Examination of reward processing dysfunctions in the left dorsal striatum and other brain regions among psychiatric inpatients with substance use.

BACKGROUND: Substance misuse is a major public health issue and research has established attenuated reward responses to drug cues in those who misuse substances. Yet, little is known about whether the expectation of natural reinforcers engages distinct brain regions in substance misuse. METHODS: Using functional magnetic resonance imaging (fMRI), we delivered juice at expected and unexpected times to examine reward processing dysfunctions. We focused on the responses within the left dorsal striatum (DS) in individuals with high-risk substance use (HRU, n = 65), low-risk substance use (psychiatric controls, PC, n = 65), and healthy controls (HC, n = 65). Additionally, we investigated whether the dysfunction in reward processing within the left DS is correlated with other common psychiatric symptoms. Finally, we conducted a comprehensive analysis of the whole brain to investigate other non-hypothesized brain regions. RESULTS: Compared to HC, HRU displayed lower responses to juice delivery (i.e., reward) in the left DS (p <.05). The whole-brain analysis demonstrated that compared to HC, HRU displayed significantly lower responses to reward stimuli in various brain regions, including the bilateral caudate, temporal gyrus, left frontal gyrus, middle frontal gyrus, and right thalamus. LIMITATIONS: Participants were individuals with polysubstance use; therefore, we were not able to examine the effects of individual substances. CONCLUSIONS: Our findings suggest that HRU displays lower responses to reward stimuli within the left DS and other non-hypothesized brain regions. Our findings may help further elucidate reward processing dysfunctions related to substance misuse.

A next-generation approach to mental health outcomes: Treatment, time, and trajectories.

Over the last several decades, inpatient psychiatric length of stay (LOS) has been greatly reduced to the detriment of patients. Latent variable mixture modeling, can be used to improve the quality of care for patients by identifying unobserved subgroups and optimize treatment variables, including LOS. This study had three objectives (1) to replicate the findings made by Oh et al. in a distinct sample, (2) to examine demographic differences related to inpatient treatment trajectories, and (3) to relate additional variables to each trajectory. We collected data on six key mental illness factors and information on felonies, misdemeanors, history of stopping psychiatric medication and psychotherapy, length of time in psychotherapy, and the number of therapists and psychiatrists from 489 patients at an inpatient psychiatric hospital. We derived latent mental illness scores after applying growth mixture modeling to these data. We identified three distinct trajectories of mental illness change: High-Risk, Rapid Improvement (HR-RI), Low-Risk, Partial Response (LR-PR), and High-Risk, Gradual Improvement (HR-GI). The HR-GI group was more likely to have patients who were female, Asian, younger, Yearly Income (YI) <$20,000, that spent more time in psychotherapy throughout their life, and had the longest LOS while inpatient. The LR-PR group had was more likely to be male, Hispanic/Latino and multiracial, older, YI >$500,000, have a history of misdemeanors, and this group had the shortest LOS (p < .05). These findings replicate and extend our previous findings in Oh et al. (2020a) and highlight the clinical utility of agnostically determining the treatment trajectories.

A Virtual Reality-Based Automated Perimeter, Device, and Pilot Study.

Purpose: The purpose of this study was to describe a novel, virtual reality (VR)-based platform for evaluating visual fields. Methods: Three subjects were tested on the VisuALL VR headset. Data collected included test duration per eye, total fixation losses (FLs), total false positives (FPs), and total false negatives (FNs). Mean threshold values were collected from the superior temporal (ST), superior nasal (SN), inferior nasal (IN), inferior temporal (IT) quadrants, and from the central 12 degrees (central), 12 to 24 degrees (pericentral), and from all testing loci (global). Results: Six eyes of 3 subjects (2 men, 1 woman; mean age 30 years) were tested using the T-24 protocol (a Humphrey visual field [HVF] 24-2 equivalent). Mean test duration was 4.43 ± (SD) 0.11 minutes/eye. Mean threshold values ± SD for ST, SN, IN, IT, global, central, and pericentral were 31.1 ± 0.95 decibel (dB), 31.9 ± 0.3 dB, 32.0 ± 0.3 dB, 32.0 ± 1.1 dB, 31.9 ± 0.5 dB, 32.8 ± 0.5 dB, and 31.5 ± 0.5 dB, respectively. Conclusions: This work describes the technical aspects of the VisuALL. Participants were able to complete the test and generate threshold values at each of 50 locations in the central 24 degrees of visual field. This VR-based visual field test shows potential to become an alternative to analog, stationary standard automated perimetry tests. Translational Relevance: The VisuALL is an immersive, VR-based, automated perimeter that effectively addresses some of the limitations inherent to other popular perimetric devices. Potential advantages of the VisuALL are its adaptability, portability, and efficiency for patients. This device may be able to fill the gap present in at-home glaucoma monitoring and expand the reach of glaucoma management.

Retrobulbar tube shunt: anterior chamber to back of the eye (A2B) efficacy in glaucomatous eyes with uncontrolled IOP.

PURPOSE: The purpose of this study is to examine the efficacy and safety of a commercial model of the retrobulbar shunt, anterior chamber to back of the eye (A2B), in lowering intraocular pressure (IOP) and medication requirements after the failure of all other IOP-lowering therapies, including trabeculectomy with antimetabolites and tube shunt procedures. METHODS: This is a single-site, prospective, nonrandomized concept study. Patients with prior failed tube shunts, or moderate to severe glaucoma refractory to treatment, were included. All subjects underwent A2B shunt implantation. Each subject's IOP and number of medications were assessed from baseline at each time interval using paired t tests. Primary outcome measures were IOP and glaucoma medication use pre- and postoperatively. Complete success is defined as (1) IOP ≤ 21 mmHg; (2) IOP reduction from baseline of ≥ 20%; (3) no reoperation for glaucoma; (4) no loss of light perception vision; (5) no chronic hypotony defined as IOP ≤ 5 mmHg; and (6) no use of supplemental glaucoma medication. "Qualified success" required satisfaction of the same criteria as "complete success" but with the use of supplemental glaucoma medication at 6 months. RESULTS: Nineteen eyes of 19 patients (mean age 39.5 ± 6.4) were followed for 6 months. The mean IOP (mmHg±SEM) at 6 months dropped from baseline of 35.3 ± 2.3 to 18.5 ± 1.1(- 16.8, - 47%; p < 0.0001). The mean number of glaucoma medications (±SEM) at 30, 90, and 180 days decreased from a baseline of 2.4 ± 0.3 to < 0.3 at each interval (p < 0.0002). The complete and qualified success rates at 6 months were 46.6% (7/15) and 66.6% (11/15), respectively. The mean number of prior incisional glaucoma surgeries was 3.2. The percent of patients that had previously failed sub-Tenon tube shunt surgeries was 79%. CONCLUSIONS: The A2B shunt is an effective rescue therapy in patients that have failed other IOP-lowering procedures. By shunting aqueous humor into the retrobulbar space, IOP and number of glaucoma medications required were substantially reduced for the 6-month postoperative assessment interval. The intrinsic properties of the retrobulbar space may limit the risk of fibrosis, the principal cause of bleb failure.

Nonpenetrating Deep Sclerectomy for Progressive Glaucoma: Long-term (5-year) Follow-up of Intraocular Pressure Control and Visual Field Survival.

PURPOSE: To monitor 5-year outcomes of nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) in a new consecutive patient cohort. MATERIALS AND METHODS: All eyes undergoing NPDS surgery between 1/08 and 6/12 were monitored for intraocular pressure (IOP), number of antiglaucoma medications (meds), and visual field indices [mean deviation (MD) and corrected pattern standard deviation (CPSD)], relative to the preoperative baseline using the two-tailed paired Student's t test. RESULTS: Of 106 eyes undergoing NPDS with MMC, mean IOP was 19.7 ± 0.5 [sem] mm Hg preoperatively, 11.9 ± 0.5 at 3 months, 12.5 ± 0.6 at 6 months, 12.4 ± 0.5 at 12 months, 12.6 ± 0.6 at 18 months, 11.1 ± 0.6 at 2 years, 11.8 ± 0.5 at 2.5 years, 11.0 ± 0.5 at 3 years, 11.7 ± 0.5 at 3.5 years, 10.7 ± 0.7 at 4 years, 11.6 ± 0.5 at 4.5 years, and 12.4 ± 0.7 at 5 years (average IOP reduction of 7.8 mm Hg or 37%; p < 10-6) at 5 years. About 92% of eyes had stable IOP ≥5 and ≤21 mm Hg at 5 years. Mean preoperative meds 2.7 ± 0.1 was reduced to 0.40 ±0.09 at 3 months, 0.51 ± 0.1 at 6 months, 0.38 ± 0.08 at 12 months, 0.49 ± 0.09 at 18 months, 0.41 ± 0.09 at 2 years, 0.39 ± 0.09 at 2.5 years, 0.49 ± 0.1 at 3 years, 0.58 ± 0.1 at 3.5 years, 0.49 ± 0.1 at 4 years, 0.64 ± 0.1 at 4.5 years, and 0.52 ± 0.1 at 5 years, corresponding to mean reduction of 2.2 meds (81%; p < 10-22) at 5 years. Mean deviation and CPSD were stable relative to baseline at all time intervals (R = 0.83-0.94; p < 0.0001). CONCLUSION: With appropriate postoperative management, eyes undergoing NPDS can maintain excellent IOP control with minimal medication use and maintain very stable visual fields over an extended time frame. HOW TO CITE THIS ARTICLE: Slagle G, Groth SL, Montelongo M, et al. Nonpenetrating Deep Sclerectomy for Progressive Glaucoma: Long-term (5-year) Follow-up of Intraocular Pressure Control and Visual Field Survival. J Curr Glaucoma Pract 2020;14(1):3-9.