Attentional biases in emotional Stroop test in girls with vegetative dysfunction of varying severity

Autonomic dysfunction is a known complication of post-acute sequelae of SARS-CoV-2 (PASC)/long COVID, however prevalence and severity are unknown. To assess the frequency, severity, and risk factors of autonomic dysfunction in PASC, and to determine whether severity of acute SARS-CoV-2 infection is associated with severity of autonomic dysfunction. Cross-sectional online survey of adults with PASC recruited through long COVID support groups between October 2020 and August 2021. 2,413 adults ages 18-64 years with PASC including patients who had a confirmed positive test for COVID-19 (test-confirmed) and participants who were diagnosed with COVID-19 based on clinical symptoms alone. The main outcome measure was the Composite Autonomic Symptom 31 (COMPASS-31) total score, used to assess global autonomic dysfunction. Test-confirmed hospitalized vs. test-confirmed non-hospitalized participants were compared to determine if the severity of acute SARS-CoV-2 infection was associated with the severity autonomic dysfunction. Sixty-six percent of PASC patients had a COMPASS-31 score >20, suggestive of moderate to severe autonomic dysfunction. COMPASS-31 scores did not differ between test-confirmed hospitalized and test-confirmed non-hospitalized participants [28.95 (15.62, 46.60) vs. 26.4 (13.75, 42.10); p = 0.06]. Evidence of moderate to severe autonomic dysfunction was seen in 66% of PASC patients in our study, independent of hospitalization status, suggesting that autonomic dysfunction is highly prevalent in the PASC population and independent of the severity of acute COVID-19 illness.

Depressed patients show cognitive deficits along with mood disturbances. Growing evidence suggests impairment at the level of executive control, which might account in part for patients' difficulties in everyday activities and cognitive performance. Furthermore, there is evidence that depressive patients show information processing biases for emotional information which are thought to play a role in the etiology and maintenance of the disorder. Attentional bias occurs in an early stage of information processing, while memory bias occurs in a later stage of processing (strategic elaboration). The goal of this study was to investigate executive control (the Stroop test) and information processing biases for emotional information in an early stage of processing (the emotional Stroop test) and in a later stage of processing (memory recognition test) in healthy subjects and depressive patients. A further objective of this study was to compare the performance of melancholic and non-melancholic depressive patients in the Stroop test, in the emotional Stroop test and in the memory recognition test. Last, we wanted to investigate the relationship between the performance in an executive control task (the Stroop effect) and information processing bias measures for emotional information. This study is the first to investigate the Stroop test, the emotional Stroop test and the memory recognition test in the same healthy subjects and depressed patients. Furthermore, this is the first study investigating information processing biases for emotional information in the melancholic and non-melancholic patients. Twenty-three depressive patients and 27 healthy subjects performed computerized mixed trial Stroop and emotional Stroop tests. Afterwards, the subjects performed the memory recognition task. Depressive patients were divided according to DSM-IV diagnosis into melancholic and non-melancholic subgroups. Furthermore the level of anxiety and depression was assessed in all subjects. Results of the Stroop task showed that when the depressed patients were analyzed as a whole group, they showed only a trend toward a larger Stroop effect at the beginning of the task. When the analysis was performed with the melancholic and non-melancholic subgroups, contrary to the expectations, only the non-melancholic patients were impaired in the Stroop task compared to the melancholic patients and healthy subjects. Furthermore, we failed to find evidence for an attentional bias in the depressed patients in the emotional Stroop task measured as longer RTs to the emotional compared to neutral stimuli. However, both groups committed more errors in the negative compared to the neutral and positive condition. Memory bias was examined with the memory recognition test since it allowed us to study both “pure” memory and response bias. Response accuracy d’ and response bias beta were calculated according to the signal-detection model. We failed to find evidence for a memory bias in depressed patients measured as discrimination accuracy d’. Considering the response bias measure beta, the analysis showed that the healthy subjects had a more conservative response bias toward positive stimuli. This means that healthy subjects were less likely to answer “yes” to the positive stimuli than to other stimuli. The patients on the other hand had a more conservative response bias toward both negative and positive stimuli compared to neutral stimuli. Contrary to the expectations, there were no differences between the melancholic and non-melancholic patients. The results of the correlational analysis provide evidence that the executive control and emotional information processing are connected phenomena in the healthy subjects but not in the depressed patients. The healthy subjects with poor executive control are paying more attention to the negative stimuli compared to neutral stimuli. This was not the case in the depressed patients. We suggest that the unexpected result of melancholic patients performing better than non-melancholic ones in the Stroop task may be due to their more pronounced rigidity, which makes them more resistant to distraction. Hence, more detailed psychopathological assessment is desirable for future investigations of the melancholic patients. Furthermore, since we failed to find attentional bias in the depressed patients toward the emotional stimuli in the emotional Stroop test, we are concluding that besides methodological issues there are more important clinical factors than diagnosis (i.e. trait anxiety). We are suggesting that memory bias is impossible or difficult to demonstrate in the depressed patients when stimulus exposure occurs under sets that are explicitly antithetical to self-referencing. The relationship found between the Stroop effect and the emotional Stroop effect in the healthy subjects is suggesting that healthy individuals with lower levels of executive control may be more vulnerable to depression.

Objective. Development of differentiated method for selection of antihypertensive drugs in hypertensive patients based on assessment of individual features of autonomic cardiovascular dysfunction evaluated by spectral parameters of heart rate variability (HRV) and synchronization of 0.1 Hz oscillation in heart rate and microcirculation. Design and methods. 105 patients with arterial hypertension stage 1-2 aged 47 ± 8 years were examined. 0.1 Hz oscillations in heart rate and microcirculation were registered during passive tilt test under spontaneous breathing. The signals were recorded before and after three-week treatment by angiotensin-converting enzyme (ACE) inhibitors (fosinopril or enalapril) and β-blockers (atenolol or metoprolol). Phase differences between 0.1 Hz oscillations were used to measure the synchronization index S . Power of low- (LF) and high-frequency (HF) bands of HRV spectrum was also assessed. Results. ACE inhibitors are preferred for treatment of hypertensive patients with initially severe systemic autonomic dysfunction (index S is 250 ms 2 in supine position). β-blockers are recommended for patients with initially severe systemic autonomic dysfunction and dysfunction of autonomic heart regulation (index S 2 in vertical body position). If severe autonomic dysfunction (index S is > 25 % and power of LF band of HRV spectrum is > 250 ms 2 ) is not present the treatment by ACE inhibitors and β-blockers is not recommended. Conclusions. The type of antihypertensive drugs (ACE inhibitors or β-blockers) should be selected based on individual features of autonomic cardiovascular dysfunction. Sensitivity and specificity of this method was 65 and 73 %, respectively.

"The emotional Stroop task (EST) is a widely used method in demonstrating how emotional material disrupts performance on a simple task through the biasing of attention. The finding that participants take longer to identify the colour of emotional material relative to neutral material is known as the emotional Stroop effect (ESE). The ESE was thought to be relatively fast, occurring on a single trial. However, recent research has suggested that emotional, primarily negative, material may disrupt colour-naming ability beyond the time of its presentation, disrupting performance in subsequent trials. That is, the ESE may be comprised of both fast and slow components. Currently there is no consensus as to the duration of the slow disruption or the mechanisms underlying this form of biased attention. Recently, Wyble, Sharma, and Bowman (2008) developed a computational model accounting for the occurrence of both fast and slow components of biased attention within the EST. The model makes specific predictions regarding the relationship between anxiety and the occurrence of fast and slow effects within the task; however these predictions have not been tested. The purpose of the research was to test these predictions in individuals with varying levels of anxiety. In total, five experiments were conducted; two to select stimuli for use in the ESTs (Experiments 1 and 3; n = 250) and three ESTs (Experiments 2, 3, and 5; n = 317) whereby fast and slow effects were examined in individuals who were low anxious, state anxious, trait anxious, and state-trait anxious. Duration of slow effects was examined by manipulating the length of the inter-trial intervals (ITIs) between words in the EST, in addition to tracking reaction times (RTs) over a series of five positions. Furthermore, positive emotion and negative emotion words with comparable arousal ratings were utilised in conjunction with neutral words to determine whether arousal, in addition to valence, played a role in biasing attention. Results showed mixed support for the hypotheses. The first emotional Stroop experiment (Experiment 2) found no evidence of fast effects. Slow effects were noted at the 32 ms block, albeit in a position later than expected. Slow effects emerged for all individuals on Position 4 between neutral words in the positive emotion sequence versus neutral words in the negative emotion sequence. There were also unexpected patterns of responding to pure sequences of neutral words. Due to the unexpected results, a decision was made to run an additional emotional Stroop experiment (Experiment 3) utilising different neutral stimuli. This experiment found no evidence of fast or slow effects occurring. Based on the inconsistencies in results between Experiment 2 and 3, Experiment 5 was conducted utilising a contingency-free methodology that allowed for the independent assessment of fast and slow effects. Results from Experiment 5 did not find evidence of a fast effect, however, in the anxious group, participants responded to neutral words that were presented after positive emotion words significantly faster than neutral words presented after negative emotion words. Collectively, the results did not find support for a fast component of attentional bias, which was contrary to predictions. Additionally, mixed support emerged for the presence of slow effects. While disruptions in colour-identification were noted on neutral words that followed emotion words, these were generally not in the position expected and did not always implicate the expected word type. The findings of the current study do not support the predictions of the Wyble et al. (2008) model. Implications of the current findings in addition to future directions are discussed."

Background: Iron-deficiency anemia (IDA) is one of the most frequently found anemias in all countries. In India itself, 60–70% of population has IDA. Autonomic dysfunctions are common in anemias so also in IDAs. The present study was conducted to categorize these autonomic dysfunctions according to severity. Aims and Objective: The objective of the present study was to find if there are any autonomic dysfunctions in IDA patients and to assess the severity of autonomic dysfunction in IDA patients. Materials and Methods: A total of 60 patients of IDA were selected from hematology OPD and included in the study. The patients were subjected to autonomic function tests, and the results of the test were compared with age and socioeconomically matched healthy subjects. Results: Comparing the pattern of involvement of autonomic nervous system in IDA patients and the severity of autonomic dysfunction, it was seen that 13 (22%) had normal functions, early involvement was seen in 17 (28%) IDA patients, definite involvement is seen in 22 (37%) patients, and 5 (8%) had severe involvement, while remaining 3 (5%) had atypical involvement. Conclusion: Autonomic dysfunction manifests in IDA patients. This autonomic dysfunction may vary from early involvement to severe involvement. Severe autonomic dysfunction may even cause death in some cases.

Background and purpose:Despite numerous studies, the mechanisms of blood pressure and heart rate regulation in cerebrovascular diseases remain not completely understood. The aim of the study was to determine the changes in blood pressure (BP) and heart rate (HR) in patients with an acute hemispheric ischemic stroke and to seek a relation to the severity of the cardiovascular autonomic dysfunction.Methods:20 healthy volunteers and 50 patients with an acute hemispheric ischemic stroke participated in the study. The values of BP and HR were registered. Cardiovascular autonomous disorders were examined with "Ewing battery" tests. Patients were divided into two groups according to the severity of the autonomous disorders.Results:Elevated BP values at admission were observed in 56% of our patients, and significantly higher values of systolic blood pressure (SBP) (p <0,001), diastolic blood pressure (DBP) (p = 0,001), and mean arterial pressure (p <0,001), as well as of the heart rate (p = 0,027) were found, compared to the control group. The most significantly increased values of the indicators were reported in patients with a stroke in the territory of the right middle cerebral artery with an involvement of the insular cortex. The results of the t-test performed, showed correlation only between the systolic blood pressure and the severity of the autonomic dysfunction, the values being significantly higher in patients with severe autonomic disorders (t = -2,14; p = 0.036).Conclusion:A variability in BP and HR with a tendency to increase was observed in patients with an acute hemispheric ischemic stroke (ICS) compared to controls, with the highest values reported in patients with ICS in the territory of right middle cerebral artery (TRMCA) with the involvement of the insular cortex (IC). A positive correlation was found between the values of systolic blood pressure (SBP) and the severity of autonomic dysfunction (AD).

Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke

Autonomic dysfunction is a common and often debilitating feature oflong-COVID (LC), however, studies evaluating frequency and severity of chronic autonomic dysfunction in LC are limited. We utilized an established online cohort of participants with LC to assess duration and severity of autonomic dysfunction, impact on quality of life, risk factors of autonomic diagnoses including postural tachycardia syndrome (POTS), and efficacy of common treatments. Our international cohort included 526 adults with LC aged 20-65 years who previously completed baseline evaluations of LC symptoms, autonomic symptom burden, and quality of life. Participants repeated survey instruments and completed new instruments assessing risk factors and symptom mitigation strategies. A subset of individuals completed a 10-min active stand test. Multivariable logistic regression identified predictors of autonomic symptom burden and incident autonomic diagnoses including POTS. A total of 71.9% of participants with LC had a Composite Autonomic Symptom Score-31 (COMPASS-31) score ≥ 20, suggestive of moderate-to-severe autonomic dysfunction. The median symptom duration was 36 [30-40] months, and 37.5% of participants could no longer work or had to drop out of school due to their illness. In addition, 40.5% of individuals with autonomic dysfunction were newly diagnosed with POTS, representing 33% of the total LC cohort. Female sex and joint hypermobility were associated with an increased risk of autonomic dysfunction. Evidence of chronic moderate-to-severe autonomic dysfunction was seen in most participants with LC in our cohort and was significantly associated with reduced quality of life and functional disability. POTS was the most common post-COVID autonomic diagnosis.

Background Few reports have evaluated the relationship between changes in postprandial blood pressure and the severity of autonomic dysfunction in patients with type 2 diabetes. This was a cross-sectional study designed to investigate postprandial blood pressure changes in individuals without type 2 diabetes and patients with type 2 diabetes and mild or severe cardiac autonomic dysfunction. Methods Forty patients with type 2 diabetes mellitus and 20 individuals without type 2 diabetes participated in this study. Fifty-two participants underwent a meal tolerance test. Blood pressure (brachial systolic blood pressure (bSBP) and central systolic blood pressure (cSBP)), electrocardiogram recordings, and blood samples were assessed before and after meal ingestion. Patients with diabetes were divided into two groups based on their coefficient of variation of R–R intervals (CVRR): a normal or mildly dysfunctional group (mild group, CVRR ≥ 2%; n = 20) and a severely dysfunctional group (severe group, CVRR < 2%; n = 15). Results In the control group, bSBP and cSBP did not significantly change after meal ingestion, whereas both decreased significantly at 60 min after meal ingestion in the mild and severe groups. While blood pressure recovered at 120 min after meal ingestion in the mild group, a significant decrease in blood pressure persisted at 120 min after meal ingestion in the severe group. Conclusions Based on these results, adequate clinical attention should be paid to the risk of serious events related to postprandial decreases in blood pressure, particularly in patients with diabetes and severe cardiac autonomic dysfunction.

Introduction. Hypertension is one of the most common diseases of the cardiovascular system, which is observed in the majority of the working population of Ukraine and around the world. Autonomic dysfunction syndrome is one of the first manifestations and precursors of hypertension. Materials and Methods. The study included 81 patients with hypertension and autonomic dysfunction. Patients were divided into 3 groups depending on blood pressure. To assess the pathology data, blood pressure was measured according to the 2018 recommendation and patients were surveyed according to a standard questionnaire to identify autonomic disorders by Vein. Results. When assessing the prevalence of symptoms of autonomic dysfunction in the study groups, there was a weak dependence of their occurrence with the severity of hypertension, even in patients with mild hypertension there was a significant frequency of symptoms, which cannot but adversely affect patients' quality of life. Assessing the severity of symptoms of autonomic dysfunction, the prevalence of symptoms such as palpitations, sweating, periodic discoloration of the extremities and paroxysmal headaches in the first group (the most favorable course of high blood pressure). For the second group, the most severe were symptoms such as intermittent numbness of the fingers and shortness of breath. The rank correlation between the degree of hypertension and the severity of autonomic dysfunction was 0.103 (p = 0.302), which indicates a positive correlation between these parameters, but the relationship was weak and did not acquire statistical significance. Conclusion. In patients with a combination of hypertension and autonomic dysfunction, the symptoms of the latter are common at any severity of hypertension. The relationship between the severity of hypertension and autonomic dysfunction could not be established, among hemodynamic indicators, pulse blood pressure was most correlated with the index of autonomic dysfunction.

P01-248 - Comparison of the emotional stroop effect on Korean children with ADHD and emotional disorder

Autonomic nervous system dysfunction exists in autoimmune diseases. Symptoms of autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric emptying. This study aims to investigate whether any autonomic dysfunction exists in autoimmune gastritis patients, and if so, to clarify the relationship between the autonomic nervous dysfunction, delayed gastric emptying, and gastrointestinal symptoms. 75 patients (50 women, mean age 56.73±11.77) diagnosed with autoimmune gastritis were investigated by means of autonomic nervous system and gastric emptying tests. All patients underwent a standardized scintigraphic gastric emptying study and five tests evaluating autonomic nervous system. Patients with autonomic nervous system dysfunction were then analyzed and compared by means of existence of delayed gastric emptying and gastrointestinal symptoms. 62 patients had autonomic nervous system dysfunction (14 mild, 40 moderate, and 8 severe autonomic dysfunction). The mean total score of autonomic tests was 3.85±2.35. Total autonomic score of patients (n=60) with delayed gastric emptying was significantly higher than patients (n=15) with normal gastric emptying (4.68±1.7 vs. 1.53±0.58, p<0.001). Mean gastroparesis cardinal symptom index was significantly higher in patients (n=60) with delayed gastric emptying half-time compared to patients (n=15) with normal gastric emptying half-time (1.89±1.16 vs 0.4±0.3, p<0.001). Most of patients with autoimmune gastritis also have autonomic nerve dysfunction. There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying. Gastroparesis cardinal symptom index has a high sensitivity and specificity in predicting both autonomic nerve function and delay in gastric emptying.

Objective: Social media (SM) have flourished and are affecting human lives on an unprecedented scale. Problematic social media use (PSMU) is a recently emerging problematic behavior that affects both physical and mental health. The purpose of this study was to investigate whether problematic users of SM display attentional bias (AB) toward SM-related cues, as well as the relationships between AB, the severity of PSMU, and negative emotions. Method: 1000 college students were recruited through classes and online forums and then tested using the Bergen Social Media Addiction Scale (BSMAS). Eventually, 60 participants, identified by the cut-off point for BSMAS, consented to participate in the study and were divided into two groups (i.e., a problematic use group and a typical use group). The severity of PSMU and negative emotions (i.e., anxiety, depression, social fear, and loneliness) were evaluated by self-report questionnaires. AB was assessed by an addiction Stroop task and a dot-probe task (DPT). Results: PSMU was found to be positively associated with anxiety (r = 0.28, p < 0.05), depression (r = 0.35, p < 0.01), and social fear (r = 0.38, p < 0.01), but not with loneliness (r = 0.19, p = 0.15). Participants with a tendency toward PSMU displayed AB toward SM-related cues in the DPT [F (1, 58) = 26.77, p < 0.001, = 0.32], but not in the Stroop task [F (1, 58) = 0.61, p = 0.44, = 0.01]. Moreover, AB toward SM-related stimuli was found to be positively correlated with the severity of PSMU (r = −0.51, p < 0.001), anxiety (r = −0.37, p < 0.01), depression (r = −0.51, p < 0.001), and social fear (r = −0.30, p < 0.05) in the DPT. Conclusions: Problematic users of SM show AB towards SM-related cues in the DPT, which is more reliable for assessing AB than the Stroop task. Moreover, it is suggested that in clinical interventions we should work to change the AB towards SM-related stimuli and improve negative emotions to decrease risks of PSMU.

Background: Most previous studies finding positive results in the emotional Stroop test did not control for concurrent anxiety symptoms. This study investigated depressive patients without comorbid anxiety disorders in order to clarify existing inconsistent findings. Furthermore, we examined the relationship between anxiety level and the emotional Stroop effect in patients and healthy subjects. Subjects and Methods: Twenty-three depressive patients without comorbid anxiety disorder and 27 healthy subjects performed a mixed computerized version of the emotional Stroop test (attentional bias test). We assessed the state and trait anxiety and examined its correlation with the emotional Stroop effect. Results: We failed to find evidence for attentional bias in the patients as measured by longer reaction times to the emotional stimuli. However, there was a positive correlation between state anxiety and attentional bias in depressed patients. On the other hand, in healthy subjects the trait anxiety correlated negatively with attentional bias. Conclusions: Attentional bias is not found in depressed patients if only patients without comorbid anxiety disorders are included. Furthermore, healthy subjects with high trait anxiety levels may be vulnerable to affective disorders because they use avoidance strategies when encountering negative information.

Women are diagnosed with posttraumatic stress disorder (PTSD) at twice the rate of men. This gender difference may be related to differences in PTSD experiences (e.g., more hypervigilance in women) or types of trauma experienced (e.g., interpersonal trauma). We examined whether attentional threat biases were associated with gender, PTSD diagnosis, and/or trauma type. Participants were 70 civilians and veterans (38 women, 32 men; 41 with PTSD, 29 without PTSD) assessed with the Clinician Administered PTSD Scale for DSM-IV who completed a facial dot-probe attention bias task and self-report measures of psychiatric symptoms and trauma history. Factorial ANOVA and regression models examined associations between gender, PTSD diagnosis, index trauma type, lifetime traumatic experiences, and attentional threat biases. Results revealed that compared to women without PTSD and men both with and without PTSD, women with PTSD demonstrated attentional biases toward threatening facial expressions, d = 1.19, particularly fearful expressions, d = 0.74. Psychiatric symptoms or early/lifetime trauma did not account for these attentional biases. Biases were related to interpersonal assault index traumas, ηp 2 = .13, especially sexual assault, d = 1.19. Trauma type may be an important factor in the development of attentional threat biases, which theoretically interfere with trauma recovery. Women may be more likely to demonstrate attentional threat biases due to higher likelihood of interpersonal trauma victimization rather than due to gender-specific psychobiological pathways. Future research is necessary to clarify if sexual assault alone or in combination with gender puts individuals at higher risk of developing PTSD.