Trauma Exposure and Problem Drinking in Late Adolescence: A Latent Profile Analysis.

Exposure to early traumatic events has been implicated in problem drinking during late adolescence, and this association may be stronger among youth with emotion regulation deficits. The purpose of this study was to identify subgroups of late adolescents based on trauma type, including loss, posttraumatic stress disorder (PTSD) symptoms; and emotion regulation deficits that confer the risk for problematic drinking behaviors. A sample of 946 participants (M age = 18.84 years, SD = 1.06) was analyzed with mixed-indicator latent profile analysis to identify subgroups and explore whether these subgroups displayed significant differences regarding elevated drinking frequency, alcohol quantity, and problematic alcohol use. A four-profile model yielded the best fit to the data, and four groups were identified and labeled "high functioning" (29.4%), "loss regulated" (32.3%), "loss dysregulated" (28.1%), and "multiple trauma dysregulated" (10.1%). Individuals in the high functioning group reported the lowest rates on all three measures of alcohol misuse (14.6-24.9%), whereas those in the multiple trauma dysregulated group reported the highest rates on all three measures (31.6-71.5%). Individuals in the multiple trauma dysregulated group (M = 0.25) differed significantly from those in the other three groups (Ms = 0.42-0.72) on the measure of problematic alcohol use but scored similarly to those in the loss dysregulated group on measures of drinking frequency (M = 0.32 and 0.24, respectively) and quantity (M = 0.43 and 0.39, respectively). These findings have implications for prevention programs targeted for alcohol use disorders among older adolescents.

Troxis necrosis, a novel mechanism for drug-induced hepatitis secondary to immunomodulatory therapy.

OBJECTIVES: A case of drug-induced hepatitis mediated by troxis necrosis, a form of autoimmune hepatitis, is described. METHODS: Clinical data, light and electron microscopy of an ultrasound-guided core needle liver biopsy specimen, were examined to investigate the cause of transaminitis in a 26year old male patient on Cellcept and Plaquenil for the treatment of lupus erythematosus. A systematic PUBMED review of troxis necrosis as the underlying mechanism for drug-induced hepatitis was performed. RESULTS: Liver function tests (LFTs) were significant for elevated AST (305) and ALT (174); the autoimmune workup was significant for anti-ANA positivity and α-SMA negativity. On light microscopy, the liver biopsy shows focal areas of lymphocytic infiltrates surrounding and forming immunologic synapses with lobular hepatocytes, indicating lobular hepatitis of autoimmune nature. Electron microscopy confirmed the presence of immunologic synapses. Upon cessation of the offending medications, the LFTs returned to baseline with no further intervention. Literature search yielded 7 previously reported cases of drug-induced hepatitis mediated by troxis necrosis. CONCLUSION: Troxis necrosis is a novel mechanism for drug-induced hepatitis, including immunomodulatory medications including a monoclonal anti-TWEAK antibody and Cellcept and Plaquenil, two widely used immunosuppression/anti-rejection medications.