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Item Anxiety Trajectories the First 10 Years After a Traumatic Brain Injury (TBI): A TBI Model Systems Study(Elsevier, 2022-11) Neumann, Dawn; Juengst, Shannon B.; Bombardier, Charles H.; Finn, Jacob A.; Miles, Shannon R.; Zhang, Yue; Kennedy, Richard; Rabinowitz, Amanda R.; Thomas, Amber; Dreer, Laura E.; Physical Medicine and Rehabilitation, School of MedicineObjective Determine anxiety trajectories and predictors up to 10 years posttraumatic brain injury (TBI). Design Prospective longitudinal, observational study. Setting Inpatient rehabilitation centers. Participants 2836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points (N=2836). Main Outcome Measure Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. Results Linear mixed models showed higher GAD-7 scores were associated with Black race (P<.001), public insurance (P<.001), pre-injury mental health treatment (P<.001), 2 additional TBIs with loss of consciousness (P=.003), violent injury (P=.047), and more years post-TBI (P=.023). An interaction between follow-up year and age was also related to GAD-7 scores (P=.006). A latent class mixed model identified 3 anxiety trajectories: low-stable (n=2195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had mild or higher GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16). Conclusions A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and 2 prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.Item Characteristics of Bipolar I patients grouped by externalizing disorders(Elsevier, 2015-06-01) Swaminathan, Shanker; Koller, Daniel L.; Foroud, Tatiana; Edenberg, Howard J.; Xuei, Xiaoling; Niculescu, Alexander B.; Bipolar Genome Study (BiGS) Consortium; Nurnberger, John I.; Department of Psychiatry, IU School of MedicineBACKGROUND: Bipolar disorder co-occurs with a number of disorders with externalizing features. The aim of this study is to determine whether Bipolar I (BPI) subjects with comorbid externalizing disorders and a subgroup with externalizing symptoms prior to age 15 have different clinical features than those without externalizing disorders and whether these could be attributed to specific genetic variations. METHODS: A large cohort (N=2505) of Bipolar I subjects was analyzed. Course of illness parameters were compared between an Externalizing Group, an Early-Onset Subgroup and a Non-Externalizing Group in the Discovery sample (N=1268). Findings were validated using an independent set of 1237 BPI subjects (Validation sample). Genetic analyses were carried out. RESULTS: Subjects in the Externalizing Group (and Early-Onset Subgroup) tended to have a more severe clinical course, even in areas specifically related to mood disorder such as cycling frequency and rapid mood switching. Regression analysis showed that the differences are not completely explainable by substance use. Genetic analyses identified nominally associated SNPs; calcium channel genes were not enriched in the gene variants identified. LIMITATIONS: Validation in independent samples is needed to confirm the genetic findings in the present study. CONCLUSIONS: Our findings support the presence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features.Item The effect of limited cognitive resources on communication disturbances in serious mental illness(Elsevier, 2017-02) Le, Thanh P.; Najolia, Gina M.; Minor, Kyle S.; Cohen, Alex S.; Psychology, School of ScienceSemantically incoherent speech is a pernicious clinical feature of serious mental illness (SMI). The precise mechanisms underlying this deficit remain unclear. Prior studies have found that arousal of negative emotion exaggerates the severity of these communication disturbances; this has been coined "affective reactivity". Recent research suggests that "cognitive reactivity" may also occur, namely reflecting reduced "on-line" cognitive resources in SMI. We tested the hypothesis that communication disturbances manifest as a function of limited cognitive resources in SMI above and beyond that associated with state affectivity. We also investigated individual differences in symptoms, cognitive ability, and trait affect that may be related to cognitive reactivity. We compared individuals with SMI (n=52) to nonpsychiatric controls (n=27) on a behavioral-based coding of communication disturbances during separate baseline and experimentally-manipulated high cognitive-load dual tasks. Controlling for state affective reactivity, a significant interaction was observed such that communication disturbances decreased in the SMI group under high cognitive-load. Furthermore, a reduction in communication disturbances was related to lower trait and state positive affectivity in the SMI group. Contrary to our expectations, limited cognitive resources temporarily relieved language dysfunction. Implications, particularly with respect to interventions, are discussed.Item Examination of Social Inferencing Skills in Men and Women After Traumatic Brain Injury(Elsevier, 2022-05) Neumann, Dawn; Mayfield, Ryan; Sander, Angelle M.; Jang, Jeong Hoon; Bhamidipalli, Surya Sruthi; Hammond, Flora M.; Physical Medicine and Rehabilitation, School of MedicineObjective To examine sex differences in social inferencing deficits after traumatic brain injury (TBI) and to examine the odds of men and women being impaired while controlling for potential confounders. Design Cross-sectional survey. Setting Two TBI rehabilitation hospitals. Participants One hundred five participants with TBI (60 men, 45 women) and 105 controls without TBI (57 men, 48 women) (N=210). Interventions Not applicable. Main Outcome Measures The Awareness of Social Inference Test (TASIT), which includes (1) Emotion Evaluation Test (EET), (2) Social Inference-Minimal (SI-M) test, and (3) Social Inference-Enriched (SI-E) test. Results Within the control sample, men and women performed similarly on all 3 TASIT subtests. Within the group with TBI, men had significantly lower scores than women on EET (P=.03), SI-M (P=.01), and SI-E (P=.04). Using impairment cutoffs derived from the sample without TBI, we found significantly more men with TBI (30%) were impaired on the EET than women (16.7%); impairment was similar between men and women on SI-M and SI-E. When adjusting for executive functioning and education, the odds of being impaired on the EET did not significantly differ for men and women (odds ratio, 0.47; 95% CI, 0.16-1.40; P=.18). Conclusions Although more men with TBI have emotion perception deficits than women, the difference appears to be driven by education and executive functioning. Research is needed in larger samples with more definitive norms to better understand social inferencing impairments in men and women with TBI as well as translation to interpersonal behaviors.Item Investigating reactivity to incentive downshift as a correlated response to selection for high alcohol preference and a determinant of rash action and alcohol consumption(2014) Matson, Liana M.; Grahame, Nicholas J.; Czachowski, Cristine; Boehm, Stephen; Cyders, Melissa A.; Chester, Julia A.Losing a job or a significant other are examples of incentive shifts that result in negative emotional reactions. The occurrence of negative life events is associated with increased drinking, and alleviation of negative emotions has been cited as a drinking motive for individuals with problematic drinking patterns (Keyes et al., 2011; Adams et al., 2012). Further, there is evidence that certain genotypes drink alcohol in response to stressful negative life events (Blomeyer et al., 2008; Covault et al., 2007). It is possible that shared genetic factors contribute to both alcohol drinking and emotional reactivity, but there is a critical need for this relationship to be understood. The first aim of this proposal will use an incentive downshift paradigm to address whether emotional reactivity is elevated in mice predisposed to drink alcohol. The second aim of this proposal will address if reactivity to an incentive shift can result in rash action using a differential reinforcement of low rates of responding task, and whether this response is also associated with a predisposition for high drinking. The third aim of this proposal will investigate if experimenter administered ethanol reduces contrast effects, and if an incentive shift increases ethanol consumption in a high drinking line. The overall goal of this proposal is to investigate whether reactivity to incentive shift is an important mechanism underlying alcohol drinking in these mice, and the role an incentive shift may play in producing rash action and influencing ethanol consumption.Item Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial(Wolters Kluwer, 2017-09) Neumann, Dawn; Malec, James F.; Hammond, Flora M.; Physical Medicine and Rehabilitation, School of MedicineOBJECTIVES: To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING: An outpatient rehabilitation hospital. PARTICIPANTS: Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN: Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION: Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS: Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION: This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.Item Social functioning in schizotypy: How affect influences social behavior in daily life(Wiley, 2020-12) Minor, Kyle S.; Hardin, Kathryn L.; Beaudette, Danielle M.; Waters, Lesley C.; White, Anna L.; Gonzenbach, Virgilio; Robbins, Megan L.; Psychology, School of ScienceObjective: Social deficits are already exhibited by people at risk for schizophrenia-spectrum disorders. Technological advances have made passive detection of social deficits possible at granular levels. Method: In this real-world study, we tested if schizotypy status (high/low) predicted two types of social behavior: (1) being around other people; and (2) actively socializing with others. We also examined if schizotypy influences relationships between social behavior and affect using subjective and objective instruments. Results: Our findings revealed that socializing with others was significantly decreased in the high schizotypy group. Positive affect increased in social situations and predicted later social behavior in those low, but not high, in schizotypy. Conclusion: Decreased social behavior in schizotypy may be explained, in part, by these individuals being less incentivized than their peers to pursue social situations. Future studies should test this explanation in larger samples exhibiting elevated positive, negative, and disorganized schizotypy traits.Item A Statewide Hallmark Event: The Exploration of Participants' Perceptions and Emotions(2022-12) Nyhuis, Millie Kathleen; Krohn, Brian; Liu-Lastres, Becky; Fu, Yao-YiThe Indiana Bicentennial Torch Relay was a one-of-a-kind event that involved over 2,000 participants from all 92 counties. The event was created to invoke community pride and connectivity. The purpose of this study is to understand the emotions and perceptions of participants in a state-wide Hallmark event. To achieve the purpose of this study, this research studied the perception and emotions of the participants of the state-wide event. Participants filled out an online survey with questions related to their sense of community, perception and emotions of the event. Four different scales from previous research were used in the survey. A total of 490 participants responded to the survey. Normality and nonparametric tests were performed. The results of the tests showed an increase in positive affect after the event than before. Most of the perceptions of the event were shown to be relatively similar based on proximity and population of the counties. Showing that no matter the population of the community, perceptions of the event could be very similar.Item What is conscience and why is respect for it so important?(The final version is available from www.springerlink.com., 2008) Sulmasy, Daniel P.The literature on conscience in medicine has paid little attention to what is meant by the word 'conscience.' This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one's ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed.