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Carmen M Galvez-Sánchez,1,* Stefan Duschek,2,* Gustavo A Reyes del Paso3,* 1Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Murcia, Murcia, Spain; 2Department of Psychology, Institute of Psychology, UMIT TIROL - University for Health Sciences Medical Informatics and Technology, Hall in Tirol, Austria; 3Department of Psychology, University of Jaén, Jaén, Spain*These authors contributed equally to this workCorrespondence: Carmen M Galvez-Sánchez, Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Murcia, Building 31, Murcia, 30100, Spain, Tel +34 868 88 868 88 7328, Email carmengs@um.esPurpose: Fibromyalgia syndrome (FMS) and rheumatoid arthritis (RA) are chronic pain disorders, with clearly distinct pathogenetic mechanisms, frequently accompanied by symptoms like depression, fatigue, insomnia and cognitive problems. This study compared performance in various cognitive domains between patients with FMS and RA. The role of clinical symptoms severity in determine the differences in cognitive performance was also investigated.Patients and Methods: A cross-sectional study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. In total, 64 FMS patients, 34 RA patients and 32 healthy controls participated, all women. Using factor analysis, questionnaire scores were combined to yield a symptom severity factor, which was used as a control variable in the group comparisons.Results: Without controlling for symptom severity, both patient groups performed worse than controls in all the cognitive domains assessed (visuospatial memory; verbal memory; strategic planning and self-regulation; processing speed, attention and cognitive flexibility; and planning and organizational abilities); overall deficits were greater in FMS than in RA patients. FMS patients reported more severe clinical symptoms (current pain intensity, total pain, state anxiety, depression, fatigue and insomnia) than RA patients. After controlling for symptom severity, a large proportion of the cognitive test parameters no longer differed between FMS and RA patients.Conclusion: The study confirmed significant impairments in attention, memory, and higher cognitive functions in both FMS and RA. The greater deficits seen in FMS patients may at least partly be explained by more severe pain and secondary symptoms. Cognitive screening may facilitate the development of personalized treatment plans to optimize the quality of life of FMS and RA patients.Plain Language Summary: The investigation substantiated noteworthy impairments in attention, memory, and executive functions among individuals diagnosed with Fibromyalgia Syndrome (FMS) and Rheumatoid Arthritis (RA).The heightened cognitive deficits observed in FMS patients compared to those with RA could be attributed in part to the heightened severity of pain and secondary symptoms characteristic of FMS.Semantic clustering, by leveraging cognitive resources optimally, may serve as a compensatory mechanism for memory deficits and thus warrants inclusion in interventions aimed at assisting patients in coping with cognitive impairments.Incorporating cognitive deficit screenings into routine diagnostic protocols for FMS and RA is recommended, as it may facilitate the development of personalized treatment strategies aimed at enhancing the overall quality of life for affected individuals.Keywords: fibromyalgia syndrome, rheumatoid arthritis, cognitive impairments, depression, anxiety, fatigue, insomnia

Carmen M Galvez-Sánchez,1 Stefan Duschek,2 Gustavo A Reyes del Paso1 1Department of Psychology, University of Jaén, Jaén, Spain; 2Department of Psychology, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria Abstract: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread and persistent musculoskeletal pain and other frequent symptoms such as fatigue, insomnia, morning stiffness, cognitive impairment, depression, and anxiety. FMS is also accompanied by different comorbidities like irritable bowel syndrome and chronic fatigue syndrome. Although some factors like negative events, stressful environments, or physical/emotional traumas may act as predisposing conditions, the etiology of FMS remains unknown. There is evidence of a high prevalence of psychiatric comorbidities in FMS (especially depression, anxiety, borderline personality, obsessive-compulsive personality, and post-traumatic stress disorder), which are associated with a worse clinical profile. There is also evidence of high levels of negative affect, neuroticism, perfectionism, stress, anger, and alexithymia in FMS patients. High harm avoidance together with high self-transcendence, low cooperativeness, and low self-directedness have been reported as temperament and character features in FMS patients, respectively. Additionally, FMS patients tend to have a negative self-image and body image perception, as well as low self-esteem and perceived self-efficacy. FMS reduces functioning in physical, psychological, and social spheres, and also has a negative impact on cognitive performance, personal relationships (including sexuality and parenting), work, and activities of daily life. In some cases, FMS patients show suicidal ideation, suicide attempts, and consummated suicide. FMS patients perceive the illness as a stigmatized and invisible disorder, and this negative perception hinders their ability to adapt to the disease. Psychological interventions may constitute a beneficial complement to pharmacological treatments in order to improve clinical symptoms and reduce the impact of FMS on health-related quality of life. Keywords: fibromyalgia, background, psychological impact, patients’ experiences, personality, mood

Directing disaster operations represents a major professional challenge. Despite its importance to health and professional performance, research on stress in crisis management remains scarce. The present study aimed to investigate self-reported stress and psychophysiological stress responses in crisis managers. For this purpose, 30 crisis managers were compared with 30 managers from other disciplines, in terms of self-reported stress, health status and psychophysiological reactivity to crisis-related and non-specific visual and acoustic aversive stimuli and cognitive challenge. Crisis managers reported lower stress levels, a more positive strain-recuperation-balance, greater social resources, reduced physical symptoms, as well as more physical exercise and less alcohol consumption. They exhibited diminished electrodermal and heart rate responses to crisis-related and non-specific stressors. The results indicate reduced stress and physical complaints, diminished psychophysiological stress reactivity, and a healthier life-style in crisis managers. Improved stress resistance may limit vulnerability to stress-related performance decline and facilitate preparedness for major incidents., Author(s): A. Janka[sup.1] , C. Adler[sup.2] , L. Fischer[sup.1] , P. Perakakis[sup.3] , P. Guerra[sup.3] , S. Duschek[sup.1] Author Affiliations: (1) UMIT - University for Health Sciences Medical Informatics and [...]

The present study investigated whether the D-camphor-crataegus berry extract combination Korodin elevates blood pressure and enhances cognitive performance in the elderly population. Eighty women aged between 50 and 80 years were examined based on a randomized, placebo controlled double blind design. Blood pressure was measured sphygmomanometrically and through continuous noninvasive recording. Cognitive performance was assessed by means of two tests measuring general information processing capacity and visuomotor speed. The administration of the drug led to a short term increase in blood pressure as well as in cognitive performance as compared to placebo. Potential physiological mechanisms of action mediating this effect, including hemodynamic alterations, sympathetic stimulation as well as improvement of cerebral metabolism are discussed. [ABSTRACT FROM AUTHOR]

A number of studies have provided evidence for reduced cognitive performance due to chronically low blood pressure. The present studies explored whether these deficits can be reduced by pharmacological blood pressure elevation. Effects of the Camphor-Crataegus berry extract combination (Korodin®) were investigated in two studies with 40 and 48 hypotensive women based on a randomized, placebo controlled double blind design. The participants were presented with different tasks assessing performance in attention and cognition. Blood pressure was measured repeatedly during the experiment.The administration of the drug led to positive and differential effects on blood pressure and cognitive performance as compared to placebo. These effects were already visible within the time range of 2-5 min. A positive correlation between blood pressure increase and performance enhancement could be demonstrated for two of the four tasks.The results show that the application of Korodin® results in beneficial effects on resting blood pressure and cognitive performance. The positive association between the increase in blood pressure and cognitive enhancement suggests that blood pressure plays a causal role in the cognitive deficits in hypotension and underlines that they can be reduced through antihypotensive treatment. [ABSTRACT FROM AUTHOR]

In the present study, the authors investigated the relationship between low blood pressure (BP) and attentional performance through the application of a multidimensional diagnostic approach. The authors compared 40 subjects with essential hypotension (mean systolic BP = 97.6 mmHg) with 40 normotensive controls (mean systolic BP = 124.1 mmHg) using 6 computer-based tasks measuring tonic and phasic alertness; selective, divided, and sustained attention; and working memory. To control for possible confounders, the authors used a test battery examining motor performance and a mood questionnaire. BP was monitored continuously during the entire experiment. Hypotensives showed prolonged execution times in each of the attentional tasks (p < .001). Moderately decreased accuracy was found in the tests assessing sustained attention (p = .059) and working memory (p = .012). Moreover hypotensives showed smaller elevations in BP during the execution of the cognitive tasks. This study is the first to demonstrate the relationship between BP and cognitive performance while controlling for motor function and mood. [ABSTRACT FROM AUTHOR]

Previous research suggested that exposure to long-lasting or repeated laboratory stressors may lead to rearrangement of cardiovascular control, with a shift of regulation mechanisms from dominant cardiac to dominant vascular influences between the early and late response phases, respectively. This study investigated whether similar rearrangement occurs during life stress accompanying chronic disease by analyzing also associations between cortisol level and cardiovascular variables in patients with fibromyalgia (FM). In 47 women with FM and 36 healthy women (HW), cardiovascular recordings were taken during active body posture changes (sitting, lying down, and standing). Moreover, hair cortisol concentration (HCC) was obtained. During standing, which involved orthostatic challenge, FM patients showed higher total peripheral resistance (TPR) but lower stroke volume (SV), cardiac output (CO), and baroreflex sensitivity than HW. During sitting and lying down, TPR was more closely associated with blood pressure (BP) than CO in FM patients; in contrast, CO was more closely associated with BP than TPR in HW. HCC correlated positively with TPR and BP in FM patients, but negatively with TPR and BP and positively with SV and CO in HW. Results suggest that chronic disease-related stress is associated with alterations in cardiovascular regulation toward greater involvement of vascular than cardiac mechanisms in BP control. Stress-related cortisol release may contribute to the long-term rearrangement of autonomic regulation. At the behavioral level, the dominance of vascular over cardiovascular control may relate to reduced somatic mobilization during an active fight-flight response in favor of passive and behaviorally immobile coping., (© 2024 The Author(s). Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

Purpose: Alterations of autonomic cardiovascular control are implicated in the origin of chronic low blood pressure (BP) (hypotension), but comprehensive analysis of baroreflex function is still lacking. This study explored baroreflex function in its cardiac, vascular and myocardial branches METHODS: Continuous BP was recorded at rest and during a mental arithmetic task in 40 hypotensive and 40 normotensive participants. Assessed cardiovascular variables included stroke volume (SV) (calculated by the Modelflow method), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and heart rate variability (HRV). Baroreflex sensitivity (BRS) was calculated using the spontaneous sequence method., Results: Hypotensive participants exhibited greater BRS in the three baroreflex branches, in addition to lower SV, HR and CO and higher HRV and TPR. Reactivity for BP, HRV and CO during the stress task was reduced in hypotensive individuals. The greater cardiac BRS can explain the lower HR and higher HRV observed in hypotension, suggestive of increased vagal cardiac influences. The higher vasomotor BRS may contribute to the greater TPR observed in the hypotensive participants. Abnormal associations between myocardial BRS and SV arose, suggesting aberrant autonomic control of myocardial contractility in hypotension., Conclusion: The results indicate that hemodynamic deficits in hypotension are related to preload factors, probably triggered by hypovolemia and reduced unstressed blood reserves, resulting in lower venous return, ventricular preload and SV. In contrast, afterload mechanisms seem to work appropriately., (© 2024. The Author(s).)

Changes in psychological variables in couples after successful in-vitro fertilization (IVF) have rarely been investigated. This paper describes follow-up assessments of a previously published study investigating changes in life satisfaction, stress and worry related to childbirth in couples undergoing IVF and those with natural pregnancy. Questionnaire data were obtained in 75 IVF couples and 70 couples with natural pregnancy before pregnancy, and at 6 and 12 months postpartum; follow-up data were recorded 18 and 24 months postpartum. IVF couples had less favourable baseline scores for all variables than those with natural pregnancy. Their life satisfaction increased, stress and worry decreased, during the first year postpartum. Couples with natural pregnancy reported transient worsening in all variables during this period. During follow-up, all variables remained largely stable in both groups; while life satisfaction and stress no longer differed between groups, worry was lower in IVF couples at month 24. Gender differences were small in both groups. In IVF couples, negative impacts of infertility may fully abate after childbirth; in naturally conceiving couples, initial negative changes in wellbeing are reversed and stabilized during the child´s first 2 years. Both groups may benefit from psychological support at different times during pregnancy and parenthood.

This study investigated effects of experimental baroreceptor stimulation on bilateral blood flow velocities in the anterior and middle cerebral arteries (ACA and MCA) using functional transcranial Doppler sonography. Carotid baroreceptors were stimulated by neck suction in 33 healthy participants. Therefore, negative pressure (- 50 mmHg) was applied; neck pressure (+ 10 mmHg) was used as a control condition. Heart rate (HR) and blood pressure (BP) were also continuously recorded. Neck suction led to reductions in bilateral ACA and MCA blood flow velocities, which accompanied the expected HR and BP decreases; HR and BP decreases correlated positively with the ACA flow velocity decline. The observations suggest reduction of blood flow in the perfusion territories of the ACA and MCA during baroreceptor stimulation. Baroreceptor-related HR and BP decreases may contribute to the cerebral blood flow decline. The findings underline the interaction between peripheral and cerebral hemodynamic regulation in autoregulatory control of cerebral perfusion., (© 2023. The Author(s).)

Background: Previous research suggested reduced well-being and quality of life in couples with an unfulfilled desire to have a child. However, changes in psychological variables in infertile couples after successful in-vitro fertilization (IVF) have been scarcely investigated., Purpose: This prospective study explored changes in life satisfaction, stress burden and habitual worry related to the birth of a child in couples undergoing IVF, and in those experiencing natural pregnancy., Methods: In total, 77 couples with successful IVF and 50 couples with natural pregnancy completed the Life Satisfaction Questionnaire, Perceived Stress Questionnaire and Penn State Worry Questionnaire; data were recorded before pregnancy (baseline) and 6 and 12 months after childbirth. Multi-level models were applied for data analysis., Results: Couples with IVF reported lower life satisfaction, and higher stress burden and worry, than those with natural pregnancy at baseline. Moreover, they showed a steep increase in life satisfaction at 6 and 12 months after childbirth, and decreased stress and worry. In couples with natural pregnancy, life satisfaction scores decreased, and those of stress and worry increased, at month 6 after childbirth and returned to initial state at month 12., Conclusions: The group difference at baseline underlines the psychosocial burden of infertility. However, the increase in life satisfaction and decreases in stress and worry suggest that the burden is lessened after the birth of a child. The changes in couples with natural pregnancy reflect the impact of the typical challenges posed by childbirth and successful readjustment during the first year of the child´s life., (© 2021 Family Process Institute.)

Objective: Previous research revealed aberrances in autonomic cardiovascular regulation in fibromyalgia, which may be relevant to symptoms genesis and the increased risk of cardiovascular disorders in individuals with fibromyalgia. This study investigated the role of comorbid depression in autonomic cardiovascular dysregulations in fibromyalgia., Methods: Cardiovascular recordings were obtained in 53 participants with fibromyalgia who also had depression ( n = 27), in participants with fibromyalgia without depression ( n = 26), and in 29 healthy controls, at rest and during a cold pressor test and an arithmetic task. Assessed parameters included interbeat interval, blood pressure, heart rate variability, baroreflex sensitivity, stroke volume, preejection period, left ventricular ejection time, Heather index, and total peripheral resistance., Results: Participants with both fibromyalgia and depression displayed lower tonic interbeat interval, baroreflex sensitivity, and heart rate variability compared with participants with fibromyalgia without depression and controls ( p values < .012, d values = 0.71-1.06). Participants with fibromyalgia but without depression did not differ from controls in these variables. Moreover, participants with fibromyalgia who also had depression, but not those without depression, exhibited lower Heather index, stroke volume, and left ventricular ejection time compared with controls ( p values < .013, d values = 0.62-0.78). No group differences arose for preejection period or total peripheral resistance. Stress reactivity was reduced in participants with fibromyalgia, independently of depression, for diastolic blood pressure, interbeat interval, left ventricular ejection time, and heart rate variability, than in controls., Conclusions: The role of depression in the autonomic dysregulation in fibromyalgia involves chronotropic cardiac control rather than adrenergic influences on contractility and vascular tone. Blunted cardiovascular reactivity may be ascribable to pathological factors inherent to fibromyalgia. These results underline the importance of diagnostics and treatment of comorbid depressive disorders in the management of fibromyalgia., (Copyright © 2022 by the American Psychosomatic Society.)

In addition to chronic widespread pain and depression and anxiety symptoms, patients with fibromyalgia frequently experience cognitive problems. This study investigated executive functions in fibromyalgia via a Go/No-Go task. To obtain comprehensive information about performance, traditional and ex-Gaussian parameters of reaction time (RT) variability were used, in addition to speed and accuracy indices. Ex-Gaussian parameters show an excellent fit to empirical RT distributions. Fifty-two female fibromyalgia patients and twenty-eight healthy controls participated. The task included 60 visual stimuli, which participants had to respond to (Go stimuli) or withhold the response to (No-Go stimuli). After 30 trials, the task rule changed, such that previous No-Go stimuli had to be responded to. Performance was indexed by the hit rate, false alarm rate, and mean ( M ) and intraindividual standard deviation (SD) of RT and the ex-Gaussian parameters mu, sigma, and tau. Mu and sigma indicate the M and SD of the Gaussian distribution; tau reflects the M and SD of the exponential function. Patients exhibited a lower hit rate, higher M RT, and higher tau than controls. Moreover, patients showed greater decrease of the hit rate after the change of task rule. In the entire sample, SD, sigma, and tau were inversely associated with the hit rate and positively associated with the false alarm rate. While the greater decline in hit rate after the change in task rule indicates deficient cognitive flexibility, the lack of any difference in false alarm rate suggests intact response inhibition. Higher M RT reflects reduced cognitive or motor speed. Increased tau in fibromyalgia indicates greater fluctuations in executive control and more frequent temporary lapses of attention. For the first time, this study demonstrated that indices of RT variability, in particular those derived from the ex-Gaussian function, may complement speed and accuracy parameters in the assessment of executive function impairments in fibromyalgia. Optimized assessment may facilitate the personalization of therapies aimed at improving the cognitive function of those with the disorder., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Stefan Duschek et al.)

Worry, which refers to uncontrollable chains of thoughts and images with negative affective load, is a transdiagnostic symptom of various mental disorders including major depressive disorder (MDD). Current theories relate excessive worry to deficient top-down control of automatically occurring perseverative thinking. This study investigated parasympathetic cardiac control in MDD in the context of worry and cognitive control. Heart rate variability (HRV) was recorded, in the high frequency (HF) and low frequency (LF) bands, in 36 MDD patients and 36 healthy controls while they performed a breathing focus task. The task included two phases during which participants' ability to concentrate on their breathing was assessed before and after an instructed worry phase. In addition to higher self-reported worry, MDD patients exhibited lower HF and LF HRV at rest, and lower LF HRV during the task than controls. MDD was also associated with impaired breathing concentration ability, more negative and neutral thought intrusions, more negative mood during breathing focus and increased stress during instructed worry. In the total sample, LF HRV correlated negatively with self-reported worry and negative thought intrusions, and positively with mood ratings. The reduction of HRV confirms the notion of low parasympathetic cardiac control in MDD. Moreover, low HRV represents a correlate of blunted prefrontal activity and impaired cognitive control that characterize the disorder. Impaired cognitive control may exacerbate worry, which is in turn involved in the genesis of aversive emotional states and maintenance of MDD., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Fibromyalgia syndrome (FMS) is a chronic pain condition accompanied by affective symptoms and cognitive impairments. This study investigated central nervous correlates of attentional and emotional processing in FMS. Therefore, event-related potentials were recorded in 26 FMS patients and 26 healthy controls during a dot probe task, which required participants to decide which side of the screen an asterisk was displayed on; the asterisk was immediately preceded by a facial expression (anger, pain, happiness, neutral) on the left or right side. Comorbid depression was also assessed. In patients, N170 amplitude was smaller for anger and pain expressions than for happy expressions, and P2 was greater for pain expressions than for happy expressions. N170 and P2 were unaffected by emotional expressions in controls. LPC was smaller overall in patients than controls. Though reaction times were longer overall in patients than controls, no behavioral effects of emotional stimuli arose in these groups. In contrast, FMS patients with comorbid depression showed less attentional interference due to emotional expressions, and less difficulty disengaging from these stimuli than patients without depression. While the observations concerning N170 suggested facilitated encoding of facial features representing negative rather than positive emotions in FMS and more automatized processing of pain expressions, those for P2 indicated increased attentional resource allocation to pain-related information. Reduced LPC reflects nonspecific deficits in sustained attention in FMS, which is in line with the longer reaction times. Behavioral data suggest lower processing depth of emotional information in patients with comorbid depression., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Fibromyalgia syndrome (FMS) is a chronic pain condition associated with a significant reduction in health-related quality of life (HRQoL). This study compared the different components of HRQoL between FMS and rheumatoid arthritis (RA) patients, and evaluated the relationships between HRQoL and clinical and emotional factors in FMS and RA patients., Method: Women with FMS (n = 80), RA ( n  = 43) and healthy women ( n  = 67) participated in the study. HRQoL was assessed by the SF-36 survey. Associations between HRQoL and symptom severity were assessed by correlation and multiple linear regression analyses., Results: FMS patients displayed lower values for all SF-36 variables than RA patients and healthy participants, while RA patients showed lower values for all SF-36 variables than healthy participants. These group differences persisted after statistically controlling for demographic, clinical and emotional variables. Clinical and emotional factors were inversely associated with SF-36 scores in the overall FMS + RA sample. Depression and fatigue were the strongest negative predictors. However, after the statistical control of the effect of diagnosis (FMS vs. RA) in the regression analysis, most of the associations disappear., Conclusions: The fact that group differences in HRQoL remained highly significant after statistically controlling of group differences in clinical symptom severity, and that associations between clinical symptoms and HRQoL disappear when the type of diagnosis was considered in the regression analysis, suggest that impairment of HRQoL could be considered a primary feature of FMS.

Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.

Objective: The ability to accurately identify facial expressions of emotions is crucial in human interaction. Although a previous study suggested deficient emotional face recognition in patients with fibromyalgia, not much is known about the origin of this impairment. Against this background, the present study investigated the role of executive functions. Executive functions refer to cognitive control mechanisms enabling implementation and coordination of basic mental operations. Deficits in this domain are prevalent in fibromyalgia., Methods: Fifty-two fibromyalgia patients and thirty-two healthy individuals completed the Ekman-60 Faces Test, which requires classification of facial displays of happiness, sadness, anger, fear, surprise, and disgust. They also completed eight tasks assessing the executive function components of shifting, updating, and inhibition. Effects of comorbid depression and anxiety disorders, as well as medication use, were tested in stratified analyses of patient subgroups., Results: Patients made more errors overall than controls in classifying the emotional expressions. Moreover, their recognition accuracy correlated positively with performance on most of the executive function tasks. Emotion recognition did not vary as a function of comorbid psychiatric disorders or medication use., Conclusions: The study supports impaired facial emotion recognition in fibromyalgia, which may contribute to the interaction problems and poor social functioning characterizing this condition. Facial emotion recognition is regarded as a complex process, which may be particularly reliant on efficient coordination of various basic operations by executive functions. As such, the correlations between cognitive task performance and recognition accuracy suggest that deficits in higher cognitive functions underlie impaired emotional communication in fibromyalgia., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This study investigated the cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia using the spontaneous sequence method. Systolic blood pressure (SBP), interbeat interval (IBI), stroke volume (SV), pre-ejection period (PEP), and total peripheral resistance (TPR) were continuously recorded in 40 fibromyalgia patients and 30 healthy individuals during a cold pressor test and a mental arithmetic task. Sequences of covariation between SBP and IBI (cardiac branch), SV and PEP (myocardial branch), and TPR (vasomotor branch) were identified. Baroreflex sensitivity (BRS) was represented by the slope of the regression line between values in the sequences; baroreflex effectiveness (BEI) was indexed by the proportion of progressive SBP changes that elicited reflex responses. Patients exhibited lower BRS in the three branches, lower BEI in the cardiac and vasomotor branches, and reduced reactivity in cardiac BRS and BEI, SBP, IBI, SV, and PEP. Moreover, BRS and BEI were inversely related to clinical pain, cold pressor pain, depression, trait anxiety, sleep problems, and fatigue. Reduced function of the three baroreflex branches implies diminished resources for autonomic inotropic, chronotropic, and vascular regulation in fibromyalgia. Blunted stress reactivity indicates a limited capacity for autonomic cardiovascular adjustment to situational requirements. The associations of BRS and BEI with pain perception may reflect the antinociceptive effects arising from baroreceptor afferents, where reduced baroreflex function may contribute to the hyperalgesia characterizing fibromyalgia. The associations with affective impairments, sleep problems, and fatigue suggest that baroreflex dysfunctions are also involved in the secondary symptoms of the disorder., (© 2021 Society for Psychophysiological Research.)

Trait worry refers to a tendency toward increased vigilance to threat and reduced tolerance of uncertainty. While it has been established as a risk factor of general morbidity, knowledge about autonomic regulation in trait worry remains scarce. This study investigated parasympathetic cardiac control in trait worry, in the context of attentional focus. Healthy groups with high and low worry were selected using the Penn State Worry Questionnaire (n = 40 per group). Heart rate variability (HRV) was recorded in the high frequency (HF) and low frequency (LF) bands while participants performed a breathing focus task. The task included a phase of instructed worry and two phases during which participants´ ability to concentrate on their breathing was assessed. As compared to the low worry group, the high worry group exhibited lower HRV in the LF band during both breathing focus phases and smaller reduction of LF HRV during instructed worry. HF HRV did not differ between groups. High worry was associated with impaired ability to concentrate on breathing and more intrusive thoughts. In the total sample, negative intrusions correlated negatively with LF HRV during the first breathing focus phase and LF HRV reactivity. Instructed worry led to greater perceived stress and deterioration of mood in high worry participants. Reduced LF HRV reflects blunted parasympathetic cardiac control in trait worry, associated with elevated risk of poor health outcomes. In addition, it might represent a psychophysiological correlate of reduced cognitive inhibition, which interferes with attentional focus and impedes control of threat processing and perseverative thinking., (Copyright © 2020 Elsevier B.V. All rights reserved.)