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Bashford-Largo J, Blair RJR, Blair KS, Dobbertin M, Elowsky J, Dominguez A, Hatch M, Bajaj S. Cortical volume alterations in the limbic network in adolescents with high reactive aggression. Dev Psychopathol 2024:1-9. [PMID: 38584251 DOI: 10.1017/s0954579424000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Previous studies show aggression-related structural alterations in frontal and limbic brain regions. Most studies have focused on overall aggression, instead of its subtypes, and on specific regions instead of networks. This study aims to identify both brain networks and regions that are associated with reactive and proactive subtypes of aggression. Structural MRI data were collected from 340 adolescents (125 F/215 M) with a mean age of 16.29 (SD = 1.20). Aggression symptomology was indexed via the Reactive Proactive Aggression Questionnaire (RPQ). Freesurfer was used to estimate Cortical Volume (CV) from seven networks and regions within specific networks associated with aggression. Two multivariate analyses of covariance (MANCOVAs) were conducted on groups for low versus higher reactive and proactive RPQ scores. Our reactive aggression MANCOVA showed a main effect in CV [F(14,321) = 1.935, p = 0.022,ηp2 = 0.078] across all the 7-Networks. Unpacking this main effect revealed significant volumetric differences in the right Limbic Network (LN) (p = 0.029) and the Temporal Pole (p = 0.011), where adolescents in the higher reactive aggression group showed higher cortical volumes. Such findings are consistent with region/voxel-specific analyses that have associated atypical structure within the LN and reactive aggression. Moreover, the temporal pole is highly interconnected with regions important in the regulation and initiation of reactive aggression.
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Affiliation(s)
- Johannah Bashford-Largo
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - R James R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Karina S Blair
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Matthew Dobbertin
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, USA
- Child and Adolescent Psychiatric Inpatient Center, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jaimie Elowsky
- Clinical Psychology Department, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Ahria Dominguez
- Clinical Health, Emotion, and Neuroscience (CHEN) Laboratory, Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melissa Hatch
- Mind and Brain Health Laboratories (MBHL), Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sahil Bajaj
- Department of Cancer Systems Imaging, MD Anderson Center, University of Texas, Houston, TX, USA
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Bashford-Largo J, Nakua H, Blair RJR, Dominguez A, Hatch M, Blair KS, Dobbertin M, Ameis S, Bajaj S. A Shared Multivariate Brain-Behavior Relationship in a Transdiagnostic Sample of Adolescents. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 2024; 9:377-386. [PMID: 37572936 PMCID: PMC10858974 DOI: 10.1016/j.bpsc.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Internalizing and externalizing psychopathology typically present in early childhood and can have negative implications on general functioning and quality of life. Prior work has linked increased psychopathology symptoms with altered brain structure. Multivariate analysis such as partial least squares correlation can help identify patterns of covariation between brain regions and psychopathology symptoms. This study examined the relationship between gray matter volume (GMV) and psychopathology symptoms in adolescents with various psychiatric diagnoses. METHODS Structural magnetic resonance imaging data were collected from 490 participants with various internalizing and externalizing diagnoses (197 female/293 male; age = 14.68 ± 2.35 years; IQ = 104.05 ± 13.11). Cortical and subcortical volumes were parcellated using the Desikan-Killiany atlas. Partial least squares correlation was used to identify multivariate linear relationships between GMV and the Strength and Difficulties Questionnaire difficulties domains (emotional, peer, conduct, and hyperactivity issues). Resampling approaches were used to determine significance (permutation test), stability (bootstrap resampling), and reproducibility (split-half resampling) of identified relationships. RESULTS We found a significant, stable, and largely reproducible dimension that linked lower Strength and Difficulties Questionnaire scores (less impairment) across all difficulties domains with greater widespread GMV (singular value = 1.17, accounts for 87.1% of the covariance; p < .001). This dimension emphasized the relationship between lower conduct problems and greater GMV in frontotemporal regions. CONCLUSIONS Our results indicate that the most significant and stable brain-behavior relationship in a transdiagnostic sample is a domain-general relationship, linking lower psychopathology symptom scores to greater global GMV. This finding suggests that a shared brain-behavior relationship may be present across adolescents with and without clinically significant psychopathology symptoms.
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Affiliation(s)
- Johannah Bashford-Largo
- Boys Town National Research Hospital, Boys Town, Nebraska; Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska.
| | - Hajer Nakua
- Center for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - R James R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Ahria Dominguez
- Clinical Health, Emotion, and Neuroscience Laboratory, Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Melissa Hatch
- Mind and Brain Health Labs. Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Karina S Blair
- Boys Town National Research Hospital, Boys Town, Nebraska
| | - Matthew Dobbertin
- Boys Town National Research Hospital, Boys Town, Nebraska; Child and Adolescent Inpatient Psychiatric Unit, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Stephanie Ameis
- Center for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sahil Bajaj
- Department of Cancer Systems Imaging, University of Texas, MD Anderson Center, Houston, Texas
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Dobbertin M, Blair KS, Aloi J, Bajaj S, Bashford-Largo J, Mathur A, Zhang R, Carollo E, Schwartz A, Elowsky J, Ringle JL, Tyler P, Blair RJ. Correction: Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care. Transl Psychiatry 2024; 14:100. [PMID: 38374005 PMCID: PMC10876519 DOI: 10.1038/s41398-024-02817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Affiliation(s)
- Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sahil Bajaj
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Johannah Bashford-Largo
- Multimodal Clinical Neuroimaging Laboratory, Institute for Human Neuroscience, Boys Town, NE, USA
| | - Avantika Mathur
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Ru Zhang
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Erin Carollo
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | | | - Jaimie Elowsky
- University of Nebraska Department of Psychology, Lincoln, NE, USA
| | - J L Ringle
- Child and Family Translational Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Patrick Tyler
- Child and Family Translational Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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Dobbertin M, Blair KS, Aloi J, Bajaj S, Bashford-Largo J, Mathur A, Zhang R, Carollo E, Schwartz A, Elowsky J, Ringle JL, Tyler P, Blair RJ. Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care. Transl Psychiatry 2024; 14:54. [PMID: 38263400 PMCID: PMC10806086 DOI: 10.1038/s41398-023-02723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/09/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Suicide is the second leading cause of death for adolescents in the United States. However, relatively little is known about the forms of atypical neuro-cognitive function that are correlates of suicidal ideation (SI). One form of cognitive/affective function that, when dysfunctional, is associated with SI is emotion regulation. However, very little work has investigated the neural correlates of emotion dysregulation in adolescents with SI. METHODS Participants (N = 111 aged 12-18, 32 females, 31 [27.9%] reporting SI) were recruited shortly after their arrival at a residential care facility where they had been referred for behavioral and mental health problems. Daily reports of SI were collected during the participants' first 90-days in residential care. Participants were presented with a task-fMRI measure of emotion regulation - the Affective Number Stroop task shortly after recruitment. Participants were divided into two groups matched for age, sex and IQ based on whether they demonstrated SI. RESULTS Participants who demonstrated SI showed increased recruitment of regions including dorsomedial prefrontal cortex/supplemental motor area and parietal cortex during task (congruent and incongruent) relative to view trials in the context of emotional relative to neutral distracters. CONCLUSIONS Participants with SI showed increased recruitment of regions implicated in executive control during the performance of a task indexing automatic emotion regulation. Such data might suggest a relative inefficiency in the recruitment of these regions in individuals with SI.
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Affiliation(s)
- Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sahil Bajaj
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Johannah Bashford-Largo
- Multimodal Clinical Neuroimaging Laboratory, Institute for Human Neuroscience, Boys Town, NE, USA
| | - Avantika Mathur
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Ru Zhang
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Erin Carollo
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | | | - Jaimie Elowsky
- University of Nebraska Department of Psychology, Lincoln, NE, USA
| | - J L Ringle
- Child and Family Translational Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Patrick Tyler
- Child and Family Translational Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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Zhang R, Blair RJR, Blair KS, Dobbertin M, Elowsky J, Bashford-Largo J, Dominguez AJ, Hatch M, Bajaj S. Reduced grey matter volume in adolescents with conduct disorder: a region-of-interest analysis using multivariate generalized linear modeling. Discov Ment Health 2023; 3:25. [PMID: 37975932 PMCID: PMC10656392 DOI: 10.1007/s44192-023-00052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV). METHODS The whole-brain structural MRI data were collected from 96 adolescents with CD (mean age = [Formula: see text] years; mean IQ = [Formula: see text]; 63 males) and 90 TD individuals (mean age = [Formula: see text] years; mean IQ = [Formula: see text]; 59 males) matched on age, IQ, and sex. Region-wise GMV was extracted following whole-brain parcellation into 68 cortical and 14 subcortical regions for each participant. A multivariate GLM was developed to predict the GMV of the pre-hypothesized regions-of-interest (ROIs) based on CD diagnosis, with intracranial volume, age, sex, and IQ serving as the covariate. RESULTS A diagnosis of CD was a significant predictor for GMV in the right pars orbitalis, right insula, right superior temporal gyrus, left fusiform gyrus, and left amygdala (F(1, 180) = 5.460-10.317, p < 0.05, partial eta squared = 0.029-0.054). The CD participants had smaller GMV in these regions than the TD participants (MCD-MTD = [- 614.898] mm3-[- 53.461] mm3). CONCLUSIONS Altered GMV within specific regions may serve as a biomarker for the development of CD in adolescents. Clinical work can potentially target these biomarkers to treat adolescents with CD.
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Affiliation(s)
- Ru Zhang
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - R James R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Matthew Dobbertin
- Inpatient Psychiatric Care Unit, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jaimie Elowsky
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Ahria J Dominguez
- Clinical Health, Emotion, and Neuroscience (CHEN) Laboratory, Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Melissa Hatch
- Mind and Brain Health Labs (MBHL), Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Sahil Bajaj
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zhang R, Blair RJR, Blair KS, Dobbertin M, Elowsky J, Bashford-Largo J, Dominguez AJ, Hatch M, Bajaj S. Reduced Grey Matter Volume in Adolescents with Conduct Disorder: A Region-of-Interest Analysis Using Multivariate Generalized Linear Modeling. Res Sq 2023:rs.3.rs-3425545. [PMID: 37961148 PMCID: PMC10635381 DOI: 10.21203/rs.3.rs-3425545/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV). Methods The whole-brain structural MRI data were collected from 96 adolescents with CD (mean age = years; mean IQ = ; 63 males) and 90 TD individuals (mean age = years; mean IQ = ; 59 males) matched on age, IQ, and sex. Region-wise GMV was extracted following whole-brain parcellation into 68 cortical and 14 subcortical regions for each participant. A multivariate GLM was developed to predict the GMV of the pre-hypothesized regions-of-interest (ROIs) based on CD diagnosis, with intracranial volume, age, sex, and IQ serving as the covariate. Results A diagnosis of CD was a significant predictor for GMV in the right pars orbitalis, right insula, right superior temporal gyrus, left fusiform gyrus, and left amygdala (F(1, 180) = 5.460 - 10.317, p < 0.05, partial eta squared = 0.029 - 0.054). The CD participants had smaller GMV in these regions than the TD participants (MCD - MTD = [-614.898] mm3 - [-53.461] mm3). Conclusions Altered GMV within specific regions may serve as a biomarker for the development of CD in adolescents. Clinical work can potentially target these biomarkers to treat adolescents with CD.
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Affiliation(s)
- Ru Zhang
- University of Southern California
| | | | | | | | | | | | | | | | - Sahil Bajaj
- The University of Texas MD Anderson Cancer Center
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Crum KI, Aloi J, Blair KS, Bashford-Largo J, Bajaj S, Zhang R, Hwang S, Schwartz A, Elowsky J, Filbey FM, Dobbertin M, Blair RJ. Latent profiles of substance use, early life stress, and attention/externalizing problems and their association with neural correlates of reinforcement learning in adolescents. Psychol Med 2023; 53:7358-7367. [PMID: 37144406 PMCID: PMC10625649 DOI: 10.1017/s0033291723000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Adolescent substance use, externalizing and attention problems, and early life stress (ELS) commonly co-occur. These psychopathologies show overlapping neural dysfunction in the form of reduced recruitment of reward processing neuro-circuitries. However, it is unclear to what extent these psychopathologies show common v. different neural dysfunctions as a function of symptom profiles, as no studies have directly compared neural dysfunctions associated with each of these psychopathologies to each other. METHODS In study 1, a latent profile analysis (LPA) was conducted in a sample of 266 adolescents (aged 13-18, 41.7% female, 58.3% male) from a residential youth care facility and the surrounding community to investigate substance use, externalizing and attention problems, and ELS psychopathologies and their co-presentation. In study 2, we examined a subsample of 174 participants who completed the Passive Avoidance learning task during functional magnetic resonance imaging to examine differential and/or common reward processing neuro-circuitry dysfunctions associated with symptom profiles based on these co-presentations. RESULTS In study 1, LPA identified profiles of substance use plus rule-breaking behaviors, attention-deficit hyperactivity disorder, and ELS. In study 2, the substance use/rule-breaking profile was associated with reduced recruitment of reward processing and attentional neuro-circuitries during the Passive Avoidance task (p < 0.05, corrected for multiple comparisons). CONCLUSIONS Findings indicate that there is reduced responsivity of striato-cortical regions when receiving outcomes on an instrumental learning task within a profile of adolescents with substance use and rule-breaking behaviors. Mitigating reward processing dysfunction specifically may represent a potential intervention target for substance-use psychopathologies accompanied by rule-breaking behaviors.
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Affiliation(s)
- Kathleen I Crum
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Neuroimaging, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amanda Schwartz
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Jaimie Elowsky
- Department of Psychology, University of Nebraska - Lincoln, Lincoln, NE, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
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Prajapati P, Wu X, Bajaj S, Gandhi D, Wintermark M, Malhotra A. Trends of Diversity in Neuroradiology Trainees in United States 2015-2022. AJNR Am J Neuroradiol 2023; 44:1009-1011. [PMID: 37500285 PMCID: PMC10494957 DOI: 10.3174/ajnr.a7947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
Radiology has historically not been a very diverse field. Many steps have been taken in the past decade to increase diversity in the field and make it more inclusive. This study shows the relative trends specifically in neuroradiology trainees, and the need for reassessment and further steps to increase diversity.
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Affiliation(s)
- P Prajapati
- From the Department of Radiology and Biomedical Imaging (P.P., S.B., A.M.), Yale School of Medicine, New Haven, Connecticut
| | - X Wu
- Department of Radiology (X.W.), University of California at San Francisco, San Francisco, California
| | - S Bajaj
- From the Department of Radiology and Biomedical Imaging (P.P., S.B., A.M.), Yale School of Medicine, New Haven, Connecticut
| | - D Gandhi
- University of Maryland School of Medicine (D.G.), Baltimore, Maryland
| | - M Wintermark
- Department of Neuroradiology (M.W.), MD Anderson Cancer Center, Houston, Texas
| | - A Malhotra
- From the Department of Radiology and Biomedical Imaging (P.P., S.B., A.M.), Yale School of Medicine, New Haven, Connecticut
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Bashford-Largo J, R Blair RJ, Blair KS, Dobbertin M, Dominguez A, Hatch M, Bajaj S. Identification of structural brain alterations in adolescents with depressive symptomatology. Brain Res Bull 2023; 201:110723. [PMID: 37536609 PMCID: PMC10451038 DOI: 10.1016/j.brainresbull.2023.110723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/10/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Depressive symptoms can emerge as early as childhood and may lead to adverse situations in adulthood. Studies have examined structural brain alternations in individuals with depressive symptoms, but findings remain inconclusive. Furthermore, previous studies have focused on adults or used a categorical approach to assess depression. The current study looks to identify grey matter volumes (GMV) that predict depressive symptomatology across a clinically concerning sample of adolescents. METHODS Structural MRI data were collected from 338 clinically concerning adolescents (mean age = 15.30 SD=2.07; mean IQ = 101.01 SD=12.43; 132 F). Depression symptoms were indexed via the Mood and Feelings Questionnaire (MFQ). Freesurfer was used to parcellate the brain into 68 cortical regions and 14 subcortical regions. GMV was extracted from all 82 brain areas. Multiple linear regression was used to look at the relationship between MFQ scores and region-specific GMV parameter. Follow up regressions were conducted to look at potential effects of psychiatric diagnoses and medication intake. RESULTS Our regression analysis produced a significant model (R2 = 0.446, F(86, 251) = 2.348, p < 0.001). Specifically, there was a negative association between GMV of the left parahippocampal (B = -0.203, p = 0.005), right rostral anterior cingulate (B = -0.162, p = 0.049), and right frontal pole (B = -0.147, p = 0.039) and a positive association between GMV of the left bank of the superior temporal sulcus (B = 0.173, p = 0.029). Follow up analyses produced results proximal to the main analysis. CONCLUSIONS Altered regional brain volumes may serve as biomarkers for the development of depressive symptoms during adolescence. These findings suggest a homogeneity of altered cortical structures in adolescents with depressive symptoms.
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Affiliation(s)
- Johannah Bashford-Largo
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA; Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA.
| | - R James R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Karina S Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Matthew Dobbertin
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA; Child and Adolescent Inpatient Psychiatric Unit, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Ahria Dominguez
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Melissa Hatch
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Sahil Bajaj
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mathur A, Bashford-Largo J, Elowsky J, Zhang R, Dobbertin M, Tyler PM, Bajaj S, Blair KS, Blair RJR. Association Between Aggression and Differential Functional Activity of Neural Regions Implicated in Retaliation. J Am Acad Child Adolesc Psychiatry 2023; 62:805-815. [PMID: 36889505 PMCID: PMC10330338 DOI: 10.1016/j.jaac.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The goal of the current study was to determine the extent to which atypical neural responsiveness during retaliation is associated with observed aggression in youth in residential care. METHOD This functional magnetic resonance imaging study involved 83 adolescents (56 male and 27 female; mean age, 16.18 years) in residential care performing a retaliation task. Of the 83 adolescents, 42 displayed aggressive behavior within the first 3 months of residential care, whereas 41 did not. During the retaliation task, participants were offered either fair or unfair divisions of $20 pots (allocation phase) and could either accept the offer or reject it, and, by spending $1, $2, or $3, punish the partner (retaliation phase). RESULTS The study's main findings were that aggressive adolescent showed the following: reduced down-regulation of activity within regions involved in representing the expected value of choice options (left ventromedial prefrontal cortex and left posterior cingulate cortex) as a function of offer unfairness and retaliation level; and reduced recruitment of regions implicated in response control (right inferior frontal gyrus and bilateral anterior insular cortex) and associated fronto-parietal regions as a function of retaliation level. The aggressive adolescents were also significantly more likely to have been aggressive prior to residential care and showed a strong trend for increased retaliation on the task. CONCLUSION We suggest that individuals with a greater propensity for aggression show reduced representation of the negative consequences of retaliation and associated reduced recruitment of regions potentially involved in over-ruling these negative consequences to engage in retaliation. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
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Affiliation(s)
- Avantika Mathur
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | | | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - R James R Blair
- Child and Adolescent Mental Health Center Research Center, Genthofte Hospital, Hellerup, Denmark.
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11
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Khan A, Khunte M, Wu X, Bajaj S, Payabvash S, Wintermark M, Matouk C, Seidenwurm DJ, Gandhi D, Parizel P, Mezrich J, Malhotra A. Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms. AJNR Am J Neuroradiol 2023; 44:460-466. [PMID: 36997286 PMCID: PMC10084911 DOI: 10.3174/ajnr.a7828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND PURPOSE Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes. MATERIALS AND METHODS We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm. RESULTS Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively). CONCLUSIONS Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers.
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Affiliation(s)
- A Khan
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - M Khunte
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - X Wu
- Department of Radiology (X.W.), University of California at San Francisco, San Francisco, California
| | - S Bajaj
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - S Payabvash
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - M Wintermark
- Department of Radiology (M.W.), MD Anderson Cancer Center, Houston, Texas
| | - C Matouk
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
- Neurosurgery (C.M.), Yale School of Medicine, New Haven, Connecticut
| | - D J Seidenwurm
- Department of Neuroradiology (D.J.S.), Sutter Health, Sacramento, California
| | - D Gandhi
- Departments of Interventional Neuroradiology, Radiology, and Nuclear Medicine (D.G.)
- Neurology (D.G.)
- Neurosurgery (D.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - P Parizel
- Department of Radiology (P.P.), University of Western Australia, Perth, Australia
| | - J Mezrich
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - A Malhotra
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
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12
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Zhang R, Aloi J, Bajaj S, Bashford-Largo J, Lukoff J, Schwartz A, Elowsky J, Dobbertin M, Blair KS, Blair RJR. Dysfunction in differential reward-punishment responsiveness in conduct disorder relates to severity of callous-unemotional traits but not irritability. Psychol Med 2023; 53:1870-1880. [PMID: 34467836 PMCID: PMC8885913 DOI: 10.1017/s0033291721003500] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Conduct disorder (CD) has been associated with dysfunction in reinforcement-based decision-making. Two forms of affective traits that reflect the components of CD severity are callous-unemotional (CU; reduced guilt/empathy) traits and irritability. The form of the reinforcement-based decision-making dysfunction with respect to CD and CU traits remains debated and has not been examined with respect to irritability in cases with CD. The goals of the current study were to determine the extent of dysfunction in differential (reward v. punishment) responsiveness in CD, and CU traits and irritability in participants with CD. METHODS The study involved 178 adolescents [typically developing (TD; N = 77) and cases with CD (N = 101)]. Participants were scanned with fMRI during a passive avoidance task that required participants to learn to respond to (i.e. approach) stimuli that engender reward and refrain from responding to (i.e. passively avoid) stimuli that engender punishment. RESULTS Adolescents with CD showed reduced differential reward-punishment responsiveness within the striatum relative to TD adolescents. CU traits, but not irritability, were associated with reduced differential reward-punishment responsiveness within the striatum, rostromedial, and lateral frontal cortices. CONCLUSIONS The results suggest CD is associated with reduced differential reward-punishment responsiveness and the extent of this dysfunction in participants with CD is associated with the severity of CU traits but not irritability.
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Affiliation(s)
- Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jamie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R. James R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
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13
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Bajaj S, Blair KS, Dobbertin M, Patil KR, Tyler PM, Ringle JL, Bashford-Largo J, Mathur A, Elowsky J, Dominguez A, Schmaal L, Blair RJR. Machine learning based identification of structural brain alterations underlying suicide risk in adolescents. Discov Ment Health 2023; 3:6. [PMID: 37861863 PMCID: PMC10501026 DOI: 10.1007/s44192-023-00033-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 10/21/2023]
Abstract
Suicide is the third leading cause of death for individuals between 15 and 19 years of age. The high suicide mortality rate and limited prior success in identifying neuroimaging biomarkers indicate that it is crucial to improve the accuracy of clinical neural signatures underlying suicide risk. The current study implements machine-learning (ML) algorithms to examine structural brain alterations in adolescents that can discriminate individuals with suicide risk from typically developing (TD) adolescents at the individual level. Structural MRI data were collected from 79 adolescents who demonstrated clinical levels of suicide risk and 79 demographically matched TD adolescents. Region-specific cortical/subcortical volume (CV/SCV) was evaluated following whole-brain parcellation into 1000 cortical and 12 subcortical regions. CV/SCV parameters were used as inputs for feature selection and three ML algorithms (i.e., support vector machine [SVM], K-nearest neighbors, and ensemble) to classify adolescents at suicide risk from TD adolescents. The highest classification accuracy of 74.79% (with sensitivity = 75.90%, specificity = 74.07%, and area under the receiver operating characteristic curve = 87.18%) was obtained for CV/SCV data using the SVM classifier. Identified bilateral regions that contributed to the classification mainly included reduced CV within the frontal and temporal cortices but increased volume within the cuneus/precuneus for adolescents at suicide risk relative to TD adolescents. The current data demonstrate an unbiased region-specific ML framework to effectively assess the structural biomarkers of suicide risk. Future studies with larger sample sizes and the inclusion of clinical controls and independent validation data sets are needed to confirm our findings.
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Affiliation(s)
- Sahil Bajaj
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA.
| | - Karina S Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA
| | - Matthew Dobbertin
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA
- Child and Adolescent Psychiatric Inpatient Center, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Kaustubh R Patil
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Patrick M Tyler
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jay L Ringle
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Johannah Bashford-Largo
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Avantika Mathur
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA
| | - Jaimie Elowsky
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA
| | - Ahria Dominguez
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USA
| | - Lianne Schmaal
- Center for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Orygen, Parkville, Australia
| | - R James R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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14
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Dobbertin M, Blair KS, Carollo E, Blair JR, Dominguez A, Bajaj S. Neuroimaging alterations of the suicidal brain and its relevance to practice: an updated review of MRI studies. Front Psychiatry 2023; 14:1083244. [PMID: 37181903 PMCID: PMC10174251 DOI: 10.3389/fpsyt.2023.1083244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Suicide is a leading cause of death in the United States. Historically, scientific inquiry has focused on psychological theory. However, more recent studies have started to shed light on complex biosignatures using MRI techniques, including task-based and resting-state functional MRI, brain morphometry, and diffusion tensor imaging. Here, we review recent research across these modalities, with a focus on participants with depression and Suicidal Thoughts and Behavior (STB). A PubMed search identified 149 articles specific to our population of study, and this was further refined to rule out more diffuse pathologies such as psychotic disorders and organic brain injury and illness. This left 69 articles which are reviewed in the current study. The collated articles reviewed point to a complex impairment showing atypical functional activation in areas associated with perception of reward, social/affective stimuli, top-down control, and reward-based learning. This is broadly supported by the atypical morphometric and diffusion-weighted alterations and, most significantly, in the network-based resting-state functional connectivity data that extrapolates network functions from well validated psychological paradigms using functional MRI analysis. We see an emerging picture of cognitive dysfunction evident in task-based and resting state fMRI and network neuroscience studies, likely preceded by structural changes best demonstrated in morphometric and diffusion-weighted studies. We propose a clinically-oriented chronology of the diathesis-stress model of suicide and link other areas of research that may be useful to the practicing clinician, while helping to advance the translational study of the neurobiology of suicide.
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Affiliation(s)
- Matthew Dobbertin
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
- Child and Adolescent Psychiatric Inpatient Center, Boys Town National Research Hospital, Boys Town, NE, United States
- *Correspondence: Matthew Dobbertin,
| | - Karina S. Blair
- Program for Trauma and Anxiety in Children (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Erin Carollo
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, United States
| | - James R. Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Copenhagen, Denmark
| | - Ahria Dominguez
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Sahil Bajaj
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
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15
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Hubbard NA, Miller KB, Aloi J, Bajaj S, Wakabayashi KT, Blair RJR. Evaluating instrumental learning and striatal-cortical functional connectivity in adolescent alcohol and cannabis use. Addict Biol 2023; 28:e13258. [PMID: 36577718 PMCID: PMC10173870 DOI: 10.1111/adb.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
Adolescence is a vulnerable time for the acquisition of substance use disorders, potentially relating to ongoing development of neural circuits supporting instrumental learning. Striatal-cortical circuits undergo dynamic changes during instrumental learning and are implicated in contemporary addiction theory. Human studies have not yet investigated these dynamic changes in relation to adolescent substance use. Here, functional magnetic resonance imaging was used while 135 adolescents without (AUD-CUDLow ) and with significant alcohol (AUDHigh ) or cannabis use disorder symptoms (CUDHigh ) performed an instrumental learning task. We assessed how cumulative experience with instrumental cues altered cue selection preferences and functional connectivity strength between reward-sensitive striatal and cortical regions. Adolescents in AUDHigh and CUDHigh groups were slower in learning to select optimal instrumental cues relative to AUD-CUDLow adolescents. The relatively fast learning observed for AUD-CUDLow adolescents coincided with stronger functional connectivity between striatal and frontoparietal regions during early relative to later periods of task experience, whereas the slower learning for the CUDHigh group coincided with the opposite pattern. The AUDHigh group not only exhibited slower learning but also produced more instrumental choice errors relative to AUD-CUDLow adolescents. For the AUDHigh group, Bayesian analyses evidenced moderate support for no experience-related changes in striatal-frontoparietal connectivity strength during the task. Findings suggest that adolescent cannabis use is related to slowed instrumental learning and delays in peak functional connectivity strength between the striatal-frontoparietal regions that support this learning, whereas adolescent alcohol use may be more closely linked to broader impairments in instrumental learning and a general depression of the neural circuits supporting it.
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Affiliation(s)
- NA Hubbard
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | - KB Miller
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | - J Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - S Bajaj
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE
| | - KT Wakabayashi
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | - RJR Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, 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Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, 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M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Bashford‐Largo J, Zhang R, Mathur A, Elowsky J, Schwartz A, Dobbertin M, Blair RJR, Blair KS, Bajaj S. Reduced cortical volume of the default mode network in adolescents with generalized anxiety disorder. Depress Anxiety 2022; 39:485-495. [PMID: 35312127 PMCID: PMC9246827 DOI: 10.1002/da.23252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Widespread structural alterations have been shown to be implicated in individuals with generalized anxiety disorder (GAD). However, there have been inconsistent findings in cortical volume (CV) differences. Most structural neuroimaging studies looking at GAD used region-based approach with relatively small sample sizes, let alone be specific to adolescents with GAD. We believe this is the first study to look at CV measures using a network-based approach in a larger sample of adolescents with GAD. The goal of the current study was to focus on three different brain networks (i.e., Limbic, Frontoparietal, and Default Mode Network [DMN]) in adolescents with GAD. METHOD The study involved 81 adolescents with GAD and 112 typically developing (TD) comparison individuals matched on age (15.98 and 15.63 respective means), sex (42F/39M and 45F/67M), and IQ (101.90 and 103.94 respective means). Participants underwent structural MRI. Freesurfer was used to estimate CV (both network-specific and region-specific within networks) and region-specific sub-cortical volume measures. Multivariate analysis of covariance (MANCOVA; with sex, age, IQ, and intracranial volume [ICV] as potential covariates) was used to estimate group differences. RESULTS We found significantly lower CV for the DMN in adolescents with GAD, compared with TD individuals. Adolescents with GAD also showed significantly lower hemispheric mean CV of the default-mode regions (particularly the prefrontal and temporal regions) and the hippocampus, compared with TD individuals. CONCLUSION The current findings suggest structural alterations in adolescents with GAD. These structural alterations will need to be addressed when implementing and developing treatments for patients with GAD.
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Affiliation(s)
- Johannah Bashford‐Largo
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA,Center for Brain, Biology, and BehaviorUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Ru Zhang
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Avantika Mathur
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Jaimie Elowsky
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Amanda Schwartz
- Department of PsychologyUniversity of North DakotaGrand ForksNorth DakotaUSA
| | - Matthew Dobbertin
- Inpatient Psychiatric Care UnitBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Robert James R. Blair
- Child and Adolescent Mental Health Centre, Mental Health ServicesCapital Region of DenmarkCopenhagenDenmark
| | - Karina S. Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Sahil Bajaj
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
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Trofimova I, Bajaj S, Bashkatov SA, Blair J, Brandt A, Chan RCK, Clemens B, Corr PJ, Cyniak-Cieciura M, Demidova L, Filippi CA, Garipova M, Habel U, Haines N, Heym N, Hunter K, Jones NA, Kanen J, Kirenskaya A, Kumari V, Lenzoni S, Lui SSY, Mathur A, McNaughton N, Mize KD, Mueller E, Netter P, Paul K, Plieger T, Premkumar P, Raine A, Reuter M, Robbins TW, Samylkin D, Storozheva Z, Sulis W, Sumich A, Tkachenko A, Valadez EA, Wacker J, Wagels L, Wang LL, Zawadzki B, Pickering AD. What is next for the neurobiology of temperament, personality and psychopathology? Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2022.101143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Elowsky J, Bajaj S, Bashford-Largo J, Zhang R, Mathur A, Schwartz A, Dobbertin M, Blair KS, Leibenluft E, Pardini D, Blair RJR. Differential associations of conduct disorder, callous-unemotional traits and irritability with outcome expectations and values regarding the consequences of aggression. Child Adolesc Psychiatry Ment Health 2022; 16:38. [PMID: 35606814 PMCID: PMC9128221 DOI: 10.1186/s13034-022-00466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous work has examined the association of aggression levels and callous-unemotional traits with outcome expectations and values regarding the consequences of aggression. Less work has examined the outcome expectations and values regarding the consequences of aggression of adolescents with Conduct Disorder (CD). Also, no studies have examined links between irritability (a second socio-affective trait associated with CD) and these social cognitive processes despite the core function of anger in retaliatory aggression and establishing dominance. METHOD The current study, investigating these issues, involved 193 adolescents (typically developing [TD; N = 106], 87 cases with CD [N = 87]). Participants completed an adaptation of the Outcomes Expectations and Values Questionnaire and were assessed for CU traits and irritability via the Inventory of Callous-Unemotional traits and the Affective Reactivity Index. RESULTS While CD was associated with atypical outcome expectations this was not seen within statistical models including CU traits and irritability. CU traits were associated with decreased expectation that aggression would result in feelings of remorse and victim suffering, as well as decreased concern that aggressive acts would result in punishment and victim suffering. Irritability was associated with increased expectations and concern that aggression would result in dominance and forced respect. CONCLUSIONS The results suggest that CU traits and irritability, often present in youth with CD, are associated with different forms of maladaptive outcome expectations and values regarding the consequences of aggression. This suggests that the atypical social cognitive processes underlying aggressive behavior among youth exhibiting CU traits may differ from those exhibiting problems regulating anger.
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Affiliation(s)
- J. Elowsky
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - S. Bajaj
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - J. Bashford-Largo
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.24434.350000 0004 1937 0060Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - R. Zhang
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - A. Mathur
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - A. Schwartz
- grid.266862.e0000 0004 1936 81633Department of Psychology, University of North Dakota, Grand Forks, ND USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - M. Dobbertin
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - K. S. Blair
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - E. Leibenluft
- grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - D. Pardini
- grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA
| | - R. J. R. Blair
- grid.414583.f0000 0000 8953 4586Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010 USA ,grid.94365.3d0000 0001 2297 5165Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,grid.215654.10000 0001 2151 2636School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ USA ,grid.466916.a0000 0004 0631 4836Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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Blair RJR, Mathur A, Haines N, Bajaj S. Future directions for cognitive neuroscience in psychiatry: recommendations for biomarker design based on recent test re-test reliability work. Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2022.101102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Blair KS, Aloi J, Bashford-Largo J, Zhang R, Elowsky J, Lukoff J, Vogel S, Carollo E, Schwartz A, Pope K, Bajaj S, Tottenham N, Dobbertin M, Blair RJ. Different forms of childhood maltreatment have different impacts on the neural systems involved in the representation of reinforcement value. Dev Cogn Neurosci 2021; 53:101051. [PMID: 34953316 PMCID: PMC8714998 DOI: 10.1016/j.dcn.2021.101051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/16/2021] [Accepted: 12/13/2021] [Indexed: 01/20/2023] Open
Abstract
Background The current study aimed to address two gaps in the literature on child maltreatment, reinforcement processing and psychopathology. First, the extent to which compromised reinforcement processing might be particularly associated with either neglect or abuse. Second, the extent to which maltreatment-related compromised reinforcement processing might be associated with particular symptom sets (depression, conduct problems, anxiety) or symptomatology more generally. Methods A sample of adolescents (N = 142) aged between 14 and 18 years with varying levels of prior maltreatment participated in this fMRI study. They were scanned while performing a passive avoidance learning task, where the participant learns to respond to stimuli that engender reward and avoid responding to stimuli that engender punishment. Maltreatment (abuse and neglect) levels were assessed with the Childhood Trauma Questionnaire (CTQ). Results We found that: (i) level of neglect, but not abuse, was negatively associated with differential BOLD responses to reward-punishment within the striatum and medial frontal cortex; and (ii) differential reward-punishment responses within these neglect-associated regions were particularly negatively associated with level of conduct problems. Conclusion Our findings demonstrate the adverse neurodevelopmental impact of childhood maltreatment, particularly neglect, on reinforcement processing. Moreover, they suggest a neurodevelopmental route by which neglect might increase the risk for conduct problems.
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Affiliation(s)
- Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.
| | - Joseph Aloi
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA; Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Steven Vogel
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Erin Carollo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Kayla Pope
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, NY, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
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Blair RJ, Zhang RU, Bashford-Largo J, Bajaj S, Mathur A, Ringle J, Schwartz A, Elowsky J, Dobbertin M, Blair KS, Tyler PM. Reduced neural responsiveness to looming stimuli is associated with increased aggression. Soc Cogn Affect Neurosci 2021; 16:1091-1099. [PMID: 33960389 PMCID: PMC8483278 DOI: 10.1093/scan/nsab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022] Open
Abstract
While neuro-cognitive work examining aggression has examined patients with conditions at increased risk for aggression or individuals self-reporting past aggression, little work has attempted to identify neuro-cognitive markers associated with observed/recorded aggression. The goal of the current study was to determine the extent to which aggression by youth in the first three months of residential care was associated with atypical responsiveness to threat stimuli. This functional MRI study involved 98 (68 male; mean age = 15.96 [sd = 1.52]) adolescents in residential care performing a looming threat task involving images of threatening and neutral human faces or animals that appeared to be either loom or recede. Level of aggression was negatively associated with responding to looming stimuli (irrespective of whether these were threatening or neutral) within regions including bilateral inferior frontal gyrus, right inferior parietal lobule, right superior/middle temporal gyrus and a region of right uncus proximal to the amygdala. These data indicate that aggression level is associated with a decrease in responsiveness to a basic threat cue-looming stimuli. Reduced threat responsiveness likely results in the individual being less able to represent the negative consequences that may result from engaging in aggression, thereby increasing the risk for aggressive episodes.
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Affiliation(s)
- R James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - R u Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Avantika Mathur
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Jay Ringle
- Translational Research Center, Boys Town, NE 68154, USA
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE 68154, USA
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Blair RJR, Bashford-Largo J, Zhang R, Mathur A, Schwartz A, Elowsky J, Tyler P, Hammond CJ, Filbey FM, Dobbertin M, Bajaj S, Blair KS. Alcohol and Cannabis Use Disorder Symptom Severity, Conduct Disorder, and Callous-Unemotional Traits and Impairment in Expression Recognition. Front Psychiatry 2021; 12:714189. [PMID: 34616316 PMCID: PMC8488132 DOI: 10.3389/fpsyt.2021.714189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with reduced emotion expression recognition ability. However, this work has primarily occurred in adults and has not considered neuro-cognitive risk factors associated with conduct problems that commonly co-occur with, and precede, substance use. Yet, conduct problems are also associated with reduced emotion expression recognition ability. The current study investigated the extent of negative association between AUD and CUD symptom severity and expression recognition ability over and above any association of expression recognition ability with conduct problems [conduct disorder (CD) diagnostic status]. Methods: In this study, 152 youths aged 12.5-18 years (56 female; 60 diagnosed with CD) completed a rapid presentation morphed intensity facial expression task to investigate the association between relative severity of AUD/CUD and expression recognition ability. Results: Cannabis use disorder identification test (CUDIT) scores were negatively associated with recognition accuracy for higher intensity (particularly sad and fearful) expressions while CD diagnostic status was independently negatively associated with recognition of sad expressions. Alcohol use disorder identification test (AUDIT) scores were not significantly associated with expression recognition ability. Conclusions: These data indicate that relative severity of CUD and CD diagnostic status are statistically independently associated with reduced expression recognition ability. On the basis of these data, we speculate that increased cannabis use during adolescence may exacerbate a neuro-cognitive risk factor for the emergence of aggression and antisocial behavior.
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Affiliation(s)
- Robert James R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Avantika Mathur
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Patrick Tyler
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, United States
| | | | - Francesca M. Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
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Bashford-Largo J, Aloi J, Zhang R, Bajaj S, Carollo E, Elowsky J, Schwartz A, Dobbertin M, Blair RJR, Blair KS. Reduced neural differentiation of rewards and punishment during passive avoidance learning in adolescents with generalized anxiety disorder. Depress Anxiety 2021; 38:794-803. [PMID: 33739566 PMCID: PMC8328882 DOI: 10.1002/da.23150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/21/2021] [Accepted: 03/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND It has been proposed that individuals with generalized anxiety disorder (GAD) show dysfunctional computations related to approach-avoidance decision-making. However, few studies have examined the neural basis of this impairment, particularly in adolescents with GAD. The goal of the current study was to address this gap in the literature. METHOD The study involved 51 adolescents with GAD and 51 typically developing (TD) comparison individuals matched on age (16.10 and 15.75 respective means), gender (30 F/21 M and 24 F/27 M), and IQ (103.20 and 103.18 respective means). Participants underwent functional magnetic resonance imaging during a passive avoidance task. RESULTS We found a significant Group-by-Reinforcement interaction within reward-related brain regions including the caudate, putamen, mid cingulate/paracentral lobule, and superior and middle frontal gyrus. TD adolescents showed a greater differential response to reward versus punishment feedback within these regions relative to adolescents with GAD. In particular, this reflected reduced responses to rewards in the adolescents with GAD. There were no group differences in neural responses when making approach/avoidance responses. CONCLUSION The results of this study suggest reduced differential responsiveness to reinforcement as a component of the pathophysiology seen in adolescents with GAD. This dysfunction likely underpins decision-making impairments that may exacerbate the participants' worry.
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Affiliation(s)
- Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Joseph Aloi
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Erin Carollo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - R. James R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
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Seok JW, Bajaj S, Soltis-Vaughan B, Lerdahl A, Garvey W, Bohn A, Edwards R, Kratochvil CJ, Blair J, Hwang S. Structural atrophy of the right superior frontal gyrus in adolescents with severe irritability. Hum Brain Mapp 2021; 42:4611-4622. [PMID: 34288223 PMCID: PMC8410540 DOI: 10.1002/hbm.25571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/22/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022] Open
Abstract
Severe irritability is common in youths with psychiatric disorders and results in significant dysfunction across domains (academic, social, and familial). Prior structural MRI studies in the pediatric population demonstrated that aberrations of cortical thickness (CT) and gray matter volume (GMV) in the fronto‐striatal‐temporal regions which have been associated with irritability. However, the directions of the correlations between structural alteration and irritability in the individual indices were not consistent. Thus, we aim to address this by implementing comprehensive assessments of CT, GMV, and local gyrification index (LGI) simultaneously in youths with severe levels of irritability by voxel‐based morphometry and surface‐based morphometry. One hundred and eight adolescents (46 youths with severe irritability and 62 healthy youths, average age = 14.08 years, standard deviation = 2.36) were scanned with a T1‐weighted MRI sequence. The severity of irritability was measured using the affective reactivity index. In youths with severe irritability, there was decreased CT, GMV, and LGI in the right superior frontal gyrus (SFG) compared to healthy youths, and negative correlations between these indices of the SFG and irritability. Our findings suggest that structural deficits in the SFG, potentially related to its role in inhibitory control, may be critical for the neurobiology of irritability.
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Affiliation(s)
- Ji-Woo Seok
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | | | - Arica Lerdahl
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William Garvey
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alexandra Bohn
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ryan Edwards
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Bajaj S, Raikes AC, Razi A, Miller MA, Killgore WDS. Blue-Light Therapy Strengthens Resting-State Effective Connectivity within Default-Mode Network after Mild TBI. J Cent Nerv Syst Dis 2021; 13:11795735211015076. [PMID: 34104033 PMCID: PMC8145607 DOI: 10.1177/11795735211015076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Emerging evidence suggests that post concussive symptoms, including mood changes, may be improved through morning blue-wavelength light therapy (BLT). However, the neurobiological mechanisms underlying these effects remain unknown. We hypothesize that BLT may influence the effective brain connectivity (EC) patterns within the default-mode network (DMN), particularly involving the medial prefrontal cortex (MPFC), which may contribute to improvements in mood. Methods: Resting-state functional MRI data were collected from 41 healthy-controls (HCs) and 28 individuals with mild traumatic brain injury (mTBI). Individuals with mTBI also underwent a diffusion-weighted imaging scan and were randomly assigned to complete either 6 weeks of daily morning BLT (N = 14) or amber light therapy (ALT; N = 14). Advanced spectral dynamic causal modeling (sDCM) and diffusion MRI connectometry were used to estimate EC patterns and structural connectivity strength within the DMN, respectively. Results: The sDCM analysis showed dominant connectivity pattern following mTBI (pre-treatment) within the hemisphere contralateral to the one observed for HCs. BLT, but not ALT, resulted in improved directional information flow (ie, EC) from the left lateral parietal cortex (LLPC) to MPFC within the DMN. The improvement in EC from LLPC to MPFC was accompanied by stronger structural connectivity between the 2 areas. For the BLT group, the observed improvements in function and structure were correlated (at a trend level) with changes in self-reported happiness. Conclusions: The current preliminary findings provide empirical evidence that morning short-wavelength light therapy could be used as a novel alternative rehabilitation technique for mTBI. Trial registry: The research protocols were registered in the ClinicalTrials.gov database (CT Identifiers NCT01747811 and NCT01721356).
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience (SCAN) Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
- Sahil Bajaj, Multimodal Clinical Neuroimaging Laboratory, Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010, USA.
| | - Adam C Raikes
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA
| | - Adeel Razi
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging at Monash University, Clayton, VIC, Australia
- The Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Department of Electronic Engineering, NED University of Engineering and Technology, Karachi, Pakistan
| | - Michael A Miller
- Social, Cognitive and Affective Neuroscience (SCAN) Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - William DS Killgore
- Social, Cognitive and Affective Neuroscience (SCAN) Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
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Alkozei A, Dailey NS, Bajaj S, Vanuk JR, Raikes AC, Killgore WDS. Exposure to Blue Wavelength Light Is Associated With Increases in Bidirectional Amygdala-DLPFC Connectivity at Rest. Front Neurol 2021; 12:625443. [PMID: 33841300 PMCID: PMC8032953 DOI: 10.3389/fneur.2021.625443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Blue wavelength light has been used successfully as a treatment method for certain mood disorders, but, the underlying mechanisms behind the mood enhancing effects of light remain poorly understood. We investigated the effects of a single dose of 30 min of blue wavelength light (n = 17) vs. amber wavelength light (n = 12) exposure in a sample of healthy adults on subsequent resting-state functional and directed connectivity, and associations with changes in state affect. Individuals who received blue vs. amber wavelength light showed greater positive connectivity between the right amygdala and a region within the left dorsolateral prefrontal cortex (DLPFC). In addition, using granger causality, the findings showed that individuals who received blue wavelength light displayed greater bidirectional information flow between these two regions relative to amber light. Furthermore, the strength of amygdala-DLPFC functional connectivity was associated with greater decreases in negative mood for the blue, but not the amber light condition. Blue light exposure may positively influence mood by modulating greater information flow between the amygdala and the DLPFC, which may result in greater engagement of cognitive control strategies that are needed to perceive and regulate arousal and mood.
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Affiliation(s)
- Anna Alkozei
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Natalie S Dailey
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Sahil Bajaj
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - John R Vanuk
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Adam C Raikes
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, University of Arizona, Tucson, AZ, United States
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Aloi J, Crum KI, Blair KS, Zhang R, Bashford-Largo J, Bajaj S, Schwartz A, Carollo E, Hwang S, Leiker E, Filbey FM, Averbeck BB, Dobbertin M, Blair RJR. Individual associations of adolescent alcohol use disorder versus cannabis use disorder symptoms in neural prediction error signaling and the response to novelty. Dev Cogn Neurosci 2021; 48:100944. [PMID: 33773241 PMCID: PMC8024914 DOI: 10.1016/j.dcn.2021.100944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
Two of the most commonly used illegal substances by adolescents are alcohol and cannabis. Alcohol use disorder (AUD) and cannabis use disorder (CUD) are associated with poorer decision-making in adolescents. In adolescents, level of AUD symptomatology has been negatively associated with striatal reward responsivity. However, little work has explored the relationship with striatal reward prediction error (RPE) representation and the extent to which any augmentation of RPE by novel stimuli is impacted. One-hundred fifty-one adolescents participated in the Novelty Task while undergoing functional magnetic resonance imaging (fMRI). In this task, participants learn to choose novel or non-novel stimuli to gain monetary reward. Level of AUD symptomatology was negatively associated with both optimal decision-making and BOLD response modulation by RPE within striatum and regions of prefrontal cortex. The neural alterations in RPE representation were particularly pronounced when participants were exploring novel stimuli. Level of CUD symptomatology moderated the relationship between novelty propensity and RPE representation within inferior parietal lobule and dorsomedial prefrontal cortex. These data expand on an emerging literature investigating individual associations of AUD symptomatology levels versus CUD symptomatology levels and RPE representation during reinforcement processing and provide insight on the role of neuro-computational processes underlying reinforcement learning/decision-making in adolescents.
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Affiliation(s)
- Joseph Aloi
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States; College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Kathleen I Crum
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States; Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Karina S Blair
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Ru Zhang
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Sahil Bajaj
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Amanda Schwartz
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Erin Carollo
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | - Emily Leiker
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
| | - Bruno B Averbeck
- Section on Learning and Decision Making, Laboratory of Neuropsychology, National Institute of Mental Health, Bethesda, MD, United States
| | - Matthew Dobbertin
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
| | - R James R Blair
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE, United States
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Bajaj S, Killgore WDS. Association between emotional intelligence and effective brain connectome: A large-scale spectral DCM study. Neuroimage 2021; 229:117750. [PMID: 33454407 DOI: 10.1016/j.neuroimage.2021.117750] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Emotional Intelligence (EI) is a well-documented aspect of social and interpersonal functioning, but the underlying neural mechanisms for this capacity remain poorly understood. Here we used advanced brain connectivity techniques to explore the associations between EI and effective connectivity (EC) within four functional brain networks. METHODS The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) was used to collect EI data from 55 healthy individuals (mean age = 30.56±8.3 years, 26 males). The MSCEIT comprises two area cores - experiential EI (T1) and strategic EI (T2). The T1 core included two sub-scales - perception of emotions (S1) and using emotions to facilitate thinking (S2), and the T2 core included two sub-scales - understanding of emotions (S3) and management of emotions (S4). All participants underwent structural and resting-state functional magnetic resonance imaging (rsfMRI) scans. The spectral dynamic causal modeling approach was implemented to estimate EC within four networks of interest - the default-mode network (DMN), dorsal attention network (DAN), control-execution network (CEN) and salience network (SN). The strength of EC within each network was correlated with the measures of EI, with correlations at pFDR < 0.05 considered as significant. RESULTS There was no significant association between any of the measures of EI and EC strength within the DMN and DAN. For CEN, however, we found that there were significant negative associations between EC strength from the right anterior prefrontal cortex (RAPFC) to the left anterior prefrontal cortex (LAPFC) and both S2 and T1, and significant positive associations between EC strength from LAPFC to RAPFC and S2. EC strength from the right superior parietal cortex (SPC) to RAPFC also showed significant negative association with S4 and T2. For the SN, S3 showed significant negative association with EC strength from the right insula to RAPFC and significant positive association with EC strength from the left insula to dorsal anterior cingulate cortex (DACC). CONCLUSIONS We provide evidence that the negative ECs within the right hemisphere, and from the right to left hemisphere, and positive ECs within the left hemisphere and from the left to right hemisphere of CEN (involving bilateral frontal and right parietal region) and SN (involving right frontal, anterior cingulate and bilateral insula) play a significant role in regulating and processing emotions. These findings also suggest that measures of EC can be utilized as important biomarkers to better understand the underlying neural mechanisms of EI.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA; Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010, USA.
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
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Zhang R, Bashford-Largo J, Lukoff J, Elowsky J, Carollo E, Schwartz A, Dobbertin M, Bajaj S, Blair KS, Leibenluft E, Blair RJR. Callous-Unemotional Traits Moderate the Relationship Between Irritability and Threatening Responding. Front Psychiatry 2021; 12:617052. [PMID: 34867494 PMCID: PMC8635046 DOI: 10.3389/fpsyt.2021.617052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Irritability and callous-unemotional (CU; reduced guilt/empathy) traits vary dimensionally in the typically developing population but may be particularly marked in youth with conduct disorder (CD). While these dimensional traits are positively correlated, they have been associated with divergent forms of dysfunction, particularly with respect to threat processing (i.e., irritability with increased, and CU traits with decreased, threat responsiveness). This suggests that interactions between these two dimensions may be complex at the neurobiological level. However, this issue has received minimal empirical attention. Methods: The study included 105 adolescents (typically developing and cases with CD; N = 59). They were scanned with fMRI during a looming threat task that involved images of threatening and neutral human faces or animals that appeared to be either looming or receding. Results: Significant irritability-by-CU traits-by-Direction-by-Emotion interactions were seen within right thalamus/PAG, left lingual gyrus and right fusiform gyrus; irritability was positively associated with the BOLD response for Looming Threatening vs. Receding Threatening trials, particularly for youth with low CU traits. In contrast, CU traits were negatively associated with the same differential BOLD response but particularly for youth showing higher levels of irritability. Similar findings were seen within left ventral anterior and posterior cingulate cortices, though the addition of the interaction with CU traits was only seen at slightly more lenient thresholds. Conclusions: The results support previous work linking irritability to increased, and CU traits to reduced, threat responsiveness. However, for adolescents with high irritability, if CU traits are also high, the underlying neuropathology appears to relate to reduced, rather than increased, threat responsiveness.
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Affiliation(s)
- Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Erin Carollo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - R James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
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Blair RJR, Bajaj S, Sherer N, Bashford-Largo J, Zhang R, Aloi J, Hammond C, Lukoff J, Schwartz A, Elowsky J, Tyler P, Filbey FM, Dobbertin M, Blair KS. Alcohol Use Disorder and Cannabis Use Disorder Symptomatology in Adolescents and Aggression: Associations With Recruitment of Neural Regions Implicated in Retaliation. Biol Psychiatry Cogn Neurosci Neuroimaging 2020; 6:536-544. [PMID: 33712378 DOI: 10.1016/j.bpsc.2020.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with an increased risk of aggression. One form of aggression seen during retaliation is reactive aggression to social provocation. This study investigated the association between AUD and CUD symptom severity and recruitment of neural regions implicated in retaliation. METHODS In this study, 102 youths aged 13-18 years (67 male; 84 in residential care) completed self-report measures of aggression-related constructs and participated in a retaliation task during functional magnetic resonance imaging to investigate the association between relative severity of AUD/CUD and atypical recruitment of regions implicated in retaliation. RESULTS AUD Identification Test scores were positively associated with irritability and reactive aggression scores. CUD Identification Test scores were positively associated with callous-unemotional traits and both proactive and reactive aggression scores. In functional magnetic resonance imaging analyses, only AUD Identification Test (not CUD Identification Test) scores were associated with an exaggerated recruitment of regions implicated in retaliation (dorsomedial frontal, anterior insula cortices, caudate, and, to a lesser extent, periaqueductal gray). CONCLUSIONS These data suggest that relative severity of AUD is associated with a disinhibited, exaggerated retaliation response that relates to an increased risk for reactive aggression. Similar findings were not related to severity of CUD.
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Affiliation(s)
- R James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska.
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Noah Sherer
- Department of Biological Sciences, Fordham University, New York City, New York
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chris Hammond
- Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Patrick Tyler
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
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Bajaj S, Blair KS, Schwartz A, Dobbertin M, Blair RJR. Worry and insomnia as risk factors for depression during initial stages of COVID-19 pandemic in India. PLoS One 2020; 15:e0243527. [PMID: 33301508 PMCID: PMC7728274 DOI: 10.1371/journal.pone.0243527] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
The biggest nationwide COVID-19 pandemic lockdown worldwide was enforced in India for an initial period of 21-days. Emerging evidence suggests that pandemic situations and associated lockdowns have an adverse impact on sleep and mental health. However, prediction of sleep health from sociodemographic characteristics and the public’s worry during the initial stages of the COVID-19 pandemic has not been extensively explored so far. It’s also unclear whether sleep outcomes mediate the association between worry and mental health during pandemic situations. A web-survey (N = 391) on sociodemographic characteristics, COVID-19 related worry, sleep health (insomnia and daytime sleepiness), and depression was conducted during the initial 21-days of the COVID-19 stringent lockdown in India. Multiple regression analyses showed that variables, including sex, age, income level, and worry score, contributed to the significant regression equation for insomnia but not for daytime sleepiness. Specifically, the female, younger, lower income, and highly worried populations contributed significantly more than the male, elderly, higher income, and less worried populations, respectively, to the prediction of insomnia. Mediation analyses showed that insomnia, but not daytime sleepiness, fully mediated the relationship between worry score and severity of depressive symptoms. We provide evidence that the female, younger, lower income, and worried populations may be at higher risk for insomnia during pandemic situations. Current evidence gives hope that improving sleep may reduce depressive symptoms during a pandemic situation. This underscores the importance of the implementation of effective public health policies in conjunction with strategical responses to the COVID-19 pandemic.
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Affiliation(s)
- Sahil Bajaj
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
- Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
- * E-mail:
| | - Karina S. Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
- Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
| | - Amanda Schwartz
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
- Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
| | - Matthew Dobbertin
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
- Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
| | - R. James R. Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
- Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States of America
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Bavdekar SB, Chandrasekaran A, Govindarajan RP, Malik S, Bajaj S, Javeri Y, Niranjan V. Physician Health in the Times of COVID-19. J Assoc Physicians India 2020; 68:21-27. [PMID: 33247638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES A virtual registry study evaluating real world evidence on physicians' use of prophylactic regimens for protection against SARS-CoV-2. This paper summarizes the interim results. METHODS Asymptomatic physicians at risk of acquiring SARS-CoV-2 responded to online questions at baseline and 7 weeks post-baseline. Baseline data included demographics, prophylaxis regimen (including "no prophylaxis") and start date. Participants who provided complete week-7 data (information on type of health facility [COVID/Non-COVID], number of presumed/confirmed cases exposed to, PPE use, SARS-CoV-2 testing and symptoms, regimen adherence and intercurrent illness) comprised the Completer population. Limited data (regimen adherence, SARS-CoV-2 testing) was collected for participants who failed to provide complete week7 data. Those providing limited/complete information comprised the Evaluable population. RESULTS Of 369 enrolled participants, 182 (mean age 42±11.05 years) comprised the Evaluable population. They showed a male preponderance (67.6%). Practitioners from Maharashtra (59.9%) and specialties of Pediatrics, Internal Medicine, Anesthesiology and Critical Care (63.2%) accounted for the majority. ICMR's HCQ prophylaxis regimen was initiated by 125 (68.7%) participants with 31 (17%) initiating 'No prophylaxis'. The highest adherence was for the ICMRregimen (87.2%). In the Completer population comprising 150 participants, 87 were exposed to presumed (81) and/or confirmed cases (60). Most exposures to confirmed cases (49, 81.7%) were high-risk. PPE use was generally high (75-100%). Most participants (94.7%) did not report an AE. The proportions with an AE was similar with ICMR regimen (5.9%) and no prophylaxis (6.5%). INTERPRETATION AND CONCLUSIONS Physicians in India preferred ICMR's HCQ regimen. The regimen appears to be safe and associated with a high level of adherence.
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Affiliation(s)
- S B Bavdekar
- Chief Academics, Department of Pediatrics, Surya Hospital, Mumbai, Maharashtra
| | | | | | - S Malik
- Professor and Head, Department of Pediatrics, TN Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - S Bajaj
- Founder Director, Ujala Cygnus Hospitals, New Delhi
| | - Y Javeri
- Head CCM and Emergency Medicine, Regency Super Specialty Hospital, Lucknow, Uttar Pradesh
| | - V Niranjan
- Founder and Director, Translational Medicine, RxMD, Chennai, Taml Nadu
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Kalra S, Das AK, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Bajaj S, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. J Family Med Prim Care 2020; 9:5450-5457. [PMID: 33532378 PMCID: PMC7842427 DOI: 10.4103/jfmpc.jfmpc_843_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - S Chandrasekaran
- Department of Endocrinology and Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Nepal
| | - T Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology and Diabetes, Dr. Wiam Clinic, Royal Hospital, Awali Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, UAE
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Shah P, Bajaj S, Polsky D. 646 Late-stage melanoma diagnosis in New York State (NYS). J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alkozei A, Dailey NS, Bajaj S, Vanuk JR, Raikes AC, Grandner MA, Killgore WD. 0070 The Effects of Acute Blue Wavelength Light Exposure on Functional Brain Connectivity and Mood. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Blue wavelength light is an effective treatment for delayed sleep phase syndrome, seasonal affective disorder and bipolar depression. The role of blue light in regulating melatonin production has been extensively studied, but other potential neurophysiological effects remain poorly understood. Some studies have suggested that daily blue light exposure may modulate functional brain responses within the amygdala and prefrontal cortex (PFC), potentially explaining blue light’s antidepressant effect. In this study we investigated the effects of a single 30-minute session of blue light exposure on functional resting state connectivity between the amygdala and PFC.
Methods
Twenty-nine healthy 18–32 year olds were randomly assigned to either receive 30 minutes of blue (n=17) or non-blue (amber) light (n=12) exposure followed by a 7-minute resting state scan. Pre- and post light exposure, participants completed the Positive and Negative Affect Scale, as a measure of state affect.
Results
Individuals who received blue versus amber light showed greater positive connectivity between the right amygdala and the left dorsolateral prefrontal cortex (DLPFC) (x=-24, y=46, z=18, k=90, volume p-FDR corrected, p<0.001). Increased amygdala-DLFC connectivity correlated with greater decreases in negative mood for the blue (ρ=-.55, p=0.03), but not the amber group. Using Granger Causality, we found that the directionality of information flow between these two areas was bidirectional (p<0.0025).
Conclusion
Blue light exposure appears to facilitate greater information flow between the amygdala and the DLPFC at rest, potentially enhancing cognitive processes that regulate arousal and mood. As blue light exposure has been shown to enhance attention and learning, using blue light exposure during practice of emotional regulation strategies, such as reappraisal, may further increase the beneficial effects of blue light on mood. In order to use blue light exposure in a more targeted manner for sleep and mood disorders, further research into the underlying neurophysiological mechanisms is needed.
Support
This research was supported by a USAMRAA grant to WDSK (W81XWH-14-1-0571) as well as by an Arizona Health Education Centers (AHEC) Research Grant to AA.
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Affiliation(s)
| | | | - S Bajaj
- University of Arizona, Tucson, AZ
| | | | | | - M A Grandner
- University of Arizona, University of Arizona, AZ
| | - W D Killgore
- University of Arizona, University of Arizona, AZ
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Kalra S, Ghosh S, Das AK, Nair T, Bajaj S, Priya G, Mehrotra RN, Das S, Shah P, Deshmukh V, Chawla M, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel. Indian Heart J 2020; 72:7-13. [PMID: 32423565 PMCID: PMC7231843 DOI: 10.1016/j.ihj.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022] Open
Abstract
AIM The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - A K Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - T Nair
- Dept. of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals in Bhubaneswar, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra
| | - M Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal
| | - S Chandrasekaran
- Department of Endocrinology & Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology & Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology & Diabetes, Royal Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Bajaj S, Blair KS, Zhang R, Bashford-Largo J, Dobbertin M, Blair RJ. Impact of Sleep Quality on the Association Between Unease and Physical Exercise During Initial Stages of COVID-19 Pandemic in India. Nat Sci Sleep 2020; 12:705-708. [PMID: 33117006 PMCID: PMC7567547 DOI: 10.2147/nss.s273380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sahil Bajaj
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.,Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Karina S Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.,Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Ru Zhang
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.,Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Johannah Bashford-Largo
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.,Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Matthew Dobbertin
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.,Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R James Blair
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA.,Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
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Das AK, Kalra S, Tiwaskar M, Bajaj S, Seshadri K, Chowdhury S, Sahay R, Indurkar S, Unnikrishnan AG, Phadke U, Pareek A, Purkait I. Expert Group Consensus Opinion: Role of Anti-inflammatory Agents in the Management of Type-2 Diabetes (T2D). J Assoc Physicians India 2019; 67:65-74. [PMID: 31801334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diabetes is a major public health emergency of the 21st century. Results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study have found prevalence of diabetes and prediabetes in India to be as high as 7.3% and 10.3%, respectively with nation-wide projection of 77.2 million people with prediabetes and 69.2 million with diabetes. It is well established that insulin resistance (IR) and islet β-cell failure are the two major features of T2D Multiple mechanisms including glucotoxicity, lipotoxicity, oxidative stress, endoplasmic reticulum stress, formation of amyloid deposits in the islets, etc. have been hypothesized to participate in the pathology of the disease. In the concluding decade of the last century, numerous studies - prospective and cross-sectional, have confirmed the role of chronic low-grade inflammation as a pathogenetic factor of T2D. It has been shown that increased levels of various inflammatory markers and mediators including fundamental markers like white blood cell count, C-reactive protein (CRP) to the more specific circulating cytokines like, interleukin-6 (IL-6), IL-1β, plasminogen activator inhibitor-1 (PAI-1), etc. correlate with incident T2D. Based on the robust evidence implying the role of inflammation in T2D pathogenesis, several studies have proven that the proinflammatory cytokines play a central role in the development of microvascular diabetic complications such as nephropathy, retinopathy, and neuropathy. Inflammation in T2D causes accelerated atherosclerosis which predisposes to CVD, the leading cause of mortality in these patients. Recently there is a considerable increase in the interest among the researchers about anti-inflammatory therapies in the setting of chronic disorders such as T2D and CV diseases. In a multi-country study conducted in Asia, approximately 50% of Indian respondents had poor diabetes control. Most patients initially respond to sulfonylurea and/or metformin, and later these agents lose their effectiveness with time. Therapeutic option in patients uncontrolled on two-drug combination therapy is either to add third oral drug or insulin. However, use of insulin is limited due to its high cost and poor compliance. Majority of new treatment options like GLP1 agonists, insulin analogs and SGLT2 inhibitors are costly considering they are still under patent. The thiazolidinedione class of drugs is associated with adverse effects like fluid retention and weight gain that may result in or exacerbate edema and congestive heart failure. Thus there is a need for a safe and inexpensive treatment option for the management of uncontrolled T2D. Considering the role of inflammation in T2D pathogenesis, the drug should not only have antihyperglycemic effects but also reduce inflammatory burden thus reducing the progression and complications of T2D. The current interest is apparently directed towards drugs targeting inflammation acting at different stages of the inflammatory cascade. In the recently published CANTOS study, canakinumab, a selective, high-affinity, fully human monoclonal antibody which inhibits IL-1β, has no consistent long-term benefits on HbA1c. Other selective inhibitors like anakinra (IL-1 receptor antagonist) and etanercept (TNF inhibitor) too have yielded modest effects on glycemic parameters and insulin sensitivity. However, hydroxychloroquine (HCQ), a broad anti-inflammatory agent has been shown to reduce HbA1c by 0.87%. Hydroxychloroquine (HCQ) is considered as one of the safest disease modifying anti-rheumatic drug, used widely for the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The effect of HCQ in preventing development of diabetes in patients with chronic inflammatory diseases was highlighted in a prospective observational study of 4905 adults with rheumatoid arthritis and no diabetes with 21.5 years of follow-up. Patients who took HCQ for more than 4 years had a significant 77% lower risk of diabetes compared with non users of HCQ (RR, 0.23; 95% CI, 0.11-0.50). Taking cue from this study highlighting the anti-diabetic effect of HCQ, pioneering research studies evaluating these effects of HCQ were conducted in India. In 2014, hydroxychloroquine 400 mg got DCGI approval as an adjunct to diet and exercise to improve glycemic control of patients on metformin, sulfonylurea combination in Type 2 diabetes.
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Affiliation(s)
- A K Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry , Corresponding Author
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
| | - M Tiwaskar
- Department of Medicine, Shilpa Medical Research Center, Mumbai, Maharashtra
| | - S Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | - K Seshadri
- Visiting Professor, Sri Balaji Vidhyapeeth, Pondicherry
| | - S Chowdhury
- Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal
| | - R Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana
| | - S Indurkar
- Consulting Diabetologist, Aurangabad, Maharashtra
| | | | - U Phadke
- Ruby Hall Clinic, Pune, Maharashtra
| | - A Pareek
- Medical Affairs and Clinical Research, Ipca Laboratories Ltd., Mumbai, Maharashtra
| | - I Purkait
- Medical Affairs and Clinical Research, Ipca Laboratories Ltd., Mumbai, Maharashtra
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Bajaj S, Muranjan M, Karande S, Prabhat D. Rare disease heralded by pulmonary manifestations: Avoiding pitfalls of an "asthma" label. J Postgrad Med 2019; 63:122-127. [PMID: 28272068 PMCID: PMC5414422 DOI: 10.4103/0022-3859.201416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary manifestations are seldom recognized as symptoms of storage disorders. The report describes the diagnostic journey in a 30-month-old male infant, born of a third-degree consanguineous marriage referred to our institute as severe persistent asthma. History revealed that the child had progressively worsening breathlessness and persistent dry cough not associated with fever but accompanied by weight loss. On physical examination, there was growth failure, respiratory distress, clubbing, hepatosplenomegaly, and occasional rhonchi. Blood gas revealed hypoxemia which improved with oxygen administration. Plain X-rays and high-resolution computed tomography of the chest showed perihilar alveolar infiltrates and patchy consolidation. The clinicoradiological features did not support a diagnosis of asthma but favored interstitial lung disease (ILD). Bronchoalveolar lavage was performed as a first-tier investigation. It showed periodic acid-Schiff-negative foamy macrophages. The clues of consanguinity, visceromegaly, ILD, and foamy macrophages in the bronchoalveolar fluid prompted consideration of lysosomal storage disorders as the likely etiology. Gaucher disease and Niemann-Pick disease A/B were ruled out by enzyme estimation. Niemann-Pick disease type C was suspected and confirmed by detecting a homozygous mutation in the NPC2 gene. This case serves to caution physicians against labeling breathlessness in every toddler as asthma. It emphasizes the importance of searching for tell-tale signs such as clubbing and extrapulmonary clues which point to a systemic disease such as lysosomal storage disorders as a primary etiology of chronic respiratory symptoms.
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Affiliation(s)
- S Bajaj
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - D Prabhat
- Department of Pathology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Bajaj S, Killgore WDS. Vulnerability to mood degradation during sleep deprivation is influenced by white-matter compactness of the triple-network model. Neuroimage 2019; 202:116123. [PMID: 31461677 DOI: 10.1016/j.neuroimage.2019.116123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/15/2019] [Accepted: 08/23/2019] [Indexed: 12/18/2022] Open
Abstract
Sleep deprivation (SD) is often associated with significant shifts in mood state relative to baseline functioning. Prior work suggests that there are consistent trait-like differences among individuals in the degree to which their mood and performances are affected by sleep loss. The goal of this study was to determine the extent to which trait-like individual differences in vulnerability/resistance to mood degradation during a night of SD are dependent upon region-specific white and grey matter (WM/GM) characteristics of a triple-network model, including the default-mode network (DMN), control-execution network (CEN) and salience network (SN). Diffusion-weighted and anatomical brain data were collected from 45 healthy individuals several days prior to a 28-h overnight SD protocol. During SD, a visual analog mood scale was administered every hour from 19:15 (time point1; TP1) to 11:15 (TP17) the following morning to measure two positive and six negative mood states. Four core regions within the DMN, five within the CEN, and seven within the SN were used as regions of interest (ROIs). An index of mood resistance (IMR) was defined as the averaged differences between positive and negative mood states over 12 TPs (TP5 to TP16) relative to baseline (TP1 to TP4). For each ROI, characteristics of WM - quantitative anisotropy (QA) and mean curvature index (WM-MCI), and GM - cortical volume (CV) and GM-MCI were estimated, and used to predict IMR. WM characteristics, particularly QA, of all of regions within the DMN, and most of the regions within the CEN and SN predicted IMR during SD. In contrast, most ROIs did not show significant association between IMR and any of the GM characteristics (CV and MCI) or WM MCI. Our findings suggest that greater resilience to mood degradation induced by total SD appears to be associated with more compact axonal pathways within the DMN, CEN and SN.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
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Bajaj S, Killgore WDS. Sex differences in limbic network and risk-taking propensity in healthy individuals. J Neurosci Res 2019; 98:371-383. [PMID: 31373060 DOI: 10.1002/jnr.24504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 01/26/2023]
Abstract
Little is known about the structural neural substrates that may contribute to sex differences in risk-taking propensity (RTP). A close association between risk-seeking behavior and the emotional-regulation network led us to hypothesize that the sex differences in RTP would be associated with sex differences in brain morphometry of the limbic network (LN). We collected RTP scores using the bubble sheet version of the evaluation of risk (EVAR) scale and neuroanatomical data from 57 healthy individuals (29 males). The EVAR scale included sub-scales measuring recklessness/impulsivity, self-confidence, and need for control (NFC). We observed significant sex differences in NFC showing greater desire for control and dominance in males than females (multivariate analysis of covariance, MANCOVAN: p = .01). Morphometry analysis showed that it was only the right LN, which showed significant sex differences in normalized surface area, normalized cortical volume, and adjusted mean curvature index (females > males) at p < .01 (MANCOVAN, corrected for multiple comparisons). Correlation analysis showed that greater curvature of the right LN was significantly associated with lower desire for control in high-risk events (r = -.31, p = .02 at 95% CI of [-0.53, -0.05]). Our findings suggest that the normalized cortical measures could indicate specific sex differences in brain morphometry, particularly within the LN. The curvature index was the only differentiating factor for greater/lower propensity for risk-taking behavior in overall sample. Therefore, the LN and the curvature measures could be key biomarkers, which play an important role in predicting risk-taking behavior.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona
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Bajaj S, Raikes AC, Grandner MA, Killgore WD. 0121 Quantitative Anisotropy Within The Default-mode Network Predicts Mood Degradation Following Sleep-deprivation. Sleep 2019. [DOI: 10.1093/sleep/zsz067.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sahil Bajaj
- Psychiatry, University of Arizona, Tucson, AZ, USA
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Raikes AC, Satterfield BC, Bajaj S, Grandner MA, Killgore WDS. 0935 Daily Blue Light Therapy Reduces Daytime Sleepiness and Post-concussion Symptoms After Mild Traumatic Brain Injury. Sleep 2019. [DOI: 10.1093/sleep/zsz067.933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bajaj S, Raikes AC, Smith R, Vanuk JR, Killgore WDS. The Role of Prefrontal Cortical Surface Area and Volume in Preclinical Suicidal Ideation in a Non-Clinical Sample. Front Psychiatry 2019; 10:445. [PMID: 31312146 PMCID: PMC6613495 DOI: 10.3389/fpsyt.2019.00445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
Suicidal ideation (SUI) can occur in the absence of concomitant psychiatric diagnoses, and even normal levels can be problematic among individuals experiencing excess stress or lack of social support. The objective of this study was to investigate the neuroanatomical basis of SUI in non-clinical human populations who are within the normal limits of SUI, after accounting for elevated stress and perceived lack of social support. Neuroanatomical data were collected from 55 healthy individuals (mean age 30.9 ± 8.1 years, 27 females) whose depression severity levels were below the Diagnostic and Statistical Manual of Mental Disorders criteria. Measures of SUI, aggression, stress, non-support, and treatment rejection were collected from the treatment-consideration scales (TCS) of the Personality Assessment Inventory (PAI). Correlations between standardized SUI scores and three brain morphometry measures, including vertex wise cortical thickness (CT), cortical surface area (CSA), and cortical volume (CV), were estimated for each participant, controlling for age, sex, intracranial volume, and the remaining TCS measures. We observed a significant negative association between scores on SUI and both CSA and CV (cluster-forming threshold of p < 0.005, clusterwise threshold of p < 0.05, FDR corrected for multiple comparisons) within the left rostral middle frontal gyrus. Our findings suggest that greater CSA and CV within the dorsolateral prefrontal cortex are associated with reduced SUI in a non-clinical population with mild levels of stress and perceived lack of social support. Because the dorsolateral prefrontal cortex has been broadly linked to cognitive reappraisal, self-critical thoughts, and emotional regulation, greater CSA and CV within these regions may lead to better mental health by protecting healthy individuals from engaging in SUI during periods of stress and perceived insufficient social support. As our data consisted of only healthy individuals with non-clinical levels of SUI, further investigation will be necessary to explore the neural basis of SUI in populations who may be at greater risk of future suicidal behavior.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Adam C Raikes
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan Smith
- The Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States
| | - John R Vanuk
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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Sardana K, Bajaj S, Bose SK. Successful treatment of PAPA syndrome with minocycline, dapsone, deflazacort and methotrexate: a cost-effective therapy with a 2-year follow-up. Clin Exp Dermatol 2018; 44:577-579. [PMID: 30259545 DOI: 10.1111/ced.13792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Affiliation(s)
- K Sardana
- Department of Dermatology Venereology and Leprosy, PGIMER Dr RML Hospital, New Delhi, India
| | - S Bajaj
- Department of Dermatology, Fjórðungssjúkrahúsið á Akureyri, Akureyri, Iceland
| | - S K Bose
- Indraprastha Apollo Hospitals, New Delhi, India
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Bajaj S, Raikes A, Smith R, Dailey NS, Alkozei A, Vanuk JR, Killgore WDS. The Relationship Between General Intelligence and Cortical Structure in Healthy Individuals. Neuroscience 2018; 388:36-44. [PMID: 30012372 DOI: 10.1016/j.neuroscience.2018.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 11/29/2022]
Abstract
Considerable work in recent years has examined the relationship between cortical thickness (CT) and general intelligence (IQ) in healthy individuals. It is not known whether specific IQ variables (i.e., perceptual reasoning [PIQ], verbal comprehension IQ [VIQ], and full-scale IQ [FSIQ]) are associated with multiple cortical measures (i.e., CT, cortical volume (CV), cortical surface area (CSA) and cortical gyrification (CG)) within the same individuals. Here we examined the association between these neuroimaging metrics and IQ in 56 healthy adults. At a cluster-forming threshold (CFT) of p < 0.05, we observed significant positive relationships between CT and all three IQ variables in regions within the posterior frontal and superior parietal lobes. Regions within the temporal and posterior frontal lobes exhibited positive relationships between CV and two IQ variables (PIQ and FSIQ) and regions within the inferior parietal lobe exhibited positive relationships between CV and PIQ. Additionally, CV was positively associated with VIQ in the left insula and with FSIQ within the inferior frontal gyrus. At a more stringent CFT (p < 0.01), the CT-PIQ, CT-VIQ, CT-FSIQ, and CV-PIQ relationships remained significant within the posterior frontal lobe, as did the CV-PIQ relationship within the temporal and inferior parietal lobes. We did not observe statistically significant relationships between IQ and either CSA or CG. Our findings suggest that the neural basis of IQ extends beyond previously observed relationships with fronto-parietal regions. We also conclude that CT and CV may be more useful metrics than CSA or CG in the study of intellectual abilities.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA.
| | - Adam Raikes
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Ryan Smith
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Natalie S Dailey
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Anna Alkozei
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - John R Vanuk
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
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Dailey NS, Smith R, Bajaj S, Alkozei A, Gottschlich MK, Raikes AC, Satterfield BC, Killgore WDS. Elevated Aggression and Reduced White Matter Integrity in Mild Traumatic Brain Injury: A DTI Study. Front Behav Neurosci 2018; 12:118. [PMID: 30013466 PMCID: PMC6036267 DOI: 10.3389/fnbeh.2018.00118] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/28/2018] [Indexed: 12/27/2022] Open
Abstract
Mild traumatic brain injury (mTBI) remains the most commonly reported head injury in the United States, and is associated with a wide range of post-concussive symptoms including physical, cognitive and affective impairments. Elevated aggression has been documented in mTBI; however, the neural mechanisms associated with aggression at the chronic stage of recovery remain poorly understood. In the present study, we investigated the association between white matter integrity and aggression in mTBI using diffusion tensor imaging (DTI). Twenty-six age-matched adults participated in the study, including 16 healthy controls (HCs) and 10 individuals in the chronic stage of recovery (either 6-months or 12 months post-mTBI). Psychological measures of aggression included the Buss-Perry Aggression Questionnaire and the Personality Assessment Inventory (PAI). Axonal pathways implicated in affective processing were studied, including the corpus callosum, anterior thalamic radiation, cingulum and uncinate fasciculus, and measures of white matter integrity included fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD). We found that adults with mTBI in the chronic stage of recovery had higher levels aggression. Individuals with mTBI also had greater RD in the corpus callosum compared to HCs, indicating reduced fiber integrity. Furthermore, we observed a significant association between reduced white matter integrity in the corpus callosum and greater aggression. Our findings provide additional evidence for underlying neuroanatomical mechanisms of aggression, although future research will be necessary to characterize the specific relationship between aggression and the white matter pathways we identified.
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Affiliation(s)
- Natalie S Dailey
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan Smith
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Anna Alkozei
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Melissa K Gottschlich
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Adam C Raikes
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Brieann C Satterfield
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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Raikes AC, Bajaj S, Dailey NS, Smith RS, Alkozei A, Satterfield BC, Killgore WDS. Diffusion Tensor Imaging (DTI) Correlates of Self-Reported Sleep Quality and Depression Following Mild Traumatic Brain Injury. Front Neurol 2018; 9:468. [PMID: 29973910 PMCID: PMC6019466 DOI: 10.3389/fneur.2018.00468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Mild traumatic brain injuries (mTBIs) are a significant social, sport, and military health issue. In spite of advances in the clinical management of these injuries, the underlying pathophysiology is not well-understood. There is a critical need to advance objective biomarkers, allowing the identification and tracking of the long-term evolution of changes resulting from mTBI. Diffusion-weighted imaging (DWI) allows for the assessment of white-matter properties in the brain and shows promise as a suitable biomarker of mTBI pathophysiology. Methods: 34 individuals within a year of an mTBI (age: 24.4 ± 7.4) and 18 individuals with no history of mTBI (age: 23.2 ± 3.4) participated in this study. Participants completed self-report measures related to functional outcomes, psychological health, post-injury symptoms, and sleep, and underwent a neuroimaging session that included DWI. Whole-brain white matter was skeletonized using tract-based spatial statistics (TBSS) and compared between groups as well as correlated within-group with the self-report measures. Results: There were no statistically significant anatomical differences between the two groups. After controlling for time since injury, fractional anisotropy (FA) demonstrated a negative correlation with sleep quality scores (higher FA was associated with better sleep quality) and increasing depressive symptoms in the mTBI participants. Conversely, mean (MD) and radial diffusivity (RD) demonstrated positive correlations with sleep quality scores (higher RD was associated with worse sleep quality) and increasing depressive symptoms. These correlations were observed bilaterally in the internal capsule (anterior and posterior limbs), corona radiata (anterior and superior), fornix, and superior fronto-occipital fasciculi. Conclusion: The results of this study indicate that the clinical presentation of mTBI, particularly with respect to depression and sleep, is associated with reduced white-matter integrity in multiple areas of the brain, even after controlling for time since injury. These areas are generally associated not only with sleep and emotion regulation but also cognition. Consequently, the onset of depression and sleep dysfunction as well as cognitive impairments following mTBI may be closely related to each other and to white-matter integrity throughout the brain.
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Affiliation(s)
- Adam C Raikes
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sahil Bajaj
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Natalie S Dailey
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan S Smith
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Anna Alkozei
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Brieann C Satterfield
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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