Task-Evoked Neural Activity During Reward Anticipation and Inhibitory Control in Preadolescent Binge Eating Disorder.

PURPOSE: Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied. METHODS: Fifty eight preadolescent children (aged 9-10 years) with BED and 68 age, body mass index and developmentally matched control children were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated task-evoked blood-oxygen-level-dependent response during functional magnetic resonance imaging, as participants completed the monetary incentive delay task and the stop signal task. We indexed group differences in regions of interest in the reward (orbitofrontal cortex, nucleus accumbens) and inhibitory control (dorsolateral prefrontal cortex, anterior cingulate cortex). RESULTS: No significant group differences emerged during tasks of inhibitory control among children with BED and children without BED. Similarly, no significant group differences emerged during the anticipation or receipt of reward among children with BED and children without BED. DISCUSSION: Preadolescent children with BED do not demonstrate abnormal neural activity in prominent nodes of reward or inhibitory control circuitry during tasks of inhibitory control, reward anticipation, and reward receipt, relative to children without BED who also had a similar body mass index.

Functional connectivity and complexity analyses of resting-state fMRI in pre-adolescents demonstrating the behavioral symptoms of ADHD.

Attention deficit hyperactivity disorder (ADHD) has been characterized by impairments among distributed functional brain networks, e.g., the frontoparietal network (FPN), default mode network (DMN), reward and motivation-related circuits (RMN), and salience network (SAL). In the current study, we evaluated the complexity and functional connectivity (FC) of resting state fMRI (rsfMRI) in pre-adolescents with the behavioral symptoms of ADHD, for pathology-relevant networks. We leveraged data from the Adolescent Brain and Cognitive Development (ABCD) Study. The final study sample included 63 children demonstrating the behavioral features of ADHD and 92 healthy control children matched on age, sex, and pubertal development status. For selected regions in the relevant networks, ANCOVA compared multiscale entropy (MSE) and FC between the groups. Finally, differences in the association between MSE and FC were evaluated. We found significantly reduced MSE along with increased FC within the FPN of pre-adolescents demonstrating the behavior symptoms of ADHD compared to matched healthy controls. Significant partial correlations between MSE and FC emerged in the FPN and RMN in the healthy controls however the association was absent in the participants demonstrating the behavior symptoms of ADHD. The current findings of complexity and FC in ADHD pathology support hypotheses of altered function of inhibitory control networks in ADHD.

The prevalence of disordered eating in outpatient general psychiatry settings in publicly insured populations: a case series.

There is a dearth of research assessing the prevalence of eating disorders in publicly insured populations. While evidence shows that eating disorders affect people of all racial, ethnic, and socioeconomic backgrounds, research has neglected to focus on the rate at which they occur among those who have public health insurance. The present study indexes the prevalence of clinically significant disordered eating in a case series of 165 adults in a publicly insured sample at an outpatient general psychiatry clinic in Los Angeles, California. Results illustrate that 46 (27.8%) participants screened positive for clinically significant disordered eating with no significant differences relating to age or gender in those who screened positive versus those who did not (p > .05). This markedly elevated frequency of disordered eating presentations underscores the need for improved clinician training and education around disordered eating and eating disorder assessment as a whole. In addition, there is a critical need to study publicly insured populations so as to mitigate stereotypes about who has eating disorders and improve the likelihood of diagnosis and care.

Functional Connectivity and Complexity Analyses of Resting-State fMRI in Pre-Adolescents with ADHD.

Attention deficit hyperactivity disorder (ADHD) has been characterized by impairments among distributed functional brain networks, e.g., the frontoparietal network (FPN), default mode network (DMN), and reward and motivation-related circuits (RMN). In the current study, we evaluated the complexity and functional connectivity (FC) of resting state fMRI (rsfMRI) in pre-adolescents with ADHD for pathology-relevant networks. We leveraged data from the Adolescent Brain and Cognitive Development (ABCD) Study. The final study sample included 63 children with ADHD and 92 healthy control children matched on age, sex, and pubertal development status. For selected regions in relevant networks, ANCOVA compared multiscale entropy (MSE) and FC between the groups. Finally, differences in the association between MSE and FC were evaluated. We found significantly reduced MSE along with increased FC within the FPN of pre-adolescents with ADHD compared to matched healthy controls. Significant partial correlations between MSE and FC emerged in fewer regions in the participants with ADHD than in the controls. The observation of reduced entropy is consistent with existing literature using rsfMRI and other neuroimaging modalities. The current findings of complexity and FC in ADHD support hypotheses of altered function of inhibitory control networks in ADHD.

Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy.

Importance: Unhoused status is a substantial problem in the US. Pregnancy characteristics and maternal outcomes of individuals experiencing homelessness are currently under active investigation to optimize health outcomes for this population. Objective: To assess the trends, characteristics, and maternal outcomes associated with unhoused status in pregnancy. Design, Setting, and Participants: This cross-sectional study analyzed data from the Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample. The study population included hospitalizations for vaginal and cesarean deliveries from January 1, 2016, to December 31, 2020. Unhoused status of these patients was identified from use of International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code Z59.0. Statistical analysis was conducted from December 2022 to June 2023. Main Outcomes and Measures: Primary outcomes were (1) temporal trends; (2) patient and pregnancy characteristics associated with unhoused status, which were assessed with a multivariable logistic regression model; (3) delivery outcomes, including severe maternal morbidity (SMM) and mortality at delivery, which used the Centers for Disease Control and Prevention definition for SMM indicators and were assessed with a propensity score-adjusted model; and (4) choice of long-acting reversible contraception method and surgical sterilization at delivery. Results: A total of 18 076 440 hospital deliveries were included, of which 18 970 involved pregnant patients who were experiencing homelessness at the time of delivery, for a prevalence rate of 104.9 per 100 000 hospital deliveries. These patients had a median (IQR) age of 29 (25-33) years. The prevalence of unhoused patients increased by 72.1% over a 5-year period from 76.1 in 2016 to 131.0 in 2020 per 100 000 deliveries (P for trend < .001). This association remained independent in multivariable analysis. In addition, (1) substance use disorder (tobacco, illicit drugs, and alcohol use disorder), (2) mental health conditions (schizophrenia, bipolar, depressive, and anxiety disorders, including suicidal ideation and past suicide attempt), (3) infectious diseases (hepatitis, gonorrhea, syphilis, herpes, and COVID-19), (4) patient characteristics (Black and Native American race and ethnicity, younger and older age, low or unknown household income, obesity, pregestational hypertension, pregestational diabetes, and asthma), and (5) pregnancy characteristics (prior uterine scar, excess weight gain during pregnancy, and preeclampsia) were associated with unhoused status in pregnancy. Unhoused status was associated with extreme preterm delivery (<28-week gestation: 34.3 vs 10.8 per 1000 deliveries; adjusted odds ratio [AOR], 2.76 [95% CI, 2.55-2.99]); SMM at in-hospital delivery (any morbidity: 53.8 vs 17.7 per 1000 deliveries; AOR, 2.30 [95% CI, 2.15-2.45]); and in-hospital mortality (0.8 vs <0.1 per 1000 deliveries; AOR, 10.17 [95% CI, 6.10-16.94]), including case fatality risk after SMM (1.5% vs 0.3%; AOR, 4.46 [95% CI, 2.67-7.45]). Individual morbidity indicators associated with unhoused status included cardiac arrest (AOR, 12.43; 95% CI, 8.66-17.85), cardiac rhythm conversion (AOR, 6.62; 95% CI, 3.98-11.01), ventilation (AOR, 6.24; 95% CI, 5.03-7.74), and sepsis (AOR, 5.37; 95% CI, 4.53-6.36). Conclusions and Relevance: Results of this national cross-sectional study suggest that unhoused status in pregnancy gradually increased in the US during the 5-year study period and that pregnant patients with unhoused status were a high-risk pregnancy group.

Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder.

BACKGROUND: Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied. METHODS: 58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses. RESULTS: Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses. CONCLUSIONS: Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.

Prevalence of anxiety and depressive disorders in pregnant women with malignancy.

OBJECTIVE: To examine national-level prevalence of anxiety and depressive disorders among pregnant women with malignancy. METHODS: This is a pre-planned secondary analysis of a previous retrospective cohort study using the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population was 14 648 135 deliveries including 10 145 patients with malignancy from 2016 to 2019. A multivariable binary logistic regression model was fitted to assess the association of malignancy and anxiety or depressive disorder. RESULTS: Pregnant women with malignancy were 49% more likely to have the diagnosis of either anxiety or depressive disorder compared with those without malignancy (prevalence rate 114 vs. 61 per 1000 cases, adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 1.40-1.58). The increase in the risk associated with malignancy on either anxiety or depressive disorder was more than two-fold among patients with brain and other nervous system tumors (aOR 2.69, 95% CI 2.01-3.60), bone and joint tumors (aOR 2.32, 95% CI 1.33-4.04), and leukemia (aOR 2.12, 95% CI 1.81-2.48). CONCLUSIONS: This national-level analysis suggests that pregnant women with malignancy experience increased rates of psychological distress more often than pregnant women without malignancy.

Sex differences in regional gray matter density in pre-adolescent binge eating disorder: a voxel-based morphometry study.

BACKGROUND: Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with broad medical and psychiatric morbidity, and obesity. While BED may be characterized by altered cortical morphometry, no evidence to date examined possible sex-differences in regional gray matter characteristics among those with BED. This is especially important to consider in children, where BED symptoms often emerge coincident with rapid gray matter maturation. METHODS: Pre-adolescent, 9-10-year old boys (N = 38) and girls (N = 33) with BED were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated sex differences in gray matter density (GMD) via voxel-based morphometry. Control sex differences were also assessed in age and body mass index and developmentally matched control children (boys N = 36; girls N = 38). Among children with BED, we additionally assessed the association between dorsolateral prefrontal (dlPFC) GMD and parent-reported behavioral approach and inhibition tendencies. RESULTS: Girls with BED uniquely demonstrate diffuse clusters of greater GMD (p < 0.05, Threshold Free Cluster Enhancement corrected) in the (i) left dlPFC (p = 0.003), (ii) bilateral dmPFC (p = 0.004), (iii) bilateral primary motor and somatosensory cortex (p = 0.0003) and (iv) bilateral precuneus (p = 0.007). Brain-behavioral associations suggest a unique negative correlation between GMD in the left dlPFC and behavioral approach tendencies among girls with BED. CONCLUSIONS: Early-onset BED may be characterized by regional sex differences in terms of its underlying gray matter morphometry.

Association of severe maternal morbidity and post-traumatic stress disorder.

BACKGROUND: Severe maternal morbidity refers to the most serious complications of pregnancy. Whether severe maternal morbidity is associated with post-traumatic stress disorder is currently under active investigation. OBJECTIVE: This study aimed to examine the association between severe maternal morbidity and post-traumatic stress disorder at delivery. STUDY DESIGN: This was a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample, which included 12,857,721 patients for national estimates who had vaginal or cesarean deliveries between January 2016 and December 2019. Patients with mental health conditions other than post-traumatic stress disorder and substance use disorder were excluded. Severe maternal morbidity was defined according to the Centers for Disease Control and Prevention definition (a total of 21 indicators). Main outcomes were trends and characteristics related to post-traumatic stress disorder, assessed with a multivariable binary logistic regression model. Sensitivity analysis included subcohort assessment restricted to patients per clinical and obstetrical demographics. RESULTS: A total of 8880 patients had a diagnosis of post-traumatic stress disorder during the hospital admission for delivery (prevalence rate, 6.9 per 10,000). The prevalence rate of post-traumatic stress disorder increased from 5.0 to 8.8 per 10,000 deliveries between 2016 and 2019. This increasing trend remained independent in multivariable analysis. The adjusted odds ratio, compared with 2016, was 1.26 (95% confidence interval, 1.19-1.35) for 2017, 1.50 (95% confidence interval, 1.41-1.60) for 2018, and 1.73 (95% confidence interval, 1.63-1.84) for 2019. Severe maternal morbidity occurred in 210,605 (1.6%) patients. Patients who had severe maternal morbidity were more likely to have a diagnosis of post-traumatic stress disorder than those without severe maternal morbidity (12.8 vs 6.8 per 10,000 deliveries; adjusted odds ratio, 1.57; 95% confidence interval, 1.39-1.78) in multivariable analysis. This association remained robust in several subcohort analyses including (1) participants aged ≤35 years (adjusted odds ratio, 1.62; 95% confidence interval, 1.41-1.86), (2) those aged ≤35 years without medical comorbidity (adjusted odds ratio, 2.01; 95% confidence interval, 1.70-2.37), and (3) those aged <35 years without medical comorbidity, cesarean delivery, and preterm delivery (adjusted odds ratio, 4.52; 95% confidence interval, 3.56-5.74). CONCLUSION: There has been a gradual increase in the number of patients with a diagnosis of post-traumatic stress disorder at delivery in recent years among those without other mental health or substance use conditions. These data suggest that there is a possible association between severe maternal morbidity and post-traumatic stress disorder.

Methamphetamine use and disordered eating: a case study of an understudied phenomenon.

PURPOSE: Little is known about co-occurring eating disorder (ED) psychopathology and methamphetamine use. Even less is known about the precise nature of how ED symptom profiles and methamphetamine use interact and influence treatment-related practices. The purpose of this study is to report a case study of a patient with co-occuring ED psychopathology and methamphetamine use. METHOD: We present the case of a White woman in her mid-30s with a long history of body image-related worries and methamphetamine use. She presented for psychiatric assessment initially for methamphetamine addiction and paranoid psychotic symptom treatment, but also reported significant weight and shape concerns. RESULTS: Over the duration of approximately 1 year of treatment, this patient experienced a reduction in her methamphetamine use, but an increased concern around how abstinence may portend weight gain. She reported that a return to methamphetamine use was underpinned by a drive to manage her weight. CONCLUSION: With increasing evidence documenting the elevated co-occurrence of methamphetamine use and ED symptomatology, this case report highlights the potential mechanisms by which these respective psychopathologies may be exacerbate the other, rendering both increased risk of relapse, and body dissatisfaction. LEVEL OF EVIDENCE: Level IV, case study.

Regional gray matter abnormalities in pre-adolescent binge eating disorder: A voxel-based morphometry study.

BACKGROUND: Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with an array of multisystemic organ morbidity, broad psychiatric morbidity, and obesity. Despite behavioral markers often developing in early childhood, the neurobiological markers of early-onset BED remain understudied, and developmental pathophysiology remains poorly understood. METHODS: 71 preadolescent children (aged 9-10-years) with BED and 74 age, BMI and developmentally matched control children were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in gray matter density (GMD) via voxel-based morphometry (VBM). We additionally performed region of interest analyses, assessing the association between GMD in nodes of the reward (orbitofrontal cortex; OFC) and inhibitory control (dorsolateral prefrontal cortex; dlPFC) networks, and parent-reported behavioral inhibition and approach tendencies. RESULTS: Diffuse elevations in cortical GMD were noted in those with BED, which spanned prefrontal, parietal, and temporal regions. No areas of reduced GMD were noted in those with BED. No alterations in subcortical GMD were noted. Brain-behavioral associations suggest a distinct and negative relationship between GMD in the OFC and dlPFC, respectively, and self-reported markers of hedonic behavioral approach tendencies. CONCLUSIONS: Early-onset BED may be characterized by diffuse morphological abnormalities in gray matter density, suggesting alterations in cortical architecture which may reflect decreased synaptic pruning and arborization, or decreased myelinated fibers and therefore inter-regional afferents.

Temporal trends and characteristics of suicide among women with gynecologic malignancy in the United States.

OBJECTIVE: To examine the trends, characteristics, and outcomes of women with gynecologic malignancies who died of suicide in the United States. METHODS: This is a retrospective, observational study using the Surveillance, Epidemiology and End Results program from 1973 to 2013. Women with uterine, ovarian, and cervical cancers who had cause of death recorded as suicide or self-inflicted injury were included, and temporal trends, patient and tumor characteristics, and outcomes were assessed. RESULTS: Of 467,368 women with gynecologic cancers, there were 309 (0.07%) suicides during the study period. Across the three malignancies, suicide rates significantly decreased during the study period, with uterine cancer exhibiting the highest interval decrease (relative reduction: uterine cancer 88.2%, cervical cancer 78.1%, and ovarian cancer 73.6%; all, P < 0.05). Women with cervical cancer were younger at age of suicide (median age, 50 versus 60-68 years), and women with ovarian cancer had a shorter time to suicide from diagnosis (median time, 27 versus 66-67 months) (both, P < 0.05). On multivariable analysis, white race (hazard ratio [HR] 3.619), Western U.S. residence (HR 2.012), ovarian cancer (HR 1.991), cervical cancer (HR 1.765), stage IV disease (HR 1.735), and divorced status (HR 1.491) remained independent clinico-pathological characteristics associated with increased risk of suicide (all, P < 0.05). CONCLUSION: This study found that suicide rates in women with gynecologic malignancies have decreased in the United States. Characteristics of suicide vary across cancer types, and certain risk factors of suicide identified in this study may be useful to triage patients at risk for suicidal behavior and inform prevention strategies.