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Reis J, Hills S, Robinson T, Hills D. The feasibility and impact of a brief behavioural intervention for anxiety in later life: perceptions of general practice nurses. Contemp Nurse 2024; 60:356-366. [PMID: 38300752 DOI: 10.1080/10376178.2024.2310254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Anxiety is prevalent in older people and is associated with adverse health outcomes. Early detection and intervention are imperative, yet clinically significant anxiety in older people is often under-diagnosed. When diagnosed, pharmacotherapy is often the initial treatment, but resistance due to stigma, polypharmacy concerns, and side effects are common among the elderly. Non-pharmacological interventions such as deep breathing and progressive muscle relaxation may offer more acceptable and cost-effective options to managing anxiety. While primary care is ideal for addressing anxiety in older adults, it is important to assess the feasibility and acceptability of nurse-led interventions in general practice. OBJECTIVE To explore the perspectives of General Practice Nurses (GPNs) on the feasibility and acceptability of implementing a guided relaxation intervention for older people living with symptoms of anxiety, in Australian metropolitan and regional settings. METHODS GPNs were trained and then administered a guided relaxation intervention to older people at three metropolitan general practices and one large rural practice encompassing four sites. Subsequently, five GPNs participated in semi-structured interviews exploring the acceptability and feasibility of implementing the intervention. Interviews were recorded, transcribed and findings were mapped to four key domains of interest: "Screening", "Training and Delivery", "Perceived impact of the Intervention" and "Barriers to the intervention". RESULTS Overall, GPNs reported that the intervention was easy to implement, was well received, helped build relationships and enabled conversations about mental health and well-being. They noted broader applicability of acquired knowledge and skills with other clients. CONCLUSION The intervention shows promise in promoting and supporting healthcare capabilities in primary care. GPNs are ideally placed to detect clinical symptoms of anxiety among older people and deliver brief well-being initiatives. However, to sustain and scale well-being interventions structured skill development, commitment from general practices, and policy shifts such as government rebates for GPNs are required.
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Affiliation(s)
- Julie Reis
- School of Nursing and Midwifery, University of Newcastle, Taree, Australia
| | - Sharon Hills
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- School of Rural Health, Faculty of Medicine, Sydney University, Orange, Australia
| | - Danny Hills
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
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Ben Thabet J, Turki M, Mezghani M, Guermazi A, Mâalej M, Charfi N, Maalej M. Prevalence of the generalized anxiety disorder in Tunisia: A study of 707 primary care outpatients. Int J Psychiatry Med 2024:912174241263235. [PMID: 38898013 DOI: 10.1177/00912174241263235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study examined the prevalence and correlates of generalized anxiety disorder (GAD) among primary care outpatients. METHOD A multicenter, cross-sectional study was conducted that included 707 primary care outpatients being seen at 20 primary healthcare centers in Tunis and Sfax, Tunisia. The Mini International Neuropsychiatric Interview was used to identify a diagnosis of GAD. The Beck Depression Inventory was used to assess depressive symptom severity, and the Sheehan Disability Scale (SDS) was used to measure functional impairment. RESULTS The prevalence of GAD was 11%. GAD was positively correlated with female gender (P = .005), family history of psychiatric disorder (P < .001), personal history of suicide attempt (P = .019), and depressive symptoms (P < .001). Based on the SDS, severe to very severe functional limitations were reported at work, in social life, and family life (56.4%, 60.2%, and 73.1%, respectively) among GAD patients. CONCLUSION This study indicated a relatively high prevalence of GAD among primary care patients in Tunisia. Risk factors were also determined that may help to identify these patients. This information may help primary care physicians recognize this diagnosis and provide timely referrals to mental health professionals to prevent complications and preserve quality of life.
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Affiliation(s)
- Jihene Ben Thabet
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mariem Turki
- Psychiatry "B" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Molka Mezghani
- Psychiatry Department, Razi Psychiatric Hospital, University of Tunis, Tunisia
| | - Asma Guermazi
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mohamed Mâalej
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nada Charfi
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Manel Maalej
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Caldiroli A, Colzani L, Capuzzi E, Quitadamo C, La Tegola D, Surace T, Russo S, Capetti M, Leo S, Tringali A, Marcatili M, Zanelli Quarantini F, Colmegna F, Dakanalis A, Buoli M, Clerici M. Clinical Markers of Panic and Generalized Anxiety Disorder: Overlapping Symptoms, Different Course and Outcome. J Pers Med 2023; 13:jpm13030491. [PMID: 36983673 PMCID: PMC10052351 DOI: 10.3390/jpm13030491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) share underlying neurobiological mechanisms and several clinical features which, with medical comorbidities, may increase misdiagnosis and delay proper treatment. The aim of the study was to evaluate the association between clinical/socio-demographic markers and GAD/PD diagnosis. Outpatients (N = 290) with PD or GAD were identified in mental health services in Monza and Milan (Italy). Descriptive analyses and a binary logistic regression model were performed. Post-onset psychiatric (p = 0.05) and medical (p = 0.02) multiple co-morbidities were associated with GAD; treatment with selective serotonin reuptake inhibitors (SSRIs) was associated with PD, while GAD diagnosis was associated with treatment with atypical antipsychotics or GABAergic drugs (p = 0.03), as well as psychodynamic psychotherapy (p < 0.01). Discontinuation of the last pharmacological treatment was associated with GAD diagnosis rather than the PD one (p = 0.02). GAD patients may have a worse prognosis than PD patients because of more frequent multiple co-morbidities, relapses and poorer treatment compliance. The different treatment approaches were consistent with the available literature, while the association between GAD and psychodynamic psychotherapy is an original finding of our study. Further studies on larger samples are necessary to better characterize clinical factors associated with GAD or PD.
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Affiliation(s)
- Alice Caldiroli
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-0392336046
| | - Lia Colzani
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Enrico Capuzzi
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Cecilia Quitadamo
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Davide La Tegola
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Teresa Surace
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Stefania Russo
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Mauro Capetti
- Department of Medicine and Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Silvia Leo
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Agnese Tringali
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Matteo Marcatili
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Fabrizia Colmegna
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Antonios Dakanalis
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Massimo Clerici
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
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Hungerford C, Hills S, Richards C, Robinson T, Hills D. Facilitating Mindfulness-Based Interventions for Anxiety in Older People: History, Effectiveness, and Future Possibilities. Issues Ment Health Nurs 2022; 43:1014-1021. [PMID: 36053887 DOI: 10.1080/01612840.2022.2116510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The origins of mindfulness go back some 25 centuries to Eastern teachings, including Buddhism and Hinduism. Mindfulness-based interventions gained credence in Western mental health settings in the late 1970s through the work of medical researcher Kabat-Zinn, whose interest in Eastern meditation led him to develop a program for stress reduction. Since then, mindfulness-based interventions have been utilized for various populations, including older people with anxiety. Group mindfulness-based interventions have demonstrated benefits for older people with anxiety living in residential aged care and the community. In primary care settings, innovative delivery models for group mindfulness-based interventions could be facilitated by nurses to support older people with anxiety to age in place with dignity. The benefits of mindfulness-based interventions suggest the value of integrating ancient Eastern techniques with modern Western strategies to achieve better health outcomes for older people with mental health concerns.
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Affiliation(s)
- Catherine Hungerford
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia.,Central Queensland University, Sydney, New South Wales, Australia
| | - Sharon Hills
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Catelyn Richards
- Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Tracy Robinson
- Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Danny Hills
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
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Patient characteristics and changes in anxiety symptoms in patients with panic disorder: Post-hoc analysis of the PARADIES cluster randomised trial. PLoS One 2022; 17:e0275509. [PMID: 36174096 PMCID: PMC9521898 DOI: 10.1371/journal.pone.0275509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
Anxiety disorders are among the most common mental health problems in primary care. The PARADIES (Patient Activation foR Anxiety DIsordErS) intervention combined elements of cognitive behavioural therapy with case management and has demonstrated efficacy. Our aim was to explore patient characteristics, which may influence the course of anxiety symptoms over a 12 months period. Multiple linear regression was used to quantify associations of baseline characteristics (demographics, clinical parameters, medication use) with changes in anxiety symptoms as measured by the Beck anxiety inventory. Treatment modalities (e.g. adherence to appointment schedules) were considered as confounders. We examined univariate associations between dependent and independent variables before considering all independent variables in a multivariate final model. To find the best model to explain BAI score changes, we performed step-wise selection of independent variables based on Akaike information criteria. We tested for interaction terms between treatment allocation (intervention vs control) and independent variables using the multivariate model. We repeated these analyses in control vs intervention groups separately. From the original trial (N = 419), 236 patients (56.3%) were included. In the multivariate model, receiving the intervention (p<0.001), higher anxiety symptom severity (p<0.001) and longer illness duration at baseline (p = 0.033) were significantly associated with changes in anxiety symptom severity to the better while depression severity at baseline (p<0.001) was significantly associated with changes in anxiety symptoms to the worse. In stratified analyses, the control group showed significant associations between depression symptom severity and illness duration with anxiety symptom changes while baseline severity of anxiety symptoms remained significantly associated with anxiety symptom changes in both groups. A brief primary-care-based exposure training combined with case management is effective in a broad range of patients with panic disorder with/without agoraphobia, including those with longer illness duration and co-existing symptoms of depression at baseline.
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The Effect of Group Play Therapy on Anxiety in Children Diagnosed with Leukemia. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2021. [DOI: 10.52547/pcnm.11.2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Perestelo-Pérez L, Rivero-Santana A, Ramos-García V, Álvarez-Pérez Y, Duarte-Díaz A, Torres-Castaño A, Trujillo-Martín MDM, Del Pino-Sedeño T, González-González AI, Serrano-Aguilar P. Effectiveness of a web-based decision aid for patients with generalised anxiety disorder: a protocol for a randomised controlled trial. BMJ Open 2020; 10:e039956. [PMID: 33303445 PMCID: PMC7733176 DOI: 10.1136/bmjopen-2020-039956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Patients with generalised anxiety disorder (GAD) have concerns and needs about their health and the healthcare they receive. Patient decision aids (PtDAs) are tools that assist patients in making health decisions, when there is uncertainty about treatment choice, incorporating their personal preferences and values about the available treatment options. PtDAs can improve shared decision-making and lead to better treatment outcomes. The aim of this study is to evaluate the effectiveness of a web-based PtDA for patients with GAD in primary care (PC). METHODS AND ANALYSIS The general study design is comprised of two stages: (1) development of a web-based PtDA for patients with GAD, derived from an evidence-based Clinical Practice Guideline and (2) assessment of the effectiveness of the PtDA in a randomised controlled trial (RCT) design, in PC centres in Tenerife (Spain). This RCT will be carried out with 124 patients with GAD, comparing the PtDA to a fact sheet with general information on mental health. Patients will review the PtDA in one session accompanied by a researcher. Post-intervention measures will be administered immediately after the intervention and at 3-month follow-up. The primary outcome will be decisional conflict. Secondary outcomes will include knowledge about GAD and its treatment, treatment preference, concordance between treatment preference and choice, and decision quality (knowledge ≥60% and concordant decision). ETHICS AND DISSEMINATION The project received ethics approval from the local committee at Nuestra Señora de la Candelaria (HUNSC) University Hospital in Santa Cruz de Tenerife (code: CHUNSC_2019_58). Informed consent will be obtained from each participant before randomisation. Results from the trial will be submitted for publication in international peer-reviewed scientific journals and will be disseminated through workshops and local and international conferences. TRIAL REGISTRATION NUMBER NCT04364958.
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Affiliation(s)
- Lilisbeth Perestelo-Pérez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Amado Rivero-Santana
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- University of La Laguna, Tenerife, Spain
| | | | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- University of La Laguna, Tenerife, Spain
| | | | - Maria Del Mar Trujillo-Martín
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
| | | | - Ana Isabel González-González
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Goethe-Universitat Frankfurt am Main Institut fur Allgemeinmedizin, Frankfurt am Main, Germany
- Centro de Salud Vicente Muzas, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
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Relationships Between Somatic Symptoms and Panic-Agoraphobic Spectrum Among Frequent Attenders of the General Practice in Italy. J Nerv Ment Dis 2020; 208:540-548. [PMID: 32205774 DOI: 10.1097/nmd.0000000000001163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Frequent attenders (FAs) of general practitioners (GPs) often complain of nonspecific physical symptoms that are difficult to define according to typical medical syndromes criteria but could be acknowledged as atypical manifestations of mental disorders. We investigated the possible correlation between somatic symptoms and panic-agoraphobic spectrum symptoms in a sample of 75 FAs of GPs in Italy, with particular attention to the impact on functional impairment. Assessments included the Patient Health Questionnaire, Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) lifetime version, Global Assessment of Functioning, and Clinical Global Impression. The PAS-SR total and domains scores were significantly higher among low-functioning FAs, especially anxious somatizations, hypochondriasis, anxious expectation, and reassurance orientation domains, suggesting this undetected symptom may determine the selective attention to the physical symptoms, illness-phobic/hypochondriac elaboration, and GP frequent attendance, often aimed at searching for reassurance, leading to severe impact on overall functioning and often inefficacious treatments.
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Rincón-Cortés M, Gagnon KG, Dollish HK, Grace AA. Diazepam reverses increased anxiety-like behavior, social behavior deficit, and dopamine dysregulation following withdrawal from acute amphetamine. Neuropsychopharmacology 2018; 43:2418-2425. [PMID: 29959439 PMCID: PMC6180061 DOI: 10.1038/s41386-018-0123-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022]
Abstract
Psychostimulants such as amphetamine (AMPH) increase dopamine (DA) release from ventral tegmental area (VTA) neurons, which is associated with their acute reinforcing actions. This positive state is followed by a negative affective state during the withdrawal period each time the drug is taken (i.e., opponent process theory). AMPH withdrawal is accompanied by symptoms of anxiety and depression, which are associated with DA system dysfunction in humans and animal models. Most studies have focused on the negative affective state after withdrawal from chronic drug administration; yet, this negative state appears even after a drug is taken for the first time in both humans and rodents. In rats, withdrawal from a single dose of AMPH (2 mg/kg) increases forced swim test immobility and decreases the number of spontaneously active VTA DA neurons up to 48 h post-withdrawal. In the current study, acute AMPH withdrawal was found to increase anxiety-like behavior in the elevated plus maze (EPM), reduce social cage time in the three-chambered social approach test (SAT), and attenuate VTA population activity. The effects of diazepam, a drug commonly used to treat anxiety disorders, were tested on anxiety-like and social behavior as well as VTA DA neuron activity following acute AMPH withdrawal. A single (5 mg/kg) dose of diazepam circumvented the neurobehavioral effects induced by acute AMPH withdrawal, as demonstrated by increased open arm time and social cage time as well as normalized VTA DA activity comparable to controls, suggesting that these neurobehavioral effects of acute AMPH withdrawal reflect an anxiety-like state.
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Affiliation(s)
- Millie Rincón-Cortés
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, 15217, USA. .,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15217, USA.
| | - Kimberly G. Gagnon
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15217 USA
| | - Hannah K. Dollish
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15217 USA
| | - Anthony A. Grace
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15217 USA ,0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15217 USA ,0000 0004 1936 9000grid.21925.3dDepartment of Psychology, University of Pittsburgh, Pittsburgh, PA 15217 USA
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