The application of ecological momentary assessment (EMA) in community settings provides a powerful opportunity to obtain measures of emotional reactivity to daily life events, as well as emotional dynamics in real time. This investigation examines the association between emotional reactivity to daily events and emotional experience in mood and anxiety disorders in a large community-based sample. Two-hundred and 87 participants with a lifetime history of bipolar I disorder (BPI; n ϭ 33), bipolar II disorder (BPII; n ϭ 37), major depression (MDD; n ϭ 116), anxiety disorders without a mood disorder (ANX; n ϭ 36), and controls without a lifetime history of mood, anxiety, or substance use disorder (n ϭ 65) completed a 2-week EMA evaluation period concerning mood states and daily events. Following positive events, individuals with BPI reported greater decreases in both sad and anxious mood than did controls, and individuals with MDD experienced greater decreases in anxious mood. Following negative events, the BPII, MDD, and ANX (but not BPI) groups experienced greater increases in anxious mood, with no group differences in sad mood. Greater variability and instability were observed for sad mood in the BPII and MDD groups, and greater variability and instability was observed for anxious mood in all of the mood/anxiety groups. However, no group differences were observed for the inertia of sad or anxious moods. The findings demonstrate differences in emotional reactivity to daily events as well as the general affective dynamics of emotional states among individuals with mood or anxiety disorders, with potential specificity for BPI disorder relative to other disorders. Emotional variability and instability may constitute a nonspecific characteristic of both mood and anxiety disorders.
Objectives: To characterize the day-night activity patterns of children after major surgery and describe differences in children's activity patterns between the PICU and inpatient floor setting. Study design: In this prospective observational study, we characterized the daytime activity ratio estimate (DARE; ratio between mean daytime activity [08:00-20:00] and mean 24-h activity [00:00-24:00]) for children admitted to the hospital after major surgery. The study sample included 221 infants and children ages 1 day to 17 years admitted to the pediatric intensive care unit (PICU) at a tertiary, academic children's hospital. Subjects were monitored with continuous accelerometry from postoperative day 1 until hospital discharge. NHANES accelerometry data were utilized for normative data to compare DARE in a community sample of U.S. children to hospitalized children. Results: The mean DARE over 2,271 hospital days was 57.8%, with a significant difference between the average DARE during PICU days and inpatient floor days (56% vs. 61%, P <.0001). The average subject DARE ranged from 43% to 73%. In a covariate-adjusted mixed effects model, PICU location, lower age, orthopedic or urologic surgery, and intubation time were associated with decreased DARE. Hospitalized children had significantly lower DARE than NHANES subjects in all age groups studied, with the largest difference in the youngest PICU group analyzed *
Electronic diary data, such as that acquired through Ecological Momentary Assessments (EMA), has historically provided novel insights into diverse psychological processes. Analyses of these data typically focus on modeling participant-specific means, variability, and stability. We propose a novel statistical framework to determine participant stability by quantifying fragmentation of standardized trajectories using the following 2-step approach: (1) participant-level EMA scores are normalized, and (2) normalized scores are dichotomized into 2 states, inside and outside a range of 1 standard deviation. Within-participant fragmentation measures were calculated from dichotomized scores and modeled with various covariates. We used this method to study patterns of emotional states and showed that the proposed fragmentation measures differentiate mood disorder subtypes, including Bipolar I (BPI), Bipolar II, and major depressive disorder (MDD) compared with unaffected controls. Fragmentation measures were regressed on the mood disorder subtype, adjusting for age, sex, body mass index, and mean squared successive difference. The analyses revealed decreased stability (more fragmentation) among those with BPI when inside the participant-specific standard range of attention (β = 0.09, p = .004) and decreased stability among those with MDD inside the standard range of mood (β = 0.04, p = .039) and attention (β = 0.05, p = .017). This work provides an illustration of the clinical significance of EMA in characterizing the stability of mood, attention, or other psychological states that may underlie psychological disorders and phenomena. The application of fragmentation provides a novel statistical approach that can characterize within-participant stability beyond currently available traditional approaches.
Oxidative damage to the cell has been implicated in the pathogenesis of a number of disorders, including chronic inflammation, aging, and cancer. Manganese superoxide dismutase (Mn-SOD) plays a major role in the protection of the mitochondrion from oxidative damage due to superoxide radicals and other excited oxygen species. In this report we describe the genomic organization and DNA sequence of the murine MnSOD gene. This gene is interrupted by four introns. The coding sequence of this gene was examined in C57BL/6J and C3H/HeJ mice that are SUSCEPTIBLE AND RESISTANT, respectively, to the pulmonary injuries induced by the inhaled oxidants, ozone, and hyperoxia. Since the predicted amino acid sequence for MnSOD does not differ for these strains, nor does the size or steady-state level of this transcript, biologic variability in the pulmonary inflammatory response to ozone and hyperoxia does not arise from an altered gene structure. Examination of the noncoding sequence revealed a dC.dA polymorphism in intron 2 and a StyI RFLV in intron 4 of the MnSOD gene. These sequence and mapping data provide the basis for continued study of biologic variability in the MnSOD gene as a cause of disease.
Delirium is a common and serious psychiatric syndrome caused by an underlying medical condition. It is associated with significant mortality and increased healthcare resource utilization. There are few biological markers of delirium, perhaps related to the etiologic heterogeneity of the syndrome. Functional near-infrared spectroscopy (fNIRS) is an optical topography system to measure changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the cerebral cortex. We examined whether altered cortical brain activity in delirious patients with end stage liver disease (ESLD) is detected by fNIRS. We found that the [oxy-Hb] change during the verbal fluency task (VFT) was reduced in patients with ESLD compared with healthy controls (HC) in the prefrontal and bi-temporal regions. The [oxy-Hb] change during the sustained attention task (SAT) was elevated in patients with ESLD compared to HC in the prefrontal and left temporal regions. Notably, [oxy-Hb] change in the left dorsolateral prefrontal cortex during SAT showed a positive correlation with the severity of delirium. Our results suggest that [oxy-Hb] change in the prefrontal cortex during the sustained attention task measured with fNIRS might serve as a biological marker associated with delirium in ESLD patients.
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