Facial emotion recognition is crucial for social interaction. However, in times of a global pandemic, where wearing a face mask covering mouth and nose is widely encouraged to prevent the spread of disease, successful emotion recognition may be challenging. In the current study, we investigated whether emotion recognition, assessed by a validated emotion recognition task, is impaired for faces wearing a mask compared to uncovered faces, in a sample of 790 participants between 18 and 89 years (condition mask vs . original ). In two more samples of 395 and 388 participants between 18 and 70 years, we assessed emotion recognition performance for faces that are occluded by something other than a mask, i.e., a bubble as well as only showing the upper part of the faces (condition half vs . bubble ). Additionally, perception of threat for faces with and without occlusion was assessed. We found impaired emotion recognition for faces wearing a mask compared to faces without mask, for all emotions tested (anger, fear, happiness, sadness, disgust, neutral). Further, we observed that perception of threat was altered for faces wearing a mask. Upon comparison of the different types of occlusion, we found that, for most emotions and especially for disgust, there seems to be an effect that can be ascribed to the face mask specifically, both for emotion recognition performance and perception of threat. Methodological constraints as well as the importance of wearing a mask despite temporarily compromised social interaction are discussed.

Background and Aims Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design Delphi approach with two sequential phases: survey development and iterative surveying of experts. Setting Online study. Participants During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n=53) identified via recommendations from the Steering Committee and a systematic review. Measurements Survey with 67 items covering four key areas of intervention development, i.e., targets, intervention approaches, active ingredients, and modes of delivery. Findings Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions, and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training, and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias-modification, goal setting, strategy learning, and meta-awareness as active ingredients; and (iv) both addiction treatment workforce and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. Conclusions Expert recommendations on cognitive training and remediation for SUD highlight the relevance of targeting implicit biases, reward, emotion regulation, and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

To assess eating behavior and associated factors in male fitness-center attendees. An anonymous questionnaire was administered to male fitness center members of Innsbruck (Austria), aged 18–80 years to assess socio-demographic features, weight history, sports activity, eating behavior including disordered eating based on the Eating Disorder Examination Questionnaire (EDE-Q) and DSM-5 key symptoms for eating disorders (anorexia nervosa, binge eating, bulimia nervosa, purging disorder) and body image. Three age groups (younger—middle-aged—older men) were compared regarding the variables described above. A total of 307 men included displayed high rates of disordered eating as described by EDE-Q cutoff scores (5–11%) as well as by DSM-5 eating disorder symptoms (10%). While EDE-Q cutoff scores did not differentiate between the groups, the prevalences of DSM-5 eating disorder symptoms yielded significant differences indicating a clear decrease with increasing age. Binge eating and bulimic symptoms with excessive exercising as the purging method were the most often reported symptoms. Although described as typically female, disordered eating does occur in male fitness-gym attendees across all ages. The older the men, the less prevalent are the symptoms. Awareness of disordered eating and possible negative effects need to be addressed for attendees and trainers of the gym. V—descriptive survey study.

Objective Recent reports from our laboratory and others suggest that the menopausal transition may represent a window of vulnerability for eating disorders in women. Here, we present new findings regarding this issue. Methods We surveyed 230 women aged 40–60 years using an anonymous questionnaire focused on eating-disorder and body-image symptomatology. We then compared groups of respondents based on (a) menopausal stage as assessed by World Health Organization (WHO) criteria and (b) menopausal symptomatology as assessed by the Menopause Rating Scale (MRS). Results WHO-defined menopausal stage (premenopausal, perimenopausal, and postmenopausal) showed no significant associations with eating and body-image measures. However, MRS scores showed strong associations with most measures of the Eating Disorder Examination Questionnaire, as well as with questions regarding satisfaction with body image. These associations remained little changed even when removing the four psychological items from the MRS score and examining only the association of the MRS somato-vegetative and urogenital items with these outcome variables. Discussion Our data augment existing evidence that the menopausal transition may be associated with eating and body-image disturbances. However, reported menopausal stage , which is difficult to define reliably, may be less informative than menopausal symptoms as a predictor of disordered eating and associated symptoms. Level of evidence V—descriptive survey study.

BackgroundDespite growing evidence of the presence and clinical relevance of deficits in social cognition in individuals with alcohol use disorder (AUD), less is known about the potential of “natural” recovery with abstinence in this neurocognitive domain. This study investigated the abstinence‐based recovery of neurocognitive social abilities in alcohol‐dependent patients (ADP) using a prospective longitudinal design with follow‐up assessment under controlled conditions of abstinence during alcohol dependence inpatient treatment.MethodsSeventy‐seven participants (42 ADP and 35 healthy controls [HC]) performed social cognition testing, including facial emotion recognition, perspective taking, and affective responsiveness twice (baseline/T1 and follow‐up/T2) during comparable follow‐up periods. Assessment of social cognition in abstinent ADP was conducted at the beginning (T1; within the first 2 weeks) and at the end (T2; within the last 2 weeks) of long‐term (2 months) abstinence‐oriented alcohol dependence inpatient treatment. Only patients abstinent for >14 days (last heavy drinking day >21 days) at baseline (T1) and who remained abstinent at follow‐up (T2) were included.ResultsADP, who on average were nearly 2 months abstinent at T1, showed poorer social cognition in all 3 areas (emotion recognition, perspective taking, and affective responsiveness) than HC. There was no difference between groups on the change in performance over time, and group differences (ADP vs. HC) remained significant at T2, indicating persistent social cognition deficits in ADP following controlled abstinence during inpatient treatment.ConclusionsOur findings indicate no natural recovery of social cognition impairments in ADP during an intermediate to long‐term period of abstinence (2+ months), the usual active treatment phase. Research aimed at developing interventions that focus on the improvement of social cognition deficits (e.g., social cognition training) and determining whether they benefit short‐ and long‐term clinical outcomes in AUD seems warranted.

Many studies have reported that heavy substance use is associated with impaired response inhibition. Studies typically focused on associations with a single substance, while polysubstance use is common. Further, most studies compared heavy users with light/non-users, though substance use occurs along a continuum. The current mega-analysis accounted for these issues by aggregating individual data from 43 studies (3610 adult participants) that used the Go/No-Go (GNG) or Stop-signal task (SST) to assess inhibition among mostly "recreational" substance users (i.e., the rate of substance use disorders was low). Main and interaction effects of substance use, demographics, and task-characteristics were entered in a linear mixed model. Contrary to many studies and reviews in the field, we found that only lifetime cannabis use was associated with impaired response inhibition in the SST. An interaction effect was also observed: the relationship between tobacco use and response inhibition (in the SST) differed between cannabis users and non-users, with a negative association between tobacco use and inhibition in the cannabis non-users. In addition, participants' age, education level, and some task characteristics influenced inhibition outcomes. Overall, we found limited support for impaired inhibition among substance users when controlling for demographics and task-characteristics.

BACKGROUNDDespite growing evidence for neurobehavioral deficits in social cognition in alcohol use disorder (AUD), the clinical relevance remains unclear, and little is known about its impact on treatment outcome. This study prospectively investigated the impact of neurocognitive social abilities at treatment onset on treatment completion.METHODSFifty-nine alcohol-dependent patients were assessed with measures of social cognition including 3 core components of empathy via paradigms measuring: (i) emotion recognition (the ability to recognize emotions via facial expression), (ii) emotional perspective taking, and (iii) affective responsiveness at the beginning of inpatient treatment for alcohol dependence. Subjective measures were also obtained, including estimates of task performance and a self-report measure of empathic abilities (Interpersonal Reactivity Index). According to treatment outcomes, patients were divided into a patient group with a regular treatment course (e.g., with planned discharge and without relapse during treatment) or an irregular treatment course (e.g., relapse and/or premature and unplanned termination of treatment, "dropout").RESULTSCompared with patients completing treatment in a regular fashion, patients with relapse and/or dropout of treatment had significantly poorer facial emotion recognition ability at treatment onset. Additional logistic regression analyses confirmed these results and identified poor emotion recognition performance as a significant predictor for relapse/dropout. Self-report (subjective) measures did not correspond with neurobehavioral social cognition measures, respectively objective task performance. Analyses of individual subtypes of facial emotions revealed poorer recognition particularly of disgust, anger, and no (neutral faces) emotion in patients with relapse/dropout.CONCLUSIONSSocial cognition in AUD is clinically relevant. Less successful treatment outcome was associated with poorer facial emotion recognition ability at the beginning of treatment. Impaired facial emotion recognition represents a neurocognitive risk factor that should be taken into account in alcohol dependence treatment. Treatments targeting the improvement of these social cognition deficits in AUD may offer a promising future approach.

BACKGROUND:Although there is considerable support for the relationship between impulsivity and alcohol dependence, little is known about the impact of neurocognitive aspects of impulsivity on treatment outcome. The aim of this study was to prospectively investigate the impact of neurocognitive impulsivity at treatment onset on treatment completion. METHODS:Forty-three alcohol-dependent patients entering inpatient treatment for alcohol dependence completed neurocognitive measures of impulsivity at the beginning of treatment. Assessments included prototypical measures of impulsive action (Go/No-go task [GNG] and Stop Signal Task [SST]) and impulsive choice (Delay Discounting Test [DDT], and Iowa Gambling Task). According to treatment outcomes, patients were divided into a patient group with regular treatment completion (e.g., with planned discharges, and without relapse during treatment) or irregular treatment course (e.g., premature and unplanned termination of treatment, "dropout," and/or relapse). RESULTS:Results show that, relative to patients completing treatment in a regular fashion (regular treatment completers [RTC]; 67%), those with an irregular course of treatment (relapse and/or dropout) (irregular treatment completers [ITC]; 33%) had significantly poorer GNG response inhibition performance (p = 0.011), and showed a trend toward greater delay discounting (DDT; p = 0.052) at treatment onset. Additional logistic regression analyses identified poor GNG response inhibition performance as a significant predictor for an irregular treatment course (GNG: p = 0.021; DDT: p = 0.067), particularly for relapse (GNG: p = 0.023). CONCLUSIONS:Neurocognitive impulsivity impacts upon treatment completion and appears sensitive for the prediction of relapse and dropout in alcohol-dependent patients. Poorer GNG response inhibition and a tendency toward steeper discounting of delayed rewards should be regarded as neurocognitive risk factors, which can be identified early in the course of alcohol dependence treatment.

OBJECTIVE:Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women.METHOD:We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms.RESULTS:Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses.DISCUSSION:ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED.

OBJECTIVENo published studies, to our knowledge, have examined the association of menopausal status with eating disorders and body image in women. We assessed these associations in a large sample of middle-aged women.METHODWe administered an anonymous questionnaire to a randomly selected nonclinical sample of women aged 40-60 in Innsbruck, Austria. The questionnaire covered demographic items, menopausal status, weight history, measures of body image, and current eating disorders as diagnosed by DSM-IV criteria. Using modified WHO criteria, we classified the respondents' current stage of menopausal transition as premenopausal (N = 192), perimenopausal (N = 110), or naturally postmenopausal (N = 134). In a separate analysis, we also examined the small group of women with surgically induced menopause (N = 12).RESULTSThe three groups were similar in all demographic features except age, and did not differ significantly on current body mass index (BMI), weight-control behaviors, or dieting history after age adjustment. However, perimenopausal women reported a significantly greater prevalence of eating disorders as compared to premenopausal women. Perimenopausal women also reported significantly higher self-ratings of "feeling fat" and higher Body Shape Questionnaire scores than premenopausal women. Women with surgically induced menopause also showed an elevated prevalence of eating and body image pathology.DISCUSSIONOur data suggest that the menopausal transition is associated with an increased prevalence of eating disorders and negative body image. Menopause, like puberty, may perhaps represent a window of vulnerability to these conditions, likely because of changes in hormonal function, body composition, and conceptions of womanhood.

OBJECTIVE:Cognitive impairments in individuals with alcohol dependence may interfere with the progress of treatment and contribute to the progression of the disease. This study aimed to determine whether cognitive remediation (CR) therapy applied during treatment for alcohol dependence improves cognitive functioning in alcohol-dependent inpatients. A secondary aim was to evaluate whether the benefits of CR generalize to noncognitive clinically meaningful outcomes at the end of inpatient treatment.METHOD:Forty-one alcohol-dependent patients entering inpatient treatment for alcohol dependence were randomly assigned to receive conventional treatment (n = 21) or an additional 12 sessions of computer-assisted CR focusing on cognitive enhancement in attention/executive function and memory domains (n = 20). Assessments of cognitive abilities in these domains as well as of psychological well-being and alcohol craving were conducted at baseline (at the beginning of inpatient treatment) and after CR (at the end of treatment).RESULTS:Results indicated that, relative to patients completing conventional treatment, those who received supplemental CR showed significant improvement in attention/executive function and memory domains, particularly in attention (alertness, divided attention), working memory, and delayed memory (recall). In addition, patients receiving CR during alcohol-dependence treatment showed significantly greater improvements in psychological well-being (Symptom Checklist-90-Revised) and in the compulsion aspect of craving (Obsessive Compulsive Drinking Scale-German version).CONCLUSIONS:CR during inpatient treatment for alcohol dependence is effective in improving cognitive impairments in alcohol-dependent patients. The benefits generalize to noncognitive outcomes, demonstrating that CR may be an efficacious adjunctive intervention for the treatment of alcohol dependence.

PURPOSE OF REVIEW:Olfaction is a field of growing interest in schizophrenia research. This article reviews recent studies on olfactory functions in schizophrenia.RECENT FINDINGS:The current literature provides additional insights into olfactory deficits, abnormalities, and olfactory hedonic dysfunction in schizophrenia. Recent findings reinforce particular associations with negative symptoms and deficit syndrome schizophrenia. Studies indicate that abnormalities in patients with schizophrenia extend to more peripheral olfactory structures and functions, including olfactory receptor neuron dysfunction. Olfactory identification ability was found to relate to prodromal disorganization symptoms in young high-risk patients. Further support for the notion of a genetic contribution to olfactory dysfunction in schizophrenia derives from studies reporting physiological olfactory dysfunction (olfactory event-related potentials) in unaffected relatives, and an odor-specific hyposmia, present in both patients with schizophrenia and family members.SUMMARY:Further research is needed to improve our understanding of olfactory dysfunction in schizophrenia. Recent encouraging findings underscore that the olfactory system is a field of research that holds promise for advancing our understanding of the pathophysiology of schizophrenia and possibly as a useful endophenotypic marker of neurodevelopmental vulnerability.

BACKGROUND:Despite the high prevalence of cannabis use in schizophrenia, few studies have examined the potential relationship between cannabis exposure and brain structural abnormalities in schizophrenia.AIMS:To investigate prefrontal grey and white matter regions in patients experiencing a first episode of schizophrenia with an additional diagnosis of cannabis use or dependence (n=20) compared with similar patients with no cannabis use (n=31) and healthy volunteers (n=56).METHOD:Volumes of the superior frontal gyrus, anterior cingulate gyrus and orbital frontal lobe were outlined manually from contiguous magnetic resonance images and automatically segmented into grey and white matter.RESULTS:Patients who used cannabis had less anterior cingulate grey matter compared with both patients who did not use cannabis and healthy volunteers.CONCLUSIONS:A defect in the anterior cingulate is associated with a history of cannabis use among patients experiencing a first episode of schizophrenia and could have a role in poor decision-making and in choosing more risky outcomes.

Objective: To examine chronology and experience of menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group.Method: We interviewed 150 females, namely 50 patients with anorexia or bulimia nervosa (ED), 50 patients with polysubstance dependence (PSD-CO), and 50 healthy controls (HE-CO) (defined by DSM-IV) on chronology and their experience of menarche, puberty, and first sexual activities adjusted for childhood sexual abuse.Results: ED women were similar to HECO in age at menarche and most sexual milestones, but differed significantly from PSD-CO women, who were "early starters." Regarding their experience of menarche, pubertal body changes, and first sexual activities, however, ED women rated these variables significantly more negatively than did either of the comparison groups. These significant differences remained after adjusting for sexual abuse.Conclusion: These findings suggest a negative body attitude in ED patients already at pubertal age, namely years before onset of the disorder. Prospective data are needed. (c) 2007 by Wiley Periodicals, Inc.

BACKGROUND Prior research indicates that chronic alcoholism is accompanied by olfactory deficits. These have been suggested to reflect dysfunctions in olfactory brain regions. The present study investigated the role of neurocognitive functioning in tests (executive function and memory) sensitive to the functional integrity of brain areas that are crucial to olfactory processing in patients with alcohol dependence. METHODS Performance on olfactory functions (detection threshold, quality discrimination, identification), executive function (Wisconsin Card Sorting Test), and memory (German version of the California Verbal Learning Test) was assessed in 32 alcohol-dependent patients and 30 healthy comparison subjects, comparable in age, gender, and smoking status. RESULTS Compared with controls, alcohol-dependent patients were impaired in all 3 domains, olfactory functions, executive function, and memory. In patients, olfactory discrimination ability was positively correlated with executive function performance. Regression analyses conducted to clarify the relation between group (patients vs controls), executive function, memory, and olfactory functions indicated that group was the only significant predictor of olfactory detection threshold and identification, and both group and executive function were found to be the significant predictors of olfactory discrimination. CONCLUSIONS Olfactory deficits in alcohol dependence appear to be associated with prefrontal cognitive dysfunction. Results indicate that olfactory quality discrimination deficits are related to executive function impairment. These findings add to the available research on frontal lobe dysfunction in alcoholism, suggesting that alcohol-related olfactory discrimination deficits may be associated with impairment in the functional integrity of the prefrontal lobe.

OBJECTIVE The aim of the study is to examine eating behavior and body attitude in elderly women. METHOD A randomly selected nonclinical sample of 1,000 women, aged 60-70 years, was contacted for our questionnaire survey covering current eating behavior, weight history, weight control, body attitude, and disordered eating (DSM-IV). RESULTS The 475 (48%) women included in our analyses had a mean BMI of 25.1 but desired a mean BMI of 23.3. More than 80% controlled their weight and over 60% stated body dissatisfaction. Eighteen women (3.8%; 95% confidence interval: 2.3-5.9%) met criteria for eating disorders (ED; N = 1 anorexia nervosa, N = 2 bulimia nervosa, and N = 15 EDNOS) and 21 (4.4%) reported single symptoms of an ED. CONCLUSION Although EDs and body dissatisfaction are typical for young women, they do occur in female elderly and therefore should be included in the differential diagnosis of elderly presenting with weight loss, weight phobia, and/or vomiting.