Intrusive Thoughts Research Articles

Intrusive thoughts and memories in adolescents with major depressive disorder or post-traumatic stress disorder.

Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD. Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts. Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group. Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.

Intrusive Thoughts and Images in Health Anxiety: Rates, Characteristics, and Responses

ABSTRACTObjectivesIntrusive thoughts and images in Health Anxiety are poorly understood. The current study aims to explore the rates and nature of health‐related intrusive thoughts and images in people with and without Health Anxiety.DesignWe used a cross‐sectional interview and survey design recruiting 82 participants (Health Anxiety: n = 37; control: n = 45).MethodsParticipants completed a diagnostic and clinical interview, and questionnaires to assess experiences and appraisals of intrusive thoughts and images about health.ResultsExperiencing an intrusive thought or image was common in both groups (Health Anxiety: 89.2%, control: 55.6%). However, the Health Anxiety group reported their intrusive thoughts as more frequent, more distressing, and associated them with more negative emotions than controls. Further, the Health Anxiety group had increased negative appraisals and specific maladaptive behaviours for both intrusive thoughts and intrusive images compared to controls.ConclusionsWe conclude that, relative to controls, individuals with Health Anxiety experience intrusive thoughts and images more intensely and negatively, have more dysfunctional appraisals of them, and are more likely to respond to them with specific maladaptive behaviours. As such, addressing intrusive thoughts and images as part of cognitive behavioural interventions for Health Anxiety is warranted.

Acute Self-Harm Ideation as Presenting Adverse Event Associated with Adalimumab Treatment of Severe Scalp Psoriasis

We present a case of a 34-year-old woman with severe scalp psoriasis who developed acute self-harm ideations and major depressive symptoms shortly after initiating adalimumab treatment. The patient had a history of major depressive disorder, post-traumatic stress disorder, and anxiety, all well-controlled with multiple medications. Following the administration of adalimumab, she experienced intrusive thoughts of self-harm and exacerbation of depressive symptoms, prompting immediate discontinuation of the drug. The patient's symptoms resolved completely three weeks after discontinuation. This case highlights the potential psychiatric risks associated with adalimumab therapy for psoriasis, especially in patients with preexisting mental health conditions. Dermatologists should carefully evaluate patients for psychiatric disorders and suicide risk factors before initiating treatment and be vigilant in monitoring for adverse psychiatric events during therapy. Proper counseling and prompt identification of adverse events are crucial to prevent serious outcomes.

4.Y.1. Climate trauma, public protest and the ethics of civil disobedience in our warming world

Abstract Eco-anxiety, defined as “a chronic fear of environmental dooms,” is related to both a direct experience of extreme weather events (e.g., floods, wildfires, hurricanes, droughts) as well as environmental changes. Although it is not yet being addressed as a proper disease, eco-anxiety is being related to symptoms such as obsessive thoughts about the climate and the total destruction of the planet, existential fear and feelings of guilt about one’s own carbon footprint, anger, frustration, depression, and anxiety, among others. Eco-anxiety is increasingly reported among children and young people (Hickman et al, Lancet Planetary Health, 2021). Less studied and understood is climate trauma at a societal level resulting from the ever-present, ever-growing threat of climate change.This session aims to facilitate a better understanding of the mechanisms that lead to this symptomatology as well as the reasons for our apparent collective paralysis as a society to act in accordance with the climate threats we face. This analysis will take into account aspects linked to cultural diversity and structural factors that can rationalise the inaction. Particularly following the COVID-19 pandemic, many states have introduced or strengthened laws restricting the right to protest, with implications for public protest about state inaction on climate change. The workshop also aims to address questions such as: Are public protest and civil disobedience rational responses to the climate crisis? Should health professionals protest publicly? How has eco-anxiety been used as a legal defence to criminal charges? How should professional accreditation bodies respond when a member is convicted in a climate protest? Is deregistration appropriate, or should we instead be hastening to revise professional codes of ethics and public health training curriculums to reflect ‘the single biggest threat facing humanity’? (WHO, 2021). In the United Kingdom, the UK Health Alliance on Climate Change has urged the General Medical Council ‘to be as lenient as the law allows’ with health professionals convicted of offences resulting from their protests against damage to nature, the climate, and health. Three expert panellists in mental health, law and ethics will present their perspectives in Pecha Kucha format. Key messages • Climate trauma at societal level may account for our collective paralysis in the face of climate change: yet political, structural and cultural factors must not be overlooked. • Ethical codes and training curriculums for public health professionals must be updated to reflect the evolving roles of PHP in response to climate change. Speakers/Panelists Jutta Lindert Hochschule Emden-Leer, Emden, Germany David Patterson University of Groningen, Groningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards Heath, UK

Effective deep brain stimulation for obsessive-compulsive disorder after failed anterior capsulotomy: illustrative cases.

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to relieve distress related to the obsessions. For patients with severe illness refractory to first-line pharmacotherapy and psychotherapy, neurosurgical treatments such as deep brain stimulation (DBS) and stereotactic lesioning are an option. The choice between DBS and lesioning is often driven by patient preference, but these options are not mutually exclusive. Here, the authors highlight the success of one surgical therapy (DBS) after the failure of another (lesioning). Two patients with severe, treatment-refractory OCD underwent DBS lead implantation targeting the ventral capsule/ventral striatum after they did not attain any worthwhile benefit from a previous anterior capsulotomy. Both patients showed significant improvement (≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale [YBOCS] score) of their OCD symptoms at the long-term follow-up after DBS. One patient experienced a 37% reduction in symptom severity as measured by the YBOCS, and the other patient experienced a 47% reduction. DBS and lesioning procedures are both effective surgical options for patients with intractable OCD. In these cases, the authors demonstrate that DBS can be utilized even after a lesioning procedure in nominally the same target (ventral portion of the anterior limb of the internal capsule). https://thejns.org/doi/10.3171/CASE24289.

Consuming 'God Juice': Using 'ethnopharmacological-connoisseurship' to situate trenbolone use and knowledge among image and performance enhancing drug communities.

Trenbolone, a potent anabolic-androgenic steroid (AAS), is used for its muscle growth benefits but poses significant health risks, including psychosocial issues. Existing research among humans is limited by lack of targeted investigation. This study addresses gaps in existing research by leveraging the ethnopharmacological expertise of trenbolone consumers. By engaging with the community's connoisseurship, we sought to enhance harm reduction strategies and foster collaboration between consumers, scholars and health practitioners. An international sample of trenbolone consumers (N = 30) were interviewed. Interviews explored trenbolone use, knowledge levels and harm reduction strategies. Analysis involved an iterative categorisation approach, incorporating the lead author's lived experience with trenbolone. Participants described trenbolone as both a physical enhancer and a source of psychological boosts, tempered by adverse effects such as emotional volatility and intrusive thoughts. Despite warnings about its dangers the drug's allure was amplified by social media and community visibility. Consumers spoke of a developing connoisseur-like knowledge about trenbolone through personal and shared experiences. Through this collective expertise, they developed harm reduction strategies such as conservative dosing and regular health monitoring. This study demonstrates the importance of integrating ethnopharmacological-connoisseurship from the image and performance enhancing drug community to develop a contextually relevant understanding of AAS use-trenbolone being one of these. By elevating community insights, we advocate for a collaborative approach to harm reduction. Ultimately, we call for partnerships between researchers, health professionals and consumers to enhance health and reduce harm in image and performance enhancing drug communities.

Mind wandering about the beloved: self-reported distraction, task performance, and enjoyment.

Romantic love is associated with mind wandering about the beloved. We tested associations between mind wandering about the beloved and infatuation, attachment, self-reported distraction, task performance, and enjoyment. Participants who were in love completed self-report measures and a sustained attention response task with thought probes. Participants reported thinking about their beloved for 67% of the time in general and up to 42% of the time during task performance. Thinking about the beloved in general was positively associated with infatuation (passionate love) but not with attachment (companionate love). The more time participants reported thinking about their beloved in general, the more distracting they found it and the less they could withhold a response to no go stimuli. The more participants thought about their beloved during the task, the slower their responses to go stimuli were. In contrast to the negative terminology typically used to describe frequent thoughts about the beloved, such as intrusive or obsessive thinking, participants overwhelmingly enjoyed thinking about their beloved. The findings suggest that romantic love impairs cognitive task performance because people are thinking about their beloved instead, which may negatively impact performance at school and work. Nevertheless, people seem to greatly enjoy thinking about their beloved.

ASD or OCD? An evidence‐based differentiation of repetitive behaviors

While distinct diagnoses, the behavioral presentation of ritualistic/repetitive behaviors seen in obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) can present similarly. This results in difficulty with accurate diagnosis and implementation of evidence‐based treatments. OCD is characterized by prolonged and recurrent unwanted thoughts, known as obsessions, which cause a feeling of intense anxiety or distress. As a result, people with OCD perform repetitive behaviors known as compulsions to help alleviate distress. ASD is characterized as a developmental disorder causing persistent challenges associated with social communication, restricted and repetitive behaviors (RRB), and impairment in functioning. While the definitions are distinct, accurate conceptualization is not always clear. The picture can become even more complex with comorbidities. To parse these behaviors apart, we can consider the course of the behavior and assess the function. With better ability to differentiate, we can have a clearer picture of how to support the youth and family.

Behavioral addictions and psychosis

M.K* is a 27-year-old, single, unemployed male that was driven to the Emergency Department by his foster father, four weeks ago with first episode of psychiatric symptoms of tactile hallucinations, auditory hallucinations of male and female voices making inappropriate sexual comments about him, persecutory delusions and delusions of control for the past five days. M.K is a daily cannabis user of 0.5-1g use for the past 2 years and has 5.5 pack year smoking history. M.K also reports having a pornography and masturbation addiction for 2 years with marked intrusive thoughts of sexual nature the past week. M.K has no medical or psychiatric history. Recent stressor was moving out of foster father’s house 8 days ago. The symptoms led to significant impact at work which he has quit since then. On presentation, M. K showed partial insight into his third person running commentary hallucinations but believed adamantly that he was being watched, followed and controlled. He reported hearing his female neighbour stating that he has sexual interest in animals and later heard his manager making pedophilic allegations on him. M.K was so distressed, he quit work and isolated himself in his room. He reported poor concentration and lack of appetite for the past week. M.K describes his baseline mood to have “always been not the greatest” and denied anhedonia, fatigue, or sleep changes. He denied thoughts of self- harm, harm to others or suicidal ideation. Four weeks following inpatient, referral to HBCT and cannabis abstinence has shown improvement in psychiatric symptoms with absence of hallucinations, however, there has been increased symptoms of anxiety with “panic attacks”. M.K’s biological mother is reported to have history of substance misuse and sister with depressive symptoms. He continues to withdraw from society with increased time spent indoors gaming and shows emotional dependence on foster father.

Obsessive-compulsive disorder with compulsive exercise leading to intensive care treatment in an adolescent male: a case report.

Obsessive-compulsive disorder (OCD) and eating disorders (ED) are compulsive disorders with overlapping symptoms. However, weight loss and over-exercise causing secondary medical complications are rarely seen in OCD. We report the case of a 15-year-old male who presented with atypical symptoms of OCD leading to severe medical compromise. Covid-19 related team sport restrictions led to compulsive exercise associated with intrusive thoughts. The onset of stress fractures limited exercise ability,prompting compensatory food restriction. Bradycardia, hypothermia and hypoglycaemia resulted from severe malnourishment and weight loss in the context of OCD. His weight was 85.8% of ideal body weight on admission, reflective of a weight 10-15 kg lower than his premorbid weight. During admission, he developed exercise-induced rhabdomyolysis with significantly elevated creatinine kinase and required intensive care unit treatment. Psychotropic medication included lamotrigine, olanzapine and high dose fluoxetine alongside cognitive-behavioural therapy. Medical stabilisation and weight restoration allowed discharge to an outpatient Child and Adolescent Mental Health Service. This atypical case of OCD highlights the potentially life-threatening risks associated with excessive exercise and malnutrition. This paper highlights the complexities of treatment in a patient who cannot adhere to bed rest and the differential diagnoses of anorexia nervosa, orthorexia nervosa and exercise addiction.

Sociodemographic, mental health, education, employment and income characteristics of adults with obsessive–compulsive disorder who accessed secondary health services in Aotearoa | New Zealand

ABSTRACT Little is known about New Zealanders who experience obsessive–compulsive disorder (OCD). Using population-level data for people aged 18–64 years, we identified a cohort of 5559 people who accessed secondary health services and had a diagnosis of OCD. We explored their characteristics in comparison to people without OCD. The rate of OCD per 10,000 people differed by ethnicity (European, 24.7; Māori, 13.4; Pacific Peoples, 5.6; Asian, 5.9). We observed variation in OCD rates by the geographic divisions of the public healthcare provider Health NZ which persisted following standardisation for age, sex, ethnicity and urban vs rural residence (Northern, 14.5; 95% confidence interval (CI) 13.7–15.2; Te Manawa Taki, 10.9; CI 10.0–11.8; Central, 19.7, CI 18.5–20.8; Te Waipounamu, 27.4, CI 26.2–28.7). These disparities suggest inequity of access to healthcare. Individuals in this cohort typically had at least one co-occurring mental health or related condition (78.8%) and were less likely to have at least level 4 educational qualifications (equivalent to first year of an undergraduate degree) (adjusted rate ratio (ARR) 0.94; CI 0.90–0.97), to be employed (ARR 0.69; CI 0.66–0.72) and to belong to a higher income bracket ($40,000 or higher, ARR 0.57; CI 0.53–0.62). These findings suggest wider support needs. What we already know Obsessive–compulsive disorder (OCD) is a mental health condition that is characterised by repetitive intrusive thoughts and compulsive behaviours and has a twelve-month prevalence of around 1–2% in adults. In clinic-based studies, most individuals with OCD have other mental health and related conditions and, to a lesser degree, this is also observed in community surveys. OCD is typically first experienced as a child, adolescent or young adult and can severely impact an individual’s ability to engage in education and employment. What this article adds Using the Integrated Data Infrastructure (IDI), a national collection of linked health and non-health data, we explored the characteristics of working-age adults with OCD who had accessed public secondary health services in Aotearoa | New Zealand (NZ). There were marked differences in the rates of OCD for geographic areas corresponding to the regional divisions of Health NZ | Te Whatu Ora, and, as previously described, by ethnicity. These findings suggest inequity of access to healthcare and merit further investigation. In comparison to other working-age adults, people in the study cohort were moderately less likely to have achieved higher level educational qualifications, and they were markedly less likely to be employed and to belong to a higher income bracket. Accessing public secondary health services is likely to be a proxy for more severe and/or complex psychological disability and many people in this cohort had other mental health and related conditions. Therefore, the characteristics of this cohort cannot be generalised to the entire group of people who experience OCD in NZ.

The impact of trauma core dimensions on anxiety and depression: a latent regression model through the Post-Traumatic Symptom Questionnaire (PTSQ)

Adverse life events (e.g., severe accidents, violence/abuse, organic disorders) can elicit traumatic responses characterized by intrusive thoughts, hyperarousal, and avoidance—highlighting the need for sound assessment tools. Also, these traumatic components could heighten anxiety and depression symptoms. This study aims included to: (1) assessing the psychometric properties of the Post-Traumatic Symptom Questionnaire (PTSQ) and delineating clinical cut-offs; (2) investigating how distinct trauma components contribute to anxiety and depression symptoms. Involving 761 participants who experienced a traumatic event, Part I tested the PTSQ psychometric properties, defining clinical cut-offs. Part II tested the impact of traumatic components on anxiety and depression symptoms, using a multiple multivariate latent regression model. PTSQ exhibited exemplary fit indices and robust psychometric properties. Clinically relevant cut-offs were identified. The differential contributions of intrusion, avoidance, and hyperarousal to anxiety and depression symptoms were evaluated, elucidating the strength and nature of these relationships. This study reaffirms the PTSQ as a psychometrically sound and reliable instrument. It underscores the effects of intrusion, avoidance, and hyperarousal on anxiety and depression symptoms in individuals with traumatic experiences. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with trauma components, fostering adaptation and supporting psychological health.

A network analysis of affective and motivational individual differences and error monitoring in a non-clinical sample.

Error monitoring, which plays a crucial role in shaping adaptive behavior, is influenced by a complex interplay of affective and motivational factors. Understanding these associations often proves challenging due to the intricate nature of these variables. With the aim of addressing previous inconsistencies and methodological gaps, in this study, we utilized network analysis to investigate the relationship between affective and motivational individual differences and error monitoring. We employed six Gaussian Graphical Models on a non-clinical population ($N$ = 236) to examine the conditional dependence between the amplitude of response-related potentials (error-related negativity; correct-related negativity) and 29 self-report measures related to anxiety, depression, obsessive thoughts, compulsive behavior, and motivation while adjusting for covariates: age, handedness, and latency of error-related negativity and correct-related negativity. We then validated our results on an independent sample of 107 participants. Our findings revealed unique associations between error-related negativity amplitudes and specific traits. Notably, more pronounced error-related negativity amplitudes were associated with increased rumination and obsessing, and decreased reward sensitivity. Importantly, in our non-clinical sample, error-related negativity was not directly associated with trait anxiety. These results underscore the nuanced effects of affective and motivational traits on error processing in healthy population.

Examining relationships among NODDI indices of white matter structure in prefrontal cortical-thalamic-striatal circuitry and OCD symptomatology

Obsessive-compulsive disorder is a psychiatric disorder characterized by intrusive thoughts and repetitive behaviors. There are two prominent features: Harm Avoidance (HA) and Incompleteness (INC). Previous resting-state studies reported abnormally elevated connectivity between prefrontal cortical (PFC) and subcortical regions (thalamus, striatum) in OCD participants. Yet, little is known about the white matter (WM) structural abnormalities in these connections. Using brain parcellation and segmentation, whole brain tractography, and Neurite Orientation Dispersion and Density Imaging (NODDI), we aimed to characterize WM structural abnormalities in OCD vs. healthy controls and determine the extent to which NODDI indices of these connections were associated with subthreshold-threshold HA, INC and overall OCD symptom severity across all participants. Four PFC regions were segmented: ventral medial (vmPFC), ventrolateral (vlPFC), dorsomedial (dmPFC), and dorsolateral (dlPFC). NODDI Neurite Density (NDI) and Orientation Dispersion (ODI) indices of WM structure were extracted from connections between these PFC regions and the thalamus (42 OCD, 44 healthy controls, mean age[SD] = 23.65[4.25]y, 63.9% female) and striatum (38 OCD, 41 healthy controls, mean age[SD] = 23.59[4.27]y, 64.5% female). Multivariate analyses of covariance revealed no between-group differences in these indices. Multivariate regression models revealed that greater NDI in vmPFC-thalamus, greater NDI and ODI in vmPFC-striatum, and greater NDI in dmPFC-thalamus connections were associated with greater INC severity (Q ≤ 0.032). These findings highlight the utility of NODDI in the examination of WM structure in OCD, provide valuable insights into specific WM alterations underlying dimensional INC, and can facilitate the development of customized treatments for OCD individuals with treatment-resistant symptoms.

Trauma reactivation 50 years later: Yom Kippur war veterans after the October 7 attack

Fifty years after the Yom Kippur War began with a surprise attack, the October 7 terror attack caught Israelis off guard in yet another surprise attack. The current study assessed the extent to which Yom Kippur War veterans thought about the linkage between the two wars, and whether such thoughts were associated with trauma reactivation and exacerbation of distress. A web-based random sample of 297 Yom Kippur War veterans (age range 68–88) completed questionnaires five months before (T1) and two months after the October 7 attack (T2). The results showed an increase in probable posttraumatic stress disorder (PTSD) rates due to the Yom Kippur War, rising from 5.4 % in T1 to 13.1 % in T2. Rates of clinical depression and anxiety also rose. The study found that a significant number of veterans experienced intrusive thoughts linking the two wars. These intrusive thoughts increased the risk for probable PTSD and clinical levels of depression and anxiety, even after accounting for pre-attack symptoms. The study is among the first to show that intrusive linkage is quite frequent among older veterans who confronted another event that resonates with their focal trauma. Supporting the stress resolution perspective, this linkage increased the risk for trauma reactivation.

Physiological, behavioral, and self-report outcomes of acceptance- and regulation-based exposure for intrusive thoughts

Leading theories regarding the mechanisms of exposure for OCD focus on Pavlovian fear reduction more than operant processes. Acceptance-based exposure directly targets operant behavior. Integrating these perspectives could lead to a more robust understanding of mechanisms of change in exposure and more effective and enduring treatments. The current study investigated acceptance and regulation of distress during exposure. Participants with intrusive thoughts were randomized into three groups, Acceptance (n = 23), Regulation (n = 20), and Control (n = 21), and completed two behavioral avoidance tests (BATs) 1 week apart. Active conditions completed a 30-min exposure plus 6 days of 10-min exposures at home; Control participants watched videos of the same durations. Self-report measures were collected at both sessions, and behavioral, subjective, and physiological repeated measures data were collected during both BATs. Compared to Control, active conditions decreased OCD symptom severity, rituals, and skin conductance levels, while Acceptance showed lower skin conductance levels than Regulation and Control. Acceptance showed greater willingness and psychological flexibility than Control, while Regulation did not. Results support theorized mechanisms of change in acceptance-based exposure and suggest willingness to experience distress may paradoxically lead to decreased physiological arousal, which has important implications for treatment and future research.

Understanding Intensive Care Unit Family Caregivers' Vulnerability to Post-Traumatic Stress Disorder: The Impact of Neurotic Personality Traits, Emotional Suppression, and Perceptions of Unexpected Death.

Rationale: Family members of patients who die in an intensive care unit (ICU) are at heightened risk of post-traumatic stress disorder (PTSD) symptoms. Not all surrogates develop these symptoms and heterogeneity exists in PTSD symptom clusters. Objectives: The study tested a personality model of PTSD symptoms in bereaved family caregivers of ICU patients. It was hypothesized that family members endorsing higher levels of neurotic personality traits would report higher levels of PTSD symptom clusters and that these associations would be explained by tendencies to view the patient's death as unexpected and to cope by suppressing their emotions. Methods: Participants were family members of ICU patients at an urban, academic medical center who either died or were discharged to an inpatient hospice unit. Participants were contacted for participation at least six months after the patient's death. Participants completed measures of personality, emotion regulation, and PTSD symptoms. Data were analyzed using path analysis. Results: Approximately one-third (35%) of the sample of 162 caregivers endorsed at-risk levels of PTSD. Individuals reporting higher levels of neurotic personality traits reported more PTSD symptoms (r = 0.53, p < 0.001). Perceptions that the patient death was unexpected partially explained the association of neuroticism with the intrusive re-experiencing PTSD symptoms (B = 0.45, p = 0.031). In contrast, emotional suppression partially explained the association of neuroticism with avoidance (B = 0.70, p = 0.010) and hyperarousal symptom clusters (B = 0.37, p = 0.041). Conclusions: Family vulnerability to PTSD after an ICU death can be conceptualized based on neurotic personality traits. Tendencies to view the patient's death as unexpected may contribute to intrusive thoughts and memories of the ICU experience. Individuals may avoid reminders and remain at heightened levels of arousal when they suppress their emotional experiences. Key Message: Family members who experience the death of a loved one following ICU treatment are vulnerable to PTSD symptoms. These reactions to ICU-related losses may be shaped by family members' personalities, expectations, and emotion regulation styles. Understanding these characteristics could inform family screening and intervention efforts in the ICU.

Suppressing the Maintenance of Information in Working Memory Alters Long-term Memory Traces.

The sensory recruitment hypothesis conceptualizes information in working memory as being activated representations of information in long-term memory. Accordingly, changes made to an item in working memory would be expected to influence its subsequent retention. Here, we tested the hypothesis that suppressing information from working memory, which can reduce short-term access to that information, may also alter its long-term neural representation. We obtained fMRI data (n = 25; 13 female / 12 male participants) while participants completed a working memory removal task with scene images as stimuli, followed by a final surprise recognition test of the examined items. We applied a multivariate pattern analysis to the data to quantify the engagement of suppression on each trial, to track the contents of working memory during suppression, and to assess representational changes afterward. Our analysis confirms previous reports that suppression of information in working memory involves focused attention to target and remove unwanted information. Furthermore, our findings provide new evidence that even a single dose of suppression of an item in working memory can (if engaged with sufficient strength) produce lasting changes in its neural representation, particularly weakening the unique, item-specific features, which leads to forgetting. Our study sheds light on the underlying mechanisms that contribute to the suppression of unwanted thoughts and highlights the dynamic interplay between working memory and long-term memory.

Paying attention to uncertainty: A stochastic multimodal transformers for post-traumatic stress disorder detection using video

Background and Objectives:Post-traumatic stress disorder is a debilitating psychological condition that can manifest following exposure to traumatic events. It affects individuals from diverse backgrounds and is associated with various symptoms, including intrusive thoughts, nightmares, hyperarousal, and avoidance behaviors. Methods:To address this challenge this study proposes a decision support system powered by a novel multimodal deep learning approach, based on a stochastic Transformer and video data. This Transformer has the ability to take advantage of its stochastic activation function and layers that allow it to learn sparse representations of the inputs. The method leverages a combination of low-level features extracted using three modalities, including Mel-frequency cepstral coefficients extracted from audio recordings, Facial Action Units captured from facial expressions, and textual data obtained from the audio transcription. By considering these modalities, our proposed model captures a comprehensive range of information related to post-traumatic stress disorder symptoms, including vocal cues, facial expressions, and linguistic content. Results:The deep learning model was trained and evaluated on the eDAIC dataset, which consists of clinical interviews with individuals with and without post-traumatic disorder. The model achieved state-of-the-art results, demonstrating its effectiveness in accurately detecting PTSD, showing an impressive Root Mean Square Error of 1.98, and a Concordance Correlation Coefficient of 0.722, signifying the model’s superior performance compared to existing approaches. Conclusion:This work introduces a new method for post-traumatic stress disorder detection from videos by utilizing a multimodal stochastic Transformer model. The model makes use of a variety of modalities, such as text, audio, and visual data, to gather comprehensive and varied information in order to make the detection.

Obsessive-compulsive disorder as a first manifestation of Ataxia with Oculomotor Apraxia type 2 due to a novel mutation of SETX gene.

Ataxia with oculomotor apraxia type 2 (AOA2) is an autosomal recessive disorder presenting with cerebellar ataxia, sensory-motor axonal neuropathy, oculomotor apraxia, cerebellar atrophy and high alpha-fetoprotein (AFP) serum level. AOA2 is due to coding mutations of the SETX gene, mapped to chromosome 9q34. Seldom noncoding mutations affecting RNA processing have been reported too. To date psychiatric symptoms have never been reported in AOA2. A 19 years-old man came to our attention for progressive gait ataxia debuted five years earlier. His past medical history was unremarkable, while his parents were consanguineous. On neurological examination, he had bilateral horizontal gaze-evoked nystagmus with hypometric saccades and saccadic horizontal smooth pursuit, appendicular ataxia, limbs and trunk myoclonic involuntary movements with hands' dystonic postures and dance of the tendons. Psychological evaluation described intrusive and obsessive thoughts experienced by the patient, then diagnosed as obsessive-compulsive disorder. Blood tests detected an elevated AFP level. Brain MRI showed cerebellar atrophy, while electroneuromyography revealed an axonal sensory-motor polyneuropathy. In the suspicion of a pathology belonging to the autosomal recessive cerebellar ataxias (ARCA) spectrum disorder, a direct search of point mutations by whole-exome sequencing was performed revealing a novel biallelic variant in SETX gene (c.6208+2dupT), which was classified as likely pathogenic. The present case expands the genotypic and phenotypic spectrum of AOA2, reporting a novel likely pathogenic SETX mutation (c.6208+2dupT) and highlighting an early psychiatric involvement in AOA2, suggesting the need for psychiatric assessment in these neurologic patients.