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Objectives The impact of the quality of discharge communication between physicians and their patients is critical on patients’ health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. Methods For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients’ immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients’ adherence to recommendations and satisfaction, as well as the patient-physician relationship. Results Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients’ immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. Conclusions and practice Implications Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients’ recall, and may therefore improve quality of care in the ED.

Highlights • Dynamic face stimuli activate face processing and limbic brain regions. • Unattractive faces are linked to higher activation of these regions. • Subclinical paranoid beliefs enhance the neural response by perceived attractiveness., The perception of faces and consequent social inferences are fundamental for interpersonal communication. While facial expression is important for interindividual communication, constitutional and acquired features are crucial for basic emotions of attraction or repulsion. An emotional bias in face processing has been shown in schizophrenia, but the neurobiological mechanisms are unclear. Studies on the interaction between face processing and the emotional state of healthy individuals may help to elucidate the pathogenesis of the paranoid syndrome in psychosis. This study addressed facial attractiveness and paranoid ideas in a non-clinical population. Using functional magnetic resonance imaging (fMRI), we investigated neural activation patterns of 99 healthy subjects during the passive perception of a dynamic presentation of faces with different attractiveness. We found that the perceived attractiveness of faces was linked to the activity of face processing and limbic regions including the fusiform gyrus, amygdala, and prefrontal areas. Paranoid beliefs interacted with perceived attractiveness in these regions resulting in a higher response range and increased activation after the presentation of unattractive faces. However, no behavioral interactions between reported subjective attractiveness and paranoid beliefs were found. The results showed that increased activation of limbic brain regions is linked to paranoid beliefs. Since similar correlations were found in clinical populations with paranoid syndromes, we suggest a dimension of emotional dysregulation ranging from subclinical paranoid beliefs to paranoid schizophrenia.

Background In mental illnesses, the language domain, including speech and thought, is often affected. The spectrum of language symptoms shows a great variability between patients with psychosis. In previous studies, we have not only demonstrated that patients and healthy controls show activation differences in the neural language circuitry, but also within the different patient groups. The Bern psychopathology scale is a tool to help differentiate patients, which presents with disinhibited or inhibited language symptoms. This aids to examine the continuum from health to psychosis in a dimensional approach. To understand the bipolarity within the patient groups on the continuum of language domain, the healthy population needs to be examined as well. Therefore, in the current study, a healthy population was tested to investigate this heterogeneity in the language domain during a lexical decision task. Additionally, a subjective rating of one’s language aptitude was measured, to gain an insight on where they would see themselves on the continuum. The aim was to examine the spectrum of inter-individual differences and its association with language-related brain networks, specifically Broca’s and Wernicke’s area. This observed heterogeneity of a healthy population would allow an extrapolation to clinical ends of the spectrum. Methods While measuring brain activity with fMRI, 102 healthy adult subjects performed a lexical priming task. Subjects had to decide if a visually presented target word would form the generic term of a previously shown prime word, in terms of its relation (e.g. Dog – Cat) or its category (e.g. Dog – Animal). To group the participants, each subject rated their own language aptitude on 7-point Likert scale. According to their rating they were then sorted into high, mid or low language aptitude groups. Results Although, we found differences in brain activation in Broca (BA44/ BA45) and Wernicke (pMTG) among the groups, the behavioral outcome, specifically reaction time (RT) and accuracy, showed no significant differences between the groups. We studied the activation patterns in the region of Broca’s area (BA45, BA44) and Wernicke’s area (pMTG) during preparation (waiting for the target after the indication of task type) and processing (target word processing) phases. We found group differences in BA45 during both preparation and processing phases. The Post hoc analysis revealed that the high group showed significantly greater activation in BA45 compared to the low group. While BA44 and pMTG showed only a significant group difference during the processing phase. Also, here the Post hoc analysis revealed that the high group showed greater activation in both areas during the processing phase. Furthermore, the psychophysiological interaction (PPI) analysis of BA44, during preparation phase, with RT as covariate revealed distinct functional connectivity patterns from seed area BA44 among the high and low language aptitude groups. We found, that a stronger connectivity from BA44 to the left posterior middle temporal gyrus (pMTG) was related with faster RT in the high group. The low group showed a same pattern from BA44 to the left fusiform gyrus, also known as the visual word form area. Discussion These results indicate that, one utilizes the language-related brain areas differently, as well as their connectivity, during the language task according to the subjective evaluation of oneself language aptitude. These new insights into the dimension of language is facilitating further research in psychosis, that analyzes the continuum from the healthy population profiles to the profiles of the population with psychosis. With this, it supports the efforts to improve diagnostic tools and treatment options for patients with psychosis.