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OBJECTIVE: Investigate the relationship between word recognition score (WRS) and pure tone average (PTA) after hearing preservation surgery for vestibular schwannomas (VS) as well as evaluate the consistency of hearing classification systems. STUDY DESIGN: A retrospective chart review was performed. SETTING: This study included patients from a single academic tertiary referral hospital. PATIENTS: Patients with VS and serviceable hearing who underwent hearing preservation surgery 2014-2023. Patients excluded for neurofibromatosis 2 and lacking pre/postop audiograms. INTERVENTIONS: All patients underwent resection of vestibular schwannoma. MAIN OUTCOME MEASURES: Pre/postop WRS, PTA, and AAO-HNS, Gardner-Robertson (GR), and WRS Class (WRSC) hearing classifications. RESULTS: Seventy-five patients were included. Average preop and postop PTA and WRS were 26 ± 12 dB, 79 ± 39 dB, 92 ± 12%, and 33 ± 43%, respectively. Postop PTAs were distributed along the complete testable decibel range, while the postop WRS displayed a bimodal distribution, with WRS >50% or <20%. Worsening intraop ABR changes were significantly associated with poorer hearing outcomes ( p = 0.005). With increasing Koos grades, intraop ABRs were significantly more likely to exhibit changes ( p = 0.005). AAO-HNS and GR classified patients nearly identically, while the WRSC resulted in more class I and fewer class II. The cutoff of serviceable hearing was comparable across all classification systems. CONCLUSIONS: Effects on the brainstem component of Koos 3-4 tumors may particularly disturb speech processing. This effect seems amplified by surgical dissection. AAO-HNS, GR, and WRSC hearing classifications are comparable in describing serviceable hearing in vestibular schwannoma patients.

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BACKGROUND: Apparent diffusion coefficient (ADC) in MRI has been shown to correlate with postoperative House-Brackmann (HB) scores in patients with vestibular schwannoma despite limited methodology. To rectify limitations of single region of interest (ROI) sampling, we hypothesize that whole-tumor ADC histogram analysis will refine the predictive value of this preoperative biomarker related to postoperative facial nerve function. METHODS: Of 155 patients who underwent resection of vestibular schwannoma (2014-2020), 125 patients were included with requisite clinical and radiographic data. After volumetric analysis and whole-tumor ADC histogram, regression tree analysis identified ADC cutoff for significant differences in HB grade. Outcomes were extent of resection, facial nerve function, hospital length of stay (LOS), and complications. RESULTS: Regression tree analysis defined three quantitative ADC groups (× 10-6 mm2/s) as high (> 2248.77; HB 1.7), mid (1468.44-2248.77; HB 3.1), and low (< 1468.44; HB 2.3) range (p 0.04). The mid-range ADC group had significantly worse postoperative HB scores and longer hospital LOS. Large tumor volume was independently predictive of lower rates of gross total resection (p <0.0001), higher postoperative HB score (p 0.002), higher rate of complications (p 0.04), and longer LOS (p 0.003). CONCLUSIONS: Whole-tumor histogram yielded a robust regression tree analysis that defined three ADC groups with significantly different facial nerve outcomes. This likely reflects tumor heterogeneity better than solid-tumor ROI sampling. Whole-tumor ADC warrants further study as a useful radiographic biomarker in patients with vestibular schwannoma who are considering surgical resection.

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BACKGROUND: Isolated cerebral mucormycosis is rare in immunocompetent adults and is only sparsely reported to be associated with obstructive hydrocephalus. OBSERVATIONS: Here, the authors report a case of obstructive hydrocephalus secondary to central nervous system mucormycosis without other systems or rhino-orbital involvement and its technical surgical management. A 23-year-old, incarcerated, immunocompetent patient with history of intravenous (IV) drug use presented with syncope. Although clinical and radiographic findings failed to elucidate an infectious pathology, endoscopy revealed an obstructive mass lesion at the level of the third ventricle, which, on microbiological testing, was confirmed to be Rhizopus fungal ventriculitis. Perioperative cerebrospinal fluid diversion, endoscopic third ventriculostomy, endoscopic biopsy technique, patient outcomes, and the literature are reviewed here. The patient received intrathecal and IV amphotericin B followed by a course of oral antifungal treatment and currently remains in remission. LESSONS: The patient's unique presentation and diagnosis of isolated cerebral mucormycosis reveal this pathogen as a cause of ventriculitis and obstructive hydrocephalus in immunocompetent adult patients, even in the absence of infectious sequelae on neuroimaging.

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Two out of three adults seeking treatment for alcohol or other substance use disorders report co-occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT-I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage = 39.5) completed assessments at baseline, post-treatment, and at 6 week follow-up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT-I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow-up. In the non-treatment group, 9/11 completed post and 7/11 completed follow-up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow-up. There was a marginal group-by-time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow-up. Participants in substance use treatment reported significant reductions in substance-related problems and symptoms of post-traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT-I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT-I among those in treatment. We speculate that integrating CBT-I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311.

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Importance: Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established. Objective: To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes. Design, Setting, and Participants: For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks. Interventions: Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment. Main Outcomes and Measures: Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up. Results: The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: -3.70; 95% CI, -6.79 to -0.61) and follow-up (-3.34; 95% CI, -6.46 to -0.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group × time interaction: -0.84; 95% CI, -1.66 to -0.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency. Conclusions and Relevance: In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence. Trial Registration: ClinicalTrials.gov Identifier: NCT03806491.

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PURPOSE: Large (> 3 cm) vestibular schwannomas pose complexity in surgical management because of narrow working corridors and proximity to the cranial nerves, brainstem, and inner ear structures. With current vestibular schwannoma classifications limited in information regarding cerebellopontine edema, our retrospective series examined this radiographic feature relative to clinical outcomes and its possible role in preoperative scoring. METHODS: Of 230 patients who underwent surgical resection of vestibular schwannoma (2014-2020), we identified 107 patients with Koos grades 3 or 4 tumors for radiographic assessment of edema in the middle cerebellar peduncle (MCP), brainstem, or both. Radiographic images were graded and patients grouped into Koos grades 3 or 4 or our proposed grade 5 with edema. Tumor volumes, radiographic features, clinical presentations, and clinical outcomes were evaluated. RESULTS: The 107 patients included 22 patients with grade 3 tumors, 39 with grade 4, and 46 with grade 5. No statistical differences were noted among groups for demographic data or complication rates. Unlike grades 3 and 4 patients, grade 5 patients presented with worse hearing (p < 0.001), larger tumors (p < 0.001), lower rates of gross total resection (GTR), longer hospital stays, and higher rates of balance dysfunction. CONCLUSION: With edema detected in 43% of this cohort, special considerations are warranted for grade 5 vestibular schwannomas given the preoperative findings of worse hearing, lower GTR rates, longer hospital stays, and 96% who pursued postoperative balance therapy. We propose that grade 5 with edema offers a more nuanced interpretation of a radiographic feature that holds relevance to treatment selection and patient outcomes.

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Background: Implementing ecological momentary assessment (EMA) methodology to evaluate the substance use disorder (SUD) treatment pipeline has clear advantages, including learning about participants' day-to-day experiences to aid in the improvement of services and accessibility for those seeking treatment. Given that the SUD treatment pipeline spans long periods of time, EMA burst designs (deployment of multiple short EMA periods spread over time) can be advantageous for evaluating the treatment pipeline over time while keeping participant burden low.Objectives: This feasibility study describes (1) the process and study design of implementing EMA burst methodology to evaluate the SUD treatment pipeline experience; (2) study implementation from the perspective of researchers, including discussion of collaboration with community partners; and (3) participant feedback on the experience of engaging with this type of research.Method: EMA metrics, feasibility ratings, and general experience ratings in the study are presented from 22 participants (64% women) who participated in a parent EMA study evaluating the SUD treatment pipeline and 8 who provided feedback in a follow-up survey.Results: Participants found the EMA burst design to be acceptable and not burdensome, although technology issues were present for some participants. Steps to partnering with community treatment programs and implementation of a burst design are outlined.Conclusions: Strategies and recommendations for implementation of an EMA burst study with community partners are provided, including aspects of study design, technology issues, retention, and funding.

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OBJECTIVE: The present study examined if identification with mainstream American culture (acculturation) and heritage culture (enculturation) are differentially associated with blackouts and other drinking consequences among male and female college students of color. PARTICIPANTS: Participants were college students (N = 150) who self-identified as a racial/ethnic minority and endorsed blackouts in the past year. METHODS: Regression models were used to examine gender-by-acculturation/enculturation interaction effects on alcohol-induced blackout and other alcohol-related consequences. RESULTS: While acculturation was not significantly associated with either drinking outcome, enculturation showed a significant relationship with blackout frequency. Gender moderated this relationship; greater enculturation was associated with increased blackout frequency among male but not female students. CONCLUSIONS: The present findings suggest the importance of considering the interplay between enculturation and gender in understanding alcohol use among college students of color. Men who endorse high levels of enculturation may be at an increased risk of experiencing negative drinking-related consequences.

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OBJECTIVE: This study compares three methods of cannabis and of alcohol use assessment in a sample of regular cannabis users: (a) ecological momentary assessment (EMA) repeated momentary surveys aggregated to the daily level, (b) EMA morning reports (MR) where participants reported on their total use from the previous day, and (c) retrospective timeline followback (TLFB) interviews covering the same period of time as the EMA portion of the study. We assessed the overall correspondence between these methods in terms of cannabis and alcohol use occasions and also investigated predictors of agreement between methods. METHOD: Forty-nine individuals aged 18-50 (Mage = 24.49, 49% female, 84% White) who reported regular cannabis use completed a 14-day EMA study. At the end of the EMA period, participants returned to the laboratory to complete a TLFB (administered via computer) corresponding to the same dates of the EMA period. RESULTS: Daily aggregated EMA and TLFB reports showed a low to modest agreement for both alcohol and cannabis use. Overall, agreement between EMA and MR was better than agreement between EMA and TLFB, likely because less retrospection is required when only reporting on behavior from the previous day. Quantity and frequency of use differentially predicted agreement across reporting methods when assessing alcohol compared to cannabis. When reporting cannabis use, but not alcohol use, individuals who used more demonstrated higher agreement between EMA and TLFB. CONCLUSIONS: Results suggest that retrospective reporting methods assessing alcohol and cannabis should not be considered a direct "substitute" for momentary or daily assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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BACKGROUND: Alcohol-induced blackouts have been associated concurrently and prospectively with alcohol-related harm. Although rates of heavy drinking among military samples tend to be comparable or higher than rates among civilian samples, the prevalence and correlates of blackout in the military population are understudied. METHODS: Veterans (N = 241, 29% female, 39% Black) reported on their alcohol consumption and mental health as part of a larger health-related study among veterans. In this secondary analysis, we tested theoretically and empirically informed predictors (gender, drinking quantity, and other drug use) and consequences [depression, posttraumatic stress disorder (PTSD)] of alcohol-induced blackout. Given the diversity of the sample, potential roles of racial/ethnic discrimination and drinking to cope in alcohol-induced blackout were also tested. RESULTS: Past-year prevalence of alcohol-induced blackout was 53% among veterans who drank alcohol and 68% among those who screened positive for hazardous drinking. Everyday experience of racial discrimination was the strongest concurrent predictor of alcohol-induced blackout. Drinking quantity and use of other drugs were significant correlates only in bivariate models. Controlling for gender, race, drinking quantity, other drug use, and discrimination, blackout frequency was significantly associated with symptoms of depression, but not symptoms of PTSD. Both blackout and racial discrimination were associated with drinking to cope. CONCLUSIONS: The prevalence and correlates of alcohol-induced blackout among veterans are largely consistent with those documented in civilian and young adult populations. Among racially diverse groups, racial discrimination may be more strongly associated with mental health symptoms than alcohol consumption or acute alcohol consequences such as blackout.

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PURPOSE: Subjective response to alcohol's stimulating and sedating effects is a person-level risk factor for heavy drinking and alcohol use disorder. Longitudinal and laboratory studies have demonstrated that at-risk individuals experience greater stimulation and lower sedation while drinking. While between-person subjective responses inform risk and etiology, in-the-moment assessments during daily-life drinking may elucidate the within-person processes by which stimulation and sedation may lead to heavier drinking. We aimed to characterize these momentary processes by testing momentary stimulation and sedation during drinking as predictors of subsequently continuing to drink during densely sampled, daily-life drinking episodes. PROCEDURES: 113 adults (54 with borderline personality disorder and 59 community participants; 77.9% female) completed ecological momentary assessment for 21 days, reporting momentary subjective stimulation and sedation throughout drinking episodes and momentary alcohol use after drink initiation (i.e., continued drinking). FINDINGS: GLMMs demonstrated that greater day-level stimulation (OR=1.48, 95% CI=[1.20, 1.82], p<.001), greater person-level stimulation (OR=1.63, 95% CI=[1.05, 2.53], p=.031), and lower momentary sedation (OR=0.54, 95% CI=[0.41, 0.71], p<.001) predicted continued drinking. CONCLUSIONS: Although greater stimulation and lower sedation have been conceptualized as individual-level risk factors for heavy drinking, our findings suggest that these associations are accompanied by processes that operate within person. Our results suggest that greater stimulation may confer risk for heavy drinking at the level of the drinking episode, possibly acting as positive reinforcement that may contribute to heavier drinking during future episodes. In contrast, lower sedation may primarily confer in-the-moment risk by contributing to momentary decisions to keep drinking within an episode.

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OBJECTIVES: To examine associations between alcohol use and sleep in middled-aged/older adults and to test sex as a moderator of this relationship. METHODS: Participants were 183 adults (46% female) ages 50 and above who consumed alcohol in the past year. Linear regressions tested sex as a moderator of associations between alcohol use and sleep parameters. Alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT). Overall sleep health and sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI), and pre-sleep arousal was assessed using the Pre-Sleep Arousal Scale. RESULTS: Overall, 11% of participants screened positive for hazardous drinking (AUDIT scores of 7+/8+ for women/men), and 59% reported poor overall sleep health (scores >5 on the PSQI). Alcohol use was not associated with overall sleep health (B = -0.25, p = .08) or pre-sleep arousal (B = 0.15, p = .64). However, contrary to hypotheses, more hazardous drinking was associated with better subjective sleep quality, only among women (B = -0.08, p = .009). Alcohol use was not associated with sleep quality among men (B = 0.01, p = .58). Associations remained significant when controlling for age, symptoms of anxiety and depression, body mass index, use of sleep medication, number of medical conditions, and chronic pain. CONCLUSIONS: Among middle-aged and older adults, alcohol use is more strongly associated with sleep patterns among women than men, when assessed concurrently (i.e., at the same time point). Findings support the need for further consideration of sex differences in associations between alcohol use and sleep.

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INTRODUCTION: Veterans in general-and especially those who identify as Veterans of color-are underrepresented in health-related treatment research. This contributes to health inequity by hindering the development of evidence-based treatment recommendations for people of color. This project utilized culturally centered research procedures to identify health-related research priorities and examine motives for and barriers to research participation in a diverse sample of Veterans. MATERIALS AND METHODS: Veterans (N = 330, 32% female; 36% Black, 28% White, 15% Latinx, 12% Asian, 4% Multiracial) reported their experiences with and perspectives on health-related research online from remote locations. Linear regression was used to test associations between discrimination and motives/barriers for research. All procedures were approved by the Institutional Review Board (#2033562). RESULTS: Participants identified psychological concerns, particularly PTSD, as research priorities for Veterans in their communities, but also prioritized physical problems (e.g., brain injury) and social concerns (e.g., homelessness, access to care). Perceptions of, motives for, and barriers to research were similar across racial/ethnic groups. The most common motive was contributing to research that seems important, and the most common barrier was not knowing about research opportunities. Every-day experiences with discrimination (e.g., people acting as if they are afraid of you because of your race/ethnicity) were associated with more barriers to research among Black participants. CONCLUSIONS: Experiences of racial/ethnic discrimination are associated with different research-related outcomes across racial/ethnic groups. Efforts to engage diverse populations should prioritize access to (not willingness to participate in) health-related research.

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AIMS: To evaluate the feasibility and validity of a new method of quantifying cannabis flower use, integrating the amount of cannabis flower smoked, and the potency of the cannabis flower. DESIGN: Ecological momentary assessment (EMA) for 14 days. SETTING: Participants' daily lives in Columbia, Missouri, USA. PARTICIPANTS: A total of 50 community participants, who were regular cannabis flower smokers (48% female). MEASUREMENTS: Momentary subjective intoxication ratings following cannabis flower smoking; momentary quantity of cannabis flower smoked; potency of cannabis flower smoked in terms of percentage of tetrahydrocannabinol (THC) concentration assessed with a portable device, the Purpl Pro; and time since finished smoking. FINDINGS: Participants completed our field testing of their cannabis flower (96.2%) and were compliant with our 2-week EMA protocol (73% for random prompts and 91% for morning reports). Momentary subjective intoxication ratings trended down as a function of time since smoking (r = -0.10, P = 0.004, 95% CI, [-0.17, -0.03]). Multi-level model (MLM) results indicated the momentary standard THC units (mg THC) were positively associated with momentary subjective intoxication ratings (b = 0.01, P = 0.03, 95% CI, [0.01, 0.012]). CONCLUSIONS: There is evidence to support the feasibility and initial validity of a new method of quantifying cannabis flower use into standard tetrahydrocannabinol units. Researchers investigating the effects of cannabis flower use on a range of outcomes (e.g. neurobehavioral effects, emotional sequelae, and driving impairment) as well as in clinical treatment trials might adopt this method to provide estimates of cannabis flower use.

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STUDY OBJECTIVES: Empirical evidence linking individual sleep hygiene practices to subsequent sleep parameters is limited, particularly at the daily level. This study compared the strength of daily, within-person associations between these modifiable sleep behaviors and nighttime sleep in young adult drinkers with insomnia. METHODS: Young adults (ages 18-30 years; n = 56) who met diagnostic criteria for insomnia and reported past-month binge drinking wore wrist actigraphy and completed online sleep diaries for 8.5 days (standard deviation = 2.3; 477 reports). Diaries assessed engagement in 11 sleep hygiene recommendations. Multilevel models tested daily associations between sleep behaviors and 3 outcomes: sleep quality, self-reported sleep efficiency, and actigraphy-measured sleep efficiency. RESULTS: Participants self-reported better sleep quality/efficiency on days that they slept in a comfortable environment, limited naps to 30 minutes, and maintained a consistent wake time. They self-reported worse sleep quality and efficiency on nights that they avoided alcohol use before bedtime. No sleep behaviors were significantly associated with actigraphy-measured sleep efficiency after correcting for inflation in type I error. CONCLUSIONS: The sleep hygiene recommendations most strongly associated with sleep at the daily level were consistent with stimulus control. Creating a comfortable sleep environment also emerged as an important correlate of daily sleep. Heavy drinkers with insomnia may perceive better sleep if they drink before bedtime; however, this finding may be unique to this population. CITATION: Miller MB, Curtis AF, Hall NA, et al. Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia. J Clin Sleep Med. 2022;18(3):703-712.

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STUDY OBJECTIVES: Cannabis use is common among young adults and has been proposed as a potential treatment for insomnia. However, controlled studies examining the impact of cannabis use on insomnia symptoms are rare. This secondary analysis of published trial data tested cannabis use during cognitive behavioral treatment for insomnia (CBT-I) as a moderator of treatment efficacy. METHODS: Young adults (ages 18-30 years) who reported past-month binge drinking (4/5+ drinks for women/men) and met diagnostic criteria for insomnia disorder were randomized to CBT-I (n = 28) or sleep hygiene (n = 28) groups. Interaction effects were tested using multilevel models. Outcomes included insomnia severity, actigraphy-assessed sleep efficiency, diary-assessed sleep quality, drinking quantity, and alcohol-related consequences. RESULTS: Twenty-six participants (46%; 12 in the sleep hygiene group and 14 in the CBT-I group) reported using cannabis during the treatment phase of the study, on an average of 23% of treatment days (range, 3%-100%). Relative to those who did not use cannabis, participants who used cannabis during treatment reported heavier drinking and more frequent cigarette use. Approximately 1 in 4 cannabis users (27%) reported using cannabis to help with sleep; however, cannabis users and nonusers did not differ in the use of alcohol as a sleep aid. Controlling for sex, race, drinking quantity, cigarette use, symptoms of depression, and symptoms of anxiety, use of cannabis during treatment did not moderate CBT-I effects on insomnia severity (b, -.002; p = .99) or other outcomes (all p > .20). CONCLUSIONS: CBT-I is effective in reducing insomnia symptoms among young adult drinkers with insomnia, regardless of cannabis use. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: The Insomnia Treatment and Problems (iTAP) Study; URL: https://clinicaltrials.gov/ct2/show/NCT03627832; Identifier: NCT03627832. CITATION: Miller MB, Carpenter RW, Freeman LK, Curtis AF, Yurasek AM, McCrae CS. Cannabis use as a moderator of cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2022;18(4):1047-1054.

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Co-use of alcohol and medication can have serious negative health effects (e.g., overdose risk, liver damage). Research has primarily focused on older adults or the pharmacokinetics of specific medication-alcohol combinations. Little work has focused on the subjective experience of persons who take alcohol-interactive (AI) medications and also drink alcohol, particularly in psychiatric samples at high risk for problematic alcohol use and high rates of prescription medication use, such as individuals with borderline personality disorder (BPD). Data from a larger ecological momentary assessment study of alcohol use in 52 persons diagnosed with BPD (83% women; Mage = 26 years) were used to examine the influence of alcohol intoxication (i.e., estimated blood alcohol concentration [eBAC]) and medication co-use on momentary subjective experience while drinking. Participants reported AI medication use at baseline and completed multiple ecological momentary assessment reports per day over 21 days, which included reports of alcohol use, subjective effects of alcohol (e.g., pleasure, feeling worse), and negative and positive affect. AI medications significantly moderated the association between eBAC and pleasurable effects of alcohol, such that at higher levels of eBAC, those taking AI medications experienced blunted subjective pleasure compared with those not taking AI medications. AI medications did not moderate the associations between eBAC and subjective relief, feeling worse, positive affect, or negative affect. Attenuated pleasure during drinking could lead to increased drinking in an attempt to achieve a desirable state among individuals who co-use psychiatric medications and alcohol, and therefore may represent a useful target for prevention and intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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BACKGROUND: Interpersonal stressors (ISs) are major factors in relapse in alcohol use disorder (AUD) and are theorized to play a role in drinking behaviors. Past work has examined this association using ecological momentary assessment (EMA), but the unique effects of rejections and disagreements on alcohol use are unknown. Research suggests the two ISs functionally differ and may display distinct associations with drinking. Further, these associations may differ in people with borderline personality disorder (BPD), a population reporting frequent IS and co-occurring AUD. METHODS: 113 drinkers (community: n = 59; BPD: n = 54) reported alcohol use and ISs using EMA for 21 days. Using generalized estimating equations, we expected that rejection and disagreement would predict increased likelihood of drinking each day. We examined both cumulative (throughout each day) and immediate momentary effects of ISs predicting subsequent drinking on that same day. Further, we predicted that these associations would be stronger in individuals with BPD. RESULTS: Greater rejections throughout the day were associated with a reduced likelihood of drinking that day (OR = 0.56, 95 % CI:[0.32, 0.97], p < .040). In contrast, disagreements immediately prior to drinking were associated with an increased likelihood of drinking that day (OR = 0.60, 95 % CI:[1.02, 2.50], p = .039). However, the effect of disagreement on drinking was moderated by BPD diagnosis (OR = 2.56, 95 % CI:[1.13, 5.80], p = .025), such that the effect was only present for individuals with BPD. CONCLUSIONS: Assessing ISs as an aggregate predictor may mask potentially opposite effects on alcohol use. Additionally, disagreements may be a risk factor for subsequent alcohol use in BPD.

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Theoretical models of non-suicidal self-injury (NSSI) posit that individuals use NSSI to influence others, but this remains largely untested. We used ambulatory assessment to test the interpersonal function of NSSI in the daily lives of 51 women with DSM-5 NSSI disorder. Participants reported NSSI events, urges, motives, and positive/negative interpersonal events (IPEs) for 14 days, providing five semi-random daily assessments and event-related NSSI reports. We analyzed 3,498 data-points, including 155 NSSI events, using multilevel models. We observed a positive concurrent association between the number of negative IPEs and NSSI engagement. Additionally, perceived distress of negative IPEs was positively associated with concurrent NSSI events and urges, and predicted later events. We saw no reduction in negative or increase in positive IPEs following NSSI. In a trait-level interview, participants endorsed interpersonal motives only minimally, but indicated that others often trigger NSSI. In daily life, participants rarely endorsed the motive 'get help/attention'. The results suggest that negative IPEs trigger NSSI, but that individuals in this sample rarely used NSSI for interpersonal motives and did not experience interpersonal reinforcement of NSSI. We discuss limitations of and possible solutions for under-reporting of interpersonal motives and benefits of studying interpersonal triggers (rather than outcomes) in future studies.

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BACKGROUND: Most of the current knowledge on the clinical effects of stereotactic radiosurgery (SRS) on the treatment of cavernous sinus meningiomas (CSM) is based on series with limited follow-up. However, determining the role of radiation in a tumor with slow disease progression such as CSM necessitates long term follow up. OBJECTIVE: To review and pool metadata in the literature to determine the long-term outcomes of SRS with respect to clinical and radiographic tumor control of CSM. METHODS: A systematic search was conducted following MOOSE guidelines. Results were screened against predefined criteria, which excluded studies with a median follow-up less than 5 years. The incidences of each outcome were calculated using random-effects metanalysis of proportions. RESULTS: Seven studies met the inclusion criteria, comprising 645 patients. The median follow-up was 74 months (range 62-87). Progression-free-survival at 5, 10, and 15 years was 93.4% (95% CI 89.1-96.7%), 84.9% (95% CI 77-91.4%), and 81.3% (95% CI 74-87.7%), respectively. Clinical response to SRS at last follow-up defined as improvement of cranial nerve deficits was found in in 36.4% (95% CI 26.3-47.1%) of patients, while worsening or onset of new cranial nerve deficits was found in 11.5% (95% CI 7.9-15.7%). Radiological regression was found in 57.8% (95% CI 43-71.8%), while tumor progression was found in 8.5% (95% CI 5.2-12.6%). CONCLUSION: SRS achieves excellent disease control and radiographic response in CSM. Although the risk of long-term cranial neuropathies is minimal, it is relatively higher to what has been previously reported in early series with limited follow-up.

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