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Despite the accumulated knowledge on moral decision-making in the early stages of development, empirical evidence is still limited in the old-aged adults. The current study contributes to unveil the neural correlates of judgments of moral transgressions as a function of aging, by examining the temporal dynamics of neural activation elicited by intentional and accidental harmful actions in three groups of healthy participants: young adults (18-35), adults (40-55), and older adults (60-75). Older adults were slower and less accurate in rating intentionality, compared to the younger groups. In ERP analysis, the older group showed increased P2 amplitude, which was predicted by poorer performance on neuropsychological tests. Reduced amplitudes were found on critical ERP components to moral cognition (N2 and LPP), namely while processing intentional harmful scenarios. Older adults seem to allocate more attentional resources (P2) to the task, probably to compensate the age-related decline in executive functioning, while younger groups show a pronounced negativity while detecting harm (N2) and increased neural activation to encode the intentions behind the acts (LPP). [ABSTRACT FROM AUTHOR]

Background: Previous analyses have shown that long-acting risperidone (LAR) is cost-effective in several Western countries. In Portugal, however, the costs of key services are lower. Therefore, available evidence in other countries may have limited relevance.Objective: To estimate costs and effects of LAR versus a conventional depot and a short-acting oral atypical antipsychotic over a 5-year period in Portugal.Methods: An existing discrete event model was adapted to reflect the Portuguese healthcare setting, based on expert opinion, clinical, epidemiological, and cost data. The model compares three scenarios. In scenario 1, patients start with a conventional depot; in scenario 2, with LAR; and in scenario 3, with oral risperidone. The model simulates individual patient histories while taking into account patient characteristics such as risk to society and side-effects. Subsequently, the model simulates patient histories in terms of outpatient appointments, psychotic episodes, treatment, compliance, symptom scores, lack of ability to take care presenting an actual risk, and treatment setting. Outcomes were number of psychotic episodes, cumulative symptom score and direct medical costs. Univariate sensitivity analyses were carried out.Results: Compared to a conventional depot and an oral atypical, LAR was estimated to save approximately euro 3603 and euro 4682 per patient (respectively) and avoid 0.44 and 0.59 relapses per patient in 5 years. Sensitivity analyses showed that the outcome of dominance was only sensitive to estimates about unit costs of hospital/institutionalization, potential risk, and to the reduction in symptoms by use of atypicals.Conclusion: Based on this modeling exercise, it could be expected that LAR may be a cost-effective treatment with limited budget impact in Portugal. However, further studies are required to test the generalizability of the results of the present modeling study to the larger population of Portugal. [ABSTRACT FROM AUTHOR]

Older adults systematically show an enhanced N170 amplitude during the visualization of facial expressions of emotion. The present study aimed to replicate this finding, further investigating if this effect is specific to facial stimuli, present in other neural correlates of face processing, and modulated by own-age faces. To this purpose, younger (n = 25; M age  = 28.36), middle-aged (n = 23; M age  = 48.74), and older adults (n = 25; M age  = 67.36) performed two face/emotion identification tasks during an EEG recording. The results showed that groups did not differ regarding P100 amplitude, but older adults had increased N170 amplitude for both facial and non-facial stimuli. The event-related potentials analysed were not modulated by an own-age bias, but older faces elicited larger N170 in the Emotion Identification Task for all groups. This increased amplitude may reflect a higher ambiguity of older faces due to age-related changes in their physical features, which may elicit higher neural resources to decode. Regarding P250, older faces elicited decreased amplitudes than younger faces, which may reflect a reduced processing of the emotional content of older faces. This interpretation is consistent with the lower accuracy obtained for this category of stimuli across groups. These results have important social implications and suggest that aging may hamper the neural processing of facial expressions of emotion, especially for own-age peers., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Schizophrenia is a chronic psychiatric disorder with a significant impact worldwide. The early onset and its relapsing nature pose a significant challenge to patients and caregivers. The PSIPROSPER study aimed to characterize the real-world context of schizophrenia treatment in Portugal and to measure the impact of including paliperidone palmitate 1-month formulation (PP1M) in the clinical outcomes (relapses and hospitalizations) and healthcare resource utilization, in a context in which payment scheme in Portugal allows for patients to receive free antipsychotics if prescribed at public hospitals., Methods: This was a multicenter, retrospective, observational study. Male and female adults with a diagnosis of schizophrenia who initiated treatment with PP1M after a minimum of 12 months on an Oral Antipsychotic (OAP), and with complete medical charts, were consecutively included. A mirror-image design over 24 months allowed the comparison of outcomes before and after the PP1M introduction., Results: Out of the 51 patients included, 80.4% were male, with a mean age of 34 (±9.8) years. Around 92% of patients were being treated with PP1M at inclusion. Lack of adherence to previous OAP was the main driver for PP1M initiation. Only 9.8% of patients were hospitalized during the PP1M period vs. 64.7% during the OAP period ( p < 0.0001). The mean number of hospitalizations (0.1) was significantly lower during the PP1M period ( p < 0.0001). Type of treatment was the only variable found to be significant in predicting a lower hospitalization rate and a lower risk of hospitalization. Relapses were significantly lower ( p < 0.0001) in PP1M (21.6%) vs. OAP (83.7%). Similarly, the mean change in the number of relapses ( p < 0.0001) showed significantly better outcomes in PP1M., Conclusion: This study supports PP1M as part of schizophrenia treatment in Portugal. Given the lower number of relapses and hospitalizations observed in schizophrenia patients treated with PP1M when compared to OAP-treated patients, this real-world study seems to provide further evidence to support the use of PP1M to treat this condition, in line with previous research. In the context of scarce public resources, these benefits should be carefully considered by healthcare decision-makers to ensure optimal value-based treatment strategies., Competing Interests: GA and AP were employed by Janssen-Cilag Farmacêutica, Portugal. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Marques-Teixeira, Amorim and Pires.)

Delay discounting (or temporal discounting) refers to the decrease of the subjective value of a reward as the time interval for receiving that reward increases. A recent meta-analysis showed that delay discounting appears to be similar across the lifespan as younger, middle-aged, and older adults prefer sooner rewards, despite smaller, over later rewards, even if larger. However further investigation is needed to understand the potential role of individual factors in delay discounting across the lifespan. The present study aimed to contribute to this debate, by investigating the influence of sociodemographic, neurocognitive, and psychological variables on delay discounting. For this purpose, 88 participants (30 younger, 30 middle-aged, and 28 older adults) aged between 19 and 73 years old completed the Monetary Choice Questionnaire (MCQ), a comprehensive battery of neurocognitive tests, and self-report measures of psychopathology. Results revealed no group differences in the rate of discounting. A well-established effect of the amount of the delayed reward was replicated, showing that medium rewards were less discounted than smaller rewards, and larger rewards had lower discounting rates than smaller and medium rewards-the magnitude effect. Regarding the influence of neurocognitive and psychological factors on delay discounting, better working memory, as assessed by the Corsi block-tapping task, significantly predicted larger magnitude effects. The findings of the current work are consistent with the results of previous studies, suggesting that temporal discounting is a stable function across the adult life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The current study aims to provide the first insights into the neural correlates of utilitarian and deontological responses to moral dilemmas across the lifespan. To this purpose, younger (n = 30), middle-aged (n = 29), and older adults (n = 29) completed moral dilemmas during an EEG recording. Behaviorally, groups did not differ in the number of utilitarian responses and reaction times. However, at the neural level, older adults had higher Error Positivity (Pe) amplitudes than younger adults after utilitarian responses. As this effect was specific to utilitarian responses, it suggests that utilitarian decisions may induce increased conflict in the older group. These findings highlight that older adults may be more aware of the harmful outcomes of utilitarian decisions during moral decision-making., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Benzodiazepines and antidepressants have been shown to change responses to unfairness; however, the effects of their combined use on unfairness evaluation are unknown. This study examines the effects of concomitant benzodiazepines and antidepressants long-term use on the evaluation of fair and unfair offers. To analyze behavioral changes on responses to unfairness, we compared the performance of medicated participants and healthy controls in the Ultimatum Game (UG), both in the proposer and in the respondent role. The results showed that long-term psychotropic users had the worse economic strategy by accepting less offers than control subjects. However, in the proposer role, the unfair offers made by participants were similar between groups. The present results suggest that long-term use of psychotropic medication, specifically the combination of benzodiazepines and antidepressants, may increase the sensitivity to unfairness, resulting in higher rejection rates in conditions where this strategy is the most disadvantageous., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fernandes, Garcez, Balaban, Barbosa, Pereira, Silveira, Marques-Teixeira and Gonçalves.)

The effect of pathological aging on economic decision-making is a topic of major relevance as impairments in this domain place older adults at increased risk for financial abuse. This review aims to characterize decision-making across the continuum that goes from healthy aging to Alzheimer's Dementia. We included 42 studies comparing patients with Mild Cognitive Impairment (MCI) and healthy older adults, patients with Alzheimer's Disease (AD) and healthy older adults, and patients with MCI and patients with AD. Substantial evidence emerged suggesting that both MCI as AD affect economic decision-making. However, a non-negligible number of behavioural tasks failed to find significant differences between patients and controls, and no differences were reported between patients with MCI and AD. On the contrary, measures of financial capacity reached more robust findings, showing that healthy older adults had better performance than patients, while MCI patients showed better performance than AD patients. This review presents the main conclusions that may be drawn from significant findings, as well as the hypotheses and recommendations for future research., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Auditory event-related potentials (ERP) may serve as diagnostic tools for schizophrenia and inform on the susceptibility for this condition. Particularly, the examination of N1 and P2 components of the auditory ERP may shed light on the impairments of information processing streams in schizophrenia. However, the habituation properties (i.e., decreasing amplitude with the repeated presentation of an auditory stimulus) of these components remain poorly studied compared to other auditory ERPs. Therefore, the current study used a roving paradigm to assess the modulation and habituation of N1 and P2 to simple (pure tones) and complex sounds (human voices and bird songs) in 26 first-episode patients with schizophrenia and 27 healthy participants. To explore the habituation properties of these ERPs, we measured the decrease in amplitude over a train of seven repetitions of the same stimulus (either bird songs or human voices). We observed that, for human voices, N1 and P2 amplitudes decreased linearly from stimulus 1-7, in both groups. Regarding bird songs, only the P2 component showed a decreased amplitude with stimulus presentation, exclusively in the control group. This suggests that patients did not show a fading of neural responses to repeated bird songs, reflecting abnormal habituation to this stimulus. This could reflect the inability to inhibit irrelevant or redundant information at later stages of auditory processing. In turn schizophrenia patients appear to have a preserved auditory processing of human voices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mazer, Macedo, Paiva, Ferreira-Santos, Pasion, Barbosa, Almeida, Silveira, Cunha-Reis and Marques-Teixeira.)

The psychopathic traits boldness, meanness, and disinhibition are theorized to be underlined by trait fearlessness and externalizing vulnerability as etiologic neurobiological processes. However, little is known about the neurophysiological correlates of these traits. In this work, we explored how the three traits are associated with event-related potential (ERP) components targeted at the etiological processes in a partial delayed threat conditioning task and in a go/no-go task. Fifty community-dwelling volunteers (25 women), without history of neurological or psychiatric conditions, were recruited and assessed for psychopathic traits using the triarchic psychopathy measure. Participants performed a threat conditioning task, and a go/no-go task while undergoing an electroencephalography recording. Results from the threat conditioning task showed that boldness was significantly associated with reduced late positive potential. Concerning the go/no-go task, disinhibition was significantly associated with reduced error-related negativity ERP component. Overall, distinct psychopathic traits were found to be associated with distinct neurophysiological correlates of threat conditioning and response inhibition. This is consistent with models of psychopathy entailing trait fearlessness and externalizing proneness, and related brain mechanisms, as distinct processes underlying the expression of psychopathic traits., (© 2020 Society for Psychophysiological Research.)

Rationale: Benzodiazepines, a class of commonly prescribed drugs, were shown to cause cognitive impairments in several domains. However, the effect of benzodiazepines on social cognition is still unclear., Objectives: In order to clarify how benzodiazepines administration affects the identification of facial expressions of emotion (FEE), we conducted a meta-analysis of 8 empirical studies (N = 153 benzodiazepines, N = 153 placebo)., Results: Results showed that participants receiving benzodiazepines were less accurate at identifying facial expressions of anger compared with those receiving placebo (M = - 0.52). Regarding the remaining facial expressions, the meta-analysis did not reveal significant differences between the groups., Conclusions: We discuss several factors that may explain the differences in the identification of emotions in facial expressions associated with benzodiazepines administration. Additionally, the relevance of assessing the effects of benzodiazepines when used on a long-term basis is addressed.

The experience of caregiving in severe mental illness is a valuable concept for research and clinical practice as it can provide access to the idiosyncratic assessment of negative and positive dimensions of informal caregiving, thus allowing the design of interventions focused on reducing risk factors and promoting protective factors. This study was aimed at testing explanatory models of negative and positive experiences of caregiving considering the role of the caregiver's perceptions of difficulties, satisfaction, and coping. A convenience sample of 159 informal caregivers of patients with schizophrenia was used in this study. Different variables were considered: (1) perception of difficulties (Caregiver's Assessment of Difficulties Index); (2) perception of satisfaction (Caregiver's Assessment of Satisfaction Index); (3) perception of coping (Caregiver's Assessment of Managing Index); and (4) the experience of caregiving (Experience of Caregiving Inventory). Using structural equation modeling, the results revealed the following: (1) the perception of difficulties and of satisfaction coexist; (2) the negative experiences of caregiving are predominantly explained by the perception of difficulties and of coping with stress; and (3) the positive experiences of caregiving are mainly explained by the perception of sources of intrapersonal satisfaction, while the perception of coping does not have robust predictive value.

With respect to De Dreu and Gross's article, we comment on the psychological functions for attack and defense, focusing on associations between individual differences in psychopathic personality traits and the behavioral patterns observed in attack-defense conflicts. We highlight the dimensional nature of psychopathy and formulate hypothetical associations between distinct traits, their different behavioral outcomes, and associated brain mechanisms.

Past research on emotions was mostly supported on emotion inducing slides, but studies in the field are moving towards more ecological stimuli, including 3D stimuli and virtual reality scenes. The present study aims to compare the effects of two-dimensional (2D) and three-dimensional (3D) emotion-inducing scenes in the modulation of attention, as indexed by the amplitude of the P3 event-related component in a dual-task paradigm. We recorded the EEG signal of 31 healthy male participants performing an active auditory oddball task, while simultaneously observing pleasant, unpleasant and neutral scenes in 2D or 3D. We analyzed the effects of emotional valence and visualization mode in the mean amplitude of the P3 component at Pz. The results revealed than revealed that 2D scenarios were as effective as 3D stimuli in capturing attention resources and this effect was consistently observed in all emotional scenes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Emotion identification is a fundamental component of social cognition. Although it is well established that a general cognitive decline occurs with advancing age, the effects of age on emotion identification is still unclear. A meta-analysis by Ruffman and colleagues (2008) explored this issue, but much research has been published since then, reporting inconsistent findings., Methods: To examine age differences in the identification of facial expressions of emotion, we conducted a meta-analysis of 24 empirical studies ( N  = 1,033 older adults, N  = 1,135 younger adults) published after 2008. Additionally, a meta-regression analysis was conducted to identify potential moderators., Results: Results show that older adults less accurately identify facial expressions of anger, sadness, fear, surprise, and happiness compared to younger adults, strengthening the results obtained by Ruffman et al. (2008). However, meta-regression analyses indicate that effect sizes are moderated by sample characteristics and stimulus features. Importantly, the estimated effect size for the identification of fear and disgust increased for larger differences in the number of years of formal education between the two groups., Discussion: We discuss several factors that might explain the age-related differences in emotion identification and suggest how brain changes may account for the observed pattern. Furthermore, moderator effects are interpreted and discussed., Competing Interests: The authors declare there are no competing interests.

This study examines age-related differences in behavioral responses to risk and in the neurophysiological correlates of feedback processing. Our sample was composed of younger, middle-aged, and older adults, who were asked to decide between 2 risky options, in the gain and loss domains, during an EEG recording. Results evidenced group-related differences in early and later stages of feedback processing, indexed by differences in the feedback-related negativity (FRN) and P3 amplitudes. Specifically, in the loss domain, younger adults showed higher FRN amplitudes after non-losses than after losses, whereas middle-aged and older adults had similar FRN amplitudes after both. In the gain domain, younger and middle-aged adults had higher P3 amplitudes after gains than after non-gains, whereas older adults had similar P3 amplitudes after both. Behaviorally, older adults had higher rates of risky decisions than younger adults in the loss domain, a result that was correlated with poorer performance in memory and executive functions. Our results suggest age-related differences in the outcome-related expectations, as well as in the affective relevance attributed to the outcomes, which may underlie the group differences found in risk-aversion., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Aging is known to alter the processing of facial expressions of emotion (FEE), however the impact of this alteration is less clear. Additionally, there is little information about the temporal dynamics of the neural processing of facial affect., Methods: We examined behavioral and neural age-related changes in the identification of FEE using event-related potentials. Furthermore, we analyze the relationship between behavioral/neural responses and neuropsychological functioning. To this purpose, 30 younger adults, 29 middle-aged adults and 26 older adults identified FEE., Results: The behavioral results showed a similar performance between groups. The neural results showed no significant differences between groups for the P100 component and an increased N170 amplitude in the older group. Furthermore, a pattern of asymmetric activation was evident in the N170 component. Results also suggest deficits in facial feature decoding abilities, reflected by a reduced N250 amplitude in older adults. Neuropsychological functioning predicts P100 modulation, but does not seem to influence emotion identification ability., Conclusions: The findings suggest the existence of a compensatory function that would explain the age-equivalent performance in emotion identification., Significance: The study may help future research addressing behavioral and neural processes involved on processing of FEE in neurodegenerative conditions., (Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Objective To adapt and validate a widely used set of moral dilemmas to European Portuguese, which can be applied to assess decision-making. Moreover, the classical formulation of the dilemmas was compared with a more focused moral probe. Finally, a shorter version of the moral scenarios was tested. Methods The Portuguese version of the set of moral dilemmas was tested in 53 individuals from several regions of Portugal. In a second study, an alternative way of questioning on moral dilemmas was tested in 41 participants. Finally, the shorter version of the moral dilemmas was tested in 137 individuals. Results Results evidenced no significant differences between English and Portuguese versions. Also, asking whether actions are "morally acceptable" elicited less utilitarian responses than the original question, although without reaching statistical significance. Finally, all tested versions of moral dilemmas exhibited the same pattern of responses, suggesting that the fundamental elements to the moral decision-making were preserved. Conclusions We found evidence of cross-cultural validity for moral dilemmas. However, the moral focus might affect utilitarian/deontological judgments.

Iowa Gambling Task (IGT) is one of the most widely used tools to assess economic decision-making. However, the research tradition on aging and the Iowa Gambling Task (IGT) has been mainly focused on the overall performance of older adults in relation to younger or clinical groups, remaining unclear whether older adults are capable of learning along the task. We conducted a meta-analysis to examine older adults' decision-making on the IGT, to test the effects of aging on reversal learning (45 studies) and to provide normative data on total and block net scores (55 studies). From the accumulated empirical evidence, we found an average total net score of 7.55 (±25.9). We also observed a significant reversal learning effect along the blocks of the IGT, indicating that older adults inhibit the prepotent response toward immediately attractive options associated with high losses, in favor of initially less attractive options associated with long-run profit. During block 1, decisions of older adults led to a negative gambling net score, reflecting the expected initial pattern of risk-taking. However, the shift toward more safe options occurred between block 2 (small-to-medium effect size) and blocks 3, 4, 5 (medium-to-large effect size). These main findings highlight that older adults are able to move from the initial uncertainty, when the possible outcomes are unknown, to decisions based on risk, when the outcomes are learned and may be used to guide future adaptive decision-making.

Background: Study of emotional responses of antisocial individuals has produced inconsistent findings. Some studies report emotional deficits, while others find no differences between people with and without antisocial behaviours., Aims: Our aim was to apply signal detection theory methods to compare the sensitivity of antisocial and control participants to emotional stimuli. We hypothesised that offenders would show lower ability to discriminate changes in the level of arousal and valence of emotional stimuli relative to the controls., Methods: Signal detection theory was applied to study the sensitivity of recidivist offenders in prison to emotional arousal and valence induced by pictures. This approach, novel in this context, provides a departure from the usual reliance on self-report., Results: Offenders reported higher arousal than controls but showed lower sensitivity to changes between different levels of arousal (whereas no differences were found for valence). Also, offenders showed increased response bias for changes in the levels of arousal, as well as in the higher levels of valence., Conclusions: Our findings show that direct observations of emotional arousal, but not valence, discriminate between recidivist offenders with antisocial personality disorder and non-offending controls. Use of such approaches is likely to provide more valid data than self-reports and may prove particularly useful in studies of intervention for recidivists or in assessment of their readiness for release., (Copyright © 2015 John Wiley & Sons, Ltd.)

Findings concerning the emotional modulation of the N170 component of the visual event-related potential are mixed. In the present report we tested the hypothesis that the emotional modulation of the N170 may be driven by the perceived emotional arousal of the stimuli, rather than by specific emotional categories. Fifty-four participants viewed facial expressions of anger, disgust, fear and happiness, plus low arousal neutral faces. All emotional categories were matched in arousal, while stimuli within each category varied parametrically in this dimension. The modulation of the electrocortical activity on the N170 time-window was analyzed in the time domain and via time-frequency decomposition. The effects of emotion and arousal were analyzed separately. In the time domain N170 amplitudes co-varied parametrically with perceived arousal, regardless of emotional category. This modulation was linearly associated with the power of the theta, alpha, and beta frequency bands. Moreover, fear was associated with a trend for increased N170 amplitudes, enhanced alpha power, and increased broad band inter-trial phase coherence. These results support the views that a) the activity in N170 time window is fundamentally modulated by perceived arousal, b) the modulation of the N170 may be the product of an increased evoked response, rather than the result of phase resetting processes, and c) facial expressions of fear retain some processing primacy, that may be related to their increased value as environmental cues., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: The literature suggests that the N1 and P2 waves of the auditory ERP are dissociable at the developmental, experimental, and source levels. At the experimental level, inconsistent findings suggest different effects of intensity on the amplitudes of the auditory N1 and P2. Our main goal was to analyze the intensity dependence of the auditory N1 and P2 while controlling for habituation effects., Methods: We examined the intensity dependence of both averaged and single-trial auditory N1 and P2 waves elicited in a repeated-stimulation protocol., Results: N1 and P2 revealed similar intensity dependence on both standard and filter denoised ERP, with a linear tendency for higher intensities to elicit higher absolute peak amplitudes. At the single-trial level, both waves covary irrespective of stimulus intensity and trial order., Conclusions: Our results suggest that stimulus intensity variation induces similar effects on both and N1 and P2 and partially contradict previous data that classified the P2 as a non-habituating component., Significance: Our findings contribute to the ongoing discussion on the functional significance of the auditory P2 deflection. In addition, the present work demonstrated the applicability of a filter denoising method for single-trial estimation in the analysis of the experimental effects on auditory ERP components., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)