Feasibility of Exenatide, a GLP-1R Agonist, for Treating Cocaine Use Disorder: A Case Series Study.

Cocaine use remains a serious public health problem associated with a marked increase in overdose deaths in the past decade. No medications have yet been proven to be effective for the treatment of cocaine use disorder (CUD). Among the highly promising medications have been glucagon-like peptide 1 receptor agonists (GLP-1RA) that are currently used for the treatment of type 2 diabetes mellitus and weight management. Preclinically, GLP-1RAs have been shown to attenuate cocaine self-administration, however, this has not yet been demonstrated in a human laboratory study. The GLP-1RA extended-release exenatide is given as a once-weekly injection, which may be clinically advantageous for addressing medication nonadherence among individuals with CUD. Here, we assess feasibility and safety by reporting on 3 cases of patients with CUD who received 6 weeks of exenatide 2 mg subcutaneously once-weekly in an open-label fashion, along with standard individual drug counseling. We observed excellent attendance and compliance, along with positive end-of-study satisfaction ratings. The medication was well tolerated and without unexpected or severe adverse events. Results for cocaine use and related clinical effects were more mixed, yet encouraging. Future empirical testing of exenatide for treating CUD should utilize a randomized controlled trial design and longer treatment duration.

Examining the Factor Structure of the Posttraumatic Checklist for Civilians.

The Posttraumatic Checklist for Civilians (PCL-C) is one of the most common tools used to assess PTSD among civilian populations. However, the underlying factor structure of the PCL-C remains under examined, with the most recent research relying on small samples with limited generalizability. Thus, the present study used exploratory and confirmatory techniques in a large North American college student sample to investigate the factor structure of the PCL-C. Results supported a 3-factor model for the PCL-C accounting for 59% of the total variance and represented by Suppression (M = 11.2, SD = 5.0); Hyperarousal (M = 6.5, SD = 3.2); and Diminished Reward Processing (M = 5.9, SD = 2.9). Regarding gender differences, females tended to score higher on suppression and avoidance related symptoms, while males scored higher on symptoms related to Diminished Reward Processing. Results also showed that embedded within college campuses are trauma exposed students experiencing distressingly high levels of posttrauma symptoms. In sum, the results revealed three factors in the PCL-C, that could be used to offer insight into assessing and treating posttrauma symptoms on a college campus.

Attentional Avoidance of Historically Relevant, Task-Irrelevant Facial Affect: Past Depression, Interpersonal Characteristics, and Ethnicity.

Experiential background can influence how individuals respond to affective interpersonal information. For formerly depressed individuals, sad facial expressions are presumably salient. If so, when performing affectively neutral daily tasks, these individuals would find peripheral sad faces particularly distracting, and thus, they might shift their attention from them. The present study examined this hypothesis by comparing how euthymic formerly depressed and never depressed adults attended to sad and happy task-irrelevant emotional facial expression stimuli. The study also measured constructs linked to interpersonal functioning and depression and conducted exploratory analyses to examine whether Hispanic ethnicity status would moderate effects of study outcomes. Results of analyses indicated that formerly depressed individuals directed more attention away from sad faces than never depressed individuals. There were no significant between-group effects for happy faces and no moderation by ethnicity on attention to affective faces. However, irrespective of depression history, Hispanic individuals reported lower fear of negative evaluation compared to non-Hispanic Caucasian individuals. Findings are in line with hypothesized attentional avoidance among formerly depressed individuals and consistent with prior research suggesting that some Hispanic individuals experience protective mental health benefits through engagement with aspects of their culture. Directions for future research are discussed.

Psychiatric comorbidity in hospitalized adolescents with borderline personality disorder.

OBJECTIVE: The goal of this study was to carry out the first comprehensive assessment of psychiatric comorbidity in adolescents (aged 12-17 years) with DSM-IV criteria for borderline personality disorder (BPD) compared to a psychiatric comparison group without BPD. Complex comorbidity (a hallmark feature of adult BPD and defined as having any mood or anxiety disorder plus a disorder of impulsivity) was also examined as a distinguishing feature of adolescent BPD. METHOD: Consecutively admitted patients (October 2008 to October 2012) to an inpatient psychiatric hospital received parental consent and gave assent for participation in the study (N = 418), with the final sample after exclusions consisting of 335 adolescent inpatients. A comprehensive, multimethod approach to determining psychiatric comorbidity was used, including both an interview-based (categorical) and a questionnaire-based (dimensional) assessment as well as both parent and adolescent self-report. Measures included the Diagnostic Interview Schedule for Children (NIMH-DISC-IV), Child Behavior Checklist (CBCL), Youth Self-Report (YSR), Car, Relax Alone, Forget, Friends, Trouble (CRAFFT), and the Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD). RESULTS: Thirty-three percent of the final sample met criteria for BPD. Adolescent inpatients with BPD showed significantly higher rates of psychiatric comorbidity compared to non-BPD psychiatric subjects for both internalizing (χ²1 = 27.40, P < .001) and externalizing (χ²1 = 19.02, P < .001) diagnosis. Similarly, using dimensional scores for self-reported symptoms, adolescent inpatients with BPD had significantly higher rates of psychiatric comorbidity compared to non-BPD subjects for internalizing (t329 = -6.63, P < .001) and externalizing (t329 = -7.14, P < .001) problems. Parent-reported symptoms were significantly higher in the BPD group only when using a dimensional approach (internalizing: t321 = -3.42, P < .001; externalizing: t321 = -3.32, P < .001). Furthermore, significantly higher rates of complex comorbidity were found for adolescents with BPD (χ²1 = 26.60, P < .001). Moreover, externalizing and internalizing problems interacted in association with borderline traits (B = .25; P < .001). CONCLUSIONS: Similar to findings in adult studies of BPD, adolescents with BPD demonstrate significantly more complex comorbidity compared to psychiatric subjects without BPD.