Nathan J. Kolla

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.

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 λk ₃, 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 λk ₃ were observed between MDD participants and controls (F _1,27 = 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 λk ₃ binding across the collective regions of medial prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, ventral striatum, and midbrain (F _1,11 = 6.75; p = 0.02). Depressive severity and anxiety did not have a significant relationship to [¹¹C]CURB λk ₃ binding. The relationship of greater fronto-limbic [¹¹C]CURB λk ₃ 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.

Background/Objectives: There is a significant gap in accessibility to mental healthcare in Canada. This study aims to examine the population of Canadian crisis hotline responders and investigate the variables that contributed to burnout and professional quality of life during COVID-19. Crisis hotline responders are hypothesized to be affected by burnout and poor professional quality of life, due to the inherent nature of the job and the widespread negative mental health effects of COVID-19, which are expected to continue even after the pandemic. Methods: An online, cross-sectional, mixed-methods survey assessed sociodemographic information, shift-related variables, burnout and related factors, and current support methods utilized by crisis hotline responders across Canada. The open-ended questions helped to more personally reflect participants’ experiences. Data were analyzed using chi-square tests, an analysis of variance, and a regression analysis. Results: The survey was completed by 136 participants (78.7% female) with an average age of 39.68. Participants reported relatively high levels of burnout/stress on both the Copenhagen Burnout Inventory and professional quality of life survey. Younger age, less work experience, and working overnight shifts emerged as possible predictors of worse mental wellbeing. Conclusions: Findings suggest that Canadian crisis hotline responders require greater support to manage workplace burnout/stress. Nevertheless, conducting comprehensive studies during times when there are no public health emergencies are warranted to understand the full scope of burnout in this population. We offer five recommendations to support the mental wellbeing of responders and improve access to this important public health resource.

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.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, includes an alternative model of personality disorders (AMPD) focusing on a maladaptive trait model utilized to diagnose several personality disorders. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are two conditions categorized by AMPD that exhibit high rates of violence and aggression. Several of the traits outlined in the AMPD, including hostility, impulsivity, risk-taking, and callousness, have been previously linked to aggression in BPD and ASPD. However, to the best of our knowledge, there has never been a synthesis of neuroimaging studies that have investigated links between these traits and aggression in BPD and ASPD. To overcome this gap, we conducted a systematic review under the PRISMA framework to locate neuroimaging articles published since the release of AMPD linking trait anger/hostility, impulsivity, risk-taking, and callousness to aggression in BPD and ASPD. Key findings included the following: i) anger/hostility, associated with alterations in the interplay between prefrontal and subcortical regions (primarily the amygdala), may be a common factor explaining aggressive reactions to response to interpersonal threat or provocation; ii) alterations of fronto-temporal-limbic regions and serotonergic and endocannabinoid signaling systems may link impulsivity to aggression in BPD and ASPD; iii) weaker cortico-striatal connectivity could relate to greater risk taking and greater proclivity for violence. Insufficient evidence from neuroimaging articles was discerned to describe a relationship between callousness and aggression. Overall, results of this review reveal a relative paucity of neuroimaging studies examining AMPD traits relevant to aggression in BPD and ASPD. In addition to encouraging further investigation of neuroimaging markers of AMPD traits linked to aggression, we recommend multi-methodological designs, including the incorporation of other biomarkers, such as hormones and indices of physiological arousal, to fully expand our understanding of aggression in BPD and ASPD.

Background: Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. Aims: To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. Method: Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. Results: Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. Conclusions: Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.

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.

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.

An emerging body of literature demonstrates differences in the gut microbiome (GMB) of patients with major depressive disorder (MDD) compared to healthy controls (HC), as well as the potential benefits of prebiotic, probiotic, and synbiotic treatment. We conducted a systematic review of 24 observational studies (n = 2817), and 19 interventional trials (n = 1119). We assessed alpha diversity, beta diversity, and taxa abundance changes in patients with MDD relative to HC, as well as the effect of prebiotics, probiotics, and synbiotics on depressive symptoms in individuals with clinical or subclinical depression. We observed no significant differences in alpha diversity but a significant difference in beta diversity between patients with MDD and HC. There were fluctuations in the abundance of specific taxa in patients with MDD relative to HC. Probiotic and synbiotic, but not prebiotic, treatment showed a modest benefit in reducing depressive symptoms in patients with MDD over four to nine weeks. The GMB profiles of patients with MDD differ significantly from HC, but further studies are needed to elucidate the benefits of prebiotic, probiotic and synbiotic treatments relative to antidepressants and over longer follow-up before these therapies are implemented into clinical practice.