Disentangling alcohol-specific alcohol use disorder criteria from externalizing psychopathology using an empirically driven approach

Within current mental disorder classification systems, alcohol use disorder (AUD) and psychopathology, more broadly, are conceptualized as distinct categorical disorders. Recent classification research has focused on commonalities across disorders to better understand psychopathology, with many arrangements combining AUD with other externalizing disorders, like conduct disorder and antisocial personality disorder. However, the focus on commonalities of AUD with externalizing disorders may preclude insight into possible unique aspects of AUD that can inform AUD classification and treatment targets. The present study aimed to identify AUD symptoms more uniquely associated to alcohol use (versus an externalizing process), using a newly developed analytic procedure, combinatorial optimization. First, we identified AUD symptom sets based on standard and alcohol-specific consumption measures. The symptom sets were then compared to existing diagnostic measures and AUD correlates to determine whether distinct relationships between standard and alcohol-specific symptom sets emerged. Results indicated standard AUD symptom sets outperformed alcohols-specific sets in most cases, with more robust relationships between standard sets and AUD correlates These findings have several clinical and research implications, such as the importance of accounting for externalizing processes in the classification and treatment of AUD. Future research is necessary to determine how to best target unique processes integral to AUD.Includes bibliographical references (pages 45-60)

Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of $ 7 Days of Mechanical Ventilation : Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study

Abstract : Background: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms. Methods: This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months. Results: BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score ≥ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P = .007), and incomplete secondary education (by 3.8 BDI-II points; P = .009); a curvilinear relation with age (P = .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P = .92), sex (P = .25), ICU LOS (P = .51), or caregiver variables (Caregiver Assistance Scale [P = .28] and Center for Epidemiologic Studies Depression Scale [P = .74]). Conclusions: Increased functional dependence, lower income, and lower education are associated with increased severity of post-ICU depressive symptoms, whereas age has a curvilinear relation with symptom severity. Knowledge of risk factors may inform surveillance and targeted mental health follow-up. Early mobilization and rehabilitation aiming to improve function may serve to modify mood disorders

The association of externalizing behavior with individual DSM-5 alcohol use disorder criteria

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] The externalizing spectrum contains a range of disinhibition-related conditions. Comorbidity among externalizing disorders is commonly investigated at the syndromal and trait level precluding insight into the relationship of symptoms across externalizing disorders. It is unknown whether comorbidity across externalizing disorders holds constant across highly varied, individual AUD criteria ranging from symptoms reflecting neuroadaptation (e.g., tolerance) to symptoms reflecting behavioral changes (e.g., social problems). The present study aimed to determine the degree to which DSM-5 alcohol use disorder (AUD) criteria are associated with symptom endorsement from two externalizing disorders. Psychometric inquiries via multivariate and factor analytic approaches estimated relative and unique associations of externalizing behavior on AUD criteria endorsement. Our results indicate modest relations of externalizing behavior and AUD criteria endorsement. For example, social problems and role interference criteria were most strongly associated with externalizing behavior across analytic approaches, with general and unique associations between externalizing behavior and social problems. Additionally, tolerance was most weakly associated with externalizing behavior across approaches. Results highlight potential etiological heterogeneity among AUD criteria that could guide future diagnostic refinements and treatment methods

Twenty-First Birthday Drinking: Extreme Drinking Episodes and White Matter Microstructural Changes in the Fornix and Corpus Callosum

Twenty-first birthday drinking is characterized by extreme alcohol consumption. Accumulating evidence suggests that high-dose bingeing is related to structural brain changes and cognitive deficits. This is particularly problematic in the transition from adolescence to adulthood when the brain is still maturing, elevating the brain’s sensitivity to the acute effects of alcohol intoxication. Heavy drinking is associated with reduced structural integrity in the hippocampus and corpus callosum and is accompanied by cognitive deficits. However, there is little research examining changes in the human brain related to discrete heavy drinking episodes. The present study investigated whether alcohol exposure during a 21st birthday celebration would result in changes to white matter microstructure by utilizing Diffusion Tensor Imaging (DTI) measures and a quasi-experimental design. By examining structural changes in the brain from pre- to post-celebration within subjects (N = 49) prospectively, we were able to more directly observe brain changes following an extreme drinking episode. Region of interest analyses demonstrated increased fractional anisotropy (FA) in the posterior fornix (p < 0.0001) and in the body of the corpus callosum (p = 0.0029) from pre- to post-birthday celebration. These results suggest acute white matter damage to the fornix and corpus callosum following an extreme drinking episode, which is especially problematic during continued neurodevelopment. Twenty-first birthday drinking may, therefore, be considered an important target event for preventing acute brain injury in young adults

Alcohol use disorder conceptualizations and diagnoses reflect their sociopolitical context

The present paper highlights how alcohol use disorder (AUD) conceptualizations and resulting diagnostic criteria have evolved over time in correspondence with interconnected sociopolitical influences in the United States. We highlight four illustrative examples of how DSM-defined alcoholism, abuse/dependence, and AUD have been influenced by sociopolitical factors. In doing so, we emphasize the importance of recognizing and understanding such sociopolitical factors in the application of AUD diagnoses. Last, we offer a roadmap to direct the process of future efforts toward the improved diagnosis of AUD, with an emphasis on pursuing falsifiability, acknowledging researchers’ assumptions about human behavior, and collaborating across subfields. Such efforts that center the numerous mechanisms and functions of behavior, rather than signs or symptoms, have the potential to minimize sociopolitical influences in the development of diagnostic criteria and maximize the treatment utility of diagnoses

Alcohol use in emerging adults associated with lower rich-club connectivity and greater connectome network disorganization

BACKGROUND: Emerging adulthood is a critical neurodevelopmental stage, with alcohol use during this period consistently associated with brain abnormalities and damage in anatomical structure and white matter integrity. However, it is less clear how alcohol use is associated with the brain's structural organization (i.e., white matter connections between anatomical regions). Recent connectome research has focused on rich-club regions, a collection of highly-interconnected hubs that are critical in brain communication and global network organization and disproportionately vulnerable to insults. METHODS: For the first time, we examined alcohol use associations with structural rich-club and connectome organization in emerging adults (N = 66). RESULTS: Greater lifetime drinks and current monthly drinks were significantly associated with lower rich-club organization (rs =-0.38, ps 0.33, ps 0.064). CONCLUSIONS: Results provide novel evidence that alcohol use is associated with decreased rich-club connectivity and structural network disorganization. Given that both are critical in global brain communication, these results highlight the importance of examining alcohol use and brain relationships in emerging adulthood