Subjective Reports Research Articles

Using imagination and the contents of memory to create new scene and object representations: A functional MRI study

Humans can use the contents of memory to construct scenarios and events that they have not encountered before, a process colloquially known as imagination. Much of our current understanding of the neural mechanisms mediating imagination is limited by paradigms that rely on participants' subjective reports of imagined content. Here, we used a novel behavioral paradigm that was designed to systematically evaluate the contents of an individual's imagination. Participants first learned the layout of four distinct rooms containing five wall segments with differing geometrical characteristics, each associated with a unique object. During functional MRI, participants were then shown two different wall segments or objects on each trial and asked to first, retrieve the associated objects or walls, respectively (retrieval phase) and then second, imagine the two objects side-by-side or combine the two wall segments (imagination phase). Importantly, the contents of each participant's imagination were interrogated by having them make a same/different judgment about the properties of the imagined objects or scenes. Using univariate and multivariate analyses, we observed widespread activity across occipito-temporal cortex for the retrieval of objects and for the imaginative creation of scenes. Interestingly, a classifier, whether trained on the imagination or retrieval data, was able to successfully differentiate the neural patterns associated with the imagination of scenes from that of objects. Our results reveal neural differences in the cued retrieval of object and scene memoranda, demonstrate that different representations underlie the creation and/or imagination of scene and object content, and highlight a novel behavioral paradigm that can be used to systematically evaluate the contents of an individual's imagination.

Brown Adipose Tissue Activity and Childhood Exposure to Cold Are Associated With Hot Flashes at Menopause.

Hot flashes (HFs) are experienced as sudden sensations of heat. We hypothesized that brown adipose tissue (BAT) activation could increase the likelihood of HFs in winter. The aim of this study was to test whether women with more BAT activity were more likely to experience self-reported or biometrically measured HFs. Women aged 45-55 years (n = 270) participated in face-to-face interviews and anthropometric and ambulatory measures. Level of BAT activity was estimated from the difference in supraclavicular skin temperature measured by infrared thermography before and after cooling. Logistic regressions were applied to examine whether bothersome HFs (yes/no) during the past 2 weeks were associated with BAT activity, adjusting for menopausal status, childhood exposure to cold, waist/hip ratio, and self-reported health. Linear regressions were used to examine the frequency of self-reported and biometrically measured HFs during the study period and BAT activity, adjusting for potential confounders. Menopausal status, childhood exposure to cold, waist-to-hip ratio (WHR), and self-reported health were associated with both BAT activity and HFs. After adjusting for potential confounders, an increase in BAT activity almost tripled the likelihood of bothersome HFs (OR 2.84, 95% CI 1.26-6.43). In linear regressions, BAT activity was not associated with frequency of subjective or objective HFs during the study period, but childhood exposure to cold was associated with subjective HF report (β = 0.163, p = 0.010). To our knowledge, this is the first study of BAT activation and HFs. Our results support a role for BAT activity in HF experience. Therefore, we encourage further examination of the role of BAT, as well as childhood exposure to cold, in HFs.

Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery.

A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery. A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress. Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress. Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty.

Automated Analysis of Stereotypical Movements in Videos of Children With Autism Spectrum Disorder

Stereotypical motor movements (SMMs) are a form of restricted and repetitive behavior, which is a core symptom of autism spectrum disorder (ASD). Current quantification of SMM severity is extremely limited, with studies relying on coarse and subjective caregiver reports or laborious manual annotation of short video recordings. To assess the utility of a new open-source AI algorithm that can analyze extensive video recordings of children and automatically identify segments with heterogeneous SMMs, thereby enabling their direct and objective quantification. This retrospective cohort study included 241 children (aged 1.4 to 8.0 years) with ASD. Video recordings of 319 behavioral assessments carried out at the Azrieli National Centre for Autism and Neurodevelopment Research in Israel between 2017 and 2021 were extracted. Behavioral assessments included cognitive, language, and autism diagnostic observation schedule, 2nd edition (ADOS-2) assessments. Data were analyzed from October 2020 to May 2024. Each assessment was recorded with 2 to 4 cameras, yielding 580 hours of video footage. Within these extensive video recordings, manual annotators identified 7352 video segments containing heterogeneous SMMs performed by different children (21.14 hours of video). A pose estimation algorithm was used to extract skeletal representations of all individuals in each video frame and was trained an object detection algorithm to identify the child in each video. The skeletal representation of the child was then used to train an SMM recognition algorithm using a 3 dimensional convolutional neural network. Data from 220 children were used for training and data from the remaining 21 children were used for testing. Among 319 behavioral assessment recordings from 241 children (172 [78%] male; mean [SD] age, 3.97 [1.30] years), the algorithm accurately detected 92.53% (95% CI, 81.09%-95.10%) of manually annotated SMMs in our test data with 66.82% (95% CI, 55.28%-72.05%) precision. Overall number and duration of algorithm-identified SMMs per child were highly correlated with manually annotated number and duration of SMMs (r = 0.8; 95% CI, 0.67-0.93; P < .001; and r = 0.88; 95% CI, 0.74-0.96; P < .001, respectively). This study suggests the ability of an algorithm to identify a highly diverse range of SMMs and quantify them with high accuracy, enabling objective and direct estimation of SMM severity in individual children with ASD.

Understanding visual perception in visual snow syndrome: a battery of psychophysical tests plus the 30-day clinical diary.

Patients with visual snow syndrome (VSS) experience uncountable flickering tiny dots in the entire visual field. Symptoms often persist over the years. Very little is known about altered perception in VSS. VSS is diagnosed based on subjective reports because there is no manual with objective measures. In this study, 20 patients with VSS and 17 healthy controls performed a battery of tests assessing visual acuity, contrast sensitivity, illusion perception, spatial-temporal vision, motion perception, visual attention, and selective attention. Surprisingly, except for one test, which is the honeycomb illusion, patients performed at the same level as controls. Patients reporting black and white visual snow performed better in the Stroop test compared to patients reporting other visual snow colours. In addition to a clinical visit, the 30-day clinical diary was administered to patients to broadly measure their symptom severity. We found that better performance in the tests, in particular in the contrast and coherent motion tests, was correlated with lower VSS symptoms, weaker VS characteristics (e.g. density and size) and lower VS severity. Our results suggest that, even if visual abilities are not deteriorated by VSS, they can determine how severe symptoms are, and show that VSS is an heterogenous disorder where symptoms and visual abilities vary between patients, for instance depending on the VS colour. The study was primarily designed to identify tests where performance differs between controls and patients. In addition, exploratory analyses were conducted to initiate an understanding of the overall pattern of relationships between patients' visual abilities and symptoms, which is of clinical relevance. Future studies with more power are necessary to validate our findings.

Cohort profile: DNA methylation in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) – recruitment and participant characteristics

PurposeEpigenetic modifications including DNA methylation (DNAm) are proposed mechanisms by which social or environmental exposures may influence health and behaviours as we age. The Northern Ireland Cohort for the Longitudinal...

The association between self-assessed improvement in mental health preceding rotator cuff repair and patient satisfaction: A retrospective cohort study.

The association between preoperative mental health trends and arthroscopic rotator cuff repair (RCR) outcomes and patient satisfaction has not been previously described. We investigated the association between a subjective change in preoperative mental health and patient-reported outcome measures (PROMs) and achievement of patient satisfaction and substantial clinical benefit (SCB), defined as an improvement of American Shoulder and Elbow Surgeons Standardized Shoulder Assessment score ≥ 17.5, following RCR. Among patients undergoing RCR, various PROMs were collected preoperatively and at follow-up intervals up to 2 years postoperatively. Patient satisfaction and achievement of SCB were analyzed relative to subjective reports of better, worse, or unchanged mental health in the year preceding RCR and preoperative PROMs. Eighty-eight patients (47 male and 41 female) with a median age of 60.0 years (interquartile range (IQR), 10.0) were included in this study. All patients (n = 13) who reported improved mental health status preceding RCR had significantly better satisfaction (P = 0.03) and SCB (P ≤ 0.05) at 2 years postoperatively compared to patients who reported worse or unchanged mental status. Subjective improvement in mental health status preceding arthroscopic RCR was associated with patient satisfaction and achievement of SCB at 2 years postoperatively.

Subjective and objective sleep quality assessment in adolescent patients with inflammatory bowel disease

ObjectivesThere is a link between inflammatory bowel disease (IBD) and poor sleep quality that is presumed to be multifactorial. The purpose of this study was to identify factors that impact sleep quality in this group including clinical disease activity, depression, anxiety, quality of life, and disordered social media use through questionnaires. MethodsThis prospective study analyzed sleep quality in adolescent patients ages 13 to 18 with a diagnosis of IBD using objective data from wrist actigraphy and subjective report from the Pittsburgh Sleep Quality Index (PSQI). Additional screeners including the Short Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index, Pediatric Quality of Life Inventory Gastrointestinal Symptoms Module, Generalized Anxiety Disorder 7-item screener, Patient Health Questionnaire depression screener, and Social Media Disorder scale were also collected. ResultsTwenty-three subjects enrolled and 16 completed questionnaires. 62.5 % of participants were in clinical remission and the remaining 37.5 % had mild to severe clinical IBD activity. Poor subjective sleep quality was associated with a shorter duration of sleep time and an increased clinical disease activity score. Patients in clinical remission slept for a longer duration than those with mild IBD activity. ConclusionsThis study did not identify a significant relationship between sleep quality and psychosocial factors in the adolescent population with IBD, though their influence cannot be discounted. There was a connection between the presence of disease activity and shorter sleep duration. Similarly, PSQI scores correlated with sleep time but not sleep quality.

Disembodiment and Affective Resonances in Esketamine Treatment of Depersonalized Depression Subtype: Two Case Studies

Introduction: Dissociative experiences are considered undesirable ketamine’s adverse events. However, they might be crucial for ketamine’s antidepressant effects, at least in some depression subtypes. Current understandings of ketamine’s therapeutic potentials converge on the so-called “relaxed prior hypothesis,” suggesting that glutamatergic blockage up-weights bottom-up surprising somatosensory/affective states. As a result, ketamine improves short-term plasticity in depression by enhancing sensitivity to interoceptive signals. Methods: We selected 2 case studies for their paradigmatic description of “depersonalized depression” (Entfremdungsdepression) symptoms. Patients were included in a 6-month-long esketamine program for treatment resistant depression, during which we collected their spontaneous experience with esketamine. According to a neurophenomenological approach, we combined subjective reports from unstructured clinical interviews and the review of previous objective neuroimaging results and neurocomputational models to unveil the relation between esketamine antidepressant effects and interoceptive sensitivity. Results: According to our clinical observations, esketamine-induced dissociation might be particularly effective in the depersonalized depression subtype, in which interoceptive awareness and interaffectivity are particularly compromised. Ketamine and esketamine’s dissociative effects and particularly disembodiment might suspend previously acquired patterns of feeling, sensing, and behaving. Conclusions: Coherently with previous research, we suggest that esketamine-induced disembodiment allows for a transient window of psychological plasticity and enhanced sensitivity, where the body recovers its permeability to affective affordances.

Dynamics of spontaneous thoughts: Exploration, attentional profile and the segmentation of the stream of thoughts

For a long time, clinical knowledge and first-person reports have pointed to individual differences in the dynamics of spontaneous thoughts, in particular in the extreme case of psychiatric conditions (e.g. racing thoughts in Attention Deficit / Hyperactivity Disorder, ADHD; rumination in depression). We used a novel procedure to investigate this individual variability by combining verbal fluency tasks and introspective reports of thought content. Our goal was twofold. First, we tested the hypothesis that a greater segmentation of the stream of thoughts would be associated with trait inattention, in line with subjective reports of ADHD patients. Second, we tested whether the segmentation of the stream of thoughts increased with an increased tendency for exploratory behavior, following recent theoretical claims on the mechanisms underpinning the generation of spontaneous thoughts. Our results support both hypotheses, shedding light on the factors contributing to the individual variability in the dynamics of the stream of thought.

Childhood family socioeconomic status is linked to adult brain electrophysiology.

A large body of research has linked childhood family socioeconomic status (SES) to neurodevelopment in childhood and adolescence. However, it remains unclear to what extent childhood family SES relates to brain functioning in adulthood. To address this gap, the present study investigated the associations between retrospective accounts of objective and subjective childhood family SES and two well-established electrophysiological indices of brain functioning in adulthood-the MMN and P3b event-related potentials (ERP) components, as neural correlates of automatic change detection and cognitive control respectively. Higher objective childhood family SES, as proxied by parent educational attainment in childhood, was associated with larger (more positive) P3b amplitudes in adulthood. In contrast, there was no association between childhood parent educational attainment and the magnitude of MMN. Adult reports of subjective family SES during childhood were not related to the magnitude of MMN or P3b. These findings suggest that the links between childhood parent educational attainment and brain functioning may extend into adulthood, especially for brain functions supporting cognitive control. These results also imply that, when using retrospective accounts of childhood family SES, objective and subjective reports likely proxy different childhood experiences that have distinct links with specific neurodevelopmental outcomes, and that some of these links may not persist into adulthood. Our findings lay the groundwork for future investigations on how and why childhood family SES relates to brain functioning in adulthood.

Unraveling the Threads: Sleep Difficulties, Neighborhood Physical Disorder, and Subjective Cognitive Decline in Older Americans.

Research suggests that the neighborhood in which people live can be a risk or protective factor for various health outcomes, including cognitive decline to Alzheimer's disease. Similar to the impact of neighborhood on health outcomes, sleep difficulties have been linked to cognitive function in older adults. However, few studies have examined how neighborhood physical disorders moderate the effects of sleep on subjective cognitive decline (SCD). The study examined the moderating effect of neighborhood factors on the relationship between sleep difficulties and SCD. Data were obtained from 2,494 respondents (1,065 males and 1,429 females) from Wave 11 of the National Health and Aging Trends (NHATS) data. Sleep difficulties were operationalized as the presence of difficulties in falling and staying asleep. Neighborhood physical disorder (e.g., vandalism, graffiti) was based on interviewer observations of respondents' neighborhoods. SCD was operationalized as subjective reports of increasing or worse memory loss in the past 12 months and present memory rating. We utilized Linear regression to test neighborhood physical disorder as a moderator of the relationship between sleep difficulties and SCD. We found a significant interaction between sleep difficulties and neighborhood physical disorder on SCD (β=0.03, SE = 0.01, 95% CI[0.00,0.51], p < 0.001). Participants who reported higher average sleep difficulties and higher levels of neighborhood physical disorder were more likely to report SCD. Our findings add to inform future health interventions and policy recommendations that address modifiable sources of cognitive decline and risk of Alzheimer's disease.

Individual variability in neural representations of mind-wandering.

Mind-wandering is a frequent, daily mental activity, experienced in unique ways in each person. Yet neuroimaging evidence relating mind-wandering to brain activity, for example in the default mode network (DMN), has relied on population- rather than individual-based inferences owing to limited within-person sampling. Here, three densely sampled individuals each reported hundreds of mind-wandering episodes while undergoing multi-session functional magnetic resonance imaging. We found reliable associations between mind-wandering and DMN activation when estimating brain networks within individuals using precision functional mapping. However, the timing of spontaneous DMN activity relative to subjective reports, and the networks beyond DMN that were activated and deactivated during mind-wandering, were distinct across individuals. Connectome-based predictive modeling further revealed idiosyncratic, whole-brain functional connectivity patterns that consistently predicted mind-wandering within individuals but did not fully generalize across individuals. Predictive models of mind-wandering and attention that were derived from larger-scale neuroimaging datasets largely failed when applied to densely sampled individuals, further highlighting the need for personalized models. Our work offers novel evidence for both conserved and variable neural representations of self-reported mind-wandering in different individuals. The previously unrecognized interindividual variations reported here underscore the broader scientific value and potential clinical utility of idiographic approaches to brain-experience associations.

Associations among attentional state, retrieval quality, and mnemonic discrimination

Memory specificity is shown when participants reject lures that are similar to studied objects. Lure rejections may reflect hippocampal pattern separation that encodes objects distinctively. However, lure features shared with studied objects may evoke pattern completion of varying quality. This was shown when self-reported attention during study promoted lure rejections and false alarms. We used an experimental and individual differences approach to examine the roles of attentive encoding and retrieval quality in lure classifications. An object-based mnemonic discrimination task included thought probes during study and subjective retrieval reports after recognition responses. On-task reports reflecting attentive encoding were associated with lure rejections and false alarms within-and between-subjects. Additionally, accurate lure and target classifications were more strongly associated with subjective recollection following on- than off-task reports. Collectively, these results suggest that attention during study was associated with recollection of criterial features that differentiated existing memories from perceptual inputs.

DiabSense: early diagnosis of non-insulin-dependent diabetes mellitus using smartphone-based human activity recognition and diabetic retinopathy analysis with Graph Neural Network

Non-Insulin-Dependent Diabetes Mellitus (NIDDM) is a chronic health condition caused by high blood sugar levels, and if not treated early, it can lead to serious complications i.e. blindness. Human Activity Recognition (HAR) offers potential for early NIDDM diagnosis, emerging as a key application for HAR technology. This research introduces DiabSense, a state-of-the-art smartphone-dependent system for early staging of NIDDM. DiabSense incorporates HAR and Diabetic Retinopathy (DR) upon leveraging the power of two different Graph Neural Networks (GNN). HAR uses a comprehensive array of 23 human activities resembling Diabetes symptoms, and DR is a prevalent complication of NIDDM. Graph Attention Network (GAT) in HAR achieved 98.32% accuracy on sensor data, while Graph Convolutional Network (GCN) in the Aptos 2019 dataset scored 84.48%, surpassing other state-of-the-art models. The trained GCN analyzed retinal images of four experimental human subjects for DR report generation, and GAT generated their average duration of daily activities over 30 days. The daily activities in non-diabetic periods of diabetic patients were measured and compared with the daily activities of the experimental subjects, which helped generate risk factors. Fusing risk factors with DR conditions enabled early diagnosis recommendations for the experimental subjects despite the absence of any apparent symptoms. The comparison of DiabSense system outcome with clinical diagnosis reports in the experimental subjects was conducted using the A1C test. The test results confirmed the accurate assessment of early diagnosis requirements for experimental subjects by the system. Overall, DiabSense exhibits significant potential for ensuring early NIDDM treatment, improving millions of lives worldwide.

Temporary Vocal Fold Augmentation Outcomes for Refractory Chronic Cough with Concurrent Nonparalytic Glottic Insufficiency due to Vocal Fold Atrophy

ObjectiveDetermine the effect of temporary vocal fold augmentation on refractory chronic cough in patients with glottic insufficiency due to vocal fold atrophy. MethodsRetrospective electronic chart review was conducted for patients with a diagnosis of bilateral vocal fold atrophy and refractory chronic cough undergoing vocal fold augmentation with carboxymethylcellulose. Patients with vocal fold immobility were excluded, and cough must have been present for at minimum 8 weeks. VHI-10, CSI, and RSI scores along with subjective overall patient report of chronic cough improvement were collected. ResultsA total of 28 patients underwent 30 vocal fold augmentation procedures with carboxymethylcellulose. All had undergone extensive cough work-up and treatment trials prior to their augmentation procedure. From chart review, 13 overall subjectively reported satisfactory improvement in their cough, 5 reported partial improvement, and 7 reported no improvement in their cough. An uncertain effect on cough was documented in 5 (either patient was uncertain or no mention of cough symptom in the interval chart history note). For those subjects with both pre- and post-augmentation data, mean pre-augmentation CSI: 22.08 + 6.8 (n=13); VHI-10: 13.6 + 8.9 (n=18); RSI: 22.4 + 7.5 (n=17). Mean post-augmentation CSI was 20.7 + 9.2 (n=13); VHI-10: 15.2 + 8.2 (n=18); RSI: 21.1 + 5.8 (n=17). Mean pre-post change in CSI was -1.4 + 5.1 (p=0.175, n=13, range -10 – +6). ConclusionsVocal fold augmentation seems to provide subjective cough improvement in some patients with concurrent glottic insufficiency due to vocal fold atrophy and refractory chronic cough. It can be offered as a diagnostic trial, on which further augmentation may be offered, for patients with persistent cough despite prior work-up and treatment trials. Further controlled prospective studies are needed to identify factors that are predictive of successful cough improvement following vocal fold augmentation, as well as the effect of durable augmentation in those patients who had improvement with a diagnostic trial.

Cross-sectional and longitudinal changes in mind-wandering in older adulthood.

Age-related declines in the frequency of mind-wandering are well established. Theories of mind-wandering have attempted to explain why this decline occurs, but no one theory firmly predicts such changes. One problem with these theoretical views, and the studies that have grown out of them, is their reliance on cross-sectional methods, which do not account for within-person changes over time in mind-wandering, and it is well-documented that cross-sectional and longitudinal changes in some cognitive domains do not align. We present a novel analysis of longitudinal change in subjective and objective indicators of mind-wandering during a sustained attention task. Cognitively normal adults (N = 277, age range 42-94) completed a sustained attention task with thought probes to measure mind-wandering repeatedly over several years. Linear mixed effect models revealed baseline differences in subjective mind-wandering reports among middle-aged and older adults. However, longitudinally, middle-aged participants showed a significant increase in subjective mind-wandering, whereas older participants showed no change. Changes in mind-wandering could not be explained by attentional control ability or contemporaneous estimates of interest and perceived difficulty, but they were explained by baseline levels of conscientiousness. Objective measures of mind-wandering did not show these same patterns and were largely only associated with participants perceived difficulty. Our results build on previous cross-sectional research and suggest that incorporating longitudinal analyses into theories of ageing and mind-wandering and mind-wandering more broadly is important for refining these theories. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study.

Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.

EEG signature of near-death-like experiences during syncope-induced periods of unresponsiveness

During fainting, disconnected consciousness may emerge in the form of dream-like experiences. Characterized by extra-ordinary and mystical features, these subjective experiences have been associated to near-death-like experiences (NDEs-like). We here aim to assess brain activity during syncope-induced disconnected consciousness by means of high-density EEG monitoring. Transient loss of consciousness and unresponsiveness were induced in 27 healthy volunteers through hyperventilation, orthostasis, and Valsalva maneuvers. Upon awakening, subjects were asked to report memories, if any. The Greyson NDE scale was used to evaluate the potential phenomenological content experienced during the syncope-induced periods of unresponsiveness. EEG source reconstruction assessed cortical activations during fainting, which were regressed out with subjective reports collected upon recovery of normal consciousness. We also conducted functional connectivity, graph-theoretic and complexity analyses. High quality high-density EEG data were obtained in 22 volunteers during syncope and unresponsiveness (lasting 22±8 s). NDE-like features (Greyson NDE scale total score ≥7/32) were apparent for eight volunteers and characterized by higher activity in delta, theta and beta2 bands in temporal and frontal regions. The richness of the NDE-like content was associated with delta, theta and beta2 bands cortical current densities, in temporal, parietal and frontal lobes, including insula, right temporoparietal junction, and cingulate cortex. Our analyses also revealed a higher complexity and that networks related to delta, theta, and beta2 bands were characterized by a higher overall connectivity paralleled by a higher segregation (i.e., local efficiency) and a higher integration (i.e., global efficiency) for the NDE-like group compared to the non-NDE-like group. Fainting-induced NDE-like episodes seem to be sustained by surges of neural activity representing promising markers of disconnected consciousness.

Diagnostic accuracy of large language models in psychiatry

IntroductionMedical decision-making is crucial for effective treatment, especially in psychiatry where diagnosis often relies on subjective patient reports and a lack of high-specificity symptoms. Artificial intelligence (AI), particularly Large Language Models (LLMs) like GPT, has emerged as a promising tool to enhance diagnostic accuracy in psychiatry. This comparative study explores the diagnostic capabilities of several AI models, including Aya, GPT-3.5, GPT-4, GPT-3.5 clinical assistant (CA), Nemotron, and Nemotron CA, using clinical cases from the DSM-5. MethodsWe curated 20 clinical cases from the DSM-5 Clinical Cases book, covering a wide range of psychiatric diagnoses. Four advanced AI models (GPT-3.5 Turbo, GPT-4, Aya, Nemotron) were tested using prompts to elicit detailed diagnoses and reasoning. The models' performances were evaluated based on accuracy and quality of reasoning, with additional analysis using the Retrieval Augmented Generation (RAG) methodology for models accessing the DSM-5 text. ResultsThe AI models showed varied diagnostic accuracy, with GPT-3.5 and GPT-4 performing notably better than Aya and Nemotron in terms of both accuracy and reasoning quality. While models struggled with specific disorders such as cyclothymic and disruptive mood dysregulation disorders, others excelled, particularly in diagnosing psychotic and bipolar disorders. Statistical analysis highlighted significant differences in accuracy and reasoning, emphasizing the superiority of the GPT models. DiscussionThe application of AI in psychiatry offers potential improvements in diagnostic accuracy. The superior performance of the GPT models can be attributed to their advanced natural language processing capabilities and extensive training on diverse text data, enabling more effective interpretation of psychiatric language. However, models like Aya and Nemotron showed limitations in reasoning, indicating a need for further refinement in their training and application. ConclusionAI holds significant promise for enhancing psychiatric diagnostics, with certain models demonstrating high potential in interpreting complex clinical descriptions accurately. Future research should focus on expanding the dataset and integrating multimodal data to further enhance the diagnostic capabilities of AI in psychiatry.