent in their responses.

Why do young women smoke? III. Attention and impulsivity as neurocognitive predisposing factors.

Since nicotine has been shown to facilitate sustained attention and control of impulsivity, impairment in these domains may influence individuals who initiate smoking for various reasons to continue to smoke cigarettes. The purpose of this study was to determine whether young women who smoke regularly but are not abstinent at the time of testing, differ in their cognitive functioning from non-smokers and whether they resemble women who smoked in the past but quit. Female undergraduate students aged 20-30 years were recruited by advertisement from institutes of higher education in the Jerusalem area. The study sample consisted of 91 current smokers (CS), 40 past smokers (PS) and 151 non-smokers (NS). 46 occasional smokers (OS) were also tested. Confounding by withdrawal state was neutralized by including only CS and OS who smoked their last cigarette less than 90 min before testing. Subjects performed a computerized neurocognitive battery, which tests the domains of attention, memory, impulsivity, planning, information processing and motor performance. Analyses were controlled for age. The results showed that CS made significantly more errors than NS on the Continuous Performance Task (CPT), Matching Familiar Figures Test (MFFT) and Tower of London (TOL) test. PS were significantly worse than NS on the MFFT and TOL test. PS did not differ significantly from CS on any test. No association was found between duration of smoking and performance. These findings suggest that a neurocognitive profile characterized by impairments in sustained attention and control of impulsivity may be one of the factors that predispose young women who initiate cigarette smoking to maintain the habit.