Excessive body fat linked to blunted somatosensory cortex response to general reward in adolescents.

BACKGROUND AND AIMS: The brain reward system is key to understanding adolescent obesity in the current obesogenic environment, rich in highly appetising stimuli, to which adolescents are particularly sensitive. We aimed to examine the association between body fat levels and brain reward system responsivity to general (monetary) rewards in male and female adolescents. METHODS: Sixty-eight adolescents (34 females; mean age (s.d.)= 16.56 (1.35)) were measured for body fat levels with bioelectric impedance, and underwent a functional magnetic resonance imaging (fMRI) scan during the Monetary Incentive Delay (MID) task. The MID task reliably elicits brain activations associated with two fundamental aspects of reward processing: anticipation and feedback. We conducted regression analyses to examine the association between body fat and brain reward system responsivity during reward anticipation and feedback, while controlling for sex, age and socioeconomic status. We also analysed the moderating impact of sex on the relationship between fat levels and brain responsivity measures. Brain imaging analyses were corrected for multiple comparisons, with a cluster-defining threshold of P<0.001, and minimum cluster size of 38 contiguous voxels. RESULTS: Higher body fat levels were associated with lower activation of the primary somatosensory cortex (S1) and the supramarginal gyrus during reward feedback after controlling for key sociodemographic variables. Although we did not find significant associations between body fat and brain activations during reward anticipation, S1/supramarginal gyrus activation during feedback was linked to increased negative prediction error, that is, less reward than expected, in illustrative post hoc analyses. Sex did not significantly moderate the association between body fat and brain activation in the MID task. CONCLUSIONS: In adolescents, higher adiposity is linked to hypo-responsivity of somatosensory regions during general (monetary) reward feedback. Findings suggest that adolescents with excess weight have blunted activation in somatosensory regions involved in reward feedback learning.

Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza» para el inicio del cambio / Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change

Objetivos: Estimar cuántos de los pacientes ingresados en la UCI por un traumatismo serían candidatos a un programa de prevención secundaria por traumatismos relacionados con el consumo de alcohol y drogas mediante intervención motivacional breve y establecer qué factores impiden la realización de esta intervención. Métodos: Se incluyeron en el estudio todos los pacientes de entre 16 a 70 años (n = 242) ingresados en la UCI por lesiones traumáticas en 32 meses no consecutivos (de noviembre de 2011 a marzo de 2015), coincidiendo con la implantación de un programa de cribado e intervención motivacional breve para traumatizados relacionados con el consumo de sustancias. El programa incluye el cribado de exposición a sustancias en el ingreso. Se recogieron prospectivamente variables sociodemográficas y clínicas. Resultados: Del total de pacientes ingresados, a 38 (15,7%) no se les realizó la determinación a sustancias. Dieron resultado negativo 101 (49,5%) de los pacientes analizados. Las variables que en mayor proporción impedían la intervención entre los positivos fueron las secuelas neurológicas debidas al traumatismo (23 pacientes; 37,1%) y el trastorno psiquiátrico previo (18 pacientes; 29%). Ambas variables aparecieron asociadas al consumo: 9,9% negativos vs 22,3% positivos (p = 0,001) y 3% negativos vs 17,5% positivos (p = 0,016), respectivamente. El número de pacientes candidatos a intervención motivacional fue de 41, el 16,9% del total de ingresados. Conclusiones: Casi 2 de cada 10 pacientes fueron potenciales candidatos a la intervención. Los factores que en mayor proporción la impedían entre los positivos fueron los que aparecieron asociados al consumo. La mortalidad en la UCI se asoció con el incumplimiento del protocolo de cribado

Objectives: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. Methods: All 16-70 year old trauma patients (n = 242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. Results: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P = .001) and negatives 3% vs positive 17.5% (P = .016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. Conclusions: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol

Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change. / Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza¼ para el inicio del cambio.

OBJECTIVES: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. METHODS: All 16-70year old trauma patients (n=242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. RESULTS: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P=.001) and negatives 3% vs positive 17.5% (P=.016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. CONCLUSIONS: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol.

The role of antiphospholipid autoantibodies in the cognitive deficits of patients with systemic lupus erythematosus.

OBJECTIVE: To analyze the role of the antiphospholipid autoantibodies (aPL) on the neuropsychological deficits in systemic lupus erythematosus (SLE) patients, comparing groups of patients with antiphospholipid syndrome (APS; n = 15), SLE with aPL (n = 12), and SLE without aPL (n = 27), and a healthy control group (n = 31). METHODS: Patients fulfilled the American College of Rheumatology SLE classification criteria or the Sydney criteria for APS. All participants were woman, and groups were matched on age and education. A standardized cognitive examination classified patients as cognitively declined or impaired according to the American College of Rheumatology. RESULTS: Differences between the groups were found in all of the studied variables, comprising attention and executive functions (sustained and selective attention, fluency, and inhibition), and memory (verbal and visual). Post-hoc analyses showed cognitive performance was equivalent between APS and SLE with aPL. Differences between SLE without aPL and control groups were found only in four of the 10 studied variables, while differences in all but two memory variables were found between SLE without aPL and control groups. Furthermore, cognitive deficit was three times more frequent in APS and SLE with aPL patients than for the control group (80%, 75%, and 16%, respectively), and two times more frequent compared to SLE patients without aPL (48%). CONCLUSIONS: Our results support the relationship between aPL and cognitive symptoms in SLE. Also, almost half of the patients with SLE and no aPL showed cognitive problems, pointing to the multifactorial causes of cognitive problems in SLE. Future research with larger sample size is guaranteed to replicate our results.

Trauma risk perception related to alcohol, cannabis, and cocaine intake.

OBJECTIVE: A high perception of risk may exert a preventive effect against the initiation of risky activities. The aims of the present study were (1) to analyze the risk perception for traumatic incidents according to drug intake (alcohol, cannabis, cocaine, no consumption) by trauma patients admitted to our hospital, and (2) to explore the influence of drugs on trauma recidivism. METHODS: Between 1 November 2011 and 1 April 2012, 404 patients aged between 16 and 70 years were admitted to our hospital for trauma cases. In 363 (89.9 %) of the patients, data were gathered on age, the trauma mechanism, and the consumption of alcohol and other drugs. Out of these 363 patients, 286 (78.8 %) attended a motivational interview and reported their consumption habits and their perception of the risk of trauma after alcohol and/or illegal drug consumption, as well as the antecedents of previous traumatisms. RESULTS: Alcohol and/or illegal drugs were detected in 37 % of the sample, with alcohol being the most frequently detected, followed by cannabis, cocaine, and other drugs. Among the trauma patients with no consumption, a high perception of trauma risk was associated with alcohol intake by 95.9 %, with cannabis consumption by 68.4 %, and with cocaine consumption by 53.4 %, whereas these percentages were significantly lower for patients testing positive for substances (79.3, 21.1, and 8.3 % respectively). Among the patients experiencing their first trauma, the mean age was almost 15 years younger in those who were positive for these substances than in those who were negative (p < 0.001). Finally, a history of previous trauma was reported by a majority (64 %) of the trauma patients testing positive for alcohol and/or drugs, but by a minority (36 %) of those testing negative (p < 0.001). CONCLUSIONS: The low perception of risk associated with alcohol, cannabis, or cocaine consumption by trauma patients under the influence of these substances on admission may be a predisposing factor for recidivism. Recommendations for both primary and secondary prevention are presented.

Effectiveness of holistic neuropsychological rehabilitation for Spanish population with acquired brain injury measured using Rasch analysis.

INTRODUCTION: The Rasch model is increasingly used in the field of rehabilitation because it improves the accuracy of measurements of patient status and their changes after therapy. OBJECTIVE: To determine the long-term effectiveness of a holistic neuropsychological rehabilitation program for Spanish outpatients with acquired brain injury (ABI) using Rasch analysis. METHODS: Eighteen patients (ten with long evolution - patients who started the program > 6 months after ABI- and eight with short evolution) and their relatives attended the program for 6 months. Patients' and relatives' answers to the European Brain Injury Questionnaire and the Frontal Systems Behavior Scale at 3 time points (pre-intervention. post-intervention and 12 month follow-up) were transformed into linear measures called logits. RESULTS: The linear measures revealed significant improvements with large effects at the follow-up assessment on cognitive and executive functioning, social and emotional self-regulation, apathy and mood. At follow-up, the short evolution group achieved greater improvements in mood and cognitive functioning than the long evolution patients. CONCLUSIONS: The program showed long-term effectiveness for most of the variables, and it was more effective for mood and cognitive functioning when patients were treated early. Relatives played a key role in the effectiveness of the rehabilitation program.

Symptom validity testing and its underlying psychophysiological response pattern: a preliminary study.

Very little is known about the autonomic psychophysiological responses while individuals are executing a Symptom Validity Test. Therefore, the aim of this study is to analyze the peripheral psychophysiological correlates (electrodermal conductance and heart rate) during the performance of the Victoria Symptom Validity Test (VSVT). The sample of this study was composed of 30 participants who underwent the VSVT under two conditions: Exaggeration of cognitive deficits (ECD) and normal effort. Our results showed differences on skin conductance between correct answers and errors limited to the decision-making phase of the ECD condition. Those differences found in the maximum conductance value when participants decide to simulate their deficits could be related to emotional activation. No differences were found on the variable heart rate between the two conditions of the study. Implications of these results are discussed.

Frontal behavioral and emotional symptoms in Spanish individuals with acquired brain injury and substance use disorders.

INTRODUCTION: Patients with acquired brain injury affecting the frontal cortex and individuals with substance use disorders share a range of behavioral problems, including apathy, poor self-control, and executive dysfunction. The Frontal Systems Behavioral Scale (FrSBe) is a self-report instrument designed to measure behavioral problems resulting from damage to the frontal-striatal neural systems, involved both in brain insult and addiction. The aim of this study was twofold: (1) to compare the scores from the Spanish version of the FrSBe with the norms collected for American, English-speaking population; and (2) to examine the ability of the FrSBe to discriminate between two clinical populations (acquired brain injury (ABI) and addiction) with putative frontal dysfunction, as compared to a group of healthy participants. PATIENTS AND METHODS: A total of 139 volunteers participated including 46 patients with frontal ABI (F-ABI), 57 abstinent substance abusers, and 36 healthy controls from the Spanish population. A Spanish version of the FrSBe was administered to all participants. We conducted multivariate analyses of variance to examine group differences across the three subscales: apathy, disinhibition, and executive dysfunction; and in the FrSBe total score. RESULTS: F-ABI and substance abusers had higher scores (i.e., greater impairment) than controls on the FrSBe total score; F-ABI patients scored significantly higher than substance abusers, and substance abusers significantly higher than controls. For specific subscales, F-ABI patients had higher scores than substance abusers and controls in the subscales of apathy, disinhibition and executive dysfunction, whereas substance abusers had greater executive dysfunction than controls. CONCLUSIONS: The Spanish version of the FrSBe is a useful instrument for the detection of behavioral problems associated with frontal systems dysfunction in two clinical samples of Spanish-speakers.