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Several studies have investigated the neural basis of effortful emotion regulation (ER) but the neural basis of automatic ER has been less comprehensively explored. The present study investigated the neural basis of automatic ER supported by 'implementation intentions'. 40 healthy participants underwent fMRI while viewing emotion-eliciting images and used either a previously-taught effortful ER strategy, in the form of a goal intention (e.g., try to take a detached perspective), or a more automatic ER strategy, in the form of an implementation intention (e.g., \"If I see something disgusting, then I will think these are just pixels on the screen!\"), to regulate their emotional response. Whereas goal intention ER strategies were associated with activation of brain areas previously reported to be involved in effortful ER (including dorsolateral prefrontal cortex), ER strategies based on an implementation intention strategy were associated with activation of right inferior frontal gyrus and ventro-parietal cortex, which may reflect the attentional control processes automatically captured by the cue for action contained within the implementation intention. Goal intentions were also associated with less effective modulation of left amygdala, supporting the increased efficacy of ER under implementation intention instructions, which showed coupling of orbitofrontal cortex and amygdala. The findings support previous behavioural studies in suggesting that forming an implementation intention enables people to enact goal-directed responses with less effort and more efficiency.

Background We provide an overview of Qatar's first epidemiological study on prevalence, predictors, and treatment contact for mood and anxiety disorders. Aims We highlight the importance of the three‐pronged study, its aims, and its key components. Materials & Methods The first component comprised a probability‐based representative survey of Qatari and non‐Qatari (Arab) adult males and females recruited from the general population and interviewed using the International Diagnostic Interview (CIDI version 3.3). The second component, a clinical reappraisal study, assessed concordance between diagnoses based on the CIDI and independent clinical assessments conducted by trained clinical interviewers. The third component comprised a resting‐state functional magnetic resonance imaging study of healthy survey respondents who were matched to patients with psychosis. Results 5000 survey interviews provided data on prevalence and treatment of common mental disorders. Clinical re‐interviews (N = 485) provided important diagnostic validity data. Finally, state‐of‐the art structural and functional brain markers for psychosis were also collected (N = 100). Discussion Descriptive epidemiological data were collected to inform future mental health priorities in Qatar and situates these within a global context. Conclusion The study fills important gaps in regional and global estimates and establish necessary baseline to develop comprehensive risk estimates for mental health in Qatar’s young population.

Objectives To estimate 12‐month prevalence, persistence, severity, and treatment of mental disorders and socio‐demographic correlates in Qatar. Methods We conducted the first national population‐based telephone survey of Arab adults between 2019 and 2022 using the Composite International Diagnostic Interview and estimated 12‐month DSM‐5 mood and anxiety disorders and their persistence (the proportion of lifetime cases who continue to meet 12‐month criteria). Results The 12‐month prevalence of any disorder was 21.1% (10.4% mild, 38.7% moderate, and 50.9% severe) and was associated with: younger age, female, previously married, and with persistence of any disorder. Persistence was 74.7% (64.0% mood and 75.6% anxiety) and was significantly associated with secondary education or lower. Minimally adequate treatment received among those with any 12‐month mental disorder was 10.6% (74.6% in healthcare and 64.6% non‐healthcare sectors). Severity and the number of disorders significantly associated with each other and with treatment received (χ2 = 7.24, p = 0.027) including adequate treatment within the mental health specialty sector (χ2 = 21.42, p < 0.001). Conclusions Multimorbidity and sociodemographics were associated with 12‐month mental disorder. Treatment adequacy in Qatar are comparable to high‐income countries. Low treatment contact indicate need for population‐wide mental health literacy programes in addition to more accessible and effective mental health services.

Objectives To estimate lifetime prevalence, risk, and treatment for mental disorders and their correlates in Qatar's general population for the first time. Methods We conducted a national phone survey of 5,195 Qatari and Arab residents in Qatar (2019–2022) using the Composite International Diagnostic Interview Version 3.3 and estimated lifetime mood and anxiety defined diagnoses. Survival‐based discrete time models, lifetime morbid risk, and treatment projections were estimated. Results Lifetime prevalence of any disorder was 28.0% and was associated with younger cohorts, females, and migrants, but lower formal education. Treatment contact in the year of disorder onset were 13.5%. The median delay in receiving treatment was 5 years (IQR = 2–13). Lifetime treatment among those with a lifetime disorder were 59.9% for non‐healthcare and 63.5% for healthcare; it was 68.1% for any anxiety and 80.1% for any mood disorder after 50 years of onset. Younger cohorts and later age of onset were significantly predictors of treatment. Conclusions Lifetime prevalence of mental disorders in Qatar is comparable to other countries. Treatment is significantly delayed and delivered largely in non‐healthcare sectors thus the need for increased literacy of mental illness to reduce stigma and improve earlier help‐seeking in healthcare settings.

Global COVID-19 pandemic containment necessitates understanding the risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lack vital representative vaccine hesitancy data. We conducted the first representative national phone survey among the adult population of Qatar, between December 2020 and January 2021, to estimate the prevalence and identify potential determinants of vaccine willingness: acceptance (strongly agree), resistance (strongly disagree), and hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between willingness groups and fifteen variables. In the total sample, 42.7% (95% CI: 39.5–46.1) were accepting, 45.2% (95% CI: 41.9–48.4) hesitant, and 12.1% (95% CI: 10.1–14.4) resistant. Vaccine resistant compared with hesistant and accepting groups reported no endorsement source will increase vaccine confidence (58.9% vs. 5.6% vs. 0.2%, respectively). Female gender, Arab ethnicity, migrant status/type, and vaccine side-effects concerns were associated with hesitancy and resistance. COVID-19 related bereavement, infection, and quarantine status were not significantly associated with any willingness group. Absence of or lack of concern about contracting the virus was solely associated with resistance. COVID-19 vaccine resistance, hesitance, and side-effects concerns are high in Qatar’s population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants), and those of Arab ethnicity.

Neurodevelopmental and neurodegenerative pathology occur in Schizophrenia. This study compared the utility of corneal confocal microscopy (CCM), an ophthalmic imaging technique with MRI brain volumetry in quantifying neuronal pathology and its relationship to cognitive dysfunction and symptom severity in schizophrenia. Thirty-six subjects with schizophrenia and 26 controls underwent assessment of cognitive function, symptom severity, CCM and MRI brain volumetry. Subjects with schizophrenia had lower cognitive function (P ≤ 0.01), corneal nerve fiber density (CNFD), length (CNFL), branch density (CNBD), CNBD:CNFD ratio (P < 0.0001) and cingulate gyrus volume (P < 0.05) but comparable volume of whole brain (P = 0.61), cortical gray matter (P = 0.99), ventricle (P = 0.47), hippocampus (P = 0.10) and amygdala (P = 0.68). Corneal nerve measures and cingulate gyrus volume showed no association with symptom severity (P = 0.35–0.86 and P = 0.50) or cognitive function (P = 0.35–0.86 and P = 0.49). Corneal nerve measures were not associated with metabolic syndrome (P = 0.61–0.64) or diabetes (P = 0.057–0.54). The area under the ROC curve distinguishing subjects with schizophrenia from controls was 88% for CNFL, 84% for CNBD and CNBD:CNFD ratio, 79% for CNFD and 73% for the cingulate gyrus volume. This study has identified a reduction in corneal nerve fibers and cingulate gyrus volume in schizophrenia, but no association with symptom severity or cognitive dysfunction. Corneal nerve loss identified using CCM may act as a rapid non-invasive surrogate marker of neurodegeneration in patients with schizophrenia.

Objectives Lifetime DSM‐5 diagnoses generated by the lay‐administered Composite International Diagnostic Interview for DSM‐5 (CIDI) in the World Mental Health Qatar (WMHQ) study were compared to diagnoses based on blinded clinician‐administered reappraisal interviews. Methods Telephone follow‐up interviews used the non‐patient edition of the Structured Clinician Interview for DSM‐5 (SCID) oversampling respondents who screened positive for five diagnoses in the CIDI: major depressive episode, mania/hypomania, panic disorder, generalized anxiety disorder, and obsessive‐compulsive disorder. Concordance was also examined for a diagnoses of post‐traumatic stress disorder based on a short‐form versus full version of the PTSD Checklist for DSM‐5 (PCL‐5). Results Initial CIDI prevalence estimates differed significantly from the SCID for most diagnoses (χ12${\\chi }_{1}^{2}$  = 6.6–31.4, p = 0.010 < 0.001), but recalibration reduced most of these differences and led to consistent increases in individual‐level concordance (AU‐ROC) from 0.53–0.76 to 0.67–0.81. Recalibration of the short‐form PCL‐5 removed an initially significant difference in PTSD prevalence with the full PCL‐5 (from χ12${\\chi }_{1}^{2}$  = 610.5, p < 0.001 to χ12${\\chi }_{1}^{2}$  = 2.5, p = 0.110) while also increasing AU‐ROC from 0.76 to 0.81. Conclusions Recalibration resulted in valid diagnoses of common mental disorders in the Qatar National Mental Health Survey, but with inflated prevalence estimates for some disorders that need to be considered when interpreting results.

The Composite International Diagnostic Interview (CIDI) has been clinically reappraised in several studies conducted mainly in the US and Europe. This report describes the methodology used to conduct one of the Middle East's largest clinical reappraisal studies. The study was carried out in conjunction with the World Mental Health Qatar-the first national psychiatric epidemiological study of common mental disorders in the country. This study aimed to evaluate the diagnostic consistency of core modules of the newly translated and adapted Arabic version of the CIDI 5.0 against the independent clinical diagnoses based on the Structured Clinical Interview for DSM-5 (SCID-5). Telephone follow-up interviews were administered by trained clinicians using the latest research edition of the SCID for DSM-5. Telephone administered interviews were key in the data collection, as the study took place during the COVID-19 pandemic. Overall, within 12 months, 485 interviews were completed. The response rate was 52%. Quality control monitoring documented excellent adherence of clinical interviews to the rating protocol. The overall methods used in this study proved to be efficient and effective. For future research, instrument cultural adaptation within the cultural context is highly recommended.

Discerning a speaker's gender from their voice is a basic and crucial aspect of human communication. Voice pitch height, the perceptual correlate of fundamental frequency, is higher in females and provides a cue for gender discrimination. However, male and female voices are also differentiated by multiple other spectral and temporal characteristics, including mean formant frequency and spectral flux. The robust perceptual segregation of male and female voices is thought to result from processing the combination of discriminating features, which in neural terms may correspond to early sound object analysis occurring in non-primary auditory cortex. However, the specific mechanism for gender perception has been unclear. Here, using functional magnetic resonance imaging, we show that discrete sites in non-primary auditory cortex are differentially activated by male and female voices, with female voices consistently evoking greater activation in the upper bank of the superior temporal sulcus and posterior superior temporal plane. This finding was observed at the individual subject-level in all 24 subjects. The neural response was highly specific: no auditory regions were more activated by male than female voices. Further, the activation associated with female voices was 1) larger than can be accounted for by a sole effect of fundamental frequency, 2) not due to psychological attribution of female gender and 3) unaffected by listener gender. These results demonstrate that male and female voices are represented as distinct auditory objects in the human brain, with the mechanism for gender discrimination being a gender-dependent activation-level cue in non-primary auditory cortex. •The female voice consistently causes greater brain activation than the male voice.•The site of increased activation is a discrete area of non-primary auditory cortex.•Independent of conscious attribution of gender or listener gender.•No brain areas are activated more by the male voice than female voice.•The mechanism for gender discrimination is a gender-dependent activation-level cue.

Abstract Background Sleep dysfunction shares a bidirectional relationship with hallucinatory experiences, with the strongest path from sleep dysfunction to the occurrence of hallucinatory experiences. This review aimed to identify potential mechanisms through which sleep dysfunction leads to hallucinations. Study Design A narrative review was conducted across 4 levels of explanation: phenomenology (via lived-experience accounts), psychology, neural networks, and neurophysiology. Study Results Relatively few studies have directly tested underlying mechanisms linking sleep dysfunction to hallucinations, particularly at the levels of neural networks and neurophysiology. There is good support for stress as a mediator between sleep dysfunction and hallucinations. Stress was a plausible mechanism across levels of explanation and was supported by sleep manipulation studies in non-clinical populations. Inflammation of the nervous system is affected by sleep loss, which in turn impacts the brain connectivity underpinning hallucinatory experiences. Lived-experience accounts identified 3 novel mechanisms, all of which are meaningful to people with lived experience of hallucinations: source monitoring, mental resilience, and reasoning skills. Quantitative studies show these mechanisms are impacted by sleep loss, but the full causal path from sleep dysfunction to hallucinations via these mechanisms requires testing. Conclusions Key priorities for future research are to (1) test stress as a mediator in clinical populations experiencing hallucinations, with stress assessed across the levels of explanation simultaneously; (2) carry out experimental tests of novel potential mediators identified in this review (eg, source monitoring, inflammation, prefrontal cortical networks); and (3) identify potential moderators that might explain individual differences in the lived-experience accounts of the effect of sleep dysfunction on hallucinations.