Increasing age is characterized by greater positive affective states. However, there is mixed evidence on the implementation of emotion regulation strategies across the life span. To clarify the discrepancies in the literature, we examined the modulating influence of contextual factors in understanding emotion regulation strategy use in older and young adults. Forty-eight older adults and forty-nine young adults completed a retrospective survey inquiring about the use of emotion regulation strategies in emotion-eliciting situations experienced over the preceding 2 weeks. We used factor analysis to establish clusters of emotion regulation strategies, resulting in cognitive strategies, acceptance, and maladaptive strategies. Overall, we found context-dependent age-related differences in emotion regulation strategy use. Specifically, older adults reported greater use of acceptance than young adults in situations of moderate intensity and in situations that evoke anxiety and sadness. In addition, older adults reported using maladaptive strategies to a lesser extent in high- and moderate-intensity situations and in situations that elicit anxiety and sadness when compared with young adults. There were no age-related differences in the use of cognitive strategies across contexts. Older adults, compared to young adults, reported less use of maladaptive strategies and greater use of acceptance than young adults, which suggests that the enhanced emotional functioning observed later in life may be due to a shift in strategy implementation. (PsycINFO Database Record
PURPOSE The development of highly effective targeted agents for chronic lymphocytic leukemia offers the potential for fixed-duration combinations that achieve deep remissions without cytotoxic chemotherapy. PATIENTS AND METHODS This phase II study tested a combination regimen of obinutuzumab, ibrutinib, and venetoclax for a total of 14 cycles in both patients with treatment-naïve (n = 25) and relapsed or refractory (n = 25) chronic lymphocytic leukemia to determine the response to therapy and safety. RESULTS The primary end point was the rate of complete remission with undetectable minimal residual disease by flow cytometry in both the blood and bone marrow 2 months after completion of treatment, which was 28% in both groups. The overall response rate at that time was 84% in treatment-naïve patients and 88% in relapsed or refractory patients. At that time, 67% of treatment-naïve patients and 50% of relapsed or refractory patients had undetectable minimal residual disease in both the blood and marrow. At a median follow-up of 24.2 months in treatment-naïve patients and 21.5 months in relapsed or refractory patients, the median progression-free and overall survival times were not yet reached, with only 1 patient experiencing progression and 1 death. Neutropenia and thrombocytopenia were the most frequent adverse events, followed by hypertension. Grade 3 or 4 neutropenia was experienced by 66% of patients, with more events in the relapsed or refractory cohort. There was only 1 episode of neutropenic fever. A favorable impact on both perceived and objective cognitive performance during treatment was observed. CONCLUSION The combination regimen of obinutuzumab, ibrutinib, and venetoclax offers time-limited treatment that results in deep remissions and is now being studied in phase III cooperative group trials.
Early life stress (ELS) confers risk for psychiatric illness. Previous literature suggests ELS is associated with decreased resting-state functional connectivity (rs-FC) in adulthood, but there are no studies of resting-state neuronal activity in this population. This study investigated whether ELS-exposed individuals demonstrate resting-state activity patterns similar to those found in PTSD. Twenty-seven adults (14 with at least moderate ELS), who were medication-free and without psychiatric or medical illness, underwent MRI scans during two 4-minute rest periods. Resting-state activity was examined using regional homogeneity (ReHo), which estimates regional activation patterns through indices of localized concordance. ReHo values were compared between groups, followed by rs-FC analyses utilizing ReHo-localized areas as seeds to identify other involved regions. Relative to controls, ELS subjects demonstrated diminished ReHo in the inferior parietal lobule (IPL) and superior temporal gyrus (STG). ReHo values were inversely correlated with ELS severity. Secondary analyses revealed decreased rs-FC between the IPL and right precuneus/posterior cingulate, left fusiform gyrus, cerebellum and caudate in ELS subjects. These findings indicate that ELS is associated with altered resting-state activity and connectivity in brain regions involved in trauma-related psychiatric disorders. Future studies are needed to evaluate whether these associations represent potential imaging biomarkers of stress exposure.
Exposure to early life stress (ELS) is strongly associated with poor treatment outcomes, particularly for trauma-associated disorders such as depression. Little research to date, however, has examined the potential effects of ELS on outcomes with newer treatments, such as repetitive transcranial magnetic stimulation (rTMS). This study evaluated whether ELS exposure impacts resting state functional connectivity associated with brain regions targeted by rTMS. Twenty-seven medication-free adults without psychiatric or medical illness (14 with a history of at least moderate ELS) were scanned using a 3T magnetic resonance imaging (MRI) scanner during two 4-minute rest periods. The primary targets of rTMS, the left and right dorsolateral prefrontal cortex (DLPFC), were utilized as seed regions in connectivity analyses. Relative to controls, when seeding the left DLPFC, ELS subjects demonstrated significantly increased local connectivity with the left middle frontal gyrus and negative connectivity with the left precuneus. ELS status was also associated with negative connectivity from the right DLPFC to the left precuneus and left inferior parietal lobule. These findings demonstrate greater dissociation between the executive and default mode networks in individuals with a history of ELS, and these results may inform neuroimaging assessments in future rTMS studies of ELS-related conditions.
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