Department of Psychiatry, UCSD

Outcomes following spine surgery vary widely, and a substantial proportion of patients continue to experience persistent postoperative pain, functional limitations, and reduced quality of life following surgical intervention. Psychological factors—including depression, pain catastrophizing, and baseline disability—are among the most consistent predictors of poorer postoperative outcomes and persistent spinal pain syndrome following surgery. Despite growing evidence supporting psychosocial risk assessment, systematic psychological screening remains inconsistently implemented across many spine programs. This article presents a practical psychological risk stratification framework integrating three brief and widely validated instruments: the Pain Catastrophizing Scale (PCS), the Patient Health Questionnaire-9 (PHQ-9), and the Oswestry Disability Index (ODI). Together, these measures assess cognitive, emotional, and functional domains associated with surgical outcomes. The article reviews current evidence regarding psychosocial predictors of postoperative outcomes, outlines clinically informed risk thresholds, and describes behavioral health intervention pathways for low-, moderate-, and high-risk patients. Multidisciplinary implementation strategies, psychological treatment approaches, and mental health equity considerations relevant to integrated spine care are also discussed. Integrating psychosocial screening into multidisciplinary spine surgery pathways may improve patient preparation, guide behavioral health referrals, enhance postoperative rehabilitation engagement, and support more individualized perioperative care.

OBJECTIVE: Loneliness - distress that arises from discrepancies between perceived and desired relationships - is increasingly prevalent and recognized as a major public health concern due to the association with negative health outcomes. People living with schizophrenia (PLWS) experience higher rates of loneliness than the general population and may be particularly vulnerable to these adverse outcomes. In the general population, loneliness fluctuates throughout the lifespan, but the relationship between loneliness and age in PLWS is not well understood. METHOD: 271 adults, 141 adults with a diagnosis of schizophrenia or schizoaffective disorder (PLWS)and 130 adults with no history of major psychiatric illness (NCs) aged 27-69 completed clinical interviews and self-report measures assessing loneliness, perceived social support, and mental and physical health. Participants also completed blood draws for biomarkers of inflammation and hyperglycaemia. Locally Weighted Scatterplot Smoothing (LOWESS) regression modelling was used to examine potential non-linear relationships between loneliness and age for both groups and to select the polynomial that best fit the observed relationship. RESULTS: We observed an age by diagnostic group interaction (log estimate = -0.005, SE = 0.003) such that PLWS reported higher loneliness scores compared to NCs of similar age. Patterns of loneliness differed with age between diagnostic groups such that loneliness remained relatively stable and high for PLWS while for NCs loneliness increased from age 40 to age 60. In both groups, loneliness was associated with worse self-reported physical health, depression, and, among PLWS, positive symptoms. CONCLUSION: Results suggest different patterns of loneliness across adulthood for PLWS and NC, reflecting the different social milestones for NCs during this age period that are not as commonly experienced by PLWS, such as marriage, empty nesting and retirement. Loneliness is linked with poor physical and mental health outcomes among PLWS and may be an important target for improving morbidity and mortality for PLWS.Plain Language Summary TitleLoneliness and Aging in Schizophrenia.

Background Adolescent substance use is a continued public health concern. The objective of this manuscript is to detail the prevalence of substance use, polysubstance use, and investigate sex differences in the Adolescent Brain Cognitive Development (ABCD) Study from ages 9-17. Methods 11,880 youth across the U.S., recruited at ages 9-10, completed annual study visits from September 2016 to January 2024. The ABCD 6.0 data release comprises baseline to year-6 data. Lifetime and annual substance use prevalence rates, sex differences, and polysubstance use are described and analyzed. Results Past-year substance use prevalence increased with age; 38% report lifetime use by age 16. Alcohol, cannabis, and nicotine were the most reported substances. There were non-significant differences observed between unweighted trends and census-weighted trends. More boys reported substance use prior to age 12, then from age 13 onward, more girls reported use. Polysubstance use analyses detail the occurrence of the most shared substance use patterns and divergent reports across the sexes. Conclusions Descriptively, these prevalence rates mirror other national surveys showing increases in reported use across early adolescence, with alcohol, cannabis, and nicotine being the most used substances. Unique sex differences and polysubstance use prevalence rates are contextualized alongside prior national reports of these behaviors in the U.S. Understanding the latest prevalences, specifically in a well-phenotyped cohort, helps to guide knowledge for continued analysis of antecedents and sequelae of substance use on health.

BackgroundIntravenous self-administration (IVSA) of opioids by rats has been shown frequently to exhibit no sex differences, in many cases a higher intake of females, and only rarely higher rates in males. A diversity of methodological parameters (opioid identity, training doses, rat strain, session duration) makes it difficult to identify consistent contributions to these outcomes.ObjectiveTo determine if Heterogeneous Stock (HS) rats derived from 8 founder strains differ by sex in the IVSA of opioids.MethodsMale and female Heterogeneous Stock (N = 7–8 per sex) rats were permitted to self-administer heroin (20 µg/kg/infusion) in 2 h sessions under a Fixed Ratio 1 schedule of reinforcement. After acquisition, animals completed sessions in which different infusion doses of heroin (0, 15, 30, 60, 120 µg/kg/infusion), oxycodone (0, 30, 60, 150, 300 µg/kg/infusion) and fentanyl (0, 0.625, 1.25, 2.5, 5.0 µg/kg/infusion) were assessed. Next, animals were evaluated on doses of heroin (15, 30, 60, 120 µg/kg/infusion), oxycodone (30, 60, 150, 300 µg/kg/infusion) and fentanyl (0.625, 1.25, 2.5, 5.0 µg/kg/infusion) under a Progressive Ratio schedule. Anti-nociceptive effects of heroin (0.56–2.4 mg/kg, s.c.) were examined with a warm water tail-withdrawal assay.ResultsFemale HS rats consistently self-administered more infusions of opioids, including heroin during acquisition, all three opioids during FR-1 dose substitution and of oxycodone and fentanyl in the PR procedure. Male rats were moderately more sensitive to the anti-nociceptive effects of heroin.ConclusionsFemale rats drawn at random from a genetically diverse population self-administer opioids at higher rates than their male counterparts.

Much of prior literature examines potentially traumatic event (PTE) exposure as a cumulative risk, though PTEs may not have an equal impact on substance use (SU). In the current study, we test McLaughlin & Sheridan’s (2016) model in a sample of 11,800 community youth (ages 9-15 years old) enrolled in the nationwide, longitudinal Adolescent Brain Cognitive Development (ABCD) Study to examine the impact of PTE types on SU. We analyze concurrent associations between PTE types (physical abuse, domestic violence, community violence, emotional neglect, poverty, and institutionalization / deprivation) and substance use (pooling alcohol, cannabis, or nicotine) and prospective associations whereby exposure to different PTE types predicts SU one year later (self-medication hypothesis). For concurrent associations, we find emotional neglect and physical abuse were significantly positively related to SU. In terms of prospective associations, institutionalization / deprivation, emotional neglect, and physical abuse significantly positively predicted SU. A majority of associations between PTE types and SU were accounted for by other PTE types and time-varying covariates (e.g., internalizing/externalizing symptoms). The association between PTEs and SU during adolescence varies across PTE types. PTEs categorized as physical abuse and emotional neglect are more likely to lead to SU. Findings suggest that surveillance for SU is especially warranted in youth experiencing emotional neglect and physical abuse relative to other PTEs. Future research should examine more types of PTEs along a wider age span to replicate findings.

OBJECTIVE: To produce a consensus statement on the psychological treatment of feeding/eating aversions seen in pediatric feeding disorder (PFD) and avoidant/restrictive food intake disorder (ARFID), diagnoses that share common symptoms and psychological mechanisms but have historically been addressed separately in the literature. METHOD: To help bridge the gaps between ARFID and PFD treatment and research, we convened a group of experts to clarify and describe the psychological interventions for treating learned food avoidance. The current manuscript summarizes the conclusions of the meeting. RESULT: The primary outcome of the consensus process was a description of a common core approach to psychological intervention across the two fields: Exposure to food and the feeding/eating experience with the goal of increasing the volume and variety of food and fluid consumed. Although our consensus process identified some differences in the mode of delivery and incorporation of specific treatment elements, the consensus panel agreed that these differences are related to three primary factors: the severity of clinical impairment, age and developmental status of the patient, and the specific feeding and eating behaviors targeted, rather than to the ARFID/PFD diagnostic distinction. DISCUSSION: Building on the consensus statement, we discuss other considerations in preparing for and delivering exposure-based treatment, including multidisciplinary assessment, readiness for treatment, and systemic factors that influence access and engagement.

BACKGROUND: In a recent coordinated meta-analysis of neuroimaging data, we reported gray matter (GM) alterations in acutely underweight patients with anorexia nervosa (AN). Here, we extend these findings by examining individual variation in brain structure within AN, individual-level differentiation between AN and healthy controls (HC), and differences between AN subtypes, with potential relevance for understanding clinical heterogeneity. METHODS AND FINDINGS: We analyzed individual-level data from 11 international sites in the ENIGMA Eating Disorders Working Group, including 570 female participants with AN and 739 HC. We examined cortical thickness, cortical surface area and subcortical volumes in AN versus HC using three complementary approaches: (i) group-level differences in a mega-analysis correcting for age effects, (ii) frequencies of extreme deviations (infra-/supranormal; z < -1.96/z > 1.96) based on normative reference models by the CentileBrain Initiative, and (iii) individual-level classification performance using machine learning. The same analytic framework was applied to compare AN restricting versus binge-eating/purging subtype, additionally correcting for BMI effects. Mega-analyses reinforced previous meta-analytic findings of pronounced and widespread GM deficits in AN compared to HC. Normative modelling revealed that the frequency of infranormal z-scores (23/68 cortical thickness, 13/14 subcortical volume metrics) and supranormal z-scores (35/68 cortical thickness, 17/68 cortical surface area metrics) was significantly higher in AN than expected based on reference data. Individuals with AN could be reliably differentiated from HC using machine-learning classifiers (ROC-AUC = 0.75-0.81). In contrast, neither group-level differences nor frequency of extreme z-scores differed between AN subtypes, and individuals with different subtypes could not be reliably differentiated from each other. Importantly, the observational design cannot distinguish neurobiological differences related to AN from the effects of starvation or low BMI in the AN versus HC analyses. The lack of differences between subtypes does not exclude brain structural differences between AN subtypes that might be detectable with other modalities or analytic approaches. CONCLUSION: Using a mega-analytic approach, we confirm widespread GM deficits in AN, show that these alterations are (in some patients) extreme, and demonstrate that they enable robust classification with superior performance compared to most MRI-based psychiatric classification studies. The absence of differences between AN subtypes may reflect shared neurobiology, though other imaging modalities may reveal distinctions beyond brain structure.

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OBJECTIVE: This study estimated the prevalence of psychological disabilities among university students, characterized associations between symptom severity and functional limitations, explored self-identification and service registration across mental health diagnoses, and examined mental health stigma's effect on service access. PARTICIPANTS: 104,729 post-secondary students from the 2023-2024 Healthy Minds Study. METHODS: Descriptive statistics addressed the first three aims; multivariable logistic regression addressed the fourth. RESULTS: Self-reported psychological disabilities comprised 13.1% of all disabilities. Self-reported functional limitations increased sigmoidally with PHQ-9 and GAD-7 scores. Students with anxiety and depression were least likely to self-identify as having a psychological disability despite reporting functional limitations. Personal and perceived stigma were not associated with DSO registration, but were negatively associated with mental health treatment access; help-seeking stigma was negatively associated with both. DISCUSSION: Novel self-identification, self-disclosure and stigma data are provided to support improved reporting and service access for students with psychological disabilities.