Neuropsychological Impact Research Articles

Meeting the multidimensional self: fostering selfhood at the interface of Creative Arts Therapies and neuroscience.

Intriguing explorations at the intersection of the fields of neuroscience and psychology are driven by the quest to understand the neural underpinnings of "the self" and their psychotherapeutic implications. These translational efforts pertain to the unique Creative Arts Therapies (CATs) and the attributes and value of the self-related processes they offer. The self is considered as a multi-layered complex construct, comprising bodily and mental constituents, subjective-objective perspectives, spatial and temporal dimensions. Neuroscience research, mostly functional brain imaging, has proposed cogent models of the constitution, development and experience of the self, elucidating how the multiple dimensions of the self are supported by integrated hierarchical brain processes. The psychotherapeutic use of the art-forms, generating aesthetic experiences and creative processes, touch upon and connect the various layers of self-experience, nurturing the sense of self. The present conceptual analysis will describe and interweave the neural mechanisms and neural network configuration suggested to lie at the core of the ongoing self-experience, its deviations in psychopathology, and implications regarding the psychotherapeutic use of the arts. The well-established, parsimonious and neurobiologically plausible predictive processing account of brain-function will be discussed with regard to selfhood and consciousness. The epistemic affordance of the experiential CATs will further be portrayed, enabling and facilitating the creation of updated self-models of the body in the world. The neuropsychological impact of the relational therapeutic encounter will be delineated, acknowledging the intersubjective brain synchronization through communicative verbal and non-verbal means and aesthetic experiences. The recognition and assimilation of neuroscientific, phenomenological and clinical perspectives concerning the nested dimensionality of the self, ground the relational therapeutic process and the neuroplastic modulations that CATs have to offer on the premise of fostering, shaping and integrating selfhood.

Neuropsychological impact of Sanda training on athlete attention performance.

Sanda, a martial art that primarily involves punching, kicking, and throwing techniques, requires athletes to maintain high levels of concentration during combat. Sanda principally involves striking the opponent to secure victory, with trauma frequently occurring to the head; however, it remains unclear whether prolonged training enhances or impairs the athletes' attentional capacities. This study aimed to investigate the impact of Sanda training on athletes' attention by employing attention network tests. A retrospective analysis was conducted on 37 professional Sanda athletes from a certain sports academy; 38 college students from the same institution majoring in physical education were recruited as the control group. Control participants had no prior experience in Sanda training, and the Sanda and control groups were matched in terms of sex, age, and education level. The Attention Network Test (ANT) was administered to both groups to compare differences in efficiency across the alerting, orienting, and executive control networks. Compared to the control group, the Sanda athletes exhibited significantly higher executive control network efficiency values and executive control network efficiency ratios (P < 0.05). There were no significant differences between the Sanda group and the control group regarding the efficiency values of the alerting and orienting networks (P > 0.05). Additionally, total accuracy and total reaction time between the Sanda athletes and control participants showed no statistically significant differences (P > 0.05). Sanda practice has detrimental effects on attention, including a decrease in the efficiency of the executive control network and a prolongation of the total reaction time. Therefore, athletes should improve attention training and use head protection to prevent frequent head impacts during training.

B - 4 The Neuropsychological Impact of Myocardial Infarction Induced Cerebral Hypoxia and Acute Encephalitis Following Electrocution: a Case Study

Abstract Objective Cerebral hypoxia and acute encephalitis subsequent to myocardial infarction (MI) are often associated with a decline in cognitive functioning (Wang et al., 2022; Caplan, 2004). While this relationship is well documented in existing literature, less research has investigated the potential nuanced cognitive and behavioral impacts of hypoxia and encephalitis due to electrocution-induced atrial fibrillation (AFib). The present case study uses neuropsychological assessment to clarify further the impact of significant electrocution and subsequent morbidities on cognition. Method We present a case study of a 30-year-old right-handed transgender female with 12 years of education who was referred for neuropsychological assessment pursuant to mental status changes manifested by disorientation and amnesia (the patient believed it was ten years prior) following the MI due to electrocution complicated by an estimated period of 10–15 minutes of non-responsiveness and anoxic encephalopathy. Results Neuropsychological assessment revealed difficulties with cognitive efficiency, language functioning, sequencing, problem-solving, complex attention, and semantic fluency. Overall, performance was inconsistent with education-weighted norms and estimated premorbid functioning. An objective measure of psychological functioning reflected a negative self-evaluation, depression, thoughts of self-harm, anxiety, and personality difficulties marked by fluctuating emotions. Findings supported a diagnosis of cognitive impairment and altered mental status associated with anoxic brain injury from the above-noted MI. Conclusion This case highlights the consequences of anoxic encephalopathy from MI subsequent to electrocution on cognitive, emotional, and behavioral functioning. Neuropsychological assessment provided clear evidence of cognitive impairment beyond the initial diagnoses, and further defined cognitive and behavioral correlates not explained by other dispositional variables.

B - 2 Life-Changing Treatment, Lifelong Challenges: a Case Study on the Neuropsychological Impact of Remission of Multiple Sclerosis Following Clinical-Trial Treatment

Abstract Objective The impact of neurodegenerative diseases on cognitive functioning is well documented; however less is known about the lasting impacts following remission of diseases with previously limited treatability. The present case uses neuropsychological assessment in furthering the understanding of the brain-behavior relationship in a case of multiple sclerosis (MS) in remission subsequent to clinical-trial treatment complicated by a history of medical comorbidities, childhood trauma, underlying psychiatric conditions, and preexisting learning disabilities. Method The patient is a 45-year-old right-handed male with nine years of education, diagnosed with MS (in remission) complicated by cerebrovascular disease, myocardial infarction, cerebral vascular accident, past substance-abuse, and multisource childhood trauma., He was referred for neuropsychological evaluation by his primary-care physician pursuant to learning, attention, and emotional concerns impacted by his medical history. Results Neuropsychological testing reflects global cognitive deficits evidenced by difficulties with intellectual functioning, motor abilities, complex sequencing, executive functioning, problem-solving, phonemic fluency, and variable attention, which affects learning and recall tasks. A self-report of psychological functioning revealed emotional difficulties associated with anxiety, depression, health concerns, hypersensitivity, emotional discord, a history of self-harm, cognitive inefficiency, and difficulty managing anger and past and present stressors. Findings were most consistent with cognitive decline associated with medical conditions, learning difficulties, and attention deficit disorder. Conclusions This neuropsychological case study provides an example of the long-term consequences of neurodegenerative diseases across multiple areas of neuropsychological functioning and quality of life, even when ground-breaking and innovative medical interventions result in remission. It further emphasizes the complex interactions between neurological disease and biopsychosocial factors.

Neuropsychological complications of hypoprolactinemia.

Prolactin (PRL) is primarily produced by the pituitary lactotrophic cells and while initially named for its role in lactation, PRL has several other biological roles including immunomodulation, osmotic balance, angiogenesis, calcium metabolism, and appetite regulation. Most of the PRL-related literature has traditionally focused on hyperprolactinemia, whereas hypoprolactinemia has received little attention. There is evidence to suggest that PRL receptors are widely distributed within the central nervous system including the limbic system. Furthermore, PRL has been shown to play key role in the stress regulation pathway. Recent data also suggest that hypoprolactinemia may be associated with increased sexual dysfunction, anxiety, and depression. In this paper we discuss the current understanding regarding the neuropsychological impact of hypoprolactinemia and highlight the need for adequately defining hypoprolactinemia as an entity and consideration for future replacement therapies.

Alterations in brain network connectivity and subjective experience induced by psychedelics: a scoping review.

Intense interest surrounds current research on psychedelics, particularly regarding their potential in treating mental health disorders. Various studies suggest a link between the subjective effects produced by psychedelics and their therapeutic efficacy. Neuroimaging evidence indicates an association of changes in brain functional connectivity with the subjective effects of psychedelics. We conducted a review focusing on psychedelics and brain functional connectivity. The review focused on four psychedelic drugs: ayahuasca, psilocybin and LSD, and the entactogen MDMA. We conducted searches in databases of MEDLINE, Embase, APA PsycInfo and Scopus from inception to Jun 2023 by keywords related to functional connectivity and psychedelics. Using the PRISMA framework, we selected 24 articles from an initial pool of 492 for analysis. This scoping review and analysis investigated the effects of psychedelics on subjective experiences and brain functional connectivity in healthy individuals. The studies quantified subjective effects through psychometric scales, revealing significant experiences of altered consciousness, mood elevation, and mystical experiences induced by psychedelics. Neuroimaging results indicated alterations in the functional connectivity of psychedelics, with consistent findings across substances of decreased connectivity within the default mode network and increased sensory and thalamocortical connectivity. Correlations between these neurophysiological changes and subjective experiences were noted, suggesting a brain network basis of the psychedelics' neuropsychological impact. While the result of the review provides a potential neural mechanism of the subjective effects of psychedelics, direct clinical evidence is needed to advance their clinical outcomes. Our research serves as a foundation for further exploration of the therapeutic potential of psychedelics.

Neuro-psychological impact on dentists in the COVID-19 pandemic

Our survey investigated dentists' perceptions of their activity during the COVID-19 pandemic. We used a ten-question survey on our conception and sent it to 122 dentists via social media; 70 responded. The Cronbach's Alpha coefficient validated our questionnaire. We applied the Shapiro-Wilk test and the Mann-Whitney test. The chosen p-significance threshold was 0.05. The respondents were 61.50% women and 38.50% men; 44.29% were between 23 -30 years old. 44.29% of the respondents were dentists with 1 to 5 years of practice. Of 70 dentists, 51.43% felt stress, 35.71% felt fear, 7.15% anxiety, and 5.71% physical fatigue during the pandemic. 65% of males and 35% of females used some drugs. 80.80% of respondents had no financial problems, 19.20% reported some troubles. Gloves, masks, and glasses were the principal ways of protection, followed by nebulizers (98%) and UV lamps (52%). 68 declared they had the support of their friends and family, 65 were relaxed by TV programs, 52 by doing sports, and 47 by listening to music. 53% of dentists had COVID-19: 30.58% female and 22.42% male; 96.24% of them managed to treat the infection at home.

Neuro-psychological impact on dentists in the COVID-19 pandemic

Our survey investigated dentists' perceptions of their activity during the COVID-19 pandemic. We used a ten-question survey on our conception and sent it to 122 dentists via social media; 70 responded. The Cronbach's Alpha coefficient validated our questionnaire. We applied the Shapiro-Wilk test and the Mann-Whitney test. The chosen p-significance threshold was 0.05. The respondents were 61.50% women and 38.50% men; 44.29% were between 23 -30 years old. 44.29% of the respondents were dentists with 1 to 5 years of practice. Of 70 dentists, 51.43% felt stress, 35.71% felt fear, 7.15% anxiety, and 5.71% physical fatigue during the pandemic. 65% of males and 35% of females used some drugs. 80.80% of respondents had no financial problems, 19.20% reported some troubles. Gloves, masks, and glasses were the principal ways of protection, followed by nebulizers (98%) and UV lamps (52%). 68 declared they had the support of their friends and family, 65 were relaxed by TV programs, 52 by doing sports, and 47 by listening to music. 53% of dentists had COVID-19: 30.58% female and 22.42% male; 96.24% of them managed to treat the infection at home.

Lifetime blast exposure is not related to cognitive performance or psychiatric symptoms in US military personnel

Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, ηp 2s < .032) or in General Cognition (Fs < 0.95, ps > .3, ηp 2s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, ηp 2 = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, ηp 2 = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, ηp 2 = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, ηp 2s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.

Highlighting the Neuropsychological Consequences of COVID-19: Evidence From a Narrative Review.

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2, although largely affecting the respiratory system, commonly presents with numerous clinical symptoms from other systems. COVID-19 has been associated with both acute and persistent neurological abnormalities in a substantial proportion of patients. Notably, post-COVID-19 neuropsychological abnormalities have garnered attention, highlighting a high prevalence of neurocognitive issues in affected individuals. This narrative review synthesizes current knowledge on the neuropsychological impact of COVID-19, drawing insights from an extensive online search of published literature conducted in the PubMed (MEDLINE) and Scopus databases. The findings underscore significant neuropsychological effects of COVID-19 observed at both individual and societal levels during the ongoing pandemic. Neuropsychological deficits such as memory difficulties, attention problems, and executive dysfunction, alongside physical symptoms like headaches and fatigue were commonly reported. Additionally, psychological challenges, including fear, anxiety, and depression, emerged as prevalent issues arising from the uncertainties surrounding the situation, social isolation, and employment insecurities. The identified neuropsychological manifestations of COVID-19 can significantly impede normal cognitive and emotional functioning, potentially resulting in decreased productivity and an overall decline in mental health and quality of life. Early identification of signs indicative of neurological or psychological decline becomes imperative, offering a crucial opportunity to mitigate the risk of long-term neuropsychological dysfunction through the development of targeted interventions.

Cenobamate as add-on therapy for drug resistant epilepsies: effectiveness, drug to drug interactions and neuropsychological impact. What have we learned from real word evidence?

Background: Cenobamate (CNB) is an anti-seizure medication (ASM) approved in 2021 in Europe for adjunctive treatment of focal-onset seizures in adults who were not adequately controlled with at least two previous ASMs. Methods: seizure outcome, treatment-emergent adverse events, neuropsychological profile, and blood levels of CNB and concomitant ASM were analyzed in a real world setting in two different Italian epilepsy centers in the context of CNB early access program. All patients performed a general cognitive evaluation, while 32 patients underwent the administration of a battery of neuropsychological tests at baseline and 6months after CNB treatment. We performed CNB quantification in plasma in 31 patients at different doses in the range of 100-400mg/day (65 measures). Results: we enrolled 54 patients with a median age of 27.9years. The mean follow-up was 10.7months. Most (91%) completed the efficacy analysis. At last follow-up visit, a 69.5% median seizure reduction was registered. Thirty-two patients (59.2%) had a ≥50% reduction of seizures that was ≥75% in 20 (42.0%) cases, whilst 10 (20.2%) patients were seizure-free. The most common adverse events were somnolence (53.1%), dizziness (28.1%) and diplopia (12.5%). The correlation between CNB dose and plasma concentration, revealed a significant linear correlation (r = 0.86, p < 0.0001), and there was a significant difference in mean plasma concentration/dose administered ratio (C/D ratio) between patients taking or not at least one inducer (0.10 ± 0.04 [(μg/mL)/(mg/day)]; n = 47 vs. 0.13 ± 0.05 [(μg/mL)/(mg/day)]; n = 18, p = 0.04). CNB dose was inversely correlated (r = -0.31, p = 0.02) to the C/D ratio of Carbamazepine blood levels. and positively correlated (r = 0.74, p < 0.0001) with an increased plasma concentration of the active Clobazam metabolite N-desmethylclobazam. General Anxiety Disorder-7 showed a significant improvement of score from baseline evaluation of 6.82 to follow-up 6months evaluation of 4.53 (p = 0.03). Conclusion: In this real-world study, we registered a clinically meaningful reduction in seizure frequency after CNB administration in most patients along with a good tolerability profile. CNB treatment is correlate to a reduction in symptom severity of anxiety score. Plasma levels measurements confirm that CNB acts both as "victim" and as "perpetrator" of drug-drug interactions.

Neuropsychological Impact of COVID-19 on Children and Adolescents

Neuropsychological Impact of COVID-19 on Children and Adolescents

Review study on neuropsychological impact of ecotherapy on urbanization

The following research is a review paper to determine what neurobiological changes occur during ecotherapy that impacts our behavior and what are its implications over urbanization. The research utilizes the selection of relevant literature across databases on the basis of their applicability in Indian context and publication date not exceeding beyond 10 years. The analysis of the 11 research articles reviewed reveals that the practice of ecotherapy has the positive impact on the brain by improving cognitive functions, attention span, inducing more relaxation and emotional wellness on a physiological level. Urbanization, on the other hand, has been documented to negatively impact cognitive function, response behavior, attentional tasks and metabolic processes due to excessive exposure to urban determinants. Therefore it can be concluded that eco therapeutic interventions can have positive impact and elicit improvement in psychological and physiological determinants of health and well-being.

Pediatric sleep: current knowledge, gaps, and opportunities for the future.

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

A-277 Neurocognitive and Psychological Profile of a 57-Year-Old Long-COVID Patient After 42 Days an a Ventilator

Objective: The neuropsychological impact of COVID-19 is a budding area of research. Studies suggest greater neurological abnormalities in patients presenting with a severe illness course, particularly those with acute respiratory distress syndrome. The purpose of this case study was to characterize the neurocognitive and psychological profile of a 57-year-old male following prolonged hospitalization for COVID-19 in March 2020, including 42 days on mechanical ventilation.Method: Relevant data were collected via clinical interview, neuropsychological testing, and medical record review. Hospital course was notable for hypertension, acute kidney failure, and pressure ulcers. Computerized tomography and electroencephalogram revealed mild cortical atrophy and mild to moderate generalized slowing, respectively. Approximately 15 months post-discharge, subjective complaints during the evaluation included cognitive “fogginess,” increased impulsivity, decreased frustration tolerance, forgetfulness, fatigue, mobility difficulties, and dyspnea upon exertion.Results: Neuropsychological testing, within the context of likely average premorbid functioning, revealed declines in motor functioning, confrontation naming, phonemic fluency, planning/organization, visual memory, and aspects of verbal memory. Poor performance on select memory tasks was likely driven by executive dysfunction. Behaviorally, the patient presented as disinhibited, impulsive and labile. Emotionally, he endorsed symptoms of posttraumatic stress, anxiety, and depression. These post-COVID-19 sequelae have impacted functioning across multiple domains including ability to work, medication and finance management, and complex decision-making.Conclusions: Results suggest bilateral frontal and temporal dysfunction rather than subcortical deficits from hypoxia. Similar to post-intensive care syndrome, the etiology of functional impairment in severely ill, hospitalized COVID-19 patients appears multifactorial. Likely mediating factors include COVID-19 itself, associated complications, intervention methods, and psychological distress.

A-2 Neuropsychological and Neuropsychiatric Symptoms Following Hypertrophic Olivary Degeneration

Abstract Objective: Hypertrophic Olivary Degeneration (HOD) is a rare neurological condition causing hypertrophy and eventual degeneration of the inferior olivary nucleus via transneuronal degeneration in the dentato-rubro-olivary pathway (DROP), or Guillain–Mollaret triangle. HOD is considered unique because the olive initially becomes hypertrophic rather than atrophic. Etiology is often cerebral vascular insult, cavernous malformation, surgical resection, and neurological disease, albeit cause may be unclear. While the neurologic and imaging findings have been well delineated in the literature, few studies investigate the neuropsychological impact. Methods: With consent, a review of the medical chart was conducted of a 39-year-old female with hypertension referred for assessment due to progressive cognitive, motor, and psychiatric symptoms. Results: Physical symptoms included progressive limb and trunk ataxia, palatal tremor, and opsoclonus myoclonus that plateaued within 4 years. Initial Magnetic Resonance Imaging (MRI) revealed bilateral, nonenhancing hyperintensity of the pontomedullary junction and enlargement of the inferior olive. Subsequent MRI displayed cerebellar atrophy. Cognitive assessment documented significant executive, language, spatial and fine motor dexterity deficits, alongside depression, anxiety, emotional blunting, and passive suicidality. She reported believing her neighbors were listening and following her in public. She remained semi-independent in daily living. Conclusions: This is the first case study that captures the neurocognitive profile associated with HOD and associated degeneration of DROP. This case highlights the potential for Cognitive Cerebellar Affective Syndrome (CCAS) to arise from damage to adjacent cerebellar pathways via transneuronal degeneration of brainstem circuits. It also provides evidence for the presence of delusions within CCAS as dysmetria of thought.

Temporosylvian arachnoid cysts in children. Part 1: Cognitive profile of children with a temporal cyst and impact of the cyst in daily life. A prospective study in 100 consecutive children.

The aim of this study was to determine the cognitive profile of children with a temporal arachnoid cyst (TAC) and its impact on daily life. The authors prospectively analyzed the cognitive and psychological profiles of 100 consecutive children relative to age and cyst characteristics (side, cyst size, and cyst shape: convex or nonconvex) and their outcome 4 years later. Mean IQs were normal but with high heterogeneity on Full Scale IQ (FSIQ; range 59-150); 29% of children had at least one Wechsler index below the norm, in particular, Processing Speed and Working Memory Indexes. Impairments were observed in language for 31% of children, as well as in verbal memory (28%), visual memory (23%), executive function (21%), and visual attention (24%). Half of the children (50%) needed rehabilitation for learning difficulties, and 26% had academic difficulties. The parental questionnaire BRIEF (Behavior Rating Inventory of Executive Function) revealed significant executive dysfunctions in daily life for 22% of the children. One-third of the patients (34%) required psychotherapy for anxiety or social disorders, with higher rates in patients with a right-sided cyst and older children. Cyst size had very little neuropsychological impact. Convex cysts were significantly associated with worse performance than nonconvex cysts on all Wechsler indexes and FSIQ, and in language, verbal memory, attention, and visuospatial skills. Children with a convex cyst had significantly more executive and behavior difficulties in daily life and more psychotherapy than other children. The effect of cyst shape was independent of Galassi type and cyst side. Children with a ruptured cyst or an incidentally discovered cyst usually had a good cognitive level. Four years later, children without initial disorders remained stable, whereas those with difficulties who did not undergo surgery needed more rehabilitation and school adaptations. This large cohort study revealed a varied profile of children with a TAC: at initial assessment, 50% had neuropsychological difficulties and needed rehabilitation and/or psychotherapy for learning or behavior difficulties, and 50% had no difficulties, which may explain the debate about this pathology. Patients with neuropsychological difficulties had a heterogeneous profile with normal intelligence but selective cognitive and/or behavior disorders that may have a long-term impact on their quality of life, particularly those with a right-sided cyst. A neuropsychological evaluation is not always necessary for a cyst discovered incidentally, but early evaluation is essential in patients with academic, learning, or psychological disorders. When assessment shows selective disorders presumably linked to cyst location, surgery may be considered, particularly for convex cysts, as this study revealed more effects in association with cyst shape than with cyst size and significantly poorer performance with a convex cyst.

Moderating the Neuropsychological Impact of Online Learning on Psychology Students

&lt;p style="text-align: justify;"&gt;The purpose of the study was to identify what neuropsychological effect online learning had on psychology students and how it could be moderated. The study was descriptive and combined qualitative and quantitative methods to address the research questions. The study relied on three phases such as baseline study, experiment, and reporting. The experiment utilised neuropsychology tests adopted from the NeurOn platform. It was found that the Psychology students’ perceptions of e-learning and their emotional reaction to them were found not to be appreciative. The practices in breathing exercises, meditation, or yoga were proved to be able to moderate the impact of online learning on the experimental group students’ attentional capacities, memory processes, and cognition abilities. The above findings were supported by the results obtained for the neuropsychology tests and the experimental group students’ self-reflections yielded from the use of the MovisensXS App. The students confirmed that breathing exercises, meditation, or yoga reduced study stress and burnout caused by e-learning and improved their academic performance. The focus group online discussion also showed that integration of breathing exercises, meditation, and yoga helped the experimental group students keep emotional balance, concentrate on their studies easier, remember more information, and meet deadlines in completing assignments. The education scientists are suggested to study how the e-learning curriculum could be reshaped so that it used relaxation practices on regular basis.&lt;/p&gt;

Celebrating 35 Years of the AJNR: November 1986 edition.

<h3>Background</h3> The term ‘moral injury’ may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them. <h3>Methods</h3> Structured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis. <h3>Results</h3> Concepts of moral injury such as witnessing events which contravene one’s moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard. <h3>Conclusions</h3> The term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma.

A-86 Reactive Attachment Disorder in Adulthood: A Neuropsychological Perspective

Abstract Objective The sequelae of poor attachment and trauma on psychological and social functioning is well documented, however, this complex relationship applied to a neuropsychological profile is less understood. The current case uses a neuropsychological assessment to further understand the brain-behavior relationship in a case of poor maternal attachment, multiple traumas, psychiatric comorbidities, and poor social adaptation. Method Patient is a 22-year-old, right-handed, Eastern European woman with fetal alcohol and infant toxic mold exposure, failure to thrive, maternal neglect, adoption and relocation to the United States (age four), posttraumatic stress disorder (PTSD; multiple reported sexual traumas and bullying victimization), and depression. Referred for a neuropsychological evaluation for longstanding inattention, learning difficulties, being socially and emotionally withdrawn, and suspected Autism Spectrum Disorder (ASD). Results Data revealed average intellectual ability, dyscalculia, Attention Deficit Hyperactivity Disorder (ADHD), PTSD, and depression. A self-report measure of ASD revealed a strong perception of ASD, characterized by inability to read verbal cues or other’s emotions, and poor communication and self-expression, however, this diagnosis was not supported by formal assessment and behavioral observations; instead, it was determined a diagnosis of Reactive Attachment Disorder (RAD). Conclusions This case provides an example of the complex interplay of poor maternal–infant bonding coupled by adolescent trauma on adult attachment style and compromised social interactions. More specifically, the case addresses the poly-etiologic and neuropsychological impact of an insecure attachment style and trauma on self-perceptions of social and emotional withdrawal commonly seen in ASD. The case further stresses the overlapping presentations RAD, ADHD, learning disabilities, and psychiatric comorbidities.