Feasibility of Exenatide, a GLP-1R Agonist, for Treating Cocaine Use Disorder: A Case Series Study.

Cocaine use remains a serious public health problem associated with a marked increase in overdose deaths in the past decade. No medications have yet been proven to be effective for the treatment of cocaine use disorder (CUD). Among the highly promising medications have been glucagon-like peptide 1 receptor agonists (GLP-1RA) that are currently used for the treatment of type 2 diabetes mellitus and weight management. Preclinically, GLP-1RAs have been shown to attenuate cocaine self-administration, however, this has not yet been demonstrated in a human laboratory study. The GLP-1RA extended-release exenatide is given as a once-weekly injection, which may be clinically advantageous for addressing medication nonadherence among individuals with CUD. Here, we assess feasibility and safety by reporting on 3 cases of patients with CUD who received 6 weeks of exenatide 2 mg subcutaneously once-weekly in an open-label fashion, along with standard individual drug counseling. We observed excellent attendance and compliance, along with positive end-of-study satisfaction ratings. The medication was well tolerated and without unexpected or severe adverse events. Results for cocaine use and related clinical effects were more mixed, yet encouraging. Future empirical testing of exenatide for treating CUD should utilize a randomized controlled trial design and longer treatment duration.

Brief Online Intervention Model Promotes Sustained Helping Behavior Across 6 Months Following a Population-Wide Traumatic Event.

BACKGROUND: Following natural disasters, early helping behavior often dissipates despite remaining disaster-related suffering and affective vulnerability in the community. Interventions that have successfully increased helping behaviors have included components of motivational interviewing (MI) and mindful compassion; however, this research is limited by laboratory-based settings and lengthy training sessions. Brief, portable, and efficient intervention is needed to increase accessibility to large groups simultaneously. METHOD: The current study piloted a brief, online, self-administered MI and mindful compassion intervention administered 4-10 weeks post-Hurricane Harvey examining if it would sustain helping behaviors over the ensuing year. The study also examined potential moderators of the relationship between compassion for others and internalizing symptoms, and whether helping behaviors predicted post-traumatic stress symptoms. RESULTS: The intervention group sustained the use of helping behaviors more than an active control group after 9-12 months. Also, compassion satisfaction and burnout moderated the relationship between compassion for others and post-traumatic stress and depressive symptoms at follow-up. CONCLUSIONS: Results suggest a potentially useful model of how an efficiently distributed intervention might sustain helping behaviors after a natural disaster and provide insight into possible longitudinal risk and protective factors for post-traumatic stress and depressive symptoms among helping volunteers.

Examining the Factor Structure of the Posttraumatic Checklist for Civilians.

The Posttraumatic Checklist for Civilians (PCL-C) is one of the most common tools used to assess PTSD among civilian populations. However, the underlying factor structure of the PCL-C remains under examined, with the most recent research relying on small samples with limited generalizability. Thus, the present study used exploratory and confirmatory techniques in a large North American college student sample to investigate the factor structure of the PCL-C. Results supported a 3-factor model for the PCL-C accounting for 59% of the total variance and represented by Suppression (M = 11.2, SD = 5.0); Hyperarousal (M = 6.5, SD = 3.2); and Diminished Reward Processing (M = 5.9, SD = 2.9). Regarding gender differences, females tended to score higher on suppression and avoidance related symptoms, while males scored higher on symptoms related to Diminished Reward Processing. Results also showed that embedded within college campuses are trauma exposed students experiencing distressingly high levels of posttrauma symptoms. In sum, the results revealed three factors in the PCL-C, that could be used to offer insight into assessing and treating posttrauma symptoms on a college campus.

Hippocampal volume as treatment predictor in antidepressant naïve patients with major depressive disorder.

Major depression disorder (MDD) limits psychosocial functioning and quality of life. One of the biological alterations is a hippocampal volume (HV) reduction. Previous prospective neuroimaging studies present inconsistencies regarding HV reductions and clinical features and response of antidepressant treatment of the participants. To clarify the relationship between antidepressant response and the HV reported, we prospectively evaluated antidepressant-naïve subjects diagnosed with MDD for the first time. We recruited twenty-one subjects and applied the Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), and the Clinical Global Impression (CGI) scale. The participants underwent brain Magnetic Resonance Imaging (MRI) scanning to measure the HV, and subsequently were treated naturalistically with first-line antidepressant medication for eight weeks. Thirteen subjects met the criteria for remission at eight weeks of treatment. The baseline right and left hippocampal volumes were larger in subjects who achieved remission (p = 0.012) and (p = 0.001), respectively. The main finding of this study is that the antidepressant naïve subjects who met the criteria for clinical remission according to the HAM-D, MADRS, and the CGI scale scores, had larger pretreatment hippocampal volumes. Our results assess the HV as a treatment outcome predictor.

Attentional Avoidance of Historically Relevant, Task-Irrelevant Facial Affect: Past Depression, Interpersonal Characteristics, and Ethnicity.

Experiential background can influence how individuals respond to affective interpersonal information. For formerly depressed individuals, sad facial expressions are presumably salient. If so, when performing affectively neutral daily tasks, these individuals would find peripheral sad faces particularly distracting, and thus, they might shift their attention from them. The present study examined this hypothesis by comparing how euthymic formerly depressed and never depressed adults attended to sad and happy task-irrelevant emotional facial expression stimuli. The study also measured constructs linked to interpersonal functioning and depression and conducted exploratory analyses to examine whether Hispanic ethnicity status would moderate effects of study outcomes. Results of analyses indicated that formerly depressed individuals directed more attention away from sad faces than never depressed individuals. There were no significant between-group effects for happy faces and no moderation by ethnicity on attention to affective faces. However, irrespective of depression history, Hispanic individuals reported lower fear of negative evaluation compared to non-Hispanic Caucasian individuals. Findings are in line with hypothesized attentional avoidance among formerly depressed individuals and consistent with prior research suggesting that some Hispanic individuals experience protective mental health benefits through engagement with aspects of their culture. Directions for future research are discussed.

Avoiding iatrogenic injuries to the vertebral artery: A morphometric study of the vertebral artery-free dissection area.

OBJECTIVE: To determine the area of a safety window that excludes the vertebral artery for the safe access of the occipital condyle screws during occipitocervical fixation. METHODS: This study included 138 cervical computed tomography angiograms. Six measurements per side were made in each imaging study. These measurements are from the vertebral artery to (A) the mastoid process, (B) the mastoid incisura, (C) the posterior condylar fossa, (D) the occipital condyle in its midline, and (E) the medial border of the condyle. We also measured from the tip of the mastoid process to the lower border of the occipital condyle on its lateral side (F). RESULTS: A total of 276 areas from 138 individuals were included, of which 51.4 % were men. The mean age was 54.2 ±â€¯18.63 years. The mean variable measurements (mm) for all the population were 21 ±â€¯4, 16 ±â€¯3, 6 ±â€¯2, 3 ±â€¯2, 2 ±â€¯1 and 35 ±â€¯4 for variables A-F, respectively. We found significant differences between sex when we compared measurements A (p = 0.003), C (p = 0.001), D (p = 0.000) and F (p = 0.000). The incidence rate of dominance for the vertebral artery was 18.8 % and 30.4 % for right and left respectively. CONCLUSION: Women had significantly smaller measures than men. This could indicate a higher risk of iatrogenic injury secondary to a smaller vertebral artery-free area. Results may guide surgeons in the pre-surgical planning aiming to reduce the risk of iatrogenic injuries to the vertebral artery.

The impact of military deployment on children: Placing developmental risk in context.

During recent conflicts in the Middle East, U.S. military families have endured multiple separations, relocations, and alterations in family structure/routines, combined with other significant stressors. This review examines what is known about children's mental health and functioning in relation to parental military deployment during conflicts spanning the last 14years. Findings are organized and considered by age group (i.e., toddlers and preschoolers, school age children, and adolescents) in an effort to highlight unique challenges and strengths present at different stages of development. Across all age groups, numerous studies document an increase in the number of military-connected children receiving mental health services in relation to parental deployment, though specific types of problems and long-term outcomes are not well understood. Evidence for a concerning increase in rates of child maltreatment related to parental deployment has also emerged. However, findings are largely based on aggregate data and the specific perpetrator is often unclear. Overall, we emphasize several critical next steps for research in this area including investigations characterized by greater methodological rigor, consideration of broader parental and contextual influences on child mental health, objective indicators of stress and coping, and longitudinal designs to examine persistence of child emotional/behavioral problems. A focus on adaptive/resilient outcomes is equally essential for understanding long-term outcomes and developing effective intervention programs.

Psychiatric comorbidity in hospitalized adolescents with borderline personality disorder.

OBJECTIVE: The goal of this study was to carry out the first comprehensive assessment of psychiatric comorbidity in adolescents (aged 12-17 years) with DSM-IV criteria for borderline personality disorder (BPD) compared to a psychiatric comparison group without BPD. Complex comorbidity (a hallmark feature of adult BPD and defined as having any mood or anxiety disorder plus a disorder of impulsivity) was also examined as a distinguishing feature of adolescent BPD. METHOD: Consecutively admitted patients (October 2008 to October 2012) to an inpatient psychiatric hospital received parental consent and gave assent for participation in the study (N = 418), with the final sample after exclusions consisting of 335 adolescent inpatients. A comprehensive, multimethod approach to determining psychiatric comorbidity was used, including both an interview-based (categorical) and a questionnaire-based (dimensional) assessment as well as both parent and adolescent self-report. Measures included the Diagnostic Interview Schedule for Children (NIMH-DISC-IV), Child Behavior Checklist (CBCL), Youth Self-Report (YSR), Car, Relax Alone, Forget, Friends, Trouble (CRAFFT), and the Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD). RESULTS: Thirty-three percent of the final sample met criteria for BPD. Adolescent inpatients with BPD showed significantly higher rates of psychiatric comorbidity compared to non-BPD psychiatric subjects for both internalizing (χ²1 = 27.40, P < .001) and externalizing (χ²1 = 19.02, P < .001) diagnosis. Similarly, using dimensional scores for self-reported symptoms, adolescent inpatients with BPD had significantly higher rates of psychiatric comorbidity compared to non-BPD subjects for internalizing (t329 = -6.63, P < .001) and externalizing (t329 = -7.14, P < .001) problems. Parent-reported symptoms were significantly higher in the BPD group only when using a dimensional approach (internalizing: t321 = -3.42, P < .001; externalizing: t321 = -3.32, P < .001). Furthermore, significantly higher rates of complex comorbidity were found for adolescents with BPD (χ²1 = 26.60, P < .001). Moreover, externalizing and internalizing problems interacted in association with borderline traits (B = .25; P < .001). CONCLUSIONS: Similar to findings in adult studies of BPD, adolescents with BPD demonstrate significantly more complex comorbidity compared to psychiatric subjects without BPD.