Faculty Bibliography

OBJECTIVE:This study evaluated a novel intervention for friendship problems in children with attention-deficit/hyperactivity disorder (ADHD). Parental Friendship Coaching (PFC) teaches parents to coach their children in targeted friendship behaviors that are lacking in children with ADHD and that help children develop good quality friendships. METHOD/METHODS:Participants were 172 families of children with ADHD and social impairment (ages 6-11; 29.7% female) at two Canadian sites, randomized to PFC or to an active comparison intervention (Coping with ADHD through Relationships and Education; CARE) to control for common therapy factors. Questionnaire and observational measures assessing primary outcomes of children's friendship quality and secondary outcomes of children's friendship behaviors were collected at baseline, posttreatment, and 8-month follow-up. RESULTS:Across both treatment conditions, children showed improvements in positive friendship quality and in friendship behaviors. Relative to CARE, PFC was associated with somewhat more positive and less negative friendship behaviors at posttreatment and follow-up, but no difference between conditions was found in friendship quality. However, moderation analyses suggested that PFC may contribute to better friendship quality among families who had previous psychosocial treatment, as well as children with comorbid externalizing disorders. CONCLUSIONS:Although PFC showed some efficacy for affecting children's friendship behaviors, these changes may not translate into friendship quality. Nevertheless, PFC may improve friendship quality for at-risk subgroups of children with ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

During a sensitive period associated with attachment, the infant brain has unique circuitry that enables the specialized adaptive behaviors required for survival in infancy. This infant brain is not an immature version of the adult brain. Within the attachment relationship, the infant remains close (proximity seeking) to the caregiver for nurturing and survival needs, but the caregiver also provides the immature infant with the physiological regulation interaction needed before self-regulation matures. Here we provide examples from the human and animal literature that illustrate some of these regulatory functions during sensitive periods, recent advances demonstrating the supporting transient neural mechanisms, and how these systems go awry in the absence of species-expected caregiving.

OBJECTIVE:To investigate the spatial patterns and the probable sequences of grey matter atrophy in spinocerebellar ataxia type 3 (SCA3). METHODS:A total of 47 patients with SCA3 and 49 age- and sex-matched healthy control subjects participated in the study. High-resolution T1-weighted magnetic resonance images were examined in all participants. We used the causal network of structural covariance (CasCN) to identify the sequence of grey matter atrophy patterns. This was achieved by applying Granger causality analysis to a grey matter atrophy staging scheme performed by voxel-based morphometry from the network level. RESULTS:Participants in the premanifest stage of the disease showed the presence of focal grey matter atrophy in the vermis. As the disease duration increased, there was progressive grey matter atrophy in the cerebellar, the neostriatum, the frontal lobe, and the parietal lobe. The patients with SCA3 also showed proximal and distal cortical atrophy sequences exerting from the vermis to the regions mainly located in the cerebellum-neostriatum-cortical network. CONCLUSION/CONCLUSIONS:Our results, although preliminary in nature, indicate that the grey matter atrophy in SCA3 lies and extends to involve more regions according to distinct anatomical patterns, mainly in the cerebellum-neostriatum-cortical network. These findings advance our understanding on the natural history of structural damage in SCA3, while confirming known clinical features. This could provide unique insight into the ordered sequential process of regional brain atrophy that targets a particular network.

Serotonin (5-HT) selective reuptake inhibitors (SSRIs) are widely used in the treatment of depression and anxiety disorders, but responsiveness is uncertain and side effects often lead to discontinuation. Side effect profiles suggest that SSRIs reduce dopaminergic (DAergic) activity, but specific mechanistic insight is missing. Here we show in mice that SSRIs impair motor function by acting on 5-HT2C receptors in the substantia nigra pars reticulata (SNr), which in turn inhibits nigra pars compacta (SNc) DAergic neurons. SSRI-induced motor deficits can be reversed by systemic or SNr-localized 5-HT2C receptor antagonism. SSRIs induce SNr hyperactivity and SNc hypoactivity that can also be reversed by systemic 5-HT2C receptor antagonism. Optogenetic inhibition of SNc DAergic neurons mimics the motor deficits due to chronic SSRI treatment, whereas local SNr 5-HT2C receptor antagonism or optogenetic activation of SNc DAergic neurons reverse SSRI-induced motor deficits. Lastly, we find that 5-HT2C receptor antagonism potentiates the antidepressant and anxiolytic effects of SSRIs. Together our findings demonstrate opposing roles for 5-HT2C receptors in the effects of SSRIs on motor function and affective behavior, highlighting the potential benefits of 5-HT2C receptor antagonists for both reduction of motor side effects of SSRIs and augmentation of therapeutic antidepressant and anxiolytic effects.

The occurrence of dreaming during rapid eye movement (REM) sleep prompts interest in the role of REM sleep in hippocampal-dependent episodic memory. Within the mammalian hippocampus, the dentate gyrus (DG) has the unique characteristic of exhibiting neurogenesis persisting into adulthood. Despite their small numbers and sparse activity, adult-born neurons (ABNs) in the DG play critical roles in memory; however, their memory function during sleep is unknown. Here, we investigate whether young ABN activity contributes to memory consolidation during sleep using Ca²⁺ imaging in freely moving mice. We found that contextual fear learning recruits a population of young ABNs that are reactivated during subsequent REM sleep against a backdrop of overall reduced ABN activity. Optogenetic silencing of this sparse ABN activity during REM sleep alters the structural remodeling of spines on ABN dendrites and impairs memory consolidation. These findings provide a causal link between ABN activity during REM sleep and memory consolidation.

Antidepressants are prescribed for the treatment of a number of psychiatric disorders in children and adolescents, however there is still controversy about whether they should be used in this population. This meta-review aimed to assess the effects of antidepressants for the acute treatment of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders (ADs), autistic spectrum disorder (ASD), enuresis, major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) in children and adolescents. Efficacy was measured as response to treatment (either as mean overall change in symptoms or as a dichotomous outcome) and tolerability was measured as the proportion of patients discontinuing treatment due to adverse events. Suicidality was measured as suicidal ideation, behavior (including suicide attempts) and completed suicide. PubMed, EMBASE, and Web of Science were systematically searched (until 31 October 2019) for existing systematic reviews and/or meta-analyses of double-blind randomized controlled trials. The quality of the included reviews was appraised using AMSTAR-2. Our meta-review included nine systematic reviews/meta-analyses (2 on ADHD; 1 on AD; 2 on ASD; 1 on enuresis; 1 on MDD, 1 on OCD and 1 on PTSD). In terms of efficacy this review found that, compared to placebo: fluoxetine was more efficacious in the treatment of MDD, fluvoxamine and paroxetine were better in the treatment of AD; fluoxetine and sertraline were more efficacious in the treatment of OCD; bupropion and desipramine improved clinician and teacher-rated ADHD symptoms; clomipramine and tianeptine were superior on some of the core symptoms of ASD; and no antidepressant was more efficacious for PTSD and enuresis. With regard to tolerability: imipramine, venlafaxine, and duloxetine were less well tolerated in MDD; no differences were found for any of the antidepressants in the treatment of anxiety disorders (ADs), ADHD, and PTSD; tianeptine and citalopram, but not clomipramine, were less well tolerated in children and adolescents with ASD. For suicidal behavior/ideation, venlafaxine (in MDD) and paroxetine (in AD) were associated with a significantly increased risk; by contrast, sertraline (in AD) was associated with a reduced risk. The majority of included systematic reviews/meta-analyses were rated as being of high or moderate in quality by the AMSTAR-2 critical appraisal tool (one and five, respectively). One included study was of low quality and two were of critically low quality. Compared to placebo, selected antidepressants can be efficacious in the acute treatment of some common psychiatric disorders, although statistically significant differences do not always translate into clinically significant results. Little information was available about tolerability of antidepressants in RCTs of OCD and in the treatment of ADHD, ASD, MDD, and PTSD. There is a paucity of data on suicidal ideation/behavior, but paroxetine may increase the risk of suicidality in the treatment of AD and venlafaxine for MDD. Findings from this review must be considered in light of potential limitations, such as the lack of comparative information about many antidepressants, the short-term outcomes and the quality of the available evidence.

Background/UNASSIGNED:With the uncertainties of COVID-19, people infected by coronavirus present with diverse psychiatric presentations. Some centers have had to manage their patients with existing protocols, others have had to come up with innovations. We aim to report the challenges and good practices recorded in the management of psychiatric conditions and delirium coexisting with COVID-19 and during the COVID-19 era across continents. Material and Methods/UNASSIGNED:Early Career Psychiatrists (ECPs) from across five continents were approached to provide their perspective on the management of psychiatric conditions in patients with COVID-19 and during the current pandemic. Results/UNASSIGNED:We collected information about the experiences from ten countries. Commonalities were similar psychiatric presentations and poor preparedness across countries. Differences were varying innovations and adjustments made in the management of psychiatric conditions coexisting with COVID-19. Good practices which can be adopted by other countries are novel approaches such as telepsychiatry, proactive consultation-liaison units and enhanced community services targeted at circumventing challenges faced yet providing mental health services. Conclusions/UNASSIGNED:This publication highlights the need for global preparedness in the mental health sector during outbreaks of infectious diseases. With our results we can conclude that there is the need for concerted efforts targeted at global and locally sensitive adaptation of existing protocols and the development of new guidelines for the management of psychiatric conditions for the present pandemic and subsequent occurrences.