Atypical Cortical Activation During Risky Decision Making in Disruptive Behavior Disordered Youths With Histories of Suicidal Ideation

Effects of comorbidity on executive functions among children with ADHD, finding trends

There is still no basic overview about the effect of various types of comorbidity in executive functions due to two main reasons: (1) the type and number of comorbidities in ADHD is significantly varied, (2) EFs are very diverse and have different neuropsychological properties. Our objective was to determine the effect of comorbid disorders (number and type) on the performance in a wide range (seven) of executive functions in a sample of children with ADHD. Fifty-five male children aged seven to nine years with ADHD were divided into six groups: G1 = ADHD only (ADHD-O), G1 = Oppositional defiant disorder (ODD), G3 = (anxiety/depressive disorder (ADD), G4 = ODD + ADD, G5 = ODD + learning disorder (LD), G6 = ODD + LD + conduct disorder (CD). The six groups exhibited different number of deficits in EFs; G1 showed only 1 deficit in contrast, G6 presented 11. Statistical analysis (ANOVA and logistic regression) identified three most affected EFs: Working memory, generation/classification of semantic categories, and inhibitory control. Alterations in EFs increased mainly in relation to the increase of the specific number and type of comorbidity. To date, no studies have addressed comorbidity from this perspective. A wide range approach of EF confirms the need to further study comorbidity in ADHD from a wide range/variety perspective and determine all possible combinations (number/type) to clarify its contribution to the complex neuropsychology functioning in ADHD.

A Systematic Review of MRI Studies and the "Emotional paiN and social Disconnect (END)" Brain Model of Suicidal Behavior in Youth

Introduction

Risk of suicidal ideation and suicidal behaviors greatly increases during adolescence, and rates have risen dramatically over the past two decades. However, few risk factors or biomarkers predictive of suicidal ideation or attempted suicide have been identified in adolescents. Neuroimaging correlates hold potential for early identification of adolescents at increased risk of suicidality and risk stratification for those at high risk of suicide attempt.

Methods

In this systematic review, we evaluated neural regions and networks associated with suicidal ideation and suicide attempt in adolescents derived from magnetic resonance imaging (MRI) studies. A total of 28 articles were included in this review.

Results

After descriptively synthesizing the literature, we propose the Emotional paiN and social Disconnect (END) model of adolescent suicidality and present two key neural circuits: (1) the emotional/mental pain circuit and (2) the social disconnect/distortion circuit. In the END model, the emotional pain circuit-consisting of the cerebellum, amygdala, and hippocampus-shows similar aberrations in adolescents with suicidal ideation as in those with a history of a suicide attempt (but to a smaller degree). The social disconnect circuit is unique to adolescent suicide attempters and includes the lateral orbitofrontal cortex (OFC), the temporal gyri, and the connections between them.

Conclusion

Our proposed END brain model of suicidal behavior in youth, if confirmed by future prospective studies, can have implications for clinical goals of early detection, risk stratification, and intervention development. Treatments that target emotional pain and social disconnect may be ideal interventions for reducing suicidality in adolescents.

Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review

Introduction

The Balloon Analog Risk Task (BART), a computerized behavioral paradigm, is one of the most common tools used to assess the risk-taking propensity of an individual. Since its initial behavioral version, the BART has been adapted to neuroimaging technique to explore brain networks of risk-taking behavior. However, while there are a variety of paradigms adapted to neuroimaging to date, no consensus has been reached on the best paradigm with the appropriate parameters to study the brain during risk-taking assessed by the BART. In this review of the literature, we aimed to identify the most appropriate BART parameters to adapt the initial paradigm to neuroimaging and increase the reliability of this tool.

Methods

A systematic review focused on the BART versions adapted to neuroimaging was performed in accordance with PRISMA guidelines.

Results

A total of 105 articles with 6,879 subjects identified from the PubMed database met the inclusion criteria. The BART was adapted in four neuroimaging techniques, mostly in functional magnetic resonance imaging or electroencephalography settings.

Discussion

First, to adapt the BART to neuroimaging, a delay was included between each trial, the total number of inflations was reduced between 12 and 30 pumps, and the number of trials was increased between 80 and 100 balloons, enabling us to respect the recording constraints of neuroimaging. Second, explicit feedback about the balloon burst limited the decisions under ambiguity associated with the first trials. Third, employing an outcome index that provides more informative measures than the standard average pump score, along with a model incorporating an exponential monotonic increase in explosion probability and a maximum explosion probability between 50 and 75%, can yield a reliable estimation of risk profile. Additionally, enhancing participant motivation can be achieved by increasing the reward in line with the risk level and implementing payment based on their performance in the BART. Although there is no universal adaptation of the BART to neuroimaging, and depending on the objectives of a study, an adjustment of parameters optimizes its evaluation and clinical utility in assessing risk-taking.

Profiles of HIV-Related Knowledge and Self-Regulation Factors in At-Risk Pre-Adolescents

Disrupted self-regulation can increase youths' risk for substance use and HIV acquisition. Latent profile analysis (LPA) was used to explore profiles among 124 youth ages 11-13 who had impulse control disorders. LPA was based on self-regulation factors and three HIV/AIDS-specific domains: AIDS-related knowledge; perceived severity of AIDS; and worry about HIV. LPA identified four profiles: 1) low knowledge/low regulation; 2) low perceived severity/high regulation; 3) high knowledge/low regulation; and 4) moderate knowledge/moderate regulation. Youth with the highest HIV/AIDS knowledge showed the highest impulsivity, emotion dysregulation, and violence exposure. Youth may benefit from tailored prevention based on HIV-related knowledge/beliefs and self-regulation.

Family history of substance use disorder and parental impulsivity are differentially associated with neural responses during risky decision-making

Background

Risky decision-making is associated with the development of substance use behaviors during adolescence. Although prior work has investigated risky decision-making in adolescents at familial high risk for developing substance use disorders (SUDs), little research has controlled for the presence of co-morbid externalizing disorders (EDs). Additionally, few studies have investigated the role of parental impulsivity in offspring neurobiology associated with risky decision-making.

Methods

One-hundred twenty-five children (28 healthy controls, 47 psychiatric controls with EDs without a familial history of SUD, and 50 high-risk children with co-morbid EDs with a familial history of SUD) participated in the Balloon Analog Risk Task while undergoing functional magnetic resonance imaging. Impulsivity for parents and children was measured using the UPPS-P Impulsive Behavior Scale.

Results

We found that individuals in the psychiatric control group showed greater activation, as chances of balloon explosion increased, while making choices, relative to the healthy control and high-risk groups in the rostral anterior cingulate cortex (rACC) and lateral orbitofrontal cortex (lOFC). We also found a positive association between greater activation and parental impulsivity in these regions. However, within rACC, this relationship was moderated by group, such that there was a positive relationship between activation and parental impulsivity in the HC group, but an inverse relationship in the HR group.

Conclusions

These findings suggest that there are key differences in the neurobiology underlying risky decision-making in individuals with EDs with and without a familial history of SUD. The current findings build on existing models of neurobiological factors influencing addiction risk by integrating parental factors. This work paves the way for more precise risk models in which to test preventive interventions.

Multimodal Elements of Suicidality Reduction After Transcranial Magnetic Stimulation

OBJECTIVES

Repetitive transcranial magnetic stimulation (TMS) is a promising treatment for suicidality, but it is underlying neural mechanisms remain poorly understood. Our prior findings indicated that frontostriatal functional connectivity correlates with the severity of suicidal thoughts and behaviors. In this secondary analysis of data from an open label trial, we evaluated whether changes in frontostriatal functional connectivity would accompany suicidality reductions following TMS. We also explored the relationship between frontostriatal connectivity change and underlying white matter (WM) organization.

MATERIALS AND METHODS

We conducted seed-based functional connectivity analysis on participants (N = 25) with comorbid post-traumatic stress disorder and depression who received eight weeks of 5 Hz TMS to left dorsolateral prefrontal cortex. We measured clinical symptoms with the Inventory of Depressive Symptomatology-Self Report (IDS-SR) and the PTSD Checklist for DSM-5 (PCL-5). We derived suicidality from IDS-SR item 18. Magnetic resonance imaging data were collected before TMS, and at treatment end point. These data were entered into analyses of covariance, evaluating the effect of suicidality change across treatment on striatal and thalamic functional connectivity. Changes in other PTSD and depression symptoms were included as covariates and results were corrected for multiple comparisons. Diffusion connectometry in a participant subsample (N = 17) explored the relationship between frontal WM integrity at treatment baseline and subsequent functional connectivity changes correlated with differences in suicidality.

RESULTS

Suicidal ideation decreased in 65% of participants. Reductions in suicidality and functional connectivity between the dorsal striatum and frontopolar cortex were correlated (p-False Discover Rate-corrected < 0.001), after covariance for clinical symptom change. All other results were nonsignificant. Our connectometry results indicated that the integrity of frontostriatal WM may circumscribe functional connectivity response to TMS for suicide.

CONCLUSIONS

Targeted reduction of fronto-striatal connectivity with TMS may be a promising treatment for suicidality. Future research can build on this multimodal approach to advance individualized stimulation approaches in high-risk patients.