An exploratory study of obstetrics trainees' experiences of breaking bad news

INTRODUCTION

Breaking bad news is one of the hardest tasks performed by doctors. The news can significantly impact on the patient's life; however, the process also generates stress for the doctor. The aim of this study was to explore the lived experiences of breaking bad news for obstetrics trainees in Ireland.

METHODS

A qualitative study using interpretative phenomenological analysis (IPA) was performed to capture the experience of breaking bad news for the trainees. Semi-structured interviews were conducted with trainees over Zoom. The transcripts were analysed in line with the IPA framework with the assistance of NVivo software.

RESULTS

Seven trainees were interviewed, five at Basic Specialist Training (BST) level and two at Higher Specialist Training (HST) level. Four superordinate themes were identified from the analysis: "the reality of working in obstetrics," "the role of the doctor," "development of communication skills" and "the importance of the patient experience." The trainees described breaking bad news in a variety of clinical contexts. This task could be emotionally draining; however, only two trainees mentioned ways of coping with this. Their formal training was limited with the majority of learning occurring "on the job."

CONCLUSIONS

This study provides an insight into factors that influence trainees experiences of breaking bad news. The results complemented existing literature and raised questions about how to better support trainees through increased training and psychological support.

Undertaking a face-to-face objective structured clinical examination for medical students during the COVID-19 pandemic

INTRODUCTION AND AIMS

Objective structured clinical examinations (OSCEs) play a pivotal role in medical education assessment. The Advanced Clinical Skills (ACS) OSCE examines clinical skills in psychiatry, general practice, obstetrics and gynaecology and paediatrics. This study examined if the 2020 ACS OSCE for fourth year medical students attending the National University of Ireland, Galway, was associated with any significant result differences compared to the equivalent 2019 OSCE. Additionally, we assessed students' satisfaction and explored any organisational difficulties in conducting a face-to-face OSCE during the COVID-19 pandemic.

MATERIALS AND METHODS

This study compared anonymised data between the 2019 and 2020 ACS OSCEs and analysed anonymised student feedback pertaining to the modified 2020 OSCE.

RESULTS

The mean total ACS OSCE result achieved in 2020 was statistically higher compared to the 2019 OSCE [62.95% (SD = 6.21) v. 59.35% (SD = 5.54), t = 6.092, p < 0.01], with higher marks noted in psychiatry (p = 0.001), paediatrics (p = 0.001) and general practice (p < 0.001) with more students attaining honours grades (χ2 = 27.257, df = 3, p < 0.001). No difference in failure rates were found. Students reported feeling safe performing the 2020 OSCE (89.2%), but some expressed face-mask wearing impeded their communication skills (47.8%).

CONCLUSION

This study demonstrates that conducting a face-to-face OSCE during the pandemic is feasible and associated with positive student feedback. Exam validity has been demonstrated as there was no difference in the overall pass rate.

Neural circuit disruptions of eye gaze processing in autism spectrum disorder and schizophrenia: An activation likelihood estimation meta-analysis

BACKGROUND

Impairment in social cognition, particularly eye gaze processing, is a shared feature common to autism spectrum disorder (ASD) and schizophrenia. However, it is unclear if a convergent neural mechanism also underlies gaze dysfunction in these conditions. The present study examined whether this shared eye gaze phenotype is reflected in a profile of convergent neurobiological dysfunction in ASD and schizophrenia.

METHODS

Activation likelihood estimation (ALE) meta-analyses were conducted on peak voxel coordinates across the whole brain to identify spatial convergence. Functional coactivation with regions emerging as significant was assessed using meta-analytic connectivity modeling. Functional decoding was also conducted.

RESULTS

Fifty-six experiments (n = 30 with schizophrenia and n = 26 with ASD) from 36 articles met inclusion criteria, which comprised 354 participants with ASD, 275 with schizophrenia and 613 healthy controls (1242 participants in total). In ASD, aberrant activation was found in the left amygdala relative to unaffected controls during gaze processing. In schizophrenia, aberrant activation was found in the right inferior frontal gyrus and supplementary motor area. Across ASD and schizophrenia, aberrant activation was found in the right inferior frontal gyrus and right fusiform gyrus during gaze processing. Functional decoding mapped the left amygdala to domains related to emotion processing and cognition, the right inferior frontal gyrus to cognition and perception, and the right fusiform gyrus to visual perception, spatial cognition, and emotion perception. These regions also showed meta-analytic connectivity to frontoparietal and frontotemporal circuitry.

CONCLUSION

Alterations in frontoparietal and frontotemporal circuitry emerged as neural markers of gaze impairments in ASD and schizophrenia. These findings have implications for advancing transdiagnostic biomarkers to inform targeted treatments for ASD and schizophrenia.

Reflective practice in psychiatric training: Balint groups during COVID-19

Reflective practice is increasingly being recognized as an important component of doctors' professional development. Balint group practice is centered on the doctor-patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

Delirium occurrence in older Irish adults admitted to an acute medical hospital: a prospective cohort study

OBJECTIVES

Delirium, which is associated with adverse health outcomes, is poorly detected in hospital settings. This study aimed to determine delirium occurrence among older medical inpatients and to capture associated risk factors.

METHODS

This prospective cohort study was performed at an Irish University Hospital. Medical inpatients 70 years and over were included. Baseline assessments within 72 hours of admission included delirium status and severity as determined by the Revised Delirium Rating Scale (DRS-R-98), cognition, physical illness severity and physical functioning. Pre-existing cognitive impairment was determined with Short Informant Questionnaire on Cognitive Decline (IQCODE). Serial assessment of delirium status, cognition and the physical illness severity were undertaken every 3 (±1) days during participants' hospital admission.

RESULTS

Of 198 study participants, 92 (46.5%) were women and mean age was 80.6 years (s.d. 6.81; range 70-97). Using DRS-R-98, 17.7% (n = 35) had delirium on admission and 11.6% (n = 23) had new-onset delirium during admission. In regression analysis, older age, impaired cognition and lower functional ability at admission were associated with a significant likelihood of delirium.

CONCLUSIONS

In this study, almost one-third of older medical inpatients in an acute hospital had delirium during admission. Findings that increasing age, impaired cognition and lower functional ability at admission were associated with increased delirium risk suggest target groups for enhanced delirium detection and prevention strategies. This may improve clinical outcomes.

247 QUALITY IMPROVEMENT IN DEMENTIA CARE: STREAMLINING CARE PATHWAYS IN A PSYCHIATRY OF OLD AGE SERVICE

Background

Dementia is increasingly considered a public health priority worldwide in the context of predicted increased prevalence. In Ireland, there are an estimated 67,000 persons living with dementia and by 2041 it is expected to rise to 145,000 persons. Challenges in dementia care have been highlighted in health services across Europe and the ineffective structure of dementia care with fragmented non-person-centred pathways has been identified.

Methods

An initial review of the existing cognitive impairment diagnostic pathways in our specialised Psychiatry of Old Age (POA) Service was undertaken. This included surveying the multidisciplinary team to identify challenges, clinical chart review and audit of physical examination equipment. Diagnostic pathway was updated based on findings and informed by the developing national ‘Model of Care for Dementia in Ireland’ and best practice.

Results

Review findings included lack of standardisation of memory assessment, delays in accessing neuroimaging and laboratory results, gaps in staff training. A care pathway document was developed detailing requirements for care from the point of referral through to cognitive impairment diagnosis. Staff training was completed to accompany the introduction of standardised dementia assessment scales. Access to laboratory/radiology booking was enhanced. A cognitive remediation group was developed by Occupational Therapy as part of post-diagnostic supports for service users. Preliminary data indicates improvements in satisfaction of those attending the group. Physical examination equipment audit resulted in quality improvements.

Conclusion

We demonstrate that a quality improvement approach can be implemented to enhance assessment, diagnosis and care provided to support diagnosis of cognitive impairment and dementia in POA service. The enhanced diagnostic care pathways will be assessed over time to assess impact on care of service users. Preliminary findings are positive and it is an approach that can be adopted in other services and inform development of national memory service developments.

232 WORKING-UP DEMENTIA, A RETROSPECTIVE COHORT STUDY OF REFERRALS TO A SPECIALIST DEMENTIA SERVICE

Background

Rates of dementia in Ireland are rapidly increasing in line with our ageing population. Cases are predicted to more than double in the next 30 years from a prevalence of 55,000 in 2018, to 141,000 in 2050. Dementia services will be placed under significant pressure. It is essential that patients referred to specialist memory services are appropriately worked-up prior to referral, to ensure efficiency and optimise the running of these services, and also to improve patient experience.

Methods

We carried out a retrospective review of patients referred to the Psychiatry of Later Life Team for specialist dementia care by General Practitioners. We obtained date of referral to the service, and carried out an electronic chart review to evaluate the work-up performed prior to referral. Our standard work-up criteria consisted of neuroimaging (CT brain or MRI brain), and blood tests including B12, folate, and thyroid function tests within 12-months. Results were analysed descriptively.

Results

104 patients were included in the study, from referrals dated Nov 2014-June 2019. Neuroimaging had been performed in 79.8% (n=83) prior to referral- 89.1% CT, 9.6% MRI, 1.2% both CT and MRI. Of those who had neuroimaging, n=37 had been performed in the previous 12-months, representing 35.6% of overall cohort. In terms of blood work-up, 23.1% (n=24) had bloods performed in the 12 months prior to referral- 70.8% B12, folate and thyroid function tests; 20.8% TFTS only; 8.3% B12 and folate levels only).

Conclusion

Referrals to specialist memory services by General Practice often lack the appropriate first line investigations, which introduces delay in review and the need for further assessment once baseline investigations have been done. There is a need for a standardised work-up prior to referral for optimum running of such services.

329 ANTICHOLINERGIC BURDEN IN PEOPLE LIVING WITH DEMENTIA ATTENDING GERIATRIC MEDICINE AND PSYCHIATRY FOR OLDER PERSONS SERVICES

Background

Anticholinergic burden is associated with an increase in cognitive decline, delirium and confusion. We aimed to examine the Anticholinergic Cognitive Burden (ACB) of patients referred to local dementia services, and the prescribing of acetylcholinesterase inhibitors in patients with a significant anticholinergic burden. We also looked at frequency of prescribing of classes of some medications known to increase anticholinergic burden.

Methods

A retrospective chart review was carried out of new referrals attending local Geriatric Medicine and/or Psychiatry For Older Persons outpatient services with a diagnosis of dementia between 2017 and 2018. Medications in use at the time of patient review were obtained. ACB was calculated using ACB score. Results were analysed descriptively.

Results

163 patients over 65 years old were included in this study, 94 (57.6%) were female. 30% (N = 49) had a significant anticholinergic burden (ACB &gt;3). The mean ACB was 1.69 (Range 0 – 8). 38% of all patients (N = 63) were prescribed an acetylcholinesterase inhibitor, and of those, 20% (N = 13) had a significant anticholinergic burden. Polypharmacy (use of 5 medications or more) was evident with 76% (N = 124) patients. Regarding groups of medications known to increase ACB, 35.5% (N = 58) were prescribed antipsychotics and 18.4% (30) were prescribed benzodiazepines.

Conclusion

There is a significant anticholinergic burden among people living with dementia attending the geriatric medicine and psychiatry of later life services. Some patients with a significant anticholinergic burden were being prescribed acetylcholinesterase inhibitors. This suggests acetylcholinesterase inhibitors may be prescribed without also discontinuing inappropriate medications that are contributing to the anticholinergic burden. We should look to further reduce the anticholinergic burden of patients attending the dementia services by avoiding these medications or using alternatives where available.

Amygdala-prefrontal connectivity in children with maladaptive aggression is modulated by social impairment

Aggressive behavior is common across childhood-onset psychiatric disorders and is associated with impairments in social cognition and communication. The present study examined whether amygdala connectivity and reactivity during face emotion processing in children with maladaptive aggression are moderated by social impairment. This cross-sectional study included a well-characterized transdiagnostic sample of 101 children of age 8-16 years old with clinically significant levels of aggressive behavior and 32 typically developing children without aggressive behavior. Children completed a face emotion perception task of fearful and calm faces during functional magnetic resonance imaging. Aggressive behavior and social functioning were measured by standardized parent ratings. Relative to controls, children with aggressive behavior showed reduced connectivity between the amygdala and the dorsolateral prefrontal cortex (PFC) during implicit emotion processing. In children with aggressive behavior, the association between reduced amygdala-ventrolateral PFC connectivity and greater severity of aggression was moderated by greater social impairment. Amygdala reactivity to fearful faces was also associated with severity of aggressive behavior for children without social deficits but not for children with social deficits. Social impairments entail difficulties in interpreting social cues and enacting socially appropriate responses to frustration or provocation, which increase the propensity for an aggressive response via diminished connectivity between the amygdala and the ventral PFC.

Inflammatory Arthritis Post Covid-19 Infection

Presentation A 63-year-old man developed polyarthritis two months post recovery from COVID-19 infection. Diagnosis We concluded that the diagnosis was rheumatoid arthritis based upon raised inflammatory markers, positive rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Treatment His symptoms improved with naproxen, corticosteroids, and methotrexate. Discussion We describe a patient with late onset rheumatoid arthritis possibly triggered or unmasked by COVID-19.

Sex differences in medial prefrontal and parietal cortex structure in children with disruptive behavior

Sex differences in brain structure in children with disruptive behavior disorders (DBD) remain poorly understood. This study examined sex differences in gray matter volume in children with DBD in a priori regions-of-interest implicated in the pathophysiology of disruptive behavior. We then conducted a whole-brain analysis of cortical thickness to examine sex differences in regions not included in our hypothesis. Exploratory analyses investigated unique associations between structure, and dimensional measures of severity of disruptive behavior and callous-unemotional traits. This cross-sectional study included 88 children with DBD (30 females) aged 8-16 years and 50 healthy controls (20 females). Structural MRI data were analyzed using surface-based morphometry to test for interactions between sex and group. Multiple-regression analyses tested for sex-specific associations between structure, callous-unemotional traits, and disruptive behavior severity. Boys with DBD showed reduced gray matter volume in the left ventromedial prefrontal cortex (vmPFC) and reduced cortical thickness in the supramarginal gyrus, but not girls compared to respective controls. Dimensional analyses revealed associations between sex, callous-unemotional traits, and disruptive behavior for amygdala and vmPFC volume, and ventrolateral prefrontal cortex cortical thickness. Sex-specific differences in prefrontal structures involved in emotion regulation may support identification of neural biomarkers of disruptive behavior to inform target-based treatments.

Genetic predictors of hippocampal subfield volume in PTSD cases and trauma-exposed controls

Behavioural, structural, and functional neuroimaging have implicated the hippocampus as a critical brain region in posttraumatic stress disorder (PTSD) pathogenesis. Recent work in a normative, primarily European, sample identified 15 unique genetic loci contributing to structural variability in six hippocampal subfield volumes. We explored the relevance of these loci in two samples (Mental Illness Research Education and Clinical Centre [MIRECC] and Grady; n = 290) of trauma-exposed individuals enriched for PTSD and of diverse ancestry. Four of the previous loci demonstrated nominal evidence of replication in the MIRECC dataset, primarily within non-Hispanic whites (NHW). One locus replicated in the Grady cohort, which was composed exclusively of non-Hispanic blacks (NHB). Our data supported genetic interactions with diagnosis of lifetime PTSD and genetic interactions with childhood trauma in the MIRECC sample, but not the Grady sample. Given the racial, diagnostic, and trauma-exposure differences with the original genome-wide association study (GWAS) report, we conducted a full GWAS in the MIRECC and Grady datasets. Interactions between genetic variants and lifetime PTSD or childhood trauma were interrogated for single nucleotide polymorphisms (SNPs) with evidence of main effects. Genetic associations surpassed false discovery rate (FDR)-correction within hippocampal subfields in fimbria, subiculum, cornu ammonis-1 (CA1), and hippocampal amygdala transition area (HATA). One association was replicated in the Grady cohort (rs12880795 in TUNAR with left (L)-HATA volume). The most significant association in the MIRECC dataset was between rs6906714 in LINC02571 and right (R)-fimbria volume (p = 5.99×10-8, q = 0.0056). Interestingly, the effect of rs6906714 on R-fimbria volume increased with exposure to childhood trauma (gene*environment [G*E] interaction p = 0.022). These preliminary results argue for G*E interactions between genetic loci with PTSD and childhood trauma on hippocampal phenotypes. Our results underscore the need for larger neuroimaging-genetic studies in PTSD, trauma, and ancestrally diverse populations.

Evaluation of psychomotor/motor disturbances in elderly medical inpatients

Introduction

Traditionally psychomotor subtypes have been investigated in patients with delirium in different settings and it has been found that those with hypoactive type is the largest proportion, often missed and with the worst outcomes.

Aims and objectives

We examined the psychomotor subtypes in an older age inpatients population, the effects that observed clinical variables have on psychomotor subtypes and their association with one year mortality.

Methods

Prospective study. Participants were assessed using the scales CAM, APACHE II, MoCA, Barthel Index and DRS-R98. Pre-existing dementia was diagnosed according to DSM-IV criteria. Psychomotor subtypes were evaluated using the two relevant items of DRS-R98. Mortality rates were investigated one year after admission day.

Results

The sample consisted of 200 participants [mean age 81.1 ± 6.5; 50% female; pre-existing cognitive impairment in 126 (63%)]. Thirty-four (17%) were identified with delirium (CAM+). Motor subtypes of the entire sample was: none: 119 (59.5%), hypo: 37 (18.5%), mixed: 15 (7.5%) and hyper: 29 (14.5%). Hypoactive and mixed subtype were significantly more frequent to delirious patients than to those without delirium, and none subtype more often to those without delirium. There was no difference in the hyperactive subtype between those with and without delirium. Hypoactive subtype was significant associated with delirium and lower scores in MoCA (cognition), while mixed was associated mainly with delirium. Predictors for one-year mortality were lower MoCA scores and severity of illness.

Conclusions

Psychomotor disturbances are not unique to delirium. Hypoactivity, this “silent epidemic” is also part of a deteriorated cognition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychometric evaluation of the Greek version of Mc Master Family Assessment Device (FAD)

Introduction

The Family Assessment Device (FAD) is a self-report questionnaire, developed to assess the six dimensions of the McMaster Model of family functioning. It has been translated to the Greek language but never validated.

Aims and objectives

To evaluate the psychometric properties of the Greek version of FAD in a non-clinical sample.

Methods

In a sample of Greek families, FAD was administered together with the already validated Family Adaptability and Cohesion Evaluation Scale (FACES-III). In a subsample of 96 participants, the scales were administered again after 1 month.

Results

A sample of 453 participants (194 children and 259 parents) had completed both questionnaires (151 families). Mean age of children was 23.62 (SD: 6.35), 68 (35%) were males. Mean age of parents was 51.4 (SD: 8.2), 117 (45.2%) males. All subscales of FAD had significant correlation (concurrent validity) with FACES-III (n = 453, P < 0.001). Test-retest reliability range from 0.58 to 0.82 (n = 96, P < 0.001). Internal consistency (Cronbach's alpha) range from 0.47 to 0.94. A model with the 6 factors had a good statistical fit but not all the items were loading in the same components as from the theory assumed.

Conclusions

The Greek FAD has good psychometric properties, although its factor structure might differ from the original version. Further evaluation of the Greek version of FAD in other settings and in different samples especially clinical remains a task for future research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Reduced Amygdala-Prefrontal Functional Connectivity in Children With Autism Spectrum Disorder and Co-occurring Disruptive Behavior

BACKGROUND

Disruptive behaviors are prevalent in children with autism spectrum disorder (ASD) and often cause substantial impairments. However, the underlying neural mechanisms of disruptive behaviors remain poorly understood in ASD. In children without ASD, disruptive behavior is associated with amygdala hyperactivity and reduced connectivity with the ventrolateral prefrontal cortex (vlPFC). This study examined amygdala reactivity and connectivity in children with ASD with and without co-occurring disruptive behavior disorders. We also investigated differential contributions of externalizing behaviors and callous-unemotional traits to variance in amygdala connectivity and reactivity.

METHODS

This cross-sectional study involved behavioral assessments and neuroimaging in three groups of children 8 to 16 years of age: 18 children had ASD and disruptive behavior, 20 children had ASD without disruptive behavior, and 19 children were typically developing control participants matched for age, gender, and IQ. During functional magnetic resonance imaging, participants completed an emotion perception task of fearful versus calm faces. Task-specific changes in amygdala reactivity and connectivity were examined using whole-brain, psychophysiological interaction, and multiple regression analyses.

RESULTS

Children with ASD and disruptive behavior showed reduced amygdala-vlPFC connectivity compared with children with ASD without disruptive behavior. Externalizing behaviors and callous-unemotional traits were associated with amygdala reactivity to fearful faces in children with ASD after controlling for suppressor effects.

CONCLUSIONS

Reduced amygdala-vlPFC connectivity during fear processing may differentiate children with ASD and disruptive behavior from children with ASD without disruptive behavior. The presence of callous-unemotional traits may have implications for identifying differential patterns of amygdala activity associated with increased risk of aggression in ASD. These findings suggest a neural mechanism of emotion dysregulation associated with disruptive behavior in children with ASD.

Perceptual and Semantic Phases of Face Identification Processing: A Multivariate Electroencephalography Study

Rapid identification of a familiar face requires an image-invariant representation of person identity. A varying sample of familiar faces is necessary to disentangle image-level from person-level processing. We investigated the time course of face identity processing using a multivariate electroencephalography analysis. Participants saw ambient exemplars of celebrity faces that differed in pose, lighting, hairstyle, and so forth. A name prime preceded a face on half of the trials to preactivate person-specific information, whereas a neutral prime was used on the remaining half. This manipulation helped dissociate perceptual- and semantic-based identification. Two time intervals within the post-face onset electroencephalography epoch were sensitive to person identity. The early perceptual phase spanned 110-228 msec and was not modulated by the name prime. The late semantic phase spanned 252-1000 msec and was sensitive to person knowledge activated by the name prime. Within this late phase, the identity response occurred earlier in time (300-600 msec) for the name prime with a scalp topography similar to the FN400 ERP. This may reflect a matching of the person primed in memory with the face on the screen. Following a neutral prime, the identity response occurred later in time (500-800 msec) with a scalp topography similar to the P600f ERP. This may reflect activation of semantic knowledge associated with the identity. Our results suggest that processing of identity begins early (110 msec), with some tolerance to image-level variations, and then progresses in stages sensitive to perceptual and then to semantic features.

Exploring the Effectiveness of an Integrated Mixed Martial Arts and Psychotherapy Intervention for Young Men's Mental Health

This research sought to establish the impact of a 10-week program combining mixed martial arts (MMA) and one-to-one psychotherapy on young males’ mental health and determine factors that predict help-seeking behavior in at-risk males. Preparticipation and post-participation interviews were employed as the method of data collection. Seven males (20–35 years; M = 24.57) completed preparticipation interviews and five completed follow-up interviews. Thematic analysis of preparticipation revealed that help-seeking behavior in at-risk males is impeded by the presence of male gender stereotypes, the absence of positive role models, as well as difficulty navigating challenging social landscapes. Post-participation interviews revealed that the sport provided structure and fitness for at-risk males, while the counseling was pivotal for personal growth. Improved relationships, work life, and self-esteem were also observed. The sporting element of the program helped to reduce stigma associated with engaging in psychotherapy, and positive male relationships were noted as particularly impactful. Findings support previous research indicating that combining sports and psychotherapy positively impacts young males’ mental health. Sport provides an acceptable doorway to psychotherapy, providing space to explore personal issues.

Category representations in the brain are both discretely localized and widely distributed

Whether category information is discretely localized or represented widely in the brain remains a contentious issue. Initial functional MRI studies supported the localizationist perspective that category information is represented in discrete brain regions. More recent fMRI studies using machine learning pattern classification techniques provide evidence for widespread distributed representations. However, these latter studies have not typically accounted for shared information. Here, we find strong support for distributed representations when brain regions are considered separately. However, localized representations are revealed by using analytical methods that separate unique from shared information among brain regions. The distributed nature of shared information and the localized nature of unique information suggest that brain connectivity may encourage spreading of information but category-specific computations are carried out in distinct domain-specific regions. NEW & NOTEWORTHY Whether visual category information is localized in unique domain-specific brain regions or distributed in many domain-general brain regions is hotly contested. We resolve this debate by using multivariate analyses to parse functional MRI signals from different brain regions into unique and shared variance. Our findings support elements of both models and show information is initially localized and then shared among other regions leading to distributed representations being observed.

Sensitivity to Faces with Typical and Atypical Part Configurations within Regions of the Face-processing Network: An fMRI Study

Perception of faces has been shown to engage a domain-specific set of brain regions, including the occipital face area (OFA) and the fusiform face area (FFA). It is commonly held that the OFA is responsible for the detection of faces in the environment, whereas the FFA is responsible for processing the identity of the face. However, an alternative model posits that the FFA is responsible for face detection and subsequently recruits the OFA to analyze the face parts in the service of identification. An essential prediction of the former model is that the OFA is not sensitive to the arrangement of internal face parts. In the current fMRI study, we test the sensitivity of the OFA and FFA to the configuration of face parts. Participants were shown faces in which the internal parts were presented in a typical configuration (two eyes above a nose above a mouth) or in an atypical configuration (the locations of individual parts were shuffled within the face outline). Perception of the atypical faces evoked a significantly larger response than typical faces in the OFA and in a wide swath of the surrounding posterior occipitotemporal cortices. Surprisingly, typical faces did not evoke a significantly larger response than atypical faces anywhere in the brain, including the FFA (although some subthreshold differences were observed). We propose that face processing in the FFA results in inhibitory sculpting of activation in the OFA, which accounts for this region's weaker response to typical than to atypical configurations.

Impact of classification systems (DSM-5, DSM-IV, CAM and DRS-R98) on outcomes of delirium

Introduction

Previous studies showed different classification systems lead to different case identification and rates of delirium. No one has previously investigated the influence of different classification systems on the outcomes of delirium.

Aims and objectives

To determine the influence of DSM-5 criteria vs. DSM-IV on delirium outcomes (mortality, length of stay, institutionalisation) including DSM-III and DSM-IIR criteria, using CAM and DRS-R98 as proxies.

Methodology

Prospective, longitudinal, observational study of elderly patients 70+ admitted to acute medical wards in Sligo University Hospital. Participants were assessed within 3 days of admission using DSM-5, and DSM-IV criteria, DRS-R98, and CAM scales.

Results

Two hundred patients [mean age 81.1 ± 6.5; 50% female]. Rates (prevalence and incidence) of delirium for each diagnostic method were: 20.5% (n = 41) for DSM-5; 22.5% (n = 45) for DSM-IV; 18.5% (n = 37) for DRS-R98 and 22.5%, (n = 45) for CAM. The odds ratio (OR) for mortality (each diagnostic method respectively) were: 3.37, 3.11, 2.42, 2.96. Breslow-Day test on homogeneity of OR was not significant x2= 0.43, df: 3, P = 0.93. Those identified with delirium using the DSM-IV, DRS-R98 and CAM had significantly longer hospital length of stay(los) compared to those without delirium but not with those identified by DSM-5 criteria. Re-institutionalisation, those identified with delirium using DSM-5, DSM-IV and CAM did not have significant differences in discharge destination compared to those without delirium, those identified with delirium using DRS-R98 were more likely discharged to an institution (z = 2.12, P = 0.03)

Conclusion

Assuming a direct association between delirium and examined outcomes (mortality, los and discharge destination) different classification systems for delirium identify populations with different outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Reevaluating the Efficacy and Predictability of Antidepressant Treatments: A Symptom Clustering Approach

IMPORTANCE

Depressive severity is typically measured according to total scores on questionnaires that include a diverse range of symptoms despite convincing evidence that depression is not a unitary construct. When evaluated according to aggregate measurements, treatment efficacy is generally modest and differences in efficacy between antidepressant therapies are small.

OBJECTIVES

To determine the efficacy of antidepressant treatments on empirically defined groups of symptoms and examine the replicability of these groups.

DESIGN, SETTING, AND PARTICIPANTS

Patient-reported data on patients with depression from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial (n = 4039) were used to identify clusters of symptoms in a depressive symptom checklist. The findings were then replicated using the Combining Medications to Enhance Depression Outcomes (CO-MED) trial (n = 640). Mixed-effects regression analysis was then performed to determine whether observed symptom clusters have differential response trajectories using intent-to-treat data from both trials (n = 4706) along with 7 additional placebo and active-comparator phase 3 trials of duloxetine (n = 2515). Finally, outcomes for each cluster were estimated separately using machine-learning approaches. The study was conducted from October 28, 2014, to May 19, 2016.

MAIN OUTCOMES AND MEASURES

Twelve items from the self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) scale and 14 items from the clinician-rated Hamilton Depression (HAM-D) rating scale. Higher scores on the measures indicate greater severity of the symptoms.

RESULTS

Of the 4706 patients included in the first analysis, 1722 (36.6%) were male; mean (SD) age was 41.2 (13.3) years. Of the 2515 patients included in the second analysis, 855 (34.0%) were male; mean age was 42.65 (12.17) years. Three symptom clusters in the QIDS-SR scale were identified at baseline in STAR*D. This 3-cluster solution was replicated in CO-MED and was similar for the HAM-D scale. Antidepressants in general (8 of 9 treatments) were more effective for core emotional symptoms than for sleep or atypical symptoms. Differences in efficacy between drugs were often greater than the difference in efficacy between treatments and placebo. For example, high-dose duloxetine outperformed escitalopram in treating core emotional symptoms (effect size, 2.3 HAM-D points during 8 weeks, 95% CI, 1.6 to 3.1; P < .001), but escitalopram was not significantly different from placebo (effect size, 0.03 HAM-D points; 95% CI, -0.7 to 0.8; P = .94).

CONCLUSIONS AND RELEVANCE

Two common checklists used to measure depressive severity can produce statistically reliable clusters of symptoms. These clusters differ in their responsiveness to treatment both within and across different antidepressant medications. Selecting the best drug for a given cluster may have a bigger benefit than that gained by use of an active compound vs a placebo.

Holistic versus feature-based binding in the medial temporal lobe

A central question for cognitive neuroscience is how feature-combinations that give rise to episodic/source memories are encoded in the brain. Although there is much evidence that the hippocampus (HIP) is involved in feature binding, and some evidence that other brain regions are as well, there is relatively little evidence about the nature of the resulting representations in different brain regions. We used multivoxel pattern analysis (MVPA) to investigate how feature combinations might be represented, contrasting two possibilities, feature-based versus holistic. Participants viewed stimuli that were composed of three source features - a person (face or body), a scene (indoor or outdoor), and an object (bike or luggage) - which were combined to make eight unique stimulus identities. We reasoned that regions that can classify the eight identities (a multiclass classification) but not the individual features (a binary classification) likely have a holistic representation of each identity. In contrast, regions that can classify the eight identities and can classify each feature are likely to contain feature-based representations of these identities. To further probe the extent of feature-based or holistic classification in each region, we developed and validated a novel approach that directly compares binary and multiclass classification. We found clear evidence for holistic representation in the parahippocampal cortex (PHC), consistent with theories that posit that pattern-separation-like binding mechanisms are not unique to the HIP. Further clarifying the mechanisms of feature binding should benefit from systematic comparisons of multi-feature representations and whether they vary with task, type of stimulus, and/or experience.

The Effects of Face Inversion and Face Race on the P100 ERP

Research about the neural basis of face recognition has investigated the timing and anatomical substrates of different stages of face processing. Scalp-recorded ERP studies of face processing have focused on the N170, an ERP with a peak latency of ∼170 msec that has long been associated with the initial structural encoding of faces. However, several studies have reported earlier ERP differences related to faces, suggesting that face-specific processes might occur before N170. Here, we examined the influence of face inversion and face race on the timing of face-sensitive scalp-recorded ERPs by examining neural responses to upright and inverted line-drawn and luminance-matched white and black faces in a sample of white participants. We found that the P100 ERP evoked by inverted faces was significantly larger than that evoked by upright faces. Although this inversion effect was statistically significant at 100 msec, the inverted-upright ERP difference peaked at 138 msec, suggesting that it might represent an activity in neural sources that overlap with P100. Inverse modeling of the inversion effect difference waveform suggested possible neural sources in pericalcarine extrastriate visual cortex and lateral occipito-temporal cortex. We also found that the inversion effect difference wave was larger for white faces. These results are consistent with behavioral evidence that individuals process the faces of their own races more configurally than faces of other races. Taken together, the inversion and race effects observed in the current study suggest that configuration influences face processing by at least 100 msec.

A survey of 554 peripheral intravenous catheters: infection, duration of cannulation and documentation issues

The purpose of this survey was to improve nursing care of patients with peripheral intravenous catheters (PVCs), focusing on duration of cannulation. The survey was conducted in 20 general wards recording data on the duration of cannulation, site-infection, dating of PVC dressing and documentation in nursing notes. Nursing staff were interviewed on duration of the PVC and a documentation form was introduced during the survey.

A total of 554 PVCs in 397 patients were surveyed. Duration of cannulation ranged from one to ten days, with 402 (73%) of PVCs removed by day three. The site-infection rate was 28 (5%) with no cases of blood stream infection. Most site infection (20 of 28 (71%)) occurred within the first three days.

The duration of cannulation, from interview, was known by nurses in 416 (75%) of cases and documented in 208 (40%) of cases. Eighteen months after its introduction, the PVC documentation form was in use in 19 of 20 wards for 60 (76%) PVCs.

While the infection rate was low and nurses were generally aware of the duration of cannulation, inadequate documentation by nursing and medical staff was a cause for concern. Information on PVCs should be included in standard documentation on all wards and in relevant departments to assist nurses and others in the provision of quality care to patients.

Review : Functional Neuroimaging of Memory

Cognitive neuroscientists have acquired powerful new tools for studying the functional neuroanatomy of the human brain. Traditional methods such as lesion analysis have been supplemented with electrical and mag netic field recording techniques that can measure the informational transactions of the brain in the scale of milliseconds and neuroimaging techniques that can provide structural details of the brain to a fraction of a millimeter. The most powerful new methods have been functional imaging techniques in which brain activity engendered by a sensory, motor, or cognitive task causes an increase in local blood flow and metabolism that can be imaged with high resolution. This article reviews recent progress in functional neuroimaging, with special emphasis on understanding the neural substrates of memory. The Neuroscientist 1:155-163, 1995

Electrophysiological correlates of face-evoked person knowledge

Face recognition includes identifying a face as perceptually familiar and recollecting biographical information, or person-knowledge, associated with the face. The majority of studies examining the neural basis of face recognition have confounded these stages by comparing brain responses evoked by novel and perceptually familiar famous faces. Here, we recorded EEG in two tasks in which subjects viewed two sets of faces that were equally perceptually familiar, but which had differing levels of associated person-knowledge. Our results dissociated the effects of person-knowledge from perceptual familiarity. Faces with associated biographical information elicited a larger ∼600ms centroparietal positivity in both a passive viewing task in which subjects viewed faces without explicitly responding, and an active question-answering task in which subjects indicated whether or not they knew particular facts about the faces. In the question task only, person-knowledge was associated with a negative ERP difference over right posterior scalp over the 170-450ms interval which appeared again at long latency (>900ms).

Reactivation during encoding supports the later discrimination of similar episodic memories

Episodic memory is characterized by remembering events as unique combinations of features. Even when some features of events overlap, we are later often able to discriminate among them. Here we ask whether hippocampally mediated reactivation of an earlier event when a similar one occurs supports subsequent memory that two similar but not identical events occurred (mnemonic discrimination). In two experiments, participants viewed objects (Experiment 1) or scenes (Experiment 2) during functional MRI (fMRI). After scanning, participants had to remember whether repeated items had been identical or similar. In Experiment 2, representational similarity between the 1st and 2nd presentation predicted participants' ability to remember that the presentations were different, suggesting that the first item was reactivated while viewing the second. A similar but weaker result was found in Experiment 1 that did not survive correction for multiple comparisons. Furthermore, both experiments yielded evidence that the hippocampus was involved in reactivation; hippocampal pattern similarity (and, in Experiment 2, hippocampal activity during the 2nd presentation) correlated with pattern similarity in several regions of visual cortex. These results provide the first fMRI evidence that hippocampally mediated reactivation contributes to the later memory that two similar, but different events occurred. © 2016 Wiley Periodicals, Inc.

Agreement and equation between Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in an old age psychiatry outpatient clinic population

Introduction

Both MMSE and MoCA are two widely used cognitive screening test. Comparison of the two tests has been done in specific populations (Parkinson) but not in general elderly psychiatric populations. In research, equating methodologies has been used to compare results among studies that use different scales, which measure the same construct.

Aims

To explore their level of agreement within a particular clinical setting.

Objectives

(a) To find MoCA and MMSE agreement. (b) To derive a conversion formula between the two scales and test it in a random population of similar setting.

Methods

Prospective study of consecutive community dwelling older patients who attend outpatient clinic or day hospital. Both tests were administered from the same researcher the same day in random order.

Results

The total sample (n = 135) was randomly divided in two. One from where the equating rule derived (n = 70) and a second (n = 65) in which the derived conversion was tested. Agreement of the two scales (Pearson's r) was 0.86 (P < 0.001), and Lin's Concordance Correlation Coefficient (CCC) was 0.57 (95% CI 0.45–0.66). In the second sample, we convert the MoCA scores to MMSE scores according to equating rule from the first sample and after we examined the agreement between the converted MMSE scores and the originals. The Pearson's r was 0.89 (n = 65, P < 0.001) and the CCC 0.88 (95% CI 0.82–0.92).

Conclusions

Although the two scales overlap considerably, the agreement is modest. The conversion rule derived showed promising accuracy in this population but need further testing in other populations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

“Reflective Learning” In Psychiatric Education: Does It Have Any Merit?

Introduction

Nowadays “reflection” and “reflective practice” is nearly in every curriculum for psychiatric training. Trainees are asked to keep reflection diaries, journals, and participate in “reflection workshops”.

Aims

To prove that reflection on or in action does not lead to learning.

Methods

Using epistemological notation.

Results/proofs

Because sciences including psychiatry are approximate, evolving and inexact, the classical definition of propositional knowledge becomes: A knows that p if:

– (a’) A believes that p is an approximate true;

– (b’) p is approximate truth;

– (c’) A has reason to claim that p is a better approximation than its rivals on available evidence.

Condition (c’) implies that A is not possible at the same time to have two mutually contradictive approximate truths.

In reflective learning we need to add two more conditions:

– (d’) A knows the outcome of p;

– (e’) A is satisfied in believing that p.

In cases of reflection in-action, the (e’) remains even the outcome is not favourable. Similarly, in reflection on-action the condition (e’) remains unchanged since this happened in the past. This leads to controversy. Is p better or worse approximation of truth than its’ rival p’? However, p has passed rigorous and different scientific tests and has proved scientifically superior to its rival p’. Therefore subject A cannot change his knowledge despite the unfavourable outcome, but A can tests further the p. Within the former reflecting learning does not occur, within the latter “critical thinking” occurred.

Conclusions

Reflection does not lead to learning but critical thinking does.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Family functioning and individual psychopathology in a non-clinical general population

Introduction

A family “constructs” an identity of its own derived from their assumptions about relationships and the social environment they live in. This identity transcends the individual while at the same time encourages individual differentiation. Family functioning is influenced from different factors like social context, qualitative characteristics, and from individual's medical or psychiatric condition.

Aims and objectives

To examined the effects of sociodemographic factors and individual psychopathology on the function of family in a non-clinical sample.

Methods

Cross-sectional study of participants and their families. The follow data collected:

Results

The sample constituted of 151 families, (453 individuals), in 48 families, 2 family members participated, in 56 families, 3 members participated, in 46 families 4 members participated and 1 family had 5 members participating. One hundred ninety-four (42.8%) were children and 259 (57.2%) were parents. The mean age of the children was 23.62 (SD: 6.35) and 68 (35%) were males. Mean age of the parents was 51.4 (SD: 8.2) and 117 (45.2%) were males. SCL-90 identified 183 participants as caseness. Multilevel analysis showed that individual psychopathology (caseness) was the only statistical significant factor for family dysfunctioning.

Conclusion

There is strong association between family dysfunction and psychopathology of a member. Dysfunctional families need further psychiatric evaluation of the members. Cause-effect cannot be concluded from this cross-sectional study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Implementation Of Health Of The Nation Outcome Scale (HoNOS) In Outpatient Clinic, Sligo Mental Health Services: Feasibility And Agreement With Global Assessment Of Functioning Scale

Introduction

Outcome measurements in mental health services is beneficial in allowing healthcare providers in determining the effectiveness of their treatment plan. Health of the Nation Outcome Scale (HoNOS) and Global Assessment of Functioning (GAF) are two well-established instruments to measure patients’ outcome.

Aims and objectives

To measure the correlation of these two scales, and the feasibility of HoNOS.

Methods

Prospective longitudinal study of psychiatric outpatients attending a clinic in Sligo. Patients were assessed using HoNOS and GAF by trained doctors during the consultation. Feedback from doctors using HoNOS during the research was taken as a measure for feasibility.

Results

Total of 441 HoNOS and 237 GAF completed on 280 patients (53.2% female, mean age 46.23; SD = 14.89). The correlation between HoNOS and GAF was (r = –0.696, P < 0.001). In reassessment, we found significant reduction in HoNOS score when comparing the first assessment with the second (t = 4.590, df = 110, P < 0.01) and the third (t = 2.876, df = 37, P < 0.01). Using a linear mixed-effects model, it was found that patients with diagnosis of schizophrenia, mood affective disorder, neurotic disorder, personality disorder and younger in age are more likely to improve during the follow-up compared to those with organic mental disorders, alcohol related problems and older age.

Conclusions

HoNOS is a feasible scale and can be potentially used as an outcome measurement in the mental health services. Can help in deciding better management plan for patient and improvement of the service. HoNOs can also be used for comparison of outcomes between services in national and international level.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Task influences pattern discriminability for faces and bodies in ventral occipitotemporal cortex

Our prior research showed that faces and bodies activate overlapping regions of the ventral occipitotemporal cortex (VOTC). However, faces and bodies were nonetheless discriminable in these same overlapping regions when their spatial patterns of activity were classified using multivoxel pattern analysis (MVPA). Here we investigated whether these spatial patterns and their time courses were influenced by different categorization tasks. Participants viewed pictures of faces or headless bodies depicting a happy or fearful emotion. In one task, they categorized the picture as a face or a body regardless of emotion. In the other task, they categorized the emotion regardless of whether it was depicted by a face or body. Using a classifier trained on independent data, we found higher face-body classification accuracy for the emotion categorization task. The classifier was applied to each post-stimulus time-point to characterize the temporal course of classification. Accuracy initially rose equivalently above chance for both tasks, but then increased over a longer duration when participants categorized emotions. Thus, the temporal course of pattern differences between faces and bodies in VOTC was modulated by the behavioral goal of the observer, suggesting the top-down modulatory effect of task context on the category-selectivity activity in the VOTC.

The Function Biomedical Informatics Research Network Data Repository

The Function Biomedical Informatics Research Network (FBIRN) developed methods and tools for conducting multi-scanner functional magnetic resonance imaging (fMRI) studies. Method and tool development were based on two major goals: 1) to assess the major sources of variation in fMRI studies conducted across scanners, including instrumentation, acquisition protocols, challenge tasks, and analysis methods, and 2) to provide a distributed network infrastructure and an associated federated database to host and query large, multi-site, fMRI and clinical data sets. In the process of achieving these goals the FBIRN test bed generated several multi-scanner brain imaging data sets to be shared with the wider scientific community via the BIRN Data Repository (BDR). The FBIRN Phase 1 data set consists of a traveling subject study of 5 healthy subjects, each scanned on 10 different 1.5 to 4 T scanners. The FBIRN Phase 2 and Phase 3 data sets consist of subjects with schizophrenia or schizoaffective disorder along with healthy comparison subjects scanned at multiple sites. In this paper, we provide concise descriptions of FBIRN's multi-scanner brain imaging data sets and details about the BIRN Data Repository instance of the Human Imaging Database (HID) used to publicly share the data.

Neural regions discriminating contextual information as conveyed through the learned preferences of others

The human brain consists of a network of regions that are engaged when one observes the movements of others. Observing unexpected movements, as defined by the context, often elicits greater activity, particularly in the right posterior superior temporal sulcus (pSTS). This implies that observers use contextual information to form expectations about an agent's goal and subsequent movements. The current study sought to identify regions that support the formation of these context-dependent expectations, with the pSTS being one candidate, given the consistent contextual modulation of its activity. We presented participants with fictitious individuals who had emotion-dependent food preferences, and instructed participants to indicate which food they expected each individual to choose based on the individual's current emotional state. Each individual's preference and emotional state therefore created a context that informed the observer's expectation of the individual's choice. Multi-voxel pattern analysis (MVPA) was used to assess if these different contexts could be discriminated in the pSTS and elsewhere in the brain. No evidence for context discrimination was found in the pSTS. Context discrimination was found instead a network of other brain regions including the anterior medial prefrontal cortex (amPFC), bilateral parietal cortex, left middle temporal gyrus (L MTG) and left anterior temporal lobe (L ATL), which have been previously associated with context processing, and semantic and memory retrieval. All together, these regions possibly support the formation of context-dependent expectations of an agent's goal.

Electrophysiological Correlates of Refreshing: Event-related Potentials Associated with Directing Reflective Attention to Face, Scene, or Word Representations

Refreshing is the component cognitive process of directing reflective attention to one of several active mental representations. Previous studies using fMRI suggested that refresh tasks involve a component process of initiating refreshing as well as the top-down modulation of representational regions central to refreshing. However, those studies were limited by fMRI's low temporal resolution. In this study, we used EEG to examine the time course of refreshing on the scale of milliseconds rather than seconds. ERP analyses showed that a typical refresh task does have a distinct electrophysiological response as compared to a control condition and includes at least two main temporal components: an earlier (∼400 msec) positive peak reminiscent of a P3 response and a later (∼800-1400 msec) sustained positivity over several sites reminiscent of the late directing attention positivity. Overall, the evoked potentials for refreshing representations from three different visual categories (faces, scenes, words) were similar, but multivariate pattern analysis showed that some category information was nonetheless present in the EEG signal. When related to previous fMRI studies, these results are consistent with a two-phase model, with the first phase dominated by frontal control signals involved in initiating refreshing and the second by the top-down modulation of posterior perceptual cortical areas that constitutes refreshing a representation. This study also lays the foundation for future studies of the neural correlates of reflective attention at a finer temporal resolution than is possible using fMRI.

An investigation into the removal of Salmonella and enteric indicator bacteria from the separated liquid fraction of raw or anaerobically digested pig manure using novel on-farm woodchip biofilters

The objective was to investigate the removal of Salmonella and enteric indicator bacteria from the liquid fraction of raw and anaerobically digested (AD) pig manure in woodchip biofilters over a 14 week (98 day) period. Antibiotic susceptible Salmonella Infantis was detected in one influent material (liquid fraction of raw manure) on two occasions but was not found in the effluent at any time point. Furthermore, mean coliform reductions of 56% were observed in the biofilters treating the liquid fraction of raw manure. However, a mean increase of 228% was found in those treating the liquid from AD manure, despite the fact that the microbial challenge to these biofilters was lower. In addition, relatively high coliform counts were still present in the effluent from both biofilter treatments, especially in the systems treating the liquid fraction of AD manure. However, findings for Escherichia coli and Enterococcus were more promising, with reductions observed for both treatments (10 and 18.5% for E. coli and 71 and 87% for Enterococcus). Moreover, E. coli and Enterococcus were at, or just above, the limit of detection in the final effluents. Overall, although, there are no microbial limits for discharge or washwaters, the woodchip filter effluent would appear safe for discharge to waterways or use on-farm as regards Salmonella, E. coli and Enterococcus but not coliform. In conclusion, woodchip biofilters offer potential as a low-cost sustainable novel treatment option for the removal of pathogens from the liquid fraction of pig manure.

Amygdala-prefrontal cortex functional connectivity during threat-induced anxiety and goal distraction

BACKGROUND

Anxiety produced by environmental threats can impair goal-directed processing and is associated with a range of psychiatric disorders, particularly when aversive events occur unpredictably. The prefrontal cortex (PFC) is thought to implement controls that minimize performance disruptions from threat-induced anxiety and goal distraction by modulating activity in regions involved in threat detection, such as the amygdala. The inferior frontal gyrus (IFG), orbitofrontal cortex (OFC), and ventromedial PFC (vmPFC) have been linked to the regulation of anxiety during threat exposure. We developed a paradigm to determine if threat-induced anxiety would enhance functional connectivity between the amygdala and IFG, OFC, and vmPFC.

METHODS

Healthy adults performed a computer-gaming style task involving capturing prey and evading predators to optimize monetary rewards while exposed to the threat of unpredictable shock. Psychophysiological recording (n = 26) and functional magnetic resonance imaging scanning (n = 17) were collected during the task in separate cohorts. Task-specific changes in functional connectivity with the amygdala were examined using psychophysiological interaction analysis.

RESULTS

Threat exposure resulted in greater arousal measured by increased skin conductance but did not influence performance (i.e., monetary losses or rewards). Greater functional connectivity between the right amygdala and bilateral IFG, OFC, vmPFC, anterior cingulate cortex, and frontopolar cortex was associated with threat exposure.

CONCLUSIONS

Exposure to unpredictable threat modulates amygdala-PFC functional connectivity that may help maintain performance when experiencing anxiety induced by threat. Our paradigm is well-suited to explore the neural underpinnings of the anxiety response to unpredictable threat in patients with various anxiety disorders.

Functional Heterogeneity and Convergence in the Right Temporoparietal Junction

The right temporoparietal junction (rTPJ) is engaged by tasks that manipulate biological motion processing, Theory of Mind attributions, and attention reorienting. The proximity of activations elicited by these tasks raises the question of whether these tasks share common cognitive component processes that are subserved by common neural substrates. Here, we used high-resolution whole-brain functional magnetic resonance imaging in a within-subjects design to determine whether these tasks activate common regions of the rTPJ. Each participant was presented with the 3 tasks in the same imaging session. In a whole-brain analysis, we found that only the right and left TPJs were activated by all 3 tasks. Multivoxel pattern analysis revealed that the regions of overlap could still discriminate the 3 tasks. Notably, we found significant cross-task classification in the right TPJ, which suggests a shared neural process between the 3 tasks. Taken together, these results support prior studies that have indicated functional heterogeneity within the rTPJ but also suggest a convergence of function within a region of overlap. These results also call for further investigation into the nature of the function subserved in this overlap region.

Face, eye, and body selective responses in fusiform gyrus and adjacent cortex: an intracranial EEG study

Functional MRI (fMRI) studies have investigated the degree to which processing of whole faces, face-parts, and bodies are differentially localized within the fusiform gyrus and adjacent ventral occipitotemporal cortex. While some studies have emphasized the spatial differentiation of processing into discrete areas, others have emphasized the overlap of processing and the importance of distributed patterns of activity. Intracranial EEG (iEEG) recorded from subdural electrodes provides excellent temporal and spatial resolution of local neural activity, and thus provides an alternative method to fMRI for studying differences and commonalities in face and body processing. In this study we recorded iEEG from 12 patients while they viewed images of novel faces, isolated eyes, headless bodies, and flowers. Event-related potential analysis identified 69 occipitotemporal sites at which there was a face-, eye-, or body-selective response when contrasted to flowers. However, when comparing faces, eyes, and bodies to each other at these sites, we identified only 3 face-specific, 13 eye-specific, and 1 body-specific electrodes. Thus, at the majority of sites, faces, eyes, and bodies evoked similar responses. However, we identified ten locations at which the amplitude of the responses spatially varied across adjacent electrodes, indicating that the configuration of current sources and sinks were different for faces, eyes, and bodies. Our results also demonstrate that eye-sensitive regions are more abundant and more purely selective than face- or body-sensitive regions, particularly in lateral occipitotemporal cortex.

Discriminable spatial patterns of activation for faces and bodies in the fusiform gyrus

Functional neuroimaging studies consistently report that the visual perception of faces and bodies strongly activates regions within ventral occipitotemporal cortex (VOTC) and, in particular, within the mid-lateral fusiform gyrus. One unresolved issue is the degree to which faces and bodies activate discrete or overlapping cortical regions within this region. Here, we examined VOTC activity to faces and bodies at high spatial resolution, using univariate and multivariate analysis approaches sensitive to differences in both the strength and spatial pattern of activation. Faces and bodies evoked substantially overlapping activations in the fusiform gyrus when each was compared to the control category of houses. No discrete regions of activation for faces and bodies in the fusiform gyrus survived a direct statistical comparison using standard univariate statistics. However, multi-voxel pattern analysis differentiated faces and bodies in regions where univariate analysis found no significant difference in the strength of activation. Using a whole-brain multivariate searchlight approach, we also found that extensive regions in VOTC beyond those defined as fusiform face and body areas using standard criteria where the spatial pattern of activation discriminated faces and bodies. These findings provide insights into the spatial distribution of face- and body-specific activations in VOTC and the identification of functionally specialized regions.

Perceived animacy influences the processing of human-like surface features in the fusiform gyrus

While decades of research have demonstrated that a region of the right fusiform gyrus (FG) responds selectively to faces, a second line of research suggests that the FG responds to a range of animacy cues, including biological motion and goal-directed actions, even in the absence of faces or other human-like surface features. These findings raise the question of whether the FG is indeed sensitive to faces or to the more abstract category of animate agents. The current study uses fMRI to examine whether the FG responds to all faces in a category-specific way or whether the FG is especially sensitive to the faces of animate agents. Animate agents are defined here as intentional agents with the capacity for rational goal-directed actions. Specifically, we examine how the FG responds to an entity that looks like an animate agent but that lacks the capacity for goal-directed rational action. Region-of-interest analyses reveal that the FG activates more strongly to the animate compared with the inanimate entity, even though the surface features of both animate and inanimate entities were identical. These results suggest that the FG does not respond to all faces in a category-specific way, and is instead especially sensitive to whether an entity is animate.

A multi-scanner study of subcortical brain volume abnormalities in schizophrenia

Schizophrenia patients show significant subcortical brain abnormalities. We examined these abnormalities using automated image analysis software and provide effect size estimates for prospective multi-scanner schizophrenia studies. Subcortical and intracranial volumes were obtained using FreeSurfer 5.0.0 from high-resolution structural imaging scans from 186 schizophrenia patients (mean age±S.D.=38.9±11.6, 78% males) and 176 demographically similar controls (mean age±S.D.=37.5±11.2, 72% males). Scans were acquired from seven 3-Tesla scanners. Univariate mixed model regression analyses compared between-group volume differences. Weighted mean effect sizes (and number of subjects needed for 80% power at α=0.05) were computed based on the individual single site studies as well as on the overall multi-site study. Schizophrenia patients have significantly smaller intracranial, amygdala, and hippocampus volumes and larger lateral ventricle, putamen and pallidum volumes compared with healthy volunteers. Weighted mean effect sizes based on single site studies were generally larger than effect sizes computed based on analysis of the overall multi-site sample. Prospectively collected structural imaging data can be combined across sites to increase statistical power for meaningful group comparisons. Even when using similar scan protocols at each scanner, some between-site variance remains. The multi-scanner effect sizes provided by this study should help in the design of future multi-scanner schizophrenia imaging studies.