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PURPOSE: Medical student burnout is becoming increasingly common. The Art of Seeing is a visual arts elective at one US medical school. The purpose of this study was to determine the effect of this course on attributes that are foundational to wellbeing: mindfulness, self-awareness, and stress. METHODS: A total of 40 students participated in this study from 2019 through 2021. Fifteen students participated in the pre-pandemic, in-person course, and 25 students participated in the post-pandemic, virtual course. Pre and post-tests included open-ended responses to works of art, which were coded for themes, and standardized scales: mindful attention awareness scale (MAAS), situational self-awareness scale (SSAS), and perceived stress questionnaire (PSQ). RESULTS: The students had statistically significant improvements on the MAAS (p < .01), the SSAS (p < .01), and the PSQ (p = 0.046). Improvements in the MAAS and the SSAS did not depend on class format. Students also demonstrated increased focus on the present moment, emotional awareness, and creative expression in the post test free responses. CONCLUSIONS: This course significantly improved mindfulness, self-awareness, and stress levels in medical students, and can be used to help enhance wellbeing and mitigate burnout in this population, both in-person and virtually.

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BACKGROUND: Resilience research to date has been criticised for its consideration of resilience as a personal trait instead of a process, and for identifying individual factors related to resilience with no consideration of the ecological context. The overall aim of the current study was to explore the multi-level process through which adults recovering from EDs develop resilience, from the perspectives of clients and clinicians. The objective of this research was to outline the stages involved in the process of developing resilience, which might help to inform families and services in how best to support adults with EDs during their recovery. METHOD: Thirty participants (15 clients; 15 clinicians) took part in semi-structured interviews, and responded to questions relating to factors associated with resilience. Using an inductive approach, data were analysed using reflexive thematic analysis. RESULTS: The overarching theme which described the process of developing resilience was 'Bouncing back to being me', which involved three stages: 'Who am I without my ED?', 'My eating disorder does not define me', and 'I no longer need my eating disorder'. Twenty sub-themes were identified as being involved in this resilience process, thirteen of which required multi-level involvement. CONCLUSION: This qualitative study provided a multi-level resilience framework for adults recovering from eating disorders, that is based on the experiences of adults with eating disorders and their treating clinicians. This framework provided empirical evidence that resilience is an ecological process involving an interaction between internal and external factors occurring between adults with eating disorder and their most immediate environments (i.e. family and social). Anorexia nervosa, bulimia nervosa and binge-eating disorder demonstrate high rates of symptom persistence across time and poor prognosis for a significant proportion of individuals affected by these disorders, including health complications and increased risk of mortality. Many researchers have attempted to explore how to improve recovery outcomes for this population. Eating disorder experts have emphasised the need to focus not only on the weight indicators and eating behaviours that sustain the eating disorder during recovery, but also on the psychological well-being of the person recovering. One way to achieve this is to focus on resilience, which was identified as a fundamental aspect of eating disorder recovery in previous research. This study conceptualises resilience as a dynamic process that is influenced not only at a personal level but also through the environment in which the person lives. This study gathered data from adults with eating disorders and their treating clinicians, to devise a framework for resilience development for adults recovering from eating disorders. The paper discussed ways in which these findings and the framework identified can be easily implemented in clinical practice to facilitate a better understanding of eating disorder resilience and to enhance recovery outcomes.

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In comparison to other art forms, dance remains underrepresented in the medical humanities, especially within the academic medical setting. Several factors, including perceived lack of applicability to patient care, contribute to this pattern. This paper contends that, to the contrary, learners across the medical education spectrum stand to gain much from engaging with the movement arts, including improvement of clinically-relevant skills such as physical self-awareness, observation, communication, and mindfulness. This paper makes the case for the nascent subdiscipline of Movement and Medicine, developed by the authors and piloted for inclusion in medical humanities curricula within a medical education context. Movement and Medicine employs a dance-inspired pedagogy to a) promote awareness of personal movement and embodiment tendencies and b) harness that awareness to gain more profound, sensory insight into the embodied experiences of others-experiences of health, illness, or otherwise. This work outlines the research, rationale, and philosophy behind Movement and Medicine; concretely defines the subdiscipline and situates it within the medical humanities landscape; proposes practical approaches to engaging with and applying this material; and describes a Movement and Medicine course developed for one American medical school.

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BACKGROUND: Although previous reviews suggest a strong association between abuse and eating disorders, less is known about non-abuse adverse life experiences, such as parental mental illness or family discord, which occur frequently for this population. The aim of the current study was to identify family-related non-abuse adverse life experiences occurring for adults with eating disorders, and to establish whether they occur for people with anorexia nervosa, bulimia nervosa or binge-eating disorder more than the general population and other psychiatric populations. METHOD: A systematic review of studies focusing on family-related non-abuse adverse life experiences and eating disorders was conducted in accordance with PRISMA guidelines. The search string was applied to four electronic databases including Psycinfo, PubMed/Medline, CINAHL Plus and EMBASE. RESULTS: Of the 26 studies selected for inclusion, six types of family-related non-abuse adverse life experiences were identified: adverse parenting style; family disharmony; loss of a family member, relative or close person; familial mental health issues; family comments about eating, or shape, weight and appearance; and family disruptions. Findings provided tentative evidence for eating disorder specific (i.e. parental demands and criticism) and non-specific (i.e. familial loss and family disruptions) non-abuse adversities, with findings also suggesting that those with bulimia nervosa and binge-eating disorder were more impacted by loss, family separations and negative parent-child interactions compared to those with anorexia nervosa. CONCLUSIONS: This review provides a clear synthesis of previous findings relating to family-related non-abuse adverse life experiences and eating disorders in adults. Implications for trauma-informed care in clinical practice were discussed (e.g. considering the impact of past life events, understanding the function of ED behaviours, reducing the risk of potential re-traumatisation).

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OBJECTIVE: Altered brain functional connectivity has been shown in youth with attention-deficit/hyperactivity disorder (ADHD). However, relatively little is known about functional connectivity in adult ADHD, and how it is linked with the heritability of ADHD. METHODS: We measured eyes-open and eyes-closed resting electroencephalography (EEG) from 38 adults with ADHD, 45 1st degree relatives of people with ADHD and 51 healthy controls. Functional connectivity among all scalp channels was calculated using a weighted phase lag index for delta, theta, alpha, beta and gamma frequency bands. A machine learning analysis using penalized linear regression was used to identify if connectivity features (10,080 connectivity pairs) could predict ADHD symptoms. Furthermore, we examined if EEG connectivity could accurately classify participants into ADHD, 1st degree relatives and/or control groups. RESULTS: Hyperactive symptoms were best predicted by eyes-open EEG connectivity in delta, beta and gamma bands. Inattentive symptoms were predicted by eyes-open EEG connectivity in delta, alpha and gamma bands, and eyes-closed EEG connectivity in delta and gamma bands. EEG connectivity features did not reliably classify participants into groups. CONCLUSIONS: EEG connectivity may represent a neuromarker for ADHD symptoms. SIGNIFICANCE: EEG connectivity may help elucidate the neural basis of adult ADHD symptoms.

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Adults with attention-deficit/hyperactivity disorder (ADHD) have been described as having altered resting-state electroencephalographic (EEG) spectral power and theta/beta ratio (TBR). However, a recent review (Pulini et al. 2018) identified methodological errors in neuroimaging, including EEG, ADHD classification studies. Therefore, the specific EEG neuromarkers of adult ADHD remain to be identified, as do the EEG characteristics that mediate between genes and behaviour (mediational endophenotypes). Resting-state eyes-open and eyes-closed EEG was measured from 38 adults with ADHD, 45 first-degree relatives of people with ADHD and 51 unrelated controls. A machine learning classification analysis using penalized logistic regression (Elastic Net) examined if EEG spectral power (1-45 Hz) and TBR could classify participants into ADHD, first-degree relatives and/or control groups. Random-label permutation was used to quantify any bias in the analysis. Eyes-open absolute and relative EEG power distinguished ADHD from control participants (area under receiver operating characteristic = 0.71-0.77). The best predictors of ADHD status were increased power in delta, theta and low-alpha over centro-parietal regions, and in frontal low-beta and parietal mid-beta. TBR did not successfully classify ADHD status. Elevated eyes-open power in delta, theta, low-alpha and low-beta distinguished first-degree relatives from controls (area under receiver operating characteristic = 0.68-0.72), suggesting that these features may be a mediational endophenotype for adult ADHD. Resting-state EEG spectral power may be a neuromarker and mediational endophenotype of adult ADHD. These results did not support TBR as a diagnostic neuromarker for ADHD. It is possible that TBR is a characteristic of childhood ADHD.

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On Tuesday evenings at New York University School of Medicine (NYUSoM), the anatomy lab is transformed into an art studio. Medical students gather with a spirit of creative enterprise and a unique goal: to turn anatomy into art. They are participants in Art & Anatomy, an innovative drawing course within the Master Scholars Program in Humanistic Medicine (MSPHM)-a component of NYUSoM, which offers elective courses across a range of interdisciplinary topics in medical humanities. Art & Anatomy has had approximately four hundred fifty participants since its inception in 2009. The educational intention of the course is to use drawing as an active mode of learning that enhances visual-perceptual ability and three-dimensional (3D) spatial understanding of the body's interior; however, the course also opens a creative space for participants to process the emotional complexities of cadaver dissection and the anatomy lab experience. The anatomy lab can be the training ground for clinical detachment, but many U.S. medical schools are beginning to attend more closely to the emotional aspects of dissection. The authors maintain that the inherently expressive nature of drawing makes the Art & Anatomy course a novel and effective approach to this endeavor. Select student artwork and a curriculum overview are provided.

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OBJECTIVES: The aim of this study was to examine symptom profiles of people diagnosed with attention-deficit/hyperactivity disorder (ADHD) and/or anxiety (ANX) in order to determine the validity of widely used ADHD and ANX rating scales for differential diagnostic use and to develop modified measures that take symptom overlap into account. DESIGN: A cross-sectional design was used to assess differences in rating scale scores between clinical (n = 52) and control (n = 74) samples as well as differences among subgroups of the clinical sample (22 ADHD; 16 ADHD + ANX; 14 ANX). METHOD: Participants completed an online questionnaire where they responded to the Conners Adult ADHD Rating Scale (CAARS; Conners, Erhardt, & Sparrow, ) and State Trait Anxiety Inventory scales (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, ). RESULTS: Results showed that the CAARS and STAI had limited sensitivity and specificity and may lack in ability to differentially diagnose ADHD and/or ANX. Cluster analysis was used to guide the proposal of modifications for the two scales, which were to use inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for use in differential diagnosis. Further parametric analysis supported these proposed modifications. CONCLUSIONS: Clinicians should be made aware of the limitations of the CAARS and STAI scales in terms of specificity, when used to inform differential diagnosis of ADHD and ANX. Further analysis on the psychometric properties of these modified scales is needed in order to confirm that they are valid and reliable scales. PRACTITIONER POINTS: Clinical implications It is possible that widely used self-report rating scales are not valid for use in the context of assessing adult ADHD when ANX is present. Clinicians should take alternative approaches to measuring ADHD symptoms in the context of ANX. Findings of the present study suggest the use of inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for differential diagnostic use. Limitations of the study The sample sizes of the clinical subgroups were relatively small. Diagnoses were not confirmed using a semi-structured clinical interview. Alternative cluster approaches (e.g., two-step clustering using larger samples) would provide further insight.

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Forensic patients with schizophrenia who had carried out a homicide scored higher on a measure of moral cognition (MFQ-30) than other violent patients. Neurocognitive impairment was associated with homicide by mediation via higher scores for in-group loyalty.

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The purpose of this research was to investigate potential demographic, developmental and psychosocial predictors of anxiety in the context of ADHD. Participants included 267 adults with a diagnosis of ADHD (168 males:99 females) and an age range of 18-70 years (M = 31 years; SD = 10.03 years). A background interview, parent questionnaire and rating scales were used to gather participant information. Correlations, independent t tests and one-way analysis of variances were used to identify variables associated with anxiety, and a stepwise multiple regression was used to identify potential predictors of anxiety. Variables associated with anxiety included childhood aggression, employment status, difficulties making friends, number of children and caffeine intake. Childhood aggression and caffeine intake were the potential predictors. Clinicians should be aware of these potential predictors of anxiety in the context of ADHD in order to minimise the likelihood of the development or maintenance of comorbid anxiety. Future research is needed in order to draw any conclusions on cause and effect.

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OBJECTIVE: Given that the diagnosis of adulthood ADHD depends on the retrospective self-report of childhood ADHD symptoms, this study aimed to establish whether current mood affects the accuracy of retrospective self-ratings of childhood ADHD. METHOD: Barkley's Adult ADHD Rating Scale (BAARS) was used to assess the retrospective self- and parent-reports of childhood ADHD symptoms of 160 adults with ADHD and 92 adults without ADHD. Self-rated current mood was also measured using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Higher BAARS self-ratings correlated with higher HADS self-ratings. Strongest correlations were evident between hyperactive/impulsive symptoms and anxiety symptoms. There was no relationship between current mood and accuracy of self-report. CONCLUSION: Current mood does not affect the accuracy of retrospective self-ratings of ADHD. Future research should aim to provide new measures of anxiety in ADHD to avoid the double counting of hyperactive/impulsive and anxiety symptoms.

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BACKGROUND: Night-to-night variability in sleep of children with attention deficit hyperactivity disorder (ADHD) may be a mediator of behavioral phenotype. We examined the potential association between alertness, sleep, and eating behaviors in children with ADHD and comorbid problems. METHODS: Sleep was monitored by actigraphy for 7 days. Questionnaires were used to assess sleep complaints, habits and food patterns by parental report, and sleep complaints and sleepiness by child report. RESULTS: The group comprised 18 children, including 15 boys, aged 9.4 ± 1.7 years, 88.9% Caucasian, who took one or multiple medications. Children slept on average for 6 hours and 58 minutes with a variability of 1 hour 3 minutes relative to the mean, and their sleepiness scores were highly variable from day to day. Most children had a normal body mass index (BMI). Sleepiness and BMI were associated with sleep schedules and food patterns, such that they accounted for 76% of variance, predominantly by the association of BMI with mean wake after sleep onset and by bedtime sleepiness, with wake after sleep onset variability. Similarly, 97% of variance was shared with eating behaviors, such as desserts and snacks, and fast food meals were associated with morning sleepiness. CONCLUSION: Disrupted sleep and sleepiness appears to favor unhealthy food patterns and may place children with ADHD at increased risk for obesity.