Altered Resting-State Networks in Adolescent Non-Suicidal Self-Injury – A Graph Theory Analysis

Non-suicidal self-injury (NSSI) is a highly prevalent transdiagnostic symptom and risk marker for mental health problems among adolescents. Research on the neurobiological mechanisms underlying NSSI is needed to clarify the neural correlates associated with the behavior. We examined resting-state-functional-connectivity (RSFC) in n = 33 female adolescents aged 12-17 years engaging in NSSI, and n = 29 age-matched healthy controls using graph theory. Mixed linear models were evaluated with the Bayes Factor (BF) to determine group differences on global and regional network measures and associations between network measures and clinical characteristics in patients. Adolescents engaging in NSSI demonstrated longer average characteristic path lengths and a smaller number of weighted hubs globally. Regional measures indicated lower efficiency and worse integration in (orbito)frontal regions and higher weighted coreness in the pericalcarine gyrus. In patients, higher orbitofrontal weighted local efficiency was associated with NSSI during the past month while lower pericalcarine nodal efficiency was associated with suicidal thoughts in the past year. Higher right but lower left pericalcarine weighted hubness was associated with more suicide attempts during the past year. Using a graph-based technique to identify functional connectivity networks, this study adds to the growing understanding of the neurobiology of NSSI

Resting-state functional connectivity predicting clinical improvement following treatment in female adolescents with non-suicidal self-injury.

BACKGROUND Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and predicts future psychopathology including suicide. To improve therapeutic decisions and clinical outcome of patients engaging in NSSI, it seems beneficial to determine neurobiological markers associated with treatment response. The present study investigated whether resting-state functional brain connectivity (RSFC) served to predict clinical improvements following treatment in adolescents engaging in NSSI. METHODS N = 27 female adolescents with NSSI took part in a baseline MRI exam and clinical outcome was assessed at follow-ups one, two and three years after baseline. During the follow-up period, patients received in- and/or outpatient treatment. Mixed-effects linear regression models were calculated to examine whether RSFC was associated with clinical improvement. RESULTS Patients' clinical outcome improved across time. Lower baseline RSFC between left paracentral gyrus and right anterior cingulate gyrus was associated with clinical improvement from baseline to one-year and from two-year to three-year follow-up. Lower and higher baseline RSFC in several inter- and intrahemispheric cortico-cortical and cortico-subcortical connections of interest were associated with clinical symptomatology and its severity, independent from time. LIMITATIONS A relatively small sample size constrains the generalizability of our findings. Further, no control group not receiving treatment was recruited, therefore clinical changes across time cannot solely be attributed to treatment. CONCLUSIONS While there was some evidence that RSFC was associated with clinical improvement following treatment, our findings suggest that functional connectivity is more predictive of severity of psychopathology and global functioning independent of time and treatment. We thereby add to the limited research on neurobiological markers as predictors of clinical outcome after treatment

The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study

Background: While several population-based studies report that pain is independently associated with higher rates of self-destructive behaviour (suicidal ideation, suicide attempts, and self-injurious behaviour) in adults, studies in adolescents are rare and limited to specific chronic pain conditions. The aim of this study was to investigate the link between self-reported idiopathic pain and the prevalence and frequency of self-injury (SI) and suicide attempts in adolescents. Methods: Data from a cross-sectional, school-based sample was derived to assess SI, suicide attempts, recurrent pain symptoms and various areas of emotional and behavioural problems via a self-report booklet including the Youth Self-Report (YSR). Adolescents were assigned to two groups (presence of pain vs. no pain) for analysis. Data from 5,504 students of 116 schools in a region of South Western Germany was available. A series of unadjusted and adjusted multinomial logistic regression models were performed to address the association of pain, SI, and suicide attempts. Results: 929 (16.88%) respondents reported recurrent pain in one of three areas of pain symptoms assessed (general pain, headache, and abdominal pain). Adolescents who reported pain also reported greater psychopathological distress on all sub-scales of the YSR. The presence of pain was significantly associated with an increased risk ratio (RR) for SI (1–3 incidences in the past year: RR: 2.96; >3 incidences: RR: 6.04) and suicide attempts (one attempt: RR: 3.63; multiple attempts: RR: 5.4) in unadjusted analysis. Similarly, increased RR was observed when adjusting for sociodemographic variables. While controlling for psychopathology attenuated this association, it remained significant (RRs: 1.4–1.8). Sub-sequent sensitivity analysis revealed different RR by location and frequency of pain symptoms. Conclusions: Adolescents with recurrent idiopathic pain are more likely to report previous incidents of SI and suicide attempts. This association is likely mediated by the presence of psychopathological distress as consequence of recurrent idiopathic pain. However, the observed variance in dependent variables is only partially explained by emotional and behavioural problems. Clinicians should be aware of these associations and interview adolescents with recurrent symptoms of pain for the presence of self-harm, past suicide attempts and current suicidal thoughts. Future studies addressing the neurobiology underpinnings of an increased likelihood for self-injurious behaviour and suicide attempts in adolescents with recurrent idiopathic pain are necessary

Stress-induced alterations in resting-state functional connectivity among adolescents with non-suicidal self-injury.

BACKGROUND Non-suicidal self-injury (NSSI) is a major mental health problem among youth worldwide. Dysfunction in emotion regulation contributes to NSSI, but research on the underlying neurobiological mechanisms of NSSI is limited. Adolescents with emotion regulation difficulties are vulnerable to stress, making them susceptible to maladaptive coping mechanisms such as NSSI. METHODS This study examined the functional neurocircuitry relevant to emotion regulation and stress coping in individuals with NSSI compared with healthy controls. This case-control study included 34 adolescents with NSSI (15.91 years) and 28 (16.0 years) unaffected controls. Participants underwent a functional magnetic resonance imaging scan before and after completing a laboratory stress-induction paradigm (the Montreal Imaging Stress Test). The effects of stress induction were quantified by both physiological measures and self-reports. RESULTS Participants with NSSI showed distinctive alterations in functional resting-state following stress induction, which differentiated them from unaffected controls. Results show a reduction in functional connectivity between frontoparietal regions and the angular gyrus within the patient group compared to controls, as well as an increase in functional connectivity between visual regions, the insular cortex, the planum polare, and the central opercular cortex. After conditions of acute stress, adolescents with NSSI show changes in functional connectivity of regions associated with sensorimotor alertness, attention, and effortful emotion regulation. LIMITATIONS The patient group showed both NSSI and suicidal behavior, therefore results might be partly due to suicidality. CONCLUSION The findings emphasize the importance of targeting emotion regulation within therapeutic approaches to enhance stress coping capacity, which in turn may contribute to counteracting self-injurious behavior

Persönlichkeitsmodelle im Kontext der Kinder- und Jugendpsychiatrie – Entwicklung, Veränderung, Stabilität und Forschungsperspektiven

Persönlichkeitsmodelle spielen für das ätiologische Verständnis von abweichender Entwicklung im klinischen Alltag eine wichtige Rolle. In diesem Überblicksartikel werden relevante Persönlichkeitsmodelle vorgestellt und insbesondere hinsichtlich ihrer Entwicklungsdynamik und ihrer Bedeutung für die Adaptationsfähigkeit über die Lebensspanne, beginnend in der Kindheit näher beleuchtet. Im Fokus steht dabei die entwicklungspsychopathologische Bedeutung von Prozessen der Ich-Flexibilität und Selbstregulationsfähigkeit im Spannungsfeld zwischen Disposition und sozialen Umgebungsbedingungen. Dies zeigt sich gerade in der Diskussion von Entwicklungspfadmodellen zu Persönlichkeitsfehlentwicklungen mit Misshandlungserleben bzw. Bindungsdesorganisation in der kindlichen Vorgeschichte. Psychopathologisch ergeben sich aus einer persönlichkeitsimmanenten Beeinträchtigung der Selbststeuerungsfähigkeit häufig stabile Fehlanpassungsmuster, die bei rein symptomatischer Behandlung meist nur zu temporären Verhaltensmodifikationen führen. Hingegen spricht die Veränderbarkeit pathologischer Persönlichkeitszüge durch den Einsatz gezielter Interventionsansätze für eine positive Entwicklungsmöglichkeit und widerspricht einer deterministischen Merkmalsstabilität. Für künftige entwicklungspsychopathologische Forschungsperspektiven werden verschiedene theoretische Persönlichkeitskonstrukte mit klinischen Beobachtungen in Verbindung gebracht und diskutiert

Neuropsychological development in adolescents: Longitudinal associations with white matter microstructure

Important neuropsychological changes during adolescence coincide with the maturation of white matter microstructure. Few studies have investigated the association between neuropsychological development and white matter maturation longitudinally. We aimed to characterize developmental trajectories of inhibition, planning, emotion recognition and risk-taking and examine whether white matter microstructural characteristics were associated with neuropsychological development above and beyond age. In an accelerated longitudinal cohort design, n 1/4 112 healthy adolescents between ages 9 and 16 underwent cognitive assessment and diffusion MRI over three years. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted for major white matter pathways using an automatic probabilistic reconstruction technique and mixed models were used for statistical analyses. Inhibition, planning and emotion recognition performance improved linearly across adolescence. Risk-taking developed in a quadratic fashion, with stable performance between 9 and 12 and an increase between ages 12 and 16. Including cingulum and superior longitudinal fasciculus FA slightly improved model fit for emotion recognition across age. We found no evidence that FA or MD were related to inhibition, planning or risk-taking across age. Our results challenge the additional value of white matter microstructure to explain neuropsychological development in healthy adolescents, but more longitudinal research with large datasets is needed to identify the potential role of white matter microstructure in cognitive development

Non-suicidal self-injury and emotional burden among university students during the COVID-19 pandemic: cross-sectional online survey

Owing to restrictions of the COVID-19 pandemic, increased stress is evident in university students with a lifetime history of non-suicidal self-injury (NSSI). Therefore, we examined two groups of university students (n = 174) in an online survey, one that exhibited early NSSI in adolescence (n = 51) and another that exhibited continuous NSSI beyond the age of 18 (n = 123) (German Clinical Trials Register DRKS00023731). We compared the two groups in terms of depressive symptoms in the previous 2 weeks as well as self-perceived changes in emotional burden, urge to self-injure and NSSI frequency in the first year of the pandemic compared with the year before (pre-pandemic). Among other findings, both groups showed an increase in emotional burden and urge to self-injure

Suicidality Presented to a Child and Adolescent Psychiatry Emergency Service: Increasing Rate and Changing Characteristics

Background: Children and adolescents who present to child and adolescent psychiatric emergency departments show a variety of reasons for their presentations. Suicidality, in particular suicidal thoughts and suicide attempts, as well as non-suicidal self-injury (NSSI) play a large and important role. In this context, inpatient admissions frequently serve as crisis intervention. Methods: In this study, face-to-face emergency presentations to the emergency department at our Clinic of Child and Adolescent Psychiatry (CAP) were analyzed over the years 2014-2018, the 4th quarter (October-December) of each year. Data from 902 emergency presentations were evaluated, primarily with regard to suicidal thoughts, suicide attempts, and NSSI as reasons for presentation. Results: Data demonstrated that the number of emergency presentations increased in general and especially for suicidal thoughts and NSSI as reasons for presentation. In addition, suicidal thoughts, suicide attempts, and NSSI as reasons for emergency presentation were more likely to result in crisis-related inpatient admissions. Furthermore, reporting suicide attempts at emergency presentation was associated with longer inpatient stays. Finally, cases with multiple diagnoses increased independent of the general increase in emergency presentations. Conclusion: The increase of utilization of clinics with CAP outpatient emergency patients and following admissions to the inpatient units for crisis intervention poses a major challenge for the future. It is important to prepare for the assessment and treatment of suicidality, which is of extraordinary importance in the care of emergency patients

Impact of preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in preschool children

Background Internalizing problems are common in young children, often persist into adulthood, and increase the likelihood for subsequent psychiatric disorders. Problematic attachment, parental mental health problems, and stress are risk factors for the development of internalizing problems. COVID-19 lockdown measures have resulted in additional parental burden and especially their impact on preschool children has rarely been investigated as of now. The current study examined the impact of sustained preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in a sample of preschool children in Germany. Methods and findings N = 128 parents of preschool children filled out a one-time online survey about children’s internalizing problems, externalizing problems, and attachment for three time points: before a nation-wide lockdown (T1), during the most difficult time of the lockdown (T2) and after the lockdown (T3). Additionally, parents answered questions about their own depressive and anxious symptomatology for the three time points and parental stress for T1 and T2. Linear-mixed effect models were computed to predict children’s internalizing / externalizing behavior. Preschool children showed a significant increase in internalizing and externalizing problems over time, highest at T2 with small decreases at T3. Parental depressive and anxious symptomatology increased significantly from T1 to T2, but also remained high at T3. Parental stress levels were comparable to community samples at T1, but attained average values reported for at-risk families at T2. Linear-mixed effect models identified higher parental stress, parental anxiety, attachment problems, parental education, and less preschool attendance as significant predictors for internalizing and externalizing problems in preschoolers with more specific associations shown in separate models. A limitation is the retrospective assessment for the times T1 and T2. Conclusions Preschool children’s mental health is strongly and negatively influenced by the ongoing COVID-19 pandemic and its lockdown measures. Sustained preschool attendance may serve as a protective factor