Neuropsychological tests of visuo-spatial exploration, line bisection, and drawing are typically employed for diagnosing unilateral spatial neglect (USN), but updated norms, including those for left and right biases, are still lacking. This study aims to standardize administration and scoring of the most widely used USN tests, providing regression-based norms and equivalent scores (ES) of a comprehensive set of old and new visuo-spatial indexes. These include asymmetry in the allocentric and egocentric spaces, execution times, as well as measures of productive symptoms (e.g., perseverations) and constructional apraxia in an Italian sample. A sample of 270 neurologically healthy participants (139 females, mean age: 60.57 ± 12.79 years) completed a neuropsychological battery including line bisection, line/star/geometrical item cancellations, copy of simple and complex drawings, the clock drawing test, and a new representational neglect test. Multiple regressions estimated the effects of age, education, and gender. Non-parametric tolerance limits and ES were calculated on ranked adjusted scores. Regression analyses showed significant influences of age and education across tasks; both predicted execution time and spatial asymmetry in cancellations, constructional apraxia in drawings, and clock drawing accuracy. Education specifically predicted perseverations in cancellations, while age specifically predicted cancellation accuracy and perseverations in drawing tasks. Gender only influenced line bisection and, along with age and education, accuracy in the butterfly memory test. This work provides updated norms for standard and novel visuo-spatial indexes in the assessment of USN and associated disorders, with standardized procedures to guide clinical assessment and support neglect rehabilitation.
The Yazidi community endured an unprecedented genocide by the Islamic State (ISIS) in August 2014, resulting in mass killings, kinocide, abductions, ongoing disappearances, and sexual enslavement. The intense trauma led to high prevalence rates of posttraumatic stress disorder (PTSD), depression, anxiety, and profound sleep disturbances. This comprehensive article integrates epidemiological data, neurobiological mechanisms, and clinical case reports to elucidate sleep disorders among Yazidi survivors. We detail the historical context, transgenerational trauma, specific sleep-related pathologies (insomnia, nightmares, parasomnias, and disrupted circadian rhythms), neurobiological underpinnings, cultural factors, and evidence-based interventions (e.g., Narrative Exposure Therapy (NET); Cognitive Behavioral Therapy for Insomnia (CBT-I)). Furthermore, we discuss the establishment and role of the Institute for Psychotherapy and Psychotraumatology (IPP) at the University of Duhok, outline barriers to care, and propose future research directions and policy recommendations.
Fibromyalgia, a syndrome characterized by hyperalgesia and 'negative emotionality', and major depressive disorder (MDD) demonstrate substantial overlaps in clinical, neurobiological, and therapeutic domains. Currently, treatment options for fibromyalgia remain limited; however, the epidemiology of this syndrome continues to grow worldwide. The use of animal models is indispensable for developing new treatment strategies for fibromyalgia. Meanwhile, the choice of animal paradigms is limited. Here, we used the ultrasound exposure of emotional stress on CBA, BALB/c, and C57BL/6 mouse strains to model this condition and to identify new molecular targets of fibromyalgia treatment. We exposed young male mice of three common strains to a three-week ultrasound stress (US) comprising emotionally negative and neutral frequencies of 20-25 kHz and 25-45 kHz, resulting in the development of altered pain sensitivity and signs of 'negative emotionality'. Specifically, mice were studied for timid-like/aggressive behaviors and the tail flick response. Serum levels of corticosterone, cortisol, β-Endorphin, and brain-derived neurotrophic factor (BDNF), as well as brain gene expression of interleukin-33 (Il-33), Bdnf, and its receptor Trkb were investigated. Among the stressed mouse strains, C57BL/6 mice displayed augmented pain sensitivity, allodynia, and suppressed dominant behavior, whereas CBA and BALB/c mice demonstrated opposing changes. Glucocorticoid levels were increased in all stressed groups. Stressed C57BL/6 mice showed downregulated gene and protein expression of functionally inter-related BDNF and IL-33 molecules in the hippocampus, amygdala, and striatum, significantly correlating with behavioral outcomes, as well as lowered blood levels of β-Endorphin and elevated cortisol concentrations. Altogether, our study identified the BDNF/IL-33 regulatory pathway as a molecular correlate of fibromyalgia, and the use of US-exposed young C57BL/6 mice as a potential model that recapitulates this syndrome.
Transcranial direct current stimulation (tDCS) has emerged as a promising tool to investigate and modulate emotional and social processes, including compassion. By targeting cortical regions implicated in empathy and prosocial behaviour (e.g., the left inferior frontal gyrus [lIFG] and the left supplementary motor area [lSMA]), tDCS may influence the distinct components of compassion: the sensitivity to suffering and the commitment to alleviate it. In this study we aimed to examine the effects of tDCS over the lIFG and lSMA on the neuropsychophysiological and behavioral correlates of compassion. In a randomized, double-blind, controlled study (N = 81), participants received 20 min of active (2 mA) or sham tDCS over the lIFG or lSMA while viewing a compassion-inducing video. We assessed self-reported compassion state (sensitivity and commitment) before and after stimulation, heart rate variability (HRV) at baseline, pre-, and post-stimulation, and brain activity at post-stimulation using high-density diffuse optical tomography (HD-DOT). Across the four groups mixed-effect models, no significant omnibus group effects or interactions were detected for self-reported sensitivity or engagement (all p > .05). However, compassionate images elicited significantly higher ratings compared to neutral (p < .001). Post-intervention, participants in all groups except those receiving active tDCS over the lIFG, presented an increased parasympathetic activity. There was a reduced neural activation of the anterior premotor cortex in the lIFG group when processing compassive eliciting images. Although a single tDCS session did not alter self-reported compassion, physiological and brain activity findings suggest distinct regional and temporal effects. These results underscore the complexity of modulating compassion using tDCS and the need for further research to clarify neural pathways and networks.
BACKGROUND: Medication-overuse headache (MOH) is a prevalent and disabling secondary headache disorder that arises in individuals with a pre-existing primary headache as a consequence of regular overuse of acute medications. Increasing evidence suggests that MOH shares fundamental pathophysiological and behavioural features with nociplastic pain conditions, supporting the view that it cannot be explained solely as a pharmacological complication. Rather, MOH appears to reflect complex interactions between neurobiological vulnerability, maladaptive neuroplasticity, and behavioural factors. In this review, we reappraise MOH through the lens of nociplastic pain to provide a unifying framework for its pathophysiology and management. MAIN BODY: Evidence from neuroimaging, neurophysiological, genetic, and experimental studies consistently indicates that MOH is associated with central sensitization, impaired descending pain modulation, and dysfunction of reward and cognitive control networks, particularly involving fronto-striatal and brainstem circuits. These alterations closely resemble those observed in other nociplastic pain conditions and appear largely reversible following successful withdrawal and preventive treatment. Behavioural features such as craving, impulsivity, catastrophizing, and cephalalgiophobia play a pivotal role in maintaining medication overuse and predicting poor outcomes, reinforcing the conceptualization of MOH as a biobehavioural syndrome. Management strategies have evolved from detoxification-centered approaches toward integrated, patient-centered care. While withdrawal remains a cornerstone of treatment, growing evidence supports flexible strategies in which preventive therapies, especially CGRP-targeting monoclonal antibodies and gepants, can be initiated before or alongside withdrawal, reducing headache burden and facilitating disengagement from acute medication overuse. Behavioural and psychological interventions, including cognitive behavioural therapy and mindfulness-based approaches, are essential to address emotional drivers, enhance adherence, and modulate nociplastic mechanisms. Current guidelines increasingly endorse multimodal and multidisciplinary management, although evidence quality remains heterogeneous. CONCLUSION: Reframing MOH within a nociplastic pain framework supports a shift from rigid detoxification models toward personalized, mechanism-based, and multidisciplinary care. Future research integrating clinical, imaging, neurobiological, and behavioural markers, potentially supported by artificial intelligence–based predictive models, may further refine patient stratification and optimize long-term outcomes in MOH.
Spontaneous pupil fluctuations (SPFs) during rest provide a non-invasive, low-cost index of central arousal dynamics, independent of cognitive task demands. These features position SPFs as promising markers for baseline neurophysiological activity in both basic and translational research. This review synthesizes current evidence on the resting-state pupil-brain system, focusing on its core components: central neuromodulatory circuits and large-scale cortical networks. We first examine the relationship between SPFs and distributed elements of the ascending arousal system, including noradrenergic, cholinergic, serotonergic, and dopaminergic nuclei. We then detail SPF coupling with intrinsic functional networks-default mode, salience, and sensorimotor systems-highlighting their role in mediating transitions between internally- and externally-oriented brain states. Finally, we discuss the spectral and directional properties of pupil-brain interactions, emphasizing analytical approaches suited for assessing directionality and outlining implications for clinical and translational applications. Converging evidence from animal and human neuroimaging studies reveals robust spatiotemporal and spectral coupling between SPFs and neural activity across micro- and macro-scales. These findings support a systems-level framework in which SPFs serve as integrative markers linking subcortical neuromodulation with large-scale cortical dynamics. We conclude that SPFs offer a sensitive window into arousal regulation and body-brain integration, with potential utility as biomarkers for neuropsychiatric conditions and altered states of consciousness.
Freezing of gait (FOG) is a common and disabling symptom in people with Parkinson's Disease (PD), characterized by paroxysmal episodes where there is an inability to step effectively, despite attempting to do so. Anxiety and stress exacerbate FOG, particularly in situations where people with FOG anticipate not being in control of their movements. Some people with PD use compensatory strategies that target anxiety and stress to improve FOG. However, tailored strategies to ameliorate anxiety- and stress-related FOG have never been evaluated in a systematic manner. We describe the study protocol of the TACKLING-FOG trial, which aims to evaluate the effectiveness of a novel 4-week Managing the Mental State intervention in reducing FOG-related anxiety and stress to improve FOG. We also aim to identify the key determinants influencing the response to the intervention. This study is a randomized controlled trial (RCT) with a waitlist control group. Forty participants with PD who experience anxiety- or stress-related FOG will be included. All participants receive a baseline measurement and are subsequently randomized to the intervention or control group in a 1:1 ratio. The intervention group immediately receives four weekly sessions of the Managing the Mental State intervention, whereas the control group enters a waitlist period. Afterwards, both groups are reassessed. Next, the intervention group enters a 10-week follow-up period, while the control group receives the intervention, is reassessed, and enters the follow-up period. Both groups receive a final measurement at the end of the follow-up. The primary outcome is the percentage of time frozen during a home-based walking course that includes self-selected FOG "hotspots." Secondary outcomes involve the percentage of time frozen during the same trajectory under elevated stress conditions and during a standardized FOG-provoking protocol. Additionally, heart rate is collected as a physiological marker of stress and anxiety, and questionnaires are administered to assess domains that may improve in response to the intervention, including anxiety, quality of life, and self-esteem. TACKLING-FOG will be the first RCT to examine the use of tailor-made behavioral strategies to tackle anxiety- and stress-related FOG in people with PD. Trial Registration: Clinicaltrials.gov NCT06302309. Registered on March 8, 2024.
This study analyzed the impact of a cognitive-motor training program on key indicators of cognitive performance. A two-arm, parallel, randomised controlled trial (with 1:1 allocation) was conducted. A total of 184 competitive eSports athletes (aged 18-25) were randomly assigned to one of two programmes: an individualised psychophysical training programme integrating aerobic exercise and cognitive self-regulation techniques, or a standard eSports training programme. Outcomes were assessed at baseline, after 4 weeks (mid-intervention) and after 8 weeks (post-intervention). Reaction time and decision-making efficiency were assessed at baseline, mid-intervention, and post-intervention using a computerized reaction-time battery and an adapted Iowa Gambling Task. Data analyzed using repeated-measures ANOVA and moderation analyses. The primary endpoint was defined as the change in the outcome variable from baseline to post-intervention. The individualized psycho-physical program was associated with greater improvements in reaction time and decision-making indicators compared to standard training, with small-to-moderate effect sizes (η² = 0.08-0.12). Significant Time × Group interactions indicated steeper and more stable performance gains in the experimental group. Age and gender exerted small but significant moderating effects; younger participants and female athletes showing greater responsiveness on selected outcomes. Integrating aerobic exercise and cognitive self-regulation was associated with improvements in attentional efficiency and decision-making stability under controlled conditions. These findings suggest that individualised psychophysical training could be useful in environments with a high cognitive load. However, further confirmatory trials are required. Not prospectively registered.
Compromised DNA integrity, including telomere attrition, has been linked to traumatic stress and early adversity. We investigated whether cumulative lifetime stress exposure is associated with telomere length and expression of key DNA repair genes, poly (ADP-ribose) polymerase 1 (PARP1) and X-ray repair cross complementing 1 (XRCC1), across two independent cohorts. In 65 postpartum women (cohort 1), childhood maltreatment (CM) and lifetime trauma exposure (LTE) were assessed using the Childhood Trauma Questionnaire and the Posttraumatic Diagnostic Scale event checklist. In 49 refugees and immigrants (cohort 2), trauma exposure was assessed using the Clinician-Administered PTSD Scale and the Vivo Checklist of War, Detention and Torture Events. Telomere length and gene expression were quantified in peripheral blood mononuclear cells using cohort-specific standard methods. In cohort 1, shorter telomeres were associated with higher PARP1 expression specifically in women with both CM and LTE, but not in those with lower cumulative stress exposure. Given the limited variance in stress exposure in this sample, we examined whether this pattern generalizes to a cohort with substantially higher and more heterogeneous trauma exposure. In cohort 2, shorter telomeres were consistently associated with higher expression of both PARP1 and XRCC1. These converging findings across independent cohorts suggest that cumulative lifetime stress exposure may be linked to altered DNA repair activity in the context of telomere maintenance, consistent with a model of stress-related allostatic load. While interpretation is limited by small sample sizes and methodological differences between cohorts, future studies in larger, longitudinal, and methodologically harmonized samples are needed to clarify underlying mechanisms and directionality.
Interpersonal synchronization is a key component of effective teaching and learning, but little is known about how it differs between face-to-face and remote settings. This study investigates interpersonal synchronization in face-to-face (FTF) versus remote learning (RL) environments through electroencephalography (EEG) and electrocardiography (ECG) hyperscanning. Eight groups of 3 students and 1 lecturer (N = 32) engaged in both conditions, consisting of a baseline, a 20-minute lecture, and a 20-minute interactive task. Neural synchronization was assessed using inter-individual Euclidean Distance (EuDist) across five EEG frequency bands (delta, theta, alpha, beta, gamma). Cardiac synchronization was assessed via intersubject correlation of heart rate (ISCHR). Learning outcomes and perception were measured through a series of self-report measures and validated questionnaires. Results revealed a modest but significant effect of learning condition across all EEG bands, with significantly lower EuDist values in the FTF condition compared to RL, indicating higher inter-individual neural alignment when participants were physically co-present. Additionally, task-specific effects emerged in delta, theta, beta, and gamma bands, with interactive tasks generally associated with lower dissimilarity. Furthermore, ISCHR was significantly higher in the FTF condition compared to the RL condition, while no significant task-specific differences emerged. Self-report measures further indicated higher perceived interpersonal closeness and lesson satisfaction in the FTF condition, while learning outcomes remained stable across modalities. These findings demonstrate that physical co-presence enhances both cortical and autonomic synchronization during instruction, particularly under dialogic conditions, and underscore the role of embodied interaction in promoting shared cognitive and affective engagement in educational contexts.
Contemporary clinical neuropsychologists primarily provide assessment and consultative services rather than direct intervention. This study examined the extent to which cognitive rehabilitation remains part of contemporary neuropsychological practice and explored reimbursement pathways and perceived barriers to implementation. An anonymous national survey was distributed to members of the National Academy of Neuropsychology through listserv and newsletter announcements. The survey included structured multiple-choice and open-ended questions assessing whether respondents provide cognitive rehabilitation, years of practice, clinical setting, insurance reimbursement patterns, and experiences with insurance denials. Descriptive statistics were used to summarize responses. Twenty-two respondents completed the survey. Eighteen (81.8%) reported currently providing cognitive rehabilitation services. Reimbursed Current Procedural Terminology (CPT) codes most commonly included 97129/97130 (54.5%) and 96116/96121 (45.5%), with additional endorsement of health and behavior intervention codes (96158/96159) and group therapy codes (97150). Insurance denial experiences were mixed, with most respondents reporting occasional or conditional denials rather than consistent rejection of claims. Respondents also described variability in session limits and billing approaches across practice settings and payer policies. Cognitive rehabilitation was reported by a majority of respondents, though service models and reimbursement pathways varied considerably. Given the small, self-selected sample, findings should be interpreted as exploratory rather than representative of broader neuropsychological practice. Larger investigations are needed to clarify training expectations, billing practices, and interdisciplinary collaboration.
Diagnosing attention deficit/hyperactivity disorder (ADHD) among adults is challenging, given reliance on retrospective symptom reporting and the overlap of core, nonspecific diagnostic symptoms with other psychiatric disorders such as depression and anxiety. This study examined the effect of perceived stress on ADHD symptom reporting. Cross-sectional data from 638 diverse adult outpatients referred for ADHD neuropsychological evaluation, who were administered the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Perceived Stress Scale (PSS), and Clinical Assessment of Attention Deficit-Adult (CAT-A), were analyzed. Linear regressions were conducted with BDI-II/BAI (block 1) and PSS (block 2) as predictor variables and ADHD symptom endorsement in childhood and adulthood (CAT-A) as the dependent variable. PSS/BDI-II (r=0.648) and PSS/BAI (r=0.523) were moderately correlated. BDI-II and BAI significantly predicted overall ADHD symptom endorsement and current/adult symptom reporting, whereas only BAI predicted childhood symptoms. After entering the PSS in block 2, all models remained significant (P<0.001; R2=0.03 to 0.08), but BDI-II and BAI became nonsignificant; only perceived stress remained a significant predictor. The results were replicated after excluding those with potentially invalid ADHD symptom reporting, so that the PSS again was the only significant predictor of ADHD symptom endorsement (R2=0.02 to 0.06). Patients' subjective experience of stress was significantly associated with nonspecific inattention symptom endorsement among adults undergoing ADHD evaluation and shared more variance with attention complaints than active depression and anxiety symptoms. Findings emphasize routinely assessing perceived stress during psychiatric evaluation of ADHD, as high stress levels may masquerade as nonspecific inattention symptoms and contribute to misdiagnosis of ADHD if not considered/assessed, and high stress levels may also exacerbate genuine ADHD symptoms.
To examine spatiotemporal modifications in electroencephalogram (EEG) microstates among individuals diagnosed with schizophrenia utilizing a five-class model, and to evaluate the potential of microstate parameters as diagnostic biomarkers. Resting-state EEG data were collected from 122 patients with schizophrenia and 72 age- and sex-matched healthy controls. EEG recordings were preprocessed and analyzed using a standardized pipeline, applying a five-class microstate framework (A-E). Temporal parameters, transition probabilities, and spatial topographies were quantified. Group comparisons were conducted, and the diagnostic utility of microstate features was evaluated using receiver operating characteristic analysis. The study also investigated the correlations between various microstate metrics and the severity of symptoms, as measured by Positive and Negative Syndrome Scale (PANSS) scores. Significant differences were observed across all five microstate classes between the groups. Patients with schizophrenia showed shorter durations and increased occurrences of all microstates, altered transition patterns, and altered topographic distributions. Notably, reduced duration of microstate A, associated with auditory and linguistic processing, demonstrated the strongest discriminatory power, with an AUC of 0.93, sensitivity of 93.1 %, and specificity of 83.6 %. Despite allowing for group discrimination, microstate metrics were not significantly correlated with symptom severity as measured by the PANSS within the group of patients with schizophrenia. This study presents robust evidence of disrupted EEG microstate dynamics in patients with schizophrenia. The reduced duration of microstate A may serve as a potential neurophysiological biomarker, independent of symptom severity, for diagnostic differentiation purposes.
Background and Objectives: The joint study of cerebral asymmetries and bipolar disorder (BD) has long attracted the interest of researchers and clinicians. Nevertheless, despite the increasing awareness of hemispheric asymmetries in BD, the combined investigation of these two constructs constitutes a relatively recent area of inquiry. The main objective of the present systematic review is to systematically examine the existing literature in order to identify, integrate and critically discuss evidence of hemispheric asymmetry in BD patients in terms of brain anatomy, physiology and neuropsychological function. The initial hypotheses support the presence of atypical cerebral asymmetry and differential hemispheric activation as a function of mood states in BD. Materials and Methods: Following the collection and analysis of numerous research papers through several databases and search engines, specific papers were identified and screened according to specified inclusion and exclusion criteria. Research papers on the adult bipolar population were included, while papers including comorbidity with other disorders, lesions, or an underage or elderly population, as well as meta-analyses and reviews, were excluded. This paper aligns with the procedures in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines, and was assessed for risk of bias according to the Cochrane guidelines by the Newcastle-Ottawa Scale (NOS). Results: A total of 56 papers were identified as eligible in this review. Despite inconsistent findings across the included studies, an emerging pattern suggests the presence of atypical hemispheric asymmetry in BD, both in terms of specific brain structures and functional activity. Moreover, several studies associate depressive states with increased activation of the right hemisphere, whereas manic states appear to be linked with increased activation of the left hemisphere. Conclusions: These findings support the aforementioned hypotheses and partly align with the theoretical framework of emotional laterality theories. However, although certain patterns were observed, a comprehensive understanding of functional hemispheric asymmetry in BD has not yet been achieved. The presence of contradictory findings highlights the need for further extensive and systematic research to improve understanding of this topic.
Exercise may reduce pain and central nervous system sensitivity by activating endogenous analgesia and spinal inhibitory mechanisms. This study examined the effects of different exercises against patient education on pain sensitivity and clinical outcomes in patients with chronic low back pain (CLBP) and central sensitisation. The study population included 172 central sensitisation-positive CLBP patients who were randomised to receive aerobic exercise, motor control exercises, muscle-strengthening exercises, and patient education. Forty-three healthy volunteers served as controls. The outcomes included changes in pressure pain threshold from the cold pressor test [CPT], pain intensity, disability, the letter-number sequencing subtest, the Stroop neuropsychology test, quality of life [QOL}, and isometric muscular strength of the spine and hips, which were evaluated at baseline [T0], after the 12-week intervention [T1], and 3 months after the completion of treatment [T2]. Compared to the healthy volunteers, the patients with CLBP showed lower conditioned pain modulation [CPM] as measured by the CPT [p < 0.05]. Post-measurement readings revealed improvements over time [p < 0.05] and no differences between experimental groups [p > 0.05] in improving pain intensity, disability, QOL, and isometric muscular strength. The effect sizes between the treatment groups were small. All the exercises evaluated were able to improve clinical outcomes, despite minimal improvement in pain modulation compared to healthy volunteers. There was however no differences between the various interventions studied.
Anhedonia, a transdiagnostic symptom for schizophrenia and depression, exists in subclinical individuals at risk of the two disorders. Prior meta-analytic reviews seldom considered both anticipated pleasure and anticipated displeasure. We conducted a three-level meta-analysis on anticipated pleasure and displeasure in people with schizophrenia and depression, and their subclinical counterparts. Clinical and subclinical individuals of the schizophrenia spectrum reported less anticipated pleasure than controls (k = 37, 1464 participants, g = -0.22, p = 0.032), but reported similar anticipated displeasure as controls (k = 20, 769 participants, g = 0.09, p = 0.345). Clinical and subclinical individuals of depression anticipated less pleasure (k = 21, 1162 participants, g = -0.62, p = 0.003) and more displeasure (k = 15, 954 participants, g = 0.82, p = 0.033) than controls. Comparisons of the schizophrenia and depression samples yielded no significant difference for effect sizes of either anticipated pleasure or anticipated displeasure. For schizophrenia spectrum, heterogeneity of anticipated pleasure was explained by sociality of anticipated stimuli. For participants with depression, higher severity of depressive symptoms were associated with larger between-group effects on anticipated pleasure and displeasure. After accounting for publication bias, the between-group effects remained of a similar magnitude. We elucidated the patterns of impaired anticipated emotions in clinical and subclinical samples of the schizophrenia and depression. Social anticipated pleasure may be a potential screening target for schizophrenia, while impaired anticipated emotions may serve as a marker for depression.
As workplaces increasingly recognise the importance of employee mental wellbeing, research into psychological flexibility and psychological inflexibility (PF/PI) has grown. PF, rooted in Acceptance and Commitment Therapy (ACT), is the capacity to pursue valued goals despite stressors and internal challenges, whereas PI reflects rigid attempts to avoid or control unwanted internal experiences, even when doing so undermines wellbeing or goal pursuit. Our systematic search across five databases identified 88 studies that had examined the relationship between PF/PI and wellbeing in workplace contexts. The findings indicate a surge in research since 2020, with PF (and, as such, PI) predominantly measured using the Acceptance and Action Questionnaire-II (AAQ-II). Most studies focus on mitigating negative wellbeing outcomes, such as burnout and psychological distress, rather than fostering positive wellbeing. PF/PI research is concentrated in high-stress professions, particularly healthcare, with limited exploration in other sectors. Finally, PF/PI research is dominant in Western research. Recommendations for future research directions were established, including a clearer construct definition, development in measurement approaches, longitudinal and intervention-based designs and broader occupational and cultural representation. Ultimately, this review highlights the need for a more nuanced and precise understanding of PF/PI to optimise its role in enhancing workplace wellbeing.
Background and Objectives: Pregnancy is associated with profound physical and psychological changes in a woman's life. Psychological distress and medical comorbidities during pregnancy remain under recognized despite their potential impact on maternal well-being. This study aimed to examine the associations between psychological distress, physical and mental components of health-related quality of life (HRQoL), lifestyle factors (alcohol and tobacco use), and the presence of medical comorbidities in pregnant women. Materials and Methods: A cross-sectional study was conducted among pregnant women in the second and third trimesters admitted to a tertiary obstetrics and gynecology center in Romania. Psychological distress was assessed using the Symptom Checklist-90-Revised (SCL-90-R) Global Severity Index (GSI), while health-related quality of life (HRQoL) was evaluated with the Short Form Health Survey-36 items (SF-36) physical (PCS) and mental (MCS) Component Summary scores. Alcohol and tobacco use were assessed using Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Fagerström Test for Nicotine Dependence (FTND). Nonparametric tests were used for correlation and group-comparison analyses. Results: Among the 337 valid answers, higher psychological distress was significantly associated with lower physical (R = -0.16, p < 0.01) and mental (R = -0.26, p < 0.01) HRQoL. Pregnant women with medical comorbidities reported higher psychological distress and poorer physical HRQoL compared with those without comorbidities, while mental HRQoL did not differ significantly. Alcohol and tobacco use were not significantly associated with HRQoL or psychological distress. Conclusions: Psychological distress is a central factor associated with both physical and mental quality of life during pregnancy. Integrating routine mental health screening into antenatal care, particularly for women with medical comorbidities, may improve maternal well-being and support better pregnancy outcomes.
Dysregulated stress response has been linked to multiple health issues, yet the brain and body dynamics of acute stress remain poorly understood. Developing interpretable models is imperative in understanding this complex interplay. The present study sought to decode acute stress response by using a systematic data-driven and experimental approach to provide insights into its underlying mechanisms, with implications for accurate prediction, precision intervention, and trauma-related phenotyping. A total of 144 healthy adults (aged 18 - 44 years; 63 men) completed the Montreal Imaging Stress Task. Multimodal electrophysiological signals were recorded throughout the experiment. The interpretable predictive model achieved an excellent test accuracy of 85.37% and revealed several key stress-related features, such as shorter inspiration duration. Causal discovery analyses revealed stress-induced disruption of bottom-up inspiratory influences on frontal neural activity. Deep breathing interventions were found to increase inspiration duration and reduce perceived stress levels. The cluster analysis identified three phenotypes. The stress-vulnerable phenotype, in particular, was found to be more susceptible to stress and have greater exposure to lifetime trauma. These findings advance our understanding of the brain and body psychophysiology causal dynamics of acute stress, identify actionable targets for precision interventions, and reveal distinct phenotypes that may inform individualised stress profiles.
Although visible symptoms of mild traumatic brain injury (mTBI), commonly known as concussion, may improve rapidly, subtle neurophysiological alterations can persist. One such indicator is the speed of visual information transfer across the splenium of the corpus callosum, also known as inter-hemispheric transfer time (IHTT). We quantified IHTT in adults with mTBI and demographically-similar control participants at an initial assessment approximately 3-4 weeks after injury and again at follow-up about 10 months later. The analytic sample comprised 94 participants between the ages of 18 and 45 years, including 48 with mTBI (24 female) and 46 demographically-similar controls (22 female). IHTT was quantified directly using the P1 and N1 components of the scalp-recorded brain event-related potential (ERP). In a subset of 19 participants with mTBI (seven female) and 19 control participants (seven female), we also quantified the integrity of white matter in the corpus callosum using fractional anisotropy (FA) values derived from diffusion-tensor magnetic resonance imaging (DTI), along with volumetric measures of the corpus callosum. Participants with mTBI showed slower early visual transfer (P1 IHTT) at both initial and ten-month follow-up time points, whereas later processing (N1 IHTT) did not differ between groups. Fractional anisotropy (FA) MRI values generally showed lower FA across the corpus callosum in individuals with mTBI compared to controls, consistent with altered white matter microstructure. No volumetric differences were observed between groups or over time. The current findings suggest that neurophysiological differences in early interhemispheric visual processing and callosal microstructure are evident at both subacute and follow-up assessments, consistent with alterations observed months after injury.