Management of psoriatic arthritis by dermatologists - a German nationwide survey.

BACKGROUND AND OBJECTIVES: Psoriatic arthritis (PsA) warrants early diagnosis and treatment for optimal results. This study aimed to elucidate routine monitoring activities for PsA with concurrent psoriasis (PsO) by dermatologists to gather data on how conditions for optimal treatment are ensured. PATIENTS AND METHODS: This non-interventional, prospective, epidemiological, cross-sectional study (2016-2019) included patients with confirmed PsA from dermatologists. Descriptive statistics were conducted for center and patient characteristics as well as for data of PsA monitoring and treatment stratified by different center types. RESULTS: 212 patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. The majority of the PsA patients were diagnosed by a rheumatologist (> 55% in each center type) at an early or intermediate stage (> 59%). Treatment was initiated most frequently by a dermatologist (office-based physicians: 69.6%, hospitals: 60.9%, university hospitals: 82.9%). Patients were treated with biologics more frequently in university hospitals (single therapy: 43.9%, in combination with systemic therapy: 26.8%) compared to private practices (single: 44.6%, combination: 13.5%) and non-university hospitals (single: 34.8%, combination: 8.7%). CONCLUSIONS: As PsA diagnosis was performed most frequently by rheumatologists whereas treatment was primarily initiated by dermatologists, an optimal collaboration between these specialists is crucial.

Linking neurophysiological processes of action monitoring to post-response speed-accuracy adjustments in a neuro-cognitive diffusion model.

The cognitive system needs to continuously monitor actions and initiate adaptive measures aimed at increasing task performance and avoiding future errors. To investigate the link between the contributing cognitive processes, we introduce the neuro-cognitive diffusion model, a statistical approach that allows a combination of computational modelling of behavioural and electrophysiological data on a single-trial level. This unique combination of methods allowed us to demonstrate across three experimental datasets that early response monitoring (error negativity; Ne/c) was related to more response caution and increased attention on task-relevant features on the subsequent trial, thereby preventing future errors, whereas later response monitoring (error positivity, Pe/c) maintained the ability of responding fast under speed pressure. Our results suggest that Pe/c-related processes might keep Ne/c-related processes in check regarding their impact on post-response adaptation to reconcile the conflicting criteria of fast and accurate responding.

The influence of error detection and error significance on neural and behavioral correlates of error processing in a complex choice task.

Error detection and error significance form essential mechanisms that influence error processing and action adaptation. Error detection often is assessed by an immediate self-evaluation of accuracy. Our study used cognitive neuroscience methods to elucidate whether self-evaluation itself influences error processing by increasing error significance in the context of a complex response selection process. In a novel eight-alternative response task, our participants responded to eight symbol stimuli with eight different response keys and a specific stimulus-response assignment. In the first part of the experiment, the participants merely performed the task. In the second part, they also evaluated their response accuracy on each trial. We replicated variations in early and later stages of error processing and action adaptation as a function of error detection. The additional self-evaluation enhanced error processing on later stages, probably reflecting error evidence accumulation, whereas earlier error monitoring processes were not amplified. Implementing multivariate pattern analysis revealed that self-evaluation influenced brain activity patterns preceding and following the response onset, independent of response accuracy. The classifier successfully differentiated between responses from the self- and the no-self-evaluation condition several hundred milliseconds before response onset. Subsequent exploratory analyses indicated that both self-evaluation and the time on task contributed to these differences in brain activity patterns. This suggests that in addition to its effect on error processing, self-evaluation in a complex choice task seems to have an influence on early and general processing mechanisms (e.g., the quality of attention and stimulus encoding), which is amplified by the time on task.

Face Perception and Narcissism: Variations of Event-Related Potential Components (P1 & N170) with Admiration and Rivalry.

Previous studies have demonstrated that highly narcissistic individuals perceive themselves as grandiose and devaluate and sometimes overvalue others. These results are mainly based on behavioural data, but we still know little about the neural correlates underlying, such as perceptional processes. To this end, we investigated event-related potential components (ERP) of visual face processing (P1 and N170) and their variations with narcissism. Participants (N = 59) completed the Narcissistic Admiration and Rivalry Questionnaire and were shown pictures of their own face, a celebrity's face, and a stranger's face. Variations of P1 and N170 with Admiration and Rivalry were analysed using multilevel models. Results revealed moderating effects of both narcissism dimensions on the ERP components of interest. Participants with either high Admiration or low Rivalry scores showed a lower P1 amplitude when viewing their own face compared with when viewing a celebrity's face. Moreover, the Self-Stranger difference in the N170 component (higher N170 amplitude in the Self condition) was larger for higher Rivalry scores. The findings showed, for the first time, variations of both narcissism dimensions with ERPs of early face processing. We related these effects to processes of attentional selection, an expectancy-driven perception, and the mobilisation of defensive systems. The results demonstrated that by linking self-report instruments to P1 and N170, and possibly to other ERP components, we might better understand self- and other-perception in narcissism.

Performance monitoring beyond choice tasks: The time course of force execution monitoring investigated by event-related potentials and multivariate pattern analysis.

Accurate force production is an essential motor function which, in most cases, requires continuous performance monitoring. Unlike choice-response tasks with two response alternatives, the accuracy in a force production paradigm is defined as an area between an upper and lower limit on the force continuum. In the present study, we investigated the neural mechanisms underlying force production. We used a force production task in which the participants (n = 48) were asked to exert a brief force pulse within a specific force range. This allowed: (1) investigation of action monitoring activity during force execution using response-locked and feedback-locked event-related potential (ERP) components known to be involved in error monitoring; (2) multivariate pattern analysis (MVPA) for ERPs. We found that the different force production ranges (characterised as too low, correct, and too high with respect to the target force range) showed no clear error-specific variations in the ERP components of interest. MVPA, on the other hand, allowed for successful classification, not only between the correct and the incorrect outcome conditions, but also between the two incorrect outcome conditions. This suggests that the classifier identified neural patterns reflecting the force magnitude rather than the correctness of a response. Moreover, additional support-vector regression (SVR) analyses showed that single-trial response parameters (i.e. peak force and time-to-peak) could be decoded from the brain activity pattern starting from 140 ms (for peak force) and 270 ms (for time-to-peak) before the response onset. These results indicate that the motor program defined the magnitude and timing of the force pulse before response execution, while the correctness of that response (in relation to the "default force" required) was not yet foreshadowed in neural signals. Finally, this study presents the first evidence of a post-error force adjustment mechanism, for which participants produced a higher force in trials after under-producing the required force, and a lower force in trials after over-producing the required force.

Error detection across the adult lifespan: Electrophysiological evidence for age-related deficits.

With increasing age, cognitive control processes steadily decline. Prior research suggests that healthy older adults have a generally intact performance monitoring system, but show specific deficits in error awareness, i.e., the ability to detect committed errors. We examined the neural processing of errors across the adult lifespan (69 participants; age range 20-72 years) by analysing the error (-related) negativity (Ne/ERN) and the error positivity (Pe) using an adapted version of the Go/Nogo task. At a stable overall error rate, higher age was associated with a greater proportion of undetected errors. While the Ne/ERN was associated with the processing of errors in general, the Pe amplitude was modulated by detected errors only. Furthermore, the Pe amplitude for detected errors was significantly smaller in older adults, in contrast to the Ne/ERN amplitude which did not show age-related changes. Structural path models suggested that through those age-related changes in Pe amplitude, an indirect effect on the performance was observed. Our results confirm and extend previous extreme-group based findings about specific deficits in error detection associated with higher age using age as a continuous predictor. Age-related reductions in Pe amplitude, associated with more undetected errors, are independent of early error processing, as evidenced by the preserved Ne/ERN.

From Positivity to Negativity Bias: Ambiguity Affects the Neurophysiological Signatures of Feedback Processing.

Previous studies on the neurophysiological underpinnings of feedback processing almost exclusively used low-ambiguity feedback, which does not fully address the diversity of situations in everyday life. We therefore used a pseudo trial-and-error learning task to investigate ERPs of low- versus high-ambiguity feedback. Twenty-eight participants tried to deduce the rule governing visual feedback to their button presses in response to visual stimuli. In the blocked condition, the same two feedback words were presented across several consecutive trials, whereas in the random condition feedback was randomly drawn on each trial from sets of five positive and five negative words. The feedback-related negativity (FRN-D), a frontocentral ERP difference between negative and positive feedback, was significantly larger in the blocked condition, whereas the centroparietal late positive complex indicating controlled attention was enhanced for negative feedback irrespective of condition. Moreover, FRN-D in the blocked condition was due to increased reward positivity (Rew-P) for positive feedback, rather than increased (raw) FRN for negative feedback. Our findings strongly support recent lines of evidence that the FRN-D, one of the most widely studied signatures of reinforcement learning in the human brain, critically depends on feedback discriminability and is primarily driven by the Rew-P. A novel finding concerned larger frontocentral P2 for negative feedback in the random but not the blocked condition. Although Rew-P points to a positivity bias in feedback processing under conditions of low feedback ambiguity, P2 suggests a specific adaptation of information processing in case of highly ambiguous feedback, involving an early negativity bias. Generalizability of the P2 findings was demonstrated in a second experiment using explicit valence categorization of highly emotional positive and negative adjectives.

How personal standards perfectionism and evaluative concerns perfectionism affect the error positivity and post-error behavior with varying stimulus visibility.

Error detection is required in order to correct or avoid imperfect behavior. Although error detection is beneficial for some people, for others it might be disturbing. We investigated Gaudreau and Thompson's (Personality and Individual Differences, 48, 532-537, 2010) model, which combines personal standards perfectionism (PSP) and evaluative concerns perfectionism (ECP). In our electrophysiological study, 43 participants performed a combination of a modified Simon task, an error awareness paradigm, and a masking task with a variation of stimulus onset asynchrony (SOA; 33, 67, and 100 ms). Interestingly, relative to low-ECP participants, high-ECP participants showed a better post-error accuracy (despite a worse classification accuracy) in the high-visibility SOA 100 condition than in the two low-visibility conditions (SOA 33 and SOA 67). Regarding the electrophysiological results, first, we found a positive correlation between ECP and the amplitude of the error positivity (Pe) under conditions of low stimulus visibility. Second, under the condition of high stimulus visibility, we observed a higher Pe amplitude for high-ECP-low-PSP participants than for high-ECP-high-PSP participants. These findings are discussed within the framework of the error-processing avoidance hypothesis of perfectionism (Stahl, Acharki, Kresimon, Völler, & Gibbons, International Journal of Psychophysiology, 97, 153-162, 2015).

The more you ignore me the closer I get: An ERP study of evaluative priming.

We used event-related brain potentials (ERPs) to investigate the various mental processes contributing to evaluative priming-that is, more positive judgments for targets preceded by affectively positive, as opposed to negative, prime stimuli. To ensure ecological validity, we employed a priori meaningful landscape pictures as targets and emotional adjectives as visual primes and presented both primes and targets for relatively long durations (>1 s). Prime-related lateralized readiness potentials (LRPs) revealed response priming as one source of the significant evaluative priming effect. On the other hand, greater right-frontal positive slow wave in the ERP for pictures following negative, as compared with positive, primes indicated altered impression formation, thus supporting automatic spreading activation and/or affect misattribution accounts. Moreover, target LRPs suggested conscious counter-control to reduce the evaluative priming net effect. Finally, when comparing prime ERPs for two groups of participants showing strong versus weak evaluative priming, we found strong evidence for the role of depth of prime processing: In the weak-effect group, prime words evoked an increased visual P1/N1 complex, a larger posterior P2 component, and a greater left-parietal processing negativity presumably reflecting semantic processing. By contrast, a larger medial-frontal P2/N2 complex in the strong-effect group suggested top-down inhibition of the prime's emotional content. Thus, trying to ignore the primes can actually increase, rather than decrease, the evaluative priming effect.

Motor inhibition errors and interference suppression errors differ systematically on neural and behavioural features of response monitoring.

Action inhibition and error commission are prominent in everyday life. Inhibition comprises at least two facets: motor inhibition and interference suppression. When motor inhibition fails, a strong response impulse cannot be inhibited. When interference suppression fails, we become distracted by irrelevant stimuli. We investigated the neural and behavioural similarities and differences between motor inhibition errors and interference suppression errors systematically from stimulus-onset to post-response adaptation. To enable a direct comparison between both error types, we developed a complex speeded choice task where we assessed the error types in two perceptually similar conditions. Comparing the error types along the processing stream showed that the P2, an early component in the event-related potential associated with sensory gating, is the first marker for differences between the two error types. Further error-specific variations were found for the parietal P3 (associated with context updating and attentional resource allocation), for the lateralized readiness potential (LRP, associated with primary motor cortex activity), and for the Pe (associated with error evidence accumulation). For motor inhibition errors, the P2, P3 and Pe tended to be enhanced compared to successful inhibition. The LRP for motor inhibition errors was marked by multiple small response impulses. For interference suppression errors, all components were more similar to those of successful inhibition. Together, these findings suggest that motor inhibition errors arise from a deficient early inhibitory process at the perceptual and motor level, and become more apparent than interference suppression errors, that arise from an impeded response selection process.

Neural correlates of confidence during decision formation in a perceptual judgment task.

When we make a decision, we also estimate the probability that our choice is correct or accurate. This probability estimate is termed our degree of decision confidence. Recent work has reported event-related potential (ERP) correlates of confidence both during decision formation (the centro-parietal positivity component; CPP) and after a decision has been made (the error positivity component; Pe). However, there are several measurement confounds that complicate the interpretation of these findings. More recent studies that overcome these issues have so far produced conflicting results. To better characterise the ERP correlates of confidence we presented participants with a comparative brightness judgment task while recording electroencephalography. Participants judged which of two flickering squares (varying in luminance over time) was brighter on average. Participants then gave confidence ratings ranging from "surely incorrect" to "surely correct". To elicit a range of confidence ratings we manipulated both the mean luminance difference between the brighter and darker squares (relative evidence) and the overall luminance of both squares (absolute evidence). We found larger CPP amplitudes in trials with higher confidence ratings. This association was not simply a by-product of differences in relative evidence (which covaries with confidence) across trials. We did not identify postdecisional ERP correlates of confidence, except when they were artificially produced by pre-response ERP baselines. These results provide further evidence for neural correlates of processes that inform confidence judgments during decision formation.

The association of dispositional anxiety with the NoGo N2 under relaxation instruction versus speed/accuracy instruction.

Prior research suggests that cognitive control, indicated by NoGo N2 amplitudes in Go/NoGo tasks, is associated with dispositional anxiety. This negative association tends to be reduced in anxiety-enhancing experimental conditions. However, anxiety-reducing conditions have not yet been investigated systematically. Thus, the present study compares the effect of a relaxation instruction with the conventional speed/accuracy instruction in a Go/NoGo task on the correlation of the NoGo N2 with two subconstructs of dispositional anxiety, namely anxious apprehension and anxious arousal. As the test of differences between correlations needs considerable statistical power, the present study was included into the multi-lab CoScience Project. The hypotheses, manipulation checks, and the main path of pre-processing and statistical analysis were preregistered. Complete data sets of 777 participants were available for data analysis. Preregistered general linear models revealed that the different instructions of the task (speed/accuracy vs. relaxation) had no effect on the association between dispositional anxiety and the NoGo N2 amplitude in general. This result was supported by Cooperative-Forking-Path analysis. In contrast, a preregistered latent growth model with categorical variables revealed that anxious arousal was a negative predictor of the NoGo N2 intercept and a positive predictor of the NoGo N2 slope. Non-preregistered growth models, allowing for correlations of anxious apprehension with anxious arousal, revealed that higher anxious apprehension scores were associated with more negative NoGo N2 amplitudes with increased relaxation. Results are discussed in the context of the compensatory error monitoring hypothesis and the revised Reinforcement Sensitivity Theory.

Predicting perceptual decision biases from early brain activity.

Perceptual decision making is believed to be driven by the accumulation of sensory evidence following stimulus encoding. More controversially, some studies report that neural activity preceding the stimulus also affects the decision process. We used a multivariate pattern classification approach for the analysis of the human electroencephalogram (EEG) to decode choice outcomes in a perceptual decision task from spatially and temporally distributed patterns of brain signals. When stimuli provided discriminative information, choice outcomes were predicted by neural activity following stimulus encoding; when stimuli provided no discriminative information, choice outcomes were predicted by neural activity preceding the stimulus. Moreover, in the absence of discriminative information, the recent choice history primed the choices on subsequent trials. A diffusion model fitted to the choice probabilities and response time distributions showed that the starting point of the evidence accumulation process was shifted toward the previous choice, consistent with the hypothesis that choice priming biases the accumulation process toward a decision boundary. This bias is reflected in prestimulus brain activity, which, in turn, becomes predictive of future decisions. Our results provide a model of how non-stimulus-driven decision making in humans could be accomplished on a neural level.

Levels of visuo-spatial selection: an ERP study of negative priming.

Usually, a probe target appearing in a recently ignored distractor location is less efficiently processed. This robust phenomenon is called (visuo-) spatial negative priming (SNP). Among other explanations, concepts of persisting or retrieved spatial inhibition play a major role. Two relevant issues were investigated using event-related brain potentials (ERPs). The first pertains to context sensitivity of inhibition: Is a probe distractor necessary for SNP? The second concerns levels of processing at which spatial inhibition operates: Does SNP affect perception, selection, and/or stimulus classification? A localization task with and without probe distractors was employed while 64-channel EEG was recorded. Obviously, SNP does not require a probe distractor; the distractor-absent SNP effect was larger than the distractor-present SNP effect. Distractor-present SNP had two lateralized ERP effects, N1pc amplitude reduction and N2pc amplitude increase. Smaller N1pc may indeed reflect perceptual decrement, but was inversely related to size of behavioral SNP. By contrast, only strong-SNP participants showed N2pc increase, which points to selection disadvantage due to persisting inhibition of higher-level spatial representations. Distractor-absent SNP had no N1pc/N2pc correlates; instead, reduced amplitude of a broadly distributed P300 component suggests impaired stimulus classification due to episodic retrieval of inappropriate prime information. Overall, SNP seems to emerge from relatively late stages of processing, thus challenging the idea of context-free persisting inhibition of low-level spatial representations. Furthermore, distractor-present and distractor-absent SNP are qualitatively different from each other.

Perfectionism-related variations in error processing in a task with increased response selection complexity.

Perfectionists strive for a flawless performance because they are intrinsically motivated to set and achieve high goals (personal standards perfectionism; PSP) and/or because they are afraid to be negatively evaluated by others (evaluative concern perfectionism; ECP). We investigated the differential relationships of these perfectionism dimensions with performance, post-response adaptation, error processing (reflected by two components of the event-related potential: error/correct negativity - Ne/c; error/correct positivity - Pe/c) and error detection. In contrast to previous studies, we employed a task with increased response selection complexity providing more room for perfectionistic dispositions to manifest themselves. Although ECP was related to indicators of increased preoccupation with errors, high-EC perfectionists made more errors than low-EC perfectionists. This observation may be explained by insufficient early error processing as indicated by a reduced Ne/c effect and a lack of post-response adaptation. PSP had a moderating effect on the relationship between ECP and early error processing. Our results provide evidence that pure-EC perfectionists may spend many of their cognitive resources on error-related contents and worrying, leaving less capacity for cognitive control and thus producing a structural lack of error processing.

Narcissism and the perception of failure - evidence from the error-related negativity and the error positivity.

The literature on narcissism suggests two contradictory ways how highly narcissistic individuals deal with their failures: They might avoid consciously recognising their failures to protect their ego or they might vigilantly turn towards their failures to process cues that are important for maintaining their grandiosity. We tried to dissolve these contradictory positions by studying event-related potential components of error processing and their variations with narcissism. With a speeded go/no-go task, we examined how the error-related negativity (Ne; reflecting an early, automatic processing stage) and the error positivity (Pe; associated with conscious error detection) vary with Admiration and Rivalry, two narcissism dimensions, under ego-threatening conditions. Using multilevel models, we showed that participants with high Rivalry displayed higher Ne amplitudes suggesting a heightened trait of defensive reactivity. We did not find variations of either narcissism dimension with the Pe, which would have pointed to weaker error awareness. Thus, our results only supported the second position: a heightened vigilance to errors in narcissism at early, rather automatic processing stages.

Larger error negativity peak amplitudes for accuracy versus speed instructions may reflect more neuro-cognitive alignment, not more intense error processing.

Understanding human error processing is a highly relevant interdisciplinary goal. More than 30 years of research in this field have established the error negativity (Ne) as a fundamental electrophysiological marker of various types of erroneous decisions (e.g. perceptual, economic) and related clinically relevant variations. A common finding is that the Ne is more pronounced when participants are instructed to focus on response accuracy rather than response speed, an observation that has been interpreted as reflecting more thorough error processing. We challenge this wide-spread interpretation by demonstrating that when controlling for the level of non-event-related noise in the participant-average waveform and for single-trial peak latency variability, the significant speed-accuracy difference in the participant-average waveform vanishes. This suggests that the previously reported Ne differences may be mostly attributable to a more precise alignment of neuro-cognitive processes and not (only) to more intense error processing under accuracy instructions, opening up novel perspectives on previous findings.

The relationship between response dynamics and the formation of confidence varies across the lifespan.

Accurate metacognitive judgments, such as forming a confidence judgment, are crucial for goal-directed behavior but decline with older age. Besides changes in the sensory processing of stimulus features, there might also be changes in the motoric aspects of giving responses that account for age-related changes in confidence. In order to assess the association between confidence and response parameters across the adult lifespan, we measured response times and peak forces in a four-choice flanker task with subsequent confidence judgments. In 65 healthy adults from 20 to 76 years of age, we showed divergent associations of each measure with confidence, depending on decision accuracy. Participants indicated higher confidence after faster responses in correct but not incorrect trials. They also indicated higher confidence after less forceful responses in errors but not in correct trials. Notably, these associations were age-dependent as the relationship between confidence and response time was more pronounced in older participants, while the relationship between confidence and response force decayed with age. Our results add to the notion that confidence is related to response parameters and demonstrate noteworthy changes in the observed associations across the adult lifespan. These changes potentially constitute an expression of general age-related deficits in performance monitoring or, alternatively, index a failing mechanism in the computation of confidence in older adults.

Divergent effects of absolute evidence magnitude on decision accuracy and confidence in perceptual judgements.

Whether people change their mind after making a perceptual judgement may depend on how confident they are in their decision. Recently, it was shown that, when making perceptual judgements about stimuli containing high levels of 'absolute evidence' (i.e., the overall magnitude of sensory evidence across choice options), people make less accurate decisions and are also slower to change their mind and correct their mistakes. Here we report two studies that investigated whether high levels of absolute evidence also lead to increased decision confidence. We used a luminance judgment task in which participants decided which of two dynamic, flickering stimuli was brighter. After making a decision, participants rated their confidence. We manipulated relative evidence (i.e., the mean luminance difference between the two stimuli) and absolute evidence (i.e., the summed luminance of the two stimuli). In the first experiment, we found that higher absolute evidence was associated with decreased decision accuracy but increased decision confidence. In the second experiment, we additionally manipulated the degree of luminance variability to assess whether the observed effects were due to differences in perceived evidence variability. We replicated the results of the first experiment but did not find substantial effects of luminance variability on confidence ratings. Our findings support the view that decisions and confidence judgements are based on partly dissociable sources of information, and suggest that decisions initially made with higher confidence may be more resistant to subsequent changes of mind.