Western State Hospital

Adolescents exhibit progressively later timing of sleep and circadian rhythms that is mismatched with the early schedules imposed by high school, resulting in circadian misalignment. Observational evidence links circadian misalignment to mood disturbance and substance abuse, as well as an altered neural response to reward, but precludes determination of causality. In the present study, we tested, for the first time, whether experimentally-imposed circadian misalignment alters the neural response to monetary reward. Healthy adolescents (n=19, ages 13-17) completed two in-lab sleep schedules followed by a card-guessing monetary reward fMRI task: ‘Aligned’ conditions based on typical summer sleep-wake times (midnight-9:30am: fMRI at 11 am) and ‘Misaligned’ conditions set to four hours earlier (8pm-5:30am: fMRI at 7 am), in counterbalanced order. fMRI analyses focused on Reward Anticipation > baseline and Reward Win > baseline contrasts (whole brain voxel-wise p<0.005, cluster-level FDR-corrected p<0.05); Dim Light Melatonin Onset (DLMO) was included as a covariate in a second round of analyses. During Aligned versus Misaligned scans, adolescents exhibited higher Anticipation-related activation in a cluster encompassing ventral medial frontal and striatal areas (k=1004, t=4.88, p<0.001). A similar cluster no longer met the cluster-level threshold after including DLMO as a covariate. No clusters exhibited higher Anticipation-related activation during the Misaligned scan, with or without the DLMO covariate. Likewise, no clusters exhibited higher Win-related activation during the Aligned scan, with or without the DLMO covariate. Interestingly, although no clusters exhibited higher Win-related activation during the Misaligned scan in unadjusted analyses, two large clusters emerged after accounting for DLMO: a cluster encompassing posterior cingulate, cuneus, and calcarine sulcus (k=983, t=8.12, p<0.001) and a cluster encompassing the anterior cingulate (k=1039, p=5.28, p<0.001). These findings provide the first experimental evidence that circadian misalignment causes altered neural response to monetary reward in healthy adolescents. Our results also suggest that circadian features, including phase and alignment, may influence different stages of reward processing. Misalignment-induced changes in reward processing may lead to enhanced sensation-seeking activities, including substance use. Funding from NIH: K01DA032557 (Hasler).

Purpose: Transgender and gender nonconforming (TGNC) youth report higher rates of body dissatisfaction and disordered eating than their cisgender peers. Despite this, systematic screening tools and evidence-based treatment for disordered eating have not yet been developed for TGNC youth. Gender affirming care may impact body dissatisfaction and disordered eating, which often arise in the context of gender dysphoria and other experiences associated with identifying as TGNC; however, the extent to which gender affirming care affects body dissatisfaction and disordered eating remains unclear. The objectives of this study were to evaluate the association between gender …

Purpose The purpose of this study is to evaluate the feasibility and effectiveness of an adapted Diabetes Prevention Program (DPP) lifestyle program, DPP Group Lifestyle Balance (GLB), delivered in 3 economically diverse senior/community centers. Methods The DPP-GLB was implemented in 3 senior/community centers in Allegheny County, PA. A 6-month delayed control intervention design was used. Participants were randomized to begin the DPP-GLB immediately (immediate) or after a 6-month delay (delayed). Adults (n = 134; mean age = 62.8 years) with BMI ≥24 kg/m2 and prediabetes and/or the metabolic syndrome took part. Weight, physical activity (PA), and diabetes and cardiovascular disease (CVD) risk factors were assessed at 6, 12, and 18 months from baseline. Results At 6 months, the immediate group demonstrated greater mean weight loss than the delayed control group as well as significantly greater improvements in PA, A1C, fasting insulin, and waist circumference. In pre-post analyses, both randomized groups showed similar success that was maintained at 18 months. Conclusions The DPP-GLB delivered in economically diverse community centers was effective in this group of older adults. These findings support provision of coverage for prevention programs in older adults at risk for diabetes/CVD, which is important considering the large number of individuals who will be Medicare eligible in the near future.

Overgeneral autobiographical memory (OGM) has been established as a risk factor for depression in both youth and adults, but questions remain as to how OGM develops. Although theorists have proposed that the experience of stressful life events may contribute to the development of OGM, no studies have examined the impact of negative life events on prospective changes in OGM. The goal of the current study was to address this gap in the literature. Participants included 251 mothers and their biological children (aged 8-14years old at the initial assessment). Using a multi-wave prospective design with assessments every 6months for 2years, we found that episodic life stress predicted prospective decreases in youths' autobiographical memory specificity to positive, but not negative, cues. This study supports theories proposing that negative life events may contribute to the development of OGM, but suggest that, in youth, the impact of life stress on OGM may be specific to positive rather than negative memories.

This article tested a contingency-oriented perspective to examine the dynamic relationships between in-the-moment borderline personality disorder (BPD) symptom events and in-the-moment triggers. An experience sampling study with 282 adults, including 77 participants with BPD, obtained reports of situational triggers and BPD symptom events five times daily for 2 weeks. Triggers included being rejected, betrayed, abandoned, offended, and disappointed; having one's self-concept threatened; being in a boring situation; and being alone. BPD was associated with increased situational triggers. Multilevel models revealed significant within-person associations between situational triggers and BPD symptoms for the average participant in the study, with significant individual variance in the strength and direction of trigger-symptom contingencies. Most trigger-symptom contingencies were stronger for individuals with greater borderline symptomatology, suggesting that triggers are meaningfully related to BPD. These findings highlight possible proximal mechanisms that maintain BPD and help explain the course of a disorder often described as chaotic and unpredictable.

This archival study explored the impact of performance on the Montreal Cognitive Assessment (MoCA), a brief cognitive screen performed as part of a mental status examination (MSE), on adjudicative competency opinions provided for 194 criminal defendants, in examinations that did not include a competency-specific instrument. The MoCA’s suggested cutoff of 26 as indicative of “mild cognitive impairment” was not determinative of examiners’ conclusions regarding competency-related capacities. However, when scores were considered dimensionally, MoCA performance during the MSE accounted for additional significant variance in examiners’ competency opinions, when added to a logistic regression model containing age and presence of psychotic symptoms.

OBJECTIVE:To evaluate alterations in cerbral blood flow (CBF) using arterial spin labeled (ASL)MRI in autosomal dominant AD (ADAD) mutation carriers (MC) compared to age-matched healthy controls. BACKGROUND:Recent work has identified alterations in (CBF) in elderly subjects with mild cognitive impairment and Alzheimer Dementia (AD) using MRI. However, similar studies are lacking autosomal dominant AD (ADAD). Furthermore, the higher prevalence of vascular disease in late onset AD may account for some of the alterations in CBF. ADAD subjects are generally free of significant vascular disease and offer the opportunity to measure CBF early in the pathologic process prior to significant symptom onset where unique markers might be identified. DESIGN/METHODS:13 MC (PS-1& APP) (CDR 0=9, CDR 0.5=3, CDR 1=1) and 50 controls underwent 3Tesla pASL-MRI. For the between group comparison (MC versus normal controls), a whole-brain voxel-wise t-test was applied to explore the effect of mutation carrier status on CBF before and after controlling for age and CDR score using SPM8 (FWE correction, p<0.05). RESULTS:MCs had significantly decreased perfusion in the caudate and inferior striatum bilaterally -an area with robust, early amyloid deposition unique to ADAD-even after controlling for age and CDR. Furthermore, separate areas of amyloid associated decreased CBF were associated with decreased performance of attention and executive function indicating possible early clinical impact of altered CBF in ADAD. CONCLUSIONS:This preliminary study indicates that early CBF changes can be identified in relatively asymptomatic subjects with ADAD, particularly in the anterior striatum -an area that demonstrates a unique pattern of early amyloid deposition. Furthermore, amyloid deposition is associated with decreased CBF even prior to significant cognitive or functional decline thus highlighting the necessity of extending the investigation of ASL in larger groups of ADAD subjects as well to spontaneous ADAD populations, particularly asymptomatic groups at high risk for developing AD. Study Supported by:National Institutes of Health grants: P50 AG005133, R37 AG025516, P01 AG025204; Doris Duke Foundation

Recent reports demonstrate a link between inflammatory bowel disease (IBD) and sleep disturbance. Increased psychiatric dysfunction is consistently reported in patients with IBD. Our objective is to examine relations among sleep disturbance, inflammation, and psychiatric dysfunction in a pediatric population with Crohn disease (CD) and depression. Pediatric patients with CD with depression (n = 96) and healthy controls (n = 19) completed measures of sleep (Pittsburgh Sleep Quality Index [PSQI]), depression, anxiety, and abdominal pain, and provided blood for inflammatory markers. CD activity was determined by the Pediatric Crohn's Disease Activity Index. Factor analysis was performed on subscales of the PSQI to derive measures of sleep disturbance. Univariate and multivariate regression analyses assessed relations between sleep disturbance, psychosocial, and biological measures of CD and psychiatric dysfunction. Sleep disturbance in depressed youth with CD was significantly greater than healthy controls, and was significantly related to measures of abdominal pain, depression, and anxiety, but not biomarkers of inflammation. Factor analysis of the PSQI demonstrated a 2-factor solution. The first factor, termed "Qualitative," included Subjective Sleep Quality, Daytime Dysfunction, Sleep Disturbance, and Sleep Latency, whereas the second factor, "Quantitative," consisted of Habitual Sleep Efficiency and Sleep Duration. This factor showed a significant relation to inflammatory markers. Multivariate modeling suggested that qualitative sleep disturbance was predicted by disease activity, pain, and anxiety, whereas quantitative sleep disturbance was predicted by disease activity. These results indicate that sleep disturbance in depressed youth with CD differs depending upon illness activity. Patients may require different interventions depending upon the sleep disturbance exhibited.