Altered brain network organization in adults with Asperger's syndrome: decreased connectome transitivity and assortativity with increased global efficiency

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that persists into adulthood with both social and cognitive disturbances. Asperger's syndrome (AS) was a distinguished subcategory of autism in the DSM-IV-TR defined by specific symptoms including difficulties in social interactions, inflexible thinking patterns, and repetitive behaviour without any delay in language or cognitive development. Studying the functional brain organization of individuals with these specific symptoms may help to better understand Autism spectrum symptoms.

Methods

The aim of this study is therefore to investigate functional connectivity as well as functional network organization characteristics using graph-theory measures of the whole brain in male adults with AS compared to healthy controls (HC) (AS: n = 15, age range 21-55 (mean ± sd: 39.5 ± 11.6), HC: n = 15, age range 22-57 [mean ± sd: 33.5 ± 8.5]).

Results

No significant differences were found when comparing the region-by-region connectivity at the whole-brain level between the AS group and HC. However, measures of "transitivity," which reflect local information processing and functional segregation, and "assortativity," indicating network resilience, were reduced in the AS group compared to HC. On the other hand, global efficiency, which represents the overall effectiveness and speed of information transfer across the entire brain network, was increased in the AS group.

Discussion

Our findings suggest that individuals with AS may have alterations in the organization and functioning of brain networks, which could contribute to the distinctive cognitive and behavioural features associated with this condition. We suggest further research to explore the association between these altered functional patterns in brain networks and specific behavioral traits observed in individuals with AS, which could provide valuable insights into the underlying mechanisms of its symptomatology.

Pathologies and the Healing of the soul: medical terms as metaphors in philosophy

This paper critically examines the metaphorical use of medical terms in philosophy. Three examples selected from distinct philosophical contexts demonstrate that such terms have been employed as metaphors both to describe the practice of philosophising and historically to diagnose philosophical positions. The selected examples are (i) the title of Avicenna's main philosophical work, The Book of Healing, (ii) the criticism of medical metaphors in Enlightenment philosophy, and (iii) recent historical diagnoses in philosophy. The underlying epistemological assumptions of all three contexts are reconstructed to critically analyse the medical metaphors. Through this tripartite synopsis, I arrive at a normative conclusions medical metaphors, such as the "healing of the soul" or "pathology of reason", do not stand up to the critique of Enlightenment and are obsolete against the theoretical background of my reference texts.

Historical forerunners of neuropsychiatry: The psychiatric works of Albert W. Adamkiewicz (1850-1921)

Albert Wojciech Adamkiewicz (1850-1821) was a Polish neurologist and researcher who is best known for his description of the so-called Adamkiewicz-artery. In contrast to his achievements in neurology, his research in psychiatry from his time in Vienna (1891-1921) is commonly overlooked. We examined all titles of his publications from 1891 to 1921 and provided a close reading of those works that were related to his research on the neural basis of mental phenomena and disorders. We demonstrate that, in later stages of his scientific career, Adamkiewicz critically engaged with contemporary positions in psychiatry and the psychogenic explanation of mental disorders. He developed a theory based on his neurological research, correlating central theorems of late-nineteenth-century psychiatry to neural networks in the human cortex. These achievements make him a historical forerunner of neuropsychiatric concepts of mental phenomena and disorders.

Access to Healthcare for Minors: An Ethical Analysis of Judgments of the European Court of Human Rights

The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe and is interpreted by the European Court of Human Rights (ECtHR). Despite its legal recognition, discrimination in healthcare provision has repeatedly been an issue of medicoethical and political consideration. In this context, minors are particularly in danger of being deprived of this fundamental right. The aim of this study is to analyze the current state of the ECtHR jurisdiction on challenges in accessing healthcare for minor patients. We conducted a systematic search of judgments by the ECtHR using the keywords "healthcare" and "child". We performed descriptive statistics and qualitative thematic analysis. Our search resulted in n = 66 judgments, which were all screened. Access to healthcare for minors played a role in n = 21 judgments, which involved applications against n = 13 countries. We formed five, partially overlapping categories, which represent recurring themes regarding the research topic. These themes are governance failure (n = 11), the status of refugee, asylum seeker or migrant (n = 5), parental home (n = 5), maternity and birth (n = 4) and others (n = 2). The normative framework of the ECtHR's jurisprudence illustrates intersections between social, legal and medicoethical aspects of minors' discrimination in the healthcare system. It emphasizes the particular vulnerability of children, who require exceptional protection. Inadequate access to healthcare manifests itself in specific situations, such as in the context of migration or staying in public institutions. Healthcare professionals need to be sensitized for such discrimination mechanisms, as they are often at the forefront of encountering structural discrimination in the healthcare system.

Auditory Deficits in Audiovisual Speech Perception in Adult Asperger's Syndrome: fMRI Study

Audiovisual (AV) integration deficits have been proposed to underlie difficulties in speech perception in Asperger’s syndrome (AS). It is not known, if the AV deficits are related to alterations in sensory processing at the level of unisensory processing or at levels of conjoint multisensory processing. Functional Magnetic-resonance images (MRI) was performed in 16 adult subjects with AS and 16 healthy controls (HC) matched for age, gender, and verbal IQ as they were exposed to disyllabic AV congruent and AV incongruent nouns. A simple semantic categorization task was used to ensure subjects’ attention to the stimuli. The left auditory cortex (BA41) showed stronger activation in HC than in subjects with AS with no interaction regarding AV congruency. This suggests that alterations in auditory processing in unimodal low-level areas underlie AV speech perception deficits in AS. Whether this is signaling a difficulty in the deployment of attention remains to be demonstrated.