The relationship between interoceptive emotional awareness, neuroticism, and depression, anxiety, and stress.

COVID-19 has caused challenges to daily living globally, with profound implications for negative mood. A variety of state and trait-based factors can influence how a person may respond and adapt to challenges such as a global pandemic. Personality is an area impacting how a person responds to both internal and external situations (trait) and Emotional Awareness (EA) is a facet of interoception (an awareness of the mind-body connection) that determines the way an individual interprets their physiological state of the body, and the associated emotions (state-trait). Both areas have been well researched in isolation, however the body of literature exploring the relationships between both is much smaller. It would therefore be beneficial to explore the interrelationships of both state and trait factors on wellbeing to enable a more comprehensive understanding. It was hypothesised that EA would moderate the relationship between Neuroticism and Depression, Anxiety, and Stress. Participants residing in Australia during periods of imposed lockdown were included within the study (n = 838; Ages = 18-60 years) and completed an online questionnaire battery including a variety of state and trait questionnaires. A moderation analysis was conducted to explore whether Emotional Awareness changed the relationship between neuroticism and depression, anxiety, and stress utilising an alpha of < .05. EA moderated the relationship between Neuroticism and Anxiety (p = .001, 95% CI .03-.17)), and Stress (p = .02 95% CI.01-.13), but not Depression (p = .23, 95% CI .03-.13). As Neuroticism increased, negative mood increased for all levels of EA, however those high in Neuroticism and EA displayed the highest Anxiety and Stress. Interventions to increase EA, such as mindfulness, may have adverse effects for individuals high in Neuroticism, emphasising the importance of tailored interventions and supporting the assumption that high levels of Neuroticism represent increased vulnerability during a pandemic.

'Interesting' or 'boring': Modifying the implicit association task to measure implicit fire interest in an adolescent community sample.

The efficacy of explicit measures in assessing fire interest is often compromised by social desirability biases, presenting a challenge for early intervention programs aimed at preventing firesetting behaviour. The current study aimed to validate a novel fire interest Implicit Association Task (IAT), as a more reliable measure of implicit fire interest in adolescents. An Australian community adolescent sample of 85 participants, aged 10-17 (M = 13.65, SD = 1.81), completed a series of questionnaires, and the novel fire interest IAT. Based on self-reports, participants were classified as firelighters (n = 52) or non-firelighters (n = 33). IAT outcomes revealed an inclination towards associating "fire" with "interesting." Notably, firelighters, compared to non-firelighters, performed significantly quicker during hypothesis-consistent trials of the IAT where fire-images were paired with interesting-words. Moreover, a weak correlation emerged between the speed of responses in these hypothesis-consistent IAT trials and self-reported fire interest. This investigation is one of the few that examined the efficacy of implicit measures of fire interest and is the first to do so using a modified IAT. With continued refinement, the fire interest IAT could be successfully used to assist with early intervention programs aimed at preventing child firesetting behaviour. PsychINFO Code: 3230.

Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study.

BACKGROUND: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. OBJECTIVE: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. METHODS: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. RESULTS: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. CONCLUSIONS: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.

Identifying self-disclosed anxiety on Twitter: A natural language processing approach.

BACKGROUND: Text analyses of social media posts are a promising source of mental health information. This study used natural language processing to explore distinct language patterns on Twitter related to self-reported anxiety diagnosis. METHODS: A total of 233.000 tweets made by 605 users (300 reporting anxiety diagnosis and 305 not) over six months were comparatively analysed, considering user behavior, Linguistic Inquiry Word Count (LIWC), and sentiment analysis. Twitter users with a self-disclosed diagnosis of anxiety were classified as 'anxious' to facilitate group comparisons. RESULTS: Supervised machine learning models showed a high prediction accuracy (Naïve Bayes 81.1 %, Random Forests 79.8 %, and LASSO-regression 79.4 %) in identifying Twitter users' self-disclosed diagnosis of anxiety. Additionally, a Latent Profile Analysis (LPA) identified four profiles characterized by high sentiment (31 % anxious participants), low sentiment (68 % anxious), self-immersed (80 % anxious), and normative behavior (38 % anxious). CONCLUSION: The digital footprint of self-disclosed anxiety on Twitter posts presented a high frequency of words conveying either negative sentiment, a low frequency of positive sentiment, a reduced frequency of posting, and lengthier texts. These distinct patterns enabled highly accurate prediction of anxiety diagnosis. On this basis, appropriately resourced, awareness raising, online mental health campaigns are advocated.

Assessment of the mind-body connection: preliminary psychometric evidence for a new self-report questionnaire.

OBJECTIVES: While interoceptive self-report scales provide a foundation for measuring the mind-body connection, they variably consider other important factors that could influence interpretations of internal bodily sensations and perceptions related to mind-body integration. The proposed Body-Mind Connection Questionnaire (BMCQ) aimed to operationalise the notion that this construct involves three major components: (a) Interoceptive Attention, (b) Sensation-Emotion Articulation, and (c) Body-Mind Values. METHODS: Following panel review and piloting with the target population, the developed BMCQ was evaluated in 316 participants (189 identifying as female) aged 18-50 (MAge=30.78), alongside established self-report measures of interoceptive sensibility, body awareness, sensory processing sensitivity, and alexithymia. We examined the BMCQ factor structure through exploratory factor analysis and analysed convergent and discriminant validity. RESULTS: Exploratory factor analysis supported three scales of the BMCQ, which explained 54.03% of variance. Factor loadings (>0.44) and reliability indices (0.74 to 0.85) were acceptable. Inter-scale correlations suggested that the scales are distinct but related (rs=0.38 to 0.59). BMCQ scales were supported by convergent (r=0.33 to 0.67) and discriminant evidence (rs=0.01 to 0.39, p range n.s. to <.05). CONCLUSIONS: Preliminary psychometric properties indicate that the BMCQ is multidimensional and consists of three constructs that differentially relate to theoretically associated measures. Interoceptive Attention, Sensation-Emotion Articulation, and Body-Mind Values may serve as a basis for efficiently assessing the mind-body connection more holistically, which could be useful for developing interventions aimed at enhancing mind-body integration.

A true reflection of executive functioning or a representation of task-specific variance? Re-evaluating the unity/diversity framework.

The unity/diversity framework, originally published by Miyake et al. (2000) has become the most cited model of executive functioning. Consequently, when researchers operationalise executive function (EF) they often exclusively assess the three "core" EFs: updating, shifting, and inhibition. However, rather than core EFs representing domain general cognitive abilities, these three EFs may instead represent specific procedural skills from the overlapping methodologies of the tasks selected. In this study, we conducted a confirmatory factor analysis (CFA) which showed both the traditional three-factor and nested-factor model from the unity/diversity framework failed to reach satisfactory levels of fit. Subsequently, an exploratory factor analysis supported a three-factor model reflecting: an expanded working memory factor, a combined shifting/inhibition factor representing cognitive flexibility, and a factor comprised solely of the Stroop task. These results demonstrate that working memory remains the most robustly operationalised EF construct, whereas shifting and inhibition may represent task-specific mechanisms of a broader domain-general cognitive flexibility factor. Ultimately, there is little evidence to suggest that updating, shifting, and inhibition encapsulates all core EFs. Further research is needed to develop an ecologically valid model of executive functioning that captures the cognitive abilities associated with real world goal-directed behaviour.

20 years on: Confirmation of P. Anderson's (2002) paediatric model of executive functioning in a healthy adult sample.

Executive Functioning (EF) is a construct that encompasses multiple interrelated higher order skills, however, conceptualising this nebulous construct remains challenging. This study aimed to confirm the validity of Anderson's (2002) paediatric model of EF in a healthy adult sample using congeneric modelling. Measures of EF were selected based on utility with adult populations giving rise to minor methodological differences from the original paper. Separate congeneric models were constructed using each of Anderson's constructs in order to isolate the sub-skills represented by each (Attentional Control-AC, Cognitive Flexibility-CF, Information Processing-IP, Goal Setting-GS), with a minimum of three tests per subskill. One hundred and thirty-three adults (42 males and 91 females) aged between 18 and 50 (M = 29.68, SD = 7.46) completed a cognitive test battery comprising 20 EF tests. AC revealed a good fitting model χ2(2) = 1.61, p = .447, RMSEA = 0.000, CFI = 1.000, after removing the non-significant indicator Map Search (p = .349), and BS-Bk as BS-Bk was required to covary with both BS-Fwd (M.I = 7.160, Par Change = .706), and TMT-A (M.I = 5.759, Par Change = -2.417). CF revealed a good fitting model χ2(8) = 2.90, p = .940, RMSEA = 0.000, CFI = 1.000 after covarying TSC-E and Stroop (M.I = 9.696, Par Change = .085). IP revealed a good fitting model χ2(4) = 1.15, p = .886, RMSEA = 0.000, CFI = 1.000 after covarying Animals total and FAS total (M.I. = 4.619, Par Change = 9.068). Lastly, GS indicated a good fitting model χ2(8) = 7.22, p = .513, RMSEA = 0.000, CFI = 1.000 after covarying TOH total time and PA (M.I = 4.25, Par Change = -77.868). Therefore, all four constructs were reliable and valid, and the utility of a parsimonious EF battery is suggested. Investigation of the inter-relationships between the constructs using regression techniques, de-emphasises the role of Attentional Control and argue instead for capacity bound skills.

The predictive validity of the family risk survey and child risk survey for identifying persistent firesetting risk.

Young firesetter behavior poses significant risks to individuals and communities. Intervention is important to mitigate youth firesetting, and treatment needs vary depending on underlying motives. Effective screening of persistent firesetter risk to inform intervention approach is critical to ensure appropriate matching of risk and needs. This study aimed to evaluate the utility of the child risk survey (CRS) and family risk survey (FRS) for predicting persistent firesetting risk, and subsequent triaging of cases toward the appropriate treatment. A total of 61 families engaged with the Firelighting Consequences Awareness Program, Melbourne, Australia, completed the CRS and FRS preintervention, and reported their firesetting behavior 1-year postintervention. The CRS was not effective for correctly predicting persistent and nonpersistent firesetters. The FRS was successful at predicting persistent firesetters 85% of the time, but had a high rate of false positives, overclassifying nonpersistent firesetters as high risk. Finally, the actual rate of firesetters that would be deemed suitable for each of the three recommended interventions based on the CRS and FRS scoring protocols was substantially different to the expected rates described in the accompanying manual. Implications for service provision are discussed.

Exploring the digital footprint of depression: a PRISMA systematic literature review of the empirical evidence.

BACKGROUND: This PRISMA systematic literature review examined the use of digital data collection methods (including ecological momentary assessment [EMA], experience sampling method [ESM], digital biomarkers, passive sensing, mobile sensing, ambulatory assessment, and time-series analysis), emphasizing on digital phenotyping (DP) to study depression. DP is defined as the use of digital data to profile health information objectively. AIMS: Four distinct yet interrelated goals underpin this study: (a) to identify empirical research examining the use of DP to study depression; (b) to describe the different methods and technology employed; (c) to integrate the evidence regarding the efficacy of digital data in the examination, diagnosis, and monitoring of depression and (d) to clarify DP definitions and digital mental health records terminology. RESULTS: Overall, 118 studies were assessed as eligible. Considering the terms employed, "EMA", "ESM", and "DP" were the most predominant. A variety of DP data sources were reported, including voice, language, keyboard typing kinematics, mobile phone calls and texts, geocoded activity, actigraphy sensor-related recordings (i.e., steps, sleep, circadian rhythm), and self-reported apps' information. Reviewed studies employed subjectively and objectively recorded digital data in combination with interviews and psychometric scales. CONCLUSIONS: Findings suggest links between a person's digital records and depression. Future research recommendations include (a) deriving consensus regarding the DP definition and (b) expanding the literature to consider a person's broader contextual and developmental circumstances in relation to their digital data/records.

Associations between self-reported psychological symptom severity and gut microbiota: further support for the microgenderome.

BACKGROUND: Research into the brain-gut-microbiota axis (BGMA) continues to reveal associations between gut microbiota (GM) and psychological symptom expression, inspiring new ways of conceptualising psychological disorders. However, before GM modulation can be touted as a possible auxiliary treatment option, more research is needed as inconsistencies in previous findings regarding these associations are prevalent. Additionally, the concept of the microgenderome, which proposes that GM may interact with sex hormones, has received limited attention in studies using human samples to date. However, such research has demonstrated sex specific associations between GM and psychological symptom expression. METHOD: This cross-sectional retrospective study explores associations between GM species (identified through faecal microbial analysis) and symptom severity across four psychological domains (Depressive, Neurocognitive, Stress and Anxiety, and Sleep and Fatigue) for males (N = 1143) and females (N = 3467) separately. RESULTS: GM species from several genera including Bifidobacterium, Clostridium, Enterococcus, and Leuconostoc were found to be differentially associated with psychological symptom severity for males and females. As such, the findings of the current study provide support for the concept of the microgenderome. CONCLUSION: While further research is needed before their implementation in psychological treatment plans, the current findings suggest that modulation of GM at the species level may hold promise as auxiliary diagnostic or treatment options. These findings may give further insight into a client's presenting problem from a more holistic, multidisciplinary perspective. The clear sex divergence in associations between GM and symptoms give insight into sex discrepancies in susceptibility to psychological disorders.

Unravelling the web of addictions: A network analysis approach.

Common elements across different forms of addiction suggest the possibility of comorbid addictions, as well as the transition/replacement of one form of addiction with another. This study aimed to conduct a Network analysis of symptoms of 10 forms of addictive behaviors to examine their behavioral commonalities/ interrelations. Methods: To address this aim, an online community sample of 968 adult participants (33.6% women, 66.4% men) completed self-rating questionnaires covering a range of addictive behaviors including alcohol, drugs, tobacco, sex, online gambling, internet use, internet gaming, social media use, shopping, and exercise. Their responses were examined with regularized partial correlation network analysis (EBICglasso) and a community detection algorithm (Walktrap) to identify: (a) specific links between neighboring forms of addiction; and (b) clustering of symptoms of addiction. Results: Findings showed positive network connections across different addictive behaviors, with addictive tendencies towards gambling showing the highest centrality, sequentially followed by addictive tendencies towards internet use, internet gaming, alcohol, shopping, social media use, drugs, sex, smoking, and exercise. Conclusion: Symptoms associated with disordered drug use and gambling are suggested to maintain severity of addictive disorders and increase the likelihood of developing cross addictive behaviors. Clinical implications for the assessment and treatment of addiction comorbidities and the replacement of one form of addiction with another are discussed considering these findings.

Distinguishing between trait emotional intelligence and the five-factor model of personality: additive predictive validity of emotional intelligence for negative emotional states.

There is ongoing debate on the utility of trait emotional intelligence and whether it is distinguishable from the five-factor model of personality. In study 1, we investigated the incremental validity of trait emotional intelligence in predicting negative emotional states, after controlling for the five-factor model personality traits. The TEIQue, Mini-IPIP, and DASS-21 were administered to a community based Australian sample. Three significant predictive models emerged: (1) wellbeing, and neuroticism predicting depression; (2) emotionality, and neuroticism predicting anxiety; and (3) self-control, and neuroticism predicting stress. In Study 2, we further explored the relationship between TEIQue domains, neuroticism, and negative emotional states. Three partial mediation models were found: (1) wellbeing mediated the relationship between neuroticism and depression; (2) emotionality mediated the relationship between neuroticism and anxiety; and (3) self-control mediated the relationship between neuroticism and stress. The findings highlight that trait emotional intelligence is related to, and yet distinct from extraversion, conscientiousness, agreeableness, neuroticism, and openness. They also provide support for the incremental validity of the TEIQue domains in predicting depression, anxiety, and stress, beyond the five-factor model personality traits in a community based Australian sample, with the domains of trait emotional intelligence potentially operating as protective factors from pervasive negative moods.

Postintervention and follow-up changes in caregiving behavior and representations after individually or group delivered hybrid Circle of Security-intensive intervention with New Zealand caregiver-child dyads.

The Circle of Security Intensive intervention (COS-I) aims to improve child attachment security and reduce disorganisation by improving caregiver capacities, including caregiving behavior and representations. Research on COS-I effectiveness with these goals is limited and none examines if positive changes are sustained. A recently revised hybrid COS-I protocol (COS-I-RH) incorporates Circle of Security-Parenting (COS-P) material and individual or group delivery options. We examined (1) post intervention and follow-up changes in caregiving behavior and representations after COS-I-RH and (2) if individual or group delivery moderated changes. New Zealand parent-child dyads with relationship concerns (n=36; child age M =35 months) referred to a community-based program completed COS-I-RH. Four caregiver capacities (supportive and unsupportive parenting (CTNES), parenting self-efficacy and satisfaction (PSOC)) were measured pre- and post-treatment, and one year later. Regardless of delivery mode, after COS-I-RH, parents showed large improvements on all 4 indices of caregiving behavior and representations, maintained at one-year follow-up.

Oculocardiac Reflex During ROP Exams.

PURPOSE: Reducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery. PATIENTS AND METHODS: Electrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls. RESULTS: From 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72-98%), kurtosis 1.60 and skewness -1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA) - 11, r(279)=0.33, p<0.01) and with birthweight (%OCR = 0.02 (BW) + 38, r(279) =0.35, p<0.01). The duration of bradycardia induced by ROP exam averaged 92 ± 34 seconds (range 34-240 seconds). CONCLUSION: Bradycardia is common during eye exams in the smallest premature infants with greater degree, more rapid onset and longer duration than OCR during strabismus surgery.

The role of the brain-gut-microbiota axis in psychology: The importance of considering gut microbiota in the development, perpetuation, and treatment of psychological disorders.

INTRODUCTION: The prevalence of psychological disorders remains stable despite steady increases in pharmacological treatments suggesting the need for auxiliary treatment options. Consideration of the brain-gut-microbiota axis (BGMA) has made inroads into reconceptualizing psychological illness from a more holistic perspective. While our understanding of the precise role of gut microbiota (GM) in psychological illness is in its infancy, it represents an attractive target for novel interventions. METHOD: An extensive review of relevant literature was undertaken. RESULTS: Gut microbiota are proposed to directly and indirectly influence mood, cognition, and behavior which are key components of mental health. This paper outlines how GM may be implicated in psychological disorders from etiology through to treatment and prevention using the Four P model of case formulation. CONCLUSION: Moving forward, integration of GM into the conceptualization and treatment of psychological illness will require the discipline of psychology to undergo a significant paradigm shift. While the importance of the GM in psychological well-being must be respected, it is not proposed to be a panacea, but instead, an additional arm to a multidisciplinary approach to treatment and prevention.

Correction to: Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons.

The original version of this article [1], published on 6 February 2018, contains a mistake in the 'Conclusions' section. The corrected version of the affected sentence is given below and the corrected part is marked in bold.

Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons.

BACKGROUND: Preliminary evidence suggests that the enteric microbiota may play a role in the expression of neurological symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Overlapping symptoms with the acute presentation of D-lactic acidosis has prompted the use of antibiotic treatment to target the overgrowth of species within the Streptococcus genus found in commensal enteric microbiota as a possible treatment for neurological symptoms in ME/CFS. METHODS: An open-label, repeated measures design was used to examine treatment efficacy and enable sex comparisons. Participants included 44 adult ME/CFS patients (27 females) from one specialist medical clinic with Streptococcus viable counts above 3.00 × 105 cfu/g (wet weight of faeces) and with a count greater than 5% of the total count of aerobic microorganisms. The 4-week treatment protocol included alternate weeks of Erythromycin (400 mg of erythromycin as ethyl succinate salt) twice daily and probiotic (D-lactate free multistrain probiotic, 5 × 1010 cfu twice daily). 2 × 2 repeated measures ANOVAs were used to assess sex-time interactions and effects across pre- and post-intervention for microbial, lactate and clinical outcomes. Ancillary non-parametric correlations were conducted to examine interactions between change in microbiota and clinical outcomes. RESULTS: Large treatment effects were observed for the intention-to-treat sample with a reduction in Streptococcus viable count and improvement on several clinical outcomes including total symptoms, some sleep (less awakenings, greater efficiency and quality) and cognitive symptoms (attention, processing speed, cognitive flexibility, story memory and verbal fluency). Mood, fatigue and urine D:L lactate ratio remained similar across time. Ancillary results infer that shifts in microbiota were associated with more of the variance in clinical changes for males compared with females. CONCLUSIONS: Results support the notion that specific microorganisms interact with some ME/CFS symptoms and offer promise for the therapeutic potential of targeting gut dysbiosis in this population. Streptococcus spp. are not the primary or sole producers of D-lactate. Further investigation of lactate concentrations are needed to elucidate any role of D-lactate in this population. Concurrent microbial shifts that may be associated with clinical improvement (i.e., increased Bacteroides and Bifidobacterium or decreased Clostridium in males) invite enquiry into alternative strategies for individualised treatment. Trial Registration Australian and New Zealand Clinical Trial Registry (ACTRN12614001077651) 9th October 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366933&isReview=true.

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review.

BACKGROUND: The pursuit for clarity in diagnostic and treatment pathways for the complex, chronic condition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) continues. This systematic review raises a novel question to explore possible overlapping aetiology in two distinct conditions. Similar neurocognitive symptoms and evidence of D-lactate producing bacteria in ME/CFS raise questions about shared mechanisms with the acute condition of D-lactic acidosis (D-la). METHODS: D-la case reports published between 1965 and March 2016 were reviewed for episodes describing both neurological symptoms and high D-lactate levels. Fifty-nine D-la episodes were included in the qualitative synthesis comparing D-la symptoms with ME/CFS diagnostic criteria. A narrative review of D-la mechanisms and relevance for ME/CFS was provided. RESULTS: The majority of neurological disturbances reported in D-la episodes overlapped with ME/CFS symptoms. Of these, the most frequently reported D-la symptoms were motor disturbances that appear more prominent during severe presentations of ME/CFS. Both patient groups shared a history of gastrointestinal abnormalities and evidence of bacterial dysbiosis, although only preliminary evidence supported the role of lactate-producing bacteria in ME/CFS. LIMITATIONS: Interpretation of results are constrained by both the breadth of symptoms included in ME/CFS diagnostic criteria and the conservative methodology used for D-la symptom classification. Several pathophysiological mechanisms in ME/CFS were not examined. CONCLUSIONS: Shared symptomatology and underlying microbiota-gut-brain interactions raise the possibility of a continuum of acute (D-la) versus chronic (ME/CFS) presentations related to D-lactate absorption. Measurement of D-lactate in ME/CFS is needed to effectively evaluate whether subclinical D-lactate levels affect neurological symptoms in this clinical population.

Support for the microgenderome invites enquiry into sex differences.

The microgenderome defines the interaction between microbiota, sex hormones and the immune system. Our recent research inferred support for the microgenderome by showing sex differences in microbiota-symptom associations in a clinical sample of patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS). This addendum expands upon the sex-specific pattern of associations that were observed. Interpretations are hypothesized in relation to genera versus species-level analyses and D-lactate theory. Evidence of sex-differences invites future research to consider sex comparisons in microbial function even when microbial abundance is statistically similar. Pairing assessment of clinical symptoms with microbial culture, DNA sequencing and metabolomics methods will help advance our current understandings of the role of the microbiome in health and disease.