Joseph T. Sakai

Although callous‐unemotional (CU) traits are linked with antisocial behavior, affected youth still engage in some prosocial behaviors. The factors contributing to prosocial behavior in these youth are relatively unknown. Relevant factors (known to inversely associate with CU traits and positively associated with prosocial behavior) are complex affective theory of mind (aToM) and cognitive control. In line with recent work demonstrating that cognitive control influences complex aToM in youth with CU traits, we investigated whether its impact moderates the association between CU traits and both a behavioral measure of prosocial behavior and a self‐reported measure of prosocial motivation (prosocial rewards). Participants ( n = 81, 52% female) completed self‐reports and a behavioral paradigm to assess prosocial motivations and behavior alongside CU traits. Results revealed that CU traits were negatively associated with prosocial rewards and goals. And, of primary interest, cognitive control's impact on aToM moderated the association between CU traits and both prosocial rewards and prosocial behavior. Findings suggest that vulnerability to cognitive load—reflected by decrements in aToM—predicts lower prosocial behavior, whereas those that are more resilient to cognitive demands are more likely to engage in prosocial behavior. This demonstrates that the level of resilience to cognitive demands on complex aToM accuracy is an important contextual factor for understanding prosocial behavior in youth with CU traits.

Cognition’s role in youth antisocial phenotypes, particularly callous-unemotional (CU) traits (e.g., lack of remorse, guilt, and empathy) and conduct problems (CP; e.g., disruptive and aggressive behaviors), remains debated. Recent findings suggest the need to distinguish inhibitory processes, as selective control (inhibiting a prepotent response for an alternative) rather than passive control (non-response action restraint) has been linked, independent of CP, to affective deficits in CU traits. However, it is not known whether CU traits relate to a general difficulty with cognitive demands or a specific impairment in selective control. The present study tested whether CU traits were differentially related to passive versus selective control, accounting for CP. Using a randomized parallel-arm trial with test and control groups, data from 85 participants (aged 12–14, 47% female) were analyzed with mixed effects models to account for individual variance. Results indicated that CU traits were associated with better passive control but worse selective control, while CP showed no significant effects when CU traits were included. This pattern was consistent across accuracy, reaction times, and contrasts between trial types (e.g., selective > passive). Further analyses suggested that CU traits were linked to a rigid cognitive style specifically during selective control trials. These findings highlight a selective control deficit unique to CU traits, distinguishing them from CP. Moreover, evidence of a rigid cognitive strategy aligns with research on adult psychopathy, suggesting potential difficulties with cognitive resource allocation. Thus, selective control may be an important feature for understanding antisocial etiological pathways.

Corrigendum: Deep brain stimulation for the treatment of substance use disorders: a promising approach requiring caution Joseph T. Sakai 1*†, Jody Tanabe 2†, Sharonya Battula1, Morgan Zipperly1, Susan K. Mikulich-Gilbertson1, Drew S. Kern3,4, John A. Thompson1,3,4, Kristen Raymond1, Pamela David Gerecht4, Katrina Foster5 and Aviva Abosch61Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States2Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States3Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States5National Institute on Drug Abuse, Bethesda, MD, United States6Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States* Correspondence: joseph.sakai@cuanschutz.eduKey words: substance use disorder, addiction, brain stimulation, neuromodulation, invasive, cravingCorrigendum on:In the published article, there was an error in the author list, and author, Steve Ojemann, was erroneously excluded. The corrected author list appears below.Joseph T. Sakai 1*†, Jody Tanabe 2†, Sharonya Battula1, Morgan Zipperly1, Susan K. Mikulich-Gilbertson1, Drew S. Kern3,4, John A. Thompson1,3,4, Steven Ojemann,3,4 Kristen Raymond1, Pamela David Gerecht4, Katrina Foster5 and Aviva Abosch61Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States2Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States3Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States5National Institute on Drug Abuse, Bethesda, MD, United States6Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States

Objectives: The authors studied the impact that the COVID-19 pandemic had on medical students’ mental health. Methods: US medical students received an online survey with questions from standardized rating scales in 2019 and 2021 in the fall prior to matriculation and in the spring of each year in medical school. The authors compared reports of depression, anxiety, stress, obsessive compulsive symptoms, substance use, impostor phenomenon, maladaptive perfectionism and childhood trauma symptoms in medical students pre-pandemic (2019) and during pandemic (2021) across all four years of medical school. Results: For depression, anxiety, binge drinking, non-cannabis substance use and Impostor Phenomenon, there were significant differences among medical school classes. For many measures, ratings were lowest at pre-matriculation, rose during medical school, and declined in the fourth year. When assessing pre-pandemic vs during pandemic ratings, 2021 scores were significantly higher than in 2019 for depression, generalized anxiety, and Impostor Phenomenon. Binge drinking and non-cannabis use were significantly lower in 2021 than in 2019. There were not significant differences for Depression, Anxiety and Stress Scale anxiety (“DASS anxiety), obsessive compulsive symptoms, and adverse childhood events. Conclusion: Medical school and the COVID-19 pandemic were associated with worsening mental health. During the COVID-19 pandemic, many of the measures of mental health worsened, and the pattern across years remained fairly consistent.

Background: Cognitions role in youth antisocial phenotypes of callous-unemotional (CU) traits (i.e., lack of remorse, guilt, and empathy) from conduct problems (CP; i.e., antisocial patterns of disruptive and aggressive behaviors) has been a debated topic. Recent evidence points to the need for more nuance in parsing different inhibitory processes. Specifically, selective control (i.e., selectively inhibiting a prepotent response for an alternative to specific stimuli) rather than passive control (i.e., non-response action restraint) has been linked, independent of CP, to affective processing deficits in CU traits. However, it is not known whether CU traits relate to a general difficulty with cognitive demands or a specific impairment in selective control. Methods: The present study tested whether CU traits were differentially related to difficulties in passive versus selective control, while accounting for CP. The design for this test leveraged a randomized parallel-arm design with test and control groups. Data from 85 participants aged 12-14 (female 47%) were analyzed using mixed effects analysis accounting for individual variance across repeated measures.Results: CU traits were associated with better passive control performance but worse selective control performance, whereas CP were unrelated to these trials when including CU traits. These findings were supported across individual trial type accuracy and reaction time, as well as contrasts between trials (e.g., selective > passive). Follow-up analysis suggested that CU traits were related to a more rigid cognitive style during selective control trials only. Conclusions: This study provides additional evidence of a specific cognitive limitation in selective control that differentiates CU traits from CP. Additionally, initial evidence on cognitive strategy during selective control may implicate difficulties with cognitive resources in how cognitive information is processed that aligns with work on adult psychopathy. Thus, selective control may be an important feature for understanding antisocial etiological pathways.

Background: Antisocial behavior in youth can encompass both conduct problems (CP; e.g., aggression, rule-breaking) and callous-unemotional (CU) traits (i.e., limited empathy, remorse, and guilt). CP are associated with pronounced and broad cognitive difficulties whereas CU traits have stronger links to disrupted affective theory of mind (ToM) and more specific cognitive difficulties involving cognitive control. Cognitive control difficulties have been linked to affective ToM among early adolescents with elevated CU traits, suggesting an interaction between cognitive and affective processing that are unique to CU traits. Here we sought to improve on those initial findings by leveraging a randomized dual-task (within-trial) design to replicate and extend prior findings.Trial design: The preregistered study leveraged a double-blind randomized controlled trial using a dual-task design. The dual-task used an inhibitory processing task as a secondary task to impose additional demands on cognitive control implicated in ToM to compete with a primary ToM task with cognitive, affective, and physical ToM condition. Participants were randomized into control and test conditions using a permuted block randomization stratified by sex at birth and severity of CU traits. The order of single ToM task or dual-task was counterbalanced to test within subject effects of cognitive control on affective ToM inferences.Methods: A total of 85 participants (47% female) were used in the final analysis. Primary and preregistered hypotheses were tested using a repeated measure random effect model that accounted for individual variance and tested fixed effect interactions for CU and CP with group across time. Outcomes tested involved change in accuracy and reaction time from single ToM to dual-task. Secondary analysis examined contrasts between ToM trial types, dual-task effect, and single ToM task performance as well as associations with antisocial behaviors. Results: CU traits were independently associated with decrements in affective ToM from single to dual-task for both accuracy and reaction time, as well as secondary contrast tests when comparing affective > physical and cognitive trials. CU traits were also related to greater dual-task effects indicating greater difficulty in ToM after taxing cognitive control. CP were related to decrements at baseline ToM task performance but were not associated with changes after taxing cognitive control during the dual-task. Importantly, a subset of participants appeared to be resilient to dual-task effects reported lower baseline antisocial behavior even at elevated CU traits. Conclusions: Resource limitations for cognitive control in those elevated in CU traits is an important mechanism underlying difficulty utilizing affective data from the environment to inform social behavior. Those less vulnerable to additional demands on cognitive control reported fewer antisocial acts even at higher CU traits. Overall, findings suggest specific cognitive-affective interactions that relate to CU traits and explain real world antisocial behavior. This is a novel mechanism outside of the traditional cognition or affect etiologies that may indicate a developmentally specific mechanism critical in the study and treatment of youth antisocial phenotypes and development of psychopathy in adulthood.

Objective The authors examined trends of individual career development awards from the National Institutes of Health (NIH) to psychiatry faculty, especially physicians, in comparison to other departments. Methods Data were obtained on 33,392 career development awards from 2013 to 2022. We examined the number of awards each year averaged for 46 non-psychiatry departments, and for departments of psychiatry, the number of awards to all faculty, physicians, and physicians without a PhD. Linear regressions determined whether number of career development awards increased with time and if estimated slopes differed between faculty in non-psychiatry departments and other groups. Results In departments of psychiatry, 534 faculty received an NIH individual career development award during the 10-year period (534/33,392 or 1.6%), with 118 (22%) to physicians. The number of awards increased significantly over time for other departments and departments of psychiatry (estimated slopes of 3.05 and 2.38, respectively) and did not differ from one another. However, the number of awards to physicians and physicians without a PhD in departments of psychiatry (estimated slopes of 0.51 and − 0.07, respectively) have not increased. This lack of growth in awards for physicians and physicians without a PhD in departments of psychiatry differed significantly in comparison with the increase shown in awards to other departments over time (both p < 0.001). Conclusions The number of NIH career development awards has increased NIH-wide, and for non-physician faculty but not for physicians in departments of psychiatry. These trends raise concerns for the future of psychiatrists in academic research.

Substance use disorders are prevalent, causing extensive morbidity and mortality worldwide. Evidence-based treatments are of low to moderate effect size. Growth in the neurobiological understanding of addiction (e.g., craving) along with technological advancements in neuromodulation have enabled an evaluation of neurosurgical treatments for substance use disorders. Deep brain stimulation (DBS) involves surgical implantation of leads into brain targets and subcutaneous tunneling to connect the leads to a programmable implanted pulse generator (IPG) under the skin of the chest. DBS allows direct testing of neurobiologically-guided hypotheses regarding the etiology of substance use disorders in service of developing more effective treatments. Early studies, although with multiple limitations, have been promising. Still the authors express caution regarding implementation of DBS studies in this population and emphasize the importance of safeguards to ensure patient safety and meaningful study results. In this perspectives article, we review lessons learned through the years of planning an ongoing trial of DBS for methamphetamine use disorder.