Cortisol boosts risky decision-making behavior in men but not in women

Decision-making under stress: A psychological and neurobiological integrative model

Understanding the impact of stress on cognitive processes, particularly decision-making, is crucial as it underpins behaviors essential for survival. However, research in this domain has yielded disparate results, with inconsistencies evident across stress-induction paradigms and drug administration protocols designed to investigate specific stress pathways or neuromodulators. Building upon empirical studies, this research identifies a multifaceted matrix of variables contributing to the divergent findings. This matrix encompasses factors such as the temporal proximity between stressors and decision tasks, the nature of stressors and decision contexts, individual characteristics including psychobiological profiles and affective states at the time of decision-making and even cultural influences. In response to these complexities, we propose a comprehensive model that integrates these relevant factors and their intricate interplay to elucidate the mechanisms governing decision-making during stressful events. By synthesizing these insights, our model not only refines existing paradigms but also provides a framework for future study designs, offering avenues for theoretical advancements and translational developments in the field of stress's impact on cognitive functions. This research contributes to a deeper understanding of the nuanced relationship between stress and decision-making, ultimately advancing our knowledge of cognitive processes under challenging conditions.

Multiple timescales of temporal context in risky choice: Behavioral identification and relationships to physiological arousal

Context-dependence is fundamental to risky monetary decision-making. A growing body of evidence suggests that temporal context, or recent events, alters risk-taking at a minimum of three timescales: immediate (e.g. trial-by-trial), neighborhood (e.g. a group of consecutive trials), and global (e.g. task-level). To examine context effects, we created a novel monetary choice set with intentional temporal structure in which option values shifted between multiple levels of value magnitude ("contexts") several times over the course of the task. This structure allowed us to examine whether effects of each timescale were simultaneously present in risky choice behavior and the potential mechanistic role of arousal, an established correlate of risk-taking, in context-dependency. We found that risk-taking was sensitive to immediate, neighborhood, and global timescales: risk-taking decreased following large (vs. small) outcome amounts, increased following large positive (but not negative) shifts in context, and increased when cumulative earnings exceeded expectations. We quantified arousal with skin conductance responses, which were related to the global timescale, increasing with cumulative earnings, suggesting that physiological arousal captures a task-level assessment of performance. Our results both replicate and extend prior research by demonstrating that risky decision-making is consistently dynamic at multiple timescales and that the role of arousal in risk-taking extends to some, but not all timescales of context-dependence.

The effects of hydrocortisone and yohimbine on human behavior in approach-avoidance conflicts

RATIONALE

Balancing approach of positive and avoidance of negative stimuli is essential when faced with approach-avoidance conflicts, e.g., situations with both positive and negative outcomes. This balance is disturbed in several mental disorders, e.g., excessive avoidance in anxiety disorders, and heightened approach in substance use disorders. Since stress is assumed to impact these disorders' etiology and maintenance, it seems crucial to understand how stress influences behavior in approach-avoidance conflicts. Indeed, some studies suggested altered approach-avoidance behavior under acute stress, but the mechanism underlying these effects is unknown.

OBJECTIVES

Investigate how the pharmacological manipulation of major stress mediators (cortisol and noradrenaline) influences task-based approach-avoidance conflict behavior in healthy individuals.

METHODS

Ninety-six participants (48 women, 48 men) received either 20mg hydrocortisone, 20mg yohimbine, both, or placebo before performing a task targeting foraging under predation in a fully crossed double-blind between-subject design. Moreover, we investigated effects of gender and endogenous testosterone and estradiol levels on approach-avoidance behavior.

RESULTS

While biological stress markers (cortisol concentration, alpha amylase activity) indicated successful pharmacological manipulation, behavior in approach-avoidance conflicts was not affected as expected. Although yohimbine administration affected risky foraging latency under predation, we found no main effect of hydrocortisone or their interaction on behavior. In contrast, we found gender differences for almost all behavioral outcome measures, which might be explained by differences in endogenous testosterone levels.

CONCLUSIONS

The investigated major stress mediators were not sufficient to imitate previously shown stress effects on approach-avoidance conflict behavior. We discuss potential reasons for our findings and implications for future research.

Later stages of acute stress impair reinforcement-learning and feedback sensitivity in decision making

Whereas the effects of the early stages of acute stress seem to improve learning and increase loss aversion in decision making, in later stages, the opposite has been found, an impairment in decision making probably due to higher reward-attraction, as the STARS approach suggests. This study aims to investigate the effects of the later stages of acute stress on decision making and its underlying processes using a computational model. We hypothesized that stress would affect underlying cognitive strategies during decision making. Ninety-five participants were randomly distributed into two groups, experimental (N = 46) and control (N = 49). A virtual version of The Trier Social Stress Test (TSST) was used as a laboratory stressor. After 20minutes, decision making was assessed by using the Iowa Gambling Task (IGT). The Value-Plus-Preservation (VPP) RL computational model was used to extract decision-making components. As expected, the stressed participants showed deficits in IGT performance on reinforcement-learning and feedback sensitivity. However, there was no gains attraction. These results are discussed by considering that decision making in later stages of acute stress could be based on impairments in prefrontal cortex functioning.

Impact of the COVID-19 Pandemic on Gender Differences in Depression Based on National Representative Data

BACKGROUND

Restrictions on daily life and changes in economic structure due to coronavirus disease 2019 (COVID-19) likely would have affected men and women differently. However, there is still a lack of research on the difference between men and women in the amount of change in depression during COVID-19 compared to before COVID-19. Therefore, the researchers investigated gender differences in the magnitude of increase in the prevalence of depression with its severity and individual symptoms during COVID-19 compared with pre-pandemic levels.

METHODS

The Korea National Health and Nutrition Examination Survey (KNHANES) 2016 and 2018 were used to assess depression levels pre-pandemic and the KNHANES 2020 for pandemic depression levels. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). To analyze the differences between men and women in the magnitude of the mental health impact of COVID-19, the researchers analyzed the weighted differences in depression prevalence, severity, and individual symptoms during the COVID-19 pandemic compared to before COVID-19 stratified by gender.

RESULTS

In men, there were significant increases in weighted prevalence for depression (1.2% percentage point; 95% confidence interval [CI], 0.0-2.3) and severe symptoms of depression (2.6-fold; 95% CI, 1.2-5.7). Among the individual symptoms of depression, significant increases during the pandemic compared to before were: little interest or pleasure in doing things, 1.26-fold; feeling tired or having little energy, 2.2-fold; and suicidal thoughts, 1.7-fold. However, there was no significant difference in prevalence, symptoms severity, and any symptom before and during COVID-19 in women.

CONCLUSIONS

Because the pandemic is likely to increase mental problems of the affected over time due to such problems as financial stress and joblessness or post-infection health issues, the researchers anticipate an increase in the prevalence of some mental illnesses. In particular, since the suicide rate of men is higher than that of women, from a public health perspective, active interventions are needed to prevent an increase in the suicide rate due to COVID-19. It is also necessary to establish national policies to overcome the psychological, social, and economic losses resulting from COVID-19.

Stress-altering anterior insular cortex activity affects risk decision-making behavior in mice of different sexes

Stress can affect people's judgment and make them take risky decisions. Abnormal decision-making behavior is a core symptom of psychiatric disorders, such as anxiety, depression, and substance abuse. However, the neuronal mechanisms underlying such impairments are largely unknown. The anterior insular cortex (AIC) is a crucial structure to integrate sensory information with emotional and motivational states. These properties suggest that AIC can influence a subjective prediction in decision-making. In this study, we demonstrated that stressed mice prefer to take more risky choices than control mice using a gambling test. Manipulating the neural activity of AIC or selectively inhibiting the AIC-BLA pathway with chemogenetic intervention resulted in alterations in risk decision-making in mice. Different sexes may have different decision-making strategies in risky situations. Endogenous estrogen levels affect emotional cognition by modulating the stress system function in women. We observed decision-making behavior in mice of different sexes with or without stress experience. The result showed that female mice did not change their choice strategy with increasing risk/reward probability and performed a lower risk preference than male mice after stress. Using the pharmacological method, we bilaterally injected an estrogen receptor (ER) antagonist that resulted in more risky behavior and decreased synaptic plasticity in the AIC of female mice. Our study suggested that the AIC is a crucial region involved in stress-induced alteration of decision-making, and estrogen in the AIC may regulate decision-making behavior by regulating synaptic plasticity.

Sex-related differences in postoperative complications following elective craniotomy for intracranial lesions: An observational study

INTRODUCTION

The integration of sex-related differences in neurosurgery is crucial for new, possible sex-specific, therapeutic approaches. In neurosurgical emergencies, such as traumatic brain injury and aneurysmal subarachnoid hemorrhage, these differences have been investigated. So far, little is known concerning the impact of sex on frequency of postoperative complications after elective craniotomy. This study investigates whether sex-related differences exist in frequency of postoperative complications in patients who underwent elective craniotomy for intracranial lesion.

MATERIAL AND METHODS

All consecutive patients who underwent an elective intracranial procedure over a 2-year period at our center were eligible for inclusion in this retrospective study. Demographic data, comorbidities, frequency of postoperative complications at 24 hours following surgery and at discharge, and hospital length of stay were compared among females and males.

RESULTS

Overall, 664 patients were considered for the analysis. Of those, 339 (50.2%) were females. Demographic data were comparable among females and males. More females than males suffered from allergic, muscular, and rheumatic disorders. No differences in frequency of postoperative complications at 24 hours after surgery and at discharge were observed among females and males. Similarly, the hospital length of stay was comparable.

CONCLUSIONS

In the present study, no sex-related differences in frequency of early postoperative complications and at discharge following elective craniotomy for intracranial lesions were observed.

The Effects of Rosiglitazone on Task Specific Anxiety-Like Behavior and Novelty Seeking in a Model of Chronic Adolescent Unpredictable Stress

Adolescence is characterized as a period of increased social behavior, risk taking, and novelty seeking, partly due to ongoing maturation in critical brain areas and the hypothalamic-pituitary-adrenal (HPA) negative-feedback system. During this period there is heightened vulnerability to stress that can drive neuro-immune-endocrine remodeling, resulting in the emergence of maladaptive behaviors that increase susceptibility to alcohol and substance abuse. Here we used a rat model to investigate the impact of chronic adolescent unpredictable stress on a battery of behavioral measures to assess anxiety, novelty seeking, risk taking, depression, and voluntary ethanol consumption while determining whether the PPARγ agonist rosiglitazone can attenuate these effects. Adolescent female rats that experienced stress showed increased risk taking behavior and novelty seeking behavior with no change in ethanol consumption. The administration of rosiglitazone during stress induction attenuated stress-induced cortisol elevation, normalized risk taking behavior in a model anxiety, and attenuated novelty seeking in a task-specific manner. Depressive-like behavior was not impacted by adolescent unpredictable stress or the administration of rosiglitazone. The results from this study demonstrate that exposure to unpredictable stress during adolescence increases the prevalence of maladaptive behaviors that are known to increase susceptibility to alcohol and substance abuse, and that rosiglitazone may be an effective therapeutic to attenuate the emergence of select risk taking and novelty seeking behaviors in females.

Impact of Perceived Stress and Immune Status on Decision-Making Abilities during COVID-19 Pandemic Lockdown

The ability to make risky decisions in stressful contexts has been largely investigated in experimental settings. We examined this ability during the first months of COVID-19 pandemic, when in Italy people were exposed to a prolonged stress condition, mainly caused by a rigid lockdown. Participants among the general population completed two cognitive tasks, an Iowa Gambling Task (IGT), which measures individual risk/reward decision-making tendencies, and a Go/No-Go task (GNG), to test impulsivity, together with two questionnaires, the Perceived Stress Scale and the Depression, Anxiety and Stress Scales. The Immune Status Questionnaire was additionally administered to explore the impact of the individual health status on decision making. The effect of the questionnaires scores on task performance was examined. The results showed that higher levels of perceived stress and a more self-reported vulnerable immune status were associated, separately, with less risky/more advantageous choices in the IGT in young male participants but with more risky/less advantageous choices in older male participants. These effects were not found in female participants. Impulsivity errors in the GNG were associated with more anxiety symptoms. These findings bring attention to the necessity of taking into account decision-making processes during stressful conditions, especially in the older and more physically vulnerable male population.

Nutritional behaviors of women and men in Poland during confinement related to the SARS-CoV-2 epidemic

The influence of the confinement on the changes of eating behaviors in men and women in Poland and between groups were assessed. Results were obtained for 112 men and 200 women. An anonymous questionnaire available on-line from 29 April to 19 May 2020 was the research tool. It contained questions about the frequency of consumption "before" and "during" confinement. Additionally, anthropometric measurements were declared by the respondents. An increase in the number of meals and an improvement in their regularity were observed in both groups. However, the frequency of snacking also increased. During lockdown women consumed potatoes, sweets, canned meat and eggs and men consumed canned meat more frequently. Products consumed less frequently were: fast food, instant soups and energy drinks (women), and white bread and fast food (men). The frequency of alcohol consumption also increased during lockdown. Average body weight and BMI increased significantly during social isolation. Body weight increase was declared by almost half of women and 40% of men. During the blockade period caused by the COVID-19 pandemic, changes in the dietary behavior of the study group of women and men were found. The nature of these changes varied according to gender and the dietary parameters analyzed.

Mental Resilience and Coping With Stress: A Comprehensive, Multi-level Model of Cognitive Processing, Decision Making, and Behavior

Aversive events can evoke strong emotions that trigger cerebral neuroactivity to facilitate behavioral and cognitive shifts to secure physiological stability. However, upon intense and/or chronic exposure to such events, the neural coping processes can be maladaptive and disrupt mental well-being. This maladaptation denotes a pivotal point when psychological stress occurs, which can trigger subconscious, "automatic" neuroreactivity as a defence mechanism to protect the individual from potential danger including overwhelming unpleasant feelings and disturbing or threatening thoughts.The outcomes of maladaptive neural activity are cognitive dysfunctions such as altered memory, decision making, and behavior that impose a risk for mental disorders. Although the neurocognitive phenomena associated with psychological stress are well documented, the complex neural activity and pathways related to stressor detection and stress coping have not been outlined in detail. Accordingly, we define acute and chronic stress-induced pathways, phases, and stages in relation to novel/unpredicted, uncontrollable, and ambiguous stressors. We offer a comprehensive model of the stress-induced alterations associated with multifaceted pathophysiology related to cognitive appraisal and executive functioning in stress.

Mild and Moderate Traumatic Brain Injury and Gender-Based Critical Care Outcomes

BACKGROUND

Traumatic brain injury (TBI) is a major contributor to death and complications. Previous studies have identified gender disparities among trauma patients. This study aims to examine the association between gender and outcomes in TBI patients.

STUDY DESIGN AND METHODS

Review of our trauma registry: Patients were classified into groups according to their gender. Demographics extracted from the registry included age, injury severity score (ISS), Glasgow Coma Score (GCS), head abbreviated injury score (AIS), and the presence of an epidural hematoma (EDH). The primary outcome was mortality; secondary outcomes included ICU length of stay (ICU-LOS), craniotomy rate, ventilator-associated pneumonia (VAP), and readmission rates. Significance was defined as p < 0.05.

RESULTS

Nine hundred and thirty-five patients with TBI were studied: 62.1% (n = 581) were male and 37.9% (n = 354) were female. There were no differences in GCS, ISS, and head AIS. Males were younger [53 (IQR 30-77) vs. 76 (IQR 49.25-84), p < 0.05] and were more likely to have an EDH (9.6% vs. 4.8%, p = 0.007). Males also had a longer median ICU-LOS [4 days (IQR 2-8) vs. 3 days (IQR 0-5), p < 0.05] and were significantly more likely to require a craniotomy (44.6% vs. 19.2%, p < 0.001). In addition, males were more likely to develop VAP (4.1% vs. 0.8%, p = 0.004). Predicted survival (79.2% vs. 72.9%) and actual mortality rates (4.5% vs. 4.5%) were similar in both genders (p > 0.05).

CONCLUSION

In the context of our study, male patients with TBI were significantly younger, were more likely to sustain an EDH, and were also more likely to require a craniotomy, but mortality rates between both genders were similar. The male gender was also associated with a significantly increased ICU-LOS and VAP.

Causal Role of the Dorsolateral Prefrontal Cortex in Belief Updating under Uncertainty

Adaptive performance in uncertain environments depends on the ability to continuously update internal beliefs about environmental states. Recent correlative evidence suggests that a frontoparietal network including the dorsolateral prefrontal cortex (dlPFC) supports belief updating under uncertainty, but whether the dlPFC serves a "causal" role in this process is currently not clear. To elucidate its contribution, we leveraged transcranial direct current stimulation (tDCS) over the right dlPFC, while 91 participants performed an incentivized belief-updating task. Participants also underwent a psychosocial stress or control manipulation to investigate the role of stress, which is known to modulate dlPFC functioning. We observed enhanced monetary value updating after anodal tDCS when it was normatively expected from a Bayesian perspective. A model-based analysis indicates that this effect was driven by belief updating. However, we also observed enhanced non-normative value updating, which might have been driven instead by expectancy violation. Enhanced normative and non-normative value updating reflected increased vs. decreased Bayesian rationality, respectively. Furthermore, cortisol increases were associated with enhanced positive, but not with negative, value updating. The present study thereby sheds light on the causal role of the right dlPFC in the remarkable human ability to navigate uncertain environments by continuously updating prior knowledge following new evidence.

The role of cortisol in trust behavior: Results from an experimental study on healthy controls and patients with juvenile myoclonic epilepsy

Trust is one of the foundations of human society and pervades all aspects of human live. Research on humans focused primarily on identifying the biological basis of trust behavior in healthy subjects, and this evidence hints to certain brain areas, hormones, and genetic factors to be fundamentally involved. The contribution of cortisol in trust has not yet elicited much attention in research, especially when specifically examined at basal cortisol levels. Trust has been previously studied in some neurological diseases but not in patients with epilepsy, and the influence of hormones on trust in these diseases remains yet unknown. Against this background, we designed an experimental study with a group of patients with juvenile myoclonic epilepsy and a group of healthy controls to compare trust behavior and plasma cortisol levels between the two groups. This economic game is frequently used in research to operationalize trust behavior. All participants further underwent neuropsychological assessment. Our results showed that there was no significant difference in trust behavior during the trust game, but a trend toward lower trust in patients. Furthermore, there was a significant difference in cortisol levels between groups with lower levels in patients. Interestingly, cortisol levels correlated with trust only in the patient group, but not in the control group. Future studies should specifically differentiate the effect of induced cortisol increases (e.g., acute stress) versus the effect of basal cortisol levels reflecting homeostasis or chronic stress on trust behavior and leverage the potential of comparison between patients and healthy controls.

Quantifying the immediate computational effects of preceding outcomes on subsequent risky choices

Forty years ago, prospect theory introduced the notion that risky options are evaluated relative to their recent context, causing a significant shift in the study of risky monetary decision-making in psychology, economics, and neuroscience. Despite the central role of past experiences, it remains unclear whether, how, and how much past experiences quantitatively influence risky monetary choices moment-to-moment in a nominally learning-free setting. We analyzed a large dataset of risky monetary choices with trial-by-trial feedback to quantify how past experiences, or recent events, influence risky choice behavior and the underlying processes. We found larger recent outcomes both negatively influence subsequent risk-taking and positively influence the weight put on potential losses. Using a hierarchical Bayesian framework to fit a modified version of prospect theory, we demonstrated that the same risks will be evaluated differently given different past experiences. The computations underlying risky decision-making are fundamentally dynamic, even if the environment is not.

Walking the Tightrope: A Proposed Model of Chronic Pain and Stress

Pain and stress are both phenomena that challenge an individual’s homeostasis and have significant overlap in conceptual and physiological processes. Allostasis is the ability to adapt to pain and stress and maintain homeostasis; however, if either process becomes chronic, it may result in negative long-term outcomes. The negative effects of stress on health outcomes on physiology and behavior, including pain, have been well documented; however, the specific mechanisms of how stress and what quantity of stress contributes to the maintenance and exacerbation of pain have not been identified, and thus pharmacological interventions are lacking. The objective of this brief review is to: 1. identify the gaps in the literature on the impact of acute and chronic stress on chronic pain, 2. highlight future directions for stress and chronic pain research; and 3. introduce the Pain-Stress Model in the context of the current literature on stress and chronic pain. A better understanding of the connection between stress and chronic pain could provide greater insight into the neurobiology of these processes and contribute to individualized treatment for pain rehabilitation and drug development for these often comorbid conditions.

Stress-related changes in financial risk taking: Considering joint effects of cortisol and affect

Many decisions under risk and uncertainty are made under physical or emotional stress. A recent meta-analysis suggested that stress reliably influences risk taking but did not find a relation between single measures of stress such as cortisol and risk taking. One reason for the conflicting findings could be that the influence of stress on risk taking depends not only on physiological but also on psychological stress responses, in particular affective valence. We tested this hypothesis in an exploratory empirical study: Seventy participants worked on a financial risk-taking task. In half of the participants acute stress was induced with a cold pressor task. For all participants we measured cortisol and α-amylase levels, blood pressure, subjective arousal, and affective valence before and after the task. The stress induction increased participants' levels of cortisol, subjective arousal, and systolic blood pressure but did not directly influence negative affect or risky decision making. Examining the interplay between physiological and psychological stress responses, a moderation analysis revealed an interaction between stress induction and affect valence: Negative affect predicted an increase in risk-seeking decision making in the stress condition, but not in the control group. A similar moderation was found with cortisol reactivity, that is, negative affect predicted an increase in risk-seeking decision making in participants with high cortisol reactivity but not in participants with low cortisol reactivity. These results suggest that the effect of stress on risky decision making depends on the interplay of affective valence and cortisol reactivity.

Cued for risk: Evidence for an incentive sensitization framework to explain the interplay between stress and anxiety, substance abuse, and reward uncertainty in disordered gambling behavior

Gambling disorder is an impairing condition confounded by psychiatric co-morbidity, particularly with substance use and anxiety disorders. Yet, our knowledge of the mechanisms that cause these disorders to coalesce remains limited. The Incentive Sensitization Theory suggests that sensitization of neural "wanting" pathways, which attribute incentive salience to rewards and their cues, is responsible for the excessive desire for drugs and cue-triggered craving. The resulting hyper-reactivity of the "wanting' system is believed to heavily influence compulsive drug use and relapse. Notably, evidence for sensitization of the mesolimbic dopamine pathway has been seen across gambling and substance use, as well as anxiety and stress-related pathology, with stress playing a major role in relapse. Together, this evidence highlights a phenomenon known as cross-sensitization, whereby sensitization to stress, drugs, or gambling behaviors enhance the sensitivity and dopaminergic response to any of those stimuli. Here, we review the literature on how cue attraction and reward uncertainty may underlie gambling pathology, and examine how this framework may advance our understanding of co-mordidity with substance-use disorders (e.g., alcohol, nicotine) and anxiety disorders. We argue that reward uncertainty, as seen in slot machines and games of chance, increases dopaminergic activity in the mesolimbic pathway and enhances the incentive value of reward cues. We propose that incentive sensitization by reward uncertainty may interact with and predispose individuals to drug abuse and stress, creating a mechanism through which co-mordidity of these disorders may emerge.

Influence of glucocorticoid and mineralocorticoid receptor stimulation on task switching

The influence of stress on executive functions has been demonstrated in numerous studies and is potentially mediated by the stress-induced cortisol release. Yet, the impact of cortisol on cognitive flexibility and task switching in particular remains equivocal. In this study, we investigated the influence of pharmacological glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) stimulation, two corticosteroid receptor types known to be responsible for cortisol effects on the brain. We conducted two experiments, each with 80 healthy participants (40 women and 40 men), and tested the effect of the unspecific MR/GR agonist hydrocortisone (Experiment I) and the more specific MR agonist fludrocortisone (Experiment II) on switch costs and task rule congruency in a bivalent, cued task switching paradigm. The results did not confirm our hypotheses; we found no significant effects of our manipulations on task switching capacity, although general switching and congruency effects were observed. We discuss the absence of MR/GR-mediated effects and propose alternative mechanisms that could explain stress induced effects on task switching.

Investigation of sex differences in delusion-associated cognitive biases

In the past few decades, sex differences have been identified in a number of clinical, cognitive and functional outcomes in patients with schizophrenia spectrum disorders. However, to date, sex differences in higher-order cognitive biases have not been systematically studied. The present study aimed to examine sex differences in jumping-to-conclusions and evidence integration impairment based on data collected in two previous studies in patients with schizophrenia spectrum disorders and healthy controls. For this purpose, data from n = 58 patients and n = 60 healthy controls on the Fish Task (as a measure of jumping to conclusions) and bias against disconfirmatory evidence (BADE; as a measure of evidence integration) task were analyzed. Results indicated a lack of sex differences in jumping-to-conclusions and evidence integration impairment both in patients with schizophrenia spectrum disorders and healthy controls. Although the present study was adequately powered to detect sex differences of a low medium effect size, larger studies are warranted to exclude differences of a smaller magnitude between men and women regarding delusion-associated cognitive biases.

Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome

Trauma data bank and other research reveal sex disparities in trauma care. Risk-taking behaviors leading to traumatic injury have been associated with sex, menstrual cycle timing, and cortisol levels. Trauma patient treatment stratified by sex reveals differences in access to services at trauma centers as well as specific treatments, such as venous thromboembolism prophylaxis and massive transfusion component ratios. Trauma patient outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient. Outcome after general trauma and specifically traumatic brain injury show mixed results with respect to sex disparity.

Cortisol levels, motor, cognitive and behavioral symptoms in Parkinson's disease: a systematic review

Parkinson's disease (PD) is a progressive and multifactorial neurodegenerative disease. It has been suggested that a dysregulation of the hypothalamic-pituitary-adrenal axis (HPA) occurs in PD. Furthermore, this dysregulation may be involved in triggering, exacerbation or progression of disease. The objective of this study was to systematically review the literature regarding cortisol levels and their relation with motor, cognitive and behavioral symptoms in patients with PD. A systematic search was performed in PubMed and Embase databases, according to PRISMA norms. Twenty-one studies were included, which evaluated baseline levels of cortisol and motor, cognitive, behavioral symptoms, drugs administration or deep brain stimulation to PD treatment. Sample size ranged from 7 to 249 individuals. In 14 studies that assessed cortisol levels in PD patients, seven showed elevation of cortisol levels. In relation to symptomatology, high levels of cortisol were associated with worst functional scores evaluated by UPDRS, depression and behavior in risk preference. Medication interactions showed an influence on the regulation of cortisol release, mainly, conventional drugs used in the PD's treatment, such as levodopa. The results found in this review point to a possible relationship between cortisol levels and symptoms in PD, indicating that an HPA axis dysfunction related to cortisol level occurs in PD.

Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults

Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.

Blunted cortisol reactivity and risky driving in young offenders - a pilot study

Adolescent risky driving is a significant burden on public health. Young offenders (i.e. under custody and supervision of the criminal justice system) may be particularly vulnerable, but research is scant. Previous work indicated that blunted cortisol reactivity to stress is a marker of risk-taking predisposition, including risky driving. In this study, we hypothesized that young offenders display higher levels of risky driving than a non-offender comparison group, and that cortisol reactivity contributes to the variance in risky driving independent of other associated characteristics (i.e. impulsivity, risk taking, alcohol and drug use). We found that young offenders (n = 20) showed riskier driving in simulation than comparison group (n = 9), and blunted cortisol reactivity was significantly associated with risky driving. The results suggest young offenders are prone to risky driving, and that individual differences in the cortisol stress response may be an explanatory factor.