Brain multi-contrast, multi-atlas segmentation of diffusion tensor imaging and ensemble learning automatically diagnose late-life depression

We investigated the potential of machine learning for diagnostic classification in late-life major depression based on an advanced whole brain white matter segmentation framework. Twenty-six late-life depression and 12 never depressed individuals aged > 55 years, matched for age, MMSE, and education underwent brain diffusion tensor imaging and a multi-contrast, multi-atlas segmentation in MRIcloud. Fractional anisotropy volume, mean fractional anisotropy, trace, axial and radial diffusivity (RD) extracted from 146 white matter parcels for each subject were used to train and test the AdaBoost classifier using stratified 12-fold cross validation. Performance was evaluated using various measures. The statistical power of the classifier was assessed using label permutation test. Statistical analysis did not yield significant differences in DTI measures between the groups. The classifier achieved a balanced accuracy of 71% and an Area Under the Receiver Operator Characteristic Curve (ROC-AUC) of 0.81 by trace, and a balanced accuracy of 70% and a ROC-AUC of 0.80 by RD, in limbic, cortico-basal ganglia-thalamo-cortical loop, brainstem, external and internal capsules, callosal and cerebellar structures. Both indices shared important structures for classification, while fornix was the most important structure for classification by both indices. The classifier proved statistically significant, as trace and RD ROC-AUC scores after permutation were lower than those obtained with the actual data (P = 0.022 and P = 0.024, respectively). Similar results were obtained with the Gradient Boosting classifier, whereas the RBF-kernel Support Vector Machine with k-best feature selection did not exceed the chance level. Finally, AdaBoost significantly predicted the class using all features together. Limitations are discussed. The results encourage further investigation of the implemented methods for computer aided diagnostics and anatomically informed therapeutics.

A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study

BACKGROUND

A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms.

OBJECTIVE

This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants' engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels.

METHODS

This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Barkley Adult ADHD Rating Scale-IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability.

RESULTS

The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5.

CONCLUSIONS

The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy.

A Systematic Review of Pharmacological Interventions for Apathy in Aging Neurocognitive Disorders

OBJECTIVE

Apathy, a frequent neuropsychiatric symptom in aging neurocognitive disorders, has been associated with cognitive decline and functional disability. Therefore, timely provision of pharmacological interventions for apathy is greatly needed.

DESIGN

A systematical literature review of existing studies was conducted up to 30 May 2023 in several databases (PubMed, PsychInfo, Cochrane, Google Scholar, etc.) that included randomized controlled trials (RCTs) and meta-analyses assessing pharmacological treatments for apathy in aging neurocognitive disorders. The quality of the studies was appraised.

RESULTS

In patients with Alzheimer's Disease (AD), donepezil, galantamine, rivastigmine, methylphenidate, and gingko biloba were proven efficacious for apathy, while rivastigmine, cognitive enhancer IRL752 and piribedil were found to be beneficial in patients with Parkinson's Disease (PD) and agomelatine in patients with Frontotemporal Dementia (FD). The extensive proportion of RCTs in which apathy was used as a secondary outcome measure, along with the considerable methodological heterogeneity, did not allow the evaluation of group effects.

CONCLUSIONS

Pharmacological interventions for apathy in aging neurocognitive disorders are complex and under-investigated. The continuation of systematic research efforts and the provision of individualized treatment for patients suffering from these disorders is vital.

The Consequentialist Scale: Translation and empirical investigation in a Greek sample

The Consequentialist Scale (Robinson, 2012) [89] assesses the endorsement of consequentialist and deontological moral beliefs. This study empirically investigated the application of the Greek translation of the Consequentialist Scale in a sample of native Greek speakers. Specifically, 415 native Greek speakers completed the questionnaire. To uncover the underlying structure of the 10 items in the Consequentialist Scale, an Exploratory Factor Analysis (EFA) was conducted. The results revealed a three-factor solution, where the deontology factor exhibited the same structure as the original work by Robinson (2012) [89], while the original consequentialism factor split into two separate factors. Significant Pearson's r correlations were observed between age and responses to the Consequentialist Scale. Separate EFAs were conducted for two age groups based on a medial split: younger (36 years old or less) and older (more than 36 years old). Interestingly, the younger group exhibited a two-factor solution with the same structure as the original work, while the older group showed a three-factor solution. A hierarchical k-means cluster analysis revealed that the cluster of participants who scored higher in deontology compared to consequentialism primarily consisted of older participants, whereas the two other clusters comprised of younger participants exhibited the reverse pattern. Neither gender nor previous experience with philosophy significantly affected scores on the Consequentialist Scale. Overall, our study provides evidence that the Consequentialist Scale is suitable for use in the Greek population.

Health Related Quality of Life and Cardiovascular Risk Factors

Cardiovascular diseases (CVD) is associated with deteriorating of quality of life (QOL) and exercise capacity (EC) but less is known on how EC interplays with QOL. The present study explores the relationship between quality of life and cardiovascular risk factors in people who present in cardiology clinics. A total of 153 adult presentations completed the SF-36 Health Survey and provided data for hypertension, diabetes mellitus, smoking, obesity, hyperlipidemia and history of coronary heart disease. Physical capacity was assessed by treadmill test. were correlated with the scores of the psychometric questionnaires. Participants with longer duration on treadmill exercise score higher on the scale of physical functioning. The study found that treadmill exercise intensity and duration were associated with improved scores in dimensions of the physical component summary and the physical functioning of SF-36, respectively. The presence of cardiovascular risk factors is related to a decreased quality of life. Patients with cardiovascular diseases should undergo particularly detailed analysis of the quality of life along with specific mental factors such as depersonalization and posttraumatic stress disorder.

Unravelling brain connectivity patterns in body dysmorphic disorder during decision-making on visual illusions: A graph theoretical approach

Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with perceived defects in physical appearance, and is associated with compulsive checking. Visual illusions are illusory or distorted subjective perceptions of visual stimuli, which are induced by specific visual cues or contexts. While previous research has investigated visual processing in BDD, the decision-making processes involved in visual illusion processing remain unknown. The current study addressed this gap by investigating the brain connectivity patterns of BDD patients during decision-making about visual illusions. Thirty-six adults - 18 BDD (9 female) and 18 healthy controls (10 female) - viewed 39 visual illusions while their EEG was recorded. For each image, participants were asked to indicate (1) whether they perceived the illusory features of the images; and (2) their degree of confidence in their response. Our results did not uncover group-level differences in susceptibility to visual illusions, supporting the idea that higher-order differences, as opposed to lower-level visual impairments, can account for the visual processing differences that have previously been reported in BDD. However, the BDD group had lower confidence ratings when they reported illusory percepts, reflecting increased feelings of doubt. At the neural level, individuals with BDD showed greater theta band connectivity while making decisions about the visual illusions, likely reflecting higher intolerance to uncertainty and thus increased performance monitoring. Finally, control participants showed increased left-to-right and front-to-back directed connectivity in the alpha band, which may suggest more efficient top-down modulation of sensory areas in control participants compared to individuals with BDD. Overall, our findings are consistent with the idea that higher-order disruptions in BDD are associated with increased performance monitoring during decision-making, which may be related to constant mental rechecking of responses.

Exploring the Role of Irrational Beliefs, Lifestyle Behaviors, and Educational Status in 10-Year Cardiovascular Disease Risk: the ATTICA Epidemiological Study

BACKGROUND

Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors.

METHODS

The ATTICA study is a population-based, prospective cohort (2002-2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria.

RESULTS

Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99).

CONCLUSIONS

The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals.

Burnout Related to Diabetes Mellitus: A Critical Analysis

Background

Diabetes burnout is a condition when a patient with diabetes feels tired from his/her disease and neglects it for a certain period or continuously.

Objective

Diabetes burnout is frequent, and there is extended literature about psychosocial stress and its negative effects on health.

Methods

A search for relevant studies was conducted using PubMed, Google Scholar and ResearchGate. A systematic review was conducted on the relevant articles after critical appraisal. Only publications in English were selected. The objective of this study was to evaluate the association between burnout syndrome and diabetes mellitus.

Results

This article mainly focused on studies that evaluated the presence of burnout and diabetes mellitus effects. Diabetes can influence psychological health equally with somatic strength. Relatives can also express depression, guilt, fright, worry, rage, and burnout. Psychosocial job stress and extended working hours are linked with a higher possibility of myocardial infarction, diabetes mellitus, and hypertension.

Conclusion

Diabetes burnout is a combination of emotions and practices, ranging from tiredness to indifference, linked with a distressing sense of hopelessness. Revealing this health condition is necessary so that preventive measures can be taken.

Psychometric properties of the Greek version of Affective Lability Scale - Short Form (ALS-18) in a sample of adults with neurodevelopmental disorders

Affect dysregulation refers to maladaptive patterns of emotional regulation that impair daily life functioning, common in many psychiatric disorders. It is expressed with the form of affective lability, an emotional construct composed of frequent and intense fluctuations in emotion in response to both pleasant and unpleasant events or the interpretations of events. The Affective Lability Scale (ALS) is a widely used self-reporting questionnaire that measures the tendency of emotions to shift from one to another as well as their tendency to oscillate between depression and elation and between depression and anxiety. The original scale had 54 items, but a shorter form of 18-items (ALS-18) was created, with three domains: anxiety-depression shift, depression-elation shift and anger shift. The aim of the present study was to evaluate the psychometric properties of the ALS-18 Greek version. The translation was conducted by two of the authors. The study took place in the 1st Department of Psychiatry of the National and Kapodistrian University of Athens, Eginition hospital. A sample of 108 adults was included in the survey in two groups, neurodevelopmental disorder group (attention deficit hyperactivity disorder or autism spectrum disorder) and controls. They all completed ALS-18, The State - Trait Anxiety Inventory (STAIT), Difficulties in Emotion Regulation Scale (DERS), The Hospital Anxiety and Depression Scale (HADS). The ALS-18 had satisfactory internal consistency; Cronbach's α value was 0.91 for the total scale and 0.89 for Anxiety/Depression, 0.86 for Depression/Elation and 0.85 for Anger. The three-factor structure was replicated in our data. The internal consistency reliability of all the ALS-18 factors in our study could be considered satisfactory with a Cronbach's alpha coefficient of 0.85 or above for all factors. Significantly higher mean values were found for all the subscales, Anxiety/Depression, Depression/Elation and Anger, in NDD subjects as compared to controls, showing good discriminative ability. The ALS factors discriminated well between clinical and non-clinical sample. The present study reveals that the Greek version of ALS-18 presents good psychometric properties, showing good internal consistency reliability as well as concurrent and discriminative validity. It has an elevated score in NDD and thus, our results indicate that affective lability could and maybe should, be a target integrated in therapeutic strategies.

Feasibility, engagement, and preliminary clinical outcomes of a digital biodata-driven intervention for anxiety and depression

Hypothesis

The main hypothesis is that a digital, biodata-driven, and personalized program would exhibit high user retention and engagement, followed by more effective management of their depressive and anxiety symptoms.

Objective

This pilot study explores the feasibility, acceptability, engagement, and potential impact on depressive and anxiety and quality of life outcomes of the 16-week Feel Program. Additionally, it examines potential correlations between engagement and impact on mental health outcomes.

Methods

This single-arm study included 48 adult participants with mild or moderate depressive or anxiety symptoms who joined the 16-week Feel Program, a remote biodata-driven mental health support program created by Feel Therapeutics. The program uses a combination of evidence-based approaches and psychophysiological data. Candidates completed an online demographics and eligibility survey before enrolment. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder Scale, respectively. The Satisfaction with Life Scale and the Life Satisfaction Questionnaire were used to assess quality of life. User feedback surveys were employed to evaluate user experience and acceptability.

Results

In total, 31 participants completed the program with an overall retention rate of 65%. Completed participants spent 60 min in the app, completed 13 Mental Health Actions, including 5 Mental Health Exercises and 4.9 emotion logs on a weekly basis. On average, 96% of the completed participants were active and 76.8% of them were engaged with the sensor during the week. Sixty five percent of participants reported very or extremely high satisfaction, while 4 out of 5 were very likely to recommend the program to someone. Additionally, 93.5% of participants presented a decrease in at least one of the depressive or anxiety symptoms, with 51.6 and 45% of participants showing clinically significant improvement, respectively. Finally, our findings suggest increased symptom improvement for participants with higher engagement throughout the program.

Conclusions

The findings suggest that the Feel Program may be feasible, acceptable, and valuable for adults with mild or moderate depressive and/or anxiety symptoms. However, controlled trials with bigger sample size, inclusion of a control group, and more diverse participant profiles are required in order to provide further evidence of clinical efficacy.

Frequent visitors in a university psychiatric emergency department in Greece

Introduction

Background :The profile of “frequent visitors” at the psychiatric emergencies (PE) has not been sufficiently investigated in Greece.

Objectives

In this study we aimed to investigate the prevalence and relevant parameters of frequent PE visits in a Greek University Psychiatric Hospital for the year 2017.

Methods

In a retrospective study, we analyzed data of patients who presented in the PE of Eginition University Hospital in Athens during 2017. Frequent visitors were grouped under this category if they had at least five visits per year. Clinical and sociodemographic data of the patients were further related to number of visits.

Results

84 patients were characterized as frequent visitors carrying out 9.8% of the total number of visits. 50% were women and 70% of them were living with family members. Anxiety, depressive and psychotic symptoms were the most frequent major complaints at the time of their visit, whereas psychosocial problems were associated with increased number of visits. Moreover, in terms of the underlying diagnosis substance use disorders significantly related to more frequent visits

Conclusions

Psychosocial problems and the diagnosis of substance use disorders significantly correlated to the number of visits at the PE of a university hospital setting in Greece for 2017.

Disclosure

No significant relationships.

Paradoxical Reasoning: An fMRI Study

Paradoxes are a special form of reasoning leading to absurd inferences in contrast to logical reasoning that is used to reach valid conclusions. A functional MRI (fMRI) study was conducted to investigate the neural substrates of paradoxical and deductive reasoning. Twenty-four healthy participants were scanned using fMRI, while they engaged in reasoning tasks based on arguments, which were either Zeno’s like paradoxes (paradoxical reasoning) or Aristotelian arguments (deductive reasoning). Clusters of significant activation for paradoxical reasoning were located in bilateral inferior frontal and middle temporal gyrus. Clusters of significant activation for deductive reasoning were located in bilateral superior and inferior parietal lobe, precuneus, and inferior frontal gyrus. These results confirmed that different brain activation patterns are engaged for paradoxical vs. deductive reasoning providing a basis for future studies on human physiological as well as pathological reasoning.

Insomnia was associated with increased risk of recurrent cardiovascular events in coronary heart disease patients

Funding Acknowledgements

Type of funding sources: None.

Background

Insomnia is highly prevalent in coronary heart disease (CHD) patients. However, the potential effect of insomnia on the risk of recurrent major adverse cardiovascular events (MACE) remains uncertain.

Purpose

To estimate the prospective association of insomnia and the risk of recurrent MACE in a CHD population from routine clinical practice.

Methods

This prospective cohort study included 1082 consecutive patients 2-36 (mean 16) months after a myocardial infarction and/or a coronary revascularization procedure. Data on insomnia, coronary risk factors and comorbidity were collected at baseline. Insomnia was assessed by Bergen insomnia scale (BIS), based on sleep symptoms per week during the past three months. BIS is constructed from the clinical diagnostic criteria for primary insomnia in DSM-IV TR. The primary composite endpoint of MACE defined as cardiovascular death, hospitalization due to myocardial infarction, revascularization, stroke or heart failure was obtained from the hospital records on average 4.2 (SD 0.3) years after the baseline study. Data were analysed using Cox proportional hazard regression on a multiple imputated dataset stratified by prior coronary events.

Results

At baseline, mean age was 62 (range 31-80) years, 21% were females, 90% were revascularized, 47% had participated in cardiac rehabilitation and the prescription rate of antiplatelets (97%) and statins (93%) were high. A total of 364 MACE (21%, 95% CI 19%-24%) occurred in 225 patients, including 39 CV deaths. Almost half of the patients (45%) suffered from insomnia at baseline and 24% used sleep medication the past week. For insomnia, the relative risk (RR) of recurrent MACE was 1.62 (95% confidence interval (CI) 1.24-2.11, p-value&lt;0.001) in age and gender adjusted analysis, 1.49 (95% CI 1.14, 1.97, p-value=0.004) in analysis also adjusted for coronary risk factors and 1.48 (95% CI 1.12, 1.96, p-value=0.006) in a multi-adjusted analysis including age, gender, coronary risk factors and cardiovascular comorbidity. When also adjusted for symptoms of anxiety and depression the RR of insomnia on recurrent MACE remained significant at 1.41 (95% CI 1.05, 1.89, p-value=0.023). Insomnia accounted for 16% of the MACE in attributable risk fraction analyses, being third in importance after smoking (27%) and low physical activity (21%). Obstructive sleep apnea (Berlin Questionnaire) was not associated with recurrent MACE.

Conclusions

Insomnia was associated with increased risk of recurrent MACE in this prospective cohort following CHD patients from routine clinical practice. The association remained significant even after adjustments for the major coronary risk factors, comorbidity and symptoms of anxiety and depression, indicating that the effects of insomnia is not mediated through poor risk factor control and other psychosocial factors alone. These results emphasize the importance of identifying patients with insomnia as part of coronary rehabilitation.

A feasibility study of the Attention Training Technique in a group format for anxiety and depression in outpatients with coronary heart disease

Funding Acknowledgements

Type of funding sources: None.

Background

Significant symptoms of anxiety and depression are prevalent (30-40%) in coronary heart disease (CHD) patients and these are associated with a greater risk of death, recurrent cardiovascular events, poorer quality of life, and more frequent use of healthcare services compared to those without this heart condition. To date, only a few psychological treatments have shown limited effectiveness on symptoms of anxiety and depression in CHD patients. Therefore, it is essential to develop and evaluate more effective treatments for depression and anxiety in CHD patients.

Metacognitive therapy (MCT) is effective in reducing significant symptoms of anxiety and depression. A key component of MCT is the attention training technique (ATT), which is based on the self-regulatory executive function model. According to the MCT treatment manual, ATT is brief and does not require extensive training to be delivered by health care personnel in routine care. A review of the empirical evidence shows that ATT can be as effective as full MCT in alleviating anxiety and depressive symptoms. However, ATT has not yet been used as a stand-alone intervention in treating symptoms of anxiety and depression in CHD patients.

Purpose

To evaluate the feasibility of implementing group ATT in CHD patients with significant symptoms of anxiety and depression and describe changes in these symptoms.

Methods

Five consecutively referred CHD patients with significant anxiety and depressive symptoms, as assessed by the Hospital Anxiety and Depression Scale (HADS)-Anxiety or Depression subscale score &gt; 8, were included in the study. They received six weekly group sessions of ATT in an open trial. Outcomes included symptoms measured by HADS at baseline, post-treatment and at six months follow-up. We also assessed psychiatric diagnoses and specific psychological factors (type D personality, insomnia, worry and rumination) as secondary measures.

Results

The sample comprised of five men between 52 and 65 years of age, with a mean age of 59.9 years. Four of the patients attended all six sessions, and one patient attended all but one session. The mean HADS-A scores at baseline, post-treatment, and follow up were 9.4 (SD 3.0), 4.2 (SD 3.0) and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (3.7) and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Wilcoxon Signed Rank Tests revealed a significant change in outcome from pre- to post-treatment for HADS-A and worry, which was maintained at 6-months follow-up, and HADS-D significantly decreased from pre-treatment to 6-months follow up.

Conclusions

ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients with significant symptoms of anxiety or depression. Based on these preliminary results, we believe that an adequately powered randomised controlled trial is now warranted.

Asclepion of Epidaurus: the application of a historical perspective in medical education

BACKGROUND

The Asclepion of Epidaurus is one of the first healing environments in the world. Descendants of Asclepius, specifically medical students, have been singularly deprived of any information concerning this legacy. This article illuminates the role of Asclepion of Epidaurus and examines the view of medical students upon the subject and the possible benefits of this knowledge in their medical education.

METHODS

The participants were 105 senior-year students from the Athens Medical School, who attended a multi-media assisted lecture related to the structure and the role of the Asclepion of Epidaurus. Afterwards, they answered anonymously a questionnaire of 12 pairs of opposite adjectives in order to describe their view regarding the meaning of Asclepion. The method used in the evaluation of their answers was that of semantic differential.

RESULTS

The attitude of the students towards the meaning of Asclepion was positive, showing interest and excitement about a powerful, though unfamiliar piece of knowledge.

CONCLUSION

Today's novice doctors have welcomed the concept of Asclepion as essential knowledge for the service they will be called to fulfill. The potential benefits of the Asclepian ideals in medical education and ethos are thoroughly discussed.

Evaluating the Modulation of the Acoustic Startle Reflex in Children and Adolescents via Vertical EOG and EEG: Sex, Age, and Behavioral Effects

Acoustic startle reflex (ASR) constitutes a reliable, cross-species indicator of sensorimotor and inhibitory mechanisms, showing distinct signature in cognitive aging, sex, and psychopathological characterization. ASR can be modulated by the prepulse inhibition (PPI) paradigm, which comprises the suppression of reactivity to a startling stimulus (pulse) following a weak prepulse (30- to 500-ms time difference), being widely linked to inhibitory capabilities of the sensorimotor system. If the prepulse–pulse tones are more clearly separated (500–2,000 ms), ASR amplitude is enhanced, termed as prepulse facilitation (PPF), reflecting sustained or selective attention. Our study aimed to investigate early-life sensorimotor sex/age differences using Electroencephalographic recordings to measure muscular and neural ASR in a healthy young population. Sixty-three children and adolescents aged 6.2–16.7 years (31 females) took part in the experiment. Neural ASR was assessed by two different analyses, namely, event-related potentials (ERPs) and first-derivative potentials (FDPs). As expected, PPF showed enhanced responses compared with PPI, as indicated by eyeblink, ERP and FDP measures, confirming the gating effect hypothesis. Sex-related differences were reflected in FDPs, with females showing higher ASR than males, suggesting increased levels of poststartle excitability. Intragroup age effects were evaluated via multipredictor regression models, noticing positive correlation between age versus eyeblink and ERP responses. Attention-related ERPs (N100 and P200) showed distinct patterns in PPI versus PPF, potentially indicative for alternative attentional allocation and block-out of sensory overload. Screening measures of participants’ neurodevelopmental (assessed by Wechsler Intelligence Scale for Children) and behavioral (assessed by Child Behavior Checklist) markers were also associated with increased N100/P200 responses, presumably indexing synergy between perceptual consistency, personality profiling, and inhibitory performance. Conclusively, modulation of ASR by PPI and PPF is associated with biological sex and internal/external personality traits in childhood and adolescence, potentially useful to guide symptomatology and prevention of psychopathology.

Deciding on Optical Illusions: Reduced Alpha Power in Body Dysmorphic Disorder

BACKGROUND

Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by excessive preoccupation with imagined defects in appearance. Optical illusions induce illusory effects that distort the presented stimulus, thus leading to ambiguous percepts. Using electroencephalography (EEG), we investigated whether BDD is related to differentiated perception during illusory percepts.

METHODS

A total of 18 BDD patients and 18 controls were presented with 39 optical illusions together with a statement testing whether or not they perceived the illusion. After a delay period, they were prompted to answer whether the statement was right/wrong and their degree of confidence in their answer. We investigated differences of BDD patients on task performance and self-reported confidence and analyzed the brain oscillations during decision-making using nonparametric cluster statistics.

RESULTS

Behaviorally, the BDD group exhibited reduced confidence when responding incorrectly, potentially attributed to higher levels of doubt. Electrophysiologically, the BDD group showed significantly reduced alpha power at the fronto-central and parietal scalp areas, suggesting impaired allocation of attention. Interestingly, the lower the alpha power of the identified cluster, the higher the BDD severity, as assessed by BDD psychometrics.

CONCLUSIONS

Results evidenced that alpha power during illusory processing might serve as a quantitative EEG biomarker of BDD, potentially associated with reduced inhibition of task-irrelevant areas.

Exploring the adult sexual wellbeing and behavior during the COVID-19 pandemic. A systematic review and meta-analysis

Implemented social distancing measures may have forestalled the spread of COVID-19, yet they suppressed the natural human need for contact. The aim of this systematic review was to explore the impact of the COVID-19 pandemic on adult sexual wellbeing and sexual behavior. An extensive search in Pubmed, Scopus, and PsycInfo databases based on PRISMA guidelines was conducted. After applying specific eligibility criteria, screening resulted in 38 studies. Results were drawn from 31,911 subjects and outlined the negative effect of the pandemic in sexual frequency, function, satisfaction, and the behavioral changes regarding masturbation and internet-based practices. Meta-analyses of the drawn data on 1,343 female, and 1,372 male subjects quantified the degree of sexual function change during the COVID-19 pandemic vs. prior the pandemic. A random effects model revealed the significant negative impact of the pandemic on female sexual function (SMD: 0.76, 95% CI:0.74 to 1.59), while no significant change was found for the males (SMD: 0.25, 95% Cl: -0.03 to 0.52). Significant heterogeneity was identified across included studies (p < 0.00001, I² = 97%, I² = 90% for females and males, respectively). As part of the global health, sexual wellbeing should be on the focus of clinicians and researchers.

Endocannabinoids and Heart Rate Variability Alterations after Exposure to Prolonged Intensive Physical Exercise of the Hellenic Navy SEALs

Background: Recent research indicates that both endocannabinoids (eCB) and heart rate variability (HRV) are associated with stress-induced experiences. However, these underlying mechanisms are not elucidated. The present study aims to investigate whether exposure to acute and chronic stress conditions can give rise to measurable changes, both to the peripheral eCB ligands and HRV. Methods: Thirteen candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (HNS) participated in the study. All subjects underwent mental state examination, while HRV variables in time and frequency domain recordings were acquired. Furthermore, at baseline and 30 days after prolonged and intensive physical exercise, hair was collected to measure eCB ligands, such as anandamide (AEA), 2-arachidonoylglycerol (2-AG), and the N-acyl ethanolamine (NAE) molecules: palmitoylethanolamide (PEA) and oleoylethanolamide (OEA). Results: Comparing basal hair concentrations of eCB ligands before and after intense physical exercise, we found that AEA, PEA, and OEA were notably increased, whereas no differences were observed regarding the ligand 2-AG. Furthermore, there were observed associations between the concentrations of peripheral eCB ligands, both at baseline and after the prolonged physical exercise and the time and frequency domains of HRV. Conclusions: These findings suggest that endocannabinoid–HRV interrelations might share a short-term, and long-term adaptability of the changes in self-regulation associated with stress. Further studies will be required to determine the validity of peripheral eCB signaling and HRV as a biomarker for different aspects of the stress response.

Clinical and dermatoscopic predictors of squamous cell carcinoma of the lips: a case-control, multicentric study

BACKGROUND

Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips.

OBJECTIVES

To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions.

METHODS

Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively.

RESULTS

A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43-fold and 6-fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6-fold and 4-fold increased risk for squamous cell carcinoma respectively.

CONCLUSIONS

A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip.

Instantaneous radiated power of brain activity: application to prepulse inhibition and facilitation for body dysmorphic disorder

Background

Global measures of neuronal activity embrace the advantage of a univariate, holistic and unique description of brain activity, reducing the spatial dimensions of electroencephalography (EEG) analysis at the cost of lower precision in localizing effects. In this work, the instantaneous radiated power (IRP) is proposed as a new whole-brain descriptor, reflecting the cortical activity from an exclusively electromagnetic perspective. Considering that the brain consists of multiple elementary dipoles, the whole-brain IRP takes into account the radiational contribution of all cortical sources. Unlike conventional EEG analyses that evaluate a large number of scalp or source locations, IRP reflects a whole-brain, event-related measure and forces the analysis to focus on a single time-series, thus efficiently reducing the EEG spatial dimensions and multiple comparisons.

Results

To apply the developed methodology in real EEG data, two groups (25 controls vs 30 body dysmorphic disorder, BDD, patients) were matched for age and sex and tested in a prepulse inhibition (PPI) and facilitation (PPF) paradigm. Two global brain descriptors were extracted for between-groups and between-conditions comparison purposes, namely the global field power (GFP) and the whole-brain IRP. Results showed that IRP can replicate the expected condition differences (with PPF being greater than PPI responses), exhibiting also reduced levels in BDD compared to control group overall. There were also similar outcomes using GFP and IRP, suggesting consistency between the two measures. Finally, regression analysis showed that the PPI-related IRP (during N100 time-window) is negatively correlated with BDD psychometric scores.

Conclusions

Investigating the brain activity with IRP significantly reduces the data dimensionality, giving insights about global brain synchronization and strength. We conclude that IRP can replicate the existing evidence regarding sensorimotor gating effects, revealing also group electrophysiological alterations. Finally, electrophysiological IRP responses exhibited correlations with BDD psychometrics, potentially useful as supplementary tool in BDD symptomatology.

Resilience of the hellenic navy SEALs assessed by heart rate variability during cognitve tasks

Background

The interaction between high physical performance under extreme conditions and simultaneous control of the cognitive executive functioning has been a subject of research in literature for the past few decades. Stroop test and Heart-rate variability (HRV), have been verified clinical tools for the assessment of cerebral and autonomic/ cardiovascular stress responses respectively.

Purpose

The investigation of HRV adaptive response to stress and cognitive stress resilience under extremely strenuous conditions.

Methods

34 consecutive subjects were enrolled. Of them, 18 were candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (HNS) and 16 were healthy controls (HC). All subjects underwent stroop tasks, along with mental state and personality examination. HRV variables in time and frequency domains recordings were acquired, during each aforementioned cognitive testing procedure.

Results

HNS's performance on both cognitive and emotion stroop tasks were equivalent to controls. During the size comparison of the number stroop and emotion stroop, HC had statistically significantly higher power content at different HRV frequency bands compared to HNS participants (p=0.036 and p=0.06 respectively). Finally, in a between group comparison of the psychometric tools, HNS had significantly higher somatization (p&lt;0.01), anxiety (p=0.037) and neuroticism (p=0.047) than HC. Correlation was conducted for each group separately, between the psychometric tools and the measurements of HRV for both number and emotion stroop. Moderate negative correlations were found between SDNN (Standard deviation of normal-to-normal RR-intervals) during the size comparison of number stroop and three out of nine categories of psychometric questionnaire; somatization (r(23)=−0.452, p&lt;0.05), anxiety (r(23)=−0.457, p&lt;0.05) and hostility (r(23)=−0.445, p&lt;0.05)

Conclusion

The above findings suggest that HNS display flexibility in their autonomic regulation during cognitive and emotional tasks. This characteristic is closely related to problem solving or adaptability skills. Additionally, HRV can be a promising clinical index regarding the assessment of psychophysiological resilience especially in the neurovisceral integration (NVI) model.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica

Endocannabinoids and heart rate variability alterations after exposure to prolonged intensive physical exercise of the Hellenic Navy SEALs

Background

Recent research indicates that endocanabinoids (eCB) and heart rate variability (HRV) are associated with stress-induced experiences. However, these underlying mechanisms have not been elucidated.

Purpose

The aim of the present study is to investigate if exposure to acute and chronic stress promotes measurable changes concurrently to the peripheral eCB ligands and the HRV.

Methods

13 candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (H.N.S.) participated in the study. All subjects underwent mental state examination, while HRV variables in time and frequency domains recordings were acquired. Furthermore, at baseline and 30 days after prolonged and intensive physical exercise hair were collected in order to measure eCB ligands, such as anandamide (AEA), 2-arachidonoylglycerol (2-AG), and the N-acyl ethanolamine (NAE) molecules: palmitoylethanolamide (PEA) and oleoylethanolamide (OEA).

Results

Comparing basal hair concentrations of eCB ligands before and after intensive physical exercise, we found that AEA, PEA and OEA were notably increased (p&lt;0.01, p&lt;0.05 and p&lt;0.01 respectively) whereas no differences were observed regarding the ligand 2-AG. Regarding time domain features of HRV, a strong positive correlation was found between mean HR, AEA and PEA [r(13)=0.934, p&lt;0.05, (r(13)=0.902, p&lt;0.05]. Regarding frequency domain, a strong negative correlation was found between low frequency (LF) HRV and PEA (r(13)=−0.853, p&lt;0.01). No statistically significant associations were noted between high frequency HRV and EC ligands.

Conclusions

These findings suggest that endocannabinoid-HRV interrelations might share a short-term, and long-term adaptability of the changes in self-regulation associated with stress. Further studies are required to determine the validity of peripheral eCB signaling and HRV as a biomarker for different aspects of stress response.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica

Diverse patterns of vulnerability to visual illusions in children with neurodevelopmental disorders

Research on how children with neurodevelopmental disorders perceive, process, and interpret visual illusions (VIs) has been extensively focused on children with autism spectrum disorder providing controversial findings. In this study, we investigated the patterns of vulnerability to a wide set of VIs comprising 23 standard text book VIs and their variations in a clinical sample of children with neurodevelopmental disorders compared to typically developing children (TD). A total of 176 children, aged between 4.6 and 13.8 years old, were distributed into four groups: high-functioning autism (HFA; N = 23), attention-deficit/hyperactivity disorder (ADHD; N = 42), specific learning disorder (SLD; N = 70), and TD (N = 41). Regression models, adjusted for sex, age, and non-verbal IQ, showed that HFA was associated with greater responses accuracy than TD children to the full battery of VIs, to the cognitive illusions, to the distortions, and to both geometrical illusions of size/shape (cognitive distortions) and lightness contrast effects (physical distortions). The susceptibility of ADHD children was found attenuated for illusory contours and greater for paradoxical illusions in comparison with TD children. No significant differences were shown between the SLD group and the TD children. Our findings, which were adjusted for the same duration of visual working memory across groups, showed that there is a potential specific tendency of HFA children to failure of processing visual information in context. Contrarily, children with ADHD showed in general normal global processing such as children diagnosed with SLD.

The effect of anxiety, psychopathological symptoms and personality traits on response to treatment in male patients with anogenital warts: a prospective study

BACKGROUND

In the era of precision medicine, identification of possible predictive factors of clinical response to treatment is fundamental. This need is particularly strong for anogenital warts (AGW), because there are several treatment modalities with different clearance and recurrence rates. However, data regarding the effect of mental health parameters on response to treatment in patients with AGW are lacking.

OBJECTIVES

The purpose of the present study was to evaluate the association between patients' mental health parameters and AGW treatment outcomes.

METHODS

This was a single-centre, prospective study that included newly diagnosed male patients with AGW. At their initial visit, all patients completed the State-Trait Anxiety Inventory (STAI), the Symptom Checklist-90-Revised (SCL-90-R) and the Eysenck Personality Questionnaire (EPQ) questionnaires, which evaluate anxiety, psychopathological manifestations and personality traits, respectively. All patients received cryotherapy until clearance of lesions and were followed up for 18 months for detection of recurrences.

RESULTS

The study included 167 male patients. The mean number of days for AGW clearance was 89 ± 65. During the 18-month follow-up, 28% of participants showed a recurrence, after a mean number of 150 ± 132 days. No statistically significant association was detected between questionnaires scores and (a) time needed for AGW clearance, (b) time until 1st recurrence and (c) number of recurrences.

CONCLUSION

If confirmed, our findings indicate that we may not need to modify our AGW treatment plan according to a patient's mental health profile.

“Young people are not invincible”: What drives young people’s health behaviours during the COVID-19 pandemic in greece?

Introduction

The illusion of invulnerability has been linked to lower perceived risk and increased engagement in risky behaviors among youth. Therefore, it has been purported to influence young people’s poor adherence to public health measures aiming to contain the COVID-19 pandemic. Concomitantly, beliefs about the virus and mental health may also shape public health behaviours.

Objectives

To investigate the role of beliefs, perceived invincibility and mental health status in explaining frequency of hand-washing and hours outside the house among youth in Greece

Methods

A total of 1.899 students, aged between 18-29 years old, were recruited from the main universities of the country. An online questionnaire entailing: (i) popular beliefs about COVID-19, (ii) the DASS-21, (iii) the Adolescent Invincibility Tool and (iv) queries about health behaviours, was distributed during the lockdown period.

Results

Most participants reported washing their hands rarely/never within a day (78.6%) and spending 2-6 hours outside the house (68.1%). Handwashing was largely influenced by mental health [OR = 0.94, 95%CI= 0.91 – 0.98 for stress; OR = 0.96, 95%CI = 0.93-0.99 for anxiety and OR = 1.05, 95%CI= 1.02-1.08 for depression]; while hours outside the house by perceptions that the virus is out of control [OR=0.76, 95%CI = 0.61-0.95], manufactured [OR=1.21, 95%CI = 1.53, 95%CI =1.21 – 1.93] and airborne [OR= 0.78, 95%CI = 0.64-0.95].

Conclusions

Addressing stress and anxiety as well as health education interventions should be prioritized to foster young people’s adherence to public health measures amid the pandemic.

Disclosure

No significant relationships.

Vascular inflammation and cardiovascular burden in metastatic breast cancer female patients receiving hormonal treatment and CDK 4/6 inhibitors or everolimus

Background

Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk.

Purpose

The aim of this study was to investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving either CDK 4/6 inhibitors and hormonal treatment or standard everolimus and hormonal treatment.

Methods

22 consecutive female patients with metastatic breast cancer that expressed estrogen and /or progesteron receptor and were HER2-negative were enrolled. Patients with active infection, chronic autoimmune disease and history of chemotherapy for the metastatic disease and/or adjuvant chemotherapy during the past 3 years were excluded. All subjects received hormonal treatment and of those, 10 received everolimus and 12 received therapy with CDK 4/6 inhibitors. The two groups were matched for age, history of hypertension, diabetes, dyslipidemia, smoking and all were free of major cardiovascular events for the past 6 months. Regional wall thickness (RWT) and left ventricle mass (LVM) measurements by transthoracic echocardiographic study were obtained followed by 24 hour ambulatory blood pressure monitoring, and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall (ascending, arch, descending, abdominal), was quantified as tissue-to-background ratio (TBR).Each patient was assessed for the aforementioned parameters before the initiation and after 6 months of treatment.

Results

At follow up, patients assigned to CDK4/6 treatment demonstrated increased measurements of 24 hour systolic blood pressure (SBP) (p=0.004), daytime SBP(p=0.004) and night time SBP (p=0.012) (Group effect). The 24 hour mean arterial pressure measurements were also higher in CDK 4/6 population, in comparison to everolimus that displayed firm values. (Group effect- p=0.035, Interaction effect-p=0.023).Additionally, 24 hour diastolic blood pressure recordings in CDK 4/6 therapy were higher opposed to everolimus that remained consistent (Interaction effect- p=0.010). In CDK 4/6 group, TBR aorta measurements also increased significantly, whereas TBR values in everolimus remained stable. (Interaction effect-p=0.049). Both therapeutic regimens displayed statistically significant damaging effect with regards to the following variables: Night-time SBP (p=0.032), RWT (p&lt;0.001), and LVM (p&lt;0.001).

Conclusion

Chemotherapy with novel CDK 4/6 inhibitors and hormonal treatment can lead to increased vascular inflammation, and higher blood pressure values compared to the combination of everolimus and hormonal treatment in female patients with HR-positive HER2-negative metastatic breast cancer. Moreover, both treatment strategies promote remodelling of the left ventricle by means of increased RWT and mass. Further research and longitudinal studies in this field are required to validate the above findings.

Funding Acknowledgement

Type of funding source: None

Gender-dependent variations in optical illusions: evidence from N400 waveforms

OBJECTIVE

The cognitive mechanisms (especially the gender-related ones) underlying optical illusion processing remain elusive. Since the N400 component of event-related potentials (ERPs) is an index of the semantic integration of information processing tasks, the present study focuses on gender-related differences in N400 waveforms elicited during the reasoning process applied to reach a valid conclusion of optical illusions engaging working memory (WM).

APPROACH

Fifty-one healthy participants (28 males, age = 34.25 years ± 10.25, years of education = 16.00 years ± 1.78; and 23 females, age = 33.43 ± 7.93, years of education = 15.56 ± 1.82) were measured. The N400 ERP component was evoked by 39 optical illusions adjusted to induce WM. We compared brain activation patterns while participants maintained conclusions of the optical illusions in WM. The N400 of ERPs was recorded during the WM phase, during which participants were required to draw a logical conclusion regarding the correctness of the optical illusions.

MAIN RESULTS

Analysis revealed that females compared to males exhibited significantly increased N400 amplitudes located at parietal and occipital sites, whereas males exhibited significantly higher N400 amplitudes located at frontal areas. Furthermore, females compared to males demonstrated significantly prolonged latencies of the N400 component located at right frontotemporal abductions.

SIGNIFICANCE

These results suggest that coupling of optical illusions with WM engages distinct gender-related variations of brain semantic processing as reflected by the N400 ERP component. Based on the dual process account, our study gives support to the notion that women tend to employ a more deliberate and slower semantic reasoning than the men who tend to employ an automatic and fast one. Topographically, within the network sub-serving the semantic operation, the posterior brain areas responsible for sensorimotor integration-related processes elicit a greater brain activation among females while the anterior brain areas responsible for control and storage/retrieval operation elicit a greater brain activation among males.

Dermatoscopic features of thin (≤2 mm Breslow thickness) vs. thick (>2 mm Breslow thickness) nodular melanoma and predictors of nodular melanoma versus nodular non-melanoma tumours: a multicentric collaborative study by the International Dermoscopy Society

BACKGROUND

Thin nodular melanoma (NM) often lacks conspicuous melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour.

OBJECTIVE

To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other nodular tumours.

METHODS

Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other nodular tumours from 19 skin cancer centres worldwide were collected and analysed.

RESULTS

Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-melanoma nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-melanoma nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-melanoma nodular lesions.

LIMITATIONS

Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community.

CONCLUSIONS

Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-melanoma nodular tumours.

A novel optical non-intrusive method for measuring acoustic startle reflex in humans

OBJECTIVE

The development of a new non-intrusive optical system for remotely measuring acoustic startle reflex (ASR) in humans.

APPROACH

The eye reflex movement during an acoustic stimulation session is recorded through a high-speed digital camera. The eyes region is isolated by the rest of the face by an advanced pyramid-like feature detection algorithm, which greatly reduces the number of false positives. A separate Lucas-Kanade optical flow routine is designed for the eyeblink movement detection and the startle eyeblink reflex (SEBR) curve extraction. Image masking is implemented for the elimination of unwanted artifacts caused mainly by voluntary eye movement. The proposed system was tested along with a valid EMG system on a sample of 32 healthy randomly selected adults, and the results were compared in order to measure the system's degree of reliability.

MAIN RESULTS

To assess the proposed method's validity the EMG data was used as a benchmark. The results showed strong correlation between EMG and Camera acquired results, which proves the validity of the proposed method. Furthermore, by comparing the response probability and the signal to noise ratio (SNR) for the two techniques, we proved that the proposed method can surpass the traditional EMG system in terms of accuracy and reliability.

SIGNIFICANCE

The proposed technique presents a simple, robust and reliable non-intrusive means of measuring ASR in humans, with the potential of future implementation on various ASR psychophysiology experiments, such as the study of PPI.

Oncology during the COVID-19 pandemic: challenges, dilemmas and the psychosocial impact on cancer patients

COVID-19 has caused unprecedented societal turmoil, triggering a rapid, still ongoing, transformation of healthcare provision on a global level. In this new landscape, it is highly important to acknowledge the challenges this pandemic poses on the care of the particularly vulnerable cancer patients and the subsequent psychosocial impact on them. We have outlined our clinical experience in managing patients with gastrointestinal, hematological, gynaecological, dermatological, neurological, thyroid, lung and paediatric cancers in the COVID-19 era and have reviewed the emerging literature around barriers to care of oncology patients and how this crisis affects them. Moreover, evolving treatment strategies and novel ways of addressing the needs of oncology patients in the new context of the pandemic are discussed.

Association of arterial stiffness burden with anxiety and depression in different stages of hypertension

Introduction

There has been an attempt to associate anxiety and depression with arterial stiffness. In the present study, we assessed differences in arterial stiffness among 3 groups of hypertensive patients compared to control normotensives as well as possible association with anxiety and depression scoring system.

Methods

The study cohort comprised of 127 patients (75 male, mean age 54 ± 14) who underwent assessment of their blood pressure levels and were divided in four groups: group I (normotensives, n = 34), group II (stage 1 HTN, n = 33), group III (stage 2 HTN, n = 30) and group IV (stage 3 HTN, n = 30). The evaluation of anxiety disorder was made by means of Hospital Anxiety Depression Scale (HADS), while the evaluation of depression was made with the Beck Depression Inventory (BDI). Arterial stiffness evaluation was done with Cardio-Ankle Vascular Index (CAVI). Statistical analysis was done with SPSS for windows. P-value was set at 0.05 for differences to be considered significant.

Results

Both CAVI R and CAVI L indices were significantly higher as the severity of hypertension progressed (P < 0.001). BDI score was significantly correlated with CAVIR (Pearson r = 0.53, P < 0.0001) and CAVI L (Pearson r = 0.39, P < 0.0001). HADS score was also significantly correlated with both CAVIR (Pearson r = 0.53, P < 0.0001) and CAVIL (Pearson r = 0.43, P < 0.0001).

Conclusions

There is a burden in the arterial stiffness of this population with the increase of the levels of BP which is not surprising. However, the new finding is that there is a strong correlation with arterial stiffness indices and both anxiety and depression scoring system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Event-related EEG oscillations in body dysmorphic disorder

BACKGROUND

Patients with body dysmorphic disorder (BDD) exhibit differential attentional mechanisms compared to healthy subjects. The exact nature of this differentiation is unclear. To this end, EEG (electrophysiological) responses to prepulse inhibition (PPI: reflecting attentional modulation) and prepulse facilitation (PPF: indicating orienting activation) were recorded and analysed. The aim of this study was to compare the respective neural oscillations associated with PPI and PPF in BDD vs healthy controls.

MATERIALS AND METHODS

Event-related EEG oscillations elicited by PPI and PPF (26 and 25 trials, respectively, randomly presented) were explored in a sample of patients with BDD (N = 30) vs healthy controls (N = 25). The Yale-Brown Obsessive-Compulsive Scale for BDD (BDD-YBOCS), the Body Dysmorphic Disorder Examination, the Dysmorphic Concern Questionnaire (DCQ) and the Brown Assessment of Belief Scale (BABS) were also administered.

RESULTS

Analysis of the power spectrum in response to PPI and PPF revealed that the BDD patient group compared to healthy controls exhibited higher theta-1 oscillations (potentially indicative of disrupted thalamo-cortical activation) and reduced beta-1 oscillations (potentially indicative of reduced top-down-controlled processing during attentional orienting).

CONCLUSION

These findings offer novel contributions with regards to the neural mechanisms underlying attention processes in BDD patients, and demonstrate the potential of event-related EEG oscillations as a tool to better understand body dysmorphic disorder.

Depression following graft-versus-host disease in a patient with acute lymphoblastic leukaemia: A case report

There is increasing evidence to suggest an association between depression and inflammation, with patients suffering from immune mediated-disorders exhibiting higher levels of depression. Inflammation in depression is a potential target for the development of novel treatment strategies. The present study presents a clinical case in which a patient with an underlying inflammatory condition acutely developed a severe depressive episode resulting in a sudden, dramatic change in their clinical picture. This case, with no similar case reports being in the literature thus far, at least to the best of our knowledge, highlights the increasing consideration that there may be a causative role between neuro-inflammation and depression. This study reports the case of a 40-year-old male with acute lymphoblastic leukaemia (ALL) and no previous psychiatric history, who developed an acute onset of a severe depressive episode in the context of the immune-mediated graft-versus-host disease (GVHD). GVHD is a complication of allogeneic hematopoietic cell transplantation, which the patient had undergone, for the treatment of his ALL. The rapid onset of depression could be explained by the neuroinflammatory processes occurring in GVHD. This provides a clinical example for the possible role of the immune system in depression, and clinicians should be aware of this association.

A Longitudinal Study of Alterations of S100B, sRAGE and Fas Ligand in Association to Olanzapine Medication in a Sample of First Episode Patients with Schizophrenia

BACKGROUND & OBJECTIVE

Neuroinflammation has been proposed as a major mechanism in schizophrenic disorder. Specifically, an increase in the inflammatory response in the central nervous system is capable of activating microglial cells, leading to the release of pro-inflammatory cytokines and thus activating apoptotic signaling. An increase in apoptosis may underlie a potential role of immune neuropathology in the etiopathogenesis of schizophrenia and specifically, the onset of the disorder. We analyzed in whole blood, levels of S100B, the receptor for advanced glycation end products (RAGE) and the apoptotic marker Fas Ligand in a sample of 13 first episode of schizophrenia twice at baseline before the initiation of any antipsychotic medication (A) and 6 weeks later following an antipsychotic monotherapy with olanzapine (B) and in a sample of 10 healthy controls. The S100B, RAGE and Fas Ligand showed statistically significant differences before and after treatment; the S100B measurements yielded a p-value of 0.004 while the soluble RAGE and Fas Ligand measurements yielded a p=0.03, and p=0.04 respectively. The differences between cases and controls were not statistically significant for all measurements, with the only exception being the S100B values where both samples A and B showed significantly higher values than the controls with p=8.5x10-8 and p=2.9x10-10 respectively.

CONCLUSION

The levels of S100B, RAGE, and Fas Ligand of drug-naive first episode psychosis patients with schizophrenia were significantly higher than that of the same medicated first episode psychosis patients, indicating that an increase of apoptotic signaling is present at the onset of schizophrenia and is also associated with treatment progress.

Clinical and psychometric features of psychiatric patients after a suicide attempt in relation with menstrual cycle phases

There is evidence that frequency of suicide attempts of fertile women is related to the menstrual cycle phases, while the influence of hormonal and psychiatric features has been hypothesized. This study aims to explore the distribution and possible differences in clinical characteristics of women who attempted suicide in relation to menstrual cycle. Seventy fertile female psychiatric patients, hospitalized in psychiatric department after a suicide attempt, were studied. Depression was assessed using Beck Depression Inventory, suicide intent with the Suicide Intent Scale, and aggression using the Buss-Perry Aggression Questionnaire. A profile of psychopathology was obtained by using Symptom Check List SCL-90-R. Attempts were more frequent during the last 4 days of luteal phase and during the 4 days of menses, with 59% of attempts to occur during these 8 days. Patterns of number of attempts and cycle phase were similar for subgroups regarding diagnosis, violent/non-violent mode of suicide attempt, and one or repeated attempts. Although attempts were unequally distributed during the cycle, none of the psychiatric features assessed in the present study were related to the higher frequency of attempts during premenstrual/menstrual days, indicating the need to include additional aspects of suicidal behavior in future studies.

Hair loss in a female patient after administration of fluoxetine: a case report and review of the literature

OBJECTIVE

Fluoxetine is a pharmacological agent that has been widely used to determine the neurotransmission of serotonin in the central nervous system. It is the drug of choice in the treatment of depression due to its safer profile, fewer side effects, and greater tolerability.

PATIENTS AND METHODS

This is a case of a 30 year-old woman suffering from mild depression according to the DSM-V criteria who had been prescribed and administered fluoxetine in a dose of 20 mg p.o./per day.

RESULTS

Six weeks after the initiation of the medication, the patient reported hair loss in the frontal area of the skull.

CONCLUSIONS

Since fluoxetine is a widely used antidepressant, clinicians should be aware of the skin complications in patients treated with antidepressants. There is further need for therapeutic monitoring in everyday clinical practice and before the prescription of an antidepressant agent, the specific guidelines, side-effect profile, drug-drug interactions and most current indications should always be taken into consideration.

Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society

BACKGROUND

Over the last few years, several articles on dermoscopy of non-neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies.

OBJECTIVES

We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non-neoplastic dermatoses through an expert consensus.

METHODS

The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three-step iterative procedure (blinded e-mail interaction in rounds 1 and 3 and a face-to-face meeting in round 2). Initial panellists were recruited via e-mail from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses.

RESULTS

Twenty-four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) 'other structures' (including colour and morphology); and (v) 'specific clues'. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure).

CONCLUSIONS

This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. What's already known about this topic? Over the last few years, several papers have been published attempting to describe the dermoscopic features of non-neoplastic dermatoses, yet there is poor consistency in the terminology among different studies. What does this study add? The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.

The prevalent dermoscopic criterion to distinguish between benign and suspicious pink tumours

BACKGROUND

Pink skin tumours are difficult to differentiate, clinically and dermoscopically. In previous studies, mainly focused on pigmented lesions, pattern analysis provided the best sensitivity and specificity values, as compared to other algorithms. These findings suggest that the global dermoscopic appearance, based on the evaluation of prevalent features, could represent a valuable and practical approach even when dealing with pink lesions.

OBJECTIVE

In this study, we aimed to evaluate the diagnostic accuracy of a new dermoscopic approach for pink tumours based on the prevalent criterion, as compared to a standard diagnostic method (Menzies algorithm).

METHODS

The databases of two referral centres were retrospectively evaluated to retrieve dermoscopic images of amelanotic/hypomelanotic skin lesions. Two experts in dermoscopy, blinded for the final diagnosis and for clinical and demographic information, evaluated separately dermoscopic pictures of 1000 lesions according to the Menzies score and to the prevalent criterion method.

RESULTS

According to the high sensitivity model of the Menzies score, 129 (12.9%) lesions were considered as non-suspicious (of which 16 were false negative) and 871 (87.1%) as suspicious (of which 212 were false positive), with 97.6% sensitivity and 34.8% specificity. According to the high specificity model, 370 (37%) lesions were evaluated as non-suspicious (of which 105 were false negative) and 630 (63%) as suspicious (of which 60 were false positive), with 84.4% sensitivity and 81.5% specificity. Concerning the prevalent criterion method, 316 (31.6%) lesions were evaluated as non-suspicious (of which 46 were false negative) and 684 (68.4) as suspicious (of which 55 were false positive), with 93.2% sensitivity and 83.1% specificity.

CONCLUSIONS

This study demonstrated that focusing on the prevalent dermoscopic features could allow to detect malignant pink tumours with similar sensitivity but higher specificity than using the conventional Menzies scoring system.

Real-Time Passive Brain Monitoring System Using Near-Field Microwave Radiometry

OBJECTIVE

Near-field microwave radiometry has emerged as a tool for real-time passive monitoring of local brain activation, possibly attributed to local changes in blood flow that correspond to temperature and/or conductivity changes. The aim of this study is to design and evaluate a prototype system based on microwave radiometry intended to detect local changes of temperature and conductivity in depth in brain tissues. A novel radiometric system that comprises a four port total power Dicke-switch sensitive receiver that operates at 1.5 GHz has been developed.

METHODS AND RESULTS

The efficacy of the system was assessed through simulation and experiment on brain tissue mimicking phantoms under different setup conditions, where temperature and conductivity changes were accurately detected. In order to validate the radiometer's capability to sense low power signals occurring spontaneously from regions in the human brain, the somatosensory cortices of one volunteer were measured under pain-inducing psychophysiological conditions. The promising results from the initial in vivo measurements prove the system's potential for more extensive investigative trials.

CONCLUSION AND SIGNIFICANCE

The significance of this study lies on the development of a compact and sensitive radiometer for totally passive monitoring of local brain activation as a potential complementary tool for contributing to the research effort for investigating brain functionality.

Effects of olanzapine on cytokine profile and brain-derived neurotrophic factor in drug-naive subjects with first-episode psychosis

Immunological abnormalities have been implicated in schizophrenia. On the other hand, antipsychotics may exert immunomodulatory effects, by triggering pro-inflammatory and anti-inflammatory agents through complex homeostatic mechanisms, which seem to be implicated in medication responsiveness and in the presence or not of adverse effects. There is evidence that olanzapine, a second generation antipsychotic, may increase synapse formation and neurogenesis through alterations in the levels of cytokines and neurotrophic factors. In the present study, we recruited 14 drug-naive inpatients with first-episode schizophrenia (male:female ratio, 7:7) with a mean age of 26.5 years. The positive and negative syndrome scale (PANSS) scores and serum levels of a broad spectrum of cytokines and of brain-derived neurotrophic factor (BDNF) were recorded twice, once at baseline prior to the initiation of olanzapine treatment and 8 weeks later, once the dose of olanzapine had stabilized. Subsequently, the associations between the PANSS scores and the measured markers were examined. Correlation analyses revealed that follow-up PANSS_negative positively correlated with baseline interleukin (IL)-6 (ρ=0.685, P=0.007) and baseline IL-27 levels (ρ=0.785, P=0.001). Furthermore, the percentage change in PANSS_negative [(PANSS-_follow-up - PANSS-_baseline)/PANSS-baseline; ΔPANSS_negative%)] positively correlated with baseline IL-27 (ρ=0.785, P=0.001) and baseline IL-6 levels (ρ=0.685, P=0.007). Finally, linear regression revealed that follow-up PANSS_negative was associated with baseline IL-27 (R²=0.301, P=0.042), ΔPANSS_negative% was associated with baseline IL-6 (R²=0.301, P=0.042) and baseline IL-27 levels (R²=0.446, P=0.009). Thus, these findings indicate that IL-27 and IL-6 may be trait markers in patients being administered olanzapine monotherapy at the onset of schizophrenia. However, further studies are warranted in order to replicate these associations and to confirm their potential use as biomarkers of treatment effectiveness and safety, as well as to explore novel immunomodulatory strategies for the treatment of schizophrenia.