Changing the Trajectory of Substance Use and Depression beyond the Formative Years: The Virginia Screening, Brief Intervention, & Referral to Treatment Project

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an important secondary prevention strategy to address substance use and depression risk beginning in youth and continuing across the lifespan. Ten healthcare settings in Virginia implemented the SBIRT model between 2017 and 2020. A total of 65,315 participants ages 18 and older were universally screened to determine the severity of their substance use and depression and offered a risk-informed intervention. 12.7 percent of individuals endorsed some level of risky substance use and 4.5 percent screened positive for depression overall (11.1 percent in the outpatient setting). 10 percent of all brief intervention recipients were enrolled for follow-up screening 6 months later. Younger adults had significantly greater prevalence of risky drug use and depression compared to older age groups while middle-age adults displayed higher prevalence of moderate to severe alcohol risk highlighting the need for early intervention among younger adults. Significant reductions were observed in risky alcohol use (52.2%), as well as illicit drug use (44.7%) and depression (63.0%)

Balance control systems in Parkinson's disease and the impact of pedunculopontine area stimulation

Impaired balance is a major contributor to falls and diminished quality of life in Parkinson’s disease, yet the pathophysiology is poorly understood. Here, we assessed if patients with Parkinson’s disease and severe clinical balance impairment have deficits in the intermittent and continuous control systems proposed to maintain upright stance, and furthermore, whether such deficits are potentially reversible, with the experimental therapy of pedunculopontine nucleus deep brain stimulation. Two subject groups were assessed: (i) 13 patients with Parkinson’s disease and severe clinical balance impairment, implanted with pedunculopontine nucleus deep brain stimulators; and (ii) 13 healthy control subjects. Patients were assessed in the OFF medication state and blinded to two conditions; off and on pedunculopontine nucleus stimulation. Postural sway data (deviations in centre of pressure) were collected during quiet stance using posturography. Intermittent control of sway was assessed by calculating the frequency of intermittent switching behaviour (discontinuities), derived using a wavelet-based transformation of the sway time series. Continuous control of sway was assessed with a proportional–integral–derivative (PID) controller model using ballistic reaction time as a measure of feedback delay. Clinical balance impairment was assessed using the ‘pull test’ to rate postural reflexes and by rating attempts to arise from sitting to standing. Patients with Parkinson’s disease demonstrated reduced intermittent switching of postural sway compared with healthy controls. Patients also had abnormal feedback gains in postural sway according to the PID model. Pedunculopontine nucleus stimulation improved intermittent switching of postural sway, feedback gains in the PID model and clinical balance impairment. Clinical balance impairment correlated with intermittent switching of postural sway (rho = − 0.705, P < 0.001) and feedback gains in the PID model (rho = 0.619, P = 0.011). These results suggest that dysfunctional intermittent and continuous control systems may contribute to the pathophysiology of clinical balance impairment in Parkinson’s disease. Clinical balance impairment and their related control system deficits are potentially reversible, as demonstrated by their improvement with pedunculopontine nucleus deep brain stimulation

Genome-Wide Association Study Identifies Novel Restless Legs Syndrome Susceptibility Loci on 2p14 and 16q12.1

Peer reviewe