Abstract Affective states underlie daily decision-making and pathological behaviours relevant to obsessive–compulsive disorders (OCD), mood disorders and addictions. Deep brain stimulation targeting the motor and associative-limbic subthalamic nucleus (STN) has been shown to be effective for Parkinson’s disease (PD) and OCD, respectively. Cognitive and electrophysiological studies in PD showed responses of the motor STN to emotional stimuli, impairments in recognition of negative affective states and modulation of the intensity of subjective emotion. Here we studied whether the stimulation of the associative-limbic STN in OCD influences the subjective emotion to low-intensity positive and negative images and how this relates to clinical symptoms. We assessed 10 OCD patients with on and off STN DBS in a double-blind randomized manner by recording ratings of valence and arousal to low- and high-intensity positive and negative emotional images. STN stimulation increased positive ratings and decreased negative ratings to low-intensity positive and negative stimuli, respectively, relative to off stimulation. We also show that the change in severity of obsessive–compulsive symptoms pre- versus post-operatively interacts with both DBS and valence ratings. We show that stimulation of the associative-limbic STN might influence the negative cognitive bias in OCD and decreasing the negative appraisal of emotional stimuli with a possible relationship with clinical outcomes. That the effect is specific to low intensity might suggest a role of uncertainty or conflict related to competing interpretations of image intensity. These findings may have implications for the therapeutic efficacy of DBS.
Poor adherence to medication is frequent in bipolar disorder (BD) and has been associated with several factors. To date, the relationship between low adherence and neuropsychological functioning in BD is still unclear. As age and neuropsychological functioning might have opposing influences on adherence, our aim was to investigate this link with a particular focus on the effect of age.In a cross-sectional study, we included 353 patients divided into two age-groups (16-46; 47-71) from a French cohort diagnosed with BD (type I, II, NOS) and strictly euthymic. All patients had a standardized clinical and neuropsychological assessment and were categorized as high (n = 186) or low (n = 167) adherent based on their score from the Medication Adherence Rating Scale. Clinical information was collected based on a standardized interview and clinical validated scales. Neuropsychological performances were evaluated with an established standardized neuropsychological battery for bipolar disorder patients. After univariate analysis, neuropsychological and clinical predictors of low adherence were included in two age-specific stepwise multiple logistic regressions.A smaller number of hospitalizations (OR = 0.846, p = 0.012), a shorter illness duration (OR = 0.937, p = 0.003) and higher adverse effects (OR = 1.082, p<0.001) were associated with a greater risk of low adherence in the younger patients. In the older patients, low adherence was also predicted by a smaller number of hospitalizations (OR = 0.727, p = 0.008) and higher adverse effects (OR = 1.124, p = 0.005). Interestingly poor inhibition performance was also a significant predictor of low adherence in older patients (OR = 0.924, p = 0.030).We found an age-specific relationship between cognitive functioning and adherence in patients with BD. Poor inhibition performances predicted low adherence in older patients only. Our results highlight the need to provide age-adapted therapeutic interventions to improve adherence in patients with BD.
Background. Exposure to fictional suicide scenes raises concerns about the risk of suicide contagion. However, researchers and clinicians still lack empirical evidence to estimate this risk. Here, we propose a theory-grounded tool that measures properties related to aberrant identification and suicidal contagion of potentially harmful suicide scenes. Methods. The items of the Movies and Video: Identification and Emotions in reaction to Suicide (MoVIES) operationalize the World Health Organization's recommendations for media coverage of suicide, and were adapted and completed with identification theory principles and cinematographic evidence. Inter-rater reliability (Cohen's kappa) and internal consistency (Cronbach's alpha) were estimated and optimized for two series of 19 and 30 randomly selected movies depicting a suicide scene. The validity of the scale in predicting identification with the suicidal character was tested in nine unknowledgeable participants who watched seven suicide movie scenes each. Results. The MoVIES indicated satisfying psychometric properties with kappas measured at 0.7 or more for every item and a global internal consistency of [α = 0.05]. The MoVIES score significantly predicted participants' strength of identification independently from their baseline empathy ((β = 0.20), p < 0.05). Conclusions. The MoVIES is available to scholars as a valid, reliable, and useful tool to estimate the amount of at-risk components of fictional suicidal behavior depicted in films, series, or television shows.
