Diagnosing callous-unemotional personality traits by heart rate orienting responses to images inducing threat and distress.

The present study aimed at developing a rather easily applicable method of testing physiological reactions to images of threats and misery. To this end, rapid-changing, transient heart rate orienting responses were used for gaining physiologically based, objective responses to the images. Additionally, subjective ratings were obtained. A significant insensitivity to other's welfare and well-being was already demonstrated as a core feature of callous-unemotional personalities. Thus, physiologically based methods may supplement and possibly improve existing assessments and, in particular, may contribute to a multimodal assessment of psychopathic traits. Out of a non-forensic community sample of 122 men, we selected two extreme groups of 30 participants with the lowest and highest callous-unemotional traits respectively, ascertained by questionnaires. As expected, participants with higher scores of callous-unemotional traits showed smaller responses to distress cues in both heart rate responses and subjective ratings. Moreover, within the group with high callous-unemotional traits heart rate responses to threatening as well as distress cues did not significantly differ from responses to neutral pictures. The study provides further evidence for the idea that a lack of responsiveness to distress cues may be seen as a central feature of callous-unemotional personalities.

Creative, yet not unique? Paranormal belief, but not self-rated creative ideation behavior is associated with a higher propensity to perceive unique meanings in randomness.

Apophenia, patternicity, and the experience of meaningful coincidences describe the propensity to perceive meaning in random arrangements, which is known to be linked with paranormal beliefs. Additionally, this trait of combining unrelated elements to create new meanings suggests an association with creativity. However, studies indicating a relationship between creativity and apophenia are scarce. To gain empirical evidence, the present study (n = 77) assessed the propensity to experience meaningful patterns in random arrangements by means of a questionnaire (coincidence questionnaire) and a behavioral measure. The applied figural association task allows to reliably differentiate between the perception of idiosyncratic/unique and intersubjective meaningful/non-unique patterns. Self-rated creative ideation behavior and paranormal beliefs were positively associated with the subjectively rated frequency of meaningful coincidences. Furthermore, participants high in both creative ideation behavior and paranormal beliefs perceived a higher number of non-unique meanings in the figural association task. Yet, participants high in paranormal beliefs additionally perceived a higher number of unique meanings. This divergence in findings suggests that creative ideation behavior and paranormal belief are associated with the perception of partly different meanings in random arrangements. In paranormal believers, this pattern of findings may indicate a lower threshold to detect meaning in meaninglessness, leading to more idiosyncratic/unique perceptions. Altogether, slight reductions of this threshold to detect meaningfulness may increase a persons' creativity; however, excessive pattern recognition may facilitate paranormal beliefs.

Clinical and Dermoscopic Features of Melanocytic Lesions on the Face Versus the External Ear.

INTRODUCTION: Melanoma of the external ear is a rare condition accounting for 7-20% of all melanomas of the head and neck region. They present classical features of extra-facial melanomas clinically and dermoscopically. In contrast, facial melanomas show peculiar patterns in dermoscopy. OBJECTIVES: To evaluate whether there are clinical and/or dermoscopic differences in melanocytic lesions located either at the external ear or on the face. METHODS: In this retrospective study we reviewed an image database for clinical and dermoscopic images of melanomas and nevi located either on the face or at the level of the external ear. RESULTS: 65 patients (37 men; 63.8%) with 65 lesions were included. We found no significant differences in comparing face melanomas with melanomas at the level of the external ear, neither clinically nor dermoscopically. However, we provided evidence for differences in some clinical and dermoscopic features of melanomas and nevi of the external ear. CONCLUSIONS: In this study, we reported no significant differences in comparing melanomas on the face with melanomas of the external ear, both clinically and dermoscopically. Furthermore, we provided data on clinical and dermoscopic differences comparing nevi and melanoma of the external ear.

Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies.

BACKGROUND: The vast majority of older people with mental illness prefer to live independently in their own homes. Barriers caused by the health care system often prevent adequate, adapted treatments. With regard to the increasing ageing of the population, the determination of effective, age-appropriate service models for elderly patients with mental illness is clearly required. The aim of this review is to examine and to evaluate multidisciplinary psychogeriatric treatment models that include home visits, particularly with regard to the effects on psychiatric symptoms, social and mental health rehabilitation and quality of life. METHODS: A systematic review was carried out of empirical studies with participants who were diagnosed with a mental illness according to ICD-10, aged 60 years or older, and who were living at home. The inclusion criteria comprised a duration of intervention of at least 12 weeks and a minimum of two interventions and domiciliary visits delivered by a multidisciplinary team. The online databases Medline, PsychInfo, Web of Science, Cochrane Register of Controlled Trials, and Google Scholar, as well as hand search, were used to search for relevant studies published between 1996 and 2016. An additional search was performed for studies published between 2016 and 2019. After removing duplicates, abstracts were screened and the remaining articles were included for full-text review. RESULTS: Of the 3536 records discovered in total, 260 abstracts appeared to be potentially eligible. Of these, 30 full-text articles were assessed for eligibility. For the additional search 415 records and abstracts were screened and 11 articles were read full text. Finally, only three studies fully met the inclusion criteria for this review. The results indicate that psychogeriatric home treatment is associated with significant improvements of psychiatric symptoms and psychosocial problems, fewer admissions to hospital and nursing homes, as well as lower costs of care. CONCLUSIONS: Psychogeriatric home treatment has positive effects on older people with mental illness. However, these findings are based upon a small number of studies. The need for further research, especially to specify the effective factors in psychogeriatric home treatment, is clearly indicated.

The propensity to perceive meaningful coincidences is associated with increased posterior alpha power during retention of information in a modified Sternberg paradigm.

There are ample inter-individual differences in the frequency with which people perceive meaningful coincidences. Previous research has identified increased proactive interference, that is a reduced working memory capacity, as one possible mechanism associated with this phenomenon. The present study aimed at extending this finding into the domain of neuroscience, (1) by assessing EEG alpha oscillations during the retention of information, (2) by replicating the behavioral link between meaningful coincidences and proactive interference. In a sample of 52 participants, the behavioral replication was successful. Furthermore, participants who perceived more meaningful coincidences showed higher alpha power increases at parietal-occipital sites, and at the same time, displayed lower alpha power increases at frontal areas, during retention of information. This neurophysiological activation pattern further underlines the assumption that participants who perceive more meaningful coincidences show lower working memory capacities, since increased alpha power at parietal areas reflects a higher load on working memory demands.

Trait positive affect and students' prefrontal EEG alpha asymmetry responses during a simulated exam situation.

Affective dispositions may shape students' typical ways of coping when faced with demanding performance situations in their educational lives. We recorded frontal EEG alpha asymmetry responses in psychology students (n = 62) during the course of a scenario designed to simulate a real examination, which required oral explanation of statistical concepts. While students with lower levels of trait positive affect (PANAS) showed relative right hemispheric activation, sustained relative left hemispheric activation was observed in students with higher levels of trait positive affect. In line with relevant models of frontal brain asymmetry, the findings suggest that students' coping behaviors in the context of academic performance situations are in part instantaneously initiated, which is reflected in spontaneous activation of relative approach versus avoidance motivation. Independently of negative affect and momentary affective states, trait positive affectivity seems to be linked to recruitment of brain processes supporting a more adaptive response in that matter.

Age-moderating effect in prepotent response inhibition in boys with Asperger syndrome: a 2.5 years longitudinal study.

Following our previous cross-sectional analysis, indicating age-related improvements of response inhibition in a random-motor-generation task (MPT) in adolescents with Asperger syndrome (AS), the present study reports data from a 2.5-year follow-up examination in the original sample. We found more marked improvements within the follow-up interval in younger AS children, while older AS boys as well as typically developing (TD) boys remained at a relatively constant level throughout. The current longitudinal study further substantiates the notion that AS children (on average) catch up with TD children when they grow older as regards the basic inhibition of developing routine response patterns.

Body mass index may predict the response to ipilimumab in metastatic melanoma: An observational multi-centre study.

INTRODUCTION: Immunotherapy is a well-established treatment option in patients with metastatic melanoma. However, biomarkers that can be used to predict a response in these patients have not yet been found, putting patients at risk of severe side effects. METHODS: In this retrospective analysis, we investigated the association between the body mass index and ipilimumab treatment response in patients with metastatic melanoma. Patients with metastatic melanoma who received a monotherapy of up to 4 doses of ipilimumab (3 mg/kg) every 3 weeks from 2011 to 2014 in three major hospitals in Austria were included. Patients were classified into two groups: normal group (BMI<25) and overweight group (BMI≥25). RESULTS: 40 patients had a normal BMI, and 36 had a BMI above normal. Patients with a BMI that was above normal showed significantly higher response rates (p = 0.024, χ2), and lower likelihood of brain metastases (p = 0.012, χ2). No differences were found between both groups with respect to gender (p = 0.324, χ2), T-stage (p = 0.197, χ2), or the occurrence of side effects (p = 0.646, χ2). Patients with a BMI above normal showed a trend towards longer overall survival (p = 0.056, Log-Rank), but no difference was found regarding progression-free survival (p = 0.924, Log-Rank). CONCLUSIONS: The BMI correlated with the response to ipilimumab treatment in a cohort of metastatic melanoma patients.

Reappraisal inventiveness: impact of appropriate brain activation during efforts to generate alternative appraisals on the perception of chronic stress in women.

BACKGROUND AND OBJECTIVES: Previous research indicated that more left-lateralized prefrontal activation during cognitive reappraisal efforts was linked to a greater capacity for generating reappraisals, which is a prerequisite for the effective implementation of cognitive reappraisal in everyday life. The present study examined whether the supposedly appropriate brain activation is relevant in terms of more distal outcomes, i.e., chronic stress perception. DESIGN AND METHODS: Prefrontal EEG alpha asymmetry was recorded while female participants were generating reappraisals for stressful events and was correlated with their self-reported chronic stress levels in everyday life (n = 80). RESULTS: Women showing less left-lateralized brain activity in the ventrolateral prefrontal cortex during cognitive reappraisal efforts reported experiencing more stress in their daily lives. This effect was independent of self-efficacy beliefs in managing negative emotions. CONCLUSION: These findings underline the practical relevance of individual differences in appropriate brain activation during emotion regulation efforts and the assumedly related basic capacity for the generation of cognitive reappraisals to the feeling of being stressed. Implications include the selection of interventions for the improvement of coping with stress in women in whom the capability for appropriate brain activation during reappraisal efforts may be impaired, e.g., due to depression or old age.

DSM-5 personality trait domains and withdrawal versus approach motivational tendencies in response to the perception of other people's desperation and angry aggression.

Expressions of affect communicate social messages, which trigger approach and withdrawal/avoidance motivational tendencies in the observer. The present study investigated relationships between inter-individual differences in the motivational responses to other people's affect expressions and DSM-5 personality trait domains. State-dependent, transient EEG alpha asymmetry responses provided indicators of the relative activation of withdrawal versus approach motivation in the respective social-emotional contexts. The Personality Inventory for the DSM-5 (PID-5) was used for the assessment of personality traits in a non-clinical sample. Individuals with higher levels of Antagonism showed relative activation of approach versus withdrawal motivation (as indicated by less relative right frontal activation) in response to confrontation with auditory expressions of angry aggression, whereas participants with higher levels of Detachment showed relative activation of withdrawal versus approach motivation (as indicated by greater relative right frontal activation) to the perception of other people's desperate crying.

Meaning in meaninglessness: The propensity to perceive meaningful patterns in coincident events and randomly arranged stimuli is linked to enhanced attention in early sensory processing.

Perception of objectively independent events or stimuli as being significantly connected and the associated proneness to perceive meaningful patterns constitute part of the positive symptoms of schizophrenia, which are associated with altered attentional processes in lateralized speech perception. Since perceiving meaningful patterns is to some extent already prevalent in the general population, the aim of the study was to investigate whether the propensity to experience meaningful patterns in co-occurring events and random stimuli may be associated with similar altered attentional processes in lateralized speech perception. Self-reported and behavioral indicators of the perception of meaningful patterns were assessed in non-clinical individuals, along with EEG auditory evoked potentials during the performance of an attention related lateralized speech perception task (Dichotic Listening Test). A greater propensity to perceive meaningful patterns was associated with higher N1 amplitudes of the evoked potentials to the onset of the dichotically presented consonant-vowel syllables, indicating enhanced automatic attention in early sensory processing. The study suggests that more basic mechanisms in how people associate events may play a greater role in the cognitive biases that are manifest in personality expressions such as positive schizotypy, rather than that positive schizotypy moderates these cognitive biases directly.

Dermoscopic characteristics of melanoma according to the criteria "ulceration" and "mitotic rate" of the AJCC 2009 staging system for melanoma.

OBJECTIVE: The present study was conducted to identify possible dermoscopic patterns, associated with mitotic rate > 1/mm2, histological ulceration in melanoma and metastatic disease. METHODS: For this retrospective data analysis all clinical and dermoscopic digital images of primary malignant melanomas between 2008 and 2013 documented at the Department of Dermatology Graz were included, using the internal image data-base. 550 patients with 559 melanomas were included. RESULTS: While clinical or dermoscopic analysis considered ulceration to be present in 120 (21.5%) and 117 (20.9%) of all lesions, respectively, histopathology reported ulceration in only 96 cases (17.2%). The presence of milky-red areas, shiny-white streaks, a blue-white veil and blue-grey areas in dermoscopy is highly correlated with histological ulceration and a mitotic rate > 1/mm2. The dermoscopic patterns shiny-white streaks, milky-red areas and blue-white veil were also significantly associated with development of distant metastases. CONCLUSION: Our study proves a significant correlation between the dermoscopic patterns "blue white veil", "milky-red areas"and "shiny-white streaks"and the histological findings "ulceration"and "mitotic rate > 1/mm2". Furthermore these dermoscopic patterns are highly related to distant metastases. Thus, dermoscopy renders earlier prognostic statements possible.

The Use of Bright and Dark Types of Humour is Rooted in the Brain.

The ways in which humour can be used are related to the manifold interpersonal functions humour can serve, some of which are positive, and some negative. In the present study, phasic changes in the functional coupling of prefrontal and posterior cortex (EEG coherence) during other people's auditory displays of happy and sad mood were recorded to predict people's typical use of humour in social interactions. Greater use of benevolent humour, the intentions of which are in keeping with the characteristics of "laughing-with" humour, was associated with greater decreases of prefrontal-posterior coupling during the processing of happy laughter. More loose prefrontal-posterior coupling indicates loosening of control of the prefrontal cortex over the incoming perceptual information, thereby opening up the perceptual gate and allowing the brain to become more affected by the social-emotional signals. Greater use of humour styles linked to malicious intentions of "laughing-at" humour was associated with responses indicating a wider opened perceptual gate during the processing of other people's crying. The findings are consistent with the idea that typical humour styles develop in line with the rewarding values of their outcomes (e.g., interaction partners are happy or hurt), which in turn are defined through the individuals' latent interpersonal goals.

The capacity for generating cognitive reappraisals is reflected in asymmetric activation of frontal brain regions.

Encouraging patients to use cognitive reappraisal constitutes the core of modern psychotherapeutic approaches. However, evidence for specific neural correlates of the capacity for cognitive reappraisal, which is a necessary prerequisite for the effective implementation of cognitive reappraisal in everyday life, has been sparse to date. In the present study, the capacity for cognitive reappraisal was studied in terms of the participants' inventiveness in generating alternative appraisals of anger-evoking events, and was correlated with frontal EEG alpha asymmetry recorded while the participants were generating reappraisals as well as during a common creative idea generation task. During cognitive reappraisal efforts, individuals higher on the capacity for generating cognitive reappraisals showed more left-lateralized activity in lateral prefrontal cortex, specifically in ventrolateral prefrontal cortex extending toward the frontal pole. This effect was observed independently from the activation during novel idea generation without emotional component, indicating that specific demands are implicated in the generation of reappraisals of emotional events. Taken together, the results indicate that individuals higher on the capacity for cognitive reappraisal are more capable or more prone to recruit appropriate brain regions when the situation demands coming up with alternative appraisals of stressful events. The findings may stimulate the development of more individually targeted interventions.

Creative ways to well-being: Reappraisal inventiveness in the context of anger-evoking situations.

Neuroscientific studies in the field of creativity mainly focused on tasks drawing on basic verbal divergent thinking demands. This study took a step further by investigating brain mechanisms in response to other types of creative behavior, involving more "real-life" creativity demands in the context of emotion regulation and well-being. Specifically, functional patterns of EEG alpha activity were investigated while participants were required to generate as many and as different ways as possible to reappraise presented anger-eliciting situations in a manner that reduces their anger. Cognitive reappraisal involves some of the same cognitive processes as in conventional verbal creativity tasks, inasmuch as it requires an individual to inhibit or disengage from an emotional event, to shift attention between different perspectives, and to flexibly adopt new solutions. To examine whether alpha oscillations during cognitive reappraisal are different from those during conventional creative ideation, the EEG was also assessed during performance of the Alternative Uses task, requiring individuals to generate as many and as original uses of an object as possible. While cognitive reappraisal was associated with a similar pattern of alpha power as observed in conventional verbal creative ideation, the former yielded significantly stronger alpha power increases at prefrontal sites, along with lower alpha increases at more posterior cortical sites, indicating higher cognitive control and less spontaneous imaginative thought processes in the generation of effective strategies to regulate an ongoing negative emotional state.

Age-related differences in inhibitory control and memory updating in boys with Asperger syndrome.

Deficits in specific executive domains are highly prevalent in autism spectrum disorder; however, age-related improvements in executive functions (reflecting prefrontal maturational changes) have been reported even in individuals diagnosed with autism. The current study examined two components of cognitive flexibility (inhibition of prepotent responses and memory monitoring/updating) by using a random-motor-generation task (MPT) in a group of 23 boys with Asperger syndrome (AS) and 23 matched healthy controls. We found poorer inhibition and more repetitive responses in younger AS children solely, but comparable memory monitoring/updating skills across groups. Overall, our findings correspond well with previous studies and reveal that even in AS specific EFs may improve with age and, thus, call for a more differentiated view of executive (dys) function profiles in children diagnosed with AS. Tests such as the random-motor-generation task may help to disentangle more specific processes of executive deficits in autism spectrum disorder as compared to the more classical tests.

The fear of other persons' laughter: Poor neuronal protection against social signals of anger and aggression.

The fear of other persons' laughter (gelotophobia) occurs in the context of several psychiatric conditions, particularly in the schizophrenia spectrum and social phobia. It entails severe personal and inter-personal problems including heightened aggression and possibly violence. Individuals with gelotophobia (n=30; 24 with social phobia or Cluster A diagnosis) and matched symptom-free controls (n=30) were drawn from a large screening sample (n=1440). EEG coherences were recorded during the confrontation with other people's affect expressions, to investigate the brain's modulatory control over the emotionally laden perceptual input. Gelotophobia was associated with more loose functional coupling of prefrontal and posterior cortex during the processing of expressions of anger and aggression, thus leaving the individual relatively unprotected from becoming affected by these social signals. The brain's response to social signals of anger/aggression and the accompanied heightened permeability for this kind of information explains the particular sensitivity to actual or supposed malicious aspects of laughter (and possibly of other ambiguous social signals) in individuals with gelotophobia, which represents the core feature of the condition. Heightened perception of stimuli that could be perceived as offensive, which is inherent in several psychiatric conditions, may be particularly evident in the fear of other persons' laughter.

Affective processing in positive schizotypy: Loose control of social-emotional information.

Behavioral studies suggested heightened impact of emotionally laden perceptual input in schizophrenia spectrum disorders, in particular in patients with prominent positive symptoms. De-coupling of prefrontal and posterior cortices during stimulus processing, which is related to loosening of control of the prefrontal cortex over incoming affectively laden information, may underlie this abnormality. Pre-selected groups of individuals with low versus high positive schizotypy (lower and upper quartile of a large screening sample) were tested. During exposure to auditory displays of strong emotions (anger, sadness, cheerfulness), individuals with elevated levels of positive schizotypal symptoms showed lesser prefrontal-posterior coupling (EEG coherence) than their symptom-free counterparts (right hemisphere). This applied to negative emotions in particular and was most pronounced during confrontation with anger. The findings indicate a link between positive symptoms and a heightened impact particularly of threatening emotionally laden stimuli which might lead to exacerbation of positive symptoms and inappropriate behavior in interpersonal situations.

Prefrontal EEG alpha asymmetry changes while observing disaster happening to other people: cardiac correlates and prediction of emotional impact.

Changes of EEG alpha asymmetry in terms of increased right versus left sided activity in prefrontal cortex are considered to index activation of the withdrawal/avoidance motivational system. The present study aimed to add evidence of the validity of individual differences in the EEG alpha asymmetry response and their relevance regarding the impact of emotional events. The magnitude of the EEG alpha asymmetry response while watching a film consisting of scenes of real injury and death correlated with components of transient cardiac responses to sudden horrifying events happening to persons in the film which index withdrawal/avoidance motivation and heightened attention and perceptual intake. Additionally, it predicted greater mood deterioration following the film and film-related intrusive memories and avoidance over the following week. The study provides further evidence for prefrontal EEG alpha asymmetry changes in response to relevant stimuli reflecting an individual's sensitivity to negative social-emotional cues encountered in everyday life.

Laughter as a social rejection cue: gelotophobia and transient cardiac responses to other persons' laughter and insult.

Other persons' laughter, normally perceived as a signal that persons are friendly and inviting others to approach, can also be perceived as a cue of social rejection. In this study, prerecorded laughter was placed in a realistic and personally relevant context, and participants' responses were related to gelotophobia, a trait predisposing to perceiving laughter as a cue of social rejection. Individuals with gelotophobia showed marked heart rate deceleration in response to the laughter stimulus, possibly indicating a "freezing-like" response. Moreover, cardiac responses to anger provocation by overtly insulting statements indicated heightened aggressive anger in response to cumulated social threat. The study adds to recent research showing specific cardiac responses to social rejection and to the literature on social rejection sensitivity by demonstrating the value of using well interpretable physiological measures in this research context.