Publications by authors named "Richard J McNally"

237 Publications

An Observational Cohort Study and Nested Randomized Controlled Trial on Nutrition and Growth Outcomes in Moderate and Late Preterm Infants (FLAMINGO).

Front Nutr 2021 8;8:561419. Epub 2021 Mar 8.

Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC) Amsterdam, Amsterdam, Netherlands.

Over the past decades, the preterm birth rate has increased, mostly due to a rise in late and moderate preterm (LMPT, 32-36 weeks gestation) births. LMPT birth affects 6-7% of all births in the United Kingdom and is associated with increased morbidity risk after birth in infancy as well as in adulthood. Early life nutrition has a critical role in determining infant growth and development, but there are limited data specifically addressing LMPT infants, which was the rationale for the design of the current study. The Feeding Late and Moderate Infants and Growth Outcomes (FLAMINGO) study aims to improve understanding of the longitudinal growth, nutritional needs, and body composition of LMPT infants as well as their microbiome development and neurodevelopment. In addition, having a nested non-inferiority trial enables evaluation of the nutritional adequacy of a concept IMF with large milk phospholipid-coated lipid droplets comprising dairy and vegetable lipids. The primary outcome of this RCT is daily weight gain until 3 months corrected age. A total of 250 healthy LMPT infants (32+0-36+6 weeks gestational age) with birth weight 1.25-3.0 kg will be recruited to the cohort, of which 140 infants are anticipated to be enrolled in the RCT. During six visits over the first 2 years of life, anthropometry, body composition (using dual energy X-Ray absorptiometry), feeding behavior, and developmental outcomes will be measured. Saliva and stool samples will be collected for oral and gut microbiota assessment. The FLAMINGO study will improve understanding of the longitudinal growth, body composition development, and feeding characteristics of LMPT infants and gain insights into their microbiome and neurodevelopment. www.isrctn.com; Identifier ISRCTN15469594.
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http://dx.doi.org/10.3389/fnut.2021.561419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982654PMC
March 2021

A Network Analysis of DSM-5 Posttraumatic Stress Disorder Symptoms and Event Centrality.

J Trauma Stress 2021 Mar 1. Epub 2021 Mar 1.

Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.

The centrality of a traumatic event to one's autobiographical memory has been associated with posttraumatic stress disorder (PTSD) symptom severity. In the present study, we investigated the associations between specific features of event centrality (EC), as measured using the Centrality of Event Scale, and specific symptoms of PTSD. We computed a cross-sectional graphical lasso network of PTSD symptoms and specific features of EC in a sample of trauma-exposed individuals (n = 451), many of whom met the clinical threshold for a PTSD diagnosis. The graphical lasso revealed intrusive memories, negative trauma-related feelings, and the perception that the traumatic event was central to one's identity to be influential nodes. Viewing the future through the lens of one's trauma exposure was the EC feature most strongly linked to PTSD. Among all PTSD symptoms, blaming oneself or others for the traumatic event showed the strongest link to EC. The network was stable, allowing for reliable interpretations. Future longitudinal research is needed to clarify the associations among EC features and PTSD symptoms over time.
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http://dx.doi.org/10.1002/jts.22664DOI Listing
March 2021

Not all types of meditation are the same: Mediators of change in mindfulness and compassion meditation interventions.

J Affect Disord 2021 Mar 2;283:354-362. Epub 2021 Feb 2.

Department of Psychology, Harvard University, USA.

Background: The general aim of the study was to examine the relative effectiveness and mediators of change in standardized mindfulness and compassion interventions.

Methods: A sample of 431 participants enrolled in a Mindfulness-Based Stress Reduction program (MBSR = 277) and a Compassion Cultivation Training (CCT = 154). The assessment before and after the program included a set of outcomes and mediators measures. A three-step data analysis plan was followed: ANCOVAs, Reliable Change Index, and mediations (simple and multiple).

Results: Both interventions yielded increased mindfulness, decentering, body awareness, and self-compassion. Yet, present-moment awareness improvements (i.e., decentering, and body awareness) were significantly larger in the MBSR than in CCT, whereas socio-emotional changes (i.e., common humanity and empathic concern) were larger in the CCT than in MBSR. The magnitude of effect sizes ranged from medium to large. Furthermore, both mindfulness and compassion interventions yielded similar changes in psychological distress (i.e., stress, anxiety, and depression), maladaptive cognitive processes (i.e., rumination and thought suppression), and well-being. The mediation models showed that although the MBSR program seemingly relies on changes in present-moment awareness mechanisms (i.e., decentering and body awareness) to reduce psychological distress and to improve well-being, the CCT program seemingly achieves the same positive outcomes through changes in socio-emotional mechanisms (i.e., common-humanity and empathy concern).

Limitations: Due to our naturalistic design in real-world community setting, it was infeasible to randomly assign participants to conditions.

Conclusions: Our results suggest that mindfulness and compassion programs operate through different pathways to reduce psychological distress and to promote well-being.
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http://dx.doi.org/10.1016/j.jad.2021.01.070DOI Listing
March 2021

Posttraumatic stress or posttraumatic growth? Using network analysis to explore the relationships between coping styles and trauma outcomes.

J Anxiety Disord 2021 Mar 16;78:102359. Epub 2021 Jan 16.

Department of Psychology, Harvard University, Cambridge, MA, USA.

Trauma can produce posttraumatic stress disorder (PTSD), but may also foster positive outcomes, such as posttraumatic growth. Individual differences in coping styles may contribute to both positive and negative sequelae of trauma. Using network analytic methods, we investigated the structure of PTSD symptoms, elements of growth, and coping styles in bereaved survivors of a major earthquake in China. Hypervigilance and difficulty concentrating were identified as the most central symptoms in the PTSD network, whereas establishing a new path in life, feeling closer to others, and doing better things with life ranked highest on centrality in the posttraumatic growth network. Direct connections between PTSD symptoms and elements of growth were low in magnitude in our sample. Our final network, which included PTSD symptoms, growth elements, and coping styles, suggests that adaptive and active coping styles, such as positive reframing, are positively related to elements of growth, but not appreciably negatively related to PTSD symptoms. Conversely, maladaptive coping styles are positively related to PTSD symptoms, but are not negatively associated with growth. Future longitudinal studies could shed light on the direction of causality in these relationships and their clinical utility.
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http://dx.doi.org/10.1016/j.janxdis.2021.102359DOI Listing
March 2021

Are memories of sexual trauma fragmented?

Memory 2021 Jan 12:1-5. Epub 2021 Jan 12.

Department of Psychology, Harvard University, Cambridge, MA, USA.

Alarmingly high rates of sexual assault on campus have motivated American colleges and universities to take steps to address this serious problem. Yet university administrators have often felt ill-equipped to assess allegations of sexual assault. Unsurprisingly, they have sought the expertise of psychologists who can educate administrative staff about the complexities of traumatic memory. Dr. Rebecca Campbell is among the most influential figures teaching university administrators about sexual trauma and memory. The purpose of this article is to review research pertinent to her views on fragmentation of traumatic memories, and the possible roles of tonic immobility and alcohol consumption on how survivors of sexual assault recall their experience.
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http://dx.doi.org/10.1080/09658211.2020.1871023DOI Listing
January 2021

Network Analysis of Psychopathology: Controversies and Challenges.

Annu Rev Clin Psychol 2020 Nov 23. Epub 2020 Nov 23.

Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA; email:

Empirical publications inspired by the network approach to psychopathology have increased exponentially in the twenty-first century. The central idea that an episode of mental disorder arises from causal interactions among its symptomatic elements has especially resonated with those clinical scientists whose disenchantment with traditional categorical and dimensional approaches to mental illness have become all too apparent. As the field has matured, conceptual and statistical concerns about the limitations of network approaches to psychopathology have emerged, inspiring the development of novel methods to address these concerns. Rather than reviewing the vast empirical literature, I focus instead on the issues and controversies regarding this approach and sketch directions where the field might go next. Expected final online publication date for the , Volume 17 is May 7, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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http://dx.doi.org/10.1146/annurev-clinpsy-081219-092850DOI Listing
November 2020

Congenital Hypothyroidism: Space-Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology.

Thyroid 2020 Dec 29. Epub 2020 Dec 29.

Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.

The etiology of most cases of congenital hypothyroidism (CHT) due to thyroid dysgenesis (DG) is unknown. If transient environmental factors can impact on thyroid gland development, then clustering of cases in time and/or space may occur, and this would be more likely in thyroid DG than dyshormonogenesis (DHG). The newborn screening program for CHT in Scotland is linked to a central database that includes case details such as postcode. The etiology of CHT is investigated in many cases of CHT using scintigraphy and/or ultrasonography. We looked for evidence of a change in CHT incidence with year of birth and according to season of the year. We then undertook space-time clustering analysis (using a method based on -functions, with nearest neighbor thresholds) of CHT in Scotland between 1979 and 2015. We also looked for evidence of overall changes associated with sex and area-based birth density. Of 531 cases with CHT during the study period, 290 cases had been categorized as DG ( = 229) or DHG ( = 61) following more detailed investigation. The incidence of CHT increased with year of birth and was in part linked to changing methodology, but there was no seasonality. There was no evidence of overall space-time clustering ( = 0.06), but there was evidence of clustering in babies with DG ( = 0.007). This picture appeared to be most closely linked to underlying thyroid gland hypoplasia rather than thyroid gland agenesis or ectopia. There was significant space-time clustering for both males and females, but clustering was restricted to lesser birth density areas. There was also evidence of clustering for unknown cases ( < 0.001). Clustering of these cases was restricted to females but was present for cases from both greater and lesser birth density areas. There was no evidence of clustering in cases of DHG. These data suggest that an unidentified environmental factor or factors may be involved in the etiology of thyroid DG in Scotland. The variation in CHT incidence observed internationally may reflect environmental as well as genetic factors.
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http://dx.doi.org/10.1089/thy.2020.0005DOI Listing
December 2020

Reframing Time Spent Alone: Reappraisal Buffers the Emotional Effects of Isolation.

Cognit Ther Res 2020 Jul 4:1-16. Epub 2020 Jul 4.

Department of Psychology, Harvard University, Cambridge, MA USA.

Background: Loneliness, a transdiagnostic feature of psychopathology, is an experience of perceived isolation only weakly linked to the amount of time spent alone. Although traditional loneliness interventions aim to increase social contact, targeting maladaptive cognition about time alone may be an effective way to reduce loneliness. We investigated whether a brief reappraisal manipulation enables individuals to experience their time alone more positively. We also tested the impact of trait loneliness, compulsive social media use, and trait reappraisal on experiences of time alone.

Methods: College students and community members ( = 220) were randomly assigned to read a passage about the benefits of solitude ( = 74), the true prevalence of loneliness ( = 72), or a control topic ( = 74). Participants then sat alone for 10 min.

Results: Across conditions, positive and negative mood significantly decreased after sitting alone. Participants who read about the benefits of solitude experienced a smaller reduction in positive mood than those in the control condition. Participants who less frequently used reappraisal in their everyday lives benefited most from the manipulation.

Conclusions: Our results provide preliminary evidence that reappraising time alone as solitude may boost resilience to the decrements in positive mood associated with time alone. Limitations, clinical implications, and directions for future research are discussed.
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http://dx.doi.org/10.1007/s10608-020-10128-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335222PMC
July 2020

Sampling Variability Is Not Nonreplication: A Bayesian Reanalysis of Forbes, Wright, Markon, and Krueger.

Multivariate Behav Res 2020 Jul 30:1-7. Epub 2020 Jul 30.

Department of Psychology, Harvard University.

Forbes, Wright, Markon, and Krueger claim that psychopathology network characteristics have "limited" or "poor" replicability, supporting their argument primarily with data from two waves of an observational study on depression and anxiety. They developed "direct metrics" to gauge change across networks (e.g., change in edge sign), and used these results to support their conclusion. Three key flaws undermine their critique. First, nonreplication across empirical datasets does not provide evidence against a method; such evaluations of methods are possible only in controlled simulations when the data-generating model is known. Second, they assert that the removal of shared variance necessarily decreases reliability. This is not true. Depending on the causal model, it can either increase or decrease reliability. Third, their direct metrics do not account for normal sampling variability, leaving open the possibility that the direct differences between samples are due to normal, unproblematic fluctuations. As an alternative to their direct metrics, we provide a Bayesian re-analysis that quantifies uncertainty and compares relative evidence for replication (i.e., equivalence) versus nonreplication (i.e., nonequivalence) for each network edge. This approach provides a principled roadmap for future assessments of network replicability. Our analysis indicated substantial evidence for replication and scant evidence for nonreplication.
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http://dx.doi.org/10.1080/00273171.2020.1797460DOI Listing
July 2020

Nonadherence to breast and cervical cancer screening among sexual minority women: Do stigma-related psychological barriers play a role?

Health Psychol 2020 Oct 20;39(10):891-899. Epub 2020 Jul 20.

Department of Psychology, Harvard University.

Objective: Sexual minority women are at heightened risk for breast and cervical cancer and are less likely than heterosexual women to obtain timely screenings for breast and cervical cancer. This study tested hypotheses about potential factors that contribute to nonadherence to these screenings among sexual minority women.

Method: Sexual minority women living in the United States aged 18 to 74 who met other eligibility criteria ( = 1,115) were recruited to complete an online questionnaire. Screening utilization, demographic information, sexual orientation, and health care indicators were collected. Variables linked to minority stress were assessed: stigma consciousness, internalized homophobia, rejection sensitivity, fear of negative evaluation, and concealment of sexual orientation from one's health care provider. Logistic regression models tested whether these psychological variables were independently associated with nonadherence for Papanicolaou (Pap) test and breast cancer screening.

Results: The variable of concealment had the strongest positive independent association with failure to obtain timely Pap tests. Among women who had a general physical in the last year, concealment, stigma consciousness, rejection sensitivity, and fear of negative evaluation were all positively associated with lower rates of timely Pap tests. Among all women, these psychological variables were positively associated with never obtaining a Pap test and concealment was also negatively associated with clinical breast exam adherence.

Conclusions: Psychological barriers and concealment of sexual identity may hinder adherence to screening guidelines among some sexual minority women. Strategies facilitating positive experiences of disclosure to health care providers and addressing psychological factors related to minority stress could promote adherence. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000887DOI Listing
October 2020

Nonadherence to breast and cervical cancer screening among sexual minority women: Do stigma-related psychological barriers play a role?

Health Psychol 2020 Oct 20;39(10):891-899. Epub 2020 Jul 20.

Department of Psychology, Harvard University.

Objective: Sexual minority women are at heightened risk for breast and cervical cancer and are less likely than heterosexual women to obtain timely screenings for breast and cervical cancer. This study tested hypotheses about potential factors that contribute to nonadherence to these screenings among sexual minority women.

Method: Sexual minority women living in the United States aged 18 to 74 who met other eligibility criteria ( = 1,115) were recruited to complete an online questionnaire. Screening utilization, demographic information, sexual orientation, and health care indicators were collected. Variables linked to minority stress were assessed: stigma consciousness, internalized homophobia, rejection sensitivity, fear of negative evaluation, and concealment of sexual orientation from one's health care provider. Logistic regression models tested whether these psychological variables were independently associated with nonadherence for Papanicolaou (Pap) test and breast cancer screening.

Results: The variable of concealment had the strongest positive independent association with failure to obtain timely Pap tests. Among women who had a general physical in the last year, concealment, stigma consciousness, rejection sensitivity, and fear of negative evaluation were all positively associated with lower rates of timely Pap tests. Among all women, these psychological variables were positively associated with never obtaining a Pap test and concealment was also negatively associated with clinical breast exam adherence.

Conclusions: Psychological barriers and concealment of sexual identity may hinder adherence to screening guidelines among some sexual minority women. Strategies facilitating positive experiences of disclosure to health care providers and addressing psychological factors related to minority stress could promote adherence. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000887DOI Listing
October 2020

Network Structure of Physical, Cognitive, and Emotional Symptoms at Preseason Baseline in Student Athletes with Attention-Deficit/ Hyperactivity Disorder.

Arch Clin Neuropsychol 2020 Jun 3. Epub 2020 Jun 3.

Department of Psychology, Harvard University, Cambridge, MA, USA.

Objective: Preexisting attention-deficit/hyperactivity disorder (ADHD) may be a risk factor for worse outcome following sport-related concussion. We used a statistical and psychometric approach known as network analysis to examine the architecture of physical, cognitive, and emotional symptoms at preseason baseline among student athletes with ADHD.

Method: A cohort of 44,527 adolescent student athletes completed baseline preseason testing with ImPACT® between 2009 and 2015. A subsample of athletes reporting a diagnosis of ADHD and at least one symptom were included in this study (N = 3,074; 14-18 years old, 32.7% girls). All participants completed the 22-item Post-Concussion Symptom Scale at preseason baseline.

Results: Student athletes reported high frequencies of difficulty concentrating (boys/girls = 50.7%/59.4%), emotional symptoms (nervousness: boys/girls = 30.2%/51.0%; irritability: boys/girls = 23.6%/34.8%; sadness: boys/girls = 21.4%/39.7%), sleep/arousal-related symptoms (trouble falling asleep: boys/girls = 39.5%/49.4%; sleeping less than usual: boys/girls = 36.2%/43.4%; and fatigue: boys/girls = 29.8%/36.4%), and headaches (boys/girls = 27.6%/39.0%) during preseason baseline testing. The most central symptoms included dizziness, which was related to multiple somatic symptoms, and increased emotionality, which was related to a cluster of emotional symptoms. Girls reported symptoms at a greater frequency than boys, and there was evidence for variance in the global strength of the symptom network across gender, but not specific intersymptom relationships.

Conclusion: In the absence of injury, symptoms that commonly occur after concussion interact and potentially reinforce each other among student athletes with ADHD at preseason. Symptoms common in ADHD (i.e., difficulty concentrating) are not necessarily the most central within the symptom network. These findings may inform more precise interventions for athletes with ADHD and prolonged recovery following concussion.
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http://dx.doi.org/10.1093/arclin/acaa030DOI Listing
June 2020

Bridging maladaptive social self-beliefs and social anxiety: a network perspective.

J Anxiety Disord 2020 08 20;74:102267. Epub 2020 Jun 20.

Department of Psychology, Harvard University, Cambridge, MA, United States.

The Clark and Wells (1995) model of social anxiety disorder postulates that three types of maladaptive social self-beliefs (high standard, conditional, and unconditional beliefs) play a crucial role in the development of fear and avoidance of social-evaluative situations-i.e., the hallmark symptoms of social anxiety disorder. In this project, we examined associations between the three types of maladaptive social self-beliefs and fear and avoidance of social-evaluative situations in a nonclinical community sample (n = 389). We used network analysis to estimate functional relations among aspects of maladaptive self-beliefs, fear, and avoidance and computed two different network models, a graphical Gaussian model (GGM) and a directed acyclic graph (DAG). Each model estimates edges and the importance of nodes in different ways. Both GGM and DAG pointed to fear and conditional beliefs as especially potent bridges between maladaptive social self-beliefs and social anxiety in our nonclinical sample. Altogether, these results offer data-driven heuristics in the field's larger, ongoing effort to illuminate pathways at play in the development of social anxiety. We situate this study within novel network approaches for developing theory-driven models and tests of the instigation and interactions of maladaptive social self-beliefs and social anxiety. However, because this is the first study to combine GGM and DAG in social anxiety research, we also discussed the caveats to this approach to help to usher the field forward.
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http://dx.doi.org/10.1016/j.janxdis.2020.102267DOI Listing
August 2020

"Identity confusion in complicated grief: A closer look": Correction.

J Abnorm Psychol 2020 Aug 18;129(6):543. Epub 2020 Jun 18.

Department of Psychology.

Reports an error in "Identity confusion in complicated grief: A closer look" by Benjamin W. Bellet, Nicole J. LeBlanc, Marie-Christine Nizzi, Mikaela L. Carter, Florentine H. S. van der Does, Jacqueline Peters, Donald J. Robinaugh and Richard J. McNally (, 2020[May], Vol 129[4], 397-407). In the original article, the following acknowledgment of funding was missing from the author note: "Donald J. Robinaugh's work on this article was supported by federal funding from the National Institute of Mental Health (Grant 1K23MH113805-01A1; principal investigator: Donald J. Robinaugh)." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-23551-001). Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/abn0000631DOI Listing
August 2020

Clinical diagnosis of Lewy body dementia.

BJPsych Open 2020 Jun 16;6(4):e61. Epub 2020 Jun 16.

Department of Psychiatry, University of Cambridge, UK.

Background: Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.

Aims: This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.

Method: We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.

Results: The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.

Conclusions: Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
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http://dx.doi.org/10.1192/bjo.2020.44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345593PMC
June 2020

Mnemonic discrimination in treatment-seeking adults with and without PTSD.

Behav Res Ther 2020 08 22;131:103650. Epub 2020 May 22.

Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States. Electronic address:

Posttraumatic stress disorder (PTSD) is characterized by overgeneralized emotional reactivity following a trauma. Similarities between current, safe contexts and past, threatening events trigger recurrent, distressing responses and can contribute to a host of symptoms, including reexperiencing and hypervigilance. Mnemonic discrimination, a component process of episodic memory, could promote overgeneralization when impaired. Mnemonic discrimination reflects the integration of old and new experiences and one's ability to differentiate them despite their similarities. To date, little research has been conducted in clinical populations and none with individuals with PTSD. In this study, we examined mnemonic discrimination performance among treatment-seeking adults with and without PTSD and healthy comparison participants (n = 190). There were significant group differences in mnemonic discrimination performance, but not in general recognition memory. Individuals without psychopathology outperformed individuals with PTSD and treatment-seeking individuals without PTSD. However, there were no differences in mnemonic discrimination performance among individuals with PTSD and any other diagnoses. Finally, clinical groups with or without trauma exposure also did not differ in mnemonic discrimination performance. Results held when we adjusted for general recognition memory. Findings suggest that poor mnemonic discrimination is transdiagnostically associated with emotional disorders. Future work is merited to explore this as a measurable and potentially malleable, though non-specific, risk factor.
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http://dx.doi.org/10.1016/j.brat.2020.103650DOI Listing
August 2020

Trigger warnings and resilience in college students: A preregistered replication and extension.

J Exp Psychol Appl 2020 Dec 13;26(4):717-723. Epub 2020 Apr 13.

Department of Psychology, Harvard University.

Trigger warnings notify people that content they are about to engage with may result in adverse emotional consequences. An experiment by Bellet, Jones, and McNally (2018) indicated that trigger warnings increased the extent to which trauma-naïve crowd-sourced participants see themselves and others as emotionally vulnerable to potential future traumas but did not have a significant main effect on anxiety responses to distressing literature passages. However, they did increase anxiety responses for participants who strongly believed that words can harm. In this article, we present a preregistered replication of this study in a college student sample, using Bayesian statistics to estimate the success of each effect's replication. We found strong evidence that none of the previously significant effects replicated. However, we found substantial evidence that trigger warnings' previously nonsignificant main effect of increasing anxiety responses to distressing content was genuine, albeit small. Interpretation of the findings, implications, and future directions are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/xap0000270DOI Listing
December 2020

Architecture of Physical, Cognitive, and Emotional Symptoms at Preseason Baseline in Adolescent Student Athletes With a History of Mental Health Problems.

Front Neurol 2020 20;11:175. Epub 2020 Mar 20.

Department of Psychology, Harvard University, Cambridge, MA, United States.

Pre-injury mental health problems are associated with greater symptom reporting following sport-related concussion. We applied a statistical and psychometric approach known as network analysis to examine the interrelationships among symptoms at baseline in adolescent student athletes with a history of mental health problems. Cross-sectional study. High schools in Maine, USA. A cohort of 44,527 adolescent student athletes completed baseline preseason testing with ImPACT® between 2009 and 2015, and those with a history of mental health problems reporting at least one symptom were included ( = 2,412; 14-18 years-old, 60.1% girls). Self-reported history of treatment for a psychiatric condition. Physical, cognitive, and emotional symptoms from the Post-Concussion Symptom Scale. Student athletes reported high frequencies of emotional symptoms (nervousness: boys = 46.6%, girls = 58.3%; irritability: boys = 37.9%, girls = 46.9%; sadness: boys = 38.7%, girls = 53.2%), sleep/arousal-related symptoms (trouble falling asleep: boys = 50.4%, girls = 55.1%; sleeping less than usual: boys = 43.8%, girls = 45.2%; and fatigue: boys = 40.3%, girls = 45.2%), headaches (boys = 27.5%, girls = 41.8%), and inattention (boys = 47.8%, girls = 46.9%) before the start of the season. Although uncommonly endorsed, dizziness was the most central symptom (i.e., the symptom with the highest aggregate connectedness with different symptoms in the network), followed by feeling more emotional and feeling slowed down. Dizziness was related to physical and somatic symptoms (e.g., balance, headache, nausea, numbness/tingling) whereas increased emotionality was related to sadness, nervousness, and irritability. Feeling slowed down was connected to cognitive (e.g., fogginess, forgetfulness), and sensory symptoms (e.g., numbness/tingling, light sensitivity). There were no gender differences in the symptom network structure. We examined the interconnections between symptoms reported by student athletes with mental health problems at preseason baseline, identifying how physical, cognitive, and emotional symptoms interact and potentially reinforce each other in the absence of injury. These findings are a step toward informing more precise interventions for this subgroup of athletes if they are slow to recover following concussion.
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http://dx.doi.org/10.3389/fneur.2020.00175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100766PMC
March 2020

Identity confusion in complicated grief: A closer look.

J Abnorm Psychol 2020 May 6;129(4):397-407. Epub 2020 Apr 6.

Department of Psychology.

Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/abn0000520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370894PMC
May 2020

Short-term effects of air pollution on daily asthma-related emergency department visits in an industrial city.

J Public Health (Oxf) 2021 Apr;43(1):e45-e53

Institute for Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne & Wear NE2 4AA, UK.

Background: Epidemiological studies from Europe and North America have provided evidence that exposure to air pollution can aggravate symptoms in asthmatic patients.

Methods: Daily number of AEDv, air pollution levels (PM10, PM2.5, SO2, NO2 and CO) and meteorological variables was obtained from Jubail Industrial City, Saudi Arabia, for the period of 2007-11. Data were analyzed using a time-series approach. Relative risks (RRs) were estimated using Poisson regression.

Results: The associations between AEDv and PM10, PM2.5, SO2 and NO2 remained positive and statistically significant after mutual adjustment in the multi-pollutant model.The RR of AEDv increased by 5.4, 4.4, 3.4 and 2.2% per an inter-quartile range increase in SO2 (2.0 ppb), PM2.5 (36 μg/m3), NO2 (7.6 ppb) and PM10 (140 μg/m3), respectively. No significant associations between AEDv and CO were found.

Conclusions: Current levels of ambient air pollution are associated with AEDv in this industrial setting in the Middle East. Greater awareness of environmental health protection and the implementation of effective measures to improve the quality of air in such settings would be beneficial to public health.
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http://dx.doi.org/10.1093/pubmed/fdaa035DOI Listing
April 2021

A network analysis of culturally relevant anxiety sensitivity and posttraumatic stress disorder symptoms in Cambodians.

Transcult Psychiatry 2021 Jun 8;58(3):440-452. Epub 2020 Mar 8.

University of Washington.

The Anxiety Sensitivity Index (ASI) measures fears of anxiety-related symptoms based on respondent beliefs about their harmfulness. This is the first network analysis of anxiety sensitivity and PTSD, and the first to explore an addendum of culturally salient fears in such an analysis. The purpose of our study was to test whether relations among PTSD symptoms and facets of anxiety sensitivity, observed clinically, can be visualized by this approach. Using network analysis, we examined in a Cambodian population the relationship of PTSD symptoms to the standard Anxiety Sensitivity Index (ASI) and to an ASI Cambodian Addendum (ASICA) that taps culturally salient fears of somatic symptoms among Cambodians not assessed in the standard ASI. Computing relative importance networks, we found that the ASI subscales, ASICA, and PTSD subscales were strongly interconnected, with the ASICA having the strongest outstrength centrality. In the network analysis of the ASI subscales, disaggregated ASICA, and PTSD subscales, several of the ASICA items had very high outstrength. The results show that fear of mental and physical symptoms of anxiety should be a key part of the evaluation of trauma-related disorder, and that those fears should be targeted. It also suggests the need for ASI addenda to assess concerns about anxiety symptoms salient for certain cultures that are not assessed by the standard ASI: among Cambodian populations, fear of cold hands and feet, "out of energy in the arms and legs," neck soreness, tinnitus, and dizziness on standing.
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http://dx.doi.org/10.1177/1363461520906005DOI Listing
June 2021

"Fake it till You Make it"! Contaminating Rubber Hands ("Multisensory Stimulation Therapy") to Treat Obsessive-Compulsive Disorder.

Front Hum Neurosci 2019 9;13:414. Epub 2020 Jan 9.

Center for Brain and Cognition, University of California, San Diego, San Diego, CA, United States.

Obsessive-compulsive disorder (OCD) is a deeply enigmatic psychiatric condition associated with immense suffering worldwide. Efficacious therapies for OCD, like exposure and response prevention (ERP), are sometimes poorly tolerated by patients. As many as 25% of patients refuse to initiate ERP mainly because they are too anxious to follow exposure procedures. Accordingly, we proposed a simple and tolerable (immersive yet indirect) low-cost technique for treating OCD that we call "multisensory stimulation therapy." This method involves contaminating a rubber hand during the so-called "rubber hand illusion" (RHI) in which tactile sensations may be perceived as arising from a fake hand. Notably, Jalal et al. (2015) showed that such fake hand contamination during the RHI provokes powerful disgust reactions in healthy volunteers. In the current study, we explored the therapeutic potential of this novel approach. OCD patients ( = 29) watched as their hidden real hand was being stroked together with a visible fake hand; either synchronously (inducing the RHI; i.e., the experimental condition; = 16) or asynchronously (i.e., the control condition; = 13). After 5 min of tactile stimulation, the rubber hand was contaminated with fake feces, simulating conventional exposure therapy. Intriguingly, results suggested sensory assimilation of contamination sensations into the body image the RHI: patients undergoing synchronous stimulation did not report greater contamination sensations when the fake hand was initially contaminated relative to asynchronous stroking. But contrary to expectations, they did so after the rubber hand had been contaminated for 5 min, as assessed disgust facial expressions (a secondary outcome) and exposure (upon discontinuing the illusion). Further, to our surprise, synchronous and asynchronous stroking induced an equally vivid and fast-emerging illusion, which helps explain why both conditions initially (5 min after initiating tactile stimulation) provoked contamination reactions of equal magnitude. This study is the first to suggest heightened malleability of body image in OCD. Importantly, it may pave the way for a tolerable technique for the treatment of OCD-highly suitable for poorly resourced and emergency settings, including low-income and developing countries with minimal access to high-tech solutions like virtual reality.
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http://dx.doi.org/10.3389/fnhum.2019.00414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962184PMC
January 2020

Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults.

J Affect Disord 2020 02 2;263:405-412. Epub 2019 Dec 2.

Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.

Background: Self-blame following bereavement has been implicated in the development of post-loss psychopathology. However, prior studies have not distinguished between the emotions of shame versus guilt. This study examined the cross-sectional associations among bereavement-related shame, bereavement-related guilt, and two mental disorders that commonly arise after bereavement: complicated grief and depression. In addition, exploratory analyses examined the associations between bereavement-related pride and post-loss psychopathology.

Methods: Participants included 92 bereaved adults who experienced the death of a family member at least one year prior to the study. Participants completed self-report measures of complicated grief symptoms, depression symptoms, shame, guilt, and pride.

Results: Shame and guilt were positively correlated with complicated grief and depression symptoms. When controlling for their shared variance, only shame remained a significant predictor of post-loss psychopathology. Follow-up analyses indicated that the effect of guilt on psychopathology depended on the level of shame, and vice versa. At low shame, guilt predicted psychopathology; however guilt did not predict psychopathology at moderate to high shame. At low to moderate guilt, shame predicted psychopathology; however shame did not predict psychopathology at high guilt. Pride negatively predicted depression symptoms, but not complicated grief symptoms, when we controlled for shame and guilt.

Limitations: Limitations include the cross-sectional design and modest sample size.

Conclusions: Our analyses identify shame as the more pathogenic moral emotion for bereaved adults. However, whereas guilt in the absence of shame is often considered adaptive, we found that guilt predicted greater psychological distress at low levels of shame in this sample.
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http://dx.doi.org/10.1016/j.jad.2019.11.164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307182PMC
February 2020

Why check? A meta-analysis of checking in obsessive-compulsive disorder: Threat vs. distrust of senses.

Clin Psychol Rev 2020 02 12;75:101807. Epub 2019 Dec 12.

Helen and Sam Beber Chair of Clinical Psychology, Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.

Compulsive checking is the most common ritual among individuals with obsessive-compulsive disorder (OCD). Yet, other than uncertainty, the variables prompting checking are not fully understood. Laboratory studies suggest that task conditions - whether threatening (anxiety-relevant) or neutral, and task type - whether requiring perceptual or reasoning decision-making - may be influential. The purpose of our meta-analysis was to compare OCD participants and healthy controls on experimental tasks involving uncertainty in which a behavioral measure of checking was obtained. Four databases were searched. Twenty-two studies met the inclusion criteria, including 43 conditions comparing 663 OCD participants to 614 healthy controls. Due to the dependent structure of the data a robust variance estimation analysis approach was used. Overall effects were similar for neutral and threatening conditions. However, OCD participants responded with greater checking compared to controls on perceptual tasks, but not on reasoning tasks. Results support previous reports suggesting that OCD checking can be observed in neutral conditions, possibly posing as a risk factor for a checking vicious cycle. In addition, our results support OCD models which focus on checking as stemming from interference with automatic processes and distrust of sensory modalities.
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http://dx.doi.org/10.1016/j.cpr.2019.101807DOI Listing
February 2020

Obsessive-compulsive symptoms in eating disorders: A network investigation.

Int J Eat Disord 2020 03 20;53(3):362-371. Epub 2019 Nov 20.

Department of Psychology, Harvard University, Cambridge, Massachusetts.

Objective: Eating disorders (EDs) are complex, heterogeneous, and severe psychiatric syndromes. They are highly comorbid with obsessive-compulsive disorder (OCD) which exacerbates the course of illness and impedes treatment. However, the direct functional relations between EDs and OCD symptoms remain largely unexplored. Hence, using network analysis, we investigated the relationship between ED and OCD at the level of symptoms in a heterogeneous clinical sample.

Method: We used cross sectional data of 303 treatment-seeking patients with clinically relevant ED and OCD pathology. We constructed a regularized partial correlation network that featured both ED and OCD symptoms as nodes. To determine each symptom's influence, we calculated expected influence (EI) as an index of symptom centrality (i.e., "importance"). Bridge symptoms (i.e., symptoms from one syndromic cluster that have strong connections to symptoms of another syndromic cluster) were identified by computing bridge expected influence metrics.

Results: Fear of weight gain and dietary restraint were especially important among the ED symptoms. Interference due to obsessions was the key feature of OCD. ED and OCD clustered distinctly with few potential bridges between clusters.

Discussion: This study underscores the importance of cognitive symptoms for both ED and OCD although direct functional links between the two clusters are missing. Potentially, a network incorporating nodes capturing features of personality may account for diagnostic comorbidity better than specific symptoms of EDs or features of OCD do.
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http://dx.doi.org/10.1002/eat.23196DOI Listing
March 2020

Obsessive-compulsive symptoms in eating disorders: A network investigation.

Int J Eat Disord 2020 03 20;53(3):362-371. Epub 2019 Nov 20.

Department of Psychology, Harvard University, Cambridge, Massachusetts.

Objective: Eating disorders (EDs) are complex, heterogeneous, and severe psychiatric syndromes. They are highly comorbid with obsessive-compulsive disorder (OCD) which exacerbates the course of illness and impedes treatment. However, the direct functional relations between EDs and OCD symptoms remain largely unexplored. Hence, using network analysis, we investigated the relationship between ED and OCD at the level of symptoms in a heterogeneous clinical sample.

Method: We used cross sectional data of 303 treatment-seeking patients with clinically relevant ED and OCD pathology. We constructed a regularized partial correlation network that featured both ED and OCD symptoms as nodes. To determine each symptom's influence, we calculated expected influence (EI) as an index of symptom centrality (i.e., "importance"). Bridge symptoms (i.e., symptoms from one syndromic cluster that have strong connections to symptoms of another syndromic cluster) were identified by computing bridge expected influence metrics.

Results: Fear of weight gain and dietary restraint were especially important among the ED symptoms. Interference due to obsessions was the key feature of OCD. ED and OCD clustered distinctly with few potential bridges between clusters.

Discussion: This study underscores the importance of cognitive symptoms for both ED and OCD although direct functional links between the two clusters are missing. Potentially, a network incorporating nodes capturing features of personality may account for diagnostic comorbidity better than specific symptoms of EDs or features of OCD do.
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http://dx.doi.org/10.1002/eat.23196DOI Listing
March 2020

Unique and predictive relationships between components of cognitive vulnerability and symptoms of depression.

Depress Anxiety 2019 10 22;36(10):950-959. Epub 2019 Jul 22.

Department of Psychology, Temple University, Philadelphia, Pennsylvania.

Background: Cognitive vulnerability theories of depression outline multiple, distinct inferential biases constitutive of cognitive vulnerability to depression. These include attributing negative events to internal, stable, and global factors, assuming that negative events will lead to further negative consequences, and inferring that negative events reflect negative characteristics about the self. Extant research has insufficiently examined these biases as distinct, limiting our understanding of how the individual cognitive vulnerability components interrelate and confer risk for depression symptoms. Thus, we conducted exploratory network analyses to examine the relationships among the five components of negative cognitive style and explore how components may differentially relate to depressive symptoms in adolescents.

Methods: Participants completed measures of negative cognitive style twice over a two-year period. We estimated Graphical Gaussian Models using contemporaneous data and computed a cross-lagged panel network using temporal data from baseline and 2-year follow-up.

Results: Results reveal interesting structural dynamics among facets of negative cognitive style and depressive symptoms. For example, results point to biases towards stable and future-oriented inferences as highly influential among negative cognitive style components. The temporal model revealed the internal attributions component to be heavily influenced by depressive symptoms among adolescents, whereas stable and global attributions most influenced future symptoms.

Conclusions: This study presents novel approaches for investigating cognitive style and depression. From this perspective, perhaps more precise predictions can be made about how cognitive risk factors will lead to the development or worsening of psychopathology.
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http://dx.doi.org/10.1002/da.22935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777955PMC
October 2019

Bridge Centrality: A Network Approach to Understanding Comorbidity.

Multivariate Behav Res 2019 Jun 10:1-15. Epub 2019 Jun 10.

a Department of Psychology , Harvard University.

Recently, researchers in clinical psychology have endeavored to create network models of the relationships between symptoms, both within and across mental disorders. Symptoms that connect two mental disorders are called "bridge symptoms." Unfortunately, no formal quantitative methods for identifying these bridge symptoms exist. Accordingly, we developed four network statistics to identify bridge symptoms: , , and . These statistics are nonspecific to the type of network estimated, making them potentially useful in individual-level psychometric networks, group-level psychometric networks, and networks outside the field of psychopathology such as social networks. We first tested the fidelity of our statistics in predicting bridge nodes in a series of simulations. Averaged across all conditions, the statistics achieved a sensitivity of 92.7% and a specificity of 84.9%. By simulating datasets of varying sample sizes, we tested the robustness of our statistics, confirming their suitability for network psychometrics. Furthermore, we simulated the contagion of one mental disorder to another, showing that deactivating bridge nodes prevents the spread of comorbidity (i.e., one disorder activating another). Eliminating nodes based on bridge statistics was more effective than eliminating nodes high on traditional centrality statistics in preventing comorbidity. Finally, we applied our algorithms to 18 group-level empirical comorbidity networks from published studies and discussed the implications of this analysis.
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http://dx.doi.org/10.1080/00273171.2019.1614898DOI Listing
June 2019

Seasonal variation of mortality from external causes in Hungary between 1995 and 2014.

PLoS One 2019 6;14(6):e0217979. Epub 2019 Jun 6.

Institute of Health & Society, Newcastle University, Royal Victoria Infirmary, Newcastle, England, United Kingdom.

Objective: To analyze trends in external mortality in Hungary between 1995 and 2014 by sex.

Methods: Data on the numbers of deaths due to external causes were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in external-cause mortality rates. Cyclic trends were investigated using the Walter-Elwood method.

Results: Suicide and accidents accounted for approximately 84% of the all-external-cause of deaths in Hungary. Annual suicide, unintentional falls and traffic accidents mortality declined significantly (p-value for annual trend: p < 0.001) from 30.5 (95% CI: 29.5-31.5) to 15.8 (15.1-16.5), from 31.2 (30.2-32.2) to 12.2 (11.7-12.8) and from 17.2 (16.4-18) to 5.4 (5-5.8) per 100 000 persons per year, respectively, during the study period. A significant declining trend in annual mortality was also found for assault, cold/heating-related accidents and accidents caused by electric current. However, the declining trend for drowning-related accidents was significant only for males. Significant winter-peak seasonality was found in the mortality rates from accidental falls, cold/heat-related accidents, other accidents caused by submersion/obstruction and other causes. Seasonal trends with a peak from June to July were observed in death rates from suicide/self-harm, accidental drowning/submersion and accidents caused by electric current. A significant seasonal variation with a peak in September was revealed in the mortality due to traffic accidents.

Conclusions: This Hungarian study suggests that there was a significant seasonal effect on almost all kinds of deaths from external causes between 1995 and 2014. Environmental effects are involved in the aetiology of suicide and accidents.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217979PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553771PMC
February 2020

Quantitative Computed Tomography (QCT) of the Distal Forearm in Men Using a Spiral Whole-Body CT Scanner - Description of a Method and Reliability Assessment of the QCT Pro Software.

J Clin Densitom 2020 Jul - Sep;23(3):418-425. Epub 2019 May 17.

The James Cook University Hospital, Middlesbrough, United Kingdom; Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.

The Mr F study investigates the pathogenesis of low trauma distal forearm fractures in men and includes volumetric bone mineral density (vBMD) measurements at the ultradistal forearm as there are no current data. A standard 64 slice CT scanner was used to determine if it was possible to adapt the existing Mindways quantitative computed tomography Pro software for measuring vBMD values at the hip and spine sites. For calculation of intra- and interobserver reliability 40 forearm scans out of the 300 available were chosen randomly. The images were analyzed using the Slice Pick module and Bone Investigational Toolkit. The 4% length of the radius was chosen by measuring the length of the radius from the scaphoid fossa distally to the radial head. The acquired image then underwent extraction, isolation, rotation, and selection of region of interest in order to generate a report on vBMD. A cross-sectional image was created to allow the generation of data on the cortical and trabecular components separately. Repeat analyses were undertaken by 3 independent observers who were blinded as to whether the image was from a participant with or without fracture. The images were presented in random order at each time point. The following parameters were recorded: cortical cross sectional area, total vBMD, trabecular vBMD, and cortical vBMD (CvBMD). Data were analyzed by calculating intraclass correlation coefficients for intra- and interobserver reliability. The lowest values occurred at the CvBMD with intraobserver reliability of 0.92 (95% confidence interval [CI] of 0.86-0.96) and interobserver reliability of 0.92 (95% CI 0.89-0.96). All other parameters had reliability values between 0.97 and 0.99 with tighter 95% CI than for CvBMD. The method of adapting the Mindways Pro software using a standard CT to produce vBMD and structural data at the ultradistal radius is reliable.
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http://dx.doi.org/10.1016/j.jocd.2019.05.005DOI Listing
May 2019