Jennifer L. Bakalar

Tolerability of transcranial direct current stimulation in childhood-onset schizophrenia

BACKGROUND In recent years, transcranial direct current stimulation (tDCS) has been used to study and treat many neuropsychiatric conditions. However, information regarding its tolerability in the pediatric population is lacking. OBJECTIVE This study aims to investigate the tolerability aspects of tDCS in the childhood-onset schizophrenia (COS) population. METHODS Twelve participants with COS completed this inpatient study. Participants were assigned to one of two groups: bilateral anodal dorsolateral prefrontal cortex (DLPFC) stimulation (n = 8) or bilateral cathodal superior temporal gyrus (STG) stimulation (n = 5). Patients received either 2 mA of active treatment or sham treatment (with possibility of open active treatment) for 20 minutes, for a total of 10 sessions (2 weeks). RESULTS tDCS was well tolerated in the COS population with no serious adverse events occurring during the study. CONCLUSIONS This is the first study to demonstrate that a 20-minute duration of 2 mA of bilateral anodal and bilateral cathodal DC polarization to the DLPFC and STG was well tolerated in a pediatric population.

A novel frameshift mutation in UPF3B identified in brothers affected with childhood onset schizophrenia and autism spectrum disorders

A novel frameshift mutation in UPF3B identified in brothers affected with childhood onset schizophrenia and autism spectrum disorders

Effects of clozapine and olanzapine on cortical thickness in childhood-onset schizophrenia

BACKGROUND Little is known about the effects of antipsychotic medications on gray matter (GM) in schizophrenia. Although clozapine remains the most effective antipsychotic medication in treatment-refractory cases, it is unknown whether it has a differential effect on GM development. METHODS In an exploratory analysis, we used automated cortical thickness measurements and prospectively scanned childhood-onset schizophrenia (COS) patients who were maintained on one medication. Two atypical antipsychotic medications, clozapine (n=12, 37 scans) and olanzapine (n=12, 33 scans) were compared with respect to effects on cortical development, in contrast to GM trajectories of matched controls. RESULTS There were no significant differences in the trajectories of cortical thickness between the two treatment groups with the exception of a small circumscribed area in the right prefrontal cortex, where the olanzapine group showed thicker cortex. As expected, both groups showed thinner GM compared to matched controls. CONCLUSIONS Although these analyses do not rule out effects of antipsychotic medications on GM development in schizophrenia, they show no differential effect between clozapine and olanzapine on GM trajectory.

Recent Advances in Developmental and Risk Factor Research on Eating Disorders.

The Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-5) currently recognizes three primary eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. The origins of eating disorders are complex and remain poorly understood. However, emerging research highlights a dimensional approach to understanding the multifactorial etiology of eating disorders as a means to inform assessment, prevention, and treatment efforts. Guided by research published since 2011, this review summarizes recent findings elucidating risk factors for the development of eating disorders across the lifespan in three primary domains: (1) genetic/biological, (2) psychological, and (3) socio-environmental. Prospective empirical research in clinical samples with full-syndrome eating disorders is emphasized with added support from cross-sectional studies, where relevant. The developmental stages of puberty and the transition from adolescence to young adulthood are discussed as crucial periods for the identification and prevention of eating disorders. The importance of continuing to elucidate the mechanisms underlying gene by environmental interactions in eating disorder risk is also discussed. Finally, controversial topics in the field of eating disorder research and the clinical implications of this research are summarized.

Child Maltreatment’s Heavy Toll: The Need for Trauma-Informed Obesity Prevention

This paper is the product of a workshop on the topic of child maltreatment and obesity at the Radcliffe Institute for Advanced Study at Harvard that brought together the listed authors, who are experts across a number of relevant fields. Emerging research has highlighted childhood maltreatment and other psychological traumas as risk factors for obesity and related comorbidities.1–3 Although the high rate of obesity in the U.S. affects the entire population, those with histories of maltreatment—making up at least 30% of the population4,5—appear to be at greater risk. Unfortunately, childhood maltreatment is often overlooked as a risk factor for adult obesity, and efforts to prevent and treat obesity underutilize promising trauma-informed approaches. Likewise, clinical care for psychological trauma has unrealized potential as an opportunity for obesity prevention. The aims of this paper are to: raise awareness of the prevalence of childhood maltreatment; present current evidence of the child maltreatment–obesity association; highlight existing research on mechanisms; and suggest areas for additional research, including trauma-informed obesity interventions that warrant testing. Although this paper focuses on childhood maltreatment, particularly physical and sexual abuse, the presented information is potentially relevant to other types of early trauma, such as community violence and peer bullying.

Marital Status, Life Stressor Precipitants, and Communications of Distress and Suicide Intent in a Sample of United States Air Force Suicide Decedents

Life stressor precipitants and communications of distress and suicide intent were examined among a sample of United States Air Force (USAF) married versus unmarried suicide decedents. A total of 100 death investigations conducted by the Office of Special Investigations on active duty USAF suicides occurring between 1996 and 2006 were retrospectively reviewed. Married decedents were twice as likely 1) to have documented interpersonal conflict 24 hours prior to suicide and 2) to have communicated suicide intent to peers or professionals. Themes of distress communication for all decedents were intrapersonal (perceived stress, depression, psychological pain) and interpersonal (thwarted belongingness, rejection, loneliness). Suicide prevention programs and policies are encouraged to adapt efforts to the unique needs of married and unmarried individuals.

General absence of abnormal cortical asymmetry in childhood-onset schizophrenia: A longitudinal study

BACKGROUND Childhood-onset schizophrenia (COS) is a rare, severe form of the adult-onset illness, with more salient neurobiological causes. Previous cross-sectional structural neuroimaging research has suggested that normal cortical asymmetry patterns [(R-L)/(R+L)] may be altered in adult schizophrenia, although these findings were not well replicated. Recent studies show dynamic changes in brain asymmetry during childhood and adolescence. We hypothesized that COS patients would show a lack of normal development of asymmetry and decreased overall asymmetry. METHODS Prospective structural magnetic resonance scans were obtained at baseline and at two-year follow-up visits in 49 right-handed COS patients (mean baseline age: 14.72+/-2.63, 117 scans) and 50 age and sex-matched, right-handed healthy controls (mean baseline age: 15.15+/-3.37, 125 scans). Cortical thickness was calculated at 40,962 homologous points across each cerebral hemisphere using a fully automated, validated method. Differences in developmental asymmetry patterns across the cortical surface were analyzed using a linear mixed effects regression model. RESULTS No significant asymmetry differences were found either for cross-sectional comparisons of COS and healthy controls across the lateral and medial cortical surfaces or with respect to timing of developmental changes in asymmetry. CONCLUSIONS The present findings do not support asymmetry differences for this severe, early form of schizophrenia.

Adjunctive Use of Lithium Carbonate for the Management of Neutropenia in Clozapine-Treated Children

Clozapine, a dibenzodiazepine antipsychotic, is the most effective medication for treatment‐resistant schizophrenia. However, its use has been limited by the high risk of neutropenia. In children, the rate of neutropenia is higher when compared to adults. We decided to explore the use of lithium to manage neutropenia in childhood‐onset schizophrenia (COS) through a systematic audit of COS cases.

Preventing Obesity in the Military Community (POMC): The Development of a Clinical Trials Research Network

Obesity impacts the U.S. military by affecting the health and readiness of active duty service members and their families. Preventing Obesity in Military Communities (POMC) is a comprehensive research program within Patient Centered Medical Homes (PCMHs) in three Military Training Facilities. This paper describes three pilot randomized controlled trials that target critical high risk periods for unhealthy weight gain from birth to young adulthood: (1) pregnancy and early infancy (POMC-Mother-Baby), (2) adolescence (POMC-Adolescent), and (3) the first tour of duty after boot camp (POMC-Early Career). Each study employs a two-group randomized treatment or prevention program with follow up. POMC offers a unique opportunity to bring together research and clinical expertise in obesity prevention to develop state-of-the-art programs within PCMHs in Military Training Facilities. This research builds on existing infrastructure that is expected to have immediate clinical benefits to DoD and far-reaching potential for ongoing collaborative work. POMC may offer an economical approach for widespread obesity prevention, from conception to young adulthood, in the U.S. military as well as in civilian communities.

The experience of weight stigma among gym members with overweight and obesity.

Persons with obesity face frequent instances of weight-related victimization and discrimination. To date, however, no research has assessed weight stigma within fitness facilities among a sample of gym members with overweight and obesity. Given the role of exercise in mitigating the health risks of obesity, it is vital to assess the presence of weight stigma within exercise facilities. We therefore assessed weight stigma within fitness facilities, factors affecting motivation to exercise, and factors that are important when selecting a gym. U.S. adult gym members with overweight and obesity completed online self-report measures of gym use, experiences of stigma within fitness settings, barriers to exercise, and gym preferences. Participants also completed measures of health and psychological functioning. Three hundred eighty-nine individuals (75% female, 53% White, 74% with obesity) participated. Adjusting for covariates, stigma at the gym was associated with negative attitudes toward the gym, maladaptive behaviors to cope with stigma, weight bias internalization, unhealthy weight control practices, and poorer self-reported physical and emotional health (ps < .05). Stigma at the gym was unrelated to self-reported frequency of gym use (p > .05). Experiences of weight stigma at the gym are associated with poor emotional and physical health among individuals with overweight and obesity. Respondents also indicated that provision of a shame-free environment is an important consideration when selecting a gym. Results may help to determine whether new gym policies to promote exercise among individuals with overweight and obesity are warranted.