Ethical and Clinical Considerations During the Coronavirus Era.

The practice of child and adolescent psychiatry is evolving during an unprecedented global health catastrophe, the coronavirus disease 2019 (COVID-19) pandemic. As child and adolescent psychiatrists grapple with COVID-19's enormous medical, educational, social, and economic toll, a mental health crisis is co-occurring. Pre-existing disparities are recognized as contributors to the disproportionate impact of the COVID-19 pandemic on racial and ethnic minorities.1 The magnitude of COVID-19's effects on child and family mental health has yet to be fully revealed. child and adolescent psychiatrists are in a unique position to address this mental health crisis. Child and adolescent psychiatrists must stay up-to-date regarding federal, state, local, and institutional mandates, regulations, and policies informed by the Centers for Disease Control and Prevention2 and other public health institutions, while also navigating the ethical dilemmas unique to child and adolescent psychiatry during the coronavirus era.

Amygdala and whole-brain activity to emotional faces distinguishes major depressive disorder and bipolar disorder.

OBJECTIVES: It can be clinically difficult to distinguish depressed individuals with bipolar disorder (BD) and major depressive disorder (MDD). To examine potential biomarkers of difference between the two disorders, the current study examined differences in the functioning of emotion-processing neural regions during a dynamic emotional faces task. METHODS: During functional magnetic resonance imaging, healthy control adults (HC) (n = 29) and depressed adults with MDD (n = 30) and BD (n = 22) performed an implicit emotional-faces task in which they identified a color label superimposed on neutral faces that dynamically morphed into one of four emotional faces (angry, fearful, sad, happy). We compared neural activation between the groups in an amygdala region-of-interest and at the whole-brain level. RESULTS: Adults with MDD showed significantly greater activity than adults with BD in the left amygdala to the anger condition (p = 0.01). Results of whole-brain analyses (at p < 0.005, k ≥ 20) revealed that adults with BD showed greater activity to sad faces in temporoparietal regions, primarily in the left hemisphere, whereas individuals with MDD demonstrated greater activity than those with BD to displays of anger, fear, and happiness. Many of the observed BD-MDD differences represented abnormalities in functioning compared to HC. CONCLUSIONS: We observed a dissociation between depressed adults with BD and MDD in the processing of emerging emotional faces. Those with BD showed greater activity during mood-congruent (i.e., sad) faces, whereas those with MDD showed greater activity for mood-incongruent (i.e., fear, anger, and happy) faces. Such findings may reflect markers of differences between BD and MDD depression in underlying pathophysiological processes.

Functional neuroimaging studies of bipolar disorder: examining the wide clinical spectrum in the search for disease endophenotypes.

Bipolar disorder (BP) is among the top ten most disabling illnesses worldwide. This review includes findings from recent studies employing functional neuroimaging to examine functional abnormalities in neural systems underlying core domains of the psychopathology in BP: emotion processing, emotion regulation and executive control, and common comorbid features of BP, that are relevant to the wide spectrum of BP rather than focused on the more traditional BPI subtype, and that may facilitate future identification of diagnostically-relevant biomarkers of the disorder. In addition, an emerging number of studies are reviewed that demonstrate the use of neuroimaging to elucidate biomarkers whose identification may help to (1) identify at-risk individuals who will subsequently develop the illness to facilitate early intervention, (2) identify targets for treatment and markers of treatment response. The use of newer neuroimaging techniques and potential confounds of psychotropic medication upon neuroimaging findings in BP are also examined. These approaches will help to improve diagnosis and the mental well-being of all individuals with BP.

Integrative medicine research at an academic medical center: patient characteristics and health-related quality-of-life outcomes.

OBJECTIVE: To characterize patients seeking care at a university-based integrative medicine practice, and to assess short-term changes in health-related quality of life (HRQoL) associated with integrative medical treatment. DESIGN: Prospective, observational study. SETTING: This study was conducted at a large U.S. academic medical center affiliated with the Consortium of Academic Health Centers for Integrative Medicine. PARTICIPANTS: Seven hundred and sixty-three (763) new patients with diverse medical conditions participated in the study. Mean age was 49 years (standard deviation = 16, range = 14-93). Two thirds of patients were women and three quarters were white. The most common International Classification of Diseases 9th Revision medical diagnoses were malaise and fatigue, myalgia and myositis, allergy, anxiety or depression, hypertension, malignant neoplasm of the breast, lumbago, and irritable bowel disease. Over half the sample had two or more comorbid medical conditions. OUTCOME MEASURE: The Medical Outcomes Study 36-item Short-Form (SF-36) health survey was used to measure HRQoL at initial assessment and 3-months following integrative medicine consultation. RESULTS: Baseline SF-36 scores fell below the 25th percentile, indicating substantially compromised HRQoL. Physician-prescribed treatment modalities included anthroposophical medicine, nutritional medicine, Western herbs, homeopathy, nutritional counseling, and acupuncture. Three (3) month follow-up assessment revealed statistically significant improvements on all eight SF-36 subscales among survey respondents. HRQoL effect sizes ranged from 0.17 (Physical Functioning) to 0.41 (Social Functioning), with a mean of 0.30. HRQoL effects were consistent among demographic subgroups. CONCLUSIONS: Integrative medical treatment at a university-based center is associated with significant increases in HRQoL for a medically diverse population with substantial comorbidity and functional limitations. Controlled studies that measure HRQoL and additional outcomes related to whole person health--physical, mental, social, and spiritual--are needed to determine the full therapeutic potential of integrative medicine, and to determine efficacy and cost-effectiveness relative to conventional medical care.

Engineering functional protein interfaces for immunologically modified field effect transistor (ImmunoFET) by molecular genetic means.

The attachment and interactions of analyte receptor biomolecules at solid-liquid interfaces are critical to development of hybrid biological-synthetic sensor devices across all size regimes. We use protein engineering approaches to engineer the sensing interface of biochemically modified field effect transistor sensors (BioFET). To date, we have deposited analyte receptor proteins on FET sensing channels by direct adsorption, used self-assembled monolayers to tether receptor proteins to planar FET SiO2 sensing gates and demonstrated interface biochemical function and electrical function of the corresponding sensors. We have also used phage display to identify short peptides that recognize thermally grown SiO2. Our interest in these peptides is as affinity domains that can be inserted as translational fusions into receptor proteins (antibody fragments or other molecules) to drive oriented interaction with FET sensing surfaces. We have also identified single-chain fragment variables (scFvs, antibody fragments) that recognize an analyte of interest as potential sensor receptors. In addition, we have developed a protein engineering technology (scanning circular permutagenesis) that allows us to alter protein topography to manipulate the position of functional domains of the protein relative to the BioFET sensing surface.

Neuroimaging in bipolar disorder: a critical review of current findings.

Bipolar I disorder (BPI) is among the top 10 most debilitating illnesses globally. In this critical review, we first review recent functional neuroimaging findings in two core domains of pathology in BPI: emotion processing and executive control. These abnormalities in core domains represent potential endophenotypes of the illness. We then show that an emerging number of studies have demonstrated that neuroimaging can help to identify endophenotypic markers whose identification would help to clarify diagnosis and discriminate the depression in BPI from that of unipolar depression and identify at-risk individuals who will subsequently develop the illness (to facilitate early intervention). We end by reviewing the new directions in neuroimaging in BPI, including studies of children with bipolar disorder, potential medication effects, and the use of newer neuroimaging techniques to help us achieve the previously mentioned goals of improving BPI patients' mental well-being.

Nanoscale adhesion, friction and wear studies of biomolecules on silicon based surfaces.

Protein layers are deployed over the surfaces of microdevices such as biological microelectromechanical systems (bioMEMS) and bioimplants as functional layers that confer specific molecular recognition or binding properties or to facilitate biocompatibility with biological tissue. When a microdevice comes in contact with any exterior environment, like tissues and/or fluids with a variable pH, the biomolecules on its surface may get abraded. Silicon based bioMEMS are an important class of devices. Adhesion, friction and wear properties of biomolecules (e.g., proteins) on silicon based surfaces are therefore important. Adhesion was studied between streptavidin and a thermally grown silica substrate in a phosphate buffered saline (PBS) solution with various pH values as a function of the concentration of biomolecules in the solution. Friction and wear properties of streptavidin (protein) biomolecules coated on silica by direct physical adsorption and a chemical linker method were studied in PBS using the tapping mode atomic force microscopy at a range of free amplitude voltages. Fluorescence microscopy was used to study the detailed wear mechanism of the biomolecules. Based on this study, adhesion, friction and wear mechanisms of biomolecules on silicon based surfaces are discussed.

Morphology and adhesion of biomolecules on silicon based surfaces.

Biomolecules such as proteins, on silicon based surfaces are of extreme importance in various applications including microfabricated silicon implants, in the fabrication of microdevices with protein compounds (e.g., biosensors), and therapeutics. Morphology of silicon based surfaces with and without biomolecules and their adhesion with the substrate govern performance and reliability of the biological application. In this research, step by step morphological changes of silicon as well as adhesion during its surface modification have been studied using atomic force microscopy. To improve adhesion between biomolecules and the silicon based surfaces, chemical conjugation as well as surface patterning have been used. Changes in adhesion as a result of surface modification have been analyzed with the help of contact angle measurements. Phase imaging technique was used to confirm the presence of biomolecules on the surface. To understand the relationship between morphology and local values of adhesion, adhesion mapping and local stiffness mapping were carried out.

Differences in word associations to pictures and words.

Normal subjects were asked to produce the "first word that comes to mind" in response to pictures or words that differed with respect to manipulability and animacy. In separate analyses across subjects and items, normal subjects produced a significantly higher proportion of action words (that is, verbs) to pictures as compared to words, to manipulable as compared to non-manipulable stimuli and to inanimate as compared to animate stimuli. The largest proportion of action words was elicited by pictures of non-living, manipulable objects. Furthermore, associates to words matched standard word associates significantly more often than those elicited by pictures. These data suggest that pictures and words initially contact different forms of conceptual information and are consistent with an account of semantic organization that assumes that information is distributed across different domains reflecting the mode of acquisition of that knowledge.