Stress and selective attention : the impact of a stressful challenge on mood, cortisol, and the processing of emotional information

The studies presented in this thesis were designed to examine the unfolding of events when an individual is faced with a stressful challenge, by monitoring subjective mood, attention to emotional stimuli, and the hypothalamic-pituitary-adrenal (HPA) response to stress. It was hypothesized that participants would selectively attend to negative words (study 1) and pictures (study 2) following an aversive stressful experience, and that the attentional response to stress would mediate mood and HPA reactivity. Stress induction was achieved by means of a competitive Stroop task with monetary rewards where participants either repeatedly lost (negative stressor) or won (positive stressor) against a confederate. Participants then performed a spatial cueing task assessing attentional shifts towards and away from emotional and neutral stimuli. The results of these studies can be summarized by three major findings. Contrary to predictions, participants selectively avoided negatively-valenced pictures and words. This attentional avoidance response was associated with effective emotional and HPA regulation, suggesting that avoidance in this context may be adaptive as a coping response to stress. Second, stress-induced changes in processing efficiency or alertness, resulting in a wide-scope and flexible attentional style, were also observed, and this too may facilitate adaptive coping. Finally, participants with mild symptoms of depression and anxiety exhibited different patterns of response to stress than euthymic subjects, several characteristics of which may indicate a vulnerability to psychopathology. In effect, the results of these studies provide a possible model of how healthy participants cope with mild stress, and point to an attentional mechanism of emotion regulation that facilitates the maintenance of goal-directed behaviour

Why Should We Care About CARE-HF?

Previous trials of cardiac resynchronization therapy (CRT) have suggested that this therapy can significantly improve functional class and exercise capacity during short-term follow-up. The impact of this therapy on morbidity and mortality has only recently been reported. The Cardiac Resynchronization-Heart Failure (CARE-HF) study has definitively shown that CRT significantly reduces mortality (36%, p < 0.002) in patients with NYHA functional class III and IV heart failure and ventricular dyssynchrony. This study also shows that CRT reverses ventricular remodeling and improves myocardial performance progressively for at least 18 months. In heart failure patients, the CARE-HF and Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) (the earlier major morbidity/mortality trial) studies together show the unequivocal benefit for CRT therapy and CRT therapy with back-up defibrillation to significantly reduce mortality and hospitalization compared with optimal medical therapy. Both studies suggest the benefit of adding the implantable cardiac defibrillator to CRT devices, as over one-third of deaths in the CRT-pacemaker arm of both the COMPANION and CARE-HF studies were sudden

A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners

Background: Individuals with bipolar disorder (BD) often possess maladaptive traits and present with various difficulties in psychosocial functioning. However, little is known about the intimate partners of adults with bipolar disorder (BD) and how mental illnesses other than BD within couples may further complicate the picture. Such knowledge is needed to inform both couple and family interventions. Methods: Participants were parents whose children were enrolled in a prospective study: 55 with BD and their partners, and 47 healthy control couples. All completed diagnostic interviews, and questionnaires describing personality traits, negative life events, coping skills, social support, marital adjustment and inter-partner verbal aggression. Parents with BD and healthy control parents were compared, as were the intimate partners. A series of exploratory analyses focused on the average measures within couples, with and without BD, and took account of comorbid personality disorders among those with BD and major depressive disorder among their partners. Results: Intimate partners of adults with BD, relative to healthy control partners, presented with more mental disorders, higher neuroticism, lower extraversion, more emotion-focused coping, smaller social networks, less satisfaction with their social networks, and little, satisfying social contact. Additionally, they reported less consensus and satisfaction in their marital relationships, and engaged in more verbal aggression towards their partners. Participants with BD showed similar, more extreme, characteristics. Marital distress and verbal aggression were greatest among couples with an adult having BD and a comorbid personality disorder or a partner with major depressive disorder. Conclusion: This study contributes to the literature by demonstrating that both parents with BD and their intimate partners exhibit high levels of mental illness, maladaptive personality traits and psychosocial difficulties, thus limiting their partners’ ability to provide support and stability in the these high risk families. Moreover, mental illnesses other than BD may contribute to marital problems within couples. Some statistical analyses, particularly those involving comorbid conditions, were under-powered in this study. As clinical implications, the current study suggests that both individuals with BD and their partners could benefit from interventions aimed at lowering emotionality and verbal aggression, and increasing social support and effective coping skills

Predicting Interpersonal Outcomes From Information Processing Tasks Using Personally Relevant and Generic Stimuli: A Methodology Study

Despite evidence of differential processing of personally relevant stimuli (PR), most studies investigating attentional biases in processing emotional content use generic stimuli. We sought to examine differences in the processing of PR, relative to generic, stimuli across information processing tasks and to validate their use in predicting concurrent interpersonal functioning. Fifty participants (25 female) viewed generic and PR (i.e., their intimate partner’s face) emotional stimuli during tasks assessing selective attention (using a modified version of the Spatial Cueing Task) and inhibition (using the Negative Affective Priming task) of emotional content. Ratings of relationship quality were also collected. Evidence of increased selective attention during controlled and greater avoidance during automatic stages of processing emerged when viewing PR, relative to generic, emotional faces. We also found greater inhibition of PR sad faces. Finally, male, but not female, participants who displayed greater difficulty disengaging from the sad face of their partner reported more conflict in their relationships. Taken together, findings from information processing studies using generic emotional stimuli may not be representative of how we process PR stimuli in naturalistic settings

Acute Intranasal Oxytocin Improves Positive Self-Perceptions of Personality

Research suggests the experimental manipulation of oxytocin facilitates positive interactions, cooperation and trust. The mechanism by which oxytocin influences social behavior is not well understood. We explored the hypothesis that oxytocin alters how people perceive themselves, which could be one mechanism by which oxytocin promotes prosocial behavior. In a between-subject, randomized, and double-blind experiment, 100 university students received a 24 I.U. dose of intranasal oxytocin or placebo, and then completed the Revised NEO Personality Inventory (NEO-PI-R) and other self-report measures 90 minutes later. Intranasal oxytocin increased ratings of NEO-PI-R extraversion and openness to experiences (F(1,98) = 4.910, p = .025, partial η2 = .05; F(1,98) = 6.021, p = .016, partial η2 = .06), particularly for the following facets: positive emotions (d = 0.48, p < .05), warmth (d = 0.47, p < .05), openness to values (d = 0.45, p < .05) and ideas (d = 0.40, p < .05), trust (d = 0.44, p < .05) and altruism (d = 0.40, p < .05). Oxytocin had no influence on ratings of negative emotionality, conscientiousness, rejection sensitivity, depression, worry, self-esteem, and perceived social support. The administration of oxytocin improved participants’ self-perceptions of their personality, at least for certain traits important for social affiliation. Increased positive self-referential processing may be one mechanism by which oxytocin promotes positive social behaviors

Depressive symptoms and social context modulate oxytocin’s effect on negative memory recall

Oxytocin promotes social affiliation across various species, in part by altering social cognition to facilitate approach behaviour. However, the effects of intranasal oxytocin on human social cognition are mixed, perhaps because its effects are context-dependent and subject to inter-individual differences. Few studies have included explicit manipulations of social context to test this supposition. We examined oxytocin’s effects on autobiographical memory recall in two contexts, with and without social contact, and evaluated whether these effects were moderated by depressive symptoms. Two non-clinical samples (Study 1 N = 48; Study 2 N = 63) completed randomised, placebo-controlled, within-subject experiments. We assessed autobiographical memory recall across two sessions (intranasal oxytocin or placebo) and two contexts (memories elicited by an experimenter or by computer). Overall, intranasal oxytocin increased ratings of vividness of recalled memories during the social context only. Individuals with elevated depressive symptoms also recalled memories that were more negative following oxytocin relative to placebo only in the non-social context across the two studies. Findings highlight the negative consequences of increasing oxytocin bioavailability in vulnerable persons in the absence of social contact. Contextual factors such as social isolation among depressed populations may complicate the clinical use of oxytocin

Quality of Life and Clinical Outcomes in Elderly Patients Treated with Ventricular Pacing as Compared with Dual-Chamber Pacing

ABSTRACT Background Standard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers are believed to be more physiologic. However, it is not known whether either type of pacemaker results in superior clinical outcomes. Methods The Pacemaker Selection in the Elderly study was a 30-month, single-blind, randomized, controlled comparison of ventricular pacing and dualchamber pacing in 407 patients 65 years of age or older in 29 centers. Patients received a dual-chamber pacemaker that had been randomly programmed to either ventricular pacing or dual-chamber pacing. The primary end point was health-related quality of life as measured by the 36-item Medical Outcomes Study Short-Form General Health Survey. Results The average age of the patients was 76 years (range, 65 to 96), and 60 percent were men. Quality of life improved significantly after pacemaker implantation (P0.001), but there were no differences between the two pacing modes in either the quality of life or prespecified clinical outcomes (including cardiovascular events or death). However, 53 patients assigned to ventricular pacing (26 percent) were crossed over to dual-chamber pacing because of symptoms related to the pacemaker syndrome. Patients with sinus-node dysfunction, but not those with atrioventricular block, had moderately better quality of life and cardiovascular functional status with dual-chamber pacing than with ventricular pacing. Trends of borderline statistical significance in clinical end points favoring dual-chamber pacing were observed in patients with sinus-node dysfunction, but not in those with atrioventricular block. Conclusions The implantation of a permanent pacemaker improves health-related quality of life. The quality-of-life benefits associated with dualchamber pacing as compared with ventricular pacing are observed principally in the subgroup of patients with sinus-node dysfunction. (N Engl J Med 1998;338:1097-104.

Ventricular pacing or dual-chamber pacing for sinus-node dysfunction

BACKGROUND Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the better outcome. METHODS We randomly assigned a total of 2010 patients with sinus-node dysfunction to dual-chamber pacing (1014 patients) or ventricular pacing (996 patients) and followed them for a median of 33.1 months. The primary end point was death from any cause or nonfatal stroke. Secondary end points included the composite of death, stroke, or hospitalization for heart failure; atrial fibrillation; heart-failure score; the pacemaker syndrome; and the quality of life. RESULTS The incidence of the primary end point did not differ significantly between the dual-chamber group (21.5 percent) and the ventricular-paced group (23.0 percent, P=0.48). In patients assigned to dual-chamber pacing, the risk of atrial fibrillation was lower (hazard ratio, 0.79; 95 percent confidence interval, 0.66 to 0.94; P=0.008), and heart-failure scores were better (P CONCLUSIONS In sinus-node dysfunction, dual-chamber pacing does not improve stroke-free survival, as compared with ventricular pacing. However, dual-chamber pacing reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life. Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing

The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale

The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in 2005. The CRT5 is designed to assist non-medically trained individuals to recognise the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention. This paper presents the development of the CRT5 and highlights the differences between the CRT5 and prior versions of the instrument