Racial and ethnic socioenvironmental inequity and neuroimaging in psychiatry: a brief review of the past and recommendations for the future.

Neuroimaging is a major tool that holds immense translational potential for understanding psychiatric disorder phenomenology and treatment. However, although epidemiological and social research highlights the many ways inequity and representativeness influences mental health, there is a lack of consideration of how such issues may impact neuroimaging features in psychiatric research. More specifically, the potential extent to which racialized inequities may affect underlying neurobiology and impact the generalizability of neural models of disorders is unclear. The present review synthesizes research focused on understanding the potential consequences of racial/ethnic inequities relevant to neuroimaging in psychiatry. We first discuss historical and contemporary drivers of inequities that persist today. We then discuss the neurobiological consequences of these inequities as revealed through current research, and note emergent research demonstrating the impact such inequities have on our ability to use neuroimaging to understand psychiatric disease. We end with a set of recommendations and practices to move the field towards more equitable approaches that will advance our abilities to develop truly generalizable neurobiological models of psychiatric disorders.

Adaptive, behavioral, and emotional outcomes following postoperative pediatric cerebellar mutism syndrome in survivors treated for medulloblastoma.

OBJECTIVE: Patients who experience postoperative pediatric cerebellar mutism syndrome (CMS) during treatment for medulloblastoma have long-term deficits in neurocognitive functioning; however, the consequences on functional or adaptive outcomes are unknown. The purpose of the present study was to compare adaptive, behavioral, and emotional functioning between survivors with and those without a history of CMS. METHODS: The authors examined outcomes in 45 survivors (15 with CMS and 30 without CMS). Comprehensive neuropsychological evaluations, which included parent-report measures of adaptive, behavioral, and emotional functioning, were completed at a median of 2.90 years following craniospinal irradiation. RESULTS: Adaptive functioning was significantly worse in the CMS group for practical and general adaptive skills compared with the group without CMS. Rates of impairment in practical, conceptual, and general adaptive skills in the CMS group exceeded expected rates in the general population. Despite having lower overall intellectual functioning, working memory, and processing speed, IQ and related cognitive processes were uncorrelated with adaptive outcomes in the CMS group. No significant group differences or increased rates of impairment were observed for behavioral and emotional outcomes. CONCLUSIONS: Survivors with CMS, compared with those without CMS, are rated as having significant deficits in overall or general adaptive functioning, with specific weakness in practical skills several years posttreatment. Findings from this study demonstrate the high risk for ongoing functional deficits despite acute recovery from symptoms of CMS, highlighting the need for intervention to mitigate such risk.

Age-dependent associations between RSA reactivity, affective and cognitive regulation, and psychopathology risk in young children exposed to varying levels of socioeconomic disadvantage.

This study examined autonomic nervous system activity (respiratory sinus arrhythmia [RSA]) as a biomarker of psychopathology in an ethnically and socioeconomically diverse sample (N = 57) of young children ages 4-7 years. RSA was measured at baseline and across four standardized tasks designed to assess self-regulation in both affective (i.e., "hot") and cognitive (i.e., "cool") contexts during early childhood. Our findings reveal that age moderated RSA activity, such that reduced RSA suppression was associated with a heightened risk of externalizing problems among older children during "cool" and "hot" contexts; for younger children, only RSA suppression during "hot" contexts predicted externalizing risk. The influence of socioeconomic disadvantage did not moderate the relationship between RSA and the risk of psychopathology, and there were minimal associations between RSA suppression and internalizing symptoms at this age range. These results suggest that autonomic variability may be a more effective predictor of psychopathology risk in older children, perhaps as they transition into formal schooling and face increasingly complex cognitive and social demands. Findings have implications for the identification of psychopathology in early developmental periods when regulation over emotions becomes essential for academic and social success.

Employing the Risk-Need-Responsivity (RNR) model and predicting successful completion in an alternative drug court program: Preliminary findings from the Orleans Parish Drug Court.

Drug courts have been in operation for decades to provide treatment alternatives to individuals whose substance use and related behaviors have brought them into contact with the criminal justice system. As research on drug courts have evolved, it has been demonstrated that different types of offenders have different mental health and substance use treatment needs. One way of approaching treatment in court-mandated substance use treatment is by the application of the risk-need-responsivity (RNR) model (Andrews, Zinger et al., 1990). The Orleans Parish Drug Court expanded assessment and treatment services to determine whether the implementation of alternative substance use programming within a traditional drug court model improved outcomes. The goals of the current study were to describe the process of implementing risk and need principles, provide a description of client characteristics, examine the factors related to successful completion of drug court, and investigate completion rates across risk and need groups. Results demonstrated that risk and need groups differed on several demographic variables, levels of substance use, mental health concerns, and legal issues, suggesting assessment and triage procedures were successful. Comparisons between individuals who successfully completed drug court and those who were terminated prematurely also showed significant differences. Specifically, baseline age, education, substance use problems and frequency, and days in jail/prison were unique predictors of successful drug court completion. Finally, as predicted, individuals in the group with the lowest risk and need had the highest graduation rate, despite receiving less intensive services. Overall, creation of specialized treatment tracks within a traditional drug court program appears to be an effective strategy to target the wide range of offenders typical of drug court participants.

The differential impact of oxytocin receptor gene in violence-exposed boys and girls.

Childhood violence exposure is a prevalent public health problem. Understanding the lasting impact of violence requires an enhanced appreciation for the complex effects of violence across behavioral, physiologic, and molecular outcomes. This subject matched, cross-sectional study of 80 children explored the impact of violence exposure across behavioral, physiologic, and cellular outcomes. Externalizing behavior, diurnal cortisol rhythm, and telomere length (TL) were examined in a community recruited cohort of Black youth. Given evidence that genetic variation contributes to individual differences in response to the environment, we further tested whether a polymorphism in the oxytocin receptor gene (OXTR rs53576) moderated associations between violence and youth outcomes. Exposure to violence was directly associated with increased externalizing behavior, but no direct association of violence was found with cortisol or TL. Oxytocin genotype, however, moderated the association between violence and both cortisol and TL, suggesting that pathways linked to oxytocin may contribute to individual differences in the physiologic and molecular consequences of violence exposure. Sex differences with OXTR in cortisol and TL outcomes were also detected. Taken together, these findings suggest that there are complex pathways through which violence exposure impacts children, and that these pathways differ by both genetic variation and the sex of the child.