Connection of social anxiety to impaired pattern of cognitive control and underlying motivational deficiencies: Evidence from event-related potentials

Numerous studies have established a correlation between social anxiety and poor cognitive control. However, little is known about the cognitive control pattern of individuals with high social anxiety (HSAs) and the underlying mechanisms. Based on the Dual Mechanisms of Control framework and the Expected Value of Control theory, this study explored whether HSAs have an impaired cognitive control pattern (Experiment 1) and whether motivational deficiencies underlie the impaired control pattern (Experiment 2). In Experiment 1, 21 individuals with low social anxiety (LSAs) and 21 HSAs completed an AX-Continuous Performance Task. Results showed that HSAs had a smaller P3b amplitude than LSAs, indicating their weakened proactive control in the cue processing stage, but a larger contingent negative variation (CNV) on cue B as compensation for the negative effects of anxiety in the response preparation stage. No group difference was found in N2 and P3a amplitude on probes, suggesting that reactive control in HSAs was not affected compared to LSAs. In Experiment 2, 21 LSAs and 21 HSAs completed a cued-flanker task, where the likelihood of proactive control engagement was manipulated. The results revealed that HSAs exhibited motivation deficiencies in engaging in proactive control, as evidenced by P3b, CNV amplitude, and response times. These findings shed light on the impaired cognitive control pattern of HSAs and suggest that motivational deficiencies may be the crucial underlying factor.

Interaction between high interleukin-2 and high cortisol levels is associated with psychopathology in patients with chronic schizophrenia

BACKGROUND

Both cortisol and interleukins appear at abnormal levels in schizophrenia. Our previous study has shown that cortisol and interleukins are associated with psychopathology and response to antipsychotic medications in a relatively small sample size of patients with schizophrenia. The current study was designed to investigate how cortisol, interleukins (ILs) and their interactions would correlate with clinical presentation in a relatively large sample size of patients with schizophrenia.

METHODS

We compared serum cortisol, IL-2, IL-6, and IL-8 levels in 162 medicated schizophrenia patients (including 27 patients in remission) and 62 healthy controls. Serum levels of cortisol and interleukins were measured by radioimmunoassay and quantitative ELISA, respectively. Clinical symptoms were assessed according to the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Patients with schizophrenia had significantly higher levels of cortisol and IL-2 compared to controls. Patients in remission had higher levels of IL-6 than non-remitting patients. PANSS positive symptoms, general psychopathology, cortisol and IL-2 were the most central nodes in the cortisol-IL-symptom network. The interaction between cortisol and IL-2 was associated with PANSS positive symptoms, general psychopathology and depressive factor. For patients with cortisol level above the median, IL-2 was negatively associated with PANSS positive symptoms and general psychopathology.

CONCLUSIONS

Our results indicated that the interaction between cytokines and cortisol may be associated with the pathophysiology of some symptoms in chronic schizophrenia. In particular, the interaction between cortisol and IL-2 is associated with the clinical phenotypes of schizophrenia.

Effectiveness of mindfulness training on pregnancy stress and the hypothalamic-pituitary-adrenal axis in women in China: A multicenter randomized controlled trial

Introduction

In the past two decades, mindfulness-based intervention programs have gradually become popular.Many studies have confirmed that these programs can effectively alleviate prenatal stress and negative emotion.The mindfulness-based stress-buffering hypothesis suggests that mindfulness training can induce changes in the levels of the cortisol secreted by the HPA axis, thereby reducing stress susceptibility. However, to date, only a few high-quality evidence-based medical studies have analyzed the effect of the mindfulness-based intervention in a maternal population.Thus, this study investigated the effects of a mindfulness-based psychosomatic intervention on pregnancy stress and the HYPERLINK "javascript:;" hypothalamic-pituitary-adrenal (HPA) axis of pregnant Chinese women.

Methods

Women experiencing first-time pregnancy (n = 117) were randomly allocated to the intervention group or parallel active control group, and data were collected at baseline and post-intervention periods. The participants completed questionnaires regarding mindfulness and pregnancy stress. Saliva samples was collected at the time of waking up, and 30, 45, and 60 min after waking up for analyzing the salivary cortisol levels. We analyzed differences between the two groups and changes within the same group before and after the intervention.

Results and discussion

A total of 95 participants completed the trial. Compared with the parallel active control group, the intervention group exhibited lower levels of stress after the intervention (P = 0.047). For HPA-axis-related indicators after the intervention, Delta value (P = 0.01) and AUCM value (P = 0.031) of the intervention group were significantly higher than that of the control group. Mindfulness-based interventions effectively reduced the level of pregnancy stress and adjusted the HPA axis function in pregnant women in China.

Clinical Trial Registration

https://www.chictr.org.cn, identifier ChiCTR 2000033149.

The prevalence and clinical correlates of suicide attempts in comorbid subclinical hypothyroidism in patients with never-treated major depressive disorder in China

BACKGROUND

Previous studies have emphasized the possible association between subclinical hypothyroidism (SCH) and major depressive disorder (MDD). This study aimed to further investigate suicide attempts and their clinical correlates in MDD patients with comorbid SCH.

METHODS

This cross-sectional study recruited 1706 eligible MDD outpatients. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression of Severity Scale (CGI-S) were applied to evaluate mental status. Fasting blood samples were collected to examine thyroid function. SCH was defined as thyroid stimulating hormone (TSH) > 8 mIU/L with normal free thyroxine levels.

RESULTS

The prevalence of suicide attempts in the SCH group (51.7 %) was significantly higher than that in the non-SCH group (15.4 %; p < 0.001). Logistic regression showed that patients with comorbid SCH were 1.81 times more likely to have attempted suicide as compared with those without (p = 0.001). Among those with TSH > 8 mIU/L, patients with severe anxiety were 3.57 times more likely to attempt suicide compared with those without (p < 0.01). Logistic regression also showed that the CGI-S score (p < 0.001) was independently associated with suicide attempts, while TSH level was not.

CONCLUSIONS

SCH comorbidity may pose a specific hazard in MDD patients due to increased suicide attempts. Exhibiting severe anxiety, overall severity of depressive and psychotic symptoms, but not TSH levels, may be independently correlated with suicide attempts in MDD patients with TSH > 8 mIU/L.

COVID-19 pandemic: study on simple, easy, and practical relaxation techniques while wearing medical protective equipment

BACKGROUND

No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment.

METHODS

This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance.

RESULTS

Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6).

CONCLUSION

Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.

Perceived Stress, Resilience, and Anxiety Among Pregnant Chinese Women During the COVID-19 Pandemic: Latent Profile Analysis and Mediation Analysis

Objective: The coronavirus disease 2019 (COVID-19) pandemic has posed a major threat to pregnant women's mental health. This study aimed to characterize the patterns of perceived stress in pregnant Chinese women during the COVID-19 pandemic, to examine the profile differences on anxiety and resilience, and to investigate whether the differences in these profiles on anxiety were mediated by resilience.

Methods: From February 28, 2020 to April 26, 2020, a sample of 2,116 pregnant Chinese women who participated in online crisis interventions completed an online self-reporting questionnaire assessing their demographic characteristics, perceived stress, resilience, and anxiety.

Results: Latent profile analysis (LPA) on two stress dimensions [perceived helplessness (HEL) and perceived self-efficacy (SEL)] indicated four perceived stress profiles: adaptive (33.7% of the sample), resistant (44.6%), insensitive (19.1%), and sensitive (2.6%). The women with both adaptive and insensitive profiles had the lowest levels of anxiety, whereas those with the resistant profile had the lowest levels of resilience. Multicategorical mediation analysis showed that resilience partially mediated the differences in the pregnant women's anxiety between the adaptive/insensitive and resistant profile.

Conclusion: This study showed the heterogeneity in the perceived stress patterns of pregnant women during the COVID-19 pandemic, revealing the internal mechanisms of pregnant women's anxiety using a person-centered approach, and provided initial evidence guiding the development of differentiated stress interventions to alleviate pregnant women's anxiety during the pandemic.

A Conditional Process Model to Explain Somatization During Coronavirus Disease 2019 Epidemic: The Interaction Among Resilience, Perceived Stress, and Sex

Background

More than 15% of Chinese respondents reported somatic symptoms in the last week of January 2020. Promoting resilience is a possible target in crisis intervention that can alleviate somatization.

Objectives

This study aims to investigate the relationship between resilience and somatization, as well as the underlying possible mediating and moderating mechanism, in a large sample of Chinese participants receiving a crisis intervention during the coronavirus disease 2019 epidemic.

Methods

Participants were invited online to complete demographic information and questionnaires. The Symptom Checklist-90 somatization subscale, 10-item Connor–Davidson resilience scale, and 10-item Perceived Stress Scale were measured.

Results

A total of 2,557 participants were included. Spearman correlation analysis revealed that lower resilience was associated with more somatic symptoms (p < 0.001). The conditional process model was proved (indirect effect = −0.01, 95% confidence interval = [−0.015, −0.002]). The interaction effects between perceived stress and sex predicted somatization (b = 0.05, p = 0.006).

Conclusion

Resilience is a key predictor of somatization. The mediating effects of perceived stress between resilience and somatization work in the context of sex difference. Sex-specific intervention by enhancing resilience is of implication for alleviating somatization during the coronavirus disease 2019 epidemic.

Association of Stress-Related Factors With Anxiety Among Chinese Pregnant Participants in an Online Crisis Intervention During COVID-19 Epidemic

Background: Previous systematic review indicated the prevalence of prenatal anxiety as 14–54%. Pregnant women are a high-risk population for COVID-19. However, the prevalence of anxiety symptoms and related factors is unknown in Chinese pregnant women during COVID-19 outbreak.

Objective: To investigate the prevalence of anxiety symptoms and the related factors in Chinese pregnant women who were attending crisis intervention during the COVID-19 pandemic.

Methods: The data of this cross-sectional study were collected in about 2 months (February 28 to April 26, 2020). Data analysis was performed from April to May 2020. Participants completed a set of questionnaires via the Wechat Mini-program before starting the online self-help crisis intervention for COVID-19 epidemic. A total of 2,120 Chinese pregnant women who were attending a self-help crisis intervention participated in this study. A survey was developed to address possible stress-related factors in pregnant women during the COVID-19 outbreak, including demographic, socioeconomic, and pregnancy-related factors, as well as COVID-19 related factors. Generalized Anxiety Disorder-7 (GAD-7) scale and the 10-item perceived stress scale were, respectively, employed to measure anxiety and stress-related factors.

Results: A total of 21.7% (459) of pregnant women reported at least mild anxiety (≥5 on the GAD-7 scale), and only 82 women reported moderate to severe anxiety (≥10 on the GAD-7 scale). Factors associated with at least mild anxiety included living in Hubei province (OR = 1.68, 95% CI = 1.32–2.13), nobody providing everyday life support (OR = 1.81, 95% CI = 1.18–2.77), pelvic pain or vaginal bleeding (OR = 1.67, 95% CI = 1.32–2.09), and higher perceived stress (OR = 6.87, 95% CI = 5.42–9.02). Having relatives or neighbors with a diagnosis of COVID-19 was not associated with anxiety (p > 0.05).

Conclusions and Relevance: Our findings indicate that evaluation and intervention for maternal and infant health are necessary in pregnant women with anxiety during COVID-19 epidemic, especially those with higher perceived stress, less everyday life support, or vaginal bleeding. Interactions among these related medical, social and psychological factors need to be investigated in future studies.

The neurodevelopment of delay discounting for monetary rewards in pre-adolescent children

Children are found to exhibit high degrees of delay discounting compared with adults in many delay discounting studies, which might be due to the asynchronous development of "bottom-up" and "top-down" neural systems. However, the temporal dynamics associated with the two systems in the development of delay discounting processes are not well known. In this study, we chose two age groups of participants and adopted event-related potential (ERP) techniques to investigate the neural dynamic differences between children and adults during delay discounting processes. Behavioral findings showed that children discounted more than adults and chose more immediate choices. Electrophysiological findings revealed that children exhibited longer neural processing (longer P2 latency) than adults during the early detection and identification phase. Children showed less cognitive control (smaller N2 amplitude) than adults over the middle frontal areas, and they devoted more neural effort (larger P3 amplitudes) to making final choices than adults. The factors of reward amount and time delay could influence the development of delay discounting in children.

Prevalence and correlates of somatization in anxious individuals in a Chinese online crisis intervention during COVID-19 epidemic

BACKGROUND

Somatization is a common comorbidity in anxious people. From January 31 to February 2, 2020, a high prevalence of moderate to severe anxiety was detected due to COVID-19 outbreak. The purpose of this study was to investigate the prevalence and correlates of somatization among Chinese participants with anxiety receiving online crisis interventions from Feb 14 to Mar 29 during the COVID-19 epidemic.

METHODS

A total of 1134 participants who participated in online crisis interventions completed the Generalized Anxiety Disorder-7 (GAD-7) scale and the Symptom Checklist-90 (SCL-90) and demographic questions online. Somatization was defined as the average score of each item ≥ 2 in SCL-90 somatization subscale. Moderate to severe anxiety was defined as a score ≥ 10 in the GAD-7 scale.

RESULTS

Among all participants, 8.0% reported moderate to severe anxiety and 7.4% reported somatization. After March 1, the prevalence of anxiety with or without somatization did not significantly change (both p > 0.05), while the prevalence of somatization increased significantly (p < 0.01). Logistic regression analysis indicated that somatization was associated with chronic disease history (with an odds ratio of 4.80) and female gender (with an odds ratio of 0.33).

CONCLUSIONS

Our findings suggest that the history of chronic diseases is associated with somatization in individuals with anxiety, indicating some stress-related mechanisms. Chinese men in crisis intervention need more attention because they are more likely to report anxiety comorbid somatization.

Prevalence and clinical correlates of subclinical hypothyroidism in first-episode drug-naive patients with major depressive disorder in a large sample of Chinese

BACKGROUND

The coexistence of subclinical hypothyroidism (SCH) and depression has been intensively examined in the patients receiving thyroxine or antidepressant treatment. This study aimed to investigate the prevalence and clinical correlates of severe SCH in Chinese first-episode drug naïve patients with major depressive disorder (MDD).

METHODS

Using a cross-sectional design, we recruited a total of 1706 MDD patients. Depressive symptoms were evaluated using the 17-item Hamilton Depression Rating Scale (HAMD). Severity of anxiety and psychiatric symptoms were evaluated by the Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS), respectively. Serum thyroid function parameters were measured by a chemiluminescence immunoassay. Based on the serum thyroid stimulating hormone (TSH) level, SCH was further divided into mild (TSH < 10 mIU/L) and severe SCH (TSH ≥ 10 mIU/L).

RESULTS

More patients with severe SCH had severe anxiety, psychotic symptoms, suicide attempts (all p < 0.001), compared with those without severe SCH. Logistic regression showed that suicide attempts and psychiatric symptoms were associated with severe SCH (both p < 0.001). Multiple linear regression showed that age (p < 0.05), BMI (p < 0.001), HAMD score (p < 0.001), HAMA score (p < 0.001), PANSS positive subscore (p = 0.001) and CGI score (p = 0.001) were associated with TSH levels.

CONCLUSION

Our findings suggest that suicide attempts and psychiatric symptoms may be associated with severe SCH. Moreover, severe anxiety, depressive and psychotic symptoms, as well as older age and higher BMI are possibly related to elevated TSH levels.

The Relationships Among Testosterone, Cortisol, and Cognitive Control of Emotion as Underlying Mechanisms of Emotional Intelligence of 10- to 11-Year-Old Children

Emotional intelligence is an important factor contributing to social adaptation. The current study investigated how salivary testosterone (T) and cortisol (C) levels, cognitive control of emotional conflict processing were associated with children's emotional intelligence (EI). Thirty-four 10- to 11-year-old children were enrolled and instructed to complete questionnaires on emotional intelligence as well as empirical tasks of emotional flanker and Stroop with event-related potential (ERP) recordings. Saliva collection took place on another day without ERP tasks. Results showed that lower T and C levels were associated with higher accuracy in emotional conflict tasks, as well as better emotional intelligence (managing self emotions). In the Stroop task, higher T/C ratios were associated with greater congruency effects of N2 latencies, and lower cortisol levels correlated with stronger slow potential activities (SP). For girls, the correlation between cortisol and emotional utilization was mediated by the SP amplitudes on fearful conflicts in the flanker task (95% CI: -8.64, -0.54, p < 0.050). In conclusion, the current study found the relationship between cortisol and an emotional intelligence ability, emotional utilization, might be mediated by brain activities during emotional conflict resolution processing (SP responses) in preadolescent girls. Future studies could further investigate testosterone-cortisol interaction and its relation with cognitive control of emotion as underlying mechanisms of emotional intelligence.

Conflict control of emotional and non-emotional conflicts in preadolescent children

Conflict control refers to an individual's goal-directed cognitive control and self-regulation of behavior. The neurodevelopment related to conflict control is crucial for the development of cognitive and emotional abilities in children. In the current study, preadolescent children and adults completed the Simon and Stroop tasks in emotional and non-emotional contexts with simultaneous electroencephalography recordings. The behavioral findings showed that adults had faster response speed and better conflict control performance compared to children. Children's accuracy was affected by the emotional context, whereby children had a lower accuracy in the emotional contexts compared to the non-emotional contexts. Adults had similar performances in both contexts. During the neural processes of conflict detection and conflict resolution, children had longer N2 latencies for conflict detection, and devoted more neural efforts with larger P3 amplitudes to execute resolution control on the conflicts than adults. Moreover, both age groups' reaction times (RT) were shorter in the Simon task than in the Stroop task in the non-emotional context, while, RTs were longer in the Simon task than in the Stroop task in the emotional context. Children showed larger P3 responses in the Simon task than in the Stroop task in the emotional contexts, while adults showed no such differences. The current findings demonstrate that children have immature neurodevelopment of conflict control compared to adults, and their cognitive control processes on conflicts were distracted by the emotional contexts. Children's emotional conflict control processes were also affected by the characteristic of conflict types, and they need to devote more neural effort to process Simon-like conflicts than Stroop-like conflicts compared to adults.

The Correlation among Neural Dynamic Processing of Conflict Control, Testosterone and Cortisol Levels in 10-Year-Old Children

Cognitive control is related to goal-directed self-regulation abilities, which is fundamental for human development. Conflict control includes the neural processes of conflict monitoring and conflict resolution. Testosterone and cortisol are essential hormones for the development of cognitive functions. However, there are no studies that have investigated the correlation of these two hormones with conflict control in preadolescents. In this study, we aimed to explore whether testosterone, cortisol, and testosterone/cortisol ratio worked differently for preadolescent’s conflict control processes in varied conflict control tasks. Thirty-two 10-year-old children (16 boys and 16 girls) were enrolled. They were instructed to accomplish three conflict control tasks with different conflict dimensions, including the Flanker, Simon, and Stroop tasks, and electrophysiological signals were recorded. Salivary samples were collected from each child. The testosterone and cortisol levels were determined by enzyme-linked immunosorbent assay. The electrophysiological results showed that the incongruent trials induced greater N2/N450 and P3/SP responses than the congruent trials during neural processes of conflict monitoring and conflict resolution in the Flanker and Stroop tasks. The hormonal findings showed that (1) the testosterone/cortisol ratio was correlated with conflict control accuracy and conflict resolution in the Flanker task; (2) the testosterone level was associated with conflict control performance and neural processing of conflict resolution in the Stroop task; (3) the cortisol level was correlated with conflict control performance and neural processing of conflict monitoring in the Simon task. In conclusion, in 10-year-old children, the fewer processes a task needs, the more likely there is an association between the T/C ratios and the behavioral and brain response, and the dual-hormone effects on conflict resolution may be testosterone-driven in the Stroop and Flanker tasks.

Puberty timing and fluid intelligence: a study of correlations between testosterone and intelligence in 8- to 12-year-old Chinese boys

Sex hormone such as testosterone was recently recognized as an important contributor of spatial cognition and intelligence during development, but the relationship between puberty timing and intelligence especially in children is largely unknown. Here in this study, we investigated the potential relationship between the level of sex hormones in saliva and fluid intelligence in 8- to 12-year-old Chinese boys. Fluid intelligence was measured by the Cattell's Culture Fair Intelligence Test. 1600 children aged 8-12 years were included in the Cattell's Culture Fair Intelligence Test and saliva samples were collected thereafter from 166 boys with normal intelligence distribution, composed of 49, 54 and 63 boys in 8-, 10- and 12-year-old group respectively. The level of salivary testosterone and estradiol was measured with enzyme-immunoassay technique. Data of BMI and age were collected. The relationship between the level of salivary sex hormones and fluid intelligence was analysed by correlation test. There was no significant correlation between salivary testosterone level and fluid intelligence in 8-year-old boys, whereas there was a significant positive correlation in 10-year-old boys and a significant negative correlation in 12-year-old boys between those two variable. To verify the correlation, we performed stepwise multivariate linear regression and discriminant analysis, with both the age and BMI of the boys and their parents, and salivary estradiol level considered. The results showed that the level of testosterone and intelligence was correlated, and the correlation was much stronger when the level of salivary testosterone was higher than 14 pg/ml. In summary, the study suggests that the relationship of testosterone and intelligence varies from late childhood to early adolescence, and the puberty timing is closely related with fluid intelligence.