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Cognitive complaints after chemotherapy are common in breast cancer patients, but the neural bases for these complaints remain unclear. This pilot study explored resting-state functional connectivity (FC) as a marker of subtle cognitive changes in breast cancer patients who experience cognitive complaints. Chemotherapy-treated (n = 20, at least 6 months off therapy) and untreated (n = 17, disease-control) female breast cancer patients with cognitive complaints and healthy controls (n = 20) were recruited. The FC of the right dorsolateral prefrontal cortex was calculated, and any correlations between this FC and neuropsychological assessments were determined. Chemotherapy-treated patients with cognitive complaints displayed increased FC between the right dorsolateral prefrontal cortex and both the contralateral cerebellar lobule VII and the cerebellar vermis XI, compared to the disease-control and healthy-control groups, despite unimpaired neuropsychological performance. The increased FC was negatively correlated with executive function and attention in breast cancer survivors with cognitive complaints. Our pilot study findings provide evidence that cerebellar-cortical FC changes may be a pathophysiological basis for chemotherapy-related cognitive complaints. In addition, the FC changes have the potential to reflect minor or compensated cognitive function impairment in breast cancer patients.

The evidence for the impact of benzodiazepine (BZD) use on infection or clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited. We evaluated the association of BZD use with SARS-CoV-2 infection and the clinical outcomes of coronavirus disease 2019 (COVID-19) using a nationwide COVID-19 database from South Korea. This nationwide cohort study was performed using the COVID-19 database from the Health Insurance Review and Assessment Service of Korea, and SARS-CoV-2 positivity was investigated according to BZD use. SARS-CoV-2-positive adult patients were assessed in three groups, those who needed hospitalization, those with severe symptoms requiring intensive care, and those who died. A multivariate logistic regression model was used for all the analyses. After adjusting for potential confounding factors, there was no association between BZD use and SARS-CoV-2 positivity. SARS-CoV-2-positive patients with BZD use showed an increased risk of need for hospitalization from COVID-19 compared to those without BZD use (odds ratio [OR]: 1.33, 95% confidence interval [CI] 1.07–1.65). In addition, there was a higher risk for long-term users (OR: 2.64, 95% CI 1.08–6.47). Chronic BZD use contributed to a higher risk of the need for hospitalization among COVID-19 patients, whereas BZD use did not increase the risk of SARS-CoV-2 test positivity, severe outcomes, or mortality.

This study applies eye-tracking paradigms to cluster data based on participants’ gaze patterns, while performing the Korean version of the Reading the Mind in Eyes Test, and to investigate whether there were differences in the neurocognitive and other Theory of Mind (ToM) tests among the classified clusters. A total of 89 (50 males) non-clinical youths were recruited. The k-means algorithm was adopted, and the optimised number of clusters was determined using the elbow, silhouette and NbClust methods. Furthermore, multivariate analysis was employed to determine whether there were differences among the clusters in the neurocognitive and other ToM tests. Four clusters were proposed based on the index used to estimate the optimised cluster. The long word fixation time cluster had significantly more total errors and fewer categories completed in the Wisconsin Card Sorting Test, lower backward Digit Span score, and lower sequencing scores in the Theory of Mind Picture Stories Task than in the other clusters. The main findings suggested that even when performing a perceptual-level ToM task that requires the ability to understand mental states, at least in some individuals, gaze patterns are related to neurocognitive strategies, especially executive function, rather than to the specific social cognitive function itself.

Social cognition, which ranges from recognizing social cues to intricate inferential reasoning, is influenced by environmental factors and epigenetic mechanisms. Notably, methylation variations in stress-related genes like brain-derived neurotrophic factor (BDNF) and the oxytocin receptor (OXTR) are linked to distinct social cognitive functions and exhibit sex-specific differences. This study investigates how these methylation differences affect social cognition across sexes, focusing on both perceptual and inferential cognitive levels. Social cognitive abilities were assessed using the Korean version of the Reading the Mind in the Eyes Test (K-RMET) and Brune’s story-based Theory of Mind tasks (ToM-PST). DNA methylation levels in BDNF and OXTR were analyzed for correlations with performance on these cognitive tasks in a cohort of male and female participants. A moderation model was applied to determine if sex moderates the relationship between social cognition and DNA methylation. No significant overall correlation was found between social cognition and DNA methylation across participants. However, sex-specific correlations were identified, including a negative impact of BDNF methylation on K-RMET scores in males, and a similar effect of OXTR methylation on ToM-PST scores in females. The findings underscore the complex relationship between epigenetic modifications and social cognition, revealing sex-specific effects and highlighting the importance of considering sex in epigenetic studies of social cognition. This research contributes to understanding how epigenetic factors, influenced by sex, shape social cognitive processes and supports the need for sex-specific therapeutic approaches.

To reduce long hospitalization durations and the high rate of compulsory psychiatric hospitalization in Korea, a revision of the Mental Health Welfare law was passed and implemented in 2017. This study quantitatively analyzed changes in hospitalization use behavior of patients with psychotic and mood disorders after revision of the Mental Health Welfare law in South Korea. The intervention time was June 2017. Data from the National Health Insurance claims were used. Participants were all patients with hospital visits involving psychotic disorders and mood disorders. We used the interrupted time-series method with segmented regression. In patients with psychotic disorders, admission decreased after the law revision. The average inpatient length of hospitalization decreased immediately after the revision, leading to a long-term decrease. Emergency room visits increased following the revision, and admission through the emergency room also increased. In patients with mood disorders, admission decreased both immediately and over the long-term after the revision. Additionally, the average inpatient length of hospitalization decreased immediately, with no significant change observed in the long term. Emergency room visits increased following the revision. Following the law revision, patients with psychiatric disorders showed a decrease in hospital admissions and length of hospital stay. However, an increasing trend in emergency room visits was identified, suggesting an increase in crisis situations. These findings indicate the need to reduce admissions and length of hospitalization while also protecting the rights of patients with psychiatric disorders. System improvements are thus necessary to prevent an increase in crisis situations and ensure appropriate treatment.

Feelings of shame and guilt have rarely been investigated in people at ultra-high risk (UHR) for psychosis. We aimed to outline differences in shame and guilt in relation to empathy and theory of mind (ToM) in young people, particularly those at UHR for psychosis. First, 166 young healthy controls were assessed for their proneness to shame and guilt using the Test of Self-Conscious Affect, empathy and its four subdomains (perspective taking, fantasy, empathic concern, and personal distress) using the Interpersonal Reactivity Index (IRI), ToM using the ToM picture stories task, and neurocognitive performance using the Raven's Standard Progressive Matrices (SPM). Next, we evaluated shame and guilt in 24 UHR individuals comparing them to 24 age- and sex-matched healthy controls. Finally, we explored relationships for shame and guilt in relation to empathy and ToM in the UHR individuals. In the healthy youth, a regression analysis showed fantasy and personal distress in IRI to be significant determinants of shame, while perspective taking and empathic concern in IRI, ToM, and SPM were independent predictors of guilt. Meanwhile, compared to the healthy controls, individuals with UHR exhibited higher levels of shame, which was associated with increased personal distress. Our findings showed that four subdomains of empathy, ToM, and neurocognition were differentially associated with shame and guilt in healthy young people. Given the correlation between excessive feelings of shame and high levels of the personal distress dimension of empathy in UHR for psychosis, redressing the tendency to focus on self-oriented negative emotions upon witnessing distress of others could possibly reduce self-blame or self-stigma of help-seeking individuals. •Shame and guilt have different associations with social cognitive abilities in healthy young individuals.•Individuals at ultra-high risk (UHR) for psychosis showed high levels of shame.•In the UHR group, higher shame was associated with higher levels of personal distress dimension of empathy.

BackgroundSelf-conscious emotions, such as shame and guilt, play a key role in one’s thoughts and behaviors. Our study investigated how shame and guilt were different concerning multiple aspects of social cognitive abilities, and we evaluated the self-conscious emotions in individuals at ultra-high risk (UHR) for psychosis.MethodsFirstly, one hundred and sixty-six healthy youths were assessed for shame and guilt using the test of self-conscious affect, for empathy using interpersonal reactivity index (IRI), and for Theory of Mind (ToM) ability using the ToM picture stories task. Multiple linear regression analysis was performed to predict shame and guilt from the social cognitive variables. Secondly, twenty-four UHR and 24 age- and sex-matched normal controls were compared for shame, guilt, empathy, and ToM ability.ResultsResults in healthy youths, regression analysis with shame revealed that fantasy (t=3.0, p=0.003, β=0.22) and personal distress (t=5.8, p<0.001, β=0.42) of IRI and affective ToM (t=2.0, p=0.044, β=0.14) were significant determinants. In the regression model of guilt, there were independent predictors including perspective taking (t=3.5, p=0.001, β=0.28) and empathic concern (t=2.1, p=0.040, β=0.17) of IRI and cognitive ToM (t=2.1, p=0.037, β=0.15). In UHR individuals, higher levels of shame (t=-2.4, p=0.021), fantasy (t=-2.3, p=0.028), and personal distress (t=-3.4, p=0.001) and lower levels of perspective taking (t=4.0, p<0.001) and cognitive ToM (t=4.2, p<0.001) were observed. Moreover, high levels of shame was correlated with increased personal distress (r=0.78, p<0.001) in UHR for psychosis.DiscussionThese findings suggest that empathy and ToM ability predict persons’ shame- or guilt-proneness in healthy youths, and heightened personal distress in UHR individuals may possibly influence the level of shame which could lead to socially maladjustment behaviors. Dealing with social cognitive function would be helpful for reparation to UHR individuals.

BackgroundSchizophrenia patients and individuals at ultra-high risk for psychosis(UHR) have shown impaired facial emotion recognition(FER). Previous studies have reported lower accuracy and negative bias of FER in schizophrenia and UHR. These impairments have been studied with various factors such as schizotypy and paranoid level, but the results were inconsistent. This study aimed to identify the impairments of FER in UHR individuals and further to examine how these impairments relate to schizotypy and paranoid level.Methodsorty-three UHR individuals and 57 normal controls (NC) were requested to perform the facial emotion recognition(FER) task that consist of 60 facial photographs selected from standardized photographs of Ekman and Friesen series. For exploratory correlation analysis, schizotypy (Revised physical anhedonia scale, Magical ideation scale) and paranoid level (Paranoia scale, Persecution/suspicious item of Positive and Negative Syndrome Scale) were also examined in UHR individuals.ResultsThe UHR individuals showed lower accuracy rate for total FER task (70.6% vs. 75.6%, p=0.010) and more “fear” responses for neutral faces (14.5% vs. 6.0%, p=0.003) than NC. In exploratory correlation analysis for UHR individuals, the total accuracy rate of FER task showed significant correlation with both scales for schizotypy, but not with both scales for paranoid level. Among threat-related emotion response rates for neutral face, only “Disgust” response rate for neutral face was correlated with all scales for paranoid level, but not with scales for schizotypys in UHR individuals.DiscussionIn this study, we could identify inaccuracy and negative bias of FER in UHR individuals, Furthermore, we found that inaccuracy and negative bias were associated with schizotypy and paranoid level, respectively. These findings imply that inaccuracy and negative bias of FER in UHR individuals are of different nature. Future studies on the clinical implications of these findings would be needed.

The early identification and prevention of dementia is important for reducing its worldwide burden and increasing individuals' quality of life. Although several dementia prediction models have been developed, there remains a need for a practical and precise model targeted to middle-aged and Asian populations. Here, we used national Korean health examination data from adults (331,126 individuals, 40-69 years of age, mean age: 52 years) from 2002-2003 to predict the incidence of dementia after 10 years. We divided the dataset into two cohorts to develop and validate of our prediction model. Cox proportional hazards models were used to construct dementia prediction models for the total group and sex-specific subgroups. Receiver operating characteristics curves, C-statistics, calibration plots, and cumulative hazards were used to validate model performance. Discriminative accuracy as measured by C-statistics was 0.81 in the total group (95% confidence interval (CI) = 0.81 to 0.82), 0.81 in the male subgroup (CI = 0.80 to 0.82), and 0.81 in the female subgroup (CI = 0.80 to 0.82). Significant risk factors for dementia in the total group were age; female sex; underweight; current hypertension; comorbid psychiatric or neurological disorder; past medical history of cardiovascular disease, diabetes mellitus, or hypertension; current smoking; and no exercise. All identified risk factors were statistically significant in the sex-specific subgroups except for low body weight and current hypertension in the female subgroup. These results suggest that public health examination data can be effectively used to predict dementia and facilitate the early identification of dementia within a middle-aged Asian population.

Accumulating evidence suggests that alterations in inflammatory biomarkers are important in depression. However, previous meta-analyses disagree on these associations, and errors in data extraction may account for these discrepancies. PubMed/MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from database inception to 14 January 2020. Meta-analyses of observational studies examining the association between depression and levels of tumor necrosis factor- (TNF- ), interleukin 1- (IL-1 ), interleukin-6 (IL-6), and C-reactive protein (CRP) were eligible. Errors were classified as follows: incorrect sample sizes, incorrectly used standard deviation, incorrect participant inclusion, calculation error, or analysis with insufficient data. We determined their impact on the results after correction thereof. Errors were noted in 14 of the 15 meta-analyses included. Across 521 primary studies, 118 (22.6%) showed the following errors: incorrect sample sizes (20 studies, 16.9%), incorrect use of standard deviation (35 studies, 29.7%), incorrect participant inclusion (7 studies, 5.9%), calculation errors (33 studies, 28.0%), and analysis with insufficient data (23 studies, 19.5%). After correcting these errors, 11 (29.7%) out of 37 pooled effect sizes changed by a magnitude of more than 0.1, ranging from 0.11 to 1.15. The updated meta-analyses showed that elevated levels of TNF- , IL-6, CRP, but not IL-1 , are associated with depression. These findings show that data extraction errors in meta-analyses can impact findings. Efforts to reduce such errors are important in studies of the association between depression and peripheral inflammatory biomarkers, for which high heterogeneity and conflicting results have been continuously reported.