Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation

Alcohol use Disorder (AUD) is one of the leading causes of morbidity and mortality worldwide. The progression of the disorder is associated with the development of compulsive alcohol use, which in turn contributes to the high relapse rate and poor longer term functioning reported in most patients, even with treatment. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines AUD by a cluster of symptoms, parsing its heterogeneous phenotype by domains of behavior such as compulsivity may be a critical step to improve outcomes of this condition. Still, neurobiological underpinnings of compulsivity need to be fully elucidated in AUD in order to better design targeted treatment strategies. In this manuscript, we review and discuss findings supporting common mechanisms between AUD and OCD, dissecting the construct of compulsivity and focusing specifically on characteristic disruptions in habit learning and cognitive control in the two disorders. Finally, neuromodulatory interventions are proposed as a probe to test compulsivity as key pathophysiologic feature of AUD, and as a potential therapy for the subgroup of individuals with compulsive alcohol use, i.e., the more resistant stage of the disorder. This transdiagnostic approach may help to destigmatize the disorder, and suggest potential treatment targets across different conditions

Children’s multidimensional health and medium-run cognitive skills in low- and middle-income countries

Este documento participa en el debate sobre los efectos de la salud infantil en su educación en etapas posteriores de la vida en países de bajos y medianos ingresos. Usando tres rondas de los ricos datos de panel del estudio de Young Lives en Etiopía, India, Perú y Vietnam, respalda un enfoque multidimensional de la salud (y la pobreza en general). En detalle, el documento tiene un objetivo cuádruple: (1) explorar si la relación positiva entre la estatura de los niños y las habilidades cognitivas en edad preescolar y primaria encontrada en estudios previos también se mantiene en nuestra muestra de países; (2) para evaluar si los indicadores adicionales de salud y nutrición, raramente disponible o utilizado en la literatura existente, se asocian significativamente con logros cognitivos posteriores; (3) examinar si la contribución total de los niños la salud multidimensional a los logros cognitivos a medio plazo se puede resumir adecuadamente mediante un índice compuesto de privación; (4) investigar algunos posibles canales a través de los cuales la salud de la primera infancia puede afectar las habilidades cognitivas

Children’s multidimensional health and medium-run cognitive skills in low- and middle-income countries

Este documento participa en el debate sobre los efectos de la salud infantil en su educación en etapas posteriores de la vida en países de bajos y medianos ingresos. Usando tres rondas de los ricos datos de panel del estudio de Young Lives en Etiopía, India, Perú y Vietnam, respalda un enfoque multidimensional de la salud (y la pobreza en general). En detalle, el documento tiene un objetivo cuádruple: (1) explorar si la relación positiva entre la estatura de los niños y las habilidades cognitivas en edad preescolar y primaria encontrada en estudios previos también se mantiene en nuestra muestra de países; (2) para evaluar si los indicadores adicionales de salud y nutrición, raramente disponible o utilizado en la literatura existente, se asocian significativamente con logros cognitivos posteriores; (3) examinar si la contribución total de los niños la salud multidimensional a los logros cognitivos a medio plazo se puede resumir adecuadamente mediante un índice compuesto de privación; (4) investigar algunos posibles canales a través de los cuales la salud de la primera infancia puede afectar las habilidades cognitivas

Children’s multidimensional health and medium-run cognitive skills in low- and middle-income countries: Young Lives working paper 129

This paper engages in the debate on the effects of children’s health on their education in later life stages in low- and middle-income countries. Using three rounds from the rich panel data of the Young Lives study in Ethiopia, India, Peru and Vietnam, it endorses a multidimensional approach to health (and poverty in general). In detail, the paper has a fourfold objective: (1) to explore whether the positive relationship between children’s height and cognitive skills at pre-school and primary-school age found in previous studies holds in our sample of countries, too; (2) to assess whether additional health and nutrition indicators, rarely available or used in the existing literature, are significantly associated with later cognitive achievements; (3) to examine whether the whole contribution of children’s multidimensional health to mid-term cognitive attainments can be adequately summarised by a composite deprivation index; (4) to investigate a few possible channels through which early childhood health may affect cognitive skills. In line with the main literature, the estimates show a positive, highly significant effect of the height-for-age of children between 6 and 18 months on almost all the dependent variables at both pre-school and primary-school age. The expansion of the informational basis to a multidimensional perspective proved to be informative, too. In particular, weight-for-height, proxy for acute malnutrition, is an important predictor of children’s learning outcomes, especially in India, Peru and Vietnam. However, the final health variable, indicating whether the child had experienced a serious illness, helps to explain only Maths scores in Vietnam. We then constructed an aggregate health-deprivation index, based on a revised version of the Alkire-Foster method. While it is associated with a variety of outcomes in the various countries, the index proved to be substantially less informative than the 'suite of indicators'. Finally, the paper sheds some light on the factors mediating the relationship between early childhood health conditions and mid-run cognitive abilities. In particular, it suggests that the level of formal education attended/completed is an important channel. However, in most of the cases, the inclusion of variables related to schooling in the estimates does not overrule the association between early health and middle-run cognition, which points to the persistent effects of health and nutrition in infancy on life-course skills formation.© Young Lives 2014. All rights reserved. Reproduction, copy, transmission, or translation of any part of this publication may be made only under the following conditions: with the prior permission of the publisher; or with a licence from the Copyright Licensing Agency Ltd., 90 Tottenham Court Road, London W1P 9HE, UK, or from another national licensing agency; or under the terms set out below. This publication is copyright, but may be reproduced by any method without fee for teaching or non-profit purposes, but not for resale. Formal permission is required for all such uses, but normally will be granted immediately. For copying in any other circumstances, or for re-use in other publications, or for translation or adaptation, prior written permission must be obtained from the publisher and a fee may be payable

Personal resources and depression in schizophrenia: The role of self-esteem, resilience and internalized stigma

Depression in schizophrenia represents a challenge from a diagnostic, psychopathological and therapeutic perspective. The objective of this study is to test the hypothesis that resilience and self-stigma affect depression severity and to evaluate the strength of their relations in 921 patients with schizophrenia. A structural equation model was tested where depression is hypothesized as affected by resilience, internalized stigma, gender and negative symptoms, with the latter two variables used as exogenous covariates and the former two as mediators. The analysis reveals that low resilience, high negative symptoms, female gender were directly associated with depression severity, and internalized stigma acted only as a mediator between avolition and resilience, with similar magnitude. The cross-sectional study design and the variable selection limit the generalizability of the study results. The model supports a complex interaction between personal resources and negative symptoms in predicting depression in schizophrenia. The clinical implication of these findings is that personal resources could be a significant target of psychosocial treatments