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Background Adolescent substance use, externalizing and attention problems, and early life stress (ELS) commonly co-occur. These psychopathologies show overlapping neural dysfunction in the form of reduced recruitment of reward processing neuro-circuitries. However, it is unclear to what extent these psychopathologies show common v. different neural dysfunctions as a function of symptom profiles, as no studies have directly compared neural dysfunctions associated with each of these psychopathologies to each other. Methods In study 1, a latent profile analysis (LPA) was conducted in a sample of 266 adolescents (aged 13–18, 41.7% female, 58.3% male) from a residential youth care facility and the surrounding community to investigate substance use, externalizing and attention problems, and ELS psychopathologies and their co-presentation. In study 2, we examined a subsample of 174 participants who completed the Passive Avoidance learning task during functional magnetic resonance imaging to examine differential and/or common reward processing neuro-circuitry dysfunctions associated with symptom profiles based on these co-presentations. Results In study 1, LPA identified profiles of substance use plus rule-breaking behaviors, attention-deficit hyperactivity disorder, and ELS. In study 2, the substance use/rule-breaking profile was associated with reduced recruitment of reward processing and attentional neuro-circuitries during the Passive Avoidance task (p < 0.05, corrected for multiple comparisons). Conclusions Findings indicate that there is reduced responsivity of striato-cortical regions when receiving outcomes on an instrumental learning task within a profile of adolescents with substance use and rule-breaking behaviors. Mitigating reward processing dysfunction specifically may represent a potential intervention target for substance-use psychopathologies accompanied by rule-breaking behaviors.

Objectives: The purpose of this study is to report the incidence and patterns of injuries, surgical interventions performed, and healthcare costs associated with unlawful border crossings. Design: Retrospective Review Setting: Level 1 Trauma center on US-Mexico Border Main outcome measurement: Demographic and treatment data Results and conclusions: 111 patients were identified with an average age of 32 ± 12 years (range 6-60), and 56% were males. Monthly frequency of admissions was 0.75 in 2017, 1.33 in 2018, and 7.1 in 2019 (p

Adults with antisocial personality disorder with (ASPD + P) and without (ASPD – P) psychopathy commit the majority of violent crimes. Empathic processing abnormalities are particularly prominent in psychopathy, but effective pharmacological interventions have yet to be identified. Oxytocin modulates neural responses to fearful expressions in healthy populations. The current study investigates its effects in violent antisocial men. In a placebo-controlled, randomized crossover design, 34 violent offenders (19 ASPD + P; 15 ASPD – P) and 24 healthy non-offenders received 40 IU intranasal oxytocin or placebo and then completed an fMRI morphed faces task examining the implicit processing of fearful facial expressions. Increasing intensity of fearful facial expressions failed to appropriately modulate activity in the bilateral mid-cingulate cortex in violent offenders with ASPD + P, compared with those with ASPD – P. Oxytocin abolished these group differences. This represents evidence of neurochemical modulation of the empathic processing of others’ distress in psychopathy.

Background: Parenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person's fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. Methods: We conducted a prospective, case-control study of boys with CPs and typically developing (TD) boys. Both groups (ages 5–10 years) completed 2 magnetic resonance imaging sessions (18 ± 5.8 weeks apart) with ASB assessed at each visit. Participants included boys with CPs following referral to a parenting intervention group and TD boys recruited from the same schools and geographical regions. Final functional magnetic resonance imaging data were available for 36 TD boys and 57 boys with CPs. Boys with CPs were divided into those whose ASB improved (n = 27) or persisted (n = 30) following the intervention. Functional magnetic resonance imaging data assessing fear reactivity were then analyzed using a longitudinal group (TD/improving CPs/persistent CPs) × time point (pre/post) design. Results: Amygdala hypoactivity to fear was observed only in boys with CPs who had persistent ASB and was absent in those whose ASB improved following intervention. Conclusions: Our findings suggest that amygdala hypoactivity to fear is a marker for ASB that is resistant to change following a parenting intervention and a putative target for future treatments.

Individuals with Disruptive Behavior Disorders in youth and antisocial personality disorder and psychopathy as adults share some clinical characteristics, but also diverge in important ways. Existing meta-analyses of structural imaging studies suggest abnormalities within these disorders, however to date none have examined the role of variability. Hence, we performed a meta-analysis to examine both variability (log coefficient of variation ratio) and magnitude of brain volume differences between antisocial groups and healthy non-offenders (quantified using Hedges g). Twenty-seven studies met inclusion criteria. In antisocial individuals, there was significantly increased variability for total gray matter and overall decreases in mean volume for: total whole brain; intracranial volume; total gray matter; and amygdala, compared with healthy non-offenders. This suggests a key role for structural variability in clinical divergence within these disorders. Further studies should seek to specify how this neurobiological variability maps to clinical variability and whether this holds potential value as a biomarker to guide prognosis or treatment selection.

Adults with antisocial personality disorder with (ASPD + P) and without (ASPD-P) psychopathy commit the majority of violent crimes. Empathic processing abnormalities are particularly prominent in psychopathy, but effective pharmacological interventions have yet to be identified. Oxytocin modulates neural responses to fearful expressions in healthy populations. The current study investigates its effects in violent antisocial men. In a placebo-controlled, randomised crossover design, 34 violent offenders (19 ASPD + P; 15 ASPD-P) and 24 healthy non-offenders received 40 IU intranasal oxytocin or placebo and then completed an fMRI morphed faces task examining the implicit processing of fearful facial expressions. Increasing intensity of fearful facial expressions failed to appropriately modulate activity in the right anterior insula and bilateral midcingulate cortex in violent offenders with ASPD + P, compared to those with ASPD-P. Oxytocin abolished these group differences by enhancing fear-associated activity in key social brain areas in ASPD + P. This represents the first evidence of neurochemical modulation of the empathic processing of others’ distress in psychopathy. Main Text

Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI 2 were more likely to return to running (OR 13.14, 95% CI, 2.50-69.19). Radiographic evidence of posttraumatic Lisfranc osteoarthritis occurred in 10 (16%) servicemembers who underwent internal fixation, and 82% of ORIF patients underwent implant removal. Conclusions: At mean 3.5-year follow-up, 80% of servicemembers undergoing ORIF or primary arthrodeses for Lisfranc injuries remained on active duty or successfully completed their military service, and 69% were able to resume occupationally required daily running. Surgeons should preoperatively counsel patients with these injuries on the possibility of persistent long-term disability. Levels of Evidence: Level IV: Retrospective series

Background: The current study aimed to address two gaps in the literature on child maltreatment, reinforcement processing and psychopathology. First, the extent to which compromised reinforcement processing might be particularly associated with either neglect or abuse. Second, the extent to which maltreatment-related compromised reinforcement processing might be associated with particular symptom sets (depression, conduct problems, anxiety) or symptomatology more generally. Methods: A sample of adolescents (N = 142) aged between 14 and 18 years with varying levels of prior maltreatment participated in this fMRI study. They were scanned while performing a passive avoidance learning task, where the participant learns to respond to stimuli that engender reward and avoid responding to stimuli that engender punishment. Maltreatment (abuse and neglect) levels were assessed with the Childhood Trauma Questionnaire (CTQ). Results: We found that: (i) level of neglect, but not abuse, was negatively associated with differential BOLD responses to reward-punishment within the striatum and medial frontal cortex; and (ii) differential reward-punishment responses within these neglect-associated regions were particularly negatively associated with level of conduct problems. Conclusion: Our findings demonstrate the adverse neurodevelopmental impact of childhood maltreatment, particularly neglect, on reinforcement processing. Moreover, they suggest a neurodevelopmental route by which neglect might increase the risk for conduct problems.

Evidence of sensitization following stimulants administration in humans is just emerging, which prevents reaching more definitive conclusions in favor or against a purported protective role of stimulant treatments for ADHD for the development of substance use disorders. Existing evidence from both animal and human research suggest that stimulants produce neurophysiological changes in the brain reward system, some of which could be persistent. This could be relevant in choosing optimal treatments for young patients with ADHD who have additional clinical risk factors for substance abuse (e.g. conduct disorder (CD) and/or familial addictions). Here we stipulate that, while the majority of youth with ADHD greatly benefit from treatments with stimulants, there might be a subpopulation of individuals whose neurobiological profiles may confer risk for heightened vulnerability to the effects of stimulants on the responsiveness of the brain reward system. We propose that focused human research is needed to elucidate the unknown effects of prolonged stimulant exposure on the neurophysiology of the brain reward system in young patients with ADHD.

Objective: Investigate spatial working memory (SWM) in typically developing periadolescent children (TDPC) as it relates to age and hippocampal volume (HV). Method: Using preliminary data from the Polygenic Risk for Alzheimer’s disease in Nebraska Kids study (PRANK, R01 AG064247), we investigated the association between SWM, age, and HV. Our sample included TDPC (N=80, age 8-13 years), recruited from the community and tested at University of Nebraska Medical Center; demographics were consistent with the recruitment area. SWM was measured using the Spatial Working Memory task between error term from the Cambridge Neuropsychological Battery. Structural MRI data were collected using a 3T Siemens Prisma instrument. HV was measured using automated segmentation in Freesurfer (Fischl, 2012). Results: SWM was associated with age, r(80) = -.334, p = .002, such that older children showed fewer SWM errors than younger children. HV was not significantly associated with SWM, controlling for age, r(77) = -.027, p = .813. However, the direction of the relationship between HV and SWM (larger HV associated with fewer SWM errors) was consistent with previous literature (Faridi et al., 2015). Conclusions: These preliminary results suggest that increasing age is associated with better SWM in TDPC; findings for HV were non-significant. Although outside the scope of this analysis, we expect that our study’s full sample will provide greater statistical power to test the association of SWM with HV. In future efforts, we will investigate this association as it relates to polygenic risk for Alzheimer’s disease and whether these results generalize to children with Down syndrome.