Lay Theories About Whether Emotion Helps or Hinders: Assessment and Effects on Emotional Acceptance and Recovery From Distress.

This investigation examined how people's beliefs about the functionality of emotion shape their emotional response and regulatory strategies when encountering distressing events. In Study 1, we present data supporting the reliability and validity of an 8-item instrument, the Help and Hinder Theories about Emotion Measure (HHTEM), designed to assess an individual's beliefs about the functionality of emotion. Participants who more strongly endorsed a Help Theory reported greater wellbeing, emotional acceptance, and use of reappraisal to regulate emotion. Participants who more strongly endorsed a Hinder Theory reported less wellbeing and more expressive suppression and substance use. In Study 2, we demonstrate that encouraging participants to view emotion as helpful affected their physiological and regulatory response to a distressing event. Participants in the Help Theory condition showed greater physiological reactivity (SCL) during a distressing film than control participants but were more accepting of their emotional response. Shortly after the film, SCL decreased for participants in the Help Theory condition. Compared to control participants, they engaged in less suppression and reported less lingering effect of the film on their mood. Together, these studies suggest that people's theories about the functionality of emotion influence their reactivity, the strategies they adopt to regulate emotion, and their ability to rebound after distressing events

The Assessment of Routine Electroencephalography in Patients with Altered Mental Status

PURPOSE: Changes in electroencephalography (EEG) patterns may offer a clue to the cause of altered mental status and suggest the prognoses of patients with such mental status. We aimed to identify the EEG patterns in patients with altered mental status and to correlate EEG findings with clinical prognoses. MATERIALS AND METHODS: We included 105 patients with altered mental status who underwent EEG. EEG and clinical chart reviews with ongoing patient follow-ups were performed to determine the clinical prognosis of the patients. Clinical data were sorted using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS). EEG findings were classified according to a method suggested by Scollo-Lavizzari. The EEGs were analyzed to find out whether any correlation existed with the prognoses of patients. Results: Nonconvulsive status epilepticus (NCSE) was detected in only three patients (2.9%). Specific EEG patterns were observed in 28 patients. Twenty-nine (27.6%) patients expired, and 45 (42.9%) patients were in a vegetative state. EEG grade and GCS significantly correlated with GOS. EEG grade alone had a correlation with GCS. Patients with a severe EEG finding had a poor prognosis. CONCLUSION: EEG findings reflect the mental status of patients, and EEG grades are correlated with the clinical prognosis of patients. Although EEG is not frequently performed on patients with altered mental state, it can play a supplemental role in establishing a prognosis. Thus, the use of EEG should be emphasized in clinical setting.ope

Public mental health during and after the SARS-CoV-2 pandemic: Opportunities for intervention via emotional self-efficacy and resilience

ImportanceDuring the pandemic, the number of United States adults reporting clinically significant symptoms of anxiety and depression sky-rocketed, up from 11% in 2020 to more than 40% in 2021. Our current mental healthcare system cannot adequately accommodate the current crisis; it is therefore important to identify opportunities for public mental health interventions.ObjectiveAssess whether modifiable emotional factors may offer a point of intervention for the mental health crisis.Design, setting, and participantsFrom January 13 to 15, 2022, adults living in the United States were recruited via Amazon Mechanical Turk to complete an anonymous survey.Main outcomes and measuresLinear regressions tested whether the primary outcomes during the SARS-CoV-2 pandemic (depressive and anxiety symptoms, burnout) were associated with hypothesized modifiable risk factors (loneliness and need for closure) and hypothesized modifiable protective factors (the ability to perceive emotions and connect with others emotionally; emotion-regulation efficacy; and resilience, or the ability to “bounce back” after negative events).ResultsThe sample included 1,323 adults (mean [SD] age 41.42 [12.52] years; 636 women [48%]), almost half of whom reported clinically significant depressive (29%) and/or anxiety (15%) symptoms. Approximately 90% of participants indicated feeling burned out at least once a year and nearly half of participants (45%) felt burned out once a week or more. In separate analyses, depressive symptoms (Model A), anxiety symptoms (Model B), and burnout (Model C) were statistically significantly associated with loneliness (βModel A, 0.38; 95% CI, 0.33–0.43; βModel B, 0.30; 95% CI, 0.26–0.36; βModel C, 0.34; 95% CI, 0.28–0.41), need for closure (βModel A, 0.09; 95% CI, 1.03–1.06; βModel B, 0.13; 95% CI, 0.97–0.17; βModel C, 0.11; 95% CI, 0.07–0.16), recent stressful life events (βModel A, 0.14; 95% CI, 0.10–0.17; βModel B, 0.14; 95% CI, 0.11–0.18; βModel C, 0.10; 95% CI, 0.06–0.15), and resilience (βModel A, −0.10; 95% CI, −0.15 to −0.05; βModel B, −0.18; 95% CI, −0.23 to −0.13; βModel C, −0.11; 95% CI, −0.17 to −0.05). In addition, depressive and anxiety symptoms were associated with emotional self-efficacy (βModel A, −0.17; 95% CI, −0.22 to −0.12; βModel B, −0.11; 95% CI, −0.17 to −0.06), and beliefs about the malleability of emotions (βModel A, −0.08; 95% CI, −0.12 to −0.03; βModel B, −0.09; 95% CI, −0.13 to −0.04). Associations between loneliness and symptoms were weaker among those with more emotional self-efficacy, more endorsement of emotion malleability beliefs, and greater resilience, in separate models. Analyses controlled for recent stressful life events, optimism, and social desirability.Conclusion and relevancePublic mental health interventions that teach resilience in response to negative events, emotional self-efficacy, and emotion-regulation efficacy may protect against the development of depressive symptoms, anxiety, and burnout, particularly in the context of a collective trauma. Emotional self-efficacy and regulation efficacy may mitigate the association between loneliness and mental health, but loneliness prevention research is also needed to address the current mental health crisis

Hyperammonemic Coma—Barking Up the Wrong Tree

Hepatic encephalopathy and myxedema coma share clinical features: coma, ascites, anemia, impaired liver functions, and a “metabolic” electroencephalogram (EEG). Hyperammonemia, a hallmark of hepatic encephalopathy, has also been described in hypothyroidism. Differentiation between the 2 conditions, recognition of their possible coexistence, and the consequent therapeutic implications are of utmost importance. We describe a case of an 82-year-old woman with a history of mild chronic liver disease who presented with hyperammonemic coma unresponsive to conventional therapy. Further investigation disclosed severe hypothyroidism. Thyroid hormone replacement resulted in gain of consciousness and normalization of hyperammonemia. In patients with an elevated ammonia level, altered mental status, and liver disease, who do not have a clear inciting event for liver disease decompensation, overwhelming evidence of hepatic decompensation, or who do not respond to appropriate therapy for hepatic encephalopathy, hypothyroidism should be considered and evaluated

Comparison of two modes of vitamin B12 supplementation on neuroconduction and cognitive function among older people living in Santiago, Chile: a cluster randomized controlled trial. a study protocol [ISRCTN 02694183]

BACKGROUND: Older people have a high risk of vitamin B12 deficiency; this can lead to varying degrees of cognitive and neurological impairment. CBL deficiency may present as macrocytic anemia, subacute combined degeneration of the spinal cord, or as neuropathy, but is often asymptomatic in older people. Less is known about subclinical vitamin B12 deficiency and concurrent neuroconduction and cognitive impairment. A Programme of Complementary Feeding for the Older Population (PACAM) in Chile delivers 2 complementary fortified foods that provide approximately 1.4 μg/day of vitamin B12 (2.4 μg/day elderly RDA). The aim of the present study is to assess whether supplementation with vitamin B12 will improve neuroconduction and cognitive function in older people who have biochemical evidence of vitamin B12 insufficiency in the absence of clinical deficiency. METHODS: We designed a cluster double-blind placebo-controlled trial involving community dwelling people aged 70-79 living in Santiago, Chile. We randomized 15 clusters (health centers) involving 300 people (20 per cluster). Each cluster will be randomly assigned to one of three arms: a) a 1 mg vitamin B12 pill taken daily and a routine PACAM food; b) a placebo pill and the milk-PACAM food fortified to provide 1 mg of vitamin B12; c) the routine PACAM food and a placebo pill.The study has been designed as an 18 month follow up period. The primary outcomes assessed at baseline, 4, 9 and 18 months will be: serum levels of vitamin B12, neuroconduction and cognitive function. CONCLUSIONS: In view of the high prevalence of vitamin B12 deficiency in later life, the present study has potential public health interest because since it will measure the impact of the existing program of complementary feeding as compared to two options that provide higher vitamin B12 intakes that might potentially may contribute in preserving neurophysiologic and cognitive function and thus improve quality of life for older people in Chile. TRIAL REGISTRATION: ISRCTN: ISRCTN02694183

Oral vitamin B12 for patients suspected of subtle cobalamin deficiency: a multicentre pragmatic randomised controlled trial

BACKGROUND: Evidence regarding the effectiveness of oral vitamin B12 in patients with serum vitamin B12 levels between 125-200 pM/l is lacking. We compared the effectiveness of one-month oral vitamin B12 supplementation in patients with a subtle vitamin B12 deficiency to that of a placebo. METHODS: This multicentre (13 general practices, two nursing homes, and one primary care center in western Switzerland), parallel, randomised, controlled, closed-label, observer-blind trial included 50 patients with serum vitamin B12 levels between 125-200 pM/l who were randomized to receive either oral vitamin B12 (1000 μg daily, N = 26) or placebo (N = 24) for four weeks. The institution's pharmacist used simple randomisation to generate a table and allocate treatments. The primary outcome was the change in serum methylmalonic acid (MMA) levels after one month of treatment. Secondary outcomes were changes in total homocysteine and serum vitamin B12 levels. Blood samples were centralised for analysis and adherence to treatment was verified by an electronic device (MEMS; Aardex Europe, Switzerland). Trial registration: ISRCTN 22063938. RESULTS: Baseline characteristics and adherence to treatment were similar in both groups. After one month, one patient in the placebo group was lost to follow-up. Data were evaluated by intention-to-treat analysis. One month of vitamin B12 treatment (N = 26) lowered serum MMA levels by 0.13 μmol/l (95%CI 0.06-0.19) more than the change observed in the placebo group (N = 23). The number of patients needed to treat to detect a metabolic response in MMA after one month was 2.6 (95% CI 1.7-6.4). A significant change was observed for the B12 serum level, but not for the homocysteine level, hematocrit, or mean corpuscular volume. After three months without active treatment (at four months), significant differences in MMA levels were no longer detected. CONCLUSIONS: Oral vitamin B12 treatment normalised the metabolic markers of vitamin B12 deficiency. However, a one-month daily treatment with 1000 μg oral vitamin B12 was not sufficient to normalise the deficiency markers for four months, and treatment had no effect on haematological signs of B12 deficiency

Biomarkers of cobalamin (vitamin B-12) status in the epidemiologic setting: a critical overview of context, applications, and performance characteristics of cobalamin, methylmalonic acid, and holotranscobalamin II1234

Cobalamin deficiency is relatively common, but the great majority of cases in epidemiologic surveys have subclinical cobalamin deficiency (SCCD), not classical clinical deficiency. Because SCCD has no known clinical expression, its diagnosis depends solely on biochemical biomarkers, whose optimal application becomes crucial yet remains unsettled. This review critically examines the current diagnostic concepts, tools, and interpretations. Their exploration begins with understanding that SCCD differs from clinical deficiency not just in degree of deficiency but in fundamental pathophysiology, causes, likelihood and rate of progression, and known health risks (the causation of which by SCCD awaits proof by randomized clinical trials). Conclusions from SCCD data, therefore, often may not apply to clinical deficiency and vice versa. Although many investigators view cobalamin testing as unreliable, cobalamin, like all diagnostic biomarkers, performs satisfactorily in clinical deficiency but less well in SCCD. The lack of a diagnostic gold standard limits the ability to weigh the performance characteristics of metabolic biomarkers such as methylmalonic acid (MMA) and holotranscobalamin II, whose specificities remain incompletely defined outside their relations to each other. Variable cutoff selections affect diagnostic conclusions heavily and need to be much better rationalized. The maximization of reliability and specificity of diagnosis is far more important today than the identification of ever-earlier stages of SCCD. The limitations of all current biomarkers make the combination of ≥2 test result abnormalities, such as cobalamin and MMA, the most reliable approach to diagnosing deficiency in the research setting; reliance on one test alone courts frequent misdiagnosis. Much work remains to be done

Lay Theories about Whether Emotion Helps or Hinders Reasoning and Wellbeing

This dissertation assessed the extent to which people endorse theories that emotion helps versus hinders reasoning and wellbeing and how these theories relate to analytical reasoning, physical health, emotion regulation and wellbeing. Study 1 examined the links between help and hinder theories, reasoning under stress, reappraisal and suppression use, and wellbeing. Help theory endorsement predicted better reasoning, more reappraisal and greater wellbeing, while hinder theory endorsement predicted more sick days in recent months and more suppression. In Study 2, a new measure of help and hinder theories (The Help and Hinder Theories Scale; HHTE) was developed which assessed the set of beliefs that form each theory. Study 3 demonstrated that the HHTE’s factor structure replicated in a separate sample, and that the scale had adequate three-week test-retest reliability. Study 3 also showed evidence of convergent and divergent validity for the HHTE. Study 4 then tested causal relations between help and hinder theories and responses to a distressing event. Specifically, participants who were randomly assigned to a condition to encourage a help theory endorsed a help theory more and endorsed a hinder theory less than those in the control condition. Participants in the help theory condition reported more emotion acceptance of their emotional response to viewing a distressing film clip, and showed faster emotional and physiological recovery. Together, these studies suggest that believing that emotion is helpful matters for emotional wellbeing and social relationships, and may motivate people to accept emotional experience and thus show faster physiological recovery after distressing events. In contrast, believing that emotion is a hindrance is linked to lower wellbeing, less social support, and less-effective emotion regulation strategies