Alessandra Gorini

Modulation of risky choices in recently abstinent dependent cocaine users: A transcranial direct-current stimulation study

Previous neurobiological and neuropsychological investigations have shown that risk-taking behaviors and addictions share many structural and functional aspects. In particular, both are characterized by an irresistible need to obtain immediate rewards and by specific alterations in brain circuits responsible for such behaviors. In this study, we used transcranial direct-current stimulation over the dorsolateral prefrontal cortex (DLPFC) of two samples of subjects (18 dependent cocaine users and 18 control subjects) to investigate the effects of left and right cortical excitability on two risk tasks: (1) the balloon analog risk task (BART) and (2) the game of dice task (GDT). All subjects randomly received a left anodal/right cathodal stimulation (LAn+), a right anodal/left cathodal stimulation (RAn+), and a sham (placebo) stimulation each run at least 48u2009h apart. Participants were asked to perform the BART and the GDT immediately before and after each stimulation. Our results reveal that the activation of the DLPFC (left and right) results in a reduction of risky behaviors at the BART task both in controls subjects and cocaine dependent users. The effect of tDCS on GDT, instead, is more complex. Cocaine users increased safe behavior after right DLPFC anodal stimulation, while risk-taking behavior increased after left DLPFC anodal stimulation. Control subjects’ performance was only affected by the anodal stimulation of the right DLPFC, resulting in an increase of safe bets. These results support the hypothesis that excessive risk propensity in dependent cocaine users might be due to a hypoactivation of the right DLPFC and an unbalance interhemispheric interaction. In conclusion, since risky decision-making seems to be, at least in part, responsible for maintenance and relapse of addiction, we argue that a neuromodulation-based approach could represent a valuable adjunct in the clinical treatment of addiction.

A P5 cancer medicine approach: why personalized medicine cannot ignore psychology

A system approach termed P4 medicine has recently been proposed in the field of oncology. This approach has been advanced as an extension of what is usually called personalized or genomic medicine. P4 medicine creates effective predictive, personalized, preventive and participatory models to treat patients. In order to give more relevance to the behavioural component that impinges on the way individuals act to prevent, cope and react to illnesses, how they decide between different therapeutic options and interact with physicians and adhere to treatment, we propose that P4 medicine should be transformed into P5 medicine. The fifth P represents the psycho-cognitive aspects to be considered in order to empower the patient, increase his/her quality of life and transform him/her from a passive recipient into an active decision-maker in the treatment process.

An overview on cognitive aspects implicated in medical decisions.

Cognitive theories on decision making show that individuals often do not decide in a full and rationale way, but instead use cognitive strategies that allow them to overcome the limitations imposed by their limited rationality and the difficulties derived from uncertainty. The first part of the paper will discuss the role of heuristics and biases in medical decision making. This is an interesting field of research since medical decisions must be fast and are often complicated by rapid changes in the patients clinical condition, uncertain prognosis and unexpected or uncontrollable treatment effects. In such contexts individuals are forced to rely on heuristics to assist them in taking decisions which can sometimes produce cognitive biases. The second part of the paper will be dedicated to discussing ways in which the patients decisions can be improved. The role of the shared decision making approach will be discussed as well as the role of decision aids. Based on personal information coming from the physical and psychological characteristics and needs of the patient, decision aids give information about specific options and outcomes related to the patients disease. Provided with a set of well-defined alternatives, patients are assisted in taking their preferred decisions, especially when there is more than one medically reasonable opinion available. Moreover, decision aids facilitate and support the shared decision-making, a process by which patients and physicians discuss and evaluate the alternatives for a particular medical decision together.

Smart Recommendation Services in Support of Patient Empowerment and Personalized Medicine

Medicine is undergoing a revolution that is transforming the nature of healthcare from reactive to preventive. The changes are catalyzed by a new systems approach to disease which focuses on integrated diagnosis, treatment and prevention of disease in individuals. This will replace our current mode of medicine over the coming years with a personalized predictive treatment. While the goal is clear, the path is fraught with challenges. The p-medicine EU project aspires to create an infrastructure that will facilitate this translation from current medical practice to personalized medicine. This Chapter focus on current research activities related to the design and implementation of an intelligent patient empowerment platform and its services. The focus of our work concerns the nature of the interaction between health institutions and individuals, particularly the communicative relation between physicians and patients, the ways of exchanging information, the nature of the information itself and the information assimilation capabilities of the patients. Our practical focus is the domain of cancer patients, whether in normal treatment or participating in clinical trials. The ultimate objective is to implement a smart environment (recommender system) able to act as a decision support infrastructure to support the communication, interaction and information delivery process form the doctor to the patient. A prerequisite of personalized delivery of information and intelligent guidance of the patient into his/her treatment plans is our ability to develop an appropriate and accurate profile of the user. In the p-medicine project we focus on modeling and profiling the psycho-cognitive capabilities of the patient based on questionnaires and other information features and behaviors extracted from a personal health record of the patient. In this chapter we will provide a systematic review of user profiling techniques and approaches and present our results in developing a psycho-cognitive profile of the user/patient. Subsequently we will describe the details and challenges of implementing the recommendation system and services using a combination of methods to counter-balance the intrinsic weaknesses in various algorithmic approaches. We will review solutions that have combined demographic user classes and content-based filters using implicit behavior and explicit preferences, collaborative filtering and demographic or collaborative filtering and knowledge-based filters. Finally, our approach will be fully described, which uses an adaptive user interface for the presentation of the e-consent, an ontology and a semantic web rule language to formally describe patient choices, and a reasoning engine to handle access and personalized delivery of pertinent disease related information.

Mathematical Problem-Solving Abilities and Chess: An Experimental Study on Young Pupils

Chess is thought to be a game demanding high cognitive abilities to be played well. Although many studies proved the link between mastery in chess and high degree of intelligence, just few studies proved that chess practice can enhance cognitive abilities. Starting from these considerations, the main purpose of the present research was to investigate the potential benefits of in-presence chess lessons and on-line training on mathematical problem-solving ability in young pupils (8 to 11 years old). Five hundred sixty students were divided into two groups, experimental (which had chess course and on-line training) and control (which had normal school activities), and tested on their mathematical and chess abilities. Results show a strong correlation between chess and math scores, and a higher improvement in math in the experimental group compared with the control group. These results foster the hypothesis that even a short-time practice of chess in children can be a useful tool to enhance their mathematical abilities.

Patient decision aids for prevention and treatment of cancer diseases: are they really personalised tools?

This article provides an analysis of cancer decision aids (DAs), instruments developed to support oncologic patients facing tough screening or treatment decisions, with a particular attention to their level of personalisation. As discussed in our previous works, we argue that the personalisation of medicine should regard not only the genetic and clinical aspects of diseases but also the different cognitive, psychological and social factors involved in clinical choices. According to this vision, we analysed the existing randomised controlled studies on cancer DAs concluding that only few of them take into account individual variables such as cultural level, individual risk attitudes, personal beliefs, and emotional state that are crucial to determine peoples reactions and health-related choices. For these reasons, although quality standards have been published for these interventions, we suggest the need for further research in order to make these instruments more efficient in transforming and improving the actual clinical practice, improving patient empowerment and participation in health-related decisions.

Understanding cognitive processes behind acceptance or refusal of phase I trials

Participation in phase I trials gives patients the chance to obtain control over their disease by trying an experimental therapy. The patients vulnerability, the informed consent process aiming at understanding the purpose and potential benefits of the phase I trial, and the complexity of the studies may impact the patients final decision. Emotionally difficult health conditions may induce patients to succumb to cognitive biases, allocating attention only on a part of the provided information. Filling the gap in patients information process can foster the implementation of strategies to help physicians tailor clinical trials communication providing personalized support and tailored medical information around patients need, so avoiding cognitive biases in patients and improving informed shared decision quality. The aim of the present review article focuses on the analysis of cognitive and psychological factors that affect patients decision to participate or not to early phase clinical trials.

A neurofeedback-based intervention to reduce post-operative pain in lung cancer patients: study protocol for a randomized controlled trial

Background Thoracic surgery appears to be the treatment of choice for many lung cancers. Nevertheless, depending on the type of surgery, the chest area may be painful for several weeks to months after surgery. This painful state has multiple physical and psychological implications, including respiratory failure, inability to clear secretions by coughing, and even anxiety and depression that have negative effects on recovery. Objective The aim of this study is to evaluate the effect of a neurofeedback-based intervention on controlling acute post-surgery pain and improving long-term recovery in patients who undergo thoracotomy for lung resection for non-small cell lung cancer (NSCLC) at an academic oncologic hospital. Methods This study will be based on a 2-parallel group randomized controlled trial design, intervention versus usual care, with multiple in-hospital assessments and 2 clinical, radiological, and quality of life follow-ups. Participants will be randomized to either the intervention group receiving a neurofeedback-based relaxation training and usual care, or to a control group receiving only usual care. Pain intensity is the primary outcome and will be assessed using the Numeric Pain Rating Scale (NRS) in the days following the operation. Secondary outcomes will include the effect of the intervention on hospital utilization for pain crisis, daily opioid consumption, anxiety, patient engagement, blood test and chest x-ray results, and long-term clinical, radiological, and quality of life evaluations. Outcome measures will be repeatedly taken during hospitalization, while follow-up assessments will coincide with the follow-up visits. Pain intensity will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations. Results We expect to have results for this study before the end of 2016. Conclusions The proposed innovative, neurofeedback- and relaxation-based approach to support post-surgery pain management could lead to significant improvements in patient short and long-term outcomes.

The impact of egocentric vs. allocentric agency attributions on the neural bases of reasoning about social rules.

We used the standard and switched social contract versions of the Wason Selection-task to investigate the neural bases of human reasoning about social rules. Both these versions typically elicit the deontically correct answer, i.e. the proper identification of the violations of a conditional obligation. Only in the standard version of the task, however, this response corresponds to the logically correct one. We took advantage of this differential adherence to logical vs. deontical accuracy to test the different predictions of logic rule-based vs. visuospatial accounts of inferential abilities in 14 participants who solved the standard and switched versions of the Selection-task during functional-Magnetic-Resonance-Imaging. Both versions activated the well known left fronto-parietal network of deductive reasoning. The standard version additionally recruited the medial parietal and right inferior parietal cortex, previously associated with mental imagery and with the adoption of egocentric vs. allocentric spatial reference frames. These results suggest that visuospatial processes encoding ones own subjective experience in social interactions may support and shape the interpretation of deductive arguments and/or the resulting inferences, thus contributing to elicit content effects in human reasoning.

Rumination in breast and lung cancer patients: Preliminary data within an Italian Sample

KEY POINTS n n• In clinical settings, rumination can be defined as a maladaptive and repetitive thinking process that focuses on symptoms, causes and consequences of one’s illness n• A cross-sectional study was designed to investigate the incidence of rumination and its determinants in two samples of 98 breast and lung cancer patients n• Results showed that rumination related to cancer was evident in almost half of the participants and was significantly correlated with general rumination n• Rumination was also negatively correlated with social support and quality of sleep and positively correlated with the perception of individual responsibility in having cancer n• The high prevalence of rumination in cancer patients suggests the need for future longitudinal studies to analyze its long-term effects on illness prognosis, patient quality of life, and psychological wellbeing, as well as the need to develop specific interventions to help reduce its impact on illness management in patients