Showing papers in "Psychiatry Research-neuroimaging in 2003"

Internalized stigma of mental illness: psychometric properties of a new measure.

Abstract: The study evaluated the Internalized Stigma of Mental Illness (ISMI) scale, designed to measure the subjective experience of stigma, with subscales measuring Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal and Stigma Resistance. The ISMI was developed in collaboration with people with mental illnesses and contains 29 Likert items. The validation sample included 127 mental health outpatients. Results showed that the ISMI had high internal consistency and test-retest reliability. Construct validity was supported by comparisons against scales measuring related constructs with the same methodology. As expected, the ISMI had positive correlations with measures of stigma beliefs and depressive symptoms, and it had negative correlations with measures of self-esteem, empowerment and recovery orientation. Factor analyses of the joint set of items from the ISMI and each scale supported the distinction between constructs. Having a validated measure of internalized stigma may encourage clinicians to include stigma reduction as a verifiable treatment goal in addition to symptom reduction.

Decreased antioxidant enzymes and membrane essential polyunsaturated fatty acids in schizophrenic and bipolar mood disorder patients.

Abstract: Oxidative stress-mediated cell damage has been considered in the pathophysiology of schizophrenia. Abnormal findings have often been considered related to differences in ethnicity, life style, dietary patterns and medications, all of which influence indices of oxidative stress and oxidative cell damage. To minimize these confounds, schizophrenic patients were compared with age-matched control subjects with the same ethnic background and similar lifestyle, as well as with bipolar mood disorder (BMD) patients. Levels of antioxidant defense enzymes (i.e. superoxide dismutase, SOD; catalase, CAT; and glutathione peroxidase, GPx) were lower in schizophrenic patients than in controls, indicating conditions for increased oxidative stress. The contents of plasma thiobarbituric acid reactive substances (TBARS) were only marginally higher in schizophrenic patients, who had normal levels of arachidonic acid (AA), a major source of TBARS, indicating no significant oxidative membrane lipid peroxidation. Levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), however, were significantly lower in schizophrenic patients. When the same indices in BMD patients were compared with findings in matched controls, levels of only SOD and CAT were lower in the patients, whereas GPx was not. Again, as in schizophrenia, the contents of TBARS were marginally higher in BMD patients with no change in levels of AA. Levels of alpha-linolenic acid and EPA were significantly lower and levels of DHA were slightly lower in BMD patients. These data indicate that certain biochemical characteristics may be common to a spectrum of psychiatric disorders, and suggest supplementation of antioxidants and essential fatty acids might affect clinical outcome.

Effective electroconvulsive therapy reverses glutamate/glutamine deficit in the left anterior cingulum of unipolar depressed patients

Abstract: Cortical glutamate/glutamine (Glx) metabolism seems to be affected by a major depressive disorder. Recently, a Glx deficit was detected by proton magnetic resonance spectroscopy (1H-MRS) in the bilateral anterior cingulum of depressives. The aim of this study was to assess the effect of successful electroconvulsive therapy (ECT) on Glx levels in the anterior cingulum. The left anterior cingulum of 17 severely depressed unipolar patients was measured by 1H STEAM spectroscopy before and after ECT, and the results were compared with those for 17 age- and gender-matched controls. We observed significantly reduced Glx levels in the patients' left cingulum compared to healthy controls. In ECT responders, in contrast to non-responders, Glx levels normalized (P=0.04) and then did not differ statistically from controls. Severe depression seems to be associated with a Glx deficit and increasing Glx may be an important mechanism of ECT action.

Magnetic resonance imaging of hippocampal and amygdala volume in women with childhood abuse and borderline personality disorder.

Abstract: Borderline personality disorder (BPD) is a common disorder associated with emotional dysregulation and other symptoms that have been hypothesized to be related to dysfunction of limbic brain areas including hippocampus and amygdala. The purpose of this study was to measure hippocampal and amygdala volumes in BPD. Hippocampal and amygdala volumes were measured with magnetic resonance imaging (MRI) in 10 patients with BPD and 23 control subjects. Patients with BPD had a 21.9% smaller mean amygdala volume and a 13.1% smaller hippocampal volume, compared to controls. These findings are consistent with the hypothesis that alterations in the hippocampus and amygdala are associated with BPD.

A naturalistic visual scanning approach to assess selective attention in major depressive disorder

Abstract: Cognitive biases in information processing play an important role in the etiology and maintenance of emotional disorders. A new methodology to measure attentional biases is presented; this approach encourages subjects to scan and re-scan images with different thematic content, while the pattern of their attentional deployment is continuously monitored by an eye-tracking system. Measures of attentional bias are the total fixation time and the average glance duration on images belonging to a particular theme. Results showed that subjects with depressive disorder (n=8; Beck Depression Inventory Score>/=16) spent significantly more time looking at images with dysphoric themes than subjects in the control group (n=9). Correlation analysis revealed that the differences between the fixation times of the two groups are significantly correlated with the valence ratings, but not with the arousal ratings of the images. The average glance duration on images with social, neutral and threatening themes were similar for both groups, while the average glance duration on images with dysphoric themes was significantly larger for subjects with depressive disorder. The above results suggest that subjects with depressive disorder selectively attend to mood-congruent material and that depression appears to influence the elaborative stages of processing when dysphoric images are viewed.

Quantification of frontal and temporal lobe brain-imaging findings in schizophrenia: a meta-analysis

Abstract: Magnetic resonance imaging (MRI) and positron emission tomography (PET) studies of the frontal and temporal lobes in schizophrenia patients and healthy controls have proliferated over the past 2 decades, but there have been relatively few attempts to quantify the evidence. In this meta-analytic review, 155 studies on frontal and temporal lobe neurobiology were synthesized, reflecting results from 4043 schizophrenia patients and 3977 normal controls. Cohen's d was used to quantify case-control differences, and moderator variable analysis indexed the relation of sample and imaging characteristics to the magnitude of these differences. Frontal metabolic and blood flow deficiencies in conjunction with cognitive activation tasks ("hypofrontality") emerged as the strongest body of evidence, demonstrating abnormalities that distinguish approximately half of schizophrenia patients from healthy people. Most case-control comparisons with structural and functional imaging yield small and in many cases unstable findings. Technical scanning parameters like slice thickness and magnet strength did not vary with case-control differences consistently across the meta-analyses. However, patient sample characteristics including sample size, handedness and gender composition emerged frequently as moderators of brain-imaging effect sizes.

Impulsivity and prefrontal hypometabolism in borderline personality disorder

Abstract: Prefrontal hypoperfusion and decreased glucose uptake in the prefrontal cortex (PFC) are found in violent criminal offenders, murderers and aggressive psychiatric patients. These abnormalities may be independent of diagnosis and associated with impulsive-aggression as a personality trait. Impulsive-aggression is a clinical characteristic of borderline personality disorder (BPD) where it is associated with assaultive and suicidal behaviors. We conducted FDG-PET studies in 13 non-depressed, impulsive female subjects with BPD and 9 healthy controls to look for abnormalities in glucose metabolism in areas of the PFC associated with regulation of impulsive behavior. Statistical Parametric Mapping-99 (SPM99) was used to analyze the PET data with Hamilton depression scores as covariate. Significant reductions in FDG uptake in BPD subjects relative to healthy controls were found bilaterally in medial orbital frontal cortex, including Brodmann's areas 9, 10 and 11. There were no significant areas of increased uptake in BPD subjects compared to control subjects. Covarying for measures of impulsivity or impulsive-aggression rendered insignificant the differences between groups. Decreased glucose uptake in medial orbital frontal cortex may be associated with diminished regulation of impulsive behavior in BPD.

Remediation of facial affect recognition impairments in patients with schizophrenia: a new training program.

Abstract: Impairments in facial affect recognition are trait-like characteristics in schizophrenia and might contribute to poor social functioning. A special Training of Affect Recognition program was developed, which shows a good feasibility and promising treatment effects. The specificity of these effects can now be demonstrated in a control group design.

Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study.

Abstract: Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxiety disorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxiety disorders significantly more frequent among women with an eating disorder than among women from the community? We assessed the frequencies of six specific anxiety disorders among 271 women with a current diagnosis of anorexia or bulimia nervosa and 271 controls, using the Mini-International Neuropsychiatric Interview, French DSM-IV version. A lifetime comorbidity with at least one anxiety disorder was found in 71% of both the anorexic and the bulimic subjects, significantly higher than the percentage of controls with an anxiety disorder. The prevalence was significantly higher in the eating disorder groups than in controls for most types of anxiety disorder, and between 41.8 and 53.3% of comorbid cases had an anxiety disorder preceding the onset of the eating disorder. Anxiety disorders are significantly more frequent in subjects with eating disorders than in volunteers from the community, a finding that has important etiological and therapeutic implications.

Neural correlates of clinical symptoms and cognitive dysfunctions in obsessive-compulsive disorder.

Abstract: Although results from neuropsychological and neuroimaging studies have postulated the involvement of the frontal lobe and the subcortical brain regions in the pathophysiology of obsessive–compulsive disorder (OCD), neuroimaging studies have provided little evidence that cognitive abnormalities in patients with OCD are related to dysfunctions in these areas. This study was designed to determine whether the clinical features and cognitive deficits of OCD might be taken to reflect frontal-subcortical dysfunction. Fourteen patients with OCD and 14 case-matched normal subjects completed clinical and cognitive evaluation, including four sets of neuropsychological tests that assessed the executive functions and visual memory. Cerebral glucose metabolic rates were measured by using positron emission tomography (PET) with 18 F-fluorodeoxyglucose. Behavioral and PET data were analyzed using statistical parametric mapping for group differences and behavioral–metabolic correlates. The right orbitofrontal cortex showed increased metabolic activity and the left parieto-occipital junction showed decreased metabolic activity in patients. Metabolism in the right hippocampus, the left putamen and the right parietal region was associated with the severity of obsessive–compulsive symptoms. Correlations between metabolic rates and neuropsychological test scores in the prefrontal cortex and the putamen occurred only in the patient group. These results suggest that patients with OCD have distinct features of brain metabolic activities for performing cognitive tasks as well as presenting obsessive–compulsive symptoms. In particular, the frontal–subcortical circuits might mediate not only symptomatic expression but also cognitive expression in patients with OCD.

Executive control deficit in depression: event-related potentials in a Go/Nogo task.

Abstract: Growing evidence suggests an impairment of executive control functions in depression. The aim of this study was to investigate whether depressive patients show a specific impairment of executive control in a response inhibition task and to investigate its neurophysiological correlates using event-related potentials. We analyzed data from 16 patients with unipolar depression and 16 healthy controls using an auditory Go/Nogo task. High resolution event-related potentials (ERPs) were recorded. Depressive patients performed similar to controls in the Go task, but worse in the Nogo task, which required response inhibition. ERPs revealed the neurophysiological correlate of this deficit. Both groups showed the same voltage pattern in the Go task. However, in the Nogo task depressive patients showed a reduction of an early fronto-temporal positivity in the N2 time window, which was associated with response inhibition in healthy subjects. This effect could not be explained by increased task difficulty in the Nogo task. There was no difference between groups in later stages of processing as indexed by the P3 complex. Therefore, the findings suggest a specific deficit in response inhibition, which requires executive control. This deficit is thought to reflect dysfunctional activation of the network subserving executive control during an early stage of cortical processing.

Lifetime comorbidity of antisocial personality disorder and anxiety disorders among adults in the community

Abstract: The association between lifetime anxiety disorders, conduct disorder (CD), and antisocial personality disorder (ASPD) among adults in the community was explored. Data were drawn from the National Comorbidity Survey (n = 5,877), a representative community sample of adults aged 15-54 in the 48 contiguous US states. Multiple logistic regression analyses were used to determine the association between anxiety disorders, CD and ASPD, and between the co-occurrence of anxiety disorders and ASPD in the likelihood of comorbid substance use and affective disorders, suicidal ideation (SI) and suicide attempt (SA). Out of the 3.3% of adults with ASPD, over half (54.33%) had a comorbid anxiety disorder (lifetime). Similarly, 42.31% of adults with a history of CD (9.4%) who did not meet criteria for ASPD had a lifetime anxiety disorder. Social phobia [OR = 1.65 (1.01, 2.7)] and post-traumatic stress disorder [OR = 2.28 (1.3, 4.0)] were associated with significantly increased odds of ASPD, after adjusting for differences in sociodemographic characteristics and other psychiatric comorbidity. Major depression was no longer significantly associated with ASPD after adjusting for anxiety disorders. The comorbidity of anxiety disorders and ASPD was associated with significantly higher odds of major depression, substance use disorders, and SI and SA compared with odds among those without both disorders. These data provide initial evidence of an association between PTSD and social phobia and an increased likelihood of ASPD among adults in the community, after adjustment for comorbid affective and substance use disorders. Adults with ASPD and comorbid anxiety had significantly higher levels of comorbid major depression, alcohol dependence, and substance dependence and substantially higher rates of lifetime suicidal ideation and suicide attempts compared to adults with ASPD or anxiety disorders alone or with neither disorder. Future studies are needed to replicate this finding using longitudinal data and to investigate the possible mechanisms of the observed links between anxiety disorders and ASPD.

Neural correlates of tactile prepulse inhibition: a functional MRI study in normal and schizophrenic subjects

Abstract: Prepulse inhibition (PPI) of the startle reflex refers to the ability of a weak prestimulus, the prepulse, to inhibit the response to a closely following strong sensory stimulus, the pulse. PPI is found to be deficient in a number of psychiatric and neurological disorders associated with abnormalities at some level in the limbic and cortico-pallido-striato-thalamic circuitry. We applied whole-brain functional magnetic resonance imaging to elucidate the neural correlates of PPI using airpuff stimuli as both the prepulse and the pulse in groups of (i) healthy subjects and (ii) schizophrenic patients. Cerebral activation during prepulse-plus-pulse stimuli with stimulus-onset asynchronies of 120 ms was contrasted with activation during pulse-alone stimuli. In healthy subjects, PPI was associated with increased activation bilaterally in the striatum extending to hippocampus and thalamus, right inferior frontal gyrus and bilateral inferior parietal lobe/supramarginal gyrus, and with decreased activation in the right cerebellum and left medial occipital lobe. All activated regions showed significantly greater response in healthy subjects than schizophrenic patients, who also showed a trend for lower PPI. The findings demonstrate involvement of the striatum, hippocampus, thalamus, and frontal and parietal cortical regions in PPI. Dysfunctions in any of these regions may underlie observations of reduced PPI in schizophrenia.

The expression and experience of emotion in schizophrenia: a study of social interactions

Abstract: Previous studies on emotional expression and experience in schizophrenia indicate that patients show significantly fewer outward displays of emotion than controls despite similar self-reports of emotional experience in response to various non-social stimuli (e.g. film clips, flavored drinks). However, it is unclear if this disjunction between emotional experience and expression in schizophrenia extends to the interpersonal domain. This study compared 33 patients with schizophrenia and 15 non-psychiatric controls on emotional expression and experience during a social role play. Results showed that patients were significantly less expressive than controls but the two groups reported equal levels of emotional experience. Neither clinical blunting ratings nor behavioral ratings of facial expressivity were related to emotional experience in patients. These results extend prior findings of an expression/experience disjunction in schizophrenia to a social domain. Implications for understanding social dysfunction in schizophrenia and directions for future study are discussed.

The Stressful Life Events Schedule for children and adolescents: development and validation

Abstract: The development and psychometric properties of the Stressful Life Events Schedule (SLES), an interview instrument to assess stressors in children and adolescents, are described. Children ( 12 years) with psychopathology (n=30) and non-psychiatric controls (n=30) were interviewed with the SLES about the occurrence of stressful life events during the prior year. To examine concurrent validity of the SLES, all subjects also completed the self-report Life Events Checklist (LEC) and half the sample completed the Life Events and Difficulties Schedule (LEDS). To examine informant validity, the parent/guardian also reported on stressful life events occurring to their child during the year prior to interview. Test-retest reliability of the SLES was examined by re-assessing all children approximately one week after the initial interview. Subjects rated subjectively how stressful an event was on a 4-point scale. Additionally, panel ratings of objective stress and behavior-dependence/independence were made on 4-point scales. The SLES was found to have substantial inter-rater consensus reliability for objective threat (kappa=0.67) and almost perfect reliability for event behavior-dependence/independence (kappa=0.84). Similarly, the test-retest reliability of the SLES was also found to be substantial at the level of specific event comparisons (kappa=0.68). The SLES discriminated between children with and without psychopathology on all measures of stressful life events. Total stressful life events assessed with the SLES concurred well with those assessed by the LEC (ICC=0.83) and the LEDS (kappa=0.77) although, as expected, examination of specific events showed much smaller overlap between the SLES and the LEC (kappa=0.26). Child-parent agreement for the occurrence of severe events was substantial (kappa=0.73) but tended to be only moderate when all events were examined (kappa=0.48). The results of this study indicate that the SLES has good psychometric properties. The SLES is a useful, cost-effective tool for assessing stressful life events in children and adolescents.

Impaired emotional facial expression recognition in alcoholics, opiate dependence subjects, methadone maintained subjects and mixed alcohol-opiate antecedents subjects compared with normal controls.

Abstract: The present study aims to explore whether an impairment in emotional facial expressions (EFE) decoding is specific to alcoholism compared with opiate dependence. An EFE decoding test consisting of 16 photographs of EFE portraying happiness, anger, sadness and disgust was administered to five different groups of 30 subjects each: recently detoxified alcoholics (RA); opiate addicts under methadone maintenance treatment (OM); detoxified opiate addicts (OA); detoxified subjects with both alcohol and opiate dependence antecedents (DAO); and normal controls (NC). Repeated measures analysis of variance using a multivariate approach was conducted on EFE decoding accuracy scores with group as the between-subjects factor. Accuracy scores were significantly lower in RA and DAO than in OM and OA, which had significantly lower scores than NC. Low accuracy scores in RA and DAO confirm previous results indicating that alcoholism is associated with impaired EFE recognition. Results in OM and OA indicate that opiate dependence is also associated with an impaired EFE decoding but less than in alcoholism. Alcohol and opiate chronic consumption could both exercise a deleterious effect on EFE-decoding brain function, alcohol having the most severe impact. Alternatively, EFE-decoding problems could be present before the development of alcohol and opiate dependence, with an additional effect of chronic alcohol consumption on EFE decoding. In this context, EFE-decoding impairment could reflect a more general emotional intelligence deficit in addicted populations.

Impairment in basal limbic function in schizophrenia during affect recognition.

Abstract: Patients with schizophrenia routinely fail to perform affect recognition tasks as accurately as healthy controls. The investigation of performance-related changes in cerebral activation in healthy subjects may facilitate the understanding of adaptation processes to different levels of difficulty and help to interpret the activation changes found in schizophrenic patients. Nine first hospitalized partly remitted schizophrenic patients and 10 healthy controls participated in an fMRI study with a facial affect discrimination and labeling task. Seven of the 10 healthy subjects were reexamined with changed stimulus conditions adapted according to the mean accuracy scores detected in schizophrenic patients. Controls showed a significantly increased activation of the right gyrus frontalis medialis with rising task difficulty during both tasks. The schizophrenic patients demonstrated a significantly decreased activation of the anterior cingulate during facial affect discrimination and of the amygdala-hippocampal complex bilaterally during facial affect labeling. In addition, an increased activation of the gyrus frontalis medialis bilaterally became apparent in the schizophrenic patients. It is suggested that the latter may reflect a compensatory effort for deficits in more basal limbic functions.

Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia: a PET correlation study.

Abstract: A [H(2)(15)O] PET correlation analysis technique was employed to correlate brain activations associated with self-reports of auditory hallucinations in hallucinating patients (n=8) and perception of transient, random human speech in non-hallucinating (n=7) patients and normal control subjects (n=8). Perception of externally generated human speech amongst the non-hallucinating and normal control participants was associated with a consistent pattern of extensive bilateral auditory cortex activation (Brodmann areas 40/41/42/22). Hallucinating participants demonstrated a network of cortical activations including bilateral auditory cortex, left limbic regions, right medial frontal and right prefrontal regions. The observed pattern of activation is consistent with models of auditory hallucinations as mis-remembered episodic memories of speech.

Why are smiles contagious? An fMRI study of the interaction between perception of facial affect and facial movements.

Abstract: In human communication there is often a close relationship between the perception of an emotionally expressive face and the facial response of the viewer himself. Whereas perception and generation of facial expressions have been studied separately with functional imaging methods, no studies exist on their interaction. We combined the presentation of emotionally expressive faces with the instruction to react with facial movements predetermined and assigned. fMRI was used in an event related design to examine healthy subjects while they regarded happy, sad, or neutral faces and were instructed to simultaneously move the corners of their mouths either (a). upwards or (b). downwards, or (c). to refrain from movement. The subjects' facial movements were recorded with an MR-compatible video camera. Movement latencies were shortened in congruent situations (e.g. the presentation of a happy face and combined with upward movements) and delayed in non-congruent situations. Dissonant more than congruent stimuli activated the inferior prefrontal cortex and the somatomotor cortex bilaterally. The congruent condition, in particular when seeing a happy face, activated the medial basotemporal lobes (hippocampus, amygdala, parahippocampal region). We hypothesize that this region facilitates congruent facial movements when an emotionally expressive face is perceived and that it is part of a system for non-volitional emotional facial movements.

The relations between cognition and the independent living skill of shopping in people with schizophrenia.

Abstract: A great deal of interest has developed regarding the impact of cognitive deficits on the everyday functioning of people with schizophrenia. This study examined the relationships between cognitive functioning and the performance of a specific independent living skill (grocery shopping) in a sample of 73 individuals with schizophrenia or schizoaffective disorder. Cognitive variables included tests of verbal memory, executive functioning, verbal fluency, sustained attention and visual motor skill. Functional outcome was measured with the Test of Grocery Shopping Skills, which is an ecologically based performance measure that requires participants to shop for 10 items within an actual grocery store. Accuracy on the shopping task was significantly associated with fewer perseverative responses on the Wisconsin Card Sorting Test, better verbal memory and faster processing speed. Shopping efficiency (i.e. less redundancy) was associated with better performance on several cognitive tasks, including verbal memory, verbal fluency, sustained attention and executive functioning. Results of this study extend previous research by examining the relation between cognition and the actual performance of daily living skills under natural circumstances.

Cerebral blood flow in chronic symptomatic mild traumatic brain injury

Abstract: Patients with mild traumatic brain injury (MTBI) challenge physicians' skills and test their patience. Their manifold symptomatology is often not supported by objective neurological findings. We sought to compare regional cerebral blood flow (rCBF) between symptomatic subjects with longstanding MTBI and healthy controls, and to examine the correspondence between neuropsychological deficit and rCBF compromise. Twenty-eight clinically symptomatic male subjects with MTBI and twenty matched controls underwent neuropsychological testing and Tc-99m-HMPAO brain SPECT imaging. Neuropsychological test data were used to categorize subjects into sub-groups according to the presumed location of lesions based on their neurobehavioral deficits. Image subtraction comparisons were made between controls, all MTBI subjects and sub-groups. MTBI patients demonstrated regions of hypoperfusion in frontal, pre-frontal and temporal cortices, and sub-cortical structures. Hypoperfusion in 'frontal', 'left posterior' and to a lesser extent 'sub-cortical' sub-groups was concordant with neuropsychological localization. This was not the case for the 'right posterior' group, where no concordance was found. The rCBF is reduced in symptomatic patients with longstanding MTBI and unremarkable structural brain imaging. Although group analysis is appropriate for the generation of statistically significant differences, the clinical application of brain SPECT imaging in MTBI calls for a capability to associate clinical examination, neuropsychological assessment and cerebral perfusion at the individual subject level. Such competence is still to be attained.

Obsessive-compulsive behaviors in parents of multiplex autism families.

Abstract: Parents of autistic probands with high and low rates of repetitive behaviors were compared for rates of obsessive-compulsive traits and disorder. The rate of repetitive behaviors was assessed using the Autism Diagnostic Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex families. Obsessive-compulsive disorder (OCD) in parents was determined by direct interview using a parental history questionnaire, with screening for obsessive-compulsive traits using the Yale-Brown Obsessive-Compulsive Scale checklist. Children who had high total scores on the repetitive behavior domain of the ADI-R were significantly more likely to have one or both parents with obsessive-compulsive traits or disorder compared with children who had low total scores on this domain. Children with high scores on D1/D2 of the ADI-R (narrow restricted interests and rituals) were significantly more likely to have one or both parents with OCD, especially fathers, than those with low D1/D2. The occurrence of obsessive-compulsive traits or disorder in parents of autistic children in multiplex families is significantly more likely if autistic children have a high occurrence of repetitive behaviors. Dichotomizing autistic probands by severity and type of repetitive behaviors (circumscribed interests and compulsive rituals) may yield more homogenous groups, which could be helpful in genetic linkage studies.

Brain processing of visual sexual stimuli in men with hypoactive sexual desire disorder.

Abstract: Although hypoactive sexual desire disorder (HSDD) is a common condition and has long been hypothesized to result from malfunctions of the cerebral control mechanisms that adjust the level of sexual motivation, very little is known about the pathophysiology of this disorder. The primary objective was to identify in patients with HSDD brain regions where functional perturbations disrupt the regulation of sexual motivation. We used positron emission tomography to compare seven male patients with HSDD with eight healthy men on their regional cerebral blood flow responses to visual sexual stimuli (VSS) of graded intensity. Statistical Parametric Mapping was used to locate brain regions that demonstrated a differential activation (or deactivation) across the groups. Whereas in control subjects the medial orbitofrontal cortex showed a deactivation in response to VSS, in HSDD patients there was an abnormally maintained activity of this region, which has been implicated in the inhibitory control of motivated behavior. By contrast, the reverse pattern-activation in control subjects, deactivation or unchanged activity in patients-was found in the secondary somatosensory cortex and inferior parietal lobules, regions mediating emotional and motor imagery processes, as well as in those areas of the anterior cingulate gyrus and of the frontal lobes that are involved in premotor processes.

REM sleep, dream variables and suicidality in depressed patients

Abstract: To examine the relationship between the emotional quality of dreams, REM sleep variables and suicidal tendency in depressed individuals, 26 depressed volunteers (10 males and 16 females) were assessed with the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS), and underwent 3 nights of polysomnography There was a significant negative correlation between suicidality scores and REM latency and a positive correlation between suicidality and REM percent Suicidal subjects had a significantly shorter mean REM latency and a higher mean REM percentage than the non-suicidal subjects As expected in normal subjects, 20 subjects had an increase in dream-like quality (DLQ) of REM reports between the first and second halves of the night The six subjects with a negative DLQ difference also scored as suicidal A reduction in dream-like quality of the REM content reports between the first and second halves of the night was found to be associated with suicidal tendency The findings may indicate that these subjects fail to self-regulate mood and integrate affect into long-term memory networks during sleep Theoretical and clinical implications of these findings in depression are discussed

An fMRI study of affective state and medication on cortical and subcortical brain regions during motor performance in bipolar disorder.

Abstract: Structural neuroimaging studies have identified abnormalities in the basal ganglia in patients with bipolar disorder. Findings have been mixed with regard to affective state and have not elaborated on the role of medication on functional brain activity. The aims of the present study were to use functional magnetic resonance imaging (fMRI) to test whether depressed and manic bipolar disorder patients differ in terms of activity in cortical and subcortical brain areas and to examine the effects of psychotropic medication. Twenty-four bipolar disorder subjects and 13 healthy comparison subjects participated in an fMRI study of manual reaction time. Both manic and depressed subjects exhibited abnormally elevated blood oxygen level dependent BOLD responses in cortical and subcortical areas. Manic bipolar subjects had significantly higher BOLD responses in the left globus pallidus and significantly lower BOLD responses in the right globus pallidus compared with depressed bipolar patients. Correlational analyses revealed significant relationships between the severity of mania and activity within the globus pallidus and caudate. Patients off antipsychotic or mood-stabilizing medication exhibited significantly higher BOLD responses throughout the motor cortex, basal ganglia and thalamus compared with patients on these medications. These results suggest that affective state in bipolar disorder may be related to a disturbance of inhibitory regulation within the basal ganglia and that antipsychotics and/or mood stabilizers normalize cortical and subcortical hyperactivity.

Qualitative analysis of verbal fluency in depression

Abstract: The aim of this study was to analyze qualitative aspects of verbal fluency in depression. Phonemic and semantic output was scored for word clustering and switching between clusters in depressed patients and normal control subjects. Depressed patients (n=25) and normal control subjects (n=19) were administered both phonemic and semantic fluency tasks. All patients were also evaluated with executive card sorting tests. Patients with depression produced fewer words on the semantic fluency task than controls and showed normal performance on the phonemic fluency tasks. The deficit on semantic fluency of depressed patients was related to a reduced number of switches with normal cluster sizes. The number of switches in depression was associated with a reduced ability to shift mental set on card sorting tests, suggesting that verbal fluency impairment reflects general executive problems in depression.

Visual scanpaths to threat-related faces in deluded schizophrenia.

Abstract: This study examined visuo-cognitive processing of threat-related (anger, fear) and non-threat faces (happy, sad, neutral) in deluded schizophrenia (n=11), non-deluded schizophrenia (n=8), and healthy control (n=22) participants. Focal analyses examined scanpath aberrations for particular facial expressions in sub-groups of schizophrenia patients determined by the presence or absence of overt delusions. Deluded schizophrenia subjects exhibited significantly fewer fixations of shorter duration for all faces, and fewer fixations of reduced duration to the feature areas of negative facial expressions (anger, sad), compared with healthy controls. Compared with non-deluded schizophrenia subjects, deluded subjects exhibited fewer fixations to fear expressions and more fixations to the feature areas of happy expressions. These findings were revealed in the context of restricted scanning (reduced number and duration of fixations, shorter scanpath length and shorter duration of fixations to facial features) in the entire schizophrenia group (n=19) compared with healthy controls. The findings suggest a controlled attentional bias away from the feature areas of negative facial expressions in deluded schizophrenia, that is, specific to threat-related expressions compared with non-deluded schizophrenia subjects. This controlled bias away from negative social stimuli in deluded schizophrenia is discussed in terms of an attentional style of 'vigilance-avoidance' operating across early and late stages of information processing.

A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction

Abstract: The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for coronary care patients following acute myocardial infarction (MI) was investigated. A confirmatory factor analysis was conducted on the HADS to determine its psychometric properties in 335 MI patients over three observation points (1 week, 6 weeks and 6 months). Internal and test-retest reliabilities of the HADS total and HADS sub-scale scores were generally found to be acceptable. The underlying factor structure of the HADS comprised three distinct factors. Support was found for the use of the HADS sub-scales to assess dimensions of anhedonia, psychic anxiety and psychomotor agitation. The HADS may be a useful screening instrument to assess post-MI patients for symptoms of psychological distress. Further research is required to determine the three-factor structure of the HADS in other clinical groups.

Correlation of subjective and objective sleep measurements at different stages of the treatment of depression

Abstract: Studies of the correlation of subjective and objective sleep measures in depressed patients have produced mixed results so far. Further, they were carried out in sleep laboratories and tended to obtain one-off assessments, thus not taking into account the effect of treatment. We investigated forty (40) patients over the course of 8-week treatment of depression with either paroxetine or nefazodone. We used home polysomnography at baseline, nights 3 and 10, and week 8 of treatment, with extensive assessments of subjective sleep, the morning after each sleep recording. The patients were able to judge accurately their total sleep time and sleep onset latency, both before and during treatment. However, they were inaccurate in estimating the number of times they woke up during the night. Sleep satisfaction correlated negatively with Stage 1 sleep at baseline. Sleep quality was represented by a combination of subjective parameters measuring the ease of initiation and maintenance of sleep, and it appeared to derive from slow wave sleep and sleep continuity as seen in polysomnography. The partial discrepancy between subjective and objective measures suggests that a cognitive element is combined with the biological element to produce the sleep problems reported by depressed patients.

Effects of behavior therapy on regional cerebral blood flow in obsessive-compulsive disorder.

Abstract: Very few functional neuroimaging studies have been performed on patients with obsessive–compulsive disorder (OCD) undergoing behavior therapy, even though it is recognized to be an effective treatment for this disorder. We measured the regional cerebral blood flow (rCBF) using the Xenon inhalation method in 31 treatment-refractory patients with OCD and the same number of age-matched normal controls. We also studied changes in rCBF in 22 OCD patients who had demonstrated a significant improvement after the behavior therapy. The OCD patients showed a significant bilateral elevation in the rCBF in the basal ganglia compared with the normal controls. After successful treatment, a significant decrease was found in the rCBF in the right head of the caudate nucleus that tended to correlate with clinical improvement. 2003 Elsevier Ireland Ltd. All rights reserved.