The diagnosis of PTSD is prone to over-reporting and malingering. There is no single sensitive and specific test procedure that can detect over-reporting in PTSD, and a comprehensive assessment is recommended. In the present study, we propose an algorithm that combines a clinical dimension (PCL-5 and CAPS-5) and credibility-focused tests (SIMS and computerized neurocognitive tests) to identify over-reporters, and classify them into five categories (reliable, probably reliable, possibly unreliable, probably unreliable, unreliable). The algorithm was tested on a sample of 115 soldiers who were at various stages of a disability/compensation application. Eighty-three were found by the algorithm to be reliable (reliable/probably reliable) and 32 were found to be unreliable (possibly unreliable/probably unreliable/unreliable). The significance and limitations of this preliminary study are discussed.

OBJECTIVE:Neuropsychological assessments commonly include word list learning tasks to assess verbal memory and learning. The California Verbal Learning Test (CVLT) provides multiple outcome measures and information regarding strategies used to enhance the coding and retrieval of information. Despite its popularity, the CVLT has not yet been formally translated into Hebrew and adapted to the Israeli population. METHODS:The CVLT-III was adapted to Hebrew (CVLT-IIIHebrew), and normative data of healthy Hebrew-speaking adults living in Israel (age range: 20 - 65, education range: 9 - 20) were collected (N = 235). RESULTS:CVLT-IIIHebrew core scores were influenced by age, education level, and, to a lesser extent, sex. Normative data for the Hebrew-speaking Israeli population were generated using an overlapping interval strategy, and regression models were used to evaluate the necessity of adjusting core scale scores for sociodemographic variables. Internal reliability was very high. Clinicians can employ an easy-to-use calculator for adjusting CVLT-IIIHebrew core scores. CONCLUSIONS:The adapted CVLT-IIIHebrew provides a valuable tool for evaluating the verbal memory of Hebrew speakers. Caution, however, is warranted when assessing individuals with lower education levels, as the normative sample was relatively highly educated. This highlights the importance of expanding the normative sample to include a broader spectrum of educational levels and ages. Moreover, the inclusion of Israeli minority groups, currently unrepresented in this normative sample, is of importance.

The Cogstate Brief Battery (CBB) includes four computerized cognitive tests that are commonly used to evaluate neuropsychiatric patients, particularly those who have sustained a mild traumatic brain injury (TBI). The current study assessed the CBB’s utility for detecting feigned and genuine cognitive impairment following TBI. CBB performance of TBI patients simulating cognitive impairment (TBIsimulators; n = 24) was compared to that of presumably honest TBI patients (TBIcontrols; n = 23). The performance of the latter group was also compared with archival data of healthy controls (Healthycontrols; n = 21). TBIsimulators performed more poorly than TBIcontrols in three of the four CBB tasks (Detection, Identification, and One Card Learning), with failure in two or more tasks associated with 95.7

INTRODUCTION:The effect of cannabis use on romantic relationship satisfaction remains unclear, partly due to methodological shortcomings in earlier studies, such as the reliance on a single index of cannabis exposure. METHODS:In this study, we explored the association between an integrated frequency-by-quantity measure of cannabis use exposure and quality of romantic relationships, while addressing possible sex differences. 110 couples completed validated questionnaires assessing cannabis use patterns, general satisfaction with relationship quality, satisfaction with the quality of sex, and perceived partner responsiveness. The effects of between-partner concordance in cannabis use intensity on relationship quality were tested using multilevel linear regression analyses. Within-partner and between-partner effects of cannabis use intensity on relationship quality, as well as possible sex differences, were tested using the Actor-Partner Interdependence Model. RESULTS:Regression analyses indicated that a discrepancy in cannabis use intensity was negatively associated with general relationship satisfaction (β = -.19, p = .008) and with the quality of sex (β = -.16, p = .02). Dyadic analyses revealed significant Actor and Partner intensity ×  sex interactions related to the quality of romantic relationship. These interactions indicated that women who used cannabis at high intensity reported greater relationship satisfaction and perceived both their own and their partner's responsiveness as higher, whereas men reported the opposite. CONCLUSIONS:Cannabis use intensity may have different effects on romantic relationship satisfaction for men and women. Further research is needed to uncover the nature of these differences.

The Numerical Pain Rating Scale (NPRS) is routinely used to assess pain severity. A recently developed NPRS integrated the pain scale with an eye tracker (NPRSETI). As part of this study, we explored the NPRSETI's utility to detect feigned pain, an ongoing challenge facing clinicians. To achieve this aim, chronic pain outpatients were randomly assigned to a simulation (i.e., requested to exaggerate their pain; n = 34) or a control condition (i.e., requested to genuinely report their pain severity; n = 35). They then rated their pain using the NPRSETI. Eye movement analyses indicated that simulators spent more time gazing at the higher NPRSETI pain ratings before providing their pain ratings and less time at the leftward ("No pain") anchor afterward. The discrimination capacities of these measures, however, were poor. In contrast, pain ratings using the NPRSETI showed excellent discriminative capacity, with a pain rating of 10 associated with 94.3% specificity and 26.5% sensitivity. Overall, the study's findings further indicate the feasibility of incorporating an eye tracker to evaluate the severity of pain. Though the findings at present do not support the utility of NPRSETI-based eye movement measures as validity indicators, pain ratings showed promise as a simple screen of feigned pain. The preliminary nature of the findings, however, calls for further research. Such research may aid in further developing effective indicators of feigned pain and hopefully clarify cognitive processes (e.g., experienced cognitive load) involved in pain deception. PERSPECTIVE: The NPRSETI enables pain ratings by patients with severe motor and speech impairments. While eye movements were not adequate in detecting feigned pain, participants' pain ratings showed initial promise. As this is a preliminary study, further research is recommended.

BACKGROUND:The availability of information regarding neuropsychological tests threatens their confidentiality. This concern may be particularly relevant to Attention-Deficit/Hyperactivity Disorder (ADHD) considering its widespread online coverage. The present study explored simulators' online search strategies. METHOD:Simulators (n = 39) searched for information before undergoing an evaluation which included performing a continuous performance test (CPT). Their search strategies were analyzed, and their performance was compared to that of ADHD patients (n = 36) and healthy controls (n = 38). RESULTS:Most simulators reached high-risk websites that provided written and video-based information regarding the test. Sixty percent, comprised mostly of 3rd-year students, reached Google Scholar. These students were also easier to detect as simulators. Common strategies included performing the CPT in accordance with typical ADHD symptoms and avoiding the endorsement of both unusual and stereotypical symptoms. CONCLUSION:Simulators can access online information that contains key test data. Higher education may increase the ability to reach academic research while decreasing the ability to convincingly feign impairment. While additional research is needed to examine coaching effects on neuropsychological testing, the risk to test security that many websites pose should be acknowledged and steps, including ones taken by test publishers, should be undertaken to minimize it.

Increase in the global prevalence of cannabis use has drawn attention to its predictors and psychosocial outcomes. Romantic relationships play a role in psychological well-being, yet data on the bidirectional association between cannabis use and romantic relationships is scarce and inconsistent. This paper aims to review existing literature and gaps in knowledge regarding this association. Over time, cannabis use may negatively affect the outcome of romantic relationships, and vice-versa. Recent methodological advances have suggested that on the one hand, concordance in cannabis use may be associated with decreased conflict and an increased sense of intimacy. On the other hand, cannabis users may perceive their communication as more positive compared to independent raters’ evaluation. Several factors may contribute to these conflicting results and should be further explored, including the intensity of cannabis use, gender, age, and the effect of cannabis use on motivation and cognition.

This chapter details the integration of a Numerical Rating Scale (NPRSETI) with a portable eye tracker, enabling the assessment of pain in conditions in which verbal communication and use of hands are limited (e.g., advanced Amyotrophic lateral sclerosis, ALS). After detailing the construction of the NPRSETI, we describe its validation in an outpatient pain clinic. More specifically, thirty chronic pain patients performed the NPRSETI and filled a conventional NPRS (order was pseudo-randomized). Eye movements, including gaze direction and additional eye movement measures (e.g., saccade rate), were recorded, while participants rated their pain using the NPRSETI. The study’s findings indicated no significant differences in pain severity ratings of the NPRSETI and conventional NPRS. Notably, ratings using the two scales were highly correlated (r = 0.99). NPRSETI’s ratings were also strongly associated with participants’ currently experienced pain rating using the Brief Pain Inventory (BPI). The findings provide initial proof of concept for integrating conventional pain rating scales with an eye tracker and validate the NPRSETI compared with the well-validated and commonly used NPRS. Enhanced usability and decreasing costs of eye trackers will ease the additional research mandated to validate these preliminary findings and hopefully advance their integration into clinical practice.

Noncredible cognitive performance among chronic pain patients garners increased clinical attention. The Word Memory Test (WMT)—a well-established stand-alone validity indicator—was recently integrated with an eye tracker, and its utility was assessed using healthy simulators. The current study expands on this earlier work by assessing the utility of the eye-tracker integrated WMT to detect noncredible cognitive performance in the context of chronic pain. Chronic pain outpatients were randomly assigned to either a simulation (i.e., patients simulating cognitive impairment; n = 22) or honest control (i.e., patients performing to the best of their ability; n = 23) conditions. They then completed the WMT’s immediate recognition (IR) subtest while their eye movements were recorded. Simulators gazed less at relevant stimuli and gazed more at irrelevant stimuli than controls. Sensitivity levels tended to be low to moderate when maintaining specificities ≥ 90

Background: Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. Objective: To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. Methods: 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. Results: DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group x time interaction [F(2, 32) = 3.51, p < .05,eta(2)(p) = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. Conclusion: Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.

INTRODUCTION:Diagnosis of combat post-traumatic stress disorder (PTSD) is largely based on the subjective reports of the claimant and is therefore prone to over-diagnosis of symptoms. Over-diagnosis of combat PTSD is associated with harm. Therefore, it is important to assess the claimant's credibility in assessing PTSD as accurately as possible.

•An increased initial evaluation of pain intensity was found in unipolar depression compared to bipolar depression.•Anxiety levels may mediate differences in initial evaluation of pain between unipolar and bipolar depression.•Unique patterns of pain perception have been described in unipolar depression but not in bipolar depression.•Unipolar and bipolar depressed patients report excessive pain symptoms compared with healthy controls.

Introduction NMDA-Receptor antagonists have rapid antidepressant and antisuicidal properties. However, the antidepressant effect is short lasting raising the question of best maintenance strategy, which is unanswered so far. Invasive vagus nerve stimulation (VNS) as a treatment option for refractory and chronic major depression was shown to reduce the need of maintenance treatment sessions in electroconvulsive therapy (ECT) patients. Objectives There are no published data on the combination of VNS and esketamine. To determine the impact of the combination of VNS and esketamine in DTD. Methods In this naturalistic observational study, we investigated the short- and long-term impact of combination of VNS and esketamine in n=8 patients with difficult-to-treat depression (DTD). Follow-up evaluations were scheduled prospectively pre-surgery at baseline and every 3 months after VNS-implantation (follow-up period 12-24 months, mean 17). Results The mean age of patients was 50,8 years. 50 % of patients (n=4) were female. All patients suffered from severe DTD (mean MADRS at baseline 30,9). Mean number of hospitalizations per months decreased from 0.17 to 0.11 after VNS implantation. 6 of 8 patients were offered maintenance esketamine treatment. Mean MADRS at 12-months was 19 (38.5 % MADRS reduction). The need of mean esketamine treatment sessions decreased from 2.3 at 6-months visit (V6) to 1.37 at V9 and 0.96 at V12 respectively. Termination of maintenance esketamine was possible in 4 cases after a mean of 11.5 months. Conclusions Combination of esketamine and VNS is a safe and effective treatment option in severely ill DTD patients to relieve disease severity and reduce hospitalizations. Need of esketamine treatment sessions decreases 6 months after VNS implantation. Disclosure of Interest None Declared

Introduction Fibromyalgia Syndrome (FMS) is a highly prevalent condition, causing chronic pain and severe reduction in quality of life and productivity, as well as social isolation (Birtane et al. Clinical Rheumatology 2007; 26(5), pp. 679–684; Arnold et al. Psychosomatics. England 2010; 51(6), pp. 489–497; Lacasse, Bourgault and Choinière. BMC Musculoskeletal Disorders 2016; 17(1), pp. 1–9). Despite significant morbidity and economic burden caused by FMS, current treatments are scarce (Busch et al. The Journal of rheumatology. Canada 2008; 35(6), pp. 1130–1144; Bernardy et al. Journal of Rheumatology 2010; 37(10), pp. 1991–2005; Jackson et al. American journal of hematology 2016; 91(5), pp. 476–80). Objectives To examine whether stimulation of the dorsal Anterior-Cingulate-Cortex and the medial Prefrontal-Cortex (ACC-mPFC) activity by deep Transcranial Magnetic Stimulation (dTMS) enhances a pain-directed psychotherapeutic intervention. Methods Nineteen FMS patients were randomized to either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. Using H7 HAC-coil or sham stimulation, we targeted the ACC-mPFC; specific brain areas that have a central role in pain processing (Fomberstein, Qadri and Ramani. Current Opinion in Anaesthesiology 2013; 26(5), pp. 588–593; Tendler, A. et al. Expert Review of Medical Devices 2016; 13(10), pp. 987–1000). Clinical response to treatment was evaluated using the McGill Pain Questionnaire (MPQ), Visual Analogue Fibromyalgia Impact Questionnaire (VAS-FIQ), Brief Pain Inventory questionnaire (BPI), and the Hamilton Depression Rating Scale (HDRS). Results DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the sensory and affective pain dimensions was demonstrated specifically in the dTMS cohort, as measured by the MPQ using paired-sample t-tests with Bonferroni correction for multiple comparisons on three-time points (Significant group x time interaction [F(2, 34) = 3.79, p < .05, η2 = 0.183]. No significant changes were found in the cognitive functions, psychophysical measurements of pain, or depressive symptoms in both dTMS and sham groups and between groups. Conclusions Our findings suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond the clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not the dTMS alone, but rather dTMS driven plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions. Disclosure of Interest None Declared

Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively undemanding nature and format may unintentionally reveal their purpose, leading to ongoing efforts to develop novel PVTs. In this study, we examined the ability of the embedded validity indices of the Poreh Nonverbal Memory Test (PNMT) to detect simulation. An initial sample of 61 participants was randomly assigned to either a simulation or control condition. Participants then completed the PNMT, the Test of Memory Malingering (TOMM), and the Digit Span subtest. A second validation study using 49 participants was conducted in Israel utilizing the same paradigm. In both studies, simulators were less accurate, exhibited shallow and- at times- reversed PNMT learning curves, and obtained lower scores on the delayed and recognition trials. Additionally, PNMT indices showed similar sensitivity and specificity and were highly correlated with more established validity measures. These findings, however, should be considered preliminary and await further validation in clinical settings.

Stress impacts prefrontal cortex (PFC) activity and modulates working memory performance. In a recent study, stimulating the dorsolateral PFC (dlPFC) using transcranial direct current stimulation (tDCS) interacted with social stress in modulating participants' working memory. More specifically, stress disrupted the enhancing effects of dlPFC tDCS on working memory performance. The current study aimed to further explore these initial findings by randomizing healthy females to four experimental conditions (N = 130); stimulation (right dlPFC tDCS vs. sham) and stress manipulation (social stress vs. control). Participants performed cognitive tasks (i.e., visual working memory task and a visual declarative memory task) at baseline and post-stimulation. They also completed self-report measures of stress and anxiety. A significant stimulation × stress interaction was evident in the declarative memory (One-Card Learning, OCL) task, while working memory performance was unaffected. Though tDCS stimulation and stress did not interact to affect working memory, further research is warranted as these initial findings suggest that immediate visual-memory learning may be affected by these factors. The limited number of earlier studies, as well as the variability in their designs, provides additional impetus for studying the interactive effects of stress and tDCS on human visual learning.

Drivers with ADHD are at greater risk for road accidents and are more prone to traffic violations and risky driving than drivers without ADHD. However, no study has tested if the greater risk of drivers with ADHD generalizes to a population of professional drivers that are monitored by their supervisors. We investigated the driving behavior of transport military drivers with and without ADHD (25 and 146, respectively) based on the reports from an Advanced Driving Assistance System. Results indicated that safety events were significantly more frequent for drivers with ADHD than for drivers without ADHD. Notably, the most significant difference was for speeding violations with a Relative Risk (RR) of 2.13 (113% increase). We conclude that the riskier driving of drivers with ADHD remains even among professional drivers that are monitored by their supervisors. Perhaps, drivers with ADHD might benefit from customized intervention programs.

OBJECTIVE The term "long-COVID" refers to the persistence of neurological symptoms after being ill with COVID-19 (e.g., headaches, fatigue, and attentional impairment). Providing information about long-COVID (i.e., "diagnosis threat") increased subjective cognitive complaints among recovered COVID-19 patients compared with those exposed to neutral information (Winter & Braw, 2022). Notably, this effect was particularly prominent among more suggestible participants. Our aim in the current study was to validate these initial findings and to explore the impact of additional variables (e.g., suggestibility). METHOD Recovered patients (n = 270) and controls (n = 290) reported daily cognitive failures after being randomly assigned to either a diagnosis threat (exposure to an article providing information regarding long-COVID) or a control condition. RESULTS Recovered patients, but not controls, reported more cognitive failures in the diagnosis threat condition compared with the control condition. Diagnosis threat added significantly to the prediction of cognitive complaints based on relevant demographic variables and suggestibility. Diagnosis threat and suggestibility interacted (i.e., suggestible individuals were particularly vulnerable to the impact of a diagnosis threat). CONCLUSIONS Diagnosis threat may contribute to the persistence of complaints regarding cognitive impairment among recovered COVID-19 patients. Suggestibility may be an underlying mechanism that increases the impact of diagnosis threat. Other factors, such as vaccination status, may be at play though we are only at the initial stages of research concerning their impact. These may be the focus of future research, aiding in identifying risk factors for experiencing COVID-19 symptoms past the resolution of its acute phase. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

OBJECTIVE:The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls.METHOD:Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored (n = 33 per group).RESULTS:ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices.CONCLUSIONS:Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.