Faculty Bibliography

The putative risk/protective factors for several personality disorders remain unclear. The vast majority of published studies has assessed personality characteristics/traits rather than disorders. Thus, the current umbrella review of meta-analyses (MAs) aims to systematically assess risk or protective factors associated with personality disorders. We searched PubMed-MEDLINE/PsycInfo databases, up to August 31, 2020. Quality of MAs was assessed with AMSTAR-2, while the credibility of evidence for each association was assessed through standard quantitative criteria. Out of 571 initial references, five meta-analyses met inclusion criteria, encompassing 56 associations of 26 potential environmental factors for antisocial, dependent, borderline personality disorder, with a median of five studies per association, and median 214 cases per association. Overall, 35 (62.5%) of the associations were nominally significant. Six associations met class II (i.e., highly suggestive) evidence for borderline personality disorder, with large effect sizes involving childhood emotional abuse (OR = 28.15, 95% CI 14.76-53.68), childhood emotional neglect (OR = 22.86, 95% CI 11.55-45.22), childhood any adversities (OR = 14.32, 95% CI 10.80-18.98), childhood physical abuse (OR = 9.30, 95% CI 6.57-13.17), childhood sexual abuse (OR = 7.95, 95% CI 6.21-10.17), and childhood physical neglect (OR = 5.73, 95% CI 3.21-10.21), plus 16 further associations supported by class IV evidence. No risk factor for antisocial or dependent personality disorder was supported by class I, II, and III, but six and seven met class IV evidence, respectively. Quality of included meta-analyses was rated as moderate in two, critically low in three. The large effect sizes found for a broad range of childhood adversities suggest that prevention of personality disorders should target childhood-related risk factors. However, larger cohort studies assessing multidimensional risk factors are needed in the field.

BACKGROUND: Covid-19 disease, resulting from the virus SARS-CoV-2, has caused significant morbidity and mortality across the globe. In the acute setting, Covid-19 is characterized by its inflammatory impact, notably leading to acute respiratory distress syndrome, increased risk of blood clots, cardiomyopathy, and acute kidney injury. Long-term complications known as longhaul Covid, chronic Covid, or post-Covid syndrome include fatigue, depression, persistent respiratory complaints, and decreased quality of life. However, little research exists to elucidate the primary care needs of those who have recovered from Covid-19. This longitudinal observational study describes healthcare usage patterns and new medical diagnoses after acute Covid-19 infection.
METHOD(S): We queried the NYU Langone COVID Deidentified Dataset for adults 18+ years old with a positive SARS-CoV-2 PCR test. Patients had at least one visit in the NYU Langone Health system >2 weeks before and >2 weeks after infection (n = 2940). We further narrowed this cohort to patients with a primary care encounter where a Covid-19 related concern was documented at follow-up (n = 454; 57% female; 22%=18-42 years, 51%=43-67 years, 27%=68+ years old). The median length of follow-up was 6 weeks (IQR=3.6-10.1 weeks, max=38 weeks). ICD-10 codes and the Clinical Classification Software Refined (CCSR) categories were used to identify diagnoses newly developed after Covid-19 infection or symptoms that persisted beyond the initial 14-day infection period.
RESULT(S): Of 2,940 patients with pre and post-infection visits, only 454 (15%) sought primary care for a Covid-19 related concern. Respiratory signs and symptoms were the most common complaint. Prevalent diagnoses included cough (8%), hypoxia or respiratory failure (8%), and shortness of breath (7%). Malaise and fatigue (7%), musculoskeletal pain (6%), and generalized weakness and deconditioning (5%) were also common. Nutritional deficiencies were documented among 28 patients (6%), most often for vitamin D deficiency (5%). Palpitations (5%) and nonspecific chest pain (such as chest tightness or discomfort, 3%) as well as deep vein thrombosis and pulmonary emboli (4%) were also reported.
CONCLUSION(S): Most patients with a Covid-19 diagnosis did not seek follow-up, consistent with reports that Covid-19 predominantly causes acute illness. For patients who developed new or persistent symptoms, the most common complaints were respiratory concerns, malaise and fatigue, and musculoskeletal pain. The persistence of these symptoms in our cohort suggests that patients may indeed present a constellation of symptoms after acute Covid-19 infection. Updated longitudinal queries and further research may continue to highlight the importance of tailoring longer term primary care for those who have recovered from acute Covid infection. LEARNING OBJECTIVE #1: Identify common symptoms of patients returning to primary care more than 2 weeks after Covid-19 infection LEARNING OBJECTIVE #2: Determine need for primary care follow-up after Covid-19 recovery

Decades of research have informed our understanding of how stress impacts the brain to perturb behavior. However, stress during development has received specific attention as this occurs during a sensitive period for scaffolding lifelong socio-emotional behavior. In this review, we focus the developmental neurobiology of stress-related pathology during infancy and focus on one of the many important variables that can switch outcomes from adaptive to maladaptive outcome: caregiver presence during infants' exposure to chronic stress. While this review relies heavily on rodent neuroscience research, we frequently connect this work with the human behavioral and brain literature to facilitate translation. Bowlby's Attachment Theory is used as a guiding framework in order to understand how early care quality impacts caregiver regulation of the infant to produce lasting outcomes on mental health.

Spreading depolarization (SD) is a sudden, large, and synchronous depolarization of principal cells which also involves interneurons and astrocytes. It is followed by depression of neuronal activity, and it slowly propagates across brain regions like cortex or hippocampus. SD is considered to be mechanistically relevant to migraine, epilepsy, and traumatic brain injury (TBI), but there are many questions about its basic neurophysiology and spread. Research into SD in hippocampus using slices is often used to gain insight and SD is usually triggered by a focal stimulus with or without an altered extracellular buffer. Here, we optimize an in vitro experimental model allowing us to record SD without focal stimulation, which we call spontaneous. This method uses only an altered extracellular buffer containing 0 mM Mg²⁺ and 5 mM K⁺ and makes it possible for simultaneous patch and extracellular recording in a submerged chamber plus intrinsic optical imaging in slices of either sex. We also add methods for quantification and show the quantified optical signal is much more complex than imaging alone would suggest. In brief, acute hippocampal slices were prepared with a chamber holding a submerged slice but with flow of artificial cerebrospinal fluid (aCSF) above and below, which we call interface-like. As soon as slices were placed in the chamber, aCSF with 0 Mg²⁺/5 K⁺ was used. Most mouse slices developed SD and did so in the first hour of 0 Mg²⁺/5 K⁺ aCSF exposure. In addition, prolonged bursts we call seizure-like events (SLEs) occurred, and the interactions between SD and SLEs suggest potentially important relationships. Differences between rats and mice in different chambers are described. Regarding optical imaging, SD originated in CA3 and the pattern of spread to CA1 and the dentate gyrus was similar in some ways to prior studies but also showed interesting differences. In summary, the methods are easy to use, provide new opportunities to study SD, new insights, and are inexpensive. They support previous suggestions that SD is diverse, and also suggest that participation by the dentate gyrus merits greater attention.

News of a videogame that received FDA clearance to treat youth with attention-deficit hyperactivity disorder (ADHD) garnered a great deal of media attention and raised questions about the role of digital cognitive training programs for treatment. In order for clinicians and clients to understand this news for the purposes of making treatment decisions one must have an understanding of what it means for a treatment to be considered evidence-based and an understanding of what is required to obtain FDA clearance. Finally, in order to fully inform decisions about treatment, clinicians and parents must be able to consider the evidence supporting cognitive training programs in relation to other treatments available for children with ADHD. A review of these standards and the evidence supporting cognitive training in general, and the new videogame that received recent FDA clearance (EndeavorRX^TM) specifically, revealed an overall lack of support for this approach to treatment. There are multiple psychosocial and pharmacological treatment options with much more evidence supporting their effectiveness than any commercially available cognitive training program. The contrast between receiving FDA clearance without evidence of any observable benefits to the child is explained within a description of the FDA process for clearance and approval. Finally, these conclusions are described in the context of clinicians' decisions regarding services offered and procedures for explaining this to families who may have seen the media attention related to FDA clearance.
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