Determinants of poor mental health of medical students in Portugal—A nationwide study

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of University of Minho (protocol code CEICVS 064/2015) on 30 May 2022.Medical students are a population that is vulnerable to the development of anxiety, depression, and burnout. This observational cross-sectional study sought to assess the levels of distress and identify precipitating factors in all students enrolled in a Portuguese medical school during the academic year of 2022/23. Students (n = 768) were surveyed via validated instruments to measure anxiety, depression, and burnout. Sociodemographic information was also collected through a questionnaire. The study indicated that almost half of this population had depressive symptoms. No differences were found in distress levels between medical schools, and when comparing curricular years, higher levels of distress were found in the pre-clinical years in comparison to the clinical ones. Burnout, being a woman, the existence of physical health problems, homo- and bisexual orientations, affective family problems, problems with relationships in the academic community, difficulties in academic performance, and daily organization were identified as predictors of distress. On the other hand, satisfaction with the social support received and with academic ratings were identified as protective factors. In conclusion, there is a high prevalence of distress in medical students, which is associated with personal, physical, social, economic, and academic factors. The identification of predictive factors of distress may allow for the early identification of vulnerable students and for intervention and prevention strategies to be defined.This research was funded by national funds through the Foundation for Science and Technology (FCT)—projects UIDB/50026/2020 and UIDP/50026/2020. This publication was funded by 2CA-Braga

Advanced Genetic Studies on Powdery Mildew Resistance in TGR-1551

[EN] Cucurbits powdery mildew (CPM) is one of the main limiting factors of melon cultivation worldwide. Resistance to races 1, 2, and 5 has been reported in the African accession TGR-1551, whose resistance is controlled by a dominant-recessive epistasis. The dominant and recessive quantitative trail loci (QTL) have previously been located in chromosomes 5 and 12, respectively. We used several densely genotyped BC3 families derived from the cross between TGR-1551 and the susceptible cultivar 'Bola de Oro' to finely map these resistance regions. The further phenotyping and genotyping of the selected BC5, BC5S1, BC5S2, BC4S1, BC(4)xPS, and (BC(4)xPS) S-1 offspring allowed for the narrowing of the candidate intervals to a 250 and 381 kb region in chromosomes 5 and 12, respectively. Moreover, the temperature effect over the resistance provided by the dominant gene has been confirmed. High resolution melting markers (HRM) were tightly linked to both resistance regions and will be useful in marker-assisted selection programs. Candidate R genes with variants between parents that caused a potential modifier impact on the protein function were identified within both intervals. These candidate genes provide targets for future functional analyses to better understand the resistance to powdery mildew in melons.This research was funded by the Spanish Ministerio de Ciencia e Innovacion (MCIN/AEI/10.13039/501100011033), grant number PID2020-116055RB (C21 and C22), and by the Conselleria d'Educacio, Investigacio, Cultura i Esports de la Generalitat Valenciana, grant number PROMETEO/2021/072 (to promote excellence groups, cofinanced with FEDER funds). M.L. is a recipient of a predoctoral fellowship (PRE2018-083466) of the Spanish Ministerio de Ciencia, Innovacion y Universidades co-financed with FSE funds.López-Martín, M.; Pérez De Castro, AM.; Picó Sirvent, MB.; Gómez-Guillamon, ML. (2022). Advanced Genetic Studies on Powdery Mildew Resistance in TGR-1551. International Journal of Molecular Sciences. 23(20):1-19. https://doi.org/10.3390/ijms232012553119232

Altered frontoparietal connectivity in patients with obsessive-compulsive disorder during an fMRI cognitive reappraisal task

Patients with obsessive-compulsive disorder (OCD) present increased brain activity in orbitofrontal and limbic regions when experiencing negative emotions, which could be related to deficits in emotion regulation abilities. 30 OCD patients and 29 healthy controls (HC) performed a cognitive reappraisal functional magnetic resonance imaging (fMRI) task and completed emotion regulation and OCD symptomatology questionnaires. Besides task activation, connectivity was also compared between groups through psychophysiological interaction analysis (PPI), using regions previously reported to be hyperactive in OCD as seeds. Finally, brain-behavior correlations were performed between activation/connectivity strength in group differential regions and the questionnaires’ scores, as well as the emotional ratings reported during the task. Behaviorally, patients with OCD were less successful than controls at lowering the emotional impact of negative images. At the brain level, there were no significant between-group differences in brain activation. Contrarily, PPI analyses showed that HC had increased frontoparietal connectivity when experiencing negative emotions in comparison to OCD patients, while this pattern was reversed when regulating emotions (increased connectivity in patients). Finally, frontoparietal connectivity was correlated with measures of emotion regulation success and OCD symptomatology. Our findings point towards frontoparietal altered connectivity as a potential compensatory mechanism during emotion regulation in OCD patients

How long does adaption last for? An update on the psychological impact of the confinement in Portugal

During the first COVID-19 related confinement in Portugal, there was a decrease in the levels of psychological symptoms measured by the Depression, Anxiety and Stress Scale 21 (March to April 2020). Upon experiencing a new period of restraints in 2021, the psychological impact of this sample was assessed again (N = 322, two more time points). It was expected that the psychological symptoms evidenced in February 2021 would be at similar levels to those found in April 2020, leading to a transfer of adaptation. Contrary to our hypothesis, in the second confinement in Portugal there were higher levels of depression and stress symptoms than at the beginning of the pandemic. On the other hand, the maximum level of anxiety was observed in March 2020. It seems that our perception of the threats in 2021 was not the same as at the onset of COVID-19, or that knowledge was not disseminated to the general population to increase their mental health literacy and help them cope with the imposed challenges.This work was funded by the Foundation for Science and Technology (FCT), under the scope of the project 110_596697345 (Research 4 COVID) and UIDB/50026/2020. This work has also been funded by ICVS Scientific Microscopy Platform, member of the national infrastructure PPBI—Portuguese Platform of Bioimaging (PPBI-POCI-01-0145-FEDER-022122; and by the project NORTE-01-0145-FEDER-000039, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF)

A functional magnetic resonance imaging study of frontal networks in obsessive-compulsive disorder during cognitive reappraisal

Background Patients with obsessive-compulsive disorder (OCD) present difficulties in the cognitive regulation of emotions, possibly because of inefficient recruitment of distributed patterns of frontal cortex regions. The aim of the present study is to characterize the brain networks, and their dysfunctions, related to emotion regulation alterations observed during cognitive reappraisal in OCD. Methods Adult patients with OCD (n = 31) and healthy controls (HC; n = 30) were compared during performance of a functional magnetic resonance imaging cognitive reappraisal protocol. We used a free independent component analysis approach to analyze network-level alterations during emotional experience and regulation. Correlations with behavioral scores were also explored. Results Analyses were focused on six networks encompassing the frontal cortex. OCD patients showed decreased activation of the frontotemporal network in comparison with HC (F(1,58) = 7.81, p = 0.007) during cognitive reappraisal. A similar trend was observed in the left frontoparietal network. Conclusions The present study demonstrates that patients with OCD show decreased activation of specific networks implicating the frontal cortex during cognitive reappraisal. These outcomes should help to better characterize the psychological processes modulating fear, anxiety, and other core symptoms of patients with OCD, as well as the associated neurobiological alterations, from a system-level perspective

Protective elements of mental health status during the COVID-19 outbreak in the Portuguese population

The outbreak of COVID-19 might produce dramatic psychological effects on individuals’ lives. In this study, we aimed to explore the elements that may reduce the negative effects on mental health of the quarantine period imposed by most governments during this worldwide crisis. We conducted an online survey to evaluate demographic, lifestyle and mental health variables in a sample of 1280 Portuguese individuals (79.8% females) with an average age of 37 years. We observed that factors related to living conditions, maintaining work either online or in the workplace, frequency of exercise and absence of previous psychological or physic disorders are protective features of psychological well-being (anxiety, depression, stress and obsessive-compulsive symptoms). Finally, the individuals previously receiving psychotherapeutic support exhibited better psychological indicators if they did not interrupt the process as a consequence of the outbreak. Our results indicate that the practice of physical exercise, reduced consumption of COVID-19 information and the implementation of remote mental healthcare measures might prevent larger impacts on mental health during the COVID-19 outbreak.This work was funded by the Foundation for Science and Technology (FCT), under the scope of the project 110_596697345 (Research 4 COVID) and partially funded by the FEDER funds, through the Competitiveness Factors Operational Programme (COMPETE), and by national funds, through the Foundation for Science and Technology (FCT), under the scope of the project UID/Multi/50026/2019. This manuscript has been developed under the scope of the project NORTE 01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)

Stress, anxiety, and depression trajectories during the “first wave” of the COVID-19 pandemic: what drives resilient, adaptive and maladaptive responses in the Portuguese population?

IntroductionThe COVID-19 outbreak and the community mitigation strategies implemented to reduce new SARS-CoV-2 infections can be regarded as powerful stressors with negative consequences on people's mental health. Although it has been shown that negative emotional symptoms subside during lockdown, it is likely the existence of inter-individual differences in stress, anxiety and depression trajectories throughout lockdown.ObjectivesWe aimed to cluster participants' according to their trajectories of stress, anxiety and depression scores throughout lockdown, and identify the sociodemographic, clinical, and lifestyle factors that may distinguish the subjects included in the different clusters.MethodsFrom March 23, 2020, to May 31, 2020, participants completed weekly online questionnaires on sociodemographic information (age, sex, education level, and employment status), psychological functioning (DASS-21, NEO-FFI-20), and clinical data (psychiatric disorders, psychiatric medication, physical disorders). Data regarding smoking status, alcohol consumption, physical activity, and time spent daily looking for COVID-19-related information were also collected. Stress, anxiety and depression trajectories were determined using latent class mixed models.ResultsA total of 2040 participants answered the survey at baseline and 603 participants answered all surveys. Three groups (“Resilient,” “Recovered,” and “Maladaptive”) with distinct mental health trajectories were identified. Younger participants, women, participants with lower education level, not working, studying, diagnosed with a mental disorder, taking psychiatric medication, smokers, those who spent more time consuming COVID-19-related information and those with higher neuroticism tended to cluster in the “Maladaptive” group, placing them at higher risk of persistent negative emotional symptoms during compulsory confinement.ConclusionAccordingly, a tailored approach to emotional suffering for vulnerable subjects during the COVID-19 and future pandemics must be devised

Brain networks alterations in cocaine use and gambling disorders during emotion regulation

Cocaine use disorder (CUD) and gambling disorder (GD) share clinical features and neural alterations, including emotion regulation deficits and dysfunctional activation in related networks. However, they also exhibit differential aspects, such as the neuroadaptive effects of long-term drug consumption in CUD as compared to GD. Neuroimaging research aimed at disentangling their shared and specific alterations can contribute to improve understanding of both disorders. We compared CUD (N = 15), GD (N = 16) and healthy comparison (HC; N = 17) groups using a network-based approach for studying temporally coherent functional networks during functional magnetic resonance imaging (fMRI) of an emotion regulation task. We focused our analysis in limbic, ventral frontostriatal, dorsal attentional (DAN) and executive networks (FPN), given their involvement in emotion regulation and their alteration in CUD and GD. Correlations with measures of emotional experience and impulsivity (UPPS-P) were also performed. The limbic network was significantly decreased during emotional processing both for CUD and GD individuals compared to the HC group. Furthermore, GD participants compared to HC showed an increased activation in the ventral frontostriatal network during emotion regulation. Finally, networks' activation patterns were modulated by impulsivity traits. Functional network analyses revealed both overlapping and unique effects of stimulant and gambling addictions on neural networks underpinning emotion regulation

Emotion Regulation and Excess Weight: Impaired Affective Processing Characterized by Dysfunctional Insula Activation and Connectivity

Emotion-regulation strategies are understood to influence food intake. This study examined the neurophysiological underpinnings of negative emotion processing and emotion regulation in individuals with excess weight compared to normal-weight controls. Fifteen participants with excess-weight (body mass index >25) and sixteen normal-weight controls (body mass index 18-25) performed an emotion-regulation task during functional magnetic resonance imaging. Participants were exposed to 24 negative affective or neutral pictures that they were instructed to Observe (neutral pictures), Maintain (sustain the emotion elicited by negative pictures) or Regulate (down-regulate the emotion provoked by negative pictures through previously trained reappraisal techniques). When instructed to regulate negative emotions by means of cognitive reappraisal, participants with excess weight displayed persistently heightened activation in the right anterior insula. Decreased responsivity was also found in right anterior insula, the orbitofrontal cortex and cerebellum during negative emotion experience in participants with excess weight. Psycho-physiological interaction analyses showed that excess-weight participants had decreased negative functional coupling between the right anterior insula and the right dlPFC, and the bilateral dmPFC during cognitive reappraisal. Our findings support contentions that excess weight is linked to an abnormal pattern of neural activation and connectivity during the experience and regulation of negative emotions, with the insula playing a key role in these alterations. We posit that ineffective regulation of emotional states contributes to the acquisition and preservation of excess weight

Trait anxiety is associated with attentional brain networks

Trait anxiety is a well-established risk factor for anxiety and depressive disorders, yet its neural correlates are not clearly understood. In this study, we investigated the neural correlates of trait anxiety in a large sample (n = 179) of individuals who completed the trait and state versions of the State-Trait Anxiety Inventory and underwent resting-state functional magnetic resonance imaging. We used independent component analysis to characterize individual resting-state networks (RSNs), and multiple regression analyses to assess the relationship between trait anxiety and intrinsic connectivity. Trait anxiety was significantly associated with intrinsic connectivity in different regions of three RSNs (dorsal attention network, default mode network, and auditory network) when controlling for state anxiety. These RSNs primarily support attentional processes. Notably, when state anxiety was not controlled for, a different pattern of results emerged, highlighting the importance of considering this factor in assessing the neural correlates of trait anxiety. Our findings suggest that trait anxiety is uniquely associated with resting-state brain connectivity in networks mainly supporting attentional processes. Moreover, controlling for state anxiety is crucial when assessing the neural correlates of trait anxiety. These insights may help refine current neurobiological models of anxiety and identify potential targets for neurobiologically-based interventions