Purpose: Ostracism is a highly aversive interpersonal experience. Previous research suggests that... more Purpose: Ostracism is a highly aversive interpersonal experience. Previous research suggests that it can increase consumption of highly palatable food in some individuals, but decrease it in others. Thus, we developed the Cyberball-Milkshake Task (CMT), to facilitate research investigating individual differences in ostracism's effects on consumption of highly palatable food. We present data on feasibility for the CMT in a sample of young adult women. Materials and Methods: Participants were 22 women, 18-30 years old, reporting very low or very high levels of emotional eating at screening. Participants performed the CMT, which consisted of 12 trials. Each trial included: playing a round of Cyberball (a computerized game of catch with fictitious "other participants" programmed to either include or exclude the participant); viewing a chocolate image; and then consuming a participant-determined amount of milkshake. Participants subsequently played an additional inclusion and exclusion round of Cyberball, each immediately followed by questionnaires assessing current mood and recent Cyberball experience. Results: Cyberball exclusion (vs. inclusion) was associated with large, significant increases in reported ostracism and threats to self-esteem; exclusion's effects on affect were in the expected direction (e.g., increased negative affect), but generally small and non-significant. Milkshake intake was measurable for 95% of participants, on 96% of trials. Intake decreased quadratically across trials, with a steep negative slope for low trial numbers that decreased to the point of being flat for the highest trial numbers. Discussion: The CMT is a generally feasible approach to investigating ostracism's effects on consumption of highly palatable food. The feasibility (and validity) of the CMT may benefit from modification (e.g., fewer trials and longer rounds of Cyberball). Future research should examine whether performance on a modified version of the CMT predicts realworld behavior in a larger sample.
Journal of Studies on Alcohol and Drugs, Jul 1, 2020
Despite preliminaryevidence of uniqueacute cognitive and psychopharmacological changes attributab... more Despite preliminaryevidence of uniqueacute cognitive and psychopharmacological changes attributable to combined alcohol and cannabis use, fews tudies have investigated more chronic effects of same-dayc o-use, particularlyd uring neurodevelopmentally sensitive periods. Therefore, relationships between past-month binge alcohol and cannabis co-use and cognitive functioning were examined in adolescents and young adults. Method: Data from the Imaging Data in Emerging Adults withA ddiction (IDEAA) Consortium were used to assess cognitive functioning in emerging adults with al arge range of substance use (n =2 32; 15-26 years old) whow ere abstinent for at least 3w eeks. Multiple regressions assessed cognitive functioning by past-month binge episodes,c annabis use episodes,a nd same-day couse, controlling for covariates (e.g., study site, sex, age). Results: After correcting for multiple comparisons, more past-month co-use episodes were related to decreased Ruff2 &7 selective attention accuracy (p = .036). Sexsignificantlycovaried with California Ve rbal Learning Te st-Second Edition initial learning. Conclusions: Although fewsignificant relationships were found and effect sizes are modest, the persistence of an effect on attention despite aperiod of sustained abstinencehighlights the need to carefullyinvestigate patterns of substance use and potential independent andi nteractive effectso nt he developing brain.(
Cannabis and aging: research remains in its infancy
American Journal of Drug and Alcohol Abuse, Aug 10, 2021
Aging of the population is a pressing concern for our society in general, and for healthcare syst... more Aging of the population is a pressing concern for our society in general, and for healthcare systems and providers in particular. Cannabis and cannabinoids may potentially alleviate a wide array of medical conditions that are prevalent among older adults, including pain, arthritis, insomnia, anxiety, and others. To date, however, the evidence supporting the safety and efficacy of medical cannabis and cannabinoids for this population remains preliminary (1). Notwithstanding, the use of cannabis for medical purposes continues to evolve worldwide across all age groups, and specifically so among older adults (2). The study by Choi & DiNitto, published in this issue of The American Journal of Drug and Alcohol Abuse (3), attempts to offer insights about cannabis use among older adults. Based on epidemiological survey data from the 2018 and 2019 National Survey on Drug Use and Health (NSDUH), the authors compared healthrelated characteristics, cannabis use patterns, and cannabis sources in older non-medical and medical cannabis users. In general, medical and non-medical users did not differ substantially on measures of physical or behavioral health status. Nevertheless, medical use was associated with lower odds of alcohol use disorder. Overall, this study underscores the blurred boundaries of medical and non-medical use of cannabis – which is partly due to the divergent shapes that cannabis legalization has taken across various societal and regulatory frameworks. Indeed, the differentiation between ‘medical’ and ‘non-medical’ use of cannabis is not always clear (4). For Choi & DiNitto, “Medical cannabis use was based on questions about whether any (i.e., at least some) or all use in the past 12 months was recommended by a doctor or other healthcare professional (regardless of the legal status of the state where they were living).” However, less than 40% of respondents who answered affirmatively to this question have reported they discussed drug use with a healthcare professional, thus alluding to self-medication with cannabis. Several questions resonate. For instance, who owns the moral/legal authority to define which use is in fact ‘medical’? Is this self-defined by the patient/user? Or is it a professional agent (healthcare provider) who has such an authority? What about patients who receive an informal recommendation from their provider (rather than a legal certification), or ones who live in places where medical cannabis is illegal? And importantly, what question(s) should be used to adequately categorize cannabis use as either medical or non-medical? We suggest a straight-forward query asking individuals if cannabis is being used to alleviate physical or psychiatric symptoms would be both simple and appropriate. Given the authors’ narrow definition of medical cannabis use, it is likely that the classification of 18.5% of users as “medical” is an underestimate. Nonetheless, the finding that 70.9% of medical users reported exclusive medical use is important, as it stands in contrast to previous studies which indicated higher rates of mixed medical and recreational use in adult (but not necessarily older adult) populations (5,6). Other findings by Choi and DiNitto further support the notion of medical use, such as more chronic conditions among medical users, and the high rate of daily or almost daily consumption. Regular cannabis use is often common among those using medically as patients use medical cannabis just as they would use a conventional medication – daily or near daily. As the evidence on the therapeutic potential of cannabis and cannabinoids is still limited, it is imperative to conduct additional studies using diversified designs and methodologies. However, the controversy over (medical) cannabis legalization is also associated with stigma, social norms, and overall deep concerns which may not be resolved with merely acquiring more data (7,8). In any case, the potential benefits and harms of medical
Experimental and Clinical Psychopharmacology, Apr 1, 2021
Previous studies have demonstrated improvements in pain following short-term medical cannabis (MC... more Previous studies have demonstrated improvements in pain following short-term medical cannabis (MC) use, suggesting long-term MC treatment may alleviate symptoms associated with chronic pain. The goal of this observational and longitudinal study was to examine patients using MC to treat chronic pain pre versus post MC treatment. These interim analyses included 37 patients with chronic pain evaluated prior to initiation of MC treatment and following 3 and 6 months of MC use; pain, clinical state, sleep, quality of life, and conventional medication use were assessed. Correlation analyses examined the relationship between changes in pain and other clinical measures, assessed the impact of cannabinoid exposure on pain and clinical ratings, and assessed whether baseline cannabis expectancies influenced outcome variables. Additionally, a pilot group of treatment-as-usual patients (n = 9) who did not use MC were examined at baseline and 3 months later. Relative to baseline, following 3 and 6 months of treatment, MC patients exhibited improvements in pain which were accompanied by improved sleep, mood, anxiety, and quality of life, and stable conventional medication use. Reduced pain was associated with improvements in aspects of mood and anxiety. The results generally suggest increased THC exposure was related to pain-related improvement, while increased CBD exposure was related to improved mood. Cannabis expectancies were not related to observed improvements. Pilot analyses revealed that treatment-as-usual patients do not demonstrate the same pattern of improvement. Findings highlight the potential efficacy of MC treatment for pain and underscore the unique impact of individual cannabinoids on specific aspects of pain and comorbid symptoms. This naturalistic study of medical cannabis (MC) patients with chronic pain provides preliminary evidence that "real world" MC treatment may be a viable alternative or adjunctive treatment for a least some individuals with chronic pain. As results also revealed that individual cannabinoids appear to exert unique effects on pain and comorbid symptoms, more research is needed to potentially optimize cannabinoid-based treatments for pain.
Background: Growing evidence suggests that cannabis and alcohol (and especially binge alcohol dri... more Background: Growing evidence suggests that cannabis and alcohol (and especially binge alcohol drinking) use independently alters neural structure and functioning, particularly during sensitive developmental time periods (e.g., emerging adulthood). However, few studies have investigated the effects of same-day use of these two substances. Here, white matter (WM) integrity was investigated in relation to binge alcohol drinking, cannabis, and same-day binge and cannabis co-use in adolescents and emerging adults. Methods: FreeSurfer's TRACULA was used to assess WM in emerging adults (n = 75; 16-26 years old). Timeline Followback calculated past month cannabis use, binge episodes, and same-day cannabis and binge drinking couse. Multiple regressions investigated WM by past month cannabis, binge, and co-use. Results: Results revealed co-use episodes were related to lower fractional anisotropy (FA), an overall measure of neuronal integrity, in three tracts (left inferior longitudinal fasciculus [ILF], p = 0.02; right anterior thalamic radiation [ATR], p = 0.01; and left cingulum cingulate gyrus [CCG], p = 0.01); and lower axial diffusivity in left ILF ( p = 0.03). Cannabis use was significantly related to greater FA in left ILF ( p = 0.005), left ATR ( p = 0.02), right ATR ( p = 0.05), left CCG ( p = 0.006), right CCG ( p = 0.03), and right superior longitudinal fasciculus parietal ( p = 0.03). Binge episodes related to greater FA in right ATR ( p = 0.03). Conclusions: These findings suggest that co-use was associated with lower WM integrity across frontolimbic tracts. In addition, greater FA was related to greater cannabis use across several tracts and binge alcohol use in one tract. Co-users also appeared to be more severe substance users. Future research should investigate the potential independent and interactive effects of these substances on pre-clinical and clinical levels.
National survey data have documented a decrease in the perception of risk and harm associated wit... more National survey data have documented a decrease in the perception of risk and harm associated with cannabis use, which in past years has been associated with increased rates of use among adolescents and young adults. Age of cannabis use onset, particularly during early adolescence, can differentially influence the organization and function of brain regions that regulate cognitive processing. Detecting structural and cognitive alterations related to cannabis use in adolescence highlights the importance of ensuring early intervention and education to help prevent/limit recreational use in adolescents.
Functional magnetic resonance imaging in schizophrenia: cortical response to motor stimulation
Psychiatry Research: Neuroimaging, Apr 1, 2004
Previous functional magnetic resonance imaging (fMRI) studies suggest that motor system abnormali... more Previous functional magnetic resonance imaging (fMRI) studies suggest that motor system abnormalities are present in schizophrenia. However, these studies have often produced conflicting or ambiguous findings. The purpose of this study was to ascertain whether activation differences could be identified in stable schizophrenic patients on the basis of BOLD measures in two motor regions, the primary motor cortex, Brodmann area 4 (BA4) and the premotor and supplementary motor area, Brodmann area 6 (BA6). Twenty-one schizophrenic patients and 21 healthy control subjects were studied with BOLD fMRI methods during a sequential finger tapping task. Statistical parametric maps were generated for each subject, and anatomic regions were automatically defined using an anatomic atlas. Compared with controls, the schizophrenic patients showed a significant reduction in contralateral activation for both BA4 and BA6 (P<0.001), and in ipsilateral activation in BA4 (P=0.007) and BA6 (P=0.002). In healthy controls, the coactivation in the ipsilateral cortex is reduced in comparison with the contralateral cortex for right and left handed tasks. In BA4, this reduction is significant for right (P=0.007) and left (P=0.003) finger tapping. Similar results were obtained for BA6. Further analyses are necessary to evaluate the activation in other motor system regions.
The endocannbinoid system and cannabis exposure has been implicated in emotional processing. The ... more The endocannbinoid system and cannabis exposure has been implicated in emotional processing. The current study examined whether regular cannabis users demonstrated abnormal intrinsic (a.k.a. resting state) frontolimbic connectivity compared to non-users. A secondary aim examined the relationship between cannabis group connectivity differences and self-reported mood and affect symptoms. Method: Participants included 79 cannabis-using and 80 non-using control emerging adults (ages of 18-30), balanced for gender, reading ability, and age. Standard multiple regressions were used to predict if cannabis group status was associated with frontolimbic connectivity after controlling for site, past month alcohol and nicotine use, and days of abstinence from cannabis. Results: After controlling for research site, past month alcohol and nicotine use, and days of abstinence from cannabis, cannabis users demonstrated significantly greater connectivity between left rACC and the following: right rACC (p = 0.001; corrected p = 0.05; f 2 = 0.55), left amygdala (p = 0.03; corrected p = 0.47; f 2 = 0.17), and left insula (p = 0.03; corrected p = 0.47; f 2 = 0.16). Among cannabis users, greater bilateral rACC connectivity was significantly associated with greater subthreshold depressive symptoms (p = 0.02). Conclusions: Cannabis using young adults demonstrated greater connectivity within frontolimbic regions compared to controls. In cannabis users, greater bilateral rACC intrinsic connectivity was associated with greater levels of subthreshold depression symptoms. Current findings suggest that regular cannabis use during adolescence is associated with abnormal frontolimbic connectivity, especially in cognitive control and emotion regulation regions.
A systematic review was conducted to evaluate whether healthier dietary consumption among childre... more A systematic review was conducted to evaluate whether healthier dietary consumption among children and adolescents impacts executive functioning. PubMed, Education Resources Information Center, PsychINFO and Thomson Reuters' Web of Science databases were searched, and studies of executive functioning among children or adolescents aged 6-18 years, which examined food quality, macronutrients and/or foods, were included. Study quality was also assessed. In all, twenty-one studies met inclusion criteria. Among the twelve studies examining food quality (n 9) or macronutrient intakes (n 4), studies examining longer-term diet (n 6) showed positive associations between healthier overall diet quality and executive functioning, whereas the studies examining the acute impact of diet (n 6) were inconsistent but suggestive of improvements in executive functioning with better food quality. Among the ten studies examining foods, overall, there was a positive association between healthier foods (e.g. whole grains, fish, fruits and/or vegetables) and executive function, whereas less-healthy snack foods, sugar-sweetened beverages and red/processed meats were inversely associated with executive functioning. Taken together, evidence suggests a positive association between healthy dietary consumption and executive functioning. Additional studies examining the effects of healthier food consumption, as well as macronutrients, on executive functioning are warranted. These studies should ideally be conducted in controlled environments and use validated cognitive tests.
Objective:Dissociative experiences commonly occur in response to trauma, and while their presence... more Objective:Dissociative experiences commonly occur in response to trauma, and while their presence strongly affects treatment approaches in posttraumatic spectrum disorders, their etiology remains poorly understood and their phenomenology incompletely characterized. Methods to reliably assess the severity of dissociation symptoms, without relying solely on self-report, would have tremendous clinical utility. Brain-based measures have the potential to augment symptom reports, although it remains unclear whether brain-based measures of dissociation are sufficiently sensitive and robust to enable individual-level estimation of dissociation severity based on brain function. The authors sought to test the robustness and sensitivity of a brain-based measure of dissociation severity.Methods:An intrinsic network connectivity analysis was applied to functional MRI scans obtained from 65 women with histories of childhood abuse and current posttraumatic stress disorder (PTSD). The authors tested for continuous measures of trauma-related dissociation using the Multidimensional Inventory of Dissociation. Connectivity estimates were derived with a novel machine learning technique using individually defined homologous functional regions for each participant.Results:The models achieved moderate ability to estimate dissociation, after controlling for childhood trauma and PTSD severity. Connections that contributed the most to the estimation mainly involved the default mode and frontoparietal control networks. By contrast, all models performed at chance levels when using a conventional group-based network parcellation.Conclusions:Trauma-related dissociative symptoms, distinct from PTSD and childhood trauma, can be estimated on the basis of network connectivity. Furthermore, between-network brain connectivity may provide an unbiased estimate of symptom severity, paving the way for more objective, clinically useful biomarkers of dissociation and advancing our understanding of its neural mechanisms.
A survey of medical cannabis use during perimenopause and postmenopause
Menopause, Aug 2, 2022
Objective Expanding access to legal cannabis has dovetailed with increased interest in medical ca... more Objective Expanding access to legal cannabis has dovetailed with increased interest in medical cannabis (MC) use; however, there is a paucity of research examining MC use to alleviate menopause-related symptoms. This survey study assessed patterns of MC use in perimenopausal and postmenopausal individuals. Methods Participants (perimenopausal, n = 131; postmenopausal, n = 127) completed assessments of menopause-related symptomatology and cannabis use, including modes of use, type of use, and menopause-related symptoms addressed by MC use. Results Most participants reported current cannabis use (86.1%) and endorsed using MC for menopause-related symptoms (78.7%). The most common modes of use were smoking (84.3%) and edibles (78.3%), and the top menopause-related symptoms for MC use were sleep disturbance (67.4%) and mood/anxiety (46.1%). Relative to postmenopausal participants, perimenopausal participants reported significantly worse menopause-related symptomatology on the vasomotor and psychosocial subscales of the Menopause-Specific Quality of Life Questionnaire (Ps ≤ 0.04), including greater burden of anxiety (P = 0.01) and hot flash (P = 0.04) symptoms. In addition, perimenopausal participants reported higher incidence of depression (P = 0.03) and anxiety diagnoses (P < 0.01), as well as increased use of MC to treat menopause-related mood/anxiety symptoms relative to postmenopausal participants (P = 0.01). Conclusions Results suggest that many individuals are currently using MC as an adjunctive treatment for menopause-related symptoms, particularly sleep disturbance and mood/anxiety. Future research should examine the impact of different MC use characteristics (e.g., cannabinoid profiles) on the efficacy of MC use for menopause-related symptoms. Increased severity and prevalence of mood and anxiety symptoms in perimenopausal participants suggest promising targets for clinical trials of cannabinoid-based therapies.
Journal of The International Neuropsychological Society, Jul 1, 2021
Objective: Cannabis use has increased dramatically across the country; however, few studies have ... more Objective: Cannabis use has increased dramatically across the country; however, few studies have assessed the long-term impact of medical cannabis (MC) use on cognition. Studies examining recreational cannabis users generally report cognitive decrements, particularly in those with adolescent onset. As MC patients differ from recreational consumers in motives for use, product selection, and age of onset, we assessed cognitive and clinical measures in well-characterized MC patients over 1 year. Based on previous findings, we hypothesized MC patients would not show decrements and might instead demonstrate improvements in executive function over time. Method: As part of an ongoing study, MC patients completed a baseline visit prior to initiating MC and evaluations following 3, 6, and 12 months of treatment. At each visit, patients completed a neurocognitive battery assessing executive function, verbal learning/memory, and clinical scales assessing mood, anxiety, and sleep. Exposure to delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) was also quantified. Results: Relative to baseline, MC patients demonstrated significant improvements on measures of executive function and clinical state over the course of 12 months; verbal learning/ memory performance generally remained stable. Improved cognitive performance was not correlated with MC use; however, clinical improvement was associated with higher CBD use. Analyses suggest cognitive improvements were associated with clinical improvement. Conclusions: Study results extend previous pilot findings, indicating that MC patients may exhibit enhanced rather than impaired executive function over time. Future studies should examine distinctions between recreational and MC use to identify potential mechanisms related to cognitive changes and the role of clinical improvement.
Journal of The International Neuropsychological Society, Jul 1, 2021
Cannabis remains the second most popular substance used among adolescents and young adults, with ... more Cannabis remains the second most popular substance used among adolescents and young adults, with approximately 30.6% of teens and 52.4% of young adults having used in their lifetime (Johnston et al., 2020). Repeated cannabis use may lead to downregulation of the endocannabinoid system and result in subtle neurocognitive effects, especially during adolescent neurodevelopment (see Sagar & Gruber, 2018). For decades, the effects of cannabis on neurocognition were largely investigated by comparing chronic, heavy, cannabis users with those who do not use cannabis. In general, the majority of studies observed subtle alterations in performance among people who use recreational cannabis regularly, particularly on cognitive measures of executive function, verbal learning and memory along with structural and functional differences in prefrontal and limbic regions (see Blest
Background:Borderline personality disorder (BPD) and Bipolar II Disorder (BD II) have significant... more Background:Borderline personality disorder (BPD) and Bipolar II Disorder (BD II) have significant clinical overlap, leaving the potential for diagnostic inaccuracies and inadequate treatment recommendations. However, few studies have probed for clinical and neurobiological differences between the two disorders. Clinically, some prior studies have linked BPD with greater impulsivity and more frequent negative affective shifts than BD II, whereas previous neuroimaging studies have highlighted both similar and distinct neural abnormalities in BPD and BD II. Notably, no prior study has specifically targeted cortico-limbic neural differences, which have been hypothesized to underlie these core clinical differences.Methods:Individuals with BPD (n = 14) and BD II (n = 15) completed various clinical measures and a RSFC scan at 3T. Whole-brain amygdala resting state functional connectivity (RSFC) were compared between the two groups.Results:Relative to the BD II group, BPD participants reported significantly higher levels of impulsivity, trait anxiety, more frequent negative affective shifts, greater interpersonally reactive affective instability, lower overall functioning, and were characterized by lower amygdala-middle frontal gyrus RSFC. Lower amygdala –middle frontal gyrus RSFC was associated with greater impulsivity, trait anxiety, affective shifts, interpersonal affective reactivity, and functional impairment.Limitations:The current study consisted of small sample sizes and lacked a control group.Conclusions:This preliminary study suggests that amygdala-frontal RSFC may distinguish BPD from BD II. These results may guide future work aimed at identifying neural markers that can help disentangle these two disorders, leading to greater diagnostic accuracy and appropriate treatment implementation.
In healthy individuals, stimuli associated with injury (such as those depicting blood or wounds) ... more In healthy individuals, stimuli associated with injury (such as those depicting blood or wounds) tend to evoke negative responses on both self-report and psychophysiological measures. Such an instinctive aversion makes sense from an evolutionary perspective. However, to engage in nonsuicidal self-injury (NSSI), this natural barrier must be overcome. The Benefits and Barriers model of NSSI predicts that people who engage in NSSI will show diminished aversion to NSSI-related stimuli compared to controls who do not engage in NSSI. We tested this hypothesis in a pilot study assessing 30 adults, 15 of whom reported current skin cutting and 15 of whom had no history of NSSI. Functional magnetic resonance imaging (fMRI) data were collected while participants viewed neutral, positive, and negative images selected from the International Affective Picture System. Participants also viewed NSSI images depicting razors, scalpels, or wounds caused by cutting. Compared to healthy control (HC) participants, the NSSI group showed decreased amygdala and increased cingulate cortex (CC) and orbitofrontal cortex (OFC) activation to NSSI and negative images. They also showed increased amygdalar and OFC activation to positive images. Neither the control group nor the NSSI group demonstrated significant activation within regions more typically associated with reward during any of the conditions; however, positive and negative affect ratings collected throughout the course of the task suggested that none of the affective conditions were viewed as rewarding. Although preliminary, these findings are suggestive of reduced limbic and greater cortical processing of NSSI stimuli in those with a history of this behavior. This has potentially important implications for current models of NSSI as well as for its treatment.
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