Psychological adjustment to lung transplantation

Lung transplantation (LTx) is an effective treatment for end-stage lung failure. Despite great advances in transplant medicine over the last few decades, LTx does not result in complete recovery of health, as transplant recipients continue to be confronted by various health problems that must be psychologically processed and overcome. Many suffer from frequent emotional distress and psychological disorders that can negatively influence their ability to cope with their new organ, negatively impacting both their adherence to immunosuppressive therapy and health-related quality of life (HRQoL). Therefore, it is both clinically and scientifically relevant to assess the postoperative HRQoL and mental health of LTx recipients to identify those at risk for poor post-transplant outcomes and to improve patients’ symptom experience. This manuscript consists of three studies that review psychological adjustment to lung transplantation in terms of HRQoL and psychosocial outcomes via three different approaches. Study 1 is a systematic review of the literature to compile and interpret the evidence on measures to assess HRQoL and psychological outcomes following LTx, summarizing psychological outcomes in studies published between 1994 and 2013. Of 371 articles, 63 studies were selected for final review. Considerable heterogeneity was found in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, eligible studies generally point to significant improvements in both mental health and HRQoL post-transplant. A huge opportunity for future research lies in the development of guidelines to aid in the selection of outcome measures to assess psychological outcomes of lung transplant recipients. The second study investigated the psychosocial outcome trajectories of 40 lung transplant recipients related to psychological distress and HRQoL over their first six months posttransplant. Three distinctive clusters were identified: (1) patients with optimal postoperative trajectories (35%); (2) patients with good postoperative trajectories (42%); and (3) patients with poor postoperative trajectories (23%). The last group tended to be older, to suffer from more severe disease, to have more co-morbid conditions, and to have had a prolonged ICU and/or hospital stay. Disease severity, length of stay, and HRQoL two weeks post-transplant were strong predictors of psychological distress and impaired HRQoL at six months of follow-up. The results underscore the psychosocial needs of patients with poor post-transplant trajectories. The third study qualitatively analyzed patient experiences with transplantation and their adjustment to normal life within the first six months post-transplant. ‘Physical benefits’, ‘fear of rejection’, ‘gratitude towards the donor’, and ‘side effects’ were the most frequently named themes with respect to the transplantation process, new lungs, donor and medication regimen. Most themes remained unchanged over time. While comments about ‘intensive care unit delirium’ and ‘worries regarding donated organ quality’ diminished significantly over time, mentions of ‘restrictions in everyday life’ increased significantly. Gender comparison revealed only marginal differences in the response categories. Improvements in physical function during the early postoperative phase may be limited by the onset of clinical complications, fear of rejection and infections, medication side effects, and restrictions in everyday life. Generally, studies on HRQoL and psychological outcomes after lung transplantation have been limited by lost to follow-up, cross-sectional designs, small sample sizes and, great variability in the use of validated and non-validated outcome measures, such that comparisons between different studies are difficult. One area of future research is the development of consensus guidelines to aid in the selection of outcome measures to assess HRQoL and psychological outcomes among LTx patients. In addition, longitudinal studies, including pre- vs. post-transplant assessment with adequately-sized samples are needed to further investigate outcome profiles and identify additional outcome predictors in these patients

Reward processing under influence: Effects of stress and cognitive load on reward processing, and their clinical implications for the vulnerability to major depression

Les humains ont la propension à rechercher les récompenses et à éviter les punitions. La motivation à rechercher des récompenses et la capacité à en ressentir les effets positifs, à constater qu’un comportement a eu des conséquences positives et celle de le reproduire sont des fonctions fondamentales du traitement de la récompense. Elles promeuvent la survie et le bien-être.Cependant, ces fonctions peuvent être menacées ou altérées par l’exposition à des situations ou des contextes stressants. Afin de clarifier les facteurs déterminants qui, chez les adultes sains, sont susceptibles de porter atteinte au traitement de la récompense, cette thèse poursuit quatre objectifs. Premièrement, investiguer les mécanismes neuronaux et psychologiques qui favorisent les comportements motivés et la sensibilité hédonique, et comment l’exposition à un stresseur aigu imprévisible peut affecter ces mécanismes. Deuxièmement, explorer comment la disponibilité de processus cognitifs régulateurs peut moduler les effets de l’exposition à ce stresseur sur le traitement de la récompense. Troisièmement, dès lors que les stratégies de régulation émotionnelle peuvent améliorer ou altérer le maintien d’un traitement adaptatif de la récompense, cette thèse examine comment la propension à utiliser des stratégies de régulation émotionnelle adaptatives ou inadaptées influence la sensibilité à la récompense chez des adultes sains. D’une importance clinique particulière, le quatrième objectif se fonde sur le fait que le trouble dépressif caractérisé (TDC) se caractérise par un dérèglement du traitement de la récompense, une sensibilité accrue au stress et une altération des processus cognitifs et de la régulation émotionnelle. Par conséquent, en utilisant la vulnérabilité au TDC comme modèle clinique, cette thèse compare les effets neuronaux et psychologiques de l’exposition à un stresseur sur les comportements motivés et la sensibilité hédonique, chez des individus présentant une vulnérabilité accrue au TDM (IV, individu vulnérable) et chez des individus sains (IC, individu contrôle). Trois études empiriques adressent ces objectifs. Notre première étude empirique investigue comment, chez des sujets sains, l’exposition à un stresseur aigu et imprévisible affecte les mécanismes neuronaux et psychologiques impliqués lors de la phase d’anticipation et de réception de la récompense, et comment l’effort cognitif requis module les effets induits par le stresseur sur le traitement de la récompense. Pour mesurer l’activation cérébrale durant le traitement de la récompense, nous avons utilisé une tâche de récompense durant laquelle un stress expérimental était induit au travers de l’administration de chocs électriques, alors que le traitement de la récompense était modulé par le renforcement ou non des réponses correctes. La disponibilité des fonctions cognitives régulatrices a été manipulée en variant le niveau d’effort cognitif requis durant la tâche expérimentale (charge cognitive faible ou élevée). Nos résultats indiquent que l’exposition à un stresseur et un effort cognitif accru influence la réactivité striatale pendant la phase de réception du feedback, sans toutefois que ces deux facteurs n’intéragissent. Dans toutes les conditions, l’exposition au stresseur a augmenté la réactivité du striatum dorsal et les performances cognitives, alors que la nécessité d’engager un effort cognitif accru s’est traduit par une réduction de la réactivité du striatum ventral lors de la réception de récompenses et par une diminution de la performance cognitive. Sur cette base, notre deuxième étude empirique porte sur la relation entre la propension d’individus sains à utiliser des stratégies de régulation émotionnelle adaptatives ou inadaptées et leur sensibilité cérébrale à la réception de récompenses, une mesure reflétant la sensibilité hédonique. Nos résultats suggèrent que la réactivité du striatum ventral en réponse à la réception d’une récompense est négativement corrélée à la tendance des sujets à réguler leurs émotions de manière inadaptée, ainsi qu’à la sévérité et à l’intensité des symptômes dépressifs subcliniques qu’ils rapportent. Avec pour objectif d’explorer les implications cliniques pour la vulnérabilité au TDC, notre troisième étude empirique explore la manière dont l’exposition à un stresseur affecte le traitement de la récompense chez les IV par rapport aux IC durant la phase d’anticipation et de réception de la récompense lorsque ceux-ci effectuent la même tâche expérimentale que celle réalisée dans notre première étude empirique. De manière exploratoire, nous examinons également si le niveau de l’effort cognitif à investir dans la tâche modère de manière différente l’effet du stresseur sur le traitement de la récompense chez les IV en comparaison aux IC. Nos résultats mettent en évidence que l’exposition à un stresseur a réduit la réactivité du striatum ventral chez les IV durant la phase d’anticipation, indépendamment d’une potentielle récompense. Cet effet induit par le stresseur était renforcé lorsque l’effort cognitif annoncé était plus faible. Durant la phase d’anticipation, les IV ont également présenté une augmentation de l’activation du striatum dorsal dans toutes les conditions. Durant la présentation du feedback, une diminution de la réactivité du striatum ventral est apparue chez les IV dans la condition où un effort cognitif accru avait été investi dans la tâche expérimentale, et ce indépendamment de la présence du stresseur ou de récompense. En somme, les résultats de cette thèse indiquent que l’exposition à un stresseur aigu imprévisible pourrait induire une augmentation du niveau d’éveil, menant potentiellement à une amplification de la motivation orientée vers la recherche de récompenses et à l’émergence de conduites automatisées au détriment de comportements orientés vers un but. Nos résultats apportent un nouvel éclairage sur la complexité de l’influence exercée par le niveau d’effort cognitif et sur la manière dont celui-ci modère les effets du stress sur le traitement de la récompense. Quant au rôle joué par la régulation émotionnelle, les stratégies inadaptées semblent avoir un effet néfaste sur la sensibilité à la réception d’une récompense. D’une importance clinique particulière, nos résultats suggèrent que la vulnérabilité familiale au TDC est associée à une difficulté à encoder la valeur d’un stimulus émotionnel et à des dysfonctions dans les processus d’apprentissage en lien avec la récompense. Ainsi, les résultats de cette thèse pourraient contribuer à ouvrir de nouvelles perspectives pour le développement de programmes de prévention efficaces visant à renforcer la résilience face au stress et à réduire le risque face à l’émergence de symptômes psychopathologiques liés au stress.Humans have a propensity to pursue rewards and to avoid punishments. The motivation to seek rewards and the ability to experience and to learn from positive consequences are fundamental functions in the reward processing. They promote survival and well-being. However, these functions can be challenged or impaired by stressful events or contexts. To clarify the determinant factors that might impair the normal reward function in healthy humans, this thesis has four aims. First, to investigate the brain and psychological mechanisms that foster adaptive motivated behaviors and hedonic responsiveness, and how unpredictable acute stress exposure might challenge these mechanisms. Second, to explore how the availability of cognitive regulatory processes may modulate the effect of stress exposure on these reward functions. Third, since emotion regulation strategies might improve or alter the maintenance of an adaptive reward processing, this thesis examines how the propensity to use adaptive or maladaptive emotion regulation strategies influences the responsiveness to reward delivery in healthy individuals. Of clinical importance, the fourth aim is based on the fact that major depression disorder (MDD) is characterized by a disrupted reward processing, increased stress sensitivity, and altered cognitive and emotion regulation processes. Consequently, we used the vulnerability to MDD as a clinical model to test the neural and psychological effects of stress exposure on motivated behaviors and hedonic responsiveness in healthy individuals vulnerable to MDD (HV) compared to closely matched healthy controls (HC). Three empirical works address these aims. Empirical work I explores how, in healthy individuals, unpredictable acute stress exposure affects the neural and behavioral mechanisms engaged during cues predicting rewards and during reward delivery, and how cognitive effort modulates stress-related effects on reward processing. To measure brain activations during reward processing, we used an event-related functional magnetic resonance imaging (fMRI) reward task with unpredictable acute stress induced by threat-of-shock, and reward responsiveness modulated by variable reinforcement schedules (rewarded vs not-rewarded trials). The availability of cognitive regulatory processes was manipulated by two levels of cognitive effort to exert in the task (low, high working memory load). Our findings indicate that both stress exposure and increased cognitive effort influenced the striatal reactivity during the delivery phase, but these factors did not interact. In all conditions, stress exposure enhanced both dorsal striatal activation during the delivery phase and cognitive performance, while higher cognitive effort reduced both ventral striatal reactivity to reward receipt and cognitive performance. Moving on from there, Empirical work II provides insight into the relationship between the propensity of healthy adults to use adaptive or maladaptive emotion regulation strategies, and their neural responsiveness to reward delivery, a measure of hedonic responsivity. Our findings demonstrate that the ventral striatal responsiveness to reward delivery was negatively associated with both the subject’s tendency to use maladaptive emotion regulation strategies, and the severity and intensity of the subclinical depressive symptoms they reported. With the aim to test the clinical implications for the vulnerability to MDD, Empirical work III examines whether unpredictable acute stress exposure affects differently HC’s and HV’s neural responsiveness to cues predicting rewards and to reward delivery when performing the reward task used in our first empirical work. In an exploratory way, we also investigate whether cognitive effort modulates differently the effect of unpredictable acute stress exposure on reward responsiveness. Our findings evidence that stress exposure reduced the ventral striatal reactivity in HV during the anticipation phase, regardless of reinforcement schedule. This stress-related effect was potentiated when individuals were asked to exert a lower cognitive effort in the task. Also, HV showed diminished dorsal striatal activation in all conditions during the anticipation phase. During the delivery phase, the exertion of higher cognitive effort decreased the ventral striatal reactivity in HV, irrespective of stress exposure and reinforcement schedule. Overall, the findings of this thesis demonstrate that stress exposure might strengthen arousal resulting possibly in increased reward-seeking motivation and in the emergence of automatized actions at the expense of goal-directed behaviors. Our results bring new insights into the complex influence of cognitive demands and how they modulate the effect of unpredictable acute stress on the reward processing. Regarding the role played by emotion regulation, maladaptive emotion regulation strategies might have an adverse effect on the ability to experience hedonic feelings. Of clinical significance, our findings indicate finally that increased familial risk for MDD may be associated with impaired ability to encode incentive value and with dysfunctions in reward learning processes including the learning of action-outcome and stimulus-outcome associations. Altogether, the results of this thesis might open new avenues for developing efficient prevention programs promoting resilience in the face of stress exposure, and for reducing the risk for stress-related psychopathological symptoms

HPA-axis activity and the moderating effect of self-esteem in the context of intimate partner violence in Cameroon

Background The experience of intimate partner violence (IPV) is stressful. One objective way to monitor it is to assess victims’ stress response by measuring the concentration of their salivary cortisol, the major stress hormone released by the hypothalamic–pituitary–adrenal axis. Objective We investigated how the IPV experienced by women in Cameroon affects their stress levels and those of their children. Method We recruited 50 mother–child dyads exposed to IPV and a control group of 25 mother–child dyads. All mothers completed questionnaires, including the Revised Conflict Tactics Scale to assess IPV, the Sense of Coherence Scale, and the Self-Esteem Scale, to assess their psychological resources. Mothers were asked to collect 3 saliva samples from themselves and 3 from their children on a single weekday: immediately after waking up, 30 minutes after waking up, and 45 minutes after waking up. The total cortisol secretion over the first hour after awakening was determined by calculating the area under the curve with respect to the ground (AUCg). Results Mothers exposed to IPV exhibited higher total post-awakening cortisol concentrations compared with those in the control group. However, no significant difference was found between exposed and non-exposed children. In addition, higher IPV, specifically injuries, was significantly and positively associated with greater AUCg among mothers exhibiting lower self-esteem. When self-esteem was high, however, no significant effect of IPV on AUCg was observed. Conclusions Of particular clinical significance is that self-esteem can modulate the stress levels of women exposed to IPV, a valuable insight into the development of effective psychosocial interventions to support IPV victims in sub-Saharan Africa

Molecular and Functional Imaging Studies of Psychedelic Drug Action in Animals and Humans

Hallucinogens are a loosely defined group of compounds including LSD, N,N-dimethyltryptamines, mescaline, psilocybin/psilocin, and 2,5-dimethoxy-4-methamphetamine (DOM), which can evoke intense visual and emotional experiences. We are witnessing a renaissance of research interest in hallucinogens, driven by increasing awareness of their psychotherapeutic potential. As such, we now present a narrative review of the literature on hallucinogen binding in vitro and ex vivo, and the various molecular imaging studies with positron emission tomography (PET) or single photon emission computer tomography (SPECT). In general, molecular imaging can depict the uptake and binding distribution of labelled hallucinogenic compounds or their congeners in the brain, as was shown in an early PET study with N1-([11C]-methyl)-2-bromo-LSD ([11C]-MBL); displacement with the non-radioactive competitor ketanserin confirmed that the majority of [11C]-MBL specific binding was to serotonin 5-HT2A receptors. However, interactions at serotonin 5HT1A and other classes of receptors and pleotropic effects on second messenger pathways may contribute to the particular experiential phenomenologies of LSD and other hallucinogenic compounds. Other salient aspects of hallucinogen action include permeability to the blood–brain barrier, the rates of metabolism and elimination, and the formation of active metabolites. Despite the maturation of radiochemistry and molecular imaging in recent years, there has been only a handful of PET or SPECT studies of radiolabeled hallucinogens, most recently using the 5-HT2A/2C agonist N-(2[11CH3O]-methoxybenzyl)-2,5-dimethoxy- 4-bromophenethylamine ([11C]Cimbi-36). In addition to PET studies of target engagement at neuroreceptors and transporters, there is a small number of studies on the effects of hallucinogenic compounds on cerebral perfusion ([15O]-water) or metabolism ([18F]-fluorodeoxyglucose/FDG). There remains considerable scope for basic imaging research on the sites of interaction of hallucinogens and their cerebrometabolic effects; we expect that hybrid imaging with PET in conjunction with functional magnetic resonance imaging (fMRI) should provide especially useful for the next phase of this research

Short-Term Effects of a Multidimensional Stress Prevention Program on Quality of Life, Well-Being and Psychological Resources: A Randomized Controlled Trial

It is well-documented that university students have an increased risk in developing psychological problems because they face multiple stressors. Cognitive, behavioral, and mindfulness-based stress prevention programs were shown to reduce symptoms of anxiety, depression, and perceived stress in university students. However, little is known of their effect on resource activation. Additionally, most validated interventions are unidimensional, i.e., including one stress-coping approach. In this study, we investigated the short-term effects of a multidimensional stress prevention program on students’ quality of life, psychological symptoms and resources, and resilience factors against stress. Using an experimental design, 64 healthy undergraduate students (56 women), between 18 and 34 years old (M = 21.34, SD = 2.53), from the University of Fribourg, Switzerland, were randomly allocated either to the intervention or the wait-list control group. The intervention group participated in a multidimensional stress prevention program, integrating mindfulness-based activities, cognitive and behavioral strategies, social skills, and emotional regulation exercises. The program consisted of eight 2-h weekly sessions. Before and after the intervention, participants completed self-reported questionnaires evaluating quality of life; psychological symptoms such as depression, anxiety, social anxiety, and interpersonal problems; as well as psychological resources like self-efficacy, sense of coherence, self-compassion, and social support, presented online. A standardized clinical interview was performed at pre- and post-measurement times. To analyze the sort-term effects of the program, we used mixed, two-factorial ANOVAs (per-protocol analyses). In accordance with our hypotheses, our results showed significant reduction of psychological symptoms, including anxiety, interpersonal problems, and symptoms of pain; a significant increase in quality of life, sense of coherence, and self-compassion in students who participated in the intervention program compared to the control group, (all p < 0.05). No significant results were found for symptoms of depression, social anxiety, self-efficacy, and social support. These preliminary findings indicate specific short-term effects of our multidimensional stress prevention program on psychological symptoms and on quality of life as well as promising effects on psychological resources and factors associated with resilience against stress. Future studies should investigate the long-term effects of the intervention as well as the effects in clinical samples

Burnout, Psychological Symptoms, and Secondary Traumatic Stress Among Midwives Working on Perinatal Wards: A Cross-Cultural Study Between Japan and Switzerland.

The aim of this study was to explore cross-cultural differences in symptoms of burnout, anxiety, depression, general psychological distress, and secondary traumatic stress between Asian (Japan) and European (Switzerland) midwives. One hundred seventy midwives participated in the study. There were significant differences in age group [χ &lt;sup&gt;2&lt;/sup&gt; (3) = 24.2, &lt;i&gt;p&lt;/i&gt; &lt; 0.01], marital or relationship status [χ &lt;sup&gt;2&lt;/sup&gt; (2) = 28.4, &lt;i&gt;p&lt;/i&gt; &lt; 0.01], and years of experience [χ &lt;sup&gt;2&lt;/sup&gt; (2) = 17.8, &lt;i&gt;p&lt;/i&gt; &lt; 0.01] between the two countries. The Japanese staff were younger, more often unmarried, and had less experience than the Swiss staff. The mean score of depersonalization was significantly higher in Switzerland (4.8 ± 3.8) than in Japan (3.2 ± 3.7; | &lt;i&gt;z&lt;/i&gt; | = 2.71, &lt;i&gt;p&lt;/i&gt; &lt; 0.01). The mean score of general psychological distress in the Swiss sample (12.8 ± 6.5) was significantly higher than that in the Japanese sample (10.3 ± 6.2; | &lt;i&gt;z&lt;/i&gt; | = 2.04, &lt;i&gt;p&lt;/i&gt; = 0.04). In addition, the mean score of secondary traumatic stress was higher in the Swiss sample (31.8 ± 9.7) than in the Japanese sample (24.1 ± 8.6; | &lt;i&gt;z&lt;/i&gt; | = 4.56, &lt;i&gt;p&lt;/i&gt; &lt; 0.01). These results may reflect cultural differences such as working conditions or family environment between Japan and Switzerland

Behavioral Responses to Uncertainty in Weight-Restored Anorexia Nervosa – Preliminary Results

Impaired decision-making under conditions of uncertainty seems to contribute to theexpression and maintenance of anorexia nervosa (AN), but it is not clear whether thisimpairment is a disease state that would remit with treatment, or a persisting trait inpatients with AN. To examine this question, a longitudinal study was conducted in12 female inpatients with AN (age M = 22.2, SE = 1.36), before (Time-1) and afterreaching a body mass index of >17.5 kg/m2 (Time-2). Intolerance of uncertainty (IU)was assessed via a decision-making task, the wheel of fortune (WOF). Weight gain atTime-2 was accompanied with significant changes in uncertainty-related performancecompared to Time-1 [(Time Uncertainty), p < 0.05]. At Time-1, reaction times (RTs)varied in function of uncertainty, while at Time-2, uncertainty did not modulate RTs.These findings support a change in decision-making under uncertainty with successfulweight-rehabilitation in AN. While IU was present in underweight patients, it becamenon-significant after weight restoration

Mental Health Symptoms and Work-Related Stressors in Hospital Midwives and NICU Nurses: A Mixed Methods Study.

Hospital midwives and neonatal intensive care (NICU) nurses frequently encounter work-related stressors and are therefore vulnerable to developing mental health problems, such as secondary traumatic stress, burnout, anxiety, and depression. However, so far, the exact nature of these work-related stressors (traumatic vs. non-traumatic stressors) has not been investigated. This concurrent triangulation mixed methods cross-sectional study aimed to compare mental health symptoms in hospital midwives and NICU nurses, and to identify and compare work-related traumatic and non-traumatic stressors for both professional groups. 122 midwives and 91 NICU nurses of two Swiss university hospitals completed quantitative measures (Secondary Traumatic Stress Scale, STSS; Hospital Anxiety and Depression Scale, HADS; Maslach Burnout Inventory, MBI) and one qualitative question in an online survey. When controlling for socio-demographic variables, NICU nurses had a higher STSS total score and higher STSS subscales scores and less HADS anxiety subscale scores than hospital midwives. Work-related stressors were classified into five themes: "Working environment," "Nursing/midwifery care," "Dealing with death and dying," "Case management" and "Others." Forty-six (46.3%) percent of these were classified as traumatic work-related stressors. NICU nurses reported more traumatic stressors in their working environment but no other differences between professional groups regarding the total number of work-related traumatic vs. non-traumatic stressors were found. Measures, such as teaching strategies to amend the subjective appraisal of the traumatic stressors or providing time to recover in-between frequently occurring work-related traumatic stressors might not only improve the mental health of professionals but also decrease sick leave and improve the quality of patient care