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Fetal Diagnosis and Therapy 2023The objective of this study was to investigate myocardial deformation of left (LV) and right ventricle (RV) using 2-dimensional speckle-tracking echocardiography...
INTRODUCTION
The objective of this study was to investigate myocardial deformation of left (LV) and right ventricle (RV) using 2-dimensional speckle-tracking echocardiography (2D-STE) in fetuses with and without congenital cytomegalovirus (CMV) infection.
METHODS
This was a prospective single-center study. Vertical transmission was defined by a positive CMV polymerase chain reaction (PCR) test on the amniotic fluid or on the neonate's urine. Fetuses were divided into group 1 and group 2 if CMV-PCR was positive or negative, respectively. LV and RV global longitudinal strain (GLS) values were obtained and adjusted for gestational age by calculating Z-scores. Univariate analysis was carried out to compare cardiac indices between group 1 and group 2.
RESULTS
Fetuses from group 1 (n = 11) had a significantly lower LV myocardial shortening than those from group 2 (n = 32). GLS was -20.7 ± 5.2% and -26.3 ± 4.1%, respectively (p = 0.001). Similarly, GLS Z-score was lower (0.02 ± 0.72) in group 1 than in group 2 (-0.80 ± 0.59) (p = 0.001). Similarly, RV GLS Z-score was significantly impaired in group 1 compared to group 2 (-0.44 ± 1.03 vs. -1.04 ± 0.71, p = 0.041).
CONCLUSION
Fetuses with congenital CMV showed subclinical biventricular myocardial dysfunction. Further studies are needed to confirm the potential role of 2D-STE in identifying fetuses with congenital CMV at risk of postnatal cardiovascular morbidities.
Topics: Infant, Newborn; Humans; Prospective Studies; Echocardiography; Fetal Heart; Cytomegalovirus Infections; Heart Ventricles
PubMed: 37517386
DOI: 10.1159/000533280 -
Journal of the Academy of... 2023We present the case of a young woman with an extensive medical history that most notably includes over 60 emergency-room visits for unfounded respiratory distress that... (Review)
Review
We present the case of a young woman with an extensive medical history that most notably includes over 60 emergency-room visits for unfounded respiratory distress that often prompted intubations. Each presentation displays elements of deceitfulness or inappropriate demands that align with factitious disorder imposed on self. Top experts in the Consultation-Liaison field provide guidance for this commonly encountered clinical case based on their experience and review of available literature. Key teaching topics include a review of risk factors for development of deceptive syndromes, distinguishing factitious disorder from malingering and conversion disorder, and the role of a consulting psychiatrist in such cases. Patients with factitious disorder often show signs of pathologic lying, obstinance, and erratic behavior. Such attributes frequently arouse negative countertransference in providers, causing frustration and dread with continuing care, rendering psychiatric involvement. We address the unique challenges in managing factitious disorder and how to effectively collaborate with an interdisciplinary inpatient team with these cases.
Topics: Female; Humans; Factitious Disorders; Malingering; Conversion Disorder; Dissociative Disorders; Risk Factors
PubMed: 37499871
DOI: 10.1016/j.jaclp.2023.07.001 -
Journal of American College Health : J... Jul 2023College students' beliefs and attitudes concerning concussion, and masculinity norms, were examined in relation to stigma and willingness to seek treatment for possible...
College students' beliefs and attitudes concerning concussion, and masculinity norms, were examined in relation to stigma and willingness to seek treatment for possible concussion. Beliefs were measured using a revised Illness Perception Questionnaire (IPQ). : Participants were 631 undergraduates at a Northeastern university, most of whom were nonathletes with no concussion. : Data were collected online. Regression analysis were performed to identify predictors of stigma and treatment willingness. Beliefs that concussion symptoms reflect malingering, are controllable, and have psychological causes were related to more stigmatizing attitudes, as was endorsement of masculinity norms regarding winning and risk-taking. Believing that concussion symptoms are long-lasting and endorsing competitiveness, pain discounting, and self-reliance predicted willingness to seek treatment. Preliminary structural models showed adequate fit. : In addition to beliefs assessed by the IPQ, traditional conceptions of masculinity warrant greater attention in the study of concussion-related stigma and willingness to seek treatment.
PubMed: 37487191
DOI: 10.1080/07448481.2023.2222845 -
Journal of Traumatic Stress Oct 2023The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no...
The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). This research aimed to develop and validate PCL-5 SVTs in two samples of veterans. Participants completed one of two prospective research studies that included cognitive and psychological tests. Participants in Study 1 were veterans (N = 464) who served following the September 11, 2001, terrorist attacks; participants in Study 2 were veterans or service members (N = 338) who had been deployed to Iraq and/or Afghanistan. Both studies included the PCL-5 and the Structured Inventory of Malingered Symptomatology (SIMS), the latter of which served as the criterion for identifying PCL-5 SVTs. For Study 1, two separate SVTs were developed: the PCL-5 Symptom Severity scale (PSS), based on the PCL-5 total score, and the PCL-5 Rare Items scale (PRI), based on PCL-5 items infrequently endorsed at the highest item ratings. At the most conservative SIMS cutoff score, the PSS achieved excellent discrimination for both the Study 1, AUC = .840, and Study 2 samples, AUC = .858, with specific cutoff scores of ≥ 51 and ≥ 56 maximizing sensitivity while maintaining a specificity of .90. The PRI achieved good discrimination, AUCs = .760 and.726, respectively, with a cutoff score of 2 or higher indicated by both studies. The results of these two studies provide provisional support for these two embedded SVTs in the PCL-5.
PubMed: 37464588
DOI: 10.1002/jts.22957 -
Clinical Infectious Diseases : An... Dec 2023Despite more than a century of research on the link between infection and chronic diseases, we again find ourselves flummoxed by a new pathogen that causes long-term...
Despite more than a century of research on the link between infection and chronic diseases, we again find ourselves flummoxed by a new pathogen that causes long-term impairment. Patients have reported being ignored or minimized, resources are lacking for diagnosis and treatment, and frustrated individuals are turning outside of the scientific profession for answers. The experience mirrors that of American Society for Microbiology past president Alice C. Evans. Accidentally infected with Brucella melitensis during her laboratory research, Evans was chronically ill for more than 20 years, during which time friends, colleagues, and physicians cast doubt on her illness. As a result, she argued passionately for improved diagnostics and for those who reported chronic infection to be taken seriously rather than presumed to be "malingering" or using their illness for financial benefit. Lessons from Evans' experience are useful as we work toward understanding long COVID and patients suffering from the condition.
Topics: Humans; Female; Post-Acute COVID-19 Syndrome; COVID-19; Brucellosis; Chronic Disease
PubMed: 37462272
DOI: 10.1093/cid/ciad427 -
The Importance of the Morel Emotional Numbing Test Instructions: A Diagnosis Threat Induction Study.Archives of Clinical Neuropsychology :... Jan 2024Marketed as a validity test that detects feigning of posttraumatic stress disorder (PTSD), the Morel Emotional Numbing Test for PTSD (MENT) instructs examinees that PTSD...
OBJECTIVE
Marketed as a validity test that detects feigning of posttraumatic stress disorder (PTSD), the Morel Emotional Numbing Test for PTSD (MENT) instructs examinees that PTSD may negatively affect performance on the measure. This study explored the potential that MENT performance depends on inclusion of "PTSD" in its instructions and the nature of the MENT as a performance validity versus a symptom validity test (PVT/SVT).
METHOD
358 participants completed the MENT as a part of a clinical neuropsychological evaluation. Participants were either administered the MENT with the standard instructions (SIs) that referenced "PTSD" or revised instructions (RIs) that did not. Others were administered instructions that referenced "ADHD" rather than PTSD (AI). Comparisons were conducted on those who presented with concerns for potential traumatic-stress related symptoms (SI vs. RI-1) or attention deficit (AI vs. RI-2).
RESULTS
Participants in either the SI or AI condition produced more MENT errors than those in their respective RI conditions. The relationship between MENT errors and other S/PVTs was significantly stronger in the SI: RI-1 comparison, such that errors correlated with self-reported trauma-related symptoms in the SI but not RI-1 condition. MENT failure also predicted PVT failure at nearly four times the rate of SVT failure.
CONCLUSIONS
Findings suggest that the MENT relies on overt reference to PTSD in its instructions, which is linked to the growing body of literature on "diagnosis threat" effects. The MENT may be considered a measure of suggestibility. Ethical considerations are discussed, as are the construct(s) measured by PVTs versus SVTs.
Topics: Humans; Neuropsychological Tests; Malingering; Emotions; Stress Disorders, Post-Traumatic
PubMed: 37449530
DOI: 10.1093/arclin/acad048 -
Journal of Clinical Psychology in... Mar 2024Chronic pain is a debilitating condition for many military Veterans and is associated with posttraumatic stress disorder (PTSD). This study examined the Minnesota...
Chronic pain is a debilitating condition for many military Veterans and is associated with posttraumatic stress disorder (PTSD). This study examined the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in 144 Veterans (88.2% male, mean age = 57.95 years) recruited from a VA outpatient pain clinic and associations with self-reported pain severity, pain-related interference in daily activities, prescription opioid use, and objective metrics of physical performance on tasks impacted by pain (walking, stair climbing, grip strength, indexed by a single latent variable). Among the cohort with valid responses on the MMPI-2-RF (n = 117) and probable PTSD, mean Somatic Complaints (RC1) and Ideas of Persecution (RC6) scores were clinically elevated. All MMPI-2-RF scales were more strongly correlated with self-reported pain interference than severity. Regressions revealed associations between self-rated pain interference (but not pain or PTSD severity) and physical performance scores (β = .36, p = .001). MMPI-2-RF overreporting Validity and Higher-Order scales contributed incremental variance in predicting physical performance, including Infrequent Psychopathology Responses (β = .33, p = .002). PTSD severity was associated with prescription opioid use when accounting for the effects of over-reported somatic and cognitive symptoms (odds ratio 1.05, p ≤ .025). Results highlight the role of symptom overreporting and perceptions of functional impairment to observable behaviors among individuals with chronic pain.
Topics: Humans; Male; Middle Aged; Female; MMPI; Veterans; Chronic Pain; Pain Clinics; Analgesics, Opioid; Malingering; Reproducibility of Results
PubMed: 37418093
DOI: 10.1007/s10880-023-09967-z -
Frontiers in Psychology 2023The false consensus effect consists of an overestimation of how common a subject opinion is among other people. This research demonstrates that individual endorsement of...
INTRODUCTION
The false consensus effect consists of an overestimation of how common a subject opinion is among other people. This research demonstrates that individual endorsement of questions may be predicted by estimating peers' responses to the same question. Moreover, we aim to demonstrate how this prediction can be used to reconstruct the individual's response to a single item as well as the overall response to all of the items, making the technique suitable and effective for malingering detection.
METHOD
We have validated the procedure of reconstructing individual responses from peers' estimation in two separate studies, one addressing anxiety-related questions and the other to the Dark Triad. The questionnaires, adapted to our scopes, were submitted to the groups of participants for a total of 187 subjects across both studies. Machine learning models were used to estimate the results.
RESULTS
According to the results, individual responses to a single question requiring a "yes" or "no" response are predicted with 70-80% accuracy. The overall participant-predicted score on all questions (total test score) is predicted with a correlation of 0.7-0.77 with actual results.
DISCUSSION
The application of the false consensus effect format is a promising procedure for reconstructing truthful responses in forensic settings when the respondent is highly likely to alter his true (genuine) response and true responses to the tests are missing.
PubMed: 37397336
DOI: 10.3389/fpsyg.2023.1093854 -
European Radiology Dec 2023Fat-water MRI can be used to quantify tissues' lipid content. We aimed to quantify fetal third trimester normal whole-body subcutaneous lipid deposition and explore...
OBJECTIVES
Fat-water MRI can be used to quantify tissues' lipid content. We aimed to quantify fetal third trimester normal whole-body subcutaneous lipid deposition and explore differences between appropriate for gestational age (AGA), fetal growth restriction (FGR), and small for gestational age fetuses (SGAs).
METHODS
We prospectively recruited women with FGR and SGA-complicated pregnancies and retrospectively recruited the AGA cohort (sonographic estimated fetal weight [EFW] ≥ 10th centile). FGR was defined using the accepted Delphi criteria, and fetuses with an EFW < 10th centile that did not meet the Delphi criteria were defined as SGA. Fat-water and anatomical images were acquired in 3 T MRI scanners. The entire fetal subcutaneous fat was semi-automatically segmented. Three adiposity parameters were calculated: fat signal fraction (FSF) and two novel parameters, i.e., fat-to-body volume ratio (FBVR) and estimated total lipid content (ETLC = FSF*FBVR). Normal lipid deposition with gestation and differences between groups were assessed.
RESULTS
Thirty-seven AGA, 18 FGR, and 9 SGA pregnancies were included. All three adiposity parameters increased between 30 and 39 weeks (p < 0.001). All three adiposity parameters were significantly lower in FGR compared with AGA (p ≤ 0.001). Only ETLC and FSF were significantly lower in SGA compared with AGA using regression analysis (p = 0.018-0.036, respectively). Compared with SGA, FGR had a significantly lower FBVR (p = 0.011) with no significant differences in FSF and ETLC (p ≥ 0.053).
CONCLUSIONS
Whole-body subcutaneous lipid accretion increased throughout the third trimester. Reduced lipid deposition is predominant in FGR and may be used to differentiate FGR from SGA, assess FGR severity, and study other malnourishment pathologies.
CLINICAL RELEVANCE STATEMENT
Fetuses with growth restriction have reduced lipid deposition than appropriately developing fetuses measured using MRI. Reduced fat accretion is linked with worse outcomes and may be used for growth restriction risk stratification.
KEY POINTS
• Fat-water MRI can be used to assess the fetal nutritional status quantitatively. • Lipid deposition increased throughout the third trimester in AGA fetuses. • FGR and SGA have reduced lipid deposition compared with AGA fetuses, more predominant in FGR.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Infant, Small for Gestational Age; Retrospective Studies; Fetal Growth Retardation; Fetus; Gestational Age; Adipose Tissue; Magnetic Resonance Imaging; Water; Lipids; Ultrasonography, Prenatal
PubMed: 37389606
DOI: 10.1007/s00330-023-09855-y