Background Despite interest in transdiagnostic dimensional approaches to psychopathology, little is known about the dynamic interplay of affecting and internalizing symptoms that cut across diverse mental health disorders. We examined within‐person reciprocal effects of negative and positive affect (NA, PA) and symptoms (depression and anxiety), and their between‐person associations with affective dynamics (i.e., affect inertia). Methods Individuals currently receiving treatment for psychological disorders (N = 776) completed daily assessments of affect and symptoms across 14 treatment days (average). We used dynamic structural equation modeling to examine daily affect–symptom dynamics. Results Within‐person results indicated NA–symptom reciprocal effects; PA only predicted subsequent depression symptoms. After accounting for changes in mean symptoms and affect over time, NA‐anxiety and PA‐depression relations remained particularly robust. Between‐person correlations indicated NA inertia was positively associated with NA–symptom effects; PA inertia was negatively associated with PA–symptoms effects. Conclusions Results suggest that transdiagnostic affective treatment approaches may be more useful for reducing internalizing symptoms by decreasing NA compared to increasing PA. Individual differences in resistance to shifting out of affective states (i.e., high NA vs. PA inertia) may be a useful marker for developing tailored interventions.

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MIdazolam has been shown to interact synergistically with propofol during "co.induction" of anaesthesia. I However, it is uncertain whether mldazolam affects propofol requirements during, and recovery times following, total Intravenous anaesthesia (TIVA) In Day Care patients. A double-blind study was therefore designed to determine these effects. Here, we deacdbe unexpected cases of awareness with recall In our study population. METHODS: Ninety unpremedlcated ASA Class I and II adult Day Care patients, 'scheduled to undergo either knee erthreacepy or laparoscoplc procedures, gave written consent to the protocol approved by the hospital REB. Patients received, in a random fashion, either placebo (Group PLAC) or midazolam at a dose of 0.015 ms-ks "~ (Group MID-15), 0.030 mg.kg "~ (Group MID.30) or 0.045 rag.ks "~ (Group MID-45) prior to Induction of anaesthesia. Anaesthesia was then Induced with propofol 0.8-1.5 rag.ks "1 an.d alfantanil 20 Fg.kg "l, and alracurlum 0.5 mg.kg "1 to facilitate tracheal Intubatlon. Anaesthesia was malntalnad with a continuous Infusion of propofol beginning at 100 p.g.kg't.min "t, titrated as required to maintain HR and SBP within =2.0% of the patient's normal values, or in response to patient movement, while atfentanll was Infused st 0.5 Fg.kg'l.mln "~ (constant). Times to awakening ware compared postoperatively. In addition, a follow-up questionnaire, designed to evaluate the overall quality of the anaesthetic experience, was completed for each patient on the first post-operative day. Data were analyzed using the Chlsquare statistic and Flscher's Exact test where appropriate, with significance assumed when P<0.05 RESULTS: Propofol Infusion requirements varied significantly from one patient to another (range 80-280 ug.kg't.min'l), but cumulative requirements were not different between groups~ Rapid awakening was observed in all four groups (5=3, 4=2, 6==3 and 6• rain for groups PLAC, M-15, M-30 andM-45, respaotively). Unexpectedly, however, six patients experienced awareness with recall using this technique (4 of 23 patients in the PLAC group compared with 2 of 67 patients in the mldezolam treatment groups, P<0.02, Table). Five of the 6 patients experienced mild or moderate pain with their re(all, but no patient described any psychologlcat distress or anxiety, In fact, despite their ~perlence of awareness, 3 of the 6 patients related the quality of this anaesthetic to heve been superior to their last anasst hotic, For ethical reasons, the study was stopped. DISCUSSION: Despite the high quality of recovery, TIVA was associated with an unacceptably high incidence of awareness with recall In this study. This may have been due, In part, to the relatively low initial infusion rate of propofoL We unexpectedly found that low dose mldazolam (0.015-0,045 rag.ks "t) reduces the likelihood of intraoperative awareness, without prolonging recovery times REFERENCE:

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