Faculty Bibliography

Background: The prevalence of child and adolescent obesity in the US has more than tripled since 1970 predicting a public health problem of considerable personal and societal costs in the coming decades. The psychological correlates of obesity have received recent attention with data showing decreased volume in orbito-frontal cortex and worsened executive function in obese children and large epidemiologic work showing associations between weight and ADHD as well as depression in youth. Relatively little of this work, however, has been performed in an urban minority population. We examined a population of African American and Latino youth from 2 New York City Public Schools to examine correlations between race, BMI, gender and psychopathology on the Child Behavior Checklist Methods: We evaluated 254 adolescents, 76.1% Hispanic, 16.3% African-American and 6.4% other ethnicity, ages 14 to 20 from 2 New York city public schools. Psychological measures were evaluated with the Child Behavior Checklist/ Youth Self Report. Weight was assessed with a Detecto balance beam scale and height with an accompanying stadiometer. The primary outcome measures were effects on weight and body mass index (BMI) as well as change in subsection score on CBCL. Results: This cohort had an average BMI of 30.1+/-5.6 (range 20.1-49.9). Girls scored higher than boys on self reports of somatic complaints 68.5+/-16.4 vs 63.8+/-14.4 p=, 01, interenalizing symptoms 59.3+/-26.0 vs 53.0+/-26.1 and total problems 61.1+/-25.9 vs 53.4+/-27.9). When looking at the effect of BMI, positive associations were found in boys between BMI and somatic complaints (r=.193, p=.035) and total psychiatric problems (r=.204, p=.026) but not in girls. In addition, only boys were sensitive to the effects of obesity (defined as BMI>30.0) with significant increases in scores of Anxiety/ Depression (62.5+/-16.3 vs 56.7+/-16.7). There were statistically significant gender by BMI interactions for somatic complaints (r=-0.128, p=.04) and total problems (r=-.121, p=.05). Race did not predict CBCL score nor did it interact with gender or BMI to predict CBCL psychopathology scores. Discussion: While measures of psychopathology were higher overall for girls, obesity was a vulnerability factor for boys in our largely overweight primarily Hispanic population. Only boys had significant correlations between increased BMI and higher self report of somatic symptoms and total problems. Obese boys also scored significantly higher on self ratings of anxiety/depression. Research has shown obesity to have clear neurobiological effects as well as social and psychological effects. In our sample weight and obesity was a vulnerability factor for boys but not for girls. Whether this is an effect of obesity interacting with hormonal or cultural factors cannot be interpreted in this cross sectional design, however this study provides preliminary data on the relationship between gender, psychiatric and metabolic dysregulation. Further exploration is needed to determine endocinologic, psychological and sociocultural factors that may underlie these trends as well as longitudinal work to help explain the temporal direction of these correlations

Pediatric bipolar disorder is a severe and impairing illness. Characterizing the impact of pediatric bipolar disorder on cognitive function might aid in understanding the phenomenology of the disorder. While previous studies of pediatric bipolar disorder have reported deficits in cognitive control and reward behavior, little is understood about how affective processes influence behavioral control. Relative to prior studies using manual-response paradigms, eye movement tasks provide a more precise assessment of reward sensitivity and cognitive and motor control. The current study compares 20 youths with bipolar disorder (mean age = 13.9 years +/- 2.22) and 23 healthy subjects (mean age = 13.8 years +/- 2.49) on a mixed pro-antisaccade task with monetary incentives. On both types of saccades, participants were presented with three types of incentives: those where subjects can win money, lose money, or neither win nor lose money. Impaired reward processing was found in youths with bipolar disorder relative to controls, particularly on antisaccades. This difference was reflected in lower error rates during incentive trials in the control but not in the bipolar disorder group. By comparison, no group differences were found on prosaccade trials. The results provide further evidence for deficits in cognitive and reward processing in bipolar disorder.

Demand for primary and revision arthroplasty is expected to double in 10 years. Coincident with this is a decreased interest in arthroplasty by residents. Retirement of arthroplasty surgeons further threatens access. This study determines if supply will meet demand. Survey data were used to calculate the 2016 workforce. Demand in 2016 was estimated using the Nationwide Inpatients Sample. Between 2008 and 2016, 400 arthroplasty specialists and 1584 generalists will enter the workforce. By 2016, 1896 arthroplasty surgeons will retire using 65 years as a conservative retirement age, whereas 4239 will retire using 59 years as a baseline retirement age. In 2016, the model estimated a procedural shortfall ranging from 174,409 ( downward arrow18.6%) using conservative retirement assumptions (age, 65 years) to 1,177,761 ( downward arrow69.4%) using baseline retirement assumptions (age, 59 years). This economic model predicts a supply side crisis that threatens patient access to specialty care. Immediate steps to stimulate supply must be taken.

BACKGROUND: Previous studies of major depressive disorder (MDD) have focused on abnormalities in the prefrontal cortex and medial temporal regions. There has been little investigation in MDD of midbrain and subcortical regions central to reward/aversion function, such as the ventral tegmental area/substantia nigra (VTA/SN), and medial forebrain bundle (MFB). METHODOLOGY/PRINCIPAL FINDINGS: We investigated the microstructural integrity of this circuitry using diffusion tensor imaging (DTI) in 22 MDD subjects and compared them with 22 matched healthy control subjects. Fractional anisotropy (FA) values were increased in the right VT and reduced in dorsolateral prefrontal white matter in MDD subjects. Follow-up analysis suggested two distinct subgroups of MDD patients, which exhibited non-overlapping abnormalities in reward/aversion circuitry. The MDD subgroup with abnormal FA values in VT exhibited significantly greater trait anxiety than the subgroup with normal FA values in VT, but the subgroups did not differ in levels of anhedonia, sadness, or overall depression severity. CONCLUSIONS/SIGNIFICANCE: These findings suggest that MDD may be associated with abnormal microstructure in brain reward/aversion regions, and that there may be at least two subtypes of microstructural abnormalities which each impact core symptoms of depression.

A polymorphism of the human Brain Derived Neurotrophic Factor (BDNF) gene that produces a valine-to-methionine substitution at codon 66 (Val66Met) is linked to adult anxiety and mood disorders, possibly through effects on brain circuitry function. Associations between BDNF gene variants and brain activity have not been explored in anxious and depressed adolescents. The current study investigated the association between BDNF genotype and amygdala-hippocampal responses to emotional stimuli in adolescents with anxiety disorders and/or major depressive disorder (MDD) and in healthy adolescents. Twenty-seven unmedicated patients with acutely-impairing current anxiety disorders and/or MDD and 31 healthy adolescents, matched on age, gender and IQ, rated their fear of fearful, angry, neutral and happy facial expressions during collection of fMRI data on the amygdala and hippocampus. Left and right amygdala and hippocampal responses were analyzed using repeated-measures analyses of variance models, with diagnosis (patients, healthy) and genotype (Met-carriers, Val/Val homozygotes) as between-group factors and facial expression (fearful, angry, neutral, happy) as a within-subject factor. Significant effects of diagnosis and diagnosis-by-genotype interactions (F's>4, p's<0.05) characterized activations in amygdala and anterior hippocampal regions. Greater activations in patients than healthy adolescents were found. Critically, these hyperactivations were modulated by BDNF genotype: Met-carriers showed greater neural responses of emotional faces than Val/Val homozygotes in patients only. These data are first to demonstrate the contribution of BDNF gene variants to the neural correlates of adolescent anxiety and depression. Early "gene-brain" linkages may lay the foundation for longer-term patterns of neural dysfunction in affective disorders.

Diffusion tensor imaging is widely used to evaluate the development of white matter. Information about how alterations in major neurotransmitter systems, such as the dopamine (DA) system, influence this development in healthy children, however, is lacking. Catechol-O-metyltransferase (COMT) is the major enzyme responsible for DA degradation in prefrontal brain structures, for which there is a corresponding genetic polymorphism (val158met) that confers either a more or less efficient version of this enzyme. The result of this common genetic variation is that children may have more or less available synaptic DA in prefrontal brain regions. In the present study we examined the relation between diffusion properties of frontal white matter structures and the COMT val158met polymorphism in 40 children ages 9-15. We found that the val allele was associated with significantly elevated fractional anisotropy values and reduced axial and radial diffusivities. These results indicate that the development of white matter in healthy children is related to COMT genotype and that alterations in white matter may be related to the differential availability of prefrontal DA. This investigation paves the way for further studies of how common functional variants in the genome might influence the development of brain white matter.

Functional homotopy, the high degree of synchrony in spontaneous activity between geometrically corresponding interhemispheric (i.e., homotopic) regions, is a fundamental characteristic of the intrinsic functional architecture of the brain. However, despite its prominence, the lifespan development of the homotopic resting-state functional connectivity (RSFC) of the human brain is rarely directly examined in functional magnetic resonance imaging studies. Here, we systematically investigated age-related changes in homotopic RSFC in 214 healthy individuals ranging in age from 7 to 85 years. We observed marked age-related changes in homotopic RSFC with regionally specific developmental trajectories of varying levels of complexity. Sensorimotor regions tended to show increasing homotopic RSFC, whereas higher-order processing regions showed decreasing connectivity (i.e., increasing segregation) with age. More complex maturational curves were also detected, with regions such as the insula and lingual gyrus exhibiting quadratic trajectories and the superior frontal gyrus and putamen exhibiting cubic trajectories. Sex-related differences in the developmental trajectory of functional homotopy were detected within dorsolateral prefrontal cortex (Brodmann areas 9 and 46) and amygdala. Evidence of robust developmental effects in homotopic RSFC across the lifespan should serve to motivate studies of the physiological mechanisms underlying functional homotopy in neurodegenerative and psychiatric disorders

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.