The Relationship Between Childhood Physical and Sexual Abuse and Adolescent Cannabis Use: A Systematic Review

Background: Among adolescents, cannabis use is a health concern due to associations with drug addiction and mental health disorders across the life course. It has been shown that childhood maltreatment is associated with drug addiction in adulthood. However, a better understanding of the relationship between maltreatment and drug use may improve targeted prevention and interventions. The aim of this systematic review is to describe the association between exposure to childhood maltreatment, specifically physical and sexual abuse, with adolescent cannabis use. Methods: A systematic search strategy was applied to Embase, PsycINFO, and Ovid MEDLINE(R) databases. Methods followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Abstract and title screening was performed to identify papers which reported an estimate of the association between childhood physical or sexual abuse and adolescent cannabis use. Full text screening of each paper was performed, and data were extracted and study quality assessed. Weighted means meta-analysis was performed on studies reporting odds ratios as effect estimates. Results: Of 8,780 screened articles, 13 were identified for inclusion. Eight papers received a quality rating score indicating lower risk of bias. Eleven papers reported the relationship between childhood sexual abuse and adolescent cannabis use; effect estimates ranged from AOR 0.53-AOR 2.18 (weighted mean OR 1.29, 95% CI 1.08-1.49). The relationship between childhood physical abuse and adolescent cannabis use was reported in 7 papers; effect estimates ranged from AOR 1.25-AOR 1.87 (weighted mean OR 1.39, 95% CI 1.12-1.66). Differences in the strength of the evidence were observed by the method of exposure ascertainment, and there was some evidence of differences in association by gender, age of cannabis initiation, and the severity of the abuse. Conclusions: This systematic review indicates childhood physical or sexual abuse may increase risk of adolescent-onset cannabis use. Few studies considered variation in timing of onset, or by gender. Adolescent cannabis use precedes is strongly associated with increased risk of negative mental health outcomes; further exploration of adolescent cannabis use's place on the causal pathway between childhood abuse and adult mental health problems is warranted to improve intervention

A functional magnetic resonance imaging study of frontal networks in obsessive-compulsive disorder during cognitive reappraisal

Background Patients with obsessive-compulsive disorder (OCD) present difficulties in the cognitive regulation of emotions, possibly because of inefficient recruitment of distributed patterns of frontal cortex regions. The aim of the present study is to characterize the brain networks, and their dysfunctions, related to emotion regulation alterations observed during cognitive reappraisal in OCD. Methods Adult patients with OCD (n = 31) and healthy controls (HC; n = 30) were compared during performance of a functional magnetic resonance imaging cognitive reappraisal protocol. We used a free independent component analysis approach to analyze network-level alterations during emotional experience and regulation. Correlations with behavioral scores were also explored. Results Analyses were focused on six networks encompassing the frontal cortex. OCD patients showed decreased activation of the frontotemporal network in comparison with HC (F(1,58) = 7.81, p = 0.007) during cognitive reappraisal. A similar trend was observed in the left frontoparietal network. Conclusions The present study demonstrates that patients with OCD show decreased activation of specific networks implicating the frontal cortex during cognitive reappraisal. These outcomes should help to better characterize the psychological processes modulating fear, anxiety, and other core symptoms of patients with OCD, as well as the associated neurobiological alterations, from a system-level perspective

Trait anxiety is associated with attentional brain networks

Trait anxiety is a well-established risk factor for anxiety and depressive disorders, yet its neural correlates are not clearly understood. In this study, we investigated the neural correlates of trait anxiety in a large sample (n = 179) of individuals who completed the trait and state versions of the State-Trait Anxiety Inventory and underwent resting-state functional magnetic resonance imaging. We used independent component analysis to characterize individual resting-state networks (RSNs), and multiple regression analyses to assess the relationship between trait anxiety and intrinsic connectivity. Trait anxiety was significantly associated with intrinsic connectivity in different regions of three RSNs (dorsal attention network, default mode network, and auditory network) when controlling for state anxiety. These RSNs primarily support attentional processes. Notably, when state anxiety was not controlled for, a different pattern of results emerged, highlighting the importance of considering this factor in assessing the neural correlates of trait anxiety. Our findings suggest that trait anxiety is uniquely associated with resting-state brain connectivity in networks mainly supporting attentional processes. Moreover, controlling for state anxiety is crucial when assessing the neural correlates of trait anxiety. These insights may help refine current neurobiological models of anxiety and identify potential targets for neurobiologically-based interventions

An fMRI study of cognitive reappraisal in major depressive disorder and borderline personality disorder

Background: One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations. Methods: We contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity. Results: When compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal. Conclusions: This study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders

Correlatos neurobiológicos de las alteraciones de regulación emocional en los trastornos de salud mental

[spa] INTRODUCCIÓN: El procesamiento de las emociones es esencial para la experiencia humana, y una correcta regulación cognitiva de este proceso es crucial para el bienestar y la salud mental. De ahí surge la necesidad de estudiar la relación entre la psicopatología y las alteraciones de regulación emocional. Esta necesidad ha tenido un interés creciente para parte de la comunidad científica en los últimos años, principalmente para tratar de entender en profundidad este proceso tan complejo, específicamente desde un punto de vista neurobiológico. HIPÓTESIS: Se presume que las dificultades, es decir la falta o falla, en los procesos de regulación emocional están presentes en una diversidad de patologías mentales y son parte integral de su fisiopatología. OBJETIVO: El objetivo del presente trabajo es investigar los correlatos neurobiológicos de las alteraciones de regulación emocional, a través de técnicas de neuroimagen funcional, en distintas poblaciones clínicas. MÉTODOS: En distintos centros hospitalarios, se estudiaron mediante técnicas de neuroimagen algunos aspectos de la regulación emocional en las siguientes patologías mentales: trastorno depresivo mayor (TDM), trastorno límite de la personalidad (TLP), trastorno obsesivo compulsivo (TOC) y trastorno de ansiedad generalizada (TAG). En todos los casos las poblaciones clínicas se compararon con una muestra de controles sanos. Dichas técnicas se desarrollaron a través de dos paradigmas diseñados para el análisis de imágenes por resonancia magnética funcional (IRMf). Posteriormente, se estudiaron activaciones en todo el cerebro, conectividad funcional entre áreas de interés y el resto del cerebro y, finalmente, redes cerebrales mediante un análisis de componentes independientes (ACI). RESULTADOS PRINCIPALES: En todas las muestras de sujetos con alguna de las patologías estudiadas se encontraron alteraciones estadísticamente significativas en el proceso de la regulación emocional. En estos sujetos, se hallaron cambios en la activación de áreas regulatorias clave, dificultades en la conectividad funcional entre áreas regulatorias y otras áreas de relevancia específica y, también, alteraciones en redes neurales completas. Algunos de estos hallazgos tuvieron correlación con aspectos psicométricos específicos para cada patología. CONCLUSIONES: A través de los estudios mostrados se puede concluir que el déficit observado en el proceso de regulación de las emociones es un común denominador en las patologías de salud mental. Sin embargo, se pueden describir diferencias específicas en las deficiencias observadas entre los distintos trastornos estudiados. Dicho hallazgo mejora la caracterización funcional de estos trastornos. El estudio de estos correlatos neurobiológicos es de importancia, ya que permite generar estrategias terapéuticas inspiradas biológicamente orientadas a mejorar el proceso de la regulación emocional en pacientes con distintas patologías mentales.[eng] INTRODUCTION: The processing of emotions is essential for the human experience and a proper cognitive regulation of this process is crucial for well-being and mental health. Hence the need to study the relationship between psychopathology and emotional regulation alterations arises. This need has had a growing interest inside the scientific community in recent years. It prevails to try to fully understand this complex process, specifically from a neurobiological point of view. HYPOTHESIS: Difficulties (i.e., lack or failure) in emotional regulation are presumed to be present in several mental pathologies and are an integral part of their pathophysiology. AIM: The aim of this work is to investigate the neurobiological underpinnings of emotional regulation alterations, through functional neuroimaging techniques in different clinical populations. METHODS: Different emotional regulation traits were studied using neuroimaging techniques in several research units, focusing on the following mental disorders: major depressive disorder (MDD), borderline personality disorder (BPD), obsessive- compulsive disorder (OCD) and generalized anxiety disorder (GAD). In all cases the clinical populations were compared with a sample of healthy controls. These techniques were performed by two tasks designed for the analysis of functional magnetic resonance imaging (fMRI). Subsequently, whole-brain activations, functional connectivity between regions of interest and the rest of the brain, and brain networks were examined using independent component analysis (ICA). MAIN RESULTS: In all the samples of subjects with the studied disorders, statistically significant alterations were found during emotional regulation. Among these subjects, outcomes were found regarding activation problems of key regulatory areas, difficulties in functional connectivity between regulatory areas and other regions of specific relevance, and network-level alterations. Some of these findings were correlated with specific behavioral scales for each pathology. CONCLUSIONS: It can be concluded that the deficit observed in the process of regulating emotions is a common denominator in mental health pathologies. However, disorder- wise specific differences in the deficiencies of the process can be found. This finding improves the functional characterization of these disorders. The study of these neurobiological underpinnings is relevant, since it allows the design of therapeutic strategies aimed to enhance the process of emotional regulation in patients with different mental health pathologies

An fMRI study of cognitive regulation of reward processing in generalized anxiety disorder (GAD)

Background: Cognitive regulation can affect the process of decision making. Generalized anxiety disorder (GAD) patients seem to have an impairment in cognitive regulation of reward processing concerning food stimuli. This study aims to explore the impact of GAD in cognitive regulation of food-related rewards. Methods: GAD patients (n=11) and healthy controls (n=15) performed a cognitive regulation craving task with food images while undergoing a functional magnetic resonance imaging (fMRI) acquisition. Between-group differences in functional connectivity were measured using dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) seeds during cognitive regulation. Results: During cognitive regulation, there was a significant interaction for functional connectivity between the right dlPFC and bilateral vmPFC with the thalamus. GAD patients had lower functional connectivity for cognitive regulation conditions (distance and indulge) than for the non-regulated condition in these clusters, while control participants presented the opposite pattern. GAD group presented fixed food valuation scores after cognitive regulation. Conclusions: GAD participants showed inflexibility while valuating food images, that could be produced by cognitive regulation deficits underpinned by functional connectivity alterations between prefrontal regions and the thalamus. These results show cognitive inflexibility and difficulty in the modulation of cognitive responses during decision making in GAD patients

An fMRI study of cognitive reappraisal in major depressive disorder and borderline personality disorder

One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations. We contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity. When compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal. This study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders

An fMRI study of cognitive reappraisal in major depressive disorder and borderline personality disorder

Background. One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations.Methods. In the present study we contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n=19), MDD patients (n=20) and healthy controls (HCs; n=19). Emotion regulation was assessed using an established functional magnetic resonance imaging (fMRI) cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity (i.e., Psychophysiological Interactions, PPI). Results. When compared to HCs, patients with BPD and MDD displayed a homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. Additionally, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal. Conclusions. Decreased activation of the vlPFC underlays emotion regulation deficits in MDD and BPD, although, beyond this finding, these groups are characterized by specific neurobiological underpinnings. Alterations in patients with MDD suggest a primary deficit in the strength of prefrontal activations, while patients with BPD are better characterized by connectivity disruptions between the prefrontal cortex and temporal emotion processing regions. These findings substantiate in neurobiological terms the different profiles of emotion regulation alteration observed in these disorders.Fil: De la Peña Arteaga, Víctor. Universidad de Barcelona. Hospital Duran I Reynals. Instituto de Investigación Biomédica de Bellvitge; EspañaFil: Berruga Sánchez, Mercedes. Universidad de Barcelona. Hospital Duran I Reynals. Instituto de Investigación Biomédica de Bellvitge; EspañaFil: Steward, Trevor. University of Melbourne; AustraliaFil: Martínez Zalacaín, Ignacio. Universidad de Barcelona. Hospital Duran I Reynals. Instituto de Investigación Biomédica de Bellvitge; EspañaFil: Goldberg, Ximena. Parc Taulí University Hospital; EspañaFil: Wainsztein, Agustina Edith. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Abulafia, Carolina Andrea. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Cardoner, Narcís. Parc Taulí University Hospital; EspañaFil: Castro, Mariana Nair. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Salud Mental; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: Villarreal, Mirta Fabiana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; ArgentinaFil: Menchón, José M.. Universidad de Barcelona. Hospital Duran I Reynals. Instituto de Investigación Biomédica de Bellvitge; EspañaFil: Guinjoan, Salvador Martín. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Salud Mental; ArgentinaFil: Soriano Mas, Carles. Universidad de Barcelona. Hospital Duran I Reynals. Instituto de Investigación Biomédica de Bellvitge; Españ

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN