Intrusive re-experiencing of traumatic events is a cornerstone of post-traumatic stress disorder (PTSD). Clinicians notice that clients also experience intrusive mental images of what they think might happen during a traumatic event. As mental imagery has a powerful impact on emotion, imagination-based imagery may be implicated in the peaks of distress (‘hotspots’) during a trauma.

A data-only study was undertaken of cognitive therapy for PTSD ‘hotspot’ charts used by Grenfell Health and Wellbeing Service clinicians after the Grenfell fire disaster. The aim was to establish the prevalence and nature of peri-traumatic ‘imagination-based hotspots’ in this sample.

Hotspots are described as the worst moments within a trauma. Two clinicians independently rated anonymised hotspot charts (N=26) for the presence and content of ‘imagination-based hotspots’, defined as ‘a peak of emotion during a traumatic event that is related to something imagined “in the mind’s eye” as opposed to directly perceived with the senses’.

81% (N=21) of individuals reported an imagination-based hotspot; 38% of all hotspots (n=159) contained an imagination-based component. The most common was an image in which the person watching the fire imagined themselves in the ‘shoes’ of a tower resident.

Imagination-based mental imagery appears to be linked to the ‘hotspots’ of a high proportion of people experiencing PTSD in this sample. Results underline the importance of enquiring about the presence of mental imagery during PTSD treatment. The presence of peri-traumatic mental images has implications for effective updating of ‘hotspots’ in PTSD treatment.

Research suggests that there may be an association between prescribed opioid use and suicide-related behaviours.

This 15-year retrospective population-based cohort study examines the relationship between opioid use, self-harm and suicide.

The study was based on the POPPY II study, a population-based cohort of 3 268 282 adults who initiated a prescription opioid between 1 July 2003 and 31 December 2018, in Australia. Prescription dispensing data were linked to hospitalisation, death and other data collections. Opioid use was defined as current opioid exposure, cumulative duration of exposure and estimated daily dose. Outcomes were self-harm hospitalisation and suicide mortality, categorised as overall and according to the method (opioid poisoning, non-opioid substance poisoning and other methods). Time-varying generalised estimating equations were used to assess the relationship with self-harm hospitalisation, and Cox proportional hazard models were used to assess the relationship with suicide mortality, controlling for known suicide-related risk factors.

There were 49 215 self-harm hospitalisations at a crude rate of 262 per 100 000 person-years and 3087 suicide deaths at a crude rate of 16.5 per 100 000 person-years. Intentional opioid poisoning was the least common method for both self-harm hospitalisation and suicide. Following multivariable adjustment, current opioid exposure, longer cumulative duration and higher doses were significantly associated with a greater risk of opioid-related self-harm or suicide. In adjusted models, associations for other methods of self-harm and suicide were not as strong or consistent.

Opioid poisoning was the least common method of self-harm and suicide. Despite this, for the minority of people prescribed high doses and/or a long duration of prescription opioids, there is an increased risk for opioid-related self-harm and suicide after controlling for known covariates. Suicide-related behaviours should be screened and monitored in people prescribed opioids, particularly among those on long-term and/or high-dose opioids.

Research indicates that demographic (e.g., age, education) and sociocultural (e.g., acculturation) factors can impact neuropsychological test performance among ethnoculturally diverse adults. Some studies suggest that greater acculturation to the United States (U.S.) is associated with better neurocognitive functioning, though no meta-analysis to date has examined this relationship. This review provides a comprehensive synthesis of the literature and determines the magnitude of the relationship between acculturation and neuropsychological test performance.

A literature search explored all published articles through January 1, 2024, using three databases (i.e., PubMED/MEDLINE, PsycInfo, PsycNET). Data to calculate study effect sizes (i.e., Fisher’s z) were extracted from in-text results, tables, and figures.

Findings (k = 18 included in quantitative analyses) revealed a small to medium (r = 0.29, partial r = 0.20, p < .01), statistically significant relationship between higher U.S. acculturation and better neuropsychological test performance. Moderation analyses indicated that language of testing emerged as a significant moderator, testing in English yielded larger effect sizes compared to testing in other languages (B = 0.29, p < .05).

Neuropsychological test performance is significantly associated with U.S. acculturation, and results suggest that the magnitude may vary depending on study methodologies and samples (e.g., ethnocultural group, U.S. born vs. immigrant) examined. The current review also provides recommendations for incorporating acculturation assessment into clinical practice and highlights the need to examine the clinical utility of acculturation tools in conjunction with neuropsychological tests to assist in clinical decision-making with ethnoculturally diverse populations.

Remote videoconference neuropsychological assessments offer opportunities that remain under-exploited. We aimed to evaluate teleneuropsychology (TeleNP)-suitable oral and digital versions of the Symbol Digit Modalities Task (SDMT) and Trail Making Test (TMT) – widely used measures of speed and attention – by comparing them to their written counterparts.

Three-hundred and twenty-one Australian Epilepsy Project (AEP) adult participants with seizure disorders completed the written SDMT and TMT in-person. One-hundred and forty-four of these participants also completed the oral SDMT and TMT during a remote videoconference-based assessment while 177 completed a novel, examiner-administered digital SDMT analogous measure named Symbol Decoding and a novel digital TMT remotely via custom videoconference-based software.

Oral SDMT and digital Symbol Decoding strongly correlated with in-person written SDMT (r (133) = .77, p < .001 and r (126) = .76, p < .001, respectively). Oral TMT-B was only moderately associated (r (126) = .52, p < .001) with written TMT-B and, less strongly related to measures of sustained attention and spatial working memory than its written counterpart. Digital TMT better reproduced the written test’s properties with improved association with written TMT-B (r (154) = .71, p < .001).

Oral SDMT and digital Symbol Decoding are strongly correlated with in-person written SDMT. The digital TMT better captures the cognitive demands and performance characteristics of the in-person written form than does oral TMT. Videoconference-integrated digital tasks offer increased standardization and automation in administration and scoring and the potential for rich metadata, making them an attractive area for further development.

Evaluate the prevalence and risk factors for inappropriately ordered urine cultures in primary care.

Cross-sectional study using chart reviews.

Two primary care, safety-net clinics in Houston, Texas.

Non-pregnant adults without a urinary catheter who had a urine culture and a primary care visit between 11/2018 and 3/2020.

We classified patients lacking physician documentation of the following symptoms as having an inappropriately ordered urine culture: dysuria, frequency, urgency, hematuria, fever, chills, costovertebral angle tenderness, nephrolithiasis, and pain (suprapubic, pelvic, or flank). We extracted patient demographics, visit-related diagnostic codes, past medical history, and urine culture results. Diagnostic codes were grouped based on body system, visit type (e.g. routine visit), or sign or symptom clusters. We evaluated the relationship between these factors and inappropriately ordered cultures using generalized estimating equations logistic regression.

We included 807 patients who had 870 visits. Most patients were Hispanic (66.3%) or African American/Black (24.8%) females (76.1%) with a median age of 50 years. Among 870 cultures, 210 (24%) were ordered inappropriately. We found having an abnormal urinalysis or urine characteristic (adjusted odds ratio (aOR): 13.66), acute low back pain (aOR: 4.88), a cardiovascular-related (aOR: 1.68) or gynecological/family planning visit (aOR: 10.84), being evaluated at the non-teaching clinic (aOR: 6.03), or having a routine health visit (aOR: 1.81) within the non-teaching clinic (interaction aOR: 4.27) were significantly associated with inappropriate urine cultures.

Our study revealed factors associated with inappropriately ordered urine cultures that may be unique to ambulatory settings and can help design outpatient diagnostic stewardship interventions.

Methylphenidate (MPH), a commonly used stimulant for the treatment of attention deficit and hyperactivity disorder (ADHD) in children and adolescents, has been associated with adverse effects on weight, height, blood pressure (BP) and heart rate (HR). This study aimed to investigate whether children with ADHD prescribed MPH by a specialist ADHD service showed a change in health data percentiles compared to their pre-treatment measures, and to investigate for any correlation with MPH dose, years prescribed MPH and gender.

In this retrospective observational study health data percentiles (weight, height, BP and HR) were analysed for change between two timepoints: prior to MPH initiation (T1) and at the most recent clinic appointment (T2). Correlations between health data percentile changes and MPH dose, treatment duration, baseline growth centiles and gender were studied.

The cohort consisted of 123 youth (age 5-17.5 years) prescribed MPH (mean dose 0.67 ± 0.32 mg/Kg). Over the treatment period (2.5 ± 2.1 years) weight (P = 0.001) and height (P = 0.007) centiles significantly reduced, BP centiles did not change, while HR centiles increased (P < 0.0001). Weight centile reduction was correlated with higher MPH dose (P < 0.0001) and this effect attenuated with longer duration of MPH treatment (P = 0.005). Height centile reduction was more pronounced in the taller cohort (P = 0.008).

This study supports international guidelines for physical health monitoring of young people prescribed MPH, specifically the conversion of health data to percentiles for accurate monitoring and early identification of concerning trends. Future integration of digital approaches are necessary for rapid and accurate physical health monitoring.

Five-Factor Model (FFM) personality traits are associated with cognitive function, however, biological pathways accounting for these relations are not well understood. Here, we examined associations between individual FFM traits (self- and informant-reported) and cognitive function (episodic memory, executive control, and working memory), and the indirect effect of a latent index of cardiometabolic risk (composed of adiposity, glycemic control, blood pressure, blood lipids, and inflammation) in a midlife sample.

Participants included 856 volunteers (M = 44.6 ± 6.9 years, range: 30 – 54; Female 54%; Caucasian 85%) from the Adult Health and Behavior (AHAB) registry. Structural equation models were used to: (1) regress cognitive performance on FFM traits and (2) test indirect effects of cardiometabolic risk. Age, sex, and race were included as covariates in all models.

Lower Neuroticism, higher Openness, and higher Agreeableness were significantly associated with better performance in each cognitive domain, and higher Conscientiousness was associated with better working memory. Associations between these traits and executive control were accounted for by a significant indirect effect of lower cardiometabolic risk, and in component-specific analyses, by indirect effects of adiposity and systemic inflammation.

Overall, FFM personality traits were associated with multiple domains of cognitive performance, which, in the case of executive control, was partially explained by differences in cardiometabolic risk. Future investigations should examine whether these pathways account for longitudinal change in cognition.