The hierarchical taxonomy of psychopathology as an approach to the psychiatric genetics of substance-related and addictive disorders in Vietnam-era twins

Pathological gambling and substance use disorders are highly prevalent and comorbid among veteran populations. These disorders also share genetic influences, although the underlying constructs and magnitude of their influence remain unclear. This project utilized the Hierarchical Taxonomy of Psychopathology (HiTOP) as a framework for modeling the underlying dimensions of psychopathology as latent factors and modeled genetic and environmental influences on substance use disorders and pathological gambling. Study 1 examined the structure of psychopathology for 15 common mental disorders in a sample of Vietnam-era veteran twins from the Harvard Drug Study (nMZ = 3,748 and nDZ = 2,996) to determine the appropriate location for pathological gambling within the HiTOP framework. The best fitting model included internalizing and externalizing spectra and an illicit substance use subfactor. Pathological gambling (loading = .30) loaded onto the externalizing spectrum with legal substance use, conduct disorder, antisocial personality disorder, and a subfactor that subsumed all six illicit substance use disorders. The best fitting model in Study 1 did not support the existence of a ‘p’ factor underlying all psychopathology. In Study 2, genetic and environmental components were modeled for the 15 disorders and 3 latent factors modeled in Study 1. Additive genetics explained from 10% (generalized anxiety disorder, panic disorder) to 49% (nicotine use) of the variance in specific disorders and from 24% (internalizing) to 46% (externalizing) of the variance of latent factors. Only cocaine use and conduct disorder demonstrated significant variance attributable to shared environment, the entirety of which occurred at the disorder-specific level. Only 9% of the genetic variance associated with alcohol use was shared across disorders, whereas 100% of genetic variance in cocaine and hallucinogen use was shared with latent factors. In total, 12% of the variance in risk for pathological gambling was associated with additive genetics, and 13% of that variance was shared via the externalizing spectrum. Findings highlight shared risk among illicit substance use disorders and among other disorders on the externalizing spectrum. These findings suggest externalizing and illicit substance use as transdiagnostic targets for treatments aimed at individuals with comorbid substance use disorders, pathological gambling, and other externalizing disorders

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Associations between depression and cardiometabolic health: A 27-year longitudinal study

Background Clarifying the relationship between depression symptoms and cardiometabolic and related health could clarify risk factors and treatment targets. The objective of this study was to assess whether depression symptoms in midlife are associated with the subsequent onset of cardiometabolic health problems. Methods The study sample comprised 787 male twin veterans with polygenic risk score data who participated in the Harvard Twin Study of Substance Abuse (‘baseline’) and the longitudinal Vietnam Era Twin Study of Aging (‘follow-up’). Depression symptoms were assessed at baseline [mean age 41.42 years (s.d. = 2.34)] using the Diagnostic Interview Schedule, Version III, Revised. The onset of eight cardiometabolic conditions (atrial fibrillation, diabetes, erectile dysfunction, hypercholesterolemia, hypertension, myocardial infarction, sleep apnea, and stroke) was assessed via self-reported doctor diagnosis at follow-up [mean age 67.59 years (s.d. = 2.41)]. Results Total depression symptoms were longitudinally associated with incident diabetes (OR 1.29, 95% CI 1.07–1.57), erectile dysfunction (OR 1.32, 95% CI 1.10–1.59), hypercholesterolemia (OR 1.26, 95% CI 1.04–1.53), and sleep apnea (OR 1.40, 95% CI 1.13–1.74) over 27 years after controlling for age, alcohol consumption, smoking, body mass index, C-reactive protein, and polygenic risk for specific health conditions. In sensitivity analyses that excluded somatic depression symptoms, only the association with sleep apnea remained significant (OR 1.32, 95% CI 1.09–1.60). Conclusions A history of depression symptoms by early midlife is associated with an elevated risk for subsequent development of several self-reported health conditions. When isolated, non-somatic depression symptoms are associated with incident self-reported sleep apnea. Depression symptom history may be a predictor or marker of cardiometabolic risk over decades

Walking the Talk: Moving Indigenous Studies from the Classroom to the Community

A presentation by the students of Anthropology 4050: Canadian Status/Treaty Indian Reserve Communities. In this session students will showcase their final assignments from the course ANTH 4050. Throughout the course we have discussed the complexities of the history of the reserve system in Canada, the nuances of the Treaty process, the rigidity of the Indian Act, the traumas of residential schools, and lived implications of forced relocations on Indigenous communities. We have examined how colonial relations are spatialized and how this spacialization translates into lived social relations. This showcase represents our desire to share what we have learned and why it matters with our TRU community in the hopes of nurturing a space of understanding, compassion, and mutually respectful conversation. Students will be in attendance to discuss their work from 3:30 - 6:00p