Development and Evaluation of a Parent-led Intervention Module for Early Autism Spectrum Disorder (PRIME-ASD) in Odisha, India: Protocol for a Multiphase Mixed-methods Study Including an Open-label Randomised Controlled Trial

Conditions: Autism Spectrum Disorder

Interventions: Behavioral: Behavioral: PRIME-ASD (Parent-led Intervention Module for Early Autism Spectrum Disorder); Behavioral: Behavioral: PRIME-ASD; Other: Treatment as usual

Sponsors: All India Institute of Medical Sciences, Bhubaneswar

Not yet recruiting

TMS-Evoked Cortical Reactivity Signatures as a Multidimensional Biomarker of Depression: A TMS-EEG Meta-Analysis from Diagnosis to Prognosis

Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) enables perturbation-based assessment of cortical reactivity and has emerged as a promising tool for identifying neurophysiological biomarkers in major depressive disorder (MDD). However, the literature remains fragmented, and TMS-EEG metrics have yet to be systematically integrated within a unified framework spanning diagnosis, treatment, and prognosis.

Inhibitory control and error processing in Obsessive-Compulsive Disorder: A mega-analysis of task-based fMRI data by the ENIGMA-OCD consortium

Obsessive-compulsive disorder (OCD) is a chronic condition in which impaired inhibitory control and excessive error monitoring may contribute to maintenance of obsessions and compulsions. This mega-analysis investigates neural activation during response inhibition and error processing using adult (OCD=563; control=348) and child (OCD=83, control=114) data from the ENIGMA-OCD consortium and the ABCD study (probable OCD=343; control=361).

Electronic Health Record–Based Phenotyping for Obsessive-Compulsive Disorder: Algorithm Development and Multicenter Validation Study

Background: Obsessive-compulsive disorder (OCD) is a common psychiatric disorder, with two-thirds of affected individuals reporting severe impairment. Despite its substantial burden and moderate heritability, the etiology of OCD remains poorly understood, and treatments are often suboptimal. Although recent genome-wide association studies (GWAS) have identified some risk loci, much of the genetic architecture of OCD remains undiscovered, underscoring the need for scalable approaches to identify large, well-defined patient cohorts. Objective: This study aimed to develop and validate a scalable electronic health record (EHR)–based phenotyping algorithm for identifying OCD cases to support large-scale genetic and translational research. Methods: We leveraged EHR-linked biobank data from 2 large hospital systems, namely Vanderbilt University Medical Center (VUMC) and Mass General Brigham (MGB), to develop a high-throughput phenotyping algorithm integrating diagnostic codes, medication records, and natural language processing (NLP) of clinical notes. Algorithm performance was evaluated through expert chart review, and genetic analyses were performed in individuals of European genetic ancestry using the polygenic scores (PGS) of OCD, major depressive disorder (MDD), and height derived from the most recent GWAS. Results: Expert chart reviews demonstrated our algorithm combining both () codes and NLP achieved the highest positive predictive values (PPV) for OCD case identification (0.84 at VUMC; 0.91 at MGB) compared to using either codes or NLP alone, albeit with reduced case yield. At both sites, algorithm-defined OCD cases of European genetic ancestry showed significantly higher OCD PGS than controls. In sensitivity analyses adjusting for MDD status, OCD PGS associations were more robust than MDD PGS associations, while height PGS showed no association, supporting the genetic plausibility and relative specificity of the phenotype. Conclusions: This study presents a scalable and cost-efficient EHR-based approach for identifying OCD cases across health systems. The algorithm achieves high PPV, and among individuals of European genetic ancestry, algorithm-defined cases show significant OCD PGS enrichment, supporting its utility for large-scale genetic studies and advancing understanding of the disorder’s complex etiology.
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Neurons Involved in Generating Anxiety After Cannabinoid Drug Exposure Identified in Mice

Working with mice, Northwestern scientists have for the first time identified a set of neurons in the brain that play a role in generating anxiety after exposure to cannabinoid drugs, especially under stressful conditions. Cannabinoids are a class of substances that includes tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis and synthetic analogs.

Scientists exposed mice to a predator odor after giving them a placebo or a cannabinoid drug. Animals given the cannabinoid froze more and spent less time investigating the odor. Using small microscopes, scientists identified neurons activated by the drug that helped drive anxious behaviors. When those neurons were silenced the cannabinoid no longer triggered the same level of anxious behaviors.

The findings could help scientists better understand how cannabis exerts its psychoactive effects, and potentially point to strategies for holding back anxiety in affected individuals. The results could provide insights into strategies for reducing anxiety symptoms in other contexts, outside of cannabis use.

“The results of this study could explain why a good trip can turn bad pretty quickly if people consume too much cannabis or the situation they are in turns stressful or scary,” said Sachin Patel, MD, PhD, chair of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.

Patel is senior and corresponding author of the team’s published paper in Nature Communications, titled “Cannabinoid modulation of central amygdala population dynamics during threat investigation.” In their paper the team concluded that their results “… could ultimately provide important insights into how cannabinoids augment threat reactivity and the interactions between cannabis use and anxiety disorders.”

Plant-derived cannabinoids are widely used for medicinal and recreational purposes, and exert broad-ranging behavioral and physiological effects on mood, anxiety, memory, appetite, and sleep, the authors noted. But they can also precipitate anxiety and panic reactions in people, and increase threat-related defensive responses in rodents. “Specifically, while tension and anxiety relief represent major reasons for cannabis use, paradoxical dose- and context-dependent increases in anxiety and panic are also well-documented, and some studies have suggested associations between cannabis use and the development and worsening of anxiety disorders, especially in heavy cannabis users.” However, they continued, Despite well-established research findings, “… how cannabinoids affect in vivo neural dynamics associated with threat-related behavior has not been examined.”

For their newly reported study the scientists exposed mice to a threatening odor. Before being exposed to the scent, derived from fox urine, the mice either received a placebo or a synthetic cannabinoid drug. Patel and colleagues tested several doses of the synthetic cannabinoid on mice and tracked how much time they spent near the predator odor, and whether they froze or fled from the scent.

To simultaneously record brain activity, the team implanted a small microscope into the mice’s brain. The results showed that mice receiving the cannabinoid drug froze more often and spent less time investigating the predator odor. These anxious behaviors were linked to the drug’s activation of a small group of somatostatin neurons (SOM) in the brain’s central amygdala (CeA), a region that processes fear and stress.

Importantly, when the scientists genetically silenced the somatostatin neurons, mice given the cannabinoid drug did not avoid the predator scent as much. The researchers also conducted brain tissue experiments to analyze how the cannabinoids affected interactions between neurons. They found that the drug weakened the brain’s natural “brake” on the somatostatin neurons, allowing them to become more active. “Our data suggest suppression of GABA release from local afferents onto CeA SOM neurons underlies cannabinoid effects on CeA SOM neurons,” they wrote.

Study authors Drs. Sachin Patel (left) and Farhana Yasmin looking at brain recordings from central amygdala neurons [Gr8y Productions]
Study authors Sachin Patel (left) and Farhana Yasmin looking at brain recordings from central amygdala neurons. [Gr8y Productions]

“Higher doses of cannabinoids and environmental stress worked together to synergistically release the ‘brake’ on the central amygdala, which in turn drove excessive anxiety,” Patel noted. “Understanding how cannabis affects brain function to generate its psychoactive effects could ultimately reveal new ways to counteract negative consequences should they arise in some people,” Patel said, also noting that the findings could have implications beyond cannabis. “Suppressing the activity of somatostatin neurons in the central amygdala could represent a final pathway for reducing anxiety symptoms, not just in the context of cannabis side effects,” he explained.

Cannabis use in the U.S. has steadily increased in recent years and so have emergency department visits related to adverse effects from the drug. Previous studies have also found an association between cannabis use and increased risk of anxiety in the long term. What’s more, anxiety and mood disorders are also on the rise globally.

Commenting that their newly reported data begin to shed light on neural mechanisms subserving the “dark-side” adverse effects of cannabinoids, the authors concluded, “… we suggest cannabinoids could trigger context-dependent adverse anxiety and panic reactions, in part, via activation of CeA-related circuits and that cannabis-induced long-term adaptations in these circuits could contribute to observed associations between cannabis use and anxiety disorders.”

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