Personalized virtual reality exposure for panic disorder and agoraphobia: A preliminary neurophysiological study.

BACKGROUND: Personalization is considered an important principle in virtual reality (VR) exposure therapy. We aimed to identify whether personalized VR exposure could provoke increased anxiety in patients with panic disorder and agoraphobia as it is considered the first step in successful treatment for anxiety. METHODS: We performed a double-arm, one-day preliminary study among 28 patients with panic disorder and agoraphobia. Three sessions of VR exposure, including a theater, train, and elevator scenario, were conducted in two groups. In the personalized group (n = 14), the brightness and crowd density were customized based on a pre-assessment. In the control group (n = 14), these conditions were fully randomized. Self-reported anxiety, heart rate, skin conductance, and electroencephalography were measured before, during, and after the VR sessions. RESULTS: In the later VR sessions, higher self-reported anxiety levels measured by the Visual Analogue Scale were observed in the personalized exposure group. Increased heart rates during and after the VR sessions were observed in the personalized group. The changes in skin conductance peaks were not significantly different between the groups, but the increase in skin conductance was associated with the participants' perception of presence. The electroencephalogram showed widespread increases in alpha waves in the frontal and temporal areas of the brain in the personalized group than in the control group. CONCLUSION: Personalized VR exposure elicits stronger anxiogenic effects in patients with panic disorder and agoraphobia as suggested by self-report and neurophysiological data. Personalization of VR exposure has the potential for effective behavioral therapy.

Clinical Advances in Treatment Strategies for Obsessive-compulsive Disorder in Adults.

In the present article, we provide a comprehensive review of the treatment strategies for obsessive-compulsive disorder (OCD), a common, chronic, and often debilitating disorder, characterized by overwhelming obsessions and compulsions. OCD typically starts in childhood or adolescence and persists throughout life, causing functional impairment across multiple domains. The article begins by describing the historical concepts of OCD from religious and guilt-based explanations to psychoanalytic perspectives, and then explores the changing understanding of OCD as a treatable condition. Recent advances include the development of evidence-based psychological treatments, such as exposure and response prevention, and pharmacological treatments, such as selective serotonin reuptake inhibitors. The latest version of the Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases, has removed OCD from the anxiety disorder grouping and regrouped it into obsessive-compulsive and related disorders. We conclude by highlighting the current state of knowledge and development in the clinical management of OCD, including recommendations for first- and second-line treatments, alternative, or augmentative strategies for and novel agents under investigation for OCD. In future, the latest advances in neuroimaging, electrophysiology, digital technology, and data-driven analysis will help elucidate the pathophysiology of OCD and develop personalized intervention strategies.

Social Stigma and Discrimination Toward People With Drug Addiction: A National Survey in Korea.

OBJECTIVE: This study aims to understand the attitudes, stigma, and discrimination of the general adult population toward drug addiction. METHODS: We conducted a cross-sectional nationwide survey with 1,020 Korean adults using an Internet web-based panel. Self-reported data were collected on demographics, experience with substance abuse, perceptions of narcotic analgesic use, beliefs about the legalization of cannabis use, coping with substance abuse and addiction, and perceptions of drug risks. All statistical analysis in this study utilized the IBM SPSS Statistics 26 program. RESULTS: In this study, 1.6% of the participants reported abuse of opioid analgesics, 88.0% reported negative perceptions of drug addiction, and 76.9% reported agreeing to unfair treatment of drug addicts. Logistic regression analysis found that perceived stigma was more prevalent among women (odd ratio [OR]=2.087, p<0.01), old adults (OR=1.939, p<0.01), those with no personal experience of opioid misuse (OR=8.172, p<0.05), and those who were non-smoking (OR=2.011, p<0.01). In addition, the discriminatory attitude was more prevalent among participants with higher income (OR=1.989, p<0.001) and those who are non-smoking (OR=1.608, p<0.05). CONCLUSION: This study provides information and guidelines for public intervention in drug addiction by identifying factors influencing social stigma and discriminatory behaviors toward drug addiction. The findings suggest that education on drug addiction prevention for the general adult population is necessary, and this education should include knowledge on coping with drug addiction and reducing stigma and discrimination toward drug addicts.

New empirical formula for neutron dose level at the maze entrance of 15 MV medical accelerator facilities.

An easily applicable empirical formula was derived for use in the assessment of the photoneutron dose at the maze entrance of a 15 MV medical accelerator treatment room. The neutron dose equivalent rates around the Varian medical accelerator head calculated with the Monte Carlo code MCNPX were used as the source term in producing the base data. The dose equivalents were validated by measurements with bubble detectors. Irradiation geometry conditions expected to yield higher neutron dose rates in the maze were selected: a 20 x 20 cm2 irradiation field, gantry rotation plane parallel to the maze walls, and the photon beams directed to the opposite wall to the maze entrance. The neutron dose equivalents at the maze entrance were computed for 697 arbitrary single-bend maze configurations by extending the Monte Carlo calculations down to the maze entrance. Then, the empirical formula was derived by a multiple regression fit to the neutron dose equivalents at the maze entrance for all the different maze configurations. The goodness of the empirical formula was evaluated by applying it to seven operating medical accelerators of different makes. When the source terms were fixed, the neutron doses estimated from the authors' formula agreed better with the corresponding MCNPX simulations than the results of the Kersey method. In addition, compared with the Wu-McGinley formula, the authors' formula provided better estimates for the mazes with length longer than 8.5 m. There are, however, discrepancies between the measured dose rates and the estimated values from the authors' formula, particularly for the machines other than a Varian model. Further efforts are needed to characterize the neutron field at the maze entrance to reduce the discrepancies. Furthermore, neutron source terms for the machines other than a Varian model should be simulated or measured and incorporated into the formula for accurate extended application to a variety of models.

Changes of brain potentials in response to smoking-induced stimuli in smokers.

Changes in P300 amplitude were used as an indicator of reactivity to smoking-related stimuli in smokers. The amplitude of P300--a component of event-related brain potentials (ERPs) elicited by 10 smoking-related (craving), 10 antismoking (aversive) and 10 neutral stimuli-- was recorded in smokers (n=10) and nonsmokers (n=10). Electroencephalography (EEG) data were obtained by the Laxtha EEG-monitoring device in the EEG recording room, and were recorded at F3, F4, C3, and C4. Three-way repeated-measures analysis of variance (ANOVA) was computed on the P300 amplitudes. The factors were group (smokers, nonsmokers), stimulus (craving, aversive, neutral), and electrode location (F3, F4, C3, and C4). The main effects of stimulus were significant, but the group effects did not show significant interactions with other factors. An interesting observation was the similarity between P300 waveforms for craving and aversive stimuli in smokers. These findings could indicate that the antismoking-related response is similar to the smoking-related one.

Effects of the combination of P3-based GKT and reality monitoring on deceptive classification.

The study aimed to investigate whether a combination of the P3-based Guilty Knowledge Test (GKT) and reality monitoring (RM) distinguished between individuals who are guilty, witnesses, or informed, and using both tests provided more accurate information than did the use of either measure alone. Participants consisted of 45 males that were randomly and evenly assigned to three groups (i.e., guilty, witness, and informed). The guilty group conducted a mock crime where they intentionally crashed their vehicle into another vehicle in a virtual environment (VE). As those in the witness group drove their own vehicles, they observed the guilty groups' vehicle crash into another vehicle. The informed group read an account and saw screenshots of the accident. All participants were instructed to insist that they were innocent. Subsequently, they performed the P3-based GKT and wrote an account of the accident for the RM analysis. A higher P3 amplitude corresponded to how well the participants recognized the presented stimulus, and a higher RM score corresponded to how well the participants reported vivid sensory information and how much less they reported uncertain information. Findings for the P3-based GKT indicated that the informed group showed lower P3 amplitude when presented with the probe stimulus than did the guilty and witness groups. Regarding the RM analysis, the informed group obtained higher RM scores on visual, temporal, and spatial details and lower scores on cognitive operations than the guilty and witness groups. Finally, discriminant analysis revealed that the combination of the P3-based GKT and RM more accurately distinguished between the three groups than the use of either measure alone. The findings suggest that RM may build upon a weakness of the P3-based GKT's. More specifically, it may build upon its susceptibility to the leakage of information about the crime, therefore helping protect innocent individuals who have information about a crime from being perceived as guilty.

Serum S100B Levels and Major Depressive Disorder: Its Characteristics and Role in Antidepressant Response.

OBJECTIVE: S100B is a neurotrophic factor that is involved in neuroplasticity. Neuroplasticity is disrupted in depression; however, treatment with antidepressants can restore neuroplasticity. S100B has previously been used as a biological marker for neuropathology and neuroplasticity; therefore, in this study, we compared serum S100B levels in depressive patients to those of normal controls. In addition, we compared the serum S100B levels of antidepressant responders to those of nonresponders. METHODS: Thirty five normal controls and 59 depressive patients were enrolled in this study. Depressive patients entered a 6 week clinical trial that included treatment with antidepressants. The serum S100B levels and clinical assessments, which included Hamilton depression rating scores, were measured at baseline and after 6 weeks of treatment with antidepressants. The difference in the serum S100B levels between depressive patients and normal controls and between antidepressant responders and nonresponders was then compared. RESULTS: There were no significant differences in the serum S100B levels of normal controls and depressive patients. In addition, 30 of the depressive patients responded to antidepressant treatment while 29 did not. Finally, the responders had significantly higher baseline serum S100B levels than the nonresponders. CONCLUSION: The results of this study suggest that the baseline serum S100B level is associated with the subsequent response to antidepressants. In addition, the high baseline serum S100B level that was observed in depressive patients may enhance neuroplasticity, which results in a favorable therapeutic response to antidepressants.