Alcohol use disorder (AUD) has been related to aberrant functional connectivity (FC) in the salience network (SN), executive control network (ECN), and default mode network (DMN). However, there is a lack of comprehensive and simultaneous examination of these networks in patients with AUD and of their relation to potential anatomical changes. We aimed to comprehensively examine the alteration in FC in the three networks in AUD patients, and the correlation of the alteration with anatomical/structural changes (volume) in the neural areas implicated in these networks, by applying voxel-based morphometry (VBM) and region of interest-to-region of interest connectivity analysis simultaneously. In all, 22 patients with AUD and 22 healthy adults participated in the study and underwent T1 magnetic resonance imaging. Patients with AUD showed increased FCs within the DMN and SN networks, especially in terms of connectivity of the frontal areas and bilateral hippocampi. They also showed decreased FCs in the ECN. In addition, there was significant volume reduction in these areas (frontal areas and hippocampus). The increased FCs within the frontal areas or bilateral hippocampi showed a negative correlation with gray matter volume of these areas in AUD patients. Our findings add to the empirical evidence that the frontal lobe and hippocampi are critical areas that are vulnerable to functional and structural changes due to AUD.

The increase in the use of psychiatric medications among children and adolescents has brought attention to the overall safety of these medications and the evidence-based data for their use in this population. This review focuses on the ethical aspects of pediatric psychopharmacology and general guidelines for practice, especially for medical residents. Ethical issues, such as (1) the lack of a sound database on long-term efficacy and safety due to a limited number of clinical trials in this population, (2) the lack of knowledge about adverse events related to the off-label use of drugs, (3) an extensive level of complexity in prescription management for the pediatric population, and (4) challenges in decision-making regarding diagnosis and prescription due to difficulties in gathering and incorporating information from multiple sources, are discussed. This article also reviews clinical guidelines for pharmacological interventions and relevant landmark research projects (Treatment for Adolescents with Depression Study, Multimodal Treatment Study of Children with ADHD, and Treatment of Severe Childhood Aggression Study). The authors conclude that, in light of the continued shortage of child and adolescent psychiatrists, research and training policies as well as goals should focus on preparing clinicians and building mental health care systems that can deliver optimal services in this new reality. [ Psychiatr Ann . 2021;51(10):450–458.]

Irritability, characterized by a tendency to exhibit increased anger, is a common clinical problem in youth. This study investigated relationships among irritability, selective impairment in process of facial emotion, and neural responses in amygdala in youth with irritability during implicit emotion processing task under functional MRI (fMRI). Fifty-nine youths with disruptive mood and behavior disorder completed a facial expression processing task with an event-related fMRI paradigm. We found a positive relationship between irritability and RT difference between negative (fear) and positive (happiness) facial expressions. Increased irritability was associated with a longer reaction time toward positive vs. negative facial expressions. Irritability was also positively associated with the difference of amygdala blood oxygen level dependent responses between the two emotional conditions (happiness > fear). This difference in amygdala activity mediated the interaction between irritability and the RT difference between negative and positive facial expressions. We suggest that impairment in the implicit processing of facial emotional expressions with different valences causes distinct patterns of amygdala response, which correlate with the level of irritability.

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