We tested the adaptive hypothesis of psychopathy in human and computer Prisoner Dilemma (PD) matches. From a cohort of 448 male undergraduates who completed the Levenson Self-Report Psychopathy Scale (LSRP), 31 high psychopathic (PP) and 29 low PP students, sampled from upper and lower quartiles of the cohort, played a 40-round PD match in which real money was at stake. The human matches were of three kinds: Low PP versus Low PP, Low PP versus High PP, and High PP versus High PP. In computer simulations, the empirical defection probabilities from High and Low PP human players were entered in a three-player round-robin match with tit-for-tat (TFT) or a less cooperative variant. The strategies proliferated or dwindled in subsequent generations in proportion to their winnings and the matches continued until two players became extinct. In the human matches, High PP players had higher earnings in matches with Low PP and lower earnings in matches with other High PP players. In the computer matches, TFT drove both Low PP and High PP to extinction. However, High PP drove both Low PP and a less cooperative variant of TFT to extinction. Our experiments showed that PP traits may proliferate in two ways. People with low psychopathy engage in selfish behaviors also and people with high psychopathy are capable of cooperation and deter defection by means of harsh punishment. The broader significance of the in silico experiment is that randomness in social encounters may allow behavioral expressions of psychopathy to thrive over an altruistic and reciprocal strategy such as TFT.

Objective:Most individuals with psychosis do not perpetrate violence. However, conduct disorder (CD) increases the risk of violence in psychotic conditions. Because it is currently unknown whether the neural correlates of first-episode psychosis (FEP) differ when CD is present, we used functional magnetic resonance imaging (fMRI) during a Go/No-Go impulsivity paradigm to investigate. Based on previous research, we hypothesized that activation differences between FEP and FEP+CD would be found in the prefrontal cortex, cingulate cortex, and inferior parietal lobule. Method:We scanned 51 male participants: 17 FEP, 16 FEP+CD, and 18 healthy controls with an average age of 24.2 years (range, 17-34 years). Whole-brain images were analyzed via a general linear model, and first-level contrast images were created comparing successful No-Go > Go trials. Paired t tests were conducted at the group level and included confound regressors for age, IQ, antipsychotic dose, psychotic symptoms, and framewise displacement. A voxel-based Z-score threshold of Z > 3.1 (p < 0.001, uncorrected) and a cluster-level extent threshold of p <0.01, corrected, was considered significant. Results:Successful response inhibition elicited hyperactivation in FEP+CD vs FEP in the cingulate gyrus; regions of the PFC, including right middle frontal gyrus (RMFG); bilateral inferior parietal lobule; temporal gyrus; and cerebellum (p values ranged from 1.11E-08 to 0.0031). There was no region in which activation was greater in FEP > FEP+CD. Conclusion:These preliminary results tentatively suggest that brain regions subserving response inhibition may be altered when CD is comorbid with FEP.

Borderline personality disorder (BPD) is highly comorbid with major depressive disorder (MDD), and the comorbid condition is associated with poorer treatment outcomes, which necessitates the investigation of transdiagnostic biomarkers. Previous research suggests that fatty acid amide hydrolase (FAAH), an endocannabinoid enzyme, is elevated in the prefrontal cortex (PFC) in BPD; however, no study has examined FAAH density in individuals with comorbid conditions. We hypothesized that FAAH level would be elevated in the prefrontal cortex, anterior cingulate cortex and hippocampus of comorbid BPD + MDD compared to healthy controls, as these brain regions are linked to the pathobiology of both disorders. For an exploratory analysis, we hypothesized that brain FAAH would be positively correlated with symptom severity, aggression, and impulsivity. Fifteen unmedicated BPD + MDD cases and 15 age- and sex-matched healthy controls underwent a [11C]CURB positron emission tomography scan to measure λk3, an index of available FAAH. No significant group differences in [11C]CURB λk3 were observed between BPD + MDD patients and controls. Negative correlations were found between [11C]CURB λk3 and physical aggression scores in the dorsolateral PFC (r = -0.64, p = 0.04), ventrolateral PFC (r = -0.75, p = 0.01), medial PFC (r = -0.64, p = 0.03), and orbitofrontal cortex (r = -0.66, p = 0.03) in the BPD + MDD group. A positive correlation was found between [11C]CURB λk3 and impulsivity, as measured by the Barratt Impulsiveness Scale-11, in the ventrolateral PFC (r = 0.62, p = 0.04) of the BPD + MDD group. We suggest that the negative correlations between [11C]CURB λk3 and physical aggression could reflect a relationship between FAAH and planned aggression whereas the latter findings may reflect a positive relationship with impulsivity.

The role of the endocannabinoid system (ECS) in major depressive disorder (MDD) is under-investigated despite reports of increased activity and/or concentration of fatty acid amide hydrolase (FAAH), a key ECS enzyme, in fronto-limbic brain regions in some animal models of depressive behavior. We hypothesized that [11C]CURB λk3, an index of FAAH density, would be elevated in the prefrontal cortex, hippocampus, and anterior cingulate cortex in major depressive episodes of MDD compared to healthy controls. Fifteen unmedicated MDD participants and 15 age- and sex-matched healthy controls underwent [11C]CURB positron emission tomography and FAAH genotyping. Psychological tests of depressive severity, apathy, and anxiety were administered and measurements were assessed as covariates in exploratory analyses. No significant group differences in [11C]CURB λk3 were observed between MDD participants and controls (F1,27 = 0.32; p = 0.58). A mixed effects model revealed that Marin Apathy Evaluation Scale scores in the MDD group had a significant main effect on [11C]CURB λk3 binding across the collective regions of medial prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, ventral striatum, and midbrain (F1,11 = 6.75; p = 0.02). Depressive severity and anxiety did not have a significant relationship to [11C]CURB λk3 binding. The relationship of greater fronto-limbic [11C]CURB λk3 to greater apathy along with the metabolic role of FAAH in the ECS, the latter which supports maintaining feelings of interest, initiative, and motivation, has important implications for the pathophysiology of apathy in MDD.

Empirical research is foundational to the discipline of forensic psychiatry. Candilis and Parker provide a cogent systematic review of the empirical literature on restoration of competence to stand trial using National Institutes of Health quality metrics. Components of the study methodology are highlighted, as they represent current best practices for conducting a systematic review. A discussion of strategies to increase empirical research uptake in forensic psychiatry is pursued alongside concrete examples of how the American Academy of Psychiatry and the Law Research Committee can help facilitate this goal.

BackgroundThe influence of mindfulness-based intervention (MBI) programs on behavioural problems among community youth is largely understudied. While technology continues to evolve and the prevalence of screen-based activities is rising, limited studies have accounted for screen time when examining the efficacy of an MBI. Accordingly, this study investigated the impact of MBI on conduct problems and hyperactivity among community youth, accounting for sociodemographic characteristics and four types of screen time.MethodLinear regression models were used to investigate 1) the association between four types of screen time and behavioural problems (i.e., conduct problems and hyperactivity) and 2) the efficacy of online mindfulness programs in reducing behavioural problems among community youth. The data were collected at baseline, intervention completion and 1-month follow-up (Spring 2021 to Spring 2022) in Ontario, Canada (n=117, mean age=16.82, male=22%, non-White=21%).ResultsThe average score for conduct problems was within the normal range, while the average score for hyperactivity was considered borderline at baseline. Accounting for other types of screen time, time spent playing video games was significantly associated with increased conduct problems (β= 1.75, p=.03), albeit rendering non-significant after correcting for multiple comparisons. The online mindfulness program was significantly associated with reduced hyperactivity, controlling for baseline mental health, age, sex and screen time.ConclusionThe current findings suggest a 12-week online mindfulness program may play a positive role in reducing hyperactivity even when accounting for screen time. Our findings advocate the evidence base on the efficacy of MBI in managing hyperactivity.

While COVID-19 impacted all aspects of health care and patient treatment, particularly for patients with mental health/substance use (MH/SU) concerns, research has suggested a concerning increase in the use of restraint and seclusion (R/S) interventions, although results vary depending on facility type and patient population. Thus, the present study sought to explore COVID-related changes in the use of R/S interventions among patients presenting to Ontario emergency departments (EDs) with MH/SU complaints. To determine whether temporal and clinical factors were associated with changes in R/S use during COVID, binary logistic regression models were computed using data from the National Ambulatory Care Reporting System database. We then compared both prevalence rates and probability of an R/S event occurring during an ED visit in Ontario before and after the onset of COVID. The number of ED visits during which an R/S event occurred for patients presenting with MH/SU concerns increased by 9.5%, while their odds of an R/S event occurring during an ED visit increased by 23% in Ontario after COVID onset. Similarly, R/S event probability increased for patients presenting with MH/SU concerns after COVID onset (0.7% - 21.3% increase), particularly during the first wave, with the greatest increases observed for concerns associated with increased restraint risk pre-COVID. R/S intervention use increased substantially for patients presenting to Ontario EDs with MH/SU concerns during the first wave of COVID when the strain on healthcare system and uncertainty about the virus was arguably greatest. Patients with concerns already associated with increased R/S risk also showed the largest increases in R/S probability, suggesting increased behavioural issues during treatment among this population after COVID onset. These results have the potential to inform existing policies to mitigate risks associated with R/S intervention use during future public health emergencies and in general practice.

BACKGROUND:After acute COVID-19, 5% of people experience persistent depressive symptoms and reduced cognitive function (COVID-DC). Theoretical models propose that astrogliosis is important in long COVID, but measures primarily indicative of astrogliosis have not been studied in the brain of long COVID or COVID-DC. The objective of the current study was to measure [11C]SL25.1188 total distribution volume ([11C]SL25.1188 VT), an index of monoamine oxidase B density and a marker of astrogliosis, with positron emission tomography in participants with COVID-DC and compare with healthy control participants. METHODS:In 21 COVID-DC cases and 21 healthy control participants, [11C]SL25.1188 VT was measured in the prefrontal cortex, anterior cingulate cortex, hippocampus, dorsal putamen, and ventral striatum. Depressive symptoms were measured with the Beck Depression Inventory-II, and cognitive symptoms were measured with neuropsychological tests. RESULTS:[11C]SL25.1188 VT was higher in participants with COVID-DC in the prefrontal cortex, anterior cingulate cortex, hippocampus, dorsal putamen, and ventral striatum than in healthy control participants. Depressive symptom severity negatively correlated with [11C]SL25.1188 VT across prioritized brain regions. More recent acute COVID-19 positively correlated with [11C]SL25.1188 VT, reflecting higher values since predominance of the Omicron variant. Exploratory analyses found greater [11C]SL25.1188 VT in the hippocampus, dorsal putamen, and ventral striatum of COVID-DC participants than control participants with a major depressive episode with no history of COVID-19, and there was no relationship to cognitive testing in prioritized regions. CONCLUSIONS:Results strongly support the presence of monoamine oxidase B-labeled astrogliosis in COVID-DC throughout the regions assessed, although the association of greater astrogliosis with fewer symptoms raises the possibility of a protective role. The magnitude of astrogliosis in COVID-DC is greater since the emergence of the Omicron variant.

INTRODUCTION:An increased proclivity towards violence is often associated with those diagnosed with schizophrenia (SCZ), despite contradictory findings from prior studies exploring the association between violence and SCZ. Evidence has shown that certain comorbidities, specifically the presence of a substance use disorders, can result in increased aggression in those with SCZ. Copy number variation (CNV) load has also previously been implicated in the genetic vulnerability of individuals with SCZ. For this study, we aimed to determine whether CNV load correlates with increased violence in SCZ.METHODS:Community-dwelling patients diagnosed with SCZ spectrum disorders (n = 203) were recruited from a non-forensic population. The assessment for aggression was completed using a cross-sectional and retrospective design, and CNV analysis was conducted analysing genomic DNA using the Illumina Omni 2.5 array.RESULTS:No correlation between the number of CNV events (either deletion or duplication) and the severity of the physical violence episode index was found. However, there was a significant association between larger deletion events across the violent behaviours under investigation.DISCUSSION:These results need to be confirmed in more extensive studies using standardized tools developed for non-forensic populations, such as the Brown-Goodwin Scale of Aggression.

The risk of violence is higher in schizophrenia spectrum disorders (SSD) compared to the general population and it is a pressing and understudied issue. Several dispositional and environmental factors have been previously correlated with violence, however, there has been little success in assessing their ability to predict violence patterns across the life span. This study aims to assess violence prediction based on personality traits, psychological resilience, and life-course adversities in a non-forensic population of SSD patients. In a sample of 231 patients with SSD, we assessed violence using the Brown-Goodwin History of Lifetime Aggression Scale and conducted cross-sectional assessments of possible predictors such as childhood trauma, personality traits and resilience scores. We then utilized a logistic regression classification algorithm to predict different violence trajectories based on the proposed risk factors. Our model significantly predicted individuals with violence in both childhood and adulthood, as well as childhood-only violence (p < 0.001). However, the model did not show significance for adult-only violence (p = 0.604). In all given trajectories, female sex appeared to be protective against violence, while stressful life events appeared to contribute to it. These results suggest that distinct factors can better inform risk assessment of lifespan violence patterns for personalized interventions in SSD.

After acute COVID-19, persistent depressive and cognitive symptoms occur in ∼5% of cases (COVID-DC). Theoretical models of COVID-DC suggest astrogliosis is important but measures primarily indicative of astrogliosis have not been studied in COVID-DC.

Previous studies aiming to establish a correlation between schizophrenia (SCZ) and aggressive behavior have resulted in contradictory results. Despite this, a certain degree of evidence suggests a potential underlying genetic component to aggression in SCZ. Polygenic risk score (PRS) analysis is a novel technique to estimate the combined effect of multiple genetic influences on aggression. Our objective was to investigate whether PRS could determine a proclivity toward aggressive behavior in patients with SCZ. Community-dwelling patients diagnosed with a schizophrenia spec-trum disorder (n = 205) were recruited from a nonforensic outpatient sample. Participants were assessed for aggression using a cross-sectional and retrospective design, and PRS was calculated using genomic DNA and the Illumina Omni 2.5 array. We did not detect any associations between lifetime physical aggression (P = .32), verbal aggression (P = .24), or aggression against property (P = .24) and the PRS for SCZ risk. There may be several reasons to explain our null findings. We recommend that future interaction analyses of PRSs in SCZ that investigate violence focus on for-ensic psychiatric patients with higher base rates of violence and use participant interviews to assess aggression.

ImportancePersistent depressive symptoms, often accompanied by cognitive symptoms, commonly occur after COVID-19 illness (hereinafter termed COVID-DC, DC for depressive and/or cognitive symptoms). In patients with COVID-DC, gliosis, an inflammatory change, was suspected, but measurements of gliosis had not been studied in the brain for this condition.ObjectiveTo determine whether translocator protein total distribution volume (TSPO VT), a marker of gliosis that is quantifiable with positron emission tomography (PET), is elevated in the dorsal putamen, ventral striatum, prefrontal cortex, anterior cingulate cortex, and hippocampus of persons with COVID-DC.Design, Setting, and ParticipantsThis case-control study conducted at a tertiary care psychiatric hospital in Canada from April 1, 2021, to June 30, 2022, compared TSPO VT of specific brain regions in 20 participants with COVID-DC with that in 20 healthy controls. The TSPO VT was measured with fluorine F 18–labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide ([18F]FEPPA) PET.Main Outcomes and MeasuresThe TSPO VT was measured in the dorsal putamen, ventral striatum, prefrontal cortex, anterior cingulate cortex, and hippocampus. Symptoms were measured with neuropsychological and psychological tests, prioritizing outcomes related to striatal function.ResultsThe study population included 40 participants (mean [SD] age, 32.9 [12.3] years). The TSPO VT across the regions of interest was greater in persons with COVID-DC (mean [SD] age, 32.7 [11.4] years; 12 [60%] women) compared with healthy control participants (mean [SD] age, 33.3 [13.9] years; 11 [55%] women): mean (SD) difference, 1.51 (4.47); 95% CI, 0.04-2.98; 1.51 divided by 9.20 (17%). The difference was most prominent in the ventral striatum (mean [SD] difference, 1.97 [4.88]; 95% CI, 0.36-3.58; 1.97 divided by 8.87 [22%]) and dorsal putamen (mean difference, 1.70 [4.25]; 95% CI, 0.34-3.06; 1.70 divided by 8.37 [20%]). Motor speed on the finger-tapping test negatively correlated with dorsal putamen TSPO VT (r, −0.53; 95% CI, −0.79 to −0.09), and the 10 persons with the slowest speed among those with COVID-DC had higher dorsal putamen TSPO VT than healthy persons by 2.3 (2.30 divided by 8.37 [27%]; SD, 2.46; 95% CI, 0.92-3.68).Conclusions and RelevanceIn this case-control study, TSPO VT was higher in patients with COVID-DC. Greater TSPO VT is evidence for an inflammatory change of elevated gliosis in the brain of an individual with COVID-DC. Gliosis may be consequent to inflammation, injury, or both, particularly in the ventral striatum and dorsal putamen, which may explain some persistent depressive and cognitive symptoms, including slowed motor speed, low motivation or energy, and anhedonia, after initially mild to moderate COVID-19 illness.

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Emergency Department (ED) visits for substance-related concerns among young people have been increasing in recent years. Understanding the factors related to repeated ED visits (two or more ED visits per year) for substance use concerns among young people is critical to developing a more efficient mental healthcare system that does not overburden ED and that provides efficient care for substance use patients. This study examined trends of substance use-related ED visits and factors related to repeated ED visits (two or more ED visits per year, in comparison to one ED visit per year) among adolescents and young adults (aged 13 to 25 years) in the province of Ontario, Canada. Binary logistic regression models were conducted to examine associations between hospital-related factors (hospital size, urbanicity, triage level, ED wait time) and visit status (2+ vs 1 ED visit/year), controlling for patient characteristics (age/sex). A population-based, repeated cross-sectional data over a 10-year period (2008, 2013, and 2018) was used. The proportion of substance use-related repeated ED visits significantly and consistently increased in the year 2013 and 2018 compared to 2008 (2008 = 12.52%, 2013 = 19.47%, 2018 = 20.19%). Young adult, male, medium-sized hospital, urban location, wait times longer than 6 hours, and symptom severity was associated with increased numbers of repeated ED visits. Furthermore, polysubstance use, opioid use, cocaine use, and stimulant use were strongly associated with repeated ED visits compared with the use of substances such as cannabis, alcohol and sedatives. Current findings suggest that repeated ED visits for substance use concerns could be reduced by policies that reinforce evenly distributed mental health and addiction treatment services across the provinces in rural areas and small hospitals. These services should put special efforts into developing specific (e.g., withdrawal/treatment) programming for substance-related repeated ED patients. The services should target young people using multiple psychoactive substances, stimulants and cocaine.

Background Current literature indicates that safety measures, including lockdowns during the COVID-19 pandemic, severely disrupted our lifestyle, marked by increased screen time. The increased screen time is mostly associated with exacerbated physical and mental wellbeing. However, the studies that examine the relationship between specific types of screen time and COVID-19-related anxiety among youth are limited.Methods We examined the usage of passive watching, social media, video games, and educational screen time and COVID-19-related anxiety at the 5-time points (Early-Spring 2021, Late-Spring 2021, Fall 2021, Winter 2022, and Spring 2022) among youth in Southern Ontario, Canada (N = 117, mean age = 16.82, male = 22%, non-White = 21%) and investigated the role of 4 types of screen time in COVID-19 related anxiety. COVID-related anxiety was measured using the Coronavirus Anxiety Scale (CAS). Descriptive statistics examined the binary relationships between demographic factors, screen time, and COVID-related anxiety. Also, partially adjusted and fully adjusted binary logistic regression analyses were conducted to examine the association between the types of screen time and COVID-19-related anxiety.Results During the late Spring of 2021, when the provincial safety restrictions were most stringent, screen time was the highest among the 5 data collection time points. Further, adolescents experienced the highest COVID-19-related anxiety during this period. On the other hand, young adults experienced the highest COVID-19-related anxiety during Spring 2022. In a partially adjusted model (accounting for other types of screen time), engaging in 1-5 h per day on social media increased the likelihood of experiencing COVID-19-related anxiety compared to those who spend less than 1 h per day (OR = 3.50, 95%CI = 1.14-10.72, p < 0.05). Other types of screen time was not significantly associated with COVID-19-related anxiety. In a fully adjusted model (accounting for age, sex and ethnicity besides four types on screen time), 1-5 h per day of social media remained significantly associated with COVID-19-related anxiety (OR = 4.08, 95%CI = 1.22-13.62, p < 0.05).Conclusion Our findings suggest that COVID-19-related anxiety is associated with youth engagement in social media during the COVID-19 pandemic. Clinicians, parents, and educators should work collaboratively to provide developmentally appropriate approaches to reduce the negative social media impact on COVID-19-related anxiety and promote/foster resiliency in our community during the recovery period.