Neural Responses to Intranasal Oxytocin in Youths With Severe Irritability.

OBJECTIVE: The authors investigated the neural impact of intranasal oxytocin on emotion processing areas in youths with severe irritability in the context of disruptive mood and behavior disorders. METHODS: Fifty-two participants with severe irritability, as measured by a score ≥4 on the Affective Reactivity Index (ARI), with diagnoses of disruptive behavior disorders (DBDs) and/or disruptive mood dysregulation disorder (DMDD) were randomly assigned to treatment with intranasal oxytocin or placebo daily for 3 weeks. Assessments were conducted at baseline and at the end of the trial; the primary outcomes were measures of irritability on the ARI and ratings on the Clinical Global Impressions severity scale (CGI-S) focusing on DBD and DMDD symptoms, and secondary outcomes included the CGI improvement scale (CGI-I) and ratings of proactive and reactive aggressive behavior on the Reactive-Proactive Aggression Questionnaire. Forty-three participants (22 in the oxytocin group and 21 in the placebo group) completed pre- and posttreatment functional MRI (fMRI) scans with the affective Stroop task. RESULTS: Youths who received oxytocin showed significant improvement in CGI-S and CGI-I ratings compared with those who received placebo. In the fMRI data, blood-oxygen-level-dependent (BOLD) responses to emotional stimuli in the dorsomedial prefrontal cortex and posterior cingulate cortex were significantly reduced after oxytocin compared with placebo. These BOLD response changes were correlated with improvement in clinical severity. CONCLUSIONS: This study provides initial and preliminary evidence that intranasal oxytocin may induce neural-level changes in emotion processing in youths with irritability in the context of DBDs and DMDD. This may lead to symptom and severity changes in irritability.

"From All Walks of Life": Attending an Alcoholics Anonymous Meeting to Reduce Addiction Stigma Among Medical Students.

OBJECTIVE: Substance use disorders (SUDs) are stigmatized conditions in medicine, with negative attitudes toward patients with SUDs beginning to form in medical school. Only a few studies with small samples show that attending an Alcoholics Anonymous (AA) meeting may help decrease addiction stigma. This study examined whether attending an AA meeting impacts medical student attitudes toward patients with SUDs and any gender and age group differences within these attitudes. METHODS: As part of their psychiatry clerkship, 138 third-year medical students attended an AA meeting and wrote reflection essays discussing expectations before the meeting, feelings while there, and thoughts on how these feelings might affect patient care. The authors performed a thematic analysis to identify themes and t tests to compare theme frequency by gender and age group. RESULTS: A primary theme in student responses was a reduction in stigmatizing attitudes, which was broken down into three subthemes: complexity of addiction (46%), diversity of people with addiction (37%), and practical applications (66%). Practical applications comprised compassionate care (53%) and intention to address SUDs clinically (35%). While no gender differences were found in theme frequency, younger students showed significantly higher frequency of all themes. CONCLUSIONS: Attending an AA meeting can challenge medical students' stigmatizing attitudes about addiction and increase flexibility of thinking. Younger students' biases may not be as solidified, stressing the importance of early exposure to patients in recovery during medical school. Attending an AA meeting and reflecting on the experience may be one way to decrease addiction stigma among medical students.