Non-problem gamblers show the same cognitive distortions while playing slot machines as problem gamblers, with no loss of control and reduced reality control, though – An experimental study on gambling

BackgroundCognitive distortions can result in maladaptive interpretations of events and maladaptive behavior. In the case of gambling, such distortions can contribute to the maintenance of the disorder. Our current research aimed to conduct an experiment to possibly detect cognitive biases characteristic of persons with gambling addiction in a non-gambling sample of the general population, and to study the effect of “big win” on cognitive distortions.MethodsA specifically designed and preprogrammed slot machine simulation was carried out, with 90 rounds split into 3 sections. During the simulation every participant verbalized their thoughts and feelings; the verbalizations were recorded. Then a content analysis was conducted to search for indications of cognitive distortions. The sample was separated into two experimental groups: one of the groups experienced the “big wins” in the first section, while the other group had them in the second section of the experiment.ResultsContent analysis revealed numerous cognitive biases. Cognitive distortions usually present in problem gambling were detected in our sample from the general population as well. However, we could not distinguish cognitive biases indicating serious loss of control, or distortion of reality control. A further finding is that early losses provoke the emergence of more cognitive distortions, while early big win leads to more intense loss-chasing in the later stages of gambling.ConclusionThe appearance of reality-checking uncertainty or loss of control can be alarming for the development of gambling. Losses and big wins can provoke different cognitive distortions, encouraging the person into further gambling behavior

Feedback-based approach in teaching medical interviewing

Educational feedback is a facilitating tool in improving medical interviewing skills through simulation practices. The simulated patient (SP) programme at the University of Pécs Medical School aims to provide efficient help for educators and students alike in language for medical purposes, communication and clinical courses. The constructivist feedback methodological approach ensures that students in history taking classes learn from role-playing in simulated scenarios and the feedback offered from the simulated patient. Effective assessment includes the learners’ own reflection and the patients’ non-judgmental observation on perceived interpersonal communication skills, observed professional misconduct, students’ ability to cope in emotionally challenging situations, and suggestions for improvement. Giving feedback has to be offered regularly to enable improvement in medical communication and nurture self-confidence. Our questionnaire survey of the students who attended history taking courses involved both self-reflection and instructor feedback based on their performance during simulated scenarios. The results of the study demonstrated substantial developments in relationship-building skills and self-confidence for students in post-course clinical practice

Új pathomechanizmusok és kezelési lehetőségek vizsgálata a vese ischémia/reperfúziós károsodásában és krónikus allograft nephropathiában = Investigation of new pathomechanisms and treatment possibilities of renal ischemia/reperfusion injury and chronic allograft nephropathy

Eredményeink az erythropoietin (EPO) védő szerepét igazolták egyoldali vese ischemia/reperfúziós (I/R) károsodásban. Ez a védő szerep elsősorban hímekben igazolható. Hátterében az EPO HSP72-mediálta hatása állhat, amellyel a Na+/K+ ATP-áz funkciójának megtartását segíti elő. Vizsgálataink során az EPO sejt-protektív hatásának hátterében egy új szignál molekulát is sikerült azonosítanunk, a szérum és glükokortikoid aktiválta kináz-1-t (SGK1). Ezek az eredmények az EPO által kifejtett sejtprotekció hátterében álló új pathomechanizmusokat írtak le. Eredményeink alapján az EPO, illetve a leírt útvonalakra ható egyéb szerek további vizsgálata és klinikai hasznosítása jöhet szóba. Másik vizsgálatunk során az I/R-s károsodás kivédésében szerepet játszó mechanizmusok során megfigyelhető nemi különbségeket írtuk le. Igazoltuk, hogy hímekben elsősorban a HIF 1α, míg nőstényekben a HSF útvonal tűnik fontosabbnak. Végül igazoltuk. hogy az SGK1 anti-apoptotikus és sejtvédő funkciójában is nemi különbségek mutathatók ki I/R-t követően. Ezekkel az eredményeinkkel magyarázhatóak az irodalomban korábban leírt és egymásnak ellentmondó közlések, amelyek a tesztoszteron SGK1 reguláló hatását mutatták be. | Our results suggest that EPO protects against severe, unilateral renal I/R injury, especially in male rats. This beneficial effect might be partly the result of EPO’s HSP72-mediated impact on Na+/K+ATPase-α1. Moreover, our data report a new signaling molecule to be involved in EPO cytoprotective actions, since we identified for the first time an important role of SGK1 in the renoprotective effect of EPO. These observations provide insights into a novel signaling mechanism by which EPO partly exerts its potent tissue protective actions. Given our results along with previous reports, the clinical use of EPO possibly leading to reduced cellular damage due to ischemic events should be considered. Our study has revealed a gender-dependent protective mechanism during renal I/R injury. In males mostly the HIF 1α, while in females the HSF is the dominant transcriptional pathway. The EPO treatment results in disappearance of the characteristic signal pathway activation in both genders. The explanation for that could be either a direct negative feedback effect on the transcription factors or an indirect renal protective effect of EPO by which these transcriptional factors do not need to be activated. We could also demonstrate that the anti-apoptotic SGK1 shows a gender-specific expression pattern after renal I/R with higher levels in male rats. These results confirm previous contradictory reports showing that SGK1 might be up-regulated and activated by testosterone

Pathology and glia type specific changes of the DPP4 activity in the spinal cord contributes to the development and maintenance of hyperalgesia and shapes opioid signalling in chronic pain states

Altered pain sensations such as hyperalgesia and allodynia are characteristic features of various chronic pain states, and remain difficult to treat. We have shown previously that spinal application of dipeptidyl peptidase 4 (DPP4) enzyme inhibitors results in a strong antihyperalgesic effect during inflammatory pain states. In this study we observed a low level of mRNA for DPP4 in the rat spinal dorsal horn in physiological conditions, which did not change significantly either in carrageenan-induced inflammatory or partial nerve ligation-generated neuropathic states. Although DPP4 protein was detected in neurons, astrocytes and microglia in naïve animals its expression significantly increased in astrocytes during inflammation and in microglia in neuropathic conditions. Intrathecal application of two DPP4 inhibitors the tripeptide isoleucin-prolin-isoleucin (IPI) and the antidiabetic drug vildagliptin resulted in robust opioid-dependent antihyperalgesic effect during inflammation and an opioid-independent effect in the Seltzer model. The opioid-mediated antihyperalgesic effect of IPI was exclusively related to mu-opioid receptors, while vildagliptin affected mainly delta-receptor activity, although mu- and kappa-receptors were also involved. Our results suggest a pathology and glia type specific changes of the DPP4 activity in the spinal cord which contributes to the development and maintenance of hyperalgesia and shapes opioid signalling

Nationwide experiences with trough levels, durability, and disease activity among inflammatory bowel disease patients following COVID-19 vaccination.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has complicated the management of inflammatory bowel diseases (IBD).This study aimed to assess the efficacy of different anti-SARS-CoV-2 vaccines under different treatments in IBD patients and identify predictive factors associated with lower serological response, including anti-tumor necrosis factor (anti-TNF) drug levels.A prospective, double-center study of IBD patients was conducted following messenger ribonucleotide acid (mRNA) and non-mRNA anti-SARS-CoV-2 vaccination.Healthy control (HC) patients were enrolled to reduce bias. Baseline and control samples were obtained 14 days after the second dose to assess the impact of conventional and biological treatments. Clinical and biochemical activity, serological response level, and anti-TNF drug levels were measured.This study included 199 IBD (mean age, 40.9 ± 12.72 years) and 77 HC participants (mean age, 50.3 ± 12.36 years). Most patients (76.9%) and all HCs received mRNA vaccines. Half of the IBD patients were on biological treatment (anti-TNF 68.7%). Biological and thiopurine combined immunomodulation and biological treatment were associated with lower serological response (p < 0.001), and mRNA vaccination promoted better antibody levels (p < 0.001). Higher adalimumab levels caused lower serological response (p = 0.006). W8 persistence of anti-SARS-CoV-2 level was equal in IBD and HC groups. Vaccination did not aggravate clinical disease activity (p = 0.65).Anti-SARS-CoV-2 vaccination is considerably efficacious in IBD patients, with mRNA vaccines promoting better antibody levels. The negative impact of combined biological treatment, especially with high adalimumab drug levels, on serological response to vaccination should be considered. Although midterm durability of vaccination is encouraging, more data are needed to expand the existing understanding on this issue

Unique, Specific CART Receptor-Independent Regulatory Mechanism of CART(55-102) Peptide in Spinal Nociceptive Transmission and Its Relation to Dipeptidyl-Peptidase 4 (DDP4)

Cocaine- and amphetamine-regulated transcript (CART) peptides are involved in several physiological and pathological processes, but their mechanism of action is unrevealed due to the lack of identified receptor(s). We provided evidence for the antihyperalgesic effect of CART(55-102) by inhibiting dipeptidyl-peptidase 4 (DPP4) in astrocytes and consequently reducing neuroinflammation in the rat spinal dorsal horn in a carrageenan-evoked inflammation model. Both naturally occurring CART(55-102) and CART(62-102) peptides are present in the spinal cord. CART(55-102) is not involved in acute nociception but regulates spinal pain transmission during peripheral inflammation. While the full-length peptide with a globular motif contributes to hyperalgesia, its N-terminal inhibits this process. Although the anti-hyperalgesic effects of CART(55-102), CART(55-76), and CART(62-76) are blocked by opioid receptor antagonists in our inflammatory models, but not in neuropathic Seltzer model, none of them bind to any opioid or G-protein coupled receptors. DPP4 interacts with Toll-like receptor 4 (TLR4) signalling in spinal astrocytes and enhances the TLR4-induced expression of interleukin-6 and tumour necrosis factor alpha contributing to inflammatory pain. Depending on the state of inflammation, CART(55-102) is processed in the spinal cord, resulting in the generation of biologically active isoleucine-proline-isoleucine (IPI) tripeptide, which inhibits DPP4, leading to significantly decreased glia-derived cytokine production and hyperalgesia

FROM A SIMULATED PATIENT INTERVIEW TO A CASE PRESENTATION

Medical communication skills are learned during undergraduate studies and residency programmes by future doctors through case presentations, medical interviews, and healthcare staff interactions. Approaches like peer tutoring, simulation-based education, and blended learning enhance these skills. Our study aims to draw attention to the significance of doctor-patient and doctor-doctor scenarios by presenting a course that facilitates sociopragmatic, pragmalinguistic, and code-switching skills that medical students need to successfully employ in future healthcare settings. We consider patient information, case presenting, and interviewing skills, as well as profound knowledge of medical language equally important elements. While highlighting the essential components of the doctor-patient discourse and revealing the students’ development of code-switching abilities, this article shares the results of a feedback survey completed by participants in a course entitled ‘History taking with actors; simulation practices in the mediskillslab’. We can see the gradual improvement in using medical terms, and the growing confidence of students presenting cases. The programme’s assessment approach, which provides constructive feedback from three perspectives—clinician, simulated patient, and communication instructor—helps the students pinpoint their areas for enhancement. Most students report no major difficulties in taking medical history by employing a simplified ‘patient-friendly’ language understandable to laypeople. However, when they intentionally choose a different code for reporting on their patients by using medical terms, younger students face challenges in creating a brief medical text. The most demanding task for senior participants proved to be delivering bad news; both emotionally and code-switch wise. Our study identifies these difficulties from history-taking simulations to case reports to raise awareness of levels of medical communication. As a conclusion, we believe that an early onset and gradual introduction of activities including history taking, case presentation, and breaking bad news should be incorporated into medical curricula to assist in the acquisition of highly professional, assertive, and empathetic communication skills by graduation

Improving Assertive Communication Skills in Simulated Medical Encounters

Assertive communication is a powerful communication skill in everyday clinical practice among staff members and in doctor-patient encounters. It has an important role in eliciting relevant information during patient interviewing, similarly, in shared decision-making or convincing patients of certain therapy options. The skills are also needed in delegating tasks or giving feedback to colleagues. Through simulated medical encounters, culturally appropriate assertive communication skills can be improved to tackle challenges in hierarchical healthcare contexts. Our comparative study analyses the results of a questionnaire survey of two simulation-based communication courses, where one explicitly aims to use assertive skills in clinical settings while the other implicitly encourages students to defend their opinions in doctor-patient scenarios. Blended-learning methods, support from clinicians and mentors in promoting self-confidence and self-esteem, constructive feedback from both simulated patients and the observers (linguists, psychologists), teamwork skills training and assertive communication techniques were applied to ensure the effectiveness of the courses. The article shares the verbal and non-verbal tools of assertive communication evaluated by the observers, and the self-evaluations of students, which focused on their own behavioural changes in terms of sense of responsibility, sense of failure and navigating between assertiveness and empathy

A mentalizáció dimenziói pszichotikus zavarokban

The clinical assessment of mentalization became one of the most important issues in clinical psychology and psychiatry. Despite extensive research efforts, the exact definition, classification, and evaluation of mentalization is unresolved, especially in psychotic disorders. The primary purpose of the present study was to investigate the factor structure of the Mentalization Questionnaire. In addition, we investigated the relationship between the dimensions of mentalization and the positive, negative, and general symptoms of psychotic disorders, as well as potential associations with antipsychotic medications. We recruited two independent samples: the first consisted of 94 individuals (schizophrenia, n=63; schizoaffective disorder, n=21; psychotic bipolar disorder, n=10), and the second included 75 patients (schizophrenia, n=60; schizoaffective disorder, n=10; psychotic bipolar disorder, n=5). Exploratory and confirmatory factor analyses revealed four dimensions in both samples: self-reflection, emotional awareness, psychic equivalence, and affective regulation. The two samples did not differ in Mentalization Questionnaire scores. The severity of negative symptoms significantly correlated with weak self-reflection. The dose of first- and second-generation antipsychotics was not associated with mentalization. In summary, the questionnaire is suitable for the measurement of mentalization in psychotic disorders. Mentalization is not a unitary phenomenon: its four psychometric components were differentially associated with clinical symptoms, but not with antipsychotic medications