Combined effects of age and BMI are related to altered cortical thickness in adolescence and adulthood

Overweight and obesity are associated with functional and structural alterations in the brain, but how these associations change across critical developmental periods remains unknown. Here, we examined the relationship between age, body mass index (BMI) and cortical thickness (CT) in healthy adolescents (n = 70; 14–19 y) and adults (n = 75; 25–45 y). We also examined the relationship between adiposity, impulsivity, measured by delay discounting (DD), and CT of the inferior frontal gyrus (IFG), a region key to impulse control. A significant age-by- BMI interaction was observed in both adolescents and adults; however, the direction of this relationship differed between age groups. In adolescents, increased age-adjusted BMI Z-score attenuated age-related CT reductions globally and in frontal, temporal and occipital regions. In adults, increased BMI augmented age-related CT reductions, both globally and in bilateral parietal cortex. Although DD was unrelated to adiposity in both groups, increased DD and adiposity were both associated with reduced IFG thickness in adolescents and adults. Our findings suggest that the known age effects on CT in adolescence and adulthood are moderated by adiposity. The association between weight, cortical development and its functional implications would suggest that future studies of adolescent and adult brain development take adiposity into account.This work was supported by Wellcome Trust [project grant 206368/ Z/17/Z] (PCF), the Bernard Wolfe Health Neuroscience Fund (HZ, PCF) and the Andalusian Health Service (Consejeria de Salud) [project grant P-10-HUM-6635 (NEUROECOBE)] (AVG). MLW was supported by the Cambridge Trust and NIH-Oxford Cambridge Scholars Program

A Program for the Comprehensive Cognitive Training of Excess Weight (TRAINEP): The Study Protocol for A Randomized, Controlled Trial

Background: The available treatments for people with excess weight have shown small effects. Cognitive training has shown promising results, but most of the research focused on normalweight university students and reported immediate results after a single training session. This parallel group, randomized, controlled trial aims to study the efficacy of a program for the comprehensive cognitive treatment of excess weight. Methods and Analysis: Participants will be 150 people with excess weight recruited through social media, who will be randomized into three groups: cognitive intervention, sham cognitive intervention, and treatment as usual. All assessment and intervention sessions will be online in groups of 5–6 participants. The three groups will attend a motivational interviewing session, and they will receive individualized diet and physical exercise guidelines throughout the program. The cognitive training will consist of four weekly sessions of approximately 60–90 min, each based on approach–avoidance bias training, inhibitory control training, implementation of intentions, and episodic future thinking, respectively. The main outcome measure will be a change in Body Mass Index (kg/m2). Secondary outcomes include changes in cognitive measures, eating and physical exercise behaviors, and anthropometric measures. Assessments will be conducted up to 6 months after the end of the program. In addition, data on the use of the health system will be collected to analyze the cost-effectiveness and the cost-utility of training. Linear mixed models will be used for statistical analysis. Findings of this study will expand the available evidence on cognitive interventions to reduce excess weight.Spanish Ministry of Science, Innovation, and Universities MCIN/AEIEuropean Regional Development Fund "ERDF A way of making Europe" RTI2018-098771-B-I0

Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age

Introduction The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship. Method From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied. Results A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40–2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age. Conclusions The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.The members of the GISyC group (SCG, CFA and ESM) are funded by “Programa Operativo FEDER Extremadura (2014-2020) y Fondo Europeo Desarrollo Regional (FEDER) Grant number: GR18146. This work was supported by 4IE+ project (0499_4IE_PLUS_4_E) funded by the Interreg V-A España-Portugal (POCTEP) 2014- 2020 program

Computational mechanisms underpinning greater exploratory behaviour in excess weight relative to healthy weight adolescents

Obesity in adolescence is associated with cognitive changes that lead to difficulties in shifting unhealthy habits in favour of alternative healthy behaviours, similar to addictive behaviours. An outstanding question is whether this shift in goal-directed behaviour is driven by over-exploitation or over-exploration of rewarding outcomes. Here, we addressed this question by comparing explore/exploit behaviour on the Iowa Gambling Task in 43 adolescents with excess weight against 38 adolescents with healthy weight. We computationally modelled both exploitation behaviour (e.g., reinforcement sensitivity and inverse decay parameters), and explorative behaviour (e.g., maximum directed exploration value). We found that overall, adolescents with excess weight displayed more behavioural exploration than their healthy-weight counterparts – specifically, demonstrating greater overall switching behaviour. Computational models revealed that this behaviour was driven by a higher maximum directed exploration value in the excess-weight group (U = 520.00, p = .005, BF10 = 5.11). Importantly, however, we found substantial evidence that groups did not differ in reinforcement sensitivity (U = 867.00, p = .641, BF10 = 0.30). Overall, our study demonstrates a preference for exploratory behaviour in adolescents with excess weight, independent of sensitivity to reward. This pattern could potentially underpin an intrinsic desire to explore energy-dense unhealthy foods – an as-yet untapped mechanism that could be targeted in future treatments of obesity in adolescents.Junta de AndaluciaNational Health and Medical Research Council (NHMRC) of Australia GNT200946

Hypothalamic Networks in Adolescents With Excess Weight: Stress-Related Connectivity and Associations With Emotional Eating

Objective: Adolescents with excess weight are particularly sensitive to stress, which may contribute to the presence of emotional eating behaviors. It is proposed that this may be due to alterations in the connectivity between hypothalamic networks and regions of the "emotional nervous system," involved in the regulation of energy balance and stress processing. However, this remains to be clarified in adolescents with excess weight. Method: We investigated whole-brain differences in the functional connectivity of the medial and lateral hypothalamus (MH and LH) between adolescents with excess weight (EW, n = 53; mean age = 14.64 years, SD = 1.78) and normal weight (NW, n = 51; mean age = 15.29 years, SD = 1.75) using seed-based resting-state analyses. Then, in a subset of 22 adolescents with EW (mean age = 15.75 years, SD = 1.70) and 32 with NW (mean age = 15.27, SD = 2.03), we explored for group interactions between the MH/LH networks and stress response in the Trier Social Stress Task (TSST) and emotional eating, assessed with the Dutch Eating Behavior Questionnaire (DEB-Q). Results: Compared to NW, EW showed higher functional connectivity in the LH-orbitofrontal cortex, ventral striatum, anterior insula, and in the MH-middle temporal cortex networks. EW also showed lower connectivity in the LH-cerebellum, and in the MH-middle prefrontal, pre-, and postcentral gyri networks. In EW, higher connectivity of the LH-nucleus accumbens and LH-midbrain networks were associated with stress response. Higher connectivity in the LH-midbrain was also associated with a greater presence of emotional eating behaviors in EW. Conclusion: Adolescents with EW showed functional connectivity alterations within both MH/LH networks. Alterations in the LH network were linked with higher levels of stress response and emotional-driven eating patterns

El autoengaño como mecanismo de mantenimiento de la adicción a las drogas

Background: This study was aimed at: (i) examining levels of self-deception in substance dependent individuals following addiction treatment, and (ii) examining the association between participants’ levels of self-deception and (a) personality disorders, (b) addiction-related beliefs, (c) duration of abstinence, and (d) estimates of craving. Method: We administered self-report questionnaires of self-deception and mixtification, and core beliefs related to addiction and craving. The sample comprised 79 outpatients who were consecutively recruited at the Centro Provincial de Drogodependencias in Granada: 87.3% were males and the mean age was 37.68 years old. Thirty-four percent of participants were diagnosed with comorbid personality disorders. Results: Results showed that individuals with substance dependence exhibit elevated scores of self-deception, particularly in the domains of active denial, selective amnesia, projection, and confabulation. Individuals with comorbid personality disorders display greater levels of self-deception compared to individuals without dual diagnosis. Conclusions: Moreover, there is a significant association between levels of self-deception and addiction-related beliefs and craving. In addition, there is a negative association between levels of self-deception and duration of abstinenceAntecedentes: los objetivos de este estudio fueron: (i) conocer el nivel de autoengaño de drogodependientes en tratamiento por su adicción, y (ii) estudiar la relación del autoengaño con (a) los trastornos de personalidad, (b) las creencias, (c) la abstinencia y (d) el craving en estos pacientes. Método: se utilizaron los cuestionarios de autoengaño y mixtificación (IAM) y de creencias relacionadas con el consumo de drogas y craving. La muestra estaba compuesta por 79 pacientes atendidos de forma consecutiva en el Centro Provincial de Drogodependencias de Granada. El 34.5% de los pacientes presentaban un trastorno de la personalidad. Resultados: los resultados mostraron que los drogodependientes obtienen puntuaciones elevadas en autoengaño, especialmente en los factores negación, amnesia selectiva, proyección y pensamiento fantaseado. Además, los pacientes con trastornos de la personalidad presentan niveles de autoengaño más elevados en comparación a los que no presentan este tipo de psicopatología, observándose una relación significativa entre las creencias nucleares relacionadas con el consumo y con el craving con el nivel de autoengaño. Conclusiones: se constata igualmente que el nivel de autoengaño se relaciona de forma negativa con el tiempo de abstinencia, lo que convierte al autoengaño en una diana terapéutica para mejorar el pronósticoS

Efecto de las drogas alucinógenas, estimulantes y depresoras del sistema nervioso central sobre la gravedad de la lesión en pacientes ingresados por traumatismos

Objective: The effect of drugs other than alcohol on severity of trauma remains unclear. Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system (CNS) may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients. Methods: The presence of alcohol, stimulant drugs (cocaine, amphetamines and methamphetamines), depressant drugs (benzodiazepines, opiates, methadone and barbiturates) and hallucinogenic drugs (THC and PCP) was analyzed in 1187 patients between 16 and 70 years old admitted to a trauma hospital between November 2012 and June 2015. Injury severity was determined prospectively as the Injury Severity Score. A multivariate analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable. Results: Drugs other than alcohol were found in 371 patients (31.3%): 32 (2.7%) stimulants, 186 (15.3%) depressants, 78 (6.6%) hallucinogenics and 75 (5.6%) polydrug use. The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.63 (1.37-15.60) for moderate injuries and 7.83 (2.53-24.21) for severe. Conclusion: CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption.Objetivo: No está claro qué efecto tienen las drogas distintas del alcohol sobre la gravedad de los traumatismos. Los análisis incluidos en estudios previos, que agrupan sustancias con efectos opuestos sobre el sistema nervioso central (SNC), pueden haber enmascarado la influencia de estas sobre la gravedad. El objetivo fue analizar el efecto de las drogas alucinógenas, estimulantes y depresoras del SNC, diferentes del alcohol, sobre la gravedad de las lesiones en pacientes ingresados por traumatismos. Métodos: Se analizó la presencia de alcohol, drogas estimulantes (cocaína, anfetaminas y metanfetaminas), depresoras (benzodiacepinas, opiáceos, metadona y barbitúricos) y alucinógenas (THC y PCP) en 1187 pacientes de entre 16 y 70 años de edad ingresados por traumatismo de noviembre de 2012 a junio de 2015. La gravedad del traumatismo se determinó prospectivamente mediante la Injury Severity Score. Se cuantificó la fuerza de la asociación entre la exposición a sustancias y la gravedad del traumatismo mediante un análisis multivariante, utilizando la presencia de alcohol como variable de estratificación. Conclusión: Las drogas depresoras del SNC tuvieron una fuerte influencia en la gravedad del traumatismo en los pacientes que además presentaban resultados positivos para consumo de alcohol.This work was supported by the Dirección General de Tráfico, Spain [No. 0100DGT22389] and the Consejería de Salud, Junta de Andalucía, Spain [No. PI-0691-2013]

頭部外傷の治療(交通事故による脳障害,第48回千葉医学会学術大会,第17回千葉県医師会学術大会,第10回日医医学講座,連合大会)

BACKGROUND:The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions). The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI) and decision-making, and the degree to which these associations are modulated by reward sensitivity. METHODS:Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT) and decision-making under ambiguity via the Iowa Gambling Task (IGT). Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). RESULTS:Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance), independently of reward sensitivity. CONCLUSIONS:Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices

Altered decision-making under risk in obesity

Background: The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions). The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI) and decision-making, and the degree to which these associations are modulated by reward sensitivity. Methods: Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT) and decision-making under ambiguity via the Iowa Gambling Task (IGT). Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). Results: Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance), independently of reward sensitivity. Conclusions: Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices

Long-term effectiveness of group cognitive-behavioral therapy for alcoholism: Impact of dual diagnosis on treatment outcome

El objetivo de este estudio fue analizar el resultado del tratamiento cognitivo-conductual grupal llevado a cabo en un centro ambulatorio para el tratamiento de las adicciones. La muestra estuvo compuesta por 130 hombres con trastorno por dependencia al alcohol. Se evaluaron los casos que reinician tratamiento tras el alta terapéutica en un rango de tiempo desde los dos años como mínimo hasta los 18. El 56.2% de la muestra finalizó el tratamiento con alta terapéutica, de los cuales el 75.3% no volvieron a iniciar tratamiento tras el alta, aumentando a 77.7% cuando el paciente completaba el periodo de revisión tras el alta. El 58% de los pacientes con trastornos de la personalidad finalizaron el tratamiento con alta terapéutica. El tratamiento cognitivo-conductual, cuyos componentes esenciales se detallan en este trabajo, es efectivo para el tratamiento grupal de los trastornos por dependencia del alcohol con comorbilidad de trastornos de la personalidad.The aim of the present study was to analyze the results of a cognitive-behavioral group therapy applied in an outpatient unit to treat drug addiction. The sample consisted of 130 males with an alcohol dependence disorder. Around 56% of the sample completed treatment – they were given therapeutic discharge. From those, 75.3% never resumed treatment, increasing to 77.7% when patients completed the check-up period after discharge. Follow-up from therapeutic discharge varies from 2 to 18 years; 58% of patients with personality disorders completed treatment with therapeutic discharge. Cognitive-behavioral treatment, whose essential components are detailed in the present study, is effective for the group treatment of patients with alcohol dependence and a comorbid personality disorder.Este estudio ha sido financiado por la Red de Trastornos Adictivos (Convocatoria RETICS 2012, Instituto de Salud Carlos III), Grupo Universidad de Granada