RECERCAT - Psiquiatria i Psicobiologia Clínica

Two-year follow-op of cognitive functions in Schizophrenia spectrum disorders of adolescent patients treated with electroconvulsive therapy

Two-year follow-op of cognitive functions in Schizophrenia spectrum disorders of adolescent patients treated with electroconvulsive therapy De la Serna, E.; Flamarique, I.; Castro Fornieles, Josefina; Pons, A.; Puig, O.; Andrés, S.; Lázaro García, Luisa; Garrido, J.M.; Bernardo Arroyo, Miquel; Baeza, I. Objective: The aim of the current study was to investigate the long-term cognitive effects of electroconvulsive therapy (ECT) in a sample of adolescent patients in whom schizophrenia spectrum disorders were diagnosed. Methods: The sample was composed of nine adolescent subjects in whom schizophrenia or schizoaffective disorder was diagnosed according to DSM-IV-TR criteria on whom ECT was conducted (ECT group) and nine adolescent subjects matched by age, socioeconomic status, and diagnostic and Positive and Negative Syndrome Scale (PANSS) total score at baseline on whom ECT was not conducted (NECT group). Clinical and neuropsychological assessments were carried out at baseline before ECT treatment and at 2-year follow-up. Results: Significant differences were found between groups in the number of unsuccessful medication trials. No statistically significant differences were found between the ECT group and theNECT group in either severity as assessed by the PANSS, or in any cognitive variables at baseline.At follow-up, both groups showed significant improvement in clinical variables (subscales of positive, general, and total scores of PANSS and Clinical Global Impressions
Improvement). In the cognitive assessment at follow-up, significant improvement was found in both groups in the semantic category of verbal fluency task and digits forward. However, no significant differences were found between groups in any clinical or cognitive variable at follow-up. Repeated measures analysis found no significant interaction of time · group in any clinical or neuropsychological measures. Conclusions: The current study showed no significant differences in change over time in clinical or neuropsychological variables between the ECT group and the NECT group at 2-year follow-up. Thus, ECT did not show any negative influence on long-term neuropsychological variables in our sample.

Subtypes of adolescents with substance use disorders and psychiatric comorbidity using cluster and discriminant analysis of MMPI-A profiles

Subtypes of adolescents with substance use disorders and psychiatric comorbidity using cluster and discriminant analysis of MMPI-A profiles Magallón Neri, Ernesto Mijail; Díaz, R.; Forns, Maria, 1946; Goti, J.; Canalda, G.; Castro Fornieles, Josefina The main aim of this study was to replicate and extend previous results on subtypes of adolescents with substance use disorders (SUD), according to their Minnesota Multiphasic Personality Inventory for adolescents (MMPI-A) profiles. Sixty patients with SUD and psychiatric comorbidity (41.7% male, mean age = 15.9 years old) completed the MMPI-A, the Teen Addiction Severity Index (T-ASI), the Child Behaviour Checklist (CBCL), and were interviewed in order to determine DSMIV diagnoses and level of substance use. Mean MMPI-A personality profile showed moderate peaks in Psychopathic Deviate, Depression and Hysteria scales. Hierarchical cluster analysis revealed four profiles (acting-out, 35% of the sample; disorganized-conflictive, 15%; normative-impulsive, 15%; and deceptive-concealed, 35%). External correlates were found between cluster 1, CBCL externalizing symptoms at a clinical level and conduct disorders, and between cluster 2 and mixed CBCL internalized/externalized symptoms at a clinical level. Discriminant analysis showed that Depression, Psychopathic Deviate and Psychasthenia MMPI-A scales correctly classified 90% of the patients into the clusters obtained.

Reduced antioxidant defense in early onset first-episode psychosis: a case-control study

Reduced antioxidant defense in early onset first-episode psychosis: a case-control study Micó,J.A.; Rojas Corrales, MO; Gibert Rahola, J; Parellada, M; Moreno, D; Fraguas, D.; Graell, M.; Gil, J.; Irazusta, J.; Castro Fornieles, Josefina; Soutullo, C.; Arango, C.; Otero, S.; Navarro, A.; Baeza, I.; Martínez Cengotitabengoa M; González Pinto A. Background:Our objective is to determine the activity of the antioxidant defense system at admission in patients with early onset first psychotic episodes compared with a control group. Methods: Total antioxidant status (TAS) and lipid peroxidation (LOOH) were determined in plasma. Enzyme activities and total glutathione levels were determined in erythrocytes in 102 children and adolescents with a first psychotic episode and 98 healthy controls. Results: A decrease in antioxidant defense was found in patients, measured as decreased TAS and glutathione levels. Lipid damage (LOOH) and glutathione peroxidase activity was higher in patients than controls. Our study shows a decrease in the antioxidant defense system in early onset first episode psychotic patients. Conclusions: Glutathione deficit seems to be implicated in psychosis, and may be an important indirect biomarker of oxidative stress in early-onset schizophrenia. Oxidative damage is present in these patients, and may contribute to its pathophysiology.

Perfil sociosanitario sexual y contraceptivo de las mujeres visitadas por primera vez en el Programa Joven del Bages

Perfil sociosanitario sexual y contraceptivo de las mujeres visitadas por primera vez en el Programa Joven del Bages Prat i Vigué, Gemma; Forn, Rosa; Riba, T.; Villena, G.; Oller, R.; Macià, T. Objetivos. Conocer las características, el perfil sanitario, sexual y contraceptivo, y los factores de riesgo en las mujeres jóvenes (menores de 24 años) que han acudido por primera vez al Programa Joven del PSAD-ASSIR del Bages. Método. Estudio transversal, descriptivo y observacional, realizado mediante el vaciado de 790 historias clínicas de jóvenes, pertenecientes a la comarca del Bages (Barcelona), que acudieron por primera vez al Programa Joven durante el año 2002. Resultados. La media de edad de las mujeres estudiadas es de 20 años (DE= 3), la mayoría nacidas en España (84%), con estudios secundarios (43%) y que viven la gran mayoría con familiares de primer grado (71%). Factores sexuales de riesgo: la edad media de inicio de relaciones sexuales con penetración es de 18 años (DE= 2,41); un 16% no emplea ningún método anticonceptivo o métodos poco fiables; un 14% tiene más de dos parejas sexuales. El porcentaje de mujeres que manifestaron haber estado embarazadas es del 18%, y habían tenido una interrupción voluntaria del embarazo (IVE) el 7%. Las principales sustancias tóxicas consumidas son tabaco (46%), alcohol (26%) y cannabis (7,2%). La petición de la anticoncepción de emergencia es el principal motivo de consulta (20%). Conclusión. En el momento de plantear políticas preventivas para la población juvenil, debería contemplarse desde una perspectiva global y no individualizada, ya que los factores de riesgo son múltiples y se hallan estrechamente relacionados.

Health-related quality of life in patients with dual diagnosis: clinical correlates

Health-related quality of life in patients with dual diagnosis: clinical correlates Benaiges Fuste, Irina; Prat i Vigué, Gemma; Adán Puig, Ana Background: Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL) in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. Methods: Cross-sectional assessment of three experimental groups was made through the Short Form&br& 36 Item Health Survey (SF-36). The sample consisted of a group with Dual Diagnosis (DD; N=35), one with Severe Mental Illness alone (SMI; N=35) and another one with Substance Use Dependence alone (SUD; N=35). The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. Results: The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. Conclusions: The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.

Antipsychotic polypharmacy in a regional health service: a population-based study

Antipsychotic polypharmacy in a regional health service: a population-based study Bernardo Arroyo, Miguel; Coma, Anna; Ibáñez, Cristina; Zara, Corinne; Bari, Josep M.; Serrano Blanco, Antoni Background To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). Methods Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. Results A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. Conclusions The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine. Background To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). Methods Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. Results A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. Conclusions The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine.

Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics Bernardo Arroyo, Miquel.; San Molina, Luis; Olivares Diez, José Manuel; Polavieja, Pepa; Gilaberte Asín, Inmaculada; Álvarez, María; Ciudad, Antonio; Dilla, Tatiana Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs. Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic. Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was 1,407 ( 897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs. Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder Guilera Ferré, Georgina; Pino López, Oscar; Gómez Benito, Juana; Rojo Rodés, José Emilio; Vieta i Pascual, Eduard, 1963-; Tabarés-Seisdedos, Rafael; Segarra Martínez, Núria; Martínez-Arán, Anabel, 1971-; Franco Martín, Manuel Á.; Cuesta, Manuel J.; Crespo-Facorro, Benedicto; BBernardo Arroyo, Miquel; Purdon, Scot E; Díez, Teresa; Rejas, Javier Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Metodologia de la presentación taquistoscópica en hemicampos visuales

Metodologia de la presentación taquistoscópica en hemicampos visuales Corbera, Xavier; Grau Fonollosa, Carles Se exponen la base lógica y los antecedentes históricos de la presentación taquistoscópica en hemicampos visuales y se comentan algunos aspectos fundamentales referente a los sujetos, aparatos, estímulos, respuestas y procedirnientos de loss disafios experimentales con esta técnica.

Potenciales evocados como marcadores de riesgo al alcoholismo

Potenciales evocados como marcadores de riesgo al alcoholismo Cadaveira Mahia, Fernando; Corominas, Margarita; Sánchez Turet, Miguel, 1942-2008; Grau Fonollosa, Carles En este informe se presenta una revisión de trabajos acerca de la utilización de distintos componentes de los potenciales evocados como marcadores de riesgo para desarrollar alcoholisrno. Los jóvenes procedentes de familias con antecedentes de alcoholismo presentan anomalías en la amplitud de P3 semejantes a las observadas en alcohólicos crónicos abstinentes. La infuencia de factores genéticos sobre las características de este componente y sobre la aparición de la adicción, hacen de P3 un posible marcador genético de riesgo. También se discute la posible utilidad de otros componentes y de la respuesta de aumento/reducción.

Estudio de la reversibilidad de las alteraciones del SN en alcoholicos cronicos abstinentes con potenciales evocados

Estudio de la reversibilidad de las alteraciones del SN en alcoholicos cronicos abstinentes con potenciales evocados Corominas, Margarita; Cadaveira Mahia, Fernando; Grau Fonollosa, Carles; Sánchez Turet, Miguel, 1942-2008 Se realizó un estudio de seguimiento de un año de duración a un gmpo de 50 pacientes alcohólicos crónicos en régimen de abstinencia completa. Se practicaron tres tipos de potenciales evocados, auditivos de tronco cerebral (PEATC), visuales en la modalidad de pattern (PEVP) y auditivos de latencia larga (LAEPs). Nuestro objetivo fue evaluar la posible reversibilidad de las alteraciones provocadas por el consumo crónico de alcohol en el sistema nervioso. Al mes de abstinencia los alcohólicos presentaron alteraciones en diversos parametros de PES. Al año de abstinencia se mantuvieron alterados P3 y NI-P2 de LAEPs, y 111-V y I-V de PEATC, mientrasse normalizaron PI00 de PEVP y N2 de LAEPs. Durante este primer aiio se produjo una recuperación parcial de las alteraciones funcionales provocadas por el consumo crónico de alcohol, dependiendo el grado de recuperación del sistema neural explorado.

Drogodependencias: aspectos terminológicos y taxonómicos

Drogodependencias: aspectos terminológicos y taxonómicos Sánchez Turet, Miguel, 1942-2008 En este estudio se efectlia una revisión de los trabajos llevados a cabo previamente por la Organización Mundial de la Salud (OMS) sobre aspectos conceptuales y terminológicos de las Drogodependencias. Se pone especial énfasis en la definición y concepto de 'droga' y 'drogodependencia' a como en el término 'neuroadaptació' el cual es presentado como una alternativa al de 'dependencia flsica'. Se hace referencia también a las nuevas terminologías de 'abuso de drogas', o 'mal uso de drogas'. Por lo que respecta a cuestiones de clasificación, el estudio se centra en las aportaciones llevadas a cabo por el DSM-III-R de la Asociación Americana de Psiquiatria y el ICD-I0 de la OMS.

Necesidad de una metapsicologia: notas sobre el libro: Psicologia y psicopatologia ciberneticas del Dr. Santiago Montserrat Esteve

Necesidad de una metapsicologia: notas sobre el libro: Psicologia y psicopatologia ciberneticas del Dr. Santiago Montserrat Esteve Sánchez Turet, Miguel, 1942-2008

Conducta simbolica en la rata blanca: Simulación del aprendizaje de palabras

Conducta simbolica en la rata blanca: Simulación del aprendizaje de palabras Veà, Joaquim Partiendo de un principio de continuidad evolutiva en los mecanismos y estructura de la función simbólica en el reino animal, se implanta el equivalente funcional de una palabra (Tact) en la rata blanca. Siguiendo a la mayor parte de los trabajos de implantación de lenguaje artificial en animales, se utilizan las técnicas de condicionamientc operante con una primera fase de aprendizaje, para dejar al sujeto una libre utilización de la relación funcional simbólica en la segunda fase (inversión).

Efectos de la desnutricion precoz sobre la capacidad de aprendizaje en la rata

Efectos de la desnutricion precoz sobre la capacidad de aprendizaje en la rata Sánchez Turet, Miguel, 1942-2008; González-Sastre, Francesc; Sabater Tobella, Juan

Conducta instrumental del chimpace (Pan troglodytes) en su habitat natural

Conducta instrumental del chimpace (Pan troglodytes) en su habitat natural Veà, Joaquim; Clemente, Immaculada La constatación del uso sistemático de instrumentos por los chimpancés en su habitat natural ha planteado el problema de la aplicación del término cultura a un primate no humano. Una de las características de la cultura es la aparición de variantes conductuales en grupos separados. El propósito de este trabajo es revisar, con los datos disponibles en la actualidad, la hipótesis formulada por Sabater Pi (1974b) de que existen tres zonas culturales en los chimpancés e intentar identificar el origen ecológico y/o social de estas diferencias.

Bases bioquimicas de los trastornos afectivos

Bases bioquimicas de los trastornos afectivos Sánchez Turet, Miguel, 1942-2008

Efectos del clobazam sobre la memoria, atención y tiempo de reacción

Efectos del clobazam sobre la memoria, atención y tiempo de reacción Bados López, Arturo; González Ibáñez, Àngels; Sánchez Turet, Miguel, 1942-2008 A través de un diseño intrasujeto contrabalanceado, y sobre una base de doble ciego, se han estudiado, en relación al placebo, 1os efectos de una dosis única de 20 mg. de clobazam sobre la memoria, atencion y tiempo de reaccion medidos a traves de pruebas de laboratorio. Se ha utilizado una muestra de 9 sujetos, universitarios voluntarios, sin patologia orgánica conocida y con puntuaciones medias en 10s factores neuroticismo y extroversión del E.P.I. No se han encontrado diferencias significativas entre el clobazam y el placebo, salvo en la prueba de Tolouse-Pieron, la cua1 pone de manifiesto un efecto detrimental del clobazam. Por otra parte, aunque no estadisticamente significativas, se han apreciado dos tendencias. En primer lugar, el clobazam tiende a disminuir el rendimiento mnemico y de atencion y a incrementar la rapidez de respuesta en comparación con el placebo; en segundo lugar, el clobazam inhibe el efecto de practica en las aplicaciones sucesivas de las pruebas de atención y memoria y 10 potencia en el caso del tiempo de reaccion. Por todo ello se requiere una investigacion adicional con mas sujetos y un diseño experimental más complejo.

Aportación a un estudio de la conducta en la naturaleza de los chimpancés y su importancia en la evolución de los primates superiores

Aportación a un estudio de la conducta en la naturaleza de los chimpancés y su importancia en la evolución de los primates superiores Sabater Pi, Jordi, 1922-2009 Los recientes estudios de campo han patentizado la elevada capacidad de los chimpancés para modificar su conducta. En este contexto aparte de las adaptaciones filogenéticas, bien estudiadas, es preciso significar la importancia de las ontogenéticas integradas por: las resultantes de factores climáticos, geológicos, botánicos, antropológicos, etc., y las provocadas por causas sociales motivadas, principalmente, por individuos integrantes del grupo. Cuando tales cambios sociales y culturales pueden perpetuarse durante varias generaciones en concreto hablar de protoculturas o culturas elementales; las mismas pueden dividirse en: sociales y materiales, siendo las últimas el objcto de este estudio. Parece existir una cultura chimpancé lítica, correspondiente a la subespecie Pan troglodytes verus ubicada en la Costa de Marfil y Liberia; otra de los bastones, patrimonio de algunas poblaciones de la subespecie Pan troglodytes troglodytes que viven en S. Camarones, Rio Muni y Gabón y, finalmente, otra de las hojas y sus peciolos que correspondiente a la subespecie Pan troglodyte schveinfurthi quedaria localizada en Tanzania occidental y Uganda. La protocultura de los bastones fue descubierta y estudiada por el autor de este trabajo durante un programa de estudios primatologicos patrocinado y subvencionado por la Tulane University, el National Institute of Health y la National Geographic Society de los Estados Unidos de América. Esta investigación se llevó a cabo en Rio Muni de 1966 a 1968. Las referidas industrias elementales coadyuvan al conocimiento de la extraitordinaria capacidad conductual adaptativa de estos póngidos y su dinámica en una línea que muchos especialistas no dudan en calificar de humanoide

Recuerdo de África

Recuerdo de África Sabater Pi, Jordi, 1922-2009

Down-regulation of negative emotional processing by transcranial direct current stimulation: effects of personality characteristics

Down-regulation of negative emotional processing by transcranial direct current stimulation: effects of personality characteristics Peña Gómez, Cleofé; Vidal Piñeiro, Dídac; Clemente, Immaculada; Pascual Leone, Álvaro, neuròleg; Bartrés Faz, David Evidence from neuroimaging and electrophysiological studies indicates that the left dorsolateral prefrontal cortex (DLPFC) is a core region in emotional processing, particularly during down-regulation of negative emotional conditions. However, emotional regulation is a process subject to major inter-individual differences, some of which may be explained by personality traits. In the present study we used transcranial direct current stimulation (tDCS) over the left DLPFC to investigate whether transiently increasing the activity of this region resulted in changes in the ratings of positive, neutral and negative emotional pictures. Results revealed that anodal, but not cathodal, tDCS reduced the perceived degree of emotional valence for negative stimuli, possibly due to an enhancement of cognitive control of emotional expression. We also aimed to determine whether personality traits (extraversion and neuroticism) might condition the impact of tDCS. We found that individuals with higher scores on the introversion personality dimension were more permeable than extraverts to the modulatory effects of the stimulation. The present study underlines the role of the left DLPFC in emotional regulation, and stresses the importance of considering individual personality characteristics as a relevant variable, although replication is needed given the limited sample size of our study.

Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state

Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state Fernández-Espejo, Davinia; Junqué i Plaja, Carme, 1955-; Cruse, Damian; Bernabeu, Montserrat; Roig-Rovira, Teresa; Fàbregas Julià, Neus; Rivas, Eva; Mercader, José M. Background: The rate of recovery from the vegetative state (VS) is low. Currently, little is known of the mechanisms and cerebral changes that accompany those relatively rare cases of good recovery. Here, we combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to study the evolution of one VS patient at one month post-ictus and again twelve months later when he had recovered consciousness. Methods fMRI was used to investigate cortical responses to passive language stimulation as well as task-induced deactivations related to the default-mode network. DTI was used to assess the integrity of the global white matter and the arcuate fasciculus. We also performed a neuropsychological assessment at the time of the second MRI examination in order to characterize the profile of cognitive deficits. Results: fMRI analysis revealed anatomically appropriate activation to speech in both the first and the second scans but a reduced pattern of task-induced deactivations in the first scan. In the second scan, following the recovery of consciousness, this pattern became more similar to that classically described for the default-mode network. DTI analysis revealed relative preservation of the arcuate fasciculus and of the global normal-appearing white matter at both time points. The neuropsychological assessment revealed recovery of receptive linguistic functioning by 12-months post-ictus. Conclusions: These results suggest that the combination of different structural and functional imaging modalities may provide a powerful means for assessing the mechanisms involved in the recovery from the VS.

Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder Fountoulakis, Konstantinos N.; Vieta i Pascual, Eduard, 1963-; Siamouli, Melenia; Valenti, Marc; Magiria, Stamatia; Oral, Timuciu; Fresno, David; Giannakopoulos, Panteleimon; Kaprinis, George S. Background: Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment. Methods: This article summarizes the current status of our knowledge and practice of its treatment. Results: It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling. Conclusion: The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.