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BackgroundLack of awareness of involuntary movements is a curious phenomenon in patients with certain movement disorders. An interesting anecdotal observation is that patients with essential tremor (ET) often seem unaware of their own head tremor. In the current study, we asked ET patients whether they were aware of head tremor while it was occurring on examination, thereby allowing us to gauge real-time awareness of their involuntary movement.MethodsET cases enrolled in an ongoing clinical research study at the Columbia University Medical Center (2009–2014). During a videotaped tremor examination, they were questioned about the presence of head tremor. True positives were cases who exhibited head tremor on examination and were aware of it; false negatives were cases who exhibited head tremor but were unaware of it.ResultsThe 126 ET cases had a mean age of 72.6 ± 12.4 years. Nineteen (48.7 %) of 39 cases with head tremor on examination did not report having head tremor at that moment. Even among cases with moderate or severe head tremor on examination, unawareness of head tremor was 45.5 %. We assessed the clinical correlates of unawareness of head tremor, comparing true positives to false negatives, and unawareness was correlated with older age, lower mental status test scores and several other clinical variables.ConclusionsNearly one-half of ET cases with head tremor on examination were acutely unaware of their tremor. Whether such agnosia for tremor may be leveraged as a diagnostic feature of ET is a question for future clinical studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s40734-016-0032-0) contains supplementary material, which is available to authorized users.

Visual stimuli are often used for obsessive-compulsive (OC) symptom provocation in research studies. We tested the induction of anxiety and OC checking symptoms across different types of checking provocation stimuli in three populations: individuals with obsessive compulsive disorder (OCD), individuals with checking symptoms but without a diagnosis of OCD, and control individuals with neither checking symptoms nor a clinical diagnosis. One set of provocative images depicted objects that are commonly associated with checking anxiety. Another set ('enhanced provocative images') depicted similar objects but also included contextual cues suggesting a specific harmful scenario that could occur. As expected, the enhanced provocative images were more effective at inducing anxiety and OC symptoms than the standard provocative images. Future studies requiring checking symptom provocation should therefore consider incorporating similarly suggestive images. Individuals with clinical OCD reported the greatest provocation in response to these images, followed by those with nonclinical checking, followed by control individuals. Thus, these stimuli are able to provoke OC checking symptoms and anxiety differentially across groups, with the intensity of provocation reflecting diagnostic status. All groups demonstrated a similar qualitative pattern of provocation across images. Finally, in all groups, reported anxiety closely tracked intrusive thoughts and checking urges.

IMPORTANCEThere are limited data regarding sex-based differences in physical and mental health domains and health care access in adults with premature atherosclerotic cardiovascular disease (ASCVD).OBJECTIVE To study the association of sex with physical and mental health domains as well as health care access-related factors among adults with self-reported premature ASCVD.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort analysis of 748 090 adults aged 18 to 55 years in the Behavioral Risk Factor Surveillance System 2016 to 2019 in the US. Data were analyzed from June to July 2021.EXPOSURES Self-reported ASCVD, defined as having a history of coronary artery disease, myocardial infarction, or stroke.MAIN OUTCOMES AND MEASURES Self-reported physical and mental health and measures of health care access, including self-reported cost-related medication nonadherence and inability to see a physician due to cost.RESULTS Between 2016 and 2019, 748 090 adults aged 18-55 years were identified, of whom 28 522 (3.3%) had self-reported premature ASCVD. Of these, 14 358 (47.0%) were women. Compared with men, women with premature ASCVD were more likely to report being clinically depressed (odds ratio [OR], 1.73; 95% CI, 1.41-2.14; P < .001), have cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11-1.82; P = .005), have not seen a physician due to cost-related issues (OR, 4.52; 95% CI, 2.24-9.13; P < .001), and were more likely to report overall poor physical health (OR, 1.39; 95% CI, 1.09-1.78; P = .008) despite being more likely to have health care coverage (85.3% vs 80.8%; P = .04) and a primary care physician (84.2% vs 75.7%; P < .001). CONCLUSIONS AND RELEVANCEResults from this study indicate that women with premature ASCVD were more likely to report worse overall physical and mental health, inability to see a physician due to cost, and cost-related medical nonadherence. Interventions addressing mental health and out-of-pocket costs are needed in adults with premature ASCVD.