Bidirectionality of LF when the movie makes you sad: Effects of negative emotions on heart rate variability among patients with major depression.

OBJECTIVES: Heart rate variability (HRV) reflects the capacity to adapt to internal and environmental changes. Decreased HRV may indicate inadequate adaptive capacity. This study aims to investigate the relationship between the heart and brain's adaptive abilities, both at rest and when negative emotions are stimulated in depression. SUBJECTS AND METHODS: The study included 30 patients (20 female, 10 male) with major depression (mean age = 29.8 ± 7.8) and 30 healthy controls, all of whom had similar characteristics in terms of age and gender, selected through convenience sampling. The patients were drug-free at the time of the assessment. Holter recordings were obtained while subjects watched videos stimulating anger, fear, sadness, and a neutral video, and at rest, HRV parameters were calculated. To control for interindividual variability and account for paired sampling, linear mixed effects models were employed. RESULTS: Watching the 'sadness video' led to an increase in low frequency band (LF) [LF change (Control vs depression); Difference:-620.80 df:107 t:-2.093 P:0.039] and LF/high frequency band ratio (LF/HF) [LF/HF change (control vs depression group); Difference:-1.718 df:105 t:-2.374 P:0.020] in the depression group. The video led to a decrease in LF and LF/HF in the controls. Although the differences between the conditions and interactions with the group were significant, the effects were independent of depression severity. CONCLUSION: In depression, brain's regulatory effect on the heart differed from controls in the sadness condition, possibly due to increased arousal levels in subjects with depression and their inability to suppress sympathetic activity when a state of sadness is stimulated.

Effects of Sadness and Fear on Moral Judgments in Public Emergency Events.

With the rapid development of society and the deteriorating natural environment, there has been an increase in public emergencies. This study aimed to explore how sadness and fear in the context of public emergencies influence moral judgments. This research first induced feelings of sadness and fear by using videos about public emergencies and music, and then used moral scenarios from the CNI model (C parameter: sensitivity to consequences; N parameter: sensitivity to norms; I parameter: general preference for inaction) to assess participants' moral thinking. In Study 1, participants were divided into a sadness group and a neutral group, while in Study 2, participants were divided into a fear group and a neutral group. During the experiment, participants were exposed to different videos related to public emergencies to induce the corresponding emotions, and emotional music was continuously played throughout the entire experiment. Participants were then asked to answer questions requiring moral judgments. The results showed that based on the CNI model, sadness induced in the context of public emergencies significantly increased the C parameter, without affecting the N or I parameters. Fear increased the I parameter, without affecting the C or I parameters. That is, sadness and fear induced in the context of a public emergency can influence moral judgments. Specifically, sadness increases individuals' sensitivity to consequences and fear increases the general preference for inaction in moral judgments.

Modeling longitudinal relationships between sleep disturbances and depressed mood in postpartum: A cross-lagged panel design.

BACKGROUND: This short communication explores the interrelationships between depressed mood and sleep disturbances in one-year postpartum period. METHODS: Utilizing data from the Interaction of Gene and Environment of Depression during PostPartum Cohort (IGEDEPP) involving 3310 French postpartum women, we employed a cross-lagged panel model (CLPM) to analyze the relationships between these two symptoms, across three time points (immediate postpartum [<1 week after delivery], early postpartum [<2 months after delivery], and late postpartum [2 months to 1 years after delivery]). RESULTS: Depressed mood significantly influences sleep disturbances in late postpartum (ß = 0.096, z-value = 7.4; p < 0.001) but not in early postpartum (p-value = 0.9). We found no cross-lagged influence of sleep disturbances on depressed mood in early (p = 0.066) or in late postpartum (p = 0.060). Moreover, depressed mood and sleep disturbances in immediate postpartum are predictive of similar symptoms in the two other postpartum periods (between each of the three periods, p = 0.006 and p < 0.001 for depressed mood, and p = 0.039 and p < 0.001 for sleep disturbances), thus demonstrating the stability of these symptoms over time. LIMITATIONS: Although conducted with a prospectively assessed cohort, this study faces limitations due to potential methodological biases. CONCLUSIONS: This study is a pioneering analysis of mutual causal interactions between depressed mood and sleep disturbances in the postpartum period, highlighting the need for vigilant monitoring, early detection, prevention of worsen outcomes and intervention on these symptoms.

The Impact of Dupilumab on Work Productivity and Emotional Health in CRSwNP: A Multicentric Study in Northeast Italy.

Chronic rhinosinusitis with nasal polyps (CRSwNP) in the severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with Dupilumab in different rhinological units were considered for this study via their evaluation at the baseline at first and the consequential follow-up at 6-, 12-, and 24 months from the first administration. At baseline (T0) and at each follow-up, patients underwent NPS, Sinonasal Outcome Test (SNOT)-22, Visual Analogue Scale (VAS) for smell, and Sniffin' sticks identification test (SSIT). The SNOT-22 domains for function and emotion were also analysed separately. Two hundred and seventeen patients with at least 6 months of follow-up were included. All parameters have improved during treatment (p < 0.0001). Noticeably, both the function and emotion SNOT-22 domains have improved within 6 months of treatment and have continued to progress during every interval within 12 months from the baseline, positively influencing patients' emotivity and augmenting their social and economic performances. Dupilumab improves the QoL of CRSwNP patients with good effects on the reported productivity and emotional health. Clinicians should pay attention to these two aspects when dealing with patients affected by severe CRSwNP.

Does sadness bring myopia: an intertemporal choice experiment with college students.

Introduction: While economics often interprets individual intertemporal choice preferences through the rationality assumption of utility maximization, the reality is that as emotional beings, individuals' preferences for intertemporal behavior are much more diverse and inconsistent. Prior research has predominantly focused on positive or negative emotions based on prospect theory, such as anxiety, anger, disgust, and depression. However, there has been relatively little research on how sadness affects individuals' preferences for immediate and future rewards. Methods: In this study, 170 college students are recruited as participants, and their emotions are primed with a video before engaging in an intertemporal task. Covariance analysis and logit regression model are established to examine the main and interactive effects of sadness on individuals' immediate reward preferences. Results: The findings reveal that sadness led individuals to prefer smaller immediate rewards, demonstrating a more myopic behavioral pattern, but didn't affect time discount rate. As the reward baseline increases, sadness's impact on immediate reward preferences is more pronounced, exacerbating individuals' myopic behavior. Discussion: In conclusion, these findings underscore the importance of considering emotional states in economic decision-making models and suggest avenues for future research to explore the complex dynamics of emotions and intertemporal choices.

Associations Between Neighborhood Resources and Youths' Response to Reward Omission in a Task Modeling Negatively Biased Environments.

OBJECTIVE: Neighborhoods provide essential resources (eg, education, safe housing, green space) that influence neurodevelopment and mental health. However, we need a clearer understanding of the mechanisms mediating these relationships. Limited access to neighborhood resources may hinder youths from achieving their goals and, over time, shape their behavioral and neurobiological response to negatively biased environments blocking goals and rewards. METHOD: To test this hypothesis, 211 youths (aged ∼13.0 years, 48% boys, 62% identifying as White, 75% with a psychiatric disorder diagnosis) performed a task during functional magnetic resonance imaging. Initially, rewards depended on performance (unbiased condition); but later, rewards were randomly withheld under the pretense that youths did not perform adequately (negatively biased condition), a manipulation that elicits frustration, sadness, and a broad response in neural networks. We investigated associations between the Childhood Opportunity Index (COI), which quantifies access to youth-relevant neighborhood features in 1 metric, and the multimodal response to the negatively biased condition, controlling for age, sex, medication, and psychopathology. RESULTS: Youths from less-resourced neighborhoods responded with less anger (p < .001, marginal R2 = 0.42) and more sadness (p < .001, marginal R2 = 0.46) to the negatively biased condition than youths from well-resourced neighborhoods. On the neurobiological level, lower COI scores were associated with a more localized processing mode (p = .039, marginal R2 = 0.076), reduced connectivity between the somatic-motor-salience and the control network (p = .041, marginal R2 = 0.040), and fewer provincial hubs in the somatic-motor-salience, control, and default mode networks (all pFWE < .05). CONCLUSION: The present study adds to a growing literature documenting how inequity may affect the brain and emotions in youths. Future work should test whether findings generalize to more diverse samples and should explore effects on neurodevelopmental trajectories and emerging mood disorders during adolescence. DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

Peripheral inflammation is associated with impaired sadness recognition in euthymic bipolar patients.

BACKGROUND: Inflammation impairs cognitive function in healthy individuals and people with psychiatric disorders, such as bipolar disorder (BD). This effect may also impact emotion recognition, a fundamental element of social cognition. Our study aimed to investigate the relationships between pro-inflammatory cytokines and emotion recognition in euthymic BD patients and healthy controls (HCs). METHODS: We recruited forty-four euthymic BD patients and forty healthy controls (HCs) and measured their inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and TNF-α. We applied validated cognitive tasks, the Wisconsin Card-Sorting Test (WCST) and Continuous Performance Test (CPT), and a social cognitive task for emotion recognition, Diagnostic Analyses of Nonverbal Accuracy, Taiwanese Version (DANVA-2-TW). We analyzed the relationships between cytokines and cognition and then explored possible predictive factors of sadness recognition accuracy. RESULTS: Regarding pro-inflammatory cytokines, TNF-α was elevated in euthymic BD patients relative to HCs. In euthymic BD patients only, higher TNF-α levels were associated with lower accuracy of sadness recognition. Regression analysis revealed that TNF-α was an independent predictive factor of sadness recognition in patients with euthymic BD when neurocognition was controlled for. CONCLUSIONS: We demonstrated that enhanced inflammation, indicated by increased TNF-α, was an independent predictive factor of impaired sadness recognition in BD patients but not in HCs. Our findings suggested a direct influence of TNF-α on sadness recognition and indicated vulnerability to depression in euthymic BD patients with chronic inflammation.

Fear of Death in Colombian Nursing Students.

Introduction: Death is a natural phenomenon inherent to the human condition and an inevitable consequence of life. As future professionals, nursing students should face the process of death and recognize their limitations, because emotional aspects can influence the quality of health care, especially in Spanish-speaking countries. This study aimed to quantify the level of fear of death among nursing students in a higher education institution in a region of Colombia. Methods: A quantitative correlational study including 258 university students selected by stratified sampling were administered the Collet-Lester Fear of Death Scale; the results were analyzed for the age, religion, marital status, number of children, and academic level of the respondents. Results: On average, the students were 22.9 years old; 83.3% of them were female, 75.6% were Catholic, 14.1% had at least one child, and 66.7% had experienced bereavement in the family. An association was found between the female gender and the fear of one's own death (p = .025). Conclusion: These findings differ from those reported in other Latin American countries where higher academic level and clinical experience are related to lower fear of death.

Acaricidal activity of synthetic spilanthol derivative against ticks of medical and veterinary importance.

The ANESPSAT, a synthetic spilanthol derivative, and its nanoformulation were evaluated against Rhipicephalus microplus and Amblyomma sculptum ticks. ANESPSAT activity was compared with spilanthol and derivatives (ANESPE and others). The compound was synthesized in a gram-scale by a 2-step process, comprising a direct ester amidation and a Horner-Wadsworth- Emmons reaction. The nanoemulsions were produced by coarse homogenization followed by high-energy ultrasonication, in which hydrodynamic diameter, polydispersity index, and zeta potential remained stable. The spilanthol-eugenol hybrid derivatives did not show significant acaricidal activity. ANESPE killed 83% of the R. microplus larvae at 30 mg.mL-1, while ANESPSAT killed 97% at 0.5 mg.mL-1, showing to be the most active compound. Spilanthol and ANESPSAT had similar high mortality rates for tick larvae, with LC50 values of 0.10 and 0.14 mg.mL-1 for R. microplus larvae, and 0.04 and 0.48 mg.mL-1 for A. sculptum larvae, respectively. The efficacy of spilanthol was lower against R. microplus engorged females when compared with ANESPSAT, which was highly effective (>98%) against R. microplus engorged females. The nanoemulsion with ANESPSAT was effective against tick females, preventing egg laying and achieving 100% efficacy at 2.5 mg.mL-1. Spilanthol had only 59% efficacy at 10 mg.mL-1. The results suggest that ANESPSAT, a natural product derivative, could be used in novel formulations for tick management that might be safer and environmentally friendly.

Personality traits and depressive symptoms among Chinese older people: A network approach.

BACKGROUND: The present study aims to investigate the network structure of depressive symptoms, the interrelationships between individual personality traits and depressive symptoms, and gender differences among Chinese older people aged 60 and above. METHOD: We performed network analyses with a regularized Graphical Gaussian Model and a case-dropping bootstrap approach. A sample of 4876 older Chinese people aged 60+ was included in the analyses. We investigated the central symptoms in the depression network and the bridge nodes that connect personality facets and depressive symptoms. Gender differences were investigated by testing the global strength, network invariance, and edge weights. RESULTS: Sadness and depressed mood were the most central depressive symptoms, while somatic symptoms such as restless sleep were the least central. Neurotic facets, particularly "worry a lot" and "get nervous easily", played significant bridging roles in the web of personality traits and depressive symptoms. Gender differences were observed in three edges among different personality traits (rude-worried, original-worried, and forgiving-nervous). LIMITATION: The study adopts a cross-sectional dataset, and therefore, cannot track the network changes over time or conclude a causal relationship. DISCUSSION: The study calls for more focus and prioritization on sadness, depressed mood and neurotic traits in the identification of depression among older Chinese people. Future researchers and practitioners should better understand of older Chinese adults' worry and nervousness to develop appropriate practices and policies.

Relationships Between Meaning in Life and Positive and Negative Spirituality in a Field Setting in Japan.

This study examined the relationships between positive/negative spirituality and meaning in life at two religious sites in Japan. Participants reported greater sadness and less meaning in life at Koyasan Okunoin, a temple with graves surrounded by nature, than at Nachi Kumano Taisha, a shrine with a waterfall. However, greater feelings of happiness protected meaning in life in the presence of sadness at Koyasan. Additionally, participants who felt a sense of awe reported greater meaning in life through self-liberation, regardless of the sites. The results provide new insights into meaning in life from the two sides of spirituality.

Not all negative emotions are equal - Sadness and anger develop differently and their adaptivity is age-graded.

We argue that a comprehensive understanding of emotional development across adulthood must go beyond broad dimensions of affect and consider discrete emotions. Current evidence focuses on sadness and anger, two negative emotions that exert contrasting age trajectories because anger has high adaptive value in young adulthood, when people have abundant resources and need to carve out a niche in society, whereas sadness has high adaptive value in old age, a time of declining resources that requires adaptation to increasingly unattainable goals. We conclude that our position about the age-graded experience and adaptive value of emotions should hold for a variety of negative and positive emotions.

When eco-anger (but not eco-anxiety nor eco-sadness) makes you change! A temporal network approach to the emotional experience of climate change.

Research on the emotional experience of climate change has become a hot topic. Yet uncertainties remain regarding the interplay between climate change-related emotions (i.e., eco-anxiety, eco-anger, eco-sadness), general emotions (i.e., regardless of climate change), and pro-environmental behaviors. Most previous research has focused on cross-sectional studies, and eco-emotions in everyday life have seldom been considered. In this preregistered study, 102 participants from the general population rated their eco-emotions (i.e., eco-anxiety, eco-anger, eco-sadness), general emotions (i.e., anxiety, anger, sadness), and pro-environmental intentions and behaviors daily over a 60-day period. Using a multilevel vector autoregressive approach, we computed three network models representing temporal (i.e., from one time-point to the next), contemporaneous (i.e., during the same time-frame), and between-subject (i.e., similar to cross-sectional approach) associations between variables. Results show that eco-anger was the only predictor of pro-environmental intentions and behaviors over time. At the contemporaneous level, the momentary experience of each eco-emotion was associated with the momentary emotional experience of the corresponding general emotion, indicating the distinctiveness of each eco-emotion and the correspondence between its experience and that of its general, non-climate-related emotion. Overall, our findings 1) emphasize the driving role of eco-anger in prompting pro-environmental behaviors over time, 2) suggest a functional and experiential distinction between eco-emotions, and 3) provide data-driven clues for the field's larger quest to establish the scientific foundations of eco-emotions.

Negative mood and optimism bias: An experimental investigation of sadness and belief updating.

BACKGROUND AND OBJECTIVES: Understanding how individuals integrate new information to form beliefs under changing emotional conditions is crucial to describing decision-making processes. Previous research suggests that although most people demonstrate bias toward optimistic appraisals of new information when updating beliefs, individuals with dysphoric psychiatric conditions (e.g., major depression) do not demonstrate this same bias. Despite these findings, limited research has investigated the relationship between affective states and belief updating processes. METHODS: We induced neutral and sad moods in participants and had them complete a belief-updating paradigm by estimating the likelihood of negative future events happening to them, viewing the actual likelihood, and then re-estimating their perceived likelihood. RESULTS: We observed that individuals updated their beliefs more after receiving desirable information relative to undesirable information under neutral conditions. Further, we found that individuals did not demonstrate unrealistic optimism under negative affective conditions. LIMITATIONS: This study incorporated a population of university students under laboratory conditions and would benefit from replication and extension in clinical populations and naturalistic settings. CONCLUSIONS: These findings suggest that momentary fluctuations in mood affect how individuals integrate information to form beliefs.

Preliminary results of the effect of music therapy treatment on anxiety, sadness, physical discomfort, mood, and quality of life in hospitalized onco-haematological patients.

BACKGROUND: Physical and psychological distress may occur in patients facing an onco-haematological diagnosis and undergoing complex therapies such as intensive chemotherapy, stem cell transplantation, and immunotherapy. Studies have shown the need for incorporating different therapeutic modalities to respond to patients' physical and psychosocial needs. AIMS: The purpose of this study was to evaluate the effectiveness of music therapy treatment on mood, anxiety, depression, and physical discomfort in hospitalized onco-haematological patients. METHODS: Forty patients were included in this music therapy study from November 2021 to May 2023. Treatment consisted of individual weekly music therapy sessions. Participants completed the following evaluation instruments before and after the intervention: the Hospital Anxiety and Depression Scale (HADS), Profile of Mood States-Short Form A-Version (POMS-A), and European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire-30 (EORTC QLQ-C30). A three-item numerical rating scale (NRS) for anxiety, sadness, and physical discomfort was administered at the beginning and end of each session (pre-/postsession). RESULTS: Differences (p < 0.05) were shown in NRS scores for anxiety, sadness, and physical discomfort before and after the music therapy sessions. Quality of life (QoL) was affected in almost all items, and patients could be anxious at a nonclinical level, but they were clinically depressed. EORTC QLQ-C30 scores for insomnia and pain related to the hospitalization process got worse after discharge. CONCLUSIONS: The interim results of our study showed that music therapy sessions can positively change emotional distress and improve the mood of haematological patients after every session. Despite the difficulties and limitations of this study, this preliminary report contributes to a greater understanding of the potential benefits of music therapy in hospitalized onco-haematological patients.

Visual metaphor of sadness in poetry comics: a socio-cognitive perspective.

Earlier literature on conceptual metaphor studies has extensively examined verbal metaphors of sadness in different text types and with cultural variations. However, there has been by far limited research on the visual metaphor of sadness. Adopting a socio-cognitive perspective, this study investigates the conceptual metaphor of sadness in the exemplary case of Chinese poetry comics drawn by Cai Zhizhong. The findings reveal that (1) BEING SAD IS BEING CONFRONTED WITH NATURAL FORCE and BEING SAD IS BEING PHYSICALLY ISOLATED are the two most frequently occurring visual metaphors across the panels; (2) all the visual metaphors at play can be explained according to the conceptual metaphor theory; (3) SADNESS IS BITTERSWEET FOOD OR DRINK and BEING SAD IS BEING PHYSICALLY ISOLATED are two additional kinds of sadness metaphors identified; and (4) the visual metaphors of sadness with Chinese cultural variations are rooted in mainstream Chinese cultural philosophies in the relevant period of history. The article also discusses the underlying mechanisms of the investigated visual metaphors in the Chinese culture by unveiling three cultural characteristics in the particular context.

The voices of youths in COVID-19 times: exploring young people's emotional representations.

Since the spread of the COVID-19 virus worldwide, the pandemic had psychological consequences for the entire population for various reasons including restrictions, isolation, and socioeconomic changes. Young people were particularly affected by these psychological consequences, which formed the focus of the mental health concerns voiced by the World Health Organization. This research aimed to analyze, first-hand, the primary emotions that COVID-19 evoked in young Spanish people after two years of the pandemic. Participants were recruited through a snowball sampling procedure using emails, virtual platforms of the schools, and social networks, and a google forms questionnaire was administered for data collection. A total of 479 Spanish young people (18-36 years) participated in this study. The questionnaire consisted of a free-association exercise based on the Grid Elaboration Method (GEM) to analyze the participants' emotional representations of COVID-19. In addition, lexical analysis was used to analyze the text corpus. As a result, it could be observed that sadness was the core emotion experienced among young people, followed by fear. Specifically, emotional breakdown, fear, fatigue, and anger figured centrally in their emotional representations. Moreover, the findings revealed new patterns of self- and onward blaming towards youths. It was concluded that results of this research provide important clues for managing the mental health of young people, particularly during future pandemics.

Naïve Theories of Emotions: Why People Might (Not) Be Uncertain or in Conflict About Felt Emotions.

Beliefs about conflict and uncertainty over felt emotions-for Joy, Pride, Sadness, Jealousy and Envy events-were studied by means of Yes/No and Why questions. Each participant (N = 1,156) judged a typical antecedent for a single emotion-e.g., Jealousy: story protagonist SP sees his or her partner kiss someone. The Yes/No results showed that SP was frequently expected to experience both phenomena, the more so the greater the event impact (Yes range: 40-86%). Beliefs associated with Yes answers (BY) were categorized into 4 categories: (BY1) reason-emotion opposition-felt emotions are unreasonable, inadequate ways of reacting; (BY2) ambivalent emotions-e.g., joy and sadness; (BY3) unclear emotions; (BY4) other causes-e.g., focused on event implications, SP's personality. No conflict or uncertainty answers (BN; range 14-60%) mirrored BY categories: (BN1) no reason-emotion opposition, (BN2) no ambivalent emotions, (BN3) clear emotions, (BN4) other causes. Attributions and beliefs about causes did not generally differ by gender. As a collective entity, expressed beliefs were complex, focusing on one or more emotion component-e.g., appraisal, regulation, expression-as well as on emotion intensity, duration, and on self-concept issues. Overall, expressed beliefs seemed to imply a malleability theory of emotions, and emotion awareness. Results overall confirmed the hypotheses that conflict and uncertainty attributions are more likely for: unpleasant experiences; when emotions are norm-incongruent for the judged event; when mixed, ambivalent emotions are felt. The study confirms that people interpret emotion processes according to their lay theories.

Differences in facial emotion recognition between bipolar disorder and other clinical populations: A systematic review and meta-analysis.

Facial emotion (or expression) recognition (FER) is a domain of affective cognition impaired across various psychiatric conditions, including bipolar disorder (BD). We conducted a systematic review and meta-analysis searching for eligible articles published from inception to April 26, 2023, in PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO to examine whether and to what extent FER would differ between people with BD and those with other mental disorders. Thirty-three studies comparing 1506 BD patients with 1973 clinical controls were included in the present systematic review, and twenty-six of them were analyzed in random-effects meta-analyses exploring the discrepancies in discriminating or identifying emotional stimuli at a general and specific level. Individuals with BD were more accurate in identifying each type of emotion during a FER task compared to individuals diagnosed with schizophrenia (SCZ) (SMD = 0.27; p-value = 0.006), with specific differences in the perception of anger (SMD = 0.46; p-value = 1.19e-06), fear (SMD = 0.38; p-value = 8.2e-04), and sadness (SMD = 0.33; p-value = 0.026). In contrast, BD patients were less accurate than individuals with major depressive disorder (MDD) in identifying each type of emotion (SMD = -0.24; p-value = 0.014), but these differences were more specific for sad emotional stimuli (SMD = -0.31; p-value = 0.009). No significant differences were observed when BD was compared with children and adolescents diagnosed with attention-deficit/hyperactivity disorder. FER emerges as a potential integrative instrument for guiding diagnosis by enabling discrimination between BD and SCZ or MDD. Enhancing the standardization of adopted tasks could further enhance the accuracy of this tool, leveraging FER potential as a therapeutic target.