Neuroanatomical Correlates of Impulsive Action in Excoriation (Skin-Picking) Disorder.

Excoriation (skin-picking) disorder (SPD) has similarities to obsessive-compulsive disorder (OCD) and is included within the obsessive-compulsive and related disorders (OCRD) diagnostic class in DSM-5. Separate neuroimaging and neurocognitive studies suggest that people affected by SPD find it difficult to inhibit dominant motor responses due to a failure of "top-down" control mechanisms. No study has examined the neural correlates of SPD in participants with varying degrees of impulsive motor behavior. This study correlated cortical thickness and volumes of selected subcortical structures with stop-signal task performance in participants with SPD (N=15) and in healthy control subjects (N=8). All participants were free from current psychiatric comorbidity, including OCD. In volunteers with SPD, longer stop-signal reaction times were correlated with cortical thinning in the right insula and right-inferior parietal lobe and with increased cortical thickness in the left-lateral occipital lobe, though these findings did not withstand correction for multiple comparisons. There were no significant correlations between cortical thickness in these three structures and stop-signal reaction times in the control group. This study suggests that structural abnormalities in the insular cortex and parietal and occipital regions may play a role in the pathophysiology of SPD. Further neuroimaging research is needed to understand the neurobiology of SPD and its relationship with other putative OCRDs.

Age at first sexual activity: Clinical and cognitive associations.

BACKGROUND: Engagement in sexual activity is common among adolescents and can be considered part of adolescent development, but it carries potential life-changing consequences. METHODS: This study examined if clinical and cognitive differences existed between adolescents who engaged in voluntary sexual behavior before age 15, between ages 15 to 18, and after age 18. All participants were part of a larger study examining impulsive behavior in young adults. Participants were assessed on measures including demographics, comorbid psychiatric disorders, and clinical scales and cognitive tasks assessing impulsivity, obsessive-compulsive traits, emotion regulation, depression, anxiety, and quality of life. RESULTS: Those who engaged in voluntary sexual activity before age 15 were more likely to have increased depression and anxiety symptoms, to score higher on the Yale Brown Obsessive-Compulsive Scale for Pathologic Gambling, and to make poorer decisions on the Cambridge Gambling Task. CONCLUSIONS: The results of this study suggest that the decision to engage in sexual activity at a young age is not an act of thinking before acting or impatience, but rather a decision to engage in sensation-seeking behavior. This finding carries implications for interventions targeting healthy sexual activity in adolescents.

Prescription opioid medication misuse among university students.

BACKGROUND AND OBJECTIVES: Prescription opioid misuse is an established problem in the United States. Less information is known regarding the clinical and cognitive characteristics of prescription opioid misusers, specifically in a college age population. This study sought to characterize individuals who misuse prescription opioids and the differences between current, past and non-misusers. METHODS: A 156-item survey was administered to over 9,449 university students at a large, public Midwestern university. Survey questions obtained demographic information, self-reported grade point average, sexual behavior, mental health characteristics, and substance use. Participants also completed assessments that asked questions regarding impulsivity, mental health, substance use, and other impulsive behaviors including gambling and sexual activity. 3,522 students completed the survey and were included in the analysis. RESULTS: Of this group, 2.2% reported misusing prescription opioids in the last 12 months and another 5.3% reported misusing prescription opioids previously but not in the past year. This study found prescription opioid misusers to be more likely to live off campus, have a lower GPA, and exhibit increased impulsivity. Prescription opioid misusers were also more likely to report earlier age of sexual activity and were less likely to use barrier protection during sexual activity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This study identifies a number of risk factors for those misusing prescription opioids that can be used to develop and refine prescription opioid misuse screening tools for university health centers. It also identifies a number of concurring behaviors that can simultaneously be addressed when prescription opioid misusers are identified. (Am J Addict 2018;XX:1-7).

An Analysis of Treatment-Seeking Behavior in Individuals with Gambling Disorder.

Gambling disorder affects approximately 1.1-3.5% of the population, with the rates being higher in young adults. Despite this high prevalence, little is known regarding which pathological gamblers decide to seek treatment. This study sought to examine the differences in three groups of pathological gamblers: those who did not seek treatment (n = 94), those who sought therapy (n = 106) and those who sought medication therapy (n = 680). All subjects were assessed on a variety of measures including demographics, family history, gambling history, comorbid psychiatric disorders and an assortment of clinical variables such as the Quality of Life Inventory, Hamilton Depression and Anxiety Rating Scales, Yale Brown Obsessive Compulsive Scale for Pathologic Gambling (PG-YBOCS), Barratt Impulsiveness Scale, Eysenck Impulsiveness Questionnaire and select cognitive tasks. Those seeking treatment were more likely to be Caucasian, have lost more money in the past year due to gambling, and were more likely to have legal and social problems as a result of their gambling. Those seeking therapy or medical treatment also scored significantly higher on the PG-YBOCS. This study suggests that pathologic gamblers seeking treatment were more likely to exhibit obsessive-compulsive tendencies likely leading to the increased legal and social problems that exist in this group.

Sub-clinical Alcohol Consumption and Gambling Disorder.

While it is well established that gambling disorder is associated with alcohol use disorder, less is known regarding whether sub-clinical alcohol consumption increases gambling behavior. This study examined the effects of varying levels of alcohol consumption on clinical and cognitive measures. The sample consisted of 572 non-treatment seeking gamblers age 18-29 who were divided into three groups: non-current drinkers, current drinkers who did not qualify for an alcohol use disorder, and those with an alcohol use disorder (AUD). All subjects were assessed on gambling pathology, severity and impulsivity using the Structured Clinical Interview for Gambling Disorder, Yale Brown Obsessive Compulsive Scale for Pathologic Gambling and the Barratt Impulsive Scale-11 and select cognitive tests. In all of the clinical measures, controlling for age, gender and education, the AUD group was significantly more likely than the non-current and current drinkers to be a pathologic gambler and to be impulsive, compulsive and depressed. On cognitive tasks, controlling for age, gender and education, the AUD group had significantly worse strategy use on a spatial working memory task than both other groups. This study suggests that the relationship between alcohol and gambling may only exist when pathology in both alcohol consumption and gambling behavior is present. Examining this relationship with alcohol consumption as a continuous variable would provide additional insight into the potential effects alcohol consumption has on gambling behavior.

A Comparative Study of Obsessionality in Medical Students, Law Students, and Controls.

Understanding obsessive-compulsive behavior in medical students and law students is necessary for administrators and educators to properly work with students struggling with obsessionality. We aim to compare the differences in obsessive symptoms between medical students, law students and a control population. A total of 100 third-year medical students, 102 third-year law students and 103 control subjects drawn from the general population completed the Leyton Obsessional Inventory (LOI). Subjects were examined on all three sections (symptoms/traits, resistance and interference) of the LOI. Obsessional symptom scores for medical students (14.29 ± 7.33) and law students (13.65 ± 6.61) were significantly greater than for the control group (11.58 ± 7.45). Medical and law students were both more likely to report checking, order, routine and attention to detail as obsessive symptoms. Medical students were more likely than law students to possess the obsessive symptoms of cleanliness and conscientiousness, while law students were more likely than medical students to possess obsessive symptoms related to difficulty in making up their mind and doubting themselves. While medical students and law students are more obsessional than the control population, each group is more likely to report different obsessive symptoms.

Community Health Workers in Schools: A Systematic Review.

BACKGROUND: Community health workers (CHWs) are trusted community members who provide health education and care. However, no consensus exists regarding whether community health worker-based interventions are effective within the school setting. OBJECTIVE: To determine outcomes and best practices of school-based community health worker interventions. DATA SOURCES: PubMed, CINAHL, and SCOPUS databases. STUDY ELIGIBILITY CRITERIA: This systematic literature review examined articles that described an intervention led by community health workers, targeted children and/or parents, and took place primarily within a Kindergarten-12th grade school setting. Articles were excluded if they described an intervention outside the United States. PARTICIPANTS: Community health workers, children, and/or their parents INTERVENTIONS: School-based community health worker programs RESULTS: Of 1875 articles identified, 13 met inclusion criteria and were included in the final analysis. Of these, 5 described a statistically significant primary outcome. Seven articles provided details regarding community health worker recruitment, training, and roles that would enable reproduction of the intervention. LIMITATIONS: This review focused on interventions in the United States. Bias of individual studies had a wide range of scores (9-21). Heterogeneity of studies also precluded a meta-analysis of primary outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The utilization of Community health workers in school-based interventions for children and/or parents is promising. This review identified a lack of detail and uniformity in program presentation, specifically with Community health worker recruitment, training, and roles. A standardized reporting mechanism for Community health worker interventions in schools would better allow for reproducibility and scalability of existing studies.

Endothelial nitric oxide synthase mediates endogenous protection against subarachnoid hemorrhage-induced cerebral vasospasm.

BACKGROUND AND PURPOSE: Vasospasm-induced delayed cerebral ischemia remains a major source of morbidity in patients with aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that activating innate neurovascular protective mechanisms by preconditioning (PC) may represent a novel therapeutic approach against SAH-induced vasospasm and neurological deficits and, secondarily, that the neurovascular protection it provides is mediated by endothelial nitric oxide synthase (eNOS). METHODS: Wild-type mice were subjected to hypoxic PC or normoxia followed 24 hours later by SAH. Neurological function was analyzed daily; vasospasm was assessed on post-surgery Day 2. Nitric oxide availability, eNOS expression, and eNOS activity were also assessed. In a separate experiment, wild-type and eNOS-null mice were subjected to hypoxic PC or normoxia followed by SAH and assessed for vasospasm and neurological deficits. RESULTS: PC nearly completely prevented SAH-induced vasospasm and neurological deficits. It also prevented SAH-induced reduction in nitric oxide availability and increased eNOS activity in mice with and without SAH. PC-induced protection against vasospasm and neurological deficits was lost in wild-type mice treated with the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester and in eNOS-null mice. CONCLUSIONS: Endogenous protective mechanisms against vasospasm exist, are powerful, and can be induced by PC. eNOS-derived nitric oxide is a critical mediator of PC-induced neurovascular protection. These data provide strong "proof-of-principle" evidence that PC represents a promising new strategy to reduce vasospasm and delayed cerebral ischemia after SAH.

Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children.

: Level of Evidence: 3.

A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity.

Excoriation (skin-picking) disorder (SPD) shares symptomology with other obsessive-compulsive and related disorders. Few studies, however, have examined the neurological profile of patients with SPD. This study examined differences in cortical thickness and basal ganglia structural volumes between 20 individuals with SPD and 16 healthy controls using magnetic resonance imaging (MRI). There were no significant differences in demographic variables (age, gender, education and race) between groups. All subjects completed a structural MRI scan and completed a battery of clinical assessments focusing on SPD symptom severity, depression and anxiety symptoms, and quality of life. No statistically significant differences in basal ganglia (caudate, putamen, and nucleus accumbens) structural volumes were found between groups. In individuals with SPD, increasing impulsiveness correlated positively with increased cortical thickness in the left insula, and skin picking severity correlated negatively with cortical thickness in the left supramarginal gyrus and a region encompassing the right inferior parietal, right temporal and right supramarginal gyrus. This study suggests similarities and differences exist in symptomology between SPD and the other obsessive-compulsive and related disorders. Additional neuroimaging research is needed to better delineate the underlying neurobiology of SPD.

HIF-1α Mediates Isoflurane-Induced Vascular Protection in Subarachnoid Hemorrhage.

OBJECTIVE: Outcome after aneurysmal subarachnoid hemorrhage (SAH) depends critically on delayed cerebral ischemia (DCI) - a process driven primarily by vascular events including cerebral vasospasm, microvessel thrombosis, and microvascular dysfunction. This study sought to determine the impact of postconditioning - the phenomenon whereby endogenous protection against severe injury is enhanced by subsequent exposure to a mild stressor - on SAH-induced DCI. METHODS: Adult male C57BL/6 mice were subjected to sham, SAH, or SAH plus isoflurane postconditioning. Neurological outcome was assessed daily via sensorimotor scoring. Contributors to DCI including cerebral vasospasm, microvessel thrombosis, and microvascular dysfunction were measured 3 days later. Isoflurane-induced changes in hypoxia-inducible factor 1alpha (HIF-1α)-dependent genes were assessed via quantitative polymerase chain reaction. HIF-1α was inhibited pharmacologically via 2-methoxyestradiol (2ME2) or genetically via endothelial cell HIF-1α-null mice (EC-HIF-1α-null). All experiments were performed in a randomized and blinded fashion. RESULTS: Isoflurane postconditioning initiated at clinically relevant time points after SAH significantly reduced cerebral vasospasm, microvessel thrombosis, microvascular dysfunction, and neurological deficits in wild-type (WT) mice. Isoflurane modulated HIF-1α-dependent genes - changes that were abolished in 2ME2-treated WT mice and EC-HIF-1α-null mice. Isoflurane-induced DCI protection was attenuated in 2ME2-treated WT mice and EC-HIF-1α-null mice. INTERPRETATION: Isoflurane postconditioning provides strong HIF-1α-mediated macro- and microvascular protection in SAH, leading to improved neurological outcome. These results implicate cerebral vessels as a key target for the brain protection afforded by isoflurane postconditioning, and HIF-1α as a critical mediator of this vascular protection. They also identify isoflurane postconditioning as a promising novel therapeutic for SAH.