Maltreatment-related childhood adversity is the leading preventable risk factor for mental illness and substance abuse. Although the association between maltreatment and psychopathology is compelling, there is a pressing need to understand how maltreatment increases the risk of psychiatric disorders. Emerging evidence suggests that maltreatment alters trajectories of brain development to affect sensory systems, network architecture and circuits involved in threat detection, emotional regulation and reward anticipation. This Review explores whether these alterations reflect toxic effects of early-life stress or potentially adaptive modifications, the relationship between psychopathology and brain changes, and the distinction between resilience, susceptibility and compensation.

The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.

Background Childhood abuse is a major risk factor for psychopathology. Previous studies have identified brain differences in maltreated individuals but have not focused on potential differences in network architecture. Methods High-resolution T1-weighted MRI scans were obtained from 265 unmedicated, right-handed 18-25-year-olds who were classified as maltreated (n=142, 55M/87F) or non-maltreated (n=123, 46M/77F) based on extensive interviews. Cortical thickness was assessed in 112 cortical regions (nodes) and inter-regional partial correlations across subjects were calculated to derive the lowest equivalent cost single-cluster group networks. Permutation tests were used to ascertain whether maltreatment was associated with significant alterations in key centrality measures of these regions and membership in the highly interconnected ‘rich club’. Results Marked differences in centrality (connectedness, ‘importance’) were observed in a handful of cortical regions. Left anterior cingulate had the second highest number of connections (degree centrality) and was a component of the ‘rich club’ in the control network but ranked low in connectedness (106th of 112 nodes) in the network derived from maltreated-subjects (p<0.01). Conversely, right precuneus and right anterior insula ranked first and 15th in degree centrality in the maltreated network versus 90th (p=0.01) and 105th (p<0.03) in the control network. Conclusions Maltreatment was associated with decreased centrality in regions involved in emotional regulation and ability to accurately attribute thoughts or intentions to others and with enhanced centrality in regions involved in internal emotional perception, self-referential thinking and self-awareness. This may provide a potential mechanism for how maltreatment increases risk for psychopathology.