Opportunity cost determines free-operant action initiation latency and predicts apathy.

BACKGROUND: Apathy, a disabling and poorly understood neuropsychiatric symptom, is characterised by impaired self-initiated behaviour. It has been hypothesised that the opportunity cost of time (OCT) may be a key computational variable linking self-initiated behaviour with motivational status. OCT represents the amount of reward which is foregone per second if no action is taken. Using a novel behavioural task and computational modelling, we investigated the relationship between OCT, self-initiation and apathy. We predicted that higher OCT would engender shorter action latencies, and that individuals with greater sensitivity to OCT would have higher behavioural apathy. METHODS: We modulated the OCT in a novel task called the 'Fisherman Game', Participants freely chose when to self-initiate actions to either collect rewards, or on occasion, to complete non-rewarding actions. We measured the relationship between action latencies, OCT and apathy for each participant across two independent non-clinical studies, one under laboratory conditions (n = 21) and one online (n = 90). 'Average-reward' reinforcement learning was used to model our data. We replicated our findings across both studies. RESULTS: We show that the latency of self-initiation is driven by changes in the OCT. Furthermore, we demonstrate, for the first time, that participants with higher apathy showed greater sensitivity to changes in OCT in younger adults. Our model shows that apathetic individuals experienced greatest change in subjective OCT during our task as a consequence of being more sensitive to rewards. CONCLUSIONS: Our results suggest that OCT is an important variable for determining free-operant action initiation and understanding apathy.

Discounting money and health effects from communicable and noncommunicable diseases in Thailand.

The purpose of this study was to determine the discount rates for money and health outcomes in the Thai context, including the discount rates for communicable and non-communicable diseases. Moreover, this study aimed to explore the socio-demographic characteristics that influence discounting. The computer-based experimental design was used to obtain time preferences for money and health in a total of 1202 Chiang Mai province population, aged 25-50, individually interviewed by trained interviewers. Money-related questions were carried out in all subjects. For health-related questions, all subjects were randomly assigned in a 1:1 ratio for response to questions about Coronavirus Disease 2019 (COVID-19) (N = 602) and air pollution (N = 600). A choice-based elicitation procedure was performed in the experiment to obtain the indifference values from subjects' time preferences. The cumulative weighting functions were generated using the indifference values to indicate the degree of discounting. The discount factors were computed from the cumulative weighting functions. The discount rates were estimated using a continuous approximation based on the relationship between the discount factors and the parameters governing the discounting model. The Tobit model was applied to investigate the relationships between discounting and socio-demographic characteristics. Discounting for money was greater than discounting for health. Money and health had annual discount rates of 6.2% and 1.3%, respectively. Furthermore, in the COVID -19 situation, the annual discount rate for health was higher than that in the air pollution situation (2.4% vs. 0.7%). Generation X subjects (aged 42 years and above), children under the age of 15 in the household, and underlying diseases were positively related to discounting, while household income was negatively related to discounting. Health should be discounted at a lower rate than money. Moreover, different discount rates should be considered for different types of diseases.

Fully Immersive Virtual Reality Using 360° Videos to Manage Well-Being in Older Adults: A Scoping Review.

OBJECTIVE: The development of negative behavioral and psychosocial factors (depression, anxiety, apathy, etc) is associated with poor well-being, which can contribute to health issues in ageing, especially in the context of COVID-19. Despite its relative novelty, fully immersive virtual reality (VR) interventions through 360° immersive videos are becoming more accessible and flexible and constitute an emerging method to potentially enhance well-being. The aim of this scoping review is to assess the effectiveness of 360° interventions on well-being in older adults with or without cognitive impairment, as well as cybersickness and attitudes toward this technology. DESIGN: Scoping review. SETTING AND PARTICIPANTS: Older adults with or without cognitive impairment. METHODS: The PRISMA-SR guideline was followed. Four databases were used, and we selected articles published until April 2022. We have analyzed the effect of 360° videos on the well-being of older adults with respect to the study design, the population, the contents, the duration of intervention, and the outcomes. RESULTS: A total of 2262 articles were screened, of which 10 articles were finally included in this review. Most of them are pilot studies and used mixed methods including scales and interviews. The material and content of VR are diversified. Many behavioral and psychological outcomes were assessed, including anxiety, apathy, loneliness, depression, social engagement, quality of life, and emotions. The results were positive or mixed, according to the outcomes. We recorded few adverse events, and the interviews show contrasting results concerning the participants' feelings (ie, degree of immersion, familiarity with technology, and VR content). CONCLUSIONS AND IMPLICATIONS: The use of VR 360° videos seems feasible in community-dwelling older adults or residential aged care facilities, as they are safe and provide enjoyment. It constitutes an emerging and promising therapeutic tool to manage psychosocial disorders. This review provides key considerations for the design and implementation of interventions using VR 360° video in clinical practice.

Are Conspiracy Theories Harmless?

In recent years, there has been an increasing interest in the consequences of conspiracy theories and the COVID-19 pandemic raised this interest to another level. In this article, I will outline what we know about the consequences of conspiracy theories for individuals, groups, and society, arguing that they are certainly not harmless. In particular, research suggests that conspiracy theories are associated with political apathy, support for non-normative political action, climate denial, vaccine refusal, prejudice, crime, violence, disengagement in the workplace, and reluctance to adhere to COVID-19 recommendations. In this article, I will also discuss the challenges of dealing with the negative consequences of conspiracy theories, which present some opportunities for future research.

Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment.

Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson's disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.

The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial.

BACKGROUND: Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited. OBJECTIVE: This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care. METHODS: In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group. RESULTS: Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=-2.24, SE 1.89; t40=-1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=-0.26, SE 1.66; t40=-0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen (Χ22=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores. CONCLUSIONS: Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-DOI: 10.1136/bmjopen-2020-046030.

COVID-19 Vaccines Programs: adverse events following immunization (AEFI) among medical Clerkship Student in Jember, Indonesia.

INTRODUCTION: Coronavirus Disease (COVID-19) caused by Novel Coronavirus named as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was declared Pandemic by The World Health Organization (WHO) and a Public Health Emergency of International Concern (PHEIC) on January 30, 2020. Many COVID-19 vaccines have been developed, including CoronaVac vaccines by Sinovac. Health care workers, along with medical clerkship students are the priority to receive the vaccine. However, the Adverse Events Following Immunization (AEFI) of the CoronaVac remains unclear. This study aims to describe and analyze the adverse events following immunization (AEFI) of COVID-19 vaccination in medical students in clerkship programs. METHOD: We conducted a cross-sectional study using a questionnaire to assess AEFI after CoronaVac vaccination among medical clerkship students. A Chi-Square test with 95 % of CI was used to determine whether gender correlated with symptoms of AEFI. RESULT: We identified 144 medical clerkship students. The most common AEFI of SARS-CoV-2 vaccinations was localized pain in the injection site during the first dose with 25 (45 %) reports and the booster dose with 34 (67 %) reports. Then followed by malaise, the first dose with 20 (36 %) reports and the booster dose with 21 (41 %) reports. Other symptoms like headache, fever, shivering, sleepiness, nausea, dysphagia, and cold were also reported. CONCLUSIONS: CoronaVac SARS-COV-2 vaccine has several mild symptoms of AEFI and not correlated with gender. Nevertheless, follow-up after vaccination is needed to prevent immunologic responses that may occur in some patients.

Apathy and Anhedonia in Adult and Adolescent Cannabis Users and Controls Before and During the COVID-19 Pandemic Lockdown.

BACKGROUND: COVID-19 lockdown measures have caused severe disruptions to work and education and prevented people from engaging in many rewarding activities. Cannabis users may be especially vulnerable, having been previously shown to have higher levels of apathy and anhedonia than non-users. METHODS: In this survey study, we measured apathy and anhedonia, before and after lockdown measures were implemented, in n = 256 adult and n = 200 adolescent cannabis users and n = 170 adult and n = 172 adolescent controls. Scores on the Apathy Evaluation Scale (AES) and Snaith-Hamilton Pleasure Scale (SHAPS) were investigated with mixed-measures ANCOVA, with factors user group, age group, and time, controlling for depression, anxiety, and other drug use. RESULTS: Adolescent cannabis users had significantly higher SHAPS scores before lockdown, indicative of greater anhedonia, compared with adolescent controls (P = .03, η p2 = .013). Contrastingly, adult users had significantly lower scores on both the SHAPS (P < .001, η p2 = .030) and AES (P < .001, η p2 = .048) after lockdown compared with adult controls. Scores on both scales increased during lockdown across groups, and this increase was significantly smaller for cannabis users (AES: P = .001, η p2 = .014; SHAPS: P = .01, η p2 = .008). Exploratory analyses revealed that dependent cannabis users had significantly higher scores overall (AES: P < .001, η p2 = .037; SHAPS: P < .001, η p2 = .029) and a larger increase in scores (AES: P = .04, η p2 =.010; SHAPS: P = .04, η p2 = .010), compared with non-dependent users. CONCLUSIONS: Our results suggest that adolescents and adults have differential associations between cannabis use as well as apathy and anhedonia. Within users, dependence may be associated with higher levels of apathy and anhedonia regardless of age and a greater increase in levels during the COVID-19 lockdown.

Impact of the COVID-19 Pandemic on Life Space Extent and Apathy: A Comparison of Competitive Japanese Swimmers with and without Disabilities.

Changes in the daily lives and mental health of people with disabilities due to the coronavirus disease (COVID-19) pandemic have not been reported. The Japanese government closed public facilities, including swimming pools, during the first wave of COVID-19, and many competitive swimmers lost their places of activities. This study aimed to investigate the impact of the COVID-19 pandemic on life space and apathy among swimmers and investigated differences in the impact on swimmers with and without disabilities. A total of 39 competitive swimmers participated in this study, including 11 male and nine female swimmers with disabilities (swimmers with disabilities = para-swimmers), and e11 male and eight female swimmers without disabilities. Baseline and follow-up web-based questionnaire surveys were conducted, and changes in life space and apathy scale (AS) were assessed. Female para-swimmers showed significantly lower apathy than female able-bodied subjects (para, during; 16.0 ± 1.9; after, 12.8 ± 3.2; non-disabled; during, 10.5 ± 4.4; after, 10.6 ± 4.8; p < 0.05). Female swimmers with disabilities may be more likely to experience worsening mental health due to changes in their lifestyle.

Victims, villains and the rare hero: Analysis of migrant and refugee health portrayals in the Indian print media.

The Indian media's reportage of the Covid-19 pandemic has exposed the State's long-standing apathy towards low-income migrants and the structural neglect and violence faced by them in society. But how consistent were the country's print media in reporting on this population group before the crisis? This paper reports the findings of a study that examines the representation of migrants and refugees and their health in the Indian print media prior to the pandemic. A secondary objective was to examine any variations in their representation based on their social positions (for example, ethnicity, nationality, gender, religion). Using frame and content analyses, three English language newspapers were examined for the period January 1, 2017 to December 31, 2018. A total of 1,111 articles were retrieved. Analysis revealed that migrants were most frequently framed as "villains", posing a threat to the security, culture, health and economy in their destination states/cities, and less often as victims. On health coverage, the study found that the media frequently pathologised migrants and projected them as carriers of infection. Migrants' religion, ethnicity and class, and their proximity to the majoritarian population appeared most prominent in determining the frame imposed. The articles mostly relied on accounts of state officials and political leaders, whereas migrants' voices comprised less than a quarter of the sources of information. The media thus play a vital role in crystallising these disparities and, through acts of both omission and commission, end up vilifying migrants.

Neuropsychiatric symptoms and quality of life in Spanish patients with Alzheimer's disease during the COVID-19 lockdown.

BACKGROUND AND PURPOSE: The COVID-19 epidemic is affecting almost all individuals worldwide, and patients with Alzheimer's disease (AD) and amnesic mild cognitive impairment (MCI) are particularly at risk due to their characteristics and age. We analysed the impact of the pandemic on these patients' neuropsychiatric symptoms and their quality of life after 5 weeks of lockdown in Spain. METHODS: A total of 40 patients with a diagnosis of MCI (n = 20) or mild AD (n = 20) from the Cognitive Stimulation Program of the Cognitive Disorders Unit were evaluated. All patients had undergone a previous evaluation during the month before the lockdown, and were re-evaluated after 5 weeks of lockdown. The Neuropsychiatric Inventory (NPI) and EuroQol-5D questionnaire (EQ-5D) were used to assess neuropsychiatric symptoms in patients and the quality of life in patients as well in caregivers. RESULTS: The mean (SD) total baseline NPI score was 33.75 (22.28), compared with 39.05 (27.96) after confinement (P = 0.028). The most frequently affected neuropsychiatric symptoms were apathy [4.15 (3.78) vs. 5.75 (4.02); P = 0.002] and anxiety [3.95 (3.73) vs. 5.30 (4.01); P = 0.006] in patients with MCI, and apathy [2.35 (2.70) vs. 3.75 (3.78); P = 0.036], agitation [0.45 (1.14) vs. 1.50 (2.66); P = 0.029] and aberrant motor behaviour [1.25 (2.86) vs. 2.00 (2.93); P = 0.044] in patients with AD. We did not observe differences in EQ-5D scores during the re-evaluation. The 30% of patients and 40% of caregivers reported a worsening of the patients' health status during confinement. CONCLUSIONS: The results of this study show the worsening of neuropsychiatric symptoms in patients with AD and MCI during 5 weeks of lockdown, with agitation, apathy and aberrant motor activity being the most affected symptoms.